Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands.
J Psychopharmacol. 2021 May;35(5):537-546. doi: 10.1177/0269881120981380. Epub 2021 Feb 2.
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.
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.
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.
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.
摇头丸（3,4-亚甲二氧基甲基苯丙胺（MDMA））的危害相对较低，依赖程度较低，但被列入荷兰《鸦片法》附表 I（“硬性毒品”）。人们对与摇头丸相关的犯罪行为不断增加以及摇头丸的可能不适当分类感到担忧，这引发了一场关于修改当前荷兰摇头丸政策的辩论。
一个由 18 名健康、社会危害和毒品犯罪方面的专家以及执法改革方面的专家组成的跨学科小组，使用多决策多准则决策分析（MD-MCDA）重新制定了基于科学的荷兰 MDMA 政策。专家们共同制定了政策工具，并对 25 个结果标准（包括健康、犯罪、执法和财务问题）进行了评估，这些标准按六个主题集群进行了分组。
专家们对 22 种政策工具的效果进行了评分，每种工具都有两到七个不同的互斥选项，对 25 个结果标准进行了评分。最优政策模型是由一组 22 种政策工具选项定义的，这些选项在 25 个结果标准上的总得分最高。实施最优政策模型，包括管制摇头丸销售，可降低健康危害、与摇头丸相关的有组织犯罪和环境破坏，同时增加国家收入和提高摇头丸产品质量并增加用户信息。为了提高其政治可行性，对该模型进行了略微修改。敏感性分析表明，当前 MD-MCDA 的结果是稳健的，并且独立于权重值的变化。
本研究结果提供了一套可行且现实的政策工具选择，以修改立法，制定合理的摇头丸政策，这可能会降低不良（公共）健康风险和与摇头丸相关的犯罪负担。
