History, drug policy & The Dutch way

Cannabis plants originally evolved in Central Asia. In fact, according to archeological evidence, people of China cultivated this plant for fiber and food 10.000 years ago. Historical records show cannabis was used by ancient Egyptians too. Inspection of mummies from ancient Egypt revealed traces of cannabis use as either medicine or food. Generally speaking, cannabis is among the plants with the longest history of medicinal use. This plant is a part of almost all ancient texts and handbooks that focused on the medicinal properties of herbs, plants, and spices. In most cases, cannabis was used as tea or tincture. The use of cannabis was not limited to the medicinal aspect only. Some religions are closely tied to it. For instance, according to Hindu tale, the god Shiva preferred cannabis due to its outstanding energizing effects. From Central Asia, cannabis spread across the globe, first to the West and then to other cultures. Over the centuries almost all cultures will get to know the power of versatile cannabis plants and their benefits.

Today, cannabis is cultivated across the globe, not just in Central Asia. It thrives in almost all tropical and temperate zones with the exception of tropical and humid. Cannabis is also known under the name hemp, which is primarily used to relate to fiber. Fiber made of cannabis is considered the strongest and most durable natural-origin fiber. Throughout history, cannabis fiber had plenty of uses. It was used to produce paper, sails for sea ships, banknotes, among other things. Did you know the first Levi’s jeans were made from cannabis fiber? The liquid, i.e. oil, that can be pressed from seeds of hemp is nutrient-rich. Thanks to its nutritious qualities, hemp oil is a suitable alternative to fish oil since it’s a plant-based source of much-needed fatty acids.

Despite the fact that cannabis has been grown for hundreds of years by many countries extensively, the recreational use of the plant for narcotic purposes was rare in the United States and Europe. Until recently, that is! The reason behind this is simple – people weren’t aware cannabis exhibits psychoactive effects. Plus, it is highly unlikely the earliest cultivars of cannabis had high amounts of THC, the main psychoactive compound in cannabis plants. The early cultivars were used and selected primarily based on the quality of their fiber. Europeans didn’t use cannabis for medicinal purposes until 1840 and it is all thanks to a young doctor from Ireland called William O’Shaughnessy. How did he know cannabis could be used as medicine? Well, O’Shaughnessy was in India where he worked for the East India Trading Company. Remember, the use of cannabis for medicinal purposes was common in Asia, including India. So, that’s where he picked up on this important piece of info. What’s more, unlike cannabis used in Europe, the plants in India had significant levels of THC. From that point and over several decades, cannabis plants were quite popular in the US and Europe. During the time of the popularity of cannabis, dozens of products and medicinal preparations featuring cannabis were made. Preparations were numerous and served for different purposes ranging from management of asthma to menstrual cramps, insomnia, cough, migraine, opium use withdrawal, and support during childbirth. In all these preparations cannabis was the primary active ingredient. See figure 6-1 for some examples of old cannabis medicine.

Unfortunately, difficulties with the supply from overseas as well as inconsistent plant material quality made it quite complicated to prepare consistent and reliable cannabis formulation. Why? You need to keep in mind at that time there were no tools and technologies that controlled the quality and safety of formulations. For that reason, it was difficult and sometimes impossible to create standardized medications i.e. preparations with the same amount of active ingredients and identical quality. As a consequence, dosages were either too low or too high, or they were ineffective. All this led to severe adverse reactions. Additionally, since the extract of the cannabis plant wasn’t water-soluble it wasn’t possible to inject it into patients. At the same time, slow and erratic absorption made the oral administration route untrustworthy or unreliable. The use of cannabis for medicinal purposes gradually decreased and even disappeared at the beginning of the 20th century due to these shortcomings. Opium-based medications such as codeine and morphine replaced cannabis. Other developments also contributed to the gradual disappearance or cessation of cannabis use in Western pharmacopeias after 1937. For example, at that time the high-tax rule was imposed on all products containing cannabis, except fiber and seeds. The legislation became strict and restrictive regarding cannabis use, as well.

It will take a few decades, until about the 1960s, for recreational use in the form of smoking cannabis to become present in the Western world. In fact, we can easily say it becomes a phenomenon. Once people started smoking cannabis, many things changed. For starters, stronger varieties were imported from tropical areas. There was also an increased interest in breeding cannabis plants. That’s why cannabis that was used in this period was a lot stronger and more potent than plants used several decades before. The use of cannabis was particularly common among American veterans of the Vietnam war. Increased recreational use and interest in cannabis made this plant a high-tech crop. As a result, many started cultivating and growing cannabis in artificial conditions indoors rather than in outdoor settings.

The Single Convention

The history of cannabis use is eventful, indeed. Even the World Health Organization (WHO) got involved in 1954 when they started claiming this plant and cannabis-containing preparations didn’t have medicinal potential. They considered these preparations practically unnecessary or obsolete. There’s more to this story, however. The reason behind this decision was tremendous pressure of ever-increasing reports from the Federal Bureau of Narcotics, which was established and newly formed at that time. The Federal Bureau of Narcotics claimed cannabis was unsafe and posed a danger to society. Until that very moment, cannabis-related legislation was shaped according to numerous conventions on international scale, causing considerable legal confusion. It was therefore proposed to combine all legislation into a single international agreement. In 1961, the United Nations accepted the draft of one such agreement called the “Single Convention on Narcotic Drugs” which described cannabis and cannabis-containing products as dangerous narcotics. The convention also stated cannabis had a high abuse potential. Additionally, as per the Single Convention cannabis had no confirmed medicinal purpose or value. Basically, the convention only mirrored the then-accepted notion that the cannabis plant was a narcotic with a threat that was equal to heroin, ecstasy, and LSD. Several additional treaties were adopted in the upcoming years and their main purpose was to strengthen the convention. These laws have been an important basis for the ‘War on Drugs’.

Since the Single Convention was introduced, the potential danger of recreational cannabis use has been much higher on the political agenda than any of its benefits as a source of fiber, food, or medicines (see chapter 7). According to the American president Nixon, cannabis was a secret weapon of the communists, being spread by the Jews to destabilize the Western world. This cannabis-related fear has been the base for the legislation that is nowadays obstructing the rediscovery of cannabis as a medicine. Although our scientific understanding of cannabis has increased significantly over the last years, these insights are only slowly and reluctantly incorporated into new legislation.

In the coming years, a large variety of scientific and clinical data is expected to become available, further showing the medicinal effects of cannabinoids and the endocannabinoid system. Several Western countries are already providing medicinal cannabis products to patients, and some steps are even taken towards the decriminalization of recreational cannabis use in a few countries. These shifts signal that the Single Convention, and the punishment-based prohibition that goes with it, may start to reach its expiry date. The legislation that follows it will depend for a large part on the quality of the scientific research available.

Drug policy of The Netherlands

Whereas most countries of the world have traditionally followed an approach of the punishment-based prohibition on cannabis and other drugs, the Netherlands has instead focused on harm reduction. In the mid-1970s the foundations of Dutch drug policy were established. The legislation does not moralize, but it goes by the presumption that the use of drugs and other substances in society is an undeniable fact. For that reason, substance use should be handled with practicality in mind. So, the primary goal of Dutch drug policy is to limit or prevent risks and dangers linked to drug use, including potential harm. Not only does it prevent dangers and risks for the substance users, but also the society at large.

The Opium Act is considered the bedrock of Dutch drug policy. This particular law entails two primary principles. The first principle is to distinguish between different kinds of substances and drugs according to their danger and harmfulness. So there’s hashish, cannabis, and psychedelic mushrooms on one side and substances that are highly dangerous and risky on the other side. They use the terms “soft drugs” and “hard drugs” to clarify these differences. Basically, this policy acknowledges not all substances are equally risky and dangerous and cannabis cannot be in the same category as heroin, for example. The second principle of the Opium Act revolves around differentiating the nature of the offense. More precisely, it specifies differences between personal use, small quantities versus possession intended for sales and distribution. Personal use of a drug itself is not an offense.

Cannabis cultivation, sales, and use are formally illegal according to Dutch law. However, through the famous outlets known as “coffeeshops”, the sales of small quantities of cannabis are condoned, or should we say tolerated, but conditions are strict though. At the moment, the Netherlands has about 600 such coffee shops. Bigger cities house most of those shops. Dutch policy instrument relies on tolerance that depends on the Public Prosecutor’s power to avoid moving forward with the prosecution of offenses. The name of this principle is the “Expediency principle” and it is defined in the law. What this principle entails is that coffee shops are allowed to perform small-scale sales and while this is a legal offense in the eyes of the law, it’s not prosecuted in certain situations. These situations or conditions that coffee shops need to adhere to include:

  • No sales of hard drugs
  • No advertising
  • No nuisance in the neighborhood
  • No admittance of minors
  • No sales to minors (persons under the age of 18)
  • No cannabis sales exceeding 5g per transaction

Per the same law, coffee shops should not hold stocks that exceed 500g of cannabis. Should these requirements be violated, the authorities will close down the shop. Currently, a new requirement is proposed stating that coffee shops should be at least 350 meters removed from any school.

The main philosophy behind the Dutch policy towards coffee shops is to reduce harm as much as possible. This kind of policy is focused on the person and their wellbeing, not the political agenda. The philosophy of Dutch policy is that small-scale sales and use of cannabis are not to be prosecuted if certain requirements are met. That way, the users who are primarily young adults experimenting with cannabis are not criminalized i.e. there is no criminal record due to this small offense. As a result, those same people don’t end up scrutinized by a society that would push them into criminal circles. In criminal circles drug use is high and those young people would be pressured into using harmful substances like heroin. That being said, the philosophy of tolerance doesn’t imply a person can use cannabis anywhere they want e.g. they can’t go outside the coffee shop and smoke cannabis there. Even though there is no specific rule that bans people to smoke cannabis in public areas such as restaurants, bars, bus or train stations, most people don’t do that. If someone goes on and smokes cannabis, they will not face some consequences or sanctions. The staff of the restaurant or bar will politely ask them to put out the cigarette.

Dutch drug policy and its relationship with drug use are often underestimated and complicated to understand to tourists and foreigners. This policy uses the advantage of absence or strict and formal regulations regarding cannabis use. Since there is no strict or formal policy, new informal norms were developed and generally accepted within the Dutch drug policy. However, they prove to be effective although foreigners might find them confusing. For instance, tourists in Amsterdam often believe it’s completely allowed or legal to smoke cannabis everywhere, even though that is not the case, as previously explained. In response to this and other problems with public cannabis use, the city of Amsterdam has even invented a new traffic sign (see figure 6-2). That said, most people in the Netherlands, particularly older adults, haven’t used cannabis and they are not really familiar with regulations regarding the use of this plant.

Starting a medicinal cannabis program

It’s not such a surprise the Netherlands was among the first countries to start with the official Government program for medicinal cannabis if we bear in mind their liberal drug policy. What’s more, Els Borst Health Minister (1994-2002) was the first policymaker who officially acknowledged the fact that a lot of patients purchased cannabis from coffee shops with the primary intention to use it for medicinal purposes. That being said, in coffee shops people who buy cannabis don’t receive guarantee regarding its composition, origin, and quality. Bearing in mind it was necessary to ensure patients obtain high-quality, reliable, and safe cannabis and with the goal to involve physicians and pharmacists in the medicinal use of cannabis, the Minister started a national program. As a result, in 2000 the OMC (Office of Medicinal Cannabis) became a National agency.

As a part of the Ministry of Health, the primary responsibility of OMC revolves around producing cannabis for both scientific and medicinal basis. Through National agency, cannabis program in the Netherlands, fully complies with the Single Convention. This agreement permits medicinal use of cannabis under strict conditions. In September 2003, medical-grade cannabis finally hit the pharmacies in the Netherlands, and since then it is possible to get it with prescription issued by a doctor. Besides supplying it to Dutch patients, the OMC also provides cannabis for scientific research, for the development of medications containing cannabis as the primary active ingredient by pharmaceutical companies, and for export to other countries with a medicinal cannabis program if those authorities issue an import license.

Right from the start, high-quality and reliable cannabis materials were considered crucial for the success of the newly-formed program that focuses on medicinal cannabis. Therefore, a skilled breeder was contracted for the cultivation of plants under highly standardized conditions, resulting in a product with a reliable and consistent composition. The OMC supervises all the processes involved in cultivation, processing, and packing cannabis material adhering to the latest and strictest standards in the pharmaceutical industry. Regular testing is performed in specialized and certified laboratories to ensure quality (see chapter 1).

The OMC used the quality and availability of scientific literature, evidence, and clinical data to select indications regarding the use of cannabis for the treatment of medical problems (see chapter 5). The product is finally delivered to patients in 5-gram packages, as shown in Figures 6-3.

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