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Marijuana meets the criteria for an addictive drug and animal studies suggest marijuana causes physical dependence and some people report withdrawal symptoms. Someone who smokes marijuana regularly may have many of the same respiratory problems that tobacco smokers do, such as daily cough and phlegm production, more frequent acute chest illnesses, a heightened risk of lung infections, and a greater tendency toward obstructed airways.

Cancer of the respiratory tract and lungs may also be promoted by marijuana smoke. Marijuana has the potential to promote cancer of the lungs and other parts of the respiratory tract because marijuana smoke contains 50 percent to 70 percent more carcinogenic hydrocarbons than does tobacco smoke. Marijuana's damage to short-term memory seems to occur because THC alters the way in which information is processed by the hippocampus, a brain area responsible for memory formation.

According to the National Household Survey on Drugs, cannabis is the most commonly used illicit drug in Australia. Dr Ingrid Lantner, a pediatrician and an expert on marijuana use among teenagers, notes these common symptoms of the chronic marijuana-using youngster: red eyes often "handled" with eye drops, which can be a clue to pot use It is important for parents to realise that, unlike the alcohol user, most pot-smoking youngsters are able to "come down" from a high and act normally when parents are around.

Thus many parents of chronic pot-smoking youngsters may remain unaware of this fact for several years. Also, in the words of Dr. And some bright youngsters with outgoing personalities seem to be able to maintain their grades and activities for a few years-although gradually all users, youngsters and adults, compromise their potential, their activities and their lifestyles". In other words, your teenagers may have no apparent symptoms of marijuana impairment. Except in one area. No matter how well they tolerate, adjust to or compensate for their pot use in other areas, over 70 research studies show that pot-induced driving impairments remain.

And they are dose related. The more one smokes and the more potent the pot, the worse the driving impairments. Heroin is a highly addictive drug and is the most rapidly acting of the opiates. Heroin is processed from morphine, extracted from the seed pod of certain varieties of poppy plants. Most illicit heroin is a powder varying in color from white to dark brown. The short-term effects of heroin abuse appear soon after taking the drug.

After the initial feeling, the user experiences an alternately wakeful and drowsy state. Due to the depression of the central nervous system, mental functioning becomes clouded. Additionally, breathing may be slowed to the point of respiratory failure. After repeatedly using heroin for a period of time, the long-term effects of the substance begin to appear in the user. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver disease. Additionally, pulmonary complications, including various types of pneumonia, may also result in the user.

One of the most significant effects of heroin use is addiction. With regular heroin use, tolerance to the drug develops. Once this happens, the abuser must use more heroin to achieve the same intensity or effect that they are seeking. As higher doses of the drug are used over time, physical dependence and addiction to the drug develop. Within a few hours after the last administration of heroin, withdrawal may occur. This withdrawal produces effects such as drug craving, restlessness, muscle and bone pain, and vomiting.

Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. In addition to the effects of the drug itself, users who inject heroin also put themselves at risk for contracting HIV, hepatitis C HCV , and other infectious diseases. Abel, E. Adams, I. Allebeck, P. Adamsson, C. Andreasson, S. Arnold, M. Baker, H. Banerjee, S. Barbers, Richard G. Barry, H. Behnke, M. Bell, R. Berman, Alan L. Biernson, G. Bland, R. Bonner, Robert C. Bosworth, K. Botvin, Gilbert J. Botvin, G. Brady, J. Budney, A.

Bush, Patricia J. Cain, Arthur H. Capriotti, Richard M. Carlson, Katherine A. Cederquist, T. Chacin, S. Chait, L. Chen, K. In Drug and Alcohol Dependence 50 2 April Chiles, J. PhD et. Christie, MacDonald J. Clark, Robert R. Cleghorn, John M. Coggans, N. Cohen, S. Commonwealth Department of Health, Housing, Local Government and Community Services, Handbook for medical practitioners and other health care workers on alcohol and other drug problems, Canberra: A. Commonwealth Department of Health, Drugs of Dependence Branch, Cannabis: a review of some important national inquiries and significant research reports, Canberra : A.

Conte, H. Crabbe, John C. Crowley, T. Day, Nancy L. Deahl, M. Debruyne, D. XLVI, No. Dews, Peter B. Dews, P. Medizinische Welt Stuttgart , 23 21 : , Dixon, L. Domino, E. Monograph series no. Dupont, R. Dyck, R. Edwards, J. Ellickson, Phyllis L. No one can deny that their work is necessary to ensure public order and peace and to fight organized crime. Most national strategies display a similar imbalance. The national strategies that appear to have the greatest chance of success, however, are those that strive to correct the imbalance. These strategies have introduced knowledge and observation tools, identified indicators of success with respect to their objectives, and established a veritable nerve centre for implementing and monitoring public policy.

The law, criminal law especially, is put in its proper place, that of one method among many of reaching the defined objectives, not an aim in itself. This chapter is divided into three sections. The first examines the effectiveness of legal measures for fighting drugs and shows that legal systems have little effect on consumption or supply. The second section describes the various components of a public policy. The third considers the direction of criminal policy, and defines the main terms used: decriminalization, depenalization, diversion, legalization, and regulation.

Two key indicators are usually applied to measure the effectiveness of drug-related criminal policy: reduced demand and reduced supply. Some authors attempt to measure the economic efficiency of various control options [2] ; we do not address this aspect as the data are incomplete. The methods of measuring the impact of public policy on supply and demand are faced with a series of methodological pitfalls. Firstly, the two indicators are relatively artificial and not easily distinguished from one another. Secondly, the capacity of agencies responsible for affecting one or the other depends on a series of factors relating to their means and resources, their practices and skills, and their competence.

For the police, the number of officers per capita and the general thrust of law enforcement services community police, traditional more reactive police as well as the priority given to drug-related offences, can influence the volume of reported incidents as well as the decision to lay a charge. Generally speaking, the total resources allocated by a government to its drug policy may affect one or both of these indicators.

In short, effectiveness cannot be measured directly. It is even more difficult to assess, even indirectly, the impact of action taken, when clear objectives, ideally associated with indicators, are not defined, as is the case in Canada at this time, as was seen in Chapter This being the case, and because we are in no position to make a rigorous assessment of public policy on drugs, we will examine the question on the basis of a series of indirect indicators. At the most general level, national governments see preceding chapter define a general direction for their policies on drugs.

Some are more tolerant or permissive e. Even in the U. Furthermore, there is often a huge gap between public policy statement and concrete action. For example, in France, a tough stance on use is accompanied by limited user-related police activity. In other words, there is no direct relationship between political statements and concrete action. Some comparative studies have attempted to determine whether or not public policy influences use levels.

The study found no significant differences between consumption levels, regardless of public policy direction. The study shows no relation between severity of legislation and level of use. We have drawn up two similar charts, classifying the policies of the various countries and adding Canada, Australia, and the United States.

We used the Chapter 6 data on lifetime prevalence of consumption in the general population Chart 1 and in the past month among year olds Chart 2. The charts show no direct relationship between consumption levels and public policy direction. Very liberal countries show low rates Spain, the Netherlands, Portugal , whereas countries that have very restrictive policies show high rates USA, Canada, France.

Another possible explanation is that, as few users are arrested, there is a strong inconsistency between words and action. The following section looks at this issue. A number of authors have looked at the relationship between arrest levels and delinquent behaviour in general, and in drug consumption in particular.

The "Willy Wonka" of Weed - Drugs, Inc

One recent study was conducted by Kilmer [6] within the context of the International Scientific Conference on Cannabis. The following graph is from that study. The graph shows that, in all countries, the number of arrests per inhabitant for simple possession of cannabis increased during the s, with Australia the only exception. Switzerland, currently considered relatively moderate, has the highest level of arrests per inhabitant, followed by the USA, Austria, the United Kingdom, France, and Germany.

Here again there appears to be no direct relationship between direction of public policy and arrests. The variation in rates of arrest cannot be explained by the number of police officers per inhabitant. We created a graph charting the relationship between the number of users among high school youth in Ontario in the past twelve months and incidents declared by the police of cannabis-related offences in the same year in Ontario. We chose Ontario because it is the only province that produces continuous time series on consumption levels, and the Ontario figures are almost identical to the Canadian mean Chapter The results are shown below.

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Number of users. The graph shows a very weak statistical relationship 0. In other words, police activity has no dissuasive effect on cannabis experimentation by young students. Criminology teaches that probability of arrest carries far more dissuasive weight than severity of sentence. As the following table shows, the probability of arrest is very low for cannabis possession offences. Probability of being arrested for cannabis possession [7]. While none of the preceding factors appears related to consumption levels, can a case be made for public spending?

There is danger in trying to estimate the overall cost of public policy on drugs. Even for a budget item as seemingly well-defined as law enforcement, estimates are unreliable. Figures on public expenditure related to treatment and prevention, even if we know that they are much smaller than those for law enforcement, are equally unreliable. Making international comparisons is even riskier.

Services are organized differently, costs are not accounted for in the same way, and service orientation and overall government direction vary widely. With these reservations, we will attempt the exercise based on data from a number of sources. The following table summarizes the data. Cost of enforcing legislation. Germany, [9]. Canada, [11]. United States [12].

The Netherlands [14]. We note that countries in which consumption levels are average Germany, the Netherlands spend less than the USA, which has a high consumption rate; in addition, these countries, specifically, show law enforcement expenditures above those of two far more restrictive countries France and Canada. In short, here again cannabis consumption levels appear unaffected by public policy that aims to reduce demand by cracking down on use. Does public policy affect drug availability or price? The available data suggest not. In spite of sustained efforts to exert national and international control, battle drug trafficking macro and micro, local and international , the availability of drugs, and cannabis in particular, has not fallen.

Price has fallen significantly e. The title of this section includes our conclusion: if the aim of public policy is to diminish consumption and supply of drugs, specifically cannabis, all signs indicate complete failure. We agree with the conclusions from the Swiss studies that prohibiting cannabis use through the application of criminal law appears to have little, if any, influence on levels of use. One may think the situation would be worse if not for current anti-drug action. This may be so.

Conversely, one may also think that the negative impact of anti-drug programs that are currently centre stage are greater than the positive effect, specifically non-compliance with laws inconsistent with majority attitudes and behaviour.

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One of the reasons for this failure is the excessive emphasis placed on criminal law in a context where prohibition of use and a drug-free society appear to remain the omnipresent and determining direction of current public policies. Does this mean nothing can be done?

We do not believe so. Does it mean market forces should be allowed to rule as if drugs were goods like any other commodity, a solution suggested by some free-market advocates? Psychoactive substances, including cannabis, alcohol, and medications, are not ordinary commodities.

Although cannabis see Chapter 7 does not have the deleterious effects that some people claim and is in some respects a less harmful substance than tobacco, it must be the subject of regulation and government intervention. This is what is discussed in the following sections. We are fully aware of the somewhat artificial distinction imposed by our mandate between cannabis and its derivatives and other psychoactive substances. Different substances lead to different types of uses. This is as true of cannabis as it is of alcohol, medications, cocaine, or ecstasy.

The uses differ with the substance - cannabis consumption differs from consumption of medications or even alcohol. There is nonetheless a common basis to the non-medical uses of psychoactive substances, which are primarily seen as a source of pleasure, even a method of enhancing awareness and the senses. There are of course other forms of use: abuse, for example, is not based on pleasure but rather a physiological and psychological mechanism symptomatic of loss of control, even distress.

Nevertheless, throughout history human beings have consumed psychoactive substances for reasons relating to self-liberation. Uses also differ for a given substance. Cannabis use, originally associated with self-medication and religious rites, in twentieth century western societies became an expression of a counter culture and the hippie movement, before becoming a recreational drug.

Although most cannabis use is self-regulated, in some cases, when associated with at-risk behaviour, use can lead to abuse. For public policy on psychoactive substances to adequately encompass the common dimensions of substance use, it must be integrated , yet flexible enough to allow for approaches that are adapted to different substances.

An integrated public policy on drugs would be administered by a decision-making body capable of making links between the substances and their uses so as to propose a meaning to different drug uses. A public policy on drugs revolves around the varying uses made of drugs and not on the substances themselves. Abuse of cigarettes causes lung cancer, not death due to impaired driving. Some medications, however, do lead to fatal accidents. Cannabis may be associated with both problems: cancer related to combustion, and highway accidents related to psychomotor effects.

There are two broad types of problems: the first affect user health, the second the health and safety of others; they must be dealt with in different ways. Certain measures must be preventive - inform users of risks and, specifically, help individuals recognize the signs of at-risk behaviour that can lead to problems. Those who consistently smoke between three and five cigarettes a day, something very few tobacco consumers may be able to do, are probably at no greater risk of lung cancer than non-smokers.

Learning to manage consumption, recognizing the dangers, and having the means and the tools to do so are key. Other methods are dissuasive in nature: where drinking and driving are involved for example. Finally, some measures are curative: whatever the substance, from simple aspirin to heroin, for all kinds of reasons that pre-date consumption of the substance itself, some individuals consume abusively in a way that leads to health problems. The tools for treatment and cure must be available. Thus, and this is the third criterion, a public policy on psychoactive substances must primarily be a public health policy : prevention, abuse deterrence, and treatment are the three prongs of public health intervention.

A public health policy does not attempt to oblige people to live healthy lives or to have the community decide individual behaviour for some elusive public good. What we envision is a public health policy that contributes to reducing the risks relating to the different uses of different substances. A public health policy on psychoactive substances is thus a risk reduction policy. Harm reduction approaches have been associated with needle exchange or the prescription of methadone or heroin.

Some think that harm reduction policies rely too heavily on a medical model, simply softening the negative effects of an otherwise prohibitionist regime. We believe that what is essential is recognition that 1 use of psychoactive substances cannot be eliminated, it is part of the human experience and not all use is abuse - whatever the substance - and 2 all substances can have negative consequences for both the user and society, making it advisable to contribute to individual and community well-being by providing information, abuse prevention tools and a treatment infrastructure.

A public policy on drugs does not target users: its implementation embraces them. For too long, in any discussion of illegal drugs, including cannabis, the focus has been on understanding the characteristics specific to consumers, as if they had some feature distinguishing them fundamentally from users of tobacco, alcohol, or psychotropic medications for non-medical use.

Although problem users may indeed have common characteristics, it is neither the substance nor being a user that is the question: other factors underlying development of at-risk behaviour should be given more attention. On the contrary, this is normalization, not trivialization. Excessive use of any substance is harmful: all substances may endanger user health, even coffee.

Normalizing the use and the user does not mean trivializing them. A public policy on drugs aims to normalize uses of psychoactive substances: that implies not marginalizing users, while at the same time not trivializing use and shrugging our shoulders, ignoring the dangers specific to various substances. To summarize: a public policy on psychoactive substances must be both integrated and adaptable, target at-risk uses and behaviours and abuses taking a public health approach that neither trivializes nor marginalizes users.

Implementation of such a policy must be multifaceted, as we will see now. The public policies described in the preceding chapter, as well as the policies of Denmark, Portugal, and Mexico, have a number of elements in common: they rely on a strong decision-making body, promote interconnection and multiple viewpoints, aim at national consensus on clear and measurable objectives, and rely on independent knowledge and assessment tools.

Each country covered in the preceding chapter has a highly visible, well-known decision-making body that has undeniable legitimacy and methods of action that meet expectations. In our opinion, the question of drugs, inasmuch as it is broader than the jurisdiction of a single government department or level of government, inasmuch as it refers to our collective ways of relating to society and others, and especially inasmuch as it demands both integration and differentiation, must be governed by an agency that is not accountable to a particular department and can define direction for not enforce diktats on all players.

The policies on psychoactive substances are the concern of educators and therapists, police officers and anthropologists, diplomats and local associations and, of course, users. The ability to tie things together for knowledge and comprehension purposes supposes an ability to link specialties, administrations, individuals. In Chapters 11 and 18, we saw that federal policy on drugs, in addition to lacking rigour and clarity, means and infrastructures, is not a national policy.

This does not mean there is no place for specific approaches by the provinces and territories that make up the Canadian mosaic. However, if a common culture on drugs is to emerge, if we are to better understand behaviours of use through geographic comparison, if players are to benefit from the experience of others, tools must be developed for the joint definition of shared objectives. Moreover, the ability - and the will - to define objectives is the foundation of any future evaluation to determine whether or not the action taken is in sync with the objectives and is effective; in short, defining objectives is necessary because we must be able to assess the impact of what we do.

A public policy must also rest on knowledge. Many witnesses, from all over, told us this. European Union member countries, the United States and Australia have developed powerful knowledge tools, specifically agencies that monitor drugs and drug addictions. These monitoring agencies, most of them independent of the government and political influence, are capable of measuring changing trends and forms of use of various substances, understanding emerging trends and new products, even assessing public policies. We are unable to see how Canada can fail to develop a national knowledge tool on psychoactive substance use.

So what do we do with the legislation? Legislation stems from public policy direction, which it supports and completes; it is a means, not an end. Cannabis debates are highly contaminated by discussions on decriminalization, depenalization, legalization. The terms are frequently poorly understood, especially as they are not necessarily clear. This section defines each key term in the debate and suggests indicators that can be used to assess each option.

Removal of penal controls and criminal sanctions in relation to an activity, which however remains prohibited and subject to non-penal regulations and sanctions e. Typically, the harsher criminal penalties still apply to the more serious offences of possession, supply, manufacture or cultivation of amounts of the drug deemed in law to be for trafficking or commercial purposes. For Caballero and Bisiou, depenalization means essentially removing drugs from the field of criminal law.

They distinguish between total depenalization and depenalization of use. Possessing or holding cannabis for personal use has been decriminalized in Germany, Australia, Spain, Italy, Portugal, the Netherlands, and some American states. The resemblance ends there because each country has slightly different way of reaching the goal. In Australia and the American states where possession of cannabis has been decriminalized, possession remains illegal and subject to a fine. In Germany, the constitutional court has ruled that prosecution for possession of small quantities of cannabis contravenes basic rights and is unjustified.

In Spain and Italy, possession of small amounts of cannabis is not an offence and consumption is authorized except in public places. However, as in Portugal, individual possession of cannabis is subject to an administrative penalty fine in Spain and Portugal; suspended licence in Italy. In all cases, decriminalization is partial.

In Canada, some authors have written in favour of decriminalizing cannabis. One of the best known papers on this option may be that published by the policy committee of the Canadian Centre on Substance Abuse. The option retains the illegality of cannabis possession and related criminal record consequences. Drug treatment courts are a form of alternative measure. However, it is difficult to understand the reasoning of the authors on this approach as it is more a form of legalization than decriminalization.

The Cannabis Act and Cannabis regulations - Promotion prohibitions -

The CPLT opinion notes the following. This timid recommendation refuses to take a systematic approach and even links cannabis consumption to delinquent or criminal activities, relating risk to consumption of products with a high THC concentration, as if consuming spirits should be subject to stronger measures than drinking wine.

Even though the term purports to remove it from the ambit of criminal law, cannabis consumption remains illegal. The sanction may be less severe, but a sanction still applies, one that, in some cases, can have the same impact as a criminal sanction and entail even greater discrimination: a young or disadvantaged person unable to pay the fine faces a far greater risk of ending up in prison than an adult or socially secure individual. As explained to the Committee by Dr. However, a cautionary note should be sounded. Many of those so ticketed failed to appear to pay their fines, and subsequent numbers entered the criminal justice system for non-payment of fines and subsequently received criminal convictions.

There was an unintended result in that the number of persons criminalized is as large, or perhaps larger, than before the measure was implemented. In spite of its merits and success, the Dutch system of controlled cannabis sale, a form of de facto decriminalization, has no way of regulating production and distribution, which is still controlled at least in part by organized crime, or exercising quality control, specifically the concentration of THC.

In the opinion of some authors, decriminalization is in fact simply less severe prohibition. Same grounds, different form. This model has no greater capacity for prevention or education than a strict prohibition model. Even worse, the prohibition model is based on clear and consistent theory, whereas the same cannot be said of decriminalization as an approach. Some will say that decriminalization is a step in the right direction, one that gives society time to become accustomed to cannabis, to convince opponents that chaos will not result, to adopt effective preventive measures.

We believe however that this approach is in fact the worst-case scenario, depriving the State of a regulatory tool needed in dealing with the entire production, distribution, and consumption network, and delivering a rather hypocritical message at the same time. Removal of the prohibition over a previously illicit activity, e. It does not necessarily imply the removal of all controls over such activity e.

To quote:. Controlled legalization is a system that aims to replace existing prohibition of drugs by regulation of their production, trade, and use with a view to restricting abuse that can damage society … unlike depenalization, penal law retains its role in preventing damage to third parties by users drunkenness or producers contraband. No system for controlled legalization of cannabis currently exists. This type of regulation is nothing new: colonial opium and kif regulatory bodies operated well into the first half of the twentieth century. Conversely, legalized systems exist for the manufacture, distribution, sale and production of such products as alcohol, tobacco, and psychotropic medications.

These could be used as a model for regulating the cannabis production chain. The rules governing all aspects of drug control promulgated pursuant to legislation.

Violation of these rules may attract criminal or non-criminal penalties, such as fines and license suspension, depending on the seriousness and the intentional nature of the violation. Although one may play with words, regulation is in fact a necessary application of any form of control, whether within a system of prohibition or a system of legalisation.

All consumer products, from the automobiles we drive to the food we eat, are subject to some form of regulation. Quality control, environmental standards, compliance with industrial standards, regulations on accessibility—all are forms of regulation essential for ensuring no one is poisoned by the food they eat, drives a defective vehicle, or plugs in a dangerous appliance.

Regulation is the most current form of government control; criminal law usually intervenes when the controls fail or mandatory standards are not met. The same is true of the current international system for controlling narcotics. The control system may range from prohibition of all non-medical and non-scientific use e.

MacCoun, Reuter and Schilling examine various systems of legal policy, which they divide into three main types: prohibitionist, controlled access, and regulated access, each of which can be broken down further. Their classification system is reproduced below. Prohibitionist systems vary along a number of lines: based on the nature of prohibited activity e. This makes it clearer why decriminalization remains in essence a prohibitionist approach, albeit a less severe one. Controlled access systems are in a grey area somewhere between prohibition and regulation.

This is the medical model criticized by Szasz, Caballero and, closer to home, Malherbe, in his discussion paper on the role of ethics and public health. One can see why harm reduction approaches belong in this grey area, somewhere between prohibition and regulation, with the prescription of methadone or heroine for treating addiction the perfect example of medical power.

A review of the world cannabis situation.

The third type is the regulatory model that exercises various types of control on who who may purchase, restrictions on minors , what different accessibility levels for different substances , how point of sale, location, requirement for producers and vendors and when time of day, days of the week.

Controlled access. Decreasing restriction. In our opinion, there are basically only two systems: a prohibition system and a legalization system. Both rest on regulation, and the nature and direction of this regulation determines their specific features. Prohibitionist systems may be subdivided into criminal and medical prohibition.

In the first case, sometimes referred to as outright prohibition, the justice system police and the courts is central. In the second, the physician is the key player. Some call this legal paternalism. Both variations can be more or less strict, more or less severe, but rest on the concept that all use that poses a danger to the user and society and must be strictly controlled. In this scenario, decriminalization of use is a weak variation of prohibition , in the long run entailing more disadvantages than advantages.

In addition to failing to affect the production chain and retaining the illegal aspect, it leaves no room for dispensing information to and promoting responsible behaviour by users, or for strong preventive measures. Conversely, the harm reduction approach is a strong variation of a prohibition system. While this approach recognizes the impossibility of eliminating the damage done by market criminalization, it seeks nonetheless to reduce the negative effects of prohibition on users, who are the focus of its main thrust, by introducing education on drug content for example, analysis of ecstasy consumed at raves.

Degree of prohibition. Prohibition of fabrication, cultivation, production, sale, trafficking, use and consumption. A prohibition system, whether criminal or medical, calls for regulation derived from criminal law: any interaction with drugs that is not authorized under the medical model is punished by a criminal or quasi-criminal penalty.

The other type of system rests on legalization of cannabis. It can also take various forms. Legalization systems range from issuing a user licence under certain conditions e. The first type of analysis is impossible simply because no two strategies are different enough for purposes of comparison: there is no cannabis regulation model that can be compared to a prohibition model.

However, as we saw in Chapter 18, it is difficult to establish the real costs related to cannabis and the response of public policy to it, and impossible to determine real social costs. The question is whether or not society would be better off if the use of one or more currently illegal drugs was authorized.

The answer is only if public well-being is enhanced or the social cost of drugs is reduced. No one knows the impact on social costs of legalization of illicit drugs. It is impossible to predict the impact of increased consumption, substitution of tobacco and alcohol for currently illegal drugs, the lower current negative impact attributable to drug illegality and, moreover, the combined impact of all these factors. The superiority of neither prohibition nor legalization is provable. The counter-factual scenario used in studies of the social costs of drugs is itself a formidable challenge, as it rests on the unproven concept of eradicating consumption of a drug.

The model is drawn from the field of health, in which a counter-factual model may be legitimate because, in some cases, a disease can be completely or almost completely eradicated e. It does not apply to drugs, as the process is necessarily so hypothetical that one wonders if it is worth the effort.

It is one thing to try and identify as accurately as possible the diversity of social and economic costs incurred by drugs and then reflect on public policy options; it is another to claim they can actually be measured. MacCoun, Reuter, and Schelling propose two series of criteria, the first considering different applications to different substances, the second based on acceptable costs and consequences.

Using a four-axis matrix, they distinguish:. How do we make a choice? At the outset, it must be understood that, at the end of the line, the decision is necessarily a political one. Epidemiological data on levels of use and empirical data on effects and consequences are clear: cannabis is not as dangerous a substance as interdiction policies would like us to believe. Comparative data on public policies, although more limited, also make it clear that measures undertaken under prohibitionist regimes have not been effective.

This much said, no one can predict what will happen under an alternative regime, such as the regulated access model we are proposing. This is why we insist that any comprehensive strategy on cannabis must be based on a public health model and involve tools to evaluate its implementation and effects. To produce such data, one would have to have experienced the different regimes of cannabis control.

Since the early twentieth century, various degrees of prohibition are all there has been, however. Be that as it may, we would hazard a guess that, even if we did have empirical data, in the final analysis the decisions would still be political in nature because they are basically public policy decisions which, as discussed in our chapter on guiding principles, are not defined on the basis of scientific knowledge alone. Nonetheless, if we attempt to apply these criteria to cannabis, we believe that a system of regulated access is most likely to reduce the negative consequences for both users and society.

We are fully aware that our statements with respect to a regulatory system are wholly theoretical. We do think, however, that all the data we have collected on cannabis and its derivatives provide sufficient ground for our general conclusion that the regulation of the production, distribution and consumption of cannabis, as part of an integrated and adaptable public policy, best responds to the principles of autonomy and governance that foster human responsibility and of the limitation of penal law to situations where there is demonstrable harm to others.

A regulatory system for cannabis should permit, in particular, :.


In our opinion, Canadian society is ready for a responsible policy of cannabis regulation that honours these basic principles. International Scientific Conference on Cannabis. Paris: OFDT. Les drogues en France. Paris: Georg, page A Glossary of Terms. Vienna: author, page Lisbon: author, available on line at www. Montreal: CPLT. Vol 15, no 3, page Fenoglio op. Over the past two years, the Committee has heard from Canadian and foreign experts and reviewed an enormous amount of scientific research. The Committee has endeavoured to take the pulse of Canadian public opinion and attitudes and to consider the guiding principles that are likely to shape public policy on illegal drugs, particularly cannabis.

Our report attempted to provide an update of the state of knowledge and of the key issues, and sets out a number of conclusions in each chapter. This final section sets out the main conclusions that emerge from all this information and presents the resulting recommendations that derive from the thesis we have developed namely: in a free and democratic society, which recognizes fundamentally but not exclusively the rule of law as the source of normative rules and in which government must promote autonomy insofar as possible and therefore make only sparing use of the instruments of constraint, public policy on psychoactive substances must be structured around guiding principles respecting the life, health, security and rights and freedoms of individuals, who, naturally and legitimately, seek their own well-being and development and can recognize the presence, difference and equivalence of others.

This Commission had far greater resources than did we. However, we had the benefit of a much more highly developed knowledge base and of thirty years' historical perspective. The Commission concluded that the criminalization of cannabis had no scientific basis. Thirty years later, we can confirm this conclusion and add that continued criminalization of cannabis remains unjustified based on scientific data on the danger it poses.

The Commission heard and considered the same arguments on the dangers of using cannabis: apathy, loss of interest and concentration, learning difficulties. A majority of the Commissioners concluded that these concerns, while unsubstantiated, warranted a restrictive policy. Thirty years later, we can assert that the studies done in the meantime have not confirmed the existence of the so-called amotivational syndrome and add that most studies rule out this syndrome as a consequence of the use of cannabis.

The Commission concluded that not enough was known about the long-term and excessive use of cannabis. We can assert that these types of use exist and may present some health risks; excessive use, however, is limited to a minority of users. Public policy, we would add, must provide ways to prevent and screen for at-risk behaviour, something our policies have yet to do.

The Commission concluded that the effects of long-term use of cannabis on brain function, while largely exaggerated, could affect adolescent development. We concur, but point out that the long-term effects of cannabis use appear reversible in most cases. We not also that adolescents who are excessive users or become long-term users are a tiny minority of all users of cannabis. Once again, we would add that a public policy must prevent use at an early age and at-risk behaviour. The Commission was concerned that the use of cannabis would lead to the use of other drugs.

Thirty years' experience in the Netherlands disproves this very clearly, as do the liberal policies of Spain, Italy and Portugal. And here in Canada, despite the growing increase in cannabis users, we have not had a proportionate increase in users of hard drugs. The Commission was also concerned that legalization would mean increased use, among the young, in particular. We have not legalized cannabis, and we have one of the highest rates in the world.

Countries adopting a more liberal policy have, for the most part, rates of usage lower than ours, which stabilized after a short period of growth. It is time to recognize what is patently obvious: our policies have been ineffective, because they are poor policies. No clearly defined federal or national strategy exists. Some provinces have developed strategies while others have not.

There has been a lot of talk but little significant action. In the absence of clear indicators accepted by all stakeholders to assess the effectiveness of Canadian public policy, it is difficult to determine whether action that has been taken is effective. Given that policy is geared to reducing demand i. A look at trends in cannabis use, both among adults and young people, forces us to admit that current policies are ineffective.

In chapter 6, we saw that trends in drug-use are on the increase. This proportion appears, at least in the four most highly-populated provinces, to be increasing. Statistics suggest that both use and at-risk use is increasing. Of course, we must clearly establish whether the ultimate objective is a drug-free society, at least one free of cannabis, or whether the goal is to reduce at-risk behaviour and abuse. This is an area of great confusion, since Canadian public policy continues to use vague terminology and has failed to establish whether it focuses on substance abuse as the English terminology used in several documents seems to suggest or on drug-addiction as indicated by the French terminology.

It is also important to identify the root cause of this trivialization against a backdrop of mainly anti-drug statements. The courts and their lenient attitude might be blamed for this. Perhaps the judiciary is at the forefront of those responsible for cannabis policies and the enforcement of the law. It must also be determined whether sentences are really as lenient as some maintain.

A major issue to be addressed is whether harsher sentences would indeed be an effective deterrent given that the possibility of being caught by the police is known to be a much greater deterrent. Every year, over 20, Canadians are arrested for cannabis possession.

This figure might be as high as 50, depending on how the statistics are interpreted. This is too high a number for this type of conduct. However, it is laughable number when compared to the three million people who have used cannabis over the past 12 months. We should not think that the number of arrests might be significantly increased even if billions of extra dollars were allocated to police enforcement. Indeed, such a move should not even be considered. A look at the availability and price of drugs, forces us to admit that supply-reduction policies are ineffective.

Drug prices have not fallen but quality has improved, especially in terms of THC content — even if we are sceptical of the reported scale of this improvement. Yet, police organizations already have greater powers and latitude — especially since the September 11, tragedy — in relation to drugs than in any other criminal matter. To what extent do we want to go further down this road? It has been maintained that drugs, including cannabis, are not dangerous because they are illegal but rather illegal because they are dangerous.

This is perhaps true of other types of drugs, but not cannabis. We should state this clearly once and for all, for public good, stop our crusade. However much we might wish good health and happiness for everyone, we all know how fragile both are. Above all, we realize that health and happiness cannot be forced on a person, especially not by criminal law based on a specific concept of what is morally right. No matter how attractive calls for a drug-free society might be, and even if some people might want others to stop smoking, drinking alcohol, or smoking joints, we all realize that these activities are well and truly part of social reality and the history of humankind.

Consequently, what role should the State play? It should neither abdicate responsibility and allow drug markets to run rife, nor should it impose a particular way of life on people. Instead, we have opted for a concept whereby public policy promotes and supports freedom for individuals and society as a whole. For some, this would undoubtedly mean avoiding drug use. However, for others, the road to freedom might be via drug use. For society as a whole, this concept means a State that does not dictate what should be consumed and under what form. Support for freedom necessarily means flexibility and adaptability.

It is for this reason that public policy on cannabis has to be clear while at the same time tolerant, to serve as a guide while at the same time avoiding imposing a single standard. This concept of the role of the State is based on the principle of autonomy and individual and societal responsibility.

Indeed, it is much more difficult to allow people to make their own decisions because there is less of an illusion of control. We are all aware of that. It is perhaps sometimes comforting, but is likely to lead to abuse and unnecessary suffering. An ethic of responsibility teaches social expectations not to use drugs in public or sell to children , responsible behaviour recognizing at-risk behaviour and being able to use moderately and supports people facing hardship providing a range of treatment.

From this concept of government action ensues a limited role for criminal law. As far as cannabis is concerned, only behaviour causing demonstrable harm to others shall be prohibited : illegal trafficking, selling to minors, impaired driving. Public policy shall also draw on available knowledge and scientific research but without expecting science to provide the answers to political issues. Indeed, scientific knowledge does have a major role to play as a support tool in decision-making, at both an individual and government level.

Indeed, science should play no greater role. It is for this reason that the Committee considers that a drug and dependency observatory and a research program should be set up: to help those decision makers that will come after us. Although the Committee has focused on cannabis, we have nevertheless observed inherent shortcomings in the federal drug strategy. Quite obviously, there is no real strategy or focused action. Behind the supposed leadership provided by Health Canada emerges a lack of necessary tools for action, a patchwork of ad hoc approaches from one substance to another and piecemeal action by various departments.

This has resulted in a whole series of funded programs developed without any tangible cohesion. Many stakeholders have expressed their frustration to the Committee at the jig-saw of seemingly evanescent pieces and at the whole gamut of incoherent decisions, which cause major friction on the front lines.

In one study of Brazilian medical students, Martins, , 37 found three main areas in which residents expressed difficulties: breaking bad news, treating patients with terminal disease, and the fear of contracting infectious diseases. The residents also pointed to two particular stresses: fear of making a mistake and lack of time to spend with family and friends. Drug use by medical students can cause a variety of problems, depending on the degree of involvement that the student has with the drug. The effects of occasional use largely depend on the circumstances in which he uses the drug, but may range from no discernible effect to a serious impairment in academic performance and concentration difficulties.

There is also an increased risk of abuse or even dependency later in life, with the associated personal and social complications that ensue. To better facilitate such early detection, there is an urgent need for research investigating the risk factors associated with initiation into drug use. Such studies need to go beyond the confines of merely examining factors related to the pressures of medical training, and look at factors that predate entry into medical school, such as family problems, personality traits and prior experimentation with other drugs.

Most medical schools in Brazil lack a structural framework which would allow students with drug problems to be identified. This type of approach would permit the development of a more trusting and confidential relationship than is normally possible with academic staff. Such a professional would be ideally placed to identify students with drug or other psychological problems, and to offer treatment where appropriate.

Treatment would have to be completely confidential and held away from school premises to ensure that students would not be identified as "drug addicts" by their classmates. When the person who identifies drug misuse in a student is a physician, his or her own attitudes toward, and personal experience with, drug use come into play. Physicians with more liberal attitudes to drug use and those who have experimented with drugs in the past may be more disposed to play down the importance of drug misuse by colleagues or students, and consequently be less likely to intervene at an early stage and offer treatment.

Extensive literature exists showing that medical students have negative attitudes towards patients with drug-dependency problems. If medical schools are to have a pivotal role in preventing drug and alcohol problems among students, then these attitudes need to be more effectively challenged. However, at the present time the amount of drug and alcohol training that most medical students receive is minimal 7,32,41, and fragmented. Regarding drug-related problems, they may lack the necessary skills to identify drug problems and deal with denial.

Consequently, when faced with a drug or alcohol abusing colleagues or classmates, the student may be paralyzed into inaction due to a combination of fear of confronting the person and inappropriate therapeutic nihilism. Often the little contact that students have with drug and alcohol dependent patients is fairly short-term and is likely to be with those patients who have more chronic problems associated with psychiatric and physical complications.

Consequently, students may not believe that these patients can be successfully rehabilitated, and therefore become unduly pessimistic in their outlook. While physicians allegedly make bad patients, they may also make bad physicians when the patient they are treating is another doctor.

7. The psychological effects of chronic cannabis use

There may be an unwillingness for colleagues to take control of the situation, allowing the doctor-patient to take liberties that would not be allowed with ordinary patients. Thus corridor consultations, inadequate supervision and permitting self-prescribing are common, behaviors that are rationalized on the grounds that busy schedules and on-call commitments make it difficult to find time to make proper consultations. These lessons are learned early on at medical school, particularly in relation to the use of benzodiazepine to relieve symptoms of stress or induce sleep after a period of on-call duty.

While such behavior may not lead to drug dependency, it is undesirable. Specialized services for students and practicing physicians need to be developed to counteract this tendency and to provide medical professionals with the treatment service they deserve. In Brazil, it is common practice for final-year medical students to have facilitated access to prescription drugs.

Drugs are often donated by pharmaceutical companies for use with impoverished patients who cannot afford to pay for them, and in some institutions, medical students themselves staff these small pharmacies. Such easy access only encourages students to self-prescribe. Later, this may lead to the inappropriate or improper prescribing of psychotropic drugs by one doctor to a colleague, patient, or even to himself.

In Brazil, consideration should be given to ending the relatively unlimited and unsupervised access that many students and physicians have to pharmacies. To really tackle the problem of drug and alcohol misuse by medical students and physicians, particularly in terms of prevention, early identification and treatment, we must do much more than simply tinker with the medical school curriculum. The following six recommendations offer a framework of where to go from here:.

Review the curriculum, not only regarding the amount of time spent dealing with this subject during the course, but also as to the themes and techniques employed, in order to increase the knowledge base that medical students have about drug and alcohol misuse. In particular, information about misuse by medical professionals and how to identify and deal with such problems must be covered and emphasized, especially reinforcing the dangers involved in self-prescription.

Provide for better and more appropriate clinical experience with patients with drug and alcohol problems, based on directly supervised case management. Require medical school authorities to develop a system in which students who are having problems during the medical school course can be identified and counselled, such as the modified tutorial system mentioned above. A similar system needs to be developed for residents and other physicians. Organizations representing the medical profession, such as regional medical counsels, need to develop a system whereby students and physicians identified as having drug and alcohol problems can be assessed and treated confidentially.

In resistant cases, there may need to be an element of compulsion. Formulate and implement a formal policy regarding drug-related issues in the school of medicine, applicable to all members of the academic community: board of directors, staff, faculty and students.

Undertake further research to investigate risk factors for drug and alcohol misuse, and whether these can be minimized. Substance use among senior medical students: a survey of 23 medical schools. JAMA ; 16 Hays Lr, Metzler DW. Survey of medical student substance use and parental alcohol use. Sub Abuse ;1. Helwick SA. Substance abuse education in medical school: Past, present and future. J Med Ed ; Nonmedical drug use patterns among medical students. Intl J Add ; Psychoactive drug use among practicing physicians and medical students. N Engl J Med ; 13 Rev Hosp Psiquiat Habana ;31 2 Roche AM.

Drug and alcohol medical education: evaluation of a national programme. B J Add ; Alcohol-use pattern through medical school. JAMA ; Assessment of drug involvement: Applications to a sample-of physicians in training. B J Add ;, Fuchs FD. Psychoactive substance use among medical students. A J Psych ; 2 Andrade AG. Carvalho FV. Murad JE. Drug abuse among students in the state of Minas Gerais, Brazil. Bulletin on Narcotics ;31 1 Zanini AC, Moraes E. Drug Forum ;6 2 Is there an epidemic of drug misuse in Brazil? Intl J Add 3 A methodology for student drug-use surveys.

WHO Offset Publication 50, Cocaine and marijuana use by medical students before and during medical school. Arch Intern Med ; Medical education on tobacco: Implications of a worldwide survey. Med Ed ; Bertschy G. Fenton GW.