Archive for August, 2013

America, Land of the Brown

Wednesday, August 21st, 2013

I warned about a resurgence of heroin use, following this year’s bumper opium crop in Afghanistan, in Smacktastic Britain, and unfortunately this may be already starting to come true, with reports of presentations of new heroin users at services (too young to remember the stigma of the last wave) and increased purity levels of the drug. But, given that there has been an international drought for the last three years, I guess this could just be business getting back to normal. And it will be another few months, possibly into early next year, before that crop reaches our shores and heroin use becomes a tempting prospect again – and people like the drug so much they start dying all over the place.

There has, however, been somewhat more of a significant increase in America. Fox News report that heroin use is “on the rise: cheap, available and out of control”, and the Wall Street Journal state that “heroin use in the U.S. is soaring, especially in rural areas”.

Fox’s Dr Manny Alvarez makes the claim that this increase is due to the last decade of prescription drug abuse, as painkillers such as Vicodin and oxycodone have been dished out like sweets and created large numbers of opiate addicts. The report also spells heroin with an ‘e’ on the end, claims that it causes miscarriage, and demands that America starts another War On Drugs – so I’m guessing we can take its contents with a pinch of salt – but it remains however an interesting suggestion that America’s increase is heroin use may be self-created. This claim is supported by other reports, which claim that OxyContin (the market name for oxycodone) has been refomulated to make it less abusable (by making it harder to crush and pastey, so that snorting or injecting is more difficult), and that, compared to the price of buying prescription meds, heroin is by far the cheaper option for those who find themselves dependent.

The Wall Street Journal, who also support the idea of a vast shift from prescribed opiates to painkillers, give some insightful and scary facts on the country’s growing heroin problem – seizures from the Mexico border have quadrupled between 2008 and 2012, and overdoses are going through the roof. Some of the rural communities are heroin-naive, most of them have no service provision, and heroin purity is at its highest in years, making overdose an inevitable consequence. Even more headline-grabbing – these medicated kids are white and middle-class.

So maybe we haven’t got as much to worry about in the UK as we first thought. The US market is prepped, desperate, and think that heroin is a bargain. If I was a drugs baron, I know where I’d be taking my bumper crop. Something tells me that the horrendous US drug overdose death rate of someone every nineteen minutes might be about to get a lot, lot worse…

Advertisements

Texas fights the War On Drugs (no, really)

Wednesday, August 14th, 2013

A bizarrely sensible change to US drug policy appears to have been made this week – based on a model trialled in Texas. In what seems to me to be a primarily fiscal move spun into a moral one by the Obama administration, the ideas from the conservative Bible Belt state are being rolled out to the rest of the country. Described as ‘a major shift in criminal justice policy’ by The New York Times, the changes are being implemented without the agreement of Congress, in order to bypass Republican opposition. Instead of changing legislation, alterations are being made to criminal justice directives, or the guidelines which inform federal prosecutors. The changes will stop the amount of the drug possessed from being declared in court, to avoid minimum sentencing requirements being triggered, and instead allow shorter sentencing or community orders where there is no violence, no sales to minors, no significant criminal history, and no links to organised crime and gangs.

This, in principle, seems like a positive move. However, when we consider the model originated in Texas, where millions of dollars were saved by avoiding building new prisons, and potential inmates were diverted into treatment and work programmes, we can be fairly confident the reasoning is financial rather than compassionate. It remains open to prosecutors’ discretion, which may well not reduce the race gap in prison populations (80% of those incarcerated for drug-related crime are black, which equates to one in three, yes that’s ONE IN THREE, young black males), and could in fact increase the racial discrepancy should prosecutors use their discretion biasedly. As the decriminalisation movement in America point out, this “tepid new directive.. smacks of… good spin and no spine”.

But Attorney General, Eric Holder, who unveiled the new plans this week to The Washington Post, offered some reassurance of the administration’s good intentions and understanding, saying “A vicious cycle of poverty, criminality and incarceration traps too many Americans and weakens too many communities… many aspects of our criminal justice system may actually exacerbate these problems rather than alleviate them”.

Only time will tell whether this will have the intended impact. But whatever the motive for the changes, the outcome will be fewer non-violent drug users incarcerated, the release of older inmates who were imprisoned for what would now be considered more minor drug offences, and hopefully a social shift in the perceived criminality and dangerousness of drug users in the US. A vast reduction the criminal justice budget is another good outcome – especially for a country which apparently now houses 25% of the world’s prisoners – and if the move is supported with an increased access to work and housing for these people, they should soon be contributing positively to tax figures instead of eating away at the other end.

Drugs policy fails – again: Postscript

Monday, August 5th, 2013

This one’s for the geeks and academics. I consider myself the former.

A mystery donor has sent me the full article for the research I wrote about recently (thanks, mystery donor), and it seems my theory about MCat was incorrect. What I didn’t deduce from the abstract was that the inverted correlation between the legal classification of cannabis and the number of people admitted to hospital with cannabis-related psychosis straddled not only the regrading from Class C to Class B, but also the earlier move from Class B to Class C. This method, known as a reversal design, references both the introduction and removal of the intervention – in this case, down-grading cannabis. The article states:

“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… 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.”

So my theory about unidentified MCat use causing an increase in psychosis admissions after cannabis was re-upgraded in 2009 doesn’t explain the previous decrease in admissions after it was downgraded in 2004. However, what became clear from reading the whole article is that the study relies entirely on participants being admitted under the criteria of ‘cannabis-related psychosis’. I query the validity of this data. In my experience, psychiatrists wang down any old shit on admission. As the article acknowledges, “This research has highlighted the need for research that explores the way that diagnoses of cannabis psychosis are made and the influences that operate on these decisions”. I would love to be the person to undertake that research, as from what I have witnessed, the pre-admission assessment usually goes something like is..

Psych: So you’ve been hearing voices?
Patient: Yes.
Psych: Have you ever used cannabis?
Patient: Yes.
Psych (writes): “Patient X is a drug user with a long history of cannabis use. Conclusion: cannabis-related psychosis.”

This diagnosis not only provides an excuse for a quick in/out treatment pathway and passing-of-the-book to substance misuse or dual diagnosis teams, it also puts the responsibility for the illness on the person being admitted. I will not mince my words – psychiatrists hate drug users. They perceive them with the same level of moral integrity that Conservative politicians do – drugs are bad. Those who use them are bad, and we need to police and punish all who use them. Certainly not treat them. Certainly not block up our hospital wards with them for more than a day or two. Get them in, give the Valium for a couple of days until they’re symptom-free, chuck them back out.

Drug users are perceived and accordingly treated by mental health services, and especially by those that rule and dominate these services, as time-wasters – impossible to assess, impossible to treat. I mean, how can I tell whether it is the condition or the substance causing the symptoms? And when I want to know the answer these questions, why won’t they just stop using drugs like I tell them to? Why aren’t they compliant?! And how am I suppose to use my tool of choice – dangerous, numbing drugs – to these liabilities when they have nowhere to live, no family member willing to supervise, and haven’t even got a lockable bathroom cabinet?!

Going back to the research, my original thought that maybe cannabis-related psychoses were in fact unmonitored MCat psychoses has been blown out the water, as overall inpatient psychotic admissions actually went down over time – not up as mephedrone and other new synthetic drugs became more commonly used. Again, this might be due to something completely different – such as psychiatric wards closing and so less space being available to admit people, or community teams such as Early Intervention or Assertive Outreach Home Treatment becoming more effective at keeping people out of hospital – but based on admission data alone, there is no trend here to suggest that psychotic incidences have increased since these new drugs became widely available.

If you consider my point above, you might feel, as I do, that this is less about the mental health of drug users and more about how mental health systems treat people who use drugs – but having spent twelve years banging this drug I am going to leave this point before I start bursting blood vessels.

%d bloggers like this: