title: Effect of reclassification of cannabis on hospital admissions for cannabis psychosis: a time series analysis.
abstract: BACKGROUND
  The UK Misuse of Drugs Act (1971) divided controlled drugs into three groups A, B and C, with descending criminal sanctions attached to each class. Cannabis was originally assigned by the Act to Group B but in 2004, it was transferred to the lowest risk group, Group C. Then in 2009, on the basis of increasing concerns about a link between high strength cannabis and schizophrenia, it was moved back to Group B. The aim of this study is to test the assumption that changes in classification lead to changes in levels of psychosis. In particular, it explores whether the two changes in 2004 and 2009 were associated with changes in the numbers of people admitted for cannabis psychosis.
  
  
  METHODS
  An interrupted time series was used to investigate the relationship between the two changes in cannabis classification and their impact on hospital admissions for cannabis psychosis. Reflecting the two policy changes, two interruptions to the time series were made. Hospital Episode Statistics admissions data was analysed covering the period 1999 through to 2010.
  
  
  RESULTS
  There was a significantly increasing trend in cannabis psychosis admissions from 1999 to 2004. However, following the reclassification of cannabis from B to C in 2004, there was a significant change in the trend such that cannabis psychosis admissions declined to 2009. Following the second reclassification of cannabis back to class B in 2009, there was a significant change to increasing admissions.
  
  
  CONCLUSIONS
  This study shows a statistical association between the reclassification of cannabis and hospital admissions for cannabis psychosis in the opposite direction to that predicted by the presumed relationship between the two. However, the reasons for this statistical association are unclear. It is unlikely to be due to changes in cannabis use over this period. Other possible explanations include changes in policing and systemic changes in mental health services unrelated to classification decisions.
authors.affiliation: University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom. Electronic address: ian.hamilton@york.ac.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Hamilton
authors.affiliation: University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
authors.forename: Charlie
authors.initials: C
authors.lastname: Lloyd
authors.affiliation: University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hewitt
authors.affiliation: University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Godfrey
mesh_terms: D002188:Cannabis / Q000009:adverse effects* / Q000145:classification*; D006291:Health Policy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015233:Models, Statistical; D011605:Psychoses, Substance-Induced / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology
keywords: Cannabis; Interrupted time series; Psychosis; Reclassification