Developing a new national MDMA policy: Results of a multi-decision multi-criterion decision analysis

Abstract

Background: Ecstasy (3,4-methylenedioxymethamphetamine (MDMA)) has a relatively low harm and low dependence liability but is scheduled on List I of the Dutch Opium Act (‘hard drugs’). Concerns surrounding increasing MDMA-related criminality coupled with the possibly inappropriate scheduling of MDMA initiated a debate to revise the current Dutch ecstasy policy. Methods: An interdisciplinary group of 18 experts on health, social harms and drug criminality and law enforcement reformulated the science-based Dutch MDMA policy using multi-decision multi-criterion decision analysis (MD-MCDA). The experts collectively formulated policy instruments and rated their effects on 25 outcome criteria, including health, criminality, law enforcement and financial issues, thematically grouped in six clusters. Results: The experts scored the effect of 22 policy instruments, each with between two and seven different mutually exclusive options, on 25 outcome criteria. The optimal policy model was defined by the set of 22 policy instrument options which gave the highest overall score on the 25 outcome criteria. Implementation of the optimal policy model, including regulated MDMA sales, decreases health harms, MDMA-related organised crime and environmental damage, as well as increases state revenues and quality of MDMA products and user information. This model was slightly modified to increase its political feasibility. Sensitivity analyses showed that the outcomes of the current MD-MCDA are robust and independent of variability in weight values. Conclusion: The present results provide a feasible and realistic set of policy instrument options to revise the legislation towards a rational MDMA policy that is likely to reduce both adverse (public) health risks and MDMA-related criminal burden.

Ethics of Psychedelic Use in Psychiatry and Beyond—Drawing upon Legal, Social and Clinical Challenges

“…This could involve creating institutions or "trip houses" that develop programs for patients under medical supervision [95]. A Dutch policymaking group suggested MDMA policies encompassing various regulation issues and monitoring aspects related to prevalence, health, criminality, and financial costs and benefits [96]. In addition to legal status, commercialization is an important matter to discuss.…”

Equasy revisited

“…Van Amsterdam et al report the results of a multi-decision, multicriterion decision analysis and how this might contribute to MDMA policy. They conclude that their results provide a feasible and realistic set of policy instrument options to revise the legislation towards a rational MDMA policy, that is likely to reduce both adverse (public) health risks and MDMA-related criminal burden (van Amsterdam et al, 2021). Borissova et al (2021) conducted a double-blind, placebocontrolled experiment examining the effects of MDMA on trust, co-operative behaviour and empathy and interestingly report no increase in prosocial behaviour in a laboratory setting.…”

“…Van Amsterdam et al report the results of a multi-decision, multi-criterion decision analysis and how this might contribute to MDMA policy. They conclude that their results provide a feasible and realistic set of policy instrument options to revise the legislation towards a rational MDMA policy, that is likely to reduce both adverse (public) health risks and MDMA-related criminal burden (van Amsterdam et al, 2021).…”