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EMCDDA MONOGRAPHS A cannabis reader: global issues and local experiences Perspectives on cannabis controversies, treatment and regulation in Europe Editors Sharon Rödner Sznitman, Börje Olsson, Robin Room 8 OLUME I V Legal notice This publication of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is protected by copyright. The EMCDDA accepts no responsibility or liability for any consequences arising from the use of the data contained in this document. The contents of this publication do not necessarily reflect the official opinions of the EMCDDA's partners, any EU Member State or any agency or institution of the European Union or European Communities. A great deal of additional information on the European Union is available on the Internet. It can be accessed through the Europa server (http://europa.eu). Europe Direct is a service to help you find answers to your questions about the European Union Freephone number: 00 800 6 7 8 9 10 11 This publication should be referenced as: EMCDDA (2008), A cannabis reader: global issues and local experiences, Monograph series 8, Volume 1, European Monitoring Centre for Drugs and Drug Addiction, Lisbon. References to chapters in this monograph should include, where relevant, references to the authors of each chapter, together with a reference to the wider publication. For example: Corrigan, D. (2008), ‘The pharmacology of cannabis: issues for understanding its use’, in: A cannabis reader: global issues and local experiences, Monograph series 8, Volume 1, European Monitoring Centre for Drugs and Drug Addiction, Lisbon. The publication is available on the Internet at: http://www.emcdda.europa.eu/publications/monographs/cannabis Cataloguing data can be found at the end of this publication. Luxembourg: Office for Official Publications of the European Communities, 2008 ISBN 978-92-9168-311-6 © European Monitoring Centre for Drugs and Drug Addiction, 2008 Reproduction is authorised provided the source is acknowledged. Printed in Belgium Rua da Cruz de Santa Apolónia 23–25, P-1149-045 Lisbon 5FM t'BY JOGP!FNDEEBFVSPQBFVtIUUQXXXFNDEEBFVSPQBFV Chapter 8 In thinking about cannabis policy, what can be learned from alcohol and tobacco? Keywords: alcohol – cannabis – economics – environmental strategy – polydrug consumption – prohibition – regulation – taxation – tobacco Setting the context Cannabis is just one of many psychoactive substances used in Europe for recreational and therapeutic purposes. Research into the topic has never really ignored this real- life polydrug use. Most joints contain tobacco. A cannabis session often includes the consumption of alcoholic drinks. These are givens. Nonetheless, only recently have professionals working in the area of cannabis control genuinely begun to look at the ‘cross-substance’ effects of legislation targeted at other, legal, substances such as alcohol and tobacco. This is not to say that there has been a revolutionary shift towards examining the interrelationships of polydrug consumption. The epidemiological regime — which splits drug taking along neat substance-specific lines (cannabis, ecstasy, cocaine, etc.) — remains in place. Rather, there has been a shift in national drug strategies — at least in Europe — to erode the substance-specific approach which traditionally segregated activity on licit psychoactive substances from activity on illicit drugs (1). Politically, it is no longer taboo to compare legal and illegal substances. The recent advent of smoking bans in Europe represents a golden opportunity to measure the knock-on effects on consumption of other substances. Moreover, evidence on the effects of decriminalisation of cannabis (that is, lower penalties for personal possession) in many European countries during the early 2000s is now filtering into the policy literature. This chapter does not retread the well-worn track of comparative drug harm indexes and the relative harms of cannabis and society’s chosen licit drugs. Instead, it examines the (1) EMCDDA Annual Report 2006, selected issue: ‘European drug policies: extended beyond illicit drugs?’. 119 In thinking about cannabis policy, what can be learned from alcohol and tobacco? ways in which the market for licit substances has been subject to government control, together with brief commentary on the merits of these interventions. The ‘elephant in the room’ has been dutifully ignored. There are no ‘what-if’ scenarios on how market controls could be transposed to cannabis in a post-legalisation environment. A postscript to this chapter provides a range of sources for further reading on the topic of mooted cannabis regulation. However, for the time being, any such options would require a huge shift in the political balance, which currently appears to be, if anything, more tipped in the favour of increased controls on cannabis rather than liberalisation (see Ballota et al., this monograph). Further reading on the regulation of alcohol and tobacco Alcohol Anderson, P., Baumberg, B. (2006), Alcohol in Europe, Institute of Alcohol Studies, London ec.europa.eu/health-eu/news_alcoholineurope_en.htm Gerritsen, H. (2000), The control of fuddle and flash: a sociological history of the regulation of alcohol and opiates, Brill Academic Publishers, Leiden. Walton, S. (2003), Out of it: a cultural history of intoxication, Random House, New York. Tobacco European Commission (2007), Green paper — towards a Europe free from tobacco smoke: policy options at EU level, Health & Consumer Protection Directorate-General. Kopp, P., Fenoglio, P. (2000), ‘Le coût social des drogues licites (alcool et tabac)’, in Observatoire Français des Drogues et Toxicomanies 22. 120 Chapter 8 In thinking about cannabis policy, what can be learned from alcohol and tobacco?(2) Robin Room If caffeine and other such banalised psychoactive substances are left out of consideration, almost everywhere in Europe today cannabis is one of the ‘big three’ of psychoactive substances, along with alcohol and tobacco. Although the international drug control system applies continuing pressure against it, cannabis has taken on a semi-legal status in many parts of Europe, at least at the level of the user. This raises the question, what can be learned from the extensive literatures on alcohol and tobacco policy which might be useful in thinking about cannabis policy? The question is obviously applicable in a situation where cannabis has a legal or semi-legal status. It also has some applicability where cannabis has a clearly illegal status. Total prohibition was once fairly common in both the tobacco (Austin, 1978) and alcohol fields, in the case of alcohol applying less than a century ago in many parts of Europe — Norway, Finland, Iceland, the Russian Empire and then the early Soviet Union. Studies of what happened during alcohol prohibition, and also of what happened with legalisation, are of interest in thinking about cannabis policy. Taking into account the alcohol and tobacco experience is particularly important because the field of empirical studies of cannabis policy is so little developed. A landmark in this field is the sustained effort by MacCoun and Reuter (2001) to assemble the evidence on the likely results of illicit drug legalisation in the USA. A byproduct of this study, however, was an underlining of how weak the evidence base is in this area. A recent review of ‘the contribution of economics to an evidence-based drugs policy’ (MacDonald, 2004) found agreement that illicit drug use showed some responsiveness to price, but that ‘there is not yet a consensus on the possible range of price elasticities for certain drugs’. Evidence on the effects of depenalisation of marijuana still depends on a rather small range of studies (Single, 1989; MacCoun and Reuter, 2001; Donnelly et al., 2000), in some cases of paradoxical instances where the reach of the criminal law actually widened (Single et al., 2000). (2) This paper draws in part on Room (2005). 121 In thinking about cannabis policy, what can be learned from alcohol and tobacco? Traditions of studying the impact of alcohol and tobacco policies Alcohol policy impact studies There is a very substantial literature on the effects of alcohol control policy changes on drinking amounts, patterns and problems. Data used in these analyses has primarily been of two types: social and health statistics, such as alcohol sales data, police statistics and mortality and hospital discharge data; and before-and-after surveys, mostly cross- sectional but in a few cases longitudinal. Some studies have included control sites, and one or two notable studies have included a random assignment to intervention or control condition (e.g. Norström and Skog, 2003). Alcohol policy impact studies have primarily been carried out in a limited range of countries, generally excluding both the developing world (Room et al., 2002) and Southern European wine cultures. Even between somewhat similar societies, there are substantial variations in the research emphasis on particular topics (Room, 2004). There is an imperfect fit between what those involved in liquor licensing decisions may want to know and what is available in the literature on alcohol controls. This gap between the content of alcohol control legislation and the research literature has been documented in the USA (Wagenaar and Toomey, 2000), but exists also elsewhere — particularly in countries where the tradition of alcohol policy impact studies has not been strong. The studies are sometimes done because a change was controversial in