Saturday, 29 June 2013

Is alcohol really a depressant?

In an attempt to make our lives less complicated, we like to simplify quite complex issues into quick grabs that are easy to understand and don't take too long to communicate to others. It's just human nature - firstly, most people don't have the time or the patience to listen to all of the subtleties that may be involved with the subject, and secondly, most of us wouldn't necessarily understand everything that needs to be said!

In the alcohol and other drug (AOD) field this has always been the case. I've been to scientific conferences where researchers who have spent their life in a laboratory with a pile of mice have tried valiantly to communicate what they have discovered and seriously, not one word has made any sense to me at all. When it comes to how different drugs work on the body, most particularly the brain, there are very few researchers across the world who I have met who can effectively communicate in words of one or two syllables how drugs do the things they do ...

As in other areas of science, messages in the AOD field have been made simpler by the classification of drugs into one of a number of groups. Three main categories are usually identified and these are based on similarities that certain drugs share, particularly in terms of their action on the user. The three are stimulants, depressants and hallucinogens. Put simply (and I mean really simply!) the three can be defined in the following way:
  • stimulants - these stimulate the brain and central nervous system - they 'speed' you up
  • depressants - these slow down the activity of the brain and nervous system - they 'slow' you down
  • hallucinogens - these interfere with the brain and central nervous system in a way that alters the user’s perception of reality - they 'mess you up'
The problem with this classification system is that most drugs don't fit neatly into any of these groups. I was doing a bit of a search on the web for drug classification recently and I found quite a few sites that referred to four drug types, the fourth being 'other', which is really helpful!

If we hope to get effective messages across to young people around alcohol we must make sure that what we say is accurate - unfortunately, one of the key pieces of information we provide to them is not entirely correct and actually conflicts with their own experience - 'alcohol is a depressant'. Try standing in front of a group of Year 11 students and tell them that and all they'll be thinking is that you're drinking something very different to them! It simply doesn't match what happens to them when they drink alcohol - it doesn't slow them down, in fact, it does just the opposite - it speeds them up and charges them. The more they drink (to a point), the more wide awake they are!

Young people are able to drink more, for longer periods of time, than adults due to them being less susceptible to the sedative effect of alcohol. The brain mechanism of this effect are not completely clear, but it is believed to be due to the neurotransmitter GABA. In an adult brain, consuming alcohol increases GABA production, reducing energy levels and calming everything down (a depressant effect). It is now believed that final levels of GABA receptors are not reached in the brain until early adulthood, once the brain is fully developed, and therefore adolescents have fewer GABA receptors on which alcohol can act. There isn't as much of a release of GABA when they drink and they are therefore able to stay awake and unfortunately drink more!

I am sure that many people reading this will be able to remember the night when their brain reached full development (i.e., early 20s), full GABA release was possible and as a result they sat on the end of their bed after a big night of drinking and realized that they could never quite drink the same way again (an oversimplification of a complex process but you know what I'm getting at!)  ….

But why the stimulant effect - why do young people get 'charged up' on alcohol?

Years ago I remember having this effect explained to me as simply the 'depression' or the slowing down of the part of the brain that controlled inhibition, i.e., alcohol turned off your 'on-off' switch, that part of the brain that stops you doing dumb things! Alcohol certainly depresses the behavioural inhibitory centres, making the person less inhibited, but this doesn't really explain the 'buzz' that young people get from alcohol.

Reading through the research that is now available in this area, it appears that the process is quite complicated and to be honest, there aren't any easy answers. What is clear is that alcohol also increases the release of another neurotransmitter in the brain called dopamine. Dopamine helps control the brain's reward and pleasure centres. By raising the levels of dopamine by drinking the first glass or two, alcohol tricks an adult into thinking that he or she is feeling pretty good. However, when you keep drinking to maintain that pleasurable effect, the other brain chemicals start to be released, particularly GABA, and they unfortunately win the battle and the depressant effect kicks in. When you are an adolescent it would appear that GABA release doesn't happen and all they're experiencing is a flood of dopamine ... they are feeling good and more alcohol is going to make them feel better!

If you haven't seen the wonderful ABC documentary - 'The Science of Teens: Binge' - take a look as it does a wonderful job of showing the very different effects, particularly those around sedation, alcohol has on teens and adults. The whole series is fantastic and every parent of an adolescent should take a couple of hours to sit down to watch these to assist them in understanding what is actually happening to their child through this difficult time.

Certainly we need to acknowledge that alcohol works in a very different way on young people than on an adult. The exact processes are still not known as yet but regardless this difference enables them to drink a lot more than many adults and puts them at great risk. Talking about the stimulant effect of alcohol with our young people is important - they may then at least listen to what we tell them and be able to say what we're telling them is credible and meaningful to their own experience.

Thursday, 27 June 2013

'Preloading' and the 'tactical vomit' ... really?

Just when I thought I had heard everything I visited a school recently and was asked what I thought about the 'benefits' of a 'tactical vomit' ... now maybe I missed something when  I was a teenager but I had never heard of this ... Asking around I have spoken to a number of my peers who had a vague idea of what these young people were talking about but all were surprised when I told them it was 15 year olds who were describing the practice and were completely staggered when I told them the context in which this was currently being carried out.

The website 'Urban Dictionary' (not a particularly pleasant site and certainly isn't up there with the Oxford English Dictionary!) defines a 'tactical vomit' as the following "the point in a night of heavy drinking where one forces themselves or chooses to throw up in order to feel well enough to continue drinking and keep up with the nights festivities - usually done after large amounts of drinking ...". There are other definitions available on the web, many of them extremely offensive, but essentially what we're talking about here is the notion of 'self-stomach pumping'.

I asked one of the young people who asked me the question about a 'tactical vomit' to send me an email describing the practice in terms of her social group - this was one Year 10 girl's response:

"Before we go out to a party for the night we usually meet at someone else's house and have a few drinks beforehand. Sometimes someone drinks too much and it gets to a point that we know she won't be able to get into the party we're going to because she looks too drunk and the parents or security guards wouldn't let her in ... That's when we would have a tactical vomit - she would go into the toilet and stick her fingers down her throat or drink a glass of salty water to throw up and sober herself up. After a bit of time she'll feel a little better and we can go to the party and get in."

Once again, I'm not sure whether it's just that I'm getting older and more conservative in my views, but this just seems really bizarre to me! Not only is it potentially extremely dangerous (vomiting can be life threatening) but maybe more important to some young people, it just doesn't seem to make economic sense ... why 'preload' with alcohol if you're only going to throw it up before you go out to do the actual partying for the night?

It's also incredibly important to remember that vomiting does not sober you up. The reason you are drunk and feeling unwell has nothing to do with what is in your stomach - you are drunk because the alcohol has reached the brain. Emptying the contents of your stomach will certainly prevent anymore alcohol from reaching the brain and increasing intoxication levels but it certainly will not sober you up.

So why do some people feel as if they have sobered up when they have thrown up?

After talking with a few doctors and other health professionals it seems that the answer is fairly simple. When you throw up, putting the body under sudden and/or physical stress, endorphins and adrenaline are released. Endorphins are often described as the body's natural pain killers (or your 'own private narcotic'), and adrenaline boosts the supply of oxygen and glucose (energy) in your brain and muscles. This makes you feel pretty good (or at least a little better) for a short time. Unfortunately, your body does not keep releasing these chemicals and the effect wears off pretty quickly. If you combine this with the fact that by emptying the contents of your stomach you have decreased the amount of toxins (alcohol) in your body, vomiting may make you feel a little better for a short time but it certainly does not sober you up.
 
Someone I respect greatly who presents to parents across the country used to say that you can do everything right to keep your kids safe and it only takes one thing for everything to go wrong - 'bad luck'! On the other hand there are adolescents across the country who take part in unbelievably dangerous behaviour every weekend who get through it all due to 'good luck' ... Tactical vomiting is dangerous behaviour but many will play around with the practice and survive simply because they were lucky!

Wednesday, 26 June 2013

'Synthetic drugs', 'research chemicals' and 'legal highs': What are we really talking about here?

The recent death of Sydney schoolboy Henry Kwan has thrust the issue of so-called 'synthetic drugs' onto the front pages of newspapers across the country. The full details of his death, including toxicology, have not been released as yet, so it is still not completely clear what substance he actually took, but regardless of that fact both the NSW Government and the Federal Government have responded by taking measures to restrict the sales of a number of products that were previously legally available.

The problem with this death is that there are a number of elements to the story that have got confused - trying to sort through it all and work out what public health messages need to be developed to prevent future harm is pretty difficult. I'm going to try to give it a 'go' here, so bear with me! As far as I see it there are four main issues that we should be looking at here:
  • the rise in interest in hallucinogens (LSD, 'acid', 'trips', mushrooms, DMT, etc) by school-based young people and the belief by a growing number of adolescents that these are 'risk-free'
  • a growing number of 'research chemicals' being developed, packaged and sold as 'legal highs', with little, if any information available on the potential negative effects of use
  • some young people believing that because of their apparent legal status this means that these 'legal highs'  are 'safe'  - i.e., 'legal means safe' 
  • some of these 'research chemicals' being sold as LSD, i.e., users buying trips believing they contain LSD but they are being 'adulterated' with other substances
Let's deal with each of these separately and see where it takes us ... firstly, the increased interest in hallucinogens. I've raised this in a number of blog entries and won't go on about it here at great length but in all my years of visiting schools and talking to young people I haven't seen a group of drugs take off as quickly amongst teens like as I am seeing with hallucinogenics at the moment. It is important to remember that they have never really gone away - although most people believe that LSD disappeared in the 70s, it has always been available but most people aren't aware of it because it is rare that it causes severe problems, i.e., LSD-related deaths are unusual, and as a result we don't see the topic raised in the media very often.

But it isn't just LSD - naturally-occurring hallucinogens such as 'magic mushrooms' (containing psilocybin), datura and DMT are also growing in popularity. Then we have pharmaceuticals or over-the-counter (OTC) medications that are being misused in an effort to try to achieve a hallucinogenic effect. Most would remember the Stilnox scandal involving the Australian swimming team but many would be surprised to hear that I was at a school recently where a group of young men were using motion sickness medication (10 or 12 at a time) to go 'tripping'. This is certainly not a new phenomenon - do a quick Google search and you can find chat room conversations discussing the use of such products - but put all of these things together and it certainly seems like something is happening in the 'psychedelia' area.

Secondly, the number of 'research chemicals' is growing exponentially. Some may not be familiar with this term but essentially it is an updated version of the term 'designer drugs' (often used to describe drugs like ecstasy or MDMA). It is used to describe substances that are created to avoid existing drug laws, usually by preparing analogues or derivatives of existing drugs by modifying their chemical structure in some way. The really interesting thing about what we are seeing at the moment is the development of substances that have entirely different chemical structures that produce effects similar to existing illicit drugs, e.g., 'synthetic cocaine'. These substances are often referred to as 'synthetic drugs' by the Australian media and really that makes no sense at all - how can you have synthetic LSD? LSD is itself synthetic - the term just doesn't make sense. Research chemicals is a better term, although certainly not perfect ...

The reality is that we simply cannot keep up with how fast these drugs are appearing on the market. Last year the EMCCDA identified 71 new substances (there have been more than 250 since 1997) and many of these are being packaged, marketed as 'legal highs' and sold and the only response that policy makers can come up with is to regularly update their 'banned list' and prohibit the sale of yet another group of products. Do we know anything about the potential harms associated with the use of these substances? Not usually. Most of them are so new that they haven't been tested on animals, there certainly hasn't been any randomised control trials on humans! That said, they're most probably not the healthiest products on the markets, but it really does annoy me when you see politicians and others who should know better who start talking about harms associated with these substances - let's be honest - we have no idea what they will do ... the best we can say is users are really being the guinea pigs for the future!
 
The one benefit of banning any of these products is that it does change how some young people perceive them. Unfortunately there is the belief by many that if something is legal it must be safe (this is one of the great problems that we have with alcohol) and when something can be bought at the local petrol station it is not surprising that adolescents (as well as many adults) start to think that there can't be anything wrong with it ... Will banning the products stop everyone from using them? Of course not, it is highly likely that a 'black market' will be created and that some people will continue to buy them via criminals that will pick-up the product, but for others, now that it is illegal this will be enough to discourage their future use.

Finally, and most probably most importantly, some of these research chemicals are being sold to users as another drug, e.g., an ecstasy user is being sold a pill he or she believes to be MDMA, when in fact it contains mephedrone. To be honest this is not a major change for stimulant users, ecstasy users rarely even call their drug of choice ecstasy anymore, usually referring to it as a 'pill' now, mainly due to them believing the drug to be of such poor quality and rarely containing MDMA anymore. What is new is that we are now seeing 'tabs' of LSD being sold that actually contain no LSD.  Instead we believe that the NBOMe group of chemicals (particularly 25I-NBOMe) are being sold as LSD and this appears to be causing a great deal of problems. Deaths have been reported in the US and Europe and we have recently seen young people presenting to emergency departments across Australia after taking what they believed to be LSD.

That said, I have also talked to quite a few young men (particularly in NSW) who claimed to have intentionally bought what they called '25Is'. They were well aware that they weren't taking LSD, knew little about what this 25I actually was and interestingly all reported that at least one of their group of friends who took it became unwell, with a couple of them having to be hospitalised. 

So what does all this mean and what messages should we be giving to young people?
  • some information needs to be provided to young people about hallucinogens, particularly that they are not 'risk-free'. We need to be sensible about the information we deliver and not focus on 'death and destruction' - but there are risks and these need to be conveyed to adolescents
  • we need to emphasise that 'legal does not mean safe' - this is a difficult one, as many adults in the community hold the belief that the legally available drugs (e.g., alcohol) are somehow safer than the illicits, purely because of their legal status
  • it is imperative that we get a message to hallucinogen users that LSD is being adulterated or that they are being sold something as LSD that is in fact another substance altogether - that is, you may not be buying the drug you think you are. LSD is not risk-free, but the substance you are purchasing and potentially taking may be much more risky.
This is not an easy area and to be quite honest, my conversations with policy makers and law enforcement about this issue have not been particularly fruitful. Realistically their only answer is to try to get 'tougher' - to try to restrict the sale of new substances (which I totally get) and to increase policing (more men and women in blue uniforms gets a great deal of media attention and certainly makes it look like the government is doing something, but does it really make a great deal of difference with young people?) .... I have no easy answers but we have to improve our response to this growing issue and do it quickly. When we have 15 year olds (and some who are even younger) who are regularly using hallucinogenic drugs who have no awareness of potential risks we have a problem! What really frightens me is where does a 15 year old go after having an intense experience like an LSD trip?

Tuesday, 18 June 2013

Sports, alcohol and bad behaviour

It seems as if not a week passes without an elite sportsperson hitting the headlines for some alcohol-related incident. In the past couple of weeks we've seen a number of sportsmen be arrested for a range of alcohol-related crimes, including indecent assault, sexual assault, wilful damage of property, drink driving and driving without a license. The most interesting thing about all of these incidents is watching the 'spin-doctor's' response - it has now almost become a formula ...

Firstly, the player comes forward and repents with a prepared statement usually read from a piece of paper, then the sporting body involved (e.g., NRL, AFL, etc) responds by saying that they will not tolerate 'bad behaviour' and that they will take appropriate action but, at the same time, carefully includes in their response that they still must 'look after' the player. They can't leave them 'high and dry' - they must support them during this time and so the punishment can't be too severe. A punishment is announced (usually talkback radio is swamped with supporters of the sport complaining about the severity of the action taken) and then a few weeks later all is forgiven because they're just young men 'letting off steam' and what is everybody making all the fuss about?

It's a never-ending cycle and it doesn't look like it is going to get any better anytime soon ...

Here is the statement released today from NRL player George Burgess (who plays for the South Sydney Rabbitohs) after being charged with wilful damage of property (ramming a sign he found on the road through the rear window of a car) after a "disagreement" with a resident of a unit complex.

"I would like to apologise unreservedly to the Rabbitohs members, sponsors and everyone in the community. I have let my team and my family down. I acknowledge that I am a role model for kids and I will do everything I can to restore my reputation through working harder in the community. It is my responsibility to ensure that this type of behaviour does not happen again. I will learn from my mistake and bounce back stronger and better as a person."
I don't know if age has made me cynical but I find it very difficult to believe that Burgess had anything to do with this statement apart from possibly reading it out! Is he sorry that this has happened? I'm sure he is - no-one wants to find themselves in court - but really this statement about being a 'role model' for kids - if he really believed that, would he be out drinking until the early hours of the morning when he is well aware of the potential consequences?

Here is the response from the Rabbitoh's Chief Executive, Shane Richardson:

“George accepts he’s done the wrong thing and that there has to be a price. For someone on his contract level it is a big price to pay and he still has to deal with the issue in court. We will support him because he has faced up to what he has done and because this isn’t reflective of his general behaviour at the club. Everyone is going to have to get the message though that the NRL is going to stay strong on these issues and that the clubs will support that stance without exception.”

It has now been announced that Burgess has been suspended for two matches and fined $10,000 by the NRL. He will also pay for the cost of the damage, undergo an anger management program and commit to a further 50 hours of community support work. There are certainly a range of consequences there - he has certainly been punished! I can imagine the outraged response from some NRL supporters tomorrow - not about the fine or the anger management program and not even the 50 hours of community work, but missing two matches - that's outrageous!

Am I asking that he be punished more - should he be tarred and feathered, crucified or whatever? Of course not, he is a man in his 20s who has made a mistake but sooner or later the sporting codes (particularly sports such as the NRL, AFL and cricket) have to realize that apart from all the issues associated with dealing with young, risk-taking men, their sponsorship deals with the alcohol industry contribute to this growing problem and send a very mixed message to their players and the wider community.

I have been delivering alcohol and other drug sessions to sportspeople since 2000, when the AIS contracted me to work with them in developing programs for athletes in the lead-up to the Sydney Olympics. Essentially these are sessions designed to assist players to celebrate (or commiserate) in a safer way. Let me assure you, elite athletes do not want to attend these sessions - no matter how great a presenter you are - they are without doubt the most difficult audiences I have ever presented to and it takes a great deal of skill to keep them even remotely interested.

I have been contracted by all four football codes (as well as by Cricket Australia) at some stage or another over the past 13 years. The one comment you hear from many of the players is that they feel the sport is being hypocritical providing alcohol education sessions to them when at the same time their team jerseys or the like have alcohol company logos all over them. Over the years, some have also commented that they also have a great problem in getting their head around the fact that they must attend official club events where they are actively encouraged to drink their sponsor's product!

The sport will argue that they are promoting 'responsible drinking' but the fact of the matter is their players are usually young men in their 20s, being paid quite large amounts of money who have a lot of time on their hands. Many of them are also actively encouraged to take part in 'team bonding' activities that often involve drinking of some description ... To be totally honest, it takes a pretty resilient young man to maintain 'responsible drinking' in that environment.

I was once told by a leading public health advocate that if the Federal Government announced tomorrow that alcohol sponsorship of sport was to come to an end, it would take at least 40 years for the process to actually finish rolling out! It took 25 years for tobacco advertising to be removed from sporting events in this country - from the day Bob Hawke announced the move to the time it was finally fully implemented - but it would be at least 40 for alcohol! That is terrifying! The alcohol industry has done an incredible job of ensuring a long future partnership with sport - it's going to take a great deal of effort to finally break that relationship but it will be worth it.

Monday, 17 June 2013

Neither prohibition nor regulation will prevent stupidity!

An article in today's Daily Telegraph written by Dr Gordian Fulde, Head of the Emergency Department of St Vincent's Hospital, Sydney, (he does one most weeks, discussing some of the injuries this busy inner city hospital (one of the most unusual in the country having both Kings Cross and the Oxford St nightclub strip nearby) deals with over the weekend) highlights the great problem we have dealing with alcohol and other drugs.

Both sides of the 'synthetic drugs' debate – those who want to regulate the industry and those who think continually banning new substances will fix the problem need to look at this very short piece and think whether either of the two ends of the spectrum are ever going to make a great deal of difference in reducing the harm associated with alcohol and other drug use …

The incidents that Dr Fulde describes in his piece are as follows:
  • a 27-year-old woman using 'meow meow' or mephedrone, mixed with amphetamine ('speed') who experienced "total body spasms, a racing heart, raised body temperature"
  • a 29-year-old danced off the podium, falling on her face and losing some front teeth and lots of blood from a cut lip (no drug was mentioned but she was obviously intoxicated on something to be included in the piece)
  • a 19-year-old woman who, after at least 15 drinks, was confused, very distressed and could not stop crying
  • a drunken man, 40, who fell down 18 stairs crashing his face into concrete and breaking his  jaw "so badly the ends burst apart"
  • a 22-year-old, beaten up and cut with something sharp with bad lacerations to his ear and scalp
  • a young man, cut and knocked out by a bottle smashed into the back of his head
  • a 19-year-old admitted "dangerously agitated after taking six ecstasy tablets"
  • a 21-year-old who became violent after mixing a cocktail of drink and drugs, admitted with a head injury
A number of the incidents involved illegal drugs. These drugs are prohibited – they are not meant to be readily available – amphetamine and ecstasy can't be bought in your local deli. But there were at least three people in the list above who were able to locate the drug of their choosing and purchase it. On the face of it, prohibition did not reduce the harm in these cases. Simply banning a substance does not mean it is going to disappear – it certainly may mean that it becomes a little more difficult to find for a while, but that doesn't usually last for too long and when it does come back it is often a little more expensive and criminal gangs are much more likely to be involved in its distribution.

The majority of the incidents described, however, were alcohol-related. This is a regulated product, labelled, only allowed to be sold under certain conditions, each can or bottle clearly indicating how much alcohol is contained (i.e., how many standard drinks and percentage alcohol content), restricted for sale to those above 18 years …. I could go on and on! Clearly regulation made little difference in the cases listed here - even though these people had all the information about what they were drinking, all the laws around the provision of alcohol were in place, it did not fix up all the problems. Would banning alcohol make the situation worse? Without a doubt. We only have to look at the US experience of prohibition in the 1920s to see what happened with that experiment!

Drugs, legal or illegal, are, for the most part, taken to 'change where we're at' – they alter our perception and in many cases, make us feel good – that's why people continue to take them. This has been happening since man first peeled off a bit of bark, chewed it and had a pleasant experience! We are pleasure-seeking animals – nothing is going to change that. Some of us don't just want a 'little bit of pleasure' – for some the belief is that if one pill makes you feel good, taking eight will make you feel fantastic!

In this article we have a woman who mixed mephedrone with speed, another who drank at least 15 drinks in a session and a 19 year old who had taken six ecstasy pills – prohibition didn't stop those who used the illicit drugs and alcohol regulation didn't make any difference for the drinker. These people did 'dumb things' – they wanted a good time and things went horribly wrong!

So is there a simple answer, is there a 'silver bullet'?

Going down the prohibition line certainly reduces access to some extent (they become harder to get) and the simple fact that something is illegal is enough of a deterrent for some people to not want to use the substance. On the other hand, the regulation of drugs such as ecstasy would reduce the risk of more dangerous adulterants being found in those substances, ensure that information would be provided on the contents of the drug, as well as the potential risks and correct dosage (similar to that of pharmaceutical drugs) and the sale of the drug would be monitored and carried out under strict conditions.

They are the pluses but in reality neither of these strategies would make a bit of difference in the three cases above … neither prohibition nor regulation will prevent plain stupidity!

I wrote another blog entry last week on this topic and Monica Barratt, one of Australia's top researchers on this topic, responded with the following:
"… one of the benefits you didn't mention about lifting prohibition is that hopefully this will enable a more frank conversation to occur about drug use - its benefits and risks - and perhaps younger people will have more respective for authorities because we would no longer be lying to them about drugs always being equally harmful. We know that people are more likely to seek help if the drug isn't prohibition or stigmatised … The key for me is if we could, as a society, have a mature and respectful conversation about drug use, then we'd have more chance of avoiding some of these tragedies and harms." 

Monica is an amazing woman who has really put herself out there in this area - I truly admire the work she has done and her efforts in the area of harm reduction. Her final sentence is the winner for me – "if we could, as a society, have a mature and respectful conversation about drug use". I have been speaking on this subject for the past 25 years and I still can't believe how both sides of the drug argument can't see that if were willing to move into the middle just a little more things could be better.

Cannabis is the best example of the polarisation of views in this area. This is a drug that people perceive as either 'the devil’s weed' or 'God's sweet nectar' – neither is true. Of course cannabis can cause harm to some people, it's ridiculous and na├»ve to think it doesn't, but it is also important to acknowledge that the majority of people who use the drug, do so (often for a short period of time) and move away from it and never experience any problems. If both sides could somehow acknowledge the other in a mature way and sit down at the table and try to work together rather than throw insults at each other maybe we could move forward in a positive way.

Wednesday, 12 June 2013

Celebrity drug use: What impact does it have on young people?

The Voice judge Joel Madden hit the headlines today with the news that NSW police had raided his room at the Star Casino after a cleaner had reported finding cannabis. The fact that the singer was not charged, as NSW law permits authorities to issue a simple caution to anyone found with less than 15 grams of cannabis, has also added fuel to the fire. Not surprisingly the tabloid press has gone into a frenzy over the story ... why was he not charged? Is it because of his celebrity status? Is Channel 9 going to allow him to appear on the Grand Final of The Voice (really - in the scheme of the world is any of this really that important?)? Has he apologised for his behaviour? Was his response (via Twitter of course) appropriate?
It goes on and on and to be quite honest I don't think most people care very much but having been at a school all day I have to say that this type of story does have an effect - the students were buzzing about it and I can imagine that it will cause some problems for some parents. How do you discuss the fact that a famous person was caught with an illegal drug and nothing really appears to have happened to him? If the drug is illegal aren't there consequences for getting caught with it - isn't that what we tell young people?
For the record, according to The Australian newspaper Madden released the following statement about the event "Sunday while I was at work, a hotel employee found a small amount of marijuana in my hotel room. The police were called and responded. Sydney is my adopted home and I appreciate the way the NSW police handled the situation. They have informed me there will be no charges. I hope this didn't cause too much drama for everyone."

In recent times there have been more and more celebrities who have either been caught using drugs or who have decided to write a 'tell-all' autobiography and spill the beans about their past drug use. For those who have willingly decided to share their past drug experiences, often for large amounts of money, they usually tell about the 'horrors' of the days they used drugs and the downward spiral that they found themselves in once they began. For those who get caught in compromising situations with drugs, there are usually heartfelt apologies for their behaviour and increasingly bizarre explanations for the choices they have made.

The media has also become increasingly interested in celebrity drug use, often directly asking people questions about whether they have ever experimented with substances. Even politicians have not escaped this trend, particularly in regards to cannabis.

The major problem is the message that these admissions send to young people. Although many would imagine that stories of famous people using drugs and experiencing a range of problems would discourage teenagers from going down the same path, in fact, in many cases just the opposite happens. You would think that hearing rock stars like Keith Richards talking about his drug use and then taking a look at him would be enough to put anyone off ever touching illicit substances. Unfortunately the only message that some young people pick up is that these celebrities have 'made it through to the other side' and continue to lead very glamorous and successful lives.

When you look at the messages that we give young people about drugs they are usually negative, warning about the potential risks associated with their use. Drugs destroy lives – people who use them lose their jobs, their families and are very unhealthy. This just doesn’t match up to what they see when they see a story on the latest rock star telling all on a TV chat show, or a famous sportsman who has been caught doing the 'wrong thing'. Even if they did have a bad time there for a while, they certainly don’t look as though they have suffered too much at the moment.

Mixed messages are extremely dangerous when it comes to providing drug information to young people. They learn when a consistent message is given to them and unfortunately celebrity drug use, particularly the way it is represented in the media, often contradicts everything they are taught by everyone else.

This is why it is incredibly important that we don't present drug information in a 'black and white' way. There are no 'definites' when it comes to the effects any drug will have on a person. Each drug will have a different effect every time it is used and there is no way of knowing what that effect will be.

When we talk to young people we need to make sure that we talk about the range of effects that a drug can cause, not just the possibility of death. There are physical, psychological and most importantly, a range of social effects that can arise as a result of using alcohol and other drugs. In some cases, the use of drugs may not result in any major physical effects that anyone can see, but the mental health may be immense. In other cases, the physical impacts of long-term drug may be extremely obvious.

The social impacts of drug use are not discussed often enough but are very real and can have devastating effects. When it comes to sportsmen, for example, the use of illicit drugs can lead to a change in how others in the community regard them. A footballer who is found to be using a drug like ecstasy can have his reputation affected for the rest of his life. He could win every award possible in his future career in the sport but I guarantee he will always be known as 'the footballer who took ecstasy'. The impact on his family and friends can also be immense and is rarely talked about.

When it comes to Joel Madden is this event going to change his life in any major way? Most probably not. You can guarantee, however, that everytime he comes to Australia the topic will come up and as he said today, this is something he did not want splashed all over the front pages of the daily papers ... the social impact of being caught with cannabis on this popular musician will not be great but he did have to front up to a news conference today to explain his actions (something I'm sure he didn't enjoy!) and he was kicked out of his hotel - there was an effect. It may not have been life changing but it was there!

Celebrity drug use does cause significant problems for educators and increasingly parents, who are struggling to work out they handle questions about this new phenomenon. Incredibly successful people (who are also usually beautiful, thin and extremely rich!) being caught or admitting to drug use, with little or no signs of any problems, challenge the messages we are trying to deliver. That is why we have to get the message right.

Making sure the information is balanced, accurate and credible is crucial. Acknowledging that not everyone is going to experience all of the same problems will enable us to explain why it would seem to appear that some people appear to get by unscathed. At the same time, no matter who you are, there are problems – some you may not be able to observe by watching the nightly news, but they are there.

Sunday, 9 June 2013

To ban or to regulate? That is the question ...


The death of Henry Kwan during the week continues to attract a great deal of media attention. The young man jumped to his death on Sydney's north shore after apparently ingesting a 'tab' of one of a new range of synthetic substances on Wednesday night. He is believed to have bought the drug from a classmate who told him it was LSD.

It is truly a tragic story and the father's relaying of how the young man's mother and younger sister tried to stop the 17 year old jumping when he told them he believed he could fly was heart-wrenching. Talkback radio and the media more generally immediately demanded action - how could these apparently incredibly dangerous 'synthetic drugs' still be legally available?

Today the Sydney Morning Herald ran a story announcing that the NSW Government will ban the sale of about 30 so-called 'synthetic drugs' with "retailers ordered to pull the products from their shelves immediately." According to the report, retailers will have until Tuesday to remove the products and there will be a huge taskforce of police put out into the community to ensure the ban is enforced. This morning NSW Fair Trading Minister Anthony Roberts held a news conference calling on the Federal Government and the Australian Competition and Consumer Commission to make the ban permanent and nationwide (he talked about 18 substances - not 30).

So will the ban actually make any difference or is it simply a 'band-aid response' from a government reacting to a tragic death and the community demanding immediate action?

First off, what will a ban do? Well, it will certainly enable police to prosecute those people who sell these products (or at least those 18 or 30 products) and it will mean that they are now illegal ... that's about it!

Will a ban mean that these products are now less accessible and that people won't use them anymore? I'm not so sure about that ... The best example I can give of when a ban hasn't worked is around 'crystal pipes' (the glass pipes used to smoke crystalline methamphetamine). These pipes were banned in some Australian states at the height of the 'ice epidemic' in response to some of the hysterical media coverage. Let me assure you that even in the week after the ban crystal pipes were still available - they have never gone away and most probably never will. Are they harder to get? Yes, most probably, but the ban didn't result in them disappearing, they simply went underground and became more expensive. It certainly didn't result in major changes to behaviour. What we also have to remember is that many of these drugs are being bought on-line (I'm told by some users that they are being imported in huge quantities - one bought tens of thousands of LSD-like tabs that got through border patrol as sleeves of a book mailed in Amazon packaging!) - a ban is not going to make any difference there.

There is one group of potential users of these products that will be impacted by this ban and they are those who choose to use them purely due to their perceived legal status. Once that changes there is no doubt that this group will no longer elect to use them. We have no idea how large (or small) this group is - but research has shown they certainly exist. The most incredible thing is that the available evidence we have suggests that the young man who died didn't even know he was using one of these newer products - he thought he was using LSD, an illegal drug! The legal status really didn't seem to make any difference to him!

I did so much media on this story on Friday and, as always, I was ripped apart by some who either accused me of coming from a prohibitionist angle ("how could you not raise the issue of drug law reform? You should be brought up in The Hague as a war criminal") or as too soft on drugs ("these drugs kill - you talk harm reduction. You contribute to the deaths of our young people") - when you think about it, I must be doing something right! The problem here, as with so much in drugs, is that there is no easy answer and that the views that are held by those at either end of the spectrum are both dangerous and certainly not helpful.

I often get asked on my views around drug law reform and I always give the same response - the current policies don't work well so we should certainly look at other options, but do I believe that legalising all drugs is going to solve the problem, absolutely not! It certainly goes towards fixing some of the problems, but it also creates a range of others. For example, even if a government was to make all drugs 'legal', would these substances be available to those under the age of 18 years? If they weren't (and I can't imagine any government, no matter how progressive, permitting underage access), you will immediately create a black market - one of the major things you are trying to prevent through drug law reform ...

So would the regulation of these newer substances solve the problems we are currently seeing? New Zealand has recently introduced a "revolutionary" approach to the 'legal high' (I much prefer this term to 'synthetic drugs') issue. On February 26, 2013, the Psychoactive Substances Bill was introduced in the New Zealand Parliament. The bill would essentially reverse the onus of proof by requiring distributors and producers of these newer substances to prove that they are safe before being legally able to sell them, thus potentially creating what some are calling a "legal recreational drugs market" in New Zealand (readers of my blog would know I don't like the term 'recreational drug').

It will be incredibly interesting to see how the New Zealand model plays out. Essentially it is asking the 'legal high' industry to work to similar standards as those expected of pharmaceutical companies. No pharmaceutical product can be sold until it is tested extensively - legal highs will now go through the same process. My question is does this model work well for the pharmaceutical industry? Every year we have thousands of people who die as a result of the use of pharmaceuticals, many misuse and abuse these substances, and countless numbers become dependent on them. Regulation is not the 'silver bullet' - it will not solve all the problems associated with drug use. Is it better than what we have? Maybe, but it's certainly not going to fix everything and let's not try to kid ourselves that it will!

A few weeks ago I met a young man who told me the following story about an LSD experience he had that was not going so well ...

Sean, a 16 year old from the northern beaches, had gone to a gathering and taken three trips (yes, three!) over a period of a couple of hours. He then started to feel extremely unwell - he was overheating, feeling quite nauseous and becoming very anxious. He told one of his friends what was going on and an older boy told him that this had happened to someone else he knew a couple of weeks before and that the way to 'fix' it was to smoke a couple of 'cones'! That's exactly what he did - he smoked quite a bit of cannabis to get over a 'bad trip'!

Prohibition certainly didn't make any difference here - both LSD and cannabis are illegal and the fact is, if you want to get an illicit drug you most probably can! Would regulation have made any difference, would the fact that the trip had come in packaging, had been tested in some trials sometime before and was guaranteed to actually contain LSD have prevented the adverse effect that Sean experienced? Probably not. Most importantly, would regulation have stopped Sean from taking three trips in the first place and then try to fix up a problem by taking more drugs? No, youthful experimentation and plain stupidity can't be stopped by regulation ... it's just what some people will do!

There is no easy answer to this issue and I can assure you that simply banning a range of products is not going to result in a significant change in behaviour. Get tough in one area and make one drug more difficult to access and another will rise to take its place ... You'd also have to be extremely naive to think that by legalising or regulating substances each and every problem is going to disappear!