The Medicalization of Cannabis

Annotated and edited transcript of a Witness Seminar held on 24 March 2009. Introduction by Professor Leslie Iversen.First published by the Wellcome Trust Centre for the History of Medicine at UCL, 2010.©The Trustee of the Wellcome Trust, London, 2010. All volumes are freely available online at: www.history.qmul.ac.uk/research/modbiomed/wellcome_witnesses/Annotated and edited transcript of a Witness Seminar held on 24 March 2009. Introduction by Professor Leslie Iversen.Annotated and edited transcript of a Witness Seminar held on 24 March 2009. Introduction by Professor Leslie Iversen.Annotated and edited transcript of a Witness Seminar held on 24 March 2009. Introduction by Professor Leslie Iversen.Annotated and edited transcript of a Witness Seminar held on 24 March 2009. Introduction by Professor Leslie Iversen.Annotated and edited transcript of a Witness Seminar held on 24 March 2009. Introduction by Professor Leslie Iversen.Annotated and edited transcript of a Witness Seminar held on 24 March 2009. Introduction by Professor Leslie Iversen.Cannabis has been considered as both an illicit drug and a medicine throughout its history. Introduced to the UK as a medicine in the nineteenth century, its medical utility was limited and it was not until tetrahydrocannabinol (THC), one of the principal active components in cannabis, was isolated in 1964 by Raphael Mechoulam and his team in Israel that scientific research on the drug expanded. Further major developments came in the 1980s, when the cannabinoid receptors in the brain were discovered. Scientists, clinicians, policy makers and patients interested in exploring and utilizing cannabis as an orthodox medication attended this seminar. Several were involved with the early elucidation of the structures of the components of the cannabis plant, or with the two MRC-funded trials in the 1990s into the therapeutic effect of cannabis on multiple sclerosis (MS) and postoperative pain. The founding director of GW Pharmaceuticals discussed the problems of growing cannabis plants and standardizing extracts to produce a medicine that could gain regulatory approval. Two MS patients related their experiences of cannabinoid medications and the significance of patient activism and self-medication in renewing research interest in the potential medical benefits of cannabis, against the backdrop of increasing recreational use, was also considered. The meeting was suggested by Professor Virginia Berridge, who chaired the meeting jointly with Professor E. M. Tansey. Contributors include: Professor David Baker, Professor Virginia Berridge Dr Vincenzo Di Marzo, Professor Griffith Edwards, Professor John Galloway, Dr Edward Gill, Dr Geoffrey Guy, Dr Clare Hodges, Dr Anita Holdcroft, Ms Victoria Hutchins, Professor Raphael Mechoulam, Professor Anthony Moffat, Dr William Notcutt, Professor Roger Pertwee, Dr Philip Robson, Dr Ethan Russo, Professor Tilli Tansey, Ms Suzanne Taylor. One appendix gives diagrams of the structures of the major plant cannabinoids and structurally-related synthetic cannabinoids. Crowther S M, Reynolds L A, Tansey E M. (eds) (2010) The Medicalization of Cannabis, Wellcome Witnesses to Twentieth Century Medicine, vol. 40. London: The Wellcome Trust Centre for the History of Medicine at UCL. ISBN 978 085484 129 5The Wellcome Trust Centre for the History of Medicine at UCL is funded by the Wellcome Trust, which is a registered charity, no. 210183

Differences in treatment for substance use disorders by insurance status: Self-help only versus outpatient medical treatment

Background: The role of insurance on substance use disorders (SUD) treatment utilization generally is poorly understood and still less is known on how insurance status relates to the use of evidence-based treatment (i.e., medicalization approach) compared to other treatments, like single self-help groups, where the research on effectiveness is less supportive. This study examines associations between health insurance and any SUD treatment utilization as well as use of single self- help versus medicalization approach. Methods: A cross-sectional study design was used. Data were from the 2015-2017, public use National Surveys on Drug Use and Health (NSDUH). Adjusted logistic regressions were used to examine the associations controlling for socio-demographics, recent major depressive episode, and survey year. All analyses used survey weights to be representative of the US population and account for the NSDUH’s complex survey design. Results: After adjustment for covariates, those with publicly insured remained more likely to use any SUD treatment in the past year (odd ratio [OR] 1.82; 95% CI: 1.36-2.43), compared to those without insurance. Further, compared with uninsured, those with public insurance reported lower odds of using only self-help treatment (OR 0.42; 95% CI: 0.23-0.74) versus medicalization approach utilization. Conclusions: Publicly insured persons with SUD are more likely to use SUD treatment in the past year than the uninsured. Uninsured people with SUD are more likely to use single self-help as a substitute for medicalization approach.https://scholarscompass.vcu.edu/gradposters/1098/thumbnail.jp

Debating medicalization of Female Genital Mutilation/Cutting (FGM/C) : learning from (policy) experiences across countries

Background: Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are increasing, and in countries of migration, such as the United Kingdom, the United States of America or Sweden, court cases or the repeated issuing of statements in favor of presumed minimal forms of FGM/C to replace more invasive forms, has raised the debate between the medical harm reduction arguments and the human rights approach. Main body: The purpose of this paper is to discuss the arguments associated with the medicalization of FGM/C, a trend that could undermine the achievement of Sustainable Development Goal 5.3. The paper uses four country case studies, Egypt, Indonesia, Kenya and UK, to discuss the reasons for engaging in medicalized forms of FGM/C, or not, and explores the ongoing public discourse in those countries concerning harm reduction versus human rights, and the contradiction between medical ethics, national criminal justice systems and international conventions. The discussion is structured around four key hotly contested ethical dilemmas. Firstly, that the WHO definition of medicalized FGM/C is too narrow allowing medicalized FGM to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of do no harm. Secondly, that medicalized FGM/C is a human rights abuse with lifelong consequences, no matter who performs it. Thirdly, that health care professionals who perform medicalized FGM/C are sustaining cultural norms that they themselves support and are also gaining financially. Fourthly, the contradiction between protecting traditional cultural rights in legal constitutions versus human rights legislation, which criminalizes FGM/C. Conclusion: More research needs to be done in order to understand the complexities that are facilitating the medicalization of FGM/C as well as how policy strategies can be strengthened to have a greater de-medicalization impact. Tackling medicalization of FGM/C will accelerate the achievement of the Sustainable Development Goal of ending FGM by 2030

The institutional foundations of medicalization : a cross-national analysis of mental health and unemployment

In this study, we question (1) whether the relationship between unemployment and mental healthcare use, controlling for mental health status, varies across European countries and (2) whether these differences are patterned by a combination of unemployment and healthcare generosity. We hypothesize that medicalization of unemployment is stronger in countries where a low level of unemployment generosity is combined with a high level of healthcare generosity. A subsample of 36,306 working-age respondents from rounds 64.4 (2005-2006) and 73.2 (2010) of the cross-national survey Eurobarometer was used. Country-specific logistic regression and multilevel analyses, controlling for public disability spending, changes in government spending, economic capacity, and unemployment rate, were performed. We find that unemployment is medicalized, at least to some degree, in the majority of the 24 nations surveyed. Moreover, the medicalization of unemployment varies substantially across countries, corresponding to the combination of the level of unemployment and of healthcare generosity

‘From Badness to Sickness’ and Back Again: The Use of Medication in the U.S. School and Foster Care Systems

This article explores the over- and under-prescription of psychotropic medication to youth of color both in public schools and the foster care system. Under the umbrella of the schools-to-prison pipeline, there is a wide array of literature addressing the under-use of medication for treatment of children of color in the public school system when treating learning or behavioral disabilities. There is also, however, a great deal of literature in a totally different realm surrounding the under-use of medication in treating mental health disorders in the foster care system. This article aims to put these two pieces of discourse in conversation with each other. In examining the use of medication in both of these institutions and the disproportionate rate of black and brown children in the foster care system, I analyze how race, class, and gender play a role in the prescription—or lack thereof—of medication for children of color. These contradicting approaches to treatment and medication illustrate the assumptions that are attached to children of color, and how these institutions ultimately were not made for children of color to survive or thrive. To better serve the needs of children in our country, these two institutions must be considered as co-actors in the system of perpetual social control exerted of youth of color

Who Are You to Tell Me What I Need and Don’t Need: An Investigation of the Medicalization of Transsexuality in the Netherlands

This research project looks at the medicalization of transsexuality in the Netherlands. The primary question posed is how the medicalization of transsexuality affects transsexual individuals, specifically in the Netherlands. Three male-to-female transsexual individuals were interviewed on their experiences with medicine, the medical community, and the medicalization of transsexuality. An analysis of the interviews revealed that the medicalization of transsexuality has both negative and positive effects on transsexual individuals in the Netherlands. Conversely, the analysis revealed that transsexual individuals have an effect on the medicalization of transsexuality. It was also discovered that the Dutch society at large and the Dutch trans community have a relationship with transsexual individuals and the medicalization of transsexuality. Ultimately, the medicalization of transsexuality in the Netherlands cannot be understood without comprehensively investigating the complex relationship between the medicalization itself, transsexual individuals, the Dutch society at large, and the Dutch trans community

The Hiddenness of Psychological Symptom Amplification: Some Historical Observations

This book chapter is a short response to a paper by the psychiatrist Nicholas Kontos, on the phenomenon of psychological symptom amplification (PSA). PSA takes place when patients present symptoms to clinicians that they do not actually have, or, perhaps more commonly, they exaggerate symptoms they do have. Kontos argues that, because of modern medical training, it is very difficult for clinicians to recognize that the patient's presented symptoms are exaggerated or nonexistent. I argue that the hiddenness of PSA is a result of far-reaching instutitional changes that took place in American psychiatry in the 1970s. In short, many psychiatrists went from seeing mental disorders as (unconscious) strategies to seeing them as dysfunctions, nothing more. Recognizing PSA involves adopting a perspective that has been effectively abolished in contemporary American psychiatry

The Psychiatrization of Poverty: Rethinking the Mental Health-Poverty Nexus

The positive association between ‘mental illness’ and poverty is one of the most well established in psychiatric epidemiology. Yet, there is little conclusive evidence about the nature of this relationship. Generally, explanations revolve around the idea of a vicious cycle, where poverty may cause mental ill health, and mental ill health may lead to poverty. Problematically, much of the literature overlooks the historical, social, political, and cultural trajectories of constructions of both poverty and ‘mental illness’. Laudable attempts to explore the social determinants of mental health sometimes take recourse to using and reifying psychiatric diagnostic categories that individualize distress and work to psychiatrically reconfigure ‘symptoms’ of oppression, poverty, and inequality as ‘symptoms’ of ‘mental illness’. This raises the paradoxical issue that the very tools that are used to research the relationship between poverty and mental health may prevent recognition of the complexity of that relationship. Looking at the mental health–poverty nexus through a lens of psychiatrization (intersecting with medicalization, pathologization, and psychologization), this paper recognizes the need for radically different tools to trace the messiness of the multiple relationships between poverty and distress. It also implies radically different interventions into mental health and poverty that recognize the landscapes in which lived realities of poverty are embedded, the political economy of psychiatric diagnostic and prescribing practices, and ultimately to address the systemic causes of poverty and inequality