Wednesday, October 4, 2023

Prepare for legalisation

Irish medicine needs to focus on reducing harms after cannabis becomes legal writes Terence Cosgrave

“I’d like a word with four ‘i’s’” said the teacher. “Mississippi” I said. “No. I want a private chat with you, you four-eyed twat,” he replied.

The essence of comedy is the mistaken phrase or concept, and I think perhaps we are now having this conversation with regard to the Citizens’ Assembly on Drugs. This is indeed a pity, as illicit drugs are a growing part of Irish life, and measures to control their use, and respond to their misuse, will be an ever-growing part of Irish medicine.

But the prohibitionist argument is deflated, losing air every day. This should be, however, not a moment of joy or celebration for pro-cannabis activists, as the legalisation of cannabis (or other drugs) will simply create a new environment – one that pro-cannabis people say will be more equal and humane, and one which anti-cannabis activists predict will be chaos.

However, when Germany passed a law last month to legalise cannabis possession up to 25 grams for recreational use, the sound of Irish stable doors being closed while German horses ran over the horizon was hard to miss.

The influence of Germany – the biggest country in the world so far – legalising cannabis has made it politically easier to make that decision here. The Bill still has to pass parliament in Germany, but it is a government Bill, and as such, should pass without any problems.

A key part of the plan – introduced by Health Minister Karl Lauterbach – is the removal of the taboo on cannabis use, and a campaign which, he says, will ultimately reduce cannabis use.

There is also the not insignificant €5 billion that the German government expect to make annually from cannabis sales. And, as we all know, the ultimate goal is also to remove the lucrative cannabis business from criminal gangs.

Now, many stakeholders from various groups (including medicine) have dipped their oars in the waters of predicting the effects of cannabis legalisation. The experience of the US and Canada has been cited, and various models of legalisation are being looked at to see which ones do the least harm.

There is no question that some of the powerful, synthetic blends of cannabis are dangerous to teens, and there is some evidence of psychotic episodes in teens using cannabis, but these arguments are rapidly being overtaken by the reality – cannabis is being made legal in more and more countries, and its legal availability has consequences for medicine, the law and society.

Ideally, one would wish that Ireland would introduce a law that protected children and teenagers, but our record in that regard in relation to smoking tobacco and drinking alcohol would suggest that we are unlikely to legislate to properly ensure that teens do not have any more access to cannabis than they had pre-legalisation.

Nonetheless, that is the most important aspect of cannabis legislation – either now, or post -legalisation. We will be in that new environment then, and how we set up our system will be crucial.

I understand the arguments about prohibition. There may even be some merit in prohibition in some cases. But that argument regarding cannabis is now lost. And fighting that retreat and losing battle is not going to help anyone in the future.

It’s unlikely that Ireland can or will hold out against the rest of the world, which sees cannabis as increasingly a drug that people should be allowed to take legally – whether for medical or recreational reasons.

Even if legalisation is still years away, the use of cannabis and cocaine has increased to a point where it is everywhere – as prevalent as alcohol.

But nothing is good or bad but thinking makes it so, and similarly, the way in which the legalised cannabis is to be run is the only conversation, the only argument. Do we have ‘clubs’ like in Germany and Canada? What limits do we put on personal use? Do we have ‘cafes’ or ‘pubs’ where people can use their drug with others? It’s impossible to predict the future, and it’s impossible to know what happens when societies make major changes to the consumption of drugs and the legalisation of the drug business – one of the biggest – if illegal – enterprises in most developed countries.

But we have a chance here to stop fighting the inevitable, and instead look to methods of harm reduction – and more importantly – use the influence of the medical community to ensure that legalisation here, when it comes, does the minimum possible damage to the nation’s health and wellbeing, rather than continually arguing for prohibition.

We can’t turn back the tide, but we can show leadership in achieving the best health outcomes in a society that has for the moment shown itself to be in favour of legalisation. In other parts of the world, hallucinogens are being legalised and even used in medicine. We need to move on from arguing against legalisation, and instead focus on harm reduction and prevention.

We have a set of Lego braille bricks to give away to a lucky reader. The first person to spell ‘Doctor’ in braille and tweet it to out IMT_latest Twitter account will win. (Sorry, Elon, it will always be Twitter to some of us).

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