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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 November 24; 335(7629): 1060–1061.
PMCID: PMC2094144
Should Drugs Be Decriminalised?

Debate the balance of harm

Stephen Black, management consultant

Any resolution of the debate should focus on the balance of harm.1 2 But neither side has defined what evidence could or should be brought to bear on this. Here are two areas where a clearer focus on evidence might move the debate forward.

Clearly, being addicted to a drug is harmful, but would it be more harmful if the person could access constant strength pure drugs? Do heroin addicts die from the side effects of heroin or from the contaminants, dirty needles, criminal activity, and lifestyle? I don't know, but I have never seen figures on mortality of long term users of pure heroin, and liberalisers need to use this evidence to make a clear case.

If drugs are decriminalised, the number of users could possibly increase. The balance of harm to society here depends on two factors—the increase in harm to addicts and the reduction of crime associated with addiction. Because a large proportion of crime is drug related, harm should be reduced. In Switzerland, medicalisation of the problem seems to have reduced the number of new addicts.3 Why did neither side quote this experiment?

The debate could be improved by prohibitionists spelling out their assumptions and evidence about how much harm would be caused by increased use, and explaining why that would be worse than the current situation where prisons and crime are dominated by the side effects of prohibition. The liberalisers should explain what sort of liberalisation is proposed and what the balance of harms is; they should admit that some things could get worse with some policy options.

Prohibitionists seem so entrenched in their belief that drug addiction is an absolute evil that they are blind to the failure of prohibition to prevent addiction and will tolerate any amount of social disruption to retain the status quo.


Competing interests: None declared.


1. Chand K. Should drugs be decriminalised? Yes. BMJ 2007;335:966 (10 November.) [PMC free article] [PubMed]
2. Califano JA, Jr. Should drugs be decriminalised? No. BMJ 2007;335:967 (10 November.) [PMC free article] [PubMed]
3. Nordt C, Stohler R. Incidence of heroin use in Zurich, Switzerland: a treatment case register analysis. Lancet 2006;367:1830-4. [PubMed]

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