Medical marijuana and beyond.

'Legalise marijuana for medical purposes' was the cry in Parliament that prompted the response by Charles Parry and Bronwyn Myers in this issue of SAMJ. Much parliamentary and public sentiment favoured such an action. But is this the wisest course to follow? The abuse of drugs is harmful to the individual, families and communities. Declaring war on drugs, as US President Nixon did in 1971, therefore has emotional appeal. However, despite this escalating war, the use of drugs has increased worldwide. While the war had noble intentions, it resulted in harmful unintended consequences. Criminalisation of drug use had the effect of hugely increasing the number of prisoners, who are later likely to resort to other criminal activities. The USA, the leader of the war, has the world's highest proportion of jailed citizens (707/100 000, as opposed to South Africa at 294/100 000 and India at 30/100 000). The huge profits from the drug trade corrupt users, politicians, police and financial institutions – the fight for turf by drug cartels in Mexico for drugs destined for the USA has been responsible for tens of thousands of murders and disappearances. While the effects of drugs are harmful, the consequences of the war on drugs are far worse. Recognition that the war on drugs has failed has resulted in a worldwide shift to review drug policies. These include medi­ calisation of the use of marijuana in several US states and elsewhere in the world. compared with the preceding 2006 ­ 2011 plan. The latest version aspires to a society free from drug abuse rather than the previous vision of a drug­free society, which does not reflect reality. The NDMP correctly aspires to use evidence of studies concerning the nature of drugs and of policies to manage them. However, clinical trials are lacking, and the Medicines Control Council would be hard pressed to prepare for medical approval and to identify appropriate indications for it. Furthermore, the approval of marijuana for medical purposes will inevitably result in some fraudulent 'patients' , and complicit doctors who provide their scripts. The NDMP has called for further research, but we already know a great deal. There have been advances in the understanding of addiction and its treatments; drug classification based on its harms can be rational and evidence based; and there are examples of countries that have changed their drug policies with beneficial effects, such as Portugal, which …