Intended for healthcare professionals

Feature Drug Laws

Cannabis regulation: high time for change?

BMJ 2014; 348 doi: (Published 21 May 2014) Cite this as: BMJ 2014;348:g3382
  1. Rebecca Coombes, magazine editor
  1. 1The BMJ, London, UK
  1. rcoombes{at}

Cannabis is widely available despite its use and production being illegal in most countries. Rebecca Coombes looks at recent moves to regulate production and the potential effects on public health

Cannabis is the world’s most widely used illicit drug. But for how much longer? In a short space of time we have moved from absolute global prohibition of the drug, with the emergence of legalised and regulated production and retail not in just one nation (Uruguay) but also, surprisingly, in two US states (Colorado and Washington). Do these and other new permissive models in Spain and Belgium, for example, point to a tipping point in the debate? Could cannabis step out of the shadows and join the ranks of alcohol and tobacco, the world’s most popular legal and regulated drugs?

Even in the Netherlands, so long at the forefront of forward thinking policies on cannabis, local politicians have joined forces to urge the government to go much further and complete the job it started nearly 40 years ago when it agreed to tolerate the licensing of “coffee shops” to sell cannabis in small quantities. Then, it stopped short of legalising the cultivation and distribution of cannabis, leaving the supply side to criminal gangs, whose activities today increasingly tarnish an otherwise successful policy.

But at this crucial stage—as other countries and US states keenly watch the fortunes of the pioneers Colorado, Washington, and Uruguay and no doubt marvel at the tax windfalls—can regulatory approaches to the use of cannabis reduce health and social harms more effectively than prohibition? Is the commercial model pursued in Colorado, for example, where shops sell customer friendly goods such as edible cannabis in the form of candy “gummy bears,” really a solution that public health can get behind? Perhaps the stricter government control favoured by Uruguay …

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