The problem not the substance

The Independent on Sunday seems to think there is a debate to have about cannabis - a debate that centres on the drug's legal status in the light of so-called 'new evidence' about the dangers of the drug and incidentally, based on a distortion of evidence about potency as revealed by the Guardian (24th March).

Last week The Lancet published a league table of drug harms including both alcohol and tobacco while the recent report by the Royal Society of Arts and last year's report by MPs, both queried whether the Misuse of Drugs Act was fit for purpose.

There are certainly questions to be raised about our response to the harms caused by drugs - not least the media-fuelled obsession with cannabis while the much greater damage caused by alcohol is glossed over. But while concerns about the evidence-base for our drug laws may help to inform the wider debate about drugs, they actually miss a key point: we should be focusing on the problem, not the substance.

The Misuse of Drugs Act is no more than a legal instrument and can also be a mechanism to signal police priorities. The reclassification of methamphetamine to Class A was not driven by a clear and present danger, but at the request of the police who argued that should they need to, it would be easier to allocate scarce resources to methamphetamine as a Class A rather than a Class B drug. Because there is no evidence that where a drug sits in the Act makes a whit of difference to the decision to use it.

So, for example if anybody thinks that placing stronger strains of cannabis in Class A is going to do much for young people with problems, they are sadly mistaken. What would actually help those teenagers chronically using alcohol and cannabis to cope with social and personal problems would be to have well-funded youth services, decent child and adolescent mental health services and comprehensive family support from social services. And generally a far greater effort to tackle the lethal alientation felt by many young people in British society highlighted in the recent UNICEF report which placed our teenagers way down the happiness league table of developed countries. These are the issues that warrant media campaigns.

Have we crossed the white line with cocaine?

This weekend George Bush visited Colombia against the background of rising cocaine production despite US aid in excess of $5bn given since 2000 to support the much-vaunted Plan Colombia aimed at reducing the coca crop by 50% in five years.

Last week saw the publication of the Royal Society of Arts report into illegal drugs in the UK, part of which involved commissioning an online poll from YouGov to gauge current attitudes, knowledge and experience of drug use from a sample of the general public, including both users and non-users.

One of the more interesting revelations from the survey which has received no publicity is that notwithstanding the constant hoo-ha about celebrity cocaine use, the drug has quietly become an unremarkable part of going out for a large number of ordinary people. And in the process, cocaine (as opposed to crack) has lost its image as a 'hard drug'.

Despite the use of the terms by YouGov, it is worth reiterating that the concept of ‘hard’ and ‘soft’ drugs has no validity either in science or law. The terms have developed as a journalistic and political short-hand that attempts to distinguish those illegal drugs which are deemed to cause the most harm to society and have the highest potential to cause addiction i.e. heroin and cocaine, from other illegal drugs.

Cocaine is a Class A drug, attracting the most stringent penalties for possession and supply and a drug classically defined as ‘hard’. Back in the 1980s and in the wake of a significant increase in heroin use, the government of the day launched the UK’s first anti-drugs campaign under the banner ‘Heroin Screws You Up’. The follow-up survey revealed that public attitudes had not been changed much by the campaign. Most people were antipathetic to heroin and cocaine before the campaign and remained so

But since the early 1990s, the statistics of cocaine use tell the tale. There has been more cocaine seized than heroin by weight, the number of cocaine seizures went up by a factor of four while the price has fallen by half in the last five years down to £30 a gram in some places.

Even if use of cocaine has become more acceptable, the dangers still exist. Some doctors believe that cocaine is the primary reason for the rise in heart attacks and strokes in young people – and because the effects of the drug wear off quickly, a regular cocaine habit is still expensive despite the fall in price.

But it may be that increasing numbers of people believe that occasional use of cocaine is not causing significant problems for themselves or their friends, and so their attitudes to the drug are changing accordingly. Back in 1995, the World Health Organisation conducted the largest international review ever on cocaine and concluded that across the world, occasional use was 'the most typical pattern of cocaine use, in which the drug is used as an aid in social intercourse and that 'there are generally few problems associated with this pattern of use'. (1) The results so infuriated the Americans that they refused to allow the report to be published officially and threatened to withdraw funding.

In the YouGov survey, half of the drug users believed it was possible ‘for some people to use some so-called ‘hard drugs’ quite safely without doing themselves and those around them any more harm than drinking or smoking in moderation.

Over 60% said they had moved on from ‘soft’ drugs to ‘hard drugs’ as an experiment while over 50% said it because they were socialising with people who used 'hard drugs’. But this could only apply to powdered cocaine because if we look at the declared drug experiences of this group, we find that cocaine powder is the most used illegal drug behind cannabis followed by ecstasy with everything else a long way behind. Only 1% say they have tried crack and nobody admitted to using heroin, the other ‘hard’ drug, at all.

(1) http://www.tni.org/docs/200703081409275046.pdf

Cannabis: super-strength me

For some while now, the international consensus on cannabis has been breaking down. According to the Single Convention on Narcotic Drugs, now over forty years old, signatory countries are supposed to treat cannabis no different legally than heroin or cocaine. Nor does international law recognise any medical benefits from the use of cannabis. But over time, and in the full knowledge of how difficult it is to get treaties amended, countries have been breaking ranks, by reducing the penalties for personal possession even down to administrative rather than criminal offences, although none have gone so far as the Dutch in allowing the sale of cannabis in specially designated premises.

Even the American government, who dominate the conduct of international drug policy, was unable to prevent eleven States decriminalising the drug in the 1970s, policies which were eventually reversed only when the incoming Republican government threatened withdrawal of Federal funding. Still today, the Federal authorities are at odds with some States who are allowing the sale of cannabis for medical purposes.

So a new battle has been joined to win over the hearts and minds of the general public as to the dangers of cannabis, by claims that cannabis is fifty or a hundred times stronger than it used to be, that it is simply a different drug and so we must redouble our efforts to curb its use.

There is strong cannabis in circulation - and ironically as a direct result of enforcement efforts. The widespread spraying of outdoor cannabis crops in the USA, prompted the growers to develop much smaller, indoor varieties and using horticultural techniques produced cannabis with a higher THC level than was usually available. The techniques were copied in Europe and now we have a highly profitable commercial home grown cannabis market using exploited immigrant labour to tend the plants. See the March/April issue of Druglink for an exclusive feature on this.

But cannabis has been available in widely varying strengths for many years. Some of the claims for the increased potency of cannabis are based on comparisons with very low grade US government-grown cannabis tested by the University of Mississippi in the mid 1970s. Yet during the same period, cannabis grown by US commecial growers could range up to 10% in THC content. In 1997, the World Health Organisation said, 'THC content in hashish ranges from 2-8%, although may be as high as 10-20%'. European research published in 2004 concluded that claims about recent significant increases in cannabis potency were unsubstantiated. And 2004 data from the US government puts the average rise in cannabis potency at only double, from 3.5% in 1985 to 7% in 2003.

Cannabis remains a potentially dangerous drug for those with mental health problems and adolescent services are more likely to see troubled young people self-medicating with alcohol and cannabis than heroin or crack. Also we know very little about the UK's cannabis using population. We don't know details about their buying habits, how easy it is to buy the higher THC brands, whether users really want a very strong experience, the price range for different brands, how many types are currently available in the UK, to what extent buyers and sellers are aware of THC content in a particular batch, what the cannabis consumer's perception is of imported hash and so on. Nor do we have any information on how THC levels relate to risk. Is a joint with 8% THC double the risk of one with 4% THC?

People should be aware of potential harms of cannabis. But as the Home Affairs Select Committee said in 2002, ' we do not believe there is anything to be gained from exaggerating its harmfulness'.