MARIJUANA: FEDERAL SMOKE CLEARS, A LITTLE

Fourteen years after narcotics police arrested Terrance Parker (who had
discovered that smoking marijuana reduced the frequency of his grand mal
seizures), and a year after the Ontario Court of Appeal ruled that Canada's
discretionary regulation of the medicinal use of marijuana was "unfettered
and unstructured ... [and] not consistent" with the principles of
fundamental justice,"1 our federal government has taken the bold little
step of drafting new regulations.

In Canada, even the simple possession of small amounts of marijuana for
personal use is a criminal offense, unless you are one of the roughly 40
Canadians who have obtained a special dispensation to use cannabis to
relieve the symptoms of cancer, AIDS, multiple sclerosis or epilepsy. The
program is unduly restrictive. The new regulations promise more
transparency in the review of applications to grow or possess medicinal
marijuana, a broader definition of medical necessity, and greater latitude
for physicians in determining the needs of individual patients.

There are no persuasive randomized trials of marijuana therapy for the
relief of symptoms such as pain and nausea. Such trials are extremely
difficult to do. But the ratio of drug effect (however subjective that
effect may be) to drug harm is large: there are no reported cases of fatal
marijuana overdose. The risks of lung cancer (from the tars in the smoke)
or the very weak (and perhaps nonexistent) risk of addiction are mostly
irrelevant to patients with terminal disease or severe chronic conditions.
About 400 000 Canadians use cannabis for medical reasons.2 Professional
organizations such as the CMA must move quickly to issue guidelines for
physicians who, increasingly, will be asked for advice by their patients.

Health Canada's decision to legitimize the medicinal use of marijuana is a
step in the right direction. But a bolder stride is needed. The possession
of small quantities for personal use should be decriminalized. The minimal
negative health effects of moderate use3 would be attested to by the
estimated 1.5 million Canadians who smoke marijuana for recreational
purposes.2 The real harm is the legal and social fallout. About half of all
drug arrests in Canada are for simple possession of small amounts of
marijuana: about 31 299 convictions in 1995 alone.4 Many lead to jail terms
or fines and all result in that indelible social tattoo: a criminal record.
This means that for anyone who's ever been caught with a stash in his or
her pocket, the question "Have you ever had a criminal conviction?" during
a job application or medical school interview can force higher aspirations
to go up in a puff of smoke.

The decriminalization of marijuana possession for personal use does not
mean making marijuana "legal" or letting it be sold in every schoolyard. It
does mean that possession of small amounts for personal use would become a
civil offense, like a traffic violation, not a criminal one. The provisions
of Canada's Contraventions Act make this a relatively simple legislative
task. Mr. Justice Minister, let's decriminalize the possession of small
amounts of marijuana for personal use. - CMAJ

References

1. R v Parker (31 July 2000). (Ont. C.A.). (accessed 2001 Apr 19).

2. Ogborne AC, Smart RG, Adlaf EM. Self-reported medical use of marijuana:
a survey of the general population. CMAJ 2000;162(12):1685-6.

3. Hall W. The cannabis policy debate: finding a way forward [editorial].
CMAJ 2000;162(12):1690-2.

4. Single E, Fischer B, Room R, Poulin C, Sawka E, Thompson H, et al.
Cannabis control in Canada: options regarding posession. Ottawa: Canadian
Centre on Substance Abuse; 1998. (accessed 2001 Apr 18).