By Gavin St Pier
DOES “420”, “4/20” or 20 April mean anything to you? It didn’t to me either, until I attended, as a guest, the first Channel Islands Cannabis Collective held in Guernsey on, you guessed it, 20 April.
I learned that the day has become, according to Wikipedia at least, an “international counterculture holiday based on the celebration and consumption of cannabis”. I won’t bother you with the history because the very fact that the event happened in the Channel Islands at all is the real story.
A young police constable with a strong Welsh accent turned up, not to raid the event but rather to checkout the rules of engagement for playing music into the evening. Forget about the cannabis, nobody wanted the neighbours upset with late and loud music. I even managed to clean up on a raffle I didn’t realise I had managed to enter as a ticket holder. The prize? Some CBD oil and a whole range of paraphernalia, which was a mystery to me. I found it a good home.
It was quite clear from the conversations with some of my fellow travellers for the afternoon that medicinal cannabis is seen as a life saver for those with, for example, cancer, chronic pain or sleep disorders. They can now live both with medicinal relief and without fear of being criminalised. So far so good. But there is a darker side to this emerging story which should concern all of us, whether we knew what 420 meant before starting this column or not.
When we hear the term “medicinal”, in western societies at least, many of us probably immediately think of pills and injections, not flowers. But there are only three licensed products that may be prescribed at public expense for licensed conditions. It is only these that are formulated as recognisable medical products.
Unlicensed medicines do not have a marketing authorisation and have not undergone any rigorous or robust clinical trials. There are no stipulated conditions or doses, although there might be anecdotal evidence and guidance to support their use. They are not usually formulated into a medicinal product but are supplied as the dried flowering parts of the cannabis plant. These are then ground into powder and heated in a vape device – the paraphernalia – and inhaled by the patient.
Most GPs don’t really want to have anything to do with this whole process. Instead, patients go to local clinics or centres outside of Guernsey, perhaps remotely, for doctors – no particular specialist experience required – to prescribe products with names such as “Gelato”, “Farm Gas” or “Hell Fire”. They certainly sound a lot more fun than most of the medicines we are used to taking. They are dispensed from a small number of pharmacies with ties to the clinics. All of this has to be paid for by the patient. With each prescription potentially costing hundreds of pounds, this is becoming quite lucrative for some of the players in this particular marketplace.
The patients, not all of whom have lots of spare cash, may have a strong incentive to sell some of their prescription, which is illegal, in order to pay for what they actually need. Diversion of prescription medicines is not new and is an on ongoing challenge with many pharmaceuticals, including opioids, such as fentanyl and gabapentin.
Poor old law enforcement agencies are somehow expected to pick up and manage this problem. It was so much easier for them when the substance was either legal or it wasn’t, not when it’s legal for some but not for others – and you can’t tell which is which. We’ve managed to create a largely unregulated ecosystem where patients, clinics and pharmacies are all financially incentivised to prescribe higher doses, wherever the product eventually ends up. Avoiding that currently relies on everyone in the chain behaving legally and ethically and, let’s face it, not all of them will.
It should be no surprise then that the anecdotal evidence is starting to roll in of diversion to children and increased psychotic episodes being witnessed by our mental-health services.
“I told you so,” will be the reaction of some, with inevitable pressure to rollback to the days of complete prohibition. It may have failed, but at least it was contained, and everyone knew the rules of the game.
Counterintuitively, perhaps, the solution is the polar opposite. If it is easier and, more importantly, cheaper for children – and it is – to get hold of cannabis than alcohol or tobacco, that tells you all you need to know about the relative effectiveness of regulation for the different substances.
Supply should only be permitted from doctors, clinics and dispensaries in the location where they are based – and all of them should be licensed and regulated. If we wanted a closed loop, we could require, as some states in the US do, that the product is grown locally, supporting a local growing industry, rather than operations elsewhere. Regulation must include a requirement to keep the individual’s GP or specialist in the loop.
The dispensaries’ licensing process should include a public procurement tender process that ensures the public coffers receive a fair share of this super-lucrative trade. The products should carry a proper tax burden. The public’s share of both needs to reflect the additional costs borne to ensure effective harm reduction education, enforcement of the regulatory regime as well as the burden put on mental-health services with an increase in their workload from a minority.
The public health successes learned from plain tobacco packaging and clearly labelled alcohol health warnings on bottles, all have equal relevance in making cannabis products look less attractive, particularly to children.
Both Jersey and Guernsey have managed to legalise medicinal cannabis in a way that is simultaneously both more liberal than the UK but more cautious than many other jurisdictions.
This half-way house is not serving our communities well. Having demonised cannabis for the best part of 60 years, we are now lauding it as a magical cure-all, prescribable by any doctor. It is neither. It is a plant from which a handful of proven, licensed pharmaceutical products have been developed. It is also the natural grown foundation of many other unlicensed products, which seem to have a multitude of benefits for a range of conditions suffered by most of us at one time or another.
And, finally, it is also, whether we like it or not, a recreational drug enjoyed by a minority. It may not be as addictive as tobacco and it may not cause as much personal and societal damage as alcohol, but, if abused, cannabis can create a harmful psychotic burden for a minority of individual users, at cost to the community.
The sooner we openly recognise all of these attributes of this plant, the sooner we will be able to put in place some decent regulation. If we were facing a Moneyval-style inspection of our cannabis regulatory regime, we’d have our ducks in a row and act cleaned up by Christmas. But we don’t, so it risks dragging on interminably – and while it drags, damage is being done to the reputation of the legitimate players and uses for cannabis products.
Legalise, regulate, tax and educate – that’s what we’ve done with tobacco and alcohol. It’s not perfect. It won’t be a panacea, but it will help keep our community safer. It needs all interested parties – users, doctors, pharmacies, growers, public health, law enforcement, education and mental-health services – to align and insist on the adoption of gold standards. “420” can then evolve to become associated with “community acceptance” rather “counterculture”.
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Gavin St Pier is a Guernsey politician. He previously served as the President of the island’s Policy and Resources Committee.
