INCB should exert caution in presenting data on cannabis regulation

At the recent 63rd Session of the Inter-American Drug Abuse Control Commission (CICAD) of the Organisation of American States, the International Narcotics Control Board (INCB) member who was present, Raúl Martin Del Campo Sánchez, spoke on a panel titled “The link between the Sustainable Development Goals (SDGs) and Drug Policy: A focus on international organisations”. At the end of a wide-ranging presentation that addressed the drug policy related facets of SDGs 3, 5, 10 and 16, Mr Del Campo Sánchez moved to present several final slides on the “Negative Effects of Cannabis Legalization in the USA”. It was unclear as to how the concluding slides related to the earlier part of the presentation, however Mr Del Campo Sánchez seemed quite determined to make the point that cannabis regulation initiatives at the state-level in the USA had only resulted in negative outcomes.

In order to make his case, he cited several alarming statistics from one source, SAM (Smart Approaches to Marijuana), which paint a one-sided picture of the outcomes of marijuana regulation in states like Colorado and Washington. While the INCB is mandated to ensure compliance with the UN drug control treaties and has stated very clearly that the legal regulation of cannabis for non-medical use contravenes these treaties, the Board also has a responsibility to present a balanced and unbiased view of the impacts of regulation initiatives, to the extent it chooses to present data at all. To quote very specific statistics without situating them within the broader context is misleading. Given the INCB’s role and mandate, this kind of one-sided presentation of the available data is problematic.

There are a wide range of studies and surveys examining the impact of cannabis regulation in the various US states where it has taken place. Many of these are official government data sources such as the 2016 Washington State Healthy Youth Survey (see pp 90-97) and Washington State Office of Financial Management's 2016 update report on "Monitoring Impacts of Recreational Marijuana Legalization" (see p 3). Neither of these reports support the claim that there has been an increase in adolescent consumption of cannabis in Washington State as presented by Mr Del Campo Sánchez.

For nearly every statistic put forward in his presentation, there is a different source refuting or more meaningfully contextualising the data (none of which were cited). For example, the percentage increase of 150% in treated for marijuana poisoning from edibles is likely to be have been drawn from the study by Clinical Paediatrics which reported that the rate of 5-year olds and under exposed to marijuana increased by 147.5%. While the percentage increase is alarming, the increase in actual numbers is very small from under 100 children in 2006 to almost 250 in 2013. In comparison, in 2013 there were more than 11,000 calls to poison centres for children in the same age group having been exposed to alcohol, 45,000 calls for antihistamine exposure and 25,000 calls for cough medicines. These figures demonstrate the need to situate the data cited in context and rather than simply quote percentage increases, and to present data more transparently by including the actual numbers. When compared with other potentially harmful substances ingested by children, the threat of poisoning from cannabis is small.

The data with regard to the impacts of cannabis regulation has to be reviewed with care given the shift away from prohibition towards a public health approach. The Colorado Department of Public Safety’s 2016 report on “Marijuana Legalization in Colorado: Early Findings” specifically caveats all the data presented by acknowledging that it is “too early to draw any conclusions about the potential effects of marijuana legalization or commercialization on public safety, public health, or youth outcomes, and this may always be difficult due to the lack of historical data. Furthermore, the information presented here should be interpreted with caution. The decreasing social stigma regarding marijuana use could lead individuals to be more likely to report use on surveys and to health workers in emergency departments and poison control centers, making marijuana use appear to increase when perhaps it has not… Thus, the lack of pre‐commercialization data, the decreasing social stigma, and challenges to law enforcement combine to make it difficult to translate these early findings into definitive statements of outcomes.” (p 5). Surprisingly, this important qualification was omitted from Mr Del Campo Sánchez’ presentation.

In addition, Mr Del Campo Sánchez neglected to mention any of the potential benefits of these regulation initiatives such as the reduction in marijuana-related arrests resulting in substantial cost savings for the criminal justice system, as well as a reduction in policy harms to individuals caused by life-long criminal records – all of which have been widely acknowledged. Tax revenues generated have been put towards notoriously underfunded drug treatment and prevention programmes, state schools and investment programmes in communities most adversely affected by drug arrests and incarceration. A report from the Drug Policy Alliance, “From Prohibition to Progress: A Status Report on Marijuana Legalization” outlines these positive social justice impacts in greater detail.

The picture with regard to cannabis regulation is complicated and the reasons for moving away from prohibition cited by the authorities where regulation is taking place are compelling. Punitive prohibition has failed to reduce the scale of the drug market and the resulting policy harms can no longer be justified. Policy makers are weighing up the pros and cons of different legal regimes with relation to cannabis and exploring new approaches that may result in less overall harm from either drug use or misguided policies. It is crucial that policy makers have unbiased, accurate data on the results of these new approaches in order to accurately evaluate their impacts on the health and wellbeing of communities.

The INCB has an important role to play in encouraging a balanced debate and in doing so should avoid drawing overly simplistic conclusions. If INCB members choose to present data, they should use a range of different sources and ensure that they provide as complete a picture as possible – acknowledging the difficulties of data analysis and the complexities of comparing the impacts under different legal regimes such as prohibition and regulation. In fact, the Board would do well to take note of UNODC’s nuanced position on this as stated in the 2017 World Drug Report, ‘It is difficult to quantify the impact of the new cannabis legalisation as it seems that a combination of elements was already in the process of changing the cannabis use market in those jurisdictions when the legalization measures were put in place.’ (Booklet 1, p20.).