The issue of legalising and regulating drugs has at last become a serious subject of debate among medics in the UK.
The reason? A passionate editorial in influential London-based medical journal TheBMJ that calls on doctors to “use their authority to lead calls for pragmatic reform informed by science and ethics”.
In the article, editor-in-chief Fiona Godlee and features and debates editor Richard Hurley urge the profession to lead a rethink of the war on drugs. “Doctors and their leaders have ethical responsibilities to champion individual and public health, human rights, and dignity and to speak out where health and humanity are being systemically degraded,” they write.
Their plea follows hard on the heels of a call from the UK’s Royal Society for Public Health and Faculty of Public Health to decriminalise personal possession of drugs – to which The Times newspaper suggested in an editorial that they hadn’t in fact gone far enough and that we should “move gradually towards legalised supply chains”.
All these calls are massively welcome in an area still treated as taboo by senior politicians in both major UK parties – the Conservatives and Labour.
This is despite the country now having the highest rate of drug-related deaths in Europe, at more than 10 times that in Portugal, where decriminalisation and a health-based approach were adopted 15 years ago. England and Wales together see about 50 drug-related deaths a week, equivalent to seven families bereaved every day.
Though the reasoning for a shift from a prohibition-based to a health and controlled trade-based system is well known, the headline economics of criminalising producers, suppliers and users bear repeating. Enforcing the global drug war costs $100 billion a year, just shy of the global aid budget. And the result is a criminal market with an estimated annual turnover of more than $330 billion.
An estimated one in three adults (36.5%), around 12 million people, had ever taken an illicit drug in their lifetime; three million people (8.9%) had done so in the last year; and 1.7 million people (5.2%) had done so in the last month.
Even the UN Office on Drugs and Crime acknowledges that the euphemistically titled “control system” it oversees to fight drug crime has created “major unintended consequences”, including the diversion of resources away from health and towards enforcement. The upshot is that millions of people all over the world become sick and die when they shouldn’t. Prohibition kills.
Push for results
So what is the place of medics in campaigning for reform? Will the government listen and, more importantly, will it act?
Harm-reduction services in response to the emergence of HIV are a great example of a case in which a health lobby achieved a substantial shift in policy that saved tens of thousands of lives. This pushed then UK prime minister Margaret Thatcher to fund provisions, including needle exchange and free condoms, that reduced levels of HIV in the country to among the lowest in the world.
At the same time, though, the UK has continued the drug war to such an extent that its excellence in this type of harm reduction is fundamentally compromised. It is the government’s dirty little secret – some of the harmful effects that it works to minimise are the very effects that criminalisation causes, a factor that it has historically failed to acknowledge.
A fatal “code of silence” shared by professionals and politicians alike is finally being broken, and it will be increasingly difficult for the government to trot out its oft-repeated mantra about drug use falling and all being well in prohibition land.
All is not well – and, in the absence of political leadership, health bodies are rising to the challenge and raising the alarm. But reform will require sustained and growing pressure, and we look forward to seeing members of the royal colleges – professional bodies for various medical specialities in the UK – also joining the campaign for change.
Ultimately, health professionals need to assert their rightful place at the head of national and international drug policy, with science and medical ethics as their trump cards