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New analysis of alcohol and cannabis – what’s the harm?

Thousands of bottles of alcohol on shelves

This blog discusss DrugScience’s latest multi-criterion decision analysis of cannabis and alcohol regulation. Read the open access paper here.

We’re all used to weighing up the benefits and pitfalls in our decision making. Is it worth the cost? Is it safe? Will I be able to get up in the morning?

These are all simple questions we ask ourselves on a daily basis and essentially this simple method enables us to make the best possible assessment using nuance and logic, so what if we based other difficult decisions on this premise?

Drug policy can often appear a black and white issue. We associate certain drugs with having harmful consequences, so therefore a place of ‘illegality’ can make sense. But now experts have come together to write a new report in the International Journal of Drug Policy, which looks at whether they think alcohol and cannabis should be legal or not.

The report, ‘A new approach to formulating and appraising drug policy’, found many factors need to be considered when looking at the harm drugs can cause and gave a fascinating insight into the different types of regulation and the effects it can have on society.

With the US and Canada setting examples of cannabis regulation, we now have the opportunity to explore whether regulation works in relation to drug use and public health concerns.

Countries have the following different legal approaches when it comes to alcohol and cannabis:

  1. Absolute Prohibition: Production, distribution, possession are illegal and laws enforced.

  2. Decriminalisation: Production, distribution, possession remain illegal, but possession is a civil offence.

  3. State control: There are legal options available for users to access the substance, but a variety of regulatory interventions may be applied to structure the market.

  4. Free market: Production, distribution, possession are not subject to any regulatory policies beyond those that apply in general to consumer goods within and modern market economy.

If we were to write a new policy for cannabis and alcohol, what do the experts think it should look like?

The paper explains that for both cannabis and alcohol, state control was the most preferred policy and absolute prohibition was the least preferred. However, for cannabis, a free market was preferred over decriminalisation for cannabis.

Looking at alcohol further, the paper concluded that state control was preferable, with perhaps a surprising leaning towards absolute prohibition.

Arguing the case for state control it said the four strongest factors are:

  1. the avoidance of criminalising users,

  2. the generation of state revenues,

  3. the avoidance of a criminal industry, and

  4. better community.

However, it said the arguments in favour of prohibition are:

  1. the medical harm to users and the cost impacts (e.g. health care costs),

  2. the harm it can cause to others (e.g. drunk driving or violence).

How would cannabis compare using this same method?

The four strongest factors favouring state control over absolute prohibiton were improved community cohesion, reduced harms from more harmful substances (e.g. synthetic cannabinoids or “spice”), medical use and family cohesion

However, the report did recognise that state control costs more to implement and can criminalise some users. It may also lead to some illicit supply that circumvents taxes and regulations.

We’re too often focused on the levels of use of a drug, but this only provides a small perspective when addressing potential harms associated with a substance.

It added: ‘Focusing too narrowly on prevalence of use might lead to strict prohibition, harsh penalties, and an over-emphasis on abstinence-based interventions over harm reduction. Focusing only on personal liberty, on the other hand, might lead to laissez faire policies with large increases in harmful use, dependence, and their concomitant consequences for health, families and communities.”

‘…whereas alcohol tends to be available through commercialised legal markets with excessive use and health impact, cannabis tends to be available through criminal markets with lower use but harms from criminalisation.’

Drug policy reforms are taking hold across the globe, so are we likely so see unexpected public health benefits from regulating cannabis? The report states that despite state control being the preferred options for both cannabis and alcohol use, the results also highlighted that legal access regimes (ie free market and state control), were ‘more consistently and clearly preferred for cannabis than for alcohol’.

For cannabis, participants expected legal access regimes to see consumption shift from smoking to less harmful delivery systems involving edibles, vaporisers and e-cigarettes, a shift away from low-CBD/high THC variants thought to involve higher health risks, and a reduction in use of more harmful synthetic cannabinoids. These effects would to some extent counteract harms from potentially increased consumption expected under legal access regimes.

This blog piece was previously published by Virgin Unite. Follow Jason on Twitter here.

For open-access to the full report of this research, see below:

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