Science backs raising of drinking age

Sue Dunlevy - National Health Correspondent News Limited Network June 17, 2013 11:30PM 52 comments Alcohol drunk booze drinking A RADICAL push to raise the drinking age to 21 has the support of half the population and senior academics and medicos will today urge politicians to tie federal road funding to the change. A national forum on teen binge drinking will be told Australian teenagers are twice as likely to abuse alcohol as adolescents in the United States, where the legal drinking age is 21. And a ten-year study of 3000 Victorian teenagers has found 45 per cent had problems with alcohol by the time they reached the age of 23. Deakin University researcher in youth development Professor John Toumbourou, who conducted the research, wants the federal government to encourage the states to raise the drinking age to 21 by tying federal road funding to the change, as happened in the United States. If politicians can't sanction raising the drinking age, they should look at introducing probationary restrictions on drinking at age 18, he says. This would place restrictions on the type and amount of alcohol 18 year olds could purchase and remove the right to drink from those who were involved in alcohol related violence or road accidents. The National Drug Strategy Household Survey, conducted by the federal government, has found public support for raising the drinking age has risen from 40 per cent to 50 per cent over the past decade. Growing support for the idea is being fuelled by concerns over rising alcohol linked violence and concern that young people may be damaging their future prospects by drinking heavily, Professor Toumbourou said. "When you drink at a young age, the brain becomes habituated to alcohol and they can drink large doses until the body needs alcohol to function," he said. One in five Australians in their twenties now has an alcohol dependence that sees them experience shakes and seizures if they don't drink, he says. And young women are now drinking the same amount of alcohol as men, raising concerns that if they become pregnant their babies may suffer brain damage caused by foetal alcohol syndrome disorder. Trauma doctor Dr Anthony Lynham, who repairs smashed skulls from alcohol related injuries at Royal Brisbane Hospital, says the teen brain is still developing at 18. "As well as rising levels of alcohol-induced violence, probably the strongest case (for raising the drinking age) is the latest scientific research which shows the brain is not fully developed at 18," Dr Lynham said. A review of 17 studies in the United Sattes found raising the drinking ag to 21 in that country was linked to a 16 per cent reduction in underage car accidents.

Newcastle CDAT Conference: Reduced Opening Hours

The news that came from the researcers who presented at the CDAT Conference in Newcastle was that restrictions and prohibitions work to reduce use of alcohol and drugs and therefore reduce the harm associated with them. Restrictions of trading hours from 5.30am to 3am and 1am lock-outs at Newcastle Hotels have produced startling results that continue to improve. The results of a trial that started 5 years showed that on average assaults in the area have declined by 33%, while for the same period 5 years ago the number of assualts have declined by 53%. The trend indicates that there is a flow-on effect with on-going reductions in violence due to intoxication. Hoteliers were concerned that these cahnges would have a damaging effect on there sales and profits. The research shows the opposite. Previously patrons would pre-load with off-site drinking and often go out to the hotels at 11 pm or later. With the restricted trading hours behaviour has changed as patrons are now tending to go out earlier and to buy the drinks at the hotel meaning profits have not declined. Not only are the streets safer, but the publicans are happy. Moreover, less Police are required to patrol the streets in the earlly hours to prevent violence, reducing costs and freeing up Police to do other more important work. So far the resutls show a WIN/WIN/WIN outcome: patrons, publicans and Police have all benefitted. Researchers believe the trial should be implemented in another areas with the expectation that the results will be the same as have been achieved in Newcastle.

Presciption Drugs and the Rising Death Toll

The news that over 1300 people die each year from prescription drug overdose is very alarming and tragic. Those who die from prescription drugs, particularly opioids include: 1. people (eg., chronic pain patients) who are legitimately prescribed these drugs and deliberately or accidently overdose 2. people prescribed methadone or buprenorphine, who die particularly in the first week of dosing (methadone) and/or misuse it (eg., inject accumulated doses or take-aways in one hit - methadone and bup) or use it with other depressants (meth and bup) 3. people who have bought methadone off the street or been given it in exchange for other drugs, who may have low tolerance and/or misuse it (see above) 4. people who are prescribed the drugs without good reason, eg., dr shoppers or from drs who knowingly prescribe to drug addicts. Fentanyl is a favourite and a killer (1000s of times more potent than morphine: One client who has been clean for 4 years now lost 11 friends to it - patches boiled and injected are lethal). 5. Opiates bought or obtained illegally that are normally prescribed or classed as prescribed as opposed to illicit drugs. Deaths from prescription opiates outweigh deaths from heroin now, here and in the US and many of these are related to methadone. For example 50% of all overdose deaths in Scotland are related to methadone and 60% of injections in the MSIC are prescribed opiates (morphine - Oxycontin and MS Contin, crushed, filtered and injected - they advertise 'workshops' there to show them how to do it 'safely'). Anex have suggested that the same tactics we have used to reduce the road toll should be applied to reducing death from drug misuse. The gist of the Anex argument is that just as we do not ban driving and we take (HR) measures to reduce the road toll, so we are obliged to regulate (license; not prohibit) drug use and to use similar measures to reduce harm when drug injecting. However, the analogy with the road toll when used to bolster the HR agenda is fundamentally flawed. Although driving (as does use of medication) carry some risks, it is not driving as such that is at fault, it is the illegal or reckless things drivers do that cause road deaths, for example speeding, ignoring road signs, drink driving or using mobile phones etc., which are prohibited. Again it is not the legal and prescribed drugs such as pain killers properly used that is the problem it is the reckless and illegal actions of those who abuse these drugs that causes the deaths. Suggesting that we should decriminalise illegal or reckless drug use is like saying we should decriminalise speeding, drink driving etc. Obviously a ridiculous and unacceptable proposition. The same argument is used to suggest that the reason injecting drug users (IDUs) get Hep C at very high rates is because there are not more and better distribution to drug users of clean needles. For a start there has been no decrease in the rate of Hep C among IDUs since the implementation of NSPs from the 1990s. Moreover, yearly surveys of IDUs at NSPs has shown that Hep C eventually reaches saturation levels even among this group: the $ms on NSPs has made no difference to Hep C rates, it has never been properly trialed or researched and it has been a waste of money, based on ideology (it seemed to intuitively make sense) and not on evidence. However, what is blindingly obvious is that the only way to prevent Hep C transmission is not to inject drugs and this means that the responsibility for their infection and the infection of sexual partners etc, lies entirely with those who chose to inject drugs. What we are obliged to do is to assist them to do stop. In the late 1990s the death toll from heroin was over 1100 annually; it fell to around 300 in the following years following the disruption of heroin supplies ( the 'heroin drought', mainly due to Howards 'Tough on Drugs' policy). Last year it has risen to just over 700 and is predicted to go higher. To this can be added the deaths due to prescription drugs including about 350 to 400 each year from methadone: higher than the road toll which has declined in terms of the numbers of cars on the roads over the last 20 years. We have also seen a softening of law enforcement and of deterrents in recent years with a gradual return to the HR policies of the 1990s when anyone could openly buy a cap of heroin on the streets of Cabramatta for less than the cost of cannabis as it was proclaimed that enforcing the law would drive the drug trade underground and result in more deaths. The absurdity of this argument is obvious, but is still used today to promote the existence of the MSIC

Hep C and Needle Exchange

It has been reported that another $25m has just been committed by the Fed Govt for more harm reduction measures for Hep C and HIV prevention. The evidence is that Hep C among IV drug
users eventually reaches saturation level indicating that needle exchange
is not making any difference. It must be obvious that stopping
injecting drugs is the only effective method to prevent transmission of
Hep C, not only among IV drug users but the people they have sex with,
especially when accompanied by STDs.

Its time they took responsibility for their behaviour (just as we all do
when we step outside the law and social norms) rather than seeking to
place it elsewhere, ie with everyone else, especially those who 'repress'
their preferred lifestyle.

Clinical Psychologists

Prof Judy Hyde recently wrote to the Minister of Health advising that all psychologists who do not have a Clinical Masters degree should not be able to provide clinical services. The first problem with this idea is that there are many who have Master's degrees in Clinical Psychology who have never delivered psychological services (eg. academics and administrators), or who are not temperamentally suited to the role, who would not be competent to effectively treat psychological problems. Other psychologist who are known by their colleagues and clients to be highly effective may not have attained post graduate qualifications for one reason or another. In other words having a degree does not always equate to competence. I should also point out that there are quite a number of prominent Clinical Psychologists such as a former President of the APS, who are no doubt very good psychologists, who do not have the Masters Degree, but achieved the title of Clinical Psychologist through grandfathering provisions. Should they be excluded from using the title and treating psychological problems? On the issue of differentiating between Clinical Health Psychologists and Health Psychologist who don't engage in clinical practice and who work in public health spheres such as the promotion of healthy lifestyles and prevention programs I would have thought this was important and legitimate and does not imply the person is a Clinical Psychologist just as Clinical Neuropsychologists don't pretend to be. Anther person who calls herself a Clinical Psychologist is Dr Lizbeth Tong (-Norris), who never had a psychology qualification except a Diploma of Psychology, no doubt because she didn't make it into the Honours class. She has a Bachelor of Arts and Masters of Arts (Pass) and a PhD in sociology. She is listed as having General Registration and not even specialist endorsement. She is a member of the Psychology Tribunal. Another is Ms Margaret Crowley who also does not have a qualification in Psychology apart from a Grad Dip in Counselling Psychology. She has a Bachelor of Applied Science and no Masters degree. She is also listed as having Generalist Registration. According to Prof Hyde's analysis it seems unreasonable that these people sit in judgement of other Psychologists and raises serious questions about the competence of these people to properly carry out these duties. It seems that in her estimation, at the very least, their qualifications and experience should be on par with those they judge.

Time to end the Alcohol Lobby political donations!

Time to end the Alcohol Lobby political donations! [“Permissibility, availability and accessibility - all increase consumption.” Dalgarno Institute.] "A call by ADCA today to end the link between Government and the liquor industry is most welcome. The severing of this nexus is a key step to better employing the same strategies that have worked so well to reduce the demand for tobacco in our nation. To end political donations is just the start of reducing the leverage that the tobacco and alcohol industries have over Governments. This includes the tax revenues from these industries that have prevented them implementing such sensible and simple policies such as reducing opening hours for hotels and increasing the drinking age. The evidence is overwhelming that such changes will reduce consumption and reduce the harm that follows. Governments must also bring some consistency into reducing supply and demand for drugs, both legal and illegal. Just as we see how a reliance on taxation has hamstrung Governments in their attempts to control tobacco and alcohol, so they must resist widening the problem by attempting to regulate illicit drug use. Not only is this impractical; it will inevitably lead to greater use and greater harm as has been illustrated by regulation of the tobacco and alcohol industries. Governments should break all ties with the drug industry and prioritise the reducing of supply and demand. There must also be the prioritising of proactive Recovery incentives for cessation of use, as well as more realistic deterrents for both suppliers and consumers, rather than piecemeal efforts to reduce harm. The most effective means to reduce harm is to reduce consumption as was so well demonstrated by Howard's 'Tough on Drugs' policy that saved thousands of young lives." Communications Liaison - Dalgarno Institute.

“Overdose deaths pass national road toll for first time” (Herald Sun 27/8/13)

But what is the solution?” [“Permissibility, availability and accessibility - all increase consumption.” Dalgarno Institute.] Can we have some clarity of what this article means? The lead ‘tag’ is “A SURGE in accidental and prescription medicine overdoses has seen drug deaths overtake the national road toll for the first time on record.” Has the line in the evidence been blurred, asked Shane Varcoe, Director of Dalgarno Institute. The issue that needs some clarification for us is about which drug is adding to this broad claim and is prescription overdose stats been hijacked to bolster an agenda? Mr Varcoe Asked. Australian Bureau of Statistics reveals that road accidents claimed 1323 lives nationally in 2011, while 1383 people died of drug overdoses. Over 50% of these deaths are heroin related with approximately another 25% Methadone overdose, leaving only around 24% deaths from other prescription drugs. If people are taking illicit substances, against all law and convention, then certainly the risk of overdose in always there, as the substances are not controlled in either content or quantity. However, if people are overdosing of prescription medicines, it is either because they genuinely don’t understand ‘prescription’ or they are deliberately over medicating for reasons that are too many to perhaps outline here. The reason the distinction is important is in trying to understand what the strategy for the release of NARCAN is based on. The CEO of Anex, Mr Ryan was quoted in the article as saying "Far too many people die or suffer brain damage because friends and loved ones did not recognise signs of overdose," Now, as a stand-alone statement it seems to be placing responsibility for overdose outcome inappropriately in the lap of the non-drug user. Now having used this syntax to posit that, he goes on to prescribe that to help the non-user to manage the problem, the thing to do would be to roll out COPE Strategy where people at risk, and their loved ones, can be trained in how to administer the ‘lifesaving’ drug naloxone to reverse opioid overdose. I’m fascinated by the language use here, (whether deliberate or not) it’s very passionate; ‘Loved ones’ and ‘life saving’, and no doubt these emotive terms are used to help promote the apparent advantage of this pharmacological ‘strategy’. However, Mr Ryan also, as he said earlier in the piece comparing this strategy with that of the Road Toll campaign; "Road safety programs work with all Australians to drive the road toll down. We need to tackle overdoses with the same determination, because at this rate we may be heading the way of the US." This is where we need to pause and give some greater scrutiny, not only to the proposed ‘strategy’, but of the legitimacof the comparison with the argument regarding the road toll. Firstly, Mr Ryan states ‘Road safety programs work …to drive road toll down.’ So we assume from that statement that he would like a similar campaign to ‘drive the overdose rate down’, is that correct? If so, is the administering of Naloxone AFTER the overdose a strategy to prevent overdose, or simply to stop one of the tragic outcomes of overdose? The best thing to prevent overdoses is not to use drugs, isn’t it? Secondly, the Road Toll campaign has an aggressive prevention message to STOP accidents by endeavouring to reduce and finally remove the elements that precipitate accidents; i.e. speed, drug use, use of devices whilst driving, etc. The multi-million dollar prevention marketing campaign had pretty much just ONE significant Key Performance Indicator; stop the activities that cause the accidents! Not a message to keep doing the activities and try and better manage them so you minimise your chances of an accident. Finally, as part of this harm prevention campaign; legislation of both an educational and punitive natture is in place for those who flaunt the strategy to reduce the road toll. This component is indispensable in any public education process. Hence the following questions… a) If drug overdoses are from prescription medicines, will doctors then have to prescribe Naloxone along with them for ‘loved ones’ to monitor the patient? Will this become standard operational protocol with the expectation that patients will deliberately overuse their prescription drugs? b) Is this really about making Naloxone available, at will, for illicit drug users? Will there be any means by which to track use of such rapid detox, or will any illegal drug user be given it, simply because the refuse to obey law or convention? c) Will Naloxone become simply the strategy of choice for the illegal drug user to manage their substance use and have no requirement to cease drug use? d) Whilst this pharmacotherapy may save some lives after an overdose will it inadvertently only add to the HARM of illicit and licit drug use for the user and the rest of the community, because it can better enable longer and greater drug use? If we don’t ask the responsible questions or worse, don’t empower/enable to drug user to exit their Harm-full behaviour, then we are easily intimidated by the Harm Reduction mantras, that care little that a person continues to wilfully self-harm, and only that they are kept alive to keep using – that seems to be the logic emanating from many of these ‘untouchable’ ideologies. It is time to save lives! It is time to educate for harm prevention! It is time to direct and enable drug users to find their way out of drug use into the harm-less space of no longer using. If our ‘strategies’ do not have this as their end, then they are not worthy of our time or resources, they are simply either a) the perpetuation or even promotion, of careless self-indulgence or disturbingly b) the deliberate ploy of callous agencies to continue the ‘incarceration’, that is drug dependency! I don’t know, but all I do know is that people need help and motivation to become drug free – to us at least, that is a NO Brainer! Media Release Dalgarno Institute admin@dalgarnoinstitute.org.au P: 1300 975 002 F: 1300 952 551 Communications Liaison – Dalgarno Institute. References http://www.heraldsun.com.au/news/law-order/overdose-deaths-pass-national-road-toll-for-first-time/story-fni0fee2-1226705302834

Drug Policy Change Urgent

There is a compelling case to change direction of D&A Policy to reflect the following facts: 1. Effectiveness of Treatment: Methadone has failed many people and caused many poeple to stay dependent on opiates unnecessarily for 30 or more years: the risk of death is higher on methadone given the years people stay dependent: there is a need to provide an exit program from this debilitating drug. The NEPOD study showed Rapid Opiate Detoxification (ROD) was not only highly effective but cost effective; a RCT by Saunders and colleagues in 2002 showed it to be very effective and safe to detoxifiy people from methadone using naltrexone. This research challenges the claims by critics that abstinence-based programs are coercive and ineffective and that there is no evidence to show detoxification from opiates works; on other hand there is a paucity of evidence for the effectiveness of methadone compared to someone who has successfully stopped using opiates. A Cochrane Review (Mattick), showed minimal benefit of methadone maintenance compared to no treatment and no benefit in terms of criminality or mortality; a review of evidence for the MTAR program (6 month, in-patient slow reduction of methadone program, State funding to WHOs) shows that for each person able to remain abstinent at 12 months the cost is over $100,000 compared to $8000 for Naltrexone detox and implants and out-patient counselling; the cost and effectiveness of programs such as NSP and Injecting Centre. The link between low HIV rates - but high Hep C rates - and these HR programs has not been demonstrated; reduction in mortality has nothing to do with injecting room, but is to do with the ‘heroin drought’ brought about by policy changes including Howard's 'Tough on Drugs' policy and enforement of laws by State Police in Cabrammatta and elsewhere; the need to divert this funding for studies comparing naltrexone and counselling/therapeutic programs to methadone and traditional treatment programs. 2. Prevention including education about the real harm of using drugs needs to be implemented in schools; increased deterrents have been proven to be effective in demand and supply reduction; reduction in supply (making drugs harder to get and more expensive) are well proven strategies in reducing demand. 3. Mandatory Treatment: an involuntary drug treatment program is being trialed at RNSH; Mandatory treatment has been successfully implemented in other countries and there is abundant evidence as to the effectiveness in reducing drug use. 4. NH&MRC Review of Naltrexone Implants: this review needs to be challenged as it came to a politically motivated conclusion despite the evidence being to the contrary; more evidence from a number of newly published Randomised Controlled Trials has added to the overwhelming evidence as to the efficacy of naltrexone for opiate dependence (see Colquhoun, (2005),Hulse (2009), Krupitsky (2011) and Kunoe (2009). The evidence of the effectiveness of naltrexone in opiate and alcohol dependence is now indisputable (and is standard practice in the US - AIAAA website) and implants increase its effectiveness by dramatically increasing compliance rates.

Appeal Against HCCC and Psychology Tribunal Decision

In December 2010 the Psychology Council suspended the registration of Dr Ross Colquhoun based on four complaints made by the Dept of Health regarding Rapid Opiate Detoxification (ROD). A year later that decision was found to be wrong and the suspension was revoked. Previous complaints had not been sustained with findings that there were no significant concerns regarding the safety of the public or his competence. The Dept then referred two of the complaints to the Psychology Tribunal to be reheard based on the opinions of well known advocates of methadone and public critics of naltrexone treatment. On 5 December 2012 the Psychology Tribunal found him to be guilty of Professional Misconduct and cancelled his registration and prohibited him from providing services related to mental health and community health. On 28 December an Appeal to the Supreme Court was filed and served on the Dept. The decision to deregister him was based on his competence as a psychologist. This is disputed. Until that appeal is heard and determined Dr Ross Colquhoun is unable provide these services. The website and any other form of communication is to provide information and not to advertise mental health or community health services. There are many people who have benefitted from the services provided by Dr Ross Colquhoun and it is hoped that at some time he will be able to resume those services. Many people still need alternatives to methadone as a treatment for opiate dependence, especially those dependent on morphine due to chronic pain. The evidence showing that naltrexone is an effective treatment is now supported by the published research. On the other hand the latest Cochrane reports show that methadone is no better than no treatment in terms of mortality and levels of criminality and worse when it comes to numbers who are opiate free.(Mattick, 2009).