“Drugs can kill” – This is how the preface of the newly published World Drug Report, written by the director of the UN Office on Drugs and Crime – the Egyptian Ghada Waly – begins. But is it drugs or bad drug policies that kill people?   

One would like to think the UN had departed from this simplistic language when speaking about the complex phenomena of drugs. But ‘drugs can kill’ looks like a didactic and moralising message from an old-school, fear-based drug prevention campaign rather than the preface of one of the most prestigious reports on drug trends.

Of course drug use can have lethal consequences under certain circumstances. But it is never the molecule in itself that has murderous properties or intentions. Even water can “kill” you if you have too much or if it is too hot/cold. It is the context we should explore in which people who use drugs die. By demonising (some) substances and attributing them “killer instincts” we distort the reality and fail to recognise the role of set and setting. 

Even tobacco does not “kill” in itself: it is the human behaviour of inhaling the carcinogenic smoke of cigarettes mass-produced and advertised by tobacco companies for many decades that kill millions of people every year. And it is not opioids in themselves that kill more young people in North America than car accidents. It is the black market supply of highly potent fentanyl-type drugs, the end products of the iron law of drug prohibition, that is responsible for the huge increase in overdose deaths.

Whenever we have seen a surge in drug-related deaths, it was because of bad regulation, either allowing full commercialisation and benefiting profit-hungry legal companies, or waging a “war on drugs”, fuelling the black market and criminal organisations.             

Ms. Ghada Waly is right to point out that “the whole of the international community shares the same goals of protecting the health and welfare of people everywhere.” But she is wrong to say that our “shared understanding…is rooted in the fact that drug use for non-medical purposes is harmful.”

I don’t share the understanding of non-medical drug use as necessarily harmful.

Risky, yes. But most adults are able to mitigate these risks. We know from epidemiological research that the vast majority of people who use drugs do not develop compulsive, abusive relationships with substances but they use them to play, to explore, and to relax, without causing much harm to themselves or to their environment.

Addiction as such is not caused by drugs themselves – it is caused by suffering. It is an unsuccessful response to the pain felt by people who may be traumatised, isolated and/or socially excluded. Only when drugs are used as tools to give temporary relief from the suffering of “sober” life, which can be miserable in many ways, do they become the source of a compulsive and self-destructive behaviour.

The more people feel that their lives are miserable, that they are isolated and can find no meaning and connection in their lives, the more people will be at risk of addictions. It is not accidental that drug dependence is the most prevalent among people who live on the margins of society. It is not simply access to drugs that creates dependence: it is social isolation, inequality, and exclusion.   

As Gabor Mate, the renowned author and healer says, we live in a toxic culture that alienates us from people around us, and even from our true selves. And toxic cultures create a toxic relationship to drugs.

It is a pervasive illusion in drug policies that governments should focus on “fighting” drugs and trying to eliminate drug demand and supply altogether. Not all non-medical drug use is harmful – and even when it becomes harmful, we need to focus on reducing the harms and not “fight” drugs themselves.

We can witness all around the world how governments kill, torture, and incarcerate millions of people in the name of “fighting drugs”. There are currently 3000 people on death row for drug offences worldwide. We can see how thousands of people who use drugs are murdered on the street in some Asian countries, without any trial, with absolute impunity. We documented in our video how hundreds of thousands of people are detained in the name of “drug rehabilitation”. It is documented how people are denied access to medications and services that could save their lives in the name of drug control. How people die of otherwise manageable/curable medical problems because they have no access to sterile needles and/or medications, due to repressive government policies. How families are broken apart by ridiculously long prison sentences for non-violent drug offences. We see how the banning of psychoactive substances leads to the emergence of ever more potent new psychoactive substances, leading to mass hospitalisations and deaths. How drug policies become a tool to control and punish ethnic minorities and the war on drugs fuels racial discrimination

But there is not much information about these harms and their policy context if you read the World Drug Report. What you can read is a lengthy analysis on cannabis legalisation, focusing mainly on its alleged harms and not so much on their benefits. There is also no reflection within the report about the devastating human rights abuses committed in the name of drug control. The lack of explicit references to harm reduction and human rights in this report is in stark contrast with the statement of UN human rights experts who called on the international community to end the so-called war on drugs on the eve of the world drug day this year.

If governments would like to prevent drug misuse, the logical step is not to spend more on drug policing, prisons or fear-based prevention campaigns in schools, but to make sure that every child grows up in a nurturing environment, protected from abuse and isolation. They should focus on reducing social, racial and gender inequalities and support the poor, the marginalised. They should respect human rights and support a free and vibrant civil society (unlike in Egypt, where civil society was under attack by the government Ms. Waly worked for).

We can have meaningful debates about how to regulate cannabis (or other drugs) and there is a valid concern about how cannabis is being commercialised in some countries, without the meaningful involvement of civil society or any focus on redressing the harms of the war on drugs. We should put the lives and health of people before profits – but our choice is not black-and-white, total prohibition or full commercialisation.

Legal regulation, unlike prohibition, has the benefit of giving us plenty of room and opportunity to maximise benefits and minimise harms.

The reduction in smoking-related deaths, one of the greatest public health successes in history, shows how this can be done. With smart regulation, without mass incarceration. Cannabis could be regulated in a similar, non-criminal international public health framework, such as the WHO’s Framework Convention on Tobacco Control. And governments should consider similar regulatory frameworks for other substances, adjusted to the special context in which they are used. 

For too long the international community demonised the non-medical use of some drugs while it ignored the harmful consequences of repressive drug policies.

We urgently need a paradigm shift, a new shared understanding about the so-called “world drug problem” – shifting the focus from fighting all non-medical drug use to supporting people to live a healthier and more meaningful life in which drugs cannot cause much harm. 

This also means that UNODC – and Ms Ghada Waly – has to show stronger leadership in its willingness to analyse, discuss and question the impacts of repressive drug policies on the lives of millions of people worldwide.