Forced Medication in Colorado -- Selected Limited Links

People v. Medina, 705 P.2d 961
(Colo. 1985)
http://law.justia.com/cases/colorado/supreme-court/1985/83sc7-0.html
We are satisfied that the interest of both the patient and the state will be adequately served if the physician or professional person desiring to administer antipsychotic medication satisfies the court by clear and convincing evidence of the following four propositions: 

(1) that the patient is incompetent to effectively participate in the treatment decision; 

(2) that treatment by antipsychotic medication is necessary to prevent a significant and likely long-term deterioration in the patient's mental condition or to prevent the likelihood of the patient's causing serious harm to himself or others in the institution; 

(3) that a less intrusive treatment alternative is not available; and 

(4) that the patient's need for treatment by antipsychotic medication is sufficiently compelling to override any bona fide and legitimate interest of the patient in refusing treatment.

                ----------Colorado Supreme Court in Medina
Orchid Perogative:  A great big shout out to our good friend & colleague retired attorney & long-time Secretary of the Elder Law Section of the Colorado Bar Association, Frank Slaninger.

Frank represented respondent Joseph P. Medina, III in the case above, still the seminal case on forced medication in the State of Colorado.

Orchid Commentary    
        From Orchid's perspective, we -- meaning the psychiatric community and the society at large -- are going to have to come to terms with the limits of our current knowledge, and what that means from an ethical perspective regarding forced medication.
           We do not say this lightly, and we are well aware that it is more than a little awkward and inconvenient, AND from Orchid's perspective  neuroscientists are making the burden increasingly unsustainable for forced medication.
           Orchid would argue there are therapeutic alternatives to anti-psychotics that could reduce the need for anti-psychotics.  Further,  Colorado mental health advocate Amy Smith has been pointing out this out for some time.                
​ 
​Further , the National Institute of Mental Health has found less may be more with  anti-psychotics and long term use is not necessarily recommended.

            Orchid believes that an unlikely alliance among neuroscientists and mental health advocates may open the door for Open Dialogue.
Food for Thought
          What are the implications of Caltech neuroscientist David Anderson's observations that:
  1. The brain is more complex than a bag of chemical soup;
  2. The brain literally has billions of neural circuits; and
  3. Taking current psychiatric medications is sometimes like pouring oil all over one's mental engine, yes some gets in the right place, but much does not -- doing more harm than good.

​The Long-Term Effect of Schizophrenia on the Brain: Dementia Praecox? 

​John A. Sweeney, Ph.D
American Journal of Psychiatry (2013)

"​Indirect evidence suggests that antipsychotic medications may have adverse effects on brain anatomy and function. 

Persistent adverse effects of antipsychotics on some cognitive processes supported by frontostriatal brain systems are well established in preclinical models. Studies using similar cognitive paradigms with schizophrenia patients show similar adverse effects. 

Reduced prefrontal connectivity in resting-state fMRI studies has also been demonstrated after initiation of antipsychotic treatment . Thus, evidence for potential adverse effects of antipsychotics outside the domain of motor systems has grown in recent years. 

The greatest reason for concern about adverse neuroanatomic effects of antipsychotic treatment stems from data showing a robust reduction in brain volume in monkeys treated with clinically relevant dosages of conventional and atypical antipsychotics .

This remains a troubling observation on clinical grounds given the lack of therapeutic alternatives to antipsychotics."
Editorial above with supporting citations  was written by Dr.  John Sweeney, Ph.D  who has served on advisory boards for Bristol-Myers Squibb, Eli Lilly, Pfizer, Roche, and Takeda and has received grant support from Janssen. 

Dr. Sweeney serves in the Departments of Psychiatry and Pediatrics, University of Texas Southwestern Medical Center, Dallas.