There remain critical areas in public health where the gap between evidence and public policy persists. Few areas suffer from this concern more than society's response to the illicit drug problem. (1,2) Despite the wealth of scientific evidence that drug law enforcement may be associated with increases in violence and homicide (3) (Figure 1), policymakers continue to focus energy on police and prisons at the expense of effective public health and regulatory approaches (4) (Figure 2).
As a result, some scientists have become increasingly critical of the 'War on Drugs' approach as scientific data continue to demonstrate that this approach has failed in its primary objectives of reducing the supply and use of illegal drugs. (5) Despite an estimated $2.5 trillion spent on drug control efforts since the 1960s, (6) drug prices have declined while drug purity has often risen (Figure 3).
Studies have also clearly shown that drug control efforts over the past 30 years, particularly in the United States, have not had a meaningful impact on the availability of illicit drugs among young people. (7) In fact, illicit drugs are sometimes more widely available to youth than alcohol and tobacco. (8)
Beyond failure to curb drug availability and use, (9) drug control efforts have also produced a range of unintended consequences, including the emergence of an international illegal market worth an estimated $320 billion annually. (10) These massive drug profits are entirely outside the control of government; they fuel crime, violence, and corruption in countless urban communities and have destabilized entire countries such as Columbia, Mexico and Afghanistan. (11-13) In some countries, an over-reliance on law enforcement has also led to unprecedented incarceration rates (Figure 1), particularly within ethnic minority communities. For instance, an estimated one in nine African American men aged 25 to 29 is incarcerated on any given day in the United States, primarily as a result of drug law violations, despite the fact that ethnic minorities use illicit drugs at the same rate as other US populations. (14)
While drug policies are having harmful effects internationally, the negative effects of drug control efforts in the US recently led to a unanimous resolution at the 2007 annual United States Conference of Mayors, which stated that "the United States Conference of Mayors believes the War on Drugs has failed and calls for a New Bottom Line in US drug policy, a public health approach that concentrates more fully on reducing the negative consequences associated with drug abuse, while ensuring that our policies do not exacerbate these problems or create new social problems of their own.” (15)
Although the failure of conventional drug control efforts has become obvious to many, it is not well understood why governments do not acknowledge these limitations and the unintended harms and consequences of certain illicit drug policies. (16) In this context, it is important to identify the role that non-scientific lobby groups play in maintaining the drug policy status quo. These include lobbying for mandatory minimum sentences for drug crimes, as well as ignoring scientific evidence demonstrating that drug control efforts have been unsuccessful at reducing drug related harms. Such activities have been undertaken by certain vested interests, including prison and law enforcement lobby groups, which also continue to fight to prevent the implementation of more effective regulatory and public health approaches. (17, 18)
While researchers from across scientific disciplines have demonstrated that drug law enforcement is ineffective and potentially harmful from a public health perspective, this research has been denied by those with a vested interest in maintaining the status quo. (19, 20) Efforts have also been made to discredit public health models that have been proven to reduce drug-related harms. (17, 21) Unfortunately, some of these strategies have been successful, and there are many examples of politicians moving to cut off research funding to scientists who wish to research and promote policy alternatives. (18, 22) These issues have contributed to a reluctance among individual scientists to speak out. (23)
Scientists Speaking Out
Because drugs and harmful policies continue to hurt communities, scientists, academics, and health practitioners have an ethical imperative to speak out.
The ICSDP is an organization founded to create a strong scientific voice to ensure that illicit drug policies are grounded in the best available scientific evidence. The ICSDP includes an international network of scientists, academics, and health practitioners committed to improving the health and safety of communities and individuals affected by illicit drugs by conducting research and public education to help guide effective and evidence-based responses to the harms of illicit drugs.
- Reuter P. Why does research have so little impact on American drug policy? Addiction 2001;96:373.
- Skolnick AA. 'Collateral Casualties' Climb in Drug War. JAMA 1994;271:1636.
- Miron JA. Violence and the US prohibitions of drugs and alcohol. American Law and Economics Review. 1999;1(1):78.
- Schrag P. A quagmire for our time: The war on drugs (Reprinted with permission from The American Prospect, vol 12, pg 28-33, 2001). Journal of Public Health Policy 2002;23:286.
- Wood E, Werb D, Marshall BDL, Montaner JSG, Kerr T. The war on drugs: a devastating public-policy disaster. Lancet 2009;373:989-90.
- Suddath C. A brief history of the War on Drugs. Time 2009.
- Johnston LD, Bachman JG, Schulenberg JE. Monitoring the Future: National Results on Adolescent Drug Use. Overview of Key Findings, 2006. Report. Bethesda, MD: National Institute on Drug Abuse; 2007.
- Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the future: National results on adolescent drug use--overview of key findings, 2005. Bethesda, MD: National Institute on Drug Abuse; 2005.
- Reuter P. The unintended consequences of drug policies. Santa Monica, CA: RAND Europe; 2009.
- UNODC. World Drug Report 2005. Vienna: United Nations Office on Drugs and Crime; 2005.
- Cornwell S. Rice to Mexico for talks on drugs. Reuters. October 21, 2008.
- Morris SK. Colombia: Prohibition's frontline. International Journal of Drug Policy 2003;14:209.
- Schweich T. Is Afghanistan a narco-state? The New York Times. July 27, 2008.
- Sabol J, Couture H. Prison inmates at midyear 2007. Washington, D.C.: U.S. Department of Justice; June 2008.
- USCM. Adopted resolutions. San Francisco: United States Conference of Mayors; 2007.
- Blendon RJ, Young JT. The public and the war on illicit drugs. JAMA 1998;279:827.
- Wood E, Montaner JS, Kerr T. Illicit drug addiction, infectious disease spread, and the need for an evidence-based response. Lancet Infectious Diseases 2008;8:142-3.
- Vlahov D, Des Jarlais DC, Goosby E, et al. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. American Journal of Epidemiology 2001;154:70.
- Des Jarlais DC, Sloboda Z, Friedman SR, Tempalski B, McKnight C, Braine N. Diffusion of the D.A.R.E and Syringe Exchange Programs. American Journal of Public Health 2006.
- Schechter MT, Strathdee SA, Cornelisse PG, et al. Do needle exchange programmes increase the spread of HIV among injection drug users?: an investigation of the Vancouver outbreak. AIDS 1999;13:F45.
- Des Jarlais DC. Research, politics, and needle exchange. Am J Public Health 2000;90:1392.
- Health Canada. No new injection sites for addicts until questions answered says Minister Clement. Ottawa: Health Canada; 2006.
- Pearson H. Science and the war on drugs: a hard habit to break. Nature 2004;430:394.
- Intergovernmental Panel on Climate Change. WMO/UNEP, 2009. (Accessed at www.ipcc.ch)