Black Sheep

2. Effectiveness of Support in an Unregulated Market

Each of the measures discussed offer different opportunities, yet the current illegal, unregulated market restricts their ability to engage people experiencing problematic cannabis use.

As consumption and purchasing is currently an illegal activity, people who consume cannabis are less visible, making it difficult to target interventions and establish a dialogue with those most in need of support.

The Adult Psychiatric Morbidity Survey has highlighted that ‘over a third of adults with current signs of dependence on ‘other’ drugs (36.2%) had received treatment, help or advice specifically because of their drug use at some point’. However, those experiencing cannabis dependence were half as likely to have received support.1

Cannabis is a substance which requires a unique response as for other substances with a potential for dependence and misuse, service designs has been implemented which can operate effectively in the current legal framework.

During the interviews, needle and syringe programmes were praised by practitioners as they gave drug injecting users a motivation to interact with treatment.  Their incentive to enter the needle and syringe service was to receive clean needles but during the interaction, the practitioner could offer harm reduction advice and, if appropriate, directly link them into support services. Reviews have highlighted that needle and syringe services effectively offer harm reduction interventions, advice on safer injecting, prevent overdoses and reduce injection risk behaviours.2

By effectively creating a decriminalised space (where service users are not criminalised for using illegal drugs), needle and syringe programmes are able to offer incentives for interaction and then utilise this opportunity to offer information, guidance and links to relevant services.

Needle and syringe programmes operate successfully within the current legal framework because they are able to offer incentives for people to engage in their services. Yet due to the nature of cannabis and how it is consumed, there is not a similar ‘carrot’ which can be offered. Cannabis consumers may be interested in testing the potency and quality of their cannabis yet unlike the needle and syringe programme, users are not facing an acute health risk if they chose to forego this service.

The few treatment centres who are attempting to link problematic cannabis users into support and guidance are frustrated that their services cannot reliably access cannabis users.

“Right now, we’re just fumbling around in the dark trying to find them.”

Providers reported that they would attempt to offer support and information at festivals and university events, yet they were unconvinced that these attempts resulted in successful engagement. Contributors also questioned whether untargeted outreach was reaching those who are genuinely affected or extending a net and bringing people in unnecessarily.

“Outreach hasn’t been effective as we don’t know where to target.”

There is no clear point of contact for cannabis users and while cannabis use remain hidden, public health responses are at risk of being untargeted.

Those who do have a regular dialogue with cannabis users are people who sell cannabis illegally with the EMCDDA reporting that ‘a significant minority of cannabis users consume the substance intensively’.3 The people to whom professionals face difficulty offering support, are the same people who will have the most contact with criminal individuals and organisations, as well as being the same people from whom those criminal individuals and organisations stand to profit most. This can lead to exploitation of disadvantaged groups as research has found that frequent cannabis users are more likely to have lower socio-economic background and experience mental health problems.4

Slim Pickings

The contributions have revealed that there has been an inadequate public health response to the rising demand of support for problematic cannabis use.

  • Among people experiencing problematic cannabis use, there is a perception that their needs will not be effectively supported at treatment centres.
  • Some drug and alcohol service providers and commissioners are being attentive to cannabis but overall, cannabis is not being appropriately prioritised.
  • One to one interventions relating to cannabis are mostly confined to drug and alcohol treatment centres. Wider community services reported that they do not have the capacity or the ability to offer brief, initial interventions.
  • There are limited amounts of public resources available, some of which are lacking in levels of quality and accessibility.
  • Attempts to target public health measures to people experiencing problematic cannabis use can be best described as a shot in the dark, with the current illegal and unregulated market reducing the visibility of cannabis users.