decriminalization of drugs canada essay

Decriminalizing drug use is a necessary step, but it won’t end the opioid overdose crisis

Assistant Professor in the School of Criminology, Simon Fraser University

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Alissa Greer receives funding from Simon Fraser University and the Social Sciences and Humanities Research Council. Dr. Greer is an assistant professor in the School of Criminology at Simon Fraser University, a research affiliate at the Canadian Institute for Substance Use Research, and a senior associate at Bunyaad Public Affairs.

Simon Fraser University provides funding as a member of The Conversation CA.

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Media, policy-makers, advocates and the public claim that decriminalization will make drug use safer and save lives . But can it?

Decriminalization has been somewhat of a policy buzzword in recent years, with ample media coverage . It comes with both public and government support.

A 2020 survey of more than 5,000 Canadians showed that the majority (59 per cent) favour the decriminalization of drugs . The Canadian Association of Chiefs of Police has also publicly supported decriminalization, along with British Columbia’s chief public health officer .

Such support has also come with action. This year, the City of Vancouver submitted an application to Health Canada for an exemption from Canada’s Controlled Drugs and Substances Act — a policy reform referred to as the Vancouver Model of decriminalization .

An alternative response

In the simplest terms, decriminalization is an alternative response to criminal penalties for simple possession. The most recent data shows there were over 48,000 drug-related offences in Canada in 2019, most of which were for possession for personal use.

The criminalization of drugs results in significant health, social and economic harms , particularly to those who are homeless, experiencing mental health issues, racialized or Indigenous. By eliminating a criminalized response to drug possession, drug policy reform efforts can minimize the contact between people who use drugs and the criminal justice system, and may increase their connection to health and social systems .

However, alongside recognition of the ineffectiveness of criminalization and support for an alternative model, we need to be realistic with our expectations of what decriminalization can do.

Decriminalization versus regulation

Decriminalization does not mean that people can buy cocaine and heroin at the store as they would alcohol and tobacco. Only legal regulation can do that. Legal regulation, which drug policy advocates endorse , includes rules to control who can access what drug and when, as opposed to a free market or full legalization.

An example of legalization is Canada’s Cannabis Act , which provides a legal framework to control the production, sale and possession of cannabis.

Unlike legal frameworks applied to the supply of drugs, decriminalization does not promote a “safer supply” of drugs. The overdose crisis is driven by an unpredictable, illegal drug supply that is marked with adulterants, contaminants and other substances . Decriminalization won’t directly impact this supply of drugs, they will continue to be made in unregulated ways and places.

The illegal drug market will continue to be criminalized, unpredictable and precarious, and people will continue to be unsure of what’s in their drugs (in lieu of better drug checking services or how potent they are. Under a decriminalized model, the overdose risk will inevitably remain high.

That said, decriminalization is still a necessary step in addressing the crisis.

The benefits of decriminalization

Decriminalization changes the way we think about drugs. Drug use will no longer be treated as a criminal issue, but instead a health and social one . This means that instead of addressing drugs through handcuffs, the focus will be on the root causes of drug use, including inequities rooted in housing and health care.

Decriminalization saves governments money. A large proportion of the justice system — police, courts, prisons — are occupied with drug-related crimes . As seen in other decriminalized jurisdictions such as Portugal , it can reduce the demands and costs to this system.

Considering the demonstrated need for addiction and mental health resources, the money saved could be well spent elsewhere, such as community-led responses, health care, housing and social programs.

Decriminalization positively impacts people’s lives. Especially for those targeted by drug law enforcement, namely poor, homeless and racialized people who use drugs, decriminalization can have a positive impact .

For example, eliminating criminal records related to drug possession offences promotes opportunities for people to access employment and housing. Interactions between people who use drugs and police can also be reduced or, better yet, won’t happen at all.

Decriminalization reduces stigma. Negative views towards drugs and people who use them is a major factor in the overdose crisis . By reshaping the way our family, friends and the medical profession think about drugs, drug use can be talked about more openly and honestly.

Reducing stigma can also encourage people who use drugs to talk to their doctors about prescription-based therapies. At the very least, it will help bring drug use out from isolation, where fatal overdoses tend to be the highest .

Decriminalization encourages people to call 911 at the scene of an overdose. Fear of police is currently a barrier to this. Although people cannot be charged with simple possession at the scene of a drug overdose under drug-related Good Samaritan laws , fear of the police is still a deterrent . Legislation that decriminalizes drug possession can reassure people that they will not face criminal penalties. And police will no longer need to respond to calls about overdoses.

Decriminalization is harm reduction. Although some people fear that decriminalization may increase or encourage drug use, this concern is simply not supported by evidence. We know from dozens of countries, states and cities that have decriminalized drugs that use does not significantly increase . In some places, it has actually decreased .

Decriminalization also lowers overdose and disease rates, while increasing people’s access to social services and health care. In this way, a decriminalization model is a basic harm reduction approach, mitigating the harms experienced by people who use drugs by eliminating or minimizing the source of those harms: criminalization.

A critical step

Overall, the notion of decriminalization is not a panacea or a standalone solution to the harms of drug prohibition — but it is a critical step in the right direction. It will have a positive impact on the lives of so many people who are harmed daily from criminalization.

However, in recognizing the limitations of decriminalization models , governments and other stakeholders can refocus efforts on what does directly impact the overdose crisis: a safer supply. Decriminalization must be paired with greater access to safer pharmaceutical alternatives to the toxic and illegal drug market.

That’s what will save lives.

Caitlin Shane, staff lawyer at Pivot Legal Society, co-authored this article.

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Drug decriminalization: The importance of policy change for the health and wellbeing of children and youth in Canada

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Alyson Holland, Selene Etches, Sarah Gander, Drug decriminalization: The importance of policy change for the health and wellbeing of children and youth in Canada, Paediatrics & Child Health , Volume 29, Issue 2, May 2024, Pages 87–89, https://doi.org/10.1093/pch/pxad006

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The criminalization of drug use and possession has demonstrable harms on the health of children and youth, with disproportionate effects on Black people, Indigenous people, people from other racially oppressed communities, and people living in poverty. Drug decriminalization, by separating personal possession and use of drugs from the criminal justice system, allows for a health-based approach to drug policy. Paediatricians are well-positioned to advocate for policies within a decriminalization framework to prioritize the physical and mental health of children and youth.

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LawNow Magazine

relating law to life

Decriminalization of Drugs in Canada: What does it mean and how would it work?

August 9, 2022 By Lee Klippenstein

Drug policy is changing in Canada, with Bill C-5 and requests for exemptions under section 56(1) of the Controlled Drugs and Substances Act .

There is a growing acknowledgement in Canada that drug use is a health issue and not a criminal justice problem. This is an important distinction given the way the opioid crisis is ravaging the Canadian population. John Cooper recently wrote an excellent piece for LawNow , which discusses the changing attitude towards drug use and decriminalization. Hopefully, he has convinced you why governments should pursue decriminalization.

I intend to use this space to explore the what and how of decriminalization in Canada. In the process, I hope the who , when , and where will also become clear.

What Does Decriminalization Mean?

When a drug is decriminalized, it means its possession is no longer a criminal act. It does not mean it is legal and anyone can buy it like a pack of cigarettes from a gas station or a bottle of vodka from a liquor store. It also does not mean the government is promoting or condoning its use. More importantly, decriminalization assists those who use drugs, not those who traffic them.

Decriminalization means that users of certain controlled substances will no longer face the criminal penalties they would have before the drug was reclassified. The goal is to reduce the burden on addicts and recreational users, while freeing up scarce justice system resources.

Practically speaking, decriminalization is an exemption from federal laws (those put in place by the Canadian government). The Criminal Code ( CC ) and the Controlled Drugs and Substances Act ( CDSA ) govern drug policy in Canada. Created by the federal government, they apply across Canada but are enforced at the provincial and municipal levels, primarily through policing. Offences under the CC and CDSA are also prosecuted through the provincially-run court systems.

Bill C-5: Proposed Federal Action

Canada is attempting to make modest moves towards reducing the criminal consequences of minor drug possession. In December 2021, the federal government introduced Bill C-5 in the legislature. If passed, Bill C-5 will amend both the CC and the CDSA in significant ways. The bill has passed through the House and is now before the Senate.

None of the changes in Bill C-5 will decriminalize any drug in the manner discussed above. Instead, the changes focus on removing certain mandatory minimum sentences for simple drug possession crimes. The changes also encourage conditional sentences and diversionary measures to address substance abuse in more appropriate ways.

Perhaps the most notable part of Bill C-5 in the context of decriminalization is the “declaration of principles” section ( 10.1 ), which will be added to the CDSA . This section states, in summary, that:

• substance abuse should be addressed primarily as a health and social issue
• interventions should aim to protect the health, dignity, and human rights of drug users
• criminal sanctions for the personal use of drugs increase the stigma of drug use and are not consistent with established public health evidence
• interventions should focus on the root causes of substances abuse, and measures should be directed towards these areas
• judicial resources should focus on offences that pose a greater risk to public safety

This federal bill does not go as far as some provinces and municipalities have requested. The proposed legislation, however, would alleviate some of the potential criminal justice issues that burden those who use these otherwise controlled substances.

How Does Decriminalization Happen?

The levels of government dealing with the immediate impacts of the opioid crisis – people dying daily – want a drug policy that goes further to address the stigma and health issues associated with drug use. Edmonton, Vancouver, and Toronto have all made requests to the federal government to decriminalize small amounts of substances such as cocaine, heroin, and fentanyl. British Columbia also made a request in November of 2021, and it is the first jurisdiction to receive an exemption.

Section 56(1) Exemptions: Municipal and Provincial Actions 

For a city or province to change drug policy in its jurisdiction, it requires an exemption from federal laws under section 56(1) of the CDSA . The Minister of Health and Health Canada grants these exemptions to an individual or a group. They decide on a case-by-case basis. Exemptions have been provided for things like research on the effects of ketamine in treating depression, or as class exemptions to allow pharmacists to provide otherwise controlled substances to their patients. (This was how Methadone was prescribed for a long time, however an exemption is no longer required.)

To receive a section 56(1) exemption, Health Canada considers several factors, including:

• potential benefits
• potential risks or harms
• evidence the substance is necessary for the activity
• safeguards for the use and storage of the substance

B.C. successfully attained an exemption by providing evidence of the severity of the opioid crisis, as well as the province’s capacity to deal with decriminalization. Health Canada accepted B.C.’s plan, which included that:

• adequate social supports would be available to drug users
• law enforcement was properly trained to educate those possessing controlled substances on how to access these resources, and
• B.C. has a comprehensive monitoring system that will allow it to provide ongoing feedback about the impacts of decriminalization in real time.

What Does Decriminalization Look Like on the Ground?

In B.C., adults over the age of 18 will no longer face criminal penalties if police find them with less than 2.5 grams of any opioid, cocaine, methamphetamine, or MDMA (or any combined quantity of these four drugs). These four drugs are the ones deemed most likely to be associated with the ongoing opioid crisis.

The exemption will not apply if there is evidence the adult is using the drugs for more than personal use. It must be stressed that decriminalization in this form does nothing to shield drug traffickers. Law enforcement agents will make these determinations. They will also be trained to provide individual users with information regarding social services and health initiatives to address the underlying issues that cause substance abuse.

No one is suggesting that we turn a blind eye towards the use of controlled substances. Instead, the focus is on acknowledging that drug users are people with health issues that have already upended their lives. Rather than defaulting to prison and punishment, decriminalization initiatives allow drug users to operate with one less fear hovering over their head – that they are going to get “busted” – while also promoting ways for them to recover from their health issues.

It is unclear whether the B.C. model will apply, in its specifics at least, to any of the other jurisdictions that have requested a section 56(1) exemption. It is not even clear whether Edmonton or Toronto will receive this exemption – Health Canada must decide if these locales have met the requirements. The B.C. model does show the potential that decriminalization may hold. And if nothing else, the individuals dependent on these substances in that province will have one less concern.

More to Come

Both Bill C-5 and the requested section 56(1) exemptions suggest Canada may be on its way to a more progressive drug policy, which understands the drug user’s struggle as its starting point. There is likely much more to come on this topic in the coming months and years.

Looking for more information?

• Canada is not yet Ready to Expand its Medical Assistance in Dying Legislation by Myrna El Fakhry Tuttle March 18, 2024
• Accessing the Justice System: Specialized support is critical for sexual violence survivors by Lisa Oracheski February 28, 2024
• There is No Such Thing as a Hate Crime Offence in Canada by Melody Izadi February 21, 2024

The information in this article was correct at time of publishing. The law may have changed since then. The views expressed in this article are those of the author and do not necessarily reflect the views of LawNow or the Centre for Public Legal Education Alberta.

Looking for articles like this one to be delivered right to your inbox?

Lee is a law student at the Faculty of Law, University of Alberta and a volunteer with Pro Bono Students Canada.

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1 (866) 324-7093, call us now, understanding decriminalization and the steps to ending the opioid crisis.

Aug 3, 2021

Opinion: Decriminalization is a critical step in curbing the opioid crisis

A recent opinion article published in The Conversation examines the benefits of drug decriminalization, as well as its potential impact in fighting the ongoing opioid crisis. The article, co-authored by Alissa Greer, Assistant Professor in the School of Criminology, Simon Fraser University and Caitlin Shane, staff lawyer at Pivot Legal Society, also critically examines drug decriminalization compared to regulation, as well as its effects on drug-related harms.

According to a survey conducted in 2020, 59% of respondents favour the decriminalization of drugs. The Canadian Association of Chiefs of Police has also recently publicly supported decriminalization, in addition to British Columbia’s chief public health officer.

Earlier in 2021, the City of Vancouver submitted an application to Health Canada for an exemption from Canada’s Controlled Drugs and Substances Act — a policy reform referred to as the Vancouver Model of decriminalization.

What is drug decriminalization?

Drug decriminalization refers to the implementation of an alternative response to criminal penalties for simple possession. It has been shown that criminalization of drugs has resulted in significant health, social and economic harms to vulnerable populations, including individuals who are homeless, have mental health issues, and Indigenous individuals.

In addition, drug decriminalization aims to “minimize the contact between people who use drugs and the criminal justice system and may increase their connection to health and social systems,” according to the authors of the opinion article.

Decriminalization vs. regulation

Legal regulation of drugs involves rules to control access to drugs, in contrast to a free market or full legalization.

Since decriminalization does not promote a “safer supply” of drugs, it will not affect the illegal supply of drugs containing toxic adulterants. Finally, the illegal drug market will continue to be criminalized following the implementation of decriminalization. According to the authors of the opinion article, the overdose risk will, nevertheless, remain high.

Advantages of drug decriminalization

One of the main benefits of drug decriminalization is that it will help to address drug use as a health and social issue in contrast to a criminal one; this would reduce the workload for the legal system, as well as the costs involved. Drug decriminalization also creates a positive impact in people’s lives, promoting their opportunities to access employment and housing. Furthermore, it reduces the stigma associated with drug use, and can serve as an effective harm reduction measure. Finally, implementation of drug decriminalization can encourage people to contact emergency services following an overdose, since fear of police can act as a deterrent in some situations.

Ontario’s mayors have called for decriminalization

Ontario’s Big City Mayors (OBCM) have been calling for the decriminalization of illicit drugs, in addition to continued funding and development of mental health crisis response units.

“While the provincial government is responsible for funding and coordinating mental health and addictions supports, all levels of government have a role to play in improving services for our residents,” OBCM said.

“The war on drugs isn’t working,” said Barrie Mayor Jeff Lehman. “We need to start understanding that this is a public health crisis for people who are addicted and to take a health approach to the people who are using drugs rather than policing.”

Decriminalization as a critical step, but not a solution to opioid crisis

According to the authors of the opinion article, decriminalization is not “a standalone solution to the harms of drug prohibition.” However, it can serve as a critical step in the right direction, since it will exert a positive impact on the lives of numerous people who are harmed daily from criminalization.

The authors maintain that it is important to be aware of the limitations of decriminalization models, so that governments and other stakeholders can refocus efforts on creating a safer drug supply. The authors also emphasize the fact that decriminalization must be coupled with greater access to safer pharmaceutical alternatives to the toxic and illegal drug market.

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Why Decriminalize Drugs?

On Thursday, May 24 th the Canadian Drug Policy Coalition released a report on Canadian drug policy. The report calls for the replacement of Canada’s National Anti-Drug Strategy with one focused on health and human rights, the scale-up of comprehensive health and social services, including housing and treatment services that engage people with drug problems; more robust educational programs about safer drug use, the decriminalization of all drugs for personal use and the creation of a regulatory system for adult cannabis use.

The Canadian media responded quickly to our recommendation to decriminalize personal possession of drugs with questions about how this approach would work, especially when it comes to drugs like heroin and cocaine. Canada’s Conservative government also reacted swiftly to media coverage of our report and publicly dismissed our proposal to decriminalize the personal use of all other drugs.

Let’s be very clear about what the Canadian Drug Policy Coalition is recommending: the full legal regulation of cannabis for adult use and the decriminalization of possession of small quantities of all other drugs for personal use. We do not at this time recommend full legal regulation of drugs other than cannabis; nor do we suggest that all currently illegal drugs should become widely available. Decriminalization of possession of these drugs will not address the harms associated with an underground market. But it is a first step towards a more effective policy. Decriminalization, a strategy currently in use by up to 30 countries world-wide, has been quietly adopted in the wake of the escalating costs of prohibition and its failure to stem the tide of drug use and eliminate drug markets.

Politicians still insist that decriminalizing drug use would send the “wrong message”. This idea is grounded in the false belief that criminalizing drugs keeps people from using them and lessening penalties for drug use will in fact result in higher rates of drug use.  But in countries and regions where decriminalization has been implemented, this has just not been the case. As the Global Commission on Drug Policy suggested in 2011,

“A key idea behind the ‘war on drugs’ approach was that the threat of arrest and harsh punishment would deter people from using drugs. In practice, this hypothesis has been disproved – many countries that have enacted harsh laws and implemented widespread arrest and imprisonment of drug users and low-level dealers have higher levels of drug use and related problems than countries with more tolerant approaches. Similarly, countries that have introduced decriminalization, or other forms of reduction in arrest or punishment, have not seen the rises in drug use or dependence rates that had been feared.”

International comparisons also show us that there is no correlation between the harshness of enforcement and the prevalence of drug use. Even in states that have decriminalized all drugs, the sky has not fallen. In 2000, Portugal moved to decriminalize all drugs, including cocaine and heroin, at the same time as it scaled up the availability of services to address drug use problems. By moving personal possession away from law enforcement, drug use did not rise significantly, especially when compared with neighbouring countries. Portugal has also seen a reduction in illegal drug use among problematic drug users and teens, a reduced burden on the criminal justice system, and a significant drop in HIV infections and drug-related deaths.

Prohibition has failed. Drug use is still high, incarceration for drug offenses is increasing and despite billions of dollars spent over the years, law enforcement has failed to meet its objectives of protecting public health and public safety.

One of the drugs that causes the most health and public safety harms – alcohol — is completely legal and widely available yet other drugs with a relatively small public health footprint remain completely illegal. Using the criminal law to discourage a behaviour like drug use only throws the law into disrepute because a complex phenomena like harmful drug use is the result of many factors, none of which the law, police, courts or prisons are prepared to address.

In preparing our report, we talked to people across the country – service providers, family members, people who use drugs — and they told us again and again that Canada’s outdated approach to drug policy is hurting our citizens. In fact, using law enforcement to curb drug use increases its harms by driving it into the shadows. The criminalization of drug use also makes it more difficult to engage people in vital and life-saving health care services.

We need to overhaul our approach to drugs. Globally, the current system of drug control is under considerable pressure to change. Some national governments have begun to chart their own paths when it comes to drug control, including experimenting with decriminalization. It’s time to follow suit, and modernise Canada’s legislative, policy and regulatory frameworks that address drugs.

The Canadian Drug Policy Coalition is based out of Simon Fraser University’s Faculty of Health Sciences.

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Original research

Impact evaluations of drug decriminalisation and legal regulation on drug use, health and social harms: a systematic review, ayden i scheim.

1 Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA

2 Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, Ontario, Canada

Nazlee Maghsoudi

3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Zack Marshall

4 Social Work, McGill University, Montreal, Quebec, Canada

Siobhan Churchill

5 Epidemiology and Biostatistics, Western University, London, Ontario, Canada

Carolyn Ziegler

6 Library Services, Unity Health Toronto, Toronto, Ontario, Canada

7 Medicine, University of California San Diego, La Jolla, California, USA

Associated Data

bmjopen-2019-035148supp001.pdf

bmjopen-2019-035148supp002.pdf

bmjopen-2019-035148supp003.pdf

To review the metrics and findings of studies evaluating effects of drug decriminalisation or legal regulation on drug availability, use or related health and social harms globally.

Systematic review with narrative synthesis.

Data sources

We searched MEDLINE, Embase, PsycINFO, Web of Science and six additional databases for publications from 1 January 1970 through 4 October 2018.

Inclusion criteria

Peer-reviewed articles or published abstracts in any language with quantitative data on drug availability, use or related health and social harms collected before and after implementation of de jure drug decriminalisation or legal regulation.

Data extraction and synthesis

Two independent reviewers screened titles, abstracts and articles for inclusion. Extraction and quality appraisal (modified Downs and Black checklist) were performed by one reviewer and checked by a second, with discrepancies resolved by a third. We coded study-level outcome measures into metric groupings and categorised the estimated direction of association between the legal change and outcomes of interest.

We screened 4860 titles and 221 full-texts and included 114 articles. Most (n=104, 91.2%) were from the USA, evaluated cannabis reform (n=109, 95.6%) and focussed on legal regulation (n=96, 84.2%). 224 study outcome measures were categorised into 32 metrics, most commonly prevalence (39.5% of studies), frequency (14.0%) or perceived harmfulness (10.5%) of use of the decriminalised or regulated drug; or use of tobacco, alcohol or other drugs (12.3%). Across all substance use metrics, legal reform was most often not associated with changes in use.

Conclusions

Studies evaluating drug decriminalisation and legal regulation are concentrated in the USA and on cannabis legalisation. Despite the range of outcomes potentially impacted by drug law reform, extant research is narrowly focussed, with a particular emphasis on the prevalence of use. Metrics in drug law reform evaluations require improved alignment with relevant health and social outcomes.

Strengths and limitations of this study

• This is the first study to review all literature on the health and social impacts of decriminalisation or legal regulation of drugs.
• We systematically searched 10 databases over a 38-year period, without language restrictions.
• The review was limited to study designs appropriate for evaluating interventions, nevertheless, most included studies used relatively weak evaluation designs.
• Included outcomes were heterogeneous and not quantitatively synthesised.
• Heterogeneity in the details and implementation of decriminalisation or legal regulation policies was not considered in this review.

Introduction

An estimated 271 million people used an internationally scheduled (‘illicit’) drug in 2017, corresponding to 5.5% of the global population aged 15 to 64. 1 Despite decades of investment, policies aimed at reducing supply and demand have demonstrated limited effectiveness. 2 3 Moreover, prohibitive and punitive drug policies have had counterproductive effects by contributing to HIV and hepatitis C transmission, 4 5 fatal overdose, 6 mass incarceration and other human rights violations 7 8 and drug market violence. 9 As a result, there have been growing calls for drug law reform 10–12 and in 2019, the United Nations Chief Executives Board endorsed decriminalisation of drug use and possession. 13 Against this backdrop, as of 2017 approximately 23 countries had implemented de jure decriminalisation or legal regulation of one or more previously illegal drugs. 14–16

A wide range of health and social outcomes are affected by psychoactive drug production, sales and use, and thus are potentially impacted by drug law reform. Nutt and colleagues have categorised these as physical harms (eg, drug-related morbidity and mortality to users, injury to non-users), psychological harms (eg, dependence) and social harms (eg, loss of tangibles, environmental damage). 17 18 Concomitantly, a diverse and sometimes competing set of goals motivate drug policy development, including ameliorating the poor health and social marginalisation experienced by people who use drugs problematically, shifting patterns of use to less harmful products or modes of administration, curtailing illegal markets and drug-related crime and reducing the economic burden of drug-related harms. 19

Given ongoing interest by states in drug law reform, as well as the recent position statement by the United Nations Chief Executives Board endorsing drug decriminalisation, 13 a comprehensive understanding of their impacts to date is required. However, the scientific literature has not been well-characterised, and thus the state of the evidence related to these heterogeneous policy targets remains largely unclear. Systematic reviews, including two meta-analyses, are narrowly focussed on adolescent cannabis use. Dirisu et al found no conclusive evidence that cannabis legalisation for medical or recreational purposes increases cannabis use by young people. 20 In the two meta-analyses, Sarvet et al found that the implementation of medical cannabis policies in the USA did not lead to increases in the prevalence of past-month cannabis use among adolescents 21 and Melchior et al found a small increase in use following recreational legalisation that was reported only among lower-quality studies. 22

Given increasing interest in quantifying the impact of drug law reform, as well as a lack of systematic assessment of outcomes beyond adolescent cannabis use to date, we conducted a systematic review of original peer-reviewed research evaluating the impacts of (a) legal regulation and (b) drug decriminalisation on drug availability, use or related health and social harms. Our primary aim is to characterise studies with respect to metrics and indicators used. The secondary aim is to summarise the findings and methodological quality of studies to date.

Consistent with our aim of synthesising evidence on the impacts of decriminalisation and legal regulation across the spectrum of potential health and social effects, we conducted a systematic review using narrative synthesis 23 without meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in preparing this manuscript. 24 The review protocol was registered in PROSPERO (CRD42017079681) and can be found online at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79681 .

Search strategy and selection criteria

The review team developed, piloted and refined the search strategy in consultation with a research librarian and content experts. We searched MEDLINE, Embase, PsycINFO, Web of Science, Criminal Justice Abstracts, Applied Social Sciences Index & Abstracts, International Bibliography of the Social Sciences, PAIS Index, Policy File Index and Sociological Abstracts for publications from 1 January 1970 through 4 October 2018. We used MeSH (Medical Subject Headings) terms and keywords related to (a) scheduled psychoactive drugs, (b) legal regulation or decriminalisation policies and (c) quantitative study designs. Search terms specific to health and social outcomes were not employed so that the search would capture the broad range of outcomes of interest. See online supplemental appendix A for the final MEDLINE search strategy. For conference abstracts, we contacted authors for additional information on study methods and to identify subsequent relevant publications.

Supplementary data

We included peer-reviewed journal articles or conference abstracts reporting on original quantitative studies that collected data both before and after the implementation of drug decriminalisation or legal regulation. We did not consider as original research studies that reproduced secondary data without conducting original statistical analyses of the data. We defined decriminalisation as the removal of criminal penalties for drug use and/or possession (allowing for civil or administrative sanctions) and legal regulation as the development of a legal regulatory framework for the use, production and sale of formerly illegal psychoactive drugs. Studies were excluded if they evaluated de facto (eg, changes in enforcement practices) rather than de jure decriminalisation or legal regulation (changes to the law). This exclusion applied to studies analysing changes in outcomes following the US Justice Department 2009 memo deprioritising prosecution of cannabis-related offences legal under state medical cannabis laws. Eligible studies included outcome measures pertaining to drug availability, use or related health and social harms. We used the schema developed by Nutt and colleagues to conceptualise health and social harms, including those to users (physical, psychological and social) and to others (injury or social harm). 18

Both observational studies and randomised controlled trials were eligible in principle, but no trials were identified. There were no geographical or language restrictions; titles, abstracts and full-texts were translated on an as-needed basis for screening and data extraction. We excluded cross-sectional studies (unless they were repeated) and studies lacking pre-implementation and post-implementation data collection because such designs are inappropriate for evaluating intervention effects.

Data analysis

Screening and data extraction were conducted in DistillerSR (Evidence Partners, Ottawa, Ontario). We began with title-only screening to identify potentially relevant titles. Two reviewers screened each title. Unless both reviewers independently decided a title should be excluded, it was advanced to the next stage. Next, two reviewers independently screened each potentially eligible abstract. Inter-rater reliability was good (weighted Kappa at the question level=0.75). At this stage, we retrieved full-text copies of all remaining references, which were screened independently by two reviewers. Disagreements on inclusion were resolved through discussion with the first author. Finally, one reviewer extracted data from each included publication using a standardised, pre-piloted form and performed quality appraisal. A second reviewer double-checked data extraction and quality appraisal for every publication, and the first author resolved any discrepancies.

The data extraction form included information on study characteristics (author, title, year, geographical location), type of legal change studied and drug(s) impacted, details and timing of the legal change (eg, medical vs recreational cannabis regulation), study design, sampling approach, sample characteristics (size, age range, proportion female) and quantitative estimates of association. We coded each study-level outcome measure into one metric grouping, using 24 pre-specified categories and a free-text field (see figure 1 for full list). Examples of metrics include: prevalence of use of the decriminalised or regulated drug, overdose or poisoning and non-drug crime.

Metrics examined by included studies. excl., excluding.

We also categorised the estimated direction of association of the legal change on outcome measure(s) of interest (beneficial, harmful, mixed or null). These associations were coded at the outcome (not study) level and classified as beneficial if a statistically significant increase in a positive outcome (eg, educational attainment) or decrease in a negative outcome (eg, substance use disorder) was attributed to implementation of decriminalisation or legal regulation, and vice versa for harmful associations. The association was categorised as mixed if associations were both harmful and beneficial across participant subgroups, exposure definitions (eg, loosely vs tightly regulated medical cannabis access) or timeframes. Although any use of cannabis and other psychoactive drugs need not be problematic at the individual level, we categorised drug use as a negative outcome given that population-level increases in use may correspond to increases in negative consequences; we thought that this cautious approach to categorisation was appropriate given that such increases are generally conceptualised as negative within the scientific literature. For outcomes that are not unambiguously negative or positive, the coding approach was predetermined taking a societal perspective. For example, increased healthcare utilisation (eg, hospital visits due to cannabis use) was coded as negative because of the increased burden placed on healthcare systems. The association was categorised as null if no statistically significant changes following implementation of drug decriminalisation or legal regulation were detected. We set statistical significance at a= 0.05, including in cases where authors used more liberal criteria.

Quality assessment at the study level was conducted for each full-length article using a modified version of the Downs and Black checklist 25 for observational studies ( online supplemental appendix B ), which assesses internal validity (bias), external validity and reporting. Each study could receive up to 18 points, with higher scores indicating more methodologically rigorous studies. Conference abstracts were not subjected to quality assessment due to limited methodological details.

Patient and public involvement

This systematic review of existing studies did not include patient or public involvement.

Study characteristics

As shown in the PRISMA flow diagram ( figure 2 ), we screened 4860 titles and abstracts and 213 full-texts, with 114 articles meeting inclusion criteria ( online supplemental appendix C ). Key reasons for exclusion at the full-text screening stage were that the article did not report on original quantitative research (n=59) or did not evaluate decriminalisation or legal regulation as defined herein (n=23). Details of each included study are presented in online supplemental table 1 . Included studies had final publication dates from 1976 to 2019; 44.7% (n=51) were first published in 2017 to 2018, 43.9% (n=50) were published in 2014 to 2016 and 11.4% (n=13) were published before 2014.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

Characteristics of included studies are described in table 1 , both overall and stratified by whether they evaluated decriminalisation (n=19) or legalisation (n=96) policies (one study evaluated both policies). Most studies (n=104, 91.2%) were from the USA and examined impacts of liberalising cannabis laws (n=109, 95.6%). Countries represented in non-US studies included Australia, Belgium, China, Czech Republic, Mexico and Portugal. The most common study designs were repeated cross-sectional (n=74, 64.9%) or controlled before-and-after (n=26, 22.8%) studies and the majority of studies (n=87, 76.3%) used population-based sampling methods. Figure 3 illustrates the geographical distribution of studies among countries where national or subnational governments had decriminalised or legally regulated one or more drugs by 2017.

Characteristics of studies evaluating drug decriminalisation or legal regulation, 1970 to 2018

*Combined total exceeds number of studies because some evaluated both decriminalisation and legal regulation.

†One global study and one multi-country European study including Belgium and Portugal.

Number of included studies from countries that implemented decriminalisation or legal regulation by 2017. Note: Policy changes were classified, following the review inclusion criteria, based on the implementation of a change to national or subnational law to decriminalise drug use and/or possession or to legalise at least one class of drugs. We did not evaluate the extent to which legal changes were reflected in policing and criminal justice practice. Implementation of cannabis legalisation for medical purposes only is not reflected in this map.

Study quality

Quality assessment was performed for the 93 full-length articles included in the review, excluding 21 conference abstracts ( online supplemental table 1 ). Scores ranged from 7 to 18 of 18 possible points, with a mean of 14.4 (SD=2.56). Quality scores were similar comparing US to non-US-based studies ( X =14.4 and 13.7, respectively, p=0.386) but higher for studies evaluating legal regulation ( X =14.8) versus decriminalisation ( X =12.8) (p=0.003). Study quality differed significantly (p<0.001) by the direction of the association with the outcome of interest, with higher quality scores among studies estimating mixed ( X =15.4) or beneficial ( X =15.2) versus null ( X =14.2) or harmful ( X =13.1) effects of legal change on the outcome of interest. Study quality did not appear to increase over time (eg, X =14.0 in 2014 and 14.4 in 2018).

Study outcome measures and metrics

Across 114 studies we extracted 224 outcome measures, which were coded into 32 metrics ( figure 1 ). The most common metric employed by studies was the prevalence of use of the decriminalised or legally regulated drug, which was examined in 39.5% of studies (n=45) and represented 22.3% of outcome measures (n=50). Of these studies, 13 (28.9%; 8 full-length articles and 5 abstracts) did not report any other metric 26–38 and an additional 6 studies (13.3%) reported on the prevalence of use in addition to a single drug-related perception metric (either harmfulness or availability). 39–44 The second most common metric was the frequency of use of the decriminalised or legally regulated drug (14.0% of studies, n=16) and the third was the prevalence or frequency of use of tobacco, alcohol or drugs that remained illegal (12.3% of studies, n=14). The fourth most commonly employed metric was any change in the perceived health harmfulness of using the decriminalised or regulated drug (10.5% of studies, n=12), which was assessed among adolescents or young adults in all studies except for one that assessed this metric among parents. 45

All other metrics were assessed in <10% of included studies. Health service utilisation was evaluated in 7.9% of studies (n=9) using 12 outcome measures, primarily related to emergency department visits and/or hospitalisations. Prescribed (primarily opioid) drug use and perceived availability of the decriminalised or legally regulated drug were reported in 7.0% of studies each (n=8). Overdose or poisoning by the decriminalised or regulated drug, and by other drugs (predominantly opioids), were examined in 5.3% (n=6) and 6.1% of studies (n=7), respectively. Driving while under the influence or with detectable concentrations of the decriminalised or regulated drug (cannabis) was examined in seven studies (6.1%) inclusive of eight outcome measures. Notably, one study assessed self-reported impaired driving, 46 while others assessed the proportion of fatally injured drivers screening cannabis-positive or the overall prevalence of driving with detectable tetrahydrocannabinol (THC) concentrations in blood. Remaining metrics were measured in less than 5% of studies ( figure 1 ). Some pre-specified metrics were not represented in any of the articles, including infectious disease incidence (eg, HIV, hepatitis C), environmental impacts (eg, drug production waste, discarded needles) and labour market participation.

Studies outside the US

Of the 10 studies conducted outside the USA, 6 focussed on cannabis decriminalisation. All three studies from Australia examined the prevalence of cannabis use post-decriminalisation, 31 34 47 while one also measured perceived cannabis availability. 47 Following cannabis decriminalisation, one European multi-country study including Belgium and Portugal examined the prevalence of cannabis use and uptake of cannabis-related addictions treatment 48 and one Czech study considered the age of first cannabis use. 49 An international study using United Nations Office on Drugs and Crime data from 102 countries compared availability, as reflected by cannabis seizures and plant eradication, in countries that had decriminalised cannabis versus those that had not. 50 Three non-US studies evaluated decriminalisation of all psychoactive drugs. Two studies from Portugal examined healthcare and non-healthcare costs and psychoactive drug prices, respectively. 51 52 One study from Mexico examined drug-related criminal justice involvement (arrests) and (violent) crimes. 53 Finally, a study of historic opium legalisation in China (1801 to 1902) measured the price and availability (quantity of exports) of opium before and after legalisation. 54

Impacts of decriminalisation and legal regulation

Results of individual studies are provided in online supplemental table 1 . Online supplemental table 2 tallies findings and average quality scores for each of the metrics; here we summarise findings for metrics examined in more than 5% of studies, in descending order based on the number of datapoints. Across all three substance use metrics (prevalence of use, frequency of use and use of other alcohol or drugs), drug law reform was most often not associated with use (with null findings for 48.0% to 52.4% of outcome measures falling under these metrics). With respect to change in perceived harmfulness of the decriminalised or regulated drug, mixed results were found in half of cases, with heterogeneity detected on the basis of age, gender and state. 39 43 55–57 For example, legal regulation of cannabis for medical use was associated with greater perceived harmfulness of cannabis among eighth graders but not older students in an analysis of US Monitoring the Future data 39 while a study employing US National Survey on Drug Use and Health data found greater perceived harmfulness of cannabis among young adults aged 18 to 25 but not adolescents aged 12 to 17. 57

Among nine studies that employed health service utilisation metrics, harmful effects were reported for 6 of 12 outcome measures, with increases in emergency department visits and/or hospitalisations attributed to decriminalisation or legal regulation. 58–63 However, all but one of those studies 58 assessed change over time in one jurisdiction, without a control group. Further, two studies that also examined changes in acute care use for non-cannabis drugs found reductions in those visits or admissions following cannabis decriminalisation or legal regulation. 60 64 In contrast, six of nine prescription drug use associations were beneficial, with reductions observed in rates of opioid 65–69 and other drug prescribing 70 71 attributed to legal regulation of cannabis for medical use; outcomes in this category came from studies of higher average quality ( X =16.3). Perceived availability of the decriminalised or regulated drug appeared largely unaffected by decriminalisation (null associations for five of nine outcome measures) but two studies indicated increased perceived availability of cannabis among Colorado, US, adolescents following legal regulation for adult use 72 and among adults in US states with legal regulation for medical use. 44 Across the subset of seven outcome measures for overdose or poisoning by the decriminalised or regulated drug (cannabis), in all cases an increase in calls to poison control centres or unintentional paediatric exposures was reported. 59 73–77 However, studies assessing the impacts of cannabis regulation on overdose or poisoning by drugs other than cannabis concluded that the effects were either beneficial (four outcome measures 64 76 78 79 ) or mixed/null (three outcome measures 80–82 ). Driving with detectable concentrations of THC was most often found to increase following decriminalisation or legal regulation (five of eight outcome measures; 83–87 ), but these studies were of lower average quality ( X =12.0).

Impacts of decriminalisation

Of the 19 studies evaluating impacts of decriminalisation, six measured the prevalence of use of the decriminalised drug with eight unique outcome measures. No association was detected for all but three outcomes; following cannabis decriminalisation lifetime use increased among adults in South Australia, 31 while past-month use increased among 12 th graders but not younger students in California, 56 relative to the rest of the country in both cases. After peyote use for ceremonial purposes was decriminalised in the USA in 1994, self-reported use increased among American Indians. 88 Three studies evaluated relationships between decriminalisation and drug-related criminal justice involvement in Mexico and the USA. One high-quality study found that decriminalisation positively influenced criminal justice involvement: in five US states, arrests for cannabis possession decreased among youth and adults. 89 When possession of small amounts of cannabis was decriminalised in the 1970s in Nebraska, however, the mean monthly number of arrests did not change, while cannabis-related prosecutions increased among youth. 90 In Tijuana, Mexico, decriminalisation of all drugs had no apparent impact on the number of drug possession arrests. 53 Two historical and one recent study measured healthcare utilisation. US states that decriminalised cannabis in the 1970s saw greater emergency department visits related to cannabis, but decreased visits related to other drugs. 60 In Colorado, US, decriminalisation was associated with increased emergency department visits for cyclic vomiting. 62 Addiction treatment utilisation, healthcare and non-healthcare costs, driving after use, price of drugs, availability of drugs, frequency of use, attitudes towards use and perceived harmfulness were each evaluated in only one or two studies of decriminalisation.

This systematic review identified 114 peer-reviewed publications and conference abstracts evaluating the impacts of drug decriminalisation or legal regulation from 1970 to 2018. Within this search period, 88.6% were published in 2014 or later. This rapid growth in scholarship was driven by the implementation and subsequent evaluation of cannabis legalisation in a number of US states beginning in 2012, and knowledge production will surely continue to accelerate as longer-term data become available and as other jurisdictions (eg, Canada and Uruguay) analyse the effects of recently implemented cannabis legalisation. Indeed, a first study on the impacts of cannabis legalisation on adolescent use in Uruguay was published in May 2020 (finding no impact on risk of use 91 ). The present study provides an overview of the emerging literature based on our systematic review and suggests three key patterns.

First, peer-reviewed longitudinal evaluations of drug decriminalisation and legal regulation are overwhelmingly geographically concentrated in the US and focussed on cannabis legalisation. Importantly, the lack of non-US studies evaluating legal regulation of cannabis for medical use may reflect the more tightly controlled nature of medical cannabis regulation in other countries, and thus the more limited potential for population-level effects. It is notable that decriminalisation in the absence of legal regulation was evaluated in only 18 studies (15.8%), despite being far more common globally than legal regulation. These gaps may hamper evidence-based drug law reform in countries that are less well-developed, that play a substantial role in drug production and transit or that have different baseline levels of substance (mis)use as compared with the US.

Second, prevalence of use was the predominant metric used to assess the impact of drug law reform, despite its limited clinical significance (eg, much cannabis use is non-problematic) and limited responsiveness to drug policy. This is because ecological analyses have indicated little relationship between drug policies and prevalence of use, 52 as have studies assessing within-state change in use related to legal regulation. 21 These findings are supported by the preponderance of evidence synthesised in this review, although some variation is evident in relation to the specific provisions of legal reforms (eg, liberal vs tightly regulated medical markets 92 ). Impacts of legal cannabis regulation on prevalence and frequency of use continue to be evaluated, with recent data suggesting small increases among adults, but not youth. 93 Drug policies may be more able to influence the types of drugs that people use, drug-related risk behaviours and modes of drug consumption. 94 Metrics to assess these outcomes, however, were lacking in the reviewed literature. For example, only one study (0.8%) investigated whether legal regulation of cannabis was associated with changes in the mode of cannabis consumption. 72 Although the prevalence of use was often measured alongside more clinically or socially significant metrics (eg, prevalence of substance use disorders, educational outcomes among young adults), 42.2% of studies assessing substance use prevalence included that metric alone or in combination with a single drug-related attitude metric.

Third, there was a lack of alignment between the stated policy objectives of drug law reform and the metrics used to assess its impact in the scientific literature. For instance, removal of criminal sanctions to prevent their negative sequelae is a key rationale for decriminalisation and legal regulation, 12 13 95 but only four studies (3.5%) evaluated changes in drug-related criminal justice involvement following drug law reform. Similarly. improving the physical and mental health of people who (already) use drugs is a motivation for drug policy reform but no included studies examined mental or physical health outcomes (aside from substance use disorders) in this population. As a result, there is a risk that decisions on drug policy may be informed by inappropriate metrics. Promisingly, in recent months, additional studies assessing legal regulation that employ a range of criminal justice metrics have been published. 96–98 Finally, despite ample evidence of the impact of criminalisation on infectious disease transmission and acquisition risks, 5 we found no studies evaluating the impact of decriminalisation on these outcomes.

Both the included studies and our systematic review have important strengths and limitations. To our knowledge, we conducted the first review of all global literature on decriminalisation and legal regulation and applied no language restrictions. All eligible articles identified were published in English; this may reflect a paucity of evaluation research published in other languages and/or limitations of our search strategy (eg, some non-English journals may not be indexed in the 10 databases searched). In addition, we excluded grey literature, non-original research and study designs that are not suited to evaluating policy effects (eg, cross-sectional studies), but these restrictions narrowed the geographical scope of included studies. For example, two articles on Portugal were excluded as non-original research, but nevertheless provide important insight on impacts of decriminalisation. 99 100 Despite restricting eligibility to more rigorous study designs, most included studies used relatively weaker eligible designs that are known to be vulnerable to pre-existing trends and confounding; only 22.8% and 5.3%, respectively, used controlled before-and-after or interrupted time series designs to address these threats to validity. The use of these study designs may be related to limited resources for prospective drug policy evaluations, with many studies relying on publicly available, routinely collected data. That the US is unique in the extent to which data on drug use and related harms are routinely collected helps to explain its over-representation in our review. Scoping reviews inclusive of grey literature and cross-sectional designs would be valuable for describing the full range of evaluations that have been conducted globally.

While beyond the scope of our high-level synthesis, the implementation and specific provisions of drug policies vary widely. Decriminalisation policies vary in their definitions of quantities for personal use, application of administrative penalties and the extent to which the law ‘on the books’ is reflected in policing and criminal justice practice. Indeed, in some jurisdictions with nominal decriminalisation, arrests for possession of small quantities of the decriminalised drugs remain routine. 53 Legal regulation models for cannabis are also heterogeneous. For example, policies legally regulating cannabis for medical use may or may not allow for legal dispensaries, and this provision has been shown to substantially modify the impact of legal regulation on cannabis use. 101 To the extent that individual studies employed crude exposure measures (eg, presence vs absence of a law), they may have obscured context-dependent effects of drug law liberalisation. Further, the impact of drug laws on drug use and related outcomes may be limited by a lack of public awareness of the details of local laws. 102

Our use of vote-counting in this synthesis (ie, categorising individual outcome measures as indicating beneficial, harmful, mixed/subgroup-specific or no statistically significant associations) is subject to the same limitation. Vote-counting should also be interpreted with caution in light of the heterogeneity of outcome definitions, the inherent arbitrariness of statistical significance thresholds and the key distinction between statistical and clinical significance. In addition, many included studies are evaluating the same policies (eg, cannabis legalisation in western US states), sometimes using overlapping data but drawing different conclusions based on analytical choices and timeframes. The existence of multiple datapoints for a particular outcome does not imply that the outcome has been well-studied across diverse contexts such that scientific consensus on its effects has been reached. Moreover, as illustrated by a recently published extension of the included article by Bachhuber et al , 79 multiple high-quality studies may generate results that are later revealed to be spurious as additional follow-up data become availability. Specifically, Shover et al demonstrated that the positive association reported between medical cannabis legalisation and opioid overdose mortality in 1999 to 2010 reversed direction in later years, suggesting that earlier findings of a protective effect should not be given causal interpretations. 103 This was foreshadowed in the included article by Powell et al , which found that the purportedly positive effect of medical cannabis legalisation was attenuated in 2010 to 2013. 82 This scientific back-and-forth can be expected given that most included articles are evaluating legal changes introduced rather recently, and thus are examining early impacts with limited years of follow-up. Longer-term impacts of non-medical cannabis legalisation, and how they might be influenced by increased commercialisation, are yet to be seen. 104

The findings of this review indicate a need for a broadening of the metrics used to assess the impacts of drug decriminalisation and legal regulation. Given the growing number of jurisdictions considering decriminalisation or legal regulation of psychoactive drugs, 14–16 the disproportionate emphasis on metrics assessing drug use prevalence, as well as the limited geo-cultural diversity in evaluations, are concerning. Experts have called for a more fulsome approach to evaluating drug policies in line with public health and the United Nations Sustainable Development Goals, with attention to the full breath of health and social domains potentially impacted, including human rights and social inclusion (eg, stigma), peace and security (eg, drug market violence), development (eg, labour market participation), drug market regulation (eg, safety of the drug supply) and clinically-significant health metrics (eg, drug-related morbidity). 105 Drawing on methods such as multi-criterion decision analysis, 19 the engagement of both scientists and policymakers in priority-setting may help to produce evidence that provides a more comprehensive understanding of the breadth of impacts that should be anticipated with drug law reform efforts. Funding will also be required to support rigorous prospective evaluations of legal reforms.

Supplementary Material

Acknowledgments.

The authors would like to thank Gelareh Ghaderi for assistance with screening and data extraction.

Twitter: @aydenisaac

Presented at: Presented at the International Society for the Study of Drug Policy (May 22, 2019) and the International Harm Reduction Conference (April 29, 2019).

Contributors: DW and AIS conceptualised and supervised the review. CZ designed and conducted the literature searches. AIS drafted the manuscript. SC, ZM and AIS conducted screening and data extraction. NM contributed to drafting the manuscript and developing figures. All authors contributed to interpretation of findings and revising the manuscript for important intellectual content.

Funding: This review was supported by the Canadian Institutes of Health Research (CIHR) via the Canadian Research Initiative on Substance Misuse (SMN-139150), the MAC AIDS Foundation, and the Open Society Foundations. Ayden Scheim was supported by a Canadian Institutes of Health Research Postdoctoral Fellowship. Nazlee Maghsoudi is supported by a CIHR Vanier Canada Graduate Scholarship. Dan Werb is supported by a US National Institute on Drug Abuse Avenir Award (DP2- {"type":"entrez-nucleotide","attrs":{"text":"DA040256","term_id":"79190989","term_text":"DA040256"}} DA040256 ), a CIHR New Investigator Award, an Early Researcher Award from the Ontario Ministry of Research, Innovation and Science and the St Michael’s Hospital Foundation.

Map disclaimer: The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Patient consent for publication: Not required.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement: All relevant data are contained within the article and supplementary materials.

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8.2 Examples of Decriminalization

Some version of drug decriminalization exists in over 30 countries around the world (IDPC, 2022). Although most of these efforts at decriminalization are a product of the twenty-first century, decriminalization is not a new policy. For example, in 1976, the Netherlands introduced a decriminalization framework that made possession and supply of soft drugs (e.g., cannabis) the lowest priority for police and prosecutors, and permitted the possession of single doses of harder drugs (Rosmarin & Eastwood, 2012). During the 1970s, 11 US states adopted cannabis decriminalization, making the possession of small amount of cannabis for personal use a non-criminal offence (Mooney-Scott, 2010). And, in 1987, South Australia (SA) decriminalized cannabis, “introducing an option to pay a fine instead of receiving a criminal charge” (ADF, October 13, 2023, para. 8). This section outlines some key aspects of more recent drug decriminalization efforts in Portugal, Oregon and the USA, and Canada.

Portugal   

In 2000, Portugal decriminalized the possession of all drugs for personal use (Greenwald, 2009). Since then, drug possession/use is no longer treated as a criminal offence (Transform Drug Policy Foundation, 2021). However, if the police find someone in possession of a drug, the substance is confiscated and the person is referred to a panel of experts, known as Commissions for the Dissuasion of Drug Addiction (CDT). CDTs have the power to impose fines and refer PWUS for treatment services (Transform Drug Policy Foundation, 2021; Greenwald, 2009). In addition to decriminalizing drug possession, Portugal also implemented and expanded programs aimed at helping people experiencing substance use disorders (SUDs) (Greenwald, 2009) and has moved to an evidence-based approached to drug education (Transform Drug Policy Foundation, 2021).  Click the link below to learn more about how Portugal tackled its drug problem.

Outcomes of Drug Decriminalization in Portugal Include:

• A reduction in drug-related deaths.
• Low levels of drug use, consistently below the European average.
• A substantial decline in the number of people in prison on drug-related offences.
• Declining HIV diagnoses linked to drug use.
• The expansion of treatment and harm reduction services.

VIDEO: How Portugal Successfully Tackled its Drug Crisis

This video explores the Portugal’s unique approach to drug policy and to helping people experiencing substance use disorders (SUDs). (Click “Watch on YouTube” below to access the video).

Oregon & USA

In November of 2020, Oregon became the first state in the US to vote to decriminalize the possession of all drugs (Transform Drug Policy Foundation, 2021; DPA, 2021; Lopez, 2020). Oregon’s approach has also encouraged other states to follow their lead. A number of States have introduced bills or launched campaigns to both remove criminal penalties for drug possession and increase access to health services (e.g., Washington, Massachusetts, Vermont, Maine, New York, Rhode Island, Maryland, Kansas, and the District of Columbia) (DPA, 2021).

VIDEO: Oregon’s Drug Decriminalization Law Takes Effect

The following video provides an example of how decriminalization policies can be implemented to increase access to treatment options.

Decriminalization is not strictly limited to the personal possession of illegal drugs, but also extends to legal exemptions from criminal charges in situations where a person may normally be charged. The Canadian Good Samaritan Drug Overdose Act (2017), for instance, provides protection to people who call 911 in the event of a drug poisoning (overdose), even if the person making the call has consumed and/or is in possession of an illegal substance (Moallef et al., 2021). Other examples of exemptions in Canada include safe injection sites/safe consumption sites (SIS/SCS) (See Chapter on Harm Reduction), where drugs can be tested prior to use, clean/safe supplies/equipment are provided, and Narcan is readily available in the event of drug poisoning (overdose) (WHO, 2021).

Currently in Canada, in response to the opioid crisis and the rate of toxic drug poisoning (overdose) deaths, there is a push to decriminalize the possession of small amounts of all controlled substances. The recommendations of the Health Canada Expert Task Force on Substance Use (2021 ) support this position (see below). The Canadian Drug Policy Coalition’s (CDPC) 2022 report, Decriminalization Done Right (see below), goes even further in their recommendations, calling for the full decriminalization of not only possession for personal use, but also sharing and/or selling in certain circumstances (i.e., for subsistence, to help with costs associated with personal use, and to ensure a safe supply) (CDPC, 2022). An example of a stop-gap measure related to the Health Canada Expert Task Force recommendations, is the CDSA subsection 56(1) exemption granted to British Columbia (from January 31, 2023 to January 31, 2026), to assist with efforts to respond to the drug poisoning (overdose) crisis in the province. Under the exemption adults found in possession of small amounts of certain illegal drugs for personal use are not subject to criminal charges (Canada, September 14, 2023, para. 2).

  Click the following links to learn more about recommendations for decriminalization in Canada:   

Decriminalization Done Right: A Rights-Based Path for Decriminalization  Policy (Read Executive Summary Pages 2-4)

Report #1: Recommendation on Alternative to Criminal Penalties for Simple Possession of Controlled Substances   (Read Executive Summary Pages ii-iii)   VIDEO: Canada’s Police Chiefs Call for Decriminalization of Drug Possession for Personal Use

In this video we hear from Canada’s chiefs of police about their recommendation to end the prohibition of simple possession of illegal substances.

Psychoactive Substances & Society (2nd Edition)* Copyright © 2024 by Jacqueline Lewis & Jillian Holland-Penney is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Should Drugs Be Decriminalized in Canada? Research Paper

In response to serious opioid issues, Canada decided to introduce the decriminalization of the possession of heavy drugs in its particular territories. According to the government, this measure will help release the burden of the justice system and concentrate on health and the ways of its promotion within the framework of the prevention of drug use. Analyzing the rationale of this decision, this work aims to provide arguments against it. In other words, the decriminalization of heavy drugs is an inefficient measure for the prevention of their use as it deals with the consequences of this issue rather than its major causes, such as inadequate health practices, poor education, and economic and social inequities.

The growing rates of opioid use disorder (OUD) and the number of opioid-related deaths have become one of the most disturbing issues in the healthcare system of Canada. According to Belzak and Halverson, “while the opioid crisis has affected every region of the country, western Canada (British Columbia and Alberta) and the northern territories (Yukon and Northwest Territories) have experienced the highest-burden” (224). In British Colombia, probably the most affected province, in 1993, the number of opioid-related deaths did not exceed 330; however, in 2017, there was an increase of 400% with 1473 deaths (Fischer et al. 81). In response to this devastating situation, the government decided to focus on health care excluding opioid-related problem from the competency of the justice system.

Thus, starting January 31, 2023, an exemption from the Controlled Drugs and Substances Act will be implemented in British Colombia for three years. According to it, individuals (18 years and older) “will not be arrested or charged for possessing small amounts of certain illegal drugs for personal use. The total amount of illegal drug(s) must be equal to or less than 2.5 grams” (British Colombia par. 5).

These drugs include opioids, methamphetamine, cocaine, and MDMA; at the same time, their traffic, purchasing, and use in public places remain illegal. According to lawmakers, the criminalization of these drugs’ possession cannot improve the problem associated with opioid misuse. Moreover, it contributes to more negative consequences – the legal punishment of drug users will not prevent them from drug misuse. However, incarceration and its consequences may create additional social issues.

At the same time, the analysis of the situation shows multiple factors that should be addressed in order to minimize the rates of opioid misuse rather than deal with its consequences. Thus, according to Fischer et al., in the 1990s, “overdose deaths were primarily from combined heroin and cocaine injecting” of drug users with HIV (81). However, later, Canada increased the prescription of opioids and other heavy drugs for medical use, implementing and expanding opioid substitution treatment and supervised consumption sites. That is why “since the early 1980s, the volume of opioids sold to hospitals and pharmacies for prescriptions in Canada has increased by more than 3000%” (Belzak and Halverson 225). At the same time, the organization of research and investments in medical science for the identification or creation of safer substituents of opioids for patients with cancer or mental health issues could minimize the prescription of opioids and their potential misuse.

While the decriminalization of opioid use aims to promote safe supply and decrease the popularity of the illegal market, medical prescription does not prevent non-patients from drug abuse. There are multiple routes of opioid supply for non-medical use, including prescription-related fraud and forgery, “double doctoring,” Internet purchases, robberies and thefts, and street drug markets. In addition, according to Health Canada, “the most common source of opioids used without a prescription was a family member” – in other words, prescribed opioids may be shared among relatives (Belzak and Halverson 225). In addition, the mixing of drugs and alcohol consumption is an additional factors in opioid-related deaths. In turn, the education of citizens, along with the spread of awareness related to the negative consequences of drug use, could prevent its potential misuse in non-patients.

Finally, opioid misuse is connected with other serious social issues, such as racism, discrimination, and poverty. As multiple research states, homeless individuals and “First Nations populations across the country are heavily impacted by high rates of problematic substance use” (Belzak and Halverson 226). In addition, adolescents are highly vulnerable to opioid misuse as well. In these cases, addiction and associated consequences are caused by economic, educational, and employment issues, along with the stigmatization of asking for help and the absence of reliable assistance. In other words, due to structural racism connected with unemployment, poverty, unavailability of health care, mental health illnesses, and the absence of culturally competent health care providers, people are involved in drug use and potential misuse. Thus, paying attention to other social issues for the improvement of people’s welfare may prevent opioid issues more efficiently than drug decriminalization.

All in all, it is possible to say that the idea of help as the basis of decriminalization may be regarded as right – the punishment of drug users may create more challenges than solve the problem of drug misuse. However, it is not efficient as it does not address the main factors of drug misuse, including social, educational, health care, and economic issues that exist in society. In turn, the improvement of people’s well-being, the spread of awareness concerning the harmful effects of drugs for non-patients, and the absence of stigmatization of their medical use will genuinely decrease the seriousness of the current situation.

Works Cited

Belzak, Lisa, and Jessica Halverson. “Evidence Synthesis-The Opioid Crisis in Canada: A National Perspective.” Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice , vol. 38, no. 6, 2018, pp. 224-233.

British Colombia. “ Decriminalizing People Who Use Drugs in B.C. ” British Colombia . 2022. Web.

Fischer, Benedikt, et al. “The Opioid Death Crisis in Canada: Crucial Lessons for Public Health.” The Lancet Public Health , vol. 4, no. 2, 2019, pp. 81-82.

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IvyPanda. (2023, December 13). Should Drugs Be Decriminalized in Canada? https://ivypanda.com/essays/should-drugs-be-decriminalized-in-canada/

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Home — Essay Samples — Social Issues — Decriminalization of Drugs — Decriminalizing Drugs: the Social and Cultural Implications

Decriminalizing Drugs: The Social and Cultural Implications

• Categories: Decriminalization of Drugs

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Published: Jan 25, 2024

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Introduction, history of drug criminalization, social implications of decriminalizing drugs, cultural implications of decriminalizing drugs, shifting the conversation around addiction and substance abuse.

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Scrutiny of B.C. drug decrim pilot program intensifies

Premier david eby said he shares the concerns over public safety raised by decriminalization pilot program.

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Scrutiny of B.C.'s drug decriminalization pilot is growing, with public safety concerns that have put the spotlight squarely on the governing NDP as the province moves toward a fall election. 

Earlier this week, Vancouver Police Deputy Chief Fiona Wilson testified at a House of Commons health committee hearing about how the pilot is limiting police response to problematic public drug use, including inside hospitals and at bus stops.

"In the wake of decriminalization, there are many of those locations where we have absolutely no authority to address that problematic drug use, because the person appears to be in possession of less than 2.5 grams," Wilson said. "So if you have someone who is with their family at the beach, and there's a person next to them smoking crack cocaine, it's not a police matter."

The decriminalization pilot was introduced in January 2023 and allows adult drug users in B.C. to carry up to 2.5 grams of opioids, cocaine, methamphetamine and ecstasy for personal use without facing criminal charges. Relying on an exemption granted by Health Canada under the Controlled Drugs and Substances Act, it also allows for open drug use in some public spaces.

The province did try to bring in legislation in October to limit public drug use, but it was blocked by the courts. 

• B.C. top court upholds pause on law restricting public drug use

Premier David Eby said he shares the concerns over public safety and intends to address the issue. 

"Simply because we have compassion and concern about those struggling with addiction, does not mean that we need to give up our public spaces, does not mean that we have to have parks and playgrounds that are less safe," said Eby.

The province's options include ending the program, or possibly asking the federal government to bring in more changes to the pilot.

A meeting between Jennifer Whiteside, B.C.'s minister of mental health and addictions, and her federal counterpart Ya'ara Saks is scheduled for next week.

In a statement echoing Eby, Whiteside defended decriminalization as a way to destigmatize addiction and treat it as a healthcare issue instead of a criminal one.

"We maintain that having compassion for individuals struggling with addiction does not preclude the need to ensure the safety of workers and members of the public," said Whiteside.

• First Nations people in B.C. continue to be hit harder by toxic drug crisis, statistics show

B.C.'s official opposition has been highlighting illicit drug use in hospitals and the lack of guard rails around the decriminalization pilot.

"We knew it would result in exactly what's happening right now, which is an explosion of drug use taking place in SkyTrains, in restaurants and public spaces," said B.C. United leader Kevin Falcon. "It's been a horrific failure and the thing that is important to recognize is we're not seeing improved results."

Advocates for harm reduction say the answer is not to scrap the pilot, because it is doing some good. 

• Opposition alleges open drug use, dealing at Vancouver hospital

"Let's get to the table and make this work because I want to tell you this, the other way is [drug users go] into isolation. So if [changes are] to alleviate some public consumption in public spaces, I'm all for that," said Guy Felicella, a harm reduction and recovery expert.

The decriminalization pilot was introduced as a measure to address B.C.'s severe overdose crisis. More than 14,000 people have died of toxic drugs in the province since the crisis was declared a public health emergency in April 2016.

With files from Meera Bains

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