The great cannabis debate: 50 top experts confirm mental health risk

[enquirewithin]

More reefer madness from the Independent on Sunday. Cannabis could well precipitate some sort of mental condition in those predisposed to it. The idea that the would have had no problems if they had not smoked cannot be established. This is not an argument for total prohibition, which is impossible, but effective regulation. More people seeking help for cannabis addiction? Again, if cannabis addiction was not recognized as a 'condition' in the past, how could people claim to be suffering from it?

http://news.independent.co.uk/health/article2814755.ece
Since the 'IoS' reversed its policy on legalising cannabis because of the drug's links with mental illness, many have joined the campaign to highlight its dangers. Here we report on the latest findings to cause concern.

By Jonathan Owen and Suzi Mesure

[top] Published: 29 July 2007

A poll of more than 50 of the world's leading authorities on drugs and mental health confirms that most believe cannabis, and particularly its stronger variant, skunk, pose significant health risks and increase users' susceptibility to psychosis and schizophrenia.

The Government's announcement last week of a review that could see the reclassification of the drug and harsher penalties for possession re-ignited the debate about the risks of using cannabis.

Launching the three-month consultation, Jacqui Smith, the Home Secretary, said: "Government must remain responsive – alive to new evidence, feedback and trends." Health ministry sources said that new medical evidence about the link between cannabis and mental illness, reported first in this newspaper, would form "a key part of the evidence" that the Government will consider.
It will also examine a new study published in The Lancet last week, which said that cannabis users increased their risk of suffering psychotic episodes by some 40 per cent. The findings by the team at Bristol and Cardiff Universities, led by Dr Stanley Zammit, said that some 14 per cent of psychotic episodes among young people could be prevented if they avoided the drug.
Inquiries by the IoS have drawn warnings from a wide range of organisations, such as the Royal College of Psychiatrists, and specialists. They include Professor Colin Drummond, addiction psychiatry and consultant psychiatrist at St George's Hospital, London, Professor Yasmin Hurd, from the department of psychiatry and pharmacology at New York's prestigious Mount Sinai School of Medicine, Dr Andrew Johns, consultant forensic psychiatrist, at the Maudsley Hospital in London, and Dr Raj Persaud, Gresham Professor for Public Understanding of Psychiatry.

The drug destroys lives by causing or precipitating psychosis in the vulnerable, argued Dr Persaud. "Just a little cannabis, if you have the wrong genetic make-up, will precipitate psychosis," he argues. "Many in my experience commit suicide secondary to psychosis brought on by cannabis, so it is lethal."
Reports of stabbings, murders and suicides caused by psychotic delusions after smoking cannabis have flooded the press in recent months. Perhaps most worryingly, it is Britain's teenagers who are most at risk due to the drug's effects on the developing brain, warn leading experts.

"Young people who otherwise would have been very unlikely to developed psychosis will, as a result of their early cannabis use, be affected by a life-long and severely disabling mental illness that will markedly narrow their life choices and quality of life," said Professor Drummond.

More than 22,000 people needed treatment for cannabis use in Britain last year. It was after publishing these figures that this newspaper revised its stance, abandoning all previous calls for legalisation of the drug.

The decision has been praised by many, including Professor Hamid Ghodse, the director of the International Centre for Drug Policy, who said: "The risks of cannabis have been overlooked for many years no. I'm glad your paper is making the public aware of the dangers. Cannabis is not the harmless drug which many people may have believed."

The main problem, according to medical authorities, is that it is impossible to predict with certainty people who might be vulnerable to psychosis and schizophrenia, aside from those with a family history of such problems.
Professor Hurd said: "Cannabis is a dangerous drug, in particular for the developing brain and for individuals with underlying psychiatric disorders."

Dr Mike McPhillips, the consultant psychiatrist runs the addiction unit at The Priory. He says that they are now seeing new patients on a monthly basis whose psychosis has been triggered by cannabis. "Ten years ago we'd hardly ever get a patient coming in for cannabis addiction but it is not uncommon now. The age at which people start taking the drug is a real concern. This drug is everywhere and very young children are experimenting with this as their first drug. We are already seeing the consequences of this and among those who are subject to mental illness anyway it is catastrophic."

Dr Linda Harris, clinical director of the substance misuse unit at the Royal College of General Practitioners, said: "From a mental health perspective we do need to look at the reasons behind a society that's drifting towards depressing and anxiety – cannabis could be a factor in this."

The medical profession is not alone in worrying about the possible long-term damage to the country's estimated 2 million cannabis users. Teachers are concerned that the casual acceptance of cannabis will result in an epidemic of children having problems at school. Anthony Seldon, the head of Wellington College, says the drug is "wrecking lives" and describes it as "pernicious". He is among those that think the decision to reclassify cannabis from a Class B to a Class C drug was a mistake and should be reviewed. "The message must be total prohibition," he said.

Keith Hellawell, the Government's former drugs czar who resigned when the Government moved to change the law in 2004, strongly agreed, although last week he worried that the apparent U-turn has come too late. "Reclassifying cannabis now is too late as a generation of young people have been led to believe it is a harmless substance. This move is no more than window dressing to ease the conscience of weak people who lacked the courage to prevent one of their own causing the damage in the first place. Shame on them."

The national cannabis debate encompassed the highest levels of government earlier this month when Ms Smith admitted that she had broken the law by smoking the drug in her youth. Her statement prompted similar confessions from nine fellow cabinet members. Ms Smith said that clearer evidence about the dangers of cannabis use since she was at university in the early 1980s was compelling and young people would be obliged to listen when she urged them not to try the drug, rather than follow her example.

Although the prevalence of skunk, which is routinely offered by dealers instead of milder forms, means smoking can do users more harm than a decade ago, government figures show that the cannabis use is falling among young people. The number of 16- to 24-year-olds who smoked cannabis in 2006 has fallen by a quarter since 1998 – the last time the Government published its drug strategy. And among 11- to 15-year-olds cannabis use is also down: 10 per cent of pupils had smoked cannabis last year, down from 13 per cent in 2003, 2002 and 2001.

Despite this, the number of people needing NHS treatment for cannabis-related mental and behavioural disorders has risen sharply in the last five years from 581 in 2001 to almost 1,000 last year, lending weight to the argument that skunk is harming more users and with greater severity.

Paul Corry, the director of public affairs at the mental health charity Rethink, believes the debate should not focus on reclassification, but instead urges the Government to "crack on with the more important job of informing the public about the health implications".

Nevertheless, despite the mounting evidence that cannabis use causes mental health problems – including The Lancet's publication last week – not everyone believes skunk poses long term health risks.

Professor Tim Kirkham, a psychologist at Liverpool University, argued: "Cannabis has been used safely for many thousands of years," and says there have been "concerted efforts to demonise the drug's use." Dr Trevor Turner, former vice president of the Royal College of Psychiatrists, says: "I don't think it causes mental illness. I have never seen a case of so-called cannabis psychosis."


Dame Ruth Runciman, the chair of UK Drug Policy Centre who set in motion the downgrading of cannabis, disputes that the drug of today is any different to the weed that Ms Smith would have toked back in early 1980s.


"How do you know it's stronger?" she said, adding: "There is indubitably some skunk that is stronger about the place, but the evidence has been hugely exaggerated and does not support such an alarmist view... Cannabis as Class C is exactly where it should be."

Skunk: the drug at the centre of the controversy
Cannabis is more potent than ever, with Britain producing increasing quantities of home-grown, hydroponic marijuana or skunk. This very strong, force-grown form of cannabis is known for its powerful smell – hence its name – and its enhanced effects on the mind of the user. It is often grown in nutrient-rich water under strong lights to produce far more tetrahydrocannabidinol (THC) – the mind-altering compound that gets users high – than regular cannabis, making it many times stronger than conventional "grass" or resin.

The researcher Zammit also said:

There could be something else about marijuana users, "like their tendency to use other drugs or certain personality traits, that could be causing the psychoses," Zammit said.

and

Scientists cannot rule out that pre-existing conditions could have led to both marijuana use and later psychoses, he added.

[top]Marijuana May Increase Psychosis Risk

http://www.physorg.com/news104734670.html
By MARIA CHENG, AP Medical Writer
(AP) -- Using marijuana seems to increase the chance of becoming psychotic, researchers report in an analysis of past research that reignites the issue of whether pot is dangerous.

The new review suggests that even infrequent use could raise the small but real risk of this serious mental illness by 40 percent.

Doctors have long suspected a connection and say the latest findings underline the need to highlight marijuana's long-term risks. The research, paid for by the British Health Department, is being published Friday in medical journal The Lancet.

"The available evidence now suggests that cannabis is not as harmless as many people think," said Dr. Stanley Zammit, one of the study's authors and a lecturer in the department of psychological medicine at Cardiff University.

The researchers said they couldn't prove that marijuana use itself increases the risk of psychosis, a category of several disorders with schizophrenia being the most commonly known.

There could be something else about marijuana users, "like their tendency to use other drugs or certain personality traits, that could be causing the psychoses," Zammit said.

Marijuana is the most frequently used illegal substance in many countries, including the United Kingdom and the United States. About 20 percent of young adults report using it at least once a week, according to government statistics.

Zammit and colleagues from the University of Bristol, Imperial College and Cambridge University examined 35 studies that tracked tens of thousands of people for periods ranging from one year to 27 years to examine the effect of marijuana on mental health.

They looked for psychotic illnesses as well as cognitive disorders including delusions and hallucinations, bipolar disorder, depression, anxiety, neuroses and suicidal tendencies.

They found that people who used marijuana had roughly a 40 percent higher chance of developing a psychotic disorder later in life. The overall risk remains very low.

For example, Zammit said the risk of developing schizophrenia for most people is less than 1 percent. The prevalence of schizophrenia is believed to be about five in 1,000 people. But because of the drug's wide popularity, the researchers estimate that about 800 new cases of psychosis could be prevented by reducing marijuana use.

The scientists found a more disturbing outlook for "heavy users" of pot, those who used it daily or weekly: Their risk for psychosis jumped to a range of 50 percent to 200 percent.

One doctor noted that people with a history of mental illness in their families could be at higher risk. For them, marijuana use "could unmask the underlying schizophrenia," said Dr. Deepak Cyril D'Souza, an associate professor of psychiatry at Yale University, who was not involved in the study.

Dr. Wilson Compton, a senior scientist at the National Institute on Drug Abuse in Washington, called the study persuasive.

"The strongest case is that there are consistencies across all of the studies," and that the link was seen only with psychoses - not anxiety, depression or other mental health problems, he said.

Scientists cannot rule out that pre-existing conditions could have led to both marijuana use and later psychoses, he added.

Scientists think it is biologically possible that marijuana could cause psychoses because it interrupts important neurotransmitters such as dopamine. That can interfere with the brain's communication systems.

Some experts say governments should now work to dispel the misconception that marijuana is a benign drug.

"We've reached the end of the road with these kinds of studies," said Dr. Robin Murray of King's College, who had no role in the Lancet study. "Experts are now agreed on the connection between cannabis and psychoses. What we need now is for 14-year-olds to know it."

In the U.K., the government will soon reconsider how marijuana should be classified in its hierarchy of drugs. In 2004, it was downgraded and penalties for possession were reduced. Many expect marijuana will be bumped up to a class "B" category, with offenses likely to lead to arrests or longer jail sentences.

Two of the authors of the study were invited experts on the Advisory Council on the Misuse of Drugs Cannabis Review in 2005. Several authors reported being paid to attend drug company-sponsored meetings related to marijuana, and one received consulting fees from companies that make antipsychotic medications.

Medical Writer Marilynn Marchione in Milwaukee, Wis., contributed to this report.

[Hadean]

There's a study in the archieves that suggests there is no increased risk of schizophrenia due to cannabis, because cannabis does not exacerbate symptoms of schizophrenia (whereas many other drugs, even caffeine, would). So, it essentially boils down to, at the moment, whose study you believe. I read one of the authors of the study was on the payroll of a company that makes antipsychotic drugs... big suprise there.

Also, this 40% increased risk seems misleading because it is such a big number. But only around 0.4% to 0.6% of the population will have this mental illness. So, if this study were true (its one study, hardly definitive, and I'm a bit suspicious of bias here) then the risk for a cannabis user would be 0.84% at most. Not exactly a huge increase. It comes down to relative risk versus absolute risk. Sure, the relative risk (40%) seems quite high, but the absolute risk is raised so little almost no cannabis smokers would care if they heard it. However, the news article will make many people think if you smoke pot, there's a 40% chance of you getting schizophrenia. Statistics and numbers can be used to say just about anything. Remember to keep a sharp eye out for numbers being used to mislead and lie.

[enquirewithin]

Good points, SWIH. This newspaper, which poses as liberal one, is very biased. They have alienated a lot of readers by their volte face anti-cannabis stance so they now need to justify their stance.

How many 'schizophrenics' drink coffee, drink alcohol, watch TV? There are no causal links.

[Hadean]

Indeed. It is well known that schizophrenics have a tendency to self-medicate and abuse substances like coffee, alcohol, and cannabis. This drug use by people with psychosis is a result of their illness, and likely not a cause of. There is still debate about it after all of these years though. You'd think someone would finally come out with a definitive study on the topic...

[bcubed]

Another thing hat comes to SWIM's mind is that, as cannabis is illegal, cannabis users most likely have had more interaction with the criminal justice system. In institutional settings, mental illness is often "discovered" in unruly inmates. Possible explanation?

What really needs to be done is a study where youths are enrolled in a study prior to any drug use, then followed-up at a later date, where it can be determined if psychiatic disorders predated drug use or only appeared afterwards.

For a long time, this same debate occued with alcohol: were people with personality disorders drawn to alcohol, or did the alcohol cause the disorders? The above mentioned study was how it was determined that most of he disorders appear to be as a consequence of drinking.

[whirlybird]

"More than 22,000 people needed treatment for cannabis use in Britain last year."

SWIM wonders if 22,000 people needed treatment, or if they were busted and required by law to receive treatment, as SWIMself was.

[dbjay417]

The only thing more dangerous about marijuana than tobacco or alcohol is its legal status.

[JDreaming]

This is true... alcoholism is just as likely to trigger latent psychosis in unstable people as a pot habit is, if not more... you can't glorify one and demonize the other arbitrarily.

[OccularFantasm]

Originally Posted by bcubed

Another thing hat comes to SWIM's mind is that, as cannabis is illegal, cannabis users most likely have had more interaction with the criminal justice system. In institutional settings, mental illness is often "discovered" in unruly inmates. Possible explanation?

This happens a lot indeed. A vast minority of these people may actually have some mental illness, but there is a reason this applies to unruly inmates. This gives a viable excuse to drug the inmate. This makes the person more placid and willing to cooperate with some hellish authority figure. I'd be willing to bet there are many introverted inmates with mental health issues, but are not treated because they are not unruly. Not to mention, the criminal justice system and jail in and of themselves can make one go mad, yet theres never a study not he link there. Also i see in these studies they do not seperate what the patient thinks, and what the doctor had recorded. Swimself was admitted to a psych ward before, and swim was/is a steady smoker (4 grams/day). Swim was also given a diagnosis of schizophrenia (mainly because psychiatrists are incompetent). Swim does not have any issues with psychosis, and he is much more rational on cannabis than not, however you can see how easy it would be to make up bullshit studies like these. Also, has anyone noticed these studies are always done in a psych ward or a prison? Its almost as if they were looking for biased results... Also lets say there were a group of people and a set number have add, and were given amphetamines for the symptoms. They also decide to smoke pot because it is fun and calms their minds. A few years later, X% of these people will have developed psychiatric symptoms. Unfortunately, the study would not link the psychosis to foolish amphetamine administration, but would to cannabis, since it is illegal and allegedly (and falsely) considered more dangerous. This is how many studies can concoct numbers to support themselves, with little factual evidence on their side.


"One doctor noted that people with a history of mental illness in their families could be at higher risk. For them, marijuana use "could unmask the underlying schizophrenia," said Dr. Deepak Cyril D'Souza, an associate professor of psychiatry at Yale University, who was not involved in the study."

So pot makes people worse by alleviating symptoms of a disease, that is defiantly an interesting take on that one. By that logic, drinking water is detrimental to your health, because it could mask symptoms of otherwise dehydration.


" Some experts say governments should now work to dispel the misconception that marijuana is a benign drug."

Who are these experts, the DEA? Do these experts really think all the reefer madness propaganda which is still flooding the streets, was done in order to make cannabis look benign?


"The drug destroys lives by causing or precipitating psychosis in the vulnerable, argued Dr Persaud. "Just a little cannabis, if you have the wrong genetic make-up, will precipitate psychosis," he argues. "Many in my experience commit suicide secondary to psychosis brought on by cannabis, so it is lethal.""

response subsection a] So the moral of this story is that if a bus hits you, and you break both your legs, then you kill yourself because of it, it is the buses fault. Choice cannot be used as a symptom of a disease, it just doesn't work that way. Suicide is lethal. Cannabis isn't.

response subsection b] How dare that person use genetic knowledge to try and convince people his point is correct. Currently we don't know enough about genetics to know definitively one way or the other. This is just another scare tactic. 'Oh my, i hope my DNA is weed friendly, or a big scary monster will come and get me.' It is no surprise they utilized a scare tactic here, as they already did the same with the misleading 40% figure Hadean was explaining.


I also have to agree with enquirewithin, that there are no casual links. I think they just wanted to use the word link in there so when people read it they said, 'oh goodness, a link between cannabis and psychosis.' Most people would completely overlook the word casually.


"More than 22,000 people needed treatment for cannabis use in Britain last year."

Swim is going with whirlybird on this one. not one single person ont hep lanet has ever and will never need treatment for cannabis use, unless you count people allergic to it, but the treatment would be for their lungs not their minds, and is completely independent of drug use in and of itself. People don't sell their bodies or go rob people so they can get weed. not rational people anyway, not for a nonaddictive benign substance.


"The medical profession is not alone in worrying about the possible long-term damage to the country's estimated 2 million cannabis users. Teachers are concerned that the casual acceptance of cannabis will result in an epidemic of children having problems at school. Anthony Seldon, the head of Wellington College, says the drug is "wrecking lives" and describes it as "pernicious". He is among those that think the decision to reclassify cannabis from a Class B to a Class C drug was a mistake and should be reviewed. "The message must be total prohibition," he said."

Oh great, teachers. Nothing against teachers mind you, however they are clearly not the most qualified to make any of these statements. He claims the drug causes 'wrecked lives', and since he is apparently a well respected teacher of something somewhere, he must have put into considerationthe wrecked lives that would occur as a result of total prohibition. Either that, or this supposed professor needs a history lesson on prohibition, especially on the part that proves it has never worked once in history. Also, the teacher doesn't seemt o be real clear on how cannabis is wrecking their lives. Are the kids actually in trouble, or did they just skip class once in a while in favor of getting high, and with a professor sized ego, I'd bet that the teacher thought that missing his/her class was such bad decision making their lives were being wrecked.


"Dr Mike McPhillips, the consultant psychiatrist runs the addiction unit at The Priory. He says that they are now seeing new patients on a monthly basis whose psychosis has been triggered by cannabis. "Ten years ago we'd hardly ever get a patient coming in for cannabis addiction but it is not uncommon now. The age at which people start taking the drug is a real concern. This drug is everywhere and very young children are experimenting with this as their first drug. We are already seeing the consequences of this and among those who are subject to mental illness anyway it is catastrophic.""

If a person comes into a hospital for a cannabis addiction, is obviously a hypochondriac. The lack of knowledge from supposed professionals here stuns me. Did they seriously not realize addictions to non addictive drugs are quit impossible. People could have compulsions to use the drug, much as some people feel a compulsion to gamble without stopping. I could see how some people could get confused, as these gamblers have been called gambling addicts before, regardless of the definition of the word addiction. There are also people who are more out of control without the use of cannabis, yet with its use, can function perfectly every day. This also, is not addiction. The fact that someone may get upset if their weed is taken away, and immediately finds more, that does not make it an addiction. It is also astonishing that this quack didn't ever consider that perhaps people are just more comfortable about admitting marijuana use, since it is benign and all. After all, in India, people use cannabis from a very early age, their entire lives. If any of this malarkey were true, we'd have about a billion crazy India-natives running around wildly in a psychotic state. I wonder if this propaganda will ever stop, its truly sad.


"Despite this, the number of people needing NHS treatment for cannabis-related mental and behavioural disorders has risen sharply in the last five years from 581 in 2001 to almost 1,000 last year, lending weight to the argument that skunk is harming more users and with greater severity."


Ugh, here we go again. Behavioral disorders. You smoke pot, your behavior changes a little, and suddenly its a disorder. Western medicine is truly useless and the worst medical system in the world. We invent more diseases than we treat, solely because it is more profitable, and almost always to the detriment of the patient.

Alcoholism is significantly more apt to exacerbate or even cause some level of psychosis. Since regular heavy alcohol consumption damages the liver, which is the filtration organ, the body has a harder time ridding itself of toxins. As these toxins build up, many different psychotic symptoms may occur. Many will probably not affect day to day life very much, but over time, it will, just from over-accumulation. This is very easily treated however, but is generally overlooked as a possibility all together. This is NOT saying alcoholism causes psychosis. no, not at all. It would leave the person more susceptible to those types of symptoms however, significantly more so than cannabis. In fact, using their own logic against them, most psychiatric drugs do more damage and cause more psychosis than any other drug in the world. Its amazing how much their propaganda can bite them on the ass, and hard too. And the very position anti-psychotic drug companies make, is that there is no significant increase in psychosis, however they do not have any evidence whatsoever that the rate is lowered at all. That is why they never boasts, Reduces risk by x%. It's just a scam.

I am going to stop here, for fear that I have already made to many people stop reading before the end. Hopefully someone made it to the end of my post, and in that case, CONGRATULATIONS, and rest up. That is a lot of ranting to take in at once.