Cannabis: A Few Issues
Cannabis (including marijuana, hash, hash oil) continues to be a controversial drug in many countries as people try to figure out the place that the drug has in their society. In the Western world, marijuana smoking by young people has become a very common activity - in some countries even more common than tobacco smoking. The UN's international conventions require countries to treat cannabis and other drug offences as criminal offences. However, these conventions leave the door open for countries to establish alternative measures as a substitute for criminal prosecution. Consequently, much of the debate about cannabis is around the legal status of the drug.
These questions are not simple. For that reason through the month of November, the Global Youth Network is going to review what is known about cannabis use and young people in a four- part series dealing with:
(i) the level of use worldwide;
(ii) why some young people use cannabis/why some have problems;
(iii) the harms associated with cannabis use; and (iv) the effect of cannabis laws.
Cannabis Series - Part 1
The level of use by young people around the world
Information is sketchy in many countries, particularly in developing regions, but it's clear that while cannabis is not as popular as alcohol and tobacco in most countries, it is usually the first illegal drug used and is the most commonly used illegal drug by youth around the world.
Worldwide it accounts for the vast majority of illicit drug use by young people (for example, cannabis use represents about 90% of all illicit drug use among students in the US and Australia and almost 95% in Europe). In the highest using countries (Australia, Canada, France, Ireland, UK and the US), cannabis use is quite common, with more than 25% of all high school students reporting use in the past year. In Europe past year rates for Grade 10 students range from 1% in Romania to 35% in France. In sub-Saharan Africa cannabis is considered the main illicit drug of concern, with increasing use by young people being cited in several countries. In Asia, there are few studies, but two showed lifetime prevalence of 4.5% and 6% among youth populations.
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In the last couple of years, use of cannabis and other illegal drugs in "high-use" countries (i.e., the US, Canada, Australia and certain countries in Western Europe) has levelled off - and in some cases declined - after rising through the mid- to late-'90s. At the same time, use rates in lower-use European countries (particularly in Central and Eastern Europe) have continued to increase, so patterns in all countries are merging to an extent. For example, while cannabis use increased among lower-use countries (e.g., Finland and Norway), it decreased in higher-use countries (e.g., the UK and Ireland).
When do people first start using cannabis?
The average age for starting to use cannabis in Western countries seems to be around 14-15 years of age. It appears that the average age of first use in developing countries may be a bit older, but it's hard to tell because there's not much information. The idea that cannabis is a gateway drug that leads to other drug use has been proposed for years. It remains a controversial idea, because while it is true that most users of other illegal drugs (e.g. cocaine, heroin) have used cannabis, the vast majority of young cannabis users do not use any other illegal substance.
Some other points:
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Age makes a difference: In the higher-use Western countries, recent use increases from under 5% in Grade 7 to 30-40% by the later grades. |
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Gender makes a difference: Boys are generally much more likely to use cannabis than girls, although as with tobacco and alcohol, the gap in several countries is closing. Boys are more likely to use frequently and heavily and (according to one study) in public places. |
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Social and economic status makes a difference: Street youth are more likely to use cannabis and to use it heavily than are "mainstream" youth. But even among mainstream youth, heavy, risky use is not unusual. One study in North America showed that one-third of youth between 14 and 17 years of age had used an illegal substance (mostly cannabis) more than five times, and among them: |
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United Nations Office for Drug Control and Crime Prevention. Global Illicit Drug Trends, 2002.
United Nations Economic and Social Council. Youth and Drugs: A Global Overview (1999). Commission on Narcotic Drugs, Forty-second Session, March 1999.
Zoccolillo, M., Vitaro, F., and Tremblay, R. "Problem Drug and Alcohol Use in a Community Sample of Adolescents", Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 38, #7, 1999.
Cannabis Series - Part 2
Why do some young people use cannabis and why some have problems
Why do some young people use cannabis?
When looking at why young people might use any drug, the first thing to keep in mind is that today's young people - more than in any other period in history - are growing up in an environment that encourages various forms of substance use, both medical and non-medical. The pharmaceutical and alternative medicine industries are huge and use their "mega" presence in the market-place to promote a climate of "solution by ingestion".
Another huge factor is the big $$ that the tobacco and alcohol industries put into marketing their products - much of which is aimed at young people. Add to these factors a Western dominated pop culture that young people around the world "consume" and that mostly tolerates drug use. We also need to remember that people have used a wide variety of substances throughout history to satisfy some need or another (ranging from enhancing pleasure, to stress relief, to helping with working longer hours). Young people use substances for many of the same reasons as adults. But when we look at a list of the tasks that young people need to take on to develop their identity, tasks that are a normal part of adolescent development, such as ...
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... we begin to see why cannabis might be popular with young people today. Couple this with the spirit of the times, which one person describes as "a runaway world" filled with uncertainty and a lack of direction, and the importance of substances to some young people is even more understandable.
As with most drug use, the reasons young people give for using cannabis are a mixture of the symbolic and reasons related to cannabis' drug effects. Young people are most often introduced to cannabis by friends. Most use cannabis for the first time out of curiosity and to be sociable. Reasons they report for continuing to use include to relax, feel good, enjoy music and movies, and to be sociable. Those who do not choose to use say they're just not interested or that they fear the adverse health effects. They do not tend to mention the penalties associated with use. Only about 50% of users report that they liked their first experience - many don't feel anything - while some experience unpleasant psychological effects (see next week).
Why some have problems with cannabis use. The reasons for a person developing problems as a result of cannabis use usually stems from a combination of personal, family and school-related factors (for example, having mental health issues, poor family life and/or doing poorly in school). An indicator of likely problems is daily use. A small but important percentage of students report using cannabis daily, and in one survey, over half of all cannabis users reported that they had experienced at least one of three indicators of dependence. Heavy use of cannabis is more likely among street youth. A review of studies shows that frequent use and cannabis use problems are linked with*:
truancy
low self-esteem
delinquent behaviour (stealing, vandalism, fare dodging)
having delinquent friends
hanging out on streets in boredom
other behavioural/mental health issues (those in special education programmes/schools tend to use more)
* (that is not to say "caused by" these factors, only that they are linked)
Cannabis 2002 Report. A joint international effort at the initiative of the ministers of public health of Belgium, France, Germany, the Netherlands, Switzerland. Ministry of Public Health of Belgium, 2002.
Cannabis Series - Part 3
Harms associated with cannabis use
The active ingredient in cannabis is tetrahydrocannabinol, or THC, which gives the following effects: sense of well-being; relaxation; enhanced sociability; difficulty concentrating; distortions in sense of time, vision and hearing and; at higher doses, auditory and visual hallucinations. Other effects include increased heart rate, reddening of the eyes, sleepiness, increased appetite and relaxed muscles.
The extent of these effects and the actual experience of the user will be determined by a number of important factors that can vary greatly:
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The way it is prepared and used: Marijuana, the leafy part of the cannabis plant, has less THC than the resin (hashish) or oil (hash oil); a "dose" of heroin will have much greater effect when injected than when smoked and a dose of cannabis that is eaten will have one-half to one-third the effect of the same dose smoked. Mental effects start within minutes of smoking and 30-90 minutes after eating marijuana in baked goods. Most effects from smoking are gone within 3-4 hours, while the effects after eating can last 4-8 hours. |
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(b) |
The size of the dose: It is very difficult to determine the amount of actual THC that is consumed by each person when a joint is passed around. Being a plant product, THC amounts vary greatly, and other factors, including the number of puffs, time between puffs, holding time and lung capacity, also effect THC levels taken in during use. Much has been made of the fact that the marijuana of today is far more potent than in the past. It is, in fact, generally quite a bit stronger, however, potency of seized cannabis varies widely, and the police and media tend to highlight the most extreme cases. Even though the strength of cannabis has increased, the effect is ultimately determined by the amount taken in, and the user can adjust their dose of THC by changing the volume of smoke they inhale per puff. |
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(c) |
The circumstances surrounding use: This is really important and refers to the setting, the motives and expectations, and whether the cannabis is combined with some other drug. |
Use of any drug has some level of risk attached to it, and cannabis is neither a demon weed nor a harmless substance. As with all substances, it is important to distinguish between casual, regular and heavy use, with negative effects being more likely with heavier use. Studies of effects are made more difficult because cannabis is often used in combination with other substances, particularly tobacco.
Physical effects: The most important physical effects associated with cannabis concern the lungs (mainly due to the effects of the burning of the cigarette rather than with cannabis itself - marijuana smoke contains about 50% more of certain carcinogens than the same amount of unfiltered tobacco). Long-term, heavy use results in increased symptoms of bronchitis, coughing and wheezing, and increased rates of pulmonary infection (3-4 cannabis cigarettes a day are estimated to result in the same levels of bronchitis as 20 tobacco cigarettes). Although it needs to be confirmed by more research, there is some evidence that heavy long-term use increases the risk of emphysema, chronic bronchitis and lung cancer. Those who regularly smoke both tobacco and cannabis place themselves at particular risk of respiratory problems because of the combined effect of the two. Concern has been expressed over the fact that THC has been shown to damage white blood cells in the lungs. As a result, heavy cannabis use may reduce the ability of the body to fight lung infections and illness, and this effect would be greater with higher potency marijuana.
THC can also cause cardiac problems in patients already suffering from high blood pressure or heart disease, however, this potential risk is much less than it is with amphetamines and cocaine. With the exception of cardiac patients (although studies on cannabis over the years have shown various physical effects), the effects tend to be slight and generated by doses that are higher than usual human doses (often in testing with animals) and they tend to pass after a period of not using.
In sum, there is evidence of lasting harm to the lungs and (among those already at-risk) to the heart, but no evidence in humans of lasting effects on the gastrointestinal or endocrine systems (governing hormones and reproduction) or the immune system.
Mental effects: In some people who seem to be mentally healthy, psychotic symptoms can be triggered (such as delusions, paranoid feelings and hallucinations); these go away as the other effects wear off but are obviously not pleasant at the time. Heavy, long-term use is more likely to produce these symptoms on an ongoing basis (as happens with alcohol and most other drugs). In these cases, recovery generally occurs within a week of quitting. In cases where the condition does not improve, it is usually because of an underlying psychological problem that is triggered by the cannabis use.
Persons with various mental health problems, such as anxiety, depression and schizophrenia are often into heavy cannabis use (indeed, drug use generally). The question of which came first - that is, whether use actually triggers these conditions or whether cannabis is being used to self-medicate these problems - is the subject of much debate, but there is less doubt that cannabis use could potentially worsen these conditions. Heavy cannabis use can impair motivation, but it is not clear whether heavy use can cause an "amotivational syndrome", described as a loss of energy and the urge to work.
A diagnosis of drug dependence involves tolerance and withdrawal as well as other criteria, such as continuing to use knowing the harm that may result, and devoting much time to acquiring, using and recovering from use. Cannabis dependence does occur but is not likely to occur in the usual patterns of social use (i.e. when doses are small or infrequent). The addictive potential of cannabis is considered weaker than that of many other drugs, including alcohol and tobacco, and dependence disrupts the user's ability to function less than does other substances. That said, cannabis dependence among young people does occur and can represent a very significant barrier to an adolescent's development.
Any discussion on risks and problems needs to include specific circumstances, such as:
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Use at an early age: The earlier the use begins, the more likely that use of cannabis may be an indication of other issues in the child's life, such as mental health problems, which can lead to other problems. |
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Using in combination with other substances: Cannabis is often used with other substances, from alcohol to heroin. The results can be difficult to predict and potentially dangerous; depending on the substance, the effects may be additive (1+1), synergistic (1x1) or cancel each other out. |
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Using in combination with other activities: |
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Driving: cannabis affects driving ability; the risks increase significantly with dose, and affect certain tasks more than others. When combined with alcohol, there is serious driving impairment even at low doses. |
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School tasks: because it can impair memory, concentration and problem solving, cannabis use combined with school or homework will reduce performance. |
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Sexual activity: use of cannabis (or other drugs) may result in unwanted sexual activity or unwanted consequences. |
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Athletics: cannabis is not a performance enhancing substance; rather, it has the potential to impair performance, possibly leading to injury. |
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Using while pregnant: As many are aware, alcohol use during pregnancy can be very risky and can result in lifelong effects on the child. Occasional use of cannabis through pregnancy does not appear to result in any effect on the newborn, while regular use has been shown to result in reduced fetal growth. One long-term study has shown that there are subtle effects on cognitive functioning among children of cannabis-using mothers at nine to 12 years of age. |
Cannabis 2002 Report. A joint international effort at the initiative of the ministers of public health of Belgium, France, Germany, the Netherlands, Switzerland. Ministry of Public Health of Belgium, 2002.
"A smoking gun? The impact of marijuana smoking on respiratory health", The British Lung Association, 2002.
Cannabis Series - Part 4
The effect of cannabis laws
A number of countries are debating their marijuana laws, in most cases, trying to decide whether the penalties for possessing small amounts of cannabis should be reduced. Some advocate legalization of cannabis, that is, making it available through controlled, legal sources, as are tobacco and alcohol. However, most policymakers see that option as a huge social experiment, with outcomes that are difficult to predict. Others advocate that possessing personal amounts of cannabis should no longer be viewed as a criminal offence and penalties should be reduced. This is because, even though marijuana is not a harmless drug, an increasing number of health officials, researchers and politicians in these countries view the penalty to be out of proportion to the potential harm of using cannabis. The following are some of the arguments being made for reducing the penalties so that possession of small amounts of cannabis is no longer a criminal offence:
A criminal record is a serious matter
A criminal record labels a person caught with possessing small amounts of cannabis as a criminal and severely limits their ability to find employment, professional certification and to travel to other countries. Criminalizing a behaviour has a number of effects: it may make it more attractive to some youth, and it may result in the further marginalization of some youth, making it more difficult to help them.Reducing the severity of the penalty doesn't seem to lead to increased use
Cannabis use (particularly heavy use in combination with other substances) poses risks, so it is important that any change not result in increased use. Based on the experiences of those countries or states that have reduced their penalties, various reviews agree that there is no indication that this will happen. For example, the 11 US states that decriminalized marijuana possession in the 1970s did not see increases in use beyond that experienced by other states; neither did the Australian states that have introduced a civil offence model over the past decade.Laws don't seem to matter one way or another to young people
Over the past 10 years in most Western countries, the use of cannabis by young people has increased and attitudes have generally grown more tolerant toward the drug, with no difference between countries that had stiff or reduced penalties. For example in the Netherlands, where cannabis use is not a criminal offence, usage rates are lower than in the US, which has some of the toughest cannabis laws in the Western world. Young people who do not use cannabis generally say that their decision is based on health concerns or that they are just not interested. They aren't as likely to mention the laws as being a factor in their decision. In fact, research with teenage students suggests that the criminalization of cannabis and the stigmatization of cannabis use as a dangerous and forbidden activity makes it even more attractive to some.Resources could be better placed elsewhere
Cannabis offences can take one or two officers off the street for up to several hours + their time for court appearances + tying up other court resources. These $$ could have more impact put into apprehending producers and traffickers, or directed at prevention, education and treatment. Although the law is an important means of controlling behaviour, accurate and balanced information and education should be seen as the primary means to enable young people to make informed choices about their drug use. For example, laws cannot distinguish between levels of use, whereas educators can help young people by providing clearer messages (for example, all drug use contains some risk - heavy use can result in serious problems for young people, while light, infrequent cannabis use poses fewer risks).
A case example
In Canada police are often reluctant to apply the penalties for possessing small amounts of cannabis, not only because of the work involved, but also because they do not want to saddle a young person with a criminal record. When a young person is found in possession of small amounts of cannabis in Canada, the typical police response is some combination of taking the drug, detaining the person in the police car or station, giving them a warning and letting them go. As a result, young people feel that the police do not take the laws very seriously; some also feel that they are applied unevenly depending on a person's ethnicity, the clothing they are wearing, etc.
One of the options being considered is to give the person a ticket, like a traffic ticket. Even though this would seem like a softer approach, it would in fact represent a greater penalty than many young people currently experience. And if the police "widen the net" (that is, become more active in apprehending youth) as apparently occurred in Australia when penalties were reduced, it would actually mean that young people would be more likely to be penalized.
Another possible outcome is that parents are more likely to be involved when their child is fined than if they are just "slapped on the wrist" and let go, providing an opportunity for parent/child discussion on the issue.
Also, creating a reduced penalty option reduces the deviance attached to the behaviour, which does lead to a climate more open to actual health promotion messages (e.g., that using around driving and sexual situations, or using to the point of intoxication, or using in combination with other substances or medications, or while involved in physical or cognitive activity can be harmful).
Fischer, B, Albanes, R, and Amitay, O. "Marijuana, Juveniles and the Police: What high school students believe about detection and enforcement", Canadian Journal of Criminology, Vol 40(4): 401-420, 1998.
Gary Roberts, Senior Associate
Canadian Centre on Substance Abuse
Phone: 613-235-4048-225 // 613-829-3152 (home)
Fax: 613-235-8101/613-829-3307 (home)