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Linking research and practice in the treatment of cannabis addiction and psychosis

Rebecca Gray, Maudsley Charity Chief Executive blogs on the role the Charity plays in supporting and enabling clinicians and researchers to pioneer new approaches to treatment and service design.

Rebecca Gray

Chief Executive, Maudsley Charity

Rebecca is chief executive of Maudsley Charity. She is responsible for developing the charity’s strategic aims, leading its involvement in major projects and overseeing grant making and governance.

When I am not working at my kitchen table, I am based in the ORTUS Centre at Denmark Hill. ORTUS is nestled in a patchwork of buildings which house the Maudsley Hospital, part of South London and Maudsley NHS Foundation Trust (SLaM), and the Institute of Psychiatry, King’s College London (IoPPN). Two interlinked and inseparable institutions we are fortunate to work with.

We often invest in projects in the space where clinical and academic work overlaps, innovations at the boundaries of NHS provision and funding. The support we have provided for the cannabis clinic – as covered in this week’s Sunday Times (paywall) –  is a great example of just that.

In 2002 Professor Sir Robin Murray and his team published convincing evidence of the causal link between cannabis use and psychosis. By 2009 Dr Marta Di Forti described the first evidence of the high impact of the use of high potency strength of cannabis on risk for psychosis. Teams at IoPPN and SLaM continue to drive pioneering work related to psychosis – driving our understanding of what causes psychosis and how we can improve the way people are treated and supported to stay well.

They are doing so right at the coal face of care – Lambeth has among the highest rates of Psychosis in Europe, and in south London up to 30% of new cases of psychosis could be prevented if there was no longer high potency cannabis use. (Lancet Di Forti et al 2019)

Those who experience psychosis for the first time – often young people (the average age is 22) whether or not their illness was caused by use of cannabis, often feel reliant on continued high use of cannabis, and we know this use has a negative impact on their recovery.

Dr Marta Di Forte and her team recognised a major gap in psychosis care – the need to support people who want to reduce their cannabis use. It was clear to the team that reducing use for those motivated to do so, would have a number of positive impacts.

On average people using the clinic spend between £60 and £100 a week on high potency cannabis (skunk). Marta told me about a young man who had gone from spending all day and night in his flat smoking, through attendance at the clinic, to reducing his cannabis use down to a level where he was getting into exercise, socialising more and had got his first job. This creates a virtuous circle – reducing cannabis use has a positive impact on treatment for psychosis, recovery from illness can go hand in hand with engagement or reengagement with education, employment or with family and friends.

Marta who developed and leads this ground-breaking clinic, the first of its kind in Europe, is able to understand at a very granular level what is happening in our local communities, understanding the levels of high potency cannabis in use, and what incentivisation individuals need to reduce and stop their use. The service, which targets those who have had period of in-patient care is, delivered by NHS clinicians, and is underpinned by the expertise of academics, in Marta’s case she is both.

Marta’s initial work has shown that combining established interventions from addiction, and skills in engaging young people with psychosis can succeed in supporting young people to reduce or stop their use. It acknowledges that there are many people want to take a step to reducing their reliance on cannabis but need support and incentivisation to do it. We are now supporting Marta’s team to develop a model of peer support which could create more sustained reductions in use over the long term.

Funding a service like the Cannabis Clinic is a natural fit for us. Across our partnership there has been pioneering research and treatment into the effects of cannabis use for decades, and proof that research can be accelerated into patient care through community and unique specialist inpatient services.

Importantly the ripple effects of this project could go way beyond south London. Work like this has historically shaped national and international policy. I hope that, if the evidence for the service builds, similar models could be developed across the NHS.

Cannabis Clinic for Patients with Psychosis

Specialist clinic changing the lives of people struggling with psychosis due to high potency cannabis use

Cannabis Clinic for Patients with Psychosis

Specialist clinic changing the lives of people struggling with psychosis due to high potency cannabis use

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