Improved health outcomes following decriminalisation

A 2014 UK Home Office report on the international evidence regarding the impact of decriminalisation of drug use reported that one of the clearest changes in Portugal since 2001 had been a considerable improvement in health outcomes for drug users:

• There had been significant reductions in the number of new diagnoses of HIV and AIDS among drug users.
• Overall, drug-related deaths had been stable since 2001.

The authors of the Home Office report concluded that these outcomes could not be attributed to decriminalisation alone, and were likely to have been influenced by increases in the use of treatment and harm reduction measures.

The Czech Republic decriminalised possession of small amounts of drugs for personal use in 2010. The authors of the Home Office Report described an evaluation of the previous drug criminalisation policy which found that adverse health outcomes for drug users had increased following criminalisation. This finding informed a policy shift towards greater focus on treatment and public health responses, although the evaluation acknowledged that the changes could not be attributed to the approach to possession alone.

 In 2010 the UN Special Rapporteur on the Right to Health stated that

‘Decriminalization and de-penalization have the potential to diminish the risks associated with drug use and increase participation of people who use drugs in drug treatment’.

The UN Special Rapporteur cited evidence from Portugal showing that drug use had decreased in absolute terms across key demographic categories following decriminalisation; both drug-related mortality and new cases of HIV among people dependent on drugs had decreased; and the number of people undertaking substitution therapy had risen from 6,040 in 1999 to 14,877 in 2003.

The UN Special Rapporteur noted that in Portugal, decriminalisation had occurred alongside other efforts, including significant expansion of drug treatment programmes, drug education and refocusing of police efforts on interruption of trafficking operations. He concluded that legislative change alone is not enough to minimise significantly the harms occurring with drug use. It needs to occur alongside treatment, education and other related interventions.

A 2016 review of the Portuguese evidence looked at trends in drug-related health harms. Noting that Portugal had experienced a ‘dramatic and sustained’ reduction in drug-related deaths between 2001 and 2012 despite a relatively small increase between 2005 and 2009, the authors of the review argued that commentators who challenged this overall decline had used ‘a different, less valid measure of the phenomenon’. The authors of this 2016 review of the evidence also described the rapid fall in the number of HIV infections through intravenous drug use between 2001 and 2013 as ‘a dramatic improvement in public health’. However, they acknowledged that these trends might not have been caused by the new strategy alone: it was difficult to disentangle the effects of the strategy’s public health interventions from independently occurring, ‘natural, downward trends in deaths and infections’.

• 2014 UK Home Office report
• UN Special Rapporteur on the Right to Health
• Decriminalisation and public health: the Portuguese approach to drug policy.  Prof Alex Stevens, University of Kent, UK and  Dr Caitlin E Hughes, Drug Policy Modelling Program, Australia