The war on drugs is a failure that harms the health of the public, according to a report that could help shape global drug policy.

The report, compiled by academics around the world and published in The Lancet, examines the public health ramifications of the current international drug policy.

The report was prepared for the United Nations (U.N.), which is convening later this month to address the world drug problem. Ironically, the second day of their gathering is April 20, an international holiday to cannabis enthusiasts.

All told, the report recommends decriminalizing minor, nonviolent drug offenses as well as strengthening alternatives to jail time and phasing out the use of military forces to enforce drug laws. They also recommend the use of harm-reduction services such as needle exchanges and injection sites, increased health services to prevent the spread of HIV, hepatitis C, and tuberculosis, and reducing the negative impact of drug policy and laws on women.

“Standard public health and scientific approaches that should be part of policy making on drugs have been rejected in the pursuit of prohibition,” the Lancet report states. “Drug policy that is dismissive of extensive evidence of its own negative impact and of approaches that could improve health outcomes is bad for all concerned.”

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Changing the Approach to Drugs

The last U.N. General Assembly Special Session that addressed drugs, held in 1998, continued the decades-old approach of prohibiting all drug use, possession, production, and trafficking.

These prohibitionist approaches, the Lancet paper authors note, has lead to enforcement-heavy policies that don’t allow illicit drugs to be given the same treatment as potentially dangerous foods, tobacco, or alcohol.

Much like how alcohol prohibition gave rise to a criminal underbelly, the prohibition of drugs has resulted in a $300 billion black market enforced by violence. This is evident in countries like Mexico where seven drug cartels control virtually all of the U.S. drug trade, according to the latest drug threat assessment from the U.S. Drug Enforcement Administration.

However, researchers say, continuing these approaches endangers more than just drug users.

“Policies meant to prohibit or greatly suppress drugs present a paradox. They are portrayed and defended vigorously by many policy makers as necessary to preserve public health and safety, and yet the evidence suggests that they have contributed directly and indirectly to lethal violence, communicable disease transmission, discrimination, forced displacement, unnecessary physical pain, and the undermining of people’s right to health,” the Lancet report concludes.

The so-called “war on drugs” and its zero-tolerance policies, the report states, have fostered lethal drug overdoses, high incarceration rates, and the spread of HIV, hepatitis C, and tuberculosis among drug users and prison populations.

However, researchers say these laws are applied with “clear racial biases in policing, arrests, and sentencing,” especially in the U.S., which has the highest incarceration rate of any country in the world.

According to the Federal Bureau of Prisons, 46 percent of all federal prisoners are behind bars for drug offenses. And despite no significant difference in drug use between whites and blacks, black men are more than five times as likely to be imprisoned for drug offenses in their lifetimes.

Globally, about 21 percent of all prisoners were incarcerated for drug-related crimes in 2014.

Some countries, such as Indonesia and Iran, use public executions in an attempt to deter drug traffickers, although there’s no evidence to suggest these methods work, the researchers say.

Women of color are also highly discriminated against in drug enforcement. Typically at the lowest levels of the drug trade, such as couriers, women often don’t have information about the highest rungs of drug cartels to use as leverage with prosecutors.

Laura Thomas, deputy state director in California for the Drug Policy Alliance, said voters are supporting those who recognize drug addiction is a health issue, not merely a criminal justice issue.

“The American people realize the drug war is a failure,” she told Healthline.

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A Brief History on the War on Drugs

Decriminalization of marijuana, needle exchanges, and other policies that would shift how the United States deals with illicit substances have been suggested before.

They are, however, political landmines when politicians run on the platform of being tough on drugs and the crimes that stem from their possession.

From President Bill Clinton testifying he did not inhale when smoking marijuana to President Barack Obama saying he did because “that was the point,” the war on drugs on U.S. soil has had some more notable moments.

President Richard Nixon may have been the first to declare a war on drugs, but, according to recent revelations, it may not have been drugs he was truly after.

In an article published in the latest issue of Harper’s Magazine, John Ehrlichman, Nixon’s former assistant for domestic affairs, told writer Dan Baum the real reason for the war on drugs was to quell opposition to the Vietnam War. This included associating the antiwar left with marijuana and blacks with heroin, and criminalizing both drugs heavily.

“We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did,” Baum quoted Ehrlichman.

Under President Ronald Reagan, drug-related incarceration rates and strict drug policies rose. In 1980, a year before Reagan assumed the presidency, there were about 50,000 people incarcerated for nonviolent drug offenses. By 1997, there were 400,000, according to the Drug Policy Alliance.

Reagan’s battles in the war on drugs also involved increased militarization of police. Also, federal grants were used to provide local police departments with surplus military goods, including tanks and SWAT gear.

The militarization of police departments continued under President George W. Bush as a post 9/11 response, but the tactics and gear were used more on drug arrests and quashing protests than terrorism. SWAT activity is rarely tracked, but in states that do, about half of their use is for search warrants for suspected drug crimes, a sliver of which result in felony charges.

Besides his stance on the drug war, Obama signed an executive order last year that forbids local law enforcement from using federal grants to buy, among other things, tracked armored vehicles, bayonets, grenade launchers, and large caliber weapons.

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Marijuana: America’s Litmus Test

Currently, 23 states and the District of Columbia have laws on the books regarding marijuana. Four have legalized it for recreational use.

In a recent poll, 61 percent of Americans believe marijuana should be legal.

Colorado, where marijuana has been legal since 2014, saw increases in hospitalizations for marijuana, but overall they only accounted for 1.5 to 2 percent of all hospital visits, according to Mike Van Dyke, Ph.D., chief of toxicology at the Colorado Department of Public Health and Environment.

Increased child poisonings have appeared to taper off, he said.

While health officials are still waiting for more data to come in, Van Dyke says there aren’t catastrophic health problems associated with legalization. Should they arise, it makes public health campaigns much easier.

“When you see problems, you can do something about it,” Van Dyke told Healthline. “It brings it out from behind closed doors.”

In the U.S., marijuana is still a Schedule 1 drug, the same as heroin, LSD, and ecstasy, meaning lawmakers believe the drugs have high potential for abuse and no therapeutic value.

The U.S. Department of Drug Enforcement announced this week it would make a decision on the status of marijuana in the first half of this year.

Besides potentially relaxing enforcement of federal drug laws, it could loosen restrictions allowing for more research to be done on cannabis’ potential therapeutic applications.

Despite being lax on marijuana use, 93 percent of Americans polled believe drugs like cocaine and heroin should remain illegal. Efforts to help those battling addictions, however, remain a mixed bag.

The U.S. is currently in the midst of a two-fold drug addiction epidemic that involves opioid painkillers and heroin.

In 2014 alone, prescription pain relievers were responsible for 18,893 fatal overdoses and 10,574 from heroin, according to the U.S. Centers for Disease Control and Prevention.

In California, where drug overdose is the leading cause of preventable death, one lawmaker introduced a bill that would allow cities to open supervised consumption services. These would be sterile, supervised areas where intravenous drug users can shoot up with a lowered risk of fatal overdose.

Several law enforcement groups oppose the bill.

San Francisco Supervisor David Campos proposed creating a site in San Francisco, which would make it the 67th city in the world with such services.

Canadian Sen. Larry Campbell helped create the first supervised injection site, InSite, in North America in 2003 when he was mayor of Vancouver in British Columbia. It’s located in the city’s Downtown Eastside, home to many drug users.

“This is a medical condition, like alcohol. You are never cured of it, but it is certainly treatable,” he told the San Francisco Chronicle.

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Most Drug Users Don’t Have a Problem

One major dilemma in the war on drugs is that the majority of people who use them don’t have a problem.

The U.N. Office on Drugs and Crime reports an estimated 246 million people used an illicit substance in the past year, but only about 11 percent experienced drug dependence or drug-use disorders.

“The idea that all drug use is dangerous and evil has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol, and other substances for which the goal of social policy is to reduce harms,” the Lancet report states. “Harm reduction, an essential element of public health policy, has too often been lost in drug policy making amid a dominant discourse on the overwhelming evil of drugs.”

The Obama Administration’s approach to drug policy follows years of research, namely neuroscience, to help understand that addiction is a disease that needs to be treated, not merely incarcerating those who use drugs.

Those who have drug problems, however, often face serious barriers in finding treatment and even safe means of doing so, namely injectable drug users. The lack of needle exchanges and other social programs directly contributes to the spread of infectious diseases, including HIV and hepatitis C.

In lieu of a failed drug policy that focuses on prohibition, abstinence, and police enforcement, the Lancet report calls for a larger focus on prevention of drug use, treatment for users, and reducing the harms associated with drug use.

Thomas says this is something public health officials have been saying for a long time, but the U.N. meeting and report help open the conversation.

“We need public health tools to address a public health problem,” she said.