Keep off the grass

One in four young people use cannabis and some heavy users blame their serious mental illness on the drug. While experts debate the link, says Katie Leason all agree that young people should understand the risks

Steve Hammond was a normal teenager. He was at college, enjoyed playing football, and had lots of friends and girlfriends. But then Steve got into cannabis and that, says his dad Terry, is when it all started to go wrong.

Steve started using cannabis when he was 16, smoking it casually when he was out with friends at the weekend. As he got older he began to smoke more heavily and by the time he was 21, would have up to 10 joints an evening.

Then, one night when he was in a club he ate a piece of cannabis resin – and collapsed in the toilet.

“When he woke up a voice said ‘it’s OK Steve you can get up, you’re alright.’ But when he looked around there was nobody there,” says Terry, who works in mental health as head of special projects at the charity Rethink.

From then on, Steve would hear voices, sometimes as many as four or five speaking to him at the same time.

“They would be coming out the walls, the TV, from passing buses, the corner of the room, from the floorboards. We were living with a young man who was totally and utterly terrified. He didn’t know what the hell was going on,” says Terry.

“He was trapped in a nightmare. He used to try and wake himself up by crashing his head on the wall. We’d walk in and see blood dripping down his face. He was doing it to get the voices out of his head.”

Eventually Steve was seen by a psychiatrist and taken into hospital for three months. He was diagnosed with schizophrenia.

Now, seven years on, Steve’s condition is stable, but he is still emotionally fragile, to the extent that he will not use the bus or go shopping on his own.

Terry is adamant that while his son may have been more prone to mental health problems – as a young boy he was sensitive and anxious about change – it was the cannabis that pushed him over the edge.

“I’ve got no doubt whatsoever, and nor has Steve, that had he not taken cannabis he would never have developed schizophrenia. That is my belief.”

Yet although personal convictions such as this are not unusual (see Danger Signs), cannabis remains a class C drug, a category which includes drugs considered as less harmful, such as anabolic steroids  – and this despite a thorough investigation into its effects on mental health.

Cannabis was downgraded from class B in January 2004, but following new research into the link between cannabis and mental illness the Advisory Council on the Misuse of Drugs (ACMD) has re-examined the evidence.(1)
 
It concluded that cannabis had effects on mental health that were “real and significant”, and that there was a likely link between cannabis use and the development of psychotic symptoms. But, given that very few of the three million people who use cannabis each year develop schizophrenia, the ACMD came to the decision that using cannabis “makes (at worst) only a small contribution to an individual’s risk”, possibly by as little as 1 per cent over their lifetime.

In addition, the ACMD was not convinced of any link between the frequency of cannabis use and subsequent psychosis, or of there being more chance of a person developing psychotic symptoms if they first used cannabis before the age of 15. Equally, it was not persuaded of any association between cannabis use and depression, bipolar disorder or anxiety.

Overall, the research found that cannabis is less harmful than other class B substances, such as amphetamines and barbiturates, and so recommended that it stay in class C.

This, combined with statistics suggesting that the lower classification had not led to an increase in use by young people (24 per cent of 16-24 year olds used cannabis in 2004-5 compared with 28 per cent in 1998) was enough to convince home secretary Charles Clarke to leave cannabis in the category of least risk.

Both the ACMD and the government agreed, however, that further research was needed into the relationship between cannabis and mental health problems, as well as a public information campaign informing people about the drug’s risks.

These developments have been welcomed by experts in the field, including Stanley Zammit, a lecturer in the department of psychological medicine at the University of Wales.

“What’s important is for people to know that there are some risks and that it is not a perfectly safe drug. If people don’t know the facts then it’s hard for them to come to any rational decisions,” he says.

Zammit was involved in a study of 50,000 men who joined the Swedish army, analysing the data to see how many of those who had used cannabis went on to develop schizophrenia.

His team found that those who used cannabis by the age of 18 had an increased risk and that the more cannabis used, the greater the risk; those who had used the drug on more than 10 occasions were at double the risk while those who had used it more than 50 times were at a threefold risk.

But as he says, a three in 100 risk (one in 100 people develop schizophrenia) is still a small number.

He says: “It’s not as though if you smoke cannabis you are definitely going to develop schizophrenia.”

But it is clear that young people and their parents should understand the risks, particularly those who might be more vulnerable, such as those who have a sibling or parent with a mental health problem.

The percentage of young people using cannabis may not have gone up in recent years, but it still represents a quarter of the UK’s young people. They deserve to know what the experts have found, so the sooner an information campaign is up and running the better.

(1) Further Consideration of the Classification of Cannabis under the Misuse of Drugs Act 1971, Advisory Council on the Misuse of Drugs, 2005

Danger signs
 “I went from being an intelligent and confident 14-year-old to a suicidal wreck in a very short time. I will never know if the onset of my mental illness was/is biological or whether it was/is solely the result of the dope use – but all I do know is that my life has been irreversibly damaged by a tiny amount of this drug.”

 “I was a daily user of skunk for five years and feel that this was a huge contributor to my mental health problems. I was 16 when I began using it daily and was totally and completely ignorant of the possible psychological harm. Had I known of the real risks I definitely think I would have thought twice about my excessive use.”

 “When I graduated from smoking a couple of times a week to smoking every night things started to become more pronounced. I was getting paranoid when I was going out in public, I believed that people were thinking things about me and people were looking at me.”

 “I do not blame my problems entirely on the drug as my mental health issues were the very reason
I began smoking it in the first place, as relief.”

 “It seems to be saturating our culture and it seems to be something that people don’t have a problem with. I just don’t understand how it can be seen as so acceptable when it has such devastating consequences.”

Source: Submission to the Advisory Council on the Misuse of Drugs, Rethink, 2005