Pubdate: Sat, 29 Apr 2000 Source: Canberra Times (Australia) Copyright: 2000 Canberra Times Contact: http//www.canberratimes.com.au/ Author: Robert Macklin THE DOPE ON DRUGS SENSATIONAL as the Oswaldian revelations are, they should not be allowed to obscure the powerful messages contained in Dr Phyll Dance's decade of research. The rigour of the work is not in dispute. It is a clear and powerful exposure of an important element of Canberra's drug scene. In two volumes totalling almost 1000 pages, it provides an understanding of the important factors at work in the process of addiction and the dangers of our present approach to drug control and harm minimisation. For example, it gives the lie to those who say heroin can be used sparingly as a "recreational" drug. It explodes the myth that prohibition is itself an effective control. Indeed, it is clear that to the Oswaldians and many others like them prohibition only adds a false glamour, to a substance that has a role in society only within a medical regime at a time of terminal illness. Dance herself makes a series of recommendations to minimise harm to illegal drug users. They include * Intravenous drug users need even better access to sterile needles and syringes. As other researchers have indicated, this could be accomplished through vending machines. * Peer outreach workers could attempt to access those not currently in contact with service providers. Special efforts should be made to contact homeless youth. * Education about ways of avoiding accidental needle sharing could be included in programs that educate intravenous drug users about safer drug use and it could also be included in peer magazines. * More stringent efforts are required to persuade intravenous drug users and their sexual partners to be immunised against Hepatitis B. * Some deaths from heroin-related overdoses might be prevented if users were given access to Narcan. Consideration should be given to this proposal. * The exclusion of intravenous drug users from Interferon treatment is inequitable. More effort needs to be made to attend to the physical and psychological health needs of users with hepatitis C, including non-judgmental ways to help them stop injecting. * Consideration should be given to reinstating a feasibility study into the controlled availability of opioids that is, the "heroin trial" should be reconsidered. * Tertiary institutions should be targeted as venues for teaching safer drug use. * Gender specific education strategies regarding genital and sexual health are needed. This education must cover the complete armoury of the potential hazards of unsafe sexual behaviours. Since so many women have been concerned enough about their genital health to have a Pap smear, this concern could be utilised by health professionals who, at time of testing, could spend some time educating women about the need to use condoms and to also teach them ways of negotiating safe sex. * In order to bring about periods of prolonged or total abstinence for those who wish to maintain the reduction in their drug use, and to assist those who choose to continue to use drugs, more stringent efforts should be put into providing them with worthwhile paid employment. Dance says that in order to best implement the suggestions she has made as well as those made by other people that she has endorsed, and to continue with existing harm minimisation strategies, there needs to be increased funding to user organisations. "People stop using drugs for a great variety of reasons," she says. "One of the most important themes to emerge from my findings was the reduction, or non-use, of a drug due to detrimental health effects. "A secondary theme was a concern for the health of significant others. This shows that people who use illegal drugs can reflect on the impact drug use has on their own lives as well as the lives of other people. "One harm-minimisation approach may be to give drug users access to the voices of people who have reported problems in studies such as this. "It is my intention to make this report available as widely as possible to the people I interviewed, as well as to other people who use illegal drugs." All but one of her interview subjects spoke of negative effects in their increased heroin use. One man said, "It just comes to dominate your life. We got to where we were using so much we weren't paying rent, we weren't buying much food. "We borrowed $1000 to buy a truck; we sold it and we used all that money to buy heroin and we still owed $1000. "A bit after that I was just so distraught about it really. "Even then, I think, my libido started going and with that great use, it just sort of petered out. "We got to the doctor about that time and he got us on methadone." Dance is also concerned with the sexual transmission of disease by illegal drug users. Australia has been very successful in preventing an epidemic of human immunodeficiency virus among intravenous drug users, she says. However, a major problem is complacency. "We have now reached the stage where both hepatitis B and C have become serious public health problems in the (intravenous drug user) community. "Future education programs aimed at people who use illegal drugs in particular, and also the wider community, should incorporate the complete armoury of potential hazards of unsafe behaviour. "Generally the potential consequences of Hep B and C and STDs such as chlamydia are poorly understood. "Educating everyone about these consequences and, therefore, the need to protect themselves against the transmission of such diseases as well as HIV and unplanned pregnancies may help overcome future problems of complacency." She also found that the Oswaldians indulged in a similar level of criminal behaviour to the rest of the drug-using community. However, she says, most crimes committed by those she interviewed were either because of the illegality of the drug or were minor such as shoplifting. "Very few had been involved in more serious crime, bringing into question the stereotypical image of people who use drugs." She says there was a possibility of under-reporting. However, her findings were consistent with other researchers who have reported that most crimes by intravenous drug users are generally not serious. Dance says. "On the sort of information I obtained in 1989 [when she first interviewed the Oswaldians and others], I could not predict which of the Oswaldians were going to have problems with their heroin use. "Much of my reason for hypothesising that they would be different from other drug users I studied was based on my close contact with a group of people who were mostly in the early stage of their drug using careers and also on their idiosyncratic invention of a 'Patron Saint' of drug use. When comparing the Oswaldians with other people who use illegal drugs over time, and at a later stage in their careers, there was little evidence to support my hypothesis. "My research with the Oswaldians began at a time when they associated drug use with pleasure. I would like to have been able to report no changes in this, but, as I have shown throughout the thesis, a variety of transitions in drug use have occurred since my first contact with the group. "Very few Oswaldians were able to maintain all their drug use, particularly their heroin use, at a non-dependent level. "For some Oswaldians, the problems associated with their increase in heroin use led them to seek their first treatment. Oswaldian group-members who stopped their heroin use, the few who managed to maintain their use at a non-dependent level, and those who reduced their illegal drug consumption demonstrate a concern for friends who have experienced problems with their heroin use. "Many Oswaldians have entered into long-term relationships, have become parents for the first time or re-entered tertiary education. "Despite the substantial changes in these realms, most Oswaldians, whatever their level of drug use, still interact at social occasions. "Increasingly, Oswaldian gatherings are becoming more mainstream, being occasions such as dinner parties, weddings, engagement or birthday parties. Thus, though the reasons for celebrations have changed, the friendship links within the group have largely been maintained during the 10 years since I first made contact with these people, who invited me into their everyday lives." - --- MAP posted-by: Keith Brilhart