"But alcohol is much worse than cannabis" and what about 'responsible drug use'?: Responding to a 16-year-old's email

I haven't posted a blog entry for quite a while. With all the different COVID-19 restrictions in place across the country it became extremely difficult to put together an article that applied to all. Now that things have settled down a little, hopefully I'll be able to get a few pieces out over the next couple of weeks that may assist parents across the upcoming holiday period. In the meantime I thought I would share an email I received from a young man and my response to him regarding a disagreement he was having with his parents ...

"Hi Paul, I am 16 year old male and have been having a disagreement with my parents. They have read your book and they have also heard you speak a number of times. I have done copious amounts of research that suggest drugs such as cannabis and psilocybin are relatively safe drugs to use in moderation. I completely agree that regular use is unsafe for a developing brain, but my usage of cannabis had only been occurring about once every 10 weeks or so. I am trying to highlight to my parents that there is such a thing as responsible drug use. I understand drug abuse is a real and dangerous issue, but similar risks still apply to things such as unhealthy eating. Just because some people abuse something at the expense of their health, it does not mean that everyone will abuse it. 
I haven't experimented with psilocybin, but I am very interested in trying it. I found, among many others, a study that shows a graph (that I have attached) that displays magic mushrooms (which contain psilocybin) as the lowest on the scale to cause harm to harm to users and to others. 
In conclusion, I would appreciate your opinion on 'responsible drug-use' and if you think they can be used safely." 

"Here is my response to your email - it is a tough one to answer and I hope you appreciate that I am trying to be as honest as I can. You have obviously done a lot of research and read a lot online and maybe elsewhere and I hope you will be as open-minded as possible in regard to my response …

Firstly, when it comes to cannabis I need to make it very clear that we are dealing with an illegal drug (psilocybin is also illegal but a little more complex so I'll deal with that a little later) - put as simply as possible, if you get caught using, possessing, growing or selling cannabis anywhere in Australia, there are consequences (although they have recently 'tweaked' the law in the ACT, you are under 18 – it is still an illegal drug). This could involve a caution, a fine or some form of intervention, including jail time. When I answer young people's questions around illegal drugs I have to be extremely careful that it does not appear as though I am condoning illegal activity … hope that makes sense!

I'll do the easy part first … the graph that you sent through regarding different drugs and their comparative harms. This is quite an old graph (it looks like it is from a 1997 study) and there have been a number of studies conducted since that have attempted to do exactly the same thing – look at a range of drugs and their harms (this is done by examining things like physical and psychological harms, number of fatal overdoses, number of hospitalisations, etc) and then ranking them in an order. Most of these studies have similar findings, i.e., alcohol, heroin, prescription drugs and tobacco cause the greatest amount of harm, hallucinogens are towards the bottom of the list and cannabis is usually ranked somewhere in the middle.

My great problem with comparing one drug to another (and it's something that I never do – even when I'm asked in media interviews to say which drug is the most dangerous I always refuse) is that it doesn't take into account individual difference. Different drugs affect different people in different ways and some drugs are going to be potentially far more harmful for some than others. Many people will be able to drink alcohol responsibly and will never experience a problem, however, there are others who may have a family history of alcohol dependence or alcoholism, and for them, even a small amount could lead to serious issues. The same applies to hallucinogens – as you say, psilocybin or magic mushrooms entail a fairly low risk as far as overdose and dependence are concerned, but if you have a pre-existing mental health problem and things go wrong, one dose of psilocybin could have devastating effects (does this happen often? Most probably not, but it certainly does happen!). Their reason for using the drug can also play a role in the level of harm. When people use a substance to 'cope', to deal with stress or anxiety or just 'block out the world' because they're experiencing problems, that drug use (regardless of what it is that they're experimenting with) is likely to become far more problematic. 

When a young person says to me, "But alcohol is much worse than cannabis", I ask them to explain exactly what they mean by that statement – in what way is it worse? Yes, more people die as a result of alcohol than cannabis - alcohol's overdose potential is much greater than that of cannabis and many would argue (quite correctly) that the physical and social impacts of alcohol are far worse than those of cannabis. If you look at the psychological impacts of cannabis for some people, however, they can be devastating. Of course alcohol can have significant impacts on some people's mental health but cannabis is much more likely to 'unlock' pre-existing mental health problems in young users than alcohol. Does this 'unlocking' of problems such as schizophrenia or bipolar happen to everyone? Of course not, but it is a risk. Comparing one drug to another is not helpful if individual difference is not taken into account and if you read some of the studies that produced these rankings most of them will end with a statement by the authors making that very clear … 

"Responsible drug use' is a term that I also avoid if I can because it tries to explain something simply that is actually extremely complex! 'Drug use' is a complicated term without adding the word 'responsible' to the front of it. 'Responsible' can be defined as 'having control over', so let's look at different drugs from that perspective – are you able to have control over their use?

Now I know that you may think I am playing with semantics here but see if you can follow my argument … Drugs can be either legal, illegal or pharmaceutical and as such, the use of each of these classifications is immediately different. As much as some people don't like the fact that some drugs are illegal, that is the reality and it's not going to change anytime soon (if you feel strongly enough about it and want the law changed - join an organisation that is fighting to change that law - don't just moan and groan, actually do something!). If a drug is illegal, I don't believe that you are able to use it 'responsibly' – basically because you have no control over its illicit nature – if you get caught with it, your life can change – no matter what you do, you have no control over that. Legal and pharmaceutical drugs are able to be used more 'responsibly' because if you follow the 'rules' and laws around their use, the risk of potential problems is minimised to some extent. Does that mean that pharmaceutical drug use is 'safe'? Of course not, many people die as a result of medications that were prescribed by their doctor ...

Now I'm guessing that you are now yelling at the computer and saying that you made it clear at the end that you wanted my views on whether there are certain drugs that are able to be used safely. There are certainly people who have used drugs, are currently using drugs and those who will use in the future, who have or will experience few, if any, major problems with their drug use. I'm certainly not going to lie to you and say that everyone who uses cannabis goes mad or all ecstasy/MDMA users die as a result of taking a pill! After doing what I do for the past 25 years, however, I don't believe that there is any such thing as 'safe drug use' – there are risks associated with all drugs, even the hallucinogens (which as you say are often regarded as the least harmful group of drugs), and those harms range from feeling unwell to psychotic episodes, relationship problems, financial difficulties and even death. If you're reading something that says that a drug like cannabis is completely harmless, my advice is to stop reading it immediately and go to another source. It's also important to note that if you're listening to someone who is trying to tell you that if you smoke cannabis your brain is going to turn to pus and slowly ooze out of your ears, they're not to be trusted either! You need to source information that is balanced and provides both sides of the argument – be a critical thinker. If you're simply looking for information that justifies your drug use (i.e., a website, podcast or journal article that tells you your drug of choice is harmless) more fool you – that's the easy way out. There is certainly 'safer drug use' – for many drugs there are things you can do to minimise the risks, (e.g., when it comes to alcohol you can limit how much you drink, make sure you prepare for the night ahead and don't drink and drive), but it is important to remember that less harm does not mean harmless.

Do I think at the age of 16 it is a smart move for you to use cannabis once in a while? No, absolutely not! As you allude to in your message, you do not have a fully developed brain yet and if you want it to be the best it can be, smoking dope (no matter how much, or how often) is not a good idea. Is it likely to cause major problems for most young people? No, if you do not have a family history of mental health problems, a smoke once in a while is unlikely to cause major issues (but how do you know for sure you do not have that propensity?) and you can't forget the risk of getting busted and ending up finding yourself in trouble with the law. As far as psilocybin is concerned, once again, you are going through an important stage of brain development and although hallucinogens are often regarded as lower risk in nearly all areas (apart from the possible unlocking of mental health issues, although the evidence is mixed), it can be a fairly extreme experience and one not advised for the young. My greatest problem with 16-year-olds playing around with hallucinogens after reading about them on the web is 'where to next'? Once you've had that experience, where do you go after that? I'm not talking about the 'gateway theory' here (i.e., once you start using cannabis you'll end up on heroin) – that has been debunked many times but once you've experienced a drug like psilocybin there are those who want something more extreme and intense. The internet has introduced a generation of teens to these drugs and if you read the chat-rooms you will see that some of them have moved onto some fairly intense substances (e.g. DMT, as well as some new synthetics that are potentially far more problematic).

I hope that I have answered your query. You sound like a smart young man who is trying to make responsible decisions – I hope you make a good one here and this email helps you have a good, positive discussion with your parents on the topic."

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