Drugs should be legalised, regulated, and taxed
BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2057 (Published 10 May 2018) Cite this as: BMJ 2018;361:k2057
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When it comes to this complex issue, it is important to be clear and specific about what we are discussing e.g. legalising vs. de-criminalising, Cannabis only vs. all drugs.
We need to look at the evidence and come to an “evidence based” conclusion, however, we need to take into consideration how each side interprets the evidence and indeed an informed public opinion.
Some evidence from the U.S. for example suggests that legalisation and subsequent “commercialisation” can lead to increased use of drugs at least in some populations (Hefei et al 2015, Martins et al 2016) while a recent systematic review and meta-analysis by Sarvet et al in 2018 did not find an association between these laws and marijuana use in adolescents in the US. A study by Rosalie et al concluded that this can vary according to the details of different laws.
The evidence from Portugal is more promising () where much less deaths from drug overdose have been reported since decriminalisation. However, we need to think about the difference between the 2 populations and also the availability of high potency Cannabis.
The Portuguese model is not only about "de-criminalisation", but more importantly, involves efforts from a public health perspective: harm reduction, cultural changes and targeting vulnerable populations. Some would argue the UK is already doing all of this but I think both sides of the argument can agree that more needs to be done.
Focusing on the public health aspects of the drug problem is a smart investment that should start by supporting the shrinking drug and alcohol services all over the country as well as a radical change in the social care system.
Competing interests: No competing interests
The decriminalisation of drug use is long overdue, and will reap benefits in many areas.
First, it will curtail the activities (and profits) of illegal importers.
Second, it will eliminate most petty crime including burglary, most of which feeds illicit drug purchase.
Third, it will reduce the enormous cost to the health service of treating the consequences of back-street injections, dirty needles, and drug contamination from 'cutting'.
The result will be the release of a substantial dividend which can be diverted to proper education and treatment programmes. The final irony is that the current misuse of these huge resources on the traditional 'war on drugs' is almost completely ineffective, so there is much to be gained. The principal obstacle to a change of tack seems to be that no politician can afford to appear 'soft on drugs', but it is surely time now for a little more courage, leadership and common sense in this area.
Competing interests: No competing interests
We are very pleased that the BMJ have used this editorial to come out in support of meaningful drug reform. The trend of the medical establishment to do this is greatly welcomed and is an important step in viewing addiction as a medical and social problem rather than a criminal one. In the UK we have long adopted an evidence-based approach to medicine and the evidence on drug policy is clear; our current policy is harmful and does not work.
Regardless of your position in the drugs debate, the measures of a successful policy remain the same: decreased morbidity and mortality, fewer young people using drugs and more people accessing rehabilitation services and recovering from addiction. Prohibition impacts upon all these outcomes. Drug users are forced to adopt risky behaviours, due to limited knowledge and lack of control over the quality and quantity of the substance being taken. They are pushed into dangerous and criminal situations to fund their habits and are deterred from seeking help due to fear of criminalisation.
One of the founding principles of the NHS was to provide universal treatment to all those who need it. We have long recognised addiction as a mental health issue, however our laws discriminate against these patients and prevent clinicians treating them in the most effective manner. To resolve this, drug policy must be moved from the Home Office to the Department of Health and driven by evidence-based public health. After this happened Portugal in 2001, they have seen the control of an HIV epidemic, more drug users receiving treatment (doi:10.1111/j.1465-3362.2011.00383.x) and large reductions in the associated social costs (doi:10.1016/j.drugpo.2014.08.017). State control and regulation of compounds such as cannabis will allow control of potentially dangerous strains, limit use in young people and will provide valuable revenue to help fund addiction and rehabilitation services. Finally, the relaxation of legal status will allow the expansion of incredibly promising research into the medical uses of currently illegal substances such as the use of psilocybin for treatment-resistant depression (doi:10.1016/S2215-0366(16)30065-7).
As medical students nearing the end of our training, we have seen the harmful effects of drug taking and the difficulties in treating those who are often amongst the most vulnerable in society. We have also seen the extent of drug use in student populations and the risks associated with forcing this underground. We hope universities move away from threatened punitive measures, towards implementing support services and safe spaces with drug-testing facilities.
We are excited that a shift in the medical consensus is taking place and that during our careers we may see a shift in policy that would allow us to deliver the best treatment to those who need it most.
Competing interests: No competing interests
As outlined in this, and other recent reports and documents, change is increasingly supported from all sectors, not least the Colleges, the police and the public. Growing unease about the damage done by drugs and the potential for a better system has lead to fragmentation of international drugs policy and a era of experimentation in countries like the Netherlands, Uruguay and several US states on the basis that anything must be better than the present blind ideology of tougher restrictions for suppliers and the frankly hostile approach to drug takers. As the recent United Nations summit on drugs in 2016 showed, politicians are understandably reluctant to venture into areas fraught with complexities and without any prospect of a simple, risk free way forward. We are therefore left with the slow emergence of experimental changes and trials of local policy relaxation. Much of this shifting applies to cannabis and the UK's leading and ground breaking rescheduling of cannabis to reduce penalties, which was reversed within a few years, demonstrates the difficulty of formal relaxation of, in this case, penalties for possession of this drug, now returned to Class B in the Misuse of Drugs Act 1971.
Are we left then with a piecemeal process of change by trial and error without the formality of proper evaluation and funding of NHS services to cope with any unintended consquences? It would be far better to have a National and cross party truce on this important issue and the establishment of a Commission to explore the possibilities of a staged, controlled series of steps to arrive at a humane approach to drug users and an economically improved system for us all.
Competing interests: No competing interests
The news that the BMJ wishes to decriminalise cannabis alarms and appals me in equal measure.
Surely doctors should know about neurotransmitters and how they operate in the brain?
THC mimics and so replaces anandamide, one of the commonest and most important ones. Anandamide is responsible for keeping the release of other neurotransmitters in the brain under control and on an even keel.
However, the action of THC is very much stronger, especially in ‘skunk’, the sole form of cannabis available in London. It damps down the activity of the other neurotransmitters so that the brain is severely impaired. This is seen especially in the hippocampus where some neurons die due to lack of stimulation. Academic performance plummets, IQ points are lost and many youngsters drop out of education altogether.
Compounding this effect is the fact that the fat-soluble THC lingers in the brain cells for weeks, constantly reinforcing its damaging message. There are no enzymes to break it down. In contrast it takes only about an hour to break down one unit of alcohol.
Competing interests: No competing interests
I can only applaud the UK if they try to stop the prohibition of drugs. I do not believe in drugs. They are only medication. Some medications can be dangerous, and that is why they need to be sold with a medical prescription, and used with some precise posology. But to get this, we need legalisation.
A "drug" is only a medication which can become dangerous when it is prohibited. That should be obvious. Once prohibited, we create a criminal market which will target the kids at all street corners. They will not ask for an identity card, nor offer any posology: quite the contrary they will try to hook their "patient" with hazardous products without any quality and price controls.
Prohibition benefits only criminals and terrorists. It provides a simple way to get rich quickly, and to corrupt all levels of society--notably, the political level if only just to pursue prohibition. Al Capone was the main defender of prohibition of alcohol, for example. I am happy to see the UK coming back to reason on that subject. They will show a good example to everybody. To protect the kids, regulation and taxes are far more efficacious than prohibition and prison. Full legalisation is better than decriminalisation. In my opinion, the best would be the full *penalisation* of prohibition. It should be anti-constitutional.
Competing interests: No competing interests
Legalizing dangerous drugs is a bad idea. All it accomplishes is making drug use more prevalent. Look at the numbers. Legal drugs such as alcohol and tobacco cause more deaths than heroin; not because they are inherently more deadly, but because they are legal and more prevalent.
Legalizing addictive drugs is bad for public health. See preventdontpromote.org for an international organization dedicated to a rational approach to address the public health issue of drug addiction.
Competing interests: No competing interests
One of the first things to be carefully legalised, regulated, and taxed should be the plant Cannabis sativa L.
Be honest, marijuana is not a plant, it's is not even a drug, but it is derived from the cannabis plant. The term has long been used as slang for varieties of the cannabis plant which have enough THC to be desirable for the smoker, not necessarily for the others nearby. The varieties of the plant can be more fairly controlled by legislation which correctly identifies what marijuana actually is, and establishes augmentable controls for that, like this:
The term "marijuana" means all parts of the smoke produced by the combustion of the plant Cannabis sativa L. which is, as are the viable seeds of such plant, prohibited to be grown by or sold by any publicly traded corporation or subsidiary company, and such smoke is prohibited to be inhaled by any child or by any person bearing any firearm, as is the intake of any part or any product of such plant containing more than 0.3% THC by weight unless prescribed to such child by an authorized medical practitioner.
Competing interests: No competing interests
Evidence suggests that criminalizing drugs endangers the safety of vulnerable populations, and exposes them to the harms of toxic and cheap drugs. Therefore, a case can be made that legalizing and regulating drugs may be justified by more than one compelling interest. First, decriminalization is likely to eliminate the stigma of drug abuse, especially given the fact that the majority of drug abusers are victims who cannot seek help out of fear of penalties and stigmatization. Second, regulating drugs will allow for clinical studies and monitoring of side effects so that evidence-based best practices can be identified.
However, the argument that regulating the markets would generate substantial tax revenues does not serve the public interest in protecting the victims of drug abuse, simply because such revenues constitute a conflict of interest which would undermine efforts to curb the problem of recreational drug use.
Competing interests: No competing interests
Re: Drugs should be legalised, regulated, and taxed
Most of the time we read blogs and news regarding robbery, killing, and street fighting and looting. There are several groups in our communities who are addicted to drugs and we discriminate against them instead of helping them out.
On several occasions, drugs endanger the protection of susceptible communities, and expose them to the harms of toxic drugs. Now, the question arises whether all drugs need medical prescriptions before they can be used by the general population. For instance, most of the people in our community use nicotine or caffeine in their daily lives for recreation and pleasure. Should it be mandatory to obtain prescriptions for such recreational substances?
Having said that, the debate that controlling the trading markets would produce considerable taxation profits isn't going to assist the general public's fascination with safeguarding the sufferers of drug addiction. These kinds of income comprise a turmoil of curiosity, which might weaken initiatives to suppress the challenge of leisure substance abuse.
It would be fair to validate the types and quantities of drugs which must have medical prescriptions before consumption. Government authorities' help and support would be vital to make this valid for the betterment of communities and victims, who often get hurt by drug abusers and addictive people. In this way, we could be able to help peoplw who are addicted to drugs and support our communities from any unwanted effects.
Competing interests: No competing interests