Dr. Albert Stuart Reece again restricted by medical authorities

The Medical Board of Australia has placed fifteen limitations on the practice of Dr. Stuart Reece of Highgate Hill QLD. The conditions, enforced on 21 December 2022, have resulted in the temporary closure of the Southcity Medical Centre where Reece practices.

Reece (pictured) is a controversial figure in addiction medicine and a vocal critic of Australia’s successful policy of harm minimisation. He holds no formal qualifications in addiction medicine, but has authored or coauthored extensively on the subject, presently as an adjunct professor at UWA. Almost exclusively, his writings link illicit drug use, methadone and medical cannabis to death and disease.

Experts have refuted certain works as “reefer madness”. Reece has long associated his Christian faith with treating addiction. His book, titled “Let My People Go: A Theology of Addiction”, was published in 2016. His work is favoured by extreme anti-drug pressure group, Drug Free Australia, and frequently cited by them in lobbyist material, media replies and parliamentary submissions.

This is not the first time regulators have acted to ensure the safety of his patients. An article published on this blog in December 2011 examined his use of unapproved naltrexone implants and the deaths of 25 patients who had undergone the treatment. In 2009 Reece was suspended from practice for supplying morphine to opiate dependent patients and falsifying records to disguise the fact. This was because of his ideological opposition to evidence backed methadone maintenance therapy. That suspension was in turn suspended for three years.

The Medical Board of QLD, Health Practitioners Tribunal observed at the time that Reece:

… has a somewhat evangelical approach to this area of medicine and because of that he does appear to lack a degree of insight and objectivity in relation to the treatment of his patients. Furthermore, he seems to feel that the ends justify the means in terms of treatment of patients.

Today, the catalyst for intervention includes the number of patients being bulk billed per hour and quality of care. This is reflected in the limitations on practice (complete list in slideshow below).

1. The Practitioner must not exceed four (4) of patient consultations in any one hour (60 minutes). […]

5. The Practitioner must only practise as a general practitioner when supervised by another registered medical practitioner with knowledge and experience in addiction medicine (the supervisor).
For the purposes of this condition, ‘supervised’ is defined as:
The Practitioner must consult with the supervisor who is always physically present in the workplace and available to observe and discuss the management of patients and/or performance of the Practitioner when necessary and otherwise at weekly intervals. […]

7. In the event that no approved supervisor is willing or able to provide the supervision required the Practitioner must cease practice immediately and must not resume practice until a new supervisor has been nominated by the Practitioner and approved by the Board. 

A search for general practitioners providing services in addiction medicine in the Brisbane area yields modest results. There just isn’t enough practitioners providing these select services across Australia. If one adds the fact that such providers have often taken on all the patients they can, it isn’t beyond comprehension that Dr. Reece is unable to find a supervisor. Reece has loyal supporters amongst his patients, who have a Facebook page here. They have argued in a petition that finding a supervisor is “an impossibility”. The petition, “Reinstate Dr. Stuart Reece Immediately”, contends that the predictable lack of a supervisor indicates that the action taken is about the control of services offered under bulk billing.

AHPRA is also advising that Dr Reece must have another Doctor with him for consultations into the future to oversee his work to their satisfaction. This requirement is an impossibility. AHPRA and Dr Reece both know that this doctor does not exist. There is not a ‘spare doctor’ lying around that is available for this. […]

THIS IS NOT ABOUT PATIENT CARE OR BETTER HEALTH OUTCOMES. THIS APPEARS TO BE ABOUT CONTROL OF THE TYPE OF SERVICES OFFERED TO PATIENTS WHO NEED BULK BILLED DOCTORS. 

The petition is a long heartfelt plea seeking to justify the way Reece operates his practice. It makes the point that certain appointments, particularly prescription refills, may require only five minutes. The petition also notes that Reece would be forced to close his doors in part because, “his practice would be limited dramatically by the immediate reduction of the number of patients he is able to see daily…”. Whilst I empathise greatly with these patients and find removal of any addiction treatment services troubling, one cannot escape the fact that such a huge patient load should never have eventuated. Health Practitioner Regulations state, “A Practitioner must NOT exceed four (4) patient consultations in any one hour (60 minutes)”.

There’s no doubt that Medicare is not meeting the needs of Australian General Practitioners. The patient rebate is beyond inadequate, being markedly out of step with the Consumer Price Index (CPI). This manifests in significantly fewer consultations being bulk billed, and in many practices fees now apply to concession card holders. For Australians surviving on the aged or disability support pensions a visit to their GP is now financially prohibitive. The end result is a health system under strain. However there comes a point where increased patient quantity, means decreased quality of care. Let’s remember that the Health Practitioners Tribunal observed in 2009 that when it came to treating patients Reece lacked insight and objectivity, and felt the ends justified the means. The same document notes (point 22):

He does provide care to a large number of detoxifying and drug dependent patients. In June 2009, alone, he had 409 Subutex patients in Queensland and I understand the numbers are larger at the moment. From 2001 to 2007 he was responsible for 8681 registrations of opiate withdrawal registrations in Queensland.

Arguably, Reece is the architect of his own professional distress. As noted above, in November 2009 the practice suspension applied to Reece was itself suspended for three years. Yet less than two years later there was no tone of contrition for falsifying medical records to supply opioid dependent patients with morphine. The occasion was a Senate Inquiry into the Professional Services Review (PSR) Scheme, to which Reece, representing the now defunct Australian Doctors Union, made a submission. Bear in mind Reece has today been saddled with limitations to prevent excessive bulk billing at the expense of Medicare. The PSR “aims to protect the Australian public from the risks and costs associated with inappropriate practice within Medicare…”. Reece began his submission:

Prof. Reece: The Australian Doctors Union is a nascent union which has come together to support each other through the nightmare experience of PSR’s incompetence, lies, intimidation and bullying. In addition to doctors damaged by—

CHAIR: Hang on please. That is making accusations and it is not the way that we take evidence. If you could please refrain from using that sort of language, that would be appreciated.

Reece continued for a full five minutes explaining why he believes the PSR “has been shown to be waging a very successful war against general practice in this country”. He blamed the PSR for doctor suicides, marriage breakdowns, a lowered bulk billing rate, marginalisation of women, being racist, sexist and for damaging “many excellent doctors”. One of these was his ideological colleague, “Dr George O’Neil of naltrexone implant and detox fame”. Despite the fact naltrexone implants are not TGA approved Reece felt O’Neil should have been assisted by Medicare. Perhaps most alarming was when Reece included himself as one of those excellent doctors. Referring to himself in the third person, he humbly submitted:

Associate Professor Stuart Reece, one of the foremost detox doctors in the nation and a world authority on the long-term effects of opiate addiction.

This dear reader, is the crux of the matter. Stuart Reece is not a world authority on the long term effects of opiate addiction. In 2007 he opposed needle-syringe programmes, methadone maintenance therapy and the policy of harm minimisation in general. He informed a parliamentary inquiry that condom use was linked to AIDS deaths. Yet in June 2009 Reece was managing 409 Subutex patients. Buprenorphine is the opioid in Subutex and today it is distributed in combination with naloxone under the brand name Suboxone. It is a successful mainstay of substitution therapy for opioid dependent patients seeking to manage addiction and eventually cease opioid use. It is a key element of harm minimisation.

Exactly how a strident opponent of harm minimisation has today found himself with so many opioid substitution patients that Ahpra require supervision and auditing of him, is baffling. It may however have something to do with the attitude toward Medicare and the PSR Scheme reflected in his 2009 submission. Or his 2012 comment, What is wrong with medicare? (p. 170) bemoaning the PSR and Medicare audits. It may also have something to do with the disdain Reece has for evidence based health policy and genuine, original research. Reece has spent a career convinced he simply knows better. Better than the bulk of his colleagues, better than global research trends and better than health authorities. In short, Stuart Reece is the cause of the dilemma faced by so many of his patients.

Having said that, one cannot deny that Reece and Southcity Medical Centre have been accomodating the needs of a great many patients. An excessive number of patients. However accounts such as this on reddit aren’t isolated. They suggest the practice is busy, waiting times are high but Reece is attentive and compassionate. Google reviews are more varied. According to the petition there are 1100 patients in need of treatment. Over the last 18 days, 224 people have signed. The goal is presently 500.

Ultimately this situation doesn’t bode well for these patients. It is doubly sad that many are not able to see that the cause of their problem is Stuart Reece himself and not Ahpra. Funnelling high numbers of vulnerable in-need, at-risk patients through the surgery is far from acceptable. The only way forward is to abide by the limitations. Anything less is to abandon his patients.

Stuart Reece must accept that the ends do not justify the means. It is time to place patients first.

Medical Board of Australia restrictions imposed on Dr. Stuart Reece


♠︎ ♠︎ ♠︎ ♠︎

Latest update: 3 January 2023

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International Overdose Awareness Day – August 31st

Time To Remember                                  Time To Act

 

 

 

August 31st is International Overdose Awareness Day.

Access the IOAD link above to find an activity, get resources or make a donation. On the main page just under a couple of videos, we read;

International Overdose Awareness Day is a global event held on 31 August each year and aims to raise awareness of overdose and reduce the stigma of a drug-related death. It also acknowledges the grief felt by families and friends remembering those who have died or had a permanent injury as a result of drug overdose.

International Overdose Awareness Day spreads the message that the tragedy of overdose death is preventable.

Thousands of people die each year from drug overdose. They come from all walks of life.

Do you recognise the signs and symptoms of overdose? What is the impact of drug use and overdose on family, friends and those experiencing it?

These videos include people affected by the impact of drugs use and overdose who share some of their stories.

Australia’s Alcohol and Drug Foundation have a comprehensive site set up for IOAD. There’s helpful information here such as Signs and Symptoms of an Overdose, Harm Minimisation, How to Help in an Emergency, along with references and resources.

This morning on ABC Melbourne Jon Faine ran a great interview. The info’ paragraphs run as follows;

Cherie Short’s son Aaron died of a drug overdose in 2015. She tells Jon Faine we need to change drug policy and “make humane decisions” to stop others from dying.
“This tragedy is preventable, I believe overdose is preventable,” she said.

Ms Short is joined by Kayla Caccaviello, who dated Aaron and has overcome her own addiction to drugs to become a drug and alcohol counsellor.

The interview is titled “Humane drug policy could have saved my son”: Mum

You can download the 8 minute mp3 file here.

Activities for this year globally and across every state in Australia can be accessed on this page. Fortunately Australia is second from the top and easy to access. But of course please use the drop down menu for fast access to the area of your choice. Australia has 79 activities with 48 in Victoria, 11 in NSW, 7 in WA, 4 in QLD and TAS, 3 in NT and 2 in ACT.

Activities are varied ranging from O.D. prevention training, to art display, to group naloxone (opioid antidote) training, to afternoon tea – followed by naloxone training and a free kit, remembrance events to de-stigmatise overdose, etc.

Australia has only two supervised injecting centres. One, the MSIC in Kings Cross Sydney opened in May 2001 and after more than 11 years of successful trial moved to permanent basis. The MSIC in Richmond, Melbourne commenced on a trial basis at the beginning of 2018. Whilst it is running successfully and saving lives daily the entire concept is a punching bag for conservative politicians.

Regrettably whilst it is easy to manufacture the illusion of government funded drug induced harm and negative community appearances the peer reviewed evidence, globally, supports the health benefits of Safe Injecting Facilities. Always be aware of the myth of a Drug Free Australia.

This notion is pushed on the back of pseudoscience, the rejection of peer reviewed evidence and moral panic. You can read up on the antics of Drug Free Australia Ltd via their tag here.

Evidence backed themes that are often presented on IOAD support the fact that prohibition and the “war on drugs” waste money, ruin and cost lives. Harm minimisation practices such as harm reduction approaches like needle exchange and injecting facilities, prevent overdose, the spread of blood borne diseases and community dysfunction.

Evidence supports harm minimisation and particularly harm reduction.

Prescription Drug Overdose

One area to receive increasing attention again this year is that of prescription opioids. According to this ABC article OD fatalities have risen almost 40% in the last decade.

A constant concern for those who need adequate pain management via prescription, is that the “war on drugs” mentality may permeate policy modification under the belief it is a sensible solution. Once again the political conservative gravitates to this mode of moral dictation.

Overseas activity suggests that those who are denied prescription medication for prolonged pain management may find their way to illicit opioid abuse and inherit all the problems of crime, disease, socioeconomic stress and violence that come with such abuse.

We must yet again be careful that in managing this emerging problem we do not allow the denial of rights and an ignorance of incumbent facts such that we see punishment and manipulation of those in need.

Cannabis misinformation and the anti-drug lobby

The most dangerous aspect of drug use is that the chemical becomes the centre of life, leads to physical debilitation after tolerance is reached, and no amount of drug produces the necessary euphoria – only coma or suicide are left

– Herschel Mills Baker (Drug Free Australia)

“Suicide/Schizophrenia: Consequences of acute and chronic cannabis use”

A recent thread on Facebook gave me cause to reflect upon the impact that the anti-drug lobby has had upon community perception of evidence specific to cannabis, its use, abuse and potential.

This perception of course can be traced in part to sensational media headlines following the release of research into the effects of chronic cannabis abuse. Yet the anti-drug lobby has been willingly involved in the perpetuation of self serving and frequently egregious falsehoods that have left inhumane policy sabotage and damaged individuals in their wake. Worse, the very real and well understood problems associated with cannabis abuse have been scattered by the gale of “cannabis psychosis”.

I should stress this is not a pro-drug nor pro-cannabis post. If anything it is a pro-evidence post and I would hope readers can reflect upon the value of evidence in a human rights manner, much as we do in a consumer rights manner. As I suggest under my “About” tab, skeptics make excellent agents of morality because they are agents of evidence. This isn’t to suggest one is endowed with superior morale. Rather, one is bound to reject subjective and predisposed constraints in favour of evidence.

An effective informed policy on cannabis use should not slant only toward the harms caused by its use but also by the harms caused by the social measures/existing policies designed to control or prevent its use. Cannabis is not a hard drug. Cannabis is not a soft drug. Cannabis is a drug, and as such deserves the respect that science and apolitical critiques can bring.

The nonsense above was originally written in 1988 and has been continually polished and rephrased over the years. Its most recent incarnation was Cannabis – suicide, schizophrenia and other ill effects, uproariously tagged “First Edition, March 2009”. Subtitled A research paper on the effects of acute and chronic cannabis use, it is in fact a biased selection of literature. Not research, nor literature review.

Cannabis “potency” is a key driver of fear and a launch pad for ongoing misinformation. This area is fraught with notable disrespect for variables involved. Is “potency” THC content per volume? If so, what strains grown under what conditions provide conclusive answers? Or does one compare the hashish and hash oil of the 1970s and 1980s (at around 20% THC content) with todays plants? If so, what of the famed sinsemilla grown for decades?

DFA choose to refute Australia’s peak illicit drug body, the ANCD, and their “Evidence-based answers to cannabis questions: a review of the literature” (2006), which concluded no significant increase in THC content had occurred. This was challenged by the unqualified lobbyists with a preposterous figure of 30% THC content from an apparent – and unsourced – 1993 Australian Bureau of Criminal Intelligence claim. Readers were to be very afraid as the equally preposterous and unsourced joint potency from the 1960s was 0.5%

Could this even be true?

In THC content of cannabis in Australia: evidence and implications, Wayne Hall and Wendy Swift reported in 1999:

The major obstacle to testing these claims is that the THC content of cannabis products has not been systematically tested by any Australian police force over the period in which average THC content has been claimed to have increased.

Well, no, it appears to be fiction.

So why are DFA misleading the public this way? A primary area of community confusion and angst is the poorly reported association between psychosis and cannabis. The most fallacious is the “puff-puff, go mad” claim. It terrifies parents and this fear can persist in the absence of evidence. I must stress that negative experiences associated with ingesting THC can certainly be exacerbated by ingesting a volume of cannabis that contains more THC than a user is accustomed to. I’m not attempting to refute this possibility. I would add however, that user titration gives control to the cannabis user over the amount ingested. In this light a number of claims pushed by DFA demand criticism.

Primary is that DFA claim that the introduction of hydroponic cannabis (itself a spin-off of prohibition’s failure) brings with it [page 11]:

…a well demonstrated dose-response relationship between cannabis and its related drug-induced psychosis, where the greater amount of cannabis consumed correlates to a higher degree of risk of psychosis any three to fourfold increase is absolutely critical in any assessment of cannabis harms. When it is further considered that changed usage patterns, whereby users smoke only the multiple potent heads of the cannabis plant… the ANCD paper’s approach to potency is of concern.

Again, as we shall see below, this is not backed by evidence. What is drug-induced psychosis in this context? Sure, hydroponic production has provided the equivalent of sinsemilla-type product to users. Yet DFA then go on to cite the ANCD paper which confirms a tripling of THC figures in the USA. Quite correctly there is no reason to suggest this hasn’t occurred here, yet as the paper notes:

…the majority of THC levels in studies of [USA] cannabis seizures have remained under 5%.

So the ANCD conclusion that no evidence exists for huge THC increases in recent decades is valid. If anything users have more of the THC rich component of the plant, and less of the THC poor component. Hydroponics ensures rapid maturation and more flowering (head). Per plant there is more THC rich matter. But that matter is not notably more THC potent.

I hate to excessively mull this over, so to speak, but once again prohibition has placed better drugs for the same price into the hands of Aussie kids.

Let’s consider DFA’s claim that, “users smoke only the multiple potent heads of the cannabis plant”. They are challenging figures from 1970 to 1997. Returning again to Hall and Swift 1999, we see on page 8:

HallandSwift_type of cannabis smoked

So consumption of “skunk” or “super-skunk” that DFA claim is driving kids insane increased as much as leaf in the 14-19 year old group, from 1995-1998. Yet head seems to be the main product. Nonetheless users are not “smoking only multiple potent heads”. Which sounds more scary than just “heads”, one presumes.

Under Changing Patterns of Cannabis Use, Hall and Swift write on page 7:

The media preoccupation with the THC content of cannabis has distracted attention from other causes for concern about changing patterns of cannabis use among Australian adolescents and young adults. These patterns of cannabis use, which may encourage younger users to use more potent forms of cannabis, may also increase their chances of developing problems as a consequence of their cannabis use.

This is of course, exactly the point. By pursuing sensationalism, co-morbid health problems and negative lifestyle changes are frequently ignored. That this has been willingly and eagerly encouraged by groups such as DFA as part of their agenda to encourage blanket illicit drug zero tolerance and the public health damage this brings, is deeply concerning.

In 2009 this manuscript of misinformation was used to lobby independent conservative QLD MP, Peter Wellington to push for the old DFA staple of School Drug Testing. Such tactics are typical of the evangelical crusade waged by this conservative Christian group. The Australian National Council on Drugs concluded in 2007 that SDT was technically unreliable, cost prohibitive, morally and legally problematic, prone to exacerbate problems faced by at-risk children, designed to normalise punitive measures and fraught with false positives.

You can read more here about Drug Free Australia and their campaign against evidence. Or just marvel at a school kid’s drawing of God espousing “be drug free and you’ll be with me”. It isn’t just punitive policies DFA seek but a quite inhumane roll back of Harm Minimisation strategies, particularly those involving harm reduction. Whilst it is unacceptable for young Aussies to be under the impression cannabis is entirely safe, we can see without much effort how a spike in reports on cannabis and psychological harm has been exploited.

Claims that cannabis is supposedly endowed with benign or even beneficial properties because it is “natural” are equally concerning. The notion that if something comes from the earth it’s therefore by default superior to a manufactured pharmaceutical analogue is certainly not backed by evidence.

In fact this point is ripe for confusion about the role of evidence, its import and what might be termed insults from intuitive reasoning. Cannabis use as a recreational drug is defended at times with argument from antiquity. Combined with the “mother earth” line it may sound quite compelling. Like many alternatives to medicine (such as TCM), cannabis is also subject to further defence with argument from antiquity. According to The Mayo Clinic medicinal use can be traced back 5,000 years. Yet a crucial distinction is made here.

Research into the medicinal benefit of cannabinoids or their application as medication is quite different from inhaling cannabis smoke and expecting better health. There is quite a lot of rot about cannabis being medicinally magical. Whilst there is some potential for a rather large range of symptoms and side effects, grasping impact on actual pathologies demands extensive investment in research.

As abundantly hinted at above, perhaps the most alarming and challenging theme I’ve faced in recent years is the media construct that cannabis “causes” psychosis or schizophrenia. The primary reason this created so much angst in the illicit drug policy and discourse deconstruction fields was the immediate negative impact on management of the many known psychological issues. The 2007 meta-analysis by Moore et al published in The Lancet was seized upon as conclusive evidence.

It remains an excellent review, and fortunately drew much needed explanation about the nature of meta-analyses and in particular that of Moore et al. Amidst the frustrating and very disappointing bad science reporting to follow (including one of the worst by Australia’s own Jonica Newby on ABC’s Catalyst), were calmer voices such as that found on Storied Conduct: Resources and News in Psychology.

Correlation, as our basic research theories tell us, can never prove causation. All of the studies examined by Moore et al. (2007) were correlational in nature. Further, the additional use of meta-analytic grouping techniques cannot turn correlational data into experimental data no matter how sophisticated the statistics. This means that, while the trends and the thrust of the data seems to make marijuana a very promising explanatory causal factor in the development of some of the psychoses that these research participants developed, such a link has not been conclusively demonstrated. And, while the gross odds ratio speaks of a 41% increased risk, the authors themselves acknowledge the impact of confounding and other variables in lowering the risk percentage in the studies they examined. Hence, we are left without a good estimate of what the actual increased risk might be.

The number of media articles poorly reporting findings grew steadily over three to four years. Diligently a steady number of D&A workers, bloggers and independent media contributors used a dual method of exposing predetermined agendas and explaining the results in proper context. Generically speaking – and I stress generically – the headline “Cannabis induced psychosis increases 300% in two years scientists find”, might pop up. On examination it reflects that a sample with 0.2% predisposition to psychotic episodes had two years later, under different methodology, been found to present a 0.6% prediction to experience the transient psychosis they are genetically predisposed to, had they continued to smoke cannabis heavily for another decade.

One of the sadder developments was the establishment in 2008 of the National Cannabis Prevention and Information Centre. The NCPIC. Coined the National Cannabis Propaganda and Infotainment Centre by a contributor to a professional e-list, it regretfully offers themes well documented as not being efficacious in reducing cannabis abuse. In 2009 NCPIC head Jan Copeland was pulled up by the same publication for dodging the need to publish bipartisan research.

The NCPIC is in the habit of presenting the style of faux science we see above from DFA and also using alarming distortion of facts in their supposed quest to “prevent”. The public is seemingly deemed at risk from balanced information which is substituted with bias and deception. In view of the documented harm this approach leads to it is not good enough for a tax payer funded organisation.

One of the best papers I’ve read is Continued cannabis use and the risk of incidence and persistence of psychotic symptoms: 10 year follow up cohort study, by Kuepper et al. This paper controlled very well for baseline incidence (Eg: self medication of psychosis/schizophrenia, supplementation of low cerebral anandamide [thus proposed alleviation of psychotic symptoms] via cannabis, cumulative effect of CBD’s anti-psychotic properties, other drugs, unstable lifestyle, etc.

In doing so, they thus also controlled for the host of suspected [exact cause remains unknown] causes of psychosis (stress, genetic predisposition, changes at puberty, assault, major life changes, biological causes, neuroses etc). This was itself arguably misused by Professor Jan Copeland who we’ve just met.

Wayne Hall and Louisa Degenhardt contributed an excellent review [BMJ 2011;342:d719] at the time. They noted the superior methodology and also that:

In the light of these findings and those of earlier studies, it is likely that cannabis use precipitates schizophrenia in people who are vulnerable because of a personal or family history of schizophrenia… A modelling study suggests that we would need to prevent 2018-4530 young people in the United Kingdom from becoming regular cannabis users to prevent one case of schizophrenia, or to prevent four to five times as many (10,000-23,000) from light cannabis use to achieve the same result.

Of course schizophrenia is a disease with a clear diagnosis. Psychosis is a transient symptom with a much less clear delineation. What’s certain is that the term is misused and frequently in the manner suggesting cannabis use/abuse leads to a permanent state of psychosis.

Copeland is quoted in an article for The Drum by Quentin Dempster:

Professor Jan Copeland, director of the NCPIC  a government-backed preventative agency, told 7.30 NSW that if cannabis was taken out of the picture the incidence of schizophrenia in Australia could be reduced by 8 to 14 per cent. She could not be more specific. That guesstimate was based on overseas studies. There have been no studies in Australia. This is revealing.

I had seen the report and was stunned. Copeland had failed to grasp the import of incident cannabis use to incident psychotic symptoms. More so she had failed to appreciate the basics of the different time periods. What she had messed up re 8% and 14% from the Kuepper et al study came from this line in the Abstract under Results:

The incidence rate of [sub threshold] psychotic symptoms over the period from baseline to T2 was 31% (152) in exposed individuals versus 20% (284) in non-exposed individuals; over the period from T2 to T3 these rates were 14% (108) and 8% (49), respectively.

The paper cited mentions “schizophrenia” twice. Once in describing instruments used to collate data and again under “methodological issues”.

I wrote to Jan and rather comprehensively outlined the incident specific nature of the results, to seek clarification. I received no reply. For the record here is the conclusion from this sterling study.

Cannabis use is a risk factor for the development of incident psychotic symptoms. Continued cannabis use might increase the risk for psychotic disorder by impacting on the persistence of symptoms.

It’s important to realise that this association is emerging as a very small but very significant issue for individuals predisposed to psychotic episodes. “Cannabis induced psychosis” is thus better viewed as schizophrenia. To date new trends and good research has been seized or sabotaged for political gain. There are areas in need of research dollars wherein we should despise bad science or exploitation of good science. Illicit drug policy is one of them.

As I mentioned way above this is not a pro-cannabis post. There are a host of reasons including psychological, physical and social to not use cannabis. Although I note it is Australia’s most popular illicit drug.

Which reminds me. There are no reasons to not use and respect evidence.

Naltrexone implants backed by zealotry but not evidence

Less than a month after Sydney coroner Mary Jerrum referred a provider of naltrexone implants to the NSW Health Care Complaints Commission, the Christian Democrats’ Reverend Fred Nile revealed he wants them used as compulsory treatment for opioid addicts.

Naltrexone implants are not backed by any convincing evidence but the rapid opioid detoxification [ROD], opioid blocking properties they offer appeal greatly to anti-drug crusading Christian evangelists. Long opposed to harm reduction measures and evidence based treatment of addiction, such as methadone maintenance, far right Christians and conservatives see naltrexone implants as a moral masterstroke. Muscling into the action in recent years are the profit-focused, such as Sydney’s Ross Colquhoun, director of Psych ‘n’ Soul.

I’ve previously written about Dr. Stuart Reece, who features in the video below with the same title as this post. His abuse of patients with naltrexone and Jesus saw 25 of them die in 20 months. His career is the epitome of callous faith based pseudoscience which uniquely targets evidence based harm reduction measures. When I posted on a faux “research” paper he had co-authored with other members of Drug Free Australia, I referred to an exchange on an email list hosted by the Alcohol and Drug Council of Australia. It was on this list years ago that I first read Ross Colquhoun defend naltrexone implants as “common sense”. Indeed his evidence free defence of implants led me to conclude that his “common sense” was the equivalent of the religious zealots’ “belief”.

Both individuals are signatories to Drug Free Australia’s so-called position statement which includes funding of naltrexone implants as an “urgent pro-active change to our illicit drug policies”.

DFAposition_statement_sigs1

Handing down scathing findings into three deaths, the coroner recommended that the HCCC consider proceedings against a doctor working at Colquhoun’s Pysch ‘n’ Soul, Dr. Jassim Daood. According to the ABC she noted, “a number of disciplinary cases have already been completed about some of the clinic’s other staff”. The scale of potential problems becomes clear when one considers the implants have never been approved for use, eager staff have little or no training and post-implant support regimes are entirely absent. For over a decade these implants have been available via the TGA’s Special Access Scheme, which is designed to allow patients access to otherwise unavailable drugs to treat conditions deemed potentially fatal in the absence of that drug.

In this case the Scheme is being exploited as a loophole whilst the implant option itself has left in it’s wake a litany of failure and fatalities. Colquhoun is unlicenced to perform ROD but ignored requests from the NSW Health Department in mid 2010. SMH wrote on October 20:

Despite this direction, Colquhoun resumed the treatments while still unlicensed between July and September of that year, only desisting when Grace Yates, a 23-year-old with a five-month-old baby, was given ROD and naltrexone at the clinic on September 29, 2010. She suffered a heart attack and died two months later, having never regained consciousness.

It’s worth considering this failed treatment option is likely to be expanded under a coalition government. As health minister in the Howard Government, Tony Abbott provided the funding for the launch of the evangelical Drug Free Australia from the Tough on Drugs/Assets of Crime kitty. Describing themselves as “Australia’s Peak Drugs Body” they failed to meet the conditions of the funding, choosing instead to sabotage related health policy basics. Without doubt they have proven to be to addiction treatment what the Australian (anti) Vaccination Network is to the management of vaccine preventable disease.

Abbott also sent $50,000 they way of Psych ‘n’ Soul in the same year, showing exceptionally poor judgement. There is little doubt with enemies of Harm Minimisation such as Bronwyn Bishop, Sophie Mirabella and Christopher Pyne on his proposed front bench, Australia’s strong evidence based approach to addiction management would suffer. As the coroner noted:

It appears that a patient only had to present at the clinic to be enthusiastically recommended for rapid opioid detoxification, no matter what their history or situation, without alternatives being discussed or considered or any information given out of the risks involved.

Another death related to the attempts at ROD Psych ‘n’ Soul is now infamous for, involved Michael Poole, 48. He was described as “delirious and delusional” after ROD and died at the Prince of Wales Hospital in Sydney two days later. The third death involved James Unicomb, 23 who died from drug toxicity following a poly-drug overdose, which followed the ROD and occurred whilst an implant remained active. This lack of appropriate follow up of patients is perhaps the most appalling failure related to the practice of ROD and implants.

Rapid detox’ doesn’t treat addiction. It removes cravings and leaves patients open to the possibility of overdose. Often they are dependent upon high doses of benzodiazapines which raises the risk of opioid induced respiratory depression. As addiction is not treated, behaviour cannot be expected to change. It is for this reason follow up should form the most important aspect of rapid detoxification. It is for the same reason that implants have such a high failure rate in “curing” addiction.

One can only imagine the profit made and moral crusading accomplished from treating now dead addicts who were essentially exploited, not treated. Of course, testimonials abound. Whether it’s those who adore Reece for showing them the way to Jesus or Colquhoun’s (third time lucky) performer in the below video, let’s not kid ourselves. The dead cannot speak.

Alex Wodak, director of Sydney’s St. Vincents Hospital Alcohol and Drug Service observed:

How they are allowed to be used for routine purposes in several states in this country beats me. It goes against all the normal regulations and I think the only explanation I can understand is that this is allowed in this case because they’re only drug addicts. […] We really need a national independent inquiry into the regulatory failure, the serious regulatory failure that’s gone on with Naltrexone implants for over a decade.

Indeed we do.

Naltrexone implants backed by zealotry but not evidence


Psych ‘n’ Soul Naltrexone Deaths Inquest Findings

Drug War tactics driving up HIV/AIDS

The Global Commission on Drug Policy recently released yet another report condemning illicit drug prohibition and the War on Drugs.

Entitled The War on Drugs and HIV/AIDS – how the criminalisation of drug use fuels the global pandemic the report lists 6 key dynamics behind the trend.

1.) Fear of arrest drives persons who use drugs underground, away from HIV testing and HIV prevention services and into high risk environments. 2.) Restrictions on provision of sterile syringes to drug users result in increased syringe sharing. 3.) Prohibitions or restrictions on opioid substitution therapy or other evidence based treatment result in untreated addiction and avoidable HIV risk behaviour. 4.) Conditions and lack of HIV prevention measures in prison lead to HIV outbreaks in incarcerated drug users. 5.) Disruptions of HIV antiretroviral therapy result in elevated HIV viral load and subsequent HIV transmission and increased antiretroviral resistance. 6.) Limited public funds are wasted on harmful and ineffective drug law enforcement efforts instead of being invested in proven HIV prevention strategies.

Let’s forget “drug war” and call this problem what it is. Treating drug use as a criminal offence. Now, just by raising that image we’re into different waters entirely. Pointing to problems with the criminal model immediately evokes suspicion of compulsory promotion of illicit drug use. We’re conditioned to assume if we don’t punish drug use, it will be everywhere and bring about a host of nasty outcomes.

Mostly, we’re well conditioned to associate drug use with crime and to see it as criminal. Stitched on to this is the pop culture image from which we draw stereotypes. My favourite is one I often refer to as Quinn Martin. Quinn Martin Productions brought us Streets Of San Francisco and a host of other unrealistic 1970’s TV Cop shows. If you wanted a crime – it was drug related. A bad guy or a weak willed loser? Toss in a druggie.

Of course, I’m not suggesting we imagine this. The reality is criminals are made from associating in criminal circles and from being incarcerated, regardless of the reason. How this fits in with the drug-crime punishment model was addressed recently by eminent Australians who authored the Australia 21 Report. They state:

The prohibition of illicit drugs is killing and criminalising our children, and we are all letting it happen

Rather than legalisation alone, that report discussed regulation, decriminalisation and de-penalisation. Far from being an open slather free ride these measures involve control, certain losses of freedom, the need to demonstrate responsibility and a major focus on rehabilitation back to a productive and useful lifestyle. What they don’t involve is the destruction of lives and sustaining criminal enterprise at huge cost to the community.

Yet in Australia we do very well managing HIV/AIDS in injection drug users [IDU]. 16 million use IV drugs globally. Almost 20% live with HIV. Fortunately, Australia managed to keep that level at 3%, and a significant number of that sample were at higher risk statistically from acquiring HIV from another high risk behaviour. This level remained stable for decades.

So the question does arise. Apart from acknowledging shocking human rights abuses, tragedy in many nations and an ongoing source of disease and corruption, what policy aspects need we mull over?

Since the Howard years Tough On Drugs initiative and emergence of groups like Drug Free Australia lobbying against expanded protective measures, the level of HIV in IDU jumped to 4%. It remains an exquisite example of how just a few years of delayed and abandoned Harm Reduction responses, increased punishment and disinformation about Harm Reduction efficacy has an immediately devastating impact on HIV control in Aussie IDU.

The fact that this collective undermining of Harm Minimisation occurred during a period when Harm Reduction services, research and supporting evidence expanded rapidly in Australia is testimony to how effective disinformation and intuitively themed attacks on evidence can actually be.

Still, as of April this year we remain extremely fortunate thanks to Harm Reduction:

HIV in IV Drug Users matched to Harm Reduction

The single greatest sabotage of Harm Reduction initiatives under the auspices of John Howard, was the suppression of a heroin on prescription trial in 1997. This had strong bipartisan support and the Federal Health Minister, four States and the ACT were excited about the decision to go ahead. Under instructions from then ANCD head Major Brian Watters – later to become a Board member of Drug Free Australia – Howard immediately vetoed the decision.

Exactly how many HIV cases, ruined lives and deaths this led to is impossible to estimate, and I would err toward a minimal estimate. Still, 15 years later we can assume the body pile is now somewhat impressive. In what is unique insight into how Howard in turn manipulated the zealots who tried to manipulate him, he never flinched on needle exchange.

To his credit he continued to fund over a thousand outlets across Australia, with some specialising in bulk dispensing, others in hard core risk management. Abandoning these programmes was insanity, despite conservative lobbyists being convinced he might do so. Yet to Howard, being seen to usher in heroin prescription – “free heroin” – as shock jocks called it was political suicide.

Despite strong support for our official policy of Harm Minimisation, which accommodated extreme spending against smuggling (Supply Reduction), this is how he presented his thoughts in 1998:

The policy of zero tolerance of drug taking in this country is a wholly credible policy and policy that ought to be pursued more vigorously by government and by people who are concerned about the problem.

Of all the lies he told, this remains one of my favourites. There was no such policy beyond words. He seemed to despise everyone equally. Which was essential for the politician he became. All that mattered to Howard was Howard, and securing votes. Manipulating drug workers, users, science advisers, policy experts and voters over what was a social crisis at the time was pure business.

British Columbia did introduce heroin on prescription in 2005. 5 years later the effects of the combined measures on HIV were compelling:

British Columbia: HIV infection matched to Harm Reduction initiatives

Similar success from heroin on prescription is found in every nation to usher in trials and programmes. Sadly, Australia was ready before the Howard years. We were in fact, world leaders. Now it’s a different story. We have one Medically Supervised Injecting Facility that ran as a successful trial for 11 years.

Seven of those 11 years were due to disinformation and sabotage from conservatives. In October 2010 the Kenaelly NSW State government passed a Drug Misuse and Trafficking Amendment bill to ensure the Centre became permanent. 11 years of moral panic was, at least legislatively, silenced.

Whilst actually attacking Harm Reduction initiatives, confusing methadone and buprenorphine with illicit drugs and muddling the lot in with AFL drug policy, Alan Jones delighted us with his wisdom on “Harm Minimisation”, in mid 2007 [MP3 here]. Obnoxious, offensive and completely ignorant of facts it is also somewhat representative of Aussie views today:

So today Australia has a long, long way to go before we do, if ever, fully recover from the rise of anti-drug conservatives under John Howard. They did far more damage than just raise HIV infection by 1% in injection drug users. Our fluency with progressive policy and public maturity has been undermined. Australia waits, on pause.

33 million people live with HIV today. Outside sub-Sahran Africa IV drug use accounts for 1/3 of new infections. For almost 15 years annual HIV infections have been falling on a global scale. Except for seven countries wherein HIV infections increased by about 25% primarily due to IV drug use.

The “drug war” is full on in Eastern Europe and Central Asia and unsurprisingly 5 of these 7 countries are in these boundaries. In the last decade people living with HIV in these areas has close to tripled. Russia has resisted Harm Reduction measures keeping methadone illegal and charging users for needle possession. As this demographic is actively abused by law enforcers the motivation to use needles based on access convenience and minimal time is heightened. The results are clear:

HIV infections – Russian Federation

Thailand has impressively cut HIV infection in workers in the famous tourist attracting sex industry from 40% in the mid 1990’s to around 5% today. This pulled male clientele infection rates down in parallel. At the same time fierce drug war tactics led to 2,500 “death squad” murders in 2003 and HIV is up to 1 in 2 IDU in some regions. A comparison of different demographics for HIV infection is compelling:

THAILAND: HIV infections per demographic

In a splendid example of stupidity the USA reinstated it’s 21 year ban on federal funding for needle exchange programmes only 2 years after ending it. A stark lesson for Australia, constantly under the assault of disinformation from anti-drug group Drug Free Australia, can be found on page 9 of the GCDP Report.

Recently in reviewing the history of Harm Reduction and HIV, I noted the stark difference between not just nations, but regions within nations favouring HR as a powerful controller of HIV spread. Similarly today it can be seen that in nations with extreme law enforcement, and regions within the USA with the most intense law enforcement that HIV levels are higher than those with low law enforcement.

For instance, a study of the 96 largest US metropolitan areas found that measures of anti-drug “legal repressiveness” were associated with higher HIV prevalence among injectors and concluded: “This may be because fear of arrest and/or punishment leads drug injectors to avoid using syringe exchanges, or to inject hurriedly or to inject in shooting galleries or other multiperson injection settings to escape detection.”

DFA fallaciously – and skillfully – report the exact opposite. Similarly DFA urge for dedicated Harm Prevention measures, described already on this blog as crude behaviour modification. Whether through blind or biblical force the aim is to do just that: force drug users to stop by changing behaviour. Forget the addiction and crush the symptom.

The easiest way to do this is control the environment. Enter compulsory detention. What DFA have called “compassionate detention”. The models they are considering are terrifying. Not only is HIV infection spread through these centres, they fail to offer any addiction treatment. Forced abstinence is associated with high fatality relapse.

Once infected with HIV criminal and punitive approaches act as a disincentive to testing and treatment. Requirements to be drug-free in order to receive treatment (as in Sweden) and denial of certain rights like child custody and employment correlate directly to higher HIV/AIDS fatalities. Confidentiality breaches and stigma impact frequently due to law enforcement regardless of country.

This leads to higher circulation of HIV in the community as treatment has been shown to reduce HIV transmitted via blood and body fluids. As such it is vital all demographics in all communities can be reached through treatment which ultimately leads to prevention.

Incarceration also increases HIV infection and Australia is heading toward a USA type model which has 25% of prisoners listed as HIV positive. Fortunately our initial lower levels in the IDU population will protect us significantly from such a nightmare. Unusually, prison needle exchange is resisted strongly. DFA play the key lobby role nationally and prison guard unions seem intent to deny evidence in favour of their health.

Australian prison guards profit enormously from selling syringes to prisoners. Secondary to money is the control of prison dynamics, control of prisoner behaviour and the essential control of these transactions in corruption entire. A syringe is power in the prison setting. The sooner we remove this tool from guards and protect prisoner health with clean exchanges, the better.

Resources spent on law enforcement are resources not spent on health initiatives generally, on a global scale. With drug crime and infection encouraged by the former and lessened by the latter, it is clear we face a major global challenge. Public health is the first principle of drug control.

Settings where HIV prevention measures have been curtailed as a result of economic concerns have been particularly vulnerable to increases in HIV risk among injection drug users. For instance, a greater than 10-fold increase in newly diagnosed HIV infections among injecting drug users has recently been reported from Greece during the first seven months of 2011.

Australia remains incredibly lucky and indeed most fortunate in this global picture. What cannot be ignored and what must be cautioned against is our slow morphing into a landing pad for USA styled conservative disasters. DFA is an arm of Drug Free America Foundation and act at their bidding. DFAF have their “division”, the Institute on Global Drug Policy who fund the Journal of Global Drug Policy and Practice.

This is no journal but a vehicle for lobbying against progressive drug policy primarily that which targets HIV control. All get together and play at the Swedish based World Federation Against Drugs which similarly is nothing like a “world federation”. What they strive for is patently out of this world.

As today’s most brilliant minds accept the evidence condemning prohibition, the global Drug Free Whomever groups seek to defend the UN Drug Conventions that originated in 1961.

Fortunate we may be, but complacent we cannot afford to become.