Risk reduction and cannabis social clubs (CSCs) (2/2)

To a point, one could launch the thesis that Spain is the site for a large-scale sociosanitary experiment on cannabis use. The fact that there are over 1.200 Cannabis Social Clubs (CSC) all over the country dispensing cannabis and derivatives to hundreds of thousands of people vouches for it. Because of the lack of specific regulation of CSCs’ activity, one of the weaknesses of this big social experiment is that there is almost no data to monitor and improve the follow-up of what is really happening. Next you will find a review of some of the surveys and publications dealing with CSCs as regards risk reduction.

Cannabis Social Clubs are labs where very interesting data might be collected to array a multiplicity of programs of risk reduction and prevention covering both users and professionals in the fields of drug users care and health care. From the point of view of scientific enquiry, very few surveys have been published, so here an effort is made to list the most outstanding.

The first survey was published in 2019 in Journal of Drug Issues under the title “Usos i hàbits dels protagonistes de la història: els clubs socials del cànnabis a Barcelona”* [“Uses and habits of the protagonists of history: cannabis social clubs in Barcelona”], made up from interviews to 155 members of CSCs in the province of Barcelona.

* Parés-Franquero, Ò., Jubert-Cortiella, X., Olivares-Gálvez, S., Díaz-Castellano, A., Jiménez-Garrido, D. F., & Bouso, J. C. (2019). Use and Habits of the Protagonists of the Story: Cannabis Social Clubs in Barcelona. Journal of Drug Issues, 49(4), 607–624. https://doi.org/10.1177/0022042619852780

Patterns of use

One of the usual arguments in the debate over the regulation of cannabis is whether facilitating access necessarily implies a rise in use. According to the results in this survey, only a 18,07% in the sample reported a rise in use after becoming a member in the club, whereas a 13,55% reported that the rise in use reached a peak and then went down. This means that only a 4,52% of participants overall reported that use of cannabis continued to rise after they joined the club. Almost half the sample (47,66%) reported they continued to use the same quantity as before, and almost a 25% of the sample reported an intermittent use of cannabis. This is congruent with the data that show that only a 68,39% of the sample of CSCs members used cannabis on a daily basis.

That is to say, in spite of the limitations of the survey, one could consider that for a large majority of interviewees, use did not grow only because cannabis was available through a CSC –even though this does not suffice to sustain that CSCs do not promote use of cannabis. As complementary information, we may inquire on what was happening around in the Catalan society to make it the burgeoning locus for CSCs: 1 CSC in 2006, 150 in 2010 and over 300 in 2015.

As can be seen, between 2007 and 2015, when CSCs were burgeoning everywhere (2 CSCs were turned almost overnight into 350), prevalence of use of cannabis in the Catalan society did not vary significantly.

Forms of use

As has already been treated in other posts at RdRCannabis, as a result of our history and particular tradition, closely related to the culture of hash, most users of cannabis smoke in a blend with tobacco. This survey proves so, whereby 100 out of 155 interviewees reported to usually smoke it thus. Only 14 persons assured they burnt cannabis, and only 7 said to vape it regularly.

Ways of accessing cannabis after joining a CSC

The survey under analysis inquired where the cannabis was obtained before they became members, and whether or not other substances were available on the site of purchase. A 37% of the sample reported that before they became members they mostly bought it in public spaces, and a 47% did so at the dealer’s house. These plummeted with membership (a 2% purchased in public spaces and a 6,5%, at the dealer’s house). As for access to other substances on the site of purchase before membership, a 34,19% reported they could purchase ecstasy, a 32,90% obtained amphetamines, a 38,06% had access to cocaine, a 27,10%, to LSD, an 11,61% reported opium derivatives, and a 9,68% of users reported “others”.

Consumption facilities for CSCs members

One of the risks for consumers is legal risk. Exactly the same situation common here for those who used drugs 30 years ago and precisely one attempted to reverse through the opening of facilities for a hygienic use of drugs. That is why CSCs may be viewed as safe facilities for users and mean a real alternative to drug use on the street. Also, it can bring a diminishing in penalties for drug use among the population groups most vulnerable.

In fact, according to results of the survey, sites most used (“usually”) for consumption are private places and CSCs (78% and 67%, respectively). Around a 15% of respondents reported to occasionally consume cannabis in a car. This opens the door to designing specific actions with a view to reduce risks of cannabis use + driving.

Legal problems deriving from cannabis use

One of the questions the research team included in the survey had to do with the number of penalties got for drug using or drug possession in public spaces before and after joining the CSC.

Before becoming a member, a 31% of the sample (48 persons) had got one penalty (25 persons) or two penalties or more (23 persons). After joining, only 17 persons had been penalised, 14 of whom once and 3 persons twice or more times.

So as summed up from the two previous points, the CSC model can be construed a protective agent against legal risks associated with cannabis.

Risk reduction assessment by CSCs’ members

According to the sample’s reporting, the paramount advantages of membership is that the clubs “offer more information on the product’s quality and consumption risks”, as well as “protection, safety and quiet”.

Almost half the interviewees (48,38%) reported that the CSC had provided “the resources to reduce their regular patterns consumption”, such as daily or monthly assessment of cannabis consumption. A 100% of the interviewees reported that this was positive and, on making them the open question “What has implied for you the continual assessment of your patterns of consumption?” they answered the following:

• “They informed me how much I consume monthly and that brought home this is an issue with me”,
• “Having more data on my consumption aids me keep it under control”,
• “Won’t reduce consumption until levels stand higher, since at present I am an activist in the movement”,
• “It improved my consumption management”.

A 30,86% of the interviewees reported that assessing consumption regularly was helpful to reduce their consumption. A 27,74% took part in workshops on responsible use organised by CSCs.

Over half the sample (58%) assessed positively the availability of reliable, objective information on the risks of cannabis consumption. A 57% of these agreed that “after I joined the CSC I’ve been more aware of the risks associated with drug use and the harms coming from it”. A bigger proportion, a 65%, considered that “consumption self-management offered by CSCs reduces consumption risks”, and a like proportion considered that “drug availability provided by clubs was helpful to prevent health risks”. Last, a 61% reported that the facility had increased the alternatives towards a healthier consumption.

Apart from broaching responsible cannabis use, some CSCs of the sample also organised workshops on other topics. Only 28 of the interviewees reported to have taken part in any of these; a 93,18% reported “to have got the quality information they needed”; a 93,18, that the workshop helped “prevent health risks”; a 75,00% was of the opinion that “after participating in the workshop they had taken up healthier use alternatives”, and for a 90,91% the workshop “was just satisfactory”.

Finally, the results of the question that follows are worth highlighting:

“Do you believe to be informed enough on cannabis?”. A 82% of answers reported they were “absolutely” or “sufficiently informed”, a 17% reported they were “partly informed”, and only a 1% reported to be “poorly informed”.

Some conclusions

According to results from the survey, data accumulate with more and more clues against the idea that alternatives to illegal trade promote consumption. In fact, the more data on the CSC model, the clearer the view that it protects drug consumers and society as a whole from some of the unwanted effects of policies based on banning.

On the issue of patterns of cannabis consumption in the context of CSCs, we should raise a flag and make CSCs the tip of an arrow in the fight to offer alternatives to consumption most at risk, that of joints made up of a blend with tobacco and no filter. On the blog RdRcannabis you will find some clues as how to do it.

Although Dutch coffee shops are known all over the world, not so much can be said of the main reasons that gave them that legal status in year 1976. What has come to been known as the “Dutch tolerance policy” has a direct bearing from the effort to achieve a “separation of markets”. Of which markets exactly? Of those called of “hard drugs” and that of “soft drugs”, that is to say, split the cannabis trade from the rest of trades with illegal drugs. European pragmatists understood that to protect their youth from the harms of drug consumption it was far preferable to facilitate access to a substance with the least risks and hamper access to the most dangerous. From the survey under review, the CSC model also underlies market separation, which almost 50 years ago the Dutch furthered to protect consumers’ health.

The second survey goes under the title “Investigació qualitativa en clubs socials de cànnabis espanyols: ‘El moment en què entres per la porta, estàs minimitzant els riscos’”*. [“The moment you enter the door, you are minimising the risks”*]. This enquiry was realised by a team of researchers of the Czech Republic and published in the International Journal of Drug Policy in 2016.

* Belackova V, Tomkova A, Zabransky T. Qualitative research in Spanish cannabis social clubs: “The moment you enter the door, you are minimising the risks”. Int J Drug Policy. 2016 Aug; 34:49-57. doi: 10.1016/j.drugpo.2016.04.009. Epub 2016 Apr 20. PMID: 27461986.

The question the survey was willing to explore was whether CSCs can reduce risks, specifically these four:

1. Respiratory risks and other health risks
2. Mental health risks
3. Risk of dependency
4. Social risks

To collect and analyse the information, 94 persons were interviewed taking part in a total of 14 focal groups in the Basque Country, Catalonia, the Balearic Islands and Galicia.

Respiratory risks and other health risks

According to the survey, CSCs members are able to detect pollutants or adulterants harmful to cannabis, and there are ways of control through which better know the quality of the product.

That is to say, CSCs do not ease respiratory risks coming from smoking cannabis but they reduce significantly health risks of consumption of derivatives of cannabis containing pollutants, moulds or unfamiliar adulterations.

Mental health risks

Cannabis consumers in the survey did not provide specific information on mental health risk reduction, yet availability of information on distinct effect types together with the availability of distinct varieties (scarce in illegal trades) would allow them to adjust their cannabis consumption to their desired psychic state or their daily activity.

This possibility is underlined as integral to enjoying a good mental health.

Social risks

Penal risks and stigma dwindle as consumers of cannabis enter the surroundings of CSCs. This underlies the potential of CSCs as strategies to reduce consumption risks and harms.

CSCs offer a unique entourage for future actions and education. These operate as a facility to boost social cohesion and share information among cannabis consumers, which may have an important synergetic effect achieved through informal social control.

Thirdly, there comes a short paper written by Anna Obradors, published in 2021 in International Journal of Drug Policy under the title “Reducció de danys i clubs socials de cànnabis: explorant el seu vertader potencial”* [Harm reduction and cannabis social clubs: Exploring their true potential], offering the results from an on-line survey to 15 CSCs that were members in CATFAC. Of these, 10 CSC had among 50 and 200 members and 5 had no more than 500.

*Obradors-Pineda, a., Bouso JC., Parés-Franquero Ò., Romaní O,. (2021). Harm reduction and cannabis social clubs: Exploring their true potential. International Journal of Drug Policy Volume 97, November 2021, 103358. https://doi.org/10.1016/j.drugpo.2021.103358

The survey grouped services of harm reduction in 3 categories:

Information:

• 11 out of 15 CSCs offered graphic information (posters) on risk reduction.
• 1 of them forwarded to their members their monthly consumption record.
• 11 out of 15 offered their members their consumption record on demand.

Other services:

• 12 out of 15 offered free access to water.
• Only 1 offered filters for a less risky consumption.
• 11 out of 15 offered free vaporisers and other devices.
• 11 of 15 offered safekeeping of cannabis in case members were not willing to take it out of the facility.
• Only 4 out of 15 were resourceful as to whom to refer a member to with a problematic consumption pattern.
• Half of them, 7 out of 15, had an alliance with organisations devoted to medicinal cannabis.

Product:

• 10 out of 15 showed information on the quality of cannabis on disposal
• 6 out of 15 had their own methods to analyse the quality of cannabis on disposal

The survey offers other data of interest and some interesting conclusions that sketch the best way to draw the most potential out of CSCs and risk reduction.

Once the synthesis of these three papers is over, we may conclude that CSC model is a very interesting and privileged option for it to develop and draw mechanisms to reduce risks in the face of cannabis consumption.

This is the exact junction where RdRcannabis came to life, a project of the Subdirectorate-General for Substance Abuse, sustained together with the staff running CSCs all around Catalonia. This project offers graphical and tailored educational resources that are to meet the needs of the target public. It also offers further training to trainers (workers and representatives of CSCs). RdRcannabis is willing to learn about the different realities that live along, hand in hand, in the big house of CSCs.

You are all welcome!