On 5 March, the UN-backed International Narcotics Control Board released their annual report. The UN has finally published their long-awaited opinion on medical cannabis legalisation and programmes. They warn that poor implementation and quick expansion of programmes poses a risk to public health, particularly for recreational use. As we know at Castle Craig, long-term use of cannabis can come with many negative physical and mental effects, including addiction.
This comes after numerous countries have legalised cannabis, both for recreational and medical use – including the UK on 1 November 2018. Just over a year after the bill was first introduced in parliament, this widely-consumed compound may now be prescribed by medical practitioners. The move will affect the delivery of healthcare, and wider society, as the awareness of the medical properties of cannabis become more well known. So how will medical cannabis legalisation impact the addiction sector and the wider medical community? Will the risks of addiction to cannabis be recognised and how will they be reduced?
Why Was Medical Cannabis Legalised?
There are currently about 1 million medical cannabis users in the UK. In recent years, there has been an evolving public attitude to cannabis, and scientific research on its benefits in medicine. The decision to legalise medical cannabis comes in the wake of this. Research has shown medical cannabis to be low-risk in the treatment of Alzheimers, cancer, chronic pain, multiple sclerosis, and Crohn’s disease. In particular, support for its use was strengthened when stories emerged about its effective treatment of epileptic children. Their seizures, resistant to more conventional treatments, were controlled or reduced with cannabis-derived medicine.
What Makes the Cannabis Plant Unique?
Cannabis has been used for thousands of years to treat a wide range of ailments—both physical and psychological. The cannabis plant itself contains at least 60 different cannabinoids, which, as isolated compounds, have varying effects. THC is usually found in highest concentration, and is responsible for the psychoactive effects. CBD is also found in all strains and has been shown to possess strong anti-inflammatory, anxiolytic, and anti-epileptic properties (among others).
Medical cannabis must be understood in the light of the botanical complexity of the cannabis plant. Some components of the plant can be harnessed to mitigate the harmful effects of other components. For example, there is evidence that CBD offsets the psychosis-generating properties of THC. Medical cannabis will have wildly different concentrations of these compounds from those used in recreational use. To compare them can be misleading.
Will Medical Cannabis Help?
So far, evidence suggests that cannabis can potentially be effective to treat disorders from anxiety, chronic pain, and epilepsy, to nicotine addiction, among others. As medical expert Professor Jonathan Chick explains “some of the conditions, such as some severe forms of childhood epilepsy, are so disabling that the benefit to risk ratio is strong enough for doctors and families to take the risk that there may be some unknown hazards from using the product.”
This change in legislation is the start of a journey to determine how to effectively regulate medical cannabis. There are many questions that need to be considered. For instance, how do we create the most effective medicine? Who can safely prescribe these medicines?
Patients and healthcare providers will now have to grapple with the potentially thorny implications of prescribing medical cannabis. In addition to the social issues that arise, healthcare providers may be wary of prescribing cannabis for another reason. And that is the current lack of quality research into cannabis.
Cannabis in the UK is currently labelled as a ‘Class B’ substance. This has made it challenging for scientists to acquire the drug for research purposes. Doctors may be understandably cautious in prescribing the drug, when they aren’t certain of its risks and benefits. And unlike most prescription drugs, cannabis-based medicines are not a standardised compound. It will take time to learn how much, and what, should be prescribed for different health problems.
In Professor Chick’s view, “Few of the preparations have been subjected to safety testing in large numbers of patients. This is necessary to provide a Licence that allows the doctor some legal protection if safety concerns emerge. There is a risk of unwanted effects when prescribing any drug i.e. new symptoms developing due to the cannabis. When medical cannabis is used for less disabling conditions, this risk might begin to outweigh the likelihood of benefits to the original symptoms. Thus, doctors will be more cautious.”
There is a lot of research that still needs to be done to determine the optimal conditions for medicinal cannabis use. Crucial questions to answer are who might benefit, and what exactly their cannabis-based medicine should contain. The UN have warned that lax implementation in North America may have already contributed to a rise in non-medical cannabis use among young people. Without proper regulation, research, and prescribing practices, the same may become true of the UK. In fact, due to the above concerns, doctors are wary of prescribing cannabis even months after it has been legalised.
The Risk of Cannabis Addiction
There is no evidence to suggest that people can become physically addicted to cannabis. However, psychological cannabis addiction can and does occur. With cannabis legally available now, prescription should be made with vigilance. Doctors should make decisions on an individual basis, with regard to personal and family medical history.
As Professor Chick explains in detail, “Starting to use cannabis as a medicine can lead to addiction. Some regular users will find it extremely difficult to reduce or stop their cannabis consumption despite being aware of increasing problems. This is partly due to withdrawal symptoms such as anxiety and sleep disturbance when they try to cut down the cannabis intake. In addition, emotional difficulties may have been masked, or created, which they are used to ‘treating’ with cannabis. They simply don’t wish to stop.”
In their report, the UN has declared that dependence is a ‘probable‘ outcome of daily medical cannabis use. The risk for dependence is as high as 1 in 3 for daily users, and dependence comes with a range of negative side effects. This includes possible physical effects such as chronic bronchitis, as well as mental – like poor memory, cognitive impairment, and risk of psychosis in young adults.
Medical Cannabis and Addiction Treatment
Another question that arises is whether there is a place for cannabis in the addiction treatment sector. Cross addiction – where a person becomes addicted to a different drug or more than one substance – is very common. This makes it difficult to treat drug abuse with drugs. Preliminary results point towards the promise of CBD to prevent opioid relapse. However, at Castle Craig, we recommend that abstinence from all mood-altering substances is essential to long-term recovery.
A Last Word
The UN has cautioned against an increasing permissive attitude to medical cannabis by governments worldwide. Particularly among young people, who are more vulnerable to the negative effects of cannabis, this may encourage increased usage and dependence. They also question how this will affect the international drug control system. Legalisation of cannabis for non-medical use contravenes international drug control treaties. Currently, only Canada, Uruguay and states in the US have legalised cannabis for non-medical use. What this means for the future is undecided now.
What we do know is that we should tread carefully. The UK legalisation will, without a doubt, open new avenues for medical cannabis in healthcare. Alongside other countries who have legalised medical cannabis, this will influence other governments deliberating on managing patient access. The decision affirms the change in public perception, supported by scientific research, that cannabis could prove to be a powerful medicine if used in the right circumstances.
However, in the context of addiction, healthcare providers should seek to avoid causing further potential harm to patients. Doctors should always be aware of what and to who, they are prescribing. In addiction treatment, cross-addiction is a very real possibility that should be reduced. Castle Craig Hospital has proved helpful in treating cannabis users in a safe total abstinence-based environment, which can support them in their journey to long-term recovery from all substances.