The National Cannabis Taskforce Report - 1994In 1994 the Australian Government's National Cannabis Taskforce ' concluded the most comprehensive review of the scientific and medical evidence and presented it's report (below). As part of the National Drug Strategy Monograph Series five of it's technical papers were published and are available for FREE from the Australian Commonwealth Department of Human Services And Health. (Australian residents can find their local branch through the White Pages of the telephone book). At present we are unaware of any online versions other than the excerpts presented on this site. The Health and Psychological Consequences
of Cannabis Use, Monograph Series No.25, Legislative
Options For Cannabis In Australia, Monograph Series . No.
26 Patterns Of Cannabis Use in Australia,
Monograph Series No. 27 Public Perceptions of Cannabis Legislation
Monograph Series No. 28 Public Perceptions of The Health and
Psychological Consequences of Cannabis Use, Monograph Series No.29
The National Cannabis Taskforce ReportTerms of Reference for the National Task Force on Cannabis The terms of reference for the National Task Force on Cannabis were as follows: 1. Sumarise the available evidence on: 3. Develop a report for the National Drug Strategy Committee summarising the findings of the Task Force's research, which presents cost-effective options available to Australian jurisdictions for the control of cannabis consumption and minimisation of harm arising from its use, and identifies legislative initiatives required to ensure uniformity of legislative approach within Australia. vi Recommendations The following recommendations represent the unanimous view of the members of the National Task Force on Cannabis. These recommendations can also be found in the later sections of this report, where they are presented in a different order, but in the context of relevant research and discussion. GENERAL With regard to the immediate consideration of the Task Force's work, it is recommended that: 1. the National Drug Strategy Committee receive the Task Force's report and associated commissioned technical papers. 2. the National Drug Strategy Committee endorse the recommendations of the Task Force's Final Report, and forward them to the Ministerial Council on Drug Strategy for consideration at its next meeting. 3. the Ministerial Council on Drug Strategy receive the recommendations of the Task Force. 4. the Ministerial Council on Drug Strategy refer
the final report and commissioned technical papers of the National Task
Force on Cannabis to the Standing Committee of Attorneys- General, for
consideration of: Following their deliberations, the Standing Committee of Attorneys-General should be invited to report back to the Ministerial Council on Drug Strategy for their meeting in 1 995. 5. the Ministerial Council on Drug Strategy commission the development of a comprehensive national policy on cannabis, based on the Task Force research and recommendations, that clearly states aims, objectives and strategies. 6. the Task Force's commissioned technical papers be made widely available, through publication as Commonwealth monographs. 7. the Ministerial Council on Drug Strategy consider releasing the final report of the National Task Force on Cannabis as a public document.
POLICY The National Task Force on Cannabis recommends
that: 9. the law enforcement focus on the detection and prevention of the importation, sale and unsanctioned cultivation of cannabis should be maintained. 10. jurisdictions consider discontinuing the application of criminal penalties for the simple personal use or possession of cannabis, without compromising activities aimed at deterring cannabis use. 11. the provision of information on the health consequences of cannabis use, and possible treatment options be considered, as a routine adjunct to the issuing of civil penalty notices for minor cannabis offences, and even where other penalties such as non-custodial sentencing prevail. 12. jurisdictions which have discontinued, or are considering the discontinuation of the application of criminal penalties for minor cannabis offences include provision for adequate monitoring and evaluation of the effects of such changes, with evaluation outcomes linked to the goals of the legislative approach. Public Education The National Task Force on Cannabis recommends that: 13. the National Drug Strategy Committee develop a consistent and nationally focused public education campaign to provide accurate information on the health effects of cannabis, with the specific aims of: a. increasing awareness among current cannabis
users and those at risk of initiating cannabis use, about the range, extent
and severity of health problems attributable to cannabis use, especially
heavy use, including: b. attempting to delay the onset of cannabis use among adolescents. 14. other targeted education activities be directed at current users of cannabis, with the aim of minimising the possible long term harms associated with cannabis use, including information on lessening the likelihood of respiratory damage and cannabis dependence. 15. the National Drug Strategy Committee sponsor the development of modified versions of the commissioned papers, suitable for a broad public audience. RESEARCH The National Task Force on Cannabis recommends that the Commonwealth Drugs of Dependence Branch consider the funding, commissioning or facilitating of further research in the following areas: Monitoring 16. trends in cannabis use, along with use of other drugs, in the Australian community,through the ongoing series of National Drug Household Surveys. 17. possible changes in average cannabis potency and modes of consumption over time. 18. trends in cannabis and other drug use among Australian schoolchildren, through the ongoing series of state-based surveys of schoolchildren's drug use, using comparable survey methodology and data analyses across states, with surveys conducted in the same years in each state. 19. investigation of the feasibility of including questionnaire items on cannabis use in the ongoing series of state-based surveys of alcohol and tobacco use among schoolchildren, coordinated by the Anti-Cancer Council of Victoria. 20. special purpose surveys of regular users of cannabis, to seek information on sources of cannabis supply, amounts purchased by users and prices, extent of "home grown cannabis production, typical preparations and amounts used, perceived availability of cannabis, and the contexts in which it is used. Such surveys should be approved under regulations to the Commonwealth Epidemiological Studies (Confidentiality) Act1981, to ensure the confidentiality of identifying information. Legal Issues 21. analysis of `the cannabis expiation systems operating in South Australia and the ACT, including comparisons with legal approaches in use in other states, and comparative analysis of the economic and social costs associated with the various systems. 22. development of a generic instrument or procedure to measure impairment of motor coordination and cognitive functions, which could be used to identify people who are intoxicated by cannabis, particularly as it relates to driving motor vehicles or operating machinery. Public Health Issues 23. the community's knowledge and opinions about the health effects of and risks associated with cannabis use. 24. appropriate education or health promotion strategies
and messages relating to cannabis use, with the aims of: 25. longitudinal research into patterns of cannabis use, including factors associated with the initiation and continuation of cannabis use, and the use of other drugs. Medical Issues The National Task Force on Cannabis recommends that the National Drug Strategy Committee request that the National Health and Medical Research Council consider the funding, facilitating or promoting of further research in the following areas: 26. biomedical studies into the health and psychological
consequences of cannabis use, especially with regard to: 27. controlled research into the efficacy of synthetic cannabinoid products as treatments for nausea associated with cancer chemotherapy, for HIV/AIDS related conditions (including Htu/AIDS-associated depression and weight loss), for glaucoma, and as anticonvulsant, antispasmodic, and analgesic agents. National Cannabis Taskforce Report CHAPTER I Introduction 1.1 Background At the meeting of the Ministerial Council on Drug Strategy of 15 April 1992, the then Commonwealth Minister for Justice, Senator Michael Tate, sought information on issues relating to cannabis use in Australia. He emphasised the need for accurate and up-to-date knowledge, in an accessible form, to inform policy decisions relating to cannabis use in the community. Among the areas where sound knowledge was needed were: consumption patterns of cannabis in Australia; health effects of cannabis use; the effectiveness of anti-smoking measures for influencing cannabis use, and whether such measures need to be supplemented by laws criminalising cannabis use and trafficking. In response to the Senator's concerns, the National Drug Strategy Committee resolved at its meeting on 25 May 1992 that a National Task Force on Cannabis be convened. The Task Force's role would be to develop papers_summarising current knowledge on aspects of cannabis use in Australia. While the Task Force was not given the role of developing a national policy on cannabis, it was thought that the review papers prepared for the Task Force could contribute to the development of such a policy, by providing a sound scientific knowledge base. The National Task Force on Carnabis first met in Adelaide on 7 September 1992. At this meeting it was agreed that the major part of the Task Force's work should be the preparation of four definitive research papers, as follows: (1) a review of the literature on the health and psychological effects of different patterns and intensities of cannabis use. (2) a review that examined the legislative options that exist for the control of cannabis use, and the impact of such options on the community and on the law enforcement sector. (3) a profile of cannabis consumption patterns in Australia, with attention given to: social, cultural and economic factors which inhibit or enhance the supply and use of cannabis; the natural history of different patterns of use; and, the role of cannabis as a `gateway' drug. (4) an examination of public opinion on the acceptability of various legislative options for the control of cannabis use, and the possibilities for educative interventions. It was agreed that for each of these four research papers, an appropriately qualified researcher would be commissioned to gather the relevant information and present it in an accessible format, for inclusion with the Task Force's final report. Funding for the work of the Task Force was sought and obtained from the National Drug Crime Prevention Fund. These funds permitted the commissioning of independent researchers to prepare the four Task Force papers. In addition, the funding allowed a project officer for the Task Force to be employed, and covered costs associated with obtaining independent peer review of all the commissioned Task Force papers. 1.2 Purpose of the report The present report aims to provide a concise overview of the work of the Task Force, with a discussion of the implications of findings of the Task Force's review papers for policy in relation to cannabis use. A number of recommendations are presented, relating to the options available to jurisdictions for cannabis control, the need for further research, and the desirability of a consistent legislative approach to cannabis. As a subcommittee of the National Drug Strategy Committee (NDSC), the National Task Force on Cannabis has had the role of developing the review papers on cannabis issues, for presentation to NDSC in an appropriate format. An important principle underlying the work of the Task Force was that its final reports and papers should be free of any bias or overemphasis on either the purported positive or negative consequences of cannabis use. The Task Force has at all times endeavoured to ensure that the material prepared for it reflects a balanced view of the current state of knowledge, particularly with regard to the-health and psychological effects of cannabis, and the suitability of various legal options relating to cannabis. It should be emphasised that the Task Force regards it as important that, in all forums in which the Task Force's findings are discussed, its report and recommendations not be considered in isolation from the accompanying commissioned technical papers. The Task Force acknowledges that it is important to recognise and make explicit those areas where knowledge is lacking. In some areas where the review papers have shown that the evidence for certain conclusions is equivocal, particularly with regard to some of the health and psychological effects of cannabis, the Task Force has chosen to recommend that further research be undertaken. These and all other recommendations are based on the findings presented in the papers commissioned specially for the Task Force, as well as on numerous other documents which the Task Force has examined. A list of other such key documents which have been received and noted by the Task Force is contained in Appendix 3. The Task Force wishes to make it clear that it regards its work as a preliminary but crucial step in the further development or refinement of policies and laws in the cannabis area. The technical papers prepared for the Task Force represent the culmination of considerable work in reviewing the relevant scientific literature, and could serve as valuable resources for researchers, policy makers, and other individuals and organisations worldwide. Government policy relating to the use of all drugs, including cannabis, must be based on the most up-to-date information available, and must be flexible enough to change in the light of changing scientific views, or professional and public opinion. Policy development must involve debate and consultation at a broad community level, and it is the Task Force's wish that its report should stimulate such debate and provide a framework for decision-making in the future. 2 CHAPTER 2 The Task Force Research Briefs For each of the scientific research and review papers commissioned by the Task Force, a detailed research brief was described.The briefs specified the issues to be covered by the authors in their review of the research literature, and also higlighted special topics for the authors' attention. In the case of the paper on the public perceptions of the laws relating to cannabis use, the research brief outlined the specific requirements for the survey of public opinion to be carried out for the Task Force. The briefs aimed to be as thorough as possible in addressing the relevant issues for each of the four commissioned papers. The commissioned researchers were expected to review the relevant literature in a wide range of disciplines, including public health, epidemiology, law enforcement, criminology, pharmacology, clinical medicine, psychology, psychiatry, sociology, social policy, drug and alcohol treatment and prevention, and others. The briefs specified that emphasis was to be placed on research findings published in the previous five years, although it was acknowledged that in some areas there would be older key research or review papers to which the authors may need to refer. The authors were expected to review both Australian and overseas literature1˜but for some issues, only the literature from Australia would be of relevance. In preparing the papers, the authors were asked to avoid highiy technical terminology where possible. In developing the research briefs, the Task Force acknowledged that it could not anticipate all of the issues which might arise in the course of the authors' investigations as having some policy, public health, research or other significance. There may be some issues which emerged in the course of the research which were not explicitly mentioned in the research briefs, but which have been included in the final papers as worthy of attention. It should be emphasised that, in developing the briefs and commissioning the writing of the four technical papers, it was the Task Force's aim that the four papers prepared for it should be totally impartial and objective accounts of the current state of knowledge, and should generally avoid making interpretative statements which might be viewed as favouring any particular policy position. The Task Force is satisfied that the commissioned researchers, in the presentation of their analyses of the available literature and/or research data, have indeed demonstrated a well balanced and fair approach to the topics, giving fair treatment to areas where opposing viewpoints might be held. This section provides details of each of the four briefs, and gives a clearer idea of the scope of the Task Force's investigations. It should be kept in mind that the briefs were intended to provide a listing of topics or issues to be covered in the papers, but that this itemisation was in no way intended to be a structure or format for the ordering of sections within each paper; it was assumed that each author would structure the paper in an appropriate and logical way, based on their own expertise and their investigations into the literature. The items explicitly documented in each of the four research briefs are listed below (not in order of priority). 3 2.1 "The Health and Psychological Consequences of Cannabis Use" ausing or carcinogenic (cancer-causing) potentials of cannabis compounds, including those found in cannabis smoke, and possible relationships to various types of cancers found in humans. ˜ Examine the health consequences of the use of different forms of cannabis (e.g. hashish, hash oil, dried flowers and leaves) via the various possible modes of consumption (e.g. smoking, eating, etc.), over the short and long term. Particular attention should be given to the health risks associated with varying frequencies and patterns of cannabis smoking, from occasional use to long term regular use. Among the smoking-related health problems that should be discussed are: - respiratory problems and pulmonary damage - lung, throat and mouth cancer. ˜ Review the evidence for effects of cannabis and its constituent compounds on the immune system. ˜ Examine the health consequences of cannabis consumption during pregn~ with reference to aspects of foetal and infant development. ˜ Examine the possible health consequences of cannabis use in terms of effects on the functioning of other body systems, such as reproductive, hormonal and cardiac/circulatory systems. ˜ Review the literature on the effects of cannabis on the human brain, and on such functions as learning, memory, psychomotor performance and information processing. ˜ Review the effects of cannabis on motor vehicle driving performance, and the relationship between cannabis use and road accidents. The risk associated with using machinery or undertaking other potentially hazardous activities while under the effects of cannabis should also be examined. ˜ Examine the relationship between carinabis use, both short and long term, and the possible development of schizophrenia, and the triggering of acute psychoses in susceptible individuals. ˜ Examine the evidence for other psychological effects of chronic cannabis use, such as the development of depression, effects on the personality and its development, the development of a cannabis dependence syndrome, and of an amotivational syndrome. 4 ˜ Examine the possible risks to young people from the use of cannabis, especially with regard to psychological development and to some of the aforementioned possible psychological sequelae of cannabis use. ˜ Examine the evidence for possible differential physiological and psychological responses to cannabis use among different sectors of the population (e.g. males vs females, ethnic groups, age groups). ˜ Examine the evidence for possible interactions between cannabis and other drugs (i.e. alcohol, tobacco, medications or other illicit drugs), with attention given to intoxication levels and undesirable effects from combinations of cannabis and other drugs. ˜ Review the evidence for therapeutically beneficial uses of cannabis compounds, including its potential uses for: - nausea associated with cancer chemotherapy - glaucoma - various neurological conditions, including epilepsy - analgesia in various chronic pain states. ˜ Review possible contraindications for therapeutic application of cannabis compounds (e.g. elderly patients with pre~xisting cardiac problems). ˜ Review the evidence for the presence of cannabinoid receptors in the human brain, and the possible role of such receptors in mediating either harmful or beneficial effects of carnabis use. ˜ Review the potential therapeutic applications of synthetic cannabinoid derivatives and their side effects compared to carmabis. ˜ Examine the range of psychological benefits of cannabis that might motivate both short and long term, occasional and regular users of cannabis. 2.2 "Legislative Options for Cannabis in Australia" ˜ Review the rartge of legislative approaches for the control of carnabis consumption in other countries, and in all Australian jurisdictions. Consideration should be given to those countries/states where schemes have been introduced in which offences relating to personal possession and use of cannabis have been partially decriminalised (i.e. prohibition with civil penalties), and the underlying rationales for these systems. Attention should be given to the legislative approaches found in: - United States of America - Netherlands - United Kingdom - South Australia / ACT ˜ Discuss the range of arguments both for and against schemes which incorporate civil penalty options for personal cannabis use, and summarise the available evidence for the costs and benefits associated with the full range of legislative options relating to cannabis. This should include: - examination of the relative costs to the law enforcement sector and the court system in dealing with different legislative approaches to Cannabis control; 5 - examination the effectiveness of the various legislative options in minimising the harm arising from carinabis use, both at an individual level and for the community as a whole. - consideration of the context in which cannabis legislation must function, including obligations under international treaties and charters, and under Commonwealth and State law. Examine available data on cannabis consumption patterns under different legal systems, and the evidence for potential harms resulting from increased levels of cannabis consumption under systems with civil penalties for personal cannabis use (i.e. partial decriminalisation), in terms of: - the percentage of the population (esp. youth) who experiment with cannabis for the first time; - the frequency and quantity of cannabis consumed by regular or occasional cannabis users. ˜ Discuss approaches for evaluating the effectiveness of new legislative approaches to cannabis issues, with reference made to the ways in which changes to carmabis legislation in other countries have been evaluated. A discussion should be included of the possible need for special or ongoing data collection systems to allow evaluations of cannabis legislation to be effectively carried out. ˜ Discuss the appropriateness of: - court diversionary schemes for dealing with small scale personal cannabis offences, particularly for repeat offenders or for those who fail to expiate fines under an expiation notice system; - compulsory treatment for cannabis offenders, particularly repeat offenders. 2.3 "Cannabis Consumption Patterns in Australia" ˜ Review the available data on levels and patterns of cannabis consumption in Australia, with emphasis given to the most recently available data, and to data derived from large population surveys. Among the surveys discussed should be the various surveys of drug and alcohol use amongst schoolchildren undertaken in a number of Australian states, and the Australia-wide population surveys undertaken as part of the National Campaign Against Drug Abuse. ˜ Examine the available survey data on trends in cannabis consumption in Austr~ over the last two decades. ˜ Contrast the trend data and recent findings on levels of cannabis use in Australia with similar data from other countries using similar gurvey methods. ˜ Examine other indirect statistical indicators which might correlate with or reflect the consumption of cannabis use in the community, such as law enforcement data on cannabis possession, use or cultivation offences, and data on police seizures of commercial quantities of cannabis. ˜ Examine and comment upon the methodologies used in various initiatives aimed at collecting information on cannabis use levels. 6 ˜ Examine the available survey and other research data on the natural history of cannabis use, with particular attention given to findings from longitudinal research studies. ˜ Report on social, cultural and ethnic factors associated with (i.e. either encouraging or inhibiting) onset of cannabis use, and with regular, frequent or prolonged cannabis use. ˜ Examine the available evidence on the role of various economic factors, particularly those that impinge directly on individuals, on carnabis consumption in the community, including: - personal income as a determinant of purchase and use of cannabis; - the effect of unemployment on levels of cannabis use, in terms of both numbers of people using cannabis, and the amount of carnabis consumed by regular users; ˜ Examine the possible effects of fluctuations in availability of cannabis on levels of carrriabis use, with attention given to: - the effects of supply reduction efforts (e.g. customs seizures of cannabis, police destruction of large cannabis crops), especially the effects on small scale cannabis cultivation; - the evidence for substitution of canriabis use with use of other licit or illicit drugs during periods of relative scarcity of cannabis; - cannabis use patterns during periods of ready cannabis availability. ˜ Examine evidence for and against the view that carinabis is a `gateway' d~~ for the use of other illicit drugs such as heroin and amphetamines. This should include a discussion of gateway theories of drug use in general, and what is known about other drugs which might be `gateways' to carnabis use. ˜ Discuss other theories or models of drug use and its initiation and maintenance which might be relevant to cannabis consumption, including models which include factors such as social class, peer influence, risk-taking behaviour, family influence and personality. ˜ Present available evidence for possible `at risk' groups for initiation to cannabis use, or for transition from occasional to frequent cannabis use. Such groups might include segments of youth, the unemployed, and individuals with other drug problems or psychological disorders. 2.4 "Public Perceptions of Cannabis Legislation in Australia" Undertake an Australia-wide survey of public perceptions of cannabis and the laws relating to its possession, use or cultivation, and of opinion on other legislative options relating to cannabis. The survey should be sufficiently large to allow reliable comparisons to be made between different Australian jurisdictions. The survey questionnaire should include items on the following issues: - respondents' knowledge of the current laws concerning both small scale (i.e. personal) and large scale (e.g. trafficking) cannabis offences in their jurisdiction; - opinions on whether cannabis should be legal or illegal, and if cannabis use should be illegal, whether or not its use should be treated as a criminal offence; - the acceptability of jurisdictions moving towards more lenient penalties for small scale cannabis offences, including schemes which involve the issuing of "on-the- spot" expiation fines for such offences; 7 - respondents' views on the penalties appropriate to various cannabis offences (i.e. penalties ranging from issuing of fines without criminal conviction to gaol sentences); - levels of cannabis use amongst respondents, including frequency and intensity of use; - respondents views on whether more effort needs to be undertaken by governments to deal with issues relating to cannabis use in the community, e.g. cannabis use amongst youth and in schools large scale importation and cultivation of cannabis the need for more public education on cannabis and its effects. - respondents' views on the safety of occasional and regular cannabis use, and on what they believe to be the specific health risks associated with cannabis use, if any1; - views on whether cannabis is a "gateway" drug, that is, its use is associated with, Or might lead to use of other illicit drugs2; - other issues as the researchers see fit, and as agreed to by the Project Manager. ˜ Examine recent data already available on public perceptions of cannabis and the legal options for cannabis control, from both Australian and overseas jurisdictions, and to contrast these findings with those from the survey. ˜ Discuss the public acceptability of cannabis decriminalisation at the national level versus its acceptability at the state level. ˜ Discuss the appropriateness and effectiveness of using the mass media to try to bring about change in public perceptions regarding cannabis. This should include consideration of whether it is appropriate to employ measures similar to those used in anti-smoking campaigns in order to bring about changes in the public's attitudes towards cannabis. Discuss the possible harm minimisation implications of mass media campaigns against cannabis use, and compare these with the harm reduction potentials of the various legislative approaches to cannabis, including those of the most common approach of criminalising users, cultivators and traffickers of cannabis. While this item was specified in the brief, it was decided by the Task Force during the development of the survey questionnaire that information on people's knowledge of the safety of or health risks associated with cannabis use would not be sought in this survey, for the following reasons: (1) there was a need to keep the telephone survey at a reasonable length. As this issue was not the prime focus of the paper, it was thought that any coverage in this survey would necessarily be superficial; (2) it was agreed that it would be difficult to develop a set of questions which would not be viewed as being biased either towards a benign view of the health effects of cannabis, or to the view that cannabis was extremely harmful. Given the suspected lack of knowledge of the health effects of carmabis (including those that had been clearly established and those that had not), it was thought that the survey could create a demand effect in ˜th~ responses tending towards either the benign or harmful extremes, depending on thenatu˜'re˜afldordering of the health risk items listed. Such information would be better collected in the context of a survey on perceptions of the health risks of a range of drugs, including legal drugs such as alcohol and tobacco, and "harder" illicit drugs such as heroin and amphetamines. In this regard, the Task Force has recommended to the Commonwealth that a separate survey on this issue be undertaken. ~ For the same reasons as above (Footnote 1), the exploration of people's views of the role of cannabis as a "gateway" drug was omitted from the survey. 8 CHAPTER 3 The Research Papers: Overview of Findings This chapter presents an overview of the key findings from each of the four papers cornmissioned for the National Task Force on Cannabis. It should be pointed out that it is not possible to summarise in a few pages the huge amount of material that has been reviewed and written for the Task Force. The overall structure of the overviews presented in this chapter reflects the structure and contents of the corresponding technical papers prepared for the Task Force, and readers may refer to the complete papers for additional detail and references. For the present report, the overviews aim to concisely cover the range of research findings reviewed or prepared for the Task Force in its technical papers, highlighting the important issues which have become apparent in the course of the Task Force's work, or which may emerge as significant issues at some time in the future. Thus, for example, while the overview in this report does not present the complete detailed findings on patterns of cannabis use in Australia, it presents information on the broad trends in cannabis use, and on the implications for public health and the legal responses to cannabis use. As far as the health and psychological effects of cannabis are concerned, attention is given not only to those issues where there are demonstrated or likely risks to the health of users, but also to the areas where the health risks to cannabis users remain uncertain. The recommendations of the National Task Force on Cannabis for further action with regard to policy and research issues are also presented in this chapter. Each recommendation is to be found immediately following the presentation of the relevant findings in the overview sections. While a number of recommendations may have relevance to more than one of the Task Force's commissioned papers, they are presented here in the section to which they have the most relevance. The recommendations are numbered to correspond with the order in which they are presented at the begirining of this report (on page vii). 3.1 "The Health and Psychological Consequences of Cannabis Use" The review of literature on the health and psychological consequences of cannabis use, of all the commissioned Task Force papers, is the one which must necessarily include the most technical language, because of the large amount of material covered from specialised disciplines such as psychology, psychiatry, immunology, clinical medicine, and others. This paper is the most significant international review of the literature on this issue to be undertaken since the one undertaken jointly by the Addiction Research Foundation and the World Health Organisation in 1981~. The authors of this paper have made explicit their approach to evaluating the large body of research literature on the health effects of cannabis. Where possible, they have relied on 3 See Addiction Research Foundation/World Health Organisation (1981). Reoort of an ARF/wHO Scientific Meeting on the Adverse Health and Behavioral Consequences of Cannabis Use. Addiction Research Foundation, Toronto. 9 the consefisus views expressed in the literature by experts in various fields. Where there is controversy or disagreement about the existence of certain health outcomes arising from cannabis use, the authors have acknowledged this disagreement. In all cases, they have endeavoured to give due consideration to those research studies which are the most rigorous, or can be shown to be well designed and conducted. This has enabled the authors to make some progress in sorting out the conflicting findings or viewpoints on some contentious issues, through the careful appraisal of the relative merits of conflicting studies. For a detailed discussion of the authors' approach to assessing the huge literature on the health effects of cannabis, see Task Force Paper No. 1 (Chapter 3). Cannabis the dtug For a discussion of the various available forms and preparations of cannabis, their routes of administration and typical dosage levels, see Task Force Paper No. 1 (Chapter 4). THC is the primary psychoactive component of cannabis. When cannabis is smoked, blood levels of THC reach a peak within about 10 minutes of smoking, and then decline rapidly to about 5-10% of the initial level within the first hour after smoking. This initial decline reflects the conversion of THC by the lungs and liver to its metabolites, some of which are psychoactive. The rapid decline in blood levels of THC is also due to the distribution of unchanged THC to tissues of the body. THC and its metabolites are highiy fat soluble. They may be stored and accumulate in fatty tissues of the body (including the brain), from which they are gradually released over time, and cleared from the body. The slow release of THC and other cannabinoids from fatty tissues into the bloodstream means that these compounds may be detectable in very small amounts in the blood for several days or weeks. THC has been shown to be held in fatty tissues in measurable amounts for over 28 days. THC is cleared from the body significantly more quickly for regular or experienced users than for inexperienced users; the half-life for THC (i.e. the time needed to clear half the given dose from the body) for experienced users is of the order of 19-27 hours, while the half-life for THC clearance for inexperienced users is around 50-57 hours. While body levels of THC depend on the dose taken and the smoking history, they are also subject to substantial individual variability. It is therefore very difficult to determine from blood levels of THC how recently cannabis has been smoked, even if the dose consumed and the individual's smoking habits are known. The health significance of the storage of cannabinoids in fatty tissues has not been fully determined. However, it is quite clear that the subjective psychoactive effects of cannabis intoxication do not persist beyond a few hours, correlating with the initial peak and subsequent rapid decline in blood levels of THC and other psychoactive metabolites. It appears that THC and other cannabinoids stored in fat do not remain active, in terms of psychoactive effects. While concern has been expressed at the possibility of marijuana "flashbacks" resulting from the gradual release of stored THC and other cannabinoids from fatty tissues into the bloodstream, the nature of the metabolism of cannabinoids suggests that such a phenomenon is very unlikely. Indeed, there is no evidence to suggest that the release of cannabinoids stored in fatty tissues can produce noticeable subjective psychoactive effects, or measurable impairment of psychomotor performance. 10 Acute psychological and health effects In addition to the desired immediate effects of the cannabis "high", which include mild euphoria, relaxation and perceptual alterations, cannabis can sometimes produce anxiety, panic or unpleasant feelings, most often in naive users. The consumption of larger than usual amounts, particularly when taken orally, is more likely to lead to these acute adverse effects, as well as symptoms such as delusions and hallucinations. Among the numerous immediate physical effects of cannabis is a consistent increase in heart rate occurring soon after a dose is taken, and blood pressure changes, such that it may increase while sitting and decrease on standing. These cardiovascular effects are unlikely to be of clinical significance, particularly for younger users. The acute toxicity of cannabis is very low, and there are no confirmed cases of deaths from cannabis overdose in the world literature. Cannabis and Driving The major acute health risk from cannabis use arises from its effects on psychomotor performance. Intoxication produces dose-related impairments in a range of cognitive and behavioural functions that are involved in skilled tasks such as driving motor vehicles and operating machinery. It is difficult to estimate the magnitude of risk of being involved in motor vehicle [accidents due to cannabis intoxication. It is known that cannabis intoxicated persons drive more slowly and take fewer risks than alcohol intoxicated drivers. Studies have shown that between 4% and 37% of motor vehicle and other accident victims have cannabinoids in their blood, often along with blood alcohol levels indicative of intoxication. However, such studies are difficult to evaluate, because comparable data on the prevalence of cannabinoids in the blood of non-accident victims is lacking. Also, the presence of cannabinoids in the blood indicates only recent cannabis use, not necessarily cannabis intoxication at the time of the accident. The presence of blood alcohol levels indicative of intoxication in 75% of road accident victims also complicates the issue, making it difficult to assess the causal role of cannabis intoxication. Despite these problems, the available evidence would suggest that there should be restrictions on cannabis use when driving. In particular, the use of alcohol in combination with cannabis appears to increase levels of impairment, with the effects of the two drugs being approximately additive. It would be desirable to have a measure of cannabis related impairment comparableto the breath test for alcohol intoxication. The major difficulty in enforcing restrictions on cannabis use in relation to driving motor vehicles is due to the lack of a simple relationship between blood levels of THC or its metabolites, and degree of impairment or subjective intoxication (unlike alcohol, where there is a clear relationship between blood- alcohol levels and degree of alcohol-induced impairment). It is therefore not possible to define a threshold blood level of THC or other cannabinoids which could serve as a basis for legal testimony in cases involving offences relating to driving a motor vehicle under the influence of cannabis. The National Task Force on Cannabis recommends that the Commonwealth Drugs of Dependence Branch consider the funding, commissioning or facilitating of further research aimed at developing a generic instrument or procedure to measure 11 impairment of motor coordination and cognitive functions, which could be used to identify people who are intoxicated by cannabis, particularly as it relates to driving motor vehicles or operating machinery (Recommendation 22). The effects of chronic cannabis use Cellular effects and the immune system Cannabis smoke has been shown to be mutagenic (causing damage to genetic material) in laboratory studies, which suggests that it is potentially carcinogenic (cancer~ausing). Any1. such capacity would be related to the presence of carcinogens created by smoking, rather than to effect of the cannabinoids themselves. Laboratory studies have demonstrated that cannabinoids produce impairments in certain immune functions in animals, and lowered resistance to introduced infectious agents. Tests have also shown that non-cannabinoids in cannabis smoke lower the effectiveness of respiratory immune functions. The clinical significance of these findings is unclear, as there is the problem of extrapolating from the often high dosage levels used in laboratory tests to those normally used by humans, and the complication of the possibility of tolerance to such effects developing. At present, there is no conclusive evidence that consumption of cannabis by humans causes major impairments in immune functioning. It is more difficult to exclude the possibility that minor impairments in immunity might arise from chronic heavy cannabis use, as such impairments could have escaped detection in the studies done to date. Despite this possibility, there has been no epidemiological or other evidence of increased rates of common viral or bacterial infections or other illnesses among chronic heavy cannabis users. Indeed, one important study of HN-positive men has shown that cchflnued cannabis use did not increase the risk of progression to AIDS. Should it be demonstrated in future that chronic heavy cannabis use has even a minor effect of lowering resistance to common infections, doubts could be raised about the therapeutic usefulness of cannabis compounds in patients who already have immune deficiencies (such as AIDS patients and those undergoing cancer chemotherapy). `˜F The cardiovascular system While the use of cannabis causes physiological changes characteristic of stress, there is no evidence that chronic use causes permanent damage to the normal cardiovascular system. However, the risk of harm may be greater for people with high blood pressure, cerebrovascular disease and coronary atherosclerosis, and such patients should be advised not to consume cannabis, and perhaps not to use carinabis therapeutically. The respiratory system Chronic heavy cannabis smoking may cause symptoms of chronic bronchitis, such as coughing, sputum and wheezing. It is likely that chronic cannabis smoking predisposes users to develop respiratory cancer, as research has shown that cannabis smoke can produce cellular changes of the kind that precedes the development of lung cancer. Concern has been raised by some case reports of cancers of the mouth, throat and airways of young adults with a history of chronic heavy cannabis smoking. Such studies are complicated by the presence of other risk factors in these subjects, such as concurrent 12 alcohol and tobacco use. However, these reports highiight the need for further case- control studies of these cancers to provide more definitive evidence. Reproductive effects While chronic cannabis use causes reproductive and hormonal effects in animals, it is uncertain whether such effects occur in humans, or whether such effects would be of clinical significance in healthy adults. Such effects may be of greater concern for young adolescents, or for males with fertility impaired for other reasons. Cannabis use during pregnancy probably impairs foetal development, leading to lower birthweight. It is uncertain whether its use during pregnancy causes a slightly increased risk of birth defects, but until this issue is clarified, women should be advised not to use cannabis during pregnancy. There is a single study which has provided suggestive evidence of an increased risk of childhood leukemia among children born to women who used cannabis during their pregnancies. Replication of these findings is urgently needed. Psychological effects of chronic cannabis use Adolescent development Although strong conclusions cannot be drawn, there is suggestive evidence from some older American studies indicating that chronic heavy cannabis use by adolescents may adversely affect their development. Some of the longitudinal research on drug use among adolescents has been interpreted as showing that cannabis use in adolescence is a causal factor in such problems as delinquency, poor educational performance, nonconformity and poor adjustment, as well as a "gateway" to the use of harder illicit drugs. However, there are more plausible and better supported explanations for these findings. It is likely that it is the nonconforming and deviant adolescents, who have a greater propensity to use illicit drugs, who are selectively recruited into cannabis use, and are more likely to be part of a subculture which gives them greater exposure and encouragement to use other illicit drugs. The use of cannabis has been associated with poorer school performance and job instability in young adulthood, but this relationship may be exaggerated because of lower pre-existing academic aspirations among those likely to use cannabis. Despite this, there may be a modest effect of cannabis use on educational performance, which may have subsequent effects throughout young adult life in terms of choice of occupation, level of income, and so on. There is weaker evidence to suggest that cannabis use has adverse effects on family formation, mental health, and involvement in drug-related crime, but it is likely that any causal effect of cannabis use is minor compared to other factors which are known to be related to these adverse outcomes. On balance, the evidence supports the view that cannabis use, particularly regular Or heavy use, should be discouraged among adolescents. 13 Adult adjustment The evidence for the existence of an amotivational syndrome resulting from Chronic heavy cannabis use is equivocal; it is probable that, if it does exist, it is a relatively rare occurrence, even among heavy, chronic cannabis users. A dependence syndrome A cannabis dependence syndrome probably occurs in some chronic heavy users of cannabis. Tolerance to some of the subjective and physiological effects has been demonstrated, and some heavy users probably experience mild withdrawal symptoms on abrupt cessation of use. Some cannabis users experience problems in controlling their use, and continue to use despite experiencing adverse personal consequences of use. The risk of cannabis dependence may be similar to that for alcohol dependence, and is most likely highest among daily cannabis users. However, the prevalence of drug-related problems in the cannabis dependent group is likely to be lower than for alcohol dependence. There is probably a high rate of remission of cannabis dependence without formal treatment. Recognition of cannabis dependence has been delayed by the fact that few people request assistance in stopping their use, and that cannabis dependence is most common among people who are dependent on alcohol or opioids, problems which demand higher treatment priority. Further research is needed on the prevalence of cannabis dependence, and on better recognition and treatment for cannabis dependent persons. Cognitive effects Long term heavy cannabis use does not appear to produce severe impairment of cognitive function. However, such use may produce subtle impairments in higher functions such as memory, attention, and the organisation of information. These impairments may affect everyday fiinctioning, particularly for adolescents with marginal educational aptitude, and adults in occupations requiring high levels of cognitive capacity. It appears that the longer cannabis has been used, the more pronounced is the cognitive impairment. Further research is needed in this area, especially to investigate individual differences in susceptibility, the effects on adolescents, and the degree of reversal of the impairments with continued abstinence from cannabis. Brain damage There is no reliable research evidence suggesting that chronic heavy cannabis use leads to gross structural changes in the brain. This is consistent with the evidence for only subtle cognitive effects from chronic cannabis use. This does not exclude the possibility that chronic, heavy cannabis use may cause structural changes at the cellular level which cannot be detected by existing methods of brain imaging. Psychotic disorders It is likely that heavy cannabis use can produce an acute toxic psychosis, characterised by confusion, amnesia, delusions and anxiety. This syndrome resembles other toxic psychoses, and remits rapidly after cessation of use. There is less evidence for an acute or chronic functional psychosis caused by cannabis which persists beyond the period of intoxication, and it is difficult to distinguish such 14 cases from schizophrenia and manic depressive psychoses occurring in individuals who also use cannabis. There is some evidence to suggest that chronic cannabis use may precipitate a latent psychosis in vulnerable persons, or exacerbate psychotic symptoms in individuals with schizophrenia. The National Task Force on Cannabis recommends that the National Drug Strategy Committee request that the National Health and Medical Research Council consider funding, facilitating or promoting further biomedical research into the health and psychological consequences of cannabis use, especially with regard to: ˜ respiratory cancer and other respiratory diseases possibly arising from long term heavy cannabis smoking; ˜ the precipitation of latent psychoses in vulnerable individuals after chronic cannabis use; ˜ the risks associated with cannabis use during pregnancy, including the possibility of an increased risk of childhood leukemia among children born to women who use cannabis during pregnancy (Recommendation 26). Therapeutic effects of cannabinoids THC has been shown to be an effective anti~metic (anti-nausea) agent for some patients undergoing cancer chemotherapy. It is uncertain whether THC is as effective as the newer anti-emetics, but there is probably sufficient evidence to justify THC being availab!e in synthetic form for patients whose nausea proves resistant to conventional treatment. There is reasonable evidence for the efficacy of THC in the treatment of glaucoma, especially in cases which have proved resistant to existing anti-glaucoma agents. There is suggestive evidence for the value of various cannabinoids as anti-.spasmodic and anti-convulsant agents. Further clinical research into these applications is warranted, as well as into the potential value of cannabinoids as analgesic and anti-asthrna agents. There is a need for further research into the effectiveness of cannabis and its derivatives in assisting patients with HN/AID$related conditions, and in particular, its value in counteracting weight loss associated with these conditions, improving mood and easing pain. Case reports have suggested that synthetic THC may be effective in reducing nausea and stimulating appetite in symptomatic AIDS patients. While there is a potential concern that possible effects of cannabinoids on the immune system may have more serious consequences for HIV positive individuals and AIDS patients, a recent study has failed to find a relationship between the use of cannabis, or any other psychoactive drugs, and the rate at which HIV positive people progress to clinical AIDS. The National Task Force on Cannabis recommends that the National Drug Strategy Committee request that the National Health and Medical Research Council consider fundIng, facilitating or promoting further controlled research into the efficacy of `synthetic cannabinoid products as treatments for nausea associated with cancer chemotherapy, for HIV/AIDS related conditions (including HIV/AIDS- associated depression and weight loss), for glaucoma, and as anticonvulsant, antispasmodic, and analgesic agents (Recommendation 27). 15 Health implications of an increase in cannabis potency Concern has been expressed in the medical literature that increasingly potent forms of marijuana are becoming more widely available, and that their use may have more serious health consequences. The evidence has been lacking on the degree to which, if any, average cannabis potency has increased over the last decade, in Australia or elsewhere. More potent forms have appeared, but whether the use of these forms increases the average health risk is arguable. It is likely that users would titrate the dosage of more potent cannabis to achieve the desired level of intoxication. It could be argued that the smoking of more potent forms of cannabis may lessen some of the respiratory risks, as less plant material needs to be smoked to obtain the desired effects. This is an area where further research is required. The National Task Force on Cannabis recommends that the Commonwealth Drugs of Dependence Branch consider the funding or facilitation of further research to monitor possible changes in average cannabis potency and modes of consumption over time (Recommendation 17). A comparative appraisal of health risks: alcohol, tobacco & Cannabis Alcohol and tobacco, as the two most widely used psychoactive drugs, provide useful comparisons for cannabis in terms of health risks. Tobacco shares with cannabis the use of smoking as a route of administration, while alcohol resembles cannabis in being used for its intoxicating and euphoric effects. Acute effects Alcohol and cannabis share the significant risk of producing psychomotor and cognitive impairment, although it remains to be determined whether cannabis increases the risk of accidental injury and death to the degree which alcohol does. It is known that alcohol taken in substantial amounts can produce a foetal alcohol syndrome, and there is some evidence that cannabis use during pregnancy can have similar effects. Unlike alcohol, which can lead to death by toxic overdose, cannabis is not known to ever have caused death through overdose. Tobacco and cannabis share the health risk of the irritant effects of smoke on the respiratory system. THC and nicotine both have stimulant effects on the cardiovascular system, which could be harmful to those with cardiovascular disease. Chronic effects Chronic head use of either alcohol or cannabis is associated with an increased risk of dependence; in the case of alcohol there is strong evidence for a dependence syndrome, with potentially severe withdrawal symptoms, while for cannabis there is reasonable evidence for a dependence syndrome, but it is uncertain whether withdrawal symptoms the reliably occur. Both alcohol and cannabis appear to have potential to produce toxic psychoses following prolonged heavy use, and cannabis may precipitate psychotic episodes in susceptible individuals, or exacerbate existing symptoms. Whereas chronic heavy alcohol use can sometimes lead to severe and irreversible co griitive impairments, chronic cannabis use does not appear to produce cognitive 16 impairment of similar severity. Chronic heavy alcohol use can lead to impaired occupational performance in adults and lowered educational achievements in adolescents. Chronic heavy cannabis use probably produces similar, but more subtle impairments. Chronic heavy alcohol use increase the risk of death by accidents, suicide and violence; comparable evidence for heavy use of cannabis is not available, although it is likely that cannabis users who often drive while intoxicated increase their risk of injury or death. Alcohol use is a risk factor for cancer of the oral cavity and throat region; chronic cannabis smoking may also be a risk factor for cancers of this type. The major health risk shared by chronic users of tobacco and cannabis relate to smoking as a route of administration. The risk of chronic respiratory diseases such as chronic bronchitis, and probably the risk of cancers of the respiratory system, is increased for both chronic tobacco smokers and chronic cannabis smokers. Implications for harm reduction The groups most at risk of adverse health consequences of acute or chronic cannabis use, and which would benefit most from efforts to discourage cannabis use, would include: ˜ adolescents - particularly those with a history of poor school performance whose achievement may be further limited by cognitive impairments produced by chronic cannabis use, and those who initiate cannabis use early in their teens, who will be at a higher risk of progression to other drug use and to dependence on cannabis; ˜ women of childbearing age - pregnant women who continue to use cannabis are probably at greater risk of having low birth weight babies and shortened gestation, and possibly increase the risk of their children being born with birth defects; ˜ persons with pre~xisting illnesses - are at risk of exacerbating existing symptoms if they smoke cannabis. This would including people with cardiovascular diseases, respiratory disease (bronchitis, asthma, emphysema), schizophrenia, and people who are already dependent on alcohol and/or other drugs. All cannabis users should be aware of the increased risk of motor vehicle accidents while intoxicated with cannabis, and should be especially careful about driving after combining alcohol and cannabis use. For those who intend to continue using cannabis, the risk of respiratory harm can be eliminated by switching from smoking cannabis to the oral route. Those who continue to smoke cannabis can lessen their risk by avoiding deep inhalation and breath-holding, which increases retention of particulate matter and tar in the lungs. Cannabis users who wish to minimise the risk of dependence should reduce their frequency of use, probably to weekly or less often, as daily or near daily use has a higher risk of producing dependence. The National Task Force on Cannabis recommends that the Commonwealth Drugs of Dependence Branch consider the funding, commissioning or facilitating of further research to ascertain the community's levels of knowledge, and opinions, about the health effects of and risks associated with cannabis use (Recommendation 23). 17 3.2 "Legislative Options for Cannabis in Australia" A paper was commissioned by the National Task Force on Cannabis to provide a balanced assessment of the range of legislative options relating to cannabis which are available to Australian jurisdictions, including a discussion of those legislative models which are currently in place in Australia, as well as those models which are not in operation in Australia but which ought to be considered and evaluated as part of a thorough review. Given the widespread community Interest which exists regarding the legal status of cannabis in Australia, and the diversity of views On how cannabis use should be dealt with, this Task Force paper fulfils the important role of making explicit the various policy goals which might be regarded as worthwhile, and reviews' the available information on how the legislative models available to governments might succeed in meeting the desired objectives. The following overview follows the general structure of the review paper developed for the Task Force. Full details, including references, can be found in the complete review (Task Force Paper No. 2). Policy goals The commissioned authors of this paper point out that it is important for a sensible discussion of drug policy to include a specification of the goals the policy is meant to achieve. The legal options paper puts forward the following issues as being important to consider in the development of policy and legislation˜ relating to drugs, including cannabis: 1. Arguments that apply to the most appropriate control regime for one drug need not - and often do not - apply to others. 2. Drug policy should be crafted to take account of the different patterns and types of harms caused by specific drugs. 3. The details of control regimes are crucial determinants of their outcomes. Such details should not be left undefined. 4. Any analysis of control regimes should attempt to estimate their effects on both consumption levels and patterns of use. 5. Control regimes should not be considered in isolation from the problems of implementation and enforcement. 6. Arguments about the consequences of drug use should be separated from arguments about morals. 7. Options should be evaluated on the basis of evidence of damage. 8. Any policy should recognise the changing nature of the drug problem and be able to change with it. Additionally, all policies should be reviewed periodically to, ensure that they are still relevant to current circumstances. 9. Policy should be made in the light of the costs of control as well as the benefits. 10. The goals of drug policy should be realistic. 11. Discussion of policy options should include a specification of which harms they are intended to reduce. 12. Discussion of cannabis policy (and drug policy generally) should recognise the existence of multiple and sometimes contradictory goals. 18 13. Policies to discourage cannabis use should be shown to be effective or be changed, and the ˜same criterion should be applied to current approaches as well as any alternative approaches. 14. The harms caused by the control regimes themselves should not outweigh the harms prevented by them. Cannabis in context: history, laws and international treaties Australian drug laws "have followed closely the development of international drug treaties, and the United States has had a major influence on such treaties. The 1925 Geneva Convention on Opium and Other Drugs required parties to limit cannabis availability to rfiedical and `scientific purposes, and this remains the status of cannabis in the international community. A number of Australian committees of inquiry into drug use and trafficking have recommended changes to the legal status of drugs, including the recommendation that cannabis legislation be liberalised, or that such liberalisation be considered. Recently, such recommendations were made by the Parliamentary Joint Committee on the National Crime Authority in 1989, and by the ACT Legislative Assembly's Select Committee on Htu, Illegal Drugs and Prostitution, in 1991. Australian controls on cannabis use were introduced in various states, starting with Victorian legislation of 1928 which penalised unauthorised use of Indian hemp and resin. From the 1960s, the Commonwealth became more involved in cannabis legislation, particularly as it relates to importation of cannabis. Since the 1960s and 1970s, there has been a shift in legislative emphasis away from drug users to drug traffickers. While in some cases penalties for trafficking offences have been increased, Commonwealth and some State laws have increasingly distinguished between offences relating to traffickable quantities of drugs (including carnabls), and offences relating to amounts deemed too small for trafficking. There was also a greater distinction made between simple possession of cannabis, and possession of other illicit drugs, reflecting an acknowledginent of the widespread nature of cannabis use, and the relatively lesser harm generally thought to arise from cannabis use compared to the use of other illicit drugs. The most significant recent legislative changes have been the introduction in 1987 in South Australia and in 1992 in the Australian Capital Territory of expiation notice schemes for dealing with minor offences involving small quantities of cannabis. Any discussion of the possibility of legislative change regarding drugs must take into consideration Australia's international treaty obligations. There is some difference of opinion on the range of options available to Australia within the scope of the international treaties; the total prohibition policy currently followed by most states is clearly one of the available options. Five Legislative Options for Cannabis in Australia The following five legislative options or models, and their variants, are put forward as encompassing the range of possibilities for cannabis control: total prohibition (with and without an administrative expediency principle); prohibition with civil penalties for ,minor offences; partial prohibition; regulation; and free availability. Each of these models will be described in some detail. 19 It should be pointed out that, in referring to the different legislative models, the terminology cannot, in itself, give an indication of all of the important features of each model. Within each broad approach, there are no doubt many variations in! thee legis\ation could be formulated and implemented. It is acknowledged that there may be alternative views on how the broad options might best be named and described. For the purposes of the Task Force's work, the authors of the review paper on leg!a'1' `options have adopted the above broad headings to describe certain legislative options, and have provided detailed descriptions of the features of each model. The Task Force believes that this broad categorisation reflects a logical and orderly approach to assessing the available legislative options relating to cannabis use. "Total prohibition", as it is discussed below, might also be described as "prohibition with criminal penalfles for all cannabis offences". However, as described below, the adoption of an "expediency principle" under this model is a variant option which has been put into practice in the Netherlands, and relates to discretionary provisions for the prosecution of minor cannabis offences. The options described under the "prohibition with civil penalties" model encompass those where the drug remains prohibited, and offences involving commercial or traffickable quantities of cannabis carry criminal penalties, while minor cannabis offences incur only civil penalties. "Partial prohibition" is used to describe the model in which offences involving commercial or traffickable quantities of cannabis carry criminal penalties, but activities relating to personal use of cannabis are not viewed as offences at all. "Regulation" refers to the model in which there would be some degree of government control of the production, distribution and sale of cannabis, but trafficking outside this system would still be considered a criminal offence. "Free availability" refers to the model in which there would be no legislative or regulatory restrictions placed on cannabis in any respect. The terms "decriminalisation" and "legalisation" have not generally been used in describing the options outlined in the Task Force's legal options paper. They are relevant only with regard to the situation in which a jurisdiction might change from one legislative model to another. Thus, where a jurisdiction has adjusted its "total prohibition" approach to include civil penalties for minor offences, they could be said to have "decriminalised" minor cannabis offences. Even though the terms "decriminalisation" and "legalisation" have wide general use, they are often used in contexts in which their meaning is vague, and can be misleading. 1. Total prohibition Under this model the use, possession, cultivation, importation, sale and distribution of any amount of cannabis is prohibited, and attracts criminal penalties. People convicted of offences under such a system acquire a criminal record, and may be subject to a variety of sanctions including imprisonment or fines, Total prohibition systems are currently in place in most Australian states, excluding South Australia and the Australian Capital Territory. The United States and The Netherlands provide contrasting examples of this model. Both countries have legislation that provides for the "total prohibition" of all aspects of cannabis supply, possession and use. However, the drug policies of these two countries are quite different. As a result, there are significant differences between the two countries in how the legislation is enforced, or not enforced, particularly with regard to the personal use of cannabis. 20 In the United States, total prohibition of all illicit drug use is thought as the most effective means of achieving the goal of eliminating all drug use, and cannabis use is dealt with in a similar way to other illicit drugs. However, the total proMbition policy as implemented in the United States and in most Australian states has not been successful in eradicating or substantially reducing drug use, despite increasing resources directed towards this goal. The financial and social costs of law enforcement under these systems are high, and they fail to meet a number of the criteria listed above for good drugs policy: cannabis policy is not separate from that of other drugs; arguments about the consequences of dni,,g use are not separated from arguments about morals; the goals of the "war on drugs˜ ,are unrealistic; and it appears that the harms caused by total prohibition (i.e. harms relating to: the involvement of cannabis users with the criminal justice system, through the imposition of criminal penalties and criminal records on large numbers people, particularly young people; and the necessity of obtaining cannabis on the illicit drug market, with its possible associations with other crime and an illicit drug using subculture), outweigh the harms caused by the drug itself. In The Netherlands, which also has a total prohibition system, legislation makes a clear distinction between "drugs presenting unacceptable risks" and "cannabis products". In addition, The Netherlands Code of Criminal Procedure includes a clause known as the "Expediency Principle" which, along with guidelines issued for the enforcement of drug laws, effectively means that dealing, possessing or producing small amounts of cannabis do not require police investigation, arrest or prosecution. Police are also only required to confront cannabis dealers when they advertise publicly or conduct their business in a provocative manner. This is part of a broader policy of "normalisation" under which efforts are made to avoid marginalising drug users and to ensure that drug related harm is minimised. The policy of separating the cannabis market from that for other potentially more harmful drugs has apparently been successful, and cannabis use has not increased in the Netherlands since this policy has been in place. Indeed; cannabis use levels are much lower `than those of the United States, where total prohibition is rigorously enforced. 2. Prohibition with civil penalties Under this model, the possession and cultivation of small amounts of cannabis for personal use is dealt with by civil penalties such as paying a monetary penalty, rather than by criminal sanctions such as court-imposed fines or imprisonment. Criminal sanctions still apply to the possession, cultivation and distribution of large quantities of cannabis. The South Australian Cannabis Expiation Notice Scheme, introduced in 1987, and the similar scheme introduced in the Australian Capital Territory in 1992 are examples of this model. A number of issues underlie the rationale for the introduction of such schemes, and these mainly relate to problems which are perceived to accompany the widespread total prohibition approach. Among these issues is the view that the criminal penalties and stigma associated with personal cannabis use offences under the total prohibition model are out of proportion to the seriousness of the offence. It is also argued that the criminal prosecution of such offences under the total prohibition model is associated with significant social harm, through encroachment on individual rights and freedoms, and through the imposition of criminal records on significant numbers of people, especially young people. Further, it has been suggested that total prohibition, with its provision of criminal penalties for cannabis use, may increase the likelihood of cannabis users coming into contact with other wholesale drug dealers and associated criminal activity, while civil penalty options allow for a greater separation of the cannabis market from other drug markets. Indeed, this notion of "separation of drug markets" is one of the key rationales 21 underlying the operation of the "expediency principle" not to prosecute minor cannabis offenders in the Netherlands. There are further pragmatic considerations underlying the introduction of civil penalty schemes. Among these are the considerable costs and workloads associated with requiring minor cannabis offenders to appear before the courts, and the fact that total prohibition systems have not been effective in reducing levels of cannabis use., Civil penalty options for personal cannabis use, as they have been implemented, generally allow for the continuation of policies which aim to discourage cannabis use, particularly through the maintenance of criminal penalties for offences such as public use of cannabis, and those relating to commercial cultivation, supply and importation. While concern has been expressed at the possibility that cannabis use levels might increase following the introduction of civil penalty schemes, the evidence available to date suggests that such systems introduced in some American states, and in South Australia and the ACT, have not led to changes in patterns of cannabis consumption, and cannabis use remains at similar levels to that in jurisdictions which have policies of total prohibition. A further concern associated with this approach is that' there could be a social class differential in terms of the application of the policy, whereby people of lower socioeconomic classes could be disproportionately represented among those who fail to expiate the offence and consequently appear in court, perhaps to obtain a criminal record. In this regard, further adjustments to these systems could remove the possibility of conviction for some people who fail to expiate notices because of financial or other restrictions. It seems that the key rationale which has formed the basis for the introduction of civil penalty schemes to date has been the view that the social and monetary costs associated with the existing prohibition schemes, as mentioned above, were too high. The available evidence suggests that civil penalty schemes, as they have been implemented, go a long way towards achieving their goals and meeting the criteria for effective drugs policy. While there may be scope for improving civil penalty schemes in terms of their application and operational efficiency, the schemes of this type which have been implemented to date have not led to undesirable effects on the community. The National Task Force on Cannabis recommends that the Commonwealth Drugs of Dependence Branch consider the funding, commissioning or facilitating of further research into the effects and operational efficiency of cannabis expiation systems operating in South Australia and the ACT, including comparisons with legal approaches in use in other states, and comparative analysis of the economic and social costs associated with the various systems (Recommendation 21). 3. Paiti˜al prohibition Under this option, controls on the production and distribution of commercial quantities of cannabis would be maintained, but it would not be an offence to use cannabis or `to possess or grow it in quantities judged appropriate for personal use. A few countries, such as Spain, have followed this model. Others, including Italy, have made possession and use unlawful, but not criminally punishable. In none of these cases does it seem that an increase in cannabis use has resulted. 22 The partial prohibition model, like the prohibition with civil penalties model, attempts to minimise the personal and social costs of the total prohibition policy by avoiding the provision of criminal penalties for cannabis users. At the same time, by providing for the prohibition of commercial cultivation and supply, and the advertising of the availability of cannabis, this model seeks to restrict cannabis availability and discourage use. The authors of the Task Force's paper on legal options argue that, while this model has not been fully implemented and evaluated in any country, it is likely that its main outcome would be to reduce the financial and social costs of having personal use of cannabis a criminal offence. As with the systems providing for civil penalties for Personal cannabis offences, it is unlikely that increased levels of cannabis use would result from the implementation of partial prohibition systems. This option meets the criteria of effective drugs policy, as it attempts to separate cannabis markets from those of other potentially more harmful drugs, it seeks to minimise the negative impact of enforcement regimes, and its goals are realistic and attainable. 4. Regulation !n this approach, the production, distribution and sale of cannabis would be controlled to a greater or lesser extent by government agencies, but trafficking outside the regulated system would continue to be a criminal offence. Activities associated with personal use would not be penalised. While no full working model of this option is available, aspects of cannabis control in The Netherlands correspond with the regulatory option. While the Dutch Government does not license production or sale of cannabis, youth centres and coffee shops openly sell cannabis products under certain clearly defined conditions. Examples of regulatory systems for other drugs include the cultivation of opium poppies under government licence in Tasmania, and the control mechanisms in place for tobacco, alcohol and many pharmaceutical products. Two options under the regulatory model are regulated commercial sale and government monopoly. Within these approaches, there is scope for a range of initiatives to limit the attractiveness of cannabis, including setting high prices through taxation and limiting availability. This model recognises that cannabis use will continue to occur, and should therefore occur in the safest possible environment. To achieve its goals, the regulatory approach would need to be structured in such a way as to remove incentives for a black market in cannabis. While certain financial and social costs could be avoided with such a policy, there could be fairly high administrative costs if the system involved a complex system of licensing and monitoring. A well designed regulatory system would achieve the separation of the cannabis market from the market for other illicit drugs, and reduce resultant harm. It would be important in such a system to allow for appropriate measures of social control, including drug education and prohibitions on advertising, so that the goals of harm reduction could co'ntinue to be pursued. 5. Free availability This model would mean the absence of any legislative or regulatory restricticns on cannabis cultivation, importation, sale, supply, possession or use. This option is not practised in any countries at present. Few lobbyists for liberalisation of cannabis legislation advoca~ free availability; some form of regulation is generally deemed acceptable. This reflects concerns about the quality of cannabis, driving or operating machinery while intoxicated with cannabis, its use by 23 children, etc. The adoption of such a model in Australia at any time is unlikely, as it would mean the abrogation of all government responsibility in the area of consumer protection, especially for vulnerable groups. The move towards minimising the harrn from the licit drugs, especially tobacco and alcohol, and the role of government in this process, makes it clear that the free availability of cannabis is not a viable contemporary option. Summary of legislative options Of the five legislative models described above, two models account for most of the systems currently in operation in jurisdictions throughout the world: the total prohibition model, and the prohibition with civil penalties model. The Task Force supports the view that the total prohibition model, in providing criminal penalties for minor cannabis offences, results in significant social harm, through the imposition of criminal records on large numbers of people, and by increasing the likelihood of involving cannabis users in illicit drug markets and criminal activity. It is believed that such harms generally outweigh any personal or social harms which may result from the moderate use of cannabis. In contrast, the provision of civil penalty options for cannabis users seeks to avoid or minimise the potential harms associated with having a criminal record, or with involvement in illicit drug markets. A similar argument can be made for the other models which do not include criminal penalties for minor cannabis offences. The question of whether personal cannabis use should be regarded as a civil offence, or not an offence at all, is one that cannot readily be answered. While the very limited evidence from jurisdictions which have removed penalties for personal cannabis use (i.e. under the "partial prohibition" model) suggests that levels of use are not higher under, such a system, there are other considerations which may be more relevant to the acceptability of this approach. Chief among such considerations is the view that it is desirable for governments to discourage drug use through the provision of some form of penalty for personal use (even if only a civil penalty), as part of a broader approach which aims to minimise drug-related harm. The Task Force acknowledges the prevailing view in our society that drug use, including cannabis use, should not be encouraged, and that we should seek to minimise the harms which result from the use of drugs. The argument has been put forward in the Ta'sk Force's commissioned paper on legislative options that the personal and social harms associated with total prohibition systems, particularly relating to the involvement of carnabis users in the criminal justice system, outweigh the harms' arising from moderate cannabis use. If this view is accepted, then other legislative options which do not provide criminal penalties for personal use of cannabis must be preferable, particularly where such options remain consistent with the general approach of discouraging carinabis use and promoting healthy drug-free lifestyles, while minimising the harms arising from use. ,,The National Task Force on Cannabis recommends that: activities relating to the possession, unsanctioned cultivation, sale and non- therapeutic use of cannabis in any quantity should remain illegal (Recommendation 8); ˜ the law enforcement focus on the detection and prevention of the importation, sale and unsanctioned cultivation of cannabis should be maintained (Recommendation 9). 24 ˜ jurisdictions consider discontinuing the application of criminal penalties for the simple personal use or possession of cannabis, without compromising activities aimed at deterring cannabis use (Recommendation 10). Diversion and compulsory treatment Diversion of cannabis offenders can include pre-arrest diversion. Provide an overview of the normal immediate physical and psychological effects, and subjective responses, associated with exposure to cannabis. Attention should be given to possible variations in psychological effects at different dosage levels, and with varying frequency and length of use. ˜ Provide a brief outline of the metabolism of cannabinoids in the human body. Consideration should be given to the evidence for retention of cannabis compounds in body flssues, the half life of such compounds in the body, and the implications for health of their storage in the body. Examine the available information on possible mutagenic (causing damage to genetic material), teratogenic (malformationourt diversion, pre- sentence diversion and post conviction diversion. Compulsory treatment may or may not be a feature of diversionary process; it may sometimes be a feature of diversion of an offender or alleged offender from the criminal justice system, or it may operate independently of that system. While pre-arrest diversion is simply the discretion exercised by police at the point of contact with an alleged offender, other more formal diversionary programs can be found in place in Australia and overseas. In the ACT, for example, legislation provides for the sentencing option of any person found guilty of a drug offence being sent for assessment as to whether they are drug dependent and suitable for referral' to treatment. The assessment panel may recommend to the court how long the person should spend in treatment. If a person fails to appear for specified periodic reviews, a summons may be issued, and the person dealt with by the courts in the usual way. Similar diversionary programs mandated by legislation exist in South Australia, New South Wales, Victoria and Western Australia. Most often, such systems are used to deal with offenders for whom illicit drugs other than cannabis are involved. The logic behind diversion programs which include treatment referral options centres on the view that offenders' encounters with the criminal justice system could provide the opportunity for problems with drug use to be evaluated and treated. While there is some dispute over the value of coercion in bringing drug users to treatment programs, involuntary c!ieflts tend, to spend longer in treatment than, do voluntary clients, contributing to more successful treatment outcomes. It should be pointed out that few cannabis users require treatment for cannabis dependence, but they may benefit from assistance which' could be' provided by treatment facilities. A few countries, and within Australia, Victoria, have legislative provisions relating to civil commitment for the compulsory treatment of drug users, generally people deemed to be drug dependent. These measures are usually adopted for people who come to the attention of the criminal justice or health systems and who refuse to enter treatment voluntarily. These use of such options raises questions about thecivil rights of the individual involved. The relevance of such provisions to the use of cannabis in Australia is limited, as few cannabis users have problems with dependence on the drug, and there is little evidence that treatment has much to offer (such ) users The National Task Force on Cannabis recommends that the provision of information on the health consequences of cannabis use, and possible treatment options be considered, as a routine adjunct to the issuing of civil penalty notices for minor cannabis offences, and even where other penalties such as non-custodial sentencing prevail (Recommendation 11). 25 Evaluating new legislative approaches for cannabis In Australia and elsewhere, there has generally been inadequate monitoring and evaluati0njesPec1al1Lb~overnm˜ent agenQ˜ies,~ drug pnlirieq. This is particularly so where drugs legislation has developed incrementally, and where new approaches have been implemented. To be of most value, new legislative initiatives should be implemented with an adequate monitoring and evaluation component built in from the outset. Policies relating to cannabis use should be evaluated in a manner consistent with the overall goal of the National Drug Strategic Plan, of rninimisi~˜the hiarmful effects Of dirn˜gsa~dr~ use in Australian society. The National Task Force on Cannabis recommends that jurisdictions which have discontinued, or are considering the discontinuation of the application of criminal penalties for minor cannabis offences include provision for adequate monitoring and evaluation of the effects of such changes, with evaluation outcomes linked to the goals of the legislative approach (Recommendation 12). Industrial and Horticultural Uses of Cannabis The fibres of the cannabis or hemp plant have been acknowledged as being of value in the making of good quality rope, fabric and paper. The commercial cultivation of hemp (generally low THC varieties) for such purposes is likely to have advantages over the cultivation of trees for paper production, or of cotton for its fibres, in terms of growing requirements for water, pesticides and herbicides. The United Nations Single Convention on Narcotic Drugs, in Article 28(2), states that "this Convention should not apply to the cultivation of the carnabis plant exclusively for industrial purposes (fibre and seed) or horticultural purposes". Australian drug legislation permits the cultivation of cannabis for scientific purposes, and limited experimentation has already occurred. Cannabis with a very low THC content could be grown for industrial uses of the plant. However, changes to existing drug legislation would be ~ required to allow this to occur. Conclusion There is no best single option for cannabis legislation. 27 3.3 "Cannabis Consumption Patterns in Australia" This overview follows the structure of the paper prepared for the National Task Force on Cannabis on patterns of cannabis use in Australia (Task Force Paper No. 3). Briefly, the aims of this paper were: 1. to describe contemporary patterns of carmabis
use in Australia, and recent trends in use, as can be inferred from the
findings of general population, high school and tertiary student surveys
of drug use; 2. to compare current patterns of cannabis use in Australia
with those in Australia over the past twenty years, and with contemporary
patterns of use in Canada, New Zealand, the United Kingdom, and the United
States; Other data sources A few surveys of drug use among young adults, including surveys of tertiary students in New South Wales and two household surveys among adolescents in Perth and Sydney, have shown similar patterns of use to the general population and school-based surveys. These surveys show that prevalence of cannabis use is higher at successively older age levels throughout adolescence and early adulthood; prevalence of use among males is higher than for females; most use tends to be experimental or occasional. Law enforcement data on arrests and convictions are not good indicators of prevalence of cannabis use. As very few cannabis users will be apprehended by police, the law enforcement cannot provide reliable prevalence figures. Crime data are not good indicators of trends in use, because they may be influenced by changes in legislation, methods of recording offences, and police activity. Cannabis consumption patterns in Australia, 1970 - 1991 The data on the prevalence of cannabis use over the past twenty years is limited, and the comparability of what is available is uncertain because of changes in the survey methods used. Despite this, the available data from population and school surveys is consistent in suggesting that the prevalence of cannabis use has increased over the past 20 years. The prevalence of cannabis use appears to have increased substantially through the 1970s and early 1980s, levelled off in the late 1980s, and shown a small increase in the early 1990s. Patterns of cannabis use in other countries Surveys of the general population and of high school students in the United States have shown clearly that the prevalence of cannabis use peaked in 1979 and declined throughout the 1980s. Bearing in mind that there is some uncertainty in comparing findings from different surveys in different countries, it is probable that the current 30 prevalence of ever having used cannabis is higher in Australia than in Canada, the United Kingdom and the United States, and comparable to that in New Zealand. The current prevalence in Australia is not as high, however, as the peak prevalence of cannabis use observed in the United States in the late 1970s. In other respects, patterns of cannabis use are very similar in different countries, with the prevalence of use higher among men than it is among women, and highest among young adults in their early twenties. The prevalence of regular carnabis use is much lower than that of lifetime use, suggesting that most users discontinue use after trying it, or continue to use occasionally. Factors affecting cannabis use Personal facto rs As discussed, age and gender are factors strongly related to cannabis use. In addition, a positive relationship has been found between income in adolescence and early adulthood and levels of cannabis use, perhaps reflecting those young people who are motivated to try to earn money to finance recreational activities, or those who enter the workforce early and have more money to spend on alcohol, tobacco and cannabis. Cannabis use also appears to be higher among people of lower socioeconomic status, although at the younger age levels, rates of use are high among children of professional parents. Availability The illegal status of cannabis makes it difficult to determine the extent to which increasing availability of cannabis correlates with higher prevalence of its use Crude estimates of availability from self-report surveys (e.g. of how easy people believe it would be to obtain cannabis) have shown very little change over time. The lack of data on this issue precludes the answering of important questions relevant to policy, such as: how effective are supply reduction efforts in reducing cannabis availability? Do cannabis users resort to the use of other illicit drugs when cannabis is not readily available? Does ready availability encourage chronic heavy use? The absence of good trend data on availability and price of cannabis prevent the examination of relationships between cannabis price, purity and use. Cannabis "decriminalisation" The impact of the "decriminalisation" of personal cannabis use (or the introduction of civil penalty options for minor cannabis offences) has been investigated in a number of jurisdictions. Problems exist for these studies, as comparisons are made difficult by the fact that civil penalty options have been implemented in different ways, and that good trend data are often lacking for the period from before to after legislative changes were implemented. Further, comparisons between jurisdictions with and without civil penalties for minor cannabis offences are complicated by the fact that many of the jurisdictions which have introduced civil penalty schemes for personal cannabis use had higher rates of use to begin with. An overview of experience in the United States indicates that states which intr oduced systems of civil penalties for cannabis use have not differed from other states in their patterns or trends in cannabis use. In The Netherlands, where personal cannabis use is 31 dealt with via an administrative "expediency principle", whereby such use is generally permitted to go unpenalised, there does not appear to have been any major changes in the prevalence of cannabis use since the policy of "de facto" decriminalisation wad introduced in 1976. In Australia, an evaluation of the effects of South Australia's Cannabis Expiation Notice (CEN) scheme has shown no evidence of any change in cannabis use rates in the few years following the scheme's introduction, which might be attributable to the new laws. Overall, the available data from different countries suggest that cannabis decriminalisation has not led to increases in cannabis use. Where slight increases in use have been observed in jurisdictions which have adopted civil penalty options, they are of a similar magnitude to the broader increases observed elsewhere. Effects of unemployment Some surveys have shown a higher prevalence of cannabis use among unemployed than employed persons. A number of explanations are plausible: it could be that unemployment is a consequence of increased drug use; unemployment may contribute to higher rates of drug use; or both unemployment and drug use might be consequences of some other personal or social factors. The lack of longitudinal research data on these issues makes it difficult to decide between these explanations. The limited overseas data does not reveal an association between unemployment and initiation of cannabis use, but suggests that unemployment may lead to increased frequency of use among existing cannabis users, and that cannabis use may predict higher turnover in jobs. The natural history of cannabis use Antecedents of cannabis use There has been a consistent finding of a positive association between the initiation of personal drug use, and drug use among peers and siblings. In addition, non-conformity (i.e. being more rebellious, less law abiding, and having more "liberal" attitudes), has been consistently associated with higher levels of alcohol and illicit drug use. The limited research evidence available suggests that some of the factors which predict initiation of cannabis use also predict its continuation. A strong predictor of continuation of cannabis use appears to be the extent of involvement in drug use; people who initiate drug use when younger, were heavier users, had used other drugs, or who used for psychological rather than social reasons, were more likely to continue use. Factors which predict cessation of cannabis use include having fewer drug using friends, higher religiosity higher self rating of health, getting married, non-participation in minor delinquency, and lower deviance. While most of the research into the antecedents of cannabis use has been carried ˜out in the United States, there is limited evidence from Australia to suggest that similar factors are related to the initiation, continuation and cessation of cannabis use in Australia. 32 The National Task Force on Cannabis recommends that the Commonwealth Drugs of Dependence Branch consider the funding, commissioning or facilitating of further research, in the form of special purpose surveys of regular users of cannabis, to seek monitoring information on sources of cannabis supply, amounts purchased by users and prices, extent of "home grown" cannabis production, typical preparations and amounts used, perceived availability of cannabis, and the contexts in which it is used. Such surveys should be approved under regulations to the Commonwealth Epidemiological Studies (Confidentiality) Act 1981, to ensure the confidentiality of identifying information. (Recommendation 20). A gateway drug? Concern exists about the possibility that cannabis use in adolescence may lead to, or increase the likelihood of use of more dangerous illicit drugs, such as cocaine and heroin. Cross-sectional surveys have shown a relationship between degree of involvement with cannabis and the use of other illicit drugs. There is also evidence from American studies for a sequence of initiation into illicit drug use, in which alcohol and tobacco use precedes cannabis use, which in turn precedes problem alcohol use and the use of "harder" drugs. Findings such as these are often incorrectly interpreted to mean that cannabis use has a high probability of leading to heroin use. This is not the case, as the overwhelming majority of cannabis users do not use harder drugs such as heroin. The sequencing of initiation to the use of the different drugs, as revealed by research, could simply reflect the association of each type of drug with different ages of initiation. It is also possible that there is a selective recruitment into cannabis use of less conforming adolescents who have a propensity to use illicit drugs, and that the sequence in which drugs are typically used reflects their differential availability. Another explanation for an apparent relationship between cannabis use and the use of other illicit drugs is that cannabis use increases the chance of using other illicit drugs by socialising users in a drug using subculture. It is likely that the selective recruitment and socialisation hypotheses can account for the observed relationships, but that the use of cannabis itself does not have a direct causal role in initiating the use of other illicit drugs; other social factors are much more critical in determining progression from the use of one drug to another. In fact, recent Australian findings suggest that alcohol and tobacco may be more important "gateway" drugs for the use of amphetamines, heroin and other illicit drugs than is cannabis. The National Task Force on Cannabis recommends that the Commonwealth Drugs of Dependence Branch consider the funding, commissioning or facilitating of further longitudinal research into patterns of cannabis use, including factors which might be associated with the initiation and continuation of cannabis use, and the use of other drugs (Recommendation 25). 33 3.4 "Public Perceptions of Cannabis Legislation in Australia" Due to the lack of good quality data relating to the Australian public's perceptions of the laws relating to cannabis, the National Task Force on Cannabis commissioned a population telephone survey to provide up-to-date information on these issues. As part of this task, the Task Force requested that the findings of the commissioned survey, where possible, be placed into context, through reference to other available data from Australia and overseas on the acceptability or otherwise of various legal options relating to cannabis. The other major specified objective for this paper was to present a discussion of the appropriateness of mass media and other strategies to bring about changes in public perceptions regarding cannabis, and to consider the harm minimisation implications of such strategies. Complete details of the survey findings can be found in Task Force Paper No. 4. The commissioned survey A random telephone survey of 1608 individuals from across Australia was conducted, comprising approximately 200 residents aged between 18 and 70 ˜ye~from each Australian state and territory. All findings presented in the report of the survey results were weighted by gender, age and state or territory of residence, to corre~faz potential biases in the sampling of respondents. Levels of personal use Overall, 39% of the sample had ever tried cannabis; this percentage ranged from 31% in Queensland to56% in the Northern Territory. Males (48%) were more likely than females (31%) to have ever tried cannabis. Younger people were more likely to have tried cannabis, with 59% of 18-34 year olds having tried it, compared to 36% of 35-54 year olds, and 7% of those aged 55 years and older. Of the total national sample, 16% had used cannabis in the previous twelve months, and 6% within the previous two weeks. Of those who had used cannabis in the previous two weeks, 71% were aged 18-34 years. The levels of cannabis use reported in this survey are comparable with those reported in the most recent National Drug Household Survey, conducted in 1993. The present survey found slightly Ngher rates of lifetime use, but slightly lower levels of recent use. These differences are within what could be expected to be due to sampling variation, and suggest that the present survey was not unduly biased in its sample composition. Knowledge of current legality There were fairly high levels of awareness of the current legal status of cannabis-related activities. Nearly all respondents correctly believed that activities involving large amounts of cannabis, or sale of cannabis to others, were illegal, and this was consistent across states. There was less certainty about the legality of activities involving small amo˜un˜ ts of cannabis for personal use, with about 14% of the total sample incorrectly believing that ˜cannabis˜ use was legal, or unsure of its legal status. Similar percentages of respondents were not aware that growing or possessing cannabis for personal use were illegal. Nearly 35% incorrectly believed that possession of implements for smoking cannabis was legal, or were unsure of its legal status. 34 In South Australia and the ACT, where minor cannabis offences are illegal but are now dealt with through civil penalty options, there was greater uncertainty about the legality of using, growing and possessing small amounts of cannabis for personal use. For example, 27% of South Australian respondents and 37% of those from the ACT incorrectly thought that cannabis use is legal, whereas only 2% of people from New South Wales and 70/¯ of Victorians thought use was legal. Similarly, 35% of South Australian respondents and 47% of those from the ACT believed that it is legal to grow cannabis for personal use, while only 5% of respondents from New South Wales and Victoria held this view. It is likely that in South Australia and the ACT, where personal cannabis use has effectively been decriminalised, there remains some confusion among members of the public regarding the legality and criminal status of personal cannabis use. In all states, and particularly in South Australia and the ACT, there is a need to provide information to the community on the legal status of cannabis and the various offences related to its use, possession, cultivation and sale. Views about what should be legal and illegal The majority of respondents in all states believed that activities relating to large amounts of cannabis, or supply/sale of cannabis, should be illegal. This included the large scale supply of cannabis without exchange of money. In contrast, between 52% and 55% of respondents thought that growing or using cannabis for personal use, using cannabis, and possessing implements for smoking cannabis should be legal. This is a higher degree of support for the legalisation of personal use than has been found in previous surveys. People from the Northern Territory were most likely to hold the view that personal cannabis use should be legal (68% of respondents), while Queensland (44%) and Victoria (47%) had the lowest levels of support. Males and younger people (aged 18-34 years) were also more likely to support personal cannabis use being legal. In addition, those who had tried cannabis were more likely to support personal use being legal than those who had never tried cannabis. Less than 5% of all respondents felt that driving while or after smoking cannabis should be legal. Views about what should be criminal and non-criminal Of the total sample, around 75% of respondents believed that crowing or possessing cannabis for personal use, using carnabis. and possessing implements for using cannabis should not be treated as criminal offences. Among those respondents who thought that personal cannabis use should remain illegal, there was a su~tantial proportion who felt that personal use does not warrant the imposition of criminal penalties. Differences between the states on this issue were present; over 50% of respondents from South Australia and Queensland who felt that possession of cannabis for personal use should remain illegal, believed that it should not be a criminal offence, compared with around 35% from New South Wales, Victoria and Tasmania. For offences relating to large amounts of carnabis (e.g. large scale cultivation, distribution or possession), more than 80% of respondents felt that criminal penalties should be applied. This opinion applied to any large scale supplying of cannabis, whether or not money was exchanged. 35 Overall, 67% of the sample felt that driving after or while smoking cannabis should be a criminal offence. In general, younger people, and those who had used cannabis at some time were more likely to feel that cannabis offences should not be regarded as criminal. Views about what the penalties should be For activities involving large amount of cannabis (i.e. commercial quantities), the respondents who felt that these should be criminal offences favoured a gaol sentence as the preferred penalty option. For activities involving small amounts or personal use, those who thought these should be criminal offences most preferred the issuing of a fine as a penalty (35% to 50%), although significant˜proportions (20% to 30%) of those who thought these activities should be criminal still favoured a gaol sentence for personal use offences. Of respondents who thought that personal cannabis use activities should not be treated as criminal offences, the issuing of formal cautions or "on-the-spot" expiation notices were commonly favoured as the appropriate penalties. For the offence of using cannabis, 45% of those who thought this should not be a criminal offence believed that a formal caution without a court appearance was appropriate, and 31% believed an "on-the-spot" fine was most appropriate. Of those who believed that possession of implements for using cannabis should not be a criminal offence, 56% thought that a formal caution should be given, and 24% favoured an "on-the-spot" fine. For both criminal and non~riminal activities, people felt that repeat offenders should be dealt with more harshly than first offenders. Views about what governments should be doing The survey showed strong support for educational measures provided by government to secondary school students and the general population, with over 90% of all respondents agreeing that this was worthwhile. There was also very strong support expressed by about 70% of the sample for increased police efforts to detect large scale growing and importing of cannabis, and for increased penalties for such offences. Overall, the majority of respondents (59%) did not feel that harsher penalties for small scale cannabis offences were warranted. About 49% expressed some level of agreement with the view that personal cannabis use should no longer be treated as a criminal offence, while 46% expressed some disagreement; about 5% held a neutral position on this question. Respondents from the Northern Territory held the most liberal views about what government ought to be doing to deal with cannabis, while Victoria had the most conservative views. More conservative views were also held by females, the older age groups, and those who had never tried cannabis. There was very strong support expressed throughout the sample for the provision of counselling services to cannabis users who develop problems or difficulties in ceasing their use, with about 90% of the total sample agreeing that this was worthwhile. There was also support expressed by 70% of the sample for requiring that people found to be using cannabis attend education sessions to reduce the likelihood of further use. This perhaps reflects the view that a substantial proportion of the population believes that people with problem drug use should not be treated as a criminal issue, although it is not clear from the survey in what context such an option might be implemented (e.g. as an alternative or in addition to "on-the-spot" fines, or as a sentencing option, etc.). 36 There was v~stron˜g support (over 85% of the total sample) for the use of cannabls being legal when prescribed by a doctor for certain medical or psychological conditions. There was strong support expressed by around 80% to 90% of respondents for police checking of cannabis use by drivers. Conclusion: survey findings The survey undertaken for this study showed that the levels of cannabis use among the sample of respondents was comparable to those found in the most recent National Drug Household Survey, conducted in 1993. There_were strong levels of support for activities relating to personal cannabis use being legal.There was even greater support for the view that personal cannabis use not be treated as a criminal matter, with three quarters f all respondents feeling that it should not be a criminal offence to possess pr gro˜w ca˜ur~is for personal use, nor to use cannabis. Related to this is the finding that most people do not think harsher penalties are warranted for personal cannabis use. In contrast, the majority of respondents in all jurisdictions think that activities involving the cultivation, sale or supply of large amounts of cannabis should be illegal, and should be treated as criminal offences. Significantly, this includes the supply of large amounts of cannabis without exchange of money. These findings suggest a clear distinction in the public's views between the personal use of cannabis, and those activities which are more concerned with dealing and trafficking in cannabis. There appears to be a widespread view that personal cannabis use should not be regarded as a criminalmatter. Indeed, there was strong support for governments providing further educational material to cannabis users to minimise further use, and for the provision of counselling services for users who develop problems in ceasing use. This suggests that harm minimisation approaches aimed at reducing levels of cannabis use, as well as reducing the potential harms associated with involvement in the criminal justice system, would be broadly in line with public opinion. An interesting finding related to the higher proportions of respondents from jurisdictions which have introduced civil penalty options for personal cannabis use (South Australia and the ACT) who_incorre˜ctly b˜e!iev˜ed pers˜onal_cannabis use to be legal. This suggests that the introduction of these schemes has led to some confusion am ong sectors of the public, whereby it is not well understood that the removal of criminal penalties for personal cannabis use does not mean that it has become legal. There is clearly scope for educational initiatives in this area, particularly for other jurisdictions which might consider civil penalty options in the future. The very strong support shown for allowing cannabis to be legally prescribed for certain medical or psychological conditions 1˜nJ˜lcates that public opinion on this issue is unlikely to be a barrier to further research on the therapeutic applications of cannabinoids, or the conjrolled availability of these ˜ ˜compoun˜˜ds ˜ in the future, should they be deemed worthwhile. The strong support shown for police checking of cannabis use by drivers reflects the public's concern about the potential harm resulting from motor vehicle accidents caused by cannabis intoxication. Further exploration of this issue is required, to find out under what circumstances such testing would be generally acceptable. This issue is complicated by the fact that there is no simple method, comparable to blood alcohol tests, of ascertaining whether drivers are under the influence of cannabis. 37 The role of mass media and other strategies in modifying perceptions about and use of cannabis The importance of public opinion in the successful implementation of any legislation aimed at controlling behaviour is generally acknowledged (e.g. the public acceptance of random breath testing and seat-belt legislation). With regard to cannabis use, there would appear to be scope for influencing the public's opinions and levels of knowledge about the drug itself and the laws relating to its use, to bring them more into line with government policy relating to cannabis use. The areas where opinions and knowledge might favourably be influenced might include: increasing the awareness of the health risks associated with cannabis use; increasing awareness of the laws and penalties associated with cannabis use and trafficking; generally promoting healthy lifestyles and discouraging use of all drugs, including cannabis; and so on. It is to be hoped that activities directed at influencing opinion and increasing knowledge, by whatever media, would lead to minimisation of personal harm through changing individual's drug use behaviour. A number of strategies are available to influence opinion and behaviour in the area of drug use, including school-based, workplac~based, legislative, mass media or via health care providers. Mass media approaches might have a role for jurisdictions considering legislative change, by setting the agenda for change, and promoting a climate of informed debate. There might also be a role for such media in educating people about the health consequences of using cannabis, particularly if such messages could be targeted at groups most likely to initiate carnabis use, or use it in a hazardous manner (e.g. young people who might be using cannabis with alcohol or other drugs; workers who might be at risk of accidents resulting from cannabis intoxication). Thus, mass media could contribute to shifting the dominant perception of cannabis use as being a criminal or law enforcement issue to it being a health or harm minimisation issue. Legislation can have an important role in influencing behaviour. However, in the case of cannabis, it appears that there is little difference between the various feasible legislative options available relating to cannabis, in terms of their effects on cannabis use behaviour; rates of use remain similar under total prohibition and civil penalty systems. There does appear to be a need for using mass media or other means for educating people more about the current legal status of cannabis. Schools provide an ideal setting in which to educate young people about issues such as cannabis use, and perhaps offer the greatest potential for bringing about behaviour change. Such educational messages could complement those already being given for alcohol and tobacco, and would in the case of cannabis involve the discouragement of use and the provision of information on the health risks. Health care providers are in a position to provide health messages to groups at risk of developing problems from cannabis use, particularly people who may already be using cannabis on a regular basis. Workplaces may also be suitable sites for cannabis education activities, particularly with regard to the potential for cannabis and alcohol to increase the risk of worksite accidents. Such worksite initiatives could be integrated with more general health promotion messages, in which drug and alcohol use is shown to pose health risks and to potentially affect employees' efficiency. Depending on the specific goals being sought, a coordinated multi-strategy approach to cannabis use may be the most effective. This could include appropriate legislative 38 restrictions, educational initiatives for youth at school, programs targeted at specific worksites, and so on. The mass media could be a useful part of such strategies, particularly if they can be targeted at certain groups, including those most likely to use drugs hazardously (e.g. the recent national amphetamines campaign). Any programs which aim to modify opinions or behaviour in relation to cannabis should be carefully planned and include provision for the evaluation of the various component strategies. The National Task Force on Cannabis recommends that: the Commonwealth Drugs of Dependence Branch consider the funding, commissioning or facilitating of further research into the development of appropriate education or health promotion strategies and messages relating to cannabis use, with the aims of: - identifying the education techniques and options which best mdet the requirements of key target groups (current cannabis users and those at risk of initiating cannabis use); - ascertaining baseline information on knowledge, attitudes and practice relating to cannabis use, as an integral component of education strategy development (Recommendation 24). the National Drug Strategy Committee develop a consistent and nationally focused public education campaign to provide accurate information on the health effects of cannabis, with the specific aims of: a. increasing awareness among current cannabis users and those at risk of initiating cannabis use, about the range, extent and severity of health problems attributable to cannabis use, especially heavy use, including: ˜ the risk of motor vehicle accidents associated with cannabis intoxication, and the additive effect on risk of combining cannabis and alcohol use; ˜ the risks of cannabis use during pregnancy ˜ the risk of respiratory cancer and other respiratory diseases associated with cannabis smoking; ˜ the risk of an acute toxic psychosis resulting from heavy cannabis use, and the potential for cannabis use to precipitate latent psychoses in vulnerable individuals; ˜ other identified likely health risks; b. attempting to delay the onset of cannabis use among adolescents (Recommendation 13); ˜other targeted education activities be directed at current users of cannabis, with the aim of minimising the possible long term harms associated with cannabis use, including information on lessening the likelihood of respiratory damage and cannabis dependence (Recommendation 14). ˜ the National Drug Strategy Committee sponsor the development of modified versions of the commissioned papers, suitable for a broad public audience (Recommendation 15). 39 CHAPTER 4 Conclusion The research and review papers commissioned by the National Task Force on Cannabis, which accompany the present report, present the findings of one of the most comprehensive analyses of the available information on cannabis to date. It is a formidable task for any individual, team of researchers, or group of policy makers to evaluate the huge amount of available information, and formulate recommendations on the basis of the findings. Nevertheless, the National Task Force on Cannabis believes that the papers prepared for it allow a number of firm recommendations to be made concerning the need for further research and informed policy directions, and these recommendations have been presented in the preceding sections of this report. There is no doubt that the debate on many of the issues relating to cannabis use will continue, and that there will continue to be a polarisation of viewpoints concerning the safety of cannabis, and the appropriate legal responses to its use. The Task Force papers present a balanced assessment of the current state of knowledge; this can be attested to by the quality and tone of the technical papers, the credentials of the authors, and the high standing of the numerous peer reviewers of the various papers. In general, the findings on the health and psychological effects of cannabis suggest that cannabis use is not as dangerous as its opponents might believe, but that its use is not completely without risks, as some of its proponents would argue. As it is most commonly used, occasionally, cannabis presents only minor or subtle risks to the health of the individual. The potential for problems increases with regular heavy use. While the research findings on some potential risks remain equivocal, there is clearly sufficient evidence to conclude that cannabis use should be discouraged, particularly among youth, as part of a general approach of discouraging use of all drugs and promoting more healthy lifestyles. The recommendations in this report reflect this general approach. The fact that it is recognised that cannabis use should be discouraged does not imply that total prohibition of its use is warranted. Cannabis has been repeatedly shown to be the most widely used illicit drug, and the personal harm that results from moderate, occasional or experimental use of cannabis appears to be minimal. Thus, a good case can be made for the view that the social harms which accompany the total prohibition of personal use outweigh the potential health and social harms arising from moderate use. In addition, the fact that rates of cannabis use do not appear to be markedly different in jurisdictions where personal cannabis use is not treated as criminal suggests that control schemes which involve the removal of criminal penalties for personal use are appropriate. Such schemes remain quite compatible with the strategy of discouraging drug use in general. The Task Force's commissioned survey research has shown significant levels of support for the general strategy of treating personal cannabis use as a health or social issue, rather than a law enforcement one, with clear indications of strong support for the removal of criminal penalties for personal cannabis use. At the same time, there remains strong disapproval for large scale cannabis cultivation and trafficking, and the view that such activities should be firmly dealt with by criminal law. These findings give strong support to the concept of separating the widespread personal use of cannabis from the criminal sector. 40 Given the prevalence of cannabis use in the community, the fact that total prohibition of personal use has not managed to stop people from using cannabis, and the considerable misinformation in the community about cannabis and its effects, there appears to be a case for well formulated education campaigns which aim to minimise the potential for harm from cannabis use, particularly among groups most at risk of harm. Young people, particularly in schools or tertiary institutions˜, are in an ideal position to receive educational messages which aim to stop the initiation of carnabis and other drug use (including the common licit drugs, alcohol and tobacco). The National Task Force on Cannabis hopes that its findings will be received and considered by many sectors in the community, and that further informed debate will be stimulated, as such debate seems timely. With regard to the immediate consideration of the Task Force's documents, it is recommended that: ˜ the National Drug Strategy Committee receive the Task Force's report and associated commissioned technical papers (Recommendation 1); ˜ the National Drug Strategy Committee endorse the recommendations of the Task Force's Final Report, and forward them to the Ministerial Council on Drug Strategy for consideration at its next meeting (Recommendation 2); ˜ the Ministerial Council on Drug Strategy receive the recommendations of the Task Force (Recommendation 3); ˜ the Ministerial Council on Drug Strategy refer the final report and commissioned technical papers of the National Task Force on Cannabis to the Standing Committee of Attorneys-General, for consideration of: ˜ the legal options described in the Task Force documents; ˜ the potential for an harmonious legal approach to dealing with cannabis throughout Australia. Following their deliberations, the Standing Committee of Attorneys-General should be invited to report back to the Ministerial Council on Drug Strategy for their meeting in 1995 (Recommendation 4); ˜ the Ministerial Council on Drug Strategy commission the development of a comprehensive national policy on cannabis, based on the Task Force research and recommendations, that clearly states aims, objectives and strategies (Recommendation 5); ˜ the Task Force's commissioned technical papers be made widely available, through publication as Commonwealth monographs (Recommendation 6); ˜ the Ministerial Council on Drug Strategy consider releasing the final report of the National Task Force on Cannabis as a public document (Recommendation 7). 41 APPENDIX 1 Commissioned Authors of the Task Force Papers Task Force Paper No. 1: The Health and Psychological Consequences of Cannabis Use Associate Professor Wayne Hall - National Drug and Alcohol Research Centre Dr Nadia Solowij - National Drug and Alcohol Research Centre Jim Lemon - National Drug and Alcohol Research Centre Task Force Paper No. 2: Legislative Options For Cannabis in Australia David McDonald - Australian Institute of Criminology Rhonda Moore - Politics Departrnent, University College (UNSW), Canberra Jennifer Norberry - Australian Institute of Criminology Grant Wardlaw - Wardlaw Consulting Pty Ltd Nicola Ballenden - Australian Institute of Criminology Task Force Paper No. 3: Patterns of Cannabis Use in Australia Associate Professor Wayne Hall - National Drug and Alcohol Research Centre Neil Donnelly - National Drug and Alcohol Research Centre Task Force Paper No. 4: Public Perceptions of Cannabis Legislation in Australia Professor Rob Sanson-Fisher - Hunter Centre for Health Advancement Dr Jenny Bowman - Hunter Centre for Health Advancement 42 APPENDIX 2 Peer Reviewers for˜ the Task Force Papers Task Force Paper No. 1: The Health and Psychological Consequences of Cannabis Use Dr Mario Argandona - World Health Organisation Programme on Substance Abuse, Geneva Dr Greg Chesher - Department of Pharmacology, University of Sydney, Australia Dr Peter Fried - Carleton University, Ottawa, Canada Dr Richard Mattick - National Drug and Alcohol Research Centre, Sydney, Australia Dr Peter Nelson - Southern Cross University, New South Wales, Australia Dr Jean-Marie Ruel - Bureau of Dangerous Drugs, Health and Welfare Canada Professor Donald Tashkin - Los Angeles Medical School, University of California, USA Members of the World Health Organisation Working Group on the Health Implications of Cannabis Use: Professor S M Channabasavanna - National Institute of Mental Health & Neurosciences, Bangalore, India Dr Bill Corrigall - Addiction Research Foundation, Toronto, Canada Dr Christine Hartel - National Institute on Drug Abuse, Maryland, USA Emeritus Professor Harold Kalant - Department of Pharmacology, University of Toronto, Canada Professor Billy Martin - Medical College of Virginia, Virginia Commonwealth University, USA Dr Mehdi Paes - Dept. of Psychiatry, University of Rabat, Morocco Task Force Paper No. 2: Legislative Options For Cannabis in Australia Professor Terry Carney - Faculty of Law, University of Sydney, Australia Task Force Paper No. 3: Patterns of Cannabis Use in Australia Visiting Professor D'Arcy Holman - Department of Public Health, University of Western Australia, Australia Professor Denise Kandel - College of Physicians & Surgeons, Columbia University, New York, USA Task Force Paper No. 4: Public Perceptions of Cannabis Legislation in Australia Associate Professor Tim Stockwell - National Centre for Research into the Prevention of Drug Abuse, Perth, Western Australia Professor Terry Carney - Faculty of Law, University of Sydney, Australia 43 APPENDIX 3 Conferences and ˜ Other Reports Noted A number of research, review and discussion papers on cannabis issues were released and brought to the attention of the National Task Force on Cannabis during the course of its investigations. Many of these papers included reviews of the literature on certain carmabis issues, or expressed views on what should be the legislative approaches to cannabis use. Such papers were not necessarily referred to in the Task Force's commissioned papers, as the authors of she Task Force papers generally relied upon primary literature sources, such as published journal articles or research reports. In addition, a number of conferences or discussion forums on cannabis issues took place, some of which involved the attendance or participation of one or more members of the National Task Force on Cannabis. The Task Force acknowledges the contribution of the following documents and discussion forums to the debate on cannabis issues. Papers Advisory Committee on Illicit Drugs, Queensland. (1993). Cannabis and the Law in Queensland. Queensland Criminal Justice Commission, Brisbane. Alcohol and other Drugs Council of Australia. (1993). Discussion Paper on Cannabis. Australian Professional Society on Alcohol and other Drugs. (1993). Draft Policy Position Paper on Cannabis. Walters E. (1993). Marijuana - An Australian Crisis?" (2nd ed.) E. Walters, Malvern, Victoria. Conferences and Symposia Criminal Justice Commission, Queensland. Cannabis Use, Supply, Enforcement and Regulatory Options, Brisbane, Queensland, 5 March 1993. Drugs Advisory Committee of New Zealand & New Zealand Drug Foundation. Cannabis and Health in New Zealand, Wellington, New Zealand, 4-6 October 1993. Law Society of New South Wales. Cannabis and Narcotics: Problems and Prospects for Dec rim inalisation, Sydney, New South Wales, 23 October 1993. 44 |