Smoke Alarm: Clearhead tackles Cannabis and tobacco.

A new website came to my attention last week called “Smokealarm“, dedicated, so it says, to

… raising awareness among community practitioners concerning the addictive interdependency of cannabis and tobacco, as well as changing the habits and lives of smokers.

The issue of cannabis and tobacco has been an issue this site has been trying to raise for some time now, in fact it’s something very close to the heart of UKCIA. Since around 2000 this site has had a whole section dedicated to breaking this addictive and highly dangerous link called Tokepure. The vast majority of cannabis users still roll tobacco joints and for many mostly young people cannabis is a very real gateway to a highly addictive and carcinogenic drug.

So any organisation which sets out to draw attention to this issue gets at least one cheer from this site, it’s an issue the government utterly refuses to be drawn on, Talk to Frank all but avoids and about which nothing has been done for way too long at any level, yet separating the use cannabis and tobacco is by far and away the biggest harm reduction measure aimed at cannabis users the government could promote.

So what follows should be read with the understanding that criticism is meant as a positive contribution to what is a new and very welcome concept and is made in the hope that Smokealarm can become something which has a real influence on what is possibly the darkest corner of the cannabis culture; the insidious link with tobacco.

Smokealarm is the latest incarnation of Clearhead, aka James Langton.

James Langton and Clearhead are names that have cropped up quite a lot over the past few years. “Clearhead” is a sort of counselling service dedicated to helping people who have a problem with their cannabis use to get control of their habit and if possible quit.  James, was, until around 2000, a self employed tradesman who by his own account had a big problem with cannabis. He quit following contact with Marijuana Anonymous and worked for them as a support line councillor for a while before founding his “Clearhead” organisation.

Now, maybe it’s because I follow these things perhaps more closely than most people, but between 2005 and last year it seemed that James was going out of his way to associate Clearhead with every prohibition supporting anti cannabis campaign there was. At one point he was even an advisor to “Talking About Cannabis”, although quite how much advice he was able to give isn’t known. Clearhead is still listed on the links page of Talking About Cannabis and the breakaway site “Talk about cannabis and skunk” where it’s desribed rather misleadingly as “Online support and advice for cannabis smokers”.  This apparent willingness to associate with the drug war side of the cannabis debate hasn’t done much for Clearhead’s reputation amongst cannabis users and certainly not among cannabis law reform sites, UKCIA being a notable exception in that we’ve carried a link to the organisation, albeit with a health warning.

Don’t be put off by the name or the born-again ex-smoker slant, the site contains good information.

To be honest, even the name seems almost designed to alienate cannabis users who as James himself admits don’t consider they have a problem, even if they do – these of course are the very people Clearhead would seem to be intended to reach out to.

A review of the whole Clearhead organisation is overdue and, having just read the supporting book “No need for weed” from cover to cover, one should be forthcoming soon.

But what of this Smoke Alarm (SA) site?

Well, to be honest the name is another example of bad PR. Surely the message James wants to put across is a positive one, he’s identified an issue which needs addressing, can easily make a case for promoting it and can suggest a desired outcome. The choice of name should reflect that constructive outlook, “smoke alarm” fails to do that on so many levels.

Now the prime audience for SA isn’t the cannabis user as such, it’s the professionals who the site calls “community practitioners” and perhaps this is where SA’s problems begin. CP’s are on the whole professional people either working at the sharp end of drug outreach work – and are thus in touch with the culture already – or else as health professionals, doctors, nurses, teachers, that sort of thing. SA has decided to appeal to these people by using a science based argument and, sadly, it’s not really up to it as we will see. Perhaps worse, it fails to present a proposal for a way to make its case to the target audience of joint smoking cannabis users.

The introduction is good:

Welcome to Smoke Alarm

Smoke Alarm is dedicated to raising awareness among community practitioners concerning the addictive interdependency of cannabis and tobacco, as well as changing the habits and lives of smokers.

The risk to physical health from inhaling the cannabis and tobacco cocktail is a phenomenon that impacts the lives of millions on a daily basis.

Sometimes it’s good to state the blindingly obvious, especially when everyone is aware of it and yet no-one dare mention it. This is good, eye catching stuff. A link invites us to read more:

Throughout Europe, and in many other countries around the world, the favoured method of cannabis delivery is to smoke the drug together with tobacco, creating a powerfully addictive carcinogenic cocktail. The risk to health from tobacco smoking is incontrovertible; the risks from cannabis are more controversial and often less readily accepted.

Well to be accurate it’s not that the claims of cannabis causing cancer are “controversial”, they are far from proven. Indeed there is a growing body of evidence to suggest that although cannabis smoking does have a negative impact on the lungs, it isn’t cancer causing (Tashkin et al) and that tobacco is a danger for cannabis users, not the other way around. More about this sort of thing later.

We are also told that

Smoke alarm is a not for profit, Community Interest Company dedicated to offering credible information to the estimated 3 million people who regularly smoke tobacco joints here in the UK. We do this directly educating through schools and colleges as well as indirectly through tobacco cessation professionals, drug agencies, and youth services.

So the aim of SA is to produce information of interest to cannabis/tobacco users which is designed to get their interest and with luck separate the two drugs. We would therefore expect the SA website to go into some detail of what that material would be and how it would be framed.

The presentation of the site is very professional looking, nice clear graphics and navigation. The main menu offers us a choice:

The first is “Who We Are”:

Smoke Alram are:

James and Zulfi

A brief introduction to James and his associate in this project, Zulfi Rahman. This sets out the stall in the way James seems to think will appeal to those who work with drug users, but which to be honest would send shivers up the back of any self respecting toker, ie the very people they want to be influencing.

James is well established as a bit of a born again ex-cannabis user on a mission to save people, but Zulfi in particular comes across as a very earnest born again drug free crusader who’s seen the light:

As my experience of current youth cultures increased I became alarmed by the position tobacco and cannabis held, and the negative effect it was having on many communities. This awareness contributed to my own personal concerns. I began the process of addressing my own destructive relationship with tobacco, cannabis and other ‘recreational’ drugs which brought me into contact with Clearhead in 2006.

Somehow this doesn’t come over as a team who are going to be well received by the target audience. But of course, this site is aimed at “industry professionals” who may see things differently, perhaps so. However, the aim is to promote a programme aimed at getting cannabis users to kick the tobacco habit isn’t it?

We then get two questionnaires, no doubt intended to identify interested people and to get some feedback; a Tobacco Cessation Questionnaire and one for Youth Workers and Substance Abuse Teams.

“Cannabis, tobacco and Young people” promises to give a bit more background:

Many young cannabis smokers do not consider themselves to be nicotine addicted simply because they mix their cannabis with tobacco. However it’s when the supply of cannabis is curtailed or they make an attempt to quit the drug that the nicotine pull gains dominance. This dynamic can set up a life-time nicotine cannabis relationship that remains one of the hardest for adult drug users to break.

This is true in part for sure, tobacco introduces an addictive element to cannabis use pure cannabis simply doesn’t present – at least to the vast majority of users. Many joint smokers will roll a joint not for the cannabis effect, but to get a hit of nicotine. In my experience of the past 40 or so years, I’ve known many young cannabis users who quit cannabis without too much of a problem, but have remained tobacco users even into their 50’s, having become addicted to tobacco through their brief experimentation with cannabis. However I have never met anyone who decided to quit tobacco but remained addicted to cannabis other than, apparently, James Langton. It’s probably at this point the alarm bells began to sound.

The next section is headed Cannabis, Tobacco and COPD:

COPD is  chronic obstructive lung disease, a condition most often associated with long term tobacco use. SA seems to imply that cannabis is a proven cause of COPD and a far greater risk than tobacco, and they dedicate a whole page to this issue. The page is actually a reprint of a BBC news item from 2002 which reported in somewhat exaggerated terms the claims made by the British Lung Foundation report “The smoking gun“. The Smoking Gun was much criticised at the time, not least of all by UKCIA and is the origin of the claims that smoking cannabis is four times more dangerous than smoking tobacco in terms of the damage it does to lungs. Over the past seven years since that BLF report, studies have been done in an effort to prove the claims one way or the other.

For example  Marijuana and chronic obstructive lung disease: a population-based study by Wan C. Tan MB, Christine Lo BSc and others concluded

Smoking both tobacco and marijuana synergistically increased the risk of respiratory symptoms and COPD. Smoking only marijuana was not associated with an
increased risk of respiratory symptoms or COPD.

Another study, mentioned above: “Marijuana Use and the Risk of Lung and Upper Aerodigestive Tract Cancers: Results of a Population-Based Case-Control Study“by Donald P. Tashkin ad others from UCLA actually came to an unexpected conclusion:

Results: Although using marijuana for 30 joint-years was positively associated in the crude analyses with each cancer type (except pharyngeal cancer), no positive associations were observed when adjusting for several confounders including cigarette smoking.

Conclusions: Our results may have been affected by selection bias or error in measuring lifetime exposure and confounder histories; but they suggest that the association of these cancers with marijuana, even long-term or heavy use, is not strong and may be below practically detectable limits.

The message given on this page of SA is highly questionable. The site seems to be making the claim that cannabis is an increased danger for tobacco users, whereas the opposite would seem to be far closer to the truth: It is more important to stop cannabis users smoking tobacco than to stop tobacco users smoking cannabis.

In any case, health professionals will likely be  up to speed on the issue of cancer and smoking. James may be well motivated and dedicated, but he clearly isn’t a scientist and this comes across by the use of this somewhat old and a certainly cherry picked alarmist news story in what should be a factual presentation.

We then have a link to the Clearhead site labelled as “Clearhead Resources” and some proposed Seminar Venues & Dates.

The heading “Seminar Topics” gives a list of topics to be covered in SA programme, sadly with no more information:

Using NRT in a cannabis context;  Cannabis and tobacco – the medical evidence; Understanding psychological addiction relating to cannabis; Physical withdrawal symptoms from cannabis, reality or myth;  Strategies for working with young cannabis users;  The mental health perspective (when, where and how to refer);  Cannabis and ambivalence;  Demographics of cannabis use;  Tolerance and the risks associated with skunk, and stronger strains of cannabis;  A uniform assessment procedure;  Lapse and relapse prevention strategies.

Many of these are interesting topics and are certainly not clear cut, indeed would demand the sort of examination I doubt James and his team can provide. I don’t mean that in a condescending way, but as has already been noted, James isn’t a scientist and this is pretty complex stuff. The mental health debate and whether or not cannabis produces an amotivational syndrome would seem to be somewhat off-topic. The section on “Tolerance and the risks associated with skunk, and stronger strains of cannabis” is clearly rather vague given the important issue isn’t so much the strength of cannabis but the THC/CBD balance.

“Strategies for working with young cannabis users” is the nearest we come to a programme of outreach to cannabis/tobacco users. How to relate to the culture, how to present the issue in such a way as to get the interest of the target group, how this can be integrated into the prohibitionist drugs strategy and so on covers a wide area and is surely the focus of the programme? Perhaps a section looking at the sale of so-called “paraphernalia” – pipes and suchlike which are essential for a safer smoking programme – could also be included, along with “headshop” regulation?

So in conclusion James Langton has identified perhaps the major issue surrounding cannabis use in the connection with tobacco and he has determined to actually get out there and do something about it and that’s good. There’s nothing wrong with the route he’s trying to take either – engaging with the industry professionals  whose interest is vital for getting the message on some kind of official footing.  However, the message he’s trying to sell is badly focused in that it seems to be aimed at stopping tobacco users from also using cannabis rather than the other way around and certainly isn’t being presented in a way that’s likely to appeal to cannabis users.

Not wanting to put words in his mouth but James would probably point out that the government simply won’t entertain a “safer use” campaign aimed at cannabis users and given the present poitical climate he would be right, but that is the message that needs putting out non the less.

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Footnote

An interesting development has taken place over on Talking About Cannabis, the rabid anti cannabis site. The “Facts about cannabis” page critiqued on this blog recently has been taken down. We await the next version of the truth with interest!