Government review on illicit drug use and violence will not look at decriminalisationBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l655 (Published 08 February 2019) Cite this as: BMJ 2019;364:l655
All rapid responses
[Response edited by Sharon Davies, 21 February 2019]
The news article wrongly claimed ”in Portugal, where non-violent possession of drugs has been decriminalised, consumption has not increased but drug related deaths have fallen considerably”.(1)
The state of affairs in Portugal has been recently disclosed.(2) Since 2001, when Portugal made using drugs a “health problem rather than a crime”, cannabis users have increased by more than 40% and, the already high consumption of alcohol, tobacco and illegal psychoactive substances has been ever increasing. Hype that this policy has increased access to care failed to account for a major confounding variable: Health expenditure per capita (current US $) has increased two fold from 1.100 in 2000 to 2.100 in 2014, peaking in 2008 at 2.500!(2) The Journal also published online several rapid responses in 2010 (https://www.bmj.com/rapid-response/2011/11/03/redrug-decriminalisation-p... , https://www.bmj.com/rapid-response/2011/11/03/redrug-decriminalisation-p... , https://www.bmj.com/rapid-response/2011/11/03/drug-decriminalisation-por...) robustly challenging the BMJ feature on drug decriminalisation in Portugal.(3)
The state of affairs in Washington State, the first US state to “legalize” marijuana in 2012, provides confirmatory evidence. There the policy was most comprehensive.(2) One year before, it ended the state monopoly on liquor sales despite warnings this could increase by alcohol consumption by 50%.(4) Previously, in 2008, it axed funding for the Basic Liquor Law Enforcement Academy, ending the program.(2) In 2017 liquor taxes and fees were decreased from $35.22/gallon to 31.48.(5)
Is decriminalisation and “legalisation the real issue? In how many countries do police officers or judges lock up people suffering from addiction for only using a drug and do not send them to professionals for treatment? “Decriminalisation” or “legalisation” is a sheep in wolf’s clothing for liberalisation, the promotion of trade and use without any external constraint for commercial endeavours.
In contrast, partial prohibition can produce substantial public health benefits at an acceptable social cost, in the absence of substantial enforcement.(6) The case of legal drugs, tobacco and alcohol, illustrates the tick. Policies cherry pick poorly effective measures, as a smokescreen, and deliberately avoid comprehensiveness, a pre requisite for effectiveness.(7) E.g., in how many countries is menthol banned from cigarettes or is nicotine content of cigarettes reduced to non-addictive levels, the most effective tools? In how many countries is a minimum unit pricing for alcohol implemented or are health labels mandatory to warn that alcohol is a human carcinogen (class I)? The latter measure is an opportunity to go to Canada, which became in 2018 the second country to legalise cannabis, after Uruguay: Coincidentally, the same year Yukon, a small territory in Canada, had to remove its genuine mandatory warnings of an elevated risk of cancer on alcoholic beverages.(https://www.theglobeandmail.com/opinion/removing-warning-labels-on-yukon...)
The Health and Social Care Committee is running an inquiry into the health consequences of illicit drugs policy.(1) Is using opinion to justify flawed public policies democracy when facts are misrepresented?
1 Wise J. Government review on illicit drug use and violence will not look at decriminalisation. BMJ 2019 ;364:l655.
2 Braillon A. Re: ‘Killing two birds with one stone? Association between tobacco and alcohol consumption.’ Public Health 2018;159:148-149.
3 Vale de Andrade P, Carapinha L. Drug decriminalisation in Portugal. BMJ 2010;341:c4554.
4 Herzenberg S. National Public Health Task Force recommends against privatization of retail alcohol sales. Keystone Research Center. 2 Jun 2011. Available at http://keystoneresearch.org/sites/keystoneresearch.org/files/KRC-Policy-... Accessed 14 Feb 2018
5 Braillon A. Effects of a Comprehensive Pro-alcohol Policy in Washington State. Alcohol Alcohol 2019;54:119-121
6 Hall W. What are the policy lessons of National Alcohol Prohibition in the United States, 1920-1933? Addiction 2010:105;1164-73.
7 Braillon A. The Framework Convention on Tobacco Control. Lancet 2016;387:1907
Competing interests: No competing interests
A recent systematic review and meta-analysis demonstrated that cannabis use triples violence in patients with mental illness.
Competing interests: No competing interests