JUST SAY “NO” TO FAILED DRUG POLICIES

I recently returned from Australia and began to connect with the addiction community there via several agencies and their newsletters and articles. One very thoughtful article published by Family Drug Support Australia (FDS) is excerpted here. Written by an emergency room physician who is on the front line with overdose victims, he is also a parent who is concerned for his children’s future unless drug policies in Australia change sooner rather than later. There, as in the US, bureaucrats spend years discussing options for change while people die in the tens of thousands. However, from people I’ve spoken with there and from all I’ve read, they are ahead of us in some significant areas. May we all learn from each other.

Stop sacrificing young lives at an altar of drug dogma
By David Caldicott
December 11, 2018

I am the very proud father of some very naughty children, and I would happily walk through fire for them. I am also an emergency consultant with an interest in illicit drug overdoses and, by obvious extension, how to reduce them.

Since the death of yet another young man at a music festival this weekend, from a presumed overdose, it is in this latter capacity that I have been asked, on several occasions now, “How do you feel about another festival death in New South Wales?”…

Put aside the politics & policy debates. A young man is dead before his time…Allow yourself, for one terrible moment, to let that wash over you, as if it were happening to your loved ones. And now tell me what you wouldn’t do, how far you wouldn’t go, to stop that happening to your family.

This is the perimeter around which I perpetually hover. I am the man who rings you to tell you that your child or partner is in our department, and that you need to come into hospital — right now. I am the man who will hold your hand if you need me to, and tell you that I am sorry…I am the man who will agree with you that you never suspected that your loved one, my patient, was in the slightest bit interested in using drugs. Every time I do this, part of me breaks, and I rush home to hold my own a little tighter.

Australia’s National Drug Strategy supposedly is based on the three pillars of demand reduction, supply reduction and harm reduction, but it is effectively a one-legged milking stool. Research conducted by the agents tasked with implementing drugs policy shows that the lion’s share of the money we spend on drugs policy goes into prohibition.

We are not without evidence to guide us from around the world. In the early 2000s, Portugal was in a worse place than where Australia is now. By flipping expenditure on drugs policy to shift the focus to health outcomes, Portugal now has a drug-related death rate 10 times lower than Australia’s.

…my heart breaks for the parents and loved ones of yet another curious, bright, naughty kid who was unlucky enough to eat the wrong thing at the wrong time…How would I cope with the loss of one of my own, in the knowledge that society has not implemented everything that it could to ensure the tragedy could be avoided? That some in society might think that it “serves them right”, dabbling with infractions of the law. Really? Death as a “learning outcome”? 

In the end, this issue is not going to be resolved… by opponents inspired by the un-attainable ideology of a “drug-free Australia”… This is an issue that will be bled out of Australia, life by life, until such time as parents decide: “No more.” I have yet to meet a parent who is prepared to sacrifice their child on this altar of ideology and I abhor those who embrace the rhetoric that suggests this is reasonable.

It’s not reasonable that young people should die before the generation that preceded them. It’s not reasonable to accept that as a norm. What is reasonable is for any civilized society to leave “nothing in the locker room” when it comes to keeping people alive.

Leadership requires bravery and wit, and whatever it is we’re seeing from politicians on drugs policy, it’s neither courageous nor clever. And if politicians of any shade can’t look down the barrel of a camera and say that they will commit to that, they don’t deserve the job with which they’ve been entrusted and for which we pay them.

David Caldicott is a consultant emergency physician at Canberra’s Calvary Hospital in Australia.
Original article can be found at:
https://www.fds.org.au/messageboard/opinion-piece-by-david-caldicott-from-canberra-s-calvary-hospital

 
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The Best Laid Plans

Mac Miller – 26 year old rapper – died of an apparent overdose last week. One more beautiful young person lost in the prime of life. Friends and fans have unanimously said he was one of the sweetest guys they’d ever known with a great sense of humor. Miller spoke openly about his struggles with addiction over the years: “It just eats at your mind, doing drugs every single day, every second. It’s rough on your body.”

August 31st is International Overdose Awareness Day. I think we are all very aware of the enormous and continuing-to-rise number of drug––mostly opioid––overdose deaths. It is clear from conversations with many of the famous and not-famous users, like our son, that they have every intention of controlling their addiction and no intention of overdosing. But something goes wrong…

Dr. Jana Burson, an addiction treatment physician in North Carolina, has a great blog (https://janaburson.wordpress.com/) with insights gathered from her patients, many of whom are long-term opiate abusers. “I’m not gonna overdose. I know my limits.” Dr. Burson writes in August 2017: “I really hate hearing these words. Usually patients say this in response to my concerns about their pattern of drug use while I’m prescribing methadone or buprenorphine. But many patients feel they are the experts. They can’t imagine making a deadly mistake with their drug use. But I’ve heard this phrase from people who are now dead from overdoses.”

She recently cited a study in Australia 2013, where overdose deaths have risen steadily since 2007. In that country, unlike the U.S., heroin use is declining while prescription opioid misuse is rising. This study looked at non-fatal overdoses in very experienced people who inject drugs––an average of 21 years of IV drug use––half of whom were in a MAT (Medication Assisted Treatment) drug program.

Most of these overdoses happened in private homes––many the subjects said they were impaired by alcohol or benzodiazepines. Over a third of the subjects had used fentanyl, a very powerful illicit opioid, leading up to the overdose. The authors of the study concluded that these experienced drug users were aware of common risks for overdose, yet drug intoxication from sedatives such as alcohol or benzodiazepines may have clouded the user’s thinking when injecting opioids. They also found that unexpected availability of drugs contributed to overdoses.

This was our son’s story: It was his first night after 6 months in sober living––but it was not his first night using again. He had been on Percocet for oral surgery (a huge mistake) a month before he overdosed and then had returned to IV heroin use the week before his overdose. He had been drinking with friends the first night in his new apartment––his decision making abilities were impaired. We are not sure exactly how much heroin he injected, and since it was Black Tar heroin from Mexico, the strength is absolutely unpredictable. What we do know from the autopsy is that he had many times more heroin in his body than a fatal dose. His was an overdose that he would not survive. Was this his last conscious thought: “I’m not gonna overdose. I know my limits.”?