#BTEditorial – Mind the Law of Unintended Consequences

Barbados has taken decisive steps in the last few weeks to make medicinal marijuana available and seems to be working diligently towards making marijuana cultivation a major plank of economic recovery.

Minister of Health and Wellness Lieutenant Colonel Jeffrey Bostic announced that the Barbados Drug Service will be adding five cannabinoids to its formulary: Sativex, a nabiximol; Eidiolex, which is described as a “purified cannabidiol oral solution”; Anabasum, “a synthetic non-psychoactive cannabinoid”; and Nabilone and Marinol, described as “synthetic cannabinoid capsules”. These drugs are expected to become available in Barbados shortly.

According to a press release from the Government Information Service, acting Chief Medical Officer Dr Anton Best says: “These will be used primarily for chronic pain, spasticity associated with multiple sclerosis, severe nausea and loss of appetite, and will be prescribed when other pharmaceuticals have not worked.”

We have also heard that Barbadians are among the highest consumers of recreational cannabis within the Caribbean.

CADRES pollster Corey Sandiford stated last year that according to surveys carried out between 2008 and 2017 by the National Task Force on Crime Prevention: “In 2008 support for partial decriminalisation was at 23 per cent, in 2014 this had gone from 23 per cent to 45 per cent, and by 2017 the number had increased to 52 per cent.”

More than one Cabinet member has been touting the benefits the medicinal marijuana industry could bring. We have also heard of Canadian investors lining up to get involved in commercial ventures.

But what is less well-known is the extent of Government’s consideration of all the social and economic costs of marijuana liberalisation as it moves slowly but we believe surely towards complete decriminalisation.

Studies carried out in some US states that fully decriminalised the drug in recent years are worthy of examination.

After Colorado legalised marijuana in 2012, violent crime rose by 20 per cent but decreased nationwide by one per cent. After Alaska decriminalised marijuana use in 2014, violent crime increased by 30 per cent. In Oregon, which also legalised it in 2014 saw violent crime rise by two per cent. Alaska: school suspensions in state capital Anchorage shot up by 141 per cent between 2015 and 2017 owing to marijuana use and possession.

Another study conducted among postal workers discovered that people who tested positive for marijuana had 55 per cent more industrial accidents, 85 per cent more injuries and 75 per cent greater absenteeism than those who tested negative.

In states which legalised marijuana, hospitals, transport companies and construction firms have been finding it hard to get workers within their state who had passed drug tests. Many have had to seek workers from elsewhere to fill the vacancies.

In terms of perceived economic benefits, we have been hearing a lot about the new jobs and spin-off industries we believe the medicinal marijuana industry will create.

Over the weekend, Minister of Agriculture and Food Security Indar Weir said: “When I look at the number of jobs we are going to create in IT, security, dispensaries, it is an opportunity for Barbadians to start businesses in security, for growers, for the Rastafarian communities in Barbados, people will benefit from a programme worth over $100 million.”

Evidence from one US state which legalised it has shown that for every dollar in tax revenue Colorado collects from marijuana sales, $4.50 is spent to battle marijuana-related social costs stemming from the health care and education systems, accidental poisonings, impaired driving and increased court costs, among other things.

And medicinal marijuana remains the subject of controversy in medical circles.  A study in the renowned British medical journal, The Lancet, said: “People who used cannabis had greater pain and lower self-efficacy in managing pain, and there was no evidence that cannabis reduced pain severity or interference or exerted an opioid-sparing effect.”

Peter Bach, head of the Centre for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Centre, said in a Wall Street Journal editorial,: “Studies have compared marijuana’s pain-suppressing qualities with a placebo, not with other pain medications.

“Every intoxicant would pass that sort of test because you don’t experience pain as acutely when you are high. If weed is a pain reliever, so is Budweiser!” As a result, it is said few doctors actually recommend it, and often only for terminally ill patients.

A study in Arizona which legalised medicinal marijuana in 2010 showed that five years later, 98 per cent of physicians were not prescribing it.

The drugs we have allowed onto our formulary have their share of issues as well, particularly as the majority of them are synthetic cannabinoids, which are said to be more potent and thus more harmful than natural cannabinoids.

Elixinol, the trading name for one of the companies producing natural cannabinoids, warns its customers: “Synthetic cannabinoids are made in laboratories and are more powerful than natural ones. There is no upper limit to the psychoactive effects of these compounds, and the potency can vary greatly. Ingestion of synthetic marijuana can lead to toxic side effects and can cause extremely severe reactions.”

The Ministry of Health has organised a series of workshops with doctors, nurses, pharmacists and other specialists in the health care sector ahead of its introduction of these products to the formulary, during which, hopefully, they will be made familiar with all aspects of the products.

We encourage the Government to make as much room as possible for intense homegrown scientific and medical research, public education and awareness, mental health advocacy, knowledge-based public policy – and a healthy respect for the Law of Unintended Consequences, as we march toward a new future with an old herb.

Let’s get this right.