Saturday, March 19, 2011

Medicine in Addiction Conference - Melbourne 2011 - Day 2

Day 2 of the Medicine in Addiction Conference started off with a session on prescribed medication dependence. Dr Malcolm Dobbin called on data from USA and Canada to paint a picture of increasing use and harms from dependence and misuse of prescribed medications - particularly strong narcotics and benzodiazepines. In some of the data from these jurisditions, prescribed narcotics are 3rd only to alcohol and cannabis of drugs that people are reporting to use recreationally, and this heavy use is reflected in the hospital activity and drug related mortality data. Trends in Australian data show that we are headed rapidly in the same direction. A/Prof Nick Lintzeris discussed some of the evidence around the potentially dependence causing medications that are commonly prescribed and the universal precautions for safe prescribing. In a health system that is focussed on acute care and has little support for psychosocial supports or for realistic drug monitoring systems, it can be challenging to balance access to appropriate treatment with reduction in risk of drug misuse and diversion. Dr Adrian Reynolds, the director of drug treatment services in Tasmania, reported on the Apple Isle's coordinated response to prescribed medication misuse which includes a real time drug reporting system. He gave a strident call to arms for medical folk involved in drug treatment to be involved in lobbying for better directions and choices nationally to improve outcomes.

The second session of the day looked at various medical complications of drug and alcohol use. Prof Paul Haber discussed the aetiology and treatment of alcoholic liver cirrhosis. The key take home message was that it is never to late to stop drinking - even in people with established fibrosis, some reversal of disease can occur following a substantial perion of abstinence. There are some medications used in specialist units that can help manage the problem. Dr Ian Kronborg discussed the difficult issues of sleep in the drug using population. It was unsurprising to hear that benzodiazepines simply don't work in the long term. In spite of claiming not to be an expert, Dr Richard Hallinan gave a broad and detailed overview of sexual dysfunction in the substance using population. The most disturbing question I'm left with is - who is Mrs Palmer and her 5 daughters?

After lunch we broke into groups for the workshop sessions. Dr Sathya Rao challenged us with a discussion of borderline personality disorder and being aware of counter-transference in the management of these patients. Tobie Sacks presented a practical "non drug" approach to dealing with chronic pain. I was unable to attend Ms Catherine Dwyer's workshop on Motivational Interviewing, but feedback received from atendees was very positive. Several people expressed their intention on following up with the website.

The highlight of day 2 would have to be the debate on involuntary treatment. It was refreshing to hear the views from a member of the legal fraternity, especially when those views came from Margaret Harding who is the magistrate presiding over the drug diversion court. A/Prof Adrian Dunlop and Dr Matthew Frei traded some lively banter on the topic, although I wonder about the academic rigor of the debate  with Adrian quaffing wine and advising folk to "get drunk" and Matthew quoting Homer Simpson. There was also the somewhat disturbing image of Matthew as Superman and Mr John Ryan as Wonder Woman. The take home message was that the evidence is poor.

An engaging and entertaining second day. It all winds up tomorrow.

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