Mattersof Substance. november 2013 Volume 24 Issue No.4 www.drugfoundation.org.nz

Through the maze: cannabis and health It has been 20 years since the New Zealand Drug Foundation’s first cannabis and health symposium. This special edition of Matters of Substance focuses on the 2013 International Drug Policy Symposium Through the Maze: Cannabis and Health. What is the current state of evidence about all things cannabis and health? What do we know now that we didn’t in 1993, what has changed and what has stayed the same? CONTENTS

REDUCING CANNABIS HEALTH HARMS 32

No longer the healthy option THE WORLD 06 WATCHES NZ NEWS 16 02 WORLD NEWS 04

02

CANNABIS AND HEALTH Become 06 16 20 22 a member No longer the healthy The world watches Not what your mum Clearing the smoke option What do Colorado, and dad smoked? Despite a lack of evidential The New Zealand Drug Foundation has There is a growing body Washington and Uruguay Putting the pot in potency: backing as a treatment been at the heart of major alcohol and of evidence that shows have in common? They’re is cannabis actually option for some ailments, other drug policy debates for over 20 years. cannabis is more harmful all legalising cannabis. Find getting stronger, and if medical cannabis is a widely During that time, we have demonstrated than people think. How out how they’re doing it. it is, what does that mean accepted prescription in a strong commitment to advocating does cannabis affect for those who have the many places. policies and practices based on the our health? occasional puff? best evidence available.

You can help us. A key strength of the Drug CANNABIS AND HEALTH Foundation lies in its diverse membership base. As a member of the Drug Foundation, you will receive information about major alcohol and other drug policy challenges. You can also get involved in our work to find 28 32 36 40 solutions to those challenges. Fake it till you make it Reducing cannabis Driving high Cracking good It looks like cannabis, it has health harms “I drive better when I’m prevention Our membership includes health promoters, cannabis in its name, but Cannabis causes harm. stoned.” WRONG! Prevention is better than primary health and community organisations, is it really cannabis? Find How can we reduce that Cannabis and cars don’t cure. What are we doing to researchers, students, schools and boards out what is really in harm and make sure that, mix. Find out the latest stop young people using of trustees, policy makers, and addiction synthetic cannabis. when people do use evidence on drug driving. cannabis, and how can we treatment agencies and workers. cannabis, the negative be doing it better? consequences are as Membership and subscription enquiries limited as possible. [email protected] or visit our website.

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matters of substance is published matters of substance invites Brand development/ New Zealand Drug Foundation by the New Zealand Drug feedback and contributions. graphic design 3rd Floor, 111 Dixon Street Foundation. All rights reserved. If you’re interested in Insight +64 4 801 6644 PO Box 3082, Wellington, Neither this publication nor any contributing a guest editorial [email protected] New Zealand part of it may be reproduced or article, please contact us: www.designedbyinsight.com p +64 4 801 6303 matters of substance without prior permission of the [email protected] November 2013 Drug Foundation. p +64 4 801 6303 Vol 24 No 4 ISSN 1177-200X the director’s cut Social

@jgreenbrookheld Things I’m addicted to: jetplanes, Cheds, Mountain Dew. What do you think my life expectancy is? 10 October

@simonbradwellnz Lowering the drink-drive limit will save lives. Any other argument is irrelevant. 2 October

@thewritertype21 I approve the medical use of marijuana, but not when it makes the doctor laugh during my prostate exam. 21 September

omething amazing happened in Wellington in August. A group of @rustyrockets read this about rat junkies and 100 people representing more than how they get clean if you’re nice to them. 60 diverse organisations came together to nzdrug.org/ratticts 20 September discuss drug policy, and at the end, everyone agreed on a way forward for S New Zealand’s national drug policy. This @jamesdunnenz An Acte to Provide for Free proves New Zealand’s response to drugs Publicke Wine at Crossroades to Improve the does not have to be a divisive issue. Ross Bell Common Weal. 29 August Executive Director Our ambitious plan brought together some of the people most affected by drugs and KEY EVENTS & DATES drug policy but who had never had a chance to talk about it: families, communities, schools. We had representatives from the addiction treatment sector, febfast teachers and principals, and the lovely people from Grandparents New Zealand Raising Grandchildren sitting next to NORML, the Police Push pause on booze for February and raise funds for young people Association and the Needle Exchange Programme. with alcohol and other drug problems.

1-28 F e b ru a r y 2014 www.febfast.org.nz This community-led approach culminated in a 10,000 word declaration that will shape New Zealand’s future drug policy. 57th session of the Commission on Narcotic Drugs: High-level review It’s not just a list of demands to government but a commitment to Vienna, Austria work together to address our nation’s drug issues. High-level discussion by the Commission on Narcotic Drugs Our collective wisdom allowed the group to find common ground on resolution 56/12. 13-14 Ma rch 2014 on some important issues. www.nzdrug.org/19Dr3YX Early intervention in schools was one such issue. We know, if National Indigenous Drug & Alcohol Conference 2014 students are engaged at school and they stay involved in Melbourne, Australia education, they are less likely to experiment with drugs and more Based on the theme What Works: Doing it our way, NIDAC 2014 likely to have fewer problems in later life. Schools play an aims to highlight approaches that are working to reduce the harmful effects of alcohol and other drugs and its associated harms among important role in this respect, and they should be supported to 4-6 J une 2014 indigenous Australians. help students in trouble. nidaconference.com.au Another area of agreement is the need to invest in more treatment services. Making treatment accessible means alerting people to the 20th International AIDS Conference fact it is available. Also, barriers such as criminal sanctions should Melbourne, Australia be removed so people aren’t fearful of seeking help. By decreasing Work together to strengthen efforts across all regions and around the the stigma associated with drug use and lowering the barriers to world and build on the momentum of recent scientific advances. 20-25 J u ly 2014 get into treatment, we will see less harm in our communities and www.aids2014.org more families getting help. Cutting Edge 2014 The group also expressed overwhelming support for a substantial Dunedin, New Zealand overhaul of the laws that govern New Zealand’s response to drugs. The next DAPAANZ Cutting Edge conference is going to be held in Dunedin. Dates haven’t been announced yet, but look out for more details.

The declaration was created with a spirit of good will and a desire S eptem b er 2014 www.cuttingedge.org.nz for better cooperation and collaboration between everyone affected by drugs and drug policy. We trust the government, and any other organisation with an interest in an Aotearoa New Zealand free from drug harm, will accept it in the spirit it was created and that Follow us we all can make it a reality. Join us online drugfoundation.org.nz/connect You can read and sign up to the Wellington Declaration on our website – nzdrug.org/wellingtondec matters of substance November 13 01 NEWS NZ. 03 AA in 04 Drug driving 05 Preventable reverse campaign poison deaths

The New Zealand Automobile Association (AA) has reversed its position and now supports a lower BAC for adult drivers of 0.05. In 2010, AA General Manager for Motoring The New Zealand A new report shows 01 Affairs Mike Noon said Transport Agency has over 70 young people died lowering the limit was not kicked off a new campaign between 2002–2008 due to to get people to think unintentional poisoning. Summit success a “silver bullet” and that the problem lies with about whether drug The Special Report: History was made in serious drink drivers. driving is safe. Unintentional deaths from Mr Noon has changed his NZTA Road Safety poisoning in young people Wellington in September tune after a survey that Director Ernst Zollner conducted by Dr Nick showed two-thirds of AA said the ads talk to people Baker for the Child and with the successful members supported a who believe that using Youth Mortality Review completion of a declaration lowered limit. cannabis has little impact Committee found volatile on their driving. substance use was the “Lowering the limit will biggest cause of death for to reshape New Zealand’s reinforce the risks of “Many believe that they 15–24 year-olds. drug policy. drinking and driving to the are safer drivers because public. The AA hopes it they think they’re more Dr Baker said that many The New Zealand Drug Foundation convened almost will have a similar effect to focused, drive slower and young people who died 100 people from over 50 organisations to develop a the zero BAC level for are therefore more careful were not well connected consensus agreement on the best way forward in areas drivers under 20, which on the roads. They don’t to support systems and such as prevention, early intervention, education, has seen the number of consider what they’re doing that lethal agents, such as treatment and legislative responses. young drink drivers fall to be dangerous – but we’re butane, are too easy to buy. asking them to reconsider “The declaration was created with a spirit of goodwill 22 percent,” Mr Noon said. “Greater collaboration and that notion, because the and a desire for better cooperation and collaboration information sharing facts tell a very different between everyone affected by drugs and drug policy,” between families, story,” Zollner said Drug Foundation Executive Director Ross Bell said. communities and with and between service “We hope that people will use the declaration as a RESOURCES providers is important,” resource to promote positive change at an Dr Baker said. organisational, community and national level.” To watch the ads, visit % nzdrug.org/drugdrivingad The report calls for safer RESOURCES prescribing, dispensing and disposal of medicines To read the Wellington Declaration, visit nzdrug.org/wellingtondec 22 and law changes to To sign up to the Wellington Declaration, visit nzdrug.org/signupdec tighten access to harmful substances. Retailers can also do simple things 02 SURVEY to reduce access, such The results of the as removing volatile Youth ’12 survey % % % substances from show a decreasing 11 8 13 in-store displays. of students smoke of students’ drink of students currently trend in use of occasionally alcohol weekly use cannabis tobacco, alcohol, RESOURCES and cannabis by To read the special report, visit secondary school % % RESOURCES nzdrug.org/poisoningreport students in 45 23 of students currently of students have ever To read the rest of the report, New Zealand use alcohol used cannabis visit nzdrug.org/youth12 since 2001.

02 matters of substance November 13 06 Increase in 07 Hepatitis C 08 Smokey alcohol-related and Victrelis™ pokies cancers

02 07 08 50,000

The estimated number of The Auckland High New figures show New Zealanders who have Court has ruled the alcohol use is a growing contracted hepatitis. As of Ministry of Health’s cause of cancer in 1 September a new calculation to determine New Zealand. 04 medication, Victrelis™, whether a room is A Ministry of Health will be available to treat “substantially enclosed” is report on cancer shows people with chronic viral contrary to the Smoke-free a 14 percent decrease in hepatitis C. The drug Environments Act. death rates over the past 10 reduces treatment times The Cancer Society, 10 years but an increase in and increases the chances Problem Gambling cancers related to alcohol of being cured. Foundation and Salvation consumption and obesity. 03 Army applied for a 01 09 RESOURCES Rates of smoking-related judicial review of a Ministry of Health cancer had fallen but To find out more about are being replaced by hepatitis C, visit decision to allow oesophageal and nzdrug.org/hepcfoundation SkyCity’s Diamond kidney cancer. Lounge to be a designated smoking area despite it only having a wall of 05 louvres for ventilation. Justice Rodney Hansen found that relying on a calculation to assess airflow through a space replaced a factual question about whether or not a 09 space was enclosed. 06 “That is contrary to the Justice Minister Judith Collins credited new justice clear scheme and purpose % sector initiatives that steer young people away from of the statute,” he said. 18 a life of crime and away from the justice system. The Ministry of Health “If we can stop young people coming before the said it would be reviewing The drop in youth courts in the first place, then we have a better the decision and the way crime from June chance of keeping them out of the system it considers applications. 2011 to March 2013 altogether,” Ms Collins said. 10 Earlier in the year, it was revealed that SkyCity The move comes after The law means people secretly lobbied the The Government government to change Drink has announced it years of campaigning caught with levels higher driving by public health groups than 0.05g will get a fine smoke-free laws to allow will lower the and the recent drawing and demerit points. gamblers to smoke inside limit the casino. drop allowable blood of a members bill of At the time of printing alcohol limit from Palmerston North Labour no bill had been tabled MP Iain Lees-Galloway 0.08g to 0.05g of in Parliament but the which also sought to first reading is expected alcohol per 100ml lower the limit. before Christmas for those over 20.

www.drugfoundation.org.nz 03

NEWS

World. 02 01 03 Holder holds back

“ One more concrete step towards more sensible drug policy in this country.” director of american civil liberties union’s criminal law reform project

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02 Supervised injection at InSite 01 10 2003—2013 2,000,000 Attorney-General Eric Holder has to attorneys across the USA that outlined number of years InSite number of visits since informed the governors of Colorado eight priorities federal prosecutors will has been operating opening in 2003 and Washington that the Department be pursuing regarding cannabis. of Justice (DOJ) will allow the states to These focus on distribution to minors, carry through with their plans to revenues going to organised crime, legalise cannabis. trafficking, drugged driving and other 529 4,564 In a phone call to the governors, Holder criminal-related elements. average number of referrals to other said that, while the DOJ will trust the The Director of American Civil Liberties injection room visits social and health states to ensure a robust regulatory Union’s Criminal Law Reform Project per day services in 2012 framework, it would reserve the called the guidance “one more concrete right to file lawsuits at later dates. step towards more sensible drug policy At the same time, Deputy Attorney- in this country”. General James Cole issued a memo 2000+ 0 overdoses at deaths at InSite InSite since 2003 since it opened Resources

For the full report, visit nzdrug.org/TLzWq7 Resources To read the memo from James Cole, visit nzdrug.org/colememo To read more about what’s happening in the USA, turn to page 16 To find out more about InSite, visit nzdrug.org/insite10years

04 matters of substance November 13

07 No logo

06 05

Australian cricketer Fawad Ahmed has been allowed to wear a uniform without the logo of beer brand VB, a team sponsor. Cricket Australia allowed the request after the spinner approached them expressing discomfort with the conflict it created for him due to his religious beliefs. Ahmed took three wickets for 25 runs in his first T20 match wearing the unbranded shirt. 04

03 Price down, 04 Fiji decree 05 Cannabis 07 purity up: War on volatile makes on Drugs fail substance use prisons calm

A new study published 06 Coffee 08 Uruguay in the British Medical shops and to legalise Journal shows the price compromise pot of illegal drugs has gone down while the purity of drugs has gone up. The paper concludes Fiji’s National Substance Research in that “expanding efforts Abuse Advisory Council Switzerland has shown at controlling the (NSAAC) is set to draft that up to 80 percent of global illegal drug a decree to deal with prisoners and 50 percent market through law volatile substance use of staff in a Swiss male A report published by The small South enforcement are failing”. in the Pacific country. prison use cannabis and the Open Society Global American nation of that it keeps prisons calm. Heroin Cocaine Cannabis Director of NSAAC Misaele Drug Policy Platform Uruguay is set to become 180 160 Driubalavu said that there Prisoners said they used shows the Netherlands’ the first country to fully 140 have been around 200 cannabis for a variety of policy towards cannabis legalise and regulate the 120 cases of inhalant use reasons including pain 100 has been a success. production, sale and 80 recorded at schools relief, as a social pacifier Coffee Shops and consumption of cannabis. 60 around Fiji every year. and to relieve stress. % 40 Compromise: Separated A Bill was passed earlier 20 “We are proposing the The study concluded that, Illicit Drug Markets in the in the year by Uruguay’s 0 formulation of this decree -20 while illegal, it was a part Netherlands shows there lower house despite only -40 because currently there’s of daily prison life. The are fewer arrests, fewer 25 percent of the public -60 no law to protect young authors suggested that -80 people using cannabis, supporting the law. -100 people and control the strategies that don’t fewer people using Decrease in price Increase in purity RESOURCES from 1990 to 2007 from 1990 to 2007 sale of these substances depend on cannabis “harder drugs” and is by shopkeepers,” or other substances generating an estimated To read more about what’s Driubalavu said. be implemented. €400 million. happening in Uruguay, visit the The decree will likely Regulación Responsible page Resources RESOURCES RESOURCES make it illegal to sell nzdrug.org/uruguaylaw To read the full paper, visit glue and other inhalants To read the paper, visit To read the full report, visit nzdrug.org/BMJpriceofdrugs to minors. nzdrug.org/swissprison nzdrug.org/coffeecompromise

www.drugfoundation.org.nz 05 Cannabis and health

No longer the healthy option

20 years on from the New Zealand Drug Foundation’s first cannabis and health conference, Keri Welham takes a look at Aotearoa’s most widely used illegal drug to see what has changed since 1993.

06 matters of substance November 13 www.drugfoundation.org.nz 07 Cannabis and health

Professor Wayne Hall at Queensland University

t is 20 years since functioning at a higher level than heavy Professor Wayne users of alcohol or opiates. However, Hall gave his first the view of cannabis as a harmless drug public lecture on has faded. cannabis and “It is quite clear that there are some health. The groups in the community who do Keri platform was the experience difficulties,” Hall says. Welham I 1993 New Zealand What else have the decades between Drug Foundation symposium. these symposia revealed? What do we now know that wasn’t known 20 years ago? He had been asked to review research on cannabis and health by the Australian Homegrown breakthrough government earlier that year, and his Let’s go back to 1993. Bill Clinton moves presentation focused on mental health. into the White House, Czechoslovakia That first lecture, at a concurrent session ceases to exist and the European Union is late on the second day of the symposium, formally established, actress Audrey led Hall down a research tangent he’s been Hepburn dies and One Direction singer following ever since. Niall Horan is born. People wear This year, the Drug Foundation and dreadlocks, waistcoats, berets. Meatloaf leading international researchers will again wails, “I would do anything for love”, fuel turn their attention to issues of cannabis injection becomes a standard feature in the and health. And Hall, now a member of the top-selling Ford Escort and, on Coronation International Narcotics Control Board and Street, brassy Bet Lynch bawls her eyes out a Queensland University professor, will when she realises her miserable ex-husband give the keynote address. These days, his Alec Gilroy has a new love interest. expertise extends to various aspects of In some ways, 1993 seems a world mental health, cannabis dependence and away, but many of the issues that were medicinal cannabis use. front of mind in drug prevention live on. Reflecting on those two decades, Hall In 1993, the Drug Foundation symposium says there have been significant shifts. featured sessions on cannabis use among “The big change is acknowledging Mäori and youth, the psychology and people can experience problems with educational philosophies of counselling cannabis use. Back then, no one got into users of cannabis, the drug’s impact on trouble with cannabis.” sporting performance, and mental health. It was believed cannabis users mostly But there were also sessions on music had jobs, homes, relationships. They were as a healer, motivational interviewing, and

08 matters of substance November 13 The big change is acknowledging people can experience problems with cannabis use. Back then, no one got into trouble with cannabis.

Professor Wayne Hall

What we do know is that the dangers of cannabis use are strongest for young users and heavy users.

the Rastafarian movement and cannabis School Students in 2012 report reveals Health and Development Study (CHDS). use in Jamaica. 38.2 percent of teenagers had tried He finds the drug’s status intriguing: Agitation for legislative reform cut a cannabis in 2001, but this had fallen to “It’s normal, even in an environment backdrop to the 1993 symposium, and it is 23 percent by 2012. where it’s not legal.” an even more visible and heated factor of The Christchurch Health and He says the Otago study shows most the political landscape today. The same Development Study found 75 percent of Kiwis try cannabis once or twice but never can be said of concern at the impacts of New Zealanders try cannabis by the age of return to the drug. “It doesn’t fit in that youth cannabis use and high levels of use 25. The study tracks 1,265 children born in well with people’s lifestyles.” among Mäori. But fear over rising cannabis Christchurch in the winter of 1977. It has There is no known fatal dose for use, which was a key feature of the been the source of some 400 reports and humans. There is a listed LD50 (lethal dose) landscape 20 years ago, has fallen away as academic papers, including some focused for rats, mice and dogs, but it is very large; newer, more alarming drugs such as on cannabis and mental health. so large that an analogous dose for humans methamphetamine take hold and cannabis Hall says, thanks to the development would be pretty much impossible to use among young New Zealanders drops. study, we now know a lot more about the consume. Cannabis has been used by impacts of regular cannabis use on young humans much longer than the 50-odd years adults than we did in 1993 (when the Cannabis remains it’s had a profile in the western world. participants were 16). The groundbreaking “Humankind has a very long history something of a societal work of Professor David Fergusson and his with the drug; has had an awareness for team at the University of Otago, oddity. It is both illegal a very long time,” Boden says. Christchurch, has established a link That’s perhaps evidenced by the fact and commonplace. between cannabis use and psychosis humans have THC receptors in the brain. symptoms such as paranoia, delusion and Boden says these ‘set points’ mature or In 1993, a drugs survey from three perhaps hallucination. The linkage is harden in adulthood (sometime around years earlier was used to gauge cannabis strongest among users who are both young 18–21years). Before the set points mature, use. It canvassed more than 5,000 and report heavy use. heavy cannabis use can cause changes New Zealanders, aged 15 to 45, and found This research has offered one of the to the brain that make a person more 43 percent had tried cannabis, 12 percent most pronounced advancements in the susceptible to some of the adverse effects had used it within the past year and had understanding of the impacts of cannabis of cannabis use. not stopped using and 3 percent had used and is supported by the findings of “What we do know is that the dangers it at least 10 times in the previous 30 days. Australian and European research. Today, a 2010 report is used. It found of cannabis use are strongest for young 14.6 percent of adults, aged 16 to 64, used Young people and cannabis users and heavy users.” Heavy use is cannabis in the 12 months leading up to Cannabis remains something of a societal defined as somewhere between daily the 2007/8 survey on which the report was oddity. It is both illegal and commonplace. and weekly use. based. Meanwhile, the Health and Otago University Associate Professor “Young brains are really susceptible Wellbeing of New Zealand Secondary Joseph Boden works on the Christchurch to the … effects of the drug.”

www.drugfoundation.org.nz 09 Cannabis and health

Paora Joseph says some Ma¯ori have adopted cannabis as part of their culture.

Adopting cannabis culture he believes the drug becomes more When it becomes habitual, Boden says Mäori have much higher levels embedded among Mäori as each new a part of the culture, a part of cannabis consumption and dependence generation is introduced to it. than non-Mäori. In the CHDS, Mäori at Cannabis and mental health of daily life, that’s when age 25 had nearly twice the rate of Hall says many researchers believed it’s a problem. cannabis dependence (20.2 percent, cannabis was a drug of dependence back in against 11.9 percent for non-Mäori). 1993, but they had no proof to offer those Paora Joseph The risk of dependency is particularly who said it was an easy drug to stop using. high for Mäori males. Since then, Hall says dependence has been This is why psychologist and film proven, and this has been bolstered by maker Paora Joseph says Mäori appear to evidence of large numbers of young adults have a particular fondness for cannabis and presenting to treatment services requesting the culture around it. Although it is not a help to get off cannabis. traditional element of Mäoritanga, the drug Today, researchers are largely agreed has been given something of a cultural on the adverse effects of dependence. status in some Mäori communities. Young people using cannabis are more like “What I see is it’s kind of built into the to leave school early, fail to develop culture,” Joseph says. “It’s been adopted satisfying personal relationships and be as the norm.” dependent on welfare. In his work and in the making of his In 1993, researchers suspected a acclaimed documentary Hiding Behind the modest association between cannabis Green Screen, Joseph has met many Mäori use and major depression. Boden says, who have adopted aspects of the Rastafarian in the intervening years, the Christchurch culture associated with cannabis as their cohort has provided evidence of an own – from music to dress to drug use. association, although it is relatively weak “When it becomes habitual, a part of and difficult to detect. There is a stronger the culture, a part of daily life, that’s when association between cannabis use it’s a problem.” (in particular, cannabis dependence) The habit is not only problematic for the and anxiety disorder. health of the user but also the health of the Research has also established a link user’s whänau. People talk past each other between cannabis and suicidal ideation, in a family where cannabis use is prevalent, particularly in males. Boden says, by the Joseph says, and their interactions lack the age of 30, the vast majority of heavy users depth necessary to adequately communicate. are male. Joseph says use of cannabis among Hall says the link between cannabis Mäori is increasingly intergenerational; and psychotic symptoms is strong, but the

10 matters of substance November 13 The longer you use, and the more heavily, the more likely you are to be impaired.

Nadia Solowij

association with depression is harder to Impairment in these areas is most understand. Did users turn to cannabis evident when the pressure is on, in It is fairly widely because they were depressed, or did cognitively demanding tasks. In 1993, this acknowledged now that there cannabis use drive their depression? was not understood. “Most people suspected there weren’t is a link [to schizophrenia]. any long-term effects,” Solowij says. It’s almost, I would say, I don’t associate cannabis It is still not certain whether cognitive undeniable. use as being particularly recovery is possible after the damage has healthy at all. We know that been done. Solowij suspects it is possible, Nadia Solowij but it could take a long time for the brain to schizophrenia and the key question: why there are a lot of harms normalise – particularly after long-term do some people develop psychosis when associated with cannabis. heavy use. they use cannabis and others don’t? “The longer you use, and the more Predisposition to schizophrenia can’t Nadia Solowij heavily, the more likely you are to be explained by a single gene. There are a be impaired.” Brainpower range of individual differences, including Solowij says the majority of the genetic make-up. Nadia Solowij is an Associate Professor effects on cognition are relatively subtle. Within the general population, about at the University of Wollongong. The effects may combine to make a person 1 percent of people develop psychosis. For more than 20 years, she has focused function less well, but they will still Researchers now know that, of these, her research on cannabis use. Her team function in the community. 13 percent would not have developed works with key laboratories across the “So maybe, in the scheme of things, psychosis if cannabis hadn’t triggered their globe on projects utilising the latest it is not so bad, but they do not function vulnerability to the condition. neuro-imaging technology. as well as they would if they hadn’t Back in 1989, a groundbreaking In 1993, as Solowij was just used cannabis.” study revealed a link between cannabis completing her PhD, she also presented Solowij says IQ is another area and schizophrenia. at the Drug Foundation symposium. impacted by cannabis use. Studies have “Most of us didn’t believe it,” She discussed novel evidence showing shown that, over time, cannabis use will Solowij says. the long-term effects of cannabis reduce a person’s IQ. Scientists stood alongside the general on cognition. The most definitive study was a population in a belief that cannabis was Cognition concerns brain function. Dunedin cohort assessed during “not that harmful”. Cannabis use seems to have the most adolescence and again at age 38. Those She says, “It took quite a long time impact on memory. Other aspects of who persisted with cannabis were shown before new studies started to emerge – a cognition that are often impaired by to have lost eight IQ points over those wide range of studies, large studies … cannabis use tend to be higher-functioning 20-odd years. It is fairly widely acknowledged now that skills such as information processing, In recent years, Solowij’s focus there is a link [to schizophrenia]. planning and executive abilities. has turned to the complex area of It’s almost, I would say, undeniable.”

www.drugfoundation.org.nz 11 Cannabis and health

Like Hall, Solowij says recognition of increase the THC in their product, and the harmful effects of cannabis is a major A number of countries are Solowij says the CBD content has change in the 20 years since 1993. It’s no making some substantial subsequently diminished or even been longer considered the “healthy option” in eliminated. This is of particular interest to terms of drug use. changes, there is an researchers because early studies have “I don’t associate cannabis use as opportunity to watch and shown CBD may have anti-psychotic and being particularly healthy at all. We know learn from that experience. anti-anxiety properties. It’s believed CBD that there are a lot of harms associated could provide neuro-protective and with cannabis. Steve Allsop anti-inflammatory benefits in multiple “I do think most people would sclerosis sufferers, control chemotherapy- recognise and acknowledge that it However, because the drug’s impact is induced nausea, prevent the formation of is harmful.” short-lived, the positive impacts would deposits in the brain associated with subside after about three hours. Alzheimer’s disease and help reduce Cannabis and the human body There is some research suggesting HIV-related neuropathic pain. It is early There is emerging evidence cannabis has a cannabis retards the growth of some forms days in terms of definitive results, but harmful effect on cardiovascular function. of cancer. Studies showed breast cancer Solowij says CBD is now a major area of Regular users may also suffer from poor cells in Petri dishes stopped in their tracks research for teams like hers. respiratory function and a higher risk of when faced with cannabis, while a Spanish chronic bronchitis. study found the chemicals in cannabis Other new However, Hall says the cancer link you promoted the death of brain cancer cells. avenues for research might expect to see with a product that is (However, other research revealed Canadian researcher Amy Porath-Waller predominantly smoked hasn’t yet been testicular cancer was 70 percent regularly reviews Police reports. She says more likely to develop in men who conclusively proven or adequately it’s now common for people to be using use cannabis.) quantified. The research is muddied multiple drugs at once. One of the major developments in because most people who smoke cannabis Porath-Waller says, 20 to 30 years ago, cannabis research in recent years also smoke tobacco. Hall insists, due to the the levels of THC present in cannabis were has been the identification of potential difficulties involved in isolating cannabis’s health benefits associated with much lower. Police hauls tested in Canada impact, the absence of evidence does not cannabidiol (CBD). in 1985 showed 3.5 percent THC – in 2008, equate to exoneration. Tetrahydrocannabinol (THC) is the the average had risen to 12.5 percent. In But cannabis also offers health benefits. compound responsible for the most the United States, THC levels averaged Solowij says there is some evidence infamous impacts of cannabis use – the 9.8 percent in 2009, while in Australia, that cannabis use lowers intra-ocular stoned feeling, memory loss and, in an they were around 15 percent. pressure in glaucoma sufferers. Of all the unfortunate minority, psychotic episodes. This increasing potency, combined medicinal claims associated with cannabis, CBD is another compound of cannabis. with what is now known about the impact this one is perhaps the most substantiated. Over the decades, breeders have sought to cannabis can have on the developing

12 matters of substance November 13 Sean Plunket: not a poster boy, just another New Zealander

“I don’t buy illicit or illegal drugs. If I’m offered marijuana in a social setting and I feel comfortable Sean Plunket last smoked ... about my privacy, and I think it would be a social cannabis with doctors lubricant, like having a drink, I’ll have some.” and surgeons at a New Year’s His preference for cannabis control would be a Eve party near Auckland. system where the drug is treated similarly to home-brewed beer: you could grow a small amount for yourself and have some mates over, but you couldn’t legally sell your crop. The RadioLIVE presenter sees nothing extraordinary in that fact – or in the fact he’s Plunket, 49, says he will not be mirroring his talking about it. childhood and exposing his son to marijuana to demystify the drug. Earlier this year, during a talkback segment on cannabis law reform, Plunket outed himself as an “I do not advocate minors using any form of drugs occasional cannabis smoker. [including] cannabis or alcohol.” adolescent brain, provides an alarming Health Ministry figures from 2010 suggest Rather, his strategy is to raise a child equipped to 14.6 percent of adults used the drug in the past make sound judgements regarding his safety and backdrop to prevention efforts. year, and the Christchurch Health and Development informed decisions about risk. It’s a plan that Steve Allsop, Director of Australia’s Study reveals 75 percent of people have tried the clearly acknowledges marijuana’s prevalence in National Drug Research Institute, drug by the time they are 25. While discussing New Zealand society. says 2013 is a fascinating moment in cannabis, Plunket revealed he was among those time for those interested in the criminal who had used the drug in the past year. status of cannabis and the impact The revelation was met with little response from that status may have on the health of the mainstream media, his audience or his bosses. I’m keen for us to say a population. “I didn’t consult anyone, and I don’t think it was as a country that, let’s be regarded as a big deal.” He values the opportunity to watch honest, marijuana and learn from the experiences of Colorado But he wouldn’t have been so complacent in 1993. permeates much of society. and Washington, as they legalise cannabis He says, back then, he probably wouldn’t have had use, production and sale, and other the confidence to speak openly about his drug use. It’s not an uncommon jurisdictions around the world that “It’s become less of an issue over the last recreational drug. are decriminalising cannabis possession 20 years.” and use. Plunket first tried cannabis in Standard 2, aged “A number of countries are making about eight, at parties he went to with his mother. Plunket says he has no intention to become a some substantial changes,” Allsop This demystified the drug for him, and although poster child for cannabis law reform; his says. “There is an opportunity to watch starting young, he has never been a regular motivation was simply about honesty. He felt he cannabis user. and learn from that experience.” couldn’t host a thorough debate about cannabis Boden, who is American, is also “It was never a big deal.” on his show without admitting that he was among the half a million New Zealanders who intrigued by the changes under way as He purchased what he thought was cannabis at use cannabis. Colorado and Washington transition to a age 17 and was caught and suspended from fully legalised cannabis trade. boarding school. In retrospect, he believes he “I’m a very, very average New Zealander, actually. actually purchased herbal tea. I wouldn’t die in a ditch for alcohol law reform, “This could be the beginning of and I wouldn’t die in a ditch for drug law reform. the end for prohibition in the States.” These days, there’s no chance he’ll be duped into But how on earth are we going to have an honest With the legalisation of cannabis, buying a tinny of tea. Plunket doesn’t buy cannabis discussion if grown adults won’t [admit] the place he expects research into the impacts and doesn’t keep any in his house. He draws the it has in New Zealand life? of the drug will expand and develop line at purchasing cannabis because he doesn’t want his discretionary dollar going into the “I’m keen for us to say as a country that, let’s greater sophistication, and the next pockets of criminal enterprise. be honest, marijuana permeates much of society. 20 years will reveal even greater It’s not an uncommon recreational drug.” knowledge of the impacts of cannabis But when he’s offered some at a party, he sometimes says yes. He says he smokes cannabis use on human health. about five or six times a year.

Keri Welham is a Tauranga-based writer.

www.drugfoundation.org.nz 13 Cannabis and health

Harms: the known, the probable and the unclear

In 2009, Professors Wayne Hall and Louisa Degenhardt wrote a review for leading journal The Lancet titled ‘Adverse health effects of non-medical cannabis use’. Below are excerpts of their findings:

What is known or probable What is unclear The ‘gateway’ drug • Acute adverse effects of cannabis • In the case of depressive disorders and Canadian researcher Amy Porath-Waller use include anxiety and panic in suicide, the association with cannabis has analysed various studies into the role naïve users and a probable increased is uncertain. of cannabis as a gateway drug. Does risk of accidents if users drive • For cognitive performance, the size cannabis use lead to the use of synthetic while intoxicated. and reversibility of the impairment drugs capable of causing more harm? The • Use during pregnancy could reduce remain unclear. debate was raging 20 years ago, and there’s still no definitive answer. birthweight but does not seem to • Whether cannabis contributes to Dr Porath-Waller, a senior research cause birth defects. behavioural disorders in the offspring and policy analyst at the renowned • Chronic cannabis use can produce a of women who smoked cannabis Canadian Centre on Substance Abuse dependence syndrome in as many as during pregnancy is uncertain. (CCSA), says, unfortunately, there is no one in 10 users. • Adolescent regular cannabis users are definitive answer to this recurring • Regular users have a higher risk of more likely to use other illicit drugs, question. The findings are mixed. chronic bronchitis and impaired although the explanation for this There is quality research to prove it respiratory function and psychotic association remains contested. and equally sound and compelling symptoms and disorders (most research to disprove it. probably if they have a history of However, researchers in her network psychotic symptoms or a family say young people report that they do see history of these disorders). cannabis as a gateway drug. • The most probable adverse She and her colleagues hear that psychosocial effect in adolescents who young people go to their drug dealer to become regular users is impaired pick up cannabis and are offered ecstasy. educational attainment. “Just by using cannabis, they are • Regular cannabis use in adolescence getting exposed to other drugs.” might also adversely affect mental health in young adults, with the strongest evidence for an increased risk of psychotic symptoms and disorders. • The public health burden of cannabis use is probably modest compared with that of alcohol, tobacco and other illicit drugs.

14 matters of substance November 13 www.drugfoundation.org.nz 15 Legalisation The world watches To legalise, or not to legalise: that is the question. Colorado, Washington and Uruguay have decided to go ahead with allowing the recreational use and sale of cannabis, and the world is watching. But there are still many questions around how these systems will work. Russell Brown investigates the devil in the detail of legalising cannabis. Russell Brown

ou’re going to Costs of Control. The jump from theory to one, so whether the outcomes are good or legalise and regulate practice must have been a thrill. bad, there will certainly be a lot of quality the trade in “Oh yeah,” agrees Kleiman. “It data to inform future debate.” cannabis. It’s the was completely irresistible when this The fact that Kleiman is helping thought experiment came along.” Washington regulate its new market doesn’t at the centre of any The real work began in March when mean what’s happening there is necessarily argument for drug the Washington State Liquor Control Board what he would do. Y selected a team from the Massachusetts- “My ideal world would not have law reform, but this time it’s for real. What do you need based think tank BOTEC Analysis as its commercial sales. But given their to know? technical vendor. Kleiman, as CEO of voters wrote their laws for them, I think BOTEC, leads the project team, which both Colorado and Washington are doing “How much cannabis is currently sold, includes Beau Kilmer, Co-director of the a perfectly reasonable job of setting by the tonne and by the dollar?” asks Mark RAND Drug Policy Research Centre and up regulation. Kleiman. “How much should you expect to Kleiman’s co-author on last year’s book “They’re operating under the alcohol sell legally? How many square feet of Marijuana Legalization: What Everyone model. As the liquor board, they are held production capacity is that? If you’re going Needs to Know. responsible if their licensed sellers are to allocate retail outlets to counties based Kleiman is now one of the key figures reselling to minors. They’re held on consumption, what would that map look in a cluster of experiments that will be responsible if there are unlicensed sellers, like? For what impurities and adulterants watched all over the world. Colorado, like if bars are operating past the allowed times should cannabis be tested, and what’s the Washington, passed an initiative to legalise or serving people who are obviously drunk available testing technology? What’s the the production, sale and use of cannabis, or allowing a lot of noise that bothers the environmental impact?” and the government of Uruguay has passed neighbours. And they’re held responsible if These are a few of the questions laws introducing direct state control of a there’s tax evasion. That’s the complete list. cannabis market. “They’re not held responsible when Kleiman, the new “pot czar” (he doesn’t “Everyone in drug policy will be somebody gets drunk and commits suicide much like the term) of the US State inevitably looking at these experiments or wrecks his car or beats up his girlfriend of Washington, has been proposing and closely – they are hugely important,” or commits a rape. And I think it’s wrong. trying to answer since voters last year, affirms Steve Rolles of the British drug If I were setting up a liquor control system, via Initiative 502, instructed their state to policy foundation Transform. I would say to local authorities, you’re legalise the production, sale and use “Lessons will need to be learnt from accountable for minimising the public of cannabis. both successes and failures, and the fact damage from heavy drinking, and figure out The former Department of Justice that there are different models in the two how to do that. analyst has been preparing for this day for a states – and in Uruguay – is also useful “I think, in the case of cannabis, there long time – it’s nearly a quarter of a century from a comparative perspective. It’s much in fact is a political matter. They’re going to since he wrote Marijuana: Costs of Abuse, easier to study a legal market than an illegal be held accountable for a much wider range

16 matters of substance November 13 Sanho Tree thinks there might be backlash against ganjapreneurs.

of outcomes. But it’s not easy for them to recently that the government, while Colorado, which has been running a much think in those terms.” emphasising that cannabis remains illegal tighter medical pot regime than California, under the federal Controlled Substances is well placed to introduce a system that Act, should not meddle with the state will keep the Feds out of its hair. Mass advertising, initiatives, subject to eight enforcement “The medical scene has been very criteria being met. These include keeping tightly regulated in Colorado – unlike promotion, using items the trade away from minors and criminal California,” says New Zealand reform that are attractive to kids – groups and preventing the “diversion” of advocate Chris Fowlie, who recently visited like medical marijuana cannabis to other states. the state. lollipops, ‘Ring Pots’, ‘Pot- Given that the Obama Administration “From the seeds all the way through has, with the help of a cluster of US to actually smoking it. All the plants have Tarts’ – are all characteristics attorneys, been actively hostile towards barcodes on them, and they see that as one of current policy. some state medical cannabis operations, of the reasons legalisation happened – it this was big news. disproved all the ‘sky will fall’ claims. It “It was the best we could have hoped was de facto legalisation, and it disproved for under our system of checks and all the lies that prohibitionists feed us. “‘Legalisation’ is just a word, it’s not balances,” says Sanho Tree, Director of the Everyone over there told me that was crucial a policy or a strategy,” observes Kasia Drug Policy Project at the Institute for to public support growing and growing.” Malinowska-Sempruch, Director of the Policy Studies. Kevin Sabet, Director of the Drug Policy Open Society Global Drug Policy Program. “Holder could not change the laws – Institute at the University of Florida, takes “To understand the policy or strategy, only Congress can, unless the Supreme a very different view of Colorado’s med-pot you need to look at what it’s intended to Court declares a law unconstitutional. experience, noting the drug-testing do. The Dutch have some smart regulations So he urged the US attorneys to exercise company Conspire’s report this year that and some great public health strategies. discretion and focus on the points that THC concentrations in the blood of state They just never resolved the supply interest the Feds. His suggestion is not high school students had risen sharply – problem. I think what they are doing in enforceable, but it is a huge political suggesting more frequent use. Washington and Colorado will resolve victory in that the executive branch has “Anyone who has been to Colorado – or some of those issues, but they will likely thrown in the towel in terms of responsible California, for that matter – since 2009 can encounter their own challenges.” adult cannabis use.” get a sense of what full legalisation looks She’s impressed by the attention to The hardline US attorneys at the sharp like already,” says Sabet. process in both US states (“all those studies end of the Federal Government’s hostile “Mass advertising, promotion, using and hearings!”), but it’s hard to debate that approach towards some medical cannabis items that are attractive to kids – like the most important formal move has come suppliers were quick to insist that Holder’s medical marijuana lollipops, ‘Ring Pots’, from the US Federal Government. US statement would make little difference to ‘Pot-Tarts’ – are all characteristics of Attorney General Eric Holder advised their approach. But it seems likely that current policy.”

www.drugfoundation.org.nz 17 Legalisation

Each cannabis plant in Colorado is tracked from seed to sale.

But by any lights, legalisation has “We already know marijuana and obliged everyone to confront questions driving is a growing problem in states with In Colorado, though traffic that had been put to one side under loose marijuana laws,” says Sabet. fatalities fell 16 percent medical cannabis. A key issue for “In Colorado, though traffic fatalities between 2006 and 2011 – regulators is standardisation, and it turns fell 16 percent between 2006 and 2011 – consistent with national trends out that the science of testing cannabis consistent with national trends – fatalities product just may not be there. Rolles involving drivers testing positive for – fatalities involving drivers doesn’t see it as a problem. marijuana rose 112 percent.” testing positive for marijuana “The medical cannabis industry has “Nobody wants to say it out loud, but rose 112 percent. established ways of reliably producing I think it probably needs a good leaving standardised products. Testing is not a alone,” says Kleiman. perfect science, but error margins can also “Here’s the problem: it’s clear that be tested and factored into regulation being stoned decreases your executive models, and we would expect testing function and multi-tasking ability. science to become increasingly It renders many people inattentive. sophisticated as time goes on.” “It’s also clear that knowing you’re Kleiman isn’t so sure. stoned leads people to be cautious – “I think it’s going to be a huge the opposite of alcohol. The stereotypical problem,” he says. stoned driver is driving 15 miles an “There’s a question about simply hour in a 40 zone. He’s paranoid about measuring THC content, which is solvable how he’s driving. up to the tolerance you need a solution to. “So that sounds like good news. The The real issue is that, for alcohol, there’s other thing that sounds like good news is, one active agent. If I know it’s 6 percent when you let an experienced pot smoker alcohol, I know everything I need to know. get as stoned as they want and put them Cannabis has at least three and maybe on a simulator, their degradation is at 40 chemicals that matter. about the level of .08 THC. That’s just “I assumed when we started this we’d about the threshold of what’s considered just look at the literature, figure out some impaired driving for alcohol. key ratios of, say, THC to cannabidiol and “So all of that doesn’t sound like it require special labels for anything over adds up to extremely dangerous driving. some ratio. And then we look at the papers, Now the bad news – people are empirically and it’s not there. We simply do not have impaired for several hours after they’re the science to put together a decent subjectively back to baseline. So the people warning label. Can I show you a paper that who don’t think they’re stoned are the shows that a 200:1 ratio of THC to CBD is potentially dangerous drivers. riskier than 6:1? I’d bet my eye teeth on it, “THC is fat soluble, and unless you do but I don’t have the paper for it.” very fancy stuff with metabolite ratios, you And then there’s the unanswerable can’t tell whether somebody smoked two question: what to do about cannabis hours ago or three days ago. And so if you and driving? have a strict nanogram per millilitre rule,

18 matters of substance November 13 which is what’s in the Washington statutes, “So it’s not that there are evil people done anywhere in the world, and it’s anybody who’s a regular pot smoker can who decide to go into these industries. something we should really be proud of. It never drive. That’s not workable. These industries create natural economic might well come with some problems and “And the other bad news is that people interests, provider interests, that are flatly some teething issues that we won’t be don’t just use pot. So here’s a rule I would contrary to the interests of consumers and aware of yet, but that hypocrisy of not have. If you have cannabis on board, then the public. That’s the case for not having a allowing the real cannabis is really jarring. your blood alcohol content limit is zero. commercial market – for having either grow People I talked to about it in Colorado You may not drive with both cannabis and your own plus co-ops or a state monopoly.” thought it was astounding.” alcohol in your system. And that’s an easy No one thinks Washington and rule to observe. Your BAC will be zero n Colorado will be the end of the story. More hours after your nth drink. So if you are If any millionaire US states and perhaps Central and South going to be a smoker, you may not drive for ‘ganjapreneurs’ attempt to American countries will follow. And in as many hours as you’ve had drinks. Zero’s create the Starbucks of pot, it New Zealand, it may not be a big leap for a good number.” natural cannabis to come under our The lack of a non-invasive roadside could trigger a federal backlash Psychoactive Substances Act. test is a significant factor, he says. and set us all back. For Sabet, there is no good rationale “Unless there’s an accident and for any of it. someone’s injured, I just don’t think “It would mean more addiction, health anyone’s going to be caught for driving costs, social problems and safety risks than under the influence of cannabis.” The potential for enterprise isn’t limited we will be able to handle. That doesn’t Here’s something everyone can agree to supplying the product. Colorado’s reform mean our current laws can’t be reformed on: if cannabis is to become one of the legal created space this year for the first Cannabis – but legalisation is a risky way to do that.” drugs, it’s important to avoid the kind of World Cup (a kind of A&P show with prizes The experts differ sharply on whether for buds rather than pumpkins) to be held damaging commercial practices that have the pot legalisation experience would have on American soil. An associated events grown around tobacco and alcohol. implications for the status of other illicit company quickly sold out a pot holiday, “If any millionaire ‘ganjapreneurs’ drugs. Kleiman and Malinowska-Sempruch with visits to growing and supply facilities attempt to create the Starbucks of pot, it regard cannabis as a distinctly separate by day and parties by night. Fowlie was the could trigger a federal backlash and set us case, but Rolles believes “the rationale is no only non-American to get a place on the all back,” says Tree. different, and we are wary of what you tour – making him the world’s first fully “Personally, I would ban commercial could call ‘cannabis exceptionalism’. Some legal international cannabis tourist. people argue we should regulate cannabis branding because it would create the drive The promoters, he says, were not because it’s safe – we think it should be to increase market share, but there are anyone’s archetypal weed dudes. regulated because it’s dangerous, and the many libertarians in the reform movement “They looked like they’d run an same goes for most other drugs. No drug is who view business interests as sacrosanct. IT company. They were very savvy made safer when produced and sold by Our First Amendment could also with the media and had a lot of media unregulated criminals.” complicate advertising restrictions.” following them.” Kleiman notes the state propositions “Unlike with tobacco in the past, we There are many other angles. Tree were strongly marketed on “taking pot out must always courageously look at the believes the politics of legalisation will tear of the hands of criminals” to free up law evidence of what policies are doing well apart the conservative and libertarian wings enforcement for more important tasks. and what needs to be changed,” says of the Republican Party. No one seems “But there’s a different, somewhat more Malinowska-Sempruch. quite sure how legalisation will affect obscure argument that may actually be the “Unlike street drug dealers, any general policing when the smell of cannabis winner, which is that cannabis may turn business that gets into the market has to is no longer an all-purpose source of out to be a substitute for alcohol and play by the rules. And I don’t know a single probable cause for stop-and-search actions. possibly for other drugs of abuse. Because drug policy reformer who will let the For Fowlie, the key impression was of it’s pretty clearly the least harmful of the mistakes of Big Tobacco be repeated.” the similarities and differences between the bunch, if cannabis substitutes for alcohol, it “In the US, it will be very difficult to American reforms and New Zealand’s new wouldn’t have to substitute very much for stem the tide of commercialisation,” Psychoactive Substances Act. the gains from reduced heavy drinking to counters Sabet. “What we’re doing with that Act in overwhelm any increase in the cost from “We have lived through 100 years of New Zealand is almost exactly what they’re heavy dope smoking. misery with Big Tobacco. Why on earth doing with real, natural cannabis in the “Yet the uncertainty about the effect would we want to repeat another 100 or United States. We’re licensing producers of cannabis on alcohol consumption is more years with Big Marijuana?” here, they’re licensing producers in large enough to swamp any rational “Big Tobacco isn’t the right way to look Colorado and Washington. The irony here calculation. We don’t think there’s enough at it,” says Kleiman. is that, if natural cannabis was available in science in the world to give us the answer “If you’re selling a product that creates New Zealand, there would be very little to the question. a subgroup of users who are heavy, out of demand for the synthetic stuff. “It’s just … here be tygers. That’s the control, problem users, they account for “Don’t get me wrong – I think the way the map reads.” such a large fraction of the total volume Psychoactive Substances Act is a really sold, they’re your primary market even good approach to controlling drugs, Russel Brown blogs at publicaddress.net. though they’re a minority of users,” he says. probably the best approach that’s ever been

www.drugfoundation.org.nz 19 Potency Not what your mum and dad smoked? Anecdotes abound comparing the mellow weed of the old days with the edgier dope of today. Has cannabis become more potent since the 70s? Rob Zorn ask whether this is so and what implications potent pot might have. Rob Zorn

n 2007, Britain’s So potency varies, and it’s not difficult It could be cannabis is now fresher due The Independent to come up with scary figures if you to the change from foreign to domestic published a compare the lowest percentages one year supply – and apparently fresher is better. retraction of its with the higher percentages of a few years There have also been continuing advances previous pro- later. For example, in the mid 1980s, during in sophisticated cultivation techniques, decriminalisation Ronald Reagan’s War on Drugs, it was though there is no real evidence that stance because it claimed cannabis was 14 times stronger than cannabis grown indoors under lights is I in 1970. If it’s now 25 times stronger than had found out necessarily stronger; it just varies a lot cannabis had become 25 times stronger it was in 1990, that would make cannabis less in quality. over the last 10 years. 350 times stronger than it was in 1970! Sevigny also argues that, if the “That’s impossible,” Goldacre wrote. These claims were based on a statement distribution of seized cannabis products “That would require more THC to be reflects the composition of the actual by the UK’s Forensic Science Service present in the plant than the total volume market, then market-related factors have (FSS). The FSS said that, in the early of space taken up by the plant itself.” been a more influential driver of potency. 1990s, cannabis typically contained around And, come to think of it, it would be This is especially so since the 1980s when 1 percent tetrahydrocannabidinol (THC) just as easy to compare the higher vintage cannabis quality improved considerably but can “now” have up to 25 percent. figures with a selection of lower modern and people moved from smoking the In reaction to these “melodramatic” ones to ‘prove’ THC levels are falling. You whole plant to smoking only the high- reports, The Guardian’s Ben Goldacre can prove anything with statistics. examined the FSS’s data and compared The truth is, despite Goldacre’s potency buds. it with data from the Laboratory of the reasonable cynicism at the time, cannabis He writes, “From this 1980s baseline, Government Chemist (LGC), the United THC levels do seem to be rising to a point one can reliably conclude that average marijuana potency more than doubled Nations Drug Control Program and the that is scientifically or statistically over the last three decades, with most of European Union’s Monitoring Centre for significant, and a good number of studies this increase occurring since 2000 as Drugs and Drug Addiction. He found there have attested to this. high-potency sinsemilla came to dominate was indeed a rising trend in cannabis A 2012 Italian meta-analysis of 21 the market.” potency but described it as “gradual” case studies containing 75 total mean and fairly “unspectacular”. THC observations from 1979 to 2009 found Does stronger pot matter? a significant correlation between year “The Laboratory of the Government That cannabis is more potent on average and mean THC in herbal cannabis, Chemist data goes from 1975 to 1989. “revealing a temporal trend of increasing probably does matter because all drugs Resin pootles around between 6 percent potency worldwide”. come with harms, and the stronger the drug, and 10 percent THC, herbal between A study by Eric Sevigny, also published the greater those harms might be for those 4 percent and 6 percent, with no clear in 2012, looked at data from the US who experience them. For example, a 2009 trend,” he wrote. government-sponsored Potency Monitoring British Journal of Psychiatry study found Goldacre pointed out varying and higher Program, which performs ongoing forensic people with a first episode of psychosis had THC levels were hardly anything new. analysis of seized cannabis samples. He smoked higher-potency cannabis for longer LGC data shows 50 seized herbal cannabis found there had been a six- to seven-fold and with greater frequency than a healthy samples in 1975 had an average THC increase in THC percentages in seized control group. The researchers attribute the content of 7.8 percent, with the highest cannabis between 1970 and 2010 and psychosis to THC, which seems reasonable at 17 percent. Samples of cannabis resin suggests there are a number of reasons according to what we currently know. THC seized ranged form 4 percent to 16 percent. why this may be so. is the most powerful psychoactive

20 matters of substance November 13 The new stuff is a bit more potent than it was 20 years ago when I started smoking. The end result for me is that I smoke a lot less of it.

cannabinoid in the cannabis plant and the New South Wales, published in July this THC levels in contemporary Dutch one that gets you high. year, found that that, on average, cannabis cannabis, which “increased the risks for What’s worrying, though, is that, while smoked by Australians is of similar high public health”. THC levels are increasing, levels of potency to that found in studies overseas Cracking down on a problem in the cannabidiol (CBD), the other important and that levels of CBD, “which may hopes of legislating it away is certainly one cannabinoid, are not. Cannabidiol is almost ameliorate some of the harmful effects approach, but when people are already the polar opposite of THC in its effects. It of THC”, are extremely low. doing something illegal because they enjoy has anti-psychotic properties and is “These results suggest the profile of it, making it even more illegal doesn’t seem thought to calm the impulses towards cannabis currently used in Australia may all that effective as a deterrent. And as long anxiety and panic that can come with a make some users vulnerable to mental as a largely uneducated market equates cannabis high. It seems important you get a health problems,” says study leader and high THC levels with quality, that’s exactly good dose of CBD with THC, and for those NDARC lecturer Dr Wendy Swift, and it what growers will work to produce in an predisposed towards mental illness, would be reasonable to assume the same unregulated environment. cannabis with a low ratio of CBD to THC applies in New Zealand. That has policy implications for a may be more dangerous. She continues, “The high THC/low country like ours whose most recent drug It’s interesting to note the composition CBD profile of Australian cannabis has legislation reflects the understanding that of Sativex – the cannabis-based medicine been linked to increased risks for cannabis drug use is inevitable and that minimising – is 50/50 THC/CBD, a composition arrived dependence, increases in treatment seeking harm should be a priority. New Zealand at because it worked well and had the least and increased vulnerability to psychosis. may be world leaders in one regard, but unpleasant side effects. “There is still little research on the there may be some things we could still The other side of the coin, of course, is impact of potency on these issues, and we learn in another. that stronger cannabis means less smoke is need to know more about the factors which In overseas jurisdictions where needed to get high. That’s a good thing affect how people respond to the drug. It is cannabis is legal for either recreational or when you consider one of the undeniable important that we have a national routine medical use, various cannabis products harms from cannabis smoking is its effects monitoring system to assess trends in the come with content description labels that on the respiratory system. profile of cannabis and to better understand say what sorts of cannabinoids they “The new stuff is a bit more potent than its relationship with health outcomes.” contain, how much of each is present and it was 20 years ago when I started Recent major policy responses in what their effects are likely to be. This smoking,” High Times editor Chris several countries have reflected the could be an effective way of reducing Simunek told CNN in August this year. high-potency health concerns. For consumption (and therefore production) “The end result for me is that I smoke a example, when reclassifying cannabis as of high THC strains because the market lot less of it.” a category Class B in 2008, the UK Home would become much more aware that THC The same article describes experiments Office said, “The significant increase in potency is not the be all and end all of that show users tend to smoke less when both the market share of higher than enjoying cannabis. the quality is good. It also quotes US average potency cannabis and its actual This strain helps with insomnia. This government statistics that show patients potency in the last few years in the UK are one produces a mellow high and is good if entering US emergency rooms with compelling factors.” you tend to get paranoid. This one works cannabis in their system have increased In Holland in 2011, the Garretsen well if you eat it. 19 percent in the last two years. Commission recommended that cannabis Food for thought. Closer to home, an analysis by the with a THC level of greater than 15 percent National Drug and Alcohol Research be classified as a “hard drug”. The Rob Zorn is a Wellington-based writer. Centre (NDARC) at the University of commission said this was due to the high

www.drugfoundation.org.nz 21 Medical Clearing the smoke

Cannabis is now widely accepted as a medical treatment, but does it have the evidential backing of other medicines? From herbal remedies to clinical therapies, Max Daly investigates the big business of medical cannabis. max daly

fter losing his In a string of emails, ‘Lee’ repeatedly Sanjay Gupta, CNN’s chief medical right leg in a road asked the 58-year-old amputee for ‘raw correspondent, completed an abrupt U-turn traffic accident as medicine’, referring to cannabis. McKee in August by giving his full backing to a young man, advised him to become a member of medical cannabis, the story went viral. New Zealander GreenCross and to apply, as McKee had Infused with political agenda, half-baked Billy McKee successfully done, to obtain an exemption claims and prejudice, it’s an issue that has discovered that, from prosecution, under Section 8 of the left many countries, states and jurisdictions A Misuse of Drugs Act, via the support of his somewhat perplexed. for him, smoking cannabis eased the pain more effectively local GP. After four months of hassling, The dilemma was explained succinctly and with fewer side effects than McKee relented, and over the next year, in a paper by Peter J Cohen, a professor conventional painkillers. He became an sold him four small bags of cannabis specialising in drugs and law at activist for the medical use of cannabis, totalling around $300. Georgetown University in Washington, DC, grew some plants to keep him in McKee’s home was subsequently raided who wrote in 2009: “Whether medical medication and set up a website, and 66 cannabis plants were found. Despite marijuana should be accorded the status GreenCross, to push for a change in the law. a defence that he was growing the cannabis of a legitimate pharmaceutical agent has for purely medical use, he was convicted long been a contentious issue. Is it a truly To Police eager for an easy drug bust, last year of supply and cultivation and effective drug that is arbitrarily stigmatised he was the proverbial low-hanging fruit. sentenced to 12 months home detention. by many and criminalised by the Federal Aware that a site that promoted medical Picking up the morning papers to read Government? Or is it without any medical cannabis could well lead them to the drug about the case, evidently the result of a utility, its advocates hiding behind a itself, Police decided that targeting McKee fairly spiteful act of low-level entrapment screen of misplaced (or deliberately using an undercover officer could well get by the Police, New Zealanders may be misleading) compassion for the ill?” them a result. Donnie Brasco it was not. forgiven for asking why, in their country, Indeed, it is fair to ask whether In 2010, a constable going by the name medical cannabis sellers were being America’s trailblazing medical cannabis of Lee Michaels called Billy, via the hunted down by the Police, while in industry is merely a thinly veiled stepping number advertised on GreenCross, and said America and Canada, the authorities were stone to full, unadulterated legalisation. Or he needed some help dealing with acute helping them fill out their tax forms. whether public health is being sacrificed migraines. McKee recommended legal Medical cannabis will soon be allowed on the altar of entrepreneurialism – and an hemp oil and told him he should see in some shape or form across half of instant state-sponsored tax bonanza for a doctor in case the migraines were America. The medical cannabis juggernaut hard times. something more serious. But Lee Michaels is on a roll, and the therapeutic powers of Whatever is claimed about the medical was persistent. cannabis are now a global concern. When properties of cannabis, it’s a plant with a

22 matters of substance November 13 long history of therapeutic use. Based on however, cannabis is back. And this time, Sativex, is a mouth spray whose chemical Chinese oral traditions going back to 2700 with a complete makeover. compound is derived from natural extracts BC, Pen-ts’ao ching (‘Big Herbal’) is the Research that began in the 1950s and of the cannabis plant. world’s oldest pharmacopoeia. It listed snowballed since the 1980s has, without GW Pharmaceuticals, the makers of cannabis as being useful for treating doubt, established cannabis as a plant with Sativex, began growing its own crop of rheumatic pain, intestinal constipation, therapeutic potential. The fact that cannabis plants in the late 1990s. They disorders of the female reproductive 18 states in America and countries such obtained a licence from Home Office system and malaria. as Canada, Israel, the Czech Republic and officials who were, according to GW, Records of its medicinal qualities pop Spain have decriminalised raw cannabis “quick to help us because they were eager up in Indian, Assyrian and Arabic medical for medical purposes is testimony to that. to put clear blue water between the literature. In 1464, for example, the scribe In many countries, courts go easy on recreational and medical uses of cannabis”. Ibn al-Badri reported that the epileptic son people caught with the drug who can To start off their cannabis grow, of the caliph’s chamberlain was prove they take it on medical grounds. which now yields 20 tonnes a year from successfully treated with cannabis resin. Studies have shown smoking cannabis a secret location in the affluent southern During the mid to late 19th century, the and taking pharmaceutical drugs English county of Kent, GW imported an world’s biggest laboratories, such as Merck containing synthetic versions of chemicals entire cannabis seed bank from the Dutch in Germany, Burroughs-Wellcome in found in cannabis, such as Marinol and firm Hortapharm. Sativex is now being England and Parke-Davis in the US, were Nabilone, can alleviate pain and combat trialled as an analgesic treatment in adult marketing a myriad of weird and nausea and loss of appetite among cancer patients with advanced cancer and for its wonderful cannabis extracts and tinctures, and AIDS patients. available in the high street store, to treat Cannabis-based drugs have been used capacity to treat epilepsy and, ironically, anything from gonorrhea to gout. Even as anti-inflammatories and to treat cannabis withdrawal. Queen Victoria was prescribed cannabis for hypertension and memory loss, while new There are many claims made about period pains. Her personal doctor declared research is looking into how it can be used cannabis, says Dr Ben Whalley, who has the plant to be “one of the most valuable for diabetes, epilepsy, post-traumatic stress spent the last 13 years leading research medicines we possess”. disorder (PTSD) and sickle cell disease. at the University of Reading in England At the start of the 20th century, Despite all this, the only thing cannabis into how components of cannabis cannabis’s quaint appeal was superseded is clinically proven to do, in terms of (cannabinoids) can help reduce and control by other medical advances and the fact meeting the gold standards of a licensed seizures in epilepsy. He says the harsh toxicological testing through clinical trials medicine, is to treat pain and spasticity reality is this: “If a drug has not gone became mandatory, before being ground associated with multiple sclerosis (MS). through randomised clinical trials, then into the dust by prohibition. Now, The medicine that is proven to do this, all you have are anecdotes.”

www.drugfoundation.org.nz 23 Medical

Records of its medicinal qualities pop up in Indian, Assyrian and Arabic medical literature. In 1464, for example, the scribe Ibn al-Badri reported that the epileptic son of the caliph’s chamberlain was successfully treated with cannabis resin.

For Dr Whalley, not enough of the majority of studies into cannabis focus on Based at the University of California and medical cannabis discourse is grounded in the plant’s harms, rather than its benefits. headed by Dr Abrams, it completed real medicine. He recites the well worn Accordingly, Dr Abrams’s research was 14 trials over 11 years. Some of the studies Tim Minchin joke: “You know what they delayed for six years, which, in terms of found cannabis to be effective in treating call alternative medicine that’s been the wasting effects of AIDS, is a long time. pain in patients with MS and HIV, but proved to work? Medicine.” The National Institute of Health (NIH), the funding dried up. Nevertheless, the It may not amount to much within the the only domestic source of the drug for findings from CMCR played a big part in confines of medical science, but the huge scientists, refused to play ball. It said it the legitimisation of medical cannabis pool of knowledge we now possess on the could not provide cannabis for projects it throughout the United States. therapeutic uses of cannabis – insight that was not funding. In 1998, after a delay Now it is big business. It is a stand- has eased the suffering of millions of Dr Adams described as “disturbing” and alone economy with its own lobby groups people around the world – has been hard “offensive”, the NIH finally approved his and energetic start-ups. There are even won. After all, working with a substance request. Abrams then initiated the first medical cannabis guided tours in Seattle viewed by many as the thin end of the federally funded effort to study the effects and in the conveniently nicknamed ‘Mile narcotic wedge and the symbol of society’s of cannabis on patients with AIDS. High City’ of Denver. The industry’s fresh moral decline was never going to be easy. and fertile pastures are being eyed by the In 1992, Dr Donald Abrams, a clinical men in suits: the accountants, the investors pharmacologist and professor of medicine In Colorado, the state’s and the bankers. at the University of California, San 100,000 registered cannabis In Colorado, the state’s 100,000 Francisco, proposed a study into whether receiving patients spent registered cannabis-receiving patients smoking cannabis could ease the symptoms $220 million on cannabis and spent $220 million on cannabis and of AIDS wasting and produce gains in body cannabis-laced products between 2011 and weight. He had heard that hundreds of cannabis-laced products 2012, generating $6 million in taxes for the people infected with HIV in the Bay area between 2011 and 2012, state. This was immediately earmarked to were using the drug for this reason. generating $6 million in taxes spruce up the area’s rundown schools. In But Dr Abrams quickly discovered, as for the state. the first nine months of the 2012/13 many scientists have since, that science financial year, medical cannabis sales had and public health are frequently trumped already reached a colossal $225 million. by political agenda. As with many other As luck would have it, the following California’s Board of Equalization countries, the US Government classifies year, a $3m budget deficit prompted the estimates that, last year, “total sales of cannabis as a substance of no medical state of California to set up the Center for medical marijuana ranged between value. Therefore, the overwhelming Medicinal Cannabis Research (CMCR). $700 million and $1.3 billion”. That

24 matters of substance November 13 A medical cannabis shop in San Francisco

translates to between $58 million to group of people growing small amounts for $105 million in tax revenue for the specific users. Fast forward 16 years, and Sunshine State. “Fast forward 16 years, and most most Californians know that But Kevin Sabet, a former drug-policy Californians know that “medical” adviser within the Obama Administration, marijuana has become a sad joke. Scantily “medical” marijuana has is not happy with the way medical clad “caregivers” and a few unscrupulous become a sad joke. Scantily cannabis is regulated in the US. He thinks “on-call” doctors line beaches and clad “caregivers” and a few boulevards promoting marijuana use for the system is a sham, merely a way of unscrupulous “on-call” backdoor legalisation. He points to the fact everything from back pain to headaches. that Colorado and Washington, two of the Today’s dispensaries – really pot shops doctors line beaches and 18 states that have permitted the use of selling the drug under the guise of boulevards promoting medical cannabis, will be legalising the medicine – bear little resemblance to marijuana use for everything voters’ intent.” drug for recreational users in 2014. Sabet has a point. A study of from back pain to headaches. “What, of course, is never talked 1,655 people seeking a physician’s Today’s dispensaries – really about is how medical marijuana recommendation for medical cannabis in programmes in states that have gone full pot shops selling the drug California found very few of those who steam ahead actually work,” says Sabet. under the guise of medicine – sought a recommendation had cancer, HIV/ He sees a big disconnect between the AIDS, glaucoma or multiple sclerosis. bear little resemblance to people voters thought the new laws Meanwhile, another study of 3,000 active voters’ intent. would be helping and those who, in medical cannabis users in the same state reality, are buying most of America’s found that nearly nine in 10 had tried medically sanctioned cannabis. cannabis before the age of 19 and that the “In 1996, when Californians passed average user was a 32-year-old white male. Proposition 215 allowing for marijuana to Hardly any had life-threatening illnesses. be used for ‘medical’ purposes, voters “It’s time to get the legalisation lobby decided that, if a cancer or AIDS patient out of the business of medical marijuana should find relief from marijuana, they and instead focus our attention on should not be arrested. Voters also believed scientists developing non-smoked that, if the patient was too ill and unable to marijuana-based medications for the truly grow marijuana on his or her own, the ill,” he says. “That would make this issue patient could buy it from a non-profit no longer the sick joke that it is today.”

www.drugfoundation.org.nz 25 Medical

Medical cannabis sold by the bud.

New Zealanders may be forgiven for asking why, in their country, medical cannabis sellers were being hunted down by the police, while in America and Canada the authorities were helping them fill out their tax forms.

While the system in these American “Being described as a serious criminal is little sign the country will head down the states may well be open to abuse by people offender by the Police was a shock to me. market-led US route, although the courts who just want to get stoned, at least those It was a bad time for us,” says 62-year-old and the public appear to have some citizens who are in desperate need of Davis, whose husband died last year. sympathy for those caught using and medical cannabis can access it without fear “But I was overwhelmed with offers growing cannabis for health reasons. of arrest and jail. of help and the fact that so many people Meanwhile, because of its remote When Victoria Davis, an environmental wanted to tell me their stories. geographical position, New Zealand has for campaigner from Nelson on New Zealand’s “One suburban housewife from Nelson decades been, by necessity, a cannabis- South Island, discovered that cannabis was offered me most of her crop. A man who growing country, and the DIY cannabis the only cure for the horrific phantom limb grew cannabis for his father’s arthritic pain culture is far more socially acceptable than pain endured by her double-leg amputee told me he had to make a huge round trip it is in Europe. husband John, she did what most other each month to hand deliver it in small On other areas of drug policy, people would do and started growing some batches because his dad was so scared of New Zealand is not so behind the times. cannabis plants. getting sent to jail if he was caught with The country’s groundbreaking Psychoactive “We both hated the side effects of a big batch. I had lots of middle-aged and Substances Act, which puts the onus on prescription painkillers – they just turned elderly people describing how they secretly drug makers to prove their products are us into constipated zombies – and Sativex grew and smoked pure cannabis joints safe before putting them on the market, has was too expensive,” she says. to help with hip pain as they awaited catapulted the drug conversation into the “Luckily, while John was smoking one replacement operations, insomnia, mainstream and thus created conditions for of his occasional cannabis joints, we found nausea caused by chemotherapy, change. Whether medical cannabis, out that it did the trick. I had some old menstrual pain and depression.” particularly the synthetic versions, will cannabis seeds a friend gave me and Ms Davis looks across at what is somehow be dragged into this legislation, planted them. It was amazing how much happening in America and other countries, remains to be seen. smoking cannabis improved the quality and it makes her angry. Dr David Allsop, of the National of John’s life.” “Our politicians are gutless, they are Cannabis Prevention and Information However, the plants were discovered, all too afraid to reform the law on medical Centre based at the University of New and Ms Davis was charged with possession cannabis. It’s criminal that people suffering South Wales, says developments in the and cultivation of cannabis. Last year, from cancer should not get the help they US have divided the international after what she described as a “stressful” need. Why is New Zealand so behind medical community. few months, she was discharged without the times?” “Normally, a medicine has to jump conviction by Judge Tony Zohrab at The government has so far refused through strict regulatory procedures, the Nelson District Court and instead to adopt the Law Commission’s 2011 governed by the Therapeutic Goods ordered to pay $300 to a Nelson alcohol recommendation to conduct clinical trials Administration in Australia and the Food and drug clinic. into the medical use of leaf cannabis. There and Drug Administration in the US. Those

26 matters of substance November 13 Sativex is changing the way we will use cannabis as a medicine. turn, stimulated interest from academics and investors. If there was a straight race into medical cannabis’s future, there can only be one winner in terms of legitimacy and effectiveness. “Smoking raw marijuana to treat illnesses and pain is about as scientific as chewing on a piece of willow bark if you have a headache,” says Dr Whalley. “Just because something is historically useful shouldn’t mean you are wedded to it. Why not just take an aspirin if you have a headache? That something is natural does not make it safe: go swim with sharks or roll around in poison ivy.” But in reality, will it be a straight race between spliffs and science? The reason drugs are so intriguing is that it’s not just about the science, it’s about culture. Drugs have an effect on the human brain, but they are also imbued with deep and varied meanings by individuals and communities. So while scientists and politicians prefer to steer people towards the regulated option, in reality, if someone feels that, by smoking some cannabis, their lives will be improved, then that’s what they will do. procedures include extensive tests of safety “There is some kickback against Sativex The future, it seems, lies within and extensive tests of effectiveness for from the hardliners and anti-capitalists in that much maligned and much treating the medical problem that the drug the dope-smoking community, who think worshipped annual herbaceous plant is intended for. The process is laborious that the government and big pharma are out Cannabis sativa itself. and extensive and, given the requirement to get them – the ‘one rule for you another “The cannabis plant has 60–80 for tightly controlled randomised for me’ sort of thing. cannabinoids and we’ve only looked controlled trials, usually costs a lot of “But at the same time, it seems selfish deeply into 12–14 of them,” says Mark money as well. to put obstacles in the way of delivering Rogerson of GW Pharmaceuticals. “Raw cannabis has not really been useful medical treatments to those who “Our research shows that the through any of those tests. This means that need them. Most people wouldn’t want to individual differences in cannabinoids there are no formal guidelines for dosages smoke, and most people with medical have separate roles to play in treating for particular medical conditions. Can you needs probably want a good handle on the different conditions. There is considerable really call something a medicine if you dosage they need.” scope for future treatment. But it’s not just don’t know what dose you need to make From a purely scientific point of view, ‘let’s make a better aspirin’, it will be the ailment better? And the fact that it is the medical cannabis revolution in North serious conditions we’ll be looking at, such usually administered by smoking makes it America is pure anarchy. Millions of as epilepsy, diabetes and actually treating a real difficult issue for the medical people taking a potentially toxic substance some forms of cancer. The cannabis plant profession to accept it as a medicine.” in the hope that it will cure them of an is a huge, unexplored area.” Dr Allsop, who is currently trialling often undiagnosed illness is not science. And as Dr Allsop says, as long as the Sativex for the treatment of cannabis For Dr Whalley, the main barrier to the naturally occurring benefits of this plant withdrawal, says the future, outside of the development of medical cannabis is the fact can be used for the good of mankind, then US, is more likely to involve Petri dishes that so much discussion is based on the we are doing the right thing. than rolling papers. psychoactive component of cannabis, THC. “All I know for sure is that “Australia and many other jurisdictions “Hopefully, in 20 years, medical cannabinoids have medical properties. are opting to go down the ‘individual marijuana will be completely separated And where there is an unmet medical need, cannabinoids’ route – such as with the from recreational use or legalisation. THC is they should be made available to people.” synthetic cannabinoids like dronabinol and only 1 percent of the discussion. There are nabilone, and Sativex, for which we have 99 percent more cannabinoids in this plant.” Dr David Allsop’s views are his own and do not extensive safety data, and the ability to Dr Whalley says that the plant’s reflect those of the Australian Government. deliver known doses in a safe manner notoriety is a double-edged sword in terms rather than via smoking.” of its medical use. The stigma that Max Daly is a journalist specialising in illegal Dr Allsop admits that this may surrounds cannabis has undoubtedly drugs and author of Narcomania: How Britain not be great news for some medical slowed progress and limited funding, but Got Hooked on Drugs (Windmill, 2013). cannabis activists. its consistent presence in the media has, in

www.drugfoundation.org.nz 27 Synthetic Fake it till you make it

It looks like cannabis, it has cannabis in the name, but is synthetic cannabis really cannabis? James Robinson investigates the health effects of and policy responses to fake pot. James Robinson

t was 2009. so much as a sideways glance from Adam Winstock, an officer of the law. It looks like cannabis, is a London-based In short: pot is illegal, this isn’t. smoked like cannabis, acts on addiction What gives? psychiatrist and In science, as in life, to synthesise is to the brain in the same way as author of the Global imitate. In the world of synthetic cannabis, cannabis … but somehow isn’t I Drugs Survey and cropping up in various guises and blends technically cannabis. Drugs Meter, across the world since 2004, things both walked into a coffee are and aren’t what they seem. The short history of synthetic cannabis were only discovered in the 1980s. An shop. Next to the fruit juices were little has shown us that, in a new era of drugs explosion in research followed, examining shiny silvery packs of something called – defined by the quest for the legal, how this part of the brain worked and the Spice, a synthetic cannabis product. This consequence-free high – complications possibilities for new chemicals. was new to him. are forever myriad. In 2013, there are thousands of Winstock was a bit startled. He kept synthetic cannabinoids, structurally seeing synthetic cannabis after that. The Okay, we get it. It’s a whole similar to THC and affecting the same parts other thing to cannabis. packets claimed a high that was natural of the brain, sprayed over a benign mix of But what is it then? and harmless, but considering the effects it herbs and sold legally as synthetic was claiming, the ingredients didn’t check When someone smokes cannabis, the cannabis, which is then rolled up and out. Something didn’t feel right. As the old sensation of being high comes from smoked in exactly the same manner as the adage goes, if it sounds too good to be true, compounds in the cannabis plant, the old fashioned illegal stuff. it probably is. primary one being THC (considered a The first riddle with synthetic “It was not something I saw being used ‘cannabinoid’), reacting against two known cannabis comes in its definition. Natural by my patients or smelled on the way to ‘cannabinoid’ receptors in the brain. These cannabis is a single defined thing with receptors are part of an entire section of work but I saw it everywhere, and it was risks and effects that can be mapped and our wiring that regulates appetite, pain, cheap,” Winstock said. expected. Synthetic cannabis is a jumbled, mood and memory. Even as an international drug addiction mixed bag of chemicals that vary in impact Cannabinoids occur naturally in the expert, his first reaction – confusion and potency. cannabis plant. Our body produces them. with a dash of intrigue – mirrors that And, eventually, certain entrepreneurial I think I get it. But for how long of most people. chemists figured how to manufacture them. have people been doing this? It looks like cannabis, is smoked like As Dave Allsop, a lecturer at the Humans have been smoking cannabis since cannabis, acts on the brain in the same way National Cannabis Prevention and the discovery of Mother Nature and a sense as cannabis … but somehow isn’t Information Centre at the University of of their own imagination. technically cannabis, allowing for it to be New South Wales, describes, the receptors Synthetic cannabis is a newborn baby bought over the counter without the risk of in the brain that cannabinoids interact with in comparison.

28 matters of substance November 13 According to Ross Bell, Executive has been little time to study its impacts, Director of the New Zealand Drug and what we do know already isn’t great. I don’t think you get many Foundation, the first synthetic cannabis In the intervening years since people presenting to an product, Spice, hit New Zealand in 2006. discovering the drug, Winstock has helped Our own Matt Bowden, considered the to publish several pieces of research on the emergency department with godfather of legal highs thanks to BZP, use and risk of synthetic cannabis. One part cannabis complications, but jumped into the market with Aroma. of this work, run in the journal Human synthetic cannabis is bringing In New Zealand, Bell said, Spice and Psychopharmacology, was a 12-month study Aroma slipped in under the radar. Concern on the adverse effects of synthetic cannabis. them in. lay more with BZP, legal ‘party pills’ that Winstock was shocked that one in 40 people David Allsop mimicked the effect of ecstasy. surveyed who had used the drug had sought “All attention was on BZP, and Spice emergency medical attention because of it. wasn’t causing any problems. Control in “That’s an insane hit rate.” the market has largely been driven by University of New South Wales’s David community concern,” Bell said. Allsop stresses we’re still getting to know The first visible signs of synthetic what impact synthetic cannabis has, but cannabis internationally were spied in certain assumptions can be made. Europe in 2004, according to Stephen “I don’t think you get many people Bright, who teaches addiction studies at presenting to an emergency department Curtin University in Australia. Spice with cannabis complications, but synthetic arrived on the market and became a cannabis is bringing them in,” he said. popular subject on internet forums. It made Allsop said part of the issue as he sees the bold claim to get someone high solely it is that the cannabinoids in synthetic through natural ingredients. The cannabis completely activate the receptors psychoactive ingredient was later revealed in the brain that these drugs work against, to be a synthetic cannabinoid named whereas THC only partially activates JWH018, a substance so nearly identical to them, making for more potent and THC in chemical structure and effect that it incapacitating highs. was outlawed in many countries, including For Bright, it is distressing that New Zealand. synthetic cannabis is producing health risks that are not associated with cannabis use How much harm could synthetic itself. He said early case reports have shown cannabis cause? people reporting to emergency rooms The history and prevalence of cannabis use experiencing psychosis or seizures, whereas over decades gives it little mystery. But in cannabis contains a natural anti-psychotic, synthetic cannabis’s short history, there and THC works as an anti-convulsive.

www.drugfoundation.org.nz 29 Synthetic

Just some of the types of synthetic cannabis available in New Zealand.

“Cannabis has been used for Synthetic cannabis sales were said “There’s this smorgasbord of highs that thousands of years. We know the effects. anecdotally to spike when the cannabis people want,” he said. With the synthetic version, thousands supply dried up in town. Winstock saw The snag in this developing market of people have unwittingly become lab synthetic cannabis had the potential to be is that people don’t really seem to enjoy rats in this global mind experiment. To attractive in rural and remote areas without smoking synthetic cannabis. Bell said he’d be sold like this, other drugs would have organised crime and drug trade. seen this talked about anecdotally on to have gone through thousands of hours “When you ask people what are the message boards where drug users share of clinical trials.” reasons for smoking synthetic cannabis, their experiences. Winstock said that, in the top four reasons are that there’s no a survey of 850 people who had smoked other drugs, drugs are of poor quality, you both real cannabis and the synthetic Put simply, if tomorrow can get them online or they’re better value version, 93 percent said they preferred a government regulated for money. No one said they are buying the real thing. Use of synthetic cannabis also falls well cannabis, MDMA and magic these because they think they’re safer,” Winstock said. behind the real thing. In Winstock’s mushrooms, there would Bright saw workplace drug testing as research, he said, amongst people be very little demand for a huge driver of synthetic cannabis use. responding, the average amount of products outside of that. He remembered one of the first stories on cannabis use was 16 days, where it was synthetic cannabis in Australian media on a day or two with synthetic cannabis. “It’s easy to buy cannabis. It’s Stephen Bright Triple J FM, where people were calling in high potency. You kind of think, well, to discuss the drug. A number of callers why would people want to smoke this talked about workers on mining sites other stuff?” What attracts people towards these smoking something similar to dope. legal highs? Isn’t this just a market “People want drugs. They want legal How have policy makers created by prohibition? drugs,” Bright said. responded to all of this? Synthetic cannabis is used by disparate “Put simply, if tomorrow a government Internationally, response to synthetic sectors of the market. regulated cannabis, MDMA and magic cannabis has worked how drug policy has Winstock said that, after synthetic mushrooms, there would be very little for a century. “We identify bad drugs and cannabis jumped onto his radar in the UK, demand for products outside of that.” then we move to ban the drug,” Bright said. he started asking shopkeepers about who Bell said a regulated synthetic drug But in 2013, chemists can make new was purchasing it. Prisoners on weekend market is always likely to exist, in line derivatives of synthetic cannabis and bring release would buy it, he was told, because with the varied demands for drugs that them to market faster than they can be it would not be detected in drug tests. don’t seem to be abating. made illegal, creating what Bright labelled

30 matters of substance November 13 Associate Minister of Health Todd McClay gives the flick to synthetic cannabis after passing legislation to regulate the products.

Photo credit: Christine McKay, Dannevirke News

“We, like everyone else, went through a Bright said that early evidence had But the consequence of cycle of banning these. But the chemists shown that synthetic cannabinoids could everything that has happened will always be a step ahead of the help reduce the brain plaque that causes legislators,” he said. Alzheimer’s disease. so far is that research on these For Bell, defining harm is the big “But the consequence of everything drugs has decreased because unknown. The law doesn’t determine the that has happened so far is that research on of the stigma around them. criteria. It creates a group of experts to do these drugs has decreased because of the that who will set benchmarks to examine stigma around them,” he said. Stephen Bright the risks of harm and addiction, a process Most importantly, though, in that will likely involve a mix of lab New Zealand, we’ve been afforded a a “whack-a-mole effect”. You ban one and tests, chemical analysis and animal and chance through drugs like synthetic others pop up immediately, with the human trials. cannabis to re-examine how we think replacement versions often more potent “In theory, it is a good piece of law, about the wider drug issue as a whole. and harmful than the ones before. but we haven’t had it under operation long “If most New Zealanders are given the In 2009, European drug monitors enough yet to know.” opportunity to get high, they’re going to identified 24 drugs. In 2012, that number Successful implementation will be key take it. That’s the benefit of a regulated was 72. “It is increasing rapidly,” he said. to its success, Bell said. The Act needs to be market. The industry comes clean about It is against this backdrop that the enforced well, and local councils need to be the chemicals, and groups like us, the 2013 Psychoactive Substances Act in on their game to utilise provisions in the New Zealand Drug Foundation, can get New Zealand represents a new step in drug Act giving them the power to take specific good prevention messages out,” said Bell. legislation. It seeks to regulate the market actions like banning sales near schools. for synthetic cannabis and other new “If we’d taken an approach more like drugs that hit the market by forcing Why don’t we just move to shut all this 40 years ago – looking at it through manufacturers to go through testing to synthetic cannabis products down? a health rather than a criminal mindset – prove the product is “low risk”. If that People first started experimenting with things would have been different. Instead, product was on the market 28 days synthetic cannabinoids to explore the up until now, we’ve been left with a before the law went into place, it is granted health benefits, UNSW’s David Allsop said. smorgasbord of laws for a smorgasbord an interim licence while it undergoes Research is still in its infancy, he said, but of drugs.” the tests. it is believed synthetic cannabis could one Bell said this Act is not the result of day have applications in treating cancer, James Robinson is a San Francisco-based a progressive government, rather that multiple sclerosis, inflammation, post- journalist. New Zealand ran out of patience faster. traumatic stress disorder and anxiety.

www.drugfoundation.org.nz 31 Harm reduction Reducing cannabis health harms

There is a wide spectrum of views on how much (or, in some cases, even whether) cannabis causes harm. The divergence of views is backed up by widely varying research, and it’s not hard for either cannabis proponents or opponents to find a good selection of studies supporting their view. Rob Zorn examines how harmful cannabis can really be and what can be done to reduce those harms. Rob Zorn

NORML’s Phil Saxby and Chris Fowlie.

32 matters of substance November 13 annabis has a of media. The first challenge is getting very low acute the cannabis user to listen to harm- The logical way to do toxicity. In other reduction messages, and of course, there’s this would be through head words, you’d have little research available so far about what to ingest massive works best. shops, but the current legal amounts of the stuff NORML spokesperson Chris Fowlie environment here makes this to overdose. suggests the best people to talk to cannabis virtually impossible. Any C users about reducing harm are cannabis Because of this, it’s very hard to find any evidence of anyone users themselves. He would like to see information the shops start dying as a direct result of taking it. harm-reduction education disseminated by handing out about drug use Nevertheless, there is enough research to trusted ‘peers’ in a similar way to needle puts their business at risk… indicate that, when used in certain ways exchanges. This could be information or by certain people, cannabis is associated about the risks associated with excessive with a variety of health and other harms, use or how to reduce respiratory harms about whether their use is becoming a especially amongst regular long-term users. through safer smoking techniques. problem and how they can use more safely. There can be short-term negative “The logical way to do this would Not combining it with alcohol or tobacco, psychological effects such as anxiety and be through head shops, but the current not driving high, the possibility of paranoia, but these will usually pass; legal environment here makes this virtually dependence and where to get help might temporary psychomotor impairment that impossible. Any information the shops form the core messages. may get you (or someone else) killed if you start handing out about drug use puts These are all important but will affect get behind the wheel; disruption to your their business at risk because it associates only some users. Something that’s relevant cognitive functions such as short-term their ‘ornaments’ and ‘vases’ with to just about all cannabis users is memory loss and disruption to temporal cannabis smoking.” respiratory harm. This is interesting and processing and learning. NORML used to provide harm significant because myths abound about However, those with sustained use reduction material in every issue of its what constitutes safe smoking, and a (daily or near daily over several years) former publication NORML News. But number of new technologies are emerging expose themselves to much greater, other than word of mouth, there is not that may reduce respiratory harm. long-term health risks. much in the public domain, unless you Most people would think (and it would There is solid evidence, for example, want to start engaging with treatment. seem to make sense) that smoking a filtered linking heavy use with respiratory disease. But even if we could find the perfect joint or a water bong would be easier on A succession of clinical studies show medium, what would our messages be? the lungs than smoking an unfiltered joint, increased risk of chronic bronchitis, sore The most obvious advice to avoid but actually quite the opposite is true, and throat, inflammation, impaired immune cannabis harm is not to smoke cannabis. it all has to do with tar to THC ratios. The function and pre-cancerous cell changes. This is especially important if you’re problem is THC molecules are ‘sticky’ and There is also evidence linking prolonged predisposed to psychosis or you have cannabis use with increased risk of mental experienced negative psychotic effects tend to adhere to other molecules such as illnesses such as schizophrenia, at least for when due to cannabis. But most people those of the tar and particulates you’re those who may be predisposed. who smoke cannabis are not, and many filtering out. The end result of this is Most people seem able to quit cannabis, just want to minimise the risks. And we that you have to smoke more to get as high, even after years of use, with very little should also not underestimate the benefits and you actually ingest more tar per withdrawal, but others will become more of cannabis, such as relaxation, which are amount of THC. chronically dependent. The commonly powerful motivators for continued use. Bongs can also harbour infectious accepted ratio is one in 10 cannabis users Some see their cannabis use as a form of germs if they’re not cleaned regularly who are predisposed towards this, and harm reduction in itself because it creates (bacteria love a warm, moist environment), that’s a lot of people considering the fewer problems for them than other drugs and bongs home-made out of plastic bottles popularity of the drug. like alcohol. are especially disastrous because of the There are a number of strategies and Knowledge is about the best weapon extra toxins you can inhale from the heated approaches aimed at reducing the harms we have in the arsenal. It doesn’t ensure plastic. If you are going to use a bong, associated with these adverse health behaviour change, but it does mean people make sure it’s a good one, preferably outcomes, and they can involve a variety are better able to make informed decisions made of glass.

www.drugfoundation.org.nz 33 Harm reduction

Cannabidiol-based chew lollies.

Meanwhile, vaporisers look like a to some sort of gaseous concoction that was promising alternative. A ‘vape’ heats the Participants were “pretty amazing but hard to describe”. cannabis to a temperature high enough to asked to return to normal “All the products had accurate content release psychoactive cannabinoids but not descriptions based on clinical research. high enough for combustion to occur, smoking for a month after There was a chocolate bar, for example, which is when most of the tar and other 30 days of using only a and the label told you how many and what nasties are released. vaporiser but were informed sort of cannabinoids each square of A 2001 study led by Dale Gieringer of this was not a requirement chocolate contained. This is what can be NORML California compared all four achieved under a legally regulated system. smoking methods (bongs, vaporisers and of the research. All four You know exactly what you’re getting, and filtered/unfiltered joints and found only participants refused… it’s much easier to titrate [regulate your vaporisers improved the ratio of tars to own dose] in that situation.” cannabinoids. The filtered joints performed In Colorado, he says, there are up to worse than the unfiltered joints (30 percent continue with the vaporiser. So though the 200 companies making edible products. more tar per cannabinoids), and the bongs high from a vaporiser takes longer (several And while these were originally mostly performed worst of all (up to 180 percent minutes to peak as opposed to two minutes for medical cannabis users, they are more tar). for smoked cannabis), it seems the effects becoming more popular with recreational Vaporisers have improved since 2001 users as there’s a growing demand for are acceptably close to those of a and are now less bulky, but they can be non-smoked alternatives. combustible high. difficult to find in New Zealand. There were also e-cigarettes available “Customs doesn’t tend to like them, Of course, another alternative is not to that deliver a standardised dose in terms and it can be very difficult to get them into smoke the cannabis at all but to eat or of strain and potency. These might be ideal the country, making them rare and drink it instead. Drinking cannabis in tea or for those not yet ready to forsake smoking expensive,” Fowlie says. eating it in cookies and cupcakes has been cannabis. E-cigarettes that deliver Many cannabis smokers here would around for a long time but has not been all cannabinoids can still be passed around as probably use them if they were more that widespread because the effects take part of sharing the ritual with your ‘fellow cheaply and readily available. An longer with oral ingestion (up to an hour or outlaw’ and mimic the pleasures of Addiction Research and Theory study more) and can be less predictable. But that smoking cannabis in the same way they published in 2010 found using a vaporiser mimic the pleasures of tobacco smoking. may be about to change. reduced the respiratory symptoms of all All well and good – but what do we Fowlie recently attended the first four participants in the study. Participants do about chronic users who want to stop World Cannabis Week (like a cannabis- were asked to return to normal smoking for because cannabis is causing them harm but a month after 30 days of using only a themed trade show) in Colorado and says for whom withdrawal is now an issue? vaporiser but were informed this was not a he was amazed at the amount of edible Symptoms can include craving, requirement of the research. All four cannabis products available. These range irritability, insomnia, headaches and participants refused and preferred to from confectionery to THC-infused drinks shakiness, and we should definitely see

34 matters of substance November 13 A range of THC- and CBD-based beverages mean you can drink your high.

Other countries are beginning to explore supplementing counselling with more pharmacologically based cannabinoid replacement therapies that would work similarly to methadone for opioid users.

withdrawal as a harm, says David Allsop symptoms of multiple sclerosis (MS), seems of the National Cannabis Prevention and especially worth a look. Information Centre at the University of A recent University of New South Reducing New South Wales. Wales study found Sativex significantly “It increases demand on treatment reduced the overall severity of cannabis respiratory harms providers and drives users back to a drug withdrawal symptoms and – always a good from smoking they don’t want to take any more.” sign – that participants given the drug New Zealand treatment relies mainly remained in treatment longer. cannabis “What might give Sativex the edge,” on hybrids of motivational interviewing From the Drugs Meter developed by Dr Adam R Allsop explains, “is that it’s cannabis-based and cognitive behavioural therapy to Winstock, Consultant Addiction Psychiatrist and and much closer to what people were manage withdrawal and help cannabis Addiction Medicine Specialist, South London, actually using. It’s administered as an oral users who want to stop. and Maudsley NHS Foundation Trust spray, so it’s more akin to smoke, and has a “It’s about getting them through those more rapid impact because it doesn’t have 1. Don’t mix cannabis with tobacco. first couple of weeks of sleeplessness, to be digested.” 2. Don’t inhale too deeply or hold craving and irritability,” says Ben Birks The ‘good’ cannabis harm-reduction smoke in the lungs. This doesn’t get Ang of Odyssey House New Zealand. arsenal of New Zealand’s future will surely you more stoned but increases tar and “Helping with sleep is a big one, include cannabinoid replacement therapy, carcinogen contact. especially for teenagers who don’t tend but right now, withdrawal sufferers should 3. remove stalks, leaves etc. to get a lot of sleep anyway and who used not be holding their breath. Sativex is a to rely on cannabis to nod off. While Class B drug in New Zealand and currently 4. Don’t use a cigarette filter. Filters just motivation is important, a lot of young only approved for MS sufferers who have reduce the cannabis/tar ratio. people haven’t had the years of use to not responded to other treatments. It is not 5. Don’t use too many papers. notice a build-up of harm. So with some funded by PHARMAC, and ministerial 6. clean bongs/pipes thoroughly. young people, we work on building approval must be gained before it can be 7. Don’t use plastic bottles/pipes as these prescribed at all. motivation and other protective factors, can increase toxic fumes. like their relationship with their family or But perhaps the first thing we should 8. use a vaporiser. school, so when they are ready to change, do is consider treating cannabis use as a health issue instead of a legal one so we the foundations are set.” can have more open dialogue with cannabis Other countries are beginning to References users who don’t fear being treated like explore supplementing counselling with criminals. What’s happening overseas Access the Drugs Meter and assess your more pharmacologically based cannabinoid personal drug use at www.drugsmeter.com seems to indicate this isn’t anywhere near replacement therapies that would work as scary as we once might have thought. See also nzdrug.org/normladvice similarly to methadone for opioid users. Sativex, a cannabis-based drug originally Rob Zorn is a Wellington-based writer. developed in the UK to treat the pain and

www.drugfoundation.org.nz 35 Drug driving Driving high

Cannabis and cars don’t mix. We know pot causes impairment, but just how much, and is it even that dangerous? Damian Christie looks at one of the emerging issues around cannabis harm.

drive better when around the world, where even the experts I’ve been drinking” disagree on some fundamentals. …there’s a certain level is not something Not surprisingly, in New Zealand, more of cannabis use in periodic people drive under the influence of you hear these users where it’s not really days. Whether it’s cannabis than any other illegal drug. What down to personal is surprising, though, is that more people fun any more, it’s almost “I experience, years report driving while impaired by cannabis self-regulating. than over the limit for alcohol. The data of watching the isn’t perfect but would suggest at least one horrific results of drunk driving on the Dr Barry K Logan in five New Zealand drivers has driven news or the millions spent on a variety of under the influence of cannabis – within advertising campaigns, the message – for three hours of smoking – in the past year. most of us – has sunk in. Drink, Drive, Two-thirds of cannabis users report drug Bloody Idiot, Ghost Chips etc. driving in the past year, and most rate it as Despite the obvious logic – things that far less dangerous than driving under the make our brain go funny don’t improve our influence of alcohol. driving – there seems to be something Among younger people, the problem stopping people who regularly use is even greater – a Canadian study found 40 percent of people aged 15–24 had driven cannabis from reaching the same stoned – double the rate who said they’d conclusion. It’d be easy to attribute the driven under the influence of alcohol. More disconnect straight back to their drug of worryingly, they’d done it not just once, but on average 10 times in the past year – far higher than the same figure for alcohol. It’d be easy to attribute the The rhetoric around driving stoned will disconnect straight back to be familiar to many: “It makes me a safer their drug of choice, but the driver.” “I drive slower when I’m stoned.” “I’m more careful.” Is it true? In a word: no. reality is more complex. But exactly how dangerous is it? And if we were to set some sort of limit in the same way as we do with drink driving, how stoned is too stoned to drive? choice, but the reality is more complex, as There is no doubt cannabis impairs is how best to detect and deal with those driving ability, says Dr Barry K Logan, who continue to drive under the influence. “within limits”. Based at Philadelphia’s The answer to those questions is a source NMS Labs, Dr Logan is one of the world’s of debate not just in New Zealand but foremost experts in drug-impaired driving,

36 matters of substance November 13 “You know I can’t eat your ghost chips.”

although he says most cannabis users’ but in fact may be constantly impaired – when performed by a trained officer, it’s chosen level of impairment is not even for some weeks after ceasing altogether. surprisingly effective. Developed in the particularly high. So if driving under the influence of 1970s, before the advent of alcohol “A user-preferred dose produces a level cannabis, with or without alcohol, always breathalyser technology, the SFST was of impairment equivalent to a moderate presents some level of danger and originally used to detect drunk drivers but level of alcohol consumption, 0.04 percent sometimes a very high one, the question is, is now routinely used to test for drugs. to 0.05 percent [blood alcohol how best to police it? Current enforcement Amy Porath-Waller from the Canadian concentration or BAC] for about 2–4 hours. differs from country to country, state to state. Centre on Substance Abuse has been And then after that, the evidence is people In states where cannabis possession is studying the test and whether it’s fit for pretty much return to the baseline.” illegal, it’s easy to impose a zero-tolerance this new-found purpose. By comparing It’s worth noting New Zealand’s blood approach. Having cannabis in your system thousands of roadside SFST evaluations alcohol concentration for drink driving is might not necessarily mean you’re a danger with the subsequent blood samples given, – rather controversially – set even higher, on the roads, but it does show you were up Porath-Waller says the answer is an at 0.08 percent. The upshot is most to no good. unequivocal ‘yes’. moderate cannabis users don’t get higher But for some experts working in this “What our results are showing is that than the level we already deem acceptable field, mixing drug enforcement with traffic you are able to predict, from these four for alcohol. safety is not the way to go, confusing two different classes of drugs we studied, the “People don’t enjoy it,” says Dr Logan, distinct purposes and creating a law people officer is able to detect if they’re impaired “there’s a certain level of cannabis use in don’t respect. And in states where cannabis and the type of drug responsible for periodic users where it’s not really fun any is legal for medical or recreational use – that impairment.” more, it’s almost self-regulating.” which is a growing number – another In general, each of the common classes Which is not to say it’s ‘safe’ – blood approach must be found. The options of drugs leaves its own ‘fingerprint’ under taken from Canadian drivers involved in include requiring proof of impairment or the SFST. So, for instance, cannabis- fatal accidents shows drivers who test setting a ‘per se’ limit. Like the system for impaired drivers will have more difficulty positive for cannabis are five times more drink driving, this establishes a defined limit with the ‘standing on one leg’ test than the likely to die than sober drivers. This is of THC in the blood, over which a driver is ‘walk and turn’ test, where an alcohol- slightly lower than those found with considered legally impaired, regardless of impaired driver would struggle with both. alcohol in their system. But – and it’s a big whether they can stand on one leg or not. Similarly, the test for nystagmus but – when cannabis is combined with Despite cannabis remaining illegal in (involuntary twitching of the eye) will alcohol, the risk of a fatal accident jumps New Zealand, rather than a zero-tolerance pick up those affected by depressants but to 40 times more likely than a sober driver. approach, our law does require proof of not cannabis. And that risk is present even just with impairment – once alcohol is ruled out If there’s an issue with the SFST, it’s moderate levels of cannabis and blood through roadside screening, drivers the degree of training required and the time alcohol under the drink-driving limit. suspected of being impaired by drugs are it takes to administer each test. For those For regular smokers, the news is worse. subjected to a standardised field sobriety enforcing the law, it doesn’t provide the A new study shows that chronic, heavy test (SFST). ‘anywhere, any time’ sort of disincentive users of cannabis are not, as one might To the untrained observer, the SFST that people now associate with random think, less impaired due to higher tolerance might seem something like guesswork, but roadside testing for alcohol.

www.drugfoundation.org.nz 37 Drug driving

Taika Waititi’s new drug driving ads have gone viral.

New Zealand’s head of road policing, tolerance legislation only requires the I call it the sausages Superintendent Carey Griffiths, says, while presence of cannabis – there’s no need for drink driving remains the priority, next impairment. If New Zealand were to head argument. You get five year will see further attention given to in this direction, we’d need to legislate to drivers who’ve crashed, drug-impaired driver testing, including the remove impairment from the offence. and they’ve got sausages best approach to take. The other option, says Superintendent in the boot of the car. It “My preference based on what I’ve seen Griffiths, is to consider a per se limit. and know so far is a saliva-based testing “It would be possible to get a panel doesn’t mean the sausages regime similar to what’s conducted in together to determine an impairment level have caused the crash. many of the Australian jurisdictions, under which you’re at a legal zero, so because there is an element of general you’re not dealing with residual effects. superintendent Carey Griffiths deterrence to that.” And you can set impairment levels for Saliva testing might be quicker than a different drugs and their analogues, so full SFST test but can still take up to eight that’s a way around it.” minutes to administer, meaning it’s Much time and effort has gone in to impractical to use the driftnet approach studying the level of impairment caused by of alcohol checkpoints. The single-use ingesting different quantities of illegal and disposable test kits aren’t cheap either, and legal drugs and trying to establish an overseas experience has shown widespread equivalent to the 0.05 percent BAC level. random testing isn’t particularly effective. On paper, it seems a sensible approach, In 2009, Victorian Police randomly and it’s been adopted in Washington and tested nearly 28,000 motorists and found Colorado, where cannabis has recently just 300 tested positive for drugs – around been legalised. 1 percent. Canadian research also shows “A per se limit for cannabis is that, despite having a high rate of drug- particularly problematic,” says Dr Logan, impaired driving, in 2011, just 1.4 percent who points out there’s a big difference of total impaired convictions were for between testing in a lab and real-world drugs. On those numbers, an average driver enforcement. The time between someone could drive under the influence of drugs being stopped by Police and giving a blood 16,500 times – or every day for 45 years – sample can easily be two hours. The active before being charged. element of THC in cannabis metabolises, at In Australian states such as Victoria least initially, much faster than alcohol and and Queensland, they’ve moved away from other drugs. This means a driver who was random testing towards an intelligence- over the limit when they were caught may based approach, pinpointing be well under by the time they give blood. neighbourhoods and locations where drug The method Dr Logan prefers – use is more likely. Queensland’s zero- regardless of whether cannabis is illegal –

38 matters of substance November 13 New Zealand’s head of road policing, Superintendent Carey Griffiths

QUOTES OF SUBSTANCE

Matters of Substance asked people if they supported cannabis law reform. Here’s what they said.

While there are good laws at the moment, the focus on criminalisation as opposed to social support for those who are using substances can often be a barrier to accessing support. Ben Birks Ang, is very close to what we currently have in current drug policy is only dealing with New Zealand: proof of impairment people “at the top end of the curve”. followed by proof of cannabis in the “I think until we deal with behaviours Yes, but reform is driver’s system, whatever the level. across the board – and that’s where a lot of not legalisation in my “It’s really going to have to come back the advertising is targeted at the moment – book; it means more to good investigative Police work, and if until we get into that space in an enforcement sense, I think we’ll just keep prevention, intervention, you get some objective evidence that the and treatment. person is under the influence of the drug chipping away at the problem long term then you base the prosecution on that. You without making massive gains.” Dr Kevin Sabet say on the one hand the observations show Research currently being done by the the person was impaired, and you have a Ministry of Transport with ESR looking at chemical test saying cannabis was in their blood taken from drivers in fatal crashes Harm reduction policy system, and the court can decide if one should shed some light on New Zealand’s needs to facilitate less risky/ is related to the other.” particular problem. At present, if a driver more healthy drug use and Rather than blood tests, Dr Logan tests positive for alcohol, no further tests might have to acknowledge prefers an evidential oral fluid sample, as are required, making it difficult to get a pleasure as the driver of use firm grasp on the prevalence of poly-drug it can be collected roadside, usually within not deviance or avoidance. 15 minutes of driving. use. The research should give a clearer idea of the risks, although Superintendent Dr Adam Winstock One further advantage the impairment Griffiths says, even then, we should approach has over setting per se limits is approach with caution. the complexity around people using more “I call it the sausages argument. You than one drug at a time, known as poly- Cannabis law reform is get five drivers who’ve crashed, and drug use. As mentioned, alcohol and long overdue and increasingly they’ve got sausages in the boot of the car. cannabis combine with a potentially lethal inevitable. It’s not a question It doesn’t mean the sausages have caused effect, even at levels where individually of whether it will happen the crash. People who consume large they would be acceptable under a per se in New Zealand, but when amounts of cannabis may also exhibit regime. Add other drugs to the mix, in and how. other incivilities, which can include endless possible combinations, and it [unsafe] driving behaviours; it might be Chris Fowlie could become a legislative and judicial that the type of person who crashes is the mess, whereas impairment is impairment, type of person who has cannabis in their regardless of the cause. system. I’m very careful not to mix This approach might not offer much in correlation with causation.” the way of a general deterrent, however, and Superintendent Griffiths says, while Damian Christie is an Auckland-based New Zealand’s drink-drive policy has an journalist. impact on the whole range of drinkers, the

www.drugfoundation.org.nz 39 Prevention Cracking good prevention

Fences at the top of cliffs are preferable to ambulances at the bottom. We know cannabis can cause harm, so how do we prevent people from using cannabis or at least delay the time they start? Keri Welham tackles the issue of cannabis prevention. Keri Welham

r Kevin Sabet is looking for fundamental change. Sabet has worked in drug D policy for 18 years. He’s Director of the Drug Policy Institute at the University of Florida and an assistant professor of psychiatry. Previously, he was an appointee to the Obama and Bush II administrations. Not so long ago, schools offered occasional classroom lessons about the evils of drugs, delivered at random. Sabet says, while these attempts were commendable and naturally very well meaning, a haphazard collection of high school life skills or PE classes devoted to drug harm just won’t cut it in 2013. The stakes are too high for such a casual approach when, as Sabet points out, New Zealand research links the early onset of heavy cannabis use to poorer life outcomes. “Public health experts talk about real consequences on the adolescent brain.” Sabet wants cannabis prevention efforts to be visible in homes, churches, businesses, sports clubs and, most A popular misconception of how children come to use drugs. importantly to his mind, in policy. He wants to see programmes that are able

40 matters of substance November 13 Dr Steve Allsop

Effective advertising needs to follow the lead of the “legend” anti-drink driving campaigns and the “don’t bring your mates” responsible drinking campaign.

to be tailored to each community’s specific more honest” discussion about the harms Stand up! and Amplify! programmes. He needs. Out with a light sprinkling of of cannabis. says some young people have adopted classroom lectures; in with community- “There are multiple negative anti-tobacco messaging with such gusto wide, community-specific, community-led consequences,” he says. that it has become part of their justification programmes to build resilience and keep “Cannabis undoubtedly reduces IQ, for using other substances. He has heard young people busy and engaged. affects driving, learning outcomes. Tobacco teenagers make comments such as: “I don’t It’s a popular call to arms, echoed by kills more people, but we shouldn’t smoke because it’s so bad for you, so I just leading researchers and those tasked with downplay [cannabis].” do pot instead.” He says one in six young people rolling out drug prevention strategies. There is much that cannabis prevention develop an addiction to cannabis, and So how is drug prevention changing in can learn from anti-smoking and anti-drink for those people, the drug causes a world New Zealand and overseas? Why is change driving campaigns, as well as from the of trouble. necessary? And is any of it working? strategies of alcohol companies. Those “Do you want to take that gamble? Where do we start? It’s not cocaine or heroin. However, it’s trying to dissuade people from smoking Dr Steve Allsop, Director of Australia’s still a gamble.” cigarettes and drink driving have shown a National Drug Research Institute, says keen eye for the impact of social pressure, Why has the anti-smoking campaign while the alcohol industry is particularly early-onset use must be at the forefront of been so successful? prevention efforts, alongside heavy use, adept at using social media to get its Allsop says good prevention engages the workplace use, stoned driving and branding and advertising alongside online whole community and happens in multiple strategies to support mental health. content popular with young people. places at once using various avenues to Early onset of smoking and drinking Birks Ang says his clients can name reinforce the core message. the attributes of the brand image of most are risk factors for early cannabis use. In the case of tobacco, this has alcohol labels, from the big-boozer of one As smoking becomes less popular, this translated to regulations around packaging, RTD to the feminine soda-pop drinker flow-on effect may lessen. However, recent public health campaigns, price of another. evidence has shown that the practice of mechanisms, limited availability, school mixing cannabis with tobacco is education, good treatment, non-smoking To counter this influence, the health introducing some young people to environments, advertising and bans on and support communities need to be just smoking. Those who mix cannabis sports sponsorship. as agile in the online space. with tobacco risk developing an The anti-tobacco message has been well He says effective advertising needs addiction to tobacco alongside a resourced and visible over several decades. to follow the lead of the “legend” anti- dependence on cannabis. Ben Birks Ang is a team leader at drink driving campaigns and the “don’t Sabet says the starting point for Auckland residential treatment facility bring your mates” responsible improved prevention should be a “much Odyssey House where he runs the facility’s drinking campaign.

www.drugfoundation.org.nz 41 Prevention

Both these campaigns created they don’t understand the motivations shorthand for discussing behaviour with of their target audience. …responses that don’t friends, which is hard to do at any age – let He says a campaign aimed at young simply disengage those alone in your teens. The legend ads, in people would need to appeal to things that particular, had a positive focus around matter to them. That might be reputation most in need of connection behaviour to increase social standing. and status, sporting prowess, sexual to an education system and Sabet says it took 80 years of use, and success. A Health Canada survey backs this the community. harm, for tobacco’s adverse effects to finally up. What resonated for young people there be understood. He fears that, if cannabis was the impact on grades, sporting success, Dr Steve Allsop were legalised, there could be a similar mental health and the ability to use their 80 years of pain before its harms were fully new, hard-earned driver’s licence. Porath- in New Zealand, it might be a regular touch realised and a backlash took hold. Waller says it’s hard for a 17-year-old to be rugby tournament. truly motivated by the thought of a death Allsop says the cannabis prevention While strategies might differ between by lung cancer in 30 or 40 years. effort must get organised and build a plan. demographics and addiction is generally “Drug education should equip young “Let’s get a 20-year plan. That’s what a more ingrained problem in poorer people to live in a drug-taking world and we’ve done with tobacco. A broad range of communities, Sabet says bored young offer skills and strategies so they can strategies [and] we endured in our efforts.” people with access to disposable income protect themselves from other people’s can quickly turn to drug use. What does good prevention drug use. look like? “Children have a right to information. What works in New Zealand? Birks Ang says young people who dabble Senior researcher at the Canadian Centre They live in a world where, even if they in cannabis and other drugs are doing for Substance Abuse Dr Amy Porath-Waller don’t use drugs, lots of other people might.” exactly what teenagers are designed to do has devoted her career to research around Part of the education process is to make – test boundaries and define themselves. cannabis use and prevention. She is part of young people aware that the majority of people don’t use drugs. Often, in an They need to feel they’re developing a team that published an analysis of the environment where drugs are not discussed social skills and are coping with difficult effectiveness of school-based cannabis at all, young people can end up social situations. prevention programmes in Health overestimating their peers’ drug use, Drug taking lets them believe they are Education & Behaviour in October 2010. Allsop says. making progress in some of these areas, but The evidence revealed school-based Some research has shown that parental it usually means they are not developing programmes did have some impact. influence plays a significant role in drug the necessary skills at all. Good prevention However, the level of success varied use in early adolescence. Parents should means putting the safety nets in place to with the approach. Programmes consisting not underestimate their influence: the support young people if they stumble. of more than 15 sessions or modules, Health Canada survey found 87 percent of A young person using cannabis is less facilitated by someone outside the teaching young people thought their parents would likely to develop a problematic habit if staff and conducted using an interactive be a credible source of information about they have the stability of a strong network approach yielded strong results. illegal drugs. of trusted adults, a safe community and Allsop says parents should offer a safe alternative opportunities for socialising, and loving home, clear expectations, an such as sport. He has heard teenagers interest in the risk profile of their child’s Birks Ang’s job takes him across wider friends and open dialogue on topics such Auckland to deliver programmes into make comments such as: as how to care for your friends if drugs are secondary schools. In some schools, where “I don’t smoke because it’s around and what to do if drugs are brought there is a culture of asking for help, his so bad for you, so I just do out at a party. teams work at a visible level and are able to achieve early intervention with young pot instead. Another key plank of prevention is effective treatment. people before habits have taken hold. “It reduces the overall number of people In other schools, the service keeps a in the community who use,” Allsop says. low profile and works with those whose What worked was age-appropriate skill “This reduces the visibility of cannabis use drug use is now causing them grief. development, such as older teenagers and potentially access to the drug.” “What we’ve noticed is there are a lot role-playing how to deal with offers of He also believes there is an argument of young people that are using.” drugs, and group discussion. For maximum for a more inclusive approach to dealing Birks Ang says Mängere is one impact, a series of sessions must be with broken rules in school. He respects a community in which he’s noted marked implemented as designed, not changed principal’s right to implement a change in recent years. Local schools have ad hoc or condensed. And the best person consequence for a student who brings become a model of the “wrap-around” to offer school-based education is a health drugs to school, but he would like to see strategy, where various groups complement professional trained in drug prevention. “responses that don’t simply disengage each other’s work to produce a swift and Allsop says a lot of young people those most in need of connection to an effective response. understand the risks of cannabis use, education system and the community”. He believes New Zealand is closer than but don’t necessarily care. Some Sabet says great prevention means ever to cracking good prevention. campaigners make the mistake of thinking offering young people alternatives. In the One effective strategy in preventing knowledge is enough – they fail because States, this might be midnight basketball; early-onset drug use is to consider the peer

42 matters of substance November 13 Students at New Plymouth’s Spotswood College engaged in learning.

group above that which you’re concerned reliance on those early classroom lessons campaigns against driving on drugs have about, he says. Young people are deeply may be reaping rewards. Birks Ang says been particularly effective and he wonders swayed by the behaviour and attitudes of there’s logic in coordination of effort – if media commentary regarding some of those a year above them. pulling together various public health the risks of cannabis use has also had They also need to know they don’t campaigns, movements, services and an impact. need to have the most dysfunctional life, or policies to develop a “healthy young Sabet says building on these recent the heaviest cannabis habit, to benefit from people” strategy. This could address a host developments in drug prevention is cutting back. Effective campaigns consider of risk factors for poor life outcomes, and essential. Parents, educators, health young people at various points on the the figures for early-onset cannabis use workers and policy makers need to drug-use continuum. could continue to fall alongside those for understand that modern best practice What doesn’t work? Scare tactics. other risky behaviours such as smoking involves a consistent message reinforced in Birks Ang points to the American and drink driving. multiple environments. This change is movement Scared Straight!, where evidently under way – he is keen for it to inmates took emerging juvenile offenders gain even greater momentum. behind bars and frightened the bejeezus “We have to change the paradigm out of them. What doesn’t work? about prevention.” He says research shows the programme Scare tactics. Porath-Waller says it’s gratifying to see was ineffective; a claim backed by recent cannabis use rates quickly decreasing in Canadian research suggesting young people Ben Birks Ang Canada. In 2008, 11.4 percent of people do not respond to shock tactics. reported using cannabis in the past year. Australia’s Now for the good news: cannabis National Drug Strategy By 2011, that figure had fallen to use is dropping. Household Survey has also shown a 9.1 percent. In young people (those aged The Health and Wellbeing of substantial drop in cannabis use. Between 15–24), those figures were 32.7 percent for New Zealand Secondary School Students in 1998 and 2010, there was a reduction of 2008 and 21.6 percent for 2011. 2012 report, known as Youth’12, surveyed more than 30 percent in the number of But this is no time to ease off, she says. 8,500 teenage New Zealanders. It found people who reported using cannabis in the “Just because we’ve seen some declines, that, between 2001 and 2012, the percentage past year. it doesn’t mean we can be complacent. of teenagers who had tried cannabis fell Allsop believes young people are now We need to be in for the long haul.” from 38.2 percent to 23 percent. better informed, there has been increased Something has changed over the past investment in education, there have been Keri Welham is a Tauranga-based writer. 11 years. The move away from total improvements in treatment, targeted

www.drugfoundation.org.nz 43 Prevention

Which cannabis prevention measures do young people think would work?

Dr Amy Porath-Waller says the They thought their peers might be In mid-September, the participants in What Canadian Youth persuaded away from cannabis by health Think about Cannabis believed risks, poor academic performance and Canadian Centre on “everyone smokes weed”. Not using negative impacts on family relationships. Substance Abuse (CCSA) cannabis was abnormal. Participants also suggested those Most did not consider cannabis who delivered prevention messages released the findings of a drug, arguing that it was naturally should have an ability to connect with in-depth interviews with grown, safe and non-addictive. They said youth as well as first-hand experience it reduced violent tendencies and did not with the drug. 76 people aged 15–24. change the user’s perception of reality. They believed cannabis was “much safer” than alcohol and tobacco. The youth surveyed believed They thought their cannabis was capable of helping people peers might be persuaded focus, relax, sleep and be less violent. Some believed it purified the body and away from cannabis by cured cancer. health risks, poor Participants believed driving stoned academic performance was not as dangerous as driving drunk, and negative impacts on largely because cannabis focused the mind on the task of driving. family relationships. They suggested providing more fact-based information at an earlier age, providing more content relating specifically to cannabis (and not all drugs) and using approaches that were aimed at reducing the harms of using cannabis rather than focusing on abstinence.

44 matters of substance November 13 Youth cannabis use in New Zealand by the numbers

8,500 Kiwi teenagers were surveyed in 2012 for comparison against surveys in 2001 and 2007

38.2% 8.3% had tried cannabis in 2001 in 2012 USED ALONE

By 2012, this had fallen to AND SOME TRIED TO CUT DOWN 23% 33.5% 12.8% 9.9% of 2012 respondents Of Kiwi teens believed it was currently used cannabis, ok for people their age to use cannabis in 2012 OF WHOM 21.4% 10% Used before or SAID THE SAME during school FOR CIGARETTES

Source: Health and Wellbeing of New Zealand Secondary School Students in 2012

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