Cannabis
– suicide, schizophrenia and other ill-effects
A research paper on the consequences of acute and
chronic cannabis use
Drug Free
Edited by Herschel Baker
First Edition, March 2008
CONTENTS
ACKNOWLEDGEMENTS
EXECUTIVE SUMMARY
INTRODUCTION
CANNABIS USE
The
History of Cannabis Prohibition
A
description of the drug
Cannabis
increased potency
Cannabis
Gateway Drug
Cannabis
Dependence
CANNABIS HARMS
Adverse
health consequences
The
younger age, the worse the effects
Effects
on the immune system
Cannabis
and cardiovascular system
Cannabis
–chronic obstructive pulmonary disease
Cannabis
and cancer
Pregnancy
and newborns
Cannabis
– effects on the brain
Cannabis
and cognitive effects
Cannabis
and depression
Cannabis
and psychosis
Cannabis
and schizophrenia
Cannabis
and suicide
Cannabis effects on Australian Indigenous community
Cannabis
- Amotivational Syndrome
Cannabis
and impaired driving ability
QUITTING CANNABIS
RECOMMENDATIONS
REFERENCES
APPENDIX A & B Articles in Print –
ACKNOWLEDGEMENTS
This review of cannabis in -date
the National Cannabis Strategy in
The editor would like to thank the following people in
particular, for taking the time to provide assistance with the content of this
review.
Mr. Gary
Christian-National Director-Adventist Development & Relief Agency
Co-Author
Booklet The case for closure the kings cross injecting room http://www.drugfree.org.au/fileadmin/Media/Reference/DFA_Injecting_Room_Booklet.pdf
1986-1987 - Co-writer of the Quit Now Stop
Smoking Program.
1999 - Co-founder of the Cabramatta
ADRAcare Centre for drug dependent and homeless people of the area.
2000-2003 - President of Hassela Australia
Teen Drug Rehabilitation program.
Editor Mr. Herschel Mills Baker
Author review paper: Suicide/ Schizophrenia Consequences of Acute and Chronic Cannabis
Use 1988
http://www.drugfree.org.au/fileadmin/Media/Reference/CannabisSchizophrenia_APFDFY_1988.pdf
Author review paper: Suicide/ Schizophrenia
Consequences of Acute and Chronic Cannabis Use 1996
http://www.drugfree.org.au/fileadmin/Media/Reference/CannabisSchizophrenia_APFDFY_1996.pdf
Author “Drug Awareness” up-date booklet for Lions
International District 201.Q5 Zone 2
Author Manual “Drug Free Kids: A Parent’s Guide” Drug
Prevention Resource
Developer
of “Parent Drug Education Courses” successful used by: Queensland TAFE and many
organization in
President
and Founding Member of Australian Parents for Drug Free Youth, since 1986.
Mr. Craig Thompson Magistrate
Co-Author “Drug
Precipice”
Board
Member Ted Noffs Foundation 7 years.
Committee
member Australian National Council on Drugs (1998-2004).
Craig Thompson, Chair of Drug Free
Australia, who provided valuable background and structure for the document’s
evidence-base.
Retired Chair of the Ethics and Legislation Committee Pharmaceutical Society of
Australia (NSW branch). Community pharmacist.
Co-Author “Drug Precipice”
Author of papers “A Heroin trail is this the
answer?”, “Cannabis for Medicinal Purposes? A parmacist’s review 2003”,
“Australia’s Policy on Illicit Drugs”, “Legal Injecting Places- A Pharmacist’s
View”, “Australia’s Policy on Illicit Drugs”and
“Legal Injecting Places - A Pharmacist's View.
Mary Brett BSC (Hons), retired biology teacher and Board Member
of EURAD for her extensive international research in the areas of the impact of
cannabis use and its damaging effects. Her contribution to this publication
consists of substantial quotations especially in the sections on Pregnancy
and Newborns, Cardiovascular effects, Dependence and Cancer. These
excerpts were previously published by Eurad (Europe Against
Drugs) in 'Cannabis - A Cause for Concern? General Survey of its Harmful
Effects including a Discussion of its Use in Medicine and Drug Education in UK
Schools' (2006), available to view at www.eurad.net.
Josephine Baxter Executive Officer Drug Free Australia for
editorial research and publication.
Community Relations Manager – Odyssey House Victoria –
2004-2005
National Director – Programs and Training, Life
Education
Project Manager, Offshore Licensing (
Chief Executive – Life Education, SA – 2000-01
Dr
Ivan Van Damme’s (
I would like to give special thanks to Dr.
Ivan Van Damme’s contribution and the great effort he has put into the content
of this paper, the evidence he supplied was invaluable and gave weight to the
thrust and purpose of the information.
Thank you to the following
people who provided useful, and specific advice on issues covered in this
review paper that are related to their jurisdiction: Hon. Chris Foley, MP, Member for Maryborough,
Queensland and Member Travel Safe Committee, Nan Ott, Debbie Mason, Sharon Baker.
This
paper provides an overview of matters related to cannabis abuse in
In June 2007 the Department of
Parliamentary Services produced a Research Note which states “Cannabis is the
most commonly used illicit drug in
The Research Note also
underscores the important reality that the age of first experience has clearly declined with time, and the active
ingredient in cannabis Δ9-tetrahydrocannabinol (THC) is now present at greater
concentration in cannabis than previously, which increases the overall risk.
Added to this is the fact that cannabinoids are fat soluble, thus allowing THC
molecules to be absorbed by the lipids in cell membranes,
therefore leading to its accumulation in body tissues. The persistence of THC
in cell membranes exacerbates its interference with the neurotransmitters
affecting learning, concentration and memory all of which adversely influence
academic performance.
Cannabis has a plethora of other toxic substances (Hiller, 1984, Ranstrom,
2003, BMA, 1997) and 66 cannabinoids of which THC is the most psychoactive, the
other cannabinoids in cannabis are not eliminated quickly, but remain absorbed
for months at a time (Cabral 1989). Cannabis has 426 chemicals of which many
are unique to the cannabis plant. Some of them will interfere with the
transmission of sodium, potassium, calcium and chloride through membranes. These complex messenger are called
neurotransmitters. This disturbance in chemical transport and cellular
communication affects thought, behaviour, feelings, memory, motor co-ordination
and glandular activity. When smoked, cannabis creates over 2,000 chemicals
(Hoffmann 1975, 1984).
Moir
et al’s 2007 study of marijuana smoke
found:
“…ammonia was found in mainstream marijuana
smoke at levels up to 20-fold greater than that found in tobacco. Hydrogen
cyanide, NO, NOx, and some
aromatic amines were found in marijuana smoke at concentrations 3-5 times those
found in tobacco smoke. Mainstream marijuana smoke contained selected
polycyclic aromatic hydrocarbons (PAHs) at concentrations lower than those
found in mainstream tobacco smoke, while the reverse was the case for
sidestream smoke, with PAHs present at higher concentrations in marijuana
smoke. The confirmation of the presence, in both mainstream and sidestream
smoke of marijuana cigarettes, of known carcinogens and other chemicals
implicated in respiratory diseases is important information for public health
and communication of the risk related to exposure to such materials.”
Zammit and co-workers (Zammit,
S et al. 2002) report a re-analysis of Andreasson’s research (Andreasson S et
al. 1987) which found that heavy marijuana users were 6.7 times more likely
than non-users to be diagnosed with schizophrenia later in life. This was true for those who used marijuana
only, as opposed to other drugs. The
authors concluded that the findings are consistent with a causal relationship
between cannabis use and schizophrenia and that self-medication with cannabis
was an unlikely explanation for the association observed.
A separate review of five
studies from s of a variety of
factors that lead to onset of schizophrenia.
At the 5th
International Conference on Early Psychosis October 4-6, 2006 a symposium of particular interest to many
conference participants was on cannabis use and its relation to the symptoms
that signal early disease onset and early psychosis (Henquet, 2006). It is known that patients with schizophrenia,
including first-episode patients, have much higher rates of cannabis use
compared with their counterparts in the general population. Recent
epidemiologic research has discovered that cannabis is likely to be one element
in the development of psychosis, meaning that cannabis use in combination with
genetic and/or environmental factors exerts a causal influence on the onset of
psychosis in individuals at risk (Smit, 2004, DiForti, 2005 and Henquet 2005).
It has been argued that 27% of
the population carry a high risk genetic variant which produces the weak
VAL/VAL type of the COMT-gen. Catechol-O-Methyl Transferase (COMT) enzyme
(Henquet 2007). The COMT enzyme is
responsible for the break down of dopamine in the brain. Henquet states that
the excessive amounts of dopamine released by cannabis use places those with
the VAL/VAL type of the COMT enzyme at 10 times greater risk of developing
psychosis and, later in life, a higher risk of developing schizophrenia.
The conclusions reached in this
and many other review papers over the last ten years (Ramstrom, 2003, Moore,
2007, Solowij, 2007, Degenhardt, 2006, Zammit, 2002, Arsenault 2004, Drewe,
2004, Mattick, 2006, Rey, 2004, Semple, 2005 and Smit, 2004,) indicate that
there is enough evidence to inform people that using cannabis could increase
their risk of developing a psychotic illness later in life. It is incomprehensible that with all this
evidence which has built up over the last ten years some researchers, policy
makers and politicians in Australia still tend to dismiss the facts – that
cannabis is a complex, toxic substance and needs to be treated as such.
The following pages summarise
a large volume of research about the adverse effects of cannabis from different methodological perspectives
on a diverse range of systems.
SECTION 1 – CANNABIS USE
THE HISTORY OF CANNABIS
PROHIBITION
The worldwide prohibition of cannabis emerged as part of a
system of international controls first developed for other psychoactive drugs.
When the representatives of a dozen nations met in
In preparing for this Conference, which represented an
attempt to deal with the international opium traffic, the government of
Cannabis was discussed at The Hague Conference - but only briefly, and it was not included as a controlled substance. However, at the conference's closing, participants agreed that the "hemp question" should be studied, to allow later assessment of the need for international intervention (Lowes, 1966).
“The Conference considers it desirable to study the
question of Indian hemp from the statistical and scientific point of view, with
the object of regulating its abuses, should the necessity thereof be felt, by
internal legislation or by an international agreement” (Willoughby, 1912).
With reference to the proposal of the Government of the Union of South Africa that Indian hemp should be treated as one of the habit-forming drugs, the Advisory Committee recommended to the Council that, in the first instance, the “Governments should be invited to furnish to the League information as to the production and use of, and traffic in, this substance in their territories, together with their observations on the proposal of the Government of the Union of South Africa” (Willoughby, 1924).
At the urging of
At the meeting in
“The illicit use of hashish is the principal cause of most of the
cases of insanity occurring in
An
Egyptian report which is frequently quoted as incriminating cannabis as a cause
of insanity was written by (Warnoch, 1903) Medical Director of the Egyptian
Hospital for the Insane in Cairo at the turn of the century, and the first to
institute some record-keeping procedures in what was then the only, and
accordingly very crowded, psychiatric facility in Egypt. Some difficulties
common to most Eastern reports are especially evident in this one particularly
in relation to his development of categories.
In investigating the hypothesis that hashish is instrumental in causing
a large proportion of the insanity in
2.
Delirium from hashish, which is accompanied by hallucinations of sight,
hearing, taste, and smell, often of an unpleasant kind. Delusions of
persecution often occur. The idea that the subject is possessed by a devil or
spirit is common. Great exaltation and the belief that the individual is a
sultan or prophet may occur. Suicidal intentions are rare. Hashish delirium is a less grave state both
physically and mentally [than delirium tremens]. Some cases are stuporous in
type.
3.
Mania from hashish. - This varies in degree of acuteness from a mild short
attack of excitement to a prolonged attack of furious mania ending in
exhaustion or even death. Most cases are exalted, and have delusions of
grandeur or of religious importance; persecutory delusions occur frequently,
and provoke violence towards others, but not suicide. Restlessness, incoherent
talking, destructiveness, indecency, and loss of moral feelings and affections,
are all ordinary symptoms. A certain impudent daredevil demeanour is a
characteristic symptom. Hallucinations are not so marked as in alcoholic mania,
but those of hearing and taste are not uncommon; delusions of being poisoned
are often based on the latter variety. A few cases are more melancholic than
maniacal in demeanour, and exhibit extreme depression and terror with
hallucinations of hearing (threatening voices, etc.).
4.
Chronic mania from hashish, including a form of mania or persecution. Many of
these cases are not distinguishable from ordinary chronic mania.
5.
Chronic dementia from hashish describes the final stage of the preceding forms.
The Egyptian proposal was referred to a subcommittee for
study and later in the Conference this group reported that the use of Indian
hemp drugs should be limited to medical and scientific purposes. The
proceedings contain no record of what medical or scientific evidence might have
been brought forward to support the inclusion of the Indian hemp drugs in the
Convention (EL Guindy, 1924).
Nevertheless, they were the subject of Chapters IV and V of the
Convention (
The 1931 League of
Nations Convention, which sought to limit the production of opium, also banned
other drugs including cannabis and cocaine.
These steps formed the basis for later Australian laws.
CANNABIS
USE – A DESCRIPTION OF THE DRUG
Cannabis is a term that refers
to marijuana and other drugs made from the hemp plant Cannabis sativa. All forms of cannabis contain mind-altering
(psychoactive) drugs; they all contain THC
(Δ9-tetrahydrocannabinol) the main active chemical in
the plant. They also contain more than 400 other chemicals.
Table 1
|
Chemical Classes |
No. known |
|
Cannabinoids Cannabigerol (CBG) Cannabichromene (CBC) Cannabidiol (CBD) Delta-9-tetrahydrocannabinol Delta-8- tetrahydrocannabinol Cannabicyclol (CBL) Cannabielsoin
(CBE) Cannabinol (CBN) Cannabinodiol (CBND) Cannabitriol (CBT) Other cannabinoids Nitrogenous
Compounds Quarternary bases Amides Amines Spermidine alkaloids Amino acids Proteins, glycoproteins and enzymes Sugars and related compounds Monosaccharides Disaccharides Polysaccharides Cyclitois Aminosugares Hydrocarbons Simple alcohols Simple aldehydes Simple ketones Simple acids Fatty acids Simple esters and lactones Steroids Tepenes Monoterpenes Sesquiterpenes Diterpenese Tritepenese Miscellaneous compounds of terpenoid origin Noncannabinoid phenois Flavanoid glycosides Vitamins Pigments |
61 6 4 7 9 2 3 3 6 2 6 13 20 5 1 12 2 18 9 34 13 2 5 12 2 50 7 12 13 20 12 13 11 103 58 38 1 2 4 16 19 1 2 |
|
Total
|
421 |
Comparison of smoke from a marijuana cigarette and a tobacco cigarette:
Dr Dietrich Hoffmann of the
American Health Foundation compared smoke from a typical ‘street joint’ with
smoke from a typical tobacco cigarette. “Both smokes contained roughly equal
amounts of irritants and gaseous toxic agents such as
carbon monoxide, ammonia, benzene and others such as methylethylnitrosamine.
Both smokes had roughly the same compounds, including lung irritants and
potential carcinogens, but the carcinogens naphthalone, benzanthracene and
benzopyrene were present in marijuana smoke in amounts 50 to 100% greater than
in the smoke of an unfiltered high-tar cigarette as shown in the tables below”.
Table 1
|
Measurements |
Marijuana cigarette – 85 mm |
Tobacco cigarette – 85 mm |
|
Cigarettes
Average weight, mg Moisture Pressure drop cm Static burning rate mg/s Puff number Mainstream
smoke Gas Phase Carbon monoxide, vol % mg Carbon dioxide, vol % mg Ammonia HCN Cyanogen Isoprene Acetaldehyde Acetone Acrolein Acetonitrile Benzine Toluene Vinyl Chloride Dimethylnitrosamine Methylethylnitrosamine pH - third puff fifth seventh ninth tenth Particulate Phase Total particulate matter, dry mg Phenol o Cresol m and p Cresol Dimethylphenol Catechol Cannabidiol ▲Tetrahydrocannabinol Cannabinol Nicotine N-Nitrosonomicotine Napthalene 1. Methylnapthalene 2. Methylnapthaline Benz(a)anthracene Benzo(a)pyrene |
1.115 10.3 |