Models for the decriminalisation, depenalisation and diversion of illicit drug possession: an international realist review

Background: Faced with the high criminal justice, social, health and economic costs of criminalisation, many jurisdictions and countries are considering alternatives to criminal sanctions for simple drug possession. However, there remain limited tools to inform policy deliberations about the models that could be employed and the potential implications of each. This paper thus describes the development of the first empirically based set of models of alternative approaches.

Methods: Nine nations with 15 alternative approaches (1-3 per nation) were selected: Australia, Czech Republic, Denmark, England and Wales, Germany, Jamaica, the Netherlands, Portugal and the United States of America. Qualitative comparative analysis was used to extrapolate across countries and produce an empirically based typology of models. A rapid realist review of 258 documents was then conducted following the RAMESES protocol (Realist And Meta-narrative Evidence Syntheses: Evolving Standards), with advantages and disadvantages synthesised for each approach.

Results: Six models were derived: depenalisation, de facto police diversion, de jure police diversion, decriminalisation with civil penalties, decriminalisation with targeted health/social referrals and decriminalisation with no sanctions. Analysis shows each have different advantages and disadvantages. For example, depenalisation is the easiest reform to adopt, but it can lead to justice by geography/demography (limiting access to specific sub-groups). In contrast, decriminalisation with targeted health/social referrals requires more inputs (e.g. legal change and treatment supports), but it is associated with reductions in the burden on the criminal justice system as well as in drug-related health and social harms.

Conclusion: This review highlights a variety of options that could be adopted, whilst bringing to the fore important trade-offs and considerations about the objectives of any reform (e.g. non-intervention, minimal intervention or switching to a health or social response). We hope this will provide a basis for generating a shared understanding of the key features of different models; enable more robust and useful research; and contribute to more informed decision-making.