Wednesday 13 April 2011

Give psychotic drug to the mentally ill, urges ASH

I returned from the International Harm Reduction Conference on Friday, a day late thanks to a cancelled flight. Carl Phillips—a more dedicated blogger than I—has written a series of posts about the conference at Ep-ology (eg. here, here and here) and I'll mention some themes in the next few posts.

As you may know, the harm reduction movement is focused on drug use, especially intravenous drug use, but is sympathetic to all forms of harm reduction. In the field of tobacco, that means snus, e-cigarettes, nicotine drugs and any other 99% less harmful nicotine delivery device.

Inevitably, there is a faction which tends towards Nuttism—defending illegal drugs as an means to condemn legal drugs (named after its greatest living exponent, David Nutt). Alarmingly, a representative of the WHO blamed drug use on smoking, using the post hoc ergo propter hoc logic that most people who take drugs have previously smoked cigarettes. Still more alarmingly, he suggested that it might be better to view smokers as criminals and drug users as victims.

Mercifully, he seemed to be in the minority. Most delegates work with—or are themselves—drug users and smokers, and they see neither as criminals nor addicts. Amongst harm reductionists, opinion varies from those who don't condone drug use but think it should be made as safe as possible, to those who think taking drugs is a human right. Certainly, there is an acceptance that people take drugs because (a) they like them and (b) they have psychological benefits.

If you suggested that people take drugs solely because of (a) peer-pressure and (b) addiction, they would laugh in your fatuous face. We tell school children that, of course, because if we told them the whole truth they would be more tempted to try drugs. And because they're children, it's okay to use a childish argument. But that's all it is—a simplistic half-truth to deter the kiddies from taking drugs. It has no place in the adult world. (I'm not saying that some drugs aren't addictive, BTW, but part of the addiction/habit comes from the enjoyment.)

When it comes to nicotine, however, simplistic half-truths persist even amongst many grown ups. And so when ASH Scotland asks why smoking prevalence is exceptionally high amongst people with mental disorders, they come up with every answer except the truth—ie. that nicotine helps alleviate the misery.

Most people start smoking in their mid to late teens before they realise how dangerous and addictive the stimulants in cigarettes are.

This is at least partly true. However, it doesn't explain why many people return to smoking years later, nor does it answer the question of why so many people with mental illness smoke, including 88% of schizophrenics.

Nicotine triggers the release of dopamine in the brain so smokers learn to associate cigarettes with pleasure and when they stop smoking they may experience withdrawal then associate relief with the next cigarette, and so begins the withdrawal/feedback loop.

Er, not really. Smokers don't learn to associate cigarettes with pleasure. Nicotine releases dopamine which provides pleasure. It's not a Pavlovian trick. It happens with each cigarette.

Some research appears to indicate that people with schizophrenia smoke as a kind of ‘self-medication’ to improve memory or reduce symptoms...

Here, the truth begins to sail into view...

...but the reasons for the higher rates of smoking amongst people with mental illness are complex and not yet clearly understood.

And sails away again, to be replaced with the standard line:

It should be remembered that people with mental illness are subject to the same peer pressure and inducements from the tobacco industry as the general population.

I'd love to know what inducements the tobacco industry have been using in Scotland in recent years (I guess it's those evil colours they use on the cigarette packs just above the massive health warning). But even if we accept this facile line of reasoning, it doesn't explain why people with mental illness smoke at three times the rate of the general population.

This being ASH, the purpose of the whole exercise is to call for total smoking bans in mental health units and to push pharmaceutical products. Not just any old pharmaceutical product either. They suggest...

Varenicline (trade name Champix)

You've got to be kidding. Champix (AKA Chantix), the drug that has been officially blamed for hundreds of deaths and many more psychotic episodes? From Michael Siegel's blog:

The FDA responded to the more than 100 reports of suicides, more than 400 reports of violence, and more than 11,000 other cases of severe side effects associated with Chantix by requiring Pfizer to place a "black box" warning label on the medication. The label warns physicians to monitor their patients for adverse psychiatric effects, such as severe depression, violent behavior, and suicidality.

According to the FDA:

Chantix has been linked to serious neuro-psychiatric problems including changes in behaviour, agitation, depressed moods, suicidal ideation and suicide. The drug can cause an existing psychiatric illness to worsen or an old psychiatric illness to recur and the symptoms can recur even after the drug is discontinued.

A recent study of 484 drugs found that Chantix made violent behaviour EIGHTEEN times more likely.

Varenicline has the largest number of reported violence cases, the highest proportion of violence cases (PRR = 18.0) ... of any of the 484 evaluable drugs.

Wow. That sounds like a great drug to be giving people who are already mentally ill and/or violent. Is there any limit to ASH's irresponsible stupidity?


Anonymous said...

I took part in a research project on the brains of schizophrenics as a member of the control group, who all had to be smokers (since the schizophrenics were). The researcher told me this was partly self medication and partly because smoking alleviated the side effects of their medication. I doubt very much whether smoking bans in psychiatric hospitals are taken seriously.

Angry Exile said...

The WHO representative who thinks smoking leads to drug use is either blinded by his own ideology or simply unable to think logically. An alternative theory that would explain why drug users often smoke or have once smoked is an extension of the argument I've used to people - often smokers and drinker, incidentally - who parrot the idea that cannabis is a 'gateway drug'. The person looking for, say, the heroin high without knowing that's what he's looking for will almost certainly sample a wide range of legal and illegal recreational drugs until he finds the one that satisfies him, and ditto cocaine, crystal meth, you name it. Cannabis will very likely be one of them, as will tobacco and alcohol. Not causes of someone taking a so-called hard drug later on, but symptoms of someone looking for a bigger or better or just different high.

On a side note, while looking for info for a comment I left at Captain Ranty's I found an article from 2006 which mentioned opposition to the smoking ban from Melbourne's licensed brothels. They argued that many clients (and I imagine more some of prostitutes too) liked to smoke after sex, just as many people do in their own homes, and that banning this could mean some working girls who smoked or had regulars who smoked leaving the fairly safe environment of the legal brothels. I'm a bit too busy at the moment to look into whether or not this actually happened in any noticeable numbers but it was something that hadn't occurred to me. Probably didn't occur to the government and the healthists either. Link if you're interested, CS.

JJ said...

Since ASH thinks this is a good idea - then perhaps Arnott et al can give first hand knowledge of any side effects by being the first to volunteer. Oh, and you can shove Peter Kellner in there too.

A nice pink straight-jacket for him would look nice.

Wait! How about this. Why not just leap-frog straight to eugencis...and cut out the middleman - eh?

BTW - I've just sold my first lorry load of highly polished jack-boots to my local health authority. I wonder what they want them for.

Mark Wadsworth said...

"Is there any limit to ASH's irresponsible stupidity?"

Tough one. It's either 'no' or 'yes'. But it can't be 'yes' so by post hoc ergo propter hoc logic it must be 'no'.

Of course mental patients smoke more, that's been known for decades. It's called 'self-medication' and clearly doesn't do any harm at all.

Anonymous said...

As one of those mentally ill folk, I have to say that in my experience not only has no experienced and effective mental health professionals (psychiatrist or nurse) ever suggested I give up smoking, some have actually said it wouldn't be a good idea at all. So they know full well it helps manage symptoms.

The exceptions to this are the numpty community mental health "workers" who are really just social workers with a bigger ego. They're very big on anti-smoking, anti-junk food and pro-exercise, which is a great help if you can't get out of bed or leave the house! If faith in positive thinking did anything they'd be miracle workers.

Magnetic said...

Psychiatric patients risking lives for a cigarette

INVOLUNTARY mental health patients are so desperate to defy smoking bans they are poking electricity sockets with paper clips to get a spark and light up, a new report says.

Anonymous said...

I've told my social worker to send me to prison next time they want to lock me up for being psychotic. Hopefully I'll be able to smoke there.