Legalising DOPE Still plenty of unknowns

An expert panel has scrutinised the evidence here and overseas in the lead up to the referendum. Derek Cheng reports

Illegal cannabis has led to a cascade of health and social harms that could potentially be addressed through legalisation, an expert panel has found — but whether that would transpire is unknown.

The panel, led by the Prime Minister’s chief science advisor Juliet Gerrard, released its work yesterday to help inform debate in the lead up to the referendum in September. The work has been peer-reviewed nationally and internationally.

The referendum, which is part of the Labour-Greens confidence and supply agreement, is about legalising cannabis for recreational use.

The illegal status of cannabis is meant to deter its use, but the panel says this isn’t working because most Kiwis have used it. It says 15 per cent of New Zealanders have used the drug in the past year — increasing to 29 per cent for those aged 15 to 24 — and a third of those who use it do so at least once a week.

Nor is criminal punishment much of a deterrent it says — 95 per cent of users “either continue or increase their cannabis use after arrest or conviction”.

And the current “systemic racism” status quo disproportionately affects Ma¯ori, the young, and males.

The panel compares the proposed legal framework with the status quo; looks at what has happened overseas where cannabis has been legalised; dives into how it can be harmful; and considers how legalisation might increase health services.

The panel says that harm exists regardless of its legal status, and legalisation has “the potential to undercut the illegal market for cannabis, help reduce cannabis-related harm through regulated product safety, better facilitate intervention and treatment services, and separate access to cannabis from the illegal market for more harmful drugs”.

“Whether this plays out in reality is yet to be determined, as legalisation reforms in other places have not been in place for long enough for a full evaluation of long-term impacts.”

Broadly speaking, use among adults overseas has increased moderately in the short-term, and there is no clear impact on groups that are most susceptible to harm: heavy users or young people, it says.

The panel includes Professor Tracey McIntosh, Professor Joseph Boden, Professor Benedikt Fisher, Dr Hinemoa Elder, Professor Michelle Glass, Associate Professor David Newcombe, Associate Professor Khylee Quince, Associate Professor Tamasailau Suaalii-Sauni, Professor Doug Sellman and Associate Professor Chris Wilkins.

The proposed legal framework

The framework is outlined in the Cannabis Legislation and Control Bill, which Parliament is expected to progress in the event of a ‘yes’ vote in September. “It is not clear how rates of cannabis use would change if recreational use is legalised but it is reasonable to expect that legalisation will ‘normalise’ cannabis use in society,” the panel says.

Among the proposed controls are a purchase age of 20, a ban on public consumption, advertising and online sales, and a daily purchase limit of 14g of dry leaves a day — the equivalent of about 30 joints.

Cannabis use would only be allowed at home or in specialised cafes, where products in plain packaging and with health warnings could be bought.

Pricing cannabis correctly would be critical, the panel says, as too low a price could increase use and too high a price would draw few people from the black market to regulated legal products.

The bill would place a 15 per cent limit on THC, the psychoactive component of cannabis, for dried plant material. Limits on other products are yet to be determined, but a balance must also be struck: too low a limit could see users shunning legal products.

“Stronger cannabis could still be grown through in the law.”

What are the health harms?

“Illegal cannabis use is common and the majority of people who use cannabis have not experienced harms from their use,” the panel says.

It is “generally accepted” that cannabis is less harmful than alcohol or tobacco.

The harms are broadly called “cannabis use disorder”, which can manifest as anxiety, sleeping problems and depression.

“People who use cannabis have a one in five risk of developing cannabis use disorder, with risk increasing for those who use cannabis early, often, and use more potent cannabis.”

Around one in 10 people who started using cannabis before they are 15 will go on to develop psychosis by age 26.

There is also a weak association between cannabis use and depression.

The panel found little to no evidence of cannabis as a gateway drug, and legalisation could even reduce a person’s exposure to other illicit drugs.

More health services could pop up if cannabis was legal.

“There is currently no or very minimal resource for treatment of cannabis-related harms, especially for young people, and availability of treatment for people with cannabis use disorder varies widely across the country,” the panel says. “If legal, more people may seek help and more help could be available.”

Social harms, the status quo, and ‘systemic racism’

The panel says these harms are not just about being locked up. Being prosecuted can lead to life-long stigma, which can lead to reduced job prospects, difficulty in finding housing, or missing out on an education.

Ma¯ori are three times more likely to be arrested and convicted of a cannabis-related crime than nonMa¯ori, the panel says.

It is estimated that legalising cannabis could reduce Ma¯ori cannabis convictions by up to 1279 per year.

“Legalisation has the potential to formally address some of the bias in the justice system by placing Ma¯ori on a substantively equal footing with other citizens regarding cannabis use.”

Added Gerrard: “Certainly the social justice experts on the panel think [the proposed legal framework] would make a big difference to those communities.”

The panel says allowing big businesses to dominate the legal market could exacerbate social inequity. To counter this, the bill includes a clause so one business would not be able to contribute more than 20 per cent of national supply.

Overseas evidence: More adult use, little change to youth or daily use

The panel found that legalisation overseas was too recent to draw firm conclusions, and data could be misleading as people may be more likely to report their use.

“It is too early to tell what the impact of legalisation on use rates will be, and we are unlikely to know longterm outcomes on patterns of use for some time,” the panel says.

The short-term trends include a moderate increase in adult use, and no clear change in use patterns among groups that are most susceptible to harm: young users and heavy users.

The proposed NZ framework is similar to what exists in Canada, tighter than US jurisdictions, and looser than state-controlled Uruguay. The short-term trends include:

● A moderate increase in occasional adult use in Canada: “Two per cent more people used cannabis in the past three months, mainly among males, adults over 25 and those from certain regions.”

● US studies also showed small increases — 1 to 5 per cent — in past-year use, particularly among college students and people older than 25.

● Between 2011 and 2014 in Uruguay, there was a 1 per cent increase in past-year use and a 1.6 per cent increase in past-month use, but this may be a continuation of a preexisting trend.

● There are different patterns of problematic use, including a small increase in cannabis harm — 0.9 per cent to 1.23 per cent — in the US for those over 26. An increase in daily or almost daily use in Canada, however, has only occurred in those over 65.

Gerrard: The known harms versus the unknown harms

Gerrard said the data from Canada was promising.

“The fact there hasn’t been major changes for youth use or at risk groups is promising. The over 65s are the least at risk. The younger you start to use, the more risk.”

She said people often had a kneejerk reaction when thinking about the referendum. “They think, ‘It does harm. Why would you legalise?’ But there’s plenty of harm happening at the moment.”

The key question is the harm it might do and whether that harm increases or decreases in a legalised framework compared to the status quo. On that question, Gerrard stuck to the panel’s remit and remained steadfastly silent.

“We’re pretty sure of the situation at the moment. We’re much less sure of what will happen if we legalise it.”