volume 10edition 6

Anex is leading INTERNATIONAL OVERDOSE AWARENESS DAYwhich is on August 31. We hope that all services find ways torecognise the Day and become involved. Founded by Sally Finn,International Overdose Awareness Day is about preventionand remembering loved ones. It’s an opportunity for peopleto mourn, some for the first time, without feelings of guilt orshame. It’s also about people supporting each other to raiseawareness about the preventable tragedies of overdose.Visit www.overdoseday.com to learn how your servicecan be involved.

Keith Hassett, now 70, looked in on his sleepingson Shane and decided to give him an extrahour of rest. It was another act of parental lovefor a son whose deep snoring was actually anunrecognised sign of being on death’s doorstep.

Shane was accidentally overdosing. Hookedon doctor-shopped opioid-based painkillers,he was suffering from an undiagnosed boutof pneumonia. With his respiratory systemalready compromised, the depressant effectsof the drugs proved deadly.

“Pneumonia and the drugs together just didn’tgo,” said Keith, who still works as a backyardmechanic based out the house - in a regionalcity - where he lives with his wife.

Shane, 29, had come up from the city thatnight 18 months ago and was staying at mumand dad’s. He was looking forward to meetinghis wife and their newborn baby the nextafternoon. As was common, Shane pacedthe house until nearly dawn.

At 6am Keith told him to lie down in hischildhood bedroom and have a good sleep,adding that he would wake him at aboutmidday and then they would go and seeShane’s daughter. “I came in at about 12.15,and he was snoring his head off. I thought,‘no, I won’t wake him. I’ll leave him lie therefor a little bit longer’.”

Keith went outside to work on a car. “I cameback in at about ten past one. And I thought,‘That’s strange - he’s not snoring anymore.’I didn’t think anything more of it. I washed myhands, came back in and said, ‘Shane, come on.Wake up’.” There was silence, and no response.

“Then I realised he was gone.”

Snoring or ‘gurgling’ is one sign of overdose,but one that too few people are aware of.According to Narelle, her sister heard Shane“gurgling horribly, which she will never forget”the previous two nights before he died.

The Facebook rumour mill cranked up justhours after his death. Shane’s sister Narelle,who works in residential care for intellectuallydisabled adolescents, was furious when she sawhow wild some of the stories were.

“On the day he passed away, I saw onFacebook… all these comments. Someonesaying that they’d heard there had been apolice chase and he had thrown himself infront of a train. Someone said they heardthere was a big shoot-out with the police.And I thought, ‘Are they talking about mybrother?’ So I just wrote something and said,‘If you are, remove it’. I told them to remove it.”

Shane’s wife Alicia had not long given birthto their first child.

“There were a lot of rumours,” Alicia said.“All this bizarre stuff started coming out.We didn’t want people thinking that [thathe jumped under a train], because he didn’t.He didn’t commit suicide. He didn’t wantto leave me and his child and his family.We wanted to make sure that people knewthat it was an accident, a tragic accident.”

Alicia and Narelle have decided to speakpublicly about pharmaceutical drugprescribing to highlight the tragicconsequences it can have upon any family.

“That’s why I decided to speak out by writingto my local newspaper,” said Narelle. “I wasthinking about it from when all this started.Our family, and me and Alicia in particular,felt so alone with it. We didn’t feel likeanyone in the world had the same issue.

“We didn’t know where to go for help, wedidn’t know how to tackle any of the bigproblems coming up. We didn’t know how todo anything. And when he actually did passaway, I just found myself so angry with thefact that we hadn’t found any help. We wereunable to sort of talk about it with anyone,and I just wanted other people to know thatthere are other people out there.

“Mum was completely against me writinga letter to the newspaper and telling anyone,really. She didn’t want anyone to know. It’sbecause of the perception that people have.I think she was worried people would thinkshe was a bad mum…all of that.”

Continued on page five.

Read Shane’s story on pages four and five.

INTERNATIONAL OVERDOSEAWARENESS DAY

Beware Snoring or Gurgling: page 5 Up In Flames: page 6 AUGUST 31 - Local Ideas: page 7

Anex’s vision is for a society in whichall individuals and communities enjoygood health and wellbeing, free fromdrug-related harm. A community-based,not-for-profit organisation, Anexpromotes and supports Needle andSyringe Programs (NSPs) and theevidence-based approach of harmreduction. We strive for a supportedand effectively resourced NSP sectorthat is perceived as being part of thesolution to drug-related issues.

Chief EditorJohn Ryan

EditorDr Patrick Griffiths

WritersRoyal AbbottNicola CowlingKelly EngDr Patrick GriffithsPaul Hines

CorrespondenceAnex BulletinSuite 1, Level 2,600 Nicholson StreetFitzroy North VIC 3068Australia

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The content of the Bulletin is intended to stimulatediscussion and information sharing and does notnecessarily represent the views of Anex. It does notencourage anyone to break the law or use illicit drugs.While not intending to censor or change their meaning,Anex reserves the right to edit articles for length,grammar and clarity.

Anex takes no responsibility for any loss or damagethat may result from any actions taken based onmaterials within the Bulletin and does not indemnifyreaders against any loss or damage incurred.

This publication has a targeted readershipand is not intended for general distribution.

All written material in this publication may bereproduced with the following citation: ‘Reprintedfrom vol. 10, ed. 6 of Anex Bulletin, published by Anex’and with credit to the author(s).

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The Anex Bulletin is funded by the AustralianGovernment. The views expressed in this publicationare not necessarily those of the Australian Government. Citations for the edition are available online athttp://www.anex.org.au/publications/anex-bulletin

ISSN: 1447 - 7483

July/August 2012

2

Investigation shows US soldiersOD-ing in AfghanistanUnited States Army investigative reports have found that eightAmerican soldiers died of overdoses during deployments inAfghanistan in 2010 and 2011.

The overdoses (involving heroin, morphine or other opioids) came tolight during an investigation into 56 soldiers who were suspected ofpossession, use or distribution of drugs. Although the results of theinvestigation, which was undertaken by Army Criminal InvestigationCommand during 2010 and 2011, show that some soldiers were usingheroin, they reveal that much of the opioid abuse by the US military inAfghanistan involves prescription drugs such Percocet (a combinationof acetaminophen and oxycodone). It should be noted that the datadoes not reflect the statistics released by the Army in early 2012 thatreported close to 70,000 drug offences by approximately36,000 soldiers between 2006 and 2011.

Fentanyl overdoses in border areaGateway Community Health in Wodonga has expressed concernabout another spate of overdose deaths from fentanyl injectionin the Albury-Wodonga region.

Fentanyl, which is marketed in Australia as Durogesic®, Actiq® andSublimaze®, is intended for use as a painkiller for people with hightolerance to opioids. It is around 80 to 100 times more potent thanmorphine (100mcg/hr fentanyl being approximately equivalent to10mg of morphine and 75mg of pethidine). It is intended for use withpeople experiencing extreme pain that cannot be controlled by othermedications.

The Gateway Community Health alcohol and other drugs teamsaid use of fentanyl was becoming more widespread. They reportedhaving been informed by clients that a doctor in nearby rural NSWwas providing scripts for the drug, which was then transformed intoan injectable liquid.

UN calls for naloxone to bein overdose prevention programsNaloxone Hydrochloride has been used to safely reverse the effectsof opioid intoxication in hospitals and by paramedics for decades.Its only action is to reduce the effect of opioids.

The UN’s supreme voice on drug policy, the United NationsCommission on Narcotic Drugs, has passed a resolution recommendingthat naloxone be provided to potential overdose witnesses as part ofoverdose prevention and treatment strategies. Naloxone’s inclusion inprevention programs is now a mainstream topic in the US, with eventhe Centers for Disease Control providing financial support to theirevaluation to inform the evidence base.

In light of evidence from around the world that naloxone provisionis safe and effective, in March 2012 the United Nations made thefollowing recommendations:“Opioid overdose treatment, including the provision of opioid receptorantagonists such as naloxone, is part of a comprehensive approach toservices for drug users and can reverse the effects of opioids andprevent mortality”;

The Commission added that it:“Encourages all Member States to include effective elements forthe prevention and treatment of drug overdose, in particular opioidoverdose, in national drug policies, where appropriate, and to sharebest practices and information on the prevention and treatment ofdrug overdose, in particular opioid overdose, including the use ofopioid receptor antagonists such as naloxone.”

Additionally, on 12 April in Washington DC, the United States’leading drug regulatory agency, the Food and Drug Administration,held its first-ever scientific symposium on naloxone distribution.

Endorsement by the UN Commission comes as Australia’s firstprogram to train potential overdose witnesses (including drug users)in administering naloxone has begun in the Australian Capital Territory.The South Australian Alcohol and Other Drugs Strategy 2011-2016has listed trialling the provision of naloxone as one of its priorities.

news briefs

OVERDOSE PERSPECTIVESDrug safety worker“I remember attending an overdose one night when working inthe CBD on NSP outreach. A couple of boozed-up young menwere doubled over laughing outside a convenience store andmade some reference to the ‘junkie’ lying on the floor. Mycolleague and I hurried over to investigate and found a man lyingflat on his back and unconscious under the bright fluorescentlights. The shop assistant, perhaps in a moment of panic, hadlocked the doors. We banged on the door and yelled for him tolet us in. He looked terrified but, after a little hesitation, openedthe doors. We promptly asked if he had called an ambulance. Hehadn’t, but did so on our instruction.

“We recognised the man on the floor as he had accessed theNSP earlier in the evening. He was pale and clammy and his lipswere turning blue. My colleague and I performed expired airresuscitation on him - this was back in the days before CPRchanges were brought in by the Australian ResuscitationCouncil. The whole process was much trickier than on theAnnie mannequin, but all that first aid information certainlycomes rushing back to you.

“Within minutes the ambulance crew arrived, took over theresuscitation process and administered Narcan. The ambos weregreat, very quick and very considerate. After what seemed likehours (but was probably more like five to 10 minutes), the manregained consciousness He eventually sat up looking overwhelmedby the situation he had suddenly found himself in, and withinmoments jumped up, out the door and ran off down the street.We followed him to check he was okay and to give our wellrehearsed harm reduction messages about the Narcan wearingoff and so on. Feeling a little deflated and concerned, we wereboth suddenly elated as the man stopped suddenly, turned back tous and called out ‘Thank you!’ before disappearing into the night.”

People who live in areas with high drug use“Last time I saw a guy … lying on the ground where I live, so I comeclose by, I kick, not kick, I touch his head and we say, ‘are you allright?’ like that and, yeah, he answer me back and I know he is ok.But once I just go and tell the security and let them go and check.

“I saw a guy lie down on the floor and I went near to his shoulder -on the head side but I don’t stand near the feet because I wastaught you never stand near the feet because they can just getup and hit you. I said, ‘Are you all right?’ One was okay, butanother didn’t respond so I go back to my building and I reportto the security that there was an overdose. But people don’tcare, they just go past.”

MICA Paramedic“I recently went to a Gamma-Hydroxybutyric acid overdosecall-out at 7am. A bloke had had a fight with his girlfriend thenight before and took a small bottle of the stuff first thing inthe morning. His dad rang us. We got there and he looked prettyfine. He was about to get into the ambulance when he said,“Hang on a minute, I’ve got to get something”. He disappearedinside and came out again eating a piece of cold pizza.

“He got in the back, [but] after a few minutes he was fading inand out. We got him going again, but when we got to Emergencyat the hospital he just blacked out. He went straight into theintensive care unit and was intubated [had a tube passed downhis throat to control his breathing]. He was unconscious for acouple of days. He would have died without the intubation.

“It just shows how lucky he was that someone called theambulance, or he’d have been dead.”

OVERDOSE PERSPECTIVES

3

From littlethings bigthings grow

In the late 1990s, newspaper headlinestrumpeted that people were dropping likeflies from drug overdoses. The analogyaccurately reflected the view of the public,many of whom saw dead drug users as pestsor worse. Even the families of the dead wereaffected by public condemnation.

Community health worker Sally Finn wasmanaging a busy needle and syringe programat the time and saw her clients wrestling withtheir sorrow over friends’ overdose deaths.She saw victims’ families struggle with thenotion that “good people don’t take drugs”and she sensed oceans of unwept tears thatneeded release.

Out of this was born Overdose Awareness Day,a commemoration that has been adoptedaround the world.

There is also Remembrance Day which wasestablished in 1996 by Family and Friendsfor Drug Law Reform (ACT) and focuses oncommemorating all those who have diedfrom the use of illicit drugs, and not justfrom overdose.

“I was talking to a lot of people who wereclients of the exchange, and some of themhad lost up to 17 friends,” Finn told the Bulletin.Yet she found that the families of the overdosevictims were often in denial about drug issuesand refused to allow friends who used drugsto attend funerals. “Some people hadn’t evenbeen invited to their partner’s funeral. In factthey were told to stay away. As a friend it waseven more difficult sometimes to attend theirfriend’s funeral. They weren’t welcome.”

Finn decided to try and break down the barriersof shame and guilt that prevented familiesfrom accepting their lost relatives as peoplebeing worthy of recognition for who they were,rather than of being denigrated for what theywere doing when they died.

“It occurred to me that not only was there nota spot for them to pause and reflect on all thatloss, but that we had no way of telling themthey were important.”

Finn was trained as a social worker in childpsychology. “I’m a family therapist and asocial worker and I’d left the [Royal)] Children’sHospital and taken a job with the SalvationArmy crisis services at the Health InformationExchange (HIE) needle and syringe program[in St Kilda, Melbourne] in 1998. I was askedto manage the program in ’99.”

This was when the heroin scene was near itshistorical peak.

She said the impetus for doing somethingcame when, early in 2001, a communitydevelopment worker from the City of PortPhillip told her there was some money fordrug and alcohol services in the St Kilda area.

The funding was a meagre $750. Withassistance from the council, Finn and theHIE team began making and distributingsilver ribbon pins both through the NSP andat other local outlets such as municipallibraries and town halls. “We bought ribbonsand pins, we set a date and we organised asmall event at the backyard of the crisis centrein St Kilda. In the lead-up to the day we werethinking we would probably give out 500ribbons - but we gave out 6000 that first year.

Joan Nicholas, whose son had died of a drugoverdose, spoke movingly about loss thatfirst year.

“She was very much able to express all of this,not only to me, but to the audience that day,”comments Finn. Her story, as in all thesestories, is not straightforward. It gave a chancefor people’s siblings, who perhaps aren’t in thisworld of drug using, to realise other peoplecare. This is something we are taking note of.It is not just a hidden epidemic or a hiddenreality.”

There was also a broader message to OverdoseAwareness Day, about drug dangers. “Rightfrom the beginning, Overdose Awareness Day

up drugs over the course of their life and haveinevitably struggled.”

Finn is still surprised at how the day caughton. “In early 2000s, India acknowledged theday in Bangalore and Hyderabad. A couple ofdoctors got together and held huge events.Then in Minnesota there was one womanrunning a needle exchange and she gotheavily involved.

“Then I started to see a few things on theinternet. Early in 2008, I wrote to AntonioMaria Costa heading up the United NationsOffice on Drugs and Crime (UNODC), whowrote to me and said he would definitelywear a badge on the day and said: ‘Our heartsgo out to people who have lost loved ones,and good luck’.

London-based Harm Reduction Internationalhas also taken up marking the day, as has theUnited States’ Drug Policy Alliance.

“It has really probably been through theinternet that it has taken on a presence in thecalendar and that’s what’s really important tome: that the more people you can get talkingabout the same thing on the same day, thebetter we are in terms of influencing change.”

was about all drugs; it wasn’t just about heroinor opioid-related drugs. Right from thebeginning, we talked about pharmaceuticalmedicines and alcohol as being a contributingfactor if not an absolute factor. There arepeople dying of alcohol overdoses - there isno doubt about it.

“We talked non-fatal overdoses. There is awhole group of people living in our societywith permanent injuries from non-fataloverdoses, and that manifests in a physicalsense. They may be paralysed or have stroke-like symptoms, so we really wanted tohighlight all the different aspects of overdose,not just the mainstream stereotype versionof what people perceive as somebody dyingfrom an overdose.

“We wanted to make sure that people andfamilies were able to attend and, for maybethe first time, felt they didn’t need to hide thefacts surrounding their child’s death or theirparent’s death. It’s very easy for mainstreamAustralia just to think of overdose victims asa kind of cardboard cut-out person. So it’sreally about elucidating the facts and strugglesaround people that have often tried to give

‘Our hearts go out to people who have lost loved ones,and good luck.’

Sally Finn who establishedOverdose Awareness Dayin 2001.

Killers of hurt bring pain to normal families

Continued from page one.

“But I just said, ‘It’s more important to let people know that Shane was areally great guy, and not just a drug addict who would die one day’. I thinktelling his story is far more important that what your neighbours think.”

Shane’s parents, who are well known in the regional city they live in, arenow more able to discuss the circumstances leading up to his death. For herpart, Alicia remembers her husband as a meticulously presented person whostudied a Bachelor of Arts and then finished a trade apprenticeship. Heworked and was a fitness fanatic whose addiction to opioids - never illicitdrugs - started after being prescribed painkillers for an earache.

Alicia and Narelle have harnessed the positive potential of Facebook bystarting a page to highlight the risks of prescription drug misuse toencourage networking for people affected by addiction, particularly thosewho have lost loved ones.

“I think the hardest thing for me was just seeing the person that I knew andloved unravel before my eyes and not having anywhere to go,” Alicia said. “Itwas just a constant daily struggle, with no solution.

“I know drug addiction doesn’t have an easy solution anyway, but it just feltfor me - I know Narelle was there as well helping, but I was living withShane, dealing with it 24 hours a day. And it was just seeing himgo downhill so quickly, and what felt like irreversibly, and not just havinganything in place to help him. That was the hardest part.”

“He used to run everyday - he’d run anywhere, five or 10 kilometres at atime,” said Keith. “Then he’d come back and do weights. He had his ownset-up. He was super fit. For a person to be that fit and go like that; it’s justnot right.”

Keith is hoping that doctor-shopping can be reduced through real-timemonitoring and is supporting Alicia and Narelle’s mini-campaign.

“Hopefully we can achieve something out of all this. And this is what myaim is - we can’t help Shane, but we might be able to help somebody else.”

Gurgling and snoring is due to collapse of the airway becausein coma, the normal muscle tone that keeps the airway open iscompromised by the depressant effects of drugs, usually combineddrug toxicity involving opioids, benzodiazepines and/or alcohol.

Other Central Nervous System depressants can also contribute tocoma, such as antidepressants and antipsychotic drugs.

The other thing about prolonged coma, whether prior to death ornot, is the retention of secretions in the airway and lungs, or alsodescribed as failure to cough up and clear normal secretions. This often results in infection of these secretions, leading topneumonia.

Many people die from unrecognised coma, like Shane, whose fatherheard him snoring loudly. People mistake this for someone sleepingdeeply, when in fact it is unrecognised coma, and the person has acollapsed airway - one of the cardinal signs of coma.

Beware snoring or gurgling

INTERNATIONALOVERDOSEAWARENESS DAY

4 5

In the dead of night, Shane,addicted to doctor-shoppedprescription drugs, stuck a samuraisword down his trouser leg andwalked into the service stationthat he intended to rob.

“It was a cry for help,” said his wifeAlicia, who is still grieving

after her husband diedfrom an overdose in

December 2010before he

could besentenced forthe robbery. Herview seems reasonablein light of the fact that theservice station Shane robbed,by the modus operandi ofpointing to the handle of theallegedly fake sword, was oppositea police station.

“He thought by doing that across theroad from a police station, that theywould be there in minutes, but thatwasn’t how it panned out and hehanded himself in a week later.

“Speaking to Shane afterwards, he felthe couldn’t do anything else otherthan to do something to get locked upto stop using. He thought that by goingto jail he could get off the drugs,” Aliciatold the Bulletin.

“So for me, in a strange kind of way, it feltlike we had turned a corner, if you knowwhat I mean. I wasn’t happy with whathe had done, and how it affected everyone,and, like, I didn’t condone it all - but therewas a part of me that thought, maybe hewill get some help now that it’s come tothat. Something will change now.’’

Cry for help or not, the service stationattendant, who is married with a youngfamily, was deeply traumatised by theexperience and has since suffered nightmaresand panic attacks. He had to quit his jobfor psychological reasons. While he has nosympathy at all for Shane, he does feel forthe family that survived the accidentaloverdose.

Never a heroin user, rarely a drinker andholding down a steady job throughout thegreater part of his addiction, Shane becamedependent after being prescribed PanadeineForte®. Alicia explained how innocently herhusband’s ultimately fatal use of painkillersbegan.

Deadly escalating cocktails“It started with his ears. He had constantearaches and we went to the local hospital.This happened constantly. One night we wentup there and they gave him Panadeine Forte®.That helped for about a month. He went tothe doctor again and again, and, rather thandoing something about it, they kept givinghim panadeine.

“The ear-aches went on and off for a coupleof months. Then he got glandular fever. Hethen had his ears, his teeth and his throatflaring up on and off, and all the time hewas given painkillers. Before he knew it,all he was doing was taking painkillers.”

Shane’s sister Narelle added: “I didn’t reallythink too much of it when he was having a lotof Panadeine Forte® and tramadol and stuff.Tramadol was the big one. That was in his

system the day he passed away. You don’t tendto think that someone is going to, you know,abuse prescription drugs, and you trust thatthe doctor wouldn’t keep giving it out.”Narelle and Alicia explained to the Bulletinthat Shane was so freely able to organise anetwork of loosely prescribing doctors anddispensing pharmacies that they are joiningthe chorus of people calling for genuineimplementation of widespread andinterlinked “real-time” monitoring systems.

Alicia said that on weekends Shane would getinto his car early on a Saturday and be goneall day as he drove hundreds of kilometreson a well-worn round of regional and ruraldoctors. He had told his family that one doctorwould not record the appointment and wouldtake cash in hand to write the script.

Eventhoughhe earned atleast $1000 a week,Shane’s spending on pillsand the petrol to get themmeant he’d be almost out of moneywithin days of being paid.

“It just started out with your regularpainkillers,” said Narelle. “In the last two yearsit got to the point where he was hiding stuff.We found out he was having Endone®,OxyContin®, Largactil®.”

He was also taking Panafen®, Nurofen Plus®and tramadol.

“There was one doctor who had prescribedhim Largactil® and then prescribed himsomething for the tremors that the Largactil®was causing. It got to the point where Shanehad to have 80 codeine tablets (NurofenPlus) just to feel normal.

“At the time of the robbery, that’s where hewas at. Plus he’d had 50 Xanax® [used to treatanxiety disorders], half a packet of Endone®and Valium® as well.”

Treatment attemptsAccording to both Narelle and Alicia, Shaneapproached local drug treatment agenciesseveral times many years ago to try to get intoa program. The treatment teams were unableto offer him a spot because, not being a heroinor amphetamine user, they couldn’t prioritisehim over those who were.

“That happened so many times,” said Alicia.“He’d be at the point where he would wanthelp, and you’d ring around detox places, andthere’d be no beds. Unless you have a lot ofmoney to pay upfront, you can’t get someonein that day, or that moment.”

Experience with heroinUnlike her sister-in-law, Narelle does haveknowledge of addiction and overdose, whichsomehow makes it all the more traumatic toher that she is alive while her brother is not.

“I used to be the heroin addict. I moved tothe city when I was young and was homelessfor a while. It was in 1998-9 and heroin wasjust everywhere. I overdosed once and nearlydied [she was revived with naloxone].

“Shane thought I was off my tree for eventhinking of doing drugs, and being an addict.He was horrified,” she said.

Narelle moved back to the country and goton a program with a doctor who would travelout from the city, and was off methadone andillicit drugs by 2003.

“Nothing really prompted me to get ontomethadone, except for the fact that

I thought one day,‘I just don’t want

to die’. Andbecauseof family:I could see

what Iwas

doingto

everyone else,” she said.“And that’s what I find absolutely bizarre:that he’s gone now, and I’m here alive.”

Real-time monitoringNarelle said she had begun tocampaign for real-time prescriptionand dispensing monitoring outof both a sense of anger and the need to raisepublic awareness to destigmatise the loss ofloved ones through overdose.

“It’s actually getting worse [pharmaceuticalmisuse], and that makes me angry. We havethese health professionals that are meant tobe looking after people, giving them the bestoutcomes, yet a lot of these doctors arecreating drug addicts.

“Whether they are doing that intentionally ornot, that’s a fact: they are giving out all thesestrong painkillers, and it’s legal so they’regetting away with it. That’s what I startedtelling people.

“Perhaps if there was a bit morecommunication - hence me wanting to getthe real-time system in - between doctorsand pharmacists and Medicare, then someonecould be alerted more quickly as to how oftensomeone is going to the doctors and gettingthose prescriptions. It could have beenmonitored a bit more closer in Shane’s case.”

Narelle added that the mother of one ofShane’s friends was a pensioner who wasable to get multiple scripts for painkillersand would then sell the pills. Her brotherwas paying $300 a packet.

Doctors lack knowledgeof addictionsIt is a well established that there are notenough doctors with extensive knowledgeof - or experience in - treating people withsubstance-misuse-related problems. This isparticularly the case in regional and ruralareas.

“At one point about five or six years ago,when we realised things were getting bad,Shane went to the family practice and askedto see a different doctor than normal. Justby luck, he saw a doctor who had come fromCanberra and had experience with [treating]addiction,” Alicia explained.

“The doctor was worried about the potentialliver damage of paracetamols, so he put himon codeine and then worked on a programto reduce the dosages. And we were seeinghim constantly, and I was going with him andhe got down to quite a low level. But thedoctor moved away so they just had anotherdoctor, who wasn’t experienced with it.”

The problems resumed, and with tragicconsequences.

Shane and Alicia Hassett with their newborn girl months before Shane passed away.

COMMENTS FROM AN EXPERT

Someone’s sister, someone’s brother

6

“It was just like living in a big share house,except with bedroom doors that are lockedfrom the outside” is how youth worker LukeMitchell describes his time mentoring juvenileoffenders between 1998 and 2004.

“Normally [in detention] they were very sweetyoung men or women. But then they weredrug-free,” he said in a tone heavywith resignation and the recollection of theall-too-frequent tragic sequel. “I rememberone girl. She said she’d get out and have justone last hit and that would be it. So shecaught up with a couple of friends.

“The three had a hit. Only two of them wokeup. That was the night after she got out. Shewas only 15 or 16.”

Between 80 and 90 per cent of the youngdetainees at the Youth Residential Centre Lukeworked at had been heroin users before theywere arrested and incarcerated. The high

heroin use rate was all the more shocking inthat Juvenile Justice incarcerated boys only upto 15 years old (the girls were aged up to 21).Keeping these young people off heroin oncethey’d been released was a significantchallenge.

“Every time you released a young person, youwondered whether you were going to see herback or go to her funeral,” Luke told theBulletin.

Preparing young drug users for survival in adangerous post-release drug environmentwas one of the officers’ and youth workers’top priorities, said Luke. Staff tried to protectthe youngsters by educating them aboutdifferent drugs and telling them to takecare when they were back on the streetbecause they would have no tolerance toheroin. They also tried to get them ontopharmacotherapy to give them a protectivebuffer against street opioids.

Getting them onto pharmacotherapyprograms and in touch with a good prescribingdoctor and an understanding dispensingpharmacist was crucial pre-releasepreparation. As the detainees drew close totheir release date, they became entitled to goout of the centre on leave. Luke said their caseworkers would take them to their doctor and,a week before getting out, they would startbeing dosed at a pharmacy.

But they could not force detainees to go ontopharmacotherapy; some chose not to,sometimes with tragic results.

“We lost quite a few who wouldn’t go on aprogram.”

Luke says coming to terms with the lostpotential in those young lives was verytraumatic.

Luke was contacted when one client, who hadonly recently been released, didn’t turn up ather job one day. “Part of my role was to keepan eye on them, and when I phoned she saidshe was at home. She sounded a bit upset soI went over there and said I was coming fora cup of tea. Little did I realise that, just beforeI got there, she hit herself up with a big dose.So I’m sitting there having a cuppa and she’sdropped in front of me. Luckily the amboswere able to save her.”

He believed most of the young people heworked with took drugs for self-medication

after a history of trauma. Mainly arrestedfor possession and dealing on the street, theywere the bottom of the food chain in the drugworld, usually dealing just to support a habit.He said one of the difficulties was that theyhad very little drug education and would mixuppers and downers and take cocktails.

Luke’s six years as a Juvenile Justice youthworker took a heavy toll. “We’d try and equipthem with harm reduction strategies,but, despite all the warnings, you just cannotcontrol what they do once they get out. Youmake follow-up phone calls to makesure they’re alright.”

Hearing about clients overdosing wasdevastating, he said. “You work with themon a daily basis and to do it well you need toconnect with them and have compassion.Inside you get to know them well becausethey’re not on drugs and you see theseare just normal kids. They’re kids in needof help.

“I went to a funeral of a girl who’d been outfor five years. I’d kept in touch through theemployment program. You don’t go becauseyou need to, it’s because you have arelationship with these people. You wantthem to succeed. You certainly don’t wantany harm to come to them.

“It wrecks you when it happens. And you haveto look their parents in the eye.”

Young offenders can be voracious andindiscriminate drug users. Juvenile Justiceworkers try their utmost to prepare youngoffenders in detention for release knowing theywill be prime candidates for overdose. They donot always succeed.

Living to tell the tale - survivors stories“Outside was the car. I looked over and thecar was a bare metal hull. You could see thesprings in the seats, it was so burned out.I thought, Jesus Christ! I just couldn’t puttogether what had happened.

“The cops were questioning me. I was stillout of it. Then the pain starts kicking in fromthe burns. But the paramedics couldn’t doanything because they know you’ve justoverdosed on heroin.

“The first person to see me at the hospitalwas my girlfriend, and from her reaction Iwas pretty bad. When I looked at myself Iwas blackened from head to toe, just blackand swollen. Took me months to recover.

“My face and head was completely bandaged,with only holes for my eyes and mouth. Andthe thing I learned from that was how it mustfeel to have some deformity, because peopletreated me like a freak, a monster.

“It’s just the way people stared and acted. Youcould tell they weren’t seeing you as a person- you were an object of horror. They standjust a bit more distant. I can’t imagine howpeople live with that.”

Gino has been on methadone for severalyears now and says he struggles with hisaddiction daily. On the subject of overdose,he can only say: “There have been moreoverdoses, some in even more bizarrecircumstances. I’ve been way too lucky.”

Continued from page eight.

Cora was living in a Sydney squat with fiveothers and studying shiatsu. She had been auser but had stopped for several months tofinish her studies. “Everyone that lived therewas using at the time, except me becauseI was doing the course. There was constantshooting up around me.

“I’d get ready for school in the morning andstep over someone mixing up in my room,walk past someone with their forehead onthe ground in the lounge room, [and] whenI’d get home from school in the eveningeveryone would be on the nod.”

It was just four days before her exams thather willpower broke. Her friend returnedfrom the dealer with two caps.

“I was like ‘Do you think I’ll be okay? I haven’tused for over four months’, and he said,‘Yeah, you’ll be fine’. Alarm bells should havesounded then, but I was too keen to get thedrugs into me.

“So we had it and all I remember is startingto take my clothes off, and then I hear avoice, a male’s voice: ‘Just be careful whenyou get up. You don’t have any clothes on, butthere is a blanket over you. You’ve overdosedand you’re out on the street. We’ve justNarcaned you twice.’”

She ran back into the house and asked herfriend why she was naked. As it turned out,they had been engaged in sex when shewent into overdose. He said he’d panickedand dragged her out into the street. Someonepassing by started mouth-to-mouth on herand called the ambulance.

Not only did her friend drag her into thestreet, when the ambos asked what hadhappened, he lied and said she’d had anasthma attack, a story he persisted with

even when they explained it was a matter oflife and death.

“They happened to see a needle mark on myarm and hoped they were doing the rightthing by giving me Narcan, even though thedick I was with wasn’t any help. I’m so gladthey did or I wouldn’t be here today recallingthis story for you all to read.”

As for the chap who dragged her into thestreet naked: “I punched him in the face.”

Up in flamesGino was someone whose overdose had anespecially costly ending. He was a partner ina restaurant and had been off heroin for acouple of months when he decided “in a rushof blood to the head” to score as a treat tohimself. He borrowed his business partner’sbrand new Saab turbo to pick up heroin.With drugs in hand, he returned to the carand started the engine, intending to drive off.But then, with the car still in park, but idling,he decided to try the gear he’d just bought.

“It knocked me socks off, and when I fellunconscious I fell forward with all my weighton the accelerator. With the car running atmaximum revs, the turbo blew. When it blewit started a fire under the bonnet.

“The flames came under the firewall. Nextthing they were at my feet, and with all theplastic (the car interior) caught fire prettyquickly. The whole car filled with smokeand then caught fire seriously. The firewent from my feet, my shoes, up my legs,my neck, my right shoulder, my ear.”

At this stage the police arrived, called byneighbours who had heard the car revving.

“They smashed the window to let the smokeout and did a pretty good job dragging meout of there because I was still unconscious.I awoke on a stretcher inside an ambulance.

Do somethinglocally for August 31

Wear the badge, inform clients and publicServices can hold information and education campaigns for staff, clients and members of thepublic - including family members of those at risk of overdose.

In the lead-up to the Day, and on August 31, it’s a good idea to have as many staff as possiblewear the Overdose Awareness Day badge. For information on how to order badges go towww.overdoseday.com

Getting the word out to the general public, which obviously includes people at risk or theirfamily members, can be done in a variety of ways. Please consider approaching local mediaoutlets well in advance and explain the significance of the Day and see if there are ways youcan cooperate on an article, or a radio or even a television piece.

Contact Anex if you would like some help with media (info@overdoseday.com). There are alreadysome draft media releases on the Overdose Awareness Day website.

If your service has a website, consider putting a notice on it with a link to www.overdoseday.com

Hold a memorial service From the outset, the idea behind International Overdose Awareness Day was to createa platform to allow grieving families and friends of countless fatal overdose victims toacknowledge their losses without shame or blame. Therefore the solemn remembranceaspect remains a cornerstone of the day.

The memorial need not be elaborate, ritualised or religious. Sometimes simplicity can giveparticipants a stronger sense of connection and be more touching than a mass ceremonyattended by hundreds. A few words to catch people’s attention, a minute’s respectful silenceand allowing attendees to speak their minds and unburden themselves about lost loved onescan be sufficient. It’s all about maintaining a sense of dignity, caring and paying respect to boththe living and the dead. Also remember that keeping any memorial non-denominational willmake it more inclusive.

Post a tribute In the lead-up to the day, some groups keep a well signposted message box somewhereprominent in which people can post notes in remembrance of lost friends or loved ones.These messages can form part of a remembrance event on the day, when they can be readout to the gathering.

Others have pinned a large piece of fabric to a wall on which people may write tributes tooverdose victims. Once again, this banner can ultimately be used as part - or even thecentrepiece - of a memorial.

High Tea The AIDS Council of South Australia last year took a novel approach in organising its event,announcing a “high tea”. The occasion was put together by Nicole Skelley of SAVIVE, theAIDS Council’s injecting drug users’ group.

“As a free event for the people who inject drugs, we offered clients a high tea with nice chinacups and saucers and scones and jam and coffee.”

SAVIVE had no money to spend on the event so they brought crockery and cutlery from homeand had staff and volunteers tackle the job of making home-baked cup cakes and scones.

Sent up the balloons SAVIVE also bought bio-degradable silver balloons and rice paper on which to write messagesabout lost loved ones. After high tea they went to the parklands nearby and heard speechesbefore releasing the balloons, expecting them to be borne aloft on the wind like free spirits.

“But they didn’t take off, did they?” Nicole told The Bulletin. “(It was) Murphy’s Law that wehad one of the stillest days in yonks. So we tied them to a native tree in the park.”

Hold a barbequeThis has been a popular, traditionally Australian way of marking 31 August and an effectivedraw-card for the drug-using client community. Combined with a short talk on overdose (andpossibly a reading), it can be a very effective grassroots event. Groups the length and breadthof the country have made barbeque lunches or brunches the focal point of their remembranceevent.

Plant a treeSome groups have convened a memorial service in a local park where they have planted aremembrance tree. One tree that was planted in 2001 has now grown into a sizeable specimenand has had a plaque attached. Make sure you have the appropriate council permission if youare considering doing something similar.

These initiatives by no means exhaust the possibilities for marking International OverdoseAwareness Day. What may be done is only limited by one’s imagination and resources.

7

Local events are an extremely effective way tospread the message of Overdose Awareness Dayat a personal level. Overdose stories splashedacross newspapers or television screens reacha mass audience, but cannot match the intimacyand effectiveness of a locally-based function,however low key it may be.

A local event gives people touched by overdosea chance to speak with sympathetic, like-mindedfolk. It can be cathartic, therapeutic or simplyeducational. Anex will be supporting local groupsacross the country with downloadable resourcesfrom the www.overdoseday.com website aheadof the day.

www.overdoseday.comWrite details of your local events on the bottom

of the poster that came with this Bulletin

Storm cloudsbuilding withharmaceuticalsConditions may exist for a “perfect storm” in which pharmaceuticaldrugs misuse, addictions and overdoses climb to their highest levels,according to a prominent Addiction Medicine Specialist.

“We could see ourselves going the way of other countries, such asthe United States. I don’t see much evidence to say otherwise -the patterns are very similar,” said Dr Matthew Frei, Head of ClinicalServices at Turning Point Alcohol & Drug Centre.

“The only real [major] difference is the phenomenon of ‘pill mills’in America. I think because it’s more a privatised medical system [inthe US], so we don’t get these pain clinics that get set up, particularlyin Florida.”

“Pill mills” are large-scale clinics (especially pain clinics) that dispenseenormous amounts of pharmaceuticals for non-medical purposes.The Drug Enforcement Agency has a program called “Operation PillMill” to clamp down on the multi-million dollar dispensing rorts.

“But in other ways there is evidence that we are tracking the US inboth the growth and the use of these drugs,” Dr Frei said.

The number of fatal overdoses from opioid analgesics recorded inthe United States rose from around 4000 in 1999 to around 15,000by 2009, far outstripping deaths from heroin overdoses.

Amanda Roxburgh of the National Drug and Alcohol Research Centreis one of the leading analysts of Australian drug overdose data. She iscurrently updating national-level overdose analysis, and, althoughhers is a work in progress, she is seeing worrying trends.

“It’s always tragic for communities when a fatal overdose occurs.Although the number of opioid-related deaths in Australia remainsmuch lower than in the late 90s, we are starting to see an upwardtrend occurring,” Ms Roxburgh said.

“Part of this is likely to be due to changes in data collation,but it’s also likely that we’re starting to see an upward trend inpharmaceutical opioid overdose. Many of these deaths are dueto multiple drug toxicity, which clearly increases the risk of fataloverdose.”

Said Dr Frei: “We are an affluent country. Like most affluent countries,we have a population who are living longer. The longer you live, themore likely you are to develop chronic degenerative conditions, whichare often what these drugs are prescribed for - back pain and so on.”

“It can happen at any age, but pain conditions seem to be moreprevalent as your bones get older and so on. Like the United States,we are also getting fatter. Obesity, and the strain it puts on joints.This is just my theory.

“I think the other things are, particularly in Australia, thatpharmaceutical opioids are cheap. They are affordable. We have areally good health care system in Australia that allows access todoctors, medical care and medications. For most of the populationtreatment is accessible.

“It’s easy to see a doctor and in many cases not be billed out ofpocket for seeing a doctor. And pharmaceuticals, particularly theones used for management of pain, have a price ceiling on them.”

Living to tell the tale- survivors’ storiesDrug users find injecting attractive largelybecause it gets them high as quickly aspossible. Someone who used narcotics for30 years told the Bulletin that, apart from thespeed of getting stoned, shooting up was alsoa lot about pushing boundaries and likenedthe experience to walking to the edge of ahigh cliff and looking down. While falling anddying would of course represent a seriousmiscalculation, part of the allure for injectorsinvolves getting close.

Newcomers to injecting heroin are less oftenoverdose casualties than older ones. Researchon heroin overdoses has shown very fewfatalities among under-20s, with the meanage in the early 30s.

Even if longer-term users do not see theirhabit in terms of going to extremes, they willstill be injecting amounts verging on overdose.This can be the case even if their use is aboutholding the sickness of withdrawal at baywhile they maintain a normal life. Maintaininga regular working life and daily heroin usedemands balance, the basic tenets of whichare not getting too stoned to function at workand not getting too sick from withdrawals tofunction at work.

But sometimes bad things just happen.

Barbwire through veinsDan was working office hours and trying tokeep a habit under control. He told theBulletin that normally he would have a taste

of heroin before heading to the office andanother after arriving home.

One particular day he was planning to havea taste and listen to the radio news on ABCbefore going to work. While he was in theshower, his partner mixed up for both of them.He reports that at the time they had a blockweighing several grams - more than enoughfor one hit, which was not normal. So Dan’spartner mixed a generous amount in twospoons, and when he returned from theshower he injected himself. Withdrawingthe syringe from his arm was the last thinghe remembered.

“I came to feeling foul, and, as I surfaced, sawuniformed trouser legs. Disembodied voicessaid: ‘Don’t worry mate, we’re the ambos.Do you want to go to hospital?’

“I sat up, feeling more and more terrible asthe seconds passed, then started to get up.With a feeling of intense horror, I realised whathad happened. I’d overdosed and been revived.

“‘Just stay where you are for a moment, mate,’one of the ambos said to me. ‘Are you sure youdon’t want to go to hospital? We had to give

you Narcan - twice. You were pretty muchdead, so just relax. But if you don’t want to goto hospital, we’ll be off. But just take it easyfor a bit, ok?’”

Narcan (or, to give it its generic name,naloxone) purges opioids from receptors. Theresult was that, as the ambo was talking, Danstarted to go into severe withdrawal.

“I felt so sh#*, the rapid comedown magnifiedthe dawning awareness of how close I’d cometo death. I felt as if barbed wire had beendragged through my veins. I was shaking andsweating.”

Dan claims the close shave with the overdosedid some good in driving him to seek outpharmacotherapy and start quitting. “Minoroverdoses become par for the course forheroin users. But when you drop and startturning blue, you can’t beat Narcan,” he said.

Revived naked in streetCora is another survivor of a near-fataloverdose. “I was young, silly and feltinvincible,” she told the Bulletin.

Continued on page six.

While overdoses claim many lives among peoplewho use drugs, it is estimated that for every deaththere are 40 to 50 near-misses. The Bulletin spoketo some survivors about their experiences.