20 april 2015
By Keith Scott*
On the 9th and 10th of April 2015, along with medical colleagues from Cape Town, I was invited to make a presentation at a conference in Gauteng titled, Cannabis for Medicine: Yes or No. The conference was organised by the Department of Social Development and the Central Drug Authority and was the government’s first invitation for the public to give their inputs regarding the proposed legalisation of cannabis for medical purposes.
Apart from employees from the two government departments, the conference was attended by approximately 100 delegates who represented a divergent range of views on the subject of medical cannabis and its proposed legalisation. Amongst the delegates were those who were undecided on the issue, those who supported only the legalisation of medical cannabis but not its legalisation for recreational purposes, and those who argued for the full legalisation of the cannabis plant.
Apart from a number of academics and health professionals there were representatives from religious groups, NGOs such as the Cannabis Working Group, the South African National Council on Alcoholism & Drug Dependence (SANCA) and several private individuals.
From the start of the conference it became evident that most of the speakers supported the legalisation of medical cannabis as long as it was well contained, supported by sound scientific principles and that it would be governed by strict legal controls. However, even though the speakers were largely in agreement with this premise, most of them articulated concerns that the legalisation of medical cannabis may still result in the wider, unauthorised use of the plant; and that this in turn would lead to an increase in health and social problems attributed to the recreational use of cannabis.
I doubt whether there were many people at the event (or those who read this article) who disagree with these concerns. However we do need to appreciate that even if we never legalise the use of cannabis for medical and/or recreational purposes (i.e. the status quo) these worries, whether valid or not, are there because not only is cannabis already easily obtainable everywhere in South Africa, its use continues to grow.
And one of the reasons that it is the most widely used illicit drug in this country is because our legal structures have completely failed to take into account the medical, social and economic dynamics that influence its use. The criminalisation of cannabis has caused a tremendous amount of collateral health, social and economic damage that has impacted negatively on the economy, society in general and on poor communities in particular.
The drug laws themselves, both in South Africa and in many other countries, have allowed organised crime structures (including gangs) to access this billion dollar international market. They now use their massive economic strength to infiltrate and substantially weaken the very same legal structures that are expected to confront and contain those involved in the illicit drug market.
Organised crime bosses, both in South Africa and abroad, have stated that the last thing they want is for cannabis and other illicit drugs to be legalised. Their reasons should be obvious to all of us – it will destroy their primary source of income and put most of them out of the crime business.
My presentation at the conference was titled A Case for The Legal Regulation of Cannabis which I used to describe an established concept whereby any drug, including cannabis, can be legalised and effectively regulated within a framework of fair and effective legal controls.
In order to clarify the terminology it is worth noting that while “legalisation” is the process of making an illegal drug such as cannabis legal, “legal regulation” refers to the end point of this process: i.e. the controls for the production, supply and use of cannabis once it has been legalised.
However it must be emphasised that legal regulation does not imply a free-for-all, where cannabis would be freely available to anyone, anywhere and at any time. Unfortunately there is a widely held misconception that legal regulation is a radical idea. And although the legal regulation of cannabis is sometimes characterised as a ‘liberalisation’ or ‘relaxation’ of the law, it is in fact the opposite: it is about bringing the cannabis trade within the law, so that strict controls can be applied (such controls being impossible to impose under prohibition). Legal regulation enables governments to control where cannabis can be grown, manufactured, sold, who has access to it, and to monitor the quality, strength and composition of cannabis products.
A well known and widely applied example of legal regulation is the one that most countries use to control the production, distribution and sale of prescription drugs, alcohol and tobacco. Although this regulatory model, when applied to alcohol and tobacco, is not always implemented as optimally as it should be, it does provide a flexible, tried-and-true administrative template for the legal regulation of cannabis.
In essence the aim of the legal regulation of any drug is to protect the young and vulnerable by controlling its availability and to educate the public about its potential harms. It also aims to reduce crime by diverting the profits generated by the illicit cannabis trade to that of the state fiscus; and to use this extra tax revenue to finance education, rehabilitation and other expenses associated with the regulation of this plant. Legal regulation would also allow for the improvement of public health issues relating to cannabis by ensuring pure, standardised products along with health education and other pertinent information.
And just as importantly, legal regulation provides a platform for us to protect human rights by abolishing the unjust laws that discriminate against those who want to grow and use cannabis for both recreational and medicinal purposes without the fear of prosecution.
Under the present laws it is virtually impossible to control any of the links in the cannabis supply chain. At the moment anyone of any age can buy cannabis – drug dealers don’t ask for ID! Under a system of legal regulation, (as with the far more dangerous drugs, alcohol and tobacco) many activities, such as sales to minors, would remain illegal and subject to sanctions. Proponents of legal regulation generally support the implementation of even better, stricter regulation of both legal drugs such as alcohol and tobacco as well as cannabis.
Furthermore it goes without saying that legal regulation of cannabis must be complemented by improvements in public health, education, prevention, and treatment of cannabis dependence; as well as action on poverty, inequality and social exclusion.
A change from the current legal situation to that of legal regulation does not have to happen overnight – it may be phased, cautious and adapted according to the results achieved. If policies do not work they can be revisited and, where necessary, reversed.
However legal regulation is not ‘silver bullet’ for the problems related to cannabis or the even worse challenges caused by legal drugs such as alcohol and tobacco. It is, however, a silver bullet for many of the disastrous crime and social problems caused by drug prohibition. Local and global experience over the past 100 years demonstrates that prohibition cannot achieve these aims, and in fact actively undermines them.
The production and sale of cannabis does not necessarily have to operate along commercial lines. Options exist for state-run institutions or non-profit organisations to manage the cannabis trade effectively in ways that remove the financial incentive to promote or initiate its use. A good example of this is the successful Cannabis Social Club concept operating successfully in New Zealand, Spain, Belgium, France, the Netherlands, Italy, Slovenia, Austria and Germany.
There is a valid concern that legal regulation of cannabis will increase its use – especially amongst minors. However in the Netherlands, where the possession and retail supply of cannabis is legal, rates of cannabis use are almost the same as the European average. Moreover, when Portugal decriminalised the possession of all drugs in 2001, drug use did not rise dramatically, as some feared. Now, over ten years later, levels of drug use remain below the European average.
In many countries, tobacco use is half what it was 30 years ago. This reduction has been achieved without blanket bans or criminalising smokers; it is the result of health education and stricter market regulation, only possible because tobacco is a legal product.
Levels of drug use are often equated with levels of drug harm, but the vast majority of drug use is non-problematic. Rather than narrowly focusing on reducing use, policy should seek to reduce overall harm.
We have a choice: the cannabis trade can be controlled by criminals or government. There is no other option. Many of my medical colleagues and I believe that the legal regulation of cannabis is the only substantiated, holistic way to deal with the issues relating to its health benefits and harms, its social impacts and the vast crime networks that the current cannabis laws help to sustain.
*Dr Keith Scott is a general medical practitioner from Cape Town who has a special interest in reforming drug laws to reflect drug use as a public health concern rather than a criminal issue.