Cases like Spejcher’s illustrate the stakes involved in the federal reclassification of marijuana. If President Trump follows through with such a move, the drug would remain illegal on the federal level, but would receive an imprimatur of being safer and face fewer restrictions, with significant commercial and social implications.  

Yet voices across public discourse persist in asking: why should anyone care if President Trump does just that? 

Celebrities like Mike Tyson and Joe Rogan and hedge-fund bosses like Andrew Lahde tell us that marijuana is no big deal. Numerous states have already legalized it for medical and recreational usage, and they claim to be regulating it well. If we are to believe the advocates, marijuana is a miracle cure for PTSD, anxiety, depression, and bipolar disorder — not to mention an unbeatable salve for the pain suffered by cancer patients.

So what sense does it make for this drug to sit in the same federal category as PCP and heroin? Isn’t marijuana’s placement in Schedule I, the most serious category, merely a relic of discredited thinking from the bad old days of the War on Drugs? It isn’t. To understand why it isn’t, and why a Trump move to reclassify weed would risk unmitigated harm to American health and safety, it’s first important to clear up some common misunderstandings around how and why drugs end up classified as they do.  

Under the Controlled Substances Act of 1971, a five-part schedule was established for classification of potentially dangerous drugs. This schedule is emphatically not an index either of a drug’s “hardness” or a kind of unofficial charging and sentencing guide for prosecutors and judges. Placement is earned specifically through consideration of a drug’s accepted medical use and its abuse risk. Drugs with no accepted medical use and a high risk of abuse get placed in Schedule I.  

That’s the commonality between marijuana and heroin; under federal law, the relevant agencies necessarily view them that way.  

Neither has an accepted medical use, though both drugs have approved medicines derived from them that remain in lower schedules (the medicine dronabinol, for example, is synthesized THC, the active ingredient in marijuana, and is in Schedule III). Both have high risks of abuse. The argument that one is a “hard” drug and the other is not  — which is debatable, especially given today’s ultra-high-potency weed — simply doesn’t come into play.  

Nor does the criminal-justice question. Keeping marijuana in Schedule I isn’t, as critics have it, a carceral strategy; conversely, moving it into Schedule III isn’t a de-carceral one. Under a move to Schedule III, the drug would remain federally illegal, still subject to the enforcement power of the Drug Enforcement Administration and the Department of Justice. No low-level offender would see his sentence commuted. This is sort of beside the point anyway, since most low-level marijuana users never receive a sentence for anything. 

But how can it be, another objection runs, that the drug has no medical use? Most US states currently allow doctors to recommend it. 

That, again, is technically correct. But the decisions those states made to allow doctors (and in some cases, “designated caregivers”) to recommend marijuana to treat pain and other issues were political decisions, not medical or scientific ones. Voters stated a preference; that has no effect on how federal agencies are required by current law to view the question. The facts of just how those recommendations get handed out drive home that political aspect. In 2022, Pennsylvania saw some 132,000 medical-marijuana certifications, a third of the state’s total for that year, issued by only 17 doctors.

Those decisions, taken in the aggregate, don’t constitute an accepted medical use. Or at least, they didn’t until October 2022. That was the month the Biden administration directed its Department of Health and Human Services to look into a possible reclassification of the drug.  

Again, history is important here. Before the Biden process, the federal government had used an eight-factor test to determine how to schedule various drugs. Those factors focus on what the current and historical patterns of its abuse look like, as well as what that means for individual users, what risk it presents to public health, how likely it is to cause dependence (either physical or psychological), the state of the science around the drug and its pharmacology, and whether it’s a chemical precursor or “analogue” of another controlled substance.  

By these metrics, marijuana is precisely where it belongs in Schedule I. The best science shows that it isn’t an effective medical treatment. One of the most frequent conditions it’s used to treat is chronic pain. But the 2017 study cited to prove its efficacy there has seen dozens of subsequent meta-analyses and reviews fail to support its conclusions; a 2022 study of a decade’s worth of surgical records from a Cleveland hospital even found that using marijuana actually increases pain after surgery. 

The data also demonstrate that marijuana poses a significant risk of dependency: addiction rates are around 30% of all users and rising. Addiction in this case means exactly what it does for other substances: inability to quit, a need for ever more of the drug to achieve the same effect, and even withdrawal symptoms. Given the recent avalanche of data cataloging marijuana’s harms specifically to cardiac and mental health — like a June British Medical Journal review  connecting it to a two-fold risk of cardiovascular death or the massive Danish study from 2023 suggesting that as much as 30% of schizophrenia cases among men between 21 and 30 were linked to cannabis-use disorder — its wider public-health risks are glaringly clear.  

The Biden administration supplanted the eight factors with a new system seemingly designed to push the drug into a less restrictive schedule. The Biden recommendation — likely a political compromise between the status quo and full legalization, timed just before Joe Biden’s re-election bid — also incorporated the shaky argument that because so many states have made political decisions to allow medical marijuana, that constitutes an accepted medical use.

An incisive article in JAMA Neurology, by the Harvard addiction scientist Bertha Madras, took a hard look at the process and found disturbing evidence of politicization. This included the fact that a high-ranking Biden DOJ official, Acting Assistant Attorney General Peter Hyun, argued that “cannabis has not been proven in scientific studies to be a safe and effective treatment for any disease or condition” — six months before the rescheduling directive appeared. Yet the science Hyun cites certainly had not changed in the interim.  

The federal government has long held the position Hyun laid out. Under the Obama administration, Jay Inslee and Gina Raimondo — then the governors of Washington and Rhode Island, respectively — petitioned the federal government to reclassify marijuana. The administration’s response made clear that federal drug schedules reflect what the science says, not “danger” or “severity.” Obama’s then-DEA chief, Chuck Rosenberg, announcing the denial of the petition, used language Hyun would later echo: “This decision isn’t based on danger. This decision is based on whether marijuana, as determined by the FDA, is a safe and effective medicine . . . and it’s not.”

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But let’s assume, for the sake of argument, that Trump reverses years of federal precedent to follow the logic of the rescheduling argument. What happens then? 

The truth: no one knows.  

It’s clear that the marijuana industry believes that rescheduling will be an enormous benefit to its shareholders. In one sense, that’s likely correct. Businesses selling substances in Schedule I face severe commercial restrictions under the tax code. A provision of the tax code prevents any such business from taking normal deductions at tax time on expenses like advertising. Lifting those restrictions seems sure to provide an enormous boost to revenues and reach for businesses selling marijuana products.

The impact on society is a different matter. The available evidence suggests that this will be a significant negative for society, especially given the research around how the young start using the drug: data published in June by researchers from the University of Southern California and Rutgers University show that exposure to marijuana social-media content plays a huge role in teens initiating use.  

But there are other externalities in play.  

If marijuana moves into Schedule III, it will be the only substance there without Food and Drug Administration approval. Will that play out in a similar way to the case of opium-poppy straw (i.e., the entirety of the plant, as it exists prior to the processes that turn it into heroin or opium)? Poppy straw is listed in Schedule II, but it also lacks an FDA approval — and it’s regularly seized by drug and border authorities, with a massive shipment grabbed up just in May. Though weed entrepreneurs clearly expect smooth sailing after a reclassification, they may well be in for a rough ride.

Then there’s the fact that substances listed in Schedule III face additional regulatory and enforcement power: Not only from the DEA and DOJ, but also from the FDA. There are strict rules around what sellers of Schedule III substances can and can’t say in advertisements. They’re forbidden from advertising off-label uses — and since marijuana lacks an FDA approval, all therapeutic uses are off-label. It’s easy to imagine another operator in the Schedule III space filing a lawsuit demanding precisely that kind of enforcement. 

In other words, rescheduling opens the door to regulatory chaos, even as it seems certain to add commercial firepower to an industry whose products, on the evidence, are extraordinarily harmful. How this combination will produce the benefits promised by proponents of rescheduling also remains unclear. 

The federal government shouldn’t signal to the American people that a drug that lacks medical or scientific imprimatur somehow possesses such approval. Others disagree — and vocally. They have a lot of money riding on it. But we should be crystal clear about what their preferred policy would  actually mean for American society — nothing good. 

I was here for the Product Earth Expo: the “UK’s no.1 legal cannabis, CBD, and nootropic experience”. The three-day event, co-organised by a former marketing lead at Facebook and a Harvard-educated medical data executive, is an outdoor festival of business and pleasure, with live music taking place alongside panel discussions on the various questions and goings-on in British cannabis. There are glassblowers, stalls for CBD businesses, tools for rolling, growing and baking weed, as well as medical and activist groups such as David Nutt’s Drug Science, Hemptank and the UK cannabis patients’ group.

Being an event centred around cannabis, it’s little surprise that funny smells were detectable throughout the grounds. No police were in sight. As with Hyde Park’s annual “4/20” gathering, last month’s Notting Hill Carnival and near-enough every music festival, the Expo’s look-the-other-way approach allows for a brief and flailing glimpse at our muddied present of drug policy.

Britain’s approach to cannabis can be described as contradictory — and in many ways backward. North America has largely legalised the drug, and Germany is following suit. But in Britain, some police forces will still raid large-scale dealers, even while medical cannabis patients are cultivating their own plants and small-scale growers are semi-officially tolerated in some counties. One scheme with a stall at the Expo was Cancard, an unapproved ID card scheme that lists users as medical cannabis patients and is backed by some police officers. If stopped, users can show their Cancard to excuse their use on medical grounds.

In reality, though, little has officially changed since 2018, when medical cannabis was first approved. Since then, senior Tory figures including William Hague have come out in favour of reform, while new cannabis companies entered the market and the City wetted its lips with anticipation. Britain swiftly became one of the world’s largest export-producers of medical and scientific cannabis. But, last year, regulators launched a crackdown on substandard and over-marketed items — and now the Expo’s founders are concerned about the CBD market’s possible collapse.

Medical cannabis was first approved in California off the back of stories of how it could relieve the symptoms of Aids patients. And this playbook has been followed in the UK. In 2018, a child whose epilepsy was treated with medical cannabis had his prescription seized at Heathrow Airport, prompting a relapse. Cameras and press were ready waiting. The resulting campaign, “End Our Pain”, was funded by commercial interests and led by Steve Moore, a former insider in the Cameron government, who later started the drug reform advocacy organisation VolteFace with funding from Paul Birch, the founder of Bebo. One of the other co-founders was Alastair Moore (no relation), who also co-founded a cannabis consulting firm called Hanway Associates.

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Two years later, the British Medical Journal documented a dense range of interconnections between pressure and patient groups and industry funders in the nascent cannabis market. New initiatives have since emerged: as well as founding VolteFace (with which he is no longer involved) Steve Moore would go on to set up the industry-funded Centre for Medical Cannabis and the Association for Cannabinoid Industry. Elsewhere, the All-Party Parliamentary Group (APPG) for CBD is managed by Tenacious Labs, a CBD firm, while the newly-elected Secretariat of the APPG for Medical Cannabis is jointly held by VolteFace and the industry-funded Medical Cannabis Clinicians Society.

It is an instinctively suspicious series of intersections between government and business lobbying. But Neil Woods, an ex-police officer and activist for drug policy reform, has questioned the significance of such connections. “Big business is of course interested in the emerging opportunities of a legal cannabis market for adult use,” he says. “But so what?” And Steve Moore himself has previously argued that a “public-private partnership” will always underlie a coalition for change. But for all the money involved, the market is still fraught with problems: many firms are loss-making, and rising interest rates are cutting the relative attraction of risky and future-looking businesses. Westminster isn’t playing ball, either, with home secretary Suella Braverman reportedly considering upgrading cannabis to Class A status.

Despite Braverman’s concerns, the medical case for cannabis has made some important advances. Medical cannabis was Nice-approved in 2018 for three conditions: severe treatment-resistant epilepsy, muscle spasticity, and chemotherapy-related nausea. Each of these conditions is prescribed as a last resort using a patented formulation, even when first-line treatments involve punishing side effects. But few prescriptions have ever been made on the NHS. Instead, a large private sector using registered cannabis clinicians has emerged, offering prescriptions to patients for a range of conditions where prior treatments have failed — including anxiety, depression and ADHD, for which evidence of cannabis’s efficacy is quite limited. For an “initial consultation” at clinics such as the Lyphe Group, Sapphire Medical Clinics and the London Cannabis Clinic, patients pay as much as £399. And many later complain that the expensive products from private prescribers are of inferior quality — often late, sometimes contaminated with mould.

Unsurprisingly, ideological arguments about the “right to get high” and bodily autonomy are rarely seen (at least explicitly) in the mainstream. All throughout the Product Earth Expo, the dominant way to present cannabis is medical — in line with broader medicalisation rhetoric that presents drug use as a public health problem and not a carceral one. And, perhaps inadvertently, allying with the medical system has exposed cannabis to greater scrutiny on its risks and benefits — as well as the demands of medical evidence. The last 10 years have produced more evidence in particular of cannabis’s link with psychosis, schizophrenia and a range of mental health problems. Indicatively, the Home Affairs Select Committee released a new report last week, which supports a “public health-based harm reduction” approach and calls for “greater provision” of medical cannabis on the NHS. Yet its authors “remain concerned” by cannabis harms and oppose full legalisation.

Walking the aisles of the Product Earth Expo, you get a two-sided picture. Users believe history is on their side. Much more than the old, the young are largely convinced of cannabis reform — though use of the drug has actually declined markedly among the young since the Nineties. Failing legal change, the growing normalcy of cannabis smoke forms part of a gradual and de facto erosion of anti-cannabis policy. Users will keep ignoring the law, until the law is so absent as to seem unworkable.

“Working in the sector it has been so frustrating to see the dialogue stagnate politically,” said Katya Kowalski, the Director of Operations at VolteFace, earlier this year. Indeed, among activists and campaigners, one hears many of the same arguments that have been made for decades, and which first caught flame in the Sixties: the motives of the original anti-hemp campaigners, the possible tax rewards, the relative safety of cannabis. Yet that final point is one on which the cannabis community seems to be losing ground. Making the case that “Cannabis Is Safer Than Alcohol”, as Bebo founder Paul Birch attempted in 2015, is no longer feasible.

Instead, it is possible that once again re-converging on a sympathetic human story will shift the debate. And Britain is full of such poignant cases. Kyle Brown, 26, is from Winchester and lives with craniometaphyseal dysplasia, a rare genetic disorder that causes the muscles and bones around the head to grow abnormally. He approached me at the Expo and told his story. Brown expects he will not live past 60, and estimates he probably has around eight years of high-capacity living left. Brown consumes medical cannabis to manage the punishing side-effects of his licit prescriptions.

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But he still relies on the so-called “legacy market” of street sales because of the high expense of legal prescription. Understandably, he is concerned about the presence of adulterants such as MDMA and fentanyl in his cannabis — as well as the lack of transparency about what exactly he’s smoking, which could contain the high THC concentrations so associated with mental health problems.

Who is truly leading Britain’s evolving cannabis policy is therefore difficult to estimate. The influx of medics, commerce and Big Pharma (though the latter is not as present at the Expo) has so far disappointed with their Whitehall strategy. But the lobbyists still hope to win through a long game, and their proximity to lawmakers would allow them to shape whatever model Britain eventually adopts.

“If they are to legalise cannabis, it will be a fully corporate model,” says Greg de Hoedt, a Crohn’s patient who manages his symptoms with cannabis. He’s also the founder of UK Cannabis Social Clubs, an activist umbrella group for private members’ clubs around the country that grow their own cannabis, smoke together, and offer testing on potency. Social Clubs are part of Germany and Malta’s legalisation models and form a third-way between community and commerce. Social Clubs have been tolerated in Britain historically, says de Hoedt, but he has noted more crackdowns from police in the five years since medical approval compared to before.

The Expo’s attendees are likely unaware of all the lobbying and politicking of the last half-decade. They form the lobby’s shock troops, normalising use and forming the consumer base for the current medical market and a future commercial one. The strategy has a shadow side, though: the more cannabis is unofficially decriminalised, the less immediate the issue seems for a short-term and crisis-driven political system.

These deaths are the predictable result of political failure. For decades, politicians have been hooked on prohibition. They have pushed the idea that use of illicit drugs should be punished and persisted with suggestions they can stifle flows of heroin, cocaine and cannabis, rather than accepting there is strong demand and focusing on harm reduction. The absurdity of their stance is exposed by the failure to keep even top-security prisons free of drugs, while on the streets prices fall, purity rises and new synthetic drugs arrive. This is, after all, a country with 11,000 miles of coast that sees 500m tonnes of goods a year move through its ports — yet total annual consumption of cocaine could fit in a solitary shipping container.

The legacy of such political irresponsibility is seen in these grim fatality figures. Our leaders outsourced the drug markets to criminal gangs, which rely on violence and grooming of young recruits to dominate their lucrative trade. There is, of course, no quality control on the content or strength of their wares. So forget all that Tory talk of levelling up, given the devastating impact of these policies on poorer parts of society. In England, the highest rate of fatalities is found in the north east, three times higher than further down the coast before the pandemic. In Scotland, epicentre for this whirlwind of misery, hospitalisation rates for drug-related incidents are reportedly 16 times higher in low-income areas than more prosperous parts.

The data is even more dispiriting when you probe prohibitionist policies. It is 50 years since signing of the Misuse of Drugs Act, which banned possession, supply, manufacture, import and export of controlled drugs — arguably the most damaging piece of legislation passed by parliament in recent decades. Since then, the number of heroin users in England and Wales has risen 25-fold, according to analysis by Transform Drug Policy Foundation, while drug-related deaths have soared more than 30-fold. The fatality rate in Scotland is ten times the average across Europe — and it has more than doubled over the past five years. Half of our homicides are also linked to drugs (along with half the acquisitive crimes and rough sleepers).

Could there be a more damning indictment of failure than all these corpses? Yet politicians cut support for treatment centres, pushed abstinence and kept pandering to fear with disastrous consequences. In Scotland, much of the rise in fatalities is down to use of benzodiazepines. Media hysteria led to tightening of the rules on legal prescriptions, which choked the supply routes for people abusing these drugs and thus incentivised criminals to develop the market for ultra-cheap, high-potency street benzos − the “blues” behind much of the horrifying carnage north of the border.

Or take events in parts of northern England after police targeted the cutting agents used by cocaine dealers to pad out their products and hike profits. Yes, this led to successful prosecutions of people found in illicit possession of large quantities of benzocaine, a mild anaesthetic used by dentists. But the result was simply a sharp rise in the purity of cocaine sold on the streets of places such as Manchester. Prices also plunged at the same time from about £45,000 a kilo to £30,000 a kilo, according to the charity Release, due to increased production in Latin America. This is close to half the £55,000 cost of a wholesale kilo 12 years ago on official figures, indicating significant rise in supplies.

“The drugs market is resilient and increased money for policing, increased busts and increased prosecutions do little to disrupt the trade,” said Niamh Eastwood, executive director of Release. “Even when borders have shut across the world in the pandemic it had little effect on the supply chains. This is a business that adapts fast, so as the government lauds the success of law enforcement closing down so-called county lines, new supply models are developed. We need new thinking, we need to start exploring decriminalisation and we need regulation of these substances.”

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She is right. The war on drugs has been a dismal failure — as shown by the government’s own reports. These admit Britain has the highest number of cocaine and high-risk opioid users in Europe, disclosing that there has been rising cocaine use over the past decade with recent hikes “clear in most age groups” and purity at highest levels on record due to “increased availability’. A 2017 review of strategy revealed central government spent £1.6bn on enforcement, yet “drug seizures… had little impact on availability” although there were “potential unintended consequences…such as violence related to drug markets”.  Even the biggest of drug busts barely dent supplies or costs on the streets, as many cops will admit.

It is estimated the “harms” cost England an astonishing £19.3bn a year, mainly due to crime and health. Yet Boris Johnson, unveiling a package of rehashed crime policies last week to look strong for his red wall voters, misleads the public with continuing pretence that we can beat the “scourge” of drugs. His ministers talk of “tough law enforcement” and win headlines for “cracking down” on recreational use with more testing after arrests. They claim this will “challenge drug misuse, reduce demand and change the perceived acceptability of using illicit drugs”, while a cross-government summit will “drive down demand for illegal drugs”.

I doubt cartel bosses and drug barons are quaking with fear over Johnson’s drug bash. In truth, it is bordering on criminal to see politicians stick to their bungling stance as the death toll mounts. Yet there are signs that behind the tough talk, the state’s backfiring drug war stance is starting to crumble. Both Scottish and English governments are putting a bit more cash into treatment while two key parliamentary committees have called for drug decriminalisation. “We recommend a radical change in UK drugs policy from a criminal justice to a health approach,” said the health and social care committee. “A harm reduction approach would not only benefit those who are using drugs but reduce the costs for their wider communities.”

Many frustrated police forces, fed up with wasting resources, are simply pressing ahead with “diversion schemes”. Avon and Somerset, North Wales, Thames Valley and West Midlands were among the first to follow the successful lead of Durham in seeking to slash reoffending rates and save costs by offering drug education or treatment as an alternative to arrest, cautioning or prosecution for people caught in possession. At least eight more have followed suit, with Scotland among others developing schemes. “You could call this de facto decriminalisation,” said Steve Rolles, senior policy analyst for Transform. “But that word seems problematic for this government because of worries it is seen as being soft on drugs.”

Rolles pointed out, however, that these strategies are winning ministerial plaudits and were backed by this month’s Black review into drug strategies. But surely it is unacceptable to have a postcode lottery that sees one person caught with a small stash of drugs end up in prison with a criminal record, while another sits through talks learning about harm reduction? Not to mention the inflammatory racial bias seen in police stop and search efforts focused on drugs. “We need to stop people going to prison for drugs since it is the wrong place for those people with problems,” said Professor David Nutt, the former government drugs adviser.

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Nutt was sacked in 2009 by the New Labour government for daring to tell the truth about cannabis, ecstasy and LSD being less harmful to public health than alcohol and tobacco. Since then, cheap potent, synthetic drugs such as fentanyl and mephedrone have arrived on our shores. But both big parties remain terrified of talking honestly to voters about drugs, although the few MPs breaking ranks have found the public in a more progressive place than they anticipated. Meanwhile there is increasing interest in Portugal, which 20 years ago this month showed a way out of the drug morass under the leadership of António Guterres, now United Nations secretary general.

Portugal acted out of desperation at a rising death toll. It had high levels of heroin use at the turn of the century, hundreds of deaths, highest rates of HIV infection in the European Union and prison cells filled with people sentenced for drug offences.

“It was almost impossible to find a family in Portugal that did not have drug-related problems,” said João Goulão, architect of their reforms. So they decriminalised drug possession, focused on health rather than punishment, shifted from abstinence-based campaigns and flipped funds into treatment. The result is shown in the latest annual data for drug-related deaths: 62 fatalities in a population twice the size of Scotland.

This is a spectacular turnaround. Now Portugal has among the lowest drug-related death rates in Europe, along with some of the lowest levels of use among younger generations. There is still a bedrock of high-risk opioid users, although numbers have fallen significantly and habits tend to be less problematic. It remains illegal to deal drugs. But those found with small quantities for personal use are sent before a local commission — typically a doctor, lawyer and social worker — to be told about support services. “We do not focus on drug problems but any issues people might have in their lives that lead to drug use,” said Goulão. “This is the key to our success. No one ends up in prison with a criminal record and stigma.”

Other countries have also seen the light, such as the Czech Republic and Spain. If Britain had followed similar policies, thousands of lives might have been saved. And these deaths should not be dismissed: they are a symbol of collective societal failures as well as a sign of lethal political stupidity. It has been shown time and again how the hallucination of prohibition can have perverse consequences by fuelling death, innovation and sales rather than depressing demand. So let us stop pretending another bust, another crackdown and another poor sod with mental health struggles being sent to prison is going to stop the use of drugs. Portugal shows there is a path forward that is cheaper, kinder and safer for everyone — as well as more honest about human nature. So why not level up with the electorate?

Such stamina seems almost alien today when, for the majority of British office workers, a glass of wine at lunch on a Friday is regarded as positively risqué. And that was before pubs were shut and people started working from home. But now that Dry January is officially over, what if Churchill was actually on to something? To be more precise: what would happen if we drank alcohol throughout the day and maintained a functional level of mild drunkenness?

That is the premise of Another Round, a riotous new film from the Danish director Thomas Vinterberg with a terrific central performance by Mads Mikkelsen. The story revolves around four jaded, middle-aged secondary school teachers — all men — who latch on to a scientific theory which claims that humans are born with an alcohol blood level that is 0.05% too low. To remedy this, to reach mankind’s optimum level of productivity and happiness, they take it upon themselves to drink throughout the day, using breathalysers to make sure they stay at the correct level.

It all sounds a tad deranged — and, of course, things quickly get out of hand — but the actual hypothesis explored in the film is drawn from real life. It is, in fact, the brainchild of Finn Skårderud, a Norwegian psychiatrist, psychotherapist and author. And he’s hardly a complete crank — he’s an international celebrated expert on eating disorders and even works as a psychiatrist for The Norwegian Olympic Committee.

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Does that mean his theory holds any water? Would we be happier and more productive if, as one of the characters does in the film, we started sipping from a bottle hidden in your office’s stationery cupboard?

It seems highly unlikely. But in Silicon Valley, the concept of micro-dosing — taking tiny amounts of LSD or other psychoactive drugs on a regular basis — has become popular in recent years, not just with hippies but with successful entrepreneurs. They report feeling more energetic, more creative and generally more at peace with themselves. Could the same be true for alcohol?

Not if you ask the vast majority of doctors. To start with, they claim, the idea that we have any level of alcohol permanently in our blood — let alone one that is too low — doesn’t make physiological sense. Yes, a number of animals in cold climates do have some alcohol in their bloodstream to effectively act as a de-icer. And there is something known as “endogenous ethanol production” in humans, where your stomach digests carbohydrates and produces an effect similar to fermentation, causing trace levels of alcohol. But it’s not a meaningful amount. Unless you’ve just had a G&T, your blood is naturally free of alcohol.

Still, even if we don’t suffer from an alcohol deficit, could we still benefit from increasing our levels by 0.05%? In terms of physical health, the scientific consensus also appears to centre around a “no”. That’s why, back in 2016, the UK’s chief medical officers reduced the recommended weekly amount men should consume from 21 units down to 14 units — roughly six pints of beer.

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For some doctors, however, even this modest limit is too much. “Basically, consuming alcohol is dangerous to health,” says Rudolf Schutte, a senior lecturer in Medical Science at Anglia Ruskin University. Meanwhile, Peter Anderson, a Professor of Substance Abuse, Policy and Practice, thinks that “there is no level of alcohol consumption that is risk-free.” But if you stick to 14 units, “the evidence shows that the lifetime risk of dying from an alcohol-related condition is about 1 in 100”.

And surely that’s the key thing. It’s a risk. But so too is crossing the road or, during a pandemic, entering a supermarket or jumping on a bus. The question is: how serious is that risk?

David Spiegelhalter, Professor of Understanding Risk at the University of Cambridge, has become something of a household name during the pandemic — at least in my house, he merits a cheer whenever he comes on the radio. He compares that 1% risk of dying to other everyday activities: “An hour of TV-watching a day, or a bacon sandwich a couple of times a week, is more dangerous to your long-term health.” He tells me that there are a lot of “exaggerated claims” about the harms of moderate drinking. In short, if you derive a lot of pleasure from a glass of wine every lunchtime, it’s a risk worth taking.

Of course, to maintain a blood alcohol level of 0.05% during working hours, the four men in Another Round need to drink a great deal more than one glass of wine during the day. (The drink drive limit in the UK is 0.08%.) But then again, they never pretend that their physical health will improve by being permanently, if lightly, sloshed. They argue it’s for the good for their psychological health.

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“This film is about being alive and being activated when you are dwelling through your midlife crisis,” Vinterberg, the director, said in a recent interview. And as Martin, the character played by Mikkelsen, points out, various great men spent much of their waking hours slightly drunk: Ulysses S Grant, Winston Churchill and Ernest Hemingway.

But while it’s true that Hemingway occasionally went on heroic benders, he didn’t drink while writing. The accusations that Grant was a full-blown alcoholic were mostly spread by his political enemies; it’s likely he was a moderate if persistent drinker. As for Churchill, he was less of an old soak than he was often portrayed. It was Hitler who called him an “insane drunkard” and Churchill himself sometimes thought it beneficial to burnish his own mythology.

However, one drinking habit of his that I did find deeply civilised was his fondness for kickstarting the day with what he called “mouthwash” — a weak whisky and soda, which he would take from about 9.30am and keep continually topped up. But the whisky (simple Johnnie Walker, no fancy malt) would only just cover the bottom of the tumbler; the bulk of the drink was fizzy water. For the morning, at least, Churchill was the embodiment of Another Round’s idea of perfection: just enough low-level inebriation to take the edge off and fire your imagination, but not so much that one made mistakes or felt tired.

Matt Field, a Professor of Psychology at the University of Sheffield and an alcohol and addiction expert, agrees that “alcohol serves a number of purposes”. It may not be good for your physical health, “but it can help you relax and it’s a big part of social occasions”. Interestingly, he points out that “the benefits of regular drink-free days are relatively understudied”. Even so, he still recommends having days off.

Still, perhaps the wisest advice comes from Churchill himself: “I’ve taken away more out of alcohol than it’s taken out of me.” As for whether that’s borne out in Another Round, I couldn’t possibly say.

This wave of assaults last week marked the end of phase one of  ‘Project Python’, a previously-secret mission to confront one of Mexico’s most terrifying drug cartels. It led to the capture of more than 600 people linked to the gang. “They promise hope and they deliver despair,” one Drug Enforcement Administration official told a receptive journalist. Agents boasted they’d seized 20,000 kilograms of drugs along with $22m in cash and other assets.

Their target had been the Jalisco New Generation (JNG) cartel, a gang that stands out for its hideous savagery even by the debased standards of the Mexican drug war. It is led by Nemesio ‘El Mencho’ Cervantes, a former police officer with a $10m bounty on his head, whose bodyguards once shot down a military helicopter to prevent his arrest. His moustachioed face stares down from billboards across California, as the authorities appeal for help in re-capturing a shadowy figure once jailed for three years in San Francisco on drug charges.

This highly-disciplined character leads a group that has used appalling violence to become probably the world’s key trafficker of heroin, fentanyl, cocaine and crystal meth; it controls at least one-third of the lucrative United States market. Using extortion, kidnapping, torture and murder it has muscled in on several other key sectors of the Mexican economy, from farming to mining — as I saw for myself last month, while visiting the state of Michoacán.

Cervantes was born here 54 years ago, one of six boys in a poor family of avocado farmers. I was there to report on how the drug cartels have muscled on production of the fruit as a new source of cash. Initially, they used avocado farming as a way to launder their mountains of money, but soon found it had become as lucrative as heroin, thanks to growing demand from Western consumers. Mexico grows almost half the avocados sold globally — and most of its ‘green gold’ comes from Michoacán.

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This fertile state was already at the core of cartel operations. I was staying in Uruapan, home to a club where five decapitated heads were rolled across the dance floor in 2006, in a move which kick-started Mexico’s war on drugs. The day I arrived, 11 bodies were found in a shallow grave. The following day, as I walked to my hotel, I stumbled across the scene of a mass shooting that had left nine teenagers dead. Soon after my departure, another farmer was kidnapped from his avocado orchard and killed, then 24 more corpses were discovered nearby with several of them showing signs of torture.

It is like the Wild West. Farmers speak of being extorted, indigenous people are armed with semi-automatic weapons to protect forests, trucks are hijacked daily and even taco sellers pay protection money. One journalist described fleeing the country after being summoned by a cartel chief who said he would pay $50,000 a month to have his public image improved. Vigilantes ran one town, boasting of having 2,000 weapons to protect 15,000 people. Police are distrusted since many are in the pay of cartels. Yet corruption is complex: as one source explained to me, often officers don’t have any choice, since if they refuse to help the gangs they — or their children — are killed.

The beautiful but brutalised state depicts with stark clarity the impact of the global war on drugs. Uruapan is in the midst of a vicious struggle for supremacy between JNG and a local cartel called Los Viagras (so called after the spikily-erect hair of one of its founders). Last year, the Jalisco mob strung up nine bodies from a bridge alongside a banner threatening Los Viagras, with 10 more corpses — many dismembered — left on the road below in a macabre show of force. To fight them is to attempt to cut heads off a hydra, as local leaders shift loyalties and new groups spring up. One source sent me a list of 20 different gangs contesting the terrain while the state’s security director told me the cartels have 200,000 members in Michoacán alone.

This huge figure puts the US arrest of 750 JNG goons in grim perspective. Now consider the cause of this spiralling violence in Mexico, which last year left 35,000 people dead in its worst year for murder since records began. For the emergence of this cartel highlights how criminal gangs descend into increasing barbarity as they battle to control illicit markets. JNG has filled a void left by the capture of Joaquin ‘El Chapo’ Guzmán, which weakened his powerful Sinaloa cartel. Typical of their depraved tactics was an incident five years ago in which dynamite was taped to a man and his son, then detonated — with the execution filmed on the sicario’s phone.

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The unintended consequence of taking out Guzman, who was jailed in the US last year, was the ending of a period of comparative peace that one analyst called ‘Pax Sinaloa’. His removal unleashed a fight for supremacy in which someone even more sinister seems to have triumphed —namely El Mencho, who oversees smuggling operations today on every continent.

The escalation of violence is a familiar story. We have seen the same thing here in Britain. Neil Woods, a former undercover cop, detailed in two superb books how risking his life for public safety made minimal impact on stopping the flow of drugs. He witnessed over his career a spiral of savagery as crooks fought to control the trade, the spoils of victory going to the most violent among them.

This partly explains the disturbing rise in knife crime in Britain, which in turn is associated with county line supply models that exploit vulnerable children to sell drugs. Politicians, though, continue to push the same old failed drug polices, which only inflame the violence — from Manchester to Mexico.

Meanwhile, we are seeing a surge in stronger synthetic drugs which are harder to detect and can be more dangerous. History has shown how prohibition fosters potency, from the days of moonshine replacing beer a century ago in the US through to skunk replacing milder cannabis more recently on our streets. Stronger products mean smaller quantities for smuggling and bigger margins. It is noticeable that JNG first emerged from Jalisco, Mexico’s centre for such products. Now, this gang is trafficking vast quantities of methamphetamine and fentanyl across the US, where the drugs are fuelling homelessness and addiction.

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Ironically, one reason these cartels moved into avocados is the recent fall in the price of heroin due to the emergence of new rivals, especially in Asia. Another reason has been the legalisation of cannabis in Canada, parts of the US and, effectively, in Mexico, which has cut off another supply of illegal cash. But this shift has happened too late to stop the cartels from becoming so strong they have corroded their country. And in any case the rise in the synthetic drug demand is filling that gap. Andrés Manuel López Obrador, a veteran socialist and close friend of Labour leader Jeremy Corbyn, won power two years ago by promising to end violence with focus on the economy and a policy of “abrazos, no balazos“ (hugs not bullets). But the economy has stagnated, despite the avocado boom, and violence worsened.

Uttam Dhillon, acting head of the DEA, boasted after the raids last week that his team had carried out “one of the largest, concentrated actions against a single criminal organisation in many years”. He argued that the arrests would have “significant impact” since they were inhibiting the cartel’s ability “to regenerate and to continue to threaten our communities with their deadly drugs”. It’s nonsense. He should listen to his own agents who say that El Mencho is a far more deadly foe than his predecessors with his extreme use of terror and violence — and he should question why the murder and mayhem grows worse for all the DEA’s noble efforts.

Eddie — not his real name — was 35 and not known to mental health services, a relatively unusual situation as symptoms normally develop earlier, often in late adolescence. University-educated and highly-skilled, he was living a comfortable life working in the IT sector. Then, five years before I saw him, he had landed a prestigious new job in Amsterdam.

It was difficult to piece together what had happened to him, because his thought process had become completely disordered, but we eventually learned that Eddie had begun smoking cannabis while in Amsterdam; at first only occasionally, and then more regularly until eventually he was using it every day.

Over a period of time, as psychotic symptoms first emerged and then developed into something bigger, Eddie began his downward drift, losing his job and eventually becoming homeless. His distraught mother paid for him to come back to Britain to live with her, before he was admitted to hospital.

There was no history of serious mental illness in the family, nor had Eddie exhibited any notable problems in childhood or even as he got older; things only began to fall apart in his life after he moved to Amsterdam, where high-strength cannabis is freely available.

Eventually Eddie received a diagnosis of schizophrenia and was placed on a community treatment order, instituted primarily to ensure that he complied with the anti-psychotic medication, given fortnightly via intra-muscular injection and prescribed in order to control his symptoms. Any hopes that he and his mother might have had for his life were now greatly diminished — job, career, children, family, all of his and her dreams crushed. Eddie was by now living with what is essentially a disability, with the prospect of a reduced life expectancy and quality of life.

I’ve been a registered mental health nurse since 2007. Post-qualification I initially worked in a ward for six years, followed by another six in the community. The gap between public perceptions of psychiatry and what you actually see working on the wards and outside can be pretty big sometimes, but none more so when it comes to the issue of cannabis.

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I first became aware of the drug as a teen, well before I had even thought about what I was going to do as a career. Like a lot of people my age — I’m 39 now — I knew people who smoked cannabis, and it wasn’t considered a big deal at the time. Despite being illegal, it was widely seen as a harmless soft drug to experiment with, sort of a rite-of-passage to adulthood. This was in the late 1990s, when most cannabis on the black market was low in THC, the psychoactive compound that delivers the high and makes the drug enjoyable to smoke.

My next encounter with cannabis was very different, involving witnessing people on the psychiatric wards where I worked from 2007-2013. Prior to becoming a mental health nurse I had known many people who had smoked cannabis but who had never experienced psychotic symptoms. In my new job it was rare to meet anyone experiencing psychotic symptoms who was not also a marijuana smoker.

The type of cannabis being smoked was by this time very different from that of the late 1990s. Commonly known as “skunk” (after its very pungent smell), this new form had come to dominate the market.

Skunk is much higher in THC than its predecessors, but almost all forms of the drug have become stronger. In a recently published polemic on the dangers of legalisation, Tell Your Children: The Truth About Marijuana, Mental Illness and Violence, author and New York Times regular Alex Berenson wrote that: “through the mid-1970s, most marijuana consumed in the United States contained less than 2 percent THC. Today’s users wouldn’t even recognise that drug as marijuana. Marijuana sold at legal dispensaries now routinely contains 25 percent THC.”

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This closely mirrors the situation in Britain, where the reputation that cannabis has acquired in the public consciousness — a mild, harmless, benign, relaxing intoxicant — is dangerously out-of-date.

A recent study published by the Lancet gave a stark warning, stating boldly that “daily cannabis use was associated with increased odds of psychotic disorder compared with never users … increasing to nearly five-times increased odds for daily use of high-potency types of cannabis”. The evidence for a link between cannabis use and serious mental illness is clear, but the difficulty remains in conveying this information to the public.

Psychosis is the clinical term describing what most lay people would understand — and what we historically would have referred to — as “madness”. There is still, even today, a large degree of stigma attached to these symptoms, and consequently not many people wish to speak about their experiences of them. You are unlikely to even hear about them unless you work in mental health services; and unless you have experienced psychosis yourself, or know someone who has, it is difficult to grasp the devastation that it causes to people’s lives.

With psychotic symptoms experienced by cannabis smokers we are primarily talking about hallucinations (usually auditory) and delusions (usually persecutory i.e paranoid.) They can be extremely frightening to those who experience them and, as a consequence, can often lead to social withdrawal, as well as social drift.

The social drift hypothesis notes that individuals who suffer from serious mental illness (SMI) — in particular those diagnosed with schizophrenia — are more likely than the general population to live in socioeconomically deprived areas and that the clinical features of mental illness contribute towards this downward trajectory in socio-economic class.

During my time working as a staff nurse on an acute inpatient male psychiatric unit I observed social drift first-hand, Eddie being only one such example. But social drift and social withdrawal also make it even less likely that the average person will know someone who has experienced these symptoms, and so their story goes untold.

It is true that not everyone who smokes cannabis will experience these symptoms. It is often asserted that the link between cannabis and psychosis is merely correlational and not in any way causative, an argument intended to muddy the waters, when THC is known as a risk factor in mental illness. It is an argument never made in relation to cigarette smoking and lung cancer, even though most cigarette smokers do not die of lung cancer, either.

But cannabis is not safe: it is associated with a number of serious side effects, including problems related to pregnancy — see here, here , here and here — life-threatening vomiting, changes to neuroanatomy, a significantly increased risk of youth suicide — see here, here and also here — an increased number of hospitalisations — see here and here — increased postoperative pain, impaired cognition/lowered IQ in adolescents and an increased risk of car crash injuries — see here, here, here and also here.

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It is, therefore, incumbent upon mental health professionals to speak up so that the general public are made aware of the risks. This has become even more important now that North America has undergone a wave of cannabis legalisation spreading from Colorado to Canada, emboldening advocates in Britain in the process.

It is true, as Berenson argues, that decriminalisation reduces the civil rights concerns expressed by legalisation advocates and campaigners. One could argue that cannabis has already been de facto decriminalised in this country anyway, despite the rather overblown claims that are sometimes made to the contrary, and de jure decriminalisation therefore seems the logical next step.

Yet legalisation tacitly endorses and normalises the idea that the drug is safe, which it isn’t, and risks creating an entrenched business community who will then promote cannabis as a product; it will do this without providing us with any certainty or assurances that the process will reduce the black market for the drug or reduce its potency.

This is what has happened in North America already, and represents the worst of all possible worlds – and once we legalise the drug it will be very difficult to turn the clock back.

If cannabis is legalised then the only winners will be big tobacco, alcohol and pharma. The rest of us will all be losers, and the worst affected will be those already living at the margins of society.

But this is unfair. What the Pharisees were trying to do was entirely laudable – they sought to extend the rules that religious conservatives believed only applied to priests in the Temple, and make them applicable to all Jews. In modern terms, the Pharisees wanted to democratise religion, to take it out of the Temple into the market place.

Christians have not only been unjustifiably harsh on the Pharisees – not least under the influence of St Paul who was himself an ex-Pharisee – they have also, precisely because of this, lost sight of a basic Christian message.

To put it crudely, Christian morality is unattainable: its basic teachings are set up as to be virtually impossible for anyone to follow. For example, in Matthew’s Gospel, Jesus argues that adultery is not just having sex with someone who is not your wife, but even to look at a woman lustfully counts as adultery. This is a council of perfection that, pretty much, no man can meet. And so hypocrisy is endemic to the whole Christian project. To put it another way, Christianity deliberately engineers a crisis of moral failure among its adherents, thus to oblige them to seek repentance and an awareness that they depend upon God for their salvation, not on their own pathetic efforts.

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Why I regret my war on drugs

By Charles Falconer

This is part of the back-story to the complicated moral valence of the word hypocrisy. These days, however, the charge of hypocrisy has risen high up the league-table of moral crimes with which to charge someone. And yes, I am thinking about Michael Gove and his cocaine admission.

I have a theory about why hypocrisy has become moral crime number one: because in an age of moral relativism, where it is widely believed that our values are self-generated, inconsistency is just about the only thing we can get someone on. If morality is our own business, our own invention, then not living up to our own rules is the only thing that counts as moral failure. And, so, moral disputation becomes a game of “gotcha!”.

I have a totally different take on hypocrisy. Better to have high standards that you fail to meet, than low standards that are designed around your own moral (in)capacity. For me, hypocrisy is an inevitable by-product of upholding high – even objective – moral standards. If you are not a hypocrite, you are just not trying hard enough.

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By Giles Fraser

Take the case of Paul Staines, aka Guido Fawkes, a mischief-making journalist who made his name with a succession of stories exposing the failures of politicians. He came onto the Moral Maze programme this week, having accused Gove of double standards – the politician was taking cocaine at the same time as condemning the practice in his Times column.

I do not condemn Staines for his “gotcha” approach to journalism. That is his job, and he serves an important function. Nonetheless, his own position struck me as a different form of failure.

He proudly admitted his regular and continued cocaine use, and refused to see anything wrong with that. He was colourful and entertaining and refreshingly open. Indeed, so open that he was even prepared to admit that as a father of teenage girls, his position to them on drug use was: do as I say not as I do. So an honest hypocrite then.

But nonetheless, I was left with the impression that his position was designed with maximum consistency in mind. He had formulated his moral position so that it could easily fit around his personal proclivity for recreational pharmaceuticals. And that is surely the wrong way around. In the world of “gotcha” morality, Staines is well protected against the very strategy that he employs to devastating effect against others. But at what cost?

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How moral is mockery?

By Giles Fraser

The guest that followed him on the Maze told a very different story about our moral formation. The psychoanalyst Dr Aaron Balick says we are all hypocrites; hypocrisy is constitutive of the human condition. And this was an unsurprising observation for a psychoanalyst to make, because in his working life he is constantly dealing with the gap that exists between people’s self-presentation and the deeper reality of their lives.

An important part of the psychoanalytic enterprise is to bring these different parts of our lives into a more fruitful conversation with each other. The Staines position seems to me a denial of the deep contradictions that form us as human beings. This makes him bullet-proof on the chat-show, but, I suspect, tragically exposed on the couch, if he were ever to find himself there.

Now, I apologise to Staines for using him as my example here. I do not know him. And he was entertaining company. But he is an interesting example because of his professional career as a hypocrisy hunter.

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By Giles Fraser

His work speaks to much of our current political predicament. On the one hand, we want out politicians to be like us, to share our complexity and to have experienced some of the same moral challenges and failures of our own lives. Thus we scorn Theresa May for the inanity of her confession that the worst thing she has ever done is run through a wheat field. If that really is the worst thing she has ever done, then she really is the Maybot – something, as the word implies, less than fully and messily human. Yet, at the same, time, we condemn our politicians when they are exposed for doing something a little more morally problematic (and interesting) than wheat-field trespass. We ask the impossible of them. And we set them up to fail.

Balick argues that we take pleasure and relief in exposing the hypocrisy of others because it is a convenient way of pointing away from our own failures. “Gotcha” morality is a strategy of misdirection. “Use every man after his desert and who should ‘scape whipping?” was Hamlet’s response to the pompous and self-righteous Polonius, a line that Freud himself quotes with approval in one of his letters. Let him who is without sin cast the first stone.

Personally, I am more comfortable with politicians who are hypocrites. Being one myself, I understand the type. The Pharisees were basically right: better to aim high and fail, than to be complacently content with the small and closed world of our own moral limitations.

Why I like my politicians to be hypocrites

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