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.

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2 comments on “Drugs policy fails – again: Postscript

  1. Ruthie says:

    So…. is the research suggesting that declassifying cannabis is a good thing? I know that is over-simplifying quite a lot but what was the research trying to prove??

    • Ha ha well in theory science doesn’t set out to prove anything – it is empirical and hence investigatory with only a hypothesis and not a presumption! But in answer to your question – I’m not really sure. The paper states that they expected the opposite result – ie a direct instead of an inverted correlation – but whether this is what they hoped to find, I have no idea.

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