Do you know what is the leading cause of death for people under the age of 45 in the US today? It's not heart attacks, car accidents, or cancer. In fact, drug overdoses have led this statistic since 2016. Responsible for this – there is ample empirical evidence for this – are excessive prescriptions of opiate pain relievers, which ultimately drive people from more affluent areas into addiction to heroin. A second deadly epidemic is raging in the shadow of the coronavirus, for which no vaccination is in sight as a solution anytime soon. The US state of Oregon pushed forward last year with a supposedly unorthodox strategy in the fight against the opiate crisis. In the course of the presidential election, the state's population voted overwhelmingly in favor of a referendum that initiated the extensive decriminalization of the possession of even hard drugs such as heroin and cocaine.
Decriminalize the same drugs that caused the drug epidemic? Behind this is the view that supply-side measures are usually much more effective in preventing harmful drug use than those targeting users. If consumption is made out of punishment, say the initiators of the referendum, the burden on the judiciary can be relieved and resources in law enforcement can be redistributed to the import and trade of drugs. Oregon is not alone in this move. Portugal, for example, was the first European country to make drug possession of all drugs out of punishment in 2001, in response to a spate of heroin deaths and the highest HIV rate in the EU.
What effects can such liberalization have? We can't say anything about Oregon yet, for Portugal there is a lack of suitable data to be able to make serious statements. Instead, it is worth taking a look at another policy experiment: the legalization of marijuana for medical purposes in the US, which has been rolled out at the state level for years. The regionally delayed rollout has massive advantages for empirical scientists because statistically similar regions can be compared shortly before and after legalization. This is only possible if liberalization is not implemented nationwide at the same time as in Portugal. In addition, the data situation in the USA, at least with regard to drug use and crime in the population, is much better than in Europe – the effects of liberalization can therefore be evaluated excellently there. In the following I want to take up knowledge from this literature that can help to think about the meaningfulness of a marijuana liberalization in Austria.
Probably the most central question is whether liberalization will attract new users who would otherwise not have used the drug. However, there is hardly any evidence for such an effect in the literature. In fact, there is much to suggest that the legalization of medical marijuana will result in the consumption of non-medicinal, i.e. still illegal, marijuana either staying the same or even decreasing. The direction in which the effect goes depends on the design of the law: Allowed self-cultivation, for example, seems to lead to greater reductions than regulated delivery points. At first glance, this reduction may not be surprising; some of the consumers switch to the legal market; the illegal market will therefore shrink because dealers will probably change their product range. At the same time, however, it can also be expected that the price on the illegal market will fall as a result of the new, legal competition and that demand will therefore increase. However, it seems that legality alone does not lead to a rapid increase in the number of consumers. It should be noted here that such studies can usually only examine short-term effects. It cannot be ruled out that there will be a destigmatization in the longer term and that the drug will become more attractive in new target groups.
A common argument against marijuana legalization is that it makes it easier for children and adolescents to have access to the drug. This is seen as problematic primarily because medical studies indicate that marijuana consumption in adolescence impairs brain development and can lead to cognitive disorders. You will never know for sure whether this is actually the case. The scientific gold standard for proving such a connection would be an experiment in which a randomly selected part of the participants is forced to consume cannabis, while the rest have to remain abstinent. Such an experiment is simply not feasible for ethical reasons.
In this context, an interesting study by Olivier Marie and Ulf Zölitz from the Netherlands should be mentioned. This looks at students in Maastricht, where in 2011 all foreigners – with the exception of Belgian and German citizens – were temporarily denied legal access to marijuana. Marie and Zölitz find that affected foreigners suddenly do much better academically than before. The probability of ending a course on a positive note increased by around 5.4 percent, while the rate of course dropouts remained constant. These are definitely great effects. However, it is unclear whether this effect actually originates from a temporary cognitive enlightenment. In any case, a study published in the Proceedings of the National Academy of Sciences in 2016 found no difference in long-term cognitive outcomes in twin pairs in which one twin consumed marijuana and the other did not.
Hardly any increased consumption among adolescents
Much more important, however, is that even among adolescents, there is hardly any evidence in the US literature that the legalization of marijuana leads to increased consumption. Sometimes there is talk of a “forbidden fruit” effect, meaning that marijuana is less attractive for young people when consumption is legal. That may be, but there is no really convincing evidence for it. It is much more likely that we are seeing a mechanical effect here. While practically everyone can take part in the illegal market, dispensing points, for example, can and must check the age of a person and, if necessary, refuse to dispense in order to avoid making themselves liable to prosecution. Young people therefore largely remain on the illegal market, which is, however, shrinking thanks to legalization, at least for a short time. There will simply be too little supply, which is why consumption will tend to fall.
Another concern is that marijuana is a gateway drug that paves the way to harder drugs. The literature on this is very one-sided: there is hardly any causal evidence for such a “gateway” effect, at least from the USA. You can even see that opioid use, like heroin, is falling sharply in states that legalize medical marijuana. The reason is obviously that opiates and marijuana are substitutes, so they are typically not consumed together. If marijuana is allowed for medicinal purposes, there is also the fact that both substances can be used in pain therapy, for example. If patients can treat their chronic pain with the soothing marijuana, they are less likely to need opiate pain relievers. Especially in the USA, where strong opiates are often prescribed even for minor symptoms, it can be assumed that there is such a substitution effect.
Incidentally, the same applies to alcohol. Again, there is credible evidence to suggest that, on average, there is less alcohol consumption when medical marijuana is legalized. This also reduces traffic accidents. For example, a study by Anderson, Hanson, and Rees from the United States found that fatal traffic accidents in states that have legalized medical marijuana decrease by up to 11 percent in the first year after legalization. That is a substantial effect.
How many police resources will be freed up?
How many police resources will actually be freed up if drugs are not only decriminalized for medical consumption? A much-cited study by Adda, McConnell and Rasul examines this question. She analyzes a policy experiment in the London borough of Lambeth, where the possession of very small amounts of cannabis was completely decriminalized between 2001 and 2002. Interestingly, it turns out that the decriminalization has increased police arrests related to marijuana. Since the purchase and possession were legal at the time, these must be dealers who could be more likely to be identified.
The increase can have two reasons: Either – contrary to the results from the USA – the demand for marijuana in Lambeth has increased due to decriminalization and dealers have expanded their offerings accordingly (which also makes them more vulnerable), or the police have been able to identify dealers more efficiently. If consumer purchases are legal, there may be more open dealing on the street, making it easier for police officers to identify dealers. The efficiency argument is also supported by the fact that above all non-drug-related crime has decreased significantly as a result of decriminalization, while clearing-up and arrest rates have improved. Overall, crime fell by almost ten percent during this time.
A study by Gavrilova, Kamada and Zoutman, which investigates the effect of medical marijuana laws on crime in border regions between the USA and Mexico, found a similar effect. The authors find that gang and violent crime have decreased massively, especially in regions that are closer to the border. Of course, this cannot be a long-term effect. It can be assumed that cartels will try to switch to other, possibly more dangerous business areas due to the loss of earnings. Some of this can already be observed in the USA today.
Drugs will always win
So would legalization of cannabis also make sense for Austria? In this country, the possession of addictive substances is a criminal offense, but the public prosecutor's office must withdraw from prosecution if they acquire or possess small quantities, provided that these are intended for personal consumption. The file then goes to the medical officer, who can order so-called health-related measures. These usually include urine tests, which are supposed to ensure that the drug is no longer consumed, otherwise the complaint goes back to the public prosecutor. Such measures may make sense, but since they have never been systematically evaluated, I prefer to go along with the great William S. Burroughs: “Junk wins by default.” Drugs will always win, we help people better control their consumption and continue to participate in society to participate.
Full legalization, which also enables the sale of marijuana and the associated tax revenue, seems a long way off at the moment; however, decriminalization could bring major economic cost savings. Like any other intoxicant – and here I am thinking of alcohol in particular – marijuana naturally has more than just positive effects. Due to the unclear evidence, children and adolescents should be denied access in any case; Education campaigns about possible cognitive consequential damage can be useful.
The Lambeth study cited above finds evidence that property prices in the district have fallen as a result of the marijuana decriminalization. This is surprising in view of the reduced crime rate; expectations and fears in the population may play a role here. Taking such fears seriously must be part of any factual liberalization debate. These and other challenges should be weighed up in a careful cost-benefit analysis. If we believe the literature, from today's perspective the benefits of liberalization seem to outweigh the rest.
