Illusion In Europe, there is currently a political cross-party consensus: cannabis is okay, as long as it is being used for medicinal purposes. Anything else should continue to be banned and in that context, many people are busily trying to keep the two discussions well apart from each other. None of the large right-wing parties, addiction researchers, doctors and even patient associations adopt a prohibitionist stance when talking about the re-legalisation of cannabis. "This question," they always say, "Has nothing to do with the other question. The medicinal use we are talking about is to reduce the symptoms of disease; recreational use is just about getting high."
How effective is cannabis as a medication without any legalisation?
Peering over the divide shows that this short-sighted view actually does more harm than good to cannabis patients, and at the end of the day, it will inevitably lead to the regulation of cannabis in all forms and all uses. Back in the mid-1990s, when California kicked things off as the first US state to legalise medicinal cannabis flowers, it was mainly people who were seriously ill with AIDS, cancer and other fatal illnesses that were using medicinal cannabis; by the time the question of re-legalisation came around, pretty much every resident who wanted to smoke cannabis had got themselves a prescription. There are two reasons for this. First, there is an ever-expanding list of areas where medicinal cannabis can be used and with the rising number of relevant symptoms came a huge rise in the number of patients. Cannabis has proven to be one of the safest painkillers, and in Germany alone, there are over two million people who suffer from chronic pain. They don’t like to talk about the second reason in California, but everyone there knows that, over the years, the cannabis pharmacies have sold cannabis flowers to more and more people who would not need to have a prescription if cannabis were legal. This is practically impossible in Germany, thanks to very strict laws, but it was an everyday occurrence in US states like California or Oregon well before cannabis was legalised for recreational use. After all, anyone who has the choice between lying to a doctor or risking a jail sentence will opt for the former, whatever their moral code.
Patient associations agree: access to medical cannabis is made unnecessarily difficult by the months-long individual testing process and cannabis medications should be treated like other forms of medication. German legislators have partially accepted this and have approved a new law under which it will soon be possible to prescribe cannabis like any other drug.
Avoiding the Californian route
Given this, put yourself briefly in the shoes of a cannabis lover in Bavaria or Baden-Württemberg. Wherever the police still stigmatise cannabis users, prosecutes them, takes away their driving licences and exposes them to social disgrace, a law like this is actually a temptation to abuse it. After all, as long as you can be held accountable for years for possession of a few grams of grass through consequences such as losing your driving licence, in addition to the actual punishment, the likelihood of so-called fake patients existing will continue. They exist, after all, despite many precautionary measures, for many other prescription drugs, and that’s without mentioning the abuse of psycho-pharmaceuticals, opiates and other dangerous substances with the complicity of doctors. But the possibility of slightly reducing the abuse figures should not be a reason to deny access – or even to just make it more difficult or more complicated – to the large majority of patients who need this medicine.
California also voted for legalisation because it was an open secret that there was no other way to protect 20-year old medical cannabis programmes from abuse. At the end of the last decade, when “recreational” cannabis was expected to remain illegal for a long time yet, cannabis was already the “top crop” with the highest earnings in California. A situation like this creates greed on all sides, which for years had been played out against a ramshackle legislative base. Since legalisation came into effect at the start of the year, Californian growers, who can legally cultivate cannabis and sell it to specialised vendors, no longer have to sell the surplus grass to cannabis pharmacies. Consumers with some grass in their pockets no longer need to worry about the police and their driving licence, and do not have to continue lying to their GP. In short, not a lot has changed, but at least things can now be talked about openly, and those who consume and/or produce cannabis also have a properly defined legal position, even when the word “medicinal” is dropped.
But even in those US states where cannabis is legal, the problem has not been completely solved. As their cannabis programmes were developed completely outside the state health systems, medicinal cannabis flowers are now sold in the same shops as cannabis for relaxation, often in the same room and on the same shelf. But anyone who turns up with a prescription pays no taxes on their purchase, which, depending on the city and state, can account for as much as 20% of the price.
Same train, different compartments
Many US states and Canadian provinces have already recognised the complexity of the problem. Doctors and patients there are more worried about the abuse of their special status and the basic medical research if cannabis is not legalised, removing the concerns of tangling with cannabis activists. In Germany, the Netherlands and other EU countries with laws on the use of cannabis for medication, it often appears to be the case that those who deal with cannabis in a scientific, medical way want to avoid being lumped together with stereotypical dope smokers. But that is precisely why those who like to puff on a joint after work need to be given the opportunity to place their legitimate interests on the political agenda, alongside those of medicinal cannabis. Politicians, doctors, cannabinoid researchers, addiction researchers and patients who are speaking out in favour of cannabis as a medicine, but who act as if the legalisation of cannabis has nothing to do with them, are blocking the necessary basic research. This is the only element at risk, and not youth or health, if the twin topics of “medicinal” and “recreational” are not cleanly separated soon, without risk of repression. Whether we like it or not, we are sitting in two compartments of the same train.
The best way to separate the markets would be a hybrid of the US and European systems. Medicinal cannabis should be cultivated under strict supervision and sold like any other medicine, i.e. through pharmacies or an equivalent state healthcare system. Cannabis that adults want to purchase for recreational use should be sold through licensed and closely regulated specialist shops, as it is in the US. This is also exactly the approach taken in Germany for the cultivation and sale of medicinal herbs such as camomile, sage or mint. Far stricter rules apply to the cultivation and minimum/maximum levels for the products sold in pharmacies, than to those sold as herbal teas in the local supermarket.