By hook or by crook

We’re not reaching people with problematic cannabis use says Lizzie McCulloch, whose report Black sheep offers a new approach to policy and treatment.

Cannabis is now being cited as a problematic substance by 21 per cent of clients going through treatment and figures from Public Health England (PHE) show that new presentations for cannabis treatment increased by 55 per cent between 2005 and 2014. These figures do not paint the whole picture though, as there are also thousands of people outside of treatment who require support.

In response to indicators showing there is an increasing need for support and guidance, Volteface, a drug policy think tank, wanted to find out how effectively existing interventions were supporting people experiencing problematic cannabis use. Drawing on contributions from leading experts and practitioners, and people with lived experience of problematic cannabis use, our newly released report, Black sheep, shines a spotlight on the harms of heavy and sustained cannabis use.

Put bluntly, we found that cannabis has been neglected in public health discourses, which is at odds with the growing number of people in England who are seeking support for problematic cannabis use. It was apparent that there has been increasing attention given to problematic cannabis use, mostly at an operational level, but overall, cannabis has not been appropriately prioritised. What is concerning is that out of non-opiate clients accessing treatment, cannabis users were the most likely to have unchanged use at the six-month review, which equated to 42 per cent of those who entered treatment.

For people who do not enter treatment, it was revealed that the ‘image’ of treatment was off-putting, whether due to social stigma surrounding treatment or the perception that treatment was only for ‘extreme’ cases. However, alternative options were limited as one-to-one interventions were mostly confined to dedicated drug treatment services, with wider community services severely limited in what they could offer. For people who are seeking to manage their cannabis use relatively independently, there are limited public resources available, with added concerns over quality and accessibility.

A unified and multifaceted approach is needed to respond to the cannabis cohort. A wider structural barrier that stakeholders identified, however, was that practitioners do not have a clear strategy for linking people experiencing problematic cannabis use into services. With the current illegal and unregulated market reducing the visibility of cannabis users, one practitioner commented that ‘we’re just fumbling around in the dark trying to find them’. Among people showing signs of cannabis dependence, only ‘14.6 per cent had ever received treatment, help or support specifically because of their drug use, and 5.5 per cent had received this in the past six months’.

To respond to these challenges, Volteface have drawn up sensible, innovative policy options, which are grounded in contributions from stakeholders and experts. We identified that a two-stage approach is needed: reforming existing public health measures to tailor support to the needs of problematic cannabis users and the introduction of a regulatory framework that links these public health measures with their intended audience.

Research into the social costs of problematic cannabis use by PHE would provide justification for commissioners, and therefore providers, to appropriately prioritise cannabis within treatment. Moreover, a shift towards holistic service provision and promotion by drug and alcohol service providers and wider community services would aim to increase interaction and engagement with support, while reducing stigma attached to drug treatment.

A move towards a regulated market would offer a targeted dialogue with people experiencing problematic cannabis use, offering opportunities for harm reduction advice to be delivered at point of purchase, and any person in need of support to be linked into reformed public health measures. There would also be the emergence of wider opportunities for more public guidance, packaging controls, products that vary in potency, and research into cannabis culture and consumption. During Volteface’s consultation with people experiencing problematic cannabis use, it became apparent that respondents felt ‘advice from a professional is far better than advice from a dealer’.

Despite numerous examples of good practice taking place across the sector, the collective effort is currently not meeting the needs of people experiencing problematic cannabis use. Change is within our grasp, but we need to be ambitious and innovative when it comes to reaching a growing and diverse group of people.

Lizzie McCulloch is policy advisor at Volteface