Acknowledgements We thank each of the following, who provided help or advice on specific points: Laurence Helfer, Les Iversen, Martin Jelsma, Shekhar Saxena, and Ambros Uchtenhagen. Particular thanks are due to Louisa Degenhardt for graciously allowing us to draw on her collaborative work with Wayne Hall. Wim Scholten and Bob Keizer provided useful advice at a Beckley Foundation meeting on the project. We also thank each of the following, who provided research or information assistance: Jude Gittins, Jonny Hazell, and Katherine Rudzinski; and Sarah Yeates for assistance in locating the literature on the health effects of cannabis and in formatting the chapter on the health effects of cannabis. Thanks also to Maggie Halls for her assistance in locating reference material for chapters on the range of reforms and their effects. The authors would like to give special thanks and appreciation to Amanda Feilding, the founder and director of the Beckley Foundation and our convenor. The report on which this book is based was Amanda’s idea in the first place, and she has been instrumental in bringing it into being, patient and helpful with suggestions, and gracious and hospitable throughout the process. i Table of Contents 4 FOREWORD 6 PREFACE 10 ACKNOWLEDGEMENTS PART I: CANNABIS POLICY: MOVING BEYOND STALEMATE 11 CHAPTER 1. INTRODUCTION 24 CHAPTER 2. THE HEALTH AND PSYCHOLOGICAL EFFECTS OF CANNABIS USE 61 ANNEX : HEALTH ADVICE ON CANNABIS USE 63 CHAPTER 3. THE CANNABIS PROHIBITION REGIME: PATTERNS OF USE, MARKETS AND POLICIES 95 CHAPTER 4. THE RANGE OF REFORMS WITHIN THE SYSTEM: SOFTENING THE PROHIBITION 130 CHAPTER 5. THE IMPACTS OF CANNABIS POLICY REFORMS WITHIN THE CURRENT DRUG CONTROL REGIME 156 CHAPTER 6. BEYOND THE CURRENT DRUG CONVENTIONS 174 CHAPTER 7. PATHS FORWARD FROM THE IMPASSE 181 PART II. CONCLUSIONS AND RECOMMENDATIONS 188 ANNEX: RESEARCH PRIORITIES 190 PART III: DRAFT FRAMEWORK CONVENTION ON CANNABIS CONTROL 229 REFERENCES 281 ABOUT THE AUTHORS AND THE BECKLEY FOUNDATION ii Preface Cannabis is by far the most widely used illegal drug and therefore the mainstay of the 'War on Drugs’. It is used by an estimated 4% of the global adult population, i.e. 166 million people out of an estimated population of 200 million illegal drug users’1. It therefore constitutes roughly 80% of the illegal drug market. However, cannabis has only ever held a relatively marginal position in international drug policy discussions. In response to its peripheral role in the global debate, I decided to convene a team of the world's leading drug policy analysts to prepare an overview of the latest scientific evidence surrounding cannabis and the policies controlling its use. The report would both bring cannabis to the attention of policy-makers and also provide them with the relevant facts to better inform their future decisions, particularly in the context of the United Nations Strategic Drug Policy Review of 2009, and thereafter. The historical context of the United Nations’ policy is critical here. In 1998, the international community agreed a 10-year programme of activity for the control of illegal drug use and markets. These agreements were made at a United Nations General Assembly Special Session (UNGASS) held in New York in June of that year, and a commitment was made to reassess the situation at the end of the 10-year period. The nature of this programme was epitomised by the slogan ‘A drug free world - we can do it!’. However, the reality is that since 1998 drugs have in general become cheaper and more readily available than ever before. At the UN Commission on Narcotic Drugs in Vienna in March 2007, it was agreed a high-level political meeting would be held in the spring of 2009 to review progress and to agree the way forward. We hope that this volume will help lead the way towards a more rational, effective and just approach to the control of cannabis. Cannabis is, however, a complicated issue, with many seemingly contradictory facets. On the one hand, it has a history of spiritual and medicinal use that dates back millennia; this, together with the explosion in its use during the latter half of the twentieth century, indicates the many subjective benefits that users attribute to it. Moreover, it is one of the least toxic substances used recreationally, where the risk of overdose is negligible. On the other hand, recent years have seen growing concern about an association between cannabis use and a variety of possible harms, particularly mental health disorders. Only through extensive and rigorous research can we hope to clarify the contradictions between the perceived benefits of cannabis and the dangers it presents. 1 The figures from the UN Office on Drugs and Crime (UNODC) indicate that in 2006-7 some 166 million people aged 15 or above, or 3.9 per cent of this age group, used cannabis regularly. Just 1 per cent of the world population uses other illegal drugs. iii Some of the many questions on which we lack reliable evidence include: Why do people choose to use cannabis? What are the psychological and therapeutic needs it fulfils? What are the processes it might enhance? Why and when is cannabis harmful? Can this be understood in terms of differences in individual genetic and personality types, or in the type of cannabis consumed, or in the pattern of its consumption? By answering these and other questions we might minimise the harms caused by cannabis use and help to prevent its misuse, as well as better understanding the benefits many users reportedly derive from it, both in alleviating sickness and promoting well-being. When considering harms, it is also important to include the adverse effects of a criminal justice approach to cannabis control. This is particularly pertinent given the evidence that cannabis control policies, whether draconian or liberal, appear to have little or no impact on the prevalence or intensity of its consumption. Indeed, at the onset of international cannabis prohibition, use of the drug was confined to a scattering of countries and cultures, but since then it has spread around the world and is now widely used in most developed countries, to the extent that it has become a rite of passage for a majority of young people. In the developed world, it is all too easy to overlook the unintended consequences of the War on Drugs, including the extensive violations of human rights, since in these countries the violations are most predominantly felt by drug-users themselves, particularly where discriminatory enforcement leads to significantly higher levels of arrests among the disadvantaged and minority groups. However, in producer/transit countries, such as in Latin America, the suffering caused by this war is vastly more widespread, affecting not only farmers but also whole populations by the destabilisation of political and social systems through corruption, violence, and institutional collapse. While attention to these systemic effects has primarily been focused on other drugs, the war on cannabis also plays a significant role. However, despite cannabis being responsible for the great majority of arrests for illicit drug-use – in the US alone approximately 750,000 arrests per annum – international drug policy discussions have tended to ignore cannabis, focusing instead on those substances that cause the most harms: opioids, cocaine and amphetamines. As discussed in this volume, although cannabis has always been marginal to the main interests of the international drug control system, the upholders of the system have been extremely reluctant to consider reforms which would change its status within, or remove it from, that system. Although this Report is specifically targeted at reviewing cannabis laws, it is worth noting that any change to the scheduling of cannabis under the international drug control system could lead to the questioning of the whole War on Drugs approach. Without cannabis within the system’s remit, the number of illegal drug-users in the world would total somewhere in the region of 40 million people – arguably too small a number to justify the vast costs – in money, human suffering and political corruption – of the current efforts to enforce the ideals behind this unwinnable war. With a much narrower target the War on Drugs might turn instead into a more sensible campaign to iv relieve the problems caused by the dependence of a small number of users on more addictive and dangerous drugs. The present volume reviews the issues which need to be considered by policy-makers in developing more effective cannabis policies that minimise the harms associated with its use and control. We hope that this Report will prove useful in policy discussions concerning cannabis, not only in the context of the 2009 international review, but also as a guide for governments seeking to reform their cannabis policies thereafter, and that it will further promote a wider discussion of these important issues amongst the general public. Amanda Feilding Director of the Beckley Foundation v i ii Chapter 1. Introduction MARIJUANA IS THE most widely used illegal drug in the world. The United Nations Office of Drugs and Crime (UNODC) estimates that, across all nations, 160 million people used cannabis in the course of 2005, 4% of the global adult populations - far more than the number that used any other illicit drug, though far less than the number that consumed alcohol or tobacco. The number of cannabis users in 2005 was 10% higher than estimated global use in the mid 1990s (UNODC, 2007). The numbers are particularly striking because fifty years ago cannabis was a very uncommon drug, with pockets of traditional use in India, Jamaica and a few other developing nations and use otherwise largely confined to fringe bohemian groups in a few rich countries.