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Notes of All Party Parliamentary Group Meeting Cannabis and Children

by CanSS, posted 20 01 2014

Dr Neil Brener was welcomed by David Amess on behalf of the All Party Parliamentary Group (Cannabis and Children).

Dr Brener explained that he had been given the task of talking about cannabis and its problems in about twenty minutes and that it was going to be difficult as he wanted to leave plenty of time for questions and discussions as it is a controversial subject.  He said that he was not going to approach it as an academic lecture but that as a jobbing psychiatrist who sees people on a daily basis with this problem and so he was going to talk from his experience (which may not be the experience of everybody) and that everybody might not approve of it, but that was what he was going to do.

Dr Brener

So is there a problem?  Is cannabis an issue?  Well, about 2 million people in this country have admitted to smoking cannabis, and if you look at the younger age group between 16 and 29, about half had said that they had at least tried cannabis at least on one occasion, and so we are talking about a large amount of people.  Now, I fully accept that only a small percentage of these people will become addicted to cannabis, but, to say that there is no problem is a fallacy.

We hear from police, politicians and all sorts of people that are concerned, but yet, the research and treatment associated with cannabis is actually very limited.  So, when we think about cannabis, there is no point, as with all drugs of taking them in isolation.  They have to be seen as part of a whole drug problem and we will come on to discuss that in more detail in a minute.  But the first thing to always remember when we do is that it is not an isolated problem for the individual.  It has an effect on the family, the community and the workplace and society at large.  It is not just purely the individual that it affects.

So, first of all, just so that everyone knows, what is cannabis?  Cannabis is a plant that comes from the nettle family.  There are basically two main types of cannabis, cannabis sativa and cannabis indica. These are the two main plant variations and the substances that are taken are either from the resin or the flowering head of the plant or occasionally the leaves.  That is what cannabis is. They are then dried and then often smoked. 

So, there is a version of cannabis which you may have heard of called skunk.  Do you know why it is called skunk?  It is because it stinks!  It smells when it is grown.  It has a very unpleasant and pungent smell and it is grown normally specially lit underground places - hydroponics or greenhouses.  It is genetically modified.  This is the problem that we forget about cannabis.  I get a lot of parents who come to me and say “I used cannabis in the sixties and it didn’t do me any harm”.

It is not the same thing!  Skunk has been grown and been genetically modified to make it about 8 times stronger than old fashioned cannabis so we are not talking about the same thing.  Cannabis and skunk are quite heavily different.   Street cannabis varies considerably in strength, but probably the stuff that is called skunk, and there is variation after variation, is probably the strongest stuff that is available. And we have seen a major increase in the use of skunk.  I don’t even bother when people come through the door of my surgery to ask whether they are using skunk or not.  Almost 90%, maybe more, of the people who come to see me are using skunk or cannabis.  How is it used?  Most people crush it up, put it into some tobacco, roll it into a joint or spliff and smoke it.  It can also be put into pipes; it can also be cooked and also made into tea.  The strongest stuff is when it is inhaled.  There is a reason for this, because when you inhale, it gets into your lungs and then from your lungs it gets into your body quickly.  It is absorbed really quickly – about 7 seconds from your lungs to your brain.  So it is fast and it is extreme, so that is why people smoke.  In cannabis there is something called cannabinoids and then about 400 different chemicals within the cannabis plants, but the strongest is THC.  That is the strongest chemical.  It gets to the brain and binds to specific parts of the brain and this is what causes the effects.

So, what is the effect of cannabis?  Well, there are two types of effect.  There are the positive and the negative.  There has to be a positive because that is why people take it.  Those tend to be relaxation, sleepy, a sense of being happy, time changes, colours change and become more vivid and some people say that music sounds better.  But let us not forget the negative side of cannabis.  Now, this occurs in 1 in 10 people, 10% of people, so a large number.  It can start to cause confusion, hallucinations, anxiety, paranoid ideas, and depression.  Always remember depression. That is something that people forget.  You can become quiet depressed on cannabis, and a lack of motivation.  A lack of motivation is a major factor, and then of course we must talk about psychosis.

When you are thinking about patients, you have to think much bigger.  You start with the patient and there are two parts – physical and mental.  The physical effects of the patient on cannabis can be noted.  For example, there is a study that has come out in France that shows that people who are involved in fatal, these are only fatal car crashes.  You are twice as likely to be killed in a road traffic accident in France by somebody who has been using cannabis compared to people who haven’t.  So its effect on you physically is to slow your reaction time down.   Now this leads to a whole range of problems with that and the testing of drugs which we will talk about in a minute.  So it can have serious implications and the other thing not to forget is that there is evidence coming through that cannabis increases your risk of cancer – lung cancer and pharyngeal throat cancer compared to people who just smoke cigarettes.  So, it is not just about its mental effects, but there are also physical effects as well.  And then when you consider the physical effects on individuals, you also have to start thinking about the psychological effects. 

Now, I mentioned depression – very common in those using cannabis, a major problem.  But then there is psychosis.  Now I am sure that some of you know what psychosis is, but I am going to talk about it so everyone understands what we are talking about.  A psychosis is a loss of touch with reality, and the second part which is really important to treatment, is that they don’t have insight.  They do not know that they are unwell and that is where your problems start coming with treatment.  So there are two parts – a loss of touch with reality and a loss of insight. And we know, and I don’t think that there is any doubt now that psychosis is a chemical change in the brain.  We have spent lots of time arguing over which bit of the brain, but without doubt, there is a change in the chemistry of the brain that leads to the problems that characterise by paranoid ideas, delusions and hallucinations. The most common hallucination tends to be that they hear voices, but you can get other types of hallucination that use smells and some that use tactile hallucinations as well.

So then you could say to me, well, hang on Brener, how do we know that these people are just not going to be ill anyway?  What is it about cannabis?  Well, we certainly know that cannabis changes the chemistry of the brain, and it causes particular problems with psychosis the younger you start it.  The younger you go on to it, the harder it is to recover.

I am afraid that I am going to have to tell you that our brains start declining from about the age of 19 so we are on a downwards stretch from there and it is interesting that the cannabis that  the kids often start on, and kids I most see, have started cannabis from about the age of 11 – 14. 

Yep, and their brain is developing – it is not fully formed.  So you then put a substance that causes a disturbance of the brain chemistry into a young brain and the problems start to compound.  And there are basically, and particularly if you are genetically vulnerable, by which I mean if you have close members of the family who have psychiatric problems as well, a combination of being young, genetically vulnerable and cannabis is not a good mixture.

Now, here comes my experience. In cannabis there are two types of psychosis and they are quite distinct in many ways.  There is the first type of psychosis which tends to be a much more undefined psychosis where in young people that have been smoking, often smoking heavily, they are paranoid and have hallucinations.  They are just not right.  They drop out of school, they drop out of education, drop out of work.  They are just not right.  It tends to occur between the ages of about 17 and 22.  That psychosis is directly related to the amount of cannabis that they are using.  If you can stop them using cannabis, that group tend to get better, and often stay there. OK, and that is where your treatment path lays.  Now the trouble is, the problem is, that there is a second group and this group get a psychosis that is much more like schizophrenia.  Very, very similar.  Probably more acute, can become a little disturbed, not often violent but can be.  And the trouble with these is, not always do they get better.  That is where the problem lies.

Now, the question that you are burning to ask me is well, are they just developing unfortunately schizophrenia that would have occurred anyway.  Well actually, the research shows possibly not.  These are people who are now developing a psychotic illness that is constant and relapsing over a number of years which they may not have got.

Denmark has done a wonderful study.  Denmark is amazing. The Danish measure everything.  They register things that we do not even begin to know about and they keep vast registers of people and doctors and hospitals and such like and they followed up a cohort of young people who developed psychosis to see what happened to them compared to people who hadn’t and they found that the incidence of developing a hospital based psychosis, i.e. needing to be admitted to hospital was about seven times greater if you had used cannabis as a child compared to those who didn’t.  And they also found, for those genetically vulnerable you were more likely.  So the point of this is, there is evidence that there are groups of people who are vulnerable and who if they start using cannabis can be simply starting psychosis that they would not have got anyway.  Against that of course comes the argument that why hasn’t the incidence of schizophrenia gone up over the years since cannabis was introduced?  Well, that is a good question, but I think it is early days and I think that we might see it still to come.  The other thing that we don’t know yet, and it is too early I am afraid, is this cohort of young people who used drugs at an early age, who maybe don’t have psychosis or have the early psychosis that gets better.  What happens to them later on in life when they hit fifty or sixty or even the great old age of forty five?  What happens to them then, because we do not know this?  Are they going to develop other illnesses that we haven’t seen such as depression or dementia?  That is a really important question and we just do not know.

So now, you say to me, well Brener, this is all very interesting but how do you treat these people?  Well, the treatment of all addiction is about the treatment of addiction, not just cannabis. Because my experience is that often if you get them off the cannabis they go onto something else, so you have to treat the whole person.  The first thing is you have to treat the crocodile nearest the boat! Yep, never forget that and that is the psychosis.  It is no good putting them into extraordinary treatment programmes or talking therapies if they are very psychotic.  They don’t do very well, so the first thing you have to do is treat the psychosis.  At the same time you have to treat the underlying psychological problems.  Now, the question you have to ask yourself is, do we aim at harm reduction or do we go for abstinence? My first tip is that harm reduction does not work in this area – it does not work!  Abstinence has to be the way forward. Now, I am going to tell you a fact that I find one of the most depressing factors in this whole area. In this country as far as I know today, there is not one in patient bed for addiction in adolescence, not one! Not in private or in the NHS.  That is terrifying.  I get phone calls, a couple a week, pleading with me from parents will I treat their fifteen year old or sixteen year old.  I can’t do it, I am not allowed to.  We are not allowed to have children on adult wards.  They might be using crack, heroin, being prostitutes but they are still deemed as children therefore I can’t take them.  I do sometimes occasionally manage, by begging, to get a seventeen year old in.  Many of them, in fact every single one of them, as part of their illness has cannabis.  It might not be the only cause, but part of it is cannabis.  So, when I see them, the first task is to get them off cannabis.  Not too difficult if they are willing and then I can treat the psychosis or depression if there is such, but then comes the hard part.  It is no good getting someone clean and then pushing them back out there.  Because, do you know what?  They will go back to using.  So you have to put them into a treatment programme.  That can be abstinence based.  Now, I am not here to sell you anything, but I believe that twelve step model works very well with some of these people, others use CBD based models, there are different options, but abstinence based.  And then it is not good enough just chucking them out because it doesn’t work.  It is a constant problem.  You have to look at a variation of treatment.  Now some patients will do very well with an organisation like AA and there is a wonderful one called MA.  Do you know MA (Marijuana Anonymous)? Those sorts of thing can work very well, or, things like protected housing, half way houses – what I am saying is that there needs to be a variation of things available for people.  I am afraid in general that is limited. My experience of a lot of the NHS, and I am not criticising the NHS because it is not easy.  A lot of the people involved land up on general psychiatric wards because they are psychotic, there is a large amount of drugs available on the wards and the whole problem just perpetuates and you are going to get a chronic patient who will continue to use drugs on the ward and who will just continue to use them when they leave. They get just better at their drug use.  I am not totally sold on that prospect, so there needs to be specialist treatment.

I believe, my personal belief is, that you really and truly you need to work towards total abstinence with the individual and to move that individual to rebuild their lives.  Sometimes they will need to on long term medication, sometimes they don’t, but if they can do that, then I often believe that the prognosis can be good, and that they can start to rebuild their lives with abstinence.

I am not saying that the Priory model is the only model.  I am not saying that.  There are many wonderful treatment centres out there around the country doing interesting work, but the one thing we cannot do is ignore this issue.

I am a doctor – I am not a politician or a policeman.  I am not here to say whether a drug should be decriminalised or legalised.  That is not a medical decision.  That is for other people to decide, but I am here to tell you that if the availability of drugs, and I mean all drugs.  If they become more available there will be more problems.  It IS that simple.  It will be the families and the doctors and other people who will have to pick up the pieces.  So, the medical profession will have to get much better at dealing with where we are now, because the problems are going to get larger.

Now, I will be quiet in a second and let you ask questions or let us debate certain areas.  Hopefully, you will start to see that treatment is not about saying to a patient oh poor you, it is terrible, you are ill.  Sympathy does not get people better.  Sometimes we have to say no.  Sometimes we have to use what is called tough love – I love you so much that I am saying this can’t go on.  And in all treatments of ALL addictions, the first thing you have to do once you have got them hopefully not psychotic and off their drugs is to break the denial of their using to make certain that they realise that they have got a problem.  That is the basis for all treatments.  Any good treatment programme anywhere in the world, in my view, has to have a family programme.  Most people working in this field will regard the illness as a family illness.  Like dropping a pebble in the river, the ripples will come out and touch us all.  The first people they will touch will be the family and it can be devastating to families so every good treatment programme has to have that, and of course work placed programmes and of course to deal with problems within society.   But I believe to treat addictions of all ages properly, the family ideally has to be involved, but that is a controversial subject.

David Amess

Thank you to Dr Brener for such an interesting talk.

Barry Twigg

One of the worries that we have when dealing with young people who are addicted whether it is to cannabis or alcohol or anything is that the lack of provision for dual core treatments is so very limited.  If you have got a lot of people who are suffering from psychological disorders – post traumatic stress disorder, mal adapted traits and so on, the tendency is, particularly from a value point of view, is to put them into treatments that just treat the basic addiction and it doesn’t provide sufficient psychotherapy in order to deal with the underlying problems.  Would you agree that this is the case and do you think that anything is going to be done about it?

Dr Brener

All treatment for addiction, once you have got rid of the drugs – detoxified them, has to be around psychotherapy.  Now, you could argue which are the best types of psychotherapy, but if you don’t do the emotional bit you are never going to keep them clean and stay clean.  Many of my patients come with all sorts of major traumas associated with their illnesses, some from childhood, some from adolescence, and some as a direct consequence of their drug usage.  We have to deal with those.  If you clean someone up and then push them out into society, you will just be pushing the problem on.  It is not going to go away because you have not done enough,  The way I describe it is, although perhaps not appropriate,  I think it is like peeling away the layers of an onion.  There are three layers to the onion.  The first layer is the chemical layer – you have to get rid of the chemicals and treat the psychosis sometimes.  The second layer is the behavioural layer which can be gambling, sex, drugs, alcohol – or a whole range of things, but the third layer is the emotional layer, but you have to start at the top and work your way down to get to the emotional stuff and I totally agree with you that unless you get into that and I would be interested in talking to you about certain sorts of treatment programme plans called trauma programmes, that is, not just about PTSD trauma but about a whole range of traumas, childhood experiences, adolescence experiences which can occur and lead into the triggers of these and unless you address both you don’t get the layers.

Kathy Gyngell

I had the good fortune to meet Neil about five years ago now when I was working on Iain Duncan Smith’s Social Justice Policy Review.  I was very impressed when I came to see you with David Burrowes.  You had started then some type of programme geared towards teenagers.  I appreciate that it probably wasn’t an inpatient.

Dr Brener

It was

Kathy Gyngell

I wonder if you could tell us something about that and whether we do need more such programmes in the NHS or privately or charity or wherever.

Dr Brener

I was shocked when I learnt that no one was doing adolescent addiction.  There are only 12 adolescent addiction consultants in the whole country.  I managed to track down one of the twelve and I managed to persuade her to come and help set up an adolescent addiction programme because I was a bit surprised to be honest.  We did it, but I had opened up a can of worms.  We found that it was extremely expensive because you need a very high ratio of staff and a lot of extras that we didn’t have.  It just became too difficult to run it.  I thought an addiction is an addiction is an addiction, so what I did with these, and we only went down to fifteen, we didn’t go to a lower age group than that, we put them in the adult treatment programme.  We had some extras but we treated them as adults.  Many of them to be honest were as adult as some of the adults. Some were very disturbed, a very difficult group and then we held them in the group.  The power of the group really worked well.  It worked far better than if we had just had them in a separate adolescent group. It worked well and they did well.  We had some wonderful success but to run it, it was just not financially viable.  Quite frankly I think it will be left with one of the charities to do it.

Kathy Gyngell

When you say that it was not financially viable, was it costing several thousand a week or did parents pay?

Dr Brener

Yes, you were talking about needing between 6 – 8 thousand pounds per week.  A lot of money because of the staff ratio needed.  A normal bed was about four thousand pounds per week.

Ruti

Can I just say was it about ten years ago?

Dr Brener

No, about seven years ago

Ruti

I was actually in The Priory myself and I do remember having a fifteen year old girl brought up into the programme and we were actually, each one of us, being recovering addicts in treatment ourselves, each one of us were given duties of babysitting her twenty four hours a day and looking after her.  She was a self-harmer and it was very hard.

Dr Brener

One of the interesting things that happened when we did put young adolescents into the adult group, the adult group changed and interestingly, we found that they started looking at their own childhoods in a very different fashion because they had to confront what they had been like as kids and many of the adult patient found that they got just as much out of having the youngsters in the group.

I think one has to be careful what age group you treat.  We didn’t go below the age of fifteen.  You need a lot of space for physical activity when you are dealing with an adolescent group which we didn’t have that.  That was one of our major problems.  With adolescents, you do have to have that physical element to get rid of energy and we just could not provide that.

John Graham

I am a therapeutic counsellor and I specialise in addiction treatment and I have spent several years working with young people.  Before I make the point that I want to make, can I please commend you for your commitment to abstinence? I think it is really refreshing to have someone of your stature to say the way that you said it today with no ambiguous meaning that we should stick to abstinence. At both ends of the sector, working with those patients at the exclusive end of the private sector as well as the statutory sector.  I am currently working for CRI and based at Camberwell Magistrates Court where I am assessing individuals for drug rehabilitation courses, as an alternative to a prison sentence.  The individuals that I am seeing are generally of a younger age and cannabis features very significantly.  I don’t want to take up too much time, but in this environment can I please make the point that there seems to be a gravitational pull towards at least decriminalising and moving towards the direction of legalising?  One of the things that young people tend to think is that if it is decriminalised, they will think, well what is wrong with it and then they will go straight into using it so I think that it is important that we bear in mind that cannabis is a very, very serious issue altogether even if there is no physical addiction.  Basically the point I want to make is that the policy makers need to think very carefully about it.

Dr Brener

As I said earlier, I am a doctor – I don’t deal with the legal issues of legalisation.  I DO agree with you that if you decriminalise or the more available any drug becomes, we have seen this already with alcohol.  Anyone can no go and pick up a bottle of cheap cider from Tesco’s etc. and the more available the more it is used. I want to talk to you about my medical students.  One of the issues I used to teach my students about is solvent abuse.  I don’t really need to teach them about it now.  I haven’t seen solvent abuse for about five to ten years.  Why?  Because why would kids bother to go and get solvents when it is much cheaper and easier and more available go and get alcohol or cannabis.  We know that the more available a substance is the more likely it is to be abused and if you want to look at something coming through, I am seeing a massive rise in prescribed drug use.  Massive, in middle aged, middle class people.  Tramadol.  You know about Tramadol?  The abuse is rife because it is more available.  Your point is absolutely right because the more available drugs become the more they will be used and therefore there will be health problems. Like you, I have worked in magistrate’s courts and the problems coming through the court system and speaking to the magistrates that tell us about it, it is vast and almost everyone is a juvenile and they talk about in how some way, cannabis is always involved.  To say that there isn’t a problem with cannabis, it is usually said by people who have not actually worked in this area and there are some very famous professors who talk about cannabis not being a dangerous drug.  But what they mean is that the mortality rate of cannabis is not very high but the morbidity and problems that it causes are vast, and remember, not just to the individual, but to everyone around them.

Richard Ayres

I had the privilege of going through your programmes under the care of you and your team six and a half years ago and I am very grateful because it pointed me in the right direction.  I can only speak and attest to everything you said about behaviour and its problems leading to addiction and cross addiction and I do firmly agree with everything you said about total abstinence.  I do suffer from the effects of addiction and with quite severe depression which I have to be medicated for and so that is a lifelong issue which I will have to deal with and will deal with over a long period of time with the care and support of the sector from which you operate.  I think to go on to the area of cross addictions that you touched on, I wonder if there are any stats you can refer to that talk about the dangers of cross addiction and the use of cannabis as a gateway drug to other, what might be considered and sometimes termed more serious drugs, but I think that is a term that should not be used, but which might have some mortality issues rather than cannabis?

Dr Brener

There are two questions there.  One is the gateway issue and the other is about cross addiction?

Richard Ayres

Yes, cross addiction.

Dr Brener

Ok. I will answer the question about cross addiction first.  I don’t treat alcoholics or drug addicts – I treat addiction which is not quite the same thing.  It is a giant umbrella where there are segments of the umbrella such as alcohol, drugs, sex, shopping, gambling, food, shopping, working exercise, etc.  And it is usually one segment of the umbrella.  The person then says thank you very much and then just moves on to another segment of the umbrella, and that it what is called cross addiction.  The proper treatment is to treat the whole umbrella, and maybe you remember, but every one of my patients say I came in with one addiction and came out with ten.  And that is true, because then they realise about their cross addiction behaviour and that brings us back to psychotherapy where you have to treat the whole umbrella psychologically or you just lay up problems. 

What is addiction?  Addiction is feeling avoidance.  That is what it basically is. You have to treat the feelings.  The way you feel leads you to behave the way you do.  One of my therapists, he is an addict in recovery; most of the best therapists are because you can’t bullshit a bull shitter!  He describes an addiction as like having his emotional radio turned up loud, and he will do anything to dampen down the sound.  He says that he remembers the first day that he took alcohol.  He says it was a miracle.  He says that it made him feel better so that he just had to keep going.  That is the trouble.  Therefore, you treat the whole umbrella.

Gateway Drugs. There is very little evidence to show that cannabis is a gateway drug.  By which I mean that a person who started by using cannabis will then progress onto heroin and such like, but, but, I have never met a heroin addict who didn’t start on cannabis.  So, what we are saying is, that if you are vulnerable and have the addiction gene, if you want to call it that, you are going to find your drug of choice to try and dampen down how you feel and that route to different drugs.  The experience of the Dutch, where the Dutch of course liberalised cannabis use and there were cafes and stuff, which interestingly they are closing down now.  They found in Holland that there was no reciprocal increase in heroin use.  What they did find though was that there was a possible increase in car accidents.  The evidence in supporting the gateway theory is probably small, but anyone who has got the addiction gene therefore, for whatever reason, cannabis seems to be the stuff that they start on to move on to other things.  That is why in the magistrate’s courts and the juvenile courts you see the youngsters have all started with it.  Some of them will not use cannabis again and they will be fine, but others go on to experiment on other things.

Now, I am waiting for your question.  Hang on Brener, you say.  Is there such a thing as the addiction gene? Well, in this area it is a Holy Grail.  We are all looking for it.  We are all looking for it because we know it is there.  And there is actually some evidence in previous studies that which show that there is a genetic component to it.

John Graham

Can I briefly add in to that, that even if that genetic component exists, the person will have to imbibe the substance in order to activate it?  So if they didn’t take it they wouldn’t activate it?

Dr Brener

No question, no question that is right and absolutely spot on. There will be people who have the addiction gene but who don’t activate it, and lucky them. Because it is up to twenty per cent of the population who are thought to carry it.

Ruti

Thank you so much.  It brings me back to the point of education and prevention.  We seem to have missed a generation.  I go to schools with the Amy Winehouse Foundation and people who I talk to, I mean teachers, they have no idea and it seems to have skipped a whole generation and surely it has to start with the education.  One thing that seems to happen, once people are clean from the effects of alcohol or drugs that seems to happen quite quickly, but the effects of coming off cannabis seems to linger and last maybe six months to a year.

Dr Brener

Yes, you make a very valid point.

Ruti

What frightens me is the thought of decriminalising.

Dr Brener

I am going to make things even harder for you.  I gave a talk to thirty GPS, all qualified doctors.  Half way through I saw a blank set of faces and I thought oh God, I have lost them, they are bored rigid, so I asked them one question.  Who can tell me the difference between cocaine and crack?  Three!  Out of thirty GPs, only three knew that.

So, if we are talking about education, maybe we need to start off by educating some doctors first.

I, in my medical education, had one lecture in my entire medical education on addiction by a guy who had just been struck off.  Seriously, he had been struck off.  He was one of the greatest dealers I have ever known!  That was my entire medical education on addiction.

John Graham

And I presume that at that time, people would have been dispensing methadone.

Dr Brener

Yes, everything was going to be about harm reduction.

Kathy Gyngell

I was very impressed because I was invited to do a peer review for a British BMJ report in which several legalising charities had unfortunately been on the editorial board which was meant to be a comprehensive medical guide for doctors.  In the end it was impossible to peer review because every assumption written in was about harm reduction and the only reference to abstinence was to a paper that I wrote.  When I told the Chair of the Board I couldn’t peer review this and why, (she used to be a cardiac surgeon or something) she was looking at me in astonishment and told me that she had been warned off by other people on the BMJ from meeting me at all.  There wasn’t even a chapter on abstinence treatment so I couldn’t even review it at all.  Where do you begin to change this and educate the medical profession?

Dr Brener

I am subversive.  What I have done is that I insist that we have medical students at the Priory.  I absolutely insist on it.  I teach more now that I am in the private sector than I did when I was with the NHS.  What I do, and those who have been to the Priory might remember this, I insist that they go into therapy groups.  They have to be part of the group.  They know a darned sight more about addiction than other students when they leave and they can then take that on into their careers.  We need to get all medical students into treatment centres for sessions.  Then we need to bring in the nurses.  That is the beginning.  Education to me is not just about going in to schools and talking to teachers and parents.  That is great, but you have to start educating the medical profession because they are going to be the ones treating the problems.  It is going to take a long time, but we are getting there slowly.

Donald Johnston

I work in a treatment centre.  The problem is everything costs.  Where will the money come from?

Are we still going to be sitting here in another three or four years’ time debating?  Will these costs start from Government level?  Where does the money come from to start the ball rolling?

Dr Brener

You are absolutely right.  It will cost money, but the money will be seed money, because if you can treat them properly, and they don’t end up in magistrate’s court, they don’t land up in hospitals.  We improve our drug monitoring in hospital because the amount of people in NHS facilities that use drugs while they are in there is large, we can actually then hopefully start saving money.  The problem is that this is not a medical decision.  This I am afraid comes from greater people than me to make the decision about how you handle things, but to go and spend large amounts of money  in putting  people into detox programmes and then just chucking them out is absurd. It just doesn’t work.  It seems to me to be wasting money.  The number of people that I see who say to me, oh, I have been treated for addiction but it doesn’t work.  So I say to them, what were you treated for? They say that they went in for a ten day detox – that was their treatment.  They are the sort of expenses that we are wasting money on.  If you just take any alcoholic, heroin addict, cocaine addict, any addict, detox them and then throw them out in to the community and give them one hour of counselling a week, which is what a lot of people get, it won’t work!  It is not going to work because you have not even begun to touch the psychological issues.  You are trying to stick a band aid over someone who needs an intravenous injection.  Well, you can say that we, in the Priory, we only see the wealthy, middle class people, well that is not entirely true, but I see plenty of really good programmes that are available, that are not as expensive and they do fabulous work.  Yes, they do have to be paid for, and we also need dry houses, half-way houses and such like but they are expensive.

 But we as society have to make our decisions on what we want our politicians to spend the money on.

I am not here to tell you what to do, but I am here to tell them that you need to get the best treatment plans.  Detoxifying them and then just chucking them out with one hour a week counselling means you might just as well flush the money down the sink.

Mary Brett

Can I get on my hobby horse again?  I was a school teacher and drug education in schools and for a long time has been harm reduction.  In other words, don’t try to stop them starting, just give them tips on safer use and it is still going on and prevention is not being practised.  Of course, the Governments official website is FRANK which not only gives harm reduction tips, but lies about things and gives the wrong information.  They say that skunk is about twice as strong as the old herbal cannabis.

Dr Brener

That is not true. 

That is where we should start, with proper prevention.

Can I just say that if you are going to do prevention in schools, don’t send me in to do it.  Waste of time.  Send in a recovered addict.

Kathy Gyngell

I think they will. I think you are wrong.

Dr Brener

Send an addict in recovery.  They listen much more to the person who has been there, done that, got the t-shirt.  Without doubt, if you are going to invest in that sort of education you need the right sort of people doing it.  That makes it much more powerful.

Mary Brett

Can I just say, I was a biology teacher, and nobody ever told me how to do this, years ago.  I drew cells, very simple cells and showed them exactly what happened with the drugs in the brain.  It was a boys Grammar School and it was very successful. 

Dr Brener

But if it was you, an addict doing the same thing, explaining that was what had happened me and would happen to their brain and the impact it would have on their lives I think the message would be more powerful.

Barry Twigg

Please could you say this to the politicians?  Because as people who regularly attend these meetings know, we say this to them at practically every meeting.  They don’t listen to us, but maybe they would listen to people like you.

Dr Brener

I love your optimism, but I have learnt from bitter experience that the person who is an addict does do the best job on this.

Jean Khan

I wanted to go back to the addictive personality which was something which I had never really thought about.  My lad ruined his life by smoking skunk at university.  He then came off the weed and then he started smoking and it just goes on and on.  He started smoking sixty cigarettes a day.  That went on for years and then I managed to get him off that and now he is on the e-cigarettes and he is now addicted to the nicotine.  I was a bit of a drinker when I was young, so was my father, so it makes you wonder if there is this genetic link in it all.

Dr Brener

Oh it is there. It is there, the Holy Grail of this whole area.  Someone needs to find it – Nobel prizes are waiting for the first person who gets it.

Hilary Hartley

I was going to say about teaching. I am a school nurse myself and I think having somebody in to do the talk for the children is a good idea.  The only thing is, sometimes they think, that person is fine now and why shouldn’t I go on and do it?  I feel that there is a slight issue.

Dr Brener

If you have the right person who turns round and says this has messed up my life and my life has changed dramatically from what it was going to be and I have to live with the consequences of my use.

Deidre Boyd

I was actually just thinking with a huge wave of sadness in that you talk about educating mental professionals etc. and cross addictions and I wrote an article about this  over twenty years ago, and our politicians have done sweet f.a.  It is so sad, I feel so frustrated.  Twenty years.

Dr Brener

You are right, maybe I have been a little negative all the way through.  There are some people, some of whom are here who would probably be dead if they hadn’t had treatment and are who are now highly successful members of society,  without doubt.

David Amess

On behalf of the rest of us, I thought that Dr Brener was absolutely marvellous.  On behalf of politicians, I might be a dinosaur, but I am totally opposed to the decriminalisation of cannabis.  When I was once the MP for Basildon and Leah Betts died of a drug overdose after taking ecstasy, the daft channel 4 programme through Mark Morris, then as a joke came into this place.  If you google me then about twenty years ago about cake, Tony Newton was the Drugs Minister.  We think that you are fantastic and I wish that we had more people like you around, particularly in South East Essex.  So can we show our appreciation for Dr Brener?