It’s Only Cannabis-

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” A framework for a regulated market for cannabis in the UK:
Recommendations from an expert panel”

https://twitter.com/cslhginfo/status/1009331027452493825

davemem

Impending Legislation in the UK from a viewpoint of a peer-led support group. Picking up the pieces regardless of the law.

1.0 Context
Cannabis is the most widely-used illegal drug in Britain.
According to the Statistics on Drug Misuse: England, 2018, 6.6% of adults 16-59 reported having smoked cannabis in the last year.
29% of adults have smoked cannabis at least once in their life (EU average 26%).
Among younger adults aged 11-15, cannabis was also the most commonly used drug,
with 8% having admitted using it in the preceding year. 

2.0 Introduction
In view of recent cuts in services, the recovery resources available to current and former drug users have been further squeezed. [REF-001] Most commissioners and providers have reverted to a ‘fire-fighting’ model of greater harm/crime reduction which naturally has prioritised users of heroin and crack to the detriment of all other service users. Buoyed by legislative…

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It’s Only Cannabis-

Impending Legislation in the UK from a viewpoint of a peer-led support group. Picking up the pieces regardless of the law.

1.0 Context
Cannabis is the most widely-used illegal drug in Britain.
According to the Statistics on Drug Misuse: England, 2018, 6.6% of adults 16-59 reported having smoked cannabis in the last year.
29% of adults have smoked cannabis at least once in their life (EU average 26%).
Among younger adults aged 11-15, cannabis was also the most commonly used drug,
with 8% having admitted using it in the preceding year. 

2.0 Introduction
In view of recent cuts in services, the recovery resources available to current and former drug users have been further squeezed. [REF-001] Most commissioners and providers have reverted to a ‘fire-fighting’ model of greater harm/crime reduction which naturally has prioritised users of heroin and crack to the detriment of all other service users. Buoyed by legislative developments in US states – where evidence suggested that even violent crime had been reduced as a consequence of cannabis legalisation [REF-002]– and the development of medical CBD markets, cannabis users in particular have been pushed even further down the list of priorities as cannabis use perception switches away from a harmful illegal drug towards a society preparing for possible legalisation. This, coupled with the wider belief that cannabis is a soft drug, with no physical dependency, does not fit into the bracket of a problematic drug [REF-003]. This view is present not only within the drug-using community, but in wider society and even some parts of addiction services.

2.1 The three strands:
(1) Increased THC content/reduced CBD content.
(2) Lack of understanding/recognition of cannabis as a problematic drug.
(3) Reduced resources and priorities as part of wider austerity cuts.

Combine to exacerbate the cannabis misuse crisis that is present in UK society.
Presently there is no evidence to suggest a physical addiction, however, there is a universally recognised condition of psychological dependency. In addition, there is Cannabis Use Disorder, documented in DSM-5 below:

2.2 The Problem Area
2.2.1 DSM-5 Definition of Cannabis Use Disorder

  • Cannabis is often taken in larger amounts or over a longer period than was intended.
  • There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.
  • A great deal of time is spent in activities necessary to obtain cannabis, consume cannabis, or recover from its effects.
  • Important social, occupational, or recreational activities are given up or reduced because of cannabis consumption.
  • Cannabis consumption is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.
  • Tolerance, as defined by either a need for markedly increased cannabis to achieve intoxication or a desired effect or a markedly diminished effect with continued consumption of the same amount of the substance.
  • Withdrawal, as manifested by either the characteristic withdrawal syndrome for cannabis or cannabis is taken to relieve or avoid withdrawal symptoms.

2.2.2  Reality
Despite the widely held view that cannabis is not a problematic drug, significantly more users are presenting at services citing cannabis as a drug that creates serious issues affecting their relationships, lifestyle, career, and mental health [REF-004]. The reasons for this are multiple and complex. Firstly, it may be argued that traditional services are now well established, accessible, and better-known to the using community, particularly in an aging, experienced, media savvy drug-using population. Secondly, users who have addressed and managed an opiate addiction, for example, may still be using cannabis and alcohol to help maintain their drug of choice recovery. They may, however, continue to be locked into a routine of cannabis use that is becoming more frequent, stronger, and increasingly problematic. Finally, and perhaps more significantly, the nature of cannabis production has changed over the past 30 years to include a higher THC content whilst containing lower CBD levels. [REF-005] With CBD showing evidence of mitigating psychotic tendencies of THC [REF-006] its absence from street cannabis may account for increasing problematic use. Furthermore, anecdotal evidence suggests untested chemical compounds are increasingly used in the domestic growing process to enhance growing/flowering with the aim of increasing potency and yield. The result of these stronger cannabis strains has manifested in more presentations of mental health problems such as: psychosis, paranoia, depression, and schizophrenia. [REF-007]

2.2.3 Services
To further compound the issues facing problematic cannabis users, individuals seeking help with their cannabis misuse are less likely to engage with traditional services. The Adult Psychiatric Morbidity Survey reports 36.2% of drug users dependent on drugs other than cannabis have received treatment, help, or advice, whereas users of cannabis were half as likely to have received the same support. [REF-003] Reasons for this are steeped in perceptions of drug treatment centres and are engulfed in widely held beliefs between users concerning drug use hierarchy and stigma. Firstly, cannabis users are less likely to see their drug use as problematic or dependent and are more likely to see users of other (harder) drugs as suffering from addiction and having nothing in common with their drug of choice. Again, this is reinforced through widely-held beliefs in the greater (non-drug using) population, including some traditional services. [REF-004]

Cannabis users do display many symptoms and issues that they have in common with other substance users. Issues such as heightened anxiety and paranoia may be shared with stimulant users, whereas Issues of isolation and withdrawal from society may be shared with depressant users. Similarly, cannabis users may, like abusers of alcohol, come under tremendous social pressures in an environment of acceptance and normalisation. Cannabis users do however have a set of unique circumstances unlike other addictions.

The single issue of isolation and the general withdrawal from society makes problematic cannabis use less visible. Cannabis users are less likely to commit crime or become violent [REF-008] than other substance users and as such reduces the visibility of problematic use. Similarly, hospitalisation and medical intervention is not likely to occur until after many years of problematic use [REF-009] Also, the production and distribution of cannabis is well established in the UK and is not limited to geographical areas.

In user-led self-help groups such as The Cannabis, Spice & Legal Highs Group, attendees report a reluctance to engage with traditional services. More so there is also initial resistance to attending other mutual aid groups such as Narcotics Anonymous (NA) and Self-Management Recovery Training (SMART) for the same reasons stated earlier of not wanting to mix with ‘hardened’ drug users. This distancing of cannabis users from the wider recovery community is a consequence of the specific characteristics of frequent and prolonged cannabis use. Problematic cannabis users are more likely to suffer from isolation, paranoia and depression and as a result are more likely to avoid larger social gatherings. Within Cannabis, Spice & Legal Highs Group meetings, attendees often have a preliminary view that they are suffering alone and that their symptoms and frustrations are unique.

2.2.4 Disclaimer
Before outlining possible solutions, it must be pointed out that there is no universal fix or ‘one size fits all’ solution. Since each cannabis user (like all substance users) began their own addiction from a unique and individual set of circumstances, their exit from addiction will be equally unique. More importantly, individuals need to define their own recovery based on their own experience and taking responsibility for a path and pace that works best for them. There is a misplaced view in recovering addicts that conflates progression with knowledge and perceived wisdom. There is also a desire to ‘give service’ and help others but without appropriate maturity this can manifest as advice given in comments such as: ‘what worked for me, will work for you’. It is common to hear recovering addicts advising those newer to recovery with ‘you should or shouldn’t do this or that’. This approach is not always helpful, worse still it can further isolate newcomers who may have had to overcome anxiety and stress to make it to the meeting in the first place.

2.3 Solutions
In order to get help, cannabis users have to be identified and offered realistic pathways into recovery. As is often the case with an aging drug-using population, word of mouth and personal referral is often the key. The vast majority of the illicit drug trade relies on an absence of marketing and thus a word of mouth culture persists, driving functionality where information on drugs and drug dealers is communicated socially. Friends often introduce a drug culture to a peer group and recovery is no exception. In the same way, one member of a social group may enter recovery and others may follow. They may act as a pathway to services and abstinence by example. This phenomenon also conforms to a cycle of drug use that is particularly prevalent where addictions last over 20 years. Users in this cohort rarely use as a result of the motivations and circumstances that originally got them into drug taking in the first place. Following this, a process of sick and tired of being sick and tired [REF-010] becomes to take hold. Such users at the end of their addiction begin to research and enquire possible pathways to recovery [Fig-1-Cycle of Change]. However, without clear guidelines, pathways, and examples of peers who have been through recovery, it is difficult for the addict who is ready for change to access traditional services and support. GP practices are often the first option but can often prove ineffective. There is also a real fear of lack of confidentiality, inadequate knowledge, a poor experience of the issues, and an absence of a practical treatment-based solution for cannabis rehabilitation.

More often than not, cannabis users are unaware of available help. Most peer examples of abstinence are achieved as individual efforts. Users of other drugs, like heroin and crack, may present at services as a result of an intervention such as a criminal conviction or hospital admission. However, with even chronic cannabis users, this is statistically less likely. Only recently has cannabis support provision been identified as a result of increased presentations. [REF-005]

Forward-looking organisations such as The Bridge Project in Bradford have been frontrunners in highlighting the increasing dangers of cannabis misuse: both traditional, contemporary, and synthetic. It was from this concern and knowledge that the Cannabis, Spice & Legal Highs Group was formed as a collaboration between Bridge practitioners and service users in March of 2015. The group offers peer-led, non-judgemental advice and information in mutual aid meetings in local venues. To date, over 200 individual users have attended meetings and events, with over 729 instances of attendance in 2017. [REF-0011]

The recent rise in synthetic cannabis, specifically the advent of spice (the so-called ‘zombie drug’), is perhaps a precursor to the future development of street cannabis with particular reference to increased potency, not necessarily by increasing THC but by the introduction of more unknown and untested psychoactive compounds. Additionally, a real risk of the addition of psychoactive substances to street cannabis is statistically likely if anecdotal evidence of fentanyl added to street heroin [REF-012] is considered as a president. Dealers are more likely to put increasing potency as a factor in highlighting their product before any medium or long-term health risks.

It could be argued that legalisation may address this issue of THC/CBD ratios where evidence has been shown that higher ratios of THC produce an increased risk of dependence, memory impairment, and psychosis. [REF-013] With a regulated market comes the opportunities to apply a uniform quality benchmark that includes an increased CBD content that will not affect the users experience but includes mitigating anti-psychotic properties [REF-006].

In addition, other benefits to legalisation include the decriminalisation of users and the control of criminal involvement in production, distribution, and significantly in terms of financial gain. Moreover, the increased state revenues through taxation and licensing can be re-invested into addiction services, education, and better research. Such measures also are likely to lead to a reduced burden on police, emergency services, the NHS, and mental health services.

Caution should accompany any talk of legalisation. As previously stated there are no silver bullet solutions. As a comparison, UK alcohol legislation, in practise, can hardly be viewed as a success story. Legalisation of alcohol has done little to reduce alcohol abuse, despite education campaigns, voluntary industry codes, and changes to licencing laws. If cannabis was to mirror alcohol’s path in terms of delivery and outcome, the UK will find its population firmly rooted to the top of misuse league tables and having to deal with all the associated problems and resulting costs. Cannabis legislation is currently less harmful as an illicit controlled drug than a rushed, ill-thought-out piece of legislation with only a verisimilitude approach to the underlying issues. In short, the harms of a poorly conceived and executed cannabis legalisation programme could be more damaging than the current status quo. This is an example where no deal really would be better than a bad deal.

2.3.1 A deeper look at Legalisation
Any effective cannabis legalisation programme would have to address the following issues:

2.3.2 Control
In order to take control out of the hands of criminal gangs, the state would have to seize the production and distribution of cannabis. The current free market in alcoholic beverages of (private) licenced premises is expensive and failing. A more effective solution would be to put the means of production and distribution in a state monopoly, at least initially, in a similar model to Sweden’s state-run monopoly on alcohol. The Systembolaget (The System) is a government-owned chain of off licences that are the only licenced retail store allowed to sell alcohol in Sweden. [REF-014] Any UK government advocating such state monopoly control would receive opposition, particularly from commercial interests that may wish (and are currently planning) to capitalise on such a scenario. However, particularly in the early years of a legislation change, overall control is essential in order for the programme to work. A correctly administered state-controlled distribution system could also comprehensively monitor and control consumption and quality. There may well be good reason to slowly turn the process over to commercial interests in the future, but only after a sustained period of stability and under strictly enforced guidelines.

2.3.3 Treatment
As with alcohol, or any drug, a certain proportion of the population, perhaps up to 10%, will misuse drugs regardless of the legal status. An effective network of drug addiction services must be adequately funded to deliver front-line services. This can be funded directly through distribution profits. Furthermore, state profits from legal cannabis sales could be re-invested into other substance misuse treatment programmes. The promotion of realistic recovery and effective treatment within a framework of un-stigmatised drug association will only work well in adequately funded, resourced and supported services, unlike the current status of drug and alcohol services.

2.3.4 Research
A criticism of current academic and scientific research is the lack of transparency and accessibility. To a certain extent, such reluctance to share information and practice also exists within traditional addiction services. [REF-015] As part of a cannabis legalisation programme, research would be adequately funded and charities and community groups should be encouraged to research wider aspects of cannabis use. Results and findings must be communicated in the wider population through: community, school, college, university, and media networks. In particular, an investigation into possible medical benefits suffers from a comprehensive qualitative and quantitative research policy. A wider funded approach would produce more effective investigation, particularly where known benefits have been highlighted in areas such as: pain relief, multiple sclerosis, arthritis, and certain cancer treatments.

2.3.5 Education
Again, using UK alcohol legislation and policy as a comparison of how not to handle a change in statute direction, education must be at the heart of any potential policy. The damage cannabis can do to the young-developing brain has been well documented. [REF-016] Applying a minimum consumption age for legal cannabis is unavoidable and by the same measure will inevitably lead to some adolescents using cannabis regardless of the law. Only a comprehensive education programme from an early age can reduce the danger of damage in young-developing brains. The unpopular but effective measure of testing under-18s for cannabis consumption would help to monitor, control, and enforce an age-related ban on legally available cannabis.

2.3.6 Enforcement
In order to maintain an effective embargo on non-legal cannabis, the law would have to be actively used in closing down what is in the UK: an advanced domestic growers market.  The proliferation of cannabis farms is more likely to become less numerous as new legislation would price criminal gangs out of the illicit market in search of greater profits elsewhere. Individual homegrown crops, however, could prove more persistent due to the isolated nature of numerous individual grows. A better regulation of the home-grow sector, hydroponics and sodium lighting distribution, including the import and sale of nutrients, would help to further control this sector. The state would also have to rigorously enforce testing particularly in the areas of transport, youth, the workplace, and prisons. Any detection of drug misuse, illicit drug or otherwise, must be met with a comprehensive treatment and education programme.

2.3.7 Pricing
The unit cost and pricing structure of a legally available product will always be in direct competition with the criminal market. If legal cannabis becomes overpriced, the illegal market will naturally prevail. The factors of quality and availability are secondary to fundamental pricing. This again reiterates state involvement. Even beyond a state monopoly the government must have the authority to set the price of cannabis. The alternative is clear to see even in the regulated pharmaceutical sector, where drug prices can spiral out of control in a race for profit. There may be evidence to underprice the market initially in order drive out the criminal sector.

2.3.8 Delivery
By taking control of the cannabis market, the state would be able to re-think the process of delivery. In terms of viewing delivery in a harm-reduction context, the distancing of smoking as a delivery method must be a priority. The development of other delivery systems such as ingestion by edible products, nasal and oral sprays, patches, and beverages should be developed and encouraged as a healthier alternative to smoking which, has proven links to increased risk with nicotine dependence displaying clear associations to cannabis use disorder symptom [REF-017]. The opportunity for controlling tobacco consumption as a health choice can also be incorporated into cannabis legislation solutions.

2.3.9 Medical Cannabis/Recreational Use
Within the context of legalisation a clear distinction must be established from the onset to distance genuine medical users from problematic recreational use. Specifically, the following areas with regard to screening need to be addressed: [REF-018]:

(1) Existing cannabis screening tools may not be equally valid across medical and recreational users.
(2) Individual screening items may have different implications for recreational and medical users.
(3) There is a need to develop and validate criteria for problematic use in medical cannabis patients.
(4) Finally, the prescription of medical cannabis must follow strict clinical guidelines with caution regarding dependency and misuse.

To some extent it is the medical cannabis sector that the state must regulate the most. Pharmaceutical corporation lobby groups will be keen to exploit any legislation change and immense pressure will be put on legislation designers to appease commercial interests, this must not be to the detriment of greater potential benefit to the overall cannabis market.

2.3.10 Micro Economy
Most issues of state revenue (through taxation) result due to a change in legislation that will require careful consideration and planning in order to support the implementation of drug policy as largely described previously. The issue of local economic factors must also be addressed. The presence of money from the local cannabis market is not inconsiderate. We must accept the reality of drug markets and illicit revenue on local communities and its absence if the market is successfully regulated. Local growers and dealers are responsible for injecting revenue, employment and investment in to certain communities and some fragile economies may suffer adverse effects of legalisation that have not been fully considered.

2.3.11 Review
The issue surrounding UK legalisation has never been closer to a realistic possibility than it is today. Examples of European and US states have led the way in sea changes in the law. Feedback is ongoing and dynamic. It is imperative to monitor progress and consequence, adapting legislation and its approach accordingly.  Controlling the cannabis market, would impact the wider drugs community. It is not uncommon for users of harder drugs to finance their addiction by selling cannabis. The advent of legalisation and state dominance of the cannabis market would close this revenue stream, resulting in severe impact to users of other drugs. Any care and treatment policy would need to react to such implications. By dominating the market, influence, and manipulation can affect potency, availability, frequency of use, choice, impact, and perceptions of drug use – none of which the state has effective influence over at the moment.

2.4 Conclusions
The imminent arrival of a change in cannabis legislation is more likely now than at any point within the past 50 years. Only in recent years has UK society begun to seriously consider and debate practical and workable scenarios and consequences. A real opportunity exists to tackle substance misuse in the wider sense. Specifically, evidence exists to suggest the likelihood of impacting tobacco and alcohol consumption, the latter of which may mirror outcomes identified in recent studies in the US where the relationship between alcohol and marijuana use was found to be decreasing since the passing of legalisation of cannabis [REF-019].

Undoubtedly, the greatest risk to cannabis legalisation lies with potentially increasing harm to youth. Both policy and legislation must be crafted carefully to incorporate opportunities for youth to self-refer to cannabis support [REF-020].

Despite the fact that, largely, the desire for legalisation is driven by (private) economic benefit motivations [REF-021], the temptation to loosely regulate the market must be resisted to enable the state to control and dominate the cannabis market in its entirety.

Cannabis, Spice & Legal Highs Group
https://www.cslhg.org
M. 07821 946 883
E. cslhginfo@gmail.com
Twitter: @cslhginfo
Facebook: fb.me/cslhg

3.0 References

[001]
“Cuts to Addiction Services Since 2010 [INFOGRAPHIC]”
Cassiobury Court
https://www.cassioburycourt.com/article/102/cuts-to-addiction-services-since-2010-[infographic]

[002]
“Is Legal Pot Crippling Mexican Drug Trafficking Organizations?
The Effect of Medical Marijuana Laws on US Crime” – (December 27, 2014). – Gavrilova, Evelina and Kamada, Takuma and Zoutman, Floris.
https://ssrn.com/abstract=2350101http://dx.doi.org/10.2139/ssrn.2350101

[003]
“Highways and Buyways: A snapshot of UK drug scenes”
Drugwise. 2016- Sharpio, H. Daly, M.
http://www.drugwise.org.uk/wp-content/uploads/Highwaysandbyways.pdf

[004]
Cuts to addiction services are a false economy
The BMJ Opinion- May 25, 2017- Colin Drummond.
http://blogs.bmj.com/bmj/2017/05/25/colin-drummond-cuts-to-addiction-services-in-england-are-a-false-economy/

[005]
“Why did cannabis treatment presentations rise in England from 2004/05 to 2013/14?”
Drug and Alcohol Today. 17(4). 2017′ -McCulloch, E.
https://www.researchgate.net/publication/320535752_Why_did_cannabis_treatment_presentations_rise_in_England_from_200405_to_201314

[006]
“Can we make Cannabis safer?” Lancet Psychiatry. 2017.
Englund, A. Freeman, T. Murray, R. McGuire, P.
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30075-5/fulltext?elsca1=tlpr

[007]
“Statistics on drug misuse, England” NHS. 2017’
https://www.gov.uk/government/statistics/statistics-on-drug-misuse-england-2017

[008]
Predictors of violence in young tourists: a comparative study of British, German and Spanish holidaymakers Hughes K et al.
European Journal of Public Health, 2008, 18:569-574

[009]
Hospitalizations Related to Drug Abuse
Cheryl A. Kassed, Ph.D., Katharine R. Levit, and Megan M. Hambrick, M.S.W.
2005- Statistical Brief #39. Healthcare Cost and Utilization Project (HCUP). May 2008. Agency for Healthcare Research and Quality, Rockville, MD.
www.hcup-us.ahrq.gov/reports/statbriefs/sb39.jsp

[010]
21st Century Research on Drugs and Ethnicity: Studies Supported by the National Institute on Drug Abuse -P19, P24, P29-31 Peter L. Myers
https://books.google.co.uk/books?id=OjxpAwAAQBAJ&pg=PA29&lpg=PA29&dq=sick+and+tired+of+being+sick+and+tired++drugs&source=bl&ots=WPMt8HWVWi&sig=gfxX2Pnq8HAkQCLQ62gpwq7knBM&hl=en&sa=X&ved=0ahUKEwj62fHZzZjZAhULW8AKHaMGBUQQ6AEIZjAN#v=onepage&q=sick%20and%20tired%20of%20being%20sick%20and%20tired%20%20drugs&f=false

[011]
Cannabis, Spice and Legal Highs Group – Report 2017 -Attendance data
https://docs.wixstatic.com/ugd/6914c2_bc1bb7915e9245c396c0f61bc0811061.pdf

[012]
Is There a Relationship Between Street Heroin Purity and Drug‐Related Emergencies and/or Drug‐Related Deaths? An Analysis from Vienna, Austria
The Journal of Forensic Sciences- Volume 52, Issue 5. September 2007 -Pages 1171–1176
Daniele Risser M.D., Alfred Uhl Ph.D., Felicitas Oberndorfer M.D., Selma Hönigschnabl M.D., Martin Stichenwirth M.D., Robert Hirz Ph.D., Dieter Sebald M.D.
http://onlinelibrary.wiley.com/doi/10.1111/j.1556-4029.2007.00507.x/full

[013]
The Tide Effect -How the World is Changing its Mind on Cannabis Legalisation- Boris Starling
Plotting Changes -Volteface Journal Issue 01-p10
http://volteface.me/volteface-publish-first-journal-plotting-change/

[014]
Systembolaget
https://en.wikipedia.org/wiki/Systembolaget

[015]
Black Sheep- Lizzie McCulloch
Plotting Changes -Volteface Journal Issue 01-p118
http://volteface.me/volteface-publish-first-journal-plotting-change/

[016]
Effects of Cannabis on the Adolescent Brain
Current Pharmaceutical Design- Volume 20, Issue 13, 2014
Joanna Jacobus, Susan F. Tapert.
http://www.eurekaselect.com/111820/article

[017]
Nicotine dependence predicts cannabis use disorder symptoms among adolescents and young adults
Lisa Dierkera, Jessica Braymillerb, Jennifer Rosea, Renee Goodwinc,, Arielle Selyae
Drug and Alcohol Dependence. 16 April 2018
https://doi.org/10.1016/j.drugalcdep.2018.02.037

[018]
Rethinking indicators of problematic cannabis use in the era of medical cannabis legalization
Sharon R.Sznitmana, Robin Room
Addictive Behaviors, Volume 77, 2018, Pages 100-101, ISSN 0306-4603,
https://doi.org/10.1016/j.addbeh.2017.09.026

[019]
The impact of the legalization of recreational marijuana on college students
Jacob Jones, K.Nicole Jones, Jenny Peil
Addictive Behaviors, Volume 77, February 2018, Pages 255-259
https://doi.org/10.1016/j.addbeh.2017.08.015

[020]
Legalization of cannabis: Considerations for intervening with adolescent consumers
Denise D.Walker
Preventive Medicine, Volume 104, November 2017, Pages 37-39
https://doi.org/10.1016/j.ypmed.2017.07.010

[021]
Public perceptions of arguments supporting and opposing recreational marijuana legalization
Emma E.McGinty, Jeff Niederdepped, KathrynHeley, Colleen L.Barry
Preventive Medicine, Volume 99, June 2017, Pages 80-86
https://doi.org/10.1016/j.ypmed.2017.01.024cslh-6


[Fig-1-Cycle of Change]

cycle-change-thumb

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Cannabis, Spice & Legal Highs Group

cslhg.org

The Cannabis, Spice and Legal Highs group provides essential information, advice, assistance and support to long-term chronic users and their families, support workers and concerned others. We host mutual aid support groups in local venues where experience and advice is shared in a safe nonjudgmental abstinence based user-led environment. We use, web, social media and emerging technologies to promote our delivery model.

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We believe all drug users have the ability to turn their lives around and make positive, sustainable change to their personal circumstances and the communities they live in.

We attract a unique membership and have assumed a responsibility to service users of cannabis, spice and legal highs who would not normally access traditional services.
The serious issues we address include; anxiety, depression, isolation, confidence, sleep & insomnia, psychosis, paranoia, schizophrenia, unemployment, homelessness, poverty, offending, child support, custody issues and institutionalisation.

castle-heights-5

Our target member might be sat in a bedsit, isolated, anxious and unfit for work or social activity. We want to project the principles and ethos of our group deep into the communities we serve, providing potential members access to safe, structured meetings and a robust support network.

We have consistently achieved transformative improvements in our hard to reach and seldom heard diverse cohort, supporting members with serious lifelong addictions and have helped them grow and develop into volunteering, employment and general health and wellbeing.CSLHG-ANI-GIF

Our spice harm reduction outreach campaign is strategically linked to our spice awareness training and is designed to support and bolster the mutual aid meeting network. This work will be focused predominately on the street homeless community. We also plan to become more heavily involved in spice use research and information gathering whilst becoming advocates for disenfranchised users and their families.

A second strand to our deeper involvement in spice provision will see increasing engagement with the current and ex-prison population. Relationships and networks are currently being formed to facilitate this.

Branded-outreach-IMG-20181215-WA0013

How you can help
Our group is an independent, self-managing user led organisation born from a need to support abstinence and empower individuals to beat addiction through sustained recovery. We believe all drug users have the ability to turn their lives around and make a positive contribution to the communities they live. If you are like minded and feel you want to contribute your support, we welcome contributions in many forms.

(i) Financial contributions can be made via our web site donation page at
https://www.paypal.com/donate/?token=a1x2ctlGDwyGxftrUFl20tlBvjVivweHTzbyDZ1Z
9-l53sqgEeWwnV-EeenBYLFO2cNEC0&country.x=GB&locale.x=GB

(ii) Material contributions such as office supplies, help with printing, photocopying,
laminating etc or you may wish to support one of our campaigns by donating mobile
phones and IT (https://www.cslhg.org/mobile-donations) or perhaps by contributing,
warm clothing, sleeping bags and food in support of our homeless outreach campaign.

(iii) Giving your time– We always require volunteers to assist us with our operations. Send an email to cslhginfo@gmail.com for more information.

IMG-20181127-WA0002Substance Misuse Training Spice Harm Reduction & Practice

COURSE CONTENTS:

SECTION 1
102.1.0 Introduction to Spice
102.1.1 How drugs work
102.1.2 Classification of Drug Types
102.1.3 Anatomy of Spice
102.1.4 Summary

SECTION 2
102.2.0 Synthetic Cannabinoid Receptor Agonists
102.2.1 Introduction to SCRAs
102.2.2 SCRA Compounds
102.2.3 Production & Distribution
102.2.4 Summary

SECTION 3
102.3.0 Known Harms
102.3.1 Toxicity
102.3.2 Psychosis
102.3.3 Withdrawal
102.3.4 Summary

SECTION 4
102.4.0 First Response
102.4.1 Unconsciousness
102.4.2 Emergency Procedure
102.4.3 Naloxone
102.4.4 Summary

SECTION 5
102.5.0 Spice Harm Reduction
102.5.1 Engagement
102.5.2 Advice for users
102.5.3 Mentoring
102.5.4 Summary

SECTION 6
102.6.0 Pathways to Recovery
102.6.1 Treatment
102.6.2 Mutual Aid
102.6.3 Spice User Support Group
102.6.4 Summary

CSLHG-let-go2-page-002

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Weighty matters – Fat to Fit Week 1

Community Quips

Day 1

Enough is enough. First steps

Benchmarking – The weigh in: waist, chest, weight, BMI and a photo.

Modesty forbids me to tell you more, it’s none of your business really, but please read on.

Went for a lunchtime walk. Well, you’ve got to start somewhere.

Tip 1: Get started. A line in the sand. Small changes make a big difference, they lead to the nextchange.

Day 2

Another lunchtime walk. What a start. I buy a bicycle, (for my daughter!) Steady on, it is only day 2. I’m pleased with my 100% lunchtime walk record.

We switch on our Co op high tech, VOIP telephone system. One or two teething problems, well, I hope they are, and there were three of them.

Tip 2: Do things your way, at your pace, unless you’re a lazy beggar, but the chances are you’re doing too much not too little. Just make sure…

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Publo #Skouries Stories

mmanonymous

freepresseurope-1

Due to the unprecedented response of Publo11 we have decided to extend our coverage of the #greekcrisis. In partnership with FreePressEurope, our intention is to publish stories, articles, papers, essays and interviews both in the magazine and via this blog.
This project is being managed by Publo11group
Tony Angelosanto Editor in chief Publo Magazine @MManonPUBLO

Our current project is Skouries Stories- A series of: interviews, opinion and analysis by #publo11 writers @davemem and @KarenLucyBlack

Background
The #Skouries hashtag represents the struggle of a local community against a proposed gold mine in the heart of one of the most diverse and untouched forests still remaining in Europe. The Canadian Gold mining corporation Eldorado gold is exploiting the austerity burdened Greek people with bribes to local officials and even police in their pursuit of profit.

At the heart of this story lies a fraud where 317 km2 of ancient forest including, countless homes…

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Myths & Solutions (French)

La crise grecque : mythes et solutionsGreek_Crisis_and_the_Future_of_the_European_Union posté le 20 janvier 2013 ” Greek crisis myths and solutions” est une série en quatre volets à propos de la crise grecque parue pour la première fois dans ABCDEF48 publication Publo11.

Première partie : les mythes de la fiscalité, la corruption et l’euro

Paresse, non soumission à l’impôt, corruption, dépenses, attaque de l’État providence, Grecs

La bombe à retardement de la crise grecque a explosé médiatiquement en décembre 2009. A la suite de l’effondrement de Lehman Brothers l’année précédente et d’un resserrement du crédit interbancaire, l’événement connu sous le nom de “Krach du crédit” qui avait dominé les médias auparavant a cédé la place aux problèmes de dette exponentielle du gouvernement grec. A l’époque, la Grèce, avec une population d’environ 10 millions d’habitants et un PIB par habitants de 24.000 dollars pouvait être comparée à l’État américain de Louisiane qui compte la moitié moins d’habitants mais avec un PIB deux fois supérieur. [1]

En dépit de sa petite taille, le problème qui se pose à la Grèce est celui de l’effet que la crise de la dette souveraine a sur ses partenaires de la zone Euro. Par effet domino, cela met encore plus de pression sur une économie mondiale affaiblie. Soudainement, juste avant Noël 2009, la Grèce s’est trouvée placée sous la pression des responsables européens qui lui réclamaient de remettre les choses en ordre chez elle. Récits et éditoriaux émanant de médias principalement d’Europe du Nord ont circulé, insinuant ce que tout le monde pensait : que les Grecs (comme la plupart des Européens du sud) étaient des paresseux et ne voulaient tout simplement pas payer d’impôts. Et qu’en tant que tels, ils étaient irresponsables et méritaient de subir des épreuves le temps nécessaire pour qu’ils assument leurs responsabilités. C’est à partir de ce point que le premier mythe de la crise grecque est né. Comme dans la plupart des autres pays du sud de l’Europe, l’attitude envers les autorités, l’observation de la loi et le fait de s’y soumettre y sont différent que dans d’autres parties, conservatrices, de l’Europe. La Grèce, comme l’Italie ou l’Espagne, a un passé fasciste. La résistance acharnée et la désobéissance civile y sont plus courantes que dans ses voisins plus placides du nord. Pour une multinationale ou une personne extrêmement riche, échapper à l’impôt est bien vu, mais quand il s’agit de la majorité du peuple, c’est considéré d’une certaine façon comme immoral. Même si le fait d’échapper au fisc est répandu à travers la Grèce et la Méditerranée, la responsabilité est à rechercher dans le mode de collecte de l’impôt. Les citoyens allemands, anglais et américains ne paieraient pas autant d’impôts s’ils n’y étaient pas obligés. La plupart des gens rouleraient plus vite si le code de la route n’était pas appliqué par les forces de l’ordre : personne n’y ferait attention à moins d’y être obligé. Ce problème de mauvaise collecte de l’impôt est aussi lié à la corruption. Et en Grèce, personne ne nie, cependant, que là où il y a de la corruption, il y a quelqu’un qui corrompt. Il suffit de taper “Siemens corruption” sur Google et de passer en revue quelques-uns des 220.000 résultats, “BAE corruption” (223.000 résultats) ou “Deutsche Bank corruption” (422.000). Quant aux travailleurs grecs prétendument paresseux, d’après l’OCDE, les Grecs travaillent 2.017 heures par an, plus que leurs homologues européens.[2]

Admettre que l’on contourne l’impôt en Grèce est une chose. Mais suggérer que la Nation toute entière est corrompue est un préjugé corrompu en lui-même. Le fardeau accablant de l’exceptionnelle dette courante repose sur la majorité des Grecs et de leurs enfants qui respectent la loi. En plus, la plupart des mesures d’austérité comme la réduction des retraites et des salaires ont un impact plus fort sur les plus pauvres. Par ailleurs, comme un pourcentage important des revenus fiscaux est collecté via la TVA (qui atteint 23 %, l’une des plus élevée de l’Union européenne), les consommateurs peuvent difficilement y échapper puisqu’elle est intégrée au prix d’achat. En revanche, les entrepreneurs peuvent échapper à la TVA à hauteur de montants massifs. D’autre part, une façon de collecter l’impôt dont l’usage est répandu en Grèce, passe par les factures de la compagnie d’électricité publique DEI. Venant s’ajouter à la part dédiée aux unités d’électricité fournies, des taxes directes sont collectées pour un vaste panel de redevances gouvernementales, depuis l’audiovisuelle (télé/radio, à l’image des taxes qui financent la BBC) jusqu’à la nouvelle taxe foncière imposée à tous. Enfin, la taxe sur les communications par mobiles (de 10 %, ensuite augmentée à 12,5 %) imposée en 2009 est une fiscalité directe promulguée après très peu de concertation à un moment où les taxes sur l’essence et l’alcool ont été accrues avec leur TVA sautant de 19 % à 21 %. Selon le rapport Deloittes de 2006/2007 sur l’imposition de la téléphonie mobile au niveau mondial (avant que la nouvelle taxe ne soit mise en oeuvre), la Grèce est le 9e pays le plus cher du monde pour se servir d’un téléphone portable. [3] Les mesures fiscales listées ci-dessus sont toutes des exemples de fiscalité directe. Pour les Grecs ordinaires, elles sont difficiles voire impossible à éviter. En général, la corruption et le non-paiement des impôts, en terme d’habitude, de nombres de personnes concernées et de montants totaux, relèvent directement de la faute d’un petit nombre de personnes, qui sont non seulement facilement identifiables mais surtout, par leur rôle politique, leurs intérêts et leur clientélisme, complices des causes de la crise de la dette. Comment est-il possible que quelqu’un qui possède de l’immobilier, des voitures, de la terre et des capitaux ne paie pas d’impôt ?

A la racine du problème, tout commence en février 1992 avec la signature du traité de Maastricht. En particulier, l’union monétaire européenne a lancé le processus de la monnaie unique européenne. L’Euro a été lancé le 1er janvier 1999, la Grèce le rejoignant un an après. L’effet positif immédiat pour la Grèce et beaucoup d’autres États fut la disponibilité de prêt à bas taux d’intérêt sous la forme de titres gouvernementaux qui sont passés sous la barre de 5% en 2002 après l’introduction des pièces de monnaie et des billets. [4] Cependant, des effets négatifs en Grèce ont été immédiatement constatés : des entreprises sans scrupule ont utilisé l’adoption de l’Euro comme une excuse pour réduire le pouvoir d’achat de leurs clients avec un taux de change défavorable engendrant de réelles hausses de prix. Ces pratiques n’étaient pas propres à la Grèce et des histoires similaires ont circulé à travers l’Europe. Néanmoins, cela a été contrebalancé par des prêts moins chers pour tous. Les banques ont travaillé dur pour arroser les citoyens européens qui ne se doutaient de rien. Il n’était pas rare à l’époque de recevoir des appels d’institutions financières offrant des prêts à taux d’intérêts bas avec très peu de vérification de la capacité à les rembourser. En Grèce en particulier, l’adoption de l’Euro et, en vérité, l’appartenance à l’Union européenne était une opportunité pour résorber la fracture entre les économies riches et pauvres (du nord et du sud). En tant que citoyens européens, les Grecs voulaient l’équité dans la protection sociale par rapport aux États du nord. De fait, des volets du traité de Maastricht incluaient le chapitre social qui était censé protéger les droits des travailleurs. Les allocations chômage et familiales ont été rapprochées des standards européens et, brièvement, les Grecs de la rue en ont bénéficié. Mais ici réside le second mythe de la crise grecque. Parmi les réprimandes faites à la Grèce, on a prétendu que les gouvernements grecs successifs utilisaient de la monnaie pas chère pour suborner leur électorat avec les prestations de l’État providence. Ce point de vue était fort dans les autres économies des pays « PIGS » que sont l’Italie, le Portugal, l’Espagne et particulièrement l’Irlande. Les dirigeants de ces États endettés tenaient absolument à prendre leurs distances vis-à-vis des problèmes de la Grèce dans le but d’attirer de l’argent pour se renflouer et d’adoucir les conditions qui y étaient rattachées. La Grèce comme l’Italie fonctionnent traditionnellement sur la base d’un système clientéliste. Les emplois-clés, notamment dans le service public, sont des récompenses de faveurs politiques. Ceci est connu et toutefois largement toléré, à tort, par les sociétés grecques et italiennes, mais ce n’est pas pire que le « old boys network » britannique ou des pratiques similaires en France et en Allemagne. Le système américain incorpore le lobbying mais on pourrait argumenter que c’est tout aussi corrompu.

Au-delà de la corruption et des allocations de l’État providence, le problème intrinsèque de la monnaie unique allait de toute façon poser des difficultés. La notion d’une Europe à deux vitesses était évidente avant Maastricht et la perte de la capacité des États à dévaluer leurs propres monnaies aurait dû être mieux comprise dans l’ensemble de l’Europe et pas seulement par la Grèce et la zone méditerranéenne. En outre, les différences d’échelles et de puissance entre chaque économie au sein de l’Euro nécessitaient un équilibrage des richesses (du nord au sud). Ce qui impliquait que les infrastructures et les économies les plus faibles en Europe soient modernisées au niveau de celles du nord. C’est la raison pour laquelle les Grecs de la rue ont été aux premiers rangs pour se saisir de l’Euro. Ce processus aurait dû suivre un chemin identique à celui de l’intégration de l’ex-RDA au sein de l’Allemagne. Bien sûr, cela a coûté beaucoup d’argent aux Allemands (de l’ouest) mais était nécessaire pour que l’Allemagne progresse. Il faut aussi noté que l’Allemagne n’a pas financé la transition toute seule et que les autres pays de l’OCDE, en particulier les États-Unis, ont contribué avec de l’argent et des ressources afin que cela soit un succès.

La question de la fiscalité, de l’Europe à deux vitesses, de l’Euro et de l’Union européenne se réduit au simple concept suivant : des États et des citoyens acceptant ou pas le fait d’aider ceux qui sont plus déshérités ou moins riches qu’eux.

Translation thanks to:

@anarettruffade

Original:

https://davemem.wordpress.com/2013/01/20/greek-crisis-myths-and-solutions/

Puplo Magazine  Reblogged from mmanonymous:

Cover Image: http://www.english.globalarabnetwork.com/201005055772/Economics/junk-status-greek-crisis-and-the-future-of-the-european-union.html

[1] http://en.wikipedia.org/wiki/List_of_U.S._states_by_GDP#2005.E2.80.932009_List
[2] http://stats.oecd.org/Index.aspx?DatasetCode=LEVEL#
[3] http://www.gsma.com/newsroom/wp-content/uploads/2012/03/taxreport1.pdf
[4] http://en.wikipedia.org/wiki/File:Long-term_interest_rates_of_eurozone_countries_since_1993.png

GREEK CRISIS: MYTHS AND SOLUTIONS: Is a 4 part series on the Greek crisis first published in ABCDEF48 publication Publo
Part 1: Myths: Taxation, Bribery & Corruption and the Euro
Part 2 Myths: Greece is not safe. Greece is a democracy

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Pages from #Publo11

Greek Crisis Infographic with full interaction and music. Hosted at mmanon. via Publo Magazine blog

  • Timeline 1990-2013
  • links to Euro news articles
  • Chronology/profiles of US Presidents, UK Prime Ministers German chancellors French Presidents
  • YouTube video clips embedded
  • Charts & Statistics
  • Amnesty International Reports
  • Articles
  • Music: The Jam Live 100 club 1977, Noel Gallagher, Stiff Little Fingers, The Beatles

mmanonymous

A selection of OUP pages from publo11. Full Greek Crisis Infographic by @davemem. PDF features just a game by @cesilCToon and embedded music by StiffLittle Fingers, The Jam, The Beatles and Noel Gallagher.
Feel free to click away.

Loaded Interactive version Open Unregistered Public (pdf)

Screenshots Low-res (jpegs)

Pages-from-Publo-Magazine-iPages-from-Publo-info4Pages-from-Publo-info3Pages-from-Publo-info2

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