Comment – Chantal Stevens

The government’s decision not to reclassify cannabis poured fuel on the debate about the drug’s effects. Chantal Stevens considers its impact on the lives of people with, or predisposed to, mental health problems

This January, following a review by the Advisory Council on the Misuse of Drugs, the government decided to uphold its 2004 decision to regrade cannabis as a class C drug. Predictably, the decision reignited the debate around the possible links between cannabis and mental ill health.

The existence of such a link was, of course, one of the areas of evidence carefully considered by the advisory committee. In its findings, it acknowledges that the mental health effects of cannabis are “real and significant” and that, among other things, cannabis can have adverse effects on psychological and psychomotor performance, and precipitate relapse in people with schizophrenia.

However, the advisory council goes on to argue that, although evidence suggests a possible link between the use of cannabis and the development of psychotic symptoms, this is neither concrete nor proven beyond doubt. In relation to the impact of cannabis on the development of schizophrenia meanwhile, it acknowledges that the consumption of cannabis is “neither a necessary nor sufficient cause”. It also mentions the role of genetics in schizophrenia, and the fact that some individuals have an increased susceptibility to developing the illness.

In my six years as a qualified mental health nurse, I have worked with and helped treat many individuals with varying types and degrees of mental health needs, many of whom have
a history of cannabis use or are current users.

For each of these individuals it has, in my opinion, been impossible to tell if the symptoms experienced (whether of a neurotic or psychotic nature) were effected by cannabis use or not. It seems to me that the “chicken and egg” theory can be applied in most cases, whereby although there may be a link between cannabis use and the presence of mental health needs, there is still no sure way of telling which came first.

It may be that, as many clients have told me, they experience the onset of symptoms and use cannabis as a way of “self-medicating” in an attempt to alleviate or cope with those symptoms. Numerous clients have informed me that they have found that cannabis helps relax them and feel more confident in facing the world, and that it is preferable to prescribed medication as it
does not have the stigma or side effects – hence their continued use.

Some clients have told me that, although they are aware of the possible effects cannabis may have on both their physical and mental health, they want to carry on using it as they are afraid that otherwise symptoms will increase and they will feel less able to cope. They consider that the risk of symptoms increasing if they stop using cannabis outweighs the potential risks using it may pose to their health.

In my view, changing the legal classifi cation of cannabis will always have little, if any, impact on the number of people who use it. There are many different reasons why people choose to use cannabis and its impact on an individual’s mental health depends on a number of factors, including their genes, their predisposition to experiencing mental health problems, and  environmental and social factors.

If we think of the thousands of people who have used cannabis who have not experienced mental health problems it seems to support the suggestion that, in most cases, cannabis alone does not cause mental illness.

However, use of the drug may certainly sustain or exacerbate symptoms in individuals who are already experiencing problems, and the advisory council is absolutely right to suggest that a greater effort should be made to provide better education about cannabis.

But as much energy should also be put in to educating people about the dangers of other substances too. Tobacco and alcohol can also impact upon an individual’s physical and mental health if used in excess, and are much more readily available and accepted in our society. 

Chantal Stevens is a community psychiatric nurse in central London