ACT Research Spotlight

Pre-drinking a key driver of alcohol-related harm

Media release, Deakin University, Wednesday, 16 November 2016, http://www.deakin.edu.au/about-deakin/media-releases/articles/pre-drinking-a-key-driver-of-alcohol-related-harm
 
A new Deakin-led study has confirmed Australians have a major problem with alcohol, prompting the report’s author to call for a minimum unit price per standard drink.
 
The recommendation is among several measures Professor Peter Miller has outlined in his report, Drug and Alcohol Intoxication and Subsequent Harm in night-time Entertainment Districts (DASHED), the result of an investigation of alcohol-related problems in Canberra and Hobart.
 
The study was conducted in collaboration with the Australian Institute of Criminology and the University of Tasmania and was supported by the National Drug Law Enforcement Research Fund. It built on previous data compiled in Melbourne, Sydney, Perth, Geelong and Wollongong.
 
Interviewees in both Canberra and Hobart reported high levels of physical aggression (17 percent in Canberra and 16 percent in Hobart), which was at least as high as that found in studies of the other Australian cities.
 
Unwanted sexual attention was also very high in or around licensed venues in both Canberra (28 percent) and Hobart (26 percent) with a median of four incidents in the three months prior to interview. 
 
The rates of alcohol-related injury found in the current study (18 percent of those surveyed in Hobart and 17 percent of those surveyed in Canberra) were among the highest of all sites in which data have been collected.
 
Professor Miller, from Deakin’s School of Psychology, said a large proportion of people were pre-drinking before they attended licensed venues, which led to an increase in their exposure to harm.
 
“We found that, particularly in Hobart, pre-drinking correlated with an increase in reports of verbal aggression and injury.
 
“We know pre-drinking is a major impediment to the responsible service of alcohol. And we know it is one of the key drivers of alcohol related harm alongside high concentration of venues, high alcohol consumption levels and late trading hours.”
 
Co-investigator Richelle Mayshak said: “The high levels of sexual harassment are deeply worrying and completely out of step with current efforts to curb sexual assault and intimate partner violence”.
 
The report provides a wide range of recommendations to tackle the problem, including:

• Last drinks at all venues set at 2am as a default minimum;
• A minimum price per standard drink;
• Bans on problem patrons entering entertainment districts, with mandatory ID scanner provisions to ensure bans are put in place;
• A public list of venues that are failing to meet licence conditions; and
• Increased penalties, such as trading hour restrictions or temporary closure, for venues with a high number of assaults

As part of the study, more than 1,600 patrons visiting Canberra and Hobart’s main entertainment precincts were randomly selected to participate in a brief interview.
 
The researchers also conducted observations inside licensed venues, and relevant data were gathered from police, ambulance services, local emergency departments and licensing bodies.
 
“This study has demonstrated that alcohol-related harm is a major burden in Canberra and in Hobart, at similar or higher levels than other cities around Australia,” Professor Miller said.
 
“This harm comes at considerable cost to the community, both in terms of the physical, psychological and emotional harms of violence and injury, but also in terms of the substantial economic cost and burden on emergency services.  And much of this cost is entirely preventable.”
 
Canberra entertainment district survey break down:

• 56 percent pre-drink before attending licensed venues
• 13 percent report using substances other than alcohol (excluding tobacco)
• 47 percent report being involved in any kind of aggression around licensed venues in past three months – 30 per cent verbal aggression, 28 percent unwanted sexual attention and 17 percent physical aggression
• 17 percent have driven under the influence of alcohol, 9 percent under the influence of drugs
• 43 percent of alcohol-related offences are committed between 2am and 6am

 
Miller, P, Bruno, R, Morgan, A, Mayshak, R, Cox, E, Coomber, K, Droste, N, Taylor, N, Dimitrovski, N, Peacock, A, Boxall, H & Voce, I 2016, Drug and alcohol intoxication and subsequent harm in night-time Entertainment Districts (DASHED), Monograph Series no. 67, National Drug Law Enforcement Research Fund, Canberra, http://www.ndlerf.gov.au/publications/monographs/monograph-67.

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Research Findings


To what extent could e-cigarettes reduce the problem of weight gain following smoking cessation?

For and against e-cigarette use in public places

How effective is the liquor industry’s involvement in policy work that aims to reduce the harmful use of alcoholic beverages?

How strong is the association between alcohol sports sponsorship and alcohol consumption?

What impacts do alcohol management practices have on sports club membership and revenue?

Is alcohol consumption a risk factor for prostate cancer?

How important are social contexts in the consumption of alcohol mixed with energy drinks?

What role should doctors have in drug policy reform?

What insights can we draw from researchers’ policy analysis of Vermont, USA’s, consideration of legalising cannabis supply and consumption?

How could the criminal justice system deal more effectively and humanely with illegal drugs?

What are the main barriers to methamphetamine users accessing treatment, and how could these barriers be reduced?

How does the use of acupuncture compare with other treatments for substance use disorders?

To what extent do mandatory drug testing and assessment of arrestees contribute to engagement in treatment or reoffending?

What evidence is available on the use of psychedelics in treating people with unipolar mood disorders?

To what extent can the prohibition of psychedelics be justified as a public health measure?
 

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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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To what extent could e-cigarettes reduce the problem of weight gain following smoking cessation?

An article in Nicotine and Tobacco Research discusses the suggestion that vaping (the use of e-cigarettes and related personal vaporisers) could help mitigate weight gain after stopping smoking and/or could help former smokers to control their weight, given that obesity may overtake tobacco smoking in many developed countries as the primary preventable cause of conditions such as diabetes, cancer and heart disease. The authors point out ‘There are several potential mechanisms by which vaping, in addition to the direct effects of nicotine, could facilitate weight control, these include taste perception, physical mouthfeel, and sensation and behavioral replacement’. They conclude that ‘E-cigs may have promise for smoking cessation and could play a valuable role in reducing preventable deaths by contributing to reductions in smoking prevalence. Obesity is set to overtake tobacco smoking in many developed countries as the primary preventable cause of conditions such as type 2 diabetes, cancer, and cardiovascular disease. It is possible that e-cigs could contribute to reductions in overweight and obesity alongside reducing smoking. More research on the potential of e-cigs to reduce disease risks is needed, and investigation of any potential role they may play in mitigating weight gain is a viable topic for future study’.
 
Glover, M, Breier, BH & Bauld, L 2016, ‘Could vaping be a new weapon in the battle of the bulge?’, Nicotine and Tobacco Research, online ahead of print.

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For and against e-cigarette use in public places

In November, the prominent international journal Tobacco Control published two short pieces on this topic, one for and one against.
 
British academics presented the ‘for’ case, concluding that:
‘The evidence to date does not support a policy to prohibit e-cigarette use in enclosed public places and such policies could have significant unintended consequences by sustaining the use of smoked tobacco. In addition, if and when vapour products with a medicinal license become available, it will be important to allow their use indoors, just as asthma inhalers, which dispense a drug and propellants into the atmosphere, can be used indoors. It remains important, however, to continue to research the impact of exposure to e-cigarette vapour on bystanders and of policies where implemented, to ensure that evidence continues to inform practice in this area.’
 
Bauld, L, McNeill, A, Hajek, P, Britton, J & Dockrell, M 2016, ‘E-cigarette use in public places: striking the right balance’, Tobacco Control, online ahead of print, open access http://tobaccocontrol.bmj.com/content/early/2016/10/14/tobaccocontrol-2016-053357.full .
 
The ‘no’ argument was presented by two Australian academics plus one of their US colleagues:
‘While some early examples of smoke-free policy were introduced because of community preferences for clean indoor air and fire safety, smoke-free policy today is predicated on a large body of evidence that has accumulated since the early 1970s about harm to others from secondhand smoke. In contrast, those advocating for vaping to be allowed in smoke-free public places centre their case on gossamer-thin evidence that vaping emissions are all but benign and therefore pose negligible risks to others akin to inhaling steam from showers, kettles or saunas.’
 
Chapman, S, Daube, M & Maziak, W 2016, ‘Should e-cigarette use be permitted in smoke-free public places? No’, Tobacco Control, online ahead of print, open access http://tobaccocontrol.bmj.com/content/early/2016/10/14/tobaccocontrol-2016-053359.full.

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How effective is the liquor industry’s involvement in policy work that aims to reduce the harmful use of alcoholic beverages?

Abstract: The alcohol industry have attempted to position themselves as collaborators in alcohol policy making as a way of influencing policies away from a focus on the drivers of the harmful use of alcohol (marketing, over availability and affordability). Their framings of alcohol consumption and harms allow them to argue for ineffective measures, largely targeting heavier consumers, and against population wide measures as the latter will affect moderate drinkers. The goal of their public relations organisations is to ‘promote responsible drinking’. However, analysis of data collected in the International Alcohol Control study and used to estimate how much heavier drinking occasions contribute to the alcohol market in five different countries shows the alcohol industry’s reliance on the harmful use of alcohol. In higher income countries heavier drinking occasions make up approximately 50% of sales and in middle income countries it is closer to two-thirds. It is this reliance on the harmful use of alcohol which underpins the conflicting interests between the transnational alcohol corporations and public health and which militates against their involvement in the alcohol policy arena.
 
Casswell, S, Callinan, S, Chaiyasong, S, Cuong, PV, Kazantseva, E, Bayandorj, T, Huckle, T, Parker, K, Railton, R & Wall, M 2016, ‘How the alcohol industry relies on harmful use of alcohol and works to protect its profits’, Drug and Alcohol Review, online ahead of print.
 
Comment: It is widely accepted, and part of the global Framework Convention on Tobacco Control http://www.who.int/fctc/en/, that tobacco industry representatives have no place in tobacco policy work. In ATODA’s view, a similar approach should be taken regarding the liquor industry’s (and related entertainment industry’s) involvement in alcohol policy work. The campaign by the ACT licensed clubs, at the October 2016 ACT election, to oppose evidence-based reforms to liquor trading hours in the ACT, provides a clear example of their overwhelming conflict of interest.

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How strong is the association between alcohol sports sponsorship and alcohol consumption?

A systematic review of the international literature reviewed evidence on the relationship between exposure to alcohol sports sponsorship and alcohol consumption. The researchers reported that ‘Seven studies met inclusion criteria, presenting data on 12,760 participants from Australia, New Zealand, the UK, Germany, Italy, Netherlands and Poland. All studies report positive associations between exposure to alcohol sports sponsorship and self-reported alcohol consumption, but the statistical significance of results varies. Two studies found indirect exposure to alcohol sports sponsorship was associated with increased levels of drinking amongst school children, and five studies found a positive association between direct alcohol sports sponsorship and hazardous drinking amongst adult sportspeople’. They concluded that ‘These findings corroborate the results of previous systematic reviews that reported a positive association between exposure to alcohol marketing and alcohol consumption. The relationship between alcohol sports sponsorship and increased drinking amongst school children will concern policymakers’.
 
Brown, K 2016, ‘Association between alcohol sports sponsorship and consumption: a systematic review’, Alcohol and Alcoholism, vol. 51, no. 6, pp. 747-55, open access http://alcalc.oxfordjournals.org/content/51/6/ .
 
Comment: As a member of the National Alliance for Action on Alcohol (NAAA) ATODA shares its commitment to advocate for the ACT and other governments to act to break the links between alcohol use and sport through (1) prohibiting alcohol sponsorship of junior sports teams, clubs or programs and (2) removing the current exemption permitting alcohol advertising during live sporting broadcasts before 8:30 pm on commercial free-to-air television.

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What impacts do alcohol management practices have on sports club membership and revenue?

Abstract
Issue addressed: The aim of this study was to assess the impact of an alcohol management intervention on community sporting club revenue (total annual income) and membership (number of club players, teams and spectators).
Methods: The study employed a cluster randomised controlled trial design that allocated clubs either an alcohol accreditation intervention or a control condition. Club representatives completed a scripted telephone survey at baseline and again 3 years following. Demographic information about clubs was collected along with information about club income.
Results: Number of players and senior teams were not significantly different between treatment groups following the intervention. The intervention group, however, showed a significantly higher mean number of spectators. Estimates of annual club income between groups at follow-up showed no significant difference in revenue.
Conclusions: This study found no evidence to suggest that efforts to reduce alcohol-related harm in community sporting clubs will compromise club revenue and membership.
 
Wolfenden, L, Kingsland, M, Rowland, B, Dodds, P, Sidey, M, Sherker, S & Wiggers, J 2016, ‘The impact of alcohol management practices on sports club membership and revenue’, Health Promotion Journal of Australia, vol. 27, no. 2, pp. 91-3.

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Is alcohol consumption a risk factor for prostate cancer?

A team of prominent researchers from Australia and Canada point out that ‘Research on a possible causal association between alcohol consumption and risk of prostate cancer is inconclusive. Recent studies on associations between alcohol consumption and other health outcomes suggest these are influenced by drinker misclassification errors and other study quality characteristics. The influence of these factors on estimates of the relationship between alcohol consumption and prostate cancer has not been previously investigated.’ (The misclassification errors mentioned here that refer to studies that incorrectly find health protective effects of alcohol consumption have been covered in earlier issues of the ATODA Research e-Bulletin.)
 
The authors conducted a systematic review and meta–analysis of studies published up to December 2014. Studies were coded for drinker misclassification errors, quality of alcohol measures, extent of control for confounding and other study characteristics. ‘A total of 340 studies were identified of which 27 satisfied inclusion criteria providing 126 estimates for different alcohol exposures.’ The researchers found, ‘…for the first time, a significant dose-response relationship between level of alcohol intake and risk of prostate cancer starting with low volume consumption (>1.3, <24 g per day). This relationship is stronger in the relatively few studies free of former drinker misclassification error. Given the high prevalence of prostate cancer in the developed world, the public health implications of these findings are significant. Prostate cancer may need to be incorporated into future estimates of the burden of disease alongside other cancers (e.g. breast, oesophagus, colon, liver) and be integrated into public health strategies for reducing alcohol related disease.’
 
Zhao, J, Stockwell, T, Roemer, A & Chikritzhs, T 2016, ‘Is alcohol consumption a risk factor for prostate cancer? A systematic review and meta–analysis’, BMC Cancer, vol. 16, no. 1, pp. online ahead of print, open access https://bmccancer.biomedcentral.com/articles/10.1186/s12885-016-2891-z.

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How important are social contexts in the consumption of alcohol mixed with energy drinks?

A team of Australian researchers examined the role the role of alcohol mixed with energy drink (AmED) consumption amongst the milieu of nightlife and party culture. They interviewed 25 regular AmED consumers aged 18-33 on the social contexts and perceived functions of AmED consumption, group dynamics and social identity. ‘Three main themes were identified: (i) AmED use was restricted to specific social contexts, (ii) AmED use performed a social function and (iii) AmED users identified with a coherent and consistent social identity. AmED use was almost exclusively reported to occur within group drinking scenarios at parties and licensed venues, particularly nightclubs. AmED users identified with a clear and consistent social identity that was distinct from other alcohol consumers, typified by gregarious and extroverted behaviour. AmED use was seen to facilitate these ideals and strengthen group cohesion in appropriate contexts’. They concluded that ‘Future efforts aiming to elicit changes in AmED consumption practices must account for the fundamental importance of social contexts to AmED use’.
 
Droste, N, Pennay, AE, Lubman, DI, Zinkiewicz, L, Peacock, A & Miller, P 2016, ‘The right place at the right time: the social contexts of combined alcohol and energy drink use’, Drugs: education, prevention and policy, vol. 23, no. 6, pp. 445-56, open access http://www.tandfonline.com.ezproxy.adf.org.au/doi/abs/10.3109/09687637.2016.1156650.

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What role should doctors have in drug policy reform?

A recent issue of the prestigious British Medical Journal contains an editorial discussing this topic. It was titled ‘The war on drugs has failed: doctors should lead calls for drug policy reform’ and had the subtitle ‘Evidence and ethics should inform policies that promote health and respect dignity’. The editorial writers stated that:

‘Health should be at the centre of this debate and so, therefore, should healthcare professionals. Doctors are trusted and influential and can bring a rational and humane dimension to ideology and populist rhetoric about being tough on crime.
 
‘Some doctors’ organisations have called loudly for change, including International Doctors for Healthier Drug Policies and the UK Royal Society for Public Health and the Faculty of Public Health.19 Recent BMA policy is for the Department of Health to take responsibility for UK drug policy and for “legislative change” to prioritise treatment over punishment of drug users. But such calls are far from universal—and far from loud enough.
 
‘Doctors and their leaders have ethical responsibilities to champion individual and public health, human rights, and dignity and to speak out where health and humanity are being systemically degraded. Change is coming, and doctors should use their authority to lead calls for pragmatic reform informed by science and ethics.’
 
Godlee, F & Hurley, R 2016, ‘The war on drugs has failed: doctors should lead calls for drug policy reform (editorial)’, BMJ, vol. 355, open access: http://www.bmj.com/content/355/bmj.i6067 .
‘Evidence and ethics should inform policies that promote health and respect dignity’.

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What insights can we draw from researchers’ policy analysis of Vermont, USA’s, consideration of legalising cannabis supply and consumption?

In 2014 the legislature of Vermont, USA, passed a law requiring the Secretary of Administration to report on the consequences of legalising marijuana. The RAND Corporation was commissioned to write that report. A summary of it translates key findings to the broader policy debate. The authors explain that ‘Marijuana legalization encompasses a wide range of possible regimes, distinguished along at least four dimensions: which organizations are allowed to produce and supply the drug, the regulations under which they operate, the nature of the products that can be distributed and taxes and prices. Vermont’s decriminalization had already cut its costs of enforcing marijuana prohibition against adults to about $1 per resident per year. That is probably less than the cost of regulating a legal market. Revenues from taxing residents’ purchases after legalization could be many times that amount, so the main fiscal cost of prohibition after decriminalization relative to outright legalization may be foregone tax revenues, not enforcement costs. Approximately 40 times as many users live within 200 miles of Vermont’s borders as live within the state; drug tourism and associated tax revenues will be important considerations, as will be the response of other states. Indeed, if another state legalized with lower taxes, that could undermine the ability to collect taxes on even Vermont residents’ purchases’. They conclude that ‘Analysis of possible outcomes if Vermont, USA, legalized marijuana reveal that choices about how, and not just whether, to legalize a drug can have profound consequences for the effects on health and social wellbeing, and the choices of one jurisdiction can affect the options and incentives available to other jurisdictions’.
 
Caulkins, JP & Kilmer, B 2016, ‘Considering marijuana legalization carefully: insights for other jurisdictions from analysis for Vermont’, Addiction, vol. 111, no. 12, pp. 2082-9.

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How could the criminal justice system deal more effectively and humanely with illegal drugs?

Abstract: Many judge the American criminal justice system to have largely failed in its drug enforcement role, and the justice system itself has suffered a loss of community support and internal morale as a consequence. Five principles should guide improvement of drug enforcement, including that drug enforcement be viewed as a preventive activity, whose main goal is reducing drug abuse and related harms, and it should be designed for sustainability. Six more specific proposals are, first, make marijuana enforcement a minor matter for police through decriminalization of possession or outright legalization; second, induce drug users who are under criminal justice supervision to refrain from drug use by imposing appropriate monitoring and graduated sanctions programs; third, expand opioid substitution therapy for heroin- and other opioid-using offenders; fourth, reduce the average severity of sentences for drug offenses, particularly for minor functionaries who are easily replaced; fifth, base sentence length on culpability, danger, and replaceability, not quantity possessed or number of prior convictions; and sixth, reduce prescription drug abuse by policing that reinforces regulatory efforts. Jointly these proposals would provide an evidence-informed approach that should both reduce America’s drug abuse problem and increase the perceived legitimacy of the criminal justice system.
 
Caulkins, JP & Reuter, P 2016, ‘Dealing more effectively and humanely with illegal drugs’, Crime and Justice, online ahead of print.
 
Comment: ATODA is noticing a trend for leading drug policy scholars and analysts, such as the American authors of this article and some Australian scholars, to become increasingly vocal, and specific, in recommending the actions that should be taken to improve policy on illicit drugs, and its implementation. We believe that this reflects, to a large extent, the increased availability, in recent years, of the research evidence base that should underpin drug policy development, including drug law reform. Caulkins & Reuter’s proposals, detailed in this article, are highly relevant to ACT policy work on illicit drugs.

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What are the main barriers to methamphetamine users accessing treatment, and how could these barriers be reduced?

A systematic review and meta-analysis of the barriers to accessing methamphetamine treatment found that ‘Psychosocial/internal barriers to accessing methamphetamine treatment were most prevalent across studies (10/11 studies). Meta-analysis confirmed the four most commonly endorsed barriers to treatment access across studies, all psychosocial barriers, were embarrassment or stigma…belief that treatment was unnecessary…preferring to withdraw alone without assistance…and privacy concerns’. The researchers concluded that ‘The primary barriers to accessing methamphetamine treatment are psychosocial/internal. Services and treatment models that address these barriers are urgently required. There is a growing need for methamphetamine-appropriate treatment services. Further research evaluating treatment engagement and effectiveness for methamphetamine and polysubstance use, including the development of effective pharmacotherapies is warranted’.
 
Cumming, C, Troeung, L, Young, JT, Kelty, E & Preen, DB 2016, ‘Barriers to accessing methamphetamine treatment: a systematic review and meta-analysis’, Drug and Alcohol Dependence, vol. 168, pp. 263-73.

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How does the use of acupuncture compare with other treatments for substance use disorders?

A systematic review involving over five thousand participants estimated the effects of acupuncture for adults with substance use disorders (SUDs). The reviewers found that ‘No significant differences were observed between acupuncture and comparators (passive controls, sham acupuncture, treatment as usual, and active interventions) at post-intervention for relapse…frequency of substance use…quantity of substance use…and treatment dropout…We identified a significant difference in favor of acupuncture versus comparators for withdrawal/craving at post-intervention…but we identified evidence of publication bias. We also identified a significant difference in favor of acupuncture versus comparators for anxiety at post-intervention…Results for withdrawal/craving and anxiety symptoms were not significant at longer follow-up. Safety data…suggests little risk of serious adverse events, though participants may experience slight bleeding or pain at needle insertion sites’. They concluded that ‘Available evidence suggests no consistent differences between acupuncture and comparators for substance use. Results in favor of acupuncture for withdrawal/craving and anxiety symptoms are limited by low quality bodies of evidence’.
 
Grant, S, Kandrack, R, Motala, A, Shanman, R, Booth, M, Miles, J, Sorbero, M & Hempel, S 2016, ‘Acupuncture for substance use disorders: a systematic review and meta-analysis’, Drug and Alcohol Dependence, vol. 163, pp. 1-15, open access http://www.drugandalcoholdependence.com/article/S0376-8716(16)00109-5/fulltext .

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To what extent do mandatory drug testing and assessment of arrestees contribute to engagement in treatment or reoffending?

Abstract
Aim: Over a 10-year period from 2003, around 1.7 million arrests in England and Wales resulted in the suspect being exposed to mandatory drug testing and assessment processes. These provisions formed part of a wider drug interventions programme costing £1.3 billion. This study sought to assess the impact of compliance with these measures on treatment uptake and reoffending. Recidivism risk factors were also investigated.
Methods: The use of linked administrative data relating to matched samples of recent heroin and/or cocaine (H/C) users identified in one English police force area over a 12-month period (N=1630).
Findings: There was no association between compliance with a compulsory model of drug diversion and subsequent engagement with structured treatment services, rates of treatment retention and successful discharge. Compliance was also not found to be associated with reductions in the rate and volume of reoffending after 12 months. The factor with the largest effect on risk of recidivism was poly use of H/C. Main offence, engagement with structured treatment, number of prior convictions and (younger) age were also identified as recidivism risk factors.
Conclusions: These results are discussed in the context of subsequent legislation and policy which further expands the reach of mandatory testing and assessment measures as a form of constraints-based drug diversion.
 
McSweeney, T, Hughes, C & Ritter, A 2016, ‘The impact of compliance with a compulsory model of drug diversion on treatment engagement and reoffending’, Drugs: education, prevention and policy, online ahead of print.

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What evidence is available on the use of psychedelics in treating people with unipolar mood disorders?

A systematic review of published clinical treatment studies using psychedelics in patients with broadly defined unipolar mood disorders, including major depressive disorder and persistent depressive disorder (dysthymia), found that, of over four hundred individuals in 19 studies, almost 80 per cent showed clinician-judged improvement after treatment with psychedelics. The reviewers reported that ‘A recently completed pilot study in the UK favours the use of psilocybin with psychological support in treatment resistant depressive disorder’, and concluded that ‘The evidence overall strongly suggests that psychedelics should be re-examined in modern clinical trials for their use in unipolar mood disorders and other non-psychotic mental health conditions’.
 
Rucker, JJ, Jelen, LA, Flynn, S, Frowde, KD & Young, AH 2016, ‘Psychedelics in the treatment of unipolar mood disorders: a systematic review’, Journal of Psychopharmacology, online ahead of print.
 
Comment: ATODA congratulates those jurisdictions that are acting to introduce medicinal cannabis programs. We point out, however, that the evidence base supporting the prescribing of injectable diacetylmorphine hydrochloride (i.e., pharmaceutical heroin) is also very strong, and that evidence continues to build supporting the use of psychedelics and MDMA in treating particular mental health disorders. ATODA calls for the legalisation of pharmaceutical heroin and hydromorphone for treating opioid use disorders, and also calls on regulators to systematically review the evidence supporting the therapeutic uses of other currently-illegal drugs.

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To what extent can the prohibition of psychedelics be justified as a public health measure?

A large population study using data from the US National Survey on Drug Use and Health examined the associations between psychedelic use and mental health. The researchers reported ‘After adjusting for sociodemographics, other drug use and childhood depression, we found no significant associations between lifetime use of psychedelics and increased likelihood of past year serious psychological distress, mental health treatment, suicidal thoughts, suicidal plans and suicide attempt, depression and anxiety. We failed to find evidence that psychedelic use is an independent risk factor for mental health problems. Psychedelics are not known to harm the brain or other body organs or to cause addiction or compulsive use; serious adverse events involving psychedelics are extremely rare. Overall, it is difficult to see how prohibition of psychedelics can be justified as a public health measure’.
 
Johansen, P-Ø & Krebs, TS 2015, ‘Psychedelics not linked to mental health problems or suicidal behavior: a population study’, Journal of Psychopharmacology, vol. 29, no. 3, pp. 270-9.

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New Reports
 

Association of South-East Asian Nations 2016, The ASEAN Work Plan on securing communities against illicit drugs 2016-2025, ASEAN, , http://idpc.net/publications/2016/11/the-asean-work-plan-on-securing-communities-against-illicit-drugs-2016-2025.  

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Butler, K, Karlsson, A & Breen, C 2016, Drug use and risk among older adults who regularly inject drugs, IDRS Drug Trends Bulletin, December 2016, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://www.drugtrends.org.au/reports/idrs-december-2016-bulletin/ .

Identifies correlates of regular injecting drug use in older adults and reports that they are less likely than others to engage in risky injecting behaviours, engage in crime and report mental health problems. Concludes that ‘Age-specific considerations into the care and treatment options provided needs attention in Australia to adequately service this ageing population’.
 

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European Monitoring Centre for Drugs and Drug Addiction 2016, Cannabis policy: status and recent developments, EMCDDA, http://www.emcdda.europa.eu/topics/cannabis-policy.
 

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Global Commission on Drug Policy 2016, Advancing drug policy reform: a new approach to decriminalization. 2016 report, Global Commission on Drug Policy, [Rio de Janeiro], http://www.globalcommissionondrugs.org/reports/advancing-drug-policy-reform/.

‘Building on current partial decriminalization models that have helped to achieve more effective drug policies and positive outcomes, with a greater emphasis on justice, dignity and human rights, this report advocates ending all penalties—both civil and criminal—on people who use drugs.’ 
 

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Harm Reduction International (ed.) 2016, The global state of harm reduction 2016, Harm Reduction International, London, https://www.hri.global/contents/1739.

‘…today’s report demonstrates that harm reduction is not a fringe position. Harm reduction services are now available in over half of the 158 countries with documented injecting drug use. Where they have been adequately scaled-up, HIV and Hepatitis C rates have plummeted. HRI is calling on governments and the UN to redirect their attention – and their funding – away from the war on drugs and into harm reduction.’
 

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Johnson, CF, Barnsdale, LR & McAuley, A 2016, Investigating the role of benzodiazepines in drug-related mortality: a systematic review undertaken on behalf of The Scottish National Forum on Drug-Related Deaths, NHS Health Scotland, Edinburgh, http://hdl.handle.net/1893/23220 .

‘Owing to a lack of research on benzodiazepines, the National Forum on Drug-Related Deaths commissioned work addressing why benzodiazepines are common in DRDs and what role they play in such deaths, particularly at the high doses often reported. This Report presents the findings of a systematic review of evidence in relation to the use and misuse of benzodiazepines and highlights significant gaps in knowledge.’
 

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Loxley, W, Gilmore, W, Catalano, P & Chikritzhs, T 2016, National Alcohol Sales Data Project (NASDP) stage 5 report, National Drug Research Institute, Curtin University Perth, WA, http://ndri.curtin.edu.au/research/nasdp.cfm.

‘Advice from ACT Health indicated that there were limitations in the 2013/14 data and it was anticipated that they might cover no more than 50% of wholesalers required to submit data. Similar limitations were found with the 2012/13 data in the NASDP. For this reason, per capita consumption estimates for the ACT for 2012/13 and 2013/14 have not been included. The overall volume of alcohol sold by the wholesalers that submitted data has been presented and was found to be similar across the two years.’
 

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McKetin, R 2016, ‘Counting people who use illicit drugs: the case of ice’, Drug and Alcohol Research Connections, open access http://connections.edu.au/opinion/counting-people-who-use-illicit-drugs-case-ice.

Suggests that several lines of evidence exist that are inconsistent with the argument that ‘NDSHS [National Drug Strategy Household Survey] data show that a stable number of people are using methamphetamine, but are experiencing more harms because they have switched to using purer forms of crystalline methamphetamine from less potent forms of the drug (e.g. speed)’. Suggests that the evidence support increases in the prevalence of use of the drug.
 

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Miller, P, Cox, E, Costa, B, Mayshak, R, Walker, A, Hyder, S, Tonner, L & Day, A 2016, Alcohol/drug-involved family violence in Australia (ADIVA), Monograph Series no. 68, National Drug Law Enforcement Research Fund, Canberra, http://www.ndlerf.gov.au/publications/monographs/monograph-68.

‘Family and domestic violence (FDV) are significant public health and social issues…The negative consequences of FDV, which include physical injury, depression, suicide and post-traumatic stress disorder, have been well-documented...A range of risk factors have been identified to contribute to FDV, including Alcohol and Other Drug (AOD) use. Of significance, AOD use represents risk factors that can be modified at individual and environmental levels.’
 

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Miller, P & Mayshak, R 2016, Alcohol and drug use exacerbate family violence and can be dealt with, The Conversation, 15 December 2016, https://theconversation.com/alcohol-and-drug-use-exacerbate-family-violence-and-can-be-dealt-with-69986.
 

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Pew Research Centre 2016, Support for marijuana legalization continues to rise, Pew Research Centre, Washington, DC, http://www.pewresearch.org/fact-tank/2016/10/12/support-for-marijuana-legalization-continues-to-rise.

‘The share of Americans who favor legalizing the use of marijuana continues to increase. Today, 57% of U.S. adults say the use of marijuana should be made legal, while 37% say it should be illegal. A decade ago, opinion on legalizing marijuana was nearly the reverse – just 32% favored legalization, while 60% were opposed.’
 

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Ritter, A 2016, Our drugs policies have failed. It’s time to reinvent them based on what actually works, The Conversation, 8 December, https://theconversation.com/our-drugs-policies-have-failed-its-time-to-reinvent-them-based-on-what-actually-works-69984.

‘…what is needed: politically neutral policy decisions based on the best evidence, integrated with other types of knowledge, and engaging all voices, including people who use drugs.
Few areas of policy-making are more emotionally charged than drugs policy. Yet if we resist knee-jerk calls to arms and engage in informed policy-setting that involves many stakeholders and types of knowledge, we can save many more lives, reduce needless suffering, and alleviate the financial burden of ineffective drugs policies.’
 

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Sutherland, R, Breen, C & Bruno, R 2016, New psychoactive substance use among regular psychostimulant users in Australia, 2010-2016, Ecstasy and Related Drug Trends Bulletin, December 2016, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://www.drugtrends.org.au/reports/edrs-december-2016-bulletin/.
 

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The Kirby Institute 2016, HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2016, The Kirby Institute, The University of New South Wales, Sydney, http://kirby.unsw.edu.au/surveillance/2016-annual-surveillance-report-hiv-viral-hepatitis-stis.

‘The Annual Surveillance Report has been published each year since 1997. The report provides a comprehensive analysis of HIV, viral hepatitis and sexually transmissible infections in Australia and includes estimates of incidence and prevalence of HIV and viral hepatitis, by demographic and risk groups, patterns of treatment for HIV and viral hepatitis infection, and behavioural risk factors for HIV and hepatitis C infection.'
 

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Therapeutic Goods Administration (TGA) 2016, Access to medicinal cannabis products, TGA, https://www.tga.gov.au/access-medicinal-cannabis-products .

The Australian Government is facilitating access to medicinal cannabis products to appropriate patients for medical conditions where there is evidence to support its use.
 

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U.S. Department of Health and Human Services (HHS), Office of the Surgeon General 2016, Facing addiction in America: the Surgeon General’s report on alcohol, drugs, and health, HHS, Washington, DC, https://addiction.surgeongeneral.gov/.

‘The first-ever Surgeon General’s Report on Alcohol, Drugs, and Health reviews what we know about substance misuse and how you can use that knowledge to address substance misuse and related consequences.’
 

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VicHealth 2016, Alcohol mixed with energy drinks: exploring patterns of consumption and associated harms. Research summary, Victorian Health Promotion Foundation, Melbourne, https://www.vichealth.vic.gov.au/media-and-resources/publications/alcohol-mixed-with-energy-drinks-report
Recommendations

• Include evidence-based messages regarding AmED [alcohol mixed with energy drinks] consumption in existing guidelines and alcohol-harm reduction campaigns, particularly to dispel the myth that that caffeinated beverages will sober drinkers up, as they may in fact increase the risk of harm.
• Policymakers should consider the roles of pricing, availability and promotion of AmED prior to and after midnight, on both Saturday and Sunday mornings, as one aspect of wider decision making regarding legislative and regulatory action to reduce alcohol-related harms in the night time economy.
• Further research should be undertaken to:
  • evaluate the impact of AmED regulation in Western Australia
  • investigate the potential links between ED and AmED use, gambling and mental health.’

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Wiggers, J, Vashum, K, Wolfenden, L, Yoong, S, Paul, C, Williams, A & Bowman, J 2016, Implementing nicotine dependence and smoking cessation care in hospitals: an Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the NSW Ministry of Health, 2016, Sax Institute, Sydney, https://www.saxinstitute.org.au/publications/evidence-check-library/implementing-nicotine-dependence-and-smoking-cessation-care-in-hospitals/.

‘This Evidence Check review examines models of managing nicotine dependence in health facilities under a smoke-free healthcare policy directive. The research evidence suggests that smoking cessation can be increased via a number of interventions including: smoking status assessment; provision of advice/counselling; nicotine replacement therapy; and referral for specialist follow-up. A number of clinical practice strategies, such as training, electronic reminders and leadership were found to be effective at increasing clinician provision of smoking cessation care. A review of best practice documents and initiatives implemented in Australasian jurisdictions identified a number of policies, frameworks, tools and services intended to support delivery of smoking cessation care.’


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