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.

 

In the May 2015 issue


ACT Research Spotlight

ATODA Report

Research Findings

New Reports
 

To what extent are parents aware of and concerned that their adolescent children's ownership of alcohol-branded merchandise might influence their attitudes to alcohol consumption?

‘There is growing evidence that young people own alcohol-branded merchandise (ABM), and that ownership influences their drinking intentions and behaviours.’ Australian researchers conducted a study in NSW schools which revealed ‘ABM ownership was high among our sample of adolescents and was associated with drinking initiation and known risk factors for drinking’. They ran focus groups with parents to ascertain their awareness of ABM, and found that, ‘Prior to participating in the study, the parents in our focus groups were largely disengaged or unconcerned about ABM, which suggests that there is a need for awareness-raising among parents. If parents consciously process the fact that ABM is a form of alcohol advertising, and thus has potential to influence their child at least as much as other forms of advertising, they are likely to be more circumspect in providing, or allowing others to provide, ABM to their children’. The researchers further concluded that ‘There is also a need for the groups that are responsible for regulating alcohol advertising to ensure advertisers are aware that ABM is subject to the same rules as other forms of advertising, to monitor and regulate ABM, and to reform the regulation of all forms of alcohol advertising to reduce youth exposure’.
 
Jones, SC, Andrews, K & Caputi, P 2014, ‘Alcohol-branded merchandise: association with Australian adolescents’ drinking and parent attitudes’, Health Promotion International, online ahead of print.

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Can liquor licensing reforms reduce the incidence of assaults?

In January 2014 the NSW Government introduced reforms to the NSW Liquor Act aiming to reduce the incidence of assault in the Kings Cross and Sydney CBD Entertainment Precincts. The new restrictions covering those areas were wide in scope, and included 1.30 am lockouts at hotels, registered clubs, nightclubs and karaoke bars; 3.00 am cessation of alcohol service in venues in these Precincts; a ban on takeaway alcohol sales after 10.00 pm across NSW; the extension of temporary and long-term banning orders issued to designated ‘trouble-makers’ to prevent them entering most licensed premises in the Kings Cross and Sydney CBD entertainment precincts; and the introduction of a new risk based licence fee for all licensed premises in which the annual fee payable by a particular venue depends upon its licence type, compliance history and trading hours.
 
Researchers from the NSW Bureau of Crime Statistics and Research assess the impacts of these and related innovations. They found that ‘Following the reforms statistically significant and substantial reductions in assault occurred in both the Kings Cross (down 32%) and Sydney CBD Entertainment Precinct (down 26 %) (including a 40% decline in the sub-section George Street-South). A smaller but still significant reduction in assault occurred across the rest of NSW (9% decrease).’ The reforms were also associated with small decreases in assault in entertainment areas contiguous with Kings Cross and the CBD, and in a group of entertainment areas not far from the Kings Cross or the Sydney CBD Precincts used as comparison locations, but neither of these changes was statistically significant. ‘There was some evidence that assaults increased in and around The Star casino, however the effects are not statistically significant and the reduction in assault elsewhere was much larger than the increase around The Star casino.’ These findings led the researchers to conclude that ‘The January 2014 reforms appear to have reduced the incidence of assault in the Kings Cross and CBD Entertainment Precincts. The extent to which this is due to a change in alcohol consumption or a change in the number of people visiting the Kings Cross and Sydney Entertainment Precincts remains unknown.’
 
Menéndez, P, Weatherburn, D, Kypri, K & Fitzgerald, J 2015, Lockouts and last drinks: the impact of the January 2014 liquor licence reforms on assaults in NSW, Australia, Crime and Justice Bulletin no. 183, NSW Bureau of Crime Statistics and Research, Sydney, open access http://www.bocsar.nsw.gov.au/Documents/CJB/CJB183.pdf.

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What shall we know about the tobacco industries use of the term 'tobacco harm reduction'?

Abstract
Objectives: To explore the history of transnational tobacco companies’ use of the term, approach to and perceived benefits of ‘harm reduction’.
Methods: Analysis of internal tobacco industry documents, contemporary tobacco industry literature and 6 semistructured interviews.
Results: The 2001 Institute of Medicine report on tobacco harm reduction appears to have been pivotal in shaping industry discourse. Documents suggest British American Tobacco and Philip Morris International adopted the term ‘harm reduction’ from Institute of Medicine, then proceeded to heavily emphasise the term in their corporate messaging. Documents and interviews suggest harm reduction offered the tobacco industry two main benefits: an opportunity to (re-) establish dialogue with and access to policy makers, scientists and public health groups and to secure reputational benefits via an emerging corporate social responsibility agenda.
Conclusions: Transnational tobacco companies’ harm reduction discourse should be seen as opportunistic tactical adaptation to policy change rather than a genuine commitment to harm reduction. Care should be taken that this does not undermine gains hitherto secured in efforts to reduce the ability of the tobacco industry to inappropriately influence policy.
 
Peeters, S & Gilmore, AB 2015, 'Understanding the emergence of the tobacco industry's use of the term tobacco harm reduction in order to inform public health policy', Tobacco Control, vol. 24, no. 2, pp. 182-9, open access http://tobaccocontrol.bmj.com/content/24/2/182.full.
 
Comment: the Institute of Medicine report, referred to here, is Stratton, K et al. (eds) 2001, Clearing the smoke: assessing the science base for tobacco harm reduction, Institute of Medicine; National Academies Press, http://www.nap.edu/catalog/10029/clearing-the-smoke-assessing-the-science-base-for-tobacco-harm.
 

Has the introduction of plain packaging of cigarettes led to an increase in the availability of counterfeit cigarettes?

Before the introduction of plain packaging of cigarettes in Australia it was claimed, by tobacco industry groups, that the legislation would have major unintended consequences, including that the standardised appearance of the packs would make them easier to counterfeit and that this, combined with the reduced valuing of brands, would lead to an increase in cigarette smoking. National telephone surveys of current cigarette smokers conducted by the Cancer Council Victoria from April 2012 (6 months before implementation of plain packaging) to March 2014 (15 months after) found ‘no evidence in Australia of increased use of two categories of manufactured cigarettes likely to be contraband, no increase in purchase from informal sellers and no increased use of unbranded illicit “chop-chop” tobacco’.
 
Scollo, M, Zacher, M, Coomber, K & Wakefield, M 2015, ‘Use of illicit tobacco following introduction of standardised packaging of tobacco products in Australia: results from a national cross-sectional survey’, Tobacco Control, vol. 24, no. Suppl 2, pp. ii76-ii81, open access http://tobaccocontrol.bmj.com/content/24/Suppl_2/ii76.abstract.

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What types of smoking cessation interventions are most effective in prisons?

This article has been usefully summarised by the editors of the journal in which it was published: MacDonald, M, Greifinger, R & Kane, D 2015, ‘Editorial’, International Journal of Prisoner Health, vol. 11, no. 1: Ashleigh Djachenko, Winsome St John and Creina Mitchell review the available literature relating to smoking cessation (SC) interventions for the male prisoner population.

A number of databases were searched for English language studies from 1990 to 2012 with 12 papers identified for inclusion. Of these, four studies focused on forced abstinence (a smoking ban) while the remainder looked at various combinations of nicotine replacement, pharmacology and behavioural techniques. Analysis of the selected studies revealed that forced abstinence (a total or partial smoking ban) had little impact on SC among prisoners, while the impact of local and national tobacco policies on prisoners’ perceptions of smoking and forced abstinence was a recurring theme. No robust studies were identified which specifically examined the role of the health care professional in promoting SC among prisoners. Several studies noted that the delivery of SC programmes was inconsistent due to under-resourcing or understaffing and that SC outcomes received lower priority than issues deemed more “important” such as drug misuse, infection control and mental health. All twelve studies described the promotion of SC in the prison environment as unique and challenging. A central theme was the identification of a “pro-smoking” culture in prison and the entrenched role of tobacco in prison society.
The authors note that key findings from the review indicate that certain SC interventions can be successfully implemented in a prison setting with various combinations of counselling, Nicotine replacement therapy and pharmacology demonstrating quit rates comparable to those achieved in the wider community. It would also appear that tobacco control, which has contributed to a reduction in smoking in the wider community are having less of an impact in prison. While noting the paucity of relevant research, the authors conclude that their review identifies that SC interventions can be successfully implemented in prison settings provided that the underlying policies are clear and consistent. However, it is apparent that the current level of evidence is scant and further research is needed to determine the best approaches for SC in the prisoner population.
 
Djachenko, A, John, WS & Mitchell, C 2015, ‘Smoking cessation in male prisoners: a literature review’, International Journal of Prisoner Health, vol. 11, no. 1, pp. 39-4.

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What other options could be considered in Australia for the regulation of nicotine use in e-cigarettes?

Abstract
Australia has some of the most restrictive laws concerning use of nicotine in e-cigarettes. The only current legal option for Australians to legally possess and use nicotine for vaping is with a medical prescription and domestic supply is limited to compounding pharmacies that prepare medicines for specific patients. An alternative regulatory option that could be implemented under current drugs and poisons regulations is a ‘nicotine licensing’ scheme utilising current provisions for ‘dangerous poisons’. This commentary discusses how such a scheme could be used to trial access to nicotine solutions for vaping outside of a ‘medicines framework’ in Australia.
Highlights include:

• The history of regulation of nicotine for vaping in Australia.
• Current Australian laws provide two options for regulating nicotine for vaping.
• No products have been approved for sale under option 1 (prescription medicine).
• Propose using option 2 (dangerous poison) to trial a nicotine licence scheme.

 
Gartner, C & Hall, W 2015, ‘A licence to vape: is it time to trial of a nicotine licensing scheme to allow Australian adults controlled access to electronic cigarettes devices and refill solutions containing nicotine?’, International Journal of Drug Policy, online ahead of print.
 

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What approaches could be adopted to the sale of electronic nicotine delivery systems other than a ban or a free market?

Abstract
Background: Some countries have banned the sale of electronic nicotine delivery systems (ENDS).
Aims: We analyse the ethical issues raised by this ban and various ways in which the sale of ENDS could be permitted.
Method: We examine the ban and alternative policies in terms of the degree to which they respect ethical principles of autonomy, beneficence, non-maleficence and justice, as follows.
Results: Respect for autonomy: prohibiting ENDS infringes on smokers’ autonomy to use a less harmful nicotine product while inconsistently allowing individuals to begin and continue smoking cigarettes. Non-maleficence: prohibition is supposed to prevent ENDS recruiting new smokers and discouraging smokers from quitting, but it has not prevented uptake of ENDS. It also perpetuates harm by preventing addicted smokers from using a less harmful nicotine product. Beneficence: ENDS could benefit addicted smokers by reducing their health risks if they use them to quit and do not engage in dual use. Distributive justice: lack of access to ENDS disadvantages smokers who want to reduce their health risks. Different national policies create inequalities in the availability of products to smokers internationally.
Conclusions: We do not have to choose between a ban and an unregulated free market. We can ethically allow ENDS to be sold in ways that allow smokers to reduce the harms of smoking while minimizing the risks of deterring quitting and increasing smoking among youth.
 
Hall, W, Gartner, C & Forlini, C 2015, ‘Ethical issues raised by a ban on the sale of electronic nicotine devices’, Addiction, online ahead of print.

Comment: ATODA recently made a submission related to the ACT Health Discussion Paper: 'Options to  protect the community from potential harms associated with personal vaporisers (e-cigarettes)'

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How effective are e-cigarettes in helping smokers with mental illnesses to quit?

A randomised controlled trial in Auckland involved over 600 dependent adult smokers who were motivated to quit. Eighty-six were identified as having a mental illness and their cessation and smoking reduction outcomes were analysed. Treatments comprised either 16 mg nicotine e-cigarette, 21 mg nicotine patch, nicotine-free e-cigarette, or minimal behavioural support. The researchers found that ‘For e-cigarettes alone, and all interventions pooled, there was no statistically significant difference in biochemically verified quit rates at six months between participants with and without mental illness, nor in smoking reduction, adverse events, treatment compliance, or acceptability. Rates of relapse to smoking were higher in participants with mental illness. Among this group, differences between treatments were not statistically significant for cessation, adverse events or relapse rates. However, e-cigarette users had higher levels of smoking reduction, treatment compliance, and acceptability’. The researchers concluded that ‘The use of e-cigarettes for quitting appears to be equally effective, safe, and acceptable for people with and without mental illness. For people with mental illness, e-cigarettes may be as effective and safe as patches, yet more acceptable, and associated with greater smoking reduction’.
 
O’Brien, B, Knight-West, O, Walker, N, Parag, V & Bullen, C 2015, ‘E-cigarettes versus NRT for smoking reduction or cessation in people with mental illness: secondary analysis of data from the ASCEND trial’, Tobacco Induced Diseases, vol. 13, no. 1, open access http://www.tobaccoinduceddiseases.com/content/13/1/5.

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How serious a problem are injecting-related injuries and diseases for people who inject drugs?

A study conducted at the Kirketon Road Centre, a targeted primary health care centre in Kings Cross, Sydney, examined the prevalence of injecting-related injuries and diseases (IRIDs) and associated risk factors among people who inject drugs (PWID). IRIDs include both cutaneous conditions such as abscess and cellulitis, and conditions such as septic arthritis, osteomyelitis, septicaemia and bacterial endocarditis. A survey of over 700 clients of the Centre revealed that ‘Lifetime prevalence of cutaneous IRIDs was 23%. Forty-two per cent of PWID with a history of abscess attended hospital at their most recent episode. Female gender, lifetime receptive syringe sharing (RSS), injecting while in custody, and ever injecting in places other than the arm were independently associated with reporting at least one episode of cutaneous IRIDs. Ever injecting in sites other than the arm, injecting for five or more years and lifetime history of RSS were independently associated with at least one episode of non-cutaneous IRIDs’. The researchers concluded that ‘IRIDs are a substantial health issue for PWID. Their ongoing surveillance is warranted particularly in primary care settings targeting PWID to inform prevention and early management, thus reducing complications that may require hospital admission’.
 
Ivan, M, van Beek, I, Wand, H & Maher, L 2015, ‘Surveillance of injecting-related injury and diseases in people who inject drugs attending a targeted primary health care facility in Sydney’s Kings Cross’, Australian and New Zealand Journal of Public Health, vol. 39, no. 2, pp. 182-7.

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How effective are drug and alcohol treatment services in Australian prisons?

An Australian survey of prison authorities, followed by a literature review, aimed to obtain data on the prevalence of drug and alcohol problems among prisoners by Indigenous status, and to obtain data on the availability of prison-based drug and alcohol treatment programs and services in all eight Australian jurisdictions, including a focus on Indigenous-specific drug and alcohol programs. The researchers found that, ‘In 2009, over 80 percent of Indigenous and non-Indigenous inmates smoked. Prior to imprisonment, many Indigenous and non-Indigenous inmates drank alcohol at risky levels (65 vs 47 percent) and used illicit drugs (over 70 percent for both groups). Reports of using heroin (15 vs 21 percent), ATS [amphetamine-type substances] (21 vs 33 percent), cannabis (59 vs 50 percent) and injecting (61 vs 53 percent) were similarly high for both groups. Prison-based programs included detoxification, Opioid Substitution Treatment, counselling and drug free units, but access was limited especially among Indigenous prisoners’.
 
The researchers concluded that ‘This study found that prisoners’ drug and alcohol use (prior to imprisonment) was extraordinarily high. The level of smoking among prisoners has remained stable while the level of risky alcohol consumption has actually increased over the last decade. Their patterns of drug and alcohol use were in contrast to declining drug and alcohol use in the Australian community. More surprising was that prisoners’ high level of drug and alcohol use continued even though a vast array of supply, demand and harm reduction strategies exist in prison...Imprisonment provides an important opportunity for rehabilitation and treatment…This opportunity is especially relevant to Indigenous prisoners who were more likely to use health services when in prison than in the community and given their vast over representations in prison populations’.
 
Dolan, K, Rodas, A & Bode, A 2015, ‘Drug and alcohol use and treatment for Australian Indigenous and non-Indigenous prisoners: demand reduction strategies’, International Journal of Prisoner Health, vol. 11, no. 1, pp. 30-8.

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To what extent does the availability of a supervised injection facility change drug use behaviours and syringe disposal methods?

In Denmark, the first standalone supervised injecting facility (SIF) opened in Copenhagen’s Vesterbro neighbourhood on October 1, 2012. A study conducted in 2013 assessed whether use of services provided by the SIF was associated with changes in injecting behaviour and syringe disposal practices among people who inject drugs (PWID). Of the 41 interviewed participants, ‘90.2% were male and the majority were younger than 40 years old (60.9%). Three-quarters (75.6%) of participants reported reductions in injection risk behaviors since the opening of the SIF, such as injecting in a less rushed manner (63.4%), fewer outdoor injections (56.1%), no longer syringe sharing (53.7%), and cleaning injecting site(s) more often (43.9%). Approximately two-thirds (65.9%) of participants did not feel that their frequency of injecting had changed; five participants (12.2%) reported a decrease in injecting frequency, and only two participants (4.9%) reported an increase in injecting frequency. Twenty-four (58.5%) individuals reported changing their syringe disposal practices since the opening of the SIF; of those, twenty-three (95.8%) reported changing from not always disposing safely to always disposing safely’. The researchers concluded that ‘Our findings suggest that use of the Copenhagen SIF is associated with adoption of safer behaviors that reduce harm and promote health among PWID, as well as practices that benefit the Vesterbro neighborhood (i.e., safer syringe disposal). As a public health intervention, Copenhagen’s SIF has successfully reached PWID engaging in risk behavior’.
 
Kinnard, EN, Howe, CJ, Kerr, T, Skjodt Hass, V & Marshall, BDL 2014, ‘Self-reported changes in drug use behaviors and syringe disposal methods following the opening of a supervised injecting facility in Copenhagen, Denmark’, Harm Reduction Journal, vol. 11, no. 1, p. 29, open access http://www.harmreductionjournal.com/content/11/1/29.

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New Reports

Australian Institute of Health & Welfare 2015, Australian Burden of Disease Study: fatal burden of disease in Aboriginal and Torres Strait Islander people 2010, Australian Burden of Disease Study series 2, cat. no. BOD 02, Australian Institute of Health & Welfare, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129550618.
 
Australian Institute of Health and Welfare 2015, National opioid pharmacotherapy statistics: highlights from the 2014 collection, Australian Institute of Health and Welfare, http://www.aihw.gov.au/alcohol-and-other-drugs/nopsad/.
 
Dietze, P, Cogger, S, Malandkar, D, Olsen, A & Lenton, S 2015, Knowledge of naloxone and take-home naloxone programs among a sample of people who inject drugs in Australia, IDRS Drug Trends Bulletin, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, https://ndarc.med.unsw.edu.au/resource/knowledge-naloxone-and-take-home-naloxone-programs-among-sample-people-who-inject-drugs.
 
Legislative Assembly for the Australian Capital Territory, Standing Committee on Health, Ageing, Community and Social Services 2015, Inquiry into exposure draft of the Drugs of Dependence (Cannabis Use for Medical Purposes) Amendment Bill 2014 and related discussion paper: submission received and oral evidence provided, Legislative Assembly for the ACT, Canberra, http://tinyurl.com/oqf5934.
 
Parliament of the Commonwealth of Australia, Senate Legal and Constitutional Affairs Legislation Committee 2015, Inquiry into the Regulator of Medicinal Cannabis Bill 2014; submissions received, Parliament of the Commonwealth of Australia, Canberra, http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/Medicinal_Cannabis_Bill/Submissions.


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