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Cannabis liberalisation is coming, but are we ready for it?

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The tide is turning on cannabis, but what’s still lacking is evidence that the alternative, so-called health-based approach can minimise the physical harm of drugs.

Drug-law liberalisation is coming, like it or not. The concern is that it may be allowed to proceed whether we are ready or not.

Irrespective of the outcome of next year’s cannabis referendum, the Government’s Misuse of Drugs Amendment Bill is set to introduce de facto decriminalisation for recreational use. Police, already inclined to use discretion in not prosecuting for possessing small amounts, will be legally obliged to overlook it.

In a number of countries, the tide is turning, at least on cannabis, as it is acknowledged that the traditional outlaw-and-criminalise approach hasn’t halted its use. But what’s still vitally lacking is evidence that the alternative, so-called health-based approach can minimise the physical harm drugs do or even deter the criminal activity around supply.

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Before New Zealanders vote on legalising cannabis for those over 20 under a proposed state-controlled regime, we need more than lectures about “the failed war on drugs”. Voters deserve facts, starting with an explanation of exactly how users will receive treatment under our already pressured health system.

We know cannabis carries health-and-safety risks, as well as dangers for brain development in those under 25. Recent University of Oxford research reveals cannabis use among adolescents is associated with significant increased risk of depression and suicidality in adulthood. Although the size of the negative effects of cannabis can vary between individual adolescents, the researchers reported that regular use during adolescence is associated with “lower achievement at school, addiction, psychosis and neuropsychological decline and increased risk of motor-vehicle crashes, as well as the respiratory problems that are associated with smoking”.

Yet, the draft legislation tells us nothing about medical help for those affected by cannabis use. Will it be available to all users? Only users under 25? Will it aim to end drug use or just limit it? What about heavy users who don’t seek treatment, yet risk harming themselves or others?

Frustratingly for the voter, the overseas jurisdictions to legalise or decriminalise the drug haven’t yet produced sufficient reliable data. A US pioneer is the state of Colorado, which has progressively liberalised since 2000. Its experience has been mixed. There’s no uptick in those under 20 using cannabis, but the state also continues to have the country’s highest youth usage – under twenties admitted to emergency wards with serious marijuana-related symptoms rose six-fold between 2005 and 2014’s recreational legalisation. In addition, fatal car crashes involving marijuana-positive drivers rose 145% from 2013 to 2016. And Colorado’s cannabis black market continues to thrive, its illegal crop 73% bigger since legalisation. Organised-crime prosecutions have almost tripled. Health authorities are concerned, too, with the rise to 11.2% (from 6.9%) of cannabis-smoking households that include children. In 5.5% of these homes, it is smoked inside.

The National Association of Sciences, Engineering and Medicine’s stocktake of America’s cannabis experiment this year reports no substantial evidence linking cannabis and general and workplace accidents, yet found a strong link with driving accidents.

It found substantial evidence for a link with respiratory problems (smoking cannabis being as harmful as tobacco) and in states with permissive cannabis laws, moderate evidence of infant respiratory problems.

It found moderate evidence of adverse effects on cognition – memory, attention and learning – but limited evidence of an effect on educational or employment outcomes, income levels or functional socialisation.

For the link to psychoses, it found substantial evidence among chronic users, and no evidence cannabis helped with depression or post-traumatic stress. The younger anyone starts on the drug, the higher the likelihood of harmful overuse in later life.

Here, we’re still grappling with the lethal popularity of synthetic drugs, their appeal stoked by a failed experiment in what was perceived as state-conferred “safe” status.

And, just last week, we learnt the cheerleading espousal of cycling has come at a high cost in serious accidents, because our infrastructure was not adequate. A study reported in the New Zealand Medical Journal included data from four district health boards showing cycling-related hospital admissions rose about 17% each year between 2012 and 2016. Of the 998 patients studied, 213 had severe injuries that were either potentially life-threatening or limb-threatening and 54 had severe traumatic brain injuries.

Let’s not make the mistake of green-lighting permissive drug laws without being certain we have the information and the infrastructure to make it safe.

This article was first published in the May 18, 2019 issue of the New Zealand Listener.