Are problem cannabis users invisible to services?
Earlier this week (7 February 2017), drug policy think tank Volteface published a new report: Black Sheep: An Investigation into Existing Support for Problematic Cannabis Use which argues that a legal regulated market would better support people experiencing problematic cannabis use as the sector is lacking a clear, effective strategy for linking people into support and guidance.
The report argues that the current illegal and unregulated market reduces the visibility of cannabis users, reporting practitioners’ views as:
We’re just fumbling around in the dark trying to find them.
Out of Treatment
It has been estimated that 2.6% of the adult population (aged 16 or over) showed signs of cannabis dependence, which is up to 1,150,000 people, though it is expected that the actual number of people who meet the threshold for clinical dependence will be far lower.
National Drug Treatment Monitoring System data shows that cannabis accounts for 21% of all problematic substances cited in UK substance misuse treatment centres and 79.7% of adults listing cannabis as a problematic substance are entering treatment voluntarily.
New presentations for cannabis treatment increased by 55.2% between 2005-2014. Volteface says that this data profoundly signals that there is a significant need for increased support and guidance for problematic cannabis use.
Among people showing signs of cannabis dependence, only 14.6% have ever received treatment, help or support specifically because of their drug use, and just 5.5% had received this in the past six months.
Symptoms of problematic cannabis use include:
- Mental health symptoms, such as anxiety, depression, paranoia, panic, de-personalisation, exacerbation
- of an underlying mental health condition
- Problems with concentration while studying or with employment and relationships
- Difficulties stopping cannabis use
- Legal or employment problems (arising from use of cannabis)
Conclusions and Recommendations
Volteface argues that cannabis is a neglected drug in public health discourses, a reality which is at odds with the growing number of people in England who are now seeking support for problematic cannabis use. The disparity of how cannabis is prioritised by drug and alcohol service providers, wider community services, local authority commissioners and public health bodies has limited the amount of support available and impeded quality.
- Among people experiencing problematic cannabis use, there is a perception that their needs will not be effectively met at treatment centres.
- Some drug and alcohol service providers and commissioners are being attentive to cannabis but overall, cannabis has not been appropriately prioritised.
- One to one interventions relating to cannabis are mostly confined to drug and alcohol treatment centres. Wider community services reported that they do not have the capacity or the ability to offer brief, initial interventions.
- There are limited amounts of public resources available, some of which are lacking in levels of quality and accessibility.
- A wider structural barrier is that the sector does not have a clear strategy for linking people experiencing problematic cannabis use into support and guidance. With the current illegal and unregulated market reducing the visibility of cannabis use, practitioners reported that they did not have effective strategies to engage problematic users into treatment.
The report says that responsibility for change does not just fall to drug and alcohol service providers, and recommends a unified, multi-faceted approach. Evidence of good practice within the sector and contributions from stakeholders and experts has been used to formulate a series of sensible, innovative policy options tailored to the needs of people experiencing problematic cannabis use:
- Research into the social costs of problematic cannabis use by Public Health England would provide justification for commissioners to appropriately prioritise cannabis within treatment. Commissioner specification of cannabis would incentivise providers to utilise existing resources and supply innovations targeted towards people experiencing problematic cannabis use.
- A shift towards holistic service provision and promotion by drug and alcohol service providers and wider community services, would aim to increase interaction and engagement with support.
- A move towards a regulated market would offer a targeted dialogue with people experiencing problematic cannabis use, providing opportunities for harm reduction advice to be delivered at point of purchase and persons in need of support relating to their cannabis use to be linked into reformed public health measures. There would also be the emergence of wider opportunities for more public guidance, packaging controls, products which vary in potency, research into cannabis culture and consumption to improve interventions, and reduced stigma to enable access to services.
Volteface’s final conclusion is that:
Effective support requires public health measures which appropriately prioritise the needs of people experiencing problematic cannabis use and a regulated market which targets these measures to their intended audience.
My view is that Volteface’s analysis makes sense. My experience is that the current situation comes from a widely shared cultural assumption that cannabis use should not be criminalised which has led to a vacuum in both public health information and education and in the provision of accessible specialist treatment.
Heavy, often problematic, cannabis use is frequently unchallenged by family and friends. I know of dozens of young people who smoke first thing in the morning and immediately on returning home after school, college or work. If these young people drank or used other drugs in the same dependent way, their loved ones would be expressing serious concern and urging them to seek help.
As a society, we appear to have invested so heavily in our belief that we shouldn’t be criminalising young people who smoke cannabis, that we feel unable to talk sensibly about the difference between recreational and dependent use.