In this centenary of the Great War, it is worth considering the lessons to be learned as we contemplate the current war on drugs. One of the distinctive features of the Great War was that the military leaders constantly reinforced failure, simplistically believing that a larger and harder push would succeed where others had failed. Many lives were pointlessly lost in the process.

Fast forward to our present war on drugs. Clearly it has not been working, yet the federal government insists on reinforcing failure, rather than pausing to re-think its options. One would have thought that we might have learned the lesson of prohibition in the 1920s; it doesn’t work. But as in the Great War, the rigid adherence to a failed strategy simply causes more harm and more deaths, to little purpose.

A current election briefing from the Canadian Public Health Association (CPHA) begins with the recognition that “the prohibition and criminalization of psychoactive substances are not achieving their intended objectives of reducing drug use and associated harms”. It then lists the many ways in which the war on drugs, and in particular prohibition, has failed.

These include the institutionalisation of organized crime as a powerful force; the spread of HIV, hepatitis, and other infectious diseases; more deaths because people are driven away from prevention and care services by enforcement, and because the unregulated illegal drugs can be much stronger or contaminated; increased property damage and criminal activity by addicts who need to support their habit, and other harms too numerous to list here.

In the face of all these harms, and little evidence that the war on drugs is being won, we need a more rational, humane, and evidence-based approach that would actually reduce the harms resulting from our current failed policies. While the policy options vary depending on the drug we are talking about, the common thread is to recognize that drug use is best dealt with as a public health issue, not a criminal justice issue.

So what might a compassionate, caring, thoughtful federal government do to address the issue of drugs, were it so disposed—as the current one is not—to pay attention to the evidence?

Fortunately, the CPHA has done a good job of bringing together the evidence and putting forward sensible policy options. This is available in their 2014 report “A New Approach to Managing Illegal Psychoactive Substances in Canada”, available on the CPHA website. The report describes a vision for such an approach:

Criminal prohibition of illegal psychoactive substances has been replaced by a public-health-oriented regulatory program to manage the production, sale, and distribution of substances. Product promotion is restricted, and exposure of youth to product promotion is prohibited. Retail models that allow for access while protecting public health are in place.

If this sounds an impossible and undesirable state, think again. The CPHA report notes that countries such as Switzerland, Norway, Portugal, Australia, and New Zealand have implemented at least some of these steps. In particular, it notes: “In 2001, Portugal decriminalized possession of all drugs and shifted their emphasis to addressing health issues. This change led to reductions in problematic substance use, drug related harms, and criminal justice overcrowding”.

For a "soft" drug such as marijuana (which I do not use, so my views are not based on my personal situation), it is hard to see a reason to treat it differently from alcohol. I have never seen the difference between people smoking a joint after work and people having a beer or glass of wine. In fact, alcohol causes far more health problems than does marijuana. The recent legalization of marijuana in Washington, Colorado, and Uruguay shows it is possible.

As to heroin, as a medical student in London in the early 1970s I saw that legally prescribing and providing heroin through a clinic could enable at least some people who have this terrible addiction—a disease, not a crime, we should recall, just like alcoholism—to lead a fairly normal and productive life.

The stubborn adherence to a failed strategy, the demonization and vilification of those who advance an evidence-based, humane and rational alternative, and ongoing efforts to shut down and prevent the replication of the successful Insite model for safe injection—all do more harm than good. It is time for a re-think.