AMD Newsletter 8 February 2019
The case for pilot studies of pill testing in Australia
It is widely accepted by experts in the field that current approaches to drug policy in Australia have yielded limited success. The reliance on crude messages (calls for total abstinence, “just say no to drugs”) and even cruder enforcement strategies (harsher penalties, criminalisation of drug users) have had little or no impact on the use of drugs or their harmful effects on the community.
Whether we like it or not, drug use is common in our society, especially among young people. In 2016, 43 per cent of people aged 14 and older had used an illicit drug, including about one in five in the 20 – 29 year age group. The use of MDMA – the active ingredient in ecstasy – is common and increasing among young people. In the last five months alone six people have died as a result of using illicit drugs at music festivals and many more have been taken to hospital.
Over the last few decades the potential benefits of “harm reduction” programs in relation to a variety of social problems have been recognised. Such programs accept that risky behaviours cannot be completely eliminated and that it is a valid aim of public health strategies to reduce the adverse outcomes they cause. Since the 1970s this approach has been applied successfully in many areas, including road safety campaigns and programs to reduce the impact of alcohol and tobacco use and to prevent the spread of blood-borne viral infections.
One of the first harm minimisation programs was the introduction of compulsory wearing of seatbelts throughout Australia in the early 1970s. At the time this was controversial, with opponents arguing that it would cause car drivers to behave more recklessly and so actually increase the road toll. This did not happen and many other successful harm reduction programs followed. Random breath testing, the wearing of helmets by bike riders, education campaigns about tobacco and alcohol use, the introduction of needle exchange and methadone treatment programs, promotion of condom use and safe sex practices, widespread access to effective treatments for hepatitis C and many other programs have dramatically reduced the health burden from car accidents, alcohol and tobacco use, infection with HIV and hepatitis C, and other dangers.
It is in this context that pill testing has been proposed as an adjunct to other programs to reduce the harms associated with drug taking by young people at music festivals. It is argued that the provision of information and advice about substances festival goers are considering taking will reduce the risk of serious harm and possibly death from toxic contaminants or from drug preparations of unknown composition or strength. Because in all cases a person seeking information would be required to undergo face-to-face counselling there would be increased opportunities to explain both the risks of drug taking in general and the multiple additional factors – such as doses, mixing of drugs, combination with alcohol, dehydration etc. – that can add further to risk.
Pill testing programs have been applied since the early 1990s in a number of European countries, with about twenty now supporting them in one form or another. Although the quality of the data collected has not always been high, the evidence available would seem to support the careful assessment of the place of such programs here. The availability of sophisticated analytical techniques – using High Performance Liquid Chromatography or gas chromatography–mass spectrometry – has added to the speed and reliability of the tests and greatly expanded the range of substances that can be identified.
Pill testing programs are not uncontroversial and so far governments and police forces around the country have been steadfast in their opposition to them. It is argued that the reliability of the tests cannot be guaranteed, that the other factors contributing to risk mentioned above are so unpredictable that it is unlikely that pill testing would help. Indeed, it is claimed, testing may lull potential drug users into a false sense of security and actually encourage them to consume dangerous substances. In addition, it would provide official approbation of illegal behaviours, thereby increasing criminality and undermining the rule of law. Members of the police force who were called upon to enforce the law in one part of a festival while tolerating breaches of it in another would be placed in an invidious position.
In support of pill testing programs, the argument that they increase drug use and its associated harms seems unlikely to be true. Evidence from both Australia and overseas suggests that people seeking advice about the constituents of their drugs do not take them if they are advised that they contain dangerous contaminants. In addition, careful communication can allow false reassurances about safety to be avoided. Indeed, the opportunity to provide face to face advice to young people about the risks of drug taking is claimed to be one of the great strengths of pill testing programs.
Nonetheless, the arguments on both sides have to be taken seriously and the lack of definitive data means that at the present time it is impossible to conclude definitively which way the balance will tip. It is for this reason that the RACP and the Australasian Chapter for Addiction Medicine have called for carefully controlled trials of pill testing programs at selected locations around the country.
Such trials would require careful design, rigorous data collection and precisely defined and carefully monitored safety outcomes. Any pill testing program would be undertaken in addition to – and not instead of – other strategies to discourage or deter young people from dangerous illicit drug taking.
Over the last half century we have learnt that public health programs have to utilise multiple approaches and provide messages carefully tailored for different audiences. What works to combat the harms associated with drug-taking in prisons is different from what works for specific cultural groups or for young people attending music festivals – and indeed, the demographic characteristics of attendees of different festivals and the drugs they are likely to consume also vary widely.
It is for these reasons that we believe that the available evidence is sufficient to support careful research into the possible use of pill testing programs in Australia and, together with many other professional organisations, are advocating accordingly. We recognise that governments do need to exercise caution in relation to innovative and controversial changes in policy but we feel now is the time to move forward.
A version of this article, written together with Dr Martyn Lloyd-Jones, President of the Australasian Chapter of Addiction Medicine, appeared in The Conversation on 8 January 2019.
Professor Paul Komesaroff FRACP AM
President Adult Medicine Division
Telephone: +61 (0)417 55 26 59
As always, I am keen to receive comments, thoughts, and suggestions about the ideas contained in this article.
AChAM President’s Report
Our President Dr Martyn Lloyd-Jones is currently off hiking in the Scottish Highlands, so I will be writing this week’s post as President-elect of the Chapter.
As members would likely be aware, the AChAM Committee has been busy in the advocacy space in recent weeks. Following the tragic deaths of several young people at music festivals in recent months the RACP, with the support of the AChAM Committee, published an open letter to all state and territory premiers urging them to listen to the medical community and develop pill testing trials that are carefully designed and evaluated to inform drug policy and minimise harms to young people and the broader community.
On the same topic, the International Medicine in Addiction (IMiA) Program Committee are excited to announce the addition of a new international keynote speaker to the conference program, Professor Fiona Measham, who will deliver a keynote address titled The Consultation Tent: festival drug use, drug safety testing & health impact and a workshop on pill testing. Professor Measham has conducted research for three decades into changing trends in festival and night time economies, including annual research at UK music festivals exploring the prevalence and policing of festival drug and alcohol use. Professor Measham is co-founder and co-director of the Loop, best known for introducing Multi Agency Safety Testing to UK festivals in 2016.
IMiA 2019 will be held from 1 to 3 March at the Melbourne Conference and Exhibition Centre. Register now to secure your place at the premier addiction conference for medical practitioners in Asia and Oceania.
Lastly, I would like to take this opportunity to congratulate Chapter Fellow Professor Paul Haber, who was recognised in the 2019 Australia Day Honours list as a Member in the General Division of the Order of Australia for significant service to medical education and research, particularly in the field of addiction medicine. Congratulations Paul!
The Chapter Committee will hold its next meeting on 15 March 2019. If you have any feedback, questions or comments for us, you can get in touch with the Committee via our secretariat at AddictionMed@racp.edu.au.
Conjoint Professor Nicholas Lintzeris
Australasian Chapter of Addiction Medicine
AChPM President’s Report
I hope everyone had an enjoyable Christmas break and a good start to 2019.
The Chapter is looking forward to a busy a year, developing a business case to pilot its Spirituality Training Workshop, finalising the revision of its Evolve list of low value clinical practices, and continuing our ongoing work advocating for Fellows, trainees and the communities we serve.
This is just a reminder for supervisors that from 2021 completion of all three Supervisor Professional Development Program (SPDP) workshops will be compulsory. Palliative medicine supervisors are encouraged to prepare for this change by getting in early and signing up for a face-to-face or online workshop. The AChPM Committee also strongly encourages experienced supervisors to complete facilitator training so they can conduct SPDP workshops in their local area or at conferences/other events. If you have any questions about the upcoming changes, workshop availability, or anything else regarding supervision, you can contact the Supervisor Learning Support team at email@example.com.
I’d also like to encourage all Chapter members to visit MyRACP and complete your work profile if you haven’t done so already. This is a College-wide project that seeks to establish a baseline database of the physician workforce. This is so important for our planning and support of trainees. Its success is dependent on College members completing the survey so that the data is both there and meaningful. You can access the survey via MyRACP, it only takes five to ten minutes to complete, so please invest in this for our profession.
The AChPM Committee will next meet via teleconference on 22 February 2019. If you have any feedback or comments for the Committee please do not hesitate to contact us through our secretariat at PallMed@racp.edu.au.
With kind regards,
Professor Greg Crawford
Australasian Chapter of Palliative Medicine
AChSHM President Report
The program for the AChSHM 2019 Annual Scientific Meeting (ASM) is shaping up to be a fantastic mix of presentations from enthusiastic and engaging speakers. Highlights include:
- Syphilis session:
- Where are we now? Outbreak overview and challenges – Dr Darren Russell.
- What the community wants: successful community engagement initiatives – Professor James Ward.
- Using the syphilis register to enhance timely responses – Dr Mandy Seel.
- Sexual Health Medicine in Youth Session:
- Understanding sexual health needs in young people – Ms Heather Macgregor and Professor Cindy Shannon.
- Youth Sexual Health Programmes – Playsafe (NSW): lessons in implementation – Dr Chris Bourne.
- Transgender session:
- Assessment and treatment in transgender patients – Dr Graham Neilsen.
- Regional issues for transgender healthcare – Dr Arun Menon.
- Transgender youth – Dr Eugene Priscott.
- Mycoplasma genitalium update – Associate Professor David Whiley.
The AChSHM ASM Organising Committee looks forward to welcoming you to Brisbane for this event on Saturday, 16 March. Register now to secure your spot of the ASM. The AChSHM appreciates your support for the ASM, which in previous years has been a valuable experience for Fellows, trainees, general practitioners and allied health professionals alike.
The next AChSHM Committee meeting will meet on Wednesday, 27 February 2019. If there are any issues you would like to raise with the Committee, or if you have any feedback for us, please don’t hesitate to contact us through our secretariat at firstname.lastname@example.org.
Associate Professor Catherine O’Connor
Australasian Chapter of Sexual Health Medicine
2019 Australia Day Honours
The 2019 Australia Day Honours recognised the following Adult Medicine Division members for their contribution to and achievements in medicine across many specialties and activities. The Adult Medicine Division Council congratulates all of these Fellows.
Companion (AC) in the General Division of the Order of Australia
- Emeritus Professor Richard Graeme Larkins AO, FRACP
Officer (AO) in the General Division of the Order of Australia
- Professor Sharon Ruth Lewin FRACP
- Professor John James McNeil AM, FRACP, FAFPHM
- Emeritus Professor Trefor Owen Morgan FRACP
- Associate Professor Beverley Jane Rowbotham FRACP
Member (AM) in the General Division of the Order of Australia
- Dr Bronte Francis Ayres FRACP
- Professor John Francis Beltrame FRACP
- Dr David Collis Burke FRACP, FAFRM
- Associate Professor Nathan Isaac Cherny FRACP
- Professor Milton Laurence Cohen FRACP, FAFRM
- Dr Paul John Garrahy FRACP
- Professor Ronald Robert Grunstein FRACP
- Professor Paul Steven Haber FRACP, FAChAM
- Professor David Charles Harris FRACP
- Dr Margaret Elena Hellard FRACP, FAFPHM
- Professor Jennifer Frances Hoy FRACP
- Professor Matthew Colm Kiernan FRACP
- Associate Professor Donald Raymond McTaggart FRACP
- Professor Paul Pavli FRACP
- Professor Matthew John Peters FRACP
- Dr Roger Konrad Wilkinson FRACP
Medal (OAM) of the Order of Australia in the General Division
- Dr Ahmad Alrubaie FRACP
- Associate Professor Steven Miles Coverdale FRACP
- Dr Peter Ian Davidson FRACP
- Dr Maharaj Kishore Tandon FRACP
RACP Congress 2019
With early bird closing in two weeks now is the time to register your attendance at RACP Congress 2019 taking place from Monday, 6 to Wednesday, 8 May 2019 at the Aotea Centre in Auckland, New Zealand.
The RACP Congress program is tailored by professionals in your field, professionals who regularly face the same situations and challenges as you. Register now to attend the AMD session The search in what we do. We will delve into the value in our practice, exploring the role of the professional organisation, equity and justice and the concept of value-based healthcare.
RACP Congress 2019 key topics include:
- Life course theory ‘How do we impact health along the life course?’
- Obesity: rising to the challenge.
- First 1000 days and non-communicable diseases.
- Medically unexplained symptoms master class.
- Mental health and addiction of patients.
- Chronic disease and integrated care.
Early bird registration closes 22 February 2019.
Visit the Congress website to register and view the program.
Did you know that Australians are living 25 years longer than they did 100 years ago?
The Australian Government has developed a new tool ‘Life Checks’, for Australians aged 45 and older to help them plan and prepare for a longer life. The website provides people with a free, quick and easy Life Check to see how ready they are for the next stage of their life.
The Life Check covers finances, health, work and social life, and provides tips on healthy eating, exercise, achieving financial goals and maintaining good health and wellbeing. Once a person completes their check, they will be directed to tailored information to help them better prepare for a healthy and secure future.
For more information please visit the Life Checks website.
Accelerating the elimination of Viral Hepatitis
Viral hepatitis is a major threat to public health and a leading cause of death worldwide. Each year, viral hepatitis kills 1.34 million people, which is comparable with deaths due to HIV, AIDS, malaria, and tuberculosis.
With the advent of highly effective prevention measures and treatments, global elimination of viral hepatitis is a realistic goal; all World Health Organization (WHO) member states have committed to a global reduction in hepatitis-related deaths by 65 per cent and new infections by 90 per cent by 2030.
The Lancet Gastroenterology & Hepatology’s new Commission on accelerating the elimination of viral hepatitis sets out to appraise the current global situation and to identify priorities – for countries, regions, and globally – to accelerate efforts towards these ambitious targets.
The Commission is available free with registration on the The Lancet Gastroenterology & Hepatology’s website.
A new training program to support your clinical practice
End-of-Life Law for Clinicians (ELLC) is a new training program for clinicians and medical students about the law relating to end-of-life decision-making.
ELLC has been developed by the Australian Centre for Health Law Research, Queensland University of Technology (QUT) and the Institute of Health and Biomedical Innovation, QUT, with funding from the Australian Government Department of Health.
ELLC is a free program, the online training modules are available on the ELLC online training portal.
For more information, please visit the ELLC website.
Have you read our new position statement?
A position statement that sets out the RACP’s role in improving Aboriginal and Torres Strait Islander health, including work within the College and our partnerships and advocacy outside the College, was released in December 2018.
The Aboriginal and Torres Strait Islander Health Position Statement was developed by the Aboriginal and Torres Strait Islander Health Committee (ATSIHC), chaired by Professor Noel Hayman.
A 2018 deliverable contained in the Indigenous Strategic Framework, the statement combines the RACP's existing support for Constitutional recognition of Australia’s First Peoples, development of a Treaty, a human rights approach to health equity, and advocacy for the health benefits of genuine reconciliation.
Read the Position Statement
New Guidelines for healthcare workers living with a blood borne virus
There has been an update to the Guidelines for healthcare workers who perform exposure prone procedures and healthcare workers living with a blood borne virus (BBV). Exposure prone procedures (EPPs) are procedures where there is a risk of injury to the healthcare worker resulting in exposure of the patient’s open tissues to the blood of the health care worker.
The Guidelines have been updated to reflect new evidence and are consistent with changes made by other countries. They provide information and recommendations for:
- all healthcare workers who perform EPPs
- healthcare workers who live with a BBV and perform EPPs
- treating doctors of healthcare workers with a BBV who perform EPPs
- public health authorities.
The new Guidelines allow healthcare workers living with a BBV, to perform EPPs, provided they abide by these Guidelines.
They also provide guidance for all healthcare workers who perform EPPs.
Healthcare workers who perform EPPs must take reasonable steps to know their BBV status and should be tested for BBVs at least once every three years. They are also expected to:
- be tested for BBVs after an occupational exposure incident
- be tested according to Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) guidelines following non–occupational exposure
- confirm that they comply with these Guidelines when applying for renewal of registration.
The new Guidelines, exposure prone procedure guidance and information sheets can be found here.
Billing multiple MBS items
The guide helps you understand Medicare Benefits Schedule (MBS) item descriptions and how to bill items together.
The updated guide, Billing multiple MBS items, has new information about complete medical services and the multiple operation rule.
It includes scenarios about:
- comprehensive and combined items
- interpreting common MBS phrases
- multiple attendances on the same day
- attendances with other health services
- independent procedures.
It also includes more detail about MBS item descriptions like:
- ‘attendance not payable with another service’
- ‘not being a service associated with’
- ‘not being a service to which another item in this group or subgroup applies’.
Subscribe to news for health professionals and get regular updates directly to your inbox.
Physician Readiness for Expert Practice Program Requirement Website Content Updated
The new Physician Readiness for Expert Practice (PREP) Program Requirements are now available on the relevant Basic Training and Advanced Training specialty pages.
The 2019 Basic Training Program Requirements apply to all trainees registered in a PREP Basic Training program in 2019.
The 2019–20 Advanced Training Program Requirements apply to all trainees registered in a PREP Advanced Training program in 2019 and/or 2020.
PREP trainees and their supervisors should familiarise themselves with the updated program requirements for their specialty.
It is the responsibility of the trainee to ensure that they are following the correct guidelines for each training year.
Guidance on implementing the The Misuse of Drugs (Medicinal Cannabis) Amendment Act 2017 in New Zealand
The Misuse of Drugs (Medicinal Cannabis) Amendment Bill came into effect on 18 December 2018 in New Zealand. The Act provides an exemption and a statutory defence for people who require palliation to possess and use illicit cannabis, or a cannabis utensil.
While the Act does not specify a requirement to renew certification, the Ministry recommends patients’ certification are renewed after 12 months.
Learn more via these resources:
NZ Ministry of Health Website and example certification letter
The Misuse of Drugs Act 1975 (NZ)
Guidance on products containing cannabidiol are now prescription medicines only in New Zealand
The passing of the Misuse of Drugs (Medicinal Cannabis) Amendment Bill means some products containing cannabidiol (CBD) are now prescription medicines only.
- Products that meet the definition of a CBD product are prescription medicines.
- Ministry of Health approval is not required to prescribe, supply or administer products for medical purposes if they meet the definition of a CBD product.
- Medical practitioners and pharmacies are allowed to import CBD products, as are persons or companies holding a licence to sell medicines by wholesale.
- Individual patients may import CBD products provided they meet the requirements for importing prescription medicines (see below) but not any other cannabis based products.
- A maximum of three months’ supply is allowed on a prescription for CBD products.
For further information please refer to the NZ Ministry of Health website
Tri-Nation Alliance annual International Medical Symposium
Register now for the Tri-Nation Alliance annual International Medical Symposium (IMS 2019), in Auckland, New Zealand on Friday, 22 March 2019.
IMS 2019 is a one-day event bringing together representatives from international and local specialist medical colleges, medical schools, health services and regulators for an inspiring day where challenges are discussed, and new ideas explored.
The theme for the 2019 symposium is Visioning the impact of advanced technology on medical education with a program featuring diverse sessions including:
- Professor Enrico Coiera - Trust and AI.
- Professor Jenny Weller - Using simulation training to learn about non-technical skills management.
- Associate Professor Rebecca Grainger - Current research on apps to monitor patient self.
- Mr Andrew Connolly - Informed by AI: the systemic challenges before us.
- Professor Jim Warren - Consumer health information revolution.
- Mr Greg Cross - Using avatars for teaching.
- Dr Jaron Chong - Training radiology residents when machines read imaging.
- Professor Tim Shaw - AI in trainee assessment.
To view more IMS 2019 sessions and to register visit the IMS 2019 website.
Survey of Attitudes of Australian Specialists to Lung Cancer Screening with Low Dose Computed Tomography
Lung cancer screening with low dose computed tomography has been implemented in the US however is still a debated topic within Australia. A survey of Australian specialists is being conducted to understand 1). their knowledge of and attitudes towards lung cancer screening and 2). perceived barriers to implementation in Australia.
This anonymous survey should take seven minutes to complete. Your opinions are very valuable.
Please participate by clicking the link below. By proceeding with the questionnaire, you are providing your consent to participate. Aggregate data will be submitted for publication in a peer reviewed journal.
The survey can be viewed via this link.
This study has been reviewed and given approval by The Prince Charles Hospital Human Research and Ethics Committee LNR/2018/QPCH/44970).
Conferences and Events
The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses.
New South Wales
Staff Specialist in General Medicine
Hunter New England Local Health District, Armadale Hospital
Contact: Dr Mark Kelly, Clinical Director Medicine Ph. 6776 9500 email@example.com or Maree Sheaves, Senior Medical Recruitment Consultant Ph. 02 6767 7780 firstname.lastname@example.org