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This chapter uses Goffman’s concept of total institutions in a comparative case study approach to explore the role of psychotropic drugs in the process of transinstitutionalization.

This chapter interprets psychotropic drug use across four institutionalized contexts in the United States: the active-duty U.S. military, nursing homes and long-term care facilities, state and federal prisons, and the child welfare system.

This chapter documents a major unintended consequence of transinstitutionalization – the questionable distribution of psychotropics among vulnerable populations. The patterns of psychotropic use we synthesize suggest that total institutions are engaging in ethically and medically questionable practices and that psychotropics are being used to serve the bureaucratic imperatives for social control in the era of transinstitutionalization.

Psychotropic prescribing practices require close surveillance and increased scrutiny in institutional settings in the United States. The flows of mentally ill people through a vast network of total institutions raises questions about the wisdom and unintended consequences of psychotropic distribution to vulnerable populations, despite health policy makers’ efforts regulating their distribution. Medical sociologists must examine trans-institutional power arrangements that converge around the mental health of vulnerable groups.

This is the first synthesis and interpretive review of psychotropic use patterns across institutional systems in the United States. This chapter will be of value to medical sociologists, mental health professionals and administrators, pharmacologists, health system pharmacists, and sociological theorists.

Aim ‐ To describe prescription drug use in a nationwide prison population and compare it with contemporary drug use in other relevant populations as well as in a prison population 25 years ago. Method ‐ Detailed medication sheets from 37 prisons, covering 90% of the Norwegian prison population, were collected. All drugs were transcribed into the Anatomical Therapeutic Chemical classification system, and Defined Daily Doses/100 inmates were calculated. Data enabling relevant comparisons were gathered from reliable sources. Results ‐ Among the 2,617 inmates investigated, 48% used no medication. Sixteen percent used both psychotropic and somatic drugs, 17% psychotropic drugs only, and 19% somatic drugs only. Strong correlations between drug use and gender, age, and prison characteristics were demonstrated. Psychotropic drug use was higher than in the general population but lower than in a psychiatric hospital unit. Somatic drug use was lower than in the general population, except non‐steroid antiinflammatory agents, antihistamines, and drugs to alleviate obstructive airway diseases. Psychotropic drug use, particularly antidepressant use, was higher than in prisons 25 years ago. Conclusion ‐ High levels of use of all psychotropic and a number of somatic drugs were demonstrated in this nationwide prison population. Treatment studies are needed in order to ascertain whether the high levels of use of particularly psychotropic medications are indeed improving the mental health of prisoners.

The paper provides a Canadian perspective on the use of psychotropic medication in the management of problem behaviours in adults with intellectual disabilities in Canada. Psychotropic medication and intellectual disabilities were explored in the context of Canadian health and social services, clinical practices, medical training and factors that have shaped these over the past few decades. Informal physician intellectual disabilities networks and the newly formed Canadian Network of the National Coalition on Dual Diagnosis provided the opportunity to survey the use of psychotropic medication for problem behaviours across the country. Geographic, political, cultural and other influences on the development of health and social services are described, as well as training requirements for physicians. Survey responses were received from all provinces and represented clinicians in mental health multidisciplinary teams, health and social services ministry representatives, agency staff (up to executive director level) and family members of individuals with intellectual disabilities. Psychiatry and family medicine perspectives of the authors from working in Canada and the UK with people with intellectual disabilities presenting with problem behaviours are described. In Canada there are no national, provincial or territorial policies or guidelines on use of psychotropic medication for the management of such behaviours. There are no requirements for physicians prescribing these medications to have training in the care of people with intellectual disabilities. Services for people with intellectual disabilities and behaviour problems in Canada appear to be more crisis‐reactive than those in the UK.

Adverse drug reactions (ADR) and interactions for patients who use substances and have a mental health problem is an area that lacks attention in research, practice and policy. The purpose of this paper is to examine what is currently known about this topic.

The paper explores the available literature and specialist information available on this subject.

This is a complex area, which is compounded by limited empirical evidence. However, information is available which when combined with individual patient assessment there is the potential to reduce the risk of detrimental ADR and improve concordance to medication.

The paper offers pragmatic suggestions which aim to improve the knowledge of practitioners and lessen the potential harm to patients.

This paper aims to analyse the fundamental principles of the main international conventions against use of drug and to verify if it would be preferable to let European Member States adopt specific measures according to own needs at a national level.

The research uses a comparative approach by examining the different national legislations in respect of the discipline of the international conventions for finding analogies and differences between them.

The research has discovered a wide variation in the criteria for triggering a legislative response and in the penalties for non-compliance. Nevertheless, there seems to be a trend towards countries focusing on penalising supply rather than possession of these substances.

To maintain a common international level in fighting against the use and commerce of drug to enforce the effectiveness of national regulations.

The achievement of a high level of health protection, well-being and social cohesion to prevent and reduce drug use, dependence and drug-related damage to health and society.

To ensure a high level of security for the general public by taking action against drug production, cross-border trafficking in drugs and the diversion of chemical precursors used in drug production, as well as by intensifying preventive action against drug-related crime through effective cooperation, embedded in a joint approach.

This is a fast-moving area of law, which continues to evolve for the different new substances being introduced in international drug traffic, so different solutions to the problem can be found by national legislators who need to be coordinated at an international level.

In the wake of the 1988 United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, attention has come to be focused on money laundering. Several developed, and some developing, countries now have in place legislative and other control measures designed to enable information to be collected and to facilitate investigations with regard to investments and transfer of funds above a certain monetary limit; to confiscate assets purchased with the proceeds from the sale of controlled drugs; and, to impose stringent jail and other sentences on persons contravening the applicable drug or banking laws.

This chapter explores the historical context of drug control in the United States, the ongoing regulation of the cannabis market at the State level and the role of the United States in the international negotiations related to the United Nations General Assembly Special Sessions (UNGASS) on drugs in 1998 and 2016. We continue by analysing the position, allies and activities of the United States before and during UNGASS 2016 to provide an understanding of possible scenarios related to the 2009 Political Declaration and Plan of Action review to take place via a High-level Ministerial Segment within the 2019 Commission on Narcotic Drugs meeting. While US drug policy is not expected to positively shift in the next few years, State-level regulation of cannabis is expected to continue and create pressure from below.

The purpose of this paper is to explore the qualitative relationship between cannabis and the most commonly used antidepressant drugs known as selective serotonin reuptake inhibitor (SSRIs) through the narratives of depressed individuals who have used both drugs at one point during their lifetime. Despite their prevalence, depression, cannabis use, and SSRI use have not been previously studied together through the perspective of those who have experienced them. Using a exploratory approach, this paper investigates and compares the user experiences of these drugs.

Semi-structured interviews were conducted involving participants who were between the ages of 16–59 in the UK and have used both SSRIs and cannabis either simultaneously or at any point in their lives. Five interviews were conducted either via telephone or in person, and the method of analysis was an inductive approach which was inspired by grounded-theory.

While the two drugs were used by participants in order to relieve symptoms of depression, they were used for very different reasons and typically at different stages of their lives. Though participants did not state that the drugs were interchangeable for improving mood, their responses indicated that these drugs were viewed as two alternatives to alleviate symptoms of depression. Participants’ relationships with their doctors also played a crucial role and affected interviewees’ decisions to use either SSRIs or cannabis, as well as perceptions of the medical industry.

This research shows the importance of doctor and patient interactions as they were crucial influences on patients’ decisions related to drugs. Participants’ experiences with SSRI and cannabis were subjective and varied, therefore, the value of personalised treatment (which may or may not include psychotropic drugs) is highlighted. These findings can help health practitioners gain a better understanding of the rationale of depressed patients in choosing treatments and thereby improve healthcare outcomes.

Given that depression is stigmatised, and cannabis use is both illegal and stigmatised, this paper examines the opinions of a difficult to reach population. Previous work involving cannabis, antidepressants and mood-elevating effects is primarily written with a biochemical or medical perspective which paid more focus on the efficacy of these drugs and had less emphasis on the beliefs of the users. This paper highlights the opinions of cannabis and SSRI users regarding these two drugs specifically, which had not been previously explored.

The management of sexual offending is a major challenge, particularly in men who have an intellectual disability. Psychological therapies have been shown beneficial, and programmes designed for use in the general population have been adapted for use in offenders who have an intellectual disability. There is also a role for pharmacological management, although the quality of evidence for this is noticeably lacking, most likely associated with the ethical and legal issues encountered in conducting well designed and controlled trials in this area. The purpose of this paper is to look at the pharmacological management options available.

A literature search of electronic databases was undertaken. Additionally, the references lists for identified papers were examined for any further relevant publications.

The two main categories of drugs used in the management of inappropriate sexual behaviour are the testosterone-lowering drugs and the psychotropic drugs. Most trials were open and utilised self-report measures of drug effectiveness, limiting their usefulness. Most trials noted beneficial effect. Side effect profiles and patient adherence can limit the effectiveness of anti-libidinal medication in practice.

There is very limited evidence available for the use of pharmacological agents in the management of inappropriate sexual behaviour, owing to the lack of adequately controlled clinical trials. New studies are therefore required, particularly of larger sample sizes, longer durations, and examining characteristics of those who benefit from pharmacological treatment, although the ethical issues of conducting such studies is duly acknowledged.

Using as an example the mental health mass screening and treatment programmes instituted in some US states, Joseph Dumit describes how the western world has arrived at a state of ‘dependent normality’ in which being diagnosed and dependent on medication is rendered ordinary, largely through the marketing activities of the pharmaceutical industry, which seeks constantly to expand its market by defining at‐risk populations as broadly as possible, and through persuading the public that all risks must be combated with drugs.