Earlier this week, the Irish College of Psychiatrists issued a stark warning that “cannabis represents the gravest threat to the mental health of young people today”.
The college further noted that there were suggestions that the drug was considered “harmless” and that the number of hospital admissions of young people with a cannabis-related diagnosis increased by 300% between 2005 and 2017.
There is no doubt that the potency levels of cannabis are different from what they were 10 years ago.
I have not met anyone who refers to cannabis as being completely harmless, but there could be a misconception held by some younger people who use it frequently that there are no short- or long-term effects caused by its consistent use.
The findings in the report are, of course, concerning to those of us that advocate ending prohibition of cannabis, but we cannot view these findings or observations in isolation when discussing the central argument of the lack of cannabis regulation.
I would like to set out the case that the consequences of the prohibition of cannabis are contributing to the lack of regulation and oversight of those who choose to use cannabis.
Without trivialising the findings from the Irish College of Psychiatrists, there are many other threats to the mental health and wellbeing of young people, particularly during this public health emergency.
Poverty, inequality, deprivation, a lack of public services, and mental health capacity all must surely pose as great a risk?
Like with alcohol, some young people are using cannabis as a form of escapism to block out the stress and anxieties they may be experiencing, particularly during the pandemic. The overuse of cannabis can sometimes exacerbate theses emotions, leading to certain difficulties in dependency for a certain age cohort.
Cannabis is a controlled drug and illegal to possess and consume. This means that criminal sanction is the only deterrent for its use, sale, and cultivation.
Thousands of people in the State have criminal convictions for the simple possession of cannabis for their own use.
Sending people through the criminal justice system for simple cannabis possession has been a complete waste of resources for both the State and the individual.
This may seem blatantly obvious, but cannabis will be used whether it is legal or not.
The demand for cannabis and use of cannabis in all age groups has never been as great.
This is borne out by the constant weekly seizures of cannabis in the past 12 months.
Even looking at the yearly cannabis seizures by the authorities over the past seven years, this has incrementally increased.
A vacuum exists for the demand and supply of cannabis and that vacuum is largely filled by the black market.
Without any regulation of the quality of the cannabis produced, there then exists an uncontrolled and deregulated system that is very profitable and, in essence, is controlled by criminal gangs.
The by-product of this can then be contamination with pesticides and other alternates that the buyer is not aware of when cannabis is been consumed.
Even in terms of potency, there is no labelling of street cannabis for levels of CBD and THC, the two main components of cannabis.
In other jurisdictions around the world, a regulated system of cannabis consumption and cultivation, replacing the system of the black market, has largely been successful.
In terms of taxation from the proceeds of the sale of cannabis, this has been ringfenced and contributes towards projects of education and harm reduction.
All indications show that public opinion as well as governmental bodies across the world are changing their stance on the prohibition of cannabis.
The Mexican government recently announced that it would legalise cannabis for recreational use.
This is a country that has endured years of a relentless war on the illicit narcotics industry — a war that has claimed the lives of tens of thousands of people.
I am not suggesting that this grotesque violence will suddenly recede because of legalisation, but the amount of resources that countries commit to stopping the cultivation, supply, and consumption of cannabis is unsustainable.
The legacy around “the war on drugs” — particularly cannabis or its Hispanic term, marijuana — is a legacy of racism, politicisation, and marginalisation.
The ongoing discussion regarding drug decriminalisation for personal use has been dragged out for years and successive governments in Ireland have failed to address a policy that was implemented in Portugal 20 years ago.
Portugal went from being one of the highest incidences of drug-related deaths to one of the lowest in Europe.
Decriminalisation is far from perfect, but the evidence clearly shows that it saves lives and protects society from the terrible effects of drug addiction.
Later this year, People Before Profit will be introducing the Cannabis Regulation and Control Bill 2021. This will be the first time in eight years that legislation around ending the prohibition on cannabis will be before the Irish parliament.
At this juncture, it is difficult to gauge the political support. However, there will be an intense debate around the upcoming bill on whether to continue to keep criminalising people for cannabis use and directing them through the criminal justice system.
It was welcome that, in January last, An Garda Sí
ochána announced that it would caution, rather than charge, people who are caught in possession of cannabis for personnel use.
The Misuse of Drugs Act 1977 needs to be reformed to reflect changing attitudes and countenance possible societal changes in attitude to drug use in the future.
I would argue that there needs to be paradigm shift in the binary choice of keeping cannabis illegal as we have now or making it legal in the future.
THIS week the College of Psychiatrists of Ireland launched an information campaign to draw attention to the negative effects that cannabis can have on mental health, particularly that of adolescents and young people. It was the college’s sole intention to return the focus of the cannabis conversation to one that is centred on the harms of this drug, which psychiatrists are seeing every day in their practices and in addiction treatment facilities. However, the discussion has somewhat predictably been dragged back into a discussion about legalisation.
From my own perspective as a practising child and adolescent psychiatrist, I cannot see any public health basis for which cannabis should be legalised in this country. I am not alone in this view, with notable opposition to legalisation recently declared by the American Medical Association.
Drug use can cause harm, both to the person using the drug and to those around them, especially family. There is no way we can eliminate all use and all drug-related harm, so our challenge as a society is to come up with a suite of policies and responses that minimise drug-related harms.
In the first instance, that basically means prevention to curtail use.
Secondly, it means a treatment response for those users who have begun to experience harm.
Prevention involves the provision of information about the hazards of drug use. It also includes laws that ban the possession and sale of drugs, which act as additional obstacles to access and deterrents to use. Against a background of these prevention efforts, we know from the most recent general population survey from the National Advisory Committee on Drugs and Alcohol that 92% of adults in Ireland have avoided using any illegal drug in the past year.
Several states in the US have seen the incremental liberalisation of cannabis laws, these being preceded by very widespread, loose ‘medical’ cannabis policies, which started in the mid-1990s. This has coincided with extremely high and increased rates of youth cannabis use.
In Europe, 0.8% of 16-year-olds use cannabis daily, according to the European School Survey Project on Alcohol and Other Drugs. This rate has been quite static over the past 25 years.
In the US, however, the Monitoring the Future survey from the National Institute on Drug Abuse has found that 4.4% of 16-year-olds use cannabis daily — this rate is five times higher than it was in the early 1990s.
In Canada, which legalised recreational cannabis in 2018, a staggering 9% of 16-19-year-olds use cannabis daily, according to its National Cannabis Survey.
Usually in the area of public health, doctors examine countries with low rates of a problem, whether that be suicide, firearms injuries or drug abuse, and seek to learn from their success. In a rational world, where public health principles influenced drug policy, North America would look to Europe to learn from our successful polices at suppressing youth cannabis use. In this crazy world, we are seriously being asked to do the opposite. This makes no sense.
While we are only seven years into the North American legalisation experiment, the early data is a cause of much concern.
Researchers from McGill University in Montreal recently reported that cannabis legalisation was associated with a 16% increase in road fatalities, presumably connected to increased use or increased willingness by users to drive while under the influence. In an Irish context, that would mean about 20 extra road fatalities every year.
Moreover, there is emerging and worrying evidence of increased suicidal behaviour linked to cannabis legalisation, especially in young men. Colorado, a state that legalised recreational cannabis in 2014, has witnessed a substantial increase in suicide.
The Colorado Health Institute reports that cases have been increasing since 2013, with 2019 seeing the high-est number of suicides ever reported in the state. There could be many reasons for this, but cannabis is being detected with increasing frequency in post-mortem toxicology in people who die by suicide, with cases doubling among 15-24-year-olds between 2011 and 2018, according to the Colorado Violent Death Reporting System.
Those who promote the legalisation of cannabis promise much. They say that it will get rid of the criminal gangs and will reduce the potency of cannabis. Unfortunately, the lessons from North America indicate that the black market is thriving. Criminals will always be able to undercut regulated and taxed legal vendors. Criminals will attract the poorest, youngest and heaviest users. Meanwhile, potency has skyrocketed in places like Colorado.
While Ireland faces challenges right now in terms of cannabis-related harms, we have faced much bigger drug challenges in the past.
The heroin epidemic in Dublin in the mid-1990s took with it a generation of young people, especially those living in the most deprived communities. However, data from Ireland’s national drug treatment reporting system indicates that teenagers growing up in those same communities are now 98% less likely to suffer from heroin addiction. This success was achieved without any change to our drug laws, but by actively supporting the affected communities, via a network of local drug task forces and social regeneration initiatives.
Given the carnage inflicted on past generations by our current legal, addictive drugs — tobacco and alcohol — it would be naive to believe that we can reduce cannabis-related harms by unleashing yet another legal, addictive drug upon the next generation.
We can take inspiration from our past successes and from places such as Iceland and its impressive Planet Youth prevention programme. This has massively suppressed youth substance use there. It is important that we remain optimistic for, and on behalf of, the young people of Ireland.