Chapter 4: Cannabis Dependency and Risks — A Comparison with Stimulants and Tobacco Chapter 5: The Future of Medical Cannabis in Japan— Policy Recommendations and Implementation Challenges5secondhand smoke exposure, raising broader public health concerns. Thus, while cannabis, stimulants, and tobacco all carry risks of addiction and health damage, their characteristics and levels of social acceptance vary significantly. In Japan, public rejection of cannabis remains especially strong, often equating it with hard drugs like stimulants, while regulations and public education around tobacco remain relatively lenient. Moving forward, there is a need for balanced public education and regulatory frameworks based on scientific risk assessments of each substance.involve elderly individuals. For these patients and their families, overcoming the deeply ingrained belief that “cannabis is a dangerous drug” requires clear communication and open dialogue to help them understand its medical effectiveness. In Japan, there remains a particularly strong social stigma against cannabis. This stems largely from conflating cannabis as an illegal drug with its legitimate use as a scientifically validated pharmaceutical. As such, society must begin to understand that “medical cannabis is not a crime,” but rather “one of many medications administered under a physician’s judgment.” Looking ahead, Japan must prepare on both institutional and societal fronts to ensure that medical cannabis reaches those in need. This will require a combination of legal rigor, transparent medical accountability, and continuous public education to promote informed understanding and support policy implementation. Cannabis is often considered to have “low dependency potential,” but that does not mean it is harmless. According to international research, cannabis dependency affects approximately 9–20% of users. While physical withdrawal symptoms tend to be mild, the risk of psychological dependence and habitual use remains. In contrast, stimulants such as methamphetamine are highly addictive and account for the majority of drug addiction cases in Japan. Relapse rates are extremely high, and use is often accompanied by hallucinations, delusions, and violent behavior, leading to severe psychological and physical harm. Tobacco (nicotine) serves as another important point of comparison. Although legal and widely distributed, tobacco ranks just below stimulants and heroin in terms of addictive potential. Nicotine induces strong physical dependence, making smoking cessation notoriously difficult. Furthermore, tobacco use significantly increases the risk of chronic health issues such as lung cancer and cardiovascular disease. The types of health risks also differ. Stimulants can cause acute mental disturbances in a short period of time. Cannabis, on the other hand, raises concerns regarding long-term use—such as impaired memory and attention, as well as developmental impacts on younger users. Tobacco not only leads to addiction but also poses risks to others through For medical cannabis to be appropriately introduced and disseminated in Japan, it will require both a carefully designed and strictly regulated institutional framework, as well as deliberate efforts to dispel deeply rooted public misconceptions. It must be emphasized that use is strictly limited to medical purposes, and should never be interpreted as an endorsement of recreational use or abuse.From a policy perspective, the use of cannabis-derived pharmaceuticals should, in principle, be restricted within medical institutions, under strict supervision and prescription by licensed physicians. For example, prohibiting patients from taking cannabis-based medications outside the hospital setting could significantly reduce the risks associated with distribution and misuse. Establishing such rigorous operational rules would contribute to public confidence and safety. Many patients who may benefit from medical cannabis are suffering from severe conditions such as cancer, treatment-resistant epilepsy, or terminal illnesses—cases which often
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