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Legalising marijuana : Some points to ponder

20 juillet 2014, 00:00

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The author posits that we might come to legalise cannabis one day. She believes that when the day does come, we should sidestep the corporate trap of mindless consumerism with strict regulation and pre-emptive education.

 

Cannabis is the most commonly used illegal drug worldwide. Its legalisation is a ferociously contentious issue that divides opinions politically, medically and scientifically.

 

There is something to be said for legalising marijuana. Fundamentally it protects the individual’s right to choice and preserves autonomy. Legalisation also eliminates the black market and provides tax revenue. Prohibition, as history has taught us, was an epic failure; alcohol bans brought more crime to the streets than they ever solved.

 

There may also be a place for medical marijuana. It is sometimes used for the management of severe nausea and vomiting in the palliative setting, although this is not common practice. Medical marijuana is not endorsed by medical treatment guidelines mostly because its use has been associated with neurological side effects such as seizures and acute psychosis. Early research of neurological disorders has suggested that marijuana, by virtue of its high concentration of cannabinoids, could potentially be used to manipulate neurological function. Again, this is not formally sanctioned by international practice guidelines but watch this space.

 

To call a spade a spade, there is no real evidence in the use of medical marijuana. For any therapy to make it into the universal standard of medical practice, the so-called guidelines, it needs to be rigorously tested in controlled conditions. Cannabis is by and large illegal in most countries. It is dealt in back alleys and private homes, where pharmaceutical companies and government officials don’t venture. Big pharmaceutical laboratories won’t invest money or intellectual power on researching illegal drugs because it’s bad for business and there’s no potential for immediate profit. Without hard data or randomised controlled studies, the use of medical marijuana is a long way away from making it to the international standards of practice. The research is promising but whether that will eventually trickle down to standard clinical practice remains to be seen.

 

As a doctor, although I am a staunch supporter of medical evidence, of practicing within guidelines, I see enough patients who struggle with intractable pain, nausea, debilitating neurological morbidity to acknowledge that sometimes, one must look the other way. As reliable as they are, guidelines don’t account for desperate measures.

 

Many have also argued that marijuana is perhaps the lesser of many evils. As it is, one could argue that cigarettes kill more people than weed, that there are more road traffic accidents caused by drunk drivers that drivers high on pot. The use of marijuana does not involve the use of needles, does not carry the risk of transmission of blood-borne viruses and is not as deadly a drug as say, cocaine or heroin; nobody has ever died from smoking too much weed as far as I know.

 

What then is the big deal with legalisation? The trouble with marijuana is this: it’s not a harmless little drug that you smoke in high school or when holidaying in Amsterdam. Cannabis is a mind-altering drug and what’s more it is a drug of addiction that can cause lifelong dependency. Therein lies the problem: Legalising marijuana means accepting the risks of an addictive and mind-altering drug becoming freely available.

 

We have allowed another addictive substance to be retailed before: tobacco. And look where that got us. Cigarette-related diseases kill six million people a year and will go down in medical history as one of our worst man-made death tolls. Legalising marijuana may leave us vulnerable to another similar kamikaze. Albert Einstein once said that the definition of stupidity is doing the same thing over and over again and expecting different results. One cannot enter the marijuana debate without evoking the disaster that was tobacco.

 

Cannabis is not a safe drug. It has a high concentration of psychoactive substances that cross from the bloodstream directly into the brain. The nerve receptors and neurotransmitters like dopamine are affected, producing the classical feeling of euphoria and establishing addiction in the long term. Messing around brain receptors is skating on thin ice.

 

Within minutes of marijuana ingestion, the nervous system is affected: intense euphoria, the classical high followed by a gross alteration of all senses: smell, visions, hearing. Depending on the concentration of neurotransmitters released, a vast spectrum of neurological states will be experienced, ranging from a mellow drowsiness to extreme alertness and hyper-vigilance. Large doses of cannabis can disrupt neurological function profoundly and chronic cannabis use is associated with high rates of psychosis, mania, depression and anxiety.

 

Cannabis causes cognitive impairment almost universally. It weakens short term memory, attention span and concentration. Coordination and judgement are impaired. Cannabinoids accumulate in the fat stores and continue to get released over up to 24 hours, so neurological impairment lasts well beyond the subjective ‘‘high’’. Most people are completely unaware of their mental impairment but the effect was convincingly demonstrated when a group of pilots were tested on flight simulators before and after cannabis use. The mental slowing and blunted reflexes were significant after even small doses of marijuana. This may explain why cannabis is associated with a ten fold increase in road accidents.

 

Cannabis also causes the heart rate and blood pressure to rise and over time can lead to cardiac enlargement. The rates of lung and brain tumours are also significantly increased.

 

Addiction is also problematic. The withdrawal from cannabis can be severe, with intractable nausea and vomiting, anxiety and insomnia. Most people will relapse from their first attempt at abstinence. Due to their ability to cause vast shifts in neuro-transmitters, cannabinoids can become addictive after just one use.

 

Maybe those problems pale in comparison to the heavy death toll caused by cigarette smoking or hard drugs but the harm remains very real nonetheless.

 

With that in mind, legalisation becomes a thorny issue. Could the key to this entire business lie in regulation? Regulating marijuana as a safety valve against abuse, to allow medical use in the palliative setting and protect the kids from it.

 

Regulation for cannabis may prove trickier than tobacco. Cigarette packets come with warnings and the sales are restricted to adults. It’s difficult to issue health warnings as we do for cigarettes as there are no proper controlled studies for marijuana. Tobacco has been extensively researched, weed hasn’t. Without hard data, warning labels cannot be issued; the marijuana lobby can easily turn around and dispute those cautionary labels. The marijuana industry also has the Internet at its disposal. Regulation of advertising and marketing is almost non-existent on the web. As an experiment, post something ludicrous on your Facebook page and see how many thumbs up you reap.

 

Releasing a highly addictive product with regulation gaps could turn disastrous: it could easily replicate tobacco in the 1940s. Everyone puffing away with no warning only to find out years later that it had been a terrible mistake and by then it was too late.

 

There is a risk that the market will expand with legalization. Currently only about 5% people in the country have access to marijuana but once it becomes legal, its use may sky-rocket. Not because prohibition is a deterrent, but because big corporations will get their hands on it.

 

I fear big corporations with buckets of money and clever business strategies. Again, one cannot help but draw from the tobacco experience. When tobacco was in its modest beginnings, when people used to roll their own cigarettes, the market reach was relatively limited. Once big corporations took over and exploited the industry, the market exploded. Suddenly you had a very different product: perfectly cylindrical cigarettes with the nicotine content ramped up to ensure loyal dependence and additives to enhance taste and increase nicotine absorption, clever marketing to target specific vulnerable consumer groups: slim cigarettes for women, minted ones for the posh and so on. It was a successful business strategy and smoking spread like wildfire.

 

This raises and uneasy question: can we guarantee that marijuana won’t go down the same path? Commercially, it would make perfect sense to cut and paste the tobacco model. Just as Big Tobacco was there to make profit at whatever cost, Big Marijuana may be the same.

 

The concern is that once legalized, marijuana may become big business. Cartons of machinerolled joints, associated with images of freedom, sex appeal, glamour and funny little cartoons, endorsed by a legion of celebrities. Private industry is designed to make profit, it’s not designed to safeguard public interest.

 

This can, to a certain extent be counter-acted by proper education campaigns. People who live in countries where cannabis is legal are not pot-heads. Quite the contrary in fact. However, they do have strong public health campaigns and they are remarkably well educated about the effects of marijuana abuse.

 

Public health in the Netherlands for instance is a well-oiled machine but our local system may not have the money to fi ght big corporations. Tobacco was such a money-making monster that it became politically and economically powerful rendering it unstoppable. This may sound like a worst-case scenario over-dramatic conspiracy theory but it is something to think about before we legalise marijuana. It could turn into a corporate Goliath and the private sector should not be given free rein with an addictive drug.

 

I believe in freedom of choice and I believe in autonomy but the free-market approach may not serve the public’s best interest in this particular case. I suspect we will come to legalise cannabis one day. When the day does come, we should sidestep the corporate trap of mindless consumerism with strict regulation and preemptive education. Easy on paper, but in real life, it’s always a different story. I suppose only time will tell but watch this space.