Intended for healthcare professionals

Education And Debate

Improving the quality of the cannabis debate: defining the different domains

BMJ 2000; 320 doi: (Published 08 January 2000) Cite this as: BMJ 2000;320:108
  1. John Strang, director (,
  2. John Witton, research workera,
  3. Wayne Hall, directorb
  1. a National Addiction Centre, Institute of Psychiatry, King's College London, London SE5 8AF
  2. b National Drug and Alcohol Research Centre, University of New South Wales, Sydney 2052, Australia
  1. Correspondence to: J Strang
  • Accepted 23 August 1999

The policy debate on cannabis has moved back into prominence in Britain and elsewhere after reports of increases in use during the early 1990s1 and renewed claims about the therapeutic value of marijuana. 2 3 Rational debate has often been obstructed because the media present a forced choice between two sets of views. One of these constructed views is that cannabis is harmless when used recreationally, is therapeutically useful, and hence should be legalised. The other is that recreational use is harmful to health and that cannabis should continue to be prohibited for recreational or therapeutic purposes.4

This oversimplification of the cannabis debate has prevented a more considered examination of eight conceptually separate issues (box). We believe that a competent consideration of these issues would contribute to a more informed debate about the appropriate public policies that could be adopted towards cannabis use for recreational or therapeutic purposes.

Summary points

Cannabis use is increasing steadily in many countries and is most prevalent among young people

The value of the debate on cannabis is seriously diminished by heated contributions that obstruct rational consideration of important public health and policy issues

The different domains of the debate should be considered in isolation at first to allow a more objective analysis of the evidence

Substantial public investment in research into the different areas is a prerequisite of rational consideration of public policies

Is cannabis a single product?

More than 60 different cannabinoids and over 400 active components have been identified in samples of cannabis.2 However, our interest and concerns about associated harms could be much more focused. Should we be especially concerned about the use of new cannabis preparations with higher concentrations of tetrahydrocannabinol? Does using cannabis that has a higher tetrahydrocannabinol content result in a higher intake of tetrahydrocannabinol or do smokers consciously or subconsciously titrate …

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