A response to Susannah Taylor’s article in The Times Weekend supplement on Saturday November 11th 2017

Trigger and Content Warnings: Drugs, Eating Disorders, Depression, Anxiety, Psychosis, Racism, Sexism, Violence.

2789 words, approx 14 mins reading time.

This morning my dad came through the door and into the kitchen while I was having breakfast, bearing croissants and a copy of The Times. He apologised, they were out of The Guardian. He handed me the Weekend supplement as I like to read the recipes. My eyes were drawn to the top of the front page: "Cannabis drops: the latest wellness craze".

I was excited. After all, I myself take hemp-based CBD drops under my tongue and use them to make a balm to apply to my aching muscles and joints. I have lived with chronic muscle stiffness and pain for many years now, and CBD balm will alleviate the pain in under an hour, and taken orally will relax my muscles and allow me a restful sleep.

I turn to page six. I find a picture of a model: conventionally Western-attractive, slim and white, wearing perfect makeup, taking up the top half of the page along with the aforementioned headline. She is holding a dropper full of green-brown liquid to her open mouth, a drop falling tantalisingly towards her lip, but not touching it. The sub-headline "It may be illegal, but it's the latest fashionable health supplement in the home counties”.

Stop. Just stop. It's already too much. This is colonialism and classism, unctuous and thick and cloying. This is how you sell the idea of cannabis to the elite: by reflecting back to them their sexist, objectifying, racist ideals. The idea that cannabis is new? Well, it's new to the rich white people in the home counties. Or it's not so new is it? The earliest recorded use of cannabis dates from 3rd century BC. Other sources say it's been cultivated for around 12,000 years. Cannabis was only made illegal for recreational use in the UK in 1928, and was still legal for medicinal use under prescription until 1971. Yes, cannabis has only been illegal in this country for medical use for 46 years. It's been under state control for 89 years. My grandmother is 91. I wonder if she'd been given cannabis instead of sectioned and strapped to the bed for her grief-induced depression if she'd be the same person today.

If you care to read some of the excellent written histories, you'll see this is not a "fashion". The criminalisation of cannabis is rooted in prejudice. Racist prejudice against Mexicans, Jamaicans and other non-white cultures. Richard Nixon's War on Drugs. Fear-mongering was rife in the USA in the 1970s, report recommendations and evidence were ignored. The tobacco companies put pressure on the US government to criminalise, after all it was affecting their profits if people chose to smoke cannabis instead of their products.

Cannabis spread across the globe, like a weed you could say! Being passed to the right from Central Asia to Japan and Indonesia, and passed to the left to Western Europe, south through the Middle East down to Africa. Later it sailed across the Atlantic to South America and the Carribean, with the colonialists and slave traders, and eventually up worked its way up to predominantly Christian, segregated North America.

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Fig 1: A map indicating how marijuana spread throughout the world, from its origins on the steppes of Central Asia. Credit: Barney Warf, University of Kansas

Susannah Taylor writes "What the fans love is that it is natural", and describes how the cannabis oil she has encountered is made. She practically gives you a recipe, minus the quantities and timings. It's decarboxylated whole-plant oil. Cannabis is easy to grow. It is easy to maintain. It is easy to extract a medical benefit from it. You can eat the leaves raw. You can dry out the buds to vaporise them. You can make a concentrated oil, which can then be taken as-is, or added to food and drinks, or applied topically. We know now that tobacco is very harmful to your health. Extensive research has proved it and yet it's still legal and it's very addictive. We know smoking any other substance can be harmful. It makes sense that inhaling hot burning leaf smoke into your delicate internal tissues would damage them.

The decarboxylated whole-plant-extract oil that the author's friends are buying is being sold, she writes, by "A middle-class, handsome man who has a legitimate day job, but is evangelical about this plant." Of course he's evangelical about this plant, he's making a huge amount of profit. Assuming a weak strength, only one gram of cannabis flower can be enough to make 10 average doses. The internet is a treasure trove of wonderful advice on strains, dosages, THC vs CBD concentrations that are optimal for different medical conditions and more. The research has been done in other countries.

In the UK, cannabis is Schedule 1. That means it is not recognised for use medically, and possession and supply is prohibited except when licensed by the Home Office to carry out research. This means that any person or company that would like to research cannabis has to kowtow to the government line: that cannabis is a dangerous drug. Between 1928 and 2004 it was placed in Class B, meaning that possession could land you up to 5 years in prison, an unlimited fine or both. Supply & production can be punished by up to 14 years in prison, an unlimited fine or both. It was briefly transferred to Class C in 2004, under Tony Blair's government with David Blunkett as home secretary. Surveys at the time found 49% of British adults supported cannabis decriminalisation, 36% were against, and 15% were undecided. That result places people who actively want cannabis criminalised in the minority.

The transfer to Class C removed the threat of arrest for possession. For a brief time, the Times author’s friends would not have been arrested for breaking the law by carrying their little bottle of oil in their expensive handbags. In July 2007 the Advisory Council on the Misuse of Drugs was commissioned to review the classification of cannabis. The report, available online and published 7th May 2008, concluded that cannabis should remain a Class C substance. Despite the report's recommendation, cannabis was reclassified as a Class B drug on 26th January 2009.

So, Susannah Taylor, your friends could go to prison for up to 5 years for possession. Or an unlimited fine. But I supposed that doesn't mean so much to your "well-heeled wellness crowd" who are being ripped off to the tune of £100 for a 30ml bottle. Ripped off by a handsome, charming, middle-class man. How it echoes our history of the wealthy and attractive and male being dominant. I can see what capitalism and the patriarchy are doing to our country. Austerity, inequality, people are overworked and underpaid. Sexism and sexual harassment rife in every corner; in our homes, schools, workplaces, and in the halls of Westminster.

Cannabis possession and supply is mainly a working-class male pursuit. If you've got nothing to lose by going to prison and everything to gain from making a good mark-up on your products, that's when you turn to capitalism to see you through. If you're being failed by the system which not only allows but feeds inequality, then why not turn against it? If you make enough profit you can live a comfortable lifestyle and escape the trappings of an impoverished life. Or you could get shot or stabbed by rivals. The current drug market is run by desperate people, looking to extract maximum money from whatever they grow. Importing is expensive and very risky. Indoor cannabis cultivation is the least risky way under prohibition in the UK. To make maximum profit cannabis is industrially farmed, with strong non-organic pesticides and fertilisers. Cannabis can be grown outdoors, organically, with few fertilisers or pesticides. You can even grow it on your windowsill.

As we can see from the states where legality has allowed best practice to develop in the USA, cannabis can be grown in your home, or it can be grown on an industrial scale, producing medicine for those who do not have the space or enough physical and mental health to grow their own. Patient choice has flourished. Cannabis companies are breeding strains to match certain cannabinoid profiles, to create medicines that are each designed to be better for different health conditions. From epilepsy, anxiety, depression, sleep trouble, digestive-system trouble and so on. Just think! Your friend Freya, 39, could choose a strain that works best for her sleep-trouble and anxiety. Your friend Anna, 43, who doesn't like to feel "high" could choose a high-CBD, low-THC strain with a minimal psychoactive effect. This is indeed a world away from the spliffs you smoked when you were at university. This is science. This is medicine. This is patient-focused cannabis policy.

This is when we start to talk about THC levels. Street cannabis in the UK is mainly being bred for high THC content, to give an uplifting head-high, euphoria, increased sociability and a good giggle. However, cannabis contains dozens, possibly over 100 cannabinoids. Research has not yet uncovered the full number, let alone the full benefits of each of these compounds, and how they work together in the body. The Times article mentions how CBD is being studied for its effects on nausea and migraines, and that THC "can promote good health in small doses", as well as give you the well-known "munchies". Has the author considered how important that appetite-boosting effect of THC is helpful for cancer patients and anorexia sufferers? However, these are just two compounds of many. Because of this lack of research on the so-called "entourage effect", it follows that pursuing the path of creating pure isolates could lead to patients missing out on medicinal benefits. I have a great deal of concern that companies, for the sake of making cannabis seem more like palatable to the MHRA, want to make it into a little white pill so it's easy to prescribe.

The MHRA already recognises one form of medical cannabis: Sativex. Sativex is a Schedule 4 drug: a mouth spray which contains chemical extracts of THC and CBD, in a 1:1 ratio. It can be prescribed for the treatment of MS-related spasticity when (and supposedly only when) a person has shown inadequate response to other symptomatic treatments and found their side effects intolerable. Cannabis-based medicine is currently seen as a last resort when nothing else has worked. There is currently one company in the UK legally allowed to provide and profit from the sale of this plant. Compared to how many in the USA, I wonder? I don't think one could count, the number is growing daily as they try to keep up with demand, as people realise the wide range of benefits this plant and products made from this plant have to offer. It is vital that cannabis policy is based around offering choice to patients of what best suits their conditions, rather than any one company gaining a monopoly. Big business has the money to plough into research, which is troubling news. We need to put patients before profits.

Cannabis and psychosis, a popular topic. One that has very little research to back it up. Obviously, like any other medicine, people should be aware of potential effects and side-effects before they take it. If you've ever looked at the side-effect list on commonly-prescribed SSRI antidepressants you'll see that it reels on into the dozens. Agitation, shakes, anxiety. Nausea, indigestion, diarrhoea, constipation. Loss of appetite and weight loss. Increased appetite and weight gain. Dizziness, blurred vision, dry mouth, excessive sweating. Sleep problems, headaches. I could go on, those are just some of the common ones. Cannabis promotes homeostasis, which is a tendency towards a stable equilibrium between all the interdependent systems in the body. The human body, like many other mammals, has a dedicated endocannabinoid system. Our bodies are designed to process cannabinoids. Our livers and minds were not built to process SSRIs, SNRIs, Tricyclics and all these other pharmaceuticals. Our livers work hard to process them, break them down, and remove them from our bodies. Hence you have to keep taking these meds frequently, and often in increasingly high doses to get the same effects. Cannabis research in other countries has supported the anecdotal evidence (which is vast and wide ranging, with over 4000 members in one online UK-based discussion group) that cannabis in its natural form is anti-anxiety, anti-emetic, promotes good digestion, promotes a healthy appetite, and relieves pain. No need to worry about the munchies too much, because if you relieve that anxiety and depression and pain, you'll feel like going out for a walk again. Or going to the gym. Or meeting your friends for coffee and a chit-chat.

And so on to mental health! As I write, the mental health services in this country are in crisis: severely understaffed and underfunded, wait lists are commonly between 6 months to a year long. I wouldn't wish depression on anyone. 9 months on a waiting list with suicidal thoughts and no professional help is unbearable. Many people on those waiting lists do not have a good support network. Due to the overbearing stigma around discussing these dark emotions, people feel totally alone. Current campaigns to "break the stigma" do nothing to drive funding to NHS Departments and mental health charities, who are breaking under the strain. One benefits advisor at Mind cried to me, about how sad my story was, and how it was just the same but different as all the others he deals with day-in day-out. People with physical disabilities and mental illnesses who cannot find an employer compassionate enough to give them adequate sick-leave to recover. So they either work until they break down, or they leave their employer and enter the benefits system, where they are then forced to relive their worst experiences and trauma for the sake of filling out a form, and harangued by outsourced ATOS PIP assessors who ask questions such as "Why haven't you killed yourself yet?". Or how about a surprise inspection to your home to check you're still disabled? This happened to an autistic lady in one online support group I'm in. She was too frightened to answer her door to the stranger hammering away on the entrance to her home, to the stranger who would not announce her business nor leave.

As an aside I'd like to point out that it's perfectly understandable that people who have to break the law to access cannabis, people who could go to prison or face fines for possessing something that treats their conditions, might come across as more than a little anxious. Don't call someone paranoid because they check for police before taking out their vaporiser. We are patients, not criminals.

With the lack of mental health provision as it is, and the stress on pain-management departments who deal with chronic pain, and the current incurability of conditions such as Crohn's, MS and fibromyalgia, it's no wonder people are turning to cannabis to self-medicate. But what they are mostly finding through their connections are those varieties with high-THC, low-CBD, intensively indoor grown with nasty pesticides. Susannah draws a line: "Taking cannabis for recreational use is one thing... what we are discussing here is medical cannabis". There is no difference, it’s the same plant. All cannabis is simultaneously recreational and medicinal. If you're stressed out, miserable, have had a bad day, why not have some cannabis to help you relax and sleep? If you've got fibromyalgia and have horrible leg pain and can't sleep, same thing! Who decides if you're sick enough to need cannabis?

I hope I've managed to show you why those "scuzzy bags of dope and lumps of hash peddled by traditional drug dealers" are still medicine. That's what most people have access to. Just because they've not been prepared for you and sold in a way that you find palatable doesn't mean they're not helping people. Just because people are taking any given medicine doesn't mean that is the medicine that is right for them. Rather than "A safety issue of receiving something poor quality" as Michael Heinrich of UCL mentions, leading to restrictions and a crackdown, it needs to lead to higher quality products being more available, with appropriate consultation available from better-funded, less-stressed, medical professionals. It's also important to note that cannabis is not a holistic treatment for complex issues such as depression and anxiety, because it does not address the root cause of the problem. It may alleviate the symptoms, but it does not address the isolation and past trauma. Cannabis does not alleviate poverty or unemployment. It does not permanently cure MS or Crohn's or epilepsy, but it does make life more comfortable. Cannabis makes life liveable.

Lois Bentall

Useful links used in researching this article:

https://www.livescience.com/48337-marijuana-history-how-cannabis-travelled-world.html

http://www.history.com/topics/history-of-marijuana

http://www.narconon.org/drug-information/marijuana-history.html

https://www.aleretoxicology.co.uk/en/home/support/drug-classifications.html

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/119174/acmd-cannabis-report-2008.pdf

https://www.leafly.com/news/cannabis-101/list-major-cannabinoids-cannabis-effects

https://www.nhs.uk/conditions/ssri-antidepressants/side-effects/

https://www.theguardian.com/commentisfree/2017/may/04/benefits-assessments-damaging-lives-hardworking-britain

https://www.mstrust.org.uk/a-z/sativex-nabiximols