Bollywood druggies!” thundered the alpha male news anchor, condemning them for their sins of alleged drug use. Apparently, their chat messages pointed out that they were ‘druggies’ and for a few days, it was national ‘breaking news’ in almost all news channels. The whole spectacle of ‘discovering’ that some Bollywood A-listers could be using drugs led us to hyperventilate with self-righteous condemnation.
Like me, many mental health workers, shuddered in silence at the vilification and what it meant for people who are afflicted with drug addiction. On a wider perspective, what was glaring was that it was a missed opportunity to have a more tempered discussion about illicit drug use. The entire national media focused on celebrities allegedly using illicit drugs but, for a moment, imagine the significant boost in public education if part of the coverage could have focused on the science and facts of illicit drug use, including cannabis use, in our country.
Illicit drug use is a complex medical, social, legal and political issue. I have deliberately refrained from using the word ‘moral’ here for reasons which I may be able to address in a future column. There are many opinions on how to address this complex problem of illicit drug use and addiction (they are not the same) and as a clinician dealing with young people, I have to live with these complexities virtually every day.
Confusion about the drug
Let me introduce you to Varun; conversations with him and his mother highlight the dilemmas we face as psychiatrists. He is a 21-year-old who was pursuing his Masters in Canada. He had to come home during the pandemic and his mother realised that he is ‘addicted’ to cannabis. Varun did what most other young people of his age do. He denied he was addicted but admitted to heavy use. He did not fail to mention that Canada has legalised use of cannabis in adults and, therefore, we were needlessly agitated because we were ‘backward’ in our thinking. We have not kept pace with social changes, was Varun’s allegation. He was referring to legalisation of cannabis in some US states, and in Canada. He also gave examples of numerous people, including many of his friends, who are using or have used cannabis, without any apparent ill-effects.
The points Varun highlighted in his favour were correct BUT they were not the whole truth. The issue of legalisation of cannabis is a vexed issue. The New Zealand Medical Association’s recent backtracking on their advice on use of cannabis highlights the differences in opinion on this matter and also the confusion.
In October 2020, along with the general elections, New Zealand held a referendum on the question of whether to legalise the sale, use, possession and production of cannabis. Those opposing the legalisation won narrowly. However, in the final week before the referendum, the New Zealand Medical Association, which had initially opposed legalisation, changed its stance. They said they have ‘no position’ on the referendum!
Let us get some basic facts about the drug straight. People often use the words ‘cannabis’ and ‘marijuana’ interchangeably, but they do not exactly mean the same thing. The word ‘cannabis’ refers to all products derived from the plant Cannabis sativa. The cannabis plant contains about 540 chemical substances. Of all these chemical substances, tetrahydrocannabinol (THC) and another product called cannabidiol are of most interest. The THC component is the intoxicant. Different products, derived from cannabis plant which is used as intoxicants rely on THC to induce the mood-altering effect. Cannabidiol does not have mood-altering effects. There is renewed interest in cannabidiol because of its medicinal properties. Hemp, or industrial hemp, is a variety of the Cannabis sativa plant species that is grown specifically for industrial use. Hemp contains very little THC (the intoxicant) and cultivation of hemp is legal in some states of India.
Confusion about the drug is also compounded by the multitude of names by which cannabis and related products are referred to. Cannabis, marijuana, dope, weed, pot, hash, charas, bhang, grass, ganja, skunk — are popular street names. Apart from the fact that some parts of the world are legalising its use in adults, recent advances in medical science on using chemicals derived from cannabis plants to produce medicines have also brought this plant into sharper focus. Medical marijuana and CBD oil are products derived from the cannabis plant. Medical marijuana is basically marijuana without the high. One of the components of the cannabis plant, cannabidiol, is used to treat some medical conditions. CBD oil is just another version of cannabidiol.
Once we try to wrap our heads around the range of products that can be obtained from the cannabis plant, we have to grapple with the nuances of cannabis legalisation and cannabis decriminalisation.
An editorial in a national daily in August 2020 called for legalisation of cannabis use in adults. The benefits of such a move are many but what about the public messaging of legalisation for young people? Would legalisation increase rate of cannabis use?
Would it increase addiction? Would the cannabis-related mental illnesses increase? What would be the impact on brain and physical health of the users if we sanction use of cannabis for the long term? These are very vitally important questions.
It is bad for mental health
Canada, where Varun was pursuing his Masters, was the second country, after Uruguay, to legalise the sale of cannabis to adults. The example of Portugal crops up in many discussions and articles. Portugal has not legalised illicit drugs, they decriminalised it in 2001. There are distinct differences in legalisation versus decriminalisation of illicit drugs.
Decriminalisation is the removal of criminal penalties for drug law violations, usually possession for personal use. Research shows that countries that have adopted less punitive policies toward drug possession have not experienced any significant increases in drug use, drug-related harm, or crimes compared to more punitive countries.
The potential long-term effects of legalisation is a different kettle of fish though. The data about consequences of legalisation of cannabis has not yet reached the critical threshold, which can inform science and public policy. This is an important point to ponder before we jump into legalising cannabis in India just because other countries have started doing it.
The concerns are that in the longer term, legalisation will increase use. In the US, after legalisation in some states, the prices of cannabis have fallen, the potency of the intoxicant (THC component) in cannabis has risen and there is a wider variety of legal cannabis products now available to lure a wider user group.
Historical experiences with the regulation of alcohol and tobacco suggest that in the short term, increasing access to more potent cannabis products at a lower price is likely to increase the frequency of cannabis use among current users. In the longer term, a profit-seeking legal cannabis industry is likely to attempt to increase the number of cannabis users in order to maximise its profits. When a larger proportion of the population uses cannabis more frequently, the larger will be any adverse public health impact of cannabis legalisation. What would be the effect on road traffic accidents if cannabis is legalised? We simply do not know.
What mental health experts know as a certainty is the adverse impact of heavy and regular cannabis use on mental health. It is bad for mental health.
Daily cannabis users have impaired cognitive performance that appears to be reversed by abstinence. Cognition, in very simple terms, is defined as “the mental action or process of acquiring knowledge”. Therefore, if students like Varun regularly use cannabis, will their educational attainments not suffer in comparison to their peers who are not using it? Cannabis-related cognitive impairment may also occur in older adults who regularly use cannabis for recreational purposes. The other undisputed fact is that heavy cannabis use is associated with an increased risk of serious mental illness, akin to schizophrenia. So what would be the impact of legalising cannabis on those who are biologically hard-wired towards addictions?
My contention is that extreme caution is warranted and a genuinely informed public debate is needed before any serious consideration is given for legalisation of cannabis in India. It is in this context I really regret the missed opportunity of igniting a public discourse on this topic. Instead of spending all their energy on vilifying a woman who allegedly supplied drugs to a deceased actor, couldn’t the national media have presented scientific facts and promoted public education on drug use? It was a shameful and colossal waste of their reach.
With my experience of working with young people, I can say that some of them will experiment with drugs. Some of them will go on to cause harm to themselves and others due to their drug use, but most of them will not. What all of us need is better information on drugs. There is significant lack of knowledge amongst parents, teachers and young people. Knowledge needs to be disseminated amongst young people, not half-baked, moralistic opinions, so that they can make more informed choices. It is time we grasp the nettle, otherwise, “legalisation” of drugs in other countries will be cited as justifications. The reality is we need not look far. For reasons, which again highlight the selective blindness in our national consciousness, we have learnt nothing from Sikkim, where a progressive drug law already exists.
Dr Jai Ranjan Ram is a senior consultant psychiatrist and co-founder of Mental Health Foundation (www.mhfkolkata.com). Find him on Facebook @Jai R Ram