Blog post

If 5% of a drug's content isn't right, users may distrust it. Perhaps the same applies to drug programmes?

Cherry Healey: Old Before My Time, BBC3

Production by Silver River TV (@silverrivertv)
Monday 28th October 2013


The BBC deserves its reputation for bringing us some of the world’s best science documentaries. There was much to commend in this programme, indeed more to commend than to criticise. This made it especially frustrating that misinformation slipped through the editorial net. The programme cannot be accused of taking a hysterical line towards drug use; whilst it exaggerated the dangers of cannabis to the lungs, it could be argued that it underplayed the risks of GBL. The outcome was that all the drugs featured from cocaine to cannabis were presented as similarly nasty, whereas actually there are crucial differences in the level and types of risk associated with each.

Cannabis
It is the most widely used illicit drug, so mistakes relating to the dangers of cannabis use are the most concerning. They start with a scene at a rave (at 13.55). Cherry is, I think, uncharacteristically unfair to the ravers she meets, compared to her non-judgemental sensitivity in the programme overall. Perhaps sensitivity is shown more generously to the repentant young people featured, rather than the unrepentant ravers! Her voiceover suggests that they are unaware or unconcerned about the risks of drug use; the unspoken implication being that any use of drugs (excepting alcohol of course) is in itself proof of poor judgement, of underestimating the risks, and will in time be regretted. This approach may patronise young users; the ravers she speaks to do not deny that drugs can be harmful, and they may well be making considered choices having balanced these harms against the pleasure they get. It is important to recognise that young people who at some point use illicit drugs, have a good time and do not suffer serious health consequences greatly outnumber the problematic users which this programme focusses on. It makes sense for a programme, and young people themselves to ask “what’s the worst that drugs can do”. However, it doesn’t make sense to judge all drug use as being as problematic as the most extreme cases.

Cherry says (14.35) that she’s amazed that “some people believe that if you choose the right drug, there won’t even be any health consequences”. The young woman used to illustrate this point doesn’t say anything of the kind; she merely opines that cannabis is a “lesser threat” than alcohol and particularly cigarettes, which is true. The following section of the programme then argues that cannabis is in fact more harmful to the lungs than tobacco. The evidence clearly shows the opposite; cannabis smoke, like any smoke can certainly irritate and inflame the lungs (wheezing, bronchitis), but there’s scant evidence that typical use does much serious or lasting damage, unlike typical cigarette use.

The programme makes the claim that each joint contributes as much to the risk of lung cancer as 20 cigarettes (17.20). This myth has now attained the status of a ‘zombie statistic’, rising from the dead no matter how many times it is shot down. It is still uncertain that cannabis causes any increase in lung cancer risk when used without tobacco, let alone a greater risk than cigarettes. The BBC reference the British Lung Foundation’s lamentable report for this statistic. I would encourage them instead to reference up-to-date peer-reviewed scientific literature where available, for instance this; “In summary, the accumulated weight of evidence implies far lower risks for pulmonary complications of even regular heavy use of marijuana compared with the grave pulmonary consequences of tobacco”.

What useful information could have been included to reduce the risks to the lungs of young cannabis smokers? The programme could have advised that including tobacco in joints is a major cause of harm, not least as this habit may lead to nicotine addiction. Also it could have mentioned that the common behaviour of holding a huge lungful of smoke does nothing to increase the high, but does increase the injury to the lung caused by hot smoke and abrupt pressure changes. Most vitally, they should emphasise that the risks are associated with very heavy use, and cutting down is the surest way to reduce any risks. The only individual recorded to have suffered emphysema having smoked cannabis without any tobacco had used an amount of cannabis equivalent to a joint a day for 437 years

Instead of evidence-based advice, the attention on cannabis culminates with the speculation that the supposed lung damage cannabis causes could be linked to “super-strength skunk” (17.25). This is an interesting hypothesis as it seems counterintuitive; if the cannabis has more THC in it, users might be expected to inhale less of the smoke to achieve the desired effect. The hypothesis might yet be true, perhaps users dilute stronger cannabis with more tobacco, causing more damage; but I’d expect all the claims in such a programme to amount to more than just vague speculation.

Just like the British Lung Foundation, the BBC exaggerated the small lung harms of cannabis whilst neglecting the vast lung harms of cigarettes. In a programme about drugs that accelerate ageing, the BBC might have considered featuring tobacco, a drug which ages the appearance of skin hair and teeth, causes sexual dysfunction, impairs physical performance and of course wrecks the lungs.

GBL
Overall, this programme was pretty rich in information, and cannot be pigeonholed as drug scaremongering. Despite the cannabis errors, the very extreme end of the dangers of ketamine and cocaine were accurately represented. In fact, the dangers of GBL may have been underplayed. Hester Stewart died from respiratory depression after combining quantities of GBL and alcohol which on their own would not have been fatal. This danger of coma and death after taking too much GBL, especially when combined with alcohol, certainly needs to be understood by anyone who might use or think of using it. But there are other reasons for caution which applies even when the dose is carefully measured out. GBL is quite addictive, and once addicted, users may need to take a dose as frequently as every few hours, even through the night, to avoid alarming withdrawal symptoms which at their most extreme can themselves be life threatening. Needing to get up several times in the night is certainly a sign of being ‘old before you time’.

Summary
Both this and the previous episode, which looked at extreme alcohol use, were welcome eye-openers for young people about some of the risks associated with untypically extreme recreational drug use. I’m disappointed though that the content was not checked more thoroughly for accuracy.

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