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Hannah Baron: Let’s be blunt – how to legalise cannabis for the public good

By Centre Write, Drugs

Public support for the legalisation of cannabis in the UK has been rising steadily for years and is now higher than it has ever been. Shradha Badiani has laid out some of the arguments for legalisation in Centre Write already. The UK’s main reasons for not legalising, apart from stigma, are fears of the harms to public health and safety. Rather than contribute more arguments for why the UK must legalise, this article seeks to demonstrate how the legalisation of cannabis can be done in a way that mitigates harms and maximise the benefits to public health.

First, the UK should combine the recreational and medicinal cannabis markets. As research clearly identifies medicinal uses for a cannabis product, it should become a part of the medical system as any other drug would. Only GPs should have the ability to prescribe medical cannabis products. All other products should be sold as recreational marijuana. This design helps avoid products being promoted and/or taken for medical purposes they have not been proven to possess. It also helps ensure that the public is not financing recreational drug use, and that youth aren’t seeking medical use to bypass age restrictions on recreational marijuana. 

But for this to work, the government needs to change which medical authorities it takes cannabis policy guidance from. This is the second key element of how the UK should go about legalisation. For example, in 2018, the government consulted the Royal College of Physicians (RCP) on whether cannabis can be used for chronic pain. The RCP said it could not despite the contrary conclusions of researchers and organisations from around the world, including the UK’s chief medical adviser. The result is an overly restrictive set of guidelines that forces thousands of people every year – including parents of children like Alfie Dingley and Billy Caldwell, who were successfully treated with cannabis for severe epilepsy and then denied access to it by the government – to choose between living with the severity of their or their child’s condition, or and turning to the black market for unregulated and unproven treatment.

Third, a future UK recreational cannabis market should be modelled after Uruguay’s. The country has a central federal regulatory commission that controls the production, quality and pricing of cannabis. Importantly, the Commission has the flexibility to change prices based on supply and demand and thus prevent supply from outpacing demand, as it has in some US states. The Commission is funded by cannabis tax revenue, though products were originally sold tax-free to compete with the black market. The expert consensus is that Uruguay’s approach to cannabis is among the best in the world from a public health standpoint. 

Certainly, that is what the evidence suggests. In 2020, three years after Uruguay legalised cannabis, risk perception remained stable, the average age when youth were exposed to cannabis had risen, and the rate of consumption among adults remained close to pre-legalisation levels. 

An important note is that a similar regulatory commission in the UK would need to be careful not to give retail licenses to growers to ensure producers can only sell to the commission and retailers can only purchase from the commission. 

Finally, after initially selling recreational products tax-free to undercut the black market, the government should tax cannabis for consumers according to THC levels. THC is a method of measuring the potency of cannabis that is equivalent to ABV as a measure for the potency of an alcoholic drink. Coupled with a hard cap on potency, this measure would help to regulate consumption. A tax linked to THC levels also has the function  of distinguishing recreational marijuana from medical marijuana, incentivising consumers to seek a medical marijuana prescription from their GP if they plan to use cannabis medicinally.

If the government was really concerned with public health and safety, it would move towards legalising cannabis. The potential harms should not be reasons not to legalise–they should be reasons to do it right.

Hannah is a Research Assistant at Bright Blue. [Image: Elsa Olofsson]

Crispin Blunt MP: The public support psilocybin research and rescheduling

By Centre Write, Drugs

It is surprising what you can find out from asking a random sample of UK citizens about psilocybin, given that it is by no means a term familiar to everybody.

Nevertheless, 58% support law changes to permit terminally ill patients to access it with therapy—a demographic for which it is already clinically evidenced to offer otherwise-unattainable solace and peace-of-mind. Tellingly, this rose to 68% with education on clinical research and similar policy advances elsewhere in the world, and opposition shrank to just 9% – the remaining proportion just not having enough information to make a decision.

The results of Psilonautica’s population sampling with DrugScience say more about the compassion and discernment of the British public than they do about psilocybin.

Support for the government relaxing resrictions on research into the medical uses of psilocybin. View the full findings, and download the report, at Drug Science.

We are overwhelmingly empathetic towards those in distress. That is why the proportion who would actively vote to deny those facing their end-of-life a chance of otherwise unattainable solace is vanishingly small, even when we are relatively ignorant as a population about the natures of various conditions that others face, or why they need access to “psilocybin-assisted therapy,” or what exactly that entails…

A vague understanding that “magic mushrooms” have something to do with ‘60s counterculture is far more common than knowledge of its clinical utility, which includes the treatment of depression, anxiety, and substance-dependency, as well as in the treatment of eating disorders, obsessive-compulsive disorder, cluster headaches and end-of-life distress. If people have zero familiarity with the strange-sounding substance (beyond its association with festival-goers and fractals), these likely combine with the garish preconceptions and rightly steer the thinking voter away from an uneducated ‘yes.’

Hearing from those who have been able to access psilocybin-assisted psychotherapy irrevocably establishes what access can do for the people that need it—it is hard to forget the vitality with which stage iv cancer survivor Dr. Lauren McDonald conveys her determination to facilitate access for others to the therapy that got her through it. The ostensibly complex puzzle of psilocybin’s regulation reveals itself in these survivors’ lived experiences to have a single, inalienably appropriate solution: Reschedule Psilocybin – Move it to Schedule 2 for clinical research purposes.

That a level of uncertainty exists about whether various population groups in acute psychological distress should be provided with psilocybin is perhaps an inevitability, given its inexplicable situation within the work-in-progress that is UK drug policy. It was placed in Schedule 1 of the Misuse of Drugs Act 1971 on the basis of a Home Office evaluation for which the paperwork can no longer be found, decades before the creation of the vast body of clinical research that now affords us a scientific understanding of its psychopharmacological profile, negligible toxicity and low potential for abuse. Over and over again, without exception, psilocybin is found to be safe and well tolerated in healthy and clinical populations alike. When used appropriately, in controlled, psychotherapeutic contexts, the potential power of psilocybin-assisted psychotherapy to heal otherwise untreatable wounds is simply stunning.

The clamour for access to psilocybin-based treatments presaged by the survey data does not yet come from the entire population simply because so few who might benefit are aware of what it entails, and even fewer having been able to access it for themselves. I am a trustee of Heroic Hearts UK, which assists veterans accessing legal psychedelic-assisted treatments abroad in the absence of domestic services that meaningfully support recovery from combat-induced trauma—a travesty which surely need not continue now that we have evidence of majority public support for relaxing restrictions on research which could in turn facilitate access to this transformative treatment for our troops, on home turf.

While psilocybin remains in the deadlock imposed by its Schedule 1 status, we lose loved ones to now apparently treatable mental health conditions, 18 people commit suicide every day. We also lose researchers, research opportunities. Our homegrown psychedelic science world expert, Dr. Robin Carhart-Harris, who produced the flagship research on psilocybin for depression at Imperial College in 2016 that has led to the development of the international psilocybin-assisted treatment industry, and the neuro-imaging data that lead to the hypothesis that it could possibly work in the first place, is bound for the United States.

Jurisdictions where regulatory permissions have been refined to actively facilitate psychedelic research and patients are furthermore legally able to receive it understandably beckon to those in the business of advancing psychedelic healing; over 6 US states have lifted criminal sanctions relating to psilocybin between 2019 and 2021, with the FDA granting ‘breakthrough therapy’ status to psilocybin in 2018, fast-tracking it through the approval process. The psychedelic treatment sector is likely to grow to £10 billion by 2027—it would be an even greater public health tragedy than the UK Government currently has on its hands if our commitment to a flagging economy proves so strong that we continue to send the clearest possible message to our remaining psychedelic scientists that their innovations are unwelcome, by keeping a death-grip on outdated, unfounded and easily-amendable regulations that continue to block their research without reason or public support.

Today we live with five decades of research handicap from psilocybin’s enduring placement in Schedule 1. This must surely end soon. However if its licensing oversight and sponsorship of its opportunities remain solely in the hands of the Home Office, the department whose role is to protect us from drugs, the lesson from cannabis is that they will continue to do so and most of the opportunities to conduct the calibre of research necessary to develop treatments that would alleviate the suffering of millions will be lost to the U.K. The cost of our current national oversight of Drugs Policy is now horrifyingly apparent. Rescheduling psilocybin will happen at some point as the evidence is entirely one-sided and the official explanations for the status quo are without foundation. But unless we get serious about enabling health, science and economic opportunities for our country we will continue to leave too many desperate people looking to criminals to supply them their medicines. Rescheduling will be welcome, but it’s fundamental regulatory reform that is required.

Crispin Blunt MP is the Chair and Chief Executive Officer of the Conservative Drug Policy Reform Group (CDPRG) and the Co-Chair of the All-Party Parliamentary Group on Drug Policy Reform. This article was originally published on PsilocybinAlpha. Views expressed in this article are those of the author, not necessarily those of Bright Blue. [Image: Images George Rex]