The war on drugs: a devastating public-policy disaster.

www.thelancet.com Vol 373 March 21, 2009 989 Illegal drug use has long been a threat to community and public health. In response, UN conventions (1961, 1971, 1988) were created to criminalise the possession, use, and manufacture of illicit drugs. Internationally, the conventions have been most strongly supported by the US Government since 1971, when President Richard Nixon described the abuse of illicit drugs as “public enemy number one” and formally declared the nation’s “War on Drugs”. In June, 1998, as part of the further consolidation of the UN’s international drug control framework, the UN General Assembly hosted a special session on illegal drugs under the slogan “A drug free world—we can do it”. The session set out international drugcontrol strategies and goals for the subsequent decade and reaffi rmed support for the existing UN drug-control treaties, which require UN member states to develop national policies based on strict law enforcement. On March 11–12, 2009, in Vienna, Austria, a Ministerial Segment of the UN’s Commission on Narcotic Drugs will meet to evaluate international progress towards the goals set out in the 1998 special session. This meeting will also prepare the fi nal draft of a declaration aimed at setting international drug-policy goals for the coming decade. Sadly, the biases inherent in the UN’s drug-control system have been well described, and it is questionable whether meaningful change will emerge from this process. If so, this process will only further discredit the UN drug-control regime, given the overwhelming evidence indicating that the War on Drugs has been an unmitigated failure. Under the current drug-control regime, a massive illicit market has emerged, with an estimated annual value of US$320 billion. In some cases, these enormous illegal revenues threaten the political stability of entire regions, such as certain South American countries and more recently Afghanistan. Paradoxically, increased drug-law expenditures have not prevented the growth of this market; instead, a long-term pattern of falling drug prices and increasing drug purity and supply has been observed. Beyond being ineff ective, increasing expenditures on drug-law enforcement have also been associated with severe unintended harms. For instance, in the USA, where the War on Drugs has been fought most vigorously, the incarceration of illicit-drug off enders has contributed to the world’s highest incarceration rate. Mainly as a result of drug-law enforcement, one in eight African–American men aged 25–29 years was incarcerated on any given day in the USA in 2007, despite the fact that ethnic minorities consume illicit drugs at similar rates to other subpopulations in the USA. An additional concern is the consistent association between drug prohibition and increased drug-market violence. A recent example is the upsurge in severe drug-related violence in Mexico coinciding with Mexican President Felipe Calderón’s announcement of an escalation in the fi ght against Mexican drug traffi ckers.