Cannabis – a potent problem - By: Dotrhey

The issues relating to cannabis pose a challenge to whether the Act is working as it was originally intended. The ACMD was requested by the Home Secretary in 2009 to review the status of cannabis because: ‘Though statistics show that cannabis use has fallen signifi cantly, there is real public concern about the potential mental health effects of cannabis use, in particular the use of stronger forms of the drug, commonly known as skunk.’ So there was a skunk scare.

The reports are very accessible and written in language that allows a lay person to understand the science as well as the policy implications:

● Cannabis is a harmful drug and there are concerns about the widespread use of cannabis amongst young people.

● A concerted public health response is required to drastically reduce its use.

● Current evidence suggests a probable, but weak, causal link between psychotic illness and cannabis use.

● The harms caused by cannabis are not considered to be as serious as drugs in class B and therefore it should remain a class C drug. Let me just guide you through some of the reasoning behind that fi nal point.

There has been a lot of commentary and some research as to whether cannabis is associated with schizophrenia, and the results are really quite diffi cult to interpret. What we can say is that cannabis use is associated with an increased experience of psychotic disorders. That is quite a complicated thing to disentangle because, of course, the reason people take cannabis is that it produces a change in their mental state. These changes are a bit akin to being psychotic – they include distortions of perception, especially in visual and auditory perception, as well as in the way one thinks. So it can be quite hard to know whether, when you analyse the incidence of psychotic disorders with cannabis, you are simply looking at the acute effects of cannabis, as opposed to some consequence of cannabis use. If we look on the generous side, there is a likelihood that taking cannabis, particularly if you use a lot of it, will make you more prone to having psychotic experiences. That includes schizophrenia, but schizophrenia is a relatively rare condition so it’s very hard to be sure about its causation.

The analysis peuple came up with was that smokers of cannabis are about 2.6 times more likely to have a psychotic-like experience than non-smokers. To put that fi gure in proportion, you are 20 times more likely to get lung cancer if you smoke tobacco than if you don’t. That’s the sort of scaling of harms that I want people to understand. There is a relatively small risk for smoking cannabis and psychotic illness compared with quite a substantial risk for smoking tobacco and lung cancer.

The other paradox is that schizophrenia seems to be disappearing (from the general population) even though cannabis use has increased markedly in the last 30 years. When we were reviewing the general practice research database in the UK from the University of Keele, research consistently and clearly showed that psychosis and schizophrenia are still on the decline. So, even though skunk has been around now for ten years, there has been no upswing in schizophrenia. In fact, where people have looked, they haven’t found any evidence linking cannabis use in a population and schizophrenia. Another interesting fi nding came from our analysis of what it would take to reduce the number of people being diagnosed with schizophrenia by targeting cannabis use. Our research estimates that, to prevent one episode of schizophrenia, we would need to stop about 5,000 men aged 20 to 25 years from ever using the drug. This is obviously a major public health challenge and one that raises questions about whether it is a viable way of intervening with schizophrenia. So, overall, cannabis use does not lead to major health problems. We were also interested in the public perceptions of drugs.

The public are often seen as major players in this debate, but we rarely fi nd out exactly what the http://www.crimeandjustice.org.uk 5 public thinks. In fact, the tendency is to assume that what the media produce is what the public think. In 2008, the government launched a consultation on a new drug strategy that included questions on cannabis to fi nd out what the public thought. Two questions were asked: ‘Do you think cannabis should be reclassifi ed?’ and ‘What are your views on tougher penalties?’ Responses from 639 people were obtained. Some responded on behalf of organisations and others responded individually.

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