ࡱ> wb( }H/ 0|DTimes New Roman( 0( 0 DArialNew Roman( 0( 0  DTimesNew Roman( 0( 0 0DSymbolew Roman( 0( 0 8@DComic Sans MSn( 0( 0 8B A.  @n?" dd@  @@``  P(e? Z'.09.19  a"   O<<Jn9       PRb,,0 )*+,G !H"#O$%]&'((  <=>?./01-;256789,:34 C xAA8c? f\\SNT3@f\'g4BdBd@ 0pp(<4!d!dlqt 0t/ <4BdBdlp 0uʚ;2Nʚ;<4ddddl@v 0Xj0___PPT10 pp*___PPT9 z?*+ DPRC 6/2001O =LDrug War Heresies(  Robert MacCoun Peter Reuter*      T Background Current U.S. policies unsatisfactory Expensive, intrusive, divisive Yet U.S. has worst drug problem in the West Prohibition costs are more prominent than benefits Legalization a tempting alternative Uncertainty about what would happenT%$$%$$U Our Goals How should alternative  regimes be compared? Project consequences of legalization of cocaine, heroin and marijuana Use analogies Other vices Legal cocaine in US 1885-1915 Other nations Assess policy consequences of projectionsBZ8Z*Z8*a Conclusions 1Legalization would generate light regulation Large reductions in drug related crime, mortality/morbidity Large increases in drug use and addiction Harms would be redistributed; some groups would benefit, others suffer The major consequences highly uncertain Addiction could rise 50 percent or 500 percent \- Ff Fo F0 F-fo01~OutlineLearning from other countries Italian depenalization Swiss heroin maintenance Dutch cannabis policy Analytic framework Policy conclusions<F&F&$&Uy,Difficulties of Inference from other nations,_Italian depenalization Inferences across countries Dutch cannabis policy Inferences across timeL,-)jItaly Conducted a  Natural Experiment in Drug Policy6b66  Depenalized possession, 1975 1990 Applied to all drugs Concerns about heroin deaths, organized crime2"C  C   Z  #jItaly Conducted a  Natural Experiment in Drug Policy6b66   $jItaly Conducted a  Natural Experiment in Drug Policy6b66  Depenalized possession, 1975 1990 Applied to all drugs Concerns about heroin deaths, organized crime Repenalized in 1990 Concerns about heroin deaths, AIDS Redepenalized in 1993 Concerns about prison overcrowding"C  F#  F#  C##  T   Z     ,     ,  tDrug Deaths Rose During Italy s First Depenalization . . .;:*&      -*. . . but Fell When They Repenalized . . .*       .-. . . and Rose Again When They Redepenalized*        /;but Same Pattern in Spain (depenalization since 1975) . . .*      07. . . and in Germany (no depenalization during period)*       Observations !   .Was 1990 1993 repenalization enforced? Cross-national comparisons show how easy it is to misinterpret data from a single nation Inherently weak design ' dq*    |    Background   Swiss heroin problem comparable to U.S. Similar prevalence, high HIV rate among intravenous drug users Much less violence Enforcement aggressive by European standards Experimental approaches in early 1990s Needle Park (Platzspitz) regarded as failureV(RT 7-(RT-*        The Swiss Trials  EDemonstrations intended to include injection of Morphine: adverse reactions to injection Methadone: patient resistance to injectable methadone Heroin: high acceptance 800 heroin injectors enrolled Weak evaluation design No control group Long political consultation before 1994 experiment Expanded in 1998 to national program00Zw0Z50Z(0Z40Z(%0Z(0w52%  *z        "Protocol Was Carefully Constructed#  8Only experienced users admitted Most already tried methadone repeatedly Up to three times daily injection Self-injection, no take-home Highly targeted rules Removal of driving license Acceptance of continued obligation to provide heroin Many psycho-social services provided Group counseling, help in finding jobs 0Z(0Z "0Z-0Z 0Z-P0Z %0Z-'0Z ("P%  '9    Outcomes    0Generally positive Participants chose high but stable doses Retention high, no overdoses Was it more effective than methadone? Kept in treatment a particularly troubled population of heroin injectors Unemployment down from 44% to 20% Methadone has much smaller effects Crime reduction effects comparableZ*Z0ZZ&0ZZIZ"0Zd#Z#0Zd*&I"  #  #  1   2Swiss Trials Establish Feasibility of Maintenance32!3  ZOften contested Dose stabilization impossible Community won t accept them Can provide heroin safely and beneficially in a well-ordered society Can maintain political support@:d d:d  0How Is Switzerland Different from United States?1  Swiss addicts criminally active but less violent Programs better integrated into health system Comply better with government regulations Better public transport, more social support, etc. Are any of these are relevant? Can t yet claim even feasibility for United StatesZ1. 2* 21.*  d$Netherlands Drug Policy 1976-present%P%#$Prohibits same drugs as U.S., Australia But has formal written policy of nonenforcement Only for cannabis Permits possession and sales Limit was 30 grams from 1976-95 Recently reduced to 5 grams Part of broader harm reduction philosophy(Z10Zx/Z<Z*0Zx(! <  *HGateway effect modest xZ22% of marijuana users have tried cocaine Only 2% current users 33% of U.S. marijuana users have tried cocaine Gateway has multiple interpretations Spurious correlation  Tantalizer that encourages hard drug use  Toe in the water  low risk encourages boldness  Foot in the door to hard drug cultured*0ZF0ZFT0ZF0ZF*T-f:Change Had No Effect on Prevalence During First Decade...;;#: gX& But Use Increased Sharply in Second Decade--#, hDutch Use Caught Up to U.S.# i(& And Surpassed Oslo# j8Why? Shift from Depenalization to De Facto Legalization99#$Z3Decriminalization Evidence: No Effect on PrevalenceDecriminalization in 12 US states in 1970s how knowledgeable is population? how much difference in legal risks? Netherlands 1976-1983 prior to development of accessible coffee shops Three Australian jurisdictions since 1985 Net widening in South Australia Italy and Spain?,ZEZZ0Z*Z ZZ,E0* [Legalization Increases UseUNetherlands 1984-1992 heavy regulation but great access, social acceptability Industry in US would defeat effective regulation Very hard to defend greater restraints on cannabis selling South Australia depenalized home growing for use and gifts to friends Allows access without promotion or black markets Weak evidence: no rise in prevalenceK8K1K;KFKVK81;FV   OutlineLearning from other countries Italian depenalization Swiss heroin maintenance Dutch cannabis policy Analytic framework Policy conclusionsHF&F$&T+Goal of drug policy is to reduce total harm+Large array of harms Health Crime Control costs Infringements on liberty Assumption of no benefits from use necessary for policy credibility Cannot find meaningful common metric Money estimates too incomplete\K4KjKK4jAverage harm Total harm$  Total harm = Average harm per use x Total use Do efforts to reduce use increase average harm? Does harm reduction increase use? Legal change might reduce average harm and yet increase total harm.ZZ.9Could cocaine, heroin or marijuana be tightly regulated?Experience with other vices discouraging Alcohol: light regulation in face of substantial adverse consequences Tobacco; twenty years required to rein in promotion after Surgeon-General s report Gambling; government promotion despite evidence of pathological gambling, other harms Prostitution: tight regulation maintained CZCB,Uncertainty about Legalization ConsequencesAverage harm would decrease: Reductions in crime and health consequences very substantial Total use would increase substantially Consistent but not overwhelming evidence Strong a priori argument Net effect on total harm unpredictabletZ=Z'ZBZ'Z='B'Not a cost-benefit calculationValues matter Legal paternalism vs John Stuart Mill Redistribution From users to non-users No common metric available highly variable harms Uncertainty irreducibletZ&ZZZJZ&J$ 2Goal Should Be to Integrate Harm and Use Reduction33# 3Need to Distinguish Goals, Policies, Implementation4   4Policies Can Effect Prevalence and Harms Differently5   :Policies and Outcomes Are Each Influenced by Other Factors;   OutlineLearning from other countries Italian depenalization Swiss heroin maintenance Dutch cannabis policy Analytic framework Policy conclusionsTF&F(&T  z.Drug policy has modest effect on drug problems///  Evidence against tougher enforcement raising prices or reducing availability Prohibition plus modest enforcement creates high prices But ten-fold U.S. incarceration increase 1980-2000 Cocaine, heroin prices fallen by 70 percent Prevention is post-epidemic Difficult to predict which drug and population Cost effective but not efficacious Treatment does have empirical support Lowers harms to users and othersMZZZRZ&Z!ZMR&!    {1Drug problems have large effects on drug policies222  Drug-related HIV in Europe induced Needle exchange Harm reduction oriented policing Emergence of new drugs in U.S. generates tougher penalties Perceived 1990s marijuana epidemic has led to dramatic increase in enforcement activity .<#1#1  |MMost important policies for drug problems may not be those targeted on drugsNNN  Welfare Australian addicts eligible for income support, less crime dependent Public housing U.S. and U.K. projects create protected market places Health care U.S. addicts have less access to primary care and may show higher morbidity and mortality as a consequenceZEZZ6Z ZkZE6 k     } Conclusions   1The empirical research on legalization will be scientifically weak Standards of proof for foreign innovations always high Cannot convincingly demonstrate superiority of legalization Exceptions for heroin maintenance and marijuana depenalization Forces focus on improving the implementation of prohibition tCZ7Z<Z?Z=ZC7<?=*    >  /%1&2*3^>_?mAoFpGqHrIsJLMNO{ ` ̙33` ` ff3333f` 333MMM` f` f` 3>?" dd%"?" dddG%PW%-%%K {%-d[ n?" dd@   @@``@n?" dd@  @@``PN  % 7 I` p>> (      `䘗PZPZ1 ?  =Title  l  ZPZPZ1 ? =   tMargin text Margin text First level bullet First level dash Second level bullet Second level dash First level bullet$u    TH&T&T8c?C A3104c-* 05/018Z2   %%%77IIB  s *bk޽h ? kacccfSL .A3104a.Burnam.6.5.01.TT0 @\.(  \ \ 0c P   c X*    \ 0c    c Z*   d \ c $ ?  c \ 0FB  | S ka1=FB | S ka1`=aFB | S ka1`=> FB | S ka1 =FB | S ka1  FB | S ka1 jl FB | S ka1   FB | S ka1 FB | S ka1 . / FB | S ka1 FB | S ka1 de FB  | S ka1  FB !| S ka1  FB "| S ka1 () dB | <DԔ`9 9 dB | <DԔ`  | 0$X6  fDepenalization&    | 0(  p Repenaliz.&        | 0D | Redepenal.2       ;| Ht8c?#`  n Drug deaths per million citizens!!!   <| 6ЛK b1985,   C| 6K b1995,   E| 6(K=} b1986,   F| 64K b1987,   G| 6Kq  b1988,   H| 6K K  b1989,   I| 6K  b1990,   J| 6K?  b1991,   K| 6lK b1992,   L| 6Ks b1993,   M| 6LK M b1994,   :| 6 ;[  eItaly.   N| B_CDEFԔa/_ @ N H | 0޽h ? ̙33s  #/O(  ^   6NT8c?`@r  S P      6 8 a0.    6!   a5.    6 ]e  b10.    6O ]  b15.    6] b20.    6|]) b25.     6d] b30.  @B   C ka1 = @B   C ka1" =# @B   C ka1 = @B  C ka1==>@B  C ka1=@B  C ka1`=> @B  C ka1 =@B  C ka1  @B  C ka1 jl @B  C ka1   @B  C ka1 @B  C ka1 . / @B  C ka1 @B  C ka1 de @B  C ka1  @B  C ka1  @B  C ka1 () ^B  6DԔ`9 9 ^B  6DԔ`    0DOX6  fDepenalization&    ! 0O(  p Repenaliz.&        " 0 O | Redepenal.2       # HDO8c?#`  n Drug deaths per million citizens!!!   $ 6OK b1985,   % 60OK b1995,   & 6lOK=} b1986,   ' 6OK b1987,   ( 64$OKq  b1988,   ) 6!OK K  b1989,   * 6P-OK  b1990,   + 61OK?  b1991,   , 606OK b1992,   - 6:OKs b1993,   . 6?OK M b1994,   / 6CO ;[  eItaly.  @B > C 1rCs O B% CDE F(Ԕd/_ % @  H  0޽h ? ̙33  5- /Q(  r  S JOh  O   6LLO 8 a0.    6RO!   a5.    6VO ]e  b10.    6ZOO ]  b15.    6^O] b20.    6dcO|]) b25.     6gO] b30.  ^   6NT8c?`@@B   C ka1 = @B   C ka1" =# @B   C ka1 = @B  C ka1==>@B  C ka1=@B  C ka1`=a@B  C ka1`=> @B  C ka1 =@B  C ka1  @B  C ka1 jl @B  C ka1   @B  C ka1 @B  C ka1 . / @B  C ka1 @B  C ka1 de @B  C ka1  @B  C ka1  @B  C ka1 () ^B  6DԔ`9 9 ^B  6DԔ`    0TpOX6  fDepenalization&    ! 0,uO(  p Repenaliz.&        " 0zO | Redepenal.2       # HO8c?#`  n Drug deaths per million citizens!!!   $ 6lOK b1985,   % 6TOK b1995,   & 6čOK=} b1986,   ' 6ЊOK b1987,   ( 6HOKq  b1988,   ) 6OK K  b1989,   * 6(OK  b1990,   + 6OK?  b1991,   , 6OK b1992,   - 6xOKs b1993,   . 6OK M b1994,   / 6XO ;[  eItaly.   0 BCDE,F4Ԕ xo_hPWG 7 (@  H  0޽h ? ̙33r  "01a(  r  S Oh  O   6wO 8 a0.    6O!   a5.    6\O ]e  b10.    6OO ]  b15.    6LO] b20.    6O|]) b25.     6O] b30.  ^   6NT8c?`@@B   C ka1 = @B   C ka1" =# @B   C ka1 = @B  C ka1==>@B  C ka1=@B  C ka1`=a@B  C ka1`=> @B  C ka1 =@B  C ka1  @B  C ka1 jl @B  C ka1   @B  C ka1 @B  C ka1 . / @B  C ka1 @B  C ka1 de @B  C ka1  @B  C ka1  @B  C ka1 () ^B  6DԔ`9 9 ^B  6DԔ`   0OX6  fDepenalization&      0O(  p Repenaliz.&        ! 0O | Redepenal.2       " HO8c?#`  n Drug deaths per million citizens!!!   # 68OK b1985,   $ 6 OK b1995,   % 6DRK=} b1986,   & 6RK b1987,   ' 6tRKq  b1988,   ( 6OK K  b1989,   ) 6RK  b1990,   * 6\RK?  b1991,   + 6\RK b1992,   , 6RKs b1993,   - 6!RK M b1994,   . 6%R ;[  eItaly.   / BCDE,F4Ԕ xo_hPWG 7 (@   `  BC0DE,F4Ԕ? 0@` 0 Pph@   a 6*R#   eSpain.  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MM pB "X H8c?  pB #X H8c? ll pB $X H8c?  pB %X Hp?n V pB &X Hp?  pB 'X Hp? y   (X  BC9DEFp?&#8 @   )X  BiCDEF$p?  H h@    *X  B7CCDEF p?B-' )6 @  L  +X T$T0i0i?r PK  Y0  ,X T(5T0i0i?" de  Z10  -X T07T0i0i? de  Z20  .X TAT0i0i?|deV  Z30  /X TJT0i0i?-de Z40  0X TST0i0i?de Z50  1X T]T0i0i?dea Z60  2X TeT0i0i?8de Z70  3X T\vT0i0i?.  ['70  4X TX TT0i0i?. Hj ['92  ?X T T0i0i?. e ['94  @X TT0i0i?.  ['96  AX TT0i0i?D.  gPercent ever used  BX NW0i0i?GPS  h Policy Change  pB CX Hp?]] pB DX H8c?[[  EX T WCC?   gNetherlands, 18 yrs pB FX H8c?~ [[ H X 0޽h ? '%%Lta. G K0 % --GG`u-(  ` ` C xWfUfU ?}  W ^ ` 6?7" d ` <8c?S pB ` H1? [ pB ` H1?[ [[ pB ` H1? [ pB ` H1?[pB  ` H1?m[mpB  ` H1?[pB  ` Hp? [ pB  ` H8c?  pB  ` H8c? }} pB ` H8c?  pB ` H8c?  pB ` H8c? ,, pB ` H8c? pB ` H8c? I I pB ` H8c? pB ` H8c? l l pB ` H8c? pB ` H8c? pB ` H8c?   pB ` H8c? pB ` H8c? > > pB ` H8c? pB ` H8c?[[ pB ` H8c?  pB ` H8c? }} pB ` H8c?  pB ` H8c?  pB  ` H8c? ,, pB !` H8c?  pB "` H8c? MM pB #` H8c?  pB $` H8c? ll pB %` H8c?  pB &` Hp?n V pB '` Hp?  pB (` Hp? y   )`  BC9DEFp?&#8 @   *`  BiCDEF$p?  H h@    +`  BC]DEF p?\G'9$G @    ,` T!W0i0i?r PK  Y0  -` T+W0i0i?" de  Z10  .` T45W0i0i? de  Z20  /` T EW0i0i?|deV  Z30  0` T(GW0i0i?-de Z40  1` TQW0i0i?de Z50  2` TZW0i0i?dea Z60  3` TcW0i0i?8de Z70  4` TmW0i0i?.  ['70  5` TuW0i0i?. * ['72  6` T@W0i0i?. %H ['74  7` TdW0i0i?. Hj  ['76  8` T` TW0i0i?. %H ['90  ?` TW0i0i?. Hj ['92  @` TW0i0i?. e ['94  A` T,W0i0i?.  ['96  B` TW0i0i?D.  gPercent ever used  C` TD^CC?   gNetherlands, 18 yrs pB D` Hp?]] pB E` H8c?~ [[ pB F` Hp?o pB G` Hp?.H ` 0޽h ? '%%Ltm4 H K0 % 330NNh3(  hpB h H1?[pB h H1?[ [[ pB h H1? [  h C xL ^fUfU ?}  ^ ^ h 6?7" d h <8c?S pB h Hp?W pB  h Hp?.y  h T^CC?A  ` U.S., 18 yrs  pB  h H1? [ pB  h H1?m[mpB  h H1?[pB h Hp? [ pB h H8c?  pB h H8c? }} pB h H8c?  pB h H8c?  pB h H8c? ,, pB h H8c?  pB h H8c? I I pB h H8c? pB h H8c? l l pB h H8c? pB h H8c? pB h H8c?   pB h H8c? pB h H8c? > > pB h H8c? pB h H8c? [[ pB h H8c?  pB  h H8c? }} pB !h H8c?  pB "h H8c?  pB #h H8c? ,, pB $h H8c?  pB %h H8c? MM pB &h H8c?  pB 'h H8c? ll pB (h H8c?  pB )h Hp?n V pB *h Hp?  pB +h Hp? y   ,h  BC9DEFp?&#8 @   -h  BiCDEF$p?  H h@    .h  BC_DEF p?^I';&F @    /h  BCDEFp?!a @.-  0h  BHC@DEFp?*&#G? @  C 1h  B'CDE Fp?8&@C ? pB 2h Hp?> pB 3h Hp? n_pB 4h Hp?N\h( 5h  BC]DE(F0p? g&BG\m @d 6h T ^0i0i?r PK  Y0  7h T*^0i0i?" de  Z10  8h T4^0i0i? de  Z20  9h TD^0i0i?|deV  Z30  :h TXF^0i0i?-de Z40  ;h ThO^0i0i?de Z50  h Tk^0i0i?.  ['70  ?h T I K0 % \>T>P\\p=(  ppB p H1?[ [[ pB p H1? [ pB p H1?[ p C x_fUfU ?}  _ ^ p 6?7" d p <8c?S pB p Hp?G pB  p Hp?&j  p TD_CC?A  ` U.S., 18 yrs    p T _CC? <  gOslo, 15-21 yrs pB  p H1? [ pB  p H1?cpB p H1?[pB p Hp? [ pB p H8c?  pB p H8c? }} pB p H8c?  pB p H8c?  pB p H8c? ,, pB p H8c?  pB p H8c? I I pB p H8c? pB p H8c? l l pB p H8c? pB p H8c? pB p H8c?   pB p H8c? pB p H8c? > > pB p H8c? pB p H8c? [[ pB  p H8c?  pB !p H8c? }} pB "p H8c?  pB #p H8c?  pB $p H8c? ,, pB %p H8c?  pB &p H8c? MM pB 'p H8c?  pB (p H8c? ll pB )p H8c?  pB *p Hp?n V pB +p Hp?  pB ,p Hp? y   -p  BC9DEFp?&#8 @   .p  BiCDEF$p?  H h@    /p  BC[DEF p?ZE'7"G @    0p  BCDEFp?!a @.-  1p  BHC@DEFp?*&#G? @  C 2p  B'CDE Fp?8&@C ? pB 3p Hp?7 pB 4p Hp? jWpB 5p Hp?FIk( 6p  B C]DE(F0p? g&BG\m @d 7p T(_0i0i?r PK  Y0  8p T2_0i0i?" de  Z10  9p TxC_0i0i? de  Z20  :p TD_0i0i?|deV  Z30  ;p T>_0i0i?-de Z40  p Tj_0i0i?8de Z70  ?p T\t_0i0i?.  ['70  @p T_0i0i?. * ['72  Ap T0_0i0i?. %H ['74  Bp T_0i0i?. Hj  ['76  Cp T_0i0i?. e  ['78  Dp T$_0i0i?.  ['80  Ep T_0i0i?.  ['82  Fp T_0i0i?.  ['84  Gp T_0i0i?.  ['86  Hp T_0i0i?. * ['88  Ip T_0i0i?. %H ['90  Jp T_0i0i?. Hj ['92  Kp T,_0i0i?. e ['94  Lp T_0i0i?.  ['96  Mp T<_0i0i?D.  gPercent ever used  Np T`CC?   gNetherlands, 18 yrs p L m& %:  Op#  \  Pp  B&C|DE Fp?{%@m : xB Qp Hp?   Rp  BHCDEFp?E&8GK @  h  xB Sp Hp?g  Tp  BCDEFp?&f @ D  Up  BCDEFp?%`Km @ =  xB Vp Hp?   Wp  B'CODE Fp?N&@ C(   Xp  BCDEF p?&bGT @c& %. xB Yp Hp?H \1 xB Zp Hp?k xB [p Hp?  pB \p Hp?]] H p 0޽h ? '%%LtT J K0 % p''xh(  xd x <8c?i0[  x C x`gg ?  _ bpB x H1?0 (c0 pB x H1? (c pB x H1?z (cz pB x H1?(cpB x H1?(cpB  x H1?c(cc  x S BCDEF1? @    x S BCDEF1? @T 9   x S BCDEF1? @  pB  x Hp? (c L  V x#   x T`fUfU?Uq V U0 B  //?? x T\)`fUfU?   U2 B  //?? x TX2`fUfU?U   U0 B  //??&L    x# n M  x TX4`fUfU?   U4 B  //?? x TE`fUfU?U   U0 B  //??&L I .  x#    x TF`fUfU?I .  U6 B  //?? x TX`fUfU?UI .  U0 B  //??&L  x#  x TZ`fUfU? U8 B  //?? x Tk`fUfU?U U0 B  //??L |a x# V6 x Tt`fUfU?|za U1 B  //?? x T~`fUfU?|a U0 B  //?? x T\`fUfU?U|a U0 B  //??L  x#   x TH`fUfU?z U1 B  //?? !x T`fUfU? U2 B  //?? "x T(`fUfU?U U0 B  //?? #x T`fUfU?  qCoffee shops in Amsterdam B  //?? $x T(`fUfU? m  Z1980 B  //?? %x T`fUfU? w " Z1985 B  //?? &x TD`fUfU? @ Z1988 B  //??pB 'x Hp?i00x H x 0޽h ? 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Tbgֳgֳf\1?]|  F Drug arrests Treatment clients Availability of syringes, methadone G% GG   HpB  @ HԔ?J pB   HԔ? D  Zbgֳgֳf\1? y/Primary goal: Use reduction vs. harm reduction000  H  0޽h ? a( M K0 6.p (      3 r\bgֳgֳ ? p  b     f?TL1))?'     f?TL1))?- pB   HԔ?; f;pB   HԔ?9 m9    Zbgֳgֳ?`  U Drug Policy       Tbgֳgֳ?B `  W Drug Outcomes  ^   6f\1?    Tbgֳgֳ\S1? y `Formal drug policies  .   Zdbgֳgֳf\1?]  @ Drug laws Treatment policies Legality of syringes, methadone A% AA   H^   6f\1?p     Tbgֳgֳ\S1?y ZImplementation  .   Txbgֳgֳf\1?]|  F Drug arrests Treatment clients Availability of syringes, methadone G% GG   HF     0  xf   6f\1?    TLbgֳgֳ\S1? i ]Prevalence of use  P   Zbgֳgֳf\1?,]  Z Juvenile cannabis use Adult  hard drug use .% ..   HF  h    0 p xf   6f\1? h    Tbgֳgֳ\S1? } Q ^Drug-related harms  "   Z0bgֳgֳf\1? E , Morbidity and mortality Crime and disorder -% --   HpB  @ HԔ?e ' pB   HԔ?e ' pB  @ HԔ?J pB   HԔ? 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T0 (  ^ S ^)   e  Z@SeYӬYӬ8c ? -  e NEvidence from 3 countries,and support from 2 others decrim in US: compare prevalence changes in decrim and non-decrim states. Negligible differences. But how prominent is the change? MacCoun class experience How much has riskiness changed; arrest rates similar Dutch clearer 1976-193. South Australia, ACT small samples Italy and Spain have decrim for all substanaces Crude comparison with rest of Europe; not the highest4'E o 6H  0޽h ? y0 91(  ^ S ^)   e+  ZDaeYӬYӬ8c ? -  e AOnly one instance directly Even constrained Dutch regulation may have increased use substantially. Based on period 1984-1992. In US constraints would not be viable. Dedication to protected free speech. Other industries have defeated control efforts also through pllitical system. If mj less dangerous, even less likely,  !H  0޽h ? 0 LD4(  4^ 4 6? 5^ 4 6?J\^ 4 6?\5 4 N1 ?V4   e 4 TcFz Fz  ? @  e @ w--[[H 4 0޽h ? J0  \(  \ \ TveFz Fz  ?a o  e ZIn this figure we plot the percentage of Dutch 18 year olds in a given year who had ever used marijuana. This trend line summarizes data from a variety of early Dutch surveys. To our knowledge, our paper is the first English language source that presents these estimates. As you can see, during the first decade after the Dutch adopted their cannabis policy, there is statistically significant effect on levels of cannabis use. If anything, there was a slight decline, though it began a few years before the change in policy.  ]L.z]d \c $ ?Z.   eH \ 0޽h ? 0 bZ d(  dN d TĀeFz Fz  ?a o  e nHowever, in the second decade of the Dutch policy, starting in the mid-1980s, marijuana use amongDutch youth escalated dramatically. Though this figure depicts the percentage of 18 year olds who had ever smoked marijuana, we see similar trends when we look at younger teens. Lifetime use may mean that someone only tried cannabis once or twice then stopped. But we see the same sort of trend when we examine past month use among 18 year olds; a rise from about 8% in 1984 to 18% in1996. In order to interpret these trends, it is useful to compare Dutch cannabis rates to those of other countries over the same period.  o]L.z]d dc $ ?Z.   eH d 0޽h ? z0 :2@l(  l& l TeFz Fz  ?a o  e FWe know of only two comparable time series. One is the annual Monitoring the Future survey of high schoolseniors. As seen here, the US trend is quite different from the Dutch trend. The most striking difference is that from 1975 to 1992, levels of cannabis use were considerably higher in the US, despite the fact that we have had considerably less tolerant marijuana policies. Our rates dropped substantially throughout the 1980s. As the Dutch rates rose, we converged in around 1992. Since then, both nations rates have been rising together.  $]L.z]d lc $ ?Z.   eH l 0޽h ?  0 `tp(  t t TeFz Fz  ?a o  e 0Of course, our drug policies are only one of many ways in which we differ from the Netherlands. Fortunately, there is another time series available for comparison. This one comes from Oslo, Norway, a country culturally similar to the Netherlands, but with drug policies much closer to those in the US. The Oslo trend describes cannabis use among 15-20 yr olds, so it isn t directly comparable to the other two series, which describe 18 yr olds. Still, we can see that cannabis use in Norway has been quite stable throughout most of the past two decades. After 1992, the Norwegian rate began rising in parallel with the US and Dutch rates. (We see similar patterns in Australia and Canada.) But between 1984 and 1992, only the Dutch rates were rising. Why? ]L.z]d tc $ ?Z.   eH t 0޽h ? 0 \T|(  |d |c $ ?Z.   eH | TleFz Fz  ?a o#  e hTo understand what happened, we think it is important to make a distinction that often gets blurred in the debate when words like  legalization and  decriminalization are used. The immediate effect of the Dutch policy was to depenalize marijuana possession and low-level sales. That had little effect on levels of use. However, during the 1980s, there was a significant escalation in the number of cannabis-selling coffeeshops. In addition, these shops became more prominent, and more promotional. Although cannabis was technically legal, w e characterize this as a  de facto legalization regime. We propose that this commercialization is responsible for the substantial increases in use. ]L.z]H | 0޽h ? Z0 `(    N1 ?    e 3 re iv iv ? @  e "  H  0޽h ? a(Z0 (    N1 ?    e 3 re iv iv ? @  e "  H  0޽h ? a(Z0 (    N1 ?    e 3 r\e iv iv ? @  e "  H  0޽h ? a( 0 T L @  (   ^   6? 5^   6?J\^   6?\5^   6? ^   6?` ^   6?`P^   6?Pv   T\eFz Fz  ? @   e jMy characterization of Europe and the U.S. is a bit of an exaggeration, but a useful one. Of course, Europeans actively invest in use reduction. And in many ways, the U.S. already engages in forms of harm reduction -- e.g., methadone maintenance, and many of our policies for alcohol, tobacco, and other vices. But we think this framework can help to integrate the concerns of both approaches. This framework also helps to demonstrate why harm reduction is a separate issue from legalization. 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