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Tips for workers

Information in this section is based on the chapter ‘Reducing the harms from substance misuse’ in the Handbook for Aboriginal alcohol and drug work [1]. You can click here to either download the book for free or buy a hard copy [2].

Handbook for aboriginal alcohol and drug work cover

Reducing the harms from substance use

This section outlines risks from alcohol and other drug use in relation to sexually transmissable infections (STIs), harms from injecting, and blood borne viruses.

Sexually transmissible infections in the setting of substance use

Sexually transmissible infections (STIs) are infections that are spread through sexual contact. They are sometimes also spread from mother to child during pregnancy or childbirth. Common STIs include gonorrhoea, chlamydia, syphilis, genital warts and herpes.

Most STIs do not cause major symptoms until after a long time (weeks or even years), so a person can have an STI without knowing and then pass it on to someone else. People who drink to intoxication or who use drugs are more at risk of being infected with a STI - due to the risky behaviour associated with alcohol and drugs - and should be regularly tested.

Testing is usually easy to organise and varies according to the type of STI, e.g. urine tests, swab tests or blood tests (a swab is like a large cotton bud, used to collect samples of fluid). Most STIs are easy to treat and this usually involves taking tablets or having an injection.

Encouraging regular condom use, regular testing, and trying to limit the number of sexual partners can help reduce the spread of STIs.

Read about how common STIs are in Australia.

STIs and substance use

People who drink or use drugs to the point of intoxication are more at risk of STIs. This may be because they have less inhibition or because they are less able to make clear decisions. They may be more likely to have sex to begin with, and also more likely to have unprotected sex. People may be heavily sedated and have unwanted sex. They may also not remember if condoms were used. Some drugs (e.g. amphetamines) may increase sexual desire.

Read about:

Read about the symptoms and available treatment for:

Harms from injecting drug use and safer injecting

There are many ways that people can be harmed from injecting drugs:

  • there are social harms, such as those related to illegal drug use, being dependent on a drug, or things a person does to raise money for drugs
  • there are physical harms of injecting such as the effects of the drug itself (overdose), harms from poor injecting technique and harms from sharing injecting equipment.

Health workers can help reduce a client’s harms from injecting drug use by encouraging them to stop using, by supporting them to attend drug treatment, or by supporting them to use safer injecting practices for those who continue to inject. Getting the person to change how they inject can reduce many of the physical harms from injecting. Harm reduction forms the basis of Australia’s national health policy on drugs.

What are the physical harms from injecting?

The physical harms of injecting drugs generally include:

  • injuries related to the process of injecting
  • infections related to poor injection technique
  • blood-borne virus infections from sharing injecting equipment
  • injuries related to other substances mixed with the drug/s
  • injury related to direct effects of the drug/s injected (such as overdose).

These problems can occur:

    • near the site of injecting (local)
    • in other body parts well away from the injecting site (distant)
    • in the whole body (systemic).

Injecting can carry germs or particles to a different part of the body

Drugs are usually injected into veins, which carry blood back to the heart and through the lungs, before going out into the rest of the body, including the brain. Any germs or small particles from the drug can get stuck in the lungs, brain or other parts of the body.

Sometimes drugs are accidentally injected into arteries, which carry blood away from the heart to the rest of the body. If particles from the drugs lodge in a finger or toe, for example, they can block the blood supply and cause the finger or toe to go black and die (gangrene).

Read more about harms from injecting:

Read more about:

There is a higher chance of having an overdose after injecting a drug than when it is taken by mouth or smoked. This is because a large quantity of the drug reaches the brain very quickly. The most common type of overdose is from opioids, but overdose can occur with all types of drugs. For example, overdose from sedating drugs (e.g. opioids, benzos) can result in loss of consciousness and slowed or stopped breathing.

When too much cocaine or amphetamines are used, a person may become very agitated, paranoid and/or psychotic.

Opioid overdose is more likely to happen when a person:

  • injects alone
  • uses more than one sedating drug (e.g. heroin used with alcohol, benzos or other opioids such as oxycodone or morphine)
  • has not used for a while and their tolerance is down (this could happen after someone leaves detox or rehab, if they come off methadone or buprenorphine treatment, or if they have recently come out of jail).

How to recognise an overdose

A person is likely to be having an overdose if they:

  • have very slow, and/or very shallow breathing. If you count more than fifteen or twenty seconds without a single breath, it is likely they are overdosing
  • are not responding in any way when you shake them or talk loudly to them (i.e. they are unconscious)
  • are turning blue (lips, finger tips).

What to do if someone overdoses:

If the client is unconscious but is still breathing:

  • place the person on their side
  • ask someone to call 000 for help
  • make sure their airway is clear so they can breathe (check that there is nothing blocking their mouth or throat, and put their head in a good position)
  • watch them to make sure they do not get worse. This is very important, as an overdose may become more severe in a matter of minutes. Continue to check their breathing until the ambulance arrives.

If the client is not breathing:

  • check that their airway is clear
  • ask someone to call 000 for assistance
  • start cardiopulmonary resuscitation. If you are not sure how to do CPR, the 000 operator will help you with step-by-step instructions until the ambulance arrives. Breathing for the person (‘the kiss of life’) is often the most important part, as in a sedative overdose (e.g. heroin, alcohol or benzos) the person’s breathing may stop before their heart does.

Other harms from injecting drug use include psychological and social harms such as:

  • increased risk of drug dependence
  • stigma and discrimination
  • financial problems
  • family and community problems
  • criminal activity.

Read more about psychological and social harms form injecting drug use.

Reducing or preventing the harms from injecting

If a person agrees to stop injecting or accepts treatment to help them stop, this is a big step to reducing the harms from injecting. However, many people take some time, or several goes, before they are able to stop. Some people may stop completely, others may reduce how often they use, or how much. Other people do not want to stop using a drug, but may be prepared to swap from injecting to another method, such as swallowing, smoking, snorting, or shelving (putting it up into their anus). There will always be some people who do not want or are unable to stop injecting. Because of this, it is important to think about ways of reducing the harms from injecting. This can keep the user safe, but can also reduce the harms that are passed on to people in their family and in their community.

While the goal of health professionals may be to help people stop using drugs, they have to be practical and realistic. Not everyone wants to stop and not everyone is able to stop as soon as they decide to. It is essential that people get help to stay healthy for as long as possible. It may be that they then live long enough to stop their drug use. It is also important that they stay healthy so that infections and other harms of injecting do not hurt them or their family and community around them.

It is not usual for an established injecting drug user to change to swallowing or smoking. Many continue injecting because they are dependent, and want the stronger, faster effect. Other methods of using drugs like taking by mouth or smoking, generally do not give as strong an effect, so the person would need to use more of the drug and spend more money to do so. For others the ritual of injecting can be very difficult to stop. So it is essential to be able to advise people who inject drugs on how to make injecting as safe as possible.

Read more about:

Needle and syringe programs

There are needle and syringe programs (NSPs) in many cities and regional centres. These programs provide clean injecting equipment to people who inject drugs, such as needles and syringes, swabs, water, spoons, filters and tourniquets. This equipment usually comes in a black plastic case known as a 'fitpack', which can also be used as a container for used equipment. Some NSPs also provide large yellow plastic containers for the safe disposal of used equipment.

NSP staff also offer information and advice to clients such as:

  • how to reduce the risks associated with injecting drugs, (e.g. becoming dependent, overdosing, or getting infections such as HIV, hep B and hep C)
  • the types of treatment and rehabilitation programs available to help them reduce or stop using drugs. They may also help clients get in contact with these programs
  • how to get in contact with other services like Legal Aid and Centrelink.

Read more about:

Where to find a NSP in your area

For information on where to find a NSP in your state, click on the links below:

New South Wales
Victoria
Queensland
South Australia
Western Australia
Northern Territory
Tasmania
Australian Capital Territory

See also the Knowledge Centre listing of programs to help reduce harm from substance use.

Hepatitis C and B

Hepatitis C and hepatitis B (known as hep C and hep B) are viruses that can harm the liver. The viruses infect and live in the liver cells. These cells are ‘attacked’ by the virus and this attack can cause scarring in the liver. Hep C is very common among injecting drug users. For many people hep C does not cause problems, but for one in six people it can lead to serious liver damage. The risk of this is much greater if the person drinks alcohol above the recommended levels. Hep B is less common in injecting drug users than hep C, and you can protect against it with vaccination. Some Aboriginal and Torres Strait Islander communities have high rates of hep B.

Read more about:

Table1: How do people become infected with hep C or hep B?

 

Hep C

Hep B

How is it transmitted?

• from blood to blood (it is also possible to become infected through unprotected sex, but this is less common)

• from blood to blood

• through unprotected sex

Risky situations

• unsafe injecting

• unsterile tattooing

• prisons (because of unsafe injecting and tattooing)

• from mother to baby (around 1 in 20 babies are born to mothers with hep C)

• unsafe injecting

• unsterile tattooing

• prisons (because of unsafe injecting and tattooing)

• from mother to baby (up to 1 in 10 babies born to mothers with hep B will get this virus)

Read more about:

How do you treat a person with hep C?

New direct-acting antiviral medications are now available to Australians living with chronic hepatitis c. These new medications are more effective, easier to take and have fewer side-effects than the older medications. The Australian Government has listed these medications on the Pharmaceutical Benefits Scheme (PBS), making them accessible and affordable to all people with hepatitis C. If someone has chronic hep C, they can see their GP for assessment and treatment or see a specialist (gastroenterologist or infectious diseases specialist). Some hep C clinics have a ‘drop in’ service, so a person can then find out more about treatment. Anyone with chronic hep C is eligible for treatment including people in prison.

Read more about hepatitis c treatment:

Living with hep C

If your client is living with hep C, there are some simple things they can do to try to stay healthy:

  • have blood tests 1–2 times per year to monitor progress
  • have a regular ultrasound, or (where available) fibroscan to check progress of the disease
  • get the vaccination against hep B, and if available, hep A
  • minimise alcohol use
  • avoid weight gain as a fatty liver can cause liver damage.

Women who have hep C can still become pregnant and breastfeed their infants. Pregnant women should let their doctor know that they have hep C.

Hep B

Hep B is a blood-borne virus like hep C. Hep B is not as common in people who inject drugs. Like hep C, hep B can live in the body without people knowing it. Over a long period of time, hep B can cause damage to the liver.

Read more about:

Cirrhosis and liver cancer

Cirrhosis and liver cancer can develop in people who have had hep C or hep B over many years. Chronic hep C and hep B infection causes irritation and inflammation of the liver. Over time, this irritation causes scarring of the liver. When this scarring becomes severe, it is known as cirrhosis.

Read more about:

HIV/AIDS

AIDS is a severe illness that can develop when a person has been infected with the HIV virus (Human Immunodeficiency Virus). AIDS stands for Acquired Immune Deficiency Syndrome. That means it is an illness that people pick up (or acquire) which interferes with the body’s ability to fight off illness. The normal system that defends the body, the immune system, is weakened by the infection. Because of this, illnesses that otherwise would be quite mild can become life threatening. Simple coughs can develop more easily into dangerous pneumonia, and people can get other less common illnesses, with germs that do not usually harm humans. It may take many years for the HIV infection to cause the disease of AIDS. These days there are treatments available if a person catches the HIV virus or develops AIDS, so it is important to detect HIV infection early and have regular monitoring to see if treatment is needed.

Read more about:

Testing for HIV involves a blood test.  The tests are very reliable. They can detect HIV within the first month of infection in most cases, and within three months of infection in almost all cases. If a test comes back positive, a new test is usually done to make sure the first test was not a mistake.

Read more about:

How is HIV treated and how can people get treatment?

Antiretroviral drugs are the main treatment for HIV. These drugs stop HIV from making more copies of itself, or stop it from entering other cells in the body. Many different medicines are used. A combination of three or four medicines is taken each day and treatment needs to be kept up continuously.

Read more about:

What about legal issues and HIV?

HIV testing can only be done if your client consents to being tested. People living with HIV are required by law to tell their sexual partners that they are HIV positive before they have sex. They must allow the other person to decide whether they still want to have sex and under what conditions (e.g. only with a condom). People living with HIV do not legally have to tell anybody else that they are HIV positive. They do not have to tell their employer.

Read more about legal issues and HIV including:

Further reading

NSW Users and AIDS Association Inc.

The National drug strategy 2010–2015: a framework for action on alcohol, tobacco and other drugs

Return on investment 2: Evaluating the cost effectiveness of needle and syringe programs in Australia

Hepatitis NSW website

Hep C and us mob: a handbook for Aboriginal people about hepatitis C

Australasian Society for HIV Medicine

 

References

1. Doyle B, Garsia R, Haber P, Lawler J, O'Connor C, van Beek I, White A (2012) Reducing the harms from substance misuse. In: Lee K, Freeburn B, Ella S, Miller W, Perry J, Conigrave K, eds. Handbook for Aboriginal alcohol and drug work. Sydney: University of Sydney:283-316

2. Lee K, Freeburn B, Ella S, Miller W, Perry J, Conigrave K (2012) Handbook for Aboriginal alcohol and drug work. Sydney: University of Sydney

 

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    Last updated: 27 October 2016
     
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