How to win the war on drugs

On June 18, 1971, US President Richard Nixon launched the “war on drugs.” But, instead of improving public health and well-being in the United States by cracking down on drug use, he destroyed the lives of millions of people, both at home and abroad, especially in Latin America, Central Africa, and Southeast Asia. The question now is how to repair the damage.

Nixon’s approach to drug use was fundamentally punitive. It thus puts great pressure on law enforcement and the penal system, while sending millions to prison for nonviolent offenses. In 2020, US law enforcement recorded more than 1.1 million drug arrests, the majority for simple possession. Nonwhite people have been disproportionately affected, despite having similar rates of drug use and sales as white people. Globally, around one in five people in prison are serving sentences principally tied to drug-related offences.

Moreover, the war on drugs has precluded effective regulation of drug production and distribution. This makes it easier for minors to access prohibited substances, and generates exorbitant profits for the criminal organizations that terrorize local communities. The war on drugs is a boon for corruption and a disaster for the rule of law.

Moreover, all this devastation has not prevented drug use: an estimated 271 million people worldwide use drugs that are prohibited under international treaties, while stigma and criminalization make users’ lives more perilous and unhealthy. Today, some 35 million people who use drugs need mental and physical health care, with seven million suffering from infectious diseases linked to intravenous drug use (HIV and viral hepatitis). More than 500,000 people die each year from overdose or adulteration, and the rates of overdose deaths are on the rise.

Nowadays, the futility and destructiveness of the war on drugs is well established and widely acknowledged, with experts, public officials, and civil-society organizations worldwide revising their positions. A growing number of countries are moving to implement drug-policy reforms. In October, US President Joe Biden pardoned thousands of people who had been convicted on federal charges of marijuana possession since the war on drugs began.

While these steps are undoubtedly welcome, they are just the beginning. Reforming international models for drug control and undoing some of the damage of the war on drugs will require a humanitarian approach, focused on non-pathologizing interventions that advance individual and public health.

This includes mental health, which is closely linked to drug use. Efforts to update and homogenize criteria for mental-health assessment and standards of care are essential. Only then can inequalities in health-care access across regions be identified and addressed. More broadly, national drug policies should be aligned with international efforts. International organizations, including the Red Cross and Red Crescent Societies, which have been working for decades to address the health consequences of drug abuse and the war on drugs, have long advocated such an approach. In 2005, the Italian Red Cross, the International Council on Security and Development, and the Rome-based Fondazione Villa Maraini came together to advance a framework for dialogue and cooperation on the development and implementation of humane and effective drug policies. The set of principles this effort produced – the Rome Consensus for a Humanitarian Drug Policy – was signed by 121 National Red Cross and Red Crescent Societies.

In 2020, the Red Cross and Red Crescent Societies – together with the C4 Recovery Foundation, the Levenson Foundation, the Police, Treatment, and Community Collaborative, and the Knowmad Institut – built on this achievement with the Rome Consensus 2.0. The goal was to recruit new signatories from around the world and provide a blueprint for policy and best practices for the coming decade.

As the Consensus points out, we have the tools, guidance, and evidence we need to “reduce and overcome the avoidable and unacceptable health and social harms associated with the world drug situation.” Prevention, treatment, harm reduction, and overdose management are all pieces of the puzzle.

The Rome Consensus 2.0 recognizes that success can be achieved only if we “advocate at all levels to ensure more investments and public awareness to

The war on drugs is a fight with no winners. The only way out is to embrace a new approach focused on saving lives, alleviating suffering, and maintaining human dignity

implement more humane and effective drug policies.” Ending the stigma and discrimination faced by people who use drugs is thus vital to progress.

By fostering a more accurate, nuanced, and holistic understanding of drugs and drug use among the public – including, crucially, health-care professionals – education campaigns can go a long way toward advancing this goal. Such campaigns should acknowledge, for starters, the socio-cultural, historical, and even religious dimensions of drug use. The use of “sacred plants” (and substances that modify states of consciousness) has been documented for centuries as a treatment for ailments and in spiritual practices.

Moreover, a growing body of research indicates that certain psychoactive substances have the potential to treat mental-health disorders. Far from being synonymous with addiction, some types of drug use can help to treat it. Casual and responsible drug use – which never turns into abuse – is often possible. The war on drugs is a fight with no winners. The only way out is to embrace a new approach focused on saving lives, alleviating suffering, and maintaining human dignity. Nobody’s human rights, whether they use drugs or not, should be in doubt.