INTRODUCTION: TRUE AND FALSE BELIEFS REGARDING CANNABIS

We are in the midst of a global cannabis revolution. For almost a hundred years, this has been the most popular illegal drug in the world.

Every year, more governments roll back their cannabis prohibition laws (or at least try to). At the time this book was written, more than two hundred million American citizens in thirty-six states had access to marijuana for medicinal use and more than one hundred million in seventeen states could legally purchase cannabis for recreational use (1).

Seventeen countries, including the Netherlands, Belgium and Germany, use cannabis for medicinal purposes. And Israel has become the first country in the world to offer a university course on medical marijuana.

However, in countries like the United Kingdom the revolution has not even begun. It was only three years ago that the British Government finally admitted that cannabis could be used legally as medicine¹, despite the fact that it has been used that way for millennia. Be that as it may, the British National Health Service (NHS) has prescribed prescriptions to very few patients, due to the absence of clear guidance, flawed cost arguments and a lack of consensus within the medical sector.

As a result, it is estimated that more than one million people in the UK use illegal (purchased on the black market) cannabis for medical purposes every day². A situation that has left the general population with little and confusing information about cannabis.

You may be one of those people. Perhaps you are considering using cannabis and want to be aware of the real harms and benefits. Or maybe you're already using it, but it still worries you. You may use it recreationally or have discovered that it is your son or daughter who uses it, and you want to know the true nature and extent of the risks.

That's why I decided to write this book: to tell the whole truth about cannabis, to reveal what science says about it (and it's about time, after a century of government propaganda against it). It is very likely that almost everything that many of us know about cannabis comes from this propaganda and, more recently, perhaps also from the commercial presentations of the new and burgeoning cannabis industry, especially regarding cannabidiol or CBD.

Readers may know me as the 'drugs tsar' who was sacked by the British government in 2009 for speaking out about the compelling evidence on the harmful effects of drugs. I've been accused of being a drug reformer, as if that were a bad thing. But it is clear that, in their current state, the laws do not serve their purpose. Globally, there is clear evidence that the war on drugs has failed. In the UK, the Government has maintained its prohibition policies, which, as can be seen in Figures 1 and 2, has not resulted in a reduction in cannabis consumption³.

The goal of prohibition is to reduce the harm caused by drugs, but all this type of policy has done is increase the harm: from wasting police time to using public funds to prosecute citizens accused of the crime. minor of possession of cannabis and thus ruin their life prospects. Efforts to maintain the illegal status of cannabis have had the perverse result of a more powerful variant (the so-called skunk) and a dangerous substitute (spice) being marketed on the black market.

Cannabis is not going away, no matter how hard governments try to pretend that their “tough on drugs” policies are working. Seen this way, wouldn't it be more sensible to find a better way of living with cannabis, one that causes the least possible harm to people and society as a whole, while providing the greatest number of benefits?

As a scientist who has held the position of advisor to the British Government, I did not begin my work with a mandate for reform. Rather, I stuck to one of the fundamentals of scientific research: question everything. I felt my job was to find the best evidence-based harm reduction policies for all types of drugs, including alcohol and tobacco.

This covered a broader context: what logic does it make for us to treat alcohol differently from cannabis, when in reality the former is more harmful? What government policies would generate maximum benefits and minimum harm? Thanks to the work I did during those years, I ended up understanding that cannabis is the drug that presents the greatest gap between what we are told about it and the true harmful effects it causes us. As a mere example, the following figure may be surprising, showing the number of people who died from the use of different drugs in the United Kingdom during 2019. Deaths due to cannabis use were very few, as can be seen⁴.

Once my functions in the Government ended, it was clear to me that I had to continue researching and speaking about drug policies that were based on conclusive evidence, since it was something very important. That's why I set up the charity Drug Science and continue to campaign in this area. My experiences and analysis of drug policies are reflected in chapters 3 and 14.

Both my perspective on the topic of cannabis and the content of this book are based on my time as an advisor to the British Government, as well as other work that I have carried out.

I trained as a doctor in the 1970s. As our imposing senior consultant, Dr Hardwick, told us first-year students on our first morning at Guy's Hospital: "The purpose of medicine is to minimize suffering." Those words stuck with me and have underpinned my entire clinical practice.

But the sadness they cause me has increased since I learned about the campaign to access medicinal cannabis. Although cannabis has been used as a medicine for millennia, its continued prohibition has prevented me from using it as a medical practice.

Either way, as I began to meet people and families whose lives had been improved by their use and listened to the personal stories they told me, some of which are included in section three, I realized how unfair it was (and still is). that governments restrict access to this medicine (2).

I have met parents whose children suffered from severe epilepsy episodes and, due to their resistance to treatments, needed this other type of medication (the only effective treatment). But sometimes his parents had to pay more than two thousand pounds a month (almost two thousand four hundred euros) to obtain it. One of them even sold his home to cover the expenses (3).

This is why my charity Drug Science is putting pressure on the Government and medical professionals to reduce barriers. And this is also why we created Project Twenty21, the first medical cannabis data registry in the UK⁵. At the time of writing this book, Twenty21 had managed to recruit more than a thousand patients, giving them access to specialized experts who guaranteed they were getting medical cannabis correctly at a fair price.

I also specialized in neuropsychopharmacology, which has allowed me to dedicate my career to studying the effects that drugs and medications have on the brain. I suspect that I have supplied more different kinds of drugs (legal and illegal) to human beings than any other living contemporary.

It could be said that the rise of psychoactive drugs formed the framework of my youth. I was a teenager during the Summer of Love and a student during the 1970s. Psychedelic drugs, especially LSD, were changing music, art and culture, and cannabis became the trendy alternative to alcohol. But I was also a child of those times when it came to the greatest revolution ever experienced in the field of neuroscience: the discovery that the brain is a chemical machine. Until the late sixties, it was believed that the brain worked through electrical connections, as if it were a telephone exchange.

During my studies at Cambridge, I was taught by some of the scientists who had discovered how neurons worked, and I was also involved in early debates about the nature of how neurons communicate through chemical neurotransmission. These findings revolutionized not only neuroscience, but also neuromedicine. For the first time, we had a means to produce molecules that worked with the newly discovered neurotransmitters.

Drugs are just another variant of this, since their mode of action also consists of disturbing brain chemistry. I was (and still am) fascinated by how much drugs change the brain. Since the first time I saw someone drunk, I have asked myself several questions. Why do people use drugs? What changes do drugs produce in the brain? And what effects do these changes have on people's feelings and thoughts?

We have only just begun to understand all this. Due to the long-standing global illegality of cannabis, these important studies had failed to prosper. But in the last ten years or so, the pace has accelerated, and in section two I share some exciting new advances in understanding how cannabis affects both the body and the brain.

As a doctor, I have also trained and practiced in the field of psychiatry. All of this, together with my research activities, has given me a comprehensive understanding of the old debates around cannabis and mental health. I am convinced that one issue that will attract great interest is the risk of dependency (see Chapter 12). And the other will be the link between schizophrenia and cannabis use, one of the main medical deterrent stories of our time (see Chapter 13).

Finally, I have also written this book as a father. I have four children, all of them now adults, but I remember their turbulent adolescence very well, especially because in our home it lasted for thirteen years. We all want the best for our children. We don't want them to have a bad academic record or criminal record, or to become addicted to something.

If you are a parent or caregiver (or even if you are a teacher), you need to know the whole truth about drugs and alcohol. More than anything, because the more information without half measures you can give young people regarding the issue of drugs and alcohol, the more you will empower them to make good decisions.

In fact, I firmly believe in empowering everyone, adults and children alike, to make decisions based on the best information. I hope this book provides you with the information you need to form your own opinion about cannabis.