APSAD Annual Scientific Conference. Cairns, Queensland.
Wed 8th November 2006.
This year�s conference was held in a purpose built conference centre, two to four city blocks from the main hotels. This had some good and bad points. Personally, I found it awkward but the walk probably did me good. The venue was comfortable if somewhat sterile - it was rather like being in an airport, without the exotic destinations. The conference rooms all had purpose built power-point connections controlled simply by the use of a mouse on the lectern which was ideal once one got the hang of it. Everything was electronically signposted and sessions timed down to the minute.
All credit to Professor Peter D'Abbs and his committee of locals who did a splendid job without the benefits of the mighty workforce available in the major capitals.
This year, there was no further debate on the contentious heroin �shortage� dating from December 2000. However, Lisa Maher did a noble job of trying to tease out the changes regarding hepatitis C seroconversions among injectors recruited from three city sites including outreach services. She found dramatic reductions (~50%) in heroin use and corresponding increases in cocaine use with higher risk taking behaviours after December 2000. There was a trend to higher rates of hepatitis C following the change in heroin availability.
On the same subject, in a letter to this month�s Addiction journal, Degenhardt and Hall back away from ascribing law enforcement as a major factor in Australia�s heroin shortage in 2001, based on Canadian evidence of �massive decreases in three markers of heroin use� there concurrently (Wood, 2006). While Degenhardt and Hall now state that supply reduction from producer countries may have played a larger role, they still do not address competition from Chinese markets (see below for evidence of the popularity of opiates in that country) and cling tenuously to their thesis: "... that the Australian heroin shortage may have been one of those rare occasions in which law enforcement activities contributed to reduced drug supply."
Aside from recent research, Maher, Hall and Degenhardt may learn more about the heroin shortage�s origin by reading William Burrough�s classic short story "The Junky�s Christmas".
We commenced the third a final day of the conference with a witty talk by David Crosbie on the ins and outs of alcohol policy: what can and cannot be done, as well as some things which ought to be done but probably won�t be. Professor Norman Giesbrecht then gave a perspective from Canada on a variety of community based initiatives. He pointed out that when following proven strategies with a sound design they were likely to be effective. However his final observation was that vast harm can be avoided by major policy shifts, dwarfing the effect of the smaller community based �boutique� projects. However, the latter can sometimes give direction for the larger policy shifts.
Dr Aramrattana gave us the discomforting news from Thailand that a �war on drugs� in 2003 involved a couple of dozen deaths officially but possibly hundreds (or even thousands) more unofficially. There were 200,000 drug users given compulsory treatment at that time of whom 1500 were surveyed with rather rosie sounding results. He seemed to have mixed messages and perhaps this reflects what is happening on the ground. It would appear that despite this draconian policy, Thailand still has a substantial drug problem.
Next we had a series of six more parallel presentations and workshops. Dr Mark Hardy, GP from Sydney�s St George area, did a fine job of demonstrating how new Medicare item numbers for Enhanced Primary Care (EPC) suit chronic conditions and ensure that doctors who treat addicted patients should be better recompensed than ever before. He felt that there is still under-utilisation of Health Care Plans, Team Care Arrangements, Case Conferences, Home Medicines Reviews and the like (see new mental health items). In some states, pharmacotherapy patients sign a treatment agreement which enshrines a goal of 3-monthly comprehensive multidisciplinary case management which is covered by two current Medicare items, initial and follow-up (between them, over $200 rebate). There is a pharmacist, practice nurse and prescriber at the minimum and most patients have other carers (eg. hepatologist, psychiatrist, physiotherapist, dentist, etc).
The next conference strand most importantly brought us up to date with China and its belated but monumental and pragmatic moves to address opiate addiction using hundreds of methadone clinics (195 are due to open in 2007). Dr Zhang Ruimin from Yunnan province was unable to attend but his presentation was given by Dr Nick Walsh quoting over 1000 health care workers with detailed education in pharmacotherapies [see my story on the first methadone clinic in Beijing just one year ago]. It is not all good news as drug use, prison and compulsory detoxification were outlined from China, Vietnam and Indonesia by other speakers.
Other sessions were held on policing, policy and problems in the indigenous community, including a description of NSW Monaro region�s opiate and stimulant approaches. The afternoon sessions covered party drugs, injecting complications, consumer perspectives, youth and "future challenges".
I was told that on the Wednesday afternoon John Strang from London gave a witty talk to RACP Addiction Chapter members taking off Donald Rumsfeld: "There are things we know that we know, and things that we know we don't know ... ". It is a shame that Strang still does not directly address the public health disaster he so clearly describes from England regarding pharmacotherapies. Furthermore, he might propose some way out of the mire which has led to some of the worst drug statistics in the European Union.
There were various �add-ons� to this conference such as a Sunday afternoon detailing session sponsored by Reckitt Benckiser, culminating in a panel �Hypothetical� to focus on expansion of treatment and changing the paradigm "unsupervised treatment" hosted by Dr Norman Swan of the ABC. There was also a separate �drug trends� meeting on the Sunday with Chapter, APSAD general and council meetings as well as a �wind-down� on the Wednesday evening.
Comments by Andrew Byrne ..
Wood E, Stoltz J-A, Li K, Montaner JSG, Kerr T. Changes in Canadian heroin supply coinciding with the Australian heroin shortage. Addiction 2006 101:689-695