With the rising trend noted drug consumption, based on the reports from the CNB Drug Situation Reports, from 2006 to 2012, as well as the challenges imposed by the aging demographics of society, lowered fertility rates and the increase in medical costs, medical cannabis and regulated recreational cannabis (marijuana) may present a solution. It could very well serve as a measure to mitigate the problems of increasing drug consumption and increased medical costs that come with an ageing society.
Exploring decriminalisation or even the full legalisation of cannabis requires understanding the Singapore currently adopts a prohibitive regime. To decriminalise cannabis is to stay within the prohibition regime but shift from criminal sanctions to civil sanctions.
To legalise cannabis would be moving from prohibition to permission, acknowledging that while it may not be right or desired, it is up to the individual rather than the government to decide upon its use. A stance which the Singapore government has adopted with two legal drugs and another traditional vice activity - alcohol, tobacco & prostitution.
Given Singapore's vulnerability as a drug transit point and proximity to the Golden Triangle, a significant opium production region, a shift in policy may help arrest the rise in drug consumption. Its legalisation would also help to shift it out of the underground economy, with its attendant criminal elements, and into the open market, where it would be subject to government regulation, taxation and market forces, as with any consumer product.
Medical Cannabis
Medical cannabis has been incorporated into the range of treatments and medical interventions available to individuals in the following jurisdictions: Austria, Canada, Czech Republic, Germany, Israel and certain states of the USA. In Traditional Chinese Medicine, it is considered one of the 50 fundamental herbs for use. During the Islamic Golden Age, Arab physicians utilised the various medicinal properties of cannabis to treat disease and illness.
Having integrated cannabis into the medical infrastructure, Israel is notable as having used it as a medical intervention in patients with cancer, paint-related disorders, chronic pain and post-traumatic stress disorder. Consumption is through oral ingestion, inhalation and skin application. All patients are registered, with their intake subject to medical oversight.
Cannabis has the ability or potential to treat a number of conditions, by virtue of the chemicals THC (tetrahydrocannabinol) and CBD (cannabidiol), as well as other cannabinoids. Some of the conditions where medical cannabis is showing or has shown potential to treat are:
- eating disorders
- anorexia
- insomnia
- PMS
- neurogenic pain
- glaucoma
- asthma
- bipolar disorder
- epilepsy
- colorectal cancer
- leukemia
- depression
In a more local context, it has the ability to act as a pain reliever and has shown itself to alleviate, manage and reduce the symptoms of glaucoma, spasticity in multiple sclerosis, Alzheimer's disease, breast cancer, brain cancer, HIV/AIDS effects, ALS symptoms, diabetes and chemotherapy-induced nausea.
Due to the wide range of symptoms it can treat, by virtue of the cannabinoids, and its potential as a way to treat and halt the progression of cancer, in some cases even reversing cancer formation, it should be considered as a viable therapy adjunct. It offers a medication that can be easily and affordably grown and prepared, with a broad spectrum of properties.
With regard to the aging demographics of Singapore and its neuroprotective ablity, as well as the potential as an anti-depression drug, it could very well have a niche to serve as a therapy adjunct within the medical ecosystem.
Cannabis Harms and Effects
Cannabis is a psychoactive drug, with the principal psychoactive constituent being THC. Cannabis is consumed for its psychoactive and physiological effects, which can include heightened mood or euphoria, relaxation and appetite stimulation. However some negative side-effects can sometimes include a decreased short-term memory, dry mouth, impaired motor skills, red eyes and feelings of paranoia or anxiety for short periods.
Research by Dr Robert Gable, an Emeritus Professor of Psychology at the Claremont Graduate University, and Dr David Nutt, the former President of the European College of Psychopharmacology and current Edmond J Safra Chair at Imperial College, London, has shown cannabis to have lower addiction potential, toxicity, personal harm and social harm 
compared to most illicit drugs. And even safer and less addictive than alcohol and tobacco.
In a 2010 study, the harm caused socially and individually by different narcotics, specific to the UK, found that tobacco and alcohol were far more harmful than cannabis.
Similar research in 2007 found that tobacco and alcohol, both legal drugs, resulted in far greater harm and dependence than even the cannabis and other psychoactive agents.
Finally, cannabis was shown to be share the same dependence potential as caffein, rating below alcohol and nicotine in terms of risk posed by addiction and lethal dose.
In short, cannabis (marijuana), while able to pose a health risk, like alcohol and tobacco, is less likely to result in addiction and results in far less harm than the consumption of tobacco or alcohol.
Aside from the economic case for legalisation, and the medical benefits that can be derived from cannabis, there also remains the issue of cannabis potentially being a gateway to harder drugs. However, research by the American Psychiatric Association in 2006 and the RAND Corporation in 2002 suggests this is not the case. A better explanation is what is called the common-liability/common-factor model, which explains the behaviour of shifting to harder, more harmful drugs as a result of environment and individual tendencies, rather than the preceding use of any specific narcotic.
The Consequences of Prohibition
Milton Friedman, George Akerlof and Vernon Smith, all Nobel Laureates for Economics, were proponents for the legalisation of marijuana, having endorsed a report on the negative economic effects of marijuana prohibition, The Budgetary Implications of Marijuana Prohibition, composed by Professor Jeffrey Miron of Harvard University, where he is the Senior Lecturer and Director of Undergraduate Studies in the Economics Department.
In the context of the USA, the point was raised that prohibition entails direct enforcement costs and indirect legal and punitive costs, as well as prevents taxation of cannabis production, distribution and sale. If cannabis were legalised, it would result in savings of USD $7.7 billion per annum in government expenditure on enforcement of prohibition. It was also noted that legalisation would yield tax revenues of USD $2.4 billion annually if marijuana were subject to a consumer tax, like all other goods, and USD $6.2 billion annually if marijuana were taxed at rates comparable to those on alcohol and tobacco.
Even before this report, Milton Friedman had predicted the negative effects of drug prohibition policies in 1972, by drawing parallels with the Alcohol Prohibition Period of the USA, from 1920-1933, and the negative effects of it, in response to Richard Nixon adopting a prohibitive stance towards drug consumption.
Milton Friedman explained that rendering it illegal did not extinguish demand but pushed consumers to buy from the black market, where organised crime syndicates operate. Operating outside the law resulted in an increase in violent crimes and social hardships, with alcohol not subject to quality control laws. This resulted in producers and traffickers moving towards hard liquor with more concentrated alcohol, rather than bulkier but more dilute wine and beer, as profit margins were higher.
With the end of alcohol prohibition in 1933, alcohol production and distribution returned to the legal market, with violence crimes reducing to former levels and organised crime deteriorating as legitimate producers returned to business with a safer, better, cheaper product. Regulation and legalisation provided safety for consumption, returned revenue to the government and removed the economic incentive enjoyed by black market syndicates.
With drug prohibition, Friedman predicted similar effects to that of the alcohol prohibition era, that demand would remain, and its forbidden status would attract vulnerable youth, increasing demand. With a strong incentive due to high profit margins, black market crime syndicates would enter as producers and sellers, forcing consumers to associate with sellers from criminal backgrounds, with minimal regard to their welfare.
The illegal nature would drive up prices, forcing consumers to potentially enter into crime to finance their addiction. And due to scarcity and illegality, it would create a seller's market where dealers operate on their own rules with regards to quality control, marketing and price.
In these conditions, producers are pushed to either produce more potent versions of one product, or shift to production of harder, more harmful drugs with greater addiction potential. Similarly, drug consumers who were treated as criminals were more likely to be socially disenfranchised and remain underground. Those arrested and imprisoned increase the expenditure of resources of the public security apparatus, prison service and judiciary.
And these predictions came to pass, as the War of Drugs and prohibitive policies has resulted in enormous financial costs imposed on the US government. The US has the highest incarceration rate and prison population in the world, related to its drug policies and sentencing guidelines for drug crimes. It has also resulted in a greater public tax burden, with the requirement to fund the judicial, police and prison service organisations sustained by these policies.
In the Netherlands, the trend of increasing THC content in cannabis, even with a policy of decriminalisation and tolerance, is an effect of the seller's market. Demand remains, and with supply scarcity, producers are incentivised obtain better conditions for a sale and higher prices, resulting in the drive to increase product potency. A situation similar to the Prohibition, and predicted by Friedman as well.
Portugal, which decriminalised the personal possession and consumption of drugs, saw a large reduction in drug consumption, drug-related harms and reduced enforcement burdens. This policy was based on the shift from viewing it as a public security matter to a public health matter, in part to reduce the spread of HIV/AIDS via needle use. It has resulted in
Legalisation within a regulatory framework minimises the economic incentive found in black markets to shift to harder drugs or more potent product versions, which comes from high profit margins. It ensures the safety of consumers and the minimisation of organised crime involvement in the trade. This was clearly shown to be the case with alcohol through the American Prohibition, a drug which is more addictive and far more harmful socially than cannabis.
Demand will always remain, and harm will occur regardless, so the best way forward would be to control and regulate supply, as well as minimise the harm that comes about through public education. And this approach is one that governments worldwide have adopted towards tobacco and alcohol.
In the case of tobacco in Singapore, per capita cigarette consumption in Singapore has decreased with the increase in real retail price, tracked from 1987-2005. Taking into account population growth, the data indicates that real retail price increases serve to regulate and reduce consumption. This illustrates the ability of economic forces to control consumption of a legal drug.
Conclusion
Legalising it would be in contravention of the Single Convention of Narcotic Drugs of 1961, which bans the sale of cannabis for non-medical use. However it must be recognised that there are 2 conversations with drugs; the positive effects and the negative consequences.
Drug use can consume and disrupt social welfare, just as much as it can contribute to positive outcomes and beneficial experiences when regulated and used in moderation. They are problems that can come from the drugs themselves and the problems that come with them being illegal, on an individual and societal scale. It requires looking at the evidence rationally and calibrating public policy to optimise the benefits and negating the costs.Legalisation and decriminalisation offer two approaches to solving an issue that will remain with us as a nation and society.
The major reasons for the continued legal status of alcohol and tobacco is a combination of both a lack of stigma and the revenue generated from their sale. Tobacco taxes generated USD $749 million for the Singapore government in 2011, a significant source of income. Notably, the government prosecutes contraband smuggling from overseas for a simple reason - theft. Smuggling and consumption of contraband cigarettes denies them their tax revenue.
We can rationally look at it and calibrate our policy in order to permit, profit and benefit from cannabis, while minimising its harms through restriction and controlled use. Or we can continue to expend resources on prohibiting it and suffering the consequences of continued prohibition.
Ultimately, the compelling economic, social and historical evidence forces one to seriously consider decriminalisation at the minimum, with legalisation and strict regulation at the maximum, in the search for a long-term solution.
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Shiwen Yap
TRS Contributor