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Major Cannabis Reports

Marijauna and Medicine - Assessing the Science Base - Institute of Medicine (IOM) - National Academy of Science 1999

Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999

Report and Recommendations of the Drug Policy Task Force. New York County Lawyer's Association, 1996

Advisory Council on the Misuse of Drugs, U.K., 2002

Twentieth Annual Report of the Research Advisory Panel, 1999, California

Drug Control Through Legalization, Netherlands, 1996

Medical Regulatory History in USA USA v. Bryan Epis, CR S-97-381 FCD



Compendium of Findings of
Major Cannabis Reports



  1. Medicinal Uses:

  2. Pain
    Cancer
    Nausea and Vomiting
    Wasting Syndrome
    Cachexia
    Multiple Sclerosis
    Parkinson's Disease
    Movement Disorders
    Alzheimer's Disease
    Glaucoma
    Cannabis Therapeutics

  3. Social Issues:

  4. Cannabis Arrests
    Criminality/Risk-taking/Violence
    Gateway Theory
    Driving
    Decriminalization
    Harm vs/ Alcohol and Tobacco
    Harm Reduction

  5. Legal:

  6. Cannabis and the Law
    Classification and Scheduling
    Single Convention on Narcotic Drugs
    Cultivation

  7. Health:

  8. Cannabis and Health
    Addiction/Withdrawal/Dependence
    Fertility
    Anxiety
    Cancer
    Cardiovascular
    Mental Illness
    Brain Damage
    Reproduction/Pregnancy
    HIV/AIDS Transmission
    Amotivational Syndrome
    Immunity
    Safety
    Tolerance
    Potency
    Schizophrenia

  9. Dutch Policy




  1. MEDICINAL USES

  2. Pain:

    ...basic biology indicates a role for cannabinoids in pain and control of movement, which is consistent with a possible therapeutic role in these areas. The evidence is relatively strong for the treatment of pain and, intriguing although less well established, for movement disorders. (Ch.2, IOM, 1999)

    (Ch.4, IOM, 1999):

    There have not been extensive clinical studies of the analgesic potency of cannabinoids, but the available data from animal studies indicate that cannabinoids could be useful analgesics.

    In a later larger single-dose study, the same investigators reported that the analgesic effect of 10 mg of THC was equivalent to that of 60 mg of codeine; the effect of 20 mg of THC was equivalent to that of 120 mg of codeine. (Note that codeine is a relatively weak analgesic.) The side effect profiles were similar, though THC was more sedating than codeine. In a separate publication the same authors published data indicating that patients had improved mood, a sense of well-being, and less anxiety.

    The results of the studies mentioned above on cancer pain are consistent with the results of using a nitrogen analogue of THC. Two trials were reported: one compared this analogue with codeine in 30 patients, and a second compared it with placebo or secobarbital, a short-acting barbiturate. For mild, moderate, and severe pain, the THC analogue was equivalent to 50 mg of codeine and superior to placebo and to 50 mg of secobarbital.

    Clinical studies should be directed at pain patients for whom there is a demonstrated need for improved management and where the particular side effect profile of cannabinoids promises a clear benefit over current approaches. The following patient groups should be targeted for clinical studies of cannabinoids in the treatment of pain:

    • Chemotherapy patients, especially those being treated for the mucositis, nausea, and anorexia.
    • Postoperative pain patients (using cannabinoids as an opioid adjunct to determine whether nausea and vomiting from opioids are reduced).
    • Patients with spinal cord injury, peripheral neuropathic pain, or central poststroke pain.
    • Patients with chronic pain and insomnia.
    • AIDS patients with cachexia, AIDS neuropathy, or any significant pain problem.

    In conclusion, the available evidence from animal and human studies indicates that cannabinoids can have a substantial analgesic effect.


    Cancer:

    (Ch.4, IOM, 1999):

    Terminal cancer patients pose different issues. For those patients the medical harm associated with smoking is of little consequence. For terminal patients suffering debilitating pain or nausea and for whom all indicated medications have failed to provide relief, the medical benefits of smoked marijuana might outweigh the harm.


    Nausea and Vomiting:

    (Ch.4, IOM, 1999):

    In studies that compared THC with a placebo, THC was usually found to possess antiemetic properties. THC is less psychoactive than THC but was found to completely block both acute and delayed chemotherapy-induced emesis in a study of eight children, ages 3 - 13 years. 2 Two hours before the start of each cancer treatment and every six hours thereafter for 24 hours, the children were given MERGEFORMATINET 8-THC as oil drops on the tongue or in a bite of bread (18 mg/m body surface area). The children received a total of 480 treatments. The only side effects reported were slight irritability in two of the youngest children (3.5 and 4 years old).

    The evidence from the well-conducted trials indicate that cannabinoids reduce emesis in about one-fourth of patients receiving cancer chemotherapy.

    ...studies of the effects of adjunctive cannabinoids on chemotherapy-induce, emesis are worth pursuing for patients whose emesis is not optimally controlled with other agents.

    in patients already experiencing severe nausea or vomiting, pills are generally ineffective because of the difficulty in swallowing or keeping a pill down and slow onset of the drug effect. Thus, an inhalation (but preferably not smoking) cannabinoid drug delivery system would be advantageous for treating chemotherapy-induced nausea.

    It is possible that the harmful effects of smoking marijuana for a limited period of time might be outweighed by the antiemetic benefits of marijuana, at least for patients for whom standard antiemetic therapy is ineffective and who suffer from debilitating emesis.


    Wasting Syndrome:

    (Ch.4, IOM, 1999):

    Anecdotes abound that smoked marijuana is useful for the treatment of HIV-associated anorexia and weight loss. Some people report a preference for smoked marijuana over oral THC because it gives them the ability to titrate the effects, which depend on how much they inhale. In controlled laboratory studies of healthy adults, smoked marijuana was shown to increase body weight, appetite, and food intake.

    ...cannabinoids could be used as appetite stimulants, in patients with diminished appetite who are undergoing resistance exercises or anabolic therapy to increase lean body mass. They could also be beneficial for a variety of effects, such as increased appetite, while reducing the nausea and vomiting caused by protease inhibitors and the pain and anxiety associated with AIDS.

    The profile of cannabinoid drug effects suggests that they are promising for treating wasting syndrome in AIDS patients. Nausea, appetite loss, pain, and anxiety are all afflictions of wasting, and all can be mitigated by marijuana.

    ...for cases in which symptoms are multifaceted, the combination of THC effects might provide a form of adjunctive therapy; for example, AIDS wasting patients would likely benefit from a medication that simultaneously reduces anxiety, pain, and nausea while stimulating appetite. (ES, IOM, 1999)


    Cachexia:

    (Ch.4, IOM, 1999):

    The only cannabinoid evaluated for treating cachexia in cancer patients is dronabinol, which has been shown to improve appetite and promote weight gain.

    ...such cannabinoids as THC might prove useful as part of a combination therapy as an appetite stimulant, antiemetic, analgesic, and anxiolytic, especially for patients in late stages of the disease.


    Multiple Sclerosis:

    (Ch.4, IOM, 1999):

    Compared to the currently available therapies, the long half-life of THC might allow for a smoother drug effect throughout the day. The intensity of the symptoms resulting from spasticity, particularly in MS, can rapidly increase in an unpredictable fashion such that the patient develops an "attack" of intense muscle spasms lasting minutes to hours. An inhaled form of THC (if it were shown to be efficacious) might be appropriate for those patients.


    Parkinson's Disease:

    (Ch.4, IOM, 1999):

    Theoretically, cannabinoids could be useful for treating Parkinson's disease patients because cannabinoid agonists specifically inhibit the pathways between the subthalamic nucleus and substantia nigra and probably also the pathways between the subthalamic nucleus and globus pallidus (these structures shown in . The latter effect was not directly tested but is consistent with what is known about these neural pathways. Hyperactivity of the subthalamic neurons, observed in both Parkinson's patients and animal models of Parkinson's disease, is hypothesized to be a major factor in the debilitating bradykinesia associated with the disease. Furthermore, although cannabinoids oppose the actions of dopamine in intact rats, they augment dopamine activation of movement in an animal model of Parkinson's disease. This suggests the potential for adjunctive therapy with cannabinoid agonists. (Figure 2.6)


    Movement Disorders:

    (Ch.4, IOM, 1999):

    The abundance of CB1 receptors in basal ganglia and reports of animal studies showing the involvement of cannabinoids in the control of movement suggest that cannabinoids would be useful in treating movement disorders in humans. Marijuana or CB1 receptor agonists might provide symptomatic relief of chorea, dystonia, some aspects of parkinsonism, and tics.


    Alzheimer's Disease:

    (Ch.4, IOM, 1999):

    Eleven Alzheimer's patients were treated for 12 weeks on an alternating schedule of dronabinol and placebo (six weeks of each treatment). The dronabinol treatment resulted in substantial weight gains and declines in disturbed behavior. No serious side effects were observed. One patient had a seizure and was removed from the study, but the seizure was not necessarily caused by dronabinol. Recurrent seizures without any precipitating events occur in 20% of patients who have advanced dementia of Alzheimer's type. Nevertheless, these results are encouraging enough to recommend further clinical research with cannabinoids.


    Glaucoma:

    (Ch.4, IOM, 1999):

    Marijuana and THC have been shown to reduce IOP by an average of 24% in people with normal IOP who have visual-field changes. In a number of studies of healthy adults and glaucoma patients, IOP was reduced by an average of 25% after smoking a marijuana cigarette that contained approximately 2% THC--a reduction as good as that observed with most other medications available today.

    In summary, cannabinoids and marijuana can reduce IOP when administered orally, intravenously, or by inhalation but not when administered topically.


    Cannabis Therapeutics:

    (Ch.4, IOM, 1999):

    Advances in cannabinoid science of the past 16 years have given rise to a wealth of new opportunities for the development of medically useful cannabinoid-based drugs. The accumulated data suggest a variety of indications, particularly for pain relief, antiemesis, and appetite stimulation. For patients such as those with AIDS or who are undergoing chemotherapy, and who suffer simultaneously from severe pain, nausea, and appetite loss, cannabinoid drugs might offer broad-spectrum relief not found in any other single medication.

    Until a nonsmoked rapid-onset cannabinoid drug delivery system becomes available, we acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting.

    (E.S., IOM, 1999):

    The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation. The therapeutic effects of cannabinoids are best established for THC, which is generally one of the two most abundant of the cannabinoids in marijuana. (Cannabidiol is generally the other most abundant cannabinoid.)

    The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for particular conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting.

    Scientific data indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances.

    For certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern. Further, despite the legal, social, and health problems associated with smoking marijuana, it is widely used by certain patient groups.

    It will likely be many years before a safe and effective cannabinoid delivery system, such as an inhaler, is available for patients. In the meantime there are patients with debilitating symptoms for whom smoked marijuana might provide relief. The use of smoked marijuana for those patients should weigh both the expected efficacy of marijuana and ethical issues in patient care, including providing information about the known and suspected risks of smoked marijuana use.

    Until a nonsmoked rapid-onset cannabinoid drug delivery system becomes available, we acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting.

    (Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999, ch.7) :

    Until 1973, tincture of cannabis had been available for medical use for over 100 years. In 1973, the medical use of cannabis was prohibited in the United Kingdom following a long decline in its use in favour of what were considered more reliable drugs. Beginning in the 1980s, interest in the potential benefits of cannabis for the treatment of certain medical conditions was renewed, and has become a significant issue. (para.56)

    Cannabis and cannabis resin should be moved from Schedule 1 to Schedule 2 of the MDA Regulations thereby permitting supply and possession for medical purposes. If there is to be any delay in adopting this recommendation pending the development of a plant with consistent dosage, we recommend a defence of duress of circumstance on medical grounds for those accused of the possession, cultivation or supply of cannabis. (para.viii)

    We conclude that there is evidence that there are therapeutic benefits from the use of cannabis by people with certain serious illnesses and that these benefits outweigh any potential harm to themselves. We therefore agree with the House of Lords Select Committee that cannabis and cannabis resin, together with tincture and extracts not covered by the 1971 convention, should be transferred from Schedule 1 to Schedule 2 to the 1985 regulations. That would automatically ensure that doctors who prescribed such substances were not criminally liable. The same would apply to their patients in possession and doctors or pharmacists who supplied cannabis. Arrangements would need to be worked out for pharmacies to secure legitimate supplies of stocks, but that should not pose insuperable problems. We do not share the Government's anxiety about the capacity of GPs to withstand pressure for the prescription of cannabis. There is no evidence that this has been a problem where the prescription of heroin for pain control is concerned. (para.67)
    Our recommendations on the law on cannabis and its implementation are:

    Cannabis should be transferred from Class B to Class C of Schedule 2 of the MDA and cannabinol and its derivatives should be transferred from Class A to Class C. (para.77, i, )

    If not decriminalized, where medically recommended, permit the medical use of marijuana and other controlled substances which have been determined by the medical community to be therapeutically beneficial. (Report and Recommendations of the Drug Policy Task Force. New York County Lawyer�s Association,1996: P.25)


  1. SOCIAL


  2. Cannabis Arrests:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    The number of cannabis offences (as persons found guilty, cautioned, given a fiscal offence, or dealt with by compounding) rose from 15,388 in 1981 to 99,140 in 1998 before falling to 88,548 in 1999. Over 90 per cent of such recorded cannabis offences in 1999 were for "unlawful possession". Offences related to heroin and amphetamines in 1999 were 12,760 and 12,102 (respectively). (P.5, para. 3.6)


    Criminality/Risk-Taking/Violence:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    Cannabis differs from alcohol, however, in one major respect: it seems not to increase risk-taking behaviour. This may explain why it appears to play a smaller role than alcohol in road traffic accidents. Cannabis intoxication tends to produce relaxation and social withdrawal rather than the aggressive and disinhibited behaviour commonly found under the influence of alcohol. This means that cannabis rarely contributes to violence either to others or to oneself, whereas alcohol use is a major factor in deliberate self-harm, domestic accidents and violence. (P.7, para.4.3.6)

    As discussed in paragraph 4.3.6, cannabis use does not commonly produce the mental states leading to violence to others; but the illegal market does contribute to violence in some parts of our cities. (P.10, para. 4.7.1)

    There is no evidence that cannabis use is crime-related in the same way as heroin or crack cocaine. (Ch.7, para.19)

    With a drug like marijuana, which enjoys popular approval in the face of legal prohibition, the associated criminal activity is regarded as nominal. (P.4, Twentieth Annual Report of the Research Advisory Panel, 1999, California)


    Gateway Theory:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    Even if the gateway theory is correct, it cannot be a particularly wide gate as the majority of cannabis users never move on to Class A drugs. (P.9, para. 4.6.2)

    Interestingly, other studies have found that the use of alcohol and tobacco in early teens (and especially in pre-adolescents) appears to be associated with the later use of many drugs including cannabis. In all these studies there is a distinct possibility that the driving factor in the misuse of drugs is the personality and/or peer group of the subject rather than the drug itself. (P.9, para. 4.6.3)

    It is not possible to state, with certainty, whether or not cannabis use predisposes to dependence on Class A drugs such as heroin or crack cocaine. Nevertheless the risks (if any) are small and less than those associated with the use of tobacco or alcohol. (P.11, para.5.5)

    (Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999):

    ...the vast majority of cannabis users do not progress to the most dangerous drugs such as heroin. Any significant causal relationship in that direction would have resulted in a far higher population of hard drug users than we have. (Ch.7, para. 15)

    In our view nothing has emerged to disturb the conclusions of the Advisory Committee on Drug Dependence in 1968 [9], when they said that there was no convincing evidence that cannabis use in itself led to heroin use. This has been largely confirmed by more recent studies. (Ch.7, para. 16)

    The suggestion, already mentioned, that there are pharmacological properties of cannabis that predispose users of it to later heroin use, has been discounted in a recent review of the United States literature [13]. Taking cannabis is not by itself an indicator of future heroin or cocaine use unless the cannabis use is heavy and combined with psychiatric or conduct disorders and a family history of psychopathology. (Ch.7, para. 17)

    It may be that some cannabis users will go on to other drugs through the influence of friends or the pressure of other factors associated with problematic drug use, such as poverty and unemployment. The WHO concluded that the most plausible explanation for some cannabis users also using other drugs was:

    '....a combination of selective recruitment into cannabis use of non-conforming and deviant adolescents who have a propensity to use illicit drugs, and the socialisation of cannabis users within an illicit drug-using subculture which increases the opportunity and encouragement to use other illicit drugs.' In particular, we take seriously the suggestion that pressure may be exercised by dealers on cannabis users to try harder drugs. If there is anything at all in the gateway theory, it is likely to be found in the structure of illegal markets. (Ch.7, para.18)


    Driving:

    Cannabis appears not to make as major a contribution to road traffic or other accidents as alcohol. (P.10, para. 4.7.1, Advisory Council on the Misuse of Drugs, U.K., 2002)

    ...a review of the scientific literature on drugs and driving commissioned by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) [7] found that evidence as to whether cannabis impairs driving and increases the risks of road accidents was not entirely consistent. Some studies found no significant effects on perception, and others pointed to some impairment of attention and short-term memory, although these effects are typically observed at higher doses. Still others suggest that drivers under the influence of cannabis actually drive more carefully. Interpretation of the causal contribution of cannabis to road accidents is further complicated by the concurrent presence of other drugs, especially alcohol. (Ch.7, para. 11, Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999)


    Decriminalization:

    (Ch.3, IOM, 1999):

    Monitoring the Future, the annual survey of values and lifestyles of high school seniors, revealed that high school seniors in decriminalized states reported using no more marijuana than did their counterparts in states where marijuana was not decriminalized.

    Despite the greater increase among decriminalized states, the proportion of marijuana users among ER patients by 1978 was about equal in states that had and states that had not decriminalized marijuana. That is because the non-decriminalized states had higher rates of marijuana use before decriminalization. In contrast with marijuana use, rates of other illicit drug use among ER patients were substantially higher in states that did not decriminalize marijuana use. Thus, there are different possible reasons for the greater increase in marijuana use in the decriminalized states. On the one hand, decriminalization might have led to an increased use of marijuana (at least among people who sought health care in hospital ERs). On the other hand, the lack of decriminalization might have encouraged greater use of drugs that are even more dangerous than marijuana.

    The authors of this study conclude that there is little evidence that the Dutch marijuana depenalization policy led to increased marijuana use, although they note that commercialization of marijuana might have contributed to its increased use. Thus, there is little evidence that decriminalization of marijuana use necessarily leads to a substantial increase in marijuana use.

    Finally, there is the broad social concern that sanctioning the medical use of marijuana might lead to an increase in its use among the general population. No convincing data support that concern.

    ...there is a broad social concern that sanctioning the medical use of marijuana might increase its use among the general population. At this point there are no convincing data to support this concern. The existing data are consistent with the idea that this would not be a problem if the medical use of marijuana were as closely regulated as other medications with abuse potential. (E.S. , IOM, 1999)

    (Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999):

    In considering the current operation of the law and sentencing patterns we are of the view that the possession of cannabis should not be an imprisonable offence. Consequentially, it should no longer be an arrestable offence in England and Wales under section 24 of PACE. Further, the prosecution of offences of cannabis possession should be the exception and only then should an offence, if there is a conviction, incur a criminal record. (Ch.7, para. 37)

    We recommend that the cultivation of small numbers of cannabis plants for personal use should be a separate offence from production, and should be treated in the same way as possession of cannabis. (Ch.7, para.41)

    The possession of cannabis should not be an imprisonable offence. As a consequence, it will no longer be an arrestable offence in England and Wales under section 24 of PACE, and arrests will only be possible under section 25 of PACE where there are identification or preventative grounds. (Ch.7, para.77, ii)

    The cultivation of small numbers of cannabis plants for personal use should be a separate offence from production and should be treated in the same way as possession of cannabis, being neither arrestable nor imprisonable and attracting the same range of sanctions. Cultivation of cannabis for personal use under section 6 and production under section 4 should be mutually exclusive offences. (Ch.7, para.77, iv)

    Decriminalize marijuana, accepting that the economic and social costs of sanctions for possession of this relatively harmless drug can no longer be justified. (P. 24, Report and Recommendations of the Drug Policy Task Force. New York County Lawyer�s Association, 1996)


    Harm vs. Alcohol and Tobacco:

    It is possible to rank the risks of dependence of abused drugs with heroin and crack cocaine the worst and cannabis generally at, or near, the bottom (and well below nicotine and alcohol). Nevertheless, repeated cannabis use does lead to a significant proportion of regular users becoming dependent although the severity of their dependence is generally not such as to lead to criminal behaviour. (P.8, para. 4.4.5, Advisory Council on the Misuse of Drugs, U.K., 2002)

    When cannabis is systematically compared with other drugs against the main criteria of harm (mortality, morbidity, toxicity, addictiveness and relationship with crime), it is less harmful to the individual and society than any of the other major illicit drugs or than alcohol and tobacco. This is why our consideration of the relative harmfulness of drugs has led us to the conclusion that cannabis is wrongly placed in Class B of Schedule 2 to the MDA. (Ch.7, para. 21, Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999)


    Harm Reduction:

    Move from policy of "zero tolerance," to one incorporating "harm reduction" principles, accepting the reality that marijuana and common recreational drugs, and other potentially harmful substances (including alcohol and tobacco), have always, and will continue to be consumed by some members of society, and concentrate efforts on reducing the harms associated with such use. (P.23, Report and Recommendations of the Drug Policy Task Force. New York County Lawyer�s Association, 1996)


  3. LEGAL

    Cannabis and the Law:

    (Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999):

    ...cannabis is the drug most likely to bring peopleY' into contact with the criminal justice system... If our drugs legislation is to be credible, effective and able to support a realistic programme of prevention and education, it has to strike the right balance between cannabis and other drugs. (Ch.7, para.1)

    We do not criticise the police for their extensive use of cautioning. It is currently the only realistic and proportional response. Without it, the courts would have ground to a halt. However, the use of discretion does not lessen the disproportionate attention that the law and the implementation of the law unavoidably give to cannabis and cannabis possession in particular. (Ch.7, para. 31)

    Even with the use of discretion on this scale, the law's implementation damages individuals in terms of criminal records and risks to jobs and relationships to a degree that far outweighs any harm that cannabis may be doing to society. (Ch.7, para. 32)

    The concentration on cannabis as an objective of law enforcement is at odds with the views of a significant proportion of the population. The surveys conducted for us by MORI show that two-thirds of adults want strong legal controls on drugs and do not regard drug use as a private matter beyond the law. But most of them do not include cannabis among the drugs that need controlling. (Ch.7, para. 36)

    There can be no doubt that, in implementing the law, the present concentration on cannabis weakens respect for the law. We have encountered a wide sense of unease, indeed scepticism, about the present control regime in relation to cannabis. It inhibits accurate education about the relative risks of different drugs including the risks of cannabis itself. It gives large numbers of otherwise law-abiding people a criminal record. It inordinately penalises and marginalises young people for what might be little more than youthful experimentation. It bears most heavily on young people in the streets of inner cities who are also more likely to be poor and members of minority ethnic communities. The evidence strongly indicates that the current law and its operation creates more harm than the drug itself. (Ch.7, para. 75)

    During the 1970s several states in the U.S.A. reduced the maximum penalty for the first offence of possession of small amounts of marijuana for personal use to a small fine. Levels of marijuana use increased between 1972 and l977 in those states but even more so in the states that had not reduced penalties. In fact the greatest rises in use took place in states with the most severe penalties. (Ch.7, para. 54)


    Classification and Scheduling:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    Cannabis, however, is less harmful than other substances (amphetamines, barbiturates, codeine-like compounds) within Class B of Schedule 2 to the Misuse of Drugs Act 1971. The continuing juxtaposition of cannabis with these more harmful Class B drugs erroneously (and dangerously) suggests that their harmful effects are equivalent. This may lead to the belief, amongst cannabis users, that if they have had no harmful effects from cannabis then other Class B substances will be equally safe. (P.12, para. 6.2)

    The Council therefore recommends the reclassification of all cannabis to Class C under the Misuse of Drugs Act 1971. (P.12, para. 6.3)

    If, as we argue, the present classification of cannabis is not justified, it follows that the response of the law is disproportionate to the drug's harm, and may bring the law into disrepute. In our view, therefore, the maximum penalties for cannabis offences should be reduced. (Ch.7, para. 25, Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999)


    Single Convention on Narcotic Drugs:

    (Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999):

    -imprisonment is not required by the conventions as a sanction either for possession or for cultivation for personal consumption. Alternatives to conviction and punishment may be considered, including treatment, education, aftercare, rehabilitation, or social reintegration. (Ch.7, para.23, iii)

    -it would be possible without renegotiating the conventions to permit the therapeutic use of cannabis, cannabis resin or extracts and tincture of cannabis. (Ch.7, para.23, v)

    The United Nations conventions are restrictive but there is more room for manoeuvre in the case of cannabis and cannabis resin than there is over cannabinols. Cannabis and cannabis resin are contained in Schedule IV to the Single Convention. Article 2.5 (b) of this states 'A Party shall, if in its opinion the prevailing conditions in its country render it the most appropriate means of protecting the public health and welfare, prohibit the production, manufacture, export and import, trade in, possession or use of any [Schedule IV] drug except for amounts which may be necessary for medical and scientific research only, including clinical trials therewith to be conducted under or subject to the control of the Party.' This does not impose a mandatory obligation on the United Kingdom to prohibit any of those activities in relation to cannabis or cannabis resin because it is subject to the proviso that the prevailing conditions in the country concerned make it the most appropriate means of protecting the public health and welfare. For example, heroin, another drug contained in schedule IV to the Single Convention, is in fact available on prescription in the United Kingdom for the treatment of organic disease or injury. (Ch.7, para.59)

    To summarise, the government has the power to allow cannabis and cannabis resin, including tinctures and extracts, to be prescribed in this country without renegotiation of the international conventions. But for cannabinols other than dronabinol and nabilone to be used therapeutically, the conventions would have to be renegotiated first. (Ch.7, para.61)

    A primary concern of ours is minimising the adverse, unnecessary and disproportionate criminal consequences for very large numbers of otherwise law-abiding, usually young, people. Our recommendations are intended to support the education, prevention and treatment elements of a broader health agenda, which itself reflects the relative risks of different drugs including cannabis. Our recommendations are not in breach of the United Nations Conventions. All of the present cannabis offences are being retained. The recommendations are in fact closer to the spirit of the conventions in taking an approach to personal consumption that is less punitive and more orientated towards health and education. (Ch.7, para.72)

    (Drug Control Through Legalization, Netherlands, 1996):

    Neither international treaties nor international political pressure need to refrain the Netherlands from introducing de facto legalisation by applying the Dutch expediency principle. This principle allows the Public Prosecution Department to decide whether or not to prosecute. (P.3)

    The Agency shall, in respect of opium, have the exclusive right of importing, exporting, wholesale, trading and maintaining stocks other than those held by manufacturers of opium alkaloids, medicinal opium, or opium preparations (....). Article 28 stipulates the same for cannabis (marihuana and hash). Similar regulations apply to cocaine and other drugs. (P.10)

    Controlling the drug problem is possible along the lines of "de-facto" or actual legalisation, and can be effectuated on a short term. Legalisation can take place without infringing on international treaties and without causing a flood of foreign drug tourists. The remaining illegal transit and export will be easier to fight than at present. (P.10)


    Cultivation:

    Allow cultivation of marijuana for personal use. Insofar as damage to the individual and society is concerned, the quantitatively most important drugs are alcohol and nicotine in the form of cigarettes. There remains, then, as the other quantitatively important drug, marijuana, which has become, for a large fraction of the population, a social drug comparable in pattern and approaching that of alcohol in extent of usage. (P. 7, Twentieth Annual Report of the Research Advisory Panel, 1999, California)


  4. HEALTH


    Cannabis and Health:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    The epidemiological evidence demonstrates that cannabis use, especially amongst adolescents and young adults, is substantial. The apparent and ready availability of cannabis is, however, disproportionate to the relatively small numbers of people seeking help from drug treatment agencies for cannabis misuse. The high use of cannabis is not associated with major health problems for the individual or society. (P.11, para. 5.1)

    The occasional use of cannabis is only rarely associated with significant problems in otherwise healthy individuals. Impaired psychomotor performance and, uncommonly, acute psychotic states are the most important. They are, however, self-limiting and (usually) readily managed. These harmful effects of cannabis, however, are very substantially less than those associated with similar use of other drugs, such as amphetamines, which (like cannabis) are currently classified as Class B. (P.11, para. 5.2)

    The British Medical Association has said [16] 'The acute toxicity of cannabinoids is extremely low: they are very safe drugs and no deaths have been directly attributed to their recreational or therapeutic use.' The Lancet published an article [17] summarising the evidence on the most probable adverse health and psychological consequences of acute and chronic use, and its editorial in the same issue comments that '...on the evidence summarised by Hall and Solowij, it would be reasonable to judge cannabis less of a threat than alcohol or tobacco....We...say that, on the medical evidence available, moderate indulgence in cannabis has little ill-effect on health, and that decisions to ban or legalise cannabis should be based on other considerations.' (Ch.7, para. 20, Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999)


    Addiction/Withdrawal/Dependence:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    No individuals are reported to the Northern Ireland Addicts Index as having problematic cannabis use. (P.5 para. 3.8)

    It is possible to rank the risks of dependence of abused drugs with heroin and crack cocaine the worst and cannabis generally at, or near, the bottom (and well below nicotine and alcohol). Nevertheless, repeated cannabis use does lead to a significant proportion of regular users becoming dependent although the severity of their dependence is generally not such as to lead to criminal behaviour. (P.8, para. 4.4.5)

    The epidemiological evidence demonstrates that cannabis use, especially amongst adolescents and young adults, is substantial. The apparent and ready availability of cannabis is, however, disproportionate to the relatively small numbers of people seeking help from drug treatment agencies for cannabis misuse. The high use of cannabis is not associated with major health problems for the individual or society. (P.11, para. 5.1)

    Regular heavy use of cannabis can result in dependence, but its dependence potential is substantially less than that of other Class B drugs such as amphetamines or, indeed, that of tobacco or alcohol. (P.11, para. 5.4)

    Withdrawal symptoms can be observed in animals but appear mild compared with those of withdrawal from opiates or benzodiazepines, such as diazepam (Valium). (Ch.2, IOM, 1999)

    ...although few marijuana users develop dependence, some do. But they appear to be less likely to do so than users of other drugs (including alcohol and nicotine), and marijuana dependence appears to be less severe than dependence on other drugs. (Ch.3, IOM, 1999)

    ...because underage smoking and alcohol use typically precede marijuana use, marijuana is not the most common, and is rarely the first, "gateway" to illicit drug use. There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs. (E.S. , IOM, 1999)


    Fertility:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    The effects of cannabis on fertility, however, are unclear. (P.6, para. 4.3.4)


    Anxiety:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    Acute cannabis intoxication can also lead to panic attacks, paranoia and confused feelings that drive users to seek medical help. These effects are generally short lived and usually respond to reassurance or a minor tranquilliser. (P.7, para. 4.3.7)


    Cancer:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    Indeed, smoking cannabis may be more dangerous than tobacco since it has a higher concentration of certain carcinogens. However, there are factors with smoked cannabis that may mitigate this risk. In general cannabis users smoke fewer cigarettes per day than tobacco smokers and most give up in their 30s, so limiting the long-term exposure that we now know is the critical factor in cigarette-induced lung cancer. (P.7, para. 4.4.1)

    Preliminary studies of lung function in regular cannabis smokers have not found a major cause for concern in the majority, but some severe cases of lung damage have been reported in young very heavy users. (P.7, para. 4.4.2)

    There is no conclusive evidence that marijuana causes cancer in humans, including cancers usually related to tobacco use. (Ch.3, IOM, 1999)


    Cardiovascular:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    Cannabis also produces an increase in heart rate. Maximum increases in heart rate occur within 15 to 30 minutes of inhalation, and remain raised for two hours or more. Tolerance to the cardiovascular effects of cannabis occurs with repeated use. (P.6, para. 4.3.1)

    The cardiovascular actions of cannabis are similar to the effects of exercise, and probably do not constitute a significant risk in healthy adolescents and young adults. (P.6, para. 4.3.3)

    Cannabis has been reported to produce modest bronchodilator effects (opening of the airways) but can worsen asthma. (P.6, para. 4.3.4)

    Unlike sedative intoxicants such as alcohol, cannabis does not cause respiratory depression or suppress the gag reflex even when extremely intoxicated. Moreover, the fact that cannabis is usually smoked means that the effects are almost immediate and once inhalation stops they begin to subside. (P.6-7, para. 4.3.5)

    The cardiovascular changes have not posed a health problem for healthy, young users of marijuana or THC. (Ch.3, IOM, 1999)


    Mental Illness:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):
    The other main concern about the chronic use of cannabis is whether it can lead to mental illness (especially schizophrenia). Although debated for well over a century, no clear causal link has been demonstrated. (P.8, para. 4.4.6)


    Brain Damage:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    There is no evidence that cannabis causes structural brain damage in man. Neither radiological studies nor post mortem examinations have revealed atrophy or other causes for concern. (P.8, para. 4.4.8)


    Reproduction/Pregnancy:

    (Advisory Council on the Misuse of Drugs, U.K., 2002):

    Tobacco smoking and alcohol use are significant causes of harm to the unborn child. A small proportion of women use cannabis during pregnancy and the birth weights of their babies are lower than expected. This is probably due to the effects of carbon monoxide in the smoke of cannabis cigarettes as similar findings are well established for tobacco smoking in pregnancy. (P.9, para. 4.5.1)

    Taken together this data suggest that cannabis use in pregnancy is not safe but that it is probably no more dangerous to the foetus than either alcohol or tobacco. Pregnant women should continue to be warned to avoid all these substances. (P.9, para. 4.5.3)

    (Ch.3, IOM, 1999)

    The presence of cannabinoid receptors in sperm suggests the possibility of a natural role for anandamide in modulating sperm function during fertilization. However, it remains to be determined whether smoked marijuana or oral THC taken in prescribed doses has a clinically significant effect on the fertilizing capacity of human sperm.

    Like tobacco smoke, marijuana smoke is highly likely to be harmful to fetal development and should be avoided by pregnant women and those who might become pregnant in the near future. Nevertheless, although fertility and fetal development are important concerns for many, they are unlikely to be of much concern to people with seriously debilitating or life-threatening diseases. The well-documented inhibition of reproductive functions by THC is thus not a serious concern for evaluating the short-term medical use of marijuana or specific cannabinoids.

    The results of studies of the relationship between prenatal marijuana exposure and birth outcome have been inconsistent (reviewed in 1995 by Cornelius and co-workers). Except for adolescent mothers, there is little evidence that gestation is shorter in mothers who smoke marijuana.

    In a study of neonates born to Jamaican women who did or did not ingest marijuana during pregnancy, there was no difference in neurobehavioral assessments made at three days after birth and at one month.

    The children in the different marijuana exposure groups showed no lasting differences in global measures of intelligence, such as language development, reading scores, and visual or perceptual tests. Moderate cognitive deficits were detectable among these children when they were four days old and again at four years, but the deficits were no longer apparent at five years.

    Despite the uncertainty as to the underlying causes of the effects of prenatal exposure to cannabinoid drugs, it is prudent to advise against smoking marijuana during pregnancy.


    HIV/AIDS Transmission:

    Injecting a drug is one of the most important causes of the spread of blood borne infections such as HIV or hepatitis. Unlike many drugs (opiates, stimulants, benzodiazepines and barbiturates) cannabis is not used by injection and so is free of these risks. (P.10, para. 4.7.2, Advisory Council on the Misuse of Drugs, U.K., 2002)


    Amotivational Syndrome:

    (Ch.3, IOM, 1999):

    One of the more controversial effects claimed for marijuana is the production of an "amotivational syndrome." This syndrome is not a medical diagnosis, but it has been used to describe young people who drop out of social activities and show little interest in school, work, or other goal-directed activity. When heavy marijuana use accompanies these symptoms, the drug is often cited as the cause, but no convincing data demonstrate a causal relationship between marijuana smoking and these behavioral characteristics.


    Immunity:

    (Ch.3, IOM, 1999):

    Despite the many claims that marijuana suppresses the human immune system, the health effects of marijuana-induced immunomodulation are still unclear.

    The short-term immuno-suppressive effects are not well established; if they exist at all, they are probably not great enough to preclude a legitimate medical use. The acute side effects of marijuana use are within the risks tolerated for many medications.


    Safety:

    (Ch.3, IOM, 1999):

    Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harm associated with smoking, the adverse effects of marijuana use are within the range tolerated for other medications. Thus, the safety issues associated with marijuana do not preclude some medical uses.

    The side effects of cannabinoid drugs are within the acceptable risks associated with approved medications. Indeed, some of the side effects, such as anxiety reduction and sedation, might be desirable for some patients. As with many medications, there are people for whom they would probably be contraindicated.

    (P.33, Report and Recommendations of the Drug Policy Task Force. New York County Lawyer's Association, 1996):

    Although between 60 to 70 million Americans have used marijuana, not one has died from an overdose, a contrast not just with alcohol but with aspirin; E. Nadelmann, A Rational Approach to Drug Legalization, American Journal of Ethics and Medicine, (Spring, 1991).

    The comparative statistics are also quite poignant. Alcohol and tobacco have been directly implicated in approximately 100,000 and 300,000 deaths per year, respectively. See R. Sweet, The Abolition of Prohibition -- on Drugs, that is, supra, at 7, and E. Nadelmann, U.S. Drug Policy: A Bad Export, Foreign Policy, No. 70, at 92 (Spring, 1988). Meanwhile, according to the National Council on Alcoholism, only 3,562 people were known to have died in 1985 from use of all illegal drugs combined, notwithstanding 1985 having been was one of the highest for per capita drug consumption. Id.


    Tolerance:

    Tolerance can appear after a few days of frequent daily administration (two or three doses per day) of oral THC or marijuana extract, with heart rate decreasing, reclining blood pressure falling, and postural hypotension disappearing. Thus, the intensity of the effects depends on frequency of use, dose, and even body position. (Ch.3, IOM, 1999)


    Potency:

    (Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999):

    It appears that, while some forms of herbal cannabis grown by hydroponic methods may have concentrations of tetrahydrocannabinol (THC), the main psychoactive ingredient of cannabis, of as much as 20%, the average THC content in both herbal cannabis and cannabis resin as analysed by the Forensic Science Service from seizures by the police is around 4-5%. There is no evidence that the presence of THC in higher concentrations leads to significantly higher health risks, just as it cannot be claimed that the risks would be eliminated if only lower-strength varieties of cannabis were available. (Ch. 7, para. 8)


    Schizophrenia:

    (Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999):

    '...cannabis is neither poisonous..., nor highly addictive, and we do not believe that it can cause schizophrenia in a previously well user with no predisposition to develop the disease. (Ch.7, para.10)

  5. DUTCH POLICY

    (Police Foundation Report of the Independent Inquiry on the Misuse of Drugs Act 1971, U.K., 1999):

    ...drug-related deaths per million population (in Holland) are the lowest in Europe. In 1995, the figure for the Netherlands was 2.4 as against 31.1 for the United Kingdom. (We recognise the difficulty of comparing mortality statistics between countries on a like for like basis but the relative success of the Netherlands seems undeniable on any conceivable interpretation). (Ch.7, para.48, iv)

    The coffee shop approach has not been without critics even in Holland itself. It seems, however, that Holland can justly claim to have separated the heroin and cannabis markets. As a result, young people are far less likely in Holland than elsewhere to experiment with heroin. Although there is room for argument over how precisely this has been achieved, it is difficult to deny that the policy of separation of markets, including the toleration of coffee shops, has made a contribution. (Ch.7, para.49)

    ...we think that the Dutch experience holds two important lessons for the United Kingdom. The first is the potential benefit from treating the possession and personal use of all drugs - not just cannabis - primarily as health problems. This should ensure that young people who experiment with drugs remain integrated into society rather than becoming marginalised. The second is the potential benefit from separating the market for cannabis from that of heroin. By doing so, the Dutch have provided persuasive evidence against the gateway theory of cannabis use, and in favour of the theory that if there is a gateway it is the illegal market place. (Ch.7, para.52)


CANNABIS STUDIES: INDEX






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