Whenever the issue of cannabis harm crops up in the conversation among Irish medics, it is pretty much inevitable that the word "liberal" will be mentioned and only in the pejorative sense.

Yesterday, a Letter to the Editor in the Irish Times was signed by 20 doctors from a range of specialities including general practice, psychiatry and emergency medicine. In it, the doctors decried what they saw as a one-sided debate about medicinal cannabis and the legalisation of the recreational drug. It rather patronisingly called most cannabis reform activists "sincere and well intentioned" and suggested that these doctors were concerned that Ireland is being brought down a path towards legalisation - which they bemoaned would be bad for the mental and physical health of our young people. They talked about cognitive impairment, heightened cancer risks and psychosis. The picture created was very gloomy indeed.

Judging by the content of this letter, Reefer Madness is alive and well in the Emerald Isle. You could be forgiven for thinking that one joint could lead to a life of rack and ruin. The implication was of gateways and Trojan horses, ready to take you to oblivion. The message is loud and clear. Cannabis is evil and the scourge of the youth. Avoid at all costs.

I have worked in the field of addiction for almost 21 years, treating a wide range of problems. Interestingly, most of the harm I have encountered is caused by legal drugs, alcohol and tobacco, and both will likely be the cause of death. Many cannabis critics will point to the fact that if alcohol and tobacco are legal then why would you allow cannabis to be legal given the harms that they cause?

REARGUARD ACTION
The answer is simple. Because if tobacco and alcohol were prohibited tomorrow these harms would rise exponentially: if the war on drugs tell us anything it is that innocent people get caught in the crossfire with all too tragic consequences. Cannabis is legal in a number of countries including Canada, some states in the US and Uruguay. Whilst it is a little early to evaluate the outcome of these reformed cannabis laws, it is clear that the benefits are already being seen. In Colorado, for example, cannabis was legalised in 2013. Almost six years after legalisation, young people are not smoking more cannabis than they used to and crime has not increased. Uruguay with a population of 3.5 million is comparable to Ireland in size. It legalised cannabis in 2013 and like Colorado there has not been an increase in youth cannabis use or addiction problems. The cultivation of cannabis has improved employment, and the tax take from the sale of cannabis is not insignificant. The tax produced in Washington State from cannabis sales was $319 million in 2018. California was not far behind at $300 million. Ireland's economy could well do with a boost like this. Despite the pioneering work of Luke Ming Flanagan - whose ultimately defeated 2013 Cannabis Bill paved the way a short time later for then Minister for Drugs Aodhan O'Riordain to explore decriminalisation of all drugs for personal use - none of these initiatives has actually reached fruition. It is clear that there is a rearguard action to derail sensible drug policies in this country and maintain the status quo by scaremongering the public.

SENSIBLE APPROACH
Add to this that two years have elapsed since the legislation was passed for Ireland's first medically supervised injecting facility and you get the distinct feeling that the Government is dragging its heels on these issues. It is important that this debate is honest and fact-based. Calling cannabis a gateway drug is not supported by research evidence and psychosis is quite rare in patients who use cannabis and tends to occur in predisposed, vulnerable individuals. The Global Drug Survey 2018 showed the unintended consequence of cannabis prohibition in the proliferation, in the UK, of the use of the far more harmful "Spice" (synthetic cannabis). Ireland beware. Finally, one should also remember that whatever the harms caused by cannabis (and they pale compared to alcohol and tobacco, never mind other more potent drugs) these harms are occurring in a system of prohibition. It seems logical then that a more enlightened, perhaps radical, but infinitely more sensible approach to this problem is needed.