ACT Alcohol, Tobacco and Other Drug Information
and Harm Reduction Training Module
September 2012 (Version 1)
www.atoda.org.au
About ATODA
Acknowledgement
of Country
• We acknowledge the traditional owners
and custodians of the land on which we
meet, and pay respect to their Elders,
families and ancestors.
Acknowledgement
About ATODA
This training module was developed by Annie Bleeker in collaboration with
the ACT alcohol, tobacco and other drug sector.
Additional thanks are owed to:
•
•
•
•
•
•
•
•
Amanda Bode, ATODA
Carrie Fowlie, ATODA
Kathryn Sequoia, ATODA
Deb Smith, Mental Health Services, ACT Government Health Directorate
Nicole Wiggins, Canberra Alliance for Harm Minimisation and Advocacy
Denise Ryan, AOD Policy Unit, ACT Government
Sally Billington, Alcohol and Drug Services, ACT Government Health
Directorate
Jo Smith, ACT Hepatitis Resource Centre
Part
1
About
ATODA
Introduction to psychoactive drug use
in Australia
Illicit
drug ATODA
consumption*
About
100
75
50
35.4
25
10.3
7.3
0
8.8
7
3.8
Hallucinogens
Meth/amphetamine
Inhalants
1.4
Cocaine
Heroin
Ecstasy
Cannabis
*Over 14 years - 2010 National Drug Strategy Household Survey (NDHS), Australian Institute of Health and Welfare
Australians’
drug use
About ATODA
Percentage of Australians who used drugs ‘last year’
• 90% used alcohol
• 15% smoked nicotine (daily)
• 10% used cannabis
• 3% used ecstasy
• 2% methamphetamines
• 2% cocaine
*Over 14 years - 2010 National Drug Strategy Household Survey (NDHS), Australian Institute of Health and Welfare
Young
people
About
ATODA
Most popular drugs ever used by Australian secondary
school students (12-17yrs)
•
•
•
•
•
•
•
•
8 in 10 had even used alcohol (1 in 5 use alcohol weekly)
1 in 2 had ever smoked a cigarette
1 in 5 have ever used inhalants
1 in 7 have ever used cannabis
1 in 14 have ever used amphetamines
1 in 25 have tried ecstasy
1 in 33 have tried hallucinogens
1 in 50 have ever tried cocaine
Cancer Council, (2009) 2008 Australian secondary school students use of tobacco, alcohol and over-the-counter and illicit substances, Victoria.
Changes in drug use
%
*Category of ‘ever used’ - 2010 National Drug Strategy Household Survey (NDHS), Australian Institute of Health and Welfare
Drug
use in
the ACT
About
ATODA
Alcohol use
• 86% adults report having used alcohol
• 5% daily drinking (below national average)
• 20% risky drinking (according to NH&MRC guidelines)
Tobacco use
• 11% of adults report smoking (below national average 15%)
• 7% female and 6% of male secondary students
Illicit drug use
• 14% of adults reported using an illicit drug in previous year
• 10% reported cannabis use
• 2.9% non medicinal use of pain killers
Trends suggest psychoactive substance use is stable – falling
McDonald, D. (2012) The extent and nature of alcohol, tobacco and other drug use, and related harms, in the ACT.
Drug
related
deaths
About
ATODA
Which drugs kill the most Australians?
Who dies from what drug? And when?
Australians’
deaths
About ATODA
In 2000, approximately 23,300 Australians died due to alcohol,
tobacco and other drugs:
Tobacco deaths
19,000 (81%)
Alcohol deaths
3,271 (14%)
Illicit drug death
1,023 (5%)
Miller and Draper (2001) Drug Use in Australia 2000. Australian Institute of Health and Welfare: Canberra
How
are drugs
used?
About
ATODA
The onset of effects differ according to the route of administration
– each presenting different harms
•
•
•
•
•
•
Smoking
Injecting
Snorting
Shelving / shafting
Swallowing
Transdermal (skin)
Drug
classifications
About
ATODA
Psychoactive drugs primarily fall into 3 classifications:
Stimulants
Depressants
Hallucinogens
Stimulants
About ATODA
Effects
•
Increase the activity of the central nervous system (CNS)
•
Speeds up messages between the brain and the body
•
Blood pumps faster - increases heart rate and breathing, etc
•
Speeds up mental processes - making people alert and energetic
•
Large doses can cause over-stimulation - causing anxiety, panic,
seizures, headaches, stomach cramps, aggression and paranoia.
Can also be the effects of long term use.
Types
•
Caffeine, nicotine, amphetamine type stimulants, cocaine, Ritalin,
dexamphetamine, etc.
Levinthal, C. (2002) Drugs, Behavior and Modern Society. Boston, MA : Pearson/​Allyn and Bacon
Australian Drug Foundation (2012) Drugs the Facts. www.druginfo.adf.org.au/drug-facts/drugs-the-facts
Depressants
About ATODA
Effects
• Depressants do not necessarily make a person feel depressed.
They affect the central nervous system, slowing down the messages
between the brain and the body.
• Slows down the activity of the CNS (breathing, heart rate)
• Makes people more relaxed - less conscious of their surroundings
•
Effect concentration and coordination - slow down the person’s
ability to respond to unexpected situations.
•
In small doses they can cause a person to feel more relaxed and
less inhibited. In larger doses they can cause drowsiness, vomiting,
unconsciousness and death.
Types
• Alcohol, Valium, Rohypnol, Serapax, Temazapan, codeine,
Panadeine, heroin, opium, morphine, gamma-hydroxy-butrate
(GHB), petrol, inhalants, etc.
Levinthal, C. (2002) Drugs, Behavior and Modern Society. Boston, MA : Pearson/​Allyn and Bacon
Australian Drug Foundation (2012) Drugs the Facts. www.druginfo.adf.org.au/drug-facts/drugs-the-facts
Hallucinogens
About ATODA
Effects
• Can significantly alter and distort our perceptions, moods, thoughts
and surroundings
• They can make people see or hear things differently (or that aren’t
really there)
Types
• Lysergic Acid Diethylamine (LSD), magic mushrooms, mescaline,
ketamine, peyote buttons, etc.
Note: cannabis and ecstasy can also have hallucinogenic qualities
Levinthal, C. (2002) Drugs, Behavior and Modern Society. Boston, MA : Pearson/​Allyn and Bacon
Australian Drug Foundation (2012) Drugs the Facts. www.druginfo.adf.org.au/drug-facts/drugs-the-facts
Other
classifications
About
ATODA
Cannabinoids
• Are a unique class of chemicals that bind to specific receptors in the
brain
• Types include: hash, cannabis
Entactogens
• Are unique in that they are ‘modified’ stimulants that also have
hallucinogenic properties
• Types include: MDMA, MDA, ecstasy, etc.
Levinthal, C. (2002) Drugs, Behavior and Modern Society. Boston, MA : Pearson/​Allyn and Bacon
Australian Drug Foundation (2012) Drugs the Facts. www.druginfo.adf.org.au/drug-facts/drugs-the-facts
Poly
drug ATODA
use
About
•
Using two or more drugs at one time
•
Increases chances of things going wrong (i.e. overdose)
•
Places a lot of strain on the central nervous system
•
Most dangerous combinations are two depressant drugs (i.e.
combining heroin and/or alcohol/benzodiazepines, alcohol/GHB,
etc.)
•
What happens if you combine a stimulant and a depressant drug
together? What about two stimulant drugs?
Levinthal, C. (2002) Drugs, Behavior and Modern Society. Boston, MA : Pearson/​Allyn and Bacon
Drug
dependence
About
ATODA
Estimated fraction of drug users who have become drug
dependent
•
Tobacco – 1 in 3
•
Heroin – 1 in 4-5
•
Crack – 1 in 5 (??)
•
Cocaine – 1 in 6
•
Alcohol – 1in 7-8
•
Stimulants other than cocaine – 1 in 9
•
Cannabis – 1 in 10
•
Anxiolytic, sedative and hypnotic drugs – 1 in 11
Adapted from Anthony et al., 1994; Chen and Anthony, 2004
Drug
dependence
About
ATODA
Estimated fraction of drug users who have become drug
dependent
•
Analgesic drugs – 1 in 11
•
Psychadelic drugs – 1 in 20
•
Inhalant drugs – 1 in 20
Levinthal, C. (2002) Drugs, Behavior and Modern Society. Boston, MA : Pearson/​Allyn and Bacon
Another
Aboutperspective
ATODA
The rational scale to assess the harm of drugs of misuse
Measures the drugs relative physical
harm and its propensity for
developing dependence.
Nutt, D., King, L. A., Saulsbury, W., Blakemore, C. Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet 369,
(9566) 1047-1053
Drug
policy
in Australia
About
ATODA
What is the current policy on drugs in Australia?
Policy
About ATODA
•
The broad policy in Australia is described in the National Drug
Strategy
•
The policy is one of ‘harm minimisation’
•
This means that we use a combination of strategies to prevent and
minimise ATOD-related problems by reducing:
•
–
Supply
–
Demand
–
Harm
The aim of the National Drug Strategy 2010 – 2015 is to:
–
“build safe and healthy communities by minimising alcohol, tobacco and other
drug-related health, social and economic harms among individuals, families and
communities”
http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/nds2015
AboutRelated
ATODAHarms in the ACT
Drug
Arrests:
In the 2009-10 year, 459 arrests for drug offences occurred (386 excluding Simple
Cannabis Offence Notices: SCONs).
Alexander Maconochie Centre:
Three-quarters of AMC inmates (74%) reported that the crimes for which they were
imprisoned were drug-related. Some 32% reported injecting illegal drugs while at
the AMC and 27% reported that the last time they had injected was in a prison.
Road Safety:
ACT Policing conducted 98,245 random breath tests for drink-driving in the year to
30 September 2011. In 1,448 cases the driver exceeded the prescribed limit, a rate
of 15 per 1,000 tests.
Source: McDonald, D. (2012). The extent and nature of alcohol, tobacco and other
drug use, and related harms in the ACT – Fourth edition, v3. Social Research and
Evaluation
About ATODA
Harms
Continued….
Overdose:
The ACT Ambulance Service attended 601 overdose incidents in the first 10 months of
2011, of which 42% were from alcohol, 22% from ‘polypharmacy’, 10% from heroin and 6%
from benzodiazepines.
Hospital presentations:
Alcohol is a major cause of deaths and hospital presentations. It is estimated that, over the
1992-2001 decade (the most recent data available), alcohol caused the loss of 341 lives in
the ACT
Blood Borne Viruses:
In 2010, injecting drug use was the source of infection in 86% of the newly diagnosed
cases of HCV infection in Australia for which data on the source were available. In 2010
there were 223 diagnoses of HCV infection in the ACT, higher than the national rate.
Source: McDonald, D. (2012). The extent and nature of alcohol, tobacco and other drug use, and
related harms in the ACT – Fourth edition, v3. Social Research and Evaluation
ATODA
A About
Harm Minimisation
Approach
• Demand reduction strategies prevent the uptake
and/or delay the onset of use of ATOD;
• Supply reduction strategies prevent, stop, disrupt or
otherwise reduce the production and supply of
illegal drugs; and control, manage and/or regulate
the availability of legal drugs.
• Harm reduction strategies primarily reduce the
adverse health, social and economic consequences
of the use of drugs.
Harm
minimisation
About
ATODA information
Why its important
•
Many people may not be willing or able to stop their drug use
immediately (or even in the short/long term)
•
However, there are ways that they can reduce some of the harms
from their drug use
–
•
i.e. use a joint rather than a bong, smoke heroin rather than hit it up, don’t
combine two depressant drugs, less = more etc
As clinicians/workers in the ATOD field it is important to be informed
about drug effects/harms so that you can pass on harm reduction
information to your clients.
Small
group
exercise
About
ATODA
Break up into small groups of 3-5 people
•
Name as many routes of administration (i.e. swallowing, smoking,
snorting, injecting and shafting/shelving) you can think of for 3 of the
following drugs
–
•
•
Alcohol, nicotine, cannabis, ecstasy, cocaine, meth(amphetamines) and opiates
Discuss what is the safest and most harmful route of administration
and why?
–
Does it differ for each drug type?
–
Can you think of ways to minimise harm with each drug?
You have 20 minutes before we discuss in the large group
Harms:
smoking
(inhaling)
About
ATODA
•
Drugs that are commonly smoked include:
–
Tobacco, cannabis, Kronic, methamphetamine, heroin, crack cocaine, etc.
–
Fastest route of drug administration (milliseconds faster than injecting)
•
Within 5-10 seconds the drug is absorbed through the lungs and
carried to the brain
•
The reason this route of administration is less risky for overdose
(than say injecting heroin x16) is because it’s a titrated dose (some
lost through the process of smoking)
•
Biggest harms caused by smoking is lung, throat, mouth damage,
cancer, emphysema, dependence, etc.
Brugal, M.T., Barrio, G., De, L.F., Regidor, E., Royuela, L., Suelves, J.M., 2002. Factors associated with non-fatal heroin overdose: assessing the
effect of frequency and route of heroin administration. Addiction 97, 319-327
Cancer Council (2011)
Levinthal, C. (2002) Drugs, Behavior and Modern Society. Boston, MA : Pearson/​Allyn and Bacon
Harms:
swallowing
About
ATODA (ingestion)
•
Drugs that are swallowed include:
–
Alcohol, pills, methamephatmine powder, mephedrone, cannabis (cake, cookies,
etc.), Gamma Hyrdoxy-butrate (GHB)
•
Slowest onset of effects (30-90 minutes) as its absorbed through the
stomach lining and then the into the bloodstream where it hits
receptors in the brain
•
Harms from swallowing include:
–
Slow onset of effects means it can be difficult to guage the dose (i.e. eating
cannabis, GHB)
–
Hence easy with these two drugs to experience an ‘overdose’ which with GHB
(which is metabolised very quickly) can be fatal especially if mixed with alcohol
–
Some people with sensitive stomachs find it very unpleasant to swallow drugs
because cramps or nausea
Brugal, M.T., Barrio, G., De, L.F., Regidor, E., Royuela, L., Suelves, J.M., 2002. Factors associated with non-fatal heroin overdose: assessing the
effect of frequency and route of heroin administration. Addiction 97, 319-327
Cancer Council (2011)
Levinthal, C. (2002) Drugs, Behavior and Modern Society. Boston, MA : Pearson/​Allyn and Bacon
Harms:
snorting
(bumping)
About
ATODA
•
Drugs that are commonly snorted include:
–
Cocaine, (meth) amphetamines, ketamine, powders, pills, Tobacco (snuff),
Ritalin, etc (drugs must be water soluble)
•
Drugs are absorbed through the soft tissue in the mucous
membrane of the sinus cavity
•
Much faster onset of effects than oral administration (within minutes)
but slower than smoking or injecting)
•
Some drugs have a higher rate of absorption, and are thus more
effective in smaller doses, through this route
•
Harms from snorting include:
–
damage to nasal cavity, collapsed nasal septum, etc.
Levinthal, C. (2002) Drugs, Behavior and Modern Society. Boston, MA : Pearson/​Allyn and Bacon
Harms:
shelving/shafting
About
ATODA
•
Drugs that are commonly shafted include:
–
Pills, powders (cocaine, (meth)amphetamines), heroin, etc.
•
Rich blood supply in this area makes absorption fast (15-20 mins)
offering a degree of ‘rush’ without significant risk of blood-to-blood
contact
•
Onset of effects is faster than swallowing, but slower than snorting,
smoking and injecting.
•
Harms from shafting include:
•
–
Ulcers, diarrhoea, damage to the mucous membrane in the rectum/vagina,
burning or tearing of rectal tissues (high risk activity for BBV)
–
This technique will have a laxative effect if there is repeated use in one session
To reduce harm lube is recommended
http://www.bluebelly.org.au/reducingrisk/articledbc2.html?aid=231
Harms:
injecting
About
ATODA
•
Drugs that are commonly injected include:
–
(meth)amphetamines, heroin, OxyContin (oxycodone), MSContin (morphine),
codeine, benzodiazepines, etc.
•
Injection is favoured by some users as the full effects of the drug are
experienced very quickly (5-10 seconds)
•
Shorter more intense high – ‘rush’ (stronger effect than swallowing
the drug)
•
Harms from shafting include:
–
•
BBV transmission, abscesses, increased chance of overdose (x16 compared
with smoking) and dependence, vein and artery damage, social stigma, etc.
To reduce harm – use a clean fit and don’t share any injecting
equipment (spoons, swabs, tournqiuets, etc.)
Harm
reduction
messages
About
ATODA
•
‘Taste’ a small amount of the drug first
•
Less (drugs) = more (fun)
•
Where possible, avoid injecting
•
If injecting – use your own clean fit and never share injecting
equipment
•
To reduce chance of overdose avoid mixing drugs, especially two
depressant drugs
•
Be aware that amphetamine type stimulants (ATS and energy
drinks) mask the sedative effects of alcohol (i.e. likely to drink more)
(More)
Harm
reduction messages
About
ATODA
•
Give your body/brain a chance to recover – eat well, rest, etc.
•
Give yourself a break if you notice you need to use more of a drug to
get the same effect (developing tolerance)
•
Make sure someone is with you and can assist if things go wrong
•
Seek medical assistance if at all concerned for your own or
someone else’s welfare – 000 (the ambulance is not the police)
•
Try to avoid using ATOD when you are pregnant and breastfeeding
•
Don’t drink/drug drive
Safe
Needle
& Syringe Disposal
About
ATODA
•
To reduce the risk of needle stick injuries, needle and syringes should be
disposed of in free syringe disposal containers made of yellow plastic.
Never put injecting material, or anything that has been in contact with
injecting material in garbage or recycling bins - even if it's in container.
•
Needle and syringe disposal facilities are located around Canberra.
Information is available at http://www.directionsact.com/nsp_disposal.
•
If you find a needle or syringe (also called a sharp) in a public place or on
your private property, call the SHARPS Hotline on 13 22 81, who will
arrange for its collection and disposal.
•
If you find a sharp, do not touch it and, if possible, stand guard,
particularly if there are children around. Be prepared to give the Sharps
Hotline accurate information on the location of the item. A City Ranger
from ACT Government Territory and Municipal Services will come and pick
it up as soon as possible.
Part
2
About
ATODA
Alcohol, Tobacco and Cannabis
Alcohol
About ATODA
Alcohol
About- costs
ATODA
•
Estimated to cost the Australian community about $36 billion
•
Directly responsible for 70 000 assaults and 24 000 domestic
violence cases per year
•
Twice the cost of illicit drug use
•
Major cause of death and injury for many Australians – especially
the young, elderly and Indigenous
•
8.1% of the population drink daily (about 1 in 12 people)
•
‘Binge’ drinking continues to be a problem among young people
AER (2010)
Alcohol
About– effects
ATODA
The effects of alcohol depend on several factors
•
How much you drink
•
How quickly you drink
•
Your sex/race
•
Your weight
•
How long since you’ve eaten
•
The condition of your liver
•
Your tolerance for alcohol
•
Your mood at the time
•
Whether you are using other drugs
About –
ATODA
Alcohol
standard drinks
The effects of alcohol depend on several factors
•
How much you drink
•
How quickly you drink
•
Your sex/race
•
Your weight
•
How long since you’ve eaten
•
The condition of your liver
•
Your tolerance for alcohol
•
Your mood at the time
•
Whether you are using other drugs
Alcohol
About– guidelines
ATODA
•
For healthy men and women, drinking no more than two standard
drinks on any day reduces your risk of harm from alcohol-related
disease or injury over a lifetime
•
Drinking no more than four standard drinks on a single
occasion reduces the risk of alcohol-related injury arising from that
occasion
–
*Binge drinking = 5 standard drinks in a row
National Health and Medical Research Council Guidelines (2009)
Alcohol
reduction
About– harm
ATODA
•
One drink is often not one standard drink
•
Try and stick within the Australian drinking guidelines
•
Have some ‘alcohol free’ drinking day
•
Try and avoid binge drinking – increases relative harm
•
Start with a non-alcoholic drink
•
Drink slowly (sips not gulps)
•
Try low alcoholic drinks (i.e. light beer)
•
Pace yourself – drink non-alcoholic beverages between alcoholic ones
•
Stay busy, don’t just sit and drink
•
Avoid rounds, ‘shouts’ or drinking games
•
Avoid salty snacks
www.alcohol.gov.au Know your Risk - New National Guidelines for Alcohol Consumption
Alcohol
harm reduction
About– (more)
ATODA
•
Have an escape plan
•
Don’t drink and drive
•
Be aware of ‘beer goggles’ – if you hook up – practise safe sex!
www.alcohol.gov.au Know your Risk - New National Guidelines for Alcohol Consumption
Nicotine
About(tobacco)
ATODA
Tobacco
harms
About- ATODA
•
Nicotine is the addictive drug in tobacco smoke that causes smokers
to continue to smoke
•
Addicted smokers need enough nicotine over a day to ‘feel normal’ –
to satisfy cravings or control their mood
•
Along with nicotine, smokers also inhale about 4000 other chemicals
in cigarette smoke (tar, carbon monoxide, Hydrogen cyanide, etc)
•
There are over 60 known cancer-causing chemicals in tobacco
smoke
•
Smoking harms nearly every organ in the body, causing many
diseases and reducing health in general
Smoking
health effects
About–ATODA
The health effects relating to cigarette smoking have been well
researched and documented:
•
Heart attack
•
Stroke
•
Cancer
•
Emphysema
•
Bronchitis
•
Asthma
•
Ulcers
•
Premature ageing
•
Impotence
•
Premature births and miscarriage
•
It claims the lives of 15 500 Australians every year
http://www.cancer.org.au/cancer-control-policy/position-statements/smoking-and-tobacco-control/
Nicotine
Aboutdependence
ATODA
•
Nicotine dependence and withdrawal can develop with all forms of
tobacco
•
Cessation procedures well-defined withdrawal syndrome
•
Use nicotine to relieve or avoid withdrawal symptoms on waking or
after situation where use restricted
•
Continued use despite knowledge of medical problems related to
smoking
American Psychiatric Association, (1994) Diagnostic & Statistical Manual of Mental Disorders (DSM-IV), Arlington, VA.
Brief
interventions
About
ATODA and pharmacotherapy
•
Ask about tobacco use
•
Advise to stop smoking
•
Assess willingness to quit
•
Assist with quit plan
•
Arrange follow up
Clinical Practice Guidelines (2000) Treating Tobacco Use and Dependence, U.S. Department of Health and Human Services , Public Health Service.
USA.
Advise
and
assess
About
ATODA
•
•
Clear, personalised, clinically-linked advice about quitting smoking
from a health professional increases abstinence rates
–
“When you stop smoking, your diabetes/cardiac/respiratory symptoms will
improve”
–
“The best thing for your health would be to quit smoking”
Assess willingness to quit
–
•
“Are you interested in quitting?” “Would you be interested in a ‘cut down and then
stop’ approach?”
Assess level of dependence
–
Fagestrom Test for Nicotine Dependence
–
Shortened Fagestrom
Fagestrom
Test for Nicotine Dependence
About ATODA
Tobacco
Harm reduction
About–ATODA
•
Traditionally harm reduction was not accepted for tobacco smoking
– abstinence focus
•
Not a lot of research on HR in tobacco cessation but we know the
more cigarettes you smoke in your lifetime the greater the risk of
lung cancer. Therefore if you can reduce the number it makes sense
that the risk may reduce – by how much we don’t know.
•
Use a patch or other nicotine replacement therapy (NRT) i.e. gum,
inhaler, lozenges, to cut down without compensating (drawing back
harder on the fewer cigarettes a person smokes)
•
NRT is safe for pregnant women
•
There are other benefits to working on cutting down – it can build a
person’s confidence that they may be able to quit and can motivate
them to have a go
Tobacco
(more) Harm reduction
About–ATODA
•
Smoke outside (including not in the car with small children – its
against the law in the ACT)
•
Avoid mixing alcohol and tobacco (increased cancer risk)
When quitting
•
Prepare and have a plan
•
Be aware of high risk situations and triggers
•
Reduce (avoid) your use of alcohol and caffeine
•
Use the 4 D’s
•
Reward yourself
The
4 D’s of
quitting
About
ATODA
•
Drink water – go get a drink before anything else
•
Do something else – have a goodie bag handy of other things to do
•
Delay – set a time limit before you decide to smoke
•
Deep breathing – take at least 10 deep breaths
Tobacco, Community Health Education Resource (2009)
https://www.cherspokane.org/uploadedFiles/Health_and_Wellness/Resources/Tobacco%202%20newsletter%2009.pdf
Heavy
smokers
should
About
ATODA
•
Put patch on before going to bed so that the nicotine level in the
blood is high on waking especially if the client normally reaches for a
cigarette on waking
•
May need to put on another patch in the morning
Cannabis
About (marijuana)
ATODA
Cannabis
in Australia
About use
ATODA
•
Cannabis is the most popular illicit drug in the world
•
Cannabis is the most commonly used illicit drug in Australia,
approximately:
–
1 in 3 have ever used it
–
1 in 10 have used it in the last year (recent use)
–
1 in 15 in the last month
–
1 in 22 in the last week
•
Much higher rates of use among Indigenous Australians
•
Average of initiation 18.5 years
2010 National Drug Strategy Household Survey (AIHW, 2011)
Cannabis
in Australia
About use
ATODA
•
Much higher rates of use among Indigenous Australians
•
Average of initiation 18.5 years
–
A decrease since 1995, when it was 19.1 years
•
Approximately 1 in 5 young Australians have ever used it
•
Use peaked in 1998 and had been decreasing until 2010 survey
2008, Australian Secondary Students Alcohol and Drugs Survey ASSAD
Cannabis use – Aboriginal and Torres
About
ATODA
Strait Islander
•
•
•
National Aboriginal and Torres Strait Islander Health Survey
–
19.1% lifetime use
–
9.1% previous year
2004 survey in a rural community in Arnhem Land amongst 336 1336 year olds
–
69% of the males, 29% of the females had ever used
–
67% of the males, 22% of the females had used it in the last month
2010 National Drug Household Survey
–
Almost one in four Indigenous Australians had used cannabis in the last year
National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2004/5
Clough AR, et al, (2006)
2010 National Drug Household Survey
Cannabis
in the ACT
About -ATODA
Hydroponic
Bush weed
Price
Price
•
$20/gram ^
•
$20/gram ^
•
$280/ounce^
•
$280/ounce^
•
Stable (80%) ^
•
Stable (80%) ^
Purity
Purity
•
Medium to high (43% each)
•
Medium (53%)
•
Stable (69%)
•
Stable (59%)
Availability
Availability
•
Very easily (62%)
•
Easy to very easy
•
Stable (86%)
•
Stable (74%)
Scott, L. (2012) Key findings from the 2011 ACT EDRS and IDRS
Cannabis
- prevalence
About use
ATODA
Frequency order
1.
Northern Territory
16.5%
2.
Western Australia
13.4%
3.
South Australia
11.3%
4.
Queensland
11.0%
5.
ACT
9.5%
6.
Victoria
9.4%
7.
New South Wales
9.3%
8.
Tasmania
8.6%
2010 National Drug Strategy Household Survey (AIHW, 2011)
Cannabis
– risk and harms
About use
ATODA
Short-term effects include:
•
Feeling of well-being
•
Lack of co-ordination/concentration
•
Bloodshot eyes
•
Loss of inhibitions
•
Anxiety and paranoia
•
Sleepiness
•
Increased appetite and dryness of the mouth and throat
http://ncpic.org.au/workforce/alcohol-and-other-drug-workers/cannabis-information/factsheets
Cannabis
– adolescent use
About use
ATODA
Research shows that young people who use cannabis in early
adolescence are at greater risk of:
•
Experiencing mental health problems
–
Up to 6x the risk of developing schizophrenia
–
Earlier on-set of psychosis by up to 2.7 years
•
Dropping out of school
•
Becoming dependent on cannabis
•
Having deviant peer affiliations and displaying antisocial behaviour
•
Using other drugs
•
Attempting suicide
•
Participating in criminal behaviour
•
Reduced life opportunities
http://ncpic.org.au/workforce/alcohol-and-other-drug-workers/cannabis-information/factsheets
Cannabis
– risk and harms
About use
ATODA
•
The earlier a person starts using cannabis, and the more heavily
they use it, the more likely they will continue to use it and develop
problems with it
•
Long term effects include:
–
Increased risk of respiratory disease, including cancer
–
Dependence
–
Decreased memory and learning abilities
–
Decreased motivation
Cannabis
tobacco
About and
ATODA
•
Cannabis is commonly used with alcohol and tobacco
•
Tobacco is often added to combine effects, help cannabis ‘burn
better’ and make the cannabis ‘go further’
•
A reduction in cannabis often means a reduction in tobacco (the
withdrawal is similar)
•
Both dependencies may be needed to be treated concurrently
•
Many people become dependent on the tobacco!
Respiratory
harms
About ATODA
•
Cannabis smoke contains 3 x more tar and 5 x more carbon
monoxide than standard cigarettes (one bong/joint equal to 3-5
cigarettes in lung damage)
•
Cannabis smokers tend to inhale deeper and hold the smoke up to
four times longer in their lungs
•
Cannabis has a higher combustion temperature and burns hotter in
the throat and mouth
Bleeker, AM and Malcolm, A. (2001) Mulling it Over, MDECC, Sydney.
Harms
of bongs
About
ATODA
• Many people use bongs (or bucket bongs) because:
•
•
•
•
its a more economical way to use cannabis
its a bigger ‘hit’
believe its a smoother inhalation
Research shows that smoking bongs does
•
not reduce exposure to tar, carbon monoxide or deeper inhalation
• Using a plastic bong with hose, aluminium foil, etc. means that
people also inhale all the by-products and petro chemicals in the
plastic
• If you must use a bong, use a glass or ceramic one
NCPIC, (2011) Clearing the Smoke Educators Kit
Vaporisers
About ATODA
Cannabis
potency
About -ATODA
• Many believe that cannabis has become much stronger
• Hydroponically grown cannabis has become the norm in Australia
the past 15-20 years
• It is ‘estimated’ to be twice as strong as it once was, due to the
following factors:
•
•
•
•
•
•
genetic (selected seed varieties and cultivation of female plants)
variation in cannabinoids and concentration of THC, CBN, etc.
environmental (cultivation techniques, prevention of fertilisation and seed
production)
freshness (production sites are close to the consumer and storage degradation
of THC is avoided)
Most importantly, we need to remember that users are now
smoking the stronger part of the plant (heads/buds), more often
http://ncpic.org.au/workforce/alcohol-and-other-drug-workers/cannabis-information/factsheets/article/cannabis-potency
THC
and other
cannabanoids
About
ATODA
• Cannabis sativa contains around 500 compounds
•
•
approximately 80 are cannabinoids, some of which provide the psychoactive
effect
THC – delta-9 tetrahydrocannabinol has the strongest psychoactive effect
• The effect of cannabis may depend not only on THC content but on
the presence of other cannabinoids such as:
•
•
•
Cannabidinol (CBD) not psychoactive but has anti-anxiety properties
Cannabinol (CBN) mildly psychoactive
Cannabinodial (CBDL) mildly psychoactive
•
http://ncpic.org.au/workforce/alcohol-and-other-drug-workers/cannabis-information/factsheets/article/cannabis-potency