MUCH ADO ABOUT MARIJUANA

Thirty years after the publication of the LeDain Commission report,1
editorial opinion at CMAJ has arrived at the same opinion: "the real harm
[of marijuana] is the legal and social fallout [editorial]."2 In 1995 The
Lancet editorialized that "the smoking of cannabis, even long term, is not
harmful to health."3 Two years later the New England Journal of Medicine
called for the reclassification of cannabis under American law4 and George
Annas wrote in the same journal that "marijuana is unique among illegal
drugs in its political symbolism, its safety, and its wide use."5

It is worth remembering that cannabis was prohibited in Canada only because
Emily Murphy managed to create a moral panic around the association of
cannabis with Blacks and Mexicans. Cannabis prohibition - as in the Opium
Act of 1908 - was from the outset a strategy for the political suppression
of selected racial groups.6

In the 30 years since the LeDain Commission report was released, thousands
of young Canadians have been incarcerated. One of the unintended
consequences of incarceration is growing into a full-blown public health
catastrophe. In the mid 1990s the Correctional Service of Canada instituted
urinalysis testing to enforce a zero-tolerance drug policy.

The inmates did the logical thing, from their viewpoint; they migrated to
the use of drugs that cleared the body in less time than cannabis. The
drugs of choice came to be heroin and cocaine.

As a result of needle sharing, our federal prisons have become incubation
centres for HIV and hepatitis C.7 Canada's drug control strategy, a
decaffeinated version of the American "war on drugs," produces more
pathology than it prevents.8

Most inmates eventually get out of prison, and thus the potential for a
public health disaster can no longer be denied.

Recent events at the Kingston Penitentiary suggest that the Correctional
Service of Canada may be looking for a face-saving alternative to its
unworkable zero-tolerance drug strategy.

Here is an opportunity for the bold stride the CMAJ editorial says is
needed: CMAJ ought to call for the vigorous expansion of harm reduction
programs across Canada and in particular within our prisons.

Unfortunately, however, the drug war needs marijuana's prohibited status
because without it the "drug problem" collapses from a social crisis
involving several million Canadians and requiring more police and more
prisons, to a situation involving a handful of hard-core addicts whose
sickness can be reduced and confined, as the experience of Holland,
Switzerland and Germany demonstrates.9

Cannabis in its numerous forms is an efficacious treatment for a number of
conditions, as the Chinese claimed as long ago as 2737 BCE,1 with
considerably fewer side effects for many people than other treatments.10
Marijuana could compete with established brand medications that are backed
by powerful global economic, social and political forces and their
legislative allies.

Thus there are at least 2 powerful obstacles to the decriminalization of
marijuana, both arising from the vested interests that have grown up and
taken hold under prohibition. Still, CMAJ is to be congratulated: better
late than never.

Craig Jones, Research Associate

Queen's Centre for Health Services and Policy Research

Queen's University Kingston, Ont.

References

1. The report of the Canadian Government Commission of Inquiry into the
Non-Medical Use of Drugs. Ottawa: Information Canada; 1972.

2. Marijuana: federal smoke clears, a little [editorial]. CMAJ
2001;164(10):1397.

3. Deglamourizing cannabis [editorial]. Lancet 1995;346(8985):1241. [MEDLINE]

4. Kassirer JP. Federal foolishness and marijuana.

N Engl J Med 1997;336(5):366-7. [MEDLINE]

5. Annas GJ. Reefer madness: the federal response to California's
medical-marijuana law. N Engl J Med 337(6):435-9.

6. Giffen PJ, Endicott S, Lambert S. Panic and indifference: the politics
of Canada's drug laws. A study in the sociology of law. Ottawa: Canadian
Centre on Substance Abuse; 1991.

7. Ford PM, Pearson M, Sankar-Mistry P, Stevenson T, Bell D, Austin J. HIV,
hepatitis C and risk behaviour in a Canadian medium-security federal
penitentiary. Q J Med 2000;93:113-9.

8. Johns CJ. Power, ideology and the war on drugs: nothing succeeds like
failure. New York: Praeger; 1992.

9. Grapendaal M, Leuw E, Nelen H. A world of opportunities: life-style and
economic behaviour of heroin addicts in Amsterdam. New York: State
University of New York Press; 1995.

10. Grinspoon L, Bakalar JB. Marihuana as medicine: a plea for
reconsideration. JAMA 1995;273(23):1875-6. [MEDLINE]