Health and the use of illicit drugs

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Illicit drugs and their misuse continue to be major issues for Governments at all levels equally in Australia and internationally. Illicit drugs are the getting higher hazard to global public health. Illicit drugs attract a high level of political and social interest in Australia. An illicit drug is defined as a drug whose production, sale or possession is prohibited (MCDS 2004). Illicit drugs such as marijuana, heroin, ecstasy and cocaine. World Health Organization defined the Drugs as "any chemical entity or mixture of entities used for treatment or alleviation of disease, or for non-therapeutic purposes. Psychoactive drugs are those that alter mood, cognition or behaviour" (Henry, 1991). The term drugs include illicit products such as alcohol, tobacco, recommendation and medication, as well as illicit products such as cannabis and heroin. Alcohol is one of the most commonly use drugs in Australia society. There is also an increase in the rate of tobacco expenditure in the Australian society.

The social and individual harms make use of alcohol and tobacco have been comprehensively publicised and recognized through the National Drug Strategy. from the time when the National Campaign Against Drug Abuse was established in 1985, in attendance a three-fold raise in the number of people who recognize alcohol as part of the drug issue.(parliament of Australia,1997) It appears that smaller number of people correlate smoking with the 'drug problem.' Illicit and licit drugs if badly treated or incorrectly used they are potentially hazardous to human health. Ownership, supply and fabricate of illicit drugs are highly dealt with minimize and Territory legislation. Illicit drugs continue to be seen by Australia major component of the drug problem (McAllister, 2005) and the subject of this essay too. The essay explains some of the major illicit drugs, their use, health effects, and the illicit drug laws and public responses to the drugs, briefly outlines current law and some future recommendation for the illicit drug policy.

2.0 Statistics on usage of illicit drugs:

Accurate information about the use of illicit drugs is difficult to obtain due to people's reluctance to admit to their use. The 2007 National Drug Strategy's Household survey found:

Females were less likely than males to use illicit drugs in all age categories except for the 14-19 year old category. The percentage of females who had ever used illicit drugs in this age group was 26.5% compared to 21.1% in males.

For both sexes, the use of illegal drugs is highest in the in 20-29 and 30-39 year old age groups.

The proportion of females who had recently used marijuana/cannabis decreased significantly from 1998 (34.2% to 12.7% in 2004)

Females aged 14-19 were more likely than males to have ever used ecstasy (6% compared to 4%)

Marijuana was the most commonly used illicit drug

Source: Australian Institute of Health and Welfare. Ibid  p25-34.

3.0 Illicit drugs and the health:

The complications of illicit drug use may affect the physical healthiness; end up damage of vital organs such as kidney, liver and heart damage, memory loss or loss of concentration, depression, the transmission of viruses in the course of sharing needles, as well as psychological and physical compulsion. A number of illicit drug products can lead to excessive aggression or enmity. There are also associated lawful risks of appealing in illicit or dangerous activity.

3.1 Mental health

3.1.1 Psychological distress:

"In 2004, approximately two in three people aged 18 years and over had low levels of reported psychological distress (71% of males and 66% of females). Overall, females (11%) were more likely than males (9%) males to have high or very high levels of psychological distress" (AIHW, 2004). Use of cannabis in the last month and use of any illicit drug except cannabis in the last month were both correlated with high or very high levels of psychological distress for both males and females. For example, approximately one in five males and one in four females who had used an illicit drug other than cannabis in the last month reported high or very high levels of psychological distress. The corresponding percentages for males and females who had not used an illicit drug other than cannabis in the last month were 8% and 10%" (AIHW, 2004).

3.1.2Mental health disorders.

"In 2004, approximately one in ten people aged 18 years and over reported being diagnosed with and/or treated for any mental health disorder in the previous 12 months (10%). Mood disorders (8%) were the most common form of mental health disorders reported, compared with anxiety disorders (4%), and other disorders (1%)" (AIHW, 2004).

Compared with those who had not used an illicit drug other than cannabis, persons who had used any illicit drug other than cannabis, either at least once in their lifetime or in the last 12 months, were approximately twice as likely to have been diagnosed with and/or treated for a mental health disorder. For example, 17% of persons who had used an illicit other than cannabis in the last 12 months had been diagnosed and/or treated for a mental health disorder, compared with 9% of non-users" (AIHW, 2004).

communicable disease

Hepatitis B, hepatitis C

"Self-reported prevalence of hepatitis B appeared to be higher for long-term injecting drug users in 2003. While 1% of injecting drug users with an injecting history of less than 5 years self-reported hepatitis B, 13% of users with a history of 10 or more years self-reported hepatitis B infection" (AIHW, 2004).

A larger proportion of people attending needle and syringe programs in 2003 tested positive to hepatitis C than self-reported ever having hepatitis B. The prevalence of hepatitis C appeared to increase with a longer duration of injecting drug use. Among long-term injecting drug users, females were more likely than males to test positive to hepatitis C. For example, 60% of female injecting drug users that had injected drugs during the previous 6 to 10 years tested positive to hepatitis C, while 50% of male injecting drug users who had injected for the same duration of time tested positive to hepatitis C.

Hepatitis C prevalence among people attending needle and syringe programs remained high over the period 1997 to 2003, with 57% of males and 61% of females testing positive to the hepatitis C virus antibody in 2003. Since 2002, hepatitis C prevalence among females attending needle and syringe programs has remained stable at 61%, and for males has declined from 59% to 57%.

3.2.2 HIV/AIDS

The number of new AIDS diagnoses in Australia among people who had a history of injecting drug use (including male homosexual contact and injecting drug use) decreased from 84 in 1993 to 33 in 2003. In 2003, 11% of new AIDS diagnoses were among injecting drug users, with 5% among injecting drug users with no male homosexual contact. This change is in line with the trend across all exposure categories, such that from 1993 to 2003, the proportion of people who contracted AIDS and were injecting drug users remained relatively stable, ranging between 7% and 11% of new AIDS diagnoses.

The number of deaths from AIDS among injecting drug users decreased from 59 in 1993 to 20 in 2003 (Table 7.6). However, the proportion of AIDS deaths among people who had a history of injecting drug use increased by 10 percentage points, from around 9% in 1993 to 19% in 2003.

Of the overall national sample, around two-thirds of injecting drug users reported that they had not shared any injecting equipment in the last month (63% in 2002 and 66% in 2003). In 2003, the jurisdiction with the lowest proportion of respondents reporting needle sharing was Tasmania (5% borrowed, 3% lent). The jurisdictions with the highest proportion of respondents reporting that they shared needles in 2003 were Queensland and the Australian Capital Territory. In Queensland, 13% of respondents reported borrowing a needle and 21% reported lending someone else a needle in the month prior to interview. The respective proportions in the Australian Capital Territory in 2003 were 11% and 24 %( AIHW, 2004).

Mortality and morbidity:

Ridolfo and Stevenson (2001) estimated that, in 1998, approximately 1,000 deaths in Australia were attributable to the use of illicit drugs. About half (580) of illicit drug-related deaths were caused by drug dependence, with most of these deaths occurring among persons aged between 15 and 34 years (390 deaths) (AIHW, 2004)..

There were an estimated 14,500 hospital episodes attributable to illicit drug use in 1998. The largest number of hospital episodes involved a principal diagnosis of drug dependence (6,300). Persons aged 15-34 years experienced the largest number of hospitalisations relating to illicit drugs (10,900) compared with persons in other age groups. In 1998, 1,023 deaths were related to the use of illicit drugs.  In 1997-98 slightly over 200,000 hospital episodes were attributable to drug use.  Of these, 7% were due to illicit drug use. Illicit drugs deaths in Australia have increased significantly during the last thirty years

4.0 Australian Illicit Drug Laws:

The Drug Laws in Australian Jurisdictions:

The law relating to illicit drugs is prepared and imposed in Australia on a state and territory level.  It varies markedly between jurisdictions but its structure is broadly similar.  The key legislation from each jurisdiction is as follows:

 

New South Wales:

Drug Misuse and Trafficking Act 1985;

Drug Court Act 1998

Victoria:

Drugs, Poisons and Controlled Substances Act 1981

Queensland:

Drugs Misuse Act 1986; Drug Rehabilitation (Court Diversion) Act 2000

Western Australia:

Misuse of Drugs Act 1981

South Australia:

Controlled Substances Act 1984

Tasmania:

Poisons Act 1971

Northern Territory:

Drugs of Dependence Act 1990

Australian Capital Territory:

Drugs of Dependence Act 1989

Commonwealth:

Customs Act 1901

Narcotic Drugs Act 1967

Psychotropic Substances Act 1976

Crimes (Traffic in Narcotic Drugs and Psychotropic Substances) Act 1990

(Source: National Drug policy, 2001)

LEGISLATIVE FRAMEWORK:

Australia's federal structure, criminal law and liability for enforcing drug laws are primarily the State Governments responsibilities.  The Commonwealth has played a critical role in the development of the current framework of drug laws in Australia.  The direct legislative and enforcement responsibilities of the Commonwealth, however, have largely been restricted to controlling the entrance of illicit drugs into the country through the operation of the Customs Act 1901.

Three international treaties on illicit drugs have been ratified by Australia.  These are:  The Single Convention on Narcotic Drugs (1961) and the Protocol (1972); The Convention on Psychotropic Substances (1971); and the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988).  The obligations in these treaties are carried out in three pieces of federal legislation:  the Narcotic Drugs Act 1967; the Psychotropic Substances Act 1976; and the Crimes (Traffic in Narcotic Drugs and Psychotropic Substances) Act 1990.  The key feature of the treaties is to create control systems that make illegal the availability of controlled drugs, including cannabis, except for scientific or medical use.  There are varying interpretations as to the extent to which the treaties require cannabis use or possession to be sanctioned.  However, it is clear that non-incarcerative, and non-criminal, sanctions, do not violate treaty obligations.  Thus, expiation schemes do not violate Australia's treaty obligations.  An additional element of the 1971 Convention on Psychotropic Substances is that treatment and rehabilitation are acceptable alternatives to punishment for cannabis related offences.( The Regulation of Cannabis Possession, 2001)

Key findings:

-Over 100 organisations involved in creating Australian illicit drugs policy.

Some are national, some at the state or local community level, and others are international organisations.

-Most of the organisations listed are 'insiders' in the sense that their roles in the policy process are explicit, and that protocols are in place to elicit and manage their contributions. An example is the national and state NGO peak organisations, most of which sit on various governments advisory bodies within their respective jurisdictions.

-Very few 'outsiders', i.e. organisations that do not have formal linkages to the vertical decision-making processes, have been identified. One example is Drug Free Australia, the membership of which is confidential and the CEO of which is active in lobbying political leaders and issuing media releases covering illicit drugs policies.

-Mapping the various organisations to the stages of the policy cycle, namely issues identification, policy analysis, identification of policy instruments, consultation, coordination and decision making, showed both the spread and clumping of organisational roles. Few organisations were identified as being actual decision-makers. Some have consultation and coordination roles. Many have roles in identifying issues, policy analysis and advocacy, particularly when 'advocacy' can be taken in a limited sense to include making policy recommendations.

-Most organisations are involved in all four areas of illicit drugs policy, i.e. prevention, treatment, law enforcement and harm reduction-Conceptual and technical challenges exist in visualising the structural data. Ideally, the tools used for this purpose would use hyperlink technology to enable the user to explore the multi-dimensional aspects of the policy structures. Another important attribute would be that the tool could produce outputs to include in written documents, e.g. complex organisational charts. In addition, it would need to be accessible to many different users, so would need to be reasonably priced, integrate smoothly with standard office software, and not be too difficult to learn to use.

An extensive search was undertaken to identify suitable IT-based visualisation tools. This included discussions with IT and knowledge management specialists. DPMP team members were invited to make suggestions.

No single software package has been identified that is outstandingly useful. The package that most closely meets the criteria listed above, and one that was recommended by a number of people consulted, is Microsoft Visio®. This is a component of Microsoft

Office® but it is not provided in most standard configurations of that software suite and needs to be purchased separately.

Visio includes a module for visualising structures in the form of organisation charts. Hypertext linkages between components of different charts or documents is possible. It is said to integrate smoothly with Microsoft Word® and Powerpoint®, though this has not been our experience to date. Some trialing of this application was undertaken as part of the pilot study.

-Much of the descriptive information needed for this type of study is available in the public domain. Some is collated in directories such as the Australian Government Online

Directory (http://gold.directory.gov.au/). It is a labour-intensive task, however, to contact the many organisations to confirm the accuracy of the information, to keep it up-to-date and to create visualisations of the resulting information. We found that, almost without exception, the people from whom we sought information on policy structures were happy to provide it. This included both officers of various public services and the heads of key NGOs.

-Although not the major focus of this study, we collected information on the membership of various committees, etc., involved in policy processes. As with information on the structures themselves, the informants we approached were generally willing to provide information of this type, as well. Some NGOs, however, do not reveal information on their membership.

HOW DOES COORDINATION OCCUR IN AUSTRALIAN ILLICIT DRUG POLICY?

Australian illicit drug policy coordination is inherently complicated because of the nature of the Australian federation and the need to involve multiple stakeholder groups. In 2005 McDonald, Bammer and Breen (2005) identified over 100 organisations involved in the process of Australian illicit drug policy making. These are at various levels of government, different sectors and from within and outside of government. The organisations involved in illicit drug policy differ somewhat to those involved in alcohol and tobacco policy. One notable difference is that illicit drugs lack a strong industry group. Conversely other drivers play an increased role in illicit drug policy making, particularly public opinion, media and politics (see for example Bammer, 1997; Gunaratnam, 2005; Lawrence, Bammer, & Chapman, 2000; Wodak, 1997).

A key feature of Australian drug policy is that responsibility for developing and implementing drug policies and responses to drug use and harm is split between the Commonwealth Government, the states/territories, and local government. Australia is a federation comprised of six sovereign states and two territories. The Commonwealth Government is responsible for a range of activities including (but not limited to) national policy management, medical services through the Medical Benefits Scheme, the Pharmaceutical Benefits Scheme and funding for the public hospital system, monitoring adherence to international treaties and border control (Ryder, 2008). While the Commonwealth has an important role in policy development and funding, the biggest area of responsibility falls on the state and territory governments for activities including state policy development and implementation, providing public sector health services for drug treatment and prevention, enforcing laws and policing within the state, and devising policies to deal with drug use and drug-related harm in areas such as schools, the criminal justice system and in public housing.

In the Australian circumstance, the community should be pertained about the harm caused by the illicit drugs. Illicit drugs, which are produced and supplied internationally has a great global impact. People start using drugs at a very young age and a large number of deaths also occur within the younger age group. In Australia there is a lot of people affected with drug related health concerns majoring the young people. The most important drug that has caused a lot of deaths is heroin. Young people do not have the capacity to manage the proportions to use drugs so that they could reduce the effects. People who are addicted to drugs use many different kinds of drugs at the same time, which could cause a serious harm to their health. The harm caused by heroin and other drugs is becoming severe than that was thought about.

Recommendations:

The three-day symposium, 'Illicit Drugs and Development: Critical Issues for Asia and the Pacific', organised by the Development Studies Network at the Australian National University in Canberra in August, enabled a multi-disciplinary exploration of the relationship between illicit drugs and development in the Asia Pacific region. The symposium ended with a need for incorporating the development agenda for implementing the interdisciplinary principle.

Key recommendations

Number of recommendations was proposed on the Round table participants, including that:

In the programs conducted for illicit drugs and harm reduction, the main focus should be on protection of human life.

The donor organisations should have considerations to reduce exposure among poor, the sacked, and the migrants

The false effects of social and economic development to the use of drugs have to be reduced. There has to be more attractive things done more than drug

An approach has to be establishing to include public health, regulation, legislation and education to prevent the spread of HIV/AIDS through the intravenous drug users.

Drug reduction networks have to be set up in order to control the usage of drugs and incorporate it in the society education and law.

programmes adopt with reducing drug supply, providing attractive livelihood alternatives, reducing drug use and demand,

The programmes dealing with drug reduction incorporate an encouragement component to increase understanding of drug use, drug treatment and harm minimisation; and

Developing programmes and projects like appropriate research, monitoring and evaluation of illicit drug should be promoted.

Rise in the funding for media liaison activities by drug and alcohol research centres and non-government organisations, such as the Australian National Council on Drugs. Media liaison personnel are often under-resourced. For example the National Drug and Alcohol Research Centre (2009) currently has less than one full-time funded media liaison person responsible for managing solicited media enquiries, which limits the capacity for proactive dissemination of results from multiple projects.

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