I had a lot of comments to my ‘risks of cannabis’ article. I will provide my responses here.
People who raised the alcohol vs. cannabis argument
There are a lot of studies showing how moderate alcohol use can prevent terminal illness like cancer. Only misuse of alcohol has externalities for the NHS, whereas when I visited East Glamorgan Hospital’s Mental Health ward in Llantwit Fardre when I was the councillor for Llantwit Fardre I saw the extent to which cannabis use cost the NHS.
If you look at the above diagram you can see that a higher dose of alcohol is required to be damaging than marijuana, or street cannabis as I call it. So on this basis I would say that to consider cannabis to be safe it would have be in the form of a cannabinoid which falls somewhere around the Caffeine mark. Caffeine is considered safe by the International Olympic Committee to be suitable for athletes, so I think this should be the benchmark. As can be seen from the diagram, street cannabis has a lower dependence rate than alcohol, but is more lethal compared alcohol, where one would need to consume more to have the same effect. So unless there is a cannabinoid with a higher active dose threshold, then it would, as I said, be preposterous to legalise it for off-prescription use.
People who raised the ‘safety’ of street cannabis
Consider the Prisoner Dilemma. A black market drug dealer has in their possession ‘safe’ cannabis of a street value of £1000. They also have an imitation of the same quantity with a street value of £10 which contains toxic substances. Which do you think they would be most likely to sell? If it was proved to be safe, without the regulation of cannabis to the extent of alcohol then people can be sold a pup, and they won’t know whether it will make them barking or not.
People who raised the ‘health benefits’ of cannabis argument
I accept that studies have shown cannabis derived medicines have greater efficacy over placebo in treating pain and anxiety. However, as someone who has taken medication for both pain and anxiety after a car accident, I know that even the most ‘proven’ medicines have side effects. I want to see clinical trials comparing the efficacy of cannabis derived medications with current treatments. If the cannabis medications are proven to have greater efficacy than placebo then they should be recommended by NICE and then only issued if approved by the person’s GP. If my GP thought it would be better at curing my anxiety than my current mediation without any serious side-effects then maybe I’d be willing to take it as a medicine. However, I am not even willing to take diazepam at present because long term use can mean its efficacy can be reduced and it can actually make the situation worse not better – I would like more longitudinal studies in the efficacy of controlled cannabinoids.
Compromise
I would be willing to budge on wish to ban substances like cannabis and nicotine and have minimum tax on them if those wishing to use them off-prescription for recreational use had to do the following:
1. Take out private/people health insurance to cover any treatment needed, which their employer can claim from to fund replacement staff while they are being treated, and the NHS can to recover costs of lifestyle choices.
2. Be restricted in their vocations if a risk assessment shows up potential problems, such as that they could injure others through not operating machinery correctly for example.
If all this happened I would be happy for a ‘safe’ cannabinoid to be sold to an even greater extent than in the Netherlands where it is still illegal but not prosecutable for personal use. I think it should also happen for people who abuse alcohol. It could be part of one’s household insurance policy, so someone who calls in sick to work with a hang-over for instance would either have to not be paid for the day or claim off their household policy. Any long term absences costing the government or business money would have to be paid by the user’s insurance
If this was not accepted, or if it was accepted and someone was not able to provide a receipt on request of where they bought the cannabinoid from, or they were drunk/stoned and disorderly, then the following would apply.
1. If found with street cannabis or drunk/stoned and disorderly, they should be given the option of taking a fixed penalty notice of £75 or going on a drug rehabilitation programme.
2. If they chose three fixed penalties they would get an ASBO. On the fourth time if they refused to go a drug rehabilitation programme they could go to a correction unit for two years.
Those dealing in street cannabis outside of the safety net would, if I had my way, face prosecution under international criminal law after an investigation by Europol.
That is really helpful!
Okay, I’ve had another look at the chart, and I retract what I said about the authors not knowing the difference between an active and a lethal dose, and about it not being in units (though I stand by what I said about wanting a source for it and access to the numbers it’s based on). I realise now that it shows the _ratio_ between an active and a lethal dose, and the numbers at the bottom represent an active dose, as against 1 being a lethal dose. So alcohol at 0.1:1 means that however much alcohol you would need to take to feel its effects, you would need to take ten times as much to kill yourself; nicotine at 0.02:1 means a lethal dose is 50 times an active dose, with caffeine you’d need to take 100 active doses to kill yourself, and with cannabis you’d need to take 1000 times an active dose. Like I say, no one has yet produced any medically documented evidence of a death from direct cannabis toxicity, so I assume this is an estimate based on animal studies (in any case, I take it we can both agree that it’s very unlikely that anyone has ever attempted to actually ingest 1000 times a normal active dose of cannabis).
The point is that the graph, properly understood, actually says that cannabis has a far lower ‘lethality’ than caffeine, let alone alcohol or heroin – it makes the opposite point from what you claimed. I’m not having a go at you for that, because I didn’t understand the graph at first either, but I would ask you to reconsider your statements about cannabis in the light of the fact that your main source actually says the opposite of what you thought it said.
I am sceptical about the chart. Who produced it; where can I see the data it is based on. What units is it even in? And why on earth are you taking seriously a chart produced by someone who cannot tell the difference between an active dose and a lethal dose?
If you are claiming that cannabis is more lethal than alcohol, here is a simple statistic you ought to be able to produce: what is the LD50 of cannabis in humans? What is the LD50 of alcohol in humans? Unless you can produce a figure for that, then you simply have no right to talk about the lethality of a drug which, as I and other commenters have pointed out, has never been known to cause death by overdose.
In response to Ben, I put it to you that you had a bad experience in which you _thought_ you nearly died, but had just suffered an unpleasant temporary effect as a result of taking more cannabis than you could handle. Again, you need to produce medically documented evidence of people who have _actually_ died as a direct result of cannabis toxicity.
And, Jonathan, you are still ducking the question of whether or not you think it ought to be illegal to take alcohol in the way it is currently illegal to take cannabis. I’d be very surprised if you dont _have_ an opinion on that, and it would be interesting to know. You also have not either retracted or defended your implied causal link between cannabis use and paedophilia. If there was genuine reason to believe that cannabis use made people more likely to commit sexual offences against children (as opposed to people who commit sexual offences against children being more likely to use cannabis) then I would happily add my voice to the ranks of the prohibitionists, but to conflate the two propositions is duplicitous in the extreme. Where do you stand?
(I don’t seem to be able to access the article, but from the abstract it sounds very much like it has found that paedophiles are more likely to use cannabis, an entirely useless statistic when asking how many cannabis users are likely to become paedophiles).
Look at that chart you added again. It is talking about probability of dependence, which alcohol clearly loses at, and also ACTIVE/lethal dose.
The lethal dose of cannabis, LD50 if you will, is much higher than alcohol, that chart doesn’t make a distinction between active and lethal doses.
These are very different things, the active dose simply means the dose which is above threshold, i.e you will experience effects.
The active dose has no bearing on the safety of a drug.
Check out this, much more accurate chart.
Look, the fact that alcohol is more harmful than cannabis is pretty much an established fact in the scientific community.
” Take out private/people health insurance to cover any treatment needed”
I think that’s a grate idea, just a few things I would add into it, any one who smokes, drives, rides a motorbike or anyone that does anything that could cause them self’s some sort of harm. Wait though, that means we would have a medical system like america where there is no NHS, just to state again, I’m not totally against this idea I just think it needs to be level across the bored
“I think it should also happen for people who abuse alcohol.”
How would you define abuse of alcohol?
the safe limit for men is 21 units a week witch would be 7 pints a week and 14 units for women the equivalent to just under 5 pints a week, are these the figures that you would set abuse of alcohol by? If so then everyone would not be entitled to NHS treatment given what you’ve said as surly everyone has at one point or another had “one to many”. Or would this abuse of alcohol have to happen within a certain time frame?
Not to mention that it would be difficult and cost an awful lot to test people when they go in for nhs treatment to see how many units they’ve consumed, what drugs they’ve taken, and if were doing this policy to save money for the NHS by saying those that do anything with a health risk need to pay for there own treatment it also means that your gonna have to monitor peoples diets, I dont see why the guy whos not entitled to treatment on NHS should have to pay for private treatment if the guy who eats takeways 7 days a week has a hart attack and then gets free treatment from the NHS.
So the only way that idea would ever really work would be to scrap the NHS altogether.
Please let me know if iv missed an obvious point
@Thomas Cantwell – I have people health insurance from Bupa. The cost of it is equivalent to 70 packets of cigarettes or 200 cans of Brains Bitter. I also spend a lot of my earnings every year on education and am saving to train to be a barrister. I go to the pub a lot to socialise, but only ever drink soft-drinks. I was speaking to the land-lady the other day about the Equality Act 2010. We both thought the statutory limits on alcohol were discriminatory. For instance Cindy Crawford, a woman, can probably handle more alcohol than Verne Troyer! I currently have a patent pending on a system that can tell when someone is intoxicated, which could be used in pubs.
With regards to ‘monitoring’ people. The State may need to do that, but the private sector doesn’t work like that. You have to disclose any pre-existing conditions and your lifestyle. My interpretation of the Equality Act is that the cost of health insurance cannot be more expensive for some on the basis of age or disability. However it can be based on lifestyle, such as alcohol consumption, smoking, etc. So, like with all insurance, if people don’t disclose things then the insurance will not be valid. There is no need for government to get involved.
My view on the NHS, as you can see elsewhere on the blog is that it should be ‘public health insurance’ that you can spend at any hospital your GP allows, including private GPs. I’d like to be able to go to Belgium and take my NHS public health insurance with me like I can my Bupa people health insurance.
I’ll have to have a think about whether National Insurance, which I want to exclusively fund social assistance, such as the NHS and welfare, should be varied based on lifestyle. I don’t know how it could be effectively implemented though, as government schemes are more difficult to run efficiently that private or people ones.
I have added to the alcohol section above, and the original article now has links to my peer-reviewed sources. You may need to be an academic or student to access it. And for everyone’s information I have an addictive personality, hence why I don’t drink alcohol very often! My addictive pursuit of choice is drinking drinks containing caffeine, now I am no longer with my ex-Filipino lover! I think we all need a bit of self-medicating, even if it is just a placebo, as I state here
I nearly died from cannabis use. I became partially paralysed loosing the ability to sit up straight and ash my fag then thankfully it regressed. I hope your views about cannabis have changed after learning about my story.
Jonathan, thank you for taking the time to respond.
David appears to have addressed everything I would have liked to ask.
I would just like to re-iterate that you have dodged the alcohol question completely. It is an insult that you have ignored the 4,000 deaths in the UK each year directly attributed to alcohol and I would like some reasoning for considering cannabis the more dangerous of the two. If your only point in favor of alcohol over cannabis is that “There are a lot of studies showing how moderate alcohol use can prevent terminal illness like cancer”, then
understand the level of casual and domestic violence and social disorder attributed to alcohol use and abuse
1) show us the studies
2) accept or refute that cannabis is far more useful medicinally than alcohol
3) accept or refute that cannabis has also been discovered to halt and reduce the rate of tumor growth and reduce the chance of developing lung cancer (obviously when used without tobacco, but a cigarette smoker is still sufficiently more likely to get lung cancer that someone who smokes cannabis and tobacco)
4) accept or refute that alcohol is a known contributer to cancers, including bowel cancer
5) accept or refute that no studies have been able to link cannabis to causing lung cancer
6) accept or refute that no one has ever died directly as a result of cannabis use
7) accept or refute that it is physically impossible to ingest a toxic level of cannabis.
9) could you also point out what “stoned and disorderly” could possibly be!?
If your point is that the 4,000 deaths are justified because of the reduced chance of developing cancer but cannabis use is not justified because although it has a great medicinal use, it’s possible that a few people may develop a psychotic illness a little earlier, then I will stop the discussion, as that is simply a ridiculous claim.
I’m going to assume that you take alcohol and do not take cannabis. I put it to you that, for whatever reason, you disagree with cannabis use due to some form of moral prejudice, whereby you disapprove of others using. I further put it for you that your view on alcohol is such, because you enjoy using alcohol and personally do not wish for it to be made illegal. If these statements are true, then your position is one of discrimination and has drastically clouded your ability to judge scientifically and objectively.
One of the strongest arguments for ending prohibition of cannabis and indeed all drugs, is the issue of “street drugs†being cut with all kinds of other dangerous chemicals. Your point is completely correct, but is a crying advertisement for legalisation and regulation.
Most of these ‘responses’ fail entirely to actually respond to the comments that I and other readers made. So let’s pick them apart:
1: People who raised the alcohol vs. cannabis argument
I’m not even sure what you’re trying to say here. Are you trying to suggest that you can extrapolate from people whose cannabis use is implicated in them being hospitalised to say that all cannabis use is equivalently dangerous, while simultaneously trying to claim that the same doesn’t apply to alcohol? I would contend that if your knowledge about the effects of cannabis is gleaned entirely from a mental health ward, then your sample is extraordinarily biased, and ask why you failed to consider the astronomically greater percentage of cannabis users who don’t develop mental health problems. It would be like basing your assessment of the risks of driving on looking at a ward of people with with motoring injuries while failing to consider the vastly greater number of drivers who go their whole lives without causing themselves or others any motoring injuries. But no matter; let the statistics speak.
What percentage of alcohol users would you consider to be ‘problem users’ for whom a health intervention by the State is justified?
What percentage of cannabis users would you consider to be ‘problem users’ for whom a health intervention by the State is justified?
In both cases, please state the criteria you are using to define problematic use, and the source of your statistics.
2: People who raised the ‘safety’ of street cannabis
Again, I’m not quite sure what you’re trying to say here, but taking your comment at face value, this is an argument for the legal regulation of recreation cannabis sales, not their prohibition. If that is the point you were trying to make, then fair enough. If not, you have at least conceded in principle that some of the dangers of cannabis result not from its pharmacology, but from the illegal marketplace in which it is produced and sold.
3: People who raised the ‘health benefits’ of cannabis argument
This is all well and good, and I’m with you on the need for clinical trials in medicine generally, but it’s worth noting that governments which are heavily invested in the War on Drug Users have always sought to stifle research into the benefits of drug use while lavishly funding research into the dangers. If we can change this, so much the better. But remember that cannabis is not an untested substance. Its history as a medicine dates back thousands of years, and is widely acknowledged to be one of the least toxic medicinal substances available. I reiterate, no one has ever been known to die as a direct result of cannabis toxicity in thousands of years of its use throughout the world. This means that the bar for whether or not people should be allowed to use it themselves is considerably lower than for a new, untested substance, and given that it is known to relieve the symptoms of several painful conditions, and its known risks are minor compared with many other medicines, the burden of proof really ought to lie on those seeking to prevent its medicinal use, not those seeking to permit it. What is your evidence in favour of preventing people from using herbal cannabis now?
4: Compromise
That’s a word I like to hear. Your concerns about paying for health risks are easily met: simply factor into the price of any recreational drug a tax sufficient to meet the likely harms. This is only possible to do under a legally regulated market, of course.
But I’m a little worried about what you mean by a ‘safe cannabinoid’. No drug, indeed no recreational activity at all, is 100% risk free – but as I mentioned in my earlier comment, in most cases we allow people to decide for themselves whether the benfits outweigh the risks. If you think that drug use is an area where people shouldn’t be permitted to make that informed decision for themselves, then again the burden of proof is on you. What exactly do you mean by a ‘safe cannabinoid’?
5: You did not address the question of whether you think alcohol ought to be illegal if cannabis ought to be illegal. My question is this: do you concede that if we are to live in a just society, all recreational drugs must be assessed according to the same consistent criteria, with no arbitrary exceptions made simply because one happens to have wider cultural acceptance?
6: You have been silent on your implied link between paedophilia and cannabis use. Do you concede that that was an unjustified post hoc ergo propter hoc fallacy, and that the percentage of paedophiles who use cannabis is irrelevant, and if you wanted to show a correlation you should be looking at the percentage of cannabis users who are also paedophiles?
To recap, that’s 5 questions:
What percentage of alcohol/cannabis users are problem users (and how are you deciding, and where are you getting your numbers from)?
Why should we prevent people who benefit medically from herbal cannabis from doing so, when so much is already known about the efficacy of herbal cannabis?
What do you mean by a ‘safe cannabinoid’?
Do you agree that, if you think cannabis ought to be illegal, then whatever your reasons are, those criteria should also be applied to alcohol, and alcohol also be made illegal if found to meet the same criteria?
Do you accept that your comment about paedophilia was unjustified?
I look forward to reading your responses.