How changes to drug prohibition could be good for the UK—an essay by Molly Meacher and Nick CleggBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6006 (Published 14 November 2016) Cite this as: BMJ 2016;355:i6006
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Re: How changes to drug prohibition could be good for the UK—an essay by Molly Meacher and Nick Clegg
Cannabis is already a medicine with Sativex approved in 16 countries for spasticity associated with multiple sclerosis and Epidiolex given “orphan” status by the FDA for patients affected by Dravet and Lennox-Gastaut Syndrome, a rare form of paediatric epilepsy (1). Cannabis should never be smoked but formulated as a standardised medicine after clinical trials. Cannabis is however, not a safe material: substantial literature for psychosis exists following use (2) and as half of the US states have decriminalised cannabis for medicinal and/or recreational use, the future mental health landscape of users is unlikely to be positive.
Heroin assisted treatment requires other approaches. Opiate use is a life style choice and takes a serious level of commitment to start: preparation of a particle free suspension and then i.v. injection is a significant step. A similar level of commitment to quit is required and the lies associated with heroin use must be laid bare: withdrawal is never fatal (unlike alcohol), withdrawal symptoms are no worse than 2 days of mild flu and are readily dealt with by hydration and mild analgesia. Many excellent UK services offer detox. Chemically assisted treatment can exacerbate addiction, with some methadone users taking the drug for decades and methadone regularly detected in drug-related deaths singularly and in combination with other opiates (3). Child deaths in households where methadone is in use are also increasing (4,5). Such state sponsored drug use is often supported by the immoral argument of crime reduction - keeping users topped up with an opiate will stop them offending. Such societal ransom is morally reprehensible.
(1) Gofshteyn JS, Wilfong A, Devinsky O, Bluvstein J, Charuta J, Ciliberto MA, Laux L, Marsh ED. (2016). Cannabidiol as a Potential Treatment for Febrile Infection-Related Epilepsy Syndrome (FIRES) in the Acute and Chronic Phases. J Child Neurol. 2016 (In Press)
(2) Mandelbaum DE, de la Monte SM. (2016). Adverse Structural and Functional Effects of Marijuana on the Brain: Evidence Reviewed. Pediatr Neurol. pii: S0887-8994(16)30478-7.
(3) Gao L, Dimitropoulou P, Robertson JR, McTaggart S, Bennie M, Bird SM. (2016). Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013. Drug Alcohol Depend. 167:214-23.
(4) Gaither JR, Leventhal JM, Ryan SA, Camenga DR. (2016). National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012. JAMA Pediatr. 170(12):1195-1201.
(5) Torjesen I. (2016). Methadone is responsible for over half of accidental drug poisoning deaths in toddlers. Bmj 353
Competing interests: No competing interests