A fear of confusion, loss of memory, a fragmented thought process, the boring repetition of the same thought, swinging moods with laughing or weeping without good cause, paranoia, hallucinations and a preoccupation with their own psyche and physique. These are the symptoms described in an Oxford study on the effects observed in social cannabis smokers — yet they are unlikely to dissuade anyone intent on having a drag on a spliff at a Christmas party.
Nor, unfortunately, is the potential smoker likely to be deterred by the rumour that research recently published in the British Journal of Psychiatry may cause some change in the Government’s approach to cannabis.
This would be the first step to do anything to dissuade people from smoking cannabis since Labour came to power in 1997. The claim now is that they became aware of the potential of cannabis to cause schizophreniform symptoms — or induce an actual psychosis, in those who are genetically vulnerable — only after they realised that modern cannabis is many times more powerful than that circulating in the Seventies and Eighties. Had they sought it, the evidence is that it may not only cause psychotic breakdown in the one in four who carries the genes that gives them a vulnerability to schizophrenia and bipolar disorder, but may do so in those without any family history of psychiatric disease.
It is rumoured that Tony Blair, having read the British Journal of Psychiatry, may reverse his decision to downgrade cannabis to a Class C drug in the light of the evidence it advances. This indicated that half the patients who had mental problems that were not considered indicative of schizophrenia were displaying the psychological symptoms sometimes associated with cannabis smoking, and later went on to develop classic schizophrenia.
Claiming that this evidence is new is less than flattering to the pharmacologists and the psychiatrists who have been giving warnings of the hazards since the 1970s. This evidence would have been available to Blair since his schooldays. When he was at Oxford, the then Professor of Pharmacology was Sir William Paton. He was one of the world’s experts on cannabis. In the 1970s Paton and his colleagues published many papers describing their observations, which had led him to conclude that even regular social cannabis smoking could induce schizophreniform symptoms. He listed these symptoms and they would have made worrying reading for any parent. Paton also drew attention to cases in which schizophrenia seemed to have been precipitated by taking cannabis in people who had previously been apparently unaffected by any form of psychiatric or psychological problems, and in whom there was no evidence that they were carrying a genetic burden that might make them liable to schizophrenic breakdown.
In one series of cases Paton and his colleagues found that there were several instances in which for some reason the person had had a psychiatric assessment, although without at the time evidence of psychological problems. Later they used cannabis and this had coincided with a psychotic breakdown.
It wasn’t only the work of Oxford that drew attention to this link. A US study indicated that once cannabis became readily available (taken as being between 1967 and 1971) the incidence of schizophrenia in US Army personnel in Europe increased 38-fold in a five-year period. The authors of the American report had no hesitation in blaming the popularity of cannabis smoking among US soldiers. Several studies in the 1980s from Sweden supported this opinion.
The introduction of Sativex has again raised the profile of the medical value of cannabis taken in forms other than smoking. Previous research had shown that this way of delivering cannabis didn’t entirely remove the psychological and psychiatric side-effects that are associated with it. It might well be that alleviation of the pain, especially in serious chronic or terminal conditions, is more important than having to face the relatively small risk of these side-effects.
The work of Professor Robin Murray, of the Institute of Psychiatry in London, supports the conclusion drawn by numerous researchers on the hazards of cannabis smoking. Professor Murray’s research was published in the BMJ after the Advisory Council on the Misuse of Drugs (ACMD) had published its initial report and made its conclusions. This however didn ’t stop the ACMD from claiming that it had taken his work into consideration when making its recommendations.
Professor Murray has drawn attention to the lack of experts in schizophrenia who were appointed to the ACMD. Nor does the membership of the committee include any biologist with an interest in pharmacology of cannabis, nor a neurologist — the medical specialists whose expertise is the human nervous system.
Surprise is not only expressed that doctors such as Murray with his special interest in schizophrenia, or, for instance, Professor John Henry, the toxicologist and emergency department physician who has written extensively on the acute medical conditions caused by cannabis and other drugs, are not members of the ACMD.
Equal concern has been voiced that five members of the committee have also served or serve on pro-liberalisation of drugs’ charities. Several of these committee members spoke publicly on the need for liberalisation of drug laws long before they were appointed to the committee. This contrasts with the lack of representation of those who were known to be opposed to the relaxation of laws relating to cannabis.
There was not one member of the committee who had a reputation for being likely to object to downgrading cannabis to Class C.
Where, for instance, was Marjorie Wallace, the founder of Sane? Her help to those suffering from psychosis and other psychiatric disease has earned her an honorary fellowship of the Royal College of Psychiatrists and the everlasting gratitude of the patients and their families, whose lives have been wrecked by cannabis.
Marjorie Wallace’s advice has always been sought by doctors who support Sane, but may not be readily available to AMCD and the Prime Minister. In my brief forays into politics it was an accepted, if not broadcast, assumption that despite the public’s faith in independent committees these were an illusion. The practice of appointing people only after careful consideration of their record and opinions was well established when I was an MP, but never publicly discussed. It would have been considered bad taste lest it implied that the members of the committee lacked integrity. This is not so. The people appointed were, and presumably still are, of the highest integrity, therein in part lies their value to a government.
They can be relied upon to be forthright in their opinions and any government is fully aware, on appointment, what these are likely to be.
Unfortunately, the opinions of the ACMD, and the conclusions the Prime Minister drew from them, will, if left unamended, have the potential to cause immense damage to those 25 per cent of people who, even if intellectually brighter than their contemporaries, are genetically predisposed to psychiatric problems from smoking cannabis.
THE SYMPTOMS
Thereafter patients may display the acute symptoms of psychotic breakdown. Later many may reach a chronic state, with symptoms of inertia, depression and intellectual decline, with evidence of the underlying psychotic condition (including disturbed thought patterns, delusions — often paranoid — and hallucinations).
