The monthly ACT ATOD Research eBulletin is a concise summary of newly-published research findings and other research activities of particular relevance to ATOD and allied workers in the ACT.
Its contents covers research on demand reduction, harm reduction and supply reduction; prevention, treatment and law enforcement. ATODA's Research eBulletin is a resource for keeping up-to-date with the evidence base underpinning our ATOD policy and practice.
ACT Research Spotlight
Updated and expanded statistical data from ACT Health and ACT Policing
ATODA is highly appreciative of the work conducted by ACT Health, ACT Policing and the Justice and Community Safety Directorate that is now delivering, each quarter, valuable statistical information covering alcohol and other drugs as part of JaCS’ ACT Criminal Justice Statistical Profiles. We note that the local media are now aware of these resources, and are reporting on the trends and other patterns revealed in the Profiles—albeit not always with complete accuracy.
In February this year JaCS released revised data for the September 2016 quarter. The Key Highlights Summary (referenced below) includes a summary table from ACT Policing: Alcohol and Other Drugs Data Set (p. A 12).
Some of the changes between the year to September 2015 and the year to September 2016 shown in this table are especially noteworthy:
- Occasions of protective custody for intoxication increased by 22% over the year, including a 16% increase in the number of admissions to the Sobering Up Shelter.
- Random alcohol breath tests of motor vehicle drivers fell by 15%, and the number of people charged for drink driving fell by 16%.
- At the same time, the number of roadside saliva tests for three illegal drugs conducted increased by 19%, with the number of drivers returning positive readings increasing by 26%. These increases undoubtedly represent changes in police practices, focussing on highly targetted (rather than random) testing, referred to by ACT Policing as an ‘intelligence-based approach’ (Canberra Times, 12 March 2017).
Comment: ATODA remains concerned that ACT Policing seems to be diverting resources away from road safety interventions that we know work (especially random breath testing for drink driving) to highly expensive interventions of unknown efficacy and demonstrated low cost-effectiveness (particularly roadside saliva testing for three illegal drugs). ATODA would be grateful to know if this reflects an explicit policy of the ACT Government.
The Statistical Profile also includes ACT Health Table 1: Alcohol and other drug behavioural disorders presenting to ACT Health Emergency Departments by drug type - 5 year trends. It shows large fluctuations in the total number of presentations each year over the five year period, and a clear upward trend in the data covering all drugs combined. The quarterly number of presentations averaged approximately 73 over this period.
Of the 1,452 presentations, 1,088 or 75% were for alcohol, alone, an average of 55 per quarter. The next largest category was multiple drugs (195 over the five year period, 13% of the total), followed by stimulants which includes methamphetamine/‘ice’ (85.6%) and opioids (44.3%). The trend line for alcohol presentations is clearly upwards. The continuing dominance of alcohol as the drug precipitating presentations to Canberra’s hospital Emergency Departments seems to be lost in some of the media reporting of drug-related harms in our community.
We note the recently launched 'Driving Change Initiative' held at the ACT Legislative Assembly on 7 March 2017. We hope this initiative will effectively contribute to better understanding alcohol and other drug presentations in our emergency departments and improved policy responses.
ACT Government, Justice and Community Safety Directorate 2017, Statistical profile, ACT criminal justice, September 2016 quarter, the Directorate.
---- 2017, Statistical profile key highlights summary: ACT criminal justice, September 2016 quarter, the Directorate.
For more information: go to http://www.justice.act.gov.au/criminal_and_civil_justice/criminal_justice_statistical_profiles
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Research Findings
How successful has the 'Drug Education in Victorian Schools' program been?
What measures can be taken to reduce alcohol-related harm in Australia?
What is the latest 'evidence about the evidence' concerning the role of cannabis/THC in motor vehicle driver impairment?
How significant is alcohol in river drownings in Australia?
How effective is naltrexone in reducing alcohol consumption among women with alcohol use disorders?
How cost-effective is extended release naltrexone in preventing opioid relapse among people involved with the criminal justice system?
How can alcohol and other drug counsellors be protected against stress and burnout?
What constitues 'success' in substance use disorder treatment, and how do we determine what works best?
What are some of the unintended consequences of tobacco regulation, and how could they be avoided?
How effective have Alcohol Management Plans been in reducing alcohol and other drug use Indigenous communities in Queensland?
What is the case for international guidelines on human rights and drug control?
How widespread is the stigma associated with methadone maintenance treatment, and how can it be reduced?
How serious a problem is hepatitis C virus transmission in NSW prisons, and what can be done to reduce the rate of transmission?
What do we know, and what don't we know, about opioid overdose prevention and naloxone rescue kits?
How long should heroin overdose patients be observed after receiving naloxone?
What is the rate of poisoning deaths of children in Australia?
To what extent can electronic cigarettes help smokers to better control their blood pressure?
Index
Note: Many of the items referenced below are available from the Library of the Australian Drug Foundation http://primoapac01.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=ADF
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How successful has the 'Drug Education in Victorian Schools' program been?
As mentioned in earlier ATODA Research eBulletins, Australian researchers are among the world leaders in developing innovative, well-evaluated approaches to school-based drug education, reflecting, in part, widespread disappointment at the limited, and even negative, results of the traditional approaches. The Drug Education in Victorian Schools (DEVS) program ‘taught about licit and illicit drugs over two years (2010-2011), with follow up in the third year (2012). It focussed on minimising harm and employed participatory, critical-thinking and skill-focussed pedagogy. This study evaluated the programme's residual effectiveness at follow up in reducing alcohol-related risk and harm’. A cluster-randomised, controlled trial was conducted with a student cohort during years 8, 9 and 10. Fourteen schools, 1,163 students, received the program and 7 schools, 589 students were the controls, receiving their usual drug education. ‘Over the 3 years, there was a greater increase in intervention students' knowledge about drugs, including alcohol. Their alcohol consumption did not increase as much as controls. Their alcohol-related harms decreased, while increasing for controls. There were fewer intervention group risky drinkers, and they reduced their consumption compared to controls. Similarly, harms decreased for intervention group risky drinkers, while increasing for controls.’ This led the researchers to conclude that ‘Skill-focussed, harm minimisation drug education can remain effective, subsequent to programme completion, in reducing students' alcohol consumption and harm, even with risky drinkers.’
Midford, R, Cahill, H, Lester, L, Ramsden, R, Foxcroft, D & Venning, L 2017, ‘Alcohol prevention for school students: results from a 1-year follow up of a cluster-randomised controlled trial of harm minimisation school drug education’, Drugs: education, prevention and policy, online ahead of print.
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What measures can be taken to reduce alcohol-related harm in Australia?
A recent article in the Medical Journal of Australia is subtitled ‘We need to increase alcohol taxation and reduce hours of sale to reduce alcohol-related harms’. The authors discuss the nature and extent of alcohol-related harm and violence in Australia and various policy approaches which could contribute to a reduction in harm.
They concluded that ‘Both state and federal governments have a responsibility to reduce alcohol-related harms in Australia. The Commonwealth can and should use its taxation powers to increase the costs of alcohol and thereby reduce all types of alcohol-related harm in Australia. Raising alcohol prices is the most cost-effective strategy. Sadly, it remains politically unpalatable because of powerful alcohol industry opposition, especially from the South Australian wine industry, which benefits from a de facto tax subsidy in the form of an ad valorem tax on Australian wine....
The Commonwealth also has the power to more effectively regulate the advertising and promotion of alcohol via sports sponsorship and alcohol advertising during popular sporting events. The current system of so-called self-regulation of alcohol advertisements is pervaded by conflict of interest because the alcohol and advertising industries control the process of adjudicating on complaints made about advertisements. The current Alcohol Beverage Advertising Code Scheme (http://www.abac.org.au) specifically excludes sports sponsorships, and remains resistant to external criticism or complaint about alcohol sponsorship during televised sporting matches.
State governments should also make more effective use of their powers to regulate the trading hours of retail liquor outlets. The latter are now much more important than licensed premises because they sell 80% of all alcohol that is consumed, often at a considerable discount to the heaviest drinkers.
Australia needs a nationally coherent alcohol policy if we are to substantially reduce alcohol-related harm. This should combine cost-effective policies at both state and federal levels. State governments should use their regulatory powers to reduce bottle shop trading hours to substantially reduce all types of alcohol-related harm, including that of most public concern—alcohol-related violence in licensed venues and entertainment precincts. The federal government should discourage heavy alcohol consumption by using its taxation powers to enact a combination of a volumetric alcohol tax and a minimum unit price for alcohol.’
Hall, WD & Weier, M 2017, ‘Reducing alcohol-related violence and other harm in Australia’, Medical Journal of Australia, vol. 206, no. 3, pp. 111-2.
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What is the latest 'evidence about the evidence' concerning the role of cannabis/THC in motor vehicle driver impairment?
Abstract:
With the lawful use of medicinal cannabis becoming a closer reality across most of Australia, the matter of roadside testing and driving impairment will be of immediate concern to patients undergoing cannabinoid pharmacotherapy. Under current roadside testing laws, the same issues will pertain to the medical patient, who wishes or needs to drive, as to the ‘recreational’ cannabis user. While there is abundant public domain, scientific and medical literature, as well as published expert opinion, exploring the epidemiological, chemical and pharmacological research evidence of cannabis ingestion and driving, this paper analyses the evidence from roadside testing that is being used to support the notion that a driver may be ‘impaired’ or ‘driving under the influence’ of cannabis. By and large, the evidence undeniably shows that cannabis ingestion can impair driving. This paper however, comes to the pharmacological opinion that the current roadside testing of saliva/oral fluid for Δ 9 -tetrahydrocannabinol (THC), without other evidence, provides a poor predictor of impairment. This paper thus intends to stimulate re-evaluation of the present pharmacological criteria under which users of cannabis might be judged legally.
Mather, LE 2016, ‘The issue of driving while a relevant drug, Δ9-tetrahydrocannabinol, was present in saliva: evidence about the evidence’, Griffith Journal of Law & Human Dignity, vol. 4, no. 2, pp. 21-52, open access https://griffithlawjournal.org/index.php/gjlhd/article/view/885.
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How significant is alcohol in river drownings in Australia?
A study of cases of unintentional fatal river drowning in Australia that occurred between 1 July 2002 and 30 June 2012, examined data from the National Coronial Information System. Of the 770 river drowning deaths over that period alcohol was known to be involved in 314 cases (41%). The researchers found that ‘Known alcohol involvement was found to be more likely for victims who drowned as a result of jumping in…identify as Aboriginal and Torres Strait Islander…and drowned in the evening…and early morning…hours.’ They concluded that ‘Alcohol contributes to fatal unintentional drowning in Australian rivers. Although prevention is challenging, better data and exposure studies are the next step to enhance prevention efforts’.
Peden, AE, Franklin, RC & Leggat, PA 2017, ‘Alcohol and its contributory role in fatal drowning in Australian rivers, 2002-2012’, Accident Analysis and Prevention, vol. 98, pp. 259-65.
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How effective is naltrexone in reducing alcohol consumption among women with alcohol use disorders?
Researchers in the United States undertook a systematic review of clinical trials which evaluated naltrexone as a treatment for women with alcohol use disorders (AUDs). The results of the study suggest that ‘…naltrexone may lead to modest reductions in quantity of drinking and time to relapse, but not on the frequency of drinking in women’. The researchers recommended that ‘Future research should incorporate sophisticated study designs that examine gender differences and treatment effectiveness among those diagnosed with an AUD and present data separately for men and women’.
Canidate, SS, Carnaby, GD, Cook, CL & Cook, RL 2017, ‘A systematic review of naltrexone for attenuating alcohol consumption in women with alcohol use disorders’, Alcoholism: Clinical and Experimental Research, vol. 41, no. 3, pp. 466-72.
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How cost-effective is extended release naltrexone in preventing opioid relapse among people involved with the criminal justice system?
A randomised trial conducted in the United States demonstrated the effectiveness of extended release naltrexone (XR-NTX) in preventing opioid relapse among criminal-justice-involved U.S. adults with a history of opioid use disorder. The researchers aimed to estimate the incremental cost per quality-adjusted life-year (QALY) gained for XR-NTX versus treatment as usual (TAU), and evaluate it relative to generally-accepted value thresholds; and estimate the incremental cost per additional year of opioid abstinence. Their findings (in US dollars) were ‘The 25-week cost-per-QALY and -abstinent-year figures were $162,150 and $46,329, respectively. The 78-week figures were $76,400/QALY and $16,371/abstinent-year. At 25 weeks, we can be 10% certain that XR-NTX is cost-effective at a value threshold of $100,000/QALY, and 62% certain at $200,000/QALY. At 78 weeks, the cost-effectiveness probabilities are 59% at $100,000/QALY and 76% at $200,000/QALY. They can be 95% confident that the intervention would be considered a “good-value” at $90,000/abstinent-year at 25 weeks, and $500/abstinent-year at 78 weeks’. They concluded ‘While extended release naltrexone appears to be effective in increasing both quality-adjusted life-years (QALYs) and abstinence, it does not appear to be cost-effective using generally-accepted value thresholds for QALYs, due to the high price of the injection’.
Murphy, SM, Polsky, D, Lee, JD, Friedmann, PD, Kinlock, TW, Nunes, EV, Bonnie, RJ, Gordon, M, Chen, DT, Boney, TY & O’Brien, CP 2017, ‘Cost-effectiveness of extended release naltrexone to prevent relapse among criminal-justice-involved persons with a history of opioid use disorder’, Addiction, online ahead of print.
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How can alcohol and other drug counsellors be protected against stress and burnout?
Abstract:
Working with alcohol and other drug (AOD) using populations in treatment services is a demanding job that has been associated with a susceptibility to stress and burnout in the workforce. The current study used an online survey methodology in Victoria, Australia, to examine staff well-being and burnout in a cohort of 228 workers in AOD specialist services in Victoria, 151 of whom hold client caseloads. Although there was a strong negative association between stress and burnout, and inverse associations with work satisfaction and well-being, the focus of the current analysis was what predicted positive well-being in workers. This was associated with four factors-lower levels of emotional exhaustion and cognitive weariness (both aspects of burnout), higher levels of opportunities for professional growth, and a greater support network in the workers own life with which to discuss things. Thus, positive well-being is not only linked to lower burnout, and to greater perceived development opportunities, but also to the support systems workers have access to.
Best, D, Savic, M & Daley, P 2016, ‘The well-being of alcohol and other drug counsellors in Australia: strengths, risks, and implications’, Alcoholism Treatment Quarterly, vol. 34, no. 2, pp. 223-32.
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What constitutes 'success' in substance use disorder treatment, and how do we determine what works best?
The author commences his essay by pointing out that ‘The two questions, “What constitutes success in addiction treatment?” and “How do we determine what works best?”, are critically important questions to address as lives and increasingly limited resources are at risk. In the 1950s and 1960s, any resumption of the use of a psychoactive substance subsequent to the cessation of formal treatment was considered a “failure” by many involved in providing treatment. The employment of this singular, absolute criterion would inevitably lead one to conclude that most treatments then did not work very well and that no treatment seemed any better than any other treatment as far as relapses were concerned. Today the addiction treatment field employs multiple criteria that are less absolute and rigid in determining what constitutes success and what works best. Nevertheless, the two questions have yet to be fully answered to everyone’s satisfaction.’
He suggests that ‘…addiction can best be understood as a form of ecological dysfunction…, a perspective that takes into account the impact of the environment, as well as the biological and psychological makeup of the person. Just as there are pathological personalities and lifestyles, there can also be pathological societies…and elements thereof that affect treatment. The ecological dysfunction model of addiction provides a more comprehensive and realistic perspective, as opposed to a biological-only model, and it is more likely to facilitate effective treatment. People who cannot successfully deal with the challenges of life due to factors such as their lack of marketable job skills and knowledge, who live in extreme poverty, who are the victims of prejudice, who have no safe and/or reliable shelter, and/or who have experienced significant traumas are very vulnerable to misusing substances and developing serious addiction problems. EBP [evidence based practice] interventions, by themselves, are not likely to resolve these types of ecological dysfunctional problems in living, especially over an extended period of time when they are combined with addiction. Nor are they likely to significantly alter a deviant, ineffective, and/or defective character structure that often coexists with the addiction.’
Carroll, JFX 2016, ‘Perspective: What constitutes “success” in addiction treatment and how do we determine what works best?’, Alcoholism Treatment Quarterly, vol. 34, no. 2, pp. 252-60.
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What are some of the unintended consequences of tobacco regulation, and how could they be avoided?
Researchers in the United States describe the unintended adverse consequences of cigarette prohibition, regulation, and taxation. They explain that ‘Laws that prohibit, regulate, or tax cigarettes can generate illicit markets for tobacco products. Illicit markets both reduce the efficacy of policies intended to improve public health and create harms of their own. Enforcement can reduce evasion but creates additional harms, including incarceration and violence. There is strong evidence that more enforcement in illicit drug markets can spur violence. The presence of licit substitutes, such as electronic cigarettes, has the potential to greatly reduce the size of illicit markets’. They apply these findings to discussion of public policy toward a potential ban on menthol cigarettes, posing the following questions: ‘How would smokers of menthol cigarettes respond to stricter regulation or a ban? Experimental or econometric studies are needed to strengthen the survey-based studies in the literature. How much is the illicit tobacco trade likely to expand under a menthol ban, and how much will that offset the ban’s benefits to public health from reduced smoking? What would be the nature of illicit trade in the face of a menthol ban? Would the market look like current tax evasion and smuggling, in which there is a relatively low level of associated violence? Would it look more like the market for illicit marijuana in the United States, where violence is not great, or that for cocaine, where enforcement and violence are high? What are the risks from Mexican drug-trafficking organizations entering trade in tobacco after a ban? Drug cartels, notorious for their propensity to violence, apparently already dominate the large Mexican black market in cigarettes. How can they better understand the many factors essential to the modeling laid out here? Estimation of the effects of alternative policies will require better baseline data on the kinds and extent of violence attendant to the illicit cigarette trade, the levels and cost of enforcement, the sizes of illicit cigarette markets, and the characteristics of illicit distribution channels’.
Kulick, J, Prieger, J & Kleiman, MAR 2016, ‘Unintended consequences of cigarette prohibition, regulation, and taxation’, International Journal of Law, Crime and Justice, vol. 46, pp. 69-85.
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How effective have Alcohol Management Plans been in reducing alcohol and other drug use in Indigenous communities in Queensland?
Alcohol Management Plans (AMPs) with a focus on alcohol restrictions were implemented in 19 discrete Indigenous communities, in 15 Local Government Areas, by the Queensland Government from 2002. A study of community residents’ perceptions and experiences of the impacts of AMPs on local alcohol and drug use used data collected during 2014–2015 in 10 affected communities. Five had some alcohol available and five had total prohibition. The researchers found that ‘…less than 50% of 1098 participants agreed that: i) the restrictions had reduced alcohol availability in their community and ii) that people were drinking less. Nearly three quarters agreed that binge-drinking had increased, attributed to increased availability of illicit alcohol. There were no statistically significant differences between communities with prohibition and those with some access to alcohol. Participants agreed overall that cannabis use had increased but were more equivocal that new drugs were being used. These views were less frequently reported in prohibition communities’. The researchers concluded that ‘Contrary to what was intended, Queensland’s alcohol restrictions in Indigenous communities were viewed by community residents as not significantly reducing the availability and use of alcohol. Furthermore, this was compounded by perceived increases in binge drinking and cannabis use; also unintended. There is a need to strengthen resolve at all levels to reduce the supply of illicit alcohol in restricted areas’.
Robertson, JA, Fitts, MS & Clough, AR 2017, ‘Unintended impacts of alcohol restrictions on alcohol and other drug use in Indigenous communities in Queensland (Australia)’, International Journal of Drug Policy, vol. 41, pp. 34-40.
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What is the case for international guidelines on human rights and drug control?
‘This special section of Health and Human Rights Journal examines some of the many ways in which international and domestic drug control laws engage human rights and create an environment of enhanced human rights risk. In this edition, the authors address specific human rights issues such as the right to the highest attainable standard of health (including health protection and promotion measures, as well as access to controlled substances as medicines) and indigenous rights, and how drug control laws affect the protection and fulfillment of these rights. Other authors explore drug control through the lens of cross-cutting human rights themes such as gender and the rights of the child. Together, the contributions illustrate how international guidelines on human rights and drug control could help close the human rights gap—and point the way to drug laws and policies that would respect, protect, and fulfill human rights rather than breach them or impede their full realization.
‘Next year marks the 70th anniversary of the adoption of the Universal Declaration of Human Rights, the foundational instrument of the modern system of international human rights law, a system now underpinned by nine core UN treaties and multiple regional conventions. The growth of the international human rights regime has provided a critical tool to address the abusive and unaccountable exercise of state power and the violations that often accompany such unaccountable power.’
Lines, R, Elliott, R, Hannah, J, Schleifer, R, Avafia, T & Barrett, D 2017, ‘The case for international guidelines on human rights and drug control’, Health and Human Rights Journal, open access https://www.hhrjournal.org/2017/03/the-case-for-international-guidelines-on-human-rights-and-drug-control.
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How widespread is the stigma associated with methadone maintenance treatment, and how can it be reduced?
Canadian researchers interviewed clients of two methadone clinics in different Canadian cities regarding the stigma associated with methadone maintenance treatment (MMT). They found that ‘78% of participants reported having experienced stigma surrounding MMT. Common stereotypes associated with MMT patients included the following: methadone as a way to get high, incompetence, untrustworthiness, lack of willpower, and heroin junkies. Participants reported that stigma resulted in lower self-esteem; relationship conflicts; reluctance to initiate, access, or continue MMT; and distrust toward the health care system. Public awareness campaigns, education of health care workers, family therapy, and community meetings were cited as potential stigma-reduction strategies’. They concluded that ‘Stigma is a widespread and serious issue that adversely affects MMT patients’ quality of life and treatment. More efforts are needed to combat MMT-related stigma’.
Woo, J, Bhalerao, A, Bawor, M, Bhatt, M, Dennis, B, Mouravska, N, Zielinski, L & Samaan, Z 2017, ‘“Don’t judge a book by its cover”: a qualitative study of methadone patients’ experiences of stigma’, Substance Abuse: Research and Treatment, vol. 10 1178221816685087, open access http://insights.sagepub.com/dont-judge-a-book-by-its-cover-a-qualitative-study-of-methadone-patien-article-a6165-abstract
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How serious a problem is hepatitis C virus transmission in NSW prisons, and what can be done to reduce the rate of transmission?
A study of trends in hepatitis C virus (HCV) transmission in prisons in NSW used data from the Hepatitis C Incidence and Transmission Study in prisons (HITS-p) from 2005-2014. The researchers found that ‘Among 320 antibody-negative participants with a history of injecting drug use…62%...reported injecting drug use during follow-up. Overall, 93 infections were observed. HCV incidence was 11.4/100 person-years in the overall population and 6.3/100 person-years among the continually imprisoned population. A stable trend in HCV incidence was observed. Among the overall population with ongoing injecting during follow-up, >/=weekly injecting drug use frequency was independently associated with time to HCV seroconversion. Among continuously imprisoned injectors with ongoing injecting during follow-up, needle/syringe sharing was independently associated with time to HCV seroconversion’. The researchers concluded that ‘This study demonstrates that prison is a high-risk environment for acquisition of HCV infection. Needle and syringe sharing was associated with HCV infection among continually imprisoned participants, irrespective of frequency of injecting or the type of drug injected. These findings highlight the need for the evaluation of improved HCV prevention strategies in prison, including needle/syringe programs and HCV treatment’.
Cunningham, EB, Harjarizadeh, B, Bretana, NA, Amin, J, Betz-Stablein, B, Dore, GJ, Luciani, F, Teutsch, S, Dolan, K, Lloyd, AR, Grebely, J & H. ITS-p investigators 2017, ‘Ongoing incident hepatitis C virus infection among people with a history of injecting drug use in an Australian prison setting, 2005-2014: the HITS-p study’, Journal of Viral Hepatitis, online ahead of print.
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What do we know, and what don't we know, about opioid overdose prevention and naloxone rescue kits?
Abstract: ‘The opioid use and overdose crisis [in the USA and elsewhere] is persistent and dynamic. Opioid overdoses were initially driven in the 1990s and 2000s by the increasing availability and misuse of prescription opioids. More recently, opioid overdoses are increasing at alarming rates due to wider use of heroin, which in some places is mixed with fentanyl or fentanyl derivatives. Naloxone access for opioid overdose rescue is one of the US Department of Health and Human Services’ three priority areas for responding to the opioid crisis. This article summarizes the known benefits of naloxone access and details unanswered questions about overdose education and naloxone rescue kits. Hopefully future research will address these knowledge gaps, improve the effectiveness of opioid overdose education and naloxone distribution programs, and unlock the full promise of naloxone rescue kits.’
The authors discuss what is already known about opioid overdose education and community naloxone distribution (OEND) and then seek to clarify what is not known. These are the topics that they suggest require further exploration if we're to be established, and make business-as-usual, the optimal levels and types of opioid overdose education and community naloxone distribution programs:
- Who should receive opioid overdose education and naloxone rescue kits?
- Should all patients receiving opioid therapy be offered naloxone co-prescribing?
- Does OEND alter opioid prescribing practices?
- How should the perception of risk compensation be addressed?
- How should naloxone be administered and at what dose?
- What happens after overdose rescue with naloxone to keep people safe?
- What are the subacute effects of non-fatal opioid overdose and how can they be treated or prevented?
- What kind of training should be provided with naloxone distribution?
- After recognizing an overdose, what is the correct order of actions?
- How do local and state laws affect OEND?
- Would dedicated CME [continuing medical education] training programs for prescribers improve naloxone prescribing and distribution?
- What are validated research and clinical measures of overdose and overdose risk behaviours?
Kerensky, T & Walley, AY 2017, ‘Opioid overdose prevention and naloxone rescue kits: what we know and what we don’t know’, Addiction Science & Clinical Practice, vol. 12, no. 1, pp. 4, open access http://ascpjournal.biomedcentral.com/articles/10.1186/s13722-016-0068-3.
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How long should heroin overdose patients be observed after receiving naloxone?
Researchers in the United States undertook a literature search to ascertain What are the medical risks to a heroin user who refuses ambulance transport after naloxone? If the heroin user is treated in the emergency department with naloxone, how long must they be observed prior to discharge? How effective in heroin users is naloxone administered by first responders and bystanders? Are there risks associated with naloxone distribution programs? They concluded that ‘Patients revived with naloxone after heroin overdose may be safely released without transport to the hospital if they have normal mentation [mental activity] and vital signs. In the absence of co-intoxicants and further opioid use there is very low risk of death from rebound opioid toxicity. For those patients treated in the ED [hospital emergency department] for opioid overdose, an observation period of one hour is sufficient if they ambulate as usual, have normal vital signs and a Glasgow Coma Scale of 15. Patients suffering opioid toxicity can be administered naloxone safely by first responders and trained lay people. Programs that train these individuals are likely safe and beneficial, however further research is necessary.’
Willman, MW, Liss, DB, Schwarz, ES & Mullins, ME 2017, ‘Do heroin overdose patients require observation after receiving naloxone?’, Clinical Toxicology (Phila), vol. 55, no. 2, pp. 81-7.
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What is the rate of poisoning deaths of children in Australia?
Ninety poisoning deaths were reported to an Australian coroner between January 2003 and December 2013 involving children sixteen years or younger. A study of these cases found that ‘Acute poisoning death in Australian children under the age of 16 years occurred at a rate of approximately eight deaths per year, all of which are considered preventable…More than two-thirds of the cases involved a death in the home, which is typical of this age group…The majority of deaths were unintentional, but more than a third were attributed to parental assault or intentional self-harm, highlighting the issue of mental illness (of victims and perpetrators) as a contributor to poisonings in this population…Death was most common in older children, with the majority occurring in teens aged 13–16 years…There was approximately the same proportion of males to females in the cohort…Prescription opioids caused death in nearly a quarter of cases. This finding aligns with global data that describes paediatric poisoning deaths in the developed countries predominantly involving pharmaceutical drugs…The opioids commonly implicated were methadone, morphine and oxycodone; potent prescription opioids used in the treatment of pain and ORT [opioid replacement therapy]…At least half the children and adolescents dying from…prescription opioids in this study had previously misused drugs…Intentional ingestion or inhalation of volatile substances to get high was observed in almost a fifth of the cohort. More…than 40% of these cases involved children of Indigenous heritage’.
The researchers concluded that, ‘In Australia between 2003 and 2013 there were on average eight acute poisoning deaths in children each year, most commonly involving prescription opioids and adolescents. There has been a downward trend in mortality since 2003. These cases generated more than twice as many recommendations for public safety compared with other Australian coroners’ cases.’
Pilgrim, JL, Jenkins, EL, Baber, Y, Caldicott, D & Drummer, OH 2017, ‘Fatal acute poisonings in Australian children (2003–13)’, Addiction, vol. 112, no. 4, pp. 627-39.
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To what extent can electronic cigarettes help smokers to better control their blood pressure?
Abstract:
Electronic cigarettes (ECs) are battery-operated devices designed to vaporise nicotine, which may help smokers with quitting or reducing their tobacco consumption. No data is available regarding the health effects of ECs use among smokers with arterial hypertension and whether regular use results in blood pressure (BP) changes. We investigated long-term changes in resting BP and level of BP control in hypertensive smokers who quit or reduced substantially their tobacco consumption by switching to ECs. A medical records review of patients with hypertension was conducted to identify patients reporting regular daily use of ECs on at least two consecutive follow-up visits. Regularly smoking hypertensive patients were included as a reference group. A marked reduction in cigarette consumption was observed in ECs users (n = 43) though consumption remained unchanged in the control group (n = 46). Compared to baseline, at 12 months (follow-up visit 2) decline in cigarette consumption was associated with significant reductions in median…systolic BP…and diastolic BP... No significant changes were observed in the control group. As expected, decline in cigarette consumption in the ECs users was also associated with improved BP control. The study concludes that regular ECs use may aid smokers with arterial hypertension reduce or abstain from cigarette smoking, with only trivial post-cessation weight gain. This resulted in improvements in systolic and diastolic BP as well as better BP control.’
Polosa, R, Morjaria, J, Caponnetto, P, Battaglia, E, Russo, C, Ciampi, C, Adams, G & Bruno, C 2016, ‘Blood pressure control in smokers with arterial hypertension who switched to electronic cigarettes’, International Journal of Environmental Research and Public Health, vol. 13, no. 11, pp. 1123, open access http://www.mdpi.com/1660-4601/13/11/1123.
Comment: This is yet another study documenting health benefits from e-cigarette use, and the minimal adverse side effects. It is illegal, in Australia, to sell nicotine for use in e-cigarettes but perfectly legal to sell nicotine-containing tobacco products. ATODA has recently produced some factsheets about e-cigarettes.
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New Reports
Association HOPS - Healthy Options Project Skopje 2017, A brief history of drug user self-organisations, HOPS, http://hops.org.mk/en/content/brief-history-drug-user-self-organisations.
‘This technical briefing tells the story of a number of different groups and networks formed by people who use drugs to promote our health and defend our rights. A historical view is taken to help draw out common themes and create a framework for discussing and developing drug user organisations. Many drug user groups take on multiple functions and also as drug user groups mature and develop so they expand, develop and extend their remits.’
Burris, S 2017, ‘Scientific evaluation of law’s effects on public health’, in P Drahos (ed.), Regulatory theory: foundations and applications, ANU Press, Canberra, pp. 555-72, http://press.anu.edu.au/publications/regulatory-theory.
‘This chapter describes scientific theory and methods for investigating the development, implementation and effects of public health laws, enforcement strategies and other basic forms of regulation.’
Capler, R, Bilsker, D, Pelt, KV & MacPherson, D 2017,
Cannabis use and driving: evidence review, Canadian Drug Policy Coalition (CDPC), Simon Fraser University, Vancouver,
http://drugpolicy.ca/wp-content/uploads/2016/11/CDPC_Cannabis-and-Driving_Evidence-Review-Full_Jan31-2017_FINAL.pdf.
‘This policy brief is the result of a review of the research on cannabis impairment and driving that is currently underway at the CDPC. This project has involved an extensive scoping review of research with the aim of critically assessing current understandings of cannabis impairment and approaches for detecting cannabis impairment for the purpose of reducing impaired driving and promoting traffic safety.’
Capler, R, Bilsker, D, Pelt, KV & MacPherson, D 2017,
Cannabis use and driving: knowledge translation strategy recommendations, Canadian Drug Policy Coalition (CDPC), Simon Fraser University, Vancouver,
http://drugpolicy.ca/wp-content/uploads/2017/02/CDPC_Cannabis-and-Driving_KT-Strategy-Recommendations-Full_Jan31-2017_FINAL.pdf.
From web: ‘In reviewing the evidence relating to cannabis impairment and driving, we have highlighted several main considerations with respect to context, tone, and audience when developing messaging for public education. This document outlines these considerations.’
Drahos, P (ed.) 2017, Regulatory theory: foundations and applications, ANU Press, Canberra, http://press.anu.edu.au/publications/regulatory-theory.
‘This volume introduces readers to regulatory theory. Aimed at practitioners, postgraduate students and those interested in regulation as a cross-cutting theme in the social sciences, Regulatory Theory includes chapters on the social-psychological foundations of regulation as well as theories of regulation such as responsive regulation, smart regulation and nodal governance. It explores the key themes of compliance, legal pluralism, meta-regulation, the rule of law, risk, accountability, globalisation and regulatory capitalism. The environment, crime, health, human rights, investment, migration and tax are among the fields of regulation considered in this ground-breaking book.’
European Monitoring Centre for Drugs and Drug Addiction 2017, Healthy Nightlife Toolbox, EMCDDA, http://www.hntinfo.eu.
‘The Healthy Nightlife Toolbox is a website designed for local, regional and national policy makers and prevention workers, to help reduce harm from alcohol and drug use in nightlife settings. The core of the online Toolbox is comprised of three databases: evaluated interventions, literature on these interventions, and other literature within the field of nightlife alcohol and drug prevention. The HNT Info sheet summarises the available knowledge on creating a healthy and safe nightlife.’
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 2017, Drug supply reduction: an overview of EU policies and measures, EMCDDA Papers, Publications Office of the European Union, Luxembourg, http://www.emcdda.europa.eu/publications/emcdda-papers/drug-supply-reduction-an-overview-of-eu-policies-measures.
‘Illicit drug markets have a global reach. This paper provides an overview of EU policies and responses to the production and trafficking of illicit drugs within the international context. It considers the different strategic areas involved, the EU structures concerned, along with some of the key measures currently being implemented by the EU and its international partners. Drug supply reduction actions cut across policy areas.’
Gilchrist, G & Hegarty, K 2017, ‘Editorial: Tailored integrated interventions for intimate partner violence and substance use are urgently needed’, Drug and Alcohol Review, vol. 36, no. 1, pp. 3-6, open access http://onlinelibrary.wiley.com/doi/10.1111/dar.12526/full.
Editorial of special issue on the topic, dated 30 January 2017 http://onlinelibrary.wiley.com/doi/10.1111/dar.2017.36.issue-1/issuetoc.
Palmer, M, Wodak, A, Douglas, B & Stephens, L (eds) 2016, Can Australia respond to drugs more effectively and safely? Roundtable report of law enforcement and other practitioners, researchers and advocates. Sydney, September 2015, Australia21, Weston, ACT, http://australia21.org.au/product/can-australia-respond-drugs-effectively-safely/#.WM8ElWclGUk.
'This is the report of a day-long roundtable of 17 experts and practitioners held at the University of Sydney in September 2015 to consider drug law reform in Australia. Participants included retired judges, prosecutors, senior police, prison and parole administrators, drug law researchers and advocates. Discussion focused on ways Australia could develop safer and more effective illicit drugs policies. The roundtable followed two Australia21 reports in 2012 that documented the failure of the International War on Drugs and explored the range of alternative options to prohibition, including initiatives introduced in other countries.'
National Institute for Health and Clinical Excellence (NICE) (UK) 2017, Drug misuse prevention: targeted interventions, NICE guideline, NICE, Manchester, UK, www.nice.org.uk/guidance/ng64.
‘This guideline covers targeted interventions to prevent misuse of drugs, including illegal drugs, “legal highs” and prescription-only medicines. It aims to prevent or delay harmful use of drugs in children, young people and adults who are most likely to start using drugs or who are already experimenting or using drugs occasionally.
The Kirby Institute 2017, Monitoring hepatitis C treatment uptake in Australia (Issue 6), February 2017 http://kirby.unsw.edu.au/research-programs/vhcrp-newsletters.
‘The Kirby Institute report “Monitoring Hepatitis C Treatment Uptake in Australia” provides information on the first year of the direct-acting antiviral (DAA) hepatitis C treatment program in Australia. The report indicates that more than 30,000 Australians were treated for their hepatitis C virus infection in 2016 – a massive increase on the 2,000-3,000 people with hepatitis C treated annually prior to the listing.’
Warren, F 2016, ‘What works’ in drug education and prevention?, Health and Social Care Analysis, Scottish Government, Edinburgh, http://www.gov.scot/Publications/2016/12/4388.
‘This literature review examines the evidence of effectiveness of different types of drug prevention and education for children and young people, principally that which is delivered in schools.’
White, V & Williams, T 2016, Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 20114: report, Centre for Behavioural Research in Cancer, Cancer Control Research Institute, The Cancer Council Victoria, Melbourne, www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/E9E2B337CF94143CCA25804B0005BEAA/$File/National-report_ASSAD_2014.pdf.
‘Just over 23,000 secondary students aged between 12 and 17 years participated in the 2014 ASSAD Survey.’
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