THE LANCET

(Note to reader from the Canadian Foundation for Drug Policy: The Lancet is an internationally respected medical periodical from Britain.) See also the more recent (1998) article on cannabis in The Lancet.

Volume 346, Number 8985, November 11 1995

Editorial

Deglamorising cannabis

The smoking of cannabis, even long term, is not harmful to health. Yet this widely used substance is illegal just about everywhere. There have been numerous calls over the years for the legalisation, or at least decriminalisation, of soft drugs, among which cannabis remains the most popular with all social groups. In this highly contentious area, the Dutch attitude has been often mentioned as the voice of sanity. In the Netherlands, customers of coffee shops can buy up to 30 g of cannabis for about 10 pounds ($15) although the drug is technically illegal. The shops are not allowed to advertise, or to sell cannabis to individuals aged under 16 years.

Prominent among those currently calling for legislative reform - and going further by making constructive proposals - are police chiefs and city medical officers, people who know only too well that the existing policies in most countries are ineffective and unworkable. Meanwhile, politicians have largely remained silent, seemingly afraid of offending powerful segments of the electorate or merely of being perceived as weak in the face of rising crime figures. When the occasional politician raises her head above the parapet - as the British opposition MP Clare Short did recently in calling for a fresh debate on decriminalisation of cannabis - the response is tediously predictable: widespread condemnation from political colleagues and overwhelming support from those who have to cope with the end result of political inertia.

In the case of Ms Short, not only was she speedily reprimanded by the party leader, but also party officials claimed that their non-legalisation stance was entirely logical since legalisation of cannabis would "increase the supply, reduce the price, and increase the usage". According to a Home Office report earlier this year, the number of people taking cannabis has doubled in a decade - without any help from "liberal" measures. Perhaps the politicians' real fear was that freedom to use soft drugs would automatically progress to increased use of substances such as cocaine and heroin. If so, they must have overlooked the recent Dutch government review which pointed out that decriminalisation of possession of soft drugs has not led to a rise in the use of hard drugs.

If the Dutch approach is so successful, why are changes afoot in The Hague to tighten up that country's drug policy.? First Amsterdam's mayor proposed closing down half the city's coffee shops that sell cannabis, and in doing so he rejected a report by his health department in favour of legalisation of soft drugs. Then the Dutch government, which had made an election promise to legalise cannabis, last month issued a discussion paper which mirrored the Amsterdam plan. If, as expected, the Dutch parliament agrees the latest proposals, half the country's 4000 cannabis-selling coffee shops will close and the amount that can be sold to an individual will be cut to 5 g. Since the government's own review provides no ammunition for such a change in policy, the real reason behind the new measures must lie elsewhere. One need look no further than the Netherlands' neighbours and co-signatories of the Schengen agreement, which introduced a border-free zone between the Netherlands, France, Germany, Spain, Luxembourg, and Belgium. When France, in particular, threatened to end the agreement, claiming that the Netherlands was the major supplier of Europe's drugs, some action had to be taken and the coffee shops became the scapegoat.

Leaving politics aside, where is the harm in decriminalising cannabis.? There is none to the health of the consumers, and the criminal fraternity who depend for their succour on prohibition would hate it. But decriminalisation of possession does not go far enough in our view. That has to be accompanied by controls on source, distribution, and advertising, much as happens with tobacco. A system, in fact, remarkably close to the existing one in Dutch coffee shops.

Cannabis has become a political football, and one that governments continually duck. Like footballs, however, it bounces back. Sooner or later politicians will have to stop running scared and address the evidence: cannabis per se is not a hazard to society but driving it further underground may well be.

-- The Lancet

(Note from the Canadian Foundation for Drug Policy: For additional views that also challenge the stereotypes about marijuana, please see Exp osing Marijuana Myths: A Review of the Scientific Evidence, by Lynn Zimmer, Associate Professor of Sociology, Queens College (New York), and John P. Morgan, Professor of Pharmacology, City University Medical School (New York). The study was prepared for New York's Lindesmith Center.)

**************************

Return to Canadian Foundation for Drug Policy home page

The war on drugs:

Prohibition isn't working - some legalisation will help

Editorial, BMJ (British Medical Journal) Volume 311, 23-30 December 1995

Drugs, says psychiatrist Thomas Szasz, have taken over the lead role from sex in the" grand morality play of human existence." (note 1) "No longer, says Szasz, "are men, women, and children tempted, corrupted, and ruined by the irresistibly sweet pleasures of sex; instead, they are tempted, corrupted, and ruined by the irresistibly sweet pleasures of drugs." Because dealing with drugs is viewed as a moral problem, politicians tend to compete in their zeal to banish the evil from the kingdom. Those who talk of legalisation are dismissed as mavericks, and whipped back into line. The British government's drug strategy for the next three years states baldly "There will be no legalisation of any currently controlled drugs." (note 2) But some legalisation would help.

The politicians fighting the jihad against drugs want to obliterate the enemy. They, of course, make an exception for legal drugs like alcohol, nicotine, and caffeine; indeed, British government last week recommended tea totallers take up drinking alcohol for the good of their health. (note 3)Yet a world devoid of drugs seems as unlikely as a world devoid of poverty and sin. Thomas Sydenham observed 300 years ago "Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium" (note 4); and Aldous Huxley wrote "That humanity at large will ever be able to dispense Artificial Paradises seems very unlikely. Most men women lead lives at the worst so painful, at the best monotonous, poor and limited that the urge to escape longing to transcend themselves if only for a few moments, is and has always been one of the principal appetites of the soul." (note 5)

If we accept that a world without drugs is unachievable (and probably intolerable) then the important question, argues drug policy expert Ethan Nadelmann, becomes "What are the best means to regulate the production, distribution and consumption of the great variety of psychoactive substances available today and in the for foreseeable future?" (note 6) To reduce the debate to arguments between "prohibitionists" and "legalisers" is to oversimplify, but it's a useful device for beginning to understand the issues.

The case for legalising drugs begins with the failure of current prohibitionist policies. The United States has been conducting a "war on drugs" for seven decades, during which time there have been steady increases in seizures of illegal drugs, the numbers of people using drugs, and the health and social costs of drug taking. Economists argue from first principles that the war on drugs must fail. Any success in reducing the supply will raise the price of illegal drugs. Addicts must then commit more crime to feed their habit; and a rise in the profit margins of drug smugglers urges them on to greater efforts.

The history of the drug trade is that supply always meets demand. Milton Friedman, the Nobel prize winning economist, puts it thus: "Illegality creates obscene profits that finance the murderous tactics of the drug lords; illegality leads to the corruption of law enforcement officials; illegality monopolises the efforts of honest law forces so that they are starved of resources to fight the simpler crimes of robbery, theft and assault." (note 7) The main result of the United States war on drugs is a prison system bursting with petty drug offenders, most of them African-Americans.

Britain has never been as warlike as the United States in efforts to control drugs. British policy is, however, essentially prohibitionist, and yet about seven million people in Britain have taken cannabis at some time in their lives.(note 8) About a quarter to a third of young people have tried solvents or illegal drugs by their 20th birthday, (note 9)and in one survey the proportion of young people who had been offered drugs rose from 2% in 1969 to 41% in 1994. LSD and ecstasy have now also been absorbed into mainstream youth culture, with about 9% of those aged 16 to 19 having used ecstasy and about 8% LSD. (note 8) These high reported prevalences are likely to be true because seizures of cannabis more than tripled from 23 592 in 1984 to 107 629 in 1994, ecstasy seizures increased from 39 in 1989 to 715 in 1994, and heroin seizures rose from 2995 in 1984 to 4480 in 1994. (note 10)

Time to consider going Dutch?

Other countries have been more willing to experiment with decriminalisation and legalization. The Netherlands effectively decriminalised penal possession of drugs in 1976, and cannabis is sold in "coffee shops." The Dutch are now coming under great pressure to reverse their experiment from neighbouring countries, worried that they are being flooded with drugs from the Netherlands. Yet the 1976 changes in the Netherlands seem to have been followed by a fall in use of cannabis: from 13 % of those aged 17-18 in 1976 to 6% in 1985. (note 11) Monthly prevalence of cannabis use among Dutch high school students is around 5.4% compared with 29% in the United States. (note 11) Forbidden fruit may, indeed, be sweetest.

One simple argument for criminalising drugs is often used by governments in the context of tobacco: that the state has no right to interfere with what individuals do in private so long as they don't harm others. Another argument is that legalisation would cut the huge costs of enforcement, prosecution, and imprisonment. Thirdly, a legal market could allow quality control of drugs and education on how to avoid them or use them more safely; drugs might more predictably be prevented from reaching the young and vulnerable. Finally, many of the adverse health effects of drugs stem from criminalisation rather than from the drugs themselves. Anyway, current policy is clearly not driven by totting up the good and bad effects of drugs: few are more harmful than tobacco.

Although, the arguments for legalisation can be expressed forcefully, almost nobody argues for a free, legal, unregulated market for all drugs, and clearly no single policy will cover all drugs. Nadelmann says: "It is imperative that any drug policy distinguishes between casual use that results in little or no harm to anyone, drug misuse that causes harm primarily to the consumer, and drug misuse that results in palpable harm to others - and then focuses primarily on the last of these, secondarily on preventing the misuse of drugs, and little at all on casual drug use." (note 6)

The key question is how the world would look if drugs were legal. The Australian National Task Force on Cannabis has identified five options for cannabis legislation: total prohibition; prohibition with civil penalties; partial prohibition; regulation of the production, distribution, and sale of cannabis; and free availability. (note 12) The task force opted for keeping possession, cultivation, and sale in any quantity illegal but decriminalising "simple personal use or possession ... without compromising activities aimed at deterring cannabis use." Others-for instance, economist Richard Stevenson have tried to describe a world where large companies produce, distribute, and advertise drugs like heroin and cocaine and invest heavily in research designed to produce drugs that will satisfy customers' wants while making them safer. (note 13)

Much more work needs to be done on envisaging a world that includes some legalisation of drugs. But it's clear that purely prohibitionist policies don't work and make the problems of drug abuse worse.

Governments worldwide have followed illogical and often counterproductive drug policies, primarily because drug use is seen in moral terms. Wars on drugs are doomed to failure, but experiments with decriminalising and even legalising drugs - as in the Netherlands - have shown promising results. Policies that allow some decriminalisation and legalisation are much more likely than prohibition to succeed in achieving everybody's aim of minimising the harm from drug abuse.

RICHARD SMITH

Editor

British Medical Journal

BMJ, London WC1H 9JR

Notes:

1. Szasz T. The morality of drug controls. In: Hamowy R, ed. Dealing with drugs: consequences of government control. Lexington, Mass: Lexington, 1987

2. Lord President of the Council and Leader of the House of Commons, Secretary of State for the Home Department, Secretary of State for Health, Secretary of State for Health, Secretary of State for Education, and the Paymaster General. Tackling drugs together: a strategy for England for 1995-98. London: HMSO, 1995.

3. Interdepartmental Working Group. Sensible Drinking. London: department of Health,1995.

4. Sydenham T. Quoted from: Merry J. A short history of narcotic addiction and the case for regulated legislation. In: Stevenson R. Winning the war on drugs: to legalise or not. London: Institute for Economic Affairs, 1994.

5. Huxley A. The doors of perception and heaven and hell. London: Penguin, 1959

6. Nadelmann E.A. Progressive legalisers, progressive prohibitionists and the reduction of drug related harm. In: Heather N, Wodak A, Nadelmann E, and O'Hare P, eds. Psychoactive drugs and harm reduction: from faith to science. London: Whurr, 1993.

7. Friedman M. An open letter to Bill Bennett. Wall Street Journal 1989; 7 September. A14

8. Baker O, Marsden J. Institute for the Study of Drug Dependence. Drug misuse in Britain 1994. London ISSD, 1994.

9. Wright JD, Pearl L. Knowledge and experience of young people regarding drug abuse, 1969-94. BMJ 1995; 310:20-4

10. Anonymous. Statistics of drug seizures and offenders dealt with, United Kingdom, 1994. Statistical Bulletin 1995: Issue 24/95. (ISSN 0143 6384).

11. Morgan JP, Riley D, Chesher GB. Cannabis: legal reform, medicinal use and harm reduction. In: Heather N, Wodak A, Nadelmann E, and O'Hare P, eds. Psychoactive drugs and harm reduction: from faith to science. London: Whurr, 1993

12. Ali R, Christie P. Report of the National Task Force on Cannabis. Canberra: Australian Government Publishing Service, 1994.

13. Stevenson R. Winning the war on drugs: to legalise or not. London: Institute for Economic Affairs, 1994.

Converted by Andrew Scriven