Inconvenient Truths

by Liz McCulloch


Just over 2 million adults in England will use cannabis this year. Most will do so occasionally, slotting their cannabis use into otherwise unremarkable lives, just as an even larger slice of the population will do with alcohol. The lack of harm accruing to most cannabis users drives the debate for reform of the Misuse of Drugs Act. If the majority of users suffer no long-term harm what right does the state have to interfere in their private pursuit of pleasure, particularly as the enforcement of the current law can result in criminal sanctions that potentially do more damage to young people’s future prospects than is likely to flow from their drug use.

So far, so familiar, but what about the minority whose use is not about occasional controlled pleasure, but daily damaging dependence?  Clearly there are cogent arguments to be made for reform, but its advocates won’t help their cause and their assumption of the moral high ground if they continue to ignore the following “inconvenient truths”.

Levels of cannabis consumption vary dramatically; 44% of users, just under a million people, will do so once a month or less, whilst 8%, around 160,000 individuals, will have a pattern of daily use. The impact of cannabis use on the lives and prospects of these two groups is very different.

The daily users consume the vast majority of all the cannabis used in the country accounting for over 93 tons ,73% of the total.

The 1.7 million occasional and weekend users collectively consume under 5 tons less than 4% of the total market.

The largely benign experience of the articulate, well-educated and politically active majority dominates the media debate about cannabis while the negative experience of the invisible marginalised and vulnerable minority is ignored, or even denied.

Inevitably frequency and intensity of use is closely associated with the onset of dependence. Daily users are three times more likely to become severely dependent than weekly users and are six times more at risk than those using monthly.

Those whose use becomes problematic are not a random subset of the entire cannabis using population. Unlike the stable recreational users, they will tend to be drawn from those with the fewest social and economic supports, the most fragile mental health, and a range of complex overlapping social and health problems.

Cannabis dependence has now replaced heroin as the primary drug of misuse for those aged 18 to 25 in treatment services, accounting for 62% of young adults in treatment, 7369 individuals.


Most individuals refer themselves to treatment and derive significant benefit from the intervention. Within six months, 36% have chosen to stop using entirely with a further 20% reducing their use from an average 20 days per month to 10, effectively halving the risk of relapse.

The negative consequences of cannabis use for the 60,000 people who enter treatment each year is not of itself the clinching argument for retention of the current law.  However, anyone advocating reform, is in my view, under a moral obligation to explain how their new regime will deal with the impact on vulnerable sections of the population. There is, at the very least, a risk that the increased availability that will accompany a regulated market, will lead to increased use and increased harm among those least able to cope.

To date, advocates of regulated markets have focused their thinking on restricting access for children and devising a pricing and taxation regime that guarantees a revenue stream for entrepreneurs and the government, while undercutting the illicit market. To these challenges needs to be added the further complexity of controlling a market which may well find, as the alcohol and tobacco markets have, that the most reliable way to grow their business is to target those groups who are least able to deal with the negative consequences of their products.

If this is the outcome, it may well be a blow for freedom, but I doubt it will make the world a better place.






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