The world over, drug and alcohol abuse remain one of the greatest challenges in addictive behavior, and Ghana is no exception.

In 2005, the three psychiatric hospitals (Ankaful, Accra and Pantang) recorded a total of 86,003 outpatient attendance (Ofori-Atta et al., 2010), with mental and behavioral disorders due to psychoactive substance use representing 22.8% of the inpatient diagnosis.

 The Out-patient Monthly Morbidity Returns records from the Psychiatric Unit of the Regional Hospital, Sunyani, for 2012, for instance, indicates that of the 2,284 clients who reported with various psychiatric illnesses for the year, 594 (26%) were substance abuse related cases, mostly marijuana.

Furthermore, the Drug News Africa in 2012 estimated that about 1.25 million Ghanaians are known to be having problems with drugs, mostly marijuana. Other studies on substance abuse in Ghana report even more frightening statistics.

Arguably more people may be using and abusing drugs in Ghana than is estimated. The Ghana Demographic and Health Survey’s (GDHS) Report for 2010 stated that the region in recent times is not only a transitory route but also a consumer market of hard drugs. This is very disturbing.

The Director of the Narcotics Control Board (NACOB), Mr. Akrasi Sarpong has made his points and called for a national debate on the legalization or otherwise of marijuana use in Ghana. I find this call both important, and to some extent – an “invitation for a monkey to tea”. Government should legalize marijuana, generate income…and then what? What are the implications?

The principal psychoactive ingredient of cannabis, delta-9-tetrahydrocannabinol (THC) has been found to: interrupt memory, learning, attention, and reaction time as long as 28 days after abstinence from the drug (Hall & Degenhard, 2009), cause an increase in the risk of a heart attack more than four-fold in the hour after use, and provokes chest pain in patients with heart disease (Hall & Degenhard, 2009), irritate the lungs, resulting in greater prevalence of bronchitis, cough, and phlegm production (Tetrault, et al., 2007), significantly linked with mental illness, especially schizophrenia and psychosis, and also depression and anxiety (Large, et al., 2011), doubles the risk of car crashes (Asbridge, et al., 2012), reduces IQ by as much as eight points by age 38 (Meier, et al., 2012), and results in poor quality of life outcomes and poor job performance (Macleod, et al., 2004). Literature is replete with several other negative effects of marijuana use including increase in the rates of crime, divorce and psychosis.

My point? Well. Can we be sure that the good people of Ghana will “use” and not “abuse” marijuana when it becomes legalized? Aside generating income for the nation, what other benefits should we expect? (One needs just a 50p worth of marijuana to get ‘high’). What are the physical, psychological and social consequences of marijuana use? Lastly, will government build rehabilitation centers and train more health personnel to cater for people who would develop substance abuse related psychological disorders – including psychosis? (I know some Ghanaians will really smoke their heads off). Already psychiatric patients (some of whom are substance abusers) are treated and medicated for free under the NHIS. Yes!! They smoke, distort their reality, become violent, beat up their spouses and children, take up guns to rob (and these days rape wives and daughters in addition), and when they get sick in their heads we finance their treatment!

What’s more? Is government generating adequate income from alcohol taxation, for instance? (I doubt because it remains so cheap that Basic School pupils can afford the sachet-packed alcoholic beverages and bitters). When alcohol producing industries in the cities are taxed, what happens to the locally-brewed “akpeteshie” that are produced and smuggled in towns and villages at night?  Recently a volunteer could not donate his kidney to save a relative at the Renal Unit of the Korle-Bu Teaching Hospital (KBTH). Why? Partly because he abuses alcohol – and it’s contraindicated for the surgery! The long list of the effects of alcohol use and abuse: from liver cirrhosis through family “disintegration” to horrendous violence and crimes should not be difficult to think of – go visit the general hospitals, prisons and psychiatric hospitals during visiting hours!

Some clinical and therapeutic uses for marijuana have been found. For instance, it is an effective anti-emetic agent for patients undergoing cancer chemotherapy, effective in treating AIDS related wasting, decreases depressive symptoms reduces neuropathic pain, improves appetite and caloric intake especially in patients with reduced muscle mass, and may relieve spasticity and pain in patients with multiple sclerosis. These are dosage-regulated medical use. Do people generally use marijuana for these benefits? A big NO!!

As part of my training as a Clinical Psychologist I have counseled and provided psychotherapy to many people addicted to alcohol and drugs – I believe my supervisors at the Psychiatric Unit at KBTH have their records in hundreds. Some addicts are dying (physically and psychologically) but cannot quit, albeit they want to. Alcohol and drugs are “notoriously” addictive. It is not funny when a client says to you: “Please help me to quit. I’d do everything”.  Just go talk with a Psychiatrist, Clinical Psychologist or Clinical Neuropsychologist, or with the alcohol and drug addicts being rehabilitated at the Chosen Rehabilitation Centre in Achimota (get yourself some handkerchiefs before going – I know you will weep).

Apparently Mr. Akrasi and his team (as with most Narcotic Control Agencies the world over) are overwhelmed by the increasing spate at which people of all age groups are abusing marijuana. So? Do we have an alternative in lieu of legalization? YES!!!

Could the syllabi of our basic and second cycle schools contain more proactive lessons on alcohol and drug abuse and its effects?  (Most clients report starting alcohol and drug use at these levels). Could the NACOB be more proactive in their education as well as operations to arrest and prosecute drug peddlers in collaboration with the security agencies? (When people “grow marijuana in their homes”, please arrest and prosecute them!).   Could the Ghana Health Service employ more Clinical Psychologists to help educate and treat people with substance use disorders and the other myriad psychological disorders? (That was one essence for the Ghana Psychological Act). Drug addiction is more of a behavioral problem – Clinical and Health Psychologists know how to treat that! Could our district and regional hospitals have Psychiatric Units for psychosocial interventions? (I guess we are yet to understand the Biopsychosocial Model of disease causation and treatment). Could community centers and sports facilities be established to serve as alternatives to drug use for the youth?

When substance users do not receive early treatment and education, they become physically and psychologically dependent and develop tolerance. At best they only influence others to join them – people are not born drug addicts! For the most part they are only genetically predisposed. Could assistance be given to agencies and NGOs such as the Chosen Rehabilitation Centre and the many others who are striving to educate and rehabilitate alcohol and drug addicts to become important members of the community?

The call is important! NACOB, and thus Mother Ghana appear to be losing the “war”. However, I would rather the call is to invite all hands on board to fight the menace. After all, NACOB is supposed to lead the “fight” – and not to lead the “surrender”. I could not agree more with Dr. Gordon Donnir’s warning. Legalizing marijuana use in Ghana is “bad”. The penalty can be predicted. When marijuana is legalized, crime rates will increase, divorce rate will double, prison population will triple and drug-related mental illness will quadruple in the next decade. I don’t want to talk about the health implications. From the day it becomes legalized, start counting 9 years and 364 days. My evidence? Ask the nations and states where marijuana is legalized!

References

Asbridge, M., Hayden, J. A. & Cartwright, J. L. (2012). Acute cannabis consumption and motor vehicle

            collision risk: systematic review of observational studies and meta-analysis. BMJ, 344

Ghana Demographic and Health Survey Report (2010)

Hall, W., & Degenhard, L., (2009). Adverse health effects of non-medical cannabis use.  Lancet, 374,

            1383-1391

Large, M., Sharma S, Compton M., Slade, T. & Olav, N. (2011). Cannabis use and earlier onset of

            psychosis: a systematic meta-analysis. Archives of General Psychiatry. 68.

Macleod, et al. (2004). Psychological and social sequelae of cannabis and other illicit drug use by young

            people: A systematic review of longitudinal, general population studies. Lancet 363(9421), 1579-

            1588

Meier, M. H., Caspi A., Ambler, A., Harrington, H., Houts R. & Keefe, R.S. (2012). Persistent cannabis

            users show neuropsychological decline from childhood to midlife. Proceedings of the National

 Academy of Sciences

Ofori-Atta , A.,  Read U. M., Lund, C. & MHaPP Research Programme Consortium (2010). A situation        analysis of mental health services and legislation in Ghana: challenges for transformation. Afr J

            Psychiatry, 13, 99-108

Out-patient Monthly Morbidity Returns (2012): Psychiatric Unit of the Regional Hospital, Sunyani

Tetrault, J.M., Crothers, K., & Moore, B. A. (2007). Effects of cannabis smoking on pulmonary function

 and respiratory complications: a systematic review. Arch Intern Med 167, 221-228

 

Writer: Richard Appiah – Trainee Clinical Psychologist, University of Ghana, Legon (Email: richardappiah2010@gmail.com)