Tag Archive | Politics

ADD / ADHD and cannabis

 

Some people with ADD / ADHD use cannabis regularly, and I have had patients who moved on to prescribed ADD / ADHD medication, finding it both more helpful and lower in unwanted effects than cannabis.

As the diagnosis of ADD / ADHD grows in the UK, I suspect this will become more of a factor in the debate about whether cannabis should be criminalised to a lesser extent, or even decriminalised altogether.

I don’t have a formal professional view either way on that issue, especially as I’m not a specialist in “Substance Misuse”. But I would say that the arguments of the leading UK advocate for reducing criminal sanctions on cannabis, Professor David Nutt, seem far from clear-cut.

On his Blog (http://profdavidnutt.wordpress.com), Professor Nutt suggests that the risk of increasing schizophrenia in young people, which could result from decriminalisation, is not of great concern. On his own figures, for every extra million young men using cannabis, about 200 might develop schizophrenia who wouldn’t otherwise do so.

His argument seems to be that alcohol use would probably decline (because of switching from alcohol to cannabis), and the benefits from that would outweigh any cannabis-related harms.

He might be right, but I think at least two aspects of the debate have not received as much attention as they should.

First, it does seem very difficult to compare the harm of an often devastating psychotic disorder, with alcohol-related problems. Is it really as simple as saying that improving and extending life for tens of thousands of people, by reducing their alcohol intake, logically outweighs the risk of “only” a few hundred people developing schizophrenia?

Secondly, I think the wider debate about “harm reduction”, and Professor Nutt’s related view that UK medical doctors should be able to prescribe cannabis (as they can elsewhere in Europe) would benefit from an acknowledgement that medical prescribing of some mind-altering substances has been, and remains, too lax.

When UK general practitioners, from the mid-1990’s, were widely encouraged to prescribe antidepressants after little more than a ten-minute consultation, this state-approved practice was never properly tested. The concerns about misuse and harms of Seroxat and other antidepressants followed.

Of course, as a specialist prescriber of mind-altering substances myself (hopefully, always as a reasonable therapy), I have a direct vested interest. But it does seem to me that promoters of medication, whether natural or synthetic, branded or generic, freely available or eye-wateringly expensive, would generally be more credible if they listened to my (free) advice.

NICE guidelines: now they really are “just guidelines”

Until recently, most of my ADD / ADHD patients who did well on a trial of medication, were then able to obtain further NHS prescriptions from their GP.

My website highlights the 2009 NICE (National Institute for Health and Clinical Excellence) ADHD guidelines, because the guidelines are strongly in favour of diagnosis and treatment choice. When NICE was set up as a state-funded body in 1999 there was a commitment, which was made legally stronger in 2005, that the NHS would be provided with enough money to follow its recommendations.

Last year, the new Government’s Conservative Health Secretary, Andrew Lansley, abolished this legal commitment for GP’s to follow NICE guidelines.

Under financial pressure to reduce prescribing, GP’s look at adult ADD / ADHD, and see that no medication is licensed. Unless the GP has direct experience of treatment benefits, this relatively new diagnosis inevitably becomes a target for cost reduction.

The fact is, medication licensing is really about the claims that a pharmaceutical company can make for its product, rather than what clinicians can prescribe (and the NICE guidelines are more relevant to that). But such distinctions make little difference to GP’s, especially when fully licensed ADD / ADHD treatment in children and teenagers is still often opposed by prominent NHS academic psychiatrists.

My own experience is that ADD / ADHD medication, together with counselling and psychotherapy which takes diagnosis properly into account, can improve interpersonal and work functioning enormously. If patients do have to fund diagnosis and treatment themselves, it is likely to be well worth it, as long as they have moderate or severe ADD / ADHD. Treatment could even be cost-effective if the ADD / ADHD is milder: what price can you put on better relationships?

Drafted by 2nd July 2011, published at DrNMblog.wordpress.com on 6th October 2011

“Nutters”, “Fruitcakes” and “Loonies”

 

Nick Clegg has apologised for using the word “nutters” to describe the conservatives’ East European allies in the 22nd April leaders’ debate: ”I am acutely aware that the stigma of mental health causes great distress to many people and my use of language that could be considered derogatory was entirely unintentional.”

This seems a bit strange, because much of the language used in these events is pre-planned. Also, only four weeks before the debate, the mental health charity Rethink obtained an agreement from Mr Clegg, together with the other leaders, not to use “mental health slurs” during the election campaign (1).

Less than a year ago the former Labour minister, Denis MacShane, made exactly the same point about the Conservative allies, but using the more derogatory “loonies and wierdos”. This was in the House of Commons, where there appears to be a guideline against “insulting, coarse, or abusive language”, but perhaps significant is the qualification “particularly as applied to other Members [of Parliament]” (2).

Back in 2006 David Cameron talked about UKIP as being “fruitcakes, loonies and closet racists, mostly”. UKIP’s Nigel Farage demanded an apology over the racism allegation, but interestingly he said that “fruitcakes and loonies” was fine, because “we have a sense of humour”.

So Nick Clegg may have thought that his own language was an improvement on “loonies”.

 

 

(1) http://www.rethink.org/how_we_can_help/news_and_media/press_releases/decision_to_ban_ment.html

(2) Some Traditions and Customs of the House: House of Commons Information Office. January 2009

Published at www.DrNM.org.uk on 30th April 2010; transferred to DrNMblog.wordpress.com on 9th October 2011

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