Alcohol and Drug Use

Harm Minimisation

• Most AOD use is experimental or recreational, and most users can be considered functional.
• The period of illicit drug use for most people is relatively short, and only a minority develop dependence.

Australian Government's Approach

• Harm minimisation has been a key policy since 1985, with a national campaign against drug abuse and the National Drug Strategy.
• The approach involves supply reduction, demand reduction, and harm reduction.

Harm Reduction Strategies

• Provide better alternatives to reduce desirability of heroin (e.g., methadone).
• Reduce harm through needle exchange, supervised injecting centres, and information on safer injecting.

The Harm Minimisation Approach

• Drug use is an inevitable part of society, occurring across a continuum from occasional to dependent use.
• A range of harms are associated with different types and patterns of AOD use.
• Multiple approaches can be used to respond to these harms.

Evaluation of the National Ice Action Strategy

• Aims to prevent methamphetamine (ice) and other drug use, help users to stop, and reduce drug-related harms.

Role of the Pharmacist

• Understand intoxication and withdrawal states of other drugs.
• Ability to refer patients to relevant services.
• Education, empathy, and non-judgemental advice.
• Support for demand reduction.

Needle Syringe Program

• Aims to reduce harm associated with drug use to the user and the community.
• Provides education, referral, and point of contact.
• Strong evidence suggests that these programs do not increase injecting drug use.

Alcohol Misuse

• External and internal implications.
• Pharmacotherapies available, including acamprosate, naltrexone, disulfram, and topiramate.

National Drug Strategy

• Increased use of pharmaceuticals for non-medical purposes.
• OTC painkillers are no longer S3, and the most commonly misused pharmaceuticals are painkillers/opiates.

Factors Affecting Drug Dependence

• Drug: pharmacological effect, onset of action, duration of action, route of administration, purity, availability, and cost.
• User: impulsiveness, risk-taking, sensation seeking, psychosocial factors, and psychiatric co-morbidity.
• Environment: family, peers, social influences.

CNS Depressants (Downers) and Stimulants (Uppers)

• CNS depressants: sedative-hypnotics (benzodiazepines, barbiturates), narcotic analgesics (opioids), general anaesthetics (nitrous oxide, GHB), cannabis, and alcohol.
• CNS stimulants: nicotine, caffeine, cocaine, and amphetamines.

Dependence

• Characterised by three or more of the following: strong desire to use, difficulties controlling use, persistent use despite harm, higher priority given to drug use than other activities, increased tolerance, and physical withdrawal.

Dependence Syndrome

• Tolerance (needing more to reach the same feeling).
• Withdrawal.
• Use to reduce withdrawal.
• Compulsion to use.
• Narrowing of behavioural repertoire.
• Early relapse after withdrawal.
• Chronic relapsing disorder.

Aetiological Factors

• Multifactorial, including dysfunctional family background, physical/sexual/emotional abuse, stressful life events, and mental health.

Mental Health of Young People

• Young people with a mental health disorder are more than 5x as likely to use illicit drugs or misuse legal drugs.
• Comorbidity between mental health and AOD use.

Harm Minimisation – Demand Reduction (Treatment)

• Drug dependence is a chronic relapsing disorder requiring medical, behavioural, and social context.
• Treatment focuses on promoting rehabilitation and improving functioning.
• Requires a therapeutic, non-judgemental relationship.

Treatment

• Opioid substitution treatment (OST) involves daily dosing of longer-acting opioid agonist (e.g., methadone, buprenorphine).
• Supervised daily dosing at a dosing site (e.g., public drug & alcohol clinic, community pharmacy, private clinic, prison).
• Most cost-effective treatment for opioid-dependent people.