24 2GM Saturday April 30 2022 | the times
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Adam’s illness caused terrifying
hallucinations. “I would see imaginary
things that weren’t there. I would have
children that didn’t exist. I couldn’t feed
them. So they would starve to death in
front of me, two or three times a day,” he
said. “But now, I don’t see them — and
that’s largely because I’ve quit weed.”
In the past year, Adam, 30, has
attended the first NHS clinic to special-
ise in the treatment of cannabis-
induced psychosis. Research suggests
that the debilitating condition, which
often involves elaborate delusional
thoughts and extreme paranoia, is
more prevalent in London than any-
where in Europe.
The clinic, based at the Maudsley
Hospital in south London, has secured
permanent funding after a two-year
pilot study during which 80 per cent of
the patients who completed their treat-
ment gave up cannabis completely. All
had been sectioned under the Mental
Health Act because of their psychosis;
most now have a job or are in education.
The psychiatrist who has led the
project, Dr Marta Di Forti, would like a
similar approach to be adopted widely.
“Until now there had been services
looking at cannabis dependence and
fantastic teams looking at people with
psychosis — but nobody was looking at
the two together,” she said.
The group most at risk of experien-
The couple saving drug takers
from terrors of skunk psychosis
cing a first psychotic episode are young
men. When stories about her work
appear in the media she receives letters
from desperate parents. “We have not
been able to meet even the local de-
mand for treatment,” she said. “Within
our local mental health trust we’ve only
been able to respond to a fifth of the re-
ferrals that we’ve been getting.”
The creation of the clinic caps two
decades of research into the link
between cannabis — or, more precisely,
the high-potency “skunk” form of the
drug — and psychosis. Much of it has
been overseen by Di Forti’s husband,
Professor Sir Robin Murray, of King’s
College London.
In the early-2000s Murray contrib-
uted to research that first illustrated a
link between cannabis and mental ill-
ness in adolescents. Other studies
have corroborated those findings.
One, published by a team led by
Di Forti and Murray in The Lan-
cet Psychiatry in 2019, found that
south London had the highest
incidence of psychosis in
Europe, with cannabis
identified as the largest
contributing factor.
Smoking skunk was
found to be asso-
ciated with a five-fold increase in the chances of develop-
ing the condition compared with non-
users. Murray said the results suggest
that about 30 per cent of psychosis
cases seen by London’s overstretched
mental health services could be pre-
vented if high-potency cannabis were
no longer obtainable.
At the cannabis clinic they deal with
the fallout. Treatment typically lasts for
about five months. Patients have week-
ly one-to-one sessions with therapists
to help them wean themselves off
skunk and to build a life without it. The
techniques include “motivational in-
terviewing”, where the aim is to harness
a patient’s own desire to change.
There is also a weekly group session,
held on Zoom, where people can share
their experiences and hear from ex-
perts. The patients set their own
goals for cutting down. Assess-
ments are made of how cannabis
is affecting their mental health
and cognition as well as their fi-
nances and vocational pros-
pects. If they hit their targets,
they can earn vouchers for
online retailers, worth up to
£150 in total.
Some have been pre-
scribed Sativex, a cannabis-
derived drug that contains
THC — the compound that
gets people high — to allevi-
ate initial withdrawal crav-
ings. A few have found it
helpful to have urine sam-
ples tested for THC levels.
Separately, they will be pre-
scribed antipsychotic medi-
cines by their community
mental health team.
The approach is tailored
and pragmatic. One patientrecently described to his therapist how
he had decided to smoke a joint to relax
before going to a job interview. “Of
course he didn’t get the job,” Di Forti
said. “But rather than just telling him it
hadn’t been a good idea, the therapist
set up a little experiment.” The patient
smoked a joint and underwent a mock
job interview, with the session being
filmed. On another day he did the same
while sober. He came to the conclusion
that “well, actually, I didn’t realise that
when I’m intoxicated I don’t look that
great. I may be very relaxed and chilled
but I don’t come across as very sharp,”
Di Forti said.
Encouraging people to learn from
experiences, rather than lecturing
them, seems to be working well. Of an
initial intake of 20 patients, 17 complet-
ed the course and 14 have completely
given up cannabis. The three others
have sharply reduced their intake,
smoking just once a week.
When they entered the treatment all
were unemployed; nine have now
found a job and four are in education.
Their psychotic symptoms have re-
duced dramatically.
Adam has not now smoked for seven
months — the longest he’s been with-
out a joint since he started using canna-
bis at 14. He gives 5 per cent of the credit
to his family for driving him to appoint-
ments. “Fifteen per cent is on me for
putting the work in,” he added. The
remaining 80 per cent should go to the
support he’s been given by Di Forti and
her colleagues, he said. His life has been
transformed. “I’ve read about 50 books.
I’m able to focus again. I can watch a
drama series on TV instead of just
watching cartoons,” he said.
“I have plans — and there’s no poss-
ible way I’ll achieve them if I’m stoned.”A cannabis clinic that
cleans up delusional
users is struggling to
meet growing demand,
writes Rhys Blakely
Sir Robin Murray
and his wife, Dr
Marta Di Forti, are
at the forefront
of researchCloud of
cow burps
can be seen
from space
Some burps are merely a minor indis-
cretion, covered by a delicate napkin to
the mouth. Some catch you unawares,
and can be politely hidden by a sudden
coughing fit. But some are so big that
they are visible from space.
So it was for the cows of California’s
San Joaquin Valley. On February 2, in
what is believed to be a world first, a
satellite orbiting 300 miles above a
group of windy cows recorded their
burps.
Their methane emissions were spot-
ted by GHGSat, an Earth monitoring
satellite that uses spectroscopy to
identify greenhouse gas emissions.
Normally the satellite operator
works with companies such as landfill
operators and oil and gas companies to
audit their emissions, as well as provid-
ing methane data to the UN. But the
detection of cow burps marks out a new
market — and perhaps an additional
tool in tackling the problem.
Livestock are estimated to account
for about 14 per cent of greenhouse
emissions globally. Methane is many
times more warming than carbon di-
oxide, although it is more rapidly re-
moved from the atmosphere. At this
particular site, an intensive beef farm,
about half a tonne of methane was
emitted per hour.
Brody Wight, from GHGSat, said
they were surprised by what they saw.
“It demonstrates a completely new ca-
pability from space,” he said.
Scientists are trying to develop ways
to help cattle digest food without pro-
ducing methane. Satellite imagery
could be a way of auditing their efforts.Tom Whipple Science EditorAll the Queen’s horses Members of the Household Cavalry practise ceremonial duties on Horse Guards Parade in central London as they prepare to play a role in celebrations of the Platinum Jubilee in June
NIGEL HOWARD