2008 September

By JAMES SLACK

Drug addicts have been given £2.5million of heroin and nursing care in NHS “shooting galleries” while law-abiding patients are denied life-prolonging treatment.

The addicts are allowed to inject themselves with a pure form of the class A drug in private rooms, under the supervision of round-the-clock nursing staff.

Despite free access to the drug – which costs £15,000 a year, including nursing care – many are still committing crimes.

But leaders of the joint Home Office and Department of Health project, which began quietly two years ago, say initial results are encouraging.

The pilot, limited to London, Brighton and Darlington, could eventually be rolled out nationwide.

Trial leader Professor John Strang, of the National Addiction Centre, based at London’s Institute of Psychiatry, said about 40 per cent of users in London had “quit their involvement with the street scene completely”. “Of those who have continued, which obviously is a disappointment, it goes down from every day to about four days per month,” he added.

“Their crimes, for example, have gone from 40 a month to perhaps four crimes per month. The reduction in crime is not perfect but is a great deal better for them and crucially a great deal better for society.”

The cost of the treatment, including providing heroin, is between £9,000 and £15,000 per patient – three times as much as a year’s course of methadone. It is restricted to hardcore addicts, who experts say cannot be helped in other ways. But critics questioned the decision to plough so much money into treating drug addicts when law-abiding citizens were being denied much-needed drugs.

Despite a huge public backlash, Alzheimer’s patients newly diagnosed with mild symptoms no longer qualify for medication – despite a cost of only £2.50 each day.

Drugs for some types of cancer, arthritis, bone disease and the prevention of blindness in older people are also being restricted, leading to claims of postcode prescribing and bitter court challenges.

Matthew Elliott, chief executive of the Taxpayers’ Alliance, said: “It shows a pretty warped sense of priorities to give criminals free drugs on the NHS whilst denying life-saving treatments to law-abiding citizens.

“Free healthcare shouldn’t be about getting high at the taxpayer’s expense. Drug users should be given help to give up their habits and to lead an honest life. We shouldn’t be aiding and abetting their personal failings.”

Shadow home secretary David Davis said: “This is a white flag approach. The Government are effectively conceding that the war on drugs is not winnable and instead spending millions of pounds trying to ‘manage’ addiction.

“We believe the Government should not focus spending on trying to manage drug addiction but should spend the drugs budget on ending addiction.

“We would do this by expanding the use of abstinence-based drug rehabilitation programs which have proved far more successful at getting people off drugs than the Government’s approach.

“By simply giving addicts drugs, the Government is betraying the people in our society who so desperately need our help, to a life of addiction.”

A spokesman for the Victims of Crime Trust said: “We should not be giving free Class-A drugs to addicts – many of whom will be prolific criminals – at a time when law-abiding members of the public are being forced to go to the High Court to get life-saving treatment.

“We need to get criminals off drugs and stop them re-offending, but it should not be at the expense of people whose only crime is to be gravely ill. We are allowing Class-A drug addicts to hold us to ransom.”

Dr Nicola Metrebian, who manages the clinical trials, acknowledged that supplying the addicts with the specially imported heroin is a heavy financial investment but she added: “It is more expensive than standard treatment, but what we do know is that standard treatment – although it is cheaper – is not effective for this group of people.”

Source: Daily Mail 19th Nov. 2007

Filed under: Drug Specifics :

The government was at loggerheads with its own advisers last night over its new drugs policy.

An influential Home Office-backed committee raised serious doubts about the consultation process behind the 10-year strategy which will be unveiled in April. The Advisory Council on the Misuse of Drugs (ACMD) described the process as ‘self-congratulatory and generally disappointing’ and questioned the credibility of much of the evidence presented to government.  

A spokesman for the Home Office said last month that the consultation process, which is being conducted by the polling agency Mori, had been ‘open’ and had included a wide range of views.

But the council said: ‘We consider that an opportunity has been missed to address the public health problem relating to drug misuse and the balance with law enforcement and the Criminal Justice System…The consultation would benefit from extending further to the wider social harm of drug misuse.’ 

It also said: ‘It is of concern that the evidence presented, and the interpretation given, are not based on rigorous scrutiny. It is not acknowledged that in many cases the information is uncertain and sometimes of poor quality.’ 

Last night politicians said the council’s response raised questions about whether the government was more interested in spinning its record than tackling the war on drugs. ‘The failures of the government’s drugs policy are laid bare for all to see when their own advisory committee condemns the Home Office as being misleading and self-congratulatory,’ said Liberal Democrat leadership contender Nick Clegg. ‘When will the government wake up and acknowledge something many members of the public know: we are losing the war on drugs?’ Clegg said  

Steve Rolles of think tank Transform, which advises the UN on drugs policy, said: ‘The consultation process behind the new strategy has been woeful.’ Last month Transform branded the consultation process a ‘sham’, saying the government had already made up its mind to continue with its current strategy. 

Concerns about the direction of the government’s next drugs strategy come as senior police officers warn that cannabis now presents a greater ‘long-term’ threat to Britain than cocaine. The increasing strength of high-grade ‘skunk’ combined with growing evidence of major criminal involvement in its production was fast becoming an issue of mounting concern. Hospitals recently revealed that the number of mental health admissions as a result of cannabis use had risen by 73 per cent.

 Source: The Observer December 2, 2007

Filed under: Drug Specifics :

Overdoses have claimed more than 30 lives in Glasgow this year

Councillors and drug groups in Glasgow and Lanarkshire are to pilot use of the anti-opiate revival drug Naloxone.

They believe heroin overdose deaths could be halved if addicts’ families are issued with the treatment to inject into overdose victims.

The Conservatives have criticised the £20,000 project as sending out a message that drug misuse is acceptable.

It is estimated that most drug overdoses are witnessed by members of family or friends of addicts.

Police have warned that purer heroin on the streets is contributing to a rise in overdose deaths.

Chaotic lives

In Glasgow alone there were 35 fatalities in the first four months of this year.

Glasgow City Council and the Lanarkshire Drug Action Team have now agreed on pilot projects to provide addicts’ families with Naloxone, which reverses opiate harm.

Neil Hunter, general manager of Glasgow Addiction Services, said: “We have to accept that there are some individuals in the city who are unable, at the moment, to benefit from rehabilitation or treatment.

“They are still leading fairly chaotic and high-risk lives and we have to do something to intervene to try to avoid any harmful consequences.”

However, Scottish Conservative health spokesman David Davidson said: “It’s as if the agencies have given up all hope of getting people away from drugs and getting people back into society.”

Source: BBC News 11th June 2006

Filed under: Drug Specifics :

DRUG USERS IGNORE NEEDLE BINS AS HUNDEREDS THROWN AWAY IN STREETS SURROUNDING CITY CBD;
By Sonia Campbell

CITY Place has been revealed as Cairns’s biggest drug shooting gallery with 1000 syringes discarded since January in toilets and streets surrounding the inner city mall. Addicts are also dumping hundreds of used syringes at many of the city’s other popular public places, including the Esplanade near Muddy’s playground and the city library.

The figures were released this week by Cairns City Council after an audit of its sharps disposal bin program. From January to October the highest number of needles placed in sharps containers in public toilets in Cairns and south of the city were – City Place (700), McKenzie St (188), Lennon Park in West Cairns (129), and Greenpatch at Gordonvale (100).

While the council says the figures confirm the sharps disposal program is working, alarmingly hundreds more used syringes are being discarded carelessly on the ground and in gardens in various public places.

Most of them were found at City Place (300), the Esplanade from Muddy’s to the pirate ship (100), City library (100), and old library site on Lake St (100). “These figures that we’ve got are basically for the southern and city areas and we’re waiting on the northern areas,” Cr Margaret Cochrane said yesterday.

Cr Cochrane said while the City Place figure of 300 syringes found improperly discarded was of particular concern, it wasn’t “disturbing”. “It’s only one improperly discarded needle a day. Which shows that the (sharps) receptacles are being utilised to their intent and the current program is working where the receptacles are,” she said. However, she said in light of the figures, the council would monitor the area more closely. “There would be an opportunity to view the footage on the (security) cameras … and our staff just need to be a little bit more aware of what’s going on.”

Dianne Forsyth from the Cairns Addiction Help Agency said while any used syringe found in a public place was a concern, the numbers being found were quite low, given that about 500,000 needles were issued to the city’s IV drug users in the needle exchange program each year.

“If you look at the number of (discarded) needles that we’re actually collecting, I’m assuming that most are disposing of them safely somewhere else,” Ms Forsyth said. She said more education material supplied to those accessing the city’s needle program, could be one solution.

Cairns Mayor Kevin Byrne said the results of the audit would be used to determine other areas where sharps disposal bins were needed.

Source: The Cairns Post/The Cairns Sun (Australia) December 3, 2005 Saturday

Filed under: Drug Specifics :

Editorial Comment on British government’s New Media strategy for drugs. May 2003

NEW BRITISH MEDIA DRUG CAMPAIGN HAS SCHIZOID TENDENCIES

Late May saw the public launch, on satellite and terrestrial channels, of the British Government’s latest strategy concerning drug misuse. The strategy includes an array of TV and radio announcements, a new web page (www.talktofrank.com), a new telephone help line (to replace the National Drugs Helpline), an email help line, and a collection of CD Rom or print based materials, which local agencies are encouraged to use to promote the campaign and to generate activities with the public. The budget for this campaign is set at £3 million a year for the next three years. The strategy has been given the brand name of ‘Frank’ – this was chosen after much internal contemplation and focus group dialogue. The organizers perceive this brand name to convey an image which is non-judgmental, honest, down-to-earth, entertaining and always there for you – maybe something like an older uncle … that kind of relative whom young people would feel more comfortable speaking with than they would with their own parents. 

The most usual dictionary definition of the word ‘FRANK’ is “open, honest and direct, especially when dealing with unpalatable matters ” … but another definition – intriguingly – is the “stamping of an official mark on a communication”. Moreover, the original Franks were a people that controlled much of Western Europe for several centuries … the choice of name for this campaign might therefore achieve a certain resonance in Downing Street (as an ‘aspirational target’, anyway).

It would be quite wrong to be unremittingly carping about Frank; there are aspects which deserve commendation and encouragement. Paul Betts, father of the late Leah Betts, whose death from ecstasy sparked off a major media campaign, expressed himself encouraged by some of the content, and by the principle of ‘talking with’ rather than ‘talking at’ the young (not a new practice, but certainly a good one). At the same time any campaign which sets itself up as being ‘open, honest and direct’ must expect commentary upon it to be likewise. An overview, therefore, would conclude that there is a mix of the good and the bad; a mix of the sophisticated and the naive – and, above all, Frank seems to be suffering from schizophrenia when he contemplates his goals.

This last point is most evident when Frank addresses drugs other than his ‘betes noire’ (heroin and cocaine) – the strategy is said to dovetail with the overall drug strategy, which has, as one of its main aims, “… helping young people resist drug misuse in order to achieve their full potential in society”. The official press release for Frank backs this up by saying that “A key priority of the drugs strategy is to educate young people and prevent them becoming involved in drugs”. These are aims which would find favour with all but the most libertarian zealots. Sadly, the actual detail of what Frank will get up to is all but invisible in respect of prevention, and seems, more often than not, to be written in terms of fatalism about drug use and thereafter acceptance of drug-using behaviour. Much is made – especially in the adverts – of the assertion that “… as many as one in three people have taken drugs …” without clarifying that this figure is for any use at all throughout one’s lifetime, and the majority of these ‘users’ never do more than ‘dabble’ once or twice before giving up. Even for the higher use group which is young people, the number who use more than twice is as low as one in six, with the figures for regular or for problematic use being very much lower than this.

If Frank intends to be “honest and direct” about “preventing them becoming involved in drugs” then why does the campaign say it will “… focus on the most vulnerable young people … (and) … will focus on cocaine and heroin”? The answer seems to rest in some of the remarks from the rostrum, to professionals and to the Press, at their respective launches. Once again the assertion was made that cocaine and heroin do more harm to society than other drugs, an assertion based on a narrow, user-centric definition of ‘harm’ which ignores significant categories of damage such as intellectual, social and emotional impacts, and which scarcely touches on the damage to people other than the user. Yet again there came the mantra: “The Just Say No approach does not work” – leaving aside the factually contentious (and sometimes tendentious) nature of this claim, there was a noticeable absence of reference to the many other varieties of primary prevention, where the reduction in use that comes from such initiatives is well documented (a more cynical observer might conclude that the underlying agenda is to neuter all primary prevention). So, Just Say No is a no-no … and yet, referring to the fact sheet for the drug ecstasy, the unequivocal statement is made that “When you buy ecstasy you have no way of knowing what is in it, so the safest thing to take is nothing” – in other words, just say no.

The adverts, both TV and radio, will be found humorous by all but the most determinedly morose, and they have a fast-moving style which should appeal to young people – and to many of their parents. There is a debate to be had about underlying messages in the depictions, particularly of adults and of drug users, but this is for the future. Similarly, the language chosen for the fact sheets on specific drugs is simplified and boiled down in order to be more accessible to the lay reader, even though this risks people misconstruing what they perceive – and gives the more pedantic professionals something to get their teeth into. The risk of people picking up the wrong message is a key aspect – reservations have been expressed by several field workers. Picking up the wrong message is almost an Olympic sport amongst young people, and as one seasoned youth worker once observed “There’s nothing wrong with an adolescent, that reasoning with him won’t aggravate”.

Several professionals had things to say on this front. Alistair Lang, the (then) chief executive of D.A.R.E. UK (Drug Abuse Resistance Education) said “There is no harm in having information about drugs in the right places, but this sounds a bit like a ‘Which? Guide to mobile phones’. From the government you want to hear a categorical health warning, of the sort you get on cigarette packets, that drugs can harm – or even kill you”. Oliver Letwin, the Shadow Home Secretary, said it was “… highly questionable for taxpayers’ money to be spent on telling young people that Ecstasy gave them a buzz”.

Mail on Sunday senior columnist Peter Hitchens was trenchant in his criticisms of Frank; in his column on 1st June he urged parents to visit the website (www.talktofrank.com ) and see for themselves the sort of advice being given out Hitchens quoted this disturbing item: “If only illegal drugs came in packets with instructions … we’d all know what the drug would do, how much is too much and what other drugs are to be avoided at the same time”. Hitchens hammers the implications of this kind of presentation, which are that the law is bound to be ignored, and – even more dangerously, that there are safe ways to do drugs. Hitchens took up the website’s invitation to ask questions, and asked two simple ones: “Is it wrong to take drugs?” and “Is it ever safe to take drugs?”. The website was unable to offer a reply to Peter Hitchens, who concluded his article by wondering whether the Home Secretary David Blunkett could answer those simple questions, and added another question – ‘ Will the Home Secretary shut this site down?’ … an answer is unlikely.

Home Office ‘drugs minister’ Bob Ainsworth claimed that “this is the first time the government has tried to reach out to parents and carers as well as children…” which will be viewed with surprise by those drug professionals whose shelves are sagging under the weight of previous government-sponsored material doing just that. Hazel Blears, Public Health minister, came in for some heavy media criticism when she said, “in many cases people do take drugs because it’s a pleasurable thing to do”. The outcry says more about the critics than about the issue; anyone who does not know that one of the primary motivations for drug abuse is pleasure needs to revisit their textbooks. Where the minister misfired was in not making it clear that pleasure from drugs up is artificial, short-lived, and ultimately empty experience, and therefore that the (legitimate) human pursuit of pleasure should be fulfilled via other routes – which a Public Health minister might be expected to not only be aware of, but to advocate. She compounded the felony by paraphrasing the attack on ‘Just Say No’ approaches, which makes one speculate whether her own ‘aspirational target’ is to render her post redundant! (Just say Go?).

Not all the critics of the Frank Campaign came from the prevention side of the field. Danny Kushlik, director of the ‘legalise everything’ Transform Drugs Policy Institute branded Frank a “wasted opportunity” because it offered no advice on ‘Harm Reduction’. He went on to emote “The campaign is crap. It focuses entirely on illegality. It looks like it’s been designed by some official at the Home Office” (hardly a breathtaking deduction). Even Release, the longtime cannabis legalisation campaigners, were unhappy; “Talk to Frank conjures up an image of a white older man”  (Release has, for several years, itself been managed by a white older man…). Of all the liberalist groups, only DrugScope seemed content – less than surprising to those who can see DrugScope’s fingerprints all over this product.

The fact sheets are certainly written in easy-to-read language, including slang, but some of the statements are a cause for serious concern. Amphetamines receive the admonition: “too much, too often can make people depressed and paranoid” – the implication being that lesser consumption is of no concern. Regular users of cocaine or crack can, it is said, develop “a regular habit” (is there such a thing as a ‘irregular habit’?) – but there is no mention of cocaine or crack addiction. With Ecstasy, “some of those who died did so from heat stroke” – but what of the others? Although, with Ecstasy, the uncertainty of what you are being sold leads Frank to recommend that you avoid it, a similar concern about uncertainty as to what you’re sold when it comes to heroin is not accompanied by any similar recommendation to just say no.

As might be expected, the fact sheet on cannabis is the biggest disappointment; and it receives fire from both sides. The UKCIA (UK Cannabis Information Agency) is incensed by what it sees as avoidance of its version of the truth; understandably enough, given their faith in the weed. Prevention professionals have also expressed serious reservations, but on the basis of research rather than faith. The extraordinary increase in strength in recent years, with the consequent major increased risks of psychoses, is brushed aside by the statement: “Some types are very mild. Some are very strong.” There is a blunt and erroneous statement that “It is very unlikely that any one will become physically dependent on cannabis…” and this is reiterated later in the same fact sheet, albeit with psychological dependency acknowledged – yet in a phrasing that suggests this is somehow less of an issue – which any drug worker worth their salt will know is far from the case. Another misleading statement is that “some people use it for medical reasons – MS, glaucoma, (etc) …” – the more correct statement would have been “some people use it in the belief that it has medical benefit”; some people will see this statement as governmental acceptance of a position which – in respect of ‘raw’ (as-grown) cannabis – remains more likely to be scientifically rejected than accepted. Frank goes on to say “medicinal types of cannabis are being researched” – this is unforgiveably sloppy writing; it is extracts of cannabis which are being researched, and then only for ingestion by means excluding smoking; there is no suggestion in the research that smoking cannabis joints is on the research or government agenda. Once again this sloppiness gives credence where none is justified, and unjustified succour to lobbies who are quite capable of making up their own fantasies without the help of the government writers.

At the launch for drugs professionals, first up to introduce Frank was Cathy Hamlyn – Head of Sexual Health and Substance Abuse at the Department of Health. Referring to an increased spend by her department, up from £236 million to £296 million per year (which makes for interesting comparison with just £3 million per year for Frank. One wonders where all the rest is going). She gave the overall aim of Frank as “helping young people understand the risks and the sources of help” (no mention of prevention there) and to “give parents more confidence”. The target age range for Frank was stated as “young people from 11-21 years and for parents of 11 to 18 year-olds”; this is probably a rational age bracket for those receiving or reading the Frank materials, even though there is some incidence of drug abuse below this age.

Next to speak was Katie Aston of the Home Office, who gave an interesting slant on one goal, which she verbalized as “… to reduce use of class A drugs and to reduce the frequent use of illicit drugs” – presumably infrequent use of illicit drugs is OK by Frank. She went on to say that one expectation was that there would be “… a shift in attitudes on specific drugs”, and she gave the example of “modifying the perception of heroin use as being linked with failure”. Quite what the advantage would be, and for whom, in this kind of ‘rehabilitation’ in the characterization of heroin use, is unclear. Equally unsettling was the stated intention, of “… starting the process of destigmatisation of drug abuse”. One can see the advantage, within a  therapeutic process (of counselling or treatment) of the client’s attitude not being clouded by such characterisations; but this is a world away from some general kind of normalisation across society, and with it the risk of suggesting an active acceptance of drug misuse. Home Office urgently needs to get its act together on these issues – assuming, charitably, that they have not already done so.

Also on the rostrum was Sarah Maclean, representing the Department for Education and Skills; she told the professionals that Frank will support schools (and young workers) through drug education advisers, and that this will involve the Drug Education Forum – not the best news for those drug educators who pursue a preventive approach; the DEF has long been dominated by a ‘harm reduction and personal choice’ model … it remains to be seen whether it changes its direction under its new chairman, Eric Carlin, who is UK chief executive of Mentor, the prevention body which has such diverse board members as HM the Queen of Sweden, and George Soros, as well as Lord Mancroft, a Tory peer with a penchant for relaxing drug laws.

A question about the absence of reference to gun crimes and turf wars, and there being only fleeting reference to crack cocaine, brought the response that Frank did not want to generate worry across the nation about specific drug problems which were more regionally concentrated. Questions about the absence of black people in the adverts threw the panel into a confusion of hand-wringing, with protestations that this was only the beginning, and that all ideas from the public and professions, for modifying the campaign will be entertained with enthusiasm. This remains to be seen.

Overall, then, there are things about Frank that are worthy of encouragement, but he has some worrying traits, and he seems to be facing in several directions when it comes to what he is trying to achieve; almost schizophrenic. Being all things to all men may seem a good strategy for a politician, but for a communicator with young people, parents and carers, Frank needs to be more than ‘open and non-judgemental’ – valuable though these values are. Young people can smell hypocrisy a mile off, and can tell when someone is pandering to them in an attempt to be ‘cool’ or to buy ‘cred’. Frank could usefully mature a little, pluck up his courage, and move beyond mere distribution of information – as a caring ‘older uncle’ might well do. Frank speaking about society’s goals does not have to be off-putting, nor does it have to stray into authoritarian mandates. If Frank can help the young and their parents understand – not only what drugs do, but also why it makes sense to avoid them – in the interest of other people, not just the user – then this would be a real leap forward … far beyond just saying ‘No’, and into a truly honest dialogue worth having, in the interests of all of us.

Website: http://www.talktofrank.com     
email: FRANK@homeoffice.gsi.gov.uk    FRANK Hotline:   0800 77 66 00

Filed under: Drug Specifics :

ROBBIE DINWOODIE, Chief Scottish Political Correspondent

A LEADING addiction expert last night said the Scottish Executive was relying too heavily on methadone to combat heroin use. Professor Neil McKeganey, of Glasgow University, was speaking after the Tories highlighted official statistics showing that prescription of the heroin substitute rose by 17% in two years.

Bill Aitken, the Glasgow MSP, accused ministers of “consigning more and more addicts to swim in a sea of methadone dependency”, with 19,000 now dependent on it.

Professor McKeganey said there was no doubt that methadone could be a useful tool in tackling heroin addiction over fixed periods, but its indefinite use was causing experts widespread concern. An executive spokesman said: “The most effective treatment will always depend on the circumstances of the individual addict – there is no ‘one size fits all’ solution.”

But the professor said: “The executive is right to say no one treatment is the answer, but this sits oddly with the fact that methadone appears to have become the first choice and its use is lasting many years. That is a genuine concern.”

Professor McKeganey said research last year, involving 1000 users, showed that overwhelmingly they wanted to get off drugs, and this posed the legitimate question of whether methadone was a route to abstention or merely a tool in stabilising their habit. Figures released by the Conservatives show that in 2002, an estimated 16,401 addicts were being prescribed metha-done. By 2004, that figure had risen to 19,227, with the cost to the taxpayer, from April 2003 to April 2004, over £11.6m.

Greater Glasgow NHS board area has the highest number of individuals being prescribed methadone, with an estimated 6623 addicts receiving the treatment in 2004.

Mr Aitken said: “Methadone is an addictive substance that is a substitute for heroin, not a cure. As a country, we are consigning more and more addicts to swim in a sea of methadone dependency – a publicly-funded drug action programme.”

Source: BBC Report August 2005

Filed under: Drug Specifics :
Despite two decades of needle exchange, London drug users continue to share needles (one in four drug addicts reported sharing needles in the past 4 weeks) and the spread of infectious disease is on the rise (40% of those who have been injecting drugs for six years or less are already infected with Hepatitis C and 3% percent are infected with HIV), according to a new study.
HEPATITIS C ‘EPIDEMIC AMONG LONDON DRUG USERS
Cases of hepatitis C among young drug users in London are reaching epidemic levels, researchers warned today.
The number of people who inject drugs who now have HIV is also worryingly high, according to a study published in the British Medical Journal.
The researchers blamed the Government’s current drug policy for failing to protect this high risk group from bloodborne viruses like hepatitis C.
The team, from Imperial College London, the Health Protection Agency and the London School of Hygiene and Tropical Medicine, estimated that four in 10 new drug users in London now had hepatitis C, which can cause fatal liver damage.
They also estimated that 3% of injecting drug users was now infected with HIV.
The results were based on tests involving 428 drug users who had been injecting for six years or less.
Hepatitis C and HIV can be spread by sharing needles and the researchers found high levels of syringe-sharing during their study.
One in four reported injecting with needles and syringes used by someone else in the past four weeks.
Researcher Dr Ali Judd, based at Charing Cross Hospital, west London, said: “Hepatitis C is now spreading at epidemic levels across London and HIV incidence is worryingly high, which if unchecked will lead to an increase in the total number of HIV infections.
“There is an urgent need for new and comprehensive programmes to tackle this growing number.”
Dr Matthew Hickman, from Imperial College London, added: “For the past six or seven years Government drug policy has focused on drugs and crime, and has been successful in expanding specialist drug treatment, especially through referral from criminal justice.
“However there is a need now to reinvigorate harm reduction policies that prevent transmission of hepatitis C and HIV.”
A Department of Health spokeswoman said the Government was committed to driving down cases of hepatitis C and other blood-borne infections like HIV.
“Almost £500 million will be spent on drug treatment in 2004-05 and we recently announced that all Drug Action Teams will get a 55% increase in their allocations between 2006 and 2008.
“The extra funding in the last few years has led to many more drug users engaging in treatment and an increase in the numbers successfully completing treatment.
“This is good news as there is clearly a link between getting people into treatment and substantially reducing the rate of blood-borne diseases.”
The spokeswoman added: “A Hepatitis C Action Plan for England was launched by the Department of Health in June 2004 calling for a review of harm reduction services to prevent hepatitis C transmission.
“Such services include provision of needle exchange services in the community, safe disposal of used needles and syringes and provision of specialist drug treatment services.”

Source: By Lyndsay Moss, Press Assoc. Health Correspondent November 12, 2004

 

Filed under: Drug Specifics :

CHILDREN as young as ten are drinking and sniffing petrol, a growing and potentially lethal form of solvent abuse, experts warned yesterday.

More children have gained access to the fuel after being bought quad bikes or off-road motorbikes. But many have become addicted to the chemicals in petrol and their parents have phoned the solvent abuse charity LOST, begging for help.

John O’Brien, who set up LOST after his son Lee, 16, died in 2002 from inhaling lighter fuel, said children were playing “Russian roulette” and added: “Parents are asleep to this danger, which could kill their children the first time they try it.”

Mr O’Brien, from Methil, Fife, said: “We first heard about kids drinking petrol about two years ago and since then we have had dozens of calls from parents whose children don’t know how to break the addiction. Kids phone us too. Some say they are being bullied into it by peer group pressure.

“Petrol abuse has always been a big problem in the US, South America and Australia. But in this country, although it has always been around to some extent, it has been exacerbated by parents buying their kids these quad bikes and off-road motorbikes. Youngsters tell each other they can get the petrol out the tank and gulp it down. They are mostly unsupervised on these bikes and out of sight of their parents.

“The chemicals in the petrol, such as butane, give them a buzz which lasts ten to 20 minutes and then they try again when it wears off. They don’t realise that the first time can kill them.”

Richard, 12, who lives in Fife, contacted LOST’s 24-hour helpline earlier this year. He said: “My dad bought me a quad bike for Christmas. He said, ‘Away you go son and have fun’. It was brilliant and everyone wanted a shot. My dad always bought the petrol but we fell out.

“Someone told me just to siphon it off his car, so I did. Then this guy says, ‘You take it from your dad and we’ll sell it to other quaddies and we’ll keep some for socialising.’ I didn’t know what he meant but didn’t want to look stupid. He said, Your mum and dad can booze so why can’t we do the same?’ “We drank the petrol in a park where we went on our bikes. It was a total buzz. I didn’t want to stop. Things were getting mad. I was feeling paranoid, so I phoned John [at LOST].”

Professor Anthony Busuttil, of Edinburgh University’s forensic pathology unit, said: “The butane in the petrol is one of the main substances giving the buzz. It is an extremely dangerous thing. Petrol evaporates quickly and stimulates the vagus nerve, which runs down from the brain stem to the back of the nose, tongue, gullet and neck, causing you to drop dead.”

In Britain, death rates from volatile substance abuse (VSA) are highest in Scotland and north-east England. Since 1971, there have been 2,103 VSA deaths, 282 in Scotland.

Campaigners said the true figures were higher as they did not include fatal accidents and suicides as a result of VSA.

The Scottish Executive said: “We are clear that there is a real need to get a clear message out to young people. We do not see volatile substance abuse as separate from drug abuse, but part of it.”

Source: The ScotsMan Tuesday 6 Sep 2005

Filed under: Drug Specifics :

ALTERNATIVES TO THE HARM REDUCTION POLICY

RESOLUTION

20 May, 2005, Vilnius

 Conference,

  -Having heard the reports of foreign and Lithuanian professionals, and representatives of the Lithuanian organizations, which work in the drug prevention field,

– taking into account the experience of international organizations, which work in the drug prevention field, and their negative assessment they presented of the so called “harm reduction” programs, such as syringes/needles exchange for drug addicts and the substitution or maintenance treatment when drugs (e.g. methadone or subutex) are used, as well as other programs by whatever name, which make the possibility to root drug culture in Lithuania and to legalize drugs,

– having discussed the alternatives suggested by foreign experts – methods and programs,

– taking into consideration the Seimas of the Republic of Lithuania Resolution of March 18, 2003, which stands strictly against attempts to legalize drugs and against the policies, which increase spreading of drugs,

– having assessed the danger for national security of Lithuania and the neighboring countries, which arises from the spreading of drugs,

– having in mind the suggestion of the 1961 conference of the United Nations to the countries, in which drug addiction is a serious problem, and if they have sufficient economies, to ensure drug-free treatment of drug addicts in hospitals,

– paying attention to the fact that in the 48th session of the United Nations Commission on Narcotic Drugs, held on April 7-14, 2005 even the mentioning of the “harm reduction” programs was refused to be included into resolutions, because the commission considered such programs are not relevant to the fight against drugs,

suggests:

For the Action Group of experts organized by the Drug Prevention Commission of the Seimas of the Republic of Lithuania to examine various harm reduction and the alternative programs, which were discussed at the conference, as well as other options and to define the ways how to implement the alternative programs in Lithuania seeking to gradually replace the programs, associated with further legalization of various forms of drug use, with other programs, which are not associated with drug use,

For the Seimas of the Republic of Lithuania to approve the State strategy and policies in the field of drug control and prevention of drug addiction, by which the alternative methods to “harm reduction” programs were legitimated, not raising danger of spreading of drugs, and reducing the drug demand, and by which the following principles would be stipulated:

The Republic of Lithuania invoking the 1961 United Nations Single Convention on Narcotic Drugs, the 1971 United Nations Convention on Psychotropic Substances, the 1988 United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, ratified by the Republic of Lithuania, and the 2002 Seimas of the Republic of Lithuania Resolution on the Prevention of Drug Addiction in Lithuania, as well the 2003 Seimas of the Republic of Lithuania Resolution on the Drugs Control Policy, Decides that:

1) the State priorities of the drug policy are drug supply and demand reduction, which include primary prevention, early diagnostics and intervention in schools and families, also interdiction of illegal distribution of narcotic drugs and psychotropic substances, and the drug-free treatment of drug addicts;

2) The State upholds the strategy against any legalization of drugs, against any theories, strategies or activities, which would stimulate, make easier, and facilitate or promote in any way the use and spreading of narcotic drugs or psychotropic substances;

3) Taking into account the aggravating factors of the criminal responsibility foreseen in the 1988 United Nations Convention, the State tightens up the administrative and criminal responsibility for activities associated with production, distribution, and usage or inducement of someone to use narcotic drugs and psychotropic substances. For persons, who had committed these crimes, with the exception of those who were using narcotic and psychotropic substances, confiscation of property is applied, while release from criminal responsibility, suspension and release from enforcement of punishment for such persons is not used;

4) Special courts (judges) are being established for the lawsuits associated with production, distribution and usage of narcotic drugs and psychotropic substances;

5) The State of Lithuania acknowledges the drug addiction as a disease, and the State undertakes a responsibility to present the adequate conditions for those who want to be treated;

6) Mandatory medical and social control programs are applied for children, who use narcotic drugs and psychotropic substances without prescription, while for those who are dependant on narcotic drugs and psychotropic substances treatment and mandatory social rehabilitation measures financed from the State budget are applied;

7) Regular analysis of normative documents associated with the control of narcotic drugs and psychotropic substances, and activities of the State officials responsible for the drug control on various state power levels, also public organizations, which work in this field is performed with the aim to prevent possible corruption activities and to stop possible attempts of liberalization of the drug policy in Lithuania;

8) The State supports non-governmental organizations carrying out the programs of drug prevention and the programs of public awareness of the drugs made harm.

The Resolution of the Conference has been adopted by consensus.

Filed under: Drug Specifics :

A man walks into your office, and over the course of  an office visit convinces you to prescribe for him a potent narcotic. He tells you that he has been using heroin steadily for the last two years but has been trying to quit. “It all started Doc, when I hurt my back 3 years ago, and I’ve tried to quit but can’t. I’ve applied for a methadone program but there’s a waiting list so can you just prescribe me something until I can get on methadone? I don’t want to have to commit any more crimes.” The two of you decide on MS Contin pills — the 100 mg. size– and before you know it you are prescribing 3 a day for him on a weekly basis, with each week’s excuse as to why he isn’t yet on methadone containing  just enough truth to keep you engaged, though reluctantly. “Well, it’s harm reduction,” you say to yourself, starting to echo the thoughts of your new and very loyal patient. “At least he isn’t out on the streets and using needles.”What you don’t know is that your new patient has been selling most of the pills that you have been providing him with, and injecting the rest. On the streets the grey “peelers” go for $40 each,  (aptly nicknamed because the outer colored coating easily peels off to make them ready for dissolving and injecting.) He’s been using the $120 a day to finance his cocaine addiction, and now he is suddenly able to afford a 2- gram-12 -fixes-a-day habit. Harm reduction? Actually the opposite– this patient was using much less before he started seeing his well intentioned doctor; he didn’t have the money, and was staying away from crime because he was on parole. This type of physician-patient interaction occurs far too frequently, especially when one substitutes Valium or Tylenol 3’s into this scenario. (Financing an alcohol dependence with Valium prescriptions for example)

So what is Harm Reduction and how might it be applied in a medical practice?

Simply put harm reduction attempts to focus on reducing the harm of using drugs rather than on reducing drug use itself. Examples of harm reduction interventions might include needle exchange, drug substitution, safe fixing sites, outreach counseling,  However, as we have seen in the above example, it’s not always that simple. There is a fine line between “enabling”, or facilitating a continued addiction and “harm reduction,”  and it can be difficult to determine when one has crossed that line, especially for those who do not have experience with addiction treatment. Such confusion is also evident on a macro, or policy scale, as any recent news article on harm reduction will illustrate.  Compounding the confusion is a lack of a consistent definition and a measurable outcome for harm reduction.

Harm reduction implemented poorly is not harm reduction. It is now clear that harm reduction needs to take place in a treatment context in order for it to be effective. Perhaps the most obvious example of this is the Swiss experience of the late 80’s, early 90’s. It was the Swiss idea at the time to set aside an area which became “Platzspitz” or Needle Park, where addicts were allowed to buy and use drugs freely. This experiment in harm reduction included free needle exchange, condoms, medical care, and food distribution. By the time this well intentioned idea was deemed a failure and the park was closed, the numbers of addicts in the park had swelled from a few hundred in 1987 to 20,000 in 1992.  Drug related violence and crime rose rapidly in the area. Doctors were resuscitating an average of 12 overdoses a day, and up to 40 on some days. In 1992 the Swiss responded with a period of increased enforcement coupled with a dramatic rise in proven addiction treatments, especially methadone treatment. By the time they were ready to embark on more controversial harm reduction trials the Swiss had a solid foundation of addiction treatment with over 15,000 patients in methadone treatment.

The parallels between the “open drug scene” of Zurich in the early 90’s and the current chaos of the “open drug scene” of downtown Vancouver in the late 90’s are striking. Unfortunately  for BC, it would appear that public policy regarding drug addiction is still being guided by  vocal “service provider” agencies rather than by “treatment providers.” But there is some cause for optimism as “the pendulum has swung back and a reappraisal of the adequacy of harm reduction is occurring…The limitations of a harm reduction framework implemented in isolation from other models has become increasingly evident.” “While promoting tolerance is admirable, the harm reductionists take it too far: if you should not stigmatize addicts, neither should you condone addiction. And with its learn-to-live-with-drugs approach, harm reduction offers no guidance on how to bring down the appallingly high levels of drug addiction in this country.” The challenge now facing those in the field of addiction medicine is how to integrate the strengths of the harm-reduction perspective with the strengths of the conventional use-reduction perspective in a unifying model.To bring it back to the micro level let me offer some suggestions for integrating a harm reduction perspective into your own practice: Expect something in return.
If you find yourself in a situation where you are prescribing abusable drugs with weak medical indications, start by expecting something in return. Consider treatment contracts. Link your prescriptions to measurable outcomes.

Case example: Mr. y has been seeing you for the last two years. He is HIV positive but hasn’t really been taking care of himself. He can’t make it to the lab to get his blood drawn so you have no idea what his T cell count or viral load is. Your relationship has degenerated to the point where you are engaged in intermittent crisis care, except of course for his regular visits to obtain prescriptions for Tylenol 3’s, which you reluctantly provide. “Doc, you can’t cut me off my T3’s, I ‘ve been on them for years, its the only thing that works…it keeps me off heroin….I haven’t used since I started seeing you.”

Sound familiar? (consider adding stats on BC’s Tylenol 3 consumption) In the back of you mind you remember that it is against College regulations to treat heroin dependence with anything other than methadone, but you note that you’re treating low back pain anyway, or headaches. And besides, isn’t it Harm Reduction to keep the patient engaged with you until the time he is ready to get better? Well, you don’t need to wait for this patient’s spontaneous epiphany.  I have seen too many die, or become HIV positive, or lose a limb, while waiting for their epiphany.  There are things you can do to help move your patient further along towards health. What you can do is tell the patient that you want to reevaluate your doctor-patient relationship, that you’re not feeling like the relationship is really benefiting him. Ask him what he wants to do, what are his goals?  What would he like to get out of the relationship?  Quite likely he will be able to offer some suggestions  — things like “I’d like to take better care of my HIV, maybe start taking medications.” or  “Stop using drugs.” The two of you could negotiate a treatment plan/contract that might contain some of the necessary steps. 1) Get bloodwork drawn. 2) Hook up with PWA 3) Start seeing a counselor etc. Down the line you might find yourself saying, ”Well I’ve given you that blood requisition 3 times now and you haven’t been able to get it done– I’m going to expect that before your next prescription is due you’ll have it done.”  The goals can continue to develop as the therapeutic relationship develops.

If your treatment contract doesn’t work out, remember that sometimes terminating a relationship can be the best medicine.
Case example: Ms.L. had been seeing me for methadone treatment for 4 months. At treatment intake she told me that she was using heroin and cocaine, although her intake of cocaine was low enough that she would be able to stop it altogether, which we included in  our contract agreement. By 4 months it was clear that all of our attempts to eradicate the cocaine from her urine samples had proved futile. Every urine came back positive, and her arms continued to show heavy track marks. The only intervention she hadn’t tried was a recovery house which would take patients on methadone, however Ms. L. refused to entertain that possibility. Since Ms. L. was also HIV positive (although she wasn’t interested in any HIV care), I was faced with a dilemma. Was I actually reducing harm with my relationship with her or was I simply facilitating a continuing and destructive addiction? I opted to discontinue the relationship, pointing out to her that the intent of the methadone treatment was to help her to get off  the street, to stop using needles and illicit drugs, and to eliminate the need for engaging in crime. (Issues covered in our pretreatment explicit contract.)

Her next prescription began a weaning process of 1 mg. per day. After 5 days she came into the office announcing that she was ready to try a recovery house where she could stay on methadone. She was admitted that same day to Renaissance House where she stayed for the next 30 days, stabilizing on her usual dose of methadone. I debriefed her on her return from recovery, when she told me that she prior to Renaissance House she had been using 2-300 dollars of cocaine per day, not the once or twice a week she had previously been trying to convince me of. She was also grateful for having been “pushed” into treatment. “I don’t think I would have gone otherwise– I would still have been messed up, I really needed that time away from coke to clear my brain.”

This case also illustrates that the helping person’s role is not limited to continuing to supply drugs until someone “hits bottom;” or waiting for someone to “want to change,”  or spontaneously recover from his/her addiction, as many of those advocating a harm reduction perspective would suggest.  In this case I “raised bottom” by increasing the costs of continuing her cocaine use – she was free to continue using the cocaine, but at the cost of our relationship and methadone treatment. She chose instead to stop the cocaine.

Harm Reduction has brought the welcome concept of “meeting and accepting people where they are at” to the fore, supplanting the rigid dogma and ideology of the past “abstinence-only” perspective. However, that does not mean being relegated to a watching-and-waiting role. Even in those patients I see that “don’t want to  quit,” one usually finds a split, with part of them wanting to quit while another part tries to stay addicted. I tell my patients that I want to align myself with that part of them that is trying to get better.

 There are many tools in the field of addiction medicine that can make the job of treating addiction easier- learning to do a proper assessment, treatment plan, or when to refer, as well as specific tools such as Miller’s  adaptation of Prochaska’s and Diclemente’s “Stages of Change.” This is a very useful framework for assessing readiness to change and how to motivate people for change. Miller offers stage specific interventions and techniques which the helping professional can use to move his patient along, one stage at a time. For instance someone who is still actively using might be in the pre-contemplative stage. Miller suggests the therapist’s role is to offer sound feedback and information in a non-judgmental fashion, and to stay away from suggesting concrete action directives which would be countertherapeutic at this person’s stage. An added strength of this framework is the conceptualization of the stages of change as a circle, or a wheel which one may have to travel around a number of times before establishing permanent behaviour change. (An average of 4.5 times for smokers, for example) This means that relapse is viewed simply as one of the stages which leads on to the next stage, and offers both the patient and therapist a productive focus. Note that this framework dovetails quite neatly with a harm reduction perspective.

Michael Massing, in a recent essay in New York Times Magazine also believes that harm reduction requires a treatment context, and carefully details the considerable potential benefits of diverting money away from enforcement and interdiction, to treatment: ”The best way to get drugs off the streets is also the cheapest: comprehensive treatment.”

Filed under: Drug Specifics :

Of course they won’t all progress, but almost 100% of heroin users started on it.
There is a frequent pattern of drug use: —
Beer/wine—>cigarettes/spirits—>marjjuana—> other illegal drugs.
Professor Denise Kandel and others of the Dept. of Psychiatry and School of Public
Health, Columbia University, New York, have found this progression in most of their
investigations, published in various journals from the seventies till the present, including,
Science, The American Journal of Public Heal/h, Journal of Drug Issues.

We must try to stop our children from smoking in the first place. Smokers have already mastered the required technique.
A MORI poll in 1991 found that 50% of smokers had tried an illegal drug compared to only 2% of non-smokers.

The more they use, the greater the risk of pro gression.
Of those who had used cannabis more than 1000 times, 90% went onto use other drugs.
Between 100 and 1000 times, it was 79%, dropping to 51% between 10 and 100 times.
Even 1 to 9 times saw 16% go down the slippery slope whereas only 6% of non-users
succumbed (Denise Kandel, 1986)

Use of cannabis and cocaine have been linked in several studies.
“The linkage between marijuana use and later heroin or cocaine use is 10 times greater than the evidence of linkage between cigarette smoking and lung cancer”, Clayton & Voss, US Journal of Drug & Alcohol Dependence, 1982. And from Science, 1997. ‘22% of Dutch youths over 12 who have ever used cannabis, have also used cocaine’. ‘The main predictor of crack cocaine use is previous daily use of pot’ (PRIDE, USA)

Recent research from Australia and New Zealand confirms all this.
Youngsters smoking one joint a week are 60 times more likely to progress, the strongest association is among 14-15 year olds (Fergusson and Horwood, Addiction 2000). Genetics was ruled out when a study of 300 pairs of same-sex twins discovered those using cannabis before the age of 17, were 2-5 times more likely to have drug problems and dependency later in life, than their non-using siblings (Linskey etal, JAMA 2003)

Some users say they are looking for a bigger and better ‘high’,
 rather like small children jumping from a higher step or swinging ever higher.
When people become tolerant of a ‘high’, they seek a more potent drug, or the withdrawal symptoms from one can be alleviated by use of another (H. Ashton, Current Opinion in Psychiatry, 2002)

Drug dealers are often blamed for pushing other drugs.
The Dutch ‘experiment’ was supposed to separate the markets of ‘soft’ and ‘hard’ drugs. This has not stopped the progression. Holland has twice as many heroin addicts per capita than Britain (Trimbos Institute 1997; Schwartz R, Hospital Practice May 1991)

Filed under: Drug Specifics :

A Post investigation suggests tens of thousands of needles given to Nottingham drug addicts through exchange programmes are not returned. Councillor Jon Collins, below, accuses health workers of handing the needles out “like confetti”. But health workers say it is unrealistic to expect every needle to be returned, Health Correspondent CHARLES WALKER reports. The moment a discarded dirty needle pierced six-year-old Rebecca Unwin’s palm is etched into her mother’s memory.” Because they want to put that rubbish in their veins they do not think about others”. Olga Unwin

“Seeing my daughter standing there with a needle and syringe sticking in her I was scared for her life,” said mum, Olga Unwin, who was terrified Rebecca might have caught hepatitis. And six weeks on, that fear has not gone away for Ms Unwin. While her young daughter has almost forgotten the day she picked up the needle and syringe, Ms Unwin is still anxiously awaiting the results of the blood tests, due next month. “I don’t think she remembers it now,” said Ms Unwin, of Coleby Avenue, Lenton. “We do not mention it. She is just a child and should not have to worry about these adult things. But it is a worry knowing the results could be positive. “It is in the back of your mind constantly.”

Rebecca and her eight-year-old friend found the needle and syringe, which contained blood and a brown substance that could have been heroin, when they were playing on the grass in a public place a few yards from Rebecca’s home in March. Despite exchange programmes, which enable drug addicts to bring back used equipment in return for new, Nottingham City Council has been called out to 317 reports of discarded needles in the last year, compared with 146 reports in the previous 12 months. Council officers believe the increase may be due to the introduction of a hotline telephone number through which to report discarded needles. The exchange system provides one needle for each used one returned, but a report from Nottingham City Primary Care Trust acknowledges that does not happen. A Post investigation suggests at least 20,000 given out last year did not come back.

Councillor Brian Grocock, the city council’s cabinet member for street services, said: “It is important people are extra vigilant and they keep their eyes open and contact the local authority about any discarded needles. Parents in particular have to keep an eye on their children and where they play. “We know these needles are out there. People are reporting more now than they were before and they have to be careful. These are extremely dangerous pieces of equipment.” The fear is they could turn up where children play and that makes Olga furious. “It makes me mad,” she said. “Some drug users just do not care who they inflict their needles on when they just drop them. “Just because they want to put that rubbish in their veins they do not think about others.” Her anger is shared by leader of the city council, Councillor Jon Collins, but he points the finger at health workers, who he says should be stricter with drug addicts. “The difficulty is in a number of cases, drug users are not handing over dirty needles,” said Councillor Collins.

“Some services appear to be handing out syringes and needles like confetti. If that was not the case, why are they lying around the city? “People are finding them on a regular basis. It is dangerous and unpleasant. This is a serious, serious issue. “Health workers need to be more responsible and if they are not getting all the needles back they should not hand them out, but we are a mile away from that. They should be one in, one out with no exceptions. “There needs to be a much higher level of accountability of what is happening through needle exchanges.”

The Nottingham PCT report estimates:

More than 300,000 needles were distributed by the various exchange schemes in Greater Nottingham from April 2003 to April 2004. The Health Shop, based in Hockley and run by Nottingham City PCT, supplied almost 200,000 needles and staff estimate only six per cent – or 11,000 – were not returned. Compass supplies more than 20,000 needles each year. The organisation does not collect figures on return rates but staff estimate up to ten per cent (2,000 needles) is not returned. The 16 pharmacies that operate a needle exchange scheme across Greater Nottingham giving out 80,000 needles each year have no figures at all on return rates. Those handing out needles claim it is unrealistic to expect every single one to be returned and they say they are doing a lot to ensure as many as possible are accounted for and return rates have improved.  They say it is vital to provide clean needles to prevent the spread of potentially lethal infections, such as HIV and Hepatitis B and C, in the drug-using population and the wider community. Tests on drug users visiting The Health Shop in the first six months of 2003 – the latest available figures – show the number of infections increased almost three-fold from 2002 and seven-fold from 2001.

A spokesman for Nottingham City Primary Care Trust, which runs the facility, where staff claim a return rate of 94%, said the needles unaccounted for would not necessarily turn up on the streets.”The percentage figure of 94% for returned needles will be higher when confiscations of needles off drug users by the police are taken into account, as well as the figures for needles exchanged by Nottingham community pharmacies,” he said. “Ideally the percentage figure would be 100% but we have to accept the realities of life for some drug users, who may be leading highly chaotic lives.” He said some needles would be left in flats and squats. He added: “There are mechanisms in place whereby at the Health Shop every client’s return rate of used equipment is assessed at every visit. If a client fails to return what has been recorded as given then supply is reduced.”

All the needle exchange programmes in Nottingham now use new tubes for the return of needles and syringes, called “visibins”, which have a clear plastic strip to allow the healthworker to see what is being handed in. Prior to this there had been reports of addicts placing twigs inside tubes to make it sound as though they were returning equipment in a bid to trick health workers. The visibins enable health workers to reduce the supply of needles if too few are returned. Jacqui Molnar, group manager in the East Midlands for Compass, said: “We are taking clear steps. We have changed all the bins so we can monitor what clients are bringing back.” Pharmacies are thought to face the biggest challenge in maintaining high return rates, and they appear to be most vulnerable to Coun. Collins’ criticism. Gordon Ross, community pharmacy project manager at Gedling Primary Care Trust, which manages the exchange scheme in pharmacies throughout Greater Nottingham, accepts some needles go astray but said: “We are doing our utmost to provide a public health service. We have been strict with our return rates and we have lost pharmacy participants in our scheme because of our strict policy of one-for-one.” However, he accepts they are probably not achieving a return rate as high as the other organisations claim. He said staff at The Health Shop and Compass can sit down with clients and interview them when they bring their needles back so they have access information about the individual they are dealing with.  But he added: “In a network of 16 pharmacies that are not linked by computer to share information, it is harder to achieve the same level of returns.” He said there are occasions when staff at all needle exchanges will give out equipment, even though the addict is not returning any.

If a drug user has recently come out of prison or custody, needles and syringes will have been confiscated. In these instances, pharmacists are more susceptible to being tricked into giving out new equipment than drug workers because they tend to have less time to spend with clients and do not have access to such detailed records, which help to check the truth of an addict’s claims. The Notts Drug and Alcohol Action Team is currently developing a programme to offer more support and training to pharmacists and it is hoped this will lead to collecting information on the rate of returns in a consistent way so it can be effectively monitored. However, Mr Ross and other health workers vigorously defend the need to hand give out equipment if it is believed an addict will otherwise use a dirty needle and syringe. Mr Ross said this may occur because of some users’ “chaotic lifestyles” where a desperate person buys drugs but has no equipment. They visit the nearest pharmacy involved in the exchange programme in order to inject as soon as possible. He added: “If a person is desperate to use we have to provide a service to minimise the risk they use old, contaminated equipment.” And he insists the whole community benefits because it helps to limit the level of infectious diseases in Nottingham. He said: “Needle exchanges are fulfilling an important public health role in trying to stop the spread of infectious diseases. Infections do not just affect the drug-using population, they are also a threat to the population at large because the two groups mix with each other and have relationships.” And Mr Ross shares Olga Unwin’s belief that ultimately most drug users are responsible. “The vast majority of the drug-using population fulfil their duty of care to the rest of the population. “Their habit does not impact on other people. But there is a minority who do not take their responsibilities fully and this leads to discarded needles. “It is down to the drug users. They are told and educated.”

‘Vital’

Drug users insist needle exchange services are vital to safeguard their health. A former heroin addict who used needle exchanges in Notts for up to five years told the Post: “They are really, really important. A lot of society thinks when you are using you are not bothered about your health, but you are. “People are very conscious of the risks of using dirty needles. And the last thing you want as an addict is to be admitted to hospital because then you cannot use.” The 32-year woman, who now works with the Notts Drug and Alcohol Action Team, to help other people overcome their addiction, attended a drop-in centre to drop off and pick up about ten needles at a time. She said: “How many you exchange depends on how much money you have and how much gear you can afford. “I would say on average I would use at least three each day. I would go and get two or three days’ worth and take the same number back.” The woman, who did not want to be identified, is adamant the majority of drug users are responsible. “Everybody I used with always took their needles back because we knew if we did not we would not get new ones in their place,” she said. “It was very strict.” However, she warned that if controls became too strict, people might feel forced to use dirty needles.

Source:  www.thisisnottingham.co.uk/displayNode

Filed under: Drug Specifics :

By Manuel Gamiz Jr. Of The Morning Call
Sixteen-year-old Christina Martucci was driving with a ”significant amount” of marijuana in her blood when she failed to yield at a stop sign, leading to a collision with a school bus that killed a Liberty High School classmate on the first day of school, Bethlehem police say.

Police ended their six-week investigation this week, concluding that marijuana use and the stop-sign violation were the key factors that led to the Aug. 31 crash at Lincoln Street and Easton Avenue.

Bill Blake, a Northampton County assistant district attorney, said blood tests showed Martucci had more than two times the minimum level of marijuana metabolite in her blood needed to prosecute for driving under the influence. The minimum level is 5 nanograms of marijuana metabolite per milliliter of blood.

The police officer heading the investigation, Kenneth Jones, said Martucci had a ”significant amount” of marijuana in her system.

Police said they also found 1.2 grams of marijuana in a ”blunt” cigarette — marijuana rolled in cigar paper — in Martucci’s purse and 2.7 grams of marijuana and a smoking pipe in Smith’s backpack.
Source: www.educatingvoices.org/EVINews.asp Oct.2004

Filed under: Drug Specifics :

 

Italy: Now has the highest heroin addiction rate in Europe and attributes 70% of all AIDS cases to IV drug users. Italy decriminalised possession of heroin in 1975. Within the European Parliament the Italian Radical Party has been one of the leading promoters of drug law relaxation; the Radicals former leader Marco Tarradash has moved on into the media empire of Berlusconi.

Amsterdam: Where marijuana was decriminalised and sold or distributed under city auspices, citizens in April 1995 successfully pressured authorities to close many coffeehouses (where drugs were openly sold), and reduce the amount of cannabis allowed on premise. Subsequently permitted individual possession was reduced from 30 grams to 5 grams.

Alaska: In 1972, with financial and legal support from NORML (the National Organisation for the Reform of Marijuana Laws), a young lawyer, Raven appealed to the Alaskan Supreme Court following arrest for possession of marijuana; he declared his arrest violated his private rights.  In 1975 the Supreme Court ruled by five to one in favour of Raven.  Raven and his supporters had declared that decriminalisation would not result in greater use, the use of other drugs would not be affected since there is no such thing as a ‘Gateway Drug’ and there would be no increase in problem use.  The police force supported the appeal – having been persuaded that there would be no increase in crime.

By 1990 there had been a major increase in the use of marijuana – to twice the national average, similarly a huge increase in problem drug use, heavy increase in health and social costs, use of all other drugs had increased, crime overall went up.  The law was later rescinded with the support of the police who had changed their minds in the face of this unequivocal evidence.

Armed forces: Compulsory drug tests introduced in December 1993 for Army personnel in the UK and Germany showed 0.5% tested positive for illegal drugs.  (3,619 men tested between January and May 1995.)

“Youthful drug use violates both formal law and informal norms for conventional behaviour. Analyses of influences on permissive drug attitudes and behaviours among adolescents should, therefore, focus on both attitude towards the law and the informal normative climate of these youths. Legal attitude and norm qualities, however, can vary depending on the cultural and situational context. The authors examined the effect of legal attitude and norm qualities on drug permissiveness attitudes, as well as actual alcohol and cannabis use of 196 adolescents comprising three cultural groups: American Indian residents of a rural community, non-Indian residents of the same community, and transient Indians attending a job-training programme in the community. In general, for all three groups, legal attitude primarily affects permissiveness towards drug use, while norm qualities of peers and personal permissiveness influence actual substance use. However, the three cultural groups vary in the relative salience of these variables”.

Sellers,C.S., Winfree,L.T., Griffiths, C.T.  – Journal of Drug Issues 23(3):493-513,1993. Available from Christine Sellers, Department of Criminology, University of South Florida, Tampa, FL 33620-8100

 

“There are a great many young people, including some of the brightest and best who have been using marijuana now more or less regularly for three or four years.   Addiction or even habituation is denied.  The smoking is said to be simply for pleasure.

Untoward effects are usually, although not always, denied.  But the experienced clinician observes in many of these individuals personality changes that seem to grow subtly over long periods of time

  • diminished drive
  • lessened ambition
  • decreased motivation
  • apathy
  • shortened attention span
  • distractibility
  • poor judgment
  • impaired communication skills
  • loss of effectiveness
  • introversion
  • magical thinking
  • derealisation
  • depersonalisation
  • diminished capacity to carry out complex plans or prepare realistically for the future
  • a peculiar fragmentation on the flow of thought
  • habit deterioration
  • progressive loss of insight.”
Ann. Internal Med.73,45.  Cited in ‘Marijuana’, Mechoulam,. R. Ed. Academic Press
NY and London 1973, page 347.

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