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Assessing the public health impacts of legalizing recreational cannabis use: the US experience

Source: National Families in Action
Published in the June 2020 issue of World Psychiatry, the official journal of the World Psychiatric Association.
https://onlinelibrary.wiley.com/doi/epdf/10.1002/wps.20735

How has recreational legalization affected US marijuana markets? The authors of this paper, Wayne Hall, PhD, and Michael Lynskey, PhD, begin their paper examining this question. Dr. Hall is a professor at the University of Queensland Centre for Youth Substance Abuse Research in Brisbane Australia. Dr. Lynskey is a psychiatrist and professor in the National Addictions Centre at the Institute of Psychiatry, Psychology, and Neuroscience of King’s College London.

They write that legalization in some US states has brought about a substantial decrease in the price of retail marijuana, allowed adults to obtain a regular supply of marijuana without risk of criminal penalty, and led to a major diversification of marijuana products.

Most legal states tie taxes to the retail price of marijuana products. As prices fall, tax revenue declines, giving industry an incentive to increase THC potency to increase profits. If legalization becomes national policy, prices are likely to fall even further as the marijuana industry expands and attracts large-scale investment from the alcohol, tobacco, and finance sectors.

Experience with alcohol and tobacco suggests that more access to high-potency marijuana at a lower price is likely to increase amounts of the drug consumed by current users as well as motivate the industry to increase the number of users and the amounts they use in order to maximize profits. Industry will likely use promotional techniques like advertising and price discounts to achieve this goal. As more people use marijuana, and use it more frequently, public health impacts will also likely increase.

The authors devote the rest of their paper reviewing the health effects of marijuana use to date, as well as those that broader legalization is likely to intensify. Both lists are too long for us to summarize here. We encourage readers to click here to read this full, groundbreaking paper.

Proposed Cannabis Law Fails Public Health & Safety Test

Media Release 20 May 2020
With the help of senior lawyers, the SayNopeToDope campaign has analysed the proposed legislation – Cannabis Legalisation and Control Bill – that would be introduced if NZ’ers voted to legalise the recreational use of cannabis in the upcoming referendum.

The 4-page summary, Analysis – Cannabis Legalisation and Control Bill, highlights significant concerns around:

  • home grows, and the large quantities that can be grown
  • consuming drugs at home in front of children and young people
  • high quantities of purchase and possession
  • age restrictions which will be difficult to enforce, as already evidenced by tobacco & alcohol
  • home production of edibles and dabbing e.g. butane hash oil (already an issue in NZ and overseas)
  • restrictions on potency which will be difficult to enforce and will empower the black market
  • difficulties for councils to ban pot shops in their local areas
  • increased regulation which will mean increased demand for policing (rather than a reduction as argued)
  • education and prevention is mentioned, but only in relation to use
  • contradicts our SmokeFree 2025 policy

The analysis is also available online https://saynopetodope.org.nz/2020/05/01/control/

This follows up the earlier resource presenting 20 reasons for New Zealanders to vote no in the upcoming referendum20 Reasons to Vote NO in 2020”.

“The use of cannabis is associated with increased risks of a number of adverse outcomes including educational delay, welfare dependence, increased risks of psychotic symptoms, major depression, increased risks of motor vehicle accidents, increased risks of tobacco use, increased risks of other illicit drug use, and respiratory impairment.”

“At a time when New Zealand’s mental health system is bursting at the seams, why would we go and legitimise a mind-altering product which will simply add to social harm?”
ENDS

Upper Hutt motel explosion caused by butane hash oil mishap – police

Stuff co.nz 10 October 2019
Family First Comment: This is what home cultivation is all about, and families and children will be put at risk…
“Butane is used to reduce cannabis to a honeycomb-like substance called BHO – short for either butane honey oil or butane hash oil. The oil is smoked and typically has HIGHER concentrations of tetrahydrocannabinol (THC) – the principal psychoactive substance in marijuana – than dried cannabis.”
#saynopetodope
#voteNO

An explosion that rocked an Upper Hutt motel complex and put one person in hospital was caused by someone making cannabis oil, police believe.

On Thursday a 44-year-old man was arrested on charges of arson and producing the drug. He is expected to appear in the Hutt Valley District Court on October 24 in relation to the explosion at Trentham Motel in September.

Cannabis oil is often produced with the use of flammable solvents such as butane. There have been several incidences of life-threatening explosions being caused by people producing cannabis oil using this method.

According to the New Zealand Drug Foundation butane is used to reduce cannabis to a honeycomb-like substance called BHO – short for either butane honey oil or butane hash oil.

The oil is smoked and typically has higher concentrations of tetrahydrocannabinol (THC) – the principal psychoactive substance in marijuana – than dried cannabis.
READ MORE: https://www.stuff.co.nz/national/116203757/upper-hutt-motel-explosion-caused-by-butane-hash-oil-mishap–police

The production of a highly-concentrated cannabis oil using butane gas has caused several life-threatening explosions in Nelson, prompting a warning from emergency services about the dangers. Emergency services have attended four explosions caused by manufacturing cannabis oil using butane gas in Nelson-Tasman in the past 15 months.
https://www.stuff.co.nz/national/crime/84503677/explosive-butane-cannabis-oil-production-risking-lives-say-emergency-services

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Cannabis Extract Explosion in L.A. Injures 11 Firefighters

What is Hash Oil? Cannabis Extract Explosion in L.A. Injures 11 Firefighters, 3 Critically
NewsWeek 17 May 2020
Family First Comment: Remember the Los Angeles fire at the weekend? 11 fire fighters injured
Guess what..
“The business operating at the building was identified by LAFD as Smoke Tokes, a wholesale supplier of butane honey oil, also known as hash oil, a concentrated form of marijuana.”
Remember the term ‘butane hash oil’. It’s going to cost us if we legalise cannabis.

An explosion at a hash oil supplier in Los Angeles has left 11 firefighters injured, three of them critically, authorities said.

Firefighters had responded to a structure fire at 327 East Boyd Street in the city’s Toy District at around 6:30 p.m. local time on Saturday, the Los Angeles Fire Department said.

Eric Scott, a spokesman for the LAFD, told The Los Angeles Times that “a significant explosion” occurred as firefighters were inside looking to find the source of the blaze.

A number of firefighters had been inside the building and on the roof when the explosion occurred, Scott said. Responding crews described the sound like a “freight train or jet engine.”

A massive ball of flame spewed out of the building and firefighters who were inside ran “straight through that ball of flame to get to safety across the street,” Scott told The Times.

He said 11 firefighters were transported to County-USC Medical Center for treatment for burn injuries. More than 240 firefighters responded to the fire, which had spread to several nearby buildings before it was extinguished at around 8 p.m., Scott added.
READ MORE: https://www.newsweek.com/hash-oil-supplier-explosion-firefighters-injured-la-1504616
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Smoking cannabis causes bronchitis and changes to lung function

New Zealand Doctor 18 May 2020
Family First Comment: More health harms from the drug
“The potential for adverse effects on respiratory health from smoking cannabis has had much less attention than the social and mental health effects. We believe policies around the liberalisation of cannabis should consider the potential impacts on the lungs… there is sufficient evidence that cannabis causes respiratory symptoms and has the potential to damage both the airways and the lungs… Many people smoke both cannabis and tobacco and are likely to get the worst of both substances.”

Cannabis is harmful to the lungs, but in a different way to tobacco, causing significant respiratory symptoms such as bronchitis with evidence to suggest it can result in destructive lung disease –sometimes referred to as ‘bong lung’ – in heavy cannabis users.

These are the key findings from a review of research on the effects of smoking cannabis on the lungs undertaken by respiratory specialists, Professor Bob Hancox, from the University of Otago’s Department of Preventive and Social Medicine and Dr Kathryn Gracie, from Waikato Hospital’s Respiratory Department.

Cannabis is the second-most commonly smoked substance after tobacco and the most widely-used illicit drug world-wide. Although cannabis remains illegal in most countries, many countries – like New Zealand – are considering decriminalising or legalising its use.

Professor Hancox explains that much of the debate about legalising cannabis appears to revolve around the social and mental health effects. Both he and Dr Gracie believe policies around the liberalisation of cannabis should consider the wider health effects of smoking cannabis.

“The potential for adverse effects on respiratory health from smoking cannabis has had much less attention than the social and mental health effects,” Professor Hancox says.
READ MORE: https://www.nzdoctor.co.nz/article/undoctored/smoking-cannabis-causes-bronchitis-and-changes-lung-function

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Star of TV’s The Flash, died of fentanyl overdose

Coquitlam actor Logan Williams, star of TV’s The Flash, died of fentanyl overdose
Vancouver Sun 17 May 2020
Family First Comment: A tragedy.
“Williams was best known for playing young Barry Allen on the DC superhero series The Flash…. just one week shy of his 17th birthday. Marlyse Williams told the Post that her son started smoking marijuana at 13 and then moved on to harder drugs.”
How many tragedies before we realise that DrugFree is the only option.

The mother of Logan Williams says drugs claimed the life of the teen actor last month.

The Coquitlam native, whose TV credits included roles on Supernatural and When Calls the Heart, died on April 2, just one week shy of his 17th birthday.

In an interview with New York Post, Marlyse Williams said preliminary toxicology results indicate that Logan died of a fentanyl overdose, following a three-year struggle with addiction.

“His death is not going to be in vain,” Marlyse Williams told the Post. “He’s going to help a lot of people down the road.”

Williams was best known for playing young Barry Allen on the DC superhero series The Flash.
READ MORE: https://vancouversun.com/news/coquitlam-actor-logan-williams-star-of-tvs-the-flash-died-of-fentanyl-overdose/

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James Farmer QC: Will The Proposed Cannabis Legislation Achieve Its “Overarching Objective” Of Reducing The Harms Associated With Cannabis Use?

James Farmer QC, LL.M (Hons) Auckland, Ph. D Cambridge
Also published in LawNews Issue 14, 14 May 2020
Family First Comment: Excellent commentary and analysis from a Lawyer (published in the latest LawNews of the Auckland District Law Society) who has examined the proposed cannabis legislation in detail – and highlights “the inherent contradictions of the bill and its failure to achieve its stated goal of reducing harm from cannabis use by allowing adults to cultivate and use cannabis without legal sanction”. James Farmer QC concludes:
“No doubt the middle classes who fashionably use cannabis for their recreation will happily bear the extra costs of, and enjoy the greater access, to their habit and also be relieved that their reputations are no longer at risk from prosecution.  The harm that is being done with the growth of the cannabis, meth and heroin markets elsewhere is to them someone else’s problem.”
Read this excellent article.  

This Bill does not absolutely legalise cannabis.  It does so only in the limited sense that it allows adults to cultivate limited amounts of cannabis for their own use under strict conditions including limiting consumption to their own homes and to special cannabis cafes.  It also permits and regulates cannabis production, wholesale distribution and licensed specialist cannabis retail outlets.  Further, it controls price, quantity sold and potency and imposes excise tax and a levy intended to fund services “that will assist in reducing the harm caused by cannabis use”.   In short, the more cannabis that is sold and used, the more money that will be raised to apply in measures to reduce the harm that is being caused.

There is a very long list of offences, which can lead to prosecution and conviction with a fine or in some cases imprisonment, in the Bill.  These include: home-growing more than permitted (fine or imprisonment if more than 10 plants: cl. 24), possessing more than 14 grams in a public place or in a vehicle (cl.29), supplying or purchasing more than 14 grams per day (cls.31, 36), possessing cannabis under the age of 20 (cl. 32), supplying or offering to supply a person under the age of 20 (cl. 35), selling to a person under the age of 20 (fine or imprisonment: cl. 38), consuming cannabis in a public place or in a vehicle (cl. 37), selling cannabis without a license (fine or imprisonment: cl. 39), supplying by mail or courier (cl. 40), importing or exporting (fine or imprisonment: cl. 41), exposing a person under 20 to cannabis emissions or vaping (cl. 43).

One very serious anomaly is that this Bill, if enacted, will emasculate the very beneficial provision that was enacted in August last year referred to above, namely section 7(5)(6) of the Misuse of Drugs Act. That provision applies to all drug offences, affirms prosecutorial discretion and directs that a prosecution should not be brought for possession or use unless it is in the public interest to do so.  In that respect, consideration must be given “to whether a health-centred or therapeutic approach would be more beneficial to the public interest”.  Clearly, given the option of prosecution or voluntary submission to counselling, medical or other therapeutic assistance, most if not all offenders who are apprehended will take the latter.  That is what is envisaged also in the Bill in the case of youth offenders who are subject to an infringement fee or fine but will be waived if the offender engages with a support service.

Under the Bill, however, it will no longer be an offence for an adult to possess or use cannabis (within the allowable limits) and so there will be no ability to incentivise a user to seek health or therapeutic assistance to deal with what may well be harmful effects from regular cannabis use or addiction.  In its campaign for the Bill to be supported at the referendum, the Green Party seems to have overlooked the fact that, if passed, the Bill will be destroying the benefit that section 7(5)(6) of the 2019 amendment achieved when it was enacted last year, an enactment which its spokesperson described at the time as “a triumph for compassion and a triumph for common sense”.

So will this Bill, if it passes the referendum hurdle and is enacted, achieve its other main objective claimed by its supporters – the elimination of the Black Market and, with it, a safer drug for those desperate for that form of recreation?   I refer above to the American experience which has been that the drug lords have simply switched cultivation and supply to a more potent and cheaper drug that undercuts the price of regulated and lawful marijuana with the result of a substantial increase in deaths from drug use.  In New Zealand, it will not be difficult for meth manufacturers and sellers to do the same.  Cannabis will be subject to regulatory costs, to excise tax, to the levy and then income tax that licensed growers, distributors and retailers are not able to avoid.  The meth and heroin markets do not have regulatory, excise or other tax costs.  Nor do illegal cannabis suppliers who will have little difficulty in undercutting the regulated product and increasing its THC potency beyond the regulated limit for those who want a bigger kick.

That has been the Canadian experience to date. Those who cite Canada as a success reform story should read the following recent account of the Canadian experience from The Guardian:

https://www.theguardian.com/society/2020/apr/05/stoners-cheered-when-canada-legalised-cannabis-how-did-it-all-go-wrong

The journalist who researched and wrote this piece said: “… all drug [reform] laws are unworkable, illogical, unjustifiable, unscientific, counterproductive and generate unintended consequences – in fact, drug laws often create the exact opposite outcome to those desired.”

There is another perspective of the relationship between legally and regulated produced and sold cannabis and black market cannabis which, once stated, is obvious.  The point was made by Patrick Cockburn, who refers to the body of scientific research that establishes a firm link between cannabis use and the onset of schizophrenia (as to which see also the Judgment of Jagose J in The Queen v. Brackenridge [2019] NZHC 1004), and then says (https://www.independent.co.uk/voices/cannabis-legalisation-psychosis-billy-caldwell-william-hague-schizophrenia-a8410581.html):

“…legal restrictions alone will not stop … people who take cannabis from going on doing so.  But the legalisation of cannabis legitimises it and says a message that the government views it as relatively harmless.”

And on the subject of the legislating to eliminate the black market, he says:

“The legalisation of cannabis might take its production and sale out of the hands of criminal gangs – [as stated above, I would suggest not entirely] – but it would be put into the hands of commercial companies who want to make a profit … and increase the number of their customers.  Commercialisation of cannabis has as many dangers as criminalisation.”

Drs Robin Murray and Wayne Hall have recently researched the increase in the use of cannabis in those States in America that have legalised cannabis and found that the risk of dependence among those who use cannabis was estimated at 9% in the 1990s but is now closer to 30% with attendant increases in such harmful effects as cognitive impairment and effects on the unborn child by women who use it to combat nausea.  They also refer to some evidence of increased risks of depression and suicide but then say that “by far the strongest evidence concerns psychosis [including] an increased risk of later schizophrenia-like psychosis”: Will Legalization and Commercialization of Cannabis Use Increase the Incidence and Prevalence of Psychosis, (American Medical Association, JAMA Psychiatry, 8 April 2020).

No doubt the middle classes who fashionably use cannabis for their recreation will happily bear the extra costs of, and enjoy the greater access, to their habit and also be relieved that their reputations are no longer at risk from prosecution.  The harm that is being done with the growth of the cannabis, meth and heroin markets elsewhere is to them someone else’s problem.

James Farmer QC
READ MORE: http://www.jamesfarmerqc.co.nz/legal-commentary/will-the-proposed-cannabis-legislation-achieve-its-overarching-objective-of-reducing-the-harms-assoc
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Father jailed after ramming bottle into baby’s mouth, causing head injuries

Stuff co.nz 17 May 2020
Family First Comment: “Indications are it is highly likely he will have significant brain damage with associated effects on his sight, hearing and physical development,” court documents state. “Smoking cannabis was a regular factor in Jacob losing control and letting anger and frustration take over, according to the pre-sentence report“
Why would we legalise and normalise drugs?
#saynopetodope #VoteNO

Frustrated his seven-week-old twin baby would not take a bottle, Jorhde Alex Te-Pere Jacob repeatedly rammed it into the infant’s mouth.

He then gripped the baby’s face tightly, attempting to burp him. His actions left the baby with bleeding on the brain and paediatricians say the baby’s long term injuries may not be known for years.

Jacob, 23, was sentenced to three years in jail after pleading guilty to one count of causing grievous bodily harm with reckless disregard and a second of wounding with reckless disregard.

According to the summary of facts, obtained from the court, the baby’s injuries were sustained at the Hamilton home Jacobs shared with his now former partner, and their twin sons, on June 13, 2019.

Jacob had been working night shift, and later admitted to being under the influence of cannabis, when the abuse occurred during a 10am feeding session in which he became increasingly frustrated at the baby’s lack of interest in taking the bottle.

Smoking cannabis was a regular factor in Jacob losing control and letting anger and frustration take over, according to the pre-sentence report.
READ MORE: https://www.stuff.co.nz/national/crime/120345591/father-jailed-after-ramming-bottle-into-babys-mouth-causing-head-injuries

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Cannabis referendum explained: What Kiwis will vote for or against

NewsHub 10 May 2020
Family First Comment: McCroskie (sic) believes CBD medicine could be an “exciting” alternative. “I think there is promise cannabidiol medicine can be an alternative to opioids that aren’t beneficial. That doesn’t mean you need to legalise it (for recreational use),” he told Newshub.

Drug Foundation executive director Ross Bell believes the legalisation of recreational cannabis would benefit patients who need cannabis for medical reasons.

“Let’s say the medical cannabis scheme is too strict, there are fewer products and the products that are available are very pricey – then the referendum becomes important.”

New Zealand’s medical cannabis scheme, which aims to give patients better access to medicines came into effect in April. The scheme allows GPs to prescribe CBD, as well as New Zealand-based growing.

However, Bell is still concerned about cost.

“A major barrier is still in place, being the cost of medicines, which face major hurdles in obtaining Pharmac or other price subsidies,” he wrote on the Drug Foundation’s website.

“We know that when patients are not able to obtain medicines from the formal scheme they will buy from the informal, illicit market, and face the risk of criminalisation.”

Although in favour of the referendum, Bell has voiced his concern about the set potency limit of 15 percent. He has suggested the Government lower the limit to 6 or 7 percent.

Family First national director Bob McCroskie is strongly against legalising cannabis for recreational use, as he believes it is harmful to the brain.

“This is not a ‘war on drugs’ – it is a defence of our brains. It is a fight for health and safety,” he wrote on his organisation’s website.

Family First is behind the ‘Say No to Dope‘ campaign, which aims to encourage families to vote ‘no’ in the upcoming referendum.

However, McCroskie believes CBD medicine could be an “exciting” alternative.

“I think there is promise cannabidiol medicine can be an alternative to opioids that aren’t beneficial. That doesn’t mean you need to legalise it,” he told Newshub.

Bell says those critical about legalising cannabis need to understand the current approach is harmful.

“People are getting criminal records, a lot of money gets wasted on law enforcement, police should spend their time doing other things,” he says.

“We don’t fix these issues by keeping cannabis illegal.”
READ MORE: https://www.newshub.co.nz/home/politics/2020/05/cannabis-referendum-explained-what-kiwis-will-vote-for-or-against.html

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Drugged driver who killed Levin cyclist Peter Jenkins sentenced

NZ Herald 8 May 2020
Family First Comment: Sadly, these tragedies will increase if we legalise cannabis. Just look overseas…
“Kinita’s vehicle was seen swerving within the lane shortly before the crash. Witnesses said she made no attempt to brake before colliding with him, flinging him into the air. She had smoked both cannabis and methamphetamine the day before.”
Read more – saynopetodope.org.nz/driving-stoned/

A drugged driver who killed a cyclist nine years after her own son was killed by a drunk driver has been sent to prison.

Cathryn Kinita appeared in the Palmerston North District Court this afternoon, having earlier pleaded guilty to causing Levin man Peter Jenkins’ death by driving under the influence of drugs.

She has also admitted possessing cannabis, methamphetamine and drug utensils.

Jenkins, 54, was out for a regular Sunday training ride when he was hit by a van being driven by Kinita on State Highway 1 at Manakau, north of Otaki, in November.

Jenkins’ father John told the Herald his son has been riding a bike for as long as he could remember and he’d grown up to love cycling with an insatiable passion.
READ MORE: https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12330527