A glowing review of the Beckley Foundation’s book “Cannabis Policy: Moving Beyond Stalemate” has been published in POP News (here), the newsletter for the Canadian Institute of Population and Public Health, one of 13 Institutues that comprise the Canadian Institutes of Health Research.
The review was written by Dr Brian P Emerson
This article reflects the views of the author and do not represent BC Government policy.
“That which is prohibited cannot easily be regulated”
The adverse public health and social impacts associated with use of and policies related to psychoactive substances (alcohol, tobacco, illegal substances) are substantial, and in many respects, preventable. They are estimated to account for 21% of deaths, 24.9% of potential years of life lost, and 19.4% of acute care hospital days, at a cost of $39.8 billion per year (Rehm et al., 2006).
The magnitude and persistence of psychoactive substance related problems calls out for increasing public health attention. The book Cannabis Policy: Moving Beyond Stalemate is a valuable resource for those working on reducing the harms of psychoactive substances at the local, provincial/territorial, and federal levels. This book was originally commissioned as a paper by the Beckley Foundation to contribute scientific evidence and ideas for improvements to the United Nations 10-year review of the international drug control program that took place in 2008-09 (Beckley Foundation, 2010).
The thesis of this book is that change is needed because “the international cannabis prohibition regime by its nature and functioning imposes substantial personal and social harms” (p.146)… , the regime is ineffective, and the international “conventions restrict the ability of signatory countries to adopt cannabis policies and laws which are driven by evidence… they also restrict the accumulation of evidence…. and yet the international drug control system seems increasingly paralyzed and immobile” (p.150).
Consequently, “at the local, state or provincial levels, the problems arising from global policies must be picked up and managed – and much of the action on policy is here because of the stalemate at national and international levels” (p.13).
To support the thesis, the authors describe the adverse health and psychological effects of cannabis; the evidence base and limitations to inform policy and practice; research gaps; the international cannabis control system; and the harms of prohibition including the “arrests of many hundreds of thousands of cannabis users in the Western world”(p.73), the unfairness with which cannabis laws are enforced “making life difficult for marginalized populations” (p. 74), the adverse consequences from creating large-scale illegal markets that breed violence, the generation of “tens of billions of dollars in revenues to criminals”(p.7), and corruption. “It is a concern about the disproportionality of these social harms relative to the dangers of the drug itself that is at the heart of many efforts to reform current policies” (p.7).
While recognizing the limitations, and drawing on lessons from alcohol and tobacco control, the authors provide suggestions to reduce harms associated with cannabis and with the current control policies. For example “there is minimal evidence that changes in statutory penalties would reduce cannabis use. The lack of evidence of a deterrent effect has to be weighed against the considerable harms that undoubtedly arise from the existing regime” (p.73) and changes would need to avoid “lax regulations on sellers, self-regulation, and promotion by industry-driven commercial interests” (p.104).
The clear definition and discussion of conceptual issues, terminology, and typologies of policy tools that have been used in different countries to try to manage cannabis is helpful, as is the explanation
of the complexities of the international control regime which contributes to the “stalemate”.
Ideas for moving forward at the international level are provided, and of particular interest to public health workers is the innovative idea of creating a new treaty based on the Framework Convention on Tobacco Control. The authors even provide a draft Framework Convention on Cannabis Control to further that discussion.
Public health policy involves weighing harms and benefits; however, there is only brief mention of the benefits of cannabis, and limited discussion about the policy implications of regulating the use of cannabis for therapeutic purposes (“medical marijuana”). This seems to be a gap given the gathering momentum for “legalization” initiatives in the USA that have their roots in state regulated medical marijuana propositions. The recent Ontario Superior Court (currently under appeal) case striking down sections of the federal Controlled Drugs and Substances Act and the entire Medical Marijuana Access Regulations indicate the pressing need for policy reform in this arena.
There is a very short section on the public health impact of cannabis use, and the authors point out the “dearth of evidence on impact on mortality and morbidity” (p.43), in contrast to the volumes of evidence available on the impacts of alcohol and tobacco, highlighting the need for more public health attention to cannabis. In view of the observation that prohibition is the source of much harm, the book would have been strengthened by including more quantitative information on the harms of prohibition, and it would have been interesting to have more discussion of the reasons for the “stalemate” affecting policy reform. For example, one value of prohibition identified by a related recent award winning book on this topic is that it “prevents large-scale corporate entities from promoting drug sales through modern marketing techniques”(Babor et al., 2009, p.255)
Overall, this book provides a valuable overview of the evidence to inform policy and practice, and achieves well its aim to “lead the way towards a more rational, effective and just approach to the control of cannabis” (p.vii). This book will be a very useful resource for anyone interested in the challenges of developing public health oriented approaches to not only cannabis, but to other psychoactive substances of public health concern. Besides reducing the harms associated with cannabis and related policies, the value of developing a public health oriented approach to cannabis will be in paving the way to designing and strengthening public health approaches to other illegal drugs, in addition to tobacco and alcohol.