September 26th 2015


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Articles from this issue:

COVER STORY Abbott era ends as Liberals oust elected PM

EDITORIAL The future of the Liberals after leadership coup

FAMILY AND SOCIETY Vulnerable GLBT youth pawns in plebiscite game

INTERNATIONAL AFFAIRS Cuts in aid trigger mass migration: more to come?

NATIONAL AFFAIRS Labor campaign to 'get' Dyson Heydon backfires

FOREIGN AFFAIRS China's official media hints at power struggle in Beijing

ASIA Taiwan: no longer the Kingdom of Youth

MILITARY HISTORY Antony Beevor at the Australian War Memorial

LIFE ISSUES Assisted suicide and our society of autonomy

SCIENCE You can trust research papers (we think; we hope)

PUBLIC HEALTH Taxpayer funding offers no immunity from failure

MINING Supreme Court dismisses attack on Qld Land Court

CINEMA Technology and the antisocial network: The Social Network

BOOK REVIEW Hollow Heroes: An Unvarnished Look at the Careers of Churchill, Montgomery and Mountbatten, by Michael Arnold

LETTERS

NATIONAL AFFAIRS Turnbull divides party in Cabinet reshuffle

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PUBLIC HEALTH
Taxpayer funding offers no immunity from failure


by Ross Colquhoun

News Weekly, September 26, 2015

One of the most common dangers associated with injecting drugs is hepatitis C (Hep C) infection. In 80 per cent of cases of Hep C, patients become chronically infected. Typically Hep C has the tendency to cause chronic disease associated with liver damage.

Eighty per cent of hepatitis C

patients become chronically infected.

Despite these facts, agencies that represent the interests of people who have or are at risk of acquiring Hep C continue to tell drug users that they can inject safely. However, to state that drug injecting can be safe is false and fails to protect those who are most vulnerable and who rely on such groups for accurate information. The message they promote is that drug injecting does not inevitably entail harm; and if infections are acquired, treatments are available, or should be available, to cure the disease.

Government-funded organisation Hepatitis Australia provides important facts on Hep C that contradicts this message. Of the 233,000 people with Hep C in Australia, the great majority have acquired the disease through injecting drugs. Rates of infection among drug injectors are as high as 80 per cent. As blood-to-blood contact is the means of transmission, infection occurs not only through needle sharing but also from contamination of drug injecting paraphernalia and from unclean practices, and can occur after injecting unsafely just once or twice.

Hep C is also acquired through unsterile tattooing and piercing equipment. Hepatitis Australia states that the most effective means of prevention is not to inject drugs.

However, it is alarming that the information Hepatitis Australia conveys to users fails to make plain the message its own evidence suggests. It states that drug injectors should contact users groups to learn how to inject safely. Despite the facts, the information it provides implies that continuing to inject drugs is a safe option if done properly. It does not provide any information about the real dangers of illicit drug use or how to seek drug treatment or to stop injecting.

The feeling is that such a message may be offensive to those who inject drugs. One would have thought it was more offensive, in fact a dereliction of the duty of care, to mislead these people with false notions of safe injecting and not to insist on helping them to become risk free by stopping this dangerous practice.

Not only is this message supressed, but the organisation persistently denies that drug users should take personal responsibility for their dangerous behaviour, behaviour that endangers their own health and lives, and imposes great burdens on families and the community. Yet Hepatitis Australia suggests that the onus for care should be borne by society: by those who choose not the use illicit drugs.

Hepatitis Australia does not suggest that people should stop injecting after they contract Hep C but implies that they can continue to do so as treatment for Hep C is available. Even this is misleading, as people who have received treatment and continue to inject drugs are at high risk of re-infection, possibly with a more virulent strain of the virus.

Nor does the organisation reveal that the Hep C treatment using interferon is not always effective and has unacceptable side effects. It is not a cure. Unless a person stops injecting, the effectiveness of any treatment is highly compromised.

The Network of Drug and Alcohol Agencies, Hepatitis Australia and users groups such as Australian Illicit & Injecting Drug Users League suggest that health services provide these harm-reduction messages to clients, including use of sterile equipment, every time, and accessing and having regular liver health checks. In fact some treatment centres provide clean “fits” and demonstrate “safe” injecting and filtering techniques.

However, advocacy of “safe” injecting, testing and new drug treatments to combat Hep C really misses the mark. With roughly 90 per cent of new transmissions of Hep C continuing to involve the sharing of injecting equipment, effective drug policy demands a much more rigorous approach.

The impossibility of injecting drugs safely is apparent from the many procedures for “safe” injecting required to reduce the risk of contracting the disease. Even failing to follow these procedures once or twice can result in infection. The recommended practices that reduce the risk of transmission include always injecting with clean hands, in a clean space, with new syringes, new sterile water, spoons and filters, plus a detailed procedure for swabbing the injecting area and sterilising equipment and more.

It is unlikely that a person who is intoxicated or affected by withdrawal symptoms, including drug-induced psychosis, could manage to do this every time they inject. Imagine a desperate heroin addict in a public toilet. The advice is delusionary.

Quite apart from the high risk of initially contracting Hep C, major harm arises from continued re-infection with more virulent strains of Hep C and other viruses, thus leading to higher risk of serious liver disease, including cancer, while drug users continue to inject.

The high incidence of Hep C due to injecting drugs demands effective action. An effective strategy involves supply-and-demand reduction and prevention, including education on drug harm and recovery-focused treatment. All government funding should be directed to agencies that focus on prevention, treatment and recovery.

Dr Ross Colquhoun is an executive member of Drug Free Australia and research fellow, and a member of the Drug Advisory Council of Australia (daca.org.au).




























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