SHOULD CANNABIS BE LEGALISED IN NZ?

A dear friend asked me to share my views as a psychiatrist in relation to the referendum on legalising cannabis that is going to take place in NZ later this year. As with most things in life, there are both pros and cons associated with this question, the balance always hanging between an individual's right to use any psychoactive substance they may like to use for recreation and pleasure, versus the consequences of such use for the society at large.


THE CONS

If cannabis is legalised it will certainly make our (psychiatrists') jobs a lot busier as cannabis use has been reported to be associated with the development of psychosis (schizophrenia), depression, anxiety and (other) substance use disorders. 


Using high potency marijuana daily can increase the risk of developing psychosis by nearly 5 times, compared to people who have never used it. The association for mood and anxiety disorders is less well established than that with psychosis. Significant associations have also been reported with alcohol and nicotine use disorders.


The other unintended consequence is the potential increase in the prevalence of cannabis use by the general population. Contrary to popular myth, it does matter to a lot of people, though clearly not everyone, whether a drug is legal or not. When I moved to NZ, synthetic cannabinoids (legal highs) were still legal, and could be bought in may dairies. We used to see a lot of people reporting using it, and also both psychiatric (like psychosis and severe mood disorders) and some physical (seizures, heart attacks in young people) associated with its use. Once it was made illegal, we noticed that a significant number of people stopped using it and we were seeing far fewer psychiatric admissions associated with use of synthetic cannabinoids.


THE PROS

One of my patients who is a regular cannabis user and also purports to have some gang affiliations, surprised me by saying that he did not want cannabis legalised. His reasons were (a) it will become a lot more expensive because of taxes, and (b) why would anyone buy it from gangs if they can buy it from the dairy? 


These are the exact reasons why the government may want to legalise cannabis. The first that the revenue from the sale of cannabis, which is not uncommonly used in NZ, will start going to the treasury rather than the gangs. The second that it will take away a major source of revenue from the gangs which may prove beneficial for the society at large in the long run.


Legalising cannabis will also free up police and criminal justice resources being used to dealing with crimes associated with cannabis import/growth, possession and sale, to more serious crimes, while the consequences of using cannabis will be seen as a health service problem, rather than a criminal justice system problem. 


As mental health clinicians our only hope will be that the government will divert at least some of these freed up resources from the criminal justice system to the health system to better equip it to deal with the consequences of the potentially increased cannabis use by the population.

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