Drug decriminalization laws are on the rise. Here’s how they impact the opioid crisis

In the last decade, national opioid-related overdose deaths have skyrocketed, rising from 21,089 in 2010 to 80,411 in 2021.^[] Overdose deaths involving opioids have prompted state officials to decriminalize harm reduction methods such as drug checking supplies, according to the AMA.^[]

As these policies rise in popularity, jurisdictions around the world are embracing comprehensive drug decriminalization laws in support of a health-based approach to substance use. Experts say that physicians may support individual and community health by mitigating the negative impacts of criminalization during healthcare service provision.

The rise of decriminalization

Since the 1970s, the US has tackled substance use with ideologies and policies championed by the “war on drugs,” a term to refer to the global anti-drug campaign, popularized by Richard Nixon during his presidency.

According to an article published by the Annals of Medicine, “drug war logic,” which supports the prohibition of substances and criminalization of those who use them, has direct negative impacts on social determinants of health, such as housing, education, income, and employment.^[]

Explicit racism from which drug criminalization policies originate has also led experts from various backgrounds—including criminal justice, bioethics, sociology, psychology, and more—to call for an end to the war on drugs, according to an article published by the American Journal of Bioethics.^[]

One example of a jurisdiction to newly implement decriminalization laws is British Columbia (BC).

According to a 2023 article published by the Government of BC, adults in BC who possess opioids, crack and powder cocaine, methamphetamine, and MDMA in small amounts will no longer be subject to criminal charges.^[]

Instead of facing legal penalties, those in possession of 2.5 grams or less of these substances will have the option to learn about health and social supports available to them.

“The predominately criminal-justice-based approach that channels people who use drugs—some of whom live with a substance use disorder—into the criminal justice system (eg, jail sentences for possession of a small amount of an illegal substance) does not address what is ultimately a health issue,” Dr. Henry wrote in a special report.^[]

“As BC’s Provincial Health Officer, I have called on the federal government to move toward regulating access to currently controlled drugs, with a focus on harm reduction associated with the use of those substances, as well as the harms associated with the current prohibition-based regulatory regime and its application.”

More time needed to prove efficacy

We know that drug decriminalization is based on the goal of helping those who use illicit drugs get treatment, as opposed to punishing them. But does it actually work?

In some places, it may be too soon to tell.

According to a 2023 report published by the Oregon Health Authority, the implementation of Measure 110—the nation’s first program to decriminalize drug possession and designate over $100 million in annual cannabis revenue to expanding treatment services—may require more time to play out before health officials can be sure of its impact on the public.^[]

“The complex, decentralized, and ever-changing nature of health records and systems has consistently hindered data collection efforts,” the authors wrote. “Previous audits from this office have routinely found gaps in collecting and analyzing accurate, meaningful data. Without such data collection, gauging M110 success and making future improvements will be difficult.” 

The stigma persists

Meanwhile, in Portugal (whose officials decriminalized drugs in 2000), decriminalization was associated with a 25% reduction in the proportion of prisoners sentenced for drugs, as noted by the Government of BC in citing international evidence in favor of decriminalization.

But some aren’t convinced that Portugal’s model is effective enough to warrant its use in other jurisdictions.

An article published by Substance Abuse Treatment, Prevention, and Policy argues 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,” stating that the policy is riddled with anachronisms and ambiguities.^[]

Overall, drug decriminalization in the US is still in its early developmental stages. It may be too soon to say whether decriminalization is the key to the opioid crisis, or substance use issues at large.

What we do know is that criminalization policies may do more harm than good, signaling the need for a new approach—one that could benefit from decriminalization.