10/10/2014 06:07 EDT | Updated 12/10/2014 05:59 EST

Hey CAMH, What Applies to Marijuana Should Apply to Tobacco

I am somewhat perplexed by the recent announcement by the Centre for Addiction and Mental Health (CAMH) in Toronto to legalize marijuana. I don't disagree but I find that they are being inconsistent as they ban patients from having any tobacco products on site even though tobacco is legal.

According to Dr. Jürgen Rehm, Director of the Social and Epidemiological Research Department at CAMH, "Canada's current system of cannabis control is failing to prevent or reduce the harms associated with cannabis use." His studies have revealed that 40% of Canadians have used marijuana at least once in their lives and that 10% have used it in the last year.

And, he points out, it is not a benign substance. "Cannabis use is associated with a variety of health harms like problems with cognitive and psychomotor functioning, respiratory issues, cannabis dependence and mental illness." In fact, it has long been hypothesized that marijuana can trigger schizophrenia in those who are genetically susceptible. It is a rather complex relationship as the most recent study in Molecular Psychiatry this past June pointed out.

Dr Rehm quite sensibly states "that the evidence examined indicates that the criminalization of cannabis does not deter people from using it. Instead, criminalization drives cannabis users away from prevention, risk reduction and treatment services. Canadians obtaining cannabis in criminal markets know little about the potency or quality of the products they purchase. They are also exposed to criminality and other drugs and run the risk of a criminal record. Enforcement of cannabis laws cost Canadians $1.2 billion per year."

Therefore, he proposes that the sale of marijuana be regulated and only sold by government agencies and that there be a minimum age for use. In the past year in Ontario, he says, 23% of students in grade 7 to 12 used and that 40% of 18-29 year old people used. As we learned from prohibition, a ban on something that people want does not work and so his proposals are realistic.

But here is where I have a problem with CAMH itself. Earlier this year, they put a total tobacco ban in place. And, tobacco is a legal substance. Not only could patients not smoke on the property but they could not even have tobacco products in their lockers or rooms. What is typical in psychiatric hospitals is that patients keep their smokes and then go outside to consume them. At the psychiatric hospital in Hamilton which I am familiar with, patients and staff can be found on the outer perimeters smoking together.

At CAMH, smokers must go out and buy a new and expensive pack each time they leave for a break. Either they throw the pack away, smuggle it into the hospital, or buy individual smokes from people on the street.

And, as I pointed out and is well known, the vast majority of people with serious mental illnesses smoke. And, they smoke because nicotine may actually have a beneficial effect on their illness.

One study found that about 60% of people with schizophrenia are smokers. And, as the union for the staff who oppose this ban have said:

For many patients, arriving as an inpatient at CAMH is the culmination of one of the worst periods in their lives.

While we are no fan of smoking in general, it appears cruel to deny patients access to this one small comfort at such a difficult time.

Some of these patients are already agitated as a result of their mental illness. Compounding it under the circumstances also poses a risk for everyone present, staff and patients alike.

Let's treat people for the reasons they came to the hospital in the first place.

Smoking cessation can wait for another day when the patients are themselves motivated to take it on. It shouldn't be a mandatory add-on.

And, if the criminalization of marijuana is of little value, according to CAMH, then the total ban on tobacco products for those who are seriously ill is also of little value.

What applies to marijuana should also apply to tobacco.


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