Commissioner Jamos-Horta in STAT: “Falsehoods and facts about drugs and the people who use them”

Read original article in STAT.

new survey of Americans shows that many regard addiction as a behavioral failing, and most would not welcome those suffering from addiction into their neighborhoods, workplaces, or families. Such attitudes toward addiction, which mirror those in many other countries, perpetuate the abundant false narratives about drugs the world over.

Misrepresentations about drugs fuel stigma and discrimination towards the people who use them. I see this all the time in my work as a member of the Global Commission on Drug Policy. This hinders effective reform and undermines human dignity and the rule of law.

We must find ways to counter prejudice against drug use with facts and break this vicious cycle: drugs are evil and should be illegal → individuals who use them are immoral because drug consumption and possession are illegal → which leads to discrimination and stigma → further reinforcing the idea that drugs are evil and should be illegal.

The place of drugs in society

The belief held by many that drugs are evil, unnatural substances that pose grave threats to society is born from fear and has almost no basis in fact. Consuming mind-altering substances is a near-universal impulse that has been documented across cultures for thousands of years.

Attempting to eradicate drugs through prohibition is ineffective. It also comes at a very high cost to individuals and communities in the form of violence and seemingly acceptable daily violations of human rights. No rational reason exists for considering one product, say marijuana, to be an evil drug and another, such as alcohol, to be an acceptable substance. This means that eliminating drug use is fueled by ideology and subjective moral judgment.

Portrayals of people who use drugs

Another pervasive misperception is that people who use drugs are weak, antisocial, morally corrupt individuals who are not entitled to the same rights as “law-abiding” citizens. Because of this portrayal, many people who recognize the failure of the so-called war on drugs still support repressive drug policies. Mention decriminalization or deregulation and they immediately see communities swamped by drugs, dealers, and junkies, corrupting youths and undermining the very fabric of society. As with the belief that drugs are evil, the portrayal of drug users as corrupt also lacks evidence.

It’s important to keep in mind that all individuals who use drugs are human beings — someone’s parent, sibling, child, cousin, friend, neighbor, coworker. As such, and as outlined in the first sentence of the preamble to the Universal Declaration of Human Rights, they are entitled to the same inalienable rights accorded to all humans, including dignity, health, fair judgment, and the choice of lifestyle.

There are many reasons why an individual might consume drugs that have little to do with character or ethics. These include youthful experimentation (like many other risky activities that are not substance based); pleasure; social bonding; relaxation, self-medication for pain, anxiety, or depression; and contexts such as experienced trauma, hardship, painful living conditions, and mental illness that may be conducive to consuming mind-altering substances.

The most common form of drug use is not problematic, as it is often portrayed, but episodic: Only 11 percent of people who use drugs have a disorder. Even people who have developed dependence on a substance have been shown for the most part to live in an orderly fashion, meaning they faithfully attend school or work, live in their own homes or with friends, shop, worship, and do other normal activities.

The nonviolent act of drug use directly affects only the user’s own health. The individual is operating outside the law only because drug consumption has been declared illegal. The main risk encountered by people who use drugs, therefore, is acquiring a criminal record that can destroy their prospects. What they require is not the looming threat of the criminal justice system but proper access to health services if and when required.

The real harms of drugs

If an individual’s drug use leads to health problems, finding care is often a challenge because services do not exist, the individual fears legal repercussions, or faces prejudice — even in the health care setting. This is a clear violation of the Universal Declaration of Human Rights, which states that everyone has an equal right to health.

What many people find hard to understand is that we cannot simply say, “Well, if they know the risks, why do they start?” Most activities humans engage in comprise an element of risk, including driving a car, flying in an airplane, or even eating too much or the wrong kinds of food.

The risks of drug use can be hard to isolate. Many of these risks actually arise from the fact that these substances are not legally regulated. These risks include the violence inherent in an illegal market, unsafe consumption practices and environments, the transmission of infectious diseases, jail time, and toxic contaminants often added to drugs. In the U.S. during Prohibition, a nationwide ban on the production and sale of alcoholic beverages from 1920 to 1933, alcohol consumption was far more dangerous and unhealthy because unregulated, illegally produced alcohol was adulterated and often more potent than it had been before. A similar thing is occurring in the opioid crisis in the U.S., which has been made even deadlier as dealers add fentanyl, a synthetic opioid 50 times more potent than morphine, to heroin sold on the street.

Compounding misconceptions about the real harms of psychoactive substances is the fact that our view of them has largely been shaped by their legal status, which tends to be arbitrarily decided with little recourse to scientific research. The United Nations still classifies cannabis as among the “most dangerous substances” alongside heroin and cocaine, even though this was based on a decision made in 1926 that has not been reviewed since. Barbiturates, on the other hand, are subjected to a lesser degree of control even though research shows that their level of harm is nearly as high as that of cocaine or heroin.

Ending the vicious cycle

One entry point to ending the vicious cycle that begins with seeing drugs as evil is to consider drugs and their use in their proper context. Once we do that, it’s possible to understand their true risks and harms, which paves the way for initiating effective prevention measures and treatment options to mitigate those risks and harms.

The issue is not fundamentally complicated: People will use psychoactive substances, which are potentially harmful. The first step to more effectively addressing them is to decriminalize their use and possession for personal use. Ultimately, however, governments should assume their full responsibility and explore models in which the production, distribution, retail, and consumption of psychoactive substances are legally and strictly regulated according to their respective harms.