Introduction Cannabis is the most widely used illicit substance in the world, The United Nations office of drugs

and crime (UNDOC) estimates that in 2009, between 2.8% and 4.5% of the world population between the ages of 15-64 had used cannabis in the past year, translating to between 125 and 203 million people1. It is however prohibited in almost all countries, which today is upheld by the 1961 and 1988 single convention on narcotic drugs, requiring all signatories to criminalize production, distribution use or possession of a wide range of drugs, including cannabis2 . The plants properties, its prohibition and its use has long been a source of controversy, with a wide variation of advocates and adversaries throughout the public arena, medical and scientific communities, academia, religion, politics and beyond. In the case of the United Kingdom, this controversy can be traced back to Britains first dealings with cannabis as an intoxicant, in the late 17th and 18th centuries during British colonial rule over India. Historical Context Hemp had been widely used and domestically grown by the British between 800 and 1800 AD, as a source of fibre for the ropes, rigging and sails of the British navy and indeed other maritime groups such as fishermen and traders, as well as paper, oil and clothing.3 It was seen as very important in supporting the interests of the empire, not only in terms of military force (and therefore control and conquering of established and yet to be established colonies), but also in terms of economic power. Britains exports and imports relied on the use of hemp in transporting merchants and their cargo, to various trading ports throughout the empire. This put hemp at the forefront of the established powers minds very early on; in 1563 landowners possessing 60 acres if of land or more were subject to a 5 fine if they did not cultivate hemp, under a decree from Queen Elizabeth I.4 In the 19th century those in the British colonial scientific and medical circles began to compile their own research and experience on cannabis as an intoxicant. One of the first and most important accounts was by Whitelaw Ainslie, superintending surgeon in Madras, who wrote an account of Ganjah in 1813.5 Before considering his research, it is important to note his religious leaning, as it considerably affects the context in which we view his results. Ainslie was a dedicated Christian, and believed heavily in abstinence of intoxicating substances, his commitment to these values and indeed to god over science, was made clear across a number of his publications such as; An historical sketch of the introduction of Christianity into India and its progress and present state in that and other countries which in the title alone suggests he was a missionary himself, or at least maintained a dedicated interest to missionary work. He also wrote a chapter in volume iii of the Historical and descriptive account of British India in which he denounces those who indulge in

UNDOC world drug report 2011 - http://www.unodc.org/documents/data-andanalysis/WDR2011/World_Drug_Report_2011_ebook.pdf 2 Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, page 7. 3 Henfaes Research Centre, University of Wales, Bangor. http://www.flaxandhemp.bangor.ac.uk/english/fibre_culti.htm 4 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 18. 5 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 33.

intoxicating substances.6 His account of Ganjah does make mention of some medical use in cases of diarrhoea and piles, they (the leaves) are also sometimes given in cases of diarrhoea and states its use as an ingredient of an application for painful, swelled and protruded piles. However he chooses instead to dwell primarily upon its intoxicating qualities of which he was heavily opposed, speaking of smoking the plant and the preparations of Bangie and Majum for intoxicating purposes.7 But it is 6 pages later in which section he more extensively discusses the preparations of Bangie and Majum that his bias towards a temperate lifestyle become glaringly apparent. This electuary is much used by the mahometans, particularly the more dissolute, who take it internally to intoxicate, and ease pain; and not so unfrequently, from an overdose of it, produce a temporary mental derangement8 He immediately brands users of these substances to be dissolute whilst continuing to shift focus from medicinal properties to intoxicant properties. His use of the word overdose is also heavily inaccurate, the human overdose range of cannabis is estimated to be 15-70g, said to be many times greater than the dose that even heavy users could consume in a day9. This text was published by the government press under special permission of the government itself, leading a relatively flawed and lacking account of Cannabis to become an accepted and authoritative text. Similarly, Dr. Robert Kaye Greville, accountable for texts such as Facts illustrative of the drunkenness of Scotland with observations on the responsibility of the clergy magistrates and other influential bodies of the community 10 and a compiler for the 1838 Scottish Church of England Hymn book11, wrote a piece on Cannabis named An account of a few of the more remarkable Indian plants in which the species are arranged according the natural families to which they belong which was a chapter of the Historical and descriptive account of British India in which Ainslie was also published. His information was drawn from John Forbes Royle and his account of cannabis in Illustrations on botany and other branches of the natural history of the Himalayan Mountains and of the flora of cashmere however Greville had ignored various statements on the plants many uses outside of Europe aside from intoxication, stating the opposite (cannabis sativa) is less well known out of Europe for its useful fibre than the intoxicating and stupifying qualities of its leaves and attributed its use to the vilest of purposes.12 It is early medical texts such as these which began, through insufficient understanding, perhaps chiefly due to a lack of direct experience with preparations, the
6

J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 35. 7 Ainslie, Whitelaw. Materia medica of Hindoostan: and artisan's and agriculturist's nomenclature. Madras, India : Printed at the Government Press, 1813. Page 80, sequence 100. Harvard university library page delivery service. http://nrs.harvard.edu/urn-3:HMS.COUNT:1171574 (searched from cannabis Britannica)
8

Ainslie, Whitelaw. Materia medica of Hindoostan :and artisan's and agriculturist's nomenclature. Madras, India : Printed at the Government Press, 1813. Page 86, sequence 106. Harvard university library page delivery service. http://nrs.harvard.edu/urn-3:HMS.COUNT:1171574 (searched from cannabis Britannica)
9

Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, page 17.
10

Archives Hub Administrative/Biographical history http://archiveshub.ac.uk/features/0503greville.html (searched from cannabis Britannica) 11 Darwin Correspondence project University of Cambridge - http://www.darwinproject.ac.uk/namedef-1981 (searched from cannabis Britannica) 12 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 37/38.

limited scientific knowledge of the time in which it was written, and through religious and moral bias that the misconceptions of cannabis were beginning to surface and become held as fact. It seems wise to observe that this kind of bias may well have been commonplace when employing the work of medical men and scientists who served a heavily Christian state. This was not, of course, the definitive case across the empire or its medical or scientific circles. William Brooke OShaughnessy, for example, is accredited with introducing medicinal cannabis to western medicine; in 1839 he published a 40 page article in consideration of the therapeutic benefits of cannabis13 which he presented to students and scholars of the Medical and Physical Society of Calcutta the same year14. Similarly he produced 25 page account of cannabis in the Bengal dispensatory and companion to the pharmacopoeia He was the first western medical man to conduct clinical trials of cannabis himself, as opposed to lifting information from second hand sources, speculation and hearsay. Whilst addressing the plants intoxicant properties in his opening he was careful to mention the medical benefits available from cannabis, in which he robustly believed and advocated. 15 This belief however was drawn from his clinical trials, beginning with trials on a phenomenally wide range of animals to ascertain its safety as a substance, these animals included fish, dogs, cats, swine, vultures, crows, adjutants, horses, deer, monkeys, goats, sheep and cows16. After concluding the substance was safe for human experimentation, gathered from his experiments with animals and reference to such authorities as Acosta, Royle and Ainslie, he began human trials. OShaughnessy successfully treated a multitude of afflictions in his patients, and discovered cannabis had analgesic and sedative properties. Amongst the afflictions treated were rheumatism, cholera, infantile convulsions of a 40 day old baby, delirium tremens and most famously the control of muscle spasms in cases of rabies and tetanus.17 Whilst many of these diseases cannot be cured by cannabis, it had therapeutic effects which improved the general health and wellbeing of the patient, and in OShaughnessys words, if he could not cure; it was his duty as a member of the medical profession to strew the path to the tomb with flowers18. He also addressed the image of cannabis which had been built on a range of bias and misconceptions; as to the evil sequelae so unanimously dwelt on by all writers, these did not appears to us so numerous, so immediate or so formidable as many which have been clearly traced to over-indulgence in other powerful stimulants or narcotics viz alcohol, opium or tobacco.19 Here, the first investigation to thoroughly address cannabis as a singular from a firsthand perspective, had demonstrated positive
13

T.H.Mikuriya MD, Marijuana in medicine: Past, present and future, Calif Med, 1969, Page 34. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1503422/?page=1 14 Michael R. Aldrich, Ph.D. The Remarkable W. B. O'Shaughnessy, 2006. http://antiquecannabisbook.com/chap2B/Shaughnessy/Shaughnessy.htm 15 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 41. 16 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 43. And Michael R. Aldrich, Ph.D. The Remarkable W. B. O'Shaughnessy, 2006. http://antiquecannabisbook.com/chap2B/Shaughnessy/Shaughnessy.htm 17 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 43. And Michael R. Aldrich, Ph.D. The Remarkable W. B. O'Shaughnessy, 2006. http://antiquecannabisbook.com/chap2B/Shaughnessy/Shaughnessy.htm and T.H.Mikuriya MD, Marijuana in medicine: Past, present and future, Calif Med, 1969, Page 34. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1503422/?page=1 18 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 44. 19 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 42.

results. James H Mills makes a critique of this work, as OShaughnessy was purported to be of humble origins, and could be said to have been attempting to establish a reputation and financial security during a period in which a lot of money resided in medical innovation. However, further scientific and medical studies of cannabis since; have proven similar results, especially in the case of muscle spasms, as medical cannabis is widely used for diseases such as MS, and will be discussed later. Whilst the colonial scientific and medical communities were forming their own opinions and debates as to the nature of Cannabis, the British noted a significant trade in the substance and began to increase its administrative involvement in this trade. Whilst supplementing the profit margins of the empire through taxation with gradual extension, the involvement of the British in the Indian cannabis trade had some adverse effects. Initially a simple licence was required to be paid for by the retailer before approaching the producers, bought from the local colonial official20, beyond requiring the use of and supplying this licence, the British paid little attention to the details of the trade. This was the case from 1793 until changes were made in 1854, when the potential for increased revenue was realised and an increased interest in production and consumption patterns arose. These changes allowed the colonial government to tax the wholesaler in their place of business, and a district collector was sent to assess the holdings of the wholesaler, and the amount the retailers were purchasing. Following this Act II of 1876 introduced a series of licences which applied to the cultivators and the wholesalers. Cultivators were required to obtain a licence to cultivate in order for the district collector to be made aware of their presence and to be able to estimate their harvest. They were also required to obtain a storage licence, which stated how much cannabis was to be stored. The wholesalers became required to obtain an export licence which limited the amount of cannabis returnable to their home district and were also required to possess a licence to purchase cannabis from the cultivators. Before returning to his home district, his stock was weighed and checked by the supervisor of staff, and his means of transportation searched to ensure his limit had not been exceeded, and no illicit cannabis was being smuggled.21 The first hints of criminality to be associated with cannabis in the minds of the colonial government originated in illicit trade of untaxed cannabis. A distinction was drawn between that which was authorised by the colonial government and government of India which was subject to tax and that which had been cultivated off of the radar of both government powers. These vast increases in tax led to an increase in ganja smuggling as the peasant cultivators attempted to protect their income from the prying hands of the British government tax system. Babu Hem Chunder Kerr was appointed as a special officer by the Bengal government in 1877 to examine the cultivation of ganja, in order to evaluate the proficiency of the current system and any reforms therein which may need to be applied. His report, known formally as Report of the Cultivation of and Trade in Ganja in Bengal was highly extensive and was referred to later by the Indian hemp drugs commission. 22
20

J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 58.
21

J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 59. 22 T.Mikuriya, Excerpts from the Indian Hemp Commission Report, Last Gasp, 1994, page 18

He made note of several issues regarding the governments attempts to control the cannabis trade, due to the mass extent of cultivatable land and the highly suitable climate available to cannabis growers in India, there were a considerable number of cases in which the area being declared for cultivation, was smaller than the area which was genuinely under cultivation. The colonial government had underestimated the limitations of their state in enforcing taxes on a plant which grew both wildly and under peasant cultivation. Limited representatives were available to survey the areas, the supervisor has not the means of making such an inquiry, as he has not men enough to go to the chators, or to the houses of about 200 men. He also stated that other evasive methods, such as clearing jungle areas for cultivation out of authoritative view, concealment of cannabis across the farms and indeed removal of supplementary stock preceding the supervisors visit and accidental fires in order to explain missing produce, were all employed by a number of the local cultivators. A network of Ganja smugglers had developed using the Bengal river system, amongst other methods. Kerrs report suggested a vast increase in law enforcements intervention with these activities, including a mounted division, stationing of officers of the ganja supervisor every 16sq miles, increased surveillance of cultivation areas and of the harvest process. This increasing economic interest of the British in Indian cannabis trade had led to the first stirrings of the black market, increased spending and time on the part of law enforcement and a criminal association with an age old trade which had previously been the simple growth and cultivation of a naturally growing plant.23 The link between madness and cannabis was first given solid backing by an authoritative power in 1872, when, following the analysis of lunatic asylum statistics which attributed the highest cause of insanity to cannabis, the Government of India issued a statement in relation to cases of lunacy, which declared that by far the largest number must be attributed to hemp.24 These statistics were deeply flawed and refuted by many, police officers with no medical knowledge and a desire to increase the efficiency of the administrative process had been known to fill the cause of insanity with cannabis where the cause was not immediately apparent or there was no evidence as to a cause, and the person in question was a known user. Subsequently, superintendents at the asylums began to record the guesses of police and local informants as official causes. As well as this, criminals used cannabis as an excuse for their crimes, similarly to the abuse of the insanity plea in contemporary law. Dr Simpson stated in the Annual Report on the Insane Asylums in Bengal for the Year 1874 that it would appear that if the man be a Ganjah-smoker the drug is invariably put down by them as the cause of insanity. Secondly, the same superintendants began to observe these patients as the sole representation of cannabis users in India, clearly ignoring the vast proportion of users across India during this period.25 Similarly flawed statistics were also drawn from Egypt, and were used in the eventual establishment of international controls following the opium conventions. The Egyptian Lunacy Department compiled statistics based on the work of an English man, John Warnock, who himself admitted a lack of funding and A lack of Arabic language skills combined with an absence of English language skills in patients and staff, leading him to rely for some time on the delusional translations of a patient, meaning he could only look on and guess in most matters. His methods are purported to have
23

J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 60-68.
24

J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 82. 25 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 86-88.

included repeated questioning of patients to obtain a confession to cannabis use, and again he based his small exposure to cannabis users in lunatic asylums as applicable to the general population, also referring to and ironically parroting similar results to the already disputed Bengal asylum statistics.26 It has been said that even were the numbers produced by these statistics correct, the proportion of those claimed to be made insane by cannabis would be infinitesimally small in comparison with the number of users in the local societies from which they were drawn.27 A review of the evidence of the link between cannabis and psychotic disorders compiled in 2008 and published in the British Journal of Psychiatry following work by researchers from the university of Bristol, produced an interesting conclusion. It seems that the contemporary evidence available in support of a link between mental illness and cannabis is open to similar criticisms. It stated Few studies adjusted for baseline illness severity, and most made no adjustment for alcohol, or other potentially important confounders. Adjusting for even a few confounders often resulted in substantial attenuation of results. Concluding that Confidence that most associations reported were specifically due to cannabis is low. 28 Some of the founding factors in the prohibition of cannabis seem to have been and continue to be ill informed and unreliable, it is interesting that over 200 years on from the publication of the Indian and Egyptian statistics, much of the available evidence seems to remain flawed and opinion remains divided. It was towards the end of the 19th and the early 20th century that cannabis prohibition made its way onto the international agenda. Following calls made to establish investigations into opium and hemp use, primarily by temperance campaigners and opponents of the opium trade, such as Mark Stewart MP, who first introduced the issue of Indian hemp to parliament in 1891, and William Sproston Caine who continued with the issue after Stewart lost interest becoming more focused on opium29, the Indian hemp drugs commission (IHDC) was formed and investigated between 1893/4. It involved seven members and compiled 8 volumes of witness statements from across India, its conclusions were that moderate use of cannabis was not harmful. 2 Members rejected the findings pointing to the asylum statistics of Bengal, but these were disputed by the rest of the commission as invalid. Its age old involvement in Indian culture and the large tax revenues gained from the trade no doubt played a part in their conclusions, tax, licences and limitations on sale and possession were its recommendations.30 Cannabis was first brought to the forum of international regulation at the International opium conference of 1912, hosted at The Hague in the Netherlands, which was to become the venue for the series of opium conferences. It was brought to the floor by the Italian delegation in a last minute proposal, but due to a lack of preparation from other delegates, a lack of a plan of action from the
26

J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 182-187. 27 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 210.
28

Zammit S, Moore TH, Lingford-Hughes A, Barnes TR, Jones PB, Burke M, Lewis G. Effects of cannabis use on outcomes of psychotic disorders: systematic review, British Journal of Psychiatry. 2008 Nov;193(5):357-63 http://www.ncbi.nlm.nih.gov/pubmed/18978312

29

J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 93-96. 30 Medical history of British India, National library of Scotland, http://digital.nls.uk/indiapapers/drugs.html

Italians and a lack of scientific definition on hemp, the proposal did not make it onto the international opium convention of 1912, which focused on opium, morphine and cocaine.31 A stagnant period followed during WW1, in which time more serious concerned gripped the worlds nations than drug regulation, but the conferences were reconvened in the post war period under the League of Nations in 1921 under the guise of The advisory committee on traffic in opium and other dangerous drugs.32 Cannabis however, remained off the agenda until 1924, following a letter from the South African union received at The Hague on the 28th November 1923, asking for the inclusion of Indian hemp preparations in the list of habit forming drugs. The British delegate Malcolm Delevigne and John Campbell of the India office were first to raise the issue to the committee, quick to indicate the British and Indian governments previous awareness and research into the issue, they suggested it for full consideration given time for other delegates to gather information on the issue. This was largely in order to establish a moral grounding from which to defend the considerably larger opium revenues of the empire. 33 It was Dr Mohamed A. S. El Guindy, the head of the Egyptian delegation, however, who carried and secured the inclusion of cannabis, previously used as cannon fodder by Britain and India. He made a speech on the 13th December 1924, denouncing cannabis as at least as harmful as opium, if not more so immediately basing his argument on complete misgivings about cannabis. He went on to accuse the incitement of violence to be related to cannabis, and associated insanity, by referring to The Egyptian Lunacy Departments flawed statistics compiled under John Warnock, to state that 3060% of cases of insanity in Egypt were down to cannabis. Finally, he stated the widely disputed gateway theory;34 some studies today have shown that cannabis may in fact have the opposite effect to encouraging harder drug use.35 He warned that following prohibition of substances other than cannabis, the drug would become a terrible menace to the whole world and that in ignoring the issue the League of Nations would appear to be taking a Eurocentric stance in solely protecting European interests. Many countries supported the motion despite admittance to knowing next to nothing about the subject such as China, The US, Turkey, Japan, Brazil, Poland and Greece and the proposal was accepted. 36 The 1920s was home to a wide range of drug scares in the United Kingdom, which created a context of social fear often surrounding misinformed institutions and medical men, moral panics created by the media, and a racist sentiment created from the ethnic origin of the drugs themselves. Eventually this had an influence in decision over policy. Scotland yard had been lobbying for cannabis to be included on the dangerous drugs act, stating it appears that it has practically the same effect as cocaine and morphine has upon its victims in a letter to the home office in 192337 Cannabis is here, yet again, being included with far more serious and harmful drugs in consideration of its prohibition. Medical journals such as the BMJ produced articles such as Cannabis Indica: A Dangerous Drug which made use of flawed Bengal asylum
31

J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 154-156. 32 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 157. 33 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, pages 160, 161 & 164. 34 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, pages 169 & 170. 35 Harm Reduction Journal, Long term marijuana users seeking medical cannabis in California (20012007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Thomas J O'Connell and Ch B Bou Matar, 2007. http://www.harmreductionjournal.com/content/4/1/16 36 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, pages 171 & 173. 37 J.H.Mills, Poisons, the police and the Pharmaceutical Society: cannabis and the law in the 1920s, The Pharmaceutical Journal, 269, December 2002.

statistics38 to make its case. Media hype and moral panic surrounded the case of Thomas Garza and Idris Abdullah in 1923, two alleged opium dealers who, following an investigation by New Scotland yard were found to be peddling hashish, a perfectly legal drug, instead of the opium they were originally accused of dealing with. The police pushed for conviction regardless but failed and the media created a flurry of headlines and articles containing gross misinformation, The Times for example stating hashish was used in that form for exactly the same purposes as heroin, cocaine and morphine on 18th august 1923, other headlines included the new dope peril and Hashish: drug forgotten by law39 It was these circumstances coupled with the international drug debate which led to major legislative changes in the UK. In 1923 the pharmaceutical society proposed cannabis be added to the poisons acts in light of the recent dealings with hashish in the courts, this was approved by the privvy council and came into effect in 1925, meaning that only chemists could sell substances containing cannabis.40 That same year the amendments to the dangerous drugs act were made following the conclusions of the opium conventions ratification in parliament41, these controlled the exportation and importation of cannabis and gave government the power to pass further regulation on cannabis. It was in 1928, in making use of the new powers granted by the 1925 opium convention, that cannabis was prohibited in the United Kingdom. The dangerous drugs act was amended once again to include the cocoa leaves and Indian hemp regulations again listing cannabis alongside constituents of cocaine, a far more harmful drug. These regulations restricted the right to sell or possess preparations of cannabis to those in medical professions, and those carrying a licence or prescription. 42 What followed this initial grouping of drug regulations was an escalation in both national and international state control and surveillance of drugs and their markets. In 1934, the home office drugs branch was formed to coordinate state drug strategies43, collect statistics on drug addiction and monitor doctors prescriptions and pharmacists dispenses to addicts, following the requirements of a 1931 International Convention.44 Contemporary Policy In 1961 the UN instated the UN Single Convention on Narcotic Drugs, this broadened and consolidated existing treaties into a coherent whole, embracing nine multi lateral treaties which were negotiated between 1912 and 1953. The convention focused primarily on plant based drugs and their derivatives, for example; Opium, Cocaine, Heroin, Cannabis and Morphine45, extending the

38

J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 201. 39 J.H.Mills, Poisons, the police and the Pharmaceutical Society: cannabis and the law in the 1920s, The Pharmaceutical Journal, 269, December 2002. 40 J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 201. 41 Transform Drug policy foundation, a history of drug prohibition and a prediction for its abolition and replacement, http://www.tdpf.org.uk/Policy_Timeline.htm#_edn3
42

J.H.Mills, Cannabis Britannica, Empire, trade and prohibition 1800-1928, Oxford University Press, Oxford, 2003, page 189. 43 Transform Drug policy foundation, a history of drug prohibition and a prediction for its abolition and replacement, http://www.tdpf.org.uk/Policy_Timeline.htm#_edn3 44 Release, Drugs through time 1900-1939, http://www.release.org.uk/drugs-law/drugs-through-time/19001939 45 Release, Drugs through time 1940-2008, http://www.release.org.uk/drugs-law/drugs-through-time/19402008

existing controls to the cultivation of plants grown as the raw material of narcotic drugs46. The significance of this being that it enshrines prohibition in domestic law and creates the foundations for a global penal response to drug use. It added Cannabis to a list of prescribed substances and introduced the schedule scheme which went on to form the basis of the UK and US drug prohibition systems. Collectively it also denies the possibility of regulated systems of production and supply, even if a member state wished to do so democratically. This was implemented in 1964 in the United Kingdom in another amendment to the Dangerous Drugs Act. The international pressures of a prohibitionist control system were only to increase from here. America had been pushing for global systems of regulation very early on during the Opium conferences at The Hague, and by 1971, President Richard Nixon had launched the War on Drugs policy which continues to this day. The drug menace was declared Public Enemy Number One by Nixon, however, this approach was first instated due to concern of rising levels of drug use in US troops serving in Indochina, one of the first measures taken being mandatory urine tests for the US military.47 The US carries heavy influence in promoting a global prohibition regime using economic, diplomatic and military influence to discourage other UN member states from adopting alternative approaches.48 The United Kingdom meanwhile, had introduced the 1971 misuse of drugs act. This act defined unlawful supply, intent to supply, import or export and unlawful production, it also introduced unlawful possession, which gave the police greater stop and search powers in the case of reasonable suspicion the suspect was in possession of a controlled drug. Most importantly, it introduced the class system which remains in place today, categorising drugs into classes A, B and C, which carry alternate sentences for both possession and supply. This system has been widely critiqued and will be discussed later. Cannabis is was initially and is currently at class B, which carries a maximum of 5 years in prison and a fine for possession, and 14 years and a fine for supply. A series of 5 schedules controls defines the regulation of drugs in regard to medical and scientific use. Cannabis is in schedule 1, the most strictly controlled schedule, which stipulates that it is not authorised for medical use and can only be supplied possessed or administered in exceptional circumstances with a licence from the home office, primarily for research purposes. This is despite Cannabis having a widespread historical use in medicine, and many studies having shown medical benefits of Cannabis, having been published prior to, and extensively after the creation of this law. This denied a legitimate form of medical treatment to people with genuine medical issues. A 2001 amendment to section 8, made it a criminal offence for anyone to knowingly allow premises they own, manage or are responsible for to be used for administration, use, supply production or cultivation of any controlled drug, with specific regard to cannabis growing and smoking.49 In January of 2004, following the recommendations of the Advisory Council on the Misuse of Drugs (ACMD), Cannabis was downgraded to class C by then home secretary David Blunkett. This reduced the penalties seriousness, and limited the application of punitive measures and arrest to aggravated circumstances. Although concern was raised over the effect of this on user numbers, the Independent Drug Monitoring Unit stated in 2005 that the number of users had remained stable. This move was condemned by UN drug agencies, demonstrating once again the international

46

International Narcotics Control Board, UN Single Convention on Narcotic Drugs, 1961, http://www.incb.org/incb/convention_1961.html 47 The Guardian, Nixon's 'war on drugs' began 40 years ago, and the battle is still raging, http://www.guardian.co.uk/society/2011/jul/24/war-on-drugs-40-years 48 Release, Drugs through time 1940-2008, http://www.release.org.uk/drugs-law/drugs-through-time/19402008 49 Drugscope, Drugs Laws, Misuse of Drugs Act 1971, http://www.drugscope.org.uk/resources/drugsearch/drugsearchpages/laws

pressure applied upon choices of domestic drug law.50 A selection of Anti-Drugs campaigners, scientists and MPs argued that this shift in classification ignored purportedly increasingly harmful forms of cannabis such as Skunk, which it was argued, post a higher risk to users due to its increased THC content, than its 1960/70s counterparts, increasing from approximately 5% to 10-15% THC51, combined with increased use would lead to increased schizophrenia. However a study conducted at Keele University, published in 2009, Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005 found nothing to support the theory that increasing cannabis use over the previous 3 decades had led to increases in the incidence of schizophrenia, noting that there were in fact significant reductions in the prevalence of schizophrenia. 52 The government announced in July 2007 its intentions to examine reclassification to class B following the 2004 change, which was linked largely to public perception and concerns about mental health issues in relation to cannabis. Gordon Brown had just filled the shoes of Tony Blair, and many have argued that the governments concern about its public image and an attempt by Gordon Brown to improve his personal public relations largely drove the decision to reclassify. The same month, the ACMD was asked to review the classification of cannabis in the light of public concern about mental health effects of cannabis use and the use of stronger strains of the drug, which it did so in Cannabis Classification and Public Health which was published on 7th May 2008. Gordons public image concern is ratified in his behaviour towards the ACMD, the council set out to advise government drug policy. Although the ACMDs recommendations are not binding, it is largely irresponsible to ignore a group of expert opinions in light of political concern. The ACMD concluded its findings in a letter to the home secretary Jacqui Smith; After a most careful scrutiny of the totality of the available evidence, the majority of the Councils members consider based on its harmfulness to individuals and society - that cannabis should remain a Class C substance. It is judged that the harmfulness of cannabis more closely equates with other Class C substances than with those currently classified as Class B 53 The government responded to this within the same month, and concluded that despite the ACMDs findings and recommendations, cannabis was to be reclassified to class B, taking effect from January 2009. Their public consultation which ran from July to October 2007, Drugs: Our Community, Your Say found that respondents were in their majority against the reclassification of cannabis, favouring either its current class C status, or the legalisation of cannabis as policy methods. The government stated in its response that whilst it does not dispute the ACMDs findings on harm, its classification policy was to reflect the inconclusive areas of potential long term health impacts, in order to err on the side of caution it also stated that In reaching its decision the government has also taken into account wider issues such as public perceptions despite their own studies demonstrating desired action was opposite to that taken by the government54.
50

Release, Drugs through time 1940-2008, http://www.release.org.uk/drugs-law/drugs-through-time/19402008 and Transform Drug policy foundation, a history of drug prohibition and a prediction for its abolition and replacement, http://www.tdpf.org.uk/Policy_Timeline.htm#_edn3 51 Politics.co.uk, Drugs, http://www.politics.co.uk/reference/drugs 52 Frisher, M, Crome, I, Martino, O, Croft, P, Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005 , Schizophrenia Research, Volume 113, Issues 2-3, September 2009, Pages 123-128. 53 ACMD, Cannabis Classification and Public Health, May 2008; http://www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/acmd1/acmd-cannabis-report2008?view=Binary
54

The Home Office, Explanatory Memorandum to The Misuse of Drugs Act 1971 (Amendment) order 2008, http://webarchive.nationalarchives.gov.uk/20100419085655/http://drugs.homeoffice.gov.uk/public ation-search/cannabis/impactassessment2?view=Binary

In January 2009, cannabis was reclassified in the United Kingdom to class B, where it currently remains, alongside drugs such as Amphetamine or Speed and Mephedrone or MMCAT. The sacking of Professor David Nutt of the ACMD by Home Secretary Alan Johnson also followed in October that year, the day after he claimed in his paper Estimating Drug Harms: A Risky Business that alcohol and tobacco were more harmful than LSD, MDMA and Cannabis and heavily criticised current government drug policies55. This is just one in a long history of examples of the politicised nature of drug control, Nutt himself stated in his report that the precautionary principle misleads. It starts to distort the value of evidence and therefore I think it could, and probably does, devalue evidence. 56 Health and Harm Psychosis The current debate surrounding cannabis is primarily centred around its supposed effect on psychosis, namely in aggravating Schizophrenia onset. The debate on mental health and cannabis, having existed since the lunatic asylum statistics of Bengal and Egypt aforementioned, has continued to lend itself to areas of state concern to this day. Schizophrenia is a chronic, severe and disabling brain disorder, its symptoms include; hallucinations, delusions, thought disorders, movement disorders, a lack of sociability, emotiveness, focus or attention and a difficulty to use information to make decisions. It affects all ethnicities and genders at a similar rate and symptoms are most likely to reveal themselves between the ages of 16-30, generally failing to develop after the age of 45.57 It is important to remember that cannabis is not a cause of schizophrenia, as is the wide misconception, but acts as a trigger for predisposed mental health issues, although these may not have surfaced without cannabis use.58 The disorder is caused by genetic traits and environmental factors, such as hereditary transfer of psychological issues and viruses, malnutrition or complications during birth, furthermore, people with schizophrenia have a different brain chemistry and structure in comparison with healthy people. A chemical imbalance of the neurotransmitters dopamine and glutamate which allow the brain cells to communicate is prevalent in sufferers; the brain may have a different physical appearance and contains differences in distribution or characteristics of brain cells which most likely occurred at birth.59 A study of 50,465 Swedish conscripts in 1987 found that those who had tried cannabis by age 18 were 2.4 times more likely to be diagnosed with schizophrenia. A follow up study in 2002 of the same Swedish cohort estimated that 13% of schizophrenia cases could be averted if cannabis use were prevented in its entirety60. Similar studies conducted by the ACMD estimated smokers were 2.6 times more likely to have a psychotic-like experience than non-smokers, however Nutt went further
55

The Guardian, Chief drug Adviser David Nutt sacked over cannabis stance, 30 October 2009, http://www.guardian.co.uk/politics/2009/oct/30/david-nutt-drugs-adviser-sacked 56 Nutt, D. Estimating Drug Harms: A Risky Business, Centre for Crime and Justice Studies, Briefing 10, October 2009, Page 8. 57 US Department of Health and Human Services, National Institute of Mental Health, Schizophrenia, NIH Publication 09-3517, 2009, pages 1,2,3 & 4. 58 Rethink, Causes of schizophrenia, Schizophrenia factsheet, page 7, http://www.rethink.org/about_mental_illness/mental_illnesses_and_disorders/schizophrenia/causes_of_schi zophre.html. 59 US Department of Health and Human Services, National Institute of Mental Health, Schizophrenia, NIH Publication 09-3517, 2009, page 6. 60 Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, page 35&36.

th

in stating To put that figure in proportion, you are 20 times more likely to get lung cancer if you smoke tobacco than if you dont. Thats the sort of scaling of harms that I want people to understand. There is a relatively small risk for smoking cannabis and psychotic illness compared with quite a substantial risk for smoking tobacco and lung cancer.61 This kind of scaling has been absent in the mainstream media, and the risk of schizophrenia to smokers has been largely overplayed by out of context statistics. For example, The Daily Mail reported in 2007 that a new study published in The Lancet had shown that A single joint of cannabis raises the risk of schizophrenia by more than 40 per cent62, however failed to mention that the general population risk of developing schizophrenia is 1%63 this means that the 40% risk The Daily Mail has chosen to emblazon across its pages, is in fact, an increase of just 0.4%, bringing the risk from 1% to 1.4%. (check the maths on this) Studies have also found that in order to prevent just one case of schizophrenia, in British men aged 20-24; you would need to prevent 5000 men from ever smoking cannabis64. Furthermore, research and a review of all the available evidence by Glynn Lewis of the University of Bristol in 2009 suggested that if regular cannabis use doubles the risk of psychosis (not to be considered indefinitely as schizophrenia, rather to be considered as an abnormal condition of the mind which could either include, or include symptoms similar to; schizophrenia), then 96% of regular users would not develop psychosis, whilst the remaining 4%, albeit anyones guess which 4%, would develop psychosis65. These statistics indicate that whilst there is a risk to vulnerable individuals, although there are some minor disparities in the scientific community as to the exact risk it poses, it is a relatively low risk affecting a minority of people, especially when brought into comparison with the risks associated with legal drugs such as tobacco and alcohol. One of the main issues surrounding conclusive evidence on cannabis in relation to schizophrenia is despite large increases in cannabis use and potency over the past 30 years; incidences of schizophrenia on a population level have experienced no upswings and no evidence has been found linking cannabis use in a population to rates of schizophrenia.66 Furthermore people who have schizophrenia are more likely to have a substance or alcohol abuse problem than the general population, notably, addiction to nicotine is most common with schizophrenics addiction at a rate of 3 times that of the general population; 75-90% vs. 25-30%67 which suggests the question as to whether or not schizophrenics are simply more likely to use cannabis. This demonstrates that whilst cannabis may be harmful to individuals with predisposed genetic traits, brain chemistry and structure, and can aggravate symptoms therein; it has little effect in increasing the prevalence of schizophrenia on a general population level and is statistically minimal in relation to the general
61

Nutt, D. Estimating Drug Harms: A Risky Business, Centre for Crime and Justice Studies, Briefing 10, October 2009. 62 Macrae, F, Andrews, E. Smoking just one cannabis joint raises danger of mental illness by 40%, The Daily th Mail, 26 July 2007. 63 Helpguide, Understanding Schizophrenia, http://helpguide.org/mental/schizophrenia_symptom.htm 64 Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, page 36&37. And; Nutt, D. Estimating Drug Harms: A Risky Business, Centre for Crime and Justice Studies, Briefing 10, October 2009, page 4. 65 Moore, T. Zammit, S. Lingford-hughes, A. Barnes, T. Jones, P. Burke, M. Glynn, L. Cannabis use and risk of psychotic or affective mental health outcomes; a systematic review, Lancet, publication 370, 2007, Pages 319328. & Email from Glynn Lewis Himself. 66 Nutt, D. Estimating Drug Harms: A Risky Business, Centre for Crime and Justice Studies, Briefing 10, October 2009, page 4. 67 US Department of Health and Human Services, National Institute of Mental Health, Schizophrenia, NIH Publication 09-3517, 2009, page 5. http://www.nimh.nih.gov/health/publications/schizophrenia/completeindex.shtml

population. This leaves us with a small number of vulnerable individuals, who should be no more neglected in consideration of cannabis policy as mentally healthy individuals, and brings us to the consideration of Cannabidiol (CBD). Before discussing CBD however, it is necessary to shed light on Delta-9-Tetrahydrocannabinol (THC); THC is the main psychoactive element of cannabis, upon smoking, it is passed from the lungs into the bloodstream, carrying it to the brain in which is received by various cannabinoid receptors which instigate cellular reactions to produce a high. These receptors are most commonly found in the parts of the brain which influence pleasure, memory, thinking, concentrating, sensory and time perception and coordinated movement. 68 Whilst cannabis releases more than 100 substances which are subsequently inhaled, THC is thought to be the ingredient most responsible for the effect of cannabis on the central nervous system. Negative psychosis and anxiety is often associated with THC, and is in direct relation, especially in forms of increased THC potency (which subsequently reduces the THC:CBD ratio), with an increased risk of psychosis. The issue of reduced CBD, lies in its recent discovery as the constituent thought to ameliorate the negative consequences of THC, significantly reducing anxiety and psychotic like symptoms associated with THC and is currently under investigation for use as an anxiolytic and as an antipsychotic, and is being considered as an alternative effective treatment for schizophrenia.69 A 2008 study examined the effects of varying levels of THC:CBD on 140 subjects who fitted into 3 groups; THC only, THC and CBD and no cannabinoids. The results were as follows; The THC only group showed higher levels of positive schizophrenia-like symptoms compared with the no cannabinoid and THC+CBD groups, and higher levels of delusions compared with the no cannabinoid group and this suggests that smoking strains of cannabis containing CBD in addition to 9-THC may be protective against the psychotic-like symptoms induced by 9-THC alone.. 70 Studies have generally reached similar conclusions; a 2005 study revealed cannabidiol to significantly reduce psychopathological symptoms of acute psychosis and as an antipsychotic drug in its treatment of schizophrenia, revealed significantly less side effects in comparison with atypical antipsychotics such as Amisulpride.71 Finally, and most importantly a 2010 study of the opposite effects of THC and CBD on human brain function and psychopathology yielded the following result; Our data are consistent with a potential therapeutic role for CBD in ameliorating the psychiatric consequences of cannabis use in the general population, and in patients with existing psychiatric disorders (Zuardi, 2008), particularly as conventional antipsychotic medication is relatively ineffective for such conditions (DSouza et al, 2008). It might also have a role in the treatment of psychotic and anxiety disorders independent of cannabis use (Zuardi, 2008). 72
68

National Institute on Drug Addiction, NIDA Infofacts:Marijuana, http://www.nida.nih.gov/infofacts/marijuana.html 69 Medscape, Drugs, Diseases and Procedures, Genen, L. Cannabis Compound Abuse, Pathophysiology, November 2011. http://emedicine.medscape.com/article/286661-overview#a0104 70 Morgan, CJA. Curran, HV. Effects of cannabidiol on schizophrenia-like symptoms in people who use cannabis The British Journal of Psychiatry, 2008, 192: 306-307. http://bjp.rcpsych.org/cgi/content/full/bjprcpsych;192/4/306
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Leweke FM, Koethe D, Gerth CW, Nolden BM, Schreibe D, Hnsel A, Neatby MA, Juelicher A. Cannabidiol as an antipsychotic. A double-blind, controlled clinical trial on cannabidiol vs. amisulpride in acute schizophrenia. Abstract, IACM 3rd Conference on Cannabinoids in Medicine, September 9-10, 2005. http://www.cannabismed.org/studies/ww_en_db_study_show.php?s_id=171 72 Bhattacharyya, S. Morrison, PD. Fusar-poli, P. Martin-Santos, R. Borgwardt, S. Winton-Brown, T. Nosarti, C. OCarroll, CM. Seal, M. Allen, P. Mehta, MA. Stone, JM. Tunstall, N. Giampietro, V. Kapur, S. Murray, RM. Zuardi, AW. Crippa, JA. Atakan, Z. McGuire, PK. Opposite Effects of D-9-Tetrahydrocannabinol and

These studies indicate an important role in the preservation of CBD in strains of cannabis which would help to counteract the negative consequences of THC consumption. The latter study goes on to note; From a public health point of view, one worrying implication of our results is that cannabis users may be at an increased risk of acute adverse psychological reactions following cannabis use, in light of the increasingly potent forms of cannabis with decreasing CBD content available on the street. The prevalence of increasingly high THC in cannabis has often been attributed to the prohibitionist approach which allows an unregulated black market to dominate the production of cannabis and which favors more concentrated forms of cannabis.73 In light of this, one suggestion would be to regulate the cannabis trade in order to increase the availability and commonality of CBD in the consumption of cannabis users in order to negate the negative mental effects which currently form so much of the basis for governmental concern. Brain Damage Myths have often formed the basis of public opinion surrounding cannabis, and this has been related to false government statements on the matter, such of that as cannabis in relation to brain damage. The best given example of this is the study conducted by Dr. Heath at Tulane university in 1974, under the administration of Ronald Reagan. Following the study, Reagan announced that permanent brain damage was an inevitable result of cannabis use. It was supposedly conducted by adminstering a group of test monkeys 30 joints per day over the space of a year, in order to determine the long term effects of cannabis on the brain. After 90 days, monkeys began to atrophy (a wasting or decrease in body tissue or organs, as a result of the degeneration of cells74) and die. After dead brain cells were counted of monkeys who had and had not been subjected to cannabis use, the conclusion was made that cannabis use causes brain damage forming a solid pillar of the drug debate surrounding cannabis, quoted by scientists, the public, politicians and special interest groups, the study became the foundation for the belief that cannabis caused brain damage. However, after 6 years of requests into how the study was conducted, it was revealed that instead of administering 30 joints per day over the space of a year, Dr. Heath and his team had in fact administered 63 columbian strength joints per day over the space of 5 minutes. Not only does this void the validity of the study in disguising the methods used, but the circumstances in light of this fundamentally undermine the findings of the study. During these five minutes, no oxygen was administered via the gas masks to the test monkeys, which has significant impact on brain function and on brain cells. Writers of Memory loss and the brain at Reuters university in considering hypoxia (the deprivation of adequate oxygen supply) state: (strangely worded?) Although the brain represents only about 2% of the body's weight, it utilizes about 20% of the body's oxygen. As a result, the brain is especially sensitive to hypoxia. After about 4 to 6 minutes without oxygen, large numbers of brain cells begin to die. Prolonged hypoxia (e.g. suffocation) results in death.75 The suffocation of the test monkeys in Dr. Heaths study adequately explains the results he gained, and no study since has been able to replicate the results free of suffocation. 76 This raises significant questions around

Cannabidiol on Human Brain Function and Psychopathology Neuropsychopharmacology (2010) 35, 764774.
http://www.nature.com/npp/journal/v35/n3/pdf/npp2009184a.pdf
73

Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, pages 39&40. 74 Oxford Dictionaries, Definition of Atrophy, http://oxforddictionaries.com/definition/atrophy
75

Myers, CE. Memory Loss and the Brain, The newsletter of the Memory Disorders Project, Reuters University, 2006. http://www.memorylossonline.com/glossary/hypoxiaanoxia.html 76 The Union, The Business behind getting high, 2007, youtube; Part 1 7.46 9.46. http://www.youtube.com/watch?v=hoK6NztH3eQ

Dr. Heaths motivation to falsify the methods used in his experiment, especially since the project was funded by the US government. Whilst this study may have been conducted in the United States, with the global nature of the prohibition regime, especially at this point in history following the 1961 UN single convention on narcotic drugs which was gradually reforming domestic laws across the world, the United Kingdom adhering to its requirements just 3 years previous to this study in 1971, it is globally relevant. The United States was a big player on the international stage and, as was indicated in its role in the opium conventions, was highly influential and pushed hard for a global prohibitionist regime. These kinds of studies could have been intended to strengthen the United States hard stance on drug prohibition. Gateway Hypothesis Cannabis has also been branded a gateway drug and this belief has formed the prevention efforts and governmental policy for six decades77. The gateway theory articulated the belief that use of marijuana was a gateway to harder drugs and harder drug problems; the hypothesis describes The phenomenon in which an introduction to drug-using behavior through the use of tobacco, alcohol, or marijuana is related to subsequent use of other illicit drugs. The theory suggests that, all other things being equal, an adolescent who uses any one drug is more likely to use another drug.78 However the theory has been repeatedly disproven, one of the main issues is that statistic correlation does not equal cause and some studies have provided results which suggest cannabis can move people away from harder drugs. For example, a longitudinal study of 224 males studied from the ages of 11-12 through 22 compared on 35 variables measuring psychological, family, peer, school, and neighbourhood characteristics conducted at Pittsburgh University in 2006 found that of the study population who had used both legal and illegal drugs, nearly a quarter exhibited the reverse pattern of using marijuana prior to alcohol or tobacco and those individuals were no more likely to develop a substance use disorder than those who had followed the traditional succession of alcohol and tobacco before illegal drugs.7980 A research study conducted for the Home Office in 2002 also stated there is very little remaining evidence of any causal gateway effect noting that the association between soft and hard drugs found in survey data is largely the result of our inability to observe all the personal characteristics underlying individual drug use81. This is further supported by a study published by the American Sociology Association in 2010 revealing a moderate relation between early teen marijuana use and young adult abuse of other illicit substances, however this association fades from statistical significance with adjustments for stress and life-course variables. Any causal influence of teen marijuana use on other illicit substance use is contingent upon
(check this is referenced properly and make sure that it references all the information you used as it is broken up by definition references.) 77 Science Blog, Study says marijuana no gateway drug, 2006, http://scienceblog.com/12116/study-saysmarijuana-no-gateway-drug/ 78 Gold, R S. Pomietto, B. eNotes, Gateway drug theory, 2002, http://www.enotes.com/gateway-drug-theoryreference/gateway-drug-theory
79

University of Pittsburgh Medical Center (2006, December 4). No 'Smoking' Gun: Research Indicates Teen Marijuana Use Does Not Predict Drug, Alcohol Abuse. ScienceDaily. Retrieved December 6, 2011, from http://www.sciencedaily.com /releases/2006/12/061204123422.htm 80 Tarter, RE. Vanyukov, M. Kirisci, L. Reynolds, M. Clark, DB. Predictors of Marijuana Use in Adolescents Before and After Licit Drug Use: Examination of the Gateway Hypothesis, American Journal of Psychiatry, 2006; 163:2134-2140. http://ajp.psychiatryonline.org/article.aspx?Volume=163&page=2134&journalID=13
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Pudney, S. The road to ruin? Sequences of initiation into drug use and offending by young people in Britain, Home Office Research Study 253, Home Office Research, Development and Statistics Directorate, December 2002, page 8. http://webarchive.nationalarchives.gov.uk/20110218135832/http://rds.homeoffice.gov.uk/rds/pdfs2/hors253 .pdf

employment status and is short-term, subsiding entirely by the age of 21. In light of these findings, we urge U.S. drug control policymakers to consider stress and life-course approaches in their pursuit of solutions to the 'drug problem82 Finally, a study from California gives further backing to this pool of thought, an analysis of the demographic and social characteristics of 4117 medical marijuana applicants, supports an interpretation of long term non problematic use. It states; In general, they (the applicants) have used it at modest levels and in consistent patterns which anecdotally-often assisted their educational achievement, employment performance, and establishment of a more stable life-style. It also found that beyond the age of 25 cannabis (barring modest alcohol consumption and nicotine addiction) was the only drug used therein, suggesting that by competing successfully with other more harmful drugs, cannabis may have actually been protective. 83 These studies indicate a repeated failure of the gateway hypothesis in recognising multiple factors which are likely to attribute themselves to drug use, furthermore, it appears cannabis has in fact moved the majority of those and the data studied away from consistent hard drug use. Comparison with other drugs Cannabis differs from many other drugs, especially in regard to its harms and toxicity, although politicians such as David Cameron would have you believe otherwise, demonstrated in his interview with Al Jazeera English. In the interview, which sheds important light on the bias and or misinformation in regards to drugs in politics, Cameron suggests that cannabis today is very very toxic84which is paradoxical to the available evidence. It is widely understood that Cannabis is one of the least toxic illicit substances, The acute toxicity of cannabinoids is very low in comparison with other psychoactive drugs, because they do not depress respiration like the opioids, or have toxic effects on the heart and circulatory system like cocaine and other stimulants. Furthermore, the estimated fatal human dose is in the range of 15-70g, many times greater than the dose that even heavy users could consume in a day 85This has two related implications, firstly that cannabis relative harm is much lower than many drugs despite its high (class B) status. Secondly, that misinformation is being provided from the very top rungs of government and is leading to poor allocation of drug policies. In this respect, cannabis is one of the least dangerous drugs due to its inability to produce a fatal human overdose. The risk of dependence is also lower in cannabis than other drugs, including alcohol; the risk for cannabis dependence is around 9% amongst persons who have ever tried cannabis, and around 1 in 6 for young people who initiate use during adolescence. In comparison, the risk of dependence for nicotine is 32%, heroin 23%, cocaine 17%, alcohol 15% and stimulant users 11%. Importantly, those at the highest risk of dependence have a history of poor academic achievement, deviant behaviour, nonconformity and rebelliousness, poor parental relationships and a parental history of drug and alcohol problems.86 Furthermore, a report of the UK Prime Ministers Strategy unit (2005) rated drugs on potential addictiveness and a French committee (1999) rated them on psychic dependence in

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Gundy, KV. Rebellon, CJ. A Life-course Perspective on the Gateway Hypothesis, Journal of Health and Social Behaviour, American Sociology Association, Issue 51 (3), page 244. http://www.asanet.org/images/journals/docs/pdf/jhsb/Sep10JHSBFeature.pdf 83 OConnel, TJ. Bou-Matar, CB. Long term marijuana users seeking medical cannabis in California (20012007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants, Harm Reduction Journal, 4:16, 2007. http://www.harmreductionjournal.com/content/pdf/1477-7517-4-16.pdf 84 Youtube, Al Jazeera World View, http://www.youtube.com/watch?v=o9kz_bKYslg 11.04-11.24 85 Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, page 17. 86 Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, page 25.

both, cannabis is at the lowest level for substances in the table.87 A report orchestrated for the Canadian senate in 2002 also came to the conclusion that physical dependency on cannabis was virtually non-existent.88 In 2009, David Nutt consolidated 10 years of research to assess the harms of drugs (some included in the Misuse of Drugs Act, others not) in regard to reviewing their current classification; the forms of harm were broken down into 3 categories containing a total of 9 parameters; Physical Harm (acute, chronic, intravenous harm) Dependence (intensity of pleasure, psychological and physical dependence) and Social harms (Intoxication, other, health-care costs). Cannabis was rated 11th out of 20 substances coming below substances such as Heroin, Cocaine, Street Methadone, Alcohol, Ketamine, Amphetamine and Tobacco and above substances such as LSD, Ecstasy and Khat. 89 This indicates not only a large skew in the classification of drugs in relation to harm as Nutt suggests, but also that cannabis is less harmful than some of the most common legal drugs in more than one element. Respiratory System and Cancer Cannabis is primarily smoked by its users, which raises significant questions about its effect on the pulmonary system and its ability to cause or aggravate cancer. Studies have generally shown that long term marijuana smoking is associated with an increased risk of respiratory complications; however in comparison to tobacco its effects are quite different. A 2007 study found that long term marijuana smoking was associated with an increase in cough, sputum production, and wheeze, persisting after adjusting for tobacco smoking.90 However, smoking tobacco has been strongly associated with the development of cancer and Chronic Obstructive Pulmonary Disease (COPD)91, which is a lung disease characterised by chronic obstruction of lung airflow which interferes with normal breathing. Chronic bronchitis and emphysema are included within COPD diagnosis, and it is not to be misunderstood as a smokers cough rather an under diagnosed, life threatening lung disease.92 Cannabis on the other hand, has not drawn such strong associations; a 2009 study indicated that amongst participants who smoked cigarettes alone, the incidence of COPD was 2.7 times higher than non-smokers, and those who combined tobacco with cannabis had an incidence rate 2.9 times higher. Sole cannabis smokers however had an incidence rate higher than non smokers but the increase was statistically insignificant.93 Another study conducted in 2009 came to similar conclusions the consistency of
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Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, page 41. 88 Nolin, P. C. Kenny, C. Cannabis: Our Position For A Canadian Public Policy, Report of the Senate Special Committee on Illegal Drugs, 2002, Page 27. 89 Nutt, D. Estimating Drug Harms: A Risky Business, Centre for Crime and Justice Studies, Briefing 10, October 2009, pages 8, 9 & 10. 90 Jeanette M. Tetrault, MD; Kristina Crothers, MD; Brent A. Moore, PhD; Reena Mehra, MD, MS; John Concato, MD, MS, MPH; David A. Fiellin, MD. Effects of Marijuana Smoking on Pulmonary Function and Respiratory Complications: A Systematic Review, Arch Intern Med. 2007;167(3):221-228. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720277/?tool=pmcentrez 91 British Lung Foundation, Smoking and your lungs, Accessed: 09/12/2011; http://www.lunguk.org/you-andyour-lungs/you-and-your-lungs/smoking-and-your-lungs 92 World Health Organisation, Chronic respiratory diseases, COPD: Definition, Accessed: 09/12/2011; http://www.who.int/respiratory/copd/definition/en/index.html
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Boyles, S. Smoking Pot, Cigarettes Ups COPD Risk, Web MD health News, 2009, Accessed 09/12/2011; http://www.webmd.com/lung/news/20090413/smoking-pot-cigarettes-ups-copd-risk

some aspects of the available data allows us to more firmly conclude that smoking marijuana by itself can lead to respiratory symptoms because of injurious effects of the smoke on larger airways. Given the consistently reported absence of an association between use of marijuana and abnormal diffusing capacity or signs of macroscopic emphysema, we can be close to concluding that smoking marijuana by itself does not lead to COPD.94 There is a somewhat mixed availability of data regarding the link between cannabis and cancer; this is largely due to other factors which need be accounted for, such as lifestyle choices and the prevalence of tobacco use amongst cannabis users as well as the limitations of studies using small numbers of participants. It is important to remember that differences in the method of consumption also affect the potential risk of cancer, as, for example, eating cannabis or using a vaporiser does not release carcinogens found in smoke. A 2006 study found an increased risk of cancers of the upper airways and digestive system; however this disappeared when adjusted to account for cigarettes and other common risk factors. They concluded that if cannabis did affect the risk of cancer, it was likely to be small. A later study in 2009 found that the risk of head and neck cancers in smokers and drinkers seemed to be lower in people who smoked cannabis. 95 However other studies have displayed near opposite results, a 2008 study found a link between cannabis and lung cancer96 and others, such as a US study published in 2009, have found a link between cannabis use and testicular cancer.97 However, some researchers having carried out an epidemiologic review of cannabis use and cancer risk, came to the conclusion that; sufficient studies are not available to adequately evaluate marijuana impact on cancer risk. Several limitations of previous studies include possible underreporting where marijuana use is illegal, small sample sizes, and too few heavy marijuana users in the study sample. They recommended a focus on tobacco-related cancer sites, more detailed exposure assessments which accounted for frequency, duration and amount of personal use as well as the mode of use, and the use of larger studies, meta-analyses or pooled analyses to maximise precision, as well as an investigation into the source of the disparities in results.98 The debate on cannabis and cancer it seems has not yet reached scientific consensus, however cannabis has been successfully used in the treatment of cancer and provides relief and treatment for many illnesses, which will be discussed in the following section. Medicinal use Although the 1971 misuse of drugs act categorizes cannabis in schedule 1 (of 5); the most strictly controlled schedule which stipulates cannabis is not authorised for medical use and can only be supplied, possessed or administered in exceptional circumstances under a licence from the home office primarily for research purposes, the plant has a wide variety of medical uses and a rich history of use in medicine, having been used for centuries to treat waste disease, rheumatism, and

94

Tashkin, DP. Does smoking marijuana increase the risk of chronic obstructive pulmonary disease? CMAJ. 2009 April 14; 180(8): 797798; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2665954/?tool=pmcentrez 95 Cancer Research UK, Does smoking cannabis cause cancer? Accessed: 09/12/2011; http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/does-smoking-cannabis-cause-cancer 96 S. Aldington, M. Harwood, B. Cox, M. Weatherall, L. Beckert, A. Hansell, A. Pritchard, G. Robinson, R. Beasley. Cannabis use and the risk of lung cancer: A case-control study, European Respiratory Journal, 2008, vol. 31 no. 2 280-286. http://erj.ersjournals.com/content/31/2/280.abstract
97

Fred Hutchinson Cancer Research Center, Marijuana use linked to increased risk of testicular cancer, Accessed: 09/12/2011; http://www.fhcrc.org/about/ne/news/2009/02/09/marijuana.html
98

Hashibe M, Straif K, Tashkin DP, Morgenstern H, Greenland S, Zhang ZF. Epidemiologic review of marijuana use and cancer risk, Alcohol. 2005 Apr; 35(3):265-75. http://www.ncbi.nlm.nih.gov/pubmed/16054989

injuries.99 Whilst findings surrounding cannabis and its role in causing cancer remain unclear, it has had remarkable success in easing the condition of terminally ill patients and has even had roles for treatment of some diseases. Medicinal cannabis is available most widely, strangely enough in the Americas, despite cannabiss strict illegality under federal law. The state of California was the first to enact the new wave of Medical Marijuana Use (MMU) laws in 1996; previous MMU laws are thought to have been largely symbolic. These laws stipulate that individuals who receive a recommendation from their doctor for marijuana use for medical purposes are allowed to grow, possess and use limited amounts of cannabis, and laws in subsequent states often define a list of specified illnesses for which use may be recommended.100 Forms of medicinal cannabis are currently available in Austria, Canada, Germany, Spain, Alaska, Arizona, Colorado, Hawaii, Israel, Maine, Michigan, Montana, The Netherlands, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Virginia and Washington.101 In California, though cannabis sold through the dispensaries only constitute a small proportion of the cannabis market, it is reported that the whole-sale price of good cannabis has fallen by half since the legalization of medical marijuana. 102This is an important demonstration of the ability of a regulated cannabis market to undercut the black market which is associated with criminality of many kinds and is arguably producing more issues than the use of the drug itself. Furthermore, the Oakland area of California dubbed Oaksterdam houses a large proportion of medical marijuana dispensaries, and is said to have been a rundown area with a lack of thriving business preceding the introduction of the cannabis industry. It is said to bring in a gross revenue of over $24,000,000 annually (2003) meaning nearly $3,000,000 in sales tax which can be added to the citys revenue, suggesting not only a role for regulated cannabis industry in ameliorating the black market but also in boosting local economies facing fiscal troubles.103 Cannabis has been used for multiple illnesses and conditions; although certain restrictions on its use lay down in international and domestic laws have often prevented extensive research or use within the medical profession. For the sake of the available data, the following will be based upon a variety of forms of medicinal cannabis, from traditionally smoked cannabis, cooked cannabis and isolated cannabinoids in pills to the GW Pharmaceuticals Sativex spray. Idea for word count; could list the diseases medical cannabis aids in and place the following section in an appendix? Also would definitions of each illness be required? Cancer One of the most famous medical applications of cannabis is the relief of negative symptoms in chemotherapy patients, including pain, nausea and vomiting, appetite and sleep104. A 2001 study of the effects of smoked cannabis and oral THC capsules on nausea and vomiting looked at reports
99

Lakhani, A. Medicinal Uses of Cannabis, Medscape Pharmacists, Medscape News Today, 2003. http://www.medscape.com/viewarticle/458076 100 Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, page 101.
101

Wikipedia, Legal and medical status of cannabis, Accessed 12/12/2011; http://en.wikipedia.org/wiki/Legal_and_medical_status_of_cannabis

102

Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, page 102. 103 Youtube, Marijuana Nation: National Geographic (3/5), 8.10-8.41, Accessed 12/12/2011; http://www.youtube.com/watch?v=gNPzffTMoFU&feature=related 104 National Cancer Institute, National Institutes of Health, Cannabis and Cannabinoids (PDQ). Accessed 12/12/2011; http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page1/AllPages

from 6 states who had conducted clinical trials on a total of 1093 patients. It found that patients who smoked cannabis experienced 70-100% relief from nausea and vomiting, whilst those who used the THC capsule experienced 76-88% relief. On the basis of these studies, it was concluded that cannabis can be a very successful treatment for nausea and vomiting following chemotherapy.105 Don Abrhams, a doctor prescribing cannabis to his cancer patients stated cannabis is the only drug that decreases nausea and vomiting and also increases appetite. Also, I think people sleep better and a little bit of euphoria I dont find is a negative thing in people facing malignent diagnosis106 There is a far more interesting and recently discovered role for cannabis and cancer however; Researchers at Harvard University in 2007 found that THC cuts tumour growth in common lung cancer in half and significantly reduces the ability of cancer to spread. THC inhibited EGF induced growth and migration in epidermal growth factor receptor (EGFR) expressing non-small cell lung cancer cell lines. The cancers which over express these characteristics are usually highly aggressive and resistant to chemotherapy. Injecting standard of doses of THC into mice implanted with human lung cancer cells had the subsequent effect of reducing tumours in size and weight by around 50% and around a 60% reduction in cancer lesions on the lungs and a significant reduction in protein markers associated with cancer progression.107 Furthermore biochemists Guillermo Velasco and Manuel Guzmn of Complutense University in Madrid have spent the past decade establishing in lab dish and animal tests that THC can kill cancer of the brain skin and pancreas. Reported in the Journal of Clinical Investigation in 2009, the research showed THC to ignite programmed suicide in some cancerous cells, stopping tumours from forming blood vessels for nourishment and by restricting cancer cell movement. THC binds to protein receptors on cancer cells surface and induces the production of a fatty substance called ceramide which prompts the cell to begin devouring itself, but allows healthy cells to live unhindered. Early human trials involving 9 brain cancer patients whose disease had worsened despite standard therapy revealed the THC injections into tumours to be safe. Further research is needed in this area but current revelations appear promising. 108 Arthritis Cannabis has been used by many for relief from Arthritis, a study conducted on test mice in 2000 found a therapeutic potential for Cannibidiol (CBD) in murine (mice) collagen-induced arthritis, an animal model of rheumatoid arthritis. CBD was administered after onset of clinical symptoms, and in both models of arthritis the treatment effectively blocked progression of arthritis. Clinical improvement was associated with protection of the joints against severe damage. These data show that CBD, through its combined immunosuppressive and anti-inflammatory actions, has a potent anti-arthritic effect in CIA.109
105

Musty, RE. Rossi, R. Effects of Smoked Cannabis and Oral 9-Tetrahydrocannabinol on Nausea and Emesis

After Cancer Chemotherapy: A Review of State Clinical Trials, Journal of Cannabis Therapeutics, Vol. 1(1) 2001. Accessed 12/12/2011; http://science.iowamedicalmarijuana.org/pdfs/clincal/Musty-Rossi%20JCANT.pdf 106 Youtube, Marijuana Nation: National Geographic (3/5), 1.10-1.27, Accessed 12/12/2011; http://www.youtube.com/watch?v=gNPzffTMoFU&feature=related 107 th Science Daily, Marijuana Cuts Lung Cancer Tumour Growth in Half, Study Shows. April 17 2007. Accessed 12/12/2011; http://www.sciencedaily.com/releases/2007/04/070417193338.htm 108 Seppa, N. Not Just a High: Scientists test medical marijuana against MS, inflammation and cancer. Science th News, Vol. 177. Issue 13. Pages 16-20, 19 June 2010. Accessed 12/12/2011; http://onlinelibrary.wiley.com/doi/10.1002/scin.5591771320/abstract 109 Malfait, A, M. Gallily, R. Sumariwalla P, F. Malik, A, S. Andereakos, E. Mechoulam, R. Feldmann, M. The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collageninduced arthritis, PNAS. August 15, 2000. Vol. 97, No. 17, 9561-9566. http://www.pnas.org/content/97/17/9561.short

In the first ever controlled trial of a cannabis preparation in 2006 (Sativex, GW Pharmaceuticals) on Rheumatoid Arthritis in humans, a significant analgesic effect was observed and disease activity was significantly suppressed following Sativex treatment furthermore the study found that the cannabis extract produced statistically significant improvements in pain on movement, pain at rest, quality of sleep and inflammation and was not adversely harmful to its participants Importantly, the trial did not demonstrate significant toxicity and Sativex was generally well tolerated. The large majority of adverse effects were mild or moderate, and there were no adverse effect-related withdrawals or serious adverse effects in the active treatment group. These results suggest a role for cannabis as a medical application for arthritis. 110 Multiple Sclerosis Largely anecdotal evidence is available in support of cannabis use for MS; however it comes highly regarded by its users. A 1997 survey of regular cannabis users with MS, 41% of which were mostly or completely confined to a bed or wheelchair, indicated that 96% regarded its effects on spasticity as beneficial, 95% on pain, 91% on tremors and depression and 90% on anxiety and research published in Practical Neurology suggests that it is becoming clear that cannabis may possess a variety of therapeutic effects, on spasticity, pain, bladder hyperreflexia, and tremor, which may make it particularly well-suited to patients with MS, in whom this group of symptoms frequently coexist.111 A 2005 trial of 66 patients with MS and central pain states of which 64 completed trials, of a whole plant cannabis based medicine containing THC and CBD delivered by spray, which could be titrated by the patient to a maximum of 48 sprays in 24 hours. The trial states that central pain in MS is common and often refractory to treatment, however their results with cannabis based medicine indicated its effectiveness in pain and sleep disturbance reduction with its side effects well tolerated.112 Finally, a 2009 study found evidence that combined extracts of THC and CBD may reduce symptoms of spasticity in MS sufferers. MS patients reported subjective perceptions of symptom reduction with the use of cannabinoids, and evidence was revealed which suggested cannabinoids may provide neuroprotective and anti-inflammatory benefits. Neuroinflammation, found in autoimmune diseases such as MS, has been shown to be reduced by cannabinoids through the regulation of cytokine levels in microglial cells. The therapeutic potential of cannabinoids in MS is therefore comprehensive and should be given considerable attention. 113 HIV/AIDS Antiretroviral therapy the traditional method used to suppress the HIV virus and stop the progression of the disease has major benefits for survival during infection, however the symptoms and side effects during long term therapy have not been sufficiently accounted for. Cannabis has been reported anecdotally as having beneficial results for common symptoms and complications in HIV, for example poor appetite and neuropathy. In 2004, HIV-positive individuals attending a large
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Hazekamp, A. Grotenhermen, F. Review on clinical studies with cannabis and cannabinoids 2005-2009, Institute Biology Leiden, Leiden University, The Netherlands. Drugtext, 2009. Accessed 12/12/2011; http://www.drugtext.org/Cannabis-marijuana-hashisch/review-on-clinical-studies-with-cannabis-andcannabinoids-2005-2009.html 111 Fox, P. J. Zajieck, J. P. Cannabis for Multiple Sclerosis, Practical Neurology, 2002, 3, 15460. http://171.66.125.86/content/2/3/154.full.pdf 112 Rog, D. J. Nurmikko, T. J. Friede, T. Young, C. A. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis, Neurology September 27, 2005 vol. 65 no. 6 812-819. http://www.neurology.org/content/65/6/812.short 113 Lakhan, S. E. Rowland, M. Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review, BMC Neurology 2009, 9:59. http://www.biomedcentral.com/1471-2377/9/59

clinic were recruited into an anonymous cross-sectional questionnaire study. Of the 523 participants, 143 (1/3 or 27%) had used cannabis to treat symptoms; patients reported improved appetite (97%) muscle pain (94%) nausea (93%) anxiety (93%) nerve pain (90%) depression (86%) and paresthesia (85%), indicating a largely beneficial effect for the majority of users.114 Two further studies were conducted in 2005 and 2007 respectively; the first found that cannabis produced substantial increases in food intake without causing major adverse effects. A combination of dronabinol (up to 10mg daily) and smoked cannabis (up to 3.9% THC) were well tolerated, and both increased daily caloric intake and bodyweight, for those in high dose conditions, a significant increase in body weight was noted over 4 days (>1kg). Pain reduction was a significant factor in the second study; patients were randomly assigned to smoke either cannabis or identical placebo cigarettes 3 times daily over 5 days. Smoked cannabis reduced daily pain significantly compared to the placebo. Minor adverse effects were reportedly higher in the cannabis group although no serious AEs were reported and no patient withdrew as a result.115 Here cannabis is useful as a supplementary treatment in maintaining the health otherwise damaged by the use of antiretroviral therapy, and arguably its improvements in the general condition of the patient not only improve the life circumstances of the patient, but could potentially extend life by maintaining a higher level of health with which the body fights against the disease. Glaucoma It has been reported since the early 1970s that cannabis smoking could lower intraocular pressure (IOP) by up to 45%. Later studies have shown that THC lowered IOP when given intravenously, orally or by inhalation, it is also known that THC may increase blood circulation in the retina and is neuroprotective, leading to the conclusion that it may increase the survival of the optic nerve. As one of the leading causes of blindness in the world, affecting around 70 million people globally, and as a chronic disease without a cure116 it is important to consider all medicinal avenues no matter how politically controversial. Following the consideration of multiple studies concerning the use of cannabis in treatment of glaucoma, Franjo Grotenherman and Ethan Russo came to the conclusion that The overall implication for the sum of these studies is potentially significant. Cannabinoids may reveal themselves to be useful for the treatment of glaucoma in quite a comprehensive manner: lowering IOP, restoring microcirculation, inhibiting apoptosis and minimizing free radical damage. They go on to state that this multiple mechanism would surpass any current ocular drug and goes some way to explaining the preservation of sight in those unresponsive to other therapies.117 The benefits of cannabis in glaucoma appear to have the potential to be some of the most valid in uses of medicinal cannabis, with the potential ability to inhibit the progression of blindness in glaucoma patients and provide high levels of relief for symptoms.
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Woolridge, E. Barton, S. Samuel, J. Osorio, J. Dougherty, A. Holdcroft, A. Cannabis Use in HIV for Pain and Other Medical Symptoms, Journal of Pain and Symptom Management, Vol. 29, Issue. 4, April 2005, Pages 358367. http://www.sciencedirect.com/science/article/pii/S0885392405000631 115 Hazekamp, A. Grotenhermen, F. Review on clinical studies with cannabis and cannabinoids 2005-2009, Institute Biology Leiden, Leiden University, The Netherlands. Drugtext, 2009. Accessed 12/12/2011; http://www.drugtext.org/Cannabis-marijuana-hashisch/review-on-clinical-studies-with-cannabis-andcannabinoids-2005-2009.html 116 Hazekamp, A. Grotenhermen, F. Review on clinical studies with cannabis and cannabinoids 2005-2009, Institute Biology Leiden, Leiden University, The Netherlands. Drugtext, 2009. Accessed 12/12/2011; http://www.drugtext.org/Cannabis-marijuana-hashisch/review-on-clinical-studies-with-cannabis-andcannabinoids-2005-2009.html 117 Grotenherman, F. Russo, E. Cannabis and Cannabinoids: Pharmacology, Toxicology, and Therapeutic Potential The Haworth Press, New York, 2002, Page 220. http://books.google.co.uk/books?hl=en&lr=&id=JvIyVk2IL_sC&oi=fnd&pg=PA215&dq=cannabis+cure+for+glau coma&ots=ABiJubwKeL&sig=cM-gCfPmIts0h4wnZwSHLd85f4I#v=onepage&q=glaucoma&f=false

Whilst cannabis has medical applications for a number of further diseases, conditions, pain relief and mental conditions, the room for discussion here is lacking. There has been some considerable debate as to the viability of using cannabis as a medicine, largely based around its illegality and standing in political circles, but also down to the limitations of research due to precisely those factors. One issue that has been repeatedly raised is the range in potencies, making it difficult to accurately titrate the dose. However, Raphael Mechoulam is the biochemist accredited along with his team of isolating the active compound in cannabis (THC) in 1964 at the Weizmann Institute of Science in Rehovot, Israel. Subsequently this discovery lead to the development of synthetic THC in pill form two decades later118 and his further research has developed a method of administering measured doses of THC by dissolving it in an oil based solution which eliminates this issue.119 Doctors, rather than politicians, have in the past generally favoured a liberal approach to the prescription of cannabis in medicine; a survey conducted in 1997 indicated that the majority of British doctors wanted cannabis prescriptions to be allowed. An earlier study in the late 1980s depicted the majority of the Washington Medical Association members as in favour of controlled medical availability of marijuana and in the early 1990s 44% of oncologists had recommended the illegal use of cannabis to at least one patient. The use of cannabis in medicine has often been argued for from a stance not only promoting the medical benefits of the plant, but also promoting freedom and autonomy in medical choice. It is widely assumed in healthcare ethics that the freedom of individuals is best protected by paying heed to the principle of self determination, or autonomy it is argued that medical facts are too vague to overturn an informed choice and concrete harm is not inflicted on any innocent third parties and that considerations of autonomy and symbolic harm cannot outweigh the suffering of the patient in need. Furthermore physicians should prescribe cannabis to their patients whenever it is, in their best professional judgement, called for in a situation of legal medical use. However if medical cannabis is prohibited and the value of such a medicine is beneficiary in patients then it should be made known to the political and legal authorities that the prohibition is unethical and should be removed.120 Sovereignty over your own mind and body should allow for you to use whichever substances you see fit for your own reasons, and it is not the role of the state or its legislature to control these life choices, which can be duly noted in the admirably spectacular failure of prohibition to halt the illicit use of cannabis.

The case against prohibition The prohibitionist regime has been under criticism for many years, beyond criticisms at its inception, one of the earliest recorded accounts of a general rejection of prohibition was published in The Times on Monday 24th July 1967, titled; The law against marijuana is immoral in principle and unworkable in practice. The article set out a variety of arguments against its prohibition, concluding with a petition to the home secretary which proposed a 5 point plan: 1. The government should permit and encourage research into all aspects of cannabis use, including its medical applications
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Seppa, N. Not Just a High: Scientists test medical marijuana against MS, inflammation and cancer. Science th News, Vol. 177. Issue 13. Pages 16-20, 19 June 2010. Accessed 12/12/2011; http://onlinelibrary.wiley.com/doi/10.1002/scin.5591771320/abstract 119 Youtube, Marijuana Nation: National Geographic (3/5), 4.36-4.45, Accessed 12/12/2011; http://www.youtube.com/watch?v=gNPzffTMoFU&feature=related 120 Hayry, M. Prescribing Cannabis: Freedom, Autonomy and Values Med Ethics. 2004 August; 30(4): 333336. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1733898/

2. Allowing the smoking of cannabis on private premises should no longer constitute an offence. 3. Cannabis should be taken off the dangerous drugs list and controlled, rather than prohibited, by a new ad hoc instrument 4. Possession of cannabis should either be legally permitted or at most be considered a misdemeanor, punishable by a fine of not more than 10 for any first offence and not more than 25 for any subsequent offence. 5. All persons now imprisoned for possession of cannabis or for allowing cannabis to be smoked on private premises should have their sentences commuted.121 The petition was signed by sixty five leading figures in the arts and sciences and eminent medical men, stopping short of outright legalisation with a clear long term prospect of legalisation if these reforms were to be implemented. The advertisement led to the January 1969 Wooton Report which endorsed the position taken that the long asserted dangers of cannabis were exaggerated, and that the related law was socially damaging, if not unworkable. The home secretary accused the report of over influence from lobbyists responsible for that notorious advertisement however after a year the recommendations of the Wooton report were implemented in the 1971 Misuse of Drugs Act, ensuring that end users of cannabis should no longer face the prospect of imprisonment.122 More recently however, a similar and perhaps more powerful report targeting the war on drugs as a whole, was released in a similar vein in its stance against prohibition. The report was commissioned by 19 prominent figures including former presidents and prime ministers of Mexico, Columbia, Brazil, Switzerland and Greece, many former UN and EU members from nations across the world, intellectuals from Mexico and Peru and members of various governments including the former US secretary of state.123 The high proportion of those who had formally held positions may shed some light on the politically restrictive environment in which the drug debate finds itself. The report was accompanied by more than 600,000 petition signatures gathered by the global advocacy organisation AVAAZ in support of its recommendations.124 The main statement of the report reads as follows; The global war on drugs has failed, with devastating consequences for individuals and societies around the world. Fifty years after the initiation of the UN Single Convention on Narcotic Drugs, and 40 years after President Nixon launched the US governments war on drugs, fundamental reforms in national and global drug control policies are urgently needed. Vast expenditures on criminalization and repressive measures directed at producers, traffickers and consumers of illegal drugs have clearly failed to effectively curtail supply or consumption. Apparent victories in eliminating one source or trafficking organization are negated almost instantly by the emergence of other sources and traffickers. Repressive efforts directed at consumers impede public health measures to reduce HIV/AIDS, overdose fatalities and other harmful consequences of drug
121

Erza, M. From the vaults: The Times, July 24 , 1967, Hurryupharry.org, March 6 2011. Accessed 13/12/2011; http://hurryupharry.org/2011/03/06/from-the-vaults-the-times-july-24-1967/ 122 Abrams, S. The Times Advertisement and the Wooton Report, Schaffer Library of Drug Policy, April 1993, Accessed 13/12/2011; http://www.druglibrary.org/schaffer/library/studies/wootton/soma1.htm 123 Global Commission on Drug Policy, War on Drugs, June 2011, page 1. http://www.globalcommissionondrugs.org/Report 124 Global Commission on Drug Policy, Global Commission on Drug Policy Chair Responds to Release of UNs 2011 World Drug Report June 2011, Page 1. http://www.globalcommissionondrugs.org/Media

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use. Government expenditures on futile supply reduction strategies and incarceration displace more cost-effective and evidence-based investments in demand and harm reduction. The report recommends an end to the criminalization, marginalization and stigmatization of drug users who do no harm to others, and a challenging rather than reinforcement of common misconceptions about drug markets, use and dependence. Furthermore, it suggests governments encourage experimentation of models of legal regulation to undermine organized crime and safeguard the health and security of their citizens, especially in regard to cannabis. It includes provisions for improved health and treatment services, as well as harm reduction measures such as syringe access to reduce the transfer of blood-borne infections whilst abolishing abusive practices such as forced detention, labour and physical or psychological abuse which contravene human rights standards or norms and remove the right to self-determination. Additionally, it recommends applying the same principles and policies to people involved in low ends of illegal drug markets E.g. Farmers, couriers and petty sellers who are themselves victims of violence and intimidation or are drug dependent. It states that arresting and incarcerating tens of millions of these people in recent decades has served only to fill prisons and destroy lives and families without an adverse effect on the availability of illicit drugs or the power of criminal organizations. It suggests investing in use preventative measures and abandoning the simplistic just say no rhetoric in favour of education grounded in credible information and prevention programmes focusing on social skills and peer influences. Law enforcement should not be focused on reducing drug markets per se, but reducing their harms to individuals, communities and national security. A review of the scheduling of drugs is recommended which the report suggests has resulted in obvious anomalies like the flawed categorization of cannabis, coca leaf and MDMA. And finally, the abolition of drug policies driven by ideology and political convenience with fiscally responsible policies and strategies grounded in science, health, security and human rights.125 The summary of these two studies indicates a progression of the consideration of anti-prohibitionist policy from artistic, academic and medical circles, to the former leaders of many of the worlds nations and international organisations, whilst this provides some hope for alternative systems of drug control and harm reduction the lack of current leaders involved in the report is a worrying indicator in the political pressures which remain in the conventional drug debate; the report states its concern towards drug policies driven by ideology and political convenience which indicates a strong case towards the ill consideration of drugs within the conventional political realm. Particularly strong examples of the inability of the prohibitionist regime are provided in the statistics produced in the UN world drug reports of 2010 and 2011. The estimate of global cannabis production for both years has been 13,300 66,100 mt of herbal cannabis and 2,200 9,900 mt of cannabis resin, the disparities between these numbers are an indicator of the unrealistic prospect of eradicating cannabis markets through prohibitionist methods when estimations are so wide. Furthermore, the seizures of cannabis in 2010 were estimated approximately 6,000mt, not even half of their lowest (and due to the secretive nature of illicit drug production and wide variations in numbers most likely inaccurate) estimate.126 Seizures in previous years have maintained similar hauls, the highest of which in 2008 reached just 6,587mt exceeding the previous peak in 2004 of 6,539 mt.127 Evidently this approach is a highly ineffective method of reducing the societal prevalence of cannabis, and one must question if the state even has a role in doing so. Black markets
125

Global Commission on Drug Policy, War on Drugs, June 2011, pages 2 and 3. http://www.globalcommissionondrugs.org/Report 126 UNODOC, World Drug Report 2011, 2011, pages 18 and 189. http://www.unodc.org/documents/data-andanalysis/WDR2011/WDR2011-web.pdf 127 UNODOC, World Drug Report 2010, 2010, Page 188. http://www.unodc.org/documents/wdr/WDR_2010/World_Drug_Report_2010_lo-res.pdf

are thriving under the current model of prohibition, and are inevitably linked to much stronger forms of crime in many levels of production and trafficking especially and in its links to organized crime. An article published in the British Medical Journal in 2002 outlined some of the issues of prohibition; it states that aside from the substantial fiscal costs in enforcement, its social costs include the damage of lives, education and careers due to the stigmatising experience of arrest. Lost incomes to families and emotional distress as most users are already socially disadvantaged meaning criminal penalties for possession of cannabis often entail additional costs including disruption of relationships and loss of housing and employment. Current policies are said to drive a wedge between parents and their children, health professionals and their patients, teachers and students, police and communities. Consequently current cannabis policies are seen to be inimical to desirable public health outcomes. As the most widely used and one of the most normalised drugs available, demand is high and inevitably results in illegal supply, which also brings cannabis consumers into direct contact with other illicit drugs. Surveys of random samples of experienced cannabis users indicated that in San Francisco under a prohibitionist model, 55% of respondents reported availability of other drugs from their cannabis source, In Amsterdam on the other hand, the same statistic rested at just 17%. The article also states that whilst prohibition is intended to reduce demand and supply, these factors have varied widely over time irrespective of controls; evidence has suggested that use is not increased by less intensive controls. The Netherlands for example has maintained a prevalence rate roughly parallel to Germany and France and has remained well below that of the US. It concludes by admitting that whilst cannabis is not harmless, adverse health consequences for the vast majority of users are modest, especially in comparison with alcohol and tobacco and that the social, economic and moral costs of cannabis control far exceed the health costs of cannabis use.128 Similar conclusions on the effect of liberalisation of controls were published in Cannabis Policy: Moving Beyond Stalemate which stated that repressive policies do not reduce consumption, but do produce problematic consumption patterns among many of those who defy authority It also found that depenalization in the Netherlands has not increased prevalence of use at a community level and has been successful in separating cannabis from other drug markets. Trends in cannabis use appear to be independent of the penalties which apply and social, economic and cultural trends have a far greater impact on use.129 A study of drug markets and use in New Zealand also highlighted common issues of prohibition, for example, the lack of safety and health regulations, ingredient or potency labelling can result in unsafe drugs being produced and sold, producing problems in users consuming unknown substances. Dealers and users are also said to be attractive targets for robbery as they are known to carry large amount of cash and/or drugs, with transactions carried out in secluded areas. Those involved in the purchase, production and sale of illicit drugs also lack the employability of the legal system in reporting victimisations, enforcing contractual agreements or settling competitive disputes, which make threats and physical violence often the sole means of resolving these problems. This is also an opportunity for criminal entrepreneurs to use intimidation and violence to remove competitors and expand market share, which can sometimes injure or kill innocent third party victims, contributing to fear of crime and victimisation in neighbourhoods where drug markets are present. Intervention by police can also have the adverse effect of eliminating those less

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Wodak, A. Reinarman, C. Cohen, P. D. A. Cannabis control: costs outweigh the benefits ForAgainst BMJ, 2002, 324. http://www.bmj.com/content/324/7329/105.extract 129 Robin Room, Benedikt Fischer, Wayne Hall, Simon Leonton, Peter Reuter, Cannabis policy, Moving beyond stalemate, Oxford University Press, Oxford, 2010, pages 125 and 127.

organised and willing to commit acts of violence, strengthening the position of organised crime syndicates and increasing their profits.130 Portugal has been a good source as a modern day model for more liberal policies, having decriminalized all drugs in 2001, studies have found positive effects. None of the fears promulgated by opponents of Portuguese decriminalization, such as increases in drug tourism and general drug use, have come to fruition. Adversely, many of the benefits predicted by policy makers supporting decriminalization have been realized; drug addiction, usage and associated pathologies have skyrocketed in many neighbouring EU states; however these problems have either been contained or significantly improved in Portugal since 2001. Similarly to the differences in use rates between The Netherlands and criminalizing countries, Portugal also has much lower rates of drug use in comparison. By freeing citizens of the fear of punitive action many drug addicts have been more inclined to seek treatment and the resources which were previously used to prosecute and imprison have been redirected to providing treatment and education. These measures have dramatically improved drug related social ills including mortalities, and disease transmission.131 A study on Dutch drug policy and markets also stated that market structure causes most of the negative externalities, and not necessarily drug consumption it came to the conclusions that enforcement increases the price of drugs and pumps out disproportionate resources into the drug market because consumers and producers alter behaviour in illegal markets. It also solidifies the aforementioned issue of eliminating competition for the most organized producers, leading to greater profits and consequently increased criminal activity; ergo the supply curve is shifted upwards causing markets to actually produce more drugs. Its final comment on prohibition states the producer surplus results in negative externalities including criminal activity, health problems, distorted education and moral stigmas. The black market is mitigated by legalised markets, as producers lose the possibility of profits and prices drop to a competitive level. Under legalised the government earns income via tax and eliminates costs previously dedicated to enforcement whilst consumers are better off and producers cannot profit. It finalises by stating that Regulation and taxation can mitigate consumption and negative externalities though price effects and tax income.132 Summary and Conclusion Cannabis is the most widely used drug in the world, it has historical use dating back thousands of years in some areas of the world and has been embedded in cultural and medical practices to present day. The British, aside from their use of hemp, came into contact with intoxicating forms of cannabis during the era of colonial expansion which led them to countries such as India with high levels of cannabis production. Through a combination of religious and moral bias in scientific and medical literature and poorly produced and limited statistical evidence of the correlations between cannabis and mental health, prohibition had formed a basis for its scientific and medical justifications. Furthermore the progressive involvement and high taxation by the British on the Indian cannabis trade created an air
130

Wilkins, C. Casswell, S. The cannabis black market and the case for the legalisation of cannabis in New Zealand, Social Policy Journal of New Zealand, Issue 18, 2002. http://www.msd.govt.nz/about-msd-and-ourwork/publications-resources/journals-and-magazines/social-policy-journal/spj18/cannabis-black-market18pages31-43.html 131 Greenwald, G. Drug Decriminalization in Portugal, Lessons for creating fair and successful drug policies, CATO Institute, White Paper, 2009, Pages 27 and 28. http://www.scribd.com/fullscreen/13784156 132 Boermans, M. A. An economic Perspective on the Legalisation Debate: The Dutch Case Drugs & the Law, Vol.2, No.4, 2010, Vrije Universieit, Page 18. http://ojs.ubvu.vu.nl/alf/issue/view/19

of criminality to be associated with cannabis as a consequence of tax evasion. Cannabis made its way onto the international agenda from 1912 during the opium conventions convened at The Hague in the Netherlands, resuming in the 1920s following a stagnant period during WWI. During these conventions cannabis was often used as a tool to bolster positions in the opium debate, with little concern or knowledge from the majority of countries, which arguably led to ill informed decisions with little regard for the wider questions of the cannabis debate. The opium conventions during the 1920s were accompanied in Britain by a series of 1920s drug scares and media hype based around misinformed medical men and scientists, dubious and unfounded court cases and the racial profiling of cannabis users. The most intense period for cannabis was between 1924-25 and this saw increased restrictions forwarded by the pharmaceutical society and its addition to the conventions passed in 1925, which allowed Britain the option of cannabis prohibition, which it duly implemented in 1928 despite resolutely low levels of use in mainland Britain, use ironically exploded in the United Kingdom during the 1960s as further controls were implemented. The following period which extended to contemporary times saw an escalation of controls which culminated in the consolidation of 9 existing treaties in the form of the 1961 UN Single Convention on Narcotic Drugs, in order to create an internationalist prohibitionist regime which enshrined the prohibition of cannabis, amongst other drugs, in domestic laws. This created the climate of political adherence to prohibitionist principles which continues to exist to this day and places considerable pressure on nations considering alternative approaches to drug issues. In the United Kingdom, the 1971 Misuse of Drugs Act in adherence with the 61 convention, established a rejection of the medicinal uses of cannabis despite evidence available to the contrary during that period and widespread historical use in medicine, even in British literature. Classification of cannabis in the 1971 Misuse of Drugs Act was downgraded from class B to C in 2004; however reclassification shortly followed in 2009, against the advice of the ACMD arguably in the name of ideology and political convenience for a newly oriented administration. Challenges to this were met with dismissal, as was the case with Professor David Nutt who was dismissed in 2009 following criticism of government drug policy. The risk of schizophrenia has been frequently overplayed by government officials and the media, leading to widespread public misconceptions, which often fail to take into account the predisposed genetic nature of the disease or the differences between psychosis especially that of transient form, and mental illness. Furthermore regulation of CBD levels could potentially ameliorate these minimal risks. The falsification of government studies, such as that of Dr. Heath at Tulane University in 1974 have also led to completely false ideas about the potential for brain cell damage and certain theories, such as the gateway theory, have proven to be incorrect, with the complete opposite being suggested in modern studies. When brought into comparison with other drugs, cannabis has significantly lower levels of harm on individuals and third parties than many other drugs. Its relative harms are minimal, with some inconclusive concerns surrounding the effect of smoked cannabis on the respiratory system and its role in the development of cancer, however these can be adjusted for by method of consumption, such as synthetic THC pills in medical use, or cannabis as an addition to food in both medicinal and recreational use. Cannabis has widespread historical and contemporary medical use and can aid in diseases and illnesses such as cancer, arthritis, multiple sclerosis, HIV/AIDS, glaucoma and many more which were not explored in this essay. Support for anti prohibitionist stances has widened over the years, from artists scientists, intellectuals and physicians in the 1960s to include former world leaders and members of international and governmental organisations across the world. There is a widespread sentiment that current policies have failed if not worsened the harms of the drug trades both nationally and internationally with policies appearing to be based upon ideology and political convenience as opposed to harm reduction. Examples of liberal drug policies have demonstrated positive results,

whilst current policies appear to increase harm. Subsequently, it would be advisable to reconsider current drug policies in favour of liberal, decriminalised and legalised models with an abstinence of commercial promotion of use, which may well significantly reduce the primarily external harm factors associated with cannabis use.

James Tiltman July December 2011 Extended Project Qualification Politics Queen Marys College First Full Draft Submitted: 14/12/2011