Decriminalizing Drugs

“We are not hunted or scared or looked upon as criminals. And that has made it possible to live and to breathe.” Nuno Miranda Portuguese heroin addict

Michael Specter writes in his October 17th New Yorker article, “Getting a Fix,” that almost 1%--100,000 individuals--of the population in Portugal were heroin addicts in 1999. Portugal also reported the highest rate of drug-related AIDS deaths in the European Union that year.

In response to these numbers, along with the failure of all previous efforts, largely punitive, to curtail drug use, Portugal took what Specter calls an “unlikely gamble” and passed a law that made it the first country to decriminalize drug use.

What is the best way to determine the effects of this law? Ideally we would like to have a pre-legislation measure of drug use, then one while the law is in effect, and a final period when drug use was then made illegal again. As is usually the case, it is impossible to employ this design outside the laboratory.

(An exception was the natural experiment of Prohibition in the U.S.—it began with a lengthy period when alcohol consumption was legal, then it was prohibited in 1919 by the 18th Amendment to the Constitution and 14 years later, it was repealed by the 21st Amendment.)

Absent such a design, we are left with a pre-and-post intervention measure of behavior. Again it would be best to have a comparative (control) group, say in another non-European Union country, that received no intervention to assess the effects of several alternative interpretations, usually historical trends, that might account for whatever changes occurred during the intervention.

In the end, Portugal fell back on the usual approach to measure the effects of any large scale social “experiment”—a pre-post test, no control group design.

Regardless of these methodological concerns, what were the effects of this radical Portuguese legislation? Specter provides three outcome measures:

• 37% of injecting drug users were receiving methadone to manage their addiction [in 1999]; ten years later that figure was 67%.

• The number of people convicted of drug offenses fell from 44% of the prison population in 2000 to 21% in 2005.

• The percentage of people using heroin in prison also fell sharply.

More generally Specter believes “In most respects, the law seems to have worked: serious drug use is down significantly, particularly among young people; the burden on the criminal justice system has eased; the number of people seeking treatment has grown; and the rates of drug-related deaths and cases of infectious diseases have fallen.”

But has the law really worked? Could these changes be accounted for by other concurrent events? Specter does acknowledge this possibility.

For example, he notes that the number of treatment facilities increased significantly at the same time the law was passed. Another possibility is that the observed changes were due to changes in European views about drug addiction, as well as wider knowledge of the consequences of excessive drug use. Without comparative data, it is impossible to rule out either of these alternative accounts.

There are also larger issues that go beyond the data, moral and philosophical issues of how a society should deal with drug addiction, an addiction that many claim is in fact a medical disease, more like a chronic illness.

Still, as Specter concludes, citing a clinical psychologist who works with a drug outreach group, “It is a program that reduces harm and I don’t see a better approach.”