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It is disturbing to read about the casual attitude towards cannabis among certain teenagers (‘Cannabis not really seen as a drug, say teenagers’, Irish Examiner, 27 October ) but reassuring to read your editorial pointing out the risks.
There is now overwhelming evidence that cannabis is bad for mental health because it substantially increases risk of anxiety, depression and severe mental illness, such as psychosis. Cannabis is also used by people with established mental illness in an attempt to self-medicate, but this serves only to compound and complicate their condition. There is now very clear evidence that in most people who smoke cannabis and have mental health problems, the misuse of cannabis came first.
Clear, consistent findings such as these should be used to shape clinical practice, future research and drugs policy. Clinically, there are now myriad reasons to encourage young people to avoid cannabis use, including those outlined in your editorial.
At policy level, robust steps should be taken with the aims of educating young people about cannabis, discouraging use, and minimising the harm caused by cannabis in society. Policy about other harmful substances provides limited guidance about how to achieve these aims. Certain extremely harmful substances with no positive aspects are legal (e.g. tobacco), while certain others are illegal (e.g. cannabis). It is not at all clear which approach is the better, or, indeed, whether reducing harm associated with different drugs requires different strategies depending on the particular drug in question. There is also an important, complicated balance to be achieved between observing civil liberties and pursuing legitimate public health concerns (e.g. curtailing activities which impact adversely on society, or place the health and wellbeing of others at risk).
What is clear, however, is that cannabis is associated with increased risk of poor mental health and that this message is not getting through to young people during an exceptionally formative period of their lives.
Education about the ill effects of cannabis is plainly vital, as is careful, informed policy-making that deals with realities rather than fantasies, and takes a clear-eyed look at the mountain of evidence that has now stacked up against cannabis.
This is neither the time nor the place for ideology: this is a time for pragmatic steps aimed at reducing harm, commencing, as you suggest, with public education about the real risks of cannabis.
Professor Brendan Kelly
Department of Adult Psychiatry
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