LOUISA DEGENHARDT: HOOKED ON ADDICTION RESEARCH

Sometime during her high school years, Louisa Degenhardt decided she
"wanted to be a psychologist" , even though, she admits, "I didn't
really know what that entailed" . But while her career path was to
become research oriented"she is currently an Australian National
Health and Medical Research Council (NHMRC) Senior Research Fellow
based at the National Drug and Alcohol Research Centre, University of
New South Wales""her wide-ranging work on drug addiction has been
influenced by a foundation in psychology.

It was while studying psychology at the University of New South
Wales, in 1997, that Degenhardt was to meet her long-time friend and
mentor Wayne Hall, NHMRC Australia Fellow at the University of
Queensland Centre for Clinical Research, Brisbane, Australia. At the
time, Hall was lecturing on health statistics, with a strong focus on
illicit drugs.

Degenhardt wrote to Hall asking about any upcoming research work and
a few months later her wish was granted; she started work as Hall's
research assistant in 1998. Around this time, there had been
much-publicised increases in heroin and ecstasy consumption in
Australia, and Degenhardt finished her PhD on the topic in 2001.
"There are so many angles from which you can look at illicit drug
use: moral, social, legal" , she says. "It's vital to correct the
misinformation around, to peel back the judgments people make and
just present facts.

Any drug can be dressed up as horrific or alternatively glamorous
depending on how you spin things."

Degenhardt quickly became hooked on research about addiction.

Predictably, there have been moments of controversy along the way.
Along with Hall, Carolyn Day, Libby Topp, and colleagues, she
investigated the effects and possible causes of Australia's sudden
heroin shortage in 2001""the first time that the effects of reduced
drug supply had been investigated at a population level.

They feared the likely effects would be more crime, as well as
riskier injecting, plus the use of multiple drugs.

Although these fears were realised, at the population level there was
also a notable decrease in overdoses, deaths, and first-time users of
heroin. "The research team could not rule out that international law
enforcement activity (as opposed to local or national policing) had
been behind the reduced supply" , she explains.

Many researchers in the field were sceptical that drug law
enforcement could have exerted such an effect, and it's an issue that
still causes fierce debate in some quarters.

An international outlook has been a feature of much of Degenhardt's
research on the cultural and social drivers of illicit drug use worldwide.

She's worked in many international collaborations, including with WHO
and the Independent Reference Group to the United Nations on HIV and
Injecting Drug Use, for which she collaborated with Bradley Mathers
at Australia's National Drug and Alcohol Research Centre. Working at
the UN's Office on Drugs and Crime in Vienna, in 2009, also helped
Degenhardt understand some global challenges. For example, drug
trafficking routes are changing: routes through Africa are leading to
a spillover effect of increased injecting drug use in that continent.

Combined with Africa's generally high prevalence of HIV, the public
health implications of this are clear.

Epidemiological studies and reviews, both global and national, can be
arduous to do, but Degenhardt says she "knows these papers can
clarify and distil issues and trends, which is especially relevant
for policy makers who are acting at a population level" . Such a
study, on the global burden of disease due to illicit drugs, forms
the first part of The Lancet's Addiction Series. According to
Professor John Strang, Head of the Addictions Department at King's
College London, UK, "Louisa has demonstrated, in particular, the
potential yield from well-conceived and applied scrutiny of large
data sets, especially when these address areas of key importance in
planning of public health and policy."

Internationally, Degenhardt acknowledges that the USA funds most of
the world's research on illicit drug use. Back home, she believes
Australia is in a good position compared with other high-income
countries. "Both the current and previous governments have
acknowledged the importance of this issue, and while one can always
say more money is needed (which it is), it should also be
acknowledged that drug research programmes in Australia are
comparatively well funded." Degenhardt's team has just been given
funding by the NHMRC to investigate the long-term effects of the
prescription of opioids, such as morphine and buprenorphine, for
chronic pain. "There are very few data to tell us whether it is
sensible to provide these drugs for chronic non-malignant pain long
term" , says Degenhardt, who will follow 2000 people receiving these
drugs over 2 years. "How many continue using these drugs? How many
have adverse outcomes?

What happens to their pain?" The researchers will also use national
databases to follow up patients prescribed opioids through
Australia's Pharmaceutical Benefits Scheme.

While this research is her current focus, Degenhardt is also curious
about "some simple questions that would be of interest to answer" .
She points to the need for prospective studies of illicit drug users
to better characterise the natural history of drug use and the
incidence of adverse outcomes of use, since their illegality makes
quality data on use difficult to come by: "There are really basic
things that we make assumptions about without hard evidence; even the
literature on the natural history of drug use is based on questionable data."