Lets just say NO, the grass is not always greener

Oulu city is the capital city of Northern Finland. It’s not quite Father Christmas country, but it’s close. The temperature can drop to as low as -40c in winter, but in the summer, you can imagine you are in the Mediterranean. In all the times I have visited Finland, I have only been to Oulu once, but I’m glad I did. It also has a world famous university. Last year, the Times Higher Education (THE) World University Rankings placed the university in the 251-300 band of the best universities in the world. The University of Oxford, the University of Cambridge and Stanford University respectively occupy the top three spots (the University of Salford is placed in the 601-800 band). 

Colleagues from the Centre for Life Course Health Research at the University of Oulu, published a paper last April that looked at the use of cannabis by adolescents and the risk of them developing a psychotic illness. It was an interesting paper. You can read it for free here. The Daily Mail and The Sun presented an unfortunate aspect of the paper; that smoking cannabis ‘just five times’ increased young people’s risk of psychosis. These two newspapers chose to ignore the stated limitations of the paper (the study used a self-reported questionnaire) or the important fact that the study was looking at any cannabis use in young people and ‘just five times or more’ just happened to be the only level where a significant link with psychosis risk was identified.  

The link between smoking cannabis and mental illness has long been discussed. The Royal College of Psychiatrists’ website highlights the link between smoking cannabis and mental illness, again describing the risk being higher in young people or those who have been using cannabis for a long time. Both psychosis and depression are cited as being caused by cannabis usage. An international study, published in February this year (see here) used a systematic review to look at nearly 100 factors associated with psychosis. Cannabis was identified as one of four most definitively linked to psychotic disorders. Schizophrenia (probably the most familiar of psychosis disorders) is one of the top 15 leading causes of disability worldwide. 

Despite there still being some dispute over the extent and precise nature of the link between cannabis use and mental illness, there is international consensus that the link exists. Against this background there were two stories last week that caught my eye. The first was the news that the UK Home Secretary, Sajid Javid announced that from the 1^st November this year, doctors in the UK will be able to prescribe cannabis products to their patients. In many ways this was a triumph for the patient voice: in this case, the parents of two young people who had a form of epilepsy with almost uncontrollable seizures. Cannabis-based medicinal products appeared to help control these, but in the UK, any form of cannabis was a banned substance.  

Interestingly, given the second news story to catch my eye last week, and also published in February of this year, a Canadian-based systematic review was published that looked at the effectiveness of cannabis-based medicinal products on a range of medical conditions (you can read the study here). This paper also supported the use of cannabis to help control seizures. Yes and the second story was the news that following Uruguay (the first country to legalise cannabis), Canada had followed suit. Canada has one of the highest rates of cannabis use in the world, and this true particularly among young people.  Last year the spent a staggeringly £3.5bn on cannabis. This of course has, up to now, been a largely illegal market. Its estimated that post legalisation, the cannabis market will be anything between £2.5bn to £6bn. As such it's going to become a big business. 

I read last week that already Coca-Cola are both looking at the growth of the so called ‘non-psychoactive’ cannabidiol wellness drinks and have entered into exploratory discussions with Aurora Cannabis (the main Canadian licensed producer of recreational cannabis) over the development of marijuana-infused drinks. Personally, I think the Canadian social experiment is hugely dangerous. I also think it was a political decision taken without looking at the evidence base of associated harm. And that evidence is there. It may not be conclusive, fully agreed or understood, but the evidence is there.

Cannabis remains the most widely used illegal substance in the UK. Just under 5.5 million 16-24 olds have used it in the last year. This suggests to me, that despite public health warnings about the health risks, many people, and young people in particular, see cannabis as harmless substance that can help you relax and ‘chill’. Sadly, I think the Canadian decision will just reinforce these perceptions.