why drugs should be legal essay

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Should drugs be legalized? Legalization pros and cons

Source: Composite by G_marius based on Chuck Grimmett's image

Should drugs be legalized? Why? Is it time to lift the prohibition on recreational drugs such as marijuana and cocaine? Can we stop drug trafficking? if so what would be the best way to reduce consumption?

Public health problem

Drugs continue to be one of the greatest problems for public health . Although the consumption of some substances has declined over time, new drugs have entered the market and become popular. In the USA, after the crack epidemic, in the 80s and early 90s, and the surge of methamphetamine, in the 90s and early 21st century, there is currently a prescription opioid crisis . The number of casualties from these opioids, largely bought in pharmacies, has overtaken the combined deaths from cocaine and heroine overdose. There are million of addicts to these substances which are usually prescribed by a doctor. This is a relevant twist to the problem of drugs because it shows that legalization or criminalization may not always bring the desire solution to the problem of drug consumption. On the other hand there is also evidence of success in reducing drug abuse through legal reform. This is the case of Portuguese decriminalization of drug use, which has show a dramatic decrease in drug related crime, overdoses and HIV infections.

History of prohibition of drugs

There are legal recreational drugs , such as alcohol and tobacco , and other recreational drugs which are prohibited. The history of prohibition of drugs is long. Islamic Sharia law, which dates back to the 7th century, banned some intoxicating substances, including alcohol. Opium consumption was later prohibited in China and Thailand. The Pharmacy Act 1868 in the United Kingdom was the first modern law in Europe regulating drug use. This law prohibited the distribution of poison and drugs, and in particular opium and derivates. Gradually other Western countries introduced laws to limit the use of opiates. For instance in San Francisco smoking opium was banned in 1875 and in Australia opium sale was prohibited in 1905 . In the early 20th century, several countries such as Canada, Finland, Norway, the US and Russia, introduced alcohol prohibitions . These alcohol prohibitions were unsucessful and lifted later on. Drug prohibitions were strengthened around the world from the 1960s onward. The US was one of the main proponents of a strong stance against drugs, in particular since Richad Nixon declared the "War on Drugs ." The "War on Drugs" did not produced the results expected. The demand for drugs grew as well as the number of addicts. Since production and distribution was illegal, criminals took over its supply. Handing control of the drug trade to organized criminals has had disastrous consequences across the globe. T oday, drug laws diverge widely across countries. Some countries have softer regulation and devote less resources to control drug trafficking, while in other countries the criminalization of drugs can entail very dire sentences. Thus while in some countries recreational drug use has been decriminalized, in others drug traficking is punished with life or death sentences.

Should drugs be legalized?

In many Western countries drug policies are considered ineffective and decriminalization of drugs has become a trend. Many experts have provided evidence on why drugs should be legal . One reason for legalization of recreational drug use is that the majority of adicts are not criminals and should not be treated as such but helped in other ways. The criminalization of drug users contributes to generating divides in our societies. The "War on Drugs" held by the governments of countries such as USA , Mexico, Colombia, and Indonesia, created much harm to society. Drug related crimes have not always decline after a more intolerant government stance on drugs. Prohibition and crime are often seen as correlated.

T here is also evidence of successful partial decriminalization in Canada, Switzerland, Portugal and Uruguay. Other countries such as Ireland seem to be following a similar path and are planning to decriminalize some recreational drugs soon. Moreover, The United Nations had a special session on drugs on 2016r, UNGASS 2016 , following the request of the presidents of Colombia, Mexico and Guatemala. The goal of this session was to analyse the effects of the war on drugs. explore new options and establish a new paradigm in international drug policy in order to prevent the flow of resources to organized crime organizations. This meeting was seen as an opportunity, and even a call, for far-reaching drug law reforms. However, the final outcome failed to change the status quo and to trigger any ambitious reform.

However, not everyone is convinced about the need of decriminalization of recreational drugs. Some analysts point to several reasons why drugs should not be legalized and t he media have played an important role in shaping the public discourse and, indirectly, policy-making against legalization. For instance, t he portrayal of of the issue in British media, tabloids in particular, has reinforced harmful, dehumanising stereotypes of drug addicts as criminals. At the moment the UK government’s response is to keep on making illegal new recreational drugs. For instance, Psychoactive Substances Bill aims at criminalizing legal highs . Those supporting the bill argue that criminalization makes more difficult for young people to have access to these drugs and could reduce the number of people who get addicted.

List of recreational drugs

This is the list of recreational drugs (in alphabetic order) which could be subject to decriminalization in the future:

Amfetamines (speed, whizz, dexies, sulph)
Amyl nitrates (poppers, amys, kix, TNT)
Cannabis (marijuana, hash, hashish, weed)
Cocaine (crack, freebase, toot)
Ecstasy (crystal, MDMA, E)
Heroin (H, smack, skag, brown)
Ketamine (K, special K, green)
LSD (acid, paper mushrooms, tripper)
Magic mushrooms (mushies, magics)
Mephedrone (meow meow, drone, m cat)
Methamfetamines (yaba, meth, crank, glass)
Painkillers, sedatives and tranquilizers (chill pills, blues, bricks)

Pros and cons of legalization of drugs

These are some of the most commonly argued pros of legalization :

Government would see the revenues boosted due to the money collected from taxing drugs.
Health and safety controls on these substances could be implemented, making recreational drugs less dangerous.
Facilitate access for medicinal use. For instance cannabis is effective treating a range of conditions. Other recreational drugs could be used in similar ways.
Personal freedom. People would have the capacity to decide whether they experiment with drugs without having to be considered criminals or having to deal with illegal dealers.
Criminal gangs could run out of business and gun violence would be reduced.
Police resources could be used in other areas and help increase security.
The experience of decriminalization of drugs in some countries such as Portugal and Uruguay, has led to a decrease in drug related problems.

Cons of decriminalizing drug production, distribution and use:

New users for drugs. As in the case of legal recreational drugs, decriminalization does not imply reduction in consumption. If these substances are legal, trying them could become "more normal" than nowadays.
Children and teenagers could more easily have access to drugs.
Drug trafficking would remain a problem. If governments heavily tax drugs, it is likely that some criminal networks continue to produce and smuggle them providing a cheaper price for consumers.
The first few countries which decide to legalize drugs could have problems of drug tourism.
The rate of people driving and having accidents due drug intoxication could increase.
Even with safety controls, drugs would continue to be a great public health problem and cause a range of diseases (damamge to the brain and lungs, heart diseases, mental health conditions).
People may still become addicts and die from legalized drugs, as in America's opioid crisis.

What do think, should recreational drugs be legalized or decriminalized? Which of them? Is legalising drugs being soft on crime? Is the prohibition on drugs making the work of the police more difficult and diverting resources away from other more important issues? Join the discussion and share arguments and resources on the forum below .

Watch these videos on decriminalization of drugs

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Why all drugs should be legal. (Yes, even heroin.)

Prohibition has huge costs

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We've come a long way since Reefer Madness . Over the past two decades, 16 states have de-criminalized possession of small amounts of marijuana, and 22 have legalized it for medical purposes. In November 2012, Colorado and Washington went further, legalizing marijuana under state law for recreational purposes. Public attitudes toward marijuana have also changed; in a November 2013 Gallup Poll , 58 percent of Americans supported marijuana legalization.

Yet amidst these cultural and political shifts, American attitudes and U.S. policy toward other drugs have remained static. No state has decriminalized, medicalized, or legalized cocaine, heroin, or methamphetamine. And a recent poll suggests only about 10 percent of Americans favor legalization of cocaine or heroin. Many who advocate marijuana legalization draw a sharp distinction between marijuana and "hard drugs."

That's understandable: Different drugs do carry different risks, and the potential for serious harm from marijuana is less than for cocaine, heroin, or methamphetamine. Marijuana, for example, appears incapable of causing a lethal overdose, but cocaine, heroin, and methamphetamine can kill if taken in excess or under the wrong circumstances.

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But if the goal is to minimize harm — to people here and abroad — the right policy is to legalize all drugs, not just marijuana.

In fact, many legal goods cause serious harm, including death. In recent years, about 40 people per year have died from skiing or snowboarding accidents ; almost 800 from bicycle accidents; several thousand from drowning in swimming pools ; more than 20,000 per year from pharmaceuticals ; more than 30,000 annually from auto accidents ; and at least 38,000 from excessive alcohol use .

Few people want to ban these goods, mainly because while harmful when misused, they provide substantial benefit to most people in most circumstances.

The same condition holds for hard drugs. Media accounts focus on users who experience bad outcomes, since these are dramatic or newsworthy. Yet millions risk arrest, elevated prices, impurities, and the vagaries of black markets to purchase these goods, suggesting people do derive benefits from use.

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That means even if prohibition could eliminate drug use, at no cost, it would probably do more harm than good. Numerous moderate and responsible drug users would be worse off, while only a few abusive users would be better off.

And prohibition does, in fact, have huge costs, regardless of how harmful drugs might be.

First, a few Economics 101 basics: Prohibiting a good does not eliminate the market for that good. Prohibition may shrink the market, by raising costs and therefore price, but even under strongly enforced prohibitions, a substantial black market emerges in which production and use continue. And black markets generate numerous unwanted side effects.

Black markets increase violence because buyers and sellers can't resolve disputes with courts, lawyers, or arbitration, so they turn to guns instead. Black markets generate corruption, too, since participants have a greater incentive to bribe police, prosecutors, judges, and prison guards. They also inhibit quality control, which causes more accidental poisonings and overdoses.

What's more, prohibition creates health risks that wouldn't exist in a legal market. Because prohibition raises heroin prices, users have a greater incentive to inject because this offers a bigger bang for the buck. Plus, prohibition generates restrictions on the sale of clean needles (because this might "send the wrong message"). Many users therefore share contaminated needles, which transmit HIV, Hepatitis C, and other blood-borne diseases. In 2010, 8 percent of new HIV cases in the United States were attributed to IV drug use.

Prohibition enforcement also encourages infringements on civil liberties, such as no-knock warrants (which have killed dozens of innocent bystanders) and racial profiling (which generates much higher arrest rates for blacks than whites despite similar drug use rates). It also costs a lot to enforce prohibition, and it means we can't collect taxes on drugs; my estimates suggest U.S. governments could improve their budgets by at least $85 billion annually by legalizing — and taxing — all drugs. U.S. insistence that source countries outlaw drugs means increased violence and corruption there as well (think Columbia, Mexico, or Afghanistan).

The bottom line: Even if hard drugs carry greater health risks than marijuana, rationally, we can't ban them without comparing the harm from prohibition against the harms from drugs themselves. In a society that legalizes drugs, users face only the negatives of use. Under prohibition, they also risk arrest, fines, loss of professional licenses, and more. So prohibition unambiguously harms those who use despite prohibition.

It's also critical to analyze whether prohibition actually reduces drug use; if the effects are small, then prohibition is virtually all cost and no benefit.

On that question, available evidence is far from ideal, but none of it suggests that prohibition has a substantial impact on drug use. States and countries that decriminalize or medicalize see little or no increase in drug use. And differences in enforcement across time or place bear little correlation with uses. This evidence does not bear directly on what would occur under full legalization, since that might allow advertising and more efficient, large-scale production. But data on cirrhosis from repeal of U.S. Alcohol Prohibition suggest only a modest increase in alcohol consumption.

To the extent prohibition does reduce use drug use, the effect is likely smaller for hard drugs than for marijuana. That's because the demands for cocaine and heroin appear less responsive to price. From this perspective, the case is even stronger for legalizing cocaine or heroin than marijuana; for hard drugs, prohibition mainly raises the price, which increases the resources devoted to the black market while having minimal impact on use.

But perhaps the best reason to legalize hard drugs is that people who wish to consume them have the same liberty to determine their own well-being as those who consume alcohol, or marijuana, or anything else. In a free society, the presumption must always be that individuals, not government, get to decide what is in their own best interest.

Drug Legalization?: Time for a real debate

Subscribe to governance weekly, paul stares ps paul stares.

March 1, 1996

11 min read

Whether Bill Clinton “inhaled” when trying marijuana as a college student was about the closest the last presidential campaign came to addressing the drug issue. The present one, however, could be very different. For the fourth straight year, a federally supported nationwide survey of American secondary school students by the University of Michigan has indicated increased drug use. After a decade or more in which drug use had been falling, the Republicans will assuredly blame the bad news on President Clinton and assail him for failing to carry on the Bush and Reagan administrations’ high-profile stand against drugs. How big this issue becomes is less certain, but if the worrisome trend in drug use among teens continues, public debate about how best to respond to the drug problem will clearly not end with the election. Indeed, concern is already mounting that the large wave of teenagers—the group most at risk of taking drugs—that will crest around the turn of the century will be accompanied by a new surge in drug use.

As in the past, some observers will doubtless see the solution in much tougher penalties to deter both suppliers and consumers of illicit psychoactive substances. Others will argue that the answer lies not in more law enforcement and stiffer sanctions, but in less. Specifically, they will maintain that the edifice of domestic laws and international conventions that collectively prohibit the production, sale, and consumption of a large array of drugs for anything other than medical or scientific purposes has proven physically harmful, socially divisive, prohibitively expensive, and ultimately counterproductive in generating the very incentives that perpetuate a violent black market for illicit drugs. They will conclude, moreover, that the only logical step for the United States to take is to “legalize” drugs—in essence repeal and disband the current drug laws and enforcement mechanisms in much the same way America abandoned its brief experiment with alcohol prohibition in the 1920s.

Although the legalization alternative typically surfaces when the public’s anxiety about drugs and despair over existing policies are at their highest, it never seems to slip off the media radar screen for long. Periodic incidents—such as the heroin-induced death of a young, affluent New York City couple in 1995 or the 1993 remark by then Surgeon General Jocelyn Elders that legalization might be beneficial and should be studied—ensure this. The prominence of many of those who have at various times made the case for legalization—such as William F. Buckley, Jr., Milton Friedman, and George Shultz—also helps. But each time the issue of legalization arises, the same arguments for and against are dusted off and trotted out, leaving us with no clearer understanding of what it might entail and what the effect might be.

As will become clear, drug legalization is not a public policy option that lends itself to simplistic or superficial debate. It requires dissection and scrutiny of an order that has been remarkably absent despite the attention it perennially receives. Beyond discussion of some very generally defined proposals, there has been no detailed assessment of the operational meaning of legalization. There is not even a commonly accepted lexicon of terms to allow an intellectually rigorous exchange to take place. Legalization, as a consequence, has come to mean different things to different people. Some, for example, use legalization interchangeably with “decriminalization,” which usually refers to removing criminal sanctions for possessing small quantities of drugs for personal use. Others equate legalization, at least implicitly, with complete deregulation, failing in the process to acknowledge the extent to which currently legally available drugs are subject to stringent controls.

Unfortunately, the U.S. government—including the Clinton administration—has done little to improve the debate. Although it has consistently rejected any retreat from prohibition, its stance has evidently not been based on in- depth investigation of the potential costs and benefits. The belief that legalization would lead to an instant and dramatic increase in drug use is considered to be so self-evident as to warrant no further study. But if this is indeed the likely conclusion of any study, what is there to fear aside from criticism that relatively small amounts of taxpayer money had been wasted in demonstrating what everyone had believed at the outset? Wouldn’t such an outcome in any case help justify the continuation of existing policies and convincingly silence those—admittedly never more than a small minority—calling for legalization?

A real debate that acknowledges the unavoidable complexities and uncertainties surrounding the notion of drug legalization is long overdue. Not only would it dissuade people from making the kinds of casual if not flippant assertions—both for and against—that have permeated previous debates about legalization, but it could also stimulate a larger and equally critical assessment of current U.S. drug control programs and priorities.

First Ask the Right Questions

Many arguments appear to make legalization a compelling alternative to today’s prohibitionist policies. Besides undermining the black-market incentives to produce and sell drugs, legalization could remove or at least significantly reduce the very problems that cause the greatest public concern: the crime, corruption, and violence that attend the operation of illicit drug markets. It would presumably also diminish the damage caused by the absence of quality controls on illicit drugs and slow the spread of infectious diseases due to needle sharing and other unhygienic practices. Furthermore, governments could abandon the costly and largely futile effort to suppress the supply of illicit drugs and jail drug offenders, spending the money thus saved to educate people not to take drugs and treat those who become addicted.

However, what is typically portrayed as a fairly straightforward process of lifting prohibitionist controls to reap these putative benefits would in reality entail addressing an extremely complex set of regulatory issues. As with most if not all privately and publicly provided goods, the key regulatory questions concern the nature of the legally available drugs, the terms of their supply, and the terms of their consumption (see page 21).

What becomes immediately apparent from even a casual review of these questions—and the list presented here is by no means exhaustive—is that there is an enormous range of regulatory permutations for each drug. Until all the principal alternatives are clearly laid out in reasonable detail, however, the potential costs and benefits of each cannot begin to be responsibly assessed. This fundamental point can be illustrated with respect to the two central questions most likely to sway public opinion. What would happen to drug consumption under more permissive regulatory regimes? And what would happen to crime?

Relaxing the availability of psychoactive substances not already commercially available, opponents typically argue, would lead to an immediate and substantial rise in consumption. To support their claim, they point to the prevalence of opium, heroin, and cocaine addiction in various countries before international controls took effect, the rise in alcohol consumption after the Volstead Act was repealed in the United States, and studies showing higher rates of abuse among medical professionals with greater access to prescription drugs. Without explaining the basis of their calculations, some have predicted dramatic increases in the number of people taking drugs and becoming addicted. These increases would translate into considerable direct and indirect costs to society, including higher public health spending as a result of drug overdoses, fetal deformities, and other drug-related misadventures such as auto accidents; loss of productivity due to worker absenteeism and on-the-job accidents; and more drug-induced violence, child abuse, and other crimes, to say nothing about educational impairment.

Advocates of legalization concede that consumption would probably rise, but counter that it is not axiomatic that the increase would be very large or last very long, especially if legalization were paired with appropriate public education programs. They too cite historical evidence to bolster their claims, noting that consumption of opium, heroin, and cocaine had already begun falling before prohibition took effect, that alcohol consumption did not rise suddenly after prohibition was lifted, and that decriminalization of cannabis use in 11 U.S. states in the 1970s did not precipitate a dramatic rise in its consumption. Some also point to the legal sale of cannabis products through regulated outlets in the Netherlands, which also does not seem to have significantly boosted use by Dutch nationals. Public opinion polls showing that most Americans would not rush off to try hitherto forbidden drugs that suddenly became available are likewise used to buttress the pro-legalization case.

Neither side’s arguments are particularly reassuring. The historical evidence is ambiguous at best, even assuming that the experience of one era is relevant to another. Extrapolating the results of policy steps in one country to another with different sociocultural values runs into the same problem. Similarly, within the United States the effect of decriminalization at the state level must be viewed within the general context of continued federal prohibition. And opinion polls are known to be unreliable.

More to the point, until the nature of the putative regulatory regime is specified, such discussions are futile. It would be surprising, for example, if consumption of the legalized drugs did not increase if they were to become commercially available the way that alcohol and tobacco products are today, complete with sophisticated packaging, marketing, and advertising. But more restrictive regimes might see quite different outcomes. In any case, the risk of higher drug consumption might be acceptable if legalization could reduce dramatically if not remove entirely the crime associated with the black market for illicit drugs while also making some forms of drug use safer. Here again, there are disputed claims.

Opponents of more permissive regimes doubt that black market activity and its associated problems would disappear or even fall very much. But, as before, addressing this question requires knowing the specifics of the regulatory regime, especially the terms of supply. If drugs are sold openly on a commercial basis and prices are close to production and distribution costs, opportunities for illicit undercutting would appear to be rather small. Under a more restrictive regime, such as government-controlled outlets or medical prescription schemes, illicit sources of supply would be more likely to remain or evolve to satisfy the legally unfulfilled demand. In short, the desire to control access to stem consumption has to be balanced against the black market opportunities that would arise. Schemes that risk a continuing black market require more questions—about the new black markets operation over time, whether it is likely to be more benign than existing ones, and more broadly whether the trade-off with other benefits still makes the effort worthwhile.

The most obvious case is regulating access to drugs by adolescents and young adults. Under any regime, it is hard to imagine that drugs that are now prohibited would become more readily available than alcohol and tobacco are today. Would a black market in drugs for teenagers emerge, or would the regulatory regime be as leaky as the present one for alcohol and tobacco? A “yes” answer to either question would lessen the attractiveness of legalization.

What about the International Repercussions?

Not surprisingly, the wider international ramifications of drug legalization have also gone largely unremarked. Here too a long set of questions remains to be addressed. Given the longstanding U.S. role as the principal sponsor of international drug control measures, how would a decision to move toward legalizing drugs affect other countries? What would become of the extensive regime of multilateral conventions and bilateral agreements? Would every nation have to conform to a new set of rules? If not, what would happen? Would more permissive countries be suddenly swamped by drugs and drug consumers, or would traffickers focus on the countries where tighter restrictions kept profits higher? This is not an abstract question. The Netherlands’ liberal drug policy has attracted an influx of “drug tourists” from neighboring countries, as did the city of Zurich’s following the now abandoned experiment allowing an open drug market to operate in what became known as “Needle Park.” And while it is conceivable that affluent countries could soften the worst consequences of drug legalization through extensive public prevention and drug treatment programs, what about poorer countries?

Finally, what would happen to the principal suppliers of illicit drugs if restrictions on the commercial sale of these drugs were lifted in some or all of the main markets? Would the trafficking organizations adapt and become legal businesses or turn to other illicit enterprises? What would happen to the source countries? Would they benefit or would new producers and manufacturers suddenly spring up elsewhere? Such questions have not even been posed in a systematic way, let alone seriously studied.

Irreducible Uncertainties

Although greater precision in defining more permissive regulatory regimes is critical to evaluating their potential costs and benefits, it will not resolve the uncertainties that exist. Only implementation will do that. Because small-scale experimentation (assuming a particular locality’s consent to be a guinea pig) would inevitably invite complaints that the results were biased or inconclusive, implementation would presumably have to be widespread, even global, in nature.

Yet jettisoning nearly a century of prohibition when the putative benefits remain so uncertain and the potential costs are so high would require a herculean leap of faith. Only an extremely severe and widespread deterioration of the current drug situation, nationally and internationally—is likely to produce the consensus—again, nationally and internationally that could impel such a leap. Even then the legislative challenge would be stupendous. The debate over how to set the conditions for controlling access to each of a dozen popular drugs could consume the legislatures of the major industrial countries for years.

None of this should deter further analysis of drug legalization. In particular, a rigorous assessment of a range of hypothetical regulatory regimes according to a common set of variables would clarify their potential costs, benefits, and trade- offs. Besides instilling much-needed rigor into any further discussion of the legalization alternative, such analysis could encourage the same level of scrutiny of current drug control programs and policies. With the situation apparently deteriorating in the United States as well as abroad, there is no better time for a fundamental reassessment of whether our existing responses to this problem are sufficient to meet the likely challenges ahead.

Governance Studies

August 14, 2024

Matthew Collin, Karan Mishra, Andreas Økland

August 13, 2024

Vanda Felbab-Brown

August 12, 2024

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Should the United States Decriminalize the Possession of Drugs?

Several states have voted to reform their drug laws in response to the opioid epidemic and as a way to address high rates of drug-related incarceration. What do you think of this, and other, solutions?

By Nicole Daniels and Natalie Proulx

Students in U.S. high schools can get free digital access to The New York Times until Sept. 1, 2021.

Attitudes around drugs have changed considerably over the past few decades. Voters’ approval of drug-related initiatives in several states in the Nov. 3 election made that clear:

New Jersey, South Dakota, Montana and Arizona joined 11 other states that had already legalized recreational marijuana. Mississippi and South Dakota made medical marijuana legal, bringing the total to 35. The citizens of Washington, D.C., voted to decriminalize psilocybin, the organic compound active in psychedelic mushrooms. Oregon voters approved two drug-related initiatives. One decriminalized possession of small amounts of illegal drugs including heroin, cocaine and methamphetamines. (It did not make it legal to sell the drugs.) Another measure authorized the creation of a state program to license providers of psilocybin.

What is your reaction to these measures? Do you think more states — or even the entire country — should decriminalize marijuana? What about other drugs?

In “ This Election, a Divided America Stands United on One Topic ,” Jonah Engel Bromwich writes about the growing support to decriminalize drugs in the United States:

Election night represented a significant victory for three forces pushing for drug reform for different but interlocking reasons. There is the increasingly powerful cannabis industry. There are state governments struggling with budget shortfalls, hungry to fill coffers in the midst of a pandemic. And then there are the reform advocates, who for decades have been saying that imprisonment, federal mandatory minimum sentences and prohibitive cash bail for drug charges ruin lives and communities, particularly those of Black Americans. Decriminalization is popular, in part, because Americans believe that too many people are in jails and prisons, and also because Americans personally affected by the country’s continuing opioid crisis have been persuaded to see drugs as a public health issue.

Then, Mr. Bromwich explores the history of the “war on drugs”:

President Nixon started the war on drugs but it grew increasingly draconian during the Reagan administration. Nancy Reagan’s top priority was the antidrug campaign, which she pushed aggressively as her husband signed a series of punitive measures into law — measures shaped in part by Joseph R. Biden Jr., then a senator. “We want you to help us create an outspoken intolerance for drug use,” Mrs. Reagan said in 1986. “For the sake of our children, I implore each of you to be unyielding and inflexible in your opposition to drugs.” America’s airwaves were flooded with antidrug initiatives. An ad campaign that starred a man frying an egg and claiming “this is your brain on drugs” was introduced in 1987 and aired incessantly. Numerous animal mascots took up the cause of warning children about drugs and safety, including Daren the Lion, who educated children on drugs and bullying, and McGruff the Crime Dog, who taught children to open their hearts and minds to authority figures. In 1986 Congress passed a law mandating severe prison sentences for users of crack, who were disproportionately Black . In 1989, with prison rates rising, 64 percent of Americans surveyed said that drug abuse was the most serious problem facing the United States. The focus on crack meant that when pot returned to the headlines in the 1990s, it received comparatively cozy publicity . In 1996, California voters passed a measure allowing for the use of medical marijuana. Two years later, medical marijuana initiatives were approved by voters in four more states.

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Notre Dame Philosophical Reviews

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The Legalization of Drugs: For & Against

The Legalization of Drugs: For & Against

Douglas Husak and Peter de Marneffe, The Legalization of Drugs: For & Against , Cambridge University Press, 2005, 204pp., $18.99 (pbk), ISBN 0521546869.

Reviewed by William Hawk, James Madison University

In the United States the production, distribution and use of marijuana, heroin, and cocaine are crimes subjecting the offender to imprisonment. The Legalization of Drugs , appearing in the series "For and Against" edited by R. G. Frey for Cambridge University Press, raises the seldom-asked philosophical question of the justification, if any, of imprisoning persons for drug offenses.

Douglas Husak questions the justification for punishing persons who use drugs such as marijuana, heroin, and cocaine. He develops a convincing argument that imprisonment is never morally justified for drug use. Put simply, incarceration is such a harsh penalty that drug use, generally harmless to others and less harmful to the user than commonly supposed, fails to justify it. Any legal scheme that punishes drug users to achieve another worthy goal, such as creating a disincentive to future drug users, violates principles of justice.

Peter de Marneffe contends that under some circumstances society is morally justified in punishing persons who produce and distribute heroin. He argues a theoretical point that anticipated rises in drug abuse and consequent effects on young people may justify keeping heroin production and distribution illegal. According to de Marneffe's analysis, however, harsh prison penalties currently imposed on drug offenders are unjustified.

The points of discord between Husak's and de Marneffe's positions are serious but not as telling as is their implicit agreement. Current legal practices and policies which lead to lengthy incarceration of those who produce, distribute and use drugs such as marijuana, heroin, and cocaine are not, and cannot be, morally justified. Both arguments, against imprisoning drug users and for keeping heroin production illegal, merit a broad and careful reading.

The United States has erected an enormous legal structure involving prosecution and incarceration designed to prohibit a highly pleasurable, sometimes medically indicated and personally satisfying activity, namely using marijuana, heroin, and cocaine. At the same time, other pleasure-producing drugs, such as tobacco, alcohol, and caffeine, though legally regulated for the purposes of consumer safety and under-age consumption, can be purchased over the counter. As a result, while the health and safety risks of cigarettes may be greater than those proven to accompany marijuana, one can buy cigarettes from a vending machine and but go to prison for smoking marijuana. A rational legal system, according to Husak, demands a convincing, but as yet not forthcoming, explanation of why one pleasurable drug subjects users to the risk of imprisonment while the other is accommodated in restaurants.

Drug prohibitionists must face the problem that any "health risk" argument used to distinguish illicit drugs and subject offenders to prison sentences runs up against the known, yet tolerated, health risks of tobacco, as well as the additional health risks associated with incarceration. "Social costs" arguments targeting heroin or cocaine runs up against the known, yet tolerated, social costs of alcohol, as well as the additional social costs of incarceration. Even if one were to accept that illicit drugs were more harmful or exacted greater social costs than tobacco and alcohol (and the empirical studies referred to in the text do not generally support this thesis), that difference proves insufficient to justify imprisoning producers, distributors or especially users of illicit drugs.

Decriminalizing Drug Use. Douglas Husak presents a very carefully argued case for decriminalizing drug use. He begins his philosophical argument by clarifying the concepts and issues involved. To advocate the legalization of drugs calls for a legal system in which the production and sale of drugs are not criminal offenses. (p. 3) Criminalization of drugs makes the use of certain drugs a criminal offense, i.e. one deserving punishment. To argue for drug decriminalization, as Husak does, is not necessarily to argue for legalization of drugs . Husak entertains, but cautiously rejects the notion of a system where production and sale of drugs is illegal while use is not a crime. De Marneffe advocates such a system.

Punishing persons by incarceration demands justification. Since the state's use of punishment is a severe tool and incarceration is by its nature "degrading, demoralizing and dangerous" (p. 29) we must be able to provide "a compelling reason … to justify the infliction of punishment… ." (p. 34) Husak finds no compelling reason for imprisoning drug users. After considering four standard justifications for punishing drug users Husak concludes that "the arguments for criminalization are not sufficiently persuasive to justify the infliction of punishment."

Reasons to Criminalize Drug Use . 1) Drug users, it is claimed, should be punished in order to protect the health and well being of citizens . No doubt states are justified in protecting the health and well being of citizens. But does putting drug users in prison contribute to this worthy goal? Certainly not for those imprisoned. For those who might be deterred from using drugs the question is whether the drugs from which they are deterred by the threat of imprisonment actually pose a health risk. For one, Husak quotes research showing that currently illicit drugs do not obviously pose a greater health threat than alcohol or tobacco. For another, he quotes a statistic showing that approximately four times as many persons die annually from using prescribed medicines than die from using illegal drugs. In addition, one-fourth of all pack-a-day smokers lose ten to fifteen years of their lives but no one would entertain the idea of incarcerating smokers to further their health interests or in order to prevent non-smokers from beginning. In sum, Husak accepts that drug use poses health risks but contends that the risks are not greater than others that are socially accepted. Even if they were greater, imprisonment does not reduce, but compounds the health risks for prisoners.

2) Punishing drug users protects children . Husak here responds to de Marneffe's essay which focuses on potential drug abuse and promotes the welfare of children as a justification for keeping drug production and sale illegal. Husak finds punishing adolescent users a peculiar way to protect them. To punish one drug-using adolescent in order to prevent a non-using adolescent from using drugs is ineffective and also violates justice. Punishing adult users so that youth do not begin using drugs and do not suffer from neglect -- which is de Marneffe's position -- is not likely to prevent adolescents from becoming drug users, and even if it did, one would have to show that the harm prevented to the youth justifies imprisoning adults. Husak contends that punishing adults or youth, far from protecting youth, puts them at greater risk.

3) Some, e.g. former New York City mayor Guiliani, argue that punishing drug use prevents crime . Husak, conceding a connection between drug use and crime, turns the argument upside-down, showing how punishment increases rather than decreases crime. For one, criminalization of drugs forces the drug industry to settle disputes extra-legally. Secondly, drug decriminalization would likely lower drug costs thereby reducing economic crimes. Thirdly, to those who contend that illicit drugs may increase violence and aggression Husak responds that: a) empirical evidence does not support marijuana or heroin as causes of violence and b) empirical evidence does support alcohol, which is decriminalized, as leading to violence. Husak concludes "if we propose to ban those drugs that are implicated in criminal behavior, no drug would be a better candidate for criminalization than alcohol." (p. 70) Finally, punishing drug users likely increases crime rates since those imprisoned for drug use are released with greater tendencies and skills for future criminal activity.

4) Drug use ought to be punished because using drugs is immoral . In addition to standard philosophical objections to legal moralism, Husak contends that there is no good reason to think that recreational drug use is immoral. Drug use violates no rights. Other recreationally used drugs such as alcohol, tobacco or caffeine are not immoral. The only accounts according to which drug use is immoral are religiously based and generally not shared in the citizenry. Husak argues that legal moralism fails, and with it the attempts to justify imprisoning drug users because of health and well-being, protecting children, or reducing crime. Husak concludes, "If I am correct, prohibitionists are more clearly guilty of immorality than their opponents. The wrongfulness of recreational drug use, if it exists at all, pales against the immorality of punishing drug users." (p. 82)

Reasons to Decriminalize Drug Use. Husak's positive case for decriminalizing drug use begins with acknowledgement that drug use is or may be highly pleasurable. In addition, some drugs aid relaxation, others increase energy and some promote spiritual enlightenment or literary and artistic creativity. The simple fun and euphoria attendant to drug use should count for permitting it.

The fact that criminalization of drug use proves to be counter-productive provides Husak a set of final substantial reasons for decriminalizing use. Criminalizing drugs proves counter-productive along several different lines: 1) criminalization is aimed and selectively enforced against minorities, 2) public health risks increase because drugs are dealt on the street, 3) foreign policy is negatively affected by corrupt governments being supported solely because they support anti-drug policies, 4) a frank and open discussion about drug policy is impossible in the United States, 5) civil liberties are eroded by drug enforcement, 6) some government corruption stems from drug payoffs and 7) criminalization costs tens of billions of dollars per year.

Douglas Husak provides the conceptual clarity needed to work one's way through the various debates surrounding drug use and the law. He establishes a high threshold that must be met in order to justify the state's incarcerating someone. Having laid this groundwork Husak demonstrates that purported justifications for drug criminalization fail and that good reasons for decriminalizing drug use prevail. For persons who worry about what drug decriminalization means for children, Husak counsels that there is more to fear from prosecution and conviction of youth for using drugs than there is to fear from the drugs themselves.

Against Legalizing Drug Production and Distribution. Peter de Marneffe offers an argument against drug legalization . The argument itself is simple. If drugs are legalized, there will be more drug abuse. If there is more drug abuse that is bad. Drug abuse is sufficiently bad to justify making drug production and distribution illegal. Therefore, drugs should not be legalized. The weight of this argument is carried by the claim that the badness of drug abuse is sufficient to justify making drug production and sale illegal.

De Marneffe centers his argument on heroin. Heroin, he contends, is highly pleasurable but sharply depresses motivation to achieve worthwhile goals and meet responsibilities. Accordingly, children in an environment where heroin is legal will be subjected to neglect by heroin using parents and, if they themselves use heroin, they will be harmed by diminished motivation for achievement for the remainder of their lives. It is this later harm to the ambition and motivation of young people that, according to de Marneffe, justifies criminalizing heroin production and sale. As he puts it:

… the risk of lost opportunities that some individuals would bear as the result of heroin legalization justifies the risks of criminal liability and other burdens that heroin prohibition imposes on other individuals. The legalization of heroin would create a social environment -- call it the legalization environment -- in which some children would be at a substantially higher risk of irresponsible heroin abuse by their parents and in which some adolescents would be at a substantially higher risk of self-destructive heroin abuse. (p. 124)

Are the liberties of individual adult drug producers, distributors and users sacrificed? Yes, but this may be justified by de Marneffe's "burdens principle." According to the burdens principle, "the government violates a person's moral rights in adopting a policy that limits her liberty if and only if in adopting this policy the government imposes a burden on her that is substantially worse than the worst burden anyone would bear in the absence of this policy." (p. 159) According to this, de Marneffe claims that burdens on drug vendors or users may be justified by the prevention of harms to a particular individual or individuals. As he puts it:

What I claim in favor of heroin prohibition is that the reasons of at least one person to prefer her situation in a prohibition environment outweigh everyone else's reasons to prefer his or her situation in a legalization environment, assuming that the penalties are gradual and proportionate and other relevant conditions are met. (p. 161)

According to this view, the objective interest of a single adolescent in not losing ambition, motivation and drive justifies the imposition of burdens on other youth and adults who would prefer using drugs. Although Johnny might choose heroin use, his objective interest is for future motivation and ambition that is not harmed by heroin use.

De Marneffe's "burdens principle" seems to hold the whole society hostage to the objective liberty interests of one individual. Were this principle applied to drug producers or distributors who faced imprisonment it seems that imprisonment could not be justified. I suspect a concern for consistency here gives de Marneffe reason to make drug production and distribution illegal but without attaching harsh prison sentences for offenders. He advocates an environment where drugs are not legal, in order to protect youth against both abuse and their own choices that may cause them to become unmotivated, but recognizes that prison sentences are unjustified as a way to support such a system.

In The Legalization of Drugs the reader gets two interesting arguments. Douglas Husak makes a compelling case against punishing drug users. His position amounts to drug decriminalization with skepticism toward making drug production and sale illegal. On the other side, Peter de Marneffe justifies making drug production and sale illegal based upon the diminishment of future interests of young people. De Marneffe introduces a "burdens principle" which is likely much too strong a commitment to individual interests than could ever be realized in a civil society. In both instances, the reader is treated to arguments that effectively undermine current drug policy. The book provides philosophical argumentation that should stimulate a societal conversation about the justifiability of current drug laws.

Legalize and regulate non-medical use of all drugs, prioritizing opioids

Personal possession and use of all drugs in Canada should be decriminalized immediately, but we need to go further. To combat the illegal market and save more lives, we need to legalize and regulate drugs. We should prioritize the provision of safe access to opioids given the toll the opioid crisis is exacting. Legalization and regulation are the options that cause the least harm.

The lessons of legalization and regulation of cannabis

It’s been two years since recreational cannabis was legalized and regulated, something that once seemed impossible. Cannabis reforms have not been without problems, but they have been widely regarded as successful. The criminalization of individuals for merely using and possessing that substance has essentially ended. A drug long thought to be limited to the criminal element in dark alleys has been hauled into the daylight and bought and sold within a tight and transparent regulatory framework.

With legalization has come a fundamental shift in thinking that non-medical use of drugs should be addressed as a public-health issue, not with use of penal sanctions. People who use drugs should not be punished – and they should get support if they need it.

Increasing support for decriminalization

There has been recent, significant momentum toward decriminalization of drugs for personal use. Those endorsing such reform include the Canadian Association of Chiefs of Police , The Canadian Association of Social Workers, many medical officers of health, including Bonnie Henry, the New Democratic Party and B.C. Premier John Horgan along with the Vancouver city council and Jane Philpott, the former minister of health. An August editorial in the Globe and Mail also voiced support for it.

The Prosecution Service of Canada has begun to pull back from prosecution for personal possession of drugs, limiting it to cases involving public safety, according to a directive it issued in August. Decriminalization combined with other harm-reduction strategies such as safe-injection sites can lower rates of fatal overdoses and HIV infection caused by tainted needles. It can also create a path to help for those who are dependent.

The positive impact of decriminalization is not theoretical. Portugal has had mostly positive results from its decision two decades ago to decriminalize personal possession and use of all drugs. There has been no significant increase in harmful use, including for kids; the country did not become a haven for people coming to it just to use drugs; HIV infections and drug overdoses have gone down.

A ballot measure in Oregon to decriminalize drugs passed in November’s U.S. election with strong support. Norway is also proceeding to roll back penal sanctions for consumption of substances. It’s time for Canada to follow suit and decriminalize drugs now.

Legalize to confront the illicit market

Decriminalization, however, does not address the illicit supply of drugs coming from ruthless criminals making billions of untaxed dollars and peddling tainted substances that cause sickness and death. Legalization and regulation confront that system of “ narconomics .” Yet even just decriminalization has met with consistent opposition from Prime Minister Justin Trudeau. He has said repeatedly that legalizing and regulating cannabis is as far as he is prepared to go to reform laws dealing with illicit drugs.

Legalizing the sale of illegal drugs seems a bridge too far despite cannabis legalization. There is widespread acceptance that the war on drugs has been a failure. Consumption for some drugs has increased, the illicit market is thriving, and individual lives are ruined.

But many people who are open to arguments favouring legalization wonder how it would be done. How is it possible to create an acceptable legal market for all non-medical use of drugs? That question must be answered.

A recent effort to address this critical challenge was undertaken by the British think tank Transform Drug Policy Foundation with the publication in October of How to Regulate Stimulants: A Practical Guide . Transform focuses on the reform of laws that criminalize non-medical use of drugs. It is highly regarded and consulted with the government of Canada regarding the legalization of cannabis. It has published work on legalization. The prestigious Global Commission on Drug Policy has also published such reports . Because stimulants, especially cocaine, are widely used, the October report focused on these drugs. But its discussion about how to regulate effectively and responsibly can be applied to any substances.

The opioid crisis and legalization

The numbers are horrific . Within the COVID-19 pandemic the opioid epidemic has taken a deadly toll. In B.C. there were more than 100 “illicit drug toxicity” deaths a month from March to August of this year – far more than in a comparable period last year (181 in June 2020 vs. 76 in June 2019). Data from Ontario indicate that the number of fatalities from opioids in that province increased by about 50 per cent this year over last year. In Alberta, related deaths from April to June this year were 302, significantly exceeding the previous three-month high of 211 in 2018. Urgent action is required to protect individuals from street drugs.

There is already something of a pathway to legalization of opioids in this country. Some police forces have stopped charging for simple possession and use of opioids, but the practice is uneven . Such lack of uniformity explains the increasing support for formal decriminalization. In addition, the federal government is permitting “ safe supply” projects . In these instances, dependent individuals are given access to opioids so that they are not consuming street drugs, which can be toxic. But the future of such projects is uncertain, and we need more of them.

So – in constrained and shifting circumstances – there is a sort of legalization and regulation unfolding regarding opioids: some de facto decriminalization combined with some safe supply. But much more needs to be done – and quickly.

There is room for debate about the details of legalization and regulation of non-medical use of drugs. Transform, the British think tank, focuses the debate by breaking down the regulatory scheme into components including production, distribution outlets, availability, higher- and lower- risk products. There is much in its October report to guide policy-makers – if there is the political will to move forward with legalization and regulation. Transform is also clear about the goals of drug policy: “improve public health, protect human rights and promote social justice,” as mentioned in the executive summary of its report .

These components analyzed by Transform can be applied to the production and sale of opioids for non-medical use to sketch a route forward. As a starting point, provision of safe supply could be expanded and improved . A further step could be to allow doctors to prescribe heroin (an opioid) for those adults determined to use the drug despite counselling about its dangers. At some level this is a horrible suggestion, but it is better than having people get these drugs on the street from a criminal network that pays no taxes, has committed crimes for a thriving system of narconomics , and doesn’t care whether the drug is tainted. In all of this we should remember that drugs were largely available with little legal restriction until the 1900s. Punishing people for using drugs was, in many ways, a project of the 20th century.

Expanding safe supply and prescribing heroin both fall short of full legalization of opioids. But together with decriminalization, they would end criminalization of people who use drugs, further confront the illicit market, and save more lives. After careful assessment of the impacts, further measures such as those suggested by Transform could be contemplated.

The least bad policy

Legalization of drugs is no cause for celebration. It’s no panacea for all the harms caused by drugs, including the ones that are now legal. It’s also not a basis for encouraging drug use. Legalization needs to be accompanied by widely available support for those who are dependent.

Many details must be hammered out, including the appropriate conditions for prescribing opioids for medical purposes . But when measured against the costs and pain of the current situation, legalization together with regulation is, as The Economist somberly put it back in 2009: “The least bad policy.”

Photo: Shutterstock.com, by Darwin Brandis

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What is Public Health?

The Evidence—and Lack Thereof—About Cannabis

Research is still needed on cannabis’s risks and benefits.

Lindsay Smith Rogers

Although the use and possession of cannabis is illegal under federal law, medicinal and recreational cannabis use has become increasingly widespread.

Thirty-eight states and Washington, D.C., have legalized medical cannabis, while 23 states and D.C. have legalized recreational use. Cannabis legalization has benefits, such as removing the product from the illegal market so it can be taxed and regulated, but science is still trying to catch up as social norms evolve and different products become available.

In this Q&A, adapted from the August 25 episode of Public Health On Call , Lindsay Smith Rogers talks with Johannes Thrul, PhD, MS , associate professor of Mental Health , about cannabis as medicine, potential risks involved with its use, and what research is showing about its safety and efficacy.

Do you think medicinal cannabis paved the way for legalization of recreational use?

The momentum has been clear for a few years now. California was the first to legalize it for medical reasons [in 1996]. Washington and Colorado were the first states to legalize recreational use back in 2012. You see one state after another changing their laws, and over time, you see a change in social norms. It's clear from the national surveys that people are becoming more and more in favor of cannabis legalization. That started with medical use, and has now continued into recreational use.

But there is a murky differentiation between medical and recreational cannabis. I think a lot of people are using cannabis to self-medicate. It's not like a medication you get prescribed for a very narrow symptom or a specific disease. Anyone with a medical cannabis prescription, or who meets the age limit for recreational cannabis, can purchase it. Then what they use it for is really all over the place—maybe because it makes them feel good, or because it helps them deal with certain symptoms, diseases, and disorders.

Does cannabis have viable medicinal uses?

The evidence is mixed at this point. There hasn’t been a lot of funding going into testing cannabis in a rigorous way. There is more evidence for certain indications than for others, like CBD for seizures—one of the first indications that cannabis was approved for. And THC has been used effectively for things like nausea and appetite for people with cancer.

There are other indications where the evidence is a lot more mixed. For example, pain—one of the main reasons that people report for using cannabis. When we talk to patients, they say cannabis improved their quality of life. In the big studies that have been done so far, there are some indications from animal models that cannabis might help [with pain]. When we look at human studies, it's very much a mixed bag.

And, when we say cannabis, in a way it's a misnomer because cannabis is so many things. We have different cannabinoids and different concentrations of different cannabinoids. The main cannabinoids that are being studied are THC and CBD, but there are dozens of other minor cannabinoids and terpenes in cannabis products, all of varying concentrations. And then you also have a lot of different routes of administration available. You can smoke, vape, take edibles, use tinctures and topicals. When you think about the explosion of all of the different combinations of different products and different routes of administration, it tells you how complicated it gets to study this in a rigorous way. You almost need a randomized trial for every single one of those and then for every single indication.

What do we know about the risks of marijuana use?

Cannabis use disorder is a legitimate disorder in the DSM. There are, unfortunately, a lot of people who develop a problematic use of cannabis. We know there are risks for mental health consequences. The evidence is probably the strongest that if you have a family history of psychosis or schizophrenia, using cannabis early in adolescence is not the best idea. We know cannabis can trigger psychotic symptoms and potentially longer lasting problems with psychosis and schizophrenia.

It is hard to study, because you also don't know if people are medicating early negative symptoms of schizophrenia. They wouldn't necessarily have a diagnosis yet, but maybe cannabis helps them to deal with negative symptoms, and then they develop psychosis. There is also some evidence that there could be something going on with the impact of cannabis on the developing brain that could prime you to be at greater risk of using other substances later down the road, or finding the use of other substances more reinforcing.

What benefits do you see to legalization?

When we look at the public health landscape and the effect of legislation, in this case legalization, one of the big benefits is taking cannabis out of the underground illegal market. Taking cannabis out of that particular space is a great idea. You're taking it out of the illegal market and giving it to legitimate businesses where there is going to be oversight and testing of products, so you know what you're getting. And these products undergo quality control and are labeled. Those labels so far are a bit variable, but at least we're getting there. If you're picking up cannabis at the street corner, you have no idea what's in it.

And we know that drug laws in general have been used to criminalize communities of color and minorities. Legalizing cannabis [can help] reduce the overpolicing of these populations.

What big questions about cannabis would you most like to see answered?

We know there are certain, most-often-mentioned conditions that people are already using medical cannabis for: pain, insomnia, anxiety, and PTSD. We really need to improve the evidence base for those. I think clinical trials for different cannabis products for those conditions are warranted.

Another question is, now that the states are getting more tax revenue from cannabis sales, what are they doing with that money? If you look at tobacco legislation, for example, certain states have required that those funds get used for research on those particular issues. To me, that would be a very good use of the tax revenue that is now coming in. We know, for example, that there’s a lot more tax revenue now that Maryland has legalized recreational use. Maryland could really step up here and help provide some of that evidence.

Are there studies looking into the risks you mentioned?

Large national studies are done every year or every other year to collect data, so we already have a pretty good sense of the prevalence of cannabis use disorder. Obviously, we'll keep tracking that to see if those numbers increase, for example, in states that are legalizing. But, you wouldn't necessarily expect to see an uptick in cannabis use disorder a month after legalization. The evidence from states that have legalized it has not demonstrated that we might all of a sudden see an increase in psychosis or in cannabis use disorder. This happens slowly over time with a change in social norms and availability, and potentially also with a change in marketing. And, with increasing use of an addictive substance, you will see over time a potential increase in problematic use and then also an increase in use disorder.

If you're interested in seeing if cannabis is right for you, is this something you can talk to your doctor about?

I think your mileage may vary there with how much your doctor is comfortable and knows about it. It's still relatively fringe. That will very much depend on who you talk to. But I think as providers and professionals, everybody needs to learn more about this, because patients are going to ask no matter what.

Lindsay Smith Rogers, MA, is the producer of the Public Health On Call podcast , an editor for Expert Insights , and the director of content strategy for the Johns Hopkins Bloomberg School of Public Health.

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The most convincing argument for legalizing LSD, shrooms, and other psychedelics

by German Lopez

I have a profound fear of death. It’s not bad enough to cause serious depression or anxiety. But it is bad enough to make me avoid thinking about the possibility of dying — to avoid a mini existential crisis in my mind.

But it turns out there may be a better cure for this fear than simply not thinking about it. It’s not yoga, a new therapy program, or a medicine currently on the (legal) market. It’s psychedelic drugs — LSD, ibogaine, and psilocybin, which is found in magic mushrooms.

This is the case for legalizing hallucinogens. Although the drugs have gotten some media attention in recent years for helping cancer patients deal with their fear of death and helping people quit smoking, there’s also a similar potential boon for the nonmedical, even recreational psychedelic user. As hallucinogens get a renewed look by researchers, they’re finding that the substances may improve almost anyone’s mood and quality of life — as long as they’re taken in the right setting, typically a controlled environment.

This isn’t something that even drug policy reformers are comfortable calling for yet. “There’s not any political momentum for that right now,” Jag Davies, who focuses on hallucinogen research at the Drug Policy Alliance, said, citing the general public’s views of psychedelics as extremely dangerous — close to drugs like crack cocaine, heroin, and meth.

But it’s an idea that experts and researchers are taking more seriously. And while the studies are new and ongoing, and a national regulatory model for legal hallucinogens is practically nonexistent, the available research is very promising — enough to reconsider the demonization and prohibition of these potentially amazing drugs.

Hallucinogens’ potentially huge benefit: ego death

Mushroom, mushroom.

The most remarkable potential benefit of hallucinogens is what’s called “ego death,” an experience in which people lose their sense of self-identity and, as a result, are able to detach themselves from worldly concerns like a fear of death, addiction, and anxiety over temporary — perhaps exaggerated — life events.

When people take a potent dose of a psychedelic, they can experience spiritual, hallucinogenic trips that can make them feel like they’re transcending their own bodies and even time and space. This, in turn, gives people a lot of perspective — if they can see themselves as a small part of a much broader universe, it’s a lot easier for them to discard personal, relatively insignificant and inconsequential concerns about their own lives and death.

That may sound like pseudoscience. And the research on hallucinogens is so early that scientists don’t fully grasp how it works. But it’s a concept that’s been found in some medical trials, and something that many people who’ve tried hallucinogens can vouch for experiencing. It’s one of the reasons why preliminary , small studies and research from the 1950s and ‘60s found hallucinogens can treat — and maybe cure — addiction, anxiety, and obsessive-compulsive disorder.

Charles Grob, a UCLA professor of psychiatry and pediatrics who studies psychedelics, conducted a study that gave psilocybin to late-stage cancer patients. “The reports I got back from the subjects, from their partners, from their families were very positive — that the experience was of great value, and it helped them regain a sense of purpose, a sense of meaning to their life,” he told me in 2014. “The quality of their lives notably improved.”

In a fantastic look at the research, Michael Pollan at the New Yorker captured the phenomenon through the stories of cancer patients who participated in hallucinogen trials:

Death looms large in the journeys taken by the cancer patients. A woman I’ll call Deborah Ames, a breast-cancer survivor in her sixties (she asked not to be identified), described zipping through space as if in a video game until she arrived at the wall of a crematorium and realized, with a fright, “I’ve died and now I’m going to be cremated. The next thing I know, I’m below the ground in this gorgeous forest, deep woods, loamy and brown. There are roots all around me and I’m seeing the trees growing, and I’m part of them. It didn’t feel sad or happy, just natural, contented, peaceful. I wasn’t gone. I was part of the earth.” Several patients described edging up to the precipice of death and looking over to the other side. Tammy Burgess, given a diagnosis of ovarian cancer at fifty-five, found herself gazing across “the great plain of consciousness. It was very serene and beautiful. I felt alone but I could reach out and touch anyone I’d ever known. When my time came, that’s where my life would go once it left me and that was O.K.”

But Mark Kleiman, a drug policy expert at New York University’s Marron Institute, noted that these benefits don’t apply only to terminally ill patients. The studies conducted so far have found benefits that apply to anyone : a reduced fear of death, greater psychological openness, and increased life satisfaction.

“It’s not required to have a disease to be afraid of dying,” Kleiman said. “But it’s probably an undesirable condition if you have the alternative available. And there’s now some evidence that these experiences can make the person less afraid to die.”

Kleiman added, “The obvious application is people who are currently dying with a terminal diagnosis. But being born is a terminal diagnosis. And people’s lives might be better if they live out of the valley of the shadow of death.”

Again, the current research on all of this is early, with much of the science still relying on studies from the ‘50s and ‘60s. But the most recent preliminary findings are promising enough that experts like Kleiman are cautiously considering how to build a model that would let people take these potentially beneficial drugs legally — while also acknowledging that psychedelics do pose some big risks.

The two big risks of hallucinogens: accidents and bad trips

Charles Grob, a UCLA professor of psychiatry and pediatrics, is leading the way in psychedelic research.

Hallucinogens aren’t perfectly safe, but they’re not dangerous in the way some people might think. As Grob previously told me , there’s little to no chance that someone will become addicted to psychedelics — they’re not physically addictive like heroin or tobacco, and the experiences are so demanding and draining that a great majority of people simply won’t be interested in constantly taking the drugs. He also said that hallucinogen persisting perception disorder, which can cause the disturbances widely known as “flashbacks,” is “uncommon, but you will see it, particularly among someone who has taken hallucinogens a lot.”

Kleiman drew a comparison to marijuana to explain the risks. “The risk with cannabis is, primarily, that you lose control of your cannabis taking,” he said. “The risk with LSD is primarily that you’ll do something stupid to ruin the experience, or you’ll have such a scary experience that it’ll leave you damaged. But those are safety risks rather than addiction risks.”

This gets to the two major dangers of hallucinogens: accidents and bad trips. The first risk is similar to what you’d expect from other drugs: When people are intoxicated in any way, they’re more prone to doing bad, dumb things. As Kleiman explained, “People take LSD and think they can fly and jump off buildings. It’s true that it’s a drug warrior fairy tale, but it’s also true in that it actually happens. People drop acid and run out in traffic. People do stupid shit under high doses of psychedelics.”

Bad trips are also a concern. A bad psychedelic experience can result in psychotic episodes, a lost sense of reality, and even long-term psychological trauma in very rare situations, especially among people using other drugs or with a history of mental health issues. Just like psychedelics can lead to long-term psychological benefits, they can lead to long-term psychological pain.

These risks are why not many people are seriously discussing legalizing hallucinogens in the same way the US allows alcohol or is now beginning to allow marijuana. But the potential benefits of hallucinogens are leading some experts to consider how these drugs could be legalized in some capacity.

“I think it’s a bad idea to treat hallucinogens like we treat cocaine or cannabis,” Kleiman said. “They pose different risks and offer different benefits.” He added, “But I don’t think we’re ever going to free these substances from careful legal control.”

How hallucinogens can be legalized

Drop some LSD — but maybe only in a controlled environment.

So how can you maximize the benefits and minimize the risks? The most convincing idea so far is letting people take psychedelics in a controlled setting, in which multiple participants can be watched over by trained supervisors who ensure the experience doesn’t go poorly.

So far, this is what the medical side has focused on: The typical medical trial involves doctors watching over a deathly ill patient or someone dealing with addiction who takes psilocybin. But if the concept is expanded to allow nonmedical users, then perhaps professionals who aren’t doctors but are trained in guiding someone through a trip could take up the role. “I imagine someone who has training in managing that experience, and a license, and liability insurance, and a facility,” Kleiman said.

Here’s how it would work: A psychedelic user would go through some sort of preparation period to make sure she knows what she’s getting into. Then she could make an appointment at a place offering these services. She would show up at this appointment, take the drug of her choice (or whatever the facility provides), and wait to allow it to kick in. As the trip occurs, a supervisor would watch over the user — not being too pushy, but making sure he’s available to guide her through any rough spots. In some studies, doctors have also prepared certain activities — a soundtrack or food, for example — that may help set the right mood and setting for someone on psychedelics. Different places will likely experiment with different approaches, including how many people can participate at once and how a room should look.

The most convincing idea so far is letting people take psychedelics in a controlled setting

Kleiman also envisions a potential system in which people can eventually graduate to using the drug solo. “It’s like Red Cross water safety instruction,” he said. “You start out, you’re a newbie. You don’t go into the pool without a trained, certified person to watch you, guide you, and keep you safe. After a while, your teacher gives you a test to certify that you’re safe to be in the water alone. And you might even get certified to become a trainer, so you can guide newbies yourself.”

If pulled off correctly, this would maximize the best possible outcomes and minimize the worst. Supervisors could help prevent accidents, and they could walk people through good and bad trips, letting users relax and get something meaningful out of the experience.

There are risks to the controlled setting. If a supervisor is poorly trained or malicious, it could lead to a horrific trip that could actually worsen someone’s mental state. This is why regulation and licensing will be crucial to getting the idea right.

Ethan Nadelmann, executive director of the Drug Policy Alliance, argued for a looser model that could, for example, allow psychedelics to be sold over the counter. “You dramatically decrease the black market. So long as you have people who have to go through some sort of gatekeeper, or who can be denied, you’re going to continue to have a black market,” Nadelmann said. “Secondly, this means the percent of consumers who got a product of known potency and purity from a reliable source would increase.”

But the black market demand for psychedelics is very small, with only 0.5 percent of Americans 12 and older in 2013 saying they used hallucinogens in the past month. So allowing over-the-counter sales would likely have a tiny benefit at best on public health and criminal groups’ profits from the black market.

The debate about which model works best will likely go on for some time, especially if different places test different approaches. There’s no doubt it will be tricky to hash out exactly how to legalize and regulate these drugs, as some states are learning with marijuana .

But if we know the benefits to public health and well-being are real, it’s irresponsible to let the potential go untapped. It may soon be time for America to seriously consider legalizing LSD, magic mushrooms, and other psychedelic drugs.

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Some numbers in this week’s journal bear reflection. The war on drugs costs each UK taxpayer an estimated £400 a year. The UK is now the world’s largest exporter of legal cannabis, yet recreational and medicinal use are criminalised. Scotland has the EU’s highest rate of drug related deaths, double that of 10 years ago. The global trade in illicit drugs is worth £236bn, but this money fuels organised crime and human misery. Why should it not instead fund public services?

A growing number of countries are taking a more enlightened route, say Jason Reed and Paul Whitehouse (doi: 10.1136/bmj.k1999 ). In Portugal, where non-violent possession of drugs has been decriminalised, consumption hasn’t increased but drug related deaths have fallen considerably. In the Netherlands, the USA, and now Canada, regulated markets for the sale of cannabis generate substantial tax revenues.

Meanwhile, in the UK vast sums are spent on prosecuting individuals and trying vainly to interrupt the flow of drugs into cities, carried along “county lines” by vulnerable children. Reed and Whitehouse speak for the Law Enforcement Action Partnership, which calls for legalisation and regulation. They say that the money could instead be spent on quality control, education, treatment for drug users, and child protection. Revenues could be diverted from criminal gangs into government coffers.

When law enforcement officers call for drugs to be legalised, we have to listen. So too when doctors speak up. Last month the Royal College of Physicians took the important step of coming out in favour of decriminalisation, (doi: 10.1136/bmj.k1832 ) joining the BMA, the Faculty of Public Health, and the Royal Society of Public Health in supporting drug policy reform (doi: 10.1136/bmj.j3461 .)

This is not about whether you think drugs are good or bad. It is an evidence based position entirely in line with the public health approach to violent crime. In their Editorial, John Middleton and Jonathan Shepherd say that the UK’s epidemic of gun and knife crime is in part due to the increased availability of fentanyl and crack cocaine (doi: 10.1136/bmj.k1967 ). The UK government’s newly released Serious Violence Strategy acknowledges the link between drug prohibition and violence, but it proposes spending £40m on prohibition related policies. Reed and Whitehouse say it will do nothing to tackle drug related crime.

The BMJ is firmly behind efforts to legalise, regulate, and tax the sale of drugs for recreational and medicinal use. This is an issue on which doctors can and should make their voices heard.

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Most Americans Favor Legalizing Marijuana for Medical, Recreational Use

Legalizing recreational marijuana viewed as good for local economies; mixed views of impact on drug use, community safety, table of contents.

The impact of legalizing marijuana for recreational use
Partisan differences on impact of recreational use of marijuana
Demographic, partisan differences in views of marijuana legalization
Views of marijuana legalization vary by age within both parties
Views of the effects of legalizing recreational marijuana among racial and ethnic groups
Wide age gap on views of impact of legalizing recreational marijuana
Acknowledgments
The American Trends Panel survey methodology

Pew Research Center conducted this study to understand the public’s views about the legalization of marijuana in the United States. For this analysis, we surveyed 5,140 adults from Jan. 16 to Jan. 21, 2024. Everyone who took part in this survey is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology .

Here are the questions used for the report and its methodology .

As more states pass laws legalizing marijuana for recreational use , Americans continue to favor legalization of both medical and recreational use of the drug.

Pie chart shows Only about 1 in 10 U.S. adults say marijuana should not be legal at all

An overwhelming share of U.S. adults (88%) say marijuana should be legal for medical or recreational use.

Nearly six-in-ten Americans (57%) say that marijuana should be legal for medical and recreational purposes, while roughly a third (32%) say that marijuana should be legal for medical use only.

Just 11% of Americans say that the drug should not be legal at all.

Opinions about marijuana legalization have changed little over the past five years, according to the Pew Research Center survey, conducted Jan. 16-21, 2024, among 5,14o adults.

While a majority of Americans continue to say marijuana should be legal , there are varying views about the impacts of recreational legalization.

Chart shows How Americans view the effects of legalizing recreational marijuana

About half of Americans (52%) say that legalizing the recreational use of marijuana is good for local economies; just 17% think it is bad and 29% say it has no impact.

More adults also say legalizing marijuana for recreational use makes the criminal justice system more fair (42%) than less fair (18%); 38% say it has no impact.

However, Americans have mixed views on the impact of legalizing marijuana for recreational use on:

Use of other drugs: About as many say it increases (29%) as say it decreases (27%) the use of other drugs, like heroin, fentanyl and cocaine (42% say it has no impact).
Community safety: More Americans say legalizing recreational marijuana makes communities less safe (34%) than say it makes them safer (21%); 44% say it has no impact.

There are deep partisan divisions regarding the impact of marijuana legalization for recreational use.

Chart shows Democrats more positive than Republicans on impact of legalizing marijuana

Majorities of Democrats and Democratic-leaning independents say legalizing recreational marijuana is good for local economies (64% say this) and makes the criminal justice system fairer (58%).

Fewer Republicans and Republican leaners say legalization for recreational use has a positive effect on local economies (41%) and the criminal justice system (27%).

Republicans are more likely than Democrats to cite downsides from legalizing recreational marijuana:

42% of Republicans say it increases the use of other drugs, like heroin, fentanyl and cocaine, compared with just 17% of Democrats.
48% of Republicans say it makes communities less safe, more than double the share of Democrats (21%) who say this.

Sizable age and partisan differences persist on the issue of marijuana legalization though small shares of adults across demographic groups are completely opposed to it.

Chart shows Views about legalizing marijuana differ by race and ethnicity, age, partisanship

Older adults are far less likely than younger adults to favor marijuana legalization.

This is particularly the case among adults ages 75 and older: 31% say marijuana should be legal for both medical and recreational use.

By comparison, half of adults between the ages of 65 and 74 say marijuana should be legal for medical and recreational use, and larger shares in younger age groups say the same.

Republicans continue to be less supportive than Democrats of legalizing marijuana for both legal and recreational use: 42% of Republicans favor legalizing marijuana for both purposes, compared with 72% of Democrats.

There continue to be ideological differences within each party:

34% of conservative Republicans say marijuana should be legal for medical and recreational use, compared with a 57% majority of moderate and liberal Republicans.
62% of conservative and moderate Democrats say marijuana should be legal for medical and recreational use, while an overwhelming majority of liberal Democrats (84%) say this.

Along with differences by party and age, there are also age differences within each party on the issue.

Chart shows Large age differences in both parties in views of legalizing marijuana for medical and recreational use

A 57% majority of Republicans ages 18 to 29 favor making marijuana legal for medical and recreational use, compared with 52% among those ages 30 to 49 and much smaller shares of older Republicans.

Still, wide majorities of Republicans in all age groups favor legalizing marijuana at least for medical use. Among those ages 65 and older, just 20% say marijuana should not be legal even for medical purposes.

While majorities of Democrats across all age groups support legalizing marijuana for medical and recreational use, older Democrats are less likely to say this.

About half of Democrats ages 75 and older (53%) say marijuana should be legal for both purposes, but much larger shares of younger Democrats say the same (including 81% of Democrats ages 18 to 29). Still, only 7% of Democrats ages 65 and older think marijuana should not be legalized even for medical use, similar to the share of all other Democrats who say this.

Chart shows Hispanic and Asian adults more likely than Black and White adults to say legalizing recreational marijuana negatively impacts safety, use of other drugs

Substantial shares of Americans across racial and ethnic groups say when marijuana is legal for recreational use, it has a more positive than negative impact on the economy and criminal justice system.

About half of White (52%), Black (53%) and Hispanic (51%) adults say legalizing recreational marijuana is good for local economies. A slightly smaller share of Asian adults (46%) say the same.

Criminal justice

Across racial and ethnic groups, about four-in-ten say that recreational marijuana being legal makes the criminal justice system fairer, with smaller shares saying it would make it less fair.

However, there are wider racial differences on questions regarding the impact of recreational marijuana on the use of other drugs and the safety of communities.

Use of other drugs

Nearly half of Black adults (48%) say recreational marijuana legalization doesn’t have an effect on the use of drugs like heroin, fentanyl and cocaine. Another 32% in this group say it decreases the use of these drugs and 18% say it increases their use.

In contrast, Hispanic adults are slightly more likely to say legal marijuana increases the use of these other drugs (39%) than to say it decreases this use (30%); 29% say it has no impact.

Among White adults, the balance of opinion is mixed: 28% say marijuana legalization increases the use of other drugs and 25% say it decreases their use (45% say it has no impact). Views among Asian adults are also mixed, though a smaller share (31%) say legalization has no impact on the use of other drugs.

Community safety

Hispanic and Asian adults also are more likely to say marijuana’s legalization makes communities less safe: 41% of Hispanic adults and 46% of Asian adults say this, compared with 34% of White adults and 24% of Black adults.

Chart shows Young adults far more likely than older people to say legalizing recreational marijuana has positive impacts

Young Americans view the legalization of marijuana for recreational use in more positive terms compared with their older counterparts.

Clear majorities of adults under 30 say it is good for local economies (71%) and that it makes the criminal justice system fairer (59%).

By comparison, a third of Americans ages 65 and older say legalizing the recreational use of marijuana is good for local economies; about as many (32%) say it makes the criminal justice system more fair.

There also are sizable differences in opinion by age about how legalizing recreational marijuana affects the use of other drugs and the safety of communities.

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9 facts about Americans and marijuana

Most americans now live in a legal marijuana state – and most have at least one dispensary in their county, americans overwhelmingly say marijuana should be legal for medical or recreational use, clear majorities of black americans favor marijuana legalization, easing of criminal penalties, concern about drug addiction has declined in u.s., even in areas where fatal overdoses have risen the most, most popular, report materials.

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v.110(6); Nov-Dec 2013

More Reasons States Should Not Legalize Marijuana: Medical and Recreational Marijuana: Commentary and Review of the Literature

Recent years have seen substantial shifts in cultural attitudes towards marijuana for medical and recreational use. Potential problems with the approval, production, dispensation, route of administration, and negative health effects of medical and recreational marijuana are reviewed. Medical marijuana should be subject to the same rigorous approval process as other medications prescribed by physicians. Legalizing recreational marijuana may have negative public health effects.

Introduction

Recent years have seen a cultural shift in attitudes towards marijuana. At the time of this writing, medical marijuana is legal in 20 states and the District of Columbia; recreational marijuana is now legal in Washington and Colorado. A substantial and growing literature documents legalized marijuana may have adverse effects on individual and public health.

Medical Use of Marijuana

The term ‘medical marijuana’ implies that marijuana is like any other medication prescribed by a physician. Yet the ways in which medical marijuana has been approved, prescribed, and made available to the public are very different from other commercially available prescription drugs. These differences pose problems unrecognized by the public and by many physicians.

Lack of Evidence for Therapeutic Benefit

In the United States, commercially available drugs are subject to rigorous clinical trials to evaluate safety and efficacy. Data appraising the effectiveness of marijuana in conditions such as HIV/AIDS, epilepsy, and chemotherapy-associated vomiting is limited and often only anecdotal. 1 , 2 To date, there has been only one randomized, double-blind, placebo- and active-controlled trial evaluating the efficacy of smoked marijuana for any of its potential indications, which showed that marijuana was superior to placebo but inferior to Ondansetron in treating nausea. 3 Recent reviews by the Cochrane Collaboration find insufficient evidence to support the use of smoked marijuana for a number of potential indications, including pain related to rheumatoid arthritis, 4 dementia, 5 ataxia or tremor in multiple sclerosis, 6 and cachexia and other symptoms in HIV/AIDS. 2 This does not mean, of course, that components of marijuana do not have potential therapeutic effects to alleviate onerous symptoms of these diseases; but, given the unfavorable side effect profile of marijuana, the evidence to justify use in these conditions is still lacking.

Contamination, Concentration & Route of Administration

Unlike any other prescription drug used for medical purposes, marijuana is not subject to central regulatory oversight. It is grown in dispensaries, which, depending on the state, have regulatory standards ranging from strict to almost non-existent. The crude marijuana plant and its products may be contaminated with fungus or mold. 7 This is especially problematic for immunocompromised patients, 8 including those with HIV/AIDS or cancer. 9 Furthermore, crude marijuana contains over 60 active cannabinoids, 10 few of which are well studied. Marijuana growers often breed their plants to alter the concentrations of different chemicals compounds. For instance, the concentration of tetrahydrocannabinol (THC), the principal psychoactive ingredient, is more than 20-fold more than in marijuana products used several decades ago. Without rigorous clinical trials, we have no way of knowing which combinations of cannabinoids may be therapeutic and which may be deleterious. As marijuana dispensaries experiment by breeding out different cannabinoids in order to increase the potency of THC, there may be unanticipated negative and lasting effects for individuals who smoke these strains.

Marijuana is the only ‘medication’ that is smoked, and, while still incompletely understood, there are legitimate concerns about long-term effects of marijuana smoke on the lungs. 11 , 12 Compared with cigarette smoke, marijuana smoke can result in three times the amount of inhaled tar and four times the amount of inhaled carbon-monoxide. 13 Further, smoking marijuana has been shown to be a risk factor for lung cancer in many 14 , 15 but not all 16 studies.

High Potential for Diversion

In some states, patients are permitted to grow their own marijuana. In addition to contributing to problems such as contamination and concentration as discussed above, this practice also invites drug diversion. Patients seeking to benefit financially may bypass local regulations of production and sell home-grown marijuana at prices lower than dispensaries. We do not allow patient to grow their own opium for treatment of chronic pain; the derivatives of opium, like marijuana, are highly addictive and thus stringently regulated.

Widespread “Off-label” Use

FDA-approved forms of THC (Dronabinol) and a THC-analog (Nabilone), both available orally, already exist. Indications for these drugs are HIV/AIDS cachexia and chemotherapy-associated nausea and vomiting. Unlike smoked, crude marijuana, these medications have been subject to randomized, placebo-controlled, clinical trials. Yet despite these limited indications where marijuana compounds have a proven but modest effect in high-quality clinical trials, medical marijuana is used overwhelmingly for non-specific pain or muscle spasms. Recent data from Colorado show that 94% of patients with medical marijuana cards received them for treatment of “severe pain.” 17 Similar trends are evident in California. 18 Evidence for the benefit of marijuana in neuropathic pain is seen in many 19 - 21 but not all 22 clinical trials. There is no high-quality evidence, however, that the drug reduces non-neuropathic pain; this remains an indication for which data sufficient to justify the risks of medical marijuana is lacking. 4 , 23 – 25

If marijuana is to be ‘prescribed’ by physicians and used as a medication, it should be subject to the same rigorous approval process that other commercially available drugs undergo. Potentially therapeutic components of marijuana should be investigated, but they should only be made available to the public after adequately powered, double-blind, placebo-controlled trials have demonstrated efficacy and acceptable safety profiles. Furthermore, these compounds should be administered in a way that poses less risk than smoking and dispensed via standardized and FDA-regulated pharmacies to ensure purity and concentration. Bypassing the FDA and approving ‘medicine’ at the ballot box sets a dangerous precedent. Physicians should be discouraged from recommending medical marijuana. Alternatively, consideration can be given to prescribing FDA-approved medicines (Dronabinol or Cesamet) as the purity and concentration of these drugs are assured and their efficacy and side effect profiles have been well documented in rigorous clinical trials.

Recreational Marijuana

The question of recreational marijuana is a broader social policy consideration involving implications of the effects of legalization on international drug cartels, domestic criminal justice policy, and federal and state tax revenue in addition to public health. Yet physicians, with a responsibility for public health, are experts with a vested interest in this issue. Recent legislation, reflecting changes in the public’s attitudes towards marijuana, has permitted the recreational use of marijuana in Colorado and Washington. Unfortunately, the negative health consequences of the drug are not prominent in the debate over legalizing marijuana for recreational use. In many cases, these negative effects are more pronounced in adolescents. A compelling argument, based on these negative health effects in both adolescents and adults, can be made to abort the direction society is moving with regards to the legalization of recreational marijuana.

Myth: Marijuana is Not Addictive

A growing myth among the public is that marijuana is not an addictive substance. Data clearly show that about 10% of those who use cannabis become addicted; this number is higher among adolescents. 26 Users who seek treatment for marijuana addiction average 10 years of daily use. 27 A withdrawal syndrome has been described, consisting of anxiety, restlessness, insomnia, depression, and changes in appetite 28 and affects as many as 44% of frequent users, 29 contributing to the addictive potential of the drug. This addictive potential may be less than that of opiates; but the belief, especially among adolescents, that the drug is not addictive is misguided.

Schizophrenia and Other Psychotic Disorders

Marijuana has been consistently shown to be a risk factor for schizophrenia and other psychotic disorders. 30 – 32 The association between marijuana and schizophrenia fulfills many, but not all, of the standard criteria for the epidemiological establishment of causation, including experimental evidence, 33 , 34 temporal relationship, 35 – 38 biological gradient, 30 , 31 , 39 and biological plausibility. 40 Genetic variation may explain why marijuana use does not strongly fulfill remaining criteria, such as strength of association and specificity. 41 , 42 As these genetic variants are explored and further characterized, marijuana use may be shown to cause or precipitate schizophrenia in a genetically vulnerable population. The risk of psychotic disorder is more pronounced when marijuana is used at an earlier age. 32 , 43

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Effects on Cognition

Early studies suggested cognitive declines associated with marijuana (especially early and heavy use); these declines persisted long after the period of acute cannabis intoxication. 44 – 46 Recently, Meier and colleagues analyzed data from a prospective study which followed subjects from birth to age 38; their findings yielded supportive evidence that cannabis use, when begun during adolescence, was associated with cognitive impairment in multiple areas, including executive functioning, processing speed, memory, perceptual reasoning, and verbal comprehension. 47 Rogeberg 48 criticized the study’s methodology, claiming that the results were confounded by differences in socioeconomic status; this claim, however, was based on sub-analyses that used very small numbers. Additional sub-analyses 49 of the original study cohort showed that marijuana was just as prevalent in populations of higher socioeconomic status, suggesting that socioeconomic status was not a confounding variable. Any epidemiological study is subject to confounding biases and future research will be needed to clarify and quantify the relationship between cognitive decline and adolescent marijuana use. However, the findings of the original study by Meier et al show there is indeed an independent relationship between loss of intelligence and adolescent marijuana use. This finding, moreover, is consistent with prior studies. 44

Other Negative Health Effects

Substantial evidence exists suggesting that marijuana is harmful to the respiratory system. It is associated with symptoms of obstructive and inflammatory lung disease, 11 , 50 an increased risk of lung cancer, 14 , 15 and it is suspected to be associated with reduced pulmonary function in heavy users. 51 Further, its use has been associated with harmful effects to other organ systems, including the reproductive, 52 gastrointestinal, 53 and immunologic 10 , 54 systems.

Social Safety Implications: Effects on Driving

Marijuana impairs the ability to judge time, distance, and speed; it slows reaction time and reduces ability to track moving objects. 55 , 56 In many studies of drug-related motor vehicle fatalities, marijuana is the most common drug detected except for alcohol. 57 , 58 Based on post-mortem studies, Couch et al determined that marijuana was likely an impairing factor in as many fatal accidents as alcohol. 59 One study showed that in motor vehicle accidents where the driver was killed, recent marijuana use was detected in 12% of cases. 57 Other research confirms a significantly increased risk of motor vehicle fatalities in association with acute cannabis intoxication. 60

Risk Perception and Use in Adolescents

Marijuana use among adolescents has been increasing. Data that has tracked risk perception and use of marijuana among adolescents over decades clearly shows an inverse relationship; as adolescent risk perception wanes, marijuana use increases. 61 As more states legalize medical and recreational marijuana, risk perception is expected to decrease, causing the prevalence of use among adolescent to continue to rise. This is among the most concerning of issues about the drug’s legalization because so many of the negative effects of marijuana—including cognitive impairment and risk for short- and long-term psychosis— are heightened when used during adolescence.

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There is some evidence that compounds naturally found in marijuana have therapeutic benefit for symptoms of diseases such as HIV/AIDS, multiple sclerosis, and cancer. If these compounds are to be used under the auspices of ‘medical marijuana,’ they should undergo the same rigorous approval process that other medications prescribed by physicians, including randomized, placebo- and active-controlled trials to evaluate safety and efficacy, not by popular vote or state legislature. Furthermore, these therapeutic compounds should be administered via a route that minimizes long-term health risk (i.e., via oral pill) and should be dispensed by centrally regulated pharmacies to ensure the purity and concentration of the drug and allow for the recall of contaminated batches.

Marijuana for recreational use will have many adverse health effects. The drug is addictive, with mounting evidence for the existence of a withdrawal syndrome. Furthermore, it has been shown to have adverse effects on mental health, intelligence (including irreversible declines in cognition), and the respiratory system. Driving while acutely intoxicated with marijuana greatly increases the risk of fatal motor vehicle collision. Legalization for recreational use may have theoretical (but still unproven) beneficial social effects regarding issues such as domestic criminal justice policy, but these effects will not come without substantial public health and social costs. Currently there is a lack of resources devoted to educating physicians about this most commonly used illicit substance. The potential benefits and significant risks associated with marijuana use should be taught in medical schools and residency programs throughout the country.

Samuel T. Wilkinson, MD, is in the Department of Psychiatry at the Yale School of Medicine, New Haven, Ct.

Contact: [email protected]

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None reported.

Should drugs be legalized? Essay

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Incensed by the steadily growing number of deaths, crime and corruption created by illicit drug trade and use in the recent years, a number of persons drawn from both the government and the private sector have been calling for the legalization of drugs to curb the problems associated with the abuse and trade in drugs such as cocaine, heroin, and marijuana.

They argue that such a move would do more than any single act or policy in removing the biggest of society’s social and political problems. However, these calls are unfortunate and could throw an already grave problem completely out of hand. If examined carefully, it becomes clear that legalization of drugs would not bring a solution to any of the problems associated with drug abuse.

Proponents of the move to legalize argue that drug use should be an individual’s choice and the government should not control it in any way. This argument has two key shortcomings. First, we cannot just do anything we want with our bodies, just the same way a person cannot walk down the street naked, or say anything we want anywhere. The government has to step in at some point. Drug use is obviously more harmful than these two inconceivable acts.

Secondly, when people opt to do “whatever they want” with their bodies, such as drug use, it not only affects them, but also those around them (DEA, 2003). To put it practically, a driver who is ‘high’ on drugs puts the life of others on the road in danger. Such a person cannot operate machinery or even tend for their children and families as required of them. Therefore, the argument that every one has a right to do whatever they want with their bodies is simply misplaced.

Proponents of the debate to legalize drugs argue that this move will discourage drug use, citing a report by the European Monitoring Centre for Drugs and Drug Addiction that the Dutch are the lowest users of cannabis. They attribute this to Netherlands’ soft stance on drugs which permits cannabis sale at coffee shops and the possession of not more than 5 grams of cannabis. However, this is a shallow argument.

The Dutch government’s soft policy on marijuana use has created a much bigger problem: the differentiation of markets between hard drug users and dealers (heroin, cocaine and amphetamines) and soft drug users (marijuana) (NSW Bureau of Crime Statistics and Research, 2001).

Consequently, the number of marijuana users has fallen as most people have resorted to hard drugs, making the country a criminal center for illegal artificial drug manufacture, especially ecstasy, in addition to becoming a home for the production and export of marijuana breeds that have been reported to be ten times higher than normal (DEA, 2003). Besides, a 2001 study in Australia that found that prohibition deters drug abuse (NSW Bureau of Crime Statistics and Research, 2001).

Drug laws are very important in keeping these harmful substances out of reach of children. As long as drugs laws are put in place, the prices will continue to be higher, beyond the reach of most underage persons and even youths. The link between pricing and rate of drug use among young adults is evident in alcohol and drug use.

Studies show that high prices of alcohol and cigarettes result into decline in use of the substances (DEA, 2003). In addition, legalization of drugs would encourage sellers to recruit children sellers who can easily convince their peers to use the substances, hence increasing drug penetration into society. As long as drugs are not legalized, such a move is very unlikely, or can occur only in small scales.

DEA (U.S. Department of Justice: Drug Enforcement Administration). (2003 ). Speaking out against Drug Legalization . Web.

NSW Bureau of Crime Statistics and Research. (2001). Does prohibition deter cannabis use? Web.

Minor and Major Arguments on Legalization of Marijuana
Leadership and Power in Political Theories
Marijuana and Its Economic Value in the USA
Cannabis Smoking in Canada
How New York Would Benefit From Legalized Medical Marijuana
Problems with Bureaucracy
Contemporary Examples of Fascist Thoughts
Revolution's Positive Effects
Crime Prevention Programs in the State of California
Fundamental Right to Live: Abolish the Death Penalty
Chicago (A-D)
Chicago (N-B)

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COMMENTS

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