“It is tempting to describe the government’s approach to cannabis as a spectacular failure. But that would be untrue: the government’s approach cannot fail, because the government has no approach. It has no goals, it has no aims, it has no policies.”
As we have witnessed this past fortnight, with their scrambled reaction to the campaign to allow six-year-old Alfie Dingley to access medical cannabis, the Home Office continue to substitute intelligent policy deliberation with ‘finger in the dike’ responses.
For more than twenty five years we have known that the cannabis sold in the UK is becoming stronger. The new Potter study only reaffirms the sharp reduction in availability of weaker cannabis resin (hashish) from 43% in 2005, to 14% in 2008, and 6% in 2016 (and only 1% in London), but also reveals that the average concentration of THC in resin has increased from 4% to 6%. Furthermore according to Dr Marta di Forti, the Clinician Scientist Fellow in the Department of Social Genetics and Developmental Psychiatry at Kings College, there has been a reduction in the concentration of CBD in cannabis resin since 2005–2008, with a consequent change in the ratio of THC to CBD — no longer the benign 1:1, but now 3:1.
While it is important not to overstate the impact of this rise in potency, the history of invoking reefer madness is not a happy one. As we revealed in our Street Lottery report last year, there has been a marked rise in both demand for treatment services and hospital admissions due to the use of cannabinoids.
- In the past 10 years there has been a 64% increase in the number of people accessing drug treatment services for cannabis use. It now accounts for 26% of all drug treatment presentations,
- In 2015/16, there were 1606 admissions to hospital psychiatric units for cannabis-related mental health or behavioural problems – a 22% increase compared to 2014/15, and more than double the level since 2006/07
In preparation for the launch of Cannabis in the UK, it is clear that the impact of potency and contiguous links to mental health have become deeply instated in public consciousness, indeed the people most opposed to any change to the law relating to cannabis are those who don’t use cannabis but know someone who does, suggesting a strong link between use and perceptions of misuse.
Given the rise of high potency cannabis, the clear dose-response relationship (i.e. the more THC, the greater the likelihood of psychosis), alongside a rise in demand for treatment and hospital services and public concern regarding cannabis use and mental health, it is now impossible to frame a convincing argument for reform which does not address this issue head on.
But for many drug reform campaigners this is sensitive territory.
The relationship between cannabis use and the more severe mental health conditions is complex and still contested. Some studies suggest a casual relationship between cannabis use and the onset of schizophrenia whilst others suggest that those who may develop schizophrenia are simply more likely to use cannabis. Dr Di Forti maintains that daily use of cannabis that is high in THC and lacking in CBD, such as skunk, increases the risk of developing psychotic disorders fivefold.
Others such as Canadian academic Rebecca Haines-Saah worry that those raising the issue are scaremongering to argue against legalisation:
“I can’t help but think that the panic about cannabis’ potential association with psychosis is less based on evidence, but more so tied to how we actively stigmatise mental illness and blame people for behaviours that are the “causes” of their illness.” – via https://twitter.com/RebeccaSaah
Many other respected campaigners for reform, such as Leap UK, posit a view that the rise in potency is a direct result of punitive enforcement (although prosecutions for possession and number of seizures have fallen by around 50% over the past ten years).
“It is the ‘Iron Rule of Prohibition’ that making a substance illegal leads to increased potency on the black market. With US alcohol prohibition it was whisky. With cannabis we have ‘skunk’” – via https://twitter.com/UKLEAP
For decades, most cannabis legalisation campaigners have framed their case for reform on the unjust criminalisation of young people and discrimination against BME groups (the latter often linked to stop and search). In recent years, they have had notable success working with local directly elected Police Commissioners in Durham and other jurisdictions to promote decriminalisation of possession, alongside a new focus on harm reduction interventions and diversion schemes.
But do these approaches deal with the most pernicious impact of the current black market for cannabis? Last year according to new data from the NHS Digital the total quantity of herbal cannabis seized by the police fell by 61% from the previous year: from 30,493 kilograms to 11,861 kilograms and overall number of seizures fell by 19% across the country. Questioned about this Sara Thornton, who leads the nation’s police chiefs, has admitted officers had given up investigating small scale cannabis farms, saying it had ‘never been a top priority’. The former Thames Valley Police Chief told the Daily Mail last year that forces tipped off about a cannabis farm at domestic address would “probably only record the fact.”
So, notwithstanding the torpidity of the Home Office, the nature of the cannabis black market is changing, it is one devoid of variety and ever more lightly policed. The public can sense this and the debate about cannabis now needs to reflect this new backdrop.
The case for cannabis reform must now go beyond calls for decriminalisation. Plainly there is a compelling pubic interest argument for decriminalisation to support people who inject drugs — as the Portugal approach attests — however the case is not nearly so clear cut in relation to cannabis. Indeed if we are to address the twin biggest public concerns about cannabis — young people having access to it and mental health — decriminalisation may even be making things worse.
What was most striking about the media response to last week’s report was how Public Health England failed to comment, especially at a time when mental health is such a public policy priority. This silence speaks to defining hallmark of our drugs policy and it is one that goes beyond the Home Office, wilful blindness.
For the many campaign groups in the space this presents a new opportunity. In the space between those who invoke ‘reefer blindness’ and those who dismiss the dangers dominated by so called ‘skunk’ there is a pathway to reform, one framed around adult use, social responsibility, education and innovation.
Key to this is to begin to set out in precise detail how a legal, regulated market with a plurality of suppliers could address the issues raised by the Kings College report. The pioneering labelling work of the UK cannabis social clubs and the lessons from the new legal market in Canada are markers of the debate to come.
Some activists knee jerk riposte to last week’s King’s College report was to dismiss them as a smear. Choosing to battle with the titans of psychiatry on this issue is not a hill I would advise them to die on. It is surely better instead to accept the report’s findings as valid, to not allow opponents to use them to argue for the status quo but instead embrace the challenge of what is maybe the final frontier on the route to legalisation.
Steve Moore is Director of Volteface. Tweets @steve4good