Public health and international drug policy

To move towards the balanced policy that UN member states have called for, we offer the following recommendations:•Decriminalise minor, non-violent drug offences—use, possession, and petty sale—and strengthen health and social-sector alternatives to criminal sanctions.•Reduce the violence and other harms of drug policing, including phasing out the use of military forces in drug policing, better targeting of policing on the most violent armed criminals, allowing possession of syringes, not targeting harm-reduction services to boost arrest totals, and eliminating racial and ethnic discrimination in policing.•Ensure easy access to harm-reduction services for all who need them as a part of responding to drugs, in doing so recognising the effectiveness and cost-effectiveness of scaling up and sustaining these services. OST, NSP, supervised injection sites, and access to naloxone—brought to a scale adequate to meet demand—should all figure in health services and should include meaningful participation of people who use drugs in planning and implementation. Harm-reduction services are crucial in prison and pretrial detention and should be scaled up in these settings. The 2016 UNGASS should do better than the UN Commission on Narcotic Drugs (CND) in naming harm reduction explicitly and endorsing its centrality to drug policy.•Prioritise people who use drugs in treatment for HIV, HCV infection, and tuberculosis, and ensure that services are adequate to enable access for all who need care. Ensure availability of humane and scientifically sound treatment for drug dependence, including scaled-up OST in the community and in prisons. Reject compulsory detention and abuse in the name of treatment.•Ensure access to controlled drugs, establish intersectoral national authorities to determine levels of need, and give WHO the resources to assist the International Narcotics Control Board in using the best science to determine the level of need for controlled drugs in all countries.•Reduce the negative impact of drug policy and law on women and their families, especially by minimising custodial sentences for women who commit non-violent offences and developing appropriate health and social support, including gender-appropriate treatment of drug dependence, for those who need it.•Efforts to address drug-crop production need to take health into account. Aerial spraying of toxic herbicides should be stopped, and alternative development programmes should be part of integrated development strategies, developed and implemented in meaningful consultation with the people affected.•A more diverse donor base is needed to fund the best new science on drug-policy experiences in a non-ideological way that, among other things, interrogates and moves beyond the excessive pathologising of drug use.•UN governance of drug policy should be improved, which should including respecting WHO's authority to determine the dangerousness of drugs. Countries should be urged to include high-level health officials in their delegations to CND. Improved representation of health officials in national delegations to CND would, in turn, be a likely result of giving health authorities an important day-to-day role in multisectoral national drug-policy-making bodies.•Health, development, and human rights indicators should be included in metrics to judge success of drug policy, and WHO and the UNDP should help to formulate them. The UNDP has already suggested that indicators such as access to treatment, frequency of overdose deaths, and access to social welfare programmes for people who use drugs would be useful indicators. All drug policies should also be monitored and assessed as to their impact on racial and ethnic minorities, women, children and young people, and people living in poverty.•Move gradually toward regulated drug markets and apply the scientific method to their assessment. Although regulated legal drug markets are not politically possible in the short term in some places, the harms of criminal markets and other consequences of prohibition catalogued in this Commission will probably lead more countries (and more US states) to move gradually in that direction—a direction we endorse. As those decisions are taken, we urge governments and researchers to apply the scientific method and ensure independent, multidisciplinary, and rigorous assessment of regulated markets to draw lessons and inform improvements in regulatory practices, and to continue evaluating and improving.