Drugs: the third rail of US politics.

In the 2012 US Presidential election, America's health-care policies remain hotly disputed. But the issue of drugs and addiction, formerly a prominent public and health concern, is now largely invisible in national political debates. Its public health importance is overlooked in favour of the continued criminalisation and punishment of drug users. Once the war on drugs was centre stage in national elections; now drugs are treated as the third rail of US politics—touch it and you die. There are some differences between the main political parties' position on drugs. The Republican Party's platform typically takes a hard line: gaol time for addicts, death penalties for drug kingpins, and drug testing in schools. 1 Democrats want to bring to justice those trafficking drugs to the USA, require addicts to stop drug use to get out of prison, and favour more enforcement of drug laws and treatment for drug users. 2 But in practice local candidates fight over who can be toughest on crime—any sign of being soft on drugs leaves candidates open to attack. Hence the deafening silence on drugs in the Presidential election. Yet drug issues— and their implications for the nation's public health and global security interests—will inevitably confront the next US President. America's HIV/AIDS epidemic, for example, has always implicated drug use among poor and minority communities. New HIV infections in the USA continue at a high rate: the US Centers for Disease Control and Prevention estimate 50 000–60 000 new HIV infections in the USA annually. 3 Meanwhile in the more populous European Union, researchers estimate there were about 5000 new HIV infections in 2008 4 —less than 10% of the US incidence, owing to better provision of access to antiretroviral therapy in many EU countries and a less punitive approach to drug use. 5 In the USA, drug offences feed the nation's bloated prison system, and damage the social and economic prospects of America's poorest families and communities where drug use is concentrated. 6 There are now more drug offenders in US prisons and gaols (more than 1 million) 7 than prisoners in the European Union for all offences. 8 Globally, drug wars have entered a new stage that demands attention from the US President—from Afghanistan, to US neighbour Mexico, where violence associated with the trade in illicit drugs has produced 60 000 murders in 6 years, and Central America, a region which now has the …