26 May 2025
At INHSU 2024 in Athens, Professor Alison Ritter, AO, Director of the Drug Policy Modelling Program at the University of New South Wales, delivered a keynote that tackled one of the most misunderstood – and, it turns out, oversimplified – topics in drug policy: decriminalisation.
With clarity and honesty, Professor Ritter didn’t just lay out the landscape. She picked it apart, showing how messy and inconsistent global efforts at decriminalisation have been.
Ahead of her return to the stage at INHSU 2025, we caught up with her to dive deeper into what meaningful decriminalisation could look like, why context matters, and how we can keep reform efforts moving forward in an increasingly complex world.
Decriminalisation is not a magic bullet
During the session, Professor Ritter walked attendees through six broad models of drug regulation, from full prohibition to commercial supply. Cannabis dominates the available evidence. But for other substances, such as opioids and stimulants, the data is limited.
Across all models, Professor Ritter warned that simply removing criminal penalties is far from a guaranteed fix to the health and social challenges that people who use drugs face around the world.
We’ve developed this idea that decriminalisation is some kind of magic bullet. And I’m more and more of the view that it will reduce arrests – we can be confident about that. But will it reduce overdose rates? Honestly, I don’t think it would. I think other things would reduce overdose rates more than decriminalisation of the personal use of drugs.
The danger of overpromising
Professor Ritter showed how decriminalisation can fall short when introduced into already strained or underprepared systems, especially without strong implementation and public engagement.
In Portugal, early reforms were linked to health improvements, but these were largely driven by mandatory referrals to treatment – a model that is now widely unsupported. And while the country’s overdose rates initially dropped, they’ve since climbed, although they remain below the EU average.
In British Columbia (Canada) and Oregon (U.S.), decriminalisation was launched amid housing crises, toxic drug supplies and under-resourced health systems. In those contexts, Professor Ritter explained, decrim hasn’t delivered the outcomes many had hoped for, particularly when it comes to reducing overdose deaths or stigma.
What we’ve seen in North America are examples where the promise of decriminalisation was not realised.There’s a lot of reasons for that, but part of it was being compared to the very high expectations that had been given to it.
Professor Alison Ritter.
She added that the path to policy reform is rarely rational or linear even with good evidence.
“We’ve all been guilty of overstating the evidence,” she said. “When advocates, researchers and community members push too hard on the promise of decrim, and the results don’t match the hype, we set ourselves up for backlash.”
Context is everything (and something is better than nothing)
The key to avoiding overpromising and underdelivering, Ritter argues, comes down to context. You can’t take a successful model from one country and expect it to work the same way somewhere else.
“People talk about decriminalisation like it’s one thing, but you can’t just copy and paste Portugal’s model into North America or Southeast Asia,” she said. “There are hundreds of variants, and outcomes depend on the details – especially how the model is implemented and the context it sits within. Every country, every state, every province faces different drivers of harm, different political pressures and different health system capacities.”
In Malaysia, for example, where Professor Ritter is currently advising on policy reform, the baseline for change is very different. Even a small reduction in criminal penalties could have a big impact.
“Context doesn’t just shape what’s possible. It shapes what’s needed,” she said.
What would a no-brainer approach to drug policy look like?
Professor Ritter pointed to the International Drug Policy Consortium’s model of full decriminalisation: removing criminal penalties for personal use and possession, ensuring voluntary (not mandatory) access to health and support services, and removing police from the process entirely.
But it turns out that no country has implemented this model in full – yet. But Alison hopes that one day it will be the norm.
In her view, a world where decriminalisation is a no-brainer would be one where drug use is treated as a health and social issue, not a criminal one, and where policing plays no role in the response.
Imagine someone suggesting in a parliamentary inquiry that we should lock people up for drug use, and everyone in the room gasps.That’s the world we’re working towards.
In the meantime, Professor Ritter urges pragmatism. She sits firmly in the “get something feasible up” camp – as long as we understand what that something is.
“Perfect is the enemy of the good,” she said. “But when we evaluate these models, we need to be clear about what was actually implemented. If it’s a less-than-perfect model that still involves some criminal justice response (such as fines or referral to mandatory treatment), it needs to be assessed in that context, not held up as decrim and then labelled a failure.”
Bring the whole community along
No matter the model, one thing is clear. Decriminalisation efforts must start with people who use drugs – but they can’t stop there.
Involving people with lived and living experience is essential, but meaningful inclusion is complex. It takes time, funding and skilled facilitation to build spaces where people feel genuinely heard and empowered, not just invited to tick a consultation box.
Even then, questions of representation remain.
Alison points to the challenges of representation, especially for overstretched and under-funded drug user organisations who cannot represent all people who use drugs.
Broad, inclusive engagement of the diverse and silenced voices of people who use drugs is crucial but very hard to achieve in practice, moving us all out of our echo-chambers.
Rather than rejecting voices, Ritter urged reflection on how the sector can create more representative, equitable models of inclusion – and acknowledged the effort required to do so.
At the same time, she stressed that engaging the broader public is just as important.
“We won’t succeed unless we bring the broader public with us,” she said. “Concerns about safety in public parks, or drug use near playgrounds, aren’t invalid. We need to engage, not dismiss, those fears.”
Final word: remember this is about justice
Drug law reform is often debated in terms of evidence, efficiency, and outcomes. But as Professor Ritter reminded us, decriminalisation is not just about health outcomes or policy wins. It’s about correcting a long-standing injustice.
The central cause for drug law reform is not its relevance to health or to the present public health catastrophe. It is a matter of correcting a social injustice.
And to get there? We need less rhetoric, more strategy, and the courage to build models that actually reflect the world we live in — not the one we wish we had.
Hear more from Alison at INHSU 2025 in Cape Town
Professor Ritter will return to the stage at INHSU 2025, taking place from 14 to 17 October in Cape Town, South Africa. She’ll chair the plenary panel discussion titled: ‘Drug Policy at a Crossroads: Reform in an Age of Change’.
The session will explore how global political shifts, including the rise of conservative and right-wing populist movements, are shaping drug policy reform. It will also highlight legal and human rights strategies, and the practical tactics needed to keep momentum alive in an increasingly volatile world.
Why not join us? Early bird registration closes 28 July. Register here.
