The Decriminalization of Illicit Drugs and its societal impact

The Decriminalization of Illicit Drugs and its societal impact

Decriminalization of illicit drugs is certainly a hotly debated topic by those in and outside of the healthcare industry. Decriminalization means to stop treating an act as an illegal or criminal offense, which is not to be confused with legalization which is a full-on endorsement of an activity. [1] For example, being found with a certain amount of a decriminalized substance may result in a small fine or citation, but no jail time while a fully legalized drug would result in no repercussions at all.

The shift from recreational to medicinal
There has been a gradual shift in how controlled substances are viewed by the public. There is a growing list of substances that were once seen as purely recreational and destructive that are now being closely examined for their potential medical benefits. The State of Oregon has been the leader in decriminalization for over four decades. Responding to the counter-culture movement of the ’60s and 70’s Oregon would decriminalize cannabis use in 1973 and reduced its penalty for possession of a small amount to a $100 fine. Very soon, other states like Alaska, Maine, Colorado and New York would also decriminalize cannabis.
The major development from a medical standpoint occurred in 1996 when the State of California chose to legalize medical cannabis with the approval of Proposition 215 which allowed patients with a valid doctor’s recommendation to possess and cultivate marijuana for personal medical use. Very soon Oregon, Alaska and Washington would all legalize medical cannabis through a ballot measure.
In total 18 states plus the District of Columbia have chosen to make it legal to buy and consume recreational marijuana and 36 states plus D.C. have approved medical marijuana.
In Canada, Canadians of legal age were able to consume and possess marijuana as it was fully legalized across the country due to bill C-45 being passed. And recently, as of Jan 31st, 2022, adults in British Columbia, Canada were allowed to possess up to 2.5grams of opioids, cocaine, methamphetamine and MDMA, a strong signal that the country will look to treat addiction as a mental health issue rather than a judicial one.

Results
The results have been mixed with a few intricacies (like the pandemic) making it hard to understand the true effect of the decriminalization and legalization of marijuana and other drugs. For instance, opioid-related deaths have been on the rise in both Canada and the US primarily due to an increasingly toxic drug supply, an indirect effect of legalization.[2] In fact, some officials are pushing hard for the replacement of black-market street drugs with a regulated safe supply of major drugs like heroin, fentanyl and cocaine.[3]
Additionally, different organizations have wildly different assessments of the effect of the results of the legalization of marijuana. For example, the Centre for Addiction and Mental Health (CAMH) in Canada said in January 2021 that cannabis consumption was noticeably up in Canada and Dr. Tara Elton-Marshall, Independent Scientist for Mental Health Policy Research at CAMH was quoted as saying that “We know that regular use of cannabis leads to greater health problems, addiction and other mental health disorders”.[4]
Similarly, the Centers for Disease Control and Prevention in the United States has nothing positive to say about cannabis and also affirms its link to mental illness. It states on its website that “People who use marijuana are more likely to develop temporary psychosis (not knowing what is real, hallucinations, and paranoia) and long-lasting mental disorders, including schizophrenia.” [5]
But with regards to criminal behavior and activity, States that have legalized marijuana in the U.S have had considerably declining rates of crime which is a huge positive and may be enough to quell detractors that highlight the negative points above.[6] Also, advocates of decriminalization and legalization highlight the ability to use proceeds from a legalized or regulated industry as another overwhelmingly positive aspect regardless of the negatives like easier access for minors.[7]
While we have primarily focused on North America, some effects of decriminalization and legalization can be gleamed from the European continent where Portugal facing a crisis of heroin overdose deaths in 2001 took the drastic step of decriminalizing all illegal drugs and instead of sending “offenders” to the legal system for drug possession, focused on an education, treatment and harm reduction model. One of the main results of the decriminalization in this country was that the number of people in treatment increased by 20 percent in the first seven years after drug legalization in Portugal and has held steady since. But this was one of the major goals. Assistant professor, Hannah Laquer in the Department of Emergency Medicine at the University of California can be quoted as saying “Most accounts of the Portugal experiment have focused on decriminalization, but decriminalization was part of a broader effort intended to encourage treatment,”.[8]
To finalize, it is quite hard to assess the overall effect of legalizing marijuana and other illicit drugs but another method would be to consider if the intended goals were met after the fact.

Other drugs that could become decriminalized
As hinted above, apart from Marijuana, other drugs are looking to be possibly decriminalized in the near future. Here is a look at some other drugs that are currently being evaluated and the potential mental ailments that they could treat.

Psilocybin
Psilocybin is one of the main compounds in magic mushrooms and considerable studies have been done on its effect on reducing end-of-life anxiety, depression and substance abuse disorders like alcoholism and nicotine addiction.[9] Medical experts estimate that there will soon be enough evidence, in the next 2 years or so, for the Food and Drug Administration (FDA) to treat some of the disorders identified above. [10]

Ketamine
Ketamine or special K has shown considerable promise in treating major depression a lot faster than other drugs and was approved by the FDA but for limited use in early 2019. [11] By clearing up atrophy in the prefrontal cortex, a major part of the brain, there is hope that it can become standardized in the treatment of schizophrenia and suicidal patients.

3,4-methylenedioxy-methamphetamine (MDMA)
Results from a 2010 study on the treatment for post-traumatic stress disorder renewed interest in MDMA or Ecstasy or Molly as it is more commonly known.[12] Since then, MDMA has shown promise in treating substance abuse disorder or social anxiety in autistic adults despite its potential to cause more damage than other psychedelics.

Lysergic acid diethylamide (LSD)
LSD has shown significant promise in treating alcohol addiction and has been studied for other conditions like depression.[13] While the results can be harmful in large doses supervised micro-doses at regular intervals seems to offer the best results

Conclusion
The question of whether decriminalization or legalization of controlled substances is a good thing for society is debatable . The bigger question is whether the goals that are set out to be achieved are reached or will be reached when decriminalization or legalization occurs. Will the questions around decriminalization be addressed as a healthcare issue, or a criminal issue? Are people getting the help they need?  What is the actual cost to taxpayers? Certainly, there is continued interest in researching more substances for their potential use in a healthcare setting, especially since the overdose crisis that plagues so many people continues. #MentalHealthAwareness #EndTheStigma

[1] Decriminalization vs Legalizations

[2] https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-020-0256-8

[3] https://time.com/6108812/drug-deaths-safe-supply-opioids/

[4] https://www.camh.ca/en/camh-news-and-stories/half-cannabis-users-increased-consumption-1st-wave-covid-19

[5] https://www.cdc.gov/marijuana/health-effects/mental-health.html

[6] https://norml.org/marijuana/fact-sheets/marijuana-regulation-and-crime-rates/

[7] https://www.forbes.com/sites/chrisroberts/2022/01/26/marijuana-taxes-far-exceed-alcohol-taxes-why-thats-bad-and-could-kill-legalization/?sh=1c58699c5080