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Tokepure - another reply from Anne Milton at the Dept of Health

19 Nov 2011

Continuing the exchange between myself and Anne Milton at the department of health regarding asking the Government to run a campaign similar to Toke pure, designed to encourage cannabis users not to smoke tobacco along with their cannabis. You can read the previous exchanges here.

It's important to remember when reading this reply that I emphasised I was not questioning the basic policy toward cannabis, I was simply and only asking for a harm reduction campaign aimed at cannabis users to encourage them to smoke without tobacco. The response is amazing for its stupidity, even by the low standards we've come to expect from especially this but also previous governments. As always the letter arrived by snail mail on paper, so I've had to transcribe it, so any errors are probably mine. Here it is, in full.

From Anne Milton MP

Dept of Health

To my MP, Simon Wright

Thank you for the letter of 28th September from your constituent (me) about cannabis and tobacco policy

I note Mr Williams' continuing concerns about this issue. However I disagree with his statement that 'the Governments policy towards cannabis is not "driven by science or even a desire to protect public health". While there are no confirmed deaths due to cannabis use, we must take into account the other harms associated with cannabis:

* Chronic bronchitis and lung damage
* Inhibited reproduction functions
* A small but significantly increased risk of psychotic symptoms and disorders in later life associated with heavy use
* Schizophrenia (although this may be due to individual vulnerability rather than a universal risk; and
* Insomnia, depression, aggression and anxiety

If, as Mr Williams suggests, we were to advocate that people smoke cannabis without tobacco, we would be ignoring this evidence and putting people at risk of harm. It is because of these risks that we advise that no one smokes cannabis. The most important harm reduction measure that cannabis users can take is to not smoke cannabis. If needed there are services and online facilities available that can help individuals reduce or stop their cannabis use.

We remain very concerned about tobacco use, which, in all its forms, remains one of our most significant public health challenges and is a major cause of health inequalities in England. We are committed to tackling the costs to health and wider society of tobacco use and are determined to reduce the rates of tobacco use. As stated in my letter of 5th September (our ref PO00000637700) we are undertaking the actions set out in "Healthy lives, Healthy People; a Tobacco Control Plan for the UK"

Over the past 10 years there have been significant steps taken to reduce tobacco use: These include:

Introducing laws to provide protection from the harm caused by exposure to second hand smoke in enclosed workplaces and public places;
Raising the age of sale for tobacco products from 16 to 18 years and;
Setting up an extensive nationwide network of local NHS Stop Smoking Services.

Today, smokers who quit with the support of the NHS are up to four times more likely to quit long termthan smokers who try to quit by going "cold turkey". In October, the sale of tobacco products through vending machines became illegal and the brightly coloured displays of tobacco that we are used to seeing will also slowly start to be removed by next year. These measures will help to reduce tobacco use uptake in young people.

The evidence is clear that cannabis is harmful to health and that tobacco in any form - whether it is in cigarettes, roll ups, water pipes (including shisha) or combined with cannabis or any other drug - is harmful to health. Because of these risks we will continue to advocate that people do not smoke either substance and continue to help and support those who want to stop.

Please do contact me again id there are any further concerns.

Anne Milton


Some comments:

First she reffered to my comment in the previous letter:

I note Mr Williams' continuing concerns about this issue. However I disagree with his statement that 'the Governments policy towards cannabis is not "driven by science or even a desire to protect public health".

The present policy is not driven by science and doesn't pretend to be. The advice from the scientific advisory body (The ACMD) to keep cannabis as a class C drug under the Misuse of Drugs Act 1971 was ignored by the previous Prime Minister quite openly. He made the decision to move cannabis to the more serious class B against the committees advice for purely political reasons and was supported by this government in doing so.

If the policy were driven by health concerns then cannabis would be a ideally regulated drug, controlled for purity, strength and potency (THC/CBD), but at the very least users would be given effective harm reduction advice on the greatest risks associated with using it. This, of course, would mean advice on ways to consume cannabis without tobacco. The government is fully aware of the risks associated with tobacco (as she makes clear in this letter) and yet refuses to communicate known information to the people most at risk.

She States

While there are no confirmed deaths due to cannabis use, we must take into account the other harms associated with cannabis:

* Chronic bronchitis and lung damage
* Inhibited reproduction functions
* A small but significantly increased risk of psychotic symptoms and disorders in later life associated with heavy use
* Schizophrenia (although this may be due to individual vulnerability rather than a universal risk; and
* Insomnia, depression, aggression and anxiety


There are, of course, no "confirmed deaths due to cannabis use" in around 5000 or so years of recorded history, I think it's reasonable to assume from this that cannabis use doesn't kill anyone. Tobacco however, does and we are dead certain about that.

The other risks she states may or may not be valid - although they are at the very least over stated in a way typical of politicians when they try to defend the undefendable. However, even if true, most of them are irrelevant to the claim that mixing cannabis with tobacco makes the health risks very much worse.

The only smoking related issues listed there are

* Chronic bronchitis and lung damage

Now there is a lot of research to indicate cannabis does not cause the lung damage it might be expected to do, for example:

Marijuana Use and Lung Cancer: Results of a Case-Control Study (Tashkin) found:

the association of these (lung) cancers with marijuana, even long-term or heavy use, is not strong and may be below practically detectable limits

Marijuana and chronic obstructive lung disease: a population-based study (Wan)
Smoking only marijuana was not associated with an increased risk of respiratory symptoms or COPD.

" COPD is "Chronic Obstructive Pulmonary Disease" - it's not nice and is strongly connected with tobacco smoking. It should be remembered that the results of those two studies only refer to pure cannabis smoking, not tobacco filled joints. So her claims of lung damage are at best doubtful, although cannabis use may cause bronchitis, especially with heavy use

However in as much as they are in any way true they are dependent on the amount of smoke inhaled, it really is a quantity thing; the more smoke you breath in, the greater the risk. Smoking pure cannabis means breathing in far less smoke, probably a factor of 10 or more less.

Also tobacco adds a level of addition and hence compulsive smoking that cannabis simply lacks. Tobacco/cannabis smokers are very likely to smoke a joint not so much for the cannabis effects as to satisfy the tobacco craving.

This is really very, very simple and it makes her statement that

If, as Mr Williams suggests, we were to advocate that people smoke cannabis without tobacco, we would be ignoring this evidence and putting people at risk of harm.

Completely and utterly braindead stupid, a statement way beyond polite comment.

I emphasis again that I am not suggesting cannabis is without harm, especially if used heavily, nothing on earth is utterly harmless and cannabis is no exception to that rule. All I'm pointing out is that mixing cannabis with tobacco certainly make things worse, very much worse. That this is true is beyond doubt, surely?

The most important harm reduction measure that cannabis users can take is to not smoke cannabis.

So is she suggesting cannabis users should eat cannabis? If so then will they advise users to do that? Or does she equate "using" with "smoking" and simply mean to imply users should stop using? I suspect it's that actually.

But in any case, assuming her claims of harm are true and assuming the best course of action is to stop smoking cannabis, it isn't going to happen and she must know that. Even if the policy of stopping use is spectacularly successful there will still be millions of mostly young cannabis users out there ignoring her advice and toking away.

I'll write a reply in a day or so.

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