Safety & Emergency Review "Supporting Safety in the Community"
Safety & Emergency Review "Supporting Safety in the Community"
IN THIS ISSUE . . . 1.
Who Uses Drugs?
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Who uses drugs? A number of state and national surveys have been conducted to assess the extent of drug use in Australia. These surveys provide clear evidence that Australia is a nation of drug users. A 2001 national survey (1) reported that, of Australians aged 14 and older: · · ·
90.4% had used alcohol 49.4% had used tobacco 33.1% had used marijuana
· · · · · · · · · ·
6.0% had used analgesics (pain-killers) 3.2% had used tranquillisers 7.6% had used hallucinogens 8.9% had used amphetamines 6.1% had used ecstasy 4.4% had used cocaine 2.6% had used inhalants 1.6% had used heroin 0.3% had used steroids 0.3% had used methadone
Harm caused by drugs
social problems, psychological and emotional difficulties, and legal and economic problems are more common experiences. It should be kept in mind that many people start and continue to use drugs to find relief or escape from these sorts of problems. People use drugs to change how they feel; because they want to feel better or different. They use drugs for their perceived or experienced benefits, not for their potential harm. There is a prevailing community fear that if a person uses drugs they will become dependent or ‘addicted’. No drug leads to an immediate physical or psychological . However, drug-related harm can happen at all levels of use, including , recreational and dependent use.
Classifying drugs Drugs are classified in a number of ways. The two most common modes of classification are: ·
according to the legal status of the drug; and
One of the most concerning measures of drug· according to the drug’s effects on the related harm to the community is the death toll. central nervous system. Drug use is a factor in about one in five of all Neither form of classification gives a clear indicadeaths in Australia. According to recent statistics in tion of the harms associated with a particular drug. Australia (2), 23,313 deaths were attributed to drug Harm is related to other variables such as the use in 1998. Of these: properties of the drug; and the frequency, duration · 19,019 deaths were associated with tobacco and method of use. use Harm reduction is a strategy used by many drug · 3,271 deaths related to alcohol use* and alcohol workers in the field that concentrates · 1,023 deaths resulted from illicit drug use. on reducing the harms associated with drug use * moderate alcohol use may play a part in preventing some select causes of death and ill health, such rather than the actual drug use itself. An example as cardiovascular disease. This appears to be of harm reduction is the needle exchange service largely applicable to the 65+ age range. which aims to reduce the spread of diseases such as HIV and hepatitis There are a range of harms that can result from excessive or inappropriate use of psychoactive substances. Loss of life is one extreme and tragic Classifying by legal status possibility. Negative health effects, family and Most people know which drugs are illegal, although the legal status of a drug is not always simple. Most ‘legal’ drugs are subject to restricSAFETY REVIEW - PAGE 3
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inserting. Drugs that are injected or inhaled act very quickly and the effects are more intense. Snorting is the next fastest acting method of administration, while the effects of ingested drugs take longer to come on.
quality and price. For example, it is against the law for a pharmacist to supply prescription drugs to a person who does not have a doctor’s prescription. It is also illegal to sell tobacco and alcohol to people under 18 years of age. Possession of some drugs that grow naturally is illegal. Examples include magic mushrooms and datura. Both are potent hallucinogens. With illicit drugs there are no quality or price controls. This means that a user can never be sure of the drug’s strength or purity. It also means that price is mediated by black market forces and not by any governed or consistent pricing policy. Some examples of other substances mixed with certain drugs include glucose, baking soda talcum powder and starch. These can be very dangerous to the body possibly causing collapsed veins, tetanus, abscesses, damage to the heart, liver, lungs and brain
Physical characteristics of the user: a person’s height, weight and gender also influence drug effects. The proportion of body fat, rate of metabolism and stage of the menstrual cycle can all influence the intensity and duration of drug effects.
The mood and environment of the user: how a person is feeling can have a significant impact on drug effects, as can the social setting of drug use. If it is a comfortable social atmosphere, users are more likely to have a good time. If it is a threatening environment or the person feels alienated from the group, they may become fearful, anxious, paranoid or depressed.
Tolerance to the substance: tolerance to a drug can develop if a person uses it frequently. The first time a person uses a drug, they have a very low tolerance and are likely to feel the effects very strongly. The more often the drug is used, the less intense the effects will be. This results in the need to take bigger amounts to get the desired effect.
Polydrug use: polydrug use refers to the use of more than one drug. Users often have a primary drug of choice (for example alcohol, marijuana, speed or heroin but will use one or more other drug(s) to top up, come down or as a substitute. Combining drugs can increase or alter their effects, often in unpredictable ways. Despite the risks, polydrug use is quite common. For example, tranquillisers or marijuana may be used to help a person come down from speed or from an trip.
Classifying by effects Knowing the legal status of a drug is important, but it is not a clear indication of harm or effects. The physical and psychological effects of psychoactive drugs depend on how they act on the central nervous system which, in turn, affects our thoughts, feelings and actions. Psychoactive substances include legal, illegal and prescription drugs. It is impossible to predict exactly how a drug will affect any one person. Effects usually relate to how much is used, how often it is used and what other drugs are used. The following factors also influence drug effects: ·
How much of the drug is taken and how often: the dose level of a drug is a major factor influencing drug effect. The higher the dose, the greater the effect. Overdose occurs when the amount of the drug taken exceeds the body’s capacity to effectively cope with the drug. Depending on the drug taken, the central nervous system is either over-stimulated or slowed down so much that life is threatened. How the drug is taken or administered: drugs can get into the body in a number of ways including ingestion (drinking, eating); smoking; injecting; snorting; inhaling and
withdrawal symptoms from speed include anxiety, irritability, tiredness and depression ·
Using two or more drugs simultaneously or within a relatively short time frame can be hazardous. There is a real risk of overdose if, for example, two drugs that are both central nervous system depressants are present in the body at the same time. Taking heroin, minor tranquillisers, methadone and alcohol (in any combination) can be SAFETY REVIEW - PAGE 5
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fatal. The three main types of drugs, classified by their effects on the central nervous system are: ·
Depressants Depressant drugs slow down, or depress, the central nervous system. They don’t necessarily make you feel depressed. Depressant drugs include: ·
opiates and opioids, including (heroin), morphine, codeine, methadone, and pethidine; cannabis, including marijuana, hashish and hash oil;
tranquillisers and hypnotics, including Rohypnol, Valium, Serepax, Mogadon, Normison and Euhypnos;
barbiturates, including Seconal, Tuinal and Amytal; and some solvents and inhalants, including petrol, glue, paint thinners and lighter fluid.
In moderate doses, depressants can make you feel relaxed. Some depressants cause euphoria and a sense of calm and wellbeing. They may be used to ‘wind down’ or to reduce anxiety, stress or inhibition. Because they slow you down, depressants affect coordination, concentration and judgement. This makes driving and operating machinery hazardous. In larger doses depressants can cause unconsciousness by reducing breathing and heart rate. A person’s speech may become slurred and their movements sluggish or uncoordinated. Other effects of larger doses include nausea, vomiting and, in extreme cases, death. When taken in combination, depressants increase their effects and increase the danger of overdose.
Stimulants Millions of Australians use stimulants every day. Coffee, tea and cola drinks contain caffeine which is a mild stimulant. The nicotine in tobacco is also
a stimulant, despite many smokers using it to relax. Other stimulant drugs, such as ephedrine, are used in medicines for bronchitis, hay fever and asthma. Stronger stimulant drugs include amphetamines speed and cocaine, which are illegal. Slimming tablets (Duromine, Tenuate Dospan, Ponderax) are also strong stimulants. Stimulants speed up or stimulate the central nervous system and can make the user feel more awake, alert or confident. Stimulants increase heart rate, body temperature and blood pressure. Other physical effects include reduced appetite, dilated pupils, talkativeness, agitation, and sleep disturbance. Higher doses of stimulants can ‘over stimulate’ the user, causing anxiety, panic, seizures, headaches, stomach cramps, aggression and paranoia. Prolonged or sustained use of strong stimulants can also cause these effects. Strong stimulants can mask the effects of depressant drugs, such as alcohol. This can increase the potential for aggression, and poses an obvious hazard if the person is driving.
Hallucinogens Hallucinogenic drugs distort the user’s perceptions of reality. These drugs include: ·
LSD (lysergic acid diethylamide): ‘trips’, ‘acid’, microdots;
magic mushrooms (psilocybin): gold tops, ‘mushies’;
mescaline (peyote cactus); ecstasy (MDMA/ methylenedioxymethamphetamine): X, XTC, eccies; cannabis: in stronger concentrations, such as in hashish and resin, cannabis can act as an hallucinogen in addition to being a central nervous system depressant; and
ketamine: K, Special K.
The main physical effects of hallucinogenic drugs are dilation of pupils, loss of appetite, increased activity, talking or laughing, jaw clenching, sweating and sometimes stomach cramps and nausea. Drug effects can include a sense of emotional and psychological euphoria and wellbeing. Visual, SAFETY REVIEW - PAGE 7
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that appear irrational or bizarre. Psychological effects often depend on the mood of the user and the context of use. Negative effects of hallucinogens can include panic, paranoia and loss of contact with reality. In extreme cases, this can result in dangerous behaviour like walking into traffic or jumping off a roof. Driving while under the influence of hallucinogens is extremely hazardous. It is common for users to take minor tranquillisers or to help them come down from an hallucinogenic drug.
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Cannabis What is Cannabis? Cannabis is a drug that comes from the cannabis sativa plant. The active chemical in cannabis is THC (Delta-9 tetrahydrocannabinol). Cannabis is a depressant drug. Depressant drugs do not necessarily make you feel depressed. Rather, they slow down the central nervous system. They slow down the messages going to and from the brain to the body. Cannabis can also have mild hallucinogenic effects. There are three main forms of cannabis: marijuana, hashish and hash oil. Forms of cannabis Marijuana is the most common and least powerful form of cannabis. It is the dried leaves and flowers of the plant. It looks like chopped grass and ranges in colour from grey-green to greenish-brown. Its texture can be fine or coarse. It can contain seeds and twigs from the plant. The flowers or “heads” are the most potent part of the plant and so the potency of marijuana will depend upon the amount of leaf and heads it contains. Marijuana is smoked in hand-rolled cigarettes (joints) or in a pipe (a bong). Hashish (hash) is small blocks of dried cannabis resin. Blocks range in colour from light brown to nearly black. The concentration of THC in hashish is higher than marijuana, producing stronger effects. Hash is added to tobacco and smoked, or baked and eaten in foods such as “hash cookies”. Hash oil is a thick oily liquid, golden-brown to black, that can be extracted from hashish. It is usually spread on the tip or paper of cigarettes and then smoked. Hash oil is more powerful than the other forms of cannabis. A very small amount can have a strong effect. This form is rarely used in Australia. A non-potent form of cannabis (Indian hemp) is used to produce fibres for use in paper, textiles and clothing. THC
THC (Delta-9 tetrahydrocannabinol) is the chemical in marijuana that makes you feel “high”. This means you experience a change in mood and may see or feel things in a different way. Some parts of the plant contain a higher level of THC. For example, the flowers or heads have more THC than the stems or leaves. THC is absorbed into the bloodstream through the walls of the lungs (if cannabis is smoked), or through the walls of the stomach and intestines (if eaten). The bloodstream carries the THC to the brain, producing the ‘high’ effects. Drugs inhaled get into the bloodstream quicker than those eaten. This means that the effects of cannabis when smoked (inhaled) happens more rapidly. Street names Grass, pot, hash, weed, reefer, dope, herb, mull, buddha, ganja, joint, stick, buckets, cones. Cannabis use in Australia According to recent research: · Cannabis is the most widely used illegal drug in Australia. · In 1998, 39% of the Australian population (44% male and 35% female) reported having ever used cannabis; and 18% had used in the last 12 months.1 · The average age of first time use of cannabis was 18.7 in 1998.1 · Of the recent users in 1998, the highest user group at 37% was the 20-29 year age group. 1
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Cannabis was the most commonly used illicit substance among secondary students with 36% of all secondary students aged between 12 and 17 years reporting the use of cannabis at some time in their life. 2 Cannabis use (taken at sometime in their life) increased with age, increasing from 13% of 12-year-olds to 55% of 17-yearolds. 2 Weekly use also increased with age, from 3% of 12-year-olds to 16% of 17-year-olds. 2
Weekly use was more common among boys than girls. 2
More drug statistics 1
1998 National Drug Strategy Household Survey, First results, August 1999, Australian Institute of Health and Welfare, Canberra. 2 Australian Secondary Students’ use of over-thecounter and illicit substances in 1996, Centre for Behavioural Research in Cancer, Anti-Cancer Council of Victoria, November 1998. Cannabis use in context Of all the illegal drugs, cannabis is the most regularly used. The claim that cannabis use will lead to the use of “harder” drugs has been a major argument for sustaining the prohibition of cannabis since the mid-1960s. However, there is little evidence to support the notion that cannabis use leads to the use of other drugs. While it is true that most heroin users have also used cannabis (and alcohol and tobacco), it is worth noting that most people who use cannabis do not progress to using heroin, amphetamines or any other illegal drug. Medical uses Cannabis has been used medicinally for many centuries. There is evidence to suggest it is useful in providing relief to cancer patients from nausea and vomiting caused by chemotherapy. Researchers now believe cannabis is worthy of further investigation in the treatment of glaucoma, nausea, anorexia nervosa, epilepsy and asthma. Effects The effects of any drug (including cannabis) vary from person to person. It depends on many factors including an individual’s size, weight and health, how the drug is taken, how much is taken, whether the person is used to taking it, what it’s being taken
for (for example, stress) and whether other drugs are taken. The effects also depend on the environment in which the drug is used - for example, whether the person is alone, with others, or in a specific social setting. When people are affected by cannabis they are said to be “stoned”, “bent” or “high”. Traces of THC can remain detectable in urine samples for days, even weeks, after use. Immediate effects Small quantities of cannabis can have effects that last 2 to 3 hours after smoking. Relaxation and loss of inhibition: Cannabis can make the user feel happy, relaxed, and comfortable. They may feel less inhibited, friendlier and laugh spontaneously. Sometimes people become quiet and reflective. They may also become sleepy. Increased appetite: Cannabis often increases the appetite and leads to snacking on junk food, “the munchies.” Affected perception: Cannabis can increase awareness and the perception of colour, sound and other sensations. It can affect vision and perception of time and space. Less coordination: Cannabis decreases coordination and balance, making it dangerous to drive or operate machinery. Thinking and memory: Cannabis can affect memory and the ability to think logically. People can lose track of what they are saying or thinking. When affected by cannabis, some people may think as though they’ve had profound ideas or insights. Other common immediate effects include increased heart rate, low blood pressure, faintness and reddened eyes. There also can be a “hangover” effect, like drowsiness and poor coordination that lasts for several hours after the initial effects.
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In greater quantities Larger quantities of marijuana make the above effects stronger, and also tend to distort a person’s perceptions. Very large quantities of marijuana can produce: · confusion · restlessness · feelings of excitement · hallucinations · anxiety or panic, or detachment from reality · decreased reaction time · paranoia. Occasional use of small quantities Currently, there is no evidence that occasional use of small quantities of cannabis causes any permanent health damage. Long-term effects Research in Australia and the USA shows evidence of some long-term effects in some regular cannabis users. Respiratory illness: Marijuana cigarettes have more tar than tobacco, placing cannabis users at an increased risk of respiratory illness such as lung cancer and chronic bronchitis. This risk is increased because marijuana smokers often inhale deeply, and hold the smoke in the lungs longer, to increase the effects of the drug. Cigarette smokers who also smoke cannabis have an even greater risk of respiratory disease. Less motivation: Many regular users, especially young people, have reported that they have less energy and motivation so that performance at work or school suffers. Usually these effects disappear gradually when cannabis use stops. Brain function: Concentration, memory and the ability to learn can all be reduced by regular cannabis use. These effects can last for several months after ceasing cannabis use. Hormones: Cannabis can affect hormone production. Research shows that some cannabis users have a lower sex drive. Irregular menstrual cycles and lowered sperm counts have also been reported. Psychosis In general, there appears to be three separate circumstances whereby cannabis and psychosis are linked. · It is believed that cannabis use - especially if heavy and regular - may be linked to a condition known as a drug-induced psycho-
sis or cannabis psychosis. This can last up to a few days. The episodes are often characterised by hallucinations, delusions, memory loss and confusion. · Cannabis use may also precipitate a latent psychosis. In other words, it could bring forward an episode of schizophrenia or manic depressive psychosis in a vulnerable or pre-disposed individual. · It is possible that cannabis use can trigger psychotic episodes in a person who already has a mental illness Tolerance and dependence With regular use, people can develop a mild tolerance to cannabis. This means they need to take more and more to get the same effect. Dependence on a drug can be psychological, physical or both. Psychological dependence: People can become psychologically dependent on any drug, including cannabis. This means that using cannabis becomes far more important than other activities in their life. Cannabis becomes part of their lifestyle (e.g. reducing stress, increasing relaxation) and some come to depend on it. Some people crave the drug and find it very difficult to stop using it. Physical dependence: Physical dependence occurs when a person’s body adapts to a drug. The body gets used to functioning with the drug present. Heavy and frequent use of cannabis can cause physical dependence. Withdrawal Abrupt termination of cannabis use can produce a mild withdrawal syndrome. Symptoms include sleep disturbance, irritability, loss of appetite and
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consequent weight loss, nervousness, anxiety, sweating and upset stomach. Sometimes chills, increased body temperature and tremors occur. The withdrawal syndrome usually lasts for less than a week, although the sleep disturbances may persist for a longer period. Treatment options In Australia, there are a number of drug treatment options. Some aim solely for the user to achieve a drug-free lifestyle. Others recognise abstinence as one option, however, due to individual circumstances, may not be possible in certain situations. The overall aim of these programs is to reduce the harm/risks related to a personâ€™s drug use. Treatment is more effective if tailored to suit a personâ€™s specific situation and usually involves a combination of methods. The different options include individual counselling, group therapy, medication and supervised/home withdrawal. More on treatment Cannabis and other drugs Combining cannabis with other drugs such as alcohol or prescribed drugs can increase and alter the effects, with unpredictable consequences. It is always dangerous to combine drugs. It is widely believed that using cannabis leads people on to using other illegal drugs. However, there is no evidence to support this. Most users of cannabis do not use other illegal drugs. Pregnancy and breastfeeding Pregnancy Little is known about the effects of cannabis on the unborn child. However, the use of cannabis during pregnancy is not recommended. If cannabis is used during pregnancy the baby may be born smaller and lighter than other babies. Low birth weight can be associated with infections and breathing problems. Breastfeeding Little is known about the effects of cannabis smoking on breastfeeding. It is believed that some of the drug will pass through the breast milk to the baby and the baby may become unsettled and demand frequent feeding. Check with your doctor, or other health professional, if you are taking or planning to take any substances during pregnancy, including prescribed and over-the-counter medications.
More on pregnancy/breastfeeding Cannabis and driving It is illegal to drive a motor vehicle while under the influence of any drug (including cannabis). Breaking this law carries heavy penalties, disqualification from driving, fines, and even imprisonment. Cannabis, particularly in combination with alcohol, will greatly increase the risk of having an accident. Cannabis and alcohol can significantly reduce the ability to drive safely. Effects, such as reduced coordination, slow reaction time, blurred vision and drowsiness, impact on driving ability. These effects can last several hours and appear to vary according to quantity, quality and content. Research on the effects of cannabis on driving is currently being undertaken. More on drugs and driving Cannabis and the law Cannabis is illegal. Federal and State laws provide penalties for possessing, using, making or selling cannabis. Drug laws in Australia distinguish between those who use drugs and those who supply or traffic drugs. For example, in Victoria penalties range from fines of $2,000 and/or one year in prison for cultivation (not related to trafficking) to fines of up to $250,000 and/or 25 years in prison for commercial trafficking. The laws in Australia vary from state to state in relation to the possession and use of cannabis. In Victoria, the police and courts have recently introduced a number of new schemes in relation to
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drug offences. Some of these aim to divert people from the criminal justice system, others involve referring people with a drug problem to treatment programs. For example, first time cannabis users will usually be fomally cautioned at a police station and then referred to drug treatment service. Failure to attend treatment may result in charges being laid. More on drugs and the law Family and work problems Family problems and other personal problems may be related to cannabis use. Disagreements over drug use can cause family arguments and affect personal relationships. Heavy cannabis use may also lead to problems at work or school. More on support for families Reducing the risks Australian drug policy is based on harm minimisation. This is about reducing drug related harm to both the community and individual drug users. Harm minimisation strategies range from encouraging â€œnon-useâ€? through to providing the means for drug users to use drugs with less risks.
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