Does it have an impact on mental health? Does regulation increase consumption? The cannabis debate, in detail


Does it have an impact on mental health?  Does regulation increase consumption?  The cannabis debate, in detail

The three legislative initiatives that various parties have presented in Congress to legalize cannabis are not going to fulfill their original objective because they do not have the support of the PSOE, and current parliamentary arithmetic requires socialist participation to pass these laws taking for granted the rejection of PP and Vox. But they have served to lower the public debate to society.

During the parliamentary process that ended last week's More Country initiative, several of the arguments of those who question the benefits of legalizing what - this all parties admit - it is still a drug. "It is an incongruity to promote legalization while alerting the population's mental problems," Íñigo Errejón, spokesperson for Más País and responsible for the first of the debated initiatives, was reproached. during the Congress session from the groups that are against.

The doubts expressed are many. Does a hypothetical comprehensive legalization have more advantages or disadvantages? Does consumption go up when it is legalized? Do you really have a mental health condition, as they say? What are the benefits of legalizing (not regulating, because the current prohibition is already a type of regulation)?

Before getting into these questions, a demographic reality beyond Parliament: 84% of Spaniards are in favor of legalizing the use of cannabis for therapeutic purposes, according to an INE survey at the end of 2018, and there are also more who would regulate its lucrative use (47%) than those who would keep it prohibited (41%).

Cannabis, in the form of marijuana or hashish, is the most widely used illegal drug in Spain by far, only behind tobacco and alcohol if the arc is opened to legal ones. Among the Spanish population aged 15 to 64, 8% have used cannabis in the last month (about 2.5 million people) and 2.9% do so daily (about 900,000 people). For reference: one in four people smoke tobacco (24.5%) and 8.8% drink alcohol daily (2.7 million people), according to the 2021 report of the Spanish Observatory of Drugs and Addictions (OEDA).

By age, the group that consumes the most is the population aged 15 to 24: almost 16% took the substance in the last month. Finally, cannabis use has been fairly stabilized in recent years: it was at 10.1% in 2007 (somewhat higher than the data indicated above because the data comparable in time includes the entire population and broadens the range of time in the one that was consumed) and by 10.5% in 2019.

The three proposals registered in Congress by Más País, ERC and Unidas Podemos propose a legalization of recreational cannabis use with small variations between them. We can propose to limit consumption to the private sphere or in specific authorized spaces, such as consumer clubs. Its text seeks to regulate self-cultivation, as do the other two, and a licensing system controlled by the State.

The More Madrid proposal is more permissive. It declares all uses of cannabis "free", allows its transport and consumption on public roads, one of the main problems that consumers now face, because consumption in homes is allowed, but not its acquisition or take it on the street.

Finally, ERC limits the acquisition of cannabis to self-cultivation - up to six plants at home - and pharmacies under prescription. Specialty stores, called grow shops, would be limited to the sale of products related to cannabis and seeds.

The positions are quite defined and the key to a regulation is in the PSOE. The small parties in Congress, such as ERC, Compromís, Más País or Cuidadanos support comprehensive regulation. Vox and the PP are against both absolute and medicinal legalization that is being debated in a congressional subcommittee (and that it does have signs of prospering). As it is the parliamentary arithmetic, a hypothetical regulation remains in the hands of the Socialists, a party that is halfway: it seems ready now to regulate medical use, but not recreational use.

"There are no good drugs or bad drugs, neither are they on the left or on the right, drugs are drugs and the ones that have attacked the most have been the working classes," said socialist deputy Daniel Vicente during this week's debate in plenary session. Viondi.

One of the arguments that questions the legalization of cannabis, and for which Más Madrid is being accused of being contradictory in its proposal, it is for the supposed condition that has its use in mental health, specifically in regards to psychotic episodes and schizophrenia.

"In the scientific literature there are numerous studies that have assessed this association - because we cannot speak of causality, we would have to do controlled trials - that give a greater association between cannabis and mental problems", begins Koldo Callado, professor of pharmacology at the University from the Basque Country and researcher on the effects of cannabis on mental health. "But especially when it comes to consumption in large quantities, on a daily basis, and especially when the beginning of consumption is carried out at a very early age", he clarifies.

Callado insists on this point. "The age of initiation of consumption is the main avoidable factor" to overcome mental problems, explains Callado. "We give many talks in high schools and we always recommend delaying the starting age if it has been decided to consume. Cannabis is associated with poor memory, cognitive difficulties, school failure ... The risk for cognitive and school development is going to be less the later you start, "he argues. A typical picture - not that it is usual in its prevalence, but that when it occurs is with these terms - is that of the consumer who begins with 14-15 years and develops an outbreak at 21, says Callado.

In this sense, Callado clarifies that the effect of cannabis depends on the variants that are consumed. The plant has thousands of compounds, including THC (the main psychoactive compound), which causes the high, and CBD (not psychoactive), which is used more for relaxing and medical purposes. "Much of the risk is associated with THC; CBD seems to have no direct relationship and we are investigating whether it may even be beneficial to the risks posed by THC."

The researcher at the Complutense University Cristina Sánchez summarized the main proven effects of cannabis on health in an interview with this newspaper: "They work as antiemetics, as antiepileptics, in gastrointestinal pathologies as powerful anti-inflammatories. These are the pathologies that are clinically proven. Apart from that, in the preclinical phase (even animal models) we know that it can have other very interesting applications, such as oncology. The potential is very great. But in addition to the potential, there are already proven clinical applications, especially with issues related to quality of life, which is an issue that is usually left aside when talking to doctors, who are more going to treat the disease. Primary symptom. It can affect the ability to sleep or anxiety, other symptoms associated with chronic pathologies. We are very clear that cannabinoids help the quality of life of the patient by attacking pain, anxiety, improving sleep and in some cases such as epilepsy decreasing seizures ... It works in many cases, in others not, but the only thing you are going to lose is the little di but the treatment costs you. " The cost of marijuana on the black market is around seven euros per gram, depending on the variety.

Another criticism of a possible regulation is based on the fact that regulating cannabis leads to an increase in consumption. Is this true? The experience in countries such as Uruguay, certain US states and Canada, the main laboratories of recreational legalization, say that a priori yes, but also that "the true impact of these regulations will not be known until more time has passed and the incipient market has stabilized, "according to the conclusion of a report on regulation in Canada.

In general, a systematic review of all studies published to date that include information on the effects of legalization in various US states reflects that only two of these investigations detected what they call "beneficial effects" in legalization, referring to the fact that it has decreased, while 13 registered "negative effects" and 24 "no effect".

Another review highlights that an increase in the prevalence of consumers both in the last month and daily has been detected among adults over 26 years of age, but not among young people, and clarifies that the results "are inconclusive, with research showing increases, falls and results without changes in the prevalence of use ".

In Uruguay, which has a free access system but requires consumers to register in one of the three ways (self-cultivation, dispensing in pharmacies or consumer clubs), they have gone from 34,108 in 2018 to 54,490 in 2020, an increase of 59 , 7% in two years, as reflected in the latest edition of the periodic report made by the Uruguayan Observatory on Drugs, which also reflects a slowdown in growth in recent months, "probably linked to the country's health emergency situation."

However, the country's Monitoring and Evaluation report states that problematic use of the substance has decreased: it was 16.7% compared to the total number of consumers in 2014, one year after the legalization was approved, and it fell to 15, 8% in 2018.

In Canada, where the model is more controlled by the industry than in Uruguay, consumption has also risen slightly after legalization, with interesting nuances by age group. The official statistics of the country show that general consumption (in the last three months) has gone from 14.9% before legalization to 16.8% later, while daily consumption has remained stable. But if you look at the breakdown, drug use has dropped by nearly half among the most vulnerable age group (15 to 17 years old, from 19.8% to 10.4%) since was regularized, while it has risen from there: from 30.9% to 33.3% between 18 and 24 years and from 13.1% to 15.5% among those over 25.

When Uruguay decriminalized the use of cannabis, it did so "against drug trafficking, to steal market," as explained by the then president, José Mujica. A first balance calculated that 55% of users now go to the legal market and that regulation has taken 22 million dollars from the mafias in the first years of legalization.

In Spain the defenders of the regulation also use this argument. Errejón did it during the parliamentary debate this past week, when he disfigured the PSOE that its refusal to regulate left the market in the hands of the mafias and represented a significant economic loss for the country. The most serious study on the issue was carried out by the University of Barcelona a few years ago, and established that the regulation would leave a total business of 8,514 million of euros per year, which would mean a collection of 3,312 million euros for the State: 1,021 million in VAT, 486.6 million of special taxes (similar to tobacco but with a low tax burden to be competitive with the black market), 371 million in corporate taxes, 1,407 million in personal income tax and Social Security contributions (workers in cannabis companies, cooperatives and social clubs) and 26 million in taxes derived from exports. This same study estimates that the black market would not disappear, but it would be reduced to 15%.

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