International Commentary

CANNABIS COULD CURE

One by one, European governments are beginning to reconsider their
positions on the recreational use of cannabis. The British government
reopened the debate this month by announcing it would reclassify simple
possession of the drug so that it will no longer be an arrestable offense.
While the recreational use of cannabis remains controversial, I believe
that the evidence for medical use is so strong that I will be investigating
in the European Parliament whether a European-wide medical license through
the EU's European Medicine Evaluation Agency is legally feasible.

In the U.K. following a recommendation in November 1998 by the House of
Lords select Committee to re-allow medical use for the first time since
1971, a number of therapeutic trials are taking place, particularly for
multiple sclerosis and pain relief. One such trial, at Hammersmith Hospital
in London, is investigating its use as a natural plant extract given
sublingually to relieve post-operative pain.

So is cannabis really dangerous? In my previous professional life, as a
practicing doctor, I used to oppose any moves to decriminalize its
recreational use (due to my own reservations against any kind of drug
abuse). But my review of the literature and extensive clinical experience
as an inner-city consultant psychiatrist has changed my views. My reasoning
is based first on the theoretical grounds that the toxicity of the drug
itself is probably smaller than that of aspirin, in terms of lethal dose or
therapeutic ratio. Second, it is based on the lack of proven addiction
potential cannabis or ability, unlike alcohol, to engender dangerous
criminal behavior.

Abnormal Personality Types

I am particularly skeptical of the findings of the often-quoted Swedish
study that allegedly provides evidence that heavy cannabis users have a
higher chance of going on to develop schizophrenia, suggesting a causative
role for serious mental illness. An equally likely explanation of this
finding (if it can be replicated) is that persons with a tendency to
schizophrenia are likely to have abnormal personality types and be
attracted to all types of drugs. Cannabis in their case may be sought to
dampen down some of the unpleasant mood-disorder symptoms of schizophrenia
that occur early on, a number of years before the full illness emerges.

In fact, in my years of medical practice I never encountered a true
cannabis psychosis in a psychiatrically normal person. Instead I
occasionally witnessed the triggering or precipitation of a breakdown in
someone with the underlying predisposition to major mental illness
(particularly schizophrenia), which is almost invariably due to genetic
factors and, less frequently, to other undetected subtle brain damage such
as birth trauma.

Sadly, if understandably, many distressed parents of mentally ill offspring
are inclined to erroneously blame their childrens' soft drug taking as the
origin and cause of the subsequent mental illness. In fact, considerable
scientific doubt exists whether cannabis, in normally consumed doses, is
actually hallucinogenic at all for mentally healthy individuals. I
certainly found alcohol to be a far more likely and frequent precipitant of
dangerous behavior amongst mentally ill patients than cannabis, while
alcohol's role as neurotoxin to the human brain (where it can eventually
lead to dementia) is, unlike cannabis, undisputed.

As a doctor, I am all too aware of the damage that drugs, and particularly
class A drugs such as cocaine and heroin, can inflict on people's lives.
Nor can one deny that cannabis has its dangers, especially when taken in
excess; as with tobacco, the tar has carcinogenic properties (although the
quantity smoked is usually far less) and no doubt the carbon monoxide in
the smoke causes heart disease too. (Interestingly, in some countries such
as the Netherlands it is deliberately consumed in foods such as cake so as
to avoid these recognized dangerous long-term toxic effects).

But the argument that cannabis is a "gateway" to harder drugs is medically
unproven. If a statistical relationship exists it may be due to nonmedical
factors such as criminal suppliers targeting cannabis-users rather than the
general population. That is why the relaxation of laws governing cannabis
possession will almost certainly have to be accompanied by much stricter
(and enforced) penalties for those dealing in hard drugs and especially for
those caught in or nearby schools.

Another major consideration is the fact that the current law in several
European countries has become a dead letter given the difficulties in
enforcing it. Paradoxically, I believe there are now more cannabis users
per capita in the U.K. than in Holland, where its use has been decriminalized.

Indulge Their Habits

The U.K. had also become increasingly out of step with other European
jurisdictions in the theoretical severity of the sanctions that could be
applied (up to five years in jail) to otherwise law abiding people who have
to rely on criminal suppliers to indulge their habit. This perversely
facilitates dealers who have an incentive to get users hooked on more
addictive and dangerous drugs. Nonetheless, as Conservative politician
Peter Lilley has rightly pointed out, the U.K. government's limited
proposals, which prevent the legal sale of cannabis, will still leave
people having to get their softer drugs from pushers who deal in hard drugs
- -- unless, of course, they are prepared to grow their own.

No one can pretend that this is an easy debate. I do not myself use
cannabis and would not recommend its recreational use to anyone else.
However, we must acknowledge that, despite its illegal status, as many as
40% of young British people have reportedly used cannabis, and that simple
prohibition may not be the best solution. Moreover, many young people
regard it as hypocritical for those who use and abuse alcohol and tobacco
to restrict them in their use of cannabis. This, in turn, has helped to
encourage a disrespect for the law and to alienate them from the political
process, which itself should be a cause for concern.

That said, those advocating liberalization should be prepared to accept
that if governments introduce reforms that only serve to worsen the
situation, then those reforms should be reversed. However, in Belgium,
where I work, and following experience in Holland, Spain, Italy and
Portugal, cannabis was quietly legalized last year with no fuss, and,
contrary to some dire predictions, there has been no epidemic of hard drug
use, visible increase in street cannabis consumption or rise in violent
drug related crime, giving at least some cause for optimism.