Newsletter of the Australian Drug Foundation s Prevention Clearinghouse

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1 DrugInfo Newsletter of the Australian Drug Foundation s Prevention Clearinghouse ISSN Volume 7 Number 2 December 2008 INSIDE THIS ISSUE: Prevention of pharmaceutical drug misuse This issue of DrugInfo looks at the two most commonly misused types of pharmaceuticals, opioids and benzodiazepines. The issue examines prevention and early intervention strategies from the perspective of general practitioners, pharmacists and psychologists. Guest editorial Non-medical use of pharmaceutical drugs 2 Trial of a new treatment for benzodiazepine withdrawal 3 Doctor, I just need a script for Oxycontin thanks 4 Pharmaceutical misuse one pharmacist s perspective 5 Non-steroidal anti-inflammatory drug toxicity secondary to codeine dependence 6 Psychological therapy: a non-drug alternative for the treatment of anxiety and substance use 7 Calendar, news and reviews 9 telephone: druginfo@adf.org.au Reconnexion: treating tranquilliser dependency, anxiety disorders and depression Gwenda Cannard, Chief Executive Officer, Reconnexion, Victoria Reconnexion (formerly TRANX and PADA) provides services for people experiencing anxiety disorders, depression and benzodiazepine dependency. Part of the rationale for providing our counselling program for anxiety disorders is to prevent the inappropriate longterm use of benzodiazepines. Benzodiazepine program Our benzodiazepine program provides counselling treatment for people who have developed a dependency on benzodiazepines. Counselling is also provided for people dependent on prescription and over-the-counter analgesics. Most of our clients are low dose users who have been inappropriately taking benzodiazepines for long periods of time most commonly between six and 10 years. Around 40 per cent of our clients were initially prescribed benzodiazepines for an anxiety disorder. The next most common reason for the initial benzodiazepine prescription is cited as being for withdrawal from alcohol or other drugs. Reduction and withdrawal support for benzodiazepine dependent clients is provided with the collaboration of the client s prescribing general practitioner and an individually tailored program is prepared. Many clients take a long time to successfully reduce their benzodiazepine intake and recover from the withdrawal symptoms counselling can continue for months and occasionally years. As is now commonly known, because of the risk of dependency, including the potential for a severe and protracted withdrawal syndrome, and the limited effectiveness of benzodiazepines, the prescribing recommendations are for short-term or intermittent use. As most people are prescribed benzodiazepines for anxiety or insomnia, Reconnexion promotes alternative strategies for these problems. Recommended best practice treatment for anxiety disorders is cognitive behavioural therapy (CBT) or, if medication is used, the selective serotonin reuptake inhibitor (SSRI) antidepressants. Education and training The Reconnexion website ( has information on the management of anxiety and sleep disorders. Information sheets on the safe use of benzodiazepines are available in community languages and resources...continued page 12

2 Prevention of pharmaceutical drug misuse Non-medical use of pharmaceutical drugs Guest editorial by Dr Malcolm Dobbin, Senior Medical Adviser (Alcohol and Drugs), Mental Health and Drugs Division, Department of Human Services, Victoria When asked which drugs are associated with a drug problem, people commonly identify heroin, methamphetamine and marijuana (AIHW 2008). The more discerning include alcohol and tobacco, but few mention misuse of pharmaceutical drugs. Among the drugs prescribed or provided over-the-counter (OTC) in pharmacies, several have potential for abuse. Many are psychoactive (mood-altering) and cause pleasurable feelings, and some are used by body builders. Pharmaceutical drugs can be chosen because they are easy to get from non-criminal sources, are perceived as safe, uncontaminated drugs of assured dose, and possession can be represented as legal because they were prescribed to that person. Non-medical use means use other than that recommended, either on the pack of OTC products or on the prescription. Non-medical use can take many forms. It includes taking more than recommended to achieve a high, injecting or snorting crushed material from tablets made to be taken by mouth, or using someone else s medication for its intoxicating effect. Unsanctioned use often involves taking considerably more than the recommended maximum therapeutic dose. Drug seeking and doctor shopping are terms used to describe attending multiple doctors and/or pharmacies to obtain drugs for non-medical use or for trafficking. The extent of non-medical use is not known. Reports by injecting drug users (IDU) from the Illicit Drug Reporting System suggest that it is highly prevalent in this cohort (Black et al 2008). The most common prescription drug reported to be used illicitly* by subjects was morphine, which had been used by 72 per cent and injected by 68 per cent. Lifetime illicit use and injection figures for oxycodone (e.g. OxyContin) were 47 per cent and 40 per cent, for methadone tablets 52 per cent and 39 per cent, for benzodiazepines (e.g. Valium) 63 per cent and 17 per cent, and for pharmaceutical stimulants (e.g. Ritalin) 34 per cent and 21 per cent. One form of harm associated with this drug use is crime associated with seeking or trafficking these drugs, or crimes committed under their influence. It is illegal to obtain drugs by falsely representing that one has a medical condition. As a result of this behaviour, doctors and pharmacists are becoming reluctant to provide drugs known to be abused, potentially leaving people with pain or psychiatric problems under-treated. Trafficking of prescription drugs is prevalent. A 47 year-old woman in Western New South Wales has been charged with obtaining prescription drugs over 12 months by doctor shopping (Fife-Yeomans 2008). She allegedly obtained 2500 *not prescribed to the user oxycodone tablets for $1.50 each and sold them for up to $50 a tablet. It has been reported that prescribed opioids (mostly MS Contin and OxyContin) accounted for almost half the drugs used by IDU in the Medically Supervised Injecting Centre in Kings Cross (Editorial 2008). Other means of obtaining pharmaceutical drugs include prescription forgery or alteration, pharmacy burglary, and coercion. There have been reports of scuffles outside pharmacies with people intimidated to hand over their medication. Harm caused by non-medical use includes fatal and non-fatal overdose of sedating drugs such as opioids or benzodiazepines, injury to veins and granuloma in the lung caused by injection of talc (used as a tablet filler). Benzodiazepines can cause amnesia and disinhibited behaviour for a time if taken in high doses, as well as falls and confusion. A number of cases of culpable driving fatalities associated with non-medical use of prescription drugs have occurred in Victoria. High dose Nurofen Plus misuse (24 48 or more tablets a day) obtained OTC from multiple pharmacies has caused numerous cases of perforated or bleeding ulcers (Dutch 2008) and kidney failure. Non-medical use of pharmaceutical drugs has emerged as a major category of drug misuse, and requires a systematic response. There is a need for a national strategy to prevent the 2

3 Prevention of pharmaceutical drug misuse Trial of a new treatment for benzodiazepine withdrawal Dr Martyn Lloyd-Jones, Specialist in Addiction Medicine, Department of Addiction Medicine, St Vincent s Hospital, Victoria Benzodiazepines such as diazepam (Valium, Antenex, Ducene), oxazepam (Serepax, Alepam, Murelax), alprazolam (Xanax, Alprax, Kalma, Zamhexal), temazepam (Normison, Temtabs, Temaze) and nitrazepam (Alodorm, Mogadon) are commonly prescribed to treat anxiety and insomnia. When these drugs are used on a daily basis for periods greater than a few weeks, dependence can occur. Withdrawal from benzodiazepines is often difficult and traditionally requires a gradual dose reduction over many weeks or months and withdrawal symptoms may last for several months. The Department of Addiction Medicine at St Vincent s Hospital is currently conducting research into a new way to help patients withdraw from benzodiazepines using flumazenil, a benzodiazepine antagonist....continued from previous page widespread diversion of these drugs from licit to illicit use, and the serious consequent harm that is now becoming evident. References AIHW (Australian Institute of Health and Welfare) National Drug Strategy Household Survey: first results, Drug Statistics Series number 20, Cat. no. PHE 98, Canberra: Australian Institute of Health and Welfare Black E, Roxburgh A, Degenhardt L, Bruno R, Campbell G, de Graff B et al 2008 Australian drug trends 2007: Findings from the Illicit Drug Flumazenil is approved in Australia for use as a medicine to reverse the sedation caused by benzodiazepines during anaesthesia. Recent research has also demonstrated that flumazenil is an effective medicine for treating benzodiazepine withdrawal, although it is not yet approved for marketing for this purpose and so its use in this project is experimental. Flumazenil works in the brain by blocking the action of benzodiazepines at the GABA receptor. Previous work has shown that an intravenous infusion of flumazenil can reduce withdrawal symptoms and craving leading to increased completion of withdrawal and reduced relapse post detoxification (Gerra et al 2002). This study will use the same medicine but instead of giving the medication into a vein, the medicine is given subcutaneously (under the skin) of the abdomen through a small needle. Reporting System (IDRS) Australian Drug Trends Series No. 1. Sydney: National Drug and Alcohol Research Centre Fife-Yeomans J 2008 Using cancer drug to make hillbilly heroin, Daily Telegraph, 27 October, p. 4 Editorial 2008 Daily Telegraph, 27 October, p. 16 Dutch MJ 2008 Nurofen Plus misuse: an emerging cause of perforated gastric ulcer, Medical Journal of Australia, 188, 56 7 The medicine will be loaded into a small syringe pump which delivers a constant low dose of the medicine through the tip of a butterfly needle. The syringe pump is carried in a small pouch for the four days that the treatment is given. The butterfly needle is inserted under the skin and taped to the skin to prevent accidental removal. This method means that patients are fully mobile while receiving their treatment. A total of 20 people will participate in this project. There is no cost to participants. Individuals who are dependent on benzodiazepines are invited to participate in this research project to test how effective this method is in the treatment of benzodiazepine withdrawal. Your participation in this research might help to improve the well-being of your patients as well as the treatment of patients in the future. If you would like more details or know anyone who might wish to participate in this trial please contact Fiona Craig at the Department of Addiction Medicine at St Vincent s Hospital on tel.: (03) Reference Gerra G, Zaimovic A, Giusti F, Moi G, Brewer C 2002 Intravenous flumazenil versus oxazepam tapering in the treatment of benzodiazepine withdrawal: a randomized, placebocontrolled study, Addiction Biology 7(4), pp DRUGINFO Vol. 7 No. 2 December

4 Prevention of pharmaceutical drug misuse Doctor, I just need a script for Oxycontin thanks Dr Benny Monheit, Medical Director, Southcity Clinic, Drug and Alcohol Physician, Alfred Hospital, Victoria Doctor, I just need a script for Oxycontin thanks. Doctors dread getting this type of request. Is this a prescription shopper, they wonder. How can I get rid of this patient without causing a fuss? The typical scenario is a new patient arriving at the clinic late in the afternoon or on weekends seeking a repeat script for a drug of addiction. In years gone past the request was for Rohypnol or temazepam capsules; now it is usually for a benzodiazepine (e.g. Xanax) or opioid (e.g. Oxycontin). Doctors facing this request from the patient often feel in a no-win situation. They fear that if they do not give the patient what they want that the patient may become aggressive or threatening, or blame them for not treating their genuine medical condition. On the other hand, giving the patient a script may in fact be a contravention of the Drugs Poisons and Controlled Substances Act 1981 and invite more drug seekers to the clinic. General practice registrars are now often given this scenario as a role play exercise as part of their training program in alcohol and other drugs. From running these programs during the past five years I have seen most registrars squirm and become uncomfortable when facing a manipulative and increasingly insistent role playing patient. We teach them that: It helps to have a clinic policy prepared for this situation so that the patient s request can be dealt with quickly, courteously and clinically appropriately. This policy may simply be that no drugs of dependence are prescribed to new patients until a full assessment (including contacting previous prescribers) is made. It is OK to say no to patients requests for drugs if the doctor feels they are inappropriate. (I am often surprised how hard it is for some doctors to say no in a polite but firm way.) If the doctor really feels that some medication is clinically necessary to tide the patient over until further data are obtained, a small amount of medication (e.g. for 1 2 days) could be prescribed and the patient then reviewed. Limited data are available to the doctor from the State and Commonwealth government on each patient s prescribing history. Unfortunately, these data are often too old or too restricted because of privacy concerns to be of much clinical relevance at the consultation time. Resources are available to doctors on how to manage the drug seeking patient (Carr 1999; Sim et al 2004). Drug seeking behaviour by patients is not new and society tries to deal with this in various ways, including blaming the doctors! In New South Wales 16 doctors have been reported this year to the Medical Board or the Health Care Complaints Commission for inappropriately prescribing opioids. Inadequate methadone and drug withdrawal services have also been blamed for contributing to this It is OK to say no to patients requests for drugs if the doctor feels they are inappropriate. drug seeking problem. In Victoria a lack of services for assessment of chronic pain conditions and inadequate expert alcohol and other drug clinics to back up general practitioners, is in my view, a more significant factor. The Victorian Parliament last year issued its report from the Inquiry into misuse/abuse of benzodiazepines and other pharmaceutical drugs in Victoria, which contained 30 recommendations for action. So there is no lack of advice about what to do. However, I think the crux of the problem is, as Senator Baume wryly pointed out in his drug inquiry in 1977 (SSCSW 1977), we have a drug problem because we live in an intoxicated society. References Carr N 1999 How to say No to prescribing NPS News, 4, p. 3 Sim MG, Hulse GK & Khong E 2004 Acute pain and opioid seeking behavior, Australian Family Physician, 12, pp SSCSW (Senate Standing Committee on Social Welfare) 1977 Drug Problems in Australia An Intoxicated Society?, Canberra: Austalian Government Publishing Service. 4

5 Prevention of pharmaceutical drug misuse Pharmaceutical misuse one pharmacist s perspective Irvine Newton, Chairman, Harm Minimisation Committee, Pharmaceutical Society of Australia, Victoria The issues around the misuse of pharmaceuticals (medicines, drugs) are often complex. Misuse implies use outside the purpose for which the medicine (drug) was intended. There is the potential to be detrimental to peoples health and certainly not improve it. The primary role of pharmacists is to provide medicines for their intended purpose and to help make people well not make them worse! Of particular concern to pharmacists is: the inappropriate use (often too much, too often and/or for too long) of prescription and over-thecounter (OTC) medications use for a purpose or effect other than the approved medical use use by a different means than the approved method (e.g. injection of tablets, capsules and mixtures) use simply to support a drug dependence at the extreme end of the scale, use by other than the actual patient and often for illicit purposes. The misuse of prescription and OTC drugs occurs across a broad crosssection of our population (men and women, working and non-working, rich and poor). No one knows the extent of the problem. Benzodiazepines (Serepax, Valium, Temaze) were only ever intended for short-term use and yet the number of patients using them over extended periods is massive. This situation has proved to be a very difficult one for pharmacists and doctors alike. Pharmacists have grappled with trying to develop protocols for intervention that would help patients understand their problem and then take measures to overcome that problem. So far, we have made little progress. We all have a moral and ethical obligation to try to do the right thing by all our patients and clients. Codeine-containing pain relievers and cough and cold preparations are used by opiate-dependent people to support their dependence. This situation is a difficult one for pharmacists dealing with people requesting these products. None of us wants to deny genuine cold and pain sufferers very useful and successful medicines. However, we all have a moral and ethical obligation to try to do the right thing by all our patients and clients. Supplying drugs of dependence to drug dependent people is not what we do. Deciding who is genuine and who is not can be very tricky. We sometimes get it wrong. The supply of pseudoephedrinecontaining cold remedies is different because these products are usually diverted directly into the illicit amphetamine market. Pharmacists have been able to play a significant role in reducing this source of supply but again there is the dilemma of wanting to prevent diversion while still providing a very useful and safe medicine to bona fide cold sufferers. Finally, the lack of an effective auditing system such as a pharmacy intranet to help reduce doctor shopping is a source of great frustration while the need for better understanding of the problems described and the development of effective community education campaigns are just some of the other issues concerning pharmacists in their desire to help reduce drug misuse. The problems are many and much work needs to be done. DRUGINFO Vol. 7 No. 2 December

6 Prevention of pharmaceutical drug misuse Non-steroidal anti-inflammatory drug toxicity secondary to codeine dependence Dr Malcolm Dobbin, Senior Medical Adviser (Alcohol and Drugs), Mental Health and Drugs Division, Department of Human Services, Victoria The drugs Over-the-counter (OTC) analgesics (painkillers) can contain the simple analgesics paracetamol, aspirin or ibuprofen as a single drug. These simple analgesics can also be compounded with codeine, an opioid drug that creates a risk of dependence if taken regularly. Misuse of OTC analgesics containing codeine (e.g. Panadeine or Mersyndol ) has been recognised for many years. The problem When codeine is combined with a fixed dose of another analgesic the user is unable to adjust the dose of each drug independently. High doses of the combination product taken to achieve an intoxicating effect lead to secondary ingestion of high and potentially toxic levels of the other analgesic. Each of the simple analgesics can cause problems if taken in higher-than recommended doses. Paracetamol can cause liver failure if taken as a single dose of 7 10 grams (e.g Panadol 500mg tablets). Most cases of serious liver toxicity have resulted from intentional selfharm when the drug is taken as a single dose. Aspirin and ibuprofen are nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are commonly prescribed for arthritis. They are among the leading causes of drugrelated morbidity and mortality in Australia and worldwide (ACSQHC 2002; Hawkey 2002). NSAIDs can cause gastrointestinal tract injury including erosions, ulcers, haemorrhage and perforation of the stomach or duodenum (Tarone et al 2004). The risk of injury increases with NSAID dose (Hawkey 2002). Other complications include kidney failure or dangerously low potassium levels in the blood. Recent problems Ibuprofen/codeine products contain a substantially higher dose of codeine per tablet and per pack compared to other OTC codeine analgesics, which may lead to their preference for misuse. (Panadeine 15 offers a higher dose of codeine per tablet but is only available in packets of 12) Ibuprofen 200mg/codeine phosphate 12.8mg is available as Nurofen Plus or Panafen Plus OTC from pharmacies. The combination of codeine phosphate, a drug with potential for dependence, with ibuprofen, a NSAID with widely recognised toxic properties, is leading to serious problems across Australia, as codeine dependence results in escalation of the dose to many times more than the recommended maximum of six tablets a day. Cases of harm In January 2008, an article in the Medical Journal of Australia described two cases of perforated gastric ulcers associated with excessive misuse of Nurofen Plus, sparking media attention and responses from the medical, pharmaceutical and manufacturing industries (Dutch 2008). A 39 year old woman reported taking Nurofen Plus tablets daily for three weeks, and a 41 year old man admitted to taking a packet of Nurofen Plus a day for one year. Both cases presented with severe abdominal pain, and surgery revealed a perforated gastric ulcer and gross contamination in the abdomen; a condition that is life-threatening without prompt specialist medical intervention. Many more cases of serious harm have since been found, with people taking or more tablets a day, including one death due to perforated gastric ulcer. Other serious complications have been described, such as low potassium levels and renal failure also caused by excessive use of ibuprofen/codeine products (Chetty 2003; Dyer 2004; Lambert 2005). The death of a young mother in the United Kingdom from renal failure caused by a two year addiction to Nurofen Plus sparked outrage last year. Responses The situation is complicated. If unilateral action is taken to limit supply of ibuprofen/codeine products, users may switch to other OTC products such as Panadeine, and substitute with a daily dose providing toxic levels of paracetamol. Getting help Anyone who is regularly taking more than the recommended daily dose of one of these pain killers and can t stop, should discuss this with their pharmacist or doctor. DirectLine ( ) is a 24 hour confidential telephone counselling and referral service for people with an alcohol or other drug problem....continued page 8 6

7 Prevention of pharmaceutical drug misuse Psychological therapy: a non-drug alternative for the treatment of anxiety and substance use Dr Hunter Mulcare, Psychologist, Clinical Services, Turning Point Drug and Alcohol Centre, Victoria Problems with anxiety are commonly experienced by the general public, and are particularly prevalent in drug using populations. An increasing research base has identified that psychological therapy, in particular, cognitive behaviour therapy (CBT), is an effective alternative to pharmaceutical treatments of anxiety and can result in longer lasting changes to anxiety levels. Additionally, CBT has been shown to be effective in helping people reduce their drug or alcohol use. Recent changes to Medicare have improved access to psychologists and made this form of treatment much more affordable. Anxiety can take many forms Common types of anxiety experienced are generalised anxiety (worry), panic and panic attacks, social anxiety (or social phobia) and post-traumatic stress disorder. Less common types include obsessive compulsive disorder and phobias. An anxiety problem can be long standing, or arise as a result of acute stress. Importantly, anxiety can have an effect on the body and behaviour. Many people who experience stress and anxiety will initially present to a general practitioner (GP) with physiological or behavioural problems rather than report anxiety. For example, difficulty sleeping, fatigue, change in diet, increase in substance use and stress related somatic problems such as more frequent illness or opportunistic infections. Anxiety and substance use problems commonly occur together. Some people begin using substances or are prescribed drugs because of their calming effect. People may then develop a dependence on the substance because they do not learn how to manage their anxiety symptoms without using the substance. For others, abuse of substances (e.g. alcohol, cannabis) can cause or exacerbate a pre-existing anxiety problem. The benefits of psychological therapy Whatever the aetiology of the anxiety, CBT has been shown to be effective in helping people reduce or stop using alcohol or other drugs, including prescription drugs. This generally results in a positive change in mood and anxiety. Psychological therapy is targeted to the specific type of anxiety experienced or substance used. Behavioural strategies are developed with a client to help them cope with anxiety without substances, to cut back their use, and to reduce other causes of anxiety (e.g. exposure to stress, caffeine and poor diet). Cognitive strategies are used to help people develop skills to be less critical of themselves and to cope with stress and cravings more effectively. Psychologists are an important resource for people who need assistance to reduce or cease use of drugs like benzodiazepines (commonly used for conditions such as anxiety), alcohol and other drugs. Under changes to Medicare, if a person is referred to a registered psychologist by their GP under a GP mental health care plan they are eligible for a Medicare rebate for 6 12 therapy sessions. This initiative has substantially lowered the cost of psychological therapy and greatly improved access to psychologists. Importantly, a person does not need to be in therapy for a long period of time and many clients report an improvement in their mood and substance use after a short period of therapy. More information For more information about accessing or referring to a psychologist see the Australian Psychological Society website or speak to your GP. People experiencing substance use problems, with or without a co-occurring anxiety (or mood) problem can be referred to Turning Point under a GP mental health care plan. Enquiries about referrals to psychologists at Turning Point can be directed to Dr Hunter Mulcare via hunterm@turningpoint.org.au or on (03) Referral information can also be found on the Turning Point website DRUGINFO Vol. 7 No. 2 December

8 CALENDAR NEWS reviews resources quick bites...continued from page 6 References ACSQHC 2002 Second National Report on Patient Safety: Improving Medication Safety, Canberra: Australian Council for Safety and Quality in Health Care Chetty R, Baoku Y, Mildner R, Banerjee A, Vallance D, Haddon A & Labib M 2003 Case report: severe hypokalaemia and weakness due to Nurofen misuse, Annals of Clinical Biochemistry, 40, pp Dutch MJ 2008 Nurofen Plus misuse: an emerging cause of perforated gastric ulcer, Medical Journal of Australia, 188, pp Dyer BT, Martin JL, Mitchell JL, Sauven NC & Gazzard B 2004 Hypokalaemia in ibuprofen and codeine phosphate abuse, International Journal of Clinical Practice, 58:11, pp Hawkey CJ 2002 NSAIDs toxicity: where are we and how do we go forward?, Journal of Rheumatology, 29, pp Lambert PA & Close C 2005 Life-threatening hypokalaemia from abuse of Nurofen Plus, Journal of the Royal Society of Medicine, 98, p. 21 Tarone RE, Blot WJ & McLaughlin JK 2004 Nonselective nonaspirin nonsteroidal anti-inflammatory drugs and gastrointestinal bleeding: relative and absolute risk estimates from recent epidemiologic studies, American Journal of Therapeutics, 11, pp Turning Point is conducting a study to learn more about over-the-counter codeine starting early next year (2009). If you are interested in finding out more about this research, or would like to be notified when the survey commences please contact Suzi Nielsen on , Suzi.nielsen@turningpoint.org.au or phone (03) Review George Aranda, Information Officer, DrugInfo Clearinghouse, Australian Drug Foundation Benzodiazepine and pharmaceutical opioid misuse and their relationship to crime: An examination of illicit prescription drug markets in Melbourne, Hobart and Darwin Fry C, Smith B, Bruno R, O Keefe B & Miller P 2007 NDLERF Monograph series, no. 21, Hobart: National Drug Law Enforcement Research Fund This report offers a review of facts, issues and future directions relating to the abuse and misuse of benzodiazepines and pharmaceutical drugs and their relationship to crime in Melbourne, Hobart and Darwin. The research, funded by the National Drug Law Enforcement Research Fund, is based on interviews with people personally affected by drug misuse and abuse, and individuals working in the law enforcement and health sectors. The report examines the status and idiosyncrasies of the drug markets of each of these Australian cities, the nature and prevalence of crime, and how licit and illicit drugs enter the market. The findings of this examination identified the difficulties of front-line policing of these drugs in each city. A number of interventions are proposed to reduce the need for law enforcement responses and these include: creation of alternatives to criminal charges; greater monitoring of prescription medication; lower drug costs; greater communication and education between relevant health and legal systems. At under 130 pages, the report provides a thorough yet succinct examination of the relationship of these drugs and crime in Australia and would be useful to anyone working from a legal, health or consumer perspective. A PDF of the monograph is available from the National Drug Law Enforcement Research Fund website at 8

9 CALENDAR Prevention NEWS reviews of pharmaceutical resources drug quick misuse bites Review Anna Gifford, Resource Centre Manager, DrugInfo Clearinghouse Resource Centre, Australian Drug Foundation How Drugs Affect You: analgesics (painkillers) Analgesics are available in over-the-counter and prescription medications as a range of compounds and brands. This compact pamphlet from the Australian Drug Foundation s How Drugs Affect You series provides a helpful summary of facts and issues surrounding the non-medical use of analgesics. Opening with general statistics on non-medical analgesic use within Australia, the publication focuses on aspirin, codeine, ibuprofen and paracetamol, outlining effects upon the body, dependence, withdrawal and overdose. It includes information on the effects of combining analgesics with other drugs and on specific risks in using analgesics during pregnancy and breastfeeding. It also contains clear and concise information on what to do if someone overdoses or has an adverse reaction after using an analgesic. This pamphlet is available for purchase from the Australian Drug Foundation Bookshop ( In the library Anna Gifford, Resource Centre Manager, DrugInfo Clearinghouse Resource Centre, Australian Drug Foundation Drugs and Crime Prevention Inquiry into the misuse/abuse of benzodiazepines and other forms of pharmaceutical drugs in Victoria: final report Melbourne: Drugs and Crime Prevention Committee This report offers a comprehensive review of facts, issues and future directions relating to the misuse and abuse of benzodiazepines and other pharmaceutical drugs. The inquiry, managed through the Parliament of Victoria s Drugs and Crime Prevention Committee, gathered submissions from a range of sources including medical personnel, alcohol and other drug organisations and individuals personally affected by prescription drug misuse and abuse. A feature of the report is the contextual section which includes statistical information and covers the extent and types of misuse and abuse and some of the adverse consequences that can arise from these. The information provided is comprehensive and well structured, and provides an excellent overview of the issues. A key point made by the report is that there is insufficient understanding both in the community and from a research perspective of the harms of inappropriate pharmaceutical use. The report proposes a number of strategies to reduce misuse of prescription drugs, covering education, research, prescription and packaging, and treatment and management responses. DRUGINFO Vol. 7 No. 2 December

10 CALENDAR NEWS reviews resources quick bites CALENDAR 2009 February NSW Bureau of Crime Statistics and Research 40th Anniversary Symposium, Sydney, NSW web VAADA Conference Direction in a time of change, Melbourne, Victoria web items/2008/09/ upload pdf March 2 3 3rd Annual Conference of the International Society for the Study of Drug Policy, Vienna, Austria web rd International Conference on Fetal Alcohol Spectrum Disorder, British Columbia, Canada web April Harm Reduction 2009: IHRA s 20th International Conference. Harm reduction and human rights, Bangkok, Thailand web Collegium Internationale Neuro-sychopharmacologicum International Thematic Meeting: Major psychoses and substance abuse, Edinburgh, Scotland web cinp.org/index.php?id= Annual ATDC Conference, Hobart, Tasmania For enquiries contact Jane Barry on tel. (03) or conference@atdc.org.au May Not just another youth site Would you like to help thousands of young people without leaving your computer? Could you spare an hour or two a week? Somazone ( is looking for qualified health professionals to volunteer their time and expertise to answer several young people s questions each week. Somazone is particularly looking for pharmacists, psychologists, psychiatrists, general practitioners, community and practice nurses, dieticians, and alcohol and drug, mental health, sexual health and relationship counsellors. Please contact Somazone at somazone@adf.org.au or tel for an application form and further details. Somazone is a website developed by young people, for young people, managed by the Australian Drug Foundation. The website provides young people with free and anonymous access to quality-assured health information on a range of topics, including alcohol and other drugs, mental health, relationships, sexual health and body image. I have loved answering these questions, they have certainly assisted in my interactions with my own clients and I hope I have been of some use to the young people who asked me such important and relevant questions. Adolescent Group Facilitator, Victoria. 6 8 Outside in: Community responses to complex and diverse needs, Sydney, NSW web Connecting up 2009: The online future of nonprofits...are we there yet? Sydney, NSW web Working well together. Diversity in the Desert Conference, Alice Springs, NT For enquiries contact Treasure Gordon on tel. (08) or dcem@desliens.com.au Reconnexion National Conference 2009, Melbourne, Victoria web displayarticle/national-conference html During the past few months, there has been a lot of hard work behind the scenes in planning for Harm Reduction 2009 ( and the Conference Director, Professor Gerry Stimson, has written an open letter to everyone interested in the event in order to update our colleagues on some of the significant developments. In particular, the conference will now be held at the Imperial Queen s Park Hotel over four full days: April Please visit to view the open letter from Professor Gerry Stimson. 10

11 CALENDAR Prevention NEWS reviews of pharmaceutical resources drug quick misuse bites Web reviews Linda Rehill, Editor Web Content, DrugInfo Clearinghouse, Australian Drug Foundation Reconnexion Reconnexion is a non-profit organisation providing education and treatment for people experiencing anxiety, depression and tranquilliser dependency, and training for health professionals. A substantial section of the site is devoted to tranquillisers and sleeping pills, with a focus on the effects of benzodiazepines, the withdrawal process, treatment options and alternatives. For health and welfare practitioners, there is a useful information sheet, Information on tranquillisers and sleeping pills, which has been translated into 23 languages and is available in PDF format to print out and hand to clients. National Prescribing Service The National Prescribing Service is a non-profit organisation that provides information on medications used in Australia, for both consumers and health professionals. The consumer section of the site allows searching for information on particular drugs, and as part of their Get to know your medicines campaign, Funding opportunities The Ian Potter Foundation This foundation funds projects to improve the community s ability to respond creatively to social, environmental, science and health issues. There are three funding rounds per year closing in February, June and October. Anyone intending to seek more than $ should speak with Foundation staff before submitting their application. Web: provides a range of consumer resources in four community languages, to order in hardcopy or download from the site. The health professionals section allows searching on individual drugs or drug issues, such as drug seeking behaviour. These searches link to articles from the journal Australian Prescriber, when relevant. Australian Prescriber RUM This independent publication, funded by the National Prescribing Service, provides online access to a range of articles on prescription drugs, including topics such as prescription drug abuse. The site also includes a Comments for consumers section with plain English summaries of the original articles. Since 1998 the Return Unwanted Medicines (RUM) program has provided for the safe disposal of expired or unwanted medicines through local pharmacies. Funded by the Commonwealth Department of Health and Ageing, the program solves problems caused by hoarding and unsafe disposal, as the medications are safely destroyed through EPA-approved high temperature incineration. Visit the RUM website for more information, including a downloadable pamphlet for consumers. The Grosvenor Foundation This foundation has grants available to charitable organisations that assist people living in Victoria and/or regional/rural Australia. The grants cover education, homelessness, community development, employment, health, drugs and addiction, disability and Indigenous youth projects. Grants are, generally, for a one-year period and no more than $ per applicant. There are two funding rounds per year closing in April and October. Web: eqt.com.au/grantseekers/trustsdetails. asp?trustid=8587 DRUGINFO Vol. 7 No. 2 December

12 CALENDAR NEWS reviews resources quick bites...continued from page 1 to assist in sleep and anxiety management include The better sleep booklet and a relaxation CD. A treatment manual Beyond Benzodiazepines is available for alcohol and other drug practitioners assisting people to reduce their benzodiazepine use. Secondary consultation for alcohol and other drug practitioners is available from counselling staff who can assist with reduction programs, withdrawal information or any related issues where practitioners might benefit from advice or support. Education and training sessions are provided to health and welfare practitioners on a range of topics including treatment of insomnia without drugs, anxiety disorders, depression, relaxation and benzodiazepine reduction and Coming up in DrugInfo withdrawal support. Similar information sessions are provided to the community with an emphasis on informed choice and providing evidence based alternatives to longterm benzodiazepine use. An annual National Anxiety and Depression Conference is held with the aim of providing counsellors and other practitioners with an opportunity to develop their skills and knowledge in current best practice and emerging therapies. The Reconnexion Education and Training Manager, Janet Haynes, can be contacted to arrange education and training sessions at your workplace or for more information about the national conference. janet@reconnexion.org.au or phone (03) The next issue of DrugInfo will focus on the prevention of alcohol-related harms in Koori communities. Meanwhile, check our website for the latest information on drugs and drug prevention ( CONTACTS Ms Betty Vassiliadis Editor, DrugInfo Australian Drug Foundation PO Box 818 North Melbourne VIC betty@adf.org.au Phone (03) Fax (03) Information Officer druginfo@adf.org.au Phone Fax (03) DRUGINFO DrugInfo is a quarterly newsletter published by the DrugInfo Clearinghouse, an initiative of the Australian Drug Foundation and the Victorian Government. Views expressed within are those of individual authors and may not reflect the views or policies of the DrugInfo Clearinghouse, the Australian Drug Foundation or the Victorian Government. First name*: Position/Program: Organisation: Postal address*: Tel*: ( ) Fax: ( ) Library membership is free and open to Victorians working or studying at postgraduate level in alcohol and other drugs, health, education or related fields. Would you like to join the library? Yes No * Essential fields become a member of druginfo clearinghouse Your area(s) of interest Surname*: All areas Community prevention Culturally and linguistically diverse communities Health and welfare Indigenous communities Justice Mental health Older people Parents and families Postcode: Policy Schools/education Treatment Workforce development/training Young people Other Would you like to receive free quarterly prevention resources, including DrugInfo newsletter, fact sheets and the latest reports on prevention research? Yes No If yes, preferred format: Post (Victoria only) Mail to: DrugInfo Clearinghouse, Australian Drug Foundation, PO Box 818, North Melbourne VIC