CharonY

That may be the case and there are similar regulations in Canada (there are lower limits if alcohol is also detected). But it is a simply a regulatory rule which is not based on our best understanding how the drug works. That being said, regulations are obviously always simplifications, but my comment was not meant as a challenge to regulation but rather to your previous assertion that folks stay impaired for days. And it is also to highlight that one cannot easily draw a direct comparison between alcohol and THC- the latter stays in the body longer without exerting measurable effects, so a low level of alcohol in the blood is a much stronger indicator of impairment than a low level of THC.

Peyote has been part of indigenous American traditions, so are coca leaves/tea in South America to give some other examples. Interestingly their interests seems to take a backseat, though. That should be the case with all drugs. Even if it only mitigates issues (as we see with alcohol). The OP was aimed at harm reduction at which point alcohol clear makes the cut for harmful substances. You have mentioned how difficult it is to enforce a ban, though similar things can be extended to other drugs. Portugal was shown as an example where decriminalization actually reduced drug-related harms on many levels and may seem like a decent way forward from a risk/benefit perspective. Policies should be guided based on harm outcomes and not by narratives as has been done in the past (or as political tools). IMO it is a public health and not moral issue, but it has been conflated a lot of it in the past (drug use in high-income classes, for example). It is in fact being legalized (or has already been). As indicated increased use has resulted in increased incidences but not by much and the detrimental effects are not even close to alcohol use. Other drugs like psilocybin are even less habit forming and harmful, for example. That is incorrect. With cannabis THC can be detected in the body for longer than a day (much longer in habitual users). However, acute impairment does not last that long. There are a series of studies involving car simulations or similar tasks and in most studies the time until individuals return roughly to their baseline is around 10 hours for edibles and closer to 5 for smoking. In other words, presence of THC in the body is not very predictive for level of impairment, especially compared to alcohol. This becomes more of an enforcement issue. While there are THC tests, they are being challenged and law enforcement in Canada tend to focus on using field sobriety tests instead (and THC levels just as an additive). I will re-iterate that comparative analyses of drug harm are tricky and obviously you can find harmful effects for virtually all compounds including things that we consume every day. As such looking at as many aspects as possible seems to me currently the only way to get at least a slightly more objective sense of harm caused by the drugs. Drugs referenced in pop culture might appear scarier than they likely are, for example. That being said, most international comparisons of that sort (UK, Australia, USA) put alcohol at the highest level of harm and some other drugs (e.g. mushrooms, LSD) fairly low. So as mentioned earlier the main argument against banning alcohol is that it does not work. But the question remains whether criminalization really has benefits. Some evidence from the war on drugs does not make a great case from a public health perspective. Another aspect is that criminalizing them has put them mostly out of reach for medical and other research. There are advocates that certain psychoactive substances might have benefit over other commonly used medications, for example. But without proper studies it is difficult to figure out. Edit: crossedited with becee's post.

Sorry to hear. The CDC has some resources and links to additional info: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html It is still a matter of ongoing research and it is important also to take care to unspecific and neurologic symptoms, such as anxiety and sleeplessness, which are easy to overlook.

I can address those and in fact may have so already in an earlier thread. Fundamentally there are risks associated with cannabis use, but those are generally speaking not higher than alcohol. Some of the associations are in fact correlated with other drug use. In fact, substance used disorders, including alcohol, are highly associated with each other. I.e. folks that drink are more likely to use cannabis, or other drugs (see for example https://doi.org/10.1111/j.1530-0277.1996.tb01953.x). The thinking is that folks who are more likely to have substance use disorders have similar risk factors. As similar theme can be seen when it comes to psychoses and schizophrenia. There are many studies out there that show that in shizophrenic patients or patients with psychotic episodes drug use, including alcohol, is very prevalent. A cause and effect relationship is very difficult to establish, though cannabis as well as alcohol are known to create worse outcomes for psychotic events, and in case of alcohol, they are also more likely to become violent (for cannabis it is still under discussion, but the association, if it exists, is apparently less robust). One of these cohorts looked in Canada for increases in cannabis-induced psychoses post-legalization and basically found none. The same paper also referenced alcohol-induced psychoses. https://doi.org/10.1177%2F07067437211070650 The other combustion related injuries have been somewhat addressed in relation with tobacco smoking and the literature had a bit of a back and forth whether cannabis is equally bad as tobacco or not. Things are further muddled by the fact that many cannabis smokers also smoke tobacco. At this point I think the jury is still a bit out, but I as precaution I would think that covering it under similar rules (also including e-cigarettes even if health effects might be milder) could be overall beneficial. None of those described risks have demonstrated an overall higher risk (legal or not) compared to alcohol (or tobacco), as far as I can see.

These can be achieved by decriminalization alone, though. Civil penalties could (and should) include referrals to treatment programs. That does most make sense for drugs that are highly addictive and/or consumption is very dangerous (e.g. high risk of overdoses, severe health effects etc.). Legalization further allows controlled production, sales and consumption. Here penalties can only be levied under specific circumstances (e.g. DUI) and treatments are can only be forced if something happens under these circumstances. This is the case with alcohol and in some areas cannabis.

Absolutely. But these laws should take a number of things into account, such as what the outcome is. I think quite a few folks have come around to the point that decriminalization would benefits, as the criminalization of drugs has, on balance, create more harm than it has prevented. This is especially true for drugs which have less severe health outcomes. The other point is to see whether those laws are applied equally and fairly. This is linked to the first point where drug laws have been especially harsh on certain groups and applied unfairly. Yet another point, which is more related to OP (but also to the other points above) is the internal consistency. I.e. on what basis do we classify certain drugs as legal or at least punish possession and use less harshly (if at all) than others. One argument is based on harm reduction, but as mentioned alcohol does great harm and remains legal. The main argument seems to be that it is not effective/possible to make it illegal. But that applies to quite a few other drugs, too. Many countries are therefore likely to make less harmful drugs (such as cannabis) legal. One of the reasons why alcohol is underestimated as health risk is of course the fact that it is socially acceptable and as such it is perhaps unsurprising that alcohol causes more deaths than all other drug uses taken together in most industrialized country (taking 2016 data death per 100k people in Canada 16.6 vs 7.3, 23.2 vs 18, UK 30.5 vs 8.5). Same goes for other measures, such as years of life lost (YLL). For disability adjusted life years (a measure of disease burden) it the outcome is a bit more mixed and in some countries impact of alcohol can be more similar relative to all other drugs (e.g. USA 1178.6 alcohol DALY per 100k vs 14603 all other drugs; UK 965 vs 614, Canada 807 vs 693). Perhaps an interesting comparison is Portugal where the discrepancy is quite visible (alcohol vs all drugs per 100k people): death: 68.1 vs 4.9, YLL: 1483 vs 162.4 and DALY 1790 vs 313. (GBD 2016 Alchol and Drug Use Collaborators, Lancet 2018; 5:12 987-1012).

In addition, many areas that have a wastewater treatment plant also have separate storm drains systems. AFAIK, sewage is mostly moved by gravity (including lift stations) or pressurized pipes. In many (especially arid) areas relying on rain would not work well.

Still working my way through the thread so sorry if I am repeating things that others have already mentioned. A couple of things related to that. Ranking intrinsic risks of a given drug is tricky as quite a few things can change the risk assessment. For example, if heroin is pure and consumed under supervision certain risks are minimized (e.g. sharing of dirty needles, fentanyl associated overdose risks and so on). Other personal risks are also associated with likelihood of addiction. Those are fairly high for opiates, but also nicotine (though the former happens faster), while cannabis is quite a bit lower on that scale (takes longer and habit formation is not quite as strong). Addicts to tobacco, tend to smoke quite a bit more to satisfy their addiction, compared to cannabis users. So if we talk about cannabis, the effects and risks are somewhat distinct from tobacco. The most common effects we see shared are likely due to combustion of the wrappers. While we still need more study, the association with cancer appears to be weaker compared to tobacco and long-term use was associated with different biomolecular markers of cardiovascular health than tobacco use. It is not quite clear what long-term effects are, but at least preliminary data shows a seemingly lower risk (or at least no higher than tobacco). While nicotine overdose is (AFAIK) a rare event, cannabis overdoses can happen, usually via edibles or oils. However, alcohol overdose is also fairly frequent and is generally more harmful (as in it can end up being deadly if not treated). In many ways comparison of cannabis and alcohol also makes sense, as part of the risk is impairment and of course the former is legal. With regard to the impact of legalization, which has been brought up a couple of times, I like to refer to Statscan data showing that two years into legal weed, the number of folks indicating to have consumed cannabis at least once in the past three months of a the survey increased slightly, from 14.9% before to 16.8 % in 2019, which remained unchanged in 2020. The number of folks with daily or almost daily used remained unchanged before and after legalization. Likewise, the rate of folks driving within two hours of smoking remained unchanged. In other words, the free availability of cannabis has not resulted in dramatic increases in its use within the population. For issues mentioned above and the fact that an alcoholic might be at different risks than a heroin addict. Alcohol is legal and you can get pure product easily, for example and treatment might be easier to come by. The other issue is that one can only calculate changes in life expectancy (or e.g. years lost) in a population by looking at reduction from the control cohort, but this could be skewed by the number of alcohol vs heroin use. From that perspective, I find the way of ranking by experts in the paper referenced earlier in the thread quite compelling. While clearly they will be biased a bit based on the available expertise, it is probably the closest to a comprehensive comparison we can get, given the many confounding factors.

Again researchers are those writing those papers, they do not need a stripped list of unknowns... they are already working on it.

Exactly. Even with increased use, cannabis-related events are nowhere near alcohol-related ones. Another comparison with a legal drug could be tobacco. Highly addictive, not a lot of acute events, little social burden, but very high long-term health burden. A reason why despite legal status there are efforts to restrict use of tobacco. Despite consumed similarly tobacco health risks are also much higher than for cannabis. But I remember that we also had a thread discussing the numerous risks associated with cannabis. Perhaps interestingly, many adverse events involving cannabis, often also involve alcohol, further highlighting how prevalent the latter is. Especially among youths, tobacco and alcohol are the most common gateway drugs which are associated with cannabis and other drug consumption later in life.

In addition to what StringJunky said, health trajectories are worse for alcohol addicts compared to cannabis addicts. While neither is great, the latter is less likely to cause death or other severe health effects. Also alcoholics are already in the more extreme area of substance harm. Regular heavy drinking, even without the hall marks of alcohol addiction has been associated with significant more lives lost than equivalent cannabis use. In Canada for males the alcohol-attributable fraction of deaths is around 7, while prevalence of alcohol use disorder or alcohol dependency is lower in Canada (8 vs 13.9 and 4.1 vs 7.7, respectively). You could make the argument then that with cannabis becoming more common you'll like also to have fewer folks having a cannabis use disorder. After all, limited social use is likely going to dilute the severe cases.

Meanwhile, even before legalization cannabis-related crimes were mostly related to possession and import. After legalization obviously those rates dropped. While impaired driving under drug but no alcohol influence increased a bit, it is still only 8% of the rate of alcohol-related impaired driving. And in contrast to alcohol there are no robust associations with violence or other crimes connected to cannabis. I.e. if one wanted to allow only one drug, it would be safer to keep cannabis and ditch alcohol. This is likely also going to be the case for things like psilocybin. It is clear that the case for legalizing only alcohol is not (entirely) based on risk, public health or similar assessments.

I think unknown is commonly used to re-iterate aspects that are under investigations. I often use this the highlight the specific aspect that I want to illuminate more in the manuscript (but then I am a fairly boring writer). So you often see a structure such as: "while the association between x and y is well documented, the underlying mechanism is still unknown/remains elusive. Here, we provide evidence that z plays an important role by ..." I agree that "mystery" and "baffled" is rarely used, if at all. Actually what I might think OP is getting at is compiling these unknowns for folks that are not well read in a field. The big issue I see here is that it misses out on context that are clear to folks in the field (who are the target audience). Generally speaking, big picture reviews are better sources for that purpose rather than taking snippets (which is a rather ineffective way to read science IMO).

I am not entirely sure what you are getting at, to be honest. Researchers working in a particular field read up on what is known and identify thereby knowledge gaps. Ultimately, there is virtually an unlimited number of things that remain unknown but usually researchers focus on particular unknowns which are extension of parts that are known (or being researched). Many unknowns will pan out to be irrelevant, for example.

That is already happening (well manslaughter) https://www.cbsnews.com/news/brittany-poolaw-manslaughter-miscarriage-pregnancy/

They actually thought about that, too. Of course it is unclear what is going to happen, but clearly folks are working on closing that access, too.

That actually is fairly way documented and not just some fringe opinion that you may think it is. Or to be more specific, many drug laws were enacted as part of racial panic. It is reflected especially heavily in its enforcement, where e.g. black drug abusers are far more likely to face charges for possession than their white counterpart, despite white folks having higher drug consumption. There many books written on the subject and not all of them by lazy academics. See here an article on the link between the ban of cannabis and anti-immigrant sentiments: https://time.com/5572691/420-marijuana-mexican-immigration/ Likewise the disparity in the laws and sentencing of crack and cocaine is related to the the association of crack with black people and was discussed extensively, a report on this issue can be found here https://www.vox.com/2016/3/22/11278760/war-on-drugs-racism-nixon, which includes a controversial quote from an Nixon aide: I will also add that these laws are often at the intersection of class and race. Folks generally agree to more severe punishments for things that they see themselves less likely to be involved in, but where they see others (i.e. their lessers) being associated with.

I think it is also the same in the prairies. If I compare prices with Europe, especially wine, it seems somewhat extreme. A part is of course the need for importing them, but prices were easily triple and more.

Two things. First, legalized does not mean that it super easy obtained. There are levels of availability. In parts of Canada, for example alcohol can only by bought at licensed stores and not in regular supermarkets. Moreover, taxes make them extremely expensive. Not sure whether that limitation has any effect. But more to the point, cannabis is legal in Canada since 2018, and is closely monitored, in case you don't know. Unless we don't (see alcohol) for example. The most common gateway drug remains alcohol. As long as that is easily available I do not see the argument as particularly strong. It should also be noted that there is no compelling data that shows that there is a gateway drug in the first place. Rather, there is a decent correlation between alcohol, cannabis and other drug abuses, but correlation is not causation. I.e. folks that are at risk to to hard drug abuse may start with what is easily available. Conversely, folks that occasionally use drugs recreationally (such as tobacco, alcohol, cannabis etc.) do not seem to be necessarily more susceptible to hard drug abuse (i.e. a lot of folks drink, but do not become heroin addicts, for example). I am pretty sure that this cannot be correct. From I am fairly certain that I have read that the US had rather high levels of alcohol dependency, even among Western countries. I checked out the WHO report https://www.who.int/publications/i/item/9789241565639 From there the US has a 7.7 prevalence of alcohol dependence (compared to Canada 4.1, UK 1.4, Australia, 1.5, Russia 9.3 for example).

The list would be far too long. Even during my time (which is not that long) I have seen female scientists getting shafted. Of course it is not exclusively them, though I'd say disproportionately so. Some of the arguments I have heard was along the line that they are likely going to have kids someday whereas the other guy (who did nothing) could have a brilliant career with more first authorships using her data. Such overt things are slowly dying out, but there are other more subtle ways.

As I mentioned, they do to some degree. And moreover many of those drugs are unlikely to be used in such a large scale, even if legalized (as Canada has shown with cannabis). So that is another part of it: availability and concentration. So from a health perspective it is undoubtedly that sugar and alcohol is harmful the way we use it. Conversely, the use of cannabis so far has a lower health burden than assumed (and certainly way lower than either alcohol or sugar). I think the bigger point is that criminalization has virtually no benefit to in terms of addressing harm of substances. The only question that remains is then really whether legalization increases the harm. For certain substances that could be the case, specifically those with a high potential for addiction. However, here we make an cultural exception because the Western world apparently cannot do without. But using the same logic, drugs used in in other cultures should also be allowed. There is nothing in alcohol that makes it categorically different from the other drugs, other than our familiarity with it (which in itself might be harm-promoting characteristic). As such it would make sense to at least put those less dangerous drugs (which are less addictive and toxic) with cultural history at least on the same level as alcohol.

Question is then why you are in favour banning substances that are clearly less dangerous than alcohol? Because data shows that it is not happening. Portugal to have high levels of drug related deaths. After decriminalization in 2001 the levels dropped significantly and Portugal has remained way lower than the European average throughout. As a comparison, in Scotland the death rates are 50x that of Portugal. So in other words, legalizing drugs do not increase deaths. Likewise, cannabis is legal in Canada for a few years and not much has changed in terms of usage and cannabis-related health incidences. I do not follow that argument at all. Why would one consider banning it? They have fairly low toxicity and it is very difficult to overdose on it. On the same note psilocybin has a lower toxicity than caffeine. If we say coffee is fine, why not also certain mushrooms? Again, this sounds fairly inconsistent to me, and may be based on faulty risk assessment.

I fail to see how this is the middle-ground. At best, it is inconsistent. We know that alcohol does great harm and we gave up on banning due to combination of cultural reasons, law enforcement challenges (including criminalizing large swathes of the population) and the realization that drug addiction are more effectively treated by health intervention rather than by legal enforcement. The opioid crisis which was not limited to the "fringes" of society anymore but also affected "good suburban" folks, further reinforced these findings. But for some reasons, we should just accept alcohol (which, again results in more deaths than any other drugs, education or not) because society accepts it? That sounds like circular logic, really.

No, the values are normalized, otherwise they would not make sense. Also, it is more of a rank score. They used multiple factors, such as mortality, dependence, impairment of cognitive functioning, etc. and the idea was to create scores that reflect their relative relationship to each other. I.e. a drug with double the mortality would receive double the score on that metric. For some, data are more lacking than others and also are shifting. Depending on what you look out for, cannabis has been shifting up and down over the years and depending on cohorts, for example. Long-term data are going to be quite interesting in that regard. That being said, certain harms could increase once the use increases. However, that is not always the case. For example, legalization of cannabis did increase hospitalizations in certain regions, but it was not an universal effect and the trend stabilized within a relatively short time frame. Conversely, if alcohol was not such an accepted social drug, harms, especially those to others, would be massively mitigated. These types of rankings are therefore somewhat tricky, but almost every way folks look at it, it is clear that the top spot belongs to alcohol by a fair margin.

Problem is that anti-abortion sentiments are not entirely party specific. In the 70s most folks were only for abortions being legal in certain cases, with little difference between Reps and Dems. In fact, the support for abortion was slightly higher among Reps and highest among Independents (if we sum up legal support with and without restrictions). The support among Reps for legal under any circumstance really dropped of starting in the 90s when conversely the support among Dems increased. https://news.gallup.com/poll/246278/abortion-trends-party.aspx So for the longest time it was a bit of a split issue, and while I think there were attempts to enshrine abortion as a right, it just had insufficient support.