“We need at least to consider and examine forms of controlled legalization of drugs.”

George ShultzSecretary of State under US President Ronald Reagan

The US Drug Enforcement Administration executed a search warrant on a log cabin in Santa Ysabel, California and discovered a sophisticated indoor marijuana operation consisting of 454 plants that were concealed underground and only accessible by a makeshift elevator and a 65-foot tunnel. Four individuals were arrested and each faced up to 40 years in prison if convicted. April 3, 2007. (Photo courtesy DEA)

DRUG POLICIES’ RELATION TO RATES OF CANNABIS USE

While it has been argued that rates of cannabis use would be higher if law enforcement measures were not in place,38 this claim is inconsistent with available scientific evidence indicating that patterns of drug law enforcement are not strongly correlated with rates of cannabis use, and is further refuted by the data presented in this report.39-41 For instance, comparisons between the US and the Netherlands, where cannabis use is de facto legalized, indicate that despite the US’s record rates of anti-drug enforcement expenditures, the lifetime rate of cannabis use in the US is more than double that observed in the Netherlands (42% compared to 20%).40

Similarly, a recent World Health Organization report indicated that country level rates of drug law enforcement and patterns of drug use demonstrate no correlation between the resources devoted to enforcement of drug laws and rates of drug use.40 It is worth noting that similar patterns exist with respect to other illicit drugs. For instance, despite an estimated $2.5 trillion spent on the US war on drugs in the last 40 years, the US also has one of the highest lifetime incidences of cocaine use, which, at 16%, is approximately four or more times that of any of the other countries surveyed, including Colombia, Mexico, Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine, Israel, Lebanon, Nigeria, South Africa, Japan, People’s Republic of China and New Zealand.40

Cannabis Decriminalization: In response to the ineffectiveness and recognized harms of strict drug prohibition, several countries, including Portugal, Mexico, Peru, Brazil, Paraguay and Argentina, have instituted varying levels of drug decriminalization. While data are limited, evaluations of decriminalization models suggest that illicit drug use decriminalization is not associated with substantially increased drug use.28, 42, 43 Portugal, for instance, decriminalized all drug use in 2001, and its rates of cannabis use are among the lowest in the European Union.44, 45 However, a limitation of decriminalization models is that, without regulatory controls allowing for limited distribution—as employed for other psychoactive substances such as alcohol and tobacco—organized crime groups continue to exercise control over the cannabis market.46

Cannabis Legalization: There is very little evidence examining the impacts of cannabis legalization on rates of cannabis use or related harm. As noted above, in the Netherlands, where cannabis is de facto legalized and amounts for personal consumption are distributed through licensed coffee shops, rates of cannabis use are lower than in the US.40 However, as has been noted by others,47 the proposals for cannabis law reform in California extend beyond the Dutch model, which is limited to regulated distribution to the end consumer (i.e., production remains illegal). Although the authors were cautious to note that there are major uncertainties about the actual impacts if proposed law reforms are passed, a recent hypothetical modelling exercise by the RAND Corporation concluded that cannabis use could increase in California under the proposed legislative changes.47

The actual effect of cannabis legalization on rates of use will likely depend on the regulatory mechanisms devised to control both use and availability, as well as the subsequent cultural norms that emerge under a legal framework.46, 48 While there is limited empirical evidence to draw upon from the cannabis literature, there has been a vast amount of study of the regulatory tools to effectively reduce the harms and rates of use of other substances such as alcohol and tobacco. The potential benefits and types of these regulatory mechanisms for cannabis control have been fully described elsewhere and are briefly summarized in Tables 1 and 2.46, 49, 50

In brief, while not all of these regulatory tools may be directly applicable to a regulated market for cannabis, a number of important regulatory mechanisms should be given serious consideration in any locality considering legalizing cannabis sale or use. These include policies in place at some medical cannabis dispensaries and could include permit systems for cannabis users and conditional licensing systems for cannabis dispensaries based upon adherence to regulatory guidelines.46, 50 Regulations could also include age restrictions, restricting driving or operating machinery while intoxicated, limiting hours of sale and outlet density, restricting bulk sales and limiting potency of legal cannabis.46, 49-55 Additional regulatory policies worthy of consideration include policies that affect the location or circumstances of use, similar to both tobacco and alcohol regulation as well as the Dutch coffee shop model for cannabis, which are designed to reduce public use.50 Strict prohibitions on marketing and product branding could also be used to avoid promotion of cannabis use,46, 53 and evidence has confirmed the utility of tamper-proof packaging, standard labelling on content and factual health warnings for licit substances.46 Since taxation (i.e., increasing consumer price) has been shown to affect levels of alcohol and tobacco use, the price of cannabis could also be kept as high as possible to limit use, but low enough to avoid incentivizing an illegal market.49-55

While comparisons to the regulated supply of alcohol and tobacco are useful, it is important to stress that the regulatory controls placed on these substances vary widely in different regions, and most US states - based on best available evidence - do not implement optimally health focussed systems for alcohol and tobacco regulation. Instead, the interests of the tobacco and alcohol industries have commonly trumped the public health interests of maintaining high prices, reducing advertising and promotion, and fully incorporating the effective regulatory controls described above.53, 56

Given the clear ineffectiveness of US cannabis prohibition, as evidenced by data collected by the US federal government, some consideration must be given as to why these policies have remained in place. One barrier to reform may be public support for cannabis prohibition, which makes debate about alternative regulatory frameworks very controversial.57 In this respect, it is noteworthy that the substantial US federal anti-drug budget has allowed for a longstanding public education campaign targeted towards maintaining public support for cannabis prohibition. Of concern, the United States Government Accountability Office has reported that some of the media produced by the Office of National Drug Control Policy violated US domestic propaganda prohibitions for several years.58 Prohibition is also in the interest of law enforcement agencies involved in executing prohibition schemes, as it provides them with massive and increasing resource flows. Obviously, optimizing cannabis control policies will require that the public have access to factual information about the limitations and harms of cannabis prohibition. This report seeks to serve that purpose.