Commentary
Could cannabis liberalisation lead to wider changes in drug policies and outcomes?

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Abstract

Cannabis policies are changing in some countries. This may have consequences that extend beyond cannabis-specific outcomes, such as an impact on the consumption patterns of other substances. Changes in cannabis policies may also influence policy responses to other drugs, as countries re-assess the balance between law enforcement and public health objectives. If this happens, it could have important health and social consequences, especially in those countries where a ‘war on drugs’ policy perspective has inhibited investment in evidence based responses in areas such as treatment and harm reduction. The burden of disease associated with opioid use for example is large and this is an area in which treatment and harm reduction have been shown to deliver benefits. Thus if the changes in cannabis policies result in a greater willingness to invest in effective interventions for other drugs, the potential net health gains could be considerable. On the other hand, if cannabis policy changes are associated with an increase in health risk behaviours, such as driving under the influence or increased use of harmful substances such as tobacco, then significant increased health costs could result. To date most attention has been focused on recent cannabis sales liberalisation in the Americas, but experiences from elsewhere are also informative. In Europe, for example, moves towards decriminalisation of drug possession are resulting in lower rates of incarceration and arguably have reduced barriers to treatment uptake. Robust monitoring and assessment of the impact of these different policy changes is crucial to evaluating and understanding their results. It is important that such monitoring is international in scope, is not limited to issues around the use of cannabis only, and considers the interactions that may exist between cannabis policies and the approaches taken to other substances.

Introduction

Important changes in drug policy are occurring in the Americas. Following commercialisation of medical cannabis in the USA under the reassurance of the Ogden memo in 2009, several US states have legalised the sale of recreational cannabis. Uruguay has legalised home growing and social clubs, and will soon start selling cannabis for recreational use in pharmacies, while Canada may soon become the second American country where cannabis can be legally bought for that purpose (NYT, 2017).

These changes are profoundly different from what has been the historical consensus for global drug policy, and may have important health and social implications (Hall & Lynskey, 2016; Subritzky, Pettigrew, & Lenton, 2016). To understand fully the consequences of these developments however a narrow focus on cannabis policies and cannabis use is not sufficient. We argue here that, first, the current rapid changes in cannabis policy may have the potential to affect wider drug policies, such as law enforcement policies around opioid and stimulant use, both in the Americas and elsewhere; and second, if such wider policy changes occur, they could have a far more significant impact on health than the current changes in cannabis policy alone. For this reason, robust and systematic monitoring and evaluation of the outcomes of changes in cannabis policy, both in terms of drug use and of their wider health and social consequences, is important (Wiessing, Des Jarlais, Hughes, Ferri, & Griffiths, 2015).

International drug control, currently framed by three UN Conventions, was introduced with an explicit intention to protect public health (UNODC, 2008). The 1961 and 1971 Conventions on narcotic drugs and psychotropic substances insisted on criminal penalties for drug traffickers, but the 1988 UN Convention against illicit traffic in narcotic drugs and psychotropic substances provided additional legal mechanisms; for the first time it requested (although did not oblige) criminal penalties for personal possession. This was an attempt to balance the existing obligations of producer countries to reduce production and trafficking with new obligations of consumer countries to reduce demand (United Nations Office on Drugs and Crime, 2005). For this reason, drug control has tended to be seen as a predominantly criminal justice issue (UNODC, 2008). As one of several drugs addressed by these Conventions, cannabis policies do not work in isolation but form part of a wider system of drug laws (EMCDDA, 2016), regulating the supply and use of other drugs such as opioids and cocaine. Despite some calls for the revision of the Conventions, such a move would be complex (Bewley-Taylor, Blickman, & Jelsma, 2014). In more recent years, policies have been developed to address the health and public safety threats posed by new psychoactive substances, though criminal penalties for personal possession might be omitted in Europe (European Monitoring Centre for Drugs and Drug Addiction and Eurojust, 2016). The issue of the interaction of policies addressing different drugs has nevertheless been somewhat neglected in the scientific literature, and this paper attempts to bring this to the fore.

Section snippets

Limitations

Some national policy interventions to protect public health, in areas such as prevention, treatment or harm reduction may be limited in variety or scope, or even prohibited, due to the nature of the drug being illicit. There are many direct examples of this, such as opioid substitution treatment and needle and syringe provision being strictly regulated or not allowed in some countries. More indirectly, if health concerns are not taken sufficiently into account in criminal justice policies and

Conflicts of interest

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

BH and LW share lead authorship. LW had the original idea, BH and LW wrote all drafts, with substantial contributions of DDJ and PG.

References (35)

  • B. Dennis

    Obama administration will not block state marijuana laws if distribution is regulated

    (2013)
  • EMCDDA

    Models for the legal supply of cannabis: Recent developments

    (2015)
  • EMCDDA

    European drug report 2016

    (2016)
  • T. Embury-Dennis

    Jeff Sessions describes marijuana as ‘only slightly less awful’ than heroin

    (2017)
  • European Commission

    Action plan to combat drugs (2000-2004). COM(1999) 239

    (1999)
  • European Commission

    Flash eurobarometer 401–Young people and drugs

    (2014)
  • European Monitoring Centre for Drugs and Drug Addiction and Eurojust

    New psychoactive substances in Europe Legislation and prosecution—Current challenges and solutions

    (2016)
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