I note the recent flurry of papers on the dangers of cannabis use (Reference AshtonAshton, 2001; Reference JohnsJohns, 2001; Reference MacCoun and ReuterMacCoun & Reuter, 2001; Reference RobsonRobson, 2001). As a clinician working with alcohol and drug users for 18 years, I find my mind strained by the disparity between what I read and what I see. Cannabis is almost universally used by my patients, yet only rarely can significant problems be attributed to its use. This is not to say that squirrel monkeys locked in cages with nothing to do but get stoned do not seem addicted to Δ ⁹-tetrahydrocannabinol (THC) (Reference Tanda, Munzar and GoldbergTanda et al, 2000; contrast with Reference PeelePeele, 1990). But what does that mean to humans living in complex interconnected worlds? We read that cannabis use “generally provokes relapse” in schizophrenia (Reference JohnsJohns, 2001) but the commonest cause of relapse is schizophrenia itself. Many people choose to reduce symptoms, feel more in control or stay numb through drug use, irrespective of what we say or fear. Generally, as symptoms improve with more effective treatments, and as life's chaos subsides, alcohol, tobacco and other drug use declines or stops.

A crucial point many do not concede is that people will and do use cannabis, at an increasing frequency in most Western countries, and that dire warnings in the face of growing public acceptance will achieve only loss of credibility for medical bodies. Driving a car, crossing a road, moving into a new relationship, let alone taking aspirin or a tricyclic antidepressant, are all dangerous, but we balance the risk with the benefit. No doubt all the reported effects of cannabis are correctly documented. But only those who can see no benefit in cannabis seem to pounce on another piece of information to confirm what they already know to be true, that cannabis really is a deadly drug. The rest of us get along with a pragmatic, balanced view.