RECENT articles in our newspapers suggest that some medical personnel have varying views on the impending decriminalisation of the possession of small quantities of ganja in Jamaica.

Ethically, one may classify one view as consequentialistic – considering the possible consequences of decriminalisation on an already overburdened health care system in general, and our psychiatric wards in particular. Another view speaks to the matter of justice – is it fair that possession of ganja is currently a criminal act, while possession and use of alcohol, which causes potentially more physical and social damage, is not currently criminalised? There is also a third issue – how to identify those who use ganja for religious reasons, for example as a sacrament, versus those who use it for recreational purposes?

OKAY TO RESEARCH GANJA FOR MEDICAL USE

Apparently all are agreed on the matter of ganja being researched for medicinal purposes. What therefore challenges us is the ethical principle of utility: what are the possible benefits as well as risks or harms that could come from the decriminalisation of possession of small quantities of ganja in the Jamaican society, and where should we balance or draw the line? For this, we should look at the current evidence from research on these issues around the world.

CLINICAL RESEARCH ON THE EFFECTS OF GANJA – SOME BENEFITS

A review article in the medical journal Epilepsy Notes in March 2014, informed that there are still no controlled trials demonstrating that marijuana is ‘safe’ or ‘effective’ in the treatment of epilepsy. On the other hand, there is evidence that marijuana may be harmful, particularly in the developing brain after regular use. The researchers however noted that for patients who had exhausted all conventional therapies, medical marijuana for which there is anecdotal evidence of seizure control, could be considered as an unproven, ‘compassionate use’ alternative. However, any such use of marijuana, they cautioned, should be under the supervision of a physician.

In a recent article in the Journal of the American Geriatric Association, which reviewed marijuana use in over 31 countries, including the United States, Germany, France, Canada, and The Netherlands, the authors stated that marijuana has been used medicinally for the management of different conditions and diseases for centuries . They said several randomised clinical trials have demonstrated the therapeutic benefits of cannabis and cannabinoids in the management of pain and nausea, however, most of these trials did not include older adults and so individual evaluation of the pros and cons would have to be made before cannabis could be prescribed to older adults.

THE POSSIBILITY OF HARM

A March 2014 article published in Reuter Health Information stated that no evidence was found to support medical marijuana use for arthritis pain or other rheumatologic conditions. In a recent edition of the journal Current Opinion in Pulmonary Diseases, an article entitled ‘Marijuana and Lung Diseases’ stated that there is unequivocal evidence that habitual or regular marijuana smoking is not harmless, and so caution against regular, heavy marijuana use is advised. The authors noted that medicinal use of marijuana is not likely harmful to the lungs in small cumulative doses, but recreational use is not the same as medicinal use, and should be discouraged.

A recent review article by investigators for the National Institute on Drug Abuse in the USA, entitled “Marijuana tied to Addiction and Long-term Cognitive Dysfunction”, informed that marijuana use is associated with substantial adverse events, and so it was reasonable and prudent to hypothesise that as policy shifts toward legalisation of marijuana, its use would increase and so would the number of persons for whom there would be negative health consequences.

Preliminary data from the Allied Cohort on the Early course of Schizophrenia (ACES) II project in the USA, published in May 2014, showed that youth between the ages of 15 – 17 years, a period of potentially critical brain development, who used marijuana experienced first-stage psychosis four years earlier than their counterparts with first-stage psychosis, who did not use marijuana.

LEGISLATION IN COLORADO

Between November 2012 and September 2013, the US state of Colorado piloted and enacted legislation permitting the use of marijuana for recreational purposes within that state. However, in the January 2014 edition of the New England Journal of Medicine, a letter entitled “Brace for Surge in synthetic marijuana Emergency Department visits, Doctors warn”, showed data from the Colorado Department of Public Health and Environment indicating that during the fall of 2013, there was an unusually large increase in emergency department visits related to synthetic marijuana use in the Denver metropolitan area.

NO EASY ANSWER

From the above, it is obvious that there is no easy answer to allowing people recreational use of ganja. While we may agree to remove the current criminal sanction against its use, we must also be concerned about its impact on public health. When people become sick because of ganja’s various possible effects and present to hospital, their health care is provided at a cost to the public purse.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is a member of the Executive Council of RedBioetica UNESCO.