Intended for healthcare professionals

Education And Debate For and against

Cannabis control: costs outweigh the benefitsForAgainst

BMJ 2002; 324 doi: (Published 12 January 2002) Cite this as: BMJ 2002;324:105

Alex Wodak and colleagues argue that the costs—to health, and fiscal and social—of controlling cannabis are greater than any benefits. In opposition, Colin Drummond lists the potential dangers of decriminalisation.


  1. Alex Wodak, directora,
  2. Craig Reinarman, professorb,
  3. Peter D A Cohen, directorc
  1. a Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia,
  2. b Department of Sociology, University of California, Santa Cruz, CA 95064, USA,
  3. c Center for Drug Research, University of Amsterdam, 1091 GM Amsterdam, Netherlands
  4. Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, London SW17 0RE

    Current debates on cannabis policy are dominated by attempts to establish the potential health costs of use of cannabis.1 While accurate assessment of the potential harms of cannabis is desirable, it is at least as important to estimate the costs—which are usually ignored—of current cannabis controls.

    High costs of control noted decades ago

    Perhaps doctors have often led the search for less harmful drug policies because the premier axiom of medicine is “first, do no harm.” In 1893 Britain's Indian Hemp Drugs Commission concluded that excessive use of cannabis was uncommon and that moderate use produced practically no ill effects. In 1926, Sir Humphrey Rolleston, then president of the Royal College of Physicians, chaired a committee that recommended against criminalising opiates.2 Similarly, Dr W C Woodward, counsel to the American Medical Association, testified in Congress in 1937 to the lack of evidence justifying criminalisation of cannabis3 and several other commissions in Britain, Canada, and the United States have come to similar conclusions.4 In 1972, an American presidential commission concluded that marijuana “does not warrant” the harmful consequences of “criminal stigma and threat of incarceration.”5 In 1978, President Carter told Congress that “penalties against the use of a drug should not be more damaging to an individual than the use of a drug itself; and where they are they should be changed. Nowhere is this more clear than in the laws against the possession of marijuana.”6 Unfortunately, little has changed since President Carter uttered these words. The UK Police Foundation's review of cannabis policy in 2000 was the most recent senior international committee to reach the same verdict: “Our conclusion is that …

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