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Would Decriminalisation of Possession and Personal Use of Drugs Benefit the NHS?
Written by In2MedSchool 2022 Essay Competition Winner, Anna Boylan
In the UK, it is currently illegal to take, carry, make, or supply drugs, with the penalty ranging between a fine and a prison sentence. However, this approach is not effective, since drug misuse and addiction are widespread problems in our society, and they put immense strain on the NHS every year. Perhaps rehabilitation would be more effective than punishing drug users like criminals- the Executive Director of the Canadian Public Health Association once said, ‘If you want to deal with drugs, you need to deal with the reasons why people use drugs’ (CMAJ, 2014). The decriminalisation of drugs involves ceasing to treat drug possession and personal use as illegal, and I believe that, with increased funding on rehabilitation and mental health facilities, this would greatly benefit the NHS.
Decriminalisation consistently results in lower addiction and substance abuse rates. For example, in 2001, Portugal decriminalised the possession of all drugs for personal use. In 1974, the strict Estado Novo regime ended, and this led to a 27 year-long war on drugs in Portugal. Drug use soared: by 2000, 1% of the population was addicted to heroin, and Portugal had the highest HIV infection rate in the EU. This is when Portugal decriminalised the possession of drugs, and since then levels of drug use have been below the European average (Sellers, 2022). The number of deaths caused by drug overdose fell to just 16 in 2012 (Drug Policy Alliance, 2015): this is a stark contrast to England and Wales, where the total number of deaths related to drug misuse was 1,605 in 2011 (NHS Statistics on Drug Misuse, 2012). This data clearly illustrates how effective decriminalisation was in Portugal, after it led to an enormous decrease in levels of drug use, and the number of deaths due to overdose has plummeted too. Drug users are now treated like unwell patients who need rehabilitation, and addiction is seen as a mental illness. Therefore, I believe that this approach would benefit the NHS since it has proven to be extremely successful in Portugal. It would reduce the strain on the NHS, as drug use rates would likely fall here in the UK too, leading to reduced addiction rates and fewer deaths due to drug overdose. If fewer people are addicted to drugs, the annual cost of drug addiction for the NHS would fall, saving valuable NHS money and resources.
Furthermore, decriminalisation would result in rehabilitation for drug misuse becoming more accessible, thus making it easier for people to get help earlier. People who suffer from drug issues would be less likely to overdose, and fewer people would suffer from long-term health conditions as a result of their drug use. Drug users suffer from a wide variety of health conditions, including mental health issues (depression, anxiety, psychosis, etc.), heart disease, blood-borne viruses, and lung disease (Public Health England, 2022). One example of this is HIV- sharing syringes is the second riskiest behaviour for contracting HIV (Centers for Disease Control and Prevention, 2019). Decriminalisation would result in fewer people sharing syringes, thus reducing the rates of HIV in the UK. The NHS would then be put under less strain, as fewer drug users would be suffering from this chronic condition and fewer NHS resources and funds would need to be allocated to treating and monitoring HIV. Another example is mental health conditions. Drugs can have a drastic effect on your mental health; many affect your mood and can lead users to develop conditions such as anxiety, depression, psychosis, and this can result in suicide. A reduction in drug rates due to decriminalisation would significantly reduce the number of people living with these conditions.
NHS mental health services are already incredibly stretched, and, over time, decriminalisation would reduce the number of people needing to access these services. Annually, drug misuse costs the NHS around £488 million in England (Morse, 2017). I believe that decriminalisation would benefit the NHS because it would reduce the amount of money that the NHS would need to spend on drug misuse, addiction, and treating long-term health conditions as a result of drug use. This money would be better spent on improving rehabilitation facilities and increasing their capacities, and on expanding mental health facilities too. Therefore, this would make rehabilitation more accessible, so drug users would be able to access rehab and mental health support easier. Overall, the cost of drug misuse, addiction, and overdose for the NHS would decrease, and this money would be best spent on improving rehabilitation and mental health care. These services would be under less strain and drug users would be able to access the support they need to recover and reintegrate back into society.
Decriminalising drugs would also reduce the number of people in prison for drug offences. For example, in Portugal, over half of the prison population was there for drug-related reasons (Sellers, 2022). Since drugs have been decriminalised for personal use, this has fallen from 40% to just 15% (Transform Drug Policy Foundation, 2021). It is clear from this evidence that decriminalising drugs for personal use would reduce the number of people in British prisons. Prisons have extremely detrimental effects on both a person’s physical and mental health. The isolation from family, shame, emotional stress, and lack of control in prisons often lead to mental health problems such as anxiety and depression. Many people turn to drugs to deal with these issues, and this, alongside the rampancy of illicit drugs in prisons, often makes people’s substance abuse problems worse rather than better whilst they are in prison. Keeping as many people out of prison as possible would reduce the number of people suffering from severe mental health problems, thus reducing the strain on the NHS. This would, in turn, reduce the number of people turning to drugs as a way of coping with these issues. Prisons are also very damaging to a person’s physical health- people in prisons are disproportionately likely to suffer from chronic conditions, such as diabetes. Health care in prisons is often low-quality and difficult to access, and other problems such as overcrowding and poor hygiene make it challenging for people to live healthy lives whilst in prison. Chronic conditions require years of monitoring and reducing numbers in prisons would lower the number of people living with these conditions. I believe that decriminalising drugs would benefit the NHS because it would lower the number of people in prisons. Therefore, fewer people would develop physical and mental health conditions in prison, thus cutting costs and reducing the strain on the NHS. These costs could potentially fund rehabilitation services, which are cheaper and often more effective than prisons. This could further reduce the number of people with substance abuse issues, as they could be rehabilitated and reintegrated back into society instead of being locked away.
Some people may argue that decriminalisation would increase addiction rates, and the NHS hasn’t got the mental health or rehabilitation facilities to cope with this. An increasing number of people are in contact with drug services in England, and decriminalisation would only cause this number to increase. Very dangerous drugs would become much cheaper and more accessible, which would encourage experimentation and it could lead to an increase in cases of overdose. Also, it could lead to an increase in syringe sharing, which is the second riskiest behaviour for contracting HIV. Drug misuse currently costs the NHS £488 million every year (Morse, 2017), and decriminalisation would only further increase this cost. Overall, some may argue that decriminalisation would not benefit the NHS because it would increase the accessibility of dangerous drugs, hence leading to more cases of overdose. The NHS is already stretched to its limit, and more overdoses would put further strain on frontline NHS workers in busy Emergency Departments. There is not adequate mental health support available to treat the psychological consequences that will follow on from an increase in drug misuse, and HIV cases would rise due to increased syringe sharing. The NHS would not be able to cope with this further pressure with the current level of funding, so decriminalisation would not be beneficial.
In conclusion, I believe that decriminalising the personal use and possession of drugs would benefit the NHS because addiction and substance abuse rates would drop, more people affected by drug misuse would be able to access help, and the number of people suffering from mental and physical health problems due to conditions in prisons would decrease. This would ease a lot of strain from an already-stretched NHS. For decriminalisation to work, I believe that the government would need to increase funding of rehabilitation and treatment facilities, but overall, this would be the best way of tackling addiction and substance abuse in the UK, since individuals are more likely to find recovery in rehabilitation than in jail.
CMAJ (2014) Decriminalize drugs and use public health [Online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081223/
Sellers, W. (2022) The decriminalisation of illegal drugs: a legal minefield [Online]. Available at: The decriminalisation of illegal drugs: a legal minefield – Will Sellers (royalhospitalschool.org)
Drug Policy Alliance (2015) Drug Decriminalization in Portugal: A Health-Centered Approach [Online]. Available at: https://drugpolicy.org/sites/default/files/DPA_Fact_Sheet_Portugal_Decriminalization_Feb2015.pdf
NHS Statistics on Drug Misuse (2012) Statistics on Drug Misuse- England, 2012 [Online]. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-drug-misuse/2012
Public Health England (2022) Misuse of illicit drugs and medicines: applying All Our Health [Online]. Available at: https://www.gov.uk/government/publications/misuse-of-illicit-drugs-and-medicines-applying-all-our-health/misuse-of-illicit-drugs-and-medicines-applying-all-our-health
Centers for Disease Control and Prevention (2019) Injection Drug Use and HIV Risk [Online]. Available at: https://www.cdc.gov/hiv/pdf/risk/cdc-hiv-idu-fact-sheet.pdf
Morse, G. (2017) Addiction and Substance misuse pathways [Online]. Available at: http://tvscn.nhs.uk/wp-content/uploads/2017/12/Gordon-Morse-Addiction-and-Substance-misuse-pathways-1.pdf
Transform Drug Policy Foundation (2021) Drug Decriminalization in Portugal: Setting the Record Straight [Online]. Available at: https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight
Commendation from student:
“Although I found it challenging, I enjoyed writing this essay and researching a subject that I previously didn't know much about. It is a controversial and stimulating topic, and I enjoyed exploring it.”