Addiction Today

CANNABIS AND SCHIZOPHRENIA: THE LINKS

1972: Study of US servicemen finds widespread cannabis smoking contributed to a five-fold increase in schizophrenia between 1968-1971.

1974: Researchers find cannabis could trigger latent schizophrenia, intensify symptoms and cause the condition even where it would not otherwise occur.

1981: Study of 16-year olds in Sweden finds that heavy users are three times as likely to have mental-health problems by 27 years old - a 10% risk.

1986: US National Institute for Drug Abuse finds that schizophrenics who smoked cannabis have worse symptoms, more relapses, need more help and are less responsive to treatment.

1987: Study of 45,000 swedish military conscripts finds that those who smoked cannabis 50 times or more by age 18 are six times more likely to suffer schizophrenia later.

2002: A 26-year study by King's College London shows that people who began smoking it in early teens faced four-fold increase in risk of schizophrenia as adults, and established that the drug directly triggered the disease.

2003: US scientists show that those using cannabis before the age of 17 are up to five times more likely to have drug and alcohol problems later in life.

2005: Study led by the Institute of Psychiatry in London finds that one in four cannabis users are genetically predisposed to suffer mental ilness due to the drug.

2005: Danish researchers find almost 50% of cannabis users who suffer a drug-induced psychotic episode go on to develop long-term schozophrenia.

2007: The Institute of Psychiatry finds that cannabis' most powerful active ingredient reduced activity in a part of the brain which helps to keep people sane.

2007: Study by the universities of Cardiff, Bristol, Cambridge and Imperial College London finds that heavy users of cannabis are more than twice as likely to suffer mental illness.

TEENAGE DRINKING CORRODES MEMORY

Binge drinking as a teenager could damage memory for years, says researcher Dr Thomas Heffernan, A Northumbria University psychologist, at the British Psychological Society 's annual conference in Dublin. This is critical, given that children of 12 are being treated for alcoholism.

"Excess alcohol and binge drinking damages parts of the brain which underpin memory," he said. "And as teenagers' brains are still developing, they could be storing up problems."

Heffernan looked at the effect of alcohol on memory in 60 youngsters aged 16-19 years old. Half were "effectively binge alcoholics" while the other half drank rarely or never. They played a computer game which required them to remember and complete tasks as they walked along a fictional high street. Binge drinkers did significantly worse, completing up to a third fewer tasks properly.

ALCOHOL INCREASES RISK OF BREAK CANCER BY 50%

Cancer Research says alcohol causes about 2,000 breast cancer cases a year. Now the Department of Health has confirmed that women who drink above the government's recommended limit of 14 units a week are 50% more likely to develop breast cancer. It has launched a £10million campaign targeting women who might underestimate their drinking.

"Many women drink too much simply because they have no idea how many alcohol units they are consuming,” Public Health minister Dawn Primarolo said. "After the campaign, no-one should be in any doubt as to how many units they're drinking and the impact on their health."

There is concern that stronger wine of up to 13% alcohol and larger 250ml glasses can make women think they are drinking less than they are. One glass can contain as much as 3.5 units of alcohol.

Primarolo said professional women who drank too much had "gone under the radar" for a long time.

Other health risks for women who binge drink include liver disease, unplanned pregnancies and ruptured bladders.

DOCTORS TO BE GIVEN SPECIAL TRAINING...

Medics to learn to identify people who drink too much, government says. 

The government promises that, within three years, all medical schools in England will have alcohol training on the curriculum. Addiction Today hopes that it will not be a matter of mere hours within a multi-year programme but instead reflect the high percentage of patients damaged by alcohol and drug abuse and dependence. We also hope that training will cover treatment and recovery – and that there will be a plan of action to redress the history of medical schools as a source of problematic drinking for its students, sometimes lasting lifetimes.

Medical schools have been allocated £650,000 to examine the best way of training doctors-to-be how to spot alcohol misuse. In all, 60,000 medical students should be trained over the next decade.

Public health minister Dawn Primarolo told the British Medical Association's public health conference: "Doctors and nurses are our eyes and ears when it comes to identifying problem drinkers”. Where they are appropriately trained in early interventions, research has proven them effective.

"For too long, GPs have avoided asking questions about alcohol use, partly due to lack of training,” commented Alcohol Concern. "However, this issue need a package of measures. GPs must also be incentivised to raise alcohol issues. Until this happens, the undergraduate training alone may not be enough to help patients reduce their drinking."

Plastic surgeon Peter Mahaffey told the British Medical Journal that police should carry breathalysers and fine those three times over the drink-drive limit. The Bedford Hospital medic said his suggestion came after seeing patients injured in drunken fights and disorder, incurring facial scarring and nerve injuries.

Alcohol consumption has been rising steadily for the past 15 years, with figures suggesting a third of men and a fifth of women drink more than the recommended levels each week. Alcohol is a factor in most crimes and is estimated to cost the economy £7billion a year.

AUDIT OF DRUG-TREATMENT PRESCRIBING SERVICES

NTA publishes "definitive guidelines" on ethical prescribing

The National Treatment Agency for Substance Misuse published definitive guidelines on ethical prescribing for UK drug treatment providers, and committed to putting in place new monitoring procedures to ensure that the guidelines are followed by all doctors.

The COI has completed an independent audit of drug prescribing services which showed: 5% using increased methadone or buprenorphine dosages as a reward for negative urine tests, 7% using decreased dosages as punishment for a positive urine test and 1% prescribing antidepressants as a reward for drug-free urine tests!

“This independent audit shows that most doctors follow correct procedure in ethical prescribing of drug treatment," said Paul Hayes, CEO of the NTA, which oversees the services provided by NHS and voluntary sector providers. "And we are taking action to prevent continuation of the poor practice identified.

“We are installing new monitoring procedures to prevent inappropriate practice. In April 2009, we will repeat the survey that has just been conducted, to assess the impact of the new measures.”

CLINICAL GUIDELINES

Drug Misuse & Dependence: Guidelines on clinical management

The National Treatment Agency for Substance Misuse published, in September 2007, a UK-wide framework for the clinical treatment of drug misuse, on behalf of the Department of Health and devolved administrations.

This was an update of the 1999 Drug Misuse and Dependence – UK Guidelines on Clinical Mangement, commonly called the ‘Orange Book’.  The new version reflects changes in drug treatment over the eight years since, and recent guidance from the National Institute for Health and Clinical Excellence.

There is greater emphasis than previously on the importance of care and treatment planning, and the importance of keyworking in the delivery, coordination and review of all elements of a treatment package for individual patients.

There is guidance on opioid drug treatment, with a clearer distinction between detoxification and opioid-maintenance regimens.

There is more guidance on psychosocial treatment for drug misuse, both in the context of keyworking and formal psychosocial programmes for polydrug and alcohol misusers and non-opioid misusers.

The value of drug treatment as a protective mechanism against blood-borne viruses and overdose and a wide range of drug-related harm is recognised and clinicians advised to respond to a “failure in treatment” by optimising or increasing interventions rather than reducing or withdrawing treatment. There is also greater emphasis on wider and specific healthcare issues for drug misusers.

Copies of the Clinical Guidelines 2007 can be ordered via the DH publications orderline on 08701-555 455 or dh@prolog.uk.com, quoting UKCG07. Orders are limited to 5 copies.

NICE GUIDELINES, TECHNOLOGY APPRAISALS

The National Institute for Health and Clinical Excellence has produced, in relation to the Clinical Guidelines 2007:

Opioid detoxification guidelines

Psychosocial interventions guidelines

Methadone and buprenorphine for managing opioid dependence technology appraisal

Naltrexone for the managemetn of opioid dependence technology appraisal.

Just click on the hyperlinks above to access them.