The American Medical Association (AMA) voted to support drug decriminalization recently on June 12. During the AMA’s annual House of Delegates meeting that was held in Chicago, Illinois, said MD/PhD candidate Ryan Englander. “The war on drugs is quite reminiscent of the phrase, ‘The beatings will continue until morale improves,’” Englander said. “We have tried for decades to criminalize our way out of a substance use crisis in this country, and it has not worked … We need to move to something different and better, something that actually works.”

Previously, language from an AMA Board of Trustees report asked that the association “continue to monitor the legal and public health effects of state and federal policies to reclassify criminal offenses for drug possession for personal use.”

During the recent meeting, delegates voted 345-171 to adopt the new position on its drug policy, which updates the association’s stance. Now it seeks 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.”

Englander stated that there is enough evidence of how decriminalization affects residents, citing how Oregon recriminalized hard drugs but Portugal has experienced better success. He stated that Oregon was “instructive, but so is the [experience of] Portugal, where that country decriminalized or removed penalties for personal possession of drugs for personal use, and they were actually able to get people into treatment, and mortality did drop. So there are models that we can use that can work,” Englander explained.

American Society of Addiction Medicine speaker Stephen Taylor proposed that it be sent to the reference committee, stating that “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.”

Of course, there were numerous delegates in opposition of endorsing decriminalization as well. “Our policy must reflect the evidence, and currently, the evidence does not support broad decriminalization,” said Bobby Mukkamala, AMA president-elect. “We just have to look at the Oregon experience. In 2020, Oregon decriminalized the possession of just small amounts of illicit drugs with the goal of getting people into treatment, but unfortunately, the outcome was quite different. There was no reduction in mortality and there was no increase in access to treatment… The board doesn’t believe it’s wise to have the AMA support policies that do not have more robust evidence behind them.”

American College of Physicians delegate Marianne Parshley commented that although Oregon appeared to improve when the decriminalization law was passed in 2020, fentanyl use and associated deaths also rose. From her perspective, recriminalization was a way to get bipartisan support for more funding and improving drug treatment programs. “So, it’s complex,” Parshley said. “We need to pay attention to the fact that [the situation] doesn’t instantaneously change if you pass decriminalization and support for treatment.”

The AMA’s drug policies have shifted over the past few years. In June 2022 during another annual House of Delegates meeting, the AMA changed its policy on expungement and called on states to implement record-cleaning services. “This affects young people aspiring to careers in medicine as well as many others who are denied housing, education, loans and job opportunities,” said Scott Ferguson, an AMA trustee. “It simply isn’t fair to ruin a life based on actions that result in convictions but are subsequently legalized or decriminalized.”

At last year’s annual House of Delegates meeting, the AMA adopted a new policy to advocate for substances like psilocybin and MDMA for psychiatric disorder treatments. “The AMA believes that scientifically valid and well-controlled clinical trials are necessary to assess the safety and effectiveness of all new drugs, including the potential use of psychedelics for the treatment of psychiatric disorders,” said Jack Resneck, AMA Immediate Past President, at the time. “The AMA appreciates that lawmakers want to help address the mental health crisis in the U.S., but there are other straightforward approaches that don’t thwart drug safety assessment and regulation, such as increasing coverage and removing barriers to care for evidence-based treatments.”

A report from the Board of Trustees, which was published prior to the 2024 House of Delegates meeting, addressed its disapproval of endorsing decriminalization. “The Board of Trustees believes that it is 1 premature to recommend decriminalizing drug possession offenses as a public health benefit in the 2 absence of evidence demonstrating public health benefits,” the report stated. During the meeting, Mukkamala spoke on behalf of the board and stated that the AMA “must reflect the evidence, and currently, the evidence does not support broad decriminalization.” The board did, however, support the expungement policy change.

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