No one can know for sure whether drug use and abuse will rise, fall, or remain stable under legalization. In nine U.S. states and in the Netherlands, where small-quantity marijuana possession has been partially decriminalized, there has been no sharp rise in the use of this drug. Evidence suggests, however, that criminalization of some drugs has produced lower use and abuse, and that legalization, if accompanied by lower cost and ready availability, might result in a significant rise in use and abuse. For example, legal controls on certain prescription drugs has been followed by a decline in their illegal street use. In addition, the continuance rates of the legal drugs alcohol and tobacco are strikingly higher than for illegal drugs. For the most part, the use of the illegal drugs tends to be more sporadic and occasional, and more likely to be given up, than the use of legal drugs. In the United States, outlawing the sale of alcohol to persons under the age of 21 has produced a significant decline in its use, as well as in the number of alcohol-related fatalities in this age group.
Many current users, abusers, and addicts state that they would take drugs more frequently if drugs were legalized and readily available. And contrary to the stereotype, evidence suggests that, during prohibition (1920-33), alcohol consumption dropped significantly. There is much information to indicate that the abuse of drugs might very well rise under a policy of legalization or decriminalization.
The prolegalization groups are almost certainly right that crime and certain medical maladies among drug abusers would decline if drugs were legalized. Perhaps a “third path” somewhere between the current punitive policy and full legalization would be most effective. Needle exchange programs have cut down on drug-related AIDS transmission in Liverpool, England. The Dutch policy of de facto decriminalization for marijuana and hashish has not resulted in a rise in use or abuse. Perhaps the guiding policy on drug use ought to be on harm reduction rather than waging a war on drug abuse. Some aspects of this policy should include a flexible or selective enforcement, vastly expanding drug treatment programs, needle exchange programs, a distinction between “hard” (cocaine and heroin) and “soft” drugs (marijuana), expanding antidrug educational efforts, and focusing on reducing the use and abuse of tobacco and alcohol. The first priority should be to make sure that the users and abusers harm themselves and others as little as possible.