Category: Content

Embracing interactivity and openness: Drugs 2.0

Last Friday, I had the pleasure of attending a presentation by Ray Stephens of Moreland Hall. Ray spoke about ‘Using Web 2.0 to engage with clients and reduce drug-related harm’.

Web 2.0 is an interactive, immersive network where participants consume and create content and connections. Young people, arguably the target group of much alcohol and other drug ‘interventions’, are primarily using the internet to source health information. Online networks facilitated through web 2.0 allow people to collaborate, gather and distribution information. Illicit drug use is no exception to this trend!

Ray argues that web 2.0 is where alcohol and other drug treatment services need to be focusing their attention if they want to capture the attention of the majority of young people who already use these online networks to discussion drug use.

The examples of online engagement in the AOD field that Ray reviewed were websites with comment facilities (like Somazone), websites that host multiple blogs (like Between the Lines) and Moreland Hall’s website Bluebelly, which is pushing the boundaries in its use of wiki articles and forthcoming feature film.

From the audience, we discovered the innovative work currently underway at the Burnet Institute using Facebook. The Queer as F**k project follows the lives of 5 fictional gay men who live together in a share house in Melbourne. The characters have their own facebook pages and interact together on the site. The main action occurs in short film clip episodes uploaded to youtube and disseminated through the facebook page. Health and social issues are introduced through the films and online interaction.

Chris Raine, founder of Hello Sunday Morning was also in the audience and had a chat to me after the show. HSM is a collective of bloggers who have taken 3, 6 or 12 months off drinking to examine why they drink and develop a new relationship with alcohol. Hello Sunday Morning uses similar logic to Queer as F**k: people who follow the experience of these individuals and interact with them will be engaged and more open to learning and experimenting with their own behaviour change. The difference is that the HSM people are real, whereas the Queer as F**k characters are fictional. There is something particularly appealing about HSM bloggers being real.

Alongside the importance of using web 2.0 to engage with people about drug issues, Ray also argued for the opening up of AOD workplaces to web 2.0. How can people who work in this field become familiar with web 2.0 when much of it is blocked by our organisation’s firewalls? How can innovation be stimulated in organisations where facebook, youtube and twitter are seen as not work related?

Ray ended his presentation with a great list of 10 reasons why we should embrace web 2.0 in the AOD field:

1. Source of information
2. Brand awareness, credibility
3. Networking and partnership development
4. Provide treatment to people we will never see
5. It’s engaging (and fun?)
6. Encourage opportunities for users to have a voice
7. Extend your staff’s working hours
8. Free (…ish)
9. ‘They’ are already using it
10. It’s not going away

What I love about this list is that it reads so much like why people should embrace the harm reduction approach to drug use. Essentially, people are using web 2.0 and it isn’t going anywhere, so we need to learn how to use it wisely and well, instead of the zero tolerance approach of ignoring it in the hope that it might be a passing phase. Hopefully more alcohol and other drug agencies will modernise their social media policies and embrace interactivity and openness through web 2.0. All they have to lose is their fear 🙂

* Thanks Ray for starting this conversation. Let’s continue it!

Mephedrone / 4-MMC

‘Meow’ trance victim! A deadly designer drug dubbed Britain’s new ecstasy has sent a man into a psychotic “trance-like” state in the first known case in Melbourne.

When I read this on the front page of the mX (11/3/2010), I knew the moral panic had officially begun. Since then Australia has seen an hour-long ‘investigation’ into the new ‘killer drug’ mephedrone on A Current Affair, with another investigation by Steve Cannane due to air on ABC’s Lateline tonight.

Firstly, what exactly is mephedrone or 4-MMC? And why are people talking about a drug called ‘meow meow’ and ‘plant food’? According to a selection of key information compiled at Bluelight, the full name for this drug is 4-Methylmethcathinone or 4-MMC. The ‘meow meow’ may refer to MM-CAT, another shortening of MethylMethCAThinone. While Australian law prohibits cathinones and any cathinone analogues, including mephedrone, the UK is in the midst of a political struggle to schedule and ban 4-MMC which is currently a legal substance, although it must be marketed as not for human consumption to get around standard regulations of consumable products.

For those who have studied the history of new drug panics, this treatment has a familiar ring to it. Like MDMA (‘ecstasy’), methamphetamine (‘ice’), and GHB (‘fantasy’) before it, 4-MMC (also with the classy so-called street name ‘meow meow’) is a menacing danger that needs to be stopped using the legal system. 4-MMC has been marketed as plant food, like other ‘new’ drugs that have made headlines in the last decade that were labelled research chemicals and incense to avoid regulations associated with food and drugs.

What has become obvious to observers in this case in Australia is that as supply reduction measures tighten and actually influence drug markets for known illegal drugs like MDMA, demand for MDMA is left unmet. It is not surprising that new synthetic drugs are created, manufactured and marketed to meet this demand. While Australia’s analogue laws mean that most new synthetic drugs are likely to be illegal, it still takes time for the police and customs to determine this – and in that time, new drugs enter the market. We will always be playing catch-up. The question I ask is whether we do more harm by perpetuating new and less studied drugs, one after another, than we would do if we regulated the supply of known drugs, even with their harms.

Furthermore, having a sharp divide between illegal and legal drugs can provide people with a false sense of security when they believe a drug is ‘legal’. Pharmaceutical drugs, ‘legal highs’ and other drugs on the margins of legality such as new analogue drugs may be perceived as less dangerous than known illicit drugs. This misplaced sense of security may be stronger among people who don’t take illicit drugs and who haven’t been exposed to them, because they are more likely to actually believe the scare campaigns in the public discourse. For example, posters warn Australians against using ecstasy or speed due it being made in ‘backyard labs’, yet this image contrasts with the imagined pristine lab in a pharmaceutical company or the scientific lab where a drug like 4-MMC/mephedrone could be made. This is surely an unintended consequence of singling out cannabis, ecstasy and methamphetamine in anti-drug campaigns, and an unintended consequence of prohibition itself.

The situation with mephedrone is a little different in the UK, where there are no analogue laws and the drug is freely available although this is likely to change as the UK government looks to include mephedrone in Schedule B. Max Pemberton from the Guardian wrote an article entitled “I took mephedrone and I liked it”, where he said:

I do not doubt that mephedrone will be made illegal, and this is probably a very sensible course of action if we want people to be as risk averse as possible. But what must be appreciated is that as soon as it is, it’s only a matter of time before another substance appears, creating the same problems all over again.

Professor David Nutt, who was sacked from the UK drug advisory board last year for speaking his mind about the inconsistency of drug scheduling in the UK, believes that regulating mephedrone alongside MDMA would be safer than imposing the current system of prohibition.

I urge the UK and Australia to consider not only the situation of this new entrant, 4-MMC/Mephedrone, but to the other new synthetic drugs that have been in its place and will be in its place should our system of prohibition remain the same. Let’s look carefully at the whole system, rather than running around after ourselves over and over again when history repeats itself.

Process vs content

So far, my posts to Drugs, Internet, Society have focused on drug-related issues I find interesting and important. I also want to write about the research process. This is the first of a series of posts more orientated towards process than content.

Why bother discussing process? Because how we come to know something is as important as what we claim to know (perhaps more important). The validity of a person’s knowledge claim is difficult to assess without understanding the argument or the methods used by that person to arrive at their conclusions.

While this may seem obvious, people accept knowledge claims everyday without having access to the process that informed those claims. We may be trusting an expert, we may not have access to the processes behind the claim, we may not have the expertise to critique those processes and/or we may not have the time to do so.

Drug policy discussions in the public sphere are an area fraught with knowledge claims that require critical analysis. It is therefore important for you, as readers of this blog, to read about at least some of the processes I participate in when I ‘do research’.* This is the aim of the ‘process’ category of posts that I’ve just started today.

* These posts are, of course, my own account and reflection upon research processes. This is a discourse in itself that cannot provide an unbiased account (or mirror) of my research.

More of the same…

The Rudd government announced another advertising campaign to ‘confront illicit drug use’ last night. Their media release states that:

Too many young Australians don’t understand the very real and dangerous impacts of taking or using illegal drugs

Their ‘new’ campaign will tackle this perceived lack of knowledge by using graphic images that emphasise the damaging effects drugs have. Young people need to ‘face facts’ about the risks involved in drug use.

I have numerous problems with this announcement.

  1. This is not a new campaign. Howard’s Tough on Drugs campaign has been on the go for many years with the same concepts and ideas.
  2. Social marketing campaigns like this are not informed by credible evidence. The National Drug Research Institute’s Prevention Monograph, a report commissioned by the Department of Health and Ageing themselves, found limited evidence to support the effectiveness of social marketing campaigns in reducing or preventing drug use and associated harms. Some studies even find such campaigns may lead to increased drug use through curiosity or reactance. Their most likely outcome is to have little influence on drug use decisions.
  3. These campaigns seem to be designed more for showing the general voting public that the government is ‘doing something’ about drug use. It seems no accident that this announcement and action comes in an election year.
  4. Assuming that young Australians don’t understand the dangers of drug use is unfair. This assumption should be tested. Research suggests that young people do understand and acknowledge the risks they are taking, yet they still choose to use drugs. Until the government can accept that choosing to use drugs can be a logical, informed decision, they will miss their mark in trying to engage young drug users.
  5. The Department of Health and Ageing needs to learn how to interpret statistics accurately!

Two prevalence estimates are compared across time by the Department to support their action in ‘tackling illicit drug use’. They appear to be drawn from the National Drug Strategy Household Survey series. The first read:

The proportion of recent regular ecstasy users who use weekly or more often has risen from 0.8 per cent in 1998 to 17.3 per cent in 2007.

I traced these figures back to their sources in the NDSHS reports and found that these figures refer to teenagers aged 14 to 19, and that the 1998 estimate was based on such small numbers that the estimate should be used with caution. The second reads:

There is also a disturbing trend in the increased ecstasy use by young females aged between 14-19 which is up from 4.7 per cent in 2004 to 6 per cent in 2007.

The table this comparison is taken from in the NDSHS 2007 report shows the increase is not statistically significant. That is, there is no disturbing trend. It is, in fact, hard to find ‘disturbing trends’ in the NDSHS series. Most drug use estimates are decreasing or steady. Whoever was charged with finding these disturbing trends to fit this media release has capitalised on the fact that most people who read it won’t know its source and how to access and interpret the original data.

I recall the Rudd government talking about its plans to use evidence-based policies on drugs and health issues more generally. This campaign is just more of the same. I guess drug policy misses out again when it comes to evidence-based policy.

This post can also be found on betweenthelines.org.au.

Do drug dogs deter use?

Ecstasy arrest numbers have been rising in the Australian state of New South Wales. While many interpret the rise in the number of ecstasy users arrested as evidence of increased popularity of the drug, it is also a likely consequence of increased policing, especially the use of drug detection dogs at music festivals and clubs.

In 2004, Victoria Police first announced their plans to use drug detection dogs (or sniffer dogs) to assist in the arrests of people in possession of prohibited substances. I was one of a group of people who gathered in a Melbourne pub to discuss the situation with other concerned citizens. Our little group talked about how people might respond to sniffer dogs: would drugs be taken at home before going out? would people who bought from regular dealers before going out turn to unknown dealers once inside the club? would people just have more house parties? We never really considered the question: will people stop taking drugs altogether because they might be slightly more likely to get arrested? We knew that this outcome was far-fetched, even though it was the official argument from police and policy makers.

Fast forward to today: I find myself having coffee with a friend from the original 2004 sniffer-dog group of concerned (clubbing) citizens. Our lives have changed a lot since then. Victoria Police now routinely employ sniffer dogs in their work. They are a feature of the Melbourne clubbing experience and according to my friends, clubbers have adapted. On a recent Melbourne outting of his, he and his partner found broken condoms and film canisters in the toilets. Through conversation, they discovered how clubbers had adapted to the reality of sniffer dogs: by storing their drugs internally in the canisters wrapped in condoms.

My friend’s observation is supported by research conducted in this area in Sydney and Melbourne. Dunn and Degenhardt conclude from their research in Sydney that:

regular ecstasy users do not see detection dogs as an obstacle to their drug use. Future research is necessary to explore in greater depth the experiences that drug users have with detection dogs; the effect detection dogs may have on deterring drug consumption; whether encounters with detection dogs contribute to drug-related harm; and the cost–benefit analysis of this law enforcement exercise.

Given these conclusions, it is not clear what purpose sniffer dogs serve. Superintendent Bingham notes that:

With MDMA, it’s lots of smaller seizures. If we go to a large music festival, we are there to target the dealers, not the users, but obviously the users will get caught up in that.

Clearly if MDMA dealers are not being caught, then the stated aim of employing sniffer dogs (to catch dealers) has not been met so far. Even most users would not get caught, given that they will either hide more effectively, choose different venues like house parties over large music events, or buy drugs inside the venues rather than from a known dealer.

So, we return to examining the media mentions of drug busts assisted by sniffer dogs. There, I believe, we find our answer. Sniffer dogs assist police in making more arrests, and these arrests become newsworthy for the general public, who in turn believe the police are doing ‘something’ about ‘drugs’.

Unfortunately, a small number of people have become casualities of the increased policing policies. In 2009, a 17-year-old girl attending the Big Day Out overdosed after consuming all of her drugs:

as she waited in line because she was frightened that she would be searched on entry

Although this response is unusual, any death like this is tragic. It is especially tragic when increased policing at events is sold as an effective deterrent to drug use, when there is no evidence to suggest this is the case.

Censoring online drug discussion

Over the last decade, Australians who use psychostimulant drugs have been increasingly using the internet to access drug-related information. This behaviour is occurring as part of a wider trend towards using always-available information (through wireless internet and internet-enabled notebooks and mobile phones) to ‘google’ just about any topic of interest. The difference with drug-related information is that there has traditionally been barriers in place around the distribution of detailed information about illicit drugs in public spaces. While barriers do exist for Australian-hosted websites containing content that could be refused classification by Australian censors, currently these rules cannot be enforced for overseas-hosted websites. Within this context, drug users have taken the opportunity to openly and anonymously share drug-related information and make connections with others with similar histories and interest in drugs.

The public, open nature of many websites that host discussion about illicit drugs has both opportunities and challenges. Allowing open discussion about taboo topics runs the risk of enabling information to disseminate freely that may be inaccurate and risky to those who choose to follow it. Discussions about drugs may glorify their use or not provide enough cautionary advice. On the other hand, open discussion also enables balanced information and strong warnings in an environment where users can ask questions free of the fear of being identified as a drug user. The public nature of these discussions helps with their monitoring by health professionals and law enforcement agencies; a benefit that cannot be said about interactions that occur privately.

Most Australian drug users now live in a context where internet use is embedded in their everyday lives. Over the next 5 years, this embeddedness will only increase. Access to vast amounts of drug-related information online changes the landscape of drug policy. Young adults who are the target of drug prevention campaigns are less likely to believe exaggerated or unrealistic warnings about drugs when they have the ability to easily and quickly check the veracity of such claims. The denial of the benefits and pleasures of drug use cannot continue for the same reason: it is too easy to find contrary information elsewhere. To gain credibility with drug users, the government will need to acknowledge the reality of drug use: its benefits and risks. Doing this while still sending a message that resonates with the rest of the population will be a formidable (if not impossible) task in the present climate fuelled by misrepresentation of all drug users as ‘addicts’ or ‘junkies’.

A key challenge to monitoring and intervening in online drug discussion over the next 5 years is how the Australian internet filter the Labor Party is planning to introduce in 2011 will affect this context of open public information. Should the filter be applied in its current form, websites hosting detailed instructions regarding drug taking would be refused classification and Australian ISPs will be directed to block such sites if hosted overseas. Should this happen, such material will be unavailable to Australians unless they use proxy connections to connect to the material through overseas-hosted hubs.

It is unclear how Australian drug users will react to this development. One of the major benefits of public online drug discussion is the ability of authorities to watch and react to the information posted. Drug users who lose access to drug information websites may use easily-available tools to set up new websites that bypass the filter through virtual private networks and secure http sites. Peer-to-peer traffic will also remain unmonitored. Should drug discussion move exclusively to these domains, it will become more clandestine and, consequently, harder for officials to track and respond to.

While the presence of detailed information that instructs people how to use a drug may encourage its use, a significant proportion of people will use a drug anyway, with or without instructions. Given that most instructional information about drug use available online is aimed at assisting users refine techniques of use to reduce possible harms, making this information harder to get forces drug users to rely more heavily upon their (offline) social networks for this instruction. The potential for inaccurate information exists in both online and offline information sources. Should these forms of information become banned in the online public domain, they will be harder to monitor and harder to critique. It will be critical to monitor such developments before, during and after the introduction of ISP-level filtering proposed by the federal government.

While there has been significant protest against the proposed internet censorship plans, these have mainly been among the internet-savvy proportion of the Australian population. The debate is yet to be known and understood by the average voter. In truth, the protection of drug user rights to free information and a chance to reduce the harms of their use may not sit well with the average voter either. However, what about fiction that contains detailed information about drug taking? Video games which simulate drug taking? Will Underbelly be taken off air? Quite possibly. How the debate plays out in the next month or so when the legislation is tabled in parliament will be critical to the future of public, open, online drug discussion in Australia.

More on the language needed for the #nocleanfeed campaign to reach a wider audience here

The debate about informed drug use

Drug safety card

The NSW government produced a booklet aimed at young drug users called Drug safety: Guide to a better night. The SMH reports that the state opposition and youth workers want the booklet destroyed, because it sends the ‘wrong’ message. Guiding drug users about how to have a ‘better night’ could be seen as endorsing drugs in the party setting.

It was great to see an alternative position in favour of the harm-reduction information booklet, written by Julie Bowen of Moreland Hall. The harm reduction philosophy is realistic about continued drug use and aims to make that drug use less harmful. After exploring common harms from drug use and ways to look after yourself and your friends, the booklet’s end message is:

Remember the best way to avoid problems with drugs is not to use them at all.

This is also the take-home message of the harm reduction approach. While using drugs, try to do all you can to reduce the harms to yourself and others who may be affect by your activities. Yet, always remember that abstinence is the only way to completely avoid harms.

Officially, since 1985, Australia’s drug policy has been described as harm minimisation, in which three approaches (supply reduction, demand reduction and harm reduction) are all aimed at reducing drug-related harms for the individual, their families, communities and society. This pragmatic approach is complex. For example, supply reduction activities may increase the harm experienced by drug users. Harm reduction activities may increase demand for a drug. Demand and supply reduction activities focused on one drug may increase harm by creating a trend towards a new, lesser-known drug. It is difficult to evaluate the effects of individual policies, especially when considering the whole system of health harms that harm minimisation policies target.

The argument against harm-reduction drug information, whether in booklets or websites, needs to be challenged. As Julie Bowen writes:

People need reliable information to make informed decisions and take care of themselves and each other. Information contained in the brochure could be the catalyst for a simple, life-saving action such as a person being rolled onto their side when unconscious. Drugs continue to play a role in the world in which we live in, therefore the only humane approach is to equip people to be aware of and manage the risks that they or their friends may face.

However, the anti-information argument also needs to be examined for aspects of truth, even by those who feel offended at the apparent lack of concern for the safety of drug users that comes through in the views of those supporting ‘zero tolerance’. It may be true that for some people, knowing how to use a drug ‘more safely’ may encourage them to try that drug or to use it more often. It is likely that the dangers or harms of some drugs put people off using them, and if these are reduced by detailed information about safer use, these people may ultimately use more drugs! However, if they do so and come to less harm overall, is this really a problem?

Taking the view that ‘informed drug use’ is desirable for those who choose to use drugs leads to activities that get appropriate information out to those that want it. For example, we could create a harm reduction app for the iPhone that would make it easy to access accurate information, such as that found in the NSW drug safety booklet, any time and place it was needed. Getting information to people when they are actually making decisions about drug use is a critical next step, in my view.

This article was also posted at betweenthelines

Drugs and nice people

The UK drugs and rights organisation Release sparked controversy in London recently, after their campaign aimed at de-stigmatising drug use was withdrawn from London buses by advertising regulators. The advertisement, featuring the deceptively simple statement ‘Nice people take drugs’, was chosen to draw attention to the way drug takers are typically demonised in the media and through drug policies.

The Guardian reports that the chief executive of Release, Sebastian Saville, stated that the withdrawal of the advert from buses was an “overreaction to a legitimate message”. He believes that “the time has come where potential leaders of our country have much to gain from real honesty about drug use in the UK, including their own drug use”. Release has also produced an animated youtube clip featuring people of all walks of life describing to their use of every manner of psychoactive drug, in an effort to humanise people who use drugs.

The truth is that a large proportion of the population (in the UK, Australia, USA, etc.) has at least tried an illegal drug, and research indicates that most people who use drugs also work, study, have families and are valued parts of our community. These facts are kept secret due to a legitimate fear of open discussion of drug use by these people, who do not want to risk their jobs and reputations over potential criminal punishment.

This situation allows politicians and the public to continue believing that ‘drugs are bad’ and anyone who uses drugs is, well, also bad, or at least, misguided and in need of treatment. It is this belief that allows continuation of the War on Drugs. If drugs are evil, there is no room to question punitive drug policies even when there is little evidence that they actually work.

I do wonder whether Nice people take drugs really captures this argument, though. There are many definitions of ‘nice’ and many definitions of ‘drugs’, and to lump all types of drug use and all types of drugs together muddies the picture. Yet, if the goal of the advertisement was to spark debate, it has certainly succeeded in spreading its message (just google ‘nice people take drugs’ and have a look for yourself!).

This article also posted to betweenthelines.net.au and inthemix.com.au