Seventeen other countries including Holland, Belgium and Germany have made cannabis a medicine. Israel has opened the world’s first university course in medical marijuana.
Yet in the UK all the government can say to the requests of the patient community is their infantile mantra: drugs are harmful – cannabis is a drug, and so it is harmful, so we will keep it illegal.
This simplistic approach is flawed in many ways. Morphine is illegal when used recreationally – yet is allowed for therapeutic purposes – so why not cannabis, a herb with a long tradition in medicine? Prohibition denies patients access and, worse, means they can be actively persecuted for its use. It is estimated that at least 30,000 people a day in the UK break the cannabis laws by using it for medicinal purposes, and if they are caught then they must be prosecuted, as there is no longer a defence of medical necessity.
Why are we so out of step with the rest of the Western world? The answer is complicated and multifactorial, a mixture of politics, commercial pressures from the alcohol and pharmaceutical industries, media exploitation and scientific misunderstandings.
Let’s look at why cannabis is illegal in the first place. In Victorian times cannabis was a massive source of revenue to the UK. The country enforced a monopoly of production and sales of cannabis in India that (along with the forced sales of opium to China) financed the growth of the Empire. Tinctures of cannabis, like tinctures of opium and cocaine, were accessible and popular self-medications, sold freely in local shops and pharmacies, and used by all strata of society including Queen Victoria. But the rise of the puritan temperance movement in the 1880s began to target these drugs: they were seen to be used rather too much to deaden the psychological pain of miserable living conditions, instead of alleviating “real” pain. This powerful anti-drug voice found support from the newly developed and rapidly growing pharmaceutical industry, which had identified and patented the active ingredients of many of these plant tinctures as “pure” medicines. They wanted to eliminate competition from the tinctures. Together with pressure from the alcohol industry to eliminate competition in the intoxicant market, these forces led to the recreational use of cannabis becoming prohibited in the UK under the Dangerous Drugs Act (1928).
However, cannabis continued as a medicine in the UK, in direct conflict with the international policy driven by the 1934 League of Nations claim that it had no medicinal value. The international anti-cannabis stance was consolidated in 1961 under the UN Convention on Narcotic Drugs, where cannabis was put in Schedule 1 along with heroin. Schedule 1 drugs were defined as those with no medicinal value and possessing of great harms. But the UK stood against this policy, and continued to allow both drugs to be prescribed. A decade of political pressure from the USA, which demanded complete prohibition internationally, ensued, and in 1971 the UK government caved in and eliminated cannabis (though not heroin) as a medicine under the Misuse of Drugs Act.
Since then, the USA (via its War on Drugs) has attacked cannabis as relentlessly as any other recreational substance. The UK has positioned itself as an ally with the US on drugs policy, and so has refused to countenance alternative approaches. Even today, although the majority of states have voted for medical marijuana, cannabis remains illegal under Federal law, providing the UK with an excuse to maintain the status quo.
Why are we so intransigent? First there is the fact that cannabis is a useful political tool. The last Labour government saw this and began to persecute users of cannabis, making them a target for policing.
Another factor is the Daily Mail. The paper has had a major influence on the public debate about cannabis by violently opposing any change in policy. Typically it does this by using case examples of teenagers supposedly damaged by cannabis, in order to frighten their readership whenever a public figure tries to engage in a rational debate about relative harm. Recently, they attacked the new Liberal Democrat policy on a regulated cannabis market by claiming that Nick Clegg was ignorant of the risks that cannabis can pose to mental health, by increasing the risk of schizophrenia. This fear of cannabis-induced psychosis is a particularly British one, largely because it has received significant support from UK academics. However, the evidential base is weak, and as more data are collected, it appears that only skunk, not herbal cannabis, poses a risk. Embarrassingly for government cannabis policy, the reason skunk is so prevalent is that our prohibitionist stance has led to the near-complete block of herbal cannabis imports from overseas.
Another factor is that, because cannabis remains in Schedule 1, research is very difficult, as it requires a special license from the Home Office. These take a year to obtain and cost at least £5,000. Only a handful of hospitals have one, the consequence of which is that clinical research on the benefits of medical marijuana is almost impossible in the UK. Without new research there is little pressure on the government from the medical profession to change the situation, so the mantra “there is little evidence of efficacy” goes unchallenged. The only exception comes from the group of parents who see their children suffering terribly from various forms of untreatable epilepsy, and then break the law to medicate them with marijuana, often with remarkable success.
The Coalition and now the Tory government have continued to pursue this alarmist agenda about the risks of cannabis. They have focused on the risk of driving under cannabis even though their own report found them to be only about one fifth those of alcohol, and new data from America suggests that the use of recreational cannabis leads to a reduction in road deaths, as people switch from the more dangerous alcohol. The government continues to be frightened that any suggestion they might change the law on cannabis will turn the Daily Mail against them. Since Paul Dacre is the only Editor who has been entertained at Number 10 under Theresa May’s premiership, I fear we can’t expect any more rational policies until she goes.
David Nutt is the Edmond J Safra Chair in Neuropsychopharmacology at Imperial College London
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