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UK: Cannabis: it's time for a rethink

Dr Thomas Stuttaford

The Times

Monday 19 Dec 2005

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The link between cannabis use and psychosis is proved. The drug must be
reclassified

A fear of confusion, loss of memory, a fragmented thought process, the
boring repetition of the same thought, swinging moods with laughing or
weeping without good cause, paranoia, hallucinations and a preoccupation
with their own psyche and physique. These are the symptoms described in
an Oxford study on the effects observed in social cannabis smokers - yet
they are unlikely to dissuade anyone intent on having a drag on a spliff
at a Christmas party.

Nor, unfortunately, is the potential smoker likely to be deterred by the
rumour that research recently published in the British Journal of
Psychiatry may cause some change in the Government's approach to cannabis.

This would be the first step to do anything to dissuade people from
smoking cannabis since Labour came to power in 1997. The claim now is
that they became aware of the potential of cannabis to cause
schizophreniform symptoms - or induce an actual psychosis, in those who
are genetically vulnerable - only after they realised that modern
cannabis is many times more powerful than that circulating in the
Seventies and Eighties. Had they sought it, the evidence is that it may
not only cause psychotic breakdown in the one in four who carries the
genes that gives them a vulnerability to schizophrenia and bipolar
disorder, but may do so in those without any family history of
psychiatric disease.

It is rumoured that Tony Blair, having read the British Journal of
Psychiatry, may reverse his decision to downgrade cannabis to a Class C
drug in the light of the evidence it advances. This indicated that half
the patients who had mental problems that were not considered indicative
of schizophrenia were displaying the psychological symptoms sometimes
associated with cannabis smoking, and later went on to develop classic
schizophrenia.

Claiming that this evidence is new is less than flattering to the
pharmacologists and the psychiatrists who have been giving warnings of
the hazards since the 1970s. This evidence would have been available to
Blair since his schooldays. When he was at Oxford, the then Professor of
Pharmacology was Sir William Paton. He was one of the world's experts on
cannabis. In the 1970s Paton and his colleagues published many papers
describing their observations, which had led him to conclude that even
regular social cannabis smoking could induce schizophreniform symptoms.
He listed these symptoms and they would have made worrying reading for
any parent. Paton also drew attention to cases in which schizophrenia
seemed to have been precipitated by taking cannabis in people who had
previously been apparently unaffected by any form of psychiatric or
psychological problems, and in whom there was no evidence that they were
carrying a genetic burden that might make them liable to schizophrenic
breakdown.

In one series of cases Paton and his colleagues found that there were
several instances in which for some reason the person had had a
psychiatric assessment, although without at the time evidence of
psychological problems. Later they used cannabis and this had coincided
with a psychotic breakdown.

It wasn't only the work of Oxford that drew attention to this link. A US
study indicated that once cannabis became readily available (taken as
being between 1967 and 1971) the incidence of schizophrenia in US Army
personnel in Europe increased 38-fold in a five-year period. The authors
of the American report had no hesitation in blaming the popularity of
cannabis smoking among US soldiers. Several studies in the 1980s from
Sweden supported this opinion.

The introduction of Sativex has again raised the profile of the medical
value of cannabis taken in forms other than smoking. Previous research
had shown that this way of delivering cannabis didn't entirely remove
the psychological and psychiatric side-effects that are associated with
it. It might well be that alleviation of the pain, especially in serious
chronic or terminal conditions, is more important than having to face
the relatively small risk of these side-effects.

The work of Professor Robin Murray, of the Institute of Psychiatry in
London, supports the conclusion drawn by numerous researchers on the
hazards of cannabis smoking. Professor Murray's research was published
in the BMJ after the Advisory Council on the Misuse of Drugs (ACMD) had
published its initial report and made its conclusions. This however didn
't stop the ACMD from claiming that it had taken his work into
consideration when making its recommendations.

Professor Murray has drawn attention to the lack of experts in
schizophrenia who were appointed to the ACMD. Nor does the membership of
the committee include any biologist with an interest in pharmacology of
cannabis, nor a neurologist - the medical specialists whose expertise is
the human nervous system.

Surprise is not only expressed that doctors such as Murray with his
special interest in schizophrenia, or, for instance, Professor John
Henry, the toxicologist and emergency department physician who has
written extensively on the acute medical conditions caused by cannabis
and other drugs, are not members of the ACMD.

Equal concern has been voiced that five members of the committee have
also served or serve on pro-liberalisation of drugs' charities. Several
of these committee members spoke publicly on the need for liberalisation
of drug laws long before they were appointed to the committee. This
contrasts with the lack of representation of those who were known to be
opposed to the relaxation of laws relating to cannabis.

There was not one member of the committee who had a reputation for being
likely to object to downgrading cannabis to Class C.

Where, for instance, was Marjorie Wallace, the founder of Sane? Her help
to those suffering from psychosis and other psychiatric disease has
earned her an honorary fellowship of the Royal College of Psychiatrists
and the everlasting gratitude of the patients and their families, whose
lives have been wrecked by cannabis.

Marjorie Wallace's advice has always been sought by doctors who support
Sane, but may not be readily available to AMCD and the Prime Minister.
In my brief forays into politics it was an accepted, if not broadcast,
assumption that despite the public's faith in independent committees
these were an illusion. The practice of appointing people only after
careful consideration of their record and opinions was well established
when I was an MP, but never publicly discussed. It would have been
considered bad taste lest it implied that the members of the committee
lacked integrity. This is not so. The people appointed were, and
presumably still are, of the highest integrity, therein in part lies
their value to a government.

They can be relied upon to be forthright in their opinions and any
government is fully aware, on appointment, what these are likely to be.

Unfortunately, the opinions of the ACMD, and the conclusions the Prime
Minister drew from them, will, if left unamended, have the potential to
cause immense damage to those 25 per cent of people who, even if
intellectually brighter than their contemporaries, are genetically
predisposed to psychiatric problems from smoking cannabis.

THE SYMPTOMS

- Withdrawn; avoids social activities

- Few friends

- Increasingly passive and quiet, or unstable, or both

- Daydreams

- Inappropriate social response and conversation

- Far-fetched and grandiose schemes

- Old and socially inappropriate clothes; fondness for black

- Turns night into day

- Worrying interest in the occult and little known religions or
philosophies; interest in remote faraway places

Thereafter patients may display the acute symptoms of psychotic
breakdown. Later many may reach a chronic state, with symptoms of
inertia, depression and intellectual decline, with evidence of the
underlying psychotic condition (including disturbed thought patterns,
delusions - often paranoid - and hallucinations).

 

 

 

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