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See SNRG member Ernie Drucker in the Lancet

Drugs: the third rail of US politics

Brief:In the 2012 US Presidential election, America’s healthcare policies remain hotly disputed. But the issue of drugs and addiction, formerly a prominent public and health concern, is now largely invisible in national political debates. Its public health importance is overlooked in favour of the continued criminalisation and punishment of drug users. America’s HIV/AIDS epidemic, for example, has always implicated drug use among poor and minority communities. New HIV infections in the USA continue at a high rate: the US Centers for Disease Control and Prevention estimate 50 000–60 000 new HIV infections in the USA annually. Meanwhile in the more populous European Union, researchers estimate there were about 5000 new HIV infections in 2008—less than 10% of the US incidence. In the USA, drug offences feed the nation’s bloated prison system, and damage the social and economic prospects of America’s poorest families and communities. There are now more drug offenders in US prisons and gaols (more than 1 million) than prisoners in the European Union for all offences. These are vital social and public health matters for the USA, as measured by morbidity and mortality alone, yet are ignored in our Presidential politics. From Afghanistan, to US neighbour Mexico, where violence associated with the trade in illicit drugs has produced 60 000 murders in 6 years, and Central America, a region which now has the highest murder rate in the world, the candidates look away, as the deadly medical and social toll accumulates.