Come clean on ganja - De La Haye
Consultant psychiatrist Dr Winston De La Haye has challenged colleagues and other professionals in mental health and related fields to better inform the public debate on the decriminalisation of ganja for public use, by sharing their individual and collective knowledge in an unbiased and objective way.
De La Haye warned against individuals with narrow, personal agendas derailing a very important public-health issue for personal gain, to the potential detriment of vulnerable members of the society.
"Most doctors know these things but doctors, by nature, don't get into arguments like that and so, by staying quiet, I recognise that you are allowing the people with their agendas to go through," De La Haye told The Sunday Gleaner. "So I have to talk, plus I have the training to talk and I have the clinical experience to talk. Other people recognise it but they are just not voicing their views."
According to consultant psychiatrist Dr Wendel Abel, the question of decriminalising the smoking of ganja is a matter that should be determined by policymakers rather than mental-health experts.
Abel has taken issue with De La Haye for comments he made in an article published in The Gleaner last week, where he insisted that the issued should be determined on the weight of scientific evidence, rather than public sentiment.
De La Haye was speaking with the newspaper at the annual conference of the Jamaica Psychiatric Association, held at the University of the West Indies, Mona, under the theme 'Cannabis & Mental Health: Implications for Public Health Policy'.
With policymakers currently reviewing the issue of 'freeing up' ganja for medicinal, recreational and religious uses, De La Haye, who spoke on 'psychopharmacology of cannabis', insisted that any move to make ganja more accessible to the public for smoking would be misguided.
However, Abel, who favours a review of the local laws under which persons convicted of smoking ganja may be fined and or imprisoned, told The Sunday Gleaner that, due to the fact that the issue remains unsettled in medicine, the public and parliamentarians must be the ones with the final say.
"The evidence is inconclusive and because it's not a settled matter, at the core of the matter then it's a legal issue. It's about laws that are unjust, prejudicial and draconian," he argued. "The association has been silent on the matter, it doesn't have a consensus opinion because the issue is so controversial and an important point you need to make is that psychiatrists and mental health experts worldwide have different opinions. It's not a settled matter, how can you make laws on matters that are not settled?"
De La Haye also drew the ire of Delano Seiveright, a director of the Cannabis Commercial and Medicinal Research Taskforce, who described the former's position as "sensational, unempirical and a failed attempt to reinforce old negative stereotypes".
Said Seiveright: "There is simply no compelling evidence to support claims that ganja is a causal risk factor for developing psychiatric issues in otherwise healthy persons. Beyond that, in the United States for instance, when ganja use rates increased, there have been no increases in schizophrenia diagnoses."
He added: "I hereby point to a recent study by Harvard University's medical school, led by its professor of psychiatry, Lynn DeLisi, which stated in summary that, 'cannabis does not cause psychosis by itself'. The study also noted that, in genetically vulnerable individuals, while cannabis may modify the illness onset, severity and outcome, there is no evidence from this study that it can cause the psychosis."
In fact, Abel, who addressed the conference on 'Medical Marijuana: The Research, Clinical and Economic Potentials', said the association has been silent because of the failure of members to agree on the way forward, an issue which should be factored into the equation going forward.
De La Haye has, however, countered by citing the position paper issued by the American Psychiatric Association (APA) which has wide membership in the United States, and which seems to support his request for further debate on the issue.
It states in part: "There is no current scientific evidence that marijuana is in any way beneficial for the treatment of any psychiatric disorder. In contrast, current evidence supports, at minimum, a strong association of cannabis use with the onset of psychiatric disorders. Adolescents are particularly vulnerable to harm, given the effects of cannabis on neurological development.
Policy and practice surrounding cannabis-derived substances should not be altered until sufficient clinical evidence supports such changes.
Medical treatment should be evidence-based and determined by professional standards of care; it should not be authorised by ballot initiatives."
The position paper continues: "Given the gravity of concerns regarding marijuana as medicine, professionals in both neurology and psychiatry have emphasised the importance of prospective studies to understand the mechanisms by which cannabis functions, and its impact on mental health and behaviour before instituting changes in practice and policy."
NEED FOR CLEAR STATEMENTS
In light of this and his own research and treatment of patients, De La Haye is insistent that medical professionals must provide the information to properly inform public debate and not allow other people in advancing their personal agendas to derail such an important national public-health debate with misinformation.
"The APA, when they have a position it is very carefully thought through on a scientific basis before they make a pronouncement, and so anybody with another view is really a diminishing minority of psychiatrists. Don't make them let you think that it is most psychiatrists who are not sure. The APA view means that the vast majority have that view and it is a few dissenting voices who are putting a different position forward and would want you to think that's the normal thing, but it isn't."
And while both consultant psychiatrists and Seiveright agreed that none of the studies had shown that smoking ganja leads to madness, they admitted that the research had found a link between ganja use and a higher risk for psychosis. In fact, the results of a study as to whether the age of ganja users affect this risk in a manner similar to the risk of dropping out of high school was addressed by Michael T. Compton, MD, at the APA 2014 annual meeting.
The meeting heard that preliminary data from the Allied Cohort on the Early course of Schizophrenia (ACES) II project, a secondary analysis of ACES, showed that youth who used cannabis between the age 15 and 17 years, experienced first-episode psychosis an average of almost four years earlier than their counterparts with first-episode psychosis who did not use cannabis.
On the question of whether he was worried about the negative impact of marijuana legalisation on vulnerable youth, Compton, who is chairman of the Department of Psychiatry, Lennox Hill Hospital, New York City, and professor of psychiatry at Hofstra University North Shore-LIJ School of Medicine, Hempstead, New York, gave this answer.
"My view is that marijuana use is not good for young people, and it's not so much because of my research on psychosis, because psychosis is a rare event. The more important issues in terms of marijuana use in adolescence is that it's associated with poorer school performance, and even academic failure and school dropouts. Not completing education is a huge public-health problem."