approach) to the non‑medical use of psychoactive drugs that were defned as illicit drugs. This is also the case in national laws on psychoactive drugs in most countries. As a result, sentences for violation of prohibitive drug laws – and con‑ sequently imprisonment rates – have increased dramatically in many countries since the 1960s, without achieving full control of the existence of the black illicit drugs market, with its violence, anarchy and powerful dynamics. It has become apparent now that this approach brought no success in the “war on drugs” and that post‑prohibition models of drugs regulation have to be designed.2 Looking at the list of socially accepted (“licit”) psychoactive drugs (tobacco, alcohol, cafeine, in some countries khat, betel nuts and other substances) and illicit drugs (opiates, cocaine, amphetamine derivatives, cannabis, hallucino‑ genic drugs, benzodiazepines and others) it becomes clear that: X the social and legal acceptance of psychoactive drugs varies historically (alcohol prohibition in the 1930s in the USA) and geographically (cannabis sale in Holland, khat accepted in Yemen but not in neighbouring Saudi Arabia); X the social and legal acceptance of psychoactive drugs does not depend on the magnitude of its health risks: the health damage to individuals, to public health and the impact on the global burden of disease by alcohol and tobacco exceeds by far the health risks of the other psychoactive substances.3 Psychoactive drugs are in general classifed according to their chemical structure and/or their efect on the central nervous system, with some over‑ lapping of categories: ethylic alcohol, nicotine in tobacco, cafeine, sedatives and hypnotics, cannabinoids, opiates and opioids, cocaine, amphetamines and derivatives, hallucinogens and volatiles. With the exception of cafeine, the chronic use of all groups of the above‑mentioned substances is associ‑ ated with adverse efects on health and the risk of developing dependence. In addition, the emergence of new synthetic psychoactive drugs on the European black drugs market – a steadily increasing phenomenon – is a matter of great concern.4 2. Transform Drug Policy Foundation: After the war on drugs: blueprint for regulation (Bristol 2009). 3. WHO: Neuroscience of psychoactive substance use and dependence (Geneva 2004). 4. EMCDDA: New drugs detected in the EU at the rate of around one per week, say agencies, News Release No. 2/2012 (26 April 2012). Prison health care and medical ethics Page 70