Dear All

I am responding to a request posted to this list by Annie Madden from AIVL for more information in relation to the recent Anex Bulletin.

Feedback on the Bulletin has varied from praise to condemnation. Five individuals have emailed Anex directly. All other comments have been on public e-lists. I have not received a call or email directly from AIVL addressing the issues.

I understand that many people on this list are not readers of the Bulletin. Whilst some people who have posted have found the edition overall and/or the “Ten Top” lists generally as offensive, there are in fact a variety of lists, ranging from serious to absurd.

There are also several in-depth articles on such issues as fentanyl, more positive publicity for naloxone provision to potential overdose witnesses, and links between dependencies and brain function. For those of you who have not read the edition, a pdf copy of Volume 10 Edition 1 is available on the Anex website. http://www.anex.org.au/new/publications/anex-bulletin/

This edition of the Bulletin was the first in 10 years to attempt to use humour to engage readers. I approved the content and take full responsibility for it.

It goes without saying that it was not meant to offend, but rather to provide readers with an opportunity to contemplate real issues from a slightly different angle.

I assumed that it would be easy for all readers to distinguish between the lists as to whether they were true, fictional, humorous or meant to stimulate reflection and discussion.

For example, there is a list that describes what some doctors say about treating drug users. This list is based on fact and was included because it exemplifies the widespread discrimination faced by people who use drugs, particularly the poor, and was meant to be exposing that very issue for critical reflection by the readership. It sits above a light-hearted list of excuses when detected with drugs by police. This in turn sits above a factual list of Needle and Syringe Program worker recruitment mistakes, which is also based on fact.

Some people think the humour was lame and a number of staff from drug user organisations have posted that they were deeply offended. There is even a threat to report me to the agency that funds the Bulletin, which is produced for NSP workers’ benefit.

I apologised for this yesterday and reiterate that sincere apology today. In hindsight, it would have been useful to provide more information to assist readers to navigate the edition, a lesson for upcoming editions. Future editions will therefore hopefully be able to avoid a repeat of the negative interpretations of this edition by some readers. I reiterate that neither myself nor the team at Anex set out to offend, and honestly I am dismayed at the tone of some responses to date.

Yours sincerely

John Ryan
Chief Executive Officer
Anex

Anex today welcomes a new report, launched today by the Minister for Mental Health, Women’s Affairs and Community Services, the Hon. Mary Wooldridge, which describes Victoria’s pharmacotherapy system as near breaking point.

The Victorian Pharmacotherapy Review  launched today in Melbourne by Minister Wooldridge paints a picture of a methadone system under ‘great pressure’ and in need for urgent reform,” said John Ryan from public health organisation Anex. (more…)

Anex today congratulates the Victorian Government for making condoms available to Victorian prisoners from next month.

“This decision by the Government to introduce proven harm reduction measures into prisons brings Victoria in line with other states. NSW has had condoms in prison for years,” said John Ryan who is CEO of health policy organisation Anex.

“The real question is why it has taken so long for it to happen?” Mr Ryan said.

Mr Ryan said that recent research suggested only about seven percent of male prisoners had sex in prison, while the rate amongst women was around a third.

“Condoms have been proven to significantly reduce the transmission of sexually transmitted infections (STI) and some blood borne viruses (BBVs) such as HIV,” he said.

Today’s announcement shines the light on conditions inside our justice system, but also on the need to take pragmatic public health measures that protect the wider community.

“Almost 30,000 Australians are in prison at any one time. It is worth remembering that many of these prisoners return back to the community and to their families after a short time,” Mr Ryan said.

“Today’s decision will have the effect of protecting the health of the larger community,” Mr Ryan said.

“The announcement is a reminder that we all deserve a basic standard of public health access – whether we are in prison or not.

“It is also a reminder that what happens behind closed walls has an impact on the broader community. Today’s decision is a pragmatic one that deserves community support,” he said.

Media contact: Kelly Eng 0414 982 049 or Patrick Griffiths 0438 664 774

It has been argued that the drug and alcohol sector would not expect people dependent on illicit drugs to go cold turkey, yet this is often the most likely scenario for cigarette smokers. Is it time to ponder evidence that non-smoking tobacco alternatives have a role in public health strategies?

It is almost 20 years since the Australian Government banned the importation, manufacture and marketing of all smokeless tobacco (ST). This ban covered tobacco which could be chewed, sucked or inhaled (such as snuff). It was aimed at preventing the marketing of an alternative product that, although significantly safer than smoking tobacco, was considered to increase risks of oral cancers.

In recent years, debate has been mounting as to whether such blanket bans serve to hinder the potential for chronic smokers to benefit from the harm reduction qualities that smokeless tobacco products may offer. Interest is growing in the potential benefits of safer non-smoking alternatives, namely low nitrosamine smokeless tobacco (LNTS).  Particular attention is being paid to snus (rhymes with goose) which is widely available in Sweden.  Snus is a moist powder tobacco product that the consumer places inside the lip, allowing the nicotine to pass through the membrane into the blood stream. Snus is banned in the European Union countries, but legal in Sweden which is not a member.

As snus has become more popular in Sweden, male cigarette smoking has declined, leading Queensland University health researchers Hall and Gartner to argue that there would be major public health gains if a substantial number of current smokers in other countries switched to it. Not only does snus reduce risk of lung cancer and emphysema, its low nitrosamine content means it is also safer than pre-existing smokeless products, almost eliminating the link with oral cancer. So, a question that has arisen in recent years in particular is: whether or not it is time to offer smokers a genuine harm reduction alternative?

Writing in the Lancet, Gray agreed that “snus is a harm-reduction product” when compared with cigarettes. It has also been argued that if the majority of inveterate smokers were to switch to smokeless tobacco use “and the majority of them quit smoking, it seems certain that public health overall would benefit.”

It has been argued that nicotine replacement therapies (NRT), namely gum, patches, lozenges and inhalers, already exist as a safer harm reduction alternative. Such arguments however do not allow for the fact that snus and versions of it are potentially more attractive to smokers. As a purely recreational tobacco product delivering similar nicotine levels to smoking, many may see it as a more enjoyable and sustainable substitute.

Currently NRT products are marketed as short-term, low-dose treatment options that may fail to address the social, recreational and pleasure seeking aspects of smoking. It must also be noted that some harm reduction proponents of snus, including Gartner and Hall, agree that promotion of LNST need not preclude the promotion of high-dose and clean nicotine products.  Rather they acknowledge the need for NRT to exist as a more effective tool for smoking cessation, citing problems with ineffectual low dosing.
       
Some cigarette manufacturers produce ‘snus versions’ of their most popular brands of cigarettes.

Gartner and Hall recognise the need for better regulation of all tobacco products, and lower taxes on certain products such as snus and clean nicotine products to enable them to more successfully compete with cigarettes.  Such measures would help to address concern that tobacco industry promotion of snus use may encourage dual use and/or increase overall tobacco use, with the potential to include current non-smokers. Long term studies from Sweden have shown that snus use rarely leads to smoking in non-smokers, and whilst there are cohorts of young people who have adopted snus use, it has been proposed that it is likely this was done instead of adopting smoking.  Similarly, dual use need not always be a negative outcome if it encourages smokers to try snus and leads to some people switching completely.

In Sweden, snus is a far more popular smoking cessation aid than NRT and smokers who use snus are more likely to quit than smokers who use NRT. The use of NRT in Australia remains similarly low, particularly amongst lower socioeconomic demographics. It seems fair to assume, therefore, that should a product such as snus prove more attractive and more effective for smokers, its introduction could increase the quitting rates and in turn produce a greater public health benefit.

Another common concern is that smokeless tobacco products are less successful in countries without a significant cultural history of use. Although widely used throughout the world, smokeless tobacco products are rarely used in Australia despite amendments to the 1991 ban allowing importation of up to 1.5kg of smokeless tobacco products for personal use. Of course, the ban still proves a significant impediment to determining if snus is indeed a culture-bound practice.  It could also be argued that this lack of popularity may limit the use of snus beyond assisting inveterate smokers to address their dependency; that is, limit snus to harm reduction purposes alone.  As snus is considered a safer form of smokeless tobacco, associated risks would be reduced.

Unlike other smokeless tobacco products, snus is pasteurised not fermented and is stored under refrigeration.  Such techniques inhibit bacterial growth and the associated formation of nitrosamines, the main carcinogens in tobacco. The elimination of high nitrosamine levels, combined with the lack of carbon monoxide, greatly reduces the risks of cardiovascular disease, chronic obstructive pulmonary disease and cancers associated with smoking. And like all smokeless products, snus does not produce environmental, or second hand smoke.

It is estimated that 20 per cent of Swedish men use snus regularly, most commonly as an aid in smoking cessation. Its use in place of smoking cigarettes is thought to be responsible for significant reduction in both the prevalence of smoking and in the rates of tobacco-related illness. Longitudinal Swedish studies comparing snus users to smokers have demonstrated not only a reduction in tobacco-related diseases, but also an overall lower mortality. It must be noted however, that snus use has been associated with a possible increased risk of pancreatic cancer. Snus use is also associated with gum and dental disease however such ailments generally clear on discontinuation of use.

Nevertheless, the Swedish experience has prompted some researchers to suggest that smokers who are unable to quit should use low-nitrosamine smokeless tobacco products, such as snus, to reduce tobacco-related harm.  Some health professionals believe that any health risk from snus, no matter how small, is too great for its use to be encouraged. Some harm reduction advocates suggest that mass marketing of snus would probably lead to less quitting as occurred with low-tar smokes “due to similar perceptions of reduced harm.” Study results from Sweden demonstrate substantial reductions in tobacco-attributable mortality despite a high prevalence of snus use.

Whilst Australian tobacco smoking has certainly declined in recent years, there continue to exist in large sections of our community who have not benefited from these advances. The challenge would be to stick to the harm reduction theme, ensuring that any messages promoting snus identify its use as a “less harmful” alternative, rather than “not harmful”.

Hall and Gartner have gone so far as to argue that the reluctance of the public health sector to find “ethical ways of regulating and engaging with tobacco harm reduction” enables the cigarette industry free to pursue  profits “while recalcitrant smokers are unjustly denied access to ways of reducing the health consequences of their tobacco use.”

This story appears in the Anex Bulletin volume 8 edition 6. To find out more about the Bulletin, including how to be added to our mailing list please visit: http://www.anex.org.au/new/publications/anex-bulletin/

Today’s Victorian Budget announcement of $188 million in funding brings some relief for the strained Victorian Drug and Alcohol sector, according to John Ryan from drug policy organisation Anex.

“With an extra $20 million dollars promised for drug treatment and dedicated funding directed toward counselling for young drug and alcohol offenders, some headway can be made in getting better outcomes for Victorians with drug problems,” he said.

“Anex commends the Baillieu Government for recognising the importance of drug harm reduction in communities with extra funding being directed toward expanding pharmacotherapy and Needle Syringe Programs.”

“The Baillieu Government recognises that NSPs and Pharmacotherapy services are critical frontline services that provide referral advice, reduce the spread of hepatitis C and HIV and help reduce the crime associated with heroin and opioid use.” said Mr Ryan.

These Budget announcements come on top of commitments toward better coordinated and people-centred services in the Metropolitan Health Plan, released earlier today.

“I am excited that the Baillieu Government is shaping an agenda for drug and mental health sector reform that will address the longstanding issues with treatment models, system performance and workforce development, with more even distribution of alcohol and drug treatment resources.”

“We need to provide new ways to help Victorians most in need – today’s Budget announcement includes important steps to help people at their most vulnerable.

“The Baillieu Government has a unique opportunity to reinvigorate a neglected area of public health policy. We look forward to participating in the development of the whole-of-government Alcohol and Drug Strategy” Mr Ryan said.

Reports of two new 24 hour needle and syringe programs in Frankston and Footscray is good news for the community, as are increases to drug treatment and prevention programs.

“Footscray and Frankston are very active drug markets that deserve more attention,” said John Ryan from drug policy organisation Anex.

“The Baillieu Government has heeded the compelling evidence that there are sound health and financial reasons to increase access to the Needle and Syringe Program.”

“But much more important than saving money, the Government has recognised the important opportunity that these programs play in providing referrals and assisting individuals to stabilise their lives and to contemplate their own journey of recovery,” Mr Ryan said.

“Despite the stereotypes that proliferate about drug users, many might be surprised by just how ordinary the people are who are in the grips of drug addiction.

“There are mums and dads, brothers and sisters, daughters and sons. People with families who all too often suffer in silence and in shame while their loved ones succumb to the disease of addiction,” he said.

“Anything that can be done to interrupt this cycle of dependence is worth doing – and the provision of sterile injecting equipment to prevent the transmission of diseases like hepatitis C and HIV when addicted people are at their most vulnerable makes sense,” Mr Ryan said.

“Adequately resourced needle and syringe programs have the potential to provide hope to those people addicted to drugs. They are an ideal place for someone to see that they have options and to be given a little bit of hope.”

“Needle and syringe programs save lives and health dollars. Every dollar invested in needle and syringe programs has saved $27 in health care and productivity savings.”

“In the past ten years these programs have prevented 32,000 HIV and almost 100,000 hepatitis C transmissions,” said Mr Ryan.

Injecting drug users are liable to suffer harm from inadvertent injection of unwanted material present in illicit and prescription drugs.

Injectable solutions prepared from pharmaceutical tablets, such as morphine, contain not only the active ingredients, but also other inactive components such as talc, cornstarch and wax.

Although wheel filters can remove microorganisms and other particles when used properly, an experienced NSP worker from an inner-city service told the Bulletin that, in her experience, there “is a concern among some drug users that filters complicate the injecting process”.

The NSP worker said: “Those who are unfamiliar with wheel filters for example, have told me that if the wheel filter was to become detached from the syringe while they are pushing the drugs through, then some or all of the contents could be spilt. If that occurred, then naturally they lose their drugs.

“Some people think that filtering contributes to dose loss even without a spillage; that is, some of the active ingredient getting stuck in the filter itself. In other words, there may be less bang for the scarce buck. Of course, if they are using the right filter correctly there is little or no risk of dose loss,” she said.

“But you can appreciate why people who’ve gone to a fair bit of effort financially and time-wise to arrange their gear don’t want to miss out on anything,” she said.

Another NSP worker who is skilled at instructing clients on correct filter set-ups said some clients have complained of their mix being stuck or blocked by a filter.

“When the filters are used correctly, including sufficient diluting of drugs, this shouldn’t be the case. Leur Lock barrels, which are screwed on, greatly reduce the likelihood of the filter coming off. In fact it’s virtually impossible,” he said.

Filters are not always available as standard distribution across the NSP networks nationally however.

ACT Directions NSP co-ordinator in Canberra, Ms Tammy Waters, said ACT Health funds filters and their availability greatly reduced incidences of vein-care related problems in clients.

Clients can receive up to six filters per day free of charge, but 12 on Fridays “so they won’t run out on the weekend”, Ms Waters said.

“In an ideal world, nobody should shoot up pills. But it happens. Wheel filters are one of the best harm reduction strategies to come out in a long time. People’s health improves dramatically. Years ago we had people losing limbs and getting abscesses – it was shocking,” Ms Waters said.

“But now there is far, far less of that. It’s a real health benefit for clients to have access to this. It is well worth the investment by the government,” she said.

“We have long-term diverted methadone users, for example, who were showing health problems from injection. When they use filters their health has improved dramatically,” she said.

Ms Waters said: “We have the Sartorious^® filters, starting at 5.0 microns for chalky pills such as MS Contin^® and for when clients may be using quite large volumes of pills. Then we go down to the 1.2 microns which is also for chalky pills, but for a lower volume such as ‘eccies’ or dexamphetamines.

“We recommend that they run them through a series of filters if they are using big quantities. We also have the 0.8, which is more for pills covered with wax such as benzodiazapams, valium or Ducene^® etcetera,” she said.

“Then we have the 0.2 – our anti-bacterial filter which we recommend for most things such as heroin, cocaine, methamphetamines. And also for diverted methadone or bupe,” Ms Waters said.

Ms Francine Smith is responsible for Tasmania’s NSPs within the Department of Health and Human Services. She said filters were “particularly important in Tasmania because of the high rate of injecting using prescription medication such as morphine, methadone and dexamphetamines.”

In Tasmania, pharmaceutical opioids were reported as the “last drug injected” by more than a quarter of people who completed the national NSP survey in 2009 [8].

This compared with the national average of 16 percent in 2009, and is far higher than in NSW, for example, where pharmaceutical opioids were reported as the last drug injected by 10 percent in 2009.

TasCAHRD’s Ms Mandy Wilton said: “Primaries in Tasmania receive a set amount of eight boxes of 50 filters per month.  Some outlets, like ours at TasCAHRD, do sell them on a cost-recovery basis in addition to what consumers receive for free – our outlets charge $1.10 per filter.”

“We have the 0.22 and the 0.45. The 0.22 is the bacterial filter and the 0.45 is the purpose-designed pill filter,” Ms Smith said.

Ms Carol Holly from SAVIVE in South Australia said they sell a wide range of filters (including Sterifilt^®) at cost recovery.

“We have a variety starting from 0.2 microns up to five microns. So that’s the 0.2, 0.45, 0.8, 1.2, and 5.0. The larger filters, such as the five, would be for larger amounts where the client would remove larger particles first before scaling down to the smaller sizes, such as 0.22, to get rid of smaller particles,” Ms Holly said.

Victoria does not provide specific funding for filters, but syringes with Luer Lock* technology, which accommodate commercial filters, are distributed to NSPs. Without set funding for filters, there is some variation amongst the primary outlets concerning price and promotion.

At Healthworks in Melbourne’s western suburbs, 0.45 and 0.22 filters are sold for $1.20, and Sterifilts^® for 30 cents. According to NSP worker, Mr Chris Howie, their “usage has increased a bit in recent times, but they are still not widely used.”

It is a situation that Healthworks would like to change, according to Mr Howie: “We think it’s a bit of a new frontier that we need to work on in regards to reducing more harm, because we are doing well with blood borne virus prevention, but there are still some harms being done with poor filtering which can lead to vein injuries.”

Healthworks ran a campaign in 2010 where filters were given out for free and staff gave lessons in how to set them up.

“We are looking at having some more campaigns later this year, and have workshops where the clients can sit down with staff and get practice at using them so they can become more confident. Hopefully, the people we teach can pass on the knowledge to their peers,” Mr Howie said.

Barwon Health, which includes the regional city of Geelong, gives out far fewer filters, according to NSP co-ordinator, Mr Joe Kim.

“We give out Sartorious^® 0.22 and 0.45. We can give them away for free at the moment because the numbers are quite low – about only 20 per month because there has not been a history of promoting them in our service,” Mr Kim said.

“If demand was to go up as more people know about them then we’d probably have to look at charging, perhaps about $1.20,” he said.

A pharmacist in Newtown in Sydney, Mr Grant Ovens, has joined a Pharmacy Guild (NSW) program aimed at further increasing the private sector’s participation in overall harm reduction strategies.

Mr Ovens is particularly in favour of offering filters as part of a full range of equipment. “We have 0.2 and the 1.2 filters, which seem to be the ones most people want. I will expand it to other sizes,” Mr Ovens said. 

“We do barrels and butterflies as well. We are aiming to be a one-stop shop. It fits in with my personal philosophy on needle exchange,” he said. “It’s just something that I have come around to. I’ve enjoyed dealing with them, the clients. I try to have a bit of a chat to them to say they are welcome to come in,” he said.

 “I would like to see harm minimisation become a bit of specialisation for some pharmacists.  Not every pharmacy is going to want to do it, but if you had one in every suburb, then you’re providing better access and better service and really saving lives and the community a hell of a lot of money. If we could do it like that, then it would be a positive for everyone,” Mr Ovens said.

Mr Scott Dodd from Queensland Injectors Health Network (QuIHN) said filters were sold at $1.30 for one or $1.10 for 10 or more.

“In terms of varieties, we have the 0.2 microns for bacteria, .8 which do most of the morphine tablets such as MS Contin^® and OxyContin^®, or ‘subbies’ (Suboxone^®). The five micron filter is for the chalky drugs, such as dexamphetamines, physeptone, ecstasy and benzos. People can use the filters in combination,” Mr Dodd said.

Demand for filters tended to be partly influenced by drug availability: “It can also depend on heroin availability, as people move across to pills if there is less heroin around,”
 he said.

The QuIHN peer education program, MixUp, includes instructing clients how to correctly assemble filters. “A while back we were doing a lot more demonstrations, but more people seem to know how to use them these days,” Mr Dodd said.

This story appears in the Anex Bulletin volume 9 edition 4. To find out more about the Bulletin, including how to be added to our mailing list please visit: http://www.anex.org.au/new/publications/anex-bulletin/

Tasmanian researchers have investigated the efficacy of wheel filtering based on injectors of pharmaceutical opioids’ accounts of preparation, filtering and injecting techniques.

Lead researcher, Dr Raimondo Bruno, said that particles as small as 10 micrometres (about one tenth of the width of a human hair) can block the smallest blood vessels in the body and cause harm. Larger particles block larger vessels and are correspondingly harmful.

Tablets of morphine (eg: MS Contin^®) are commonly used by injecting drug consumers in Tasmania, he said.

“It is not possible to prepare an injection to pharmaceutical standard without clean facilities, as particles and micro-organisms from the environment will contaminate the preparation,” he said.

“We wanted to know how people filter morphine for injection, whether these methods are useful in removing particles, and whether they affect the amount of morphine received,” Dr Bruno said.

“We surveyed 260 injecting drug users in the Hobart area to determine the filtering methods they applied on their last occasion of morphine injection. The survey revealed that, on their last occasion of morphine injection, one third used no filter, 41 percent used cigarette filters and 21 percent used syringe filters,” he said.

“People typically prepared tablets by removing the tablet coating, crushing them and stirring the powder in cold or heated water. While many people did not filter at all, common filters included hand-rolling cigarette filters, cotton balls and commercial syringe filters (0.45 or 0.22 micrometres),” Dr Bruno said.

“One reason IDUs do not filter their injections is a belief that some of the dose will be lost in the process. We found that this need not be the case, since by rinsing the filters, the morphine could be recovered without significant loss,” he said.

Samples were prepared using hot and cold methods and before and after filtering. The number and size of particles in each sample was determined by examining the solution under a microscope.

The key findings:

Unfiltered solutions of morphine were cloudy with visible particles and estimated to contain millions of particles large enough to block blood vessels.

Morphine content was largely unaffected by any filtering technique, provided that the filters were rinsed with small amounts of extra sterile water to recover any solution held up in the filters.

The roll-your-own cigarette filters and cotton balls produced cloudy solutions. Those cigarette filters removed most of the very large particles, but had limited effect on smaller particles.

Commercial syringe filters tended to produce solutions that looked clear to the eye, but they blocked easily. Virtually all of the particles from the tablet were removed if solutions were first filtered using a cigarette filter, and then filtered again by a commercial syringe filter.

The finding that the problem of blocked filters was removed by a simple pre-wheel filtering step (using roll-your-own cigarette filters) is a good example of the importance of the requirement for educating IDUs about the most effective use of these filters, rather than solely providing the equipment, Dr Bruno said.

If the filters were rinsed with a small amount of sterile water at each stage, there was no change in the amount of morphine recovered by this two-step filtering process. While the solution looked perfectly clear there were still some particles large enough to cause harms, but this is similar to the level seen in the control (sterile water only) solutions.

Preparing the tablets by heating them produced a new set of problems, Dr Bruno said.

“Some of the waxy components of the tablet would melt due to the heat, and could be passed through the filter if the solution was even slightly warm,” Dr Bruno said.  “While the solution cooled, these waxy parts re-solidify and are liable to cause harm.”

Heating should therefore be avoided, the study found. Hot preparations did not contain more morphine than preparing injections without heat.

Syringe filters (0.45 or 0.22 micrometres) can remove the vast majority of particles, but they tend to block easily unless a coarse filter, such as a hand-rolling cigarette filter, is used first. If the filters are rinsed with a small amount of sterile water at each stage, very little of the morphine is lost in the process, Dr Bruno said.

None of the filtering techniques could produce perfectly particle-free solutions that would achieve the medical standard required to be considered safe. However, the harms from injection of these tablets are substantially reduced by a combination of an initial coarse filter and a syringe filter.

The finest syringe filters (0.22 micrometres) are preferable as they can remove bacteria that cause infections around injection sites and internally. Skin preparation with an alcohol swab is also essential to minimise the infection risk.

The study had potential implications for NSPs, he said, including the recommendation that all NSPs product range should be extended to include at least 0.22 sterile syringe filters capable of filtering crushed tablet extracts in a single operation. NSPs should also provide information on how to use filters correctly.

This story appears in the Anex Bulletin volume 9 edition 4. To find out more about the Bulletin, including how to be added to our mailing list please visit: http://www.anex.org.au/new/publications/anex-bulletin/

Strained rural and regional alcohol and drug treatment services need funding boosts to cater for chronic pain and alcohol misuse rates far higher than people in major cities, drug policy organisation Anex said yesterday.

A study by the Australian Bureau of Statistics this week showed that people living outside major cities are more likely to experience alcohol-related harm through violence, acute and chronic health problems and drink driving, said Mr John Ryan from Anex.

Mr Ryan said the nature of people’s work was often different in regional and rural areas, exposing more people to risk of injury.

“People who live outside major cities are 30 per cent more likely to have had a long-term health condition resulting from of an injury than those in major cities,” he said.

Injuries are contributing to a growing epidemic in illicit use of pharmaceutical pain-killers, said Mr Ryan.

“A growing feature of addiction is driven by increased prescription of opiate-based painkillers such as MS Contin,” said Mr Ryan. “This means there needs to be more funding for programs such as opioid replacement therapy.”

“Many people’s addiction to opiate-based painkillers begins with chronic pain. The ABS study shows that people outside major cities were 23 per cent more likely to have had back pain,” he said.

Men major cities were 42 per cent more likely to drink excessively, while for women the ratio was 20 per cent more likely, he said.

The full study released by the ABS can be accessed at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30Mar+2011