Category Archives: General debate

NSW Opposition gaining credit for ATOD approach?

MEDIA RELEASE
For those outside of NSW who are unaware, the current Labor government has been in power since 1995 and to put it politely, is well and truly showing signs of disrepair. The current NSW Opposition has managed to stay disciplined since the 2007 election and under Barry O’Farrell has mad a much needed move to the centre-right.

NADA has put out a press release applauding the NSW Opposition for its call to improve funding for treatment services rather than the ever-expanding rollout of prison beds. Kudos to NADA for being vocal on this, and here’s to a lot more of that by ATOD peak bodies.

I’m far from a Liberal Party supporter but it shows how bizarre things have become where a Labor government are promising more and more prisons whilst the so-called conservatives are wanting an increased focus on treatment.

For those living in NSW, have you noticed whether things have deteriorated in regards to the government’s grasp of health issues? Post a comment below – feel free to use a psuedonym and fake email address if you’re worried about protecting your privacy. There’s not enough open discussion about the impact of politics on health and the current NSW situation is as good a place as any.

The NADA press release:

NADA applauds calls for the expansion of drug crime diversion programs

The Network of Alcohol and Drug Agencies (NADA) welcomes the NSW Opposition’s justice spokesperson’s call to end simplistic “tough on crime” approaches to deal with offenders with severe drug and alcohol and mental health issues. NADA CEO Larry Pierce thinks the NSW Opposition got it right in identifying that more funding for drug and alcohol rehabilitation programs are more effective than building more prisons. “There is strong evidence for the effectiveness of drug crime diversion programs like Drug Courts and magistrates referral to treatment in NSW and across the country” .

“it would be good to see real political bi-partisanship on this issue” says Mr Pierce. NADA also calls on the State and Australian government to further strengthen their current commitment to drug crime diversion and rehabilitation programs.

Virginity pledges: fail

Some interesting research that may interest harm reduction proponents. Anyone who’s worked in health promotion / community development knows there’s significant overlap between sexual health and ATOD topics.

The research below illustrates the potential downfalls of an abstinence based approach without wider strategies in place for those who don’t choose abstinence. In the case of this research it was in regard to ‘virginity pledges’ and their likelihood of preventing sexual activity in younger people.

The abstract:

Patient Teenagers? A Comparison of the Sexual Behavior of Virginity Pledgers and Matched Nonpledgers
Janet Elise Rosenbaum, PhD, AM
Health Policy PhD Program, Harvard University, Cambridge, Massachusetts; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

OBJECTIVE. The US government spends more than $200 million annually on abstinence-promotion programs, including virginity pledges. This study compares the sexual activity of adolescent virginity pledgers with matched nonpledgers by using more robust methods than past research.

SUBJECTS AND METHODS. The subjects for this study were National Longitudinal Study of Adolescent Health respondents, a nationally representative sample of middle and high school students who, when surveyed in 1995, had never had sex or taken a virginity pledge and who were >15 years of age (n = 3440). Adolescents who reported taking a virginity pledge on the 1996 survey (n = 289) were matched with nonpledgers (n = 645) by using exact and nearest-neighbor matching within propensity score calipers on factors including prepledge religiosity and attitudes toward sex and birth control. Pledgers and matched nonpledgers were compared 5 years after the pledge on self-reported sexual behaviors and positive test results for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, and safe sex outside of marriage by use of birth control and condoms in the past year and at last sex.

RESULTS. Five years after the pledge, 82% of pledgers denied having ever pledged. Pledgers and matched nonpledgers did not differ in premarital sex, sexually transmitted diseases, and anal and oral sex variables. Pledgers had 0.1 fewer past-year partners but did not differ in lifetime sexual partners and age of first sex. Fewer pledgers than matched nonpledgers used birth control and condoms in the past year and birth control at last sex.

CONCLUSIONS. The sexual behavior of virginity pledgers does not differ from that of closely matched nonpledgers, and pledgers are less likely to protect themselves from pregnancy and disease before marriage. Virginity pledges may not affect sexual behavior but may decrease the likelihood of taking precautions during sex. Clinicians should provide birth control information to all adolescents, especially virginity pledgers.

Thanks to Paul D on the ADCA Update list for the heads-up. What are your thoughts – any surprises in the findings for you?

The biggest drug myths

Over the years I’ve been asked numerous questions about which substances will get people high. To reduce some harm I though I’d list the biggest myths I’ve come across below. If you know of others, post a comment below and I’ll update the list.

The myths

1. Banana skins have a hallucinogenic effect

The most details description of this myth I’ve come across involves boiling up banana peels until they have a consistency of paste, then spreading that paste onto cookie sheets for further cooking in the oven. This allegedly creates a fine black powder that can be smoked.

I’m yet to meet a person who has gotten any effect from this and even a cursory review of online discussion sites will show it up for the myth it is.

2. There’s flavoured versions of Crystal Meth

We’ve covered this one previously – there seems to be endless questions about crystal meth that tastes like strawberry pop rocks, chocolate, peanut butter, cola, cherry, grape and orange.

Essentially, any colourations are due to impurities and there’s been no documented cases to date of such substances being flavoured to increase desirability. And anyway, to use an analogy, strawberry flavoured dog excrement will still taste like dog excrement – flavouring never fully disguises what’s underneath.

3. I can get high from peanut shells

I’ve seen this one float around the internet a bit: shell some raw peanuts, grind up the shells and smoke them. Zero reports of this doing anything other than making an interesting smell.

4. Yeast extracts / spreads as hallucinogenic agent

I’ve had direct exposure to this myth as far back as the early 1990’s. Apparently ‘some people’ were creating grazes or deeper lacerations and then rubbing an iconic Australian yeast extract into the area to get high. The result? A lovely infection and nothing else from everything I’ve seen.

A treatise on psychoactive drugs

Thanks to Andy via the ADCA Update list for this:

“Psychoactive drugs are everywhere. Any discussion of drug use needs to take this into account. The broad category of “psychoactive drugs” consists of natural and synthetic substances that alter a person’s thoughts or feelings. There exist hundreds of plants, which, if eaten, smoked, snorted, or injected, will affect the mind—whether acting as a stimulant, depressant, or psychedelic. Thousands of known chemicals will do the same. Used recreationally, medicinally, or for work, some are illegal and others not: They include coffee, wine, and tobacco; prescription pain medications, sleep aids, and antidepressants; as well as cannabis, LSD, and heroin. Psychoactives are in the kitchen, in the hardware store, in the greenhouse, in home medicine cabinets, and in fuel tanks across the country.

Everyone uses them. Would you believe that nearly 90% of 45-year-olds in the United States have tried an illegal drug in their lifetime?[1] As of 2006, more than 35 million Americans had taken an illicit drug in the previous year.[2] Monitoring the Future (MTF), the best current survey about illegal drug use in the United States,[3] reports that one in five college students used an illicit drug in the past month. Nearly all adults in the U.S. have tried alcohol, while over 80% use caffeine daily.[4] Last year there were over 180 million prescriptions written for opiates alone,[5] and a diverse assortment of psychoactives are increasingly used by older Americans from coast to coast.[6]

They are not going away. Humans have used psychoactive substances for as long as we have records[7] and some of the largest corporations in the world are actively developing new ones for the future. There is no magic bullet that will suddenly make these compounds disappear from our society. If there were, the past century of ever-increasing penalties for possession and sale of recreationally used drugs, along with massive anti-drug “education” campaigns, would have reduced use. But they have not.

The United States has implemented random drug testing of junior high and high school students who participate in chess club. No-knock warrants allow police to invade private homes with guns drawn in case a suspect might try to flush illegal drugs down the toilet. Taxpayers spend 8 billion dollars each year to incarcerate drug law offenders,[8,9] and pay for ideologically driven, abstinence-only education programs that are so factually misleading that they often fail to acknowledge the pleasurable or useful effects of the substances they teach about.

Despite these extreme measures, a majority of the population age 18-65 has chosen to try an illegal drug.[10] The mainstream reaction is to continue the calls for “getting tougher.” Instead of working towards unrealistic, naïve goals such as a “drug free century,” our response has been to step back and reassess, asking: How can society adapt to the realities of the communication age and develop more sophistication and balance regarding the use of psychoactive drugs?

Modern humans must learn how to relate to psychoactives responsibly, treating them with respect and awareness, working to minimize harms and maximize benefits, and integrating use into a healthy, enjoyable, and productive life. But above all else, in a world filled with materials and technologies that affect the mind, adults must have the robust education and accurate, pragmatic information necessary to help them take charge of their relationships with psychoactives and teach their children how to do so from an early age.

Rest at: http://www.cato-unbound.org/2008/09/08/earth-and-fire-erowid/towards-a-culture-of-responsible-drug-use/ ”

I couldn’t disagree with a lot there – psychoactives have only ever been on the perimeter of mainstream drug education, usually due to a somewhat legitimate fear of widening the use options for young people. WHat do you think – how would you mainstream education on psychoactives?

Interesting ruling on drug testing in the workplace

This is a fascinating decision as it shows the long way the industry has to go in offering comprehensive testing solutions. At best a company can assume it’s usually ok to do oral fuid testing and that some urine testing might be acceptable when testing regimes are up to par.

The summary of the decision:

AIRC Decision on “Implementation of random drug testing: use of oral fluids or urine as specimen for testing”

On 25 August 2008 in the Australian Industrial Relations Commission, Senior Deputy President Jonathan Hamberger, handed down his decision in the case of Shell Refining (Australia) Pty Ltd, Clyde Refinery versus the Construction, Forestry, Mining and Energy Union regarding the matter of “Implementation of random drug testing: use of oral fluids or urine as specimen for testing”.

In a private arbitration, which both parties agreed to waive confidentially, and consented to the decision being made public, Senior Deputy President Jonathan Hamberger, said the question at stake was:

“… Whether it would be unjust or unreasonable for the company to implement a urine-based random testing regime with its wide ‘window of detection’, with all that implies for interfering with the private lives of employees, when a much more focussed method is available, where a positive test is far more likely to indicate actual impairment, and is far less likely to detect the use of drugs at a time that would have no consequential effect on the employee’s performance at work.”

In his conclusion “… that the implementation of a urine based random drug testing regime in these circumstances would be unjust and unreasonable … ” , Senior Deputy President Hamberger gave two qualifications to his decision. The first was that no Australian laboratories were yet accredited for oral fluid testing under the relevant standard [not-for-profit company RASL gave evidence that it would shortly seek accreditation], and Shell could not be expected to implement its system until they were.

The second was that there were drugs (such as benzodiazepines) for which the relevant standard did not contain target concentration levels. Shell, he said, again could not be expected to implement an oral fluids based regime until it had the agreement of the union and the laboratory it would use on what other drugs it wished to test for and what would be an appropriate target concentration level.

Senior Deputy President Hamberger said that once these two issues were satisfactorily resolved, any random drug testing should be conducted using oral fluids. Until then, it would not be unreasonable for the company to implement a urine-based testing regime on an interim basis.

The full ruling can be found here.

Thanks to ADCA for the heads-up.

Strength of cannabis – a 1970’s perspective

I came across this interesting snippet on the Update list:

“A study done by L.G.Cartwright and L.E.Mather of the Department of Pharmacy at Sydney University published in The Australian Journal of Pharmaceutical Sciences in 1972 found that in seven samples of cannabis grown in Australia THC content varied from 0.4 to 11%. The lowest concentration was found in a whole plant grown in a suburban garden in Forest Lodge, Sydney. The highest concentration was found in female flowering tops gathered wild in the Hunter Valley. Other samples contained an estimated THC content of 9.2%, 9.4%, 1.6%, 4.3% and 3%. Climate, temperature and soil were all factors cited as influencing THC content.

This study was reported in the Technical Information Bulletin No. 15, November, 1972 published by the Commonwealth Department of Health to inform the Alcohol and drug field of national and international research. It is a good source for past scientific thinking on cannabis.

This study would suggest that not all the cannabis smoked in the 1960s and early 1970s was of low THC content.”

Nothing particularly surprising there but a useful historical perspective.

A changing of the guard at the MSIC

For more than ten years the Medically Supervised Injecting Centre (MSIC) has been a sometimes controversial addition to the Sydney landscape. The conservative aspects of the ATOD sector have at best been uneasy about its existence and the more rabid groups like DFA would love it to disappear tomorrow.

The stats provided by Dr van Beek are compelling and aside from straw man arguments around their statistical veracity, it’s hard to understand why anyone would argue anything other than its retention and expansion.

There’s a discussion on the MSIC at independent news outlet Crikey.com.au

The full media release on Dr van Beek’s departure from the MSIC:

“Media Release

Groundbreaking founder says goodbye

It’s been a long and arduous journey for Dr Ingrid van Beek who as the medical director of Australia’s first Medically Supervised Injecting Centre (MSIC) has put her heart and soul into this ground-breaking public health initiative over the past eight years. Today, in an historic announcement, Dr van Beek announces her resignation as its inaugural Medical Director.

“It’s been a great privilege to work in a field that I have such a strong commitment and passion for. My only disappointment is that the MSIC continues to operate on a trial basis,” says Dr van Beek.

The Kings Cross service received a four-year trial extension by the NSW Government in June last year, making it a ten and a half year scientific trial.

“It’s important the MSIC is judged on its health outcomes and it is now well-established the MSIC has been effective in reducing the various drug-related harms associated with street-based injecting to both individual drug users and the greater community,” says Dr van Beek.

The statistics speak for themselves –

80 per cent of long term local Kings Cross residents and 68 per cent of local business managers support the MSIC

Over 10,000 injecting drug users have registered to use the MSIC to date

More than 200 injecting episodes occur at MSIC every day i.e. in a clinical setting where in the event of a medical emergency eg overdose, specially trained registered nurses provide prompt and effective resuscitation. These injecting episodes would have otherwise occurred in unsupervised, often public and squalid circumstances in the local environs where timely help is in the lap of the gods.

2,458 drug overdoses have been successfully treated onsite in the past seven years

Ambulance callouts to heroin overdoses in the area have decreased by 80 percent thereby freeing Ambulance services to attend other medical emergencies in the area

MSIC staff have referred drug users to other services including drug treatment and rehabilitation programs on more than 7,000 occasions to date

“One of the highlights of my time spent at the MSIC is seeing first hand staff helping drug dependent users who are often in desperate personal circumstances and leading socially isolated lives. I am humbled to know we have helped these people get their lives back on track.” says Dr van Beek.

“My one hope is that the MSIC’s trial status is revisited prior to the next State election. The MSIC’s apparently endless trial status is a barrier to its integration with the rest of the public health system affecting continuity of care, workforce development and staff morale, especially as the end of each trial period draws near. It also ensures that the service remains politicised; the work we do is too important to be subject to partisan politics,” says Dr van Beek.

Rev. Harry Herbert, Executive Director, UnitingCare NSW says without the insight, personal dedication, political acumen, tenacity and determination of Dr van Beek, the MSIC would not have succeeded as it has.

“Ingrid made the dream a reality. She played an integral part in establishing the MSIC. She has been an inspiration to the staff, clients, businesses and community members associated with the MSIC.”

“Ingrid is congratulated and should be recognised and admired for her work in preventing and reducing drug-related harm and communicable diseases amongst one of society’s most marginalised groups – injecting drug users,” says Rev Herbert.

Dr van Beek was recently inducted into the National Drug and Alcohol Awards Honour Roll for her tireless and significant contribution to the drug and alcohol field over many years. The Awards are a collaborative effort of the Ted Noffs Foundation, The Australian Drug Foundation, The Alcohol and Other Drugs Council of Australia and the Australian National Council on Drugs.

Dr van Beek is returning to her original post as the full time Director of the Kirketon Road Centre in Kings Cross. Dr Marianne Jauncey, a public health physician, will take over as the Medical Director of the MSIC in the coming weeks. Dr Jauncey started her public health career working at the clinical coalface at the nearby Kirketon Road Centre, so she is well placed to take on this important role.”

Jobs board success

I’m really pleased that our jobs board is growing in popularity, with a handful of Australian ATOD jobs on there. If you’re an organisation looking for another avenue to promote positions, do take the time to use the board, It’s free and my stats show a not insignificant number of people are browsing the jobs advertised.

If you’re someone looking for a job in the alcohol, tobacco and other drugs sector, then just bookmark the jobs board and check back intermittently. As it grows I’ll feature a ‘job of the week’ here as well.

ATCA asks for more Ice treatment

I received the below press release yesterday – I’d love to see any sane individual argue with ATCA’s points on the lack of treatment facilities.

“ICE USERS NOT GETTING THE TREATMENT THEY NEED

The Australasian Therapeutic Communities Association (ATCA) today called for more treatment options for methamphetamine or ICE users. This follows the release of the position paper on methamphetamines, developed by the Australian Medical Association (AMA).

Ms Janice Jones, Executive Officer of the ATCA, said today that the ATCA supports the position paper on methamphetamines released by the AMA and is calling for a review of how the health system deals with this very difficult drug problem.

Therapeutic Communities (TCs) in Australia & New Zealand have been successfully treating amphetamine dependence for over 30 years, and recognise the need to respond differently and strategically to the problems faced by ICE users seeking help. The increase in aggressive behaviours amongst ICE users, often leading to psychosis, can create chaos and disruption for treatment providers.

Ms Jones said today, “We need strategic planning and targeted responses to avoid any reactions that may result in scarce funds being inadvertently misdirected”.

The ATCA also supports the recommendations made by the AMA in calling for all emergency departments to have a specialist drugs liaison officer to engage and support methamphetamine and other drug users.

However, Ms Jones added, “These workers also need to be trained in the range of mental health conditions that ICE users can present with. They also need to be aware of what services are out there that are experienced in treating the complex needs of these people.

Therapeutic communities deal very well with clients with complex and problematic behaviours which often result from polydrug use, including ICE.

“Working with clients with a comorbidity of mental health and substance use disorders is now the expectation, rather than the exception. At least 70% of clients undertaking treatment for drug addiction also suffer from mental health issues. Likewise, a similar number of clients with a presenting mental health problem will have a co-occurring substance use disorder. This is our area of expertise but we need an increase in beds and qualified staff to cope with this disturbing trend”, Ms Jones said. ”