Is the outlawing of marijuana driving people to drink and a fate worse than getting stoned? That is the claim of one liberal pundit following a recent high-level row in Britain over the legal status of the drug that the British always call cannabis.
It started last year when the government, responding to public concern over links between high-strength cannabis, or “skunk”, upgraded the classification of cannabis from Class C to Class B — reversing what it had done only four years previously. The move went against the recommendation of the official Advisory Council on the Misuse of Drugs, which was also thwarted in its view that ecstasy should be downgraded from Class A to Class B.
This annoyed council chairman Professor David Nutt so much that in July this year he gave a public lecture, and last month published a paper, in which he accused ministers of devaluing scientific research and maintaining an “artificial” separation of alcohol and tobacco from illegal drugs.
The government, understandably, did not take kindly to having its tough line on drugs sabotaged by its own advisory body (which, incidentally, has up to 40 members and must cost a pretty penny to run) so it sacked Professor Nutt. He was followed out the door by several colleagues who resigned in sympathy.
But is the professor — a scientist, after all (a neuropsychopharmacologist to be exact) — right and are the politicians wrong? Are we making too much fuss over relatively harmless drugs and not paying nearly enough attention to the demon drink and that common weed, tobacco?
One expert who has absolutely no time for this argument is New Zealand drug counsellor and educator Trevor Grice. “It’s true that alcohol abuse is bad and needs attention, but let’s not argue about which is worse,” he says. “They both have catastrophic effects on teenagers.”
Grice can tell you a lot about the ways in which alcohol, cannabis and other recreational drugs do their destructive work in the developing adolescent brain: how they are metabolised, which neurotransmitters they deplete, which brain sites they affect and what their acute and long-term side effects are. He has co-written a popular book about it, The Great Brain Robbery, for the information of teenagers, their parents and anyone else who cares.
He could even tell you that, dose for dose, cannabis is more harmful than alcohol because alcohol is metabolised more quickly than cannabis, although both pass through the body of an adolescent more slowly than in an adult. Cannabis, especially in today’s more potent forms, suppresses the short-term memory and makes kids unable to learn or act purposefully. “They are locked in chemical handcuffs.” If they persist in regular use they may wind up schizophrenic.
What Grice really wants to talk about, then, is the kids themselves, and saving them from chemical damage as they enter adolescence. “From the day a girl or boy enters puberty they have a seven-year journey of manufacturing the neurochemistry for adult life. Any interference during those years is a disaster. I know, because I am dealing with 29- and 35-year-olds who are still emotionally 17.”
So the message has to be a strong one, he says: “Don’t do it,” from parents, teachers and the law.
But doesn’t Professor Nutt care about teenagers too? Yes he does. And he knows the neuroscience; in fact, he specialises in research on drugs and addiction. But his approach is a little different. In his briefing paper he said: “We have to accept that young people like to experiment — with drugs and other potentially harmful activities — and what we should be doing in all this is to protect them from harm at this stage of their lives.
“We therefore have to provide more accurate and credible information. If you think that scaring kids will stop them using, you are probably wrong.”
Well, it’s true. Kids today are not easy to scare, and we should never tell them lies. But there are ways and ways of telling them the truth, and Grice maintains that Nutt’s way, which he calls “harm minimisation”, gives a mixed message and masks the truth.
“They’ve been following this approach in the UK for more than 20 years. It’s behind the free needles for addicts and methadone maintenance programmes, which cause huge problems — basically, the government is providing the means to keep the drug trade going.”
New Zealand, which, according to Grice, has just replaced Jamaica as having the highest per capita consumption of cannabis, has followed much the same route, he says. He cites a district health board that has just released a harm minimisation brochure advising kids not to sniff a substance like nitrous oxide (laughing gas) straight out of the can, but to use a balloon, and to make sure they are lying down in a well-ventilated area so as not to fall on the concrete… “It’s written by people from the social sciences who think they are teaching children how to use dangerous substances safely.”
As if they would. In the field of sex eduction, this ideology has given the UK the highest teenage pregnancy rates and abortion rates in the whole of Europe — nearly 222,000 and 48,150 respectively in 2007.
The schools go along with this sort of thing, says Grice, with the result that parents are disenfranchised. “The school can counsel them about drugs, or even arrange for a girl to have an abortion, and the parents are not allowed to know.”
The clash of studies
Yet it is not only strategy that is debated — prevention versus harm minimisation. The truth about how much actual harm cannabis does is also contested thanks to conflicting research on virtually every problem linked with the drug. These include cognitive impairment, car crashes, respiratory diseases, depression, suicide, psychosis and use of other illicit drugs. The very idea that the drug has become more potent is disputed.
Professor Nutt contends that there is a very small risk of cannabis causing psychotic illness and he puts last year’s reclassification down to a “skunk scare”. He says skunk has been widely used for about 10 years but there has been no upswing in schizophrenia. To quote the BBC: “He accepts that cannabis can sometimes cause mental illness, but argues that it is safer than tobacco and alcohol and, overall, does not lead to major health problems.”
You might come to the same conclusion about the “overall” harm of the drug from reading a recent Lancet article, “Adverse health effects of non-medical cannabis use”, based on a review of the research. It summarises the effects thus:
“The most probable adverse psychosocial effect in adolescents who become regular users is impaired educational attainment. Adolescent regular cannabis users are more likely to use other illicit drugs, although the explanation of this association remains contested. Regular cannabis use in adolescence might also adversely affect mental health in young adults, with the strongest evidence for an increased risk of psychotic symptoms and disorders.”
But the study then concludes:
“The public health burden of cannabis use is probably modest compared with that of alcohol, tobacco, and other illicit drugs. A recent Australian study estimated that cannabis use caused 0•2% of total disease burden in Australia—a country with one of the highest reported rates of cannabis use. Cannabis accounted for 10% of the burden attributable to all illicit drugs (including heroin, cocaine, and amphetamines). It also accounted for around 10% of the proportion of disease burden attributed to alcohol (2•3%), but only 2•5% of that attributable to tobacco (7•8%).”
Only 0.2 per cent of the total disease burden in a high-usage country? What on earth are we worrying about?
But what looks modest (“not much to worry about”) from a lofty public health perspective, looks much more significant in light of the fact that cannabis is predominantly a young person’s drug and often the first, the gateway to more harmful drugs and habits. There is also its overlap with other drugs — by suppressing the vomiting command in the brain, for example, it allows much more serious binge drinking — and with general crime. A case in a New Zealand court this week concerns the death of 14-year-old cannabis courier.
Naturally, the boy was from the wrong side of town, as drug offenders and addicts often are. Obviously there is a huge social problem to be addressed in such urban ghettos, but does the harm minimisation school really believe their rationalistic approach (“take precautions”) will help these kids?
Trevor Grice says it all comes back to one question: “Who cares?”
A society that cares, he suggests, will have strong anti-drug messages coming from parents, schools and the law. That’s how Sweden has done it, he notes. It will have proper testing of all the so-called recreational drugs. It will sack the army of civil servants engaged in harm minimisation exercises and appoint in their place a drug czar and drug courts geared to treatment and rehabilitation — in treatment centres built to replace the ones that have been closed.
As for the harm minimisers, Grice says: “They can change the classifications if they like, but the chemistry of the drugs will never be altered by their legal status. They can legalise the drug market and tax it, if they want, but we are still going to deal with what the drugs actually do to people.”
And in the case of cannabis, it’s no small amount of harm.
By Carolyn Moynihan, 27 November 2009