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 cover 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.
The National opioid pharmacotherapy statistics 2013 report provides information on clients receiving opioid pharmacotherapy treatment on a snapshot day in June 2013, the doctors prescribing opioid pharmacotherapy drugs and the dosing points (such as pharmacies) that clients attend to receive their medication.
: AIHW 2014. National Opioid Pharmacotherapy Statistics 2013. Drug treatment series 23. Cat. no. HSE 147. Canberra: AIHW.
was chosen by the Scientific Program Committee to reflect the changing times and increased pressures faced by the drug and alcohol sector.
The conference will feature an exciting program of international and national speakers, focusing on new treatments, prevention and policy in the areas of drug and alcohol research. With original and innovative work from the field, the program will encourage alternative presentation styles.
The 2014 Scientific Program Committee invites the submission of abstracts for original work in consideration for symposia at the 2014 APSAD Conference.
Can the application of a social determinants of health approach reduce cannabis-related harm?
An overview of the literature on the effects of early cannabis use explains that ‘Cannabis is the most widely used illicit drug in the world. Although the risk of problematic cannabis use is relatively low, the lifetime prevalence of dependence is greater than for all other illicit drugs. As such, the population burden of problematic cannabis use warrants attention. Many health and psychosocial risks associated with cannabis use are exacerbated or predicted by initiation of cannabis use in early adolescence and early adolescent users are more vulnerable to negative developmental outcomes, longer cannabis use trajectories, earlier transitions to heavier use and dependence. This suggests a need for effective prevention interventions targeting this age group. Unfortunately, most prevention efforts focus on individual-level risk factors and evidence indicates that they are not particularly effective for deterring use’.
The author outlines what she sees as a more effective approach for preventing cannabis-related harm. ‘Using a social determinants of health perspective, it highlights peer networks and family structure and quality as the main risk factors associated with early adolescent cannabis use…[and] suggests that interventions that target these determinants can be effective for preventing cannabis use. It concludes by suggesting complementary harm reduction programmes for older adolescents as a means to further reduce cannabis-related harm…policy and decision-makers interested in preventing early adolescent cannabis and other substance use should consider implementing prevention interventions as part of a broader adolescent health agenda and target social determinants as a means to improve young people’s overall health and well-being’.
Hyshka, E 2013, ‘Applying a social determinants of health perspective to early adolescent cannabis use – an overview
’, Drugs: Education, Prevention, and Policy
, vol. 20, no. 2, pp. 110-9.
Comment: This paper highlights the need for an inter-sectoral approach to preventing and/or delaying initiating cannabis use.
back to top
Does eliminating punishment for possession of illegal drugs for personal use lead to more or less illegal drug use?
Eurobarometer repeated cross-sectional surveys in 2002 and 2004 of adolescents aged 15–24 in fifteen European countries covered last month drug use; attitudes toward drugs, school and work participation; and demographics. A recent study examined the association between these variables and national-level policy measures including drug offence levels, the decriminalisation of drug possession, and presence and usage of harm reduction strategies. The findings were that ‘in countries where there is no restriction on possession of drugs for personal use, the odds of drug use in the last month are 79% lower…[however] higher usage of treatment and drug substitution are associated with higher levels of drug use’. The researcher concluded that ‘eliminating punishments for possession for personal use is not associated with higher drug use…[further] nations could consider eliminating the criminal penalties for possession for personal use, as it is associated with lower use and frees up resources’.
Vuolo, M 2013, ‘National-level drug policy and young people's illicit drug use: a multilevel analysis of the European Union
’, Drug and Alcohol Dependence
, vol. 131, no. 1–2, pp. 149-56.
Comment: This cross-national study adds to the evidence base supporting the legalisation of personal-level drug behaviours including the self-administration of drugs and cultivating and possessing small quantities.
back to top
What resources are available to assist staff to cater to the specific behavioural needs of adult men with substance abuse disorder?
‘The physical, psychological, social, and spiritual effects of substance use and abuse on men can be quite different from the effects on women. Those differences have implications for treatment in behavioral health settings.
‘TIP [Treatment Improvement Protocol] 56: Addressing the Specific Behavioral Health Needs of Men presents the specific treatment needs of adult men with substance use disorders
… reviews gender-specific research and best practices, such as common patterns of initiation of substance use among men and specific treatment issues and strategies’.
Center for Substance Abuse Treatment (U.S.) 2011, Addressing the specific behavioral health needs of men
, Treatment Improvement Protocol (TIP) Series 56. HHS Publication No. (SMA) 13-4736, Substance Abuse and Mental Health Services Administration, Rockville, MD.
What are the consequences of stigmatisation of people with substance use disorders?
‘Background: A stigma is a long-lasting mark of social disgrace that has a profound effect on interactions between the stigmatized and the unstigmatized. Factors governing the extent of stigmatization attached to an individual include the perceived danger posed by that person and the extent to which she/he is seen as being to blame for the stigma.
‘Methods: Systematic database searches identified 185 papers for inclusion in the review, all of which were read and findings analysed and compared.
‘Results: Stigmatizing attitudes towards problem drug users (PDUs) are common among the general public and non-specialist professionals. The impact on users is profound and represents a significant barrier to recovery. Reasons for this extreme stigmatization include negative reactions to injecting and widespread attributions concerning danger and blame. Advocacy and practice responses include challenging media language and stereotypes, encouraging public figures to speak out about their personal experiences, improved training for non-specialist staff and greater contact between PDUs and the public.
‘Conclusion: Stigmatization has a profound effect on PDUs’ lives and their chances of recovery. Efforts need to be made to diminish inflated fears about users and help people to understand that PDUs are not simply and solely “to blame” for their condition.’
Lloyd, C 2013, ‘The stigmatization of problem drug users: a narrative literature review
’, Drugs: Education, Prevention, and Policy
, vol. 20, no. 2, pp. 85-95.
back to top
Is it common for health professionals to have negative attitudes towards patients with substance use disorders?
An analysis of 28 articles published between 2000 and 2011 found that ‘Health professionals generally had a negative attitude towards patients with substance use disorders. They perceived violence, manipulation, and poor motivation as impeding factors in the healthcare delivery for these patients. Health professionals also lacked adequate education, training and support structures in working with this patient group. Negative attitudes of health professionals diminished patients’ feelings of empowerment and subsequent treatment outcomes. Health professionals are less involved and have a more task-oriented approach in the delivery of healthcare, resulting in less personal engagement and diminished empathy’.
The reviewers concluded that ‘negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care for these patients’.
van Boekel, LC, Brouwers, EPM, van Weeghel, J & Garretsen, HFL 2013, ‘Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review
’, Drug and Alcohol Dependence
, vol. 131, no. 1–2, pp. 23-35.
How effective are interventions to reduce alcohol consumption among general hospital inpatients?
A study of the effectiveness of interventions in reducing alcohol consumption among general hospital inpatient heavy alcohol users found that ‘Results from single session brief interventions and self-help literature showed no clear benefit on alcohol consumption outcomes, with indications of benefit from some studies but not others. However, results suggest brief interventions of more than one session could be beneficial on reducing alcohol consumption, especially for non-dependent patients. No active intervention was found superior over another on alcohol consumption and other outcomes’. The researchers concluded that ‘Brief interventions of more than one session could be beneficial on reducing alcohol consumption among hospital inpatients, especially for non-dependent patients’.
Mdege, ND, Fayter, D, Watson, JM, Stirk, L, Sowden, A & Godfrey, C 2013, ‘Interventions for reducing alcohol consumption among general hospital inpatient heavy alcohol users: a systematic review
’, Drug and Alcohol Dependence
, vol. 131, no. 1–2, pp. 1-22.
Why are non-medical use of prescription opioids and prescription-related harms higher in North America than in other regions?
This study aimed to ‘identify possible system-level factors contributing to the marked differences in the levels of non-medical prescription opioid use (NMPOU) and prescription opioid (PO)-related harms in North America (i.e. the United States and Canada) compared to other global regions’. It examined health systems, policy and practice. It found that ‘North American health-care systems consume substantially more POs—even when compared to other high-income countries—than any other global region, with dispensing levels associated strongly with levels of NMPOU and PO-related harms. Secondly, North American health-care systems, compared to other systems, appear to have lesser regulatory access restrictions for, and rely more upon, community-based dispensing mechanisms of POs, facilitating higher dissemination level and availability (e.g. through diversion) of POs implicated in NMPOU and harms. Thirdly, we note that the generally high levels of psychotrophic drug use, dynamics of medical–professional culture (including patient expectations for “effective treatment”), as well as the more pronounced “for-profit” orientation of key elements of health care (including pharmaceutical advertising), may have boosted the PO-related problems observed in North America’.
The researchers concluded that ‘Differences in the organisation of health systems, prescription practices, dispensing and medical cultures and patient expectations appear to contribute to the observed inter-regional differences in non-medical prescription opioid use and prescription opioid-related harms’.
Fischer, B, Keates, A, Bühringer, G, Reimer, J & Rehm, J 2013, ‘Non-medical use of prescription opioids and prescription opioid-related harms: why so markedly higher in North America compared to the rest of the world?
, online ahead of print.
back to top
Has Kronic caused a panic in Australia?
‘Background: Having first appeared in Europe, synthetic cannabis emerged as a drug of concern in Australia during 2011. Kronic is the most well-known brand of synthetic cannabis in Australia and received significant media attention. Policy responses were reactive and piecemeal between state and federal governments. In this paper we explore the relationship between media reports, policy responses, and drug-related harm.
‘Methods: Google search engine applications were used to produce time-trend graphs detailing the volume of media stories being published online about synthetic cannabis and Kronic, and also the amount of traffic searching for these terms. A discursive analysis was then conducted on those media reports that were identified by Google as “key stories”. The timing of related media stories was also compared with self-reported awareness and month of first use, using previously unpublished data from a purposive sample of Australian synthetic cannabis users.
‘Results: Between April and June 2011, mentions of Kronic in the media increased. The number of media stories published online connected strongly with Google searches for the term Kronic. These stories were necessarily framed within dominant discourses that served to construct synthetic cannabis as pathogenic and created a “moral panic”. Australian state and federal governments reacted to this moral panic by banning individual synthetic cannabinoid agonists. Manufacturers subsequently released new synthetic blends that they claimed contained new unscheduled chemicals.
‘Conclusion: Policies implemented within in the context of “moral panic”, while well-intended, can result in increased awareness of the banned product and the use of new yet-to-be-scheduled drugs with unknown potential for harm. Consideration of regulatory models should be based on careful examination of the likely intended and unintended consequences. Such deliberation might be limited by the discursive landscape.’
Bright, SJ, Bishop, B, Kane, R, Marsh, A & Barratt, MJ 2013, ‘Kronic hysteria: Exploring the intersection between Australian synthetic cannabis legislation, the media, and drug-related harm
’, International Journal of Drug Policy
, vol. 24, no. 3, pp. 231-7.
back to top
How effective is injectable extended-release naltrexone as a treatment for opioid dependence?
A study of patients who received injectable extended-release naltrexone (XR-NTX) for opioid dependence at thirteen clinical sites in Russia found that, compared with a control group, ‘XR-NTX patients maintained their improvements over time in regard to abstinence from opioids, craving for opioids and overall health functioning…Because of the clinical importance of retention and abstinence, opioid-negative urine was analysed imputing missing urine as positive—a conservative approach to describing the pattern of results. There was no evidence that patients increased their use of other drugs and alcohol after decreasing their use of opioids over the course of the double-blind and open-label phases’.
The researchers reported ‘improvements over time following a 6-month double-blind phase were maintained during 1 year of long-term treatment with XR-NTX and no new safety concerns were evident’.
Krupitsky, E, Nunes, EV, Ling, W, Gastfriend, DR, Memisoglu, A & Silverman, BL 2013, ‘Injectable extended-release naltrexone (XR-NTX) for opioid dependence: long-term safety and effectiveness
, online ahead of print.
Comment: Although the evidence for the effectiveness of this intervention is building, other studies demonstrate negative outcomes, meaning that the evidence base is not yet strong enough for regulatory authorities to sanction widespread use of extended-release naltrexone for the treatment of opioid dependence.
back to top
How common is driving while under the influence of cannabis among police detainees?
A recently published AIC Research into Practice Brief analyses data on the frequency of self-reported driving under the influence of cannabis by police detainees. ‘Of the 159 detainees who self-reported driving under the influence of cannabis in the past 12 months, 18 per cent reported doing so once or twice a week on average, while a further 32 per cent reported doing so three or more times a week. Combined, these data suggest that half of those who report driving under the influence of cannabis did so on at least a weekly basis’.
The authors of the study state that ‘this study reinforces that drug driving, and in particular driving after the use of cannabis, is an ongoing concern to law enforcement and other criminal justice policy makers and practitioners. Relatively high rates of recent drug use were found among those who were driving at the time of their arrest (35%) as well as relatively high rates of self-reported cannabis drug driving among all police detainees (19%), the majority of whom admitted drug driving at least once a week, and often more frequently. However, the perceptions and beliefs held by cannabis users about its impact on their driving ability, as well as its links with other risky driving activities, are perhaps the most important findings in this study. It confirms earlier research that those who use cannabis and drive tend to believe that their intoxication has little or no effect on their driving ability. The fact that cannabis drug drivers were also more likely in this study to report other risky driving behaviours, such as drink driving and failing to stop when requested by the police, suggests that drug driving is unlikely to be an isolated practice in this group but instead, one that occurs largely within the context of other risk-taking behaviours’.
Payne, J, Sweeney, J & Macgregor, S 2013, Attitudes and perceptions towards drug driving amongst a sample of cannabis using police detainees
, AIC Research into Practice Brief 8, Australian Institute of Criminology & National Cannabis Prevention & Information Centre, Canberra; Sydney.
back to top
Is it possible to set blood concentration limits for drug driving?
All Australian states and territories have laws criminalising driving while having detectable levels of certain specified drugs in the body. These are per se
laws, i.e. the prosecution does not need to prove that the driver was impaired, all it needs to prove is that the testing device detected the presence of the specified drug. This approach breaches a number of fundamental human rights.
As a response to the problems with the per se
approach used in Australia, the UK Department for Transport commissioned an Expert Panel on Drug Driving to report and make recommendations on the drugs to be covered in a planned new drug driving offence, and the limits to be set for each drug.
The Panel has now done so. It stresses that ‘Setting a concentration or “limit” for a psychoactive drug, for the new drug driving offence, means that if a driver exceeds this threshold the driver can be prosecuted without the requirement to prove that he or she was impaired and that this impairment was caused by the drug in his body. The implications of setting such a limit in law are therefore far‐reaching, and the Panel members accept that their task in advising Government on such limits is crucial. Before recommending drug thresholds the Panel have therefore properly considered both the empirical (epidemiological) and experimental evidence, in relation to blood drug concentrations and driving behaviour, whilst being mindful of stakeholders, practical and ethical considerations.’
For each drug, and for some drug/alcohol interactions, the report presents the scientific evidence about what levels cause impaired driving, and recommends the thresholds that should be applied.
Wolff, K, Brimblecombe, R, Forfar, JC, Forrest, R, Gilvarry, E, Johnston, A, Morgan, J, Osselton, D, Read, L & Taylor, D 2013, Driving under the influence of drugs: report from the Expert Panel on Drug Driving
, Department for Transport (UK), London.
Comment: This recommended UK approach to determining if a person should be charged with drug driving is far superior to the Australian/ACT per se approach as it means that a driver is charged because their driving is likely to be impaired by their drug use, rather than (as now) being charged for having a detectable amount of the drug in their body. That makes it a more valid road safety intervention. The ACT Government adopted a per se approach because, at the time it created the offence, it did not have sound evidence as to the amount of a drug in the body that was likely to cause impaired driving. The data are now available, suggesting that the ACT, and other Australian governments, should review and bring up-to-date their drug driving policies and legislation, removing the per se approach and specifying the impairment thresholds.
back to top
What types of school-based programs are most effective in preventing young people from starting to smoke?
‘Increasing numbers of young people are smoking in developing and poorer countries. Programmes to prevent them starting to smoke have been delivered in schools over the past 40 years. We wanted to find out if they are effective.
‘We identified 49 randomised controlled trials (over 140,000 school children) of interventions aiming to prevent children who had never smoked from becoming smokers. At longer than one year, there was a significant effect of the interventions in preventing young people from starting smoking. ‘Programmes that used a social competence approach and those that combined a social competence with a social influence approach were found to be more effective than other programmes. However, at one year or less there was no overall effect, except for programmes which taught young people to be socially competent and to resist social influences.
‘A smaller group of trials reported on the smoking status of all people in the class, whether or not they smoked at the start of the study. In these trials with follow-up of one year or less there was an overall small but significant effect favouring the controls. This continued after a year; for trials with follow-up longer than one year, those in the intervention groups smoked more than those in the control groups.
‘When trials at low risk of bias from randomisation, or from losing participants, were examined separately, the conclusions remained the same. Programmes led by adults may be more effective than those led by young people. There is no evidence that delivering extra sessions makes the intervention more effective.’
Thomas, R, McLellan, J & Perera, R 2013, 'School-based programmes for preventing smoking
', Cochrane Database Syst Rev
, no. 4, p. Art. No.: CD001293.
back to top
What changes are needed to improve drug courts as a tool for diverting drug-involved offenders into treatment rather than incarceration?
‘Drug courts have been widely praised as an important tool for reducing prison and jail populations by diverting drug-involved offenders into treatment rather than incarceration. Yet only a small share of offenders presenting with drug abuse or dependence are processed in drug courts. This study uses inmate self-report surveys from 2002 and 2004 to examine characteristics of the prison and jail populations in the United States and assess why so many drug-involved offenders are incarcerated. Our analysis shows that four factors have prevented drug courts from substantially lowering the flow into prisons and jails. In descending order of importance, these are: drug courts’ tight eligibility requirements, specific sentencing requirements, legal consequences of program noncompliance, and constraints in drug court capacity and funding. Drug courts will only be able to help lower prison and jail populations if substantial changes are made in eligibility and sentencing rules.’
Sevigny, EL, Pollack, HA & Reuter, P 2013, ‘Can drug courts help to reduce prison and jail populations?
’, The ANNALS of the American Academy of Political and Social Science
, vol. 647, no. 1, pp. 190-212.
back to top
How important are social factors in access to HIV treatment by people who inject drugs?
Background: Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access.
‘Method: We undertook a review of the social science and public health literature pertaining to HCV treatment for PWID, with a focus on barriers to treatment access, uptake and completion. Medline and Scopus databases were searched, supplemented by manual and grey literature searches. A two-step search was taken, with the first step pertaining to literature on HCV treatment for PWID and the second focusing on social structural factors. In total, 596 references were screened, with 165 articles and reports selected to inform the review.
‘Results: Clinical and individual level barriers to HCV treatment among PWID are well evidenced. These include patient and provider concerns regarding co-morbidities, adherence, and side effect management. Social factors affecting treatment access are less well evidenced. In attempting to map these, key barriers fall into the following domains: social stigma, housing, criminalisation, health care systems, and gender. Key facilitating factors to treatment access include: combination intervention approaches encompassing social as well as biomedical interventions, low threshold access to opiate substitution therapy, and integrated delivery of multidisciplinary care.
‘Conclusion: Combination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access.’
Harris, M & Rhodes, T 2013, ‘Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors
’, Harm Reduction Journal
, vol. 10, no. 1, p. 7.
back to top
Alonso, J, Chatterji, S & He, Y 2013, The burden of mental disorders: from the WHO world mental health surveys, Cambridge University Press, Cambridge.
American Psychiatric Association 2013, The Diagnostic and Statistical Manual of Mental Disorders (DSM-5): Substance-Related and Addictive Disorders (fact sheet), American Psychiatric Association, http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf.
Australian Bureau of Statistics 2013, Profiles of Health, Australia, 2011-13 ABS, www.abs.gov.au/ausstats/abs@.nsf/mf/4338.0 - incudes data on psychoactive drug use as a risk factor.
ACT Government, Health 2013, Future directions for tobacco reduction in the ACT 2013-2016, Canberra, http://health.act.gov.au/c/health?a=sp&did=10152911.
Australian Crime Commission 2013, Illicit drug data report 2011-12, Australian Crime Commission, Canberra, http://www.crimecommission.gov.au/publications/illicit-drug-data-report/illicit-drug-data-report-2011-12 - large file warning: 32 MB.
Australian Institute of Criminology 2013, Australian crime: facts and figures 2012, Australian Institute of Criminology, Canberra, http://aic.gov.au/publications/current%20series/facts/1-20/2012.html - see chapter 8 ‘Spotlight on crime, alcohol and other drugs’.
European Monitoring Centre for Drugs and Drug Addiction 2013, European drug report: trends and developments 2013, Publications Office of the European Union, Luxembourg, http://www.emcdda.europa.eu/publications/edr/trends-developments/2013 - includes a major focus on new psychoactive substances.
Manning, M, Smith, C & Mazerolle, P 2013, The societal costs of alcohol misuse in Australia, Trends & Issues in Crime and Criminal Justice, no. 454, Australian Institute of Criminology, Canberra, http://www.aic.gov.au/publications/current%20series/tandi/441-460/tandi454.html.
New South Wales, Parliament, Legislative Council, General Purpose Standing Committee No. 4 2013, The use of cannabis for medical purposes (final report), New South Wales, Parliament, Legislative Council, General Purpose Standing Committee No. 4, Sydney, http://www.parliament.nsw.gov.au/Prod/Parlment/committee.nsf/0/FDB7842246A5AB71CA257B6C0002F09B?open&refnavid=CO4_1.
Stevens, A 2013, Applying harm reduction principles to the policing of retail drug markets, Modernising Drug Law Enforcement: Report 3, International Drug Policy Consortium, London, http://www.drugsandalcohol.ie/19567/1/MDLE-report-3_Applying-harm-reduction-to-policing-of-retail-markets.pdf.
back to top