International status of decriminalisation of drug use. Report for the Swiss Federal Office of Public Health

Criminalisation and decriminalisation of illicit drug use and possession has been hotly debated. Fuelled by increasing evidence of the ineffectiveness of the harms and costs of criminalisation, there has been a resurgence in interest in decriminalisation across many countries and international fora. This study was commissioned by the Swiss Federal Office of Public Health (FOPH) in response to a report of the Swiss Federal Council (2021) that concludes that the Swiss drug policy regarding drug use and possession was not achieving its desired aims and that the advantages and disadvantages of decriminalisation should be examined. This project thus sought to analyse the latest international experiences of depenalisation, decriminalisation or legalisation of drug use and possession for personal use and put forward models that could be adopted by Switzerland.

The project comprised a two-stage evidence review and interviews with two groups of stakeholders. Specifically, a targeted review was conducted of the latest international decriminalisation models as of 2023 and 13 countries with alternative responses involving the use and/or possession of all illicit drugs were selected for detailed analysis (Czechia, Germany, Italy, Portugal, Spain, Slovenia, United Kingdom, Canada, USA, Costa Rica, Colombia, Uruguay, Australia). Interviews were conducted with 8 Swiss stakeholders about the Swiss drug policy context. A realist review of 153 studies from the 13 countries and interviews with 17 international drug policy experts and practitioners was used to elucidate the latest evidence of the public health, social reintegration, public safety and criminal justice impacts of decriminalisation. The data collected was triangulated and synthesised to analyse individual experiences by country; to produce an empirically derived set of decriminalisation models (extrapolating across the set of countries) and advantages and disadvantages of each; and to elucidate policy implications for the Swiss drug policy context.

This research showed expanding interest in decriminalisation reforms in every continent of the globe and that most reforms involve all illicit drugs (not cannabis alone). Interviews with Swiss stakeholders and analysis of the criminal justice trends showed that despite the four-pillar Swiss drug policy and history of incremental drug law reforms, there remain shortcomings with the current legal context e.g. many young people continue to be policed and sanctioned for minor drug offences and there are barriers to treatment seeking and effective harm prevention messaging. Importantly, the interviews revealed an appetite for further drug law reform in Switzerland. Our report analysis and findings thus support the central conclusions of the Swiss Federal Council (2021) about the desirability of expanding decriminalisation of drug use and possession in Switzerland.

The evidence review of international experiences with decriminalisation showed decriminalisation of use and possession of all illicit drugs can lead to many criminal justice, health, social and economic benefits particularly reducing the burden on police, prosecutors and courts; reducing stigma and discrimination associated with drug use; increasing access to services; reducing drug misuse and demands on emergency services; improving relationships with families; and increasing housing and employment stability. But some models do carry risks such as net-widening, justice by geography or creating new burdens on health or associated systems. Based on this analysis we put forward eight different models of decriminalisation. Five could operate in the Swiss drug context and the evidence reviewed suggests all could produce net gains compared to the status quo. But the models most likely to elicit desired gains in the Swiss context are 1) decriminalisation with no sanctions or 1) decriminalisation with targeted civil penalties, health and social responses.
Both models offer the opportunity to reduce stigma and discrimination, improve access to treatment and harm reduction services, reduce the burden on the criminal justice system, reduce inequity and systematise responses across cantons and reduce drug-related health and social harm. While we acknowledge any alternative approach to addressing drug use and possession carries risks, maintaining the status quo also carries its’ own unique set of risks. We have raised several other important points that warrant discussion about any model including the importance of a clear set of objectives, clarifying the types of offences in scope and responses to public possession or use, and building education and communication and a robust evaluation design into any new reform. We hope this report will help to inform discussion on future legislative responses to use and possession of drugs in Switzerland.