Part I: Cannabis in the past

1 Cannabis as medicine in Europe in the 19th century
Manfred Fankhauser

2 The re-emergence of the therapeutic use of cannabis products: recent developments and future prospects
John Witton

3 The pharmacology of cannabis: issues for understanding its use
Desmond Corrigan

4 Soma, the Wootton Report and cannabis law reform in Britain during the 1960s and 1970s
Stephen Abrams

5 Cannabis’s role in drawing attention to ‘the drugs problem’ in Sweden
Börje Olsson

6 Enlargement 2005: cannabis in the new EU Member States
Jacek Moskalewicz, Airi-Alina Allaste, Zsolt Demetrovics, Danica Klempova and
Janusz Sierosławski with Ladislav Csemy, Vito Flaker, Neoklis Georgiades, Anna
Girard, Vera Grebenc, Ernestas Jasaitis, Ines Kvaternik Jenko, Richard Muscat,
Marcis Trapencieris, Sharon Vella and Alenka Žagar

Our understanding of cannabis today is bound up in an understanding of the past. We begin this monograph by looking back on how cannabis was used and understood in the past. Throughout human history, cannabis has been used for many purposes such as recreation, therapy, art, religion, medicine and as a textile.

The first two chapters in this section examine the role of cannabis as a medicine in Europe in the 19th century, together with more recent developments in developing cannabis as a medicine. In the past two decades, great efforts have been made to assess the usefulness of cannabis as medicine, as cannabis is currently being used in a small way as medicine. Nevertheless, the role cannabis plays in medicine today is modest compared with the past, and although there are reviews on the subject, well established and secure conclusions of the extent to which cannabis is a reliable and useful medicine remain uncertain. Many have pointed out that there is a need for further research on the subject .

Moving on from a historical and contemporary perspective on cannabis as medicine, a general introduction to the pharmacology of cannabis is also presented. Although the psychoactive effects of cannabinoids have long been known, it was not until the 1980s that the first evidence for the manner in which tetrahydrocannabinol (THC) acts on the brain became known and, as Corrigan’s chapter highlights, important advances have been made since then.

This section proceeds to focus on two case studies that discuss the role of cannabis in youth cultures in the 1960s. As Abrams and Olsson show, cannabis became widely known as a recreational drug with the youth cultures of the 1960s. Government responses to the increased use of cannabis were probably as much concerned with a response to the youth cultures as they were a response to the substance use in its own right.

The section ends with development in the more recent past: the enlargement of the European Union in 2005, to embrace 10 countries in Eastern Europe, the Baltic States and the Mediterranean Islands. This round of enlargement is an event that remains fresh in the minds of those who will read this monograph in Europe. Yet with the subsequent addition of Bulgaria and Romania, and the welcoming of new candidate countries, these Member States are beginning to become more firmly integrated within the fabric of the EU. Time will tell whether the large variations currently seen in cannabis use across these countries will evolve to reflect those in pre-2005 Member States.

The different chapters included in this section constitute only a limited presentation of cannabis in the past. Nevertheless, we hope that the section facilitates the beginning of an understanding of present-day processes. As people living in contemporary society with contemporary concerns, we sometimes neglect the importance of the past. We hope that these introductory chapters illuminate that although much of this monograph is based on up-to-date data, our understanding of cannabis today is partly a product of its past.

Part II: Policies, legislation and control strategies

7 Cannabis control in Europe
Danilo Ballotta, Henri Bergeron and Brendan Hughes

8 In thinking about cannabis policy, what can be learned from alcohol and tobacco?
Robin Room

9 An open front door: the coffee shop phenomenon in the Netherlands
Dirk Korf

10 Cannabis policy: tightening the ties in Denmark
Vibeke Asmussen

11 Cannabis: a harm reduction perspective
Andrew Bennett

There are three main UN drug conventions, two of which are significant for cannabis. The 1961 Single Convention on Narcotic Drugs provides for controls over cannabis, as well as other drugs. The 1988 Convention Against Illegal Traffic in Narcotic Drugs and Psychotropic Substances strengthened the international scope and framework of cooperation against drug trafficking, including trafficking in cannabis. All EU members are signatories of the three UN conventions on illicit drugs, and the EU itself is a signatory of the 1988 Convention. Consequently, all countries within the EU have adopted some sort of legal prohibition against cannabis, and the UN conventions have played a role in constraining national legal experimentation on drug law and policies. The international UN conventions on drugs are unique. There is no other issue where one can find a universalised discourse translated into such similar legislation around the world.

Nevertheless, and as made apparent in this section, the appearance of harmony in the EU is to a large extent not a reality. Wide room for manoeuvre within illicit drug legislation has been taken within the EU. Individual national legislation is possible despite the UN conventions, as treaties allow for discretion. Additionally, national variations in drug use policies are accommodated within the EU organisational structure. Although the EU has launched several drug action plans, full harmonisation has not 1materialised. And though the EU takes complementary measures, there is no coherent holistic approach to drug issues in the EU. The EU considers drugs to be mainly an internal security concern. This implies that there is little overarching influence from the EU on national drug policies. Individual countries are relatively free to experiment with different drug-related policy regimes. Especially prominent is the case of cannabis liberalisation policies, explored by Ballotta et al. in this section. The chapter makes evident that many EU Member States have gone their own way in terms of how to interpret the UN global control regime on cannabis.

The different approaches to cannabis-related issues are often discussed in terms of a philosophical shift between zero tolerance approaches and harm reduction approaches, or in terms of criminalisation and decriminalisation or repressive versus liberal regimes. This is, however, too simplistic a notion of the issue at hand. Clearly, as shown in Ballotta et al.’s chapter, there exist multiple approaches to legislation regarding cannabis within the European Union today, and specific legislative categories are often difficult to determine. The Netherlands, for instance, which is often thought of as a liberal regime, is still a prohibitionist country. The Netherlands uses roughly two-thirds of its budget for drug problems on criminal action. As noted in Korf’s chapter, although possession for personal use and use of cannabis is decriminalised in the Netherlands, production and supply of cannabis are prohibited, and criminal sanctions are enforced. Seen from this perspective, it might be informative to think of the various issues related to cannabis control as continuous and blurred, rather than a case of dichotomy of liberal or repressive.

In terms of the effectiveness of the various cannabis policies which exist in the EU, evidence is scarce. As Room points out, the drug field has much to learn from the tobacco and alcohol fields, in which policy measures are more rigorously examined and there is a relatively well-developed evidence base on which strategies work and which are most effective in terms of reducing the harms. In comparison, the policy impact literature is relatively undeveloped with respect to illicit drug use. Indeed, different drug control regimes are rarely rigorously evaluated. Despite scarce evidence, a modest research literature exists which remains sceptical about the effectiveness of cannabis prohibition. Korf suggests, for instance, that cannabis possession laws have little influence on cannabis prevalence rates and are thereby not an effective way to deter use.

It is also generally agreed that there is a gap between formal policies and policy as implemented. As is shown by Ballotta et al., the most common penalties for cannabis possession range from fine to incarceration. Nevertheless, reports suggest that in practice most detections lead to a fine. Additionally, evidence of a ‘net widening effect’ exists. Researchers have noted that a relaxation of policies may not have the intended effect of less severe consequences of cannabis prosecution. Some have suggested, for instance, that cannabis reclassification in the UK might have led to offenders that were previously dealt with informally being subject to on-the-spot formal warnings, recorded as such by the police force. Since there are few long-term data on cannabis policies as implemented and the effects they have, it is difficult to determine the impact of ‘decriminalisation’ policies.

Researchers generally agree that the harm to the defendant in drug cases extends far beyond the cost of the actual criminal justice sentence or caution. Exactly what the impact of a cannabis prosecution entails is, however, far from clear. Administrative measures do not necessarily mean a more gentle approach than criminal measures, as administrative measures might be associated with additional costs for the individual user, for instance through a reduction or withdrawal of a student’s loan or difficulties in employment opportunities. While evidence of this is available in the literature for the US and Australia, little evidence exists for European countries.

Harm reduction policies, as mentioned by Bennett, start from a recognition that substance use has been and will continue to be part of human experience. Acceptance of this fact leads harm reduction approaches to develop strategies with the aim of moving people towards safer forms of substance use, possibly with abstinence as the ideal. In this way harm reduction is a radical move away from more traditional illicit drug strategies that solely aim at abstinence. Another distinct feature of harm reduction is its emphasis on respecting drug users and on moving away from paternalistic models of care.

A strength of harm reduction strategies is the firm focus on secondary as well as primary harms of cannabis use. In addition to the attempt to reduce primary and adverse health effects of cannabis use, harm reduction strategies recognise that harm also arises as a consequence of legislation, policies and police strategies. Unfortunately, the secondary harms are far less researched than the primary harms of cannabis use, and this poses a challenge for future research efforts. Indeed, and as pointed out already, the current evidence base on the impact of drug policy regimes is weak. In order to learn more about the relation between policies and effects, there is a need for carefully designed studies that are able to determine the impacts, primary and secondary, of cannabis use. The most appropriate way to go about such work is through quasi-experimental designs, and where possible true experiments.

One criticism of harm reduction strategies has been that it sends out the ‘wrong’ messages. This claim can be countered by a variety of responses, for example, that public health approaches in other fields such as sex education have adopted a harm reduction approach, that the community understands harm reduction messages, and that they are not an encouragement to use drugs. But symbolic values can be as important as evidence and the emphasis on symbolic values might be a useful starting point for reaching an understanding of how cannabis policies have developed and how they may develop in the near future.

What the future holds in terms of drug law harmonisation is, however, impossible to predict. What is clear is that a possible harmonisation, if occurring at all, is likely to be very slow, and national and regional distinctions within the EU in terms of cannabis policies are likely to continue to be the rule rather than the exception.

Part III: Supply and production issues

12 Global cannabis cultivation and trafficking
Ted Leggett and Thomas Pietschmann

13 Monitoring cannabis availability in Europe: issues, trends and challenges
Chloé Carpentier, Meredith Meacham and Paul Griffiths

14 Understanding cannabis potency and monitoring cannabis products in Europe
Leslie King

15 Multinational export–import ventures: Moroccan hashish into Europe through Spain
Juan Francisco Gamella and Maria Luisa Jiménez Rodrigo

16 An analysis of the significance of supply and market factors for variations in European cannabis use
Leif Lenke

The market

Current research shows that the main supplier of cannabis to the EU is Morocco. This claim is based to a great extent on research efforts made by the United Nations Office on Drugs and Crime (UNODC), as shown by Pietschmann and Leggett. Gamella and Jiménez Rodrigo have provided an in-depth analysis of the cannabis trade from Morocco to Europe. As they point out, hashish is generally taken from Morocco to Spain and Portugal and is thereafter exported across Europe. This should come as no surprise in view of the geographical location of the countries. It must, however, also be noted that cannabis on the European market travels through other routes as well.

Although it is clear that Morocco plays an important role in the European cannabis market, it must not be forgotten that there are other significant supply sources of cannabis. As is mentioned by Pietschmann and Leggett, cannabis in Europe also derives from Thailand, Afghanistan and Pakistan. Various central Asian states and former parts of the Soviet Union are also suppliers of cannabis resin to the European market. This suggests that there is a strong correlation between poverty and the drug trade. In a poor region such as Morocco, cannabis production constitutes an important means for families to reach a sustainable standard of living.

It should also be highlighted that over the last decade, domestic cultivation of cannabis has started to change the shape of the cannabis market, so that home cultivation has in some countries become an important part of the cannabis supply. The Netherlands has long been known to be a producer of marijuana, or ‘netherweed’. Netherweed is produced for domestic as well as international consumption, and in the last few years ‘netherweed’ has been seized in the UK, Scandinavia, Germany, Belgium and France. New evidence also indicates that the supply of cannabis produced elsewhere in Europe is on the rise. Switzerland has, for instance, reported a sharp increase in illegal cannabis cultivation. A 1999 Swiss EKDT report argued that in 1998 more than 100 tonnes of cannabis were harvested for the drug trade, and it was plausible that Switzerland became the second largest European exporting country after the Netherlands. An increase in domestic cultivation has also been noted in the UK, with some arguing that cannabis cultivated in England and Wales may now make up well over half of the consumption there.

Owing to the illegality of cannabis, both use and trade are mostly hidden. Carpentier et al. demonstrate a certain degree of uncertainty when it comes to measuring and researching the cannabis market. One can never really know if seizures are indications of general trends or of the extent of law enforcement. The trend of an increase in domestically grown sinsemilla at the European level is possible, but currently relatively undocumented. While international trafficking, mainly from Morocco, evidently occurs, it is unclear what share of the market home-produced cannabis actually comprises. Although much domestic cannabis cultivation is small-scale production for personal use, it should not be neglected, as it contributes to the European cannabis market and it might make up a larger proportion in the future. Seen from this perspective, although continued attention to Morocco and other international suppliers is important, there is a need for more research on domestic cultivation. Too strong a focus on Morocco may indeed produce a partly distorted picture of the European cannabis market today.

If cannabis production is to an increasing extent produced on European soil this raises new and important questions. Apart from the issue of THC potency, as discussed above, a geographical change in the production of cannabis is also connected to questions regarding the relationship between the industrial and the developing world. As Gamella and Jímenez Rodrigo point out, the cannabis market is an important economic asset to poor farmers in Morocco. A possible turnover of the market, with a shift of production to Europe, may have negative implications for peasant farmers in the developing world. Further, European domestic cultivation has implications for national criminal justice responses. At the moment heated debates regarding cannabis are usually confined to the issue of possession and not cultivation. As the geographical production of cannabis changes it might, however, also change the focus of the public debate towards more emphasis on appropriate responses to cultivation. Indeed, EU Member States might increasingly have to deal with criminal justice issues such as cultivation for personal use, and commercial cultivation, as well as medical growers. We might expect new policy initiatives, and with these a need for scientific investigation into how the market is evolving and how it responds to new developments.

Potency

From time to time, a wave of media interest across Europe contends that cannabis in contemporary society is stronger and thus more harmful than it was in the 1960s and 1970s. Claims have been made that cannabis consumed today is 30 % stronger than in the past. This belief, though strongly held, is something of an urban myth. As King in this section notes, the myth has been fuelled by media and politicians, and researchers have suggested that the figures come from misinterpretation of the data which, when calculated in accurate terms, actually translate to a 1 % increase.

Clearly, there are controversies concerning cannabis potency, and in-depth and careful investigation is required in order to explore properly the issue of THC potency. King investigates data from seven European countries. When using potency data combined with data on resin and herbal cannabis consumption, a weighed mean potency is found. Following this strategy, King finds a potency increase only in the Netherlands and he thus concludes that no overall upward trend is found except from indoor-cultivated Dutch resin, which is thought to make up a small share of the market. But despite King’s reassurance that overall cannabis potency has not increased dramatically, there is evidence which challenges this view. This is, for instance, pointed out by Leggett and Pietschmann in this section, who point towards a possible trend for indoor domestic cultivation of sinsemilla to increase in several European countries. Claims have been made that this type of cannabis is easily modified and does often imply an increase in potency. At present the size of the European domestically produced cannabis market is, however, unclear. Additionally, it is unclear to what extent domestic production actually implies an increase in cannabis potency.

Clearly, contradictions prevail, and we may conclude that at present it is difficult to gain adequate data on the issue of trends in cannabis potency. Forensic data provide only a weak basis for evaluating potency trends, largely due to problems associated with standardising definitions of cannabis products and sampling issues. Additionally, analysis based on drug enforcement seizures may be anomalous in a number of ways, including a disproportionate focus on large cultivators and seizures. Finally, it is evident that the discussion has been contaminated by scare tactics and ignoring of sound evidence. Thus, there is clearly a need to pursue these issues further in order to create an improved knowledge base from which the potency issue may be further explored and better understood.

In order to facilitate an informed policy debate, there is also a need to explore issues indirectly linked to the issue of THC potency, for instance, to investigate adverse shortand long-term health effects that might arise from a potential increase in potency. Indeed, as pointed out by King, THC potency increase does not necessarily mean that there will be an increase in adverse health effects, as an increase in potency may lead to an adaptation by the users to smoke less cannabis. In turn this would lead to less inhaled smoke in lungs and thus decreased risk of respiratory diseases.

Knowledge of potency as well as the dose consumed by individual users is an important and sometimes neglected area in the research literature. As is well accepted in the alcohol and tobacco field, the effects of cannabis must be considered in relation to type of cannabis consumed, and pattern of consumption, and hence also THC levels. There is little disagreement that there is a difference between drinking a full glass of vodka and a full glass of wine and that intense, prolonged use of alcohol is deleterious to both physical and psychological well-being. In the case of cannabis, on the other hand, there seems to be little effort made to ascertain actual dose rates and hence lifetime intake of cannabinoids. Thus, little account is taken of the wide range of concentrations of THC and related compounds in smoked cannabis and differences of smoking habits from one individual to another. This poses a challenge for future research.

Sharon Rödner Sznitman
Sorad

Börje Olsson
Sorad