The vicious circle: the case for decriminalisation of illicit drugs
With regards to drug policymaking, the views of governments and the populations they influence have become increasingly hard-line and regressive over several decades. In this article, I argue that a toxic escalation in the way society views drugs and those who take them is fuelling a vicious circle of violence and harm.
Much of the early story of the “War on Drugs” is concentrated in the US, with other countries following their lead. In 1971, Richard Nixon declared drug abuse to be a “public enemy number one”, drawing on new legislation that greatly expanded state controls of various classes of drugs. The UK quickly followed with the Misuse of Drugs Act 1971, which transformed the UK from a relatively liberal into an authoritarian state, making the possession and supply of many classes of drugs a criminal offence. Ostensibly, the goals of prohibition were to protect the public, but many have instead described the War on Drugs as a political ruse to manipulate popular opinion. One only has to look at America’s major foreign policy issue of the time, the Vietnam War, and the left-leaning hippies and black communities who were disproportionately targeted, in order to appreciate this. The association of these groups with cannabis and heroin use was politically expedient for the administration of the time. In the 1980s, Ronald Reagan greatly expanded the War’s scope, with far-reaching and devastating consequences. This policymaking agenda has come at an enormous financial expense, with an estimated cost to the US exceeding $1 trillion, and continuing to cost over $50 billion annually .
The premise behind the War is that drug prohibition will decrease drug use, which will in turn reduce drug-related harm. Unfortunately, the links in this chain of causation do not withstand scrutiny. Despite the huge financial cost of the War so far, there is no sign that drug use has decreased. The Crime Survey for England and Wales for the year ending March 2020, showed that 35% of 16 to 59-year-old adults reported using a drug in their lifetime . The survey noted that 9.4% had used a drug within the last year, which represents an 8.6% increase from the year ending March 2010 . Drug-related harm has also only worsened since the War began. Perhaps most strikingly, deaths from drug overdose in the US have risen sharply, from less than 3 in 100,000 in 1980 to approximately 12 in 100,000 in 2008 . Since 2010, the US has seen a terrifying escalation in the numbers of opioid-related deaths from overdose , with Fentanyl being the most common cause since 2013 .
The obligation of government to protect the public is often-referenced as a rationale for prohibition, referring to the almost universal view that all drugs are inherently dangerous. However, this position is not supported by the available evidence. In the late 2000s, Professor David Nutt, then Chairman of the UK’s Advisory Council on the Misuse of Drugs (ACMD) famously ‘poked the proverbial hornets’ nest’ with a series of damning publications which were critical of the UK government’s drug policies. Famously, in 2010, he published a paper in the Lancet, “Drug harms in the UK: A multicriteria decision analysis”  which detailed the findings of an expert panel on the relative harms of various legal and illegal drugs. In this analysis, several commonly used recreational drugs such as LSD and ecstasy were rated as far less harmful than others, including the legal drug alcohol.
This evidence stands in contrast to the often reductionist and dichotomous way in which drugs are represented by the mainstream media. In the 1980’s, Nancy Reagan’s oversimplified “Just Say No” campaign categorised all drugs under the same umbrella and promoted the frankly absurd idea that drug users merely had to make a moral choice to abstain. Closer to home, a similarly reductionist approach was taken by the campaign following the ecstasy-related death of Leah Betts in 1997. Whilst her death was of course tragic, the overly simplistic manner in which the individual circumstances affecting her were extrapolated to an entire population provoked an unjustified moral panic. In reality, the issue of drug-related harm is highly complex, and while it is true that some drugs can cause real harm to the individual and to society, this is invariably within the context of interacting biological, psychological and social factors. Treating the drug use in isolation completely misses the mark.
In this environment, discrimination towards those who use drugs will continue. Overly simplistic stereotypes percolate the public consciousness, and lead to societal division and a poor understanding of the underlying reasons why individuals use drugs. The overwhelming weight of research evidence tells us that those who use drugs frequently have a history of adverse childhood experiences and emotional dysregulation. This has been demonstrated across a range of substances [6, 7, 8, 9, 10]. If we fail to respect those who use drugs as individuals, and the true complexity of the situation, there will be little progress.
It is also important to consider the role of the criminal justice system. The very act of prohibiting drugs means that all drug-related activity is driven underground, handing a ‘golden’ financial opportunity to criminals. The UK drug market is estimated to be worth in excess of £9 billion a year . With such a sizeable black-market economy, inevitably significant levels of violence are associated with drug-related crime. Dame Carol Black’s independent review concluded that the widespread involvement of children and young people in the drug market was likely to be driving the increase in violence and homicides in young people, with the homicide rate among victims aged 16 to 24 almost doubling between 2015/16 and 2017/18 .
It is clear from available evidence that the criminalised prohibition of drugs is not only ineffective in reducing drug use and drug-related harm, but also actively stimulates high levels of violent drug crime which often affects the most vulnerable in society. In addition, reductionist media reporting entrenches stigmatisation of individuals that use drugs which results in regressive and intolerant policymaking. There is however growing evidence that progressive drug policymaking can be an effective strategy to break this vicious circle of ever-worsening outcomes.
To date, around 40 countries have taken the progressive step to decriminalise some degree of drug use or possession. Portugal serves as an example of the positive effects this can bring. In the 1990s Portugal was being ravaged by an opiate overdose crisis, with a staggering 1% of the population addicted to opiates at the worst point . In 2001, the Portuguese government took the almost unprecedented step of decriminalising all drug possession, which meant no custodial sentences and no criminal records for possession. Cases were dealt with administratively rather than criminally, with drug users being assessed on a case-by-case basis with a range of harm-reduction interventions available. The success of this approach has been overwhelming, with a dramatic reduction in drug deaths within the first five years . There has been no increase in drug use, and there has been a decrease in drug-related harm . Strikingly, the number of new HIV diagnoses has fallen from 1287 in 2001, to just 16 in 2019 .
With such overwhelming evidence to support progressive drug policymaking, the continued and damaging insistence of the UK government to tackle drug-related harm through the criminal justice route is unjustifiable. Alternative approaches can be successful, as shown in Portugal, and a number of other countries are following their lead. The UK cannot hope to move towards a healthier and more understanding society whilst this regressive approach remains in place, and thus wholesale change is desperately required.
 Coyne CJ and Hall AR. Four Decades and Counting: The Continued Failure of the War on Drugs. CATO Institute 2017. Available at: https://www.cato.org/policy-analysis/four-decades-counting-continued-failure-war-drugs
 Anon. Drug misuse in England and Wales: year ending March 2020. Office for National Statistics 2020. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2020
 Anon. Opioid Data Analysis and Resources. Centres for Disease Control and Prevention 2022. Available at: https://www.cdc.gov/opioids/data/analysis-resources.html
 Hedegaard H et al. Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016. U.S. Department of Health and Human Services, Centres for Disease Control and Prevention, National Centre for Health Statistics, National Vital Statistics System 2018. Available at: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_09-508.pdf
 Nutt DJ et al. Drug harms in the UK: a multicriteria decision analysis. Lancet 2010; 376: 1558-65
 Bonn-Miller MO et al. Emotional dysregulation: association with coping-oriented marijuana use motives among current marijuana users. Subst Use Misuse 2008; 43: 1653-65
 Dvorak RD et al. Alcohol use and alcohol-related consequences: associations with emotion regulation difficulties. Am J Drug Alcohol 2014; 40: 125-30
 Lawson KM et al. A comparison of trauma profiles among individuals with prescription opioid, nicotine, or cocaine dependence. Am J Addiction 2013; 22: 127-31
 Spatz Widom C et al. Childhood victimization and illicit drug use in middle adulthood. Psychol Addict Behav 2006; 20: 394-403
 Mandavia A et al. Exposure to Childhood Abuse and Later Substance Use: Indirect Effects of Emotion Dysregulation and Exposure to Trauma. Journal of Traumatic Stress 2016; 29: 422-29
 Black C. Review of Drugs Executive Summary. 2020. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/897786/2SummaryPhaseOne+foreword200219.pdf
 Slade H, Nicholls J and Rolles S. (2021). Drug Decriminalisation in Portugal: Setting the Record Straight. Transform Drug Policy Foundation, Bristol, UK
About the author
Dr Ben Harman-Jones is a Speciality Doctor in Psychiatry, working at Kent and Medway Partnership Trust.