Uruguay is set to legalise cannabis. Should we celebrate?

Assuming this law will pass though the country’s Senate, Uruguay is set to become the first country to legalise cannabis. Might this reduce the level of harm cannabis causes there to individuals and society?

To get closer to an answer, it is essential to move beyond the binary of legal and illegal, and to think more about the controls and regulations in place. Legality can look very different depending on the details of how a product is controlled. Compare an uncontrolled ‘legal high’, a legal and aggressively marketed drug like alcohol and a legal drug like paracetamol. The obsession with legal vs. illegal disguises the complexities and subtleties of how policy can produce positive or negative outcomes. Markets for legal drugs can be dangerously unregulated just as illegal markets are. It is clear that neither legalisation nor prohibition are themselves solutions to drug harm.

The good news is that the government of Uruguay are not so naive to believe that drug harms can be tacked simply through the legalisation or prohibition of drugs. They have been consulting in depth with many international experts to develop detailed plans to reduce the harms of cannabis. They are even setting up a unit which will evaluate and monitor evidence in how the law is performing so it can continue to be optimised. We will need to wait to see how these plans are implemented, but at this very early stage, Uruguay are making all the right signals that they intend their policy to work to reduce harm, not just to signify a particular posture on drug use. This looks like truly evidence-led policymaking.

Uruguay have had a policy of depenalisation for a while, where cannabis is prohibited, but possession of small quantities for personal use is tolerated. So their public and politicians know that the sky does not fall in when cannabis users go unpunished. That knowledge is not quite so widely accepted here, but international evidence shows that the wide variation and many local readjustments in ‘toughness’ of cannabis policy have no clear connection to how popular the drug is. And if use rises somewhat in Uruguay, is that itself a disaster if the overall burden of harm can be reduced? If we consider the harms of scuba-diving, is it better for this to be a popular and licensed activity with some risks or an illicit and dangerous habit of fewer people? We will have to look beyond the raw figure of cannabis prevalence to evaluate this law. Drops in crime and the use of more dangerous drugs are other vital measures of success.

Those who are close-minded to options beyond criminalisation frequently point to alcohol and cigarettes, which despite their legality causes more harm than any other drugs. As stated above, they are right, in the sense that legality itself is no magic bullet. But Uruguay intends to have a state monopoly over the production and sale of cannabis. Whilst kids’ sporting heroes are sponsored by booze companies here, all promotion of cannabis in Uruguay will be illegal, no companies will be seeking to maximise their sales. For our government, where a man who earns money from Big Tobacco has a job in the heart of the system, it proved a step too far to regulate tobacco packets so that they are not designed to appeal to new users. In Uruguay, to buy cannabis a user will have to be over 18, will need to register, and will buy the drug from pharmacies, unless they want to grow a personal supply themselves. Scrutiny of this state monopoly will still be essential to ensure that policy is never skewed by any vested interests that conflict with harm minimisation.

Alcohol provides a useful comparison in other ways. Illegal alcohol often contains a high amount of methanol, which blinds and kills drinkers. Legal alcohol has quality control. Like alcohol, the chemistry of cannabis affects the risks. Cannabis in this country has changed, 24 hour lighting in growhouses have produced a product with less or no CBD in it, which now dominates the market. CBD is a chemical which offers some protection from both the more unpleasant and more harmful effects that THC in cannabis can have. Uruguay has a great opportunity to offer their cannabis users access to a better, less harmful product. It is worth noting that illegal alcohol still exists and kills; a regulated market can only aim to outcompete and minimise the illegal market. Legalisation should slash the harms drug crime and illegal markets do to society, but will not eliminate them. Uruguay must follow the evidence of outcomes to find the optimum between over-regulation (for example a very weak product), which will push users back to unregulated illicit sources, and under-regulation, which I would argue is what we have for tobacco and alcohol, where opportunities to reduce harm, such as plain packaging, are rejected.

This article has focussed on the ways politicians can influence drug harm, but the Uruguayan proposals show understanding that top-down State action is not enough, and users’ decisions determine outcomes too. They propose education that equips citizens to make these judgements over their drug use, and healthcare and support for people needing help with cannabis problems. 

Cannabis is not harmless, for example it can worsen the mental health of some heavy users, especially the young. But the mental health impact of prison, unemployment and illegal drug gangs is considerable, legalisation reduces this burden of criminalisation. When deciding a drug's legal status, the question of whether it is harmful is less important than the question of how the legal status might reduce or increase those harms.

The world must watch what happens in Uruguay closely. If their approach works, this evidence should provoke reform elsewhere.