APSAD Conference Day 3

The third and final day of the APSAD conference arrived and another action packed day was in store. The day commenced with keynote addresses delivered by Vladimir Poznyak, Department of Mental Health & Substance Abuse, World Health Organisation, and Professor Elizabeth Elliot AM, who has worked extensively in the field of paediatrics.

I found Dr Poznyak’s presentation about the global state of harmful alcohol use particularly interesting. While it is estimated that 2.5 billion people consume alcohol each year , more than half the world population consume no alcohol at all.

In 2004 2.5 million (10% of all alcohol consumers) died due to alcohol related causes. Prevalence patterns of risky alcohol consumption vary across the world, with the former Soviet Union ranked as having the largest concentration of risky drinkers per capita. The wide prevalence of risky drinking is particularly concerning when we consider that alcohol is ranked as the third most prevalent risk factor for premature death globally. (Tobacco was ranked 6th and illict drugs did not even make the top 10).

With alcohol  also being the most prevalent drug accountable for entry into treatment, AOD services, in concert with a range of regulatory strategies such as taxation, and drink drive breathalyser testing, play an important part in addressing the international burden of death and disease.

Professor David Pennington was another speaker who was particularly inspiring. Professor Pennington was invited to deliver the annual James Rankin Oration. He spoke eloquently about the politics of illicit drugs, tracing the roots of prohibition from the glut of opium flooding Chinese markets in the 19th to the racist motivations that are the antecedents of the first drug laws, and the advent of international drug control.

Professor Pennington then spoke about prohibition in the Australian context and the political struggles that have shaped Australian drug policy. Pennington spoke with intimate knowledge about the political opposition to the introduction of a National heroin treatment trial in 1997, (the trial never came to fruition after it was effectively blocked at the last minute by the then Prime Minister, John Howard).

He also told of the struggle to open a medically supervised injecting centre in Kings Cross. Despite strong opposition the MSIC was approved as a trial in 2001, and legislation was passed just this year by the NSW government to end the trial status of the program and continue its operations as an important intervention catering to the health needs of Sydney’s injecting drug users.

With a number of presentations throughout the conference focussing on peer administered naloxone, it was great to hear Sharon Stancliff of the Harm Reduction Coalition in the U.S. speak about the American experience of peer administered naloxone.

Sharon described the peer training that is undertaken to equip peers to administer naloxone. She pointed out that naloxone is a safe and effective medication for the reversal of heroin overdose and that training can be accomplished in a short period of time (10 minutes in some cases). Peers are also trained to contact emergency services to ensure that if the person experiencing the overdose receives any follow up that maybe required.

In the U.S., as in Australia it is legal for G.P.s to prescribe naloxone, however when the drug is administered to a third party (i.e. to a person who has not been prescribed the medication) then this can cause concerns regarding liability. Different jurisdictions in the U.S. have created legal safeguards in order to address this, enabling G.P.s to prescribe the drug with the full knowledge that the recipient of the prescription will administer the drug to another person. The legal mechanisms from state to state do differ however. In New York State specific legislation has been enacted which provides similar legal protections that are applied to first aiders.

According to Sharon naloxone is currently distributed in a range of settings in the U.S. including Needle syringe Programs and drug treatment centres. There is even a peer naloxone program trial being undertaken on a U.S. army base to address the safety needs of personel who are requiring opioid pain management!

Sutcliff pointed out that while it has been difficult to obtain the resources to effectively analyse the data obtained through the various peer naloxone programs in the U.S. a preliminary examination of the data demonstrates that naloxone distribution is feasible, safe, and likely to be effective.

Well that is the final blog from the 2010 APSAD conference. A big ‘thank you’ is due to all of the people involved in organising the conference, to the presenters and to the delegates who attended for making the conference a rich and informative experience.

I am very much hoping that I will get to attend the APSAD conference in Hobart next year!

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