“Generally there is evidence that the public health burden of marijuana use is modest compared to that of alcohol, tobacco and other illicit drugs, and occasional marijuana use is not harmful to the majority of adults who use it . . . Enforcement of the policy of criminalization of marijuana has caused major social harm to individuals who have been arrested and imprisoned for marijuana possession, and poses undue burden on the judicial system with major economic effects.”133 5.47. The Commission also takes note of the Risk Guidelines developed by the Centre for Addiction and Mental Health (CAMH), of Canada.134 Noting that cannabis‐related harm is mainly concentrated among a limited sub‐group of users who use cannabis heavily and/or began to use it at an early age, and that these risk factors are potentially modifiable, the authors recommended these guidelines as a way of reducing the harms of cannabis use at an individual and a population level. The Guidelines are modelled on the example of low‐risk drinking guidelines that have been introduced in Canada and elsewhere. They include: delayed use until early adulthood, avoiding frequent use, shifting away from smoking cannabis towards less harmful (smokeless) delivery systems such as vaporizers, use of less potent products, or titrated THC dose, avoiding driving for 3 to 4 hours after use etc. and abstention where there is a personal or family history of psychosis, or cardiovascular problems.135
Dosage and Administration
5.48. The optimal dose and the most appropriate route of administration for medical marijuana remains unclear. Dosing to date has been heavily based on a patient self-titration model. Numerous experts have argued for more rational guidelines for the dosing for medical marijuana (Carter, Weydt, Kyashna-Tocha & Abrams, 2004). The drug may be administered by numerous routes (oral, via inhalation, sublingually, topical etc.), the amount of marijuana that gets into the system varies when inhaled as compared to when smoked. (Martinez, 2000). Although smoking is the most common route of administration of marijuana, it is to be noted that, the smoking of any substance, including marijuana, is to be discouraged. There are reasonable grounds to support the smoking of marijuana in terminal disorders in which the benefits would far outweigh the potential risks. Vaporization has been suggested as a safer option to smoking (Campbell, 2001).
Providing Opportunities for Caribbean Medical Researchers
5.49. Of particular importance is the negative impact of the illegal status of cannabis on the ability of the scientific community to research the plant to determine more comprehensively its benefits and potential demerits. This is an often overlooked factor in the cannabis/ marijuana debate. There is need for law reform to catalyse and support indigenous scientific and medical research from and for the CARICOM community itself. Researchers and scientists complained to the Commission about the deleterious effect that prohibition has on the development of research, not only accessibility to materials, but the high costs involved because of the security and safety requirements, direct incidents of its illegal status and prohibition ideology. 5.50. The UWI was among the first in the world to research marijuana for medicinal purposes and formulate a medicinal product for glaucoma.136 However, it has been difficult to engender long term research. The Commission heard of medical research initiatives, with external partners from world renowned scientific institutions partnering with Caribbean institutions that had to be abandoned due to the obstacles of researchers. The opportunity costs to these aborted initiatives are immeasurable. As stated by the President of the Caribbean Association of Pharmacists, the region is “perfectly positioned”
Ibid, at pp 11-12. In 2011, a team led by Dr. Benedikt Fischer and Dr. Jürgen Rehm of CAMH developed and published a set of lower‐risk cannabis use guidelines (LRCUG). Fischer et al., 2011. 135 These guidelines have been endorsed by a number of organizations including CAMH and the Canadian Public Health Association (CPHA) as an educational means of reducing high‐risk cannabis uses and practices.”, CAMH Study, above, p.5. 136 The work of Professor Manley West and his team from The UWI, Mona campus. See, e.g. The Use of Certain Cannabis Derivatives (Canasol) in Glaucoma,’ West Indian Medical Journal 1978 Vol 23:16-25. 133 134
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