Pubdate: Sat, 07 Jan 2012
Source: Lancet, The (UK)
Copyright: 2012 The Lancet Ltd
Page: 21
Author: Tony Kirby
Note: Volume 379, Issue 9810, Page 21, 7 January 2012


Sometime during her high school years, Louisa Degenhardt decided she 
"wanted to be a psychologist" , even though, she admits, "I didn't 
really know what that entailed" . But while her career path was to 
become research oriented"she is currently an Australian National 
Health and Medical Research Council (NHMRC) Senior Research Fellow 
based at the National Drug and Alcohol Research Centre, University of 
New South Wales""her wide-ranging work on drug addiction has been 
influenced by a foundation in psychology.

It was while studying psychology at the University of New South 
Wales, in 1997, that Degenhardt was to meet her long-time friend and 
mentor Wayne Hall, NHMRC Australia Fellow at the University of 
Queensland Centre for Clinical Research, Brisbane, Australia. At the 
time, Hall was lecturing on health statistics, with a strong focus on 
illicit drugs.

Degenhardt wrote to Hall asking about any upcoming research work and 
a few months later her wish was granted; she started work as Hall's 
research assistant in 1998. Around this time, there had been 
much-publicised increases in heroin and ecstasy consumption in 
Australia, and Degenhardt finished her PhD on the topic in 2001. 
"There are so many angles from which you can look at illicit drug 
use: moral, social, legal" , she says. "It's vital to correct the 
misinformation around, to peel back the judgments people make and 
just present facts.

Any drug can be dressed up as horrific or alternatively glamorous 
depending on how you spin things."

Degenhardt quickly became hooked on research about addiction.

Predictably, there have been moments of controversy along the way. 
Along with Hall, Carolyn Day, Libby Topp, and colleagues, she 
investigated the effects and possible causes of Australia's sudden 
heroin shortage in 2001""the first time that the effects of reduced 
drug supply had been investigated at a population level.

They feared the likely effects would be more crime, as well as 
riskier injecting, plus the use of multiple drugs.

Although these fears were realised, at the population level there was 
also a notable decrease in overdoses, deaths, and first-time users of 
heroin. "The research team could not rule out that international law 
enforcement activity (as opposed to local or national policing) had 
been behind the reduced supply" , she explains.

Many researchers in the field were sceptical that drug law 
enforcement could have exerted such an effect, and it's an issue that 
still causes fierce debate in some quarters.

An international outlook has been a feature of much of Degenhardt's 
research on the cultural and social drivers of illicit drug use worldwide.

She's worked in many international collaborations, including with WHO 
and the Independent Reference Group to the United Nations on HIV and 
Injecting Drug Use, for which she collaborated with Bradley Mathers 
at Australia's National Drug and Alcohol Research Centre. Working at 
the UN's Office on Drugs and Crime in Vienna, in 2009, also helped 
Degenhardt understand some global challenges. For example, drug 
trafficking routes are changing: routes through Africa are leading to 
a spillover effect of increased injecting drug use in that continent.

Combined with Africa's generally high prevalence of HIV, the public 
health implications of this are clear.

Epidemiological studies and reviews, both global and national, can be 
arduous to do, but Degenhardt says she "knows these papers can 
clarify and distil issues and trends, which is especially relevant 
for policy makers who are acting at a population level" . Such a 
study, on the global burden of disease due to illicit drugs, forms 
the first part of The Lancet's Addiction Series. According to 
Professor John Strang, Head of the Addictions Department at King's 
College London, UK, "Louisa has demonstrated, in particular, the 
potential yield from well-conceived and applied scrutiny of large 
data sets, especially when these address areas of key importance in 
planning of public health and policy."

Internationally, Degenhardt acknowledges that the USA funds most of 
the world's research on illicit drug use. Back home, she believes 
Australia is in a good position compared with other high-income 
countries. "Both the current and previous governments have 
acknowledged the importance of this issue, and while one can always 
say more money is needed (which it is), it should also be 
acknowledged that drug research programmes in Australia are 
comparatively well funded."  Degenhardt's team has just been given 
funding by the NHMRC to investigate the long-term effects of the 
prescription of opioids, such as morphine and buprenorphine, for 
chronic pain. "There are very few data to tell us whether it is 
sensible to provide these drugs for chronic non-malignant pain long 
term" , says Degenhardt, who will follow 2000 people receiving these 
drugs over 2 years. "How many continue using these drugs? How many 
have adverse outcomes?

What happens to their pain?"  The researchers will also use national 
databases to follow up patients prescribed opioids through 
Australia's Pharmaceutical Benefits Scheme.

While this research is her current focus, Degenhardt is also curious 
about "some simple questions that would be of interest to answer" . 
She points to the need for prospective studies of illicit drug users 
to better characterise the natural history of drug use and the 
incidence of adverse outcomes of use, since their illegality makes 
quality data on use difficult to come by: "There are really basic 
things that we make assumptions about without hard evidence; even the 
literature on the natural history of drug use is based on questionable data."
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MAP posted-by: Keith Brilhart