Luke Graham: The case for medicinal cannabis is strong; the jury’s out regarding legalising it for recreational use

The case for medicinal cannabis has come to the front line of public debate in recent months. This has primarily been driven by several high-profile cases, and the willingness of an increasing number of medical professionals to state the benefits of cannabis-based derivatives in helping to treat and manage a range of conditions. I have spoken in several debates both in and outside of Parliament on the topic, arguing for a more wide-ranging legalisation of cannabis for medicinal purposes, and for putting medical professionals in charge of issuing licences for these medicines, rather than politicians.

As seen in a recent ministerial statement, and following debate in the House of Commons, there is still considerable parliamentary concern about widening access to cannabis-based medicines, let alone moving towards the legalisation of cannabis for recreational purposes. And yet, in other parts of the world, cannabis has already been legalised for both medicinal and recreational uses. It seems important, therefore, to continue to look to evidence and experiences from other countries and areas that have already legalised it in one way or another, to see how this might work in the UK.

Arguments against the general legalisation of cannabis — outside of purely medicinal use — are well established, typically citing concerns about its impact on the mental health of users, and claims that it acts as a ‘gateway’ to further, harder drugs. Certain current strains of cannabis are known to have particularly harmful psychological effects, and awareness of this has also had an impact on ongoing debate. We cannot ignore claims around the health implications of legalising cannabis, both good and bad. An NHS webpage entitled ‘Cannabis: the facts’ states that regular cannabis use increases a person’s risk of developing a psychotic illness, such as schizophrenia.[1] There is no denying, however, that certain types of cannabis use can have medicinal benefits, too.

Those in favour of general legalisation argue that the government already allows other harmful substances — such as alcohol and cigarettes — to be bought and sold, even though they are proven and demonstrable health risks. They also argue that, by legalising cannabis, the government could take the drug and its supply chain out of the hands of criminals, put it under taxation, and therefore make those involved contribute towards state spending, supporting areas such as the NHS, police, or social security.

There is also a further, freedom-based argument, however, which speaks to a growing tension in modern politics. We are witnessing a clear push for empowerment within our democracy, to increase involvement and lower the voting age to 16 — but there are also simultaneous calls, often from the same people, to raise the age at which people can access products and services such as sunbeds and cigarettes. Instinctively, as a liberal, I believe that people should be free to make their own choices — that they should be provided with all the available information, so they are able to make informed decisions for themselves.

I’m also in favour, however, of coming down hard on those who have created the exploitative supply chains that fuel the UK’s drug habits. And when choices have serious costs for society — in terms of expensive healthcare provision, or additional policing requirements — there’s a strong argument to be made for state intervention. Of course, this approach runs contrary to the reasoning currently applied to policy related to alcohol use: increased policing, health, and town-centre management costs are baked into the average Friday and Saturday night in virtually every town in the UK.

Regarding policing costs, it is important to be aware of the current situation. While exact figures on cannabis-related offences are not available, in 2017-18 there were 1,177 drug offences per 100,000 of the population across the whole of the UK, and, where figures on cannabis offences are available, it typically constituted more than half of all drug offences.[2] With an already overstretched police and prison system, legalisation could arguably relieve the police and prison staff, as a great deal of their time and resources is currently being spent on what was recently a class C drug. This would be coupled with the additional taxation that could be raised.

Worrying information from Canada, related to healthcare utilisation and traffic accidents, should not be ignored, however. The government of Alberta recently commissioned a systematic review into the impact of cannabis legalisation, to inform Alberta’s response to the Canadian federal decision to legalise cannabis.[3] One of the most concerning conclusions of the report was that:

Overall, there is some evidence that experience with cannabis legalisation may have negative repercussions with respect to: resource utilization, law enforcement and impaired driving cases. Broadly, legalization of cannabis results in more burn cases reported to the local burn centre, more calls to paediatric poison control centres, and more cannabis-related traffic accidents.

The report also found there had been an increase in traffic fatalities involving drivers testing positive for marijuana in the US states of Colorado and Washington.

So, while legalising cannabis for recreational purposes might well relieve some of the burden on the police and prison services, and ease some of the financial strain on the Treasury, it is also clear that legalisation could simply shift the burden elsewhere on the system — whether that be in mental healthcare provision, A&E, or in the response to road traffic accidents. The jury is, therefore, still out on the resource-based debate about whether we should legalise cannabis as a recreational drug.

However, what is clear is that after almost three decades of the ‘war on drugs’, they are as prolific as ever, and our current approach facilitates the criminal gangs and exploitation our ‘war’ was designed to end. It is also clear that extracts of cannabis can be beneficial for conditions such as epilepsy — the illness that affects Alfie Dingley and Billy Caldwell, whose campaigns were ultimately successful in changing the law on medicinal cannabis-based products. The case for medicinal cannabis is extremely strong, and welcome progress has been made in enabling patients to access it.

As I said in the chamber of the Commons recently, ‘[a]s our scientific knowledge continues to progress, so should the views and the laws made in this House’. We know, for instance, that it is possible to extract the medically beneficial parts of cannabis, and we know that we can keep stringent legal controls over its THC levels. As our scientific knowledge and culture continue to develop, it is important that it remains the case that our laws do, too, in reflection of those developments.

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[1] https://www.nhs.uk/live-well/healthy-body/cannabis-the-facts/

[2] Home Office Outcomes open data tables, 2006 to 2018, Scottish Government Recorded crime in Scotland 2017-2018, table A5; Police service of Northern Ireland Police recorded crime Annual Trends 1998/99 to 2017/18; ONS Population time series explorer.

[3] https://open.alberta.ca/dataset/0239e5c2-5b48-4e93-9bcc-77f72f7bdc5e/resource/021d8f84-5d8b-4e21-b0bb-81340d407944/download/ahtdp-cannabis-evidence-series-2017.pdf

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