Street Lottery

3. The Current Picture

A multitude of factors paint a complex and problematic picture with regards to cannabis and mental health in the UK. Not only are treatment and mental health services experiencing an increased demand from cannabis consumers, but funding has been significantly reduced. There is also a severe lack of awareness and policy solutions on this issue in either the latest drug strategy or mental health policy. No clear plan exists to eliminate the illicit cannabis market and police forces are de-prioritising this issue across the country; enforcement continues to fail.

This failure of policy and ongoing erosion of services is taking place at a time when street cannabis is more potent, dominates the UK market more than ever before, and is exceptionally easy for many young people to access.

The Weed on our Streets

Volteface, in partnership with Dr Oliver Sutcliffe of Manchester Metropolitan University, tested the THC and CBD levels of fifty samples of cannabis flower seized by Greater Manchester Police. This data provides an up-to-date snapshot of the content and variation of street cannabis in the UK today.

Key results

  • The mean THC content was 14.7% w/w and ranged from 3.37 – 27.6% w/w.
  • 90% samples contained THC contents greater than 10% w/w; 14% samples contained THC contents greater than 20% w/w.
  • The mean CBD content was 0.38% w/w and ranged from 0.06 – 1.50% w/w.
  • Only one sample contained a THC content greater than 1% w/w CBD.
  • The THC:CBD ratio in 49 of the 50 samples tested ranged from 24:1 – 65:1.
  • The mean THC:CBD ratio was 48:1, the median was 49:1.
  • Only one sample displayed a THC:CBD ratio of less than 24:1. This sample was an outlier, with a THC:CBD ratio of 7:1.

The samples tested in our study are in agreement with the existing literature on the subject, and reinforce our knowledge that the THC content of street cannabis is high in the vast majority of cases, while the CBD content in almost all cases is negligible.1234 While greater variation in THC and CBD contents and ratios may be more common among cannabis that is home-grown or ordered online by enthusiasts, it is evident that street cannabis shows very little variation, being almost exclusively high in THC and markedly low in CBD.

Caveats exist around the data. Only cannabis flower was analysed, with resin and cannabis extracts excluded. Samples were taken from the Greater Manchester area only so are not a perfect representation of the content of the street cannabis market nationally. Samples were the result of police seizures, which is not a perfectly representative sampling method.

However, as an indication of the cannabis that is being consumed by the majority of people, the results are highly revealing.

High THC, low CBD cannabis dominates the UK’s illicit market as it has a rapid growth period up to maturity and can be grown indoors. This enables those selling cannabis to make the greatest profit and presents the lowest risk. While popularity of this product is undoubtedly high, this may well be due to the fact that no other product is easily available and consumers have neither the access to nor the experience of any alternative.

The result of the increasing potency and market dominance of street cannabis may be having a direct impact on the number of drug treatment presentations in the UK.

Increased Treatment Presentations

In the past ten years, there has been a 64% increase in the number of individuals who have accessed drug treatment services for their cannabis consumption in the UK – with 31,129 adults seeking support in 2016.56 This increase in presentations is taking place at the same time as a steadily declining population of cannabis consumers in the UK.7 Despite the reducing number of consumers, cannabis now accounts for 26% of all drug treatment presentations, and is the fastest growing drug-consuming cohort in treatment.8 In young people’s drug treatment services, 87% of service users reported consuming cannabis.9

Frontline treatment workers are noticing this increase in cannabis referrals and finding that those heavily dependent on the drug also experience mental health issues:

“A lot more cannabis users coming into treatment, mainly social services referrals e.g. parents. Lots of young people coming in for cannabis problems including addiction, saying it’s taking over their life, can’t do anything, smoke non-stop, agoraphobic, psychotic effects.”10

“Big rise in cannabis users accessing services that are more usually accessed by opiate users. All for Skunk. Almost all presentations have mental health issues. They see our cannabis group, consultant psychiatrist, one-to-one key work for issues around dependence, exacerbating mental health problem, onset of anxiety.”11

“Young people are now committing more serious crimes and more crime to buy cannabis. Before they would be stealing money off parents or doing a bit of social dealing on the side, now they are shoplifting and doing home burglaries. Why? Because there are a lot younger dependent cannabis users.”12

The vast majority of street cannabis now contains high THC levels and very little CBD to mitigate its problematic effects.

“80% of our clients are here for Skunk problems. People sorting out their own grows in spare rooms, buying seeds and hydroponics over the web from Barney’s Farm online. Their favourite blend is Amnesia ‘Ammy’. Impact on their mental health, hearing voices and hallucinations. Cannabis sometimes used as way of getting kids involved in crime. One boy was given £3,000 worth of driving lessons he thought through kindness from a friend and the elder who then told him he owed money and threw him a bag of weed and said start selling that.”13

As our own study indicates, the vast majority of street cannabis now contains high THC levels and very little CBD to mitigate its problematic effects. This trend appears to be having a direct impact on the number of people who present for help in drug treatment, a subject examined in depth by McCulloch in ‘Why did cannabis presentations rise in England between 2004/5 and 2013/14?14

Despite this growing number of consumers accessing treatment, as our previous report Black Sheep outlined, this is just the tip of the iceberg and accounts for 14.6% of those who show signs of cannabis dependence and problematic use.15

Drug treatment services have experienced severe cuts to their budgets, with some areas set to lose up to 50% of their funding.

Funding Cuts with No Clear Plan

In the past few years, drug treatment services have experienced severe cuts to their budgets, with some areas set to lose up to 50% of their funding.16 The Government’s latest drug strategy does not provide any clear guidance or solutions to this issue. There is an increased demand on services to meet the growing number of cannabis users accessing them, alongside other pressures – but no clear action plan or incentives are in place for such a need to be addressed. With budgets being stretched even further and targets still focused heavily on opiate users, vast numbers of problematic cannabis users are being missed.

Treatment services not only need more funding, but they require the Government to recognise that street cannabis is an escalating problem in the UK. Regulation of cannabis would not only help provide this funding, but it would create opportunities where treatment services could work innovatively with licensed premises selling cannabis.

“The main thing we are measured on in treatment are the number of opiate users who we successfully discharge. While users of other drugs are important the reality is that sometimes resources are tight as the opiate cohort are quite hard to deal with in terms of time, and they are the ones we need to get out to meet the targets” – Anonymous drug treatment lead worker

Increased Hospital Admissions for Drug-Related Psychosis

Hospital psychiatric units have also experienced an increasing number of cannabis presentations over the past ten years. 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 2006/07.17 Just like the increasing number of presentations at drug services, this is taking place at a time when there is:

  • An overall decrease in the number of drug consumers in the UK, including cannabis consumers
  • An increase in the level of THC found in street cannabis
  • A reduction in the level of CBD found in street cannabis

The reduction in overall consumption should, in theory, result in a decrease in admissions. However, this is clearly not taking place and street cannabis could be playing a significant role. Research carried out by Patel et al found that, in the UK, 46.3% of first episode psychosis admissions had documented consumption of cannabis and, in terms of their demographic, were mainly male, single and between the ages of 16-25.18 Far more men were also admitted to hospital psychiatric units for drug-related mental health problems – 70% male compared to 30% female.19 This data also matches the far higher percentage of male cannabis consumers, who are twice as likely to smoke cannabis than females.20 This disparity could, however, be due to women avoiding treatment contact and having different needs. The report ‘Mapping the Maze’ highlights how many women avoid treatment services completely and that they are not suited to deal with their needs.21

The study also found that patients who had documented consumption of cannabis had far higher rates of readmission, spent more time in hospital when admitted, and had increased likelihood of compulsory admission.22 The research also concluded that there were poorer clinical outcomes within the cannabis-consuming cohort, which could indicate cannabis preventing the effectiveness of prescribed antipsychotic medication.23 As with drug treatment, when speaking to frontline staff, this same increase is observed.

The majority of people being admitted for drug-related mental health problems in my experience have cannabis-induced psychosis… We see people who have been smoking cannabis on a regular basis for years, but who’ve been destabilised after going onto smoking Skunk. It’s like someone drinking four pints of lager a day and then suddenly switching to triple strength lager. It’s going to trip you up.” – Dr Derek Tracy, consultant psychiatrist24

Our research, along with other studies, shows a dramatic reduction in the CBD content of street cannabis, which could be contributing to the increase in hospital admission for psychosis.25

Admissions for psychosis are the tip of the iceberg when it comes to problems related to cannabis. If we are seeing an increasing number at this tip, it is likely that increasing numbers of cannabis consumers are experiencing problems further down the spectrum. The increase of cannabis presentations in drug treatment suggests that this is the case, as do the statements from those who work in such services who see consumers presenting with mental health problems.

As drug treatment services see only 14.6% of those who show signs of dependency on cannabis, most consumers who are experiencing a problematic relationship are not getting professional support and are relatively unknown when it comes to research or data.26 With 31,819 cannabis consumers in treatment, this accounts for around 190,000 individuals who are consuming cannabis problematically but not accessing treatment.27 With so many dependent consumers not seeking support, we can only speculate as to the number who experience problematic mental health conditions, but do not access services. With the majority of problematic consumers not getting support, the true scale of this problem is unknown.

Our findings suggest that young people felt it is far easier for them to access cannabis than alcohol.

Young People Access Cannabis More Easily than Alcohol

We conducted a survey and focus group with teenagers from London to find out how easy it is for young people to buy cannabis in the UK. Our findings suggest that young people felt it is far easier for them to access cannabis than alcohol. From our national survey of those aged 13-18, 44% of respondents said it was ‘extremely easy’ for them to get cannabis for free or to find a dealer or a friend who would sell it, while just 23% said the same was true for alcohol. This supports anecdotal comments from the frontline, although further research is required to substantiate.

The focus group also provided similar feedback and even laughed when asked how easy it was for them to buy cannabis:

“When I asked how easy it was for them to get cannabis, they literally laughed in my face.” – workshop facilitator

“When we’re walking to school, people come up and ask if we want to buy weed.” – Tereke, 16

“If you’ve got the money, you can get cannabis, no problem.” – Harry, 17

“Knock on a door.” – Tereke, 16

The young people also showed an awareness around the quality and type of weed they were buying. When asked in the focus group, respondents said that they smoked ‘Skunk’ not ‘weed’, and knew that it contained a lot of THC. The focus group felt that it was the only type of cannabis that they could buy and knew it was not the safest, but had little other choice:

“We don’t smoke weed, we smoke skunk.” – Nubiyah, 16

“But skunk is more available.” – Billy, 16

“I don’t even think it’s that great, but it’s all you can get, there’s just bare THC in it.” – Harry, 17

Our results suggest that cannabis is easier for young people to procure than alcohol and that, despite knowing street cannabis is typically high in THC and not a preferable experience, they would still rather buy it as nothing else is available. Although some studies have suggested that high potency cannabis is the preferred option,28 this may be due to a lack of consumer choice and branding of products.

With regards to the prevalence of use, data from the NHS shows that young people are more likely to take cannabis than any other drug, and that 26% of 15-year-olds have been offered it, with 10% going on to try it.29 Out of those who had tried cannabis, 43% had done so in the last month and 20% of 15-year-olds thought it was okay for them to do so.30 In total, 6.7% of pupils from the ages of 11-15 stated that they had taken cannabis in the last year, making it three times more popular than the entire category of stimulant drugs.31 This data, alongside statistics from drug treatment and our own research, suggests that cannabis is the drug of choice among young people.

Young people should not be able to access a Class B drug more easily than they do alcohol. However, despite the illegality of the market, it is impossible to effectively police and the availability of cannabis is exceptionally high. Street cannabis is typically grown indoors in a comparatively short space of time, which means that the market in the UK is saturated with high THC, low CBD cannabis, sold directly to young people up and down the UK. With the market in the hands of criminals, the priority is on making a profit, with no recourse to effective regulation. The strains that are grown are chosen to maximise profit, which due to the market’s illegality, means higher strength strains, as any other tools for creating market advantages are unavailable. This does not take into consideration any of the product’s harmful effects. While an illegal market continues to exist, young people will remain exposed to street cannabis from an early age, which the existing research on brain development and growth suggests is highly problematic. A regulated market could effectively prevent this problem by reducing the ability of young people to procure cannabis. Even if young people managed to obtain cannabis in a regulated market, effective regulation could ensure high THC, low CBD strains were not commonplace or as readily available.

The issues of access are also compounded by the way in which the police are inconsistently dealing with cannabis in the UK. This is creating a confusing message for young people, the implications of which we will now highlight.

Inconsistencies Breed Confusion

Since 2010, cannabis arrests in the UK have fallen by almost 50%, cautions for possession by 48% and the total number of people charged by 33%.32 These reductions have taken place alongside a vast increase in the number of presentations at psychiatric units for drug- induced mental health problems and a rise in the number of people accessing drug treatment for cannabis. Our research showed that 76% of young people were worried about getting into trouble with the police when procuring cannabis. However, with police forces struggling to manage the issue, and many areas of the country relaxing their approach, young people should be less concerned about the criminal implications of procurement and consumption.

The police are even less able to effectively tackle the illicit cannabis market in the face of severe budget cuts, with police spending having been reduced by 25% by the Government in the past decade.33

As enforcement is no longer prioritised, police forces are creating their own models of decriminalisation.

Across the UK, police forces have taken contrasting approaches to managing cannabis. Between 2010-2015, Hampshire police charged or gave a court summons to 65% of those caught in possession of cannabis. During the same period, just 14% were charged in Cambridge, while Staffordshire, Hertfordshire, Cornwall and Devon all reported 16%.34 The inconsistency continues in Durham, where its elected Police and Crime Commissioner Ron Hogg has announced that those growing cannabis for personal consumption are not a priority and that, in low-level cases, it is better to help the individual to recover than punish.35 While the approach taken in Durham could be seen as both progressive and logical, it highlights the vast inconsistencies that exist across the UK. The result of this is that young people are not given a consistent message about cannabis and the chance of prosecution for possession is a postcode lottery.

Police enforcement of cannabis is not working. Many young people are not deterred and the street cannabis market is making vast sums of money, most of which funds criminal gangs. As enforcement is no longer prioritised, police forces are creating their own models of decriminalisation. The Government needs to address this and create a system that provides regulation and control, so money can be diverted out of the hands of criminals and the police can focus on a much smaller illicit market.

Summary

This chapter has highlighted the current state of street cannabis in the UK, both in terms of its content and the experiences of treatment services, which are experiencing an apparent increase in its problematic use. There are an estimated 190,000 problematic cannabis users who are not in treatment and there is growing evidence from hospital admissions that street cannabis is having a negative impact on the mental health of some consumers. While it is still a minority of consumers who experience a mental health issue that might warrant hospital admission, these people represent the tip of an iceberg of cannabis consumers who are experiencing low level problems further down the spectrum of these mental health conditions.

Part of the problem when exploring cannabis and mental health is that the debate has become so focused on psychosis that we are losing sight of the bigger picture. This is something worth exploring in more detail and will help to further inform the debate.