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Why Don’t We Have Guidelines For Cannabis Use?

And how do we fix it?

Professor Adam R. Winstock, MBBS, BSc, MSc, MD, MRCP, MRCPsych, FAChAM

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Why Don’t We Have Guidelines For Cannabis Use?

The Global Drug Survey (GDS), which is held each year, is committed to helping people use drugs more safely and thinks that experts by experience are an essential part of that process. Here’s what 40,000 people think safer guidelines for cannabis use should look like.

In the last few years, the U.S. has shown that legalizing cannabis does not lead to the world collapsing.

In fact, other than an amazing new tax revenue for local governments and green businesses employing thousands, you don’t often hear anything negative about the possible consequences of making weed legal. Putting an end to pointless criminal conviction and imprisonment and allowing diversion of precious police resources to things more worthwhile are such overwhelmingly positive aspects of enlightened drug reform that it seems almost a shame to ask a few uncomfortable questions.

But at Global Drug Survey that’s what we do.

We ask people who use drugs to share their experience with us so we can help people use drugs more safely—regardless of the legal status of the drug. And the sad truth is that unfortunately ‘for profit industries’ don’t often put public health ahead of profit. History tells us that when you put a bunch of private companies in charge of selling a product that can create dependence (yes, that’s cannabis, along with tobacco and alcohol), those industries will try to create and maintain a group of heavy users because that is where most of the profit is.

As a rule, higher potency drug preparations tend to do people more harm than lower potency ones because it’s easier to consume larger amounts of the active ingredient and go past the point of pleasure to problems (think fentanyl over heroin, spirits over beer).

Given that concentrates and edibles represent the fastest growing part of the cannabis market in the U.S., this issue deserves serious attention. A recent paper from GDS in Drug and Alcohol Dependence (Chat et al 2017, if you’re interested) on the effect profile of BHO (as a proxy for cannabis concentrates) showed it had a less desirable effect profile (less positives, more negatives) than high potency weed, and although not necessary, causal users reported poorer mental health than users of high potency herbal forms. Higher potency preparations make it easier to take too much and can lead to the increased risk of harms associated with acute intoxication, as well as the more rapid development of tolerance which can increase overall consumption and risk of dependence.

Given the potential of increased access to cannabis to increase use, it’s at least possible that legalization may, in the coming years, increase the number of people who develop problems. I think, so far, many governments have missed a trick relying on a top-down approach to regulation and asking experts in health and policy (with a little lobbying from the industry, no doubt).

Now, of course, they have a role, but what about consumers?

Surely the people who are going to keep the industry in profit should have a say? In GDS2017, we asked people how they wanted to see cannabis regulated. Some key findings included, 47 percent supported minimum pricing/gram based on the percent of THC in the product; with higher potency preparations being more expensive (28 percent unsure) and 45 percent supported lower prices for preparations balanced by higher CBD levels (39 percent unsure). In the U.S. and Canada, 45 percent wanted shopfronts with no advertising at all.

All of this shows that users may be a great resource for sensible advice on cannabis regulation.

What About Government Guidelines On Cannabis Use?

It struck me as very odd that legalization in the U.S. did not come hand-in-hand with mandated health warnings and guidelines on safer use and how to reduce harm and self-regulate use, as exist in many countries for alcohol. In GDS2017, over 75 percent of 5,000 people who answered the section on cannabis regulation supported the idea that government should produce such guidelines.

We agree.

By suggesting guidelines for illicit drugs, I am not suggesting that drugs are safe, and I am not suggesting guidelines will be a panacea to society’s drug problems. But as social care budgets are slashed and governments are starting to embrace population-based strategies such as behavioural economics to moderate unhealthy behaviors, having some common-sense guidelines that highlighted that taking less drugs less often was associated with a reduced risk of harm might be a useful benchmark for people to reflect upon.

This is why GDS developed the world’s first Safer Using Limit guidelines for cannabis. The Safer Use Limits are aimed at raising people’s awareness of the level of risk from different patterns of drug use. We developed the guidelines by asking 40,000 cannabis users to rate how the ‘risk’ of harm from different drugs (including alcohol) is related to different patterns of use. ‘Risk’ here refers to the probability, range and severity of harm. The higher the score, the more likely it is for a person to experience harms and problems, with higher scores indicating an increased severity of said harms.

We also asked our respondents to think about the likelihood of a person experiencing harm over the next one to two years. By harm, we mean anything that causes a person problems, such as mental or physical health, relationships and behaviors, finances or ability to work, study or just do the things in life they want to do. Check out www.saferuse.limits.co to see how you rate.

If you want to help us understand how the world uses cannabis in 2017, please take 15-30minutes to take part in the world’s biggest drugs survey HERE. at

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