Topic Two - substance induced mental illness
The Motion: Specialist services are not specialist enough if they fail to give vitamin prophylaxis and treatment
For…
Specialist services must be equipped to deal with the gamut of problems that come under the umbrella of substance misuse. It is critical that service can recognise and treat as well as prevent brain damage. It will increase the stigma attached to people with addiction problems to abrogate this responsibility.
Against...
There is no reason why specialist services should shoulder the costs of making medical procedures available. Addiction agencies need to develop expertise in psychosocial interventions rather than employ staff to deal with rare conditions that are best referred to an Accident & Emergency Department.
Thiamine Administration
This summary of a research article should help you clarify your thoughts on the issues raised by the debate. The article reviews the evidence for the effectiveness and safety of administering intravenous vitamins for people at risk of or currently experiencing Wernicke’s encephalopathy. It is a useful guide for agency policy on prescribing.
It is generally agreed that parenteral thiamine hydrochloride, given early enough, and in a sufficient dose, can prevent permanent brain damage in individuals with Wernicke’s encephalopathy. It is equally true that many individuals with Wernicke’s encephalopathy remain untreated or inadequately treated and suffer brain damage which can be demonstrated in post-mortem studies. The decision to give any medication will depend, in part, on the perceived risk-benefit ratio. Where this ratio is unknown or where the risk is perceived to be unreasonably high, therapy is frequently withheld. In the UK the usual treatment for suspected or actual Wernicke’s is Pabrinex™ which contains a high dose of thiamine and other vitamins. It is difficult accurately to estimate the incidence of anaphylactic reactions caused by Pabrinex™. However, available data indicate that there have been 10 anaphylactic reactions to Pabrinex from between 5,431,235–6,651,947 patient-days of treatment. In short the risk is extremely low and lower than many other medications.
Find the full text of the articles here…
Thomson A, Guerrini I, and Marshall JE (2019) Incidence of Adverse Reactions to Parenteral Thiamine in the Treatment of Wernicke’s Encephalopathy, and Recommendations Alcohol and Alcoholism 54: 609–614 doi: 10.1093/alcalc/agy091
What are your reflections on the use of vitamin supplements by agencies dealing with problem drinkers?
