Editorial

Illicit drugs, governments would have us believe, are all bad and always bad. Few in authority would dare to concede that illicit drugs might be beneficial in any way, lest they be seen to be promoting drug use. Worse still, it now seems certain that governments have in the past deliberately exaggerated or made up adverse consequences of illicit drug use. This is particularly true of LSD: stories abound of ‘bad trips’, flashbacks and people leaping out of windows. Might LSD have therapeutic uses? Surely not. Two reviews in this issue suggest that we may have missed an opportunity with LSD. In their systematic review, dos Santos and colleagues describe successful therapeutic trials of LSD and other psychedelic drugs. Saibal Das and coworkers discuss those findings and many others derived from animal studies and observational trials. Their review shows that LSD clearly has activity in anxiety and addictions and probably other conditions too. Thus, LSD may, like ketamine, emerge from the shadow of recreational nonmedical use to become a valued therapeutic agent. Also in this issue, John Muller and colleagues discuss the possible pharmacological actions of ketamine in treating depression. Taken together these three papers make a strong case for further research into the benefits of illicit drugs, and, inevitably perhaps, a loosening of regulations around research of this nature.

The remaining papers in this issue focus on psychoses. My colleague Anne Connolly reports on her examination of prescribing biases. She sent out two case vignettes differing only by one word - white/black - and asked to outline what they would prescribe for the patient described. No differences were found in prescribing practice between the ‘white’ and ‘black’ patient. This is the latest study in the series conducted by Anne Connolly in which she has discovered numerous moderators of pre-scribing practice but failed to find any influence of race.

From Ireland, Senan Maher and coworkers describe their observations of nearly a hundred patients prescribed clozapine. They report that an incredible 92% of patients prescribed clozapine experienced hypersalivation. This is a value a great deal higher than most other studies, particularly randomized controlled trials (RCTs). Clearly further research needs to examine why RCTs tend to underestimate adverse effects frequency.

Imran Chaudhry’s team from Manchester, UK, report on outcomes with risperidone long-acting injection compared with typical depots. In this observational study, the authors found no difference in adverse effect severity or frequency and no difference in satisfaction with medication. This is striking given the massive differential in purchase cost of risperidone compared with conventional depots.

Finally, a case report by Rabia Nazik Yuksel and colleagues outlines a known but rare adverse effect of dopamine agonists. Cabergoline, a long acting dopamine agonist was given to a previously well young woman to stop lactation. She very quickly developed a manic episode that could only be related to the use of cabergoline. Since dopamine agonists are still sometimes used to treat antipsychotic-induced hyperprolactinaemia, it is important to be reminded of the possible consequences of such prescribing.