Should the UK legalise cannabis for medical and recreational use?
It was the plight of 12-year-old Billy Caldwell that started the ball rolling. Just over a week ago, the severely epileptic boy from County Tyrone was taken to hospital in a “life-threatening condition” after the cannabis oil that stops his seizures was confiscated at Heathrow Airport. Along with all bar one cannabis-based medicine, the oil Billy depends on is illegal in the UK, though legal in many other countries. His mother Charlotte had been trying to bring it in from Canada after her own GP had been told he could no longer prescribe it.
The backlash that followed was a political embarrassment; so much so that, within a few days of the story hitting the headlines, the government had agreed to grant an emergency 20-day licence for the banned medication and announced a review of the law surrounding it.
The review will be carried out in two stages: the first will make recommendations on how cannabis-based medicines might offer patients medical and therapeutic benefits. The second will see the Advisory Council on the Misuse of Drugs assess the balance of harm and public health needs and consider whether changes should be made. If the review identifies significant medical benefits, then the drug will be rescheduled, so it can be licensed for medical purposes, the Home Secretary Sajid Javid has said.
So far, so sensible. After all, Billy’s case is not an isolated one. Across the country there are hundreds of parents who believe cannabis-based medicines would help their children. They include six-year-old Alfie Dingley, who suffers up to 30 seizures a day as a result of a rare genetic mutation and who has also now been granted an emergency licence.
Here in Scotland, however, Karen Gray has been offered no guarantees about her own son Murray, five, who has myoclonic astatic epilepsy. Since December, Murray has been suffering up to 600 fits a day; he has been prescribed a variety of medications including steroids and ketamine, but nothing is working.
“This review is to be welcomed, but Murray needs this medicine now,” says Karen, from Edinburgh. “There are lots of children who will now be looking for licences and we have been given no guarantees. Are we just going to have to join a massive queue? And how long will it take before the situation is resolved?”
All of this is without taking into account the thousands of adults with chronic conditions who say cannabis relieves their pain and who are forced to illicitly grow their own or turn to dealers.
Depriving sufferers of such treatment seems particularly illogical given the UK is now the world’s largest producer and exporter of legal cannabis. In 2016, 95 tonnes of marijuana (44.9 per cent of the world’s total) was grown here for medicinal use, even though the UK government refuses to licence such products on the grounds that they have “no proven therapeutic value”.
The government’s position is further undermined by the fact that a British company, GW Pharmaceuticals, is one of the biggest producers of legal cannabis. GW Pharmaceuticals makes the UK’s only licensed product, Sativex, which is currently so expensive it is prescribed only in Wales.
Such contradictions make the present policy unsustainable and it seems likely that, having committed to the review, the government will move to reschedule cannabis by the end of the year.
However, the debate over legalisation does not end with its use for medical purposes. In 2009, cannabis was upgraded from Class C to Class B, amidst concerns about the increased prevalence of stronger “skunk” varieties of the drug. Now, however, a growing lobby across the UK is calling for the decriminalisation/legalisation of cannabis for recreational use (with a slightly smaller one in favour of decriminalisation/legalisation of drugs in general).
Most of those who advocate change believe the so-called War on Drugs – a zero tolerance approach imported from America – has demonstrably failed to tackle the problem and that governments should start to treat drugs as a health as opposed to a criminal enforcement issue.
Such campaigners take a pragmatic view: they argue cannabis use is now so widespread that many young people in the UK find it easier to buy weed than alcohol. Legalising cannabis would take it out of the hands of criminal cartels, they say. It would generate tax revenues and allow for a degree of regulation; age restrictions, strength and distribution could all be subjected to government control.
Last week, Prime Minister Theresa May was adamant the government review would be confined to cannabis’s medicinal use and that, in criminal justice terms, cannabis would remain a Class B Drug for the foreseeable future.
But then former Tory leader William Hague challenged that stance, calling the current policy “inappropriate, ineffective and utterly out of date”. In Scotland too, there is growing support for a shift towards legalisation. The most high-profile advocates for change include former Scottish justice secretary Kenny MacAskill and Liberal Democrat MSP Alex Cole-Hamilton.
Police Scotland has already effectively decriminalised possession, with many cannabis users given warnings instead of facing prosecution. Because it feels its hands are tied, the Scottish Government has called for drug laws (which are currently reserved) to be devolved to Holyrood.
“When we started out, we found some former MPs were saying: ‘Yes, we support that,’ after they left office,” says Martin Powell, head of campaigns and communications at Transform, a charity that has been campaigning for the legalisation of drugs for 20 years. “Then it was former drugs ministers such as Mo Mowlam and Bob Ainsworth, and now it’s former party leaders, such as Hague and Ed Miliband. That’s only one step away from having current ministers supporting it, so we believe the tide has turned.”
Last week, Canada became the second country in the world after Uruguay to legalise cannabis, but there are many other nations – such as Holland and Spain – where the drug’s use and/or distribution is permitted in specific circumstances (such as coffee shops or members-only clubs). Though cannabis use is still prohibited under US Federal law, 29 US states have legalised it for medical use and nine – including California, Maine, Colorado, Oregon and Vermont – have legalised it for recreational use.
The way in which the legalisation works varies greatly from place to place.
In Uruguay, for example, there is a virtual state monopoly; the government buys all its supplies from just two producers, sets the price and then sells the drug through state-regulated pharmacies. In Colorado the set-up is much more commercialised.
In Canada, a federal state, sales of cannabis, which analysts estimate could eventually be worth somewhere between C$5 billion and C$7 billion annually, will vary widely from province to province. In Alberta, for example, recreational cannabis will be available at more than 200 private retailers, while in New Brunswick, the provincial government will operate a chain of stores called Cannabis NB. Analysing the impact in different areas should produce some thorough data which other countries will be able to draw on when formulating their own policies.
Transform, which produced the book How To Regulate Cannabis: A Practical Guide, has helped shape drug policy across the globe. The charity served as an official adviser to Canada’s parliament and its national task force on legalisation and regulation.
“We would like to see an over-arching reform of the way the UK approaches drugs so that the focus is on minimising harm, benefiting public health, reducing crime and taking power and money away from organised crime rather than on enforcement,” says Powell.
“Once you see the evidence from around the world, you realise there are only two options: you can either have governments, pharmacists, doctors and licensed retailers controlling the trade or you can have cartels and criminals. There isn’t a third way in which these drugs don’t exist and suddenly miraculously no-one takes them. We tried that for half a century and it just doesn’t work.”
Colorado is probably the US state in which the legalisation of cannabis has caused the most controversy. Some critics linked the new law to a spike in homelessness and an alleged increase in road traffic accidents. On the other hand, use of marijuana among teenagers went down and is now lower than the national average.
At the same time, in 2017, the state raised $247 million from taxes, fees and licensing costs. Several million of that was invested in anti-marijuana public information campaigns. Perhaps tellingly, the proportion of citizens who support the legalisation of cannabis in Colorado has remained stable at 54 per cent.
Powell anticipates that if the UK opts for legalisation, it will adopt a model somewhere between the stringent state control of Uruguay and the commercialism of Colorado.
“We know the terrible things that were done in terms of the regulation of alcohol and tobacco, so we would be able to learn from that, “ he says.
“I imagine the UK government would impose age restrictions, licence only a small number of producers, ban all promotion and advertising and find ways to reduce the profit motive.”
Many of those who continue to oppose legalisation do so because they are worried about the links between the substance Tetrahydrocannabinol (THC) and mental illness. A succession of studies has found regular consumption of “skunk” – UK-grown cannabis with high levels of THC and low levels of Cannabidiol (CBD) which helps neutralise the effects of THC – significantly increases the risk of schizophrenia. Around 94 per cent of cannabis seized by the police today is super-strength skunk, compared with 51 per cent in 2005.
Over the past few years, a number of mothers whose sons have developed mental illness after regularly smoking skunk have pleaded with the government not to yield to pressure to relax the policy.
But Powell insists legalisation would help alleviate the problem by allowing the government to control both the THC and the CBD levels of legally sold cannabis. “In some of these skunk products, the THC level is 20 per cent, but in Uruguay, they capped it at 10 per cent” he says.
But wouldn’t capping THC levels ensure a black market in stronger varieties continued to flourish? “In the UK, around 80 per cent of the tobacco market is legit,” Powell says. “If we are looking at a move that would remove 80 per cent of the criminal drugs market, that has to be a good thing. Once you have reduced the illegal market, it becomes a much smaller target for the police to focus on.”
At the Edinburgh-based drugs information, advice and support charity, Crew 2000, chief executive Emma Crawshaw supports the decriminalisation of cannabis so long as it is carefully thought out and there is an associated increase in health and social care services. But she says one of the things working in this field has taught her is that some of the people most vociferously opposed to change have seen friends or family succumb to addiction or other drugs-related issues.
“In the past, I could be guilty of saying it’s just 50-plus men behind internet screens who think like that, but, even within Crew, we have people who have lost loved ones to drugs and have just had enough and believe only really tough measures are acceptable.
“Harsh measures against complex problems will always seem like solutions to some and that can be the result of experience, rather than ignorance; so it is important to keep the dialogue going and help people understand what the benefits to the community as a whole might be.”
Crawshaw also cautions against viewing the decriminalisation or legalising of cannabis as a panacea. “We have to remember taking a source of income away from illegal criminal networks is not just going to happen in a vacuum,” she says. “People who have a vested interest in criminality are going to look for other things to sell. It would be irresponsible to think we could take cannabis and other drugs out of criminal networks and not expect them to adapt. So we should be monitoring the impact of any change in policy.”
Last August, as statistics revealed drugs-related deaths in Scotland had risen to a record high, Professor Neil McKeganey of the Centre for Substance Abuse Research criticised the SNP for its soft touch harm reduction approach.
But as the party overhauls its own strategy (and the campaigns for a drug consumption room in Glasgow), it seems ever more committed to treating drugs as primarily a health issue.
At Westminster, SNP MP Tommy Sheppard is seeking a review of the Misuse of Drugs Act, which he believes is no longer fit for purpose, and pushing for powers over drugs law to be devolved to Holyrood.
He is also hoping to persuade the Scottish Affairs Select Committee to set up an inquiry into drug policy north of the border which would look at the relationship between the two governments.
“It is a weird devolution anomaly that the Scottish Government has got the authority for criminal justice to punish people and the health service to mop up the problem, but has no say over the classification of drugs,” he says.
Sheppard wants to kick-start a mature conversation on a non-partisan basis and to build a consensus.
But it is no secret that he inclines towards legalisation. “Since human beings first discovered fire they have been using stimulants of various kinds to make life more bearable,” he says. “It’s never not going to happen so we might as well grow up as a society, face that fact and try to regulate it.”