Developing a new national MDMA policy: Results of a multi-decision multi-criterion decision analysis (MD-MCDA)

In this preprint (2022), eighteen experts reformulated the Dutch MDMA policy using multi-decision multi-criterion decision analysis (MD-MCDA) with a science-based approach. The optimal policy model was defined by a set of 22 policy instrument options. Implementation of the optimal policy model, includes 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.

Abstract

“Background: MDMA(ecstasy, 3,4-methylenedioxymethamphetamine)has a relatively low harm and low dependence liability but is scheduled on List I of the Dutch Opium Act together (“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 eighteen experts on health, social harms, and drug criminality and law enforcement reformulated science-based the 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 2-7 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: Present results provide a feasible and realistic set of policy instrument options to revise the legislation toward a rational MDMA policy that is likely to reduce both adverse (public) health risks and MDMA-related criminal burden.”

Authors: Jan van Amsterdam, Gjalt-Jorn Y. Peters, Joost Breeksema, Ed Pennings, Tom Bickman, Kaj Hollemans, Johannes G. Ramaekers, Cees Maris, Floor van Bakkum, Ton Nabben, Willem Scholten, Tjibbe Reitsma, Judith Noijen, Raoul Koning & Wim van den Brink