Did we lose the war on drugs, or have we just surrendered?

Dr Joseph Borg is a clinical psychologist

President Nixon had declared drug abuse as “public enemy number one”. Today the United States of America spends approximately 51 billion dollars on the so-called war on drugs. What are the results?

A recent study conducted by The Substance Abuse and Mental Health Services Administration (SAMHSA) for the National Institute on Drug Abuse, estimated that in 2013, 24.6 million Americans aged over 12 years 9.4 percent of the population, had used an illicit drug in the past month. This number is up from 8.3 percent in 2002. Drug use is highest among people in their late teens and twenties. In 2013, 22.6 percent of 18 to 20 year olds reported using an illicit drug in the past month. 

The most common drug of choice in this age cohort was cannabis with 70.3%, followed by pain relievers with 12.5%. Drug use is increasing among people in their 50s and early 60s. This increase is, in part, due to the ageing of the baby boomers, whose rates of illicit drug use have historically been higher than those of previous generations.

When it comes to “legal” substances the study shows that there was a decline in use. Alcohol consumed by persons aged 12-20 has declined in this age group from 28.8 to 22.7 percent between 2002 and 2013, while binge drinking declined from 19.3 to 14.2 percent and the rate of heavy drinking went down from 6.2 to 3.7 percent. Tobacco use is also on the decline: in 2013 an estimated 55.8 million Americans aged 12 or older, or 21.3 percent of the population, were current cigarette smokers. This reflects a continual but slow downward trend from 2002, when the rate was 26 percent. 

Maltese results, to some extent, reflect the same trends as other countries. Data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) (2015) shows how since 1999, the trend has been a downward decline in most patterns of alcohol use among young people aged 15 and 16. Lifetime use of alcohol (40+ times) declined from 36 percent to 20% in 2015. Alcohol use in the last 12 months (20+ times) declined from 51% in 1999 to 19% in 2015, while alcohol use in the last 30 days declined from 30% to 11%.

On the other hand, cannabis use showed an upwards trend from 7% in 1999 to 13% in 2015. This is a clear manifestation that in Malta, like any other country in the world, illegality doesn’t hinder our youths from using psychoactive substances. 

Should we legalise cannabis? 

I believe an informed debate based on scientific proof is required. A reoccurrence of the divorce debate where everything was black or white, heaven or hell will do more harm than good.

I agree wholeheartedly with Dr Nigel Camilleri, psychologist for children and adolescents, that if adolescents are given mixed messages about substances (alcohol and drugs) by their parents, or are provided with false information, then there is more of a chance that the former will make use of the substances.

The debate shouldn’t be if smoking cannabis is good or bad. Cannabis has several components, with the two most common ones being THC, which causes psychosis, and CBD, that could be beneficial for mental well-being. It has been already proven scientifically that smoking cannabis, especially at a young age can cause schizophrenia, and I advise people not to consume the plant especially if they have a family history of schizophrenia. Schizophrenia is a very severe condition and I believe that whoever uses cannabis should be aware they could get the condition. 

The debate should be between keeping the status quo or the legalisation of cannabis as a harm reduction measure, and the regularisation of the market.

This is not the first time that such a measure has been taken in Malta. In the 90s, although controversial at the time, harm reduction measures such as the distribution of syringes for free had some very positive proven outcomes. The number of persons infected with diseases such as Hep C, Hep B and HIV from the sharing of needles within the drug community were negligible. Also, we supply methadone as a substitute for heroine, a class of drugs known as narcotic analgesics or opioids which work on the brain to change how your body feels and responds to pain, and is also highly addictive.

Copying legislation from other countries would be a huge mistake as the dynamics are different from one country to the other. ReLeaf, a pro-cannabis lobby group, is proposing that users over 21 years, will be allowed to carry up to 30 grams of cannabis and grow up to 6 plants for their personal use. This would be complete madness! And a copy and paste of the proposed Canadian legislation. 

The Canadian legislation is in the second reading and the probable date for the official effect of the legislation will be 1st July 2018. The provinces will have the power to determine the method of distribution and sale as well as the legal age for cannabis use. In response to the federal government’s plan to legalise cannabis by July 2018, Ontario is committing to a safe and sensible framework to govern the lawful use and retail of recreational cannabis as a carefully controlled substance within the province.

Approximately 150 stand-alone stores will be opened by 2020, including 80 by July 1, 2019, servicing all regions of the province. When you consider the size of Ontario (1.076 million sq.km or three times the size of Germany) 150 shops by 2020 will be one per 7,173 sq.km, that is one shop for an area of 22 times the size of Malta. Considering the distance you should travel to buy 30 grams, that’s reasonable. Malta is 316 sq.km so there is no need to have more than 5 grams even if we will have only one shop to service the whole island.

Cultivation of the plant should be banned as this will make it impossible for the authorities to control who is the end-receiver of the product.

Act of surrender

Is legalisation of cannabis “an act of surrender” as the Director of Caritas, Mr Leonid McKay, was quoted as saying?

Facing reality is not surrender. From 1999 to 2015 the number of youths (15 to 16 year olds) using cannabis has doubled from 7% to 13%, while the use of alcohol and cigarettes has declined in the same age cohort. This shows that education campaigns about the harm caused by cigarettes and alcohol are leaving a positive effect, and prohibition did nothing to disincentive our youths from using cannabis, as the results show.

McKay acknowledged we have a problem and that “the battle is not lost and there are people who are still completing rehab with success.” I disagree completely with this line of thought. Doing nothing is not the answer: youths who abuse the substance will keep increasing dramatically as results have already showed. With rehabilitation programmes, one does not exclude the other. The government will still be financing NGOs such as Caritas and OASI to the tune of hundreds of thousands of euros for rehabilitation programmes. An aggressive education campaign in schools, TV and social media needs to be ongoing to inform and provide scientifically proven information on the real effects and harm the use of cannabis can do to the brain. 

I agree with McKay that calling the smoking cannabis “recreational” is ridiculous. Playing a game of football, tennis, billiards or another game is recreational, not making use of a mind-altering substance.

And the most important point is that “the black market will not disappear”.

The black market will not disappear. Other drugs will still be sold on the black market. If this law makes it legal for those over 21 to buy cannabis, where will the under-21s buy it from? If someone under 21 is found carrying 3.5g of cannabis, is it considered for personal use, or will they be judged under Articles 6-13 of the Drug Dependence (Treatment not Imprisonment) Act?

Or will they get an administrative fine as proposed in the Canadian law? These are the issues professionals need to discuss in the upcoming debate on legalising non-medical cannabis. I hope the discussion will be mature and based on scientific research with proven studies based on facts, and not on emotional or personal beliefs.