Drug Policies and Policy Reform

Page last updated Sept. 23, 2021 by Doug McVay, Editor.

1. States With Legal Medical and/or Adult Social ("Recreational") Use of Marijuana

States and cities that have opted to legally regulate adult social use and/or medical use of marijuana:

Marijuana Legalization
(18): Alaska, Arizona, California, Colorado, Connecticut, Illinois, Maine, Massachusetts, Michigan, Montana, Nevada, New Jersey, New Mexico, New York, Oregon, Vermont, Virginia, Washington.
*Note re Washington, DC: Marijuana is also legal in Washington, DC but DC is not yet a state.
*Note re South Dakota: Voters in the state of South Dakota approved a legalization measure in November 2020 but a circuit court ruled that it's unconstitutional. The South Dakota Supreme Court as of June 30, 2021, the Court is still considering the ruling. The SD State Court Administrator declared that "Until the Court issues an opinion, the ruling of the circuit court declaring Amendment A unconstitutional remains in effect."

Marijuana Decriminalization
(14): Connecticut, Delaware, Maryland, Hawaii, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Rhode Island

Medical Marijuana Legalization
(35): Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Louisiana*, Maine, Maryland, Massachusetts, Michigan, Minnesota*, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York*, North Dakota, Ohio*, Oklahoma, Oregon, Pennsylvania*, Rhode Island, South Dakota, Utah, Vermont, Washington, West Virginia* (also, Washington, DC)

*no smoking allowed

Medical Marijuana Legalization - CBD Oil Only
(14): Alabama, Georgia, Indiana, Iowa, Kansas, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, Wisconsin, Wyoming

Hemp Legalization*
Hemp is now federally legal. Only two states in the country - Idaho and Mississippi - do not allow cultivation of hemp for commercial, research or pilot programs.

Cities That Have Legalized Marijuana
(5): Breckenridge, CO; Denver, CO; Portland, ME; South Portland, ME; Washington, DC

Cities That Have Decriminalized or Depenalized Marijuana
(57): Albuquerque, NM; Allentown, PA; Ann Arbor, MI; Athens, OH; Atlanta, GA; Austin, TX; Bellaire, OH; Berkeley, CA; Berkley, MI; Chicago, IL; Cincinnati, OH; Cocoa Beach, FL; Columbia, MO; Dayton, OH; Daytona Beach, FL; Detroit, MI; East Lansing, MI; Eau Claire, WI; Ferndale, MI; Flint, MI; Fremont, OH; Grand Rapids, MI; Houston, TX; Huntington Woods, MI; Jackson, MI; Jersey City, NJ; Kansas City, MO; Keego Harbor, MI; Lancaster, PA; Logan, OH; Madison, WI; Miami, FL; Milwaukee, WI; Monona, WI; Mount Pleasant, MI; New Orleans, LA; Newark, OH; Norfolk, VA; Norwood, OH; New York, NY; Oregon, OH; Orlando, FL; Philadelphia, PA; Pittsburgh, PA; Pleasant Ridge, MI; Portage, MI; Port Huron, MI; Roseville, OH; Saginaw, MI; State College, PA; Santa Fe, NM; St. Louis, MO; Tampa, FL; Toledo, OH; Wichita, KS; Windham, OH; York, PA

Cities That Have Made Marijuana Arrests the Lowest Priority
(12): Eureka Springs, AR; Fayetteville, AR; Hailey; ID; Kalamazoo, MI; Oakland, CA; San Francisco, CA; Santa Barbara, CA; Santa Cruz, CA; Santa Monica, CA; Seattle, WA; Tacoma, WA; Tampa, FL; West Hollywood, CA

States That Have Decriminalized Entheogenic Plants (including psilocybin)
(1): Oregon, New Jersey*

*for possessing an ounce or less of mushrooms from a third-degree crime to a disorderly-persons offense

Cities That Have Decriminalized Entheogenic Plants (including psilocybin)
(8): Ann Arbor, MI; Cambridge, MA; Denver, CO; Oakland, CA; Santa Cruz, CA; Somerville, MA; Vancouver, BC; Washington, DC

States That Have Decriminalized Possession of Controlled Substances
(1): Oregon

Nations That Have Legalized Marijuana
(2): Canada, Uruguay

Nations That Have Decriminalized Possession of Controlled Substances
(1): Portugal

National Organization for the Reform of Marijuana Laws. Legalization. Last accessed June 30, 2021.
ProCon.org. (2021, June 22). Legal Medical Marijuana States and DC, last accessed Sept 23, 2021.
Statement on Amendment A from South Dakota State Court Administrator, Gregory Sattizahn, June 24, 2021, last accessed June 30, 2021.
Office of the Governor, State of Connecticut, Governor Lamont Statement on Final Passage of Legislation Legalizing Adult-Use Cannabis, June 17, 2021.
State of NY.
"Governor Cuomo Signs Legislation Legalizing Adult-Use Cannabis." Governor's Office. March 31, 2021.
"Madison Takes ‘Pot’shot at Wisconsin, Joins Growing List of Municipalities to Decriminalize Cannabis." National Law Review. Dec. 11, 2020.

2. Nixon Declares War On Drugs

"America's public enemy number one in the United States is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new, all-out offensive."

The American Presidency Project. Richard M. Nixon. 37th President of the United States: 1969 ‐ 1974. Remarks About an Intensified Program for Drug Abuse Prevention and Control, June 17, 1971.

3. Rhode Island Becomes First State in US to Approve Legal Establishment of Overdose Prevention Sites

"Gov. Dan McKee has signed legislation introduced by Majority Floor Manager John G. Edwards (D-Dist. 70, Tiverton, Portsmouth) and Sen. Joshua Miller (D-Dist. 28, Cranston, Providence) that authorizes a two-year pilot program to prevent drug overdoses through the establishment of harm reduction centers, which are a community-based resource for health screening, disease prevention and recovery assistance where persons may safely consume pre-obtained substances.

"The law (2021-H 5245A, 2021-S 0016B) authorizes facilities where people may safely consume those substances under the supervision of health care professionals. It requires the approval of the city or town council of any municipality where the center would operate."

State of Rhode Island General Assembly. Harm reduction center pilot program to combat overdose deaths becomes law. News Release, July 7, 2021.

4. Washington State Data On Marijuana Use Following Enactment of I-502

"In these initial investigations, we found no evidence that I-502 enactment, on the whole, affected cannabis abuse treatment admissions. Further, within Washington State, we found no evidence that the amount of legal cannabis sales affected cannabis abuse treatment admissions.

"The bulk of outcome analyses in this report used the within-state approach to focus on identifying effects of the amount of legal cannabis sales. We found no evidence that the amount of legal cannabis sales affected youth substance use or attitudes about cannabis or drug-related criminal convictions.

"We did find evidence that higher levels of retail cannabis sales affected adult cannabis use in certain subgroups of the population. BRFSS respondents 21 and older who lived in counties with higher levels of retail cannabis sales were more likely to report using cannabis in the past 30 days and heavy use of cannabis in the past 30 days.

"We also found two effects that are difficult to interpret. Among the portion of the population aged 18 to 21, BRFSS respondents living in counties with higher sales were less likely to report using cannabis in the past 30 days, in some analyses. It may be that legal cannabis sales have made cannabis more difficult to access by persons below the legal age, for instance, by reducing black market supply through competition.

"We also found that in the portion of the BRFSS sample who smoked cigarettes, respondents living in counties with higher levels of legal cannabis sales were less likely to report past-month cannabis use. It is particularly difficult to explain why increased sales would lead to lower cannabis use among cigarette smokers."

Darnell, A.J. & Bitney, K. I-502 evaluation and benefit-cost analysis: Second required report. Document Number 17-09-3201. Olympia, WA: Washington State Institute for Public Policy, 2017.

5. Prevalence in Marijuana Use in Colorado Before and After Legalization

Total US
According to the National Survey on Drug Use and Health (NSDUH), in 2008-2009, an estimated 13.37% of young people in the US aged 12 through 17 had used marijuana in the past year, falling to 12.29% in 2015-2016. The NSDUH also estimates that, in 2008-2009, an estimated 7.03% of young people in the US aged 12 through 17 had used marijuana in the past month, dropping to 6.75% in 2015-2016.

Colorado State
According to the NSDUH, in 2008-2009, an estimated 18.55% of young people in Colorado aged 12 through 17 had used marijuana in the past year, falling to 16.21% in 2015-2016. The NSDUH also estimates that, in 2008-2009, an estimated 10.17% of young people in Colorado aged 12 through 17 had used marijuana in the past month, dropping to 9.08% in 2015-2016.

Table: Prevalence of marijuana use in Colorado before and after passage and implementation of Amendment 64

Substance Abuse and Mental Health Services Administration. (2017). National Survey on Drug Use and Health: Comparison of 2008-2009 and 2015-2016 Population Percentages (50 States and the District of Columbia). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
Substance Abuse and Mental Health Services Administration. (2017). National Survey on Drug Use and Health: Comparison of 2014-2015 and 2015-2016 Population Percentages (50 States and the District of Columbia). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

6. Limitation on Federal Interference With Implementation of State Medical Marijuana Laws

In December 2014, the federal budget for FY2015 was enacted, containing this provision:
"SEC. 538. None of the funds made available in this Act to the Department of Justice may be used, with respect to the States of Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Oregon, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Washington, and Wisconsin, to prevent such States from implementing their own State laws that authorize the use, distribution, possession, or cultivation of medical marijuana."

"Consolidated and Further Continuing Appropriations Act, 2015," US Congress, Enrolled Bill Published December 17, 2014, p. 88.
https://www.congress.gov/113/b...

7. Marijuana Legalization and Arrests in Colorado

"The total number of marijuana arrests decreased by 52% between 2012 and 2017, from 12,709 to 6,153. Marijuana possession arrests, which make up the majority of all marijuana arrests, were cut in half (‐54%). Marijuana sales arrests decreased by 17%. Arrests for marijuana production increased appreciably (+51%%). Marijuana arrests that were unspecified, meaning the specific reason for the arrest was not noted by law enforcement, went down by 45%.

"The number of marijuana arrests decreased by 56% for Whites, 39% for Hispanics, and 51% for Blacks. The marijuana arrest rate for Blacks (233 per 100,000) was nearly double that of Whites (118 per 100,000) in 2017.

"Nine large Colorado counties (Adams, Arapahoe, Boulder, Douglas, El Paso, Jefferson, Larimer, Mesa, and Weld) showed a decrease in marijuana arrests, ranging between ‐8% (Boulder) and ‐67% (Adams). The average decline across these nine counties was ‐46%.

"Separate data provided by the Denver Police Department’s Data Analysis Unit indicates an 81% decrease in total marijuana arrests, from 1,605 in 2012 to 302 in 2017.

"The most common marijuana industry‐related crime in Denver was burglary, accounting for 59% of marijuana crime related to the industry in 2017."

Impacts of Marijuana Legalization in Colorado: A Report Pursuant to Senate Bill 13-283. Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. October 2018.

8. Impact of Marijuana Legalization on Traffic and Driving Safety in Colorado

"The increase in law enforcement officers who are trained in recognizing drug use, from 129 in 2012 to 214 in 2018, can increase drug detection rates apart from any changes in driver behavior.

"Traffic safety data were obtained from a number of different sources. Please note that traffic safety data may be incomplete because law enforcement officers may determine that alcohol is impairing the driver, and therefore additional (time consuming and costly) drug testing may not be pursued.

"The total number of DUI citations issued by the Colorado State Patrol (CSP) decreased from 5,705 in 2014 to 4,849 in 2017. The prevalence of marijuana or marijuana‐in‐combination identified by Patrol officers as the impairing substance increased from 12% of all DUIs in 2014 to 15% in 2017.

"In 2016, the most recent data available, 27,244 cases were filed in court that included a charge of driving under the influence; 17,824 of these were matched with either a breath or blood test.1

"Of these, 3,946 had blood samples screened for the presence of marijuana: 2,885 cases (73.2%) had a positive cannabinoid screen and a follow‐up confirmation for other cannabis metabolites, and 47.5% detected Delta‐9 THC at 5.0 ng/mL or above.

"According to CDOT, the number of fatalities in which a driver tested positive for Delta‐9 THC at or above the 5.0 ng/mL level declined from 52 (13% of all fatalities) in 2016 to 35 in 2017 (8% of all fatalities).

"The number of fatalities with cannabinoid‐only or cannabinoid‐in‐combination positive drivers increased 153%, from 55 in 2013 to 139 in 2017.

"However, note that the detection of any cannabinoid in blood is not an indicator of impairment but only indicates presence in the system. Detection of Delta‐9 THC, one of the primary psychoactive metabolites of marijuana, may be an indicator of impairment.

"A 2017 survey conducted by the Colorado Department of Public Health and Environment found that 3.0% of adults reported driving within two‐to‐three hours of using marijuana in the past‐30 days, while 19.7% of recent marijuana users reported this behavior."

Impacts of Marijuana Legalization in Colorado: A Report Pursuant to Senate Bill 13-283. Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. October 2018, pp. 2-3.
https://www.colorado.gov/pacif...
http://cdpsdocs.state.co.us/or...

9. Emergency Department Visits and Hospitalizations Related to Marijuana Use Post-Legalization in Colorado

"The Colorado Department of Public Health and Environment (CDPHE) analyzed data from the
Colorado Hospital Administration (CHA) with these findings:

"Hospitalization rates (per 100,000 hospitalizations) with possible marijuana exposures, diagnoses, or billing codes increased from 803 per 100,000 before commercialization (2001‐2009) to 2,696 per 100,000 after commercialization (January 2014‐September 2015). The period from October 2015‐December 2015 indicated another increase, but due to changes in coding systems, variable structures, and policies at CHA, the numbers for 2016 are considered preliminary by CDPHE.

"The period of retail commercialization showed an increase in emergency department visits, from 739 per 100,000 ED visits (2010–2013) to 913 per 100,000 ED visits (January 2014–September 2015). There was no definitive trend during the period October 2015‐December 2015 and, due to changes in coding systems, variable structures, and policies at CHA, these figures for 2016 are considered preliminary by CDPHE.

"The number of calls to poison control mentioning human marijuana exposure increased over the past 10 years. There were 45 calls in 2006 and 222 in 2017. Between 2014 and 2017, the frequency of calls reporting human marijuana exposure stabilized."

Impacts of Marijuana Legalization in Colorado: A Report Pursuant to Senate Bill 13-283. Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. October 2018, pp. 4-5.
https://www.colorado.gov/pacif...
http://cdpsdocs.state.co.us/or...

10. Uruguay Legalizes Marijuana

“President José Mujica has quietly signed into law the government’s plan to create a regulated, legal market for marijuana, the president’s spokesman said Tuesday. The presidential secretary Diego Canepa said Mr. Mujica signed the legislation on Monday night. That was the last formal step for the law to take effect. Officials now have until April 9 to write the fine print for regulating every aspect of the marijuana market, from growing to selling in a network of pharmacies. They hope to have the whole system in place by the middle of next year. But as of Tuesday, growing marijuana at home was legal, up to six plants per family and an annual harvest of 480 grams, or about one pound.”

Source: Associated Press, “Uruguay: Marijuana Becomes Legal,” in the New York Times, December 24, 2013.

11. Arrests of Young People on Marijuana Charges in Colorado Since Legalization

"The number of juvenile marijuana arrests decreased 16%, from 3,168 in 2012 to 2,655 in 2017. The rate of juvenile marijuana arrests per 100,000 decreased from 583 in 2012 to 453 in 2017 (‐22%).

"The number of White juvenile arrests decreased from 2,146 in 2012 to 1,703 in 2017 (‐21%).

"The number of Hispanic juvenile arrests decreased from 767 in 2012 to 733 in 2017 (‐4%).

"The number of Black juvenile arrests decreased from 202 in 2012 to 172 in 2017 (‐15%)."

Impacts of Marijuana Legalization in Colorado: A Report Pursuant to Senate Bill 13-283. Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. October 2018, p. 5.

12. Marijuana Use by Young People in Washington State Following Legalization

"More schools and students are captured in the HYS [Washington Healthy Youth Survey] than MTF [Monitoring The Future Survey] (Table). The MTF included fewer low–socioeconomic status and nonwhite youth in the prelegalization vs postlegalization period.

"Estimates from the MTF show statistically nonsignificant change in the prevalence of cannabis use for 8th graders (from 6.2% [95% CI, 4.4%-8.7%] to 8.2% [95% CI, 6.3%-10.7%];P = .16), and a significant increase for 10th graders (from 16.2% [95% CI, 14.0%-18.6%] to 20.3% [95% CI, 16.9%-24.1%]; P = .02). In contrast, the HYS shows statistically significant declines in prevalence from 2010-2012 to 2014-2016 among both 8th graders (from 9.8% [95% CI, 9.1%-10.5%] to 7.3% [95% CI, 6.6%-8.0%]; P < .001) and 10th graders (from 19.8% [95%CI, 18.6%-21.0%] to 17.8% [95%CI, 16.7%-18.9%]; P = .01). Neither MTF nor HYS analysis showed changes among 12th graders (Figure). Findings from HYS comparisons to 2014 alone were of less magnitude but similar direction."

Dilley JA, Richardson SM, Kilmer B, Pacula RL, Segawa MB, Cerdá M. Prevalence of Cannabis Use in Youths After Legalization in Washington State. JAMA Pediatr. 2019;173(2):192–193. doi:10.1001/jamapediatrics.2018.4458

13. Marijuana Arrests in Washington State Following Legalization

"Preliminary look at racial disparities in select counties of Washington

"The Crime, Cannabis & Police Research Group at Washington State University used preliminary data from a Department of Justice funded study to compare white vs. Black arrests.11 Latinos were not included in the analysis, because of difficulties measuring ethnicity in arrest data. Their main preliminary findings are that after legalization in Washington, African Americans/Blacks continue to be disproportionally arrested for the possession and selling of marijuana when compared to whites. Though the disparity in marijuana possession between African American/Blacks and whites was reduced slightly after legalization, the disparity for selling marijuana has more than doubled since legalization.

"Local trends

"While statewide studies have the ability to control for individual law enforcement agencies or police departments, monitoring trends in marijuana-related crimes within a local police department can provide details of violations that statewide data systems do not. For example, violations for public consumption of marijuana cannot be directly queried from state-derived data; however, local law enforcement agencies and municipal courts maintain details on the nature of the crime that would indicate whether someone was ticketed for public consumption vs. possession or a different drug-related charge. One example of the potential of local data to explore issues of criminal justice can be made using data from the Seattle Police Department (SPD). A 2015 report for the Seattle Community Police Commission showed a disproportionate number of citations for marijuana public consumption issued to African Americans/Blacks in Seattle.12 Using local police department data is key to understanding differences in the implementation and enforcement of polices pertaining to the legalization of marijuana."

Firth C. Marijuana Legalization in Washington State: Monitoring the Impact on Racial Disparities in Criminal Justice. Alcohol & Drug Abuse Institute, University of Washington, June 2018.
http://adai.uw.edu/pubs/pdf/20...

14. Use of Marijuana by Young People in Colorado Since Legalization

"Data on youth marijuana use was available from two sources. The Healthy Kids Colorado Survey (HKCS), with 47,146 high school and 6,704 middle school students responding in 2017, and the National Survey on Drug Use and Health (NSDUH), with about 512 respondents in 2015/16.

"HKCS results indicate no significant change in past 30‐day use of marijuana between 2013 (19.7%) and 2017 (19.4%). Also, in 2017, the use rates were not different from the national 30‐day use rates reported by the Youth Risk Behavior Survey.2 In 2017, 19.4% of Colorado high school students reported using marijuana in the past 30‐days compared to 19.8% of high school students nationally that reported this behavior.

"The 2017 HKCS found that marijuana use increases by grade level, with 11.0% of 9th graders, 17.7% of 10th graders, 23.7% of 11th graders, and 25.7% of 12th reporting use in the past 30‐days.

"The 2015/16 NSDUH, with many fewer respondents compared to HKCS, indicated a gradual increase in youth use from 2006/07 (9.1%) to 2013/14 (12.6%); however, the last two years showed decreased use, with 9.1% reporting use in 2015/16. The NSDUH showed that youth use of marijuana in Colorado (9.1%) was above the national average (6.8%)."

Impacts of Marijuana Legalization in Colorado: A Report Pursuant to Senate Bill 13-283. Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. October 2018, p. 5.

15. Racial Disparities in Marijuana Arrests in CO and OR

"Compelling evidence in other states suggest racial disparities persist or have become worse after legalization and the opening of a licensed marijuana market, even while total marijuana-related criminal justice incidents have decreased.

"In Colorado, marijuana court filings decreased by 85% from 2010 to 2014 after legalizing marijuana in 2012. During the same time frame the rate of arrests for marijuana possession among African Americans/Blacks remained 2.4 times higher compared to the arrest rate for whites. The disparities for African American/Blacks were even larger for arrests for marijuana cultivation (2.5 times the arrest rate for whites) and distribution of marijuana (5.4 times the arrest rate for whites).13

"Results from Oregon are consistent with findings in Colorado. The Oregon Public Health Division examined changes in the age-adjusted rates of marijuana arrests by racial groups.14 The age adjusted rate of marijuana arrests for African Americans/Blacks was 2 to 3 times the rate of whites during 2010–2014. Oregon legalized marijuana in 2014 and in the following year the disparity between African Americans/Blacks and whites persisted. Specifically, the rate of arrest was 77% higher among African Americans/Blacks in 2015 when compared to whites.

"Preliminary results suggest that legalization of marijuana for adults has greatly reduced the number of people arrested and convicted for marijuana-related crimes, yet racial disparities persist in Washington and in other states. Other factors may contribute to sustaining the racial disparities, such as over-policing in low-income neighborhoods, racial profiling, and other racially biased police practices. 15 These inequitable practices may minimize the potential positive impacts of I-502 and marijuana legalization on all communities."

Firth C. Marijuana Legalization in Washington State: Monitoring the Impact on Racial Disparities in Criminal Justice. Alcohol & Drug Abuse Institute, University of Washington, June 2018.
http://adai.uw.edu/pubs/pdf/20...

16. Impact of Marijuana Legalization on the State of Washington

"In these initial investigations, we found no evidence that I-502 enactment, on the whole, affected cannabis abuse treatment admissions. Further, within Washington State, we found no evidence that the amount of legal cannabis sales affected cannabis abuse treatment admissions.

"The bulk of outcome analyses in this report used the within-state approach to focus on identifying effects of the amount of legal cannabis sales. We found no evidence that the amount of legal cannabis sales affected youth substance use or attitudes about cannabis or drug-related criminal convictions.

"We did find evidence that higher levels of retail cannabis sales affected adult cannabis use in certain subgroups of the population. BRFSS respondents 21 and older who lived in counties with higher levels of retail cannabis sales were more likely to report using cannabis in the past 30 days and heavy use of cannabis in the past 30 days.

"We also found two effects that are difficult to interpret. Among the portion of the population aged 18 to 21, BRFSS respondents living in counties with higher sales were less likely to report using cannabis in the past 30 days, in some analyses. It may be that legal cannabis sales have made cannabis more difficult to access by persons below the legal age, for instance, by reducing black market supply through competition.

"We also found that in the portion of the BRFSS sample who smoked cigarettes, respondents living in counties with higher levels of legal cannabis sales were less likely to report past-month cannabis use. It is particularly difficult to explain why increased sales would lead to lower cannabis use among cigarette smokers."

Darnell, A.J. & Bitney, K. (2017). I-502 evaluation and benefit-cost analysis: Second required report. Document Number 17-09-3201. Olympia: Washington State Institute for Public Policy.

17. Good Samaritan and Naloxone Access Laws Save Lives

"GAO found that 48 jurisdictions (47 states and D.C.) have enacted both Good Samaritan and Naloxone Access laws. Kansas, Texas and Wyoming do not have a Good Samaritan law for drug overdoses but have a Naloxone Access law. The five U.S. territories do not have either type of law. GAO also found that the laws vary. For example, Good Samaritan laws vary in the types of drug offenses that are exempt from prosecution and whether this immunity takes effect before an individual is arrested or charged, or after these events but before trial.

"GAO reviewed 17 studies that provide potential insights into the effectiveness of Good Samaritan laws in reducing overdose deaths or the factors that may contribute to a law’s effectiveness. GAO found that, despite some limitations, the findings collectively suggest a pattern of lower rates of opioid-related overdose deaths among states that have enacted Good Samaritan laws, both compared to death rates prior to a law’s enactment and death rates in states without such laws. In addition, studies found an increased likelihood of individuals calling 911 if they are aware of the laws. However, findings also suggest that awareness of Good Samaritan laws may vary substantially across jurisdictions among both law enforcement officers and the public, which could affect their willingness to call 911."

"Most States Have Good Samaritan Laws and Research Indicates They May Have Positive Effects," US General Accountability Office, March 2021, GAO-21-248.

18. No Relationship Between Drug Imprisonment Rates and States' Drug Problems

"One primary reason for sentencing an offender to prison is deterrence—conveying the message that losing one’s freedom is not worth whatever one gains from committing a crime. If imprisonment were an effective deterrent to drug use and crime, then, all other things being equal, the extent to which a state sends drug offenders to prison should be correlated with certain drug-related problems in that state. The theory of deterrence would suggest, for instance, that states with higher rates of drug imprisonment would experience lower rates of drug use among their residents.

"To test this, Pew compared state drug imprisonment rates with three important measures of drug problems — self-reported drug use (excluding marijuana), drug arrest, and overdose death — and found no statistically significant relationship between drug imprisonment and these indicators. In other words, higher rates of drug imprisonment did not translate into lower rates of drug use, arrests, or overdose deaths.

"State pairings offer illustrative examples. For instance, Tennessee imprisons drug offenders at more than three times the rate of New Jersey, but the states’ rates of self-reported drug use are virtually the same. (See Figure 3.) Conversely, Indiana and Iowa have nearly identical rates of drug imprisonment, but Indiana ranks 27th among states in self-reported drug use and 18th in overdose deaths compared with 44th and 47th, respectively, for Iowa.

"The results hold even when controlling for standard demographic variables, including the percentage of the population with bachelor’s degrees, the unemployment rate, the percentage of the population that is nonwhite, and median household income."

The Pew Charitable Trusts. More Imprisonment Does Not Reduce State Drug Problems: Data show no relationship between prison terms and drug misuse. March 2018.

19. Impact of National Drug Policies on Drug Use Prevalence

"Differences in the prevalence of drug use are influenced by a variety of factors in each country. As countries with more liberal drug policies (such as the Netherlands) and those with a more restricted approach (such as Sweden) have not very different prevalence rates, the impact of national drug policies (more liberal versus more restrictive approaches) on the prevalence of drug use and especially problem drug use remains unclear. However, comprehensive national drug policies are of high importance in reducing adverse consequences of problem drug use such as HIV infections, hepatitis B and C and overdose deaths."

European Monitoring Center for Drugs and Drug Addiction, "2001 Annual Report on the State of the Drugs Problem in the European Union" (Brussells, Belgium: Office for Official Publications of the European Communities, 2001), p. 12.

20. Marijuana Legalization May Lead To Decreased Use By Young People

"Consistent with the results of previous researchers,2 there was no evidence that the legalization of medical marijuana encourages marijuana use among youth. Moreover, the estimates reported in the Table showed that marijuana use among youth may actually decline after legalization for recreational purposes. This latter result is consistent with findings by Dilley et al4 and with the argument that it is more difficult for teenagers to obtain marijuana as drug dealers are replaced by licensed dispensaries that require proof of age.6"

Anderson DM, Hansen B, Rees DI, Sabia JJ. Association of Marijuana Laws With Teen Marijuana Use: New Estimates From the Youth Risk Behavior Surveys. JAMA Pediatr. Published online July 08, 2019. doi:10.1001/jamapediatrics.2019.1720

21. Alcohol Use v Marijuana Use - Young People and "The Displacement Hypothesis"

"Alcohol and marijuana are the two most commonly used substances by teenagers to get high, and a question that is often asked is to what extent does change in one lead to a change in the other. If the substances co-vary negatively (an increase in one is accompanied by a decrease in the other) they are said to be substitutes; if they co-vary positively, they are said to be complements.

"Interestingly, the answer may differ by historical era. Before 2007 patterns of use for the two substances suggested they acted as complements. When marijuana use increased in the late 1970s, so too did alcohol use. Between 1979 and 1992 marijuana use declined and a parallel decline took place in annual, monthly, and daily alcohol use, as well as in binge drinking among 12th graders. As marijuana use increased again in the 1990s, alcohol use again increased with it, although not as sharply. In sum, before 2007 there was little evidence from MTF to support what we have termed “the displacement hypothesis,” which asserts that an increase in marijuana use will lead to a decline in alcohol use, or vice versa.8

"However, since 2007 a new trend has emerged that would be consistent with the “displacement” hypothesis. From 2007 through 2019 alcohol use declined markedly, reaching historic lows in the life of the study. Meanwhile, for most of this time period marijuana use has stayed steady or increased for all age groups. For the first time trends in alcohol and marijuana use are substantially diverging, suggesting that the historical relationship between these two drugs may have changed."

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2020). Monitoring the Future national survey results on drug use, 1975–2019: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan.

22. Cornerstones of Drug Policy in the Netherlands

"All recent policy documents state that the Dutch drug policy has two cornerstones - and this was confirmed by the Minister of Health, Welfare and Sport during the major drug debate in the House of Representatives in March 2012: to protect public health and to combat public nuisance and drug-related crime (TK 24077-259; TK Handelingen 69-28 maart 2012). In the current Opium Act Directive the objective of the drug policy is described as: 'The [new] Dutch drugs policy is aimed to discourage and reduce drug use, certainly in so far as it causes damage to health and to society, and to prevent and reduce the damage associated with drug use, drug production and the drugs trade' (Stc 2011-11134)."

Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag.

23. Supply Reduction Has Little Or No Impact On Substance Use

"Overall, supply reduction—that is, reducing the availability of drugs—does not appear to have played as major a role as many had assumed in four of the five most important downturns in illicit drug use that have occurred to date, namely, those for marijuana, cocaine, crack, and ecstasy (see, for example, Figures 8-4, 8-5, and 8-6). The case of cocaine is particularly striking, as perceived availability actually rose during much of the period of downturn in use that began in the mid- 1980s. (These data are corroborated by data from the Drug Enforcement Administration on trends in the price and purity of cocaine on the streets.8) For marijuana, perceived availability has remained very high for 12th graders since 1976, while use dropped substantially from 1979 through 1992 and has fluctuated considerably thereafter. Perceived availability for ecstasy did increase in parallel with increasing use in the 1990s, but the decline phase for use appears to have been driven much more by changing beliefs about the dangers of ecstasy than by any sharp downturn in availability. Similarly, amphetamine use declined appreciably from 1981 to 1992, with only a modest corresponding change in perceived availability. Finally, until 1995, heroin use had not risen among 12th graders even though availability had increased substantially.

"• What did change dramatically were young peoples’ beliefs about the dangers of using marijuana, cocaine, crack, and ecstasy. We believe that increases in perceived risk led to a decrease in use directly through their impact on young people’s demand for these drugs and indirectly through their impact on personal disapproval and, subsequently, peer norms. Because the perceived risk of amphetamine use was changing little when amphetamine use was declining substantially (1981–1986), other factors must have helped to account for the decline in demand for that class of drugs—quite conceivably some displacement by cocaine. Because three classes of drugs (marijuana, cocaine, and amphetamines) have shown different patterns of change, it is highly unlikely that a general factor (e.g., a broad shift in attitudes about drug use) can explain their various trends.

"• The increase in marijuana use in the 1990s among 12th graders added more compelling evidence to this interpretation. It was both preceded and accompanied by a decrease in perceived risk. (Between 1991 and 1997, the perceived risk of regular marijuana use declined 21 percentage points.) Perceived peer disapproval dropped sharply from 1993 through 1997, after perceived risk began to change, consistent with our interpretation that perceived risk can be an important determinant of disapproval as well as of use. Perceived availability remained fairly constant from 1991 to 1993 and then increased seven percentage points through 1998.9

"• We do think that the expansion in the world supply of heroin, particularly in the 1990s, had the effect of dramatically raising the purity of heroin available on the streets, thus allowing for new means of ingestion, such as snorting and smoking. The advent of new forms of heroin, rather than any change in respondents’ beliefs about the dangers associated with injecting heroin, very likely contributed to the fairly sharp increase in heroin use in the 1990s. Evidence from this study, showing that a significant portion of the self-reported heroin users in recent years are using by means other than injection, lends credibility to this interpretation. The dramatic decline in LSD use in the early to mid 2000s is also not explainable by means of concurrent changes in perceived risk or disapproval; but availability did decline sharply during this period and very likely played a key role in reducing the use of that drug.

"We should also note that other factors, such as price, could play an important role for some drugs. Analyses of MTF data have shown, for example, that price probably played an important role in the decline of marijuana use in the 1980s, and in changes in cigarette use in the 1990s.10,11 However, price does not appear to have the same influence in all periods for all drugs, as the dramatic reduction in cocaine prevalence during the late 1980s took place at the same time that the price of cocaine decreased,12 contrary to the supply/demand model."

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2018). Monitoring the Future national survey results on drug use, 1975–2017: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan.

24. Temporary Scheduling Authority of the US Attorney General and the DEA

"Because policymakers were concerned about the effects of pharmaceutically created and other modified drugs, Congress gave the Attorney General the authority to temporarily place a substance onto Schedule I of the CSA to 'avoid imminent hazards to public safety.13 When determining whether there is an imminent hazard, the Attorney General (through the DEA) must consider the drug’s history and current pattern of abuse; scope, duration, and significance of abuse; and risk to public health. Once scheduled through this temporary scheduling process, a substance may remain on Schedule I for one year. The Attorney General then has the authority to keep the substance on Schedule I for an additional six months before it must be removed or permanently scheduled."

Sacco, Lisa N. and Finklea, Kristin M., "Synthetic Drugs: Overview and Issues for Congress," Congressional Research Service (Washington, DC: Library of Congress, October 28, 2011), p. 3.

25. Drug Decriminalization In Portugal Reduced Problematic Drug Use

"The information we have presented adds to the current literature on the impacts of decriminalization. It disconfirms the hypothesis that decriminalization necessarily leads to increases in the most harmful forms of drug use. While small increases in drug use were reported by Portuguese adults, the regional context of this trend suggests that they were not produced solely by the 2001 decriminalization. We would argue that they are less important than the major reductions seen in opiate-related deaths and infections, as well as reductions in young people’s drug use. The Portuguese evidence suggests that combining the removal of criminal penalties with the use of alternative therapeutic responses to dependent drug users offers several advantages. It can reduce the burden of drug law enforcement on the criminal justice system, while also reducing problematic drug use."

Hughes, Caitlin Elizabeth and Stevens, Alex, "What can we learn from the Portugese decriminalization of drugs?" British Journal of Criminology (London, United Kingdom: Centre for Crime and Justice Studies, November 2010), Vol. 50, Issue 6.

26. Drug Decriminalization Could Lead To Less Violent Crime

"Generalizing from the findings on Prohibition, we can hypothesize that decriminalization would increase the use of the previously criminalized drug, but would decrease violence associated with attempts to control illicit markets and as resolutions to disputes between buyers and sellers. Moreover, because the perception of violence associated with the drug market can lead people who are not directly involved to be prepared for violent self-defense, there could be additional reductions in peripheral settings when disputes arise (see Blumstein & Cork, 1997; Sheley & Wright, 1996)."

Jensen, Gary F., "Prohibition, Alcohol, and Murder: Untangling Countervailing Mechanisms," Homicide Studies, Vol. 4, No. 1 (Sage Publications: Thousand Oaks, CA, February 2000), pp. 33-4.

27. Origin of the Controlled Substances Act

"With increasing use of marijuana and other street drugs during the 1960s, notably by college and high school students, federal drug-control laws came under scrutiny. In July 1969, President Nixon asked Congress to enact legislation to combat rising levels of drug use. Hearings were held, different proposals were considered, and House and Senate conferees filed a conference report in October 1970. The report was quickly adopted by voice vote in both chambers and was signed into law as the Comprehensive Drug Abuse Prevention and Control Act of 1970."

Eddy, Mark, "Medical Marijuana: Review and Analysis of Federal and State Policies," Congressional Research Service (Washington, DC: March 31, 2009), p. 3.

28. Failure of Law Enforcement Interventions

"Based on the available English language scientific evidence, the results of this systematic review suggest that an increase in drug law enforcement interventions to disrupt drug markets is unlikely to reduce drug market violence. Instead, from an evidence-based public policy perspective and based on several decades of available data, the existing scientific evidence suggests drug law enforcement contributes to gun violence and high homicide rates and that increasingly sophisticated methods of disrupting organizations involved in drug distribution could paradoxically increase violence. In this context, and since drug prohibition has not achieved its stated goals of reducing drug supply, alternative regulatory models for drug control will be required if drug market violence is to be substantially reduced."

Werb, Dan; Rowell, Greg; Guyatt, Gordon; Kerr, Thomas; Montaner, Julio; Wood, Evan, "Effect of drug law enforcement on drug market violence: A systemic review," International Journal of Drug Policy (London, United Kingdom: International Harm Reduction Association: March 2011) Vol. 22, Issue 2.

29. Legalization, Decriminalization, and Police Priorities

"Some experts propose easing certain laws to allow the government to concentrate its limited resources on the most pressing criminal activities. For example, some advocate decriminalizing the possession of small amounts of marijuana. Others, concerned that the government may be overwhelmed, have proposed legalizing some counterfeit products and easing certain piracy restrictions. Intellectual property-related legal changes would probably require contentious negotiations with affected U.S. industries. Approaches such as these can be controversial and politically difficult; critics believe they risk sending society an inappropriate message. But some argue that similar strategies are already employed. The United States, for example, has taken steps to regularize the status of certain illegal immigrants. Many foreign countries have reduced legal penalties for marijuana possession. Some experts propose more funding for studies on various policies’ economic and social effects."

Wagley, John R., "Transnational Organized Crime: Principal Threats and U.S. Responses," Congressional Research Service (Washington, DC: Library of Congress, March 20, 2006), p. CRS 14.

30. Commissions and Reports Have For Decades Recommended Marijuana Decriminalization or Legalization

"The identification of cannabis as a potentially dangerous psychoactive substance did not, however, prevent a substantial number of these enquiries to explore the issue of whether current legislation reflected the real dangers posed by cannabis. Already in 1944, the La Guardia Committee Report on Marihuana concluded that ‘the practice of smoking marihuana does not lead to addiction in the medical sense of the word’ and that ‘the use of marihuana does not lead to morphine or heroin or cocaine addiction’ (Zimmer and Morgan, 1997). In 1968 the Wootton Report stated that ‘the dangers of cannabis use as commonly accepted in the past and the risk of progression to opiates have been overstated’ and ‘cannabis is less harmful than other substances (amphetamines, barbiturates, codeine-like compounds)’. A similar conclusion was arrived at 34 years later in 2002 when the Advisory Committee on Drug Dependence proposed the reclassification of cannabis from Class B to Class C (enforced by law in 2004 and confirmed in 2005). These views were reiterated by other enquiries, such as the Baan Committee in the Netherlands, which affirmed in 1971 that ‘cannabis use does not lead directly to other drug use’ (16) or by the US National Commission on Marihuana and Drug Abuse, which in 1973 stated that ‘the existing social and legal policy is out of proportion to the individual and social harm engendered by the use of the drug [cannabis]’ (17). The Canadian Le Dain Commission saw ‘the UN Single Convention of 1961 as responsible’ for such a situation which ‘might have reinforced the erroneous impression that cannabis is to be assimilated to the opiate narcotics’. The same commission, however, suggested that the UN Convention did ‘not prevent domestic legislation from correcting this impression’ (18)."

EMCDDA (2008), "A cannabis reader: global issues and local experiences," Monograph series 8, Volume 1, European Monitoring Centre for Drugs and Drug Addiction, Lisbon.

31. Federal Controlled Substances Act of 1970

"Enacted in 1970, the CSA [Controlled Substances Act] establishes a statutory framework through which the federal government regulates the lawful production, possession, and distribution of controlled substances.7 The CSA places various plants, drugs, and chemicals (such as narcotics, stimulants, depressants, hallucinogens, and anabolic steroids) into one of five schedules based on the substance’s medical use, potential for abuse, and safety or dependence liability.8 Further, the act requires persons who handle controlled substances or listed chemicals (such as drug manufacturers, wholesale distributors, doctors, hospitals, pharmacies, and scientific researchers) to register with the Drug Enforcement Administration (DEA) in DOJ, which administers and enforces the CSA.9 Registrants must maintain detailed records of their respective controlled substance inventories, as well as establish adequate security controls to minimize theft and diversion.10"

Garvey, Todd, "Medical Marijuana: The Supremacy Clause, Federalism, and the Interplay Between State and Federal Laws," Congressional Research Service (Washington, DC: Library of Congress, March 6, 2012), p. 2.

32. NIH Expert Panel Conclusions Regarding Methadone Treatment

"• Vigorous and effective leadership is needed within the Office of National Drug Control Policy (ONDCP) (and related Federal and State agencies) to inform the public that dependence is a medical disorder that can be effectively treated with significant benefits for the patient and society.

"• Society must make a commitment to offering effective treatment for opiate dependence to all who need it.

"• The panel calls attention to the need for opiate-dependent persons under legal supervision to have access to MMT [methadone maintenance treatment]. The ONDCP and the U.S. Department of Justice should implement this recommendation.

"• The panel recommends improved training of physicians and other health care professionals in diagnosis and treatment of opiate dependence. For example, we encourage the National Institute on Drug Abuse and other agencies to provide funds to improve training for diagnosis and treatment of opiate dependence in medical schools.

"• The panel recommends that unnecessary regulation of MMT and all long-acting agonist treatment programs be reduced.

"• Funding for MMT should be increased.

"• We advocate MMT as a benefit in public and private insurance programs, with parity of coverage for all medical and mental disorders.

"• We recommend targeting opiate-dependent pregnant women for MMT.

"• MMT must be culturally sensitive to enhance a favorable outcome for participating African American and Hispanic persons.

"• Patients, underrepresented minorities, and consumers should be included in bodies charged with policy development guiding opiate dependence treatment.

"• We recommend expanding the availability of opiate agonist treatment in those States and programs where this treatment option is currently unavailable."

"Effective Medical Treatment of Opiate Addiction," NIH Consensus Statement 1997, Nov 17-19 (Washington, DC: National Institutes of Health), 15(6), p. 24.

33. Efforts Are Needed to Overcome Opposition to Opioid Agonist Treatment

"The wide international variation in the availability of opioid agonist treatment for opioid-dependent injection drug users, despite documented scientific evidence in support of its efficacy, highlights the impact of political and philosophical forces that determine the availability of this treatment. Few proven therapies for medical conditions are restricted in this fashion. Therefore, efforts to address the political and philosophical opposition to opioid agonist treatment are needed to meet the global needs to prevent HIV transmission."

Sullivan, Lynn, David S. Metzger, Paul J. Fudala & David A. Fiellin, "Decreasing International HIV Transmission: The Role of Expanding Access to Opioid Agonist Therapies for Injection Drug Users," Addiction, February 2005, Vol. 100, No. 2, p. 153.

34. Incarceration for Drug Crimes Both Ineffective and Counterproductive

"The potency of incarceration is further diminished by three other forces, researchers have found. The first, sometimes referred to as the 'replacement effect,' applies largely to crimes that occur as part of a market, such as fencing stolen property or, most notably, drug transactions. Once incarcerated, drug dealers tend to be quickly replaced by new dealers and, as during the crack epidemic, the new recruits can be younger and more prone to violence than their predecessors.57 Thus while drug dealers no doubt deserve punishment, most leading researchers, and many law enforcement officials, now agree that incarcerating the foot soldiers in drug gangs, not to mention drug users, has a negligible impact on crime.58 Moreover, by creating job openings in drug-dealing organizations, it draws more people into criminal lifestyles and may in certain cases exacerbate crime.59"

Pew Center on the States, "One in 31: The Long Reach of American Corrections" (Washington, DC: The Pew Charitable Trusts, March 2009), p. 19.

35. Former Drug Czar Gen. Barry R. McCaffrey: "We have created an American gulag."

"We must have law enforcement authorities address the issue because if we do not, prevention, education, and treatment messages will not work very well. But having said that, I also believe that we have created an American gulag."

Gen. Barry R. McCaffrey (USA, Ret.), Director, ONDCP, Keynote Address, Opening Plenary Session, National Conference on Drug Abuse Prevention Research, National Institute on Drug Abuse, September 19, 1996, Washington, DC.

36. Drug Free Policies and Growing Underclass

"But while drug-free schools remain a fantasy, their policies are contributing to an uneducated underclass that just gets larger, more despairing, and more entrenched. This underclass now includes five million young adults between sixteen and twenty-four who are both out of school and out of work, with few skills and fewer prospects. It includes most ex-prisoners, half of whom lack a high school education, and most of whom are jobless one year after release. And it includes Black Americans and other racial minorities who have never remotely attained the standard of well-being common throughout the developed world."

Eric Blumenson, Eva S. Nilsen, "How to Construct an Underclass, or How the War on Drugs Became a War on Education," The Journal of Gender, Race & Justice, (May 2002), p. 76.

37. Marijuana Tax Act of 1937 and Federal Prohibition

"Marijuana essentially became illegal in 1937 pursuant to the Marijuana Tax Act.39 The use of marijuana required the payment of a tax for usage; failure to pay the tax resulted in a large fine or stiff prison time for tax evasion.40 Drug prohibition was elevated to another level by targeting 'marijuana,' a plant that had never demonstrated any harm to anyone.41

"Anslinger’s [Harry J. Anslinger, the first Commissioner of the Federal Bureau of Narcotics] efforts to eradicate marijuana continued when Anslinger sought similar anti-narcotic laws against marijuana at the state level.42 Guided by Anslinger’s policy direction, states began passing their own laws or adopting more strident versions of federal laws.43 By 1952, nearly all states had anti-narcotic laws in place.44"

Gilmore, Brian, "Again and Again We Suffer: the Poor and the Endurance of the 'War on Drugs,'" University of the District of Columbia Law Review (Washington, DC: The University of the District of Columbia David A. Clarke School of Law, 2011) Volume 15, Number 1, p. 64.