Substance use issues and challenges

Question 1

Describe drug use in social and historical contexts

Answer 1

Drug Use in Historical Context
- Humans have consumed organic substances for their various effects for millennia
- Patterns of production, use, and social views change across time

Drug Use in Social Context
- Pleasurable
- Functional
- Religious/social rituals
- Relief from discomfort (psychological/physical)
- Heal or cure eg in modern context, psychedelic-assisted therapy
- Socially acceptable/normal/encouraged
- Socially unacceptable/unusual/discouraged
- these last two points are constantly in flux

Question 2

Discuss the impact of drug use and population health

Answer 2

• Nearly 5% of all deaths are from alcohol and illicit drug use
• Most common drug type involved in drug overdose deaths is opioids
• Over the past decade, drug-induced deaths increasingly likely to involve prescription drugs

Question 3

Describe issues around defining drug use as a problem

Answer 3

• Our personal and professional opinions of ‘drug problem’ are shaped by:
  
  • What is visible
  • What is reported by the media
  • The era and culture in which we live
  • Individual experience

Australian attitudes tend to identify meth as drug with biggest issues.
Also tend to overestimate alcohol and meth as contributors to mortality when tobacco accounts for more than these two combined.

Medical Definition of Problematic Drug Use - ‘Dependence’
- In 1964 the World Health Organization recommended abolishing the term ‘addiction’ favoring instead the term ‘dependence’
- However, ‘addiction’ is still the term commonly used
- Many differentiate between physical dependence and addiction

Question 4

Who Develops Drug Dependency?

Answer 4

• Anyone!
• Those who start using regularly and progress to habit/dependency
• Those who are escaping pain and poor fortune
• High-risk contexts: prison, military personnel, doctors, hospitality workers, athletes
• Genetics

Question 5

What are the ways we reduce drug harms in Au?

Answer 5

• Australia engages in three approaches to reduce the negative impacts of drug use: supply reduction, demand reduction, harm minimization
  
  • includes harm to self and others (which may not arise from the drug itself, but how it is administered, obtained, its purity etc…)

Question 6

Provide examples of supply reduction

Answer 6

• Laws
• Border controls
• Reducing production of drugs
• Punishment of dealers eg burning crops or destroying labs
• Resourcing & training of relevant personnel
• Requirements of liquor licenses
• Restrictions for some OTC drugs
• (Also controlling import of precursor substances)

Question 7

Provide examples of demand reduction

Answer 7

• Education in schools
• Health promotion strategies & media campaigns
• Drug-free events
• Treatment of those who are dependent
• Deterrence

Question 8

Describe harm minimisation and provide examples of some measures

Answer 8

What is Harm Minimization?
- Recognition that drug use is a common feature of human experience
- It is a pragmatic approach aimed at reducing the risks and harms associated with drug use

Harm Minimization Measures – Clinical Practice
- Brief interventions ie asking the question
- Safer routes of drug administration
- Alternative, safer substances - have been an issue in the US sparking opioid use disorders with synthetic opioids eg fentanyl (an example of commercial determinants of health, see also [[PopH Lecture 3]])
- Reduce frequency and intensity of drug use

Harm Minimization Measures – Population Level
- Drug education eg do not take heroin and alcohol together
- Clean injecting equipment
- Naloxone
- Drug checking
- Decriminalization of personal use