Intended for healthcare professionals

Rapid response to:

Education And Debate

Improving the quality of the cannabis debate: defining the different domains

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7227.108 (Published 08 January 2000) Cite this as: BMJ 2000;320:108

Rapid Response:

Legalising cannabis: public health domains of debate are too narrow

Strang et al raise a number of salient issues concerning the debate
over whether or not cannabis should be legalised. However, the eight
"domains of the cannabis debate" identified are exclusively centred around
a public health conception of what the relevant policy issues are. Whilst
this is understandable given the audience they address, it still fails to
take on board more fundamental considerations as to what the objectives of
public policy regarding recreational cannabis use should be.

The focus of the discussion provided by the authors is a reflection
of the fact that the medical profession has a natural tendency to judge
the public regulation and legal control of activities according to there
impact on the health of the public. Thus anything demonstrated as harmful
to human health is seen as inherently bad, whilst acitivities that promote
health are seen as something to be encouraged by public institutions.

An alternative vision of the objective of public intervention and
legislative structures is that they should exist to protect and improve
public welfare as distinct from public health. Whilst individual welfare
is clearly affected by health it will also encompasses a broader class of
personal benefits that people enjoy when freely undertaking specific
activities (including cannabis use), even where they are knowingly
exposing themselves to possible health risks.

This "welfarist" angle should not be confused with the libertarian
line which would espouse the removal of legal barriers that prevent people
having the freedom to do as they wish. In the welfarist paradigm public
regulation and control will always be required if cannabis use affects the
welfare (including the health) of parties external to the decision to use.
Public intervention is also needed to ensure that users are informed of
any risks involved with use, even if this involves telling people that at
present that the risks are largely unknown.

If it is accepted that health is only one aspect of individual
welfare, and that it is the responsibility of govenment to promote the
latter even if in certain instances this means compromising the former,
then a public health driven domain of debate will never offer a
satisfatory guidance over the desirability of the legal status quo
concerning cannabis use.

No competing interests

Competing interests: No competing interests

07 January 2000
Andrew Healey
Research Officer
London School of Economics and Political Science