Transcript Anecdotal Trends in Substance Use

Anecdotal Trends in
Substance Use
Melbourne CBD
Ramez Bathish
Living Room PHS
Overview
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Introduction
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Trends in Melbourne
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Commonwealth Games
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Impact of Policing
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Addressing Future Trends
Living Room PHS
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Primary Health Service for marginalised people who
use drugs.
Community Development, Harm Reduction and
Primary Health.
1 Doctor (pharmacotherapy), 1 nurse, 4 drug safety
workers, 2 laneway workers.
Client group: PWID, 18-35yo, homeless, mental
health issues, dual diagnosis, Hep. C, intellectual
disabilities, HIV, no triple diagnosis.
Foot Patrol – NSP in Melbourne CBD – Russell St.
Case Example
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“Paul” – 30yo male, homeless, IDU, injects pills
(without wheel filter), mental health issues (ADHD &
undiagnosed disorder)
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Presents regularly at both PHS and NSP.
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Increasingly chaotic over last few months.
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Homelessness is compounding mental health &
substance abuse issues – visa versa
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Daily pick-up of meds, limiting substance abuse.
Trends in Melb CBD 2006-07
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Gauged through ppl. Presenting at PHS and Foot
Patrol NSP.
(Most common to least common): Alcohol, heroin, benzos poly-drug use, methamphetamine, Opioid-based
pharmaceuticals – e.g. MS Contin, Cappinol,
Physeptone, “bupe”, “done”, VSU – chroming, other
pharmaceuticals (seroquel)
Increasing quality / purity of heroin – more
intoxicated clients, no change in rate of ODs.
Street-based heroin scene most active in Richmond
area.
Trends cont..
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Pharmacotherapy program at Living Room PHS is
full, operating near capacity over the last year- 60%
methadone, 40% suboxone / bupe.
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Clients tend to prefer pharmacotherapy treatment
over detox / rehab. – indicative of greater efficacy?
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No noted change in BBV transmission.
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Not seeing increased diversion with increased
flexibility of takeaways - suboxone.
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Increase in street price / availability of Xanax.
Other trends 2006 - 07
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Increase in use of Opioid-based medication – MS
Contin etc..
Large percentage of pill injectors not familiar with
wheel filters.
Slight increase in knowledge and awareness of
butterflies for methadone diversion.
No noted increase in methamphetamine use – in
line with stats. (Statistics on drug use in Australia 2006, Victorian Drug Statistics
Handbook 2006)
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Less VSU clients, (more commonly youth).
Dual diagnosis & homelessness an ongoing issue.
Since the “drought”
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CBD not significantly affected by drought 2000 - 01.
Significant drop in Foot Patrol NSP contacts since
Nov. 2005-2006 but relatively stable since.
Slight peak in activity into Nov. 2005 then policing
presence stepped up 4 - 5 months before
Commonwealth Games.
Increased police presence in CBD Nov ‘06- April ’07
– street-based heroin scene dropped off – no
outreach on Russell St.
Increased activity in Richmond area 2006 -07.
Commonwealth Games
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Heroin scene on Russell St. effected- no outreach on
Russell St.
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Scene activity in Richmond increases.
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Police pressure in Melb. CBD, less so in Richmond.
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Police brought in from regional Victoria - not familiar with
particulars of policing CBD.
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Marginalised people more “exposed” / targeted.
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Increase in police harassment / clients placed in holding
cells for minor offences.
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Collaboration with Office of Police Integrity & Fitzroy
Legal Service with Living Room & Foot Patrol NSP.
Impact of Policing
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Significant impact on street-based heroin scene / trends
in CBD.
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Saturation policing poses risk to PWID and public health.
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Compounds existing risk factors – e.g. less inclined to
access NSP, unsafe disposal practices.
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Improved relations / dialogue with Police since mid
2006– encourage referrals to Living Room.
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Foot Patrol now gives new Police recruits (East Melb.)
induction about Harm Reduction, NSPs, drug use etc..,
Safe Injecting Facilities addressing future trends..
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Challenge of addressing harms associated with
street-based drug use in PHS.
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Often the impacts of drug related harm are
addressed down-stream – post BBV transmission,
ODs, legal issues etc..
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A Safe Injecting Facility addresses risk factors for
street-based users directly – addresses safe
injecting practices, referrals etc..
Insite Safe Injecting Facility
Vancouver Canada.
the stats, 2006 – A case for Safe Injecting Facilities
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7,278 unique individuals registered at Insite
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453 overdoses resulted in no fatalities
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4,084 referrals were made with 40% of them made to addiction
counseling
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Referral to withdrawal management: 368
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Referral to methadone maintenance: 2 per week
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Daily average visits: 607
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Busiest day: May 25, 2005 (933 visits in 18 hours)
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For more info on InSite: http://www.vch.ca/sis/