Shaleen Title: Let’s talk about legalizing and regulating all drugs, not just marijuana

Still, her position has drawn little attention recently, and it’s a relatively radical stance for a public official to take. I followed up with Title and asked her to walk us through her thinking. She stressed that she was speaking in her personal capacity, and not on behalf of the commission.

Our conversation appears below, edited for clarity.

Why is legalizing and regulating all drugs the right approach?

The reason marijuana was legalized was because a legal market and legal regulation is better than prohibition for public health, for public safety, and for consumers. If you look at that rationale and the rationale of Representative [Joe] Kennedy [III] when he decided to support legalization this week, all those same arguments and principles apply to other drugs as well — even more so to drugs that are more dangerous and risky than cannabis.

That’s a pretty bold stance.

I understand that might come off as radical if it’s the first time you’re thinking about it. But marijuana legalization was radical to people as well in the beginning. If you look at harm reduction measures like Narcan [or naloxone, a medication that reverses opioid overdoses], people used to say that would enable drug users and cause usage to go up. But the data is clear: prevention and treatment work better than criminalization. Now police officers carry it, and I see ads for how naloxone can save lives. As time goes on and data comes in from marijuana legalization, it will be become clear that this isn’t a radical idea. It was prohibition that was radical all along.

How did you come to support the legalization and regulation of all drugs?

I started in the drug policy reform movement in 2002. But I’ve specifically advocated for the legalization and regulation of all drugs since 2009, when I started working with Law Enforcement Action Partnership (LEAP). That group is made up of police officers and judges and other law enforcement officials who had come to the same conclusion. And as a trustee for Students for Sensible Drug Policy (SSDP), I worked with experts in a bunch of different areas, and with drug consumers themselves. I think that doing both helped me see all sides of the issue. That was the basis for my understanding that, regardless of how you feel about a drug, legal regulation is a better policy from a practical perspective than prohibition.

Why are you coming forward with this now?

I saw the Kennedy op-ed [renouncing his previous opposition to marijuana legalization]. That and the [marijuana] stores opening. Alcohol and marijuana are very different substances but when you look at the principles that apply to both — that it’s better to have it regulated and controlled, with the decisions left up to public health and safety experts — that applies to other drugs as well. Now that we can see alcohol stores and marijuana stores in operation, that’s becoming more intuitive to people.

But marijuana is far less harmful than a drug like, say, heroin, which can literally kill you if you take too much.

Those harms and risks are the reason we should consider regulation. Regulation is all about the reduction of risk and imposing control rather than leaving it up to the underground market.

Who can sell the drugs? How can they be tested? Who has access? What happens if you sell to minors? All of those are questions that should be under the government’s control.

The level of medical supervision would be related to how risky and dangerous the drug is. I think cannabis is somewhat in the middle of the spectrum, but more dangerous drugs would require more supervision. Certainly we don’t want to see any advertising, and we want to minimize or eliminate commercialization for more dangerous drugs.

Look, right now, the drug market is controlled by illicit dealers who are not subject to any type of regulatory controls. And the question is, as it was with cannabis: do we want that market to be controlled by them, or by public health and safety experts? There is no third option where we don’t have a drug market. Prohibition has not been effective — just look at the opioid crisis. Public health, education, prevention, and treatment — those are effective. When we shift resources away from criminalization and towards improvements in those areas we’ll see an impact.

We can learn from alcohol and tobacco here. It’s clear to drug policy experts and public health experts that alcohol and tobacco should not have been commercialized to the extent that they were, that advertising shouldn’t have been allowed. We can apply those principles without criminalizing users.

Think about the warnings on cigarette labels and the public awareness campaigns around tobacco. Smoking rates have decreased drastically, and it’s been done without putting smokers in jail. It’s been done with education and regulation. If we can put in place the right regulatory frameworks from the start, we won’t be in the position we’re in with alcohol or tobacco where we’re trying to undo the advertising and promotion that was allowed.

There’s also ongoing research about the medical uses of certain drugs that are currently illegal. As research continues, we may decide that their medical benefits for certain people outweigh the harms.

What would this actually look like? The government selling drugs in brown paper bags without any marketing?

We don’t have to do this overnight. It can be in a careful, phased way, as we have with cannabis. And as a larger point, the regulated market for one drug doesn’t look the same for every other drug, because different drugs have different inherent levels of risk. Something like coffee can be sold in a grocery store. Something like heroin would have to be very strictly regulated and controlled. And then there’s a whole spectrum in between.

The data also show people are more likely to use regulated markets than illicit ones if they’re more convenient and accessible. Creating one will reduce the risks. Consumers want to be aware of what they’re taking.

Couldn’t this policy make dangerous drugs more available to those who currently have no access to them?

Portugal decriminalized all drugs in 2001, and there were fears that by taking away criminal penalties, crime and drug-use rates would go up. That hasn’t happened. Several Massachusetts legislators recently visited Portugal to try to learn from that model because it was so successful.

What about the potential for diversion to youths?

As a mother, it’s my first priority to protect young people and marginalized populations. We want to minimize diversion as much as possible — and you can do that more easily when something’s regulated.

And to the extent that someone who shouldn’t get a hold of a product does, it’s better if it’s quality-controlled and the dosage is controlled. A tested product with a standard dose is always better than an untested product with an unknown dose that could contain other substances. On the illicit market, there are incentives for the product to be higher dosage and cut with other substances. That presents far more danger.

Is your support for the legalization and regulation of all drugs rooted purely in the practicalities — a belief that it’s a cheaper and more effective method of reducing the harms and costs of problematic drug use — or is there also a philosophical component? Some people simply believe that it’s their right to consume whatever they choose without government interference.

I’m not a philosopher, I’m a regulator. The question for me is, should whoever is making the sales be regulated, pay taxes, and follow the law or not? So yes, it’s a practical question for me.

What, if anything, will you do to advance this policy?

I don’t think it’s appropriate for me to speak about this in my role as a commissioner. It’s totally outside the scope of cannabis regulation and the job of the commission. But as a drug policy expert, I think that it’s important to talk about the devastation that drug prohibition is causing. It’s a waste of money and resources, but the harmful use of drugs is a real problem. More of the same isn’t going to produce different results. We need a new approach, and I’m just one of many experts on this subject who are starting to consider legal regulation as an option.

I have a full-time job and a full plate at the moment. But I think it’s important to start a serious dialogue about it, collect data, and consider different options. That’s why I’m talking about it.

Is it realistic to hope that this will ever be implemented? Massachusetts recently abandoned a proposal to create safe injection sites, despite supportive data, after the US Attorney for Massachusetts issued a threatening statement calling them illegal — and that’s a lot less controversial than what you’re proposing.

Sensible drug policies tend to start with the people, not with political leaders. Just as we saw with cannabis legalization, it starts with people having discussions with their neighbors, family, friends, and then political leaders have to follow.

Dan Adams can be reached at daniel.adams@globe.com.