“Lancet” editor on second report on illicit drugs

Below is the text of an opinion piece by Dr Richard Horton, Editor-in-Chief of the prestigious British medical journal The Lancet, which appeared today Monday 10 September 2012 in The Sydney Morning Herald (see the it on the SMH website here). It is an edited version of remarks made by Dr Horton in launching Australia21’s second report on illicit drugs, Alternatives to Prohibition: How we can stop killing and criminalising young Australians.

Drug use is an issue for society, not the criminal justice system:

Last week, my 11-year-old daughter started senior school in London. In some ways, it was her initiation into the foothills of adolescence. She is a smart and sensible girl. But I know there are illicit drugs used at her school.

I also have to recognise some troubling truths. I know that when the best scientific evidence in the world is brought together, as was done earlier this year by researchers Louisa Degenhardt and Wayne Hall, it shows about one in 20 people aged 15 to 64 have used an illicit drug in the past year.

So what do I hope for my daughter? I hope she won't get drawn into drug use, of course. I hope she won't be that one out of 20. But hope isn't good enough.

When it comes to illicit drugs, we need intelligent policies. Intelligent policies need good data and reliable evidence drawn from carefully conducted research studies. We would never knowingly allow a medicine to be prescribed without good evidence about its safety and effectiveness. Yet we seem to be happy to let our policies around drugs be shaped by ignorance and prejudice.

A report launched in Adelaide yesterday by Australia21, Alternatives to Prohibition, is subtitled Illicit drugs: how we can stop killing and criminalising young Australians. It sets out the lessons learnt about the failed war on drugs from other countries, especially Sweden, Switzerland, the Netherlands and Portugal. Those lessons should send an electric shock to wake Australian politicians from their comatose response to one of the most important social emergencies facing this country.

Drug use is often linked with poor school performance, early school leaving, behavioural disorders, social and family disadvantage, parental substance use and mental ill-health. And yet Australia sees drug use, as does much of the rest of the world, led by the US, as an issue for law enforcement agencies.

But the evidence tells us that until we see drug use as an issue for society, and not one for our criminal justice system, we will be condemned to worsening, not improving, the lives of those who come into contact with drugs.

Why is criminalisation not the answer? There is just no reliable evidence that tougher criminal sanctions deter drug use or offending. On the contrary, criminalisation worsens the health and wellbeing of drug users, increases risk behaviours, drives the spread of HIV, encourages other crime and discourages people who use drugs from seeking treatment.

There is good evidence that the use of illicit drugs is increasing. Is harsher and more intensive criminalisation - arresting young people, locking them up, in some countries even executing them - the answer? No. So far, politicians and policymakers have tended to resist changes to drug policies. They believe the public would never accept it. I don't accept that cynical view. I believe the public would begin to shift its opinion if people knew the full facts.

Prohibition is not the only means available to us. There is a wealth of evidence to suggest alternative strategies that will have a much greater dividend for those who take drugs, as well as for the society we share. The sad fact is that in the world of policy making around drug use, evidence hasn't counted for much.

So let me return to my daughter. The wrong approach would be to threaten her with criminal prosecution. The right approach is to ensure that all the conditions that might lead her towards drugs - what her parents do, the stability of her family life, her school, her friends, and her general health - are such that she will not be tempted into a destructive addiction.

But if the worst happened, if she did one day use drugs, I'd want to protect her from harm, not see her branded a criminal. This principle, harm reduction, is one of the most important ideas in public health. It underpins everything we do.

Coming from Britain, which has repeatedly failed to address drug use rationally and with compassion, I welcome Australia21's efforts. The report recommends a national drug summit next year. Even more importantly, it recommends young people be included in the debate about drug policy.

This enlightened and evidence-driven report deserves not only our unreserved admiration, but also our urgent attention.

Dr Richard Horton is editor-in-chief of The Lancet. This is an edited version of a speech he gave in Adelaide yesterday.