Those of us old enough to wax poetic about the 1970s know that the Caribbean used to be the place to go to enjoy the ganja, pot, weed, marijuana. Where does the Caribbean stand on the legalization of marijuana today?
A panel discussion was held at the Caribbean Tourism Organization State of the Industry Conference on September 16, 2014 on the decriminalization and legalization of marijuana from a public health perspective.
Here, the remarks made by Dr. C. James Hospedales, ED, Caribbean Public Health Agency (CARPHA) are shared:
Thanks for asking CARPHA to participate in this panel and speak on the public health perspective on decrimimalization and legalization of marijuana. I guess I can summarise in one sentence: “Proceed with an abundance of caution, given the significant adverse effects of cannabis smoking on health and social and occupational functioning, and especially so among youth.”
We already have two major legal substances of abuse, alcohol and tobacco, which cause a tremendous amount of harm. In the case of the latter, it is harmful when used as directed and in all its forms, hence the Framework Convention on Tobacco Control.
But first let’s define some terms: There are perhaps 3 general policy perspectives concerning the status of marijuana: prohibition, decriminalization, and legalization. Prohibition describes current US Federal policy and that of many countries toward marijuana use, which classifies marijuana as a Schedule 1 drug, with a high potential for abuse, and with strong legal sanctions and aggressive interdiction of supply routes. Some US States have taken a less restrictive approach. Decriminalization refers to the elimination, reduction, and/or non-enforcement of penalties for the sale, purchase, or possession of marijuana, although such activities remain illegal, and advertising would be banned.
Legalization, one step beyond decriminalization, would fundamentally change the status of marijuana in society and allow possession, sale and advertising. No country in the world has done the latter.
Overall, we can see that many different types of public health and scientific studies clearly demonstrate significant adverse effects of cannabis smoking on physical and mental health, as well as its interference with social and occupational functioning.
These negative data far outweigh a few documented benefits for a limited set of medical indications, for which safe and effective alternative treatments are readily available. If there is any medical role for cannabinoid drugs, it lies with chemically defined compounds, not with unprocessed cannabis plant. I’ll say more on this in a moment as CARPHA recently conducted a review at the request of CARICOM on the “Therapeutic uses of Cannabis.” But Legalization or medical use of smoked cannabis is likely to impose significant public health risks, including an increased risk of schizophrenia, psychosis, and other forms of substance use disorders.
As decriminalization is considered, I must draw attention to some of the significant neurologic, cognitive, behavioral, and physical consequences of short- and long-term marijuana use, which are well known. These include negative effects on short-term memory, concentration, attention span, motivation, and problem solving, which clearly interfere with learning; There are adverse effects on coordination, judgment, reaction time, and tracking ability, which contribute substantially to unintentional deaths and injuries among adolescents.
Three recent studies 11–13 demonstrate an association between marijuana use and the subsequent development of mental health problems.
People sometimes say that smoking marijuana is not addictive because withdrawal symptoms are not pronounced, but it’s interesting that a high percentage of regular users in a recent study also say that they would like to reduce or stop because they realise its harming them but can’t, or that they feel guilty about the amount they are using. These are classical signs of addiction.
Important perspectives on how changing the status of marijuana could affect use by adolescents can be gleaned from an examination of the US experience with drugs in the past. During the 19th century, Opium use was common, especially among middle-class white women.15 Use of morphine also was extensive, and heroin was marketed as a “sedative for coughs.” Cocaine, which routinely was added to patent medicines and beverages, also was legal; it was prized for its local anesthetic effect and its ability to counteract the effects of morphine. The national opiate addiction rate increased more than fivefold from 1840 to the 1890s, thereafter beginning a sustained decline, as the scope of the problem was realised.
If we focus on youth for a moment, the latest data on drug use among secondary school students in 12 Caribbean countries has recently been published by the Inter-American Observatory on Drugs (OID). The report, launched at the fourth biennial meeting of Caribbean Drug Observatories in Port of Spain (2011), offers a comprehensive, regional analysis of drug use in this group. The findings demonstrate that even though the countries have similar histories, the dimensions of drug use are quite unique to each country.
Other recent studies concerning American adolescents, the Dutch experience with decriminalization (from 1984 to 1992), and the relationship between cheaper marijuana and use by adolescents suggest that decriminalization increases marijuana use by adolescents, though not all studies come to this conclusion.
Legalization of marijuana could decrease adolescents’ perceptions of the risk of use and increase their exposure to this drug. Furthermore, data concerning adolescents’ use of the 2 drugs that are legal for adults (alcohol and tobacco) suggest strongly that legalization of marijuana would have a negative effect on youth. Alcohol and tobacco are the drugs most widely abused by adolescents, although their sale to adolescents is illegal. Research demonstrates that manufacturers of alcohol and tobacco systematically market their products to young people; if marijuana were legalized, restrictions on the sale and advertising of the substance to young people would prove daunting. Finally, two in-depth reviews of medical marijuana conclude that future research should focus on the medical use of cannabinoids, not smoked marijuana.
CARPHA recently did a review of the Therapeutic benefits of Cannabis by studying the systematic reviews of the subject. The use of Cannabis or its constituents as a medicine is a keenly debated issue. Based on numerous anecdotal reports and findings from clinical trials, those in favour assert its pain killing, anti-nausea, and antispasmodic and appetite stimulant properties.
Note that no evidence of the clinical effectiveness of smoked marijuana for treating any disease condition emerged from this review. This reasons for this are two-fold: i) the available systematic review studies did not evaluate smoked marijuana as one of the interventions and ii) when this route of administration was under consideration, due to study design issues, the available clinical trials did not meet the criteria for inclusion in our reviews.
Lack of available evidence, however, does not unequivocally mean lack of effect.
A few cannabis-based medications have been approved and registered for use in some countries. This includes Marinol® for use in the treatment of HIV/AIDS anorexia, Canasol® for treatment of intraocular pressure associated with late-stage glaucoma and Asmasol® for relief of asthma and allergy symptoms.
And from a public health point of view, I repeat what I said at the beginning, “Proceed with an abundance of caution, given the significant adverse effects of cannabis smoking on health, and social and occupational functioning, and especially so among youth.”