Alternative Systems of Cannabis Control in New Zealand: Part 3

Introduction

In this Section we address certain key issues with respect to alternative systems of cannabis control, the ones being (1) specification of a plan for ascertaining the outcomes of a reformed cannabis policy, (2) development of appropriate drug education and of (3) treatment programmes for use within a reformed cannabis policy. These issues are of such substantial complexity that we defer detailed consideration of them here. To a large extent the Drug Policy Forum will depend on recommendations it receives from advisors and submissions in addressing these issues in its final report.

Nevertheless, a few observations can be offered concerning each of these items

Outcome Assessment

It seems self-evident that any substantial revision in the system of cannabis control should be accompanied by an assessment of important outcomes. These include changes in the extent of use within society of cannabis and other drugs, including cocaine, heroin, tobacco and alcohol. As discussed in Appendix A, there is reason to believe that increased cannabis use could lead to decreased use of these other drugs.

Additional outcome measures would include:

• number and seriousness of crimes committed due to drugs or black market
• health care costs attributable to drugs (analysed by drug)
• treatment rates for various drugs
• performance in schools, including number of suspensions
• extent of child and spousal abuse
• road accident rates
• costs of police and enforcement

Data concerning these outcomes are likely to be relatively accessible and should be of generally high quality. The scope and methods required for a suitable assessment program are well within the capabilities of contemporary New Zealand researchers. Nevertheless, a considerable effort will be required to obtain these data and considerable care must be devoted to the always challenging process of deriving sound causal inferences. Such an effort should be carefully planned using the combined efforts and resources of several relevant research and governmental bodies.

Education Programmes

It is imperative that appropriate and effective education programmes be developed in conjunction with a reformed cannabis control system. As always, specialised programmes would be needed for different target audiences (e.g., adults, school children). The cornerstone of all programmes would be the provision of accurate information. School-based drug education programs based on harm exaggeration have been shown either to have no effect or to produce a "boomerang effect" by increasing drug use rates in children exposed to these programs compared to those not so exposed.(70) (71)

Effective education programmes would likely require acknowledgement of the fact that among other innate appetites, people from childhood on seek to alter their normal state of waking consciousness from time to time, and that like all appetites, this one is neither good nor bad, but can be indulged in more or less productive and more or less harmful ways. Drug use is, therefore, a fact of life(although accepting this particular fact and communicating it to children is difficult for many adults. Indeed, the situation is similar to the problems faced when communicating sexual information to children.

Moving from a "just say no" or a "just be careful" approach to drug education will be seen by many as encouraging youthful drug use. However, a more realistic and honest approach to the whole issue of drug use deserves a try, and is probably essential within the context of a reformed cannabis policy. Such an approach would emphasise the importance of delaying psychoactive drug use until well along in the psychological maturation process, as well as the key tenets of safe and responsible drug use.

Another key goal of drug education programmes would to facilitate the evolution of appropriate public attitudes regarding the responsible use of cannabis. The 1995 Australian Institute of Criminology report addressed this issue:

Secondly, society not only defines which substances are illegal, but it also determines in which social situations it is acceptable to partake, how much should be taken, and even the nature of the drug experience itself (that is, the effects on individuals and their behaviour). Thus, new legislation may alter societal definitions of appropriate marijuana use. It may be hypothesised that increased marijuana use in public places, at work, or while driving, may antagonise societal attitudes. Public disapproval of certain types of behaviour may aid the development of safe patterns of use.

Evidence for the instrumental effect of public values upon marijuana use has been presented in a number of studies. One study found that excessive use of cannabis was regarded among most young people to be unproductive and those who over-indulged were branded 'druggies' and 'vegos'. The consequence of this appeared to be that young cannabis users, who were sensitised to the perceptions of their peers, restricted their levels of use in order to avoid receiving these derogatory labels (Davey 1990, cited in Davey & Dawes 1994).(72) Rather than the commonly perceived notion that drug use among young people is a defiant, non- conformist response to the dominant adult power structure, it would appear that adolescent drug use can be guided and restrained by peers. . . . [R]ealistic information (not scare tactics) about the risks associated with drug use, when communicated by a credible source, can play an important part in reducing demand and, ultimately, in reducing drug use.(73)

Thus, the importance of credible and (therefore) effective drug programs is difficult to overstate in the context of a reformed cannabis control system.

Treatment Programmes

Relatively little is known about the effectiveness of treatment programmes aimed at rehabilitating cannabis users with problems of dependence or harmful use. Certainly effectiveness will depend on voluntary presentation for treatment, as is the case also for alcohol and other drug treatment programmes. Also, treatment programs are likely to be both better attended and more effective outside a prohibition context, as the problematic behaviour is then no longer subject to criminal sanctions or to such substantial stigmatisation.

The Forum will depend on advice and submissions from experts in this arena to arrive at additional recommendations concerning cannabis treatment programmes in our final report.

Cannabis and Driving

Like all other provisions of a cannabis control policy, any restrictions placed on driving after the use of cannabis should be based on evidence. In reviewing the evidence on this topic, we find(somewhat surprisingly(that almost every major study performed in this area has shown that drivers who use cannabis only (i.e., no concomitant alcohol) perform as well or better than "straight" drivers.

In the only study of drivers under actual driving conditions (conducted in Holland), the U.S. Department of Transportation, National Highway Traffic Safety Administration, concluded that:

This program of research has shown that marijuana, when taken alone, produces a moderate degree of driving impairment which is related to the consumed THC dose. The impairment manifests itself mainly in the ability to maintain a steady lateral position on the road, but its magnitude is not exceptional in comparison with changes produced by many medicinal drugs and alcohol. Drivers under the influence of marijuana retain insight in their performance and will compensate, where they can, for example, by slowing down or increasing effort. As a consequence, THC's adverse effects on driving performance appear relatively small . . . .Of the many psychotropic drugs, licit and illicit, that are available and used by people who subsequently drive, marijuana may well be among the least harmful.(74)

This study represents the "gold standard" study of cannabis effects on driving. All other studies must be based on indirect evidence, including (and especially) determining whether victims of fatal traffic accidents had cannabis in their system. For example, another study by DOT/NHTSA, published in 1992,(75) examined blood samples taken from 1882 drivers killed in car, truck and motorcycle accidents in seven states during 1990-91. Importantly, this was one of the few studies to make a substantial effort to determine whether fatally injured drivers were responsible for the accident. (Studies that fail to do this are of questionable validity.)

In this study, alcohol was found in 51.5% of the specimens. Just 17.8% showed traces of other drugs; marijuana was a distant second to alcohol at 6.7%, followed by cocaine (5.3%), benzodiazepine tranquilizers (2.9%) and amphetamine (1.9%). Two-thirds of marijuana- and other-drug-using drivers were also positive for alcohol.

The report concluded that alcohol was by far the "dominant problem" in drug-related accidents. A responsibility analysis showed that alcohol-using drivers were conspicuously culpable in fatal accidents, especially at high blood concentrations or in combination with other drugs, including marijuana. However, those who used marijuana alone were found to be if anything less culpable than non-drug-users. The report concluded, "there was no indication that marijuana by itself was a cause of fatal accidents."

Quoting from the report:

Evidence of causal contributions of the drugs to the crashes was very limited. . . . In the absence of alcohol, no drug or drug group evidenced a driver responsibility rate significantly different from the drugfree control group. When drugs were combined with alcohol, no drug or drug group exhibited a responsibility rate significantly different from alcohol itself. . . .The THC-only drivers had a responsibility rate below that of the drugfree drivers, as was found previously by Williams and colleagues (1985). While the difference was not statistically significant, there was no indication that cannabis by itself was a cause of fatal crashes. However, the responsibility rate for the alcohol-plus-THC combination was 95%, and the normalized relative risk for the combination was higher than alcohol by itself in the intoxication range. Again, the small numbers of cases and lack of statistical significance justify only the conclusion that the possibility of a cannabis-alcohol additive effect is suggested by the data and it merits further discussion.(76)

A similar conclusion was reached in Australia, as reported by the Alcohol and Other Drugs Council in its internet "news of the day" feature:

The Sydney Morning Herald, 10 May 1996, p3 "Marijuana: it doesn't make a hash of driving"
The Daily Telegraph (Sydney), 10 May 1996, p19 "Safe driving, with cannabis"
Herald Sun (Melbourne), 10 May 1996, p21 "Dope link to road deaths"

The first two of the above articles both report that forensic scientist, Prof Olaf Drummer, claimed that the combination of drugs and alcohol provided the greatest risk to drivers, but cannabis alone could even be good for driving because, where alcohol tends to make people take more risks on the road, cannabis tends to make people slow down and drive more carefully.

The second and third articles each focused on one of two recent studies examining the issue: a VicRoads study which revealed that cannabis users tended to be aware of the problems the drug caused and to compensate for them and a study of 1000 drivers involved in major road traumas which revealed that drugs could be linked to about 13% of fatal road accidents but that drugs, including marijuana and amphetamines , directly caused only 5% of road deaths and that 9% of drivers were affected by a cocktail of drugs and alcohol. Both these articles also quote suggestions (from AMA federal vice-president, Dr Keith Woollard and from Prof. Drummer) that to be safe it would be better not to use drugs and drive.

A study performed by the State of Washington(77) found that only about 6 percent of drivers killed in automobile crashes tested positive for marijuana and not also alcohol. This study was conducted for one year from September '92 through August '93. This study is open to varying interpretations depending on one's estimate of the prevalence of cannabis-positivity in the driving population (and recalling that cannabis can be detected for days or weeks after last use). Based on available statistics, cannabis use among young males who are at highest risk of involvement in automobile crashes is on the order of 30-35 percent,(78) again indicating that cannabis-only drivers were under-represented in this group. In addition, it is highly unlikely that all of the cannabis-positive victims were "high" at the time of the crash.

Finally, Mason and McBay assessed a series of 600 drivers killed in single-vehicle accidents.(79) These investigators estimated that at most one driver was significantly impaired by cannabis, compared to between 9 and 28 drivers impaired by alcohol and cannabis, and 476 drivers who had blood alcohol concentrations over 0.10 mg/100cc.

The 1995 AIC report describes additional studies on cannabis and driving, most of which reached similar conclusions:

One study found that some 9 to 16 percent of all fatal accidents involved both THC and alcohol, while only two to four percent showed THC alone, leading to the conclusion that marijuana use by itself was a minor or negligible risk factor in fatal accidents (Gieringer 1988(80)). Another study of over one thousand drivers killed in road accidents between 1990 and 1993 in New South Wales, Victoria and Western Australia found that the drivers whose bodies tested positive for cannabis were, in fact, less culpable for the accidents that killed them than those who were drug free (Drummer 1994(81)). Other studies, however, have concluded that marijuana does cause a significant increase in fatal accidents, although they also concede that alcohol poses far higher risks (Robertson 1991; cited in ADCA, 1993b(82)).

One possibility of these findings is that, should decriminalisation of cannabis result in the substitution of cannabis for alcohol among those who persist in driving while intoxicated (which could happen given the common - and accurate - perception that alcohol can be readily detected while cannabis cannot), the level of motor vehicle crashes and fatalities may, in fact, decrease, a result consistent with the Australian National Drug Strategy's objective of harm minimisation. Clearly, the current extent of driving while intoxicated with marijuana and the frequency of related crashes needs to be determined and present campaigns (and public attitudes) directed toward reducing the incidence of drink-driving should be extended to include all psychoactive substances (whether decriminalisation occurs or not).(83)

The strength and consistency of this body of evidence is surprising, to say the least. Indeed, on the basis of these studies one could conceivably recommend, as the AIC appears to do, that drivers consider using cannabis (only) as a means to reduce the accident rate!

Although we certainly do not make such a recommendation, we must nonetheless take account of the evidence. One important conclusion emerging from this evidence, as noted in the 1992 DOT/NHTSA study, the combination of alcohol and cannabis appears to be particularly conducive to the production of fatal accidents. This effect was also observed in, among others, the studies by Gieringer, Williams et al., and Mason and McBay, cited above.

Accordingly, one might consider a policy in which the consumption of any alcoholic beverages be prohibited if one also consumes cannabis prior to driving. Such a policy might be difficult to enforce, however, in the absence of a test for recent cannabis use.(84) More important and effective would be public education campaigns designed to foster an ethic of "no drinking if you're toking and driving" (or some such motto). Driving after consuming cannabis alone would be legal, except insofar as impairment is produced.

In this regard, we believe that laws should address impairment in driving ability per se, rather than chemical tests of body fluids. Such tests of functional impairment are commonly applied by police (although more so in countries other than New Zealand, apparently). Penalties for driving while impaired (regardless of the cause) are already substantial.(85) As such, probably no change is required in the law on this point.

Other Issues

A range of additional issues will require clarification, some of which are listed below, including only sketchy suggestions about how they might be addressed.

Should the policy cover hashish and cannabis oil? Experience in The Netherlands has shown that an open market in cannabis products resulted in minimal use of cannabis oil (which is messy and offers no real advantage over medium-high potency cannabis(86)). People generally do not wish to "overdo" the cannabis experience.(87) These considerations, together with problems of enforcement, lead us to recommend that the revised cannabis law include all forms of cannabis products. An educational campaign would aim to produce a culture that disapproved of the use of more potent forms.(88) Like all others, this provision would be revisited after an assessment of the impact of the law change.

Age limit? 18 for cultivation and use. Make consistent with alcohol laws.

Where can it be smoked? Private homes and adults-only premises where permitted by establishment, e.g. pubs, bars, designated coffee-shops.

Penalties for unauthorised cultivation, possession, or sale? Sales to minors by adults would be heavily penalised, as would for-profit sale of cannabis outside the regulated system. More minor infringements, such as exceeding the five-plant limit by a plant or two would presumably be treated as a minor offence.