Despite its portrayal, cannabis is not a soft and cuddly narcotic. Everyone needs to remember it’s a very addictive drug of marginal medicinal value, says Dr Bobby Smyth
CANNABIS is a complex drug, often presented as a miracle medication. But I see its darker side. Cannabis has become the dominant reason for young people to seek addiction treatment across Ireland, rising slowly and relentlessly over the past 10 years.
In the past week, our courts dealt with a young man killed over a drug debt of €100. Most media reports of this sad affair glossed over the drug involved. It wasn’t heroin. It wasn’t cocaine. It was soft, cuddly cannabis.
Our clinical services routinely encounter young people who have racked up debts of thousands of euro to fund their insatiable appetite for this drug. Frankly, I didn’t believe these young people, when I first met them, in 2008.
I assumed that there had to be an undisclosed addiction to another drug, such as cocaine, to explain the vast sums of money. I was wrong. It was simply cannabis, smoked at a rate of two grams per day, which costs €350 per week. That’s enough money to maintain a decent heroin habit. Debts build rapidly when you’re 16 and not working.
The dealers’ approach to selling cannabis is different to their approach to selling heroin. The latter has to be paid for in advance. With cannabis, you get it ‘on tick’.
Enjoy today and pay later. Just like other commercial activities, your credit history is important. If you’ve demonstrated an ability to clear a debt of €300, you will be allowed to build up a debt of €600 next time.
Pressure will then be applied. First to the young person. Then to their families. The dealers will come knocking at your door, just brazenly demanding the cash, or else.
While many of the crazy claims about the benefits of cannabis irritate me, I am disgusted by the suggestion that it is a good treatment for anxiety or mental disorders. Cannabis is a bad drug if you have an underlying mental disorder, as it is likely to exacerbate it.
But cannabis is a chill-out drug, isn’t it? No, it isn’t. Low mood, paranoia, and irritability are extremely common symptoms among the young cannabis-users who attend clinical services.
Stories of holes being punched in bedroom walls, belongings smashed, and parents verbally and physically assaulted have become routine. We have had to develop new therapeutic interventions, called non-violent resistance, specifically for the parents of these teenagers, so as to equip them with the skills to respond safely to aggression.
These parents are in a horrible predicament because of their child’s use of this drug. They can see their child’s distress. They desperately want them to stop smoking cannabis.
The children say they’ll be cut with a knife if they don’t have the €1,000 to pay off the dealer. They promise to never use again, but the parents have heard that before. The children threaten to kill themselves. Would you take the chance with your child? And so the cycle continues.
Ten years ago, I used to meet the odd teenager who was referred to our services because he/she was caught smoking a bit of hash, this being cannabis resin.
The associated problems were quite minimal and these cases were at the mild end of the ‘addiction’ spectrum. Now, I am frequently meeting young people who look a lot like the caricatures of addiction portrayed in the scaremongering B movies of 1930s America, like Reefer Madness.
I used to lampoon these movies, during lectures, as great examples of how to do prevention work really badly. I have had to think again.
What has changed? Hash has disappeared and has, instead, been replaced by ‘weed’, the dried plant material. This plant is genuinely complicated in its chemical make-up, containing dozens of psychoactive substances, which we call cannabinoids.
The best-known, and most important, are THC and cannabidiol. Modern ‘weed’ contains lots of the former and little of the latter. THC is addictive and associated with adverse mental health problems.
Against this backdrop of a change in the type of cannabis available in Ireland, there has been a surge in use. The recently published population survey by the NACDA reports that 8.1% of people aged 15 to 34 years used cannabis in the past month, this being almost the double the rate of the preceding ten years.
About 10% of people who use a drug like cannabis are dependent upon it. This suggests that there are 9,000 young people in Ireland, today, whose lives are being damaged by this drug, and this damage is collateral, too, in terms of negative impact on family and loved-ones, who are left to pick up the pieces.
While the increased potency of cannabis has probably contributed to increased use, we must consider other factors.
Many of the young people who attend our services are politicised regarding cannabis, talking about it with a quasi-religious fervour. It’s not just something they do; it’s how they define themselves.
They often feel like they have betrayed ‘the cause’ by seeking treatment, akin to the conflicted ambivalence of someone who is escaping a cult. These attitudes are unique to cannabis. As society is bombarded by a hugely effective and well-resourced campaign to persuade people that cannabis is benign, more teenagers are willing to give it a go, and more parents are willing to turn a blind eye.
OVER the past 40 years, efforts have been made to learn if any of the cannabinoids have medicinal value. A huge proportion of medicines have their origins in plants. Unfortunately, those decades of research indicate that cannabinoids are either wholly or largely ineffective for most disorders that have been examined.
Independent TD, Gino Kenny, has a private-members bill on cannabis before the Dail. It purports to deal with medicinal cannabis. The media coverage of this bill has been breathtakeningly superficial, in light of the tremendous changes proposed.
The limited media discussion seems to have confined itself to the question of whether we should or should not make available medicines derived from cannabis.
That horse has bolted. We already have such a medicine available in Ireland. It is called Sativex and it contains a combination of the aforementioned THC and cannabidiol.
There is some evidence that it can be of help to people with MS, who suffer severe muscle spasms. Its availability, as an option to doctors and their patients, is good. Drafting legislation to permit it to be prescribed in Ireland was complicated by the fact that THC is illegal, and is listed in the Misuse of Drugs Act.
It would be great if there was a a legislative method which ensured that other, evidence-based medicines that contain some THC could be prescribed by prudent doctors.
Cannabidiol can reduce seizures in a minority of children who have the rare, but devastating Dravat’s Syndrome. This can be legally prescribed in Ireland, albeit via a cumbersome route for both doctor and patient.
Deputy Kenny’s bill seeks to fundamentally change how we make ‘medicines’ derived from cannabis available to the public. At best, it is using an industrial jack-hammer to crack open a peanut and, at worst, it is a Trojan horse.
This bill plans to remove THC from the Misuse of Drugs Act, thereby making it legal for anyone to possess and use cannabis, irrespective of its source. The pretext is the assertion that the cannabis plant is a ‘medicine’ itself.
Health Minister Simon Harris is awaiting a report from the Health Products Regulatory Authority (HPRA) on the subject. It is due to report back by the end of January.
Deputy Kenny is also proposing that doctors issue a certificate, not a prescription, to the person seeking cannabis. The certificate could be issued for any and all conditions.
This would then be dispensed not in a pharmacy, where real medicines are sourced, but in some unspecified dispensary, what I assume to be a type of cannabis off-licence. There, the person could get up to an ounce of cannabis, enough to get stoned for two weeks.
This is a bill to legalise the use and distribution of cannabis, for any purpose, albeit asking doctors to provide it with a fig leaf of respectability.
Most doctors will run a mile from it. However, enough of them will be happy to facilitate this charade for a range of diverse motivations. I struggle to see how the Medical Council could, or would, provide oversight for such a practice.
While its declared intentions are admirable, this is a crazy bill. Many of the TDs who spoke in support of it in the Dail said that it was not a Trojan horse, I have great difficulty seeing it as anything else.
The bill goes way beyond its stated remit, and although I accept that it is an early draft, it is more liberal than the most laissez-faire legislation anywhere else in the world.
Comparisons with the US should be made cautiously, in view of the very different social context and healthcare system. But there is evidence of increased ‘recreational’ use among young adults in the US states which have legalised medicinal cannabis.
This bill, and the discussion around it, ignore the escalating cannabis dependence in Ireland. This escalation warrants a robust political response in itself. It’s a fire that doesn’t need any more fuel.
The presentation of cannabis as a medicine must be recognised in the context of a wider agenda to liberalise all drug policy. In Ireland, if and how far we go down that track will be determined by our citizens.
For most of us, drugs have little or no impact on our day-to-day lives. The highly organised, and extremely motivated, groups who are driving the drug-liberalisation agenda will rely heavily on your complacency. In this post-post-modern era of ‘fake news’, it has never been harder to fathom what is happening in our world.
You will be told many lies by such groups. You will be told that ‘the war on drugs has failed’. Like all pieces of brilliant spin, this collection of words is neither true nor untrue. It’s just plain nonsense. We have no war on drugs in Ireland. Our national drugs strategy, of the past 20 years, is built upon principles of harm-reduction, not warfare.
You will be told that the ongoing use of drugs is proof that their illegality is a failure. Murder is vastly more common now than it was in the 1950s, but people aren’t calling for its legalisation. Criminal laws are designed to curtail behaviours which society views as harmful and unwanted.
You will be told that regulating the sale and availability of these drugs will eliminate criminals from the equation. Two words counter that nonsense: Diesel and cigarettes.
Is there scope for any tweaking of current drugs policy? I think there is a need to look at the proportionality of the sanctions imposed on people who break the rules on drug use.
If I drive my car at 70km/h through a town, I am putting the lives of others at risk, but my only sanction in a fine and some points on my licence. If I am caught smoking a joint, I risk a criminal conviction. This seems disproportionate. There is a strong argument for a civil sanction for personal drug use. This is what is meant by decriminalisation.
If we fully legalise cannabis, you will be told that our politicians will monitor the situation and will intervene if health issues or social problems arise.
The most reliable predictors of the future are the past and the present. Our politicians have consistently refused to put the interests of public health ahead of industry profits for the drugs which we do regulate.
They welcome in the army of lobbyists and spin doctors employed by ‘big alcohol’ and the retail giants, and they water down measures that would certainly save lives. Why would I trust the next generation of politicians to look after my grandchildren’s interests in 2066, when ‘big weed’ comes knocking on the door?
You will be told that past interventions targeting drug use have all failed. This is a lie. There were a number of communities in Dublin, all suffering extreme deprivation, which witnessed a massive increase in heroin use in the 1990s.
If you were a 15-year-old boy living in those communities in 1994, you had a one-in-five chance of being addicted to heroin by your 20th birth. Thousands of young lives were destroyed and we continue to deal with the legacy of that era.
It was a major social and political issue at the time. Action was demanded, and occurred in the form of the aforementioned National Drugs Strategy. Heroin hasn’t gone away.
It never will.
However, 15-year-old boys in those same communities now have a risk of substantially less than one in 100 of becoming heroin-dependent. If the strategy had a flaw, it was that it wasn’t genuinely national enough, focusing almost exclusively on Dublin. It failed to respond proactively to similarly deprived communities across Ireland, where heroin use has grown steadily.
THE ‘headshops’ that burst onto the scene in Ireland in 2010 are another case in point. They sold a vast array of potent drugs, including mephadrone and synthetic cannabinoids.
The headshops gives us a glimpse into how Ireland might cope if our population had free-and-easy access to potent, psychoactive substances. The rates of use of headshop drugs in Ireland were double those in the next highest European country. We have an unusual enthusiasm for intoxication in Ireland. This is an extra reason to be wary of expanding the menu of intoxicants.
At the time, the government resisted the chorus of calls for regulation, which came from the drug-liberalisation lobby. They banned the drugs and added new laws to make the sale of psychoactive substances a crime. Did this have a positive impact on reducing use? Yes, it did.
The previously mentioned general population survey found a 75% fall in use of headshop-type drugs in 2014, compared to 2010. The number of people presenting to addiction services with problems linked to these drugs fell steadily.
The purpose of legislation is to limit use. It cannot, and does not, aspire to the impossible goal of eliminating all use. As the great changes in heroin use among youth in Dublin indicates, you can achieve major change without any alterations to legislation.
In that instance, it involved collective and collaborative endeavour by the statutory, voluntary, and community sectors, all focused on a single goal. We can achieve great things when we work together.
Our new challenge is cannabis. We must now tackle it with the same commitment that we did heroin in Dublin two decades ago.
Dr Bobby Smyth is lecturer in public health at Trinity College Dublin and consultant child and adolescent psychiatrist in the HSE’s Adolescent Addiction Service.
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