Doctors reveal surge in psychosis linked to cannabis
Hospitalisations up 74% since use decriminalised
The number of Scots suffering mental illness linked to cannabis has surged since use of the drug was effectively decriminalised.
Figures reveal the number of users being hospitalised because of psychiatric issues has climbed by 74% since 2016 when police began warning those caught with the drug for their own use.
The admissions data has prompted experts to call for a reassessment of the risks posed by cannabis in comparison to Class A drugs and alcohol and urgent action to bolster support for users trying to give up.
Professor Jonathan Chick, medical director of a world-leading rehab clinic in the Borders, said the figures confirmed his experience, adding: “The eye has been taken off the ball with cannabis. We do need to worry about the numbers of young people presenting with psychosis and schizophrenia because of it.”
In January 2016, Police Scotland changed the guidance to officers, advising that simple possession of cannabis could be dealt with using a warning rather than a report to the Fiscal and possible prosecution.
Comparing the data from 2015/ 16 to the latest figures reveals the number of prosecutions has more than halved from 1,809 to 877 in 2019/ 20. However, drug- related hospital stays due to mental or behavioural problems linked to cannabis use rose by 74% from 1,191 to 2,067 last year. And in 2020/ 21, a record 1,263 new patients sought hospital treatment for a range of psychiatric disorders blamed on the drug, including schizophrenia.
A recent report by Public Health Scotland states: “There has been a notable increase in the percentage of [ psychiatric hospital] stays attributed to cannabinoids in recent years, increasing from 9% in 2014/ 15 to 18% in 2019/20.”
Chick said the increasing potency of cannabis had led to an increase in people needing help at his Castle Craig clinic around five years ago but, he said, “first step” support services are already overwhelmed while his clinic rarely gets NHS referrals for cannabis.
He said: “We’re dealing with both dependence and psychosis. Often, where there has been a second or third psychotic breakdown, there has been hospital or police involvement because of incidents of self- harm or harm to others. These patients have terrifying thoughts. It is a paranoid
“It is a paranoid psychosis where they can’t even go into the street without misinterpreting thoroughly innocuous cues as malevolent. It is a horrible experience.
“In some cases, people have used cannabis for 20 years and got by up till that point, but, typically, psychosis will occur within the first three to four years. Sometimes the damage is permanent in which case the treatment for schizophrenia involves living and working in safer environments and medication – though there is no medication that doesn’t come without effects such as weight increase, mental slowing and involuntary movements.”
Researchers in the US have bolstered the link between cannabis and mental illness. Recent analysis by Mclean Hospital, Massachusetts, found that admissions due to cannabis- associated psychosis are up to 2.5 times higher in parts of the country where the drug has been legalised. Meanwhile, Harvard Medical School studied 246 new psychosis patients aged 16- 35 and discovered that a total of 78% had used cannabis. In all, 47% were currently or had been dependent on the drug – compared with 5% in the general young population.
The onset of the damage caused by cannabis was often swift. The typical age of first use was 15 with symptoms appearing between 17 and 19 and psychosis setting in between 19 and 21.
Chick added: “We receive regular small numbers of referrals from the NHS and social services for all addictions: alcohol, opioids, prescription drugs, but very rarely cannabis. We have fewer cannabis patients coming to us from the UK than we do from other countries,
par ticularly the Netherlands, because the Dutch are more generous at funding treatment for dependence.
“Here, cannabis is considered more of a gateway drug. It is not contributing to the overdose deaths and doesn’t cause the acute physical damage of alcohol. So with limited budgets, residential treatment is prioritised for those whose conditions would otherwise cost more to treat. A middle- aged man with liver disease is seen as the priority over a teenager with two years of cannabis use. But that teenager may go on to need years of hospital treatment for psychosis.
“Health economics is a fine art – and it becomes finer still when there are fewer resources. All this conspires to hide the pernicious effect of cannabis use. We need a tiered approach to try to deal with the problem at an early stage with the least expense and disruption. But‘ step one’ services like counselling and advice are pretty much overwhelmed already.”
Since Scots police began warning users instead of charging them, the amount of cannabis seized has risen 60% from 984 kg to 1,570 kg and the number of plants 6% from 31,398 to 33,295. Last week – in a case reflecting both the scale of cannabis cultivation in Scotland and also the difficulties in convicting those behind the industrial- scale farms – two men arrested after police raided one of the country’s biggest ever drugs factories walked free from court after it emerged they were victims of human trafficking.
Police had discovered “a very large and sophisticated” cannabis farm divided into 13 growing rooms and producing up to £ 9.5 million worth of the drug in a converted industrial building in Possilpark, Glasgow in November 2020.
Annemarie Ward, chief executive of the charity Faces & Voices of Recovery, said: “We’re still in the grip of this really worrying narrative that cannabis is about peace, love and opening your mind with no harm done. In fact, the current type is addictive and psychoactive with horrendous consequences.
“The cannabis myth has to be challenged but the preventive messages to children and young people are not loud or clear. And you cannot get people into services if they don’t exist. Between the police giving someone a warning for possession and that person further down the line turning up at hospital for treatment for psychosis, there is a massive vacuum.
“Ever y warning handed out should come with a referral to a local drugs centre where that person is assessed and given help where it’s needed – before it ever gets to the stage where they have to be admitted to hospital.”
The body produces natural cannabinoids, which are fatty acids that send messages within the brain, known as neurotransmitters. They spark chemical chain reactions that help produce feelings of reward linked to food and exercise, affect memory and co-ordination and may also influence sleepiness and pain.
Cannabis also contains dozens of cannabinoids which have the potential to trigger the same types of cascades in the brain. One of them, known as THC, is the substance that produces the drug’s wellknown psychoactive effects and gets people high. CBD is another – though this is far more benign, the one that is the focus of medicinal cannabis. However, research shows that THC damages the crucial links between brain cells.
These bridges in the brain’s neural network are burnt temporarily,
potentially causing the classic hallmarks of psychotic episodes: hallucinations, delusions and voices in one’s head. But, over time, the damage can become permanent and the spells of detachment from the real world longer- lasting and more frequent.
Last year, German research also found a link with lung cancer, separate to the risk posed by tobacco smoke. Munich’s Ludwig-Maximilian University looked at those with a genetic liability to
lifetime cannabis use and found that their risk of developing squamous cell carcinoma is 22% higher.
FAV O R and the Scottish Conservatives are backing a new Right to Recovery Bill at Holyrood
which would give those with drugs problems a right to treatment.
Scotland has the worst drugs death rate in Europe, with a record 1,339 people dying in 2020. Last year, Malta became the first European country to make it legal to grow and possess cannabis for personal use.
So far, the UK Government – which retains the powers on prohibition – has resisted calls to follow suit but medicinal cannabis was, in effect, legalised here in 2018 where a specialist doctor prescribes it.
The Scottish Government said: “We have launched a national mission with an additional £ 50 million per year for services to help save and improved lives impacted by drugs of all types.
“The aim of the national mission is to get more people into treatment or recovery where they will receive the right treatment at the right time.
“We have been clear in our commitment to tackling the specific harms caused by the use of synthetic cannabinoids.”
It added :“A public health approach to substance use and harm prevention seeks to reduce harms and addresses the broader context of health outcomes and inequalities.”
Police Scotland Chief Inspector Anton Stephenson said: “Recorded police warnings in cases involving a single charge of possession of a controlled drug gives officers another tool to support those at risk of becoming vulnerable in our communities. Issuing such a warning is not the only option available to officers dealing with people in these circumstances and officers can use their discretion to determine the best course of action.”
He added: “Our advice is simple: there is no safe way to take drugs, there is always a risk, and the only way of staying safe is to avoid drugs altogether.”