Lifting drug policy barriers to evidence-based treatment

Punishment, rather than treatment, is the focus of many national drug policies today. This approach not only fails to address drug-related problems, but also leads to public health crises and human rights abuses. Substitution treatment and needle exchange are effective in managing opiate dependence and reducing the risk of HIV transmission. Yet these evidence-based interventions are rarely implemented on a national scale, and remain controversial in many countries. In much of Eastern Europe and South-East Asia, where such interventions are illegal, estimates of HIV prevalence among injecting drug users often exceed 50%. Worldwide, only a handful of countries offer needle exchange in prisons. Through a series of informal policy discussions, involving top policy-makers and opinion-leaders, sustained media outreach, and academic study, our partners have managed to open up the debate in Latin America, leading to last year's policy changes in Mexico and Argentina. In Europe, studies of Portugal and the Czech Republic show that decriminalizing small amounts of illegal substances has greatly decreased the number of fatal overdoses and new HIV infections. Thanks to ongoing public debates, supported by video-advocacy, Germany, Switzerland, and Denmark all voted in 2009 to introduce heroin-assisted treatment. Recent policy reforms in Latin America and Europe show that governments are waking up to advocates' calls for drug policy to support public health interventions. To move forward, new voices need to join the debate, particularly in countries where prohibitionist policies remain dominant.