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June -
July 2002 FDS
Queensland Launch |
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A Great Success Deb Sands & Margie Riley, FDS Qld Supported by the Brisbane City Council, the Queensland launch of Family Drug Support went far beyond our expectations! Everything came together and ran smoothly for a change. It was great to welcome Tony back to this lovely city and we have been re-inspired by his tireless efforts to help families who are struggling with drug issues. Our official launch on Thursday 9 May 2002 at Brisbane City Hall was extremely well attended with an address given by the Lord Mayor, Jim Soorley. The Lord Mayor spoke about the problems associated with illicit drug use and how the community's attitude towards drug users is changing, and about related issues. Tony then spoke of his efforts to encourage education and assistance for families, friends and for people who use drugs. The final speaker was Queensland committee member, Margie Riley, whose 22-year-old son Ted died two years ago from a heroin overdose. A well attended public forum was held in the evening at City Hall. The Council had allocated seating for 150, but had to increase this to accommodate the 200+ who had booked. On the night there was standing room only. An introduction was given by Councillor Catherine Bermingham who spoke as a councillor and concerned parent. Tony's emotive and powerful slide presentation followed. Cynthia Morton, who has fought dependency, spoke about issues facing drug users. Cynthia has also started a peer support group. Pertinent questions were asked from the floor and there was some interesting debate. On Friday, Tony, Debra and Margie had a very full day visiting officials from the Department of Families and the Premier's Department. Although Parliament was sitting, interviews were also held with the Minister for Police and Corrective Services, Tony McGrady, the Health Minister, Wendy Edmond (who gave about an hour of her time) and the Attorney General, Rod Welford. On the weekend, the volunteers attended Tony's telephone training at the City Hall. Again, there were more participants than anticipated. Everyone gained greatly from Tony's training and input and participants look forward to giving their time to this important service. The Queensland committee looks forward to a good relationship with the government and its departments and hopes that the interest expressed by the Ministers will be followed up with practical support and assistance in achieving our aims and objectives. Queensland Family Drug Support is a small but dedicated group of family members who have been affected by drug use and are committed to supporting other families who are struggling alone with similar problems. |
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I am a different person, a better person, since we first became friends. Your honesty helps me to see my weaknesses, and your support helps me to turn them into strengths. Thank you for not saying the things you think I want to hear, but for saying the things I need to know. You're one of the few people I trust when you tell me that I've done well, because you are one of the few who will tell me when I could do better. You challenge me to be the best I can be . . . by accepting and appreciating me, you've helped me learn to accept and appreciate myself Thank you for being my friend. Kathy |
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Such a hectic time. With the launch of FDS in both Queensland and South Australia, as well as continued commitment to the ACT, we have not stopped in the last couple of months. It is very exciting though to see FDS volunteers in all parts of the country. Kath and her group in Adelaide and Deb and Margie and the group in Queensland can be very proud of their efforts and I am sure these groups will go from strength to strength. I also spent some time in Inverell and Glen Innis working with the Community Drug Action teams. Interesting places!I got into a debate with the Mayor of Inverell over the issue of whether Inverell could become a drug-free town and what the implications for drug users and their families might be in the attempts to stamp out drugs!! Also, I saw some really progressive groups in action in these towns, and I am sure that `Stepping Stones' will be running in these areas very soon. In June, we will be celebrating five years of running FDS. It all started at Rev Bill Crews Church in Ashfield and we will be returning there on Tuesday 25 June. We have lined up some great speakers and we hope many of you will attend. Please try and make it and bring your friends. We want to fill the church and do a reality check on how far things have progressed in the past five years and where we go from here. While talking about up and coming events, on Thursday 20 August, we are planning to take a bus to Canberra to have a vigil at Federal Parliament. If this is to have meaningful effect, we need to involve lots of people. Please ring the office on 9715 2632 to register your intention to attend. We plan to try and obtain meetings with key politicians from all parties and hand over the results of the heroin trial survey. Please try to come to the June forum and if possible the Canberra trip. The closure of the Ryde Needle Centre is another issue that has concerned us, leaving no primary needle service in the triangle bounded by St Leonards, Hornsby and Parramatta. It is sad that public education and leadership gets left to organisations like ours instead of our political leaders. On a brighter note, we are seeing an ever-expanding volunteer base as more people get involved in FDS activities. Those who are on the telephone are the life blood of FDS and we thank all our volunteers so much for their commitment and enthusiasm. Our next training at Burwood is on 28 and 29 July, and training in Brisbane and Canberra will be held over the next six months. So you can see that busy times lie ahead. However, we hope all our members have peaceful times ahead. Tony T |
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Prevention: The New Harm Minimisation? Margaret Hamilton, Director!Turning Point Melbourne With the term `prevention' becoming embedded in our language, it is important for us to be clear about what we are aiming to prevent. Policies and services developed and funded under the banner of prevention should encompass the full range of responses to alcohol and drug-related problems, including those more traditionally thought of as harm reduction initiatives. What is different (if anything) about the `prevention' approach is that it more comfortably accommodates the range of interventions that aim to prevent people taking up drug use, along with programs that aim to prevent people relapsing back into drug use (abstinence-based programs). It has been established that the use of certain drugs can lead to people taking up other drugs. In this regard, tobacco smoking is the strongest predictor of subsequent use of illicit drugs. Clearly not all tobacco smokers will become users of illicit drugs, but it does mean that prevention strategies aimed at stopping people from taking up, or giving up smoking and remaining non-smokers, will have potential benefits beyond reducing smoking-related harm. Treatment and support services have a significant role to play in preventing drug problems through demand reduction, harm reduction and early intervention. The effectiveness of treatment can be seen in reduced drug use, positive changes in high-risk behaviour, health and social functioning. Obviously, the earlier treatment is sought or provided, the greater the harm prevention. Early intervention initiatives are viewed, along with conventional services, as an important component of prevention. Providing treatment and support for parents can also provide early intervention for children who are at a high risk of experiencing drug-related problems. Removing significant demand for drugs by getting people into treatment has other benefits through the changes that are produced in the drug market place as more people seek treatment. Experience in Europe shows that providing saturation treatment opportunities and attracting people into treatment reduces both the pool of active drug users as well as the number of people taking up drug use. Prevention is extensive and includes initiatives that build resilient communities, provide drug education in schools, and improve the range and quality of treatment and support services made available to people who are drug dependent. We are aiming to prevent commencement of drug use, harmful consequences of ongoing use, and relapse or resumption of harmful patterns of drug use. |
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Endorsed by the NH&MRC October 2000 Review by Michael Stevens Alcohol is widely used in Australian society and for the majority of people it forms part of their healthy lifestyle and social interaction and relaxation, together with cardiac benefits from middle age on. There are also some unwelcome social, health and economic consequences for many people who have regular drinking patterns and consume higher amounts. The Australian Alcohol Guidelines highlight the health risks and benefits from alcohol consumption. They are `evidence based', i.e. the recommendations follow from evidence from clinical trials and research. Upper limit levels have been set for low risk drinking, risky drinking and high risk drinking. In addition, these guidelines differentiate between short term risk and long term risk. Limits given are based on a standard drink that contain 10g of alcohol. Bottles of alcoholic drinks sold in Australia must list the number of standard drinks contained in the bottle and the alcoholic strength. The effects of alcohol vary from person to person according to age, gender, health, drinking history, medications and family history. These guidelines differ from previous ones and are a world first by differentiating short term risks from long term risks. Short term risks result from drinking excessively over a period that may be very brief or over hours or days. The effects include vandalism, economic loss, death and injury from road injuries, accidents, falls, suicide, drowning, assault and child abuse. Long term risks from following a risky pattern or history of drinking include dependence, depression, disruption of work and social commitments, illness and death. Consumption limits are given for health benefits which include some protection against heart disease from middle age on, however, a person who does not drink should not be encouraged to drink for the cardiac benefits. Guidelines for men in the general population For long term low risk drinking, an average of up to four standard drinks a day and 28 drinks a week. The limits for short term low risk drinking are up to six drinks in any one day, no more than three days a week, provided one does not become intoxicated by drinking quickly or exceeding the limits for long term low risk drinking. Note that this short term level may result in a blood alcohol level above 0.05 and make driving or flying illegal and some activities such as swimming or skiing inadvisable. High risk long term levels for men are more than seven drinks a day or 43 per week. Short term risky levels are 7!10 drinks and more than 11 drinks a day constitute a very high risk. Guidelines for women in the general population Women have lower risk limits for several reasons. Put another way, a given amount of alcohol will cause a higher blood concentration in a woman than a man. They usually have a smaller body size. Alcohol circulates in body fluid and women have a lower ratio of body fluid to fat. Alcohol is metabolised in the liver and women have a smaller liver than men. The guidelines for women are an average of no more than two drinks a day or 14 drinks in a week, not more than four drinks in any one day. Both men and women are encouraged to have one or two alcohol-free days per week as it helps drinkers stay in control of drinking and lower their risk of dependence. Drinks should be consumed at a moderate rate and preferably with food. Variations for groups with particular added risk There are 12 guidelines in all and they outline variations applicable to particular groups of people in the community. C Zero blood alcohol concentration is recommended for some risky activities while legislation limits the BAC for driving. C People serving or supplying alcohol should promote responsible drinking. C People with a health or social problem that is related to alcohol should consider not drinking at all, could drink at sustained lower levels, or should not drink at all if suffering from cirrhosis or pancreatitis. People with Hepatitis C or with a relative who has had a problem with alcohol should consider drinking infrequently and at low levels. Excessive alcohol can result in reduced sexual function in men. Medical conditions that can be caused or worsened by risky alcohol consumption include heart disease, stroke, high blood pressure, circulation problems, digestive problems, liver disease, some cancers and dementia. C People with a mental health problem, anxiety, depression or difficulty in sleeping should stay within the low risk guidelines or should stop drinking. If they drink and symptoms persist, consider not drinking at all. C People taking medications should follow the advice of their doctor or pharmacist because of harmful interactions between alcohol and drugs. Drinking may need to be reduced or ceased altogether. Alcohol has a depressant effect and adds to the depressant effect of illicit drugs such as heroin and cannabis as well as prescription drugs including sedatives, as well as drugs such as benzodiazepines and methadone that may be acquired on the black market. C Three age groups are identified for extra care: i) Guidelines for young people up to 18 years are important as they minimise risk in a group that may not have experienced alcohol before and set a pattern of responsible drinking for the rest of their lives. ii) The age group of young adults from 18 to about 25 years are warned against risky drinking and encouraged not to drink while taking mood-altering drugs. iii) Older people should consider drinking less than the guidelines and are alerted to the risks of falls, driving and taking medications. C Women who are pregnant or breastfeeding may consider not drinking at all. If they do drink, it should be no more than an average of one drink a day and no more than two in any one day spread over at least two hours and they should not become intoxicated. The risk of drinking are higher earlier in the pregnancy starting from the time of conception. C People who choose not to drink alcohol should not be encouraged to drink because of any perceived health benefit but should be encouraged to adopt other good health strategies such as giving up smoking, reducing weight or increasing exercise and following a good diet. Review by Michael Stevens In reviewing these guidelines, I cannot help but think that a lot of the strategies applied to promote low risk drinking would also apply to other legal and illegal substances. The strategies of limiting consumption or deciding to cease the use of alcohol to reduce risk, either short or long term, apply to all drugs. For example, one can limit the risk of using cannabis if it is only used once a week. When it is used every day, the short and long term risks increase. Risks are reduced if it is NOT smoked while drinking alcohol. Similarly, the scale of risk increases from low if one ecstasy tablet is taken, assuming that it is really ecstasy of known strength, too risky if two are taken and very risky if more are taken or other drugs are taken at the same time. With heroin, there is a low risk of infection if it is smoked, but the long term risks of tolerance and dependence remain high. The risks of taking drugs of unknown quality and strength will always be high and the risks of injecting is very high. The aim of a prescription heroin trial is an attempt to reduce the risk of using heroin by supplying a drug of known quality and strength and in a fixed quantity per day, while the operation of supervised injecting rooms reduces the risk of infection from shared needles or other equipment and monitoring the user before and after they inject. |
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Heroin Drought Gives Rare Chance To Evaluate Drug's Impact Paola Totaro, Sydney Morning Herald 4/4/02 When supply is short, crime goes up but overdoses plummet. So who are we trying to protect? It is indisputable: some crimes rise when the price of heroin goes up, or when the drug is in short supply. In NSW it is armed robberies, which rose 34 per cent in the two years to December 2001 coinciding neatly with the heroin shortage that began just after Christmas 2000 and saw the cost of a gram of heroin skyrocket from $218 to $381. The flip side of the drought is equally telling: heroin overdoses dropped dramatically in Cabramatta, the rate fell 74 per cent between June 2000 and July 2001. Nobody knows exactly what caused the recent shortage. It could have been the big seizures and the arrest of distribution figures in the same period, or it could have been low rainfall in opium-growing areas affecting crops. Probably, the shortage was a combination of the two. But the drought provided a unique opportunity for drug and crime researchers to examine what happens when heroin supplies are dramatically reduced. What has emerged more clearly than ever is the dilemma faced by policy-makers and communities: when we talk about harm reduction, harm reduction for who? In Sydney 880 men, women or children in four big communities Blacktown, Canterbury-Bankstown, St George-Sutherland and Central Western Sydney endured the trauma of a threat with a gun, or worse. On the other hand, drug-related deaths in NSW fell from a high of 65 in April 1999 to a low of 11 by October last year. Nationally, the drop in fatal heroin overdoses plunged from 345 in 1999-2000 to 265 in 2000/01. So what approach should we take? Don Weatherburn, the director of the Bureau of Crime Statistics and Research, argues that weighing up the costs and benefits of `the many policy levers' in the drugs arena is the debate we are all avoiding and should be having. But he joins the growing chorus of experts convinced that a small, nationally funded heroin trial is overdue. |
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Australian National Council on Drugs Meeting Address by Evan Thomas 14/3/02 The purpose of these suggestions is to introduce transparency into the cost of measures designed to reduce illegal drug use in this country. Over recent years, and particularly during the last three years, there have been huge increases in the amount of money spent on many aspects of the illicit drug problem. The most recent, but unofficial guess of the cost is around $2 billion per year nationally. Ten years ago, the United Nations estimated than Australian governments spent $534 million. There have been no official estimates since. In 1997, the Prime Minister said that the Tough on Drugs' first instalment would be $87.5 million. In March 1998, he announced a second instalment of $100 million over four years. In December 2001, Major Watters, Chairman of Australian National Council on Drugs (ANCD) said that the government had added another $110 million on top of the $400 million previously provided. The ANCD and governments have done a good job in a number of areas of illicit drug control. C More money for Federal Police and Customs C More money for school education C More money for family awareness advertising C More money for State government programs C More money for a variety of non-government programs And in July 1999, the NSW government released its Drug Summit Plan of Action that involved spending $176 million over four years (400 new programs are said to be planned). Large sums have been either spent or committed, or are proposed for the future. What is lacking are initiatives by all governments to evaluate and compare the entire range of publicly-funded illicit drug programs, new and old. I am not saying that none of the new programs are being evaluated. Many of the new ones are. But what we need is across-the-board cost efficiency audits so that we can compare one program with another. The time has come to take stock of what we are doing so that we can be sure that our money is being spent where it does the most good. And of course, so that new programs can be planned. This proposal is NOT about advocating one particular program or method over another. It is about measuring current programs, doing cost-benefits on proposed programs, and above all, providing transparency. Australian taxpayers are putting their money into programs designed primarily to reduce the use of illicit drugs, and yet these projects are not audited in such a way so that we can make a judgement as to how successful they are compared to other programs. To quote two New York research workers: What gets measured gets done. If you don't measure results, you can't tell success from failure. If you CAN demonstrate results, you CAN win public support. If you can't see success, you can't reward it. If you can't reward success, you are probably rewarding failure. If you can't recognise failure, you can't correct it. Illicit Drugs Policy 1.1 Current Supply Reduction Operations (i.e. criminal justice measures such as Federal Policy, Customs, State Police, gaol terms, incarceration, drugs courts and legislation) should be evaluated so that their relative cost effectiveness can be compared to one another and other measures. 1.2 Demand Reduction Measures (such as criminal justice legislation, education, advertising, treatment programs) that involve public money should be appropriately evaluated so that their cost effectiveness (together with other evidence-based factors) can be compared to one another and other measures. 1.3 Harm Reduction Programs (such as needle syringe programs, safe injecting facilities, detox and rehabilitation programs) that involve public money should be appropriately evaluated so that their cost effectiveness (together with other evidence-based factors) can be compared to one another and other programs. 1.4 With the exception of trials, measures designed to reduce problematic illicit drug use and harm should be assessed on their cost effectiveness before being allocated public funds. |
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And lonely, So tired The hearts aches. Meltwater trickles Down the rocks, The fingers are numb, The knees tremble. It is now, Now, that you must not give in. On the paths of the others Are resting places, Places in the sun Where they can meet. But this Is your path, And it is now, Now, that you must not fail. Weep If you can, Weep, But do not complain The way chose you! And you must be thankful. Dag Hammarskjold (former Director-General, United Nations) |
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Andrew Byrne, GP!Drug & Alcohol, Redfern Rabinowitz, J., Cohen, H., Atias, S. `Outcomes of Naltrexone Maintenance Following Ultra Rapid Opiate Detoxification Versus Intensive Inpatient Detoxification', American J on Addictions (2002) 11; 1:52 t last we have a scientific report from the country which popularised rapid detox treatment, sometimes incorrectly called the `Israeli method'. These authors prospectively chose 63 consecutive patients from a Social Service agency needing opioid detoxification. For those `who specifically requested it' ultra-rapid opiate detoxification (UROD) using naltrexone and clonidine under anaesthesia was performed (30 cases). Otherwise, they received a `standard' 30-day in-patient detox using non-opioid medicated care with intensive counselling (33 cases). The authors found no significant differences between the two groups: mean age!34 years; age of first opiate use!17 years; 60% had a prison history; mean of 2 previous detoxification per patient; 10% also using cocaine; 40% married. Only 10% were women, a lower proportion than in most such series. Of the 80% who were followed up (the same proportion in each group) 73% `traditional' detox patients had completed the 30-day program and 70% of these subjects had `not relapsed' at follow-up after a mean of 13 months. `Relapse' was defined as at least two weeks daily heroin use on telephone interview. While 100% of the UROD cases probably completed detoxification, of the 80% who could be traced at 13 months, 62% had `not relapsed'. The time to relapse for the standard detox cases was 3.3 months and for the UROD cases, 2.8 months. The trend for benefits in the standard treatment group was not significant. The UROD non-relapse rate of 62% at 13 months compares with 57% at 18 months found by these authors in a previous report. Rather than just observational evidence, we now have a comparison with a control group (of sorts) in a published study. However, it was the subjects themselves who chose which treatment they would take based on their own information and experience. As the authors rightly point out, only randomisation of such decisions can lead to persuasive scientific evidence on the relative efficacy of the experimental treatment (UROD) which has not been scrutinised by its proponents. A randomised trial from experienced researchers in Adelaide, South Australia, has been reported at conference presentations as finding no difference between two groups given rapid detoxification with antagonists under anaesthesia when compared with traditional in-patient detoxification. This is consistent with other data. I think we can now confidently say that rapid detoxification under anaesthesia has comparable 12-month abstinence outcomes to traditional detoxification. Rapid detox may have a higher complication rate and, depending on the duration of intensive care, it costs more than a week in a detox unit, although it would appear to be less expensive than a month in hospital as used in this Israeli study. Whether this treatment can be recommended will depend on careful analysis of the morbidity and small mortality rate to compare with deaths and other complications which may be associated with traditional detoxification. These matters are not easy to study in a mobile, risk-take population. |