By Tony Bartone
Updated April 17, 2018 20:11:12
The use of cannabis in society is complex. Cannabis has been used since pre-modern times, mostly for medicinal and spiritual purposes.
Today, cannabis is the most commonly used illicit substance in Australia, with 35 per cent of the population having tried it.
It is not surprising that the Australian Greens have called for cannabis to be legalised.
Many other countries, such as Portugal, Spain, Italy, Denmark, Austria, Brazil, Netherlands, and Norway, have either made cannabis legal or decriminalised its use. A number of US States, including California, Oregon, and Colorado, have similar legislation.
For most cannabis users, use is relatively light. Many young people have used it once or twice.
However, the younger that people start using cannabis, and the greater the frequency with which they use it, the greater the risk of harm.
Due to the apparent popularity of cannabis in Australia, we need to be cautious and evidence-based in deciding how to manage its use.
The AMA does not support the personal use of cannabis, but criminal sanctions for personal cannabis use are equally problematic.
Cannabis is not without risk, and the first response of doctors must be to do no harm.
Although the AMA is not supportive of the Greens' proposal, the AMA welcomes the debate about illicit drug use and addiction. The way Australia manages drug use is clearly not working.
Increased investment in policing and incarceration is not having the desired impact. There are other more appropriate measures available.
The AMA supports the harm-reduction approach to cannabis and other illegal drugs. This includes policies and initiatives that aim to reduce the adverse health, social, and economic consequences of substance use to individual drug users, their families, and the community.
Harm reduction considers both the potential harms to individuals using substances such as cannabis, and the potential harms and negative impacts of the different approaches for controlling the use and supply of these substances.
While harm reduction is the primary goal, the key policy focus should be on measures that reduce individuals' harmful levels of cannabis use, or cannabis use among individuals who are most vulnerable to adverse health impacts.
We must also ensure that there is treatment and support available to those cannabis users who wish to stop. While it may not require the type of residential rehabilitation that we think of when considering other drug dependence, some heavy cannabis users will require support in their efforts to quit.
Prohibition of cannabis use with criminal penalties has the potential to produce harms and risks. Furthermore, the effectiveness of criminal prohibition of cannabis use in reducing the health-related harms associated with cannabis use is questionable.
It is entirely consistent with the principles of harm reduction for the possession of cannabis for personal use to attract civil penalties, such as court orders requiring counselling and education (particularly for young and first time offenders), or attendance at "drug courts", which divert users from the criminal justice system into treatment.
Cannabis use should be seen primarily as a health issue and not as a matter for law enforcement. Of course, there should be vigorous law enforcement and strong criminal penalties for the cultivation and trafficking of cannabis.
The Greens policy does recognise a harm reduction approach, but it doesn't address how young people and those with mental health problems can be protected from potential harms.
Cannabis use can be harmful, and in some instances may lead to acute-onset psychosis, or the exacerbation of pre-existing psychotic symptoms. There are potentially serious health implications for young people with mental health problems who use cannabis.
Any moves to decriminalise cannabis must recognise that young people may be vulnerable to both the effects of the drug, as well as dependence.
Suggestions that the Greens policy mirrors the so-called "Colorado model" miss a very critical difference — in Colorado, the legal age for alcohol (and cannabis) is 21.
There is strong medical evidence about the impact of certain drugs and alcohol on developing brains, and the crucial few years between 18 and 21 are considered vital in protecting young people from harms.
In the context of increasing prison populations, and recognising dependence and addiction as primarily a health problem, the issue of decriminalisation is increasingly pertinent.
A more mature discussion around decriminalisation and other novel approaches to reducing the harms associated with drug and alcohol use is welcome.
Importantly, we know that countries that have adopted non-punitive responses to drug use have not experienced major increases in the prevalence of drug use, and have reduced the stigma associated with drug use and seeking treatment from doctors.
Dr Tony Bartone is the AMA vice-president.
First posted April 17, 2018 18:37:24