Drug policy and culture: A cross-national comparative study using Hofstede’s index

Background National drug policies vary widely across countries, shaped by historical, institutional, economic, and social factors. However, the role of cultural values in shaping drug policies remains underexplored. This study applies Hofstede’s cultural dimensions index to assess associations between national cultural norms and Global Drug Policy Index (GDPI) scores. Methods We conducted a cross-national comparative analysis using data from 25 countries with both GDPI scores and Hofstede’s cultural dimension scores in 2021. The dependent variable was the GDPI overall score and four sub-indices: Absence of Extreme Sentencing, Proportionality of the Criminal Justice Response, Health and Harm Reduction, and Access to Controlled Medicines. Independent variables included four Hofstede dimensions: Power Distance, Individualism, Masculinity, and Uncertainty Avoidance. Control variables included GDP per capita (log), cannabis prevalence, continent dummies, and opium/coca production status. Ordinary least squares (OLS) regressions with robust standard errors were used. Results Higher Power Distance was associated with lower overall GDPI scores (β = -0.296, p = 0.015), as well as with the Absence of Extreme Sentencing, and Access to Controlled Medicines indicators, suggesting that hierarchical societies tend to adopt more punitive and restrictive drug policies. Uncertainty Avoidance was positively associated with Access to Controlled Medicines (β = 0.234, p = 0.051). Higher cannabis prevalence showed consistent positive associations with progressive policy outcomes, while regional variation was evident, particularly in Europe and the Americas. Conclusion This study highlights the role of cultural values in shaping national approaches to drug policy, with power distance and uncertainty avoidance emerging as significant factors. Higher cannabis prevalence, a reflection of the epidemiological context, was also associated with more progressive policy outcomes. Policymakers should consider cultural and public health factors when designing drug strategies, particularly in hierarchical societies, where specific reforms may be needed to limit punitive laws and expand access to essential treatments.