National Amphetamine-Type Stimulant Strategy Background Paper

More documents

Recommendations

Info

106 only significant difference was in the uptake of counselling, which was greater in the dexamphetamine group. The most serious adverse consequence of dexamphetamine cited has been the potential development of psychotic symptoms, particularly for those who have experienced amphetamine-induced psychosis. Another potential risk is the diversion of prescribed amphetamine (Shearer et al., 2002). On the other hand, some clinical trials have reported that such risks do not necessarily eventuate in adverse outcomes (e.g., Carnwath et al., 2002). Further research is currently underway, in South Australia, which involves a randomised double blind placebo controlled trial of dexamphetamine as maintenance treatment for amphetamine dependence. Aside from dexamphetamine, more recently both methylphenidate (e.g., Ritalin) and the antidepressant bupropion (e.g., Zyban) have been studied as potential amphetamine substitutes. Tiihonen and colleagues (2007) compared aripiprazole, a partial dopamine agonist, oral methylphenidate and a placebo among a sample of intravenous meth/ amphetamine users. They reported that while aripiprazole was associated with significantly more amphetamine-positive urine samples, methylphenidate was associated with significantly fewer such samples. Bupropion is currently being trialled through several phases and has been shown to decrease subjective effects of methamphetamine and reduce cravings (Newton et al., 2006). At present, evaluations suggest that ATS users find services offering substitution therapy attractive when offered in addition to advice and counselling, and results from international trials indicate that pharmacological treatment is most effective when used in conjunction with psychosocial intervention (Mattick & Darke, 1995). Thus, from both the perspective of the consumer and as indicated by the research, safe and effective medication potentially represents a valuable adjunct to psychosocial interventions that may enhance both participation and retention. However, as noted in the written submission from NDARC: NDARC, in collaboration with St Vincents’ Hospital and the Kirketon Road Centre, conducted the first randomised controlled trial of dexamphetamine as a substitute for methamphetamine dependence (Shearer et al., 2001). This trial found modest benefits from dexamphetamine treatment which needed to be confirmed in larger trials. … Overall, existing evidence suggests that modest benefits from dexamphetamine substitution are outweighed by problems associated with this treatment, including diversion and sideeffects from interactions with concurrent illicit drug use (Mattick & Darke, 1995). Antidepressants Depression is commonly associated with ATS use, sometimes predating use, and also emerging as a consequence of use. As noted by Shearer and Gowing (2004): Antidepressants have been investigated in the treatment of comorbid depression, depressive symptomatology associated with psychostimulant withdrawal, or for their dopamine agonist properties (p.121). The range of trials, with various agents, has provided equivocal results. One interpretation of the data is that those with pre-existing affective disorders may be responsive to antidepressant treatment, whereas those with symptoms that emerge as a consequence
107 of ATS use may be less responsive. Some evidence exists to suggest this differential responsiveness (e.g., Donovan & Nunes, 1998). A final concern is the combined effect of using SSRIs (selective serotonin reuptake inhibitors) with people who are using ATS. Research suggests that the SSRI fluoxetine may potentiate acute toxic effects of MDMA in susceptible individuals (e.g., Hegadoren et al., 1999) and thus, more research is needed to investigate the interaction of SSRIs and MDMA and its potential contribution to serotonin toxicity. This all suggests the need for more research, particularly research identifying subgroups with whom antidepressants may be indicated and contraindicated. Shearer and Gowing (2004) have observed that in fact the evidence for pharmacotherapies is generally limited, except for managing co-existing dependence on other drugs (such as using evidence-based pharmacotherapies for opioid dependence) or managing co-existing conditions (such as attention deficit hyperactivity disorder (ADHD) or affective disorders). These researchers provide a succinct and useful summary of the pharmacotherapy research: …with the exception of pharmacotherapies targeted towards accurately and appropriately diagnosed comorbid conditions such as affective disorders, psychotic disorders, attention deficit disorders and opioid dependence, the use of pharmacotherapies for the promotion or maintenance of psychostimulant abstinence or the management of psychostimulant withdrawal continues to be experimental. The inherent risks of pharmacotherapy may suggest that the use of pharmacotherapeutic agents should be limited to users diagnosed with more severe dependence who experience the greatest burden of psychostimulantrelated harms (Shearer & Gowing, 2004, p.130). The potential role of pharmacotherapy in treatment for ATS abuse was repeatedly raised during the consultation process. There were many appeals for more research into substitution therapy in recognition that, at present, there is no strong evidence base for pharmacotherapy for ATS related problems. Furthermore, it was suggested that substitution therapy could make treatment more appealing, at least to some ATS users. However, the view that substitution therapy was problematic and only served to replace one form of dependence with another was also expressed. Thus, it was argued, use of substitution in the long term needs to be carefully considered on a case-by-case basis. It was also recognised that pharmacotherapy may be more beneficial when used in conjunction with other forms of treatment, such as psychosocial interventions. In particular, the initial role of pharmacotherapy in crisis management was acknowledged, but that there was a need for this to be followed by helping clients to cope with the underlying psychosocial issues. Thus, the need for better relations and collaboration between services and treatment options was again emphasised. Finally, pharmacotherapies were discussed in relation to the management of psychotic presentations, detoxification and withdrawal. In relation to the former, it was suggested that there was a need for improved protocols due to the risks associated with administering antipsychotics to those with methamphetamine-induced psychosis, as opposed to psychosis unrelated to drug use. The appropriateness of sedation regimes for those in heightened arousal due to a combination of amphetamine use and alcohol consumption was also questioned due to pre-existing levels of intoxication. Medically-assisted detoxification
Page 1:
National Amphetamine-Type Stimulant
Page 4 and 5:
ii Acknowledgments This research wo
Page 6 and 7:
iv Table of contents Acknowledgemen
Page 8 and 9:
vi List of tables Table 1.1: Amphet
Page 10 and 11:
viii
Page 12 and 13:
2 The NDS framework and the Law Enf
Page 14 and 15:
4 Table 1.1: Amphetamine-type stimu
Page 16 and 17:
6 particularly on the Pacific Coast
Page 18 and 19:
8 Figure 1.1: MDMA (ecstasy) tablet
Page 20 and 21:
10 a 10-year period. While some of
Page 22 and 23:
12 Figure 1.4: Forms of methampheta
Page 24 and 25:
14 Figure 1.5: Median purity of met
Page 26 and 27:
16 As noted, the route of administr
Page 28 and 29:
18 Chapter 2: Setting the Context T
Page 30 and 31:
20 Figure 2.2: Prevalence of ecstas
Page 32 and 33:
22 19 years (Dunn et al., 2007). Th
Page 34 and 35:
24 The use of MDMA among police det
Page 36 and 37:
26 this survey is conducted with th
Page 38 and 39:
28 models might be useful. On the o
Page 40 and 41:
30 the questionnaire in February 20
Page 42 and 43:
32 2.5 Summary According to the lat
Page 44 and 45:
34 anxiety, agitation, tremor, teet
Page 46 and 47:
36 may be stronger than the link wi
Page 48 and 49:
38 Srisurapanot and colleagues (200
Page 50 and 51:
40 Psychiatric problems appear to o
Page 52 and 53:
42 In 2005, there was a total of 68
Page 54 and 55:
44 The most recent EDRS survey foun
Page 56 and 57:
46 same reasons they use the drugs
Page 58 and 59:
48 Shoptaw and Reback (2007) review
Page 60 and 61:
50 It has also been speculated that
Page 62 and 63:
52 Parental ATS use In addition to
Page 64 and 65:
54 The Minnesota Department of Heal
Page 66 and 67: 56 Chapter 4: Prevention and Harm R
Page 68 and 69: 58 should cover the full range of d
Page 70 and 71: 60 specific drug (Spoth et al., 200
Page 72 and 73: 62 be applied regularly and systema
Page 74 and 75: 64 Strategies targeting vulnerable
Page 76 and 77: 66 Examples of particular periods t
Page 78 and 79: 68 At-risk workplaces There is incr
Page 80 and 81: 70 The consultation forum with Abor
Page 82 and 83: 72 young people was noted in the su
Page 84 and 85: 74 and/or others); mental health ef
Page 86 and 87: 76 of the fact that frequently peop
Page 88 and 89: 78 Sexual risk behaviour is a furth
Page 90 and 91: 80 • Cleaning up; • Transport o
Page 92 and 93: 82 Assessing the risks of illicitly
Page 94 and 95: 84 4.4 Challenges of applying preve
Page 96 and 97: 86 but a number of studies are now
Page 98 and 99: 88 The pack included a video, train
Page 100 and 101: 90 Chapter 5: Treatment and Service
Page 102 and 103: 92 to the occurrence of amphetamine
Page 104 and 105: 94 In relation to the need for spec
Page 106 and 107: 96 These studies replicate earlier
Page 108 and 109: 98 addressed not only the drug user
Page 110 and 111: 100 Research conducted in the subse
Page 112 and 113: 102 users, data that may be general
Page 114 and 115: 104 that limit brain exposure to me
Page 118 and 119: 108 through the use of antipsychoti
Page 120 and 121: 110 to develop the capacity of the
Page 122 and 123: 112 It was also suggested that link
Page 124 and 125: 114 as new evidence emerges. New ps
Page 126 and 127: 116 border in 2000 (McKetin et al.,
Page 128 and 129: 118 Table 6.1: Number of clandestin
Page 130 and 131: 120 Table 6.2: Examples of domestic
Page 132 and 133: 122 Tasmania In 2004, strengthened
Page 134 and 135: 124 Recommendations from the consul
Page 136 and 137: 126 Although there are a number of
Page 138 and 139: 128 illegal drugs. When incarcerate
Page 140 and 141: 130 heroin) (Payne et al., 2007). I
Page 142 and 143: 132 Some examples of diversion prog
Page 144 and 145: 134 Other research has compared psy
Page 146 and 147: 136 Rehabilitation in Corrections T
Page 148 and 149: 138 Synthetic Drugs measure will im
Page 150 and 151: 140 • Stealing from motor vehicle
Page 152 and 153: 142 criminal offences There continu
Page 154 and 155: 144 • Increase international coll
Page 156 and 157: 146 • Ensuring offence and penalt
Page 158 and 159: 148 Law enforcement agencies are pl
Page 160 and 161: 150 Appendix 1 National consultatio
Page 162 and 163: 152 Appendix 2 Written submissions
Page 164 and 165: 154 Australian Institute of Health
Page 166 and 167:
156 Bowers, J. & Johnson, S. (2003)
Page 168 and 169:
158 Crits-Christoph, P., Siqueland,
Page 170 and 171:
160 Drug & Alcohol Services South A
Page 172 and 173:
162 Halkitis, P.N., Parsons, J.T.,
Page 174 and 175:
164 Hull, P., Rawstorne, P., Zablot
Page 176 and 177:
166 Leek, L., Seneque, D., & Ward,
Page 178 and 179:
168 McKetin, R., McLaren, J., Kelly
Page 180 and 181:
170 NSW Health (2006). Psychostimul
Page 182 and 183:
172 Ressler, K.J., & Nemeroff, C.B.
Page 184 and 185:
174 Small, W., Kerr, T., Charette,
Page 186 and 187:
176 United Nations Office for Drug
Page 188 and 189:
178
Page 190:
180
show all

National Amphetamine-Type Stimulant Strategy Background Paper

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?