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While listening to the RSA talk Addiction: What to Do When Everything Else has Failed I'm reminded of an article in the Times from 2009 about Portugal's decriminalization of drugs.

The Cato paper reports that between 2001 and 2006 in Portugal, rates of lifetime use of any illegal drug among seventh through ninth graders fell from 14.1% to 10.6%; drug use in older teens also declined. Lifetime heroin use among 16-to-18-year-olds fell from 2.5% to 1.8% (although there was a slight increase in marijuana use in that age group). New HIV infections in drug users fell by 17% between 1999 and 2003, and deaths related to heroin and similar drugs were cut by more than half. In addition, the number of people on methadone and buprenorphine treatment for drug addiction rose to 14,877 from 6,040, after decriminalization, and money saved on enforcement allowed for increased funding of drug-free treatment as well.

Does the Cato report hold up under scrutiny, and is there research that paints a different picture of decriminalization? Is the effect of decriminalization in Portugal seen in other countries like the Netherlands?

Sklivvz
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Kit Sunde
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  • Too late here for me to write an answer, but the Vienna Declaration might be a good place to start: http://www.dangardner.ca/index.php/articles/item/34-why-our-drug-policy-is-inconsistent-with-all-available-evidence – Borror0 Apr 18 '11 at 06:34
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    Note that the main claim of decriminalisation is not the decreased use of drugs, but damage containment - less crime, less health impact, etc. The general assumption is that consumption is unavoidable. – Sklivvz Apr 18 '11 at 06:45
  • Cato reports generally are well researched. But of course one has to take things into context. Does the report include data on the reasons of the decline in drug use? For example it talks about heroin use specifically. Did that decline because of an increase in e.g. cocaine use? Or did the number of ODs go up so much that there are simply many more who die quickly rather than become longterm addicts. Your quote doesn't mention such factors yet they are important. – jwenting Apr 18 '11 at 08:34
  • @jwenting Actually it does mention that *any illegal drug use* went down in the early and late teens group, before it mentions heroin. I wanted to include another quote from a paper that (as far as I can remember) said that every metric they looked at improved for Portugal except for one, but I seem to be unable to find it. I'll try to dig it up tomorrow unless someone else beats me to it. – Kit Sunde Apr 18 '11 at 09:53
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    If you make drugs legal, isn't it kind of natural that illegal drug use goes down, since the drug is no longer illegal? :p – Svish Apr 18 '11 at 10:10
  • That would depend on the text of the law. For example the use (but not production and sale) of marihuana has been decriminalised in the Netherlands, but not that of other drugs. This could lead people migrating to other drugs that aren't monitored. – jwenting Apr 18 '11 at 10:23
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    @Svish: There's a difference between legal and decriminalized. Decriminalized means it's a minor offense that probably puts nobody in jail, and definitely nobody in prison. Illegal parking around here isn't a crime, but it is illegal. – David Thornley Apr 18 '11 at 12:34
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    I think there shall be a definite reduction in consumption. This is because if you decriminalize it, you are effectively _allowing_ people to legitimately sell it. This will lead to a situation where the "sale of drugs" can be monitored and regulated. Automatically it becomes impossible for kids to buy drugs (even today it more difficult for a teenager to buy cigarettes than drugs). It also becomes difficult for adults to abuse the drug. We could implement limited "Drug Rations" for adults which can be used for recereational purpose. – Chani Apr 18 '11 at 13:03
  • To be included in Sklivvz' list of harm that might be mitigated: the imprisonment of people who's only "crime" is engaging in commerce. – dmckee --- ex-moderator kitten Apr 18 '11 at 14:25
  • Here in the Netherlands cannabinoids are legal but in countries like Spain it's illegal. There are however more people in Spain using the drug... –  Apr 18 '11 at 14:31
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    @BigChief Unfortunately this does not automatically prove the point, because there are many other factors playing into this. The interesting number would be if drug use dropped after the Netherlands legalized cannabinoids. – Lagerbaer Apr 18 '11 at 15:02
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    It is also worth pointing out that, regardless of how it affects drug consumption, there are arguments for de-criminalization. Some say that it isn't right for the government to outlaw an activity which is only risky for those who consented to that activity. – Colin K Apr 18 '11 at 18:27
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    @Colin the problem in that is that few risky things are risky solely for people that consent to them - the consequence of living socially. – Jakub Hampl Apr 18 '11 at 19:07
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    @Jakub: Sure, but at what point do you make it alright for the government to regulate behavior? One could, in theory, argue that I must eat a healthy lunch because if I die due to unhealthy eating habits, then my employer is harmed by the loss of his employee. Should the government dictate my eating habits? Of course not. – Colin K Apr 18 '11 at 19:21
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    @Colin K - There are plenty of government agencies all around the world that dictate your eating habits. The FDA being one of them. However this isn't a question about the government rights but one about policy effects, and as such this whole discussion seem pretty uninteresting in this contexts. – Kit Sunde Apr 18 '11 at 19:29
  • I'd be interested to know how the FDA regulates what I eat, but in any case I was just offering an example. Don't miss my point because you don't like my example. Regardless, this question is about a different topic. I was simply pointing out that there are aspects of the legalization debate that are important, but different from the topic in question here. My hope was to keep this question on topic by acknowledging the other points that are often made, in order to avoid confusion. – Colin K Apr 18 '11 at 23:54
  • There are some other factors at play - the less a substance is forbidden and risky, the lesser the rewards. But you won't have much increased consumption. In lot of the developed world the people who want to use, use. So at the end you profit margins on the substance shrink and you move to more profitable venues. – Daniel Iankov Aug 24 '11 at 09:58
  • Yes, Bravo to Roy T. The U.S. policy is a failure. Individuals who were given prescription drugs and became addicted are treated like criminals. Their lives and the lives of their children and families have been devastated. They're arrest records prevent employment. This traps them in an unnecessary cycle of poverty, instead of gainful employment. The death toll from this war is like a 911 every month in our country. The only winners from this policy are those who make the untaxed profit. Money flows out of the country like a river, while the tax-payers bear the costs. The upshot of synthetic –  Aug 24 '11 at 07:46
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    @Sklivvz this is pretty accurate. Damage containment appears to be more successful when the source of the damage is regulated by state (but not always). Or like I would say, "You can't regulate what you outlaw". – JustChris Sep 28 '11 at 17:23
  • The questions of whether decriminalisation lower *consumption* is narrower that the related question of whether it lowers *harm*. Should we start a new question or should we answer both questions here? – matt_black Sep 30 '11 at 22:27

1 Answers1

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Summary: decriminalisation clearly doesn't lead to catastrophe, seems to reduce harm and might reduce consumption in some cases

Before attempting a proper answer to the question as asked it is worth making a clarification: the expected benefits of decriminalisation are much broader than just a reduction in use (lower crime and lower policing costs could happen even if consumption increased). Asking whether consumption decreases is a very narrow question compared to asking whether harm as a whole is reduced. I'm sticking with the narrow question here and assuming the broader question might get asked later so other evidence can be brought to bear.

It is also worth defining what we mean by decriminalisation. I think there is evidence about 3 different models (there are probably others but these cover a broad range). I'm going to call them the Swiss model, the Dutch model and the Portugese model.

In the Swiss model (which applied to injected opiates) the point is to medicalise the problem of addiction by providing medical grade opiates and clean needles to addicts in a supervised environment. The intent is to reduce the harm from criminality (i.e. stealing to pay for the drugs), medical complications (impure drugs of uncertain concentration, dirty needles etc.). Addicts also have access to the services they need for withdrawal. The model has been so successful in Switzerland that even the relatively prohibitionist UK is piloting it (Lancet report here). But assessments have been done on the number of regular addicts. And the results suggest that the numbers of long term addicts drop albeit slowly (broader measures of harm reduce by large amounts).

The Dutch model represents a sort of supervised tolerance of soft drugs (mainly cannabinoids) from licensed premises. The detailed rules have been tweaked several times in the last 40 years. But there is little clear evidence on the relationship between the specific rules and consumption. One expert argues in this debate thread in the BMJ (see the contribution by Rolles) that:

It should also be noted that cannabis use has risen across the Western world since 1976, but has risen slower in Netherlands than many other countries. Young people's cannabis use in the Netherlands is substantially lower than either the UK or the US.

A more thorough study in 2002 concluded that:

Although changes in cannabis policy went along with changes in availability of cannabis and prevalence of cannabis use, it is questionable whether changes in cannabis policy were causally related to trends in cannabis use. Cannabis use also developed in waves in other European countries that did not decriminalize cannabis, as well as in the US. Consequently, trends in cannabis use seem to develop rather independently of cannabis policy.

So while it is clear that the jeremiads of anti prohibitionists who forecast an explosion of use on decriminalisation have not occurred, we can't say that, in this case, consumption actually declined.

The third model is Portugal. Here possession of up to ten days supply was decriminalised and addicts referred to treatment if caught. This summary of the results claimed a significant reduction in use of injectable drugs after the policy had been in action for some time. It should be pointed out that these results are controversial (see the comments on the report here.)

My summary of the evidence above is that it clearly shows that decriminalisation is not a catastrophe leading to big increases in the consumption of dangerous substances, and there is some evidence that consumption might fall. In all cases it is likely that harm was substantially reduced.

There is plenty of other debate on this topic (thought the quality often leaves something to be desired as many of the participants seem unable to separate logic end evidence from their emotional and intuitive starting positions). A good place to start is the BMJ debate here but the follow up online debate is also worth reading.

A very recent publication from an international group, the Global Commision on Drugs is available here but it is only fair to report that some of their numbers have been criticised (see the analysis by StraightStatistics here).

EDIT. A recent summary of the Portugese case appears in the BMJ in october 2011 and reinforces the above conclusions.

matt_black
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    I wonder how they concluded that cannabis use in the Netherlands is low compared to the UK and US. If they just count arrest records, of course it's lower as most use is not criminalised, and thus noone gets arrested for it. As to injected opiates, the Netherlands employ a very similar system to the Swiss, and it seems to work (though data is hard to get, as there's little data about addicts who are outside the supervised groups) for those in the groups. They live longer, fewer health problems, less criminal behaviour (though they're still incapable of holding jobs, thus a continued drain). – jwenting Oct 03 '11 at 09:30