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Studying the Relationship Between Drugs and Crime

Sidebar to the article Identifying New Illicit Drugs and Sounding the Alarm in Real Time , by Jim Dawson, published in NIJ Journal issue no. 281.

In 1976, Congress directed NIJ to collaborate with the National Institute on Drug Abuse to explore the relationship between drug use and crime. By 1980, a team of four NIJ-sponsored researchers had compiled and published Drugs and Crime: A Survey and Analysis of the Literature . [1] This report summarized existing research on patterns of drug use and criminal behavior and the effects of drug treatment strategies on criminality, setting the stage for NIJ to launch its Drug Use Forecasting (DUF) program in 1987. DUF measured and tracked drug use among arrestees to generate reliable and current information on drug use in relation to the criminal justice system. After a decade of collecting data, NIJ refined and expanded DUF to form the Arrestee Drug Abuse Monitoring (ADAM) program, improving the quality of its annual estimates of drug use prevalence. ADAM was in operation until 2003. [2] The data from these two NIJ efforts proved foundational for understanding the changing landscape of drug use across regions and over time.

In addition to tracking drug use trends, NIJ has also invested significant resources in original research on how to decrease drug use. NIJ-funded studies in the 1990s showed that drug treatment could be integrated into the criminal justice system to effectively reduce criminality. Building on these findings, NIJ began to evaluate an array of drug treatment modalities for persons convicted of crimes, including drug courts, residential drug treatment corrections programs, intensive probation supervision, and systemwide approaches. NIJ’s drugs and crime portfolio over the past decade has focused on crime reduction by studying prevention and intervention strategies for drug-related crimes, tactics for disrupting and dismantling drug markets, and technologies for improved drug detection and recognition.

More recently, NIJ research has focused on the policies, practices, and resources available to law enforcement to deter, investigate, and prosecute opioid use. As part of the U.S. Department of Justice’s overall response to the opioid epidemic, NIJ’s current priority is to address drug trafficking, markets, and use related to heroin and other opioids such as fentanyl and its analogues.

About This Article

This article was published as part of NIJ Journal issue number 281 , published May 2019, as a sidebar to the article Identifying New Illicit Drugs and Sounding the Alarm in Real Time , by Jim Dawson.

[note 1] Robert P. Gandossy, Jay R. Williams, Jo Cohen, and Henrick J. Harwood, Drugs and Crime: A Survey and Analysis of the Literature , Washington, DC: U.S. Department of Justice, National Institute of Justice, May 1980, NCJ 159074.

[note 2] Although NIJ ended ADAM in 2003, the Office of National Drug Control Policy operated ADAM II from 2007 to 2013. Ten of the original ADAM sites were selected for geographic diversity to address questions regarding methamphetamine trends beyond the Southwest, and instrumentation was modified to add items specific to methamphetamine.

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Drugs and Crime by Richard Wright , Scott Jacques LAST REVIEWED: 14 December 2009 LAST MODIFIED: 14 December 2009 DOI: 10.1093/obo/9780195396607-0061

The relationship between drugs and crime has a long history and is a mainstay of fiction, widely documented in media reports, and the subject of substantial scientific investigation. Drugs are not always illegal, and their sale and use does not always lead to crime. Nevertheless, drugs and crime are related to each other in at least three ways. First, the immediate effect of drugs on the mind and body may create mental or physical states that somehow facilitate aggression or theft. Second, drugs are connected to crime when a drug user has a pressing need to consume them but lacks the necessary funds to do so; such situations may lead to predatory crimes, including burglary, robbery, or theft, among others. A third way in which drugs and crime are related is that some psychoactive substances are illegal to use, trade (buy or sell), or grow/manufacture. When drugs are illegal, illicit market participants are unlikely to report being victimized to the police, which means that predators are more likely to prey on them; in turn, there may be retaliation when this happens. In short, drugs can be related to crime if they cause a mental or physical state conducive to lawbreaking, lead to a perceived need that results in the motivation to steal, or result in a decrease in access to formal mediation and a corresponding increase in predatory and retaliatory crimes.

Several general treatments provide a comprehensive review of the drugs-crime relationship. Although Goldstein 1985 is limited by its focus on violence, the framework it suggests is obviously applicable to nonviolent crimes. Conceived in general terms, Goldstein is suggesting that the psychopharmacological effect of drugs can increase the chances of any kind of crime occurring, the perceived need for drugs can increase predatory crimes (e.g., robbery, burglary, and theft) and entrepreneurial crimes (e.g., drug dealing or prostitution), and the absence of formal mediation can increase crimes of predation but can also spark retaliatory measures such as assault and murder. Two edited volumes, Tonry and Wilson 1990 and National Institute of Justice 2003 , offer a wide-ranging look at the current knowledge concerning the drugs-crime relationship. Goldstein, et al. 1997 provides qualitatively and quantitatively oriented chapters on the relationship between crack cocaine and violence. Inciardi and McElrath 2007 contains a series of papers on the drugs-crime connection, including Paul J. Goldstein’s influential paper on the topic. The basic facts surrounding the drugs-crime connection, such as definitions and statistics, are available from the ONCDP ( Office of National Drug Control Policy 2000 ) and the BJS ( Bureau of Justice Statistics 1998 and Bureau of Justice Statistics 2009 ).

Bureau of Justice Statistics. 1998. Alcohol and crime: An analysis of national data on the prevalence of alcohol involvement in crime . Washington, DC: U.S. Department of Justice.

Presents and discusses statistical relationships between alcohol and crime.

Bureau of Justice Statistics. Drug and Crime Facts .

Website that provides an array of statistics on various drug-crime connections in the United States.

Goldstein, Paul J. 1985. The drugs/violence nexus: A tripartite conceptual framework. Journal of Drug Issues 15:493–506.

Provides the conceptual foundation for much of the post-1985 work on the drugs-violence relationship. This is a necessary read for all persons interested in the link between drugs and crime, especially violent crime.

Inciardi, James A., and Karen McElrath, eds. 2007. The American drug scene: An anthology . 5th ed. New York: Oxford Univ. Press.

Provides a general overview of illicit drugs and drug use. One section, however, consists of a series of papers on the drugs-crime relationship. Included are discussions of the “date-rape drug” and Paul J. Goldstein’s classic article ( Goldstein 1985 ) on the drug-violence connection.

National Institute of Justice. 2003. Toward a drugs and crime research agenda for the 21st century . Washington, DC: U.S. Department of Justice.

A comprehensive review of concepts, theories, and research on the drugs-crime relationship. Suggests avenues for future work based on the limitations of and gaps in previous research. This work is especially useful for persons interested in the economics of drugs and drug control. Available online .

Office of National Drug Control Policy. 2000. Drug-related crime . Rockville, MD: Drug Policy Information Clearinghouse.

Defines various potential drug-crime relationships and provides statistical data pertaining to those relationships. Available online .

Tonry, Michael, and James Q. Wilson, eds. 1990. Drugs and crime . Vol. 13 of Crime and justice: A review of research . Edited by Michael Tonry. Chicago: Univ. of Chicago Press.

Explores several drugs-crime relationships, including the link between drugs and prostitution, predatory crime, and aggression.

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The Wider Impact of Drug Legalization on the Criminal Justice System

by aseneviratne | Mar 16, 2021 | All , Criminal Justice Reform , Public Health

This paper will discuss the effect of legalizing possession of all drugs on the criminal justice system. This paper will begin with a brief history of the modern War on Drugs to establish why drug possession should not be a criminal matter. Discussion of the impact of legalization will primarily focus on reduction in caseload and the resulting benefits.

The modern War on Drugs began during the Nixon presidency with the passage of the Controlled Substances Act of 1970 (“CSA”), which established federal regulatory power over the manufacture, importation, possession, use, and distribution of certain substances. [1] The CSA was ostensibly a public health response to the growing heroin epidemic in the mid-1960s. [2] In 1973, Nixon created the Drug Enforcement Agency (“DEA”) to carry out enforcement of the CSA. [3]

The War on Drugs expanded into a system of mass incarceration under the Comprehensive Crime Control Act of 1984, which increased criminal penalties associated with cannabis possession and established mandatory minimum sentences. [4] From 1980 to 1997, “the number of [individuals incarcerated] for nonviolent drug law offenses [jumped] from 50,000 . . . to over 400,000.” [5] “By 1991, the United States had surpassed the former Soviet Union and South Africa as having the largest prison population in the world.” [6] The racial impact from the ‘Tough on Crime’ approach reared its ugly head as “the sentences of black inmates were 41% longer than that of whites.” [7]

Most critically, the War on Drugs has been ineffective in deterring drug use. [8] In 2000, law enforcement seized over 4.4 million tablets of ecstasy, an increase from 350,000 tablets just two years prior. [9] From 2010 to 2015, the lifetime prevalence of 8th graders who have used illicit drugs consistently hovered around 20%. [10] Over that same period, the number of drug-induced deaths increased from 40,393 to 55,403. [11]

In light of the racial bias stemming from the War on Drugs as well as its failure to achieve its supposed intended purpose, drug possession is a worthy candidate for exploration into forms of treatment outside of the criminal realm. [12]

Legalization v. Decriminalization

For the purposes of this paper, assume that legalization means that the possession, sale, and manufacturing of all drugs would be regulated similarly to alcohol or cigarettes. At the outset, it is important to note why legalization is preferable to decriminalization. Decriminalization of drug possession simply means that possession is not a criminal offense. [13] In 2001, Portugal decriminalized all drugs, and the public health benefits have been palpable. [14] Under a system of decriminalization, however, the manufacturing and sale of drugs is still criminal. [15] As a result, the drug market is still propped up and supplied by drug cartels, just as it is in a system of prohibition. [16] Legalization goes further than decriminalization by legalizing drug production. [17] Allowing companies to manufacture drugs removes the viability of the black market drug trade, such as in Mexico where one cartel alone “had annual earnings calculated to be as high as $3 billion.” [18] In 2018, the DEA spent over $445 million on international enforcement to decrease the impact of these cartels in the United States. [19] Legalization treats the cause of the disease, and the consequent reduction in symptoms would decrease the need for these yearly international enforcement expenditures.

Court Decluttering

In 2017, there were 1,632,921 drug related violations in the U.S., of which 85.4% were for possession; an average of 3,820 possession arrests per day. [20] Under a system of legalization, American courts would no longer be inundated with this entire class of offense. The benefits of legalization on the courts are multifaceted: for the drug possessor, who is no longer a victim of the fruitless War on Drugs; for the judge, who enjoys greater flexibility with a decluttered docket; and most importantly, for the public defender, who can take advantage of the much-needed decrease in workload to provide better counsel to clients. [21]

In 2016, Louisiana had an estimated annual workload of 147,220 total cases to be divided among its 363 public defenders. [22] This meant that “the Louisiana public defense system [could only] handle 21 percent of [its] workload in compliance with [state] guidelines.” [23]

“Unsurprisingly, excessive workloads diminish the quality of legal representation.” [24] With such an enormous caseload, public defenders do not have the time available to conduct basic defense tasks necessary for a trial, creating an incentive for guilty pleas. [25] Guilty pleas based on time constraint rather than merit render “an ethical and constitutional plea bargain . . . impossible.” [26]

Given the sheer number of drug arrests, legalization would likely drastically reduce the public defense system’s case load. [27] With this caseload reduction, public defenders would be able to work towards closing the gap between the actual and necessary amount of time devoted to each client. [28] With more time to evaluate each case, public defenders can more effectively assess the appropriateness of a plea deal on the merits, rather than time constraints. [29] The increased legitimacy and efficiency of the public defense system resulting from legalization will likely lead to broader indirect benefits for all public defense clients, no matter what crime they are accused of. [30 ]

An argument against legalization posits that these reductions in public defense caseload would be offset by an increase in crime, such as petty crime and driving under the influence, due to legalization. [31] This line of reasoning rests on the assumption that if there are no criminal penalties for drug possession or use, then the number of drug users will increase. [32] With more people using drugs, more people will become addicts, who are more prone to committing crimes. [33]

The assumption that the absence of criminal sanctions entails more people using drugs is unsound, as under Portugal’s system of decriminalization, “in almost every category of drug, and for drug usage overall, the lifetime prevalence rates . . . were higher” prior to decriminalization. [34] Cocaine usage in Portugal was significantly lower than usage in the United States, which was head and shoulders above the rest of the world. [35] The heroin usage rate in Portugal from 1999 to 2005 actually decreased from 2.5% to 1.8% among those in the 16-18 age group. [36] Decreased drug use does not necessarily follow from from punitive state response, just as increased drug use does not necessarily follow from rehabilitative state response. [37] If the pool of drug users remains consistent after legalization, then pool of criminal drug users would likely remain consistent as well.

Still, even assuming that the number of drug addicts would increase post-legalization, leading to an increase in the number of petty crime and driving under the influence (“DUI”) cases, these cases differ quantitatively and qualitatively from possession and crimes currently associated with the black market for drugs.

Quantitatively, the increased caseload for petty crime and driving under the influence would still be significantly less the number of possession charges the system currently deals with. [38] Further, under the current system of prohibition, courts and society at large must deal with violent crimes associated with the black market for narcotics: in 2016, 11.2% of all federal prisoners held in state correctional facilities were incarcerated for drug trafficking and drug offenses other than possession. [39] Under a system of legalization, the profitability of the black market is greatly reduced, which would likely result in these arguably more serious crimes becoming less prevalent and further decreasing the caseload related to drugs despite a potential increase in petty crime and driving under the influence cases. [40]

Qualitatively, DUIs directly present significant and real risks of harm to other members of society in a way that drug possession does not. “In 2016, 10,497 people died in alcohol-impaired driving crashes, accounting for 28% of all traffic-related deaths in the United States.” [41] Given the increased culpability and blameworthiness of these crimes, it is not a waste of the public defense system resources to criminalize DUI and bear the associated costs of doing so; rather, these are precisely the crimes which fall under the purview of the criminal justice system. [42]

In conclusion, the War on Drugs has disproportionately impacted minorities [43] and has not effectively reduced drug consumption and usage. [44] In light of this, the United States should take steps to legalize drug possession and emulate the success of other nations who have treated drug use as public health matter, instead a criminal one. [45] Further, the benefits of legalization extend beyond drug users. [46] Globally, legalization helps to curtail the influence of cartels. [47] Domestically, legalization frees up the criminal justice system, permitting more efficient and legitimate legal representation for all individuals. [48]

[1] See Controlled Substances Act of 1970, 21 U.S.C. § 811.

[2] See Pub. Broadcasting Serv., Interview Dr. Robert DuPont , FRONTLINE: DRUG WARS, https://www.pbs.org/wgbh/pages/frontline/shows/drugs/interviews/dupont.html (last visited Mar. 20, 2020).

[3] See History , DRUG ENF’T AGENCY, dea.gov/history (last visited Jun. 29, 2020).

[4] See Comprehensive Crime Control Act of 1984, Pub. L. No. 98-473, 98 Stat. 1976.

[5] A Brief History of the Drug War , DRUG POL’Y ALL., https://www.drugpolicy.org/issues/brief-history-drug-war, (last visited Mar. 23, 2020).

[6] Charles Ogletree, Getting Tough on Crime: Does It Work? 38 Boston B. J. 9, 27 (1994).

[8] See Ross C. Anderson, We Are All Casualties of Friendly Fire in the War on Drugs , 13 Utah B.J. 10, 11 (2000).

[9] Id. at 11.

[10] See OFFICE OF NAT’L DRUG CONTROL POL’Y, NATIONAL DRUG CONTROL STRATEGY: PERFORMANCE REPORTING SYSTEM REPORT 27 (2016); What is Prevalence? NAT’L INST. MENTAL HEALTH (Nov. 2017), https://www.nimh.nih.gov/health/statistics/what-is-prevalence.shtml (explaining that “[l]ifetime prevalence is the proportion of a population who, at some point in life has ever had the characteristic.”).

[11] Id. at 12.

[12] See Anderson, supra note 8, at 11.

[13] See GLENN GREENWALD, DRUG DECRIMINALIZATION IN PORTUGAL: LESSONS FOR CREATING FAIR AND SUCCESSFUL DRUG POLICIES 2 (2009), https://www.cato.org/publications/white-paper/drug-decriminalization-portugal-lessons-creating-fair-successful-drug-policies.

[14] See id. at 14-15 (explaining that since decriminalization, Portugal has experienced a slight decline in drug use, a significant decline in drug related pathologies such as HIV, and a substantial increase in use of treatment programs).

[15] See i d. at 2.

[16] See German Lopez, What People Get Wrong About Prohibition , VOX (Oct. 19, 2015), https://www.vox.com/2015/10/19/9566935/prohibition-myths-misconceptions-facts.

[17] See GREENWALD, supra note 13, at 2.

[18] JUNE S. BEITTEL, CONG. RSCH. SERV., R41576, MEXICO: ORGANIZED CRIME AND DRUG TRAFFICKING ORGANIZATIONS 19 (2019).

[19] DRUG ENF’T ADMIN., FY 2019 BUDGET REQUEST, 4 (2018).

[20] See 2017 Crime in the United States: Persons Arrested , FED. BUREAU INVESTIGATION: UNIFORM CRIME REPORTING, https://ucr.fbi.gov/crime-in-the-u.s/2017/crime-in-the-u.s.-2017/topic-pages/persons-arrested (last visited Aug. 15, 2020).

[21] See Lisa C. Wood et al., Meet-and-Plead: The Inevitable Consequence of Crushing Defender Workloads , 42 LITIG. 20, 23 (2016).

[22] See A.B.A. & POSTLETHWAITE & NETTERVILLE, THE LOUISIANA PROJECT: A STUDY OF THE LOUISIANA DEFENDER SYSTEM AND ATTORNEY WORKLOAD STANDARDS 2 (2017).

[24] Wood et al., supra note 21, at 23.

[25] See id.

[27] See id. at 26.

[28] See id .

[29] See id .

[30] See id.

[31] See Paul Stares, Drug Legalization?: Time for a Real Debate , BROOKINGS INST. (Mar. 1, 1996), https://www.brookings.edu/articles/drug-legalization-time-for-a-real-debate/.

[32] See id.

[33] See id.

[34] GREENWALD, supra note 13, at 14-15 (emphasis added).

[35] See id. at 22-24.

[36] Id. at 14.

[37] See Stares, supra note 31 .

[38] See 2016 Crime in the United States: Table 18 , FED. BUREAU INVESTIGATION: UNIFORM CRIME REPORTING, https://ucr.fbi.gov/crime-in-the-u.s/2016/crime-in-the-u.s.-2016/topic-pages/tables/table-18 (last visited Aug. 15 2020) (illustrating that arrests for drug abuse violations are nearly eight times as high as arrests for burglary – a petty crime that is often related to drugs).

[39 ] JENNIFER BRONSON & E. ANN CARSON, BUREAU OF JUSTICE STATISTICS, NCJ 252156 , PRISONERS IN 2017 21 (2019).

[40] See Lopez, supra note 16 .

[41] Impaired Driving: Get the Facts, CENTERS FOR DISEASE CONTROL AND PREVENTION ( Aug. 24, 2020, 12:00 AM), https://www.cdc.gov/motorvehiclesafety/impaired_driving/impaired-drv_factsheet.html.

[42] See Janine Geske, Achieving the Goals of Criminal Justice: A Role for Restorative Justice , 30 Quinnipiac L. Rev. 527, 530-31 (2012).

[43] See Anderson, supra note 8, at 11 .

[44] See id.

[45] See GREENWALD, supra note 13, at 14-15.

[46] See Stares, supra note 31.

[47] See i d.

[48] See Wood et al., supra note 21, at 23, 26; s ee also Lopez, supra note 16.

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v.10(9); 2020

Original research

Impact evaluations of drug decriminalisation and legal regulation on drug use, health and social harms: a systematic review, ayden i scheim.

1 Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA

2 Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, Ontario, Canada

Nazlee Maghsoudi

3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Zack Marshall

4 Social Work, McGill University, Montreal, Quebec, Canada

Siobhan Churchill

5 Epidemiology and Biostatistics, Western University, London, Ontario, Canada

Carolyn Ziegler

6 Library Services, Unity Health Toronto, Toronto, Ontario, Canada

7 Medicine, University of California San Diego, La Jolla, California, USA

Associated Data

bmjopen-2019-035148supp001.pdf

bmjopen-2019-035148supp002.pdf

bmjopen-2019-035148supp003.pdf

To review the metrics and findings of studies evaluating effects of drug decriminalisation or legal regulation on drug availability, use or related health and social harms globally.

Systematic review with narrative synthesis.

Data sources

We searched MEDLINE, Embase, PsycINFO, Web of Science and six additional databases for publications from 1 January 1970 through 4 October 2018.

Inclusion criteria

Peer-reviewed articles or published abstracts in any language with quantitative data on drug availability, use or related health and social harms collected before and after implementation of de jure drug decriminalisation or legal regulation.

Data extraction and synthesis

Two independent reviewers screened titles, abstracts and articles for inclusion. Extraction and quality appraisal (modified Downs and Black checklist) were performed by one reviewer and checked by a second, with discrepancies resolved by a third. We coded study-level outcome measures into metric groupings and categorised the estimated direction of association between the legal change and outcomes of interest.

We screened 4860 titles and 221 full-texts and included 114 articles. Most (n=104, 91.2%) were from the USA, evaluated cannabis reform (n=109, 95.6%) and focussed on legal regulation (n=96, 84.2%). 224 study outcome measures were categorised into 32 metrics, most commonly prevalence (39.5% of studies), frequency (14.0%) or perceived harmfulness (10.5%) of use of the decriminalised or regulated drug; or use of tobacco, alcohol or other drugs (12.3%). Across all substance use metrics, legal reform was most often not associated with changes in use.

Conclusions

Studies evaluating drug decriminalisation and legal regulation are concentrated in the USA and on cannabis legalisation. Despite the range of outcomes potentially impacted by drug law reform, extant research is narrowly focussed, with a particular emphasis on the prevalence of use. Metrics in drug law reform evaluations require improved alignment with relevant health and social outcomes.

Strengths and limitations of this study

This is the first study to review all literature on the health and social impacts of decriminalisation or legal regulation of drugs.
We systematically searched 10 databases over a 38-year period, without language restrictions.
The review was limited to study designs appropriate for evaluating interventions, nevertheless, most included studies used relatively weak evaluation designs.
Included outcomes were heterogeneous and not quantitatively synthesised.
Heterogeneity in the details and implementation of decriminalisation or legal regulation policies was not considered in this review.

Introduction

An estimated 271 million people used an internationally scheduled (‘illicit’) drug in 2017, corresponding to 5.5% of the global population aged 15 to 64. 1 Despite decades of investment, policies aimed at reducing supply and demand have demonstrated limited effectiveness. 2 3 Moreover, prohibitive and punitive drug policies have had counterproductive effects by contributing to HIV and hepatitis C transmission, 4 5 fatal overdose, 6 mass incarceration and other human rights violations 7 8 and drug market violence. 9 As a result, there have been growing calls for drug law reform 10–12 and in 2019, the United Nations Chief Executives Board endorsed decriminalisation of drug use and possession. 13 Against this backdrop, as of 2017 approximately 23 countries had implemented de jure decriminalisation or legal regulation of one or more previously illegal drugs. 14–16

A wide range of health and social outcomes are affected by psychoactive drug production, sales and use, and thus are potentially impacted by drug law reform. Nutt and colleagues have categorised these as physical harms (eg, drug-related morbidity and mortality to users, injury to non-users), psychological harms (eg, dependence) and social harms (eg, loss of tangibles, environmental damage). 17 18 Concomitantly, a diverse and sometimes competing set of goals motivate drug policy development, including ameliorating the poor health and social marginalisation experienced by people who use drugs problematically, shifting patterns of use to less harmful products or modes of administration, curtailing illegal markets and drug-related crime and reducing the economic burden of drug-related harms. 19

Given ongoing interest by states in drug law reform, as well as the recent position statement by the United Nations Chief Executives Board endorsing drug decriminalisation, 13 a comprehensive understanding of their impacts to date is required. However, the scientific literature has not been well-characterised, and thus the state of the evidence related to these heterogeneous policy targets remains largely unclear. Systematic reviews, including two meta-analyses, are narrowly focussed on adolescent cannabis use. Dirisu et al found no conclusive evidence that cannabis legalisation for medical or recreational purposes increases cannabis use by young people. 20 In the two meta-analyses, Sarvet et al found that the implementation of medical cannabis policies in the USA did not lead to increases in the prevalence of past-month cannabis use among adolescents 21 and Melchior et al found a small increase in use following recreational legalisation that was reported only among lower-quality studies. 22

Given increasing interest in quantifying the impact of drug law reform, as well as a lack of systematic assessment of outcomes beyond adolescent cannabis use to date, we conducted a systematic review of original peer-reviewed research evaluating the impacts of (a) legal regulation and (b) drug decriminalisation on drug availability, use or related health and social harms. Our primary aim is to characterise studies with respect to metrics and indicators used. The secondary aim is to summarise the findings and methodological quality of studies to date.

Consistent with our aim of synthesising evidence on the impacts of decriminalisation and legal regulation across the spectrum of potential health and social effects, we conducted a systematic review using narrative synthesis 23 without meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in preparing this manuscript. 24 The review protocol was registered in PROSPERO (CRD42017079681) and can be found online at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79681 .

Search strategy and selection criteria

The review team developed, piloted and refined the search strategy in consultation with a research librarian and content experts. We searched MEDLINE, Embase, PsycINFO, Web of Science, Criminal Justice Abstracts, Applied Social Sciences Index & Abstracts, International Bibliography of the Social Sciences, PAIS Index, Policy File Index and Sociological Abstracts for publications from 1 January 1970 through 4 October 2018. We used MeSH (Medical Subject Headings) terms and keywords related to (a) scheduled psychoactive drugs, (b) legal regulation or decriminalisation policies and (c) quantitative study designs. Search terms specific to health and social outcomes were not employed so that the search would capture the broad range of outcomes of interest. See online supplemental appendix A for the final MEDLINE search strategy. For conference abstracts, we contacted authors for additional information on study methods and to identify subsequent relevant publications.

Supplementary data

We included peer-reviewed journal articles or conference abstracts reporting on original quantitative studies that collected data both before and after the implementation of drug decriminalisation or legal regulation. We did not consider as original research studies that reproduced secondary data without conducting original statistical analyses of the data. We defined decriminalisation as the removal of criminal penalties for drug use and/or possession (allowing for civil or administrative sanctions) and legal regulation as the development of a legal regulatory framework for the use, production and sale of formerly illegal psychoactive drugs. Studies were excluded if they evaluated de facto (eg, changes in enforcement practices) rather than de jure decriminalisation or legal regulation (changes to the law). This exclusion applied to studies analysing changes in outcomes following the US Justice Department 2009 memo deprioritising prosecution of cannabis-related offences legal under state medical cannabis laws. Eligible studies included outcome measures pertaining to drug availability, use or related health and social harms. We used the schema developed by Nutt and colleagues to conceptualise health and social harms, including those to users (physical, psychological and social) and to others (injury or social harm). 18

Both observational studies and randomised controlled trials were eligible in principle, but no trials were identified. There were no geographical or language restrictions; titles, abstracts and full-texts were translated on an as-needed basis for screening and data extraction. We excluded cross-sectional studies (unless they were repeated) and studies lacking pre-implementation and post-implementation data collection because such designs are inappropriate for evaluating intervention effects.

Data analysis

Screening and data extraction were conducted in DistillerSR (Evidence Partners, Ottawa, Ontario). We began with title-only screening to identify potentially relevant titles. Two reviewers screened each title. Unless both reviewers independently decided a title should be excluded, it was advanced to the next stage. Next, two reviewers independently screened each potentially eligible abstract. Inter-rater reliability was good (weighted Kappa at the question level=0.75). At this stage, we retrieved full-text copies of all remaining references, which were screened independently by two reviewers. Disagreements on inclusion were resolved through discussion with the first author. Finally, one reviewer extracted data from each included publication using a standardised, pre-piloted form and performed quality appraisal. A second reviewer double-checked data extraction and quality appraisal for every publication, and the first author resolved any discrepancies.

The data extraction form included information on study characteristics (author, title, year, geographical location), type of legal change studied and drug(s) impacted, details and timing of the legal change (eg, medical vs recreational cannabis regulation), study design, sampling approach, sample characteristics (size, age range, proportion female) and quantitative estimates of association. We coded each study-level outcome measure into one metric grouping, using 24 pre-specified categories and a free-text field (see figure 1 for full list). Examples of metrics include: prevalence of use of the decriminalised or regulated drug, overdose or poisoning and non-drug crime.

An external file that holds a picture, illustration, etc.
Object name is bmjopen-2019-035148f01.jpg

Metrics examined by included studies. excl., excluding.

We also categorised the estimated direction of association of the legal change on outcome measure(s) of interest (beneficial, harmful, mixed or null). These associations were coded at the outcome (not study) level and classified as beneficial if a statistically significant increase in a positive outcome (eg, educational attainment) or decrease in a negative outcome (eg, substance use disorder) was attributed to implementation of decriminalisation or legal regulation, and vice versa for harmful associations. The association was categorised as mixed if associations were both harmful and beneficial across participant subgroups, exposure definitions (eg, loosely vs tightly regulated medical cannabis access) or timeframes. Although any use of cannabis and other psychoactive drugs need not be problematic at the individual level, we categorised drug use as a negative outcome given that population-level increases in use may correspond to increases in negative consequences; we thought that this cautious approach to categorisation was appropriate given that such increases are generally conceptualised as negative within the scientific literature. For outcomes that are not unambiguously negative or positive, the coding approach was predetermined taking a societal perspective. For example, increased healthcare utilisation (eg, hospital visits due to cannabis use) was coded as negative because of the increased burden placed on healthcare systems. The association was categorised as null if no statistically significant changes following implementation of drug decriminalisation or legal regulation were detected. We set statistical significance at a= 0.05, including in cases where authors used more liberal criteria.

Quality assessment at the study level was conducted for each full-length article using a modified version of the Downs and Black checklist 25 for observational studies ( online supplemental appendix B ), which assesses internal validity (bias), external validity and reporting. Each study could receive up to 18 points, with higher scores indicating more methodologically rigorous studies. Conference abstracts were not subjected to quality assessment due to limited methodological details.

Patient and public involvement

This systematic review of existing studies did not include patient or public involvement.

Study characteristics

As shown in the PRISMA flow diagram ( figure 2 ), we screened 4860 titles and abstracts and 213 full-texts, with 114 articles meeting inclusion criteria ( online supplemental appendix C ). Key reasons for exclusion at the full-text screening stage were that the article did not report on original quantitative research (n=59) or did not evaluate decriminalisation or legal regulation as defined herein (n=23). Details of each included study are presented in online supplemental table 1 . Included studies had final publication dates from 1976 to 2019; 44.7% (n=51) were first published in 2017 to 2018, 43.9% (n=50) were published in 2014 to 2016 and 11.4% (n=13) were published before 2014.

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Object name is bmjopen-2019-035148f02.jpg

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

Characteristics of included studies are described in table 1 , both overall and stratified by whether they evaluated decriminalisation (n=19) or legalisation (n=96) policies (one study evaluated both policies). Most studies (n=104, 91.2%) were from the USA and examined impacts of liberalising cannabis laws (n=109, 95.6%). Countries represented in non-US studies included Australia, Belgium, China, Czech Republic, Mexico and Portugal. The most common study designs were repeated cross-sectional (n=74, 64.9%) or controlled before-and-after (n=26, 22.8%) studies and the majority of studies (n=87, 76.3%) used population-based sampling methods. Figure 3 illustrates the geographical distribution of studies among countries where national or subnational governments had decriminalised or legally regulated one or more drugs by 2017.

Characteristics of studies evaluating drug decriminalisation or legal regulation, 1970 to 2018

*Combined total exceeds number of studies because some evaluated both decriminalisation and legal regulation.

†One global study and one multi-country European study including Belgium and Portugal.

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Object name is bmjopen-2019-035148f03.jpg

Number of included studies from countries that implemented decriminalisation or legal regulation by 2017. Note: Policy changes were classified, following the review inclusion criteria, based on the implementation of a change to national or subnational law to decriminalise drug use and/or possession or to legalise at least one class of drugs. We did not evaluate the extent to which legal changes were reflected in policing and criminal justice practice. Implementation of cannabis legalisation for medical purposes only is not reflected in this map.

Study quality

Quality assessment was performed for the 93 full-length articles included in the review, excluding 21 conference abstracts ( online supplemental table 1 ). Scores ranged from 7 to 18 of 18 possible points, with a mean of 14.4 (SD=2.56). Quality scores were similar comparing US to non-US-based studies ( X =14.4 and 13.7, respectively, p=0.386) but higher for studies evaluating legal regulation ( X =14.8) versus decriminalisation ( X =12.8) (p=0.003). Study quality differed significantly (p<0.001) by the direction of the association with the outcome of interest, with higher quality scores among studies estimating mixed ( X =15.4) or beneficial ( X =15.2) versus null ( X =14.2) or harmful ( X =13.1) effects of legal change on the outcome of interest. Study quality did not appear to increase over time (eg, X =14.0 in 2014 and 14.4 in 2018).

Study outcome measures and metrics

Across 114 studies we extracted 224 outcome measures, which were coded into 32 metrics ( figure 1 ). The most common metric employed by studies was the prevalence of use of the decriminalised or legally regulated drug, which was examined in 39.5% of studies (n=45) and represented 22.3% of outcome measures (n=50). Of these studies, 13 (28.9%; 8 full-length articles and 5 abstracts) did not report any other metric 26–38 and an additional 6 studies (13.3%) reported on the prevalence of use in addition to a single drug-related perception metric (either harmfulness or availability). 39–44 The second most common metric was the frequency of use of the decriminalised or legally regulated drug (14.0% of studies, n=16) and the third was the prevalence or frequency of use of tobacco, alcohol or drugs that remained illegal (12.3% of studies, n=14). The fourth most commonly employed metric was any change in the perceived health harmfulness of using the decriminalised or regulated drug (10.5% of studies, n=12), which was assessed among adolescents or young adults in all studies except for one that assessed this metric among parents. 45

All other metrics were assessed in <10% of included studies. Health service utilisation was evaluated in 7.9% of studies (n=9) using 12 outcome measures, primarily related to emergency department visits and/or hospitalisations. Prescribed (primarily opioid) drug use and perceived availability of the decriminalised or legally regulated drug were reported in 7.0% of studies each (n=8). Overdose or poisoning by the decriminalised or regulated drug, and by other drugs (predominantly opioids), were examined in 5.3% (n=6) and 6.1% of studies (n=7), respectively. Driving while under the influence or with detectable concentrations of the decriminalised or regulated drug (cannabis) was examined in seven studies (6.1%) inclusive of eight outcome measures. Notably, one study assessed self-reported impaired driving, 46 while others assessed the proportion of fatally injured drivers screening cannabis-positive or the overall prevalence of driving with detectable tetrahydrocannabinol (THC) concentrations in blood. Remaining metrics were measured in less than 5% of studies ( figure 1 ). Some pre-specified metrics were not represented in any of the articles, including infectious disease incidence (eg, HIV, hepatitis C), environmental impacts (eg, drug production waste, discarded needles) and labour market participation.

Studies outside the US

Of the 10 studies conducted outside the USA, 6 focussed on cannabis decriminalisation. All three studies from Australia examined the prevalence of cannabis use post-decriminalisation, 31 34 47 while one also measured perceived cannabis availability. 47 Following cannabis decriminalisation, one European multi-country study including Belgium and Portugal examined the prevalence of cannabis use and uptake of cannabis-related addictions treatment 48 and one Czech study considered the age of first cannabis use. 49 An international study using United Nations Office on Drugs and Crime data from 102 countries compared availability, as reflected by cannabis seizures and plant eradication, in countries that had decriminalised cannabis versus those that had not. 50 Three non-US studies evaluated decriminalisation of all psychoactive drugs. Two studies from Portugal examined healthcare and non-healthcare costs and psychoactive drug prices, respectively. 51 52 One study from Mexico examined drug-related criminal justice involvement (arrests) and (violent) crimes. 53 Finally, a study of historic opium legalisation in China (1801 to 1902) measured the price and availability (quantity of exports) of opium before and after legalisation. 54

Impacts of decriminalisation and legal regulation

Results of individual studies are provided in online supplemental table 1 . Online supplemental table 2 tallies findings and average quality scores for each of the metrics; here we summarise findings for metrics examined in more than 5% of studies, in descending order based on the number of datapoints. Across all three substance use metrics (prevalence of use, frequency of use and use of other alcohol or drugs), drug law reform was most often not associated with use (with null findings for 48.0% to 52.4% of outcome measures falling under these metrics). With respect to change in perceived harmfulness of the decriminalised or regulated drug, mixed results were found in half of cases, with heterogeneity detected on the basis of age, gender and state. 39 43 55–57 For example, legal regulation of cannabis for medical use was associated with greater perceived harmfulness of cannabis among eighth graders but not older students in an analysis of US Monitoring the Future data 39 while a study employing US National Survey on Drug Use and Health data found greater perceived harmfulness of cannabis among young adults aged 18 to 25 but not adolescents aged 12 to 17. 57

Among nine studies that employed health service utilisation metrics, harmful effects were reported for 6 of 12 outcome measures, with increases in emergency department visits and/or hospitalisations attributed to decriminalisation or legal regulation. 58–63 However, all but one of those studies 58 assessed change over time in one jurisdiction, without a control group. Further, two studies that also examined changes in acute care use for non-cannabis drugs found reductions in those visits or admissions following cannabis decriminalisation or legal regulation. 60 64 In contrast, six of nine prescription drug use associations were beneficial, with reductions observed in rates of opioid 65–69 and other drug prescribing 70 71 attributed to legal regulation of cannabis for medical use; outcomes in this category came from studies of higher average quality ( X =16.3). Perceived availability of the decriminalised or regulated drug appeared largely unaffected by decriminalisation (null associations for five of nine outcome measures) but two studies indicated increased perceived availability of cannabis among Colorado, US, adolescents following legal regulation for adult use 72 and among adults in US states with legal regulation for medical use. 44 Across the subset of seven outcome measures for overdose or poisoning by the decriminalised or regulated drug (cannabis), in all cases an increase in calls to poison control centres or unintentional paediatric exposures was reported. 59 73–77 However, studies assessing the impacts of cannabis regulation on overdose or poisoning by drugs other than cannabis concluded that the effects were either beneficial (four outcome measures 64 76 78 79 ) or mixed/null (three outcome measures 80–82 ). Driving with detectable concentrations of THC was most often found to increase following decriminalisation or legal regulation (five of eight outcome measures; 83–87 ), but these studies were of lower average quality ( X =12.0).

Impacts of decriminalisation

Of the 19 studies evaluating impacts of decriminalisation, six measured the prevalence of use of the decriminalised drug with eight unique outcome measures. No association was detected for all but three outcomes; following cannabis decriminalisation lifetime use increased among adults in South Australia, 31 while past-month use increased among 12 th graders but not younger students in California, 56 relative to the rest of the country in both cases. After peyote use for ceremonial purposes was decriminalised in the USA in 1994, self-reported use increased among American Indians. 88 Three studies evaluated relationships between decriminalisation and drug-related criminal justice involvement in Mexico and the USA. One high-quality study found that decriminalisation positively influenced criminal justice involvement: in five US states, arrests for cannabis possession decreased among youth and adults. 89 When possession of small amounts of cannabis was decriminalised in the 1970s in Nebraska, however, the mean monthly number of arrests did not change, while cannabis-related prosecutions increased among youth. 90 In Tijuana, Mexico, decriminalisation of all drugs had no apparent impact on the number of drug possession arrests. 53 Two historical and one recent study measured healthcare utilisation. US states that decriminalised cannabis in the 1970s saw greater emergency department visits related to cannabis, but decreased visits related to other drugs. 60 In Colorado, US, decriminalisation was associated with increased emergency department visits for cyclic vomiting. 62 Addiction treatment utilisation, healthcare and non-healthcare costs, driving after use, price of drugs, availability of drugs, frequency of use, attitudes towards use and perceived harmfulness were each evaluated in only one or two studies of decriminalisation.

This systematic review identified 114 peer-reviewed publications and conference abstracts evaluating the impacts of drug decriminalisation or legal regulation from 1970 to 2018. Within this search period, 88.6% were published in 2014 or later. This rapid growth in scholarship was driven by the implementation and subsequent evaluation of cannabis legalisation in a number of US states beginning in 2012, and knowledge production will surely continue to accelerate as longer-term data become available and as other jurisdictions (eg, Canada and Uruguay) analyse the effects of recently implemented cannabis legalisation. Indeed, a first study on the impacts of cannabis legalisation on adolescent use in Uruguay was published in May 2020 (finding no impact on risk of use 91 ). The present study provides an overview of the emerging literature based on our systematic review and suggests three key patterns.

First, peer-reviewed longitudinal evaluations of drug decriminalisation and legal regulation are overwhelmingly geographically concentrated in the US and focussed on cannabis legalisation. Importantly, the lack of non-US studies evaluating legal regulation of cannabis for medical use may reflect the more tightly controlled nature of medical cannabis regulation in other countries, and thus the more limited potential for population-level effects. It is notable that decriminalisation in the absence of legal regulation was evaluated in only 18 studies (15.8%), despite being far more common globally than legal regulation. These gaps may hamper evidence-based drug law reform in countries that are less well-developed, that play a substantial role in drug production and transit or that have different baseline levels of substance (mis)use as compared with the US.

Second, prevalence of use was the predominant metric used to assess the impact of drug law reform, despite its limited clinical significance (eg, much cannabis use is non-problematic) and limited responsiveness to drug policy. This is because ecological analyses have indicated little relationship between drug policies and prevalence of use, 52 as have studies assessing within-state change in use related to legal regulation. 21 These findings are supported by the preponderance of evidence synthesised in this review, although some variation is evident in relation to the specific provisions of legal reforms (eg, liberal vs tightly regulated medical markets 92 ). Impacts of legal cannabis regulation on prevalence and frequency of use continue to be evaluated, with recent data suggesting small increases among adults, but not youth. 93 Drug policies may be more able to influence the types of drugs that people use, drug-related risk behaviours and modes of drug consumption. 94 Metrics to assess these outcomes, however, were lacking in the reviewed literature. For example, only one study (0.8%) investigated whether legal regulation of cannabis was associated with changes in the mode of cannabis consumption. 72 Although the prevalence of use was often measured alongside more clinically or socially significant metrics (eg, prevalence of substance use disorders, educational outcomes among young adults), 42.2% of studies assessing substance use prevalence included that metric alone or in combination with a single drug-related attitude metric.

Third, there was a lack of alignment between the stated policy objectives of drug law reform and the metrics used to assess its impact in the scientific literature. For instance, removal of criminal sanctions to prevent their negative sequelae is a key rationale for decriminalisation and legal regulation, 12 13 95 but only four studies (3.5%) evaluated changes in drug-related criminal justice involvement following drug law reform. Similarly. improving the physical and mental health of people who (already) use drugs is a motivation for drug policy reform but no included studies examined mental or physical health outcomes (aside from substance use disorders) in this population. As a result, there is a risk that decisions on drug policy may be informed by inappropriate metrics. Promisingly, in recent months, additional studies assessing legal regulation that employ a range of criminal justice metrics have been published. 96–98 Finally, despite ample evidence of the impact of criminalisation on infectious disease transmission and acquisition risks, 5 we found no studies evaluating the impact of decriminalisation on these outcomes.

Both the included studies and our systematic review have important strengths and limitations. To our knowledge, we conducted the first review of all global literature on decriminalisation and legal regulation and applied no language restrictions. All eligible articles identified were published in English; this may reflect a paucity of evaluation research published in other languages and/or limitations of our search strategy (eg, some non-English journals may not be indexed in the 10 databases searched). In addition, we excluded grey literature, non-original research and study designs that are not suited to evaluating policy effects (eg, cross-sectional studies), but these restrictions narrowed the geographical scope of included studies. For example, two articles on Portugal were excluded as non-original research, but nevertheless provide important insight on impacts of decriminalisation. 99 100 Despite restricting eligibility to more rigorous study designs, most included studies used relatively weaker eligible designs that are known to be vulnerable to pre-existing trends and confounding; only 22.8% and 5.3%, respectively, used controlled before-and-after or interrupted time series designs to address these threats to validity. The use of these study designs may be related to limited resources for prospective drug policy evaluations, with many studies relying on publicly available, routinely collected data. That the US is unique in the extent to which data on drug use and related harms are routinely collected helps to explain its over-representation in our review. Scoping reviews inclusive of grey literature and cross-sectional designs would be valuable for describing the full range of evaluations that have been conducted globally.

While beyond the scope of our high-level synthesis, the implementation and specific provisions of drug policies vary widely. Decriminalisation policies vary in their definitions of quantities for personal use, application of administrative penalties and the extent to which the law ‘on the books’ is reflected in policing and criminal justice practice. Indeed, in some jurisdictions with nominal decriminalisation, arrests for possession of small quantities of the decriminalised drugs remain routine. 53 Legal regulation models for cannabis are also heterogeneous. For example, policies legally regulating cannabis for medical use may or may not allow for legal dispensaries, and this provision has been shown to substantially modify the impact of legal regulation on cannabis use. 101 To the extent that individual studies employed crude exposure measures (eg, presence vs absence of a law), they may have obscured context-dependent effects of drug law liberalisation. Further, the impact of drug laws on drug use and related outcomes may be limited by a lack of public awareness of the details of local laws. 102

Our use of vote-counting in this synthesis (ie, categorising individual outcome measures as indicating beneficial, harmful, mixed/subgroup-specific or no statistically significant associations) is subject to the same limitation. Vote-counting should also be interpreted with caution in light of the heterogeneity of outcome definitions, the inherent arbitrariness of statistical significance thresholds and the key distinction between statistical and clinical significance. In addition, many included studies are evaluating the same policies (eg, cannabis legalisation in western US states), sometimes using overlapping data but drawing different conclusions based on analytical choices and timeframes. The existence of multiple datapoints for a particular outcome does not imply that the outcome has been well-studied across diverse contexts such that scientific consensus on its effects has been reached. Moreover, as illustrated by a recently published extension of the included article by Bachhuber et al , 79 multiple high-quality studies may generate results that are later revealed to be spurious as additional follow-up data become availability. Specifically, Shover et al demonstrated that the positive association reported between medical cannabis legalisation and opioid overdose mortality in 1999 to 2010 reversed direction in later years, suggesting that earlier findings of a protective effect should not be given causal interpretations. 103 This was foreshadowed in the included article by Powell et al , which found that the purportedly positive effect of medical cannabis legalisation was attenuated in 2010 to 2013. 82 This scientific back-and-forth can be expected given that most included articles are evaluating legal changes introduced rather recently, and thus are examining early impacts with limited years of follow-up. Longer-term impacts of non-medical cannabis legalisation, and how they might be influenced by increased commercialisation, are yet to be seen. 104

The findings of this review indicate a need for a broadening of the metrics used to assess the impacts of drug decriminalisation and legal regulation. Given the growing number of jurisdictions considering decriminalisation or legal regulation of psychoactive drugs, 14–16 the disproportionate emphasis on metrics assessing drug use prevalence, as well as the limited geo-cultural diversity in evaluations, are concerning. Experts have called for a more fulsome approach to evaluating drug policies in line with public health and the United Nations Sustainable Development Goals, with attention to the full breath of health and social domains potentially impacted, including human rights and social inclusion (eg, stigma), peace and security (eg, drug market violence), development (eg, labour market participation), drug market regulation (eg, safety of the drug supply) and clinically-significant health metrics (eg, drug-related morbidity). 105 Drawing on methods such as multi-criterion decision analysis, 19 the engagement of both scientists and policymakers in priority-setting may help to produce evidence that provides a more comprehensive understanding of the breadth of impacts that should be anticipated with drug law reform efforts. Funding will also be required to support rigorous prospective evaluations of legal reforms.

Supplementary Material

Acknowledgments.

The authors would like to thank Gelareh Ghaderi for assistance with screening and data extraction.

Twitter: @aydenisaac

Presented at: Presented at the International Society for the Study of Drug Policy (May 22, 2019) and the International Harm Reduction Conference (April 29, 2019).

Contributors: DW and AIS conceptualised and supervised the review. CZ designed and conducted the literature searches. AIS drafted the manuscript. SC, ZM and AIS conducted screening and data extraction. NM contributed to drafting the manuscript and developing figures. All authors contributed to interpretation of findings and revising the manuscript for important intellectual content.

Funding: This review was supported by the Canadian Institutes of Health Research (CIHR) via the Canadian Research Initiative on Substance Misuse (SMN-139150), the MAC AIDS Foundation, and the Open Society Foundations. Ayden Scheim was supported by a Canadian Institutes of Health Research Postdoctoral Fellowship. Nazlee Maghsoudi is supported by a CIHR Vanier Canada Graduate Scholarship. Dan Werb is supported by a US National Institute on Drug Abuse Avenir Award (DP2- {"type":"entrez-nucleotide","attrs":{"text":"DA040256","term_id":"79190989","term_text":"DA040256"}} DA040256 ), a CIHR New Investigator Award, an Early Researcher Award from the Ontario Ministry of Research, Innovation and Science and the St Michael’s Hospital Foundation.

Map disclaimer: The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Patient consent for publication: Not required.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement: All relevant data are contained within the article and supplementary materials.

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Drug Use and Crime, Essay Example

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Introduction

Drug use and crime are directly correlated to criminal mischief. Criminal behavior and drug abuse have been linked for an extended period of time. Criminal behavior due to drug abuse can range from driving under the influence of narcotics or alcohol to violent robberies or rapes. Nonetheless, the relationship between drug use and crime is difficult to establish. The question to be answered is whether or not drug or alcohol use leads to criminal behavior. Statistics supports the fact that not all drug and alcohol users go out and commit crimes, however, statistics support that a great deal of crimes that are committed are done so by people under the influence of drugs and alcohol. Likewise, research has suggested that there is strong correlation between drug use and criminal behavior. There are many reasons why this may be so. Drug and alcohol users often have a distorted perception of reality. For example, “The Justice Department says 80 percent of the people who commit crimes are addicted to drugs or alcohol. Many addicts will do just about anything to support their habit.” (Reuter, Peter. 2009)

One key factor of crimes is alcohol. Alcohol affects crimes in several ways. Some crimes are even defined in relation to alcohol use. According to statistics, 1 in every 5 person arrested by police is under the influence of alcohol. Likewise, over 60 percent of all homicides committed in the United States are done so by someone under the influence of alcohol. Alcohol also plays a role in 75 percent of all stabbings 70 percent of all beatings, and 50 percent of all domestic assaults. A third of all offenders have had a problem with alcohol in the past or currently have an issue with alcohol. Among prison users, alcohol dependence was 2 times higher among female offenders than in the general free population.

A study also shows that there is a correlation between incarcerations and alcohol use. Even while in prison, 25 percent of prisoners in the United States have tested positive for alcohol use. (Thoumi, Francisco 2003)

The use of illegal drugs is considered a crime in the United States. Cocaine, heroin, marijuana, and amphetamines are drugs linked to violent behaviors .Violent crimes are often committed to support drug habits. For example, “Research on dependent opiate users have shown that the frequency of criminal behavior increases significantly during periods of dependence when compared to periods of abstinence.” (Zhang, Z. 2004) Drugs are related to crime because they affect the users personality. There is also a direct link between rapes, assaults, and other violent crimes with drug use. It is estimated that between 40 and 85 percent of all prostitutes are drug users. Both men and women prostitutes sell sex for money to support drug habits. Consequently, prostitutes are often the victim of violent crimes. Nonetheless, because of the kind of lives they live, prostitutes more than likely never support these crimes. Nearly 70 percent of all prostitutes have been victimized since they have been working the streets. Data collected from male arrestees in 2004 in 24 cities showed that the percentage testing positive for any drug ranged from 42 to 79 percent; in some instances more than half of the persons arrested were under the influence of some type of drug. (Zhang, Z. 2004)

An abundant amount of evidence supports the belief that drug users are more likely to commit crimes than non-drug users. This was supported by evidence that frequent arrests were under the influence of drug or alcohol at the time they committed the criminal behavior. Likewise, persons incarcerated are often under the influence of drugs and alcohol. There is an identifiable link between alcohol and drug use and criminal behavior.

Reuter, Peter. 2009. “Systemic Violence in Drug Markets.” Crime Law and Social Change 52:275–284

Thoumi, Francisco. 2003. Illegal Drugs, Economy, and Society in the Andes. Baltimore: Johns Hopkins University Press

Zhang, Z. (2004). Drug and alcohol use and related matters among arrestees, 2003. Washington, DC: National Institute of Justice.

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The Relationship Between Drug Use And Crime Essay Examples

Type of paper: Essay

Topic: Drugs , Abuse , Social Issues , Relationships , Bullying , Criminal Justice , Crime , Violence

Words: 1200

Published: 01/28/2020

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Drug use and crime have a complicated and intricate relationship. Everyone who uses drugs does not become addicted to them, nor does everyone who uses drugs commit violent crimes. Apart from crime, the use of drugs gives rise to a variety of economic and social concerns, such as illness, early death, and considerable decline in productivity. Currently, two of the most obstinate social problems that the United States is facing are drug addiction and drug-related crimes. Policy makers and scholars have both held countless debates on the relationship between drug use and crimes, and the large volume of literature is proof of this. Goldstein (1985) was the first to suggest that drug use leads to crime. However, many researchers believe that not only does drug use lead to crime but even crime leads to drug use. Their assumption is that deviant individuals are more likely to find themselves in social situations where the use of drugs is common and they are encouraged to use drugs. The context for drug use stems from such a criminal subculture (White, 1990). Drug use and crime have long been connected to each other, and this research paper will analyze the association between the two. The notion that drugs lead to crime and a casual relationship between the two has been supported by various studies. After years of research, the apparent conclusion is that crime inherently stems from illegal drug use and that the commission of crimes encourages and supports dependence of different types of drugs, such as amphetamine, cocaine, crack, heroin, and marijuana (Anglin & Perrochet, 1998). Similarly, it has been noted that during periods when narcotic addiction was on the rise, the rates of crime were six times higher (Nurco, 1998). Numerous other studies show that rates of crime increased during periods of drug use. Much of this research focuses on the economic motivation model to explain the relationship between the use of drugs and property crime. However, there is also evidence that suggests that particular drugs, such as amphetamines, have a pharmacological effect on people that increases their likelihood of committing a crime (Gelles, 1994). Although the relationship between drug use and consequent criminal involvement has been documented by these studies, there have been preexisting differences in their analytical techniques. Some studies have even failed at established that the commission of crime likely arises of an increase in drug use. Although it a known fact that manufacturing, distributing, and carrying drugs is a crime, and it is also known that driving under the influence of drugs is also a criminal activity. However, it is far more complicated to discover how crime is related to the use of drugs. Counting offenses of violent behavior that have resulted from the effects of drug use is not easy. Additionally, the risk factors of drug addiction, violent temperament, and to commit crimes vary from person to person depending on their personality traits. Drug use and crime are both an indication that the individual has a lower self-control. Usually people with an impulsive nature are more willing to try drugs, and once addicted to these drugs, they may turn to street crime. A criminal offender is not created by drug use; however, the likelihood of committing criminal actions is indeed intensified by the use of drugs. Additionally, people who use drugs generally do not the requisite education to get a job or a legitimate occupation. Environmental factors, genetic factors, and lifestyle choices also determine who is more likely to abuse drugs and consequently commit crimes. Both Gizzi (2010) and Darke et al. (2010) have discovered that drug addicts are also more likely to commit violent crimes under the influence of certain drugs, such as methamphetamine, than others. Additionally, violent crimes are not the same as violent crimes, and the motives involved are also different. In comparison to people who have used other types of drugs, arrest records show that more offenses have been committed in the past by meth users, and many of the crimes committed by them were property crimes (Gizzi & Gerkin, 2010). Moreover, people on probation who have been previously convicted of violent crimes are more likely to abuse drugs and consequently engage in criminal activity, and often they also have mental health symptoms too (Webster et al., 2010). There are certain hindering factors that make it difficult to measure the relationship between drug use and crime. Nonetheless, evidence suggests that among male drug users who are arrested for committing violent crimes, the relationship between drug use and violent crime is mediated by poverty (Valdez et al., 2007). Researchers have also found that the use and abuse of drugs has a greater relationship with property crimes than with violent crimes. Even though, every year addictive drugs are tried by many people, but only a small number of them actually become addicted. There are many environmental and genetic factors that determine whether or not an individual may be vulnerable to become addicted and abuse a drug. Similarly, there are a variety of factors that cause people to commit crimes. Moreover, both drug use and the commission of crime have certain similar risk factors, such as employment, family environment, peer influences, poverty, and social support structure. Nonetheless, the fact that increased levels of crime are related to the use and abuse of drugs cannot be denied. The conclusion that has been reached through this research paper is that while a relationship between drug use and crime certainly exists, measuring it is difficult because the likelihood of a drug user committing a crime varies from person to person, and also depends on the type of drugs being used. The available literature on the relationship between drug use and crime also suggests that drug use is more likely to lead to property crime. It can also be hypothesized that crime rates to some extent can be reduced through drug treatment.

Anglin, M. D., & Perrochet, B. (1998). Drug use and crime: a historical review of research conducted by the ucla drug abuse research center. Substance Use and Misuse, 33(9), 1871-1914. Gelles, R. J. (1994). Alcohol and other drugs are associated with violence—they are not its cause. In R. J. Gelles & D. R. Loseke (Eds.), Current controversies on family violence (pp. 182-196). Newbury Park, CA: Sage Publications. Gizzi, M. C., & Gerkin, P. (2010). Methamphetamine use and criminal behavior. International Journal of Off- ender Therapy and Comparative Criminology, 54(6), 915-936. Goldstein, P. J. (1985). The drugs/violence nexus: A tripartite conceptual framework. Journal of Drug Issues, (15), 143-174. Retrieved from http://www.drugpolicy.org/docUploads/nexus.pdf Nurco, D. N. (1998). A long-term program of research on drug use and crime. Substance Use and Misuse,33(9), 1817-1837. Valdez, A., Kaplan, C. D., & Curtis, R. L. (2007). Aggressive crime, alcohol and drug abuse, and concen- trated poverty in 24 u.s. urban areas. The American Journal of Drug and Alcohol Abuse,33, 595-603. White, H. R. (1990). The drug use-delinquency connection in adolescence. In R. Weisheit (Ed.), Drugs, crime, and criminal justiceCincinnati: Anderson Publishing Company.

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UC Berkeley

Essays on Drug Use and Crime

Deza, Monica
Advisor(s): Card, David

This dissertation consists of three studies which analyze different aspects of risky behaviors and criminal participation.

A longstanding question is whether alcohol and marijuana use by teenagers exerts a "stepping stone" effect, increasing the chances that they will use harder drugs in the future. Empirically, teenagers who use alcohol or marijuana in one period are more likely to use cocaine in the future. This pattern can be explained in one of two ways: by a causal effect of soft drug consumption on future consumption of hard drugs (i.e., a true stepping-stone effect) or by unobserved characteristics that make people more likely to use soft drugs at a relatively young age, and hard drugs at a later age (i.e., correlated unobserved heterogeneity). Distinguishing between these alternatives is highly policy relevant because, to the extent that there is a true stepping stone effect, policies that reduce the use of soft drugs by young people will have lasting impact on the use of hard drugs by adults. In Chapter 1, I use data from the National Longitudinal Study of Youth 1997 (NLSY97) to estimate a dynamic discrete choice model of teenager's use of alcohol, marijuana and cocaine over multiple years, and separately identify the contributions of state dependence and unobserved heterogeneity. I find modest-sized but statistically significant "stepping-stone" effects from softer to harder drugs that are largest among the youngest individuals in my sample. In contrast, I find little evidence of a stepping stone effect from cocaine to alcohol or marijuana. Simulations show that restricting alcohol and marijuana use at young age has a modest impact on reducing later cocaine use.

Chapter 2 examines the role of an increase in alcohol consumption on drug initiation, hard drug consumption, and criminal participation. Using a regression discontinuity research design, I exploit the discontinuous increase in alcohol consumption at age 21 provided by the minimum legal drinking age. Using a survey of respondents during the year after they turned 21, I found that the probability of cocaine initiation decreased by 1.5 percentage points and the share of respondents who consumed cocaine in the last year decreased by 2 percentage points. Self-reported criminal participation, such as drug dealing, property destruction and attacking an individual, remained unchanged at age 21, with the exception of stealing, which decreased by 3 percentage points. These estimates are robust to a variety of specifications.

Between 1993 and 1995, a number of states implemented "Three Strikes and You're Out" laws that enhance the sentence length for repeat violent offenders. Chapter 3 develops a simple dynamic model that suggests that these laws will lead to an increase in the number of criminal cases that go to trial, rather than being settled with a plea bargain, since the threat of higher future sentences increases the cost of a being convicted for a strikeable offense. I use data from the 1990-2006 State Court Processing Statistics database and a state-by-year difference-in-differences research design to compare the change in the likelihood of plea bargaining by violent offenders after the passage of Three Strikes laws, relative to the trend among non-violent offenders. I also separately examine effects for offenders with at least one prior violent conviction, and compare the effects of the Three Strike law in California, which imposes extra sentencing for any third felony (violent or not), versus the eleven other states with Three Strikes laws. The results show that the introduction of Three Strikes laws significantly reduce the number of criminal cases that are settle with a plea bargain, imposing a potentially costly burden on the legal system.

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This Is a Very Weird Moment in the History of Drug Laws

The war on drugs failed, but decriminalization is facing its own backlash. what’s next.

[MUSIC PLAYING]

From New York Times Opinion, this is “The Ezra Klein Show.”

In 2020, voters in Oregon passed a ballot measure, a drug reform policy, that was beyond what I ever thought would pass in any state in America.

Overnight, Oregon became the first state in the country to decriminalize most street drugs.

Even drugs like cocaine, heroin, meth, and oxycodone.

It’s a sea change. Measure 110, which was passed by 58 percent of Oregon voters, treats active drug users as potential patients rather than criminals.

I’ve been involved in drug policy reform for a long time. I got into it in high school. And this was not a politics that seemed possible back then. In that era, the idea that you would have a state decriminalize heroin possession, I mean, it was unthinkable. But in the coming decades, there would be a real turn on the war on drugs — the overpolicing, the mass incarceration, the racism, the broken families. It was not achieving, as far as anybody could tell, anybody’s policy goals.

So we began to move in this other direction. Oregon was at the vanguard of this, but it wasn’t alone. In Washington state, you saw the Supreme Court overturn the law that had made a lot of drug possessions and felonies. In a bunch of different cities, you had these very liberal district attorneys who instead of running on tough on crime platforms were running against overpolicing, against mass incarceration.

Something that had really never been tried before in America was all of a sudden being tried. We were moving towards a radically different equilibrium than anybody had imagined even just a few years before on drugs. I mean, you could walk down the streets — you can right now in many states — and buy all kinds of cannabis products from shops. It was, again, unthinkable.

But this politics and these policies are not working out the way people had hoped. Chesa Boudin, who was the district attorney in San Francisco, one of these very liberal set of reformers, he was recalled. Legislation was passed rebuilding an enforcement structure around drugs in Washington state. There are a lot of concerns and, I think, quite bright ones about how cannabis legalization and particularly cannabis commercialization is working out in a bunch of places.

And in Oregon, Measure 110 was gutted. The results of it had not been what many of the advocates had hoped for. Drug policy feels very unsettled to me right now. The war on drugs was a failure, often a cruel one. The war on the war on drugs has not been the success its advocates had hoped. So what comes next?

Keith Humphreys is a professor at Stanford University who specializes in addiction and drug policy. He’s advised the White House, California, the UK. I always find that he balances compassion and rigor unusually well. So I wanted to have him walk me through what he has seen and where he’s landed. As always, my email for guest suggestions, for reflections, [email protected].

Keith Humphreys, welcome to the show.

Thanks, Ezra. Good to talk to you.

There’s a tendency to just use this term “drugs.” And that tendency just belies a huge amount of variation, I think, in how people think about different drugs, how they think about opioids, how they think about stimulants, how they think about psychedelics, how they think about cannabis, alcohol, caffeine. Is this a useful term?

So “drug” is an incredibly vague term that covers an enormous number of drugs that have very different properties. The biggest one, I think, is the capacity to instill addiction. People don’t get addicted to LSD, for example. But they do get addicted to heroin. That’s really important. They do get addicted to nicotine. That’s really important. So you would think about those drugs differently, the ones that have the ability to generate an illness with obsessive compulsion to use in the face of destructive consequences over and over and over again. Those belong in their own class, I think.

The second thing is that we should stop pretending that legal and illegal drugs are so different for lots of reasons. We could learn much more about what to do with illegal drugs if we looked at legal drugs. When I talk to policymakers, they say, well, I know what I don’t want. And that’s a carceral, racist war on drugs. I say, OK, I’m glad that option is off the table. That, of course, leaves millions and millions of other options to choose from.

And how some people have framed that is there’s really only two choices here. You can have that, that horrible thing. Or you can throw the switch the other way — tolerance, acceptance, public sale. And that’s going to be better.

And the problem with that argument, even before we get into what happened in places like Oregon, is the number one drug that kills people on the planet is cigarettes. The number one drug associated with arrests, violence, and incarceration is alcohol. Those drugs are legal. It’s not that drugs suddenly become easy to deal with once they’re legal.

You get to pick the set of problems you have, as our mutual friend Mark Kleiman used to say. But you don’t get to get rid of those problems. So people are right to identify substantial costs to prohibition of drugs or for that matter of everything. But that is different than saying there is some other framework that doesn’t also include pretty substantial costs.

So this major drug policy reform went into effect in Oregon in 2021, Measure 110. It passes. What happens next?

Part of what happens is exactly what the reformers hoped would happen, which is that there’s a dramatic drop in arrests — arrests for drug possession and arrests for drug dealing. So they say, wow, that’s a victory. On the other hand, some of the other aspects of it didn’t work out the way people planned.

So there was a system that they thought would encourage people to enter treatment in replacement of criminal penalties. You’d be written a ticket, let’s say, if you were using fentanyl on a park bench. And it said there’s $100 fine for doing this, but you don’t have to pay the fine. All you have to do is call this toll free number, and you can get a health assessment and a potential referral to treatment. Well, it turned out that over 95 percent of the people got those tickets simply threw them away, which, keeping with the spirit of the law, there was no consequence for doing that. Hardly anybody called. The new body they set up to distribute the new funds had very serious management problems because the people — they may have been terrific human beings, but they weren’t actually experienced in how do you run a government bureaucracy.

So there was no real improvement in the availability of treatment, no real improvement in the number of people interested in seeking it. And those things may well have contributed to Oregon having a very high overdose rate. So currently going up about 40 percent per year, 4-0. Of course, some of that is due to fentanyl, which is raising — I’m here in California. Our rate’s up 5 percent, but it’s certainly not up 40 percent.

And the last thing is the intangible. And I say this as someone who goes to Oregon a lot and talks to people there almost every week, which is just the change in neighborhoods was really palpable of what it was like to go out in the street or try to go to a park, how much visible drug use you saw, how much disorder connected to it. And this was accentuated even further by the pandemic. There were fewer people on the street who had the choice. So the experience became more frightening as people were perhaps outnumbered in their neighborhood by people who had clearly visible problems were using drugs. And that generated significant and, I think, understandable upset as to how things were going in Oregon.

So not everybody agrees that Measure 110 was a failure, certainly not as a policy. I mean, it definitely failed politically. The Drug Policy Alliance says that it failed because of disinformation because there was a concerted effort to undermine it. And they cite data from the Oregon Health Authority saying that, look, health needs screenings increased by almost 300 percent. Substance use disorder treatment increased by 143 percent. Is there some argument to this that we’re looking at the wrong measures and, judged according to its goals, 110 was actually kind of working?

If what you care about the most was a drop in drug arrests and involvement of people who use drugs and deal drugs in the criminal justice system, then it was a success clearly because there was very little contact anymore between law enforcement and people who sell and deal drugs. But on the health side, no, I don’t think that. And those statistics on treatment I believe count a lot of one time consultations. I think what most people, particularly people who love someone who has an addiction, are looking for is evidence on people getting better, people getting into recovery, not just at some point having some transitory contact with the system.

There’s another argument that’s made in the Drug Policy Alliance document and other things I’ve seen and that has occurred to me, too, because when I think about Oregon, when I think about San Francisco, when I think about Washington State, I mean, you’re talking about places with very broken housing markets. We’ll talk I’m sure more about the Tenderloin.

But the Tenderloin is dystopic in the way the Tenderloin is dystopic because it is a giant homeless encampment. And that was true well before the current wave of drug policy liberalization. And so one argument here is that the drug system is being blamed for policymakers’ inability to solve these other problems. Is there something to that?

There’s an intense argument out here in the Bay Area between people who say, look, the homeless crisis is just a side effect of addiction. And people say, look, the addiction crisis is just a side effect of homelessness. And I would say they’re both wrong in that, even within my personal group of acquaintances, I know people who lost their home because of an addiction. And it’s not that the housing market discharged them, they had an empty property. But they were out on the streets. And then there are people who lost their housing and then were living next to drug markets on the streets and developed an addiction there.

So I don’t think we can separate that Gordian knot. And I don’t know if in policy terms we have to. I mean, I think we should be able to pursue policies that increase the access to housing and still work on policies that reduce the damage from addiction.

So to go back to Oregon and one of the theories that was operating there was that we’re going to move more money into treatment. We’re going to make it easier and safer in the sense that you will not be arrested for seeking treatment. We’re going to make it easier and safer for you to seek treatment. We’re going to make it cheap to seek treatment. Why didn’t more people seek treatment?

That theory reflects a misunderstanding about the nature of addiction, which is that it is like, say, chronic pain or depression, conditions that feel lousy for the person who has them all day long, and they will do anything to get rid of them. Drug addiction is not like that. It has many painful experiences. It destroys people’s lives.

But drug use feels in the short term incredibly good. That is why people do it. They’re getting intense reward. So they are ambivalent about giving that up in a way no one with chronic pain is ambivalent about giving up chronic pain and no one with depression is ambivalent about giving up depression.

The other point about it is a huge number of the problems from drug use and addiction fall on other people rather than the person concerned. And so people like me who work in this field, we get calls and calls and calls from mothers, fathers, brothers, sisters, children concerned about their loved ones. But it’s very rare we get a call from somebody concerned about their own use.

Take the law out of it and look at a drug that is legal and widely accepted. Studies of people who seek treatment for an alcohol problem, slightly over 9 in 10 of those people say they were pressured to come. And the pressure might be family pressure, mom and dad said or my spouse said, this keeps up, I’m moving out. The boss said, one more day drunk at work, and you’re fired. Doctor said, you keep doing this, you will be dead in six months. It could be this is your fourth or fifth arrest for drunk driving, and your lawyer says, you better get into treatment because the judge otherwise might throw you in the penitentiary. That is overwhelmingly the situation of people seeking treatment — pressure from outside.

So let’s just remove all pressure. No legal pressure, no disapproval. Then people will spontaneously say, OK, I really want to make a change, and I’ll come in. Look, those of us who do this for a living, we pray for patients like that. It’s great when they come in, but that is just a very rare person.

Let me ask about this from the other direction, which is maybe this all just wasn’t nearly liberal enough because one of the arguments made — and I do think there’s evidence behind it — is people are getting stuff they don’t know. And the reason people die from fentanyl laced heroin or simply fentanyl that they thought was heroin is because they don’t have a source they can trust. Part of the difficulty here is, yes, people end up addicted. We don’t have really good treatments for addiction that we can come back to whether you think that is a true claim.

And then we also make it very difficult for people and dangerous for people to get what they need to avoid withdrawal to keep feeling normal. And if we made that easier on them, if we made it so they didn’t have to go to a place like the Tenderloin and instead get something safe, they would not die from overdose. They would not die from fentanyl laced heroin. Is there validity to that?

Yeah, well, certainly using fentanyl in an illicit market is extraordinarily dangerous. And my colleagues and I are trying to figure out the death rate per year of a regular user. It might be as high as 5 percent. So that is an extraordinarily dangerous thing to do.

And the arguments you’re making have been influential in this region to the point that if you go up slightly even further in the Pacific Northwest into Canada and British Columbia, they’ve gone so far to say it’s the government’s job to supply these drugs because prohibition makes things more dangerous, so we have a positive obligation to do this. But the problem with that reasoning is we did flood communities with legally made, consistent quality, clearly labeled opioids for years. And the net effect was millions of people getting addicted and hundreds of thousands of people dying.

That’s, in fact, how we got here. I think everyone knows what OxyContin is, all the other opioids that were really pushed out there. So it’s just really hard to sustain that argument that at a population level, huge access to addictive drugs is not going to cause a lot of addiction and overdose as long as they’re clearly labeled and of consistent quality. If that were true, we would never had an opioid crisis.

So Measure 110 passes in 2020. It goes into effect in 2021. What happens to it in 2023?

At that point, overdoses were way up. And popular sentiment has shifted pretty dramatically. I think quite a few people felt burned. They hadn’t gotten what they’d been promised. And that included people who, for example, had relatives who were addicted who they assume would be getting into treatment and recovery and then weren’t able to get services.

Neighborhoods are decaying. Polling showed that about two thirds of the Oregon population wanted Measure 110 repealed in part or in whole. And interestingly, those sentiments were even stronger among Black and Hispanic Oregon residents.

In response to all this, both Houses by very large margins replaced Measure 110 with a different approach to drug policy. It restored the ability to impose criminal penalties, to use those penalties particularly to leverage people to change their behavior — for example, by restoring drug courts and other kinds of diversion and monitoring programs. It is definitely not correct to say they reinstated the war on drugs because, it has to be remembered, Oregon never really had a war on drugs policy. They were the first state in the nation to decriminalize marijuana over 50 years ago, in fact. They decriminalized marijuana. They had a very low rate of putting nonviolent criminals into prisons.

So it was more a restoration of that progressive, liberty loving approach that they’d had before but supplemented with a lot more funding for treatment, which is something they’ve had a lot of problems standing up for years, which had nothing to do with Measure 110. The treatment system was in very bad shape before Measure 110. And it still is.

If you’ve been around drug policy conversations for a long time, you’ll have heard a lot, I have heard a lot, about Portugal. And Portugal is a place where they decriminalized drugs. And it has been a much more sustainable, solid policy. So what is different about Portugal?

Portugal is different in policy and different in culture. So they definitely don’t throw people in prison, and it’s decriminalized. But they do have what are called dissuasion commissions that do assessments of people, say, who arrested in the street for using drugs. And you have to show up to this assessment. And they can push and nudge people to seek care.

And they can also apply penalties if they want to. They can say, you’re a cab driver. You’ve been caught using cocaine. And we’re going to take your cab license away until you seek treatment and stop using cocaine. Things like that. It is not a war on drugs approach, but it is a push in the policy. And that has never been taken on seriously by American advocates who cite Portugal.

Portugal also has a universal health care. We do not have that. We are the only developed Western country that doesn’t have that. So that makes it easier to get help irrespective of what the laws are. And Portugal had at least at the time of their decriminalization a very nice network of treatment services and harm reduction services for people. And all that together worked in the policy mix.

The other point is the culture of Portugal is much more family oriented. It’s much more communitarian than American general and certainly much more true than our freedom loving Libertarian Pacific Coast. If you spend time in Lisbon, you have a common experience of running into people and say, where are you born? And they’ll say, well, Lisbon. And where were your parents born? Lisbon. And they still live in my neighborhood. And my grandparents live in my neighborhood, too. You never hear this in San Francisco or Portland. Everybody is from somewhere else. And many people actually moved to the West to get away from everybody else, to get away from social constraints. I want to be my own person. Well, Portugal is the opposite of that.

So there’s a lot of constraint on behavior. It’s loving constraint, but it is constraint, those boundaries around people’s behavior that don’t exist out in the West with the exception of recent immigrant communities, which, by the way, have very low rates of drug problems.

This is something that I always think people underestimate at least about San Francisco, which is one of these cities under the best, which is that it is a culture of enormous tolerance. And that is a lot of what makes San Francisco remarkable, what has made it a home for L.G.B.T.Q. people when that was a very rare thing to be, what has made it open to all these weird ideas from computer scientists and strange nerds who came around with their thoughts about AI and their thoughts about visual operating systems.

And people don’t like necessarily the dark side of this open, tolerant, nonjudgmental way of looking at the world. There’s a bit of a divided soul, a difficulty judging, a discomfort with paternalism, and a kind of optimism that if you let subcultures have their freedom and grapple their way forward, they’ll find their way to an equilibrium and that we should be very, very, very skeptical of heavy handed particularly law enforcement as a way of changing culture.

That is a very nice description of the city we both love. And we’d be much poorer without San Francisco’s embrace of individual freedom and all the great things that it gives, which you just articulated. To me, the resolution here is taking addiction seriously as a problem.

So if you look at somebody who is using methamphetamine five times a day, you could say, well, that is really an expression of their individual freedom. I need to respect that. But if you recognize the likelihood that they are not particularly free because they are addicted, the inconsistency disappears. And so I feel personally no contradiction between saying the state should intervene with pressure — for example, mandating people into treatment. For me, that doesn’t conflict with individual freedom at all. So when I talked to somebody who said, look, you need to just let people do what they want, I say, look. I volunteer in the Tenderloin. And I carry naloxone, the overdose rescue medication, with me. If someone were in front of me in overdose and dying, should I administer naloxone even though the person can’t consent, they’re unconscious?

And I’ve never had anyone say, you’re right. You should just respect their right to die. They say, well, no, of course, you should do that, conceding the principle that there are times that the thing we can do the most to help other people is take care of them when they were not in a fit state to take care of themselves.

Is that a straw man, though? I can’t really think of people at least that I have heard arguing that somebody under the throes of heroin addiction is free and is choosing the life they live, that they’re likely to be happy with the world they now exist in.

One of the really striking things about this new rhetoric about drug policy out here is how rarely addiction is even mentioned. The fact that there’s so much focus on drug overdose, which is, of course, terrible, but that is treated as the only index and not addiction reflects a viewpoint that that’s not either an important thing or not that real a thing. Because if it were, you would note that in the heyday of wild opioid prescribing, there were fewer overdoses, but there were far more people who were addicted to those substances. And that made their lives dramatically worse.

I also see the lack of attention to addiction in the investment in harm reduction without the idea of using it as a springboard into treatment, which to me is a very novel idea that’s only become more powerful in the last couple of years where people feel like that in itself is the goal versus trying to eliminate addiction and get somebody into recovery.

So this is complicated, I think, because there’s this interaction in this period between what you might call elite and mass drug culture. In this period, you have the rise of a lot of super popular podcasters like Joe Rogan and Tim Ferriss, who are very open about their psychedelic use. You have Michael Pollan’s great book on psychedelics, “How to Change Your Mind.” I do a bunch of podcasts about psychedelics. You have a book by Carl Hart, who’s a well-known drug researcher at Columbia, called “Drug Use for Grownups” where he talks openly about using heroin to relax at the end of the day. Ketamine use rises in a very public way.

And so you have this change in drug culture among elites. It becomes much more acceptable to talk about how you use drugs to improve your life that I think also makes it look hypocritical to have a punitive approach not just legally but culturally towards other kinds of drug use. Do you think there’s something to that?

Yeah. I’ve seen that very much, too. And people with a platform, they’ve got a hearing. One of the most important things to understand about Measure 110, for example, is it passed easily. It was not that controversial as people thought it would be. And that elite change, I think, was part of the dynamic.

And definitely, you could see that in psychedelics in Oregon, which, as you know, has set up an entire system to administer psychedelics as a healing force. At least that’s the theory. These are transformative medicines often, by the way, in advance of evidence. But put that aside for a minute. And that is a remarkable change.

I think the criticism you could make of people who are well off and well resourced and have a lot of social capital and have access to treatment and health care whenever they need it is that they could be overgeneralizing what it’s like to use drugs in that situation versus the situation most people find themselves in with a lot less resources and a lot fewer things to catch them if they develop a problem. Now, some would say, well, the real problem is the law, and it’s the punishment you get and all that. And that can absolutely ruin people’s lives. There’s no question to that.

But there’s also quite a few people whose lives are ruined by drugs, including cannabis. There’s some people whose lives have been ruined by psychedelics and certainly people’s lives ruined by cocaine and fentanyl and so on. You don’t think about that much maybe when you are in a really comfy, well-resourced environment. But the average person who lives in a more typical environment does think about it, does have to worry about it. And that gives them a different understanding of what drugs are, how risky they are, and what they want their government to do about them.

That all makes sense to me. But something else I would say was here was that I would have described the consensus for a very long time as drug use is bad, and policing is good. And to some degree, by the time of 110 and some other reforms we were seeing in other states, I think that there was — and you can tell me if this tracks for you — a belief that drug use is somewhere between neutral and good depending on the drug, and policing is bad.

Yeah. There’s no way to separate what happened in Oregon from the murder of George Floyd and from Black Lives Matter. I mean, the protests against police were as intense in Oregon as anywhere they were in the United States and indeed throughout the region and a lot of concern — and it’s got to be said — a lot of justifiable concern about racism and policing. And a huge portion of that was focused on drug enforcement. And that flip was clearly part of why the bill passed.

In terms of drug use, I think there’s a split. I mean, so there are people who accept it’s a health matter. So let’s move to that part of the population, some of whom will say, it’s not a good idea, but we should add health services, and I certainly wouldn’t punish anybody for it, to people would say, no, it is good. In fact, it is actively good. Drug use is good. Drug use should be accepted and maybe even promoted or celebrated. And the debate has been, I think, between those two strands, whereas in the ‘80s, it was more between “drugs are bad — period” and “they should be legal even if they’re good or bad.”

You’ve written about billboards that I used to see and always thought were somewhat strange around fentanyl use and showing happy people — and these were in San Francisco — showing happy people and suggesting if you’re going to use this stuff, use it with friends. Use it around others. Make sure you’re not doing it alone.

One way of looking at them was as a destigmatization of this. It’s totally fine. Just be safe. And another way of looking at it was a total last gasp, but we don’t know what to do. We’re going to try this approach to everything else is failing. Maybe if we completely turn around our approach and just try to change the social dynamics in which people use, that might have an effect on the margin.

So several things there you’re saying, I think they’re important. One is, absolutely. In the face of all this death and all this suffering, we’re all desperate for solutions. And I think it is good that we are thinking in very fundamental ways about what the solutions are. That should be the case when you have this much suffering.

I think it is not irrelevant that these changes have unfolded during a pandemic where, let’s face it, we all went a little crazy. It was very stressful. It was emotional. Many policy debates took on a very personal cast. And we did rock between different extremes in our politics.

With the billboards — and just to describe these billboards, what to me is interesting about them is that the public health department signed off on these. And if they had been promoting beer, they would’ve been outraged by them because they would’ve said, well, you’re making it look like this is something young, attractive, successful people do. And it’s a lot of fun. And you’re understanding all the risk. And you’re going to be tempting kids. You’re basically giving people really bad information. But it wasn’t alcohol. It was fentanyl.

And so I guess they felt it was reasonable on the idea that this will destigmatize. And then people will be comfortable talking about it and using fentanyl together. And they would show people in the apartment having a nice party. Then they could take care of each other in the event of an overdose. It would be a social event, and then you could be there. To me, it’s an extraordinary chain of reasoning. But that’s where San Francisco got in 2021.

I lived in San Francisco during this period. It also had a highly liberalizing attitude on drugs. It had significant open air drug markets, particularly in the Tenderloin.

But what I always saw as the core thing that was infuriating people because I lived in places like D.C. that had a much higher murder rate but where crime was much less of an angry political issue was a feeling that the government was tolerating disorder, that it wasn’t fighting it and failing or fighting it and failing to triumph over what’s a very hard problem, but that the government was allowing it, that they were allowing these open air drug markets, that they were allowing people to shoot up on the street, and that it turned out the politics of permitting disorder were really, really, really bad.

Yes, they are. And I volunteer in the Tenderloin. So I’ve spent a lot of time in those neighborhoods and definitely pick up that sense. And, say, for a number of people would express it in an even harsher way, which is the government is tolerating it where I live in a way they would never tolerate it in a wealthier neighborhood. That could be coupled also with a sense of some of those people in the wealthier neighborhoods say this should be tolerated, but they’re not having to tolerate it. I am. And that generates understandable anger.

And this has had an interesting racial dimension in my observation of it is that a lot of this tolerance has been pushed in the name of racial justice often by white college educated progressives but is unpopular with many, many people of color who live in low income neighborhoods because they’re paying the cost of it while it’s being advocated for for people who they don’t even know who live in neighborhoods that don’t have these kinds of problems.

I was reading recently a lawsuit filed by residents of the Tenderloin against San Francisco. And it was saying in a way that is illegal and unconstitutional, it was alleging that San Francisco — and everybody knows this to be true — was not enforcing laws in the Tenderloin the way it was in other parts of the city, that it had settled on a containment strategy in the Tenderloin. And the Tenderloin is really rough for people who have not walked around there. I mean, the disorder, the despair, the difficulty’s incredibly visible. And one of the things that was noted in the lawsuit was that the Tenderloin has a much higher ratio of children than most parts of San Francisco. It has a lot of immigrant families, a lot of poor families. And so this is being tolerated where really a lot of kids were.

And the argument was that this was not allowed where richer people lived in San Francisco, and it was where these poorer people lived. And even knowing that, it was striking to see it laid out and to see these experiences of people who were living amidst it laid out and their fury that containment was being done on their backs.

Why are there hundreds of dealers standing on street corners in the Tenderloin and in the south of Market? They are not there to service the neighborhood. Because if you live in a neighborhood and your dealer lives in the neighborhood, your dealer doesn’t have to stand on a corner. You know each other. You can text. You can just stop by and make your transactions.

Open air markets are there to service strangers. They’re so that buyers and sellers can find each other really fast. And in an open air market, it’s serving people who don’t live in the neighborhood. There’s no reason there’d be that many dealers. The Tenderloin doesn’t need that many dealers to pay for its own drug use.

So it’s a legitimate gripe if you live in a neighborhood and you’re trying to raise a family in a neighborhood that is taken over by an open air market to say, we’re taking all the harms of all the drug use of the other neighborhoods where they don’t allow open air dealing. But people know they can just drive from there to here pick up their drugs and then go off about their way. And that’s unfair. And so I sympathize with the residents of the Tenderloin who are raising that very legitimate gripe about not getting equal protection under the law.

One question I’ve had about all this is how much of it is a set of policies that might’ve worked or certainly worked better than they did, but fentanyl rolled a grenade underneath this? I mean, a lot of this thinking was happening years before fentanyl just completely invaded America.

The emergence and dominance of powerful synthetic drugs like fentanyl among the opioids or super strong methamphetamine that is now a larger share of the market than cocaine has, I think, undermined basic assumptions about drug policy across the world. When a kind of person who might come into, say, a methadone clinic addicted to heroin, their heroin use might be once a day or maybe twice a day, including people who were holding jobs, people who still were in touch with their families. Not that life was going well, but there was some level of manageability. We now have people with fentanyl using 10, 20, 30 times a day. Their entire existence is — because fentanyl has a very short cycle of action.

So you wake up. You’re in withdrawal. Withdrawal is incredibly unpleasant. You may smoke fentanyl, smoke, smoke, smoke. Maybe it takes 10 minutes, 20 minutes, 30 minutes. Your withdrawal finally stops. You smoke some more till you get high. You fall asleep. You wake up, and you’re in withdrawal. And you’re just really stuck like that.

And I see people like that. I mean, I’m very optimistic about the potential of recovery for addiction. Those are what I’ve seen. And those are also my values. I try to approach everybody that way.

And I also sometimes am frightened that it’s just much, much harder to help people in this state when their life is that consumed by drugs even relative to how consumed their lives were by drugs like heroin and OxyContin. It’s really pretty frightening. And we are getting it first. The United States and Canada too are being exposed to these drugs.

It’s interesting to note in Europe, they’re just starting to get these drugs. And whether they’ll keep with their same policy mix is a really interesting question. It isn’t entirely sure. I have a colleague who says fentanyl is like an antibiotic resistant infection. The stuff we always done that used to work doesn’t work anymore. And that’s terrifying.

How good now is our best gold standard addiction treatment?

So this varies a lot by drug. I’m going to start with the bad news first, which is the stimulants. So the biggest disappointment of my career is about cocaine and methamphetamine. I started my career in the late 1980s. And the care that people got for those drugs then is almost the same as what they get now. There’s been very little progress.

Billions have been spent. Brilliant people have tried to develop, for example, pharmacological treatments for them. Nothing has panned out yet. Most of the behavioral treatments don’t work. We have one thing that seems to work, which is contingency management, a particular way of structuring and giving rewards to help people make changes in their behavior. But we’ve had that for a very long time. So the news there is kind of disappointing.

For alcohol, funnily enough, one of the best things we have has been around forever, which is Alcoholics Anonymous. And for a long time, people in my field looked down on it as too folky and not medical enough. And yet there’s now tremendous evidence that myself and some colleagues assembled in what’s called a Cochrane Collaboration showing that does work, that people do, in fact, as well or better in Alcoholics Anonymous as they do coming to see people like myself.

There’s also some medications available. Acamprosate is one. Naltrexone is another. Some people benefit from those.

On the opioids, we have multiple approved FDA medications. Methadone has been around a very long time. It’s a substitute medication. It is effective for many people. Buprenorphine is another substitute medication, slightly different pharmacologically, but also effective for a great many people. And we have naltrexone, which is it works differently. It’s a blocking agent. And there are people who do very well on that.

So those things are all good. That’s considered the front line. You offer people medication first. And people also can benefit from other kinds of things — therapies and from residential care. And if somebody is out on the street with an addiction, it’s not believable that they are going to check in once a week for an hour with a therapist because their lives aren’t that organized. They usually need a safe substance free environment in which to stay. And those are often in short supply. So we sometimes don’t have success there not because we don’t know what to do, but because we haven’t allocated the resources to do it.

But how good are any of these? I mean, let’s zoom in on alcohol for a minute. I’ve known a lot of people — people I’ve loved — who have had very severe alcohol addictions. And you can’t be near that and not realize how differently different drugs act on different people. If I am drinking, just at some point, my body is like, that’s good. We’re done.

And there are people I know who they have burnt their life down around them. And they’ve been in and out of residential treatment. They’ve gone to A.A. Some people recover. Often they really don’t. How likely is it if you go into A.A. or some of these other things that you’ll recover?

People who seek for alcohol treatment or Alcoholics Anonymous can fall into three bins. If you look at them about 6 or 12 months later, somewhere between 40 percent, 50 percent are dramatically better off. Their lives are dramatically better. And that could be the completely abstinent, or they’re much more abstinent, but their lives are dramatically better.

Then there’s another group of people who seem to be somewhat better. That might be 20 percent, 25 percent. They’re still having significant problems. But maybe they make some things like, at least I’m not drinking and driving at the same time, or at least my spouse and I are making some progress in our marital communication. And then the remaining people unfortunately look exactly the same as the day they came into treatment. They either made no progress, or they made some slight progress and then relapsed.

The perception that we have of it tends to be driven by that last group. That’s because when people get better, they disappear into the woodwork. So when I worked in the White House, I used to think when I walked by somebody getting out of the metro who’s actively using drugs or alcohol, I’m very aware. That’s so visible to me.

And yet I know every day people walk by me in suits or in recovery, and I don’t notice them at all. Just looks like another Washington lawyer or civil servant or politician. So the cognitive effects of people who are doing the worst or the most vivid give us, I think, a more despairing view than we ought to have.

How much is the risk of developing an addiction genetic?

Genes affect us a lot. Studies across addictions show a genetic contribution. It varies by the substance, but at least 30 percent, sometimes even 50 percent. How much control people have just in general — some people are more impulsive than others, have a harder time thinking about the future than others from their first day on this Earth. And that will increase your risk for addiction.

If you’re very, very risk averse person who thinks a lot about the future, drug use looks differently to you than if you’re someone who wants to feel good today and is a happy go lucky person. Some of why we get addicted has to do with things that nobody can really control. And those can be things like liking. Even for the first time we use them, we like drugs differently.

When my boys were little, they were in the backyard, and they were climbing a tree. And I said, ah, that’s not how to climb a tree. I’ll show you how to climb a tree. So when I got to the emergency room, I said, this bone is broken. And I know it because I can see the way it’s knocked off my wrist.

And they nicely patched it for me. And they sent me home with Vicodin, the opioid Vicodin, bottle of 30, and said, it’s going to hurt. So you’re going to want to take these.

I take one. And I feel terrible. Stomach all feels bound up. I feel just really groggy. I don’t like this. For me, it was very easy to say pain is better than taking even one more of these pills. Meanwhile, I’ve treated people who say, the first time I had an opioid, it was like a hole that had been in my heart my whole life filled up for the first time.

Now, both those experiences are real. You cannot attribute them to, well, Keith must be a real solid and moral person, and that’s an immoral person, or Keith must have made good choices, and that person made bad choices, because we had no learning history at all. It was just the kismet of genetics that drugs feel differently to different people from the very first time, not just learning history.

And so I find it very easy to be sympathetic to someone who’s addicted to opioids because I think the reason I’m not going to do that is not because I’m a better person. It’s because they just don’t feel good to me. And to you, they felt fantastic. And so you were willing to keep on using them.

It’s not just that I find it easy to be sympathetic. But I find it hard to know how to think about it because, to be blunt, I’ve had very positive personal experiences with certain drugs. And at the same time, I’m somebody who is extremely nonaddictive in this area of my life. I have never wanted more puffs on a cigarette than I had. I’ve never smoked a cigarette and been like, I need another one. Obviously, other people I knew when I was in college, that was not how that went for them.

There is something here where, on the one hand, I worry that a fair amount of the discourse around drugs comes from people for whom maybe it actually is positive for them. There are people who have real positive relationships with different kinds of substances both legal and illegal. Adderall can be amazing for somebody with A.D.H.D., and it can be very destructive for somebody who ends up using it recreationally. I mean, you were talking about methamphetamines. And it’s not all that different.

And it becomes, I think, almost philosophically hard to know how to think about these substances that really can range. How to think about something where for some people it can be a very good part of their life, either pleasurable or even very profound. For other people, it can be a complete disaster that will actually ruin their life. And who are you making policy for and how feels like something that this conversation gets caught on a lot.

I agree, yeah, because drugs aren’t good, and drugs aren’t bad. They are good and bad. And sometimes I envy colleagues who work in areas like cholera prevention. If there’s a cholera outbreak, and you get rid of it, you’re a hero. Everybody loves you. Nobody says, but I was having a party. I need a little cholera. Can’t you keep a little cholera for special occasions? It’s like, no, everyone just hates cholera. Drugs are absolutely not like that. People have great experiences with drugs. I drink wine, by the way. That’s a drug. Or ethanol is a drug.

So we can’t resolve it that simply. And so we have to get into these questions of, well, when is it good? And when is it bad? And for whom is it good? And for whom is it bad?

And then there’s a question that is to me a philosophical question, in fact, religions grapple with, which is should I give something up for the benefit of others? Perhaps I can use fentanyl freely and enjoy it. But should I still say it shouldn’t be in recreational market because I’m aware enough of my fellow people would find it life ruining? And so the moral thing is for me to give it up so the sense that all of us can live together in a spirit of common humanity. And there’s always going to be tougher discussions, things that are good and bad versus things that are just clearly good, and we should just embrace them, and clearly bad and just reject them.

I wonder about this with the rollout of legal cannabis across a lot of the country. So this is something that I occasionally take. I’ll sometimes have a 5 milligram edible to help me sleep or to relax at the end of the night. It isn’t something I want all that often. And when I go into these stores, and I look in them, and I see the way they’re popping up in New York the way they popped up in California, it’s pretty clear this market is not catering to me.

And I think a lot about something that, as you mentioned, our mutual late friend Mark Kleiman, who was one of the great drug researchers and crime researchers, used to say to me, which is that alcohol companies do not make their money on people who drink a beer or two a week. They make their money on people who drink a case. And when I go into these stores, what I see are the rise of super high potency products that I wouldn’t touch. And clearly the money is being made given how many of the stores there are on people taking a lot more than I am a lot more often. When you look at what is going on with legal cannabis, how do you feel about it?

So start at the question of should we ever throw people in a cell for cannabis? Oh, so that was a terrible idea. So let’s take that off the table and just say if we’re going to have a legal industry, have we regulated it well? And I think it’s absolutely clear we have not.

And this is something we’re generally I’d say bad at relative to other countries of constraining profit when the profit damages public health. And so we have an industry with hardly any constraints on their products, not a very good record with even labeling their products accurately, very poor enforcement of even keeping the legal regime in place. And the pot shops in New York are a good example of that. A huge number of them are unlicensed and just doing whatever they want. And they’re being allowed to do that.

So I think we’ve done a really bad job with cannabis and in part driven by this phenomenon of not being willing to admit that cannabis isn’t good or bad, but it is both. And so when Mark Kleiman and I worked with Washington state, who was one of the first states to legalize, and we said, you still need to have some enforcement to make a licensing system work, I remember people literally either laughing or getting angry at us saying, the war on drugs is over. No more enforcement ever.

It’s like, actually, no. Why would you have a license and do the right thing and not hire minors? And why would you be sure to card? And why would you sell clean and safe products when you do that because you get a market advantage in a licensed market? And so if we just allow anybody to do anything, well, then there’s really no point in getting licensed, no point in paying your taxes, no point in being a good citizen, no point in not in hawking dangerous products.

And that’s the situation that we have. And we’re going to be really sorry for it. The distribution of consumption is also really important to think about. It’s not quite half, but it’s certainly a plurality of cannabis users today are using it every single day, usually a high strength product.

Wow, really? Almost half?

Yeah. I’d say about 40 percent are daily or near daily users. And so that’s where the money is if you’re running an industry. And so you want to produce cheap high-strength product that that population will use and use and use and use. And I just think we’re really going to regret that.

My friends over at “Search Engine,” which is a great podcast, just did this two part series on the New York cannabis market. And I had not really understood that while New York is now completely full of what appeared to me to be legal cannabis stores, virtually none of them are legal cannabis stores. There’s a very small number of legal ones and then a huge number of illegal ones.

And you might say, well, how are there all these illegal stores? And the answer is that nobody wants to send the police to bust people for cannabis. And so much of the theory of legalization as I understood it for years was that we will legalize and then be able to regulate the market. But if what we’ve done is legalized, but we’re not willing to use law enforcement, and so we cannot regulate the market, that’s actually a dramatically different policy equilibrium than I feel like I was promised.

Yeah, the experience you’re having — I think people have had across a lot of drug policy — is expecting one thing and then getting another and underestimating the ideological commitments of the people who designed it. So there are people who say, we’re going to have this legal market, and we’ll get rid of the illegal sellers and all that. But that isn’t what necessarily they wanted. They just thought, look, this should not be restricted at all. And you should just be able to deal with it and sell it and have a classic Libertarian understanding of it as opposed to a more progressive understanding of what we expect from industries. And this problem is replicated all over the country.

There’s also something that’s happened in policing, which is there’s always more to do for police than they have to do. So they’re not super interested in getting involved. Even with some of the massive problems we have, for example, here in California, we have huge illicit groves, some of them staffed by people who have literally been human trafficked. But it hasn’t really risen up as an enforcement priority because, cannabis, we don’t do that anymore.

You said this about cannabis, and I found it really striking. Quote, “The newly legal industry looks a lot like the tobacco industry — an under-regulated, under-taxed, politically connected, white dominated corporate entity that generates its profits mainly by addicting lower income people to a drug. 85 percent of Colorado’s cannabis, for example, is consumed by people who did not graduate from college.” Can you say a bit more about that socioeconomic breakdown?

Yeah. So I think that in middle upper class society, that figure’s really shocking. And the idea is, oh, cannabis user is, oh, someone like you, someone who has a good job, went to college, and maybe uses occasionally. No. I say if you want to think of the typical user, think of somebody who works in a gas station who gets high on all their breaks. That’s much more the sociodemographic breakdown of it.

And by the way, that’s what you see with tobacco as well. In my professional middle class life, it is so rare for me to see somebody smoking a cigarette. But if you go into a poor neighborhood, there’s still a lot of people who smoke cigarettes.

And so we’ve won the war on smoking I guess, middle class and well off. But it’s far less the case as you move into people who have much more challenging lives. And this comes back to the point that you raised and I think is really important one is that since that professional class makes the policies, it’s really important for them to remember that their lives are different than the people whose lives will be most profoundly affected by those policies.

One thing that a lot of drugs, cannabis being one of them, do is allow you to escape from a life that doesn’t feel good to you. If I had a job that bored the hell out of me, it might be more appealing to use something like cannabis more often. I really like my job. And I definitely cannot do it high, so I don’t. But there’s both a question of how does this affect you as a person but also how much might you want it, need it, need the escape?

I think this gets down to one of the most important questions to ask, which is, why don’t more people use drugs? People say, why does anybody use drugs? And it’s like, well, do you ask me why anybody has sex? That’s a really strange question. It feels good. We don’t need an explanation why people use them.

It’s actually far more interesting to think, why aren’t we all using them? Why aren’t you and I using drugs right now? And big reasons why are, well, we have other rewards in our lives. And we have a lot of other stuff that we want to do that is rewarding.

So in the absence of those things, the why not question, the answer seems to be, well, I can’t think of a reason why not. I might as well. Well, you won’t live as long. Well, I don’t expect to live that long. You won’t do well in your brilliant career. I don’t have a brilliant career. You won’t enjoy your fabulous house. I don’t have a fabulous house.

And that’s a reason I think it’s easy or it should be easy to have some sympathy. We all don’t have the same set of rewards to choose from. Rewards any neuroscientists would tell you are judged relative to each other. We don’t just make judgments over good, bad, but we do a lot of this is better than that. So as you pull rewards out of an environment, yeah, drugs become relatively more appealing.

It feels to me across this conversation that we’re talking about two eras that didn’t really work. I think a lot of people are worried about just a pendulum swinging between extremes. I’m curious if to you there is a synthesis out there either in a place or in a theory that feels like it balances these different realities, that people will use drugs? They are good for some people and terrible for others, that we don’t want to be throwing adults constantly into jail because they did something with their own bodies. We don’t want tons of people to get addicted because we decided not to throw anybody in jail. Is there something that feels to you like it strikes a balance here?

So years ago, when I worked for President Obama, we cited Washington’s example because they had taken a couple of hundred million dollars, spent it on mental health and substance use treatment, and showed within 12 months they’d actually made all their money back because of less crime, because of less disability, because of less trips to the emergency room. And importantly, they had gathered data to show that. And that was one of the things we used when the Affordable Care Act was being done to explain why covering substance use in that package would be a good deal for the taxpayer in addition to, of course, being a good deal to any person who had that problem.

There’s also certain issues where people with very different views and feelings about drugs can agree. So I’ve been working with a lot of people around the country on building Medicaid into the correctional system starting in California. It was pushed by a fabulous assembly member named Marie Waldron. We turn Medicaid on before people leave. And that gets them typically on some type of medication. And that can pull people together because it makes it far less likely for them to die of an overdose or to have other health problems. And it also makes them much less likely to commit crimes. And so you can get people like, well, I’m not very sympathetic. I don’t want to spend money on the health of some drug user. But if it makes them less likely to commit more crime, I like that. And other people say, well, this is a health matter. It’s like, well, then they like it too.

And that approach, which now multiple states have been approved for and the Biden administration C.M.S. has said, you can all have this Medicaid waiver — I don’t know the current number. I think it’s about 14 or 15 other states are applying. And as an example of something where you don’t necessarily have to resolve all the disagreements, but you can find a policy that maximizes multiple outcomes that a broad section of people care about.

Something I’ve seen you talk about and write about is this idea that the way that policing should work here is it should be very, very predictable, very certain you will get picked up, and very modest. It’s sort of almost like it operates as a constant annoyance. You end up in jail for 24 hours and are let loose. And there was some evidence that definitely did decrease repeat offending not among everybody but among enough people to really matter in the study. Do you still think that’s a good idea?

Absolutely. It’s a good principle for enforcement and for deterrence to have it be predictable, responsive, and fair. There’s been a lot of success with drink driving and alcohol through the program 24/7 Sobriety, which started in South Dakota and has now spread to about 15, 20 states and is also now in other countries.

It’s all across England, all across Wales where I was just last week actually working on that, which is a model whereby people are sentenced after their second, third, fourth, fifth alcohol related arrest to not be allowed to drink. They aren’t sent to jail. They aren’t fine. Their cars aren’t taken away. But their alcohol use is monitored literally every single day with swift and certain but modest consequences if they drink.

And that program has reduced incarceration. It has reduced crime. It has reduced domestic violence. And it strikes a good balance between using the criminal justice system to protect and put some constraints on people but not in a way that ends up being carceral.

And the place where we can really make a huge impact on that in the United States is the million people we’re already supervising on probation and parole who have substance use problems. And we need to roll those out more broadly. For example, Oregon’s new policy mix if implemented properly, which will be a challenge, I think it would be a very good one. They do put pressure on people to seek treatment. But they say literally, no one is going to be put into a prison in Oregon simply because they used a drug. And now they’re building up the other part you got to have, which is have to have the health system and the services that keep people alive while they use and then help them get into recovery. That, I think, is a very appealing mix of things.

We have a really hard time, I think, in the U.S. and lots of policy issues of realizing that it’s not a series of on/off switches. It’s a series of dials. And you can adjust things and find sensible, nuanced approaches that are more effective than what fits on a bumper sticker.

And I feel like that’s what my job is. And people like me who do not have to take the great risk to stand up and people and say, please vote for me. And then that means I have to explain something simply. It can’t be any other way but are next to it and are very fortunate to have the time to sift through evidence in a calm environment before they venture out with some suggestions about what we might do better.

I think that’s a good place to end. So then as a final question, what are three books you would recommend to the audience?

So there’s so many good books written about in this area. It’s hard to pick. So I decided to prioritize personal relationship starting with your late friend of mine Mark Kleiman, who wrote a book called “Drugs and Drug Policy: What Everyone Needs to Know,” coauthored with Jonathan Caulkins and Angela Hawken.

And it is exactly what the title promises. It’s accessible. It’s something you can dip into and out of and answer any question you want. And I also point to it as just a model of how academics in any area can write in such a fashion that a broad audience can engage their work and learn from it.

The second book I would suggest, again, from a friend who’s someone I’ve known since she was a psychiatric resident and I was an assistant professor. And that’s Dr. Anna Lembke here at Stanford. And the book is called “Dopamine Nation,” which was a deserved bestseller around the world.

But that gives you much more of the human experience describing, what is it like to be addicted, to not be able to stop doing something even though you know it’s destructive? How does it feel? How do you try to overcome it? And what is going on in that person neurologically that makes it so hard? And then the book also talks about just the seeking of reward in a reward saturated society and how we all are chasing all these things, whether it’s on our cell phones or with drugs and so on.

And then the last one — maybe a more eccentric choice, but it’s such a good book — is by Thomas De Quincey. And it’s called “Confessions of an English Opium Eater.” So De Quincey was a hangers on of the romantic poet set about 200 years ago in England. And he wrote at the time a very scandalous account. But, of course, also scandalous things in Britain are often very popular things.

So it became a bestseller about his experience of long time opium use. And he talks about the pains of opium and the pleasures of opium and a bit about how it affects social relationships, how it affects human psychology. And what I like about is, first off, it has a wonderfully florid over the top poetic style. And the other thing is almost everything you and I have talked about today is touched on in that book. And that shows that while we do learn things and we go forward with science, with policy, it is also true that the human relationship with drugs has had the same benefits and challenges in it for time immemorial. And so that’s a reminder of that when you read a book written that long ago and can resonate with so much of what’s going on today.

Keith Humphreys, thank you very much.

The show’s production team also includes Rollin Hu and Kristin Lin. Original music by Isaac Jones. Audience strategy by Kristina Samulewski and Shannon Busta. The executive producer of New York Times Opinion Audio is Annie-Rose Strasser. Special thanks to Sonia Herrero.

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Produced by ‘The Ezra Klein Show’

Drug policy feels very unsettled right now. The war on drugs was a failure. But so far, the war on the war on drugs hasn’t entirely been a success, either.

Take Oregon. In 2020, it became the first state in the nation to decriminalize hard drugs. It was a paradigm shift — treating drug-users as patients rather than criminals — and advocates hoped it would be a model for the nation. But then there was a surge in overdoses and public backlash over open-air drug use. And last month, Oregon’s governor signed a law restoring criminal penalties for drug possession, ending that short-lived experiment.

Other states and cities have also tipped toward backlash. And there are a lot of concerns about how cannabis legalization and commercialization is working out around the country. So what did the supporters of these measures fail to foresee? And where do we go from here?

[You can listen to this episode of “The Ezra Klein Show” on the NYT Audio App , Apple , Spotify , Amazon Music , YouTube or wherever you get your podcasts .]

Keith Humphreys is a professor of psychiatry at Stanford University who specializes in addiction and its treatment. He also served as a senior policy adviser in the Obama administration. I asked him to walk me through why Oregon’s policy didn’t work out; what policymakers sometimes misunderstand about addiction; the gap between “elite” drug cultures and how drugs are actually consumed by most people; and what better drug policies might look like.

You can listen to our whole conversation by following “The Ezra Klein Show” on the NYT Audio App , Apple , Spotify , Google or wherever you get your podcasts . View a list of book recommendations from our guests here .

(A full transcript of this episode is available here .)

This episode of “The Ezra Klein Show” was produced by Annie Galvin. Fact-checking by Michelle Harris, with Kate Sinclair and Mary Marge Locker. Our senior engineer is Jeff Geld, with additional mixing by Aman Sahota and Efim Shapiro. Our senior editor is Claire Gordon. The show’s production team also includes Rollin Hu and Kristin Lin. Original music by Isaac Jones. Audience strategy by Kristina Samulewski and Shannon Busta. The executive producer of New York Times Opinion Audio is Annie-Rose Strasser. Special thanks to Sonia Herrero.

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , WhatsApp , X and Threads .

Open access
Published: 11 May 2024

How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives

Lissa Moran 1 ,
Jeff Ondocsin 1 , 2 ,
Simon Outram 1 ,
Daniel Ciccarone 2 ,
Daniel Werb 3 , 4 ,
Nicole Holm 2 &
Emily A. Arnold 1

Harm Reduction Journal volume 21 , Article number: 92 ( 2024 ) Cite this article

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Mortality related to opioid overdose in the U.S. has risen sharply in the past decade. In California, opioid overdose death rates more than tripled from 2018 to 2021, and deaths from synthetic opioids such as fentanyl increased more than seven times in those three years alone. Heightened attention to this crisis has attracted funding and programming opportunities for prevention and harm reduction interventions. Drug checking services offer people who use drugs the opportunity to test the chemical content of their own supply, but are not widely used in North America. We report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered.

We conducted in-depth semi-structured key informant interviews across two samples of drug checking stakeholders: “clients” (individuals who use drugs and receive harm reduction services) and “providers” (subject matter experts and those providing clinical and harm reduction services to people who use drugs). Provider interviews were conducted via Zoom from June-November, 2022. Client interviews were conducted in person in San Francisco over a one-week period in November 2022. Data were analyzed following the tenets of thematic analysis.

We found that the value of drug checking includes but extends well beyond overdose prevention. Participants discussed ways that drug checking can fill a regulatory vacuum, serve as a tool of informal market regulation at the community level, and empower public health surveillance systems and clinical response. We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.

This study contributes to growing evidence of the effectiveness of drug checking services in mitigating risks associated with substance use, including overdose, through enabling people who use and sell drugs to test their own supply. It further contributes to discussions around the utility of drug checking and harm reduction, in order to inform legislation and funding allocation.

The opioid crisis in the U.S. consists of multiple overlapping and inter-related waves of surging opioid exposure, dependency, overdose, and death rates. Each wave has emerged from different eras of an evolving drug market and multiple intersecting contextual factors such as trends in pharmaceutical manufacturing and prescription, socioeconomic inequities, and positive supply shocks of both licit and illicit opioids [ 1 , 2 , 3 ]. Though its history can be traced back to the 1980s and 1990s, the past decade has redefined the crisis [ 4 ].

By the time the U.S. Department of Health and Human Services (HHS) declared the opioid crisis a public health emergency in 2017 [ 5 ], a wave of unprecedented magnitude had been on the rise for nearly 4 years, marked by the rapid proliferation of fentanyl and synthetic analogues into the drug market [ 4 , 6 ]. Even as mortality from heroin and prescription opioids leveled off or decreased, opioid overdose and death rates rose precipitously [ 6 ]. From 2018 to 2021, the rates of opioid overdose deaths in the U.S. nearly doubled, and by 2021, roughly 9 out of every 10 opioid overdoses in the country (88%) were fentanyl-related [ 7 ].

In California, home to the highest number of opioid-related deaths in the U.S. [ 8 ], the opioid overdose death rate curve from 2011 to 2021 tells a harrowing story. The third wave was later to arrive in California than the national average, but its onset was rapid and dramatic. Opioid overdose death rates more than tripled from 2018 to 2021, and synthetic opioid (e.g., fentanyl) deaths increased 7.2 times, responsible for 37% of opioid overdose deaths in 2018, and 86% just three years later [ 9 ].

In response, the California Department of Public Health has committed to the expansion and promotion of policies, programs, and services to combat the overdose epidemic, with a special focus on harm reduction and drug checking strategies [ 10 ].

Drug checking services

Drug checking services (DCS) have garnered particular interest as an expansion of harm reduction strategies, as they offer the opportunity for people who use drugs to test the chemical content of their own supply [ 11 , 12 ]. In doing so, people who use drugs may be afforded the possibility of changing their use behavior to remove or reduce the likelihood of harm [ 13 , 14 ]. Multiple DCS have been operating in Europe for years—particularly in venues known for high rates of recreational drug use like music festivals [ 14 , 15 ]—but are less common in North America. In the U.S. and Canada, DCS have emerged primarily in response to the needs of marginalized people who use opioids, and operate predominantly within the context of frontline services [ 16 , 17 , 18 ].

Though not mainstream or broadly implemented, studies from North America indicate that DCS are generally acceptable among people who use drugs [ 19 , 20 ], and report that both service users and providers have expressed desire for better access to DCS, legal protections for those providing and using drug checking, and advanced technologies that provide information on drug concentrations—not just drugs present—at the point of care [ 21 , 22 , 23 , 24 ]. Several studies explore the potential impact of drug checking when used at various points along the supply chain [ 25 , 26 ], with findings that suggest feasibility, acceptability, and uptake of DCS among drug sellers [ 27 ], noting particular importance to drug sellers who are embedded in their community and hold long-term trusted relationships with customers [ 28 , 29 ].

Arguably the most common and well-known drug checking modality in North America are fentanyl testing strips (FTS), or lateral flow assays, which were originally designed for the clinical use of detecting fentanyl in urine samples, but have been publicly available for several years for modified use with drug samples [ 30 , 31 , 32 , 33 ]. FTS have been a powerful tool to combat accidental fentanyl exposure: they are small, portable, relatively accessible, and detect fentanyl in minute concentrations that could still be enough to trigger an overdose in an opiate-naïve individual [ 31 , 34 ]. They have been found to be particularly useful for outreach and street use [ 13 , 25 , 35 ]. That said, FTS are not useful in the same way for those who intend to use fentanyl, where the overdose risk is not in the presence of fentanyl, but in the concentration and presence of additional adulterants like sedatives [ 36 ].

Drug checking technology has advanced, and continues to advance, such that a greater amount can be known about the chemical components of a drug sample in a shorter period of time, in a broader array of environments [ 37 ]. Multiple drug checking modalities can inform people who use drugs about the presence of unexpected adulterants, such as benzodiazepines and xylazine, among others. Technologies that offer the greatest specificity and sensitivity include Gas Chromatography Mass Spectrometry and High-Performance Liquid Chromatography, which can detect the presence and concentrations of a wide array of chemicals present in even small amounts in a sample, but must be used in a laboratory setting by a trained technician [ 37 ]. More flexible technologies have emerged, like Fourier-Transform Infrared Spectroscopy (FTIR) [ 38 ], which is semi-portable, and returns information on the main chemical components of a drug sample (above 5% concentration) in a matter of minutes [ 31 ]. Paper spray mass spectrometry is more expensive than FTIR but is just as fast, and provides quantitative results [ 39 ]. Today, multi-technology-based drug checking services are available in some areas as standalone programs, or as added components to existing harm reduction centers [ 30 , 40 ].

These innovations continue to advance amidst complex and evolving social, legal, political, and funding conditions [ 11 , 21 , 41 , 42 ]. Legally, drug checking can be complicated as a public service, requiring the handling and, often, exchange of illicit drug material, of which possession and distribution is often criminalized [ 21 ]. Harm reduction initiatives more broadly—DCS, syringe access services, naloxone distribution, HIV/HCV testing, wound care, supervised consumption sites, and medications for opioid use disorder (MOUD), among others—can at times be unpopular socially and politically, as stigma associated with addiction and drug use combined with concerns about the goals and practices of harm reduction can generate powerful community pushback [ 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Legislators and policymakers at local, state, and federal levels who rely on constituent support may therefore shy away from supporting various harm reduction strategies, despite endorsement from public health officials and robust evidence showing that harm reduction improves the health, survival, and recovery potential for people who use drugs, without compromising community safety [ 48 , 49 ]. At the same time, California was one of several states to bring lawsuits against opioid manufacturers, distributors, and pharmacy chains, alleging that they played an active and/or negligent role in the genesis and exacerbation of the opioid crisis [ 50 ]. Of the $43.3 billion in settlement funds that have been awarded thus far, California may receive nearly $4 billion [ 51 ]. These funds are specifically earmarked for activities that are to include “prevention, intervention, harm reduction, treatment and recovery services.” [ 52 ].

As the opioid crisis reaches an unprecedented magnitude and strategies to address it are at once both a priority and a topic of controversy, we aimed to explore the value of drug checking services and their role within harm reduction more broadly. In this study, we report on qualitative data from providers and clients of harm reduction and drug checking services, to explore how these services are used, experienced, and considered. We aim to contribute to an existing qualitative evidence base exploring the value and utility of drug checking services, particularly as data are leveraged to inform political narratives, legislation, and funding allocation.

For this study, we conducted in-depth semi-structured key informant interviews across two samples: a “provider” sample and a “client” sample. The “provider” sample consisted of individuals providing clinical and harm reduction services to people who use drugs, as well as drug checking subject matter experts such as researchers and program heads. The “client” sample consisted of individuals who use drugs and were receiving harm reduction services at an agency where multiple forms of drug checking were included in the services provided.

From June to November 2022, two authors (DC & LM) conducted in-depth semi-structured key informant interviews with 11 providers—8 working in the U.S., 2 working in Canada, and one working in both countries. Included in the sample were 2 clinical providers, 4 researchers, and 5 harm reduction service providers [Table 1 ].

We employed purposive sampling of known providers first, then snowball sampling, contacting additional potential participants at informants’ recommendation. All potential participants were contacted via email and invited to participate. If the participant agreed, an appointment was made for the interview to take place over Zoom. Interviews lasted between approximately 45 and 60 min, and solicited provider perspectives on the state of the drug market in their area, the perceived needs of and challenges faced by their local client population, and their attitudes and experiences with drug checking methods and programs and integrating such programs into existing services. Verbal consent was collected at the outset of the interviews, which were then recorded. Audio from the recordings was isolated and transcribed using a secure third-party professional transcription service. All transcripts were deidentified and researchers created unique anonymous ID numbers for each participant. Participating providers were offered an honorarium of $100 in the form of a gift card. The study protocol was reviewed by the University of California San Francisco Institutional Review Board (IRB #22-36262).

Client participant ( n = 13) recruitment and data collection took place over a one-week period in November 2022 [Table 2 ].

We employed a non-random convenience sample, recruiting from four harm reduction programs in San Francisco, where clients were approached either by interviewers (NH & JO) or program staff who had been instructed on eligibility requirements. Eligible participants were at least 18 years of age, and currently using fentanyl, heroin, or methamphetamine. Clients were excluded from eligibility if they were intoxicated or otherwise unable to provide informed consent. Given that current drug use was an eligibility requirement, we assessed “intoxicated” as an inability to respond to simple questions, providing responses that are incoherent or unintelligible, or if the participant indicates that they are too high to continue. Potential participants who were eligible and interested were then formally verbally consented and interviewed on-site. Client interviews explored participants’ history of drug use and experiences with harm reduction services, as well as their awareness of, attitudes about, and experiences with various drug checking modalities. Interviews lasted approximately 30–60 min and were recorded, then submitted to the same external third-party transcription service being used for provider interviews. Participants were provided a $25 cash incentive as a token of appreciation for their time and expertise, and were provided unique ID numbers to anonymize their data. This study protocol, distinct from the protocol covering provider interviews, was reviewed and approved as well by the UCSF IRB (#22-36640).

Client interview transcripts were uploaded to Dedoose, a qualitative analytic program [ 53 ]. Four analysts (EA, LM, SO, and JO), two of whom were involved in data collection (LM & JO), read transcribed interviews from both client and provider data sets and drafted summaries which were then systematically reviewed as a team. Following the tenets of thematic analysis and adopting the framework developed by Miles and Huberman (1994) [ 54 ], the team collaboratively identified cross-cutting themes from interview summaries, covering areas of concordance, discordance, and particular importance, as well as exemplar and negative cases. Once major themes and sub-themes were identified and articulated, authors drafted analytic memos which consolidated and explored in detail each major theme.

Following publication of an article focused on findings from the provider data set [ 55 ], further analysis of the client data set included the development of a formal coding scheme (SO), based on a priori codes extracted from the interview guide, as well as codes reflecting themes and sub-themes identified in the summarizing process and further refined via ongoing weekly analytic meetings. Coding was led by the primary qualitative analyst [SO] with secondary coding by client interviewer and author [JO]. The application of codes was discussed regularly among all team members, focusing on discrepancies between primary and secondary coders, insights developed, and the potential emergent themes. Discrepancies occurred approximately 10% of the time, and these were resolved through group consensus in accordance with established qualitative research methods [ 56 ].

Through key informant interviews, we captured diverse perspectives on how existing and emerging drug checking services are being used, and their potential for future impact within the harm reduction suite of services.

We present our findings within three key themes: (1) the role of drug checking in overdose prevention; (2) benefits to the overall agency, health, and wellbeing of people who use drugs; and (3) impacts of drug checking services at the community and systems levels.

The role of drug checking in overdose prevention

Service providers and clients expressed varying opinions on the extent to which information from drug checking services would prevent overdose and, indeed, whether overdose prevention is the appropriate metric by which drug checking’s impact should be measured. Clients reported diverse experiences and perspectives on how they use (or don’t use) drug checking, and expectations for their own future use.

Fentanyl test strips

Almost all client participants reported having had some experience with fentanyl testing strips (FTS), either using them personally or seeing others use them. Attitudes about FTS varied. Some expressed concern that they are difficult to use correctly or that they have heard they may be unreliable (prone to false positives or negatives):

We were using them constantly when they were telling us that all the drugs had fentanyl in them. But then we found out that if you don’t put enough water on speed, that it can come up positive because of some chemical. [Client, 40, female].

Others reported relying on them heavily and using them often:

I’ve just got to have that insurance that there’s no fentanyl in [my drugs]. … I have a drawer. Like that? That’s all full of test strips. Usually every time I come to a needle exchange, if they have them, I grab as many as I can and just put them in the drawer. [Client, 43, male].

Spectrometry

Although many had not heard of spectrometry, spectroscopy, or anything beyond FTS, once it was described what a range of drug checking services could look like, clients were interested and excited about the possibilities. Some expressed interest in using mobile or site-based spectroscopy, but were concerned about their safety, one expressing worry about “ judgment from the community ” or bystanders taking videos and calling the police, another wondering if they would be an “ easy target ” for law enforcement harassment. Those who reported having used FTIR as part of their harm reduction visits, however, had positive things to say:

Interviewer: And how do you feel about that testing service at the van? Participant: I think it’s remarkably great. Interviewer: yeah? Participant: Yeah. They answered my questions, exactly what I wanted to know. [Client, 66, male]

Some participants described high percentages of testing experiences coming back with a positive or unexpected result, like a client who said that he’d used the FTIR mobile service four times with meth from four different suppliers, and “ only one came back pure .”

Using drug checking results

What participants reported doing with the results of checking their drugs varied as well. Some participants spoke about specific situations where drug checking prompted them to avoid buying contaminated drugs.

Actually I just used [drug checking] yesterday. Luckily, I didn’t buy the heroin I was going to, because it tested for fentanyl . [Client, 32, male]

Other community members expressed disinterest in checking drugs, often citing a lack of realistic options for using test results in a way that made sense for them. One participant stated directly that they didn’t want to test because they didn’t want to have to not use drugs if they got a result they didn’t like:

What if it comes up with fentanyl in it? Then I bought it but I can’t do it? They’re not going to take it back, the people I bought it from. I mean even if I get them to write me a receipt, you know? [Client, 49, male]

Another client said that she was interested in drug checking generally, but wouldn’t bother if she only had a little bit and was relying on it to keep her from getting sick:

If I was trying to [check my drugs], I would do it when I had enough to do that, you know. Because if I was dope sick and I only had two hits of fentanyl, I probably would not [test]. [Client, 24, female]

Data from service provider interviews echoed these dynamics. We heard from provider participants that, broadly, drug checking services prevent overdose directly some of the time, but not all the time, by way of individual behavior change on a case-by-case basis. One provider—a clinician with a lengthy career in addiction medicine and harm reduction—echoed doubts about how common it would be for a patient to make use choices based on drug checking results, broadening the focus to personal harm reduction behavior change rather than abstinence behavior alone:

And then the question is, what do you do about it? I’ve had a patient who is, like, yeah, I tested it. It was positive for fentanyl. I go, well, what did you do? Well, we just used anyway because it’s all we had. And we had, like, the Narcan out, and I – I just felt really sleepy afterwards. … So I guess that’s the other question – if you do drug testing and it isn’t what you expect, like, you can’t take it back to the dealer and say, hey, this isn’t – I want a refund; right? So what do you do with that information? And if, you know, if you’re in withdrawal and you really need to use that drug, like, what kind of safeguards are you going to take if you decide, yeah, I’m going to go ahead and use this; right? [Clinician, U.S.]

Other service providers similarly drew a distinction between drug checking sparking behavior change that prevents overdose versus behavior change that reduces the risk of death from overdose, situating drug checking services as a set of tools that dovetail with existing personal harm reduction strategies.

The reality is, you know, people still are using their drugs. Now, a large proportion of people who use our service say that they’ll do something differently after, you know, accessing our service, so they maybe will do a test dose first, or start, like, start with a smaller dose, or use with a friend, or use at an SCS [supervised consumption site]. [Direct service provider, Canada].

Overdose prevention versus overdose rates

Interestingly, many service providers when asked for their perspective on the role of drug checking services in overdose prevention expressed concern about a gulf between the overdose prevention they observe at the service level versus what they see represented in population-level data.

Will drug checking save a life? Absolutely. Yes, for sure. Will it, at a population level, drop overdose rates? I don’t know the answer to that. [Researcher, U.S.]

Participants offered multiple explanations for this. One described challenges inherent in proving prevention, while another explained how population overdose rates can obscure the impact of drug checking programs when they operate within a rapidly-changing drug supply:

It will be very hard to prove within these prevention paradoxes. I think prevention is one of those things that is so important, but within our scientific frameworks … preventable events are so rare and on the grand scheme of things, they’re really hard to prove. … But will [DCS] save lives? Yeah. [Clinician, U.S.] The numbers aren’t showing [an overall decrease in overdose], right, because at the same time, even though we’re offering this service, the supply is just getting worse and worse, so overdose rates are rising. [Direct service provider, Canada].

Not every participant who commented on this gulf found it to be wide or troubling, but instead remarked on it as a neutral distance between two related but distinct constructs, one of which is a measure of what outcomes drug checking information could yield, and the other of which is a fundamental right to that information.

It’s really a great question if we’re going to see things pan out in the numbers. I certainly hope so and I certainly think so, but I think that we just have the right to know what we’re putting into our bodies, regardless of what outcome measures are. We deserve to know what’s in our drugs . [Direct service provider, U.S.]

Similarly, a direct service provider offered a structural perspective on overdose prevention, decoupling the value of drug checking services from overdose outcomes, prioritizing instead the intrinsic value of equipping people with critical information about what they are putting in their body and the importance of empowering people to make decisions with as much information as possible.

I don’t really know if [drug checking] is going to decrease the rate of overdose. In my mind, the problems that contribute to overdose are prohibition, law enforcement harassment, and everything that surrounds that that creates a shitty drug supply and then prevents people from investigating it. But what [drug checking] does do, again, is this piece around like, people should know that they can find out there’s more in their drug. … I think that it just enables people to make better educated decisions around their substance use and to understand their bodies better . [Direct service provider, U.S.]

Benefits to the overall agency, health, and wellbeing of people who use drugs

Drug checking services offer users the tools to independently identify risks in the drug supply and make decisions about what to do with that information in the short and long term. Many of the service providers interviewed for this study, when asked how drug checking would impact overdose rates, gave some version of a reframed response, repositioning the focus from the drug use decisions themselves to the importance of information in fortifying the overall agency, health, and wellbeing of people who use drugs.

The provider quoted in the above section went on to reflect on the intrinsic value of giving people information, arguing that it contributes to essential experiences of bodily autonomy and health equity:

What’s really important to me as well is just sort of building this momentum around people feeling entitled to bodily autonomy and seeing that [drug checking] is a part of [that], and having folks know that, yeah, they fucking deserve to have this information. They are entitled to know what is in their stuff. And so, that’s not the only piece to health equity and justice around substances and substance use, but I think that it’s a significant piece. [Direct service provider, U.S.]

Knowledge of what is in their drugs can also confirm users’ internal experience. One provider, who had piloted an early drug checking intervention in a major metropolitan area in the U.S., believed that drug checking for people who use drugs offers confirmation of the embodied experience of their substance use, which in this provider’s experience was often regarded with skepticism by health workers:

I think that people are able to connect experiences that they’re feeling in their body with real information. And I think that actually validates the really organic knowledge and experiential knowledge of drug users as the true experts about drugs. You know, when we were doing our project in [city] and fentanyl was not everywhere [yet]—almost 100% of the time, if someone brought us a sample and said, “I think this has fentanyl in it,” it was true. … It validates experience where people’s experiential knowledge is not really validated by an educational system. It’s always this kind of thing where public health people are telling drug users what’s true. And drug checking sort of validates that drug users actually know what’s true, and we’re just using science to confirm it.” [Direct service provider, U.S.]

Client interviews echoed this theme. Several clients recounted experiences that illustrated how navigating the drug market is becoming increasingly difficult, and that drug checking provides an important tool that they can pair with their own instincts and expertise as they try to keep themselves safe.

I can look at it and I can be like, “Wait a minute, we might want to test that.” Because speed and fentanyl are different. They actually look different than the other one, so when I start seeing traces of fentanyl being in the speed, I go, “We need to check that before we do any of it.” And, hey, sometimes I’m wrong. [Client, 43, male] The [meth] that was in the medicine bottle [tested positive for fentanyl], yeah. But I kind of knew it was going to because I packed a bowl right before and if it’s dirty … yeah, the color starts changing wrong right away. [Client, 43, male] I like that [drug checking] gives us some certainty of what’s in the drug … like with the heroin, there was stuff in that that just did not feel good. I’d love to know what they were cutting that stuff with. We used to joke it was shoe polish because it was so dark and dirty, but it’s really important what you put in your body . [Client, 48, female]

Our client data further provide evidence that people who use drugs are making health-related decisions for themselves and care about their own health and wellbeing. Woven throughout community member interviews were examples of health-seeking decision-making in users’ everyday lives, demonstrating agency in considering health behaviors and expressing both implicitly and explicitly a desire to care for themselves. Examples of these pro-health micro-decisions include choosing not to smoke out of foil (it’s “ not healthy to smoke out of ” and “ it’s going to give us Alzheimer’s or something ”) or reducing smoking marijuana due to a “ sensitive ” respiratory system. One informant laid out explicitly their hopes for their future, shaped too by an acute awareness of the risks of the current drug market:

I don’t want to be a statistic out here. I want to go back to regular life and experience all the rest of the highs that there still are out there before I die. I want to jump out of an airplane, or take a balloon ride, or ride more rollercoasters. … I don’t want to limit myself to one freaking high. … it’s not worth it anymore at all. … You’d never OD on meth before. Meth and weed were two things you just didn’t overdose on. If you did too much, you passed out and you slept it off and that was it. Now, no matter what drugs you’re doing, every time you use, it’s a 50–50 chance that you could die. [Client, 49, female]

These excerpts from client interviews highlight the demand among potential DCS users for strategies that contribute to their agency, health, and wellbeing, even within the context of continued drug use in the short- or long-term.

Impacts of drug checking services at community and systems levels

In addition to use at the individual level, participants talked extensively about the ways that they experience and imagine DCS having an impact at community and systems levels. They described the ways that drug checking could facilitate upstream regulation of the drug market, how the information and transparency made possible by checking drugs can fill a policy and regulatory vacuum, and how drug checking can empower public health surveillance systems and clinical response.

Community level regulation of the drug market

Multiple informants, both service providers and clients, reflected on the use—or potential use—of drug checking as a grassroots tool to regulate the drug market.

Participants talked about using, or thinking one could use, DCS as a vetting tool for sellers or suppliers.

And if people could get their shit tested, almost every time if not every time, not only would it help them to be safer by them regulating themselves and knowing what’s in their stuff … But I feel like if they knew exactly what was in it, they could go tell their guys that they got it from, “Look, man, I’m not buying that shit anymore if it’s like that. If that shit -- if this or that’s in it or whatever. Or if you don’t, whatever, I’m not buying it from you. I’m buying it from someone else.” And that might even make them be… It’ll hold them more accountable. [Client, 32, male]

This use was so important to one participant that they expressed interest in their samples being sent for more extensive in-lab spectrometry testing that could give them greater detail about the compounds and amounts in their sample:

Hey, [a full spectrometry report] may take a week, but at least in that week, I find out if I should go back to that person or not. [Client, 43, male]

Client participants frequently referred to DCS as a tool to “keep [suppliers] honest”; that is, as informal regulatory pressure on currently unregulated illegal drug markets. Some reported that they spread the word if drugs from a supplier come up contaminated or low-grade. One participant, who uses fentanyl, reported using FTS to ensure that what they are about to buy is, indeed, fentanyl:

I keep them [FTS] around. … Then I say, “Can I test it?” and I test it in front of them. And like some of it’s turned up negative. And so I totally outed them out on the block with it. It pisses them off – it kind of keeps them honest. … When you got a bunch of test strips, I can go down the line and keep, yeah, at least trying to keep them honest, you know. I got a pile of those things right now. That’s actually what I use them for. [Client, 40, male]

Of particular value, according to our participants, was the idea that spectrometry would provide formal documentation of drugs’ contents. Analytical evidence that something was either dangerously contaminated or not what the seller claimed it to be can shift the balance of power in the transactional dynamic, placing upstream pressure on suppliers to better monitor what they are contributing to the market.

If you could get results that are on paper or on a text or on a whatever, then you could bring it to them that, “Look, dude. I’m not fucking around. You need to make this shit right or I’m not buying it anymore.” That would be a game-changer . [Client, 32, male]

From the service provider standpoint, one participant, a drug checking technician and program manager with a longstanding history in their city’s drug scene, identified similar opportunities for DCS to impact the drug market, were it made easily accessible to those at multiple points in the drug supply chain in addition to consumers.

It’s not just people who are consuming the drugs that can use the service. It’s also people who are selling them. And so, oftentimes people who are not essentially the first or second hands that are creating the substance and then moving it down the chain towards the end consumer, they don’t know what is in their product. For folks who are selling drugs, if they’re able to come and get an ingredient list, they can then kind of know what to say to folks who are buying. [Direct service provider, U.S.]

This was not discussed as just a hypothetical. One informant who sells drugs validated this use as feasible and valuable:

I want to make sure what I’m buying is what it is. … I do sell it myself, so [spectrometry]’s a good service because that’s what I want to know is the chemical balance as to how much it is and how much it isn’t and whether it’s good every time. [Client, 66, male]

Filling a policy and regulatory vacuum

In the absence of a government or regulatory body that will monitor and report on the verified contents of illicit drugs, our data suggest that drug checking services, and spectrometry in particular, may be filling a policy and regulatory vacuum.

Clients likened the idea of having access to a list of drugs present in a sample to knowing ingredients of something that they would eat.

I mean we know what’s in our food, right? The packaging is all labeled and the ingredients are listed. It’s just too important, especially with drugs. Especially because we don’t know who’s making them. We don’t know exactly where they’re coming from. And every single one is different. Every week is different. Even if you buy it from the same person all the time, they’re always having something different. Maybe you’ll have the same thing twice or three times but that’s it. [Client, 48, female]

Providers, meanwhile, explicitly framed the value of drug checking within the context of an unmet regulatory need. One service provider qualified many of their statements about drug checking services with “until prohibition goes away,” situating DCS as being necessary only in a regulatory vacuum. Another spoke more directly to the relationship between drug checking and regulation:

And with drugs, because of prohibition, we just have this unknown, unregulated supply, and people are – what they’re putting in their bodies and what they’re purchasing is obscured, right? And so, drug checking is like a series of sort of imperfect tools to help consumers of drugs regain a little bit of control in the form of information around what it is that they are using. …. And there’s a very good argument that, if we had some kind of safe, regulated supply, we wouldn’t need drug checking at all, which is true . [Direct service provider, U.S.]

Empowering public health surveillance systems and clinical response

Data from our interviews suggest that drug checking technologies and programming may also contribute meaningfully at a structural level, to public health surveillance systems and clinical response. Aggregated sample results provide real-time data about what drug compositions are trending across regions, and what the clinical implications may be for providers treating clients who use drugs [ 57 ]. One drug checking program team posted results to their website in the hopes of informing local clinicians and public health policy makers about what was circulating in the drug supply. This program manager talked about making results available “at the societal level”:

And then at the kind of societal level what we do … [is] every other week we take all of the results from the samples that we’ve checked, and we combine them, and then we put out a report and update our website about, like, what’s circulating in the drug supply. So we talk about, you know, trends in the drug supply over that period, and new drugs that have been introduced, and what those drugs could mean, that type of thing. So service doesn’t only benefit individuals, but it also benefits the larger community by being able to say, okay, this is what we’re seeing. If you can’t access the service, you still at least know, you know, what is circulating. [Direct service provider, Canada]

Community members expressed an awareness of this function. One participant cited drug checking’s role in a larger tracking network as one of the things they value most about the service:

I liked a lot about [drug checking]. One, that it was available in the first place. Two, that it was not just doing its own thing. It was part of a larger network that was keeping track of what drugs were popping up on the streets and what their makeup was. I really like that that’s happening. [Client, 30, male]

At the point-of-service level, provider informants discussed significant benefits that drug checking could provide to clinicians and other medical professionals who work closely with people who use drugs. This informant posited specifically that having more detailed knowledge about what was circulating in the drug supply could help clinicians better formulate strategies for managing opioid use disorder and transitioning patients onto MOUD:

Understanding what’s actually in the supply… allows clinicians to tailor the care that they are providing to people who use drugs. So, you know, if they know that the average amount of fentanyl in a fentanyl sample is this and they want to transition someone off the unregulated drug supply onto, like, a pharmaceutical alternative, well, what pharmaceutical alternative is actually suitable based on what they’ve been using? [Direct service provider, Canada]

This is especially critical given the significant difficulties that have been recently reported when transitioning people using fentanyl to appropriate longitudinal services [ 58 ]. A provider we interviewed who runs a mail-based drug checking service in the U.S. reported that developing a more thorough knowledge of the drug supply outside of the current surveillance panoply may provide important clinical toxicology assistance to help physicians connect health outcomes to specific substances or components of the drug supply, and more quickly provide tailored treatment:

There’s one other really big one for me, which is that it allows us to link specific physiological harms with specific chemicals. So, we’re not just talking about dope anymore. We’re talking about this component of dope causing this specific reaction. What we have been able to do is, we’ll get calls from our central hospital on campus, and they’ll say, “We have this patient with an idiosyncratic presentation. Boom, boom, boom, boom, boom, boom. Here it is. We think it might be… You know, they’ve been injecting this, this, and this. We have some of their samples. Can we get them tested?” Or if they don’t have the samples, they’re like, “This is what the symptoms are. This is where they’re from. What are you seeing about the drug supply in their area?” And I can be like, “Well, yeah, there’s been a spike in levamisole in that area or xylazine,” you know, whatever it is. And then they can get to treatment quicker because the physicians have a more specific knowledge about the ideology of the harm that they’re observing in clinic. [Researcher, U.S.]

Negative cases

While the vast majority of participant responses reflected positive experiences with or attitudes about DCS, some participants additionally expressed ambivalence or concern. Many of these perspectives are embedded within the themes reported above, but deserve reiteration: service users expressed concerns about the accuracy of drug checking technologies, their privacy and safety relative to community stigma and law enforcement, and anxiety about having to make hard choices about drug use in the face of an unexpected result. Service providers expressed concern about the “then what” of drug checking, citing constrained choices and limits to what could be realistically expected in terms of behavior change without other supports in place. Some further lamented the challenges of translating the benefits of what they were seeing in practice to what is visible to a broader audience.

Not included in the above findings, but important to note, are two additional concerns that arose in interviews. First, service users and providers cautioned that the street drug supply changes so quickly that new compounds may be showing up on the street before they are identified in spectrometry libraries, potentially limiting their ability to accurately identify contaminants. Finally, one provider, a clinician with a longstanding career in addiction medicine and harm reduction, closed their interview with a somber caution against decontextualizing drug checking from a broader commitment to multi-method harm reduction, health equity, and social justice.

[I worry that] we’re just throwing yet another technology at a much bigger problem. My fear is that people will say, oh, now we have drug checking, so now we can stop trying to dismantle, you know, structures of racism and oppression in society, right? We can stop looking for homes for people because we have this technology that’s going to prevent people from dying. … It doesn’t work that way. [Clinician, U.S.]

While the magnitude of the opioid crisis is often communicated in terms of overdose and death rates, the harms associated with opioid use—intentional or unintentional—in an unregulated drug market extend far beyond those data points alone, and so too must the strategies leveed to combat them. Our findings demonstrate that drug checking services offer diverse benefits at the individual, community, public health, and health systems levels.

Overdose prevention and beyond

If the question is, do and will these technologies contribute to overdose prevention , our findings suggest that the answer is yes, with some important caveats. The first being that, according to our participants, they do not prevent overdose all the time. Our findings reflect that individuals make complex and highly contextualized decisions regarding their use behavior each time they use drugs. Information about the chemical composition of a drug sample sometimes leads to decisions to abstain, but more often leads to decisions to engage in other types of harm reduction behaviors—like using with a friend rather than alone, making sure to have naloxone on hand, using at a supervised consumption site, alerting others to a bad batch, using a tester first, or avoiding a certain supplier in the future. Sometimes it leads to no observable behavior change at all.

Further, DCS have not been scaled up to meet the needs of everyone at risk for overdose; until it is, it is premature to discuss population-level prevention. This study does not purport DCS to be in and of themselves sufficient to prevent overdose, but they are clearly part of a continuum of services that can prevent overdose mortality.

Many participants took care to note as well that the needs of people who use drugs are not solely to avoid overdose; people navigating drug use are whole people, and the stigmatization and criminalization of drug use regulates their access to a multitude of essential needs and liberties, like health care, housing, employment, agency, and a host of social and legal protections. Access to information that contributes to agency and autonomy, and enables more informed decision-making, is an essential service regardless of other outcomes.

Of course, among harm reductionists and researchers acquainted with the diverse and dynamic ways that harm reduction functions within communities, this is not news. Our findings reflect and reinforce much of the existing evidence from studies aiming to understand the role of drug checking within the larger constellation of harm reduction and, indeed, the role of harm reduction itself.

One recent qualitative study in particular reported themes with striking similarities to the prevailing themes from our interviews. Wallace et al. [ 59 ] explored the potential impacts of community drug checking on prospective service users, finding drug checking to “increase quality control in an unregulated market,” “improve the health and wellbeing of people who use substances,” and “mediate policies around substance use.”

Our findings further add to existing evidence that links drug checking with consumer empowerment within an opaque drug market [ 25 , 26 , 29 ] and underlines the reciprocal relationship between individual agency and the adoption of harm reduction strategies [ 46 , 60 , 61 ].

Of note is the shifting context in which many existing drug checking studies, including ours, are situated. In some areas, fentanyl appears most often as an unwanted adulterant in another drug—be it a non-opioid or a less potent opioid like heroin—and DCS are used primarily for fentanyl avoidance [ 13 , 19 ]. Increasingly, however, pockets of consumers are preferring fentanyl, as seen in our San Francisco client sample and within populations reflected in recent drug checking studies. Our data echo the broader finding that drug checking technologies are likely to be used differently by fentanyl-seeking opioid users versus fentanyl-avoiding opioid users, and differently still among those using stimulants, psychedelics, or other non-opioid drugs [ 22 , 62 ].

On the subject of behavior change—whether and how drug checking can be understood to prompt changes in drug use behavior—our findings align with existing evidence showing that drug checking is at times followed by contaminated drug disposal, and at times followed by the employment of personal harm reduction techniques such as spreading information within the community [ 30 , 63 ], and reduction in polysubstance use or dosage [ 13 , 14 , 15 , 64 ]. Lacking as we do a robust methodological-empirical foundation to assess this type of causality, whether and to what extent drug checking in various contexts leads to less use or more safe use among different populations cannot be stated concretely [ 16 , 65 , 66 ]. Whether individuals change their use behavior based on drug checking results is highly informed by such matters as how limited their access to drugs is, realistic options for modified use, and their perceived relative risks of knowingly ingesting a potentially dangerous compound or compounds versus not.

The tension at the center of harm reduction policy

The role of harm reduction services within communities have long reflected a central tension: in contrast with abstinence and criminalization models, harm reduction is often socially and politically criticized as enabling drug use and making neighborhoods less safe [ 67 , 68 , 69 ], while research consistently finds harm reduction to yield positive outcomes for both service users and surrounding communities [ 70 , 71 ]. In addition to improving the health and wellbeing of people using drugs, evidence suggests that those accessing harm reduction services are more likely to ultimately seek treatment and pursue recovery [ 49 , 70 , 72 , 73 ]. Concerns about public safety, too, while in many cases expressed in good faith, have been shown to be largely misplaced: multiple studies show harm reduction programs to have no significant impact on nearby violent or property-related crime, with some findings suggesting improved indicators of public order and safety [ 48 , 49 , 74 , 75 ]. Harm reduction strategies have additionally been found to be cost-effective in the short term and cost-saving to public monies in the medium- and long-term [ 76 ]. Nonetheless, public perception of harm reduction has historically been interwoven with deeply entrenched cultural stigmas related to race and ethnicity, socioeconomics, and an imprecise moralism that positions access to health and protection as a privilege that should be earned or denied based on behavior [ 67 , 69 , 71 ].

This tension plays out most concretely in the public policy space. Even as the opioid crisis dominates public health discourse and funding is earmarked for research and programming to combat it [ 77 ], harm reduction programs on the ground are under siege. At the federal level, the House Appropriations bill for the Fiscal Year 2024 HHS budget dramatically cuts funding to HIV/AIDS programs—a budget umbrella under which many harm reduction, substance use support and treatment programs are funded [ 78 , 79 ]. In California, a $15.2 million state grant supporting syringe access services has dried up amidst an overdose crisis at its peak, with no plans for replacement [ 80 ]. In 2022, a landmark bill (SB58) that would have authorized overdose prevention programs with supervised consumption in Los Angeles, Oakland, and San Francisco was vetoed by the Governor, despite broad support and robust evidence behind it [ 81 ]. Funds for such safe consumption sites have further been excluded from receiving opioid settlement funds in San Francisco [ 82 ], and in September of 2023, a bill was put forth by the San Francisco Mayor’s office to require drug screening and mandatory treatment for anyone receiving public services [ 83 ]. This, despite the expressly articulated commitment to and acknowledged necessity of harm reduction services—services explicitly aimed at helping people who use drugs to be more safe rather than abstaining from use—highlighted in policy language across multiple levels of government and legislature [ 10 , 84 , 85 , 86 , 87 ].

It is worth noting that one of the harm reduction sites where several of this study’s client participants were receiving services was defunded shortly after we completed data collection, and since then, overdose death rates in the city have climbed [ 88 ] and public order in that area has reportedly deteriorated [ 89 ].

The framing of effectiveness is crucial in this policy environment

In light of these tensions, we offer the findings of this study as a contribution to an evidence base that may play an increasingly central role in California’s—and the nation’s—opioid crisis response. The allowable expenditures for opioid settlement funds list “evidence-informed programs to reduce the harms associated with intravenous drug use” as a focus area [ 51 ] and California’s Overdose Prevention Initiative describes its approach as being “data-driven.” [ 10 ] The proposed HHS FY2024 budget, in addition to cutting much of the funding that covers harm reduction programming, proposes the rejection of “controversial programs” while maintaining funding for “an effective opioid response.” [ 78 ] As California faces a $68 billion budget deficit [ 90 ] and supplementary federal and settlement funds are to be apportioned based on strategy effectiveness and the body of scientific evidence, the role of research comes into sharper focus. It is the strength or weakness of the evidence base—of the complexity of the research inquiry and integrity of the data—that may ultimately frame which initiatives are eligible for support.

When asked about the place and promise of drug checking within the broader constellation of harm reduction services, it was drug users’ humanity and right to health, more so than the public health implications, that grounded many of our participants’ responses. Their responses implicated, too, the underlying operating principle that, ultimately, people make choices that make sense for them. Whether by the hand of addiction or desire, constrained options or access, or every individual’s complex hierarchy of relative dangers and needs, people’s choices are reflections of their full humanity. Approaches to stemming the tide of this crisis cannot be effective unless they are built on respect for the individuals living it, and focused on understanding their needs.

We encourage continued research and reporting on drug checking services and emerging technologies, with an emphasis on exploring effectiveness within a broad scope, reflective of the impacts of these services on whole lives and systems.

Limitations

Many of the community members we interviewed had not heard of spectrometry or spectroscopy, and the interview represented the first time they were introduced to the technology as a concept and the first time they considered whether and how they could see themselves using it in their own lives. This limits the range of our findings among the client sample, given that much of our qualitative data speaks to hypothetical future use rather than past or current use of emerging technologies. The absence of data on client use should not be interpreted to mean that participants chose not to use DCS.

Additionally, the sampling frame for clients was limited to one setting, while providers were sampled from across North America, and the small sample size for both groups may have limited saturation. Finally, providers did not reflect all North American regions where drug checking has been implemented, nor all DCS models, limiting the generalizability of findings.

Our manuscript contributes to growing evidence of the effectiveness of drug checking services in mitigating a range of risks associated with substance use, including overdose, and offer diverse benefits at the individual, community, public health, and health systems levels. For that reason, policymakers should consider allocating resources towards its implementation and scale-up in settings impacted by overdose mortality.

Data availability

Due to ethical restrictions, the data generated and analyzed during the current study are not available to those outside the study team. Data and materials are of a sensitive nature, and participants did not consent to transcripts of their interviews being publicly available. Portions of interviews about which editors have questions or concerns may be provided upon request after any details that may risk the confidentiality of the participants beyond de-identification have been removed. Researchers who meet the criteria for access to confidential data may send requests for the interview transcripts to the Human Research Protection Program (HRPP)/IRB at the University of California, San Francisco at 415-476-1814 or [email protected].

Abbreviations

Fourier–Transform Infrared Spectroscopy

Fentanyl testing strips

US Department of Health and Human Services

Medications for opioid use disorder

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Acknowledgements

This study would not have been possible without the client participants who so generously shared insights about their lives and how they access harm reduction services, and our provider key informants and their work on behalf of people who use drugs. The authors would also like to thank the staff of the Northern California HIV/AIDS Policy Research Center who supported the project during its inception, data collection, and writing.

This research was funded by the California HIV/AIDS Research Program (CHRP) to the Northern California HIV/AIDS Policy Research Center (PI Arnold), H21PC3238. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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Lissa Moran, Jeff Ondocsin, Simon Outram & Emily A. Arnold

Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA, 94143, USA

Jeff Ondocsin, Daniel Ciccarone & Nicole Holm

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Contributions

E.A.A. and D.C. conceptualized and designed the study; J.O., L.M., D.C., and N.H. were responsible for data collection, each conducting in-depth key informant interviews. L.M., J.O., S.O., and E.A.A. analyzed the data. L.M. led the writing of the original manuscript draft with significant contributions from J.O., S.O., and E.A.A. L.M., J.O., D.C., S.O., D.W., N.H., and E.A.A. were directly involved in iterative review and revision. E.A.A. provided supervision, project administration, and funding acquisition. All authors have read and agreed to the submitted version of the manuscript.

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Correspondence to Lissa Moran .

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The study was conducted in accordance with the Declaration of Helsinki and informed consent was obtained from all subjects involved in the study. The study protocol and consent procedures were reviewed and approved by the UCSF IRB (#22-36640) on 12 September 2022.

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Competing interests

D.W. is a founder of DoseCheck, a commercial entity that is developing a mobile drug checking technology. D.C. reports the following relevant financial relationships during the past 12 months: (1) he is a scientific advisor to Celero Systems; and (2) he has been retained as an expert witness in ongoing prescription opioid litigation by Motley Rice, LLP. The remaining authors have no relevant financial or non-financial interests to disclose. The remaining authors have no relevant financial or non-financial interests to disclose.

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Moran, L., Ondocsin, J., Outram, S. et al. How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives. Harm Reduct J 21 , 92 (2024). https://doi.org/10.1186/s12954-024-01014-w

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DEA Releases 2024 National Drug Threat Assessment

WASHINGTON – Today, DEA Administrator Anne Milgram announced the release of the 2024 National Drug Threat Assessment (NDTA), DEA’s comprehensive strategic assessment of illicit drug threats and trafficking trends endangering the United States.

For more than a decade, DEA’s NDTA has been a trusted resource for law enforcement agencies, policy makers, and prevention and treatment specialists and has been integral in informing policies and laws. It also serves as a critical tool to inform and educate the public.

DEA’s top priority is reducing the supply of deadly drugs in our country and defeating the two cartels responsible for the vast majority of drug trafficking in the United States. The drug poisoning crisis remains a public safety, public health, and national security issue, which requires a new approach.

“The shift from plant-based drugs, like heroin and cocaine, to synthetic, chemical-based drugs, like fentanyl and methamphetamine, has resulted in the most dangerous and deadly drug crisis the United States has ever faced,” said DEA Administrator Anne Milgram. “At the heart of the synthetic drug crisis are the Sinaloa and Jalisco cartels and their associates, who DEA is tracking world-wide. The suppliers, manufacturers, distributors, and money launderers all play a role in the web of deliberate and calculated treachery orchestrated by these cartels. DEA will continue to use all available resources to target these networks and save American lives.”

Drug-related deaths claimed 107,941 American lives in 2022, according to the Centers for Disease Control and Prevention (CDC). Fentanyl and other synthetic opioids are responsible for approximately 70% of lives lost, while methamphetamine and other synthetic stimulants are responsible for approximately 30% of deaths.

Fentanyl is the nation’s greatest and most urgent drug threat. Two milligrams (mg) of fentanyl is considered a potentially fatal dose. Pills tested in DEA laboratories average 2.4 mg of fentanyl, but have ranged from 0.2 mg to as high as 9 mg. The advent of fentanyl mixtures to include other synthetic opioids, such as nitazenes, or the veterinary sedative xylazine have increased the harms associated with fentanyl. Seizures of fentanyl, in both powder and pill form, are at record levels. Over the past two years seizures of fentanyl powder nearly doubled. DEA seized 13,176 kilograms (29,048 pounds) in 2023. Meanwhile, the more than 79 million fentanyl pills seized by DEA in 2023 is almost triple what was seized in 2021. Last year, 30% of the fentanyl powder seized by DEA contained xylazine. That is up from 25% in 2022.

Social media platforms and encrypted apps extend the cartels’ reach into every community in the United States and across nearly 50 countries worldwide. Drug traffickers and their associates use technology to advertise and sell their products, collect payment, recruit and train couriers, and deliver drugs to customers without having to meet face-to-face. This new age of digital drug dealing has pushed the peddling of drugs off the streets of America and into our pockets and purses.

The cartels have built mutually profitable partnerships with China-based precursor chemical companies to obtain the necessary ingredients to manufacturer synthetic drugs. They also work in partnership with Chinese money laundering organizations to launder drug proceeds and are increasingly using cryptocurrency.

Nearly all the methamphetamines sold in the United States today is manufactured in Mexico, and it is purer and more potent than in years past. The shift to Mexican-manufactured methamphetamine is evidenced by the dramatic decline in domestic clandestine lab seizures. In 2023, DEA’s El Paso Intelligence Center (EPIC) documented 60 domestic methamphetamine clandestine lab seizures, which is a stark comparison to 2004 when 23,700 clandestine methamphetamine labs were seized in the United States.

DEA’s NDTA gathers information from many data sources, such as drug investigations and seizures, drug purity, laboratory analysis, and information on transnational and domestic criminal groups.

It is available DEA.gov to view or download.

Drugs, Crime, and Violence: Effects of Drug Use on Behavior Essay

Psychoactive substances are known to affect behavior. Different substances have a range of various possible effects on different people. The same substance can affect different people differently (Abadinsky, 2014, p. 28). Moreover, in two separate cases, the same person may be affected differently by the same drug. However, a lot of efforts have been made to define general effects of drug use on behavior, particularly criminal and violent behavior. Studies show that drug use, in fact, is connected to crime and violence, but exploring this connection is complicated.

The correlation between drug use and crime has been the subject of numerous researches within recent decades. Various studies of drug use among criminals as well as of crime among drug users were aimed at defining causal links between the two things. As a result, most researchers agree nowadays that there is no clear cause-and-effect correlation and that the “question of whether crime is a pre-drug-use or post-drug-use phenomenon is actually an oversimplification” (Abadinsky, 2014, p. 11). However, drug use or addiction can shape inclinations to crime. Goldstein (1985) points out three types of drug-use effects on criminal behavior: pharmacological (crimes under the influence of intoxication), economic-compulsive (crimes for obtaining money for drugs), and lifestyle (criminal behavior induced by the environment of drug users).

A particular issue in this area is whether or not drug use promotes violence. Based on a literature review and own experience of being a parole officer, Abadinsky (2014) asserts that drug users and addicts are more disposed to commit violent acts. It is also noted that the drug distribution subculture is “permeated with extreme levels of violence” (Abadinsky, 2014, p. 12). Although different psychoactive substances have different effects on people in terms of inducing aggression, many street drugs, including cocaine, heroin, and PCP, have been confirmed to cause violence. Also, according to Abadinsky (2014), alcohol is a factor in approximately 40 percent of violent crimes in the United States.

However, even if drug use is chemically proven and sociologically observed to stimulate aggression, there is still the challenge of attributing particular violent acts to intoxication. Studies show that, in many cases, criminals consumed alcohol or cocaine to gain courage and disinhibition to commit crimes that they had planned before (Abadinsky, 2014), which might or might not mean that they would have committed those crimes even without the influence of intoxication. The impossibility to state conclusively that drug use leads to violence suggests the necessity of a different approach. Abadinsky (2014) proposes that, instead of attempting to define the impact of drug use on crime or crime on drug use, researchers should focus on the impact of environmental and biological variables on drug use and crime.

An important aspect of the relationship between drug use and crime is that people who have illegal drugs in their possession are technically criminals already. The criminalization of drug use creates environments that predispose these people to disregard the law in general, increasing the risk for drug users to commit other crimes, including violent ones. Besides, the effect of intoxication in many cases is an increased level of aggression. However, I think it is very important that researches in the area of drug use and crime recognize that there are other social and psychological factors that drive the same people into addiction, and into violence. I believe that this recognition is particularly significant for the study of drug use.

Drug Use Effects on the Central Nervous System

The Central Nervous System (CNS) of humans consists of the brain and the spinal cord. The brain contains 10 billion to 50 billion neurons, i.e. cells that exchange information in the form of signals. This is where everything about the way our bodies function is controlled and regulated. The control and regulation are exercised through releasing particular chemicals that launch and govern various processes in our organisms. Some of these processes are responsible for our mood, desires, motivation, determination, etc. Psychoactive substances are able to intervene in those processes, altering the ways a person feels and acts. To understand this alteration, it is necessary to explore how these processes work and how they are affected by drug use, which will provide evidence for the discussion of legality or illegality of particular drugs.

One of the most important survival mechanisms in humans is that actions aimed at staying alive or reproducing are rewarded. The so-called reward circuit in our CNS generates pleasure when we fulfill surviving functions like assuaging our hunger or quenching our thirst. The pleasure we thus gain teaches us to repeat such actions. The communication within the reward system is performed through neurotransmitters, a specific kind of chemicals, one of which, dopamine, participates in shaping our mood and motivation. The release of dopamine makes one feel good and accomplished. The lack of dopamine causes depression and unwillingness to do anything (Abadinsky, 2014). Dopamine is important for the proper functioning of an organism as a whole.

Although various psychoactive substances may have many different psychological and physiological effects on humans, the common feature is that these substances intervene in the reward circuit. They imitate neurotransmitters to overstimulate the reward system, thus gaining pleasure and satisfaction for the drug user (Abadinsky, 2014). There are two main consequences. First, a compulsion develops to take the drug again. The reason is that the initial meaning of rewarding is teaching to repeat actions. Second, the overstimulation of pleasure centers disrupts their normal functioning. When a person gets addicted, the natural release of dopamine decreases as it is replaced by the effects of drug use. Therefore, when the person stops taking the drug, they are likely to experience depression.

There is an ongoing debate on which psychoactive substances should be legal and which should not, based on their effects on the organism. In many countries, the possession and sale of cocaine, heroin, marijuana, and LSD are crimes, while alcohol and nicotine are sold without any or with significantly lesser restrictions. Abadinsky (2014) stresses that, although the laws may distinguish between legal and illegal drugs, “biology recognizes no such distinction” (p. 3). Kleinman (1992) points out that, in terms of addiction and overdose risks, alcohol and nicotine are as much of drugs as heroin and cocaine. The legality of drugs is thus a discussion that goes beyond physiological considerations.

Drug use disturbs the natural processes of gaining pleasure in human organisms. It causes addiction and, when the consumption is discontinued, withdrawal. Drug use creates a kind of artificial happiness, which makes a person miserable when the drug influence is over. I believe that this knowledge is important and should be spread so that more people who use drugs understand what those drugs do to them. I do not think that banning some psychoactive substances altogether, while imposing no restrictions on other ones, is a smart policy. The debate on drugs should go on, involving governments and societies, as well as taking into consideration the scientific knowledge.

Abadinsky, H. (2014). Drug Use and Abuse: A Comprehensive Introduction, 8th Edition . Web.

Goldstein, P. J. (1985). The drugs/violence nexus: A tripartite conceptual framework. Journal of Drug Issues, 15 (4), 493-506.

Kleinman, M. A. (1992). Against excess: Drug policy for results . New York, NY: Basic Books.

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IvyPanda. (2022, January 22). Drugs, Crime, and Violence: Effects of Drug Use on Behavior. https://ivypanda.com/essays/drugs-crime-and-violence/

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IvyPanda . 2022. "Drugs, Crime, and Violence: Effects of Drug Use on Behavior." January 22, 2022. https://ivypanda.com/essays/drugs-crime-and-violence/.

1. IvyPanda . "Drugs, Crime, and Violence: Effects of Drug Use on Behavior." January 22, 2022. https://ivypanda.com/essays/drugs-crime-and-violence/.

Bibliography

IvyPanda . "Drugs, Crime, and Violence: Effects of Drug Use on Behavior." January 22, 2022. https://ivypanda.com/essays/drugs-crime-and-violence/.

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Justice Department formally moves to reclassify marijuana as a less dangerous drug in historic shift

FILE - Cannabis clones are displayed for customers at Home Grown Apothecary, April 19, 2024, in Portland, Ore. The Justice Department has formally moved to reclassify marijuana as a less dangerous drug in a historic shift to generations of drug policy in the United States. A proposed rule sent Thursday to the federal register recognizes the medical uses of cannabis and acknowledge it has less potential for abuse than some of the nation’s most dangerous drugs. (AP Photo/Jenny Kane, File)

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WASHINGTON (AP) — The Justice Department on Thursday formally moved to reclassify marijuana as a less dangerous drug, a historic shift in generations of U.S. drug policy.

A proposed rule sent to the federal register recognizes the medical uses of cannabis and acknowledges it has less potential for abuse than some of the nation’s most dangerous drugs. The plan approved by Attorney General Merrick Garland would not legalize marijuana outright for recreational use .

The Drug Enforcement Administration will next take public comment on the proposal in a potentially lengthy process. If approved, the rule would move marijuana away from its current classification as a Schedule I drug, alongside heroin and LSD. Pot would instead be a Schedule III substance, alongside ketamine and some anabolic steroids.

The move comes after a recommendation from the federal Health and Human Services Department, which launched a review of the drug’s status at the urging of President Joe Biden in 2022.

Budtender Rey Cruz weighs cannabis for a customer at the Marijuana Paradise on Friday, April 19, 2024, in Portland, Ore. (AP Photo/Jenny Kane)

Biden also has moved to pardon thousands of people convicted federally of simple possession of marijuana and has called on governors and local leaders to take similar steps to erase convictions.

“This is monumental,” Biden said in a video statement, calling it an important move toward reversing longstanding inequities. “Far too many lives have been upended because of a failed approach to marijuana, and I’m committed to righting those wrongs. You have my word on it.”

AP AUDIO: Justice Department formally moves to reclassify marijuana as a less dangerous drug in historic shift

AP correspondent Jackie Quinn reports the government effort to reclassify marijuana has gotten underway.

The election year announcement could help Biden, a Democrat, boost flagging support, particularly among younger voters .

The notice kicks off a 60-day comment period followed by a possible review from an administrative judge, which could be a drawn-out process.

Biden and a growing number of lawmakers from both major political parties have been pushing for the DEA decision as marijuana has become increasingly decriminalized and accepted, particularly by younger people. Some argue that rescheduling doesn’t go far enough and marijuana should instead be treated the way alcohol is.

Democratic Senate Majority Leader Sen. Chuck Schumer of New York applauded the change and called for additional steps toward legalization.

The U.S. Cannabis Council, a trade group, said the switch would “signal a tectonic shift away from the failed policies of the last 50 years.”

The Justice Department said that available data reviewed by HHS shows that while marijuana “is associated with a high prevalence of abuse,” that potential is more in line with other Schedule III substances, according to the proposed rule.

The HHS recommendations are binding until the draft rule is submitted, and Garland agreed with it for the purposes of starting the process.

Still, the DEA has not yet formed its own determination as to where marijuana should be scheduled, and it expects to learn more during the rulemaking process, the document states.

Some critics argue the DEA shouldn’t change course on marijuana, saying rescheduling isn’t necessary and could lead to harmful side effects.

Dr. Kevin Sabet, a former White House drug policy adviser now with the group Smart Approaches to Marijuana, said there isn’t enough data to support moving pot to Schedule III. “As we’ve maintained throughout this process, it’s become undeniable that politics, not science, is driving this decision and has been since the very beginning,” Sabet said.

The immediate effect of rescheduling on the nation’s criminal justice system is expected to be muted. Federal prosecutions for simple possession have been fairly rare in recent years.

Schedule III drugs are still controlled substances and subject to rules and regulations, and people who traffic in them without permission could still face federal criminal prosecution.

Federal drug policy has lagged behind many states in recent years, with 38 states having already legalized medical marijuana and 24 legalizing its recreational use. That’s helped fuel fast growth in the marijuana industry, with an estimated worth of nearly $30 billion.

Easing federal regulations could reduce the tax burden that can be 70% or more for marijuana businesses, according to industry groups. It also could make it easier to research marijuana, since it’s very difficult to conduct authorized clinical studies on Schedule I substances.

Associated Press writers Zeke Miller in Washington and Joshua Goodman in Miami contributed to this report.

Follow the AP’s coverage of marijuana at https://apnews.com/hub/marijuana .

A 21-year-old woman has been charged by the DA in a fentanyl bust amid a push to end Kensington drug market

Jada Williams, 21, was charged with multiple counts of manufacturing and possession of narcotics and related crimes for allegedly running a "trap house" in Kensington.

Philadelphia District Attorney Larry Krasner, left, speaks during a news conference on Thursday to announce the arrest of a woman charged with running a fentanyl packing and narcotics operation.

Amid Mayor Cherelle L. Parker’s push to clean up Kensington’s open-air drug market , District Attorney Larry Krasner announced the arrest of a woman prosecutors described as a “mid-level” drug manufacturer who packaged fentanyl and was found with more than 1,000 packets of the deadly opioid and two guns, part of a renewed push for drug enforcement in the long-beleaguered neighborhood.

Jada Williams, 21, was charged with multiple counts of manufacturing and possession of narcotics, firearms violations, and related crimes for manufacturing and packaging fentanyl, a powerful synthetic opioid, out of a drug house on the 3100 block of Kensington Avenue, Krasner said Thursday afternoon.

Williams, who is being held on $500,000 bail, was arrested Tuesday with 1,147 packets of fentanyl worth between $5,500 and $11,000, said Paul Reddell, supervisor of the office’s Dangerous Drug Offenders Unit. Two guns — a 9mm and a .32 caliber revolver — were also found in the Kensington Avenue residence, he said.

The arrest, a joint investigation with the Pennsylvania State Police, was carried out in collaboration with and a s part of an effort by Parker to step up drug and gun crime enforcement in Kensington. It was one of the first moves in a strategy to move away from what Krasner said was an old and ineffective tactic of combatting the drug market by focusing only on top-level busts or smaller, low-level drug crimes.

A more effective approach, he said, was to chip away at the drug market through operations that take months, rather than years, and target mid-level drug dealers and manufacturers, he said.

“One of the things that has failed before is when you’re only doing the really big stuff and it takes years and you’re only doing the really little stuff and it’s replaced before the end of the day with new workers,” said Krasner. “It’s just not as comprehensive a strategy.”

What did Krasner say about Parker’s Kensington strategy?

Krasner’s announcement comes at a time when the Parker administration is taking the first steps to dismantle the internationally known open-air drug market in Kensington, an initiative she made a cornerstone of her mayoral campaign and now a critical goal for her tenure.

Philadelphia police and city workers cleared out a homeless encampment on two blocks of Kensington Avenue in the neighborhood on May 8 and moved 31 people into shelter or treatment on that day alone, 59 in total since early April, drawing praise from neighbors and criticism from advocates and people living on the streets.

City officials initially said the clearing would be led by outreach teams, but no city social service workers were on the scene when police arrived and escorted away people who were living on the streets.

Kensington drug users and service providers have said police had been conducting an informal enforcement initiative for months, ahead of Parker’s planned crackdown on the drug market in the neighborhood this month, citing people for offenses such as loitering and possession of drugs or paraphernalia.

Krasner said he agrees with Parker’s strategy, which focuses on enforcement along with directing people to treatment and housing services, and the hope is that a multi-pronged approach will improve the situation in Kensington.

“The reality is whenever you try to disturb a location that has been opioid central for 60 years, when you try to do that, there are going to be consequences,” he said. “They’re not all going to be good. But I think what is being said by the administration, a sentiment with which I agree, I think what’s being said is we have to do more, in every area.”

What do the data show?

Despite city officials’ renewed focus on drug enforcement in Kensington, narcotics arrests remain near their lowest level in 15 years, the district attorney’s office’s data dashboard shows .

The DA’s office charged 1,691 drug offenses in the 24th District, which includes Kensington, last year, the data show. This was a decrease from 2022, when the office charged 1,854 drug offenses, including drug sales and drug possession, in the same district.

As of Tuesday, the office had charged 854 drug offenses in the area this year, which is roughly on a pace to match last year, data show.

Charges for drug sales, data show, are already outpacing last year’s numbers, with 1,095 drug sales offenses charged as of Tuesday. Last year by the same date, there had been 981 such charges.

Staff writer Max Marin contributed to this article.

Drug Task Force: Muncie teen repeatedly sold fentanyl pills to agent

MUNCIE, Ind. — A Muncie teenager has been accused of repeatedly selling fentanyl pills to agents for the Muncie/Delaware County Drug Task Force.

Antron D'Shaun Young, 18, was arrested Tuesday on five preliminary charges — dealing in a narcotic drug, dealing in cocaine, dealing in marijuana, maintaining a common nuisance and possession of a controlled substance.

The Delaware County prosecutor's office will determine whether formal charges will be filed in the case.

According to an affidavit, members of the drug task force, accompanied by the Muncie Police Department's SWAT team, on Tuesday executed a search warrant Young's home. in the 600 block of West Ninth Street. The raid came after a "two-month drug dealing investigation."

The court document alleged Young had been involved in "multiple controlled buys" of "pressed fentanyl M-30 pills,"

In the house, officers reportedly recovered three plastic bags and a shoe box containing a "large amount" of the pills, weighing a total of 130 grams.

Also seized, according to the affidavit, were three bags containing a total of 5.1 grams of cocaine, and 20 bags, each containing 3.5 grams or marijuana, along with 10 Suboxone strips.

Cash found in shoe boxes included bills that had been used in earlier controlled drug deals, investigator Mike Nickens wrote.

Interviewed after his arrest, Young reportedly told investigators he was "just a (drug) user."

An affidavit signed by Delaware Circuit Court 2 Judge Kimberly Dowling on Wednesday indicated Young would be held in the Delaware County Jail without bond.

At this time of his latest arrest, Young already faced a total of 14 charges in five cases pending in courts in Delaware and Madison counties. Those charges include dealing in a narcotic drug, conspiracy to commit dealing in a narcotic drug, dangerous possession of a firearm, visiting a common nuisance and driving without ever receiving a license, along with two counts of resisting law enforcement, three counts of possession of a narcotic drug, and four counts of possession of marijuana,

In other crime news:

Neglect : A Muncie woman was preliminarily charged with neglect of a dependent after she reportedly discharged a firearm with two children present.

Jerrica Gore, 40, reportedly admitted firing a shot into the air. A gun was recovered from her vehicle, and a .22-caliber shell casing was found nearby, according to an affidavit.

The arresting officer — who had responded late Tuesday to a report of gunshots in the 1000 block of East Willard Street — also reported that Gore "appeared to be intoxicated."

She was also preliminarily charged with criminal recklessness and driving while intoxicated and continued to be held in the Delaware County Jail on Thursday under a $10,000 bond.

The Delaware County prosecutor's office will determine whether formal charges will be filed.

Douglas Walker is a news reporter at The Star Press. Contact him at 765-213-5851 or at [email protected] .

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A Comprehensive Analysis of the Drug-Crime Relationship
White and Gorman (2000) explain the relationship between drugs and crime connection through three explanatory. models: "1) substance use leads to crime, 2) crime leads to substance use, and 3) the. relationship is either coincidental or explained by a set of common causes" (p. 170). The.
Studying the Relationship Between Drugs and Crime
Robert P. Gandossy, Jay R. Williams, Jo Cohen, and Henrick J. Harwood, Drugs and Crime: A Survey and Analysis of the Literature, Washington, DC: U.S. Department of Justice, National Institute of Justice, May 1980, NCJ 159074. Although NIJ ended ADAM in 2003, the Office of National Drug Control Policy operated ADAM II from 2007 to 2013.
Insights into the link between drug use and criminality: Lifetime
The underlying causal mechanism(s) is likely to be more complex than these explanations suggest (Bennett and Holloway, 2009, Seddon, 2000).Our previous work has highlighted the need for longitudinal studies with a non-drug user comparison group to examine the natural history of drug use and offending (Hayhurst et al., 2017).Whilst cross-sectional studies can provide information on the extent ...
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One section, however, consists of a series of papers on the drugs-crime relationship. Included are discussions of the "date-rape drug" and Paul J. Goldstein's classic article (Goldstein 1985) on the drug-violence connection. National Institute of Justice. 2003. Toward a drugs and crime research agenda for the 21st century. Washington, DC ...
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The illicit income of cocaine and heroin users alone totaled close to £3 million. Therefore, this study would suggest that one, there is a clear and strong connection between drug use and crime and two, addictive, expensive drugs such as heroin and cocaine account for at least 75 percent of crime where drugs are involved (Bennett, 1998: 46).
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The link between. drug use and criminality is supported by the finding that 70. percent of state prison inmates and 57 percent of federal. prison inmates reported "regular" use (i.e., used the ...
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When examining the relationship between drug use and crime, it is important to establish the direction of causality. This is one of the aspects that both researchers and the media fail to do. Stuart (2008) highlights that media as well as governments paint disproportionately the use of certain drugs as the cause of crimes.
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Relationship between Drug Use and Crime
Each theory shall be described below to explain the relationship between drugs use and crime. The crime leads to drugs use, drugs use cause crime, and common cause are the three models to be further discussed (Bennett & Holloway, 2006; White, 1990, White & Gorman, 2000). Furthermore, Goldstein's (1985) tripartite model, including the ...
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US drug overdose deaths decreased in 2023 for the first time in five years. Link Copied! An estimated 107,500 people died from a drug overdose in the US in 2023, a 3% decrease from 2022, according ...
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However, drug use or addiction can shape inclinations to crime. Goldstein (1985) points out three types of drug-use effects on criminal behavior: pharmacological (crimes under the influence of intoxication), economic-compulsive (crimes for obtaining money for drugs), and lifestyle (criminal behavior induced by the environment of drug users). A ...
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Updated 12:58 PM PDT, May 16, 2024. WASHINGTON (AP) — The Justice Department on Thursday formally moved to reclassify marijuana as a less dangerous drug, a historic shift in generations of U.S. drug policy. A proposed rule sent to the federal register recognizes the medical uses of cannabis and acknowledges it has less potential for abuse ...
DA says Jada Williams, 21, arrested with 1,147 packets of fentanyl in
The arrest, a joint investigation with the Pennsylvania State Police, was carried out in collaboration with and as part of an effort by Parker to step up drug and gun crime enforcement in Kensington. It was one of the first moves in a strategy to move away from what Krasner said was an old and ineffective tactic of combatting the drug market by focusing only on top-level busts or smaller, low ...
Drug Task Force: Muncie teen repeatedly sold fentanyl pills to agent
According to an affidavit, members of the drug task force, accompanied by the Muncie Police Department's SWAT team, on Tuesday executed a search warrant Young's home. in the 600 block of West ...

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Drugs and Crime by Richard Wright , Scott Jacques LAST REVIEWED: 14 December 2009 LAST MODIFIED: 14 December 2009 DOI: 10.1093/obo/9780195396607-0061

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