Marijuana Moment: American Medical Association Endorses Drug Decriminalization

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The American Medical Association (AMA) has formally endorsed drug decriminalization, adopting the policy position at its annual meeting on Wednesday.

AMA delegates voted in favor of the decriminalization proposal, 345-171. The body is calling for the “elimination of criminal penalties for drug possession for personal use as part of a larger set of related public health and legal reforms designed to improve carefully selected outcomes.”

That’s actually a bolder position than what was included in the AMA Board of Trustees report that delegates initially took up. That prior policy statement simply said the organization should “continue to monitor the legal and public health effects of state and federal policies to reclassify criminal offenses for drug possession for personal use.”

Stephen Taylor of the American Society of Addiction Medicine (ASAM) proposed the revised language, MedPage Today reported. ASAM, which has historically aligned itself with prohibitionists and resisted modest marijuana reforms, came out in favor of drug decriminalization last year.

AMA’s new drug decriminalization position builds upon a broader drug policy reform platform that has developed over years. Last year, for example, the organization adopted positions advocating for psychedelics research, opposing the criminalization of kratom, calling for an end to the sentencing disparity between crack and powder cocaine and supporting the continued inclusion of marijuana metabolites in employment-based drug tests.

In 2022, AMA delegates also voted to amend its policy position to support the expungement of past marijuana convictions in states that have legalized the plant.

The broad drug decriminalization proposal passed despite objections from the Board of Trustees, which said in a report prepared for the meeting that it “believes that it is premature to recommend decriminalizing drug possession offenses as a public health benefit in the absence of evidence demonstrating public health benefits.”

AMA President-elect Bobby Mukkamala, speaking on behalf of the board on Wednesday, said the organization’s policy “must reflect the evidence, and currently, the evidence does not support broad decriminalization.”

However, the board did recommend adopting a policy supporting “federal and state efforts to expunge, at no cost to the individual, criminal records for drug possession for personal use upon completion of a sentence or penalty.”

At Wednesday’s meeting, Ryan Englander, representing AMA’s New England delegation, said the “war on drugs is quite reminiscent of the phrase, ‘The beatings will continue until morale improves.”

“We have tried for decades to criminalize our way out of a substance use crisis in this country, and it has not worked,” he said. “We need to move to something different and better—something that actually works.”

He also pushed back on arguments that Oregon’s since-rescinded drug decriminalization law is evidence that the reform doesn’t work, noting that there are other case studies such as Portugal where the policy has proved effective at reducing rates of addiction and overdose by taking a public health approach to the issue.

Taylor of ASAM said “there is, in fact, evidence that decriminalization can have public health benefits if it is done correctly. We would suggest that we have yet to see it done correctly” in the U.S.

Marianne Parshley, a delegate for the American College of Physicians, said there are “several things wrong” with the assessment of Oregon’s decriminalization experience, pointing out that the reform was implemented at a time when fentanyl started become prevalent in the illicit drug supply, exacerbating the overdose crisis nationwide.

“It’s complex,” she said. “We need to pay attention to the fact that [the situation] doesn’t instantaneously change if you pass decriminalization and support for treatment.”

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