Issue #7 June 2020

Even a short post about any aspect of drug policy does not exactly write itself while the world’s attention is focused on the COVID19 pandemic and the protests on the systemic racism that plagues our society. On those matters I will defer to others who are better qualified to comment on, and more profoundly impacted by, these monumental events. I will simply offer my thanks to the front line workers who provide care and allow us all to retain a semblance of normality in our lives, my respect for those working tirelessly towards a vaccine, and my support and encouragement for those who challenge injustice.

Of course, drug policy has its own problems. For the better part of a century, Canada passed and maintained drug laws with the specific purpose of oppressing people based upon their race and social standing. The application of these harsh laws was justified with a perverse construct of morality. People who used illegal drugs – drugs not sold by a licensed industry – were bad people. And the people who sold these drugs were not just law-breakers – they were the devil incarnate – deserving of the most unforgiving of punishments. But it was the harsh punitive consequences for simple possession of even a small amount of drugs – too often prison terms and typically lifelong criminal records – that has prompted demands for change.

For half a century, calls for the decriminalization of the most popular illegal drug, cannabis, failed to achieve political or legal acceptance in Canada. This was despite possession of cannabis being decriminalized in many states across the US and in countries spanning much of the world. Governments had been pressured to recognize that the harms to a person’s social determinants of health from a criminal record far exceeded the harms typically experienced by a cannabis user. Many governments, no longer able to justify criminalizing its young people for a victimless crime, decriminalized possession of cannabis, and in some countries, possession of all drugs. But not in Canada. Like a small handful of US states, Canada had a different, more ambitious plan – one that would create a legal trade in cannabis on the same level as other recreational drug trades such as alcohol and tobacco.

In my previous posting (February 29), I provided the data demonstrating that in Canada, the harm and economic costs from our legal drugs far outweighed those from illegal drugs. So, what are the implications of that finding for the historic transition of cannabis from reviled drug to glamourous pastime? The correlation between legal status of a drug trade and respective harm from the drug does not prove that the legal drug industries caused high levels of problems related to their respective products. In popular parlance, correlation is not causation. But a correlation is not cause for dismissal either. Correlations, as uncertain and pesky as they may be, are worthy of our attention.

Ethically, it is a good thing that I cannot point to a double blind clinical trial showing that people who were randomly assigned to experiencing the business and promotional practices of revenue-driven industries were more likely to develop problems than were people randomly assigned to a group receiving a difficult-to-imagine placebo. So, where does that leave us for developing evidence-based policy? By necessity, we rely upon data sets that are less compelling than clinical trials. I have heard academics argue that if we do not possess the highest quality of evidence, we should remain silent. I can appreciate the comfort that this perspective affords. The problem is that if we are silent on the public health side, legislators hear only the industry side – a perspective that typically excludes any consideration of public health evidence.

So, as the lesser evil of available options, we enter the fray with our imperfect data – a weakness which can also be exploited by the industries in their lobbying for policy that is favourable to their revenue objectives. Thus, policy development becomes a battleground in a different kind of war on drugs – one fought between drug industry revenue and public health protection, and one arbitrated by governments. It seems somewhat odd that the onus is always placed on public health to demonstrate the harm of a proposed policy rather than on industry to demonstrate its safety.

I will be clearly candid about where I stand on research and drug policy. When we cannot be certain on a course of action given a lack of the highest quality evidence, I am inclined to err on the side of protecting public health. We call this “the cautionary principal”. It places the onus on industry or government, to demonstrate the safety of a proposed policy change.

In my next post, I will begin to explore the evidence for how a drug industry’s practice and government regulation may play an important role in creating drug problems. While typically correlational, the evidence is sufficiently compelling to invoke the cautionary principal in policy decisions. We will start with the tobacco industry that so successfully exploited correlation is not causation as its battlefield banner. That banner helped to delay much needed policy reform for decades. There were many preventable deaths. In subsequent posts, I will cover the alcohol industry and the pharmaceutical industry. Spoiler alert: more preventable deaths.

As your organizations continue to rely upon virtual or spatially safe educational arrangements, please consider including drug policy issues. I look forward to the opportunity to work with you on design or delivery.