Due to the controversial nature of this topic and the target audience (young people) it is important that the reader reads the complete answer and not
simply one paragraph or a few sentences. Taking one part of the answer out of context can lead to a misinterpretation of the intended message.
Paul Dillon speaks to thousands of students across Australia providing information on alcohol and drugs, particularly in relation to looking after
themselves and their friends. Some young people make contact with him to ask questions that they did not feel comfortable asking in front of their peers.
The Real Deal on Drugs allows young people to ask questions about drugs and provides them with access to accurate and up-to-date information.

What's the drug that kills more people than any other?

What's the drug that kills more people than any other? We had a debate in class and we couldn't agree on which one it was. I think it's tobacco but others thought it was illegal drugs like ice and heroin.

Well, you were right - across the world, tobacco kills more people than any other drug. In countries like Australia, alcohol is the second largest cause of drug-related deaths, followed by prescription medications and illicit drugs.
Before we look at the actual numbers, it is important to understand what we mean by a 'drug death'.
In Australia, deaths are considered 'drug-induced' if directly attributable to drug use. For example, when an alcohol or drug overdose occurs. Drugs can also contribute to 'drug-related deaths' as a result factors such as violence, driving while drunk or intoxicated or when an underlying health condition exists. For example, a stimulant drug may cause death in a vulnerable individual with an undiagnosed heart problem.
It is often the case that a death occurs as a result of the combined effect of alcohol and illicit drugs making it difficult to attribute the death to one specific substance. Sometimes deaths may occur as a result of ill health caused by alcohol or drug use many years ago and there are instances when doctors may not record drugs on a death certificate even where drugs might be involved. Despite these difficulties there are estimates of the number of deaths associated with different tobacco, alcohol and drugs.
When you look at the statistics, smoking is by far the leading cause of preventable death. Worldwide, tobacco use causes nearly 6 million deaths per year, and current trends show that tobacco use will cause more than 8 million deaths annually by 2030. Around 15,000 people die every year in Australia due to smoking – that's about 40 each day!
According to the World Health Organisation, in 2012, there were around 3.3 million deaths attributable to alcohol consumption. That accounts for around one in 20 of all global deaths. The number of Australians that die due to alcohol can vary each year from between 3,500 up to more than 5,000. That means up to 15 alcohol-related deaths per day.
There are many prescription drugs that can cause death and in recent years it is the painkillers such as oxycodone, morphine and codeine and benzodiazepines, a range of drugs used to treat anxiety or sleep problems, which lead to many accidental and intentional fatal overdoses. Using drugs in combination (or 'polydrug' use) is often the cause of death. For example, the latest statistics show that in 2016 over 96% of benzodiazepine deaths in Australia involved other drugs including alcohol.
In 2014, there were an estimated 207,400 illicit drug-related deaths worldwide. Overdose deaths account for almost half of these worldwide, and in most cases the drugs involved were opioids (i.e., drugs like heroin). According to the latest Australian statistics, in 2016 the total number of prescription and illicit drug-related deaths was 1,808 – the highest number in 20 years. Stimulant drugs including methamphetamine (speed or ice) and MDMA (ecstasy), as well as heroin accounted for 724 of these deaths.
Using any drug involves risk. Using alcohol, prescribed or illicit drugs at the same time massively increases the risk of illness and death.
First published: February 2018

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Could one try of cannabis have affected my school grades?

Having read your answer to "can smoking weed once have a lasting effect" I was wondering how obvious, after having smoked once, any negative long-term effects would be. If I can't say for certain that there are long- term effects does that mean that there aren't any or just that they are too subtle to perceive? Basically, I smoked cannabis once and since then I have noticed school grades going down (like from 100s to 95s), is this probably just in my head?

Some people who experiment with an illegal drug, whether it be cannabis, ecstasy or whatever, do not necessarily have the experience they were expecting. As a result, many will choose never to use the drug again. In some cases, particularly if their experience was unpleasant, people are tempted to 'over-analyse' what happened and start to stress about what impact the drug had on them and could potentially have on them in the future.

Realistically, the most likely negative effect of smoking cannabis just once is having an accident when intoxicated or making a fool of yourself in front of your friends. Some people who have used only once, but perhaps smoked too much or unknowingly used a high THC product, may have extremely unpleasant effects. They could feel faint as the drug causes a drop in blood pressure, become paranoid, anxious or nauseous. In extreme cases, some first time users may even vomit. In these cases, it becomes obvious to the person experimenting with cannabis that it is not a 'harmless' drug (i.e., things can go wrong) and, as a result, they'll choose to never use the drug again.

You ask specifically about long-term effects that are "too subtle to perceive" and highlight how your experience could have affected your school grades. Could that 'one try' have resulted in an effect on your school performance? Most probably not ...

You have obviously been performing at an extremely high level and any drop, no matter how small, is noticeable but this change has much more likely explanations. Focus on the reason you decided to smoke cannabis in the first place and whether it was associated with other new activities or challenges that were happening around the time you decided to experiment. It could be one of these, or even a combination of all of them, that could explain the slight change in school marks.

You are obviously concerned about your grades and that is the first step to maintaining or even improving them. You might like to talk with your school counsellor about anything else that might be concerning you and causing you to worry about your once-only cannabis use.

First published: February 2018
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What effect does alcohol have on antidepressants and anti-anxiety medications?

Hi Paul, you recently talked at my school about the effects of alcohol and how long it takes to get out of your system. I was wondering what are the effects of alcohol on antidepressants and anti-anxiety medications? Does using these types of medication cause alcohol to stay in your system any longer and do they amplify the effects of alcohol?

Anti-anxiety and antidepressant medications should only be taken when prescribed by a doctor. Using either medication on their own can cause a range of problems including, in extreme situations, death by overdose. When you drink alcohol at the same time this dramatically increases the risk of something going wrong.

Anti-anxiety and anti-depressant medications do not cause alcohol to stay in your system any longer. Understanding the interaction between the types of medications and alcohol is important.

Anti-anxiety and anti-depressant medications affect the body in different ways.

The most commonly prescribed anti-anxiety medications in Australia are benzodiazepines (also known as minor tranquillisers or 'benzos') and are classified as 'depressants' (i.e., drugs that 'slow down' the central nervous system). Examples include diazepam, temazepam, nitrazepam and oxazepam. These are prescribed to help people with anxiety or sleep problems. The effects may last from a few hours to 12 hours or even longer, depending on the dose and type of drug taken. Using benzodiazepines at the same time as other depressants - such as alcohol, GHB, heroin and methadone - is extremely dangerous. It can cause loss of consciousness, breathing problems, coma and death.

The situation with anti-depressant medications and alcohol is more complex due to the availability of different types of anti-depressants. Drinking alcohol while taking these medications, however, is generally not advised. Even in small amounts, alcohol can affect concentration and coordination, cause drowsiness and dizziness and lead to injuries and road traffic accidents. It is also important to note that drinking alcohol and taking anti-depressants at the same time can also make depression worse.

Combining alcohol with monoamine-oxidase inhibitor (MAOI) anti-depressants is especially risky. This is because a substance called tyramine, often found in alcoholic drinks, can cause serious side-effects if taken with MAOIs, including a sudden and dangerous rise in blood pressure.  Speak to your GP or pharmacist if you're not sure what type of anti-depressant you're taking and don't know whether you should avoid alcohol.

It is always a good idea to ask your GP or pharmacist about how alcohol interacts with prescribed and over the counter medications. If the doctor has known you for a long time, they may not even think about the possibility of you drinking and prescribe you something that could be particularly risky. If you want to continue to drink and need to take medication, your GP may be able to find a safer alternative.

There are some people who try to push the boundaries to see what will happen if they intentionally combine medications with alcohol or, as you say in your question, to 'amplify the effects of alcohol'. This is extremely dangerous. There is no effective advice that can be provided to reduce risks other than 'please don't do it'.

First published: January 2018
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