Substance D - A New Scourge?

2015-08-24 06:35

This article is a response to the following post:

http://www.sun.ac.za/english/Lists/news/DispForm.aspx?ID=2681

In Dr. Lize Weich's article on the dangers of cannabis use, she lists the myriad of ways in which cannabis does damage to those who use it.  In my experience working as a Clinical Psychologist in communities in Johannesburg I came across a new, very dangerous drug, called "Substance D."  Taking my lead from Dr. Weich, I believe it is my duty to inform the reader about this deadly scourge.

After just four weeks of continuous use, a Substance D user is at risk of developing a number of very severe side-effects including: anorexia, severe liver damage that may progress to coma and death, abnormalities of glucose metabolism, cardiac arrhythmia, which may lead to heart attacks, and cerebral oedema (brain swelling).  Although it is uncommon, addiction to Substance D does occur, and a Substance D addict may resort to a multitude of dangerous behaviours in order to get their next fix.  But the real danger of Substance D is that many people think  it’s safe because it is used medicinally by millions of people.  Substance D is sold by unscrupulous dealers under the street name "paracetamol".  Fortunately for the user, the side effects of Substance D are included on a leaflet inside every box, so you only have yourself to blame if you fall victim to this most insidious drug.

The paragraph above illustrates the absurdity of articles such as the one written by Dr. Weich, in which the continued prohibition of cannabis appears justified due to its purported harmfulness.  If the author's intention in writing such articles is merely to scare the reader in an attempt to deter them from using a particular substance, then all they need to do is simply list the potential harmful effects of said substance, as the good Dr. Weich has done.  Most readers will take these facts at face value, without any further investigation.  Unsurprisingly, the reader will be left with the impression that the substance in question is exceedingly dangerous and is best avoided at all costs.  However, a scaremongering author must also take special care to omit any information that contextualises the harms of a substance relative to others.  They must also completely disregard the normative view of substance use, which provides a framework in which dysfunctional behaviour is understood in relation to so called "normal" behaviour.

If the author's intention is to educate the reader, however, they must provide the reader with a context in which the facts they present hold water.  To fail to educate is to misinform, and it is egregious that someone of Dr. Weich's standing within the academic community would deliberately ignore the nuances that characterise the debate around the legal regulation of cannabis.  In an attempt to quantify the relative harms of drugs using empirical methods, Prof. David Nutt, a world-renowned Psychiatrist and Neuropharmacologist who specialises in harm reduction strategies related to drug use, has devised a scale of harmfulness which takes into account several measures of drug-related harm.  The results of his first study can be seen below:

Nutt, D. J. (2012). Drugs-- without the hot air: Minimising the harms of legal and illegal drugs. Cambridge, England: UIT.

One thing should be abundantly clear at this stage: simply listing the harms of a drug does not provide a true and accurate reflection of its real harmfulness.  When we consider the harmfulness of cannabis we must compare it to the harmfulness of other drugs; without such a context "the facts"  become misleading.    In spite of Dr. Weich's failure to provide a comparative context for her argument she does raise some valid points, and I share her concerns regarding the youth abusing cannabis as they are more vulnerable to any potential negative effects.  However, in her article, Dr. Weich simply lists some potential harmful effects of cannabis without even making the slightest attempt to provide information about how harmful cannabis actually is at an individual or societal level.  Clearly, her argument cannot be used as a basis to justify the continued illegality of cannabis, much like my quick review of a paracetamol insert cannot be used to argue for the illegality of any medication containing the drug.

Dr. Weich also fails to take into account the fact that the negative effects of cannabis use she so readily (and lazily) lists are in no way characteristic of non-problematic cannabis use, which happens to be the norm. Her conclusions about cannabis use are no doubt largely informed by her years of clinical experience treating mental illness, but the fatal flaw in her argument is that she generalises her conclusions to non-clinical populations without taking into account the vast differences between these groups of people. By the time a person comes to the attention of psychiatry there is a good chance that their behaviour or mental state has deviated from what is considered normal, and they are usually unable to function effectively in their day to day lives.  Such a person is not a scientifically valid representation of the general population, and as such we cannot draw conclusions about the effects that cannabis has on the general population by making reference to the effects it has on the unfortunate souls who are afflicted by mental illness.  As an example, one cannot compare the negative effects that alcohol has on an alcohol dependent person who also suffers from depression with the effects that alcohol may have on someone who drinks responsibly and is otherwise psychologically healthy.  As is evident from Prof. Nutt's research, alcohol has the potential to be exceedingly harmful, undoubtedly more so than cannabis, yet most people who use it do so without suffering any negative consequences.  Society tends to readily accept the normative view of alcohol, but to truly provide a valid account of cannabis use one needs to do the same, regardless of its legal status. Dr. Weich abjectly fails to do so, and perhaps this reveals a broader truth about our approach to this issue as a society.

By contributing her expertise to such puerile drivel, Dr. Weich is complicit in a broader systemic problem; the drug problem is as it is today because it is fundamentally a health problem that is being managed as if it were a criminal problem.  It is time we re-think our stance on cannabis, and begin to ask the tough questions about whether allowing cannabis to be regulated by the black market is a viable solution to our drug problem.  Cannabis is not a safe drug; all drugs regardless of their legal/medicinal status carry with them some potential risk to the user.  However, cannabis can be made safer in a systemic framework where it is legally regulated,  where those in the minority who may experience negative effects of their cannabis use are given access to treatment.  It makes no sense to intervene in the lives of people who use cannabis without any negative consequences, much in the same way that nobody comes beating my door down for drinking a beer or two at dinner time.  Sadly, few in the healthcare profession seem capable of moving the debate to a broader systemic level, and this is part of the reason why we have lost the war on drugs.

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