Shining a light on illicit drug use in regional Victoria Monash Lens

Associate Professor Bernadette Ward from Monash Rural Health is helping to lead a massive expansion of research into illicit drug use in rural Victoria, gathering information on what is now the largest active group of people using drugs in Australia.

The new study, called MIXMAX, combines two established projects: the SuperMIX study of people who inject drugs, and the VMAX study of methamphetamine (ice) smoking in metropolitan and regional Victoria.

MIXMAX is a partnership between Monash Rural Health and the Burnet Institute. It will initially focus on the Mildura region after receiving new funding from the National Health and Medical Research Council (NHMRC).

SuperMIX started in 2008 and is a study from the Burnet Institute in Melbourne. VMAX started in 2016 and focused on Melbourne, Bendigo, Shepparton and Gippsland.

This evening, November 8, a community event will be held in Mildura by Monash Rural Health and the Burnet Institute to explain the expansion. Researchers will also meet with health professionals and a regional Indigenous health group ahead of the study.

Here, Associate Professor Ward describes the new project for Lens ahead of the Mildura event.

‘We know that in Mildura, anecdotally, there are many reports of people, relatives and friends who have experienced some of the harm associated with illicit drug abuse.

“Traditionally, in places like Mildura, small rural towns, some research has been done, but it is usually a one-off. And what we’re starting now is a five-year study in Mildura, where we’ll follow people for five years.

“There will be enormous flexibility. We will recruit several hundred research participants in the Mildura area. We will follow them over time and talk to them about their illicit drug use, their mental health, their support services, their families, who they live with, what support they receive, their involvement with the criminal justice system and their behavior. around things like driving, how they use the drugs and the frequency.

We will also ask permission from them to collect some blood to look at their blood-borne virus status, i.e. their hepatitis C and HIV. Naturally, participants in the study will be shown the results of these tests.

“One of the challenges we have here is making sure that people know that we are not going to the local providers of these services and asking for data. When we ask for arrest information, we go to the state police data set, not to the local police station, not to the local hospital, not to their local doctor, not to the local pharmacy, because there are certain sensitivities, especially in rural towns .

“We need this evidence to inform local health care planning. Unless we know this, we are operating in the dark.

“With blood-borne viruses, we know that many people may know they have one but may not seek treatment for fear of embarrassment or stigma, or they may not even know what their diagnosis is.

“These things are easy to fix, but people need to be in a position where they feel safe to go and look at those things. We take a harm minimization approach in Australia and that is the framework within which we have to operate. So we need to make sure people understand the language we use around illegal drug use, how we need to support people and how this is a health risk. issue and not a criminal issue is very important.

“The other thing we know in rural and metropolitan areas of Australia is that smoking is now the most common route of administration for people using methamphetamine. And many people who use illegal drugs also smoke tobacco and cannabis.

“No one knows much about their lung function. We’re also going to ask people for permission to take pulmonary function tests, and we can give people those results if we do that.

“The richness of this research is that, in addition to collecting all this data from people, we’re going to build a very broad picture of what’s happening to people and try to find out where we could intervene, and what things make a difference.

“For people who use methamphetamine, we hypothesize that they may be different from people who inject drugs. People who smoke methamphetamine don’t go to a needle exchange service to get seizures. They often do not form a visible population. And in rural towns, we really need to try to identify what works for people and how we deliver those services, and unless we have the evidence, we can’t do that.

“One of the problems, however, is that methamphetamine use in rural towns has received unprecedented amounts of negative media attention, resulting in names like ‘ice towns.’

“People just don’t want those names attributed to their small rural community, and that’s absolutely fair enough. We will not identify them by the name of their city. We report using geographic classification systems.

“In our presentations, we provide people in the region with an overview of the patterns of illicit drug use in Australia and what we already know. We’ll talk about what might be unique about methamphetamine use versus other illegal drugs. We’ll talk about what we know in terms of what works.

“Currently, there is no pharmacotherapy for methamphetamine. Unlike opioid use, where you can access treatments like methadone, there is nothing comparable. If not, what do we know that could make a difference, and what don’t we know?

“We know that the social determinants of health make a huge difference. Just because you live in a rural area doesn’t mean you’re worse off. There are people who use methamphetamine and they can handle it quite well, but for some people who use it, combined with all their other disadvantages, it causes a lot of drug-related harm.

“We know that people who inject drugs are very high users of hospital emergency departments and inpatient services, but we don’t always know whether people disclose their drug use and whether people are asked about their drug use in a way that allows them to provide information about their drug use. can receive treatment.

“We know that the stigma in rural areas is enormous, and so are many people.

“We also know that access to treatment services is poor in many rural areas, so we don’t know if people have stopped seeking treatment, or if the treatment is simply not there. Do they just get tired of trying? Should we be thinking about other ways to support people in getting treatment? And in the post-COVID world of telehealth, that might be something we need to think about too.

“One of the great things about the Mildura region is that the services generally work well together, and there is a real commitment to helping people. Stakeholders are enthusiastic, they want more research. However, it is crucial to get the community on board.”