19 March 2016

Cannabis Saved This Australian Boy's Life

Jai in Brisbane, sitting among the MCUA's 'Leaves of Change'
In what politicians in Australia would have you believe was an historic vote, the Australian federal parliament 'legalised' Cannabis for medical and scientific purposes. Health Minister Ley announced in February, 2016: “This is an historic day for Australia and many advocates who have fought long and hard to challenge the stigma around 'medicinal cannabis products' so genuine patients are no longer treated as criminal”. Jai was seen by one of the leading neurologists in Australia, Professor Ingrid Scheffer. Tests uncovered that Jai had a rare combination of three different types of epilepsy: Landau Kleffner Syndrome, Continuous Spike Wave Syndrome, Pseudo Lennox Syndrome, plus autism. Violent physical seizures and unseen seizures were almost constantly damaging his young brain.

JaiHospitalisedOne Australian mother who has long campaigned to give her child a chance to survive the cruellest of afflictions without having to worry about being arrested is Michelle Whitelaw from Brisbane. Michelle has spoken widely about the amazing story of how she had to risk all and go against everything she knew about Cannabis when it became the only hope to save her son’s life. And how his miraculous case has helped change the minds of Australia’s lawmakers. Michelle brought up her five children disapproving of recreational drugs, but when one of the country’s top neurologists confirmed there was nothing more Western medicine could do for her son Jai, 11, Cannabis became their only hope. Terrified she would get a knock on the door from the police and face losing her family, Michelle documented their story meticulously.

Michelle remembers clearly the moment her life changed forever. It was the 16th of January, 2010; a sweltering sunny afternoon in Melbourne at a family barbecue. Her bubbly, chatty, youngest son Jai, then aged 5, stood chatting to his cousins. Then, without warning, his legs gave way and he collapsed. “For 18 long minutes, he convulsed on the ground”, recalls Michelle. “We called an ambulance. Jai was wired up for EEG tests, given blood tests, brain scans. His condition was pretty unusual. They even spoke with neurologists in the United States”.

“As well as the physical fits, Jai was suffering up to 500 sub-clinical seizures a day. Every three to five seconds his brain was misfiring”, recalls Michelle. “Sometimes he’d drop to the floor, other times he’d get that blank look we came to recognise, or we couldn’t even tell”. Jai’s life was never the same again. He was given a cocktail of 35 tablets. His parents Michelle and Andrew installed cameras, microphones, alarms all over the house. They never left their youngest son alone for a minute.

Jai2010“Over the next four years, my husband Andrew and our four children: Lachlan, then 11; Samantha, 15; Emily, 16; and Benjamin, 19; all rallied round their little brother”, says Michelle. “We were in and out of hospital. Brain scans revealed that every time his brain misfired, it was frying his brain, which was slowly shrinking. The helplessness of seeing our little Jai deteriorate impacted each one of us. We lost count of the amount of times we nearly lost him and had to resuscitate his tiny body. I was diagnosed with post traumatic stress disorder (PTSD). Our cheery, chatty child, with a huge vocabulary, able to turn his hand to most musical instruments, was left slurring, stuttering, barely able to walk and talk”. In early 2013, Professor Scheffer had some grave news for the family: all clinical solutions on offer had been exhausted. There was nothing else Western medicine could do to stop their son’s continual decline.

Jai2010bWe were told to be prepared for sudden, unexpected death”, says Michelle, bitterly. “It was a dark time. The neurologists had warned that weaning Jai off all his high strength medications would be very difficult and could even kill him. We knew other families with children who had died trying. But the side-effects were almost as heartbreaking as his illness. He’d lost 17 teeth due to calcium deficiency; the steroids had damaged his muscles, even his vocal chords; and he had cataracts like an old man. Jai suffered horrible withdrawal symptoms. But like a drug addict coming back to life, Jai improved. By March 2014, his seizures weren't as frequent or brutal. We had Jai back for eight good months”.

Sadly, it did not last. “Then one horrific night in November 2014, Jai’s little body shook with six hours of seizures. We didn’t know what to do. I lay next to him in bed, terrified of what would happen next. When he woke up, Jai had no idea who any of us were. He was wetting himself, choking on food. Doctors said there was nothing more they could offer. We brought Jai back home”. Michelle had created a Facebook page for sharing information with other families affected by epilepsy. Many reported great results using Cannabis Oil (CO). “I’d spoken to hundreds of families around the world. Many had been investigated by the police and had children’s services called in for treating children with Cannabis. But we had no other hope”, insists Michelle. “The more I read, I thought the side effects couldn’t be worse than the drugs we’d weaned Jai off”. The family decided to give Cannabis extracts are a try.

Mullaways-Medical-CannabisI phoned a Cannabis farmer recommended by another family with an epileptic child and 24 hours later, it arrived: a bottle of THCa extracted from the whole Cannabis plant”, recounts Michelle, referring to tetrahydrocannabinolic acid, the non-psychoactive biosynthetic precursor to THC. “We kept it refrigerated. The heat of the Australian sun could change its effects. I sat on my couch for two days and wondered what I’d do if it didn’t work. Jai was dying. I wasn’t prepared for Jai or my other children to suffer like this any longer. One thing I knew was I was ready to take my own life and his rather than carry on like this. Jai was slumped in his seat, drooling and having constant seizures”. Despite the legal risk that could land Michelle in prison and her children to foster homes, she started the treatment.

On the morning of 14 December, 2014, I squirted a syringe with one millilitre of whole plant THCa liquid into his little mouth. Jai looked up at me, it was the first time he made eye-contact with me in a long time. A couple of hours later, I gave him another micro-dose. I waited and watched. And that evening, he looked up at me again. And then he asked, ‘Mum can I go outside?’ I cried”. Was it real? It was impossible not to have doubts. “Did I want him to get better so much that I was imagining things?” Michelle explains, describing her shock. “I hooked his little arm under mine and we walked out and sat on the grass. ‘I’m hungry’, said Jai. The transformation was miraculous. Within 48 hours, I said to my husband, ‘We’ve got Jai back!’”

Jai2Last January, just six weeks after Michelle and Andrew had brought Jai home from school and said goodbye to all his friends and teachers for what they all believed was the last time, Jai started school again. “When we took Jai to our local neurologist, she was stunned”, adds Michelle. “Jai told her all about the bicycle he got for Christmas and how he was riding it and enjoyed going to the park. ‘I don't need to know what you're doing’, the neurologist said, ‘but keep doing it’. The last time I’d seen her, I’d asked about medical Cannabis. ‘I can’t support medical Cannabis’, she’d insisted. ‘All I can say, Michelle, is you need to do what you need to do’. Jai has had just four fits in the past 14 months. The theory is we all have cannabinoid receptors linked with all kinds of functions. Jai suffers from a cannabinoid deficiency that can be treated with Cannabis Oils”.

JaiMichelleWhitelawBrisSept2014Despite the incredible recovery, the whole time Michelle admits she was terrified that the family would get a knock on the door from the police and that children services would be informed of her illegal activities. So she began to campaign and travel to meet any local and national health official and politician who would see them and hear Jai’s extraordinary story. “Over the last year, Jai has come with me whenever possible to meet politicians to tell them about his amazing transformation”, says Michelle. “He tells them he can kick a ball now, write, ride a bike and shows them videos on his iPad”. And they appear to have listened. In an historic vote earlier this year, the Australian Parliament voted to pass an amendment to the drug laws to allow farmers to grow and supply Cannabis for medical and scientific purposes. But Michelle has mixed feelings about the 'landmark' legislation. She doubts it will apply to the natural whole-plant Cannabis tincture a grower supplies her son for free.

“It's a positive step forward as it means the government has recognised Cannabis as a 'medicinal product'”, said Michelle. “But it's still unlikely to make a difference for families like mine. Each state of Australia needs to adopt the federal legislation changes. People are assuming they can now go to their doctor and grab a script, but there is no supply at present. The changes mean that anyone with a chronic condition should be able to work with their specialists and eventually will have access to pharmaceutical-grade Cannabis, but unless you opt for costly pharmaceutical-grade Cannabis products, families like mine remain criminals”. Michelle says that anecdotally she has heard of mixed results for people with epilepsy in trials of Cannabis-based pharmaceutical products.

“I won't risk Jai on pharmaceutical Cannabis-based medicines when he's seizure-free on the whole plant Cannabis tincture he’s on”, she adds. “It is unclear how the legislation will be implemented, but likely that growers will require a license to grow large cultivations and will have to submit applications. Most compassionate growers here all have criminal convictions. So who ends up being the growers? What experience will they have? Will they be rich businesses who want to make money from the sick and dying with no expertise?” These questions will likely be answered soon.

“It’s a start”, she concludes. “But we still have a long way to go. Still, it’s not that complicated. Jai is 11 years old and gets it. He calls Cannabis ‘my medicine’”.

On 25th of October, 2015, Jai speaks about his wonderful transformation in his own words

Adapted from, Cannabis Saved My Son's Life

28 February 2016

Hemp for Optimal Brain Health

There are over 400 phytonutrients that exist in hemp (Cannabis sativa L.), the same plant as Cannabis. Optimal brain health is achieved when linoleic acid (LA) and alpha linoleic acid (ALA) are consumed in a ratio only naturally found in hemp. The brain also has a requirement for cannabinoids, which regulate most of the major functions of the body including alertness, emotions, inflammation and cancer defences. The brain can make a small number of its own cannabinoids, but as 4,000 years of history and decades of scientific research indicate, it operates optimally when supplied with dietary cannabinoids, such as those found in hemp. The brain can build itself from saturated and monounsaturated fats but it has a preference for Omega 3 and 6 fatty acids. Research on humans and animals suggests that optimal brain health is achieved when linoleic acid (LA) and alpha linoleic acid (ALA) are consumed in a ratio of between 3.5:1 and 4:1, a ratio only naturally found in hemp. 

The fruit of hemp is not a true seed, but an 'achene', a tiny nut covered by a hard shell. But, like other oil seeds, hemp consists mainly of oil (typically 44%), protein (33%) and dietary fibre and other carbohydrates (12%, predominantly from residues of the hull). In addition, the nut contains vitamins (particularly the tocopherols and tocotrienols of the Vitamin E complex), phytosterols and trace minerals. Hemp’s main nutritional advantage over other seeds lies in the composition of its oil, i.e., its fatty acid profile and its protein, which contains all of the essential amino acids in nutritionally significant amounts and in a desirable ratio. More and more people are discovering the nutritional benefits of hemp seed, nut and oil.

However, confusion among the public on exactly how hemp oil differs from cannabidiol, or CBD oil, prompted the non-profit Hemp Industries Association in the United States (US) to issue a statement explaining the difference between the oils in order to ensure consumers, specifically medical Cannabis patients, were not misled about intended use. Confusion between hemp and Cannabis oil spiked as states in the US passed laws that allowed use of strains of Cannabis low in THC and high in CBD. Consumers often confuse hemp oil with CBD oil because both are low in THC and contain CBD. “With hemp research and development pilot programs taking off ... and the hemp retail market growing at an incredible rate, it’s crucial consumers and retailers alike understand the difference between hemp oil and CBD extracts”, Eric Steenstra, Executive Director of Hemp Industries Association, said.

Though hemp oil does contain low levels of CBD, typically less than 25 parts per million (ppm), CBD extracts “are produced either directly from Cannabis flowers that are up to 15% CBD (150,000 ppm), or indirectly as a co-product of the flowers and leaves that are mixed in with the stalks during hemp stalk processing for fibre”. Because of this distinction, the Association says, “It is important for American farmers and processors of hemp to understand that most CBD in products mislabelled as ‘hemp oil’ is a product of large-scale hemp stalk and fibre processing facilities in Europe where fibre is the primary material produced at a large scale. CBD is not a product or component of hemp seeds and labelling to that effect is misleading and motivated by the desire to take advantage of the legal grey area of CBD under federal law”.

The reason hemp is illegal is not because of any negative impact to the environment or human health, but exactly the opposite. It is so environmentally friendly, nutritionally and medicinally beneficial, that it provides too many abundant resources which would make it impossible for powerful corporations to compete. Although hemp was once the most important cash crop in the US, more so than corn and wheat combined, hemp was banned and classified as a Schedule I 'drug' under the Controlled Substances Act of 1970. While classification under Schedule I meant hemp could no longer be grown in the US, products containing hemp, such as lotions, fabric and food, are legal for purchase in the US and are found at natural and health food retailers and grocers.

According to scientific and clinical studies, hemp oil has the potential to help a range of conditions including epilepsy, diabetes, rheumatoid arthritis, chronic pain, alcoholism, schizophrenia, PTSD, antibiotic-resistant infections and various neurological disorders. In addition to trying an alternative energy source, what if it were possible to address the underlying source of the brain’s energy problems? It has been shown that glucose receptor dysfunction in the brain is related to membrane instability from dietary essential fatty acid (EFA) deficiency. Restoration of adequate membrane EFA content increases glucose uptake and utilisation in brain cells. 

One of the functions of Omega 3 and 6 fatty acids is to act as oxygen magnets and transporters. It is known that haemoglobin carries oxygen around the body; however, before oxygen can bind with the haemoglobin in red blood cells, it first has to be attracted to and released into the cell. This is exactly what Omega 3 and 6 do. Research in cystic fibrosis has shown that as cell membrane levels of linoleic acid (Omega 6) decrease and levels of oleic acid increase, the amount of oxygen entering the cell decreases. Linoleic acid, as found in hemp seed oil, undergoes “reversible oxygenation” much more easily than oleic acid. Researchers concluded that a diet overly rich in oleic acid and too low in linoleic acid can impair the oxygenation of cells.

The brain can produce its own cannabinoids, all of which are made from metabolites of linoleic acid as found in hemp seed oil. The receptors cannabinoids interact with are also made from Omega 3 and 6. Research shows Omega 3 deficiency leads to destruction of cannabinoid receptors resulting in various mental, emotional and physical dysfunctions. The entire Endocannabinoid System is best fuelled by hemp seed oil. Hemp seed oil’s unique content of Omega 3 and 6 fatty acids may be capable of addressing a number of medically neglected metabolic issues as well as optimising the function of the Endocannabinoid System.

Hemp seed oil is a great source of high-quality nutrients and has a long history of use in Eastern culture as a multi-purpose natural remedy. Despite its widespread popularity, prejudice related to its association with Cannabis has kept it from common use in the West. Thankfully, education is prevailing and the market for hemp seed oil is growing in the US, with an increasing number of people seeking it out for its reported health benefits.

Hemp seed oil contains essential fatty acids, including docosahexaenoic acid (DHA), that are required for brain development. DHA is crucial to the health of the brain as well as the retina of the eye, particularly in the first year of life as described in the study,
The effects of n-3 fatty acid deficiency ... and function of the brain and retina. Mothers who supplement with hemp seed oil during pregnancy may provide brain- and eye-protective benefits for the developing baby.

Taking a fish oil supplement can be a helpful way to increase Omega 3 fatty acids in your diet, a nutrient that is essential for brain development, immune system health, and mood regulation. Expectant mothers certainly want to include these nutrients in their diet; however, fish contains a great deal of
mercury which can hinder neurological and developmental mechanisms in the unborn baby. Fortunately, hemp seed oil works as a terrific alternative to traditional Omega 3 fatty acid supplements and doesn’t carry the same risk of mercury ingestion.

Adapted from The Brain Needs Cannabinoids And Dietary Hemp Is The Answer, with Hemp Oil Versus CBD Oil: What’s The Difference?, Dr Edward F. Group III, DC, ND, DACBN, DCBCN, DABFM, Roles of unsaturated fatty acids (especially omega-3 fatty acids) in the brain at various ages and during ageing, n-3 fatty acids and the immune system in autoimmunity, Omega-3 fatty acids in the treatment of psychiatric disorders, Maternal Fish Consumption, Hair Mercury, and Infant Cognition in a US Cohort, 5 Health Benefits of Hemp Seed Oil

23 February 2016

Hazy Drug Driving Advice On Australian Roads

Random Drug Testing on Australia's roadsides, it’s probably not just because of what you’re smoking.

Random roadside or Mobile Drug Testing is being rolled out across the country at an increasing rate, with as many as 200,000 drivers to be tested in Victoria and 100,000 in New South Wales (NSW) by 2017. Prompted by a recent NSW court case, where a Lismore man was acquitted after being pinged nine days after having Cannabis. What is the current state of play in each Australian state? Cannabis is, after all, the most widely cultivated, trafficked and used 'illicit drug'* and accounts for almost half of all drug seizures worldwide, while 34.8% of Australians aged 14 years and over have used it one or more times in their life, 10.2% using it in the 12 months to 2014.

But state governments in Australia, perhaps reflecting their territories' approach to illegal drugs in general, give different advice to drivers about just how long the psychoactive component of Cannabis, 9-tetrahydrocannabinol (THC), can be detected by a roadside test; ranging from zero tolerance, general guidelines over how long it takes to become undetectable, to no advice at all.

In NSW, Queensland and the Northern Territory (NT), roadside saliva swabs are tested in the Draeger 5000. While the machines can pick up many drugs, in Australia RDT's are generally geared towards the psychoactive chemicals in Cannabis, methamphetamine and ecstasy. Drugs such as MDMA and crystal methamphetamine can generally be detected within 24 hours of taking them, but with THC it’s all a bit vague about how long it takes to get out of your system. In NSW, RDT's are developing into a hotly debated issue following reports people have been picked up days after using Cannabis despite having been told to only wait 'at least 12 hours' before getting behind the wheel.

Both NSW and the NT use the same testing device, however NT drivers are advised by the Department of Transport that THC takes an average of about 5 hours, with caveats, to break down and become undetectable in the body. The NT Department of Transpor goes further, and breaks down what happens to THC in your system: "After approximately 5 hours, the ∆9-THC component has metabolised into Carboxy-THC in your body. Carboxy-THC is inactive and may be present in your body for days or weeks after consuming the drug. Police will not be testing for Carboxy-THC during the roadside swab test". The NSW road safety website says Cannabis can typically be detected in saliva by an RDT test stick for up to 12 hours after use.

Even Draeger points to slightly different advice on their website, linking to a 2013 industry product review that says the device can detect very small quantities of THC (five nanograms per millilitre), and pinpoints the time of drug consumption within an 8-hour time window. “This makes it very easy to determine whether a person has taken one or more drugs recently and is still influenced by them”, Dr Stefan Steinmeyer, responsible for 'Drug Testing' at Draeger is quoted as saying in the review.

In Victoria, police use Securetec's Drugwipe swabs and according to police media, test them in Securtec's Drugwipe Twin II Combo. Victoria's Road Accident Commission warns the effects of THC can last for up to 24 hours and warns that "recent use of THC and the risk of being killed in a fatal crash is similar to a driver with a BAC of up to approximately 0.15".

In South Australia (SA), THC can be detected for "several hours after use (again the exact time varies depending on the amount and potency of the Cannabis used and individual metabolism). “Inactive THC residue in the body of a driver from use in previous days or weeks will not be detected”, the SA advice says. The state's Legal Services Commission is slightly more specific about the window and advises THC can be detectable for up to 4 hours.

In Western Australia (WA) they also use the Draeger (if you test positive roadside with the Securetec swab, the swab is placed in the Draeger 5000 for further analysis). WA's Road Safety Commission says THC is generally detectable for up to 4 hours after use, again with the usual caveats.

Queensland has an absolute zero tolerance policy toward drugs and driving and neither the Queensland Police nor the state's Department of Transport offer any advice on how long it takes for THC to become inactive.

Tasmania police warn it is illegal to drive a vehicle with illicit drugs in your blood, but offer no readily available breakdown of THC.

NSW Greens MP David Shoebridge compares the NSW drug testing system to the UK's, where a range of illicit and prescription drugs are tested for, with set detectable levels of impairment. He believes the Lismore decision will open the state government to a flood of legal challenges, as drivers are fined despite believing they are taking sound government advice. The NSW Greens recently used Freedom of Information laws to access police documents that show there is no lower limit of drugs that are detectable in the saliva of people subjected to the roadside oral drug tests.

drug impairment
An excerpt from the NSW Police RDT Standard Operating Procedure Handbook

Shoebridge believes RDT's should test for impairment and the limited trio of drugs screened for expanded to take in cocaine and some prescription drugs (the NSW Greens are preparing to move a motion in parliament to have the state's tests reviewed). “Roadside drug testing is not about getting impaired drivers off the road”, Shoebridge said of drug testing in NSW. “It’s an ideological war on a handful of illegal drugs dressed up as a road safety campaign”.

Shoebridge recently sat in on Lismore local court, where he said there were about 150 matters listed for mention on the day. Forty six were for drug-driving matters, he said, or one third of the court list. “The magistrate was having enormous difficulty getting to some of those seriously important cases, domestic violence, dangerous driving, assault matters, things you want magistrates and barristers spending their time on”.
He pointed to the UK's Wolfe report, which sets out the effects that various drugs have on driving.

But we don’t know as much about the effects surrounding driving and Cannabis as we do about the effects of alcohol on driving, Queensland University of Technology's Professor Jeremy Davey said. Davey, from the CARRS-Q Centre for Accident Research and Safety, sat on an expert panel that advised Queensland on its own drug driving laws. He says THC can be detected in your saliva for up to 24 hours.

He argues the focus on impairment is misplaced and likens it to the roughly 70-year history of observations into alcohol and driving and old arguments people used to use about alcohol, such as "I drive better on on the sauce""The next one is 'I’m used to it and I’m not affected by it'. Well, you think you’re not affected by it. The other one is ‘Oh, I’ve used only a little bit'. All these excuses they said for alcohol 30, 40 years ago, are being used for illicit substances”. he said.

“We know that at .05 (alcohol reading) you are twice as likely to be involved in a motor accident. This fixation on impairment, we know that there are varying levels of impairment but where do you draw the line on impairment? Impairment is impairment”. he said. “And also, and this is the nature of drugs, the same level may impair you to some degree today, and tomorrow it may impair you to another degree and that can be more or less and operate differently on different people, and at different times. So you have to look at it on a population base”.

random drug test australia

A saliva drug test being performed by a Melbourne police officer in 2006, shortly after it was announced the technology to detect the drug in saliva and blood samples had been perfected.

Random Breath Testing changes driver behaviour and there is some evidence to suggest the same approach works for drug testing, said Sydney University's Professor Rebecca Ivers, an injury epidemiologist and researcher in global health. From a road safety perspective, the deterrence approach is generally seen as the most effective way of keeping people safe on the roads. "When it comes to road safety, when we're talking about preventing people from crashing and having serious injuries and death, we have to be pretty hard line about it", she said.

"What we do know works, having random alcohol testing works very well in changing people's behaviour and there is some evidence that the same approach does work for drug testing. If they think they're going to be caught at a random roadside test and be penalised, then they are not going to do that behaviour". The reality is the ‘safe level of alcohol’ when you’re behind the wheel is set at a politically and socially prescribed level and changing the test to narrow or expand it (to take in fewer or more drugs, including prescription drugs) will require a long conversation with the community.

"Like when Random Breath Testing was introduced, with the upper prescribed level .08, before we worked our way down while drawing on tens of thousands of clinical tests and controlled experiments", Davey said. “Now, we don’t have those controlled experiments with Cannabis. However, we have enough knowledge of the drug that we know that it does impair. One does use a piece of common sense”.

Common sense? Where? Statistics show benzodiazepines and cocaine are causal in more fatal road accidents than all the other 'illicit drugs' put together (excluding only alcohol)! According to Australian drug detection expert Tony Graham, incorporating a test for cocaine in the saliva swab would be a simple matter. "There is absolutely no reason, if they choose to, why they can’t do it", he said, in November 2015.

Random or Mobile Drug Testing is not a road safety measure when you know all the facts. It is an attack on the lifestyle of some and unfortunately, and in some cases tragically, the sick and suffering are caught up in the mix as it is hard otherwise to explain why some drivers are stopped more than once for these purported ‘random’ tests (police themselves admit to targeting previously tested drivers). And this is an expensive campaign, with the drug test kits costing about $40 each (as opposed to $1 each for alcohol breath tests) and a mobile drug testing bus costs up to $500,000. Add in the cost of training, laboratory work and all the television ads and the taxpayer is footing the bill for activities that are not evidence based and DO NOT SAVE LIVES!

Australian governments have lately found it hard to frame policies consistent with even some science and this is just one of them. Alcohol breath testing works because of the nature of alcohol. Roadside drug testing for Cannabis does not work as a road safety measure because it does NOT understand the nature of Cannabis. And too many otherwise law-abiding Australian citizens are paying a ridiculously high price for NOT driving whilst impaired!

*The term ‘illicit drug’ can encompass a number of broad concepts, according to the Australian government, including;
• illegal drugs - a drug that is prohibited from manufacture, sale or possession in Australia, for example, Cannabis, cocaine, heroin and ecstasy
• misuse, non-medical or extra-medical use of pharmaceuticals - drugs that are available from a pharmacy, over-the-counter or by prescription, which may be subject to misuse, for example opioid-based pain relief medications, opioid substitution therapies, benzodiazepines, over-the-counter codeine, and steroids
• other psycho-active substances - legal or illegal, potentially used in a harmful way, for example, kava, or inhalants such as petrol, paint or glue (but not including tobacco or alcohol)