Transcript About ATODA
Cocaine harm reduction messages About– ATODA • The safest way to use cocaine is to mix it in a drink and swallow it (comes on gradually 10-20 mins and lasts longer) • Snorting is the next safest way – bigger and faster hit • (2-3 mins) but wont last as long as swallowing • The hit from cocaine through injecting is intense and fast and also short acting • Make sure you don't hit up too much in one go – can result in respiratory complications, hear failure and overdose • Crack cocaine is freebased (smoked) highly potent and addictive (go up fast, and crash hard) • Regular use can lead to dependence this is more likely with smoking or injecting cocaine Marlatt, et.al. (2012) Harm Reduction Pragmatic Strategies for Managing High Risk Behaviors Cocaine harm reduction messages About– ATODA About ATODA Opioids Opioids what are they? About– ATODA • • • • • • • • • • Heroin Morphine Codeine Methadone Buprenorphine Oxycodone (OxyContin) Hydrocodone (Vicodin) Fentanyl Opium Hydromorphone (Dilaudid) Source: http://www.flickr.com/photos/superfantastic/68321333 Opioids & National demographics About– ACT ATODA People who inject drugs (PWID) regularly ACT National 38 years 38 years 63% male 66% male 10 school years education 10 school years education 53% prison history 55% prison history 100% ESB 96% ESB Scott, (2012) Key findings from the 2011 ACT EDRS and IDRS Drug of choice IDRS About ATODA 70 60 50 40 ACT National 30 20 10 0 Heroin Morphine Scott, (2012) Key findings from the 2011 ACT EDRS and IDRS (meth)amphetamine Cocaine Cannabis Heroin –price, purity & availability About ATODA Price: • $50/ cap (stable) • $300/ gram • Stable Current purity 2010 2011 Availability 2010 2011 Low 57 51 Very Easy 51 48 Medium 28 31 Easy 45 42 High 4 13 Difficult 4 10 Fluctuates 11 5 Very Difficult 0 0 Scott, (2012) Key findings from the 2011 ACT EDRS and IDRS Heroin –short term (immediate) effects About ATODA • • • • • • • • • Feelings of well being and euphoria Relief from pain Nausea and vomiting Sleepiness and drowsiness (on the ‘nod’) Narrowing of pupils Shallow breathing Drop in blood pressure and pulse rate Unconsciousness Overdose (and death) Scott, (2012) Key findings from the 2011 ACT EDRS and IDRS Heroin –long term effects About ATODA • Dependence • Withdrawal (craving, restlessness, stomach/leg cramps, vomiting, goose bumps, etc.) • Constipation • Menstrual irregularities • Infertility in women and loss of sex drive • Infection with HIV and other BBVs (IDU) • Malnutrition • Legal, financial and social problems Heroin – risk factors for overdose About ATODA • Mixing drugs • • • • • • Most fatal overdoses (around 75%) involved a combination of two or more depressant drugs Change in tolerance Using alone Route of administration Strength/amount General health Dietze, P., Jolley, D., Fry, C., Bammer, G., 2005; Darke, S. & Zador, D. (1996) ACT Overdose Prevention and Management About ATODA • ACT Health Directorate have funded a two year overdose prevention and management program that includes take-home prescription naloxone (Narcan) to ‘Eligible Participants’.* • The training program is being coordinated through the drug user organisation CAHMA (Canberra Alliance for Harm Minimisation and Advocacy). • Naloxone (Narcan ®) is a schedule 4 opioid antagonist used to reverse the effects of opioid overdose. Naloxone is widely used in Australia and internationally by paramedics and emergency room staff in cases of suspected opioid overdose. It has no psychoactive effect, is not a drug of dependence, and therefore, is not a substance which is likely to be diverted or misused. The purpose of expanding naloxone availability is to further reduce and prevent death, disability, and injury from opioid overdoses through provision of training and resources to opioid users and their friends and family members who could be potential overdose witnesses. http://www.atoda.org.au/policy/naloxone/ Harm reduction messages About ATODA 1. 2. 3. 4. 5. 6. Know your tolerance - be aware when it might be lower (e.g. not using for a while, being in prison, etc.) and use less if not sure Avoid mixing drugs - mixing opioid drugs with other depressants (benzodiazepines, alcohol, other opioids) Take care of your health - eat well, drink plenty of water and sleep Use caution if you have a new dealer or unfamiliar supply - use a small amount at first to see how strong it is Avoid using alone - if you overdose, you want someone around to help You’re less likely to overdose from snorting or smoking drugs than injecting them Trafficking thresholds About ATODA • You can be charged for even possessing small amounts of drugs in the ACT • Trafficking thresholds for illicit drugs are: Heroin: 2 grams Methamphetamines 2 grams Cocaine 2 grams MDMA 0.5 grams (1 pill 0.3) Cannabis 300 grams McDonald, D. (2011) Consultation with people who use illicit drugs regarding threshold quantities Canberra July-August 2011. Justice and Community Safety Directorate Part 4 About ATODA New and emerging drugs, ‘legal highs’ and referral information Popularity of ‘legal highs’ About ATODA • Changes in availability of other drugs • Relatively low price for more reliable purity (compared to ecstasy, methamphetamine, cocaine, etc.) • Ease of purchase – through internet, delivered to your door • Purported euphoric effects • Perception of it not being a ‘dangerous’ drug (i.e. ‘legal’) • Ecstasy users had a desire to experiment with something ‘new’ Lancaster, K. et al (2011) Curiosity killed the M-Cat: an Examination of Illicit Drugs in the Media, The Australian and New Zealand Criminology Conference 2010. Mephedrone About ATODA • 2-methylamino-1p-tolylpropane-1-one also known as 4-methylmethcathinone (4-MCC) • Synthetic stimulant similar to amphetamine and cathinone • AKA miaow miaow, M-cat, drone, meph, plant food, bath salts, bubbles and ‘legal high’ • Gained popularity in early 2009/10 • Duration of effect two – four hours Lancaster, K. et al (2011) Curiosity killed the M-Cat: an Examination of Illicit Drugs in the Media, The Australian and New Zealand Criminology Conference 2010. Mephedrone - history About ATODA • 4-methylmethcathinone is a synthetic stimulant with empathogenic effects • Between 2007 and 2009, it became available for purchase online, was used increasingly in Europe, Australia and New Zealand • Associated with several deaths, and as a result, was controlled (banned) in some countries • Crazy media attention especially in the UK blamed partly for the drugs popularity Lancaster, K. et al (2011) Curiosity killed the M-Cat: an Examination of Illicit Drugs in the Media, The Australian and New Zealand Criminology Conference 2010. Mephedrone About ATODA M-Cat - effects About ATODA • Often compared to MDMA, MBDB, bk-MDMA (methylone), cocaine, methamphetamine and other euphoric stimulants • Positive effects include: • mental and physical stimulation euphoria, mood lift, feelings of empathy, openness increase in sociability, desire to talk with others, pleasurable rushing, etc. • Negative effects include: • • • • • changes in body temperature regulation (sweating/chills/bad in hot environment) increase in heart rate, blood pressure, strong desire to re-dose – craving to recapture initial euphoric rush (animal studies have found that rats love it – appears more addictive) impaired short term memory, insomnia tightened jaw muscles, grinding teeth, muscle twitching Lancaster, K. et al (2011) Curiosity killed the M-Cat: an Examination of Illicit Drugs in the Media, The Australian and New Zealand Criminology Conference 2010. Other synthetic drugs About ATODA • Synthetic cocaine - methylenedioxypyrovalerone (MDPV) • Sold as Ivory Wave and Cloud-9 • Contains structural similarities to pyrovalerone and MDMA which is the active ingredient in ecstasy • Users get a temporary sense of an amphetamine-like high by; snorting, injecting or smoking the bath salt • These drugs have not been subjected scrutiny and may contain many harmful by-products as a result of their production Shanks et al., 2012 Synthetic - history About cannabinoids ATODA • Synthetic cannabiniods work on the same receptors in the brain as cannabis • ‘Spice’ brand first appeared in Europe in 2004 • In late 2008 THCPharm announced that the synthetic cannabinoid JWH018 had been identified as one of the active components in three varieties of the Spice brand • JWH-018 is a synthetic cannabinoid first synthesized in 1995 for experimental purposes • It is a naphthoylindole (belonging to the aminoalkylindole family) • Chemical structure differs substantially from THC but it produces similar effects in animal experiments • Reported to be more potent than THC Deluca et al, 2010 Synthetic - history About cannabinoids ATODA • Typically sold in foil packages over the Internet and in specialised shops • Most sachets contain one – three grams of dried ‘plant matter’ which is believed to have been ‘sprayed’ with synthetic cannabinoids • ‘Kronic’ most well known brand here – produced in New Zealand • Drug became popular in Australia is 2011 (also because it couldn’t be picked up in random urine tests) • Synthetic cannabinoids made illegal in Australia in May 2012 Deluca et al, 2010 Kronic About ATODA Synthetic - effects About cannabinoids ATODA What we know: • produce cannabis-like subjective effects Largely unknown: • side effects, adverse reactions, long-term damage or dependence potential It can be assumed that different amounts or combinations of synthetic cannabinoids are added to the range of products currently available http://ncpic.org.au/ncpic/publications/factsheets/article/synthetic-cannabinoids Referral Aboutinformation ATODA Useful numbers and websites Referral - ACT ATOD Services AbouttoATODA • ACT Alcohol, Tobacco and Other Drug Services Directory: Version 8 http://www.atoda.org.au/directory/ Over 38 ATOD specific programs in the ACT: • Case management and support (e.g. complex needs, multiple treatment case management) • Community information and education • Consultation and Liaison • Counselling (e.g. individual, family, for adults and young people) • Family support service (e.g. groups and counselling) • Needle and syringe programs • Outreach support • Peer support • Pharmacotherapies (e.g. methadone, buprenorphine, suboxone) • Rehabilitation (e.g. residential, short – long term) • Relapse prevention (e.g. groups) • Specialist services (including Aboriginal and Torres Strait Islander, women, men, youth (12 – 25), justice and diversion) • Withdrawal support (e.g. medicated or non-medicated) Referral - ACT ATOD Services AbouttoATODA For more information About ATODA (24/7) Alcohol and Drug Services, ACT Government Health Directorate 24 hour phone line: (02) 6207 9977 Provides information on drug treatment and support in the ACT. http://health.act.gov.au/c/health?a=&did=1003 8160 Other useful references About ATODA • Australian Drug Foundation: www.adf.org.au/ • National Cannabis Information and Prevention Centre www.ncpic.org.au Helpline: 1800 30 40 50 • National Drug and Alcohol Research Centre: ndarc.med.unsw.edu.au/ • Australian Drug Information Network www.adin.com.au • National Centre for Education and Training on Addiction: www.nceta.flinders.edu.au • National Drug Research Institute: www.ndri.curtin.edu.au/ • Turning Point Alcohol and Drug Centre: www.turningpoint.org.au/ Photo references About ATODA All photo’s authors own or sourced from Creative Commons Attribution-Share Alike 2.5 Generic Thanks forATODA participating today About Please fill out the workshop evaluation form Thank You Comments – Questions For further information please contact an ATODA team member on: (02) 6255 4070 [email protected]