OPINION: PUBLIC HEALTH APPROACH TO MARIJUANA USE BEATS CRIMINAL MODEL

In 1932, Ernest Lapointe stood before the House of Commons and asked
"What is cannabis sativa?" It was an odd question since the drug had
been illegal for nine years, and since we would expect Lapointe, as a
former attorney general, to know something about it.

But then again, virtually no Parliamentarians knew anything about
cannabis in 1932, or in 1923 when its possession was first
criminalized. Indeed, when Minister of Health Henri-Severin Beland
introduced the bill that would add cannabis to the list of prohibited
drugs in the Opium and Narcotic Drug Act, he mentioned not a word about it.

Needless to say, then, there was no debate about its inclusion, which
is just as well since Parliamentarians would have had no idea what
they were debating about. Instead, the wise MPs of '23 voted in favor
of adding marijuana to the growing list of forbidden substances,
thereby solving a problem that didn't exist.

I guess you could call that proactive government. And other
politicians certainly think so, since the behaviour of the MPs of '23
has proved to be something of a template for future drug legislators:
Pols around the world now routinely pass drug laws while remaining
utterly ignorant of the potential effects of either the drugs or the
laws.

And they do so despite the fact that we've learned a lot about drugs
and drug laws in the nearly nine decades since marijuana was first
criminalized. We have learned, for example, that drug laws act as a
boon to organized crime networks, but do little to deter drug use. And
we have learned that there are risks associated with the use of any
drug, including marijuana.

Perhaps most importantly, we have learned that drug laws can make it
more difficult to address, and reduce, those risks. For example, laws
prohibiting the production of drugs make it impossible for anyone but
the producers - usually organized crime - to control the purity of the
product and the veracity of the labeling.

Furthermore, since drug laws typically apply to everyone, making it
equally illegal for anyone to possess drugs, it becomes difficult to
target high risk users, or high risk activities. This is one thing we
have learned from Insite, Vancouver's supervised injection site, which
has been successful at reaching the highest risk users and at reducing
the risks of the most dangerous behaviors.

Yet Insite has only been able to do so because it is exempt from the
operation of the criminal law - because it treats drug use and
addiction within a public health model, rather than a criminal one.
And if we want to similarly reduce the risks associated with marijuana
use, we ought to treat it within a public health model too.

That's the prescription of a international team of experts led by
Benedikt Fischer, director of the Centre for Applied Research in
Mental Health and Addictions at Simon Fraser University. In an effort
to reduce marijuana risks, the team has just published a set of lower
risk use guidelines. Much like the already existing guidelines for
lower risk alcohol use, but unlike laws criminalizing possession of
drugs, the guidelines are informed by the scientific evidence about
the effects of marijuana, and are targeted at high risk users and activities.

For example, those who start using cannabis at a young age are more
likely to develop dependence or other problems, as are those who smoke
daily, so the guidelines address these people and behaviors.
Similarly, use during pregnancy or while driving presents special
dangers, which the guidelines again highlight.

Now of course such guidelines aren't going to solve all problems
associated with marijuana use, and Fischer doesn't suggest they will.
Rather, he stresses that they are part of a broader public health
approach to marijuana use, which, ideally, would include a prevention
strategy for young people, risk reduction strategies and better access
to treatment for problem users.

But it is clear the guidelines can only exist within a public health
approach - for while emphasizing that abstinence is the most reliable
way of avoiding cannabis-related harms, the very fact that they speak
of "lower risk cannabis use" means they recognize that some people
will continue to use marijuana.

This is true, of course, but its something the criminal model simply
can't tolerate. And by aiming for an ideal world while recognizing
that we live in a real one, the public health approach renders our
efforts to tackle drug abuse effective rather than illusory.