Smoking gun?

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.

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.”

• For more, go to www.turning-point.co.uk

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.
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