Transcript Slide 1

National Drug Research Institute
Preventing Harmful Drug Use in Australia
Steve Allsop
Director
National Drug Research Institute
www.ndri.curtin.edu.au
What is a drug?
• In this program we focus on psychoactive drugs – drugs
that have effects on the central nervous system, perhaps
affecting mood, thinking and behaviour.
• This can include legal drugs (e.g. alcohol and caffeine)
illegal drugs (e.g. cannabis and amphetamine) and
prescribed or over-the-counter medicines (e.g. pain
killers; benzodiazepines)
• Depending on the context and nature of use, these drugs
might have implications for safety and health in the
workplace, and perhaps other factors such as team
cohesion, productivity and risk of criminal activity
How do drugs affect you?
• Drugs are usually categorised depending on the nature of the effect
they have on the Central Nervous System (CNS)
– Depressants (e.g. alcohol, heroin, solvents) depress the CNS
– Stimulants (e.g. caffeine, amphetamine, cocaine) stimulate the CNS
– Hallucinogens (e.g. LSD) can result in perceptual distortions and
hallucinations
• Some drugs (e.g. ‘ecstasy’) might have effects in more than one
area (e.g. stimulant and hallucinogen) while heavy doses of some
drugs might alter the types of effects (e.g. while cannabis is usually
categorised as a depressant, in very heavy doses there might be
hallucinogenic effects
How do drugs affect you
• How a drug affects a person depends on several factors
– the properties of the drug and how it is ingested(e.g. the potency
or strength)
– how much is used
– risks vary depending on whether the drug is used via oral
ingestion, smoking, inhaling, injecting)
– Individual factors such as
– the person’s sex (e.g. the same amount of alcohol affects men
and women differently)
– the person’s health
– Environment or context in which the drug is used
– Drinking alcohol on an empty stomach immediately prior to
work or driving a car is a different risk to drinking at home with
a meal
A simple model summarises this
information
• Drug use and drug related problems are
influenced by things to do with:
– The drug
– The individual
– The environment or context
• And the relationship among these things
Individual
e.g. Health
Sex
Age
Drug
e.g. Pharmacology
Amount and How often
Environment/context
e.g. Time
Place
Some background comments
• Drug use can vary from time to time and region to region
• Pressures of work make workplace more sensitive to
risks of drug use
• Is drug use getting worse
– Not necessarily so
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Alcohol
Heroin
Amphetamine
Ecstasy
Cannabis
Pharmaceuticals
• Heavier use among some people (young; some
Indigenous communities)
• Decrease in the age of onset of heavy use for some
How could you tell if alcohol and other drug
use had relevance in your workplace?
• You could engage in some sophisticated research,
interviewing staff and key stakeholders – while some
workplaces do undertake such research, it is timeconsuming and can be expensive
• A simple approach is to understand what is going on in
the broad community – if you lived in a region or country
where, for example, heavy alcohol consumption was the
norm, you might expect there to be higher workplace
risks compared to a country with low alcohol
consumption.
• The relationship between drug use and work is
complex
• Much opinion and rhetoric - little valid and
reliable evidence
• Prevalence of drug use in workforce likely to
reflect general community
– Biggest harms from alcohol, tobacco, followed by high
prevalence illegal drug use such as cannabis and
amphetamines (it might vary among diff industries)
• Some evidence that risk factors brought to work
– community patterns of use
• Some evidence that workplace factors contribute
to hazardous and harmful drug use
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stress/alienation
work culture
poor/low level supervision
availability
work conditions
Social and structural control factors
• Costs or barriers to obtaining alcohol (Is it easy or hard?)
• Physical availability (Is it actually easily available)
• Subjective availability (do people think it is easily available)
• Perceptions of norms about use
• Is there a cultural acceptance of use? Do I think everyone
else does it?
• Structural factors
• Quality of supervision, Quality of policy
implementation
• Perceptions that use will lead to negative consequences
(if caught there will be consequences)
Alienation and stress
• Rewarding and supportive work improves
wellbeing
• Sense of lack of control and sense of
powerlessness increases risk
– (people who perceive they have no control over their
environment are more at risk)
• Monotonous and boring jobs increase risk
• Shift work can increase risk (coping; separation
from restraints)
• Thus, alcohol may be used to cope with poor
work conditions
Work culture
• Work team attitudes
• Alcohol norms (is it perceived as acceptable to use
alcohol?)
• Isolation (physical, from culture, from family etc)
• Low/Poor supervision
• Low visibility (eg. people who work in isolation from
workmates or good supervision)
• Perceived availability and peer approval/disapproval
• Peer accountability
Intoxication
Dependence
Regular use
Drug use
• Drug use is an outcome of:
– Individual resilience and vulnerability
– Cultural and sub-cultural influences
– Work structures, supervision and quality of
working life
• Different patterns of drug use result in different
kinds of problems
• Different factors influence the development of
problems
• Specific problems require specific responses
• As with any OSH problem, it is important to
correctly “diagnose” the risk, identify contributing
factors and develop specific responses
• Avoid making things worse
Effective interventions- What works? What
should we look for in the future?
• Evidence on what works: ‘not a lot’! But – Recognise various factors that influence use and harm
– Specific responses for specific problems and circumstances –
conduct accurate diagnosis
– Address occasional intoxication
– Target all three domains of individual, environment and drug
– Adopt quality processes for policy development and
implementation
– Consider timing of introduction – good policy=good timing
– Use credible change agents
– Invite and attract people to change with sensible evidence-based
interventions that are subjectively relevant
Developing policy
• Different problems will require specific
responses
• Effective responses are likely to involve
strategies in the Drug, Individual and
Environmental areas
Developing a policy
• The first step will be to identify the risk factors in your
workplace and to think of potential responses.
Remember that effective responses are likely to involve
strategies in areas of the
– ‘Drug’ (what are you doing about availability?),
– Individual (what are the risk factors associated with your workforce) and
– Environment/context (what are you doing to ensure a safe workplace;
what workplace factors increase risky alcohol/drug use?)
• You will also need to be mindful of the legislative context
– Is your policy consistent with relevant laws and OSH legislation?
• Attract stakeholders to change – how will you
ensure that employees, unions, supervisors,
community etc. support your activities?
• Many people might resist alcohol/drug
interventions but may be more responsive if
attached to broader intervention (e.g. CVD)
• Tailor interventions – each workplace (in fact each site) will have specific needs
• Express policy in simple and clear language and
communicate widely & regularly - ensure it is
known & understood
Raising awareness about drug use
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In order to gain support for a policy or strategy, or to encourage healthy
choices, a company might invest in an education/awareness raising
program. The aims might be to:
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Educate about the risks of alcohol and drug use, especially in the context of the workplace
Support healthy choices and behaviour
Provide a rationale and build support for a workplace policy and procedures
Challenge perceptions of risk and norms – e.g. if employees think alcohol use is a normal
part of day to day work, they may be more inclined to drink more. Many young people think
their peers are drinking more than they really are and their personal drinking choices are
influenced by these perceptions
Illustrate how other people’s drug use has relevance for the whole workforce
Inform the workforce how to get further advice and help
Raising awareness about drug use
• Different modes of delivery for raising awareness have been used
such as online programs, face-to-face workshops, posters and so on
• There is little evidence about the impact of such approaches,
although there is some evidence that online delivery is attractive for
some employees and has some small benefits in terms of
knowledge. A key benefit is that they can be accessed
anonymously, but then not all workplaces and employees have
broad access to computers and the inter or intranet
• Embedding alcohol and drug information in broader health programs
(e.g. about diet or cardio-vascular disease) may enhance their
attractiveness
Rehabilitation
• Rehabilitation has been found to be cost
effective and has been adopted by some of the
most productive companies in the world
• Supervisor’s role
Performance management, not identification of drug symptoms
Referral to services if indicated/available
• If you use external services/expertise,they
should
• Have knowledge and skills (about counselling/treatment and
about drug use)
• Be confidential
Drug Testing
What is it?
Urine, blood, saliva, breath, sweat, hair.
Contentious, but if it works then we
might still justify its use
What does it measure?
• Urine Testing
–Exposure to drugs in recent past
–No available evidence linking
metabolites with performance
eg “...Under no circumstances can impairment be
diagnosed or even presumed from a urine test....
(It) does not provide any information about patterns
of drug use, about abuse of or dependence on drugs
or about mental or physical impairments that may
result from drug use”
• Despite being around for a long time, NO
strong evidence from controlled studies
that it reduces drug problems
• IT MIGHT – but no clear evidence to say it
does
• Unclear about unintended adverse
consequences
• Recent evidence POTENTIALLY raises
concerns regarding cannabis testing
Oral fluid/Saliva testing
• Less intrusive?
• Measures presence of active drug – not
how much nor how intoxicated but
technically intoxicated
• Weaknesses in relation to particular
drugs?
• Any screening test must be followed by
confirmatory analysis
• No evidence yet that they reduce drug use and
importantly reduce harm – doesn’t mean they
don’t – just no evidence
• Possibly have some unintended adverse
outcomes – moves to use drugs with shorter
detection window; binge use after site visit
• They are NOT a magic bullet and should not be
used alone – if you adopt, recognise risks as
well as potential benefits
What does drug testing measure?
• To summarise the debate on alcohol and breath testing:
– It is important to be aware that there is not a strong body of evidence indicating
that they reduce drug use and related harm. This does not mean they don’t do
this. It means there is no strong evidence that they do
– Equally – there is no evidence that they do not make things worse (e.g. people
might move to using drugs that are not included in the drug testing program and
which may be more harmful). This is not to say this does or does not happen –
we simply do not have enough evidence to reach a firm conclusion
– Drug testing does not identify someone who is impaired from the after- or
hangover effects of drug use
– Some people find drug testing intrusive, and question the right of the employer to
test body fluids, especially in the absence of evidence about their effectiveness
to reduce harm
– Drug testing can be expensive and may undermine support for other approaches
to prevent and reduce use. Its cost-efficiency has not been determined
– A concluding comment is that drug testing approaches are often oversold and
workplaces should be aware of risks and shortfalls as well as their potential
Performance Testing
• Direct measure of ability, not an attempt to
indirectly measure or attribute cause
• In its “infancy”
• Raises a number of other debates
Conclusion
• What lessons can be learned from success in other
areas of safety and health?
• What lessons can be learned from success in reducing
drug related problems – tobacco?
• Identify existing factors that contribute to and prevent
hazardous and harmful drug use in relation to work
• Avoid ‘lure of masterstrokes’
• Be aware of limitations as well as strengths of strategies
• Recognise role of broader community/government
Steve Allsop
National Drug Research Institute
[email protected]
www.ndri.curtin.edu.au