Introduction: Cannabis Policy

In the concluding remarks of Part A, we noted that the very setting of the dichotomy along with the stereotypical connotations associated with each term restricts and hides important aspects of the debate. But how and why, did this way of framing the debate come about?

The distinction became increasingly popular in the mouths of policy makers and people alike following a very simple conscious and subconscious observation: Cannabis policy needs reform. The latter was arrived at after years of failed repressive policies, failing on two main domains: 1) Public Health 2) Criminological considerations and prison population. It is within this context that novel approaches and policies, as well as public perception of the issue, have increasingly been centred on the ‘Medical v Recreational’ distinction.

Public Health & Harms Reduction

 A notable recent example of policy-analysis that resists the ‘Medical v Recreational’ temptation is a report originating from France (April 2016). Following a public debate in cooperation with La Direction Génerale de la Santé, the report tackles the issue for all ‘substances that can potentially lead to addictive behaviours’. It argues for a decriminalisation of all such substances (including Cannabis) regardless of nature of use, focusing instead on a ‘Risks & Harms Reduction Principle’ (RdRD).

The strengths of such approaches are best appreciated form a Public Health perspective. However they fail to address another large-scale socio-economic aspect, leaving aside the issue of re-articulating the existing demand and providing adequate models of distribution*. On the other hand, they offer the best short-term approach on how to begin tackling the existing situation with its determinate and known parameters. It is interesting to examine some assumptions of the ‘Medical v Recreational’ distinction and their impacts in terms of distribution and economic activity.

Cannabis Legislation Models: Use, Distribution & Demand

It is often taken for granted that the ‘Medical v Recreational’ dichotomy maps exactly onto the ‘Regulated v Unregulated (Market)’ distinction. It is true that ‘Medical Cannabis’ (in our western understanding of the word ‘medical’) implies a highly regulated market and distribution mechanism. However it doesn’t follow that ‘Recreational Cannabis’ implies necessarily an unregulated market free of a ‘Risks & Harms Reduction Principle’. A parallel illuminating example is the tobacco industry – taxes, limited marketing, restrictions on points of sale, age etc.

From a somewhat sceptical standpoint one could argue for a legalisation and regulation of Cannabis exclusively for medical purposes. Arguing on the basis of a fully regulated market along the lines of the existing Healthcare & Pharmaceutical models, stressing that such an approach is supposed to only benefit people that could potentially gain actual medical improvements on their existing conditions, thus implicitly taking the ‘Risks & Harms Reduction Principle’ to its maximum application. However there are drawback to such restrictive policies.

The main concern of the above model is that it doesn’t address the so-called recreational demand for cannabis that exists in our (European) societies. Paralleling western Healthcare Models, ‘Medical Cannabis’ would most likely be available to ‘eligible’ patients on prescription, based on a set of criteria. The very high proportion of users who would not fit those criteria would still drive the ‘underground’ demand, thus maintaining the black market and its criminal organisations in place. Furthermore, it still criminalises a high proportion of users, thus failing to solve another societal issue (criminalisation of cannabis users is often linked to marginalisation which leads to violent behaviours).

Restrictive Medical Cannabis models also run the risk of excluding patients that could potentially benefit from cannabinoid consumption but do not fit the official criteria for prescription. It would be a mistake to try and fit a versatile plant like cannabis to our traditional Healthcare Distribution Models. There is also an argument to be made on human right’s grounds in the sense of the right to self-determination and self-care – allowing people to treat themselves the way they see fit. Furthermore, cannabinoid consumption is liable to bring overall improvements on quality of life which are not necessarily perceived from a purely bio-medical standpoint. Rigorous and well-funded scientific research is necessary to further our understanding of the plant and its beneficial applications. However, the implementation of those scientific findings into prescriptive, normative policies is a very different issue.

A Hybrid Model is therefore necessary to provide value for society as a whole, addressing public health concerns as well as criminological and socio-economic considerations and at the same time integrating cannabis into established medical and scientific practices. There are several questions that need answering though, pertaining with the distribution and Harms-Reduction principle of use that falls outside explicitly medical bounds. Distribution in that case can take several forms. Which is actually adopted in particular instances is highly dependent on cultural factors as well as goal-oriented considerations such as economic activity, employment, human rights, use reduction, public health etc. Approaches can vary from favouring small individual cultivation models to extremely liberal Colorado-Dispenser systems depending on local culture and perceived objectives of the policies (of course, in the majority of countries cannabis is still outright illegal).

A liberal proponent of cannabis legalisation might take, however, a different approach. Favouring the legalisation of cannabis simpliciter, the argument makes the point that in such scenario cannabis would effectively be available for any use (including medical), avoiding any discrimination based on usage and/or outcome. The merits of this view are to be found in its simplicity as well as its inherent non-discriminatory commitment – traits which ought to be transposed to actual policies. It nonetheless skips over some potential pitfalls.

Assuming that there is legitimate medical use for cannabis there need to be social-security mechanisms for reimbursement of treatment. This issue is notoriously problematic and a ‘simple legalisation’ policy does not guarantee the production of cannabis products and treatment procedures that are liable to be recognised by insurance bodies (both public and private) as reimbursable. This would lead to a major social injustice which is precisely what the above argument was purporting to dispense with. Furthermore, proper medical accompaniment, expertise and research should be available to those explicitly medical users that wish to access it. Again, there is no guarantee that such tangible and intangible social goods will emerge out of minimalist policies.

Medical v Recreational: What to make of it?

As we have previously argued, the ‘Medical v Recreational’ distinction cannot be effected by the plant in isolation, barring any contextualisation with actual usage and individual biological interaction. Even when usage is defined, the relationship is not straightforward considering that medical use can have recreational effects and vice versa. However the distinction is somewhat illuminating on a policy level – not in a descriptive / ontological sense, but rather as decent model to represent actual use-patterns. It helps bring into focus some issues of social justice, human rights and criminological considerations as argued above. There is one direct way of effecting this distinction, namely in the event whereby a person is explicitly treating a serious a recognised disease / condition with cannabis. In that case it can unambiguously be labelled as ‘Medical’ and enjoy the same status as other medical treatments.

In Part C. of this series of articles, a brief overview of some actual European examples will be presented.

*This is not aimed to be a severe criticism. The report is very thorough within its intended scope and provides detailed arguments for its conclusions, particularly in terms of Justice, Public Health & Safety, Employment, Social Life and Education.