Silence costs lives: The World Drug Report 2021 and the importance of political courage

“Drugs cost lives” – so begins the preface of the World Drug Report 2021, the flagship annual publication from the United Nations Office on Drugs and Crime (UNODC) which is published on the UN’s International Day against Drug Abuse and Illicit Trafficking. This year’s slogan for the day was #ShareFactsSaveLives and in the preface, UNODC’s Executive Director states that, “it is crucial to cut through the noise and focus on facts, a lesson that we must heed in order to protect societies from the impact of drugs”.

It is therefore deeply disappointing that UNODC’s report omits so many facts and fails to present the full picture of the impact global drug control.

As always, the World Drug Report is an impressive document which includes an astounding amount of information and analysis. Yet within its 500 odd pages, there is scant reference to the severe human rights violations associated with drug control efforts. Given that the human rights record of the war on drugs is atrocious, and intimately intertwined with stigma, discrimination and preventable drug-related deaths, this continued omission from a major UN report is unconscionable.

These well-documented violations include the death penalty, extrajudicial killings, the mass incarceration of millions, the systematic denial of harm reduction, the arbitrary detention of hundreds of thousands in public and private treatment centres, and uncounted acts of police brutality and violence – often against racial and ethnic minorities, people living in poverty, women and other oppressed groups. By staying silent on these issues, UNODC – the UN lead agency on drugs – unfortunately isolates itself from growing UN efforts to place health and human rights at the centre of global drug policy.

For 15 years, the International Drug Policy Consortium (IDPC) has published an annual response to UNODC’s World Drug Report, and we have noted and welcomed the increasing emphasis of the health dimension of the world drug situation, the recognition of how marginalisation and poverty often underlie engagement in the drug market, and clear efforts to produce a more balanced and accurate picture.

In a welcome move, the 2021 World Drug Report suggests that “a societal culture that protects and promotes the human rights of people who use drugs and encourages people to access health-care services voluntarily without stigma or fear of recrimination reduces barriers and facilitates access to a range of services” (see Booklet 2, page 19). However, this falls far short of clearly stating that the criminalisation and punishment of people who use drugs is a key driver of harm. There is not one single reference to the dire impact of criminalisation within the report, putting UNODC dramatically out of step with UN norms.

The wealth of both political and UN system commitments on this issue continues to increase. The 2021 Political Declaration on HIV/AIDS, adopted last month with the vote of 164 states, calls for the reform of discriminatory laws and practices that create barriers, or reinforce stigma and discrimination; the 2021-2026 Global AIDS Strategy places decriminalisation at the forefront of its recommendations to end AIDS; and the 2018 UN system Common Positions on drugs commits all UN agencies to promote drug policies that put people, health and human rights at the centre, explicitly endorsing the need to decriminalise people who use drugs.

The UNODC Executive Director’s preface states that ‘drug use killed half a million people in 2019’. But this is not the whole picture – as how many of these deaths (and how many more) were caused by drug policies? A quarter of the reported deaths relate to overdose, while majority were due mainly complications relating to hepatitis C and HIV. The majority of these tragic deaths could have been prevented with access to appropriate harm reduction, evidence-based drug treatment as well as HIV and hepatitis C treatment. However, access to harm reduction services is alarmingly low, with less than 1% of people who inject drugs living in countries with adequate coverage of these programmes, while funding for harm reduction is only around 5% of the actual global need. Criminalisation further compounds this and drives people away from live-saving services where they exist. Given that the World Drug Report itself tells us that only 1 in 8 people have access to some form of drug treatment, and that health harms associated with drug use are borne disproportionately by those suffering marginalisation and inequality, stating that ‘drug use’ killed people is at best unhelpful, and at worst deeply stigmatising. It amounts to a deadly failure to recognise the harms caused by drug policies themselves.

The political resistance to the term ‘harm reduction’ has all but dwindled away to a very few hard-line governments. Even the USA – historically opposed to the term – has now begun to show unprecedented support. Yet, within the 531 pages there is not one single appearance of the term ‘harm reduction’, beyond the footnotes – this is a common and deliberate omission across UNODC’s publications and work.

It is true that interventions such as needle and syringe programmes, opioid agonist therapy and naloxone are mentioned – but if UNODC is seriously concerned about the rising number of people who use drugs in regions like Africa (as they highlight this year), its policy recommendations must include clear and unequivocal support for harm reduction as an evidence-based policy response, in addition to endorsing specific interventions. The same goes for strong calls for the decriminalisation of drug use and possession for personal use – in line with the UN System Common Position on drugs that UNODC is meant to lead on implementing.

Overall, this year’s slogan, #ShareFactsSaveLives, rings hollow upon close read of the 2021 World Drug Report. At the time of the release, UNODC urged people to trust information only from ‘verified sources’, including UNODC itself. However, as long as UNODC continues to carefully and deliberately hold back from mentioning the harmful impact of states’ own drug policies, we cannot trust the agency to communicate all the facts. Let’s hope that, just as the World Drug Report has improved in many aspects, in the future it will make clear that much of the harm that people who use drugs and affected communities face is driven by ineffective and punitive laws and policies.

In the meantime, silence will continue to cost lives.