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7/27/2019 Pacific Views - Spring 2013
1/8
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...
7/27/2019 Pacific Views - Spring 2013
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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:
7/27/2019 Pacific Views - Spring 2013
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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...
7/27/2019 Pacific Views - Spring 2013
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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...
7/27/2019 Pacific Views - Spring 2013
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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...
7/27/2019 Pacific Views - Spring 2013
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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.
7/27/2019 Pacific Views - Spring 2013
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...
7/27/2019 Pacific Views - Spring 2013
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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
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