GLOBAL OVERVIEW – SMOKING CIGARETTES
Mr Speaker, the impact of cigarette smoking and other tobacco use on chronic disease is well documented. Worldwide, over 1 billion people currently use tobacco, mostly in the form of cigarettes and 7 million die each year, with 80% of these tobacco related deaths occurring in developing countries.
Mr Speaker, in “The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide” 88% of adult smokers who smoke daily report that they started smoking in their teenage years (Chapter 3 in Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General, Center for Disease Control 2012).
Mr Speaker, the adolescent period is a time of great susceptibility to social influences, presented through the marketing of products, peer group interaction and of behaviour exhibited by role models. Therefore, Mr. Speaker, with the aim to stem the resulting health and economic consequences, primary prevention strategies are focused on youth and young adults; to drastically lower youth initiation and use of substance use (Tobacco, Marijuana and Alcohol).
Mr Speaker, the WHO Framework Convention on Tobacco Control (FCTC) was a global response to the globalization of the tobacco epidemic. Jamaica signed on September 24, 2003 and ratified on October 5, 2005, grounded in the Public Health Act: the Public Health (Tobacco Control) Regulations was promulgated and came into effect on July 15, 2013.
TOBACCO CONTROL BILL
A comprehensive Tobacco Control Bill has been developed and is under review. However, based on the multi-sectoral nature of the Bill and the time involved in legislative development process, Regulations were promulgated in 2013 under the Public Health Act. This was done as an interim measure to uphold its obligations, pending the development and finalization of a Comprehensive Tobacco Control Bill.
The comprehensive legislation seeks to address critical Articles, which have not been addressed under the existing Tobacco Control Regulations. These include:
- to regulate the interactions of government officials with the tobacco industry and to ensure that government bodies only interact with the tobacco industry only when and to the extent strictly necessary to enable them to effectively regulate the tobacco industry and tobacco products;
- to regulate Price and Tax measures in a manner that will effectively contribute to the reduction of tobacco consumption;
- testing and measurement of the contents and emissions of tobacco products and provisions for the disclosure of toxic substances to the public;
- full prohibition on tobacco advertising, promotion and sponsorship, and including a ban on point-of-sale tobacco displays; this will bring us closer to ‘plain packaging’.
- Jamaica’s commitment to eliminate all forms of illicit trade in tobacco products; and
- prohibit sale of all forms of tobacco products to and by minors. The Child Care and Protection Act (CCPA) does not prohibit the sale of tobacco products in general (including electronic nicotine delivery systems) to and by minors. The current provision restrictively references cigarettes, cigars, cheroots, and cigarillos. We recognize however that attempts were being made by the Office of the Children’s Advocate to amend the CCPA to accord with the FCTC requirements
Mr. Speaker, I can unequivocally state that the government is committed to the translation of the FCTC into effective national implementation of the treaty. Therefore priority areas for the government includes inter alia: full implementation of a comprehensive ban on tobacco advertising; promotion and sponsorship; enacting a comprehensive tobacco control legislation; and reducing demand on tobacco products through increased taxes.
Multi-sectoral collaborations are underway in reviewing and developing the draft Bill. The Ministry of Health has engaged the Ministry of Foreign Affairs and Foreign Trade to lead the process, which involves deliberations among legal personnel from the various ministries. The Ministry is currently developing the Cabinet Submission in relation to this legislation.
In the meantime, current informational and social marketing campaign efforts to reduce both initiation and prevalence of tobacco use (and overall substance use) include:
- Y.P.E (Healthy Youth Positive Energy) island tour in schools- tobacco control one of the priority interventions
- World No Tobacco Day, which was celebrated on May 31, 2017 – with an island-wide school competition under the Theme: “Tobacco and Threat to Me and My Country.”
- READ (Resistance Education against Drugs) – A programme designed for students as an indigenous response to our Jamaican reality of a cultural acceptance to drug use. Selection for participation is based on students that belong to a group that have a high risk for substance use. (Ongoing NCDA programme)
- Strive – This is an NCDA selective prevention programme that is designed to increase knowledge of the consequences of substance abuse. It builds life skills, including resistance and problem solving mechanisms.
PUBLIC EDUCATION CAMPAIGN
Mr Speaker, it is also irrefutable that sustained efforts are needed for behavioural change. Therefore, Mr Speaker, as part of our larger social intervention initiative a National Communication campaign will be rolled out this fiscal year with a focus on raising awareness about the harmful effects of tobacco; as we fully commit the necessary resources consistently and aggressively to making our youths as well as future generations tobacco-free.
IMPACT OF CANNABIS
As it relates to Cannabis Mr Speaker, The Dangerous Drugs (Amendment) Act, 2015 was passed to provide for “among other things, the modification of penalties for the possession of cannabis in specified small quantities and the smoking of cannabis in specified circumstances, and for a scheme of licences, permits and other authorizations for medical, therapeutic or scientific purposes”. This amendment has been referred to as the ‘decriminalization of cannabis’.
Reports from key stakeholders in the law-enforcement, education and health sectors, have been consistent regarding public perception of the recent Amendments to the Dangerous Drugs Act. The perception, particularly among youth, is that cannabis is now a legal drug to be used at leisure regardless of location, age, quantity and context.
Locally, the impact of cannabis on cognitive functioning (including memory) along with the existing challenges with education/literacy in school children and the increased prevalence of cannabis use and misuse by Jamaican adolescents is a major concern, such as incidence of ‘drugged driving’, dangerous and harmful reactions to the consumption of cannabis edibles.
There are edibles (cookies, sweets, etc.) present in the Jamaican context – some being sold within prominent schools. Mr. Speaker, a study by Professor Archibald McDonald (1999) examining trauma injuries presented at the University Hospital, showed that 46% of patients were positive for cannabis; while fifty per cent (50%) and fifty-five per cent (55%) of victims of road traffic accidents and interpersonal violence, respectively, were positive for cannabis.
Within the general population, a Drug Prevalence Survey conducted by the NCDA in 2016 among 4,623 individuals island-wide revealed that 28% of the population (12-65 years) had used cannabis at some point in their lifetime and 18% used in the past year with the average age of first use being 16. One in four (1 in 4) individuals reported using cannabis in drinks, while just over 7% reported using edibles (cannabis in food). Over 70% of population reported having easy access to cannabis.
Mr. Speaker, there has been much public discussion about the implications of the new legislation and much misinformation surrounding its provisions. Nevertheless, as we welcome the paradigm shift on the one hand, there is also the question of enforcement on the other.
The lack of enforcement of laws concerning possession and smoking of cannabis will lead to a breakdown in law and order and deterioration of non-smokers’ rights to enjoy smoke free environments especially in public spaces. Indeed, appropriate regulations must focus on protecting public health. Policy structures must be based on the need to keep harm to a minimum and should be guided by science.
Mr. Speaker, the consensus is that a public education strategy is urgently required to address the implications of these changes for various groups in our society especially targeting youth. Therefore, the National Council on Drug Abuse (NCDA) will be embarking on a full scale youth public education campaign to delay initiation into smoking and to provide youths with information about healthy coping and lifestyle options.
This campaign will build on the youth #talkditruth #FutureComeFirst (#TDT/FCF) prevention programme that is owned by the NCDA. The TDT/FCF programme will utilize mass media campaigns to include social media and special edutainment strategies.
Mr. Speaker, this campaign will be implemented over a two-year period, then evaluated and adjustments made to the main promotional messages if necessary. A defining feature of this campaign is the integration of peer and family support strategies to support and maintain behaviour change.
WHO CANNABIS REVIEW
Mr Speaker, at the 140th Session of the Executive Board of the World Health Organization (WHO) in Geneva, Switzerland, Jamaica (MOH) signalled its readiness to support and participate in the WHO’s planned review of the UN’s classification and governance of cannabis. This review Mr. Speaker should enable the removal of cannabis from its current classification as a Schedule I drug deemed to have no medicinal benefits, to another schedule which reflects its important potential for medicinal use.
Mr Speaker, the MOH supports the use of EXTRACTS (in varied CBD/THC concentrations) containing cannabis products for research and medicinal purposes, where there is scientific evidence for the use of these substances for specific conditions. There are grave misperceptions about the recreational use of cannabis bereft of its health effects. Therefore, Mr. Speaker, the MOH does not support the recreational use of cannabis or any form of smoked cannabis products, even for medicinal uses, as smoking anything is hazardous to health.
Mr. Speaker, The Health Sub-Committee of the Cannabis Licensing Authority, which is chaired by the Chief Medical Officer (CMO), is working on the following initiatives:
- Ethical Guidelines for Medicinal Cannabis Research – which are presently being crafted by a consultant and collaboratively funded by the CLA and the Jamaica Promotions Corporation (JAMPRO).
- Medicinal Cannabis cards – these have been designed for the use by persons with evidence that they are using cannabis for Medicinal purposes
- A mandatory Continuing Medical Education (CME) training programme for physicians registered in Jamaica – who will be prescribing/recommending medicinal cannabis for patients as well as training for others in the industry (e.g. smoke houses) has been completed by NeuroPsychServices.
- The registration of cannabis products (nutraceuticals and pharmaceuticals) – for importation or export will be carried out by the MOH/CMO.