Monday, November 17, 2014

7th Annual ACT Alcohol Tobacco and Other Drug Sector Conference (ATODA) Conference Report by Kim Novack



7th Annual ACT Alcohol Tobacco and Other Drug Sector Conference (ATODA)
Wednesday 24 September 2014
                                   
 
Summary:

The ATODA conference comprised of approximately 115 delegates from a variety of ACT Heath Service Organisations, which included ten guest speakers. This conference was highly interactive and provided all participants with the opportunity to raise issues around the current solutions in place.   

“What’s the problem represented to be?”  This was a very clever question raised to initiate discussions and various perspectives around the key topics of e-Cigarettes, Drug Driving, New Psychoactive Substances and Medicinal Cannabis.

ATODA discussed the different approaches that are used to address these Drug Policy problems.  Their focus being: understanding that problems are created by the way we implement policy and solutions. There is no right or wrong decision but there will always be ways to improve the systems and solution in place.
The Policy models comprise of:
  1. Policy as an authoritative choice – decision making by authorities, i.e Pharmaceuticals
  2. Policy as structured interaction – governance networks, i.e King Cross violence and re-structuring alcohol licences
  3. Policy as social construction – of target populations, i.e UKDPC and ANCD consensus

The following notes are a summary of the key points raised by each of the guest speakers on their topic of interest. The conclusion to each of the main topics is somewhat confusing as it appears there are more questions than solutions at this stage. Most issues are still facing much uncertainty and debate in moving forward to obtain consensus and approvals through communities, governments and legislation.    

e-Cigarettes

Speaker: Anke van der Sterren
Organisation: Alcohol Tobacco and Other Drug Association ACT (ATODA)
Topic: e Cigarettes and personal vaporisers also called ENDS, ANDS and E Smokes

Anke raised the current debate around the use of e Cigarettes in our community and whether these are safe or safer than Tobacco cigarettes.  

Questions that have been raised with the Health Services sector include:

  1. Safe for vapour users and the people around them?
Yes, better than cigarettes, less smell, nil or limited nicotine, however no real evidence based assessments have occurred regarding the safety of others.

  1. Effective to help smokers quit?
Possible smoking reduction, however no real evidence based assessments have been conducted as yet.

  1. Is this a gateway for young people to use or start smoking?
Young people could get addicted to Vapours. There is also concern that vaporisers will be used with other illicit substances.

  1. Is this a way to re-normalising smoking activity?
This is undecided. No real evidence based assessments have been conducted as yet.

Issues with the Solution: Group Discussion Perspective:
  • Many studies have been conducted however no real evidence has been produced.
  • It is too early at this stage to determine the effects on indoor air quality and biomarkers in vapours.
  • The World Health Organisation (WHO) recently commissioned a report reviewing evidence on E-Cigs, however this was not considered as substantial evidence based results.
  • The “Big Tobacco Company” is cashing in via advertisements and pushing the use of e-Cigs.  Also developing new e-Cigs and false terminology as “real tobacco” is used.
  • Question if this is a middle class problem? Who does this affect? This information needs to be qualified and verified.
  • The cost associated is very expensive
  • The quality of information must be addressed
  • Is this a distraction and are we misdirecting our efforts?
  • Should we focus on the low socio economic majority, to reduce smoking?
  • Should we be focusing on similar campaigns that were used for the HIV and Condom education?
Speaker: Dr Coral Gartner
Organisation: University of Queensland
Topic: Long term Regulatory goals and minimise nicotine use and the black market trade.

Dr Gartner discussed the legal aspects and the current regulation state around the use of e Cigs in Australia.

There are currently multiple laws in place for States and Federal Government. Queensland was the first to propose regulation of e-Cigs and is currently in Legislation review.  

Personal Vaporisers without Nicotine: are legal to obtain, possess and import.
Current State sale provisions:
  • NT, TAS, VIC, ACT = legal
  • QLD = legal however must be inline with the Tobacco Laws
  • WA = possibly illegal, the appeal outcome is pending
  • SA, NSW = possibly illegal.
Personal Vaporisers with Nicotine: are only legal, where there is a therapeutic claim and a medical prescription must be obtained.  

Issues with the Solution: Group Discussion Perspective:
  • How are we regulating cigarettes in the supermarket?
  • If personal vaporisers are not sold in supermarkets should cigarettes be removed from open sales?
  • Cannabis and other drugs could be used in the vaporiser tool which could encourage further illicit drug use.
  • Only high quality safe products are legally sold, how will this be monitored?
  • Taxation – Tobacco has high tax levies, should vaporisers incur the same?  
  • More research is needed to acquire data on the safety for person using and others and is this good for public health?
  • Economic issue – are people in low socio economic status the focus?
  • Safety and Harm – Is this a legitimate harm control tool with a positive reduction in Tobacco use?
  • Social and Community to obtain information and communications about this product.
Drug Driving

Speaker: Professor Maxwell Cameron
Organisation: Monash University
Topic: Accident Research Centre study on random roadside drug testing in Victoria.

Professor Cameron discussed the effectiveness of roadside drug testing (RDT).  

The Accident Research Centre study has shown that increased drug tests and detection have had a positive deterrent effect on Victorian roads. However, this is a very costly exercise. To become cost effective in the long term the testing tools and technology will need to become cheaper to sustain RDT.

Future focus on a targeted approach to test truck drivers is hopeful as the carnage is severe in most cases in truck accidents due to the high use of Methamphetamine.  


Issues with the Solution: Group Discussion Perspective:
  • How effective is RDT?
  • Consider the cost ‘vs’ time?
  • Is the message of reducing driving under the influence of substances being heard?
  • Are fewer drivers being killed due to less impairment from substance abuse?
  • An expensive exercise however worth the investment as RDT is working as a deterrent. 
Speaker: Mr David McDonald
Organisation: Australian National University
Topic: Social Research and Evaluation on Drug Driving

Mr McDonald raised the current debate into whether the drug driving problem is a road safety or drug law enforcement problem, should it be focusing on prevention or targeted and the issues around prosecution of drug driving is quite different to driving under the influence of alcohol.

What are the underlying assumptions?
  • Some drivers could be impaired by the use of drugs
  • Some drivers use drugs and some drive after use
  • RDT will reduce prevalence of drug impaired driving
  • RDT will reduce the increase of road side crashes
  • Currently only testing for Cannabis, MDMA and Methamphetamine
  • It is valid to breach human rights
  • Community awareness and knowledge regarding RDT and road safety
  • Education is needed in the ACT in regards to the consumption and impairment thresholds - when is it safe to drive after taking drugs.
  • High rates and remain high from past ten years on usage and driving under the influence.

What are we seeking to achieve?
  • Can the problem be thought about differently?
  • Costly, different set-ups could be put in place
  • Safety ‘vs’ Prosecution?
  • Publicity for government and police
  • Proof that testing of Drugs is stopping accidents
  • Prescribed limits – The UK Government is trying to come up with quantitative impairment thresholds for 16 Drugs 

Issues with the Solution: Group Discussion Perspective:
  • Does drug testing take away resources from other police resources?
  • Equipment ‘vs’ police man power?
  • What is the best investment for Road Safety?
  • RDT is still very effective and important
  • Threshold of effect is very complicated and not as simple as testing alcohol in breath and blood samples.
  • Focus on the effect not the level in the system needs to be considered.
  • Look at medicated cannabis and how to monitor if users are safe to drive?
  • Current Legislation any impairment under any substance will be prosecuted
  • What about Opiates? Currently not being tested first hand.
  • What are the varied State jurisdictions?
  • What about new psychoactive substances and synthetic cannabis


New Psychoactive Substances (NPS) 

Speaker: Dr Monica Barrat
Organisation: University of NSW
Topic: Drug Policy Modelling Program

Dr Barrat discussed the use of New Psychoactive Substances; Synthetic Cannabis, Methadrone, 2CI and 2CB and Cathinones in relation to the findings in the September 2014 Senate Committee report and EMCDDA which is monitoring drugs and analogues.

What are the underlying assumptions?
  • Users of cannabis will try synthetic
  • It is not encouraging new addiction or new users
  • People use Synthetic Cannabis as it is legal, easier to get, produce an effect they were curious about.
  • A full import ban on NPS is with the Senate at the moment.
  • Illegal and will produce harm to humans – both social and health related harm
  • NPS is similar in effect or structure
  • Key public messages – it is not safe nor legal
  • Some people may think this is safe.
  • Motivation for use
Speaker: Mr Ross Bell
Organisation: New Zealand Drug Foundation
Topic: Legalisation of NPS in NZ

Mr Bell discussed the process in which the NZ government attempted to legalise NPS use and the problem with governments trying to control illegal substance use through Drug Laws and Prohibition.

Mr Bell is fighting for Regulation rather than Prohibition. Prohibition is not working as there are too many new products being created. Prohibition worked when only a dozen substances existed 40 years ago. NZ tried various forms of controls, including;  banning substances quickly, implementing drug laws, adding illicit substances to controlled analogue lists. Nothing worked.

The NZ Government soon ran out of patience. A review of the current Drug Policy Law commenced. New reform recommendations were put in place and a Regulation model, under tight controls was created.

Industry had to prove their drug is not harmful including; labelling, poison centre line, testing regime and prove that their drug is low risk of harm. A licence to sell the product would only be issued if this process was passed successfully. This would enable the legal selling of these New Psychoactive Substances.

Evidence Drug Policy making was passed through Parliament Law. The Law was passed but Regulation had not been written as yet. Then a new Election year proved to cause trouble and the process stopped.  The Media got involved and pursued a negative campaign against legalising NPS. Advertising a picture of a 17 year old boy called Jesse, coughing up blood into a tissue when detoxing after 4 years of synthetic Cannabis use and possibly other drugs, was an influential campaign in changing the community support for legalisation.  The media then created a new campaign which involved the testing of Synthetic Cannabis on animals, at this stage the public didn’t hear that the products will be approved through an intensive process and only sold under an approved license. The public soon changed their mind on the new Drug Law. Parliament then changed the Law and removed all licences.

Issues with the Solution: Group Discussion Perspective:
  • The professionals don’t know how big the problem is and can’t confirm that NPS are safe for long term use.
  • Public eye – Politicians reputation backlash from community
  • Does this reduce organised crime? 
  • Politicians are too afraid to act
  • Regulations – Education is needed
  • Fear in people with propaganda and corruption from media
  • Keeping prohibition Laws in place is not working
Benefits if Law is passed:
·         Controlled – low risk harm and legally tested products
·         Monitored, tested and licensed.
·         If NZ get the model right this could change the world model. Uruguay is next to implement legalisation of NPS, then Colorado and Washington
·         History of improvement in NZ
·         This will not be built overnight
·         Regulation ‘vs’ no Regulation
·         Disconnect between Policy and the Public
Medicinal Cannabis 
Speaker: Professor Laurence Mather
Organisation: Sydney University
Topic: Advocate for the use of medicinal cannabis


Professor Mather discussed the different types of Cannabis and the critical importance for legalisation of Medicinal Cannabis to give much needed relief for cancer patients. Professor Mather suggests that enough extensive testing and evidence has been produced with the evidence showing huge benefits for patients.  

Crude Cannabis – plant produces 400+ recognised chemicals. A mixture of cannabonoids - THC, CBD, CBN with contaminants such as pesticides, mould and other dangerous chemicals. 
Home growing model – Chemical consistency is a problem. Cannabis Hybrids produce over 800+ strains.

Pharmaceutical Cannabis –  pure chemical entity (biosynthetic or synthetic) in the final dose form. Marinol or dronabinol are the synthetic THC substances.

Issues with the Solution: Group Discussion Perspective:
  • Political
  • Unsure/unknown long term effects
  • Money/ Profit for pharmaceutical companies
  • Does this need more research?  


Speaker: Dr Alex Wodak
Organisation: Australian Drug Law Reform Foundation
Topic: Legalisation of medicinal cannabis

Dr Wodak raised the remaining questions that need to be addressed before the legalisation of medicinal cannabis occurs. How and when will this occur and should this be used clinically or conduct further trials? Dr Wodak also believes that the debate will continue for many more years and will require a campaign to educate the community on the beneficial affects for medical purposes.

Obstacles and moving towards supporting medicinal cannabis:
  • Political – both sides support use
  • Strong growing community support – male, female and all ages
  • Now discussed in all 9 jurisdictions
  • Supply – Import, domestic, Dept of Health Supply?

  • Will medicinal Cannabis cause recreational use? Evidence does not support this contention.
  • Is natural cannabis better for medical treatments ‘vs’ synthetic?
  • Regulating cannabis – enough but not too much, purpose is not to over regulate.

Regulation:
·                     Need TGA approval
·                     Requires application which is costly
·                     Establish ‘office of Medicinal cannabis’ to set standards
·                     20 Countries now provide
·                     USA – 23 our of 50 States now provide
·                     Uruguay starts to legalise use in 2014/2015

Issues with the Solution: Group Discussion Perspective:
  • Prohibition prevents the medicinal properties of this drug to be utilised for great benefit especially for Cancer suffers
  • Denial – people are already using this
  • Legal in ACT – decriminalised but can only grow two plants outside – can not grow plants inside as considered hydroponics growing
  • Do we focus on legalising recreational use and leave medicinal for now?
  • Do we follow the Dutch model which has a vast range available to the public, including high and low level THC
  • What about Medicinal use of MDMA and LSD? This will not be addressed until Cannabis is legalised.
  • Recreational ‘vs’ medicinal use – must keep this fight separate and fight for medicinal use first
  • The use of Cannabis for medicinal use may cause further stigma for those that use it for recreational use?  
 By Kim Novack HCCA Member



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