One hundred years ago this month, global drug prohibition began with a meeting convened by the US in Shanghai, China, of 13 nations. One of the key issues considered was concern at British policy forcing China to take opium from colonial India.

The meeting, which agreed to try and prohibit the use of opium, marked the start of a process that culminated in an important meeting in Geneva in 1925 that started the development of the international system we have today.

At a United Nations General Assembly Special Session (UNGASS) on Drugs in New York city in 1998, the United Nations Office on Drugs and Crime (UNODC) declared: “a drug free world: we can do it”.

The meeting agreed to review the achievements of global drug policy in 10 years with a mid term review in 2003. The 2003 whitewash review duly concluded that the world’s drug policy was indeed half-pregnant as “encouraging progress” had been made “towards still distant goals”.

The 10 year review has been much more thorough. This time round UNODC conceded that “global drug policy has to be made fit for purpose” and accepted that the world’s drug problem has only been “contained”.

But how can a 1998-2007 global increase of opium production of 102% and cocaine production of 20% be accurately described as “containment”? Was the increase in global cannabis production (1998-2004) of 36% “containment”?

AIDS is now the fourth most important cause of death in the world, with injecting drug users accounting for one in ten new global HIV infections (30% outside Sub Saharan Africa). Is that “containment”? Global illicit opium production is now 20 times greater than legal medicinal production. Does that sound like “containment”?

The 10 year review culminates in a high level meeting in Vienna on March 10-11. International delegates have been taking part in numerous discussions in Vienna in recent months. US delegates maintained their traditional hard-line position even after the change of Administration on January 20.

But on February 12 the US finally indicated that they are starting to change their position: “The United States supports evidence-based approaches to reduce the negative health and social consequences of drug abuse.”

That is a revolutionary statement for the US. The statement specified that the US now supports needle syringe programmes and [methadone and buprenorphine] treatment intended to reduce the spread of HIV. However, “the United States continues to believe that the term ‘harm reduction’ is ambiguous. It is interpreted by some to include practices that the United States does not wish to endorse or see included in UNGASS documents, not in the Political Declaration nor in the Plan of Action.”

The European Union has been a strong advocate for harm reduction in these sessions. But European unanimity was predictably broken by Berlusconi’s Italy this week. It is understood that Australia has recently begun to strongly support harm reduction after an earlier more ambiguous position. Some Asian countries are now supporting harm reduction.

The Executive Director of the Global Fund for AIDS, TB and Malaria, Michel Kazatchkine, recently urged the meeting “to send a strong message to the world with clear and specific language that calls for comprehensive harm reduction services.”

UNAIDS Executive Director, Michel Sidibe, recently noted the “considerable body of strong and consistent evidence on the effectiveness of harm reduction approaches” and cited numerous UN General Assembly and UNAIDS Programme Coordinating Board resolutions supporting harm reduction.

As TS Eliot said, “Humankind cannot bear very much reality.”