There is a growing body of evidence to support the use of medical cannabis as an adjunct to or substitute for prescription opiates in the treatment of chronic pain. When used in conjunction with opiates, cannabinoids lead to a greater cumulative relief of pain, resulting in a reduction in the use of opiates (and associated side-effects) by patients in a clinical setting. Additionally, cannabinoids can prevent the development of tolerance to and withdrawal from opiates, and can even rekindle opiate analgesia after a prior dosage has become ineffective.
In 1976 the Netherlands adopted a formal written policy of non-enforcement for violations involving possession or sale of up to 30 g of cannabis. The ‘gateway theory’ has long been seen as an argument for being tough on cannabis, but interestingly, the Dutch saw that concept as a rationale for allowing retail outlets to sell small quantities. Rather than seeing an inexorable psychopharmacological link between marijuana and hard drugs, the Dutch hypothesized that the gateway mechanism reflected social and economic networks, so that separating the markets would keep cannabis users out of contact with hard-drug users and sellers.
No serious commentator doubts that cannabis is potentially damaging to the user. Like tobacco, it is typically smoked and thus shares the potential for lung disease. Like alcohol, it affects reaction times and may raise the risk of road accidents. Cannabis has also been associated with cognitive impairment, deterioration in education performance (van Ours and Williams 2008), and psychotic illness (Arsenault 2004). Moreover, cannabis is often – albeit contentiously – seen as a causal gateway to more serious drug use (Kandel 2002). The question is what to do about it?
Craig Reinarman, Peter Cohen, Sebastian Scholl , Hendrien L. Kaal
01 May 2004
Decriminalizing cannabis doesn't lead to more widespread use, according to a study comparing cannabis users in two similar cities with opposing cannabis policies — Amsterdam, the Netherlands (decriminalization), and San Francisco, California (criminalization). The study compared age at onset, regular and maximum use, frequency and quantity of use over time, intensity and duration of intoxication, career use patterns, and other drug use. No evidence was found to support claims that criminalization reduces use or that decriminalization increases use.
An ethnographic study of women and drug use in inner city neighborhoods in Kingston, Jamaica, revealed that cannabis is commonly used in conjunction with crack cocaine to minimize the undesirable effects of crack pipe smoking, specifically paranoia and weight loss.
Cannabis is the cutting-edge drug for reform, the only politically plausible candidate for major legal change, at least decriminalisation (removal of criminal penalties for possession) and perhaps even outright legalisation (permitting production and sale). Compared with other drugs, the harms, physiological or behavioural, are less severe and the drug is better integrated into the culture. Throughout Western Europe and in the Antipodes there is pressure for reductions in the punitiveness of the marijuana regime.