President Trump stomped into the United Nations General Assembly meeting in September with a plan for “effectively addressing and countering the world drug problem.” He rehashed a business-as-usual global strategy, centered on law enforcement that would crack down on drug trafficking, eradicate narcotics production, and “reduce demand.” But today, the world is demanding something else altogether. Growing increasingly disillusioned with Washington’s War on Drugs, some communities and lawmakers are raising a white flag, seeking instead more humane ways to fix the ruins of a failed crusade.

After Trump pushed 100 other countries to sign onto his plan to renew the drug war, the International Consortium on Drug Policy published a scathing declaration of defeat. Based on a review of past decade of UN-led anti-narcotics efforts, ahead of a global summit on drug policy, the civil-society coalition’s analysis denounced an enforcement strategy that has spectacularly failed to curb drug use and aggravated its associated social harms.

The report begins by condemning a litany of human-rights disasters: mass incarceration, the devastation of vital health and social-welfare institutions, and massive criminal and state violence that has “resulted in millions of people murdered, disappeared, or internally displaced.”

Despite massive militarized eradication efforts around the world, illicit drug markets are flourishing, with bumper crops in opium and coca—130 percent and 34 percent increases, respectively, in worldwide production. As for “reducing demand,” adult drug consumption has swelled by more than 30 percent since 2011, with an estimated 275 million people aged 15 to 64 having used drugs at some point. Marijuana tops the list, followed by opioids and meth. Overall drug deaths soared by 145 percent between 2011 and 2015, to about 450,000 people worldwide. Overdose deaths claimed about 72,000 lives in just the past year in the US alone, driven in large part by the opioid epidemic.

The underground cash flow is estimated at anywhere from $800 million to $2 trillion, “representing 2 to 5% of global GDP–with a quarter of overall revenues of transnational organised crime proceeding from drug sales.” Just 1 percent of that total is actually seized by authorities. At the retail end, new black markets are rapidly flourishing through opaque global crypto-currency platforms.

Overall, harsh enforcement is arguably doing more public-health damage than the illicit substances themselves: Running parallel to the overdose crisis are continual prescription drug shortages in poorer countries. Currently about 75 percent of the Global South cannot access painkiller medication for common ailments or palliative care, yet more than 90 percent of the world’s morphine supply is “used by just 17 percent of the world population.” Meanwhile, irrational marijuana restrictions in the West are limiting access to a major potential safe alternative, medical cannabis, because of reactionary fears about reefer madness.

At the same time, the prevalence of drug-related HIV, hepatitis C, and tuberculosis has plateaued, at 8 percent to 12 percent, with progress inhibited by underfunding for harm-reduction programs for intravenous-drug users. The UN estimates that “only US$188 million was allocated to harm reduction in 2016—the same amount (inflation adjusted) as in 2007, and just 13 percent of what is needed.” International-aid funding has shrunken by a quarter over the past decade, and Trump is gunning to slash even more humanitarian aid.

According to UN statistics, people charged with drug offenses now constitute an estimated one in five prisoners worldwide, the vast majority based on personal consumption. Many anti-drug regimes have driven systematic brutality against women, who now make up one of the fastest-growing subsets of prisoners, and exacerbated social inequality. Security measures have undermined basic rights through “forced urine testing, compulsory registration requirements, incarceration in compulsory detention centres and corporal punishment, including on children.”

States themselves have also added to the death toll, with some 3,940 formal executions for drug offenses. On the streets of the Philippines under the regime of Rodrigo Duterte, under the guise of cracking down on drugs, some 27,000 estimated extrajudicial killings have occurred since 2016.

The social crisis wrought by the drug war is a US export, according to Hannah Hetzer, senior international policy manager for the Drug Policy Alliance, since the federal government “has absolutely been one of the key drivers of prohibition historically, and has also responded negatively when other countries have moved to reform drug policies.” But even as Trump defends the drug war’s status quo, the global approach to drugs is changing, through humane social-development programs and rational regulation.

In Bolivia, for example, regulated coca has been successfully integrated into local farm economies, with a supportive monitoring framework that simultaneously honors the plant’s cultural significance while curbing illicit cultivation. Thailand has similarly combined managed opium production with targeted investments in public health, education, and other social benefits. In both agricultural models, strong community participation, and an emphasis on reducing poverty as a driving factor in drug trafficking, forms the foundation for positive transition.

The number of countries offering opioid-substitution therapy and safe needle-exchange programs has risen over the past decade. Safe-injection sites have been established in about 10 countries, mostly in Canada and Europe, offering regulated, supervised consumption spaces to mitigate health risks.

The impending introduction of safe-injection sites in San Francisco, New York, and other cities also signals a new realism in drug policy, as local governments “take the lead in advancing innovative, evidence-based, life-saving interventions,” Hetzer says. Despite Washington’s adherence to hard-line tactics, the push for safe-injection programs is cutting through the stigma surrounding addiction and “debating something that wouldn’t have been politically feasible years ago.”

The public conversation around opioids has suggested policy-makers were moving toward more “compassionate” approaches to the crisis (in no small part because opioid abuse has been portrayed as more prevalent among whites). But the White House has nonetheless ramped up punitive enforcement measures, while providing minimal funding for rehabilitation.

Within impacted communities, however, the opioid epidemic has forced a paradigm shift away from the dogma of prohibition. “The term decriminalization might not always be fully understood or supported,” Hetzer says. “But the conversation shifts when people are asked whether people should be jailed for drug use and possession alone…. There’s work to be done around explaining why mass criminalization of people who use drugs is never the answer.”

For decades, the United Nations’ quest for a “drug-free world” has driven governments and civil society around the globe to pursue the wrong answers to the wrong problems. Now, finally, they’re learning to ask the right questions.