Let's talk about pot

In an ideal world, public policies towards cannabis would be informed by both evidence on the personal harms it causes and social and economic evaluations of the costs and benefits of alternative policies in minimising these harms. A paucity of both types of evidence is a major challenge to the development of such “evidence-based” policies towards cannabis use. Wayne Hall.

There is a limited quantity and quality of research into the health effects of cannabis, but it is nonetheless possible to identify its most probable adverse health effects. These include: an increased risk of motor vehicle crashes if users drive while intoxicated; the development of dependence; increased respiratory symptoms; poorer mental health, including increased risks of psychosis and possibility of depression; and poorer adolescent development, including early school leaving and increased risk of using other illicit drugs.

There is less research into costs and benefits of cannabis policies because, internationally, a narrow range of policy approaches is available for evaluation. These generally involve marginal differences in penalties for cannabis use and possession (for example, imposing fines or counselling rather than imprisonment). The effects of these changes in penalties are likely to be small, and none has been detected in evaluations to date. Evaluations of the more controversial Netherlands cannabis policy – decriminalising personal cannabis use and small-scale retail sales in coffee shops – have come to different conclusions about its effects on rates of use.

Public debate about cannabis policy has often been radically simplified by the media. The public has been invited to believe either that cannabis use is harmless, and hence should be decriminalised (if not legalised), or that cannabis is harmful to health, and so its use should continue to be prohibited. As a consequence, public debate often presents highly polarised evaluations of the health effects of cannabis, with any rational discussion of its health risks the first casualty.

Proponents of prohibition have taken evidence of harms found among cannabis users at face value, ignoring any alternative explanations. Proponents of reform of the existing laws, by contrast, have discounted evidence of harm caused by cannabis use, while emphasising the social costs of enforcing cannabis prohibition.

Discussions of public policy towards cannabis should use consistent standards in appraising evidence of harm from cannabis use and cannabis policies. Good public policy on cannabis requires investments in epidemiological research on the long-term health consequences of its use and social science research on the costs and benefits of current and alternative policy options.

The epidemiological research need not be expensive if cannabis use is routinely asked about in prospective studies of adolescent development, as has been done in New Zealand or in longitudinal studies of adult health such as those in the USA. Another critical ingredient for policy progress is a wider public involvement in the debate. A more realistic understanding of the health effects of cannabis and the impact of cannabis policies requires less partisan appraisals than usually dominate media debates.

Better evidence on the harms of use and cannabis policies is important, but it cannot determine what cannabis policy we should have. In pluralistic social democracies like New Zealand and Australia, social policies in controversial areas like cannabis use must involve a search for a societal compromise that is the most acceptable to the most people (or least objectionable to the fewest). This is because cannabis policy must balance competing social values that are in conflict, namely, the individual freedom of adults to use cannabis, protecting the health of young people, reducing crime, minimising the societal costs of enforcing widely broken laws, and so on.

There is no consensus on what priority these competing social values should be given, so policy debates in democratic societies are and ought to be resolved by a deliberative political process. The political process should take into account evidence on both the harms caused by cannabis use and those that arise from the social policies we implement to prevent its use and resulting harm. This holds the greatest prospect of producing a cannabis policy that enjoys broad community support and best reduces related harm.

Professor Wayne Hall is based at the School of Population Health, University of Queensland.

The current high levels of use and the level of black market activity indicate that the current prohibition regime is not effective in limiting cannabis use. Prohibition results in high conviction rates for a relatively minor offence, inhibiting people’s education, travel and employment opportunities. Prohibition makes targeting education, prevention, harm minimisation and treatment measures difficult because users fear prosecution. It also facilitates the black market and potentially exposes cannabis users to harder drugs. Chris Fowlie

So said the Health Select Committee’s report on the inquiry into the legal status of cannabis, in August 2003.

Whatever your take on the health effects of cannabis – and we all have our opinions – it is clear that prohibition has not worked, and a drugs policy re-think is in order.

If the aim of prohibition has been to prevent use, it has failed spectacularly. Despite having the highest cannabis arrest rate in the world, more New Zealanders use cannabis now than ever before. Half of New Zealanders are criminalised by this law. Eighty percent of 21-year-olds have tried cannabis. How many should be arrested before prohibition is judged a success?

Enforcement of cannabis prohibition by the police, courts and prisons cost taxpayers $56 million in 2000. While more than twenty million dollars is spent every year chasing ordinary Kiwis for small amounts of cannabis, treatment services and effective education are struggling or, in places, don’t exist. Furthermore, fear of arrest is the biggest barrier to those seeking help.

Though use is widespread in New Zealand, enforcement of drug laws impacts much harder on Maori, who are five times more likely to be arrested for cannabis than non-Maori.

The present law is a form of institutional racism. Its enforcement alienates police from society and causes enormous harm to the lives, careers and families of more than ten thousand people arrested every year.

Research confirms that drug laws have little effect, if any, on drug use rates, but they do increase or decrease the harms associated with use. Countries that have reformed their laws have not experienced increased use, but have spent millions of dollars less on law enforcement than countries where prohibition remains.

The Dutch, who have allowed the sale of cannabis to adults since 1976, have one-third the per capita usage of New Zealand. In the United Kingdom, teen cannabis use dropped after it was made a non-arrestable offence.

There is no difference in use between those Australian states who have decriminalised cannabis and those that continue to arrest users. The United States also shows no difference between the ten states – representing half the population – who decriminalised in the 1970s and those that did not. Recent analysis of cities in California, Colorado, Washington State and Oregon showed there was no influence of medical cannabis laws on the extent of illegal cannabis use. The researchers said that the “use of the drug by those already sick might ‘de-glamorise’ it and thereby do little to encourage use among others”.

The most commonly voiced concern about ending prohibition centres around the protection of children. However, problems in our schools or communities are made worse under current law, not better. Prohibition promotes a ‘forbidden fruit’ mentality, glamorising cannabis as a token of rebellion. Open and honest communication is made more difficult in an environment of guilt and persecution. The untaxed cannabis economy is worth hundreds of millions of dollars and controlled by whoever is prepared to break the law. Violence and intimidation rule the market, just as was the case under alcohol prohibition in 1930s America.

So what should be done about it?

If we are genuinely committed to harm minimisation, we should immediately repeal cannabis prohibition and investigate the failure of current drugs policy.

Let’s control the way cannabis is used and sold through appropriate regulations such as age limits, health warnings, dosage and packaging controls, marketing restrictions and so forth.

Let’s use cannabis excise taxes to provide effective education about drugs so that people can make responsible and informed choices, and fully fund treatment services for those who need them. Let’s provide enough resources to research the effect of any law changes.

Modern research shows cannabis is an effective and safe medicine for many conditions including cancer, HIV wasting syndrome, glaucoma, chronic pain, arthritis, multiple sclerosis, paraplegia and epilepsy. Let’s allow doctors and patients to decide what treatment is best for them, not politicians or police.

Given the spectacular failure of the current law, the burden of proof should be on prohibitionists to show why we should persist with this expensive and destructive mistake.

Chris Fowlie is President of the National Organisation for the Reform of Marijuana Laws in New Zealand.

Two ways some jurisdictions have tried to reduce cannabis-related harm is by changing the laws that apply to cannabis (de jure changes), or by modifying the way these laws are enforced by police (de facto changes). Simon Lenton

De jure changes can include prohibition with civil penalties, and partial prohibition. Under the former, possession and use remain illegal but civil rather than criminal penalties apply, and more severe sanctions are maintained for larger-scale possession supply offences. Such a system applies to cannabis use in 11 US states and four Australian jurisdictions – South Australia (1987), the Australian Capital Territory (1992), the Northern Territory (1996) and Western Australia (2004). Under partial prohibition, personal use activities are legal, but commercial activities are illegal. Examples exist in Columbia, Spain (where possession is only considered punishable if it is for consumption in public places) and Switzerland.

De facto de-penalisation can include prohibition with cautioning and/or diversion schemes (examples of which operate for a range of drugs in Italy, Portugal and Australia) and prohibition with an expediency principle. Under the latter, all drugrelated activities are illegal, but cases involving defined small quantities are not investigated or prosecuted. Examples of this system operate for cannabis in Belgium, Germany, Denmark and the Netherlands.

Although the published evidence evaluating the impact of cannabis policies is not large, caution needs to be exercised in its interpretation. The policy environment is a dynamic one where effects decay, and what is originally implemented changes over time. International comparisons are difficult, and results can be confounded by cultural, political, geographic and climatic differences. Cannabis law reforms often occur in locations with already high rates of use. Consequently, pre-post or longitudinal designs with ‘matched’ control locations are needed to identify true impacts. Any research evidence is at best indicative, as the actual impacts of any future cannabis policy reforms will depend on contextual factors and how the reforms are implemented. Therefore, it is important that changes to cannabis policy are evaluated, monitored and reviewed.

Most of the available published research has been done on moving from strict prohibition to prohibition with civil penalties. Taken as a whole, this research finds that removing criminal penalties for cannabis possession and use does not result in higher rates of cannabis use, but does reduce the adverse social impacts of conviction in terms of employment, further contact with the criminal justice system and so on. Savings in police and court resources can be considerable, but depend on the size of the jurisdiction and the way the schemes are implemented. There have been a small number of studies in the economics literature that have claimed that rates of cannabis use are higher in those states that have “decriminalised”.

However, because these studies have not taken into account rates of use prior to the legislative changes, it cannot be concluded that the higher rates of use were as a result of the legal changes, particularly as those states that reduce penalties often have higher rates of use beforehand. Yet there is more compelling evidence that rates of cannabis use would likely increase, especially among the young, if use was legalised.

Cautioning schemes where first-, second- or third-time apprehended cannabis users are required to attend education or treatment, rather than get a conviction, are in place in four Australian jurisdictions. While politically expedient and supported by the drug treatment sector, evidence of their effectiveness is thin. There is a concern that tying up treatment resources with this group may not be the best use of this valuable resource.

Questions remain about whether those diverted to treatment actually engage or may be more willing to do so in future. Also, given that only between two and five percent of cannabis users have contact with the criminal justice system in any one year, it is doubtful whether a system built around this group is ideal, even if we assumed that the majority of them had significant cannabis use problems.

Similarly, prohibition with civil penalties schemes can have unintended consequences depending on the scheme and how it is implemented. For example, the South Australian (SA) scheme has been shown to have a low rate (45 percent) of people paying their fines by the due date. In comparison, the Cannabis Infringement Notice Scheme implemented in Western Australia (WA) since 2004 has an overall rate of 65 percent, as those who fail to pay or attend an education session in lieu of fine risk having their driver’s licence cancelled.

Similarly, the SA scheme resulted in significant “net widening”, with the number being processed for minor cannabis offences increasing by 2.5 times after the scheme was introduced, due to the ease with which notices could be issued. While the WA scheme has resulted in some net widening, this has been modest, possibly because police are processing apprehended users at the police station where they are photographed and finger printed, rather than issuing the notices in the field, as intended by the scheme’s designers.

Socially and economically disadvantaged members of society, such as indigenous people, may be disadvantaged by new penalty options, just as they often are with existing criminal justice responses. Special effort needs to be made to monitor and address this.

The legislative changes in WA were about treating cannabis use as a health and social issue, rather than primarily one of criminal law. Importantly, this was not simply for the small proportion of cannabis users who are apprehended by police each year, but for the more than 90 percent who are not. Limited but growing evidence suggests that cannabis users may be more willing to voluntarily seek help for cannabis problems in an environment where civil rather than criminal penalties apply.

Yet legislative changes themselves at best only provide a context for reducing use and harm. If this is to be capitalised on, the penalty changes need to be accompanied by: balanced public education about cannabis, the law, the realistic risks and harms and how these can be reduced; and provision of a range of accessible, effective and attractive treatment options for those with cannabis-related problems.

Associate Professor Simon Lenton is a Deputy Director at the National Drug Research Institute in Perth.

The next 12 months will not be fruitful for those wanting a serious policy debate about possible changes to our cannabis laws, but there may be an opening for such a debate during the 2008–11 Parliament. Matthew Hooton

Those wanting to lobby for policy change need first to understand the cardinal rule of politics: politicians care about nothing except getting elected and re-elected.

Most people suspect that this rule is true but they don’t understand the extent of it, and they can be shocked when initially confronted by its savagery. In fairness to our politicians, it could be argued that the rule is highly democratic in that it demands they reflect the will of the people. Politicians also justify themselves by saying that, unless they are elected and re-elected, they can do nothing to put in place their brilliant plans for our futures.

When it comes to cannabis, the basic political assumption is that the public is either conservative or indifferent on the question of law reform. Those in favour of liberalisation are seen as a minority of mostly youngish Green or Labour voters, or libertarian ACT or National voters, who take their policy guidance from the pro-legalisation Economist magazine. Neither of these groups is seen as swing voters, who politicians care most about because they ultimately decide elections.

This basic assumption may be discouraging for proponents of decriminalisation or legalisation and, in fact, may even overstate the public’s appetite for liberalisation of existing laws.

A brief poll carried out exclusively for the New Zealand Drug Foundation by New Zealand’s most-respected polling company, UMR Research Ltd, suggests that fully 25 percent of the population agree that existing laws should be made “a lot tougher”. Another 9 percent believe the law should be made “a little tougher”.

That means more than a third of the population say they want tougher laws. In contrast, just 11 percent say the law should be made “a lot more liberal”, and another 8 percent think it should be “a little more liberal”. Nearly half of us, 46 percent, believe there should be no change at all.

Most significantly, these proportions are relatively stable across income groups, gender and geography – although far fewer Wellingtonians than the national average want the law made tougher, reflecting how out of touch with the rest of the country the capital city often is.

When it comes to age groups, there is the expected general trend of people becoming more conservative as they get older. Interestingly, however, 20 percent of people under 30 say they want tougher laws.

There is no majority for liberalisation in any demographic group.

Professionals in the cannabis abuse and public policy industries argue that a simple polling question is not a sound basis on which to develop public policy, and they are right. But they are experts in a particular field, not politicians having to develop policy across the full range of topics and needing it to be popular in order to be elected. All our political parties will receive roughly the same polling data telling them that the net result from adopting a policy of more liberal cannabis laws will be to lose votes, and none of our important political parties has any room to lose votes over the next 15 months.

National is sitting on 50 percent support but with no obvious coalition partners. To be assured of becoming the government, it can’t afford to lose even a few percentage points.

Labour is now sitting in the low 30s. It knows that, should a poll be published giving it a result with a two at the front of it – even 29.9 percent, the media will talk of the risk of a “collapse”, and that such talk will become self-fulfilling, driving its support to levels from which it cannot recover.

The Green Party, usually seen as the most likely to push for liberalisation, sits at around MMP’s five percent threshold. Should it fall below five percent, it is out of parliament altogether, and its strategists believe that Nandor Tanczos’s association with cannabis law reform in previous elections cost it support from the sort of worried suburban mums that Sue Kedgley might otherwise appeal to.

The Maori Party draws its funding and many of its votes from more traditional Maori society, many of whom perceive that colonisation has poisoned their people with alcohol and tobacco. They will oppose anything that risks being seen as condoning the use of any drug. While the party’s leading figure, Tariana Turia, has said there should be a level of cannabis reform, she says she cannot support full legalisation. She will not want cannabis to be an issue for her party, which seeks every vote possible in order to hold the balance of power after the next election.

The centre parties, New Zealand First and United Future, reflecting their elderly and conservative voters, are staunchly opposed to liberalisation. The Jim Anderton and ACT parties do not count.

If advocates for liberalisation want to make progress politically, they will first need to convince the public, in order to shift the polls. Labour’s Electoral Finance Bill, however, will make it illegal for the New Zealand Drug Foundation or anyone else to effectively communicate with the public on this or any other political issue in 2008.

There is one opening ahead, however. Our likely next Prime Minister, John Key, has staked his political career on addressing the issue of the so-called “underclass”, reversing social exclusion and building social cohesion. Key knows that, when he is seeking re-election in 2011, he will be accountable against those goals.

In the lead-up to the 2011 election, our media will return to McGehan Close (which is in the Mt Roskill electorate of likely opposition leader Phil Goff) to interview Aroha Ireland, who Key took to Waitangi this year. The media will ask her and her neighbours what has changed in the three years Key has been Prime Minister. If the answers are not satisfactory, Key knows he will be a one-term Prime Minister.

Those who believe in the principle of harm minimisation rather than criminalisation have an opportunity to demonstrate to the new Prime Minister that reform of cannabis laws is necessary to break the influence of criminal gangs, allow effective treatment for drug abuse and improve the quality of information available to young people.

Reform advocates need to show Key that only by acting on this issue, will he be able to make progress in reducing the underclass. In short, they need to show Key how liberalisation will help him get re-elected, notwithstanding what he reads in the polls about public attitudes towards cannabis law reform.

Some will read this as a pessimistic assessment of New Zealand politics. But if it is true that liberalisation will help tackle wider social issues, then it should not be beyond the New Zealand Drug Foundation and others to make that case to help secure the social gains that are claimed. If those gains cannot be demonstrated conclusively to the new Prime Minister, then it is only right that any government should proceed cautiously.

Matthew Hooton is Managing Director of Auckland public relations company Exceltium Ltd, and a prominent political commentator.

I awoke this morning to a flurry of colourful and fantastic insights for my story on cannabis. By the time I made it to my desk, all those wonderful ideas had dissolved like smoke in the wind. Michael B

In so many ways, that sums up my 20 years of cannabis use.

From the start, I loved using cannabis because it opened my mind, heightened my senses and made me feel connected with the universe and the otherwise scary people that populated my world.

Gradually I set up my life around pot. Early on, I learnt to grow it because that kept the cost down. Inevitably, this led to a prosecution for cultivation. Along the way, I began to deal in pot (and other drugs) to ensure supply and help fund my own use.

When I was finally earning enough in my career to fund my habits, I surrounded myself with folk who supported my using; people who often found me more accessible, thoughtful, even useful, I suppose, when I was stoned.

At one point, I even had the landlord build a deck off my office so I only had to walk a couple of paces to have a smoke in privacy.

Most of my friendships were founded on drug use and my ability to supply. At first, I liked the needy nature of the supply relationship, but later on, I found it pathetic and embarrassing.

As I had my first smoke at breakfast, I knew there was a good chance that in an hour or so I would feel edgy, unfocused and indecisive, yet the lure of that wonderful first-up rush of warmth was just too much to resist. The sense of physical wholeness and the psychological shift that came from that first smoke overpowered my knowledge of the consequences.

In the end, my best friend turned on me. My mind had become closed and could barely function. The world had become a grey and foggy place, and my overwhelming paranoia had distanced me from everybody.

People couldn’t understand my using, and they found it difficult to understand my behaviour and even my words a lot of the time. My work became at best unpredictable, and my ability to have intimate relationships was negligible.

This was all from a drug that the press at the time suggested was not harmful. Apparently, it was neither physically nor psychologically addictive, and the only real harm was to the lungs. I so wanted to believe the “evidence”.

At about age 35, I decided that I needed to grow up, get a life and be like the folk around me who weren’t stoned, yet seemed to be leading pretty good lives. I began to want a life that didn’t have so many crutches.

I decided to stop smoking cannabis.

But stopping turned out to be a little trickier than I thought. First, there was the physicality of the whole process, the feeling of total discomfort in my being, an itchiness coupled with an inability to sit still, and an overwhelming sense that something was missing.

The psychological withdrawal could be summed up by the word “craving” – a complete and absolute obsession with cannabis 24 hours a day. No matter how much I drank or what other drugs I used, I couldn’t shake that obsession.

I realised then that I had a problem and that the problem was something I could not easily deal with.

Over the next few years, I would often swear off pot on a Sunday and by Wednesday – or maybe, if I was really lucky, Thursday – I would find that I was stoned, but with no real connection to how it had happened. This was a period of constant internal strife and struggle.

Seven years after my first attempt to put pot away, I surrendered to its power over me and, through treatment and support, found a way of living without my dear friend. I was given tools to help me live with the physical craving and mechanisms to deal with the overpowering mental obsession. In this way, I was able to walk though the withdrawal that dragged on for many months.

Ten years on and the veil that is my relationship with cannabis has been lifted. I am now able to see what I was like to the world and how I had short-changed myself by living that shrouded existence.

I have watched others close to me go along a similar path, and I’ve felt sad and powerless to help. But there has also been gladness that I am finally free of that grey, clouded, smoky world.

To contact Michael about his story, please email cannabisveil@ihug.co.nz.