I want to give a couple of acknowledgements my colleague, dr susan, lane who’s a consultant psychiatrist. Allow me to use her fantastic slides. I also want to acknowledge reconnect for organizing this online seminar. I just want to make some declarations. I have absolutely no conflicts of interest whatsoever on this topic in the sense that i’ve got no affiliation with political parties, and i also have no affiliation with any pro or a game floppy groups on this issue. By the way, my apologies because my youngest child is constantly coming in and out of the room and that’s all the noises. What i’m hoping to do today is talk a little bit about effects of cannabis range of legislative options that are available when thinking about cannabis, reform and the arguments for and against them. And i guess what i bring to this is more health and asian perspective and and just a slide to give a bit of a harm reduction message on cannabis, which we, i think we should all consider whether the law changes or not. So what are the effects? In small doses? It can relax. The user can sort of instill the feeling of well being and sort of on the high, but it can also make people struggle to concentrate. It can increase the appetite it can impair. Balance and coordination increase heart rate and makes the eye bloodshot. There are a number of long term facts. Some raga there’s, a medicinal benefit we’ll, come back to that later, hormonal imbalance that are associated with lower libido and infertility.

Interestingly, there is a emergence of this syndrome called cannabis hyperemesis. This is sort of unstoppable vomiting that happens in heavy users when they stop, and then there are obviously respiratories and lung effects. So infection, like bronchitis infections and inflammations of your lung and the windpipes so again in terms of kind of harm of cannabis, especially psychiatric. This is mental health, related harm, there’s, obviously, dependence because people can physically become dependent addicted to it and that there is acute effect. So when you use it, especially in high potency or like really high strength, it can cause short term memory to be impaired. Tension and concentration people can experience anxiety, paranoia and psychopsychosis beyond that kind of acute effect. The short term effect of cannabis may include impairment in your cognitive function. That is your intellectual function. Some of it may be reversible. However, if you use high amount, especially from young age, the impairment it causes damage it caused, your intellectual ability may not be reversible. Even if you stop it. Doesn’T, come back it’s, also associated with increased risk of schizophrenia, especially again using regularly high amount from young age. Cannabis use is very wide and very prevalent. One figure from 2017 suggests that over 188 million people across the world use cannabis. And if you look at the graph on the right, you can see that general trend is going up. It’S important to note asia is about two percent and in australia is 18, and new zealand is very similar it’s about 15 to eighteen percent.

Two percent in asia seems like a very small amount, but in fact, if you think about the fact that sixty percent of world population reside in asia after the asians, it actually means that one third of people who use cannabis across the world are actually asians. This means that the law reform may have a very different effect to asians living in new zealand compared to other ethnic groups in new zealand. The greatest proportion of cannabis user are focused into the young people, also more in men and more in maori much lower nation. Now it may be that this low rate of use of cannabis in asian population may be due to the fact that this survey was done in english, and this part of the survey was not done if the person needed interpreter. However, even if we consider that, i think what’s really clear is the rate of people using cannabis in this population and the asian population in new zealand is much lower than the general population. So let’s look at the law side of things now this graph is from center for addiction and mental health in canada. This is from 2014. This was made at the point when they were debating legalization. So when you look at the spectrum of law that may exist, on the left hand, side you’ll see that there is total prohibition on the other side is completely legalized and in between there’s legalization, with strict regulations. So we’ll talk about that.

So, where are we in new zealand? Well, we are at this stage where in total prohibition section, but some countries have decriminalized it. So what it means is that people who are growing it and supplying it it’s still illegal. To do that, however, people who are in position of small amount for personal use, they’re not going to be charged by police as a criminal offense and what we’re looking at in new zealand the bill that are in front of us at the moment on which a Referendum is being carried out, we’re looking at legalizing cannabis with very strict regulation. Now it means that manufacturing sales, progession and use of cannabis are all legal, but the government maintains tight control over the cannabis market by a variety of means. As far as the public health goes, that you can minimize the social and health harms by legalizing it and yet control it very, very strictly you kind of need to think about what law means so having a law, a law means essentially a boundary between what is Acceptable behavior and what’s, not so when we prohibit something it conveys to society that it’s not a desirable thing to do so. In the case of cannabis, prohibition law conveys a very strong message that cannabis, manufacture, sales and use is just unacceptable and it’ll be punished. In this context, then, you can make an assumption that that means, if we legalize it, then we’re giving a message of society that it’s okay to use, but i think the biggest factor where people are supporting this is that we know, because we know how things are When we change it change it, we really don’t know what’s going to happen, and some people argue that well that’s, not great that’s, not good enough.

People have been using it quite widely and in fact the overall rate has increasing. Therefore, this current law does not work. Therefore, we should change it, especially if you think about the most vulnerable people that is young people and high users, making it illegal like as it is now has not worked for them. It has not deterred them, stopped them from using it. The current system, current law, does not really protect them. Also, one of the biggest arguments for change has been that criminalization causes social harm people when they get, for example, charged they, you know not only lose their job, they may lose future opportunity for employment, education opportunities and so on and so forth, and there are inequities That exist around arrest, prosecution and sanctions against cannabis locally, but also internationally. Some of you may be aware that when the u.s federal government’s proclaimed so called war on drugs from the 1770s onwards, it disproportionately targeted african americans. The criminalization of use of cannabis may affect certain groups more so, even though they use the same amount, for example, because it’s illegal, we cannot really get public health campaigns around disused, because people just say well, this is illegal, no one should be using it, whereas, for Example with tobacco, it’s legal, but because it’s tightly controlled, we can do public health campaigns on the harms same thing with alcohol, so making it legalized or decriminalized that made them open up these venues so housing zone.

New zealand is that, since the misuse of drugs after 1975, we know that, under this law, that possession of cannabis can carry a maximum sentence of three months imprisonment or 500 vine. If you are carrying 28 grams or more 100 joints or more presumption, is that you’re carrying it for supply and dealing cannabis carries a maximum penalty of 14 years and cultivation is growing. Cannabis have maximum penalty of seven years. The number of people who have been convicted with cannabis offences have been dropping it’s still high, though in 2019 there are 3 000 people per year. In terms of the argument, staying with the prohibition has been around the cost: the new zealand drug harm index of 2016. So this study estimated the social cost of drug related harms and intervention, is about 1.8 billion dollars in 2014 to 2015.. A lot of that is related to cannabis or cannabinoids. Here now this is the important part we talked about the racial inequity that exists. The percentage of people convicted with cannabis offences by ethnicity, the dark orange line is the european. The gray line is mari. The maori communities are disproportionately impacted. New zealand population wise. We think about maori population consisting about 17 percent, the number of percentage of people convicted with cannabis, offense for marriage about close to 50 percent. So it means the rate of police. Contact is three times higher for maori than non murray, which is not explained by differences.

In offending so just to reiterate that mari was three times more likely to be arrested and convicted of a cannabis related crime than non murray and mario, almost twice as likely as non maori to go to court over first offense and nearly seven times more likely to Be charged it’s, a society we’re producing this inequity. Even if we say the cannabis is illegal by legalizing cannabis, it may cause positive implications for social equity outcomes for maori legalizing. It may actually reduce that social harm that may come from unconscious racial bias and i’m. Just going to highlight the fact that the current referendum, the referendum, is about recreational use of cannabis, nothing to do with medicinal cannabis cannabis for medical purposes, entirely separate issue from recreational use, and we should not conflate that. Having said that, at the same time, there is actually a significant overlap between recreational and medicinal use. Some people then say that we should actually just decriminalize it. This will lead to reducing criminalization that reduce the cost of enforcement, like the policing cost and justice costs, and evidence seems to suggest that decriminalizing doesn’t seem to increase, use or dependence. People who are against this idea suggest that, even if you decriminalize it and reduce that social harm that are related with making people criminal, but you know around use of cannabis, the market still is unregulated. The people who are using are not really directed to prevention or heart; you know, treatment and still the risks around police discretion exists.

Therefore, the social harmonic that are caused from kind of the unconscious racial bias can still persist within the model of legalization. So it means that it’s no longer criminal, no longer illegal to you, know, grow supply or sell or use, and the idea is that by legalizing, it’ll reduce, or at least potentially get rid of the illicit market that are usually, you know, run by organized. You know crime groups like gangs and again, the argument is that it may produce income in the form of tax and levy and increase the opportunity for health interventions to occur. People who are against the idea of legalization sense that it sends the wrong message and it may lead to increased access in use and because the private sector will be you know, growing and selling groups or these companies you know to maximize profit. They’Ll be lobbying for greater access to influence or increase use, and some you know argue that legalizing can lead to increased harm psychosis and motor vehicle accident. It’S. Also clear that evidences suggest that there is an increased rate of motor vehicle accidents related to cannabis use as well. Even the legalization model there’s two different models: there’s model like a north american model, which is regulated commercial markets, so the private companies run these businesses but they’re regulated by the government laws but there’s also uruguay, model, where government has a monopoly on cannabis sales. So the builder we’re facing in new zealand, the cannabis legalization and control bills, it says the manufacturing purchasing user restricted to 20 years and over purchase and possession quantities are limited as 14 grams.

You can only use it in private, your own home or licensed promises. You can’t use it in public spaces, you can only grow two plants per person or maximum of four plants per house. Advertising is prohibited, it’s going to be completely regulated and the product will be taxed and there will be a licensed regime and agency, and there is a cap put on legal quantity available for sales and business so that the market does not just grow and grow and Grow so the question that you will be voting on is that do you support the proposed cannabis legalization and control bill if the referendum results in more than 50 percent of voters saying yes, it will lead to next government incoming government introducing bills to parliament, and then They will discuss this further and finalize it. Cannabis is still a substance that can be addictive and it does cause harm so there’s, no such thing as safe use as a population abstinence, is the only way to completely guarantee avoidance of health risk associated with cannabis use. But if people are using delaying the use till they’re older, limiting the use or reducing the use, frequency of use is helpful. Shifting away from the smoking to something like vaporizers may be safer because if they can affect from the lungs, less potent obviously safe as well and again, people with the highest risk of cannabis. Lead problems are people whose family history of psychosis or cardiovascular problems and obviously pregnant women.

These people really should abstain altogether. So, in summary, the proposed cannabis legalization and control bill tries to address multiple health, social and justice issues through the reformation of the cannabis related law. Since it’s, not just health issues, not just social issues or justice issues, we’re trying to address all of these issues in one go and ultimately what i believe is that it’ll be up to you, your own values or what’s, important to decide how you want to vote. So, for example, you might be really really concerned about social injustice, racial inequities and those people are most vulnerable, the young, maori, poor and, and you might think, on the heavy or regular users and you think actually for those groups, this legalization and control bill may actually Reduce harm across the population. Therefore, i support this. However what’s also interesting – and it probably has been talked about a lot – is that for asians, i think in new zealand, for whom there’s a really low prevalence, low rate of cannabis use. This law can also have a very different impact. It may, in fact, increase use in our group as well, so this is again to something to think about. I think what the bill is trying to achieve, as i mentioned, is about reducing social and health related harms. So have a read have a think about it. I don’t think it’s a simple, yes or no.