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FASD Day - 9 September 2017

9/09/2016


Stay Strong and Healthy

​9 September is FASD day – a good time to remind pregnant women and all the community that drinking alcohol during pregnancy can cause Fetal Alcohol Spectrum Disorders (FASD). A child born with FASD may have a range of problems including physical defects and a life-long challenge with learning, behaviour, memory, language, communication and everyday living.

The disabilities associated with FASD are permanent and preventable.

Go to http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/wwtk for Women Want to Know brochures, videos and e-learning courses which encourage health professionals to routinely discuss alcohol and pregnancy with women and to provide advice that is consistent with the NHMRC Guidelines.

For Aboriginal Stay Strong and Healthy FASD videos and resources for community and health professionals go to http://www.yourroom.com.au/for-aboriginals/ and http://www.facebook.com/staystrongandhealthy

  1. Coming out of the green closet: All you wanted to know about cannabis medicines

    ​ Guest contributor Dr Jan Fizzell, public health physician for NSW Health and advisor to the NSW Chief Health Officer on medicinal cannabis, talks to the Your Room team about cannabis medicines – the state of play in Australia, what the evidence (and your doctor) says, and where next for NSW.  Bud, dope, grass, marijuana, mary jane, hash, weed – whatever you call it, there is no doubt that we are entering a historic time for cannabis.  In the last two months alone, a number of landmark developments have changed the global landscape for both recreational and medicinal cannabis.  On 19 June 2018, Canada's parliament voted to become the first G7 nation to fully legalise cannabis (legalisation comes into effect on 17 October 2018). Days later, on 25 June, the US Food and Drug Administration approved, for the first time, a drug derived from the cannabis plant. As recently as last month, the UK's Home Office announced, on 27 July, that medicinal cannabis will be available in the UK on prescription later this year.  Given Canada's recent legalisation announcement, recreational use of cannabis has been hot in the press. However, cannabis for medical purposes continues to drive public and political interest.  91 per cent of Australians  support legalisation of cannabis for medicinal purposes (in comparison,  only 32 per cent  believe recreational cannabis use should be legal).  A range of countries worldwide have legalised medicinal cannabis, either through a largely unregulated general access model, such as the market in California, or as a form of registered medicine market, such as has been established in Israel. But where does this leave Australia?  From Perth to Sydney: Medicinal cannabis in Australia   In 2016, Australia's Therapeutic Goods Administration (TGA) decriminalised supply and use of medicinal cannabis. The following year, the TGA rescheduled certain medicinal cannabis products to schedule 8 of the Poisons Standard, making the prescription of cannabis medicines legal in Australia.  Governments at both Commonwealth and State and Territory levels have implemented legislative and policy change to allow the cultivation, manufacture, prescribing and dispensing of medicinal cannabis products for patients in Australia. This has been driven partly by community and advocacy groups and the media and informed by the development of medicinal cannabis programs in other countries.  Cannabis medicines are now available on prescription in all Australian states and territories. In NSW specifically, doctors have been able to seek approval to prescribe medicinal cannabis for patients since 1 August 2016. This was a result of changes under the Poisons and Therapeutic Goods Amendment (Designated Non-ARTG Products) Regulation 2016 (under the Poisons and Therapeutic Goods Act 1966). Previously, NSW patients could only legally access cannabis-based medicines through clinical trials.  The use of cannabis outside of regulated medicinal purposes for specific products remains illegal in Australia. If you use, personally cultivate, sell or supply cannabis (leaf, resin or oil) to someone else and get caught, you could face significant fines and other penalties, including a prison sentence. Back to basics: What is a cannabis medicine and who can get it?  A cannabis medicine is a lawfully prescribed and dispensed pharmaceutical-grade, cannabis-derived product used specifically for human therapeutic (medical) purposes. All cannabis medicines in Australia need to meet a quality standard to ensure they are free from contaminants and are manufactured to a consistent standard. In Australia, cannabis medicines are regulated in the established medicines framework that applies to all drugs and poisons.  Only doctors can apply to prescribe a cannabis medicine – not patients or carers. NSW doctors apply for approval to prescribe cannabis medicines through a  single application process  when they consider it the appropriate treatment for their patients.  The doctor prescribing should consult with other doctors involved in the care of the patient. For some health conditions, a specialist in that treatment area is expected to lead or support prescribing. This is because those health conditions are usually managed by such a specialist. There is no pre-determined list of conditions for which a cannabis medicine can be prescribed in Australia. Each application from a prescribing doctor will be considered on its merits. Blazing a trail: The NSW Government's approach to cannabis medicines  The NSW Government has committed $21 million to develop a better understanding of the therapeutic potential of cannabis medicines.  This includes $9 million over four years in  clinical trials  to evaluate the safety and effectiveness of cannabis medicine in providing relief from the symptoms of serious conditions: children with severe treatment-resistant epilepsy, adults with chemotherapy-induced nausea and vomiting unresponsive to standard treatments; and improving quality of life for adult palliative care patients. The NSW Clinical Trials program was established after advice from an expert advisory panel regarding the most important areas to understand the use of cannabis medicines.  The NSW Government has also invested up to $12 million over four years to establish and operate the NSW Centre for Medicinal Cannabis Research and Innovation. The Centre will draw on local and international researchers to advance our formal understanding of medicinal cannabis, monitor the NSW-funded clinical trials, educate the community, and help people navigate regulatory processes. The NSW Centre for Medicinal Cannabis Research and Innovation has funded the $6 million Cannabis Medicines Access Program. The  NSW Cannabis Medicines Advisory Service  was opened in January 2018 to provide health practitioners anywhere in NSW with timely, high-quality clinical advice. It is Australia's first cannabis medicines 'hotline' and aims to simplify and speed up access for doctors whose patients may benefit from this type of treatment.  The NSW Government has also provided funding support for the  Australian Centre for Cannabinoid Clinical Research and Excellence  (ACRE). ACRE will develop prescribing protocols for the use of cannabis medicines and provide blood monitoring for patients and data collection tools for their health care professionals to collect more information on the safety and efficacy of these medicines. Is cannabis a medical miracle? The jury is still out  Cannabis is a complex plant and we are still learning about the hundreds of compounds that make up the plant; how they interact with each other and how they affect organs and systems in the human body. Although medicinal cannabis has been introduced in a number of countries, it is still an emerging field. Little high-quality clinical research has been conducted into its therapeutic use and the strength and quality of scientific evidence from the research that has been conducted varies, as does the evidence of safety and effectiveness for many products currently available. Doctors rely on high quality evidence from clinical trials to help make prescribing decisions. While positive stories of treatment from patients help us understand where to investigate further, we know that success sometimes comes from other treatments they are on at the same time, sometimes from a positive mental disposition towards the treatment working (a "placebo" effect), and sometimes only work in certain circumstances. Clinical trials help us. We also often see work done in the laboratory or in mice promote cannabis as a miracle cure. However, sadly, "miracle" drugs in the laboratory don't always translate to successful treatments in humans. For example, in general, nine out of ten drugs for cancer that were promising in the laboratory or in animal models of disease don't work in clinical trials in humans.  Some new cannabis medicines will expose patients to much higher doses of cannabinoids (the chemical compounds of cannabis) than they would have been exposed to. Cannabinoids work all over the body. As such, we need a degree of caution in ensuring that they do not have unexpected adverse effects. For example, we know that some cannabinoids interact with the immune system. If we are trying to treat a cancer with a different medicine that needs the immune system to function, giving a cannabis medicine that might interfere with the immune system might do more harm than good.  Some uses of cannabis medicines have had significant amounts of research. The Commonwealth Department of Health through the Therapeutic Goods Administration (TGA), and with the support of the NSW, Victorian and Queensland state governments, commissioned a team to review the available scientific evidence for the use of cannabis medicines in five areas: palliative care, nausea and vomiting, epilepsy, multiple sclerosis and pain. The  resulting guidance  reveals that currently there is limited evidence about the effectiveness of medicinal cannabis for use in different medical conditions. There is also little known about the most suitable doses of individual cannabis products.  Currently, only one product has been fully assessed for safety, quality and efficacy and is registered on the Australian Register of Therapeutic Goods (ARTG). All other cannabis medicines are experimental and their effects on different people are still being studied.  Straight from the horse's mouth: What does your doctor think?   On 2 March 2018, the NSW and Commonwealth governments introduced a streamlined application process for doctors to prescribe unregistered cannabis medicines. On 30 July 2018, this was supplemented by an online system which enables medical practitioners to submit Special Access Scheme (SAS) applications and notifications electronically. Previously, physical application forms had to be emailed or faxed to the TGA for review.  As of 17 July 2018, NSW Health has received three times as many applications (335) from doctors in the 4.5 months since streamlined arrangements were introduced on 2 March 2018, than the 113 applications received in the preceding 18-month period (from 1 August 2016 when changes to NSW legislation came into effect, up until 1 March 2018).  The NSW Government is working to support appropriately qualified medical practitioners to access legal, safe and effective pharmaceutical-grade cannabis products where they consider this to be an appropriate treatment option for their patients. However, a doctor's first duty of care is to ensure their patient's safety. To feel confident prescribing any new medicine, a doctor requires evidence – high quality clinical research, where carefully designed studies are conducted in humans – showing that the medicine is safe and effective. Despite widespread anecdotal claims that cannabis is a natural, benign product, a cannabis medicine, like any experimental medicine, offers potential risks in the way it interacts with other medicines as well as uncertainty in what side effects it may cause. For a doctor, anecdotes do not equal evidence. It is ultimately the decision of the patient's doctor as to whether they prescribe, or not.  NSW doctors can access the NSW Cannabis Medicines Advisory Service to access up-to-date information about the use of cannabis medicines; formulations, dosing regimens and potential interactions with other drugs. Cannabis medicines: Where to next  Australia is proceeding towards a registered medicine model for cannabis. Legislation passed last year allowing cannabis to be prescribed as a Schedule 8 drug (a category that includes a varied range of addictive drugs such as morphine and codeine) reflects this.  However, although humans have been using cannabis products for thousands of years, we are still at the very beginning of the journey towards cannabis as medicine. High-quality clinical research, such as the three NSW Government-funded cannabis medicine trials, is vital to understand how cannabis products can contribute to patient outcomes.  Where it concerns cultivation, the Federal Parliament of Australia passed landmark legislation – the  Narcotic Drugs Amendment Bill 2016  – on 29 February 2016 to allow the controlled cultivation of cannabis in Australia for medicinal and related scientific purposes.  As of 11 July 2018 , 18 Medicinal Cannabis Licences (cultivation and production), 10 Cannabis Research Licences (cultivation and production), and 13 Manufacture Licences have been granted. The NSW Government has also funded $1 million for agronomic research undertaken by the NSW Department of Primary Industries to support the development of high quality cannabis products in NSW.  The data collected through the NSW Cannabis Medicines Advisory Service and clinical trials program will accelerate knowledge and understanding about the role of cannabis medicines and inform future practice. These investments in building the evidence base can help support applications for registration of cannabis medicines on the ARTG and listing on the Pharmaceutical Benefits Scheme (PBS) – the standard pathways for accessible and affordable quality medicines for Australian patients.  Cannabis as a medicine remains a topical, complex and emotionally-charged issue. It is also operating in a quickly changing public and political sphere. The NSW Government is committed to patients having access to cannabinoid products where they improve patient outcomes and this will remain a core focus in the months and years ahead.  Want to learn more about cannabis? Check out our  cannabis drug page  to get the facts. Where can I find more information? Visit the website of the Centre for Medicinal Cannabis Research and Innovation:  www.medicinalcannabis.nsw.gov.au   Patients, their families and carers can also seek further information through: Calling the cannabis medicines helpline: 1800 217 257 Emailing:  cannabistrial@doh.health.nsw.gov.au Writing to the Centre for Medicinal Cannabis Research and Innovation, NSW Ministry of Health, Locked Mail Bag 961, North Sydney, NSW 2059 

    07/08/2018

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  2. Hepatitis C can be cured!

    Hepatitis C (hep C) is a disease that is caused by the hepatitis C virus. The virus lives in the liver and can cause severe scarring and damage to the liver which can have long-lasting health effects.  Hep C is spread when the blood of an infected person enters the blood of an uninfected person. According to Hepatitis NSW, roughly 230,000 Australians have contracted hep C via the sharing of drug injecting equipment, contaminated medical procedures (prior to 1990) or medical procedures overseas.  How do I know if I have hep C if there can be no symptoms? Many people have no symptoms when they are first infected with hep C, so you might not know if you have been infected. For those who do feel ill they may get nausea, tiredness, or loss of appetite. Hep C can be diagnosed with simple blood tests and should be considered if you: Have injected drugs Been in prison Have had a blood transfusion, blood product or organ transplant in Australia before February 1990 Have a tattoo or body piercing Have emigrated from a country where hep C is widespread Are male and have sex with men Are born to a mother who was hep C positive during her pregnancy Have a needle-stick injury Have abnormal liver function tests or are experiencing hep C symptoms Can Hep C be cured? Hep C can be easily cured with new treatments called direct acting antivirals (DAAs). For every 20 people treated, 19 will be cured. Once cured from hep C, you should no longer have hep C symptoms and treatment may reverse the damage to your liver. However, if hep C has already caused damage to the liver, clearing your hep C might not mean that you feel healthy straight away. You might need to see a doctor or specialist for ongoing monitoring and you will still have a risk of liver complications, even after clearing your hep C.  When it comes to treatment, there are a range of different medications. Your doctor will recommend the best option for you depending on your treatment assessment and there is no need for a liver biopsy.  Should I start treatment? There has never been a better time to get your hep C treated. The treatment usually lasts for 12 weeks, has very few side effects and is taken in tablet form, so there are no injections and you don't need to get a liver biopsy before starting treatment. Treatments for hep C can now be prescribed by GPs and doctors at hospital liver clinics. Inside prison, treatment can be prescribed by clinic nurses or doctors.  Can I start treatment if I'm using drugs?  Yes, even if you are currently injecting drugs, you can get start hep C treatment. If you have a history of drug and alcohol use and are unsure of whether now is the right time to begin treatment, call the Hepatitis Infoline on 1800 803 990 for advice.  The Let's Talk counselling service also offers free support to people in NSW affected by hep B or C related liver disease, their family and carers. Counselling can be delivered face-to-face, via Skype or over the phone. For more support and treatment information, check out our Getting Help section  here . What if treatment doesn't work? The new hep C treatments have a 95 per cent rate of curing the disease. There are a very small number of cases where treatment does not work and you may be referred to a liver specialist who will talk to you about the best treatment for you.  It's important to remember:  There is no limit on how many times you can access treatment There is no evidence to suggest that, if treatment didn't work the first time, it's never going to work Liver specialists will do everything they can to ensure you are cured of hep C What is Hepatitis NSW?  Hepatitis NSW is a not-for-profit health promotion charity funded by the NSW Ministry of Health which connects patients with doctors who can prescribe hepatitis C treatment.  Hepatitis NSW have worked proactively with GPs and pharmacists to build an online NSW-wide directory of services for people with hep C to access treatment locally and visit a GP close to them for testing and ongoing hep C management.  For more information about Hepatitis NSW visit  www.hep.org.au  or to speak to someone who has experienced hep C treatment call 1800 803 990 today. 

    25/07/2018

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  3. What to do if you’re concerned about someone’s drug use

    ​Drug use is something that we all see on a daily basis. Whether it be the groups of smokers huddled down the side street that we walk past on the way to work, the long queue of people waiting to get their morning fix of caffeine at the local coffee shop, or the endless bars and pubs on a Friday night packed with people sipping on a glass of wine or schooner of beer to celebrate the end of the work week. Drug use doesn't have to be illegal to be a problem. Each year, legal drug use causes more harm to society than illegal drugs, with alcohol and tobacco being two of the leading contributors to the burden of illness and deaths in Australia, according to  a study  by the Australian Institute of Health and Welfare.  But drug use that we don't see as often, including illicit drug use, can also cause harm to society and the individual. In 2011, Opioids accounted for the largest proportion (41%) of the illicit drug use burden. The reality is that many of us know someone who uses drugs, but knowing what to do when you're concerned about their drug use can be difficult. The alcohol and drug information service (ADIS) advises: 1.  Be aware that everyone has different drug preferences – not everyone wants to use the same drug. 2.  Avoid judging people based on their drug preference. 3.  Accept that people don't always want to talk about their personal drug use when you do. 4.  Be aware that everyone's relationship with drugs is different and can change over time i.e. a person's relationship with a drug can start off pretty casual then become very intense and then become intermittent again. 5.  Understand not all drug use evolves into problematic use or dependence. 6.  Invite the person you are concerned about to reflect on their relationship with drugs and consider asking: Whether they are happy with the relationship?  Whether they see it as a life-long relationship? Whether there is anything about their relationship they want to change? 7.  Be aware there is no handbook you can follow to persuade someone to stop taking drugs which means there are limits to helping in some situations. Avoid the temptation to lecture someone who won't stop taking drugs. 8.  If a person refuses to talk to you about their relationship with drugs they can phone a free, anonymous and confidential helpline like ADIS on 1800 250 015 What is ADIS? ADIS is a free, 24-hour phone service available across New South Wales, offering information, support and advice for people seeking help to stop or reduce their drug use, as well as for their family and friends. The ADIS service provides information, treatment referrals, crisis counselling, and support for illegal drugs like heroin, ice and cannabis, as well as legal drugs such as alcohol. ADIS can also give you contact information to help you access treatment services. Help for families and friends The influence of alcohol or other drug problems affects the person using the substance, but it can also impact on their family, friends and colleagues. Often, other people can see the problem that substance use is causing before the person using does.  The person may not want to change or might not see a need to change. It may be the case that they are experiencing mental illness, such as depression, which makes it more difficult for them to realise their drug use is a problem or have the motivation to change.  Family Drug Support (FDS) is an organisation that provides support and assistance to families throughout Australia who are dealing with a family member who is using drugs. Learn more about FDS  here . Want to learn more about some of the most commonly used drugs affecting Australians right now? Check out the Your Room A-Z Drug listing  here.  

    24/07/2018

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Your Room > What's New > FASD Day - 9 September 2017