Chapter 21 - Public policy options

General economy of a public policy on cannabis

We are fully aware of the somewhat artificial distinction imposed by our mandate between cannabis and its derivatives and other psychoactive substances. Different substances lead to different types of uses. This is as true of cannabis as it is of alcohol, medications, cocaine, or ecstasy. The uses differ with the substance - cannabis consumption differs from consumption of medications or even alcohol. There is nonetheless a common basis to the non-medical uses of psychoactive substances, which are primarily seen as a source of pleasure, even a method of enhancing awareness and the senses. There are of course other forms of use: abuse, for example, is not based on pleasure but rather a physiological and psychological mechanism symptomatic of loss of control, even distress. Nevertheless, throughout history human beings have consumed psychoactive substances for reasons relating to self-liberation.

Uses also differ for a given substance. Cannabis use, originally associated with self-medication and religious rites, in twentieth century western societies became an expression of a counter culture and the hippie movement, before becoming a recreational drug. Although most cannabis use is self-regulated, in some cases, when associated with at-risk behaviour, use can lead to abuse.

For public policy on psychoactive substances to adequately encompass the common dimensions of substance use, it must be integrated, yet flexible enough to allow for approaches that are adapted to different substances.

An integrated public policy on drugs would be administered by a decision-making body capable of making links between the substances and their uses so as to propose a meaning to different drug uses. A public policy on drugs revolves around the varying uses made of drugs and not on the substances themselves. In other words, an approach more like that taken by France’s Mission interministérielle instead of an approach by multiple decision-making bodies, each one operating in a functional silo, in competition with the others as in the States, or for that matter in Canada, where illegal drugs, tobacco and alcohol are handled by different agencies.

An adaptable policy would be able to propose, define and develop tools suited to the various substances. Abuse of cigarettes causes lung cancer, not death due to impaired driving. Some medications, however, do lead to fatal accidents. Cannabis may be associated with both problems: cancer related to combustion, and highway accidents related to psychomotor effects. We must be in the position to understand what is specific to a given substance and what is common to a variety of substances.

A public policy, both integrated and adaptable must aim for knowledge of the relationship between substances and methods and contexts of use, in order to define the determining factors that separate non-problematic self-regulated consumption, from at-risk behaviour, and excessive use and related problems. There are two broad types of problems: the first affect user health, the second the health and safety of others; they must be dealt with indifferent ways. Certain measures must be preventive - inform users of risks and, specifically, help individuals recognize the signs of at-risk behaviour that can lead to problems. Those who consistently smoke between three and five cigarettes a day, something very few tobacco consumers may be able to do, are probably at no greater risk of lung cancer than non-smokers. Learning to manage consumption, recognizing the dangers, and having the means and the tools to do so are key. Other methods are dissuasive in nature: where drinking and driving are involved for example. Finally, some measures are curative: whatever the substance, from simple aspirin to heroin, for all kinds of reasons that pre-date consumption of the substance itself, some individuals consume abusively in a way that leads to health problems. The tools for treatment and cure must be available.

Thus, and this is the third criterion, a public policy on psychoactive substances must primarily be a public health policy: prevention, abuse deterrence, and treatment are the three prongs of public health intervention. A public health policy does not attempt to oblige people to live healthy lives or to have the community decide individual behaviour for some elusive public good. What we envision is a public health policy that contributes to reducing the risks relating to the different uses of different substances. A public health policy on psychoactive substances is thus a risk reduction policy.

Harm reduction approaches have been associated with needle exchange or the prescription of methadone or heroin. Some think that harm reduction policies rely too heavily on a medical model, simply softening the negative effects of an otherwise prohibitionist regime.[1][17]Harm reduction has been described as a “transitiondoctrine, contradictory and ambiguous, with the ambiguity enabling unlimited adaption.” [Translation][1][18]Even worse, according to American psychiatrist Thomas Szasz, it is a morally repugnant position reflecting government therapeutic paternalism.[1][19]

We believe that what is essential is recognition that (1) use of psychoactive substances cannot be eliminated, it is part of the human experience and not all use is abuse - whatever the substance - and (2) all substances can have negative consequences for both the user and society, making it advisable to contribute to individual and community well-being by providing information, abuse prevention tools and a treatment infrastructure. Recognition that an individual is no less a citizen, indeed no less a good citizen, because he chooses to smoke cannabis rather than drink alcohol, or chooses to use rather than abstain, but that individuals and societies, according to the circumstances and method of consumption, will have different needs is the key .

A public policy on drugs does not target users: its implementation embraces them. For too long, in any discussion of illegal drugs, including cannabis, the focus has been on understanding the characteristics specific to consumers, as if they had some feature distinguishing them fundamentally from users of tobacco, alcohol, or psychotropic medications for non-medical use. Although problem users may indeed have common characteristics, it is neither the substance nor being a user that is the question: other factors underlying development of at-risk behaviour should be given more attention.

Some people told us that harm and risk reduction policies, or for that matter decriminalizing cannabis, would “trivialize” its use. On the contrary, this is normalization, not trivialization. Excessive use of any substance is harmful: all substances may endanger user health, even coffee. Normalizing the use and the user does not mean trivializing them. A public policy on drugs aims to normalize uses of psychoactive substances: that implies not marginalizing users, while at the same time not trivializing use and shrugging our shoulders, ignoring the dangers specific to various substances.

To summarize: a public policy on psychoactive substances must be both integrated and adaptable, target at-risk uses and behaviours and abuses taking a public health approach that neither trivializes nor marginalizes users. Implementation of such a policy must be multifaceted, as we will see now.