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.
Recently, ATODA presented a paper on the 'We CAN Project' to the Australasian Professional Society on Alcohol and Other Drugs (APSAD) Annual Scientific Alcohol and Drug Conference in Perth. The abstract for the paper has been published in a special supplementary issue of the Drug and Alcohol Review, and is reproduced below.
Workers in specialist alcohol, tobacco and other drug (ATOD) non-government organisations (NGOs) in the Australian Capital Territory (ACT) have identified access to affordable nicotine replacement therapy (NRT) as a significant barrier to smoking cessation for their service users.
This paper describes a model of NRT delivery through the We CAN Program (Communities Accessing all-types of NRT) in the ACT. A partnership between specialist ATOD NGOs and local community pharmacies enables service users to access all-types of NRT at no cost and without attending a general practitioner. The Program is managed by the Alcohol Tobacco and Other Drug Association ACT (ATODA).
ATODA worked closely with its member ATOD services to establish the model for this Program. Workers at participating organisations provide service users who want to quit or reduce smoking with vouchers redeemable at pharmacies for 8–12 weeks worth of any types of NRT. Services nominated one or more local community pharmacies, and ATODA facilitated the development of program-specific partnerships to streamline Program delivery. The Program is being evaluated through the collection of operational data and surveys with program participants.
The We CAN Program is currently being rolled out across the ACT, and has been well received by ATOD services and community pharmacies.
The We CAN Program is an example of a collaborative community-based model that is focused on facilitating equity in access to a successful smoking cessation tool (ie NRT) by disadvantaged smokers.
: Health workers and policy makers may be interested in this collaborative model that facilitates access to costly smoking cessation treatment and smoking cessation advice by disadvantaged smokers. The model can be translated into other community- and government-based health settings.
Do drug seizures predict drug-related emergency department presentations or arrests for drug use and possession?
Highlights:
- Large-scale seizures of heroin, cocaine and ATS exert no effect on drug overdose frequency.
- Large-scale seizures of heroin, cocaine and ATS exert no effect on use/possession arrests.
- Increases in seizures of heroin, cocaine and ATS presage increases in arrests for use of these drugs.
Background: Direct evidence of the effect of drug seizures on drug use and drug-related harm is fairly sparse. The aim of this study was to see whether seizures of heroin, cocaine and ATS predict the number of people arrested for use and possession of these drugs and the number overdosing on them.
Method: They examined the effect of seizure frequency and seizure weight on arrests for drug use and possession and on the frequency of drug overdose with autoregressive distributed lag (ARDL) models. Granger causality tests were used to test for simultaneity.
Results: Over the short term (i.e. up to 4 months), increases in the intensity of high-level drug law enforcement (as measured by seizure weight and frequency) directed at ATS, cocaine and heroin did not appear to have any suppression effect on emergency department (ED) presentations relating to ATS, cocaine and heroin, or on arrests for use and/or possession of these drugs. A significant negative contemporaneous relationship was found between the heroin seizure weight and arrests for use and/or possession of heroin. However no evidence emerged of a contemporaneous or lagged relationship between heroin seizures and heroin ED presentations.
Conclusion: The balance of evidence suggests that, in the Australian context, increases in the monthly seizure frequency and quantity of ATS, cocaine and heroin are signals of increased rather than reduced supply.
Wan, W-Y, Weatherburn, D, Wardlaw, G, Sarafidis, V & Sara, G 2015, ‘
Do drug seizures predict drug-related emergency department presentations or arrests for drug use and possession?’,
International Journal of Drug Policy, online ahead of print.
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How does drug prohibition and its enforcement affect violence in drug markets?
Drug consumption and addiction are known to increase the incidence of violent and property crimes. For this reason, governments prohibit the trade in some psychoactive substances and vigorously enforce the law. The unfortunate consequence of this governmental control is that it increases drug market violence. This article examines how drug prohibition and its enforcement affect violence among illicit drug traders. Two processes are considered: the role of virtual anarchy and police pressure in exposing illicit drug traders to predation and motivating them to retaliate. After reviewing the empirical literature bearing on these theories, this article concludes by outlining what is needed to move the field forward.
Jacques, S & Allen, A 2015, ‘
Drug market violence: virtual anarchy, police pressure, predation, and retaliation’,
Criminal Justice Review, vol. 40, no. 1, pp. 87-99.
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Should women abstain from alcohol throughout pregnancy?
Commences: ‘Everyone agrees that current advice on alcohol is inconsistent and confusing, but whereas Mary Mather and Kate Wiles conclude we should move to a clear recommendation to abstain, Patrick O’Brien thinks it is wrong to assume pregnant women cannot understand the evidence.’
Mather, M, Wiles, K & O’Brien, P 2015, ‘Should women abstain from alcohol throughout pregnancy?’, BMJ: British Medical Journal, vol. 351, open access
http://www.bmj.com/content/351/bmj.h5232
Can a computer-based, single session brief intervention in hospital emergency departments affect adolescent alcohol use?
Objectives: This study examined the efficacy of emergency department (ED)-based brief interventions (BIs), delivered by a computer or therapist, with and without a post-ED session, on alcohol consumption and consequences over 12 months.
Methods: Patients (ages 14-20 years) screening positive for risky drinking were randomized to: BI (n = 277), therapist BI (n = 278), or control (n = 281). After the 3-month follow-up, participants were randomized to receive a post-ED BI session or control. Incorporating motivational interviewing, the BIs addressed alcohol consumption and consequences, including driving under the influence (DUI), and alcohol-related injury, as well as other concomitant drug use. The computer BI was an offline, Facebook-styled program.
Results: Among 4389 patients screened, 1054 patients reported risky drinking and 836 were enrolled in the randomized controlled trial. Regression models examined the main effects of the intervention conditions (versus control) and the interaction effects (ED condition x post-ED condition) on primary outcomes. The therapist and computer BIs significantly reduced consumption at 3 months, consequences at 3 and 12 months, and prescription drug use at 12 months; the computer BI reduced the frequency of DUI at 12 months; and the therapist BI reduced the frequency of alcohol-related injury at 12 months. The post-ED session reduced alcohol consequences at 6 months, benefiting those who had not received a BI in the ED.
Conclusions: A single-session BI, delivered by a computer or therapist in the ED, shows promise for underage drinkers. Findings for the fully automated stand-alone computer BI are particularly appealing given the ease of future implementation.
Cunningham, RM, Chermack, ST, Ehrlich, PF, Carter, PM, Booth, BM, Blow, FC, Barry, KL & Walton, MA 2015, ‘
Alcohol interventions among underage drinkers in the ED: a randomized controlled trial’,
Pediatrics, vol. 136, no. 4, pp. e783-93.
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What links are there between adolescent substance use and educational attainment?
Background: The relative contributions of cannabis and alcohol use to educational outcomes are unclear. We examined the extent to which adolescent cannabis or alcohol use predicts educational attainment in emerging adulthood.
Methods: Participant-level data were integrated from three longitudinal studies from Australia and New Zealand (Australian Temperament Project, Christchurch Health and Development Study, and Victorian Adolescent Health Cohort Study). The number of participants varied by analysis (N=2179-3678) and were assessed on multiple occasions between ages 13 and 25. They described the association between frequency of cannabis or alcohol use prior to age 17 and high school non-completion, university non-enrolment, and degree non-attainment by age 25. Two other measures of alcohol use in adolescence were also examined.
Results: After covariate adjustment using a propensity score approach, adolescent cannabis use (weekly+) was associated with 1(1/2) to two-fold increases in the odds of high school non-completion (OR=1.60, 95% CI=1.09-2.35), university non-enrolment (OR=1.51, 95% CI=1.06-2.13), and degree non-attainment (OR=1.96, 95% CI=1.36-2.81). In contrast, adjusted associations for all measures of adolescent alcohol use were inconsistent and weaker. Attributable risk estimates indicated adolescent cannabis use accounted for a greater proportion of the overall rate of non-progression with formal education than adolescent alcohol use.
Conclusions: Findings are important to the debate about the relative harms of cannabis and alcohol use. Adolescent cannabis use is a better marker of lower educational attainment than adolescent alcohol use and identifies an important target population for preventive intervention.
Silins, E
et al. 2015, ‘
Adolescent substance use and educational attainment: an integrative data analysis comparing cannabis and alcohol from three Australasian cohorts’,
Drug and Alcohol Dependence, online ahead of print.
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Do workplace AOD policies work?
Background: There is growing interest in workplace policies as a strategy to prevent or manage alcohol and other drug (AOD) problems. This study is the first to explore the prevalence and impact of AOD policies in Australian workplaces using a nationally representative dataset.
Methods: A secondary analysis of the 2010 National Drug Strategy Household Survey was conducted (n = 13,590). Descriptive analyses explored the prevalence of AOD policies. Multinomial and logistic regression assessed the relationship between policies and health behaviours.
Results: Workplace AOD policies were associated with reduced employee substance use. Having any AOD policy in place was associated with significantly decreased odds of high risk drinking (OR: 0.61). In terms of specific policy types, policies on ‘use’ and ‘use plus assistance’ were associated with significantly decreased odds of high risk drinking (OR: 0.64 and 0.43, respectively). ‘Comprehensive’ policies were associated with significantly decreased odds of drug use (OR: 0.72). AOD policies were not significantly related to absence due to AOD use, attending work under the influence, or usually consuming AOD at work.
Conclusion: These findings provide empirical support for the value and efficacy of policies to reduce alcohol and drug problems. While basic policies on ‘use’ were associated with a reduction in high risk drinking, more comprehensive policies were required to impact drug use. Notably, alcohol/drug testing in isolation does not appear to be related to reduced employee substance use. Scope exists for Australian workplaces to implement effective AOD policies. This could result in considerable benefits for both individuals and workplaces.
Pidd, K, Kostadinov, V & Roche, A 2015, ‘
Do workplace policies work? An examination of the relationship between AOD policies and workers’ substance use’,
International Journal of Drug Policy, online ahead of print.
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How prevalent is e-cigarette use in NSW?
‘We found the prevalence of current e-cigarette users in NSW was 1.3% (95% CI, 0.9–1.7), while 8.4% (95% CI, 7.5–9.3) of the population was estimated to have tried an e-cigarette (Box). Current smokers were 7.5 times more likely to be current e-cigarette users than non-smokers (RR, 7.5; 95% CI, 4.2–13.7), while males (RR, 1.2; 95% CI, 0.7–2.2) and people aged 18–44 years (RR, 1.8; 95% CI, 1.0–3.3) were more likely to have ever tried an e-cigarette compared with females and people aged 45 years or older, respectively. We estimate that about 78 000 people are current users of e-cigarettes in NSW. Current use of e-cigarettes is relatively low compared with other countries, such as the US and the UK.1,2 While increases in e-cigarette use were observed in the US and the UK, it is unclear whether NSW will see a similar growth pattern. The NSW Ministry of Health will continue to monitor the use of e-cigarettes in the state’.
Harrold, TC, Maag, AK, Thackway, S, Mitchell, J & Taylor, LK 2015, ‘
Prevalence of e-cigarette users in New South Wales’,
Medical Journal of Australia, vol. 203, no. 8, p. 326.
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What links are there between cigarette smoking and risk of alcohol use relapse among adults in recovery from alcohol use disorders?
Background: Individuals in recovery from alcohol use disorders (AUDs) frequently continue to smoke cigarettes. The purpose of this study was to examine the relationship between cigarette smoking status and risk of AUD relapse in adults with remitted AUDs among adults in the United States.
Methods: Data were drawn from Wave 1 (2001 to 2002) and Wave 2 (2004 to 2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Analyses included the subsample of respondents who completed both waves of data collection reported a history of alcohol abuse and/or dependence prior to Wave 1 (N = 9,134). Relationships between Wave 1 cigarette smoking status (nonsmoker, daily cigarette smoker, and nondaily cigarette smoker) and Wave 2 alcohol use, abuse, and dependence were examined using logistic regression analyses. Analyses were adjusted for Wave 1 demographics; mood, anxiety, and substance use disorders; nicotine dependence; and AUD severity.
Results: Both daily and nondaily cigarette smoking at Wave 1 were significantly associated with a lower likelihood of alcohol use and a greater likelihood of alcohol abuse and dependence at Wave 2 compared to Wave 1 nonsmoking. These relationships remained significant after adjusting for demographics, psychiatric disorders, substance use disorders, AUD severity, and nicotine dependence.
Conclusions: Among adults with remitted AUDs, daily and nondaily use of cigarettes was associated with significantly decreased likelihood of alcohol use and increased likelihood of alcohol abuse and alcohol dependence 3 years later. Concurrent treatment of cigarette smoking when treating AUDs may help improve long-term alcohol outcomes and reduce the negative consequences of both substances.
Weinberger, AH, Platt, J, Jiang, B & Goodwin, RD 2015, ‘
Cigarette smoking and risk of alcohol use relapse among adults in recovery from alcohol use disorders’,
Alcoholism: Clinical and Experimental Research, vol. 39, no. 10, pp. 1989-96.
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Who smokes unbranded illicit tobacco in Australia?
This brief article, for which no abstract is available, concludes:
‘This analysis paints a picture of users of unbranded tobacco as predominantly male, but otherwise covering a somewhat broader social spectrum than might have been expected. The apparent drop in prevalence of use in 2010 may be due to a re-phrasing of the question in this year to not include cigarettes in the definition of unbranded tobacco; however, this was reinstated in 2013 and a further drop was detected. As expected, use of unbranded tobacco is more prevalent among heavier smokers and among those who did not intend to quit. The finding that prevalence is higher among dual users of RYO [roll your own] tobacco and factory-made cigarettes than among those who exclusively smoke RYO cigarettes was unexpected and should be explored further. The finding that unbranded tobacco is used by a small number of people who smoke neither form of cigarettes is also intriguing. Use of unbranded tobacco with cannabis is a possibility that warrants further investigation.’
Scollo, M, Zacher, M, Bayly, M & Wakefield, M 2015, ‘
Who smokes unbranded illicit tobacco in Australia: results of nationally representative cross-sectional household surveys in 2004, 2007, 2010 and 2013’,
Australian and New Zealand Journal of Public Health, online ahead of print.
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How prevalent are new psychoactive substances in fatally-injured drivers in Victoria?
The presence of new psychoactive substances (NPS) in Victorian drivers was determined in the blood of 253 Victorian fatally-injured drivers covering a 2-year period, from 2012 to 2013. The validated LC-MS/MS methods was used to detect 56 synthetic cannabinoids and 32 synthetic cathinones. In only two of the drivers were cathinones detected; 4-methylenedioxypyrovalerone (MDPV) and α-pyrrolidinopentiophenone (α-PVP) in one driver and methylone in another. Synthetic cannabinoids were detected in four of the fatally-injured drivers, and comprised four different drugs: JWH-122, JWH-122-pentenyl derivative, CRA-13 and PB-22, all at quite low concentrations (less than 1 ng/mL). The prevalence of NPS was 2.4% compared with about 29% for the presence of all psychoactive drugs in this period.
Yap, S & Drummer, OH 2015, ‘
Prevalence of new psychoactive substances in Victorian fatally-injured drivers’,
Australian Journal of Forensic Sciences, online ahead of print.
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What are researchers and advocates saying about prison NSPs [PNSPs] in Australia?
‘However, there remains an overriding belief in Australian correctional systems that PNSPs are incompatible with security; a contention not borne out by international experience’ (p. 319).
‘While limited progress towards a PNSP trial in Australia is disappointing in a country that once led the world in drug harm reduction policy and practice, one jurisdictional government has consistently demonstrated political leadership on the issue’ (p. 319).
An interview with author Prof Mark Stoové is available here:
https://www.youtube.com/watch?v=Z6ZTp_Qp0e4&feature=youtu.be
Stoové, M, Treloar, CJ, Maher, L, Tyrrell, H & Wallace, J 2015, ‘Salvaging a prison needle and syringe program trial in Australia requires leadership and respect for evidence’,
Medical Journal of Australia, vol. 203, no. 8, pp. 319-20, open access
http://www.mja.com.au/doi/10.5694/mja15.00523.
Comment: The ACT Government has demonstrated leadership on PNSP. An AMC NSP working group has been established.
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What changes have occurred in Australian non-opioid substitution treatment episodes for pharmaceutical opioids and heroin over the last decade?
Background: There has been a well-documented increase in the non-medical use of pharmaceutical opioids (PO) worldwide. However, there has been little detailed examination of treatment demand, or the characteristics of those presenting for treatment, particularly for treatments other than opioid substitution.
Methods: Data from closed drug and alcohol treatment episodes from the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS, representing non-opioid substitution treatment) in Australia for 2002-2003 to 2010-2011 were examined. In the four jurisdictions where detailed data were available, episodes where heroin was the principal drug of concern were compared to episodes for the four most frequently reported pharmaceutical opioids (morphine, codeine, fentanyl and oxycodone).
Results: In 2002-2003, most (93%) opioid treatment was related to heroin with seven percent of all opioid treatment episodes reporting a PO as the principal drug of concern. In 2010-2011, 20% of all opioid treatment episodes were attributed to POs. Distinct changes over time were observed for different opioids. There was an increase in the average age at the start of treatment for heroin and oxycodone episodes, and a reduction in the proportion of females for codeine episodes, with 67% in 2002-2003 compared with 44% in 2010-2011. Codeine and oxycodone episodes had the lowest current or past injection rates.
Conclusions: Clear differences were observed over time and between different opioids. Monitoring these emerging patterns will be important to inform treatment needs, particularly in light of different patterns of poly drug use, different routes of administration and changing demographic characteristics.
Nielsen, S, Roxburgh, A, Bruno, R, Lintzeris, N, Jefferson, A & Degenhardt, L 2015, ‘
Changes in non-opioid substitution treatment episodes for pharmaceutical opioids and heroin from 2002 to 2011’,
Drug and Alcohol Dependence, vol. 149, pp. 212-9.
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New Reports
Cockayne, J & Walker, S 2015, What comes after the war on drugs? Flexibility, fragmentation or principled pluralism?, United Nations University, Nw York, http://unu.edu/news/news/unu-report-launch-what-comes-after-the-war-on-drugs.html.
Coyne, J, White, V & Alvarez, C 2015, Methamphetamine: focusing Australia’s National Ice Strategy on the problem, not the symptoms, Australian Strategic Policy Institute, Canberra, https://www.aspi.org.au/publications/methamphetamine-focusing-australias-national-ice-strategy-on-the-problem,-not-the-symptoms, large file warning: 7MB.
Harm Reduction International (ed.) 2015, The global state of harm reduction 2014, Harm Reduction International, London, http://www.ihra.net/contents/1524.
International Network of People who Use Drugs (INPUD 2015, INPUD Consensus Statement on Drug Use Under Prohibition - Human Rights, Health, and the Law, INPUD, http://www.inpud.net/en/news/consensus-statement.
KPMG 2014, Evaluation of the Drug Court of Victoria: Final Report, Magistrates’ Court of Victoria, 18 December 2014 KPMG, Melbourne, http://www.magistratescourt.vic.gov.au/news/drug-court-victoria-evaluation-released.
Tolhurst, P & Australian Health Policy Collaboration 2015, Development of Australian chronic disease targets and indicators, Victoria University, Melbourne, https://www.vu.edu.au/australian-health-policy-collaboration/publications#goto-development-of-australian-chronic-disease-targets-and-indicators=1.
United Nations Office on Drugs and Crime 2015, Briefing paper: decriminalisation of drug use and possession for personal consumption, UNODC, Vienna, http://www.tdpf.org.uk/blog/truth-behind-unodcs-leaked-decriminalisation-paper.
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