Count the costs: Threatening public health, spreading disease and death

The global war on drugs has historically been promoted as a policy that protects public health, on the basis that it can restrict or eliminate drug availability and use. Research shows it has failed to achieve either of these aims, with global trends in drug use – particularly high-risk use – rising consistently over the past half-century and illegal drugs cheaper and more available than ever.

Worse, the policy has increased the risks associated with drug use, tilting the market towards ever more potent and risky products often cut with contaminants, and encouraging high-risk behaviours (such as injecting) in unsupervised and unhygienic environments. As a result, users suffer avoidable neonatal problems, overdoses and poisonings, and contract blood-borne diseases – such as HIV and hepatitis – that can spread to the general population, as well as devastate drug-using populations.

Populist drug war rhetoric has also tended to push scarce drug policy resources into counterproductive enforcement, at the expense of proven public health initiatives, including prevention and treatment. It has also created obstacles to pragmatic harm reduction measures for the most vulnerable high-risk users.

• Outside of Sub-Saharan Africa, injection drug use accounts for approximately one in three new cases of HIV. In Russia, where injecting drug users now number over 1.8 million, 37% are HIV-positive(1)
• In China, figures from 2006 showed that 48% of HIV cases were people who inject drugs,(2) but only 15% of those on antiretroviral drugs were people who inject drugs(3)
• Despite official guidance, in the UK active injectors are often refused treatment for the hepatitis C virus

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