Side event: The importance of drug prevention in the era of cannabis deregulation

Permanent representative of Slovenia (Chair): dialogue on adaptation of prevention in context of cannabis regulation is timely.

Mrs Ada Hoceyev, Slovenian Institute of Public Health: new developments are triggering debates on how to respond to cannabis. Slovenia is a very small country in the heart of Europe. Lifetime prevalence of the use of illicit drugs is increasing in the last 6 years, mostly due to cannabis. This increase is for all age groups, for both sexes, so cannabis is quite a big issue for our country. Use is particularly high amongst young adults aged 15 – 34. 21% of 15 year old teens, 43% of 17 year old teens have ever used cannabis.

There have been initiatives and discussions around loosening controls on cannabis. There have been many smoking adverts in the 1950s before the surgeon-general released his report on the adverse effects of smoking. Now, cannabis adverts are everywhere – do we need another drug? Why?¡

What should be our goal? Especially for young people it should be health in all its dimensions, including physical, emotional, social, spiritual and intellectual health. Some need more support to promote their optimal health. Prevention and intervention programmes should be designed to encourage healthy behaviours that will follow the young people through adulthood. They should support the person as a whole.

Carlos Charme Fuentes, National Director SENDA, Chile on “National Prevention Plan “Choose to live without Drugs””: in Chile we have the worst and shameless record for the top use of marijuana, cocaine and cocaine paste without prescription amongst young people in the Americas. Our consumption rates are double that of the Americans. We have a national plan to combat this. In April 2019, our President presented the national plan called ‘Planet Youth’ which is a strategy that we adapted, not adopted, from Iceland. Our challenge was to recognise the good practices in Iceland and adapting them to the Chilean context. There was a positive evaluation of the pilot by the Pan American Health Organization in 2019, and then it was launched in 46 municipalities. In 2020 its implementation will expand further.

First there will be a data collection, which is focussed on all the schools, then interventions will be developed, then evaluation of it.

The new focus on prevention focus on children’s social environments, looking at the aspects of family, leisure time, peer group and school life of an individual. The elements of the prevention strategies are: community approach, intersectoral coordination and evidence-based programs.

Other initiatives include 5,000 parental skills trainings along the country, and new initiatives such as one called ‘study without drugs’.

Kevin Sabet: several states in the US have legalised marijuana, and it is mostly to do with high-THC synthetic products such as edibles with up to 90% THC. We have seen this in every state, and where we have data we have seen an increase in use and incidents such as car crashes, employee absenteeism, hospital admissions for e.g. panic attacks. The problem with the US is that we have an unhinged industry, and they hire lobbyists and former politicians, making a lot of money, spreading a lot of wealth amongst investors. We are seeing the consolidation of the marijuana industries which are being taken over by big tobacco and alcohol, who see it as an advantage to have an alternative product line.

We are often caught in a false dichotomy between incarceration on one hand and legalisation on the other. No one wants to imprison people for marijuana but legalisation is not the answer. In some states that have legalised, the sales of marijuana have been banned in several local jurisdictions.

I commend the government of Slovenia, and hope this side event will be successful. If anyone wants more information, our website is learnaboutsam.com .

Kristina Sperkova, International President, Movendi ‘The importance of drug prevention in the era of cannabis deregulation’: The reasons given for legalisation are: everyone is doing it anyway so why put people in prison, to get rid of black market, to get revenues, and discrimination leading to adverse experiences with the criminal justice system.

I will address each of these reasons to debunk them. Only 5.5% of people who use drugs so not that many, the black market will always offer a cheaper option, the costs of use (Eg. loss of productivity, workplace injuries) outweigh the revenues gained, and so far we have not seen a change in the proportion of people in prison so there has not been a positive impact on discrimination. Marijuana arrests have tripled, and pot shop density has increased.

3 million of people are dying from substance use every year.

On the control of alcohol and tobacco, the conventions keep prevalence low. We are addicted to profits. Legalisation is unleashing profits. Reducing availability is the best way to reduce consumption.

Products with marijuana include those with up to 95% potency, and which target children.

Big alcohol and tobacco are investing huge amounts of money into marijuana industries. They have experienced how to get around policies in place to generate profits without problems.

That is why prevention is so important. There needs to be a comprehensive and human rights-based approach which is not exclusive to the rights of people who use drugs.

Professor Inga Dora Sigfusdottir ‘Improving lives based on evidence’: I bring you good news, bad news and a call for action. The good news is that we know how to prevent bad things happening to young people. We are bringing up sober generations with our young populations drinking less alcohol, using a simple methodology based on a complicated history of great thinkers, eg. Emile Durkheim (1868 – 1917). We know the risk factors and how to address them. Our work is based on three pillars of success:

  1. Evidence-based practice: we do nothing without research
  2. Using a community-based approach
  3. Creating and maintaining a dialogue among research, policy and practice

By now we have reached an important milestone, and publishing our first scientific paper showing that Iceland is not an exceptional strange place and that the same principles applies to other places, eg. Lithuania. The growing threat in cannabis:

  • Famous celebs have become advocates for cannabis
  • Global marketing, US companies reaching out to other countries for future business
  • Children and young people the target group
  • Vape and cannabis industry interconnected

What do young people want? The short story is this: you practically never get the answer: I’m going to become a drug addict.

People behind legalising drugs are just thinking about how to make their wallets fatter, and don’t give a damn about the future generation. In a world where there are no longer national and cultural boundaries, we are joining forces and learning from each other, with upstream thinkers using the Planet Youth methodology around the world, including Chile – we are going to succeed. It is not an easy task. We need to be patient. Prevention needs to be consistent and comprehensive, it’s not a single movement, it’s a quiet revolution.

Matej Kosir, Institute Utrip ‘Impact of attitudes, beliefs, and norms on cannabis use among young people (prevention science perspectives)’: my country Slovenia is a very small country but with similar problems to other countries. Our work is driven purely by science so I will try to be as objective as possible. Some trends are global, eg. perception of risk on cannabis use among young people is decreasing, and so is the perception of harmful effects/consequences on cannabis use among young people, eg. people think it is natural and healthy. Perception of accessibility of cannabis among young people is also increasing. There is constant abuse of medical and industrial (hemp) potential of cannabis towards legalization for personal use and supply.

From the prevention science perspective, we build our work on ethnographic models, on factors around individuals, eg. how belief and attitudes can impact individual behaviour. There is a link between attitudes and behaviour and three sets of perceptions/attitudes guide behaviour (Azjen, 1991):

  • Beliefs about the outcomes or consequences of the behaviour
  • Beliefs about others’ normative expectations (or social acceptability) of the behaviour

Theory of planned behaviour considers how environmental constraints affect individual behaviour. Industry focuses on this. Prevention science looks at how to prevent risk factors and promote protective factors to prevent individual behaviours. Risk factors which could have impact on cannabis use among youth includes positive attitudes towards cannabis.

If we take legalisation of cannabis as an example, we can see that by changing views and attitudes on cannabis we can of course change behaviour. We can increase accessibility of cannabis which can be a risk or protective factor. It can create more difficulties for parental control and prevention.

Solutions? We have to stop this process of commercialisation. It is not legalisation or regulation, it is commercialisation. The biggest problem involving alcohol and tobacco is commercialisation. We have to strictly separate the debates on various aspects of cannabis (medical, industrial and psychoactive use). These three areas are completely different and we cannot mix them. We also need to increase investment in evidence-based prevention and increased knowledge and skills.

Moderator: open to questions

Ambassador for Iceland: there is not a family that hasn’t come into contact with the drug problem and the dire consequences of the health and social impacts. Therefore we need prevention and community-based approaches, and the Planet Youth approach that is implemented by us and now around the world.

Lauren, Health Poverty Action: is there much thought on including harm reduction in your prevention approaches because obviously there are people facing risks of overdose for example, and this wasn’t discussed in your presentations?

Questions: what is the budgets in your countries on treatment and prevention?

Matej: everyone on this panel supports evidence-based harm reduction approaches for people who need them, but this panel is focussed on prevention. Regarding cannabis use, there are several harm reduction approaches that can be implemented so we also agree with this perspective.

Kristina Sperkova: we cover the whole range of drug-related interventions and are not taking harm reduction out, we haven’t mentioned it but we do agree with it. Harm reduction is not supposed to become a replacement for prevention, and we notice this is happening in the discourse. It is important to save lives but it is also important to do prevention.

Ada Hoceyar: we do have harm reduction in our country, even drug testing, but we realised that maybe we focussed too much on that and that we need to do more on primary prevention.

Carlos Fuentes: we have an annual budget of $100million

Inga Dora: we spend too little on prevention, and need to spend more on primary prevention – if we did this we can spend far less on harm reduction.

Matej: in the OECD, countries only spend 2.8% on prevention but actually very little of that is spent on school, youth centres.

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