Australian drug overdoses

Australian Real Drug Talk

Translation into most languages at tab to the right.

One of the things I have come to appreciate about the Australian way is their straightforward approach to life. They are easy-going yet they say what they mean and you know where you stand. A lack of pretense – with a large dose of slightly off-color humor added in.

I think that is why they are more advanced in their drug policies and treatments than America – they are more honest and have less taboos. They benefit from having had comprehensive public health for decades which has facilitated progressive drug policies such as clean needle exchanges, safe-injecting sites, and medication assisted treatment.

John and I had an interesting conversation a few weeks ago here in Australia with Jack Nagel. Jack does the “Real Drug Talk” podcast from Melbourne and also runs the Connection Based Living Recovery Programs. We were preparing to record a podcast with Jack – see links below – and were asking about his experiences and what the current trends are here with drugs of abuse.

https://podcasts.apple.com/us/podcast/saying-goodbye-to-my-son-in-a-body-bag/id1507177011?i=1000533422150

About

In discussing opioids, I wondered why methamphetamines seems to be the main drug of choice and why heroin is not as common here as it is in the States. Jack said that in the 1990’s there was a big problem with heroin coming in from the Golden Triangle of SE Asia and lots of overdose deaths. And the heroin use was IV, not smoking. So, there is a collective memory of street people using heroin and dying which created a lot of stigma and fear associated with IV use.

After that trend slowed, people began using meth – young people like Jack –because smoking or snorting meth seems more innocuous and a less intrusive way to take a powerful drug than IV. Jack said that there is a huge cohort of people who don’t live on the streets and who smoke meth for years. Sadly, they don’t seek help because the public messaging that portrays meth addicts as homeless people with sores and missing teeth doesn’t apply to them. But meth addiction will eventually burst that bubble and ruin their lives too.

There is also a growing problem with cocaine. While once considered the drug of the wealthy city dweller with some high-flying users in Australia spending $10-$20K per week, statistics reveal cocaine usage has now spread much further. Consumption has grown in other areas and demographics where prosperity has increased such as middle-class teachers, tradesmen, etc. Australia is now the highest per capita user of the drug in the world. And the rise in use is being driven by men aged in their 20’s, with Sydney leading the country in use. The most recent stats reveal that there are nearly 1 million weekly cocaine users in Australia out of a population of 26 million. (1,2,3)

We also talked with Jack about what the entry drugs are for kids here in Australia. After alcohol and pot, they usually begin with hard “party” drugs used at house parties and concerts like ecstasy/MDMA, benzodiazepines, GHB/GBL. All mood-altering drugs that create different types of euphoria, but which are dangerous because many times they are mixed with alcohol and other drugs, sometimes without the user’s knowledge.

Even though heroin is in the background in Australia, it is still available and becoming more dangerous due to fentanyl being mixed in to the supply of much of the heroin, and all opioids, along with other drugs of abuse. (4)

When our son, JL, began using Oxy’s he never thought he would even try heroin. Then, as Oxy’s became more expensive and heroin was cheaper, he started smoking heroin. He then swore he would never stick a needle in his vein – the danger and stigma to him was clear. Eventually, just like 95% of heroin users, he did just that. He was living under the delusion that smoking opioids – or any drug – would never lead him to become a “junkie”, an IV drug user.

My concern for the young people and families of Australia is that, as The Age reported in 2020, pain management with opioids has increased here too, although not to the degree it had in the States. Opioid-related deaths have increased in the past decade and today at least three people die from opioid harm each day and 150 are hospitalized. (5) Fentanyl is showing up in wastewater testing and drug overdoses of cocaine and meth, drugs where the users are not expecting a potent narcotic. Because it is synthetic and cheaper to produce in China and India, it brings its criminal networks a greater profit margin.

As I’ve said before and will continue to say: We will not treat our way out of the opioid/drug epidemic. Prevention is key. Let’s continue to stay aware and educated about what we all can do to keep our children and their future safe and healthy.

http://www.RealDrugTalk.com.au

1. Why cocaine is most used drug in Australia behind cannabis

https://www.heraldsun.com.au/news/national/why-cocaine-is-most-used-drug-in-australia-behind-cannabis/news-story/0fa9bbcec60dfe0ecfb52a5cb58a38f5

2. Australia the highest per capita cocaine user in the world

https://www.news.com.au/national/australia-the-highest-per-capita-cocaine-user-in-the-world/news-story/c91869d4e2b2adeef266917d82f705e0

3. Sydney and cocaine: an illicit love affair for the ages

https://www.smh.com.au/national/nsw/sydney-and-cocaine-an-illicit-love-affair-for-the-ages-20210225-p575uz.html

4. Fentanyl in the Australian illicit drug market

https://adf.org.au/insights/fentanyl-australian-illicit-drug/

5. Australia’s opioid crisis: How pain management got out of control

https://www.theage.com.au/national/australia-s-opioid-crisis-how-pain-management-got-out-of-control-20200204-p53xrn.html?login_token=6k67UOPLwp5Xl2j0rc4YRnMBCQfFMYmi_oQ7Wy-FhUoshvJtqTVUQRQtnZMeXk9e6ZvG2rO1y9HCtcf1QfpRxw&expiry=1659821531

Loneliness in a Lonely Time

It has been said that the opposite of addiction is not sobriety, it is connection – to others, to a community. The Coronavirus pandemic has brought disconnection and magnified loneliness and stress for people the world over due to social isolation, economic instability, reduced access to spiritual communities, and overall national anxiety and fear of the future. “We certainly have data from years of multiple studies showing that social isolation and social stress plays a significant role in relapse…and relapsing to drug use can play a role in overdose.” Dr. Wilson Compton, deputy director NIDA.

The acronym HALT: Hungry, Angry, Lonely, Tired, is used in Alcoholics Anonymous and most recovery programs. It is a simple reminder that when our basic human needs are not met, one is susceptible to toxic thoughts and self-destructive behaviors including relapse and suicide.

Benefits of Public Dialogue

John and I live in Melbourne, Australia with our daughter and her family several months of the year. Since our son’s death by overdose from heroin 5 years ago, we have become interested in and involved with some of the Alcohol and Other Drug (AOD) programs there. We also receive news reports on current trends etc.

What is interesting to me is the contrast between the Australian approach to AOD use and the American approach. Australians accept that there will be drug and alcohol abuse in their society and therefore speak openly and candidly about it. A recent newsletter (Dec. 13, 2019) from VAADA (Victorian Alcohol and Drug Association) is a perfect example of their approach. It was an alert about “ increasing numbers of reports about very strong heroin in Melbourne, which has resulted in an increase in accidental overdoses.”

The alert asks providers in the AOD sector to alert their clients (heroin users) to this problem and to be careful and look out for their fellow users. They also urge providers to share specific harm reduction information to help reduce the risk of overdose, such as: get naloxone and keep it handy; try not to mix drugs (there is a lot of methamphetamine use mixed with heroin/opioid use); be smart about your tolerance, knowing it can change if you haven’t used for even a few days; and try not to use alone or in an unfamiliar place where you wouldn’t get help if you do overdose (which was the case for our son).

Fentanyl & Breathing Under Water

BREATHING UNDER WATER

I built my house by the sea.
Not on the sands, mind you;
not on the shifting sand.
I built it of rock.

A strong house
by a strong sea.
And we got well acquainted, the sea and I.
Good neighbors.
Not that we spoke much.
We met in silences.
Respectful, keeping our distance,
but looking our thoughts across the fence of sand.
Always, the fence of sand our barrier, always, the sand between.

And then one day,
-and I still don’t know how it happened –
the sea came.
Without warning.

Without welcome, even
Not sudden and swift, but a shifting across the sand like wine,
less like the flow of water than the flow of blood.
Slow, but coming.
Slow, but flowing like an open wound.
And I thought of flight and I thought of drowning and I thought of death.
And while I thought the sea crept higher, till it reached my door.

And I knew, then, there was neither flight, nor death, nor drowning.
That when the sea comes calling, you stop being neighbors,
Well acquainted, friendly-at-a-distance neighbors,
And you give your house for a coral castle,
And you learn to breathe underwater.

(Sr. Carol Bieleck, RSCJ, from an unpublished work)

I first heard this poem as it was read at our son’s memorial by the director of a recovery program we had attended with JL in Tucson. It is full of spiritual metaphors and allusions to addictive behaviors. It came back to me this week as I received the latest information on fentanyl deaths in a report from the Centers for Disease Control (CDC), summarized by CNN:
Fentanyl deaths skyrocketed more than 1,000% over six years in the US.
By Nadia Kounang, CNN, 03/21/2019
https://www.cnn.com/2019/03/21/health/fentanyl-deaths-increase-study/index.html

Continue reading “Fentanyl & Breathing Under Water”

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. Continue reading “JUST SAY “NO” TO FAILED DRUG POLICIES”

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.”?