Citation

Kalant H. Int. J. Drug Policy 2016; 34: 17-19.

Affiliation

Department of Pharmacology & Toxicology, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada. Electronic address: harold.kalant@utoronto.ca.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.drugpo.2016.07.006

PMID

27498401

Abstract

Excerpt: The reply by Fischer, Rehm, and Crépault (2016) to my critique (Kalant, 2016) of their proposals (Crépault, Rehm, & Fischer, 2016) for cannabis legalization has helped to clarify the issues in this debate by making clearer the points of agreement and of continued disagreement. We agree on the following:•though not the most dangerous of drugs, cannabis can nevertheless cause serious physical and mental harm to some users, especially young ones•application of criminal sanctions against those charged solely with possession for personal use causes harm disproportionate to their offence, but only a small fraction of cannabis users in Canada are thus affected•control policy should be based on public health considerations, including prevention or minimization of cannabis-induced harm to the health of its most vulnerable users•for public health purposes it is important to know the number of users engaged in heavy, potentially harmful, use•increasing government revenue by taxation should not be a primary purpose•the policy should include research on more effective methods of preventive education, and on monitoring the consequences to society of the adopted policy•formulation of good policy requires both sound, objective knowledge about the matters at issue and value judgments that permit choice of the option yielding the greatest good and least harm. Fischer et al. (2016) reject decriminalization as incomplete and counterproductive policy, yet in arguing that liberalization of the law does not carry risk of major lasting increases of cannabis use they cite only evidence based on decriminalization, not on full legalization (e.g. Hughes & Stevens, 2010; Room, Fischer, Hall, Lenton, & Reuter, 2010). They do not discuss evidence concerning the extent of use in Colorado after full legalization, including that which appears to show a sharp increase in current use (RMHIDTA, 2016) and that which appears to show only a small increase (from 19.7% current use in 2013 to 21.2% in 2015) (Healthy Kids, 2015). Neither do they discuss young people’s anticipated changes in their own use after legalization (Palamar, Ompad, & Petkova, 2014), or the claim (Shi, Lenzi, & An, 2015) that use by adolescents – though only by girls, not by boys (Rogeberg & Stevens, 2016) – was higher in countries with the most liberalized laws. Fischer et al. thus offer no evidentiary basis for their contention that legalization would probably not seriously or lastingly increase use. Although we agree on the greater importance of dangerous rather than total use, it must be noted that Fischer et al. (2016) do not discuss the evidence concerning the relation between the two. While they are not always linked, the two have varied in tandem in most of the cases studied, both for alcohol and for cannabis (CANYS, 2009; Hughes et al., 2014; RMHIDTA, 2016; Rose & Day, 1990; Salomonsen-Sautel, Min, Sakai, Thurston, & Hopfer, 2014; Schmidt & Popham, 1978; Skog, 1985), in apparent compatibility with the single-distribution theory (Rossow, Mäkelä, & Osterberg, 2007). Therefore possible increases in total use after legalization of cannabis would offer at least a strong suggestion of what is likely happening to level of harmful use. My statement (Kalant, 2016) that if we lack important knowledge about fundamental questions that is needed to permit a meaningful cost-benefit assessment of policy options, those policy choices can rest only on broader social values, ideals and hopes, is dismissed by Fischer et al. (2016) as “somewhat condescending”. To me it seems self-evident, with no element whatever of condescension. Values and ideals play a very important role in policy formulation (Kalant, 2010; Humphreys & Piot, 2012), and Fischer et al. themselves imply this when they refer to “social justice-based” policy, and to the symbolic value of the law as an indicator of the values of society. The point is simply that a policy based primarily on such values should not be called “evidence-based”. Fischer et al. (2016) repeat, again without presenting any evidence, the claim that decriminalization hinders, but legalization facilitates, the application of key interventions such as preventive education, early diagnosis and treatment. My critique (Kalant, 2016) presented evidence to the contrary, including the reports on the Portuguese decriminalization system (Hughes & Stevens, 2010, 2012; Stevens & Hughes, 2016) which Fischer et al. have themselves cited. School-based preventive education programs are already widely employed, but are not very effective (Porath-Waller, Beasley, & Beirness, 2010). Neighbourhood and peer group influences appear to be at least equally important in persuading adolescents to stop using cannabis (Pollard, Tucker, de la Haye, Green, & Kennedy, 2014). Intensive research...

Language: en