Vector Volume 11 Issue 2 - 2017

and substance use programs).[9]
Criminalisation: Central Asia
Central Asian countries, such as Tajikistan, Kazakhstan,
and Uzbekistan, have adopted an increasingly stringent
approach to drugs.[14] In the year following the September
11 attacks, these countries received US $187.5 million
from the US government to improve border control, counterterrorism
measures and counter-narcotics initiatives.[14]
Between 2004 and 2007, a strong criminal justice-based
approach was further reinforced in Central Asia with funding
from international agencies, other foreign governments and
national budgets directed to legal action against drug use.
[14]
Further, national campaigns in Central Asia often label
drug users as evil, increasing the stigma and discrimination
which perpetuates cycles of drug use.[15] Little or no
rehabilitation or treatment is available for substance users,
with such countries preferring a model of criminalisation and
incarceration.[14] For example, opioid substitution treatment
is prohibited in Tajikistan and Turkmenistan, minimally
available in Uzbekistan and Kyrgyzstan, and non-existent in
Kazakhstan.[14] The lack of treatment for drug users and
increasing accessibility of opiates has resulted in a growing
HIV epidemic in Central Asian prison systems with poor longterm
health outcomes.[14]
Decriminalisation: Portugal
Prior to 2001, drug use was criminalised in Portugal,
yet rates of heroin use and drug trafficking continued to
increase.[3] Consequently, the Portuguese government
drafted a law decriminalising all drugs purchased, possessed
or consumed for personal use. This law also had a public
health focus towards rehabilitating those with substance
use disorders, and a punitive focus towards high-level drug
trafficking. This involves a committee of two medicallytrained
persons and one legally-trained person, deciding first
whether an offence is protected by this law, and then whether
the offender is suffering from a drug use disorder.[3] This law
only aimed to decriminalise low-level drug offences; strict
laws remain against high-level offenders and drug traffickers
who propagate this vicious cycle and endanger the general
community.[16]
After this law was passed,
Portugal reduced its burden on the
criminal-justice system, allowing
more funding allocation towards
public health endeavours, including
prevention campaigns, treatment,
and facilities.[17] Treatment
uptake consequently increased,
resulting in decreasing rates of drug-associated illnesses.[4,
18] During the four years following decriminalisation in 2000
to 2006, there was a significant decrease in the incidence
of new cases of HIV/AIDS amongst drug users in Portugal,
from almost 1400 to 400 persons.[18] Decreased rates of
new hepatitis B and C infections have also been evident,
attributed to the improved treatment and rehabilitation
programs afforded by decriminalisation.[17, 18] Moreover,
“...a staggering 400 Australians die yearly
from heroin overdose, and most areas have
a demand for substitution products far outweighing
the supply”
absolute numbers of drug-related deaths by each prohibited
substance decreased; the total number of drug-related
deaths decreased from 400 in 1999 to 290 in 2006.[18]
Importantly, while some speculated that decriminalisation
would lead to lower prices of drugs and subsequent
higher rates of usage, the cost of drugs did not decrease.
[19] In fact, the rates of cannabis and cocaine use after
decriminalisation have been three times lower than before.
[18] Further, data extrapolations have predicted lower lifetime
prevalence rates of drug use for almost all drug categories
post-decriminalisation.[18]
Decriminalisation: West Africa
West African countries must contend with both
international drug cartels and the growing transit of illicit
substances to Europe and North America. Consequently, local
consumption of illicit substances has increased, especially
among younger persons, with significant economic, health
and social consequences.[20] While data is scarce, in 2008 it
was estimated there were 1.8 million intravenous drug users
in Sub-Saharan Africa, of whom 12% were thought to be living
with HIV.[20, 21]
In 2014, the West Africa Commission on Drugs published
a declaration specifically stating that “criminalisation of drug
use worsens health and social problems, puts huge pressures
on the criminal justice system and incites corruption”, and
that “drug use must be regarded primarily as a public health
problem”, mirroring the movements of Portugal.[20] Despite
these recommendations, there is currently no evidence
that any West African countries have been successful in
implementing drug decriminalisation policies.
Drug policy in Australia and the way forward
In 1985, the Australian Government adopted an official
national drug policy of harm minimisation.[1] In the 2002-
03 financial year, the Australian Government allocated $3.2
billion to managing illicit drugs, 75% of which was spent on
drug law enforcement, aiming to decrease drug and drugrelated
crime, and improve public health and safety.[1,
16] Despite this investment, a staggering 400 Australians
die yearly from heroin overdose, and most areas have
a demand for substitution products far out-weighing the
supply, notwithstanding the costly
co-payment.[1] The methadone
substitution program and syringe
exchange services available in
Australia have made an impact, yet
with a growing affected population
and the root cause unaddressed,
the need is largely unmet.[1]
Harm minimisation still perpetuates discrimination and
marginalisation of drug users, instead, decriminalisation can
reduce stigma and is essential to better health outcomes.[3]
The Australia21 report, published in 2012, was effective
in initiating a debate on drug reform. The report not only
illustrated the harmful effects of criminalising possession
and personal use on drug-dependent individuals in an
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