| Dear
Editor,
Please find enclosed my contribution for continuing
to subscribe to this magazine and some donation to
continue the work which I am sure consumes a good
deal of money as well as all of your time. I also
thought I might discuss with you one of the issues
raised in your last newsletter (May/June 1998).
The issues raised by Vaughan Rees with respect to
cannabis were in the main congruent with current research
and thinking. But I fear that there has been a significant
misrepresentation of the effects of cannabis use,
albeit not deliberate, since the publication of some
evidence to support a `cannabis dependence syndrome'.
These concerns should be shared with your readers,
and in particular, concerned parents, because there
exists a significant potential for harm to be maximised
by such misinformation.
I refer to the alleged link between cannabis use and
psychotic illness, particularly schizophrenia. In
the past year or so, I have seen three young men referred
because of their "cannabis misus" with strong
advice that all they had to do was stop using cannabis
and everything would be OK. It did not take long to
establish that their behaviour was due to the early
presentation of a psychotic illness (the word "schizophrenia"
should be avoided at all costs until it is really
clear what is going on) and in all three cases, improvement
was significant once they had entered formal psychiatric
treatment including appropriate medication. In the
most recent case, the patient did not wish to stop
or reduce cannabis use and he has continued to improve
anyway to the point where he no longer has positive
symptoms and a change of medication may well, we hope,
reduce his negative symptomatology such as apathy,
lack of energy and so on. It is my feeling that when
he feels more confident, energised and interested,
he will significantly reduce or stop his cannabis
use.
Cannabis use has had little or nothing to do with
the onset of illness in these people and fiddling
around debating cannabis use whilst ignoring the need
for definitive psychiatric intervention is tantamount
to negligence. Further, many practitioners and even
psychiatrists make the same assumptions that all the
person has to do is stop smoking cannabis. The evidence
linking cannabis use and frank psychosis is poor,
and it would be my very firm advice that any major
mental health symptoms are managed entirely on their
merits, including a psychiatric assessment and medication,
if appropriate, whether cannabis use is involved or
not.
This will ensure that all the benefits of early psychiatric
intervention are experienced. We could then confidently
predict that a number of people presenting with a
first episode of psychosis will be, to all intents
and purposes, cured provided intervention is not side
tracked pursuing some cannabis related phantom.
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