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Terms of reference
Sub-Committee has invited evidence on the medical
use of cannabis and its derivatives. In this report
we have attempted to respond to some of your specific
questions with data from our own research, and in
some cases reviews of the relevant literature where
this has been gathered, (where I.D.M.U. evidence has
been provided for legal cases involving medical uses).
Some references are given which were not in the BMA
report on Therapeutic Uses of Cannabis (November 1997)
- chiefly on traditional medical uses and other studies
conducted prior to 1970. There are also other sources
which may not have been previously brought to your
attention. These reviews are not comprehensive, and
do not cover important areas including multiple sclerosis,
use as antiemetic/appetite stimulant e.g. in cancer
chemotherapy and HIV, or reduction of intraocular
pressure in glaucoma sufferers.
to reply coherently, we have begun with background
information, based on our research and others",
which gives the context in which your specific questions
can be addressed. This is in: Section 1: Types of
cannabis available, Section 2: Methods of use, Section
3: Consumption patterns of regular users, and Tables
1: Amounts smoked per day and 2: Cannabis use levels
areas which are relevant though not specifically
7: Medical use in California
describes a recent social experiment in making cannabis
widely available for medical purposes, with popular
support, legal and medical controls on misuse, and
a nascent system for production and distribution.
Whatever the scientific or other evidence on which
they based their vote, Californians devised a system
which supports medical uses while maintaining prohibition
on recreational use.
8: Treatment of "medicinal" cannabis users
by the UK criminal justice system:
Lordships expressed an interest in this matter in
a recent session. Data from our research, court
experiences, and other sources.
6: Outcomes of criminal prosecutions reported among
7: I.D.M.U. Medicinal Cannabis Cases
Specific Questions posed by the Committee
are the physiological effects (immediate, long-term
and cumulative), of taking cannabis, in its various
are the psychological effects?
5: Effects of cannabis - effects of duration,
dependence?, on driving.
5.4: Health problems and benefits attributed to
3: Reported health problems attributed to cannabis
4: Reported health benefits attributed to cannabis
5: Reasons for using cannabis.
from our surveys of regular cannabis users - total
2794 respondents. Overwhelmingly the most common
positive psychological effect reported by regular
users is relaxation/stress relief, followed by mood
elevation and increased sociability or personal
development. Negative effects most commonly reported
include memory problems, paranoia/anxiety, amotivation
and respiratory problems. Significant associations
between respondents reporting problems, levels of
use, and related variables including duration of
use, other drug use, spending, subjective ratings
of drugs, methods of use etc. are summarised in
the tables. The most common "beneficial"
physical effects are on pain relief and respiratory
benefits, such as reduced asthma and drying of mucosae
during colds and flu.
do these effects vary with particular methods of
preparation and administration?
4: Methods of Ingestion. In our studies, an
estimated 96.2% of cannabis use is by smoking, usually
with tobacco, although 25% of respondents eat or
drink it on occasions. Also, a small US study comparing
the harmfulness of smoking methods is reviewed.
cannabis poses clear risks to physical health, as
would smoking any substance, although this represents
a rapid and controllable route of administration.
The effects of oral cannabis preparations vary considerably,
with a risk of overdose due to the slow onset of
action. Many medicinal users report the effects
of smoked cannabis to be more beneficial than oral
cannabinoids, and it is possible that modulation
of the effects of THC by "minor" cannabinoids
may reduce some of the unwanted side-effects or
potentiate the therapeutic effect.
provides the most comprehensive studies currently
available of the dosages of cannabis/cannabinoids
and methods of use among large samples of short
and long-term cannabis users in the UK.
what extent is cannabis addictive?
what extent do users develop tolerance to cannabis?
5.1: Effects of duration of use.
2: Effects of duration of use on patterns of use.
proportion of users continue into middle age, and
a greater proportion use the drug daily than with
other controlled drugs. After approx. 2 years experimental
and heavy use, average monthly use declines with
age. The pattern of cannabis use among regular/long-term
users is comparable to that of caffeine, with the
average regular user consuming the drug on around
5-6 occasions per day.
is the evidence that cannabis in its various forms
has valuable medicinal actions?
the treatment of which diseases?
rigorous is the evidence?
6: Medical uses of cannabis. Raw material vs.
cannabinoid compounds. Literature reviews on historical
uses, pain relief, anti-convulsant, stress and depression,
asthma relief, opiate/ alcohol dependence.
4: Reported health benefits attributed to cannabis
is strong evidence that cannabinoids may be of benefit
in the management of pain and spasticity in conditions
such as spinal injury, arthritis and multiple sclerosis.
Cannabinoids (Nabilone/Dronabinol) have been approved
for medical use in treating the side-effects of
cancer chemotherapy, as antiemetics and appetite
stimulants. There is convincing evidence of bronchodilator
activity, although smoking as a route of administration
would not be a preferred route for asthmatics. There
is conflicting evidence of the efficacy of cannabinoids
in the treatment of glaucoma, epilepsy (particularly
cannabidiol), and addiction to opiates and alcohol.
Anecdotal evidence of anti-anxiety activity runs
counter to the little scientific evidence available,
although this may be attributable to differences
in the effect of cannabis on na"ve and experienced
General questions of the Committee - A Case for Change?
there a case for promoting clinical trials even
if the current level of control is maintained?
There is substantial anecdotal evidence of health
benefits from cannabis, and from some cannabinoids.
Recent work on cannabinoid receptors suggests new
lines of enquiry and provides a theoretical basis
for several commonly-reported conditions. The Misuse
of Drugs Act and other regulations were intended
to permit research, but the present licensing system
and policy has severely limited research opportunities,
and should be reviewed. There is an urgent need
for fundamental research and/or clinical trials
for a variety of conditions. The risks of morbidity
and mortality attributed to cannabinoids are surprisingly
low, particularly in comparison to existing medications
such as opiates, non-steroidal analgesics and benzodiazepines.
is now being published at an increasing rate, recent
publications have indicated therapeutic potential
of CBD as an antioxidant in the management of strokes,
and reduction of tumours in breast cancer from anandamide,
and also shown that cannabinoid receptors in the
skin are activated by traumatic injury. On the other
hand, researchers have also reported gene mutation
from cannabis smoke, and a review of cognitive effects
in long term users concluded that cannabis may interfere
with the "filter" system used by the brain
to keep out unwanted or irrelevant information.
Clearly the field of "therapeutic" cannabis
and cannabinoid research is advancing rapidly, with
economic implications from the development of a
new class of drugs. Should the UK maintain the hitherto
strict regulatory regime, the opportunities for
the British pharmaceutical industry to benefit from
new product development could damage our international
strong is the scientific evidence in favour of permitting
cases cannabis products may be more effective than
other treatments. It would seem inhumane to completely
block legal access to a substance which makes sick
people feel better, when no better alternative is
available, even if any beneficial effects were of
unknown aetiology or of undetermined efficacy. Where
the drug is of demonstrable benefit and alternative
treatments are less effective or carry greater risks,
a continued refusal to permit medicinal use, due
to perceived risks of a change in public attitudes,
appears unjustifiable both on moral and on public
strong is the scientific evidence in favour of maintaining
prohibition of recreational use?
commentators would seriously argue that legalising
the recreational use of cannabis would lead to a
breakdown of society, others would counter that
cannabis/hemp could "save the world".
In our view, both these positions are equally erroneous.
harmful effects of cannabis have, over the past
century, been investigated far more thoroughly than
potential benefits, with generally negative results.
The main physical dangers associated with cannabis
arise from smoking it, particularly mixed with tobacco
in unfiltered cigarettes, leading to respiratory
or cardiovascular problems. Psychological risks
include anxiety/panic/paranoia attacks mainly among
na"ve users, and a risk of psychosis in a small
number of predisposed individuals. Even if the worst
plausible dangers were all proved, using cannabis
would pose a lesser risk to health than many common
sports, other recreational activities, legal drugs
or products such as alcohol, tobacco, caffeine,
sugar or saturated fats.
and medical reports, from several countries including
the UK, have suggested that the harmful effects
of a prohibition policy, on individuals and society,
may be greater than the harmful effects of the drug.
Prohibition, particularly the effects of arrest,
may reinforce rather than deter drug use by reducing
the options for full participation in society, including
lost opportunities for employment, housing, foreign
travel and to the users driving license as a result
of a criminal record or positive urine sample.
has created a confrontational atmosphere which stifles
open debate and dissemination of information as
to the real risks of using different drugs, and
creates an incentive to experiment among teenagers
keen to rebel against the strictures of their elders.
A forbidden fruit, when no longer forbidden, loses
much of its sweetness. Experience in the Netherlands
and elsewhere does not suggest that a relaxation
in the law leads to an increase of use over the
longer term, and rates of drug use, including problem
indicators, in Holland are lower than in the UK.
evidence is only one of a number of considerations
which apply in formulating drug policy; public moral
and political attitudes and international treaty
obligations appear to take precedence over rational
consideration of such evidence. Any decision as
to the desirability and nature of law reform would
need to take account of matters beyond the scope
of this committee, including prevalence of use,
effects on crime/driving, economic effects both
direct (enforcement expenditure, tax revenues) and
indirect (effect on manufacturing industry and employment
of reduced acquisitive crime), international relations
(including drug tourism) and social attitudes, as
well as public health considerations and the proper
constitutional role of the state in the control
of individual behaviour.
of any change in the law is critical, whether this
involves an increase or reduction in penalties,
rescheduling to Class C (de facto decriminalisation
of possession), and/or the means of achieving a
legitimate method of supply in a legalised market
(e.g. taxation/regulation, licensing, coffee-shops,
clubs or free-market solutions). Each of these options
would create advantages and disadvantages which
must be carefully weighed before any policy is adopted.
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