Cannabis legalisation ... OK idea, bad timing

Next year New Zealanders go to the polls to decide if cannabis should be legalised. As we have some of the highest rates of cannabis use and addiction in the world, this increased focus on what is a key public health challenge for our country will be welcome.

There are a number of ways to address harms from cannabis use and legislation has an important part to play. Specifically, research has shown much cannabis-related harm comes from the criminalisation of users, young and old. The justice system is an ineffective and inefficient way to manage a health problem like addiction. And it’s racist too, with young Māori men charged with minor cannabis-related crimes disproportionately more often than other parts of the community.

The harms to society from convicting young people for minor cannabis offences are significant. Prison is an effective gang recruitment agency and does a good job of increasing criminal contacts and know-how, but it doesn’t work so well as a deterrent. With this in mind, decriminalising possession of small amounts of drugs for personal use is a no-brainer, and experience and research from overseas supports this approach. Our police and courts are well aware of this and, over the last few years, have used alternative disposition options when available.

Legislation is now catching up with this practice and an amendment to the Misuse of Drugs Act, currently in Parliament, is making charges for possession (for personal use) discretional.

It would take a few years to determine whether these changes to the Act will be effective, however, by next year we will have voted on cannabis legalisation. If people vote in favour, it means cannabis could be purchased through licensed outlets following similar rules to the sale of alcohol (although hopefully stricter).

But the timing is poor, for those supporting legalisation and for those who feel decriminalisation is a better approach. Although Kiwis are progressive, we are also a cautious bunch and the pro-cannabis lobby, riding high on a wave of overstated benefits for ‘medicinal cannabis’, will still have a task on their hands to convince Kiwis that we need to fix something that most don’t see as particularly broken. On the other hand, if we vote to legalise, those who believe decriminalisation is preferable will not get a chance to see how it works.

Unfortunately, as with many health decisions, we’ve ended up with a political, somewhat hodgepodge approach to an issue that will have far-reaching and significant public health implications.

A staged, systematic approach would have been better, where the current ‘de facto’ decriminalisation proposed by amendments to the MODA could be evaluated after three years and decisions made from that point, maybe for more formal decriminalisation or legalisation.

Whatever happens, decriminalisation or legalisation will not diminish other cannabis harms which, like justice related problems, mostly affect young people. Early, heavy and sustained cannabis use changes developing brains. It increases the risk of psychotic illness including schizophrenia. Regular use, even in small amounts, causes real memory and learning problems and stunts young peoples’ academic progress. Recent research linking cannabis use to depression and mood disorder is increasingly convincing, confirming what those of us working in the area have always thought, that heavy cannabis does cause depression in teenagers.

Finally, cannabis is addictive and addiction to one substance leads to addiction in others. Because addiction is more likely to take hold in children who have suffered trauma and adversity, this burden is carried by young people already at risk, further stacking the odds against the most vulnerable in our society.

One argument in favour of legalisation is that the sale of cannabis to young people will be controlled via policies such as age restrictions similar to those for alcohol. However, as most teenagers get their cannabis from older siblings and friends, the fact that these older peers will be able to buy legitimately is unlikely to stop them supplying younger users. Another pro-legalisation argument correctly assumes that, with decreased stigma, people will be happier to access treatment if required. But addiction services are already oversubscribed throughout New Zealand so the next question is, where will these people go to get help?

A key concern about legalisation is it will increase acceptability of cannabis, which may lead to increased use. Research supports this to some extent; studies of attitudes in young people show that as perception of risk falls, use of substances rises. That said, some overseas studies suggest legalisation doesn’t recruit new users and has a limited impact on the amount young people smoke.

However, extrapolating findings from overseas is fraught and we should be cautious. We have a ‘heavy drinking’ culture in New Zealand and getting wasted is the NZ way. Rather than trust that we’ll be the same as countries such as Canada and Holland, perhaps we should ask the question, why wouldn’t we adopt a ‘heavy stoning’ culture? Concerns about recruiting new users aside, there is growing consensus legalising cannabis leads to increasing numbers of heavy users, and these people, as with alcohol, experience the most harm and inflict most cost on society.

So which approach will be better for New Zealand. Decriminalisation or legalisation? We may never know. If Kiwis vote for legalisation in next year’s referendum we will have missed the chance to see how decriminalisation suits us. Easing restrictions around cannabis will be a significant culture change for our country with far reaching health implications. We could be approaching this issue gradually, step by step, taking time to evaluate and reflect on how it suits us. Instead, we will be forced to choose – or rather, make a best guess – and hope we get it right.