Intended for healthcare professionals


Illicit drug use should not be a crime, says Royal College of Physicians

BMJ 2018; 361 doi: (Published 25 April 2018) Cite this as: BMJ 2018;361:k1832
  1. Richard Hurley
  1. The BMJ

The Royal College of Physicians of London has joined calls for an end to criminal sanctions against people who take drugs such as heroin, cocaine, and cannabis for non-medical reasons.

The college now endorses the stance of the Faculty of Public Health and the Royal Society for Public Health (RSPH). In a 2016 report1 the RSPH concluded that the “war on drugs” fails to deter drug misuse but instead deters people with drug use disorders from seeking treatment and inhibits harm reduction efforts.

Jane Dacre, president of the Royal College of Physicians (RCP), told The BMJ, “The criminal justice system is not the place to address the often complex needs of people addicted to drugs. We are committed to ensuring that all people who need to do so are able to access timely and appropriate prevention and care services.”

David Cohen, a consultant physician in London and an official at the RCP, told The BMJ, “We don’t encourage drug use, and we certainly wouldn’t want to legalise [the supply of] currently illegal drugs.”

Shirley Cramer, chief executive of the RSPH, said, “It is critical that the health community speaks with a united voice to drive meaningful policy change, and so we hope that other medical colleges will soon follow the lead of the RCP.”

The 2016 report by the RSPH/Faculty of Public Health said that the UK should consider Portugal’s model, which maintains prohibition but which in 2001 switched criminal for civil processes for non-violent personal use, while ramping up investment in prevention and treatment.2

The 2016 report also called for evidence based rather than ideology based policy, for drug education for children, for the Department of Health to take responsibility for drug policy from the Home Office, and for drug strategy to align more with alcohol and tobacco strategies.

The RCP joins The BMJ, BMA, FPH, and RSPH in calling for drug policy to shift focus from criminal justice to public health.3 Few other doctors’ organisations have taken a stance on the issue4: the Royal College of Psychiatrists, the Royal College of General Practitioners, and the Royal College of Emergency Medicine had not responded to requests for comment by the time of posting.

In 2016 The BMJ called for pragmatic and evidence based drug policy that prioritises health and human rights, including regulated, legalised supply to reduce violent criminal trade.5 Fiona Godlee, The BMJ’s editor in chief and a fellow of the RCP, said, “Decriminalisation of use is an important first step, and it is vital to have the medical profession leading on this, but ultimately I believe that legalisation may be the right solution.”

An unprecedented 2593 people were recorded as having died from drug misuse in England and Wales in 2016.6 In 2016-17 some 14 053 people in England were admitted to hospital with a primary diagnosis of drug poisoning, up 40% in a decade.7

About 2.8 million adults in England and Wales, one in 12, took an illegal drug in 2015-16.8 Penalties for drug possession in the UK extend to seven years’ imprisonment and unlimited fines.9

The RCP represents 34 000 hospital and community based doctors worldwide. The RSPH represents some 6000 professionals, and the Faculty of Public Health represents 3300. The BMA, which represents 160 000 doctors, supports “legislative change so treatment and support are prioritised over criminalisation and punishment of individual drug users.”10

Drug law reform is also supported by the World Health Organization, UNAIDS, the UN Development Programme, and the UN’s human rights agency, as well as non-governmental organisations, former world heads of state, UK parliamentarians, and law enforcers.11

Last year Norway announced its intention to decriminalise drug use.12


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