MatthewJAthaBScMScLLB

IndependentDrugMonitoringUnit(IDMULtd)

Cannabis–AnIntroduction

HITSeminar19­6­12

CannabisWhatisit?Cannabis is the fourthmostwidely‐usedpsychoactive substanceon theplanet,behindcaffeine,alcoholandnicotine.Itisthedrugwhicharousesthestrongestcontroversy between advocates of prohibition, legalization and all shades inbetween.Cannabisisderivedfromaplant–CannabisSativa–whichisgrownthroughouttheworld.Itsmedicinalpropertieswerefirstrecordedin2737BCinShenNungdynastyChina,anditwaswidelyusedinVictorianBritainasapatentmedicineand tonic. Itspsychoactivepropertieswereknownto theScythians inAncientGreece,butwerefirstreportedinEuropefollowingNapoleon’sinvasionofEgypt,butusewasconfinedtobohemiangroupssuchaswritersandJazzmusicianuntilthesocialrevolutionofthe1960s.UsageinBritaingrewsteadilysincethe1960sandpeakedinthelate1990sandearly2000s.Theactiveingredientofcannabisistetrahydrocannabinol,betterknownasTHC,although the plant contains many different cannabinoids, most notablyCannabidiol(CBD).Mostusersseekasenseofrelaxationwithenhancedappreciationofmusic,food,conversationorotherpleasures. Rollingajointinvolvesaritualofpreparationand smoking cannabis is frequently a communal experience, sharing the jointbetweenseveralpeople.There have been claims and counter‐claims as to the effects of cannabis onmental health. Much has been made recently of links between cannabis use,schizophreniaanddepression. Howeverahighproportionofuserswouldtakethe drug semi‐medicinally to relieve stress at the end of the day or copewithadversity. Apopular sayingof the1960swas thatdopewillget you throughtimesofnomoneybetterthanmoneywillgetyouthroughtimesofnodope.TypesofCannabisCannabis now most commonly appears in herbal form commonly known asskunk. The majority of this is grown in the UK or imported from WesternEurope,grownindoorsunderlights.Althoughskunkstartedlifeasatradenameforaspecificpedigreevarietyofcannabis,thetermhascometobeusedtoreferto any type of cannabis in the form of unfertilized female flowering topswithlittle or no leaf present. Skunk typically contains between 8% and 20%THC,occasionallyhigher.There are many ‘brands’ of skunk‐type cannabis which vary in parentage,potency,appearanceandflavour.TwoofthemorecommonwouldbeCheese,ahighly pungent variety with high THC levels (typically over 15%), and PurpleHazewhich has purple‐coloured flowers (virtually blackwhen dried) but onlymid‐levelTHCcontent(typically6‐13%)

Herbalcannabiscanappearintwootherforms,thefirstisbush,whichisgrownoutdoorsinthetropics(Caribbean,Africa,SEAsia)andcompressedintoblocksbefore being imported into the UK. This is readily distinguished from skunkcannabis via thepresenceof seedswhich can compriseup to30%of the totalweight. Bush typically contains 2%‐10% THC. It is usually referred to viacountryoforiginifknown,orotherwiseas‘bush’or‘weed’.The final type of herbal cannabis is ‘homegrown’ this can either representmaterial grown outdoors or the remains left over when skunk has beenharvested from plants, typically amix of leafmaterial and small or immaturefloweringtops. Mostleafmaterial issimplythrownawaybygrowers. Potencycanvaryfromunder1%forpoorqualityleaf(orhemp)toaround10%forthesmallerleavessurroundingthebudsorsmallerflowerbuds.

Skunk

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CannabisResinCannabis resin used to dominate the UK market until around 10 years ago,beforebeingsupplantedbyskunk.

Changes in UK Market Shares of Resin & Herbal Cannabis

Aswithherbalcannabis therearemanydifferent types. Pharmacologically themain difference between resin and herbal cannabis is that resin typicallycontains higher levels of CBD. Resin is prepared either by sieving the herbalmaterial through progressively finer meshes and compressing the resultingmaterial,orbyhand‐rubbingandscraping theresin fromthe flowersofplantsand pressing the resulting material into blocks or fashioning into ‘fingers’ or‘medallions’or‘TempleBalls’.ThefirstmethodischaracteristicofresinfromtheArabic‐speaking areas, the second method of resin from the Indian sub‐continent.Soap Bar resin remains themost common variety available in the UK, this isgenerallyconsideredtobeoflowtomediumquality,andisimportedfromNorthAfricaintheformof9ozorquarter‐kilopillow‐shapedblocksknownas9‐bars.It is hard in texture with a shiny, usually curved outer surface and an innersurfacerangingfromyellowish‐greentoadarkreddish‐brown.Potencytypicallybetween 3% and 7% THC. Much soap‐bar resin is heavily adulterated, aresearch study by Edinburgh University found instances of adulteration withsubstances including: Beeswax, turpentine, milk powder, ketamine, boot polish,henna, pine resin, aspirin, animal faeces, ground coffee, barbiturates, glues anddyespluscarcinogenicsolventssuchasToluene&BenzeneHigher quality forms ofMoroccan resin have become increasingly availableover the past decade, themost common being flat‐press. This is found in flatslabs of 100 or 200g inweight typically 10‐15mm thick,mid‐brown in colour.

TypicalTHC content 5‐12%. Lebanese resin, common in the1960s‐1980shaseffectivelydisappearedfromtheUKmarket.ResinfromAsia(Pakistan,Afghanistan,India)isnormallydark‐browntoblackincolour(knownasblackhash),andissoftandmalleableintexture.Thisusedtobe common in the UK but is now rarely found. Typical THC contents 3‐10%,occasionallyhigherforpremiumvarieties.Growersofcannabisareincreasinglyproducinghome‐maderesinusingshakersorotherformsofextraction,thismaterial,knownas‘skuff’or‘bubblehash’canbeextremelypotent(haveencounteredupto59%THC),butisrarelysold.The final type of cannabis, also rare, is ‘hash oil’ which is an extract of plantmaterial using organic solvents to dissolve the THC, the solvent is thenevaporatedofftoleaveagreenish‐brownstickyviscousoil.Potenciescanagainbeextremelyhigh.Itwouldnormallybesmearedonacigarettepaperormixedinto tobacco forsmoking,orusedorallymixed in foodordrinkcontaining fatsand/oralcohol.

SoapBarResin

Moroccan

AsianBlack

Skuff/BubbleHash

WhoUsesCannabis?Cannabisisthemostwidely‐usedillegaldrugintheUK,probably20millionhavetrieditatleastoncewith2‐4millionregularusers.

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Mostusersstartintheirmid‐teens,witharound95%ofusersstartingbyage20.Themeanageofinitiationhasfallenoverthepast5yearsfrom16yearsoldtojustover15yearsold.Usage levels peak in the 18‐24 age range and decline steadily thereafter,althoughsomeuserscontinueintooldage.Cannabis is used by people in all walks of life, from professionals to theunemployed, and from schoolchildren to pensioners, from Members ofParliament to criminals. The stereotypical long‐haired hippie still exists, butmostusersareotherwiselaw‐abiding‘normal’people.SignsofcannabisuseincludeThe smell – skunk cannabis has a distinctive and penetrating odour which

persistsonclothingandfurnishings.Paraphernalia – items associated with cannabis smoking would include

cigarette papers (particularly if packets are partially torn up), brokencigarettes, torncard,empty/usedsmallresealableplasticbags,grinders,‘roachends’,aswellaspipes,bongs,digitalscalesetc.

Appearance–contraryto theopinionofsome,cannabishasnoeffectonpupilsize, however reddened conjunctivae is consistent with ‘stoned’intoxication(amongotherpossibilities).

Clothing–pinholeburnsfromresinHowiscannabisused?Cannabisismostfrequentlyusedbysmoking.Mostcommonlycannabisorresinwouldbemixedwith tobacco inahand‐rolledcigarette, theproportions in themixcanvaryconsiderably. Herbalcannabiscanbesmokedneatinhand‐rolledcigarettes. Resin or herbal cannabis can be smoked in a variety of pipes,includingplainpipes,bongs,chilloums,hookah‐pipesorbuckets.Othersmokingmethods include pressing resin between two heated knife blades and inhalingthe fumes (hot‐knives) or using vapourisers to release the THC withminimalcombustionofvegetablematter.

Cannabis can be eaten neat or used in a herbal tea, but these do not provideeffectivemethodsofdrugdelivery.Tobeeffectivewhenusedorallythecannabisorresinmustbeheatedandmixedwithoils, fatsoralcohol inordertoreleasetheTHCinausableform.FrequencyofUseAlthoughmanypeopleusethedrugoccasionallyoratweekendsonly,dailyuseofcannabis iscommonwithasimilarpatternofuse to teaorcoffee. Howeverdailyusecanvaryfromaspliffatbedtimeorafterworktovirtualchain‐smokingalldayeveryday.

Howmuchdouserstake?Thespectrumof lifetimecannabisusersranges fromsomeonewhooncehadadrag on a spliff at a party to individuals who virtually chain‐smoke the drugthroughout waking hours. A typical user would smoke 2‐5 spliffs over aneveningafterworkmaybesmoking2‐3timesasmuchovertheweekend,andgetthroughbetweenhalfagramand2gramsaday.Heavyuserswouldsmoke3‐5grams a day over 10‐15 spliffs, with the very heaviest users smoking 20‐30xstrongorneatspliffsadayandgettingthrough10‐20gcannabis.The distribution of usage is one‐tailedwith a large number ofmoderate usersandprogressivelyfewerusersoflargeramounts.

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HealthProblemsPhysicalHealthLungs–Smokinganysubstance,includingcannabis,damagesthelungsandcan

lead to problems such as bronchitis, asthma and chronic obstructivepulmonarydisease.

Cancer–Althoughcannabissmokecontainsknowncarcinogens,bothTHCandCBD have been shown to have potent anticarcinogenic propertiescurrently being exploredby researchersworldwide. This could explainwhy cancer rates among users of cannabis are lower than mightotherwisebeexpected.

Cardiovascular – Cannabis tends to increase heart rate but tends to reducebloodpressureandstresslevels.

Pregnancy–There isnoevidence that cannabis specificallyharms theunbornchild,howeveranysortofsmokingduringpregnancyistobeavoided.

MentalHealthSchizophrenia – several studies have found that adolescents using large

amounts of skunk cannabis are at significantly increased risk ofdeveloping psychotic symptoms. Inmost cases the effect is short‐livedandwearsoffwithinhoursordays,butinseverecasesthesymptomscanrecurorpersist in theabsenceof thedrug. Thepeakyearsof cannabisuse coincidewith the typical age of onset of schizophrenia so a user intheir20swhohasnotdevelopedpsychoticsymptomsisunlikelytodosoinfuture.Thevastmajorityofusersdonotdeveloppsychoticsymptomsotherthanshort‐livedparanoiawhenseverelyintoxicated.

Depression – There are conflicting reports on the effects of cannabis anddepression, several studies have suggested a link between prolongedcannabis use and depression. Certainly a proportion of cannabis users

will do little and spend all day stoned, the so‐called amotivationalsyndrome.Howevermanydepressedpeopleself‐medicatewithcannabissothenatureoftherelationshipisunclear.Iknewofoneindividualwhohad suffered long‐termdepression,havingbeenprescribedvirtually thewholemedicinecabinetinbetweenboutsofhospitalization,butwhowasabletofunction(almost)normallyafterusingcannabisandgivinguptheprescribedantidepressants.

THC&CBD‐TheeffectsofskunkcannabisareduenotonlytothehighlevelsofTHCbuttothevirtualabsenceofCBD. CBDtendstotaketheedgeoffthehighand producing a more relaxed effect whereas high‐dose THC alone can makeusersedgyandparanoid.HealthBenefitsThe most commonly cited health benefit of cannabis is relaxation and stressrelief. This allowspeople to copewith stressful situations fromwork‐relatedstress to poverty and post‐traumatic stress disorder in most cases withoutresortingtoprescribedmedications.Since the cannabinoid receptor was first discovered in the late 1980s anexplosion of research into the endocannabinoid system has ensued andeffectivelycreatedanewbranchofpharmacology.Thesystemhasbeenfoundtomodulatethebody’scontrolofanumberoffunctionsincluding:Pain relief – Cannabinoids can have potent analgesic activity acting alone or

potentiatingtheeffectsofopiatemedications.Theeffectsaremostusefulincasesofchronicpaincausedbyconditionssuchasarthritisandspinalinjuries.

Multiple Sclerosis – Cannabinoids can relieve and in some cases reverse thedisablingeffectsofMS,itisnowbelievedthatthediseasemayresultfromdisorders of endocannabinoidmetabolism. Reduction of spasticity alsocanbenefitsufferersofotherneuromusculardisorders

Bowel Disorders – there are many cannabinoid receptors in the GI tract andcannabinoidshavebeenfoundtorelievesymptomsofIBS,CrohnsdiseaseandUlcerativeColitis.

Cancer –THCandCBDhavebeen found todelayor reversedevelopmentof arange of cancerous tissues, including reductions in vascularisation,growthandmigrationandcausingapoptosis(programmedcellsuicide)ofcancer cell cultures. Again research is focussing on the roleendocannabinoidsystemsplayinregulationofcancercelldevelopment.

AlternativeMethodsofControlCannabiswas firstmade illegal in theUK in 1928,with the current legislationclassifying itasaClassBControlledDrugunder the1971MisuseofDrugsAct.Maximumpenaltiesare5yearsprison forsimplepossessionorup to14yearsfor trafficking offences (possession with intent, supply, import/export andproduction/cultivation). Most first‐time possession offenders would be dealtwithviaapolicecaution.

Reclassification/Declassification –Cannabiswasdowngraded fromClassB toClass C in 2004 with the reverse happening in 2009. The period ofdeclassificationcoincidedwiththefirstrecordeddeclineinUKcannabisuse(andasignificantdeclineinuserratings).Italsocoincidedwithalargeincreaseinthenumbersofusersdealtwithbypolice(mainlyduetoreducedcostsper ‘bust’),andwithincreasedpoliceenforcementagainstgrowersofcannabis.TheBrowngovernment decision to reverse declassification was against the advice of theofficial advisory council on themisuse of drugs. However cannabis remainedillegal throughout the declassification period and therewas little effect on thepenalties imposed by the courts. The move effectively made official thewidespreadsentencingpracticepriortodeclassification.Decriminalisation – This policy would remove criminal penalties for simplepossession (possibly under a prescribed limit) butmaintain criminal penaltiesforsupplyingthedrug.Co­Operatives–IntheUSAandSpainusers(particularlymedicinalusers)haveformedcooperativestosupplythemselveswithcannabis.Regulation – This would involve controls on supply including licensing andtaxation (excise duty and VAT), treating the drug like alcohol and tobacco,including age limits, restrictions on premises and quality control. Increasedcontroloptionscouldincludeuser‐licensingviaasmartcardscheme.Ithasbeenestimatedthata licensedandtaxedcannabismarketcouldgeneratearound£6billionperyearingovernmentrevenues.Legalisation –Themost liberal regimewould treatcannabis likecaffeinewithnorestrictionsonsupplynoranyspecifictaxes(otherthanVAT).Growing Cannabis – Themajority of the UKmarket is supplied by domesticgrowers.Thesecanrangefromone‐personoperatorswhogrowafewplantsfortheirownuseuptocriminalgangscontrollingmultiplepropertiesorlargescaleindustrial or agricultural premises. It is possible to buy a kit sufficient forgrowingenoughplantstosustainamoderateuser foraround£200includingaself‐contained grow‐tent, HPS light with timer and extraction system withcarbonfilter.Forabout£600itispossibletokitoutabedroomwithlightingandventilationandproduceacropofaroundakilooveraperiodof3‐4months.Anysystem of designating home‐growing systems as being for personal orcommercialusewouldneed tobebasedonavailable spaceand lighting ratherthanthenumberofplantsgrownatanyonetime.Driving – Cannabis users tend to performworse on some psychomotor taskssuch as tracking tests, but there is no effect on reaction timewhen under theinfluence, and decision making may be impaired. However cannabis‐usingdrivers tend to drivemore conservatively and take fewer risks. Inexperiencedusersandinexperienceddriversaremostatriskofaccidents,anddrivingwhilstunfitthroughdrugsisanoffencewithpenaltiessimilartodrink‐drivingoffences.Fitnessisdeterminedbyabatteryoffieldimpairmenttests.

Workplace/Prison Drug Testing – Employees, particularly those in safety‐sensitivejobs,aswellasprisoners,canbesubjectedtourinetestsfordruguse.These tests usually determine presence of an inactive metabolite which canpersist in the body for days after a single use and for weeks ormonths aftercessationofchronicheavyuse.Manyofthetestsuseacut‐offthresholdwhichistoolowtodifferentiatebetweenactiveuseandpassiveexposure,andmostfailto‘normalise’ the results for creatinine content (ameasure of the dilution of theurinesample). Mostof thecalibrationexperimentsreferredtousage levels farlowerthantheTHCexposureofchronicheavysmokersofskunk,whocouldtestpositiveforwellover2months.AboutIDMUMatthewAthaisDirectoroftheIndependentDrugMonitoringUnitwith30yearsexperienceofresearchintotheuseofcannabisandotherdrugsintheUK.IDMUconductslarge‐scaleannualsurveysofdrugconsumptionandpriceswithatotalofover30,000responsessince1994IDMU provides expert evidence to the courts in criminal cases involving drugpossession, trafficking, production, and supply, offences committed under theinfluenceofdrugs,drug‐drivingcases,drugtestingcases(criminalandcivil),andcasesinvolvingtherapeuticusesofdrugs. Feesfromconsultationservicesfundourresearchprogramme.IDMUhasprovidedresearchservicesforanumberofclientsincludingtheBBC,the Advisory Council on theMisuse of Drugs, EuropeanMonitoring Centre onDrugs and Drug Addiction (EMCDDA), GWPharma, CLEAR and severalParliamentaryEnquiries.

www.idmu.co.uk©IDMULtdJune2012