It is known from case-controlled studies that impairment from cannabis use can last. But there are limitations of these studies; the question remains which came first, the chicken or the egg?
Dr. Meier’s research used data from the Dunedin longitudinal study, a representative sample of 1,000 people from birth to age 38. IQ was assessed between ages 7-13, ages 18-38, and then at age 38, after these individuals developed persistent pattern of cannabis use.
These individuals were assessed for cannabis dependence at ages 18, 21, 26, 32, and 38. Diagnosis of cannabis dependence included compulsive use despite health, social, legal problems, etc.
One question asked was if persistent cannabis users have different IQs. Those who never used cannabis had a slight increase in IQ. As cannabis user increased, there was greater decline in IQ.
Dr. Meier eliminated from the sample anyone who reported cannabis use in the previous 24 hours prior to IQ assessment. Then eliminated anyone who used cannabis in the past week. Finally, she eliminated persistent tobacco users, persistent hard drug users, persistent alcohol users, and the diagnosis of schizophrenia. The effect sizes remained about the same. None of these factors could explain IQ decline.
Another question to consider was if friends and relatives notice cognitive problems? Does IQ drop impact everyday life? Among persistent cannabis users, friends and relatives noticed more attention problems (e.g. easily distracted, side tracked) and memory problems (e.g. forgets to do errands, pay bills, etc.).
Studies of rats show that the adolescent brain is especially vulnerable to cannabis than the adult brain. Among the Dunedin study sample, there was a difference between adolescent-onset cannabis users and adult-onset cannabis users.
Individuals who were dependent on cannabis before age 18 showed more severe IQ decline. The more persistent users lost about 8 IQ points from childhood to adulthood. People diagnosed with cannabis dependence after age 18 did not show much IQ decline at all.
Dr. Meier’s research also asked if quitting cannabis use restore cognitive functioning? Among adolescent-onset cannabis users, their childhood IQ was higher than their adult IQ. Childhood and adulthood IQs were similar among those who quit or greatly cut down cannabis use by age 38, but their adult IQ still wasn’t as high as their childhood IQ. Among those with adult-onset dependence who quit by age 38 their IQ was restored. But among those still using cannabis, their adult IQ was less.
A final question was if persistent cannabis users show IQ decline? Dr. Meier’s research confirmed that they do, but this effect is limited to adolescent-onset cannabis users. The effect was not explained by other factors.
This study provides many implications related to the brain. We know that the adolescent brains are vulnerable. An 8-point drop in IQ means a drop out of the 50th percentile (where the average is an IQ of 100 IQ). We also know that as perceived risk of harm from cannabis use declines, the use of cannabis increases.
The policy implications of this research include the need to delay the onset of cannabis use and to encourage cessation of cannabis use – especially those who use in adolescence.
There is a remaining question about how to get the message out about early onset of cannabis use given the movement to legalize the drug. Kids don’t seem to believe research findings. They need to understand that their brains are different. These messages are important for everyone who works with adolescents, and parents.
There is a shift taking place today in the drug policy debate, a shift away from drug use as a health question (focused on the need for treatment and prevention) and drugs as a market question (focused on alternative supply control arrangements). He stressed that it is immoral to debate drug policy as a question as who is going to make money off addicts – will it be cartels, governments, hedge funds, etc.? Addicts must be treated as people and not as a source of funding.
Mr. Costa spent many years at the United Nations Office on Drugs and Crime (UNODC). Based on his work, he is convinced that health is a human right that must be maintained at all levels, including drug policy, rather than drugs seen as source of revenue.
The cost-benefit assessment of current drug policy produces mixed results.
From a health perspective, current drug controls have had very positive impact. They have kept addiction to a fraction of what it could be. There are approximately 220-250 million people who use drugs in the world. About 20 million people use drugs daily. The demand for drug treatment is growing due to pharmaceutical drug abuse. In relative terms, 0.3% of people worldwide use drugs daily, compared to use of legal drugs which are far greater.
There are far fewer deaths due to controlled drugs (500,000 each year) compared to deaths from tobacco and alcohol. The illegality of drugs keeps their use and deaths from their use down. For all substances, the greater the availability in the market, the greater the use and the greater harm.
From a security/operational perspective, drug control has produced partially good results. The so-called “failure” of drug policy is what drives the call for legalization. Giant criminal drug supply system that puts countries at risk. The annual drug business puts $300 billion in the hands of mafia each year, equivalent to the GDP of Sweden.
The mafia has infiltrated countries and has firepower greater than many nations. It is a threat to peace and security in the world. Current drug control policy needs reform on two grounds: first, to continue and progress using what is working, and second, to correct what is failing.
Mr. Costa encouraged attendees to reject a zero-sum solution. We must not give up the health perspective by changing the control of security (e.g. drug legalization). He suggested a dual strategy of protecting security and protecting health.
This strategy should reject money laundering. Most crime money finds its way to rich countries where it generates high revenue. He noted that many banks have been identified in laundering money from drug cartels. These crimes have not resulted in sanctions against senior bank officials or meaningful fines. Greed is pushing public opinion.
There is a significant amount of money in the drug industry. At present investors are positioning themselves to be ready for drug legalization. They are developing drug brands and marketing plans to enter drug trade with electronic platforms and campaigns to influence legislators. Drug legalization was even proposed as a possible solution to Greece’s bankruptcy.
The three drug-related corruptions – crime, corruption and greed – have become threats worldwide. Whatever comes out of UN in 2016 must improve and strengthen aspects of drug policy that are not working today.
Judge Jamey Hueston focused on the importance of the areas of health and the criminal justice system providing effective alternatives to drug addicted offenders. She is the longest sitting Drug Court judge in the United States, and the world. Hers is a work of passion.
The connection between drug use and crime is significant. In the United States, about two thirds of adult arrestees and one third of juvenile arrestees test positive for drugs. The majority of parolees use drugs. Many child abuse/neglect cases and domestic violence cases are drug-related. Moreover, relapse to drug use and recidivism among offenders in the community is significant.
The courts are facing tough cases; there are often insufficient resources and services for offenders and inadequate supervision to guide them. Drug Treatment Courts provide an avenue for uniting the court system with health system to dramatically improve outcomes.
In Drug Courts, treatment is provided to offenders who are closely supervised by the courts/criminal justice system. Offenders are subject to intensive drug testing. It is not good enough to place someone on community supervision when they have serious drug use problems; testing is needed to ensure they are in compliance. Drug testing is done frequently and randomly. Otherwise, scheduled testing leads to scheduled drug use. Drug Courts also provide support systems, services related to mental health, medical problems, among others.
Using judicial oversight ensures that everyone works together and holds participants accountable for their behaviors. Drug Courts use behavior modification, a combination of sanctions and incentives. This is a system of behavioral changes – mostly positive – that helps encourage and motivate changes.
Judge Hueston noted that there is extensive research to show that Drug Courts increase treatment success. Drug Courts reduce costs related to the criminal justice system, including crime, rearrests, drug use and jail. Drug Courts also save families, directly impacting the children of Drug Court participants, Children are up to 40% more likely to be reunified with their families, spend significantly less time in foster care, and are returned to their families much sooner.
Drug courts also reduce victimization costs such as medical expenses, property losses, and reduction in work productivity. There are also non-economic victimization costs related to fear, pain/suffering, and loss of quality of life.
Drug Courts increase productivity with tangible benefits: $2.21 dollars savings to the justice system for every $1 invested, and $27 saved in socioeconomic costs for every $1 invested.
Drug Courts in the United States produce a savings of between $3,000-$13,000 per participant.
The greatest threat is not drugs themselves but the dilution of our efforts to tackle this most persistent of social problems. Sweden provides an important example for drug policy for the world, demonstrating that something other than liberalization can be successful in today’s policy climate.
Dr. McKeganey reviewed a range of claims and policy proposals that have taken root within the public, among professionals and in political circles that discourage continuing restrictive drug policies:
First is the idea that drug use is a health issue, unrelated to the criminal justice system. This argument made is that health agencies rather than criminal justice or law enforcement agencies should take the lead in drug policies. To make this argument, a false dichotomy is made between treatment and enforcement. These systems are most effective when they are linked rather than when one is emphasized more than another.
Tremendous progress has been made to reduce the problem of drink-driving. No one would argue that the same progress could have been made by only providing treatment to drivers identified as impaired. The public may not like the penalty that comes to a drink-driver when that person is a relative or child but those penalties reduce the prevalence of drink-driving and are needed at the societal level.
A second argument often used to promote liberalization of drug laws is that the global war on drugs has failed. This idea has to be challenged at every opportunity. The “war on drugs” is a term promoted by the liberalization movement. When we compare the prevalence of use of legal and illegal drugs, there is no question that the existing legal barriers to certain drugs have resulted in much lower levels of their use.
A third argument made is that the involvement of criminal justice agencies in drug policy has led to an increase in harm; that drug use is a public health hazard. But we have good evidence that enforcement can be successfully linked to treatment. Criminalizing drugs does increase their value, but with alcohol, we are deliberately trying to use inflation to reduce use. As such, we should be doing the same for drugs to decrease their use.
Fourth, on its face, the idea that we should take away the stigma from drug users seems laudable. On societal terms, stigma may be the most important tool we have – to reinforce the message that drug use is not a legitimate lifestyle. It is not something that is tolerated. If we embrace extracting stigma from drug use then we make drug use acceptable.
Fifth, the idea that drug laws and enforcement do not work is inaccurate. Some of most effective interventions are those within enforcement and criminal justice that use certain, proportionate and immediate consequences. This is a lesson that is coming out from research of innovative criminal justice programs in the United States.
Finally, the argument that drug use is a human right is not appropriate for policy or funding social services. It is inappropriate to reap profits from drug use.
In terms of global drug policy, Dr. McKeganey reflected that the increasing push toward liberalization of cannabis laws in the United States is pivotal for future drug policy development and provides a unique opportunity to assess the effect of a policy shift. Additionally, we are at a time when there is growing evidence of increases in cannabis use, harm from that use, fewer financial gains than those promised from a legal market, and continuing illicit supply of the drug, etc.
The INCB and the UN international drug conventions are the next targets for the drug liberalization movement. The international conventions are one of the most powerful tools in our international efforts to tackle the global drug problem.
Dr. McKeganey concluded by encouraging all that it is time for quiet diplomacy, encouragement and support rather than public accusation and overt criticism. We must challenge these permissive drug policy proposals at every opportunity. Our opponents miss none and will use every occasion to embed in the public and professional discourse that legalization is the solution. We know it is not.