Drug decriminalisation: grounding policy in evidence

What has long been clear is that punitive approaches are both ineffective and harmful. Decades of criminalisation have not only spectacularly failed to disincentivise drug use but also propelled the global epidemics of HIV and hepatitis by hindering efforts to prevent transmission and provide care for people in need. The Johns Hopkins– Lancet Commission on drug policy and health found no evidence that the threat of imprisonment is an effective deterrent against drug use. Incarceration often reduces access to care, introduces adverse outcomes (eg, homelessness) following release, and facilitates negative exposures during time spent in prison, where the lack of safe injecting equipment and other harm-reduction services heighten the risk of viral hepatitis and HIV transmission—which is already approximately 35 times higher for adults who inject drugs than among those who do not. Stigma and discrimination only make it less likely that people who use drugs will get the help they need.

Meanwhile, evidence supporting the approaches advocated for by the Global Commission on Drug Policy grows stronger. Harm reduction strategies such as opioid-agonist treatments, sterile injecting equipment, safe injection centres, and psychosocial interventions do not, contrary to belief, promote drug use. For example, 2 years of monitoring showed no substantial increases in crime, disorder, or health emergency calls after the first two government-sanctioned safe consumption sites opened in New York, NY, USA.