Review of the Cannabis Control Act 2003

Submission by the AMA (WA)
2 August, 2007

Summary

1. In making this submission on the review of the Cannabis Control Act 2003 (CCA), the Australian Medical Association in Western Australia [AMA (WA)] has consulted widely on the prevalence and health consequences of cannabis use in Western Australia and the perceived strengths and weakness of the CCA in reducing the harmful effects of this illicit drug.
   
   
2. The AMA (WA), because of an increasing ambivalence to cannabis use, feels the need to remind the Minister that the overwhelming body of medical evidence points to Cannabis being a harmful drug, both at the individual and community level.
   
   
3. In order to reduce the health and social consequences arising from cannabis and other drug misuse, public policy should provide for programmes aimed at delaying the use of cannabis by adolescents and reducing the frequency of use by all cannabis users, not just the small minority in contact with the justice system.
   
   
4. At present, young cannabis users (under 18 years) are not eligible for a Cannabis Infringement Notice (CIN). They are dealt with under the Young Offenders Act 1994 and are most at risk from the harmful effects of cannabis use. However, they cannot be compelled to undergo any form of counselling or social assessment.
   
   
5. The AMA recommends that new legislation is introduced to provide for the conditional cautioning of all teenagers with a cannabis related offence and the mandated assessment of their drug problem including its impact on their health and social wellbeing, family relationships and school performance.
   
   
6. The Cannabis Infringement Notice (CIN) scheme has proved a total failure in persuading cannabis offenders to undertake a drug education course. The reasons for this require examination. One possibility is that the option of paying a small fine is a disincentive for cannabis users to examine the health and social consequences of their drug use. Access to services, appropriate to needs and under the umbrella of the CIN scheme, may also be an issue.
   
   
7. There are well researched and evidence-based harm reduction approaches to supporting young people and others with drug related problems. These motivational interventions may be employed to advantage across the health sector and are designed to support drug users challenge their drug use and make lifestyle changes.
   
   
8. Family doctors are the first point of contact for most drug users, the vast majority of whom are neither in contact with the police or specialist drug users. Family doctors are an important resource in the prevention and management of drug related problems and are uniquely placed to work with offenders issued with a Cannabis Infringement Notice.

AMA (WA) Feedback on Specific Issues

1. Trends in the prevalence of cannabis use before and after the CIN scheme

1. The AMA (WA) notes that cannabis use in WA is declining but cautions against drawing any association between this decline and the introduction of the CCA. There has been a parallel reduction in smoking across the population and an increased awareness of smoking related health effects. The reduction in cannabis use could be a secondary effect of a highly successful and sustained public education campaign to reduce smoking.

2. Increased knowledge of and awareness about the harms and prohibition associated with cannabis

1. Prior to the introduction of the CCA, a Working Party recommended that in order to prevent confusion about the status of illicit drugs in general, there should be a comprehensive public education campaign. Key aims were to educate the community that the possession and cultivation of cannabis was still illegal, that cannabis use was harmful to health and that specialist services were available to support those with problems.
   
   
2. The AMA (WA) is concerned that there has been a systematic failure to educate the public on cannabis, with negative consequences within the wider community and on the health of young people. Importantly, this failure may have contributed to an acceptability of cannabis within youth culture and led to a view that cannabis is a relatively harmless drug.
   

Recommendation 1

The AMA (WA) recommends a renewed, comprehensive and sustained public education programme on the health and social consequences relating to cannabis use.

3. Improving the help-seeking behaviour of those with cannabis related problems

1. Only 2% of cannabis users have contact with the criminal justice system in any one year so the CIN scheme was only ever going to reach a small percentage of users. Of those issued with a CIN (9328 to end of March quarter 2007), only 13% (1250) completed a cannabis education course. This is an extremely disappointing outcome. In addition, the scheme has a high default rate amongst those with a criminal record, amongst indigenous offenders and amongst those with poor access to specialist services.
   
   
2. At a population level, the CIN scheme has had minimal impact on improving help-seeking behaviour of those with cannabis related problems. We note that in previous surveys, 78% of a general population sample viewed education as a more appropriate response to minor cannabis offences than legal sanctions that resulted in a criminal record. In addition, 81% of a sample of regular (at least weekly) cannabis users reported they would be more willing to seek treatment as a result of the CIN scheme.
   
   
3. The poor uptake of cannabis educational sessions is therefore at contrast to these surveys and would indicate that present arrangements are not meeting health needs. Furthermore, the opportunity provided by the legislative change to remove a barrier for cannabis users in the community to voluntarily seek help has not been capitalized on by developing community based treatment services for cannabis users.
   
   
4. There is strong evidence that brief motivational interventions by health professionals are effective in helping drug users to examine their lifestyle and make positive changes to reduce harm.

Recommendation 2

The AMA (WA) recommends expanding cannabis educational sessions to include GPs (trained in motivational techniques) as a way of improving access to services for all cannabis users including those receiving a CIN, especially those living in rural and remote areas.

4. Framework for cautioning juveniles who commit minor cannabis offences

1. In WA, approximately 600 young people under 18 years are cautioned each year for drug related offences. However, under existing cannabis legislation, they cannot be issued with a conditional caution that mandates for a full assessment of their drug problem and its impact on their health and wellbeing, including relationships with family and school performance.
   
   
2. The AMA (WA) wishes to highlight the vulnerability of young people to cannabis and other drugs and the need for special measures to protect their health.
   
   
3. Young people are physically and emotionally immature. They have a propensity for risk taking, including experimentation with drugs. Feelings of invincibility and a failure to think through the consequences of their actions means they are at high risk of harm when intoxicated with cannabis and other drugs.
   
   
4. Young people fail to appreciate the ease with which they may become dependent on cannabis as a coping strategy for stress. When faced with problems, they have difficulty understanding and talking about their feelings and are reluctant to seek help. Cannabis and other drugs may therefore be used to manage short term stress. Use can quickly escalate and dependency can follow. The regular use of cannabis can lead to family and relationship problems and impact on school performance. Early cannabis use can be an indicator of other problems within the young person and their family.
   
   
5. The early use of cannabis by teenagers and "daily or near daily use" are consistent predictors of a range of serious consequences, including depression, anxiety and psychosis. In addition, young people who are regular users are more likely to become dependent on cannabis and to drop out of school. Once marginalized, vulnerable young people have difficulty in accessing help and in obtaining support from mainstream services.
   
   
6. There is good evidence that health professionals and others can make a difference in young people’s lives through positive engagement and the use of consultation skills based on motivational interviewing principles. This opportunity to reduce the harmful effects of cannabis use by young people must not be missed.

Recommendation 3

The AMA recommends that new legislation is introduced to provide for the conditional cautioning of all teenagers with a cannabis related offence and the mandated assessment of their drug problem including its impact on their health and social wellbeing, family relationships and school performance.

5. The feasibility of introducing mandatory cannabis education sessions for all persons issued with a CIN

1. As cannabis is primarily a health issue, a key consideration of criminal justice initiatives should be the reduction of barriers to those wishing to voluntarily access health services or seek help with cannabis and other drug related problems. Family doctors are well placed to support those at risk of cannabis related problems, but only if they have the necessary skills and confidence to work with drug users and are supported by specialist drug and mental health workers and agencies.
   
   
2. Brief interventions using techniques such as Motivational Interviewing can be employed to advantage within the primary care setting. Skills in such techniques can help users identify their own problems, make lifestyle changes and set outcome goals.
   
   
3. Mandating cannabis education sessions for all persons issued with a CIN is probably not a feasible option - for two reasons. Firstly, access and choice of service provider is an important consideration if uptake is to be improved. Ideally, such education should be primary care based with onward referral to specialist agencies where appropriate. However, there is presently a lack of capacity within the health sector and a need to develop educational programmes aimed at enhancing brief-intervention skills for interested GPs. Secondly, young people apart, forcing adult cannabis users who lack motivation to attend education sessions is unlikely to result in a positive outcome. Motivation to attend for education may be improved if financial penalties are significantly increased.
   
   
4. Women who are pregnant are more highly motivated than the general population to make lifestyle changes. Cannabis is the most commonly used illicit drug amongst women of child bearing age and women who continue to smoke cannabis during pregnancy may have lower birth weight babies. While cannabis use does not appear to increase the risk of miscarriage or birth defects, children exposed to cannabis in the womb can experience more difficulty with problem solving and attention, impacting adversely on their education potential. For this reason, females issued with a CIN should also receive advice on the potential risks of cannabis during pregnancy and specialist ante-natal services available.