Methadone Factshttp://www.druginfo.adf.org.au/drug-facts/methadonehttp://www.druginfo.adf.org.au/images/methadone-20may16.pdf

Please note: The information given on this page is not medical advice and should not be relied on in this way. Individuals wanting medical advice on this issue should consult a health professional.

What is methadone? Methadone is a prescription drug, and is part of a group of drugs known as opioids. Opioids are depressant drugs, which means they slow down the messages travelling between the brain and the rest of the body.1

Methadone is taken as a replacement for heroin and other opioids as part of treatment for dependence on these drugs. Replacing a drug of dependence with a prescribed drug in this way is known as pharmacotherapy. As well as improving wellbeing by preventing physical withdrawal, pharmacotherapy helps to stabilise the lives of people who are dependent on heroin and other opioids, and to reduce the harms related to drug use.2

Methadone is also used to relieve pain following heart attacks, trauma and surgery.

Slang names

Done or 'the done'.

How is it used?

The Victorian pharmacotherapy program uses the syrup form of methadone. There are 2 brands of this liquid: Methadone Syrup® and Biodone Forte®.3 Generally, there are 2 types of methadone programs:

Maintenance (long-term programs): May last for months or years, and aim to reduce the harms associated with drug use and improve quality of life.

Withdrawal (short-term detoxification programs): Run for approximately 5-14 days and aim to ease the discomfort of stopping the use of heroin.4

For pain relief methadone is administered through an injection or tablets.

How effective is it?

Methadone treatment is more likely to be successful if it is part of a comprehensive treatment program, which addresses the body, mind and environment in which heroin has been used.

For example, treatment may include a combination of methadone, counselling, alternative therapies and the development of a positive support network of peers, friends and a support group.5

Methadone maintenance may not work for everyone, so it is important to work with a doctor or drug counsellor to find the best approach.5

Advantages of methadone maintenance over heroin use

Using methadone on its own is unlikely to result in an overdose. Methadone maintenance keeps the person stable while they make positive changes in their life. Health problems are reduced or avoided, especially those related to injecting, such as HIV,

hepatitis B and hepatitis C viruses, skin infections and vein problems. Doses are required only once a day, sometimes even less often, because methadone's effects are

long lasting. Methadone is much cheaper than heroin.5

Effects of methadone There is no safe level of drug use. Use of any drug always carries some risk – even medications can produce unwanted side effects. It's important to be careful when taking any type of drug.

Methadone affects everyone differently, based on:

Size, weight and health Whether the person is used to taking it Whether other drugs are taken around the same time The amount taken

The effects of methadone last much longer than the effects of heroin. A single dose lasts for about 24 hours, whereas a dose of heroin may only last for a couple of hours.6

People with pre-existing impaired liver function (due to conditions such as hepatitis B, hepatitis C or prolonged alcohol use) may require careful monitoring while receiving methadone treatment.7

Side effects

The most common side effects of methadone are:

Sweating (drink at least 2 litres of water each day to prevent dehydration) Difficulty passing urine Loss of appetite, nausea and vomiting Abdominal cramps Constipation Aching muscles and joints Tooth decay Irregular periods Low sex drive Rashes and itching Sedation1

Dose-related effects

Some people on methadone programs will experience unwanted symptoms during their treatment due to their dosage not being right for them. This occurs particularly at the beginning of treatment.7

If the dose is too low, the following symptoms may be experienced:

Runny nose and sneezing Yawning, feeling weak and difficulty sleeping High temperature but feeling cold and sweating with goosebumps Tears, irritability and aggression

Loss of appetite, nausea and vomiting Abdominal cramps and diarrhoea Tremors, muscle spasms and jerking Back and joint aches Cravings for the drug they were dependant on1

Overdose

If the dose is too high, the following symptoms may be experienced. If any of the following effects are experienced an ambulance should be called straight away by dialling triple zero (000). Ambulance officers don't need to involve the police.

Pinpoint pupils Slow pulse and shallow breathing Low body temperature Low blood pressure, poor circulation and dizziness Cold clammy skin with bluish tinge Mental numbness Occasional seizures Coma1

Long-term effects

Methadone in its pure form will not cause damage to the major organs of the body.

Prolonged use of methadone will not cause any physical damage, apart from tooth decay.8

WithdrawalMethadone withdrawal develops more slowly and is less intense than withdrawal from heroin. Withdrawal symptoms are similar to those listed under 'Dose-related effects' under 'too low' dose. Most of these effects will begin within 1 to 3 days after the last dose and will peak around the 6th day, but can last longer.1

Further informationStatistics

Statistics on methadone

Reducing the risks

Treatment Reducing harms from pharmaceutical misuse Using medicines safely Coping with a family member or friend with a problem Why do people use alcohol and other drugs? Pregnancy, alcohol and other drugs Drug & alcohol: Methadone stabilisation in pregnancy Addressing problems in your community Driving

Workplace The Law Help and support Overdose National drug policy The Other Talk - Advice for parents

Resources

Heroin pamphlet Methadone handbook Free handouts and online resources  Prevention Research publications  SMS service: Get the effects by text

ADF SEARCH – Find further credible research and information on methadone. 

ADIN – Find other credible websites and apps on pharmacotherapy. 

References

1. Upfal, J. (2006). The Australian Drug Guide. (7th ed.). Black Inc: Collingwood.

2. Brands B; Sproule B; & Marshman J. (Eds.) (1998) Drugs & Drug Abuse (3rd Ed.) Ontario: Addiction Research Foundation.

3. Harm Reduction Victoria. (n.d.). Methadone.

4. Kleber, H. (2007). Pharmacologic treatments for opioid dependence: detoxification and maintenance options.

5. Rankin, J. & Mattick, R. (1997). Review of the effectiveness of methadone maintenance treatment and analysis of St. Mary's clinic, Sydney.

6. NSW Health. (2013). Methadone.

7. Henry-Edwards, S., Gowing, L., White, J., Ali, R., Bell, J. Brough, R., Lintzeris, N. Ritter, A. & Quigley, A. (2003). Clinical guidelines and procedures for the use of methadone in the maintenance treatment of opioid dependence.

8. Centre for Addiction and Mental Health. (2011). Do you know... Methadone.

Reducing the risks Treatmenthttp://www.druginfo.adf.org.au/treatment-options/treatment

How do I know if I need treatment?

If your alcohol or other drug (AOD) use is affecting your health, family, relationships, work, school, financial or other life situation, you should seek help.

Support services are available for you, and also for your family and friends if they feel it would help them.

How can I get help? A good place to start is with your local doctor who is likely to know your medical history.

Your doctor can give you information, a referral to a treatment service and ongoing treatment after specialist AOD treatment is completed. 

Another option is self-referral. Many treatment services allow this, and you can contact them directly. To find and discuss treatment services call DirectLine on1800 888 236. Note that privately funded treatment services often require a referral from a doctor or psychologist, so it is a good idea to check first.

After you have made contact with a treatment service, an assessment will be arranged. This may be done over the phone, or face-to-face at first, and then your options for treatment can be discussed.

There may be a waiting list for some services, but if the appropriate treatment is not available at a particular agency, referral will be made to access those services elsewhere.

If you have any special needs you may be referred to a specialist service, such as those helping Aboriginal and Torres Strait Islander peoples, women, men, gay, lesbian, bisexual, transgender, intersex and queer, parents with young children, young people, or people with particular mental health issues.

What kinds of treatment are available? A range of treatment options is available to both private and public patients.

In line with Australia's National Drug Strategy, many treatment services follow the harm minimisation approach. This means that they work to reduce the harms caused by AOD, which doesn't always require stopping use because that isn't always possible.

There are a number of different types of help available, which may be combined, and include:

Withdrawal Pharmacotherapy Counselling Rehabilitation Complementary therapies Peer support Social support Family support

Withdrawal or detoxificationWithdrawal or detoxification (also called detox) is a process of stopping the use of AOD while minimising unpleasant symptoms and the risks of harm.

Read more about withdrawal.

Pharmacotherapy

Substitution pharmacotherapy is the use of medication to replace a harmful drug. This is given as a legal, measured, prescribed dose of a drug, and helps take away cravings so that you can work on other issues that will help you to recover.

Pharmacotherapy is only available for withdrawal from some drugs. For example, buprenorphine, methadone and naltrexone are used in the treatment of opioid dependence.

Your doctor or treatment service can give you more information about what is available to help you.

CounsellingThis is the most common kind of treatment, and there are a number of different approaches that might be taken. These might involve talking through your problems, learning to change the way you think, or thinking about how you might deal with difficult situations.

Counselling can be provided individually or in a group situation, and is available both to people who use AOD, and to their family members or support people. A support service can offer counselling or direct you to a service appropriate for you. Speak to your doctor, AOD treatment service or local community health service.

Find help and support services.

RehabilitationRehabilitation programs take a long term approach to treatment to help you achieve an AOD-free lifestyle.

Residential programs can last from a few weeks to a number of years. No withdrawal medication is provided in the centres, so it is very important that you have already successfully completed your withdrawal treatment.

Residential withdrawal is also available from some treatment services.

Find out more about withdrawal.

Complementary therapiesThese include treatments such as massage and relaxation therapies, which can be useful to help you manage withdrawal symptoms. Some herbal or natural remedies can also help, but you should first seek advice from your doctor or treatment service because withdrawing from alcohol and some drugs can be life-threatening.

Peer support These programs are provided both for people who use AOD, and their family members or support person. They are usually established by people who have had personal experience with AOD, and are often based on the Twelve-step Program model. Alcoholics Anonymous and Narcotics Anonymous are two examples of these.

Social supportA range of social support services can help you to access housing, financial, legal, general health, dental and other assistance. Speak with your local community health service or AOD treatment service for details.

Family support Services are available to support those who have been affected by a family member's AOD use. As well as providing understanding, these services can also provide information about how best to help during treatment.

Read a fact sheet about drug use in the family.

How much will it cost?There may be minimal costs for some services in the public sector, but a number of different treatment options (such as counselling and withdrawal) are generally free.

Before you start treatment, contact Medicare and/or your private health insurer, if you have one, to confirm exactly what you’re covered for. Private health insurance is recommended if you wish to access the private treatment sector.

Further informationRelated articles

Coping with a family member or friend using alcohol or other drugs Help and support Overdose Relapse Supporting someone through home-based withdrawal Withdrawal

Print resources

Your guide to alcohol and other drug treatment (booklet) Your guide to drug withdrawal (booklet) Your guide to mental health and alcohol and other drug problems (booklet) Take it away handbooks: Planning for change and Keeping going Cannabis diary Drinking diary

 

Reducing harms from pharmaceutical misusehttp://www.druginfo.adf.org.au/fact-sheets/reducing-harms-from-pharmaceutical-misuse-web-fact-sheethttp://www.druginfo.adf.org.au/attachments/221_FS_78_HRstrat_final.pdf

IntroductionThis fact sheet provides information about issues related to reducing the risk of harm associated with the misuse of pharmaceuticals. It is not meant to be a substitute for professional advice.

Talk to an alcohol and other drug worker, your local user group, needle and syringe program worker, your doctor or other health professional for more information and if you have any problems or questions.

Be informedDo your research and make sure you have accurate and factual information about the pharmaceutical drug you are using, or considering using, and the risks associated with its misuse. Make sure the information comes from a reputable and knowledgeable source - there are many myths about drug use and some of these can be dangerous. Friends and the Internet are not always reliable sources of information.

Know what is in the pharmaceutical What are the active ingredients and how much is in a dose? What other ingredients are included? Pharmaceuticals contain other substances that can be

harmful if misused. For example, some substances used in tablets can damage blood vessels if injected.

What are the potential risks associated with pharmaceutical misuse?

What are the effects of taking larger doses? How is the pharmaceutical supposed to be taken (e.g. swallowed) and what are the risks

associated with taking it another way (e.g. snorted or injected)? Can you become dependent on the pharmaceutical? What are the expected withdrawal

symptoms? Some medicines, such as benzodiazepines, can have quite dangerous withdrawal symptoms and withdrawal should be carried out under medical supervision.

Are there any other risks?

Be aware of potential interactionsOther medicines, illegal drugs, alcohol and even some foods can interact with pharmaceutical drugs and may increase the risk of overdose, or increase the likelihood of side effects and adverse reactions. Using more than one type or pharmaceutical or drug (polydrug use), either deliberately or by accident can result in unpredictable and potentially dangerous effects.

For example:

Naltrexone blocks the effects of codeine and other opioids. Taking codeine with some medicines, such as sedatives, certain antidepressants and certain

antihistamines can increase the sedative effects and reduce the breathing rate. Drinking alcohol or using barbiturates, heroin, methadone or other opioids while using

benzodiazepines can increase the risk of overdose, dramatically slow the breathing rate and may even result in death.

Pharmaceuticals do not have to be taken at the same time to interact, some pharmaceuticals stay in the body after the effects have worn off and can affect other substances taken hours later.

Do you really know what you are taking?Is the pharmaceutical damaged or too old?If the pharmaceutical is out-of-date, has not been stored properly, or has changed colour, odour or consistency its potency and ingredients may be affected. It may even be toxic.

Where did the pharmaceutical come from?

It is important to know exactly what you are considering taking so you can weigh up the risks and make an informed decision.

In Australia, the Therapeutic Goods Administration (TGA) has strict regulations about the quality of pharmaceuticals. Pharmaceuticals purchased overseas or via the Internet may not have the same quality assurance. You may even be purchasing fake pharmaceuticals that do not have the correct ingredients or may even contain dangerous substances.

Be aware of the effects on driving abilitySome medicines can make a person drowsy and affect coordination, reaction times, vision and decision making skills. This can affect a person’s ability to drive or operate heavy machinery safely. These effects can increase with larger doses or if alcohol or medicines or other drugs are also taken, further increasing the risk of an accident.

Do not shareDo not share pharmaceuticalsEveryone is different and will respond to pharmaceuticals differently. Body size, age, metabolism, hormones, medical history and other pharmaceuticals can all influence the way a pharmaceutical works. Just because you did not have an adverse reaction to the pharmaceutical does not mean that someone else won’t.

Do not share equipment and gearSharing equipment that is used to take pharmaceuticals can increase the risk of contracting viruses such as hepatitis B, hepatitis C and HIV (Human Immunodeficiency Virus—the virus that causes AIDS). This not only includes needles, syringes and other equipment used for injecting, but also equipment used for snorting and smoking.

Use safe injecting practicesInjecting any pharmaceutical or drug carries an increased risk of harms such as overdose, damaged or collapsed veins; red, swollen and infected skin; organ damage; amputation of limbs due to poor circulation; stroke and the transmission of blood-borne viruses. The risks of harm are increased when pharmaceuticals that were not intended for injecting are injected.

For example, pills or tablets that are made to be swallowed may contain ingredients that do not easily break down in water and may cause damage if injected. These insoluble particles can block small blood vessels, cutting blood flow to cells, which can rot and die. Insoluble particles can also result in harmful deposits in the larger blood vessels, eyes, lungs and other organs.

More information about safer injecting is available from needle and syringe programs or from the Australian Injecting & Illicit Drug Users League (AIVL).

Keep pharmaceuticals and equipment in a safe placeAre they stored safely?Pharmaceuticals and any associated equipment, such as syringes and needles, should be stored out of children’s sight and reach. If you carry them with you in your handbag or briefcase make sure they are also kept out of children’s reach.

Are they stored according to their directions?Pharmaceuticals must be stored according to their directions. Things such as heat, humidity and sunlight can affect the medicines’ quality and effectiveness. Some medicines can become toxic if they are not stored properly.

Look after yourself

Your body may be under a lot of pressure and strain as it copes with the effects of the pharmaceuticals. Allow your body to recover and try to get enough sleep, eat plenty of healthy foods and exercise regularly.

Responding to emergenciesIf someone overdoses or has an adverse reaction to a medicine, it is very important that they receive professional help as soon as possible. Call an ambulance. Ambulance officers are not obliged to involve the police. Do not delay because you think you might get into trouble.

Seek help and more information

Contact a health professional or specialist service for treatment options or further information about reducing the risk of harms associated with the misuse of pharmaceuticals and other drugs.

More information and support is available from:

Your doctor, pharmacist or other health professional You local needle and syringe program Counselling Online Directline, tel. 1800 888 236 Australian Injecting and Illicit Drug Users’ League (AIVL) Harm Reduction Victoria DrugInfo

More informationFor more information on drugs and drug prevention contact DrugInfo or see our website.

Using medicines safelyhttp://www.druginfo.adf.org.au/fact-sheets/using-medicines-safely-web-fact-sheethttp://www.druginfo.adf.org.au/images/using-medicines-safely-22aug16.pdf

IntroductionWhen used correctly, medicines (including prescription and over-the-counter medicines), can help to keep us healthy and recover from illness. However, when medicines and herbal, vitamin and mineral supplements are not used correctly they can be ineffective or even harmful.

This fact sheet provides tips on how to use medicines safely and effectively.

Talk to your health professional

Health professionals will prescribe and supply a medicine based on your particular needs and situation. By talking to your doctor, pharmacist or other health professional about your medicines and general health you will ensure they have a full understanding of your particular situation and medical history. This will help them to choose a medicine that is best suited to help you and reduce the chances of side effects or an interaction with other medicines you may be taking.

Some of the things you should talk to your health professional about include:

Any other medicines (including prescribed medicines, herbal and natural medicines, vitamin and mineral supplements, over-the-counter medicines) you are taking; why you are taking them, how often you are taking them and when you started taking them.

Any allergies or medical conditions you have or have had. Whether you are pregnant, breastfeeding or planning to become pregnant. Whether you drink heavily, smoke or are using an illegal drug.

It is important that you understand what medicines you are being prescribed, why you are taking them and how to take them to make sure you use them effectively.

There can be a lot of information to remember. Make sure all the instructions are written down. If the medicine has a Consumer Medicine Information (CMI) leaflet, make sure you have a copy.

You should also ask your health professional if you can reduce your need for the medicine by changing lifestyle factors such as diet and exercise.

Understand what the medicine is and what it is forSome medicines may have different brand names but contain the same active ingredient. By knowing the active ingredients of your medicines you can better understand what you are taking and reduce the chances of overdosing, underdosing or interactions between different medicines.

There can be a lot to remember so having it written down can help. This is especially helpful if you are taking more than one medicine. The list should include:

The name of the medicine or medicines The active ingredients and strength What it is for How much to take and how often When you started taking it When you should stop taking it or review it with your health professional Is there anything you should or shouldn't do while taking the medicine If there are any side effects.

You should take this list with you when you visit your health professional. They can check it each time you visit to make sure that particular medicine is still the best option for you.

Many organisations provide information about medicines. You can visit the National Prescribing Service Limited website or you can call the Medicines Line on tel. 1300 633 424.

Take medicines according to the instructionsMedicines can be less effective, ineffective or even harmful if they are not used properly. Therefore, it is important to carefully follow your health professional's instructions or the directions on the label or CMI leaflet and:

Only take the recommended amount at the prescribed time Take it as prescribed—for example, with food, on an empty stomach, swallow tablet whole, do

not chew tablet Take the medicine for the recommended period of time—do not stop taking it because you feel

better or take it for longer because you don't feel better; if in doubt talk to your health professional

Find out what you should do if you miss a dose.

To help you remember to take the medicine, get into a routine and take it at the same time every day. Use a reminder such as an alarm on your watch or mobile phone so you don't forget. If you are taking more than one medicine, a medicine organiser with compartments can also help you keep track of what to take and when.

Be aware of potential interactionsOther medicines, illegal drugs, alcohol and even some foods can interact with medicines. They may reduce the effectiveness of the medicine, increase the risk of overdose or increase the likelihood of side effects and adverse reactions.

For example:

St John's wort can interact with some antidepressant medicines to cause unpleasant side effects. Drinking alcohol while taking some antihistamine medicines can cause drowsiness. Taking aspirin while using another blood-thinning medicine such as warfarin can increase the

risk of bleeding. Ecstasy (MDMA, methylenedioxy methamphetamine) can interact with some antidepressant

medicines and result in a severe adverse reaction.

Store medicines properly and safelyMedicines should be stored in their original containers with the labels intact

Labels include information about what the medicine is, how it should be taken, how it should be stored and expiry dates. Only remove a medicine from its container or packaging when you are ready to take it.

Are they stored according to their directions?

Medicines must be stored according to their directions. Things such as heat, humidity and sunlight can affect a medicine's quality and effectiveness. Some medicines can become toxic if they are not stored properly.

Are they stored safely?

Many medicines can be harmful if taken by children so it is important that they are stored out of children's sight and reach. If you carry medicines around in your handbag or briefcase make sure they are also kept out of children's reach.

If possible, ask your pharmacist to package your medicines in childproof containers.

Other tipsMake sure the medicine is not damaged or too old

Never use any medicine that has not been stored properly or has changed colour, odour or consistency. You should also never take medicine that is no longer prescribed or past its “use by” date.

Regularly clean out the medicine cabinet and dispose of any medicine that you no longer use or is past its expiry date. Unwanted medicines can be returned to your local pharmacy to be safely disposed (www.returnmed.com.au).

Regularly review your medicines with your health professional

Regularly reviewing what medicines you are taking and why with your health professional will help ensure that you are getting the best available treatment. Our bodies and health are always changing and medicines may need to be adjusted in response to this.

Do not share medicines

Everyone is different and will respond to medicines differently. Body size, age, metabolism, hormones, medical history and other medicines can all influence the way a medicine works. Just because a medicine worked for you does not mean it will work for someone else. A medicine that worked for you could actually have unpleasant side effects if someone else took it.

Be aware of the effects on driving ability

Some medicines can make a person drowsy and affect coordination, reaction times, vision and decision-making skills. This can affect a person's ability to drive or operate heavy machinery safely.

In Australia, it is an offence to drive while impaired by any drug that makes the driver incapable of having proper control of the vehicle. This includes medicines. Before driving, ask your health professional or read the CMI leaflet and if in doubt, do not drive.

Babies and children

Babies and children respond differently to some medicines than adults do. Extra care must be taken when giving babies and children medicines to ensure that the medicine is suitable for them and the correct dosage is given.

Some medicines should never be given to babies and children. Always check with a health professional.

Set an example

Try to avoid taking medicines in front of children. They may try to imitate you later. If you are taking medicines when children are around, you may wish to use the opportunity to talk to them about medicine safety.

Buying medicines online

There are several issues to consider if buying medicines through an online service instead of through a pharmacy.

You are not dealing directly with a pharmacist who can provide you with additional information and advice on the safe and effective use of the medicine.

You cannot be sure of the quality of overseas medicine. In Australia the Therapeutic Goods Administration (TGA) has strict regulations about the quality of medicines. Other countries may not have the same quality assurance. You may be purchasing fake medicine that does not have the correct ingredients or even medicines that contain dangerous substances.

What if you experience side effects or an adverse reaction?

If you experience any side effects make notes about them and contact your health professional to discuss your concerns.

There are also telephone lines that you can call for advice and to report problems (they are not emergency services):

Medicines Line on tel. 1300 888 763 Adverse Medicines Events Line on tel. 1300 134 237

If you experience a serious adverse reaction, call an ambulance immediately by dialling 000. If possible, have the medicine with you so the ambulance officers know what you have taken.

Reducing the risks Overdose Using medicines safely Reducing harms from pharmaceutical misuse Coping with a family member or friend with a problem Why do people use alcohol and other drugs? Pregnancy, alcohol and other drugs The Other Talk - Advice for parents Addressing problems in your community Driving Workplace The Law Help and support National drug policy

Further information Your doctor, pharmacist or other health professional Better Health Channel Consumers' Health Forum Medicines Line, tel. 1300 633 424 National Prescribing Service Limited

Coping with a family member or friend with a problemhttp://www.druginfo.adf.org.au/family-and-friends/drug-information/information-for/coping-with-a-family-member-or-friend-using-aod

The following resources provide advice and support for people affected by the alcohol or other drug use of their family members or friends.

Ice: family & friends support guideBrochure

A free support guide for family and friends, providing more information on how you can support a loved one using ice.

Inhalant use: a guide for parents and familiesBooklet

A booklet designed for parents, family members and other carers concerned that their young person could be using inhalants.

Strong Spirit Strong Mind:   Aboriginal ways to reduce harm from alcohol and other drugsBooklet

Sniffing and Chroming: A guide for parents and carers worried about their children.

Drug use in the familyFact sheetIt's normal to feel helpless, frustrated, worried and upset when someone close to you has a drug problem. This fact sheet outlines practical steps you can take to work through the issues. 

Healthy eating during treatment for alcohol and other drugsFact sheetGood nutrition should be a part of the withdrawal process as poor dietary habits can contribute to increased cravings and the risk of relapse. This fact sheet provides tips on a healthy diet and lifestyle.Supporting children: a guide for grandparentsFact sheetIf you're one of the estimated 22,500 Australian grandparents acting as primary caregiver for your grandchildren, this fact sheet provides some helpful strategies for supporting your grandchildren and looking after yourself.Supporting someone through home-based withdrawalFact sheetThis fact sheet focuses on home-based withdrawal, which involves the person going through withdrawal while living in their own home or some other safe place as opposed to going to a drug and alcohol treatment service or withdrawal facility. Is someone you care about using drugs?BookletThis 29 page booklet provides advice for people wanting to support a friend or family member who is using alcohol or other drugs. Call Family Drug Helpline on 1300 660 068 for a single free copy.Why can't they just stop?BookletThis 32 page booklet provides support for people living with the consequences of having a family member or close friend who is a problem drinker. Call Family Drug Helpline on 1300 660 068 for a single free copy.Myth busting alcoholBookletThis 33 page booklet helps parents to understand and deal with underage drinking. Call Family Drug Helpline on 1300 660 068 for a single free copy.

The merry-go-round of addictionBookletThis booklet provides proven strategies to help those dealing with a family member's addictive behaviours to regain control of their life and improve family relationships.  Limited hard copies available. Contact DrugInfo.Walking a tightrope. Alcohol and other drug use and violence: a guide for families [PDF:854KB]PDF booklet This online booklet provides advice and strategies for people coping with the violent behaviour of a family member who uses alcohol or other drugs. A guide to coping: Support for families faced with problematic drug useBook

A resource guide developed by Family Drug Support providing families with practical strategies and information when facing problematic drug and alcohol use.

Not my family, never my child: What to do if someone you love is a drug userBookWritten by Tony Trimingham, CEO of Family Drug Support, this book provides detailed information on warning signs, early intervention, coping and survival strategies, treatment, and where to go for additional advice and support.Stepping Stones workbookBookPublished by Family Drug Support & the Alcohol and Drug FoundationThis is the essential workbook for families coping with problematic drug use of their loved ones. Developed by Family Drug Support, this workbook provides a step-by-step guide to help people turn crisis into coping.

 

Why do people use alcohol and other drugs?http://www.druginfo.adf.org.au/fact-sheets/why-do-people-use-alcohol-and-other-drugshttp://www.druginfo.adf.org.au/images/Why-Do-People-Use-AOD-30jun16.pdf

People use alcohol and other drugs (AOD) for a variety of reasons: to relax, to function, for enjoyment, to be part of a group, out of curiosity or to avoid physical and/or psychological pain.

Many may also use AOD to cope with problems, relieve stress or overcome boredom while others may experiment out of a sense of curiosity, excitement or rebellion1.

AOD use is influenced by a number of factors but most people use them to feel better or different. They use AOD for the benefits (perceived and/or experienced), not for the potential harm. This applies to both legal and illegal substances.

Some drugs are prescribed by medical practitioners or sold over-the-counter to treat medical conditions.

The vast majority of people who drink alcohol and/or use legal or illegal drugs do not become dependent on any of the substances2.

What drugs are being used in Australia?The majority of people in Australia drink alcohol (78.3%) with 12% of the population using illicit drugs. Cannabis is the most commonly-used illicit drug (10.2%). A much smaller proportion (2%) use illegal drugs, such as crystal methamphetamine (ice), cocaine and ecstasy, and even smaller misuse inhalants (0.8%).3

Types of AOD useThe list below details some of the different categories of AOD use. People can move between the categories, and one stage will not inevitably lead to another. The majority of people who use AOD do not become dependent or develop serious problems as a result of using them.

Experimental use: a person tries a substance once or twice out of curiosity.

Recreational use: a person chooses to use AOD for enjoyment, particularly to enhance a mood or social occasion. The majority of people use substances for this reason and never develop problems as a result.

Situational use: AOD is used to cope with the demands of particular situations such as responding to peer group pressure, overcoming shyness in a social situation or coping with some form of stress.

Intensive use or 'bingeing': a person intentionally consumes a heavy amount of AOD over a short period of time, which may be hours, days or weeks.

Dependent use: a person becomes dependent on AOD after prolonged or heavy use over time. They feel the need to take the substance consistently in order to feel normal and/or to avoid uncomfortable withdrawal symptoms.

Therapeutic use: a person takes a drug, such as a pharmaceutical, for medicinal purposes.4

Why do people choose certain drugs?People choose AOD for the specific feelings they get as a result of using them. For example, people may use codeine to relieve pain, drink alcohol to relax and relieve stress, take amphetamines to increase energy or use hallucinogens to alter their perception.5

Using one drug does not necessarily lead people to trying other drugs with research dismissing concerns about so-called 'gateway drugs'. There is no evidence suggesting people who use cannabis will graduate over time to other drugs such as heroin or amphetamines.6

However, a person's AOD use may be influenced by the availability, price and purity of specific drugs. It is worth noting that often it is the combination of such factors that determine which drug a person uses. For example, tougher law enforcement policies combined with lower profit margins made Australia a less attractive option for heroin traffickers, which led to the heroin drought in the early 2000s. Similarly, if supplies of a preferred drug fall (which in turn can significantly increase the price) then people may switch to an alternative drug to satisfy their needs. 7

Effects

The feelings people experience when taking a certain drug play a major role in their decision to use it. Some substances might be used for a specific occasion. For example, people often use ecstasy and amphetamines to increase their energy during a dance party.8

Another person may use performance and image enhancing drugs, such as steroids, or cognitive enhancers to improve their performance at work, study or sporting competitions. While others may turn to alcohol and tobacco to relax after work or to combat stress.9,10

Availability

Availability can be a major factor determining whether people use a specific drug. The greater the level of supply of a drug in a society, the more likely they are to be used and the more likely people are to experience problems with it11. For example, alcohol is the most commonly-used drug given its widespread availability. Whereas drugs such as heroin and amphetamines are less likely to be used because they are illegal drugs which make them more difficult to obtain.5

Even within the illicit drug market, availability plays a major role. Supplies of heroin and ecstasy have fluctuated in the past two decades for a number of reasons, including stronger law enforcement restricting supplies of the drugs.7,12

Price

Price is also a major influence, which is closely linked with availability. Drugs that are available in high quantities tend to be cheaper to buy, and lower drug prices may result in higher levels of drug consumption and drug-related harm.13,14

The cheaper the price the more likely the drug will appeal to more people. For example, an oversupply of heroin in the 1990s saw prices drop to a historic low, resulting in it becoming the most-commonly injected drug15. Conversely, a dramatic heroin shortage in 2000 saw the price skyrocket from $360 to $1200 per gram in Australia14.

It is also worth noting that the price of one drug can affect the demand for another. If the price rises too high, in some cases people who use a particular drug may seek a cheaper alternative if they can no longer afford their preferred choice.16

Purity

The purity of a drug refers to the strength or amount of the active ingredient. While a person's individual perception of purity can be influenced by their tolerance levels and frequency of use, the actual purity of a drug can be impacted by external market forces that affect its availability.

For example, the popularity of ecstasy fell in 2010 when international restrictions on the chemicals needed to make the drug saw its purity levels drop significantly. Although ecstasy demand is on the rise again, many people had already switched to using the synthetic compounds, which had been introduced as a substitute when ecstasy's availability and purity levels had fallen.6

Initial reports suggest the shift around 2013 to the more potent form of crystal methamphetamine (ice) from the more traditional powder methamphetamine form (speed) may be linked to the higher purity of crystal methamphetamine, which means the effects of the drug are much stronger3.

Multiple (poly) drug use

Some people combine different kinds of AOD to increase the intensity of the experience5. They may also combine substances such as alcohol with prescription drugs without thinking about the side effects. They may not be aware of the harms that may be caused when the different drugs interact with each other.16,17

People may also use some drugs to counteract the effects of another drug. For example, people may smoke cannabis to 'come down' from the stimulating effects of amphetamines. However, using one drug after another means the person may suffer the side effects from both drugs.5

Further informationDrug facts

Statistics

References

1. Ritter, A., King, T., & Hamilton, M. A. (Eds.). (2013). Drug use in Australian Society. Oxford University Press.

2. National Council on Alcoholism and Drug Dependence, Inc. (n.d.) Alcohol and Drug Information.

3. Australian Institute of Health and Welfare. (2014). National Drug Strategy Household Survey detailed report 2013. Canberra: AIHW.

4. Australian Drug Foundation (2000). Drugs in Focus: Dealing with drug issues for 9 to 14-year-olds. West Melbourne: ADF.

5. Brands, B., Sproule, B., & Marshman, J. (1998). Drugs and drug abuse. Addiction Research Foundation. Toronto, Canada.

6. Jadidi, N., & Nakhaee, N. (2014). Etiology of Drug Abuse: A Narrative Analysis. Journal of addiction, 2014.

7. Degenhardt, L., Reuter, P., Collins, L., & Hall, W. (2005). Evaluating explanations of the Australian 'heroin shortage'. Addiction, 100(4), 459–469.

8. Ritter, A., King, T., & Hamilton, M. A. (Eds.). (2004). Drug use in Australia: preventing harm. Oxford University Press.

9. Urban, K. R., & Gao, W. J. (2014). Performance enhancement at the cost of potential brain plasticity: neural ramifications of nootropic drugs in the healthy developing brain. Frontiers in systems neuroscience, 8.

10. Wan, W., Weatherburn, D., Wardlaw, G., Sarafidis, V. & Sara, G. (2014). Supply-side reduction policy and drug-related harm.

11. Gossop, M. (2000). Living with drugs. Ashgate Publishing, Ltd.

12. Scott, L., & Burns, L. (2011). Has ecstasy peaked? A look at the Australian ecstasy market over the past eight years. EDRS drug trends bulletin, April.

13. Angell, M. P., Chester, N., Green, D., Somauroo, J., Whyte, G., & George, K. (2012). Anabolic steroids and cardiovascular risk. Sports medicine, 42(2), 119–134.

14. Degenhardt, L. J., Conroy, E., Gilmour, S., & Hall, W. D. (2005). The effect of a reduction in heroin supply on fatal and non-fatal drug overdoses in New South Wales, Australia. Medical Journal of Australia, 182(1), 20–23.

15. Jofre-Bonet, M., & Petry, N. M. (2008). Trading apples for oranges?: Results of an experiment on the effects of Heroin and Cocaine price changes on addicts' polydrug use. Journal of Economic Behavior & Organization, 66(2), 281–311.

16. Nauert, R. (2015). Alcohol & many medications make a risky mix.

17. National Institute on Drug Abuse. (2011). Prescription Drugs: Abuse and Addiction.

Pregnancy, alcohol and other drugs

http://www.druginfo.adf.org.au/fact-sheets/pregnancy-alcohol-and-other-drugs-web-fact-sheethttp://www.druginfo.adf.org.au/images/pregnancy-AOD-29jun16.pdf

Pregnancy is a time of great change. If you are pregnant, or thinking about having a baby, it is important to consider the types of drugs you might be taking and how they might affect you and your pregnancy.

Drugs that may be harmful during pregnancy include:

Legal drugs such as alcohol, tobacco and caffeine Complementary medicines such as herbal preparations and nutritional supplements 'Over-the-counter' medicines such as antacids, cold and 'flu medicines, diet pills, laxatives and

painkillers Prescribed medicines such as painkillers, tranquillisers and sleeping pills Illegal drugs such as cannabis, amphetamines, cocaine, ecstasy, GHB, hallucinogens and heroin Drugs used to treat opiate or alcohol dependence such as methadone, buprenorphine and

naltrexone Other substances such as glues and aerosols (inhalants or volatile substances)

Why be concerned about drug use during pregnancy?Alcohol and other drugs can be harmful to a developing foetus throughout the pregnancy, as they will reach the baby through the placenta (the afterbirth).

However, there can be great variation in babies' responses to drugs, depending on:

The type of drug taken. The baby's response to a sedative drug will be different from its response to a stimulant such as caffeine or amphetamines.

How often the drug is used, how it is used and the amount taken. Whether one or more drugs are used—combining drugs can increase or alter the effects of the

drugs in unpredictable ways. Each individual baby's response.

Two of the most common complications of drug use during pregnancy are premature labour and small birth size. Babies born prematurely or with a low birth weight have a higher risk of illness and may experience a number of problems.

Sudden Infant Death Syndrome (SIDS) is the sudden death of a baby for no known reason. The risk of SIDS is greater if you smoke, use alcohol and/or other drugs during pregnancy or after your baby is born.

Planning your pregnancyThe first thing to do if you are planning to become pregnant is to seek advice from your doctor or other healthcare professional. They can assist you with information about the available health services and your choice in pregnancy care.

However, there are a few simple steps you can take to improve your health before you become pregnant. These will increase the chances of a healthy conception and baby:

Eat a well-balanced diet and drink plenty of water. If you are a smoker, ask your doctor or other health professional for information about quitting.

Avoid caffeine, alcohol and other drugs. Seek counselling if you need help to reduce or stop using alcohol or other drugs. Unless specifically recommended by your doctor or health practitioner, avoid taking any

medications including those purchased over-the-counter. If you are taking complementary medicines or supplements, make sure you tell your prescriber

that you are planning to become pregnant, read the label for safety messages, and discuss these medicines and supplements with your doctor or health practitioner.

Get plenty of rest and exercise. Avoid stress.

Managing your pregnancy and drug useIf you haven't already done so, you should consult your doctor or healthcare professional as soon as you find out you are - or suspect you are - pregnant. Cutting down or stopping your alcohol and other drug use at any stage of your pregnancy, even late pregnancy, will benefit both your baby and your health.

It is important to tell your pregnancy care provider if you are drinking alcohol or taking any other drugs, or if you have any concerns about your use. If you are using alcohol or other drugs, your baby will need to be carefully monitored during your pregnancy.

Reducing the risk of complications of drug use in pregnancyTo reduce the risk of complications to yourself and your baby:

Speak to your doctor or healthcare professional to discuss your use of alcohol and other drugs. Get regular pregnancy care as soon as you know you are pregnant. Consult with your doctor or healthcare professional before you attempt to stop or reduce your

alcohol and other drug use. Contact your doctor or healthcare professional if you experience withdrawal symptoms.

Contact detailsWomen's Alcohol and Drug Service9:00am–5.00pm Monday to FridayThe Royal Women's HospitalCnr Grattan St & Flemington RdParkville Victoria 3052Tel: 03 8345 2000

DrugInfo Tel: 1300 85 85 84Contact DrugInfo

DirectLine (Victoria only)Free call: 1800 888 23624 hour counselling and referral service

Maternal and Child Health (Victoria only)Tel: 132 22924 hour help line

Further information

Pregnancy, drugs & alcohol (Royal Women's Hospital)

Pregnancy, breastfeeding and alcohol (fact sheet)

Alcohol, other drugs and pregnancy (booklet) Contact DrugInfo for a single free copy, or visit the ADF Bookshop to buy multiple copies.

Drug & alcohol: Methadone stabilisation in pregnancyhttps://thewomens.r.worldssl.net/images/uploads/downloadable-records/clinical-guidelines/drug-and-alcohol-methadone-stablisation-in-pregnancy.pdf

1. PurposeThis document outlines the clinical guideline details to

• assist staff to care for women admitted to hospital for methadone stabilisation in pregnancy and to engage the woman in a continuing therapeutic relationship, • minimise opioid seeking behavior, • reduce the incidence of pre-term birth and stabilise foetal opioid exposure, • initiate or to progress psychosocial care, • assess co-morbidities and to initiate appropriate care at the Women’s.For methadone stabilization1,2 to be effective, psychosocial counselling and support should be provided3 concurrently.

2. DefinitionsMethadone Stabilization is the therapeutic transfer of a person from dependent but intermittent narcotic use to prescribed methadone.

The terms “narcotic” and ”opioid” appear to be synonymous in MeSH4 and ICD-105 medical terminologies, except that the term “opioid analgesia” is preferred.

3. ResponsibilitiesAt the Royal Women’s Hospital, Methadone Stabilisation of Inpatients is arranged by the Women’s Alcohol and Drug Service (WADS) and prescribed by the WADS obstetrician ( for further details see appendix 1).

Key personnel include Midwives, Social Workers, Pharmacists, Psychiatrists, Paediatricians, Obstetricians and others.

4. Guideline 4.1. Assessment:• Arrange Psychosocial Assessment if this has not already been done. • Contact Medicare Australia prescription shopping service for details of recently prescribed medicines such as benzodiazepines analgesics and psychotropics. (This is normally done by the WADS obstetrician,see appendix 1). • Assess for medical (blood-borne virus, hepatic or cardiac dysfunction, dental), mental health and pregnancy related comorbidities2 . • Assess the fetus with appropriate monitoring. Be aware that methadone or buprenorphine administration alters the fetal activity and heart rate. Neonatal Abstinence Syndrome (NAS) may occur in the neonate of a mother who has been treated with methadone or buprenorphine in pregnancy.

4.2. Who should be offered treatment?• Women who have withdrawal symptoms if narcotics are discontinued. • Women who have received information and counselling, who want treatment and who agree to abide by the Royal Women’s Hospital code of behaviour. • Those who are not allergic to methadone.

4.3. Admission planning• The woman is informed that current evidence6 shows methadone is preferable to buprenorphine. It is safer, and more women remain on treatment rather than relapsing. Buprenorphine may be prescribed by the WADS obstetrician instead of methadone if the woman is allergic to methadone or declines methadone treatment. There is no evidence that breast feeding on buprenorphine causes harm to the neonate (see section 4.10). • Prior to admission the woman is informed that the process of methadone stabilisation will take five days7 and is usually done Monday to Friday when all WADS support staff are available. • The WADS Midwife or Team Care Midwife should discuss and provide the woman with written information about substance use and its possible effects on the pregnancy, birth, infant feeding, safe sleeping and other relevant issues8 . • Referral to the Dietitian should be arranged during the admission to enable nutrition assessment, to provide nutrition education, food service extras and to manage constipation, eating disorders or other disorders of nutrition. • If required, arrange outpatient Mental Health assessment9,2 after methadone stabilisation has been completed, by faxing the request for Consultation to the Women’s Mental Health Service.

4.4. Methadone induction• For prescribing Methadone see appendix 1. • The initial dose should be 20 mg methadone9, 7 and subsequent doses of 5-20mg are given at four hourly intervals or earlier if indicated. The daily dose prescribed is based on the total dose given in the preceding 24 hours and the response to treatment. • Advise the woman that optimising the methadone dose greatly reduces the chance of preterm birth. • The woman should remain on the Ward for 30-60 minutes after dosing. • Ask the woman to request that staff contact the WADS obstetrician promptly if supplementary dosing is needed. • Initially the amount and the rate of dose increases are judged according to the amount of narcotic or of opioid analgesic being used prior to methadone induction. • At each review symptoms of nausea, agitation or sweatiness and dilatation of the pupils are checked. Use the “Withdrawal Scale” in Appendix 4 of the National Guidelines2 . • Due to the prolonged action of methadone, doses over 50mg during the first 24 hours should be avoided to prevent oversedation9,10, unless the prior narcotic dose was very large and discontinuation of treatment because of severe withdrawal symptoms is anticipated. • Considerable care should be exercised to avoid overdosing with methadone if the woman may also be self medicating. This should be considered if she has left the ward without explanation or has had visitors who may have supplied non-prescribed substances. • If the woman is a polysubstance user and is experiencing cannabis withdrawal, then treatment with diazepam10,2, may be required concurrently. This should only be ordered by the WADS obstetrician.• Analgesics during methadone stabilisation should only be ordered by the WADS obstetrician, except for analgesics during labour and analgesics after Caesarean birth.• The rate of methadone dose increase should be sufficient to relieve opioid craving, agitation, nausea or upper respiratory symptoms, otherwise the woman may discontinue treatment. • Half hourly observations including pulse oximetry should be commenced if oversedation occurs, until fully alert. Withhold further methadone until this occurs. Transfer to a High-Dependency facility if indicated. • The time of dosing is adjusted to be within normal commercial pharmacy opening hours.

• See section 4.10 for Buprenorphine induction.

4.5. Methadone stabilization• For most women, daily methadone dosing is appropriate2 , once Induction has been completed. • As pregnancy advances, the dose of methadone required to avoid symptoms of withdrawal will need to be increased. • Women who are already stabilised on buprenorphine and who accept advice to change to methadone should be managed according to the National Guidelines. • Women who are already stabilised on buprenorphine/naloxone (Suboxone® ) 11 should be advised to change to methadone, or to buprenorphine alone if this advice is not accepted. • After delivery the methadone dose usually remains unchanged. If sedation occurs the methadone dose is reduced by 5 mg. Further reductions are normally arranged by the community Prescriber during the next few months.

4.6. Preventing and managing relapse• Watch for poor clinic attendance and check for symptoms of opioid withdrawal. If these are observed, recommend an increase in the methadone dose. • Continuation or resumption of narcotic use may be due to social/relationship pressures, which are best dealt with by counselling and support, not by changing the methadone dose. • If three doses of methadone are missed, the woman may require readmission for methadone stabilization2.

4.7. Methadone dosing in labor and immediately after the birth• Methadone dosing should continue without interruption. • Post-partum analgesia with paracetamol, tramadol and diclofenac may be used. • Post-Caesarean analgesia is given according to the Clinical Guideline. • If the woman has not had any antenatal care and is a narcotic user who accepts the advice to commence methadone stabilisation, referral to WADS is arranged using the Internal Referral form and by contacting the WADS clinician. It is better to commence dosing after delivery of the baby.

4.8. Breast feeding• Methadone stabilization is not a contra-indication to breast feeding.

4.9. Discharge planning• If narcotic analgesia is being considered, please discuss this with the WADS obstetrician.• A Prescribing Service or Prescriber is chosen appropriate to the clinical complexity, which is as close as possible to the woman’s place of living. Agreement is reached that the woman will be accepted as a patient, and a Discharge Summary [Refer to Pregnancy with Substance Use Disorder CPG] giving the dose and frequency of all medicines is faxed to the new Prescriber. • The General Practitioner is contacted to request that no psychoactive medicines such as benzodiazepines are to be prescribed as these will be managed by the Prescribing Service. • A Dispensing Pharmacy is chosen which is as close as possible to the woman’s place of living. An Identity Certified Passport Photograph of the woman and an interim prescription is provided to cover the gap between leaving hospital and seeing the new Prescriber.

• The WADS clinician will make an appointment for the woman to be followed up in the WADS outpatient clinic.

4.10. Buprenorphine stabilisation in pregnancyBuprenorphine stabilisation3, 6 in pregnancy is arranged by the Women’s Alcohol & Drug Service after appropriate referral ( appendix 1 for futher details). Maintenance doses of buprenorphine may be prescribed by Team medical officers12 ( see appendix 1 for futher details)..

Admission to hospital, provision of information, psychosocial support6 , antenatal care and postnatal care are offered in a similar way to that which is provided to a woman who is to receive methadone pharmacotherapy.

Methadone pharmacotherapy remains the recommended treatment13 for most women with narcotic dependency in pregnancy.

The safety14 of buprenorphine in pregnancy and lactation is discussed prior to obtaining consent to start treatment. Refer to Pregnancy and Breastfeeding Medicines Guide, RWH.

If the woman for buprenorphine stabilization is in labor, buprenorphine dosing is deferred until after the birth.

Dosing should be delayed until narcotic withdrawal symptoms commence, as buprenorphine may induce rapid opioid withdrawal. This should be discussed before treatment is commenced. Dosing in pregnancy is 24 hourly14 and the buprenorphine tablets are crushed (not powdered) and given sublingually under supervision.

Other side effects of buprenorphine are similar to those of other opioids. Buprenorphine has a 24 - 72 hour duration of action.

Caution must be exercised14 if:

• poly drug use is suspected,• continued narcotic use is suspected, • recent head injury has occurred, • respiratory compromise is evident, • if there is an acute abdomen, • severe hepatic disease, • acute Mental Health condition, • chronic pain,• Post-Caesarean analgesia: per Clinical Practice Guideline

Notes:• Ketoconazole, nifedipine and macrolide antibiotics may potentiate the action of buprenorphine,

• Monilial retinitis with visual impairment may be caused if the woman injects buprenorphine which has not prescribed for her.

If transfer from methadone maintenance is being considered, explain that precipitated withdrawal may occur and that transfer from methadone to buprenorphine is most effective if the dose of methadone is less than 100mg.

Dose titration for buprenorphine:Look for features of narcotic intoxication and consider:

• cravings for heroin • consider the possibility of use of other substances especially codeine oxycodone and benzodiazepines side-effects • adherence to dosing regimen and compliance with staff requests • the woman's satisfaction with buprenorphine treatment.

When buprenorphine stabilization is to be commenced, the starting dose should be 4mg14, unless there has been prior evidence of buprenorphine or other narcotic sensitivity.

Dose increments14 for buprenorphine:• if below 16 mg buprenorphine dose changes of 2-4 mg • if above 16 mg buprenorphine dose changes of 4-8 mg are appropriate. • the effective dose range of buprenorphine is usually 12-24 mg per day.

If buprenorphine 32mg is insufficient to control narcotic withdrawal symptoms, methadone treatment may be required.

Postnatal careIf a woman is not breastfeeding, buprenorphine-naloxone sublingual tablets or buprenorphine-naloxone film in an appropriate dose may be recommended 15 to her Prescriber when she is discharged from hospital.

5. Evaluation, monitoring and reporting of compliance to this guidelineCompliance with this Guideline will be monitored, evaluated and reported through a review of incidents, annual audit and other internal reviews achieved through staff meetings

6. ReferencesAUTHOR TITLE SOURCE LEVEL OF

EVIDENCE

1 Minozzi S. et al.

Maintenance agonist treatments for opiate dependent pregnant women

Cochrane Database. DOI: 10.1002/14651858.CD006318.pu b2 Published Online: 21 JAN 2009.

l

2 Ministerial Council on Drug Safety

National Clinical Guidelines for the Management of Drug Use during Pregnancy, Birth and the Early Development Years of the Newborn, 2006.

http://www.health.nsw.gov.au/pubs/2006/ncg_druguse.html

ll

3 Amato L. et al.

Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification.

Cochrane Database. DOI: 10.1002/14651858.CD005031.pu b4 Published Online: 7 SEP 2011.

l

4 Medical Subject Headings: the National Library of Medicine controlled vocabulary

http://www.ncbi.nlm.nih.gov/mesh

5 International Classification of Diseases, World Health Organization

http://www.who.int/classifications/icd/en

6 Mattick R.P. et al

Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence.

Cochrane Database. DOI: 10.1002/14651858.CD002207.pu b3 Published Online: 16 JUL 2008

l

7 Dunlop A., O’Donnell H.

Methadone prescribing in an obstetric setting.

WADS and Turning Point Alcohol and Drug Centre, 2006.

lll

8 Ostfeld BM et al.

Concurrent risks in sudden infant death syndrome.

University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Department of Pediatrics Pediatrics. 2010 Mar;125(3):447-53. Epub 2010 Feb 15; http://www.ncbi.nlm.nih.gov/pubm ed/20156907?tool=bestpractice.bmj.co m

lV

9 Alsop S. (Ed.) Drug Use and Mental Health:

Effective Responses to Cooccurring Drug and Mental Health Problems

IP Communications, East Hawthorn, Victoria, Australia. 2008.

lll

10 Bohnert, A.S.B et al.

Association between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths.

JAMA 305, 13, 1315. April 6, 2011. lV

11 Buprenorphine Treatment of Heroin dependence. http://www.health.vic.gov.au/dpu/downl

oads/guidelines-buprenorphine.pdfll

12 Methadone Prescribing in Victorian Hospitals Feb 2009 http://www.health.vic.gov.au/dpu/downl

oads/sec8-hosp.pdflV

13Sue Henry-Edwards et al.

National Clinical Guidelines and Procedures for the Use of Methadone in the Maintenance Treatment of Opioid Dependence 2003

http://www.health.vic.gov.au/dpu/downloads/guidelines-methadone.pdf lll

14Lintzeris N et al

National Clinical Guidelines and Procedures for the Use of Buprenorphine in the Treatment of Opioid Dependence 2006 p64-67.

http://www.health.vic.gov.au/dpu/downloads/guidelines-buprenorphine.pdf lll

15 Buprenorphine film listing information;

http://pbs.gov.au/medicine/item/6470M-9749D-6471N-9750E lV

16Ministerial Council on Drug Strategy

The National Drug Strategy 2010-2015

http://www.nationaldrugstrategy.gov.au /internet/drugstrategy/publishing.nsf/C ontent/DB4076D49F13309FCA257854 007BAF30/$File/nds2015.pdf

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17 A new blueprint for alcohol and other drug treatment services 2009 - 2013.

Department of Human Services, Melbourne, Victoria 2008 http://docs.health.vic.gov.au/docs/doc/ 9228A36CB98A6417CA2578A10013A 10E/$FILE/blueprint09-13.pdf

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7. Legislation related to this guideline• National Drug Strategy 2010-201516 and the Victorian blueprint for alcohol and other drug treatment services 2009 – 201317. • Medicare Australia prescription shopping service, Phone 1800 631 181

Conflict of InterestThe leading author states that no conflict of interest influenced the preparation of this Clinical Guideline.

8. Keywords or tagsMethadone stabilization, Buprenorphine stabilization, cannabis withdrawal, naloxone

9. AppendicesAppendix 1: Methadone and Buprenorphine Treatment Pathway

PGP Disclaimer Statement The Royal Women's Hospital Clinical Guidelines present statements of 'Best Practice' based on thorough evaluation of evidence and are intended for health professionals only. For practitioners outside the Women’s this material is made available in good faith as a resource for use by health professionals to draw on in developing their own protocols, guided by published medical

evidence. In doing so, practitioners should themselves be familiar with the literature and make their own interpretations of it. Whilst appreciable care has been taken in the preparation of clinical guidelines which appear on this web page, the Royal Women's Hospital provides these as a service only and does not warrant the accuracy of these guidelines. Any representation implied or expressed concerning the efficacy, appropriateness or suitability of any treatment or product is expressly negated In view of the possibility of human error and / or advances in medical knowledge, the Royal Women's Hospital cannot and does not warrant that the information contained in the guidelines is in every respect accurate or complete. Accordingly, the Royal Women's Hospital will not be held responsible or liable for any errors or omissions that may be found in any of the information at this site. You are encouraged to consult other sources in order to confirm the information contained in any of the guidelines and, in the event that medical treatment is required, to take professional, expert advice from a legally qualified and appropriately experienced medical practitioner. NOTE: Care should be taken when printing any clinical guideline from this site. Updates to these guidelines will take place as necessary. It is therefore advised that regular visits to this site will be needed to access the most current version of these guidelines.

Addressing problems in your communityhttp://www.druginfo.adf.org.au/information-for/addressing-alcohol-and-other-drug-use-in-your-community

Dignity, Diversion, Home and Hope:A Review of Interventions for Volatile Substance Misuse in Regional North Queensland.

Developing an Inhalant Misuse Community StrategyThis booklet aims to assist local communities to address inhalant misuse.

NT community group reduces sniffing harmsEducation workshops and camps succeed in lowering inhalant use among Darwin youth.

Warlpiri Youth Development Aboriginal Corporation (WYDAC)Strong community involvement and high engagement lies beneath the success of one of Australia's most successful programs combatting inhalant misuse in remote communities.

Targeting inhalant use head on in Mt IsaA holistic approach to inhalant misuse sees intervention, prevention and community engagement reduce inhalant misuse.

Follow the GrogWatch blogBecome part of an online community taking action on preventing alcohol-related harm in families and the wider community.

Community Drug Action Teams (CDATs)If you're in New South Wales, volunteer to join a CDAT. These teams work together to minimise and prevent harmful use of alcohol and other drugs in their neighbourhoods.

Targetting workplaces in your community projectsIssues relating to alcohol and drug use cost Australian workplaces an estimated $6 billion a year, mainly arising from lost productivity, absenteeism, injuries in the workplace and death.

Lobbying for change through the  mediaAdvocacy has played a key role in tobacco law reform. Communities can play an important role in continuing to send governments a message on the need for more change.

Tackling the root of alcohol and drug problemsRunning projects that focus on why people misuse alcohol and drugs, like dysfunctional family relationships, can be more effective than concentrating on the actual alcohol and drug use.  

What is alcohol and drug prevention?There are different types of alcohol and other drug prevention programs. Understanding each type can help you set clear aims for your next community project.

Coordinated approach needed for behaviour changeFrom schools, to GPs to bars and pubs to workplaces – ensuring your project covers a number of these community settings can help you be more effective and achieve behaviour change.

Keeping school leavers safe‘Schoolies’ events are often associated with risky drinking among young people. But the Surf Coast Shire community in Victoria has managed to develop a school leavers event that has reduced alcohol-related harm.

Preventing alcohol and drug problems in your communityTacking AOD problems can be challenging and it’s often difficult to achieve results. This publication looks at best practice approaches to community programs to give you some ideas for your next project.

6 steps to planning community alcohol and drug projectsDiscussion guide to assist your working group plan its next community project. Taking some time to follow these steps will help you achieve a better result.

Leveraging social mediaSocial media offers huge opportunities to connect with people. Learn how alcohol companies are taking advantage of these opportunities and how you can too in your community projects.

Preventing alcohol and drug problems through schoolsSchools can play a key role in preventing alcohol and drug problems. Learn how parents and the wider community can help them.

Sporting clubs prove an ideal setting for preventionResearch has shown that programs like Good Sports can reduce AOD harm in communities. Learn how sporting clubs have implemented this program to achieve significant results.

ADF SearchOnline access to reports, books and journal articles on AOD community interventions.

DrivingInformation for drivershttp://www.druginfo.adf.org.au/information-for/information-for-drivers

Note: If you intend driving, the safest option is not to have any alcohol or other drugs in your system at all. This includes prescription medications that affect driving ability.

To drive safely, we need to be mentally alert, to have clear vision, physical coordination and the ability to react appropriately.

Avoiding the risksThe affects of alcohol and other drugs can make it difficult for a person to assess how much their driving skills are affected. Avoid driving if you are:

Feeling dizzy or light-headed Unable to think clearly Edgy Nauseous or otherwise unwell Drowsy or tired

Planning aheadIf you intend to use alcohol or other drugs and need to travel, plan ahead by:

Organising a driver who will not be using any alcohol or drugs Arranging to be picked up Using public transport or a taxi Arranging to stay overnight

It is important to remember that alcohol and other drugs can continue to affect you the next day. Fatigue, hangovers and 'coming down' can also impair your driving ability.

Drivers at high riskSome drivers are at particular risk of problems relating to drugs and driving. If you belong to any of the following groups, follow the links to find out more.

Young drivers Parents of young drivers Older drivers Commercial drivers Drivers taking medication

How do alcohol and other drugs affect driving?

Visit our resources section for fact sheets, posters and wallet cards about the effects of drugs on driving.

Workplacehttp://www.druginfo.adf.org.au/fact-sheets/alcohol-and-drugs-in-the-workplacehttp://www.druginfo.adf.org.au/fact-sheets/alcohol-and-drugs-in-the-workplace

The impact of alcohol and other drugs on the workplaceThe use of alcohol and other drugs can impact on workplaces in a number of ways, including affecting relationships, safety and productivity.

The following statistics demonstrate the extent of this impact in Australia: 

Alcohol and other drugs cost Australian workplaces an estimated $6 billion per year in lost productivity1.

Recent research has estimated that 2.5 million days are lost annually due to alcohol and other drug use, at a cost of more than $680 million2.

One in 10 workers says they have experienced the negative effects associated with a co-worker's misuse of alcohol. The negative effects include reduced ability to do your job, involved in an

accident or close call, worked extra hours to cover for a co-worker, and took at least one day off work3. 

How do hangovers and coming down affect work?Having a hangover or coming down from drugs at work can be just as problematic as being intoxicated. Headaches, blurred vision, irritability, problems concentrating, lost voice and extreme tiredness can all create problems for you and your co-workers.

Alcohol

Sobering up takes time. As a guide, an average person in good health can process one standard drink per hour.

Hangover cures like cold showers, doing exercise, strong coffee or being sick will not speed up the process. These cures may make you feel better, but they don't change your blood alcohol concentration (BAC).

Other drugs

It can take several days to come down from other drugs like ecstasy, ice and amphetamines, so using these drugs on the weekend can still affect your work.

Do prescription drugs affect work?There is always a level of risk when using any drug including prescription or over-the-counter medications.

Drug reactions vary from person to person. If you are taking a drug you haven't had before, you won't know how it will affect you. It's important to follow your doctor's advice when taking prescription drugs and discuss any side-effects and how this might impact on your work.

The effects of prescription drugs such as benzodiazepines (e.g. Xanax®) can have an impact on your work and you should discuss these with your doctor. Long term use in particular may become problematic.

What is an alcohol and other drug problem?An alcohol or drug problem isn't necessarily measured by how much, how many or what type of drugs a person uses, but by how the drug affects the person's life and the lives of those around them. It's often a matter of personal perception.

Here are some examples of a drug problem:

Regularly returning from lunch a bit tipsy, then disturbing everyone in the office and making it harder for them to work.

Taking prescription medication for a long time, which causes memory problems, clumsiness and tiredness. 

Often taking ecstasy or drinking alcohol heavily on the weekend and then coming into work tired, irritable and moody the next day.

Concerned about a co-worker?If a co-worker's use of alcohol or other drugs is affecting you then they do have a drug problem. This person may not be aware their drug use is affecting those around them, so you need to talk to them or the most appropriate person in your organisation such as a manager or someone from human resources.

Find out the facts

If you are concerned that a co-worker is intoxicated while at work, it is important to be very sure that the person is actually under the influence of drugs – and not unwell – before you take any further action. It is very difficult to know if someone is impaired by the use of drugs or if someone is misusing them. Read through the drug facts pages to find out about the effects of different drugs.

If you are concerned that a co-worker's drug use is affecting their work and/or the safety of others, it would be helpful to document evidence of incidents.

Speak up

If your workplace has an alcohol and drug policy, follow the procedures outlined in that document.

If your workplace does not have an alcohol policy you may wish to discuss the issue with:

Your health and safety representative A member of the health and safety or other formal workplace committee A manager, supervisor or employer

If you choose to talk to your co-worker directly about your concerns, there is no easy way to begin the conversation. The following suggestions may help:

Talk to a counsellor, health professional or your workplace's Employee Assistance Program (EAP) for advice on how to handle the situation.

Speak to a manager or supervisor about your concerns and seek their advice (you do not need to identify the co-worker).

It may be best to talk to the person away from the workplace and outside of working hours. Explain how the person's use of alcohol is affecting you and other people around them at work.

Give concrete examples. Try to remain calm and logical and stick to the point – refuse to be drawn into an argument. Offer your support and encourage them to seek professional help. Provide them with information

about available services (see below 'Further information').

Employee responsibilitiesIt's important to consider how your use of alcohol or drugs may impact on your co-workers because the OHS Act imposes a duty on all workers not to recklessly endanger any other person in workplaces.

Different industries and workplaces may have more specific rights and responsibilities for employers and employees detailed in a policy. For example, some industries and workplaces may require people driving vehicles to have a blood alcohol concentration (BAC) of 0.00. Others may have policies about testing employees for alcohol.

Make sure you are aware of your rights and responsibilities around alcohol within your workplace and/or industry.

Employer responsibilitiesYour employer has a legal obligation to address alcohol and other drug issues in the workplace through the 'duty of care' provisions in the OHS Act. These provisions require employers to take all reasonable or 'practicable' steps to ensure the health and safety of all workers and any other people who may be affected by the actions of the employer, such as contractors or clients.

The Alcohol and Drug Foundation works with employers to help them develop alcohol and drugs policies, train employees about alcohol and drugs, and organise safe parties. If you think your workplace could benefit from these services, put your manager or human resources department in contact with the Alcohol and Drug Foundation's Workplace Services.

Further informationAlcohol and Drug Foundation's Workplace Services team: Tel. 03 9611 6100 or visit adf.org.au/workplace

Unions: If you are in a union, you should contact them for assistance.

WorkSafe Victoria Advisory Service: Tel. 1800 136 089 (toll free).

Your local doctor, other health professional, or workplace Employee Assistance Program should be able to provide you with confidential advice or refer you to a more appropriate service.

DirectLine is a 24-hour telephone counselling and referral service for people in Victoria wanting help with alcohol or other drug related issues. Tel. 1800 888 236.

Counselling Online offers free alcohol and drug counselling online 24 hours a day, 7 days a week. Visit counsellingonline.org.au.

Related articles

Safe partying for all ages

Simple strategies to prevent alcohol and drug related violence

PolicyTalk: Workplace drug testing

PolicyTalk: Workplace alcohol and drug programs

References

1. Manning, M., Smith, C. & Mazerolle, P. (2013). The societal costs of alcohol misuse in Australia. Trends and Issues in Crime and Criminal Justice. 454. Canberra: Institute of Criminology.

2. Roche, A., Pidd, K. & Kostadinov, V. (2015). Alcohol – and drug-related absenteeism: a costly problem.

3. Dale, C. & Livingston, M. (2010) The burden of alcohol drinking on co-workers in the Australian workplace, Medical Journal of Australia, 193(3), 138-140.

The Lawhttp://www.druginfo.adf.org.au/topics/drug-law-in-australia#legalPlease note: This information does not constitute legal advice and should not be relied upon in this way. The information is correct at the time of publication. For information specific to your situation contact a legal aid service in your state or territory.

Although we think of some drugs being legal, and others being illegal, many drugs are somewhere in between. Some substances are legal, but there are laws restricting their use or sale. Others are illegal to use, possess or produce.

New psychoactive substances (synthetics) - including synthetic cannabisA range of terms have been used to describe new psychoactive substances (NPS), including new and emerging drugs (NEDs), synthetics, legal highs, herbal highs, party pills, herbal ecstasy, bath salts, drug analogues and synthetic cannabis.

The laws surrounding NPS are complex, constantly changing and differ between states/territories, but in general they are increasingly becoming stronger.

In Queensland, New South Wales, and South Australia there is now a ‘blanket ban’ on possessing or selling any substance that has a psychoactive effect other than alcohol, tobacco and food.

In other states and territories in Australia specific NPS substances are banned and new ones are regularly added to the list. This means that a drug that was legal to sell or possess today, may be

illegal tomorrow. The substances banned differ between these states/territories (G. Barnes, personal communication, April 23, 2014).

Get the facts on new psychoactive substances (synthetics) . Watch our seminar and read our publications on new and emerging drugs.

 

See below for an outline of laws relating to individual drugs in Australia. For more detailed information contact a legal aid service in your state or territory.

Legal and restricted drugsAlcohol

There are laws that govern how alcohol may be used. These laws may differ depending on the state, territory or local area. For example, in some areas local by-laws make it illegal to drink alcohol in public places such as beaches, parks and streets.

It is an offence for a person who is under 18 years of age to buy, receive or drink alcohol on licensed premises, unless they are with a parent or guardian.

In some states in Australia, it is also an offence to supply a person under 18 years of age with alcohol in a private home, unless the young person’s parent or guardian has given permission and the alcohol is supplied in a responsible manner. This is known as secondary supply.

It is illegal to drive under the influence of alcohol.

Penalties for breaking these laws can include fines, imprisonment and disqualification from driving.

Employers have legal obligations in relation to health and safety of their workers and people who visit their workplace. Find out more about the responsibilities of employers and employees.

Amphetamines

Use of amphetamines is restricted. They can only be prescribed by a medical practitioner for medical reasons.

Federal and state laws provide penalties for possessing, using, making, selling or driving under the influence of amphetamines without a prescription from an authorised person. There are also laws against forging or alerting a prescription or making false representation to obtain amphetamines or a prescription for them. Laws have been introduced that prevent the sale and possession of ice pipes in some states and territories.

Benzodiazepines

Using benzodiazepines without a prescription from a doctor, or selling or giving them to someone else, is illegal. There are also laws against forging or altering a prescription or making false representation to obtain benzodiazepines or a prescription for them.2

In 2014, in response to concerns about the use and harms associated with the benzodiazepine, alprazolam (Xanax®), it was rescheduled under the Pharmaceutical Benefits Scheme (PBS) as a Schedule 8 drug. Doctors must now follow additional state and territory laws when prescribing alprazolam and must notify, or receive approval from, the appropriate health authority.1

Betel nut

The active ingredient in betel nut is arecoline, which is a Schedule 4 poison (prescription only medicine) and therefore is illegal to possess or sell without proper authority.

Buprenorphine

Using buprenorphine without a prescription from a doctor, or selling or giving it to someone else, is illegal. There are also laws against forging or altering a prescription or making false representation to obtain buprenorphine or a prescription for it.2

Cognitive enhancers (smart drugs)

Modafinil is a Schedule 4 substance that can only be prescribed by a doctor or dentist in the ordinary course of their professions.

Methylphenidate is a Schedule 8 drug which means doctors must follow state and territory laws when prescribing it and must notify, or receive approval from, the appropriate health authority.

Using modafinil or methylphenidate without a prescription from a doctor, or selling or giving them to someone else, is illegal. There are also laws against forging or altering a prescription or making false representation to obtain pharmaceuticals or a prescription for them.2

Inhalants

Inhalant use is not a criminal offence in any Australian state or territory.

In recent years, some Australian states and territories have revised police powers to intervene in inhalant use in two main ways. Police are authorised to:

Take away inhalants and related equipment Pick up young people who are misusing inhalants, and release them into the care of a responsible

person, or a place of safety.

It is also illegal in some states and territories to sell or supply products to someone if they believe they are to be used for inhaling.

State/territory legislation on inhalant salesIt is an offence in Queensland, Western Australia, Victoria, South Australia, New South Wales and the Northern Territory to knowingly supply an inhalant to a person for the purpose of intentional inhalation.

QueenslandSection 23 of the Summary Offences Act 2005 [PDF:373KB]Section 603 – 607 of the Police Powers and Responsibilities Act 2000 [PDF:3MB]Part 2 Section 10 of the Drugs Misuse Act 1986   [PDF:557KB]

Western AustraliaSection 206 (1) of the Criminal Code Act 1913. Sections 5-14 of the Protective Custody Act 2000Section 7 (1) (g) of the Aboriginal Communities Act 1979

VictoriaSections 57-60T of the Drugs, Poisons and Controlled Substances Act 1981Drugs, Poisons and Controlled Substances (Volatile Substances) Regulations 2004 [PDF:559 KB]

South AustraliaSection 19 of the Controlled Substances Act 1984. Section 42D of the Anangu Pitjantjatjara Yankunytjatjara Land Rights Act 1981.Section 7 of the Public Intoxication Act 1984

New South WalesThere is no specific legislation in NSW that refers directly to inhalant abuse only legislation referring to intoxicated persons. Part 14 and 16 of the Law Enforcement (Powers and Responsibilities) Act 2002Section 9 of the Summary Offences Act 1988

Northern TerritoryPart 2, Part 4 and Part 5 Sections 52 of the Volatile Substance Abuse Prevention Act 2005

Australian Capital TerritoryThere is no specific legislation in the ACT that refers directly to inhalant abuse, only legislation referring to intoxicated persons.

Ketamine

Legally produced ketamine is a restricted substance and only a doctor or vet may prescribe or administer it. All other ketamine is illegal in Australia.

Federal and state laws provide penalties for the illegal use, possession, production, selling or driving under the influence of ketamine. Penalties can include fines, imprisonment and disqualification from driving.

Kava

The import, advertising and sale of kava in Australia are strictly controlled. Kava is listed as a controlled substance under the Customs (Prohibited Imports) Regulations Act.

As of 26 June 2007 commercial importations of kava are no longer allowed, except for medical or scientific purposes.

Passengers coming into Australia, who are over the age of 18 years, are allowed to bring 2 kg of kava without a license or permit, provided it is in their accompanied baggage.3

Read more about importation of kava.

Khat

It is illegal to import khat into Australia for personal use. Khat can only be imported for medical and/or scientific use. Importing khat without a permit is subject to fines or prosecution. For more information visit the Australian Government's Department of Health website.

Methadone

Using methadone without a prescription from a doctor, or selling or giving it to someone else, is illegal. There are also laws against forging or altering a prescription or making false representation to obtain methadone or a prescription for the drug. It is also illegal to inject methadone.4

Oxycodone

Under the Pharmaceutical Benefits Scheme (PBS), oxycodone is a Schedule 8 drug. Doctors must follow state and territory laws when prescribing oxycodone and must notify, or receive approval from, the appropriate health authority.

Using oxycodone without a prescription from a doctor, or selling or giving them to someone else, is illegal. There are also laws against forging or altering a prescription or making false representation to obtain oxycodone or a prescription for them from a health professional.

Performance and image enhancing drugs (including steroids)

It is illegal to manufacture, import, possess, use or supply steroids without a prescription or medical practitioner licence. The penalties for illegally administering steroids varies for every Australian state and territory5.

It is also against the law to inject another person with steroids, or for them to be self-administered without a prescription.

Medical practitioners can only prescribe steroids for legitimate medical reasons5.

Steroid use is banned in competitive sport. Testing positive for steroids can result in fines, suspensions or permanent bans6.

Tobacco

Federal and state laws make it an offence to sell or supply tobacco products to people under 18 years of age. It is also illegal for anyone under 18 years to purchase tobacco products.

There are laws that regulate and restrict how tobacco products are advertised, promoted and packaged.

There are also laws and regulations that restrict smoking in public areas such as shopping centres, cafes and workplaces. Most states and territories have laws that ban smoking in cars with children.

Illegal drugsThe following drugs are some of the drugs that are illegal in Australia. Federal and state laws provide penalties for possessing, using, making or selling them, or driving under their influence.

Cannabis, including some synthetic cannabinoids Cocaine Ecstasy (MDMA) GHB (gamma hydroxybutyrate) Heroin Ice (crystal methamphetamine) LSD (lysergic acid diethylamide) Mephedrone PCP (phencyclidine) PMA (paramethoxyamphetamine) and PMMA (paramethoxymethamphetamine).

 

There are also laws that prevent the sale and possession of bongs and other smoking equipment in some states and territories. (For example, Victoria has passed legislation that will ban the sale of cannabis water pipes (bongs) from January 2012.)

Ice (crystal methamphetamine)

Use of methamphetamine (ice) is against the law. Federal and state laws provide penalties for possessing, using, making, selling, importing or exporting, or driving under the influence of methamphetamine. The importation or exportation and the procuring of precursor drugs (such as pseudoephedrine) with the intention of manufacturing a controlled drug, is also against the law. Laws have been introduced that prevent the sale and possession of ice pipes in some states and territories.

Mephedrone

Mephedrone is classified as a controlled substance and has been added to Schedule 4 of the Customs (Prohibited Imports) Regulations 1956. It can only be imported into Australia with a valid licence and permit.

Drug offencesDrug laws in Australia distinguish between those who use drugs and those who supply or traffic drugs.

The Federal Customs Act covers the importing of drugs, and each state has its own laws governing the manufacture, possession, distribution and use of drugs, both legal and illegal. 

The Drugs, Poisons and Controlled Substances Act (DPCSA) includes these major drug offences:

Use includes smoking, inhaling of fumes, or otherwise introducing a drug of dependence, into a person's body (including another person's body).

Possession is the most common offence. Possession means having control or custody of a drug. Knowledge of such possession must be proven in court. Possession applies both to drugs found on the person or their property, unless it is proven the drugs do not belong to that person.

Cultivation is the act of sowing, planting, growing, tending, nurturing or harvesting a narcotic plant.

Trafficking is a very serious offence. It includes the preparing of a drug of dependence for trafficking; manufacturing a drug of dependence; or selling, exchanging, agreeing to sell, offering for sale or having in possession for sale, a drug of dependence. If this is done in commercial quantities, the penalties are extremely severe.

Driving

It is illegal to drive under the influence of drugs. Breaking this law carries penalties including disqualification from driving, heavy fines and/or imprisonment.

Some states have introduced random roadside testing for cannabis and amphetamines.

Read more about drugs and driving.

Find information for drivers.

PenaltiesPenalties for breaking laws in relation to alcohol and other drugs may include fines, imprisonment and disqualification from driving.

Drug diversion

Some states and territories have drug diversion programs that refer people with a drug problem to treatment and/or education programs where they can receive help, rather than going through the criminal justice system.

For information specific to your situation contact a legal aid service in your state or territory.

Read the September 2012 issue of PolicyTalk, "Drug policy reform: Moving beyond strict criminal penalties for drugs"

References1. Australian Government Department of Health. (n.d). Prescribing Medicines – Information for PBS Prescribers.

2. Drugs, Poisons and Controlled Substances Act 1981 - Sect 36B. 

3. Australian Government Department of Health. (2011). Importation of Kava.

4. State Library NSW. (2011). Possession, use and supply.

5. Australian Institute of Criminology (2011). Steroids.

6. World Anti-Doping Authority (2014). Anabolic agents.

Help and supporthttp://www.druginfo.adf.org.au/contact-numbers/help-and-support

InformationCall 1300 85 85 84, email DrugInfo or browse online drug information.Get information on prescription drugs.

Support or treatmentContact a national service or a service in your state or territory.Read more about your treatment options.Advice for friends and family members.Visit the Australian Drug Information Network (ADIN) for more treatment and information services.

Telephone numbers below appear as links. Please note that these will only work if you are viewing this page on a smart phone.

National beyondblue1300 22 463624 hours a day, 7 days a weekSupport for depression, anxiety and related disorders.

CounsellingOnline24 hours a day, 7 days a weekFree alcohol and drug counselling online.

Cannabis Information and Helpline1800 30 40 5011am–7pm, Monday to Friday (including public holidays)

Family Drug Help1300 660 06824 hours a day, 7 days a week

Family Drug Support1300 368 186 24 hours a day, 7 days a weekSupport for families faced with problematic drug use.

Kids Help Line1800 55 1800 24 hours a day, 7 days a weekFree and confidential telephone and online counselling service for young people aged between 5 and 25.

Lifeline13 11 14 24 hours a day, 7 days a weekConfidential telephone counselling.

Quitline13 78 488am–8pm, Monday to Friday

SANE Australia helpline1800 187 263 9am–5pm, Monday to FridayInformation and referral about mental health issues.

Say WhenOnline support for monitoring alcohol intake.

Prescription drug help lines

Adverse Medicine Events Line1300 134 2379am to 5pm, Monday to Friday (excluding NSW public holidays)Not for emergencies. Report and discuss adverse experiences with your medications.

Medicines Line1300 MEDICINE OR 1300 633 4249am to 5pm, Monday to Friday (excluding NSW public holidays)Information on prescription, over-the-counter and complementary (herbal, ‘natural’, vitamin and mineral) medicines.

State and territory servicesVictoria

DirectLine1800 888 23624 hours a day, 7 days a weekConfidential alcohol and drug counselling and referral line.

1800 ICE ADVICE1800 423 23824 hours, 7 days a weekAdvice and support for people who use ice, their families and health professionals.

Pharmacotherapy, Advocacy, Mediation & Support (PAMS)1800 443 84410am–6pm, Monday to FridayAdvice for anyone experiencing trouble with their pharmacotherapy program (Methadone, Suboxone etc.).

Youth Drug and Alcohol Advice (YoDAA) Line1800 458 6859am–8pm, Monday to FridayTelephone information and advice for young people and others concerned about them. 

New  South Wales 

Alcohol and Drug Information Service (ADIS) Sydney: 02 9361 8000 Regional NSW: 1800 422 599A 24-hour confidential information, advice and referral telephone service.

Ted Noffs Foundation help lineNSW/ACT: 1800 151 045QLD: 1800 753 30024 hours a day, 7 days a weekCounselling and support for young people and their families.

Queensland

Alcohol and Drug Information Service (ADIS)1800 177 83324-hour Alcohol and Drug Information ServiceTelephone information, counselling and referral. 

Western Australia

Parent Drug Information Service (PDIS)Perth: 08 9442 5050Regional: 1800 653 203

Alcohol & Drug Information Service (ADIS) Perth: 08 9442 5000 Regional WA: 1800 198 024 A 24-hour, confidential telephone service that provides information, counselling, referral and advice.

South Australia

Alcohol and Drug Information Service (ADIS)1300 131 340

24-hours, 7 days a weekTelephone information, counselling, and referral service.

Australian Capital Territory

Alcohol and Drug Information Service (ADIS) 02 6207 997724-hour telephone service offering information, advice, referral, intake, assessment and support.

Tasmania

Alcohol and Drug Information Service (ADIS)1800 811 994 A 24-hour telephone information and counselling line.

Northern Territory

Alcohol and Drug Information Service (ADIS) 1800 131 350 24-hour Alcohol and Drug Telephone Information and counselling service.

 

Overdosehttp://www.druginfo.adf.org.au/topics/overdosehttp://www.druginfo.adf.org.au/images/overdose-9jun16.pdf

What is overdose?Someone overdoses when their body can't handle the effects of alcohol or another drug. This could happen because they take too much or because they take different drugs at the same time. Combining drugs increases the changes of overdose.1

Why do people overdose?Some people overdose intentionally because they want to end their life. Others overdose unintentionally, which could be due to a number of reasons including:

o The drug taken was stronger than or different to what was expected. It's impossible to know what substances illegal drugs contain or how strong they are as they vary from batch to batch.1 With new psychoactive substances ('synthetic drugs') entering the market and being added to common drugs, there is more chance of not knowing what illegal drugs contain. For example, there are reports of NBOMes being added to ecstasy pills.3

o Alcohol and other drugs affect memory, thinking and judgement. This makes it easy to forget what and how much has already been taken. A large amount or a mix of drugs can then be taken without enough thought for the possible risks.1 It can also lead to people making someone else's drink stronger than expected or adding a drug to it for fun, without thought for the serious mental and physical consequences. This is classed as 'drink spiking', which is illegal and can result in a hefty fine.

The decision to take a drug and/or the dose was based on someone else's reaction to it. Drugs affects everyone differently, depending on:

o Sizeo Weighto Healtho Whether the person is used to taking ito Whether other drugs are taken around the same timeo The amount takeno The strength of the drug

Signs and symptoms of overdoseDepressant drugs

Depressant drugs, including heroin and other opioids, benzodiazepines and alcohol, slow the messages travelling between the brain and the body.

Some signs of a depressant drug overdose include:

Vomiting     Unresponsive, but awake  Limp body  Pale and/or clammy face Bluish fingernails and/or lips  Shallow or erratic breathing, or not breathing at all  Slow or erratic pulse (heartbeat) Choking sounds or a gurgling noise  Loss of consciousness Death3

Stimulant drugs

Stimulant drugs, including amphetamines (such as ice) and cocaine, speed up the messages travelling between the brain and the body.

Some signs of a stimulant drug overdose include:

Agitation Paranoia Severe stomach pain Difficulty breathing Seizures Chest pain Heart attack Heart stops  Coma  Stroke Death4

Paracetamol

Paracetamol causes the largest number of overdoses where the person is taken to hospital. It's often involved in episodes of intentional self-harm by young people, where they take more than the recommended dose.

Some signs of paracetamol overdose include:

Yellowing of the skin and the whites of the eyes (jaundice) Loss of coordination Low blood sugar (hypoglycaemia), which can cause sweating, trembling and irritability Liver damage Death5,6

Overdose and organ damage

Non-fatal overdoses may still cause permanent organ damage. The liver and the kidneys are two organs at very high risk. Overdose can also cause brain damage due to the person not breathing for a period or limited oxygen intake.7

What to do if someone overdosesIf someone looks like they are in trouble or sleeping and can't be woken after consuming alcohol or using other drugs, it's very important that they receive medical help as soon as possible. A quick response can save their life.

o Call an ambulance. Dial triple zero (000). Ambulance officers are not required to involve the police.

o Stay with the person until the ambulance arrives. Find out if anyone at the scene knows CPR in case the person stops breathing.

o Ensure the person has adequate air by keeping crowds back and opening windows or taking them outside. Loosen tight clothing.

o If the person is unconscious or wants to lie down, put them in the recovery positionby gently rolling them onto their side and slightly tilting their head back. This is to prevent them choking if they vomit and allows them to breath easily.

Provide ambulance officers with as much information as you can, such as how much of the drug was used, how long ago and any pre-existing medical conditions. If they have taken a drug that came in a packet, give the packet to the ambulance officers.

If you can't get a response from someone, don't assume they are asleep. Not all overdoses happen quickly and sometimes it can take hours for someone to die. Action taken in those hours could save a life.

Naloxone

Naloxone (also known as Narcan®) reverses the effects of opioids, particularly in the case of an overdose. Naloxone can be injected intravenously (into a vein) or intramuscularly (into a muscle) by medical professionals, such as paramedics. It can also be administered by family and friends of people who use opiates. Speak with your doctor or general practitioner for more information.

Overdose response plan

Further informationStatistics

Statistics on overdose

Reducing the risks

Drink spiking Supervised injecting facilities Help and support Treatment

Resources

SMS service: Get the effects by text

References

1. Pennington Institute. (n.d.) Overdose basics.

2. Gerstner-Stevens, J. (2013). Analysis results for Victorian seizures of emerging psychoactive substances and pharmaceutical opioids for 2012–13. Drug Trends Conference 2013. Melbourne: Victoria Police.

3. Harm Reduction Coalition. (n.d.). Recognizing opioid overdose.

4. MedlinePlus. (2014). Methamphetamine overdose.

5. Quay, K. & Shepherd, M. (2010). Starship Children's Health Clinical Guideline: Paracetamol poisoning [PDF:31KB].

6. National Health Service. (2013). Symptoms of poisoning.

7. E Medicine Health. (2014). Drug overdose.

National drug policyhttp://www.druginfo.adf.org.au/drug-facts/national-drug-policyhttp://www.nationaldrugstrategy.gov.au/

Australia's national drug policy is based on harm minimisation. Strategies to minimise harm include encouraging people to avoid using a drug, through to helping people to reduce the risk of harm if they do use a drug. It aims to reduce all types of drug-related harm to both the individual and the community.

National Drug StrategyThe National Drug Strategy (NDS) and its forerunner, the National Campaign Against Drug Abuse (NCADA), have been operating since 1985. Both NCADA and NDS were created with strong bipartisan political support and involve a cooperative venture between the Commonwealth and state/territory governments as well as the non-government sector.

WelcomeThe National Drug Strategy, a cooperative venture between Australian, state and territory governments and the non-government sector, is aimed at improving health, social and economic outcomes for Australians by preventing the uptake of harmful drug use and reducing the harmful effects of licit and illicit drugs in our society.

On this website you will find information about the National Drug Strategy and the advisory structures that support the strategy; links to the current drug campaign sites with information on initiatives at national, state/territory or community levels; the key research and data components supporting the strategy; publications; and key links to relevant government, professional organisations and drug-related portal sites.

What's New? Public consultation for draft National Drug Strategy 2016-2025 National Aboriginal Torres Strait Islander Peoples Drug Strategy 2014-2019 National Alcohol and other Drug Workforce Development Strategy 2015-2018 Framework for a National Response to New Psychoactive Substance National Guidelines for Medication-Assisted Treatment of Opioid Dependence National Pharmaceutical Drug Misuse Framework for Action (2012-2015) Updated Fetal Alcohol Spectrum Disorders in Australia: An Update Australian secondary students' use of tobacco, alcohol, and over-the-counter and

illicit substances in 2011 National Tobacco Strategy 2012-2018 National Drug Strategy 2010-2015

Public consultation for draft National Drug Strategy 2016-2025The Intergovernmental Committee on Drugs (IGCD) invites feedback on the draft National Drug Strategy 2016-2025.

National Drug Strategy 2010-2015The Ministerial Council on Drug Strategy approved the National Drug Strategy 2010-2015 at its meeting held in Perth on 25 February 2011. 

The strategy is the result of an extensive consultation process that began in December 2009 with the release of a consultation paper and concluded in December 2010 with the close of comments on a draft of the strategy.