Tobacco smokers are more likely to develop mental illness than non smokers apparently.

It has long been the view of this website that tobacco represents the biggest health threat to cannabis users and it’s a view that’s easy to justify: Tobacco is highly addictive and a known carcinogen, whatever the risks associated with cannabis use it cannot be a good idea to add those presented by tobacco into the mix. Yet this is precisely what most cannabis users in the UK (and other places) do, the tobacco joint has long been the “traditional” way to smoke cannabis and is sadly still the most common method used by tokers.

This is  why UKCIA has been trying – so far without success – to get drug advice agencies and in particular the government’s rather useless “Talk to Frank” advertising campaign to undertake something akin to the UKCIA “Toke pure” campaign. So far no “official” advice service has seen fit to support Toke pure – or to come up with their own version – although most now do advise users not to smoke with tobacco, but it’s all pretty low key. Talk to Frank actually make it plain that tobacco spliffs are the normal way to smoke cannabis.

Most people mix cannabis with tobacco and smoke it as a spliff or a joint.

Whereas this is probably true, it’s a pretty daft concept to re-enforce.

Now one of the worries about cannabis use given a great deal of publicity over recent years is the claim – possibility, call it what you will – that cannabis use can lead to mental ill health. One of the reasons for adopting an anti tobacco campaign for cannabis users is based on the addictive nature of tobacco leading to excessive use of cannabis as non-cigarette smoking tokers roll joints simply to satisfy a tobacco craving, hence leading to more cannabis use.

This new study seems to provide an even greater reason to develop a “Toke pure” type campaign; tobacco use in and of itself is apparently associated with higher levels of mental illness and much more besides.

So this blog makes no apology for dragging all this tobacco stuff up again, as a report in the Guardian carried the interesting headline on Monday 11th Ocober

Smokers ‘more likely’ to binge drink, eat badly and face mental illness

This was a report about a paper by Dr. Sarah Whitehead from the Cardiff Institute of Society and Health which found that:

half of all smokers drink more than official limits recommend, but under 40% of those who have never smoked do. That trend is especially pronounced in men. And while 35% of smokers binge drink, only 23% of non-smokers and 31% of ex-smokers do.

39% of non-smokers eat the five portions of fruit and vegetables a day everyone is advised, only 28% of cigarette users do. The differences are particularly stark in mental health. While 8% of both non-smokers and ex-smokers have been treated for some form of mental illness, 14% of smokers have been.

Now without wanting  to apply a Daily Mail style of reporting to this, it would seem that smoking tobacco almost doubles the risk of developing a mental illness. Now of course many of the lurid claims we’ve heard about the risk of cannabis causing mental illness have been carried out amongst a cannabis using population which co-uses tobacco. It’s been a feature of just about all the studies into cannabis and mental health that no consideration has been given for the role of tobacco as a confounding (ie complicating) factor, this would now seem to be a serious mistake if this report is to be believed.

An important health warning of course; correlation does not prove cause. It may be that some other influence causes people who go on to develop mental illness also to smoke, perhaps people who develop mental illness “get something” from the tobacco smoke that (for want of a better term) “normal” people simply don’t experience.  Indeed, the fact that the majority of people with severe mental illness smoke like chimneys comes close to proving there is something if not causal then certainly interactive with tobacco and mental illness. Strangely this is brushed under the carpet by mental health campaigners and even the mental health services, often justified by the apparently beneficial effects of smoking on the symptoms of mental illness which itself should suggest some kind of active drug link.

However, the fact that this association between tobacco and mental illness does seem to exist and the fact that tobacco is highly addictive surely clinches the argument that there needs to be a safer use campaign aimed at cannabis users to break this deadly tobacco link? The precautionary principle would seem to suggest that it’s worth doing even if the link isn’t actually proven, let alone for all the other reasons.

The report does more than “just” expose the the link with mental illness however, if also finds a link between tobacco use and heavy drinking. Now this shouldn’t come as a great surprise as tobacco and alcohol have long gone hand in hand – the “fag and pint down the pub” culture ran very deep in this country until impacted by the smoking ban recently, although the sight of smokers huddling together outside pubs in the deep midwinter shows how strong the link is still.

Where this affects the cannabis debate of course is the old mantra of prohibitionists that cannabis is a “gateway” drug, the first step on the ladder towards hard core drug addiction. It used to be a common sight to see reformed addicts wheeled out, now “free of drugs”, telling how they “started on cannabis” as they puffed away on a cigarette. In truth the first drug most people come into contact with is nicotine via tobacco smoking. It’s often the way people come into contact with cannabis as well actually.

Yes, it’s another example of an association which doesn’t prove anything.  But what is non the less true is that most if not all problem drug users – heavy drinkers, heroin addicts and yes, people with a cannabis problems – are also tobacco smokers, usually heavy tobacco smokers. On a personal level all – without exception – of the problem drug users I’ve known have been heavy tobacco users. Why is this? There might be a simple explanation.

Tobacco is a perfect “mixer” drug. It seems to do nothing in and of itself but it amplifies the pleasure derived from taking other drugs greatly. Hence a pint with a fag, or a cannabis spliff with tobacco is so very much more enjoyable than either without the tobacco. Ask any tobacco user, that’s the answer they’ll always give. It makes these drugs far more “moreish” than they are alone.

It’s odd then that the Misue of Drugs Act doesn’t include tobacco within its remit. The supposed aim of the MoD Act is to control any drug which is causing or is likely to cause a problem for public health, yet the government refuses to include tobacco (and alcohol) because (from the Drug Equality Alliance  website)

This stance recognises that whilst alcohol and tobacco pose health risks and may have anti-social effects, their use is embedded in society, and responsible use of alcohol and tobacco is possible and commonplace.”

Given the extreme addiction posed by tobacco and the serious risks to health it poses really justify excluding it from the drugs laws because of its widespread use? The problem is that the MoD Act is wrongly interpreted as simply being a tool of prohibition by politicians, whereas in fact it could be so much more – a genuine way to actually control drug use.

To argue that tobacco should be thought of as a drug and included in the drugs laws isn’t to argue that it should be prohibited in the same disastrous way that cannabis is, but that the MoD Act should be able to encompass proper regulation and control of a legal market as instruments of control. As has often been pointed out the exercise of controls on the legal use of tobacco has been very successful at reducing the use of tobacco without creating a black market selling an uncontrolled contaminated product by organised crime.

One great step that could be taken in the fight to reduce tobacco use would be to get cannabis users to quit the evil weed, but it needs a properly run campaign and the government won’t have any of it. Tobacco use is the elephant in the room when it comes to drugs policy.

Although other reports about Dr Sarah Whitehead’s study can be found through Google there doesn’t seem to be an abstract online – nor the full text. If someone can dig this out it would be appreciated.