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?

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