Drug abuse in Cayman is on the rise, the island’s senior psychiatrist has warned.
Dr. Marc Lockhart said that people were also using a variety of substances, which worsened the abuse problem in Cayman.
Lockhart, medical director of George Town’s Behavioral Health Associates Cayman, warned that the trend was a major factor in what he has called a mental health crisis in prisons.
“We are seeing rising trends in substance abuse,” he said.
“There is also an increased presence of polysubstance use – people presenting with problems with more than one substance, be it alcohol, prescription medications they are getting illicitly, or other types of substances.”
Lockhart explained that the range of drugs that could be abused was wider than ever and that synthetic drugs could be easily produced.
“We have more companies making prescription medications than we used to. We have more pharmacists, more chemists than we used to have back in the day,” he said.
“There has been development of more potent and more types of medications than we had 10, 20 or 30 years ago.”
Lockhart said that, although there had been benefits from research, such as improved pain management and use of patches rather than pills, technological advances were “a double-edged sword”.
He added, “There has been an escalation in the potency of medications in general, particularly ones that have the potential to be abused.”
Lockhart said that the active ingredients of cannabis had also become more potent and that “bath salts” – powerful synthetic drugs related to khat, a naturally occurring stimulant plant, that’s hard to detect – had also appeared.
He revealed that an unconscious patient admitted to hospital in Cayman about two years ago had to be resuscitated and was later found to have used bath salts, which routine tests had not picked up.
Lockhart said the patient’s mother mentioned he had received a package ordered online from overseas that had not aroused suspicion.
It was checked and found to contain the drug in powdered form, which the patient had mixed incorrectly and overdosed.
“It’s not just the illicit substances; it’s not just the crack cocaine and heroin,” Lockhart said.
“Some of them are medications that are legitimately prescribed and diverted or stolen, or people faking illness to get the drugs.”
He added, “A lot of it is people bringing in these drugs from places such as South America, where they are really easily obtained.”
Lockhart said that use of lab-created “designer drugs, the party drugs” had also increased.
He warned that, as more students studied overseas and the population from other jurisdictions increased, the potential for importation of illicit substances also went up.
He said that the “war on drugs” had been an “abysmal failure” and led to most of the money available to combat substance abuse being used for enforcement rather than treatment, prevention and education.
“Another reason we need to shift to more treatment and a balanced approach is it would work to reduce harm, rather than waiting for a health crisis or serious events before we start making adjustments.”
Problems in prisons
Lockhart said that the increase had also contributed to drugs problems in the prison system.
The Compass reported last month that the prison system was in the grip of a mental health problem and that 30% of inmates at Northward, the adult male jail, were being treated for mental health problems.
The Human Rights Commission said the situation had caused tinderbox conditions, with an increase in violent incidents.
Lockhart, who also works in the prison system and is a former chairman of the Mental Health Commission, said police in Cayman made hundreds of arrests for drugs every year, many of them for cannabis offences.
“It’s consuming police resources and it’s diverting their resources from other, more serious, crimes and adding to the problems at Northward prison,” he said. “It’s adding to the over-crowding and adding to some of the complexity.”
Lockhart said he had only this month seen a disturbed and disruptive prisoner who required assessment and treatment.
He added, “The primary problem he was going through was substance withdrawal – it wasn’t primarily his mental health issue. That was secondary.”
He said the drugs problem also added to the stress on hospital emergency departments and that the identification of particular drugs used a lot of time and resources.
“That’s the front line for acute addiction withdrawal symptoms and overdoses.”
He added “about half, if not three-quarters” of the women in Fairbanks, the female prison, suffered from substance abuse problems.
Lockhart said crack cocaine, alcohol and cannabis addiction were often seen, and that “what we are seeing now is the polysubstance problem – it’s rare to get someone with just one drug problem”.
He added, “One of the big, over-arching problems is we are still playing catch-up in terms of our general psychiatric component and getting enough beds.
“We are in an even more dire situation from a substance-abuse standpoint.”
Lockhart highlighted that Caribbean Haven in Bodden Town was the only residential substance abuse centre in the country and it was looking at expanding.
“They are saying they’re getting increasing numbers and more complex cases – people that have a substance dependence problem along with an underlying mental health condition.”
Lockhart added, “You cannot treat one thing alone to get real remission and improvement.”
He pointed out that inadequate treatment would inevitably lead to “more people in the prison system with serious problems”.
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