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BMJ. 2007 November 10; 335(7627): 967.
PMCID: PMC2071997
Head to Head

Should drugs be decriminalised? No

Recent government figures suggest that the UK drug treatment programmes have had limited success in rehabilitating drug users, leading to calls for decriminalisation from some parties. Kailash Chand believes that this is the best way to reduce the harm drugs cause, but Joseph Califano thinks not

Drug misuse (usually called abuse in the United States) infects the world's criminal justice, health care, and social service systems. Although bans on the import, manufacture, sale, and possession of drugs such as marijuana, cocaine, and heroin should remain, drug policies do need a fix. Neither legalisation nor decriminalisation is the answer. Rather, more resources and energy should be devoted to research, prevention, and treatment, and each citizen and institution should take responsibility to combat all substance misuse and addiction.

Vigorous and intelligent enforcement of criminal law makes drugs harder to get and more expensive. Sensible use of courts, punishment, and prisons can encourage misusers to enter treatment and thus reduce crime. Why not treat a teenager arrested for marijuana use in the same way that the United States treats someone arrested for drink-driving when no injury occurs? See the arrest as an opportunity and require the teenager to be screened, have any needed treatment, and attend sessions to learn about the dangers of marijuana use.

The medical profession and the public health community should educate society that addiction is a complex physical, psychological, emotional, and spiritual disease, not a moral failing or easily abandoned act of self indulgence. Children should receive education and prevention programmes that take into account cultural and sex differences and are relevant to their age. We should make effective treatment available to all who need it and establish high standards of training for treatment providers. Social service programmes, such as those to help abused children and homeless people, should confront the drug and alcohol misuse and addiction commonly involved, rather than ignore or hide it because of the associated stigma.

Availability is the mother of use

What we don't need is legalisation or decriminalisation, which will make illegal drugs cheaper, easier to obtain, and more acceptable to use. The United States has some 60 million smokers, up to 20 million alcoholics and alcohol misusers, but only around six million illegal drug addicts.1 If illegal drugs were easier to obtain, this figure would rise.

Switzerland's “needle park,” touted as a way to restrict a few hundred heroin users to a small area, turned into a grotesque tourist attraction of 20 000 addicts and had to be closed before it infected the entire city of Zurich.2 Italy, where personal possession of a few doses of drugs like heroin has generally been exempt from criminal sanction,2 has one of the highest rates of heroin addiction in Europe,3 with more than 60% of AIDS cases there attributable to intravenous drug use.4

Most legalisation advocates say they would legalise drugs only for adults. Our experience with tobacco and alcohol shows that keeping drugs legal “for adults only” is an impossible dream. Teenage smoking and drinking are widespread in the United States, United Kingdom, and Europe.

The Netherlands established “coffee shops,” where customers could select types of marijuana just as they might choose ice cream flavours.2 Between 1984 and 1992, adolescent use nearly tripled.2 Responding to international pressure and the outcry from its own citizens, the Dutch government reduced the number of marijuana shops and the amount that could be sold and raised the age for admission from 16 to 18.2 5 In 2007, the Dutch government announced plans to ban the sale of hallucinogenic mushrooms.6

Restriction

Recent events in Britain highlight the importance of curbing availability. In 2005, the government extended the hours of operation for pubs, with some allowed to serve 24 hours a day.7 Rather than curbing binge drinking, the result has been a sharp increase in crime between 3 am and 6 am,8 in violent crimes in certain pubs,9 and in emergency treatment for alcohol misusers.7

Sweden offers an example of a successful restrictive drug policy. Faced with rising drug use in the 1990s, the government tightened drug control, stepped up police action, mounted a national action plan, and created a national drug coordinator.10 The result: “Drug use is just a third of the European average.”11

Almost daily we learn more about marijuana's addictive and dangerous characteristics. Today's teenagers' pot is far more potent than their parents' pot. The average amount of tetrahydrocannabinol, the psychoactive ingredient in marijuana, in seized samples in the United States has more than doubled since 1983.12 Antonio Maria Costa, director of the UN Office on Drugs and Crime (UNODC), has warned, “Today, the harmful characteristics of cannabis are no longer that different from those of other plant-based drugs such as cocaine and heroin.”13

Evidence that cannabis use can cause serious mental illness is mounting.13 A study published in the Lancet “found a consistent increase in incidence of psychosis outcomes in people who had used cannabis.”14 The study prompted the journal's editors to retract their 1995 statement that, “smoking of cannabis, even long term, is not harmful to health.”15

Drugs are not dangerous because they are illegal; they are illegal because they are dangerous. A child who reaches age 21 without smoking, misusing alcohol, or using illegal drugs is virtually certain to never do so.16 Today, most children don't use illicit drugs, but all of them, particularly the poorest, are vulnerable to misuse and addiction. Legalisation and decriminalisation—policies certain to increase illegal drug availability and use among our children—hardly qualify as public health approaches.

Notes

Competing interests: None declared.

References

1. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Results from the 2005 national survey on drug use and health: national findings Rockville, MD: Department of Health and Human Services, 2006
2. Kleber HD, Califano JA, Demers JC. Clinical and societal implications of drug legalization. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. Substance abuse: a comprehensive textbook Baltimore, MD: Williams and Wilkins, 1997: 855-64.
3. European Monitoring Centre for Drugs and Drug Addiction. The state of the drugs problem in Europe: annual report 2006 Lisbon: EMCDDA, 2006:66-73.
4. European Red Cross/Red Crescent Network on HIV, AIDS and Tuberculosis. Background information: the HIV/AIDS situation in Italy www.erna.sk/nsitaly.html
5. Van Laar M, van Gageldonk A, Ketelaars T, van Ooyen M, Cruts G, van Gelder P. Report on the drug situation 2004. Report to the EMCDDA by the Reitox National Focal Point Utrecht: Trimbos Institute, NDM/Netherlands Focal Point, 2004:27.
6. Sterling T. Dutch cabinet bans sale of hallucinogenic mushrooms in new retreat from liberal policies. Associated Press 2007. Oct 12.
7. Newton A, Sarker SJ, Pahal GS, van den Bergh E, Young C. Impact of the new UK licensing law on emergency hospital attendances: a cohort study. Emerg Med J 2007;24:532-4. [PMC free article] [PubMed]
8. Ford R. All-night drinking law fuelling rise in street violence and disorder. Times 2007. Jul 20:2.
9. Slack J. Pub violence has soared by half since 24-hour licensing. Daily Mail 2007. Aug 15:2.
10. United Nations Office on Drugs and Crime. UN drugs chief praises Swedish drug control model Press release 7 September, 2006. www.unodc.org/unodc/press_release_2006-09-06.html
11. Costa AM. Cannabis . . . call it anything but soft. Independent 2007. Mar 25. http://news.independent.co.uk/uk/legal/article2390867.ece
12. US Office of National Drug Control Policy. Study finds highest levels of THC in US marijuana to date Press release 25 April, 2007. www.whitehousedrugpolicy.gov/news/press07/042507_2.html
13. United Nations Office on Drugs and Crime. UN drugs chief sounds warning about Afghan opium production, cocaine consumption in Europe Press release 26 June, 2006. www.unodc.org/unodc/en/press_release_2006_06_26_1.html
14. Moore THM, Zammit S, Lingford-Hughes A, Barnes TRE, Jones PB, Burke M, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 2007;370:319-28. [PubMed]
15. Rehashing the evidence of psychosis and cannabis. Lancet 2007;370:292
16. National Center on Addiction and Substance Abuse at Columbia University. Shoveling up: the impact of substance abuse on state budgets New York: NCASA, 2001

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