Monday, 12 October 2015

The Case for Cannabis

I wrote to my MP:


Dear Neil Coyle,

I write as your constituent regarding today's Parliamentary debate in Westminster Hall, led by your colleague Paul Flynn MP,  'That this House has considered the e-petition relating to making the production, sale and use of cannabis legal.' As a new Labour MP and in the wake of your party's recent leadership election, you would do well to emulate the example of Mr Flynn, a veteran who has represented the cause of cannabis legalisation in the Commons for many years as a matter of principle, but also pragmatism. 'A 50-year experiment in drug prohibition has been a disaster.' he writes. 'Prohibition increases drugs use, harm and crime. It builds empires of criminals as the alcohol prohibition did in America in the twenties.'

'The good news is that the world has recognised the futility, waste and cruelty of prohibition,' Flynn continues, but 'the bad news is that UK has the worst of all worlds.' The Conservative Government has already responded to more than 200,000 people who signed the e-petition, negatively, but today's debate is an opportunity to support rational, evidence-based drugs policy, such as that proposed by Transform, which has published a practical guide to regulating recreational cannabis. Today, I see that Transform is also participating in an expert panel on cannabis legalisation that's been set up by the Liberal Democrats, impotently, now that they can do nothing about it.
 
In commencing what I hope will not become a protracted and one-sided correspondence, I recall how many times I wrote to your impotent Liberal Democrat predecessor, Simon Hughes, over the years, on the topic of making cannabis legal. Typically, he ignored me, although there was one occasion in 2009 when I almost persuaded Mr Hughes to ask a Parliamentary question concerning the distribution of Sativex - a cannabis preparation made in Britain - as an unlicensed medicine imported from Canada. Since then, in June 2010, Sativex was licensed by the MHRA and, in April 2013, it was placed in Schedule 4 of the MDA.

This is anomalous, since Sativex is a whole plant extract of cannabis - it is essentially a tincture, fundamentally no different from what Queen Victoria took for her period pains - and yet raw cannabis remains in Schedule 1 of the MDA, indicating that it has no medicinal value. In fact, the medical efficacy of cannabis is well-established, with an extensive and ever-growing database of Clinical Studies and Research Papers.

As far back as November 1997, in its report into The Therapeutic Uses of Cannabis the BMA recommended 'changing the Misuse of Drugs Act to allow the prescription of cannabinoids [active chemical compounds in cannabis] to patients with certain conditions causing distress that are not adequately controlled by existing treatments'.

One occasion upon which Simon Hughes did respond promptly to me was in late 1998, during his tenure as LibDem Health spokesperson. He happened to be on BBC Question Time when the House of Lords Science and Technology Committee published its Ninth Report, examining 'the scientific and medical evidence to determine whether there was a case for relaxing some of the current restrictions on the medical uses of cannabis.' Summarily, the Report recommended: ' The Government should take steps to transfer cannabis and cannabis resin from Schedule 1 to the Misuse of Drugs Regulations to Schedule 2, so as to allow doctors to prescribe an appropriate preparation of cannabis.' Mr Hughes endorsed these recommendations on TV and so I congratulated him, to his evident pleasure.

However, here we are all these years later and there is now a cannabinoid drug that may be prescribed - at a cost that may be unaffordably high - and yet raw cannabis remains a Schedule 1 drug, and cannot be used at all in medicine, except for research under special Home Office licence that costs £5000, a situation Baroness Meacher, chair of the All-Party Parliamentary Group for Drug Policy Reform, recently described as, “deeply shocking”. Referring to the legalisation of medical cannabis in Germany, the Netherlands, and parts of the United States, she remarked, “it’s exciting to see what’s happening internationally, but here we [the government] have been a failure. Britain is getting left behind”.

Until 10 years ago, British Courts tacitly acknowledged the medicinal value of cannabis when the defence of 'Medical Necessity (Duress of Circumstances)' was accepted in a succession of cannabis trials. Defendants with a range of serious and intractable illnesses, particularly Multiple Sclerosis, successfully argued that cannabis was uniquely beneficial for them and they grew their own medicine, sooner than score via criminals on the street. In 2005, however, the Court of Appeal considered appeals against conviction by five appellants and a cross appeal by the Attorney General against the judges direction in a case where the defendant - Jeff Ditchfield - was acquitted on the basis of medical necessity. Three Law Lords decreed that 'necessity' would no longer be a viable defence in British courts, a decision about which Professor David Nutt memorably blogged, some five years later. (As you will recall, Prof Nutt was the Government's leading drugs adviser until he was sacked by the last Labour administration in 2009 for his insistence that policy should be dictated by scientific evidence, rather than prejudice or expediency.)

While cannabis continues to be used as a political football, anyone who impartially evaluates the evidence of its medicinal value will come to the same conclusions as Norman Baker, the Liberal Democrat minister, who, having been lobbied by the United Patients' Alliance, last year called for more liberalised drug laws, and specifically the legalisation of cannabis grown for medicinal use. His suggestion was rejected reflexively: "This government has no plans to legalise cannabis or to soften our approach to its use as a medicine," declared an anonymous spokesperson, who continued to state: "There is clear scientific and medical evidence that cannabis is a harmful drug which can damage people's mental and physical health." The hypocrisy of that sentence would be shocking, if we were not inured to the cant that surrounds this topic.

To be clear: there has long been an association between chronic cannabis use and the onset of mental illness. In fact, the roots of its prohibition - explored by James H. Mills in 'Cannabis Britannica: Empire, Trade, and Prohibition, 1800-1928' - lie in a claim made by the Egyptian delegate to the League of Nations' Opium Convention, held in Geneva in 1925, that ‘illicit use of hashish is the principal cause of most of the cases of insanity occurring in Egypt… generally speaking, the proportion of cases of insanity caused by the use of hashish varies form 30 to 60 percent of the total number occurring in Egypt’. His statistics were spurious and his assertions not supported by the British, whose colonial experience, as recorded in the Report of the Indian Hemp Drugs Commission, 1893-1894, indicated that banning preparations of cannabis was unnecessary. Consequently, the British delegate to the sub-committee that subsequently decided to prohibit cannabis abstained, but the UK was still constrained by its decision to ban cannabis, internationally, in 1928.

From the very beginnings of its Prohibition, cannabis has been unfairly associated with hard drugs and mental illness. In the notorious 'Reefer Madness' campaign conducted against cannabis in the 1930s in the USA, dried flowers of the cannabis hemp plant was called, 'marijuana,' and lurid tales were put about that purported to show how the stuff prompted its users to commit insane acts. Now, several generations later, the same tactic is being deployed, with a newly-invented kind of cannabis  - 'skunk' - that is purportedly so potent that it tips teenagers over the edge. South London, in particular Sir Robin Murray's work at the Maudsley has been ground zero for this phenomenon.

'Smoking skunk cannabis triples risk of serious psychotic episode' declared The Guardian in February, 2015. It reported the results of a study published by The Lancet that set out to calculate the proportion of new cases of psychosis attributable to different types of cannabis use in south London. The article was subsequently modified 'to make clear that the study found skunk use was responsible for a quarter of new cases of psychosis in the population in South London that the researchers looked at – not across the country as a whole.' Another study, of 16-year-old twins, conducted jointly (sic) by Oxford and Leeds Universites, found that both cannabis use and psychotic episodes were triggered by environmental factors, including being poor, or bullying.

In fact, while the correlation between cannabis use and the onset of mental illness has long been noted, and despite the weight of research in this area, causality has still not been clinically demonstrated. “It is now well known that use of cannabis increases the risk of psychosis," Prof. Murray was quoted as saying to the King's College newsletter. "However, sceptics still claim that this is not an important cause of schizophrenia-like psychosis. This paper suggests that we could prevent almost one quarter of cases of psychosis if no-one smoked high potency cannabis. This could save young patients a lot of suffering and the NHS a lot of money.” While these bald statements may be true, Sir Robin fails to add the caveats: risk increases, 'for those with a pre-disposition'; we could avoid a quarter of cases if no-one smoked, 'immoderately and all day long'.

The King's report suggests that 'a theoretical explanation of why skunk might have been preferred by patients with first-episode psychosis is that, when they began to experience their illness prodrome, these individuals might have sought increased concentrations of THC to self-medicate. However, experimental studies show that THC induces psychotic symptoms, while cannabidiol (CBD) ameliorates them and reduces anxiety.' This touches upon the area of cannabinoid research that has been opened up by GW Pharmaceuticals' development of Sativex, which contains equal amounts of THC & CBD. Clearly, work must be done to discover the ways in which the numerous cannabinoids interact, but the prohibition inhibits that research, as Baroness Meacher complained.

One argument against decriminalisation - deployed by David Cameron during his notorious interview with Jonathan Ross - is that such a move would encourage more people to consume cannabis. The evidence from tolerant regimes, such as  the Netherlands and Portugal, does not support that assumption. There may be an initial surge in use as the curious and law-abiding experiment, but then the numbers fall back to where they were. In fact, across Europe, with different regimes being more-or-less hostile to cannabis users, the incidence of cannabis use remains fairly consistent, which indicates that Drugs Policy has little impact. More people in England & Wales (6.6%) use cannabis than in the Netherlands (5.4%) where the average age of first use is higher (sic).

Prof. Murray told The Guardian back in 2004, when the last, lamentable Labour Government experimented with re-classifying cannabis, downgrading it from B to C, before The Daily Mail persuaded them to put it back: "To be frank, in south London, it doesn't matter what the classification is. People who want cannabis can get it; it is readily available." Back then, Murray did not see his role as preaching to people about what they choose to put into their bodies. "I don't think it's a particularly useful thing for somebody like me to come over heavy-handed and say that under no circumstances should you smoke cannabis when all their peer pressure will be to smoke cannabis. If people want to smoke cannabis, they have the right to do so," he admitted.

While Britain continues to persecute people for self-medicating with cannabis, or for simply getting high, we waste a considerable amount of public money every year on policing a victimless crime. Quantifying the economic benefits of legalisation is, inevitably, a case of thinking of a number and doubling it. The Guardian, today, quotes 2013 figures from the Institute for Social and Economic Research at the University of Essex, which estimated that legalising cannabis would save the UK between £500m and £1.25bn in costs, while raising a tax revenue of £400m-£900m.

Whatever the true figures, it is undeniable that cannabis is the most widely-used illegal drug in the UK and that policing its prohibition is a massive, counter-productive drain upon public resources. Whereas the evidence that is now coming in from the four States of the USA that have fully legalised cannabis, making it available to all adults via regulated outlets, is that they are generating phenomenal tax revenues. In Colorado, where voters legalised cannabis in 2012, taxes on weed sales were specifically intended to go toward school construction, but $50 million in recreational pot taxes has been collected in the first year, which is more than the State constitution permits it to take. They've raised so much tax revenue in Colorado by legalising pot that the state may offer its taxpayers a rebate.

To summarise: cannabis  is potentially the most versatile and efficacious medicine and its prohibition benefits no-one except the pharmaceutical industry. While it is not entirely harmless, the prohibition does nothing to make cannabis safer, nor to limit its availability. Cannabis can be bought anywhere, but its quality is highly variable and the people who sell it have few scruples and pay no taxes. It is past time that we end the failed experiment of cannabis prohibition, you must agree.


Yours faithfully,