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Smoking gun?

Posted: 05 May 2005 | Subscribe Online


Lord Victor Adebowale, chief executive, Turning Point

"The debate on cannabis has again become reactionary, fuelled more by misconception than hard facts. Research is cited in absolute terms, partially quoted or even distorted to give definite answers about what causes mental illness. The hyperbole from certain parts of the media and political world is not only unhelpful but risks being hugely damaging to those needing support for drug misuse or mental health challenges.

Looking at media coverage over the 16 months since reclassification you would think a raft of new reports had been produced showing that cannabis caused a host of mental health problems and the problem was at epidemic proportions.

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Yet the evidence of the drug's long-term effect on mental health is not clear-cut, and much, if not all of it, was already available to the Advisory Council on the Misuse of Drugs when it recommended reclassification. The most recent studies seem to confirm what we already know about the drug. They give further evidence of the harm caused by cannabis and to the risk of mental health problems in vulnerable people, but they do not indicate a higher risk than we were already aware of. Moreover, they do not conclude that cannabis can cause schizophrenia in people who were previously well.

There has also been no explosion in use. Evidence suggests that cannabis use among young people has remained stable since reclassification, and has even fallen among 11 to 15 year olds. A new study by the Independent Drugs Monitoring Unit in the UK found that the increase in regular use fell to just 0.5 per cent in 2004, compared with 45 per cent of all age groups at its peak in 1998.

Turning Point works across the areas of mental health and substance misuse and we get a dual perspective from our service users: from those with mental health issues who have been in effect self-medicating with cannabis to young people who need access to clearer information about the real potential harms of the drug.

Yes, cannabis may exacerbate mental health problems in those susceptible to them. But so can poverty, lack of work opportunities and social exclusion. Cannabis alone is not to blame and we should be taking a social care approach to working with the whole range of people's needs rather than blaming a simplistic notion of "cannabis psychosis". This is particularly true of people from ethnic minorities.

People from these groups, particularly African-Caribbean males, are already disproportionately likely to face a diagnosis of schizophrenia. And treatment is just as disproportionately likely to over-rely on medication and constraint for these groups. Racial stereotypes remain prevalent and the additional stereotype of "cannabis psychosis", partly fuelled by the media, could exacerbate this state of affairs still further. African or Caribbean people with a mental health problem may find themselves labelled with cannabis-induced psychosis, with little evidence for such a diagnosis.

The current debate on cannabis is confused, and risks leading to equally confusing responses. For example, we know that very young, heavy users of the drug can face particular problems. We also know that such groups face a range of compounding factors, especially exclusion from school. In which case, why prioritise school drug testing over youth outreach and inclusion programmes? The evidence tells us those we most need to identify and work with won't be in school to be tested.

We need clear, targeted education and prevention campaigns tailored to the most vulnerable groups, particularly those vulnerable to mental ill health and those who work with them. I have raised these issues with the Home Office a number of times and it has asked the National Institute for Mental Health in England to develop a range of education materials.

It is through such evidence-driven public health responses that we can best tackle the harms associated with cannabis. I hope the next government takes the time and space to consider the next steps. They could be crucial ones."

Cliff Prior, chief executive, Rethink

"Let's be clear. Cannabis damages the lives of people with a severe mental illness. It puts people vulnerable to psychosis at grave risk. And it may raise the risk for everyone. This is a major public health issue and that is how it must be treated.

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Rethink was neutral on the reclassification of cannabis from a Class B drug to Class C. However, we could see dangers in dismissing mounting concerns about the mental health risks associated with the drug and ducking them in the Home Office publicity that accompanied the reclassification announcement.

That is why we stepped up our long-running campaign to encourage more research into the links between cannabis and psychosis and louder and clearer public health warnings about them.

For the past year we have been knocking on doors along the corridors of Whitehall, lobbying MPs and peers, pestering the media and meeting colleagues in the voluntary sector to press the case for more research and better public health information. We have been sent back and forth between the Home Office and the Department of Health government departments try to bat away responsibility.

We welcome the government-ordered review, not because we expect the Advisory Council on the Misuse of Drugs (ACMD) or the home secretary in the next administration to perform a u-turn on classification itself. We welcome it because the ACMD has a reputation for thoughtful investigations, and it has the authority to call for research and a powerful public information campaign.

It does not have to recommend that cannabis be shifted back to Class B status. Indeed, with three to four million people using cannabis regularly - mainly, but not exclusively, young - it may be foolish to do so. No one wants to see the casual cannabis user pushed through the criminal justice system. What the ACMD can do is take a close look at the evidence and recommend that the Home Office and the Department of Health should get their acts together and launch a long, powerful public information campaign backed up by more long-term research.

The campaign would be based on three key findings from existing research. First, the consensus that using cannabis while experiencing a severe mental illness such as schizophrenia is deeply harmful. Second, long-term research across broad populations of people show those at high risk of developing a psychotic illness - perhaps because a close relative has already done so or because they themselves have had early symptoms - often experience cannabis as the trigger for a full-blown, long-term severe mental illness. And, third, there is emerging evidence that cannabis can raise the risk of a long-term and debilitating psychotic illness for anyone, even where other risk factors, such as family history, are absent or weak. This is where further research is most needed.

The popular media try to conflate these three issues into a simplistic debate to answer the question: "Does cannabis cause schizophrenia?" The answer is far more complex than the question allows. People have an underlying vulnerability to psychosis. Stressful life experiences interact with that vulnerability. Cannabis has a biological, psychological and social impact. And for some - particularly those already at risk and for the young - it will trigger a disabling, distressing, long-term psychosis.

This is not a problem that can be deterred or solved by a court fine or prison sentence, any more than tobacco smoking. The task is to overcome the myth that cannabis is the "safe" drug.

In France, €10m is being spent on taking mental health warnings about cannabis to young people. In the UK, just £250,000 has been spent on a limited campaign. We need to learn the lessons."

  • For more, go to www.rethink.org


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