How Well Do International Drug Conventions Protect Public Health?

As stated in the abstract of this Lancet study on national and international illicit drug use policies [footnotes removed by the editor]: "The Single Convention on Narcotic Drugs in 1961 aimed to eliminate the illicit production and non-medical use of cannabis, cocaine, and opioids, an aim later extended to many pharmaceutical drugs. Over the past 50 years international drug treaties have neither prevented the globalisation of the illicit production and non-medical use of these drugs, nor, outside of developed countries, made these drugs adequately available for medical use. The system has also arguably worsened the human health and wellbeing of drug users by increasing the number of drug users imprisoned, discouraging effective countermeasures to the spread of HIV by injecting drug users, and creating an environment conducive to the violation of drug users' human rights. The international system has belatedly accepted measures to reduce the harm from injecting drug use, but national attempts to reduce penalties for drug use while complying with the treaties have often increased the number of drug users involved with the criminal justice system. The international treaties have also constrained national policy experimentation because they require nation states to criminalise drug use. The adoption of national policies that are more aligned with the risks of different drugs and the effectiveness of controls will require the amendment of existing treaties, the formulation of new treaties, or withdrawal of states from existing treaties and re-accession with reservations."

Related to the spread of HIV: "The international conventions severely restrict the ability of national governments to experiment with alternative drug control systems by requiring all signatories to criminalise non-medical drug use. This constraint has had different effects on policies for injected drugs like heroin and cocaine and policies for the most widely used illicit drug, cannabis.

In the case of injected drugs, public health advocates in many developed countries have successfully campaigned to provide clean injecting equipment to prevent HIV transmission. Eight countries (Australia, Canada, Germany, Luxembourg, the Netherlands, Norway, Spain, and Switzerland) have provided supervised injecting centres to reduce blood-borne virus transmission and overdose and to increase drug users' contact with treatment services. These changes, which have largely been made without legislation to remove criminal penalties for use, have been criticised by UNODC [United Nations Office of Drug Control] and the International Narcotics Control Board as contrary to the treaties. UNODC has now accepted that needle and syringe programmes and treatment diversion programmes comply with the treaties, but the International Narcotics Control Board continues to argue that the status of supervised injection centres is unclear....

Research summaries  suggest that the effects of increased criminalisation on prevalence of drug use is negligible. The proposition that the international drug control system has had a positive effect on human health and wellbeing is difficult to defend, even if precise accounting for the system's aggregate effects is impossible...

Research lends support to harm reduction services for problem drug users (eg, opioid substitution treatment, needle and syringe programmes, antiretroviral treatment, and other psychosocial interventions), most of which the international system now supports. These developments in harm reduction are welcome, but a more radical overhaul of the international system is needed to attune it to differences in the risks posed by different prohibited drugs."

The report suggests 4 models of drug control with differing approaches to limitation, structure of choices, punishment, and minimisation of rates of use and harm. It reviews possible amendments to international treaties.

The conclusion suggests: "National experimentation in approaches to prevention and reduction of drug-related harm should be allowed. The international drug treaties in their present form seriously constrain governments' capacities to engage in such policy experiments. They have restricted the freedom of action to change penalties for personal use, with the result that reduction in penalties has sometimes counterproductively increased the numbers of young people penalised for drug offences. Countries that wish to experiment with different ways of regulating drug use and reducing drug-related harm will need to consider opting out of provisions of the existing drug control treaties."