"Smoking gun in the drugs debate"

Dr Alex Wodak's plan to have the Government sell cannabis in little packets at the post office wasn't just a throwaway line to a bunch of senile hippies at the Mardi-Grass festival in Nimbin last weekend.

It was part of a considered strategy by the esteemed director (for 26 years) of St Vincent's Hospital's drug and alcohol service to convince authorities to legalise marijuana and other illicit drugs.

In evidence to last year's inquiry into the impact of illicit drug use on families by the House of Representatives Standing Committee on Family and Community Affairs, chaired by Bronwyn Bishop, Wodak again advocated the legalisation of cannabis, describing it as "the least-worst option".

Wodak, also president of the Australian Drug Law Reform Foundation and the International Harm Reduction Association, asserts that more than 2 million Australians are cannabis users and thus prohibition is a losing battle.

But just because there are Australians who smoke cannabis is not a sound reason to legalise the drug, particularly at a time of mounting scientific evidence of its long-term devastating health effects, in particular its link to schizophrenia.

It is exactly the wrong time to legalise cannabis, just as its popularity among young people is diminishing, as shown by the latest Australian Secondary School Students' Use of Alcohol and Drug Survey.

Cannabis use by 12-to-15 year olds in the previous month plummeted from 15 per cent in 1996 to 6 per cent in 2005, with the percentage of 12 to 15 year olds who had ever tried cannabis falling from 28 per cent to 13 per cent. The evidence is that fewer children are even experimenting with cannabis, which is a far more potent drug today than it was when Nimbin's hippies were young.

While the 6 per cent of young teens who are monthly tokers is still a worry, the trend is distinctly downward after two decades of rising drug use.

That is a success in anyone's language and it is perverse for Wodak and others in the "helping" professions to deny that success, and pour scorn on the federal "Get Tough on Drugs" approach that underpins it, and which the Rudd Government has shown no signs of dismantling.

Rather than drug harm-minimisation advocates admitting they are wrong and that their careers up to this point were misguided, they have stepped up their attacks, describing the so-called War on Drugs as a failure and those who disagree as "zealots", "ideologues" and "evangelists". But this is the pot calling the kettle black, for what else do you call people who refuse to change their minds in the face of overwhelming evidence but zealots? Even harm minimisers admit that legalising cannabis will create more cannabis users - because the stigma associated with breaking the law will no longer apply. Thus we would expect more mental health problems.

But Wodak has minimised evidence of the link between cannabis and mental illness, both at Nimbin last weekend and to the Bishop inquiry, when he said: "Cannabis probably does not precipitate severe mental illness in people who have not been previously mentally ill."

It is irresponsible for a doctor in his position to play down serious research showing the link between marijuana and schizophrenia, and not just for those who are already psychotic.

What he is doing is no different from the tobacco industry denying the links between smoking and lung cancer.

Medical opinion is moving against him, with the journal The Lancet, on July 28 last year, recanting its 1995 editorial which claimed smoking cannabis was not harmful to health, and citing studies which showed "an increase in risk of psychosis of about 40 per cent in participants who had ever used cannabis".

Another long-term Swedish study of 50,465 Swedish Army conscripts has found those who had tried marijuana by age 18 had 2.4 times the risk of being diagnosed with schizophrenia in the following 15 years than those who had never used the drug. Heavy users were 6.7 times more likely to be admitted to hospital for schizophrenia.

In a study of 1037 people in Dunedin, New Zealand, those who used cannabis at ages 15 and 18 had higher rates of psychotic symptoms at age 26 than non-users. In both studies, the link between cannabis and psychosis remained even after controlling for the possibility that people had pre-existing symptoms.

Wodak also claimed this week that cannabis "is soon going to be consumed by more people than tobacco". But the facts just don't support his assertion. According to the United Nations the number of smokers worldwide has grown, from 1.1 billion in 1998 to a projected 1.3 billion in 2010, whereas only 147 million people consume cannabis. It will take a lot of Nicorette patches before cannabis replaces tobacco as the world's most widely-smoked drug.

For a full demolition of the soft-on-drugs approach, the Bishop report is a goldmine, concluding: "The evidence received … in the course of this inquiry has shown there is a drug industry which pushes harm reduction and minimisation at the expense of harm prevention and treatment [which has as its aim] making an individual drug free."

The inquiry found the push for legalisation of illicit drugs flies in the face of overseas evidence. Sweden, once a harm minimisation pioneer, has learnt from bitter experience, adopting a restrictive drug policy, criminalising illicit drug use, and providing early intervention and treatment, with spectacular results.

Last year a UN review of Swedish drug policy found: "The vision of a drug-free society … has, on occasion, been derided as 'unrealistic', 'not pragmatic' and 'unresponsive' to the needs of drug abusers … The ambitious goal of the drug-free society has been questioned … Nevertheless … the prevalence and incidence rates of drug abuse have fallen in Sweden while they have increased in most other European countries. It is perhaps that ambitious vision that has enabled Sweden to achieve this remarkable result."

Which brings us back to Wodak. Isn't it about time that the Mercy nuns who founded St Vincent's Hospital account for their head of drug and alcohol services?

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Medical opinion is moving against him, with the journal The Lancet, on July 28 last year, recanting its 1995 editorial which claimed smoking cannabis was not harmful to health, and citing studies which showed "an increase in risk of psychosis of about 40 per cent in participants who had ever used cannabis".

Another long-term Swedish study of 50,465 Swedish Army conscripts has found those who had tried marijuana by age 18 had 2.4 times the risk of being diagnosed with schizophrenia in the following 15 years than those who had never used the drug. Heavy users were 6.7 times more likely to be admitted to hospital for schizophrenia.

In a study of 1037 people in Dunedin, New Zealand, those who used cannabis at ages 15 and 18 had higher rates of psychotic symptoms at age 26 than non-users. In both studies, the link between cannabis and psychosis remained even after controlling for the possibility that people had pre-existing symptoms.

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bucketbill said:

Cannabis use by 12-to-15 year olds in the previous month plummeted from 15 per cent in 1996 to 6 per cent in 2005, with the percentage of 12 to 15 year olds who had ever tried cannabis falling from 28 per cent to 13 per cent.

Miranda Devine - Opinion Page, Sydney Morning Herald. 8/05/08 http://www.brisbanetimes.com.au/new...he-drugs-debate/2008/05/07/1210131061922.html

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Post office cannabis idea just plain potty
By Harry Clarke
Posted Wed May 7, 2008 10:44am AEST
Updated Wed May 7, 2008 11:00am AEST

I wonder what Australia has done to deserve having people in charge of drug treatment services advocating the decriminalisation of illicit drugs such as cannabis.

The director of the alcohol and drug service at St Vincent's Hospital, Dr Alex Wodak, proposes selling cannabis in post offices to cut consumption. He made the proposal for taxed and legalised cannabis at the Mardi Grass festival in Nimbin on Sunday (an appropriate site for a medical practitioner to make a recommendation for decriminalising cannabis?) but said he would be happy to express his opinion as a policy proposal to the Federal Government.

People such as Dr Wodak have a high profile and their views carry weight. Is the Australian taxpayer getting value for the dollars it spends on such services? I also wonder why doctors so concerned with the health problems of managing illicit drug use seek to employ measures that will increase illicit drug use and, from my perspective, add to community harm.

Cannabis use in Australia is falling as the recent National Drug Survey shows. The proportion of males aged 14 and over in Australia that used cannabis over the past 12 months peaked in 1998 at 21.3 per cent, declining to 13 per cent in 2007. Among male youth aged 14-19 years use fell even more dramatically from 35 to 13.1 per cent over the same period. Comparable findings hold for female users. The problem of cannabis use is being reduced with public policies now in place. The problem is not one that is 'out-of-control' - to the contrary it is being steadily and effectively addressed.

This call by Dr Wodak is irresponsible. Providing cannabis legally, he claims, would reduce the harm of the drug. But there are two effects of decriminalisation. Those who do not wish to operate in illegal markets would now have the opportunity to purchase cannabis in legal markets, increasing supply. Furthermore, those troubled by the possible harmful effects of cannabis would now have the opportunity to purchase material that had a government-guaranteed seal of quality and social acceptability stamped on it. Those purchasing legal material would believe it to be less risky and more socially acceptable than illegal supplies so that non-price user costs of consuming the drug would fall. This would also encourage additional use.

But Dr Wodak believes that adding an additional source of legal supplies to pre-existing illegal supplies would substantially reduce consumption. How could this be? If prices (inclusive of other user costs) were less than illegal market prices then quantities demanded would increase. If legal prices exceeded prices in illegal markets then there would be two sources of supply: illegal cheap cannabis and more expensive legal cannabis. How will having an additional source of supply reduce demand? In short, it will not.

The move to decriminalise would substantially reduce the user costs of consuming cannabis and, given that the demand for cannabis certainly depends on price and other costs of accessing the drug, its decriminalisation would certainly encourage use.

Moreover, would providing legal cannabis reduce harm even to those users who simply switch from illegal to legal use without increasing use?

There are several well-recognised damages from smoking cannabis. One is simply the increased prospect of contracting lung cancer. Researchers in New Zealand found a 5-fold increase in the incidence of lung cancer from those who smoked cannabis. Smoking cannabis does far more damage to the lungs than smoking cigarettes and is linked to the emergence of emphysema. This is hardly surprising when the act of smoking a joint or bong is analysed - the objective is the hold smoke in your lungs as long as possible to maximise the effects of the THC.

Among young people cannabis use is associated with far worse mental health problems than even alcohol consumption. There are significant issues of dependence among cannabis users and a literature suggesting links between cannabis and psychosis.

How will any of these problems be reduced by providing an additional legal source of cannabis?

As I have written before, Dr Wodak's uncritical support for harm-minimisation at the expense of the most basic appreciation of the laws of supply and demand makes no sense.

Are not physicians supposed to 'do no harm'? How is reducing the cost of a dangerous drug by decriminalising it going to help? Why pretend that current policies seeking to limit the use of cannabis are failing when they manifestly are succeeding?

Fortunately Nicola Roxon, the Minister for Health, has promptly rejected even considering Dr Wodak's proposal. Good.

Harry Clarke is professor of economics at La Trobe University.

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