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: (Published 03 July 2019) Cite this as: BMJ 2019;366:l4473

Rapid Response:

Re: Should the supply of cannabis be legalised now?

Legalising cannabis now would be an experimental risk on a population with unpredictable results. We therefore agree it’s wise to wait for long-term results from the States to fully understand the pros and cons of cannabis legalisation. It’s suggested that the Portuguese model would be the best to adopt in the future. Their drug policy is similar to Spain and Italy's, and seems a far more compassionate response to some of the most vulnerable people in society. However, since Portugal decriminalised cannabis in 2001, use has increased by 40%.[1] It is unsurprising that decriminalisation has increased use. Without fear of criminal repercussions, cannabis is effectively liberalised.

Should cannabis be legalised, our greatest concern is that of the impressionable young. The risk of psychosis and altered brain development is especially worrying amongst this age group.[2] Legalisation is unlikely to allow children under 18 years to buy cannabis, but illegal activity will inevitably target this impressionable age group and many will likely continue to fall victim to drug networks, crime and addiction.

Cannabis use is common and its illegal status has failed to succeed in deterring its users. We agree that legalisation will add much needed regulation to allow safer consumption and reduce adverse health effects, helping us to protect the more vulnerable of our society. However, we do not want the message for the current and potential users to be that cannabis is a socially accepted norm. Alcohol is an example of the possible harm this may precipitate.

Alcohol has been ranked as the most harmful drug used in the UK [3] and costs the NHS £3.5billion a year. Additionally, roughly 20% of in-patients use alcohol harmfully and alcohol-related incidents are very common up and down the country’s A&E departments.[4] Our question to the BMJ’s readers is a hypothetical one: if alcohol were ‘discovered’ now, would there be efforts to legalise and industrialise it, despite knowing how harmful it is for both short- and long-term use?

Braillon A. Re: ‘Killing two birds with one stone? Association between tobacco and alcohol consumption.’ Public Health 2018;159:148-149.
Wilkinson S, Radhakrishnan R, D’Souza D. Impact of Cannabis Use on the Development of Psychotic Disorders. Current Addiction Reports. 2014;1(2):115-128.
Nutt D, King L, Phillips L. Drug harms in the UK: a multicriteria decision analysis. The Lancet. 2010;376(9752):1558-1565.
Roberts E, Morse R, Epstein S, Hotopf M, Leon D, Drummond C. The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: a systematic review, meta‐analysis and meta‐regression. Addiction. 2019;.

Competing interests: No competing interests

15 July 2019
Elias Jamieson
Medical Student
Keira J Bralsford
University of Manchester