Medical Education Project

Abstract: The New South Wales Medical Education Project is described, with an emphasis on its first major workshop. The reasons for increased instruction for doctors in alcohol and other drug related problems are outlined.     

Intercollegiate Working Party on Medical Education in Alcohol and Drugs

Abstract: The history of medical education in alcohol and other drug problems is sketched and the development of professional interest groups and an Inter-Collegiate Working Party outlined. Progress with a conjoint training approach is discussed.     

Hospital based alcohol and drug units in New South Wales

The four existing hospital-based drug and alcohol units in New South Wales at Royal Prince Alfred, St Vincent's, Westmead and Newcastle are reviewed in terms of staffing, services offered, clientele outcomes and management practices. It is concluded that the basic premises under which the units were set up have been confirmed. Improved and standardised data collection is recommended.     

Drug Electives for Undergraduate Mcdical Students

Abstract: Drug and alcohol related problems are currently taught in a non-integrated manner at Flinders Medical Centre. There is an elective, specific teaching in pharmacology, gastroenterology, neurology and psychiatry and a proposed elective to start in 1986.     

Training in Alcohol and Drug Related Problems in the Royal Australian College of General Practitioners

Abstract: Alcohol and drug education programs conducted under the aegis of the Royal Australian College of General Practitioners are described and plans for the future are outlined.     

Education and Training in the Drug and Alcohol Field,with Special Reference to Programs at Macquarie University

Abstract: A distinction is made between education and training. Education means that knowledge or information is gained. Training involves the acquisition of specific, usually practically oriented skills. Training and education often go hand in hand, but while it is possible to educate without training, training without prior education is difficult and never optimal. At Macquarie University, education and training aspects of drug and alcohol issues have been separated into distinct programmes, and individual courses within these are tailored to somewhat different target groups.     

Opioid drug accidental deaths in the Newcastle area of New South Wales, 1970-1987

Opioid drug accidental deaths were reviewed in coronial post-mortem files of the Newcastle City Morgue, New South Wales, between 1970 and 1987. There were 23 accidental deaths directly caused by opioids, with 19 deaths (83%) involving the use of heroin/morphine. Deaths on weekends/public holidays were over-represented compared with weekdays. In 14 cases (61%), the police notes suggested that help-seeking had been inappropriately delayed by people in the presence of the subject. In almost half the cases where blood alcohol analyses were performed, the results were positive with a mean of 0.14 g alcohol per 100 ml. For a shorter time period 1985-1987, opioid-related suicides were also examined. Data on the five subjects involved in the suicides suggested they were a different target group for prevention. Opioids appear to be a very much smaller cause of death than alcohol and tobacco in the Newcastle Area.     

Methamphetamine use,dependence and treatment access in rural and regional North Coast of New South Wales,Australia

Introduction and Aims. To identify the sociodemographic, health, drug use patterns, treatment coverage and barriers to treatment among regular methamphetamine users in rural and regional North Coast of New South Wales. Design and Methods. A structured questionnaire was used to measure sociodemographic factors, health and well‐being, drug use patterns, methamphetamine dependence, engagement in methamphetamine treatment and barriers to treatment. Participants were 140 regular methamphetamine users. Dependent and non‐dependent participants were compared to identify factors associated with dependence. Results. Participants were predominantly in their thirties, male and had low levels of education, high levels of unemployment and polydrug use. Participants who were dependent on methamphetamine (59%) were more likely to report impaired mental health and to have been diagnosed with depression, anxiety and drug‐induced psychosis. One quarter of dependent methamphetamine users had received treatment in the last year and half had ever received treatment. The main barriers to receiving treatment were a lack of perceived need or motivation to seek treatment and concerns about confidentiality. Discussion and Conclusions. Methamphetamine users living on the North Coast of New South Wales require treatment options tailored to address a complex array of physical and psychological problems. The findings highlight the need for psychiatric support and improved coordination between mental health and drug and alcohol services in rural and regional areas.[Wallace C, Galloway T, McKetin R, Kelly E, Leary J. Methamphetamine use, dependence and treatment access in rural and regional North Coast of New South Wales, Australia. Drug Alcohol Rev 2009]     

Risky drug practices and treatment needs of youth detained in New South Wales Juvenile Justice Centres

Demographic, drug use and criminal correlates of risky drug practices were examined among 279 detained youth in NSW Juvenile Justice Centres. Binge drinking was common, with 63% reporting the consumption of at least five drinks in a row in the 2 weeks prior to incarceration. It was associated with being older, being from an English-speaking background, regular tobacco consumption and having a current drug problem. A quarter (24%) of the sample had injected an illicit drug, over one-third (37%) of whom also reported sharing needles. Injectors were more likely to be polydrug users, regular amphetamine users and have a past history of drug treatment. While 16% of the sample indicated a need for drug treatment, only 10% were currently receiving some form of treatment, most commonly counselling. Appropriate strategies are needed among this population to address gaps in treatment provision.     

Documenting the heroin shortage in New South Wales

Australian heroin markets have recently undergone dramatic change, sparking debate about the nature of such markets. This study aimed to determine the onset, peak and decline of the heroin shortage in New South Wales (NSW), using the most appropriate available methods to detect market level changes. The parameters of the heroin shortage were determined by reviewing: reports of heroin users about availability and price (derived from the existing literature and the Illicit Drug Reporting System); qualitative interviews with injecting drug users, and health and law enforcement professionals working in the illicit drug field; and examining data on heroin seizures over the past decade. There was a marked reduction in heroin supply in NSW in early 2001. An increase in the price of heroin occurred in 2001, whereas it had decreased steadily since 1996. A reduction in purity also occurred, as reported by drug users and heroin seizures. The peak period of the shortage appears to have been January to April 2001. The market appears to have stabilised since that time, although it has not returned to pre-2001 levels: heroin prices have decreased in NSW for street grams, but not to former levels, and the price of 'caps' (street deals) remain elevated. Heroin purity in NSW has remained low, with perhaps a 10% increase above the lowest recorded levels. These data support the notion that the heroin market in NSW underwent significant changes, which appear to have involved a lasting shift in the nature of the market. [Day C, Degenhardt L, Hall W. Documenting the heroin shortage in New South Wales. Drug Alcohol Rev 2006;25:297 - 305]     

Professional Training

Abstract: The discernment and treatment of alcohol and other drug related problems, while continuing to involve those working in specialised agencies, will, if only because of the prevalence of such problems, need to engage the attention of professionals working in a variety of settings. For such professions to respond with competence and confidence to these problems will require that their training accord much more attention to these matters. Examples are given of initiatives being taken in Western Australia to ensure the “institutionalisation” of training in the addictions in a variety of professional and vocational groupings.     

Changes in patterns of drug use among injecting drug users following changes in the availability of heroin in New South Wales, Australia

The aim of this study was to examine changes in drug use patterns among groups of injecting drug users (IDU) who remained in the drug market during a period of reduced heroin availability in NSW, Australia. Cross-sectional data collected from regular IDU interviewed as part of the NSW Illicit Drug Reporting System (IDRS) between 1996 - 2003 were analysed. Drug use patterns, reported drug availability and price were assessed. There was a marked decrease in the frequency of heroin use during the period of reduced availability in 2001, with some increase in 2002 and 2003. Heroin availability and frequency of use have not returned to levels reported prior to 2001; however; even at the peak of the reduction in supply, users continued to access heroin. There was a significant shift among IDU from heroin to cocaine during 2001, which subsequently reversed. The availability of cocaine has fluctuated in recent years, but the price has remained stable. The price of heroin appeared to be more responsive to market fluctuations, and co-varied with heroin availability. IDU used cocaine when heroin was less available; however, patterns of cocaine use were not maintained. The frequency of heroin use remained lower, which may be indicative of a less consistent supply, increased price or increased numbers of IDU entering treatment. The reduced supply of heroin in 2001 highlighted the adaptable nature of IDU patterns of use, indicative of the need for a commensurate treatment response. It also highlighted the importance of the ongoing monitoring of drug trends in Australia. [Roxburgh A, Degenhardt L, Breen C. Changes in patterns of drug use among injecting drug users following changes in the availability of heroin in New South Wales, Australia. Drug Alcohol Rev 2004;23:287-294]     

Comparison of needle and syringe programme attendees and non-attendees from a high drug-using area in Sydney, New South Wales

The aim of this study was to compare demographic and drug use profiles of non-needle and syringe programmes (NSP) attendees with NSP attendees from the same geographic area. Two data sources were used. One was from an annual national survey of injecting drug users (IDU) at NSP and analysis was restricted to survey sites in Kings Cross and Kogarah in 2003 (NSP survey). The other was from a survey of IDU who do not use NSP as their primary source of injecting equipment within the same broad geographical region (Access survey). Of the total 264 survey participants, 102 had never attended a NSP (non-NSP attendees) and 162 had previous experience of NSP (NSP attendees). Compared with NSP attendees, non-NSP attendees were less likely to report severe drug problems and more likely to report lower prevalence of HIV, hepatitis B and hepatitis C infection. Nevertheless, about 20% of non-NSP attendees reported re-use of needles and syringes after someone else in the previous month. Compared to NSP attendees, a lower rate of usage of health services was reported by non-NSP attendees. Strategies to promote access to NSP and harm reduction services, including testing for blood-borne viruses, information provision and consideration of referral to treatment among non-NSP attendees are recommended. [Cao W, Treloar C. Comparison of needle and syringe programme attendees and non-attendees from a high drug-using area in Sydney, New South Wales. Drug Alcohol Rev 2006;25:439 - 444]     

Cancer incidence in New Zealand born residents of New South Wales

Cancer incidence in New Zealand born residents of New South Wales (NSW) has been compared with that in the Australian born population using data from the NSW Central Cancer Registry for the period 1972-84. Indirectly age-standardised incidence ratios (SIR) showed that New Zealand born women living in NSW had higher rates of cancer at all sites combined (SIR = 112) and a significant excess of colorectal cancer (SIR = 126). Although overall cancer rates were similar in men born in New Zealand to those in the Australian born men, the New Zealanders had a significantly higher risk of colorectal (SIR = 124) and testicular cancer (SIR = 227), cancers which are more common in New Zealand than in Australia. While the SIRs for lung cancer in men and melanoma of skin in both sexes were low, no cancer was significantly less common in New Zealand born residents of NSW than in the Australian born.     

Comorbidity of mental disorders and alcohol- and drug-use disorders: analysis of New South Wales inpatient data

Introduction and Aims. Alcohol‐ and other drug‐use disorders have been found to be associated with mental disorders, however, complete characteristics of these comorbid mental disorders are not completely clear in early population based studies. This study aimed to explore the extent and profiles of comorbid mental disorders with alcohol‐ and other drug‐use disorders using a large inpatient dataset. Methods. The data source was the New South Wales (NSW) Inpatient Statistic Data Collection which collects the clinical data of hospital admissions in NSW, Australia. The data were coded using the International Classification of Diseases—10th Revision (ICD‐10). The data were from 1 July 2005 to 30 June 2006 the Australian financial year and statistical analysis was performed using SAS. Results. Of 1 592 156 patients admitted, 91 510 (6%) had at least one mental disorder diagnosis and 18 283 (1.1%) had at least one alcohol‐ or other drug‐related diagnosis. Of these patients, an overall 9.6% had dual diagnoses. Comorbidity was nearly five times higher in alcohol‐ and other drug‐use disorders than in mental health disorders (52.4% vs. 10.5%). Comorbidity was higher in males than females (12% vs. 7.1%) and was the most common in patients aged from 20 to 49 regardless of sex. There was a significantly increased risk of developing a comorbid condition in all age groups above 10 years. The most common mental health disorders were major depressive disorders, followed by dementia, anxiety and severe stress. Alcohol‐use disorder was the most common diagnosis, followed by cannabis and opioids. Discussion and Conclusion. This study shows the characteristics of comorbid mental and alcohol‐ or other drug‐use disorders. The study extends our understanding of issues addressed in previous population studies.[Lai HMX, Huang QR. Comorbidity of mental disorders and alcohol‐ and drug‐use disorders: Analysis of New South Wales inpatient data. Drug Alcohol Rev 2009]