APA Institute on Pyschiatric Services 2011

SAN FRANCISCO – When police officers are trained to recognize and handle psychiatric emergencies, they are less likely to arrest the mentally ill and more likely to refer them to treatment centers.

And people with mental illness who arrive from police custody are likely to be less agitated, less in need of seclusion and restraints, and more cooperative with initial psychiatric evaluations, "because the officers interact with patients in a very different way compared to most police encounters," said Dr. Michael T. Compton, the lead investigator of a study that evaluated the impact of one such training course, the Memphis Crisis Intervention Team (CIT) program.

Photo (c) Antonprado/iStock.com

Officers who volunteer for the 40-hour program hear lectures about how to recognize mental illness, learn de-escalation techniques, and visit local psychiatric facilities to meet staff and hear first-hand from patients what it’s like for them to deal with the police.

In the study, Dr. Compton asked 183 officers in six Georgia police departments – most around Atlanta and one in Savannah – to record how they resolved encounters with people they suspected were mentally ill, developmentally disabled, or suffering from drug or alcohol problems. In 1,098 encounters over 6 weeks, the 93 officers who went through the training were twice as likely as the 90 who did not to refer those people to treatment, instead of arresting them. The results were statistically significant.

CIT-trained officers logged 517 encounters; 40% ended in referral, and 13% ended in arrests. Among the 183 officers as a whole, 34% of the 1,098 encounters ended in referrals, and 19% ended in arrests. CIT officers also used less force.

The Memphis CIT program is not new; it was launched in 1988 in response to a fatal police shooting in that city. Since then, about 2,400 police departments nationwide have implemented the Memphis model, but sometimes need help training new officers, said Dr. Compton, a professor of psychiatry and behavioral sciences at George Washington University, Washington.

It would help "if mental health providers can volunteer for some of the lectures or to do a site visit because, in a way, police officers are doing part of what ought to be our work; they’re out in the streets performing psychiatric triage," he said.

Officers who were at least 40 years old, and those who had been on the force for at least 10 years were also more likely to refer people to services.

Role playing is central to the de-escalation training; officers learn to actively listen, reflect back what they’re told, and give people plenty of time to answer questions.

They also are taught not to argue against the delusions of acutely psychotic people, but not go along with them, either. Instead, officers learn to pick up on the emotions. They might say something like, " ‘Am I understanding you correctly? It feels like there’s someone following you? That sounds really scary, and you’re really upset. Tell me more about what’s going on and how I may be able to help you,’ " Dr. Compton explained.

The idea is to slow the encounter down so mistakes aren’t made on either side.

Dr. Compton said he has no disclosures.

SAN FRANCISCO – When police officers are trained to recognize and handle psychiatric emergencies, they are less likely to arrest the mentally ill and more likely to refer them to treatment centers.

And people with mental illness who arrive from police custody are likely to be less agitated, less in need of seclusion and restraints, and more cooperative with initial psychiatric evaluations, "because the officers interact with patients in a very different way compared to most police encounters," said Dr. Michael T. Compton, the lead investigator of a study that evaluated the impact of one such training course, the Memphis Crisis Intervention Team (CIT) program.

Photo (c) Antonprado/iStock.com

Officers who volunteer for the 40-hour program hear lectures about how to recognize mental illness, learn de-escalation techniques, and visit local psychiatric facilities to meet staff and hear first-hand from patients what it’s like for them to deal with the police.

In the study, Dr. Compton asked 183 officers in six Georgia police departments – most around Atlanta and one in Savannah – to record how they resolved encounters with people they suspected were mentally ill, developmentally disabled, or suffering from drug or alcohol problems. In 1,098 encounters over 6 weeks, the 93 officers who went through the training were twice as likely as the 90 who did not to refer those people to treatment, instead of arresting them. The results were statistically significant.

CIT-trained officers logged 517 encounters; 40% ended in referral, and 13% ended in arrests. Among the 183 officers as a whole, 34% of the 1,098 encounters ended in referrals, and 19% ended in arrests. CIT officers also used less force.

The Memphis CIT program is not new; it was launched in 1988 in response to a fatal police shooting in that city. Since then, about 2,400 police departments nationwide have implemented the Memphis model, but sometimes need help training new officers, said Dr. Compton, a professor of psychiatry and behavioral sciences at George Washington University, Washington.

It would help "if mental health providers can volunteer for some of the lectures or to do a site visit because, in a way, police officers are doing part of what ought to be our work; they’re out in the streets performing psychiatric triage," he said.

Officers who were at least 40 years old, and those who had been on the force for at least 10 years were also more likely to refer people to services.

Role playing is central to the de-escalation training; officers learn to actively listen, reflect back what they’re told, and give people plenty of time to answer questions.

They also are taught not to argue against the delusions of acutely psychotic people, but not go along with them, either. Instead, officers learn to pick up on the emotions. They might say something like, " ‘Am I understanding you correctly? It feels like there’s someone following you? That sounds really scary, and you’re really upset. Tell me more about what’s going on and how I may be able to help you,’ " Dr. Compton explained.

The idea is to slow the encounter down so mistakes aren’t made on either side.

Dr. Compton said he has no disclosures.

SAN FRANCISCO – When police officers are trained to recognize and handle psychiatric emergencies, they are less likely to arrest the mentally ill and more likely to refer them to treatment centers.

And people with mental illness who arrive from police custody are likely to be less agitated, less in need of seclusion and restraints, and more cooperative with initial psychiatric evaluations, "because the officers interact with patients in a very different way compared to most police encounters," said Dr. Michael T. Compton, the lead investigator of a study that evaluated the impact of one such training course, the Memphis Crisis Intervention Team (CIT) program.

Photo (c) Antonprado/iStock.com

Officers who volunteer for the 40-hour program hear lectures about how to recognize mental illness, learn de-escalation techniques, and visit local psychiatric facilities to meet staff and hear first-hand from patients what it’s like for them to deal with the police.

In the study, Dr. Compton asked 183 officers in six Georgia police departments – most around Atlanta and one in Savannah – to record how they resolved encounters with people they suspected were mentally ill, developmentally disabled, or suffering from drug or alcohol problems. In 1,098 encounters over 6 weeks, the 93 officers who went through the training were twice as likely as the 90 who did not to refer those people to treatment, instead of arresting them. The results were statistically significant.

CIT-trained officers logged 517 encounters; 40% ended in referral, and 13% ended in arrests. Among the 183 officers as a whole, 34% of the 1,098 encounters ended in referrals, and 19% ended in arrests. CIT officers also used less force.

The Memphis CIT program is not new; it was launched in 1988 in response to a fatal police shooting in that city. Since then, about 2,400 police departments nationwide have implemented the Memphis model, but sometimes need help training new officers, said Dr. Compton, a professor of psychiatry and behavioral sciences at George Washington University, Washington.

It would help "if mental health providers can volunteer for some of the lectures or to do a site visit because, in a way, police officers are doing part of what ought to be our work; they’re out in the streets performing psychiatric triage," he said.

Officers who were at least 40 years old, and those who had been on the force for at least 10 years were also more likely to refer people to services.

Role playing is central to the de-escalation training; officers learn to actively listen, reflect back what they’re told, and give people plenty of time to answer questions.

They also are taught not to argue against the delusions of acutely psychotic people, but not go along with them, either. Instead, officers learn to pick up on the emotions. They might say something like, " ‘Am I understanding you correctly? It feels like there’s someone following you? That sounds really scary, and you’re really upset. Tell me more about what’s going on and how I may be able to help you,’ " Dr. Compton explained.

The idea is to slow the encounter down so mistakes aren’t made on either side.

Dr. Compton said he has no disclosures.

SAN FRANCISCO – A simple questionnaire can pick up obstructive sleep apnea in psychiatric patients, according to a small study.

Screening is rare in psychiatric patients at present, but it’s important to diagnose obstructive sleep apnea (OSA) because it can make mental illness worse, contributing to depression and possibly to the risk of manic episodes. Symptoms can mimic mental illness as well, making patients irritable and tired, and OSA makes the use of benzodiazepines and other respiratory depressants problematic, said lead investigator Dr. Vanita Jain, a psychiatry department resident at the University of Utah, Salt Lake City.

"Sleep problems are so integral to psychiatric problems, [and] we wanted to make sure that along with psychiatric disorders, we were treating obstructive sleep apnea, too," she said.

The researchers screened 85 adult community hospital psychiatric inpatients with the STOP-Bang questionnaire, which is typically used as a presurgery screen and takes less than 2 minutes to fill out.

"Sleep problems are so integral to psychiatric problems."

The name refers to the survey’s eight yes/no questions: Do you snore loudly?, Do you often feel tired, fatigued, or sleepy during daytime?, Has anyone observed you stop breathing during your sleep?, Do you have or are you being treated for high blood pressure?, Body mass index more than 35 kg/m²?, Age over 50 years old?, Neck circumference greater than 40 cm?, and Gender male?

Most of the 85 subjects were white, and more than half were men. In all, 46 of the subjects answered yes to at least three of the questions, which is considered a positive screen.

Those patients had overnight pulse oximetry monitoring; 26 desaturated more than 10 times per hour. Fifteen of the 26 – most of the rest had been discharged or refused additional testing – underwent a polysomnography sleep study. Fourteen were ultimately diagnosed with OSA; three had more than 30 apneic episodes per hour.

They would have gone undiagnosed were it not for the questionnaire, Dr. Jain said.

Psychiatric patients can complicate OSA work-up. In the current study, for example, when patients were not coherent enough for an overnight stay in the sleep lab or if they were an escape risk, polysomnography was conducted in their rooms. If patients were "very psychotic or agitated, we just let it be" and asked them to return for an outpatient sleep study, Dr. Jain said.

Treatment options include continuous positive airway pressure (CPAP), special pillows to encourage side or elevated sleeping, dental prostheses to keep the jaw forward during sleep, weight loss, and surgery.

Dr. Jain said she has no disclosures.

SAN FRANCISCO – A simple questionnaire can pick up obstructive sleep apnea in psychiatric patients, according to a small study.

Screening is rare in psychiatric patients at present, but it’s important to diagnose obstructive sleep apnea (OSA) because it can make mental illness worse, contributing to depression and possibly to the risk of manic episodes. Symptoms can mimic mental illness as well, making patients irritable and tired, and OSA makes the use of benzodiazepines and other respiratory depressants problematic, said lead investigator Dr. Vanita Jain, a psychiatry department resident at the University of Utah, Salt Lake City.

"Sleep problems are so integral to psychiatric problems, [and] we wanted to make sure that along with psychiatric disorders, we were treating obstructive sleep apnea, too," she said.

The researchers screened 85 adult community hospital psychiatric inpatients with the STOP-Bang questionnaire, which is typically used as a presurgery screen and takes less than 2 minutes to fill out.

"Sleep problems are so integral to psychiatric problems."

The name refers to the survey’s eight yes/no questions: Do you snore loudly?, Do you often feel tired, fatigued, or sleepy during daytime?, Has anyone observed you stop breathing during your sleep?, Do you have or are you being treated for high blood pressure?, Body mass index more than 35 kg/m²?, Age over 50 years old?, Neck circumference greater than 40 cm?, and Gender male?

Most of the 85 subjects were white, and more than half were men. In all, 46 of the subjects answered yes to at least three of the questions, which is considered a positive screen.

Those patients had overnight pulse oximetry monitoring; 26 desaturated more than 10 times per hour. Fifteen of the 26 – most of the rest had been discharged or refused additional testing – underwent a polysomnography sleep study. Fourteen were ultimately diagnosed with OSA; three had more than 30 apneic episodes per hour.

They would have gone undiagnosed were it not for the questionnaire, Dr. Jain said.

Psychiatric patients can complicate OSA work-up. In the current study, for example, when patients were not coherent enough for an overnight stay in the sleep lab or if they were an escape risk, polysomnography was conducted in their rooms. If patients were "very psychotic or agitated, we just let it be" and asked them to return for an outpatient sleep study, Dr. Jain said.

Treatment options include continuous positive airway pressure (CPAP), special pillows to encourage side or elevated sleeping, dental prostheses to keep the jaw forward during sleep, weight loss, and surgery.

Dr. Jain said she has no disclosures.

SAN FRANCISCO – A simple questionnaire can pick up obstructive sleep apnea in psychiatric patients, according to a small study.

Screening is rare in psychiatric patients at present, but it’s important to diagnose obstructive sleep apnea (OSA) because it can make mental illness worse, contributing to depression and possibly to the risk of manic episodes. Symptoms can mimic mental illness as well, making patients irritable and tired, and OSA makes the use of benzodiazepines and other respiratory depressants problematic, said lead investigator Dr. Vanita Jain, a psychiatry department resident at the University of Utah, Salt Lake City.

"Sleep problems are so integral to psychiatric problems, [and] we wanted to make sure that along with psychiatric disorders, we were treating obstructive sleep apnea, too," she said.

The researchers screened 85 adult community hospital psychiatric inpatients with the STOP-Bang questionnaire, which is typically used as a presurgery screen and takes less than 2 minutes to fill out.

"Sleep problems are so integral to psychiatric problems."

The name refers to the survey’s eight yes/no questions: Do you snore loudly?, Do you often feel tired, fatigued, or sleepy during daytime?, Has anyone observed you stop breathing during your sleep?, Do you have or are you being treated for high blood pressure?, Body mass index more than 35 kg/m²?, Age over 50 years old?, Neck circumference greater than 40 cm?, and Gender male?

Most of the 85 subjects were white, and more than half were men. In all, 46 of the subjects answered yes to at least three of the questions, which is considered a positive screen.

Those patients had overnight pulse oximetry monitoring; 26 desaturated more than 10 times per hour. Fifteen of the 26 – most of the rest had been discharged or refused additional testing – underwent a polysomnography sleep study. Fourteen were ultimately diagnosed with OSA; three had more than 30 apneic episodes per hour.

They would have gone undiagnosed were it not for the questionnaire, Dr. Jain said.

Psychiatric patients can complicate OSA work-up. In the current study, for example, when patients were not coherent enough for an overnight stay in the sleep lab or if they were an escape risk, polysomnography was conducted in their rooms. If patients were "very psychotic or agitated, we just let it be" and asked them to return for an outpatient sleep study, Dr. Jain said.

Treatment options include continuous positive airway pressure (CPAP), special pillows to encourage side or elevated sleeping, dental prostheses to keep the jaw forward during sleep, weight loss, and surgery.

Dr. Jain said she has no disclosures.

SAN FRANCISCO – For the most part, veterans get first-line pharmacotherapy for posttraumatic stress disorder, but Iraq and Afghanistan veterans are less likely than others to finish an adequate 90-day therapeutic trial, especially if they are also depressed, according to an analysis of Veterans Affairs pharmacy records presented at the American Psychiatric Association’s Institute on Psychiatric Services.

Younger, more recent veterans might be too busy with school, jobs, or young families to bother with refills or dose adjustments. They also might not be as aware of mental health issues as older veterans, or as good at navigating the health system, according to lead investigator Dr. Shaili Jain, a psychiatrist at the Palo Alto, Calif., Veterans Affairs (VA) Medical Center and a research fellow at the VA’s National Center for Posttraumatic Stress Disorder.

Whatever the case, the findings "suggest a more vulnerable subtype of veterans," she said. "If I have a vet coming back from Iraq or Afghanistan who has PTSD [posttraumatic stress disorder] and also is pretty depressed, that’s somebody I know I’ve got to watch out for. Maybe I’ll have them come back sooner for an appointment or make sure I am collaborating with" their other doctors to keep them from falling through the cracks. Establishing a strong therapeutic alliance is also essential.

The 482 VA patients in the study all had DSM-IV diagnoses of PTSD. Half served in Iraq or Afghanistan. Their average age was 40; 47% were women, and 69% were white.

"If I have a vet coming back from Iraq or Afghanistan who has PTSD and also is pretty depressed, that’s somebody I know I’ve got to watch out for."

Psychotropic drugs were prescribed to 377; of those, 73% got a first-line treatment, either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI). Just 61% stayed on the drug for 90 days or longer, judging from whether or not they refilled their prescriptions to cover the full 3 months.

In general, veterans were more likely to be started on an SSRI or SNRI if they were in psychotherapy (odds ratio, 2.51) or had concurrent depression (OR, 7.38).

Iraq and Afghanistan veterans were about half as likely as others to take the drug for 90 days (OR, 0.44); concurrent depression made that even less likely (OR, 0.29).

The results echo previous work finding the group less likely than other vets to use mental health services and more likely to quit a recommended course of psychotherapy early, Dr. Jain said.

To build the therapeutic alliance, "I always try to be cognizant of how important that first impression is. It’s really important to listen to their story" without interrupting or being distracted by a computer screen. It’s also important to tell "patients that we want to see them again and that we can make them better," Dr. Jain said.

Like other people, it is likely that veterans worry about drug side effects. When that’s the case, "I start off with some real basics – that these meds are not going to make you into a zombie. You’re not going to get hooked on them. You’re not going to have to check out of your life because you’re on these meds. Millions of people take them and lead perfectly full and active lives," Dr. Jain said.

Discussion of side effects comes after that point has been made.

Dr. Jain said she has no disclosures.

SAN FRANCISCO – For the most part, veterans get first-line pharmacotherapy for posttraumatic stress disorder, but Iraq and Afghanistan veterans are less likely than others to finish an adequate 90-day therapeutic trial, especially if they are also depressed, according to an analysis of Veterans Affairs pharmacy records presented at the American Psychiatric Association’s Institute on Psychiatric Services.

Younger, more recent veterans might be too busy with school, jobs, or young families to bother with refills or dose adjustments. They also might not be as aware of mental health issues as older veterans, or as good at navigating the health system, according to lead investigator Dr. Shaili Jain, a psychiatrist at the Palo Alto, Calif., Veterans Affairs (VA) Medical Center and a research fellow at the VA’s National Center for Posttraumatic Stress Disorder.

Whatever the case, the findings "suggest a more vulnerable subtype of veterans," she said. "If I have a vet coming back from Iraq or Afghanistan who has PTSD [posttraumatic stress disorder] and also is pretty depressed, that’s somebody I know I’ve got to watch out for. Maybe I’ll have them come back sooner for an appointment or make sure I am collaborating with" their other doctors to keep them from falling through the cracks. Establishing a strong therapeutic alliance is also essential.

The 482 VA patients in the study all had DSM-IV diagnoses of PTSD. Half served in Iraq or Afghanistan. Their average age was 40; 47% were women, and 69% were white.

"If I have a vet coming back from Iraq or Afghanistan who has PTSD and also is pretty depressed, that’s somebody I know I’ve got to watch out for."

Psychotropic drugs were prescribed to 377; of those, 73% got a first-line treatment, either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI). Just 61% stayed on the drug for 90 days or longer, judging from whether or not they refilled their prescriptions to cover the full 3 months.

In general, veterans were more likely to be started on an SSRI or SNRI if they were in psychotherapy (odds ratio, 2.51) or had concurrent depression (OR, 7.38).

Iraq and Afghanistan veterans were about half as likely as others to take the drug for 90 days (OR, 0.44); concurrent depression made that even less likely (OR, 0.29).

The results echo previous work finding the group less likely than other vets to use mental health services and more likely to quit a recommended course of psychotherapy early, Dr. Jain said.

To build the therapeutic alliance, "I always try to be cognizant of how important that first impression is. It’s really important to listen to their story" without interrupting or being distracted by a computer screen. It’s also important to tell "patients that we want to see them again and that we can make them better," Dr. Jain said.

Like other people, it is likely that veterans worry about drug side effects. When that’s the case, "I start off with some real basics – that these meds are not going to make you into a zombie. You’re not going to get hooked on them. You’re not going to have to check out of your life because you’re on these meds. Millions of people take them and lead perfectly full and active lives," Dr. Jain said.

Discussion of side effects comes after that point has been made.

Dr. Jain said she has no disclosures.

SAN FRANCISCO – For the most part, veterans get first-line pharmacotherapy for posttraumatic stress disorder, but Iraq and Afghanistan veterans are less likely than others to finish an adequate 90-day therapeutic trial, especially if they are also depressed, according to an analysis of Veterans Affairs pharmacy records presented at the American Psychiatric Association’s Institute on Psychiatric Services.

Younger, more recent veterans might be too busy with school, jobs, or young families to bother with refills or dose adjustments. They also might not be as aware of mental health issues as older veterans, or as good at navigating the health system, according to lead investigator Dr. Shaili Jain, a psychiatrist at the Palo Alto, Calif., Veterans Affairs (VA) Medical Center and a research fellow at the VA’s National Center for Posttraumatic Stress Disorder.

Whatever the case, the findings "suggest a more vulnerable subtype of veterans," she said. "If I have a vet coming back from Iraq or Afghanistan who has PTSD [posttraumatic stress disorder] and also is pretty depressed, that’s somebody I know I’ve got to watch out for. Maybe I’ll have them come back sooner for an appointment or make sure I am collaborating with" their other doctors to keep them from falling through the cracks. Establishing a strong therapeutic alliance is also essential.

The 482 VA patients in the study all had DSM-IV diagnoses of PTSD. Half served in Iraq or Afghanistan. Their average age was 40; 47% were women, and 69% were white.

"If I have a vet coming back from Iraq or Afghanistan who has PTSD and also is pretty depressed, that’s somebody I know I’ve got to watch out for."

Psychotropic drugs were prescribed to 377; of those, 73% got a first-line treatment, either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI). Just 61% stayed on the drug for 90 days or longer, judging from whether or not they refilled their prescriptions to cover the full 3 months.

In general, veterans were more likely to be started on an SSRI or SNRI if they were in psychotherapy (odds ratio, 2.51) or had concurrent depression (OR, 7.38).

Iraq and Afghanistan veterans were about half as likely as others to take the drug for 90 days (OR, 0.44); concurrent depression made that even less likely (OR, 0.29).

The results echo previous work finding the group less likely than other vets to use mental health services and more likely to quit a recommended course of psychotherapy early, Dr. Jain said.

To build the therapeutic alliance, "I always try to be cognizant of how important that first impression is. It’s really important to listen to their story" without interrupting or being distracted by a computer screen. It’s also important to tell "patients that we want to see them again and that we can make them better," Dr. Jain said.

Like other people, it is likely that veterans worry about drug side effects. When that’s the case, "I start off with some real basics – that these meds are not going to make you into a zombie. You’re not going to get hooked on them. You’re not going to have to check out of your life because you’re on these meds. Millions of people take them and lead perfectly full and active lives," Dr. Jain said.

Discussion of side effects comes after that point has been made.

Dr. Jain said she has no disclosures.

SAN FRANCISCO – People who qualify for medical marijuana prescriptions frequently report substituting the substance for their other prescription medications.

In an anonymous survey, 66% of 350 clients at the Berkeley (Calif.) Patients Group, a medical marijuana dispensary, said that they use marijuana as a prescription drug substitute. Their reasons: Cannabis offered better symptom control with fewer side effects than did prescription drugs.

©ron hilton/iStockphoto.com

Those with pain symptoms said that marijuana has less addiction potential than do opioids. Others said marijuana helped to reduce the dose of other medications.

"Instead of having a pain medication, an antianxiety medication, and a sleep medication, they are able to just use cannabis, and that controls all of those symptoms," said Amanda Reiman, Ph.D., the director of research and social services at the Berkeley center. Almost 50% of those surveyed said they use cannabis two or three times per day.

More than 75% of respondents said they used cannabis for psychiatric disorders, including bipolar disorder, posttraumatic stress disorder, depression, anxiety, and persistent insomnia. Unlike some psychiatric drugs, they said, marijuana didn’t leave them feeling like "zombies," Dr. Reiman reported at the American Psychiatric Association’s Institute on Psychiatric Services.

Almost 70% of those surveyed were men and about 66% were white, in line with the center’s overall demographics. Respondents’ mean age was about 40 years, and ranged from 18 to 81 years. About two-thirds were employed; 81% had at least some college; and 28% made more than $60,000/year. More than half were single.

About 75% had health insurance that covered prescriptions. Even so, "they are still opting to utilize medical cannabis, which is not covered by insurance," Dr. Reiman said.

About 70% said they had a chronic condition, such as diabetes or arthritis. Just over half said they used marijuana for pain relief, including arthritis, migraines, and accident-related injuries. Other uses included appetite stimulation and relief of symptoms from carpal tunnel syndrome and multiple sclerosis.

"Instead of having a pain medication, an antianxiety medication, and a sleep medication, they are able to just use cannabis."

The amounts used – typically 3-8 g per week – were fairly stable with about 70% reporting no change in marijuana use in the past 6 months. Most "experience a stable level of use throughout their entire course of treatment," Dr. Reiman said.

In operation for 12 years, the Berkeley Patients Group has more than 6,000 patients who pay $15-$60 for one-eighth of an ounce of marijuana – 3.5 grams – depending on strain and potency.

To buy, patients must have a letter from their doctor recommending marijuana for a medical condition. Center staff verifies the letter with a call to the physician. The center obtains the marijuana from its own patients – a must under California law – who grow it and sell it to the dispensary.

Besides smokable marijuana, BPG offers cannabis-laced edibles, capsules, and extract drops to put under the tongue or in tea or coffee, as well as topical marijuana cream for pain and inflammation relief, Dr. Reiman said.

Money remaining after operational costs is used to provide free marijuana to those who couldn’t otherwise afford it, as well as free counseling, message, and other services to BPG members. The dispensary functions more like a community center than a pharmacy, and has a large lounge and regular social events like bingo and films. People often drop by even when they’re not buying.

Dr. Reiman said she has no conflicts.

SAN FRANCISCO – People who qualify for medical marijuana prescriptions frequently report substituting the substance for their other prescription medications.

In an anonymous survey, 66% of 350 clients at the Berkeley (Calif.) Patients Group, a medical marijuana dispensary, said that they use marijuana as a prescription drug substitute. Their reasons: Cannabis offered better symptom control with fewer side effects than did prescription drugs.

©ron hilton/iStockphoto.com

Those with pain symptoms said that marijuana has less addiction potential than do opioids. Others said marijuana helped to reduce the dose of other medications.

"Instead of having a pain medication, an antianxiety medication, and a sleep medication, they are able to just use cannabis, and that controls all of those symptoms," said Amanda Reiman, Ph.D., the director of research and social services at the Berkeley center. Almost 50% of those surveyed said they use cannabis two or three times per day.

More than 75% of respondents said they used cannabis for psychiatric disorders, including bipolar disorder, posttraumatic stress disorder, depression, anxiety, and persistent insomnia. Unlike some psychiatric drugs, they said, marijuana didn’t leave them feeling like "zombies," Dr. Reiman reported at the American Psychiatric Association’s Institute on Psychiatric Services.

Almost 70% of those surveyed were men and about 66% were white, in line with the center’s overall demographics. Respondents’ mean age was about 40 years, and ranged from 18 to 81 years. About two-thirds were employed; 81% had at least some college; and 28% made more than $60,000/year. More than half were single.

About 75% had health insurance that covered prescriptions. Even so, "they are still opting to utilize medical cannabis, which is not covered by insurance," Dr. Reiman said.

About 70% said they had a chronic condition, such as diabetes or arthritis. Just over half said they used marijuana for pain relief, including arthritis, migraines, and accident-related injuries. Other uses included appetite stimulation and relief of symptoms from carpal tunnel syndrome and multiple sclerosis.

"Instead of having a pain medication, an antianxiety medication, and a sleep medication, they are able to just use cannabis."

The amounts used – typically 3-8 g per week – were fairly stable with about 70% reporting no change in marijuana use in the past 6 months. Most "experience a stable level of use throughout their entire course of treatment," Dr. Reiman said.

In operation for 12 years, the Berkeley Patients Group has more than 6,000 patients who pay $15-$60 for one-eighth of an ounce of marijuana – 3.5 grams – depending on strain and potency.

To buy, patients must have a letter from their doctor recommending marijuana for a medical condition. Center staff verifies the letter with a call to the physician. The center obtains the marijuana from its own patients – a must under California law – who grow it and sell it to the dispensary.

Besides smokable marijuana, BPG offers cannabis-laced edibles, capsules, and extract drops to put under the tongue or in tea or coffee, as well as topical marijuana cream for pain and inflammation relief, Dr. Reiman said.

Money remaining after operational costs is used to provide free marijuana to those who couldn’t otherwise afford it, as well as free counseling, message, and other services to BPG members. The dispensary functions more like a community center than a pharmacy, and has a large lounge and regular social events like bingo and films. People often drop by even when they’re not buying.

Dr. Reiman said she has no conflicts.

SAN FRANCISCO – People who qualify for medical marijuana prescriptions frequently report substituting the substance for their other prescription medications.

In an anonymous survey, 66% of 350 clients at the Berkeley (Calif.) Patients Group, a medical marijuana dispensary, said that they use marijuana as a prescription drug substitute. Their reasons: Cannabis offered better symptom control with fewer side effects than did prescription drugs.

©ron hilton/iStockphoto.com

Those with pain symptoms said that marijuana has less addiction potential than do opioids. Others said marijuana helped to reduce the dose of other medications.

"Instead of having a pain medication, an antianxiety medication, and a sleep medication, they are able to just use cannabis, and that controls all of those symptoms," said Amanda Reiman, Ph.D., the director of research and social services at the Berkeley center. Almost 50% of those surveyed said they use cannabis two or three times per day.

More than 75% of respondents said they used cannabis for psychiatric disorders, including bipolar disorder, posttraumatic stress disorder, depression, anxiety, and persistent insomnia. Unlike some psychiatric drugs, they said, marijuana didn’t leave them feeling like "zombies," Dr. Reiman reported at the American Psychiatric Association’s Institute on Psychiatric Services.

Almost 70% of those surveyed were men and about 66% were white, in line with the center’s overall demographics. Respondents’ mean age was about 40 years, and ranged from 18 to 81 years. About two-thirds were employed; 81% had at least some college; and 28% made more than $60,000/year. More than half were single.

About 75% had health insurance that covered prescriptions. Even so, "they are still opting to utilize medical cannabis, which is not covered by insurance," Dr. Reiman said.

About 70% said they had a chronic condition, such as diabetes or arthritis. Just over half said they used marijuana for pain relief, including arthritis, migraines, and accident-related injuries. Other uses included appetite stimulation and relief of symptoms from carpal tunnel syndrome and multiple sclerosis.

"Instead of having a pain medication, an antianxiety medication, and a sleep medication, they are able to just use cannabis."

The amounts used – typically 3-8 g per week – were fairly stable with about 70% reporting no change in marijuana use in the past 6 months. Most "experience a stable level of use throughout their entire course of treatment," Dr. Reiman said.

In operation for 12 years, the Berkeley Patients Group has more than 6,000 patients who pay $15-$60 for one-eighth of an ounce of marijuana – 3.5 grams – depending on strain and potency.

To buy, patients must have a letter from their doctor recommending marijuana for a medical condition. Center staff verifies the letter with a call to the physician. The center obtains the marijuana from its own patients – a must under California law – who grow it and sell it to the dispensary.

Besides smokable marijuana, BPG offers cannabis-laced edibles, capsules, and extract drops to put under the tongue or in tea or coffee, as well as topical marijuana cream for pain and inflammation relief, Dr. Reiman said.

Money remaining after operational costs is used to provide free marijuana to those who couldn’t otherwise afford it, as well as free counseling, message, and other services to BPG members. The dispensary functions more like a community center than a pharmacy, and has a large lounge and regular social events like bingo and films. People often drop by even when they’re not buying.

Dr. Reiman said she has no conflicts.