Epidemiologist Professor Louisa Degenhardt doesn’t like the word “should” when it comes to formulating responses to drug use, whether they are illicit or legal drugs, or even prescribed medicines.
“People have very strong opinions about approaches to drug and alcohol use – but it’s a really complicated problem,” she says. “What I am trying to do is to ensure we have increasingly better quality data available.”
Only then can governments, clinicians, service providers and communities begin to reliably estimate the prevalence of drug use and dependency, and drug related harm.
And by using a similarly rigorous approach to scrutinising the effectiveness of policies and programs, researchers can help identify what works and why.
Degenhardt’s research has already gone a long way to establishing a sound evidence base. At an international level, she is advising the World Health Organization’s Global Burden of Disease study – which measures years of life lost due to premature mortality or illness, in this case related to illicit drug use – and other international agencies, from UNAIDS to the UN Office on Drugs and Crime.
In Australia, at the UNSW-based National Drug and Alcohol Research Centre (NDARC), she is playing a leading role in pioneering “strategic early warning systems” for illicit drug markets. This ongoing program, which began in 2001, provides regular, detailed snapshots that reveal emerging trends in illicit drug markets across the country.
“A lot of concerns arise about issues related to illicit drug use – and although some case studies are very dramatic, they might not be representative of a wider problem.”
Degenhardt and her colleagues at NDARC have tracked disruptions to heroin supply, the increased use of methamphetamine (“ice”) and increased injection of pharmaceutical drugs.
More recently, Degenhardt has expanded her research to investigate pharmaceutical opioids used to treat chronic non-cancer pain, particularly in older people.
“Over the past 10 years, more pharmaceutical opioids – from morphine, to OxyContin and even over-the-counter codeine – are being used in the community, but there is a risk to anyone taking opioids over a long period of time,” she says.
“We need to know whether or not these drugs are actually improving people’s quality of life, and whether there are people developing problems with addiction.”
As technology evolves, new approaches to data are proving increasingly important in identifying useful patterns, Degenhardt says. For example, by linking data dating back to 1985 for methadone and buprenorphine treatment programs, Degenhardt’s group was able to establish the significant impact these treatments had in reducing drug overdoses, one of the major killers for opioid dependent people. This was a big advantage for policymakers who had otherwise relied on assumptions.
The treatments reduced the mortality risk for people of every age group and socioeconomic background, and improved prospects for people leaving jail, for example, Degenhardt says.
“In an area as fluid and complicated as illicit drug markets, we need to keep working transparently and carefully to make sure we have reliable information at hand.”