Introduction: The Size, Distribution and Risks Associated with the Health Problem
Cannabis appears in many forms, from marijuana (the dried flowers) to hashish or hash (the compressed resin or sap). However cannabis refers to the plant itself as well as its associated products. Cannabis is most often smoked in the form of a "joint", but it can also be smoked in a pipe called a "bong", as well as it is able to be eaten, this is very rarely done though (Health 2009). When smoked the effects are felt quite quickly, the opposite of when it is eaten, however it is harder to control the dose when it is eaten (Health 2009). The use of cannabis in Australia today is not only wide spread and ever increasing, so are the problems associated with its use. Cannabis use cannot only lead to respiratory illness, cancers and other physical illnesses (Kalant 2004) but is can also result in many mental health problems, such as schizophrenia, acute anxiety or panic, psychosis and depression (Kalant 2004), and the number of cases of poor mental health associated with cannabis use continues to increase at an astounding rate each year.
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While cannabis itself causes no deaths on its own, when it is mixed with other chemicals the "high" effect that results from its use plays a leading role in the chain of events that causes a given death. In 1993 there were found to be 466,897 drug related episodes reported, of these cannabis was the subject of 29,200 mentions (Network 1995) . The number of cannabis related episodes had increased by 22% between 1990 and 1993 (Network 1995), (see Table 1) for more details on cannabis use. Australia is ranked 2nd in the world for cannabis usage (NationMaster.com 2010), 60% of Australia's population admitted to using cannabis at least once by the age of 20, of these people 7% admitted to using it regularly (Health 2009). While there are no statistics that demonstrate the costs of treating cannabis and its related problems, the cost of therapy for cannabis addiction coupled with that of the physical and mental health problems, the treatment would be quite costly to the government and tax payers. The fact that Australia is ranked the 2nd highest cannabis using country in the world and having a greater rate than that of the US by 5.90% (NationMaster.com 2010) is definitely a worry for the government and many health care professionals.
A study conducted by Marroun et al. (2008) has discovered that ethnicity, religion and social status play a large part in cannabis use distribution. Men are more likely than women to smoke cannabis especially if they are not married, unemployed and uneducated. However women will also adopt smoking cannabis if exposed to abuse or violence (Hanan el Marroun 2008). Another study by Dengenhardt et al. (2007) has shown that non Hispanic white people are more likely than any other race to use cannabis. However life time cannabis use is significantly higher among black and mixed ethnicity young people (Jayakody et al., 2006). Furthermore being religious decreases the odds of cannabis use almost 3 fold (Dengenhardt 2007). There are no risk factors per say that directly cause a person to use cannabis, however in the study by Marroun et al., (2008) it has been proven that exposure to violence or abuse as a child has a high cannabis use rate as an adult, furthermore if as an adult the partner is a cannabis user then the person is more likely to use cannabis. These factors coupled with low socio-economic status, being uneducated and being of mixed or black ethnicity will increase the risk of using cannabis immensely.
Table 1 Summary of selected mentions during emergency room visits from reporting sample in 1993. (Network 1995)
Number of Mentions
alcohol in comb.
marijuana in comb
* aspirin, acetaminophen and ibuprofen
** alprazolam (Xanax), diazapam (Valium) and lorazepam
Source: DAWN, SAMSHA Advanced Report #8. 12/94
Body: The Evidence
A study by Henquet and colleagues, conducted a meta-analysis in which it was shown without a doubt that the consumption of cannabis is associated with a doubling in the risk of schizophrenia later in life. The main ingredient of cannabis is tetrahydrocannibinol (THC), in which the psychological effects stem from the activation of the CB1 receptor in the brain. The psychological effects of cannabis use is a result of the disruption or flooding of the normal CB1 receptor mediated signaling (Marta Di Forti 2007). In 1999 data was extracted from the Danish Psychiatric central register, these patients were followed for a minimum of 3 years. Half of the patients who received a diagnosis for cannabis induced psychosis had developed schizophrenia spectrum disorder, just 1 year later and at a younger age than that of people with no history of cannabis use (Marta Di Forti 2007). In a 15 year study of cannabis use and schizophrenia, it was found that there is a dose-response relation between the risk of schizophrenia and the frequency of cannabis use by the age of 18 (Hall 2006). Not only does the use of cannabis cause schizophrenia, it has also been proven that heavy cannabis use can also cause acute toxic psychosis, and psychiatric comorbidity. There has also been some weaker evidence emerge of a relation between cannabis use and depression. Wilcox et al. (2004) discovered that cannabis use in females younger than 15 raised the risks of suicide ideation or attempt in the 15 years following, significantly. These results prove that the use of cannabis is associated with an earlier onset of mental health disorders, and that higher doses of cannabis are also a contributor of mental health disorders in people who use the drug. Using cannabis may also lead to dependence on the drug (Kalant 2004) and has been proven to be a gateway for using harder illicit drugs (Marta Di Forti 2007).
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Unfortunately the primary stakeholders in the cannabis debate are the dealers, growers and distributors of the drug, making millions every year from this ever increasing business. There is however a positive stakeholder in the equation, the government has a large investment in the cannabis business. The government has introduced laws to protect its citizens from the harmful effects of the drug. They have also set up clinics to help people with cannabis induced mental health disorders and also to help wean them off of their addiction. Lastly the rest of society is a major stakeholder. Tax payers pay for user's hospital bills and also their addiction. Users are likely to become violent and often steal to fund their addiction. All of these parties have an important investment in the use of cannabis, some are positive, and others are very negative as illustrated by (Government 2009).
Barriers and Interventions
Many of the barriers to using the interventions of cannabis are the law itself, laws are in place to try to stop the trafficking and use of cannabis, however these same laws prevent traffickers from being caught and prosecuted. Police firstly need a warrant to search any persons house suspected of carrying illegal drugs, giving many dealers plenty of time to get rid of the evidence. Also people's freedom of choice makes obtaining the drug very easy. If people want it badly enough, then they will be able to get their hands on it. There are simply too many factors to police. Many people find their way around these interventions (the law and the government). Even the threat of a fine and imprisonment (Government 2009) doesn't deter dealers and users. The very laws set in place to prevent the use and distribution of cannabis, also act as barriers to these interventions, through all the formalities and technicalities involved.
Addressing the problem?
Thus far there are laws in place to try and address the current cannabis problems, these include: hefty fines if a person is caught using, selling, growing or transporting and carrying cannabis. Not to mention there are possible prison sentences for those found guilty in a caught of law. Each state is different in the laws they implement (see Table 2 and 3), some will give out a $50 fine while others will charge for criminal offence. Some jurisdictions have decriminalized minor cannabis offences, meaning the offence can be dealt with by a civil penalty, however this doesn't not neglect the fact that cannabis is an illicit drug (Government 2009).
Minor cannabis offences in jurisdictions that have decriminalised cannabis (Government 2009).
Diversion programs for minor cannabis offences (Government 2009).
To prevent cannabis from becoming more popular and causing harm to many Australian citizens, the government should increase the consequences of being caught in possession of cannabis. The government needs to participate in research that focuses on the more harmful long term effects of cannabis use, and they should educate schools and high-school level students on the harmful effects. Not enough effort is put into educating people on the negative side of cannabis use. Furthermore the government should place advertisements on TV to demonstrate to the general public, the harm that cannabis can not only do to your physical being but also your mental health and all the people around you.
Cannabis should not be legalized in Australia; there is an overwhelming body of evidence that links cannabis usage to mental health problems in the short term as well as later in life. Cannabis users were found to be at double the risk of developing schizophrenia than those who do not use cannabis, and at a much earlier age in life than others. The larger the dose of cannabis that is used the more severe the consequence. Not only are the effects harmful physically and mentally, but once used the cannabis user may also develop a dependence on the drug and may suffer withdrawal symptoms if they don't use the drug for periods of time. Cannabis has also been found to be a gateway drug, leading to the use of many more dangerous and illicit drugs. However the studies do have their drawbacks, while the more recent studies support the link between psychosis and cannabis, other studies have also suggested that this link is only plausible if the user is genetically mediated toward mental health disorders. These studies also note a difficulty in specifying these genetic vulnerabilities (Hall 2006), and with many people viewing cannabis as a soft drug that causes no harm (Health 2009), opinion for the legalization of cannabis in Australia is very biased. Even with these supports, the negativities far outweigh the positives. With all the negative effects cannabis has on the human body, mind, government resources, time, tax payer's money and wellbeing, Cannabis should most definitely not be legalized in Australia, In order to protect the future health and wellbeing of the people of this country.
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