Raising awareness

Mental Health Nursing,  Mar 2006  by Harris, Jane

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Following home secretary Charles Clarke's decision not to reclassify cannabis, Jane Harris, senior campaigns officer with Rethink, looks at addressing the issue of cannabis in the long-term

Rethink has campaigned for many years on the issue of cannabis. Not because of ideology or politics, but because our members, service users and carers alike, told us that it was an issue for them.

The longer our campaign has gone on, the more our members have been proved right. There is no significant population research which shows that using cannabis does increase the risk of mental illness and that rather than people using cannabis to cope with psychotic symptoms, actually cannabis is a causal factor of those symptoms.

That's not to say that cannabis won't have this kind of effect on some people. It's a bit like peanuts - for most people, they're just a bar snack, but for some people they're very dangerous. We all know that about peanuts now - and young people, confronted with choices about using drugs, need to know that about cannabis too.

Rethink never campaigned to increase the legal penalties for using cannabis. People know that the chances of being caught were low, so this alone was never going to be an effective deterrent. What we wanted was proper health education for people, about their health, so that they could make decisions for themselves.

We want people to know that:

* if you smoke when you're under 18, you're doubling or tripling your chances of getting psychotic symptoms;

* if you smoke heavily for a long time, you're also increasing your chances of psychosis;

* if you've already got a mental illness, using cannabis is going to make things much worse in the long run;

* cannabis causes some people more problems than others.

Rethink doesn't want cannabis to be legalised either. Making it legal will inevitably make the price drop and young people are very sensitive to price changes. Currently, young people use cannabis much less than legal drugs like alcohol or tobacco. Making it legal risks driving up the number of young people using cannabis - and that's a big risk.

Rethink was the only mental health charity to give evidence to the Advisory Council on the Misuse of Drugs, the body that advises the home secretary on drugs issues. As well as two members of staff giving evidence on policy options, a service user explained his experiences to the Council.

He had smoked heavily during his teens, believing cannabis to be far safer than other drugs. At one point, when he was feeling very bad, he went to his GP to ask if it might be because of his cannabis use - his GP told him that the cannabis was probably helping to stay calm! Eventually he had a psychotic episode and it was only once he stopped using cannabis that he began to feel better. He himself came to the realisation that it was cannabis that was giving him problems and cut it out. He's now in much better health, but feels he wasted years of his life and missed out on a good education because of experimentation with cannabis - and nobody ever told him the risks.

The government needs to make a real commitment to giving people information about cannabis. Charles Clarke has now said that he will fund a 'massive' campaign on this issue. We need to ensure that this campaign reaches young people, their parents and people who have mental illness.

Countless studies have found that it's really dangerous to smoke cannabis if you already have a mental illness. Negrete et al (1986) and Jablensky et al (1992) found higher rates of continuous hallucinations and delusions, and more hospitalisations, amongst active users.

Linszen et al (1994) compared 24 users with 69 non-users over a year with assessments of mental state on a monthly basis. Cannabis users experienced significantly more, and earlier, psychotic relapses or exacerbation of symptoms over the 12-month period and the effect was dose-responsive.

Martinez-Arevalo et al (1994) followed up 62 young adults with schizophrenia over a oneyear period and found that cannabis use was the best predictor of relapse and hospitalisation during this time. In a longer study, Caspari (1999) followed up 39 patients with schizophrenia over 68 months and found a significantly higher rate of rehospitalisation.

We are delighted that finally the government is recognising the research evidence on cannabis and has promised to act on it. We now need to make sure that service users, young people, carers and the public get some real information, rather than the myths and confusion which have for so long surrounded cannabis.

References

Caspari D (1999) Cannabis and schizophrenia: Results of a followup study. European Archives of Psychiatry and Clinical Neuroscience, 249, 45-49

Jablensky A, Sartonus N, Ernberg G, et al (1992) Schizophrenia: manifestations, incidence and course in different cultures. Psychological Medicine. Monograph Supplement 20.

Linszman, DH, Dingemans P M & Lenior ME (1994) Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives of General Psychiatry, 51, 273-279