International approaches to drug law reform: research

4. Other international examples of note

• Uruguay is the first country in the world to create a legal, regulated market for adult cannabis use with the explicit goal of undermining the illegal drug market and severing cannabis revenue from those who also sell harder drugs. The law allows people to grow their own cannabis, purchase it commercially, and join a cannabis club that cultivates and distributes to members (Leite, 2019)
  
• Mexico: In 2009, Mexican Federal Government enacted "narcomenudeo" reforms decriminalizing possession of small amounts of drugs, delegating prosecution of retail drug sales to the state courts, and mandating treatment diversion for habitual drug users. There is not a large body of evaluative work on the impact of this change. Two studies from Tijuana are informative, but impacts on a wider range of health and social outcomes, and in other parts of the country, are not known:
  • A mixed methods study in Tijuana found that "Narratives underscored the law's irrelevance to PWID; 699 (98%) saw police practice as generally inconsistent with formal law. Instead of treatment diversion, police encounters were associated with risk behaviors, including syringe sharing" (Beletsky, et al., 2015).
  • A study that looked at policing practice in Tijuana found that the change did not appear to have significantly shifted drug law enforcement practices, and other factors, such as electoral cycles, were more strongly associated with arrest volumes (Arredondo, et al., 2018).
• Germany's Federal Constitutional Court ruled in 1994 that drug addiction is not a crime, and neither is possession of small amounts for personal use, although production, distribution and acquisition remain illegal. Threshold quantities for the decriminalisation of personal possession have been defined by the courts over time. In 2000 a new narcotic law was passed to allow safe injecting facilities. German research into heroin-assisted treatment in the 2000s yielded positive results, and heroin-assisted treatment has been part of mandatory health insurance there since 2009.
• USA: There is a growing trend amongst US states towards liberalising state drug laws, despite tension with the federal law characterised by the war on drugs.
  • Recreational cannabis is now legal in fifteen states, and ballot measures have also been used to ease restrictions on harder drugs in some. Most notably, in the 2020 US election Oregon decriminalised personal possession of small quantities of drugs including cocaine, heroin, methamphetamines and psychedelics.
  • Most drug law reforms in the US are relatively recent and their impact cannot be fully assessed yet, but the following findings are available from those jurisdictions that were relatively early reformers:
    • Cannabis
      • Cannabis decriminalization showed improvements in risk areas for teenagers, declines in possession arrests, and reduction in illegal markets in 5 states, but true public health effects of cannabis legalisation cannot yet be assessed, because it has only been implemented within the past 5 years and cannabis remains illegal under US federal law (Hall & Lynskey, 2016) (Hall et al., 2019)
      • Law reform in California has also enabled automatic expungement of past marijuana convictions and an estimated 218,000 individuals are due to benefit as a result.
      • Colorado: the contraband cannabis industry still flourishes in Colorado (Stuart, 2014) and Washington (Kleiman et al., 2015). The Washington data showed that more than a year after legalization, illegal sources still accounted for an estimated 28% of cannabis sold in the state.
      • FBI data from Colorado and Washington show that crime clearance rates — the frequency of crimes being solved by police — increased for both violent and property crimes after legalization (Makin, et al., 2018).
      • Oakland, California and Massachusetts have both considered social equity for people and communities disproportionately impacted by cannabis law enforcement in the design of their legalisation programmes. In Oakland, half of the licenses to grow and distribute cannabis are reserved for people who earn less than 80% of the average income, have been charged with a cannabis offense in the last 20 years, or have lived for a decade or more in a neighbourhood with disproportionately high cannabis arrests. There is a similar programme in Massachusetts. Elsewhere, state taxes ensure a portion of the revenue generated from legal sales is allocated back into such disproportionately impacted communities (Nicol, 2019).
      • National: In a national survey of US students, Palamar et al. (2014) found that 10% of non-using students intended to use cannabis if made legal, and that 18% of users expected to increase their use upon legalization of the drug (Palamar, Ompad, & Petkova, 2014).
    • Other drugs
      • By 2015, 30 states had Naloxone programmes, covering 654 police departments. Rando et al, found that following these police officer Naloxone programs, the number of opioid overdose deaths decreased (Rando, Broering, Olson, Marco, & Evans, 2015).
      • A process evaluation of Seattle's Law Enforcement Assisted Diversion (LEAD) programme, a pre-booking diversion scheme for narcotics and sex work charges, highlighted the importance of ensuring reforms are implemented and supported by front line police. They found examples in Seattle's programme where officers were reluctant to divert people who use drugs through LEAD because they felt the programmes 'enabled' addiction. Beckett emphasises the importance of ensuring buy-in from all levels of police forces, not just the leadership (Beckett, 2014).
      • Many studies in the US have looked at the costs and benefits of treatment programmes.
        • A California study of treatment outcomes found a benefit to cost ratio of 7 to 1, largely attributable to reductions in subsequent criminal activity (Ettner, et al., 2005).
        • A literature review of 18 benefit-cost studies found that benefits exceeded costs, with benefit–cost ratios of 1.6 to 26 (Cartwright, 2000).
        • A Minnesota study found benefit–cost ratios for treatment and recovery services of between 2.4 and 16.1. For prevention and early intervention services, the study found benefit–cost ratios of 0.2 to 20.4 (Merrick et al. 2017).