Wk 8: substance use and misuse Flashcards

1
Q

What are the three areas of harm that result from substance use and misuse?

A
  1. health harm
  2. social harm
  3. Economic harm
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2
Q

Does substance use physiologically impact the health of one group of the population more?

A

No and this is key to remember!

It impacts people regardless of their;
- age
- sex
- gender
- religion

= a complex public health issue

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3
Q

What are the economic impacts of substance use and misuse?

A
  • significant personal financial costs
  • significant costs to the community
  • health illness
  • job related issues (sick leave)
  • physical impacts
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4
Q

What are specific examples of health harm that are linked to substance use and misuse?

A
  • injury
  • chronic conditions and preventable diseases
  • diseases/disorders (e.g. lung cancer cardiovascular disease, fetal alcohol spectrum disorder)
  • mental health problems
  • road trauma
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5
Q

What are specific examples of social harm that are linked to substance use and misuse?

A
  • violence
  • crime and other
  • unhealthy childhood development and trauma
  • intergenerational trauma
  • low drive to be social
  • stigma around taking medication (particularly for those with mental health problems)
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6
Q

What are specific examples of economic harm that are linked to substance use and misuse?

A
  • health care costs
  • decreased productivity
  • loss of income/employability (e.g. getting fired because you have an addiction to illicit substances or even alcohol in our system)
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7
Q

What is the impact of substance use on mental health?

A
  • use of tobacco, alcohol and other drugs can interact with a person’s mental health.
  • Mental disorders can be induced by substance use e.g. psychosis
  • Can have serious adverse effects on areas of functioning (e.g. work, relationships, health, safety)
  • Can cause co-occurring disorder (occurrence of substance use disorder with one or more mental health disorders)
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8
Q

Define co-occurring disorders

A

Co-occurring disorder: occurrence of substance use disorder with one or more mental health disorders
- Can also occur with physical health conditions (e.g. cirrhosis, hepatitis, intellectual/learning disabilities, cognitive impairment)

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9
Q

What are the DSM 5 10 different drug criteria?

A
  1. alcohol
  2. caffeine
  3. cannabis
  4. hallucinogens
  5. inhalants
  6. opioids
  7. sedatives/hypnotics/anxiolytics
  8. stimulants
  9. tobacco
  10. other unknown substances
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10
Q

What are the DSM5’s 2 types of substance-related disorders? and what they?

A

Substance-use disorders: occurs when the use of a substance affects a person’s brain and behavior, resulting in symptoms that affects and leads to an inability to control the use of a substance; severity ranges from mild to severe based on symptoms experienced.
- Overtime, the person might build up tolerance

Substance-induced disorders: occurs as a result of the use of a substance known to produce mental changes that may mimic another mental disorder, and are the result of intoxication, or withdrawal.

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11
Q

Explain the DSM 5 11 criteria points for problems associated with substance use disorder and how it is used.

A

Used to gauge the severity of the disorder. The number of problems experienced correlated to the severity in the key below;
- Mild substance use disorder = 2 or 3 symptoms
- Moderate substance use disorder = 4 or 5 symptoms
- Severe substance use disorder: 6 or more symptoms

DSM 5 outlines 11 criteria for problems associated with substance use:
1. Taking the substance in larger amounts or longer than intended
2. Wanting to cut down but not able to
3. Spending a lot of time getting, using, or recovering from use
4. Cravings and urges
5. Inability to do what you need to do (e.g. work, home, school)
6. Continuing to use even when it causes problems in relationships
7. Giving up important events (e.g. social, occupational, recreational)
8. Continually using when it is physically hazardous
9. Continual use despite physical/psychological problem that could have been caused by or made worse by the substance
10.Needing more of the substance (tolerance)
11.Experience of withdrawal symptoms (can be relieved by taking moreof the substance)

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12
Q

Define a substance-induced disorder and what it does?

A

= it occurs as a result of the use of a substance known to produce mental changes that may mimic another mental disorder, and are the result of intoxication, or withdrawal

  • Symptoms experienced are a direct result of the substance use
  • Can range from mild anxiety to mania and psychosis
  • Can occur with use of alcohol, caffeine, cocaine, amphetamines, hallucinogens, nicotine, opioids, sedatives
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13
Q

Define intoxication

A

= any change in a person’s perception, mood, cognition, or behaviour after using a drug

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14
Q

What are the impacts of intoxication that nurses and midwives need to consider?

A
  • complicates assessments
  • complicated treatment/management
  • can mask illness/injury (e.g. infection, hypoxia, injuries, pain levels)
  • Can be life-threatening due to altered physical function (e.g. respiratory depression, temperature dysregulation), changes in mental state (e.g. paranoia)
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15
Q

Define withdrawal?

A

= process that occurs after stopping the use of a drug, or reducing the amount that is used.

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16
Q

What are key considerations of withdrawal symptoms?

A
  • Signs, symptoms and length of withdrawal vary depending on the drug and the amount used
  • Mostly, symptoms of withdrawal are the opposite of what is observed during intoxication
  • Range from mild or uncomfortable to life-threatening
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17
Q

Define dependence

A

= occurs when withdrawal symptoms occur when the substance is not being used.
- Can be physical (physical symptoms of withdrawal e.g. sweating, nausea) or
- Psychological (cravings for substance when not using)

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18
Q

Define tolerance

A

= The need for more of a substance in order to achieve the same effect

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19
Q

Define overdose

A

= occurs as a result of accidental or intentional use of a drug in an amount that is higher than normally used, or higher purity of the substance.

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20
Q

What is associated challenges and effects are associated with co-occurring mental health disorders?

A
  • complex challenges for staff
  • serious adverse effects
  • complicated other treatments
  • More severe symptoms of mental disorder
  • Reduced effectiveness of medications and adherence
  • Reduced quality of life
  • Family/social support disruptions
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21
Q

How do we categorise drugs? and what are they?

A

by their impact on the body
- stimulants
- Depressants
- Hallucinogens
- Cannabinoids*

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22
Q

What specific population groups are recognised by the National drug strategy are recognised as disproportionately more likely to increase harm associated with alcohol, tobacco and other substance use?

A
  • people with mental health problems
  • young people
  • ATSI people
  • The elderly
  • Culturally and linguistically diverse people
  • people in contact with those in the criminal justice people
  • those who identify as in the LGBTIQA+ community
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23
Q

Describe the effect of stimulants, what are some symptoms and give examples of drugs in this category.

A

= Increase/speed up function of CNS

Symptoms: increased HR, increased BP, increased resps, reduced appetite, agitation, sleeplessness
- Larger doses can cause anxiety, panic, seizures, paranoia

E.g. amphetamines, caffeine, cocaine, ice, nicotine

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24
Q

Describe the effect of depressants, what are some symptoms and give examples of drugs in this category.

A

= Decrease/slow down function of CNS

Symptoms: affect concentration and coordination
- Small doses can cause relaxation, sense of calm and inhibition
- Larger doses can cause sleepiness, nausea and vomiting, unconsciousness, death

E.g. alcohol, benzodiazepines, GHB, kava

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25
Q

What can affect the symptoms of a substance?

A

= Effects are highly individual

Impacted by a persons;
- height
- weight
- age
- frequency
- interactions with other drugs

The drug
- route used
- amount
- purity
- the form
- use with other drugs
- price
- availability

The environment:
- use of drug where
- with whom
- what time
- safety of setting
- peer influences
- cultural factors
- influence of advertising or other influences
- how/where they use it (glass of wine at home vs the pub

The individual:
- gender
- age
- health
- mood
- genetic factors
- previous use
- expectations of use,
- tolerance
- beliefs
- attitudes

26
Q

Describe the effect of halluciogens, what are some symptoms and give examples of drugs in this category.

A

= Affect/distort senses and change experience of taste, sight, hearing, touch, smell

Symptoms:
- Small doses can cause a feeling of floating, numbness, confusion, disorientation, paranoia
- Larger doses can cause hallucinations, memory loss, anxiety, increased HR, paranoia, aggression

E.g. cannabis, LSD, ketamine, PCP, psilocybin (magic mushrooms)

27
Q

Describe the effect of cannabinoids, what are some symptoms and give examples of drugs in this category.

A

*difficult to classify as can fall into all three above categories due to multiple effects on the body

Symptoms: Causes euphoria, relaxation, perceptual disturbances
- Small doses can cause stimulatory and depressant effects
- Larger doses can cause mainly depressant effects

E.g. cannabis, synthetic cannabis, medicinal cannabis, hash

28
Q

What are some other common groups of drugs and their purposes?

A

Analgesics (aspirin, paracetamol, codeine, morphine)

Inhalants (paint thinner, petrol, spray paint, nitrous oxide, helium; depressants)

Opioids (heroin, methadone; feelings of euphoria)

Party drugs (ecstasy, amphetamines/methamphetamine; stimulants)

Performance and image enhancing (anabolic steroids, peptides, hormones)

Prescription drugs (codeine, benzodiazepines)

Psychoactive drugs (caffeine, cannabis, LSD; stimulant/hallucinogen)

Synthetic drugs (drugs that have been developed which create similar effects to banned substances; synthetic cannabis)

29
Q

What is the role of a RN/RM in working with someone who has a substance use/misuse problem?

A
  • Assessment and screening
  • Managing and supporting safety
  • Planning appropriate interventions
  • Managing withdrawal
  • Harm minimisation
  • Education
  • Supporting recovery
30
Q

What are some key principles for working with someone effectively when they have a substance use problem?

A
  • Non-judgemental and empathetic approach during assessment – this reduces the risk of underreporting/and the truth of the information they provide- this then impacts our ability to give the right treatment
  • Avoid telling the person what to do – the goal is for the person to recognise need for change
  • Support safety
  • Using open-ended questions
  • Reflective listening
  • Use common names for substances, e.g. ice rather than methamphetamine
  • Utilise a holistic approach to address related issues (e.g. relationships, housing problems, work/school)
  • Explore an increase understanding between mental health and substance use
  • Consider harm minimisation approaches – abstinence may not be realistic for some
  • Collaborative care planning – negotiate goals, treatment plans/options
  • Enhance problem-solving and focus on strengths
  • Involve family/carers in assessment, treatment and education
31
Q

What should be included in the substance history section of a comprehensive assessment?

A

*note that drug and alcohol should be considered in every assessment.
e.g. drug and alcohol use in pregnancy at antenatal assessments

  • A substance use history needs to be comprehensive, as no single symptoms or result is conclusive evidence to indicate a substance use problem.

Need to consider:
- separate risk assessment
- Indicators of risk
- Past medical history
- Psychological issues
- Physical signs and symptoms
- Mental health problems
- Pathology results

32
Q

When specifically conducting a broad substance use assessment what should be included?

A
  • Start with legal substances before assessing illicit substances
  • Substance being used, how much, how often
  • Route of administration (e.g. smoking, injecting, oral, snorting)
  • Age of first use
  • Most recent use (e.g. yesterday, today; may indicate drug/substance induced problems)
  • Patterns of use (past and current)
  • Features of dependence
  • Consequences of use (e.g. physical, psychological, social, occupational)
  • Past treatment
  • Periods of abstinence
  • Reason for use
  • Readiness for change (goals, intentions)
    - do they want to stop using or get help
  • Mental state examination (including risk assessment)
  • Physical examination
33
Q

What are some pharmacological considerations to supporting recovery from substance use and/or misuse?

A

S- ome substance use disorders require pharmacological treatment – often involve substitution therapy
- Can also be used to support a person during withdrawal or other symptoms requiring medication (e.g. psychosis, anxiety)
- Used in conjunction with psychotherapeutic approaches

34
Q

Explain the pharmacological approach to supporting someone with substance use/misuse of: opioid substitution therapy

A

= harm reduction strategy
- Are synthetic opioids inorder to slowing reduce the persons use and prevent withdrawal
- Used for those with opioid dependence e.g. heroin
- Drugs used include: buprenorphine (Subutex) or methodone
- Prevents the person from going through withdrawal
- Must be prescribed by a person who is able to prescribe; the person is registered and doses closely monitored and tapered down over time until they don’t need that substance
- May involve the person ‘picking up’ their daily dose from a pharmacy then eventually weekluy
- Aim is to slowly reduce the medication over a period of time
- Used in conjunction with psychosocial/therapeutic support

35
Q

Explain the pharmacological approach to supporting someone with substance use/misuse of: nicotine replacement therapy (NRT)

A
  • Works by releasing a lower and more slowly absorbed dose of nicotine compared to smoking
  • May reduce withdrawal symptoms and cravings
36
Q

Explain the pharmacological approach to supporting someone with substance use/misuse of: Nalterxone

A
  • Used in those who have withdrawn from opioids (e.g. heroin) and stop the person from achieving a ‘high’
  • Also used for people with alcohol dependence and reduces the cravings for alcohol, reduces tendency to want to drink more if alcohol has been consumed, helps people abstain from alcohol
37
Q

Explain the pharmacological approach for withdrawal with Benzodiazepines (e.g. diazepam) as well as what the drub does

A

Benzodiazepines (e.g. diazepam)
- Reduce symptoms of withdrawal, such as insomnia, severe anxiety or if there is a risk of seizures
- Protective against withdrawal symptoms (reduces risk of seizures)
- Modulates CNS activity
- remember that one can become dependence on Benzodiazepines

Benzodiazepine loading: involves large dose (up to 80mg diazepam) on one day in an inpatient setting, then no further doses.

Tapering doses: predetermined dose of benzodiazepine, administered in tapering doses

Symptom triggered: doses administered depending on severity of symptoms

38
Q

Explain the pharmacological approach in withdrawal that is: antipsychotics

A

Antipsychotics (e.g. olanzapine) can be used for people experiencing symptoms of psychosis

39
Q

Explain the pharmacological approach in withdrawal that is: Paracetamol

A
  • for heaaches
40
Q

Explain the pharmacological approach in withdrawal that is: Metoclopramide

A

Metoclopramide (Maxolon) for nausea/vomiting

41
Q

Explain the pharmacological approach in withdrawal that is: Thaimine

A

= Routinely used prevention of Wernicke’s encephalopathy
- people with increase alcohol intake have a lower food intake and therefore lower thiamine.

Lower thiamine or thiamine deficiency can cause Wernicke’s encephalopathy

42
Q

Explain Wernicke’s encephalopathy

A

Wernicke’s encephalopathy= acute neurological condition associated with excessive alcohol use and subsequent thiamine deficiency

Symptoms: ataxia, confusion
- All people being treated for alcohol withdrawal should receive prophylactic thiamine to prevent Wernicke’s encephalopathy or may develop into Wernicke-Korsakoff syndrome

Wernicke-Korsakoff syndrome= neurological disorder Symptoms: affecting short term memory as a result of long term, heavy alcohol use
Cause= thiamine deficiency related to have alcohol use
- Can result in irreversible and permanent brain damage

43
Q

What are some key points when managing alcohol withdrawal?

A
  • it is serious and potentially life-threatening
  • Based on screening – Alcohol withdrawal scale (AWS)
    - Assesses perspiration, tremor, anxiety, agitation, temperature, and scores to indicate severity of withdrawal
  • Assesses severity of withdrawal symptoms and includes
    assessment of: perspiration, tremors, anxiety, agitation,
    temperature, hallucinations and orientation (Brighton & Smith, 2018)

Symptoms of mild/minor withdrawal:
- Hypertension, restlessness, sweating, diarrhoea, headache
- Occurs within 24 hours of last drink
- Can usually be managed at home

Those with severe alcohol dependence:
- Hallucinations, confusion, disorientation, agitation
- Typically requires support in hospital

44
Q

What is the symptom of alcohol withdrawal: Delirium tremens (DTs) and what is the management?

A

= a medical emergency and requires immediate treatment
- Delirium tremens (DTs) is rare, but seriously life-threatening
- Typically occurs within 2 – 5 days after stopping or reducing alcohol intake
- Usual course is 3 days, but can be up to 14 days

Symptoms: confusion, disorientation, extreme agitation/restlessness, gross tremor, automatic instability (fluctuations in BP, pulse), hyperthermia, electrolyte imbalance, paranoia/delusions, hallucinations

Management: see alcohol withdrawal, administration of medication depending on symptoms

45
Q

What is the nursing management of alcohol withdrawal and what are some considerations?

A

nursing management includes:
- Minimising progression to severe withdrawal
- Reducing risk to the person and others
- Reducing/eliminating physical health problems (e.g. dehydration)
- Identifying co-occurring illness that may mask or mimic symptoms of withdrawal

Remember to consider
- Symptoms of withdrawal can range from mildly uncomfortable to life threatening
- Can occur when use has ceased or if less of a substance has been used
- Can occur at home or in a hospital setting, depending on severity and the person’s wishes

46
Q

What is the RN/RM roles in managing alcohol withdrawal?

A
  • Screening and assessment
  • Monitor symptoms
    - Physical observations
    - Withdrawal scale
  • Administration of prescribed medications
  • Monitor nutrition and hydration (record nutritional intake, fluid intake and output) – fluid replacement may be required depending on severity
  • Support recovery
47
Q

Describe harm minimisation

A

= Harm minimisation is the current drug related policy in Australia which governs laws and responses.
- We can’t stop substance use, but can reduce associated harm

  • It considers the health, social and economic consequences of substance use for the person and community

Based on the following considerations:
- Drug use occurs across a continuum (occasional to dependent)
- Range of harms associated with types and patterns of use
- Responses to harms require a multifaceted approach

48
Q

What are the three approaches to reduce substance-related harm in Australia and what is considered in them?

A

Three approaches to reduce harm:
1. Demand reduction
2. Supply reduction
3. Harm reduction

  1. Demand reduction
    - media complain, packaging, tv commercials
  2. Supply reduction
    - reduce supply of substances
    - drink driving interventions
    - lockout laws
    - legislations
    - managing scheduling
  3. Harm reduction
    - needle syringe programs
    - safe injection rooms
    - opioid substitution therapy
49
Q

What is the role of nurses/midwives
in harm minimisation?

A
  • consider the harm of the substance use and tailor care to that. e.g. dealing illicit substances may cause incarceration where as drinking alcohol during pregnancy may harm the unborn child.
  • Identify and engage with people who use substances around their use
  • Screening and assessment
  • Education
  • Improve health behaviours (e.g. physical activity, nutrition)
  • Increase access and uptake of public health services (e.g. medical, social support services, access to housing)
  • Act as a liaison between the person who uses substances, law enforcement, health services
50
Q

Why is experience so important to recognise when talking about substance and substance misuse?

A
  • Because everyone’s experience is different.
  • Using can be considered a normal part of humanity. e.g. drinking alcohol at a celebration or taking pain relief after major surgery

Some examples of why people use drugs and alcohol include:
- Enjoyment
- Curiosity
- Boredom
- To work/perform better
- To feel different (to relax, for pleasurable effects, reduce stress, relief of pain)
- Peer pressure or because they are there
- A part of religious ceremony
- A part of a social events
- Self-medication or to manage symptoms of illness

51
Q

Define intoxication

A

describes any change in a person’s perception, mood, cognition, or behaviour as a result of the effects of a drug.

52
Q

Define harmful use

A

damage to the health of the person caused by use of substance/s. Damage may be physical (e.g. hepatitis from intravenous drug use or mental harm such as psychosis or a mood disorder secondary to the substance use)

53
Q

What objective data can be assessed to gauge someone’s substance use?

A

Physical findings
- malnutrition
- obvious signs of substance intoxication (e.g. ‘track marks’, smell of alcohol)
- laboratory tests (e.g. blood alcohol concentration)

Mental state changes
- maybe seen in people who have been using substances, but not always and do not specifically indicate substance use.
- Confusion, disorientation and agitation may be seen in people who are intoxicated, but also could be present in someone with dementia.
- Thought disorder (e.g. paranoia) is common in people who use stimulants or cannabis. People who use hallucinogens or are withdrawing from alcohol may experience hallucinations.

54
Q

What subjective data can be assessed to gauge someone’s substance use?

A
  • How many packets of cigarettes do you smoke?
  • Do you take any prescription drugs prescribed to you or another person?
  • Do you drink alcohol? How many drinks per day? When was your last drink?
  • When was the last time you drank more than you wanted to?
  • Do you use other drugs? What type of drugs, how do you use them and how much is the cost?

Must consider
- Gathering subjective data in a non-judgemental way, is also important and can provide the space for the person to openly talk about their substance use, whilst also providing important data in order to plan care.

Some questions can include:
- Where a person does use substances and when they experience difficulty with their use, it is useful to consider their thoughts on their use, and what others think of their use and any feedback they may have received. The questions below can assist you with gathering this information:

  • What have you thought about your substance use?
  • Does your drug use affect your life in a negative or a positive way? How would you describe it?
  • What have those people who are important to you said about your use? Do you agree or disagree with them?
  • What happens the day after you have had a drink/s or used substances?
55
Q

What is one screening toool that can be used to assess alcohol use?

A

CAGE alcohol questionnaire.
- This questionnaire contains four questions to screen for problem drinking and consider the following:
C: Cutting down
A: others Annoyed by drinking
G: felt Guilty about drinking
E: need to drink first thing in the morning (Eye-opener)

56
Q

What are some principles of working effectively with people who use substances?

A
  • Non-judgemental and empathetic approach during assessment – this reduces the risk of under-reporting
  • Use common names for substances, e.g. ice rather than methamphetamine
  • Utilise a holistic approach to address related issues (e.g. relationships, housing problems, work/school)
  • Explore an increase understanding between mental health and substance use
  • Consider harm minimisation approaches – abstinence may not be realistic for some
    Collaborative care planning – negotiate goals, treatment plans/options
  • Enhance problem-solving and focus on strengths
  • Involve family/carers in assessment, treatment and education
57
Q

What are people who are acutely unwell with substance-related disorders often suffering?

A
  • alcohol withdrawal
  • overdose
  • hepatic coma
  • respiratory depression
  • cardiac issues

= are cared for in medical/surgical wards or in intensive care units

58
Q

What are some interventions to manage a patient with a substance problem?

A
  • obtain and monitor vital signs
  • monitor mental state and level of risk (if present)
  • undertake screening assessments
    administer prescribed medication
  • decrease stimulation where a person is overstimulated (provide a darkened, quiet room)
  • support the person and provide reality based feedback (where appropriate) e.g. “I know you are frightened. You are in hospital and we are caring for you. You are safe”
  • ensure adequate fluids and nutrition
  • assess changes in consciousness
  • provide emotional support and encouragement to the person and their family/carers
  • education related to reducing use, safer use, housing, education etc.
  • provide referrals and links to other services (where appropriate)
59
Q

What principle does harm minimisation recognise in overcoming substance use and misuse?

A
  • recognises that substance use is complex
  • that people who use drugs need to be supported to reduce harm associated with use.

The Department of Health (2017) describes harm minimisation as “building safe, healthy and resilient communities through preventing, reducing and responding to alcohol, tobacco and other drugs related to health, social and economic harms”.

60
Q

The National Drug Strategy 2017-2026 identifies three pillars of harm minimisation, what are these and what is their purpose?

A

Purpose: to reduce harm associated with drug use using three approaches:
- demand reduction
- supply reduction
- harm reduction.

61
Q

Define demand reduction and give some examples

A

= prevent uptake and delay first use.
= reduce harmful use
= support people to recover

Examples of demand reduction include;
- community development projects
- targeted media campaigns
- taxation or warning labels (e.g. cigarettes or alcohol)

62
Q

Define supply reduction and give some examples

A

= control of illicit drugs and precursor avalibility
= reduce illicit drug availably and accessibility.

Examples of supply reduction include;
- legislation and law enforcement operations related to drug seizures and arrest