Liam

One of the key aims of Social Drinking is to help normalise conversations around mental health and addiction. I learned the hard way that alcohol and other addictions, and depression and anxiety thrive when I don’t talk about these things and isolate from my social networks. I don’t offer advice on this blog. I just try and tell my unremarkable story honestly in the hope it will spark a conversation.

We’ve all heard that men are less likely than women to seek help if they’re experiencing mental health issues. Many men I know have been taught they need to be self-reliant and that it is inappropriate to express their emotions. But, this wasn’t the case in my family at all.

Rather, I think my unhealthy way of dealing with emotions was partly a product of a distinctly parochial, Australian, small-town masculinity. I looked up to the surfer’s who charged the hardest, in the water surfing or at parties. The tough guys who rolled with the punches, who could work all day, drink all night and never complain. The ones who were holding up the bar at the end of Liam’s wake. Let’s just say I had a misplaced appreciation of what matters. Many of those guys are alkies now and don’t surf. A couple took their own lives.

Mental health and addiction is a chicken and the egg relationship of unsure causality. I’m not sure if it actually matters all that much, since most of the alkies I’ve met on the street, in rehabs, sitting on the gutter outside bars in Mexico as the first fishing trawlers come into port at dawn, have some sort of ‘other’ mental health issue bubbling away.

This blog has focussed on my drinking because that was what I believe brought me undone. However, through my own research and by working with a specialist cousellor, I’ve recently discovered a post-traumatic stress disorder has been with me, pretty much all along.

It was so easy to brush aside a traumatic event as though it was no big deal. That’s what I thought was expected of me as a twenty-year-old male: just get over it and get on with the business of living.

Of course, when we speak to people who are knowledgeable about trauma they will tell us to seek help. Peers, co-workers and drinking buddies? They’ll help us drown our sorrows, because that was how they were taught to deal with grief and stress.

Liam was a big teenager, both in physicality and presence, much like his father and grandfather. I surfed against him a few times in junior boardriders’ contests when he really should have been in the under-14s division. I was a few years older and, when I got my licence, I started dragging the big grommet down the coast in the hunt for bigger, badder waves. He was a lump of a kid with a heavy back foot in the water. He, as I, loved a beer.

I was on holidays from undergraduate university and was slogging away waiting tables, clearing filthy ashtrays (remember when that was a thing?!), frothing milk, and dreaming of the girls I was going to meet at the pub later.

It was late afternoon and, as was my usual practice, I was killing time playing the old timber upright piano on a break in a split shift. In the backgound was the usual Saturday arvo sounds of lawnmowers, Currawongs and Kookaburras, and a slosh of a small, lazy, onshore swell washing up on the rocky shore at the bottom of the hill. The local footy game had just wrapped up down the road, whistles and cheers gone. The oily smell of eucalyptus was drifting through the fly-screen.

I remember other scents in the bush that day too: the spilt fuel and stirred up dust, the ferrous tang of blood and the unmistakeable, indefineable smell of fear. These smells have been imprinted, returning seemingly without cause with a vividness that makes me feel as though the experience were happening all over again.

I heard a car gunning its engine along the last stretch of bitumen before my street turned into the forest road leading to the lookout. As it sped past I glimpsed an old 4×4 pick-up with passengers waving beers, crouching behind the driver in the rear tray. I recognised those ratbags, my friends. They’d been drinking at the footy.

A shot of adrenaline and foreboding.

Foot counting 4:4 time.  Two bars of empty space, fingers on keys, breath held.

The sound of wheels locked, a horrible sliding, an echoing percussion of impact rolling through the Otway valleys.

The car had hit the loose, corrugated gravel at speed on a slight angle. The skid marks showed a long, four wheel drift to the left, an attempted correction, terminating at the base of a very large gum tree.

Others had called the paramedics, who arrived not long after me.

Liam lay still, remarkably uninjured except for where he hit his head.

I remember Liam making fun of my swollen and bruised face after I survived a car accident a few years before his death. He, like many of the other locals, heard on the radio a (misinformed) report I had died.

On that day, I took a 1978 Ford Falcon XY sedan, laden with the family’s Xmas presents and a virgin, unwaxed surfboard for two, end-over-end somersaults,  Dukes of Hazard style into the intertidal zone, off a four metre cliff at 60MPH. Jessie the wonderdog was in the car with me. She survived, but wouldn’t trust me to drive for many years. Smart dog.

So, within the short space of two years, I had narrowly escaped with my own life and had witnessed my friend’s dying breath. By my 21st birthday, I had realised that the only way to stop the dreams was to pass out drunk. I had to have my quota.

The reason I tell this story is because it is unremarkable in its remarkableness: these things happen with all-too-frequent regularity in Australian towns. Everyone knows someone who didn’t make it out of their teens or early-20s because of the poor decisions they made. The experience of shock, grief and trauma is part of the human condition and we rely on our social networks to get us through. But I didn’t. I turned to the bottle.

None of this will bring Liam back, but remembering this sequence of events and talking about them with someone I trust has been both revealing and healing.

 

 

 

 

 

 

Pills, booze and the devil’s lettuce be

We humans are constantly doing things to change the way we feel: for example, through exercise, sex, food, meditation, prayer, alcohol and other legal and illegal drugs. Each of these things produce chemical changes in our brains. But, despite knowing that a good run can be the best way to ease stress and anxiety, we only refer to legal drugs as ‘medicine’ while singing songs about sexual healing. People drink wine with dinner to take the edge off. So did I, until there was no edge.

The more I write about my own relationship with alcohol, the more I realise that I have always used a range of substances to produce changes in myself. I am not the only person who does this. I still use a stimulant daily (strong, hot and black), and despite my best intentions to quit smoking via Nicotine Replacement Therapy (NRT), I have simply transferred one disgusting habit to another – chewing nicotine gum. I also take an antidepressant, which I am hoping to cease in the next few months in favour of a more natural alternative.

On the surface, NRT (like methadone and buprenorphine for opiate addicts) is marketed and recommended by doctors as a pathway to quitting. However, nicotine chewing gum is extremely addictive and has a pleasant minty taste. Methadone and bupe, so I’m told by people who know, are far less tasty but no less addictive.

On another level, NRT is an example of harm reduction through substitution, in this case replacing the harmful method of drug delivery with a safer one. In buying a pack of NRT gum at the supermarket, I am no different to my peers who line up outside our local AoD outpatient service on sub-zero mornings for methadone and bupe to ward off crippling opioid withdrawal for another day.

Nicotine triggers the release of dopamine in the brain, meaning that it can provide short-term feelings of relief to people experiencing withdrawal from other substances, including heroin and alcohol. This is true even in the smoke-free* rehabs of the public health system, where nurses dole out NRT to calm nerves and prevent unnecessary nicotine withdrawal, along with benzos (also highly addictive) to prevent seizures.

Bio-power and harm reduction

I’ve mentioned previously that Philippe Bourgois and Jeff Schonberg’s book Righteous Dopefiend (2009) presents some powerful ideas about heroin addiction, drawn from the theories of some of social science’s heaviest hitters (Marx, Bourdieu and Foucault). Righteous Dopefiend develops a theory of abuse in which power is misused in people’s relationships with the state, and each other, by gender, race and socioeconomic class.

One key term Bourgeois and Schonberg introduce from Foucault is ‘biopower’. This is about ‘techniques for achieving the subjugations of bodies and the control of populations’.** Biopower is partly about the state turning us all into good, tax-paying, law-abiding citizens who make rational decisions. Because, if we don’t comply, the government has instruments of control (for example, family services or the cops).

Bourgeois and Schonberg note that, while Foucault did not examine illegal drug use, it is ‘ideal terrain’ for many of his ideas including ‘a critical application of biopower, governmentality, and the deconstruction of knowledge/power discourses.’ ***

Bourgeois and Schonberg’s theory also implicates neoliberalism in class-based abuse, which helps explain why poor and socially marginalised people bear a greater health burden from addiction, which in turn generates self-destructive thinking and behaviours (subjectivities).

In relation to methadone, Bourgeois and Schonberg suggest that the ‘radical, user-friendly intentions of harm reduction activists’ has been captured to some extent by a ‘logic of governmentality.’**** They argue that harm reduction operates within a middle-class public health discourse that promotes disciplined citizens capable of regulating their own behaviour and making rational decisions.

Bourgeois further develops his ideas about how power relations shape drug treatment in the United States by showing how a methadone clinic is an unhappy compromise between competing discourses: a criminalizing morality versus a medicalizing model of addiction-as-a-brain-disease.*****

Bio-power is about real power too, and in the so-called real economy, power equals money and money equals power. A real-estate tycoon and former reality television star is now President of the United States. If Obama showed African-American kids that they truly could be anything, then what message is being sent by Trump? Money buys votes and votes make laws.

Legal, illegal

We live in a world where some substances are regulated by states: they are tested, trialled, approved, taxed, scheduled, prescribed, administered, served, sold, distributed and consumed. Other substances are banned and fall outside of the state apparatus, or at least to systems of citizen control (law and order).

While the plants Coffea Arabica and Robusta enjoyed a celebrated status in the 20th century, Cannabis Sativa and Indica have been synonymous with the illicit. ‘Marijauna’ (a word with dubious etymology) was used to campaign against the plant’s use in the United States and elsewhere, in a series of early 20th‐century moral panics that led to cannabis’ demonisation as the devil’s lettuce. More recently, cannabis is enjoying gradual liberalisation. But, not in Australia, where policy reform remains some way off.

The United States, like Australia, is in the grip of an opioid crisis as the dried latex of Papaver somniferum, the opium poppy, continues its march across the world. This latex is made up of morphine, which is processed to make heroin and other synthetic opioids for medicinal/legal or recreational/illegal consumption, and other opioids including codeine.

In West Virgina, a media  investigation found that from 2007 to 2012, drug firms poured a total of 780 million opioid painkillers into the state:

  • Number of oxycodone dosages shipped to West Virginia pharmacies between 2007 and 2012: 224,260,980
  • Number of hydrocodone dosages shipped to West Virginia pharmacies between 2007 and 2012: 555,808,292

The unfettered shipments amount to 433 pain pills for every man, woman and child in West Virginia.

The region includes the top four counties — Wyoming, McDowell, Boone and Mingo — for fatal overdoses caused by pain pills in the U.S., according to CDC data analyzed by the Gazette-Mail. Another two Southern West Virginia counties — Mercer and Raleigh — rank in the top 10. And Logan, Lincoln, Fayette and Monroe fall among the top 20 counties for fatal overdoses involving prescription opioids. One of the drug companies implicated in these shipments was H.D. Smith, which made $4.0 billion from drug distribution in 2016 alone.

But, it seems, these legal drug dealers have killed the goose that layed the golden egg. Legal proceedings involving the major hydrocodone distributors are ongoing and a consolidated case is expected to yield an unprecedented settlement from manufacturers and distributors alike. McKesson and Cardinal Health, in the past two years, agreed to pay the federal government $150 million and $44 million, respectively. It was recently announced that AmerisourceBergen, Miami-Luken, and H.D. Smith have agreed to pay $16 million, $2.5 million, and $3.5 million, respectively, to West Virginia’s government, among other penalties and settlement agreements.

While opioid manufacturers and distributors are on the nose with regulators, legislators and the public, many investors are pouring into medical and recreational cannabis businesses. A century of prohibition has meant that scientists have only very recently begun to unlock cannabis’ vast therapeutic potential and there has been a real chance of a bubble emerging in cannabis-based company stocks, most recently in Canada. Even in laid-back Colorado, Silicon Valley entrepreneurs are fighting for an ounce of the action. Is there not some irony in headlines like High Hopes Ride on Marijuana Amid Opioid Crisis?!

Exercise as treatment

Like drugs, sex and exercise stimulate the release of happy hormones in the human body, with the two activities not being mutually exclusive. Again, is it any surprise that some addicts swap their drug of choice for a sweaty sex addiction? Or become adrenaline-chasers and gym-junkies?

In May 2018, a group of Australian cancer specialists launched a ‘world-first’ position statement calling for exercise to be prescribed to all cancer patients as part of their routine treatment. Cancer patients who exercise regularly have fewer and less severe side effects from treatments like chemotherapy. They also have a lower risk of cancer recurring and a lower chance of dying from cancer. Dr Prue Cormie, Chair of the Exercise and Cancer Group within the Clinical Oncology Society of Australia, writes:

If the effects of exercise could be encapsulated in a pill, it would be prescribed to every cancer patient worldwide and viewed as a major breakthrough in cancer treatment. If we had a pill called exercise it would be demanded by cancer patients, prescribed by every cancer specialist, and subsidised by government.

I too consider exercise to be an important part of my treatment for alcoholism. Not only does exercise provide an alternative healthy activity to drinking and other addictive behaviours, it has been shown to improve mood and psychological wellbeing. But, as we know, exercise requires a person to be active in their treatment. You have to want to get fit and enjoy doing it. For this reason, treatment with exercise is more likely to succeed when you are free to choose the type of exercise you enjoy. For me, this is surfing and more recently, trail running.

Research as treatment

If you hang around rehabs and AA long enough you’ll realise that many recovering alkies and addicts dream of getting a job in social services, particularly drug and alcohol support. This makes sense, since those of us who stay alive long enough to get sober and stay that way have become subject area specialists in our own personal recoveries. We have been through many different rehabs, tested and trialled and failed various pharmacological/psychological interventions, chewed through piles of literature, browsed countless websites and spent hundreds of hours either in quiet self-reflection, or conversation with other novice-experts.

I mentioned previously that I completed a PhD in anthropology around the same time as my alcoholism and other addictions were reaching crisis point. My PhD research was not about why and how people use pills (of various descriptions), booze and yarndi/cannabis. Regardless, the seeds of my present understanding of these things were first laid bare during fieldwork.

My research was also an example of anthropology at home. I did research in the same location as I spend most of my time when I’m not working. It is a type of Australian ecosystem in which I feel most at home (i.e. it has great waves and lots of gum trees). As much as I wanted to treat the ‘site of my research’ as a distinct spatial-temporal entity, it just simply wasn’t and isn’t.

In practical terms, my research ended with my PhD. This includes the funding and the research ethics agreement. Plus, I now work in the public sector for an employer that doesn’t support individual publishing. My circumstances have changed, and this doesn’t allow me to do formal research.

But, my ‘field’ has not shifted. It hasn’t gone anywhere. If anything, it’s become bigger, and more all-consuming. My focus shifted from *insert research question* to finding similarities between my experience and those of many of my informants and friends.


* For an excellent anthropological analysis of how the social, moral, political and legal atmosphere of ‘smokefree’ came into being, see: Simone Dennis, SmokeFree: A Social, Moral and Political Atmosphere, 2016, Bloomsbury Academic, London and New York.

** Michel Foucault, The History of Sexuality, Vol. 1, 1976, p. 140.

*** Philippe Bourgois and Jeff Schonberg, Righteous Dopefiend, 2009, University of California Press, Oakland, CA, p. 19.

**** Philippe Bourgois and Jeff Schonberg, Righteous Dopefiend, 2009, University of California Press, Oakland, CA, p. 106.

***** Philippe Bourgois,  ‘Disciplining addictions: the bio-politics of methadone and heroin in the United States’, Culture, Medicine and Psychiatry, 2000, 24, pp. 165–95.

A case for cannabis legalisation

Prohibition has made criminal syndicates rich and little else. The legalisation of cannabis will drive quality and variety, further blurring the lines between medicinal and recreational use.

On 17 April 2018, the Leader of the Australian Greens, Senator Dr Richard Di Natale, launched a drug reform campaign aimed at legalising recreational cannabis use for all Australian adults. The Greens propose creating a tightly regulated cannabis market, overseen by a new statutory body:

The Australian Cannabis Agency would be established to issue licenses for cannabis production and sale, act as the single wholesaler of legally accessible cannabis, carry out a program of monitoring and enforcement of premises of production and sale, and conduct ongoing review and monitoring of the regulatory scheme to ensure it is functioning optimally.

We would also establish retail stores to sell cannabis. These stores would require ID to enter and ban sales to anyone under the age of 18, sell only plain packaged cannabis (with visible health warnings) and require staff to undertake a responsible sale of cannabis course.

Growth of six plants at home for personal use would be permitted, but strict penalties would apply for unlicensed or underage sales, or driving whilst under the influence of cannabis.

The Greens argument, which I strongly support, is that prohibition has failed:

Criminalisation of the production and use of cannabis has caused multiple harms, including forcing people to live with criminal records for possessing only a small amount of weed, pushing cannabis users to purchase from drug dealers and consume a product of unknown strength and quality, and diverting money into the futile law enforcement response and away from drug and mental health treatment and education.

Federal Health Minister, The Hon. Greg Hunt MP came out and called for the Greens to dump the policy, stating that cannabis is ‘a gateway drug’ to methamphetamine and heroin use.

Dr Alex Wodak AM,  president of the Australian Drug Law Reform Foundation and one of the most respected AoD researchers in the country, argues that ‘cannabis taxation and regulation is an idea whose time has come’. He says that, ‘like the debate about same sex marriage, the idea will seem strange to some in advance but once the reform has been completed we will wonder why it took us so long.’

Dr Wodak provides a brief history lesson to show that the decision to ban cannabis in the 1920s was, at the very least, devoid of evidence. ‘There was no careful root and branch review of the evidence. Instead, Australia was represented at a League of Nations meeting in Geneva in 1925 where delegates from several countries decried the dangers of cannabis.’ Dr Wodak cites Robert Kendell in his 2003 article Cannabis Condemned:

“A claim by the Egyptian delegation that [cannabis] was as dangerous as opium, and should therefore be subject to the same international controls, was supported by several other countries. No formal evidence was produced and conference delegates had not been briefed about cannabis.”

Dr Wodak remarks:

Accordingly, the Commonwealth wrote to the states after the meeting instructing them to prohibit cannabis. This is the quicksand upon which the mighty edifice of cannabis prohibition in Australia was constructed.

From an international perspective, the Greens’ state-controlled proposal is similar to the model adopted by Uruguay in 2014, in which Uruguay legalised growing up to six plants at home, as well as the formation of growing clubs, a state-controlled dispensary regime, and the creation of a cannabis regulatory body.

By comparison, Colorado in the United States legalised the sale and possession of cannabis for non-medical uses in 2012, including private cultivation of up to six  plants, with no more than three being in flower at the one time. Colorado established a commercial market for consumers aged 21 years and over, as well as regulations for the commercial cultivation, manufacture, and sale similar to alcohol, for recreational use.

The prohibition effect: limited knowledge, quality and variety. Rich bikers.

Australian consumers’ knowledge of cannabis has been shaped by their experience of prohibition and is, in general, unsophisticated by international standards. Many Australians have experienced cannabis smoked through a bong with tobacco or rolled into a joint. Combustion, however, is only one way in which people consume cannabis products. Some Australians may have eaten decarboxylated cannabis in a cake or brownie. Comparatively few know that cannabis can be vaporised or used in concentrated forms such as dabs. Along with edible products, personal vaporisers have emerged as a preferred method of delivery for medicinal cannabis patients because there is no evidence they adversely affect the respiratory system.

The average Australian cannabis consumer might distinguish between two types of cannabis: ‘hydro’, a catch-all term describing high-potency, indoor-grown hydroponic cannabis that can sometimes have a strong chemical odour and taste; and, ‘outdoor’ or ‘bush weed’, which is more commonly found outside of the major city centres. This is a false dichotomy.

In communities where both cannabis markets and consumer knowledge is more advanced, consumers choose between sativa dominant or indica dominant strains. These categories relate directly to the two major species, Cannabis sativa and Cannabis indica. A third species,  Cannabis ruderalis, is mainly used to breed autoflowering hybrids because of its unique ability to flower without a photoperiod cue.

Cannabis plants produce a unique mix of terpeno-phenolic compounds called cannabinoids. There are over 100 different cannabinoids that have been isolated from the plant, including the two most prevalent: the psychoactive delta-9 tetrahydrocannabinol (THC), and cannabidiol (CBD). CBD is not considered psychoactive and is being offered by doctors in the United States for its ability to reduce nausea and anxiety, among other things.*

In jurisdictions where medical cannabis is legal, dispensaries fill prescriptions for specific strains of cannabis – for example, strains that stimulate the appetite and suppress pain, or relieve anxiety and stress. Medicine Man, a family-run business in Denver offers over 40 different medicinal and recreational strains, all varying in THC/CBD content and ratio, with wildly different terpene profiles.

Differentiation between medicinal and recreational strains is relatively arbitrary: popular medicinal strains such as G-14, Liberty Haze, Super Sour Diesel, Jamaican Lion and Girl Scout Cookies are equally, if not more, popular with recreational consumers.

Dispensaries offer strains specifically bred to taste of citrus, tropical fruits such as mango, berries, pine and even cheese. These plants are bred for particular concentrations of naturally occuring terpenes in their flowers. The four most common terpenes found in cannabis are Myrcene (found in hops, mangoes, lemongrass, citrus, thyme and bay leaves), Pinene (found in conifers and some citrus), Limonene (found in citrus rind, rosemary and peppermint) and Linalool (found in mint, bay leaves, lavender and cinnamon).

In Australia, most of the hydroponic cannabis bought on the streets is produced by criminal syndicates, predominantly outlaw motorcycle gangs. These producers favour fast growing, high-yielding, high-THC strains with next to no CBD content.

The chemical taste associated with ‘hydro’ is caused by producers pumping as many nutrients into the flowering plants as they can to maximise their yield per watt of electricity used. Outlaw motorcycle gangs are not known for their subtlety. They do not take the extra week needed to ‘flush’ their plants with fresh water prior to harvest, which leads to the excess nutrients remaining in the plant’s flowers and leaves producing an unpleasant taste. It is this high-potency, foul-tasting, low-medicinal-value product that most Australian cannabis consumers are introduced to, often by the same people selling methamphetamine, pills of dubious consistency masquerading as MDMA, prescription drugs (Xanax and Oxycontin) and heroin.

Competitive markets drive quality and variety in produce. Uncompetitive markets, such as bikie oligopolies, do not. Cannabis prohibition in Australia has succeeded in enriching organised crime and little else.

Jimmy

‘Jimmy’s a good kid’, scrawls my handwriting under a brown tea stain, ‘looks after his mum and little sister, working a shit job for worse pay. He always seems to be down on his luck’.

I met Jimmy in 2008 while I was doing ethnographic research in a New South Wales country town. As luck would have it, Jimmy and I also crossed paths in an alcohol rehab several years later in another country town about six hours drive inland.

Jimmy went to juvie in his teens after committing a bunch of minor misdemeanours culminating in significant time away from his family. His last crime was purchasing and being caught by the cops with a quarter ounce bag of cannabis.

Jimmy didn’t go back to school after juvie. When I met up with him years later, Jimmy was a shell of what he once was. He had broken both legs in a car accident and had become hooked on opioid painkillers, washed down with whatever was on special at the bottle shop. Jimmy was in rehab as a circuit-breaker for his ongoing legal and family problems. Still, we shared old stories and some laughs; hit the weights together and snuck cigarettes at the AA meetings.

Jimmy took his own life later that year.

Rachel

When I met Rachel she was 29, trying to establish her own small business. Rachel smoked bongs, which she believed helped her anxiety. She refused to take the new antidepressants prescribed by her doctor because she said her first prescription didn’t help her anxiety at all and caused what the pharmaceutical companies call ‘discontinuation symptoms’ when she stopped taking them. Rachel said that these symptoms, including vertigo, severe headaches, nausea and heavy sweating, left her in a constant state of panic and made it impossible for her to leave the house for a week.

Rachel preferred to grow her own bush weed because she was terrified of the people who deal hydro. When she was younger, living for a while in Redfern, she was scoring  from some guys in the Cross. One night, they asked her to come to a pub for a drink. She woke up many hours later looking down the barrel of a video camera documenting her rape by multiple assailants.

Gateways and other hyperbole

Minister Hunt’s response to the Green’s policy proposal is unfortunately characteristic of much of modern Australian politics which appeals to emotion first and intellect a distant second. Hyperbole works only when people do not question the underlying assumptions being proposed.

It is true that cannabis prohibition can be a gateway to other drug use precisely because it forces consumers onto the black market. Consider Rachel’s horrific experience of having the date rape drug, Rohypnol, slipped in her drink by her dealer. Or consider that Jimmy maintained his opioid addiction long after his doctor stopped prescribing him Oxycontin because he already had access to a black market network.

The majority of people who use cannabis do not go on to use other, so-called ‘harder’ substances that are physically addictive (including alcohol, which is legal). In the United States, the 2014 National Household Survey on Drug Use and Health found less than half of Americans aged over 12 had tried cannabis, while less than 15 percent had used cocaine and less than 2 percent had used heroin. In general, only 10 to 20 percent of those who try alcohol and other drugs get hooked.

While cannabis may cause cross-sensitisation to other drugs, alcohol and nicotine also prime the brain for a heightened response to other drugs and are, like cannabis, also regularly used prior to a person progressing to other, more harmful substances.

There is a growing body of research supporting an ‘anti-gateway’ hypothesis, which proposes that cannabis use can provide a way out for people suffering from physical addictions to alcohol, and other recreational and prescription drugs. One recent study surveyed medical marijuana users in Canada,  and found that 87 percent of participants used it to replace alcohol, prescription opioids or other recreational drugs. 52 percent reported that cannabis helped them reduce alcohol use, while 80 percent reported using less prescription pain medications.

Final word

As medical cannabis reform gathers pace there will be increasing pressure on the government to open up its very restrictive regime to a wide variety of medical conditions. Indeed, the line between medical and recreational use is arbitrary, and does not reflect the reality of how people consume cannabis: most self medicate with the same substance they use for recreation.

If we turn to the the potential benefits, legalisation in Australia would reduce the costs of drug enforcement, taking the pressure off police, courts and prisons, and customs. It would limit the income of black market cannabis suppliers, including outlaw motorcycle gangs, and would raise substantial revenue through tax receipts at a time when the Commonwealth is struggling for tax revenue. Lastly, legalisation would create a functioning market in Australia, providing quality and variety, and a safe way for consumers to purchase their drug of choice.

NOTE: Names have been changed to maintain confidentiality.

 

*Caroline A. MacCallum and Ethan B. Russo,  ‘Review Article: Practical considerations in medical cannabis administration and dosing’, European Journal of Internal Medicine, 2018, 49: 12-19. Available for free: http://www.ejinme.com/article/S0953-6205(18)30004-9/pdf

In the latest edition of the European Journal of Internal Medicine, researchers argue that the ‘legal prohibition, biochemical complexity and variability, quality control issues, previous dearth of appropriately powered randomised controlled trials, and lack of pertinent education have conspired to leave clinicians in the dark as to how to advise patients pursuing such [cannabis-based] treatment. With the advent of pharmaceutical cannabis-based medicines (Sativex/nabiximols and Epidiolex), and liberalisation of access in certain nations, this ignorance of cannabis pharmacology and therapeutics has become untenable.’ As a correction, they provide the most up to date data on cannabis pharmacology, methods of administration (smoking, vaporisation, oral), and dosing recommendations. Suggestions are offered on cannabis-drug interactions, patient monitoring, and standards of care, while special cases for cannabis therapeutics are addressed: epilepsy, cancer palliation and primary treatment, chronic pain, use in the elderly, Parkinson disease, paediatrics, with concomitant opioids, and in relation to driving and hazardous activities.