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 December 2013 issue


ACT Research Spotlight

Canberra Collaboration Workshop Follow Up

Research Findings

New Reports

 

What benefits do young people feel they get from using drugs?

A recent article in The Conversation discusses the results of studies conducted in Melbourne, Sydney and the UK on drug use by teenagers. The findings of the Sydney study were that young people used drugs ‘to manage daily stress and to escape the difficulties of their day-to-day lives…as a mean to build or strengthen friendships or other relationships, to alleviate boredom and to have fun’. The two other studies had similar results. The reviewer concludes that ‘Young people who see their drug use as purposeful in this way will reject approaches for treatment or prevention that construct their drug use as compulsive and pathological, and themselves as somehow inadequate as a result’.
 
Bryant, J & MacLean, S 2013, What do young people gain from drug use?, The Conversation, 9 Nov 2013, http://theconversation.com/what-do-young-people-gain-from-drug-use-18878.
 
Comment: Various observers have pointed out that the mainstream drug and alcohol field, both in Australia and abroad, consistently fails to take account of the important place of pleasure in understanding the initiation and maintenance of the use of psychoactive substances. This discussion is a contribution to remedying that situation.

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What do injecting drug users think about the legal status of illicit drugs?
 
Researchers from the National Drug and Alcohol Research Centre interviewed three hundred injecting drug users (IDU) on their attitudes towards continued prohibition, decriminalisation or legalisation of the major illicit drugs. They found that ‘Methamphetamine was rated the most harmful of the five illicit substances and cannabis the lowest. By far the highest level of support for legislative change was for cannabis, with only 8.7% supporting continued prohibition. While there was majority support for change to the legal status of heroin, the modal position was for decriminalisation. Support for changing the status of the three illicit psychostimulants was low, with the majority believing that methamphetamine (63.3%), cocaine (53.3%) and [MDMA] (53.3%) should remain illegal’. The researchers pointed out that ‘IDUs expressed nuanced views on different substances’ and concluded that ‘In policy debates, care should be taken not to speak for IDUs by imputing their beliefs. It is clear that the fact that a group uses illegal drugs does not necessarily imply that they support changes to their legal status’.
 
Darke, S & Torok, M 2013, ‘Attitudes of regular injecting drug users towards the legal status of the major illicit drugs’, Drug and Alcohol Review, vol. 32, no. 5, pp. 483-8.
 
Comment: It is important that we, as a community and a sector, support and develop opportunities for people who use drugs to express their views and participate in policy processes. Specific and thoughtful efforts need to be made, particularly given the stigma and illegality of drug use.

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What does drug-related violence in Mexico have to do with us?

Abstract: ‘Up to 100,000 people died in drug-related violence in Mexico in the last 6 years. We might think this has nothing to do with us, but in fact we are all complicit, says Yale professor Rodrigo Canales in this unflinching talk that turns conventional wisdom about drug cartels on its head. The carnage is not about faceless, ignorant goons mindlessly killing each other but is rather the result of some seriously sophisticated brand management.’

‘Rodrigo Canales wants to understand how individuals influence organizations or systems--even those as complex as the Mexican drug cartels.’
 
Canales, R 2013, The deadly genius of drug cartels, http://www.ted.com/talks/rodrigo_canales_the_deadly_genius_of_drug_cartels.html .

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What impacts do government drug law enforcement systems have on the availability of illegal drugs?

A study of illegal drug supply indicators aimed to assess the long-term impact of enforcement-based supply reduction interventions. It examined European and US data from government surveillance systems assessing price, purity and/or seizure quantities of illegal drugs; systems with at least ten years of longitudinal data assessing price, purity/potency or seizure. The conclusions of the study were that ‘With few exceptions and despite increasing investments in enforcement-based supply reduction efforts aimed at disrupting global drug supply, illegal drug prices have generally decreased while drug purity has generally increased since 1990. These findings suggest that expanding efforts at controlling the global illegal drug market through law enforcement are failing...It is hoped that this study highlights the need to re-examine the effectiveness of national and international drug strategies that place a disproportionate emphasis on supply reduction at the expense of evidence-based prevention and treatment of problematic illegal drug use’.
 
Werb, D, Kerr, T, Nosyk, B, Strathdee, S, Montaner, J & Wood, E 2013, ‘The temporal relationship between drug supply indicators: an audit of international government surveillance systems’, BMJ Open, vol. 3, no. 9.
 
Comment: This is an important study as it has quantified prices and purity for a range of drugs, across the globe, using a fairly long time series. It provides firm underpinnings for the arguments of the drug law reform movement that too high a proportion of the drug budget goes to interdiction and law enforcement. It provides evidence supporting the argument that a higher proportion of resourcing should go to those treatment and harm reduction initiatives of demonstrated cost effectiveness rather than to less effective criminal justice system approaches.

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Will the closure of the Silk Road reduce the harms associated with illicit drugs?
 
A website known as the Silk Road, from which illicit drugs could be obtained, was recently closed down by the US Federal Bureau of Investigation. A recent article in The Conversation questions whether this closure will make the public safer from the harms caused by illicit drugs. ‘The thousands of sellers registered on Silk Road were each ranked according to user feedback, which came in the form of consumer comments and a rating out of five stars. Top vendors often provided additional information, such as detailed chemical analysis of their products. This allowed consumers an unprecedented level of choice and control over the potency of the drugs they wished to purchase.’ The writer concludes ‘Conventional drug distribution, characterised by violence and “dirty” products, seems a vastly poorer alternative to better understood illicit drugs arriving quietly and anonymously in the post. As with many of the so-called “victories” in the War on Drugs, the closure of Silk Road ultimately bears the hallmarks of short-sightedness and harm maximisation: one step forward, two steps back, and more blind progress on the road to nowhere.’
           
Martin, J 2013, Misguided optimism: the Silk Road closure and the War on Drugs, The Conversation, 7 October 2013, http://theconversation.com/misguided-optimism-the-silk-road-closure-and-the-war-on-drugs-18937
 
Comments: In early November the media was reporting that ‘Anonymous internet market for illegal goods reopens just four weeks after original site was shut by US authorities’.
http://www.aljazeera.com/news/americas/2013/11/silk-road-illicit-online-market-reopens-2013116191645668363.html

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What are the barriers to the legalisation of cannabis for non-medical use, and how could these barriers be overcome?

Writing in the journal Addiction, Professor Robin Room, Director of the Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, discusses the work currently underway in Uruguay, and in Colorado and Washington State in the USA, to design legal non-medical markets for cannabis. He points out that these initiatives contravene the 1961 and 1988 international drug conventions, and comments that ‘From a public health perspective, the emphasis should be on holding down consumption with regulatory measures, but the public health agenda does not seem to be a strong consideration in the implementation of the US schemes, and they are paying little attention to what can be learned from the history of alcohol and tobacco regulation’.
 
He explains that ‘if a country wishes to construct a legal domestic cannabis market, it has two choices which would stay within current international law. One is the path taken by Bolivia with respect to legalizing its domestic market in coca leaves: to denounce the relevant treaty or treaties, and re-accede with a reservation concerning cannabis… The other path is to legalize cannabis in its weaker forms. The “cannabis” which is controlled under the 1961 Convention is defined as “the flowering or fruiting tops of the cannabis plant (excluding the seeds and leaves when not accompanied by the tops) from which the resin has not been extracted, by whatever name they may be designated”... Parties to the treaty are thus not required to outlaw or criminalize cultivation, sale or use of cannabis leaves for whatever purpose’.
 
He concludes that ‘the legalisation initiatives underline the need to revise the drug conventions, making prohibition of domestic markets an optional matter. Such changes would also ease the path for including alcohol under the conventions, which would be an important step forward in global health’.
 
Room, R 2013, ‘Legalizing a market for cannabis for pleasure: Colorado, Washington, Uruguay and beyond’, Addiction, online ahead of print

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Is the retention rate of people in treatment for illicit opioid use higher for those receiving methadone or those receiving buprenorphine? 
 
Researchers based in the USA examined patient and medication characteristics associated with retention and continued illicit opioid use in methadone (MET) versus buprenorphine/naloxone (BUP) treatment for opioid dependence. Over a thousand opioid-dependent individuals participating in nine opioid treatment programs between 2006 and 2009 were randomised to receive open-label buprenorphine/naloxone or methadone for 24 weeks. 74% of participants receiving MET completed the treatment compared with 46% of those receiving BUP and ‘the rate among MET participants increased to 80% when the maximum MET dose reached or exceeded 60mg/day…Higher medication dose was related to lower opiate use, more so among BUP patients’. The researchers concluded ‘Provision of methadone appears to be associated with better retention in treatment for opioid dependence than buprenorphine, as does use of provision of higher doses of both medications. Provision of buprenorphine is associated with lower continued use of illicit opioids’.
 
Hser, Y-I, Saxon, AJ, Huang, D, Hasson, A, Thomas, C, Hillhouse, M, Jacobs, P, Teruya, C, McLaughlin, P, Wiest, K, Cohen, A & Ling, W 2013, ‘Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial’, Addiction, online ahead of print.

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How effective are existing pharmacotherapies for treating substance use disorders involving methamphetamine?
 
Abstract

Issues: Methamphetamine- or amphetamine-type stimulants are the second most frequently used illicit drug worldwide, second only to cannabis. Behavioural treatments are efficacious, but their impact is limited underscoring the need for other treatment options, notably, pharmacotherapy.

Approach: A review of randomised controlled trials of pharmacotherapies for methamphetamine- or amphetamine-type stimulants was performed using PubMed and Google Scholar databases. Evidence for efficacy of medications is reported.

Key findings: Clinical trials have yielded no broadly effective pharmacotherapy. Promising signals have been observed for methylphenidate, naltrexone, bupropion and mirtazapine in subgroups of patients in reducing stimulant use (e.g. patients with less severe dependence at baseline and men who have sex with men), though none has produced an unambiguous, replicable signal of efficacy.

Implications: Problems in Phase II trials, including high dropout rates, missing data and a lack of agreement on outcomes, complicate efforts to find a broadly effective pharmacotherapy for amphetamine-type stimulant disorders. Efforts to address these problems include calls for better validation of pharmacological target exposure, receptor binding and functional modulation. As well, there is a need for agreement in using findings from preclinical and early phases of the medication development process for selecting better pharmacotherapy candidates.

Conclusion: After over 20 years of efforts worldwide to develop a broadly effective medication for dependence on methamphetamine- or amphetamine-type stimulants, no candidate has emerged. This highlights the need for new compounds, consistent and stringent research methods, better integration between preclinical and clinical stages of medication development, and improved collaboration between government, industry and researchers.
 
Brensilver, M, Heinzerling, KG & Shoptaw, SJ 2013, ‘Pharmacotherapy of amphetamine-type stimulant dependence: an update’, Drug and Alcohol Review, vol. 32, no. 5, pp. 449-60.

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How significant a problem is workplace stress for Aboriginal and Torres Strait Islander drug and alcohol workers?

Researchers based at the National Centre for Education and Training on Addiction investigated the impact of work stress and burnout on Aboriginal and Torres Strait Islander alcohol and other drug workers. They found that areas of stress included ‘excessive workloads, extensive demands and expectations, workers’ proximity to communities, loss and grief issues, lack of recognition, inadequate rewards, stigma and racism, and Indigenous ways of working. Stressors were compounded by workers’ complex personal circumstances, profound levels of loss and grief, and lack of culturally safe working environments’. Their conclusion was that ‘Indigenous workers’ stress was exacerbated by close links and responsibilities to their communities and a “dual accountability”, being constantly on call, playing multiple roles, complex personal and professional lives, and needing to interact with multiple agencies. Many Aboriginal and Torres Strait Islander AOD workers had developed mechanisms to deal with work-related pressures and received valued support from their communities. The study identified the importance of workforce strategies to improve Aboriginal and Torres Strait Islander workers’ well-being and reduce stress, including: mutual support networks, training in assertiveness and boundary setting, workloads that take account of Indigenous ways of working, adequate remuneration, supervision and mentorship, and cultural sensitivity training for other workers’.
 
Roche, AM, Duraisingam, V, Trifonoff, A, Battams, S, Freeman, T, Tovell, A, Weetra, D & Bates, N 2013, ‘Sharing stories: Indigenous alcohol and other drug workers’ well-being, stress and burnout’, Drug and Alcohol Review, vol. 32, no. 5, pp. 527-35.
 
Comment: A workshop for ACT Aboriginal and Torres Strait Islander ATOD workers will be held during December 2013 to explore the workforce’s strengths, needs and opportunities and ideas for further development.

For further details please contact Carrie Fowlie on carrie@atoda.org.au

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What strategies are Americans recommending to prevent unintentional opioid overdose deaths, and in which settings should they be focused?

Abstract: Drug poisoning is the leading cause of death from injuries in the United States. In New York City (NYC), unintentional drug poisoning death is the third leading cause of premature death, and opioids are the most commonly occurring class of drugs. Opioid overdose prevention efforts aim to decrease the number of people at risk for overdose and to decrease fatality rates among those using opioids by improving overdose response. These strategies can be enhanced with a comprehensive understanding of the settings in which overdoses occur.

Methods: A cross-sectional analysis of unintentional opioid poisoning deaths in NYC from 2005 to 2010 (n = 2649). Bivariate and multivariate analyses were performed to identify factors associated with settings of fatal opioid overdose.

Results: Three-quarters of the sample overdosed in a home; one-tenth in an institution, and the remaining in a public indoor setting, the outdoors or another non-home setting. Factors associated with overdosing at home include female gender, college degree, residence in the borough of Staten Island, and combined use of opioid analgesics and benzodiazepines. Factors associated with overdosing outside of the home include ages 35–64, residence in Manhattan, and use of heroin.

Conclusion: The sample represents a near census of unintentional opioid overdose deaths in NYC during the study period, and allows for the identification of demographic and drug-using patterns by setting of overdose. Because most opioid overdoses occur inside the home, opioid overdose response programs can most efficiently address the epidemic by both reducing the risk of overdose in the home, and targeting those who may be in the home at the time of an overdose for overdose response training. Approaches include minimizing risk of misuse and diversion through safe storage and safe disposal programs, physician education on prescribing of opioid analgesics and benzodiazepines, prescription of take-home naloxone, and Good Samaritan laws.
 
Siegler, A, Tuazon, E, O’Brien, DB & Paone, D 2013, ‘Unintentional opioid overdose deaths in New York City, 2005–2010: a place-based approach to reduce risk’, International Journal of Drug Policy, online ahead of print.

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Are we justified in proceeding with programs using naloxone to reduce the incidence of opioid overdose fatalities?

Writing in The Conversation, Alex Wodak, Emeritus Consultant, St Vincent’s Hospital, Sydney expresses scepticism about the strength of evidence for the safety and efficacy of using naloxone to prevent opioid overdose deaths. He writes:

‘These days we need to ensure new policy and practice is based on strong evidence of effectiveness, safety and, preferably, cost effectiveness.

‘Too many past policies and practices were introduced because they “seemed like a good idea at the time”, but later turned out to be ineffective or unsafe. The problem is that, once introduced and found to not work or be harmful, these are often exceedingly difficult to get rid of.

‘The only evidence for naloxone distribution so far comes from observational studies, which are considered among the weakest form of research design. The abundance of such studies does not compensate for their inherent lack of rigour.

‘The biological action of the drug and the mechanism of heroin suggests it should be effective for reversing opioid overdoses. But that on its own doesn’t constitute evidence.

‘Even the fact that naloxone can be used effectively and safely by medical professionals doesn’t tell us whether it would be effective and safe in the very different sorts of conditions likely to prevail when people who inject drugs or their families and friends decide to use it.

‘The most exacting evaluation of medical interventions are considered to be randomised controlled clinical trials. In a trial like this for naloxone, half the subjects would be given the drug and compared with the other half, who would not. Such a trial is now underway in the United Kingdom where 10% of the subjects have already been recruited.

‘Some people argue we shouldn’t delay implementing naloxone until the results from this study become available because that will take some time and too many lives may be lost in the meantime.

‘But that assumes we already know that naloxone distribution is effective and safe.

‘…There are several current alternatives to naloxone distribution – expand and improve methadone and buprenorphine treatment (including reducing its cost to the patient), assess the data for naloxone distribution using the Bradford Hill [an English epidemiologist] criteria, wait for the results of the UK trial, or undertake an Australian randomised controlled trial.

‘The number of deaths from an overdose of heroin or other opioids in Australia is unacceptable. We need to make a sensible decision to prevent these deaths, but this decision should be based on evidence rather than just opinion.’
 
Wodak, A 2013, Should naloxone be used to reduce opioid overdoses?, The Conversation, 15 Nov 2013, http://theconversation.com/should-naloxone-be-used-to-reduce-opioid-overdoses-19896.
 
Comment: The author is a highly respected leader of the Australian and international harm reduction and drug law reform movements. With regard to incorporating take-home naloxone into opioid overdose fatalities prevention programs he is, however, out of step with mainstream thinking. AOD researchers, practitioners and policy workers have a broad consensus that the current evidence is strong enough to support take-home naloxone programs such as the I-ENAACT Program currently running in the ACT, see http://www.atoda.org.au/policy/naloxone/ . Contrary to Wodak’s assertion, randomised controlled trials are not necessarily the best way of researching complex social interventions such as overdose prevention programs.

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How likely is it that people who have misused prescription pain medication will move to injecting heroin?

Using data from the United States Substance Abuse and Mental Health Services Administration collected from 2002 to 2011 in the USA National Survey on Drug Use and Health, an annual anonymous survey of a nationally representative sample of 70 000 US individuals, ‘scientists found that the incidence of heroin use is 19 times higher among individuals who have abused prescription pain medications than among those who have not. Although the overall incidence of heroin use in the population is low, there was a substantial difference in heroin use rates between the groups, with 0.39% of those with a history of pain medication abuse reporting heroin use compared with 0.02% of those who reported that they had never used prescription opioid medications for nonmedical purposes.
‘A staggering 79.5% of the individuals who reported that they began using heroin in the past year had previously abused prescription pain medications. But only 3.6% of individuals who reported they recently began using pain medication for nonmedical purposes reported using heroin in the 5 years preceding their abuse of the prescription pain drug’.
It is reported that ‘The switch often comes when they are struggling with withdrawal and requiring higher doses to ease their symptoms and can no longer afford to purchase pain medications, which have a far higher price on the illegal drug market’.
 
Kuehn, BM 2013, ‘SAMHSA: Pain medication abuse a common path to heroin: experts say this pattern likely driving heroin resurgence’, JAMA, vol. 310, no. 14, pp. 1433-4.

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Has lobbying by the alcohol industry delayed the introduction of alcohol health warning labels in Australia?

Abstract

Aims: This paper examines the strategies and arguments used by segments of the alcohol industry to delay the introduction of mandatory health warning labels on alcohol containers in Australia. These strategies are compared with those used by the tobacco industry to delay the introduction of warning labels for cigarettes.

Methods: Submissions made by members of the alcohol industry to the Australian Government’s review of labelling and Parliamentary Inquiry into Fetal Alcohol Spectrum Disorders were analysed.

Results:  Segments of the alcohol industry have delayed the introduction of mandatory alcohol health warning labels in Australia by questioning the rationale and evidence base for labels; arguing that they will cause damage to public health and the economy; lobbying and seeking to influence government and political representatives including through monetary donations; and introducing its own voluntary labelling scheme. The arguments made by these organisations against the introduction of mandatory health warning labels for alcohol are flawed and their empirical basis is limited.

Conclusion: The Australian Government has delayed the introduction of mandatory alcohol health warning labels in Australia by 2 years, until at least December 2013. The campaigning of some parts of the alcohol industry appears to have been instrumental in this decision.’
 
Mathews, R, Thorn, M & Giorgi, C 2013, ‘Vested interests in addiction research and policy. Is the alcohol industry delaying government action on alcohol health warning labels in Australia?’, Addiction, vol. 108, no. 11, pp. 1889-96.

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What instruments are available and effective for assessing people’s substance misuse?

Abstract

Issues: Health-care systems globally are moving away from process measures of performance to payments for outcomes achieved. It follows that there is a need for a selection of proven quality tools that are suitable for undertaking comprehensive assessments and outcomes assessments. This review aimed to identify and evaluate existing comprehensive assessment packages. The work is part of a national program in the UK, Collaborations in Leadership of Applied Health Research and Care.

Approach: Systematic searches were carried out across major databases to identify instruments designed to assess substance misuse. For those instruments identified, searches were carried out using the Cochrane Library, Embase, Ovid MEDLINE((R)) and PsychINFO to identify articles reporting psychometric data.

Key findings: From 595 instruments, six met the inclusion criteria: Addiction Severity Index; Chemical Use, Abuse and Dependence Scale; Form 90; Maudsley Addiction Profile; Measurements in the Addictions for Triage and Evaluation; and Substance Abuse Outcomes Module. The most common reasons for exclusion were that instruments were: (i) designed for a specific substance (239); (ii) not designed for use in addiction settings (136); (iii) not providing comprehensive assessment (89); and (iv) not suitable as an outcome measure (20).

Implications: The six packages are very different and suited to different uses. No package had adequate evaluation of their properties and so the emphasis should be on refining a small number of tools with very general application rather than creating new ones. An alternative to using ‘off-the-shelf’ packages is to create bespoke packages from well-validated, single-construct scales.
 
Sweetman, J, Raistrick, D, Mdege, ND & Crosby, H 2013, ‘A systematic review of substance misuse assessment packages’, Drug and Alcohol Review, vol. 32, no. 4, pp. 347-55.
 
Comment: If stakeholders (particularly non-ATOD specialist services) are interested in utilising an ATOD screening tool, which can also be utlised as an outcome measure, the ACT e-ASSIST can be obtained by contacting ATODA The ACT e-ASSIST was developed through a partnership between Drug and Alcohol Services South Australia (DASSA) and ATODA and is an electronic version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), designed by the World Health Organization.

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Who won the 2013 Ig Nobel Psychology Prize?

The Ig Nobel Prizes are awarded annually. They ‘…honor achievements that first make people laugh, and then makes them think. The prizes are intended to celebrate the unusual, honor the imaginative-and spur people’s interest in science, medicine, and technology’ (http://www.improbable.com/ig/ ). It is not often that ATOD research is so ‘honoured’ but it was this year, with a study conducted by an international group of researchers winning the Ig Nobel Psychology Prize for confirming, by experiment, that people who think they are drunk also think that they are attractive!
 
‘This research examines the role of alcohol consumption on self-perceived attractiveness. Study 1, carried out in a barroom (N= 19), showed that the more alcoholic drinks customers consumed, the more attractive they thought they were. In Study 2, 94 non-student participants in a bogus taste-test study were given either an alcoholic beverage (target BAL [blood alcohol level] = 0.10 g/100 ml) or a non-alcoholic beverage, with half of each group believing they had consumed alcohol and half believing they had not (balanced placebo design). After consuming beverages, they delivered a speech and rated how attractive, bright, original, and funny they thought they were. The speeches were videotaped and rated by 22 independent judges. Results showed that participants who thought they had consumed alcohol gave themselves more positive self-evaluations. However, ratings from independent judges showed that this boost in self-evaluation was unrelated to actual performance.’
 
Bègue, L, Bushman, BJ, Zerhouni, O, Subra, B & Ourabah, M 2013, ‘“Beauty is in the eye of the beer holder”: people who think they are drunk also think they are attractive’, British Journal of Psychology, vol. 104, no. 2, pp. 225-34.

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New Reports

Australian Institute of Health & Welfare 2013, Smoking and quitting smoking among prisoners 2012, AIHW cat. no. AUS 176, Australian Institute of Health & Welfare, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129544877 .
 
Australian National Council on Drugs 2013, ANCD position paper: needle and syringe programs, October 2013, ANCD, Canberra.
 
Australian National Council on Drugs 2013, Alcohol Action Plan, Issues Paper, ANCD, Canberra, http://www.ancd.org.au/images/PDF/Generalreports/AlcoholActionPlan.pdf .
 
Australian National Preventive Health Agency 2013, Australia’s tobacco-related datasets, Australian National Preventive Health Agency, viewed 16 October 2013, http://anpha.gov.au/internet/anpha/publishing.nsf/Content/tobacco-datasets .
 
National Drug and Alcohol Research Centre 2013, Highs and lows of contemporary drugs in Australia: Emerging Psychoactive Substances, pharmaceutical opioids and other drugs, NDARC, http://ndarc.med.unsw.edu.au/event/2013-national-drug-trends-conference .
 
Roxburgh, A, Ritter, A, Slade, T & Burns, L 2013, Trends in drug use and related harms in Australia, 2001 to 2013, National Drug and Alcohol Research Centre, University of New South Wales, viewed 16 October 2013, http://ndarc.med.unsw.edu.au/resource/trends-drug-use-and-related-harms-australia-2001-2011-0 .
 
United Nations office on Drugs and Crime 2013, Afghanistan opium crop cultivation rises 36 per cent, production up 49 per cent, UNODC, http://www.unodc.org/unodc/en/frontpage/2013/November/afghanistan-opium-crop-cultivation-rises-a-record-36-per-cent-opium-production-up-49-per-cent.html?ref=fs1 .
 
United Nations Office on Drugs and Crime & World Health Organization 2013, Good governance for prison health in the 21st century. A policy brief on the organization of prison health, WHO, Copenhagen, http://www.euro.who.int/en/health-topics/health-determinants/prisons-and-health/publications/2013/good-governance-for-prison-health-in-the-21st-century.-a-policy-brief-on-the-organization-of-prison-health .

For information on other reports, please visit the ‘Did you see that report?’ page at the website of the National Drugs Sector Information Service.

 
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