Pathways to Drug Liberalization: Racial Justice, Public Health, and Human Rights.

In our recent article, together with more than 60 of our colleagues, we outlined a proposal for drug policy reform consisting of four specific yet interrelated strategies: (1) de jure decriminalization of all psychoactive substances currently deemed illicit for personal use or possession (so-called “recreational” drugs), accompanied by harm reduction policies and initiatives akin to the Portugal model; (2) expunging criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs (and releasing those serving time for these offenses), while delivering retroactive ameliorative relief; (3) the ultimate legalization and careful regulation of currently illicit drugs; and (4) the delivery of a new “Marshall Plan” focused on community-building initiatives, expanded harm reduction programs, and social and health care support efforts (Earp et al. 2021). We were gratified to see so many thoughtful commentaries on our proposal, and we respond to them in part in this reply. As noted within these commentaries, we explicitly defend strategies (1), (2), and (4) on the grounds of racial justice. Specifically, we argue that such strategies are needed to combat the harmful effects of prohibition and the practices of discrimination that continue to disproportionately affect individuals and communities of color, especially Black and Hispanic men and those who care for them or depend on them for care. However, questions arise as to whether the third strategy (i.e., legalization and regulation) is required to deal with the deep-seated racial injustices associated with current drug laws. In our article, we argued that illicit drug markets generate specific harms, and in conjunction with current drug laws contribute to the stigmatization of drug use and drug users. Insofar as these markets and associated stigmatization disproportionately affect or disempower—or contribute to the mistreatment of— individuals in certain racialized groups, then addressing them is a matter of racial justice. And if decriminalization and harm reduction efforts alone cannot remove the harms associated with illicit markets—nor adequately deal with these stigmatizing attitudes— then full legalization with regulation may be required. Similarly, if the existence of civil penalties for drug-related misdemeanors not captured by de jure decriminalization policies is used as a pretext for racial discrimination, then a case can be made for legalization/regulation along racial justice lines. The same claim could also be made if racialized groups were found to be disproportionately impaired from accessing supportive services afforded by decriminalization that would otherwise be more freely available under a regulated regime. We do not make such a case in the associated article. Yet, as Dineen and Pendo (2021) demonstrate in their commentary on the mistreatment of people with substance use disorders in health care, there is evidence to support such a case. The majority of the commentaries recognize that we do not go into the details of how drug policy reform might be implemented in practice. In their respective commentaries, Roberts (2021) and Rolles, Nutt, and Schlag (2021) offer helpful insight into the policy design process, from real-time developments in different policy models in the United States, Spain, and Uruguay to the possibility of democratically pursuing explicit policy experiments or trials in limited geographical areas (along the lines of those used to gather evidence about Universal Basic Income). As we argue in our article, the key point is that policy design must be informed by meaningful participation from relevant stakeholders, including people who use drugs and those communities that have borne the