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| Where There's Smoke .... |
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In recent years there has been a serious re-evaluation of the relationship between cannabis use and mental
disorders. Until recently, cannabis has been seen as a relatively safe drug, and this has resulted in the propagation of mixed messages about its status and risk within both clinical settings and across the wider community.
Increasing concern among clinicians, families, the media and community leaders, combined with some influential recent research studies have contributed to a changing attitude to illicit drug use in general, and to cannabis use in particular. This is an arena where anxieties and other emotions run high, so this MHCA report with its objective approach to the issue, drawing on the latest available evidence is most timely.
The information provided in this report is of the highest quality and the recommendations are generally reasonable and practical, especially in the context of recent and overdue reform and investment in mental health by Australian governments. Some challenging issues remain however and I will only mention two. Firstly, cannabis is an illicit drug, yet despite this, availability, arguably the main driver of levels of morbidity from drugs and alcohol, is almost universal. Secondly, the major harm in terms of mental health flowing from cannabis, as emphasised in the report, occurs in a minority of those who try or continue to use the drug. Combined with the extreme difficulty in limiting availability, this implies that the major focus should be on the prevention of progress from initial or occasional to harmful use.
Of particular concern are those with a vulnerability to psychosis, and those with an established or revealed mental illness, again especially psychoses, such as schizophrenia. The most harm in these vulnerable subgroups comes from heavy use and from combined poly drug abuse.
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