Obviously, marijuana should be removed from Schedule 1 of the Controlled Substances Act. Although marijuana is being rapidly legalized or decriminalized at the state level, as is appropriate, this Federal treatment creates uncertainty for the industry and causes practical problems with things like banking services. The Federal treatment also makes it very hard to conduct scientific research on the medical benefits of marijuana and its derivatives, a potentially very valuable industry where the United States has fallen behind countries like Israel and Canada.
For other drugs, and especially the opioid crisis, we need to shift our focus to harm reduction. We also need to allow doctors to be doctors, and move away from the false narrative that pain treatment with opioids is a major cause of the crisis.
If there is one lesson that we should have learned from the failed War on Drugs, it is that punishing the user never works. This is also the lesson from other countries that have decriminalized drugs, such as Portugal in 2001, and treated drug use as a public health problem and not a criminal one. These actions have not caused a spike in the use of drugs and they have unquestionably reduced its consequences. Portugal, for example, has the lowest rate of opioid deaths in Europe, much lower than in the United States.
A focus on harm reduction can take multiple forms. It means drug injection sites, like they are experimenting with in Philadelphia, where the risk of overdose deaths or HIV/hepatitis infections are greatly reduced. It means “good Samaritan” laws under which a person can help a drug user without fear of prosecution. It means making naloxone readily available to treat opioid overdoses, including over the counter, as it has been in Italy for over 20 years and in Australia since 2016. It also means trusting doctors to do what is right in their treatment of patients with chronic pain and not establishing arbitrary rules which sometimes drive patients into the black market, where drugs are far more potent (fentanyl) and unpredictable; the fact that opioid prescriptions have been falling since 2012, while opioid deaths have been going in the opposite direction, should tell us something. We should be also promoting alternatives to opioids, including marijuana legalization, where there is growing evidence that – contrary to the “gateway” narrative – readily available marijuana decreases opioid abuse.
Ultimately, we should consider decriminalization of all drugs. I would not advocate that as a policy until the results of marijuana legalization are clear, but the experience in other countries and the early results from marijuana certainly point in this direction. When this occurs, it should, as with marijuana, be led by the states and on an experimental basis.