Professor Neil McKeganey who was the subject of last weeks blog has been having another prohibitionist rant, this time about a leaflet published by NHS Health Scotland called “Fags ‘n’ hash”, about cannabis and tobacco. – see it here (pdf)

Prof Neil McKeganey

Prof Neil McKeganey (picture: Scottish Sun)

Neil was quoted in the  Scottish Sun “news” paper today in an item headed “Fury over guide to cannabis” – it is funny how prohibition supporters are always “furious” or “outraged” by such things, but that’s just the way they are.

Prof Neil McKeganey, of Glasgow’s University’s Centre for Drug Misuse, said: “The leaflet conveys a far too positive image of cannabis.”

And he was backed up by  Tory justice spokesman John Lamont who said:
“A lot of drug addicts who use heroin start off on cannabis.”
Lamont’s contribution will get the contempt it deserves here by simply being ignored, but as we’ve noted before McKeganey is a respected scientist who, with his unshakable faith in prohibition as a workable regime, does much to give it the sort of respectability such a failed regime would not otherwise have.Whereas John Lamont is just some idiot politician, Neil McKeganey is a genuine drugs expert – or he should be.
The leaflet that’s caused so much fury is actually a minor update of a leaflet that’s been around since 2005 (original here pdf), so why Neil has only just noticed it isn’t clear. The only change that’s obvious is in the information about the legal status of cannabis, having been moved from C to B since the old leaflet.
Fags ‘n’ hash looks at first sight like just the sort of thing UKCIA has wanted to see for a long time; a leaflet describing the added dangers of tobacco and how to use cannabis in ways which avoid these dangers; at the risk of over repetition, Tokepure is the sort of thing. Sadly, this leaflet is no Tokepure, although it gets so close.
This is what the leaflet says:
Cannabis and tobacco are both smoked, often together. This booklet tells you how using them can affect you, what the law says and how to reduce the risks.
The big problem this leaflet suffers from right from the start is that it isn’t just a health advice leaflet, it’s also a part of law enforcement. This mixing of stating the law and trying to give health advice really doesn’t work, why should anyone trust information in such a leaflet to be fair and balanced? This is something prohibitionists simply don’t understand yet is at the heart of why their approach fails so badly.
How is tobacco used?
Tobacco is usually smoked in:
• cigarettes
• roll-ups using cigarette papers
• pipes or cigars.
There are over 4,000 chemicals and gases in tobacco (such as ammonia, carbon monoxide and hydrogen cyanide). Many of them are killers, causing cancer and heart disease. Nicotine is the drug in tobacco that makes it addictive. Cigarettes are designed to send a nicotine rush to your brain within a few seconds of inhaling.
No problem with that
How is cannabis used?
Cannabis is usually found in two main forms:
• dried leaves and/or flowering tops of the plant (known as grass or weed)
• blocks of resin (hash, pot or blow).
Both forms are often mixed with tobacco and smoked together (known as joints) or in pipes (bongs). Cannabis can also be mixed with food, taken as a tea or eaten on its own.
Oh dear. This leaflet is aimed at cannabis users, so why describe the two forms cannabis comes in or what it’s called? Yes, both forms are often mixed with tobacco in joints, but not in pipes or bongs (although bongs can sometimes be mixes, but that’s less common).
Then we get the bit that so annoyed Neil:
Why are they used?
People use cannabis and tobacco for their effects. With any drug, the effects depend partly on your mood, personality and surroundings. One of the most common reasons why people begin to use tobacco and cannabis is that their friends encourage them.
Probably reasonably true – but then how do we discover anything interesting?
People who smoke describe it as relaxing, making them feel more at ease. They often smoke to be sociable.
People do smoke to be sociable, but often – if not mostly – they smoke to relieve a tobacco craving caused by the addiction to nicotine. The drug effect of tobacco is to make them feel good about having smoked.  They could have added that tobacco smoking often leaves the user short of breath and tight chested, but they chose not to mention any bad aspects of tobacco use. It then goes on to describe cannabis:
Cannabis is a mild hallucinogen, which means it can alter the way you see colours and shapes. Most people who smoke say the most common
effects are:
• relaxation and tiredness
• the ‘munchies’
• being talkative
• things sounding, looking and tasting different.
Other people feel it makes them tense and anxious.
We could quibble about that but it’s not too far off the mark and manages to get a bad effect in as well although it didn’t do that for tobacco.
Accepting that people use drugs for fun and pleasure is important. Prohibition campaigners would seem to like us to be told that drugs are bad and never any more than that.
Then we have two pages of the leaflet devoted to the legal state of the two drugs – which amounts to one paragraph about age limits for tobacco sales and the rest about the prohibition and legal risks attached to cannabis use. As mentioned above this sort of information has no place in a health leaflet which is supposed to be giving plain, trustworthy and honest information so we’ll ignore it.
What’s the harm?
The smoke from burning cannabis or tobacco or both contains poisonous gases that reduce your blood’s ability to carry oxygen, and tars that can cause cancer.
When you smoke, these poisons go straight to your lungs. Smoking cannabis can give you even higher levels of cancer-causing tars, gases and chemicals than cigarettes.
Again, this is something this blog has covered at length before, but whereas lab experiments have indicated cannabis smoke should be carcinogenic because it does, indeed, contain chemical nasties, when populations of cannabis users (of pure cannabis) are studied cancer and lung damage  isn’t found (Tashkin). This could be because THC actually kills cancer (anti-tumour). Despite all the research which has been done into this in recent years – and there’s been quite a lot now, they still try to claim cannabis smoke is worse than tobacco – it isn’t, they’re wrong.
It’s worth noting this use of the word “poison” as well. Whereas tobacco is actually a poison – it will kill you if you eat enough – cannabis isn’t. Cannabis smoke contains some nasties, but it also relaxes blood vessels making breathing easier.
Smoking cannabis and tobacco multiplies the dangers.
Rather more importantly, smoking tobacco with cannabis makes the risk much worse than smoking pure cannabis. Smoking cannabis alone – which they don’t even mention as a possibility – does not appear to lead to lung problems in real life studies of users, smoking tobacco or cannabis/tobacco does.
Joints don’t usually have filters. What’s more, the smoke is often drawn in deeper and held in the lungs for longer. These two factors mean that smoking cannabis and tobacco together is probably the most damaging way to use them.
It’s probably the most damaging way to use cannabis for sure, as they are about to tell us, there is no safe way to use tobacco.
Tobacco and your body
There is no safe level of smoking. Half the people who smoke will die from it.
• Tobacco can quickly become very physically addictive because of the nicotine it contains.
• You are more likely to catch colds and chest infections as a smoker.
• Smoking gives you wrinkles.
• Smoking causes cancers, strokes, lung and heart diseases.
• Tobacco is the single biggest preventable killer in Scotland, killing over 13,000 people every year.
Smoking is hard to stop, hard on your health and hard on your pocket.
All true. And about cannabis they say
Cannabis and your body
• Using cannabis makes some people feel tense and anxious.
• A common bad effect is the ‘whitey’ – light headedness, fainting and sometimes feeling sick. This is particularly associated with taking cannabis and alcohol together.
• Cannabis may make you less alert and can affect your decision-making and judgement. It is dangerous and illegal for you to drive or operate machinery when you are under its influence.
• Cannabis can contribute to mental health problems.
Despite what Neil McKeganey claims, they really have tried quite hard to make cannabis sound dangerous here, but compared to tobacco it does look pretty mionr stuff – which of course it is.
Can I become addicted?
if you smoke cannabis or tobacco or both regularly you may become dependent on using them and have withdrawal symptoms if you stop.
It can be hard to stop using tobacco. While your body gets rid of the chemicals in tobacco you might have:
• cravings for nicotine
• mood swings
• panic attacks
• headaches.
You may also feel cut off from friends who continue to smoke.
And for cannabis
Regular cannabis users who stop may experience:
• restlessness
• anxiety
• sleeplessness.
You may also feel cut off from friends who continue to use cannabis.

They don’t say that the withdrawal form tobacco is often severe, from cannabis rarely so. Indeed, the worst problem people who quit face is common to both – you’ll lose your old friends and ways of socialising. They also don’t make the point that quitting both is much harder than quitting one and that if you usually smoke both together, quitting either makes the other less satisfying.

There is then a page dedicated to drug testing as a part of cannabis law enforcement – again, nothing to do with the health advice this leaflet is supposed to be giving so again we’ll ignore it.

How can you reduce the harm?
• There is no safe level of smoking – stopping is the only way to reduce harm to zero.
• Be aware of fire risks if you drink and smoke.
• Keep smoking materials away from children. Every year, young children are admitted to hospital, having poisoned themselves by eating cigarette ends. If you decide that you want to stop smoking, you can talk to your GP, teacher or pharmacist. They can talk to you about the best ways to stop.

Yep – simple advice, there is no safe way to use tobacco – and it’s true.

Limiting when you smoke cannabis may reduce the risk of becoming a heavy user. Smoking cannabis with tobacco increases the damage to your mouth, throat and lungs –
reduce the harm by smoking less.

Surely the advice that should have come there is to toke pure – don’t mix cannabis with tobacco. Why didn’t they say so?

If you eat or drink cannabis, it can be difficult to judge how much you’ve taken. It also takes longer to kick in and the effects can hit you suddenly and harder than you expect. Hash is not produced in the most hygienic of conditions; it may come already mixed with other substances, which may be harmful, and with germs that are only destroyed by heating. Don’t mix drugs – that includes alcohol. You don’t know what will happen.

Not bad advice apart from the obvious missing safer smoking pure bit. The risks from cannabis do pale into insignificance when compared to the risks attached to tobacco use and this is a hard fact for prohibitionists to swallow. Cannabis is not without downsides and risks, but when compared to drugs like tobacco it’s  a real pussycat. It makes the government’s decision not to include tobacco in the Misuse of Drugs Act on the basis of tobacco wide social acceptance, yet to take the opposite approach to cannabis so clearly illogical and the prohibition policy so hard to understand and rationalise. This is what makes the hypocrisy of cannabis prohibition so apparent and it’s what Neil McKeganey and people like him are so worried about.

As regards this leaflet, it’s worth 2/10 and half a cheer at best. It falls down because it mixes up the legal and the health messages, which compromises its integrity. The sections on the law and drug testing simply do not belong in a leaflet like this. Most of all it fails to give the most important message which would be an enormous benefit to cannabis users – don’t mix cannabis with the killer drug tobacco. All in all, a wasted opportunity and not worth getting all furious about.