Several key themes emerge from the positive responses with respect to the first question. 

First, a distinction is made between treating drug use as a health malady versus a criminal activity. If considered as a health malady then we need to apply health services to help addicts to increase their wellbeing (Beatton, Rojas, Helliwell, Ferrer-i-Carbonell ). Frijters cites evidence that decriminalization of hard drugs in Portugal reduced both the use of hard drugs and the numbers of drug-related deaths (Hughes and Stevens 2007) so improving health outcomes.

Second, the criminalization of drugs creates an illegal industry with the capacity to corrupt all layers of government, from the police to the highest judicial and political spheres of a state (Rojas). Thus other forms of criminal activity are heightened by the criminalization of drugs. This leads some countries to an erosion of trust and social capital which, in turn, erodes wellbeing. Frijters notes that Hughes and Stevens (2007) show that the Portuguese drug law changes reduced levels of crime in that country. He also cites a study by Gavrilova et al. (2019) which finds that legalized marijuana in the US helped to diminish crime along the Mexican border. Ada Ferrer-i-Carbonell mentions the work by Becker, Murphy and Grossman (2006) who argue to legalize and tax drugs as a better instrument to reduce its consumption. With these taxes, one could finance health services to help addicts.

Third, the people who are hurt by anti-drug laws are often in marginalised groups who are penalised further through the legal system; hence criminalization exacerbates existing inequalities. decriminalization reduces the hold that organized crime has over these people. (Grimes, Schoeb, Foster, Tov).

Fourth, criminalization effects stretch beyond country borders with the ‘war on drugs’ increasing threats to wellbeing in drug producing countries (Rojas).

Fifth, Pugno, citing Felbab-Brown (2008), makes the point that interventions to combat drug use are costly, so decriminalization can free up resources that could be better used for other purposes. 

Sixth, a higher dimension of wellbeing is at stake with respect to drug laws. decriminalization is part of a wider change to greater personal freedom, and while this may involve negative effects (e.g. drug dependency), Ruut Veenhoven says the positive effects of greater freedom dominate.

A number of caveats and counter-arguments to these positive aspects are, however, also noted by our experts.

First, Kapteyn makes a distinction between the legal treatment of drug use versus drug trafficking (which may indeed do harm to others). One issue to address, therefore, is whether decriminalization of drug use should also extend to decriminalization of drug trafficking. 

Second, several experts indicate that there have been negative wellbeing outcomes from the use of drugs such as alcohol and tobacco that have long been legal in most countries (Beatton, Binder). These negative effects may well apply to drugs that are currently criminalized. It is important therefore that public policy provides correct information on the wellbeing costs of drug addiction, as has been done with tobacco, but not so much with alcohol (see the awarded movie of Thomas Vinterberg, “another round”) (Ferrer-i-Carbonell).

Third, Wenceslao explores the issue from the perspective of economic theory: decriminalization of drugs would increase drugs supply (through lower costs of crime) and would increase drugs demand (through lower costs of illegal consumption). Thus, we may expect higher drugs consumption. He questions whether these predicted outcomes are good for well-being. In contrast, Ada Ferrer-i-Carbonell cites Becker, Murphy and Grossman (2006): “[…] a monetary tax could cause a greater reduction in output and increase in price than optimal enforcement against the same good would if it were illegal, even though some producers may go underground to avoid a monetary tax.” 

Since 2016, we have seen the effective use of an annual 12.5% tax increase on cigarettes in Australia, where a packet of cigarettes now costs $AUD40 and has been credited with reducing cigarette consumption (Wilkinson et. al., 2019). However, such annual tax increases on drugs may send retail purchases into the black market. In Australia this appears not to have occurred with cigarettes, perhaps because there are next-to-no illegal suppliers. This is not the case with drugs, where importation is the domain of organized crime and distributed through anti-social motorcycle and other gangs. Thus, a policy for decriminalizing drugs will need to be a coordinated health, drug enforcement and border control initiative.

At an empirical level, the implications of a recent survey paper by Scheim et al. (2020) are interpreted in different lights by two of our experts. Wooden considers that the review shows that the jury is still out on both the mental health impacts of decriminalization and on the physical health impacts. Furthermore, the incidence of driving under the influence of drugs, hospital admissions and overdoses all rise. Frijters, meanwhile, notes that the Scheim et al. study found no negative effects on public health while, on the positive side, Kalbfluss et al. (2018) find that decriminalization reduces the length of time spent in bad mental health.    

On the back of conflicting evidence, and given the paucity of high quality statistical evidence to date on the effects of decriminalization, both Wooden and Binder argue that there is still much that we do not know about the wide range of effects of recent decriminalization changes. This paucity of evidence on recent decriminalization changes suggests a potential role for economic historians to assist through analysis of the health, crime and other impacts of the criminalization of drugs that occurred over the twentieth century.  

There was even stronger agreement amongst our panelists with the second proposition: Further decriminalization of both soft-drugs and hard-drugs, if well-designed, can be expected to lead to net wellbeing gains in the population.” Twelve of the panel agreed or completely agreed with this statement, three were neither in agreement nor disagreement, and no panelists opposed the statement.

Multiple respondents (including Beatton, Rojas, Binder, Frijters) addressed the potential of decriminalization to reduce the power of criminal gangs who are currently involved in distributing drugs. Not only does decriminalization reduce the power of these gangs, but also reduces policing and justice system costs and reduces a major source of corruption throughout levels of government and in producer countries. 

A note of caution, however, comes from Wooden who cites evidence in Scheim (2020) that decriminalization has resulted in an increased incidence of driving under the influence of drugs which is itself a criminal action. Grimes notes that criminal penalties can be replaced by civil penalties for certain drug-related activities as an alternative to full legalization. 

Views on health effects are nuanced across the panel. Foster, Grimes, Rojas and Beatton indicate that treatment of addicts is likely to be more comprehensive if drug-taking is not a criminal activity; addicts are more likely to present themselves for treatment. Addiction may well be a symptom of deeper psychological problems for the individual so treatment for addiction may open up the avenue of treating these deeper mental health problems that face the addict (Grimes). In addition, treated addicts may gain access to better housing which will further improve their health and their wellbeing (Beatton). 

Wooden is more cautious, noting that evidence to date on decriminalization is not strongly supportive of improved health outcomes. Wenceslao draws a distinction between decriminalizing ‘soft’ and ‘hard’ drugs reflecting potential differing health outcomes across different classes of drugs. Relatedly, Foster says that decriminalization must be done carefully so that young people do not receive the message that it's either expected or in their interests to use mind-altering and/or addictive drugs on a regular basis. We need a public health program that communicates the risk from drugs before we decriminalize them.

Two additional health issues are highlighted by panellists. The first is the opioid crisis (especially in the United States) in which legally prescribed drugs are causing major wellbeing costs (Frijters, Helliwell). Frijters argues the crisis indicates that one wants to avoid medicalising drugs use whilst still decriminalizing it (see: Soelberg et al., 2017). The second is that evidence shows strong potential to use hallucinogenic drugs in medicine, e.g., in the supervised treatment of resistant PTSD, but this treatment path is currently banned in many countries (Foster).

Schoeb identifies a positive externality (spillover benefit) of decriminalization: a benefit for addicts’ families. Thus decriminalization may reduce mental distress not only for the addict but also for their wider family.

Tov and Pugno also consider issues that extend beyond the immediate circumstances of the addict. They discuss complementary policy initiatives that need to be taken along with decriminalization. Tov, for instance, considers that decriminalization “must come with added investment in the larger community that users come from”, and governments “must attend to broader inequities in economic opportunities since poverty can put individuals at greater risk for substance abuse.” Pugno considers that decriminalization of drugs should be “preceded and accompanied by policies for well-being, including economic, social, and health policies.” This is particularly important since drug-taking is more prevalent amongst those with already low levels of well-being. For instance, the opioid crisis in the United States is predominantly observed in people who are less educated, earn less labour income than their parents, and who lose their jobs (and social status) in mid-career (see: Case and Deaton, 2017; Dasgupta et al., 2018), while Heckman et al. (2006) show how extra schooling can help to reduce marijuana use by strengthening both cognitive and noncognitive skills.

The views of the World Wellbeing Panel respondents indicate that while there is majority support amongst the panelists for drug decriminalization, the decriminalization issue cannot be divorced from broader societal issues. These issues include the power of organized crime, corruption, poor education, poverty and inequality. decriminalization itself may help to address some of these broader issues (e.g. the power of organized crime) but also needs to be accompanied by complementary policies that address the root causes of drug-taking amongst significant groups of the population.

References

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