The story of Bob the Ten Pound Pom is the true tale of a person, that for the rest of their life, may well need to take something medicinal on an almost-daily, if not daily basis. Any person with complex trauma from their childhood and adolescence and any person who has sustained a physical injury or serious disease of the hard science variety meets this category. As a society, we’ve stopped batting an eyelid at the notion of lifetime pill popping on doctor’s orders.
It started with the DSM
For better or worse, the DSM and the medicalisation of human suffering has extended the ambit of this group of people to those that’ll need to consume something from a pharmacy, daily, to treat or manage an ongoing diagnosis of depression, anxiety, PTSD, CPTSD, all spectra of sleep disorders and increasingly, executive functioning disorders. Whether it’s an SSRI, benzo, tricyclic, quetiapine, z-class or manky antihistamines or straight-out amphetamines – there is quite literally a market of billions of people on this planet who require a daily medication because a medical practitioner asserts that the person meet the DSM criteria for Condition X with the appropriate first, second and third line single molecule (and originally patentable) pharmaceutical treatments, ideally in combination with cookie-cutter talking therapies. Or they just give patients the whole cocktail – for life, and put everything down to a chemical imbalance theory which cannot ever be detected, identified, analysed, proven or disproven.
For all manner of DSM matters, SSRIs are the something that a certain class of person is going to need to take for the rest of their lives. That being anyone who fits the DSM criteria for anxiety or depression. In late-stage capitalism and a climate crisis, that is probably 90% of the population at any given time As explained here previously:
SSRIs came into being as a result of a late 80’s patent rush and guys in white coats flinging patentable molecules at histamine receptors. Our knowledge of histamines ultimately stems from powdered European aristocrats huffing ether and other whacky gasses in the 1700’s, getting munted then bumping into sharp table corners and realising they felt no pain. Not the most auspicious of beginnings for a line of science that eventually gave us anaesthesiology, a branch of medicine for which we’re all eternally grateful.
But in the realm of treating the creations of the DSM (depression /anxiety/PTSD/trauma), we’ve got an armada of emerging options from cannabinoids through to psychedelics showing remarkable promise in treating those conditions. More promise than anything patented by the SSRI Club over the last 30 years, anyway. If you’re reading this far then I’m preaching to the choir. You all know the drill and the disclaimer speel that has to come next.
There is not enough evidence to the Phase III triple blind standard for anyone to make a statement any stronger than “showing promise” when it comes to medicinal cannabis products approved under SAS B or prescribed by APs.
For those with chronic pain, nerve damage or other physical issues, it’s opioids, gabapentinoids or both. For life.
The vicissitudes of life
Any lawyer who has spent any amount of time around any personal injury file (for a physical injury) knows the psychological sequelae accompanying the compo shuffle only compounds that client’s original suffering. This is met with an SSRI for life or periodic use (and dependence battles) with benzos, for life. The tab occasionally covered for life by insurers and the PBS.
Life just happens harshly to some people and those people need something every day, for life. If they don’t find that thing then, in Straya, the things that usually finds them are alcohol followed by a trail of poor decision-making. Sometimes alcohol and an abusive relationship with the fun prescription meds that the DSM Casino provides them with; both uppers and downers. For life or until they run out of road or whatever the vehicle of life is, it goes flying off the rails.
I am not a doctor. I’m just a lawyer who has had hundreds of interactions with harmed and vulnerable folk over the last 15 years. It is perfectly normal and viable for a person to swear to me that they are no longer abusing drugs and alcohol and that the sole drug they partake in is the consumption of cannabis under the care of a healthcare practitioner. It is, for some, the sole thing keeping them on the rails. I believe them.
The Great Migration
It’s the people who need something every day (for any number of the ailments described above) who are leading the Great Migration over from single molecule therapies (or a cocktail of the lot) to emerging classes of therapeutics, most of which are not patentable unless Frankensteined into something new and novel.
There’s a mixed herd in this migration. It is mostly the people who need something else because the white-coat-and-clipboard-brigade’s greatest hits (ie the meds) of the last 50 years never worked, have stopped working or have resulted in harms and undesirable and unproductive dependencies. Even in circumstances of the barely (but allegedly functional) bearable blur, a lifetime of permanent sexual dysfunction/weight-gain/numbness on SSRIs or a lifetime of doing the z-class/quetiapine, booze & benzo with the Restavit Roulette is not appealing. There are many push factors behind the Great Migration that have nothing to do with any purported pull factor of destinations cannabinoids or psychedelics.
Also, who wants the quetiapine diabetes and earlier-onset dementia risks all because you complained to your doctor about sleeplessness and were given Thors-hammer-in-pill-form to take nightly. Am not qualified to speak to quetiapine’s actual uses as an antipsychotic – where it is reportedly the duck’s nuts. My professional knowledge is limited to prisons and nursing homes going through an MCG-worth of the stuff annually. However, allowing off -label quetiapine use for insomnia was a grave error should never have bloody happened. It is causal to a significant chunk of people being in the Great Migration over to that something else. To be able to sleep. To get through the night and have a useful day ahead without trudging through the ‘Seroquel zombification’.
When the People who Need Something get properly assessed by a healthcare practitioner, how many of those HCPs would concur that the patient could benefit from the long-term, perhaps life-long treatment with certain types of medicines (those set out in the DSM of course) ? The overwhelming majority of HCPs would tow the line. Give or take some outliers for extremely good or extremely poor clinical judgement over which patients on their books would pass third party DSM-vetting. It would still result in the validation of most pre-existing diagnoses. Like the common law, the hard sciences are also self-reinforcing systems when it comes to defending their own technology and terminology.
Given the primacy of the DSM over recent decades, there are a lot of people in the migratory herd now but there ought be many, many more in the future. It’s not like prescription rates for the usual depression/anxiety meds have gone down since the 90’s is it?
The herd will grow sustainably and more organically through ‘more traditional healthcare channels’ if more hard science gets done (ie clinical research into the safety and efficacy of cannabinoids) and Jah rejoice, maybe a college or two might embrace a good hard look at the long-term use of cannabinoid therapeutics as something that could be less harsh on the bodies of those on those struggling through the impact of decades on the cocktail.
Sustainability and durability as a viable medical option also means implementing THC prescribing limits, protocols and outright common bloody sense bans to prevent people who simply should not be on THC-containing meds from getting access to them. It’s not enough to roll out the truthdom that ‘cannabis medicines are not for everyone’. It is far better that proactively probative enquiries be made to ensure a person’s past and current diagnoses are properly obtained. It’s a common sense obligation to not facilitate access to a potentially psychosis-triggering drug for a person who has previously had psychosis or is at risk of it as a result of the things that ought leap of the screen at the ordinary reasonable medically qualified reader of any given patient history.
DSM Diagnosis a Pick n Mix or Lucky Dip?
Over the last 50 years hundreds of thousands of Australians have cycled through many DSM diagnoses and associated unsuccessful med regimes to either little to moderate or no benefit at one end and iatrogenic harm at the other end. Even when a person feels subjectively un-harmed, it’s still a state of being that’s, as David Heilpern puts it, a “barely bearable blur.”
The recent growth of cannabinoid therapeutics in Australia has been, yes, to a measured and limited degree, spurred on by non-medicinal users accessing the medical route via DSM Drama School. Dishonesty is never good but it is better those consumers of cannabis be dealing with doctors not cops & courts. It is better that a white coat, practising responsibly, provides a safe and lawful justification for the possession and consumption of cannabis products, one that keeps the consumer away from blue badges and white wing-collars. A conviction for pot is a blip for the well educated and wealthy, it ends careers before they start for minority kids, especially mob. Honesty and the Lintzeris protocols are the the way. It’s just not the most profitable way as it involves less product being moved when a person is under medical supervision with the goal of limiting, moderating and lowering their THC intake.
Whole swathes of the legal profession would starve but for the DSM. As a diagnostic tool, its upcoming editions will cover the clangers of past editions. It is not going anywhere. IMO, the overwhelming majority of current diagnoses of anxiety or depression underpinning a prescription for MC ought (by now) also be undergirded by a pre-existing diagnosis of a DSM condition and the trail of documents/tears evidencing everything trialled to date. If not tears then drips from sheets being wrung out after a night of SSRI withdrawal shivers, shakes, zaps and shits.
Some folk are only in the Great Migration herd due to receiving a DSM diagnosis from a McRandom GP thirty years ago and trialling dozens of different drug combinations in that time-frame to correct this apparent ‘chemical imbalance’, which it turns out, was utter nonsense. This Person was part of the ‘worried well’ who received a diagnosis of depression in the 90s and just never came off SSRIs because they simply could not without the sensation of pulling your brain out through your kneecaps. As a result of the DSM Sedation Biscuit Craze, this Person is now a Person Who Needs Something.
After 20 odd years on an SSRI, many of these People would not prefer it if the medicine they purportedly need to take for the rest of their life actually enabled them to have a sex life.
Reddit rumbles
There is no peer reviewed research (yet) on my gut-feels herein that the DSM-ification of mental health care in this country laid the groundwork for a whole lot of people to find alternative, lawful and legitimate (although not Phase III triple blind reviewed, yet) medical alternatives to the meds originally prescribed many years ago upon receipt of their original DSM-diagnosis and then every pick n mix from the great tome ever since.
The original scoped-out intent with my Reddit research expedition was to figure out, medically and socio-culturally, who made up these multiple hundreds of thousands lawfully prescribed medicinal cannabis patients. Sure, some days that research was akin to walking naked through a motorised carwash on a dare. I’m in no rush to do that again and am content with what I know. That is that most MC patients are legit.
The academic descendants of the original ether huffers have done well for themselves over the last 50 years. But could this be the time limit for long-term for genuine believability of any safety and efficacy claims for use of many single-molecule medicines? The growing numbers of the migration speak for themselves. The People Who Need Something are dependent on alternatives away from things that might kill them or prematurely erode their quality of life.
The Law of the Land
Businesses providing these alternative medical services (with HCPs) need to operate within the bounds of the law in order to be able to continue to provide those services. This is essential for the cannabinoid space to remain viable, vibrant (for those in it) and accessible/affordable with actual medical care being provided (for all who are properly vetted and approved to access it) alongside proper checks and balances to ensure that proper all-round medical care was being provided, not single use-treatment or ‘treatment-themed’ businesses. It goes without saying that the proper standards of medical care involves insuring that a person at risk of harm due to past psychosis or contra-indicated conditions should not be prescribed THC. It should also go without saying that those with dependence issues with THC should not be prescribed products containing that drug unless it in accordance with the Lintzeris protocols (not really protocols, but key learnings from important research).
As set out by Martin Lane in Cannabiz today:
Almost four years after low-dose CBD was down scheduled, opening up the possibility of over-the-counter pharmacy sales, we are still waiting for a product to be approved by the TGA and included on the Australian Register of Therapeutic Goods.
Some of those that have tried and failed have been criticised by competitors for their methodologies.
Our view is that any firm trying to plug the evidence gap should be applauded. It’s in all of our interests to support them rather than sniping from the sidelines.
While building the evidence base is clearly going to take time, it’s vital the industry steps into the void in the meantime, offering positive examples of patient care and demonstrating ethical behaviour wherever we can.
Hear hear.
Wallumedegal Country 15/10/24
Mat Henderson 