Intended for healthcare professionals

Rapid response to:

Head To Head Head to Head

Should the supply of cannabis be legalised now?

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4468 (Published 03 July 2019) Cite this as: BMJ 2019;366:l4473

Rapid Response:

Should the supply of opium be re-legalised by Great Britain?

The pros and cons debate about cannabis deserved comment.(1)

First, why limiting the issue to cannabis? Comprehensiveness is the cornerstone of public policies, a prerequisite for effectiveness.

Second, the issue is not about “legalisation”. In Western countries access to cannabis is most simple, use most frequent and no criminalization against users since long. The real issue is “economic liberalisation”: promoting business and trade. Considering the huge profitability of the nicotine and alcohol businesses it is hardly understandable how the cannabis business can have stay out of the capitalistic economy yet.

Third, the debate should have been nurtured by a real life experiments:

a) in China. In 1838 the Daoguang Emperor acted against the opium trade and Special Imperial Commissioner Lin Zexu confiscated opium. British traders demanded compensation from their government and they succeeded in 1842 with the treaty of Nanking which opened a freeway for the opium trade …(https://en.wikipedia.org/wiki/History_of_opium_in_China)

b) in Portugal. Meacher, Nutt and Liebling concluded “the best option at present is to adopt the Portuguese model.”(1) This is flying in the face of devastating consequences.(2) In 2001 Portugal claimed it made using drugs a “health problem rather than a crime”. Since then the number of people using cannabis has gone up by more than 40 per cent and, the already high consumption of alcohol, tobacco and illegal psychoactive substances have been even increasing in the last years.(http://www.sicad.pt/PT/Cidadao/SubstanciasPsicoativas/Paginas/default.aspx ; http://www.sicad.pt/PT/EstatisticaInvestigacao/EstudosConcluidos/Paginas...) This has been reported in the media.(http://www.theportugalnews.com/news/alcohol-tobacco-and-drug-consumption...) Further, claims that this policy has increased access to care deliberately failed to account for a major confounding variable: health expenditure per capita (current US $) have increased two fold from 1.100 in 2000 to 2.100 in 2014, peaking in 2008 at 2.500!(2)

c) in Washington State. It was the first US state to “legalize” marijuana in 2012, with a most comprehensive public policy. One year before leaglization, it ended the state monopoly on liquor sales despite warnings it has been warned it could increase by 50% alcohol consumption. Previously, in 2008, it axed funding for the Basic Liquor Law Enforcement Academy, ending the program. In 2017 liquor taxes and fees were decreased from $35.22/gallon to 31.48.(3)

Public heath, as medicine, must rely on evidence but not on expectation or on opinion.

1 Meacher M, Nutt D, Liebling J, Murray RM, Gridley A. Should the supply of cannabis be legalised now? BMJ 2019; 366.

2 Braillon A. Re: 'Killing two birds with one stone? Association between tobacco and alcohol consumption.' Public Health 2018;159:148-149.

3 Braillon A. Effects of a comprehensive pro-alcohol policy in Washington State. Alcohol Alcohol 2019;54:119-121.

Competing interests: No competing interests

09 July 2019
alain braillon
senior consultant
university hospital 80000 Amiens. France.