Drug use disorders: impact of a public health rather than a criminal justice approach
Authors: Nora D. Volkow, Vladimir Poznyak, Shekhar Saxena, Gilberto Gerra
Journal: World Psychiatry (2017)

The Outcome Document of the 2016 United Nations General Assembly Special Session on drugs (UNGASS 2016), unanimously approved by the 193 Member States, has recognized "drug addiction as a complex multifactorial health disorder characterized by chronic and relapsing nature" that is preventable and treatable and not the result of moral failure or a criminal behavior. Historically, most nations' strategies for addressing substance use disorders have centered on punishment, and thus recognition of the need to shift from a criminal justice to a public health approach represents a major shift in mentality by United Nations Member States. This achievement was the result of a continuous dialogue between policy makers and the scientific community during recent sessions of the United Nations Commission on Narcotic Drugs. In 2015, the United Nations Office of Drugs and Crime and the World Health Organization created an Informal International Scientific Network, consisting of experts in addiction sciences, to advise the Commission. Network members were appointed by Member States and represented widely diverse geographical regions, political systems, and cultures. The Network's input for the Commission's preparation of UNGASS 2016 provided the scientific support for the concept that substance use disorders are brain disorders1; that they can be treated; that people with even the most severe forms can recover with access to evidence-based treatment and social supports2; and that criminal sanctions are ineffective at preventing or addressing these disorders. It also highlighted evidence-based approaches to drug policy based on public health principles, emphasizing social protection and health care instead of conviction and punishment. The Network issued eight recommendations, which were adopted unanimously by all the United Nations Member States at UNGASS 2016 and summarized in the Outcome Document of that meeting. These recommendations are a testament to a momentous shift in mentality, to which science and the Network have contributed. The public health goal of reducing the world's drug problems cannot be achieved without addressing substance use disorders with the same scientific rigor, compassion, and commitment that other physical and mental health problems are addressed. Substance use disorders are common psychiatric disorders, and access to affordable, quality health care for such disorders has been declared an inherent right for all United Nations Member State citizens. The strong consensus reached by the Network – scientists representing very different countries that have widely varying policies, political views, and stages of development – is an unprecedented and positive step toward a world where science guides nations' approach to drug misuse and its associated health and safety consequences. Adopting these recommendations will be crucial to fulfilling Member States' joint commitment to effectively address and counter the world drug problem. Nora D. Volkow1, Vladimir Poznyak2, Shekhar Saxena2, Gilberto Gerra3, and the UNODC-WHO Informal International Scientific Network 1National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA; 2Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; 3Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, Vienna, Austria The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated. The authors thank E.M. Wargo for his valuable editorial work. The members of the Network are C.F. Damin, G. Fischer, T. Mota Ronzani, S.T. Zhenkova, M. Zhao, Z. Liu, O. Scoppetta Diaz Granados, M. Mahfouz, P. Arwidson, T. Pfeiffer-Gerschel, E. Adjei-Acquah, R. Lal, S. Ben Ezra, P. Rosca, C. Leonardi, I. Maremmani, M.T. Matar, J.A. Villatoro Velazquez, J. Toufiq, I. Obot, J.G. Bramness, K.M. Ostaszewski, M.J. Rodrigues Dias, S.N. Al-Emadi, E.A. Bryun, G. Korchagina, E. Krupitskiy, O.A. Alibrahim, T. Hernandez Fernandez, N. Stenström, M.P. Schaub, M. Boyle, I. Grant, S. Gust, A.T. McLellan, N.D. Volkow, S. Weiss, G. Campello, E. Mattfeld, E. Saenz, A. Busse and N. Clark.