We have attempted to show how human behaviors related to parenteral substance use have driven epidemics of HIV, HCV and other infectious diseases, and how in turn social and political responses to substance use have so often contributed to disease spread rather than control. Are there better ways? While attempts to reduce the absolute volume of illicit drugs worldwide will no doubt continue and should be supported, it is probably wise to consider that humans have used psychoactive drugs throughout our known history, and that addiction is a powerful force for continued use. A prudent and moderate approach would be to provide drug treatment to those who want it, to investigate new and better approaches to addiction therapy, and to attempt to minimize the health impacts to individuals and communities with the recognition that substance abuse is likely to continue for the foreseeable future. Simple first steps would be to take to scale the prevention measures we have with evidence for efficacy for reducing infectious disease spread among drug users. These include needle and syringe exchange programs, outreach and education, access to drug treatment (including substitution therapy), and access to effective clinical care for infectious diseases where such care is known to be beneficial. Anti-viral therapy for AIDS and HCV are examples. Taking this approach further, a human rights-based approach which recognizes that drug users are people deserving of compassion and care, and attempting to reduce the social isolation, official harassment, and criminalization of addiction, could go a long way to reducing the harm for individuals and communities. Human beings are the vectors for infections spread through injection drug use, and so this is one group of diseases for which humans can truly be said to be in control. That we have failed so miserably to control the global epidemics of infections among drug users says a great deal about our approach to these challenges. We have tried decades of prohibition and criminalization to little avail.

It is well past time to consider other options.

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