Is Your Neighbour a Functioning Junkie?

Meet Anna. A wonderful, well balanced professional with a bright future. You probably know of many ordinary people just like Anna and in fact, she might even be your neighbour. 

But there's something that distinguishes Anna from most other people ... a heroin addiction. 

How would you react if you knew your neighbour was shooting up heroin each day? What if your child's teacher, your local pharmacist or a social worker was using heroin? How would you react?

This is Anna's story.

My name is Anna and I’m 36 years old. I live in metropolitan Sydney after I moved from South Australia over 10 years ago. 

As soon as I came to Sydney it felt like home. It’s eclectic, big, anonymous and pretty much no one stands out if they’re a bit different. The complete opposite to suburban Adelaide.

I live with my partner in a small rental house. We’ve been in the same house for seven years. It’s just a neat little weatherboard. It’s nothing fancy but it’s clean, most things work and it’s close to everything I need. I’ve lived in some horrible places in horrible conditions over the years. Thankfully it’s not like that now. 

There is just us and the cats. No kids. This was a conscious decision. We both like kids but after much thought and discussion, we realised that while it would be great to have them, the desire to not have them is stronger. I don’t think it’s fair to bring a child into the world if it isn’t truly and wholeheartedly wanted. That’s not to say this decision hasn’t had an impact. I’m a major disappointment to my family. To them, that’s just what you do. Find a partner, get married, buy a house, have kids … die. I’m not married either. But I’ve learned to put their judgements aside and focus on what I want. Probably something a lot of users have to do.

My partner is my age. We met in our 20’s through a mutual friend. We were both with other people at the time but remained friends for the next 5 years, even writing to each other when we were in different states. Eventually we got together and have been so for nearly 10 years. He works part time in a 9 to 5 job then devotes the rest of his time to artwork. There’s not much money in it but it keeps him sane. Plus the nine to fiver solves the money issue. 

Both of us being heroin users presents challenges. During the bad times, we’ve been hopeless at supporting each other to get on top of things. I’m sure a lot of people can relate to that feeling of when you’re with someone who also uses and you’re both trying not to. But you manage to convince each other that it will be ok if you do. Or that feeling when you’re both hideously sick and feeling utterly hopeless and using seems the only reasonable response. It can be hard being with someone who is suffering as you are. 

Over the years we’ve gotten onto programs and are now on a much more even keel. We are both on the same page when it comes heroin like how much we’re prepared to spend etc. It’s a huge help having my partner with me through this. It makes it feel so much less lonely.

My work day usually begins at about 6am. I get up, feed the pets and plonk myself in front of the heater..I spend an hour drinking coffee and getting mentally prepared for another day of work. Around 7am I start getting ready.

These days, I never use before work. Being at work diminishes my experience of using. It’s also not fair on clients or colleagues as I’m not fully focussed at work when I’ve used. That’s not to say I’m out of it when I use. In fact, most people probably wouldn’t even know. That’s what having a huge tolerance and pharmacotherapy will do.

I work full time as a Social Worker. I got my degree a few years ago and have worked in the sector ever since. It took me a few years to get my four year degree but I got there eventually. It’s put me in a position to be able to do work that I actually want to do.

I’ve noticed a lot of users who work in the ‘Human Services’ tend to work in the Alcohol and Other Drugs (AOD) area, but I’m not there. I work in mental health. Naturally a lot of my clients also experience issues with AOD and I can respond to that but it’s not the primary focus of my work.

Around 7.45am I’m out the door. 

A few days a week -if I don’t have a takeaway- I’ll have to go to the chemist to get my dose. You see, I’m on pharmacotherapy (methadone). This is both a blessing and a curse. I suspect I’d be dead or in jail without it and it enables me to keep stable. I am so grateful for that. However it’s restrictive, expensive and something I don’t feel is the best treatment for heroin addiction. However, my thoughts on that would take up too much space here!

There’s inevitably an unexplained wait as other customers are served before me (who arrived after me). There’s also the added unpleasantness having to go to the very edge of the chemist in a tiny box to get my dose. The box is filthy with blood, mucus, spit and other unknown substances. There is graffiti all over the walls. A gigantic sign reminds me, ‘No Pay No Dose’ just in case I‘d forgotten. It’s generally an unpleasant experience but I know there are places in Australia where people can’t get on programs and chemists are full. In comparison, I’m lucky.

Finally, I can get going to work.

My work is extremely varied. It can go from helping a client manage their mental illness to supporting clients to access dental services. From testifying in Court on behalf of clients, visiting clients in hospital or prison to writing reports for Government departments. The work keeps me on my toes and every day I feel honoured to be a part of people lives, hopefully making a difference.

Depending of the day of the week e.g. if it’s a pay day for either my partner or I, scoring will be on my mind. It always amazes me the way I can be so focussed on my work but also working out how to score. I think that‘s a skill that functioning heroin addicts have. The ability to compartmentalise, to bring one area of the brain to the forefront and work on the task at hand while also working on something else in your head. It’s probably a skill a lot of people have but I can use this skill to buck society’s general view. That view that every user is a walking disaster; stealing, hocking and unable to do anything except using and scoring.

Another skill I’ve developed is the ability to wait and to endure. I can’t fast forward my day and I can’t 'go home sick’. My job’s too important to me and I want to keep it. It wasn’t always like this. There have been many jobs prior to my degree, that I essentially lost due to unexplained absences and erratic behaviour.

Cravings are part of every day but most of the time I can now manage them. Distraction and keeping busy are the best tools I have but it is still a constant challenge.

When it’s one of those joyous days that I can use, I have to wait for work to finish. If all goes to plan, my partner -whose works much more flexible and autonomous- will have scored late afternoon and he’ll wait for me to get home so we can use together. But thanks to most dealers being unable to actually do the deal within the time frame discussed and that they seem to be operating in an alternate version of time, I often have to score once I’m home. This involves calling the dealer (who hopefully is on) and having him come around. Occasionally it involves one of us doing some horrible mission but that’s rare these days. In the past I’d go pretty much anywhere for what I needed and tolerate all sorts of crap but now that I’m a regular customer and have a couple of reasonably solid dealers, home delivery is usually the go.

Once he comes I can finally truly relax. I treasure this time. We mix up, have the shot and kick back. It’s soft time. It feels gentle and calm. Other worries slip away, my constant aches and pains minimise to insignificance and the world is good. Of course there’s variation in quality but essentially I get what I need every time. I’ve worked hard to lower my pharmacotherapy dose to the point that I can stay well when I dose but don’t use, but when I do use, it's worth it. Depending on finances, I’ll generally do this once or twice during the week and then perhaps once or twice on the weekend too.

With finances, it’s a constant balancing act. I’ve been an addict for about 15 years and for the first 6 – 8 years, rent, bills, food and other essentials were secondary to heroin. Naturally this had a destructive impact. It’s hard living like that and I just can’t do it anymore. It’s certainly not easy for me to not spend all my money on junk but it’s also not easy to be homeless, hungry and broke. I’ve learned how to wait and endure much more. I can put off using so my rent is paid and I know I’ll be better off. That’s not to say there aren’t occasional slips ups and it will always be a challenge. But the majority of the time, I manage this juggling act.

Using is what keeps my on an even keel. It gives me such joy and pleasure that I imagine I’ll do it for the rest of my life. It probably sounds odd but it's really what kept me going all these years. There’s a background history of trauma in my life which may be a reason why I started using but in no way do I put the blame completely on that. I take responsibility for what I do.

Heroin has taken a lot from me but not the actual use itself. It’s more about what I’ve needed to do to be able to use when things weren’t stable. I won’t bore you with all that, but don’t worry, I’m not naive. I know what’s been taken from me because of my use. There are people who to this day want nothing to do with me. I’ve never been and never will be rich, my arms are scarred and there have been some very hard and demoralising times. I wish I didn’t have to spend what I do on junk and that I could be truly honest about the things that are important to me. But I cant and that’s that.

I suppose most people think I lead an awful life but I’m actually ok with it all. I’ve worked hard to get to where I am and even though part of my life is not socially acceptable, I’m happy and proud to be who I am.

I have people I love and who love me. I have a great house. I have a job I love and a university education. I have happy and healthy pets. I participate in the community and have a range of interests in life. I’m respected by my colleagues, friends and family.

I’ve heard other people say you can’t be a functioning heroin addict and dream big … I disagree. Really it just depends on your interpretation of a big dream, doesn’t it? Society’s interpretation of big (and acceptable) dreams include things like buying a house, having children, gaining seniority in your work, consuming-consuming, buying-buying-buying etc. But these aren’t my dreams at all. My dreams include a decent place to live, the love of my partner, work I enjoy and a meaningful life. They may not be big dreams but they’re mine and I’m making them a reality every day.

Cannabis is a Hard Drug Too! - More DFA Deceit

Here is just another in a long line of farcical positions held by Drug Free Australia (DFA). Their arguments are thin, their science is junk and their evidence is cherry picked from millions of pages of research. DFA are notorious for producing misinformation and twisting facts. This article is a another example.

CANNABIS is a Hard Drug Too! 

DFA Newsletter

Spring 2008 

Why is cannabis still separated out from the so-called ‘hard drugs’ in Australian statistical data, given that we now have strong evidence of its devastating harms?

In countries such as Sweden, which has the lowest illicit drug use in the OECD, cannabis has NEVER been considered ‘soft’. In the UK it has just been re-classified up to a Class B drug – sending a strong message to their community that this drug is definitely NOT soft!

However, the situation may be about to change in Australia. The establishment of the innovative new cannabis research centre (NCPIC) is certainly a step in the right direction. Drug Free Australia welcomed the excellent address given by the Federal Minister for Health and Ageing, Nicola Roxon, when she opened the Centre earlier this year.

She, along with Professor Alan Budney, a specialist in the field, both emphasised the complexities and harms of cannabis. We were further heartened by meetings with two Federal Ministerial Advisers, both of whom assured us a preventative approach to illicit drug policy is being taken seriously by Labor.

The most recent, compelling evidence cannot be disregarded. For instance, the Australian Medical Association has issued warnings on the health risks associated with smoking marijuana. Risks of cannabis use include memory loss, psychosis, impaired driving, hallucinations, asthma, and even lung cancer. Moreover, warns the AMA, one third to one half of detained patients admitted to psychiatric units in Australia are there because marijuana use has precipitated their condition. A new scientific study conducted in New Zealand indicates that long term cannabis use increases the risk of lung cancer in young adults. The study recognised that cannabis smoke has been shown to have greater concentrations of carcinogenic hydrocarbons than tobacco.

Many national and international studies have found that drivers intoxicated with cannabis, pose a high risk of road accidents. For example a 10 year Victorian study found a 7 times greater risk of a fatal accident. Other studies clearly show that cannabis impairs vehicle control, including the ability to stay in one lane, as well as slowing reaction time. (ANCD Report, Dec 2004).

Highly respected medical practitioners in Australia and overseas have confirmed that cannabis use is linked to psychosis. Dr Brian Boettcher, Consulting Psychiatrist in the UK reports that ‘Cannabis is capable of precipitating psychosis, going on to the chronic cases in people who have had no family and personal history of psychiatric illness. There have been suggestions that such people may be the ones who have started cannabis in their teens’.

So far as cannabis use and birth defects is concerned, a Commonwealth Department of Health publication to medical practitioners warns of foetal brain development, relative prematurity, smaller length and head circumference, malformations, higher rate of miscarriage and perinatal death. A US study found a 10 times greater risk of non- lymphoblastic cancer to infants of marijuana- using mothers. Other effects in the new born are lethargy, slow to gain weight, increased startle reflexes, tremors and possible long- term developmental and behavioural effects. All of this clearly points to the fact that cannabis should be considered at least as serious as other ‘hard’ drugs such as heroin or methamphetamines.

I have watched almost daily as Jo Baxter and Gary Christian contribute their special brand of drug propaganda to the Australian National Council on Drugs (ANCD) email forums, DrugTalk and Update. I have also recently watched many members unsubscribe as the content quality is reduced by these people. 

Maybe it’s the posts from Jo Baxter using comments from the religious, anti-drug zealots, Drug Advisory Council of Australia Inc.(DACA) as some sort of authority or Gary Christian bombarding every topic with multiple emails and his never ending focus shifts when he hits a wall of expertise. 

Just today on the radio, I heard Jo Baxter suddenly switch topics from prescription heroin to openly legalising heroin in an attempt to mislead the listeners. She was defending her position on a possible heroin trial in Australia and when asked to respond to Dr. Alex Wodak’s suggestion for such a trial said that legalising heroin would be a mistake. Instead of responding to why prescription heroin wouldn’t work for long term addicts, she simply said legalising heroin sends the wrong message. 

This is standard stuff for DFA to change the focus of the debate with the intention to misrepresent what their opponents are really talking about. In their tiny little world there is no middle ground. Prescription heroin equals free for all drug legalisation, Harm Minimisation equals encouraging people to use drugs, decriminalisation equals legalisation, human rights for addicts equals moral decay. 

To be fair, I need to clarify my position first. I detest DFA and consider them probably the most dangerous organisation in Australia. Their polices are crude and harsh, cruel and non compassionate, unscientific and unrealistic, based on proven failures and unsuccessful strategies, full of religious rhetoric and fundamentalism, are founded on misapprehension and mythos, sly and disingenuous and basically unworkable. DFA tactics include misinformation and propaganda, arrogance and bullying, political manoeuvring and opportunity, exaggeration and guesswork, lies and deceit and especially misleading the public and government. 

Most of the DFA board/fellows are affiliated with religious groups. These include the Salvation Army and the Catholic Church and also radical evangelists like The Festival of Light, Seventh Day Adventists, Australian Family Association and even Scientology. 

Many have been part of abstinence only programs that reject Harm Minimisation like Tough Love, Drug Stop, Parents for Drug Free Youth. They have affiliation with shady groups like Southern Cross Bioethics Institute, Wilderness Therapy, Drug Free America Foundation and Knights of the Southern Cross. 

The patron is a TV evangelist who performs magic tricks on stage like curing the sick. She claims god works through her to heal the crippled or cancer sufferers. I have decided to dissect their article and seek out the actual facts. Not surprisingly it wasn’t hard. The content of the article is in red. 

CANNABIS is a Hard Drug Too! Why is cannabis still separated out from the so-called ‘hard drugs’ in Australian statistical data, given that we now have strong evidence of its devastating harms?

Because it’s not a hard drug. Don’t take my word for it, look to the world trend that is decriminalising cannabis at a rapid rate. 

The main reason given for decriminalisation is the separation of hard drugs from soft drugs. You are probably now asking yourself, isn’t this what the whole article is about? And you are dead right, which makes DFA dead wrong. The many countries who have or are considering classing cannabis as a soft drug have obviously researched the issue rigourously so why are DFA taking the opposite view? This is exactly my point and one of the clearest examples of why DFA has little or no credibility. Cannabis has never killed anyone, no-one has ever overdosed from it and it doesn’t cause devastating harm as DFA claims. This doesn’t mean it’s harmless but cannabis is many times safer than legal drugs like tobacco and alcohol. In moderation, there’s debate whether it’s even harmful at all but like any drug, excessive use may cause problems. 

In countries such as Sweden, which has the lowest illicit drug use in the OECD, cannabis has NEVER been considered ‘soft’. In the UK it has just been re-classified up to a Class B drug – sending a strong message to their community that this drug is definitely NOT soft!

Sweden is often used as the success story of a Zero Tolerance drug policy but there is a good reason for this. Other countries with Zero Tolerance policies like the US show that the policy has no effect whatsoever on rates of drug use. 

The US for example has the highest rate of drug use on the planet although it has similar strategies like Sweden including the classing of cannabis as a hard drug. Sweden is selectively singled out because it has always had a relatively low rate of drug use including alcohol. The Swedes are just not regular users of drugs in comparison to most countries. The statement from DFA that cannabis has been re-classified to a class B drug in the UK only claims it’s sending a message that cannabis is not a soft drug. This is not evidence that cannabis is a hard drug at all but merely political posturing. The UK government decided to raise the classification of cannabis against all recommendations from experts, the police, their own party and even a special enquiry commissioned by themselves. The enquiry report from a few years prior had suggested to lower the classification to the lowest class of C, which they did and cannabis use then dropped as a result. Move forward a few years to 2008 and the government has a new unpopular leader. In a politically motivated stunt, the lower use rates were somehow completely overlooked and cannabis was again raised to a class B drug. So much for evidence based policies when your popularity is at stake.

However, the situation may be about to change in Australia. The establishment of the innovative new cannabis research centre (NCPIC) is certainly a step in the right direction. Drug Free Australia welcomed the excellent address given by the Federal Minister for Health and Ageing, Nicola Roxon, when she opened the Centre earlier this year. She, along with Professor Alan Budney, a specialist in the field, both emphasised the complexities and harms of cannabis. We were further heartened by meetings with two Federal Ministerial Advisers, both of whom assured us a preventative approach to illicit drug policy is being taken seriously by Labor.

The National Cannabis Prevention and Information Centre (NCPIC) is being bandied about a lot by anti-drug groups. They are also receiving much criticism for being another propaganda machine. Michael Gormly, editor of Kings Cross Times gives an example in his article titled, NCPIC spouts more junk science. 

Funnily, Jan Copeland, the head of NCPIC recently slipped up and admitted publicly that most cannabis smokers DO NOT have problems. I wonder who the two Federal Ministerial Advisers were that met with DFA? Apparently DFA were not important enough to be welcomed by Nicola Roxon (Federal Minister for Health and Ageing), Jenny Macklin (the Minister for Families, Housing, Community Services and Indigenous Affairs) or Jan McLucas (Parliamentary Secretary to the Minister for Health and Ageing). 

I did a search for DFA on the website for Health and Ageing and only found one reference to them in a one line comment regarding amphetamine-type stimulants (ATS). All other instances of DFA were for Direct Fluorescence Assay or diseases like Syphilis. So much for being noticed by the government. 

DFA do a good job of telling us they are a peak body NGO and often suggest they are part of the Australia’s strategy on illicit drugs. They make a lot of fuss about their influence on the government including their demand that Australia’s political parties come clean on their support of being “tough on drugs”. They were mostly ignored with their demand except by the Libs who coincidentally approved funding for DFA when in government. For a “Peak Body”, the have surprisingly little support from professionals. 

Looking through the websites of official organisations that deal with illicit drugs, I am yet to find support for DFA. The only links to DFA seem to be from similar groups who are also ignored by the professionals. 

Their biggest claim to fame and the source for much of their delusion is being prominent contributors to the The Bishop Report: “The Winnable War on Drugs”. This report was the result of the most loaded enquiry ever held in Australia and although it’s been written off by most experts worldwide and completely ignored by the current government, DFA still promote it as the answer to our drug problem. Apart from like minded groups, they are seen for what they are - a bunch of radical religious weirdoes who care not for addicts but their own personal ideology. 

The most recent, compelling evidence cannot be disregarded. For instance, the Australian Medical Association has issued warnings on the health risks associated with smoking marijuana. 

Risks of cannabis use include memory loss, psychosis, impaired driving, hallucinations, asthma, and even lung cancer. Moreover, warns the AMA, one third to one half of detained patients admitted to psychiatric units in Australia are there because marijuana use has precipitated their condition. 

A new scientific study conducted in New Zealand indicates that long term cannabis use increases the risk of lung cancer in young adults. The study recognised that cannabis smoke has been shown to have greater concentrations of carcinogenic hydrocarbons than tobacco.

The evidence might appear compelling but it is not fact. Only a tiny percentage ever have problems with cannabis and this is mostly confined to heavy users. Any sensible person would agree that abusing any drug increases the risks of harm. 

Most anti-drug campaigns including tobacco, focus on the extreme examples of what may occur if used excessively over many years. Nearly all illicit drugs have very little effect on the user unless abused. Heroin for example is basically non toxic and has almost no physical effects. The same is for cannabis. 

You may notice that half the list of possible harms are easily avoidable through common sense but they always seem to be included as additional scare tactics. For example, impaired driving is a no brainer. If drinkers can avoid driving when intoxicated why wouldn’t cannabis users do the same? Someone under the effects of cannabis is much more likely not to drive than alcohol affected persons but this is never mentioned. 

What about asthma or lung cancer? Do asthma sufferers smoke cigarettes? Do cigarette smokers continue if they start to get asthma? The difference with cannabis is that it can consumed by other methods apart from smoking. It seems that cannabis users again have been targeted as lacking common sense. Users with respiratory problems can include cannabis in food or use the many vaporisers available on the market. Cannabis may have greater concentrations of carcinogenic hydrocarbons than tobacco but the process of intake is completely different. Cigarette smokers inhale all day whilst cannabis users only take what they need to. Smoking 20 cigarettes a day with 10-20 puffs is vastly different to 1-4 puffs per day or week. Research on inhaling burnt plant matter shows that the body can natural accommodate a certain amount of fumes without any effect. It varies from person to person but if say 10% is harmless then 40 puffs on a cigarette being 10% of a daily total of 400 is significantly more than say 4 puffs for cannabis. It again comes down to use versus abuse. That being said, anyone who has 40 puffs of cannabis a day, every day probably needs help. 

On a side issue, since prohibition makes cannabis expensive, users often mix in tobacco to maximise their stash or control the intake potency. There is some suggestions now that a lot of craving to take cannabis is the really the desire for nicotine, not cannabis. Cannabis is classed as a very mildly dependant drug like caffeine but tobacco is classed as extremely addictive like heroin. 

Many national and international studies have found that drivers intoxicated with cannabis, pose a high risk of road accidents. For example a 10 year Victorian study found a 7 times greater risk of a fatal accident. Other studies clearly show that cannabis impairs vehicle control, including the ability to stay in one lane, as well as slowing reaction time. (ANCD Report, Dec 2004).

Ah, again the assumption that all cannabis users are completely irresponsible. No one should drive with any mind altering substance including alcohol or prescription drugs. Why would cannabis smokers be different from alcohol drinkers? You may start to see the tactics used by DFA a little clearer now.

Highly respected medical practitioners in Australia and overseas have confirmed that cannabis use is linked to psychosis. Dr Brian Boettcher, Consulting Psychiatrist in the UK reports that ‘Cannabis is capable of precipitating psychosis, going on to the chronic cases in people who have had no family and personal history of psychiatric illness. There have been suggestions that such people may be the ones who have started cannabis in their teens’.

The main medical argument by groups like DFA is the claim that it leads to psychosis. What is known is that people with a history of metal illness in their family may be prone to similar symptoms. The big question is whether those who smoke cannabis without a generic link to metal health have a greater chance of suffering psychosis than those who do not use cannabis. Again moderation is the key. Heavy use of cannabis may cause psychotic conditions but does moderate use? This has never been conclusive. DFA cite a quote from a report by Dr Brian Boettcher. What they leave out from his report is:

The drug induced psychosis seen when Cannabis is the main substance being abused is distinct phenomenologically from other psychosis. It is unusual for such a psychosis to occur without other drugs being involved to some extent and so it is difficult to tease out the differences between the effects of Cannabis and other drugs. -Dr Brian Boettcher

Then a few years later, Reuters wrote an article about a report from Dr. Mikkel Arendt of Aarhus University in Risskov, Denmark:

They found that individuals treated for post-pot smoking psychotic episodes had the same likelihood of having a mother, sister or other "first-degree" relative with schizophrenia as did the individuals who had actually been treated for schizophrenia themselves. This suggests that cannabis-induced psychosis and schizophrenia are one and the same, the researchers note. "These people would have developed schizophrenia whether or not they used cannabis" Based on the findings, the researcher says, "cannabis-induced psychosis is probably not a valid diagnosis. It should be considered schizophrenia." 

-Reuters

This brings up a very important point.

It's "very common" for people to have psychotic symptoms after using marijuana, such as hearing voices, feeling paranoid, or believing one has some type of special ability, Arendt said. But these symptoms typically last only an hour or two. "It's a very important distinction, this 48 hours criterion," he said. 

-Reuters

So it still seems there is still no conclusive link to psychosis from moderate cannabis use. The psychotic symptoms are just that, symptoms or psychotic conditions not psychosis itself. Like a drinker who becomes violent or depressed when drinking, a cannabis users who suffers adverse effects should probably abstain. DFA again assumes cannabis users are incapable of controlling their use. Any normal person who has negative effects like psychotic type symptoms from taking something will most probably avoid it. 

The very reason I don’t smoke cannabis is because it has an adverse effect on me. I get paranoid and stay extra quiet until the effect wears off. I know many people like this who simply don’t take alcohol or other drugs that have unpleasant effects. So why do DFA suggest cannabis users will continue down a self destructive path as opposed to most drinkers? 

Many of the reports that suggest cannabis does cause psychosis are statistical witch hunts that process millions of possibilities until they find a result they are looking for. This is known as junk science and is well known throughout the research world. The often used “gateway theory” where cannabis leads to harder drug use is an example of this. Because X once used Y and now has psychosis then X must be a precursor for psychosis. Using their logic, alcohol and tobacco have more chance of being a precursor for psychosis than cannabis. In other words, certain groups seek out particular results to add credibility to their often tenuous agenda. DFA is one of these groups.

Norman Swan: And how often, you talk about bias and statistical bias in the reporting, to what extent do you see the statistics manipulated in order to get a positive result? 

Dr. John Ioannidis: Well one does not necessarily need any manipulation. Let's say that someone does the perfect study, the perfect epidemiological study, the perfect exploratory analysis hunting for associations. However there are ten other teams that do equally perfect studies and only one is lucky just because of chance to find some particular association with some exposure or intervention of interest. Now if we had the benefit of reporting the results of all ten, or eleven investigations with equal weight and equally soon and in equal detail then we would not be misled, we would see that here are ten studies that find nothing, and there's one that's found something but if you pull them together you see that there's absolutely no effect, nothing to be seen, so it's just statistical rules that say if you run too many studies and too many analyses a few of them will show something that is just chance. However in the current publication environment researchers are really urged to report that they have made discoveries, competition is very fierce, they have to say that we have found something and they probably don't have much time or even willingness to report and comment on what 'negative results', even though these studies may be just as important and as well conducted. So what we end up seeing many times is just the tip of the significant results that appear due to chance. 

-The Health Report, ABC - The validity of published research findings

The facts are clear. 

• Most users of cannabis will NOT become psychotic.
• Those with a history of mental illness in their family including themselves have a greater chance of psychosis.
• Some of the negative effects of cannabis abuse appear as symptoms of psychosis but only last for an hour or two.
• Cannabis use may be damaging to the young brains of teenagers.

There’s a lot of maybes in cannabis research but the fact is most users have no problems whatsoever. The small group who are prone to abuse cannabis or have adverse effects should not use it. It's simple really and I fail to see why DFA do not ever mention this. Instead, DFA are well known to cherry pick their data and write their own biased conclusions. Paul Gallagher from DFA Watch gives an excellent example in the article, Drug Free Australia; telling you what you think.

So far as cannabis use and birth defects is concerned, a Commonwealth Department of Health publication to medical practitioners warns of foetal brain development, relative prematurity, smaller length and head circumference, malformations, higher rate of miscarriage and perinatal death. A US study found a 10 times greater risk of non- lymphoblastic cancer to infants of marijuana- using mothers. 

Other effects in the new born are lethargy, slow to gain weight, increased startle reflexes, tremors and possible long- term developmental and behavioural effects. All of this clearly points to the fact that cannabis should be considered at least as serious as other ‘hard’ drugs such as heroin or methamphetamines.

No one should take potentially harmful drugs whilst pregnant including alcohol, cannabis or prescription drugs! Again, a no brainer. I keep asking this question ... why do DFA assume cannabis users can’t control themselves? Any normal person would not risk hurting their unborn child and this includes cannabis users. There is a greater chance of a drinker risking the health of their child so why aren’t DFA promoting the more dangerous situation?  

But DFA leave the best to last. In the last paragraph, the last line is the all encompassing attitude and misleading tactics of DFA. Apart from the last line, the last paragraph explains about the possible effects of cannabis on pregnant mothers but is irrelevant if the mother doesn’t use cannabis. There’s lots of grisly descriptions and damning statistics but still has nothing to do with non users or anyone not pregnant. It only mentions medical conditions and statistics on the risk of non- lymphoblastic cancer to infants. But what seems to be the case of a lazy writer, they strangely throw in:

All of this clearly points to the fact that cannabis should be considered at least as serious as other ‘hard’ drugs such as heroin or methamphetamines.”

LOL. Did they forget a paragraph? Maybe they got confused with their own lies and deceit? The last line does though give an appropriate ending to their poor attempt at providing serious information. It is out of place, out of context, not relevant to the current subject, misleading, sensationalism, incorrect and a lie. 

Journalist Should Be Ashamed

Just as I finished posting about a rare occurrence where the MSM wrote something sensible concerning drug use, I find one of the most pretentious and overdone articles I have ever seen in the Australian media. It’s probably no surprise to you that the article is from the Daily Telegraph and it’s author, Fiona Connolly has exceeded their own dismal standards and produced what seems to be, a Piers Akerman style masterpiece. Akerman and Connolly are work buddies so maybe there’s been some in-house tuition going on. How else could Connolly come up with such crap?


Cokehead Should be Ashamed
The Daily Telegraph
By Fiona Connolly
December 2008

HER heart is thumping. She can feel it pulsing in her throat, a loud wooshing sound ringing in her ears.

It's loud enough it drowns out the noise of the pokies and the dull beats spilling out of The Bourbon. Her toes are sticky. Damn it, there's blood on her foot. She hitches her micro mini and bends over to take a look. But it's no good, she can't see.

She blinks, or are her eyes actually flitting now? She can't tell. The bright lights of the Cross are as blurry as hell.

OK, try to focus on that Macca's sign then, she thinks. But she can't. The wobbling yellow sign makes her laugh out loud, even though she's alone. Even though blood is dripping from her nose.

She's been drinking for 24 hours and is still not drunk. A couple of grams will do that to you, she laughs to herself.

All right, so her nose is stuffed but if she could just scab one more line from someone, just a bit to rub on her gums even, then she'd call it a night.

This could well be the sad story of a low-life Sydney prostitute, an ice addict or speed freak. But it's not.

It is an all too typical picture of Sydney's well-heeled 20, 30 and 40-something professionals, where a weekend cocaine binge is somehow not only acceptable but something of a status symbol in this city today.

Bankers, lawyers, engineers, IT professionals, doctors ("they're the worst" apparently) all "racking up" until their nostils can take no more or until the "gear" eventually runs out.

You see, it's perfectly OK because it's cocaine. Real druggos don't use cocaine, they can't afford it. Real druggos are skanky speed and ice users. Coke is glam. It's part of the scene. Rich people, celebrities use it.

The other common attitude is that they're all proud of it.

To offer someone a line of coke is to say they've got a spare $300 to throw away on a gram for the weekend. It's a badge of honour. And you're particularly popular if you're sharing your stash.

It goes some way to explaining why Young Australian of the Year contender Iktimal Hage-Ali made no attempt to apologise for her cocaine use as she testified in the District Court this week where she is suing the NSW Government for unlawful arrest and wrongful imprisonment.

Instead, she was filled with pride over her former coke habit, telling the court she had lied to her dealer and childhood friend Bruce Fahdi so she could get drugs on credit.

"I'm not ashamed of the fact that I have used cocaine. I know I took drugs but I still did a good job." she puffed.

What? Not even a hint of a "naughty me, drugs are bad" when you are talking to a judge - and an entire courtroom full of reporters?

If we didn't already know, I'd be asking what this supposedly intelligent girl was on, that she's so keen to tell the world she was an out-and-proud cokehead. I didn't hear Hage-Ali crow about the coke addicts who lick toilet seats for leftover grains of powder, or the users who suffer brain bleeds or those who have heart attacks and die after one too many lines.

I note too that in her self-assured, independent woman spiel to the court she didn't brag about the men and women rocking back and forth with severe psychosis in the corner of the state's mental institutions.

Nor did she mention the good folk who undertake the drive-by shootings and murder innocent people which allow her - and Sydney's bulging white collar cocaine crew - their illicit supply. Given she would "happily admit" to the District Court to snorting 3g of cocaine a week, I take it Hage-Ali hasn't pondered these things. After all, it's not like its grubby heroin or ice - otherwise known as "poor man's coke". She was speaking of cocaine. The expensive stuff.

This is also presumably the attitude of Assistant Director-General Michael Talbot, Hage-Ali's former boss, who yesterday gave evidence that the Attorney-General's Department wanted her back despite the criminal charges she faced.

"There was no impediment of her returning to work," he told the court.

"I would have had her back in the role that she was partaking in at the time."

In recent weeks I've heard more than a few people talk of having a "white Christmas" this year. They will do so courtesy some of Sydney's high-end clubs which perpetuate this city's rampant cocaine use with custom-made mirrored shelves in their toilet cubicles.

They will "smash" a bag or two a night, while the likes of supermax prisoner Bassam Hamzy and his crew map out a crime spree to satisfy Sydney's never-ending demand for this evil drug.

May I ask Ms Hage-Ali, what's not to be ashamed about that?


Bwhahahahahaha. Hahahahahaha. Ho Ho Ho, hahaha. [sigh] I’m sorry about that but I couldn’t help it. This is just too funny to be true. I have read some classics before but Jesus Q. Christ, this is the best of them by far. If someone should be criticised for allowing drugs to interfere with their life, it’s Fiona Connolly. I don’t see any other explanation except she must be on magic mushrooms or LSD. Maybe it’s a script for some B-grade movie or a plot for a trash novel but what it is not, is an article worthy of being taken seriously. I feel that television and cinema have been mixed up with moral outrage with a good healthy dose of Daily Telegraph mentality.


Bankers, lawyers, engineers, IT professionals, doctors ("they're the worst" apparently) all "racking up" until their nostils can take no more or until the "gear" eventually runs out.

You may have noticed that journalists are left off her list. Apparently, Bankers, lawyers, engineers, IT professionals and doctors are the worst. Where the hell did she get this from? Maybe she popped her head into Akemans office and asked him considering he is supposedly a journalist and also an ex cokehead. And don’t you love the phrase, “cokehead”? Remember, the Daily Telegraph regularly uses derogatory terms for medical issues that involve drugs e.g. Akerman calls the Medically Supervised Injecting Centre (MSIC), a shooting gallery, drug addicts are usually referred to as junkies and of course there’s speed freaks, cokeheads, potheads etc. Connolly makes out that Iktimal Hage-Ali is some proud, arrogant socialite who looks down on the lower classes especially those “speed freaks” and “ice addicts”. Using terminology like “out-and-proud cokehead” or “braggging” is taking a bit too much journalistic freedom. Connolly also writes that Iktimal Hage-Ali is selfish because she didn’t alert the court that cocaine can cause problems in Australia. It just shows how far she will go to make her point. It’s like criticising a drink driver for not telling the judge that alcohol abuse causes liver cirrhosis. Yes, way too much journalistic freedom.

Instead, she was filled with pride over her former coke habit [...] I note too that in her self-assured, independent woman spiel to the court she didn't brag about the men and women rocking back and forth with severe psychosis in the corner of the state's mental institutions.

Like all good moralists protesting about drug users, Connolly introduces extreme examples and images from popular culture to make her point. Sometimes it sounds more like a scene from a Superman movie

...supermax prisoner Bassam Hamzy and his crew map out a crime spree to satisfy Sydney's never-ending demand for this evil drug.

Or a scene from some gangster movie set in L.A.

Nor did she mention the good folk who undertake the drive-by shootings and murder innocent people which allow her - and Sydney's bulging white collar cocaine crew - their illicit supply.

Some times it’s from Jackie Collins new novel.

In recent weeks I've heard more than a few people talk of having a "white Christmas" this year. They will do so courtesy some of Sydney's high-end clubs which perpetuate this city's rampant cocaine use with custom-made mirrored shelves in their toilet cubicles.

Yep, it's funny, isn't it. If I didn't know the circumstances, I would assume it's satire. Cocaine, lots of money, drive-by shootouts, unrepentant Muslims, fancy night clubs with snorting mirrors in toilet cubicles, murder, glamorous professionals in mini skirts, wrongful imprisonment, a city in chaos and more. Iktimal Hage-Ali is guilty of using cocaine. She admitted to it which should score a few brownie points but for Connolly, this is her worst crime. It’s not Iktimal Hage-Ali’s job to be a role model or to fit in with Connolly’s criteria of acceptable behaviour. As some readers pointed out, Iktimal Hage-Ali is one of the 90% of drug users who don’t have a problem with their usage except when faced with contrived drug laws. Singling out well-to-do cocaine users as the core reason for street violence, severe psychosis and the downfall of society is disingenuous. In fact, these outcomes are rare in Australia compared to the US where harsher laws apply. It is obvious that Connolly is confused between the street violence in the US, Mexico etc., the world of movies/TV and the reality in Australia. Even the commitment of her previous boss, Assistant Director-General Michael Talbot, that the Attorney-General's Department wanted her back was seen as unacceptable. Was the whole world falling into a spiralling mess with no morals or heaven forbid, lack of family values? Think of the children! I also noticed she left out that Iktimal Hage-Ali was “sending the wrong message”. Hasn’t she read the politicians book of rhetoric? “Sending the wrong message” is clearly marked as vital to all public statements on drug use.

I didn't hear Hage-Ali crow about the coke addicts who lick toilet seats for leftover grains of powder, or the users who suffer brain bleeds or those who have heart attacks and die after one too many lines.

The fact is, most drug use is uninteresting so without moral judgement or dressing it up, it is unlikely to make for compelling reading. A good NEWS.com writer needs to follow the in-house procedures and introduce moral decay or sinister sub plots to make it into the published pages. Fiona Connolly certainly did that.


Some sample comments from The Daily Telegraph readers.
There are some mighty fine comments here. Read on.

The article makes the same mistake that ineffective government anti-drug advertising does. It goes too far in demonising the experience of taking drugs, and in the process reads as fake. Most people who use recreational drugs hold steady jobs, maintain responsibilities, and generally have a great time on the drugs which is why they keep on using them. They may be aware of the longer term issues, but like smokers and drinkers, negotiate these risks with the great feeling they get in the present. The tawdry piece of fiction that intros the piece is just that - fiction - and would represent less than 1% of the experiences of regular drug users. The journalist maintains this piece of fiction is the experience of young professionals in Sydney. Really? Where is the evidence? Who was interviewed? This is not journalism, it is moralising rubbish. 
-Posted by: Fred of Petersham of Sydney [My choice for best comment]

A quick search of Fiona Connelly in google shows some quality journalism for quality publications. You owe your living to drugs my dear, as no straight person would pay you for this drivel. -Posted by: dave Everyone uses coke, you only hear the bad stories of it. Get a life and mind your own business. Smoking and alcohol is legal and a hell of a lot worse. Stop telling people how to live their lives. 
-Posted by: Steve of Sydney 

fiona- Who made you the arbiter of public morality? If someone can use a substance and still function in thier life then who are they harming.. all of the gang violence, drivebys, and other sensationalist pap you mentioned are actually a result of prohibition of drugs, and nothing to do with the substances themselves. 
-Posted by: Johnston of Sydney 

What a sensationalist article. Look out! every where you turn, surrounded by evil drug fiends, ready to murder for their next hit!!!! You should give up writing news and turn to pulp fiction crime thrillers! Take a reality check, if that's a typical picture of your average drug user, and drug use is as rampant as you suggest then why hasn't society collapsed in a drug addled heap? Perhaps its because most people use recreational drugs responsibly, hold down jobs and have normal lives. People like getting intoxicated - on legal drugs or otherwise. It's more normal than you think. If you doubt it go to your local pub and see how many people there are drinking non-alcoholic drinks (probably not many!) 
-Posted by: Paul of Sydney 

The article mentions use of cocaine by "Bankers, lawyers, engineers, IT professionals, doctors" But no mention of journalists. Maybe that's for another article, one where you detail how a drunk person looks and then refer back to those journalists who are proud to proclaim their drinking capacity. 
-Posted by: adam of null 

Fiona - no mention of journalists on your list of coke taking scum? 
-Posted by: Mick 

Bankers, lawyers, engineers, IT professionals, doctors ... Yeah I'm sure they're into it, but you left out a few other groups that are extremely well represented, though some don't do it as publicly for obvious reasons. Add reporters, real estate agents, police officers, Labor MPs and their staffers to your list and you'd be closer to the mark. 
-Posted by: Julie A of Sydney 

Bankers, lawyers, engineers, IT professionals, doctors ("they're the worst" apparently)....I note your forgot Journailsts! 
-Posted by: Andrew of Canberra 

Plenty of people get off their faces on alcohol and make a disgrace of themselves. This is a much larger social problem than cocaine. Where are the outraged articles about that? This moral distinction between potentially harmful substances because some are legal and others not doesn't work for me. -Posted by: rucksack I'm not ashamed of the fact that I drink water, but I wouldn't say I'm proud of it either. Iktimal Hage-Ali has said she's not ashamed of using cocaine. That means she's not ashamed. And that's all it means. 
-Posted by: Sylvia Else of Forestville 

I blame the touchy feely left wing ALP government who have allowed this behavious to occur. People who are caught with any drugs should be immediately and summarily incarcerated for 30 days hard labour out in the states central west where they can brak rocks, dig holes, etc. No appeals, no phone a friend, nothing. Invite Channel 7, 9 or 10 to film them. Make a reality show out of it. Shame them so that their family and friends know what junkies they are. When they get released, how many of these so called 'professioanls' will still hold their job? Not many I presume. Garbage people like Iktimal Hage-Ali should be washed down the sewer where they belong. 'nuff said!! 
-Posted by: Stefano of Sydney 

Strip her of the award, and lock her up for a couple of nights. There's nothing like tough love! She only won the award in the first place as an appeasement to the left, so that the chardonnay crowd can pat themselves on the back and tell all those who care to hear about the success of immigration and how well they've assimilated 
-Posted by: Chappy of The Rocks 

Go to any nightclub in sydney on the weekend and you will find people like Iktimal Hage-Ali everywhere. Young succesful people just letting their hair down and its back to work as normal on monday. These people are not addicts and most of them grow out of it as they get older. They are probably doing less damage than binge drinking to the point of oblivion and starting fights and damaging property. Yes some people do become addicts but these people probably had problems before they even tried drugs. 
-Posted by: anna bella of sydney 

good on you girl for being proud of your achievements. i wonder if your parents reprimand u everynight for not wearing a burqa, taking drugs and drinking alcohol. repent, if u still want half an ounce of your ex-reputation returned. 
-Posted by: Clayton of Sydney 

You'll find that the people who have a harsh opinion of cocaine like the stories above are mostly the uneducated ones, talking about drivebys and junkies and etc. There are many high profile professionals that recreationally use - not harming anyone. Its the illiterate, niave and uneducated that are always just quick to pass judgement. Drawing parralells between gotham city and sydney i mean come on. 
-Posted by: Simon Westaway of Sydney 

High profile users - not harming anyone. Simon W comment 47 you are the muppet in serious need of an education. Tell that to the thousands that end up on the wrong end of a gun because they're in the way of the drug cartel supplying you with your "recreational hobby". 
-Posted by: Jako of Sydney

Drug Users - Good or Bad People?

It's Time To Get Rid of the Good-People-vs.-Bad-People View of Drug Use By Maggie Mahar and Niko Karvounis Health Beat June 2008 When discussing treatments for drug addiction, instead of arguing about ideology, let's look at science. In 1986, Nancy Reagan made it clear that there is "no moral middle ground" when it comes to drug use. You either don't take drugs, which means you are a "good" person, or you do take drugs, which means you are a "bad" person." The Reagan-era outlook on drug addiction has dominated our political culture for nearly three decades, though not without sharp criticism. In March, for instance, the writers of "The Wire," the critically acclaimed HBO series that brought the realpolitik of Baltimore's war on drugs to the small screen, made it clear what they thought of the Reagan approach: "What once began, perhaps, as a battle against dangerous substances, long ago transformed itself into a venal war on our underclass. Since declaring war on drugs nearly 40 years ago, we've been demonizing our most desperate citizens, isolating and incarcerating them and otherwise denying them a role in the American collective. All to no purpose. The prison population doubles and doubles again; the drugs remain." They're right -- we are not winning the war on drugs. But the question remains: What should we do now? Those who view illicit drug use as willful behavior believe that we have no choice but to jail those who choose to continue committing crimes. Others who argue that drug addiction is a disease that weakens the addict's ability to choose argue that rather than stigmatizing the addict and punishing him, we must find new ways to "treat" the patient. One could argue about who is right. But rather than engaging in yet another political argument about personal responsibility vs. society's responsibility to help its poorest citizens, it might be helpful to take a look at what medical science has been learning about drug addiction over the past few decades. Addiction Treatment: Science and Policy for the Twenty-First Century (Johns Hopkins University Press, 2007) does just that, and in the process "highlights the amazing discord between scientific knowledge and public perception," according to a review by Stanford University's Dr. Alex Macario in the June 4 issue of JAMA. In this collection of short, incisive essays, the authors don't always agree on specifics, but they do reach a consensus of sorts: The scientific community needs to educate the public about drug addiction -- and our approach to treatment should be based on medical evidence rather than personal ideology. Today, medical technology allows scientists to observe firsthand what happens inside the brain when it is, in the words of William R. Miller, a psychiatrist at the University of New Mexico, "hijacked by drugs." Thanks to brain imaging, for example, we know that regular drug use disrupts the frontal cortex, which regulates cognitive activities like decision-making, planning and memory. In other words, drugs affect an individual's capacity to make the choices that the Reaganites insist addicts should be able to make (Just Say No!). Undoubtedly the drug user could have said "no" the very first time he or she let desire override good judgment. But after that, Miller notes, "neuroadaptation involves biological changes in response to drug use that increase the likelihood of repetition and escalation, undermining the person's capacity for volitional control." Recent studies have even shown that drug addiction changes our brains at the genetic level, influencing how our DNA is translated into enzymes and proteins. As a result of this new information, experts are increasingly incorporating the recognition that addiction is, in part, a "brain disease" into their treatment recommendations. This perspective has even made headway in the halls of power. Last year Congress introduced the Recognizing Addiction as a Disease Act, which would institutionalize the disease model by changing the name of the National Institute on Drug Abuse to the National Institute on Diseases of Addiction and change the name of the National Institute on Alcohol Abuse and Alcoholism to the National Institute on Alcohol Disorders and Health. The text of the act embraces the disease model, noting that "the pejorative term 'abuse' used in connection with diseases of addiction has the adverse effect of increasing social stigma and personal shame, both of which are so often barriers to an individual's decision to seek treatment." This statement reflects the logic of Alan Leshner, CEO of the American Association for the Advancement of Science and former director of the National Institute on Drug Abuse, who notes in his contribution to Addiction Treatment that "addiction is ... at its core a brain disease," and that consequently, "addicts cannot simply will themselves to stop using drugs" because they are "in an altered brain state." If addiction is a disease, then addicts are patients -- and they need treatment, just as a cancer patient may need chemotherapy. Yet putting too much emphasis on the "brain disease" model risks oversimplifying the issue. Addiction is not simply biological; it is psychological. There are treatments that work for some patients that involve behavior modification and decision-making. Consider a promising strategy known as "contingency management," which provides rewards for reduced drug use. In these treatments, patients leave multiple urine samples with researchers over the course of a week and receive rewards -- like vouchers that can be traded in for goods like clothing and theater tickets -- for each specimen that tests negative for drugs. Or consider the successes of drug courts, community-based courts where drug offenders are sentenced to treatment and supervision programs. These programs, like contingency management, offer tantalizing rewards, like the reduction of prison sentences, for adherence to treatment, and the guarantee of punishment (jail time) if a patient fails. Studies show that drug courts are effective. Only 4 percent to 29 percent of drug court graduates relapse, compared to a whopping 48 percent recidivism rate among other users. Here we see the limits of thinking about drug addiction only as a disease -- that is, as an entirely biological condition. As Sally Satel, a physician at the American Enterprise Institute, notes in her contribution to Addiction Treatment, the fact that incentives can change drug behavior shows that there's more here than simply a biological problem. "Imagine bribing a cancer patient," she muses, "to keep her tumor from mestasizing or threatening her with jail if her tumor spread." Crude though this statement may be, Satel has a point: You can't really reason with disease -- yet it seems that sometimes you can reason with addiction. In the preface to Addiction Treatment, the authors note: "When treating most medical conditions, health professionals will explore several treatment options with the patient to determine which is acceptable and effective, whereas with addiction treatment a person is typically offered a single option in a one-size-fits-all" approach that fails many. Why do we offer the addict so few options? There's little doubt that our inflexibility is tied up with the fact that society has stigmatized not just addiction, but the addict himself. "Historically, people have disdained addicts because they thought addicts 'did it to themselves' and could just quit if they really wanted to," notes Leshner in his chapter, "Advancing the Science Base for the Treatment of Addiction." As a result, we haven't been terribly generous in the treatments we offer addicts, even when we have clear medical evidence of what needs to be done. For example, "it has been established that psychosocial interventions alone do not work well for the majority of opioid-dependent individuals," points out Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment. Most need medication in the form of a methadone maintenance program. Yet as Mark W. Parrino, president of the American Association for the Treatment of Opioid Dependence, points out in a later essay, "the stigma that surrounds heroin addiction has interfered with providing access to care both for the general public and for incarcerated" addicts. In a study that surveyed how correction staff in a large Southwestern jail felt about methadone maintenance therapy for heroin addiction, researchers found "negative attitudes ... that appear to be related to negative judgments about the clients the program serves. The survey results indicate that people don't object to methadone treatment per se, but they object to drug users in general, and heroin users in particular, getting any kind of treatment that might ... condone their behavior. An unexpected finding was that the older jail staff was much more sympathetic to methadone maintenance treatment than the younger staff." This may be because older staff came of age at a time when we were beginning to realize that alcoholism and other drug dependencies were diseases -- and not simply signs of a lack of character. Meanwhile, younger staff grew up in the post-Reagan era, when much of the public was led to believe that addiction is a moral crime that should be punished. Yet, as Parrino notes, "the Rikers Island KEEP (Key Extended Entry Program) program has demonstrated that providing access to methadone treatment for inmates is extremely cost-effective." And for heroin addicts who are not in jail, "Methadone/buprenorphine treatment is a low-cost medical intervention. In most outpatient programs, the cost for providing access to this treatment generally amounts to $5,000 per patient per year. This is much lower than the roughly $22,000 per inmate per year cost of incarceration, especially in view of the fact that a large number of methadone patients pay for their own treatment." But this does not mean that we want to simply "maintain" the heroin addict with methadone, and leave him or her on that lonely plateau. With proper incentives, counseling and reinforcement, addicts can still make choices. Like other patients, they need to be drawn into the treatment process, where they can share in decision-making. Much of 21st century addiction research focuses on understanding the fundamentals of motivation. In Addiction Treatment, the University of London's Robert West offers the PRIME model, a compelling framework for understanding what drives us. According to West, responses ("R") exist at the most basic level of the human motivation. These are basic actions, like starting or stopping an activity. At the next level are our impulses ("I"), which are catalysts for specific action (i.e. hunger impels us to eat). These impulses bridge our actions to higher-order mental states, like motives ("M"), our conscious desire for specific things, and evaluations ("E"), moral perspective on how the world works. At the most complex level lie our plans ("P"), which refers to how we think about and plan for the future. This model does a good job of linking various dimensions of motivation. And in a PRIME treatment, says West, "both medication and psychological techniques should be considered." Patients could be given drugs that help regulate their impulses or reduce the discomfort associated with quitting cold turkey, while psychological techniques can be used to restructure motivations, future plans and habits. PRIME gives you a real sense of how mind and body interact to trap the addict. As Maxine Stitzer, a professor at Johns Hopkins, suggests in her essay, drug addiction should not be thought of as either a choice or as a brain disease, but rather as a "chronic relapsing disorder." This is certainly true for some, if not all addictions. Again, there is no "one-size-fits-all" model or treatment for a disease that we are only beginning to understand. Finally, while "society at large may consider injury from addiction to be the 'just desserts' of drug abuse, this perspective is not shared by those responsible for the public health," observes Dr. Curtis Wright. "From a public health perspective, the path forward is to recognize that these disorders are a major health problem." Yet, "for whatever reason," he writes, today, "there are few physicians or medical institutions to speak to the need for addiction treatment. Many of the clinical experts and clinical researchers in this area were trained almost 40 years ago, and relatively few physicians are currently entering the field." Most likely, the Reagan-era notion that drug use is a moral problem discouraged many who might otherwise have seen it as a medical problem well worth exploring. Meanwhile, Wright reports, "the lack of strong physician advocates has been one of the factors leading to why the FDA treats these disorders as lower-priority illnesses than many other diseases." This is yet another area that the next FDA commissioner might want to investigate. We are very hopeful that 2009 will mark a rebirth of an agency that plays a major role in setting priorities for the nation's health.

A Day in the Life ...

There has been some interesting feedback about the Who Is April Morrison article. For those who don’t know, April Morrison is a secondary school teacher and a functioning heroin addict. After reading the article, David contacted me, telling a similar story about himself and his partner that also challenges the stereotype image of junkies. David and his girlfriend are I.T. professionals and heroin addicts but not necessarily in that order. Between them, they have a double degree, 2 diplomas including one advanced and a swag of highly regarded industry certificates. They both work for large multinational companies and have senior positions. This does not sound like the kind of desperate, dangerous junkie that I hear about so often in the nations media. This is a day in the life of David in his own words.

You can say I’m some what of a "normal" person, I have family, a job, live with my girlfriend and do some part time study in my free time. I keep myself semi-active on weekends enjoying a game of basketball or badminton with mates. 

However, there is one thing about me that I dare not advertise to the faint hearted. ... I’m an heroin addict. 

I am currently 26 years of age and have been working in the I.T. industry for the last 9-10 years building my career. You can say that I look totally "normal". My arms don’t have track marks, I don’t have a face full of zits and I wear a suit on a daily basis. I spend most of my day working for a multimillion dollar I.T. firm that is known worldwide, my job is tough ... but my secret life I hide from others is a whole lot tougher. 

7:00AM Monday morning, my alarm goes off. As I struggle to pry my eyes open I need to get ready and dressed for work. Instead of heading straight to the bathroom, I instead roll over to my night stand and pull out my "kit". Yawning constantly from withdrawal symptoms I go ahead and prepare a shot of heroin. The shot is ready, I inject the solution into my body .... instant relief ... warm tingles and a sense of well being. I am ready to tackle my day head on. I sit there for 10 minutes, enjoying a cigarette. After 15 minutes of psyching myself up I head to the bathroom for my morning shower. 

When I get into the office, a pile of work is sitting there waiting for me in my inbox. My day has truly begun. As lunch time arrives, my mobile rings with Joe displayed on the caller ID. "G'day mate, can we meet up?" Joe says. "Yep sweet, how long", I reply. Joe is a long time acquaintance of mine and we have known each other for a good 5 years or so. You can say we are friends but there is another reason he wants to meet up with me. No, we are not meeting up to have lunch together ... he too is a heroin addict. I head down stairs and out to meet up with Joe. A few minutes of chit chat and he then hands me some money. I, in turn hand him a small package I had prepared earlier that morning for him. I am as cautious as possible and look around to make sure no one from work sees me. Joe himself is a working man, with a wife, 2 kids and a mortgage. Sometimes I feel like he sees me more than he sees his own wife, but such is life for an addict. I may possibly meet up with 1 or 2 other people before I head back to the office. Same deal here as with Joe. Im not meeting these people for lunch but to give them their daily medicine. I head back up stairs to the office to have lunch. By this time my stomach is churning and groaning. The funny thing is I’m not hungry or have an appetite. I need another fix before I can even think of putting food into my mouth. I quickly grab my "kit" and innocently head to the toilet. Mulled up and prepared, I have my shot. Instant satisfaction ... man I’m hungry and could do with some lunch now. I am in board meetings most of the day. As I sit there listening to someone blab on, stroking their own ego about how much of a good job they have done, my mind drifts. I wouldn’t mind a hit right now, I ponder. As I look around the room, I wonder... what if these people know about my secret? If I told them would they understand? Would I still have a job if I told them I just shot up half a gram in the toilets before lunch? I think not! I know for a fact I would be out on my arse and jobless. 

Being a Gemini, I should be able to easily keep up with this escapade of hiding my other self. To be honest, hiding my secret seems like a full time job in itself. Its not easy putting on a smile or concentrating on a large project when hanging out ... withdrawal symptoms suck. To maintain a normal life, I have to deal. I’m not a big time dealer, but I make enough for our personal use. I put myself in a position where I do not spend a single dollar of my hard earned legitimate salary. Unfortunately though, an addicts life never quite works out to be how you want it to be and half my salary at least is spent on gear each week. As the clock ticks by my work day is coming to an end. I finish up my workload so I don’t have much to do the next morning. I then head home. 

I cook up dinner with my partner, sit down on the couch and watch TV or a movie. With dinner finished, I clean up the dishes and head straight to my room to see Lady H one last time for the night. I prepare, shoot and head back outside to continue to the movie or play some games. As I start to get worn down, I get ready to turn in for the night and hit the sack. Ahhh thank god Monday is over, I wonder what tomorrow will have in store for me? 

I had been chasing the dragon for 8 years and started injecting H for the last year and a half. I use to be scared and against needles, having so many friends die from overdoses or seeing so many of them getting locked up for crime to finance their habits. I actually despise those that steal from family and friends for heroin, or anyone that steals at all. I can proudly hold up my head and say that I have never once tricked, lied or stole for my drugs, I was raised by great parents which taught me to work hard from an early age and do not act deceitfully towards anyone. I believe in karma. 

Over the years, I have developed depression and anxiety. These days my anxiety has been getting quite bad so I have pushed my ego aside and I am currently seeing a psychiatrist. I have a lot of issues that I need to deal with and I know that it would be a good idea for me to quit. I have detoxed a total of 27 times over the years with each detox harder than the previous one. I haven’t given up but for now I have just come to accept that I am an addict and will not quit until I am truly ready to ... someday.