Developing a new national MDMA policy: Results of a multi-decision multi-criterion decision analysis
An interdisciplinary panel used multi-decision multi-criterion decision analysis to score 22 policy instruments and identified an optimal model — notably permitting regulated MDMA sales — to revise Dutch ecstasy policy. Implementation of this model is predicted to reduce health harms, organised crime and environmental damage while improving product quality, user information and state revenues, and results remained robust in sensitivity analyses and were slightly adjusted for political feasibility.
Authors
- Johannes Ramaekers
- Joost Breeksema
- Wim Van Den Brink
Published
Abstract
Background
Ecstasy (3,4-methylenedioxymethamphetamine (MDMA)) has a relatively low harm and low dependence liability but is scheduled on List I of the Dutch Opium Act (‘hard drugs’). Concerns surrounding increasing MDMA-related criminality coupled with the possibly inappropriate scheduling of MDMA initiated a debate to revise the current Dutch ecstasy policy.
Methods
An interdisciplinary group of 18 experts on health, social harms and drug criminality and law enforcement reformulated the science-based Dutch MDMA policy using multi-decision multi-criterion decision analysis (MD-MCDA). The experts collectively formulated policy instruments and rated their effects on 25 outcome criteria, including health, criminality, law enforcement and financial issues, thematically grouped in six clusters.
Results
The experts scored the effect of 22 policy instruments, each with between two and seven different mutually exclusive options, on 25 outcome criteria. The optimal policy model was defined by the set of 22 policy instrument options which gave the highest overall score on the 25 outcome criteria. Implementation of the optimal policy model, including regulated MDMA sales, decreases health harms, MDMA-related organised crime and environmental damage, as well as increases state revenues and quality of MDMA products and user information. This model was slightly modified to increase its political feasibility. Sensitivity analyses showed that the outcomes of the current MD-MCDA are robust and independent of variability in weight values.
Conclusion
The present results provide a feasible and realistic set of policy instrument options to revise the legislation towards a rational MDMA policy that is likely to reduce both adverse (public) health risks and MDMA-related criminal burden.
Research Summary of 'Developing a new national MDMA policy: Results of a multi-decision multi-criterion decision analysis'
Introduction
Ecstasy (MDMA) is commonly used by urban, higher-educated young adults at dance events and house parties and typically only a few times per year; last-year prevalence in the Netherlands has stabilised at around 3%. MDMA was placed on List I of the Dutch Opium Act in 1988, a decision that the authors characterise as having an unclear evidence base at the time and one that was driven more by concerns about large-scale trade than by demonstrated health harm. Since that scheduling, evidence has accumulated that MDMA has relatively low dependence liability compared with other List I substances, that it may have therapeutic utility (notably as an adjunct in PTSD psychotherapy), and that illegal MDMA production in the Netherlands has contributed to organised crime, environmental damage and other social harms. Against this background, Van Amsterdam and colleagues convened an 18-member multidisciplinary expert panel to develop a science-based, politically feasible national MDMA policy. Using a multi-decision multicriteria decision analysis (MD-MCDA) framework, the group generated 95 policy instrument options and assessed their effects on 25 outcome criteria to identify an "optimal" policy model that maximises net benefits (public health, crime reduction, fiscal outcomes and related factors) and a slightly modified, more politically feasible variant (the "X-shop" model). The exercise compared the optimal model with four reference models (coffeeshop, adapted coffeeshop, free market, repressive) and with the current legal situation.
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van Amsterdam, J., Peters, G. Y., Pennings, E., Blickman, T., Hollemans, K., Breeksema, J. J. J., Ramaekers, J. G., Maris, C., van Bakkum, F., Nabben, T., Scholten, W., Reitsma, T., Noijen, J., Koning, R., & van den Brink, W. (2021). Developing a new national MDMA policy: Results of a multi-decision multi-criterion decision analysis. Journal of Psychopharmacology, 35(5), 537-546. https://doi.org/10.1177/0269881120981380
References (1)
Papers cited by this study that are also in Blossom
Szigeti, B., Winstock, A. R., Erritzoe, D. et al. · Journal of Psychopharmacology (2018)
Cited By (1)
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Van Dongen, N. N. N., Zijlmans, J., Vermetten, E. et al. · European Journal of Psychotraumatology (2024)
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