Drug liberalization ballot initiative
cost-effectiveness analysis
In a nutshell:
- A California ballot initiative that increases access to psychedelic drugs is a promising intervention in terms of DALYs averted.
- We estimate the cost-per-DALY-averted to range from $26/DALY to $92,950/DALY, with a best-guess estimate of $472/DALY. Full analysis available here.
- $472/DALY is our best-guess cost-effectiveness for the medical benefits of a California drug liberalization initiative.
- Many benefits are not included in the analysis (e.g. pushing US federal drug policy away from a crime model & towards a public health model), as they are speculative and difficult to model. We believe the speculative benefits may actually outweigh the medical benefits of an initiative, but that question is not considered in our model.
Q & A:
What intervention is being modeled, exactly?
- The analysis models the costs & benefits of a ballot initiative that increases access to psychedelics such that sufferers of depression, PTSD, alcoholism, and tobacco addiction can receive psychedelic treatment for these conditions in California.
- The analysis is intentionally agnostic re: the policy specifics of such an initiative. We are still learning about the strategic landscape here, and are currently unsure what specific initiative text would be best.
Why model mental health impacts if the largest benefits would come from other impacts?
- The mental health benefits from psychedelics are one of the least speculative benefits of liberalizing US drug policy. Our model gives the expected benefit a ballot initiative would achieve if all speculative impacts were net zero.
- Simpler to model: other impacts are complicated by considerations like flow-through effects. It would be very difficult to build a believable quantitative analysis of these impacts.
Is a drug liberalization ballot initiative cost-effective on the grounds of mental health benefits alone?
- GiveWell top charities achieve cost-per-DALYs on the order of $100s per DALY. However, these results rest on philosophical assumptions about population ethics (for AMF, discussion here (a) and here (a)) and empirical interpretations of the interventions' effects on happiness and income (for GiveDirectly and deworming interventions, some discussion here (a)).
- We don't take a position on these issues here; we raise them only to point out that arriving at apples-to-apples comparisons of heterogenous interventions is very complicated, and that there are reasonable assumptions under which GiveWell top charities are not extraordinarily cost-effective compared to other interventions.
- Mental health interventions have the benefit of directly increasing life satisfaction (which physical health and economic development interventions can only do indirectly).
- Our best-guess is that the medical benefits that flow from a drug liberalization ballot initiative have a cost-effectiveness of $472/DALY. This is competitive with the cost-effectiveness of GiveWell top charities.
Why doesn't the model account for adverse effects of psychedelics, like bad trips?
- Contrary to common belief, psychedelics are quite safe, and very nontoxic – see the “Background and safety” section here (a), as well as the “Safety of psychedelics” section of Nichols 2016.
- Carbonaro et al. 2016 surveyed 2,000 psychedelic users who self-reported having a “challenging experience” with psychedelics. Despite the difficulty of the experience, 84% reported benefiting from the bad trip. Given this result, it's not obvious that bad trips are pathological.
One plausible strategy for increasing access to psychedelics is to decriminalize all drugs. Wouldn't all-drug decriminalization cause a major uptick in use of addictive drugs?
- It's definitely possible, though Portugal decriminalized all drugs in 2001 and didn't see an uptick in drug use.
- Assessing this impact is complicated – all-drug decriminalization would increase access both to addictive drugs (e.g. opioids) and psychedelic anti-addiction treatments; it's unclear what the net impact of this would be.
Release notes:
- The model assumes that a ballot initiative polls well. Based on private polling we have seen, drug liberalization policy proposals are very popular in most US states.
- Compared to our minimum-benefit model, our best-guess model yields a much better cost-effectiveness ($472/DALY compared to $119,000/DALY).
- This change is largely driven by no longer including costs of treatment in the model. In our minimum-benefit model, we included costs of treatment to avoid issues around charitable leverage (a).
- However, we no longer think it's appropriate to include all costs of treatment in the model.
- Unlike global health interventions, where nearly all costs are covered by philanthropic actors, much of the treatment costs of psychedelic-assisted psychotherapy in the US will likely be covered by patients & insurance companies. These actors are not acting philanthropically, so it makes less sense to consider their contributions in the context of donor coordination.
- Our best-guess model includes an adjustment – "percent of impact attributable to campaign." This adjustment is necessary as it's not accurate to attribute 100% of the benefit of psychedelic-assisted psychotherapy to the campaign that legalized the intervention.
Enthea