Navigating the nexus between British Columbia's public consumption and decriminalization policies of illegal drugs

In January 2023, the province of British Columbia (BC) decriminalized the possession of certain illegal drugs for personal use. The province's primary intent was to reduce the stigma associated with drug use, as well as barriers for people who use drugs (PWUD) to access treatment and supports. However, less than ten months into the decriminalization policy, due to growing concerns about public safety voiced by municipal governments and communities, the provincial government made amendments to the policy to ban the public consumption of illicit drugs in additional locations, and subsequently introduced additional legislation, Bill 34, aimed at regulating public consumption of drugs in public spaces. Some communities have also implemented local bylaws similarly regulating public drug use. Bill 34 and local bylaws may serve as tools to promote community health and safety and minimize direct and indirect harms associated with public drug use. However, such legislation may re-criminalize PWUD and reinforce negative perceptions surrounding drug use, especially if these policies are not paired with strategies to expand the availability and accessibility of critical harm reduction and housing services. Without ample access to these services, limitations on public drug use can potentially displace individuals to areas where they are more likely to use alone, further exposing them to substance use-related harms, and undermining the goals of decriminalization. The potential effects of these restrictions may also disproportionately impact marginalized populations. As of April 2024, Bill 34 remains on hold. Moving forward, it will be important to monitor this bill, as well as other public consumption bylaws and legislation, and their impact on BC's overall decriminalization initiative. Decision-makers are urged to increase engagement with PWUD and relevant stakeholders in the design and implementation of policies pertaining to public consumption to ensure that they effectively address the evolving needs and realities of PWUD, and align with decriminalization goals.

'It has gotten a lot better, but it is still bad': Experiences with the police among marginalized PWUDs in a context of depenalization

Based on a survey (n = 249) and qualitative interviews (n = 38) with marginalized people who use drugs (PWUDs) in Copenhagen, Denmark, we investigate the experiences of this group with the police in a context where drug possession had been depenalized in and around drug consumption rooms (DCRs). Our findings point to positive experiences with the police, especially with the local community police in the depenalization zone, who refrained from drug law enforcement and practiced 'harm reduction policing.' However, marginalized PWUDs also reported that they were still targeted for drug possession by other sections of the police despite the depenalization policy. Specifically, the drug squad of the police would continue to confiscate illicit drugs for investigatory purposes to counter organized drug crime, as well as continue to target user-dealers who were not formally included in the depenalization policy. The findings illustrate how marginalized PWUDs still found themselves in a precarious legal situation without any legal rights to possess the drugs that they were dependent on, even though possession of drugs had been depenalized in and around DCRs.

Drug decriminalization: The importance of policy change for the health and wellbeing of children and youth in Canada

The criminalization of drug use and possession has demonstrable harms on the health of children and youth, with disproportionate effects on Black people, Indigenous people, people from other racially oppressed communities, and people living in poverty. Drug decriminalization, by separating personal possession and use of drugs from the criminal justice system, allows for a health-based approach to drug policy. Paediatricians are well-positioned to advocate for policies within a decriminalization framework to prioritize the physical and mental health of children and youth.

Public opinion on the expenditure of adult-use cannabis tax revenue: Evidence from New Jersey

OBJECTIVES

To describe New Jersey residents' relative priorities for the allocation of tax revenue generated by recreational cannabis sales. We aim to assess preferences for public health initiatives, including drug treatment, compared to a range of alternatives, including traditional policing, especially within the social and demographic groupings of people generally most impacted by punitive drug enforcement policies.

METHODS

We collected population-representative survey data four months post-implementation of recreational cannabis sales in New Jersey (N = 1,006). We gauge respondents' top preferences for the allocation of new revenue generated by the legal cannabis market. Using multinomial logistic regression, we assess how various demographic and political factors shape public support for devoting revenue toward public health initiatives.

RESULTS

While priorities are mixed within the sample, we find more general support for funding community-based initiatives in public health, housing, and education than for funding police, courts, and prisons. Among Black residents, the largest proportion chose investments in affordable housing. Regression analysis reveals political orientation as having the most consistent association with expressed preferences, with Republicans favoring investments in traditional law enforcement priorities over other potential funding domains.

CONCLUSIONS

Recreational cannabis legalization is occurring at a rapid pace, yet important context, including how the tax revenue could be invested in communities, remains unclear. Insight into current public opinion on funding priorities suggests a desire for investment in fundamental societal institutions, including education and public health, rather than the punitive enforcement mechanisms that have defined cannabis policy for many decades.

People who use drugs' prioritization of regulation amid decriminalization reforms in British Columbia, Canada: A qualitative study

BACKGROUND

North America and the province of British Columbia (BC), Canada, is experiencing an unprecedented number of overdose deaths. In BC, overdose has become the leading cause of death for people between the ages of 10-59 years old. In January 2023, BC decriminalized personal possession of a number of illegal substances with one aim being to address overdose deaths through stigma reduction and promoting access to substance use services.

METHODS

We conducted a qualitative study to understand people who use drugs' (PWUD) perceptions of the new decriminalization policy, immediately prior to its' implementation (October-December 2022). To contextualize decriminalization within broader drug policy, we also asked PWUD what they perceived as the priority issues drug policy ought to address and the necessary solutions. Our final sample included 38 participants who used illegal drugs in the past month.

RESULTS

We identified four themes: 1) The illicit drug supply as the main driver of drug toxicity deaths 2) Concerns about the impact of decriminalization on drug toxicity deaths 3) Views towards decriminalization as a policy response in the context of the drug toxicity crisis 4) Regulation as a symbol of hope for reducing drug toxicity deaths.

CONCLUSION

From our data it became clear that many anticipated that decriminalization would have minimal or no impact on the overdose crisis. Regulation was perceived as the necessary policy approach for effectively and candidly addressing the drivers of the ongoing overdose crisis. These findings are important as jurisdictions consider different approaches to moving away from prohibition-based drug policy.

Awareness and knowledge of drug decriminalization among people who use drugs in British Columbia: a multi-method pre-implementation study

BACKGROUND

In January 2023, British Columbia implemented a three-year exemption to Controlled Drugs and Substances Act, as granted by the federal government of Canada, to decriminalize the personal possession of small amounts of certain illegal drugs. This decriminalization policy, the first in Canada, was announced in response to the overdose emergency in British Columbia as a public health intervention that could help curb overdose deaths by reducing the impact of criminalization and increasing access to health and social services through stigma reduction.

METHODS

The current multi-method study examines people who use drugs' awareness and knowledge of British Columbia's decriminalization model through cross-sectional quantitative surveys and qualitative interviews among people who use drugs from September-November 2022, immediately prior to the implementation of decriminalization.

RESULTS

Quantitative findings show that two-thirds (63%) of people who use drugs were aware of the policy, but substantial knowledge gaps existed about the legal protections afforded (threshold amount, substances included, drug trafficking, confiscation). The qualitative findings suggest that people who use drugs misunderstood the details of the provincial decriminalization model and often conflated it with regulation. Results suggest that information sharing about decriminalization were minimal pre-implementation, highlighting areas for knowledge dissemination about people who use drugs' rights under this policy.

CONCLUSIONS

Given that decriminalization in British Columbia is a new and landmark reform, and that the success of decriminalization and its benefits may be undermined by poor awareness and knowledge of it, efforts to share information, increase understanding, and empower the community, may be required to promote its implementation and benefits for the community.

'Drug decriminalization' in Canada: a plea for a nuanced, evidence-informed, and realistic approach towards improved health outcomes

Canada has been home to an exceptional public health crisis of illicit (mainly synthetic opioid but increasingly other) drug deaths for numerous years. Despite extensive health-oriented interventions, this crisis remains acute and devastating. Earlier this year, the federal and British Columbia governments implemented the 'drug decriminalization initiative' (DDI) which exempts drug users from criminal enforcement of small amounts of personal drug possession; this has been promoted as a 'solution' for the drug-death crisis. This commentary examines and discusses that while decriminalization of drug use is fundamentally required to align drug policy with principles of health, evidence-based consideration of the drug death crisis' essential dynamics as well as enforcement realities substantially curtail the DDI's plausible prospects to significantly reduce the drug-fatality toll. Decriminalization efforts elsewhere ('Portugal model') are set in distinct ecologies and parameters, and not readily transferable to Canadian contexts. While the DDI has symbolic value for policy reform, for decriminalization to provide tangible benefits for drug users and public health, its scope and design require fundamental reconsideration and improvement. Meanwhile, given the principally causal role of toxic drug supply for the current drug-death epidemic, more effective health and life-saving measures-specifically involving 'safer supply'-need to be urgently implemented to alleviate this crisis.

Changes in arrests following decriminalization of low-level drug possession in Oregon and Washington

BACKGROUND

Despite evidence that the U.S. "War on Drugs" is associated with increases in drug-related harm and other negative outcomes, all U.S. states have long criminalized most drug possession. In early 2021, both Oregon and Washington became exceptions to this rule when they fully (Oregon) or partially (Washington) decriminalized possession of small amounts of all drugs.

METHODS

We obtained arrest data for 2019 to 2021 for intervention states (Oregon and Washington) and control states (Colorado, Idaho, Montana, and Nevada). We calculated monthly rates for arrests overall and for violent crimes, drug possession, equipment possession, non-drug crimes, and a set of low-level crimes termed displaced arrests. Using an interrupted time series analysis, we examined changes in monthly arrest rates after the implementation of policy change in Oregon and Washington compared to control states.

RESULTS

In Oregon, there were 3 fewer drug possession arrests per 100,000 in the month after the policy change; the rate decreased throughout the post-implementation period. In Washington, there were almost 5 fewer drug possession arrests per 100,000 in the month following policy change, and the rate remained stable thereafter. Both declines were significantly greater than in comparison states. There were also statistically significant reductions in arrests for possession of drug equipment in Washington and a significant increase in displaced arrests in Oregon. There were no significant changes in overall arrests, non-drug arrests or arrests for violent crime in either state, relative to controls.

CONCLUSION

This analysis demonstrates that it is possible for state drug decriminalization policies to dramatically reduce arrests for drug possession without increasing arrests for violent crimes, potentially reducing harm to people who use drugs and their communities. Additional research is needed to determine whether these legal reforms were associated with changes in overdose rates and other drug-related harms.

Decriminalization thresholds for drug possession: A multi-criteria policy analysis framework

BACKGROUND

Decriminalization of personal possession of drugs has been proposed as an approach to mitigate the harms of drug prohibition. Despite growing interest, particularly in Canadian settings, analyses of approaches to defining the parameters of what constitutes personal possession within decriminalization models are lacking. Using the Province of British Columbia, Canada, as a case study, we undertook an evidence-based multi-criteria policy analysis of three models for defining personal possession: 1) a model that defines personal possession as the absence of evidence of drug trafficking; 2) a cumulative threshold of 15 grams; and 3) a cumulative threshold of 2.5 grams.

METHODS

We utilized data from four sources: qualitative interviews with 16 experts, including representatives from government and law enforcement; Vancouver Police drug seizure data; self-reported drug consumption data from longitudinal cohorts of people who use drugs in Vancouver; and publicly available government documents (e.g., the Government of BC's submission for decriminalization). Data was used to identify and define evaluation criteria which reflect the stated policy objectives of decriminalization alongside other policy considerations. This framework was used to conduct a multi-criteria policy analysis of the three different models.

RESULTS

The seven evaluation criteria included: 1) reduction in interactions with police; 2) reduction of police drug seizures; 3) coverage for those with high consumption; 4) impact on equity-deserving groups; and acceptance on the part key stakeholders, including: 5) people who use drugs; 6) law enforcement; and 7) the public. The model that performed the best was the cumulative threshold model of 15 grams.

CONCLUSION

Findings highlight that different threshold models advance and constrain the stated policy objectives of drug decriminalization to varying degrees. This analysis provides a framework that other jurisdictions considering decriminalization could use to help inform determinations of threshold levels based on stated policy objectives.

Attitudes and beliefs about Vermont's 2021 buprenorphine decriminalization law among residents who use illicit opioids

BACKGROUND

In July 2021, Vermont removed all criminal penalties for possessing 224mg or less of buprenorphine.

METHODS

Vermont residents (N=474) who used illicit opioid drugs or received treatment for opioid use disorder in the past 90 days were recruited for a mixed-methods survey on the health and criminal legal effects of decriminalization. Topics assessed included: motivations for using non-prescribed buprenorphine, awareness of and support for decriminalization, and criminal legal system experiences involving buprenorphine. We examined the frequencies of quantitative measures and qualitatively summarized themes from free-response questions.

RESULTS

Three-quarters of respondents (76%) reported lifetime use of non-prescribed buprenorphine. 80% supported decriminalization, but only 28% were aware buprenorphine was decriminalized in Vermont. Respondents described using non-prescribed buprenorphine to alleviate withdrawal symptoms and avoid use of other illicit drugs. 18% had been arrested while in buprenorphine, with non-White respondents significantly more likely to report such arrests (15% v 33%, p<0.001).

CONCLUSION

Decriminalization of buprenorphine may reduce unnecessary criminal legal system involvement, but its health impact was limited by low awareness at the time of our study.

"2.5 g, I could do that before noon": a qualitative study on people who use drugs' perspectives on the impacts of British Columbia's decriminalization of illegal drugs threshold limit

BACKGROUND

In May 2022, Health Canada approved a three-year exemption from the Controlled Drugs and Substances Act decriminalizing possession of certain illegal substances for personal use among adults in the province of British Columbia. The exemption explicitly includes a cumulative threshold of 2.5 g of opioids, cocaine, methamphetamine, and MDMA. Threshold quantities are commonly included in decriminalization policies and justified within law enforcement systems to delineate personal use among people who use drugs versus drug dealers who are carrying for trafficking purposes. Understanding the impact of the 2.5g threshold can help define the extent to which people who use drugs will be decriminalized.

METHODS

From June-October 2022, 45 people who use drugs from British Columbia were interviewed to gain an understanding of their perceptions on decriminalization, particularly on the proposed threshold of 2.5 g. We conduced descriptive thematic analyses to synthesize common interview responses.

RESULTS

Results are displayed under two categories: 1) Implications for substance use profiles and purchasing patterns, including implications on the cumulative nature of the threshold and impacts on bulk purchasing, and 2) Implications of police enforcement, including distrust of police use of discretion, potential for net widening and jurisdictional discrepancies in enforcing the threshold. Results illustrate the need for the decriminalization policy to consider diversity in consumption patterns and frequency of use among people who use drugs, the inclination to purchase larger quantities of substances for reduced costs and to guarantee a safe and available supply, and the role police will play in delineating between possession for personal use or trafficking purposes.

CONCLUSIONS

The findings underscore the importance of monitoring the impact of the threshold on people who use drugs and whether it is countering the goals of the policy. Consultations with people who use drugs can help policymakers understand the challenges they may face when trying to abide by this threshold.

From punishment to help? Continuity and change in the Norwegian decriminalization reform proposal

BACKGROUND

In 2018 the Norwegian government appointed a committee to prepare the implementation of a drug decriminalization reform. The overall goal of the committee was to propose a model where responsibility for society's response to the use and possession of illegal drugs for personal use would be transferred from the justice sector to the health service, under the catchphrase 'from punishment to help'. While the proposal ultimately did not get the necessary backing in parliament, the proposed reform still constitutes a very comprehensive and recent proposal for reforming national drug policy and it provides an ideal case for studying contemporary discourses on 'drug decriminalization'.

METHODS

The analysis of this reform proposal is guided by the post-structuralist "What's the Problem Represented to be" (WPR) approach, which is used for investigating the problem representation(s) in the proposal, as well as the rationalities, practices and deep-seated assumptions underpinning these. In doing this, the paper explores how the strategy represents both changes and continuities in discourses around illicit drugs and the people who use them.

RESULTS

Based on the WPR approach, two problem representations in the proposal are identified: the 'problem of illicit drug use' and the 'problem of criminalization'. However, the 'problem of illicit drug use' is argued to be the authoritative representation, that takes precedence over the other. In that regard, the paper points to how the proposed shift from the justice sector to the health sector would only be partial, given that the role of the police and drug law enforcement would be retained in the reform. Furthermore, the paper points to how illicit drug use continued to be fundamentally pathologized in the proposed reform.

CONCLUSION

The paper concludes with a discussion about the overall ambition of shifting from a crime-centered to a health-centered approach to people who use drugs and some reflections on the potential of an additional rights-based approach is provided.

Adolescent Cannabis Use During a Period of Rapid Policy Change: Evidence From the PATH Study

PURPOSE

To determine whether shifts in various state-level cannabis policies are associated with individual-level changes in adolescent cannabis use following implementation.

METHODS

We use the restricted-access youth cohort of the PATH Study, a recent, longitudinal, and nationally representative dataset, to assess whether changes in cannabis policy affect youth cannabis use. Data include respondents aged 12 to 17 years across up to six repeated observations (N = 26,673). Hybrid (between-person and within-person) panel models are used to examine adolescent past-month cannabis use.

RESULTS

Within-person effects showed that the odds of past-month cannabis use are lower (odds ratio [OR] = 0.632; p < .05) in years when a respondent's state allowed only cannabidiol (CBD) compared to years when the state had legalized medical cannabis. The odds of past-month cannabis use are lower during years when a respondent's state had decriminalized (OR = 0.617; p < .01) or criminalized (OR = 0.648; p < .05) adult recreational cannabis possession compared to years when it was legalized. These effects were robust to numerous controls, including time and state fixed effects. By contrast, significant between-person effects became nonsignificant with state fixed effects included, implying that state-level average use distinguishes average differences between states rather than policy.

DISCUSSION

Liberalized cannabis policy is significantly associated with recent adolescent cannabis use. The most consequential policy shift associated with adolescent use is from either criminalization or decriminalization of cannabis possession to legalization, such that states making these changes should consider additional prevention efforts.

"What will we do if we get infected?": An interview-based study of the COVID-19 pandemic and its effects on the health and safety of sex workers in the United States

Emerging evidence suggests that sex workers face unique and profound risks arising from the COVID-19 pandemic. To illuminate the pandemic's effects on sex worker health and safety and identify intervention opportunities, from May-August 2020 in-depth interviews were conducted with a purposive sample of 15 sex workers, four service providers and two individuals who were both. Sampled sex workers included eight people of color, eight cisgender women, five cisgender men, three non-binary people, and one transgender woman. Using Conservation of Resources Theory to define impacts on sex worker resources and resulting health and safety implications, a deductive thematic analysis was conducted. Seven resources were threatened due to the pandemic: work opportunity, sex work venues, social support, health services, money, food, and housing. The loss of these resources was exacerbated by stigma - notably sex work criminalization - and significantly undermined health and safety by increasing food and housing instability, increasing risks of violence, and diminishing safer sex negotiation. Six resources were activated in response: social support, digital skills, health knowledge, non-sex work employment, money, and resilience. While social support had numerous benefits, investing digital skills and non-sex work employment were generally of limited impact. The pandemic's negative health and safety effects were most profound at the intersections of race, gender, class, and migration status. These findings suggest sex workers need urgent and ongoing support, with investments in social support and sex work decriminalization likely to have the greatest effects on health and safety relative to and beyond the COVID-19 pandemic.

(De)criminalisation of psychedelics in the Czech Republic-Where are we heading in drug policy and legislation?

The article deals with the issue of decriminalization of drugs, in all relevant contexts, both in terms of criminal policy and legislation, as well as law enforcement, with focus on the Czech Republic. The article proceeds deductively from the general to the specific. First, it discusses the role of law in society and its legitimacy, with focus on legitimate criminal sanctions, which are discussed in the context of the principle of subsidiarity of criminal repression and the principle of opportunity (discretionary prosecution). After these general considerations, the article turns to the issue of drugs and discusses both drug policy and legislation, arguing that the general considerations are in favor of decriminalization tendencies in this area. In the final part, the article focuses on psychedelics, emphasizing a fundamental discrepancy between their factual and legal status and then considering ways of changing the perspective. At this point, the article outlines the importance of decriminalization of psychedelics for therapeutic use, which basically consist of rescheduling of these drugs. The aim of such decriminalization is to make psychedelic-assisted therapy legally available. The article concludes that this is the direction that criminal policy and law in the Czech Republic should take.

Understanding successful policy innovation: The case of Portuguese drug policy

INTRODUCTION

In 2000, the Portuguese minority socialist government decriminalized the possession and consumption of drugs. This law made Portugal unique in having a formal system that directs the person using drugs to a panel under the purview of the Ministry of Health, as opposed to the Ministry of Justice, and hence constitutes an 'original innovation'. In this article, we ask under which conditions such kinds of reforms are introduced and successfully implemented.

AIMS AND DESIGN

After discussing the limitations of the existing literature, we present a new theoretical framework: the 'six-stars' framework. We argue that successful policy innovation in democracies will only occur and persist when six institutional and individual 'stars' are aligned: attention, motivation to innovate, a new solution, political strategies, quality and legitimacy of the decision-making process and guarantees for full implementation. We then apply this framework to the Portuguese Drug Policy Case through theory-testing/process-tracing. Relying upon a qualitative analysis of three different types of data-primary and secondary sources, official documents emitted by key actors and interviews-we identify the presence of the six aligned 'stars'.

CONCLUSIONS

The proposed 'six-stars' framework of successful drug policy innovation shows the importance of electoral mandates, communication, inclusion, transparency, deliberation and evaluation when designing innovative drug policies. It also illustrates the importance of ensuring the support of implementing agents and quickly creating visible, positive policy feedback.

Racial resentment and support for decriminalization of drug possession in the United States

Drug criminalization creates significant barriers to prevention and treatment of substance use disorders and racial equity objectives, and removal of criminal penalties for drug possession is increasingly being endorsed by health and justice advocates. We present empirical data estimating the share of U.S. adults who support eliminating criminal penalties for possession of all illicit drugs, and examine factors associated with public support. Data from the Johns Hopkins COVID-19 Civic Life and Public Health Survey, a probability-based nationally representative sample of 1222 U.S. adults, was collected from November 11-30, 2020. Support for decriminalizing drug possession was assessed overall and by sociodemographic factors and attitudes towards politics and race. Correlates of support were examined using multivariable logistic regression. Thirty-five percent of adults supported eliminating criminal penalties for drug possession in the U.S. In adjusted regression models, respondents who were younger or identified as politically liberal were more likely to support decriminalization relative to other groups, and respondents who were Hispanic or identified strongly with their religious beliefs were less likely to support decriminalization. Among white respondents, greater racial resentment was strongly associated with reduced support for drug decriminalization. Support for drug decriminalization varies considerably by beliefs about politics and race, with racial resentment among white Americans potentially comprising a barrier to drug policy reform. Findings can inform communication and advocacy efforts to promote drug policy reform in the United States.

Decriminalizing suicide attempt in the 21st century: an examination of suicide rates in countries that penalize suicide, a critical review

BACKGROUND

Decriminalizing suicide may decrease overall suicide rates because then individuals who are at risk of suicide would be more willing to seek help from the community and from mental health professionals, therefore enabling early interventions for preventing suicidality. We aimed to examine the suicide trends over the last 20 years in 20 countries that still criminalize attempted suicide, and to compare the suicide rates of these 20 countries against the global average suicide rate and to a comparison sample of 20 countries that do not criminalize suicide, matched according to region and majority religion.

METHODS

Age-standardized suicide rates were extracted from the WHO Global Health Estimates, available for the period 2000-2019. Population data were extracted from the World Bank. We analyzed only countries which criminalize attempted suicide under its criminal justice system. Countries were further categorized according to their membership in the Commonwealth of Nations and countries in Africa. Countries from the same region and with the same majority religion were chosen as a matching group. Joinpoint analysis was used to compare the trends of the two groups with the global average.

RESULTS

Based on the 2019 WHO Global Health Estimates data, there is a large range in the suicide rates of the countries that criminalize attempted suicide, from 2.5 (Brunei) to 40.9 (Guyana) per 100,000 population. The mean suicide rate was 8.3 (Standard Deviation = 10.6). Out of the 20 countries, seven have suicide rates higher than the global average, covering a total population of about 387.3 million. Of these seven countries, five are in the African region. The other thirteen countries have suicide rates between 2.5 to 8.2. Mean scores of the countries which criminalized attempted suicide was lower than the global average and 20 comparison countries over the 20 years, but average annual percentage in the decrease of suicide was greater for countries in which attempted suicide was not criminalized.

CONCLUSIONS

Based on our review, there was no substantial evidence here to indicate that countries which criminalized attempted suicide had consistently lower suicide rates compared to the global average. There is a need to acknowledge that the currently available evidence is inadequate to definitively claim that criminalizing suicide is beneficial or harmful for the reduction of suicide rate for the entire populations. Future studies should continue to evaluate the unique effects of decriminalizing attempted suicide while controlling for other key associated factors.

"There are solutions and I think we're still working in the problem": The limitations of decriminalization under the good Samaritan drug overdose act and lessons from an evaluation in British Columbia, Canada

BACKGROUND

Drug prohibition has been associated with increased risk of overdose. However, drug prohibition remains the dominant drug policy, including in Canada with the Controlled Drugs and Substances Act. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted, to encourage people to contact emergency medical services by providing bystanders at the scene of an overdose with legal protection for simple possession and conditions related to simple possession.

METHODS

We conducted an evaluation of the GSDOA in British Columbia, Canada that included one-on-one interviews with people who use illicit drugs (PWUD), to determine peoples' experiences and perceptions surrounding this form of decriminalization. We present findings from a thematic analysis of 37 interviews.

RESULTS

We identified limitations of the GSDOA at overdose events; key themes and concerns causing PWUD to hesitate to or avoid contacting emergency medical services included drug confiscation, the thin line between simple possession and drug trafficking, and enforcement of other charges and court ordered conditions that are not legally protected by the GSDOA. Moreover, participants discussed the GSDOA as inequitable; benefiting some while excluding PWUD with intersecting marginalized identities.

CONCLUSION

Our findings are pertinent in light of many jurisdictions across the world considering dejure decriminalization, including BC and Vancouver. The GSDOA and associated limitations that emerged in our evaluation can serve to guide jurisdictions implementing or amending dejure decriminalization policies.

Should commercial sex workers have unrestricted healthcare access across the world?

We argue commercial sex workers have rights to healthcare and psychosocial support. While decriminalization is not legally enacted in most countries, we would suggest these workers rights include freedom from harassment and opportunities to lead healthy lives. The need for healthcare access for all is heightened in the COVID-19 pandemic where some people flout rules on lockdown by engaging with commercial sex workers and may unwittingly spread SARS-CoV-2 in so doing. Unrestricted healthcare access without stigma for commercial sex workers protects them, and has a beneficial societal effect on those who engage with them and on their contacts.

Harm Reduction and Decriminalization of Sex Work: Introduction to the Special Section

INTRODUCTION

This special section of Sexuality Research and Social Policy, edited by Belinda Brooks-Gordon, Max Morris and Teela Sanders, has its origins in a colloquium sponsored by the University of Cambridge Socio-Legal Group in 2020. The goal was to promote the exchange of ideas between a variety of disciplinary research fields and applied perspectives on harm reduction and the decriminalization of sex work. The colloquium took place during the emergence of the coronavirus pandemic in February 2020.

METHODS

We explore the impact of Covid-19 on understandings of sex work, outline the basic underpinning legal philosophical question, explore the intersectional politics of decriminalization, summarize contemporary international health and human rights campaigns, explore contemporary public opinion trends on the issue, and illustrate the universal principles. Finally, we summarize the special section papers (N=12).

RESULTS

The Covid pandemic provided a lens through which to analyse the changes that have occurred in sex work and sex work research in the past decade and it also exacerbated intersecting inequalities, accelerated many social shifts already in motion whilst changing the course of others. In combination the papers in this special issue examine sex work policy and research across 12 countries in four continents to provide and important space for international and cross-cultural comparison.

CONCLUSIONS

We present the timely contributions of diverse authors and comment on the significance of their research projects which support a decriminalization policy agenda for the benefit of academics, policymakers and practitioners to improve public health strategies and international responses.

POLICY IMPLICATIONS

The research here amplifies the focus on harm reduction and strengthens the case for public policy that decriminalizes commercial sex between consenting adults as the best strategy to reduce harm.

Simple possession as a 'tool': Drug law enforcement practices among police officers in the context of depenalization in British Columbia, Canada

BACKGROUND

Examining drug law enforcement practices in the context of an evolving drug policy environment is critical for informing policy reforms and practices as they unfold. In this study, we aimed to examine police officer accounts of drug law enforcement practices, including officer use of discretion in simple possession cases, within the sociolegal context in British Columbia, Canada.

METHODS

Using a qualitative approach, we conducted a thematic analysis of interviews with sixteen police officers across nine jurisdictions in the province. The analysis provided insights into police officers' recent experiences enforcing drug laws. Two major themes and several subthemes are presented which relate to drug law enforcement practices within the context of depenalization.

FINDINGS

Officers' experiences and views towards simple possession enforcement suggested a model of de facto depenalization in the province, although enforcement practices including police discretion were inconsistent across officers and jurisdictions. Prosecutorial discretion was a major factor that shaped officers' enforcement practices. While officers reported not pursuing simple possession offences, many used simple possession charges as a 'tool' to do investigations, pursue other charges, and to promote social order.

CONCLUSION

This study provides unique insights into drug law enforcement in an evolving sociolegal context, highlighting the potential inconsistencies, inequities, and harms that may arise from relying on a model of depenalization. In the face of drug law reforms both in Canada and elsewhere, these findings have important implications regarding the design and implementation of alternatives, such as depenalization, decriminalization, and diversion programs, which may potentially rely on, remove, and/or enhance police discretion. Where drug possession is formally decriminalized, police officers may need alternative enforcement 'tools' to support their work moving forward.

Police officers' knowledge, understanding and implementation of the Good Samaritan Drug Overdose Act in BC, Canada

INTRODUCTION

In May 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted in Canada - amending the Controlled Drugs and Substances Act. For people present at an overdose, the GSDOA offers legal protection from simple drug possession as well as breach of charges related to simple possession including probation, pre-trial release, conditional sentences, and parole. It is unclear if the GSDOA has been fully implemented by police officers.

METHODS

We conducted 22 key informant interviews with police officers across British Columbia, Canada. Convenience sampling was initially employed, followed by purposeful sampling to ensure diversity in jurisdictions and participant demographics (e.g. age, sex, policing experience). A thematic analysis was conducted RESULTS: Our findings show that awareness and knowledge of the GSDOA vary among police officers. Many officers reported being unaware of the GSDOA or could not correctly define for whom and when the GSDOA applies. Information about the GSDOA was largely disseminated via email. Many officers expressed concerns with this dissemination method given the potential that key legal information would be overlooked. Police officers reported that not arresting for simple possession at an overdose was common practice, even before the enactment of the GSDOA. Thus, some officers did not believe that the GSDOA considerably changed police practices. Finally, police officers reported that they exercised discretion applying the GSDOA. Police officer interpretation of the intention and content of the GSDOA had critical implications for how they applied it in practice.

CONCLUSION

Effective education for law enforcement, including the dissemination of information beyond email, is needed to improve officers' awareness and understanding of the GSDOA. Given officers' use of discretion when applying the GSDOA, greater legal reforms, such as de jure decriminalization, may be required to fully protect persons at an overdose from simple possession for controlled substances.

20 years of Portuguese drug policy - developments, challenges and the quest for human rights

Portugal decriminalized the public and private use, acquisition, and possession of all drugs in 2000; adopting an approach focused on public health rather than public-order priorities. Arguing that the Portuguese Drug Policy Model has not proven influential enough to emancipate drug use from the stigma that associates it either with crime or pathology, this article critically discusses the developments and current challenges the Portuguese drug policy confronts, namely the growing diversity of drug use patterns observed in Portugal as well as in Europe. To this end, international and national legal instruments concerning drugs and official local data were analysed. Despite encouraging results, conclusions indicate that these policies are marked by contradictions and ambiguities that have permeated its history since the very beginning, and modest ambitions, particularly regarding the implementation of harm reduction measures. Moreover, the polemical Supreme Court judgment that reestablished, in 2008, drug use as a crime when the quantities at play exceeded those required for an average individual's use for 10 days, might have impacted the landscape of drug use penalization. The last decade saw an increase of punitiveness targeted at drug users, including criminal sentences of jail terms. We finish with some suggestions that could be employed in the practical application of drug policy.

Attitudes towards Kratom use, decriminalization and the development of a community-based Kratom control mechanism in Southern Thailand

Kratom (Mitragyna speciosa Korth.) is an indigenous plant of Southeast Asia, which has been used in traditional medicine for centuries. Despite local communities in Southern Thailand viewing Kratom as a traditional remedy and not as an illicit drug, Thailand criminalized Kratom in 1943 which has led to tensions between government authorities and local communities. This study employed a mixed-method design to explore alternative ways to decriminalize Kratom, using a Participatory Action Research framework to develop a community charter to better manage Kratom in Tambon Namphu, a rural sub-district in Southern Thailand. Quantitative data consisted of face-to-face surveys with 457 Tambon Namphu residents, 104 students and teachers and on-line self-complete surveys conducted with 1,058 people outside Tambon Namphu. Qualitative data were collected using focus groups, in-depth interviews and through public forums conducted with Tambon Namphu residents. Survey results indicate that most participants agreed with decriminalization of both Kratom cultivation and consumption and typically reported positive attitudes towards people who use Kratom. The most common reasons for supporting Kratom decriminalization were Kratom's perceived benefits for work productivity and health. People had more positive attitudes towards the consumption of fresh Kratom leaves than Kratom decoctions which were deemed more harmful. Participatory action research methods were used to pilot the development of a community consensus framework for Kratom control in Donsai, a village of 127 households. Following successful piloting, the community consensus framework on Kratom control was adopted in Donsai, adapted across Tambon Namphu and then extended to cover 135 villages across Thailand.

Cannabis Legalization and College Mental Health

PURPOSE OF REVIEW

To assess how the changing landscape of marijuana use affects the developing brain and mental health of college students.

RECENT FINDINGS

Legalization of cannabis may facilitate use in the college population, with 38% of college students, whose brains are still maturing, regularly using marijuana products. Earlier and increased use, higher potency, pre-existing issues, and genetic predispositions increase negative outcomes by precipitating or worsening mental illness and ultimately impacting academic success. In the USA, the sharpest increase in cannabis users following legalization has been in the college age population (18-25 years of age). This population is especially vulnerable to the negative impacts and risks associated with cannabis use, including risk for the onset of major psychiatric illness. College mental health practitioners should remain informed about health effects of cannabis use, assess patient use on a regular basis, provide education and be familiar with interventions to reduce harm.

A multi criteria decision analysis (MCDA) for evaluating and appraising government policy responses to non medical heroin use

BACKGROUND

Globally, non-medical heroin use is generating significant public health and social harms, and drug policy about heroin is a controversial field that encompasses many complex issues. Policy responses to illegal heroin markets have varied from militarized eradication of the opium poppy and harsh punishment of users, to more tolerant harm reduction approaches with decriminalized possession and use.

METHODS

This paper reports the outcomes of a multi-criteria decision analysis (MCDA) on four generic regulatory regimes of heroin: prohibition, decriminalisation, state control and free market. Invited experts on drug harms, addiction, criminology and drug policy developed a comprehensive set of 27 policy outcome criteria against which these drug policy regimes were assessed.

RESULTS

State control of heroin was identified as the preferred policy option although other policy regimes scored better on specific outcome criteria. The free market model scored better than decriminalisation, with absolute prohibition scoring worst on every criterium. The ranking of the regimes was robust to variations in the criterion-specific weights.

CONCLUSION

The implications of these findings for the development of future policy responses to heroin and opioids generally are discussed in detail. Despite increasing overdose deaths and an opioid epidemic in North America, prohibition remains the predominant policy approach to heroin regulation at present. It is hoped that the current paper adds to the discussion of finding a valid regulatory alternative.

The drug war must end: The right to life, liberty and security of the person during the COVID-19 pandemic for people who use drugs

Since the start of the opioid epidemic in 2016, the Downtown Eastside community of Vancouver, Canada, has lost many pioneering leaders, activists and visionaries to the war on drugs. The Vancouver Area Network of Drug Users (VANDU), the Western Aboriginal Harm Reduction Society (WAHRS), and the British Columbia Association People on Opiate Maintenance (BCAPOM) are truly concerned about the increasing overdose deaths that have continued since 2016 and have been exacerbated by the novel coronavirus (SARS-COVID-19) despite many unique and timely harm reduction announcements by the British Columbia (B.C.) government. Some of these unique interventions in B.C., although in many cases only mere announcements with limited scope, are based on the philosophy of safe supply to illegal street drugs. Despite all the efforts during the pandemic, overdose deaths have spiked by over 100% compared to the previous year. Therefore, we urge the Canadian federal government, specifically the Honorable Patty Hajdu, the federal Minister of Health, to decriminalize simple possession immediately by granting exemption under the Controlled Drugs and Substances Act. The Canadian federal government has a moral obligation under Sect. 7 of the Canadian Charter of Rights and Freedoms to protect the basic human rights of marginalized Canadians.

Bereaved mothers' engagement in drug policy reform: A multisite qualitative analysis

BACKGROUND

Globally, a tainted drug supply is claiming the lives of tens of thousands of people who use drugs and current measures are not quelling this crisis. Within this context, mothers who have lost a child to substance use have emerged as vocal advocates for drug policy changes. This paper explores mothers' experiences in drug policy advocacy to uncover how they are using their stories to drive policy change.

METHODS

Critical qualitative and narrative methods informed individual interviews with 43 mothers who had lost a child to substance use from across three regions in Canada: British Columbia, Prairie Provinces, and Eastern Provinces. Multisite qualitative analysis (MSQA) provided a rigorous analytical method to identify how social context informed participants' advocacy efforts within and across geographies, together with a theoretical lens from Haraway to understand mothers' activism as situated knowledge.

RESULTS

Mothers' drug policy advocacy was shaped by social context and norms, which influenced the types of advocacy targets pursued, within the constraints of the social and political ethos of each geographic region. Yet across regions, narratives of shared aims and experiences also emerged. Specifically, the notion that people of all backgrounds are dying and that losing a child to substance use can "happen to anyone" - though people who experience structural vulnerabilities are disproportionately impacted. Additionally, mothers' stories were identified as a particularly powerful tool for conveying emotional knowledge and prompting action that complements other forms of knowledge or evidence.

CONCLUSION

To date, efforts to address the drug poisoning epidemic have done little to curb casualties. Mothers whose child's death is related to substance use are one group who are bringing their experiences to advocacy efforts aimed at generating new solutions, including calls for decriminalization and legal regulation of drugs. This and other lived experience perspectives represent a critical voice in decision-making and hold the potential to inform more responsive and impactful drug policy.

Decriminalization in action: lessons from the Los Angeles model

Los Angeles County's Office of Diversion and Reentry (ODR) has removed over 3800 people from the largest jail system in the country. Across various diversion programs, ODR's fundamental goal is to provide permanent, lifetime care for each diverted person. This article describes ODR's various diversion programs, and elucidates the types of elaborate clinical and court-related interventions that are necessary to remove persons with serious mental disorders from jail custody. As Los Angeles continues to build the necessary community-based continuum of mental health care, ODR's model proves that thoughtfully removing persons with serious mental disorders from jail is possible and necessary for the health of both patients and community.

Experience obtaining legal abortion in Uruguay: knowledge, attitudes, and stigma among abortion clients

BACKGROUND

The abortion law in Uruguay changed in 2012 to allow first trimester abortion on request. Implementation of the law in Uruguay has been lauded, but barriers to care, including abortion stigma, remain. This study aimed to assess women's experiences seeking abortion services and related attitudes and knowledge following implementation of the law in Uruguay.

METHODS

We interviewed 207 eligible women seeking abortion services at a high-volume public hospital in Montevideo in 2014. We generated univariate frequencies to describe women's experiences in care. We conducted regression analysis to examine variations in experiences of stigma by women's age and number of abortions.

RESULTS

Most of the women felt that abortion was a right, were satisfied with the services they received, and agreed with the abortion law. However, 70% found the five-day waiting period unnecessary. Women experienced greater self-judgement than worries about being judged by others. Younger women in the sample (ages 18-21) reported being more worried about judgment than women 22 years or older (1.02 vs. 0.71 on the ILAS sub-scale). One quarter of participants reported feeling judged while obtaining services. Women with more than one abortion had nearly three times the odds of reporting feeling judged.

CONCLUSIONS

These findings highlight the need to address abortion stigma even after the law is changed. Some considerations from Uruguay that may be relevant to other jurisdictions reforming abortion laws include: the need for strategies to reduce judgmental behavior from staff and clinicians towards women seeking abortions, including training in counseling skills and empathic communication; addressing stigmatizing attitudes about abortion through community outreach or communications campaigns; mitigating the potential stigma that may be perpetuated through policies to prevent "repeat" abortions; ensuring that younger women and those with more than one abortion feel welcome and are not mistreated during care; and assessing the necessity of a waiting period. The rapid implementation of legal, voluntary abortion services in Uruguay can serve in many ways as an exemplar, and these findings may inform the process of abortion law reform in other countries.

Twelve years after abortion decriminalization in Mexico City: Can we still remain an island of liberties?

Latin America hosts the most restrictive abortion legislation globally. In 2007, Mexico, the second largest Catholic country in the world, decriminalized elective abortion within the first twelve weeks of pregnancy in the capital: Mexico City (also known as Federal District of Mexico). Following the reform, the Mexico City Ministry of Health (MX-MOH) implemented safe and legal services. Free services are provided to Mexico City residents and a sliding fee of up to $100 is applied to women from other Mexican states. Conscientious objection (CO) was addressed and included in service provision guidelines. Since 2007, 18 of 32 states amended their penal codes to restrict abortion. The road toward increasing access to abortion services at the MX-MOH included a shift from dilation and curettage (D&C) to medical abortion (MA), first with the misoprostol-alone regimen, followed by the combined mifepristone-misoprostol regimen. Manual vacuum aspiration is offered to out-of-state-women or to those beyond the gestational age where MA is less effective. Contraceptive uptake among abortion seekers is high (up to 95% of them prefer a free method of their choice). The Legal Interruption of Pregnancy program at the MX-MOH continues to provide effective, safe, reliable, and free services. However, women from indigenous groups residing in rural areas, those with low schooling, and adolescents with an unintended pregnancy who live in rural, urban, peri-urban districts, and at the state level are underserved despite being legally eligible to receive abortion services. Therefore, information and services for the disadvantaged groups need to be strengthened.

Decriminalization of abortion - A human rights imperative

This chapter reviews the evolving consensus in international human rights law, first supporting the liberalization of criminal abortion laws to improve access to care and now supporting their repeal or decriminalization as a human rights imperative to protect the health, equality, and dignity of people. This consensus is based on human rights standards or the authoritative interpretations of U.N. and regional human rights treaties in general comments and recommendations, individual communications and inquiry reports of treaty monitoring bodies, and in the thematic reports of special rapporteurs and working groups of the U.N. and regional human rights systems. This chapter explores the reach and influence of human rights standards, especially how high courts in many countries reference these standards to hold governments accountable for the reform and repeal of criminal abortion laws.

When there are no abortion laws: A case study of Canada

Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of relevant Canadian legal, political, and policy events before and since decriminalization. We assess implications for clinical care, health service and systems decisions, health policy, and the epidemiology of abortion in the absence of criminal legislation. As the criminal abortion law was struck down, dozens of similar private member's bills, and one government bill, have been proposed, but none were passed. Key findings include that initially Canadian provinces attempted to provide restrictive regulations and legislation, all of which have been revoked and largely replaced with supportive policies that improve equitable, accessible, state-provided abortion service. Abortion rates have been stable over 30 years since decriminalization, and a falling proportion of abortions occur late in the second trimester. Canada demonstrates that abortion care can safely and effectively be regulated as a normal component of usual medical care.

"It's something that marks you": Abortion stigma after decriminalization in Uruguay

BACKGROUND

Abortion stigma is experienced by women seeking abortion services and by abortion providers in a range of legal contexts, including Uruguay, where abortion was decriminalized up to 12 weeks gestation in 2012. This paper analyzes opinions and attitudes of both abortion clients and health professionals approximately two years following decriminalization and assesses how abortion stigma manifests among these individuals and in institutions that provide care.

METHODS

In 2014, we conducted twenty in-depth, semi-structured interviews with abortion clients (n = 10) and health care professionals (n = 10) in public and private facilities across Uruguay's health system. Interviews were recorded, transcribed, and then coded for thematic analysis.

RESULTS

We find that both clients and health professionals express widespread satisfaction with the implementation of the new law. However, there exist critical points in the service where stigmatizing ideas and attitudes continue to be reproduced, such as the required five-day waiting period and in interactions with hospital staff who do not support access to the service. We also document the prevalence of stigmatizing ideas around abortion that continue to circulate outside the clinical setting.

CONCLUSION

Despite the benefits of decriminalization, abortion clients and health professionals still experience abortion stigma.

Cannabis decriminalization: A study of recent policy change in five U.S. states

BACKGROUND

A number of public health professional organizations support the decriminalization of cannabis due to adverse effects of cannabis-related arrests and legal consequences, particularly on youth. We sought to examine the associations between cannabis decriminalization and both arrests and youth cannabis use in five states that passed decriminalization measures between the years 2008 and 2014: Massachusetts (decriminalized in 2008), Connecticut (2011), Rhode Island (2013), Vermont (2013), and Maryland (2014).

METHODS

Data on cannabis possession arrests were obtained from federal crime statistics; data on cannabis use were obtained from state Youth Risk Behavior Survey (YRBS) surveys, years 2007-2015. Using a "difference in difference" regression framework, we contrasted trends in decriminalization states with those from states that did not adopt major policy changes during the observation period.

RESULTS

Decriminalization was associated with a 75% reduction in the rate of drug-related arrests for youth (95% CI: 44%, 89%) with similar effects observed for adult arrests. Decriminalization was not associated with any increase in the past-30 day prevalence of cannabis use overall (relative change=-0.2%; 95% CI: -4.5%, 4.3%) or in any of the individual decriminalization states.

CONCLUSIONS

Decriminalization of cannabis in Massachusetts, Connecticut, Rhode Island, Vermont, and Maryland resulted in large decreases in cannabis possession arrests for both youth and adults, suggesting that the policy change had its intended consequence. Our analysis did not find any increase in the prevalence of youth cannabis use during the observation period.

Reefer madness or much ado about nothing? Cannabis legalization outcomes among young adults in the United States

In 2012, Colorado became one of the first two U.S. States to legalize cannabis for recreational use for adults 21 and older. Given that cannabis use holds potential physical and mental health risks, particularly among adolescent users, concerns have grown regarding changes in use following this change in policy. Studies examining medical cannabis legalization have found inconsistent changes in cannabis use and prevalence of dependence following medical implementation. However, recreational legalization holds potential unique changes, such as increased availability and social acceptance, as well as decreased price and perceived harm of use. There also may be increased interest in moving to Colorado related to the changes in cannabis laws. Based on past literature, two hypotheses were made for this study. First, college student cannabis use would increase after recreational legalization, however just for those 21 years old and older. Second, there would be a positive relation between the influence of cannabis legislation on out-of-State student's decision to attend a Colorado university and their cannabis use. Data from 5241 undergraduate students was available to test study hypotheses using Pearson's Chi-square, negative binomial regressions, and path analysis. Results indicated that cannabis use increased since recreational legalization for all students, but more so for those over 21 years. No differences in past month use frequency were found between pre- and post-legalization. Influence of cannabis laws on non-resident student's decision to attend a Colorado college predicted lifetime and past 30-day use. Additionally, out-of-State students reported higher past 30-day use than in-State students. These findings may help inform other States considering recreational legalization of potential outcomes, as well as potential interventions.

The law on the streets: Evaluating the impact of Mexico's drug decriminalization reform on drug possession arrests in Tijuana, Mexico

BACKGROUND

In 2009, Mexican Federal Government enacted "narcomenudeo" reforms decriminalizing possession of small amounts of drugs, delegating prosecution of retail drug sales to the state courts, and mandating treatment diversion for habitual drug users. There has been insufficient effort to formally assess the decriminalization policy's population-level impact, despite mounting interest in analagous reforms across the globe.

METHODS

Using a dataset of municipal police incident reports, we examined patterns of drug possession, and violent and non-violent crime arrests between January 2009 and December 2014. A hierarchical panel data analysis with random effects was conducted to assess the impact of narcomenudeo's drug decriminalization provision.

RESULTS

The reforms had no significant impact on the number of drug possession or violent crime arrests, after controlling for other variables (e.g. time trends, electoral cycles, and precinct-level socioeconomic factors). Time periods directly preceding local elections were observed to be statistically associated with elevated arrest volume.

CONCLUSIONS

Analysis of police statistics parallel prior findings that Mexico's reform decriminalizing small amounts of drugs does not appear to have significantly shifted drug law enforcement in Tijuana. More research is required to fully understand the policy transformation process for drug decriminalization and other structural interventions in Mexico and similar regional and international efforts. Observed relationship between policing and political cycles echo associations in other settings whereby law-and-order activities increase during mayoral electoral campaigns.

Measuring improvement in knowledge of drug policy reforms following a police education program in Tijuana, Mexico

Background

Mexico’s 2009 “narcomenudeo reform” decriminalized small amounts of drugs, shifting some drug law enforcement to the states and mandating drug treatment diversion instead of incarceration. Data from Tijuana suggested limited implementation of this harm reduction-oriented policy. We studied whether a police education program (PEP) improved officers’ drug and syringe policy knowledge, and aimed to identify participant characteristics associated with improvement of drug policy knowledge.

Methods

Pre- and post-training surveys were self-administered by municipal police officers to measure legal knowledge. Training impact was assessed through matched paired nominal data using McNemar’s tests. Multivariable logistic regression was used to identify predictors of improved legal knowledge, as measured by officers’ ability to identify conceptual legal provisions related to syringe possession and thresholds of drugs covered under the reform.

Results

Of 1750 respondents comparing pre- versus post training, officers reported significant improvement (p < 0.001) in their technical understanding of syringe possession (56 to 91%) and drug amounts decriminalized, including marijuana (9 to 52%), heroin (8 to 71%), and methamphetamine (7 to 70%). The training was associated with even greater success in improving conceptual legal knowledge for syringe possession (67 to 96%) (p < 0.001), marijuana (16 to 91%), heroin (11 to 91%), and methamphetamine (11 to 89%). In multivariable modeling, those with at least a high school education were more likely to exhibit improvement of conceptual legal knowledge of syringe possession (adjusted odds ratio [aOR] 2.6, 95% CI 1.4–3.2) and decriminalization for heroin (aOR 2.7, 95% CI 1.3–4.3), methamphetamine (aOR 2.2, 95% CI 1.4–3.2), and marijuana (aOR 2.5, 95% CI 1.6–4).

Conclusions

Drug policy reform is often necessary, but not sufficient to achieve public health goals because of gaps in translating formal laws to policing practice. To close such gaps, PEP initiatives bundling occupational safety information with relevant legal content demonstrate clear promise. Our findings underscore additional efforts needed to raise technical knowledge of the law among personnel tasked with its enforcement. Police professionalization, including minimum educational standards, appear critical for aligning policing with harm reduction goals.

Cannabis decriminalization and the age of onset of cannabis use

BACKGROUND

In the Czech Republic in 2010 a law was introduced decriminalizing personal possession of small quantities of several illicit drugs, including cannabis.

METHODS

We use 2012 survey data to examine the effect of a change in cannabis policy on the age of onset of cannabis use. We estimate the effect of the policy change using a mixed proportional hazards framework that models the transition to first cannabis use.

RESULTS

The change in cannabis policy did not affect the transition to first cannabis use.

CONCLUSION

We find no evidence of cannabis decriminalization affecting the age of onset of cannabis use.

A critique of cannabis legalization proposals in Canada

An editorial in this issue describes a cannabis policy framework document issued by a major Canadian research centre, calling for legalization of non-medical use under strict controls to prevent increase in use, especially by adolescents and young adults who are most vulnerable to adverse effects of cannabis. It claims that such a system would eliminate the severe personal, social and monetary costs of prohibition, diminish the illicit market, and provide more humane management of cannabis use disorders. It claims that experience with regulation of alcohol and tobacco will enable a system based on public health principles to control access of youth to cannabis without the harm caused by prohibition. The present critique argues that the claims made against decriminalization and for legalization are unsupported, or even contradicted, by solid evidence. Early experience in other jurisdictions suggests that legalization increases use by adolescents and its attendant harms. Regulation of alcohol use does not provide a good model for cannabis controls because there is widespread alcohol use and harm among adolescents and young adults. Government monopolies of alcohol sale have been used primarily as sources of revenue rather than for guarding public health, and no reason has been offered to believe they would act differently with respect to cannabis. Good policy decisions require extensive unbiased information about the individual and social benefits and costs of both drug use and proposed control measures, and value judgments about the benefit/harm balance of each option. Important parts of the necessary knowledge about cannabis are not yet available, so that the value judgments are not yet possible. Therefore, a better case can be made for eliminating some of the harms of prohibition by decriminalization of cannabis possession and deferring decision about legalization until the necessary knowledge has been acquired.

The legal status of suicide: A global review

Copies were obtained of the criminal codes from 192 countries and states; in 25 suicide is currently illegal, and an additional 20 countries follow Islamic or Sharia law where suicide attempters may be punished with jail sentences. The vast majority of countries have laws making it illegal to abet, aid or encourage suicide, but the nature and punishment of the actions that are illegal varies. Laws in places with Civil, Common Law, Islamic Law and Traditional Law systems are compared. Great variances in application were noted, sometimes within countries. It is impossible to estimate the number of persons currently in jail for having attempted suicide, but jail sentences are still given to suicide attempters. Some countries do not prosecute suicide attempters despite the laws, while others consistently jail suicide attempters. In countries where suicide attempts have been decriminalized, attempters may still face prosecution when another person is injured or dies as a result of their suicide attempt or where the attempter is a member of the military. We discuss the roots of laws making suicide, aiding, and encouraging suicide illegal and examine prospects for future changes. The recent Supreme Court Decision in Canada, invalidating the law making it illegal to assist in the suicide of physically ill people who are suffering (abeit with restrictive conditions) illustrates current trends towards "liberalization" of assisted suicide.

Trends in use of marijuana and attitudes toward marijuana among youth before and after decriminalization: the case of California 2007-2013

BACKGROUND

This analysis examines decriminalization as a risk factor for future increases in youth marijuana acceptance and use. Specifically, we examine marijuana-related behaviors and attitudes of 8th, 10th, and 12th graders in California as compared to other U.S. states during the years before and after California passed legislation in 2010 to decriminalize marijuana.

METHODS

Data come from Monitoring the Future, an annual, nationally representative survey of 8th, 10th, and 12th grade students.

RESULTS

In 2012 and afterwards California 12th graders as compared to their peers in other states became (a) 25% more likely to have used marijuana in the past 30 days, (b) 20% less likely to perceive regular marijuana use as a great health risk, (c) 20% less likely to strongly disapprove of regular marijuana use, and (d) about 60% more likely to expect to be using marijuana five years in the future. Analysis of 10th graders raises the possibility that the findings among 12th graders may reflect a cohort effect that was set into place two years earlier.

CONCLUSION

These results provide empirical evidence to support concerns that decriminalization may be a risk factor for future increases in youth marijuana use and acceptance.

Does liberalizing cannabis laws increase cannabis use?

A key question in the ongoing policy debate over cannabis' legal status is whether liberalizing cannabis laws leads to an increase in cannabis use. This paper provides new evidence on the impact of a specific type of liberalization, decriminalization, on initiation into cannabis use. Our identification strategy exploits variation in the timing of cannabis policy reforms and our estimation framework marries a difference-in-difference approach with a discrete time duration model. Our results reveal evidence of both heterogeneity and dynamics in the response of cannabis uptake to decriminalization. Overall, we find that the impact of decriminalization is concentrated amongst minors, who have a higher rate of uptake in the first five years following its introduction.

Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: 2003-11

BACKGROUND

In 2009, policy changes were accompanied by a rapid increase in the number of medical marijuana cardholders in Colorado. Little published epidemiological work has tracked changes in the state around this time.

METHODS

Using the National Survey on Drug Use and Health, we tested for temporal changes in marijuana attitudes and marijuana-use-related outcomes in Colorado (2003-11) and differences within-year between Colorado and thirty-four non-medical-marijuana states (NMMS). Using regression analyses, we further tested whether patterns seen in Colorado prior to (2006-8) and during (2009-11) marijuana commercialization differed from patterns in NMMS while controlling for demographics.

RESULTS

Within Colorado those reporting "great-risk" to using marijuana 1-2 times/week dropped significantly in all age groups studied between 2007-8 and 2010-11 (e.g. from 45% to 31% among those 26 years and older; p=0.0006). By 2010-11 past-year marijuana abuse/dependence had become more prevalent in Colorado for 12-17 year olds (5% in Colorado, 3% in NMMS; p=0.03) and 18-25 year olds (9% vs. 5%; p=0.02). Regressions demonstrated significantly greater reductions in perceived risk (12-17 year olds, p=0.005; those 26 years and older, p=0.01), and trend for difference in changes in availability among those 26 years and older and marijuana abuse/dependence among 12-17 year olds in Colorado compared to NMMS in more recent years (2009-11 vs. 2006-8).

CONCLUSIONS

Our results show that commercialization of marijuana in Colorado has been associated with lower risk perception. Evidence is suggestive for marijuana abuse/dependence. Analyses including subsequent years 2012+ once available, will help determine whether such changes represent momentary vs. sustained effects.