ACT ATOD Sector Research eBulletin - November 2016
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 November 2016 issue


ACT Research Spotlight

Research Findings

New Reports

 



ACT Research Spotlight

Seven posters or oral presentations by ACT-based researchers and worers were part of the October-November 2016 APSAD Scientific Alcohol and Drug Conference, held in Sydney. Their abstracts are available online at https://www.eiseverywhere.com/ehome/apsadconference16/466402/ .
 
Dietze, PM, Cogger, S, Malandkar, D, Olsen, Anna & Lenton, S 2016, ‘Knowledge of naloxone and take-home naloxone programs among a sample of people who inject drugs in Australia’, Drug and Alcohol Review, vol. 35, no. supp. 1, p. 11.
 
Griffiths, Scott, Murray, S & Mond, J 2016, ‘The stigma of anabolic steroid use’, Drug and Alcohol Review, vol. 35, supp. 1, p. 41.
 
McKetin, R, Gardner, J, Baker, AL, Dawe, S, Ali, R, Voce, Alexandra, Leach, L & Lubman, DI 2016, ‘Correlates of transient versus persistent psychotic symptoms among dependent methamphetamine users’, Drug and Alcohol Review, vol. 35, no. supp. 1, p. 54.
 
Smith, Amy, Buffinton, Lisa & Thorn, Michael 2016, ‘Social marketing: taking us beyond “awareness raising” on alcohol harms’, Drug and Alcohol Review, vol. 35, no. supp. 1, p. 68.
 
Van der Sterren, Anke & Fowlie, Carrie 2016, ‘Satisfaction and self-reported outcomes for service users of specialist alcohol and other drug treatment and support services in the ACT’, Drug and Alcohol Review, vol. 35, supp. 1, pp. 70-1.
 
Voce, Alexandra, McKetin, R, Calabria, B, Burns, Richard & Castle, D 2016, ‘The symptom profile and clinical course of methamphetamine-induced psychosis: a systematic review’, Drug and Alcohol Review, vol. 35, no. supp. 1, p. 72.
 
Wiggins, Nicole 2016, ‘Role of alcohol and other drug workers in facilitating access to hepatitis C care’, Drug and Alcohol Review, vol. 35, no. supp. 1, p. 75.

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Update on the contents of an earlier issue of the ATODA Research eBulletin: authors' potential conflict of interest not fully revealed

In ATODA’s September 2016 Research eBulletin we summarised an article Elzey, MJ, Fudin, J & Edwards, ES 2016, ‘Take-home naloxone treatment for opioid emergencies: a comparison of routes of administration and associated delivery systems’, Expert Opinion on Drug Delivery, online ahead of print. The paper concluded that auto-injectable naloxone delivery devices (not available in Australia, and extremely expensive) are the optimal delivery systems for take-home naloxone programs at present. It was subsequently brought to ATODA’s attention that two of the authors of the paper are employees of the US pharmaceuticals company kaleo, Inc, and that this company manufactures auto-injectable naloxone delivery devices. While the authors’ employment status was declared in the paper they failed to inform readers that their employer manufactures these devices. Readers of their paper should bear in mind this potential conflict of interest on the part of the authors.

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Research Findings

How Effective are online school-based prevention programs in reducing students' intentions to use new psychoactive substances?

What resources are available on effective health promotion initiatives in rural Aboriginal communities?

How effective are positive youth development programs in reducing substance use in young people?

How effective is patient-centred methadone treatment compared to regular treatment?

How does the mortality risk of opioid substitution therapy with methadone compare with buprenorphine?

How effective would ultra-brief interventions implemented in the hospital emergency department be in reducing alcohol-related harm and risky drinking?

How prevalent are alcohol use disorders in the criminal justice system and what evidence is available about the effectiveness of brief interventions in that setting?

What is known about strategies to encourage tobacco cessation among smokers with comorbid conditions?

What might be the effect of reducing the nicotine content of tobacco products?

What is known about the attitudes of mental health professionals to smoking bans within mental health facilities?

What has research shown about the global burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B?

What has been the effect of the increased availability and use of crystal methamphetamine in Australia?

Where are Australians who drink alcohol more likely to consume it?

What is the likelihood that supermarket advertising of alcohol at discounted prices could contribute to alcohol-related harms?

What does the term 'binge drinking' mean to various groups in the Australian community?

How do buprenorphine and methadone prescribed to pregnant women with opioid use disorder compare with respect to safety in the mother, fetus and child?

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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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How Effective are online school-based prevention programs in reducing students' intentions to use new psychoactive substances?

Researchers based at the National Drug and Alcohol Research Centre evaluated the effectiveness of an online school-based prevention program for ecstasy (MDMA) and new psychoactive substances (NPS). The participants were over one thousand teenage students in eleven independent schools in Australia. The program was the internet-based Climate Schools: Ecstasy and Emerging Drugs module which uses cartoon storylines to convey information about harmful drug use. It was delivered once weekly for four weeks during health education classes. Control schools received health education as usual. The primary outcomes of the study were self-reported intentions to use ecstasy and NPS at twelve months. The researchers found that ‘Few students in the present study reported using NPS…and ecstasy…Results revealed some intervention effects…students in the control group were more than 10 times as likely to use NPS and more than three times as likely to intend on (sic) using synthetic cannabis at the 12-month follow-up. Students in the control group also reported significantly less knowledge about both NPS and ecstasy at post-test’. They pointed out that ‘there were no intervention effects for actual use of ecstasy and NPS up to 12 months following the intervention…A 24-month follow-up scheduled for 2016 will provide important long term data and allow for continued monitoring of increases in the uptake and patterns of ecstasy and NPS use’. They concluded: ‘The Climate Schools: Ecstasy and Emerging Drugs module, a universal online school-based prevention program, appeared to reduce students’ intentions to use new psychoactive substances and increased knowledge about ecstasy and new psychoactive substances in the short term’.
 
Champion, KE, Newton, NC, Stapinski, LA & Teesson, M 2016, ‘Effectiveness of a universal internet-based prevention program for ecstasy and new psychoactive substances: a cluster randomized controlled trial’, Addiction, vol. 111, no. 8, pp. 1396-405.
 
Comment: The widespread pessimism that exists in professional circles relating to the effectiveness of harmful drug use preventive interventions among young people largely reflects the fact that most approaches are not well based on evidence of effectiveness and/or are not implemented with sufficient fidelity. The Australian-developed Climate Schools program, in contrast, is an outstanding example of how effective preventive interventions can be.

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What resources are available on effective health promotion initiatives in rural Aboriginal communities?

An evaluation of an Aboriginal health program which was designed specifically for the local Worimi Aboriginal community in Forster/Tuncurry NSW examined the program’s effectiveness in reducing injury, poor foot health, smoking, alcohol consumption and improved diet for young Aboriginal people in a rural community, and in providing a comprehensive guide to successful health promotion in Aboriginal communities. The health promotion package was designed to reduce injury, assist poor foot health and provide education on the effects of smoking, alcohol consumption, and poor diet, specifically related to exercise, training and playing sport. The results of the program were ‘Only 1 participant that reported back at the 4 month follow up had an injury in that period and all participants stated that they had better knowledge of how to prevent injury. For participants who gave feedback at the 4 month follow up, 6 out of 16…had lost between 1 and 3kgs, 5 out of 16…had attempted or have now quit smoking, 3 out of 16 had reduced or quit drinking alcohol and 3 out of 16...had increased their intake of fruit and veg’. The evaluator concluded that ‘The multifaceted health promotion was very successful. Attendance at sessions were very high, which was a huge part of the success. The education sessions were flexible, and very practical and encouraged participation. The program was delivered how and when the Aboriginal community wanted it. Due to community ownership there was real enthusiasm for the program, and this was one of the main reasons for the success’.

Charles, J 2015, ‘An evaluation and comprehensive guide to successful Aboriginal health promotion’, Australian Indigenous HealthBulletin, vol. 16, no. 1, open access http://healthbulletin.org.au/articles/an-evaluation-and-comprehensive-guide-to-successful-aboriginal-health-promotion.

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How effective are positive youth development programs in reducing substance use in young people?

Researchers in the United Kingdom undertook a systematic review of the international evidence on positive youth development (PYD) interventions, which favour promotion of positive assets over traditional risk reduction, to prevent adolescent substance use. The results were ‘Ten studies reported in 13 reports were included in our synthesis. PYD interventions did not have an effect of statistical or public health significance on any substance use, illicit drug use or alcohol outcomes in young people’. They concluded that ‘Our review suggests that existing PYD interventions subject to evaluation do not appear to have produced reductions in substance use of public health significance. However, these interventions may not be the best exemplars of a PYD approach. Therefore, our findings should not be taken as evidence for the ineffectiveness of PYD as a theory of change for reducing substance use among young people’.
 
Melendez-Torres, GJ, Dickson, K, Fletcher, A, Thomas, J, Hinds, K, Campbell, R, Murphy, S & Bonell, C 2016, ‘Positive youth development programmes to reduce substance use in young people: systematic review’, International Journal of Drug Policy, vol. 36, pp. 95-103.

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How effective is patient-centred methadone treatment compared to regular treatment?

Researchers in the USA investigated whether a patient-centred approach to methadone treatment (PCM) improved participant outcomes at 12-months following admission, compared with methadone treatment-as-usual (TAU) by means of a randomised trial in Baltimore. In the patient-centred arm of the study, the methadone program rules were modified (e.g., counselling attendance was optional) as were the counsellor roles (e.g., counsellors were not responsible for enforcing clinic rules). ‘The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior, and quality of life, and retention in treatment’. The study showed ‘…no significant differences between PCM and TAU conditions in opioid-positive urine screens at 12-months…There were also no significant differences in any of the secondary outcome measures…except Quality of Life Global Score…There were no significant differences between conditions in the number of individual or group counseling sessions attended’. They concluded that ‘Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual’.
 
Schwartz, RP, Kelly, SM, Mitchell, SG, Gryczynski, J, O’Grady, KE, Gandhi, D, Olsen, Y & Jaffe, JH 2016, ‘Patient-centered methadone treatment: a randomized clinical trial’, Addiction, online ahead of print.
 
Comment: In the article the authors expressed their surprise at these findings; they were certainly unexpected. High threshold methadone treatment programs with mandated counselling is not supported by these findings. The authors discuss some of the possible reasons for the absence of significant differences between the patient-centred approach and treatment-as-usual, suggesting that a number of system-wide contextual factors may have been responsible. Of course, a single study conducted in a particular context is not sufficient to conclude that a patient-centred approach cannot be helpful in a different context.
 

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How does the mortality risk of opioid substitution therapy with methadone compare with buprenorphine?

A retrospective cohort study of all patients with opioid dependency in NSW, who started a methadone or buprenorphine treatment episode from August 1, 2001, to December 31, 2010, compared crude mortality rates for all-cause and drug-related overdose mortality, and mortality rate ratios, according to age, sex, period in or out of treatment, medication type, and in-treatment switching. The researchers identified ‘…strong evidence that the risk of drug related overdose during the first 4 weeks of treatment induction and stabilisation is almost five times higher, and all-cause mortality double, for patients inducted on to methadone than for those inducted on to buprenorphine. By contrast, if a patient switched to methadone after already having been stabilised on buprenorphine, there was no such comparative elevation in risk. These patients also had a reduced rate of mortality compared with those inducted on to a methadone-only treatment episode. The evidence for a differential risk between methadone and buprenorphine in overdose or all-cause mortality at other periods during and after treatment is less compelling or consistent’.

They commented that ‘Clinicians providing opioid substitution treatment face an important dilemma: which is more likely to reduce patient risk, buprenorphine or methadone? Buprenorphine is argued to have a superior safety profile to methadone but also has a higher dropout rate. Our data suggest that induction of patients on to buprenorphine has clear benefits in settings in which risk of death is elevated in the first 4 weeks of treatment, such as Australia and the UK, but thereafter little evidence exists for any difference in mortality risk or dangers in switching opioid substitution therapy. This finding has direct clinical relevance to clinicians, patients, and policy makers worldwide’.
 
Kimber, J, Larney, S, Hickman, M, Randall, D & Degenhardt, L 2016, ‘Mortality risk of opioid substitution therapy with methadone versus buprenorphine: a retrospective cohort study’, The Lancet Psychiatry, vol. 2, no. 10, pp. 901-8.

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How effective would ultra-brief interventions implemented in the hospital emergency department be in reducing alcohol-related harm and risky drinking?

Australian researchers assessed the effectiveness of ultra-brief interventions (ultra-BI) or technology-involved preventive measures in the ED to reduce alcohol harm and risky drinking by means of a systematic review of the literature. They reviewed randomised controlled trials and quasi-randomised trials which compared an ultra-BI with screening, standard care or minimal intervention for adults and adolescents at risk for alcohol-related harm presenting to a hospital ED. ‘For the purpose of this review, an ultra-BI was deļ¬ned as any face-to-face interaction of 10 min or less or any non face-to-face intervention involving technology.’ Outcomes of interest were frequency of alcohol consumption, quantity of alcohol consumed, binge drinking and ED re-presentation. Of the thirteen studies included, six ‘…showed a significant reduction in the quantity consumed with intermediate effect size at 3 months…and small effect size at 12 months…Two studies showed a significant reduction in binge drinking with small effect size at 3 months…and 12 months…No studies showed an effect on frequency of alcohol consumption or ED representation (sic)’. They concluded ‘The use of an ultra-BI in the ED has some effectiveness in reducing alcohol use in the short-term. Given the small number and moderate quality of these studies, further research is warranted. With the large number of people attending EDs with risky drinking, finding an effective ultra-BI would have the potential to have a measurable population effect. Providing clinicians with a simple standardised screening and ultra-BI tool is likely to be of benefit to some of these patients’.
 
McGinnes, RA, Hutton, JE, Weiland, TJ, Fatovich, DM & Egerton-Warburton, D 2016, ‘Effectiveness of ultra-brief interventions in the emergency department to reduce alcohol consumption: a systematic review’, Emergency Medicine Australasia, online ahead of print.

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How prevalent are alcohol use disorders in the criminal justice system and what evidence is available about the effectiveness of brief interventions in that setting?

A group of researchers in the UK reviewed the evidence about alcohol use disorders within the different stages of the criminal justice system in the UK, and the worldwide evidence of alcohol brief interventions in the various stages of the criminal justice system. They found ‘…that 64-88 per cent of adults in the police custody setting; 95 per cent in the magistrate court setting; 53-69 per cent in the probation setting and 34-86 per cent in the prison system and 64 per cent of young people in the criminal justice system in the UK scored positive for an alcohol use disorder. There is very little evidence of effectiveness of brief interventions in the various stages of the criminal justice system mainly due to the lack of follow-up data’. They commented: ‘Brief alcohol interventions have a large and robust evidence base for reducing alcohol use in risky drinkers, particularly in primary care settings. However, there is little evidence of effect upon drinking levels in criminal justice settings. Whilst the approach shows promise with some effects being shown on alcohol-related harm as well as with young people in the USA, more robust research is needed to ascertain effectiveness of alcohol brief interventions in this setting’.
 
Newbury-Birch, D, McGovern, R, Birch, J, O’Neill, G, Kaner, H, Sondhi, A & Lynch, K 2016, ‘A rapid systematic review of what we know about alcohol use disorders and brief interventions in the criminal justice system’, International Journal of Prisoner Health, vol. 12, no. 1, pp. 57-70, open access http://www.emeraldinsight.com/doi/abs/10.1108/IJPH-08-2015-0024.

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What is known about strategies to encourage tobacco cessation among smokers with comorbid conditions?

Abstract

Smoking affects comorbid disease outcomes, and patients with comorbid conditions may have unique characteristics that are important to consider when treating tobacco use. However, addressing tobacco in patients being treated for comorbid conditions is not a consistent practice. Recognizing the need for a “call-to-action” to address tobacco use in people with comorbid conditions, the Tobacco Treatment Network within the Society for Research on Nicotine and Tobacco (SRNT) convened a Comorbidities Workgroup to explore the relationship between smoking and comorbid disease to identify common themes including: the harms associated with continued tobacco use, the frequency of comorbid disease and tobacco use, the potential effect of comorbid disease on the ability to quit tobacco use, the association between tobacco use and suboptimal disease-specific treatment response, and evidence regarding potential approaches to improve addressing tobacco use in patients with comorbid disease. Five candidate conditions (psychiatric, cancer, cardiovascular, pulmonary, and human immunodeficiency virus infected patients) were explored. Across comorbid conditions, smoking adversely affects treatment efficacy and promotes other adverse health conditions. People with comorbid conditions who smoke are motivated to quit and respond to evidence-based smoking cessation treatments. However, tobacco cessation is not regularly incorporated into the clinical care of many individuals with comorbidities. Optimal strategies for addressing tobacco use within each comorbid disease are also not well defined. Further work is needed to disseminate evidence-based care into clinical practice for smokers with comorbid disease and addiction research should consider comorbid conditions as an important construct to explore.

Implications: This article explores how physical and psychiatric conditions may interact in the treatment of tobacco dependence, and discusses the need for smoking cessation as a critical component of comorbid condition management. Five common comorbid domains—psychiatric, cancer, pulmonary, cardiovascular, and human immunodeficiency virus (HIV)—are highlighted to illustrate how these different conditions might interact with smoking with respect to prevalence and harm, motivation to quit, and cessation treatment utilization and success.
 
Rojewski, AM, Baldassarri, S, Cooperman, NA, Gritz, ER, Leone, FT, Piper, ME, Toll, BA & Warren, GW 2016, ‘Exploring issues of comorbid conditions in people who smoke’, Nicotine & Tobacco Research, vol. 18, no. 8, pp. 1684-96.

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What might be the effect of reducing the nicotine content of tobacco products?

Abstract

Large reductions in nicotine content could dramatically reduce reinforcement from and dependence on cigarettes. In this article, we summarise the potential benefits of reducing nicotine in combusted tobacco and address some of the common concerns. We focus specifically on New Zealand because it may be ideally situated to implement such a policy. The available data suggest that, in current smokers, very low nicotine content (VLNC) cigarettes decrease nicotine exposure, decrease cigarette dependence, reduce the number of cigarettes smoked per day and increase the likelihood of contemplating, making and succeeding at a quit attempt. New smokers would almost certainly be exposed to far less nicotine as a result of smoking VLNC cigarettes and, consequently, would probably be less likely to become chronic, dependent, smokers. Many of the concerns about reducing nicotine including compensatory smoking, an exacerbation of psychiatric symptoms, the perception that VLNC cigarettes are less harmful, and the potential for a black market are either not supported by the available data, likely mitigated by other factors including the availability of nicotine-containing e-cigarettes, or unlikely to offset the potential benefit to public health. Although not all concerns have been addressed or can be a priori, the magnitude of the potential benefits and the growing evidence of relatively few potential harms should make nicotine reduction one of the centrepieces for discussion of how to rapidly advance tobacco control. Policies that aim to render the most toxic tobacco products less addictive could help New Zealand attain their goal of becoming smokefree by 2025.
 
Donny, EC, Walker, N, Hatsukami, D & Bullen, C 2016, ‘Reducing the nicotine content of combusted tobacco products sold in New Zealand’, Tobacco Control, online ahead of print.
 
Comment: The University of Auckland, where Professor Bullen, one of the senior authors, is based, issued a media release which discusses this article: http://www.scoop.co.nz/stories/GE1610/S00138/low-nicotine-cigarettes-could-help-achieve-smokefree-goal.htm. The contents of this article are controversial owing to the opposition, in some quarters, to tobacco harm reduction. Being conscious of this, the authors have gone to some lengths to present what they see as the evidence underpinning their proposals. ATODA advocates for evidence-informed tobacco harm reduction interventions on the basis that, to maintain the current fall in population-wide smoking prevalence, and to better target sub-populations with high smoking prevalence, we need to scale-up the familiar, effective tobacco control approaches and carefully trial innovative approaches such as the one discussed here.

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What is known about the attitudes of mental health professionals to smoking bans within mental health facilities?

A survey of almost a hundred mental health professionals in Australia aimed to gather information on attitudes toward smoke-free policies in mental health/psychiatric units. The results indicated that ‘…only 25.5% agreed with a total smoking ban. Although supporting smoke-free initiatives within the wider community, participants commonly held attitudes that were unsupportive of smoking bans, and indicated beliefs inconsistent with a smoke-free policy for clinical populations’. The researchers stated that these results ‘…suggest the need for appropriate staff education and training regarding smoking behaviours and risks, and smoking cessation treatments for clinical populations if smoke-free policies are to be successfully implemented’.
 
Magor-Blatch, LE & Rugendyke, AR 2016, ‘Going smoke-free: attitudes of mental health professionals to policy change’, Journal of Psychiatric and Mental Health Nursing, vol. 23, no. 5, pp. 290-302.


Comment: Most ATOD services in the ACT have become either totally or mostly smoke-free over the past few years. The successful implementation of smoke-free services has been facilitated through project support provided to the ATOD sector to implement tobacco management policies, and programs that support these policies. The evaluation of the Workplace Tobacco Management Project found that while initial support for tobacco management policies was low, by the end of the project staff were supportive. When tobacco policy was framed as consistent with the service delivery philosophy of the ATOD sector, workers were more accepting of tobacco management policies. Furthermore, the implementation of tobacco management policies has been complemented and enhanced by a suite of smoking cessation activities, such as: formally incorporating tobacco into standard assessment and treatment protocols; providing free nicotine replacement therapy to ATOD workers and service users; and providing smoking cessation training to ATOD workers. Uptake of these complementary activities within ATOD services has been high suggesting solid support among ATOD workers for the need for smoking cessation supports and tobacco management policies within the treatment context.
 

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What has research shown about the global burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B?

Abstract

Background: Previous estimates of the burden of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. We aimed to provide these estimates as part of the Global Burden of Disease (GBD) Study 2013.

Methods: We modelled the burden of HBV and HCV (including cirrhosis and liver cancer burden) and HIV at the country, regional, and global level. We extracted United Nations data on the proportion of notified HIV cases by transmission route, and estimated the contribution of injecting drug use (IDU) to HBV and HCV disease burden by use of a cohort method that recalibrated individuals’ history of IDU, and accumulated risk of HBV and HCV due to IDU. We estimated data on current IDU from a meta-analysis of HBV and HCV incidence among injecting drug users and country-level data on the incidence of HBV and HCV between 1990 and 2013. We calculated estimates of burden of disease through years of life lost (YLL), years of life lived with disability (YLD), deaths, and disability-adjusted life-years (DALYs), with 95% uncertainty intervals (UIs) calculated for each metric.

Findings: In 2013, an estimated 10.08 million DALYs were attributable to previous exposure to HIV, HBV, and HCV via IDU, a four-times increase since 1990. In total in 2013, IDU was estimated to cause 4.0%...of DALYs due to HIV, 1.1%...of DALYs due to HBV, and 39.1%...of DALYs due to HCV. IDU-attributable HIV burden was highest in low-to-middle-income countries, and IDU-attributable HCV burden was highest in high-income countries.

Interpretation: IDU is a major contributor to the global burden of disease. Effective interventions to prevent and treat these important causes of health burden need to be scaled up.
 
Degenhardt, L, Charlson, F, Stanaway, J, Larney, S, Alexander, LT, Hickman, M, Cowie, B, Hall, WD, Strang, J, Whiteford, H & Vos, T 2016, ‘Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013’, The Lancet Infectious Diseases, online ahead of print, open access http://thelancet.com/journals/laninf/article/PIIS1473-3099(16)30325-5/fulltext.

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What has been the effect of the increased availability and use of crystal methamphetamine in Australia?

Abstract

Introduction and Aims: Concerns about crystal methamphetamine use and harm have increased in multiple countries. This paper describes how changes in the availability and use of crystal methamphetamine have impacted on methamphetamine-related harms in Australia.

Design and Methods: Data on methamphetamine use were obtained from population-level surveys, health service data and surveys of drug use among sentinel groups of ecstasy users and people who inject drugs. Data were obtained on seizures, arrests, clandestine laboratory detections, hospital separations, mental health unit admissions, drug telephone helpline calls and drug treatment episodes. Segmented linear regression models were fitted to identify changes in these series using log-transformed data where appropriate.

Results: The availability of crystal methamphetamine has increased as evidenced by increased laboratory detections, domestic seizures and purity of the seized drug. Population surveys do not report an increase in the number of people who used at least once in the past year. However, more users report using crystal methamphetamine rather than lower-purity powder methamphetamine and more regular use. Indicators of methamphetamine-related harms have increased in parallel with this change. Amphetamine-related helpline calls, drug treatment, arrests and hospital admissions for amphetamine disorders and psychosis all peaked in the mid-2000s, declined for several years and have increased steeply since 2010.

Discussion and Conclusions: The increased availability and use of crystal methamphetamine have been associated with increased regular use and harms. Treatment is required for those experiencing problems and the capacity of health services to provide care needs to be enhanced.
 
Degenhardt, L, Sara, G, McKetin, R, Roxburgh, A, Dobbins, T, Farrell, M, Burns, L & Hall, WD 2016, ‘Crystalline methamphetamine use and methamphetamine-related harms in Australia’, Drug and Alcohol Review, online ahead of print.

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Where are Australians who drink alcohol more likely to consume it?

A study using data from the Australian arm of the International Alcohol Control study examined where Australians in different demographic groups and drinker categories consume their alcohol. Almost two thousand respondents who reported consuming alcohol in the past six months were asked detailed questions about the location of their alcohol consumption and how much alcohol they consumed at each place. The researchers found that ‘Sixty-three percent of all alcohol consumption reported by respondents was consumed in the drinker’s own home, with much less consumed at pubs, bars, and nightclubs (12%). This is driven primarily by the number of people who drink in the home and the frequency of these events, with the amount consumed per occasion at home no more than in other people’s homes or pubs, and significantly less than at special events. The average consumption on a usual occasion at each of these locations was more than five Australian standard drinks (above the Australian low-risk guideline for episodic drinking). Short-term risky drinkers had the highest proportion of consumption in pubs (19%), but they still consumed 41% of their units in their own home’. The researchers concluded that ‘The majority of alcohol consumed in Australia is consumed in the drinker’s own home. Efforts to reduce long-term harms from drinking need to address off-premise drinking and, in particular, drinking in the home’.
 
Callinan, S, Livingston, M, Room, R & Dietze, P 2016, ‘Drinking contexts and alcohol consumption: how much alcohol is consumed in different Australian locations?’, Journal of the Study of Alcohol and Drugs, vol. 77, no. 4, pp. 612-9.
 
Comment: ATODA has consistently advocated, to the ACT Government, for stronger interventions addressing take-away alcohol, i.e. sales from off-licence premises such as bottle shops and supermarkets. ATODA is particularly concerned at the too-ready availability of alcoholic beverages in ACT supermarkets, often placed near their entrances, owing to the normalising effects of this type of marketing. It flies in the face of the fact that alcohol is ‘No Ordinary Commodity’.

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What is the likelihood that supermarket advertising of alcohol at discounted prices could contribute to alcohol-related harms?

Researchers from Curtin University in Perth, Western Australia, examined the nature and variety of promotional methods used by Coles and Woolworths to promote alcoholic beverages in their weekly supermarket catalogues over a twelve-month period. They found that ‘Each store catalogue included, on average, 13 alcohol promotions/week, with price-based promotions most common. Forty-five percent of promotions required the purchase of multiple alcohol items. Wine was the most frequently promoted product (44%), followed by beer (24%) and spirits (18%). Most (99%) wine cask…promotions required multiple (two to three) casks to be purchased. The average number of standard drinks required to be purchased to participate in catalogue promotions was 31.7…The median price per standard drink was $1.49…Cask wines had the lowest cost per standard drink across all product types’. They concluded: ‘Supermarket catalogues’ emphasis on low prices/high volumes of alcohol reflects that retailers are taking advantage of limited restrictions on off-premise sales and promotion, which allow them to approach market competition in ways that may increase alcohol-related harms in consumers. Regulation of alcohol marketing should address retailer catalogue promotions’.
 
Johnston, R, Stafford, J, Pierce, H & Daube, M 2016, ‘Alcohol promotions in Australian supermarket catalogues’, Drug and Alcohol Review, online ahead of print.

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What does the term 'binge drinking' mean to various groups in the Australian community?

A team of researchers from the Centre for Health and Social Research at the Australian Catholic University conducted a survey of 221 adolescents, 104 parents of adolescents and 224 adult community members in two regional communities to assess thei perceptions of binge drinking. The most common definitions of binge drinking were ‘drinking “a lot in a short time” (27.7%), “to get drunk” (27.5%) or “in excess” (24.9%). Parents were more likely than the other two groups to describe binge drinking as drinking “more than recommended”; and none of the adolescents described it as drinking to the point of “experiencing side effects”’. The key findings of the study were that ‘The majority of respondents described binge drinking negatively and, in most cases, more negatively for adolescents than adults. However, both adult groups perceived binge drinking to be more enjoyable and pleasant for adolescents than for adults, and more enjoyable and pleasant than adolescents did themselves’. The researchers concluded that ‘There is a need for shared understanding of terms to ensure that educational interventions and communication campaigns are using the same definitions as their target audiences. There is also a need to ensure adults are not providing young people with mixed messages about excessive alcohol consumption’.
 
Jones, SC, Gordon, CS & Andrews, K 2016, ‘What is “binge drinking”? Perceptions of Australian adolescents and adults, and implications for mass media campaigns’, Australian and New Zealand Journal of Public Health, vol. 40, no. 5, pp. 487-9.

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How do buprenorphine and methadone prescribed to pregnant women with opioid use disorder compare with respect to safety in the mother, fetus and child?

This is a systematic review of the scientific literature on the topic published in the world’s leading AOD journal. The authors set out to assess the safety of buprenorphine compared with methadone to treat pregnant women with opioid use disorder. The review included literature published up to February 2015, focussing on randomised controlled trials (RCT) and observational cohort studies (OBS). The authors state that ‘We ascertained each study’s risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random-effects models for each outcome with two or more studies. Three RCTs (n = 223) and 15 cohort OBSs (n = 1923) met inclusion criteria. In meta-analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth…, greater birth weight…and larger head circumference…No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.’ These findings led the researchers to conclude that ‘Moderately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.’
 
Zedler, BK, Mann, AL, Kim, MM, Amick, HR, Joyce, AR, Murrelle, EL & Jones, HE 2016, ‘Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child’, Addiction, online ahead of print.

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New Reports

Australian Institute of Health & Welfare 2016, Mental health services in Australia, AIHW, http://mhsa.aihw.gov.au/home/ .
Mental health services in Australia provides a picture of the national response of the health and welfare service system to the mental health care needs of Australians.’ The mental health conditions covered include substance use disorders.
 
Australian Mines and Metals Association (AMMA) 2016, AMMA Drug and Alcohol Testing Survey 2016, AMMA, Melbourne, http://www.amma.org.au/.
‘During July and August 2016, AMMA conducted an anonymous survey of resource industry employers on drug and alcohol testing policies and procedures at their workplaces.’ The findings are presented here.
 
Bewley-Taylor, D & Schneider, C 2016, Can the Sustainable Development Goals help to improve international drug control?, GDPO Working Paper no. 2, Global Drug Policy Observatory (GDPO), Swansea University, Swansea, Wales, http://www.swansea.ac.uk/gdpo/gdpoworkingpaperseries/.
‘How can the outcomes of international drug control policy be measured? Currently, the UN drug control system lacks appropriate metrics to do so. However, the adoption of the Sustainable Development Goals (SDGs) offers a chance to find new – and potentially better – answers to this question.’
 
Cook, C, Phelan, M, Sander, G, Stone, K & Murphy, F 2016, The case for a harm reduction decade: progress, potential and paradigm shifts, Harm Reduction International, London, https://www.hri.global/harm-reduction-decade.
‘The study uses data we have collected over the last 10 years for our biennial Global State of Harm Reduction reports to assess progress and reflect on challenges faced around the world. Using mathematical modelling, it then outlines the potential impact of increased investment in harm reduction on avoidable health-related harms associated with injecting drug use over the next decade and beyond,’
 
European Monitoring Centre for Drugs and Drug Addiction 2016, How can contingency management support treatment for substance use disorders? A systematic review, Publications Office of the European Union, Luxembourg, http://emcdda.europa.eu/publications/papers/contingency-management-systematic-review.
‘Contingency management is a general behavioural intervention technique used in the treatment of drug dependence. This EMCDDA Paper contains a systematic review of studies on the effectiveness of contingency management when used alongside the pharmacological treatment of dependence. The 38 studies concerned related to people using various drugs, and were complemented by three economic studies. The analysis contained in the Paper concludes that contingency management is a feasible and promising adjunct to treatment for drug users.’
 
Goldsmid, S & Willis, M 2016, Methamphetamine use and acquisitive crime: evidence of a relationship Trends & Issues in Crime and Criminal Justice, no. 516, Australian Institute of Criminology, Canberra, http://aic.gov.au/publications/current%20series/tandi/501-520/tandi516.html.
‘This paper examines the engagement in acquisitive crime, and perceived motivations for methamphetamine-driven crime, of a sample of Australian police detainees recruited in 2013 through the Drug Use Monitoring in Australia program.’
 
Kara, H 2016, How to write a killer conference abstract: the first step towards an engaging presentation, London School of Economics and Political Science, http://blogs.lse.ac.uk/impactofsocialsciences/2015/01/27/how-to-write-a-killer-conference-abstract/?platform=hootsuite .
‘So, to summarise, to maximise your chances of success when submitting conference abstracts: Make your abstract fascinating, enticing, and different. Write your abstract well, using plain English wherever possible. Don’t write in the future tense if you can help it – and, if you must, specify clearly what you will do and when. Explain your research, and also give an explanation of what you intend to include in the presentation.’
 
Lensvelt, E, Gilmore, W, Gordon, E, Liang, W & Chikritzhs, T 2016, Trends in estimated alcohol-attributable assault hospitalisations in Australia 2003/04-2012/13, National Alcohol Indicators Project, Bulletin 15, National Drug Research Institute, Perth, WA, http://ndri.curtin.edu.au/research/naip.cfm .
‘In 2012/13 about 10,360 people aged 15+ years were admitted to hospital for alcohol-attributable assaults in Australia (rate 5.7 per 10,000 persons). The rate was highest among males aged 20-29 years old (15.0 per 10,000 persons)…By 2012/13 rates of male alcohol-attributable assaults across all age groups were either lower or similar to 2003/04 levels across all jurisdictions except the NT. The rate for females has slightly increased in some states over the 9 year period.’
 
Mao, L, Adam, P, Treloar, C & Wit, Jd (eds) 2016, HIV/AIDS, hepatitis and sexually transmissible infections in Australia: annual report of trends in behaviour 2016 (viral hepatitis supplement), Centre for Social Research in Health, UNSW, Sydney, https://csrh.arts.unsw.edu.au/research/publications/reports-trends-in-behavior/.
‘The Annual Report of Trends in Behaviour presents data from a selection of the behavioural and social research conducted by the Centre for Social Research in Health. The report focuses in particular on studies assessing trends over time or addressing emerging issues.’
 
Memedovic, S, Iversen, J & Maher, L 2016, Drug injection trends among participants in the Australian Needle and Syringe Program Survey, 2011-2015, IDRS Drug Trends Bulletin, October 2016 (Supplement), Kirby Institute, UNSW, Sydney, http://www.drugtrends.org.au/reports/2016-idrs-october-supplement-bulletin-1/.
‘Methamphetamine was the most commonly reported drug last injected nationally in 2015 and 2014, surpassing heroin, which was the most commonly injected drug in previous years (2011-2013). Over the period 2011 to 2015, prevalence of methamphetamine injection increased from 27% in 2011 to 36% in 2015. Reports of heroin injection were stable over the period 2011 to 2015, with approximately one third of respondents in each of the survey years reporting last injecting heroin.’
 
Office of National Drug Control Policy (USA) 2016, Draft: changing the language of addiction, Office of National Drug Control Policy, Washington, DC, https://www.whitehouse.gov/ondcp/changing-the-language-draft .
‘This document draws attention to terminology that may cause confusion or perpetuate stigma around substance use disorders.’ The terms highlighted are Substance Use Disorder, Person with a Substance Use Disorder, Person in Recovery and Medication Assisted Treatment.
 
Stafford, J, Burns, L & Breen, C 2016, Key findings from the 2016 IDRS: a survey of people who inject drugs, Drug Trends Bulletin, October 2016, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://www.drugtrends.org.au/reports/2016-idrs-october-bulletin/.
‘Heroin remained the most commonly reported drug of choice for participants (46%) followed by any methamphetamine (29%), with a significant increase in those specifically reporting crystal methamphetamine as their drug of choice (15% in 2015 to 21% 2016).
In 2016, similar proportions reported heroin (39%) and methamphetamine (40%) as the drug injected most in the last month. In particular there was a significant increase in crystal as the drug most often injected in the last month (28% in 2015 to 36% in 2016).’
 
Stafford, J, Sutherland, R, Burns, L & Breen, C 2016, The 2016 EDRS key findings: a survey of people who regularly use psychostimulant drugs, Drug Trends Bulletin, October 2016, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, http://www.drugtrends.org.au/reports/2016-edrs-october-bulletin/.
‘Ecstasy was the drug of choice nominated by over a third of the sample (36%) followed by cannabis(21%). The most popular form of ecstasy consumed regularly was pill(tablet) form. There remains an increasing trend in the use of MDMA crystal/ rock which is considered to be a more potent form of ecstasy. Over half(54%) of MDMA crystal/rock users reported it being of ‘high’ purity compared to 25% of those reporting pills, powder and caps as ‘high’.’
 
United Nations Office on Drugs and Crime & Ministry of Counter Narcotics, Islamic Republic of Afghanistan 2016, Afghanistan Opium Survey 2016, cultivation and production - Executive Summary, United Nations Office on Drugs and Crime & Ministry of Counter Narcotics, Islamic Republic of Afghanistan, Vienna, Kabul, https://www.unodc.org/unodc/en/crop-monitoring/index.html?tag=Afghanistan.
‘The area under opium poppy cultivation increased by 10% in 2016. Total eradication of opium poppy decreased by 91%. Potential opium yield and production increased in 2016.’
 
Winstock, AR, Barrett, M, Ferris, J & Maier, DL 2016, Global Drug Survey: 2016 findings, Global Drug Survey, London, https://www.globaldrugsurvey.com/wp-content/uploads/2016/06/TASTER-KEY-FINDINGS-FROM-GDS2016.pdf. ‘More people shopping on the dark net, more people using MDMA & experiencing harm, synthetic cannabinoids the most dangerous drugs in the world.’


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The Alcohol Tobacco and Other Drug Association ACT (ATODA) is the peak body representing the non-government and government alcohol, tobacco and other drug (ATOD) sector in the Australian Capital Territory (ACT). ATODA seeks to promote health through the prevention and reduction of the harms associated with ATOD. 

Views expressed in the ACT ATOD Sector eBulletin do not necessarily reflect the opinion of the Alcohol Tobacco and Other Drug Association ACT. Not all third-party events or information included in the eBulletin are endorsed by the ACT ATOD Sector or the Alcohol Tobacco and Other Drug Association ACT. No responsibility is accepted by the Alcohol Tobacco and Other Drug Association ACT or the editor for the accuracy of information contained in the eBulletin or the consequences of any person relying upon such information. To contact us please email ebulletin@atoda.org.au or call (02) 6255 4070.








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Alcohol Tobacco and Other Drug Association ACT · 11 Rutherford Crescent Ainslie · Canberra, ACT 2602 · Australia

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