Over the last 30 years, few substances have elicited such stigma and polarizing debate among political, social and medical groups as cannabis has. But could legalizing cannabis be of social, medical and economic benefit to Barbados? I believe it could.
The main active components found in the cannabis plant are cannabinoids. These are a diverse group of chemical compounds that bind to inhibitory receptors in the human body. Cannabinoids are naturally found in the humans (endocannabinoids), but may be produced synthetically or harvested from the cannabis plant (phytocannabinoids).
Cannabis research has historically been stymied by its legal status in many countries. The paucity of data regarding cannabis, the complexity of multiple strains of the cannabis plant, and the poor quality of existing studies of patient and social groups have complicated cannabis decision-making and debate in modern times.
What is known is that medical cannabis has been shown to benefit persons suffering from chronic neuropathic pain (e.g. some painful conditions related to diabetes), nausea and vomiting, decreased appetite and insomnia. There is significant, but less, evidence to support its use in the treatment of other types of chronic pain, such as cancer-related pain. There is not sufficient evidence to recommend its general use for weaning persons off other addictive substances or treating acute pain (e.g. after surgery), epilepsy or cancer.
While it is very difficult to “overdose” on cannabinoids consumed from plant sources, adverse effects may occur with its use. These undesirable effects include drowsiness, slowed reaction time, cognitive impairment, paranoia, toxic psychosis and depression. Habitual use may result in withdrawal symptoms when cannabis is stopped – such as nausea and vomiting, disturbed sleep, sweating, loss of appetite and tremor. Additional long term potential benefits of cannabis use such as anti-cancer and anti-inflammatory effects; and drawbacks such as increased cancer risk and increased risk of cardiovascular complications, are still being studied.
As a recreational drug, cannabis seems no worse than other legalized recreational drugs (tobacco and alcohol). Its legalization in parts of the United States was associated with a significant increase in fatal car crashes (approximately a 16 to 30 per cent increase), and its adverse effects on the developing brain (persons under the age of 25), such as increased risk of mental illness, are well known. However, it is easy to argue that tobacco and alcohol use from a young age are also very harmful to developing adults, and that alcohol use is also associated with fatal car crashes.
Similar to tobacco and alcohol, cannabis (smoked, vaporized or eaten) poses significant consequences to pregnant women and their babies. Cannabis does cross the placenta and is present in breast milk for up to 4 hours after consumption. As per young adults, cannabis does permanently affect the developing brain. It also worsens the health of the placenta. Low birth weight babies, premature delivery and difficulties learning on entering school (at age four) can be expected in children born to cannabis consuming mothers.
So what do we stand to gain with cannabis legalization?
Cannabis use in Barbados is extremely common. Infrequent or habitual cannabis use among patients I have treated at the Queen Elizabeth Hospital is common, especially in those under the age of 40. I do not believe this clinical experience is unique to me and many of my colleagues would likely echo the same experience. I do not believe legalizing cannabis will make it more attractive to those at risk of using cannabis because I believe these people are likely already using it.
Barbados is a tourist destination. Canada and parts of the United States continue to loosen cannabis regulations and are engaged in finding productive uses for this product. We receive visitors and investment from these countries. Legalizing cannabis may make us more competitive in marketing our island for tourism and other investments. If many countries continue to loosen cannabis regulations, we may also be drawn into unprofitable legal conflicts and end up turning away or persecuting tourists and investors from these countries.
There is money to be made in cannabis, but the time to make it is now. This is likely not an indefinite opportunity, and as time passes demand for cannabis will shrink and our regional and international competitors will grow. There is currently a huge demand for cannabis as a recreational and medicinal product.
Financial gains from cannabis could fund public programmes and contribute to our economic recovery. It may also reduce the power of and divert money away from some criminal enterprises and allow the Government to save money and time spent on the prosecution and imprisonment of cannabis users. Finally, cannabis farming techniques at an individual and national level may help improve other local agricultural pursuits such as food production as well as the infrastructure around it.
What about the drawbacks?
There are potential pitfalls in cannabis legalization- there may be motor vehicle accidents and at-risk persons may have health related issues, such as the onset of schizophrenia. People who use cannabis irresponsibly, either for recreational or medical reasons, will be harmed. Unexpected issues will also arise.
If Barbados were to go ahead with legalizing cannabis, the country would need to prepare for it. The public would need to be properly and continually educated on cannabis. This is especially true regarding health related risks associated with its recreational use. Cannabis myths would need to be debunked e.g. it is natural and cannot cause harm. A legal age for cannabis consumption would need to be set (ideally 21-25 years old) and zero tolerance legislation for cannabis use around children, in pregnancy, on-the-road and in the workplace should be established. Additional guidelines for cannabis consumption in many jobs (e.g. nurses, police, pilots, equipment operators, truck and bus drivers, soldiers, doctors) should be established. Police would also have to review and develop roadside tests for impairment.
In summary, I am an anaesthesiologist from the Queen Elizabeth Hospital and am currently doing further training in pain medicine at the University of Toronto in Canada. Given the social and medical relevance of cannabis in Canada, I have reviewed a lot of current medical evidence regarding it – especially with respect to pain and palliative care. When appropriate, I will prescribe cannabis for the pain patients I have been seeing in Canada and it is of definite benefit to some of these persons. Prior to this, I have practiced medicine for many years at the Queen Elizabeth Hospital and have often treated patients that happen to also use illicit recreational cannabis.
The medical role of cannabis continues to be defined, but I have no doubt it will be relevant in the practice of modern medicine. Cannabis is also of great social relevance due to the number of people who have, and will, consume it. I also believe that the legalization and production of cannabis could be of great financial benefit to Barbados and Barbadians.
As a doctor, I do not support any recreational drug use- tobacco, alcohol or cannabis, but these drugs do have a relevant social and health related context that needs to be further acknowledged. I believe under current legislation and social practice, we are suffering all the harms (health, criminal, financial) and gaining none of the benefits of cannabis consumption and production – much as we would if alcohol or tobacco were illegal.
My enthusiasm regarding cannabis legalization in Barbados is further tempered by the acknowledgement that without extensive public education and without evidence or multidisciplinary expert guided preparation, the potential for national cannabis-related benefits decrease and the potential for national cannabis-related harms increase.
Dr Alexander McLaren-Bladessenior, registrar in Anaesthesia from the Queen Elizabeth Hospital, currently in Toronto doing advanced training in pain medicine for this year.