tag:theconversation.com,2011:/us/topics/illicit-drug-use-13467/articlesIllicit drug use – The Conversation2023-03-28T12:15:09Ztag:theconversation.com,2011:article/1994822023-03-28T12:15:09Z2023-03-28T12:15:09ZWhat is xylazine? A medical toxicologist explains how it increases overdose risk, and why Narcan can still save a life<figure><img src="https://images.theconversation.com/files/517430/original/file-20230324-20-vu2ybd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5444%2C3627&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Although xylazine is not an opioid, naloxone can reverse the effects of the fentanyl and heroin it is often mixed with.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/PhotoEssayFentanylsScourge/6b522b7eb85b4bf3aca36ae6cb30ed2a">AP Photo/Jae C. Hong</a></span></figcaption></figure><p>The White House officially designated fentanyl adulterated with xylazine as an <a href="https://www.whitehouse.gov/ondcp/briefing-room/2023/04/12/biden-harris-administration-designates-fentanyl-combined-with-xylazine-as-an-emerging-threat-to-the-united-states/">emerging threat to the U.S.</a> on Apr. 12, 2023. Earlier, the U.S. Drug Enforcement Administration <a href="https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine">issued a warning</a> on Mar. 21, 2023, about an increase in trafficking of fentanyl adulterated with xylazine, which can increase the risk of overdosing on an <a href="https://theconversation.com/what-is-fentanyl-and-why-is-it-behind-the-deadly-surge-in-us-drug-overdoses-a-medical-toxicologist-explains-182629">already deadly drug</a>. Xylazine is <a href="https://doi.org/10.1016/j.drugalcdep.2022.109380">increasingly appearing</a> within the U.S. supply of illicit opioids like fentanyl and heroin. The agency noted that it has seized mixtures of xylazine and fentanyl in 48 of 50 states.</p>
<p>Xylazine, commonly referred to as <a href="https://khn.org/news/article/xylazine-tranq-drugs-dangerous/">tranq</a>, is a <a href="https://www.drugsandalcohol.ie/13119/">drug adulterant</a> – a substance intentionally added to a drug product to <a href="https://theconversation.com/rat-poison-is-just-one-of-the-potentially-dangerous-substances-likely-to-be-mixed-into-illicit-drugs-163568">enhance its effects</a>. Illicit drugmakers may include xylazine to <a href="https://doi.org/10.1016/j.drugalcdep.2022.109380">prolong opioid highs</a> or prevent withdrawal symptoms. </p>
<p>As a <a href="https://scholar.google.com/citations?user=X55PT8EAAAAJ&hl=en">physician who cares for people who use fentanyl</a>, I worry about the ways xylazine increases their risk for overdose. I worry even more that misunderstandings about xylazine can make bystanders less likely to <a href="https://umasstox.com/narcan/">administer the lifesaving drug naloxone (Narcan)</a> during an overdose. If you suspect an overdose, calling emergency medical services and administering naloxone are still the critical first steps to saving a life.</p>
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<figcaption><span class="caption">Learning what to do when someone overdoses can help save a life.</span></figcaption>
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<h2>Tranq overdoses and fentanyl</h2>
<p>Xylazine was originally developed as a veterinary anesthesia. It was first identified as an adulterant in heroin supplies <a href="https://doi.org/10.1186/1747-597X-6-7">in the early 2000s</a>. Although xylazine is not an opioid, it induces opioidlike effects, including sedation, slowed heart rate and small pupils, similar to the effects produced in people by its pharmaceutical cousin clonidine. Xylazine use is also associated with <a href="https://doi.org/10.1007%2Fs11524-011-9662-6">serious skin and soft tissue ulcers and infections</a>.</p>
<p>The use of opioids with sedating medications like xylazine increases the risk of fatal overdose. Historically, people who use drugs <a href="https://doi.org/10.1007%2Fs11524-011-9662-6">have been unaware</a> that xylazine is in the drug supply and are <a href="https://theconversation.com/rat-poison-is-just-one-of-the-potentially-dangerous-substances-likely-to-be-mixed-into-illicit-drugs-163568">unable to tell</a> whether they have been exposed to it. Routine hospital drug testing does not detect xylazine, further complicating surveillance.</p>
<p>Xylazine overdoses rarely occur in isolation. Xylazine detection in heroin- and fentanyl-associated deaths in Philadelphia has grown from less than 2% before 2015 to <a href="http://dx.doi.org/10.1136/injuryprev-2020-043968">more than 31% in 2019</a>. Similarly, one study of 210 xylazine-associated deaths in Chicago from 2017 to 2021 found that fentanyl or a chemically similar substance was detected in <a href="http://dx.doi.org/10.15585/mmwr.mm7113a3">99.1% of overdoses</a>. This data underscores the key role that fentanyl plays in causing fatal overdoses in cases where xylazine is found, and anecdotal evidence suggests the problem is only increasing.</p>
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<a href="https://images.theconversation.com/files/517435/original/file-20230324-1164-oqro8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of hands holding pieces of fentanyl" src="https://images.theconversation.com/files/517435/original/file-20230324-1164-oqro8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517435/original/file-20230324-1164-oqro8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517435/original/file-20230324-1164-oqro8m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517435/original/file-20230324-1164-oqro8m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517435/original/file-20230324-1164-oqro8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517435/original/file-20230324-1164-oqro8m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517435/original/file-20230324-1164-oqro8m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Xylazine overdoses often occur in the presence of fentanyl or heroin.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/PhotoEssayFentanylsScourge/4e185189ef7e4b35b1c5fad7d66c75d9">AP Photo/Jae C. Hong</a></span>
</figcaption>
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<h2>Naloxone and xylazine</h2>
<p>Unfortunately, increasing awareness of xylazine has contributed to the myth of <a href="https://www.changingthenarrative.news/naloxone-resistant-fentanyl">“naloxone-resistant” overdoses</a>. Unlike overdoses with opioids only, patients experiencing xylazine-associated overdoses may not immediately wake up after naloxone administration. While naloxone may not reverse the effects of xylazine, it is still able to reverse the effects of the fentanyl it is often mixed with and should be used in all suspected opioid overdoses. </p>
<p>The critical goal of administering naloxone is to prevent patients from dying of dangerously low breathing rates. Bystanders who suspect an overdose <a href="https://www.youtube.com/watch?v=HzAvzNoUERE">should always call 911</a> to bring in experts in case treatment is required.</p>
<p><em>Article updated to include a White House announcement on Apr. 12, 2023</em></p><img src="https://counter.theconversation.com/content/199482/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kavita Babu receives funding from the National Institute on Drug Abuse, the MA Department of Public Health/ Bureau of Substance Addiction Services, the Centers for Disease Control and Prevention, and the National Highway Traffic Safety Administration. All opinions here are hers and do not represent the position of these organizations. </span></em></p>Xylazine, or tranq, is increasingly being mixed with drugs like fentanyl or heroin and can be difficult to detect. Most people who use drugs are unable to tell if they have been exposed to it.Kavita Babu, Professor of Emergency Medicine, UMass Chan Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1826292022-05-10T12:06:06Z2022-05-10T12:06:06ZWhat is fentanyl and why is it behind the deadly surge in US drug overdoses? A medical toxicologist explains<figure><img src="https://images.theconversation.com/files/462077/original/file-20220509-18-ruua59.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Only a small amount of fentanyl is enough to be lethal.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/OverdosesLosAngeles/9b9e2555c6654b1094d2be9f3ef43226">AP Photo/Jacquelyn Martin</a></span></figcaption></figure><p>Buying drugs on the street is a game of Russian roulette. From Xanax to cocaine, drugs or counterfeit pills purchased in nonmedical settings may contain life-threatening amounts of fentanyl.</p>
<p>Physicians like me have seen a rise in unintentional fentanyl use from people buying prescription opioids and other drugs <a href="https://doi.org/10.1016/j.drugalcdep.2022.109398">laced, or adulterated, with fentanyl</a>. Heroin users in my community in Massachusetts came to realize that fentanyl had entered the drug supply when <a href="https://www.bostonindicators.org/reports/report-website-pages/opioids-2018">overdose numbers exploded</a>. In 2016, my colleagues and I found that patients who came to the emergency department reporting a heroin overdose often <a href="https://doi.org/10.1080/15563650.2017.1339889">only had fentanyl present in their drug test results</a>.</p>
<p>As the Chief of Medical Toxicology at UMass Chan Medical School, I have <a href="https://scholar.google.com/citations?user=X55PT8EAAAAJ&hl=en">studied fentanyl and its analogs</a> for years. As fentanyl has become ubiquitous across the U.S., it has transformed the illicit drug market and raised the risk of overdose.</p>
<h2>Fentanyl and its analogs</h2>
<p><a href="https://doi.org/10.1016/j.jpain.2014.08.010">Fentanyl</a> is a synthetic opioid that was originally developed as an analgesic – or painkiller – for surgery. It has a specific chemical structure with multiple areas that can be modified, often illicitly, to form related compounds with marked differences in potency.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram depicting various functional groups that can be substituted in fentanyl." src="https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=435&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=435&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=435&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=546&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=546&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462058/original/file-20220509-19-b5q65.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=546&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Fentanyl’s chemical backbone (the structure in the center) has multiple areas (the colored circles) that can be substituted with different functional groups (the colored boxes around the edges) to change its potency.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1002/cpt.1418">Christopher Ellis et al.</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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<p>For example, <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Carfentanil">carfentanil</a>, a fentanyl analog formed by substituting one chemical group for another, is 100 times more potent than its parent structure. Another analog, <a href="https://doi.org/10.1097/ADM.0000000000000324">acetylfentanyl</a>, is approximately three times less potent than fentanyl, but has still led to <a href="https://dx.doi.org/10.15585%2Fmmwr.mm6643e1">clusters of overdoses in several states</a>. </p>
<p>Despite the number and diversity of its analogs, fentanyl itself continues to <a href="http://dx.doi.org/10.15585/mmwr.mm6910a4">dominate the illicit opioid supply</a>. Milligram per milligram, fentanyl is roughly <a href="https://www.cdc.gov/stopoverdose/fentanyl/index.html">50 times more potent than heroin and 100 times more potent than morphine</a>.</p>
<h2>Lacing or replacing drugs with fentanyl</h2>
<p>Drug dealers have used fentanyl analogs as an adulterant in illicit drug supplies <a href="https://doi.org/10.1021/ac00235a790">since 1979</a>, with fentanyl-related overdoses clustered in <a href="https://doi.org/10.1111/j.1556-4029.2008.00669.x">individual cities</a>. </p>
<p>The modern epidemic of fentanyl adulteration is far broader in its geographic distribution, production and number of deaths. Overdose deaths <a href="https://dx.doi.org/10.15585%2Fmmwr.mm6634a2">roughly quadrupled</a>, going from 8,050 in 1999 to 33,091 in 2015. From May 2020 to April 2021, <a href="http://dx.doi.org/10.15585/mmwr.mm7050e3">more than 100,000 Americans</a> died from a drug overdose, with over 64% of these deaths due to synthetic opioids like fentanyl and its analogs.</p>
<p>Illicitly manufactured fentanyl is <a href="https://www.dea.gov/documents/2020/2020-03/2020-03-06/fentanyl-flow-united-states">internationally synthesized</a> in China, Mexico and India, then exported to the United States as powder or pressed pills. China also exports many of the precursor chemicals needed to synthesize fentanyl.</p>
<p>Additionally, the emergence of the <a href="https://doi.org/10.2196/24486">dark web</a>, an encrypted and anonymous corner of the internet that’s a haven for criminal activity, has facilitated the sale of fentanyl and other opioids shipped through <a href="https://www.npr.org/2018/05/24/613762721/deadly-delivery-opioids-by-mail">traditional delivery services</a>, including the U.S. Postal Service.</p>
<p>During the 2023 Asia-Pacific Economic Cooperation summit, U.S. President Joe Biden and Chinese President Xi Jinping reached an agreement to <a href="https://apnews.com/article/biden-xi-apec-san-francisco-58d11e7e3902955302182c2bc41430e0">combat fentanyl trafficking</a>.</p>
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<figcaption><span class="caption">Fentanyl is driving an increasing number of opioid overdose deaths.</span></figcaption>
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<p>Fentanyl is both sold alone and often <a href="https://theconversation.com/rat-poison-is-just-one-of-the-potentially-dangerous-substances-likely-to-be-mixed-into-illicit-drugs-163568">used as an adulterant</a> because its high potency allows dealers to traffic smaller quantities but maintain the drug effects buyers expect. Manufacturers may also add bulking agents, like flour or baking soda, to fentanyl to increase supply without adding costs. As a result, it is much more profitable to cut a kilogram of fentanyl compared to a kilogram of heroin. </p>
<p>Unfortunately, fentanyl’s high potency also means that even just a small amount can prove deadly. If the end user isn’t aware that the drug they bought has been adulterated, this could easily lead to an overdose.</p>
<h2>Preventing fentanyl deaths</h2>
<p>As an emergency physician, I give fentanyl as an analgesic, or painkiller, to <a href="https://www.mayoclinic.org/drugs-supplements/fentanyl-injection-route/description/drg-20075614">relieve severe pain</a> in an acute care setting. My colleagues and I choose fentanyl when patients need immediate pain relief or sedation, such as anesthesia for surgery. </p>
<p>But even in the controlled conditions of a hospital, there is still a risk that using fentanyl can <a href="https://doi.org/10.1073/pnas.2022134118">reduce breathing rates</a> to dangerously low levels, the main cause of opioid overdose deaths. For those taking fentanyl in nonmedical settings, there is no medical team available to monitor someone’s breathing rate in real time to ensure their safety. </p>
<p>One measure to prevent fentanyl overdose is <a href="https://www.cdc.gov/stopoverdose/naloxone/index.html">distributing naloxone to bystanders</a>. Naloxone can reverse an overdose as it occurs by blocking the effects of opioids.</p>
<p>Another measure is increasing the availability of <a href="https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work">opioid agonists</a> like methadone and buprenorphine that reduce opioid withdrawal symptoms and cravings, helping people stay in treatment and decrease illicit drug use. Despite the lifesaving track records of these medications, their availability is limited by <a href="https://www.statnews.com/2021/12/22/inflexible-methadone-regulations-impede-efforts-reduce-overdose-deaths/">restrictions on where and how they can be used</a> and <a href="https://www.npr.org/sections/health-shots/2021/11/08/1053579556/dea-suboxone-subutex-pharmacies-addiction">inadequate numbers of prescribers</a>.</p>
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<figcaption><span class="caption">Naloxone can rapidly reverse an opioid overdose.</span></figcaption>
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<p>Other strategies to prevent overdose deaths include <a href="https://doi.org/10.1097/adm.0000000000000555">lowering the entry barrier</a> to addiction treatment, <a href="https://www.cnn.com/2021/12/01/health/fentanyl-test-strip/index.html">fentanyl test strips</a>, <a href="https://doi.org/10.1007/s11904-017-0363-y">supervised consumption sites</a> and even <a href="https://doi.org/10.1192/bjp.bp.114.149195">prescription diamorphine (heroin)</a>. </p>
<p>Despite the evidence supporting these measures, however, <a href="https://www.ncbi.nlm.nih.gov/books/NBK541389/">local politics and funding priorities</a> often limit whether communities are able to give them a try. Bold strategies are needed to interrupt the ever-increasing number of fentanyl-related deaths.</p>
<p><em>This article was updated on Nov. 16, 2023 to note developments regarding fentanyl at the Asia-Pacific Economic Cooperation summit.</em></p><img src="https://counter.theconversation.com/content/182629/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kavita Babu receives research support from the National Institutes of Health, Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Massachusetts Department of Health Bureau of Substance Abuse Services and royalties from UptoDate.</span></em></p>Fentanyl’s wide availability in the drug supply has led to an increase in unintentional overdoses. While prevention strategies are available, limited availability stymies their use.Kavita Babu, Professor of Emergency Medicine, UMass Chan Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1438742020-08-10T12:23:50Z2020-08-10T12:23:50ZRise in fake benzodiazepines in the UK may put people at risk of serious harm<figure><img src="https://images.theconversation.com/files/351977/original/file-20200810-24-1hdnlq9.jpg?ixlib=rb-1.1.0&rect=18%2C0%2C4007%2C3024&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fake benzodiazepines (including diazepam and alprazolam – better known as Xanax) could cause serious harm.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/january-26-2020ogden-utah-usa-alprazolam-1650256819">PureRadiancePhoto/ Shutterstock</a></span></figcaption></figure><p>Counterfeit, or “fake”, <a href="https://www.statnews.com/2019/05/07/stopping-murder-counterfeit-medicine/">medicines</a> are a <a href="https://www.theguardian.com/science/2019/mar/11/fake-drugs-kill-more-than-250000-children-a-year-doctors-warn">growing problem</a> worldwide, from antimicrobials to cancer treatments. <a href="https://www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products">They are</a> are designed to look exactly like the real thing, but typically contain the wrong type or amount of active ingredient, which may cause serious harm, illness or premature death.</p>
<p>In the UK, there’s been a <a href="https://publichealthmatters.blog.gov.uk/2018/07/30/alprazolam-xanax-what-are-the-facts/">concerning rise</a> in the use of counterfeit benzodiazepines, among young people and those are already dependent on drugs. Public Health England has even issued a <a href="https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103075">rare warning</a> about drugs sold as <a href="https://www.drugwise.org.uk/benzodiazepines/">benzodiazepines</a>, including diazepam, temazepam, and alprazolam (better known as <a href="https://theconversation.com/xanax-how-does-it-work-and-what-are-the-side-effects-94594">Xanax</a>).</p>
<p>Benzodiazapines are prescribed around the world for anxiety, depression and even epilepsy. However, Xanax can only be obtained illicitly in the UK as doctors are unable to prescribe it. Drugs like these are also used by young people <a href="https://www.vice.com/en_uk/article/ne4mvb/how-british-teens-got-hooked-on-xanax">recreationally</a>.</p>
<p>Fake benzodiazapines can produce a similar effect to the real thing. However, incorrect dosages may cause drowsiness, which could potentially lead to unconsciousness. Many people may also see these drugs as being low risk, or may rely on their friends – rather than medical opinion – on how many pills they should take. Unfortunately many fake benzodiazepines aren’t safe – and the strength of the dosage often isn’t known until it’s too late.</p>
<p>Toxicological and chemical analysis has shown that some of these counterfeit medicines <a href="https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103075">contain dangerously high</a> doses of benzodiazapines, or even novel substances such as flubromazolam, flualprazolam and etizolam. These chemicals are related to benzodiazapines in that they cause a similar effect but can present a greater risk of toxicity due to their side-effect profile. </p>
<p>The main risks from taking these drugs is overdose, either because the user doesn’t realise how strong they are or they combine them with alcohol. Like benzodiazapines, alcohol is a <a href="https://www.tandfonline.com/doi/abs/10.1081/CLT-120002887">respiratory depressant</a>. Using them together increases the chances of breathing difficulties or even death.</p>
<p>Deaths following exposure to these drugs have been rising in recent years among all age groups. In <a href="https://www.gov.uk/government/publications/novel-benzodiazepines-prevalence-and-harms-in-the-uk">Scotland</a>, novel substances were responsible for 85% of the 792 deaths from benzodiazepines in 2018. Analysis has also shown that drugs bought as <a href="https://bnf.nice.org.uk/drug/diazepam.html">diazepam</a>, and packaged to look like legitimate medicines, contained completely unrelated substances. One sample even contained the anaesthetic drug <a href="https://theconversation.com/ketamine-the-illicit-party-psychedelic-that-promises-to-heal-depression-115697">ketamine</a>. </p>
<figure class="align-center ">
<img alt="A Xanax box and tablets." src="https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351978/original/file-20200810-22-1tbm1hi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fake versions are packaged and sold as the real thing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/genevaswitzerland-0303-xanax-pills-anxiolytic-antidepressant-1415011127">LMWH/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Benzodiazapines used to simply be stolen from pharmacies and <a href="https://www.bbc.co.uk/news/uk-northern-ireland-40658649">pharmaceutical manufacturers</a> and sold on the streets or purchased from bogus online pharmacies. But there’s now a <a href="https://www.emcdda.europa.eu/publications/joint-publications/eu-drug-markets-report-2019_en">sophisticated international market</a> in these illicitly synthesised alternatives, many of which can easily be <a href="https://www.bbc.co.uk/news/resources/idt-sh/fake_xanax_the_uks_largest_ever_dark_net_drugs_bust">purchased in bulk</a> from the internet, and distributed via local drug markets. </p>
<p>People also obtain these types of drugs from <a href="https://theconversation.com/instadrugs-new-research-reveals-hidden-dangers-when-young-people-use-apps-to-buy-illicit-substances-110319">social media apps</a> or the dark web. People may believe they’re buying a licensed medicine online, while unwittingly consuming a significantly higher dose or a harmful substitute. There’s no quality control in illicit drug manufacturing. </p>
<p>It’s currently unknown how many people have required hospitalisation or died as a result of these fake medicines. However Public Health England doesn’t typically issue <a href="https://www.gov.uk/government/publications/issuing-public-health-alerts-about-drugs">drug alerts</a> unless cases have been rising, or particularly harmful substances have been detected. </p>
<h2>Illicit use</h2>
<p>Many people may find these drugs appealing as they’re easy to access and cheap. Typically, tablets <a href="https://www.bbc.co.uk/news/resources/idt-sh/fake_xanax_the_uks_largest_ever_dark_net_drugs_bust">won’t cost</a> more than a couple of pounds and are easy to access online. People may also believe these fake medicines are safer than other types of illicit drugs, as they may think they’ve been through quality control. And given that taking medicine <a href="https://www.sciencedirect.com/science/article/pii/S0277953616303938?casa_token=-9FLpiawTj4AAAAA:3tYJIMoVjRIs70eqmib61RHpsK4jTPEK1HjlAw1cxR3OJfCZQrKZ7dOQmbS2bRguMQ5imhd2PYYj">is so normalised</a> in our society, this can create a perception of low risk and even benefit. </p>
<p>Perhaps of more concern is that these <a href="https://www.vice.com/en_uk/article/ne4mvb/how-british-teens-got-hooked-on-xanax">fake medicines appeal</a> to those who experience mental health problems <a href="https://journals.lww.com/co-psychiatry/fulltext/2009/01000/Current_use_of_benzodiazepines_in_anxiety.16.aspx?casa_token=qgaXylV0utMAAAAA:xSTnvszeVY8Elu7EUBqqkoRA1I6levJ6l2aN_URLsQ7FA2BMxWGJEXBqnqQ0suNBcy8tYLFUXMczzWnEPApY83ppcsmS1yo">like anxiety</a>. Despite efforts to <a href="https://www.time-to-change.org.uk/category/blog/talking-about-mental-health">reduce the stigma</a> of mental illness, some people will be too ashamed or anxious to seek help, and may self-medicate using these illicit medicines.</p>
<p>These drugs are also more readily accessible than the professional support that these people need. There are no long <a href="https://epi.org.uk/publications-and-research/access-to-child-and-adolescent-mental-health-services-in-2019/">waiting times</a> or invasive assessments with professionals that need to be navigated before treatment is even offered. Users know they can source a temporary quick-fix solution to the way they feel in a matter of hours – while they may wait eight weeks on average for a specialist appointment in the UK, if <a href="https://epi.org.uk/wp-content/uploads/2020/01/Access-to-CAMHS-in-2019_EPI.pdf">they’re referred</a> at all.</p>
<p>Despite promises by the NHS <a href="https://www.kingsfund.org.uk/blog/2019/10/mental-health-staff-shortage">to prioritise</a> mental health treatment and reduce waiting times, access to these services is still challenging. Rates of mental illness have been <a href="https://theconversation.com/the-uk-doesnt-spend-enough-on-the-mental-health-of-young-people-we-found-out-why-124315">rising</a>, but it’s still no easier to get treatment. It’s unsurprising that some young people are trying to find their own solutions.</p>
<p>The rise of illicit or fake benzodiazepines shows this is a growing problem in the UK. Without important changes to the UK’s mental health services, many people could continue to be harmed by fake medicines.</p>
<p><em>If you need someone to talk to or need specialist support for substance use, please visit <a href="https://youngminds.org.uk/">Young Minds</a>, <a href="https://www.talktofrank.com/get-help/find-support-near-you">Talk to Frank</a>, or <a href="https://www.crew.scot/drug/xanax-alprazolam/">Crew 2000</a>.</em></p><img src="https://counter.theconversation.com/content/143874/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harry Sumnall receives and has received funding from public grant awarding bodies for alcohol and other drugs research.</span></em></p><p class="fine-print"><em><span>Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Young people may be at particular risk.Ian Hamilton, Associate Professor, Addiction and Mental Health, University of YorkHarry Sumnall, Professor in Substance Use, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1279192019-11-29T03:55:15Z2019-11-29T03:55:15ZParents of teens, here’s what you really need to know about MDMA<figure><img src="https://images.theconversation.com/files/304200/original/file-20191128-176629-1msht1l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Just around 3% of teens have used MDMA (ecstasy) in the past year.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-cheering-crowd-sitting-upon-shoulders-63911971?src=ed7875ef-bfd7-4bb9-9c82-906ad7006c79-1-31">Franz Pfluegl/Shutterstock</a></span></figcaption></figure><p>We all want to reduce drug-related harm and ensure young people don’t take unnecessary risks. But <a href="http://www.emcdda.europa.eu/attachements.cfm/att_93977_EN_Health%20Development%20Agency%20Review%20of%20Reviews.pdf">decades of research</a> shows fear isn’t an effective way to do this. </p>
<p>This week, Newscorp Australia released <a href="https://www.dailytelegraph.com.au/search-results?q=ripple+effect">The Ripple Effect</a>, a series of articles and <a href="https://www.dailytelegraph.com.au/news/rippleeffect/drugs/the-ripple-effect-education-video-part-one-molly-and-the-toxic-relationship-that-can-turn-deadly/news-story/ead6e1f87dc712deea960f841529a653">accompanying videos</a> about party drugs, aimed at parents of young people.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-your-teen-off-to-schoolies-heres-what-to-say-instead-of-freaking-out-126203">Is your teen off to schoolies? Here's what to say instead of freaking out</a>
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<p>Rather than drawing on the science about reducing harm, the series overstates the nation’s drug problem and the likelihood of problems from taking MDMA (ecstasy). And it’s likely to scare the wits out of parents of teens.</p>
<p>So, what do parents really need to know about party drugs?</p>
<h2>Most young people don’t use drugs</h2>
<p>Illicit drug use among teens is low and has <a href="https://www.aihw.gov.au/getmedia/15db8c15-7062-4cde-bfa4-3c2079f30af3/21028a.pdf.aspx?inline=true">been in decline</a> for nearly a decade.</p>
<p>Although Australians overall have a relatively high rate of MDMA use compared to similar countries, only a small proportion of teenagers (around 3%) and young adults (7%) have <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents">used MDMA</a> in the last year. Among high school students, the overwhelming majority (94%) have <a href="https://www.health.gov.au/resources/collections/australian-secondary-school-students-alcohol-and-drug-assad-survey-2017">never tried</a> MDMA.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-charts-on-who-uses-illicit-drugs-in-australia-110169">Three Charts on who uses illicit drugs in Australia</a>
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</em>
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<p>Normalising the idea that drug use isn’t that common is a key <a href="https://www.unodc.org/documents/prevention/UNODC_2013_2015_international_standards_on_drug_use_prevention_E.pdf">prevention strategy</a> in drug education. If young people think “everyone” is using drugs, they are more likely to want to do it too.</p>
<h2>Scare tactics don’t work</h2>
<p>As the <a href="https://www.dailytelegraph.com.au/news/rippleeffect/drugs/nsw-health-ditches-mdma-fear-campaign-in-favour-of-stayok/news-story/fbfa1cfe6b42e33776e9fc5ef2cd2bd9">Ripple Effect</a> notes, NSW Health decided to drop a “shock campaign” on MDMA. The <a href="https://bmjopen.bmj.com/content/5/9/e007449">evidence</a> shows scare tactics don’t help reduce young people’s drug use.</p>
<p>Fatal overdoses are relatively rare. Most people who use party drugs have no adverse consequences. So when young people see messages suggesting all drug use is dangerous, they know it’s not true and may switch off, ignoring effective harm reduction messages. </p>
<p>Describing drugs as “deadly” or “dangerous” can actually make them more <a href="https://www.tandfonline.com/doi/abs/10.1080/09581590601045220">appealing</a>, encouraging some people to seek out more of the potent product.</p>
<p>A far more effective approach is to <a href="https://www.unodc.org/documents/prevention/UNODC_2013_2015_international_standards_on_drug_use_prevention_E.pdf">normalise not using alcohol or other drugs</a>.</p>
<p>Two examples of <a href="https://www.ncbi.nlm.nih.gov/pubmed/22455104">effective</a> approaches were the <a href="https://abovetheinfluence.com">Above The Influence</a> and <a href="http://myowninfluence.org">Be Under Your Own Influence</a> media campaigns by the US <a href="https://www.whitehouse.gov/ondcp/">Office of National Drug Control Policy</a>. These campaigns promoted not using drugs as a way to support the goals of autonomy and achievement.</p>
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<h2>Prohibition doesn’t work either</h2>
<p>The idea we can eliminate drugs from society by telling young people to “<a href="https://en.wikipedia.org/wiki/Just_Say_No">just say no</a>” is, at best, misguided. Campaigns with a prohibition approach are <a href="https://www.scientificamerican.com/article/why-just-say-no-doesnt-work/">not effective</a>.</p>
<p>These interventions fail for <a href="https://www.indiana.edu/%7Eengs/articles/drughysteria.html">many reasons</a>. They don’t teach teens the interpersonal skills needed to refuse drugs; they don’t address internal motivation to experiment or take risks; and they don’t take into account the “forbidden fruit” effect in which restricted or banned activities become more desirable. </p>
<p>Young people who use drugs say the threat of police and drug dogs <a href="https://www.ncbi.nlm.nih.gov/pubmed/30176423">does not deter</a> them from taking drugs. The NSW Coroner recently noted that some police practices at festivals, such as strip searches and sniffer dogs, can result in young people making more <a href="https://theconversation.com/when-the-coroner-looked-at-how-to-cut-drug-deaths-at-music-festivals-the-evidence-won-but-what-happens-next-126669">dangerous decisions</a> about drug use, such as taking multiple doses at once. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-the-coroner-looked-at-how-to-cut-drug-deaths-at-music-festivals-the-evidence-won-but-what-happens-next-126669">When the coroner looked at how to cut drug deaths at music festivals, the evidence won. But what happens next?</a>
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<h2>Harm reduction is effective</h2>
<p>The reality is that a small percentage of people will experiment with drugs and some will continue to use them. Harm reduction accepts that reality and seeks to keep those who choose to use drugs as safe as possible. Most people who <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents">use drugs</a> do so only occasionally and for a short time in their lives.</p>
<p>While all drug use <a href="https://theconversation.com/how-does-mdma-kill-109506">carries risks</a>, most drug-related problems, including fatal overdoses, are preventable. This is because drug-related harms are heavily dependent on a range of factors such as temperature, knowledge of what you are taking, and how you take a drug.</p>
<p>How events such as music festivals are <a href="http://theconversation.com/testing-festival-goers-pills-isnt-the-only-way-to-reduce-overdoses-heres-what-else-works-118827">regulated</a> impacts the kinds of harms that arise. Freely available water, medical staff who understand drug use, peer support and education can greatly reduce risks.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/testing-festival-goers-pills-isnt-the-only-way-to-reduce-overdoses-heres-what-else-works-118827">Testing festival goers' pills isn't the only way to reduce overdoses. Here's what else works</a>
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<p>We recently conducted a review of drug-checking facilities internationally and found compelling evidence these services can <a href="https://www.360edge.com.au/assets/uploads/2019/11/360Edge-What-works-Testing-drugs-for-harm-reduction-November-2019.pdf">reduce risky behaviour and reduce the chance of finding adulterants in illicit drugs</a>. Many MDMA related deaths can be traced to people not knowing the contents or dosage of the pill they have taken.</p>
<p>Data from a dance festival pill testing initiative in Portugal found <a href="https://www.ncbi.nlm.nih.gov/pubmed/28635119">74% of participants</a> would not use the tested drug after receiving unanticipated results; they said they were concerned about the “unknown” nature of the adulterants or potential harms of known adulterants.</p>
<p>In countries where pill testing is well-established, tested samples <a href="https://www.ncbi.nlm.nih.gov/pubmed/28582668">more closely match what people think they are buying</a>, compared to countries not using these services.</p>
<h2>Talk early, openly and often to young people about drugs</h2>
<p>Remember, few young people use recreational drugs. And if they do, their drug use is most likely to be occasional. More than half the people who use MDMA use only <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents">once or twice a year</a>.</p>
<p>Preventing drug use and reducing harms can start at an early age, even before school. Early and age-appropriate education about medicines, tobacco, alcohol and illicit drugs means a young person already has well-formed attitudes before the influence of their peers kicks in.</p>
<p>Children are strongly influenced by their <a href="https://theconversation.com/how-does-ice-use-affect-families-and-what-can-they-do-41186">parents’ attitudes</a> when it comes to alcohol and other drug use. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393944/">For example</a>, exposure to parents’ drinking or drug use can increase risk of teens drinking and using drugs; an inattentive approach to monitoring children’s activities is associated with teen alcohol and other drug use; and openness to discussing drugs is associated with lower rates of substance use. </p>
<p>Young people with parents who keep an open and honest dialogue about drugs are more likely to discuss difficult issues with them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
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<img src="https://counter.theconversation.com/content/127919/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jarryd Bartle works as a paid consultant in the alcohol and other drug sector. </span></em></p><p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector, including education and training for parents on drugs. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Paula Ross works as a paid consultant in the alcohol and other drug sector and has a private practice.</span></em></p>Few teens use MDMA and scare tactics, like those we’ve seen recently, are unlikely to reduce existing drug use further.Jarryd Bartle, Sessional Lecturer, RMIT UniversityNicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityPaula Ross, Sessional psychology lecturer, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1221282019-10-23T04:59:37Z2019-10-23T04:59:37Z‘My friends are taking MDMA at raves and music festivals. Is it safe?’<figure><img src="https://images.theconversation.com/files/288664/original/file-20190820-123736-amjiz1.png?ixlib=rb-1.1.0&rect=77%2C59%2C3892%2C1916&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No drug is 100% safe. </span> <span class="attribution"><span class="source">Wes Mountain</span></span></figcaption></figure><blockquote>
<p>My friends are taking ecstasy at raves and music festivals. Is it safe? — Anonymous</p>
</blockquote>
<h2>Key points</h2>
<ul>
<li>no drug use, including ecstasy, is 100% safe</li>
<li>festivals can present unique risks </li>
<li>look out for friends, know the risks and where to get help.</li>
</ul>
<p><a href="https://theconversation.com/au/topics/i-need-to-know-66587"><img src="https://images.theconversation.com/files/290837/original/file-20190904-175686-polw3q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" width="100%"></a></p>
<h2>What is ecstasy or MDMA?</h2>
<p>Ecstasy is a slang term for drugs <em>meant</em> to contain 3,4- methylenedioxymethamphetamine (MDMA), a stimulant that can also cause mild hallucinations at high doses. While ecstasy was traditionally sold as tablets, it’s <a href="https://ndarc.med.unsw.edu.au/sites/default/files/National%20EDRS%20Interview%20Report%202018_1.pdf">increasingly sold in crystal, capsule and powder forms</a>. </p>
<p>According to the <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/data">most recent data</a>, only 1% of Australians aged 12-17 said they had tried ecstasy. However, studies suggest young Australians who attend music festivals are <a href="https://www.ncbi.nlm.nih.gov/pubmed/29304871">much more likely</a> to have tried it.</p>
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<h2>So, is it ‘safe’?</h2>
<p>There seems to be a common perception ecstasy is “safe”. But no drug use — legal or illegal — is completely safe. While drug experts <a href="https://www.ncbi.nlm.nih.gov/pubmed/31081439">rank</a> ecstasy as less harmful than other drugs, such as “ice” and alcohol, there are still significant risks involved:</p>
<ol>
<li><p>given ecstasy is illegal, the market is unregulated. As a result, drugs sold as “ecstasy” <a href="https://www.harmreductionaustralia.org.au/wp-content/uploads/2018/06/Pill-Testing-Pilot-ACT-June-2018-Final-Report.pdf">commonly do not contain MDMA</a> and may contain something far more dangerous. This means the effects can be unpredictable</p></li>
<li><p>even if your drugs contain MDMA, the dose or potency can <a href="https://www.acic.gov.au/sites/default/files/illicit_drug_data_report_2017-18.pdf?v=1564727746">vary hugely</a>. Recently, <a href="https://www.smh.com.au/national/nsw/tragic-reveller-told-friend-he-would-push-through-inquest-hears-20190716-p527lm.html">very high purity ecstasy</a> has been detected in Australia. This can significantly increase the risk of overdosing or having serious side-effects </p></li>
<li><p>even pure MDMA at normal recreational doses can be risky in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24899699">wrong conditions</a> (for instance, when it’s very warm)</p></li>
<li><p>common short-term effects also include <a href="https://www.ncbi.nlm.nih.gov/pubmed/16771886">increased heart rate and body temperature, teeth grinding and anxiety</a>. While evidence on the long-term effects of taking MDMA is still emerging, there may be lasting impacts on <a href="https://www.ncbi.nlm.nih.gov/pubmed/23881877">memory, mood, cognition and sleep</a>.</p></li>
</ol>
<h2>What are the risks when taking it at festivals?</h2>
<p>In recent years, there have been more reports of <a href="https://www.smh.com.au/national/nsw/music-festival-deaths-inquest-set-down-for-july-20190228-p510sz.html">drug-related deaths at festivals</a>. While the media typically describes deaths involving ecstasy as “overdoses”, most ecstasy-related deaths are <a href="https://www.tandfonline.com/doi/abs/10.1080/14659891.2018.1436607?journalCode=ijsu20">not</a> the result of simply taking too much. </p>
<p>Drug experiences can be influenced by <a href="https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front12-fa-toc%7Edrugtreat-pubs-front12-fa-secb%7Edrugtreat-pubs-front12-fa-secb-2%7Edrugtreat-pubs-front12-fa-secb-2-5">lots of different things</a> and music festivals can sometimes result in a “perfect storm” of risk factors. For example, an experienced male taking an ecstasy pill at a quiet gathering at home is likely to have a very different experience to an inexperienced female taking her ecstasy pills at a crowded festival on a 35°C day. </p>
<p>Females, those with lower body weight, and/or those who haven’t used ecstasy before, and therefore haven’t built up any physical tolerance, should use a smaller dose.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=559&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=559&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=559&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=702&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=702&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292154/original/file-20190912-190044-elzxfw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=702&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drug experiences can be affected by lots of different things.</span>
</figcaption>
</figure>
<p>Some key risks at music festivals include:</p>
<ul>
<li><p><strong>hyperthermia aka heatstroke:</strong> MDMA <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/">affects the body’s ability to regulate temperature</a> (it can increase body temperature and also make it harder to cool down). Environmental factors at festivals such as warm weather, crowds and dancing can significantly increase the risk of overheating (see <a href="https://dancesafe.org/heatstroke/">tips</a> for staying cool)</p></li>
<li><p><strong>hyponatremia aka water intoxication:</strong> MDMA can <a href="https://www.ncbi.nlm.nih.gov/pubmed/23476039">disrupt the body’s water/electrolyte balance</a> (can make your body <a href="https://cjasn.asnjournals.org/content/3/6/1852">retain water</a>). While you need water to avoid dehydrating, drinking too much can also be dangerous. Read up on these <a href="https://drugaware.com.au/getting-the-facts/staying-safe/#Dehydration-and-overhydration">guidelines</a> on dehydration and overhydration for more information</p></li>
<li><p><strong>dodgy on-site sellers:</strong> <a href="https://www.ncbi.nlm.nih.gov/pubmed/30541674">UK research</a> found people buying drugs on-site (inside the festival grounds) were more than twice as likely to buy drugs that did not contain what they thought. There have been cases where festival goers thought they were buying MDMA but actually bought N-ethylpentylone (a riskier stimulant linked to psychosis and <a href="https://www.dea.gov/press-releases/2018/08/31/dea-acts-against-dangerous-deadly-designer-synthetic-drug-linked-151">deaths</a>)</p></li>
<li><p><strong>policing or legal problems:</strong> festivals often have a heavy police presence with sniffer dogs and being caught with drugs can lead to possession or supply charges. However, it’s very important not to panic and swallow your drugs if you see sniffer dogs. This has been linked to at least three <a href="https://www.pedestrian.tv/news/defqon-1-drugs-death-reignites-sniffer-dogs-debate/">festival deaths</a> in Australia.</p></li>
</ul>
<h2>Worried about your friends?</h2>
<p>If you’re going to a rave or festival and suspect some of your friends might take illicit drugs, it’s important to be aware of the risks, look out for your friends and know where to get help. Here are some tips:</p>
<ol>
<li><p><strong>make emergency plans with friends:</strong> download the festival map, have a meeting point, make sure mobiles are charged, stick together and know where on-site support services are </p></li>
<li><p><strong>look out for <a href="https://drugaware.com.au/getting-the-facts/staying-safe/#Signs-someone-needs-immediate-help">red flag symptoms</a></strong> (for instance, feeling hot, unwell, confused or agitated) and never be scared to seek help from on-site medical or support services. They’re there to help you, not judge or arrest you</p></li>
<li><p><strong>be informed:</strong> <a href="https://drugaware.com.au/getting-the-facts/staying-safe/">Drugaware</a>, <a href="https://www.dancewizensw.org.au/patron/#block-yui_3_17_2_1_1524198824688_25530">Dancewize</a> and <a href="http://www.boomtick.com.au/listen-out-perth-save-a-mate-training/">Boomtick</a> all have great information about drugs and how to keep safe.</p></li>
</ol><img src="https://counter.theconversation.com/content/122128/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jodie's doctoral research was funded by a scholarship from the Australian Government Department of Health. The National
Drug Research Institute at Curtin University is supported by funding from the Australian Government under the Drug and Alcohol Program.</span></em></p>A person’s drug experience can be influenced by many different things, such as heat, access to water and dosage.Jodie Grigg, Research Associate at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1230962019-09-09T04:56:55Z2019-09-09T04:56:55ZDrugs don’t affect job seeking, so let’s offer users help rather than take away their payments<figure><img src="https://images.theconversation.com/files/291422/original/file-20190909-175663-1kss60k.jpg?ixlib=rb-1.1.0&rect=7%2C136%2C5064%2C3482&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drug testing risks further marginalising welfare recipients. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-confused-man-looking-laptop-sitting-180999986?src=LPOLOKvY9T2BDQE8aqVbJA-2-57">Iakov Filimonov/Shutterstock</a></span></figcaption></figure><p>The Morrison government is <a href="https://www.theguardian.com/commentisfree/2019/sep/06/the-recycled-drug-testing-plan-is-just-one-more-cruel-and-pointless-diversion">having another shot</a> at getting its proposal to drug test people on welfare through the Senate.</p>
<p>Welfare, health and drug treatment experts have consistently opposed the proposal since it was first introduced three years ago. They say these measures will only serve to <a href="https://ama.com.au/media/dr-chris-moy-doorstop-drug-testing-welfare-recipients">further marginalise people on welfare</a> and people who use drugs, and may have a range of <a href="https://www.theguardian.com/australia-news/2017/sep/14/drug-testing-welfare-recipients-an-absolute-disgrace-australian-of-the-year-says">unintended consequences</a> such as homelessness.</p>
<p>If the government really wanted to assist people who have drug problems to return to work, it would increase funding for drug treatment.</p>
<h2>What’s being proposed?</h2>
<p>The new proposal appears very similar to those the Senate <a href="https://parlinfo.aph.gov.au/parlInfo/download/legislation/ems/r6065_ems_5df415e5-bf55-4745-8db8-6d653265a900/upload_pdf/665144.pdf;fileType=application%2Fpdf#search=%22legislation/ems/r6065_ems_5df415e5-bf55-4745-8db8-6d653265a900%22">previously rejected</a> in 2017 and 2018.</p>
<p>A <a href="https://www.anneruston.com.au/media_release_drug_testing_trials_to_help_welfare_recipients_become_job_ready">two year trial</a> would test around 5,000 new recipients of Newstart Allowance and Youth Allowance for a range of illegal drugs in three locations in Queensland, New South Wales and Western Australia. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-testing-welfare-recipients-raises-questions-about-data-profiling-and-discrimination-77471">Drug testing welfare recipients raises questions about data profiling and discrimination</a>
</strong>
</em>
</p>
<hr>
<p>Cocaine has been added to the list of drugs to be tested for. The list already included methamphetamine, MDMA (ecstasy), opioids (such as heroin) and cannabis in <a href="https://ajp.com.au/news/drug-testing-welfare-recipients-really-mean/">earlier versions</a>.</p>
<p>Welfare recipients who test positive will be placed on income management, with 80% of their income quarantined. </p>
<p>They will undertake a second test within a month. Two positive tests will result in a referral to a medical professional for treatment. Ongoing treatment may be a requirement of their job plan. </p>
<p>If they return two positive tests, or they dispute a test and ask for another test, they will be required to <a href="https://parlinfo.aph.gov.au/parlInfo/download/legislation/ems/r6065_ems_5df415e5-bf55-4745-8db8-6d653265a900/upload_pdf/665144.pdf;fileType=application%2Fpdf#search=%22legislation/ems/r6065_ems_5df415e5-bf55-4745-8db8-6d653265a900%22">repay the cost of the tests</a>.</p>
<h2>What is the rationale?</h2>
<p>The government is attempting to frame the measure as a helping hand for people who have problems with drugs. </p>
<p><a href="https://www.sbs.com.au/news/morrison-backs-drug-testing-politicians-as-well-as-welfare-recipients">Social services minister</a> Anne Ruston said the measure was not to punish people on welfare but to identify those who needed help. </p>
<p>During previous attempts to get this legislation through the Senate, former prime minister <a href="https://www.sbs.com.au/news/drug-test-trial-for-welfare-recipients-all-about-love-says-turnbull">Malcolm Turnbull</a> described it as a measure of “love”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=415&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=415&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=415&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=521&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=521&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291424/original/file-20190909-175673-10synt0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=521&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the plan goes ahead, most people detected for drug taking won’t have problems with substance abuse.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/468262262?src=TC07ZbO2VeGASJShfquTbg-1-3&size=huge_jpg">TK Kurikawa/Shutterstock</a></span>
</figcaption>
</figure>
<p>But a positive drug test is not an indicator of problems. It cannot distinguish between one-off, irregular or regular use. It cannot indicate how much of a drug has been used. So it will not be able to fulfil the government’s wish to identify those who need help.</p>
<p>Most people who use drugs do not have problems with them. Only 20% of people who use methamphetamine, for example, <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents">use it more than once a week</a>. Using more often than weekly is a marker for dependence. </p>
<p>So the majority of people who test positive will probably not have a problem, and will be inadvertently and unnecessarily caught up in the treatment system.</p>
<p>Alcohol and tobacco are the drugs that <a href="https://journals.sagepub.com/doi/abs/10.1177/0269881119841569">cause the most harm</a>, including dependence and longer-term health problems. They are also the biggest financial burden on the community. Neither is addressed under this measure, so it will not assist the majority of people who need help.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
</strong>
</em>
</p>
<hr>
<p>If the aim was to help people address ongoing drug problems, MDMA would not be on the list of drugs to be tested. There are <a href="https://theconversation.com/how-does-mdma-kill-109506">very few long-term problems</a> with MDMA. It rarely requires treatment, despite it being the <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents">in the top three most commonly used illicit drugs</a> in Australia.</p>
<h2>Why it’s unlikely to be effective</h2>
<p>Prime Minister Scott Morrison <a href="https://www.sbs.com.au/news/morrison-backs-drug-testing-politicians-as-well-as-welfare-recipients">has said</a> the plan is “about helping people get off welfare, off the dole and into work”.</p>
<p>But there is no evidence drug use is a barrier to job seeking. In fact, most people who use drugs are <a href="https://theconversation.com/three-charts-on-who-uses-illicit-drugs-in-australia-110169">employed</a>.</p>
<p>A 2001 <a href="https://www.researchgate.net/publication/247245354_Drug_testing_and_mandatory_treatment_for_welfare_recipients">Canadian study</a> concluded drug testing welfare recipients was an expensive process that would result in a very marginal increase in employment.</p>
<p>A 2013 position paper from the <a href="https://www.drugsandalcohol.ie/20368/1/ANCD_paper_DrugTesting.pdf">Australian National Council on Drugs</a>, the Australian government’s previous drug advisory body, similarly concluded:</p>
<blockquote>
<p>There is no evidence that drug testing welfare beneficiaries will have any positive effects for those individuals or for society, and some evidence indicating such a practice would have high social and economic costs. In addition, there would be serious ethical and legal problems in implementing such a program in Australia.</p>
</blockquote>
<p>There’s also <a href="https://public-health.uq.edu.au/article/2017/09/evidence-or-against-drug-testing-welfare-recipients">little evidence such a measure would save money</a> by kicking people off welfare, given the costs of running such programs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-evidence-for-or-against-drug-testing-welfare-recipients-it-depends-on-the-result-were-after-83641">Is evidence for or against drug-testing welfare recipients? It depends on the result we're after</a>
</strong>
</em>
</p>
<hr>
<p>New Zealand originally looked at a scheme similar to the Australian proposal, but subsequently modified it to subsidise existing pre-employment testing. It tested more than 8,000 people on welfare and returned only <a href="https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11184479">22 positive results</a>.</p>
<p>Trials in the US found <a href="https://www.nytimes.com/2014/01/01/us/florida-law-on-drug-testing-for-welfare-is-struck-down.html?_r=0">relatively few people</a> who received government benefits tested positive to illicit drugs. Among seven states that trailed a similar measure in the US, nearly all of them had <a href="http://thinkprogress.org/economy/2015/02/26/3624447/tanf-drug-testing-states/">detection rates</a> of less than 1%. </p>
<p>The trials showed <a href="https://www.tandfonline.com/doi/abs/10.1300/J045v17n01_03">little net benefit</a>, also making it an expensive exercise.</p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395915003588">The evidence</a> in favour of forcing people into treatment is limited. It is <a href="https://www.health.harvard.edu/blog/involuntary-treatment-sud-misguided-response-2018012413180">less effective</a> than voluntary treatment for long-term outcomes, and increases overdose risk. </p>
<p>Financial sanctions can lead to <a href="https://www.drugfoundation.org.nz/assets/uploads/2011-uploads/Policy-Briefing-Welfare-Reform-and-Substance-Use-July-2011-0.pdf">poorer outcomes</a> in people with alcohol or other drug problems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/forcing-ice-users-into-rehab-wont-solve-the-problem-heres-what-we-need-instead-45946">Forcing ice users into rehab won't solve the problem – here's what we need instead</a>
</strong>
</em>
</p>
<hr>
<h2>Instead, increase funding for drug treatment</h2>
<p>Every $1 spent on <a href="https://www.ncbi.nlm.nih.gov/pubmed/16430607">drug treatment saves</a> about $7 in health, welfare and other costs to the community.</p>
<p><a href="https://ndarc.med.unsw.edu.au/resource/new-horizons-review-alcohol-and-other-drug-treatment-services-australia">Drug treatment</a> reduces drug use and harms, which has knock-on effects of improving participation in the community (including employment and <a href="https://pdfs.semanticscholar.org/d6e5/e2aa51b17b1863d07c823a19a531e7f54788.pdf">training</a>), improving health and well-being, and reducing criminal behaviour. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291425/original/file-20190909-175673-1lw0sqd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Every dollar spent on drug treatment saves $7.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/343847333?src=LwGO8_sqWKmBO8aKvhrfpg-1-54&size=huge_jpg">Rawpixel.com/Shutterstock</a></span>
</figcaption>
</figure>
<p>Yet there are too few drug treatment places for people who want it, let alone forcing people who don’t want or need it into treatment.</p>
<p>Along with drug testing welfare recipients, the government has announced a <a href="https://www.anneruston.com.au/media_release_drug_testing_trials_to_help_welfare_recipients_become_job_ready">A$10 million treatment fund</a>. But we need at least double the <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/New%20Horizons%20Final%20Report%20July%202014.pdf">A$1.2 billion</a> currently spent to just meet the existing demand for voluntary treatment. </p>
<p>The proposed measure is a blunt response to a nuanced problem. There are much more effective, and cost effective, ways to address both alcohol and other drug problems and unemployment than drug testing welfare recipients.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/helping-drug-users-get-back-to-work-not-random-drug-testing-should-be-our-priority-77468">Helping drug users get back to work, not random drug testing, should be our priority</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/123096/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She has previously been awarded grants by state and federal governments, NHMRC and other public funding bodies for alcohol and other drug research. </span></em></p>There’s no evidence drug use is a barrier to job seeking. And testing can’t distinguish between one off, irregular or regular use.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1188222019-07-04T07:06:44Z2019-07-04T07:06:44ZHow rehab helps heavy drug and alcohol users think differently<figure><img src="https://images.theconversation.com/files/282639/original/file-20190704-126391-11u9iqh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Living in a group environment is part of learning how to manage without using drugs.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Around 16,700 Australians stay in residential rehabilitation centres each year, most commonly for problems with alcohol, amphetamines <a href="https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/aodts-2017-18-key-findings/contents/treatment">and opiates</a>. </p>
<p>Rehab is a structured, drug- and alcohol-free environment. Residents participate in the same daily and weekly routines and activities, including educational and therapeutic groups and individual counselling sessions. Household chores, cooking, exercise, education and recreational activities fill the time. </p>
<p>Some rehabs have as few as 12 residents at one time, others have as many as 60. Programs last from six weeks to 18 months, with eight weeks the average in Australia.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/30925888">Our recent study</a> of 12 rehab residents in Australia found the safe, structured environment and the support of others going through the same experience were key to helping residents change their thinking about drug and alcohol use. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-rehab-what-works-and-what-to-keep-in-mind-when-choosing-a-private-treatment-provider-95431">Drug rehab: what works and what to keep in mind when choosing a private treatment provider</a>
</strong>
</em>
</p>
<hr>
<h2>Safety and routine</h2>
<p>We asked people what program elements they thought were important. They most often talked about the safe environment, structured routines and staff support. As one woman explained, “I love my room, it’s my space. I am safe there.”</p>
<p>Living in a group environment with strangers while fighting mood swings and cravings is tough. The staff maintained the routines and monitored the group dynamics but they also responded to individual needs for support: </p>
<blockquote>
<p>I’ve had down days and they’re (staff) pretty quick to pick it up. I’m not the sort of person that likes to talk about emotions and let it out, but they’re pretty quick. The times I’ve been down, they pick it up pretty quick.</p>
</blockquote>
<p>Living in a group environment is part of learning how to manage without using drugs. Critical changes that study participants attributed to the program were about dealing with their own and others’ emotions:</p>
<blockquote>
<p>I think, what I’ll take away is to understand that that’s the person I am and I’ll manage it. To understand my feelings, like when I am angry, to get away from the situation and take a breath and understand my feelings, I guess. Just understand what I’m feeling. If I’m angry, I know there’s other options than to go use, or drink.</p>
</blockquote>
<h2>A new way of living</h2>
<p>Most participants described the shared experience of everyday life without drugs or alcohol for an extended period as particularly important. One woman said:</p>
<blockquote>
<p>we’d sit around laughing our heads off and actually we’d say we’ve probably never laughed so much in our lives. We were just sitting around with no alcohol, no drugs and just making do with what we’ve got.</p>
</blockquote>
<p>For many, that change was unexpected: </p>
<blockquote>
<p>There was no drugs or alcohol involved and pretty much the first time since I was a young teenager, I realised you can be happy. I don’t know. It was just a bit of a change in life. </p>
</blockquote>
<p>Rehab programs are not usually designed around a specific type of drug or individual. The same therapies are applied to everyone. </p>
<p>The group content used in the rehab we studied included health and well-being education and psychological therapies intended to help people deal with triggers and make decisions around drug use. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-rehab-and-group-therapy-do-they-work-65413">Drug rehab and group therapy: do they work?</a>
</strong>
</em>
</p>
<hr>
<p>However, the most important thing for most people was a daily, group-based reflection on personal values which helped create a different view of themselves as, say, a mother or friend. As one man said:</p>
<blockquote>
<p>so it makes me look at myself, like I’m forgiving and humility, and really looking at me and going, okay, well, I’m not such a crap person, because I’m an addict. I’ve got some good values there.</p>
</blockquote>
<h2>Possibility of relapse</h2>
<p>Fear and anxiety about relapse after leaving rehab were common. People felt vulnerable to resuming drug use despite gains made during the program and their desires to remain substance-free:</p>
<blockquote>
<p>I’m getting a bit anxious, knowing that I’m going. I’ve been here, wrapped in cotton wool for two months, and being released back into the big, wide world, I’m scared that I’m going to relapse.</p>
</blockquote>
<p>Few study participants had support to cope in the future. Friends and social groups were limited because past connections usually involved drug use: </p>
<blockquote>
<p>That’s going to be the hardest thing for me, seeing old mates and them asking if I want some. That’s the hardest part. You are who you hang around. It’s sad to say, but I’ve started hanging around some pretty ordinary people. You think they’re your friends but they’re not.</p>
</blockquote>
<p>Maintaining change after rehab is a challenge and few supports are available. </p>
<p>Relapse rates are high. Most people use drugs in the year after treatment. Between 40% and 60% <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fadb0000386">return to substance dependence</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-success-in-drug-rehab-programs-need-more-than-just-anecdotes-to-prove-they-work-76081">What is 'success' in drug rehab? Programs need more than just anecdotes to prove they work</a>
</strong>
</em>
</p>
<hr>
<h2>The downsides</h2>
<p>Several people described being fearful of what would happen when they got there. Others described conflicts between residents and lack of contact with children as challenges they faced.</p>
<p>Cost can also be an issue. The centre we studied charged A$240 a week for all facilities including therapeutic programs. But private rehabs are also available and can cost as much as A$30,000 a <a href="https://www.smh.com.au/national/money-makes-all-the-difference-when-it-comes-to-tackling-ice-addiction-in-victoria-20150210-13b2ic.html">month</a>.</p>
<p>Rehab fills the day and provides intensive support for people but that doesn’t exist when they go home. </p>
<p>Community support programs like counselling, employment and drug-free social and recreational programs, which bring safe family members and friends back into the picture, could reduce relapse.</p><img src="https://counter.theconversation.com/content/118822/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julaine Allan has received funding from NHMRC, ARC, Ian Potter Foundation, NSW Health to conduct research on services for people who use drugs. Julaine has worked for Lives Lived Well, a not for profit drug and alcohol service provider.</span></em></p><p class="fine-print"><em><span>Dr Alice Munro receives funding from NSW Health. </span></em></p><p class="fine-print"><em><span>Susan Collings receives funding from NSW Family and Community Services</span></em></p>Residential drug rehab programs usually last for around eight weeks and include everything from counselling sessions to household chores, which help build connections and support between residents.Julaine Allan, Senior research fellow, Charles Sturt UniversityAlice Munro, Conjoint Research Associate, National Drug and Alcohol Research Centre, UNSW SydneySusan Collings, Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1106962019-02-07T19:07:53Z2019-02-07T19:07:53ZIn debates about drug use, fun is important<figure><img src="https://images.theconversation.com/files/257659/original/file-20190207-174857-19hll8p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">"Just say no" messages are ignored because young people want to have fun.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/IB5bld_weak">Marvin Meyer</a></span></figcaption></figure><p>Millions of Australians use, or have used, <a href="https://campaigns.health.gov.au/drughelp/drug-trends-and-statistics">illicit substances</a> at some point in their life, while millions more are regular users of legal drugs such as <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001%7E2014-15%7EMain%20Features%7EAlcohol%20consumption%7E25">alcohol</a>, <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/tobacco-control-toc%7Esmoking-rates">tobacco</a> or <a href="https://www.abc.net.au/triplej/programs/hack/misuse-of-pharmaceuticals-on-the-rise/9271046">sleeping pills</a>. </p>
<p>While some people become heavy users of alcohol or other drugs as a way of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2010.02902.x">coping</a> with past trauma or mental illness, this is not the story for millions of others. Young (and older) people use drugs and alcohol for fun, enjoyment and socialisation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-charts-on-who-uses-illicit-drugs-in-australia-110169">Three Charts on who uses illicit drugs in Australia</a>
</strong>
</em>
</p>
<hr>
<p>NSW Greens MP Cate Faehrmann <a href="https://www.smh.com.au/national/i-m-coming-out-about-drugs-it-s-time-get-real-about-pill-testing-20190120-p50shc.html">summed it up well</a> when she explained why she had used MDMA (ecstacy) in her 20s (and since):</p>
<blockquote>
<p>We knew there were risks but we were prepared to take them because having a good time was our priority … The ‘Just Say No’ message was around then too. We ignored it. Some things never change.</p>
</blockquote>
<p>“Fun” or “having a good time” as a reason for drug use is often dismissed as trivial or inconsequential. Why would people risk their health or life for simple fun? </p>
<p>Let’s look at the evidence for why people use three different types of drugs: <a href="https://www.racgp.org.au/download/documents/AFP/2010/August/201008frei_partydrugs.pdf">party drugs</a>, such as MDMA (ecstasy), cocaine or crystal methamphetamine (ice/crystal meth); marijuana; and alcohol.</p>
<h2>Party drugs</h2>
<p>The party drug category includes a range of drugs commonly used for dance parties, particularly MDMA (ecstasy), cocaine or gamma hydroxybutyrate (GHB), as well as crystal methamphetamine (ice). </p>
<p>In <a href="https://www-tandfonline-com.ez.library.latrobe.edu.au/doi/pdf/10.1080/13676260600983668?needAccess=true">studies</a> exploring motivation for party drug use, fun and pleasure are central. Users describe party drugs as giving them energy to dance and socialise, reducing inhibition and enhancing feelings of <a href="https://www-tandfonline-com.ez.library.latrobe.edu.au/doi/pdf/10.1080/13676260600983668?needAccess=true">connection to others</a>. </p>
<p>For some, party drugs also <a href="http://sigmaresearch.org.uk/projects/item/project59">intensify sexual experience</a>. </p>
<p>In these studies, party drug users’ descriptions of fun often relate to the quality of social relationships – drugs are fun because they allow for intense and disinhibited experiences with friends and lovers. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-do-young-people-gain-from-drug-use-18878">What do young people gain from drug use?</a>
</strong>
</em>
</p>
<hr>
<p>Some studies have suggested that party drug use can lead to <a href="https://theconversation.com/what-do-young-people-gain-from-drug-use-18878">social benefits</a> that carry through into other areas of life, including building friendship networks and social connections through which people derive support. </p>
<p>Fun, in this sense, is not just about hedonism, but about the experience of belonging and developing social bonds. </p>
<h2>Marijuana</h2>
<p>Marijuana is the <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/cannabis">most commonly used</a> illicit drug in Australia, with 35% of the nation trying it at least once.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257661/original/file-20190207-174890-xoyyz4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One in three Australians have used marijuana.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/UoXLndT32Hg">Thought Catalog</a></span>
</figcaption>
</figure>
<p>There are many studies examining reasons why people use marijuana. For some, it is about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696937/">coping</a> and managing stress or difficult emotions. However, most people <a href="https://www-sciencedirect-com.ez.library.latrobe.edu.au/science/article/pii/S030646030600298X">tend to use marijuana</a> for fun, enjoyment, or relaxation in a social setting. </p>
<p>In the 1950s, sociologist <a href="https://www.jstor.org/stable/2771989?seq=1#page_scan_tab_contents">Howard Becker</a> described the ritual of smoking marijuana as a process in which people formed social ties and established a sense of group identity as they learned how to derive pleasure from the act of smoking marijuana.</p>
<p>For young people, marijuana use can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3847659/">symbolise independence</a> and a sense of freedom – a change in their social status. </p>
<h2>Alcohol</h2>
<p>Understanding what motivates people to drink alcohol is a complex task, given that unlike illicit drugs, alcohol is integrated into mainstream <a href="http://cw.routledge.com/textbooks/anthropologyofstuff/alcohol_home.html">rituals and routines</a> of modern life. We drink together to mark success, to celebrate marriages, to commiserate loss. Bars, pubs and restaurants are the focal points of most adults’ social lives. </p>
<p>The <a href="https://theconversation.com/how-alcohol-makes-you-friendlier-but-only-to-certain-people-41730">physical effects of alcohol</a> – relaxation and disinhibition – are part of the pleasure associated with alcohol. But this can be hard to disentangle from the pleasure of participation in <a href="https://www.jstor.org/stable/4189107?seq=1#page_scan_tab_contents">social rituals</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/zSKsSrXXj7E?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s what happens when we take the first, second and fifth drink.</span></figcaption>
</figure>
<p>As with other drugs, studies which ask people why they drink cite <a href="https://www.sciencedirect.com/science/article/pii/S0376871610000992">social reasons</a> – fun, enjoyment and disinhibition – as common motivations for drinking. </p>
<h2>Why is this relevant?</h2>
<p>Emphasising the social nature of drug use should not detract from the recognition that drug and alcohol use can devastate the lives of some individuals. </p>
<p>There is also a valid argument that the legitimised social status of alcohol allows us to <a href="https://theconversation.com/social-acceptance-of-alcohol-allows-us-to-ignore-its-harms-10045">ignore its health risks</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">History, not harm, dictates why some drugs are legal and others aren't</a>
</strong>
</em>
</p>
<hr>
<p>However, understanding the social nature of drug use reveals why fun-seeking is so compelling. When people <a href="https://www-tandfonline-com.ez.library.latrobe.edu.au/doi/pdf/10.1080/02614369100390131?needAccess=true">describe fun</a>, they are often talking about an experience of social connection and belonging. Fun is not insignificant in human lives.</p>
<p>Understanding this might help to make sense of why “just say no” messages are so often ignored.</p><img src="https://counter.theconversation.com/content/110696/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Power receives research funding from the Australian Department of Health, The Victorian Department of Health and Human Services and the Australian Research Council.</span></em></p>People who use party drugs say it gives them energy to dance and socialise, reduces their inhibitions and enhances their feelings of connection to others.Jennifer Power, Senior Research Fellow at the Australian Research Centre in Sex, Health and Society, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1022682018-09-06T20:06:59Z2018-09-06T20:06:59ZPrisoners need drug and alcohol treatments but AA programs aren’t the answer<figure><img src="https://images.theconversation.com/files/235179/original/file-20180906-190673-tm9huw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Around half of prisoners have a substance dependence.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1046600194?size=huge_jpg">Karanik yimpat/Shutterstock</a></span></figcaption></figure><p>Prisons and drug use are closely linked. Two-thirds of Australian prisoners report <a href="https://www.aihw.gov.au/reports/prisoners/health-of-australias-prisoners-2015/contents/illicit-drug-use">using illicit drugs</a> in the 12 months before they entered prison, compared with <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/summary">12% of the general</a> population in the previous 12 months. Around half of prisoners are likely to meet the criteria for substance dependence. </p>
<p>Some 18% of detainees reported alcohol and 32% reported illicit drugs directly <a href="https://aic.gov.au/publications/sr/sr4">contributed to their crime</a>. The relationship is complex but there’s no doubt untreated alcohol and other drug problems are a key factor for reoffending.</p>
<p>Our report, <a href="http://www.360edge.com.au/resources/what-works">What works in alcohol and other drug treatment in prison settings</a>, published today, shows some interventions currently used in prisons have little evidence to support them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-australian-prisoners-are-smoking-nicotine-infused-tea-leaves-100966">Why Australian prisoners are smoking nicotine-infused tea leaves</a>
</strong>
</em>
</p>
<hr>
<h2>Why is drug use so high among prisoners?</h2>
<p>A <em>causal</em> link between alcohol and other drugs and offending has not been established. </p>
<p>It may be that people who are risky drinkers or who use illicit drugs are more likely to commit crimes. Or people who are at risk of criminal behaviour are more likely to be risky drinkers or use illicit drugs. Or there might be common underlying causal factors that make both more likely. </p>
<p>But there is a clear <a href="https://aic.gov.au/publications/tandi/tandi439">relationship</a> between drug use and involvement in criminal activity, particularly:</p>
<ul>
<li>offences related to illicit drug markets, such as illicit use, possession, selling or manufacturing</li>
<li>offences committed to acquire drugs, such as <a href="https://aic.gov.au/publications/sr/sr4">theft</a></li>
<li>offences related to being intoxicated on alcohol or other drugs, such as <a href="https://aic.gov.au/publications/sr/sr4">violent crimes</a>.</li>
</ul>
<h2>Reducing harms</h2>
<p>Harm reduction is one of the key strategies of <a href="http://www.nationaldrugstrategy.gov.au">Australia’s official drug policy</a>. We know from history there will always be a small percentage of the population who use illicit drugs. Most do so for a short period and either stop on their own or go into treatment. Harm reduction aims to reduce harms to the person using and the community.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-in-prison-histories-of-trauma-and-abuse-highlight-the-need-for-specialised-care-68668">Women in prison: histories of trauma and abuse highlight the need for specialised care</a>
</strong>
</em>
</p>
<hr>
<p><a href="http://penington.org.au/wp-content/uploads/2017/01/bulletin_vol4_1.pdf">Surveys indicate</a> around 10% of prisoners use illicit drugs while in prison, and 6% use drugs by injection while in prison. </p>
<p><a href="http://www.360edge.com.au/resources/what-works">Harm-reduction measures</a>, including prison needle and syringe programs and peer support, are effective in reducing overdoses. They also reduce the spread of blood-borne viruses, which in turn iprotects the public when prisoners are released.</p>
<h2>Effective treatment</h2>
<p>Individual or group <a href="http://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive behaviour therapy</a> (CBT) that addresses both offending and substance use has had the most success in reducing reoffending. <a href="https://www.researchgate.net/publication/252778703_Effects_of_Cognitive-Behavioral_Programs_for_Criminal_Offenders">CBT programs</a> can reduce the risk of recidivism among prison participants by around 25%.</p>
<p>Other <a href="http://www.360edge.com.au/resources/what-works">well-supported interventions</a> include: </p>
<ul>
<li>therapeutic communities, which are live-in treatment settings</li>
<li>opioid substitution therapy such as methadone and buprenorphine</li>
<li>exit preparation programs such as pre-release centres, which gradually reintegrate offenders back into the community by helping them develop life skills and find work. </li>
</ul>
<h2>What’s less likely to work?</h2>
<p>Twelve-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are often used in prisons but they do not have much evidence to support their use. </p>
<p>In the community, the success rate is <a href="https://www.theatlantic.com/health/archive/2014/03/the-surprising-failures-of-12-steps/284616/">as low as 8%</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-3b-a-year-system-is-flying-blind-in-supporting-ex-prisoners-39999">Our $3b-a-year system is flying blind in supporting ex-prisoners</a>
</strong>
</em>
</p>
<hr>
<p>Contingency management, a behaviour therapy that focuses on the use of rewards for meeting treatment goals (the same principle behind star charts for kids), are used in some parts of the criminal justice system, such as drug courts. </p>
<p>Contingency management is effective in promoting abstinence in community settings, but there has been little evaluation of its success in prisons.</p>
<p>Other interventions with <a href="http://www.360edge.com.au/resources/what-works">limited evidence</a> for prison populations include mindfulness-based relapse prevention, and specialist treatment programs for alcohol-related offending.</p>
<h2>The difficulty with treatment in prisons</h2>
<p>Prisoners typically have many risk factors and therefore complex needs, making treatment more complex. Custodial sentences themselves <a href="http://journals.sagepub.com/doi/abs/10.1177/1477370809341128?journalCode=euca">increase an offender’s risk of recidivism</a>. And prisoners have <a href="https://www.aihw.gov.au/reports/prisoners/health-of-australias-prisoners-2015/contents/mental-health-of-prison-entrants">rates of mental health problems and personality disorders</a>, and poor education levels. </p>
<p>Prison is a highly monitored and controlled setting. This creates an artificial environment during treatment and it’s difficult to know whether the skills learned in prison translate to the outside world, with its a broader range of temptations and stresses. </p>
<p>Many ex-prisoners experience periods of <a href="http://journals.sagepub.com/doi/abs/10.1375/acri.39.1.20">unemployment or homelessness</a> after release, which drastically increases their risk of relapse. Post-release therapeutic support is therefore essential.</p>
<p>It’s in the community’s best interest to support people with alcohol and other drug problems in prison to reduce their substance use problems and their reoffending.</p>
<hr>
<p><em>Linda Jenner, 360Edge principal consultant, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/102268/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She has previously been awarded grants by state and federal governments, NHMRC and other public funding bodies for alcohol and other drug research. She is a member and past President of the Australian Association for Cognitive and Behaviour Therapy. She is a registered Psychologist who also works in private clinical practice.</span></em></p><p class="fine-print"><em><span>Jarryd Bartle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some drug and alcohol programs
currently used in prisons have little evidence to support them.Jarryd Bartle, Sessional Lecturer in Criminal Law, RMIT UniversityNicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/953682018-04-24T06:27:09Z2018-04-24T06:27:09ZCannabis and psychosis: what is the link and who is at risk?<figure><img src="https://images.theconversation.com/files/216051/original/file-20180424-94163-7i8ktj.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Only certain compounds in cannabis are at fault. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>There has been a recent global rise in “green fever”, with <a href="https://www.indy100.com/article/marijuana-weed-cannabis-legal-decriminalise-medical-world-mapped-7693396">various jurisdictions</a> either decriminalising or <a href="https://theconversation.com/greens-want-cannabis-to-be-made-legal-95071">legalising</a> cannabis. </p>
<p>But alongside relaxing the rules comes concern about the health implications of cannabis use. We often hear of a link between <a href="https://www.ncbi.nlm.nih.gov/pubmed/29557759">cannabis use and psychosis</a>. So how strong is the link, and who is at risk?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/greens-want-cannabis-to-be-made-legal-95071">Greens want cannabis to be made legal</a>
</strong>
</em>
</p>
<hr>
<h2>What is psychosis?</h2>
<p>There’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/26568030">consistent evidence</a> showing a <a href="https://www.ncbi.nlm.nih.gov/pubmed/29557758">relationship over time</a> between heavy or repeated cannabis use (or those diagnosed with cannabis use disorder) and an experience of psychosis for the first time.</p>
<p>Psychotic disorders are <a href="https://www.sane.org/mental-health-and-illness/facts-and-guides/psychosis">severe mental health conditions</a>. They’re characterised by a “loss of contact with reality”, where the individual loses the ability to distinguish what’s real from what’s not. Psychotic symptoms can include visual hallucinations, hearing voices, or pervasive delusional thinking. </p>
<p>These can often present as a “<a href="https://www.sane.org/mental-health-and-illness/facts-and-guides/psychosis">psychotic episode</a>” – which is a relatively sudden worsening of psychotic symptoms over a short time-frame, frequently resulting in hospitalisation.</p>
<p>The heaviest users of cannabis are around <a href="http://doi.org/10.1093/schbul/sbw003">four times as likely</a> to develop schizophrenia (a psychotic disorder that affects a person’s ability to think, feel and behave clearly) than non-users. Even the “average cannabis user” (for which the definition varies from study to study) is around <a href="http://doi.org/10.1093/schbul/sbw003">twice as likely</a> as a non-user to develop a psychotic disorder.</p>
<p>Furthermore, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801827/">these studies found</a> a causal link between tetrahydrocannabinol (THC - the plant chemical which elicits the “stoned” experience) and psychosis. This means the link is not coincidental, and one has actually caused the other.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-cannabis-cause-mental-illness-54890">Does cannabis cause mental illness?</a>
</strong>
</em>
</p>
<hr>
<h2>Who is at risk?</h2>
<p>People with certain gene variants seem to be at higher risk. However our understanding of these factors is still limited, and we’re unable to use genetic information alone to determine if someone will or won’t develop psychosis from cannabis use.</p>
<p>Those with these genetic variants who have also experienced childhood trauma, or have a paranoid personality type, are <a href="https://www.ncbi.nlm.nih.gov/pubmed/29557759">even more at-risk</a>. So too are adolescents and young adults, who have growing brains and are at an age where schizophrenia is <a href="https://www.ncbi.nlm.nih.gov/pubmed/29557758">more likely to manifest</a>. </p>
<p>The type of cannabis material being used (or the use of synthetic cannabinoids, known as “spice”) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801827/">may also increase the risk of psychosis</a>. As mentioned above, this is due to the psychological effects of the chemical THC (one of over 140 cannabinoids found in the plant). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/216053/original/file-20180424-94115-njsll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/216053/original/file-20180424-94115-njsll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216053/original/file-20180424-94115-njsll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216053/original/file-20180424-94115-njsll.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216053/original/file-20180424-94115-njsll.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216053/original/file-20180424-94115-njsll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216053/original/file-20180424-94115-njsll.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216053/original/file-20180424-94115-njsll.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Even healthy people given THC can experience psychotic symptoms including paranoia.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>This compound may actually mimic the presentation of psychotic symptoms, including paranoia, sensory alteration, euphoria, and hallucinations. In <a href="https://www.ncbi.nlm.nih.gov/pubmed/15173844">laboratory-based research</a>, even healthy people may exhibit increased symptoms of psychosis when given THC compounds, with more severe effects observed in people with schizophrenia. </p>
<p>Many cannabis strains contain high amounts of THC, found in plant varieties such as one called “skunk”. These are popular with consumers due to the “high” it elicits. However with this goes <a href="http://dx.doi.org/10.1016/S2215-0366(14)00117-5">the increased risk of</a> paranoia, anxiety, and psychosis.</p>
<h2>But can’t cannabis also be good for mental health?</h2>
<p>Ironically, one compound found in cannabis may actually be beneficial in treating psychosis. In contrast to THC, a compound called cannabidiol (CBD) <a href="https://www.ncbi.nlm.nih.gov/pubmed/26852073">may provide a buffering effect</a> to the potentially psychosis-inducing effects of THC. </p>
<p>This may occur in part due to its ability to partially block the same brain chemical receptor THC binds with. CBD can also inhibit the breakdown of a brain chemical called “anandamide,” which makes us feel happy. Incidentally, anandamide is also found in <a href="https://www.ncbi.nlm.nih.gov/pubmed/11363932">chocolate</a> and is aptly named after the Sanskrit word meaning “bliss”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/remind-me-again-how-does-cannabis-affect-the-brain-40641">Remind me again, how does cannabis affect the brain?</a>
</strong>
</em>
</p>
<hr>
<p>CBD extracted from cannabis and used in isolation is well-tolerated with minimal psychoactive effects. In other words, it doesn’t make a person feel “high”. Some <a href="https://www.ncbi.nlm.nih.gov/pubmed/29241357">studies</a> have <a href="https://www.ncbi.nlm.nih.gov/pubmed/22832859">found</a> CBD is actually beneficial in improving the symptoms of schizophrenia. But <a href="https://www.ncbi.nlm.nih.gov/pubmed/29619533">one more recent study</a> showed no difference in the effects of CBD compared to a dummy pill on symptoms of schizophrenia. </p>
<p>Perhaps this means CBD benefits a particular biological sub-type of schizophrenia, but we’d need further study to find out.</p>
<h2>Would legalising make a difference?</h2>
<p>It’s important to note most studies finding a causal link between cannabis use and psychosis examined the use of illicit cannabis, usually from unknown origins. This means the levels of THC were unrestricted, and there’s a possibility of synthetic adulterants, chemical residues, heavy metals or other toxins being present due to a lack of quality assurance practices. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/legal-highs-arguments-for-and-against-legalising-cannabis-in-australia-95069">Legal highs: arguments for and against legalising cannabis in Australia</a>
</strong>
</em>
</p>
<hr>
<p>In the future, it’s possible that standardised novel “medicinal cannabis” formulations (or isolated compounds) may have negligible effects on psychosis risk. </p>
<p>Until then though, we can safely say given the current weight of evidence, illicit cannabis use can increase the risk of an acute psychotic episode. And this subsequently may also increase the chances of developing schizophrenia. This is particularly true when high-THC strains (or synthetic versions) are used at high doses in growing adolescent brains.</p><img src="https://counter.theconversation.com/content/95368/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jerome Sarris is supported by an NHMRC Clinical Research Fellowship (APP1125000) and conducts psychotropic plant and nutraceutical research. He has been the past recipient of institutional grants and consultancy payments from this work. He may potentially provide in the future paid consultation to companies developing or selling medicinal cannabis products. He is affiliated with an academic collaboration: The Australian Medicinal Cannabis Research and Education (AMCREC) which conducts research on cannabis and cannabinoids (<a href="http://www.AMCREC.org">www.AMCREC.org</a>). </span></em></p><p class="fine-print"><em><span>Joseph Firth is supported by a Blackmores Institute Fellowship.</span></em></p>Cannabis use is linked to psychosis, but only a small number of users will experience it.Jerome Sarris, Professor of Integrative Mental Health; NICM Deputy Director, Western Sydney UniversityJoe Firth, Postdoctoral Research Fellow at NICM Health Research Institute, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/789932017-06-11T20:31:12Z2017-06-11T20:31:12ZFactCheck Q&A: are rates of drug use 2.5 times higher among unemployed people than employed people?<figure><img src="https://images.theconversation.com/files/172661/original/file-20170607-5704-1s46ltx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social Services Minister Christian Porter, speaking on Q&A.</span> <span class="attribution"><span class="source">Q&A</span></span></figcaption></figure><p><strong>The Conversation fact-checks claims made on Q&A, broadcast Mondays on the ABC at 9.35pm. Thank you to everyone who sent us quotes for checking via <a href="http://www.twitter.com/conversationEDU">Twitter</a> using hashtags #FactCheck and #QandA, on <a href="http://www.facebook.com/conversationEDU">Facebook</a> or by <a href="mailto:checkit@theconversation.edu.au">email</a>.</strong></p>
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<figure>
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<figcaption><span class="caption">Excerpt from Q&A, June 5, 2017. Quote begins at 4:04.</span></figcaption>
</figure>
<blockquote>
<p>… We absolutely know that rates of drug use amongst unemployed are 2.5 times higher than amongst employed people. <strong>– Social Services Minister Christian Porter, <a href="http://www.abc.net.au/tv/qanda/txt/s4659222.htm">speaking on Q&A</a>, June 5, 2017.</strong></p>
</blockquote>
<p>The 2017-18 federal budget introduced a <a href="https://www.dss.gov.au/sites/default/files/documents/05_2017/budget_2017_-_welfare_reform_-_fact_sheet_for_web_0.pdf">random drug testing trial</a> for recipients of the Newstart Allowance for job-seekers and Youth Allowance in three locations. During a discussion of the measure on Q&A, Social Services Minister Christian Porter said “rates of drug use amongst unemployed are 2.5 times higher than amongst employed people”.</p>
<p>Is that right?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"871707254692732928"}"></div></p>
<h2>Checking the source</h2>
<p>Asked for sources to support his statement, a spokesperson for Christian Porter confirmed the minister was referring to illicit drugs, and directed The Conversation to page 84 of the Australian Institute of Health and Welfare’s <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">2013 National Drug Strategy Household Survey</a>.</p>
<p>The relevant finding reads:</p>
<blockquote>
<p>Use of illicit drugs in the past 12 months was more prevalent among the unemployed, with people who were unemployed being 1.6 times more likely to use cannabis, 2.4 times more likely to use meth/amphetamine and 1.8 times more likely to use ecstasy than employed people.</p>
</blockquote>
<h2>Collecting data on employment status and drug use</h2>
<p>The <a href="http://www.aihw.gov.au/2016-national-drug-strategy-household-survey/">National Drug Strategy Household Survey</a> quoted by the minister’s spokesperson is a reliable and comprehensive dataset. </p>
<p>The federal government has conducted the survey every three years since 1998. It is currently conducted by the Australian Institute of Health and Welfare, a federal government agency. The survey collects data on drug use and drug-related issues in the Australian population.</p>
<p>The first findings of the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/key-findings/">2016 survey</a> were <a href="https://theconversation.com/three-charts-on-australias-changing-drug-and-alcohol-habits-78597">released on June 1</a> this year, but those results didn’t include detailed employment data. The latest employment-level data <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549642">is from 2013</a>, when the Australian Institute of Health and Welfare collected information from almost 24,000 people across Australia.</p>
<p>The <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">2013 survey</a> asked questions about people’s use of illicit drugs, alcohol, and tobacco.</p>
<p>The Australian Institute of Health and Welfare defines “illicit drugs” as “illegal drugs, drugs and volatile substances used illicitly, and pharmaceuticals used for non-medical purposes”. So that’s the definition used in this FactCheck. You can read the full list of drugs included <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/glossary/">here</a>.</p>
<h2>Recent drug use among employed and unemployed people</h2>
<p>The data below is based on the number of employed and unemployed people aged 14 and over who said they had used the drugs listed at least once in the 12 months prior to the 2013 survey.</p>
<p>Compared to employed people, unemployed people were 1.5 times more likely to have used an illicit drug. They were:</p>
<ul>
<li><p>1.4 times more likely to have used cocaine;</p></li>
<li><p>1.6 times more likely to have used pharmaceuticals for non-medical purposes;</p></li>
<li><p>1.6 times more likely to have used cannabis;</p></li>
<li><p>1.8 times more likely to have used ecstasy; and</p></li>
<li><p>2.4 times more likely to have used methamphetamine (for example, ice and speed).</p></li>
</ul>
<p>So, according to the Australian Institute of Health and Welfare data, Porter’s statement that drug use among unemployed people is 2.5 times higher than among employed people is a selective use of the data. It’s true for methamphetamine use, but not for other types of drugs, or illicit use of drugs overall.</p>
<p>The most commonly used illicit drug among unemployed people was cannabis, which had been used by 18.5% of that population in the previous 12 months. Methamphetamine had been used by 5.6% of the unemployed population in that period.</p>
<p>In the 12 months prior to the 2013 survey, 24.5% of unemployed people had used illicit drugs, compared to 16.8% of employed people. </p>
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<h2>Other trends in illicit drug use</h2>
<p>According to the data, a larger proportion of unemployed people had <em>never</em> used illicit drugs (55.5%) compared to employed people (48.8%).</p>
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<p>While people who were unemployed were less likely to have ever used illicit drugs, those who did were 1.4 to 2.4 times more likely to have used them in the previous 12 months.</p>
<p>Overall, unemployed people were 1.5 times more likely than employed people to have taken an illicit drug in the the previous 12 months.</p>
<h2>Verdict</h2>
<p>Christian Porter’s statement that “rates of drug use amongst unemployed are 2.5 times higher than amongst employed people” was incorrect. </p>
<p>Australian Institute of Health and Welfare data showed unemployed people were 1.5 times more likely than employed people to have used an illicit drug in the previous 12 months.</p>
<p>The figure Porter quoted relates to methamphetamine, which unemployed people were 2.4 times more likely than employed people to have used in the past 12 months. <strong>– Nicole Lee</strong></p>
<h2>Review</h2>
<p>I agree with this FactCheck. The Australian Institute of Health and Welfare has the most appropriate and up-to-date statistics on drug use by Australians with the most recent data on this particular issue being for 2013.</p>
<p>I have checked the Australian Institute of Health and Welfare data. The data show the unemployed had been recent drug users at a higher rate than employed people in the year leading up to the 2013 survey. But overall this was at a rate a bit less than 1.5 times that of the employed, not 2.5 times as Christian Porter said on Q&A. <strong>– Peter Whiteford</strong></p>
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<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/162128/original/image-20170323-13486-72k52f.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Conversation FactCheck is accredited by the International Fact-Checking Network.</span>
</figcaption>
</figure>
<p><em>The Conversation’s FactCheck unit is the first fact-checking team in Australia and one of the first worldwide to be accredited by the International Fact-Checking Network, an alliance of fact-checkers hosted at the Poynter Institute in the US. <a href="https://theconversation.com/the-conversations-factcheck-granted-accreditation-by-international-fact-checking-network-at-poynter-74363">Read more here</a>.</em></p>
<p><em>Have you seen a “fact” worth checking? The Conversation’s FactCheck asks academic experts to test claims and see how true they are. We then ask a second academic to review an anonymous copy of the article. You can request a check at <a href="mailto:checkit@theconversation.edu.au">checkit@theconversation.edu.au</a>. Please include the statement you would like us to check, the date it was made, and a link if possible.</em></p><img src="https://counter.theconversation.com/content/78993/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the public, private and not for profit health sector to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research.</span></em></p><p class="fine-print"><em><span>Peter Whiteford has received funding from the Australian Research Council and the Department of Social Services. He is affiliated with the Centre for Policy Development. </span></em></p>Social Services Minister Christian Porter told Q&A that ‘rates of drug use amongst unemployed are 2.5 times higher than amongst employed people’. Is that correct?Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/785972017-05-31T20:15:49Z2017-05-31T20:15:49ZThree charts on: Australia’s changing drug and alcohol habits<p>Australians are using less alcohol, tobacco and other drugs than they did a decade ago, new results from the <a href="http://www.aihw.gov.au/">Australian Institute of Health and Welfare’s</a> (AIHW) National Drug Strategy Household Survey show.</p>
<p>Although the drug of most concern to the general public is methamphetamine, the rate of methamphetamine use has been showing a steady decline since 1998 and, at 1.4%, is now at its lowest point since the survey began, down from 2.1% three years ago.</p>
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<p>So why are people worried? The data over the past several years has shown a decrease in people who prefer to use the lower purity methamphetamine speed and an increase in people preferring to use the more potent crystal form, “ice”. </p>
<p>This trend continues in this survey. The drop in the proportion of people who use methamphetamine overall appears to be driven by fewer people using speed. </p>
<p>With an increase in crystal methamphetamine as the preferred form has come significant increases in harms. </p>
<p>Recent <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/aodts-nmds-2015-16/">treatment data </a>show an increase in treatment presentations - methamphetamine now represents close to 25% of drug treatment episodes - and there has been increases in ambulance call outs, hospital separations and deaths due to methamphetamine.</p>
<p>The trends in methamphetamine use and harms highlight why policies should focus on harms and harm reduction rather than use and use reduction.</p>
<p>In fact, illicit drug use more generally has decreased, mainly driven by a reduction among teenagers, suggesting that fewer young people are trying illicit drugs. This is also continuing a trend seen over the past decade.</p>
<h2>Age of first drug use is on the rise</h2>
<p>Not only are fewer people using illicit drugs, those who do are trying them later. Specifically methamphetamine, cannabis and hallucinogens showed an increase in the age of first use:</p>
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<p>People aged 35-55 years have increased their use of illicit drugs significantly, driven primarily by increases in use of cannabis, methamphetamine and cocaine. We don’t know whether these are people new to using illicit drugs or people who have a history of use who have moved into an older age group.</p>
<p>Traditionally harm reduction messages have been primarily targeted at young people, but an important growing group of people at risk of harms is now those in middle age.</p>
<p>The proportion of people using illicit drugs in their 60s has also been increasing over time. Although the increase is relatively small from 2013 to 2016, people in their 60s have had the largest increase since 2001. This is mostly accounted for by use of pharmaceuticals for non-medical purposes. Careful monitoring of pharmaceutical prescriptions and over-the-counter medicines are part of a harm reduction solution.</p>
<h2>More people report being non-drinkers</h2>
<p>Despite a lot of media interest in illicit drugs, it is still the legal drugs, alcohol and tobacco that cause most harm in the community.</p>
<p>The good news is that there was a decline in drinking that increases risk of harm over a lifetime (such as chronic health problems). For healthy men and women, drinking no more than two standard drinks on any day <a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">reduces the lifetime risk</a> of harm from alcohol.</p>
<p>There was no overall change in drinking that increases risk on a single drinking occasion (such as injuries), but younger people under 30 years old showed a significant decline in risky drinking. For healthy men and women, drinking no more than four standard drinks on a single occasion <a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">reduces the immediate risk</a> of alcohol-related harm. Alcohol-related incidents also decreased, and the proportion of people who reported never having a full glass of alcohol grew.</p>
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<p>Nearly 94% of 12-15 year olds and 58% of 16-17 year olds did not drink at all, both increases from the previous survey.</p>
<p>There was an increase in the proportion of the population who have never smoked and who are ex-smokers, with a significant increase in teenagers who do not smoke.</p>
<p>Overall, legal and illegal drugs are showing a stable or downward trend in proportion of population who use them over the last decade or more. However, while fewer young people are using, the proportion of people using alcohol and other drugs in the older age groups has increased.</p>
<p><em>CORRECTION: This article was corrected on June 1 to change “a significant decrease in teenagers who do not smoke” to “a significant increase in teenagers who do not smoke.” The Conversation apologies for the error and thanks readers who picked it up.</em></p><img src="https://counter.theconversation.com/content/78597/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the public, private and not for profit health sector to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research.</span></em></p>The proportion of population who use legal and illegal drugs has remained stable or trended down. Fewer young people are using, but the proportion of older people using drugs and alcohol has grown.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/733732017-02-22T19:19:21Z2017-02-22T19:19:21ZWhy there’s no legal barrier to a Melbourne drug injecting room, despite political setbacks<figure><img src="https://images.theconversation.com/files/157802/original/image-20170222-20326-17q0zh3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medically supervised injecting facilities can prevent overdoses turning into a medical emergency. So why has progress in Victoria stalled?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/532689901?src=xX5-YaxaqXGzz0cOgctlpw-1-24&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Drug injecting rooms have made news this week following a
coroner’s <a href="http://www.coronerscourt.vic.gov.au/resources/d48c9cdc-8db0-45b5-83c2-5ea6918e3ccd/ms+a_+241816.pdf">recommendation</a> to set up a trial of a supervised injecting facility in the Melbourne suburb of North Richmond.</p>
<p>Despite opposition from <a href="http://www.theage.com.au/victoria/premier-daniel-andrews-rejects-coroners-call-for-a-safe-injecting-room-20170221-guhuif.html">Victorian Premier Daniel Andrews</a> and <a href="https://www.theguardian.com/australia-news/2017/feb/21/victorias-health-minister-rejects-trial-of-safe-heroin-injecting-room">Health Minister Martin Foley</a>, there are no legal reasons to prevent one from being set up.</p>
<p>And despite media reports, such a facility would not “legalise drugs”. Rather, there are legal options to set up what the coroner described as an “essential intervention” that would likely save lives and prevent further overdoses.</p>
<h2>How can a drug injecting room be legal?</h2>
<p>Australia already has a legal supervised injecting facility, the <a href="https://uniting.org/our-services/for-adults/sydney-medically-supervised-injecting-centre">Medically Supervised Injecting Centre</a>, in Sydney’s King’s Cross. This is one of about <a href="https://theconversation.com/why-australia-needs-drug-consumption-rooms-53215">90 such facilities around the world</a>, mostly in Europe.</p>
<p>A <a href="http://www.legislation.vic.gov.au/domino/Web_Notes/LDMS/PubPDocs.nsf/ee665e366dcb6cb0ca256da400837f6b/45DA3F157657671FCA2580C0007268EF/$FILE/581PM25exi1.pdf">private member’s bill</a> before the parliament proposes an 18-month trial of a supervised injecting facility. This would need similar law reform in Victoria to the types of reforms that occurred in New South Wales before the Sydney facility opened. If passed, the law would provide a licence for the Melbourne facility to operate under a series of strict conditions. </p>
<p>People who use the facility would need to be exempt from prosecution for being in possession of small amounts of drugs for personal use, and exempt from being prosecuted for using those drugs.</p>
<p>This exemption would apply to a designated area – immediately around the facility – to allow people using the service to get in and out of it without arrest. There would be nothing unusual about such an approach; most facilities around the world operate with similar exemptions.</p>
<h2>Part of wider harm reduction</h2>
<p>Many people who oppose supervised drug injecting facilities do so out of fear they undermine Australia’s criminal justice system.</p>
<p>One commentator <a href="http://www.heraldsun.com.au/news/opinion/tom-elliott/tom-elliott-injecting-rooms-are-at-odds-with-our-laws/news-story/3e6604c86d21db89f8463256d8176a04">argued</a> the proposal was an “appalling idea” that encouraged breaches of the law and sent mixed messages about the legality of drugs:</p>
<blockquote>
<p>While harmful drugs remain illegal, there’s no sound way society can tolerate a government-subsidised facility in which people are permitted to ingest them. Facilities like the one suggested for North Richmond, would force Victoria Police to ignore some of the important laws they’ve taken a serious oath to uphold.</p>
</blockquote>
<p>There is a flaw in this argument. Australia’s <a href="http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/nds2015">National Drug Strategy</a> involves measures aimed at reducing the demand for, and supply of, drugs. The strategy also recognises it is not possible to eradicate all drug use, and so it encourages harm reduction.</p>
<p>A supervised injecting facility would be yet another harm reduction measure.</p>
<p>Australia already has a suite of measures aimed at reducing harms from drug use. This includes a national <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/775BC0C9246B864ACA257BF000195991/$File/frame.pdf">network of needle and syringe programs</a> for people who use drugs to access clean needles, the <a href="http://www.anex.org.au/reducing-harm/needle-and-syringe-programs-nsps/">benefits of which</a> have been widely reported.</p>
<p>Australia was a <a href="https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&ved=0ahUKEwjF3N2S4qLSAhWFoJQKHeykASwQFghGMAc&url=https%3A%2F%2Fwww.turningpoint.org.au%2FMedia-Centre%2Fcentrepubs%2FGetFile.axd%3Foid%3D743daa22-e465-4cb3-b6b2-1b5c98380247&usg=AFQjCNHp34g-HGmut10JpFLXp3n1Z58jlQ&cad=rja">pioneer of harm reduction measures</a> like these. Such measures are now rightly acknowledged as a vital part of our national drug strategy. A supervised drug injection facility that offers support and access to other health services for people who use drugs is not all that different.</p>
<h2>At odds with the evidence</h2>
<p>Political opposition to a supervised drug injecting facility in Victoria is at odds with evidence finding they bring <a href="https://theconversation.com/why-australia-needs-drug-consumption-rooms-53215">health, social</a> and <a href="http://www.health.nsw.gov.au/mentalhealth/Documents/msic-fr.pdf">economic benefits</a> to the community. </p>
<p>For example, such facilities are often a gateway for connecting marginalised and disadvantaged people to vital health care and other support services. This includes, for those who want it, alcohol and drug treatment services.</p>
<p>Most importantly, supervised drug injection facilities around the world have <a href="http://dpmp.unsw.edu.au/sites/default/files/dpmp/resources/DPMP%20Bulletin%2022_0.pdf">prevented many fatal drug overdoses</a>. And Sydney’s Medically Supervised Injecting Centre has overseen nearly one million injections and managed over 6,000 overdoses <a href="https://uniting.org/__data/assets/pdf_file/0005/139370/Uniting-MSIC-Brochure-.pdf">without a single death</a>. </p>
<p>Calls for a such a facility in Melbourne have also received <a href="https://media.wix.com/ugd/6fc9bb_71256c598c034005b319e8db26b0ecd5.pdf">high-profile support</a> from doctors’ groups and former <a href="http://www.theage.com.au/victoria/kennett-renews-calls-for-safeinjecting-room-every-human-being-is-entitled-to-life-20151229-glw7jn.html">Victorian Premier Jeff Kennett</a>, as well as from <a href="http://www.heraldsun.com.au/leader/north/richmond-traders-change-tune-on-support-for-safe-injecting-room-to-combat-drug-use-on-victoria-st/news-story/b1dc86d6c5cee59ff04dc436e57d88df">local traders</a> and <a href="https://www.facebook.com/VictoriaStreetDrugSolutions/">residents</a>. </p>
<h2>We need to act now</h2>
<p>Law reform is simple, necessary and urgent if we are to prevent further overdoses. So, while there are <a href="http://creidu.edu.au/system/resource/9/file/Report-Nth_Richmond_Public_Injecting_Impact.pdf">drug overdoses</a>, the issue will remain on the political agenda.</p>
<p>As well as the <a href="http://www.legislation.vic.gov.au/domino/Web_Notes/LDMS/PubPDocs.nsf/ee665e366dcb6cb0ca256da400837f6b/45DA3F157657671FCA2580C0007268EF/$FILE/581PM25exi1.pdf">private member’s bill</a>, drug law reform is the subject of a Victorian parliamentary <a href="http://www.parliament.vic.gov.au/lrrcsc/inquiries/article/2809">inquiry</a>, due to report in March 2018.</p>
<p>The Victorian government needs to reconsider its position and implement the coroner’s recommendation without delay.</p><img src="https://counter.theconversation.com/content/73373/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Seear receives funding from the Australian Research Council through a Discovery Early Career Researcher Award (DECRA) Fellowship (DE160100134). Her research examines comparisons of addiction concepts in law across Australia and Canada. This article is based on research undertaken for that project, which has included an analysis of the establishment of Canada's first supervised injecting facility, Insite, in Vancouver. She also receives funding from the Queensland Mental Health Commission to study the relationships between stigma and discrimination through alcohol and other drug law and policy. </span></em></p>There’s no legal reason why Victoria can’t have its own medically supervised drug injecting room to prevent more overdoses, despite political setbacks.Kate Seear, Academic Director of Springvale Monash Legal Service & Senior Lecturer in Law, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/733432017-02-22T04:29:56Z2017-02-22T04:29:56ZYes, we can do on-the-spot drug testing quickly and safely<figure><img src="https://images.theconversation.com/files/157623/original/image-20170221-18627-1q1ya9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The not-for-profit UK group The Loop said it tested the drug ecstasy with 'loop lasers' at a festival in July 2016. </span> <span class="attribution"><a class="source" href="https://www.facebook.com/WeAreTheLoopUK/photos/a.476925732388189.1073741829.454797594601003/1080182912062465/?type=3&theater">The Loop UK/Facebook</a>, <span class="license">Author provided</span></span></figcaption></figure><p>The Victorian Police Chief Commissioner Graham Ashton’s recent claim that it’s not practical to conduct on-the-spot drug tests “<a href="http://www.abc.net.au/news/2017-02-19/electric-parade-festival-more-than-20-overdose-hospital/8283828">safely and quickly</a>” is, at best, misinformed. These tests have been taking place successfully in Europe for more than a decade.</p>
<p>Ashton’s statement came in response to renewed calls for on-the-spot drug testing in Victoria after more than 20 people were hospitalised as a result of a <a href="http://www.theage.com.au/victoria/more-than-20-drug-overdoses-at-electric-parade-dance-party-20170218-gug5as.html">mass overdose</a> at a dance party in Melbourne on Saturday night. The incident occurred just weeks after <a href="https://www.theguardian.com/australia-news/2017/jan/16/three-dead-after-overdosing-on-bad-batch-of-ecstasy-in-melbourne-court-told">three people died</a> after taking a “bad batch” of MDMA in Chapel Street nightclubs. </p>
<p>In response to the calls, Ashton <a href="http://www.abc.net.au/worldtoday/content/2016/s4623002.htm">appeared to question</a> the availability of the systems required for on-the-spot drug tests.</p>
<blockquote>
<p>That’s a bit of a myth really, that there is a proper testing regime that can suddenly test on-the-spot what quality drugs [are]. We take quite a long time to test drugs when we seize them.</p>
</blockquote>
<p>Ashton <a href="http://www.abc.net.au/news/2017-02-19/electric-parade-festival-more-than-20-overdose-hospital/8283828">told the ABC</a> it takes laboratories days to determine what is in a pill.</p>
<blockquote>
<p>So to do that, at those sort of events, to do it safely and quickly is not really a practical option.</p>
</blockquote>
<p>Years of experience in numerous countries around the world tell us this is factually incorrect.</p>
<p>On-the-spot drug analysis has been taking place in Europe for more than a decade, with the support of <a href="http://www.politics.co.uk/comment-analysis/2016/07/28/how-patch-grass-uk-first-decriminalised-drugs-space">law enforcement</a>, associated forensic toxicologists, analytical chemists and academics. A wide variety of drug testing systems using laboratory technologies are <a href="https://www.theguardian.com/society/2016/jul/24/secret-garden-party-pioneers-drugs-testing-for-festival-goers">successfully deployed</a> at events across Europe. </p>
<p>The <a href="http://idpc.net/profile/trans-european-drug-information-project">Trans European Drug Information (TEDI) project</a> combined the data collected in drug testing systems used in Spain, Switzerland, Belgium, Austria, Portugal and the Netherlands. The TEDI project <a href="http://onlinelibrary.wiley.com/doi/10.1002/dta.1954/full">analysed just over 45,000 drug samples</a> taken from public events in those countries between 2008 and 2013. Most of those 45,000 tests, conducted using forensic equipment, were completed in seven to 25 minutes.</p>
<p>Many on-site drug checking systems use a variety of techniques to chemically analyse the composition and dose of the drugs presented. The technology used includes <a href="http://hiq.linde-gas.com/en/analytical_methods/liquid_chromatography/high_performance_liquid_chromatography.html">high-performance liquid chromatography</a> (HPLC), <a href="https://en.wikipedia.org/wiki/Liquid_chromatography%E2%80%93mass_spectrometry">liquid chromatography–mass spectrometry</a> (LCMS), <a href="https://en.wikipedia.org/wiki/Gas_chromatography%E2%80%93mass_spectrometry">gas chromatography–mass spectrometry</a> (GCMS), <a href="https://en.wikipedia.org/wiki/Thin-layer_chromatography">thin-layer chromatography</a> (TLC), <a href="https://en.wikipedia.org/wiki/Fourier_transform_infrared_spectroscopy">fourier transform infrared spectroscopy</a> (FTIR) and <a href="https://en.wikipedia.org/wiki/Tandem_mass_spectrometry">quadrupole time-of-flight mass spectrometry</a> (Q-TOF). </p>
<p><a href="http://www.checkyourdrugs.at/">Checkit!</a> in Vienna have a mobile van from which they run a range of analytical tests more commonly found in a laboratory. These tests are conducted in seven minutes. <a href="http://www.saferparty.ch/allgemein.html">SaferParty</a> in Zurich uses HPLC and GCMS technology, and these tests take 15 minutes. <a href="https://energycontrol.org/noticias/528-international.html">EnergyControl</a> on the Iberian Peninsula uses TLC and GCMS technology, and provides a result in under 20 minutes.</p>
<p>Professor Fiona Measham of <a href="http://wearetheloop.co.uk/">The Loop</a> in the UK uses a new sampling tool that takes 20 minutes. Professor Measham’s <a href="https://www.dur.ac.uk/news/newsitem/?itemno=23079">methodology</a> is supported by the <a href="http://www.tictac.org.uk/">TICTAC database</a>, one of the largest forensic drug databases in the world.</p>
<p><a href="https://en.wikipedia.org/wiki/Marquis_reagent">Reagent tests</a> – the easily available kits that change colour when they come in contact with a drug – are advocated and used by many in the Australian music festival scene. But this is only because there is nothing else to offer.</p>
<p>Reagent tests only identify one substance in a sample, even when many substances are present. With 750 different drugs now on the market, and often used in conjunction with each other, these simple tests are not adequate. Drug testing is also best done by professionals.</p>
<p>This information is widely available. Drug testers are happy to <a href="https://ndarc.med.unsw.edu.au/event/2015-national-drug-trends-conference">discuss</a> their methodology; they are proud of it. They’ve also published it. In Europe, there are publicly available <a href="http://newip.safernightlife.org/digital-library">good practice guidelines</a>. And the technology is already in Australia. By my calculations, there are in excess of 10,000 GCMS machines in laboratories across Australia. </p>
<p>So why the disbelief from the Victorian Police Chief Commissioner?</p>
<p>It could be because the majority of illicit drug samples in Australia are processed by forensic laboratories at the request of law enforcement, and do take some time. The tests run for use in trials are often run multiple times, and analysts take days to return their results. This is entirely appropriate in a legal setting. But we don’t do that in medicine.</p>
<p>We don’t get 10 chest X-rays to confirm a chest infection. We use the appropriate equipment, ensure that it’s well calibrated, and act on the results that we are confident are real.</p>
<p>It is important to acknowledge the role law enforcement plays in stemming the flow of drugs in the community. But it is not the only, or even the best, way to prevent the harm and deaths caused by bad batches of drugs and drug overdoses. </p>
<p><a href="http://www.lapresse.ca/videos/actualites/201309/12/46-1-faire-tester-sa-drogue-en-vingt-minutes.php/c2e6226bdc9c4b828f029c8f9f123800">Drug testing at music festivals</a> is very much about intervention and encouraging behavioural changes, rather than just drily delivering a result. We know from <a href="http://www.sciencedirect.com/science/article/pii/S0955395906001058">research</a> that the majority of consumers would not take a pill if test results indicated the substance wasn’t what they thought it was.</p>
<p>My own work in South Australia between 2002 and 2007 showed clearly that two thirds of consumers chose to do something other than take their pills when they found they contained a substance other than what they expected. The modern generation is <a href="http://www.abc.net.au/triplej/programs/hack/will-sylvia-chois-stereosonic-death-change-pill-testing-policy/6991736">far more interested</a> in having their pills tested than when this practice started.</p>
<p>In addition to changing people’s behaviour, drug testing provides us with information about the specifics of the drugs available. This is an ever changing market. Drug testing can identify substances that <a href="http://www.abc.net.au/triplej/programs/hack/drug-dogs-cost-nsw-9-million-per-year/7444908">sniffer dogs</a> are not yet trained to detect.</p>
<p>In the past year a consortium of scientists, nongovernmental organisations and doctors (including myself) has reached out to the Victorian Department of Health, the Office of the Commissioner and the Victoria Police Forensic Services Department to offer them the opportunity to review our methodology and discuss collaborating in this space. Both have declined.</p>
<p>Should they ever change their minds, our door remains open.</p><img src="https://counter.theconversation.com/content/73343/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Caldicott is a member of Harm Reduction Australia and ATODA, and is the Clinical Lead in the Australian Drug Observatory. He has offered bipartisan academic advice in the development of medical cannabis legislation and drug early warning systems in Australia and overseas. He has no political affiliations or financial disclosures to make.</span></em></p>Victorian Police Chief Commissioner Graham Ashton said conducting on-site drug tests at public events “safely and quickly is not really a practical option”. But the technology is available.David Caldicott, Emergency Medicine Consultant, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/725062017-02-14T05:38:41Z2017-02-14T05:38:41ZFactCheck: it’s true – Western Australia has the nation’s highest rate of methamphetamine use<blockquote>
<p>We have the worst rate of methamphetamine usage in the country. – <strong>West Australian Labor leader Mark McGowan, <a href="https://thewest.com.au/politics/state-election-2017/crime-spike-gave-labor-weapon-hurt-liberals-ng-b88371752z">quoted</a> in The West Australian, February 6, 2017.</strong></p>
</blockquote>
<p>The illicit drug methamphetamine, commonly known as “speed”, “crystal meth” and “ice”, continues to <a href="http://www.abc.net.au/news/2017-01-25/adelaides-methamphetamine-use-climbs-sewage-analysis-shows/8210188">make</a> <a href="http://www.smh.com.au/entertainment/tv-and-radio/tom-carroll-on-his-recovery-from-addiction-and-taking-part-in-the-new-abc-doco-ice-wars-20170202-gu4n35.html">headlines</a> in Australia as communities grapple with its <a href="https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">destructive effects</a>. </p>
<p>In a <a href="https://thewest.com.au/politics/state-election-2017/crime-spike-gave-labor-weapon-hurt-liberals-ng-b88371752z">news report</a> outlining the Liberal and Labor party’s strategies for tackling drug-related crime in Western Australia, state Labor leader Mark McGowan was quoted as saying “we have the worst rate of methamphetamine usage in the country”.</p>
<p>Is that right?</p>
<h2>Checking the source</h2>
<p>When asked for sources to support his statement, a spokesperson for Mark McGowan referred The Conversation to the <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">2013 National Drug Strategy Household Survey</a>, particularly page 11 of the report, which says:</p>
<blockquote>
<p>Meth/amphetamine use was higher in Western Australia (3.8%) than any other jurisdiction. </p>
</blockquote>
<p>The spokesperson also referred The Conversation to the state government’s <a href="https://www.mediastatements.wa.gov.au/MediaDocuments/WA%20Meth%20Strategy%202016.pdf">Western Australian Meth Strategy 2016</a> report, which states on page seven that meth use in Western Australia is higher than the national average.</p>
<p>And the spokesperson cited Western Australia’s Police Commissioner Karl O'Callaghan, who was <a href="http://www.perthnow.com.au/news/western-australia/wa-speaks-meth-drug-issue-voted-states-top-crime-problem/news-story/8274d9ef179070d27a93818c0c39b1eb">reported</a> as saying the state continues to have the highest methamphetamine use per capita in Australia. </p>
<p>You can read the full response from McGowan’s office <a href="http://theconversation.com/full-response-from-mark-mcgowan-72723">here</a>.</p>
<h2>Does Western Australia have the highest rate of methamphetamine use?</h2>
<p>Yes. The latest available Australian data, published in the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/">2013 National Drug Strategy Household Survey</a>, show that 3.8% of the West Australian population had used methamphetamine in the 12 months prior to the survey. That’s nearly double the Australian average of 2.1%.</p>
<p>This isn’t a recent phenomenon. The rate of methamphetamine use in Western Australia has been higher than the rest of the nation since at least the 1990s.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=754&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=754&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=754&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=948&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=948&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156711/original/image-20170214-25962-1msla1b.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=948&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
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<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=545&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=545&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=545&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=685&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=685&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156688/original/image-20170213-25987-1vk4i6c.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=685&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>The rate of methamphetamine use across Australia has been declining since 1998 – including in Western Australia. But over that time, the rate of use in the state has remained consistently higher than the Australian average.</p>
<p>The rate of use of many other drugs, including binge drinking, cannabis and pharmaceuticals for non-medical purposes, is also <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/ch7/">higher in Western Australia</a> than the Australian average. </p>
<h2>How do we know?</h2>
<p>The data in the charts above come from the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/about-ndshs/">National Drug Strategy Household Survey</a>. It’s a reliable data set that’s been collected every three years since the 1990s.</p>
<p>It’s the only population level data we have that shows drug use trends. That means it collects data from the general population, including people who don’t use drugs at all, not just among specific groups of people who use drugs.</p>
<p>It’s not perfect; no dataset is. The survey has been criticised because it’s likely to underestimate drug use. But it is likely to underestimate usage of all drug types in all locations and relatively consistently over time, so it can give us a good sense of trends over time and differences between states.</p>
<p>All the other reliable data available is collected among people in <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/aodts-nmds-2014-15/aodts-nmds/">treatment</a>, people in the <a href="http://aic.gov.au/about_aic/research_programs/nmp/duma.html">justice system</a>, or populations of people who <a href="https://ndarc.med.unsw.edu.au/project/illicit-drug-reporting-system-idrs-d1">regularly use</a> drugs. The rates of use among these groups is much higher than the general population, so the data doesn’t reflect drug use in the general community.</p>
<p>The <a href="http://www.aihw.gov.au/2016-national-drug-strategy-household-survey/">2016 National Drug Strategy Household Survey</a> is due to be released shortly. In general, drug use shows relatively small increases and decreases over time (typically less than half to one percentage point change between years), so it’s unlikely that the 2016 data will buck the long term trend too much.</p>
<h2>People are using more potent forms of methamphetamine</h2>
<p>Although the rate of methamphetamine use across Australia has stabilised at <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">2.1%</a> of the population between 2010 and 2013, we have seen a major shift in the <em>type</em> of methamphetamine people are using. Western Australia has seen the <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549643">same shift</a> as the rest of the country.</p>
<p>In 2010, most people who used methamphetamine preferred to use the less potent powder form, known as “speed”. But by 2013 around half the people surveyed preferred to use the stronger crystal form, known as “ice”. Speed and ice have the same chemical makeup, but ice is a lot stronger.</p>
<p><strong>Changes in methamphetamine use among Australian users aged 14 or older, 2007 to 2013</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156305/original/image-20170210-8655-1hmoiv7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This shows the main forms of methamphetamine used by recent users (meaning within the last 12 months) aged 14 or older, 2007 to 2013.</span>
<span class="attribution"><a class="source" href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2013/ch5/#t5_4">Australian Institute of Health and Welfare, 2013 National Drug Strategy Household Survey</a></span>
</figcaption>
</figure>
<p>The majority of people who use methamphetamine use a small amount, very occasionally, for a short period in their life, and never experience any major problems with it. Around 70% of people who used a methamphetamine in the last year used it <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">fewer than 12 times</a>, and many of those used it only once or twice.</p>
<p>But for the small percentage who do experience problems, it is a drug that can cause significant <a href="https://theconversation.com/crystal-meth-harms-on-the-rise-in-australia-18190">harm</a>.</p>
<p>Even though there hasn’t been a significant increase in the number of people using methamphetamine, the shift to the stronger form means that the risks – which include <a href="https://www.mja.com.au/journal/2016/204/4/estimating-number-regular-and-dependent-methamphetamine-users-australia-2002-2014">drug dependence</a>, <a href="https://ndarc.med.unsw.edu.au/news/methamphetamine-deaths-increase-across-australia-and-ice-use-jumps-52-cent-among-people-who">overdose</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12474/abstract">aggression</a> and <a href="https://www.promises.com/articles/abused-drugs/meth-causes-psychosis-study-finds/">mental health</a> problems – are amplified. As a result, we have seen a big increase in people who use methamphetamine regularly coming to <a href="https://www.mja.com.au/journal/2007/186/7/hospital-separations-cannabis-and-methamphetamine-related-psychotic-episodes?inline=true">hospital</a>, needing an <a href="http://apo.org.au/node/56610">ambulance</a>, seeking <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/aodts-nmds-2014-15/clients/age-profile/">drug treatment</a> and being <a href="http://www.abc.net.au/news/2015-05-15/drug-data-shows-ice-arrests-nearly-double-in-five-years/6471024">arrested</a>.</p>
<h2>Verdict</h2>
<p>Mark McGowan’s statement is correct. Western Australia has the highest rate of methamphetamine use in Australia – and has since records of the use of this drug began. Western Australia has a higher rate of other drug use as well. <strong>– Nicole Lee</strong></p>
<hr>
<h2>Review</h2>
<p>This is appears to be a fair representation of the available population data. As the author notes, no data set is perfect. When you look at groups of people who regularly use drugs, the jurisdictional trends differ from general population trends.</p>
<p>In addition we’d note the heading would more accurately read “It’s true – Western Australia has the nation’s highest rate of methamphetamine use according to available population data”. <strong>– Courtney Breen and Amanda Roxburgh</strong></p>
<hr>
<p><div class="callout"> Have you ever seen a “fact” worth checking? The Conversation’s FactCheck asks academic experts to test claims and see how true they are. We then ask a second academic to review an anonymous copy of the article. You can request a check at checkit@theconversation.edu.au. Please include the statement you would like us to check, the date it was made, and a link if possible.</div></p><img src="https://counter.theconversation.com/content/72506/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant to public, private and not for profit services to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research. She is a member of AOD Media Watch, a site that monitors reporting on alcohol and other drug issues in the media. Nicole was interviewed for the program.</span></em></p><p class="fine-print"><em><span>Amanda Roxburgh receives funding from the federal government.</span></em></p><p class="fine-print"><em><span>Courtney Breen receives funding from the federal government. </span></em></p>West Australian Labor leader Mark McGowan said his state has the “worst rate of methamphetamine usage in the country”. We asked the experts to check the evidence.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/411862016-09-11T20:09:17Z2016-09-11T20:09:17ZHow does ice use affect families and what can they do?<figure><img src="https://images.theconversation.com/files/137130/original/image-20160909-13345-w0v9ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">US TV-style 'interventions' aren't the answer. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-210886186/stock-photo-teenager-problems-teenage-girl-cries-while-her-mother-looks-at-her-on-the-background.html?src=5UtKCi4Tk9jhy81jHfcEMw-1-15">Kamira/Shutterstock</a></span></figcaption></figure><p>Some of the <a href="https://www.youtube.com/watch?v=aVA3Pj6gBGk">greatest impacts</a> of drug use are on families, but families sometimes feel in a position of little control when it comes to responding. Often they receive mixed messages about what they should do.</p>
<p>Ice or crystal meth, the strongest form of methamphetamine, has arguably the biggest impact on families of all drugs. It increases the <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12474/abstract">risks</a> of psychosis, violence and impulsivity and decreases emotional control. This can create a volatile and chaotic environment for people living with a person with an ice problem.</p>
<p>So, what can families really do?</p>
<h2>The good news</h2>
<p>The good news is fewer teenagers and young people are drinking and <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/">trying drugs</a> than in the past. Those who are drinking and taking drugs do so less often than in previous years. Most young people who are offered drugs don’t try them.</p>
<p>Drug <em>use</em> does not necessarily mean drug <em>dependence</em>. So parents shouldn’t panic if they discover their son or daughter has tried drugs. Most people who use drugs do so very occasionally, for a short period and then stop.</p>
<p>Most people who use drugs don’t need treatment. Specialist treatment in a drug and alcohol centre is designed for people who are experiencing moderate to severe harms, such as addiction or dependence (which is the clinical term). </p>
<p>For crystal meth, more than <a href="http://www.sciencedirect.com/science/article/pii/S0376871606001475">weekly use</a> is associated with dependence. Around 15% of people who have used methamphetamine in the last year use once a week. A further 15% use more than once a month but less than once a week. These groups are at higher risk of other harms such as overdose. </p>
<p>That means 70% of people who use methamphetamine do so irregularly and won’t be dependent or experiencing the harms of long-term use.</p>
<h2>Prevention is better than cure</h2>
<p>The best protection for kids is prevention. Children are strongly influenced by their <a href="http://dera.ioe.ac.uk/6903/1/rdsolr0507.pdf">parents’ attitudes</a> – sometimes more so than by their peers. Parents influence when and how their kids use drugs and alcohol through timing, supervision, modelling, attitudes and communication.</p>
<h3>Timing</h3>
<p>There’s a popular myth that introducing kids to small amounts of alcohol early has a protective effect. The argument is that they can learn to drink safely when supervised by parents. </p>
<p>But there’s no evidence that early sips of alcohol are protective, and lots of evidence that delayed drinking reduces risk. </p>
<p>Early supply of alcohol from years 7 to 9 is the single biggest <a href="http://connections.edu.au/publicationhighlight/parents-who-supply-sips-alcohol-early-adolescence-prospective-study-risk">predictor</a> of drinking in year 10. </p>
<p>So delay the introduction of alcohol as long as possible.</p>
<h3>Supervision</h3>
<p>Parents who establish clear and understandable rules and then supervise their children to ensure those rules are followed tend to have children <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084357/">with lower rates of alcohol and drug use</a>.</p>
<p>Low parental supervision is associated with <a href="http://www.sciencedirect.com/science/article/pii/S0890856709634092">earlier</a> drinking and drug use.</p>
<h3>Modelling</h3>
<p>Parents have an important influence on whether kids drink and use drugs through their own <a href="http://scholar.google.com.au/scholar_url?url=https://www.researchgate.net/profile/Judy_Andrews2/publication/14839250_The_Influence_of_Parent_Sibling_and_Peer_Modeling_and_Attitudes_on_Adolescent_Use_of_Alcohol/links/55c1280908aed621de154156.pdf&hl=en&sa=X&scisig=AAGBfm118HWb8-pU_V2x8wRUmrno4bCoTA&nossl=1&oi=scholarr&ved=0ahUKEwir1ZyyvO_OAhUEJJQKHbAUDPcQgAMIHCgAMAA">behaviour</a>. Not getting drunk or using drugs in front of your kids – or not reaching for a medicine for every minor ailment – are the kinds of strategies parents can use to reduce early exposure to alcohol and other drugs.</p>
<p>Kids who learn effective coping and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518980/">social skills</a> and good emotion regulation are also less likely to use drugs. These skills are typically learnt through parental modelling.</p>
<h3>Attitudes</h3>
<p>Clear and early communication of values and <a href="http://www.ncbi.nlm.nih.gov/pubmed/16228115">attitudes</a> to drugs heavily influences children’s attitudes to drug use and the likelihood they will try drugs.</p>
<p>Talk to pre-school kids about safe use of medicines when they are sick. Talk to them about the effects of smoking and alcohol in primary school, especially if you notice smoking and drinking in movies or on TV. Communicate family rules about drinking and drugs in high school, including drinking and driving.</p>
<p>Make not using alcohol and other drugs “normal”. Only a small proportion of teenagers drink and a very small proportion try drugs. Those who do generally drink or take drugs only very occasionally. If teenagers think everyone is doing it, they are more likely to do it themselves.</p>
<h3>Communication</h3>
<p>Keep an open dialogue with young people about alcohol and drugs. Particularly talk to high school students about what is happening in their year level. </p>
<p>Young people are more likely to discuss difficult issues, including drugs and alcohol, when they believe their parents will not be reactive. Using the <a href="http://friendlyschools.com.au/cyberstrong/5-teaching-and-learning/5.4">LATE Model</a> has been shown to increase help-seeking: <strong>l</strong>isten, <strong>a</strong>cknowledge issues, <strong>t</strong>alk about options, and then end with <strong>e</strong>ncouragement.</p>
<h2>What about when there is a problem?</h2>
<p>When someone in the family has a problem with alcohol or other drugs, family members cope in a number of ways, with both positive and negative impacts on the family. <a href="http://opus.bath.ac.uk/21589/1/paper4jo.pdf">Some</a> will tolerate substance use and its impact; some will attempt to change the drug use; and some will withdraw by reducing interaction.</p>
<p>There’s no right or wrong way of responding. But when family members have vastly different coping styles or change the way they cope in unpredictable ways, conflict in the family can result. Agree on boundaries and responses, and stick to these as much as possible.</p>
<p>It can help family members to get support from a family therapist who specialises in alcohol or other drug problems in the family, or from one of the many support groups available. These include <a href="http://sharc.org.au/program/family-drug-help/support-group">Family Drug Help</a> and <a href="http://www.fds.org.au/meetings-and-events/family-support-meetings">Family Drug Support</a>.</p>
<h2>What works?</h2>
<p>Families can encourage the person who uses drugs to seek help from a number of <a href="http://theconversation.com/you-dont-have-to-go-off-the-grid-to-get-treatment-for-drug-dependence-50075">sources</a> if they’re ready. When families are involved in an effective way, the person using drugs is <a href="https://www.researchgate.net/publication/8228917_Family-based_therapies_for_adolescent_alcohol_and_drug_use_Research_contributions_and_future_research_needs">more likely to engage</a> in treatment and outcomes are better.</p>
<p>If the person isn’t ready to seek treatment, talk to a family specialist who can explore options for encouraging someone into treatment.</p>
<h2>What doesn’t work</h2>
<h3>Fat camp</h3>
<p>American TV-style “family interventions” or Southpark “fat camp”-style interventions aren’t generally effective.</p>
<p>The premise behind them is that the person using is in “denial” about their drug use and how it affects others. They are designed to force the person to see those connections. However, confrontation is rarely helpful and it’s often distressing for all involved.</p>
<p><a href="http://www.researchgate.net/publication/14475502_A_Comparison_of_the_Johnson_Intervention_with_Four_Other_Methods_of_Referral_to_Outpatient_Treatment">Research</a> suggests those who enter treatment as a result of a family intervention are less likely to stay in treatment and more likely to relapse.</p>
<h3>Forced treatment</h3>
<p>Last year, Tasmanian MP Jacqui Lambie <a href="http://www.news.com.au/national/politics/senator-jacqui-lambie-reveals-her-son-is-addicted-to-the-drug-ice/news-story/d6804a56adc30cf7d7a8e680c44c2641">voiced</a> many families’ frustration, proposing forced treatment for people who use ice. Lambie eventually admitted, though, that this type of strategy would not have helped her son.</p>
<p>Her assessment was correct. There is <a href="http://www.ncbi.nlm.nih.gov/pubmed/26790691">no evidence</a> that forcing people into treatment has any long-term benefits in reducing drug use. In some cases it can actually backfire, making it less likely a person will seek treatment in future.</p>
<p>While forced treatment is an <a href="https://www2.health.vic.gov.au/alcohol-and-drugs/aod-policy-research-legislation/aod-legislation/severe-substance-treatment-act-ssdta">option</a> in some states in Australia, there are many more palatable options available for people who use ice and their families if treatment is required.</p>
<hr>
<p><em>The <a href="http://abc.net.au/4corners">Four Corners</a> report <a href="http://www.abc.net.au/4corners/stories/2016/09/08/4535254.htm">Rehab Inc, The high price parents pay to get their kids off ice</a> goes to air on Monday, September 12, at 8.30pm on ABC television & iView.</em></p><img src="https://counter.theconversation.com/content/41186/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee provides alcohol and other drug policy development and training to schools and other workplaces as a private consultant. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Paula Ross consults to 360edge which provides alcohol and other drug policy development and training to schools and other workplaces and conducts evaluations of drug treatment programs.
She is affiliated with Family Drug Help@SHARC by her position on the advisory committee. She conducts a private practice in which she sees family and individuals with problems associated with substance use.</span></em></p>Ice increases the risks of psychosis, violence and impulsivity, and decreases emotional control. So what can families really do?Nicole Lee, Associate Professor at the National Drug Research Institute, Curtin UniversityPaula Ross, Sessional psychology lecturer, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/650752016-09-08T10:17:43Z2016-09-08T10:17:43ZThe history behind Philippine President Duterte’s Obama insult<p>Philippine President Rodrigo Duterte speaks his mind. He does not back down. </p>
<p>Some believe he took his plain speaking too far this week before leaving the Philippines for a summit in Laos. </p>
<p>Reporters asked how Duterte intended to answer President Obama’s concerns over the more than <a href="http://www.nytimes.com/2016/09/06/world/asia/in-philippine-drug-war-little-help-for-those-who-surrender.html?_r=0">1,300 drug suspects killed</a> over the past two months in Duterte’s anti-drug campaign. Using a well-known Tagalog obscenity, the Phillipine president called Obama a son of a bitch.</p>
<p>The U.S. responded by canceling a previously arranged official meeting between the two heads of state, although the two men did share an amiable exchange at the summit following Duterte’s comment. </p>
<p>While many are amused by these theatrics, they raise an important question: Why would the Philippine president risk alienating an important and generous ally? This is particularly curious due to the Philippines’ recent public spat with China over activities in <a href="http://thediplomat.com/2016/07/the-philippines-triumph-right-over-might/">the South China Sea</a> – a fight the U.S. could help Duterte maneuver. </p>
<p>Born and raised in the Philippines, I have spent my career in the U.S. studying and <a href="http://catalogue.nla.gov.au/Record/2553587">writing about</a> the Southeast Asian country. While President Duterte’s comments may be a surprise to many, his words are not particularly shocking for Philippine watchers who understand the colonial history of this island nation.</p>
<h2>Pope, president and ambassador</h2>
<p>Within the past year, President Duterte has spoken ill of Pope Francis and <a href="http://www.huffingtonpost.com/entry/duterte-calls-us-ambassador-son-of-a-whore_us_57ab38e1e4b0ba7ed23e537b">labeled</a> the U.S. ambassador Philip Goldberg a “gay son of a whore.” Several weeks ago <a href="http://www.reuters.com/article/us-philippines-duterte-un-idUSKCN10W05W">he threatened</a> to take the Philippines out of the United Nations. In a seeming change of mood, he also praised the United Nations Convention on the Law of the Sea when it recently sided with the Philippines in its loud public claim against China’s activities in the South China Sea. </p>
<p>Duterte may not be popular around the world, but he is a superstar at home, enjoying an unprecedented <a href="http://www.philstar.com/headlines/2016/07/21/1605066/rody-gets-91-trust-rating-leni-62-pulse">91 percent</a> approval rate among Filipinos. It seems he has the pulse of his nation.</p>
<p>Unfortunately, the global press has focused on Duterte cursing at Obama rather than what he said just before. He spoke rather eloquently about leading a sovereign nation and answering only to that nation’s citizens. He noted that he was not a slave and had no master. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ZXdPa4jgupw?wmode=transparent&start=19" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Duterte: ‘I have no master except the Philippine people.’</span></figcaption>
</figure>
<p>President Duterte’s ribald comments are rooted in Philippine history. In insulting the pope, he, in essence, struck at 350 years of Spanish colonial rule. As the famous Phillipine writer León María Guerrero <a href="https://books.google.com/books?id=2Z-n_kDTxf0C&pg=PT48&lpg=PT48&dq=The+history+of+Spain+in+the+Philippines+begins+and+ends+with+the+friar.&source=bl&ots=NF3eZk24kZ&sig=MvQcF-wCoWa_0g9sUvC_i9fK6FA&hl=en&sa=X&ved=0ahUKEwisicmqp_7OAhUhJsAKHdf5A3gQ6AEIIDAA#v=onepage&q=The%20history%20of%20Spain%20in%20the%20Philippines%20begins%20and%20ends%20with%20the%20friar.&f=false">noted,</a> “The history of Spain in the Philippines begins and ends with the friar.”</p>
<p>After attacking Obama, Duterte claimed he meant nothing personal against the U.S. president or his mother. But the reality is that Obama, like the pope, represents a colonial master. The Philippines was an American colony from 1898 to 1946, and I’d argue that America was not as benevolent toward Filipinos as some history books claim. </p>
<h2>Remembering history</h2>
<p>While serving as America’s first Philippine governor general between 1901-1904, William Howard Taft <a href="http://www.u-s-history.com/pages/h1009.html">referred to</a> the Filipinos as “our little brown brothers.” While most people would be little compared to Taft, it was a patronizing nickname – one of the nicer ones American officials and civilians used when referring to Filipinos. Dean Worcester, <a href="http://philippinestudies.net/ojs/index.php/ps/article/viewFile/863/854">arguably the most influential</a> American in the Philippines between 1900-1914, commented that “honesty among Filpinos is a theme for a humorist.” </p>
<p>Still, compared with other 20th-century global colonial experiences, there was unprecedented courtesy between most Americans and Filipinos. That bond was sealed in blood during World War II as they fought and died side-by-side. </p>
<p>After gaining post-war independence without the wars that plagued the other Southeast Asian colonies like Indonesia and Vietnam, the Philippines allowed the U.S. to maintain major naval and air force bases on the island of Luzon. Money flowed into the Philippine economy as the U.S. paid a great deal to maintain these strategic stations. The economies of Olongapo City and Angeles also profited, though many of the businesses that emerged exploited women in the sex industry.</p>
<p>President Duterte is not a historian. But like most Filipinos, he is aware that the U.S. continued to support President Ferdinand Marcos even after he had lost the mandate of his citizens. Marcos’ administration was rumored to be occupied by individuals interested in filling their bank accounts through nefarious means. It took the 1983 assassination of popular opposition leader Benigno Aquino to finally <a href="http://www.nytimes.com/1989/03/19/magazine/reagan-and-the-philippines-setting-marcos-adrift.html?pagewanted=all">convince President Reagan</a> that a time had come to step back from supporting Marcos.</p>
<p>While the current problems Filipinos face – abject <a href="http://www.straitstimes.com/asia/se-asia/philippines-is-still-poor-philippine-daily-inquirer">poverty</a>, <a href="http://business.inquirer.net/210532/ph-has-worst-unemployment-rate-despite-high-gdp-growth-research">unemployment and underemployment</a> and challenges to the <a href="http://business.inquirer.net/166164/a-symptom-of-the-greater-problem-in-health-system">health care system</a> – are largely home-grown, there are legacies of colonialism that contribute to a nation seeking its way out of graft and corruption. Apart from the People Power’s ousting of President Marcos, two former presidents, Joseph Estrada (1998-2001) and Gloria Macapagal Arroyo (2001-2010), were arrested for corruption following their time in office. </p>
<p>Both colonial powers, the Spanish and the Americans, supported an economically and educated elite class that cemented a system where advancement was tied to relationships. The Philippines finally has a president who does not care what the world thinks. He, like many Filipinos, will no longer dance to an outsider’s tune. According to Duterte and his advisors, <a href="http://www.rappler.com/newsbreak/iq/144331-data-drug-problem-philippines">the drug epidemic</a> is destroying the Philippines and they are determined to rid their country of this plague on the land.</p>
<p>So, can Duterte’s comments against a pope, president, ambassador and the world’s largest international organization just be attributed to a grouchy 71-year-old man and a country with a colonial hangover? </p>
<p>In my opinion, it is much more than that. </p>
<p>This is a man – and a country – tired of the judgments of the United Nations that China ignores and weary of promises that foreign nations have the best intentions in the Philippines. </p>
<p>It is a nation that last year wildly celebrated on the big screen the man it sees as real hero of the Philippine-American War which ended in 1902. The Filipinos’ hero was not a colonial collaborator, but General Antonio Luna – a man who fought and died against the Americans.</p><img src="https://counter.theconversation.com/content/65075/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shelton Woods does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Why would the Philippine president risk alienating an important and generous ally?Shelton Woods, Professor of East/Southeast Asian History, Boise State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/644262016-08-29T20:05:46Z2016-08-29T20:05:46ZIs Australia really being flooded by new killer drugs?<figure><img src="https://images.theconversation.com/files/135723/original/image-20160829-17865-h3cynm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Since 2009 an increasing number of drugs have emerged that are designed to circumvent the law and are cheap to produce.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-182841779/stock-photo-hands-holding-grams-and-tabs-of-drugs.html?src=iJka4O3HSqTK0p0yQE-NoA-1-18">Photographee.eu/Shutterstock</a></span></figcaption></figure><p><a href="http://www.theage.com.au/victoria/designer-death-new-killer-drugs-to-flood-local-market-20160823-gqz1lp.html">Recent media reports</a> have suggested Australia is set to be flooded with new types of deadly “synthetic” drugs. </p>
<p>Don’t worry, as far as we know, there’s no “turbo-charged version of ice” on its way. And we need to steer clear of <a href="https://theconversation.com/wont-somebody-think-of-the-children-five-reasons-why-drug-panics-are-counterproductive-50078">drug-related moral panic</a>, which increases stigma and makes it harder for users <a href="https://www.researchgate.net/profile/Jaap_Van_Weeghel/publication/236046466_Stigma_among_health_professionals_towards_patients_with_substance_use_disorders_and_its_consequences_for_healthcare_delivery_Systematic_review/links/00b7d52166fba5dc90000000.pdf">to seek help</a>.</p>
<p>But there is a potential for significant harm in Australia if we don’t have adequate systems in place to monitor our drug markets and respond rapidly when specific dangers are detected.</p>
<p>So what are these so-called “synthetic” drugs? And how are they changing the illicit drug landscape?</p>
<h2>The facts about new drugs</h2>
<p><a href="http://www.emcdda.europa.eu/edr2016">Since 2009</a>, we have detected an increasing number of drugs that are designed to circumvent the law and are cheap to produce. By selling these new drugs as traditional drugs, manufacturers have been able to make large profits. </p>
<p>Take the emergence of <a href="https://theconversation.com/explainer-what-is-nbome-16950">NBOMe</a> drugs, for example. These were first sold as LSD in Australia in 2012. Australians can now buy NBOMe from <a href="http://www.ijdp.org/article/S0955-3959%2816%2930227-4/abstract">drug cryptomarkets</a> in bulk for 36 cents per dose, which can be sold as LSD for A$10-A$20 per dose. </p>
<hr>
<blockquote>
<p><strong>Further reading</strong> – <a href="https://theconversation.com/explainer-what-is-nbome-16950">Explainer: what is NBOMe?</a></p>
</blockquote>
<hr>
<p>Young people have increasing access to new drugs about which we have little information. </p>
<p>One example is <a href="https://theconversation.com/legal-highs-what-should-we-do-about-synthetic-cannabis-10386">synthetic cannabis</a>. More than 40 Australian legislative changes have tried to ban synthetic cannabis, yet it is <a href="http://www.ibtimes.com.au/melbournes-synthetic-cannabis-blue-lotus-sends-consumers-psychotic-state-1524489">still available</a>. However, the toxicity of synthetic cannabis has increased as manufacturers use novel chemicals after each legislative change. </p>
<p>Fortunately, people have <a href="https://www.theguardian.com/society/2016/jun/14/synthetic-drugs-posing-increased-risk-to-australians-global-drug-survey-reveals">become more aware</a> that synthetic cannabis can be harmful and are using it less. </p>
<p>But the number of people seeking emergency medical attention for synthetic cannabis continues to grow. The risk of needing emergency medical treatment when using synthetic cannabis is now <a href="https://www.globaldrugsurvey.com/past-findings/the-global-drug-survey-2016-findings/">30 times greater</a> than for those who use regular cannabis.</p>
<p>The situation is only made worse by the “<a href="https://en.wikipedia.org/wiki/Iron_law_of_prohibition">iron law of prohibition</a>”. When a drug is prohibited, manufacturers look for drugs that are active at lower dosages since this makes them easier to smuggle. If it’s active at a lower dose, you need less of it. During prohibition of alcohol in the United States, people were not brewing beer, they were brewing moonshine.</p>
<p>When it comes to heroin, drugs such as fentanyl have a similar effect, but are much more potent and cheap to produce. It makes economic sense for people to import these chemicals and sell them as heroin. </p>
<hr>
<blockquote>
<p><strong>Further reading</strong> – <a href="https://theconversation.com/fentanyl-and-other-synthetic-opioids-sold-as-counterfeits-in-deadly-new-trend-62814">Fentanyl and other synthetic opioids sold as counterfeits in deadly new trend</a> </p>
</blockquote>
<hr>
<p>North America has had a massive spike in the rate of people overdosing from fentanyl-like drugs, most of which are sold as heroin. In some cases <a href="http://www.cleveland.com/metro/index.ssf/2016/08/carfentanil_powerful_animal_se.html">these drugs</a> are 100 times stronger than fentanyl (or 5,000 times stronger than heroin). </p>
<p>These drugs are also appearing in counterfeit pain medicines in the US. While the singer Prince overdosed on fentanyl, he also had a much stronger <a href="http://kstp.com/news/prince-u-47700-painkiller-system-toxicology-drug-synthetic-opioid/4204272/">drug called U-47770</a> in his system. </p>
<h2>What do we know about new drugs in Australia?</h2>
<p>According to Australia’s <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/2013/illicit-drug-use/">2013 household drug survey</a>, 1.2% of Australian adults reported use of synthetic cannabis products and 0.4% reported use of other “new and emerging psychoactive substances” in the past 12 months. </p>
<p>However, surveys can only provide information on “known” or “intentional” use. There is likely to be a much larger number of people who are using new drugs without knowing. </p>
<p>There have been seizures of a drug called <a href="http://www.smh.com.au/national/health/w18-the-new-street-drug-that-is-10000-times-more-toxic-than-morphine-20160428-gohbaw.html">W-18</a>, for example, that could have been destined as counterfeit heroin. <a href="http://www.abc.net.au/news/2016-06-07/coroner-warns-of-deadly-batch-of-heroin/7488164">Some experts</a> have also linked a recent spate of heroin overdoses across Australia to fentanyl-like drugs. </p>
<p>Wastewater analysis shows that Australians are using a range of novel psychoactive substances <a href="http://www.sciencedirect.com/science/article/pii/S0048969715311955">such as methylone</a>, even though very few Australians report using these drugs. A likely explanation is that they have been sold it as ecstasy. </p>
<p>Again, wastewater analysis provides information only about drugs we already know of.</p>
<h2>So what do we need to do?</h2>
<p>Fear-based campaigns are <a href="http://link.springer.com/article/10.1007/s11121-008-0098-5">counterproductive</a> and may even lead to increased drug use. </p>
<p>What is needed are evidenced-based approaches to reduce harm. For a start, Australia could begin <a href="https://theconversation.com/what-is-drug-checking-and-why-do-we-need-it-in-australia-51578">testing drugs</a> as part of a drug-monitoring system aimed at improving public health and safety.</p>
<p>In the Netherlands, <a href="http://www.ncbi.nlm.nih.gov/pubmed/21898860">testing services for consumers</a> guarantee anonymity and legal protection to donate samples, describe what they believe it is, and get test results on what it actually contains.</p>
<p>If implemented here, this system would give us unparalleled data on the nature and characteristics of the discrepancies between expected and actual drug composition. Combined with forensic testing of police seizures, this monitoring data would allows us to see changes in the drug market and respond rapidly.</p><img src="https://counter.theconversation.com/content/64426/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Monica Barratt receives funding from the National Health and Medical Research Council. She is also Director of Research at Bluelight.org, a not-for-profit harm reduction website.</span></em></p><p class="fine-print"><em><span>Stephen Bright does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is a potential for significant harm in Australia if we don’t have adequate systems in place to monitor our drug markets and respond rapidly when specific dangers are detected.Stephen Bright, Adjunct Research Fellow with the National Drug Research Institute, Curtin UniversityMonica Barratt, NHMRC Post-Doc Research Fellow, National Drug and Alcohol Research Centre, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/579772016-08-28T20:08:02Z2016-08-28T20:08:02ZHow big a problem is ice use among Indigenous Australians?<figure><img src="https://images.theconversation.com/files/128258/original/image-20160627-28373-1r0h8gs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There has been particular concern about methamphetamine use among Aboriginal and Torres Strait Islander Australians.</span> <span class="attribution"><a class="source" href="http://www.flickr.com">Matthew/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>While rates of methamphetamine use in Australia have remained fairly stable at 2.1% over the past ten years, there has been a <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs">shift</a> among people who use the lower-grade powdered form of methamphetamine (speed) to using the higher-grade crystal form (ice) in recent times.</p>
<p>Ice is much stronger than speed and has the potential to cause greater problems.</p>
<p>Purity and availability have increased, while the price of both speed and ice has decreased. The number of people using <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs">weekly or more</a> has grown, which is an <a href="http://www.ncbi.nlm.nih.gov/pubmed/16723192">indication of dependence</a>.</p>
<p>As a result, Australia has seen significant increases in ambulance call-outs, hospital visits, people seeking treatment and police arrests <a href="http://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">related to methamphetamine use</a>.</p>
<p>There has been <a href="http://www.parliament.vic.gov.au/57th-parliament/lrdcpc/article/2135">particular concern</a> about increases in methamphetamine use among Aboriginal and Torres Strait Islander people. So what do we know about ice in these communities? And what are the effective responses? </p>
<h2>Rates of use</h2>
<p>Across Australia, around 2.3% of Aboriginal and Torres Strait Islander people 15 years and over report using methamphetamines in the <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument">past year</a>. This is similar to the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs">general population</a> rate of 2.1%.</p>
<p>Methamphetamine use in remote Aboriginal communities appears to be very limited. Only <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument">0.8%</a> of the remote area population uses methamphetamine. Like the general population, the greater percentage of users are in the cities.</p>
<p>However, there are concerns this may be <a href="http://www.mja.com.au/journal/2015/203/1/recent-warnings-rise-crystal-methamphetamine-ice-use-rural-and-remote-indigenous">changing</a>. <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs">Remote areas</a>, which are largely populated by Aboriginal communities, showed an increase in recent use of methamphetamine between 2010 and 2013.</p>
<h2>Seeking help</h2>
<p>The data is limited, but the rate of Aboriginal people seeking treatment for methamphetamine-related problems seems to be following the same upward trend as other people who use. <a href="http://www.parliament.vic.gov.au/57th-parliament/lrdcpc/article/2135">Service providers</a> report the use of ice in particular has increased among young Aboriginal people.</p>
<p>Although there is no widely available medicine to treat methamphetamine dependence, psychological treatment is effective. <a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/%24File/Patient%20Pathways%20National%20Project.pdf">One study</a> found people who use methamphetamine have the best treatment outcomes of all alcohol and other drug users.</p>
<p>Cognitive behaviour therapy (<a href="http://www.aacbt.org">CBT</a>), motivational interviewing (<a href="http://www.motivationalinterview.net/clinical/whatismi.html">MI</a>) and acceptance and commitment therapy (<a href="http://contextualscience.org/act">ACT</a>) are both effective, as is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">residential rehabilitation</a>. As little as <a href="http://www.ncbi.nlm.nih.gov/pubmed/15733250">two sessions</a> of CBT and MI increases abstinence, even among heavily dependent users. </p>
<p>The evidence is limited for mutual support groups, such as 12-Step (Alcoholics and Narcotics Anonymous) and SMART Recovery (Self-Management and Recovery Training). But this type of post-treatment support may increase the chances of <a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/%24File/Patient%20Pathways%20National%20Project.pdf">maintaining abstinence</a>. Peer worker or telephone contact are other options, but there is little methamphetamine-specific research.</p>
<p>The overall <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">relapse</a> rate after treatment, however, is high and there are few ongoing supports after treatment.</p>
<p>Although Aboriginal and Torres Strait Islander people access these interventions through both mainstream and Aboriginal-specific services, <a href="http://www.publish.csiro.au/?act=view_file&file_id=PY14126.pdf">little is known</a> about their outcomes. </p>
<h2>Prison diversion programs</h2>
<p>There are a number of mechanisms through which people who use drugs can access treatment via the justice system. </p>
<p>Drug courts, for instance, divert illicit drug users from the prison system into treatment. These operate in most states and have been found to be <a href="http://www.aic.gov.au/criminal_justice_system/courts/specialist/drugcourts.html">effective</a>.</p>
<p>Aboriginal people are heavily over-represented in the justice system, but participation rates in drug court programs <a href="http://www.aic.gov.au/media_library/conferences/2006-drugdiversion/keynoteking.pdf">varies</a>. Where drug courts have taken a collaborative approach to design and implementation, working closely with Aboriginal and other organisations, participation rates are <a href="http://www.aic.gov.au/media_library/conferences/2006-drugdiversion/keynoteking.pdf">higher</a>. </p>
<h2>Improving access to treatment and support</h2>
<p>It is generally agreed responses to alcohol and other drug use in Aboriginal and Torres Strait Islander communities should be community owned and driven. </p>
<p>The Mallee District Aboriginal Services (MDAS) in Victoria, for example, has conducted <a href="http://www.onemda.unimelb.edu.au/sites/default/files/docs/Onemda%20Ice%20Report-WEB.pdf">research</a> to advocate for service improvement. MDAS developed a <a href="http://www.youtube.com/watch?v=EG-f3HQRhwo">short film</a> where Aboriginal people discuss how they have reduced their own ice use and ice use in their families. </p>
<p>This work highlights the vital role of families in helping people to give up using ice and avoid relapse. The <a href="http://www.lowitja.org.au/family-wellbeing-program-empowerment-research">Family Wellbeing Program</a> has been shown to empower Aboriginal individuals and families to take greater control of their lives. This may involve re-engaging in education and employment, addressing challenges such as family conflict and advocating for community services and support. </p>
<p>MDAS is partnering with La Trobe University to evaluate whether the program is a useful add-on to alcohol and drug treatment in supporting individuals and families who are affected by ice use.</p>
<p>The Victorian government has <a href="http://www.parliament.vic.gov.au/57th-parliament/lrdcpc/article/2135">made some progress</a> in improving treatment and support. It has piloted an <a href="http://www.healthinfonet.ecu.edu.au/key-resources/programs-projects?pid=2587">18-month program</a> to link mainstream specialist services with Aboriginal services. The aim is to build the capacity of both sectors to respond specifically to Aboriginal people and their families who are affected by the use of methamphetamine. The pilot is under evaluation.</p>
<p>But there is plenty of room for improvement. Both the Aboriginal and generalist drug and alcohol workforce have identified a need to be <a href="http://www.parliament.vic.gov.au/57th-parliament/lrdcpc/article/2135">better skilled</a> in responding to the needs of Aboriginal people who use methamphetamine.</p>
<p>Culturally appropriate harm-reduction strategies are critical for people who continue to use methamphetamine. Indigenous people in the United States, for example, have successfully used <a href="http://www.tandfonline.com/doi/abs/10.1080/02791072.2011.629140#.V0KzB2Y3nbE">culturally targeted education</a> and social marketing, plus individual and family treatment, to reduce methamphetamine-related incidents and arrests.</p>
<p>Finally, we need better data and project evaulations to create an <a href="http://www.publish.csiro.au/?act=view_file&file_id=PY14126.pdf">accurate picture of methamphetamine use</a> among Aboriginal Australians and develop more effective responses.</p><img src="https://counter.theconversation.com/content/57977/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant to health services to support best practice implementation of methamphetamine and other drug treatment and is the President of the Australian Association for Cognitive and Behaviour Therapy. She has previously been awarded grants by the NHMRC and Australian Government for research into methamphetamine treatment options. Nicole is leading the team evaluating the Aboriginal Metropolitan Ice Partnership Program.</span></em></p><p class="fine-print"><em><span>Sarah J MacLean receives funding from the Australian Research Council. She has received funding in the past from the University of Melbourne to investigate methamphetamine use in Aboriginal communities, and is currently funded by La Trobe University to undertake pilot research into the effectiveness of a family wellbeing intervention as an adjunct to alcohol and drug treatment for methamphetamine users. </span></em></p>Around 2.3% of Aboriginal and Torres Strait Islander Australians 15 years and over report using speed or amphetamine in the past year. This is similar to the general population.Nicole Lee, Associate Professor at the National Drug Research Institute, Curtin UniversitySarah J MacLean, Senior lecturer, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/532152016-01-18T03:12:41Z2016-01-18T03:12:41ZWhy Australia needs drug consumption rooms<p>As senior law enforcement officials line up to say Australia <a href="http://www.theaustralian.com.au/national-affairs/ice-a-crisis-for-all-to-tackle-says-new-tsar-ken-lay/news-story/92fdf9dd9895dc8a011a6b1b32abcb70">cannot arrest</a> its way out of our illicit drug problems, some politicians have expressed <a href="http://www.theaustralian.com.au/national-affairs/health/push-for-injecting-room-trial-divides-state-libs/news-story/0b835c6f57e9e2adda150dbcdb64cb82?login=1">opposing views</a> about drug consumption rooms. This debate is now raging in Melbourne.</p>
<p>Drug consumption rooms enable people to use drugs under the supervision of trained staff. Generally established close to large drug markets, <a href="http://www.salledeconsommation.fr/_media/drug-consumption-rooms-emcdda-pod2015.pdf">they have been shown</a> to reduce the spread of HIV and hepatitis C, reduce deaths and injuries due to drug overdose, reduce ambulance call-outs, increase referral to health and social services including detoxification and drug addiction treatment and reduce public drug injecting and numbers of discarded needles.</p>
<p>The <a href="http://www.sydneymsic.com/images/resources/pdfs/MSIC_Final_Report_26_9_08_Saha.pdf">annual cost</a> of Sydney’s Medically Supervised Injecting Centre is about A$3 million, roughly equivalent to the annual cost of imprisoning about 30 people. While the benefits of incarceration can be difficult to identify, the Medically Supervised Injecting Centre produces <a href="http://www.sydneymsic.com/images/resources/pdfs/MSIC_Final_Report_26_9_08_Saha.pdf">larger financial savings</a> than it costs to run.</p>
<p><a href="http://www.theaustralian.com.au/national-affairs/health/heroin-making-comeback-as-painkillers-become-noninjectable/news-story/ae1f1eaa424e0ea71abb38dca3bcbc5c">Another benefit</a> of drug consumption rooms is providing authorities with rapid feedback about the drugs currently used in the street.</p>
<p>Drug consumption rooms are remarkably effective at attracting isolated people with almost no contact with any health or social service. Many have off-the-scale mental and physical health problems.</p>
<p>Some drug consumption rooms only focus on supervised drug consumption and emergency care in the event of an overdose. Others also provide a wide range of health and social supports. The range of additional services can include counselling, health education, food, referral to health care including drug treatment and social assistance, shower and clothes wash, the use of a phone, and referral to work or social integration services.</p>
<p>The first official drug consumption rooms established in Bern, Switzerland, in 1986. <a href="http://www.salledeconsommation.fr/_media/drug-consumption-rooms-emcdda-pod2015.pdf">There are now</a> 88 drug consumption rooms operating in 58 cities in nine countries. Most drug consumption rooms are in Europe. Outside Europe there is only one drug consumption room in Sydney and another in Vancouver. Canada wants to open more drug consumption rooms while France, Ireland, Slovenia and Portugal are all planning to open drug consumption rooms this year.</p>
<p>The best evaluations of drug consumption rooms were carried out in Sydney and Vancouver. <a href="http://www.salledeconsommation.fr/_media/drug-consumption-rooms-emcdda-pod2015.pdf">These found</a> no evidence of increased crime in the vicinity, and no evidence for increased drug use or delayed entry to drug treatment. Fears that the problems of drug markets might be exacerbated have proved groundless.</p>
<p>In some European cities, inhalation of drugs such as crack cocaine, heroin and ice has become more common than injecting. Consequently, drug consumption rooms are now being set up to provide supervised inhalation. </p>
<p>These drug consumption rooms may be a great help in Australia, where there is considerable anxiety about ice – a drug that is often heated, releasing a vapour that is then inhaled. In order to avoid occupational health problems for staff, drug consumption rooms providing supervised inhalation have powerful ventilation and extraction systems.</p>
<h2>The Melbourne debate</h2>
<p>Former Victorian premier Jeff Kennett has been <a href="http://www.theage.com.au/victoria/kennett-renews-calls-for-safeinjecting-room-every-human-being-is-entitled-to-life-20151229-glw7jn.html">strongly advocating</a> the establishment of a Melbourne drug consumption room since visiting the Medically Supervised Injecting Centre in Sydney’s Kings Cross in 2015. After 15 years of work on mental health at Beyondblue, Kennett understands how tough life is for people who attend a drug consumption room.</p>
<p>Victorian Premier Daniel Andrews made an <a href="http://www.heraldsun.com.au/news/victoria/angry-richmond-traders-and-residents-say-heroinshooting-gallery-is-not-the-answer/news-story/4115f165883c821e0481bccc0b4ace19">election promise</a> not to establish a drug consumption room in the state. However, he could make a commitment – preferably a bipartisan one – to establish a drug consumption room in Melbourne after the next state election. The case for drug consumption rooms is now extremely strong and the case against them is remarkably weak.</p>
<p>Melbourne Lord Mayor Robert Doyle is strongly against establishing a drug consumption room in the city. He <a href="http://www.abc.net.au/news/2016-01-14/jeff-kennett-robert-doyle-at-odds-over-safe-injecting-rooms/7088166">argues</a> that drug consumption rooms don’t break the crime nexus. While that is true, this was never their objective. It is equivalent to objecting to safety belts because they don’t stop car crashes. </p>
<p>Doyle’s claims that drug consumption rooms don’t get people off drugs is simply incorrect. They increase referral to treatment in a population with almost zero current access to treatment, and there is <a href="http://www.drugsandalcohol.ie/17898/1/IDPC-Briefing-Paper_Drug-consumption-rooms.pdf">plenty of evidence</a> treatment helps people to come off drugs.</p>
<p>His argument that drug consumption rooms are “not a silver bullet” conveniently set up a straw man: no serious advocate has made this claim.</p>
<p>Doyle’s claim that drug consumption rooms are still experimental is irreconcilable with their 30-year history and the impressive evidence of their impact. </p>
<p>He was closer to the mark when he argued that services for drug users should be better co-ordinated, but why not improve co-ordination and establish a drug consumption room? His claim that a single drug consumption room doesn’t reach “all addicts” is true, but neither does a single police station.</p>
<p>Doyle’s most interesting suggestion was his surprising defence of prescription heroin treatment. Trials of heroin-assisted treatment in six countries involving a total of more than 1,670 severely dependent heroin users who never responded to previous treatment provided substantial health and crime-reduction benefits. The Howard government was wrong to stop Australia’s trial 19 years ago; the Turnbull government would be agile, nimble and innovative to allow a heroin trial to now proceed.</p>
<p>Sydney’s Medically Supervised Injecting Centre began operating in 2001. Despite the strong evidence of its benefit, it is still the only one in the country. A country that based drug policy on evidence would have established additional drug consumption rooms years ago.</p><img src="https://counter.theconversation.com/content/53215/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alex Wodak does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With use of drugs such as ice on the rise, drug consumption rooms are now being set up in Europe to provide supervised inhalation.Alex Wodak, Emeritus Consultant, St Vincent's Hospital, DarlinghurstLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/500752015-11-12T19:20:32Z2015-11-12T19:20:32ZYou don’t have to go off the grid to get treatment for drug dependence<figure><img src="https://images.theconversation.com/files/101652/original/image-20151112-9374-zpl23l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Evidence-based drug treatments are relatively successful at reducing use and improving quality of life.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-329595416/stock-photo-mature-woman-discussing-problems-with-counselor.html?src=pp-same_model-329595437-9CTx2p4rAJ1fyYCwfk1MMA-2&ws=1">SpeedKingz/Shutterstock</a></span></figcaption></figure><p>Every other week stories appear online and in the media about alternative “treatments” for drug dependence. <a href="http://www.smh.com.au/world/rock-im-a-drug-addict-and-other-cracking-rehab-admissions-in-kyrgyzstan-20151031-gkepee.html?skin=text-only">Rock therapy</a> in Kyrgyzstan and <a href="http://www.sbs.com.au/news/dateline/story/last-resort-rehab">vomit therapy</a> in Thailand are two recent examples. </p>
<p>Long <a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/$File/Patient%20Pathways%20National%20Project.pdf">waiting lists</a> for drug treatment in Australia and a perception that drug treatments are ineffective may be driving people to seek solutions elsewhere. But these untested interventions are expensive at best and potentially dangerous at worst. </p>
<p>So what treatments <em>do</em> work for ice and other drug users?</p>
<h2>Not all drug users need treatment</h2>
<p>Different drugs have different dependence thresholds. For most drugs, infrequent, short-term users make up the larger group of people. They eventually stop without experiencing any significant problems.</p>
<p>For <a href="http://www.ncbi.nlm.nih.gov/pubmed/16723192">methamphetamine</a> (which includes ice and speed), using more than weekly is associated with dependence. Around <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/">15% of people</a> who used methamphetamine in the past year fall into this category. </p>
<p>For <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1360-0443.2001.9657379.x/abstract">cannabis</a>, around 20% of people who have used in the past year are likely to be dependent. Around 4% of <a href="http://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/TR.097.pdf">drinkers</a> are dependent. </p>
<p>This means that 85% of methamphetamine users, 80% of cannabis users and 96% of drinkers are probably not dependent and are unlikely to need treatment. </p>
<p>Those who are not dependent are still at risk of unwanted side effects and overdose. Harm-minimisation strategies are designed to keep this group, and the community, as safe as possible while they continue to use. Measures include police random breath testing, drug checking (testing the content of drugs) and needle and syringe programs.</p>
<p>Methamphetamine users also commonly experience mental health problems such as transient psychosis (25%) or symptoms of depression (80%). </p>
<p>This group may not be willing, or need, to access drug treatment but may seek help for their mental health symptoms through their GP or other health service. Addressing mental health symptoms can encourage users to <a href="http://www.emeraldinsight.com/doi/abs/10.1108/17570971211225145">seek help</a> for their drug use earlier.</p>
<h2>What works for those who need treatment?</h2>
<p>The goal of treatment for alcohol or other drug dependence is to reduce use and to improve quality of life. According to the National Institute of Drug Abuse (NIDA) in the United States, people who enter and remain in treatment reduce their use of alcohol or other drugs, are less involved in criminal activity and have better general functioning. </p>
<p>There are also <a href="http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment">cost savings</a> to the community through better health and reduced crime.</p>
<p>For those people who use alcohol or other drugs and need treatment there are a number of effective options. The <a href="http://psychology.org.au/Assets/Files/Evidence-Based-Psychological-Interventions.pdf">Australian Psychological Society</a> has undertaken a review of psychological interventions for mental health conditions and found that <a href="http://www.aacbt.org/viewStory/WHAT+IS+CBT%3F">cognitive behaviour therapy</a> (CBT) has the best evidence for its effectiveness. </p>
<p>NIDA endorses a number of <a href="https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies">treatments</a> as effective. Most fit within the group of behavioural and cognitive therapies.</p>
<p>For dependent heroin users and cigarette smokers, and to some extent dependent drinkers, <a href="http://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/pharmacotherapies">drug therapies</a> are also effective. But for other drugs, medical treatments are generally limited to medicines to relieve symptoms of withdrawal or use such as mental health symptoms.</p>
<p>Drug dependence is a chronic health condition and relapse is likely along the road to recovery. The <a href="http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment">overall relapse rate</a> is around 50% after one year. This is similar to relapse rates after treatment for other chronic health conditions, such as diabetes, hypertension and asthma. It is also similar to other mental health conditions such as <a href="http://www.australianprescriber.com/magazine/30/2/44/6">psychosis</a>, which has a reoccurrence rate of 70%, and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2169519/">depression</a> (50%).</p>
<p>The <a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/$File/Patient%20Pathways%20National%20Project.pdf">Patient Pathways</a> study in Australia found that one year after treatment, about 40% of dependent users in treatment were abstinent, ranging from 60% (methamphetamine) to 28% (alcohol). However, continuous abstinence was harder to achieve, with only around 30% of people remaining abstinent for an entire year. </p>
<p>But not everyone who goes through drug treatment aims to be abstinent from drugs. Around 55% of people in treatment succeeded in making significant changes to their use.</p>
<p>A <a href="http://www.odysseyhouse.com.au/uploads/70255/ufiles/ATOS_11_year_bulletin_FINAL.pdf">follow-up of heroin users</a> who entered treatment found substantial reductions in heroin and other drug use, crime and injecting-related health problems. Reductions were still evident after two years and maintained after 11 years.</p>
<h2>When is treatment most effective?</h2>
<p>The idea that drug users need to hit “rock bottom” before recovery is possible is not supported by evidence. Many people make significant changes to their use well before they reach crisis point.</p>
<p><a href="http://pubs.niaaa.nih.gov/publications/arh23-2/086-92.pdf">Motivation</a> is important in the success of drug treatment, but part of the core skills expected of alcohol and other drug treatment professionals is the ability to increase motivation for engaging in treatment and reducing drug use. </p>
<p>In <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2005.01002.x/abstract">a study</a> of an intervention for methamphetamine users, which included a motivational component, more than a third of people entering the study were not interested in changing their drug use. But their outcomes were similar to those who were motivated at the beginning of treatment and both groups showed increased abstinence.</p>
<p>Mandated treatment programs, such as court diversion or <a href="http://www.aic.gov.au/criminal_justice_system/courts/specialist/drugcourts.html">drug court</a> programs, also show that people who are ordered to treatment through the justice system do well once they get there.</p>
<h2>What treatments are available in Australia?</h2>
<p>Specialist alcohol and other drug treatment services vary between states. </p>
<p>Publicly funded services are run by government and non-government organisations. These services are generally free or low cost to the consumer. They offer a range of options including outpatient counselling, group programs, rehabilitation day programs (typically six to 12 weeks), inpatient rehabilitation programs of typically between two and 12 months, and inpatient and outpatient detoxification. </p>
<p>The different treatment options show similar outcomes.</p>
<p>In the public sector, most people needing drug treatment choose <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129551454">outpatient counselling</a>, which is the <a href="http://nationaldrugstrategy.gov.au/internet/main/publishing.nsf/Content/699E0778E3450B0ACA257BF0001B7540/$File/Patient%20Pathways%20National%20Project.pdf">least expensive</a> option. </p>
<p>Although self-help groups are considered peer support rather than treatment services per se, programs such as <a href="http://smartrecoveryaustralia.com.au/">SMART Recovery</a> and a range of 12-Step programs are widely available. These are usually run by consumers and peers at low or no cost.</p>
<p>Private services are also available in all states, both through hospitals – usually offering inpatient detoxification, inpatient stays of typically up to three months that include individual and group attendance – and private individuals, such as psychologists, psychiatrists and addiction medicine specialists. These services vary in cost, some of which may be claimable through Medicare and/or private insurance.</p>
<p>In Australia, government-funded services are expected to meet minimum standards of accreditation for health providers, and some states require minimum qualifications for practitioners. Private providers, such as hospitals, psychologists, nurses and medical professionals, may be required to meet certain professional standards for registration and accreditation. </p>
<p>However, many providers that offer drug and alcohol treatment, such as “counsellors” and “psychotherapists”, are unregulated. There are also no specific minimum requirements for establishing a private drug rehabilitation program. </p>
<p>Some use frameworks that are not consistent with the evidence. Very few have been independently evaluated. If considering treatment, it is important to check into any potential program to ensure it meets best practice standards.</p>
<p>Evidence-based treatments for drug use problems are available in Australia at low or no cost to consumers, but waiting lists can be long. Public investment in these treatment options for drug users is essential if we’re serious about improving access to and outcomes of treatment. </p>
<p>Innovation is important, but new and untested treatment programs should be subjected to well-conducted evaluation of outcomes to ensure they’re not only doing good but are also doing no harm.</p><img src="https://counter.theconversation.com/content/50075/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a private consultant to health services and is the President and Board Chair of the Australian Association for Cognitive and Behaviour Therapy</span></em></p>Many untested drug therapies are expensive at best and potentially dangerous at worst. So what treatments do work for ice and other drug users?Nicole Lee, Associate Professor at the National Centre for Education and Training on Addiction, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/488122015-11-04T03:08:11Z2015-11-04T03:08:11ZExplainer: what is naloxone and how can it help save drug users who overdose?<figure><img src="https://images.theconversation.com/files/99431/original/image-20151023-27631-vcrtwn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most opioid overdoses occur among experienced users.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-147732503/stock-photo-syringe-on-a-grunge-surface-closeup.html?src=8cw-kBNumrGRjcT3dsYwIg-4-53">Alexander Trinitatov/Flickr</a></span></figcaption></figure><p>Naloxone, commonly known as Narcan, is a medicine that temporarily reverses the effects of opioid drugs such as heroin, morphine and oxycodone. If a person overdoses on an opioid, administering naloxone can help revive them.</p>
<p>Naloxone has been widely used in hospital emergency departments and many ambulance services since the 1970s. It <a href="http://espace.library.curtin.edu.au/R?func=dbin-jump-full&local_base=gen01-era02&object_id=212929">has been shown</a> to be remarkably safe, reliable and effective.</p>
<p>In most countries, including Australia, naloxone is only available in the community on prescription. But since the mid-1990s, clinicians and advocates have called for regulators to make naloxone more widely available to opioid users, their peers and family members who might be present or nearby when an overdose occurs.</p>
<p>Earlier this month Australia’s Therapeutic Goods Administration (TGA) heeded this advice and <a href="https://www.tga.gov.au/scheduling-decision-interim/reasons-scheduling-delegates-interim-decision-and-invitation-further-comment-acms-october-2015">recommended</a> rescheduling naloxone to allow over-the-counter (OTC) purchase of single-use pre-filled syringes through pharmacies. </p>
<p>It is likely that from February 2016 Australia will become the second country (after Italy in 1995), to have naloxone formally available without a prescription.</p>
<h2>Prescription take-home naloxone programs</h2>
<p>Take-home naloxone programs involving supply through prescription have successfully operated in Australia since April 2012, when a program was launched in the Australian Capital Territory. This was soon followed by programs in New South Wales, Western Australia, Victoria and South Australia. </p>
<p>A <a href="http://www.atoda.org.au/wp-content/uploads/Naloxone-Evaluation-Report-FINAL_August-2015_BI.pdf">recent evaluation</a> found that over two years, the ACT program reversed 57 overdoses. The program trained more than 200 participants (mostly opioid users) in overdose-prevention and management, and naloxone administration.</p>
<p>A 2010 survey of naloxone programs operating in the United States since 1996 found that 53,000 kits containing naloxone were distributed through 188 programs across 16 US states. This distribution <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm">was reported</a> to have resulted in over 10,000 successful overdose reversals.</p>
<p>Growing international research on implementation of take-home naloxone programs provides further evidence that people who are at risk for overdose and other bystanders are willing and able to be trained to prevent overdoses and administer naloxone. </p>
<p>Recent <a href="http://www.biomedcentral.com/1471-2458/14/297">research shows</a> that even very brief minimal training in using the medicine can be all that is needed to safely administer naloxone.</p>
<p>There is no evidence that wider availability of naloxone leads to riskier or more widespread drug use.</p>
<p>In 2014 the World Health Organization <a href="http://www.who.int/substance_abuse/publications/management_opioid_overdose/en/">recommended</a> that people likely to witness an overdose should have access to naloxone.</p>
<h2>How does naloxone reverse overdoses?</h2>
<p>When a person has an opioid overdose, they lose consciousness and their breathing can slow and even eventually stop. This results in damage to the brain and other organs and, eventually, death.</p>
<p>Most opioid overdoses occur among experienced users. People are most at risk of overdose when their opioid tolerance drops after a period of abstinence or reduced opioid use, such as after prison release, or if they use other drugs such as alcohol or sleeping pills in addition to the opioids.</p>
<p><a href="http://link.springer.com/article/10.1093%2Fjurban%2Fjtg022">Research shows</a> that most overdose deaths occur more than an hour after last injection and that others, such as friends or family, are usually nearby. </p>
<p>However, in most fatal cases, tragically, there is no intervention before death. This is primarily because most people are ill-equipped to respond to overdose (wrongly) assuming, for example, that the deep snoring or gurgling associated with impending respiratory collapse means that the person can be left to “sleep it off”. </p>
<p>But opioid overdose can be managed by monitoring the person, maintaining their airway, providing ventilation (with rescue breathing), basic life support and calling an ambulance. </p>
<p>Naloxone administration can greatly assist in reversing overdose by helping to quickly restart normal breathing.</p>
<p>Naloxone has a very specific action in reversing the effects of opioid intoxication. It does not produce any intoxication itself and has no effect on people who don’t have opioids in their system. </p>
<p>In an emergency situation, naloxone is typically administered by injection into a muscle. It can also be provided in a device so it can be sprayed into the nostrils, but naloxone is not licensed for nasal use in Australia.</p>
<h2>Taking the next step</h2>
<p>While over-the-counter access to naloxone will be an important step in facilitating wider access to the medicine, a number of measures will be needed to expand naloxone availability sufficiently to have a significant impact on the rate of lethal overdoses in the community. </p>
<p>Work will be done over the next few months to make the naloxone product packaging and instruction materials suitable for lay people buying it over-the-counter. Systems must also be developed to train people in how to use the medicine, such as through brief advice from pharmacy staff.</p>
<p>Naloxone is not a silver bullet for preventing overdose deaths. But its wider availability should be one important component of an effective strategy to prevent opioid overdose fatalities. The rescheduling of naloxone in Australia will set a new precedent for other countries and will help save lives for years into the future.</p><img src="https://counter.theconversation.com/content/48812/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Lenton is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund through its core funding of The National Drug Research Institute at Curtin University. For more than 10 years he has conducted research based advocacy calling for the wider availability of naloxone.</span></em></p><p class="fine-print"><em><span>Paul Dietze receives funding from the National Health and Medical Research Council, the Australian Research Council, the National Drug Law Enforcement Research Fund and government health departments. </span></em></p>Naloxone, commonly known as Narcan, is a medicine that temporarily reverses the effects of opioid drugs such as heroin, morphine and oxycodone.Simon Lenton, Deputy Director and Project Leader, NDRI, Curtin UniversityPaul Dietze, Head of Alcohol and other Drug Research, Centre for Population Health; Burnet Principal for Alcohol, other drugs and harm reduction, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/462002015-08-18T20:33:14Z2015-08-18T20:33:14ZSickness or scourge, Australia’s ice problem can’t be summed up in soundbites<figure><img src="https://images.theconversation.com/files/92226/original/image-20150818-12386-r9fiy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">These mixed messages reflect a longstanding tension in public policy and legal debates about drug use.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-193975568/stock-photo-man-slumped-on-sofa-with-drug-paraphernalia-in-foreground.html?src=qKzJQ31tSERFqi00eE97_w-1-1">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>Over the past week, we’ve seen two conflicting messages about the use of crystal methamphetamine, commonly known as “ice”.</p>
<p>On the one hand, Independent Tasmanian Senator Jacquie Lambie has <a href="http://www.themercury.com.au/news/opinion/talking-point-i-just-want-my-son-back/story-fnj4f64i-1227481025883">spoken about</a> her son’s struggle with ice addiction: “I refuse to watch, helpless, as ice seizes my child and turns him into a stranger,” she said. Lambie claims her son is no longer himself, and that she is dealing with the drug, and no longer a person. </p>
<p>Lambie has also called for “addicts” to undergo involuntary treatment for their addiction, a stance that has been criticised by <a href="https://theconversation.com/forcing-ice-users-into-rehab-wont-solve-the-problem-heres-what-we-need-instead-45946">some experts</a>.</p>
<p>In contrast, the federal government announced a new policy priority that would <a href="http://www.theaustralian.com.au/news/latest-news/govt-splurges-18m-for-new-ice-crackdown/story-fn3dxiwe-1227481632744">toughen punishments</a> for people on ice who attack health workers as well as a new “<a href="http://www.abc.net.au/news/2015-08-16/tony-abbott-announces-dob-in-a-dealer-hotline-fight-ice-epidemic/6700794">Dob in the Dealer</a>” campaign designed to reduce drug supply.</p>
<p>Herein lies the central policy dilemma. Are addicts sick and helpless victims with little control over their own behaviour, or brazen criminals who deserve to be punished accordingly? </p>
<p>These mixed messages reflect a longstanding <a href="http://www.tandfonline.com/doi/full/10.3109/16066359.2014.910511#.VdGOA87FHuQ">tension</a> in public policy and legal debates about drug use. How we respond to this dilemma depends in part on how we understand drug “addiction”. </p>
<h2>Ice addiction as a ‘brain disease’</h2>
<p>The view that “ice addicts” are hijacked by a drug that overwhelms their behaviour is supported by neuroscience research that suggests addiction is a “brain disease”. </p>
<p>The brain disease model of addiction is most prominently advocated by the United States <a href="http://www.drugabuse.gov/">National Institute on Drug Abuse</a> which funds around 85% of addiction research worldwide. According to the brain disease model, addiction is a chronic medical illness. This model commonly cites differences between the brains of addicts and non-addicts to explain the compulsive and involuntary nature of addiction.</p>
<p>Senator Lambie’s stance is consistent with the brain disease model of addiction, in that she understands drug use to be compulsive and involuntary. </p>
<p>But if ice addicts are hijacked by changes in their brain due to chronic ice use, should they be held responsible for their behaviour? Wouldn’t their addiction, on this view, make them less – not more – culpable? This is where some of the tensions in how politicians speak about drug use become most obvious. </p>
<h2>But ice users have some control</h2>
<p>Not everyone agrees addiction is a real condition, nor that it’s a brain disease. Critics come from a variety of sources, but commonly centre on different conceptualisations of “addiction”. </p>
<p>Libertarian critics see drug addiction as the hedonistic pursuit of pleasurable substances, no different than other pleasures we engage in, such as sex or food. For these critics, problems arise only when people who use drugs make poor choices, prioritising immediate desires over longer-term needs.</p>
<p>Others, including one of us, have argued that neuroscience research does not prove that drug addiction is a “brain disease”. At best, neuroscience shows that [some individuals](http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14) have developed changes in brain function and structure that make decisions not to use drugs such as ice more difficult.</p>
<p>The view that individuals are unable to control their drug use is inconsistent with other sorts of evidence. Even seemingly severely addicted people are able to control, reduce or stop their drug use following changes in their life, such as marriage or the birth of a child. In fact, if people didn’t maintain some control over their drug use, it’s hard to imagine how anyone would recover, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23653607">as the vast majority do</a>. </p>
<p>Drug use is also sensitive to changes in the cost of drugs in ways that are hard to reconcile with the view that people who use drugs are suffering from a disease that robs them of control over their behaviour.</p>
<p>Other scholars question the push to conceptualise certain behaviours as “pathological” or “<a href="http://www.palgrave.com/page/detail/habits-remaking-addiction-suzanne-fraser/?isb=9780230308107">compulsive</a>”, on the basis that it undermines an individual’s agency. For these <a href="http://www.researchgate.net/publication/228654303_Users_using_used_A_beginner's_guide_to_deconstructing_drugs_discourse">scholars</a>, models of addiction that portray individuals as “sick” and in need of state protection can be hugely damaging, creating and reinforcing the stigma often associated with drug use. It also does not account for the fact that people who use drugs are a <a href="http://www.ashgate.com/isbn/9781409408390">diverse group</a> with a range of experiences. </p>
<h2>The need for informed, rational policy</h2>
<p>Over the coming months the federal government’s <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/MC15-009596-national-ice-taskforce">National Ice Taskforce</a> will develop a National Action Strategy to tackle the harms associated with ice. But so far the debates about policy priorities have been hampered by inconsistent messages about drug use, drug effects, drug addiction and the characteristics of people who use drugs. </p>
<p>Attributing ice addiction to a “brain disease” is not helpful to our understanding of ice use, and grossly distorts the scientific evidence. But while we’re sceptical of the “brain disease” account of addiction, the alternatives are multifaceted and complex. </p>
<p>Policymakers and politicians must go beyond simplistic accounts of drug use and addiction, ideally in ways that exceed notions of addicts as either sick or criminal. The emphasis should instead be on <a href="https://theconversation.com/awareness-campaigns-need-to-target-the-real-victims-of-ice-40631">proven harm-reduction approaches</a>, including increased access and funding to treatment and other support programs that respect the dignity and humanity of people who use drugs.</p><img src="https://counter.theconversation.com/content/46200/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrian Carter receives funding from the Australian Research Council and Monash University.</span></em></p><p class="fine-print"><em><span>Kate Seear receives funding from the Australian Institute of Criminology. </span></em></p><p class="fine-print"><em><span>Jarryd Bartle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Are addicts sick and helpless victims with little control over their own behaviour, or brazen criminals who deserve to be punished accordingly?Jarryd Bartle, Sessional Lecturer in Criminal Law, RMIT UniversityAdrian Carter, Senior Research Fellow, Monash UniversityKate Seear, Academic Director of Springvale Monash Legal Service & Senior Lecturer in Law, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/459462015-08-12T03:50:52Z2015-08-12T03:50:52ZForcing ice users into rehab won’t solve the problem – here’s what we need instead<p>Tasmanian Independent Senator Jackie Lambie <a href="http://www.news.com.au/national/politics/senator-jacqui-lambie-says-she-refuses-to-let-her-sons-ice-addiction-ruin-his-life/story-fns0jze1-1227477370843">this week revealed</a> her 21-year-old son’s problem with ice. She plans to introduce a private member’s bill to enable parents to force their drug-dependent children into treatment. Unused immigration detention centres, Lambie <a href="http://www.abc.net.au/news/2015-08-11/turn-detention-centres-into-ice-detos-units2c-says-senator-lam/6688696">suggests</a>, could be turned into detox facilities.</p>
<p>Assistant health minister <a href="http://www.theaustralian.com.au/national-affairs/jacqui-lambies-ice-rehab-proposal-to-await-taskforce-report/story-fn59niix-1227479375168">Fiona Nash said</a> the Coalition would wait for the National Ice Taskforce to release its final report later this year before deciding whether to support the proposal.</p>
<p>But Australia already has a number of effective options to divert dependent users from prison and into treatment. And there is no evidence to suggest mandatory treatment outside of the criminal justice system would work. Instead, we need to increase funding for treatment, including early intervention programs and “aftercare” services to reduce the rate of relapse.</p>
<h2>How big is the problem?</h2>
<p>Ice is the crystalline form of methamphetamine. Speed is the powder form of methamphetamine and base is a paste form of the drug. But they vary in potency, with ice being the <a href="https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">strongest</a>. It’s like comparing light beer and extra-strength rum: it’s all alcohol, but the latter is much stronger, so you don’t need as much to get the same effect. Or if you use the same amount, you’re more likely to be intoxicated and become dependent.</p>
<p><a href="https://theconversation.com/are-we-in-the-midst-of-an-ice-epidemic-a-snapshot-of-meth-use-in-australia-39697">Around 2%</a> of Australians use methamphetamine, with half of those preferring ice over speed or base. It’s hard to know how many people are dependent on methamphetamine but <a href="http://www.aihw.gov.au/publication-detail/?id=60129549469">around 15%</a> of those who took the drug in the past year used weekly, which is much more likely to cause dependence.</p>
<p>Long-term methamphetamine use can <a href="https://theconversation.com/ice-epidemic-or-not-heavier-use-and-higher-purity-is-increasing-harms-40687">significantly change</a> the structure and function of the brain, which takes a long time to recover. So, although the rate of dependence is relatively low, once users get hooked, it can be really hard to get off, and the relapse rate back to drug use is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">very high</a>: more than 70%. This can be very frustrating for users and the people close to them.</p>
<h2>Drug diversion programs</h2>
<p>Australia already has a number of types of mandated treatment. These all operate through the police and justice systems. The main aim is to reduce reoffending through reductions in drug use.</p>
<p>Police can refer people into treatment as an alternative to the justice system. All states have some kind of “police diversion” initiative, most commonly for cannabis. In South Australia, police are required to refer people who are arrested for simple possession of any drug to treatment as a first-line option instead of to the justice system. Police diversion to treatment has been <a href="http://www.aic.gov.au/media_library/publications/rpp/97/rpp097.pdf">shown to be effective</a> in reducing crime.</p>
<p>Drug courts are special courts where users who have committed non-violent crimes can opt for an intensive treatment program if they plead guilty. Similar to police diversion, courts divert users to treatment instead of the justice system. Drug courts operate in most states and have been <a href="http://www.aic.gov.au/criminal_justice_system/courts/specialist/drugcourts.html">found to be effective</a>.</p>
<p>Police and court diversion all still have an element of choice: the main incentive to choose treatment is to avoid prison or criminal justice system. These programs have shown <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578041/">good results</a> and treatment mandated through the courts can be as effective as voluntary treatment when the practitioners are skilled and well-trained. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2005.01002.x/abstract">Our study</a> of voluntary methamphetamine users showed that even when people were not very motivated for treatment they could still achieve good outcomes.</p>
<p>There is one compulsory treatment centre in Australia in New South Wales for drug users who repeatedly commit crimes. The program has <a href="http://www.bocsar.nsw.gov.au/Documents/l20.pdf">undergone evaluation</a> and shown good health outcomes for participants but we do not know what impact it has on reoffending.</p>
<p>We do not have any treatment facilities in Australia that make treatment compulsory for drug users without criminal charges. There is no evidence that compulsory treatment outside the criminal justice system is effective.</p>
<p>In some countries, including in East and Southeast Asia, people who are suspected of using drugs can be placed in <a href="http://www.sciencedirect.com/science/article/pii/S0955395914003351">compulsory drug treatment centres</a>, which are essentially prisons for drug users. They may not have committed any other crimes. </p>
<p>These facilities are <a href="http://www.ihra.net/files/2010/11/01/IHRA_BriefingNew_4.pdf">internationally opposed</a> on ethical and human rights grounds. They have been criticised for lack of both due judicial process and medical or health assessment prior to a person entering compulsory treatment.</p>
<h2>Why mandatory treatment isn’t the answer</h2>
<p>Drug use is complex and different things work for different people.
But not everyone who uses drugs needs treatment. If someone is a danger to themselves or others as a result of their drug use, there may be an argument for forced treatment. The problem is that a person can be ordered to a treatment facility but they still have to want to take in the information once they are there. </p>
<p>Drug dependence is a chronic health condition and qualified medical and health practitioners are best placed to make recommendations about treatment options, in conjunction with the user. </p>
<p>There are a range of effective treatment options for methamphetamine dependence, including residential rehabilitation and cognitive behaviour therapy (a type of counselling), which, even in <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2005.01002.x/abstract">small doses</a>, can have an impact.</p>
<p>But the relapse rate is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">high</a>. One study showed that after three years, people who had been through residential rehabilitation reported <a href="onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">similar levels</a> of use to those who had not had treatment: more than 70% were no longer abstinent. However, relapse rates are likely to be lower when people receive ongoing support. </p>
<p>Withdrawal on its own, either at home or in a treatment facility, is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03933.x/abstract">not considered effective</a> as a way to reduce drug use in the long term without further treatment.</p>
<p>In Australia, a large percentage of methamphetamine users use less than once a week and <a href="http://www.aihw.gov.au/publication-detail/?id=60129549469">are not likely to be dependent</a> but may experience problems with their use, such as mental health issues and other harms, that would benefit from early treatment.</p>
<p>There is a gap in funding for early intervention programs to help methamphetamine users before they become heavily dependent and also for <a href="https://www.linkedin.com/pulse/article/what-effects-drug-ice-nicole-lee-1">aftercare support services</a> to assist in relapse-prevention in the long recovery time post treatment. </p>
<p>Families and friends can be significantly affected by a person’s drug use and may need support themselves. Family support services can assist parents, partners and other family members and friends to understand how to respond and help methamphetamine users cut down, quit or get professional help. Family support services can help families and friends set boundaries, learn how to provide support and find effective treatment options. </p>
<p>In <a href="http://www.druginfo.adf.org.au/drug-facts/ice#effects">emergency situations</a>, if you or other family members feel threatened, call the police or if someone is showing symptoms of psychosis or overdose, call an ambulance.</p><img src="https://counter.theconversation.com/content/45946/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee receives funding from a range of government and non-government organisations as a consutant to help services respond to ice users. She is Director of The LeeJenn Group consultancy and President of the Australian Association for Cognitive and Behaviour Therapy.</span></em></p>There is no evidence to suggest mandatory treatment outside of the criminal justice system would work. Instead, we need to increase funding for treatment programs, including early intervention.Nicole Lee, Associate Professor at the National Centre for Education and Training on Addiction, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/429742015-06-09T16:39:57Z2015-06-09T16:39:57ZBlanket ban on legals highs could push users towards more dangerous substances<figure><img src="https://images.theconversation.com/files/84388/original/image-20150609-10689-1wjlzhp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Prohibition of popping pills to hit night clubs near you</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/stevendepolo/7315158252/sizes/l">' stevendepolo/flickr'</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>New Psychoactive Substances have repeatedly been labelled the latest “<a href="http://www.emcdda.europa.eu/topics/pods/controlling-new-psychoactive-substances">major challenge</a>” facing those who work in drugs policy. Now, there is new legislation dealing with these so-called “legal highs”; the plethora of substances that mimic the effects of illegal drugs like MDMA and cannabis. The government’s proposed <a href="https://www.gov.uk/government/collections/psychoactive-substances-bill-2015">Psychoactive Substances Bill</a> has been making its way through parliament, and is <a href="http://www.theguardian.com/science/head-quarters/2015/jun/08/the-psychoactive-substances-bill-an-opportunity-or-threat-for-research">now under debate</a> in the House of Lords. </p>
<p>New Psychoactive Substances (NPS) have been gaining attention around the globe over the last 10 years, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.02934.x/full">partly because of</a> their potential to be bought, sold and distributed over the internet. These substances have exposed a crucial flaw in existing drug legislation: namely, that it is generally reactive in its response to new drugs. </p>
<h2>Cat and mouse</h2>
<p>Whenever a new substance is developed, marketed and gains in popularity, it comes to the attention of the authorities and is eventually added to the list of controlled substances. But once a substance has been banned, drug developers can simply make minor tweaks to its chemical structure to create new substances. This locks the government into a cycle of “<a href="http://www.emeraldinsight.com/doi/abs/10.5042/daat.2010.0123">cat and mouse</a>”-style policy-making.</p>
<p>Governments around the world have sought new ways to limit the use of NPS, but the UK’s proposed “blanket ban” is undoubtedly the most stringent approach. If passed, the Psychoactive Substances Bill will ban the production, distribution, sale and supply, and possession with intent to supply of all psychoactive substances, except for those alcohols, foods and medicines which have been listed as exempt. </p>
<p>There are three main premises behind this move: a large number of people are using NPS, implementing such a ban will reduce the number of users, and this in turn will lead to a reduction in overall harm. The only problem is, a closer examination of these claims shows that they are not generally supported by existing research and evidence.</p>
<h2>Where’s the evidence?</h2>
<p>Despite <a href="http://www.theguardian.com/society/2015/may/01/chinese-labs-legal-highs-west-drugs">media hype</a>, the number of people using NPS is <a href="http://www.emcdda.europa.eu/publications/edr/trends-developments/2014">generally quite low</a>. Out of over 500 new substances that have been reported to the <a href="http://www.emcdda.europa.eu/">European Monitoring Centre</a>, only a handful have gained any enduring popularity; namely, mephedrone (or “meow meow”), BZP and synthetic cannabinoids. </p>
<p>Although there is limited evidence on the numbers of NPS users, one <a href="http://ec.europa.eu/public_opinion/flash/fl_330_en.pdf">widely cited survey</a> suggests that around 8% of young people (among whom prevalence is likely to be the highest) in the UK have ever used a new psychoactive substance. In comparison, <a href="http://www.nta.nhs.uk/uploads/uk-focal-point-report-2014.pdf">about 35%</a> of adults in the UK have tried an illegal drug at some point in their lives.</p>
<p>The government may argue that a “blanket ban” prohibiting NPS will still reduce the overall numbers of users. But this seems more optimistic than realistic, in a world that is increasingly recognising that more than 40 years of <a href="http://www.theguardian.com/society/2014/oct/30/punitive-drug-laws-are-failing-study">strict prohibition</a> has not noticeably reduced the overall use of any particular illegal drug. </p>
<p>Again, there is only limited research on the ability of policy to prevent or disrupt use of NPS. But <a href="http://www.lancaster.ac.uk/users/ext-rel/press/LU%20News%20web%20links/Mephedrone_Bubble.pdf">one study</a> shows that while mephedrone was legal in the UK it was the 11th most popular lifetime drug among clubbers. Once it was banned, it moved up to become the 4th most popular.</p>
<h2>Swings and roundabouts</h2>
<p>And even if the UK goverment’s new brand of prohibition were to have unprecedented success in reducing the overall number of users of NPS, it doesn’t necessarily follow that it would reduce harm. In fact, “blanket bans” like the one proposed by the UK government may increase overall harm. </p>
<p>Thriving existing markets for illegal drugs – including <a href="http://www.substance.com/does-dark-web-drug-dealing-make-the-world-a-better-place/11447/">dark web-based cryptomarkets</a> – provide a natural arena for the sale of newly-banned substances. Markets such as these increase harm due to the involvement of organised criminals. Meanwhile, the lack of regulation in these markets increases the price and decreases the quality and purity of the drugs sold on them. </p>
<p>Driving the market for NPS underground will also make it more difficult for potential users to gain reliable information about sensible dosages and likely effects of the substances they are going to take anyway. It will make it harder for experts to gather evidence about the risks associated with the use of these substances, and is likely to have a negative affect on those who want to use these substances for <a href="http://www.theguardian.com/politics/2015/may/29/psychoactive-substances-ban-end-brain-research-britain-david-nutt">legitimate research</a> purposes. </p>
<p>And there is still the potential for “blanket bans” to push people towards the other, potentially more harmful substances that are still available through legitimate outlets, such as solvents and paints.</p>
<p>So, the UK’s stringent Psychoactive Substances Bill is being introduced in an area where levels of use are relatively low, is based on the false assumption that a stricter policy will result in lower numbers of drugs users, and may actually increase the overall harm caused by these substances. Not British drug policy’s finest hour.</p><img src="https://counter.theconversation.com/content/42974/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Chatwin receives funding from the ESRC to run a seminar series focusing on new psychoactive substances..</span></em></p>The government’s “blanket ban” on legal highs goes against the evidence.Caroline Chatwin, Senior Lecturer in Criminology, University of KentLicensed as Creative Commons – attribution, no derivatives.