Cannabis is in my view the greatest hidden threat to our society - it causes individual harm and community harm.
On 15th June 2022 I was invited to speak to the Home Affairs Select Committee on my thoughts on illegal gateway drugs (particularly Cannabis) and consumption rooms. I did that and the chair asked me to follow up with written evidence. I did and hopefully contributed to their later decision not to legalise cannabis.
A section of the text of that document is shown here and outlines my arguments against it.
Legalisation/Decriminalisation of Cannabis
For the avoidance of doubt cannabis, when I use the term, refers to THC containing substances. The current cannabis products contain significantly higher concentrations than in the past.The argument for the legalisation of cannabis is topsy turvy – those advocating it constantly ask for proof of cannabis being negative rather than making a case for cannabis to prove itself a positive addition to society.
The arguments they put forward are that (i) cannabis is not a gateway drug; (ii) it is harmless and safe; and (iii) if legalised/decriminalised then there would be less crime overall and money could be diverted from law enforcement to treatment.
Taking these arguments in turn:
i. Cannabis as a Gateway Drug
There are a number of arguments that together provide a case for this assertion. Rather than a clinical definition, a more real-world definition of “gateway” as meaning an increased desire or opportunity for taking Class A drugs is taken here. The following arguments and evidence support this gateway statement.
The alcohol argument uses the paradigm of alcohol to explain why cannabis can be seen as a gateway drug. Put simply, people do not just drink low alcohol, or ‘light’ beers alone – they can gravitate to stronger beers (analogous to stronger concentrations of cannabis) and to other forms of alcohol (analogous to Class A drugs). Common sense tells us this may occur with illegal drugs. In addition, drug tolerance, or the reduced reaction to a drug following its repeated use, is a widely understood concept within pharmacology. Regular users of cannabis can develop tolerance, meaning they must use larger amounts or higher concentrations to achieve the same effect. Common sense tells us this will occur with illegal drugs, and persistent users over time may gravitate towards Class A drugs.
The Business Model evidence fits with everything that is seen on the ground. There are countless case histories of young people starting on cannabis and gravitating to Class A drugs. Dame Carol Black in her first review clearly shows the business model 4 – drug dealers want users to gravitate
to more addictive Class A drugs that not only give more profit per unit but allow greater power to be exerted over individuals to leverage other criminal activity. It is indicative that young people most commonly treated for addiction are those on cannabis. No child ever went to a drug dealer for heroin for their first deal – they would all have started with a bit of weed.The Neurophysiology argument looks at the anatomy of receptors in the brain - firstly in animals 5 and also in humans 6 . This shows close relationships between cannabinoid receptors and opiate receptors including receptor linkage. Also, cross-sensitisation is thought to occur with heroin. 7 I would suggest that these two points together adds further weight to the argument.
Finally, there is empirical evidence, where decriminalisation has been piloted, that an increase in Class A drug usage was demonstrated. This was shown in Lambeth in 2014, where cannabis was decriminalised and the hospitalisation for Class A drugs increased by 40 - 100%. 8 The multi-drug use argument also adds weight to this. In Scotland over 8000 users were surveyed and over 75% of cannabis users also take between 2 and 10 other drugs. 9 Intuitively, and with all
other evidence pointing that way, they have added to their first drug so either there was an addictive reason for a different experience, or it is purely due to increased access to the supply channel.
ii. Cannabis is not harmless but is an addictive and harmful drug
In the late nineties, a lot of drug companies were researching for chronic pain treatments. Chronic pain is a huge market but requires a symptomatic remedy and also a long-term treatment and as such any such drug has to be safe and effective. Efficacy in chronic pain needs to be demonstrated above the placebo effect and for pain that is 30-50%, so there is a high bar to prove a product works. The side effects that would preclude a product licence were those that were in
any way either life threatening, eg carcinogenic or teratogenic (birth defects). Cannabinoids were unable to get such a product licence and have been unable to do so since. To demonstrate that it is viable it would require large scale clinical studies in reputable peer reviewed journals. For that investment to occur it would need to satisfy safety criteria. That has not occurred.The risk – benefit decision however is changed for more serious or life threatening circumstances
and that is why it is entirely rational to restrict cannabis use to secondary care initiation in serious or potentially fatal conditions where other licenced preparations have failed. This is proportionate and in keeping with other untested or unsafe pharmaceuticals.
It is therefore counter intuitive to support widespread use of a substance that has significant safety issues. It is completely ridiculous to suggest that it should be sold and easily available to the general public. There is now epidemiological data available from countries and states where there has been
decriminalisation. This coupled with the new science of genomics means that there is now a unified mechanism that explains why different morbidity occurs.
Cannabis affects 59% of the human genome and therefore can be seen to affect a significant number of bodily systems. 10 In the US this is acknowledged with tiny genotoxin labels on legal products.
The work of Professor (Albert) Stuart Reece and Professor Gary Hulse from University of Western Australia brings all this together. It provides an explanation for the mental health issues seen, as well as flagging other long term health implications from cannabis use. I believe even if they were only half correct this would have huge public health ramifications and this, in association with previous work on psychosis and the gateway issue, provides a clear rationale for not weakening
legislation but to strengthen it. I have attached their latest review paper summarising the data to date.
It would be a huge risk to ignore this large body of emerging data much of it published in renowned peer reviewed journals. Their references are shown separately at the end of this submission.Although there will be other bodily systems implicated such as cardiology and gastro-intestinal,
there are four areas to highlight in particular:
Psychosis and Mental Health
Its effect on mental health and particularly psychosis is well known as an issue for cannabis. There have been a number of pieces of evidence in this regard recently:
• In Portugal there has been a 30-fold increase since decriminalisation.11
• In the US every four minutes someone is hospitalised for cannabis induced psychosis.12
• In Scotland there has been a significant increase (74%) in hospitalisation for psychiatric
issues. 13
There are other serious mental health conditions such as depression, schizophrenia and autism. The last has been predicted by 2030 to be 60% higher in US States that have legalised cannabis. 14
Cancer
There appears to be a causal link for cannabis with the most common male cancer – testicular cancer – the most common female cancer – breast cancer – and also common cancers in children amongst others. This has been demonstrated in the US and Europe. 15,16
Birth Defects
The implication that cannabis has an intergenerational detrimental effect was first suggested in Hawaii.17 It has now been correlated across both the Europe18 and US19. These include highly significant life threatening or life changing defects such as gastroschisis or phocomyelia. This is concerning as it would appear that cannabis demonstrates similar risks to thalidomide which was the very reason we have a strengthened drug regulatory system. 20
Premature Aging
There has long been felt that markers of aging such as teeth loss and greying hair/loss were connected with drug use. There is now a clear explanation for why this should be connected to cannabis. It has been shown that cannabis use can accelerate aging by 30% at the age of 30. This could be a way to make the case to young people to not take cannabis in the first place.21,22
I would also like to draw your attention to road safety. There has been a significant increase in deaths due to cannabis use in the states where it has been legalised. Particularly noteworthy are Washington State and Colorado.23, There is evidence that in addition to the psychoactive effects,
cannabis also directly affects the optic nerve causing a loss of peripheral vision and inability to process glare. The latter has implications for driving at night. It would be useful to contact Dr Phillip Drum, a Pharmacist in California with a special interest in cannabis and road safety for more details on this issue.24
Finally, cannabis also can kill as witnessed by the death of Damilola Olakanmi 25. This was actually due to cannabis sweets and this packaging to appeal to young people and children is deliberate targeting and particularly disgusting given the toxicity of the substance.
iii. Cannabis legalisation/decriminalisation will reduce addiction and pressure on the criminal justice system
It can be seen that decriminalisation is a half-way house that just removes cannabis from the criminal justice system but still leaves it being produced illegally. No benefit would accrue and where this has occurred harm has risen significantly. Portugal has been seen as the leader in decriminalisation but there are issues and, for example, Mayor Rui Moreira of Opporto is a believer in re-introducing the criminalisation of drugs to try and get their street criminality under control.26 Whether legalisation or decriminalisation, the empirical and anecdotal evidence points in all cases in the opposite direction. Let us take a common-sense view and answer the question of what would be the scenarios if cannabis was legalised:
1. Cannabis with a limited strength of THC is legalised
That will mean that with advertising and promotion more people will try the product and become addicted to cannabis. Production is heavily regulated. That will lead to a larger market for drug dealers selling cheaper alternatives to the legal strength and a stronger form of cannabis. It still leads to an increase in Class A drug use as the business model takes hold. No drug dealers give up their trade and the market has been increased
2. All cannabis is legalised – no matter what the strength
More advertising and promotion as across all strengths. Production is heavily regulated. Drug dealers produce cheaper and illegally as they ignore regulations, health and safety, etc. Enforcement is opaquer around technical arguments with fines and sanctions being less through bodies like trading standards etc. The market increases for all and drug dealers have an even larger and increasingly groomed pool to drive Class A use. This is exactly the situation in America
with some estimates of the cannabis market in California being 80-90% illegally supplied.27 It is very clear that the drug dealers have not gone away just adapted their business model to take advantage of a new more fertile environment.
In summary, cannabis is an addictive harmful substance that currently is being championed for profit over harm. The only people who would benefit would be the
manufacturers and financiers both legal and illegal. Harm and addiction would increase to the detriment of our young people and society as a whole. Does the committee want to recommend and facilitate the widespread use of a toxic substance potentially more dangerous than thalidomide?