By akademiotoelektronik, 14/03/2023

Cannabis, more dangerous illegal than legal - Heidi.news Share this article by email Share this article on Facebook Share this article on Twitter Share a link to this article Share this article by email Share this article on Facebook

In July 2021, a poll revealed that a third of the population is clearly in favor of legalization and another third is rather in favor. A parliamentary initiative for legalization is currently underway.

What consequences would the legalization of cannabis have? It is difficult to know what this would mean in both social and public health terms, because all studies so far have been held back by a very coercive legislative framework. The illegality of cannabis has hampered for decades research on its use, both therapeutic and recreational, and for this reason, despite its popularity, cannabis remains poorly known and surrounded by several myths.

What is cannabis?

Cannabis is the Latin name given to hemp. Female hemp plants produce many substances, including over a hundred cannabinoids. The most important are tetrahydrocannabinol (THC) and cannabidiol (CBD).

These dock in the body with what are called cannabis receptors. Because our body also produces canabinoids, endocannabinoids. One of them is for example anandamide, which plays an important role in the regulation of pain, sleep rhythm, but also appetite, and whose molecular structure is similar to that of THC and of CBD. The human body's cannabis receptors are found in many different places in the body:

This is why cannabinoids are active on so many levels.

But research into the medical effects of cannabis remains difficult, as it is illegal in many countries. Most of the data therefore comes from animal or in vitro experiments. According to Gabriela Gobbi, psychiatrist and neuroscientist at McGill University in Montreal, speaking in 2019 in the journal Nature:

"The body of evidence gathered by research on CBD and THC is rather poor - when it comes to cannabis, it is difficult to conduct randomized clinical trials with a homogeneous group", adds Barbara Broers, Vice-President of the Swiss Society of Cannabis in Medicine, who practices at the HUG Addictions Unit. For all these reasons, the medical effect of cannabinoids is often still insufficiently proven and documented.

What effect does THC have?

THC is the main psychoactive substance in cannabis, which causes euphoria. THC docks in the brain with cannabinoid receptors, and activates them, which will have an effect on memory, mood, appetite and the feeling of pain. The substance increases the heart rate and may cause palpitations, anxiety and drowsiness.

Consumed too frequently, THC can impair memory, concentration, and learning, planning, and decision-making abilities — especially in adolescents. Smoking several joints a day for decades changes the structure of the brain, especially the volume of the amygdala and hippocampus, in the frontal part of the temporal lobe. Cannabis use in adolescence, particularly before age 17, can also have this effect. These brain changes may, however, be reversible.

THC could also promote the onset of psychosis in people who are genetically predisposed to it, especially in the event of heavy consumption. However, the causal link is not yet clearly established. Perhaps also people with mental health problems are more likely to smoke cannabis – there are no large studies on this yet. In people with schizophrenia, a disease that usually manifests in their twenties, THC can also promote the onset of the disease. According to Barbara Broers:

Prescription THC. Despite its risks and psychoactive properties, THC is used in medicine because it is effective against nausea, pain and lack of appetite. Doctors prescribe it for example to cancer patients, after chemotherapy, against nausea. THC-based drugs also help AIDS patients restore their appetite. Finally, THC drugs can also provide a remedy in cases of chronic pain.

What effect does CBD have in the human body?

The second most important active molecule, CBD can counteract the negative effects of THC. Because CBD also binds to cannabinoid receptors, but to reduce their activity. CBD can also inhibit proteins and receptors that trigger cramps, pain, and inflammation.

Side effects include dizziness, fatigue, and irritability. This substance can also increase the concentration of certain drugs in the blood – such as grapefruit juice. However, the use of CBD is in principle safe. The WHO concludes in its 2018 CBD report:

CBD is therefore not subject to the narcotics law in Switzerland, so it is legal. Likewise, cannabis with less than 1% THC and a high CBD content can also be sold.

However, the researchers issued warnings about the commercial use of products containing CBD. In 2017, they had analyzed the chemical composition of 84 products containing CBD. The CBD level listed was only labeled correctly for a third of them. And most importantly: many of them contained THC, heavy metals, pesticides and toxic substances, resulting from the manufacturing process. Contaminated and not pure CBD products are increasingly common in Switzerland.

Are the medical applications of CBD scientifically based? Legal CBD is touted by many lifestyle product manufacturers as the ultimate cure for all ailments. However, the positive effects of CBD on health have not yet been clearly proven – even for its medical uses. From a therapeutic point of view, CBD remains interesting, because unlike THC, it has few side effects and above all, it is not psychoactive.

The best documented effects of CBD relate to the treatment of certain rare forms of epilepsy in children, such as Dravet syndrome and Lennox Gastaut syndrome, two pathologies for which other drugs are almost ineffective.

Another promising field of application according to experts: that of mental disorders – from insomnia to anxiety, and even schizophrenia. The researchers also hope for a positive effect against depression, because CBD acts on the brain in a similar way to antidepressants. In addition, CBD raises hopes of better treating chronic pain.

And the spectrum of potential medical applications for CBD is even broader: it could have an antibacterial action, and studies have even shown that it can hinder the multiplication of certain cancer cells. However, it is still far from being a proven cancer treatment.

Another problem with the use of CBD in medicine is that its effect is very dose-dependent. It requires a precise prescription: a dose of 300 milligrams can, for example, help a patient against anxiety, while 100 or 900 milligrams would have no effect in the same person. The optimal dose is different not only depending on the symptoms, but also depending on the person.

Can medical cannabis be used in Switzerland?

As for products that contain more than 1% THC, only one drug is authorized in Switzerland. It treats spasms related to multiple sclerosis. Doctors also have the right to prescribe products containing more than 1% cannabis in certain specific cases: chronic pain, severe depression, or attention deficit disorder - however, for this they must recover for each order an exceptional prescription authorization from the Federal Office of Public Health (OFSP). In 2019, the FOPH issued nearly 3,000 authorizations of this type. Parliament voted last March in favor of a legislative change to simplify this obstacle course.

And yet, cannabis-based treatments are not reimbursed by compulsory health insurance. According to doctor Barbara Broers, this is regrettable:

In addition, these drugs are inexpensive. The federal government has previously investigated the possibility of reimbursement for cannabis-based medications, but the results have been inconclusive. Because the problem remains: the medical benefits of cannabis have not been sufficiently proven and documented….

Is non-medical cannabis suitable for self-medication? “For us doctors, self-medication is problematic when there is a disease that needs to be treated,” explains Dr. Barbara Broers. It is safer to discuss the dosage with a specialist, to rule out the risks. The problem also comes from the black market: "Cannabis bought on the sly contains far too much THC, but also pesticides and other impurities," she warns.

Is recreational cannabis use bad for your health?

Most of the time cannabis is smoked. All the disadvantages and health risks of smoking, namely cardiovascular and respiratory diseases, are therefore associated with it. However, consumers often don't smoke cannabis as much as tobacco. "The average smoker smokes 10 cigarettes a day – stoners usually don't exceed one joint a week," says Reto Auer, director of a cannabis study and researcher at the University of Bern, among other things on the effects of smoking.

"As surprising as it may seem, there is some data that shows that cannabis use has no effect on the incidence of lung cancer," he adds. large cohort studies, for which consumers were followed for thirty years, researchers compared the lung function of tobacco smokers, cannabis smokers, and consumers of both substances. They could not detect any negative effects of occasional cannabis use. Similarly, the risks of developing cardiovascular, renal or hepatic diseases were not higher among occasional cannabis users.

When it comes to the risks to the body of consuming THC and CBD, it all depends heavily on the cannabis consumed. Since the 1960s, cannabis growers have favored hemp plants with the highest possible THC content. While in the 1960s, cannabis contained on average less than 3% THC, today the THC level rises between 10 and 20%.

A large joint can contain up to 100 milligrams of THC. "Thanks to police data, we know that cannabis, in the form of grass, marijuana, contains on average 12 to 13% THC", says Frank Zobel, vice-director of Addiction Switzerland, and engaged for decades in drug research and public policy. For resin, hashish, this figure is much higher, at 25%.

The higher the THC level, the greater the risk of encountering side effects, even if the CBD comes to counteract them. However, on the black market, it is impossible to know what you are consuming. This is the main argument in favor of legalization: “In the case of cannabis, the effects of illegality are very clearly negative,” concludes Dr. Barbara Broers.

There is no consensus of experts on the stage at which consumption is a problem. In the eyes of many researchers, a person who smokes cannabis at least three times a week, or even every day, is considered a heavy user. But the frequency of consumption is, according to Barbara Broers, only one factor: "The quantity, the time of day and the personal situation of the consumers are just as decisive."

Is cannabis addictive? "It's a very old debate," says Frank Zobel. "Today, a consensus seems to be established around the fact that an addiction can appear, but less often than for alcohol and tobacco." According to Barbara Broers, it is mainly tobacco that makes you addicted to smoking joints. The addiction potential of cannabis itself is limited, the withdrawal syndrome very marginal. "No possible comparison with alcohol or opioids," she says. But a psychological dependence can of course appear.

Does cannabis make you lose motivation? "It's also a big open question: whether the famous amotivational syndrome really exists," continues Frank Zobel. The problem is that half of cannabis users are under 25. Cannabis is therefore a youth drug. And it is precisely in this phase of life that puberty occurs…. The question then is is cannabis the cause or the effect of the loss of motivation? The answer of the researchers is not yet decided.

The black market in Switzerland

Cannabis is the second most lucrative illegal drug in Switzerland after cocaine. This is the result of a Vaud study for which researchers from Addiction Switzerland and the Institute of Criminology at the University of Lausanne scrutinized the narcotics market. According to this study, the turnover of the canton of Vaud in terms of cannabis amounts to 46.3 million francs. If we transpose this figure to the whole of Switzerland, we obtain a turnover of 500 million francs. By comparison: Feldschlösschen Boissons SA achieved sales in Switzerland of approximately 910 million Swiss francs in the same year. The cannabis market is also very heterogeneous; small-scale local crops represent about a tenth of the whole, at least in the canton of Vaud.

The big problem with the black market is that consumers have no visibility into what they are buying. "Synthetic cannabinoids, which have appeared recently, are particularly dangerous," worries Frank Zobel. Some people buy legal CBD cannabis, then order synthetic cannabinoids from China, vaporize them on the cannabis, and then sell them on the black market. These synthetic substances are often much stronger than the THC in natural cannabis, and can have dangerous side effects. Deaths have even been documented — but not in Switzerland.

What would be the consequences of legalization? Legalization generally goes hand in hand with an increase in the number of users. “This was also the case for CBD in Switzerland,” explains Frank Zobel. "When the sale of this 'legal cannabis' was authorized in 2016, there was quickly a real CBD Boom – this curiosity effect disappeared after about a year".

Would it be the same with cannabis that contains THC? "We cannot anticipate the effects that legalization would have," says Frank Zbel. He has just written a summary study on the effects of legalization in the United States and other countries. Because cannabis is legal in 18 American states, as well as in Canada and Uruguay. The study shows that in the short term, legalization does lead to an increase in consumption – but only among adults.

One of the main unanswered questions around legalization is whether legalization would cause an increase in regular users. “Regular consumption over long periods of time is problematic, as is the case with alcohol,” explains Frank Zobel. Those most at risk are those who use cannabis daily or almost daily — for months or years.

Little research has been done on cannabis consumption patterns. “Until now, cannabis use has been measured in a very simple way,” says Frank Zobel. That is to say, on how many days per week the Swiss population consumes cannabis. But in what quantities, with what concentration and in what way? Data is missing. "It's a bit like asking, in a study of alcohol consumption, how many days you drink alcohol, and it doesn't matter if it's schnapps or beer, just a drink or an entire bottle,” explains the drug expert.

According to Frank Zobel, many questions still remain unanswered: For example, how does the consumption of tobacco and alcohol add up with that of cannabis? Do people who smoke cannabis drink less alcohol in return? Are they, on the contrary, more likely to become tobacco smokers?

Upcoming pilot studies. It is precisely these kinds of questions that the Swiss pilot studies will have to answer, in Bern, Basel, Zurich, Geneva and Lausanne.

The city of Bern was a forerunner in cannabis research. As early as 2017, she had planned a study on cannabis, which had been rejected for lack of a suitable legal framework. The aim of this study was to assess the effects of regular sale of cannabis in pharmacies.

This study should be revisited here. According to Reo Auer, director of the study in Bern: "Our aim is, among other things, to observe whether consumers achieve less harmful types of consumption for their health, and what the delivery of cannabis could bring to pharmacies”. In particular, with regard to the THC level. “Most users use cannabis for pleasure, and only some of them are interested in the “high”, that is to say a high level of THC”.

The study under the magnifying glass

The study. Attitudes Regulation and Legalization Cannabis

The comment. This is a self-assessment based survey. It is not certain that the result will be the same in a possible referendum. The survey can only be understood as an indication of a trend.

Reliability. Non-peer-reviewed, representative survey conducted between late January and early April 2021, 3166 participants, random sample.

The type of study. Population survey.

Financing. Federal Office of Public Health (OFSP).