Pacific Views - Spring 2013

7/27/2019 Pacific Views - Spring 2013

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Synthetic cannabinoids arrived in Australia about three years

ago and have been widely promoted as legal highs. What

effects do they have and how concerned should we be?

Jarred had smoked marijuana for several years, usually after work or with

friends at the weekends. He had become somewhat concerned about its

effects: particularly in the winter months after catching a cold he often

had a chest infection. However, smoking relaxed him and it was what

many of his friends did.

Jarred had recently been offered a new job. This involved using complex

machinery and he would be required to undergo periodic urine drug

screening. The salary increase was very tempting, but Jarred did not

think he would be able to cease marijuana use in order to comply with

the drug testing regime. A friend of his told him that he was smoking a

synthetic cannabis drug, which he had bought from a tobacconist in the

City. He said it was legal, a legal high and the beauty of it was the drug

could not be detected by urine screening.

Jarred started smoking this new drug. He switched easily from his usual

marijuana and took up the new employment. Life was good for a period.

Jarred felt that the new job was within his capabilities. However, the

industry seemed to attract an odd group of people; he couldnt really

relate to them. They often commented on his appearance and he found

this quite offensive. They began to criticise his way of working with the

machinery, which Jarred found distressing as he considered himself quite

expert in this type of work. The comments and criticisms went on until

one day Jarred had what he described as a melt-down. He was shouting

at the other workers telling them he was the only person who really

understood the job and this special understanding was because he had a

direct line of communication with The Boss. Jarred was stood down fromwork one day and the next thing he knew he was in hospital.

IN THIS ISSUE

Spring 2013

Newsletter for Healthcare Professionals

Pacific Views

continued...

Synthetic CannabinoidsProfessor John Saunders,

Consultant Physician in Addiction Medicine,

South Pacific Private

Research Round Up

Biomarker may predict which

patients respond better to CBT

Cannabis users report weaker

therapeutic allianceN-Acetylcysteine is showing

promise in preventing relapse

Consumer &

Carer Committee

The Value of

Consumer Engagement

Working withinFamily Systems

Connecting Minds conference

The Genetics of Alcohol

Dinner & Discussion Series

SPP Update

Accreditation

He said it was a legal

high and the beauty of

it was the drug could notbe detected by urine

screening...


2/8

FEATURE ARTICLE

naturally occurring cannabinoids (e.g. cannabidiol)

are more typically relaxing and soothing. The actions

of the synthetic cannabinoids are more like pure

THC but with even greater psychotic effects. More

prolonged psychosis is now increasingly recognised.

Treatment programs over the past year have been

admitting increasing numbers of people because of

the effects of the synthetics. Treatment typically

involves prescribing an antipsychotic medication to

alleviate the deeply disturbing experiences and bizarre

behaviours seen in the user, who often nds it difcult

to explain exactly what he (or she) is experiencing.

Typically a week is required for the patient to

settle down sufciently to engage in therapy.

Staff skills are vital to reassure the person that the

effects will decline with time and treatment. It can

be a deeply worrying period for the patient and the

family. Following regular anti-psychotic medications,

the person will usually settle and engage with

staff without it being a fearful experience. The

therapy program is based on relapse-prevention

techniques and encouraging the person to makesignicant adjustments in their life to avoid

the use of these and similar drugs in the future.

Recognising the dangers posed by synthetic

cannabinoids, governments in Australia imposed

a blanket ban on them which took effect in early

July 2013. Prior to this these drugs were legal as

international regulations can only declare illegal a

specic chemical compound, rather than a whole

class of drugs. This allowed drug manufacturers the

opportunity to bypass the law and to sell syntheticcannabinoids openly. However, they continue to

be widely available although in a more clandestine

way. We need to be continually alert to them.

Synthetic cannabinoids represent a distinct

and novel class of compounds now available in

Australia. They are chemical analogues of delta-9-

tetrahydrocannabinol (THC).

More than 100 of these chemical variants have

now been identied and they are given reference

numbers (when identied by research laboratories)

rather than chemical names. These drugs are

typically sold in small transparent plastic bags (like

a coin bag) and have the appearance of herbal tea;

the price is typically $30 per bag. They are usually

smoked by themselves or with tobacco, or sometimes

mixed with standard marijuana. Sometimes the so-

called synthetic is standard marijuana laced with

amphetamines. The rst of these drugs was called

Kronik and now there are scores of brand names.

The effect of the synthetics is recognisable as that

of cannabis (i.e. like standard marijuana) but is

described by users as being raw. These drugs are

generally much more powerful than marijuana and

cause pronounced psychotic experiences. Users

may feel that everyone else is looking at them, and

particularly the police and bikies. One patient said

that when outdoors he would talk to other peoplespontaneously, assuming that they had him under

surveillance and possessed listening devices, but

if he engaged with them they would think that he

was one of them and he would not be harmed.

Those affected report they are unable to stop these

thoughts coming into their mind. If they do not

smoke for a while, they develop a withdrawal state.

Synthetic cannabinoids are thus more

psychotomimetic than natural cannabis. Many people

think that natural cannabis contains just delta-9-THC,

but in fact there are up to 60 different cannabinoids

present. Pure delta-9-THC produces euphoria but

can also cause bizarre experiences, whereas some

Kronik AshInferno

Bombay Blue MauiWaui

KilimanjaroSky Galaxy

Zeus Ash-BlackLabel

NorthernLights Vortex

BlackWidow CampFire

Circus AK-47

Raw JamaicaGoldBlackAsh BeyondDeath

Synthetic cannabinoids brands:


3/8

RESEARCH ROUND UP: SYNTHETIC CANNABINOIDS

The problem

Synthetic cannabis contains a large number of

synthetic cannabinoid chemicals which have notbeen formally identied.

In addition, attempts to ban the drugs have beenlargely thwarted by manufacturers who change thechemical components to get around laws. Despite

being marketed as herbal highs and being relativelynew on the drug scene, the effects of synthetic

cannabis are far from benign.

Commonly reported side effects include: acute

onset nausea, anxiety, agitation, paranoid ideation,hallucinations and exacerbation of psychosis orpsychotic relapse.

What was the goal?

This 2012 report from the Department of Psychiatry,University of Medicine and Dentistry of New Jersey,was the rst to describe two cases of use of syntheticcannabis leading to respiratory depression andhospital admission for intubation.

What did they fnd out?

Case one describes a 19 year old Caucasian

male who presented with altered mental statessubsequent to using synthetic cannabis. Tests in theemergency room revealed a low resting respiratory

rate of 7. He was intubated and discharged whenhe returned to his usual state of health. Hehad been smoking Spice for six months prior to

admission and had been abusing alcohol for threeyears.

In case two a 15 year old male presented to the EDwith loss of consciousness. He had been abusing

non-synthetic cannabis for nine months. On theday of admission he had consumed large quantities

of alcohol and synthetic cannabis. His restingrespiratory rate was 8. He fully recovered after fourdays of treatment.

What does this mean forhealth care professionals?

Synthetic cannabis is a relatively new drug of

abuse and health care professionals need to beaware of its potentially greater toxicity comparedwith natural cannabis. Although the drug is sold in

health shops, users such as these two case studies

are likely to be well entrenched dented drug sceneand abusing other drugs and alcohol.

Citation: Synthetic Cannabis and Respiratory

Depression. Jinwala FN; Gupta M (MD) Journal

of Child and Adolescent Psychopharmacology. Vol22(6) 2012.

Synthetic cannabis linked to respiratory depression

...healthcare professionals needto be aware of its potentially

greater toxicity compared to

natural cannabis...


4/8

RESEARCH ROUND UP: SYNTHETIC CANNABINOIDS

The Problem

As well as synthetic cannabis the past decade has

seen the development of an array of emergingpsychoactive substances including stimulants suchas mephedrone and psychedelics such as DMT

which have been implicate din high prole deaths ofyoung people. As such drugs are relatively new toAustralia and appear to be use sporadically there is

a lack of information about who is using them andthe likelihood of them becoming a drug of abuse.

How did they investigate?

The authors looked at a sample of 693 regularecstasy users who are part of the long running

study, the Ecstasy and Related Drugs ReportingSystem.

What did they fnd out?

More than a quarter of regular ecstasy users hadused an emerging psychoactive substance in the

past six months, most commonly a stimulant suchas mephedrone. Psychedelic stimulants were less

commonly used. Signicantly users of mephedronewere similar to ecstasy users while users ofpsychedelic stimulants were more entrenched in

their drug use had initiated ecstasy earlier, tookecstasy more frequently and took a wider array ofdrugs.

What does this mean forhealth care professionals?

The authors suggest that use of psychedelicstimulants is largely restricted to a sub group ofnon-injecting poly drug users. The similarity of

ecstasy users and users of the new classes ofstimulants such as mephedrone, combined withdeclining purity of ecstasy, suggested that these

new stimulants may become more commonly usedby Australian drug users in the future. These drugsare likely to have an even greater public health

impact than ecstasy and require monitoring.

Emerging psychoactive substance use among

regular ecstasy users in Australia. RaimondoBruno et al. Drug and Alcohol Dependence 124(2012). 19-25

Use of emergingpsychoactives such asmephedrone on the rise

...the past decade has seen

the development of an array

of emerging psychoactive

substances...


5/8

RESEARCH ROUND UP: MAJOR DEPRESSIVE DISORDER

The problem

Major depressive disorder (MDD) is a highlyprevalent, disabling and costly illness. First linetreatment for MDD is currently antidepressant

medication or evidence based psychotherapy.Unfortunately only 40% of patients treated for MDDachieve remission after the initial treatment and

there is no reliable way for clinicians to predict whowould respond better to medication and who topsychotherapy.

What was the goal?

The authors led by researchers from EmoryUniversity in Atlanta Georgia, USA set out to

identify a treatment specic neurological biomarkerthan would predict individual response to eithermediation or psychotherapy.

How did they investigate?

The study design was a 12 week randomisedcontrolled trial (RCT). Positron emission

tomography (PET) was used to measure brainglucose metabolism prior to randomisation to eithermedication escitalopram oxalate - or cognitive

behaviour therapy for 12 weeks. 82 patients, maleand female, aged 18-60, commenced the studyand 38 had clear outcomes and PET scans allowing

their results to be used in the analysis. The mainoutcome measure was remission at 10- 12 weeks

as dened by the 17pt Hamilton Depression RatingScale.

What does it mean for

health care professionals?

The results suggest that patients who respondto CBT have a distinct neurophysiology that

differs from patients who require escitalopram.

If conrmed in future studies this could improveclinical practice in particular the practice of addingor substituting an additional pharmacotherapy inresponse to treatment failure, when the patient

may benet from being switched to CBT. The

authors acknowledge that limitations include lackof a placebo in the study design and also inability

in the study design to identify patients who do notrespond to either of the rst lien treatments, eitheralone or in combination.

Citation: Toward a neuroimaging treatmentselection biomarker for major depressivedisorder. McGrath C L; Kelley M E, Holtzheimer

P E; Dunlop B D, Craighead E W; Franco A R ,Craddock C, Mayberg H S,. JAMA Psychiatry.August 2013, Vol 70, No. 8

Biomarker may predict patients who respondbetter to CBT andwhich respond better topharmacotherapy

...patients who respond to CBT

have a distinct neurophysiology

that differs from patients who

require escitalopram...


6/8

CONSUMER & CARER COMMITTEE

The value of consumer engagement:

creating positive change

In the past year we have seen a number of changes

implemented because of the Committee, to name a few:

A 24 hour alumni support line was established

May 2013

Client Rights and Responsibilities have been

re-written with the clients best interests

in mind

The Changes 2 program was developed and

introduced due to feedback received from the

Committees annual phone survey

Pacic Connections was developed following

phone survey feedback

A complete revision of our Step Down program

resulted in the introduction of our Transitions

program

Aftercare planning groups and lectures were

developed to improve client aftercare

knowledge and engagement

SPP extends a huge thank you to the Consumer and

Carer Committee for delivering our staff training and

their continued valuable contributions. Thanks alsoto our past clients and carers for taking the time to

provide feedback on their SPP experience.

The Value of Consumer Engagement:Consumer & Carer Advisory Committee

Recently SPP staff received valuable training from members of our Consumer & Carer Committee (CACA)

to discuss why meaningful consumer engagement is so important.

Our Consumer and Carer Advisory Committee is comprised of past clients and carers who are passionate

about ensuring the client experience at SPP is positive and establishes solid foundations for recovery.

Committee members either received treatment at SPP or were carers and each have their own personal

investment in ensuring the quality and safety of our service.

Heres what a few of the Committee

members had to say during our training:

SPP is much more than a Treatment Centre;

its a community with a culture of belief,

compassion, and conviction. My ongoing

involvement is a way to give back from the

bounty I have received since treatment.

It is my experience that the Family Program

plays a vital role in recovery it is a way for

clients and their family/support persons to

get on the same page and for the support

person to be better equipped to support the

client in their re-entry into society. My goal is

to encourage the ongoing development and

expansion of the Family Program.

Through participating in the CACA Committee,

I have seen an opportunity to help provide

tools for clients to get back to a career or

begin a renewed vocational journey.

I am grateful that the Committees

suggestions are taken onboard and

implemented and am amazed at some of the

great ideas put forward by Management. The

Committee works as per its Charter and I am

proud to be a part of it.


7/8

EVENT REVIEW

Working within the Family SystemSteve Stokes, Program Director of South Pacic

Private, recently delivered a well-received

workshop for GPs on Working within the Family

System at the Australian Society for Psychological

Medicine (ASPM) and Royal College of General

Practitioners (RACGP) Connecting Minds

conference in Melbourne.

South Pacic Private has been treating trauma

as the underlying issue in addictions and mental

illness since 1993. Approaching family systems

is also an integral part of our therapeutic

approach as often the family system enables an

individuals addictive and destructive behaviours.

We therefore treat the whole family, not just the

individual as this is fundamental in the success

of recovery. Our experience working in complex

family systems is that within in an addictive or

shame-based family system, the disease becomes

the organising principle.

What is the SPP approach?

One of the rst things we do is understand the

clients family system by creating a genogram,

which helps visualise hereditary patterns and

psychological factors that punctuate relationships.

The model we work within is the Developmental

Immaturity Model, developed by Pia Mellody,

our International Consultant and Senior Clinical

Advisor for the Meadows in Arizona. Often, clients

present with comorbidity and therefore the model

helps us to understand not only the clients

secondary symptoms, such as addiction, but also

the underlying or primary symptoms such astrauma.

We help clients understand where they t into

the model through re-parenting by modeling

a healthy family system to support the clients

development of functional maturity skills. The

model also helps clients identify any lack of

childhood nurture, trauma, abuse or neglect

that have led to the current crisis and caused

developmental immaturity.

We work within this model as both our experience

and research shows us that children need healthy

parenting in order to develop and maintain:

healthy self-esteem boundaries, a sense of self,

practice self-care, containment and moderation.

Our Family Program is the cornerstone of our

treatment, as we know how important it is to work

within the whole family system to create change.

Clients also embrace recovery more effectively

when family members have had the opportunity

to understand their family members treatment,

the complexity of their issues and how they have

organised their lives around a relationship with

their secondary symptoms. Through this 4-day

intensive program, a Family Therapist guidesthe family through psycho-education lectures,

structured exercises, and discussions, all within a

safe therapeutic environment.

This workshop was an excellent opportunity for

us to share our expertise with GPs who are often

the rst point of contact for many individuals

experiencing a crisis.

Steve Stokes has over 25 years experience

working in the Addictions and Mental Health feld.

To fnd out more about our Family Program visit:

www.southpacificprivate.com.au/concerned-

friends.htm

...often the family system

enables an individuals addictive

and destructive behaviours...


8/8

SOUTH PACIFIC PRIVATE EDITORIAL

If you have suggestions, comments or would like to unsubscribe from receiving further news from South Pacic Private, then please

email us at [email protected] with your full name and address.

SPP UPDATE

EVENTS

As you are likely aware, the National Accreditation

Scheme is driven by the Australian Commission

on Safety and Quality in Health Care who have

National Safety and Quality Health Service

Standards (NSQHS) that work to ensure the

safety and quality of health care in Australia.

All hospitals must meet these standards in order

to achieve accreditation. This year, not only did

we have to achieve accreditation, but we also

had to meet 10 new standards introduced by

the NSQHS.

Within the 10 new standards were a total of 256

actions that needed to be met. On the 28 and 29

August two surveyors from the Australian Council

on Healthcare Standards (ACHS) conducted an

extensive survey to ensure all requirements were

met as outlined in the standards.

South Pacic Private is pleased to announce that

not only did we achieve all 256 actions but we

also exceeded requirements in two areas and

achieved a merit rating. Those two areas were:

Consumer Engagement

Decision-making around Quality and Safety

We were delighted with the results, and are

pleased to have the high standard of treatment

we have delivered for 20 years endorsed.

Accreditation achieved with flying colours!

Follow us on

Twitter

Our Twitter network of professionals is growing! Follow us to keep up to

date with the latest news, events and commentary as it relates to SPP

& the general therapeutic eld.@SPPrivate_

Professor Paul Haber, Medical Director for Drug Health Services in Sydney and

physician in addiction medicine and gastroenterology, will present on the Genetics

of Alcohol, Related Disorders and their Treatment in the nal installment of

our Dinner & Discussion series on Wednesday 16 October in the Harbourview Room,

Woles, 27 Circular Quay, The Rocks. It has long been known that alcohol problems

run in families, suggesting a genetic basis to these problems, but it is only recently that

the genes involved with alcohol problems have started to be understood in any detail.There is now evidence that genetic factors inuence response to naltrexone treatment

and also to the risk of developing medical complications such as pancreatitis and liver

disease. This presentation will describe the most important of these recent studies but

will focus on practical information and how our understanding of drinking problems is

improved through better knowledge of these genetic studies.

Venue:

Harbourview Room, Woles,

27 Circular Quay, The Rocks

Date: 16 October, 6:30pm

A Certicate of Attendance will be provided for claiming CPD points.

Genetics of Alcohol Related Disorders and New Treatment

To register your

interest in attending please email

[email protected] call the PR department on (02) 9905 3667

Dinner & Discussion

Series

SOUTH PACIFIC PRIVATE

Documents

Pacific Views - Spring 2013