The union representing the UK's 35,000 Prison Officers is calling for urgent action to address prison violence. The call came following the publication of the latest Safety in Custody statistics from the Ministry of Justice in England and Wales.
New figures show that an average of 27 assaults on Prison Staff are recorded each day, with 9,833 incidents representing 230% increase since 2010’s 2,977 figures.
While the number of deaths in custody fell by 42 to 359 deaths in custody in the year to June 2026, the number of serious assaults has risen to 3,419 in the past year - an average of 14 serious assaults a day - an increase of 141.8% since 2010 when 1,414 serious assaults were recorded.
All recorded Prisoner-on-prisoner assaults reached 21,245 (58.2 a day), up 3.3% on the year to March from 20,574. This is an 81% increase since 2010, which recorded 11,736 prisoner-on-prisoner assaults.
POA General Secretary Steve Gillan said:
“The level of violence in prisons across the country is completely unacceptable - it is endemic.
“It is being fuelled by drugs and contraband, the influence of organised crime gangs and a prison system that is overcrowded and understaffed.
“The POA will continue to campaign for urgent action from the Government and the Ministry of Justice to address the root causes of high levels of violence in our prisons.”
Mark Fairhurst, POA National Chair said:
“Prisoner-on-prisoner and prisoner-on-staff assaults are making the UK's jails one of the most hostile working environments in Europe.
“The POA has repeatedly called on the UK Government to take preventative action to protect both prisoners and Prison Officers.
“The introduction of stab-proof body armour, taser trials and PAVA in the youth estate are a result of the POA’s campaigning work. Every time we meet the Secretary of State, Civil Servants and Prison Service officials we raise the issue of prison violence and the need to protect our members. We will step up that campaigning work until we see lasting, positive change.”
As Mark S. Gold M.D. writes:
If you carry a genetic or neurobiological vulnerability to psychosis, using cannabis may increase the likelihood that psychosis will emerge, particularly during adolescence and young adulthood. Cannabis-induced psychosis is not always temporary. Numerous studies have shown that many affected individuals develop schizophrenia-spectrum disorders.
Few investigators have done more to shape contemporary thinking about cannabis and psychosis than Deepak D’Souza, M.D., the Vikram Sodhi ’92 Professor of Psychiatry at Yale University School of Medicine. His work demonstrated that delta-9-tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, can induce transient psychotic symptoms in healthy volunteers and worsen existing symptoms in patients with schizophrenia. For more than two decades, D’Souza’s research, scientific publications, and public statements have challenged assumptions about the psychiatric safety of cannabis.
D’Souza’s trailblazing research helped move the field beyond the simple observation that cannabis use and psychosis are associated. The more important question became whether cannabis could cause psychotic disorders. His studies also found that abstinence reduces relapse risk, whereas continued cannabis use is associated with poorer clinical outcomes and a diminished treatment response.
Today, D’Souza is asking a different question. Amid concerns about increasingly potent commercial cannabis and unprecedented levels of THC exposure, he’s raised the possibility that cannabis may trigger a lifelong psychosis in some individuals. Recently, D’Souza and colleagues published a study comparing patients hospitalized with first-episode psychosis who had documented cannabis exposure with similar patients who had no evidence of cannabis exposure.
The study examined 119 men hospitalized with first-episode psychosis, including 66 with toxicology-confirmed cannabis exposure and 53 without cannabis exposure. Patients in the cannabis-associated group exhibited fewer negative symptoms, such as affective flattening and loss of motivation, while showing comparable levels of hallucinations and delusions. They also displayed more depressive and manic features, denoting a clinical presentation differing from classic deficit-form schizophrenia.
While both groups entered the hospital with similar levels of cognitive impairment, only the cannabis-associated group demonstrated significant cognitive improvement after four weeks of treatment and cannabis abstinence. The investigators also detected distinct EEG patterns that may reflect differences in cortical excitation and inhibition. Together, these findings suggest cannabis-associated psychosis may differ from non-cannabis-associated psychosis in ways that extend beyond clinical symptoms alone.
D’Souza summarized the evolution of his thinking in a recent conversation with me:
“Schizophrenia (SCZ) or, as Bleuler in 1911 appropriately coined, the “group of schizophrenias”, is heterogeneous on a number of levels, including its phenomenology and clinical manifestation, environmental risk factors, micro-scale molecular genetics, transcriptomics, proteomics, and macro-scale alterations in brain structure, function, and connectivity. Several attempts have been made to identify and tease apart SCZ subtypes based on clinical manifestations, genetics, and biomarkers. It is a bit too early to make any definitive conclusions, but our findings raise the fascinating possibility that there may be a cannabis subtype of psychotic disorders.”
D’Souza’s study, however, included only men and followed patients for just four weeks. The long-term trajectory of cannabis-associated psychosis remains unclear. Some cases may evolve into schizophrenia-spectrum or mood disorders, whereas others may not. Whether cannabis-associated psychosis represents a distinct subtype of psychotic illness remains an open question.
No single research finding has yet proven that cannabis-associated psychosis is biologically distinct. However, stellar investigators at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, including Marta Di Forti and Robin Murray, have provided clear evidence linking cannabis exposure to psychotic disorders. Their studies demonstrated that daily use of high-potency cannabis is associated with markedly increased odds of developing psychosis and showed that a substantial proportion of first-episode psychosis cases are attributable to exposure to potent cannabis products.
What is becoming increasingly difficult to dismiss is the possibility that cannabis-associated psychosis represents more than a temporary drug-induced syndrome. It may, in some individuals, constitute a persistent psychotic illness triggered by cannabis exposure. As D’Souza told me:
“Our findings need to be replicated. Furthermore, it is important to collect longer-term follow-up data to understand whether the long-term course and prognosis of this proposed subtype is distinct.”
Earlier debates about cannabis and psychosis regularly revolved around polarized positions. One camp argued that cannabis merely unmasked schizophrenia in genetically vulnerable individuals. Another viewed cannabis-induced psychosis as a transient intoxication-related phenomenon fundamentally distinct from schizophrenia. Increasingly, the evidence suggests neither formulation is entirely adequate. Nevertheless, the convergence of clinical, cognitive, and somatic differences raises the possibility that cannabis exposure may be associated with a recognizable psychosis subtype rather than simply serving as a trigger for conventional schizophrenia.
Several high-quality epidemiologic studies support D’Souza’s concerns and challenge the longstanding belief that cannabis psychosis is usually benign and self-limited. A Danish registry study found cannabis-induced psychosis had one of the highest conversion rates to schizophrenia-spectrum disorders among substance-induced psychoses, with approximately 41 percent of affected individuals later receiving a schizophrenia diagnosis. Meta-analyses have similarly demonstrated substantial progression rates from cannabis-induced psychosis to chronic psychotic illness.
Individuals with substantial cannabis exposure regularly develop psychosis at younger ages than non-users. Some studies have found fewer negative symptoms and better cognitive functioning than in patients with non-cannabis-associated schizophrenia. Reviews by Yücel and colleagues and Løberg and Hugdahl suggest the pathway to psychosis in cannabis-exposed patients may involve less severe neurodevelopmental impairment than typically seen in primary schizophrenia. Cannabis-associated psychosis may not be ordinary schizophrenia.
The strongest epidemiologic support for a novel cannabis-related psychosis pathway comes from the fact that high-potency cannabis is associated with markedly increased odds of psychotic disorder, meta-analyses documenting a dose-response relationship between cannabis exposure and psychosis risk, evidence that abstinence reduces relapse risk, and continued cannabis use is associated with poorer clinical outcomes and diminished treatment response.
What psychiatry currently labels “schizophrenia” may represent a final common clinical pathway reached through multiple genetic and environmental routes. Cannabis could plausibly be one of those routes. If so, the key question becomes whether cannabis-associated psychosis differs meaningfully from schizophrenia occurring without cannabis exposure.
D’Souza’s findings are particularly relevant today, with earlier cannabis initiation, more frequent use, and commercial products containing THC concentrations far higher than those available in the past. Complementing these observations, studies from the London groups have shown that daily use of high-potency cannabis is associated with substantially increased odds of developing psychosis. These findings raise concerns that modern cannabis products are contributing to the increasing incidence of psychotic illness.
The treatment implications are equally important. Existing evidence suggests cannabis-associated psychosis responds to antipsychotic medications as primary psychosis does. However, continued cannabis use substantially increases the risks of relapse, rehospitalization, medication nonadherence, and treatment failure. These findings also underscore the importance of cannabis cessation and treatment of cannabis and other co-occurring substance use disorders.
Cannabis use is consistently associated with an increased risk of psychosis and with exacerbations of psychotic symptoms in both healthy individuals and people with psychotic disorders.
Rather than asking whether cannabis can produce psychosis, we may need to ask what kind of psychosis it produces, in whom, and under what circumstances. Psychiatry must also move beyond the simplistic question of whether cannabis “causes” schizophrenia. The more important questions concern cannabinoid-system mechanisms, individual vulnerability, and timing of exposure. Cannabis may not create an entirely separate disease entity, but growing evidence suggests it can dictate the timing, expression, and long-term course of psychotic illness in vulnerable individuals.
The Drug Report has seen the future, and indeed the present:
For a century, the daily cigarette smoker was the face of American addiction. According to the federal government’s own data, he has just been replaced.
The Substance Abuse and Mental Health Services Administration released the 2025 National Survey on Drug Use and Health on Monday, and buried in its appendix tables is a milestone no federal survey has ever recorded: 21.4 million Americans now use marijuana daily or almost daily. That is more than the 19.9 million who smoke cigarettes daily, and well more than the 17.2 million who drink daily or almost daily.
The agency’s press materials led elsewhere, with encouraging trends among adolescents. The daily-use figures appear nowhere in the 157-page national report. They sit in Section 9 of the detailed tables, where the survey’s own significance testing marks nearly every marijuana measure that matters as a statistically significant increase since 2021.
The Numbers
[You will have to follow the link.]
The trend lines are moving in opposite directions. Since 2021, daily cigarette smoking has fallen by 7.6 million people and daily drinking by 5.3 million, the continued payoff of decades of public health work. Daily marijuana use rose by 3.7 million over the same four years. Nearly half of everyone who currently uses marijuana (48.8 percent) now uses it daily or almost daily.
America’s Second-Largest Addiction
The survey counted 19.3 million Americans meeting clinical criteria for marijuana use disorder in 2025, roughly one in three past-year users. That places marijuana second only to alcohol (25.7 million) among the nation’s substance use disorders, and nearly five times ahead of opioid use disorder (4.0 million).
The gap at the top is closing. Alcohol addiction has declined by 4 million since 2021; marijuana addiction has grown by 2.7 million. Both shifts are statistically significant. Four years ago the distance between America’s first- and second-largest addictions was 13 million people. It is now 6.4 million.
Among young adults aged 18 to 25, one in seven (14.1 percent of the entire age group) has marijuana use disorder.
The Teen Story Has Two Halves
Adolescent marijuana use fell again: past-year use among 12-to-17-year-olds dropped from 10.9 percent in 2021 to 8.7 percent in 2025, a significant decline that legalization advocates promoted within hours of the release.
The same tables complicate that story in two ways. First, the decline is not marijuana-specific. Teen alcohol use fell at a statistically indistinguishable rate over the same window, down roughly 20 percent, alongside nicotine, tobacco, and prescription-drug misuse. Youth use of virtually everything is falling.
Second, the teens still using marijuana are using it far more intensively. The share of adolescent past-year users consuming daily or almost daily jumped from 9.5 percent in 2023 to 14.7 percent in 2025, with every earlier year in the trend window significantly below 2025. More than one in three current teen users (36.8 percent) used daily or almost daily in the past month. And because heavy use held steady while casual use fell, the raw count of teen daily users, 327,000, is the highest in the five-year window. Half of teens who used marijuana in the past year already meet criteria for marijuana use disorder.
Perception is moving the other way: just 36 percent of adolescents see great risk in smoking marijuana weekly.
Elsewhere in the Survey
Past-year marijuana use reached 61.6 million Americans (21.2 percent), up significantly from 2021 though down from its 2024 peak. Adults 26 and older remain the engine of growth, up 24 percent since 2021, with daily use in that group up 33 percent. Past-month use among pregnant women rose from 5.1 percent to 6.7 percent, a change that did not reach statistical significance but will bear watching. And 10.3 million people reported driving under the influence of marijuana in the past year, approaching the 12.6 million who drove under the influence of alcohol.
The 2025 survey, drawn from interviews with roughly 70,000 Americans, is the fifth consecutive year of comparable data since the survey’s 2020 redesign, making this the first release in which four-to-five-year trends can be tested with confidence across the board. What those tests show is consistent: every major indicator of heavy marijuana use and marijuana addiction is significantly higher than in 2021.
The milestone itself required no test at all. The national report never mentions it; Table 9.38A states it plainly: in 2025, America’s most common daily drug habit is no longer tobacco.
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