Monday 17th Nov 2003
Australian Professional Society on Alcohol and other Drugs (APSAD)
Dear Colleagues,
The first day of the APSAD conference incorporated a very full program from 9am until 10pm. Welcome formalities were performed by Professor John Saunders, Aboriginal Elder Auntie Roz Graham and Minister Trish Worth with a letter of support to all delegates from the Prime Minister. Mats Berglund from Sweden then spoke about �what government can expect from treatment�, followed by a historical perspective from Neal Blewett regarding the Australian response to drugs and viral diseases over the past 20 years. He gave a hilarious description of his own need to back-track after seemingly supporting decriminalisation of cannabis as a federal minister in the 1980s.
A new magazine called �Of Substance� was then launched by Brian Watters and Margaret Hamilton. This quarterly is hoped to fill a �niche� in the dependency market. Its first two copies will be free, then it will cost $50 per year.
A bewildering array of concurrent sessions were then held in six separate rooms. First were post detoxification vocational services in cities. Next were �free papers� on opiate dependence treatment, starting with a description by Deborah Zador of a rather negative opinion survey of 104 English patients on injectable methadone and heroin. Those on methadone expressed a preference for heroin and many found prescribed doses inadequate. Malcolm Dobbin described the explosion in prescribing of benzodiazepines, long acting morphine and other drugs and their negative impacts. Nico Clark told us about some buprenorphine patients who required morphine and other drugs for serious surgical pain. One such was given up to 300mg morphine daily but sent home, still sick and immobile, with a prescription for daily methadone 40mg from a chemist they could not get to. Such a patient should have had adequate analgesic doses dispensed, regardless of existing �regulations� which should be waived when they stand in the way of good treatment. If the patient were not considered safe with such medicines then the GP and/or district nurse should have been called in to assist with supervision. Nick Lintzeris then reminded us of how little research literature there is on the interaction between benzodiazepines and opiates. He quoted the few animal studies which supported the notion of additive effects, consistent with the French experience of buprenorphine overdose deaths of which 80% were associated with benzodiazepines, alcohol being involved in most of the rest. A series of 50 rapid detox cases were then presented by a Sydney group, half the cases receiving a naltrexone implant with the remainder oral prescription. Nine of the 24 oral cases had relapsed in a six month period compared with only one of the implant group.
Carolyn Edmonds and Jason White performed a wonderful service by carefully examining the effect of a single dose of naltrexone on binge drinking footballers, double blind, cross-over in about 10 subjects. They found no overall effect on quantity of alcohol consumed but some effects of the perception of the drink itself. This session included numerous other short papers on alcohol. Jane Maxwell started the session on party drugs, explaining that research in this area was particularly messy, as well exemplified by the �Science� paper on MDMA which had to be withdrawn by its authors after erroneous conclusions due to the wrong reagent being used in lab experiments. She reminded us of the very local nature of some drug habits and differences which can occur even between adjacent areas. This was taken up by John Grabowski, also from Texas, in his afternoon plenary speech on the use of dexamphetamine in cocaine users. There was also a session on �pathways to treatment� and the �consumer perspective�.
The afternoon started with 6 parallel sessions followed by a wonderful description of the �science of opiate treatment� by Wim van den Brink from Holland. His own heroin trial for treatment resistant addicts was described in detail (smoked/injected; up to a gram per day; good outcomes in treatment; bad outcomes returned with end of trial) as well as his support for higher doses in methadone treatment. This was echoed by John Grabowski who described several approaches to psychostimulant use in the USA. Next we had the launch of yet another publication �Dealing with Risk�, also by Margaret Hamilton and Brian Watters. I wonder if it is a record for the same pair to launch two publications at opposite ends of the same (very long) day? Copies were handed out to all delegates the following morning (perhaps as a reward for making it to the second day!).
The evening brought welcome drinks and nibbles, followed by three international speakers on pharmacotherapies for alcoholism. It was nice to see our interstate and overseas colleagues again but a shame that so much about alcohol research was repeated while the wine flowed freely and perhaps we should have been relaxing.
