Kyle Esplin, chairman of the Scottish Hemp Association, said he had concerns about the King’s College team’s research methods.
He took issue with one of Di Forti’s previous studies, looking at potential links between high potency cannabis and psychosis, in which some of the data indicated that regular to occasional use of hashish in fact reduced the risk of psychosis compared to no cannabis use. But this was downplayed in the study’s conclusion, which stated only that hashish “had no increased likelihood of psychotic disorders compared with those who never used cannabis”, while emphasising the potential link between high potency cannabis and psychosis.
Meanwhile Peter Reynolds, cannabis advocate and president of drug policy reform group Clear Cannabis Law Reform, said he did not trust the team’s motives or the scientific objectivity of their results presentation.
“All they are ever interested in is focusing on harm,” he said. “In person they are much more balanced but the way they present their research to the world is relentlessly, ‘cannabis is bad’.”
One article in the Lancet journal of psychiatry, “High-potency cannabis and incident psychosis: correcting the causal assumption”, questioned that aspect of the team’s research. It said the conclusions of studies by Di Forti and her colleagues had not acknowledged “compelling, alternative hypotheses” and that their conclusion about the harmful effect of high-potency cannabis use on mental health “is likely to be overestimated”.
The Lancet called for more subtle presentation of results. “Nevertheless, our findings strongly suggested that associations between measures of cannabis use and psychosis or psychotic disorders are far more nuanced than Di Forti and colleagues assume,” it said.
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She said the new King’s College study would welcome all cannabis users, particularly those who were using cannabis for medicinal or recreational use “who are coming to no harm but indeed getting from it only pleasure or benefit”.
“Ultimately, we shall compare not only psychological but also biological data that might help to explain why a minority of cannabis users develop psychosis and how we can we screen them apart from everyone else,” she said. “This might allow us to understand better the biology of how cannabis compounds interact with our endocannabinoid system, genetic and epigenetic, to produce the variety of effects we see, the one I am concerned about and the one you are interested in.”
She said she welcomed questions and queries from the cannabis community. “This research is open to those who, in fact, disagree with what my work has shown so far, and I hope that it will create more collaboration from both sides of the argument rather than further divisions. We can advance science only if we collaborate,” she said.
To highlight the fact that she was not “anti cannabis”, as some cannabis advocates have implied, Di Forti has also publicly stated that she was one of the few clinicians who have used their own funding to prescribe products that contain cannabis.
“I prescribe Sativex, off-licence, to my young patients who have a psychotic disorder and are heavily dependent on cannabis to help them reduce their reliance on street cannabis,” she said. “I think that if you can use well-controlled medicinal cannabis compounds to give people a chance to feel better, then why not?”
Our study aims to provide data and tools that can make physicians in the UK and across the world more confident, where appropriate, in prescribing cannabis safely.”
Kyle Esplin, chairman of the Scottish Hemp Association, said he had concerns about the King’s College team’s research methods.
He took issue with one of Di Forti’s previous studies, looking at potential links between high potency cannabis and psychosis, in which some of the data indicated that regular to occasional use of hashish in fact reduced the risk of psychosis compared to no cannabis use. But this was downplayed in the study’s conclusion, which stated only that hashish “had no increased likelihood of psychotic disorders compared with those who never used cannabis”, while emphasising the potential link between high potency cannabis and psychosis.
Meanwhile Peter Reynolds, cannabis advocate and president of drug policy reform group Clear Cannabis Law Reform, said he did not trust the team’s motives or the scientific objectivity of their results presentation.
“All they are ever interested in is focusing on harm,” he said. “In person they are much more balanced but the way they present their research to the world is relentlessly, ‘cannabis is bad’.”
One article in the Lancet journal of psychiatry, “High-potency cannabis and incident psychosis: correcting the causal assumption”, questioned that aspect of the team’s research. It said the conclusions of studies by Di Forti and her colleagues had not acknowledged “compelling, alternative hypotheses” and that their conclusion about the harmful effect of high-potency cannabis use on mental health “is likely to be overestimated”.
The Lancet called for more subtle presentation of results. “Nevertheless, our findings strongly suggested that associations between measures of cannabis use and psychosis or psychotic disorders are far more nuanced than Di Forti and colleagues assume,” it said.
20 April 2023
UK’s major new cannabis study accused of bias before it even begins
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King’s College London launched its major new study, Cannabis & Me, in early September, backed by more than £2.5m ($2.67m) in funding from UK government agency The Medical Research Council.
Headed by Marta Di Forti, senior clinical fellow at King’s Institute of Psychiatry, Psychology and Neuroscience, Cannabis & Me will use DNA genetic and epigenetics testing, psychological and cognitive analysis, and virtual reality to explore the link between a user’s biological make-up and the effect cannabis has on an estimated 6,000 participants. The study’s key goal is identifying the environmental, genetic and epigenetic markers that are most likely to cause mental health and social problems in users.
Di Forti says her aim is to provide data that will inspire more confidence in cannabis so that UK physicians will be more willing to prescribe it.
“In the UK, the prescription of medicinal cannabis remains rare,” she said. “Our study aims to provide data and tools that can make physicians in the UK and across the world more confident, where appropriate, in prescribing cannabis safely.”
But despite this stated goal, some pro-cannabis industry members have raised concerns that the results of the study could be biased towards suggesting the potentially harmful effects of cannabis, because the results of Di Forti’s previous studies have highlighted the “causal link between cannabis use and psychosis”.
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Defending the work and motivations of her team in an interview with Leafie magazine, Di Forti said her studies had not evolved from her own beliefs on cannabis but from her interaction with the young people who came to her clinic for treatment.
“Nevertheless, it is the minority I care for as a clinician and for whom I am committed to make a difference. This is why my research has focused on the link between cannabis use and psychosis, not because I believe this is the full story,” she said.
She said the new King’s College study would welcome all cannabis users, particularly those who were using cannabis for medicinal or recreational use “who are coming to no harm but indeed getting from it only pleasure or benefit”.
“Ultimately, we shall compare not only psychological but also biological data that might help to explain why a minority of cannabis users develop psychosis and how we can we screen them apart from everyone else,” she said. “This might allow us to understand better the biology of how cannabis compounds interact with our endocannabinoid system, genetic and epigenetic, to produce the variety of effects we see, the one I am concerned about and the one you are interested in.”
She said she welcomed questions and queries from the cannabis community. “This research is open to those who, in fact, disagree with what my work has shown so far, and I hope that it will create more collaboration from both sides of the argument rather than further divisions. We can advance science only if we collaborate,” she said.
To highlight the fact that she was not “anti cannabis”, as some cannabis advocates have implied, Di Forti has also publicly stated that she was one of the few clinicians who have used their own funding to prescribe products that contain cannabis.
“I prescribe Sativex, off-licence, to my young patients who have a psychotic disorder and are heavily dependent on cannabis to help them reduce their reliance on street cannabis,” she said. “I think that if you can use well-controlled medicinal cannabis compounds to give people a chance to feel better, then why not?”
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