Global health. The current scenario and future perspectives

212 The information from a country (such as the United States, with high demand due to high prevalence and population) can illustrate the real magnitude the illicit drug market can have worldwide and, therefore, it is relevant to analyze this situation in order to better understand phenomena associated with drug trafficking, but mainly to discuss possible medium- and long-term solutions. Everything described so far occurs within the context of current drug policies, which have prioritized the persecution of drugs and related crimes and leave an extremely lucrative business in the hands of transnational organized crime and numerous groups dedicated to drug trafficking at different scales in our countries, with the aforementioned consequences. This does not mean that a paradigm shift in drug policies will immediately and fundamentally solve organized crime, but States have the obligation to react in some way to address current problems. It is never too late for reflection, evaluation, proposing and rectifying, if necessary, by analyzing costs and benefits of different options but always based on the best available evidence. New regulations on drug policies There have been some changes, there is not a doubt about it; for example, changes in legislation regarding decriminalization of drug use in several countries as well as possession of doses for personal use; furthermore, therapeutic use of cannabis has been allowed in several countries along with scientific research into its potential benefits. The most recent development is marijuana legalization for recreational purposes, i.e., legally permitting its production and commercialization. In this section we will analyze some effects resulting from these changes, particularly their impact on consumption. The first situation we review is Europe where, at some point, different countries made changes regarding penalties for offenses related to cannabis use, mainly crimes for possession of this substance. Some countries tightened penalties while others reduced them. In 2011, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) analyzed the impact of these changes and then, in 2018, Hughes et al. updated this information. The hypothesis was that tightening criminal sanctions should lead to decreased prevalence of cannabis use, whereas those countries that reduced penalties should experience an increase in consumption. In their publication, Hughes et al. analyzed a 10-year follow-up period for each country (mainly 5 years before and 5 years after the corresponding legislative change), as illustrated in Figure 4. The solid lines represent countries where penalties were reduced,