“manifestly unsuitable for (psychiatric) treatment”

Will Self reviews a recently published book on psychiatry and has some interesting observations on the relationships between addicts, mutual aid groups and psychiatry:

healinghands

Interestingly there is one large sector of the “mentally ill” that Burns believes are manifestly unsuitable for treatment – drug addicts and alcoholics. He points to the ineffectiveness of almost all treatment regimens, possibly because the cosmic solecism of treating those addicted to psychoactive drugs with more psychoactive drugs hits home despite his well-padded professional armour. Elsewhere in Our Necessary Shadow he seems to embrace the idea that self-help groups of one kind or another could help to alleviate a great deal of mental illness, and it struck me as strange that he couldn’t join the dots: after all, the one treatment that does have long-term efficacy for addictive illness is precisely this one.

Psychiatrists are notoriously unwilling to endorse the 12-step programmes, and argue that statistically the results are not convincing. There may be some truth in this – but there’s also the inconvenient fact that there’s no place for psychiatrists, or indeed any of the psy professionals, in autonomously organised self-help groups. Burns agrees with Davies that our reliance on psychiatry, and by extension, psycho-pharmacology, may well be related to our increasingly alienated state of mind in mass societies with weakened family ties, and often non-existent community ones. Surely self-help groups can play a large role in facilitating the rebirth of these nurturing and supportive networks? But Burns seems to feel that just as we will always need a professional to come and mend the septic tank, so we will always need a pro to sweep out the Augean psychic stables. I’m not so sure; psychiatry has been bedevilled over the last two centuries by “treatments” and “cures” that have subsequently been revealed to be significantly harmful. From mesmerism, to lobotomy, to electroconvulsive therapy, to Valium and other benzodiazepines – the list of these nostrums is long and ignoble, and I’ve no doubt that the SSRIs will soon be added to their number.

Sooner or later we will all have to wake up, smell the snake oil, and realise that while medical science may bring incalculable benefit to us, medical pseudo-science remains just as capable of advance. After all, one of the drugs that Irving Kirsch’s meta‑analysis of antidepressant trials revealed as being just as efficacious as the SSRIs was … heroin.

Labeling legal weed

marijuana marlboroMark Kleiman’s looking for ideas about how to label marijuana in a hypothetical legal, commercial market:

Imagine – just hypothetically – that a state decided to open a legal (at the state level) commercial market in cannabis, with some of the users intending to use the substance to treat some medical condition and others using it for other purposes.

Such a market would have an advantage over purely illicit markets that the state could require that the product be tested and labeled with its content of active agents. Those labels might (or might not) help consumers what experience to expect from roughly how much of the product, avoiding unintentional overdose. They might also “nudge” users toward less hazardous patterns of use.

We’re pretty sure that THC is the primary “stoning” agent and that CBD (cannabidiol) has some buffering properties against, e.g., panic attacks. It seems likely that lots of the terpenoids that help give the product its flavor and odor also have their own psychoactivity, but the detailed science mostly hasn’t been done. It may also be the case that user-to-user variation in reactions will be higher for cannabis than it is for alcohol.

With respect to edible products, the label might try to inform consumers about how the content of (e.g.) a brownie compares to the content of some more familiar dosage form, such as a joint.

Finally, the label might contain warnings of various kinds: e.g., not to drive under the influence.

Since there’s more relevant information than can be legibly placed on a package label, there could also be required package inserts (as for pharmaceuticals) and/or a state-maintained website with information about cannabis and about how to interpret the information on the label.

There must be some optimal labeling system, but I’m damned if I can figure out what it is.

Some of the comments point out the difficulty of scaling an unprocessed crop, using hot peppers as an example.

 

 

This is your culture on pot

Medical Cannabis Growing Operation in Oakland,...
(Photo credit: Blazenhoff)

Keith Humphreys and Mark Kleiman offer some great commentary on marijuana legalization and what a legal marijuana market might look like.

First, Humphreys:

About eighty percent of the market is “commercial grade” cannabis, which has a THC content of about 5% and sells for $70 to $230 per ounce, depending on how far a buyer is from the producing farm and in what amount he or she buys. If that level of potency and price surprises you, you are probably an observer or participant in the small, nationally unrepresentative marijuana “upmarket“.

The reason for the current dominance of commercial grade pot is simple: It’s an inexpensive product for a price-sensitive population.

But, he argues price would likely drop and …

The cannabis-using population would experience a vast increase in average drug potency. Caulkins and colleagues estimate that in the past 15 years, average potency of marijuana in the U.S. has doubled. But after legalization, with the 80% commercial grade market share being almost completely supplanted by sinsemilla, average potency would roughly triple very rapidly.

This increase in exposure to highly potent cannabis is one of the mechanisms through which legalization would result in a higher prevalence of addiction (Some of the other mechanisms are discussed here). It at first seems reasonable to assume that experienced users would simply titrate their dose of higher-potency pot, making higher or lower doses equivalent from a biological viewpoint. But surprisingly, laboratory studies of experienced marijuana users show that they are in fact poor at judging the potency of cannabis.

Kleiman isn’t so certain. Here are a few of his reasons. Read the entire post for the rest of his thinking:

  • Even if high-potency product were legal, it could be heavily taxed, as whiskey is heavily taxed compared to beer.
  • In the current illicit market, “quality” and “potency” are conflated in consumers’ minds. Post-legalization, …THC could be extracted from the vegetable matter and used to “fortify” pot to any desired potency. That may push consumers’ ideas of “quality” away from potency and toward other factors.
  • Unlike alcoholic beverages, which mostly contain only a single psychoactive, cannabis contains a mix. Some consumers will want lower-THC, higher-CBD product.

Alcohol remains our one experiment with legalization of an intoxicant. Two-thirds of the alcohol consumed in the U.S. is taken in the form of beer rather than higher-potency forms.

As is so often the case, the answer here is “Hard to say; it depends.”