Health Podcast Highlights

• How Big of a Problem is Alcohol? [02:11-07:04]
• Adult Drinking Habits Today in Focus [07:04-09:04]
• Tobacco and Vaping [09:04-15:06]
• Drugs: A Historical Overview [15:06-23:29]
• MDMA [23:30-27:02]
• Illicit vs Prescription Drugs [27:03-33:18]
• Prescription Drugs and Children [33:18-40:22]
• The impact of Antidepressants on Children [40:23-48:00]
• Tips for Parents to Keep Their Children Safe [48:01-52:42]
• The Biggest Health Challenge [52:43-54:40]
• Conclusion [54:44-01:02:08]

Paul Dillon: Drugs & Alcohol Education – A Lesson For Us All Introduction

Today we are going to be exploring drug and alcohol addiction. Oh, actually research education, particularly focussed on our youth.

My guest today is Paul Dillon. Now, Paul has worked in the drug education field for almost 25 years and through his company, Drug and Alcohol Research and Training Australia (DARTA), he has been contracted to provide information on a range of drug issues to many audiences. And for the last 13 years, he has worked as an information officer at the National Drug and Alcohol Research Centre. In 2009, his book, Teenagers Alcohol and Drugs, was released by Allen and Unwin. It’s a great conversation.

We cover some great topics. It’s wonderful to get Paul’s insight into this really challenging field, which is a challenge for us as individuals, certainly for us as parents, and for those that are young in our society. Look, I hope you enjoy this conversation I had with Paul Dillon.

Podcast Transcript

Dr Ron Ehrlich: [00:00:00] I would like to acknowledge the traditional custodians of the land on which I am recording this podcast today, the Gadigal people of the Eora Nation, and recognise their continuing connection to the land, waters, and culture. I also pay my respects to their elders of the past, present, and emerging. 

Hello and welcome to Unstress. My name is Dr Ron Ehrlich. Well, today we are going to be exploring drug and alcohol addiction. Oh, actually research education, particularly focussed on our youth. 

My guest today is Paul Dillon. Now, Paul has worked in the drug education field for almost 25 years and through his company, Drug and Alcohol Research and Training Australia (DARTA), he has been contracted to provide information on a range of drug issues to many audiences. And for the last 13 years, he has worked as an information officer at the National Drug and Alcohol Research Centre. In 2009, his book, Teenagers Alcohol and Drugs, was released by Allen and Unwin. It’s a great conversation. 

We cover some great topics. It’s wonderful to get Paul’s insight into this really challenging field, which is a challenge for us as individuals, certainly for us as parents, and for those that are young in our society. Look, I hope you enjoy this conversation I had with Paul Dillon. Welcome to the show, Paul. 

Paul Dillon: [00:01:44] Thank you for having me, great pleasure to be here.

Dr Ron Ehrlich: [00:01:47] Paul, I’ve been looking forward to talking to you for some time and actually covering this really important topic of drug and alcohol, particularly amongst young people. I wonder if we might just start with alcohol because I think for anybody that’s ever tried to give it up, even for a week or two, you’d realise how ubiquitous it is in our society. It’s for good or bad, you know, celebrations, funerals, whatever. Tell us how big a problem is alcohol in our society?

How Big of a Problem is Alcohol?

Paul Dillon: [00:02:18] These have certainly changed. I’ve been in this field for a very long time now and certainly when I started working in the alcohol and other drug fields back in the early 90s, it was very, very difficult to talk about alcohol in a realistic way. You know, alcohol was not only socially acceptable, it was socially expected. 

And so if anyone kind of tried to challenge that in any way and say, take a look at your drinking, let’s take a look at the alcohol culture in this country, you were met with quite a ferocious response. So I think that has changed. I think certainly we talk about it now. I think also the lockdown, COVID-19 restrictions, all those kind of things, has made us look at our own alcohol use as well.

So there’s lots of conversations about it. I think in terms of young people, I’ve seen a tremendous change over the years of working with school based young people. I mean, we now have one of the highest number of non-drinkers in our schools that we’ve pretty well seen since records began. To give you some sort of an idea of what I mean by that, way back in 1999, we had one in ten 12-17 year olds who had never consumed alcohol. That is now from the latest study which was 2017, that’s four years ago. But unfortunately, COVID-19 stopped the 2020 data from being collected. But in 2007, it was now one in three who had not drank alcohol. So that’s really yeah, it’s a cultural change. 

And I mean, look, there are some people who refuse to believe that that’s true. They say this survey is wrong, but I go to about 120 schools, speak to 200000 sorry, 200 schools, 120000 young people across the country. And yeah, I’ve seen the shift way back. If you talked about nondrinking, you could see the non-drinkers in the room, but they kind of like just wanted to hide.

Paul Dillon: [00:04:28] Now, the non-drinkers are an important part of a social group. They’re the people who look after everyone. So now is a valid, it’s a viable choice. And I think that’s really important. I think it’s a trickle down effect from a designated driver. That’s where it comes from. For young people. It has social value. And look, I don’t drink. I’ve never drunk alcohol. I didn’t drink alcohol as a teenager. I’m 61 now and I still don’t drink. 

And I’d have to say there was a period of time, maybe about 15 years ago, where it was mostly the hardest time for me to be a non-drinker, because everywhere I went, even giving talks at schools about alcohol, other drugs, you know, it would end with a wine and cheese evening, which kind of really didn’t make much sense. But I used to get asked, if I said I didn’t drink.. they would say: Why? People wanted to know the reason why. And that has certainly shifted.

Dr Ron Ehrlich: [00:05:25] I’m really pleased to hear that. And I think even your contact with 120000 students and 100 or plus 200 schools, I think that’s got to count for quite an interesting observation.

Paul Dillon: [00:05:37] Yeah. And the best part about it is, is backed by the research as well as backed by the stats. Now, as I said, you know, whenever I talk about the fact that we have a growing number of non-drinkers and can I say we’ve seen the same data from the European data came out at the end of 2020, and it’s exactly the same story there. They’ve gone from something like I think one in ten to one in five. The US has seen somewhat similar changes. So it’s around the world and there’s people try to kind of come up with reasons why it’s happening.

In Europe, it’s very much they talk about that parents are better informed and there’s also been some legislative changes. So places like the Netherlands, for example, raised their drinking age from 16 to 18. France introduced a legal drinking age for the very first time. So there have been some legislative changes, too. 

But as I said, I think there is a greater, I suppose, to be a non-drinker has social value. I think that is important now. You know, most people, most adults would like to go out to dinner and have at least one person they know who’s sitting there who doesn’t drink so they can drive them home. They don’t have to pay for it. An UBER or a cab. I think it’s the same thing with young people that’s really reflecting that. [00:06:58][48.4]

Dr Ron Ehrlich: [00:06:58] Are we seeing that? I know your focus is on youth, but are you seeing that same trend in adults?

Adult Drinking Habits Today in Focus

Paul Dillon: [00:07:05] Look, I don’t really look at the adult data as much as I maybe should, but a quick kind of cursory, you know, general sort of scan of the research shows that we’re certainly not seeing greater amounts of drinking. I think we do have things like, the Dry July and all of that kind of thing that happens, which I’m not a great supporter of, I have to admit. 

But my problem with Dry July is if anybody is a non-drinker in it, they know anybody who goes on Dry July. I mean, truly, it’s okay for the first couple of weeks, but by the final week, you just want to kill them because I mean, honestly and truly, if it’s that tough and, you know, they’re screaming out, how am I going to get to the end of this month? Don’t do it. I mean, particularly if you’re a parent, because I give in completely the wrong message to a kid, if it’s that difficult for you to stop. I think we’re having a conversation about alcohol. It’s a much more mature conversation.

I think the next step in this and people have seen the campaigns that have been really pushing the whole idea right now on colon cancer. I just don’t think people realise, particularly women. I mean, the data now and the evidence is so clear about the link between alcohol and breast cancer. 

And I was just reading just before speaking to you that they did a survey of adults in the ACT, and I think it was three quarters of the people surveyed did not know that there was a link between alcohol and breast cancer. That’s kind of terrifying. So I think having those conversations is really, really important.

Dr Ron Ehrlich: [00:08:38] I know. I think the whole idea of a little bit of one, you know, when you know about the biochemistry of it all, you can I mean, you know, even the claim of resveratrol being positive, I’ve heard some estimates that you actually have to drink about 100 liters a night to get the food, you know, but anyway, it’s good to know the trends are heading in the right direction on alcohol.

And we’re going to get into some other things. But let’s touch on tobacco because these are the two ones that we find illegal in our society. What’s the trends happening with tobacco? What’s happening out there?

Tobacco and Vaping

Paul Dillon: [00:09:14] Well, certainly. I mean, we have one of the lowest rates of daily smoking in the world. I think we kind of fight with some Scandinavian countries where we kind of stand, but we do incredibly well. The world looks to us for our tobacco prevention campaigns and the results of them. I think anybody, any Australian who goes to Europe for the first time is, I’m still really, to this day, kind of surprised at how many people they see smoking, even though their smoking rates have dropped. But we have done it incredibly well. And certainly when it comes to young people unbelievably well.

Look, I was a teacher back in the late 70s-early 80s and a primary school teacher. And way back then, I mean, we were having, when we went on playground duty, we’d have to go round the toilets to see if there were any primary school children having a quick puff. Of course, it just doesn’t happen anymore. I mean, we are seeing this kind of vaping issue that has kind of popped up. 

And, of course, there’s huge public health, there’s a huge debate at the moment around the whole issue of vaping, because you’ve got public health campaigners who are saying, look, this is a problem because it could lead to normalises smoking it. It’s a gateway to future smoking.

Paul Dillon: [00:10:37] And then you all have, on the other hand, the harm reduction group, the pro-vaping lobby, who are saying, look, we still have a group of hard-core smokers who can’t quit. This is a safer way of nicotine delivery. So that debate is raging at the moment. And can I tell you, the pro-vaping lobby is savage, I have never in my entire, I’ve done media for a very long time, 25 years, and I’ve never been attacked. 

Like I wrote a piece for parents so if your child turns and says, ah, you know, they find out their child’s vaping and said: “Mom I’m only vaping, I’m not smoking.” And I gave some suggestions on how you could respond. I was attacked. I was accused of being a Nazi. I was accused of killing more people than the Holocaust. All my social media accounts were all attacked from around the world.

Now, as I always say, I don’t really care of what people in their 20s do, and you know what, if vaping can help anybody move away from nicotine, you know, any greater harm, that’s fine. I don’t want to get into that debate, but to what I hope what I care about what my passion is, these young people. And as always, what happens with any of these debates, we had the same thing with pill testing a couple of years ago with these pills, with these very, very heated debates. Kids get caught in the middle here because I think people forget that teens are very good at cherry-picking their information.

Dr Ron Ehrlich: [00:12:16] And you were attacked because you were suggesting that vaping was..? Why were you attacked?

Paul Dillon: [00:12:21] Well, I think the issue is that the pro-vaping lobby maintains a very strong, everything they say they will respond. Anything about teenagers, they will go “Teens should not be vaping.” OK, that’s a statement. And but when you actually put a prevention message out there,q you actually give a potential harm associated with vaping. They attack you.

Now, I put a call out and I said very, very clearly, if teens should not be vaping, please tell me why. Because if you can actually give me reasons why you don’t think they should, then I can use those. And I gave some simple little things that I thought were most likely going to be acceptable.

 And you get kind of no response because, of course, any of them, they believe, can be used to attack vaping and to prevent it from coming onto those people who are nicotine dependent. And as I said, I totally support if someone wants an alternate nicotine delivery system and they go through the right process, et cetera, they are aware if there are potential risks.

Paul Dillon: [00:13:37] I’ve looked at all the research and the trouble is, the research is so contradictory. You’ll get one piece of research that will say very clearly what causes this lung disease. It does this. It does this. And an expert says it doesn’t do any of those things. That’s really problematic. And what the pro-vaping lobbies say is that the anti-vaping research is funded by big tobacco. They want to keep you smoking. And then I was accused of being funded by big tobacco. That is just laughable, but also insulting.

And I think the trouble is that you know, I hate the term vaping epidemic. And I have been very, very careful not to do that because over the years of doing this has been all part of epidemics. And you’ve got to actually look what an epidemic really is. And that’s not what we’re saying. 

But we certainly are seeing young people who are struggling with nicotine dependence as a result of vaping and their parents are really, really distraught. And when someone turns around and we keep seeing it in the media that this is not happening. And that’s what they keep saying, this is not happening. It’s an insult, a total insult to those parents who and young people who are struggling. Is it an epidemic? I have never said that. I never will. But is it an issue and a growing issue? Yes, certainly it is.

Dr Ron Ehrlich: [00:15:06] Let’s move on to drugs. Because drugs are a big issue in our society. We know that. And before we dive into some of the problems, I wondered if you might give us a bit of a historical perspective about what drugs are we talking about, what drugs are of concern for society as a whole?

Drugs: A Historical Overview

Paul Dillon: [00:15:24] Well, I think we’re going through a very interesting time currently because of the whole COVID-19 pandemic and the resulting restrictions are lockdown. Certainly in Australia, you would have to say when we talk about drugs, of course, we’re saying other drugs apart from alcohol because alcohol, you know, there are illicit drugs and there are prescription medications. So let’s look at the illicits first, I suppose is the best way to go. We know quite a lot about our illicit drug use in this country.

We have a fantastic data collection instrument, which is the National Drug Household Survey. It’s collected every couple of years and they interview around about 23000 people. The only issue with it is that it’s of households. So you’re missing a couple of key groups there, like the homeless, people in prison, and things like that. So I suppose the hardcore people are not captured in it. 

But why I love the household survey is when I’m presenting particularly to parents, I said I’m saying, look, this is you. This is Mr. Mrs. Joe Normal. And the best part is being collected for a number of years. So you can track trends over time. So what you are seeing really is that Cannabis, the most popular illicit drug in Australia and around the world, has reduced quite dramatically. It’s dropped. It certainly has kind of picked up again in the last couple of surveys, but nowhere near where it was in the 90s.

Dr Ron Ehrlich: [00:16:58] Give us some known indication of how common it was and what those trends were. Just not for.. I don’t know. I’m not going to hold you to this.

Paul Dillon: [00:17:05] Yeah look, I mean, for young people particularly, I mean, I think we hit our lowest point a couple of surveys ago, but across 12 to 17-year-olds, across young people, it went from something like 16-year-olds. It was about 50%, not 40, I think it’s 49.6% to 16-year-olds had tried in 1996. And it went down to I think it was around about 26%. It’s about 29% now. And that’s ever driving. That’s not regular use. So what we saw was quite a tremendous drop across the general population I think it came about when it was that it kind of dropped to its lowest rate. But once again, it’s picked up again, but it’s much lower than it was in the 90s. 

Look, I think there are a couple of reasons for that. I think the main one around Cannabis for a long time was that it is typically smoked. And we now have the vast majority of people choose not to smoke. That’s changing, I think, because of the kind of the return of and the escalation of edibles. Edibles is certainly a growing trend. But I think also amongst young people, one of the reasons that cannabis has dropped is there’s a kind of a greater understanding or there’s some kind of concept of cannabis and mental health. 

And I don’t think young people are quite aware of what the link is. And it needs to be said and want to make it very clear, cannabis does not cause a mental health problem. But in those people who have a predisposition, it appears that it’s likely to unlock a mental health issue. And so things like Schizophrenia and Bipolar, it doesn’t cause those, but it unlocks them. 

I think young people have an awareness of that. And I think young people are more aware of mental health in general. I don’t know about you, but when I was growing up, I didn’t know, even though I had mental health. But kids are very aware of it. And so I think that’s another reason why we’ve moved away. 

But it’s certainly, as I said, it’s there’s a bit of an uptick at the moment. And I think that what I believe that’s likely to be due to is a real confusion amongst young people of Iran, its legal status. I think, you know, the medicinal cannabis issue is confusing to everyone. No one really knows how the scheme works in this country.

Dr Ron Ehrlich: [00:19:37] We’ve just done a programme with Professor Ian Brighthope on that very subject, Paul. So we will be exploring that.

Paul Dillon: [00:19:45] Yeah. Look, it’s a fascinating area. And as I always say, if anyone asks me what my belief, you know, where do I stand on medicinal cannabis, I said totally if it helps one person, it’s fantastic. But it’s like any treatment, any treatment option is going to work for some people. It’s not going to work for others. 

And I think that’s a very sad part. I’ve been involved with a couple of families whose children had particularly Dravet Syndrome, you know, awful epilepsy, and they had been waiting and waiting and waiting for their child to get access to medicinal cannabis. And one family, in particular, I remember it was heartbreaking. They wanted to get onto this scheme and they used it just didn’t work for their child, had no success at all. And unfortunately, their son died not long after which which was just tragic.

I think sometimes medicinal cannabis is put up as a kind of like a silver bullet that, you know, it’s going to fix everything. And once again, it’s like any treatment option. So medicinal cannabis is one thing that confuses kids. And the other one is, of course, the legalisation debate that goes on. We now have two countries in the world that have legalised it, Uruguay and Canada. We have I’m not sure if it’s 14 or 18 states in the US that have legalised it. And it looks like Mexico will be the next one, it’s in the process in Mexico.

Paul Dillon: [00:21:10] But I think young people hear that, they’re confused and of course, to top it all off, they’re totally bamboozled by the ACT. They believe it’s legal in the ACT. And that’s not what’s happened. They’ve done partial legalisation in the ACT, but yeah. Well, it basically means, as I understand it, they wanted to legalise it, but it’s incredibly difficult to legalise a drug in Australia because we signed up to a whole pile of international treaties. 

Some people may remember the issues with the heroin injecting rooms when they were proposed. So as I understand it and if I’m incorrect, I apologise but I think you have to be 18 years or over. You can grow up to two plants in your house, you can have up to 50 grams of cannabis in your possession. But and this is big but you can only use it yourself. You can’t share it. You can’t get it. You can’t sell it. You can’t take it to someone else’s house and use it. The most bizarre thing about the law is that you can’t buy seeds. So I’m not quite sure how you’re growing yourself. So it’s kind of a bit confusing.

Paul Dillon: [00:22:28] And look, always my issue around the legalising of anything is I totally support decriminalising because, you know, I don’t like seeing young people ending up in the check in the justice system. But I think legalising, the trouble is that if you make a drug legal and make it available, what’s going to happen is there will always be a black market because no country is ever going to legalise a drug and allow everyone to get it. 

They usually are going to have a cut-off of 18 or 21. What that means instantly is that there’s a black market for those under the age of 18. And if you’re a supplier, who are you then going to target? So as much as legalising kind of solves a whole pile of problems. And I totally get that. It also creates some new ones for the group of people that I am most concerned about, because, I mean, you only have to look at alcohol to see what’s happened.

Dr Ron Ehrlich: [00:23:30] I was going to say that on the subject of legalisation, there are always caveats put on it. And if you had to say the range of problems in our society from all drugs, including alcohol and tobacco, if that was 100, what number would be tobacco and alcohol? You know, they would be the main concern by a long, long way, wouldn’t it? 

MDMA 

Paul Dillon: [00:23:53] Yeah, I think we have to be.. Yeah, I totally agree. I think in terms of, you’ve got to look.. 

Dr Ron Ehrlich: [00:23:58] And we have caveats on those? 

Paul Dillon: [00:23:59] We do and you kind of got to look at also what danger, you know, the dangers are or risks or whatever, because if it’s at risk of overdose, for example, you’d put heroin way up. They up the NGHB, way up the end of cannabis, way down the other end. But if you talk about risk, the potential risk for mental health, cannabis would move up the other end and you’d put other drugs further down. 

So I hate that young people love throwing a thing of, oh, you know, alcohol, alcohol’s legal, but it causes all these problems. Cannabis is illegal and it doesn’t cause any deaths. And I go, well, maybe it doesn’t. But, you know, comparing substances is really problematic because it’s like comparing apples and oranges. So as much as people love to hear, let’s put them in an order. I don’t think it works particularly well. 

Paul Dillon: [00:24:57] And yeah, I think, as I said, my concern is always young people and what I loved about what Canada has done. I don’t know if anybody’s looked at how when Canada legalised it in 2017, Trudeau came in with a very, very strong caveat about legalising it, that if they were going to legalise it, they know the greatest harm when it comes to cannabis is likely to be the earlier use. 

The more you use it when you’re younger, the greater the problem. So it became very much that lots and lots of money, huge amounts of money were put into education campaigns for young people around prevention of cannabis, trying to prevent early use. The fines, the legislation that was introduced around providing and supplying cannabis to young people, they’re astronomical. It’s really, really huge.

Paul Dillon: [00:25:54] And what is also done when you do legalise a drug, it does enable you to talk about it in a much more open and honest way. And certainly, if you look at the campaigns in Canada that have come up with for young people and prevention, they’re fantastic. They’re wonderful. And so there are benefits there. 

And, yeah, I wish it was, you know, New Zealand went to the polls to find out whether they were going to legalise it earlier this year. And I was stunned to find out that they didn’t approve it because look, I’ve worked in New Zealand. I do a number of schools in New Zealand and New Zealanders love their cannabis, and so I was really, really surprised that it didn’t get up, but I think it would be really interesting to see what New Zealand would have done if they had legalised because I think they would have gone in a very similar way to Canada. 

And, you know, we have to look at other countries and see what they’re doing and kind of pick the best bits, I think.

Dr Ron Ehrlich: [00:26:51] Well, how amazing to hear of a government taking an intelligent, well-informed, well-organised public health response to legislation.

Paul Dillon: [00:27:01] Based on science.

Dr Ron Ehrlich: [00:27:03] Based on science. Well, I’m going to get to that in a moment. But hang on. We’re just taking a few.. we’re just putting a list here. And you’ve covered the cannabis. What are some other drugs that, well you know, we’re talking about illicit and prescription. We could be here all day, Paul. But let’s go on. What are some other illicit drugs that are an issue for young (people)?

Illicit vs Prescription Drugs

Paul Dillon: [00:27:23] Well, the second most popular illicit drug in Australia is Ecstasy, MDMA, caps, pills, pingers, whatever you want to call them. And we have one of the highest, and this is sometimes challenged by some researchers, but we have one of the highest rates of Ecstasy use in the world. I think it’s 12% of our population have ever tried ecstasy. I think it’s around that figure. It’s a similar figure for 12 to 17-year-olds as well. 

And yeah, for some reason, ecstasy has always maintained fairly steady popularity in this country. It’s kind of slow down for a while, and mainly because the purity of the drug was very, very poor. But that has certainly changed in recent times. We’ve seen a very steep return to very high purity MDMA, and it’s mainly due to the fact that people found alternative ways of manufacturing the drug. 

So, ah, but I mean, at the moment, I think it’s really interesting because really, are we seeing a lot of people likely to be using this drug in the current situation? I mean, you know, very few people take ecstasy and then watch neighbours. I mean, the reality is there, you know, it’s more like tonight’s nightlife and those and those kinds of settings. So it would be interesting to see what’s happening.

Paul Dillon: [00:28:52] Certainly, there’s been a number of files. There are a number of studies internationally and in Australia where they’re looking at trends through the pandemic. So, you know, what happened during the lockdown? Did we see what happened to access, availability, and use of drugs? And certainly, during the lockdown, we saw ecstasy use drop by because, well, no one people weren’t going out to places. They weren’t seeing each other. And it was less opportunities to use the drug.

There were also reports of drugs that were imported like ecstasy, heroin, cocaine. They had gone down. You know, you couldn’t get them as easily. That changed very, very quickly because people found alternative ways of getting the most drugs are flown into the country because planes weren’t coming in. But you only had to look at the news and see, you know, these boats full of cocaine that was intercepted by police or those great big blocks of cocaine that got washed up onto beaches on the East Coast to see that they are alternative ways of getting them either.

So in terms of use, we would say maybe cannabis and it’d be ecstasy. I think cocaine comes next. And that’s a very interesting trend because that’s the first time that cocaine really came up. And it’s almost challenging ecstasy or MDMA for that spot. And then you’d kind of look at hallucinogens, LSD, magic mushrooms, a whole pile of naturally occurring ones. They kind of either the level that’s the order for school-based young people. It’s pretty much the same for the general population.

Dr Ron Ehrlich: [00:30:28] It’s interesting that out of the four, three or four that we’ve named, because we’ve also done a programme with Mind Medicine Australia and are about to do another one soon because they’ve got a conference coming up in Melbourne about the use of these drugs therapeutically in very controlled, in very controlled situations.

Paul Dillon: [00:30:48] I like how you’re emphasising the very controlled situation.

Dr Ron Ehrlich: [00:30:51] It’s true, wasn’t it?

Paul Dillon: [00:30:52] Totally t.

Dr Ron Ehrlich: [00:30:53] They are used in very controlled situations but yet have incredible therapeutic benefits.

Paul Dillon: [00:31:01] Look, I went to a conference in Paris in 1996 and I heard the very first, I mean, this was not the hallucinogens like psilocybin and things like that. This was about the use of MDMA as a therapeutic tool for PTSD. And it was a Spanish study. I remember it so well, 1996. And this young woman stood up and talked about it with survivors of sexual assault and rape, and it was, to my knowledge, one of the very first studies that actually looked at the use of MDMA. 

You know, it had been used by the shoguns many, many years before in psychotherapy, but it was kind of mind-blowing, actually, even thinking about a drug like opioid ecstasy being used as a therapeutic tool. But when you heard how it was used and, you know, in very controlled settings, guiding, a counselor, a therapist, guiding someone through an experience. 

Yeah. And certainly, now the work that’s been done by maps in the US, the multidisciplinary area, if I remember what the acronym stands for. But yeah, it’s quite incredible. And to see people getting it up here I think is really fantastic. Any option to help people with those kinds of issues? I think we have to look at.

Paul Dillon: [00:32:28] Once again, I think we have to be incredibly careful about the messaging around this. And what I get quite often is young people going are LSD or magic mushrooms. They’re absolutely fine, blah, blah, blah, blah, blah. They’re used for therapy, for anxiety or depression, or whatever. And I’m very quick to say, have you read the studies? 

Have you seen how it’s done? It’s not like they throw a mushroom at you and say go for it. That, I think is very, very important because sometimes the headlines that you see in newspapers around, you know, there is a very famous one. I’ve actually got it that says LSD cures depression. Those kinds of things are risky when you’re particularly talking about young people 

Dr Ron Ehrlich: [00:33:16] And when we come to prescription medication because, you know, people think there’s a drug problem and they think of these illicit drugs. But sometimes and a lot in America, particularly, some of these prescription drugs have been a problem. How are you seeing those impacting our kids?

Prescription Drugs and Children

Paul Dillon: [00:33:35] Well, I think they’ve always been around. Certainly, the ones that really, I suppose, got the main kind of coverage in the media would have been the ADHD medications for a long period of time, things like Ritalin, Dexamphetamine. And there were lots of stories about them being sold by young people who had been diagnosed with ADHD and also used to study more effectively. The idea was that if ADHD kids use them to focus better then if you use them to study, you would do the same thing. 

They were the ones that, look, I was involved in a study a number of years ago that was funded by the New South Wales Education Department to find out how big an issue this was and what they found. What we found was that we couldn’t find very many young people who were actually doing it, although everyone was talking about it. It was meant to be a six-month study. I think we ended up doing it for 18 months, trying to find young people who were doing it.

It’s certainly happening. But that was the big one there for a while. But now, certainly, I’ve seen just particularly in the last 18 months, a real upswing to particular medications, both Benzoin and Valium and way upfront is that that kind of really worries me. I sometimes get asked by young people, why don’t I talk about this in my talks in schools? And the main reason I don’t is because I really don’t want to kind of in any way promote it.

 And not that I believe talking about it would necessarily promote it, but I think some people just have no what would not even think about it. But many of these kids are drinking and using these medications. And, you know, if you look at the overdose potential of something like Xanax, if you drinking, using it with alcohol, I mean, that’s terrifying.

Dr Ron Ehrlich: [00:35:33] Both are antidepressant antianxiety, aren’t they?

Paul Dillon: [00:35:36] Yeah, yeah, yeah, yeah. But Xanax is a particularly strong one. And I just did a blog a couple of weeks ago about the purchasing of drugs online, which is a really and particularly through social media apps. And the reason I did it was I’ve been contacted by a number of parents to say, what do I do to help? You know, where do I go? And in all these cases, young people had purchased a range of different substances, both legal, illegal, and pharmaceutical via particularly Snapchat.

Snapchat is the one that young people are more likely to use, but also Instagram. And I had one parent of a 13-year-old girl who had been purchasing Cannabis and Valium via social media apps and then running quite a thriving business on selling them. She was 13, and this is not a kid with a whole part of social, you know, other social issues, social problems, she comes from a great family, loving family. There are no outward problems there. 

But, yeah, more and more, I am seeing kids who are starting to mess around with pharmaceuticals. And I think one of the reasons for it is that I’ve said for many, many years, we always talk about, you know, one of the greatest dangers about illicit drugs is you never know what’s in it. Well, kids are confident when they get pharmaceutical, they know what’s in it. And also they come from a doctor. So how can they be bad?

Dr Ron Ehrlich: [00:37:11] Yeah, well, I mean, we’ve done it. We’ve also done a programme with Dr. Jodie Lowinger of Sydney Anxiety Clinic. And she shared with me a statistic. I think this was one in one in four or one in five kids under the age of 18 are being diagnosed with depression and anxiety. Was it a one in four or one in five, although I don’t know whether I’m not exactly sure. It’s a shocking statistic that one.

Paul Dillon: [00:37:34] I think it’s one in five. I think in the last secondary school survey, which was conducted in 2017, they asked a couple of questions about mental health. And they said, have you, they asked the young people, so this is self-report.. Have you been diagnosed with a mental health condition? And the numbers, particularly for, you know, 14, 15, 16, that age group was terrifying. And I think, yeah, of course, if a child has a mental health problem, of course, they need help and everything. But you’ve got to remember that when you actually give them a diagnosis and you tell them you’re kind of labelling someone as well, which I think is incredibly problematic.

And yeah, if you look at and also I think we have I don’t know if you’ve seen the data that’s coming out now about the impact of lockdowns on young people and restrictions across the world. And we have seen increased rates of anxiety, increased rates of depression, and you are bound to see increased, you know, medication of these young people, which look, I’m totally supportive if there’s something that helps someone feel better, if they’re going, I get that. But I think this, we wonder why some young people start using illicit drugs. Well, we start making them drug users at a very, very early age. I mean, we have baby Panadol, for heaven’s sake, baby Nurofen.

Paul Dillon: [00:39:09] And as I always say to parents, if you want to kind of they say, when should I start talking about drugs with my child? I go when you start giving them to them. And so, you know, one thing I often say to parents is think about the last time your son or daughter had a headache. What was your first response? And so many times it’s gone grab a Panadol instead of saying for most young people, go and get a glass of water because, you know, it’s dehydration for most and you have a glass of water, you fix it up. But it’s this whole idea of and also I think we live in this world currently of the five-minute go into a doctor consultation. 

And that’s kind of, I remember when I was growing up, I’ve spoken to my mother about this, that I remember going to the doctor and something was wrong. And the doctor would tell you, you’re going to be on this medication and blah blah blah and they talk it through. Even with you as a child, they would have a chat. Now you get a prescription, you walk out the door, you go to your pharmacist. Your pharmacist might say something. In fact, most of them do. I think they’re pretty responsible that way. But realistically, it’s just a medication. You pop it don’t think about it.

Dr Ron Ehrlich: [00:40:23] Another aspect to that, of course, is that if you are prescribed it, say you are a young 14 to 16 year old on anti-depressants. I mean, some of the reading that I’ve done is some of those classes of anti-depressants have been research has been done on adults, but the effect on children is to increase suicidal thoughts. Is that what you.. have you heard that kind of statistic, too?

The impact of Antidepressants on Children

Paul Dillon: [00:40:50] It’s not my area. So I’m very hesitant to actually speak on it. But certainly, I think there are concerns, I suppose, to put what you’re saying in a different kind of context. I will get many young people who will come up to me who have a pre-existing condition. So something like epilepsy, diabetes, or depression. And they will come up and they’ll say, “Look, I’m on medication. And what effect will it have if I drink alcohol?” And now I don’t know anything about their pre-existing condition. 

So what I always say is, well. You need to talk with your doctor. Do you have a specialist who deals with you and they will say yes, particularly with, you know, the more extreme conditions? And I say so. Have they ever talked about this now? Well, I think we tend to forget this and I say this to kids, how long have you been seeing this doctor? Some of them have been four or five years. They’re now 15, 16. 

And I go I guarantee they still see you as a 12 or 13 year old. They’re not looking at you now and thinking, oh, you’re going to parties and you’re drinking alcohol. So it’s really important you have a conversation with your doctor and go, look, I’m getting to that age where I might be considering drinking. And when it comes to anti-depressants, as I understand it and as I said, I’m not a doctor, so I have to be very careful.

 But as I understand it, what some doctors can do is they can prescribe medication to children. And realistically, if they move into that area where they’re going to start drinking, that medication is not good with alcohol. So I put them on to something else or at least have a discussion about it. And I don’t think that’s happening.

Dr Ron Ehrlich: [00:42:32] Look the other aspect that I wanted to just touch on is, you know, there’s been a war on drugs now for I don’t know, I think Nixon came up with it in the late 60s and even as late as a year or so ago, I remember hearing our premier talk about zero tolerance. Just say no. How does that kind of advice play out in reality?

Paul Dillon: [00:42:56] Like we said, the war on drugs is a horrible kind of term because it implies, you know, a battle, number one. And number two, someone has to lose at the end. Look, I’ve been working in this field for a long time, gone through quite a few through a number of different prime ministers and different governments. 

And certainly, you know, the John Howard years of the war on drugs, which were, you know, that time if you worked in the alcohol and other drug fields during that time, my goodness, so much money was pumped into this area. It was phenomenal. You know, you go to a public health conference and anyone from the Heart Foundation or Cancer Council would spit at you because, you know, so much money was pumped into alcohol, the drugs when the reality was that there were other public health issues that were not ignored, but certainly weren’t getting as much attention.

Paul Dillon: [00:43:54] Now, of course, alcohol, the drugs continues to be a significant issue. It needs to be dealt with. And back then there was a lot of money put into treatment, everything but an awful lot of money also put into supply reduction. So going into the policing out of particular illicit drug use, is that appropriate? I think certainly we need to make sure there is some kind of supply reduction ’cause you don’t want the world swamped by drugs. But it should be more of a balanced approach. And that’s what we’re meant to have in this country, an approach which is three tiers and it’s demand reduction, supply reduction and harm reduction, three parts and are meant to be balanced.

They never really have been balanced because, of course, harm reduction strategies, those ideas of keeping those people a little bit safer if they choose to drink alcohol or choose to use other drugs. And those kinds of when you put money into those things, there’s nothing to kind of see. And they’re not necessarily particularly palatable to the general community.

Paul Dillon: [00:45:07] Now, on the other hand, demand reduction, you just pull out a whole pile of police officers or a helicopter or a police boat or a machine that goes, bing, you’re going to get a government, a minister standing in front of them going, look where we’ve put our money. It looks good. And so that’s where a lot of the money has gone. I do have to say that certainly through the Howard years, I was involved in a study that last year is kind of a worldwide one. 

And I was asked to look to do the Australian aspect of it, which is to look at, you know, policies over the last few years. And we are asked, I think we interviewed something like 13 experts in Australia about their beliefs, about how well we have done in this country, in this area over that time. And although everyone said, pretty well everyone, in the alcohol drug field was very critical of the John Howard years, the tough on drugs policy, that’s what it was, not war on drugs, the tough on drugs policy. 

Pretty well everyone said that if you really looked into what was happening back then, there were some pretty incredible things that had happened. There was, you know, funding of needle syringe programmes. There were a whole pile of really quite incredible initiatives that were introduced during that time that didn’t get a lot of publicity because, of course, they weren’t palatable to the general community. Now, a lot of that since then has eroded over time, and I suppose that’s kind of popped up when we saw the so-called and I hate the term the ice epidemic that hit. You know, there was lots of discussions around, well, the treatment options that were once around treatment centres, detox rehabs just weren’t available as they had been a number of years before.

Paul Dillon: [00:46:56] So I think in this country, it’s difficult because I think we live much more conservative times now than we did. If anyone listening to this ever listens to Triple J in the 90s, they might remember listening to me. I had my own spot on Triple J for many years called Doing Drugs with Paul Dillon, which was a great name. 

Now, to be quite honest, what we talked about back then you could not do on a radio station now. You couldn’t do it. We were able to be incredibly honest, get people to call in, and talk about their drug use. And it was always balanced, always balanced. But I don’t think in today’s world, I mean, we would have a newspaper very, very quickly taking one little kind of sentence that was said splashed across the front page of the paper, and it would be removed. And, of course, you know, the whole cancel counterculture kind of thing works both ways. I think.

Dr Ron Ehrlich: [00:48:01] Gee, Paul, I think you and I are a similar age and we’ve what we are and we grew up in a time when we just thought there would be a trajectory of liberalism, you know, openness. We never saw you know, and this is just the history of the world really. There are swings and roundabouts and we were at that very conservative point. That’s a whole other story as well.

Listen, if a parent was listening to this, and I’m sure many parents are, well, I’m going to ask you to give advice to the parent and to the teenager. What would be your tips for the parent who is wanting to keep their child safe?

Tips for Parents to Keep Their Children Safe

Paul Dillon: [00:48:38] Oh, look, the most important thing is it’s always the same. It doesn’t matter what social issue it is, whatever issue it is with teenagers, it’s about talking to them, keeping the lines of communication open as best you can. It could be incredibly difficult when you’re working with, when you are dealing with an adolescent, a teenager because their brain is primed for them to pull away from their parents. You know, their peers become far more influential. 

They want to establish an identity that’s different from their parents. They push boundaries and it’s hard. But if you can keep them talking and always remember that you were the most important influence in their life very early, and you will always be a very important influence in their life. It’s just that your role as a parent of a teenager, particularly as you change from a managing role when they’re a child to a consulting role when they move into adolescence. 

And if you can kind of keep that in mind, you have a much better chance of keeping a good relationship with them. That is not going to inoculate them from alcohol and drug use or bullying or a whole range of horrible, you know, cyber safety stuff, all of that stuff. It’s not going to inoculate them, but it gives them a better chance of being as resilient as possible and getting through that difficult time. 

Dr Ron Ehrlich: [00:50:00] Hmm. And for the teenager who when, you go into schools and you talk to kids, what do you say to them? Because they’re going to be confronted saying no is not always the choice that they have. What do you say to kids in schools?

Paul Dillon: [00:50:17] Well, I’m certainly not a just say no person. I don’t. But number one I don’t think it would work. I mean, to be honest, if I was speaking, you know, I’m speaking of 10, 15-year-olds. There is a group of young people in that room who last weekend went out highly likely to have drunk alcohol and had a really good time. And if I turn around and say don’t do it well, I might as well get my head and bashed against a wall for about an hour. It’s not going to work. So it’s interesting. I’ve just got a couple of questions from a young person to who I’m trying to respond because he’s talking about, you know, normalising drug use when you talk about it in school. 

And I always try to present in a way of number one, always giving the context that most importantly, we know that most young people actually don’t use illicit drugs, school-based young people. We also know that we have a growing number of young people who are choosing not to drink. So that context needs to be put there first. But then you have to kind of acknowledge. But if you are involved in this, you know, the reality is we’d like you not to be, but we are going to give you as much information as we can to keep you as safe as possible. I see my role as being a person who puts pillows around kids, you know, so that if anything goes wrong, whether they find themselves at a party with a friend who’s drunk and they don’t know what to do, there are pillows to protect them. They’re going through a really, really high-risk time of their life. 

Paul Dillon: [00:51:44] Adolescence is an incredibly risky time. Their brain is kind of, they weigh risk-reward differently. They could know all of the risks. They don’t downgrade the risks, but they give far more weight to the payoff. So they’re going to when they look at a situation as an adult, we look at a situation. We look at risk. We look at rewards. And because we’re terrified of everything as adults, we go risk, risk, risk. We don’t do it. 

Adolescents do the absolute reverse. They look at the risks. They look at the reward. And the reward is just too great. So are we going to be able to stop kids from drinking or using illicit drugs if that’s what they want to do? Most probably not, but we can’t keep them as safe as possible, putting those pillows and strategies to keep them a bit safer.

Dr Ron Ehrlich: [00:52:28] I love that metaphor because as a parent if I was going to use that metaphor, I would encourage my child to know that as a parent, I’m their most reliable pillow.

Paul Dillon: [00:52:40] That’s a wonderful thing, right?

Dr Ron Ehrlich: [00:52:42] Yeah.

Paul Dillon: [00:52:43] Wonderful. I love that.

Dr Ron Ehrlich: [00:52:43] I really love that, too. Listen, thank you. Look, I want to finish up now, and I want you just I wondered if we might just take a step back from your role in education in the world of drug and alcohol because we are all on a health journey in this modern world. I wondered if you might think about what the biggest challenge is for an individual on a health journey in our modern world?

The Biggest Health Challenge

Paul Dillon: [00:53:05] I think is as a guy who’s going now in his early 60s, I think it’s the challenge of, you know, your mind as you get older, you kind of realise what you want and what you don’t want. You know, you’ve got a much more you’ve got greater clarity about the things that you don’t want to think. You have a lower tolerance for certain things. The trouble is, your body doesn’t keep up with that. 

And to actually like last year during lockdown, I broke my shoulder, one of the worst experiences of my entire life. It was awful. And all of a sudden everything was limited. And it gave me a great kind of insight into, well, you know, in 10, 15 years time, this is actually going to be even more limited than I am now.

So I think my kind of health journey is that idea of trying to keep as fit as possible, trying to do the right thing to ensure that I can have the best quality of life I can have in the future. And so I think to have something like that broken shoulder, and particularly during an awful time like lockdown was incredibly challenging. But it did give me a great insight into how I have to look after myself for the future.

Dr Ron Ehrlich: [00:54:28] Well, Paul, that’s a great message for us to finish on. And thank you so much for joining us today. We will, of course, have links to your website. And thank you again for the wonderful, wonderful work you are doing.

Paul Dillon: [00:54:40] Thank you so much, Ron. Nice to be with you.

Conclusion

Dr Ron Ehrlich: [00:54:44] Well, the subject of drug and alcohol is a subject that affects us all. It’s ubiquitous in our society, as I said, and to anybody who has bothered to try and give up alcohol, whether it’s dry July or just to give it up for a few weeks or a few months or even a few years, it doesn’t take you many days to realise how ubiquitous it is. It is in absolutely every celebration. And look, the biochemistry really doesn’t stack up. 

I mean, I enjoy a drink and there’s no question about that. And I’ve often described myself as just a social drinker. But there have been times in my life when I have been too social and I know I’ve never kidded myself that was ever good for me, even as a social drinker of just one or two glasses of wine a night.

But it’s interesting that alcohol is a big problem, but it’s so encouraging to hear that the trends are very positive amongst young people. And the same is true for smoking. Vaping was an interesting discussion. I thought what was so fascinating was the Canada model where they introduced, they decriminalised cannabis, but they launched a big public health campaign to try to make it clear that for young people, you know, it’s just not enough to say no. There are actually serious mental health issues for those that are vulnerable and who are those that are vulnerable?

Dr Ron Ehrlich: [00:56:23] Well, I think Paul was equally shocked when he heard the statistic, as I did with Jodie Lowinger from the Sydney Anxiety Clinic, that one in five children are being diagnosed with anxiety or depression. Now, that’s diagnosed. So one can only imagine how many other kids who are feeling anxious and depressed are similarly going undiagnosed. 

And, of course, the whole story about ADHD we’ve covered before, but one in ten children in Australia are being diagnosed with ADHD and Ritalin is being used sometimes diagnostically, because if the response to Ritalin is one of calming the child down, then that’s almost diagnostic for them having ADHD.

Interestingly, and I’m hoping to do a podcast with a respiratory, a paediatric respiratory physician, I did one many years ago who shared a statistic, who said of the one in 10 children that are diagnosed with ADHD, 50 per cent of those diagnosed are have an underlying sleep disorder breathing condition. So that goes off on another whole tangent. But the point being that it’s a big problem that exposes kids to medications in our society. And, of course, the use of cannabis, ecstasy, cocaine, LSD. I hadn’t really, for me, I wasn’t familiar with GHB (Gamma Hydroxybutyrate), Xanax, Valium. Boy, they’re out there, aren’t they? And alcohol, of course.

Dr Ron Ehrlich: [00:58:00] Look, I remember when my kids were growing up and this was about 20 years ago and they were just entering high school. And a child, a young girl a little bit older than them, had just died of ecstasy overdose. 

And our message to our kids and this is why I jumped on that analogy of putting pillows around kids because I think it’s really important to put a pillow around with, the biggest pillow around your child is to let them know that no matter what, you are the best pillow, pillow and pure for them going through the young adolescence and growing up that you’re always there for them. 

And with this child who died of ecstasy, one of the tragedies I thought was two things: 1) Perhaps they were mixing drugs, which is an important message to convey to children not to do that because they will inevitably experiment with drugs. And the second one is that 2) No matter what happens, no matter how bad the situation is, always feel that you could ring me because I will always be there for you and I will not judge. 

So you know, what a pity someone didn’t say, Hey, my friend is dying, come and help. Or as I spoke to Paul after this and said at the very worst, ring up triple zero on an ambulance will come, no one will judge. They will in fact be grateful that you saved a person’s life. 

Dr Ron Ehrlich: [00:59:31] I think this whole issue of drugs is an annoying one. I think I’ve had in my practise patients who are been undercover police officers in the drug squad. And I’ve asked them, hey, are we winning the war on drugs? And they just look at me and go, we probably get 5% of the drugs that are coming in. 

And then I have other patients who are judges and I say, you know, are we winning the war on drugs? No, we’re not. They should you know, it’s a losing battle. And I remember reading a report from a retired public prosecutor, DPP, that anyway, the public prosecutor who says we need to reform drug laws and X heads of police departments and Australian federal police departments who also said we need to reform drug laws.

And my question is to politicians in this space, what is going on in your head? I mean, are you not listening or looking at the harm the criminalisation of drugs has done in our society? To the individuals, to the families, to society, to the judicial system? Well, maybe one could argue there a winner there because it’s providing a lot of work. But no one, to my knowledge, is a winner are other than those that are supplying drugs illicitly in our society. 

So the politicians that are making this policy are either just plain ignorant, pig-headed or colluding. Colluding with those that are selling drugs because there are no other winners and we need this to be a public health win for everybody. If we could just take these huge resources that are being placed in policing, prosecuting and incarcerating people and transfer those billions of dollars, not to mention the billions of dollars that would come into government coffers, you know, on collecting revenue and translate that into public health messages we would be a better society for it. And let’s face it, drugs are not going to disappear. 

So let’s just accept that and do the best we can do for public health. That is overwhelmingly a message that I keep repeating on this podcast. What is the best that medicine has to offer and the best the public health messages have to offer? And that’s what we should be focussed on anyway. I’ll get off my soapbox. I hope this finds you well until next time. This is Dr Ron Ehrlich. Be well. 

This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.