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

Abstract

ObjectivesTo 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.DesignSystematic review with narrative synthesis.Data sourcesWe searched MEDLINE, Embase, PsycINFO, Web of Science and six additional databases for publications from 1 January 1970 through 4 October 2018.Inclusion criteriaPeer-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 synthesisTwo 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.ResultsWe 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.ConclusionsStudies 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.

The details of decriminalization: Designing a non-criminal response to the possession of drugs for personal use

“…If neither a criminal nor civil offence applies, features such as prosecutorial and/or police discretion or diversion, are similarly inapplicable. This latter model is a gold standard amongst organizations of people who use drugs and many health professionals as it eliminates punitive drug policies and permits a more health-and rights-based approach (International Association of People Who Use Drugs (INPUD), 2021; Scheim et al, 2020;Shane, 2020). A model that does not introduce new penalties or sanctions is considered full decriminalization (Stevens et al, 2019).…”

“…Several reviews examine the impact of removing or downgrading criminal penalties across jurisdictions, highlighting "tremendous variation in the laws and regulations surrounding so-called decriminalization policies adopted by Western countries" (Pacula et al (2005) p. 347) and internationally (Eastwood et al, 2016;Hughes et al, 2018;Scheim et al, 2020;Stevens et al, 2019;Unlu et al, 2020). In fact, 'decriminalization' is not a singular, uniform approach, but is instead a term that describes myriad CrimRxiv • How to decriminalize drugs: the design features of a non-criminal response to the personal possession of drugs 3 legislative models.…”

Analysis of the UK Government’s 10-Year Drugs Strategy—a resource for practitioners and policymakers

“…The assumption that the threat of punishment will reduce demand is not supported by evidence, with no clear relationship between the stringency of drug laws and drug use prevalence. [97][98][99][100][101] The Home Office previously concluded 'levels of drug use are influenced by factors more complex and nuanced than legislation and enforcement alone'. 102 These may include socioeconomic deprivation 19 and adverse childhood experiences 24 ; factors that may be exacerbated by the health and social harms associated with contact with the criminal justice system.…”

Development and Validation of a Novel and Fast Detection Method for Cannabis sativa: A 19-Plex Short Tandem Repeat Typing System

“…In recent years, under the influence of legalization of C. sativa in Canada, Netherlands and some states in the United States, the number of people who smoke or abuse C. Sativa has continuously grown, with increasing cases of transnational C. sativa trafficking ( Hillmer et al, 2020 ; Scheim et al, 2020 ). Therefore, fast and accurate judicial identification and source tracking of C. sativa have become an urgent social need to launch a scathing attack on drug crime.…”