Cannabis, medicine and the law

 

Sir, – Last month we wrote outlining our concerns relating to dramatic increases in cannabis-related harm which we have witnessed in our clinical practice as doctors in Ireland (Letters, May 20th). Our backgrounds included psychiatry, general practice, neurology and emergency medicine. We are experienced medical practitioners in Ireland in senior roles.

The figures are stark. The number of young adults admitted to our psychiatric hospitals with a cannabis-related psychiatric disorder has increased by 130 per cent in just eight years. Cannabis causes one in every five new cases of psychosis. The last general population survey of drug use found that 22 per cent of young adult cannabis users reported symptoms consistent with dependence. That is 45,000 young lives being seriously damaged by this drug. The number of young adults presenting with cannabis addiction trebled between 2007 and 2015. In spite of increased harms, the proportion of people who see regular cannabis use as posing little or no risk has doubled.

Given these facts we were dismayed to see that a letter was written opposing a public education campaign on cannabis related harms, many of the authors working in Irish addiction treatment services. We find it odd that they do not want the general public to better understand the drug which is contributing so much to the workload in the services where they, and many of us, work.

Their letter eulogised about the outcomes accruing to places like Canada and some US states which have legalised cannabis recently. They make the claim that “the evaluations to date have been positive from a health perspective”. This is simply untrue. We hear of increased cannabis use already in Canada. In Colorado, there has been increases in cannabis related presentations to emergency departments, increases in cannabis-related mental disorders, increased deaths caused by cannabis-impaired drivers and increased accidental cannabis poisonings in children.

Others have entered the debate from abroad, with backgrounds primarily in economics and sociology. They misrepresent the comments we made in our original letter where we highlighted the blurring of boundaries which others are making regarding decriminalisation and legalisation of drug use. They failed to declare their links to the marijuana industry via the Open Society foundation.

Decriminalisation constitutes a relatively minor change to our drug policy. As defined by the EU drug policy organization, the EMCDDA, drug use is still prohibited under decriminalisation regimes. It is just that the sanction imposed with the goal of deterring drug use is a civil or administrative punishment, such as a fine, and not a criminal conviction. People who shout about their support for “decriminalisation” but who fail to state that drug use is still prohibited are misleading the public. It is a pity that decriminalisation, a policy which has substantial merit, has been hijacked by people whose real goal is the fundamentally different policy of legalisation.

While those pushing for legalisation resent our efforts to highlight the harms of this drug, we will continue to honestly talk about these problems. The legalisation movement seeks to inspire a sense of hopelessness and inevitability in the public and amongst policy makers. Our enlightened and progressive drug policy in Ireland has been focused on health and social outcomes for the past 20 years. It was born out of a crisis of heroin addiction in the 1990s. The success in tackling that problem should cause encouragement and not despair. The incidence of youth heroin addiction has dropped by over 95 per cent since that time. Cannabis use had actually been in decline also among youth until around 2011. Something has gone badly wrong in those past eight years.

As medical doctors, we wish to emphasise that we take a public-health perspective on this topic. We are not wedded to any drug policy ideology.

At present we see harms escalating. Our patients, and their families, report being blindsided by the problems that hit them, having generally held benign attitudes to this drug.

We share the view expressed in your editorial (“The Irish Times view on cannabis: a debate long overdue”, May 22nd) that “awareness [of the dangers] does not seem to have penetrated the public consciousness”. This must be urgently addressed. – Yours, etc,

Dr RAY WALLEY,

On behalf of the

Cannabis Risk Alliance,

Dublin 2.

Sir, – I refer to the ongoing debate on the subject of cannabis regulation. For those of us who approach the subject from the regulatory perspective we are acutely aware the current system of prohibition has failed from both a public health and criminal justice perspective and the only sensible solution is to regulate cannabis both for medical and adult use.

The current system of supply controls which emanate from international treaties (which have been transposed into domestic law by virtue of the Misuse of Drugs Acts and the accompanying regulations) has created an unregulated illicit market which affords no protection to those who wish to access cannabis for medical use and cannot under the existing licensing rules, and those who choose to use cannabis as a drug of choice.

It is accepted that no drug is made safer in the hands of criminal gangs or amateur growers, however nefarious the first are or indeed well-meaning the later may of may not be. Prohibition affords no protection to public health in so far that there are no quality controls, no guidelines on use or indeed restrictions on THC potency. Moreover, prohibition affords no protection to minors, in so far that if a teenager wishes to purchase cannabis, all that is required is that child has the money and knows whom to buy it from. Consequently, there is no ID requirement and no responsibility on the part of the suppliers to this black market. Rather than safeguard public health, prohibition is contributing to the hard cases that anti-cannabis activists hold up as the reason for continuing the failed policies of supply control, which make no sense.

In other words, all prohibition has achieved is the the abrogation by the state for the existing market for cannabis (whether you like it or not) to those who care nothing for the consequence. This has resulted in low potency cannabis being displaced, in the same manner that beer was displaced by high potency spirits during alcohol prohibition in the United States.

From a criminal justice perspective, prohibition has been an abject failure in so far that it has incentivised those who wish to supply while acting as no deterrent to those who wish to consume. Whereas decriminalisation is often held up as a means to remove sanctions from those who choose to consume, it is prohibition-light, namely a person is entitled to possess what the market is by law prohibited from selling. Again, it does little to remove the aforementioned problems which exist under the illicit market.

From a public health and a criminal justice perspective therefore, the sensible solution is to regulate cannabis both for medical (something which is in the process of taking place) and adult use. At the very least, regulation enables Governments to control the types of cannabis products placed on the market in terms of who can sell them, and who can consume, thus providing greater protection for minors and indeed medical patients. Moreover governments employing sensible policies and regulations can reduce consumption in the same way they have dampened and reduced the demand for tobacco among the general public.

Perhaps the group calling themselves the Cannabis Risk Alliance, in their call for an unbiased examination of the evidence, should look at the true effects of prohibition a little more carefully before they unilaterally dismiss regulation as an option. – Yours, etc,

NIALL NELIGAN,

Lecturer in Criminal Law

& Drug Policy Regulation,

School of Law, Languages

& Social Sciences,

Technological

University Dublin,

Dublin 2.