There has been increasing discussion in public circles on the tenets of legalization of marijuana in Ghana in the wake of the call for a national debate by Mr Akrasi Sarpong, the head of the Narcotics Control Board of Ghana. The call for a national debate is believed to be borne out of his frustration and that of his outfit in controlling the drug problem effectively.
Unfortunately, most of the discussions in the public have all been based on moral justification and exaggeration of the effects of the marijuana plant with scientific evidence thrown out of the window. This is however not surprising since most public policies are devoid of the scientific evidence.
In our effort as a country to solve the myriad of challenges confronting us, it is the hope of some that, public policy in all facets of our society should aim at the scientific evidence and not ideology. Ghana’s current discussion on the issue with marijuana, ‘to legalize or not to’, is however not new since most countries and jurisdictions that has either legalized or decriminalized use and possession also went through such debates in the past which were sometimes characterized by misinformation and exaggeration of the harms associated with use.
The evidence available indicates that, such public campaigns on the use of drugs aimed at distorting the facts have never yielded the required results. It is for this reasons that I put together this write up to lay the facts bare so all readers will be well informed which will invariably, lead to a sound public health policy for the good of the public.
The world over, psychoactive substances are receiving increasing public attention especially when they are defined broadly to include alcohol, tobacco, illicit drugs and certain types of pharmacological agents that have high dependence potential.
The effects that these substances have on individuals and society depends on a number of factors including the pharmacological properties of each drug, the way the drugs are ingested, their cultural meanings in everyday life, reasons for using them and the harms associated with their misuse. Unfortunately, public discussions of drug policies have too often failed to consider these complexities.
Simplistic views that all drugs are the same and all are equally dangerous not only limit our understanding of drug-related problems but also impede our ability to develop meaningful policy responses. Advances in psychiatry, psychology, neurobiology, cultural anthropology, epidemiology and a variety of other disciplines have substantially increased the understanding of experts in the addiction field on psychoactive drugs, their actions and misuse.
WHAT IS MARIJUANA?
Cannabis is a plant (botanical) known popularly as marijuana, which is a derivative of Cannabis Sativa and has medicinal as well as psychoactive qualities. ‘Marijuana’ is a slang term for the dried leaves and flowers of the varieties of the cannabis plant that are rich (1-20+ %) delta-9-tetrahydrocannabinol, or “THC”- the primary psychoactive cannabinoid found in the cannabis plant. It is variously called Hashish, ‘THC’, ‘bhang’, ‘wee’, ‘weed’, ’abosa tawa’, etc.
A brief Historical Perspective
Cannabis, popularly called marijuana, has a long history of medical use worldwide. Records of it use dates back to 2700 B.C. when the Chinese use marijuana for maladies ranging from rheumatism to constipation. There were similar reports of Indians, Africans, ancient Greeks and medieval Europeans using the substance to treat fevers, dysentery and malaria.
In the history of US marijuana use, physicians documented the therapeutic properties of the drug as early as 1840, and the drug was included in the US Pharmacopoeia, the official list of recognized medical drugs from 1850 through 1942. It was reported that, lack of appetite was one of the indications for marijuana prescription.
To appreciate the complex nature of drug use as well as the public policy issues associated with the different psychoactive substances, three (3) necessary distinctions must be made. First is whether a particular drug is natural or synthetic. Until the 19th Century, almost all psychoactive substances were used in their natural forms.
With the advent of modern chemistry, the active components of these natural products could be identified, and this knowledge led to the production of potent extracts, such as morphine and cocaine. Subsequently, it become possible to create synthetic forms of many psychoactive substances such as heroin and crack cocaine and to produce new or more potent substances such as Lysergic Acid Diethylamide (LSD), Diazepines and the Opioids.
As in the case of distilled spirits, the ability to produce highly concentrated forms of natural substances greatly increased their portability and thus, dependence potential.
Another important distinction about psychoactive substances relates to the way in which they are ingested. There are four (4) main ways by which to ingest drugs: (1) through the mouth in the form of natural substances (e.g. coca leafs of the people of Bolivia), or synthetic products (e.g. some pain medications); (2) insufflated across mucous membranes such as when cocaine powder is snorted; (3) through inhalation, such as crack vapour and cannabis; and (4) through injection as with heroin. It must be emphasized that, drugs that can be injected into the veins which goes directly into the bloodstream provide rapid delivery which greatly increases their abuse potential, dependence and harm. The recent addition to the mode of ingestion is chewing.
The third distinction is whether or not a particular psychoactive substance has an accepted use in medicine. Many substances such as sedatives and opioids were developed for medicinal purposes but are now restricted in most countries for use only under a prescription system.
Some remain available as accepted medicines, but with controls (e.g. morphine, amphetamines and barbiturates); others are no longer regarded as medicines despite their original development. Substances with medicinal benefits have subsequently been used in amounts larger than recommended on the medication label. In such instances, their use may present the risk of physical, psychological and even legal problems which is a major concern for drug policy makers.
Despite the medicinal value of some psychoactive substances and the social and recreational uses of others or both, government policies ban many such substances and impose penalties on the user. Throughout human history, but particularly since the late 19th century, national governments have regulated or prohibited the use, manufacture and sale of various psychoactive substances with heroin, cocaine and cannabis among the most notable drugs.
At the international level, treaties developed within the framework of the UN and WHO coordinate the control of different psychoactive substances. The International control conventions notably the 1961 and 1971conventions to which Ghana is a signatory state, were designed to prevent diversion of pharmaceutical drug into illegal markets, combat drug trafficking and to tailor controls to the pharmacological properties and dependence potential of each drug.
The main principle was to reduce the availability of these substances which brought in its wake, ‘the war on drugs’ attitude towards managing the escalating drug menace through enforcement over the years.
The classification of substances within the international conventions reflects historical circumstances and cultural factors as well as scientific evidence. For this particular reason, international treaties may not always be consistent with current expert opinion and the scientific evidence regarding the danger or harm associated with a particular substance.
For instance, many experts in the addiction field consider tobacco and alcohol to pose greater risk of harm than cannabis, yet these substances are legal while cannabis is illegal in most jurisdictions. In fact, alcohol and tobacco are believed to be enjoying privileged statuses in society for various reasons.
I however wish to emphasize that, most drugs especially the permissible or legal drugs have also had their fair share of prohibition in history. In the sixteenth century, it is reported that the Egyptian government banned coffee. In the seventeenth century, the Czar of Russia and the Sultan of the Ottoman Empire executed tobacco smokers. In the eighteenth century, England tried to halt gin consumption and China penalized opium sellers with strangulation.
Coffee and for that matter, chocolate which are now seen as not harmful were viewed with suspicion when they first became available in Europe and the near East.
They were associated with laziness, sexual licence and political intrigue. In the seventeenth century, just visiting a coffeehouse was a capital offence in what are presently Egypt, Saudi Arabia, and Turkey. Currently, all coffeehouses that provide marijuana (which has been subjected to quality control measures with labels) for sale are now important centres of sociability and business as well as the discussion of very important national issues.
SUCCESS OR OTHERWISE OF THE INTERNATIONAL CONVENTIONS
One would like to ask, has the international treaties been successful in reducing the abuse of these psychoactive substances as well as the black-market and the associated violence? In terms of its most recognized aim of suppressing illicit traffic in drugs, the international drug control system is generally seen as a failed mission by most experts in the addiction field in most accountings.
The United Nations Office on Drugs and Crime (UNODC)’s own banner publication, the World Drug Report of 1997, noted that, ultimately, supply reduction strategies ‘must be judged by how they affect consumer demand, through the decreased availability of drugs’, and that, ‘in this domain, the outcome is undoubtedly less than satisfactory’(UNIDCP 1997). Ten years later, the UNODC’s Annual Report, 2007 was equally damning.
‘2006 was a mixed year for International drug control’. The ‘good news’ of reduction of illicit opium production in the Asian Golden Triangle countries was ‘eclipsed by the bad news from Afghanistan, the year’s big story (...). The UNODC warned countries to prepare for a possible increase in drug overdose as a result of increased purity of heroin. Rising cocaine consumption in Europe was another cause of concern’ (UNODC, 2007, P.11).
What does the situation look like in Ghana? The frustration expressed by Mr Akrasi Sarpong of NACOB, Ghana, is an indication that, the situation is getting out of control since many more people are having access and using marijuana especially children.
In fact, let nobody get deluded about the fact, marijuana is simply available on our streets and cheaper. As a psychiatric nurse, I am equally frustrated about the marijuana situation since patients on admission in the psychiatric hospital with diagnoses of Substance Abuse/ Dependence are able to put some coins (from benevolence donation) together and send for some rolls. Legalization will check this anomaly by raising the cost of marijuana and the production of varieties with varying strengths.
The available evidence shows that, second hand smoke is even more dangerous to everyone around the smoker and since there are no designated places like the coffee shops in Holland where one can walk in and have marijuana that has been subjected to quality control measures to use; marijuana users in Ghana mostly hide behind public school buildings to smoke dangerous and harmful varieties of marijuana.
A case in point was a front page story in the Daily Graphic recently of some marijuana smokers at ‘Kwasieman’ (a suburb of Accra) cluster of schools. The report had it that, the marijuana smokers come to start their smoking activity as early as 3pm or there about while the children are still in the classroom. In an effort by the children to keep out the smoke, noise and the sight of the smoking activity, they close the windows.
These results in the smoke getting trapped in the classroom and one could imagine the effects of these dangerous and harmful varieties of marijuana smoke to the young and developing brains of these children. Legalization and regulation which will ensure product quality, will protect children, pregnant women and the public in general from second hand smoke since places for smoking would be created.
According to the California Medical Association (CMA), the criminalization of marijuana has proven to be a failed public health policy for several reasons, including:
1. The diversion of scarce economic resources to the criminal justice system cost and away from other more socially desirable uses such as funding health care, education and infrastructure, solving our energy crises and enhanced economic development.
2. The social destruction of family units when cannabis users (mostly men who are bread winners) are incarcerated, rather than offered treatment and other social assistance.
3. The disparate impacts that drug law enforcement practices have on communities of colour.
4. The continued demand for cannabis which supports violent drug cartels from Mexico and other international sources.
5. The failure to decrease national and international supplies of cannabis from criminal and unregulated sources and
6. The failure of government’s limited action through the ‘war on drugs’ in mitigating substance abuse and addiction.
DIRECTION OF PUBLIC DRUG POLICY
Legalization of marijuana use in Ghana means changing the public health policy direction of Ghana. But as a country, we need to ask ourselves, what do we want to achieve? A drug - free society? Is it even possible to achieve a drug free society? The obvious answer is an emphatic No. Sociology has made us aware that deviation is a necessary evil in society.
Smoking is harmful and as a health worker, I do not condone smoking of anything but people will smoke anyway. One of the main aims of the international drug control conventions was to achieve a drug-free society by reducing their availability and use by wagging war on drug usage. This mechanism is called; Supply reduction. However, this has been proven to be a failed policy direction. Most countries decided to change their public health direction from one of prohibition leading to a drug-free society to one of harm reduction in the wake of the HIV/AIDS pandemic such as providing syringes and needles to drug users who hitherto would have been arrested when seen with these, to reduce the harms associated with using substances especially heroin. This is called; Demand reduction.
Recently, it was reported that South Africa had started distributing flavoured condoms to students. This is a harm reduction strategy which will save them the headache of contending with teenage pregnancy as compared with preaching abstinence which has failed as a public policy aimed at preventing unwanted pregnancies in school going girls.
As a result of the shift in public health policy to one of harm reduction, most countries have taken steps to reduce the criminal sanctions associated with possession, use and cultivation of small quantities of marijuana. Currently, contrary to federal laws, a number of states in the US have decriminalized use of medicinal and recreational marijuana.
The Argentine Constitutional court, in ruling that possession of any psychoactive drug for personal use could not be prohibited, said that the government should not intrude into private life. Portugal had shifted to civil penalties for all drug possession offences in 2001 because the government believed that criminal penalties were ineffective and intrusive.
Indeed, Portugal, the first European country to decriminalize personal possession of cannabis, cocaine, heroin and methamphetamines in 2001, is reported to have a lifetime marijuana use in people over age fifteen of 10%, after five years of the implementation of decriminalization policies, the lowest in any European Union (Szalavitz, 2009). Therapy is offered in place of criminal penalties for drug possession.
Most countries that have made reforms reduced the penalties for all psychoactive drugs: only a few indeed singled out cannabis (Belgium, Holland and some jurisdictions in Australia and the US). Some jurisdictions (e.g. Spain and Alaska in the past) allowed for limited growing for self supply and Holland tolerates retail sales, waiving arrest and persecution for small quantities. Currently, Uruguay has completely legalized marijuana in December, 2013.
Legalization does not mean any enforcement at all. The crust of legalization is, ‘go after the big fishes’ whose activities is associated with violence and crime and leave out the ‘small fishes’ but ensure that, the ‘small fishes’ use less dangerous types which have been subjected to quality control measures just like other legal drugs.
This fact has been reiterated by the West African Commission on Drugs headed by the former president of Nigeria, H.E Olusegun Obasanjo. The Commission had stated categorically that, “Low level drug offences should be decriminalised” and that enforcement should be aimed at the cartels since “punishing personal use of drugs did not work”. The commission further stated that “current policies promote corruption and violence”.
THE HARMS OF DRUGS COMPARED
Many individuals are able to engage in “casual,” “social,” or “recreational” use of drugs of abuse (both legal and illegal) without any grave consequences. A finite number lose control of their drug using behaviour and become dependent on these substances.
Drug dependence or addiction is a significant illness with social, personal and legal consequences. A drug-using individual’s development of addiction does not depend on the legality or illegality of a substance. Drug dependence is most often accompanied and it’s likely caused by specific neurochemical changes precipitated by the interaction of the drug in question and its user.
Transition from use through abuse to dependence has a known incidence for several drugs of addiction.
Based upon data from a National Comorbidity Survey with 8,100 participants of both sexes (15-54yrs) who were interviewed for when they first used drugs and when they became dependent over a ten (10) year period, researchers from John Hopkins University found that 12 -13% became dependent on alcohol, about 15 to 16% of those who use cocaine became dependent, (5-6% during the first year of use), and about 8% of marijuana users became dependent.
The epidemiology figures provided above, though incomplete, are very close to previously published incidence numbers of dependence: alcohol (10% of users); cocaine (17-18% of users); marijuana (4% of users). For other drugs such as nicotine and heroin, only estimates are available which stands at 40% for each drug. It is evident that, use is necessary but not sufficient for the development of drug dependence.
A very important question for public policy is the extent of risk or harm resulting from the use of different substances. Implicit in the development of prevention strategies is the notion that some drugs are more risky or harmful than others and for that matter, require more control, resources and monitoring.
This is reflected in the international control conventions with respect to psychoactive substances which are based on expert committee recommendations regarding a drug’s ‘liability to abuse (constituting) a risk to public health’, with the various schedules differentiated in terms of the degree of risk for both social and public health problems (WHO 2000, pp. 41). Experts in the addiction field believe these schedules are unjustified.
There have been several attempts to characterize different substances in terms of their relative potential for causing harm, taking into account modifying factors such as route of administration or context of use that can increase or reduce the dangers.
One of such efforts compared the severity of effects for heavy users of different substances in their most harmful common form. The evidence indicates that, alcohol is considered to have the greatest potential for harm, with tobacco, heroin and marijuana estimated to have fewer adverse effects on health, (Hall et al, 1999). In another such attempt, four (4) alternative approaches to the issue of dangerousness were investigated.
The first was the likelihood of an overdose based on estimates of the ‘safety ratio’ of different substances. According to this measure, heroin, alcohol and cocaine have the lowest safety ratios, whilst marijuana has the highest (Gable 2004).
Another dimension of dangerousness is the level of intoxication produced by a substance. It was reported by Hilts (1994), that intoxication increases the personal and social damage produced by a substance. Taking into account, dose, set and setting, the resultant ratings suggest that alcohol has the highest intoxication effect, followed closely by heroin, cocaine, marijuana and tobacco.
The other two dimensions reveals results from a more global approach to the same general dimensions as reported by a French expert committee. The committee rated seven (7) substances on general toxicity and social dangerousness. Toxicity here includes long-term health effects (such as cancer and liver disease), infections and other consequences of intravenous use, as well as the acute effects represented by the safety ratio.
Social dangerousness focuses on aggressive and uncontrolled conduct induced by or associated with use of the drug. In general, heroin and alcohol rank relatively high on all four (4) dimensions of dangerousness, with marijuana scoring in the lowest range. The other drugs vary according to the criterion employed, with tobacco ranked high on toxicity and low on social dangerousness.
One other dimension of harmfulness is what psychopharmacologist call dependence potential and this term refers to the propensity of a substance, as a consequence of its pharmacological effects on physiological or psychological functions, to give rise to dependence on that particular substance. Henningfield and Benowitz (cited in Hits, 1994) made comparative ratings of different substances on dependence, withdrawal, tolerance and reinforcement.
Tobacco was considered to have the highest dependence potential, followed by heroin, cocaine, alcohol, caffeine and marijuana in that order.
One of the most comprehensive, current and up-to-date attempts to estimate the harms associated with the full range of psychoactive substances was one done by using the Multi Criterion Decision Analysis (MCDA) method by an expert committee in the UK.
Based on the experts ratings of physical damage, the tendency of the drug to induce dependence and the effect of drugs use on families, communities and societies, the experts plotted a graph which shows the average scores based on all three (3) parameters plotted in rank order for 20 psychoactive substances, both legal and illegal.
The results of this MCDA do not support the classification of drugs into high, medium and low categories of harm currently being used as the basis for criminal penalties, policing, prevention and treatment programmes, (Nutt et al, 2007). While heroin and cocaine rank first and second respectively, alcohol (5th) and tobacco (9th), - both legal drugs in most countries including Ghana, are ranked more harmful than marijuana, solvents and LSD.
So far, rating systems for estimating the dangerousness or risk associated with different substances indicate that, legal substances such as alcohol and tobacco are sometimes more dangerous as compared to marijuana. At the same time, the risk associated with each of these substances varies according to the drugs health effects, safety ratio (i.e. lethal dose), intoxication effect, general toxicity, social dangerousness, dependence potential, environmental/context of use, and social stigma. These considerations suggest that, the chemical substance itself, such as marijuana, in its pure form, its only one among many factors that determines whether and how much harm occurs. Policies on substance use must reflect the social and pharmacological complexities of psychoactive substances as well as the relative differences among them.
WHAT ARE THE AIMS OF LEGALIZATION?
1. Allowing for more research so society enjoys from its medicinal value
2. Raising tax revenues
3. Elimination of arrest
4. Undercutting black markets and associated harms from corruption and violence.
5. Allowing criminal justice resources to be redirected to other priorities.
6. Assuring product quality and
7. Increasing choices for those seeking intoxication.
POLICY RECOMMENDATION BY THE C.M.A.
· “Reschedule” medical cannabis in order to encourage research lending to responsible regulation.
· Regulate recreational cannabis in a manner similar to alcohol and tobacco.
· Tax cannabis
· Facilitate dissemination of risk and benefits of cannabis use.
· Refer for national action.
USES OF MARIJUANA
Cannabis may be effective for the treatment of neuropathic pain, which is a severe and often chronic pain resulting from nerve injury, disease or toxicity. The University of California Centre for Medicinal Cannabis Research (CMCR) recently reported the findings based on the results of a number of studies which involved the treatment of neuropathic pain which demonstrated a significant improvement in pain after cannabis administration.
Other indications include appetite stimulation and cachexia (weakness and wasting of the body due to chronic illness).
Nausea and vomiting following chemotherapy.
WHAT ARE THE RISK OF CANNABIS USE
a. Distorted perception
b. Impaired coordination
c. Difficulty in thinking and problem solving
d. Problems with learning and memory and
e. Long term challenges such as addiction, anxiety, depression, psychotic symptoms, respiratory difficulties and heart attack.
Epidemiological data from a national comorbidiy study indicate that, about 9% of adult cannabis users become addicted and that this risk is substantially increased among individuals who begin using before age 18 (Anthony et al, 1994). Further evidence suggests that cannabis can adversely affect adolescents who become regular users because they have a greater vulnerability to the toxic effects of cannabis on the brain (Hall, 2009).
Those who oppose the decriminalization and legalization of cannabis cite these risks enumerated above and other potential threats that the use of this substance pose to public health and safety.
Epidemiological studies have been inconclusive regarding whether cannabis use causes an increased risk of motor vehicle accidents; in contrast, unanimity exist that alcohol use increases crash risk (Sewell et al, 2009).
In test conducted using driving simulation, neurocognitive impairment varies in dose-related fashion and symptoms are more profound with highly automatic driving functions than with more complex task that require conscious control. The fact is that, cannabis smokers tend to over-estimate their impairment and compensate effectively while driving by utilizing a variety of behavioural strategies. Under the current prohibition of cannabis, public health is also affected by increased rates of crime surrounding the cannabis business. It is currently estimated that, incarceration and parole supervision of marijuana users cost the US, tens of millions of dollars annually.
THE WAY FORWARD
Regulate Medical Cannabis
Rescheduling medical cannabis to allow for further clinical research will be the acceptable avenue for providing an opportunity to formulate a workable, evidence-based state regulatory structure that protects public health and safety. By allowing adequate research to determine the utility, safety and efficacy of cannabis as well as the necessary controls for the substance’s production, distribution, taxation and exportation etc., cannabis regulation is able to mirror that of other prescribed medications. The appropriate regulatory bodies can use part of the funds collected through a cannabis tax to enforce violations of the implemented standards.
Production and Distribution
Production of cannabis should be held accountable to quality control measures and standardization. All growers and vendors should be licensed and distribution of cannabis should include restrictions on purchase and use to all minors. All cannabis supply should be subject to purity, concentration and product labeling standards. Labeling standards should include warning labels, similar to those on tobacco and alcohol products (such as the percentage of THC content).
Public advertisement of cannabis should be subjected to time and place provisions, similar to tobacco and alcohol, with sanctions including loss of licensure for those entities that violate this provision.
An outcome reporting system is needed to track beneficial and adverse effects of cannabis in real-time which will come under the supervision of the Narcotics Control Board.
A tax should be levied on cannabis as a means of checking abuse and collecting funds dedicated to regulation, enforcement, education and running mental health facilities.
Support Educational Efforts
Various educational campaigns targeting different demographics are needed. These educational activities can be funded through an earmarked portion of the cannabis tax. The aim of these educational strategies should be to reduce cannabis use among under-age people. Separate strategies should be launched targeting the public, physicians and medical students.
SOME KEY QUESTIONS ON MARIJUANA LEGALIZATION IN GHANA
For policy makers, these are seven (7) very important decision areas that will ensure the maximization of the cost and benefits of Marijuana legalization in Ghana
Production- Where Should Cannabis be grown?
Should it be grown outdoors on commercial farms, inside in confined growing spaces under the control of government or something like public-private partnership? If, as they say, government has no business being in business, there must be a regulator such as the NACOB which has the prerogative to issue licences and renewals to complying producers and withdrawal of licences for non- complying firms.
If there is a commercial pot industry, indeed, businesses will have strong incentives to create and maintain their regular customers who use most of the pot. Will private companies be allowed to enter the pot market, or will states limit it to home producers, non-profit groups or cooperatives? If a state insisted on having a monopoly on the pot production, it could rake in decent amount of much needed revenue and there is no question about this fact.
Will states try to limit or counter advertisements in the communities and shops that sell cannabis? There certainly must be enforcement of the regulations regarding promotion.
If pot is legal for adults, how will school and community prevention programs adapt their messages to prevent children from using? Money from the marijuana tax will be used to give relevant information to the communities as to the best way of prevention while encouraging evidence-based practice.
Marijuana potency is usually measured by its tetrahydrocannabinol (THC) content, the chemical compound largely responsible for creating the ‘high’ from pot. Much of the marijuana going into the US from Mexico is about 6% THC. Currently, I do not know the THC content of the Ghanaian marijuana and no effort has been made so far by any institution or individual in Ghana to measure that. However, most of the users in Ghana have consistently admitted that the potency of the marijuana in Ghana is very high. It is for this reason that most people try to traffic it outside including highly respected individuals in the society. Meanwhile, the Dutch are now considering limiting the pot sold in their famous coffee shops to not more than 15% THC. While THC receives the most of the attention, other compounds like cannabidiol, or CBD, which is believed to counter the effects of the THC, is also found in the marijuana herb, and could be used to produce friendlier version of marijuana for recreational use to control the THC content of the herb.
Legalization and taxation will raise the prices especially the variety with high THC content should we agree to legalize it based on the THC-Cannbidiol ratio, (just like the whiskeys, vodkas, rums etc for alcohol) so as to protect the vulnerable from using the highly potent varieties. In other words, the way taxes are set will also have an effect on what is purchased and consumed, that is, whether pot is taxed by value, total weight, THC content or other chemical properties.
In our efforts to create an evidenced based public policy, there will be the need to build in some flexibility into the intended taxation regime. For example, while it makes sense to tax marijuana as a function of its THC to CBD ratio, ten (10) years from now, we may have research suggesting a better way to tax. This may require a sunset provision that would give an escape clause in case we change our mind after the legalization. This will be a chance to, in other words, sit still to overcome the lobbying muscle of the newly legalized industry that will no doubt fight hard to stay in business. As the sunset date approaches, legislators or voters could choose either to keep their legalization regime or try something different.
MEDICINAL USES OF CANNABIS
There is now an overwhelming evidence of the efficacy of medicinal cannabis in hundreds of peer reviewed published scientific papers. Extraordinary results are being achieved in the treatment of multiple sclerosis, Cancer, Alzheimer’s, epilepsy, Spinal injury, pain, Post Traumatic Stress Disorder, Hepatitis, Glaucoma, Depression and the list goes on and on... Cannabis has a transformational effect on some people’s lives, freeing them from pain and suffering without the use of highly toxic pharmaceutical products. There is good scientific evidence that cannabis may offer control of the immune system and in turn provide protection from viral infections such as HIV/AIDS and Ebola.
Assuming there is this prominent Ghanaian public personality who is suffering from cancer and has been going for medical check-ups from one of the states in the US, say California, Washington, etc. His medical team decided that he will do better on Dronabinol, (a medication made from the marijuana herb) which is effective in treating nausea and vomiting for people undergoing cancer treatment. This prominent Ghanaian is likely to refuse to be put on this medication just for the fact that it is made of marijuana and (s)he will be skeptical about what the Ghanaian public will say when they get to know about the medication.
Another scenario; Assuming this particular medication gets to the Ghanaian market due to the fact that, some Ghanaians needed it to survive, there is no way this medication will be put under the National Health Insurance Scheme for the benefit of all even when it is produced by Ghanaian companies, not forgetting the fact that, our soil supports the cultivation of marijuana.
As I have stated earlier, smoking is only one of the ways by which a drug can be taken into the body. However, public discussions so far has focused only on smoking with no regards to the fact that, the marijuana herb has a long standing history in medicine and could be ingested through the mouth in many forms such as medications, candies, chocolates, bread etc. According to the WHO, access to controlled medicines is non-existent or almost non-existent in over 150 out of the 193 member states, while 90% of controlled medicines are consumed in Europe and North America. It is estimated with a wide margin of uncertainty that perhaps as many as 86 million persons suffer from untreated moderate-to-severe pain annually.
The International Narcotics Controlled Board has long been concerned that despite the existence of plentiful supplies of opiate raw materials to meet global demands, many governments do not ensure the wider availability of the essential medicines that derive from them. Even in countries that grow the raw materials from which those medicines are derived, it can happen that less than 1% of the population have access to appropriate pain relief.
‘Smoking is dangerous to your health’ does not only mean smoking tobacco or marijuana, but anything even including our local ‘kontomire’ if ever one decides to smoke it. However, the fact still remains that, even though smoking is dangerous to one’s health, people are still smoking any way. The question we need to ask ourselves is how we could formulate policies to reduce the harms associated with such behaviours. The best way to go is to formulate public policies to reduce the harms associated with the habit of smoking by legalizing marijuana in Ghana just like the promotion of condom usage.
Currently, Ghana is going through economic challenges and all efforts must be made to broaden the tax net and expand the commodities that bring in the much needed foreign exchange. As a psychiatric nurse of 15 years, I get very frustrated when the authorities of the various psychiatric hospitals struggle to raise money to manage the various psychiatric facilities which also serves to cater for individuals who are addicted to substances including marijuana. Currently in Ghana, there is no rehabilitation facility that is doing drug toxicology medically (either public or private) for people who get addicted to various drugs as there is no specialist in addictions in the country. Most of the supposed Rehabilitation centres in the country operate on the principle of Therapeutic communities (TCs) and Self-help groupings. The question is? Whose responsibility is it to provide these facilities and if as a nation; we have failed to provide these facilities, why should we continue arresting the users?
You can call the taxes from marijuana ‘sin taxes’ just like those from alcohol and tobacco but which country in this world has not thrived on such taxes. As a country, we can decide to devote the revenue from such taxes to improve on the mental health services delivery in the country especially addiction facilities. Legalization and taxation will raise the cost of the marijuana we have in Ghana.
Sincerely speaking, marijuana is too cheap in Ghana and easily available on our streets which make it possible for children and youth from deprived communities to cultivate, sell or purchase. Legalization will reduce the cost of the commodity in some jurisdictions due to the fact that, apart from the cost of cultivation and production, dealers try to factor in the cost of the risk associated with the business such as arrest and incarceration.
In our jurisdiction, legalization and taxation will rather raise prices up and we could allow those who want to smoke the more potent varieties to pay more in taxes just like is done for the spirits and the whiskeys in the alcohol industry because the cost of production of marijuana in Ghana is less costly and it is the reason why some youths have entered into the business.
Ghana could also decide to legalize the cultivation and exportation of marijuana to rake in the much needed foreign exchange to support our ailing economy. Raising tax revenues was one of the cardinal reasons why some jurisdictions decided to legalize and institute control mechanisms.
Marijuana thrives very well on our soil and the cultivation requires no special implements. We can licence some companies to cultivate the herb for our local pharmaceutical companies to produce the medications that could be consumed locally and exported since it is the vision of the government to turn Ghana into a hub of pharmaceuticals.
Recently, it was reported that the UK economy could benefit from a net profit of £6.7 billion per annum. This estimate is made from a detailed study of the size of the UK cannabis market, potential tax revenues, criminal justice system savings and additional cost of regulation including health information and education. Evidence from the US and Europe shows that, a regulated system would also reduce all health and social harms, better protect children as well as permitting enormous gain from the medicinal and therapeutic benefits of cannabis.
PROHIBITION DOES NOT WORK
Prohibition has proven beyond any reasonable doubt that it is a failure. It does not protect anybody not even children. The evidence shows that, it is easier for children to obtain cannabis as compared to alcohol, tobacco and prescription drugs and the recent report of school children trading in marijuana is a case in point.
Also, prohibition has resulted in the flourishing of the criminal market in which cannabis is grown intensively to produce higher levels of THC and the important balancing factor of CBD has been almost eliminated in some strains. Plants are often harvested early before the full range of cannabinoids, terpines and flavonoids have had time to develop.
Many instances have been reported of cannabis being sprayed with glass particles, mixed with fibreglass or other adulterants to increase weight or give the appearance of high quality. These are impurities. These are harms of prohibition, all of which would be eliminated under a regulated system. A properly regulated system would mean cannabis was available only through licensed outlets for adults only.
Under a regulated system, children and the vulnerable would be much better protected. Yes, it is true that we have challenges with regulation in this country but when we want it, ‘yes we can’ under the right motivation.
DECRIMINALIZATION OF DRUG USE
At the national and international level, efforts to control drug use have been directed to two areas, supply reduction and by criminalizing or punishing possession or use of illicit drugs by the user.
As a practical matter, criminalizing possession can also be used as a tool for enforcing laws against suppliers (It is easier to catch a dealer in possession of drugs than it is to catch him/her at the point of sale). Nevertheless, punishing the user is a substantial step beyond prohibition of sale and/or possession. It often involves efforts to police otherwise a private behaviour.
At the international level, the requirement that nations criminalize the possession or use of illicit drugs came relatively late to the drug control system. The 1961 Convention requires each country, ‘subject to its constitutional limitations’, to outlaw the possession of controlled substances (Article 36).
While there have been doubts as to whether this required criminalization, many countries had criminalized possession or use of controlled substances long before 1988, when the doubt was removed by article 3, Section 1 of the 1988 Convention, which called for the punishment of possession or purchase ‘as criminal offences under its domestic laws’. As a result, there have been a huge number of arrests worldwide which seem to reflect intensified enforcement against marijuana in particular.
The call for decriminalization is a responds in part by politicians and opinion leaders from countries that has presently acted proactively to decriminalize drug use to the fact that, young people of the middle class, often including their own children, were being swept up in the criminal justice system by the criminal laws on possession of marijuana. This has called for efforts to mitigate these effects by reducing the penalties for cannabis possession.
What decriminalization is calling for is to depoliticize drug abuse and substitute treatment programs for criminal sanctions which are inappropriate, judgemental and unduly expensive. In Ghana, it seems no much effort is made to cost the implementation of certain laws and policy makers do not look at the cost implication of certain policies to the national purse.
In addition, we also have a poor culture of evaluation. Countries that have taken steps to decriminalize drug use came to the conclusion to decriminalize not for the fun of it but based their actions on sound scientific reasoning. The evidence available has proven that, the current classification of marijuana as a very dangerous substance with no medicinal benefits is wrong.
Most people who are against the move to decriminalize drug possession allude to the fact that, it will lead to increased abuse. However, a number of researches have proven that this assertion is unfounded. Canada is reported to be one of the countries with a high rate of cannabis use while Portugal, a country that has shifted from criminal penalties to civil sanctions and treatment, is reporting very low drug use among young people, indeed, the lowest in any European country.
As a country, our current implementation of the laws criminalizing drug possession goes a long way to depict our understanding of drug addiction. Among the things we now know of drug addiction is that, it has genetic contribution to its development.
Moreover, most people’s development of addiction is partly the doing of society as resources are unevenly distributed either through social stratification or as a result of the insatiability of some public officers as most drug abusers live in deprived communities. Some studies have also reported a high co- occurance of addiction and mental Illness with some studies reporting a rate of as high as 90% which makes psychiatric comorbidity the rule, rather than the exception.
Thus, the state continual interest in arresting and incarceration of drug users without recourse to psychiatric/addiction assessment is rather very unfortunate in the face of dire economic challenges.
Indeed, one of the inclusion criteria for Dependence as defined by the Diagnostic and Statistical Manual (DSM) of the American Psychological Association is the continues use of the substance despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. This is definitely not one of the characteristics of someone who is mentally healthy.
Article 38 of the Single Convention on Narcotic Drugs, (1961) to which Ghana is a signatory; state in part that, “parties will provide adequate facilities for the medical treatment, care and rehabilitation of drug addicts”. Article 20 of the Convention on Psychotropic Substances, 1971, state in part that parties are to “take all practical measures for the prevention of abuse of psychotropic substances and for the early identification, treatment, education, after- care, rehabilitation and social reintegration of persons involved, and shall coordinate their efforts to this end...”
It is said that, the provision of treatment facilities for people with addiction problems is an obligation of a humane society. By my personal estimation, I think we have failed as a nation to be sympathetic to our kith and kin who have addiction challenges but more sympathetic to foreign nationals who smoke publicly on our streets. Is it a case that, the Ghanaian hospitality which we all pride ourselves in is only to be enjoyed by foreign nationals? Let us STOP arresting patients and rather offer them treatment.
NB: The writer is a Fellow of the West African College of Nursing and a foundation fellow of the Ghana College of Nurses and Midwives and has been working at the Accra Psychiatric Hospital since 2001. He is also a student of International Programme in Addiction Studies (IPAS).
Source: Samuel Cudjoe Dzidepo Hanu/ email- [email protected]
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