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She just read the slides: File:ICSA SH.CP.DrugVio.L.HarmMini S1T113.pdf.

Additional notes

  • Demand reduction
    • Drug education - to inform about the harms associated with drugs (doesn't really promote abstinence, just stops people using one drug over another)
  • Supply reduction
    • AFP in Thailand to stem supply
    • Border protection
    • Regulate availability of legal drugs (e.g. <18 yo people can't use alcohol)
  • Harm reduction
    • People will use drugs even though we encourage abstinence and cessation, so we have ways to reduce risks/harms
    • Most people use drugs without any harm at all
    • Strategies = don't acquire viruses, don't overdose, etc
    • Don't forget the burden of disease of alcohol and tobacco
  • Prevention is an integral theme across all 3 pillars

Costs

  • Tobacco and alcohol cost more and contribute more of the burden of disease and mortality than illicit drugs
    • Decreasing for tobacco (mainly from the workplace regulations, not passive smoking; that hasn't been done enough), increasing alcohol
      • The government makes more money from taxes in alcohol and tobacco than it costs in healthcare
  • Increase prices --> decrease use (economic laws hold as true here as everywhere else)
    • Education in drugs doesn't work; it's just economics
  • Alcohol hasn't been legalised in the proper way (too socially acceptable, constant ads), and illicit drugs should be legalised in the proper way (harm minimisation)
  • Society doesn't believe that heroin users are worth saving (don't value their lives even though it's a problem of young people - lots of DALYs)

Australia's drug budget

  • Most money is put into law enforcement and interdiction (supply reduction). Priorities are done wrong
    • We AREN'T putting enough money into the lives of people who have gone down the wrong path

Messages

  • Sending messages to young people is ineffective.
  • Having NSPs does not send the message that injecting drug use is safe
    • Young people don't think about long-term consequences
  • It's a contingency plan for if abstinence doesn't work
  • It is hard to argue against harm reduction
  • Harm reduction takes no moral position "what is right and wrong" - instead looks at public health perspective. Reduce suffering while we aim for abstinence
  • When the means to reduce suffering is available, it's unethical not to accept those means
  • A lot of diseases are related to human behaviour (smoking, drinking, overeating) etc. Noone cares about your moral opinion. Just prevent suffering.
    • You are not employed for your moral opinion - you are employed to give ethical health care
    • it doesn't give up on cure. Opioid dependence is a chronic relapsing condition
  • Australia should get NSPs in prisons
  • NSPs (1988) were the first appearance of harm reduction (also demand reduction) in Australia; stemmed the HIV epidemic
    • Australia leads the world in the HIV prevalence amongst IDUs: the disparity in prevalence between gay and IDU is the greatest in the world
      • bipartisan approach: both opposition and government agreed it was a good idea
    • hep C burden of disease is very high, so counting direct costs, for every dollar invested we get $4. Including indirect, you get $27. Fantastic bang for buck.


  • By having overdoses happen in the NSP, it's in a controlled fashion so that the O/D can be treated, saving lives
    • Demand reduction strategy - they're engaged at the injecting centre so the nurses etc talk to them and try to find a moment where they're vulnerable and they encourage them to seek help (treatment program; fast-track to treatment)
    • Helps bring it off the streets; clean and safe, trusted by drug users; advice of nurses etc is sometimes taken.
  • Methadone: legal (no drug market), dose controlled (know what they're taking), orally taken, long-acting, opportunity to see doctor while you're taking it
    • partial agonist - cravings reduce, and it reduces the heroin's effect
    • more stable opioid tolerance
    • reduces by half the risk of overdose (compared to detox where the tolerance drops, so that 75% relapse and their O/D increases)
    • methadone at a therapeutic level does not give a high - it takes the sharp edges off life
      • keeps them out of crime, prostitution, etc; heroin etc keeps people in that vortex
  • buprenorphine
    • partial antagonist - less drug affected, better for employed people, high functioning people