Fifty years into the world “war on drugs”, the drugs are winning. Global levels of drug use and production, as well as drug-related deaths and incarcerations, are at all-time highs.

Leading proponents of drug-policy reform who have gathered at the International Harm Reduction Conference in Melbourne this week say the evidence is in that it is time for the world to adopt a new approach. 

“The irony of the profound failure of the war on drugs is that it has actually driven the illicit production of more and more substances and has led to more toxic drug supply,” said Naomi Burke-Shyne, executive director of Harm Reduction International, the UK-based drug-policy justice NGO that convened the conference. 

“In order to save lives, we must offer overdose prevention and supervised space for people injecting drugs; together with pill testing to understand the potency, adulteration or toxicity of a substance,” she said. 

Helen Clark, chair of the Global Commission and Drug Policy and former prime minister of New Zealand, called the war on drugs “a complete failure”.

“The war on drugs is completely counterproductive. It has failed, and we need to try new approaches,” she told the conference. “Drug use continues to grow around the world, millions of people are imprisoned for drug possession and millions more are unnecessarily contracting HIV and hepatitis C because of lack of access to effective harm reduction measures.”

“Human beings have been using substances, for whatever reason, for thousands of years,” Clarke said. “We’re not dealing with new issues here. We’re dealing with totally inappropriate and wrong ways of tackling them.”

Supervised injection centers work

People who inject drugs in medically supervised settings are less likely to overdose, share needles, report emergency room visits, or develop abscesses when compared to people without access to such facilities, according to a new study presented to the conference on Tuesday by researchers from the French Institute of Health and Medical Research (INSERM). 

The 12-month study is the first-ever controlled trial on the efficacy and impacts of medically supervised injection rooms, which are hygienic facilities where people struggling with addiction can inject drugs under the watchful eye of medical staff. These facilities are government-operated, stocked with drug-testing kits and overdose-prevention medications like naloxone, and allow patients to access other health services like mental health support, blood tests and essential primary care.

“People can get tested for hepatitis and get started on treatment within two hours, there are sexual reproductive health services for women, lawyers dropping around, housing officers,” Burke-Shyne said.  “Yes, the space has drug consumption, but I think that really underplays how important the holistic approach to supporting vulnerable communities is.”

The study compared the behaviour of people who injected drugs in the supervised injection sites in Paris and Strasbourg to users in Bordeaux and Marseille, where no centers exist. In addition to the benefits to health and overdose reduction, the study found that people with access to supervised injection services were also far less likely to inject in public spaces or commit crimes.

Today, 16 countries around the world officially operate medically supervised injection rooms. These include the Netherlands, the United States, Canada, Australia and Switzerland – which pioneered the approach by legalizing prescription heroin in 1994.

 Results from a control study at New York City’s new supervised injection site are expected by the end of June.

 “Medically supervised injection rooms, the medicine naloxone to reverse overdoses, and drug checking technology work,” Burke-Shyne said. “They are public health no-brainers.”

Fentanyl fears multiply 

As the consequences of the push by Purdue Pharma to mainstream the prescription of high doses of the opiate pain-medication, Oxycontin, continues to ravage the United States, a new lethal drug has taken over: fentanyl.

The synthetic opiate, which is up to 50 times stronger than heroin and 100 times stronger than morphine, was identified in 66% of US drug overdose deaths in 2021. The growing inflitration of fentanyl in the country’s drug supply has resulted in many users unintentionally taking the drug – with deadly consequences.   

In New York City, where drug overdose deaths have nearly tripled since 2015, only 18% of people who inject drugs reported intentional fentanyl use, yet over 80% tested urine-positive for fentanyl, according to new toxicology data presented by researchers from the University of New York (NYU) on Tuesday.

Fentanyl is used by cartels and drug-smuggling networks to cheapen their up-front costs for heroin, which is more expensive to produce. Cutting heroin with fentanyl greatly increases their profit margins at the cost of heightened danger for users unaware their supply is mixed with a far more potent drug.

Drug-testing facilities, such as medically supervised injection rooms, can greatly reduce people’s risk of overdosing by providing clarity on the composition of the drugs they are injecting.  Intentional use of fentanyl was associated with more severe substance use disorders, high drug use frequency, and recent overdoses, the study found.  

“No one should die of an overdose,” Burke-Shyne said. “Drug consumption rooms should be accessible; they should be where people need them. It’s that simple.”

More than 1,500 people die from opiate overdoses every week in the United States. In the year leading up to March 2022, a staggering 110,366 people lost their lives to drug overdoses – nearly 20 times the per capita death rate of the European Union.

Needle-borne diseases are critically underfunded 

Medical advances in recent years have made hepatitis C highly treatable. While the medications are affordable in most low- and middle-income countries, chronic underinvestment in hepatitis C and harm prevention programmes have handicapped efforts to eradicate the disease. 

On Tuesday, UNITAID announced a $31 million commitment to prevent hepatitis C in high-risk populations like people who inject drugs and people in prisons. The investment represents a 20% increase in global harm prevention efforts, which UNITAID said will also assist health systems in curbing the transmission of other blood-borne diseases like HIV. 

While people who inject drugs make up just 10% of the world’s 58 million people infected with hepatitis-C, injecting drugs contribute to 43% of new infections. Eighty percent of people infected with hepatitis-C live in low- and middle-income countries. 

Criminalisation has long been a hallmark of the war on drugs, but advocates say the practice of confining high-risk populations to prisons actually multiplies the risk of infection. 

Criminalising drug use “only serves to overpopulate the prison services and the risks, therefore, multiply,” said Kgalema Motlanthe, former president of South Africa and a commissioner at the Global Commission on Drug Policy. “Those who are literally sleeping over each other in prisons that are overcrowded end up really being exposed to more risks.”

Jason Grebeley, head of the University of New South Wales’ Hepatitis C and Drug Use Group, added that the health benefits of decriminalisation are often overlooked. 

“It’s really critical that we think about the fact that decriminalisation could actually play a major role in reducing a range of harms for people who inject drugs,” he said. 

Image Credits: Conor Ashleigh/Harm Reduction International.