1. Anecdotal Trends in Substance Use Melbourne CBD Ramez Bathish Living Room PHS

2. Overview Introduction Trends in Melbourne Commonwealth Games Impact of Policing Addressing Future Trends

3. Living Room PHS Primary Health Service for marginalised people who use drugs. Community Development, Harm Reduction and Primary Health. 1 Doctor (pharmacotherapy), 1 nurse, 4 drug safety workers, 2 laneway workers. Client group: PWID, 18-35yo, homeless, mental health issues, dual diagnosis, Hep. C, intellectual disabilities, HIV, no triple diagnosis. Foot Patrol – NSP in Melbourne CBD – Russell St.

4. Case Example Paul – 30yo male, homeless, IDU, injects pills (without wheel filter), mental health issues (ADHD & undiagnosed disorder) Presents regularly at both PHS and NSP. Increasingly chaotic over last few months. Homelessness is compounding mental health & substance abuse issues – visa versa Daily pick-up of meds, limiting substance abuse.

5. Trends in Melb CBD 2006-07 Gauged through ppl. Presenting at PHS and Foot Patrol NSP. (Most common to least common): Alcohol, heroin, benzos - poly-drug use, methamphetamine, Opioid-based pharmaceuticals – e.g. MS Contin, Cappinol, Physeptone, bupe, done, VSU – chroming, other pharmaceuticals (seroquel) Increasing quality / purity of heroin – more intoxicated clients, no change in rate of ODs. Street-based heroin scene most active in Richmond area.

6. Trends cont.. Pharmacotherapy program at Living Room PHS is full, operating near capacity over the last year- 60% methadone, 40% suboxone / bupe. Clients tend to prefer pharmacotherapy treatment over detox / rehab. – indicative of greater efficacy? No noted change in BBV transmission. Not seeing increased diversion with increased flexibility of takeaways - suboxone. Increase in street price / availability of Xanax.

7. Other trends 2006 - 07 Increase in use of Opioid-based medication – MS Contin etc.. Large percentage of pill injectors not familiar with wheel filters. Slight increase in knowledge and awareness of butterflies for methadone diversion. No noted increase in methamphetamine use – in line with stats. (Statistics on drug use in Australia 2006, Victorian Drug Statistics Handbook 2006) Less VSU clients, (more commonly youth). Dual diagnosis & homelessness an ongoing issue.

8. Since the drought CBD not significantly affected by drought 2000 - 01. Significant drop in Foot Patrol NSP contacts since Nov. 2005-2006 but relatively stable since. Slight peak in activity into Nov. 2005 then policing presence stepped up 4 - 5 months before Commonwealth Games. Increased police presence in CBD Nov 06- April 07 – street-based heroin scene dropped off – no outreach on Russell St. Increased activity in Richmond area 2006 -07.

9. Commonwealth Games Heroin scene on Russell St. effected- no outreach on Russell St. Scene activity in Richmond increases. Police pressure in Melb. CBD, less so in Richmond. Police brought in from regional Victoria - not familiar with particulars of policing CBD. Marginalised people more exposed / targeted. Increase in police harassment / clients placed in holding cells for minor offences. Collaboration with Office of Police Integrity & Fitzroy Legal Service with Living Room & Foot Patrol NSP.

10. Impact of Policing Significant impact on street-based heroin scene / trends in CBD. Saturation policing poses risk to PWID and public health. Compounds existing risk factors – e.g. less inclined to access NSP, unsafe disposal practices. Improved relations / dialogue with Police since mid 2006– encourage referrals to Living Room. Foot Patrol now gives new Police recruits (East Melb.) induction about Harm Reduction, NSPs, drug use etc..,

11. Safe Injecting Facilities - addressing future trends.. Challenge of addressing harms associated with street-based drug use in PHS. Often the impacts of drug related harm are addressed down-stream – post BBV transmission, ODs, legal issues etc.. A Safe Injecting Facility addresses risk factors for street-based users directly – addresses safe injecting practices, referrals etc..

12. Insite Safe Injecting Facility Vancouver Canada. the stats, 2006 – A case for Safe Injecting Facilities 7,278 unique individuals registered at Insite 453 overdoses resulted in no fatalities 4,084 referrals were made with 40% of them made to addiction counseling Referral to withdrawal management: 368 Referral to methadone maintenance: 2 per week Daily average visits: 607 Busiest day: May 25, 2005 (933 visits in 18 hours) For more info on InSite: http://www.vch.ca/sis/