Should cannabis be legalised?

There is a lot of confusion across the globe regarding whether to decriminalise cannabis use with or without legalisation.  Some countries like Canada, UK, France, Switzerland, Belgium have been trying to make rules more permissive. The realisation that cannabis may have therapeutic value in certain situations like cancer & HIV weight loss, nausea associated with chemotherapy etc may be partially responsible for this. But there is strong international pressure, especially from the International narcotics control bureau (INCB), to abide by the global policies framed in accordance to UN conventions.

I recently presented a seminar in regard to this reviewing the evidence for and against cannabis use decriminalisation and legalisation.

These are the bottom lines-

Hazards related to cannabis use:

It is a well accepted fact that deaths related to alcohol and tobacco (which are legally permitted substances) are more than cannabis by a ratio of at least 10:1. So question is, what is the basis of cannabis being illicit while both alcohol and tobacco are not? Is it just that the countries which are major producers of alcohol and tobacco products have more clout in the international arena?

Current evidence suggests that there is robust evidence for an association between cannabis and psychosis. But there is not enough evidence for a suggestion of causality. The relation could be through a third, hidden environmental or genetic factor.

Another point that has been often raised against cannabis is that, it acts as a gateway drug. That is, use of cannabis leads to use of other harder drugs like cocaine or heroin. Actually, the evidence suggests that this could be true. But the conclusion could be different depending on what mechanism one accepts as behind this. For example, if this is due to users of cannabis coming in contact with drug peddlers who also deal in hard drugs, then the best approach would be uncoupling the supply by legalising cannabis and decreasing the contact with hard drug peddlers. But if the gateway effect is due to a decreased psychological resistance after using cannabis or a need for bigger highs, avoiding contact by prohibition of cannabis may be more relevant. Evidence from Netherlands where cannabis was legalised suggests that hard drug use has not been dented by allowing coffee shops which serve cannabis products. So probably, legalisation of cannabis is not going to help to prevent the gateway effect.

Medicinal cannabis use:

One of the developments which have led to a revival of ‘legalise cannabis’ argument has been the recent realisation that cannabis has significant role in managing cancer or HIV weight loss, nausea related to chemotherapy etc. But a review of evidence suggests that there are lot of methodological issues with the studies conducted including lack of any real blinding. Meta-analyses suggest that currently there doesn’t appear to be any hard evidence to prefer cannabis for any of these medical indications over the currently available medications for the same indication.

Experiences with cannabis policy:

So what is the problem with maintaining the status quo and letting cannabis be a prohibited drug? The question is whether the costs of prohibition are more than acceptable. In the specific case of India, since 1985, after Narcotic drugs and Psychotropic substances act (NDPS) came into being, 75% of law enforcement activities has been in relation with cannabis. Almost 80% of all arrests in relation to drug use are due to cannabis. All this in a country where there is long tradition of using cannabis as indigenous medicine. Bhang is a part of our festivals and use of cannabis is so closely intertwined with our culture… Also wild growth of cannabis is so rampant in some states that banning the growth of cannabis doesn’t have any meaning… Even in USA, which is comparatively very stringent in enforcement of prohibition of cannabis, the use of cannabis has remained constant despite increasing number of arrests (by around 150%) over the years. Compared to Netherlands which is an example of legalisation of cannabis, the rates of cannabis use in USA has been higher. It has been also shown that the trends of cannabis use in Netherlands in last 2-3 decades are similar to waves in many other countries which have stringent policies. So it has been proposed that cannabis use go through certain trends which are independent of the government policies for controlling or liberalising cannabis use. So what is the point of shelling out tax payer’s money for law enforcement for controlling cannabis use?

So what is the verdict? It appears that decriminalisation of cannabis personal use may be sensible. But at the same time, as trends in certain situations show, legalisation of cannabis can lead to unhealthy promotion of cannabis use by private interests (like tobacco or alcohol) leading to unhealthy trends.

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4 thoughts on “Should cannabis be legalised?

  1. a few thoughts in reply (and to be clear, much is based on my experiences in the US):
    The deaths related to cannabis vs alcohol/tobacco is much wider then 10/1. I am unaware of a single confirmed death due to ingestion of cannabis. And while there are certainly accidental deaths where cannabis is involved, these numbers are murky at best, and substantially below those of alcohol. One problem is that cannabis is detectable longer in the system then any other substance- and toxicology reports will often note the presence of cannabis, but it is in no way and indication that cannabis played a role.

    I would argue the point of evidence of cannabis/psychosis link as well. Much of the current research I am aware of indicates that while it may cause an earlier onset by 2-3 years, the underlying psychosis was already there. There is also a body of evidence suggesting that these people are more likely to “self medicate” with cannabis before the signs become readily apparent- further skewing the numbers.

    Your statements on the “Gateway Effect” seem somewhat contradictory. And your understanding of the research on hard drug use in the netherlands superficial. While it is true that there was not a major decrease in harder drug use- specifically heroin, that number alone does not tell the story. The dutch also have various harm reduction programs in place- and they kept many of their addicts from dying. They actually saw a substantial decrease in new hard drug users, while the existing populations average age grows- because they are still alive. And certainly- if cannabis was a gateway drug- one would expect a substantial increase in harder drug use with its decriminalization, which has not occurred in the netherlands, portugal, czech republic.

    From personal experience- and simple logic, the point of legalizing removing users from contact with other illicit substances is a valid one.
    Another point- that I think every marijuana user will tell you- we grow up being told marijuana is this demon drug. And when we try it, we learn we have been lied to. So then the obvious question- have I been lied to about mushrooms? LSD? Cocaine? …and overwhemingly, the answer is yes- regardless of what nuggets of truth may have actually been hidden among the lies. As the saying goes- honesty is the best policy- and this has been missing from Drug Policy for decades.

    There is no pharmacological evidence to support the “gateway theory”, and in fact the NIH has disavowed it. And lets be honest, by the time an american tries marijuana- they have already experienced some or all of the following drugs: the sugar high, caffeine, alcohol, tobacco, stimulants in the form of ritalin or other add/adhd drugs, codeine in pain killers, dextromethorphan (DXM) in cough syrup…

    1. I agree that differences between licit substances and cannabis may be even more skewed in favour of cannabis.
      But I differ regarding cannabis and psychosis link. There are at least 4-5 meta-analyses out there in last one decade which clearly shows that ever use of cannabis increases the risk of psychosis. As I mentioned, the causality is not established. But still with the current evidence, it is not possible to push this under the carpet just because one believes in a permissive cannabis policy.
      ‘Your statements on the “Gateway Effect” seem somewhat contradictory’- Don’t know what you really meant. May be it was about the inferences one could draw if cannabis is a gateway drug. What I was trying to say is that, while trying to decide about legalising or prohibiting cannabis based on gateway effect, one can go in opposite directions depending on how one explains the mechanism of gateway effect. If it is due to ‘breaking the contact,’it would be in favour of legalisation. If it is through augmenting personal predisposition (3 mechanisms are cited in literature for this), then stricter policies may be warranted.
      ‘ And certainly- if cannabis was a gateway drug- one would expect a substantial increase in harder drug use with its decriminalization, which has not occurred in the netherlands, portugal, czech republic.’-Again that depends on which mechanism of gateway effect one accepts.
      ‘While it is true that there was not a major decrease in harder drug use- specifically heroin, that number alone does not tell the story. The dutch also have various harm reduction programs in place- and they kept many of their addicts from dying. They actually saw a substantial decrease in new hard drug users, while the existing populations average age grows- because they are still alive.’-If what you are trying to say is that dutch drug policies were so effective that old drug users didn’t have a premature death and so overall prevalence of hard drug use was same even though cannabis legalisation decreased new onset of hard drug users, the question is, how can one be sure that legalisation actually decreased hard drug use? What if these ‘very effective dutch drug policies’ compensated for gateway effect of cannabis?
      ‘There is no pharmacological evidence to support the “gateway theory”, and in fact the NIH has disavowed it.’- It’s news to me. Is it that there is no pharmacological evidence but other kinds of evidence? Or is it that there is no evidence at all? Can you sent me reference to this comment about NIH?
      ‘By the time an american tries marijuana- they have already experienced some or all of the following drugs: the sugar high, caffeine, alcohol, tobacco, stimulants in the form of ritalin or other add/adhd drugs, codeine in pain killers, dextromethorphan (DXM) in cough syrup…’- well, don’t know whether this is true of every American. Anyway, in many other countries, cannabis is a part of the experience of growing up while many in the list are not.

  2. Very interesting post. I have always felt that marijuana should not be legalized but the punishment for its consumption relaxed. It’d be interesting to note what the creative/sports/scientific output of countries like Netherlands are as compared to say a country which is tough on these drugs.

    1. Hi Sameer, The problem is that the creative/scientific/sports output of countries cannot be said to be wholly dependent on drugs. There are going to be many other factors involved, like culture, work ethics, opportunities, govt policies regarding same etc.

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