In her editorial, Fiona Godlee, draws our attention to points raised by Meacher et al (1) as to why the Royal College of Psychiatrists should join the BMJ’s position in legalising cannabis. Godlee (2) also recommends the legalisation of cocaine and heroin, but in this response, I will focus on cannabis, which is often considered “harmless” (3), in comparison to cocaine or heroin.
As psychiatrist Prof Robin Murray and “recovered cannabis-user” Adam Gridley (1) point out, the use of cannabis impacts mental health services disproportionately. Besides issues of dependence, the development of psychosis, schizophrenia, the loss of liberty through psychiatric detention, use of hospital beds through involuntary admissions; there is also the strong association with violence (Coid et al, 2017), and the consequent risk of incarceration for the user. This is no small matter for psychiatry.
Unlike many of our colleagues in the medical sub-specialities, we cannot miss the enormous impact that cannabis use has on the mental health, life and liberty of our patients.
As a forensic psychiatrist working in England, it would be amiss of me not to highlight the significant relationship between violence and substance misuse in the UK (4). Any savings for the police from decriminalisation will be likely replaced by a surge in violent crime (3), and the use of police time in escorting individuals who become mentally unwell (8) after using cannabis.
Given the recent increase in knife crime (5), the rise of homicides (6), the upsurge of mental health problems among young people in UK (7) against the backdrop of cuts in healthcare and policing (8), the unknown impact of Brexit on the NHS and the economy; this is surely not the time to conduct an expensive social experiment?
When it comes to legalising cannabis, Murray and Gridley (1) point out to the opportunity for the UK to watch and learn from the mistakes of others across the pond.
What can we learn from the British experience so far? The legal status of the best-known drug of abuse, namely alcohol, poses a significant burden on health and public safety despite health campaigns to ameliorate its negative impact. Alcohol is the most dangerous drug in the UK (9) because it is legal. Do we need cannabis to displace it from its prime position (3)? Can we afford the luxury?
The very nature of addiction means that those who become dependent will develop tolerance to milder forms of cannabis and begin to abuse stronger and more potent iterations as evidence from the US suggests (3).
Any illusion that decriminalising can help streamline access is immediately dispelled as I begin my weekly psychiatric clinic in prison, where my almost inevitably poor patients, the majority of whom accept that cannabis is harmful, will sell out their soul for a puff.
While it is tempting to pander to the greed of corporations desperate to capitalise on this industry, and doctors and politicians who want their piece of cannabis cake, without any fear of reprisal, let us consider the real price. The impressionable young, those vulnerable to develop psychosis, or become violent, will find their future potential reduced to a mental health and/or crime statistic. Cannabis legalisation will hurt the poorest and the most vulnerable in our society, disproportionately. How can we agree to that?
1. Meacher M, Nutt D, Liebling J, Murray RM, Gridley A. Should the supply of cannabis be legalised now?. BMJ. 2019 Jul 3;366:l4473.
2. Godlee, F., 2019. Should we legalise cannabis?.
4. Coid J, Hu J, Kallis C, Ping Y, Zhang J, Hu Y, Bui L, Ullrich S, Bebbington P. A cross-national comparison of violence among young men in China and the UK: psychiatric and cultural explanations. Social psychiatry and psychiatric epidemiology. 2017 Oct 1;52(10):1267-79.
7. Pitchforth J, Fahy K, Ford T, Wolpert M, Viner RM, Hargreaves DS. Mental health and well-being trends among children and young people in the UK, 1995–2014: analysis of repeated cross-sectional national health surveys. Psychological medicine. 2019 Jun;49(8):1275-85.
Rapid Response:
Re: Should we legalise cannabis?
In her editorial, Fiona Godlee, draws our attention to points raised by Meacher et al (1) as to why the Royal College of Psychiatrists should join the BMJ’s position in legalising cannabis. Godlee (2) also recommends the legalisation of cocaine and heroin, but in this response, I will focus on cannabis, which is often considered “harmless” (3), in comparison to cocaine or heroin.
As psychiatrist Prof Robin Murray and “recovered cannabis-user” Adam Gridley (1) point out, the use of cannabis impacts mental health services disproportionately. Besides issues of dependence, the development of psychosis, schizophrenia, the loss of liberty through psychiatric detention, use of hospital beds through involuntary admissions; there is also the strong association with violence (Coid et al, 2017), and the consequent risk of incarceration for the user. This is no small matter for psychiatry.
Unlike many of our colleagues in the medical sub-specialities, we cannot miss the enormous impact that cannabis use has on the mental health, life and liberty of our patients.
As a forensic psychiatrist working in England, it would be amiss of me not to highlight the significant relationship between violence and substance misuse in the UK (4). Any savings for the police from decriminalisation will be likely replaced by a surge in violent crime (3), and the use of police time in escorting individuals who become mentally unwell (8) after using cannabis.
Given the recent increase in knife crime (5), the rise of homicides (6), the upsurge of mental health problems among young people in UK (7) against the backdrop of cuts in healthcare and policing (8), the unknown impact of Brexit on the NHS and the economy; this is surely not the time to conduct an expensive social experiment?
When it comes to legalising cannabis, Murray and Gridley (1) point out to the opportunity for the UK to watch and learn from the mistakes of others across the pond.
What can we learn from the British experience so far? The legal status of the best-known drug of abuse, namely alcohol, poses a significant burden on health and public safety despite health campaigns to ameliorate its negative impact. Alcohol is the most dangerous drug in the UK (9) because it is legal. Do we need cannabis to displace it from its prime position (3)? Can we afford the luxury?
The very nature of addiction means that those who become dependent will develop tolerance to milder forms of cannabis and begin to abuse stronger and more potent iterations as evidence from the US suggests (3).
Any illusion that decriminalising can help streamline access is immediately dispelled as I begin my weekly psychiatric clinic in prison, where my almost inevitably poor patients, the majority of whom accept that cannabis is harmful, will sell out their soul for a puff.
While it is tempting to pander to the greed of corporations desperate to capitalise on this industry, and doctors and politicians who want their piece of cannabis cake, without any fear of reprisal, let us consider the real price. The impressionable young, those vulnerable to develop psychosis, or become violent, will find their future potential reduced to a mental health and/or crime statistic. Cannabis legalisation will hurt the poorest and the most vulnerable in our society, disproportionately. How can we agree to that?
1. Meacher M, Nutt D, Liebling J, Murray RM, Gridley A. Should the supply of cannabis be legalised now?. BMJ. 2019 Jul 3;366:l4473.
2. Godlee, F., 2019. Should we legalise cannabis?.
3. Berenson A. Marijuana is more dangerous than you think. WSJ. Jan 4, 2019 https://www.wsj.com/articles/marijuana-is-more-dangerous-than-you-think-...
4. Coid J, Hu J, Kallis C, Ping Y, Zhang J, Hu Y, Bui L, Ullrich S, Bebbington P. A cross-national comparison of violence among young men in China and the UK: psychiatric and cultural explanations. Social psychiatry and psychiatric epidemiology. 2017 Oct 1;52(10):1267-79.
5. Knife and Offensive Weapon Sentencing Statistics, England and Wales – 2018. Ministry of Justice. March 14, 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
6. Crime in England and Wales: year ending September 2018. ONS. 25 April 2019. https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bull...
7. Pitchforth J, Fahy K, Ford T, Wolpert M, Viner RM, Hargreaves DS. Mental health and well-being trends among children and young people in the UK, 1995–2014: analysis of repeated cross-sectional national health surveys. Psychological medicine. 2019 Jun;49(8):1275-85.
8. Dodd V. Police 'picking up pieces of mental health system', says watchdog. The Guardian. 27 Nov 2018. https://www.theguardian.com/society/2018/nov/27/police-mental-health-sys...
9. Nutt, D.J., King, L.A. and Phillips, L.D., 2010. Drug harms in the UK: a multicriteria decision analysis. The Lancet, 376(9752), pp.1558-1565.
Competing interests: No competing interests