Research paperCannabis consumption patterns among frequent consumers in Uruguay☆
Introduction
In 2013, Uruguay became the first country in the world to regulate the possession, growth and distribution of cannabis. The initiative, introduced by then president José Mujica, was passed by the Uruguayan Congress and signed into law on December 20, 2013. Although there seems to be no consensus in the literature about the effects of reforming cannabis laws on cannabis consumption (Chu, 2014, Pacula and Sevigny, 2014, Single, 1989), studies in several locations have pointed to the importance of cannabis legalization on the way people use cannabis, whether recreational or medical (Cerdá et al., 2012, Hasin et al., 2015, Khatapoush and Hallfors, 2004, Pacula et al., 2015). Learning about consumers’ habits prior to the full enactment of the regulation provides a baseline upon which we can evaluate the new cannabis policy. Independent assessments might contribute to inform and even reshape policy implementation.
Legalization of cannabis has several potential policy implications (Caulkins et al., 2012, Caulkins et al., 2014, Singleton and Rubin, 2014). Commercialization involves issues of retail price and tax revenues. Availability impacts issues of health and unintended consequences, such as spill-over effects in neighboring states where cannabis remains illegal. The decision of the Uruguayan government to regulate the cannabis market chain, from production to retail, implies a titanic effort in terms of policy making, regulation and evaluation.
The innovative drug policy approach on which Uruguay has embarked has been met with great enthusiasm by the civil movements that clamored for legal cannabis in Uruguay1 and were a key part of the current policy design (Garat, 2015). However, the legislation has also faced important challenges. According to the AmericasBarometer 2014 survey, more than 60% of Uruguayan citizens disagree with the law (Cruz, Queirolo, & Boidi, 2016). Leaders of the International Narcotics Control Board also oppose legalization on the grounds that the new law violates international drug control treaties.2 Uruguay, therefore, faces both domestic and international opposition in pursuing its innovative cannabis regulation model.
In this context, the Latin American Marijuana Research Initiative (LAMRI) is conducting a series of studies about different aspects of the new drug policy environment in Uruguay.3 This article focuses on one of our most recent studies: a Respondent Driven Sample (RDS) survey of frequent cannabis consumers in Montevideo and its metropolitan area. The main goals of this research are to describe the attitudes and behaviors of recurrent cannabis users, especially in light of the new regulations, and to elaborate on the implications of such attitudes and behaviors for policy implementation. Collecting this information early in the cannabis policy implementation process is crucial, providing a baseline for policy impact evaluation.
Law 19.172 provides three ways for consumers to legally obtain cannabis: growing it, participating in cannabis clubs, or purchasing cannabis at a pharmacy. Users must first register with the state-run office for the control and regulation of cannabis: The Institute for Regulation and Control of Cannabis (IRCCA). Currently, the three channels for obtaining cannabis are mutually exclusive: individuals can register for only one mode of access, and are entitled to a maximum of 40 g of cannabis per month. Only citizens, age 18 or older can become registered users.
To register as cannabis growers, individuals must present at a National Post Office branch, with their national identification card and a utility bill as proof of residence.4 Those planning to acquire cannabis in pharmacies need to present proof of citizenship. And for club members, the club completes the registration on their behalf. The registry is free and confidential; individuals acquiring cannabis without being registered are considered to be violating the law.
This regulation was essentially designed for recreational consumers. Although medical users can grow their own plants and become members of cannabis clubs, the market for medical cannabis in Uruguay is embryonic and clubs have none or very limited offers in terms of strains for medical use (Queirolo, Boidi, & Cruz, forthcoming). Individuals wishing to purchase cannabis for medical purposes would need a doctor's prescription to buy it at a pharmacy, and will be part of a separate registry designed to control and limit the amount of cannabis dispensed for medical use.5
The implementation of the cannabis policy is uneven. According to the most recent accounts, the registry for growers comprises 3150 individuals6; the registration process for cannabis clubs is under way, with about 17 clubs in the process of obtaining IRCCA approval. Pharmacy sales have been deferred several times, mostly due to the complexity of implementation (including an open call for companies interested in cultivating cannabis for this purpose and the negotiations with pharmacies for the instrumentation of sales through them). This and many other aspects of cannabis regulation policy implementation are still being drafted.
Section snippets
Methods
Our research team conducted a Respondent Driven Sample (RDS) study of frequent cannabis consumers in Uruguay's capital and largest city, Montevideo, and its metropolitan area. The target population was defined as individuals aged 18 or older who live in the capital area and consume cannabis at least once a week. Frequent consumers are a portion of all cannabis users and therefore they are not necessarily representative of all cannabis consumers. Nevertheless, evidence from several studies shows
Findings
To date, growing small amounts of cannabis for personal use and cannabis club membership are the only legal methods of obtaining the drug in Uruguay. However, the vast majority of high-frequency consumers report acquiring cannabis some other way, which means they obtain it from the illegal market. Our survey requested respondents to report all ways in which they had obtained cannabis during the past 12 months (Table 2, column A), the method they used most frequently during the past 6 months
Discussion
With the cannabis regulation law, Uruguay embarked on an ambitious drug policy shift. By enacting a national regulation of the entire cannabis production chain, the government sought to tackle public health and security problems while meeting long-standing demands (from some groups, at least) for individual rights and judicial security. The unprecedented nature of this approach makes implementation a complex task, forcing the authorities to make macro and micro policy decisions in conditions of
Conflict of interest
The authors declare that they have no conflicts of interest.
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The authors wish to express their gratitude to Florida International University, Universidad Católica del Uruguay and the Open Society Foundations, whose joint efforts funded data collection for this project, and have led to the creation of the Latin American Marijuana Research Initiative (LAMRI). Special thanks go to Héctor Suárez and Jessica Ramírez, from the Observatorio Uruguayo de Drogas; Gustavo Robaina and the team at Pro-Derechos; Liesl Picard from LACC; Brad Hittle; Beau Kilmer; and Peter Reuter. Finally, a huge thanks goes to the Red de Usuarios de Drogas, and especially to Milagros, for opening her house and network to our project. The final responsibility for the content is, of course, solely ours.