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.
Stakeholders are progressing a proposal to expand and strengthen alcohol, tobacco and other drug (ATOD) research in the ACT and region, and enhance ATOD policy and its implementation, through establishing a structured collaboration, such as a Centre for ATOD Research, Policy and Practice in the ACT. For more information please see the
. If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on
Most of the reports and research items referenced below are available from the Alcohol and Other Drug Council of Australia’s
Are opioid-dependent patients on a waiting list for treatment at risk of dying before they are admitted to treatment?
Researchers at the Dr Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research in Tel Aviv, Israel evaluated the possible impact of a waiting list for methadone maintenance treatment (MMT) on the survival rate of patients. They found ‘Of the 608 opiate addicts who were seeking treatment and registered for our MMT clinic, 60.2% were eventually admitted either to our MMT clinic or to any other treatment facility. The remaining 39.8% were not treated anywhere. Throughout the 2 years since they registered, 21 of the 24 opiate addicts who died were among those who did not enter any treatment at all. The mortality rate was more than 10-fold higher for the non-treated addicts compared with those who were admitted to MMT’. The researchers concluded that ‘these drug addicts wanted to enter treatment (ie, they had registered and were willing to start immediately), but they encountered the barrier of a long waiting list and died before their treatment could begin’.
Peles, E, Schreiber, S & Adelson, M 2013, ‘Opiate-dependent patients on a waiting list for methadone maintenance treatment are at high risk for mortality until treatment entry’, Journal of Addiction Medicine
, online ahead of print.
Readers will be aware of the unconscionable situation in much of Australia of people not being able to enter life-saving treatment for opioid dependence owing to Government decisions to limit the number of treatment places. The need to actively manage waiting lists, in these situations, is highlighted by this study from abroad. Much can be done to prevent drug-related deaths among people on waiting lists for methadone-/buprenorphine-assisted treatment.
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Can we reduce appointment no-shows and is it important to do so?
A recent American study of how to reduce AOD treatment appointment no-shows was undertaken on the basis that no-shows adversely impact upon clinical outcomes and treatment agency productivity. During 2007–2010, 67 treatment organizations were asked to reduce their no-show rates by using practices taken from no-show research and theory. These treatment organizations reduced outpatient no-show rates from 37 percentage points to 20 percentage points, a massive 47% reduction.
Although all the strategies used had positive results, the most effective were creating a welcoming environment, reduce waiting times, adding service/staff capacity and behavioural engagement strategies. ‘Organizations that worked on creating a welcoming environment all focused on improving the appearance of the public entrance areas. Examples of interventions used to increase capacity included adding new groups at the new times (e.g., evenings and Saturdays; adding new types of groups (e.g., pretreatment and vocational; and adding more appointment slots. Those reducing wait times by >10% implemented walk-in appointment; double-booked appointments; and centralized appointment scheduling (vs counsellor scheduling). Behavioural engagement strategies included motivational interviewing and contingent management’.
Molfenter, T 2013,’Reducing appointment no-shows: going from theory to practice’, Substance Use & Misuse
, online ahead of print.
It is remarkable how little research evidence exists on how to reduce appointment no-shows and the linked issue of how to manage the people on waiting lists. This study, undertaken in busy agencies rather than in trial sites, provides useful information that can probably be generalised to other settings.
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How effective are school-based alcohol and other drug prevention programs delivered by computer or the Internet?
Alcohol and other drug prevention program delivered in schools by computers or the Internet have advantages over other types of programs. It is not necessary for the programs to be delivered by professionals. The programs are inexpensive to update, and can be delivered to large numbers of students. It is possible to achieve ‘a high degree of implementation fidelity as consistent and complete delivery of materials’. In relation to drug education ‘computers and the Internet have the potential to increase self-disclosure and reduce stigmatisation about drug use by enhancing perceptions of privacy and anonymity’.
A systematic review of this type of programs undertaken by researchers from the National Drug and Alcohol Research Centre found that ‘existing computer- and Internet-based prevention programs in schools have the potential to reduce alcohol and other drug use as well as intentions to use substances in the future. These findings, together with the implementation advantages and high fidelity associated with new technology, suggest that programs facilitated by computers and the Internet offer a promising delivery method for school-based prevention’.
Champion, KE, Newton, NC, Barrett, EL & Teesson, M 2013, ‘A systematic review of school-based alcohol and other drug prevention programs facilitated by computers or the Internet’, Drug and Alcohol Review
, vol. 32, no. 2, pp. 115-23.
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Would changing the law to encourage the prescription and use of nalaxone reduce opioid overdose deaths?
An article in a recent issue of The Journal of Law, Medicine & Ethics
states that ‘Drug overdose has recently surpassed motor vehicle accidents to become the leading cause of unintentional injury death in the United States. The epidemic is largely driven by opioids such as oxycodone, hydro-codone, and methadone, which kill more Americans than heroin and cocaine combined’. After reviewing the legal issues relating to naloxone, the authors conclude ‘Opioid overdose is the leading cause of accidental injury death in the United States, taking the lives of over 16,000 Americans every year. Many of those deaths are preventable through the timely provision of naloxone, a drug that reliably and effectively reverses opioid overdose. However, that drug is often not available where and when it is needed, due in large part to laws that pre-date the overdose epidemic. Preliminary evidence suggests that amending those laws to encourage the prescription and use of naloxone will reduce opioid overdose deaths, and a number of states have done so in the past several years. Since legal amendments designed to facilitate naloxone access have no documented negative effects, can be implemented at little or no cost, and have the potential to save both lives and resources, states that have not passed them may benefit from doing so’.
Davis, C, Webb, D & Burris, S 2013, ‘Changing law from barrier to facilitator of opioid overdose prevention’, The Journal of Law, Medicine & Ethics
, vol. 41, no. s1, pp. 33-6.
The ACT has led Australia in making naloxone available, on prescription, to potential overdose witnesses who have been trained in responding to overdoses. However, there still remains a number of legal impediments in this jurisdiction to further expanding this potentially life-saving initiative. It is expected that this topic will be addressed in the evaluation of the ACT naloxone program that is currently being conducted.
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Are prisoners who have visitors while in prison less likely to reoffend on release?
A US study examined the effects of prison visitation on recidivism among 16,420 offenders released from Minnesota prisons between 2003 and 2007. The researchers found that ‘visitation significantly decreased the risk of recidivism, visits from siblings, in-laws, fathers, and clergy were the most beneficial in reducing the risk of recidivism, whereas visits from ex-spouses significantly increased the risk’. They concluded that ‘revising prison visitation policies to make them more “visitor friendly” could yield public safety benefits by helping offenders establish a continuum of social support from prison to the community. We anticipate, however, that revising existing policies would not likely increase visitation to a significant extent among unvisited inmates, who comprised 39% of our sample. Accordingly, we suggest that correctional systems consider allocating greater resources to increase visitation among inmates with little or no social support’.
Duwe, G & Clark, V 2013, ‘Blessed be the social tie that binds: the effects of prison visitation on offender recidivism’, Criminal Justice Policy Review
, vol. 24, no. 3, pp. 271-96.
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What type of drug treatment programs is most effective in a prison setting?
Research by the Campbell Collaboration’s Criminal Justice Review Group ‘synthesized results from 74 evaluations of incarceration-based drug treatment programs using meta-analysis. Incarceration-based drug treatment programs fell into four distinct types: therapeutic communities (TCs), group counseling, boot camps specifically for drug offenders, and narcotic maintenance programs. We examined the effectiveness of each of these types of programs in reducing post-release offending and drug use, and we also examined whether differences in research findings can be explained by variations in methodology, sample, or program features. Our results consistently found support for the effectiveness of TC programs on both outcome measures and this finding was robust to variations in method, sample, and program features. We also found support for the effectiveness of group counseling programs in reducing offending, but these programs’ effects on drug use were negligible. The effect of narcotic maintenance programs was also mixed with reductions in drug use but not offending. Boot camps had no substantive effect on either outcome measure’.
Mitchell, O, Wilson, DB & MacKenzie, DL 2012, The effectiveness of incarceration-based drug treatment on criminal behavior: a systematic review
, Campbell Collaboration Criminal Justice Review Group.
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Are prisoners who are given methadone maintenance treatment before release from prison more likely to continue this treatment port-release than prisoners referred to treatment at the time of release?
A randomised controlled trial conducted in the USA compared the results of initiating methadone maintenance treatment (MMT) between (a) prisoners before their release and (b) prisoners referred to treatment upon release. The researchers explained that ‘The time up to enrolment in community-based MMT, after release from incarceration, is critically important given the high risk for relapse, crime, disease transmission, and overdose in the period immediately after release from incarceration. A major finding of this study is that offering pre-release MMT initiation and payment assistance post-release was significantly associated with increased enrolment in post-release MMT and reduced time to enter community-based MMT. Further, offering pre-release MMT initiation and payment assistance post-release was significantly associated with reduced heroin use at 6-month follow-up’.
They concluded that ‘initiating MMT in the weeks prior to release from incarceration is feasible and an effective way to improve MMT access post-release. Both initiating methadone prior to release, even with the relatively short duration and low dose of methadone, and ensuring a means of payment for methadone after release were beneficial. These findings have important implications for policy makers, correctional administrators, politicians, and drug treatment programs that serve individuals with opiate dependence and/or addiction, namely that ways to overcome obstacles to initiation of methadone during and after re-entry should be explored aggressively’.
McKenzie, M, Zaller, N, Dickman, SL, Green, TC, Parihk, A, Friedmann, PD & Rich, JD 2012, ‘A randomized trial of methadone initiation prior to release from incarceration’, Substance Abuse
, vol. 33, no. 1, pp. 19-29.
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How effective is testing of exhaled breath as a means of detecting drugs of abuse?
Swedish researchers compared the sampling of exhaled breath as a method of detecting drugs of abuse with analysis of plasma and urine samples and with self-reporting in 47 patients recovering from acute intoxication. ‘In all 47 cases, recent intake of an abused substance prior to admission was reported. In general, data from breath, plasma, urine and self-reporting were in good agreement, but in 23% of the cases substances were detected that had not been self-reported. All substances covered were detected in a number of breath samples. Considering that breath sampling was often done about 24 hours after intake, the detection rate was considered to be high for most substances. Analyses with low detection rates were benzodiazepines, and a further increase in analytical sensitivity is needed to overcome this. This study further supports use of exhaled breath as a new matrix in clinical toxicology.’
Beck, O, Stephanson, N, Sandqvist, S & Franck, J 2013, ‘Detection of drugs of abuse in exhaled breath using a device for rapid collection: comparison with plasma, urine and self-reporting in 47 drug users’, Journal of Breath Research
, vol. 7, no. 2, p. 026006.
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Is it safe for people on methadone or buprenorphine maintenance therapy to drive?
Norwegian researchers reviewed the literature on methadone and buprenorphine treatment in relation to traffic crash risk and their effects on cognitive and psychomotor functions relevant to driving. They stated that ‘recent studies have found an increased risk of traffic accident involvement for both MMPs [methadone maintenance therapy patients] and buprenorphine maintenance therapy patients (BMPs). When comparing MMPs with BMPs, the latter appeared to be less impaired than MMPs, but this difference may be unrelated to the maintenance therapy. Further impairments have been observed among MMPs after single doses, after an additional versus regular daily dosing, in multiple versus single dosing, and after long-term treatment compared to baseline levels. All studies showed impairments among opioid-naive subjects after the administration of a comparatively low and single dose of either methadone or buprenorphine’. They concluded that ‘Both methadone and buprenorphine were confirmed as having impairing potentials in opioid-naive subjects. At least some opioid maintenance therapy patients are observed having only slight impairments of relevance to driving. Knowing this when approaching the question of ability to drive, an individual evaluation of the driving performance, pertaining to the opioid maintained patient, may be the most useful and conclusive procedure’.
Strand, MC, Fjeld, B, Arnestad, M & Morland, J 2013, ‘Can patients receiving opioid maintenance therapy safely drive? A systematic review of epidemiological and experimental studies on driving ability with a focus on concomitant methadone or buprenorphine administration’, Traffic Injury Prevention
, vol. 14, no. 1, pp. 26-38.
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Can a program of frequent testing for alcohol and modest sanctions have a positive effects on public health?
Researchers in the USA examined ‘the public health impact of South Dakota's 24/7 Sobriety Project, an innovative program requiring individuals arrested for or convicted of alcohol-involved offenses to submit to breathalyzer tests twice per day or wear a continuous alcohol monitoring bracelet. Those testing positive are subject to swift, certain and modest sanctions’. They compared changes in arrests for driving while under the influence of alcohol (DUI), arrests for domestic violence and traffic crashes in counties with the program to counties without the program. They found that ‘Between 2005 and 2010, more than 17 000 residents of South Dakota-including more than 10% of men aged 18 to 40 years in some counties had participated in the 24/7 program. At the county level, we documented a 12% reduction in repeat DUI arrests and a 9% reduction in domestic violence arrests following adoption of the program’. They concluded that ‘In community supervision settings, frequent alcohol testing with swift, certain and modest sanctions for violations can reduce problem drinking and improve public health outcomes’.
Kilmer, B, Nicosia, N, Heaton, P & Midgette, G 2013, ‘Efficacy of frequent monitoring with swift, certain, and modest sanctions for violations: insights from South Dakota’s 24/7 Sobriety Project’, American Journal of Public Health
, vol. 103, no. 1, pp. e37-43.
These very impressive results appear to demonstrate the effectiveness of strictly enforced mandatory sanctions. It is important that this strategy be evaluated in other settings to see if it is generalisable or in fact in some ways specific to the situation in South Dakota.
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Are people who inject drugs reluctant to disclose their drug use when accessing health services, with possible adverse consequences for their health?
A University of New South Wales project investigated whether people who inject drugs (PWID) report limited access to healthcare and may avoid disclosing drug use. It involved an examination of health service utilisation among participants in the Australian Needle and Syringe Program Survey (ANSPS), an annual cross-sectional sero-survey of over 2,000 needle syringe program (NSP) attendees. The findings were that ‘Participants who recently accessed healthcare or had previously visited their most recent provider were more likely to disclose injecting drug use. Participants presenting to a GP or medical centre were less likely than others to disclose injecting. Those accessing emergency departments were more likely to report recent imprisonment’. The researchers concluded that ‘Despite Australia's universal healthcare system and harm reduction policies, NSP-participants remain reluctant to disclose injecting, potentially hindering appropriate care and highlighting the need for multiple entry points to the healthcare system, including NSPs and opioid substitution therapy clinics’.
Islam, MM, Topp, L, Iversen, J, Day, C, Conigrave, KM & Maher, L 2013, ‘Healthcare utilisation and disclosure of injecting drug use among clients of Australia’s needle and syringe programs’, Australian and New Zealand Journal of Public Health
, vol. 37, no. 2, pp. 148-54.
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How effective is random student drug testing as a school-based drug prevention strategy?
An article in a recent issue of Addiction
describes the goals and current practice of school-based random student drug testing (RSDT) as part of an overall drug prevention strategy, briefly explores the available literature evaluating its effectiveness and discusses the controversies related to RSDT. The authors discuss criticisms of RSDT: it promotes a negative school climate; does not reduce drug use; is cost-prohibitive for schools; identifies students who have only experimented with drugs and do not require treatment; a positive result will hinder a student from education and employment opportunities; and there are many false positives. They acknowledge there is limited empirical evidence to support or refute the efficacy of RSDT in schools and concluded that ‘Rigorous long-term evaluations are needed to evaluate the effectiveness of various versions of RSDT programs to prevent drug use and identify students in need of assistance to become and stay drug-free’.
DuPont, RL, Merlo, LJ, Arria, AM & Shea, CL 2013, ‘Random student drug testing as a school-based drug prevention strategy’, Addiction
, vol. 108, no. 5, pp. 839-45.
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What might be the effect of an improved understanding of addiction neuroscience on policy towards drugs of dependence?
In a article recently published in Drugs: Education, Prevention and Policy
, Wayne Hall and Adrian Carter from the University of Queensland Centre for Clinical Research explain that ‘Leading proponents of neurobiological addiction research have argued that it provides strong support for the view that addiction is a chronic brain disease [and] also argue that broad acceptance of the model will improve societal attitudes and policies towards addicted persons’. Hall and Carter examine the research evidence for the claim that addiction is a chronic relapsing brain disease and discuss the promised advantages of the brain disease model of addiction and the likelihood of their realisation. They then discuss ‘the potential costs of social policies advocated on the basis of addiction neuroscience research, namely, advocacy of “high risk” social policies that are congenial to legal industries that promote the use of addictive commodities; renewed advocacy of legally coerced addiction treatment; and the promotion of research into expensive, high technology, biomedical interventions that aim to treat addiction by directly intervening in “addicted brains”. They point out this might be used to undermine public health drug control policies ‘despite the fact that it is much simpler, cheaper and more efficient to use social policies to discourage the whole population from smoking tobacco, drinking heavily or engaging in problem gambling’.
Hall, W & Carter, A 2013, ‘Anticipating possible policy uses of addiction neuroscience research’, Drugs: Education, Prevention, and Policy
, online ahead of print.
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Do we have the necessary data to monitor trends in opioid analgesic prescribing in Australia?
Queensland researchers have observed that ‘there has been increased use of prescription opioid analgesics in Australia in the past 20 years with increasing evidence of related problems. A number of data sources collect information about the dispensed prescribing for opioid medications, but little is known about the extent to which these data sources agree on levels of opioid prescribing.’ The researchers compared data from the high quality, comprehensive Queensland opioid prescriptions database with two national data sources: the Pharmaceutical Benefits Schedule (PBS) and the annual national survey of representative pharmacies which assesses non-subsidised opioid prescribing. They found that ‘The three data sources provided consistent estimates of use over time. The correlations between different data sources were high for most opioid analgesics. There was a substantial (60%) increase in the dispensed use of opioid analgesics and a 180% increase in the dispensed use of oxycodone over the period 2002-2009. Tramadol was the most used opioid-like medication. They concluded that, since the different data sources provide similar results, ‘Improved access to PBS data for relevant stakeholders could provide an efficient and cost-effective way to monitor use of prescription opioid analgesics.’
Hollingworth, SA, Symons, M, Khatun, M, Loveday, B, Ballantyne, S, Hall, WD & Najman, JM 2013, ‘Prescribing databases can be used to monitor trends in opioid analgesic prescribing in Australia’, Australian and New Zealand Journal of Public Health
, vol. 37, no. 2, pp. 132-8.
it appears that we are currently experiencing an epidemic of prescribed opioid overdoses and related morbidity and mortality. At the same time, little routine monitoring data of prescribing of these drugs and harms related to that prescribing are available. This leaves policymakers operating in a vacuum, one that should be filled using the data sources assessed by the authors.
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Erbach, G 2013, Electronic cigarettes, Library of the European Parliament.
Miller, P 2013, Patron Offending and Intoxication in Night-Time Entertainment Districts (POINTED): final report, National Drug Law Enforcement Research Fund, Monograph Series no.46, Canberra.
Monaghan, G & Bewley-Taylor, D 2013, Police support for harm reduction policies and practices towards people who inject drugs, Modernising Drug Law Enforcement: Report 1, International Drug Policy Consortium, London.
Mutch, R, Watkins, R, Jones, H & Bower, C 2013, Fetal Alcohol Spectrum Disorder: knowledge, attitudes and practice within the Western Australian justice system, final report, Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA.
NSW Parliamentary Research Service 2013, Medical marijuana, Issues Backgrounder no. 1, Parliament of NSW, Sydney.
National Institute on Drug Abuse (USA) 2012, Principles of drug addiction treatment: a research-based guide, 3rd ed, NIH Publication no. 12–4180, NIDA, Washington, DC.
Office of National Drug Control Policy (USA) 2013, National Drug Control Strategy 2013, Office of National Drug Control Policy, Washington, DC.
Taplin, S 2013, Mothers in methadone treatment and their involvement with the child protection system: A replication and extension study,
Child Abuse & Neglect, In Press.
For information on other reports, please visit the ‘Did you see that report?’ page at the website of the National Drugs Sector Information Service: http://ndsis.adca.org.au/research-tools/did-you-see-that-report.
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