At the end of last week, the World Health Organisation (WHO) made what should have been an unremarkable announcement. Namely, that cannabis is less harmful than heroin. The WHO’s Expert Committee on Drug Dependence delivered its recommendations of how ‘cannabis and cannabis-related substances’ should be treated to the UN’s Commission on Narcotic Drugs (CND). The recommendations come two months before the Commission is due to review the scheduling of cannabis – how tightly it is controlled – in the UN’s Single Convention on Narcotic Drugs, the treaty around which many countries, including the UK, have developed their drugs legislation.
In the Single
Convention, cannabis sits not just in Schedule I (drugs with significant risk
of abuse and ill effect), but also in Schedule IV, the most restrictive
designation for those especially dangerous substances with ‘extremely limited
or no medical value’. Sitting alongside cannabis in this dual I/IV designation
is heroin. The status quo of a treaty to which 186 countries are signatory
claims that, as far as the risk of harms are concerned, cannabis and heroin are
indistinguishable. Last week’s WHO announcement included the modest
recommendation that cannabis be kept in Schedule I, but removed from Schedule
The original drafters of the Convention might be forgiven for dismissing cannabis as lacking medical value. They were writing before the discovery of the body’s endocannabinoid system, which we now know is so widely distributed around the central nervous system that it is easier to name the bodily functions that it does not influence in one way or another.
Today, the world can see that the UN’s 60-year-old stance on cannabis is wholly unjustified by the evidence. As a result, a wave of cannabis reform is sweeping the globe. As well as rapidly increasing access to medicinal cannabis worldwide, some 30 countries have decriminalised possession, while South Africa, Luxembourg, and Mexico look set to join Uruguay and Canada in developing legal, regulated markets. The United States itself, the muscle behind the global ‘War on Drugs’, cannot even maintain adherence to the prohibitionist approach within its own borders.
With this state of affairs, the CND simply cannot reject the WHO’s recommendations. This isn’t a matter of the strength of the evidence. Instead, the CND will accept the WHO’s recommendations, removing cannabis from Schedule IV, largely motivated by self-interest. Were the CND to do otherwise, doubling down on its position on cannabis as equally harmful to heroin, it would be gambling its legitimacy on all drug matters. With increasing numbers of countries stepping out of line with the Single Convention, abrogating their international obligations to pursue safer, more evidence-based cannabis policies, this would not be a sensible gamble for the CND to take.
The Director of the Beckley Foundation, Amanda Feilding, anticipating these developments in international drug policy in 2012, commissioning the report Roadmaps to Reforming the UN Drug Conventions. Roadmaps sets out multiple routes by which a country – or group of countries – might create a legal recreational market for a controlled substance like cannabis while honouring the terms of the treaty.
While advocates for drug law reform are celebrating the WHO’s report as good news, the magnitude of the shift can be overstated. Within the UK, hopes that the announcement will ease the current stalemate with medical cannabis prescriptions are misplaced. Since the UK’s rescheduling of cannabis-based medicinal products in November, a vanishingly small number of prescriptions have been written. Although the UK’s medicinal cannabis laws are the most liberal in Europe, with little legal restriction on product, and no rules on qualifying medical conditions, because of overly cautious prescription guidelines, generated in haste by the Royal College of Physicians, only a handful of patients have received cannabis medicines. Meanwhile, tens of thousands are relying on the black market, or looking abroad, to procure the treatment they are seeking.
Although a full review of the guidelines is underway, with the National Institute on Health and Care Excellence (NICE) due to deliver updated advice for doctors in October, the body is unlikely to attribute significant weight to the decisions reached by other bodies, even the WHO. Although NICE have sought input and evidentiary submissions from stakeholders in civil society, including the Beckley Foundation and the United Patients’ Alliance, their due diligence resides in a thorough and independent review of the primary research of the effectiveness and side effects of cannabis medicines, rather than other institutions’ conclusions.
Where the UK may see some progress as a consequence of the anticipated international rescheduling is in research. While cannabis’ Class B designation within the Misuse of Drugs Act will remain for at least as long as the current government, its Schedule 1 status in the Misuse of Drugs Regulations (MDR), which govern legitimate uses of controlled drugs, may be reviewed.
The WHO has recommended that cannabis be scheduled “at a level of control that will prevent harm from cannabis use and at the same time will not act as a barrier to research.” As it stands, cannabis’ placement in Schedule 1 of the MDR – more heavily restricted than cocaine or heroin – imposes significant bureaucratic and financial burdens on research that are so significant, that research with whole-plant cannabis is simply impossible for all but the most determined, well-resourced scientists. A research study with cannabis, or any other Schedule 1 drug, will attract costs ten times higher than a comparable study with alcohol. Quite clearly, this level of control is a barrier to research.
British politicians and voters from across the cannabis divide have reason to welcome a national rescheduling. We have strong but disputable evidence that cannabis can relieve chronic pain, spasticity in Multiple Sclerosis, and other conditions too numerous to list. We also have strong but disputable evidence that cannabis consumption is a significant risk factor in the development of psychosis, especially amongst adolescents. Cannabis is, by far, Britain’s most popular illicit drug. Independently of the discussion surrounding legalisation, it is surely preferable that we have as fully-developed as possible an understanding of the consequences of its use. Cutting the red tape to research by moving cannabis in its entirety to Schedule 2 (Sajid Javid rescheduled ‘cannabis-based medicinal products’ in November) will allow scientists to better understand both the potential benefits and harms of the plant.
Our understanding of how cannabis works remains partial, largely because 60 years of prohibition has been more successful at blocking research than stopping recreational use. But, however cannabis policy ultimately develops in the UK, it will not be improved by further obstructing cannabis science.
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