Research from Australia and across the world shows no clear relationship between the number of people using cannabis and the severity of penalties for cannabis offenders. So, what practical steps can be taken to try to reduce harm from cannabis?
In June the National Cannabis Prevention and Information Centre released first-aid guidelines for problem cannabis use. These were designed to help the community identify and assist users who are developing a problem with their cannabis use or are in a cannabis-related crisis.
The guidelines provide tips for effective communication with people experiencing problems. Some sensible advice is also offered about what to do if the cannabis user with problems does not want any help.
Most people prefer to manage their own drug use and, should they develop problems, manage these themselves.
Why not try to help people using cannabis try to avoid problems in the first place?
For many years Australia has had National Health and Medical Research Council guidelines to help drinkers reduce the harm from alcohol. But we have never had any official guidelines for people using cannabis that could help them do so more safely.
As Australia has one of the world's highest rates of cannabis use, it seems sensible to offer realistic guidelines to help users reduce potential harm.
A group of us recently gathered in the northern NSW town of Nimbin to develop guidelines for people using cannabis.
The group included Ann Symonds, a former member of the NSW Legislative Council as well as a grandmother, along with many local residents who have used cannabis heavily for many years but were keen to reduce their risks. We decided to call these the Nimbin Health and Medical Research Committee cannabis guidelines.
Our Nimbin guidelines make it clear that the form of cannabis use with the lowest health, social, legal and economic risk is abstinence. But, recognising that people will choose to use the drug regardless, we outlined ways to minimise harm.
Social cannabis users are recommended to consume cannabis only moderately, that is for five days a week or less, trying to keep at least two days each week cannabis-free. Cannabis smokers are advised to not exceed four joints a day. This advice resembles some of the NHMRC guidelines for alcohol.
As cannabis is illegal and possession or use can lead to severe legal and social consequences, cannabis users are advised to be discreet and never carry more than the caution amount, which varies from one state or territory to another.
Those concerned that cannabis may be seriously affecting their life in important areas such as relationships, child-rearing, job or finances are advised to consider reducing or stopping consumption of the drug. Young people considering experimenting with cannabis are advised to delay this until their body and mind have matured, and to be moderate and responsible.
Cannabis smokers should avoid smoking in the presence of children and in confined areas with non-smokers present. Adults should never forget that they serve as role models for the young.
As the potency and contaminants of different strains may vary widely, cannabis users consuming a new batch are advised to try a small quantity first.
Women who are pregnant, breastfeeding or likely to become pregnant soon are advised to refrain from using cannabis. Those who nevertheless choose use cannabis are advised to minimise usage in terms of quantity as well as frequency.
It is recommended that cannabis consumers allow at least a few hours between their last use of cannabis and driving a car or operating heavy machinery. Those consuming alcohol and cannabis should allow twice as long.
People who have had a serious mental illness or have a family history of serious mental illness are advised to avoid cannabis and other powerful mood altering drugs. Those still keen to use cannabis are advised to minimise their use and avoid smoking cannabis on their own.
Mixing tobacco and cannabis increases risks and should be avoided. As smoke harms lungs, inhaling the vapour from a vaporiser or eating foods made with cannabis is less damaging than inhaling cannabis smoke. Eating cannabis has less predictable effects than inhaling.
Plastic bottles, rubber hoses, PVC, aluminium or foil, when used to smoke cannabis, may give off toxic fumes while hot. Health risks are lower with a pipe made from glass, steel or brass.
Our Nimbin guidelines note that sharing smoking equipment such as joints, pipes or bongs can spread infections. It is safer if smoking equipment is not shared and is cleaned after every use.
To protect the environment and minimise the risk of starting a fire, all smoking implements, waste or roaches should be carefully and responsibly discarded.
As with the NHMRC guidelines for alcohol, our cannabis guidelines will be revised as additional information becomes available.
Isn't it time we all got real about cannabis?
Alex Wodak is a physician, director of the Alcohol and Drug Service at St Vincent's Hospital in Sydney and president of the Australian Drug Law Reform Foundation.
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