Turning a page in drug control and public health: advancing HCV/HIV prevention through reform of drug law and policy

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Authors: Joanne Csete and Daniel Wolfe
Date: Jan. 2015
From: Future Virology(Vol. 10, Issue 1)
Publisher: Future Medicine Ltd.
Document Type: Report
Length: 7,810 words
Lexile Measure: 2080L

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Author(s): Joanne Csete [*] aff1 , Daniel Wolfe aff2


drug policy; harm reduction; hepatitis C; HIV; incarceration; law enforcement; UN

The first UN General Assembly summit on controlling illicit drugs in almost 20 years will take place in 2016. The last such summit in 1998 had as its theme 'A drug-free world - we can do it!' By the UN's own reckoning, the world in the lead-up to the 2016 summit is much further away from being 'drug-free' than in 1998. The UN's 1998 estimate of the number of persons having consumed drugs in the past year was 8 million for opiates, 13.3 million for cocaine and 141 million for cannabis [ 1 ]. The corresponding figures from the 2014 World Drug Report were 16.4, 17.2 and 177.6 million - that is, increases of 105, 29 and 26%, respectively [ 2 ]. Increased consumption shadowed significantly increased drug supply over this period, which resulted from many factors. These included dramatic increases in opium production in Afghanistan [3 ] and southeast Asia [4 ] and in cannabis cultivation in many parts of the world [2 ] and, as we will argue here, policies that were largely ineffective to reduce demand or supply. The optimism of 'we can do it!' seems misplaced.

If the prohibitionist pursuit of drug eradication has not succeeded in reducing drug supply and demand, has it at least contributed to the environment for advancing prevention of HIV and HCV? We consider this question and make some recommendations for currently dominant criminal law-oriented drug policies based on lessons from the experience of countries that have reshaped some elements of their prohibitionist policies. Some of these experiences came about as responses to HIV epidemics linked to injection drug use. We focus on the global situation but also highlight developments in the USA in view of the influence the USA has had in global drug policy debates.

The drug policy environment globally & in the USA

The imposition of criminal sanctions for drug consumption and/or minor possession is still the rule rather than the exception in the world. A 2012 survey noted 21 countries (of 193 member states of the UN), mostly in Europe, where use and/or minor possession were not subject to criminal sanctions, at least for certain drugs [5 ]. These include countries that have decriminalized use and minor possession for all drugs, though in certain countries cannabis has been the focus of decriminalization efforts. Since the 2012 survey, for example, Uruguay legalized and created a state monopoly for cannabis, Switzerland decriminalized cannabis consumption and minor possession and the US states of Colorado and Washington legalized use, production, sale and transportation of cannabis under a state regulatory authority similar to that of alcohol and tobacco. But other countries, such as many in western Europe, as well as Mexico, Colombia, Peru and Brazil, have decriminalized use and in some cases minor possession of all drugs [5 ].

Seen through the lens of prevention and treatment of infectious disease, whether a country has decriminalized...

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Gale Document Number: GALE|A407934434