By The International Drug Policy Consortium

In 2024, the World Drug Report broke its historical silence on the human rights dimension of drug policy with a special chapter on “Drug Use and the Right to Health.” The present analysis compares this chapter with the April 2024 report on “Drug Use, Harm Reduction, and the Right to Health” by the UN Special Rapporteur on the Right to Health, Dr. Tlaleng Mofokeng, to assess whether the 2024 edition of the World Drug Report constitutes a genuine move towards integrating a human rights perspective into the global drug control regime.

The answer is negative. The World Drug Report chapter suffers from a critical and unjustifiable methodological flaw: it has been developed without any reference to the standards and recommendations on drugs and the right to health developed over the last 15 years by UN human rights mechanisms. These standards were created precisely to provide Member States with guidance on their human rights obligations. Instead, the chapter is often guided by the UNODC’s own policy preferences and its desire to manage political tensions at the UN Commission on Narcotic Drugs (CND).

The result is a flawed rendering of the right to health that omits essential elements such as a robust interpretation of harm reduction and support for the decriminalisation of people who use drugs. It also glosses over the undeniable tension between the drug control regime and the right to health, and introduces problematic concepts such as “the right to health of communities affected by drug use.” This notion is not grounded in human rights standards and risks decentring people who use drugs.

Although the special chapter pitches itself as the basis for a new framework to evaluate States’ performance with regards to the right to health, Member States should withhold support for this flawed initiative until it fully integrates the guidance developed by the UN human rights system.

London: International Drug Policy Consortium, 2025. 23p.

By Michael J. Zoorob, ; Ju Nyeong Park, ; Alex H. Kral,  et alBarrot H. Lambdin, PhD3; Brandon del Pozo, PhD, MPA, MA1,2

IMPORTANCE-  With the implementation of Measure 110 (M110) in 2021, Oregon became the first US state to decriminalize small amounts of any drug for personal use. To date, no analysis of the association of this law with overdose mortality has fully accounted for the introduction of fentanyl—a substance that is known to drive fatal overdose—to Oregon’s unregulated drug market. OBJECTIVE -  To evaluate whether the decriminalization of drug possession in Oregon was associated with changes in fatal drug overdose rates after accounting for the rapid spread of fentanyl in Oregon’s unregulated drug market. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, the association between fatal overdose and enactment of M110 was analyzed using a matrix completion synthetic control method. The control group consisted of the 48 US states and Washington, DC, all of which did not decriminalize drugs. The rapid spread of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogues. Mortality data were obtained from the Centers for Disease Control and Prevention for January 1, 2008, to December 31, 2022. Data analysis was performed from fall 2023 through spring 2024. EXPOSURES Measure 110 took effect in Oregon on February 1, 2021. MAIN OUTCOMES AND MEASURES The primary outcome assessed was fatal drug overdose rates per half-year. A changepoint analysis also determined when each state experienced a rapid escalation of fentanyl in its unregulated drug market. RESULTS In this analysis, rapid spread of fentanyl in Oregon’s unregulated drug supply occurred in the first half of 2021, contemporaneous with enactment of M110. A positive crude association was found between drug decriminalization and fatal overdose rate per 100 000 per half year (estimate [SE], 1.83 [0.47]; P < .001). After adjusting for the spread of fentanyl as a confounder, the effect size changed signs (estimate [SE], −0.51 [0.61]; P = .41) and there was no longer an association between decriminalization and overdose mortality in Oregon. Sensitivity analyses were consistent with this result. CONCLUSIONS AND RELEVANCE In this cohort study of fatal drug overdose and the spread of fentanyl through Oregon’s unregulated drug market, no association between M110 and fatal overdose rates was observed. Future evaluations of the health effects of drug policies should account for changes in the composition of unregulated drug markets.

  JAMA Netw Open. 2024;7(9):e2431612. doi:10.1001/jamanetworkopen.2024.3161