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UK: Haze of confusion hangs over dangers to health

Jason Burke and Anushka Asthana

The Observer

Sunday 18 Jan 2004

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From the end of this month cannabis will be reclassified as a class C
drug, alongside tranquillisers and steroids. But does anyone really know
what the dangers of smoking dope are? Jason Burke and Anushka Asthana report


Steve, 25, Jamie, 23, and Amit, 30, all liked, or like, a smoke.

Steve tried cannabis at school and was smoking 10 to 15 joints every
evening by the time he was at college. He lost his job and started behaving
erratically. One night, drunk and stoned in a club, he ate a lump of
hashish resin and woke up hearing voices. He is still being treated for
schizophrenia.

For several years Jamie had smoked 20 joints, often of powerful skunk, a
week. He holds down a well-paying office job and says that he has no
problems with motivation or concentration. He says he has never suffered
any adverse effects, let alone mental health issues, and describes his
consumption as a 'positive lifestyle choice'.

Amit smoked 15 joints a day for six years. 'My life was like something from
The Office,' he said last week. 'I had an undercurrent of depression
throughout that time. Without cannabis, it would have been much worse.'
Amit has a new job and stopped using cannabis six months ago. But he admits
it was hard to break his habit. 'There is no doubt I was addicted,' he said.

All three men were heavy users. According to the Independent Drugs
Monitoring Group, a typical user consumes more than seven grammes (a
quarter of an ounce) of average-strength cannabis a week. This year an
estimated one in 10 Britons aged between 16 and 59 - about 3.3 million
people - will use the drug. Few of them will smoke as much as Steve, Jamie
and Amit ever did. Instead it will be a quiet spliff on a park bench
outside school, or with coffee after a dinner party, or while watching a
video on a Sunday evening when the children have gone to bed.

The amount of cannabis smoked in the UK is unprecedented. But for an
activity that has such mass appeal - one in four 15- to 24-year-olds smoked
it in 2002, according to the British Crime Survey - very little is known
about the effects of such broad consumption on people, on health, on society.

At the end of this month, cannabis will be reclassified from a class B to a
class C drug - putting it on the same level as steroids and tranquillisers.
The effect of the change, and the police guidelines issued along with it,
will make it extremely unlikely that anyone consuming cannabis in private
will be arrested. Smoking pot in your own home will, in practical terms at
least, be legal. Offend repeatedly or smoke in a public place or outside a
school and the consequences could be severe, however. Under-18s, say the
guidelines, should be arrested, although in reality it is unlikely that the
police will always follow the law to the letter. Possession can still
result in a two-year prison sentence. There are also increased penalties
for dealing.

The changes, recommended first in a report by the Police Foundation, a
council of scientific experts and the Commons Home Affairs Select
Committee, regularise the reality of the enforcement of soft drugs law. In
much of the country, police rarely arrest and prosecute 'personal users'.
None the less, in 2000 there were 70,000 convictions for possession of
cannabis.

The changes are controversial. Some criticise any move to liberalise drug
laws, others criticise the confusion surrounding the new policy and many
say the changes don't go far enough.

The debate grew more heated again last week when new research by leading
psychiatrists pointed to a strong link between mental illness and cannabis use.

Professor Robin Murray, a psychiatrist at the Maudsley hospital in south
London, published findings stating that cannabis both increases the risk of
serious mental illness and exacerbates existing psychotic conditions.

Murray's conclusions were controversial. His research was not published in
time to be presented to the council of experts consulted by the Home Office
when it decided to go ahead with the declassification. Critics of Home
Secretary David Blunkett's decision seized on it as evidence that the
Government's drugs policy is, in the words of the Daily Mail's Melanie
Phillips, 'reckless'. The Conservative Party accused the Government of
'mixed messages' and vowed to reverse the move.

In fact, the situation is more nuanced. Murray cited research in Sweden and
Holland that confirmed the link between cannabis and psychosis. Research at
Yale Medical School showed that tetrahydrocannabinol (THC) - the active
ingredient in cannabis - can produce a psychotic reaction. The studies
confirmed that no one could sensibly say that cannabis was 'harmless'.
However, they did not prove that cannabis was necessarily dangerous for
everyone.

According to Paddy Power, a consultant psychiatrist with the Lambeth Early
Onset Service in south London, 70 per cent of the 170 people referred to
the clinic each year take cannabis. 'A proportion of the population is
certainly at risk of psychosis from heavy use of cannabis, but they are a
minority and it is possible that they are already at risk of psychosis for
a variety of other factors,' he told The Observer last week.

And, to many, this is key. Power likens the connection between cannabis and
psychosis to the link between cigarette smoking and lung cancer and heart
disease. 'It does not mean one leads inevitably to the other. The more you
do, the more you are at risk,' he said.

Steve, quoted above, is certain that cannabis triggered his psychosis.
Trying cannabis since developing his condition set off an immediate
reaction. 'It made me feel instantly crazy,' he said. 'It was like turning
on a switch.' But Steve may have been vulnerable already, backing up the
general consensus that cannabis can make mental illness worse or increase
the risk, but does not cause it. Steve's father, Terry Hammond, now works
for the mental health charity Rethink. He agrees that, though cannabis had
'hurled [his son] over the edge, Steve had previously showed signs of
vulnerability'.

But no one knows how many might be vulnerable. Some talk of as many as one
in seven or in 10. Yet Les Iversen, professor of pharmacology at Oxford and
a House of Lords adviser on drugs misuse, said the fraction was 'tiny'.
Harry Shapiro, of the independent research centre Drugscope, referred to a
'handful out of millions' being affected.

The issue of psychosis touches on many key debates within the broader
argument over the legalisation of cannabis and, more generally, society's
approach to other drugs.

Is the risk of exposing a vulnerable minority to possible psychosis
outweighed by the harm done to society by criminalising millions of people
who safely enjoy cannabis? Is it even correct to lump cannabis with other
controlled drugs such as heroin or crack that are far more dangerous to
individuals and to society? What about the differing strengths of cannabis?
What would happen if cannabis supply was controlled by the government? Is
it not irrational to focus on cannabis when alcohol, almost all health
professionals agree, is a far more harmful drug and is misused far more widely?

Despite decades of debate, there is little clear consensus over the way
forward.

Peter Coker, who has worked with drug users for nearly 20 years and
currently runs the National Drug Prevention Alliance, opposes the
reclassification, let alone any further liberalisation. 'Blunkett thought
that, if he gave this concession to the liberalising lobby, it would be
satisfied. Instead it has just been encouraged,' Coker said. 'The
reclassification is being read [by potential users] as a signal that there
is a more relaxed attitude to all drugs, and that is very dangerous.'

Bob Carstairs, of the Secondary Heads Association, is also concerned about
the message sent to children by the reclassification. His organisation,
which represents headteachers at more than 4,000 schools, has recommended
that they maintain a policy of suspending first offenders and of expelling
those who sell cannabis to their school mates, or who otherwise encourage
consumption of the drug.

'The majority of heads are disappointed at the confused message that is
being sent,' Carstairs said last week. 'There is a huge amount of
confusion. There are eight-year-olds trying cannabis. They are simply too
young to make a mature judgment.' But predictably others criticise the
policy for not going far enough.

Francis Wilkinson, a former chief constable of Gwent, says the cannabis
laws discredit all drug laws. 'Children experiment [with cannabis] and find
it is not harmful. They then think that all the laws are wrong, even those
dealing with drugs that are very damaging.' He says cannabis and heroin
have a completely different impact on the individual and on society. 'For
example, people who smoke cannabis do not commit crime to get more,'
Wilkinson, who claims widespread support within the police force, said.

'If there is one thing that would substantially reduce crime, it is
government regulation and control of the supply of both cannabis and heroin.'

Another supporter of the reform is Mike Trace, the Government's former
deputy drug tsar from 1997 to 2002. He said that, in 1999 and 2000, he and
his staff calculated that 'in the realms of UKP100 million' would be saved
by the criminal justice system if cannabis was legalised. He blames fear of
a 'Middle England' backlash for politicians' failure to push through
radical measures. 'There is a fear of being portrayed . . . as soft on
drugs,' he said.

Some, such as Professor Iversen, advocate a 'coffee shop system' like
Holland's. 'We need to separate the supply of cannabis from those drugs
that are more harmful.'

However, major change in drugs legislation is unlikely in the short term,
not least because Britain is bound by a series of United Nations
conventions to keep cannabis use illegal. Policy is likely to come from the
broad moderate consensus represented by drugs professionals such as Power
and others working on the front line of drugs and mental illness in
Lambeth. Despite his concerns on health issues, Power backs reform. 'The
main risk is the extremely detrimental effects on youngsters of being
caught up in the criminal justice system simply because of the recreational
use of a drug that has relatively limited adverse health effects compared
to other drugs and alcohol,' he said.

Most health professionals see education as the critical issue. The Home
Office officials say they are sensitive to the need for teaching people
about health risks and are investing UKP1 million in a campaign to educate
the nation about the new legal situation regarding cannabis use and about
the impact smoking the drug can have on bodies and minds. Campaigners such
as Hammond say that much more effort is needed.

What no one denies is that millions in Britain will continue to use
cannabis - whatever the legal situation and whatever the health advice.

Alex makes UKP50,000 a year selling cannabis and cocaine to mainly
middle-class clients. 'Even if they legalise cannabis, it would be taxed
and we could undercut it,' he said. 'The really low-quality goods would be
taken off the market and some street dealers would go out of business. But
I'd carry on. There is a huge demand for cannabis. That's capitalism. Where
there is demand, there will always be a market.'

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