Cannabis policies & cannabis use

Point of departure Does an increased interest in cannabis regulation result in the tendency to view the world through a lens that gives an over emphasis to, or over simplifies, the relationship between the legal status of the drug and levels consumption and harm? a one dimensional policy analysis For way of example 2

The importance of prohibition for inhibiting the use of cannabis in the USA 19 22 20 20 13 12 16 14 14 8 3

Lifetime use 12 th grade Monitoring the future 19 22 20 20 13 12 16 14 14 8 4

Cannabis policies & cannabis use some observations from the EU debate Policy and public discourse often appears to assume, explicitly (or implicitly) that cannabis control policies are directly reflected in consumption level Even small policy adjustments generate considerable public debate - `sending the right message (not clear who is listening?) Differential control policies are sometimes used to explain differences seen between countries in prevalence Evidence from the tobacco and alcohol field would suggest that some relationship should exist especially in respect to a free market But is it evident in the data we have available on cannabis in Europe where policies differ but still within an overall prohibition paradigm? 5

Research Evidence Less evidence than you would expect Australian case study (Williams & Betterville-Jensen) Temporary impact on earlier initiation rates in states that decriminalised no impact on overall rates of use Data emerging from the different regulatory models in USA & Some Latin American countries 6

What can we see from a European perspective? Public attitudes to this drug are different! 7

Drug prohibition? Opinions among young Europeans, age 15 24, June 2014 Source: European Commission, Eurobarometer Young People and Drugs (Flash Eurobarometer 401), August 2014. 8

Drug prohibition? Opinions among young Europeans, age 15 24, June 2014 Source: European Commission, Eurobarometer Young People and Drugs (Flash Eurobarometer 401), August 2014. 9

Some people think legal status makes a difference (British Drugs Survey, 2014)* Q: Would you consider taking drugs** in the future if they were decriminalized? (Base: NON DRUG TAKERS) Which drugs would you consider taking in the future? Marijuana: 81% Do you think that certain drugs that are currently illegal should either be legalised or decriminalised? Yes: 39% No: 61% Which drugs should be legalised or decriminalised? (among persons in favour of decriminalisation/legalisation) Marijuana: 88%; (ecstasy, cocaine 15%) 10

Cannabis use in the Europe national heterogeneity Most commonly used drug: 15 million young adults report use in last year. Last year prevalence of cannabis use among young adults (15 34) No simple relationship between policy in respect to legal sanctions and prevalence is easily observable Social, historical and other factors appear equally credible in explaining national differences This also applies to more intensive consumption patterns Policy changes do not seem to be the drivers for trends Might change if more radical models are adopted? 11

Last Year Prevalence (young adults) % 12

Prevalence of daily and almost daily cannabis use among young adults (15 34) 13

Cannabis: divergent national trends Last year prevalence of cannabis use among young adults (15-34): countries with statistically significant increasing trends Increasing trends France, Bulgaria and Nordic countries But in some highprevalence countries decreasing or stable trends (DE, ES, UK) 14

Changes in cannabis policy not observable in measures of use in the short term 15

Other issues we need to consider Policies & prevalence may both be influenced by other factors (for example social disapproval) Survey data is a crude measure and reporting biases are likely be greater in countries where harsher penalties are applied Many policy changes in Europe are actually quite minor and many policies are actually quite similar so we are not comparing polar positions (harsh enforcement V free market) We need consider initiation into use or impact on those already using the drug Longer term time interval 16

Critical question When comparing legal penalties and changes in this policy parameter: We need to also know to what extent they impact on: Policing practice? Users perception of risk of incurring a negative sanction? The relative availability of cannabis? Attitudes to the health or social risk of using the drug? 17

Perceived risk appears to be associated with in increased prevalence: Prevalence and perceived availability (students, 15-16 ESPAD 2011) 45 Czech Rep. 40 France Monaco 35 30 Life-time prevalence in% 25 20 15 Liechtenstein Germany Slovak Rep. Estonia Belgium Latvia Poland Bulgaria Slovenia Italy Lithuania Hungary Denmark Ireland Croatia Portugal Russia (Moscow) 10 5 Norway Finland Sweden Iceland Malta Greece Cyprus Faroe Ukraine Romania Serbia Moldova Montenegro Albania Bosnia and Herzegowina (RS) 0 0 10 20 30 40 50 60 70 Risk in % * Sources: Council of Europe,CAN, EMCDDA, Percentage who viewed using once or twice as a great risk 18

Perceived availability also associated with prevelance: Prevalence and perceived availability (students, 15-16 ESPAD 2011) 50 45 Czech Rep. 40 France Monaco 35 Life-time prevalence in % 30 25 20 Lithuania Estonia Latvia Liechtenstein Italy Hungary Germany Slovak Rep. Belgium Bulgaria Poland Slovenia Denmark 15 Russia (Moscow) Portugal Ireland Croatia 10 Ukraine Finland Malta Romania Cyprus Iceland Sweden Greece Serbia 5 Moldova Albania Faroe Montenegro Norway Bosnia and Herzegowina (RS) 0 0 10 20 30 40 50 60 70 Availability in % Sources: Council e,can, EMCDDA, The 2011 ESPAD Report, May 2012. Percentage of students saying that it would be fairly easy or very easy to obtain cannabis. 19

Some tentative conclusions A relationship may exist but it is likely to be a complex one and mediated by other factors in the current EU contex Regardless of your policy approach to cannabis: delaying age of onset and reducing use among the young appear wise from a public health perspective We need to be thinking about prevention models and how they interact with different regulatory models In Europe articulation between smoking reduction policies and cannabis policies is likely to be particularly important 20

Some tentative conclusions So in Europe formal legal status and possible penalties may not be the most important thing to think about when we are considering difference in prevalence This might change if the current prohibition framework is modified? Evidence from USA and elsewhere will be important But it does have some implications.. 21

Cannabis: predominant in drug law offences data Over 1 million drug law offences 63 % for cannabis use/possession Social costs? Policing costs? 22