Anecdotal Trends in Substance Use Melbourne CBD Ramez Bathish Living Room PHS
Overview • Introduction • Trends in Melbourne • Commonwealth Games • Impact of Policing • Addressing Future Trends
Living Room PHS • Primary Health Service for marginalised people who use drugs. • Community Development, Harm Reduction and Primary Health. • 1 Doctor (pharmacotherapy), 1 nurse, 4 drug safety workers, 2 laneway workers. • Client group: PWID, 18-35yo, homeless, mental health issues, dual diagnosis, Hep. C, intellectual disabilities, HIV, no triple diagnosis. • Foot Patrol – NSP in Melbourne CBD – Russell St.
Case Example • “Paul” – 30yo male, homeless, IDU, injects pills (without wheel filter), mental health issues (ADHD & undiagnosed disorder) • Presents regularly at both PHS and NSP. • Increasingly chaotic over last few months. • Homelessness is compounding mental health & substance abuse issues – visa versa • Daily pick-up of meds, limiting substance abuse.
Trends in Melb CBD 2006-07 • Gauged through ppl. Presenting at PHS and Foot Patrol NSP. • (Most common to least common): Alcohol, heroin, benzos -poly-drug use, methamphetamine, Opioid-based pharmaceuticals – e.g. MS Contin, Cappinol, Physeptone, “bupe”, “done”, VSU – chroming, other pharmaceuticals (seroquel) • Increasing quality / purity of heroin – more intoxicated clients, no change in rate of ODs. • Street-based heroin scene most active in Richmond area.
Trends cont.. • Pharmacotherapy program at Living Room PHS is full, operating near capacity over the last year- 60% methadone, 40% suboxone / bupe. • Clients tend to prefer pharmacotherapy treatment over detox / rehab. – indicative of greater efficacy? • No noted change in BBV transmission. • Not seeing increased diversion with increased flexibility of takeaways - suboxone. • Increase in street price / availability of Xanax.
Other trends 2006 - 07 • Increase in use of Opioid-based medication – MS Contin etc.. • Large percentage of pill injectors not familiar with wheel filters. • Slight increase in knowledge and awareness of butterflies for methadone diversion. • No noted increase in methamphetamine use – in line with stats. (Statistics on drug use in Australia 2006, Victorian Drug Statistics Handbook 2006) • Less VSU clients, (more commonly youth). • Dual diagnosis & homelessness an ongoing issue.
Since the “drought” • CBD not significantly affected by drought 2000 - 01. • Significant drop in Foot Patrol NSP contacts since Nov. 2005-2006 but relatively stable since. • Slight peak in activity into Nov. 2005 then policing presence stepped up 4 - 5 months before Commonwealth Games. • Increased police presence in CBD Nov ‘06- April ’07 – street-based heroin scene dropped off – no outreach on Russell St. • Increased activity in Richmond area 2006 -07.
Commonwealth Games • Heroin scene on Russell St. effected- no outreach on Russell St. • Scene activity in Richmond increases. • Police pressure in Melb. CBD, less so in Richmond. • Police brought in from regional Victoria - not familiar with particulars of policing CBD. • Marginalised people more “exposed” / targeted. • Increase in police harassment / clients placed in holding cells for minor offences. • Collaboration with Office of Police Integrity & Fitzroy Legal Service with Living Room & Foot Patrol NSP.
Impact of Policing • Significant impact on street-based heroin scene / trends in CBD. • Saturation policing poses risk to PWID and public health. • Compounds existing risk factors – e.g. less inclined to access NSP, unsafe disposal practices. • Improved relations / dialogue with Police since mid 2006– encourage referrals to Living Room. • Foot Patrol now gives new Police recruits (East Melb.) induction about Harm Reduction, NSPs, drug use etc..,
Safe Injecting Facilities - addressing future trends.. • Challenge of addressing harms associated with street-based drug use in PHS. • Often the impacts of drug related harm are addressed down-stream – post BBV transmission, ODs, legal issues etc.. • A Safe Injecting Facility addresses risk factors for street-based users directly – addresses safe injecting practices, referrals etc..
Insite Safe Injecting FacilityVancouver Canada.the stats, 2006 – A case for Safe Injecting Facilities • 7,278 unique individuals registered at Insite • 453 overdoses resulted in no fatalities • 4,084 referrals were made with 40% of them made to addiction counseling • Referral to withdrawal management: 368 • Referral to methadone maintenance: 2 per week • Daily average visits: 607 • Busiest day: May 25, 2005 (933 visits in 18 hours) • For more info on InSite: http://www.vch.ca/sis/