“A drug-free world — we can do it!” was the tragically misguided slogan of the last major United Nations summit on drug control in 1998. UN member states will soon come together in the General Assembly, from April 19 to 21, for another try at getting drug control right. There is good cause to wonder if they will be more in step with reality this time around.
Many things have happened in the drug policy world since 1998 that should lead the member states’ thinking in new directions. First of all, it is clear from the UN’s own figures that drug supply and demand are both significantly higher than in 1998, an indication that something went seriously wrong on the way to a drug-free world. Since 1998, evidence has mounted that punitive drug policies are leading to epidemics of HIV and hepatitis C in many parts of the world, even while sexual transmission of HIV is declining.
In 2001, Portugal showed the world a different way of handling drug control. The Portuguese removed criminal sanctions for all low-level infractions involving all drugs — not just cannabis — and scaled up health services and social support for people who use drugs. The result was a dramatic drop in HIV transmission linked to drug use and a decrease in both drug addiction and drug injection. The Czech Republic has a similar policy, and numerous other countries have effectively decriminalized low-level cannabis offenses with good public health results.
In much of Europe, HIV transmission linked to injection with contaminated needles is no longer a public health problem, largely because people whose only “offense” is drug use or minor possession are not imprisoned but rather helped with HIV-prevention services and other support. But the UN still has trouble recognizing that comprehensive HIV prevention, including providing clean needles to people who inject, is essential to good drug policy.
Then there are developments in the United States, which has gone from being the greatest champion of punitive drug wars to being the home of groundbreaking experiments in legalization of cannabis. Rapidly increasing evidence on medical benefits of cannabis, including for treatment of childhood epilepsy as well as cancer-related pain and nausea, and clear proof of the wastefulness of locking people up for minor cannabis offenses are changing cannabis policy in the US and beyond.
In the UN drug control regime, cannabis remains classified with heroin and cocaine in the most dangerous category with no therapeutic value. The UN risks making itself irrelevant in drug control by failing to face the reality of the changing status of cannabis in many national policies.
Part of the UN’s being out of step with a changing drug policy world is the inherent sluggishness of the body itself; but part of the problem may also be that drug policy governance in the UN is dominated by the UN Office on Drugs and Crime (UNODC), based in Vienna. The office has a history and staff capacities that are more suited to dealing with crime than with managing the health, social and economic development aspects of drug policy. Yet the office leads drug policy discussions, and sectors other than policing, especially health, are sidelined.
The World Health Organization is mandated by the various UN drug treaties to be the source of expertise on drug addiction and on therapeutic value of controlled substances, but it has often been overruled with the tacit or active support of the Office on Drugs and Crime.
That office is also a leader in programs that are meant to provide alternative development or alternative livelihood possibilities to rural households making their living on the cultivation of coca leaf, opium poppies or cannabis. Alternative development programs have a lamentable record. As the UN Development Program has noted, these programs are often singly focused on reducing drug crop production without a good understanding of what motivates or constrains people to grow these crops in the first place. Programs often fail to offer any comparably remunerative activity before they attempt to push people away from drug crops.
But why should anyone think that the UN Office on Drugs and Crime would be good at complicated economic development programs? It was not set up for such activities, and they should not be in its mandate.
The General Assembly special session on drugs next week, called UNGASS, is likely to call for balanced drug policy — meaning not just policing but also health and social support for people with problematic drug use and effective assistance for drug crop producers. But it needs to revisit the balance in its own house too.
The World Health Organization should be empowered to lead the way on judging the therapeutic value of drugs and encouraging the greatest possible investment in essential health services, including all forms of HIV-prevention and harm-reduction measures.
And the UN Development Program and other agencies working on economic and social matters should be the leaders in alternative development. The UN as a whole needs to do a better job in helping member states to step into 21st-century realities and let go of drug-free fantasies.
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Joanne Csete is an expert on health and human rights, especially access to health services for criminalized people and gender-related rights. She is an adjunct associate professor of public health at Columbia University’s Mailman School of Public Health and a member of the Johns Hopkins-Lancet Commission on Drug Policy and Public Health. Csete has a Ph.D. in public health nutrition from Cornell University, a master’s degree in public health from Columbia and a B.A. in economics from Princeton University.
