G Model
ARTICLE IN PRESS
DRUPOL-1350; No. of Pages 9
International Journal of Drug Policy xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
International Journal of Drug Policy journal homepage: www.elsevier.com/locate/drugpo
Research paper
Preferences for policy options for cannabis in an Australian general population: A discrete choice experiment Marian Shanahan a,∗ , Karen Gerard b , Alison Ritter a a b
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia Faculty of Health Sciences, University of Southampton, Southampton, UK
a r t i c l e
i n f o
Keywords: Cannabis policy Public preferences Discrete choice experiments Preference elicitation Social policy
a b s t r a c t Background: Policy choices for illicit drugs such as cannabis entail consideration of competing factors such as individual health, societal views about pleasure, and criminal justice impacts. Society must weigh up these factors in determining the preferred cannabis policy; although often cast as a contest between legalisation of cannabis or full prohibition the actual policy choices are not so black and white. This study assessed societal preferences for different cannabis policies and multiple consequences. Method: A discrete choice experiment (DCE) quantified value-based preferences for alternative cannabis policies described by the five key attributes legal status, health harms, criminal justice service costs, rates of cannabis use and purchase location. An online survey was conducted on a population sample of 1020 Australians. The analytical model was based on stated choices for Policy A, B or Current Policy. Results: The results revealed a strong general preference for either civil penalties or legalisation compared to cannabis cautioning (Current Policy) and a strong dislike of criminalising possession and use of cannabis. Results also demonstrate difference in preferences among those with different demographics and beliefs. Understanding these nuances help to quantify the range of preferences held within the population and can be used to inform policy. Conclusion: This is the first known DCE survey applied to the area of illicit drugs policy. It demonstrates the public hold disparate views on the most appropriate status for cannabis offences and they are able to make trade-offs between policy choices and outcomes in complex areas of social policy. © 2014 Elsevier B.V. All rights reserved.
Introduction Although countries vary to some extent on cannabis policy (Hall & Pacula, 2003; Room, Fischer, Hall, Lenton, & Reuter, 2008) the primary international policy response to preventing cannabis use is prohibition (Macleod & Hickman, 2010). Some notable exceptions to prohibition are the recent legalisation of cannabis in Colorado and Washington in the United States and its’ decriminalisation in Portugal (Hughes & Stevens, 2010). In spite of this, an estimated 128.9 million to 190.7 million people across the globe used cannabis in 2010 (UNODC, 2010). In Australia cannabis remains the most commonly used illicit drug, with one in three persons (35.3%) aged 14 and older having used it in their lifetime, and one in ten having used in the last year (Australian Institute of Health & Welfare, 2011). These numbers would suggest that prohibition may not function well as a deterrent for preventing use.
∗ Corresponding author. Tel.: +61 2 2 8936 1215. E-mail address: [email protected] (M. Shanahan).
Prohibition can further place excessive burden on the police and courts and this is frequently used as an argument to legalise or at least decriminalise cannabis (Egan & Miron, 2007; Ludgwig & Cook, 2001; Miron, 2005; Nadelmann, 1989; Wodak, Reinarman, & Cohen, 2002). For those who receive a criminal record for a cannabis offence, research suggests that there may be negative impacts on subsequent employability (Pager, 2003); stigmatisation from family and friends (Ali et al., 1999; Hathaway, Comeau, & Erickson, 2011; Lenton & Ovenden, 1996); and they may be less likely to enter and complete treatment for dependence (Ahern, Stuber, & Galea, 2007). Indeed, some jurisdictions in Australia have introduced programs that divert cannabis use offenders away from the criminal justice system and into education or treatment options (Hughes & Stevens, 2007; Lenton & Heale, 2000; van Laar & van Ooyen-Houben, 2009; Weatherburn & Jones, 2001). The afore mentioned Portuguese decriminalisation seeks to provide a more humane framework for those detected with drugs through improved prevention, harm reduction and treatment activities in order to minimise social exclusion and marginalisation of drug users (Hughes & Stevens, 2010).
http://dx.doi.org/10.1016/j.drugpo.2014.03.005 0955-3959/© 2014 Elsevier B.V. All rights reserved.
Please cite this article in press as: Shanahan, M., et al. Preferences for policy options for cannabis in an Australian general population: A discrete choice experiment. International Journal of Drug Policy (2014), http://dx.doi.org/10.1016/j.drugpo.2014.03.005
G Model DRUPOL-1350; No. of Pages 9 2
ARTICLE IN PRESS M. Shanahan et al. / International Journal of Drug Policy xxx (2014) xxx–xxx
There is also an established research literature on the harms associated with cannabis use (Degenhardt, Calabria, Hall, & Lynskey, 2008; Hall & Pacula, 2003; Room et al., 2008). For example, there appears to be an association between cannabis use and traffic accidents (Mann, Stoduto, MacDonald, & Brands, 2008), and evidence that cannabis might precipitate schizophrenia in vulnerable individuals (Cohen, Solowij, & Carr, 2008; Ferguson, Poulton, Smith, & Boden, 2008; Fergusson, Horwood, & Ridder, 2005; Moore et al., 2007). Additionally, among those who have ever used cannabis the risk of dependence is between 7% and 9% (Anthony, Warner, & Kessler, 1994; Perkonigg et al., 2008). As a result of these different consequences of cannabis use and associated cannabis policies there have been long-standing debates over the legal status of cannabis (Nadelmann, 1989; Room et al., 2008; Wodak et al., 2002). Determining the optimal cannabis law for any given society appears to be a challenging and fraught exercise. The simple application of research evidence is not adequate given the potential for greater health harms associated with relaxation of laws and the potential for criminal justice harms associated with prohibition. What is needed, but currently absent, is evidence that takes into account trade-offs between the multiple wide ranging social harms and the legal status of cannabis and uses this to inform socially acceptable policy solutions. Considerations of public opinion, in this context, become central. Research suggests a connection between public opinion and public policy decisions particularly when the issue has salience (Burstein, 2003; Monroe, 1998). Many polls have summarised, in a dichotomous fashion, the extent of support or opposition for different cannabis policies such as legalisation or decriminalisation. For example, USA Gallup polls have shown increases in support for cannabis legalisation, from 12% in 1969 to 50% in 2011 (Newport, 2011). However, there are concerns that public opinion polling is simplistic and highly driven by the type of question posed (Matthew-Simmons, Love, & Ritter, 2008). Surveys do not always distinguish between whether they are referring to consumption or supply of cannabis, and whether the policy of interest is legalisation or decriminalisation (Newcombe, 2004). Further, as many individuals are unaware of the current legal status of cannabis in their jurisdiction (Chanteloup, Lenton, Barratt, & Fetherston, 2005; MacCoun, Pacula, Chriqui, Harris, & Reuter, 2009; Pacula, Chriqui, & King, 2004) it is difficult to interpret the results of these surveys. In this context, and given the potential influence of public opinion in determining public policy, it is necessary to have a more nuanced understanding of societal preferences for cannabis policies. This ought to link the legal status of cannabis preferences with associated attributes such as prevalence of use, health consequences and criminal justice sector consequences. We argue the best research tool available for examining tradeoffs between different cannabis policies and their consequences is the Discrete Choice Experiment (DCE) approach. It is a stated preference technique that uses an attribute-based survey method to measure the value of multiple impacts on a single scale. In the current context, DCE draws upon economic theory to allow the identification and quantification of key characteristics which are likely to influence society’s preferences for the legal status of cannabis. The DCE approach uses the choices respondents make between hypothetical (yet realistic) options to estimate utility. In stating a choice the respondent is revealing the alternative that yields highest utility to them and the DCE approach, thus, relies on an individual’s knowledge or perceptions of her/his own preferences and on her/his ability to make trade-offs between alternatives in terms of having more of one attribute level and less of another. Underpinning this behaviour is economic consumer theory which assumes individuals derive wellbeing (utility) not from a good (or in this case a policy) itself but rather from the attributes
Table 1 Attributes and levels. Attribute
Definition
Levels
Legal status
Legal consequence of offence
Health harms
The annual cost to treat health problems from cannabis use The cost to enforce the cannabis laws
Arrested and go to court Civil fine or attend educational session for less than 15 g but police may choose to charge; arrest for more than 15 g Cannabis caution possible but police may charge for less than 15 g; arrest for more than 15 ga No offence – legally traded good; Crime if provide to persons
ARTICLE IN PRESS
DRUPOL-1350; No. of Pages 9
International Journal of Drug Policy xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
International Journal of Drug Policy journal homepage: www.elsevier.com/locate/drugpo
Research paper
Preferences for policy options for cannabis in an Australian general population: A discrete choice experiment Marian Shanahan a,∗ , Karen Gerard b , Alison Ritter a a b
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia Faculty of Health Sciences, University of Southampton, Southampton, UK
a r t i c l e
i n f o
Keywords: Cannabis policy Public preferences Discrete choice experiments Preference elicitation Social policy
a b s t r a c t Background: Policy choices for illicit drugs such as cannabis entail consideration of competing factors such as individual health, societal views about pleasure, and criminal justice impacts. Society must weigh up these factors in determining the preferred cannabis policy; although often cast as a contest between legalisation of cannabis or full prohibition the actual policy choices are not so black and white. This study assessed societal preferences for different cannabis policies and multiple consequences. Method: A discrete choice experiment (DCE) quantified value-based preferences for alternative cannabis policies described by the five key attributes legal status, health harms, criminal justice service costs, rates of cannabis use and purchase location. An online survey was conducted on a population sample of 1020 Australians. The analytical model was based on stated choices for Policy A, B or Current Policy. Results: The results revealed a strong general preference for either civil penalties or legalisation compared to cannabis cautioning (Current Policy) and a strong dislike of criminalising possession and use of cannabis. Results also demonstrate difference in preferences among those with different demographics and beliefs. Understanding these nuances help to quantify the range of preferences held within the population and can be used to inform policy. Conclusion: This is the first known DCE survey applied to the area of illicit drugs policy. It demonstrates the public hold disparate views on the most appropriate status for cannabis offences and they are able to make trade-offs between policy choices and outcomes in complex areas of social policy. © 2014 Elsevier B.V. All rights reserved.
Introduction Although countries vary to some extent on cannabis policy (Hall & Pacula, 2003; Room, Fischer, Hall, Lenton, & Reuter, 2008) the primary international policy response to preventing cannabis use is prohibition (Macleod & Hickman, 2010). Some notable exceptions to prohibition are the recent legalisation of cannabis in Colorado and Washington in the United States and its’ decriminalisation in Portugal (Hughes & Stevens, 2010). In spite of this, an estimated 128.9 million to 190.7 million people across the globe used cannabis in 2010 (UNODC, 2010). In Australia cannabis remains the most commonly used illicit drug, with one in three persons (35.3%) aged 14 and older having used it in their lifetime, and one in ten having used in the last year (Australian Institute of Health & Welfare, 2011). These numbers would suggest that prohibition may not function well as a deterrent for preventing use.
∗ Corresponding author. Tel.: +61 2 2 8936 1215. E-mail address: [email protected] (M. Shanahan).
Prohibition can further place excessive burden on the police and courts and this is frequently used as an argument to legalise or at least decriminalise cannabis (Egan & Miron, 2007; Ludgwig & Cook, 2001; Miron, 2005; Nadelmann, 1989; Wodak, Reinarman, & Cohen, 2002). For those who receive a criminal record for a cannabis offence, research suggests that there may be negative impacts on subsequent employability (Pager, 2003); stigmatisation from family and friends (Ali et al., 1999; Hathaway, Comeau, & Erickson, 2011; Lenton & Ovenden, 1996); and they may be less likely to enter and complete treatment for dependence (Ahern, Stuber, & Galea, 2007). Indeed, some jurisdictions in Australia have introduced programs that divert cannabis use offenders away from the criminal justice system and into education or treatment options (Hughes & Stevens, 2007; Lenton & Heale, 2000; van Laar & van Ooyen-Houben, 2009; Weatherburn & Jones, 2001). The afore mentioned Portuguese decriminalisation seeks to provide a more humane framework for those detected with drugs through improved prevention, harm reduction and treatment activities in order to minimise social exclusion and marginalisation of drug users (Hughes & Stevens, 2010).
http://dx.doi.org/10.1016/j.drugpo.2014.03.005 0955-3959/© 2014 Elsevier B.V. All rights reserved.
Please cite this article in press as: Shanahan, M., et al. Preferences for policy options for cannabis in an Australian general population: A discrete choice experiment. International Journal of Drug Policy (2014), http://dx.doi.org/10.1016/j.drugpo.2014.03.005
G Model DRUPOL-1350; No. of Pages 9 2
ARTICLE IN PRESS M. Shanahan et al. / International Journal of Drug Policy xxx (2014) xxx–xxx
There is also an established research literature on the harms associated with cannabis use (Degenhardt, Calabria, Hall, & Lynskey, 2008; Hall & Pacula, 2003; Room et al., 2008). For example, there appears to be an association between cannabis use and traffic accidents (Mann, Stoduto, MacDonald, & Brands, 2008), and evidence that cannabis might precipitate schizophrenia in vulnerable individuals (Cohen, Solowij, & Carr, 2008; Ferguson, Poulton, Smith, & Boden, 2008; Fergusson, Horwood, & Ridder, 2005; Moore et al., 2007). Additionally, among those who have ever used cannabis the risk of dependence is between 7% and 9% (Anthony, Warner, & Kessler, 1994; Perkonigg et al., 2008). As a result of these different consequences of cannabis use and associated cannabis policies there have been long-standing debates over the legal status of cannabis (Nadelmann, 1989; Room et al., 2008; Wodak et al., 2002). Determining the optimal cannabis law for any given society appears to be a challenging and fraught exercise. The simple application of research evidence is not adequate given the potential for greater health harms associated with relaxation of laws and the potential for criminal justice harms associated with prohibition. What is needed, but currently absent, is evidence that takes into account trade-offs between the multiple wide ranging social harms and the legal status of cannabis and uses this to inform socially acceptable policy solutions. Considerations of public opinion, in this context, become central. Research suggests a connection between public opinion and public policy decisions particularly when the issue has salience (Burstein, 2003; Monroe, 1998). Many polls have summarised, in a dichotomous fashion, the extent of support or opposition for different cannabis policies such as legalisation or decriminalisation. For example, USA Gallup polls have shown increases in support for cannabis legalisation, from 12% in 1969 to 50% in 2011 (Newport, 2011). However, there are concerns that public opinion polling is simplistic and highly driven by the type of question posed (Matthew-Simmons, Love, & Ritter, 2008). Surveys do not always distinguish between whether they are referring to consumption or supply of cannabis, and whether the policy of interest is legalisation or decriminalisation (Newcombe, 2004). Further, as many individuals are unaware of the current legal status of cannabis in their jurisdiction (Chanteloup, Lenton, Barratt, & Fetherston, 2005; MacCoun, Pacula, Chriqui, Harris, & Reuter, 2009; Pacula, Chriqui, & King, 2004) it is difficult to interpret the results of these surveys. In this context, and given the potential influence of public opinion in determining public policy, it is necessary to have a more nuanced understanding of societal preferences for cannabis policies. This ought to link the legal status of cannabis preferences with associated attributes such as prevalence of use, health consequences and criminal justice sector consequences. We argue the best research tool available for examining tradeoffs between different cannabis policies and their consequences is the Discrete Choice Experiment (DCE) approach. It is a stated preference technique that uses an attribute-based survey method to measure the value of multiple impacts on a single scale. In the current context, DCE draws upon economic theory to allow the identification and quantification of key characteristics which are likely to influence society’s preferences for the legal status of cannabis. The DCE approach uses the choices respondents make between hypothetical (yet realistic) options to estimate utility. In stating a choice the respondent is revealing the alternative that yields highest utility to them and the DCE approach, thus, relies on an individual’s knowledge or perceptions of her/his own preferences and on her/his ability to make trade-offs between alternatives in terms of having more of one attribute level and less of another. Underpinning this behaviour is economic consumer theory which assumes individuals derive wellbeing (utility) not from a good (or in this case a policy) itself but rather from the attributes
Table 1 Attributes and levels. Attribute
Definition
Levels
Legal status
Legal consequence of offence
Health harms
The annual cost to treat health problems from cannabis use The cost to enforce the cannabis laws
Arrested and go to court Civil fine or attend educational session for less than 15 g but police may choose to charge; arrest for more than 15 g Cannabis caution possible but police may charge for less than 15 g; arrest for more than 15 ga No offence – legally traded good; Crime if provide to persons
