Reclassification: a look back

CANNABIS: THE FACTS

Eddie Nestor invited Addiction Recovery Foundation CEO Deirdre Boyd onto his BBC Radio London show – at midnight! – Sunday [4 May 2008] to debate the reclassification of cannabis with legalisation campaigner Steve Rolles. For listeners, these are the statistics and references used in the show – with acknowledgment to the help of Dr Andrea Grubb-Barthwell, formerly the [White House] deputy drug czar.

BACKGROUND:

Cannabis is the most commonly abuse illicit drug in the US and Europe. Its main active chemical is THC (delta-tetrahydrocannabinol). The membranes of certain nerve cells in the brain contain protein receptors which bind to THC. Once in place, THC kicks off a series of cellular reactions which ultimately lead to the high that users experience when they first smoke marijuana.

HARMS: LEGAL v ILLEGAL DRUGS

“Annual drug-related deaths are about 1,600 people a year — compared to 22,000 from alcohol, 90,000-100,000 deaths from tobacco use – even benzodiazepine-related deaths each year exceed that of all illegal drugs except heroin. The harms by making drugs legal are multiples of illegal drugs, indicating that lessening their availability is a better option than legalisation.”   The sources for this data are below.

“Drug -related deaths for the year are 1,608”
“Measuring the harm from illegal drugs: the drug harm index 2005”, Home Office update 2007

“Alcohol-related harm costs around £20billion a year”
Tony Blair, Prime Minister’s Foreword, Alcohol Harm Reduction Strategy for England

“The annual cost of alcohol misuse includes… up to 22,000 premature deaths per annum”
Alcohol Harm Reduction Strategy for England

“In Britain, 6 million deaths were caused by tobacco over the past 50 years” Average – 120,000 pa.
British Medical Journal 2004.

“Involuntary addiction to prescribed tranquillisers is the most serious drug problem in the UK today. Benzodiazepine-related deaths each year exceed that of all illegal drugs except heroin. The number of addicts (1.5) million exceeds by far the number addicted to all illegal drugs. And tranquillisers are more addictive than heroin”
All Party Parliamentary Group for Involuntary Tranquilliser Addiction, Newsletter 1, 22 January 2008

Hospital emergency visits:  alcohol-related 48.7%   cocaine 20%   marijuana 12.6%
Reference: Drug Abuse Warning Network, www.samhsa.gov

FACT: “MEDICAL MARIJUANA” SENDS THE WRONG MESSAGE TO KIDS

Benchmark surveys of drug use show that when young people believe a drug is harmful, the fewer young people use that drug.

US states which passed “medical” marijuana laws have among the highest past-month drug use (8 out of the 10 top slots) and addiction (7 out of the 10 top slots). Follow-up studies show this is a consistent cluster in those states.

The most recent study released in 2008 shows that these states are in the majority of the top 10 for first-time use of marijuana in the past year – for people aged as young as 12 to 25.
References: Monitoring the Future Survey, which has tracked drug use annually among US high-school students since1974. National Household Survey on Drug Abuse, which has tracked drug use among Americans aged 12 and older since 1972.

FACT: MARIJUANA IS THE No 1 DRUG CHILDREN ARE IN TREATMENT FOR

In 2004, 14.6million Americans used marijuana at least once in the month before being surveyed; about 6,000 people a day started to use it for the first time: 2.1million people – of which 63.8% were younger than 18.
Reference: NIDA IndoFacts: Marijuana, National Institute of Drug Abuse. 2004 National Survey on Drug Use and Health: National Findings (Office of Applied Statistics), SMA 05-4061.

One study showed that, of about 182,000 children in treatment, 48% were admitted for abuse or addiction to marijuana – compared to ‘only’ 19.3% for alcohol, 2.9% for cocaine, 2.4% for methamphetamine and 2.3% for heroin.
References: Monitoring the Future, National Institute of Health, National Institute on Drug Abuse – www.monitoringthefuture.org Overview of Findings from the National Survey on Drug Use and Health.

FACT: HOSPITAL EMERGENCY ROOMS

Every year, marijuana accounts for over 99,000 young people admitted to US hospital emergency rooms with marijuana-related complaints. Adults multiply the numbers. The figures are:

6-11 year olds                      380
12-17 year olds                    39,035
18-20 year olds                    27,742
21-24 year olds                    32,154
T o t a l = 99,311
Reference: Drug Abuse Warning Network.

FACT: OTHER DAMAGE FROM “MEDICAL” MARIJUANA LAWS

“Medical” marijuana laws open the door for kids to use drugs. In California, high-school students openly smoked pot in class under protection of such laws – they managed to get it prescribed for conditions such as “sleeplessness” and “stress”.

The mixed message of “medical” marijuana will most likely have a terrible effect on parents’ ability to provide unequivocal information about drugs to their young children.
References: Office of National Drug Control Policy: What every American should know about medical marijuana. www.whitehousedrugpolicy.gov. DEA Congressional Testimony, statement by Thomas Constantine, administrator of the Drug Enforcement Administration, US Dept of Justice; 2 December 1996.

FACTS: OTHER DAMAGE TO CHILDREN

“Cannabis use and educational attainment”
VOX, 18 September 2007

“Differential effects of delta-9-THC on learning in adolescent and adult rats”
Pharmacology Biochemistry and Behavior, 2 May 2005

“Occurrence of cannabis use disorders and other cannabis-related problems among first-year college students”
Addictive Behaviors 33(3): 397-411, March 2008

FACTS: THERE ARE BOTH SHORT- AND LONG-TERM EFFECTS, including WITHDRAWAL

“”Drug craving and withdrawal symtoms can make it hard for long-erm marijuana smokers to stop abusing the drug. People report irritability, sleeplessness and anxiety…”
NIDA InfoFacts: Marijuana. Psychopharmacology 1999, 143(3):302-308 “Changes in aggressive behaviour during withdrawal from long-term marijuana use”

“… They also display increased aggression on psychological tests, peaking about one week after the last use of the drug”
NIDA InfoFacts: Marijuana. Psychopharmacology 1999, 141(4):395-404 “Abstinence symptoms following smoked marijuana in humans”

“The short-term effects of marijuana can include problems with memory and learning; distorted perception; difficulty in thinking and problem solving; loss of coordination; and increased heart rate. Research findings for long-term marijuana abuse indicate changes in the brain similar to those seen after long-term abuse of other major drugs.”
Reference: NIDA IndoFacts: Marijuana, National Institute of Drug Abuse. Science 1997, 276(5321): 2050-2054 “Activation of cortocotropin-releasing factor in the limbic system during cannabinoid withdrawal”. Proc National Academy of Science 1998, 95(17): 10269-10273 “Melolimbic dopaminergic decline after cannabinoid withdrawal”

FACT: CANNABIS IS LINKED TO VIOLENCE

“Cannabis linked to aggression”
Press Association 2006, www.scotsman.com/news

“Marijuana had a greater effect on increasing the degree of violent behaviour in non-delinquent individuals than in delinquent individuals”
Journal of Addictive Disorders 2003, 22: 63-78

FACTS: DAMAGE TO PHYSICAL HEALTH

Birth defects:

“Risk of Selected Birth Defects with Prenatal Illicit Drug Use”
Reference: Journal of Toxicology and Environmental Health, part A, 70: 7-18, 2007.

“Some babies born to women who abused marijuana during pregnancy display altered responses to visual stimuli, increased tremulousness, and a hightched cry, whic may indicate neurological problems in development”
NIDA InfoFacts: Marijuana. Neurotoxicology and Teratology 1987, 9(1): 1-7 “Neonatal behavioural correlates of prenatal exposure to marijuana, cigarettes and alcohol in a low-risk population”
Child Development 1989, 60(23/24): 764-771 “Effects of marijuana use during pregnancy on newborn crying”

During pre-school years, marijuana-exposed children performed tasks involving sustained attention and memory more poorly than nonexposed children”
NIDA InfoFacts: Marijuana. Life Sciences 1995, 56(23-24):2159-2168 “”The Ottawa prenatal prospective study: methodological issues and findings. It’s easy to throw the baby out with the bath water”
Neurotoxicology and Teratology 2001, 23(1):1-11 “A literature review of the consequences of prenatal marihuana exposure: An emerging theme of a deficiency in aspects of executive function”

“In the school years, these children are more likely to exhibit deficits in problem-solving skills, memory and the ability to remain attentive”
NIDA InfoFacts: Marijuana. Life Sciences 1995, 56(23-24):2159-2168 “”The Ottawa prenatal prospective study: methodological issues and findings. It’s easy to throw the baby out with the bath water”

Pain:

“Too much cannabis worsens pain”
BBC News, 24 October 2007

“Marijuana won’t stop multiple sclerosis pain”
Neurology 2002, 58: 1404-1407

“[Shedding] light on controversial medical marijuana study”
Pushing Back, www.pushingback.com

Respiratory system damage:

“Marijuana smoke contains higher levels of certain toxins than tobacco smoke”
Science Daily, 18 December 2007

“Marijuana smokers face rapid lung destruction – as much as 20 years ahead of tobacco smokers”
Science Daily, 27 January 2008

“One cannabis joint is as bad as five cigarettes”
Reuters UK, 31 July 2007

“Someone who smokes marijuana regularly may have many of the same respiratory problems that tobacco smokers do”
NIDA InfoFacts: marijuana. Western Journal of Medicine 1990, 152(5): 525-530 “Pulmonary complications of smoked substance abuse”

“Use of marijuana impairs lung function”
Addiction 2002, 97: 1055-1061

“Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which increases the lungs’ exposure to carcinogenic smoke”
NIDA InfoFacts: marijuana.

“Study: Smoking cannabis causes damage to lungs”
Reuters UK

“Respiratory and immunologic consequences of marijuana smoking”
Journal of Clinical Pharmacology 2002

“Respiratory effects of marijuana and tobacco use in a US sample”
Journal of Gen Intern Medicine 2004, 20:33-37

“A study of 450 individuals found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than non-smokers. Many of the extra sick days were for respiratory illness.”
Reference: NIDA IndoFacts: Marijuana, National Institute of Drug Abuse. Western Journal of Medicine 1993, 158(6): 596-601 “Health care use by frequent marijuana smokers who do not smoke tobacco”

Cancer:

“Association between marijuana use and transitional cell carcinoma”
Adult Urology 2006, 100-104

“A study comparing 173 cancer patients and 176 healthy patients produced evidence that marijuana smoking doubled or tripled the risk of head and neck cancers”
NIDA InfoFacts: Marijuana. Cancer Epidemiology, Biomarkers & Prevention 1999, 8(12): 1071-1078 “Marijuana use and increased risk of squamous cell carcinoma of the head and neck”

“Marijuana use has the potential to promote cancer of the lungs”
NIDA Infofacts: Marijuana. NIDA InfoFacts: marijuana.
Western Journal of Medicine 1990, 152(5): 525-530 “Pulmonary complications of smoked substance abuse”.
Journal of Psychoactive Drugs 1994, 26(3):285-288 “Possible role of marijuana smoking as a carcinogen in the development of lung cancer at a young age”.
Recent Advances in Phytochemistry, 1975 “On the carcinogenicity of marijuana smoke”.

Aids/HIV:

“Marijuana component opens the door for virus that causes Kaposi’s Sarcoma”
Science Daily, 2 August 2007

Strokes:

“More evidence ties marijuana to stroke risk”
Reuters Health, 22 February 2005

“Pot use tied to stroke in three teenagers”
Reuters Health, 26 April 2004

Heart attack:

“An abuser’s risk of heart attack more than quadruples in the first hour after smoking marijuana”
Reference: NIDA IndoFacts: Marijuana, National Institute of Drug Abuse. Circulation 2001, 103(23): 2805-2809 “Triggering myocardial infarction by marijuana

Immune system damage:

“Immunological changes associated with prolonged marijuana smoking”
American College of Allergy, Asthma and Immunology, 17 November 2004

Infertility:

“Marijuana firmly linked to infertility”
Scientific American, 22 December 2000

Brain damage:

“Marijuana may affect blood flow in brain”
Reuters UK, 7 February 2005

FACTS: DAMAGE TO MENTAL HEALTH

Schizophrenia, depression:

“Cannabis-related schizophrenia set to rise”
Science Daily, 26 March 2007

“Using pot may heighten risk of becoming psychotic”
Associated Press, 26 July 2007

“Anterior cingulated grey-matter deficits and cannabis use in first-episode schizophrenia”
British Journal of Psychiatry 2007, 190: 230-236

“Marijuana increases risk of both psychosis in non-psychotic people as well as poor prognosis for those with risk of vulnerability to psychoses”
American Journal of Epidemiology 2002, 156: 319-327

“Psychophysiological evidence of altered neural synchronisation in cannabis use: relationship to schizotypy”
American Journal of Psychiatry 2006, 163: 1798-1805

“Marijuana linked to schizophrenia, depression”
British Medical Journal, 21 November 2007

“Cannabis shows anti-depression benefits but too much has reverse effect”
Canadian Press, 24 October 2007

“Depression, anxiety and personality disturbances have been associated with chronic marijuana use”
NIDA InfoFacts: Marijuana.
NYS Psychologist, January 2001, 35-39 “The effect of early marijuana use on later anxiety and depressive symptoms”.
Journal of Academy of Child and Adolescent Psychiatry 1998, 37(3): 322-330 “Longitudinal study of co-occurring psychiatric disorders and substance use”.

FACTS: ADDICTION TO MARIJUANA AND GATEWAY EFFECT

“Occurrence of cannabis use disorders and other cannabis-related problems among first-year college students”
Addictive Behaviors 33(3): 397-411, March 2008

“Regular or heavy use of cannabis was associated with increased risk of using other illicit drugs”
Addiction 2006, 101: 556-569

“As marijuana use rises, more people are seeking treatment for addiction”
Wall Street Journal, 2 May 2006

“Adolescent cannabis exposure alters opiate intake and opioid limbic neuronal populations in adult rats”
Neuropsychopharmacology 2006, 10-9

“25-year longitudinal study affirms link between marijuana use and other illicit drug use”
Congress of the United States, 14 March 2006

“New study reveals marijuana is addictive and users who quit experience withdrawal”
All Headline News, 6 February 2007

“Cannabis withdrawal among non-treatment-seeking adult cannabis users”
American Journal on Addiction 2006, 15: 8-14

“Escalation of drug use in early onset cannabis users vs co-twin controls”
Journal of the American Medical Association 2003, 289: 4

FACTS: LEARNING AND SOCIAL BEHAVIOUR

“Because marijuana compromises the ability to learn and remember information, the more a person uses it the more s/he is likely to fall behind in accumulating intellectual, job or social skills. Moreover, marijuana’s adverse impact on memory and learning can last for days or weeks after the acute effects of the drug wear-off”.
NIDA InfoFacts: Marijuana.
JAMA 1996, 275(7): 521-527 “The residual cognitive effects of heavy marijuana use in college students”.
Psychopharmacology 1993, 100(1-2): 219-228 “Effects of chronic marijuana use on human cognition”.

“Students who smoke marijuana get lower grades and are less likely to graduate from school, compared with their non-smoking peers”
NIDA InfoFacts: Marijuana.  Addiction 2000, 95(11): 1621-1630 “”Effects of adolescent cannabis use on educational attainment: a review”
Archive General Psychiatry 1996, 53(1):71-80 “High school students who use crack and other drugs”
Australia NZ Journal of Psychiatry 1990, 24(1):45-56 “Adolescent marijuana use: risk factors and implications”
Am Journal of Public Health 1999, 89(10):1549-1554 “The risks for late adolescence fo early adolescent marijuana use”.

“The ability of long-term heavy marijuana abusers to recall words from a list remained impaired for a week after quitting but returned to normal in 4 weeks”
NIDA InfoFacts: Marijuana.  Archive General Psychiatry 2001, 58(10):909-915 “Neuropsychological performance in long-term cannabis users”

“Depression, anxiety and personality disturbances have been associated with chronic marijuana use”
NIDA InfoFacts: Marijuana. NYS Psychologist, January 2001, 35-39 “The effect of early marijuana use on later anxiety and depressive symptoms”.
Journal of Academy of Child and Adolescent Psychiatry 1998, 37(3): 322-330 “Longitudinal study of co-occurring psychiatric disorders and substance use”.

EMPLOYABILITY:

“A study of 450 individuals found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than non-smokers. Many of the extra sick days were for respiratory illness.”
Reference: NIDA IndoFacts: Marijuana, National Institute of Drug Abuse. Western Journal of Medicine 1993, 158(6): 596-601 “Health care use by frequent marijuana smokers who do not smoke tobacco”

“Several studies associate workers’ marijuana smoking with increased absences at work, tardiness, accidents, workers’ compensation claims and job turnover”
NIDA Info Facts: Marijuana. JAMA 1990, 264(20): 2639-2643 “Efficacy of pre-employment drug screening for marijuana and cocaine in predicting employment outcome”

“Heavy marijuana abusers reported that the drug impaired several important measures of life achievement including cognitive abilities, career status, social life and physical and mental health”
NIDA InfoFacts: Marijuana. Psychological Medicine 2003, 33(8): 1415-1422 “Attributes of long-term heavy cannabis users: a case control study”

QUOTES FROM EXPERTS:

“Five years ago, 95% of psychiatrists would have said that cannabis doesn’t cause psychosis. Now I would estimate that 95% say it does.”
Professor Robin Murray, director – Institute of Psychiatry, London, October 2006

“The mistake was that in its 2002 report, the Advisory Council on the Misuse of Drugs denied that cannabis was a contributory cause of schizophrenia, continued to deny this for the next two years and thus misled ministers into repeatedly stating that there was no causal link between cannabis and psychosis.”
Professor Robin Murray, letter to the Guardian, 19 January 2006

“Use more often than twice a week for even a short time, or use for 5 years or more even once a month, may each lead to a compromised ability to function to their full mental capacity, and could possibly result in lasting impairments.”
Dr Nadia Solowij, “Cannabis and cognitive functioning” 1998

“THC encourages both physical and psychological dependence and is highly abusable. It causes mood changes, loss of memory, psychoses, impairment of coordination and perception, and complicates pregnancy.”
The warning on Nabilone, a THC replacement

“In the 60s and 70s, the average THC content of herbal cannabis was under 1%. Today’s specially bred varieties such as skunk and nederweed have THC contents of anything from 9-27%. These strong types are now commonly grown in the UK and are thought to account for 60% of cannabis consumed here.”
Mary Brett, former head of health education, Dr Challoner’s Grammar School, Amersham, Bucks

THE INDEPENDENT, 16 Sept 2007

“When the Independent on Sunday campaigned for decriminalisation of cannabis, we reflected the common view… that the drug was less dangerous than either tobacco or alcohol. Our editorial line was followed by the Daily Telegraph. Now that confusion has become a real problem… No sooner had cannabis been downgraded in the eyes of the law than most credible authorities began to warn it was considerably more dangerous than originally thought. That evidence led this newspaper, in March to renounce its campaign to decriminalise cannabis.

“For most people, cannabis is not as dangerous as amphetamines or heroin; the trouble is you cannot be sure who is susceptible to the risk of serious psychological harm. For those people, cannabis can be as destructive of personality as any other illegal drugs. [There is] a simple test to identify vulnerability to cannabis-induced psychosis, but ti will not be generally available for several years.

“We report a further complication. One of the arguments for reclassifying cannabis as less serious was that users did not tend to steal to pay for their habit. But disturbing new research suggests otherwise. An academic study in Sheffield suggests one in four young offenders stole to pay for cannabis.

“As we also report, many young people think that cannabis is legal and harmless. They are not aware that under-18s should be arrested for possession of cannabis.

“Public information campaigns have not succeeded so far. The simpler the message, the better; and the simplest is that cannabis is dangerous and illegal.”

Consistent policing is important. It is not clear that most poice forces ahve a zero-tolerance approach to amoking cannabis in public places, which is essential to reinforce the message that the drug is illegal.

Criminalising young people is no answer. The best way to get across information about the health risks of cannabis is to make it a medical or mental-health issue rather than one of criminal justice.

5th May 2008