Thursday, 22 September 2011

My speech to the fringe event on cannabis regulation

This is an edited version of the speech I gave to the fringe event "Legal regulation of the cannabis market: How, why and when" yesterday:

I said in my speech proposing the drug motion on Sunday that the documentary Killer in a Small Town was a major inspiration for me in my drug policy campaigning, but I do also have another personal motivation for my work that stems from my family's experience of insanity. I have a brother with schizophrenia and the effect of that upon my family is a major motivation in my wish that the government control and regulate cannabis. The science suggests that those who smoke cannabis have around a doubled risk of psychosis. There is a lot of debate about whether this link is causal or just correlation. Psychiatrists will tell you it is causal. Users will tell me that it is correlation often combined with some degree of personal abuse in my direction.

My position on the matter is that it is much better to be safe than to be sorry. I have a Masters degree in Neuroscience. I have read the evidence and find the causation explanation both biologically plausible and the best fit to the epidemiological data. If we sold cannabis from pharmacists then, even if it the relationship was mere correlation, an individual with a doubled risk of psychosis would be armed with the knowledge to identify the early warning signs in both themselves and their friends. If customers experienced problems with their use it is my hope they could go back to the pharmacist and be diverted onto other strains or encouraged to abstain if necessary.

I have settled on pharmacists and not coffee shops. The Dutch coffee shop model is absolutely not one we should follow. The continued illegality of the supply chain to these coffee shops means that they are generally controlled by organised crime groups. This is obviously not a satisfactory endpoint for regulation. But even if we regulated all aspects of the trade, if I am slightly offended by the sight of a cannabis outlet in an otherwise charming street in Utrecht, how would the genuinely conservative members of our society respond to it?

Why should cannabis be the first drug for which full legal regulation is proposed? It is pure political expediency. Myself and colleagues commissioned a poll last year which asked 2000 people whether they would prefer a variety of drugs were lightly regulated like alcohol and tobacco, were prohibited as they are now or were strictly controlled and regulated by the government.

The strict control and regulation measures described included things like pharmacy sale, age restrictions and bans on branding and marketing, prices set by an independent panel in order to maximally undermine criminals and yet deter use. Full education on harms given before people are permitted to use for the first time, and manufacturers, distributors and retailers competing for government contracts with profits directed into drugs treatment and education programs.

Cannabis came out very clearly as the currently illegal drug that people wish to be regulated by the government. 33% wanted it lightly regulated. 37% wanted it strictly regulated, making 70% in favour of legal regulation in total. The next most favourable result was Magic Mushrooms with 52%, while ecstasy had only 39% in favour of regulation. A much higher proportion for legal regulation than ever found in traditional polls, but not ready for the next step. The most striking thing in the cannabis figures however was the fact that regulation was appealing to many of the people you would presume would bristle at the thought of legal cannabis. Totals for legal regulation for conservatives were 67%. Daily Mail and Express readers 66%. When you break it down to examine those in favour of strict regulation, it becomes very interesting indeed. 42% of women favoured strict regulation, to only 32% of men.

The newspaper readership group most in favour of strict regulation. Any guesses?... The Daily Mail and Express at 41% support.

The single demographic group most favouring strict regulation... 35-54 year old women. Presumably the group containing the most mothers of teenage children. They understand that prohibition isn't working and strict regulation presents the best opportunity to restrict children's access to the drug. And we should be absolutely determined to do so. While adult risk is doubled if they use cannabis, under 15s who smoke regularly are thought to increase their risk of subsequent psychosis by 5-fold. The benefits of strict regulation don't need to be explained to these women. They can just look at a policy proposal and recognise its potential.

I'd like to pan out slightly at this point and look at the international picture.

The Americans look like they are going to be the first to legalise cannabis, and I really hope they are not. Looking at the Proposition 19 ballot that was narrowly rejected in California, there was nothing in it that suggested health harms should be taken seriously at all. I think this is a grave mistake.

I was talking to some researchers from the American RAND corporation at a conference in the Netherlands this summer, and they were saying that if they legalised cannabis the price would reduce by 80%. This creates some real problems. If they want to tax the drug sufficiently so that the price of it doesn't plummet, creating a presumed increase in use rates, then they risk retaining a massive black market in cannabis. Americans culturally just instinctively don't like strict regulations getting in the way of the market.

In the UK though, I'd hope that we could recognise that this experiment with legal regulation necessitates really strict control. I would be happy to see the state growing the plants, distributing them to pharmacists and using the proceeds for education and drug treatment. I am uncomfortable with there being anyone in the business who has a financial incentive for people to use more cannabis or for young people to start using. If there is that 80% gap in the UK market too, then we could spend an awful lot of money on regulating the market and still raise a fair bit of tax on top before we came close to failing to undercut the criminal dealers.

On the issue of the drug conventions. The more careful we are, the less the UN would be able to object to our measures. If we say that our state is going to grow all these different strains of cannabis securely for restricted sale to only those who are fully educated on health harms, then they might find it hard to say no. We have to go up to the UN and say these conventions are restricting our ability to protect our citizens from harm. As I said last year, the argument “the people of Britain would like to get high” isn't quite so persuasive. There are of course important medical issues to consider, and I would certainly welcome the day when people with serious medical conditions can use cannabis for those reasons.

The control and regulation process could work to get cannabis farms out of suburban houses, stops Chinese and Vietnamese gangs smuggling in child slaves to tend plants, reduce the proceeds for organised crime, and vastly increases public knowledge of the early warning signs of psychosis. If evaluation indicates a relaxation of the strict regulations would better reduce harm then those steps should be taken.

I think the new legal market could compete on price, quality, predictability of dose, choice and ethical considerations. We may have to seriously consider issues of convenience (a pharmacist is often going to be further away than a dealing neighbour or the plants you are growing in your basement), and stigma (do we need to give cannabis users pads of things that look like prescription sheets so that they can hand them over like everyone else does in a pharmacist and receive the drug in a closed bag)?

To finish, I just want to emphasise again that cannabis regulation has to be about reducing harm as far as is practically possible. It would be pure folly to start at the level of regulation we have for tobacco just to see how it goes. How we deal with all of our drugs from alcohol to heroin, to energy drinks that are attractive to children needs to be looked at.

But if the UK could demonstrate it is possible to strictly control and regulate cannabis effectively I think the world could breathe a sigh of relief and reap massive benefits from following our example.


Bolivia Newton-John said...

I agree with most of that, particularly in the short term. I'm inclined to believe though, that licensed and responsible producers would do more than just compete on quality and predictability of dose. Presently regulated quality produce would emerge that posed spectacularly lower health risks and the "correlation vs. causation" argument would solve itself. I would hope we move towards this slowly, using scientific evidence as our guide, but surely in the end that is the hoped-for direction of travel?

Peter Reynolds said...

Ewan, As you know, I support your efforts in principle but you vastly overstate the dangers of cannabis and your distortion of the evidence would do credit to any prohibitionist.

What sort of absurd generalisation is it to say:

"Psychiatrists will tell you it is causal. Users will tell me that it is correlation often combined with some degree of personal abuse in my direction."


Those sentences reveal an awful lot about you that is unhelpful in this debate.

The fact is that those who believe that the relationship between cannabis and psychosis is causal are in a tiny minority. When you accused me of lying about Glyn Lewis and Stanley Zammit's research on the LibDem ACT website, a psychiatrict who had worked with them told you that you are wrong.

I understand and sympathise with your personal experience but it does not determine the truth.

The CLEAR plan for the regulation of cannabis in Britain sets out proposals which are based on consultation with users, doctors, scientists, lawyers and policymakers. I hope you will give it proper consideration.

Finally, the ommission of anything to do with the medicinal use of cannabis is a serious oversight. The potential for cannabis as medicine is huge and far more significant than these other issues. I urge anyone who has not yet done so to find out about the endocannabinoid system.

Dan Ford said...

Yet another news story showing what a backward nation we are, lagging behind more progressive nations in our approach to cannabis. I think America is a good example to be following. They have had legal medical use of cannabis in many states for some years now, and have not seen any rise in teenage use, and the legally licensed users have not been moving onto hard drugs, or developed mental problems. Having seen this 'living evidence' the general public there are now moving towards favouring legal, regulated use for the whole population, over 21 years of age.

ravehat said...

it seems that having the state as a sole controller makes no sense if worrying about the criminal element of legalisation.
if it was to be state controlled what do they control exactly? if its distribution then yes state should set certain levels and this is controlable. however when it concerns growing and sale there are issues. 1st)as you mentioned who to they higher? a scientist ? an doctor? a current cannabis grower? or a gardener? 2nd)breeds of cannabis. there would be assumingly a list of breeds that a grower would be permitted to grow. this will likly be more stable (ths,cbd) breeds. this is bound to leave breeds out and would constanly need updating. if it is not then criminal eliments will step in and sell those breed excluded which most likly will be high thc and low cbd.
and 3rd)if place of sale is purly chemist based, then young adults will turn to street sellers to avoid lectures or having to register etc.
if the main concern is health the worst option is to leave huge holes in the criminal market. purly state based leaves holes that can be manipulated by the wrong elements in society. the best solution is to have a balence of state and private working together. this will minimise criminal activities keeping young adults away from street sellers and easy routes to other more dangerous drugs. but most importantly away from contamination of street weed and the health risks that follow.

Dave Harris said...

I like these ideas, though they're a sensible starting point rather than the end game. We should continue to push for less restrictions in the long-term, as this is the ONLY way we can redirect demand for cannabis to legitimate, regulated sources and really hit drug dealers where it hurts.

The problem I foresee with this pharmacy model is that many cannabis users are not going to warm to it if they continue to feel ostracised, misjudged or patronised (especially while tobacco and alcohol sales continue with nowhere near the same restriction), or if they simply can't get a strain or quantity of cannabis that they want. There's little incentive for people to jump through hoops for the government's sake when they can call up their local dealer to meet their demands without a hitch. Basically, it has to be worth it to people not to go to dealers instead.

I'm also wondering exactly how it is pharmacies would seek to educate would-be buyers. Would purchasing cannabis necessitate going on a cannabis crash course (and resulting license)? Or a doctor's note proving a clean bill of mental health? Or would it be something like a simlpe information pamphlet with every purchase? It's an interesting idea but again, I'd be concerned that it if it's too restrictive it'd do little to dissuade people from the street market.

Peter is correct about the risks here being overstated. I think we rightly could move to market regulation off the bat and see a reduction in harms to society as a whole (greatly reduced heroin and cocaine use is a fair tradeoff for a rise in use of cannabis from a clean, quality-assured supply), but I have sympathy for a cautious approach nonetheless. What's most important is that we make some kind of progress rather than going backwards.

Peter Reynolds said...

Ewan vastly overstates the risks of psychosis from the use of cannabis.

Hickman, Lewis, Zammit et al, based on a 2009 meta analysis of ALL published research (so not cherry picked) said that "there is no certainty of a causal link" but that if cannabis does cause psychosis then the risk is at worst 0.013% and probably less than 0.0030%

Mr Bimble said...

Having read several scientific papers on cannabis and psychosis - the evidence seems to point to high THC and Low CBD strains being the higher risk factor for triggering an underlying mental condition (most of the papers I've read do not state that cannabis causes psychosis but can in those predisposed to suffer from it agrivate it, just like alcohol can).

But until the government gets its head out of the daily mail and has a grown up debate on drugs we will never tell if that evidence stacks up.

Until then the majority of cannabis users will have more damage done to them by the criminal system than the cannabis they take.

Anonymous said...

Is there any chance you could reference the evidence you have used to come to your conclusions on cannabis?

If i were to undertake such a journey i would be asking the foremost experts on cannabis., names like;
Dr Lester Grinspoon
Our very own Dr Leslie Iverson or maybe even Professor David Nutt if your feeling especially controversial. Even Peter Lilley wrote a paper on it that Mr Cameron referenced in his maiden speech as Prime minister in the commons.

There are many other good works to reference too in Holland and Spain especially. I also believe there is a lot of very positive research going on in Israel too.

The balance of the evidence for and against cannabis MUST be weighed and not merely drawn from evidence of self proclaimed experts with corporate pharmaceutically backed agendas. Sources need to come from a wide spectrum. Never has a plant been so closely studied in human history, yet seemingly we know so little about it.

So as a nicely put request i'd love to see where you have drawn your conclusions from please.


Anonymous said...

while already working regulation models are now moving towards the cooprative model !

Sunshine Band said...

Don't get bogged down with Ewan's unshakeable belief - it's a simplistic way out for people to avoid their family issues by blaming drugs. Context is everything, and the context of criminality makes many people ill through drug use.

What is more important is that the whole regulatory ethos being touted is WRONG. Yes, it makes some sense to look at regulating certain large scale activities, but you simply must stop thinking it is cannabis or a drug being regulated - it's the consumer!! Start from this premise, a person has some basic rights to privacy do they not, and then frame the criterion of the law which is social harm into the equation. Now, from the perspective of the individual, what regulation of the person should take place with someone who is not causing harm? Answer is none, it's a private matter concerning his/her body chemistry. The threshold for personal freedom needs to be brought out, and this is why I despair at this whole fetishised focus on cannabis and IT'S regulation. And the 'illegal drugs' idiocy comes up again here which shows me you are locked into the wrong mind set about this. I am glad by the way Ewan that the outcome of your work at the LibDems is perhaps better than it looked like it was going to be from reading your plemic, in that there seems to be an 'all options on the table' possibility. But it's the whole way of thinking that is wrong, and making comparisons with tobacco is fruitless. It was encouraged for generations as part a cynical exploitative official drug dealing in addictive drugs policy. Drugs like alcohol and tobacco cause most harm because the dealers in them enjoy monopolies - start to regulate persons properly and all will become clear.

Ewan Hoyle said...

Numerous references can be found in this helpful publication produced by Rethink Mental Illness:

To answer some specific points raised, I'd hope that a very wide variety of strains and preparations would be available in each pharmacist, covering a much broader range of potential experience than even your most well-stocked illegal dealer.

On the education required before first sale, it is not for me to say what is appropriate, but "going on a course" would be a bit much. I think a leaflet and maybe a maximum ten minute chat about health harms should be sufficient to encourage safe use and an appropriate response to health concerns. If people were to be excluded from purchasing on the grounds of mental health concerns then these people would presumably prop up the illegal market, so the education process and age should probably be the only requirements. The education should be just the facts, delivered in a non-judgemental fashion. We do the same with family-planning clinics...

I hope this answers your concerns Dave. I'm very aware that users will not play ball if they feel judged or patronised. There may need to be a fair bit of training provided to vendors for implementation to prove successful.

The medicinal use of cannabis is an important issue. I did raise it in my speech.

Sunshine Band clearly thinks my brother developed psychosis after using drugs. This was not the case.

Stephanie. said...

I by no means claim to be an expert on the link between cannabis and psychosis. I am aware that what I say is simply personal experience and having studied “lay health beliefs” I know that many people do develop explanatory theories for health conditions that draw on their own experience. In addition to this I am not suggesting any of the above commentators are wrong.

Having been in a psychiactric unit for a few months I find it hard to shake the feeling that cannabis does, even in a minor fashion, lead to psychosis. I recall sitting in a room with five young people diagnosed with first episode psychosis when the subject of cannabis came up. Four of them had been heavy users and they admitted lying about it to their health workers – the general concenus being that they wanted to avoid the grief that they would get. Having seen how high a percentage of people in hospital care were heavy users it did make me feel that there was a link. Of course this is not a peer reviewed article - just my thoughts.

The Royal College Of Psychiatrists on their website do suggest a link. I can only assume if this is not based on studies then they are taking a “better safe than sorry approach” based on what they see in their work.

Also, great article Ewan.