If you cast your eyes back to articles published recently on the Volteface website, you’ll find one entitled ‘We need to talk about cannabis dependency’. The author is completely right of course – we do need to talk about it. Cannabis dependency and the potential to abuse cannabis is a very real problem for some and, perhaps of equal importance, it’s a problem which stands firmly at the forefront of arguments against improving access to medical cannabis or indeed, changing cannabis legalisation and regulation as a whole.
If you wish to advocate for cannabis and those who choose to use cannabis, it’s vital that this concern is well understood and addressed – it helps no-one to act as though this issue doesn’t exist. However, a large part of the reason why most people who are unsure about the safety of cannabis or against the idea of making legal cannabis more accessible in the U.K feel this way not because of a balanced review of the facts or a worry that is backed up by science. It’s a direct result of media-fuelled moral panic and a century of anti-cannabis propaganda, much of which is hooked on the risk of addiction and potential damage to mental health.
Because of this, I feel it’s essential to delve into the nuance of this fear and understand how likely addiction to and abuse of cannabis really is, particularly for patients using the drug medicinally.
When cannabis is prescribed by a clinician, addiction and abuse are extremely unlikely to arise. In this situation, you are using cannabis under guidance – following dosage instructions, using a CBD:THC oil blend formulated and titrated to suit your needs, or cannabis flower chosen carefully to treat particular symptoms or conditions. Most people using cannabis for a medicinal purpose don’t want to get high – they just want to feel well. It’s key to making cannabis widely available to those who need it that we all realise this.
Incredibly, cannabis actually has the potential to be effective for treating a wide range of conditions in very small doses. One study, performed by Dr Mark Ware et al, demonstrated that a low dose of 25mg of herbal cannabis with 9.4% THC, taken spread out in single inhalations 3 times a day, resulted in significant improvements in pain, sleep, mood, appetite, stiffness and nausea, compared to placebo. However, in the trial, there were only 3 episodes of euphoria. None of the other participants described feeling ‘high’ as a side effect.
When left to their own devices, it’s admittedly easy for people to ‘over use’ cannabis to the point where they do feel ‘too’ stoned, but that amount varies depending on the person and need. I say ‘too’, because feeling stoned isn’t necessarily a negative, if that’s a sensation that might benefit a patient. It’s just a word with negative connotation thanks to prohibition. Everyone’s limits on what is beneficial and what’s not are different – what’s ‘too’ stoned to someone might be perfect for another. However, I think most cannabis users will agree that there comes a point, whatever unique point that is, where ‘too stoned’ would be an appropriate phrase! However, plenty of people enjoy this side effect and still don’t develop dependency. When following clinical guidance with exact dosing to reach a therapeutic effect, it’s important to understand that cannabis can be (and is) taken without feeling ‘stoned’ or ‘high’ at all. Just, better. Balanced.
But is addiction a concern even without feelings of euphoria? Tolerance does tend to increase when using cannabis regularly as a medicine, but again, this rarely leads to dependency. This is because addiction is almost always a result of being predisposed to addiction, rather than the substance itself.
Dr Ben Sessa MBBS (MD) BSc MRCPsych, Chief Medical Officer at AWAKN Life Science Inc and addictions expert explains “All mental health issues are combination of biological, psychological & social factors; addictions especially so. Addictions are over represented in low SES groups & people with attachment difficulties. Most drugs can, & are, taken benignly by most people most of the time.”
What’s more, the low risk of addiction to and abuse of cannabis is even further reduced when prescribed under clinical guidance and progress is monitored.
London GP and founder of The Primary Care Cannabis Network, Dr Leon Barron, explains “There’s a very low risk of addiction and abuse if medical cannabis is prescribed under the close guidance and supervision of a doctor. Cannabis can even be used to help wean patients off other more addictive and harmful drugs, such as strong opioids [which are often prescribed as a first line treatment before cannabis], and there is now a growing body of evidence from across the globe supporting the use of cannabis as a deprescribing tool.
And what of tolerance? It’s true that patients will often need to increase the amount of cannabis used over time to achieve the same, desired therapeutic effect – but is this really a cause for concern?
“Tolerance does exist for cannabis, but the effect is weak compared to other commonly prescribed medications” Explains Dr Barron.
“This is possibly because cannabis has a wide and subtle onset of actions throughout the body and only partially stimulates the body’s own endocannabinoid system, whereas medications such as opioids and gabapentinoids target specific receptors in abundance. In practice, it’s true that some patients may need to increase the dose of their medication over time, however this may be avoided by switching to alternative strains of cannabis and/or alternative delivery methods.”
Of course, given the current state of cannabis regulation, poor access to legal cannabis, it’s not possible for all cannabis users to use the drug under clinical guidance. This, paired with lack of education on cannabis as anything other than a substance for abuse naturally leads to a higher risk, albeit still a low one in comparison to other drugs. However, constantly highlighting concerns, both in the media and in research, only leads to further harm and misrepresentation. Not everyone wants or needs to use cannabis under clinical guidance, however understanding how to use cannabis responsibly, as we are educated on with alcohol, would give people the ability to do so safely.
As with all drugs, while we focus on harm, not benefit, and while we continue to push cannabis users onto the illegal market with no guidance or education, we will see people using cannabis to their detriment and indeed falling victim to addition or abuse cycles. But it’s archaic regulation and outdated education that puts them there, not the drug.