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The rock and hard place

by PeakCare Qld
on 12th April 2017

This week the State Government entered polarising space between the proverbial rock and hard place. Cabinet must have known that a decision to withhold public release of the Child Death Review Panel’s Report into the death of Mason Lee would draw ire and criticisms from many who would perceive it as a reneging on the Premier’s promise concerning its release. However, the advice provided by the Director of Public Prosecutions Michael Byrne to Cabinet which indicated that public release of the report at this time could prejudice juries at the trials of those charged with offences in relation to Mason’s death and potentially establish grounds for a mistrial, could not be ignored. The Government was right to heed this advice and defer its release of the report.

It is hoped, and it appears, that the decision was not made lightly or expeditiously as a means of avoiding public accountability and transparency, but rather was a decision made with due process in mind in achieving fair trials and justice for Mason.

Lindsay Wegener
Executive Director, PeakCare

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In the vault

by PeakCare Qld
on 12th April 2017

“The tabloid press would have us believe the drug ‘ice’ is currently the biggest threat to Australian society. But doctors and drug professionals alike will tell you that potentially, the unfettered spread of Carfentanil and the illicit synthetic fentanyls is much worthier of your fear.”
David Caldicott, Emergency Medicine Consultant, Australian National University

Whilst we are busily researching the history and impact of Ice in our communities, through contributions to our Ice Bank, in order to actively respond to the growing issue that ice represents in our communities, we’re warned of the need to be proactive about another far deadlier substance entering the fray.

Carfentanil citrate (carfentanil) is an extremely potent synthetic version of fentanyl, a synthetic opioid similar to morphine. Fentanyl is 50 to 100 times more potent than morphine but it is regularly used in emergency departments primarily for pain relief.

This is the drug that has medical practitioners really nervous. Originally developed in the 1970s as a sedative for wild animals, carfentanil is 10 thousand times more potent than morphine and 20 micrograms equals a lethal dose for humans. Such is its potency that lab technicians employ protective measures to analyse it and must have the antidote Naloxone available at the lab bench when working with the product.

What is really concerning about carfentanil is that it is being used despite having no therapeutic purposes for humans and the clear majority of those who have consumed it have done so involuntarily believing it to be another substance such as heroin. Its use is disguised as a more ‘pure’ form of heroin which enhances the perceived value. The completely synthetic nature of the drug also means that it is not reliant on growth conditions and is easier to smuggle around the world.

Hundreds of Americans died between 2005 and 2007 from a fentanyl/fentanyl related compound. Globally fentanyl use from late 2013 is presenting as far more deadly with 5000 deaths in the US alone in 2014. In Ohio 1,100 people died in 2015. In Australia, the presence of fentanyls has been noted for some time initially through reports of questionable heroin overdoses not responding to standard doses of naloxone. Recently there have been a couple of deaths attributed to carfentanil seizure. The concern is that these types of substances can appear on the streets in an instance.

Working to prevent an epidemic from occurring is the ultimate position which involves engaging with consumers in our communities. The seeming reticence of policy makers in Australia has been an issue to date.

Click here to read the full article.

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From substance abuse to self-discovery. Icelands answer.

by PeakCare Qld
on 4th April 2017

“We didn’t say to them, you’re coming in for treatment. We said, we’ll teach you anything you want to learn: music, dance, hip hop, art, martial arts,”
Professor Harvey Milkman.

20 years ago Iceland was concerned by the increasing substance abuse of teenagers and the resultant social issues. Despite school based drug and alcohol education drug abuse was deemed to be spiralling out of control.

To confront their drug and alcohol abuse, Iceland hired American Psychology Professor Harvey Milkman whose research in New York and later Denver suggested that drugs and alcohol are people’s ways of dealing with stress. Milkman discovered that uppers or downers were selected depending on individual coping mechanisms. He concluded that alcohol and heroin numb the user whilst speed, cocaine and other stimulants are used by those who want to confront issues. It was their style of coping that users were abusing and the addiction was to changes in brain chemistry.

Milkman had previously founded Project Self- Discovery in Denver, an initiative that offered young people alternatives to drugs and crime. Based on the observations that drug education doesn’t work due to many not paying attention to the messages, the aim instead was to offer something better than substance use - natural ‘highs’ and improved opportunities for enjoyment and fulfilment. This program attracted Iceland.

Under a plan called Youth in Iceland, a team of law enforcement officers, community workers, health professionals, policy makers, politicians and teachers worked closely with families on strategies to deviate young people from drug use. All key community stakeholders worked in a holistic manner to develop a number of initiatives, which were adopted alongside the principles of Project Self-Discovery. These included limiting alcohol sales by banning the sale of alcohol to under 20 year olds. Children 13 to 16 years were placed on a 10pm curfew in winter with a midnight curfew in summer. Each local district developed a communal pledge which parents signed. These pledges include parental agreements such as not to buy alcohol for underage children.

Most significantly, social engagement opportunities were offered and parents were encouraged to spend more time with their children. Young people were also directed to do out-of-school activities. Experiences that could either reduce anxiety or create a ‘high’ were identified and delivered. State funding was increased for organised sport, music, art, dance and other clubs. Families were given financial assistance so they could afford recreational opportunities. For example, in Reykjavik, families received a leisure card which assisted in the costs of activities. Residential drug treatment facilities were designed around similar mechanisms including various learning, sporting and creative activities.

Every year, nationwide, Icelandic children and teenagers 10 to 16 years of age take part in a comprehensive survey. Assured of confidentiality, children and young people answer questions about risk and protective factors including: self-esteem; patterns of alcohol or other drug use; family living conditions; neighbourhood characteristics; attitudes about school, leisure time activities; religious affiliations; quality of parental supervision; love and guidance; support from peers; neighbourhood support; anxiety, depression, and suicide. This means up-to-date, reliable data is always available. So too are the opinions and needs of young people. This information allows the alternatives to drug use to be current and relevant to the identified needs and wishes of young people.

In the program’s first 15 years, from 1997 to 2012, the number of children spending time with their parents doubled, as did the number of children and young people doing organised sports. Substance use plummeted. Today, Iceland tops the European table for the cleanest-living teenagers.

Iceland is now exporting its model to around 35 cities. The surveys and programs are tailored to fit local needs and problems. Alcohol and drug use is dropping in participating cities.

Promoting alternative recreational activities, strengthening family ties, improving self-efficacy, building social competence and broadening cultural experiences are the most effective strategies for drug abuse intervention and prevention. This model has demonstrated that young people can turn their lives around when exposed to and engaged in fulfilling alternatives to drugs and crime.

Milkman and his colleagues have endeavoured to encourage implementation in other countries such as the United States and the United Kingdom. There are many barriers to this program being adopted that include tiered governments, a focus on law enforcement, and disagreement between key stakeholders about the answers to drug and alcohol intervention and prevention.

Click here to read the full report.

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In the vault: Tackling Ice Nationally

by PeakCare Qld
on 24th March 2017

“Its use creates a distinct problem for society. Unlike cannabis and heroin, ice is an extremely powerful stimulant. For some people, it can trigger psychological disturbances or violent and aggressive behaviour. Long term use may damage the brain and cause impaired attention, memory and motor skills. The distress ice causes for individuals, families, communities and frontline workers is disproportionate to that caused by other drugs.” Final Report of the National Ice Taskforce, 2015.

Such was the concern over the growing issue of crystal meth (ice) in Australia that a National Ice Taskforce was convened in 2015. This Taskforce consulted extensively with stakeholders around the country and accepted over 1300 written submissions from organisations and members of the public. Further to this they spoke with over 100 experts from the fields of law enforcement, health, the community sector and commonwealth, state and territory government departments. The common overarching statement was: “ice is a drug like no other, and is causing a great deal of harm across our community.”

Proportionally, Australia uses more ice than most other countries with a growing number of users reported. In 2013 a reported 200,000 users had grown from less than 100,000 just 6 years prior.

Per the Taskforce report, there are factors that, in combination, make ice unlike other illicit drugs that have commonly been used in Australia:

Ice is manufactured from chemicals, not produced from plants, and can be mass produced in industrial scale labs offshore for export into Australia, so any seized product can be quickly replaced.

Methamphetamines, including ice, are the only illicit drug that is both imported and locally manufactured in significant quantities, increasing complexity of the required response from law enforcement agencies.

Ice is easily concealed and trafficked. For example, it can be dissolved in oil and reconstituted as crystals Ice is also a dangerous drug for new users, offering the promise of euphoria, confidence and enhanced sexual pleasure at a relatively cheap price. At $50 per dose in some parts of Australia, it can be cheaper than a night out drinking alcohol.

The effects of ice can be achieved through smoking, not just through injecting, making its use appear safer and more socially acceptable.

Ice is more likely to cause dependence than other drugs, and has a very long withdrawal and recovery phase. Prolonged heavy use can impair cognitive functioning for months after giving up the drug. Relapse is understandably common.

Ice’s unique factors have created a perfect opportunity for organised crime —a growing demand for a highly attractive and addictive substance, which can be sold at a high price in Australia.

The Taskforce deemed that: “Australia’s response must be designed to address the uniquely complex characteristics of the problem we face. The demonstrated buoyancy of the ice market suggests this is not a problem that can be solved overnight.”

Named as the first priority for action is the importance of supporting families, workers and communities to better respond to those affected by ice. It was acknowledged that families, frontline workers and communities are struggling to respond to the increasing issues associated with the growing number of ice users in our community. The immediate priority, therefore, is to support Australians most affected by ice use. This support includes ensuring advice for families on how to assist their relatives who are struggling as a consequence of their ice use. Frontline workers need guidance on how to engage with ice users. This includes safe engagement with those in crisis, in particular where aggressive behaviour or violence is present.

The need to enable communities to play their part was also emphasised alongside the assistance communities require to take action. Communities are considered key to sending strong messages against ice use, supporting users who want to cease usage, and working with police and other services to keep local communities safe from ice.

The report also calls for strengthened efforts to reduce the demand for ice including quit assistance and targeted preventative measures. Appropriate treatment and support services that cater to the needs of ice users including detoxification, counselling, rehabilitation, residential and follow up services are also called for.

Further education and information about ice needs to be broadly disseminated, including through schools. Despite the difficulty in quelling the tide of ice in terms of its ready availability, the Taskforce called for ongoing and considerable efforts to disrupt supply. These need to be coordinated by Commonwealth, state and territory law enforcement agencies.

Improved data and more research in the area alongside regular reporting was believed to be another strategy in strengthening Australia’s response and keeping it on track in the face of the unique complexities of the ice problem for Australia and the current gaps in understanding of the market place for the drug. Enhanced up to date data needs to be accessible to all stakeholders. Emerging trends can be identified through this means and allow for more proactive and targeted responses and reporting on progress as opposed to the age-old crisis driven reactions.

Click here to read the full report.

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In the vault II

by PeakCare Qld
on 17th March 2017

As we delve into the varying articles members have shared with us regarding ice, addiction and the multitude of arguments for changing the way we look at addiction and treatment, a few perspectives stand out. This week we focus on a blog post in the Huffington post focused on changing the criminal manner with which we respond to ice users.

Independent Member for Sydney, Alex Greenwich penned Treating Ice Users Like Criminals Won't Fix the Problem through which he argued for a rethinking of the ways in which our institutions react to drug addiction. One of his key concerns was media hype and hysteria, moral stances and stigmas associated with ice usage and the way such reactions impede those struggling with this problem in seeking assistance: “Drug experts tell me that many prevention campaigns and media reports are damaging when they focus on extreme examples, stigmatising people who use ice, thereby discouraging them from seeking help.”

His other concern was the common usage of ice as a recreational drug with research suggesting that 70% of those who use do so less than once a month. This reality alongside governments tackling the issue through law enforcement is a nonsensical reaction rather than a thoughtful response, according to Greenwich.

He notes that: “The drug-detection dog laws introduced in 2001 were supposed to identify drug trafficking and deter use. A 2006 Ombudsman review found they targeted low-level users, with most people searched not found with drugs. The Ombudsman recommended withdrawing the program, but drug dog searches have doubled since 2009 with 16,000 people subject to an intrusive search every year. During this time drug use increased from 12.1 percent to 13.8 percent.”

He calls for harm reduction approaches and a change away from the emphasis on criminal responses as they discourage young people seeking assistance if they become ill and focuses criminal processes on users rather than on traffickers and suppliers.

Greenwich asserts that in addressing ice problems in a manner that is evidence based and consistent with human rights, we must engage with those using ice to work together to find solutions rather than stigmatising this population.

To read the full article click here.

If you have any research, case studies, personal or professional experiences you’d like to contribute to the ice bank, please email Lorraine Dupree.

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In the vault

by PeakCare Qld
on 9th March 2017

The Alcohol and Drug Foundation (ADF) is committed to preventing the harm caused by alcohol and other drugs in Australia with their focus being on primary, secondary and tertiary prevention. ADF is working towards new and effective approaches to drug and alcohol issues in Australia, particularly in light of the research and knowledge that prohibition doesn’t alleviate harm. As such, ADF supports the principle of decriminalisation of the personal use of illicit drugs with a focus on treating the usage as a health issue. Greater access to treatment and harm minimisation measures are also required.

ADF supports primary prevention as the best way to improve rates of harm from alcohol and other drugs. They endorse growing funding for primary prevention, focusing on education for parents in early childhood, with ongoing support for parents, particularly those at risk. ADF is looking to partner with others to improve the protective factors or social determinants that put families at risk generation after generation.

Established in 1959 to support war veterans suffering from alcohol dependence as a release from the trauma of war, ADF acknowledges that trauma continues to be a major factor for individuals and communities who find themselves facing the challenge of alcohol and other drug misuse. To help overcome this, they are increasing their focus on building safe, healthy, and resilient communities.

ADF is evidence-based and independent. Their expert knowledge and research reaches millions of Australians in their communities through sporting clubs and workplaces, by supporting and informing drug and alcohol prevention programs, and through the provision of educational information.

ADF’s information on ice is both comprehensive and succinct. It offers an excellent overview of the key information and highlights issues such as immediate and long term effects, withdrawal, legal aspects and statistics.

To access the webpage click here.

If you have any research, case studies, personal or professional experiences you’d like to contribute to the ice bank, please email Lorraine Dupree.

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