High Time For Drug Policy Reform. Part 1/4: Introduction and Cause Summary

In the last 4 months, I’ve come to believe drug policy reform, changing the laws on currently illegal psychoactive substances, may offer a substantial, if not the most substantial, opportunity to increase the happiness of humans alive today. I consider this result very surprising. I’ve been researching how best to improve happiness (i.e. increase happiness whilst people are alive) for nearly 2 years. When I argued effective altruism (‘EA’) was overlooking mental health and happiness a year ago, drug reform featured nowhere in my analysis, nor had I heard anyone (inside or outside EA) suggest it was seriously important. This is the first in a series of four posts for the EA forum where I examine drug policy reform (‘DPR’) and explain why I think it should be taken seriously. I don’t claim to know all the empirical facts, nor do I claim to have a fully considered set of suggestions for what to do next. I wanted to share the problem with others as I’ve reached the limits of my knowledge and expertise on the topic and hope other brains can help.[1]

I want to thank Lee Sharkey for his assistance. We started collaborating on this before work commitments dragged him elsewhere. He wrote section 2.2 (on pain) and I wrote the rest with him providing helpful comments. Many of the ideas are his.[2] Because the entire analysis came to over 15,000 words, which seems unreasonably long, even for EA standards, we decided to split the essay into four parts I’ll upload on consecutive days [edit: have uploaded over consecutive days]. The motivation for this unusual move is to make the topic more readable and to keep the discussion of the different parts of the problem into separate places.

Here are the lengths and contents of the four parts:-

Part 1 (1,800 words): introduction and cause summary.

Part 2 (8,000 words): I make the case for DPR, explain why it might do a lot of good and anticipate objections.

Part 3 (3,000 words): I’ll discuss how drug policy could and should be reformed and take a stab and its tractability and neglectedness.

Part 4 (3,500 words): I provide some simplistic but illustrative cost-effectiveness estimates comparing an imaginary campaign for DPR against current interventions for poverty, physical health and mental health; I also consider what EAs should do next.

[Edit 10/08/2017: this forum post originally contained what I above call parts 1 & 2 because Lee and I thought we should divide this topic into three posts. A commentator below suggested this was still too big and we should split this four ways; Lee and I agreed, so we've moved part 2 into a another forum post. This may make the comments from before 10/08/2017 slightly confusing, sorry.]

What follows is a summary of DPR as a cause area.

1. Summary

All around the world, governments restrict access to psychoactive drugs, drugs that change how you think or feel, because they deem them unsafe to the public. These are the sorts of things your parents probably told you to stay away from when you were growing up: LSD, magic mushrooms, cocaine, cannabis, ecstasy and so on. While a drug is anything that has a physiological effect on the body, by ‘drugs’ I am more narrowly referring to those that are both psychoactive and illegal. This rules out things like antibiotics (not psychoactive) and alcohol and caffeine (not typically illegal). Legality may change from country to country, though all countries nominally subscribe to the international scheduling and control of certain drugs under UN treaties. A full list of the drugs controlled by the UK government can be found here. 

Drug prohibition causes two sets of effects, each of I’ll claim causes unnecessary misery. The first comes from the fact these bans are (at least somewhat) successful in restricting access to drugs. They make it harder for people to use drugs for medical or recreational purposes or to conduct research into their impact.

The second surround the efforts required to enforce these bans. Governments worldwide have been a fighting a ‘War or Drugs’ since the 1960s, punishing those who try to create, transport, distribute or use drugs, often by putting them in prison, sometimes by killing them.

I think we can identify six separate pathways drug reform, either by changing what’s banned, or how those bans are enforced, could improve happiness. I’ll list these briefly and explain them in more detail in the next section, provide numbers and citations. 

1. Fighting mental illness. Many currently illegal drugs, such as LSD and magic mushrooms, have shown great promise for treating mental health conditions in recent small-scale trials. The ability to conduct research or provide these to patients is greatly restricted by drug policies.
2. Reducing pain. Many people in physical pain (and often dying from terminal illnesses) lack access to effective pain relief, such as morphine, again because governments restrict access. This is primarily a problem in the developing, rather than developed, world.
3. Improving public health. Perversely, prohibition may cause more harm by pushing people towards more harmful drugs. Where addicts fear punishment, they don’t seek help.
4. Reducing crime, violence, corruption and instability. The drug trade can destabilise entire drug-producing countries (e.g. Afghanistan, Columbia). In drug-consuming countries it creates a demand for criminal gangs to distribute drugs, turns recreational users into criminals, leads individual addicts to engage in petty crime (e.g. theft) to fund their habit and takes up the time and focus of police, courts, prisons and politicians.
5. Raising revenue for governments. Governments around the world spend billions (unsuccessfully) fighting the war on drugs, both at home and abroad. If they stopped, they would save money. If they legalised (some) drugs and taxed them, governments would have much more money to spend on other policies.
6. Recreational use. Many people unproblematically consume alcohol, a legal recreational drug, and think it improves their enjoyment of life. It’s possible (although uncertain) other drugs could increase happiness too.

As we can see, there are several different ways drug reform might do considerable good. Those who wish to claim we should maintain the status quo approach have a considerable task. It’s not sufficient to show one or two of above avenues fail. What’s needed is to show DPR is, on balance, bad. I’ll explore each of the six avenues in the next section and suggest the case for DPR seems strongly positive overall.

For those who think DPR is promising, there is still a very open question about what the best policies would be. There are a range of options here and the legal situation is slightly complicated, so I won’t explain this in any depth until part 2 in the series. For those what want some concrete suggestions to chew on, my current, tentative view is we should:

• change the medical classification of several drugs, such as LSD, MDMA (‘ecstasy’), psilocybin (‘magic mushrooms’), so it’s much easier to conduct research on their effects and use them in treatment of mental illnesses.
• improve access to morphine worldwide so it can be used to treat pain.
• decriminalise, but not necessarily depenalise, all drugs and offering addiction treatment, rather than prison cells, to users.
• legalise the less dangerous common recreational drugs, perhaps cannabis and ecstasy, and treating them like alcohol and tobacco; putting a minimum age limit on them and taxing them heavily.

In terms of neglectedness and tractability, I think this is (highly) neglected, both within effective altruism and the world as a whole. In contrast, tractability is up for debate. What’s ultimately required is changing the law, which requires changing public opinion. It’s not clear how much public opinion would need to change, what the best ways are to change it, or much this would cost (assuming money does help). Attitudes towards drugs are changing: many states in the USA are legalising weed, and there seems to be growing agreement the War on Drugs is a failure. Once we add to that the sudden de-stigmatisation of mental health and the realisation certain drugs, such as LSD, may offer new, cheaper, more effective treatments for mental health, we can suddenly see a few reasons to believe drugs policy reform is tractable now whilst it wasn’t before. There are still open questions on whether the best thing to do would be to fund a public advocacy group (e.g. the ACLU), a drug policy reform group (e.g. the Beckley Foundation), start a new EA organisation or fund clinical trials testing the safety and efficacy of drugs, or something else. I don’t have a firm view on this yet.

The final question is whether DPR does more good than other interventions EAs might support. I assume DPR would be of most interest to EAs who focus on benefiting humans alive today and therefore support poverty and physical health interventions (e.g. Give Directly, SCI and AMF). I produce some cost-effectiveness numbers which indicate funding a campaign for drug policy reform in the UK, if it costs less than £10bn, would be more cost-effective than giving money to AMF. This is on the assumption roughly $9,000 to AMF caused 45 years of happy life to be lived. Roughly then, if you think we could successful pull off a DPR campaign in the UK for less than £10bn (which, for what it’s worth, I do), you should think DPR is a more cost-effective than AMF. I stress this requires several assumptions I won’t discuss here but set out in part 3. Those with different assumptions will reach alternative conclusions and I encourage others to run their own numbers.

I’m uncertain whether those who currently believe X-risk or animal welfare are the top causes should believe DPR would do more good (in expectation) than their present priorities. This is because I don’t know how many times more cost-effective such people believe their causes are than near-term, human-focused alternatives. Hence, I’m unsure how many more times effective I would need to show DPR is than current options, such as AMF, before, say animal welfare advocates, would switch from animal welfare to DPR. I don’t touch on how DPR might help animals, but I do identify some ways DPR could benefit humanity over the long run in addition to how it should increase the happiness of humans alive today. In reality, I don’t expect to convert people who aren’t already focused on near-term human interventions, but I would invite such people to offer me some simplistic estimates explaining how much more effective their top causes are to improve the debate.

Links to the articles in this series:

Part 1 (1,800 words): Introduction and Summary.

Part 2 (8,000 words): Six Ways DPR Could Do Good And Anticipating The Objections

Part 3 (3,000 words): Policy Suggestions, Tractability and Neglectedess.

Part 4 (3,500 words): Estimating Cost-Effectiveness vs Other Causes; What EA Should Do Next.