ACT Research Spotlight


Release of the 2014-15 Illicit Drug Data Report: drug consumer arrests skyrocket in the ACT

The Australian Criminal Intelligence Commission (ACIC) recently released its Illicit Drug Data Report (IDDR) covering the year ending 30 June 2015. As their website explains, it ‘…informs Australia’s understanding of the illicit drug threat and focuses collective efforts by bringing together data from a wide range of sources into the one unique report. ‘In the 2014–15 financial year, Australian law enforcement agencies made a record 105,862 national illicit drug seizures, weighing a total of 23.5 tonnes, with a record 133,926 national illicit drug arrests. For the first time, the IDDR includes data from wastewater analysis, gathered through the chemical analysis of sewerage water. Data on methylamphetamine, MDMA and cocaine was collected, indicating methylamphetamine use in the community has been increasing since 2009–10. The data obtained from wastewater analysis will provide law enforcement, policy, regulatory and health agencies with additional and more objective data in relation to the usage of methylamphetamine and other drugs.’
 
With respect to the ACT, the report shows that, during that year, the ACT had 649 arrests for illicit drug offences, including 97 Simple Cannabis Offence Notices (SCONs). 74% of the arrests plus SCONs were classified as drug consumers and only 26% as drug providers. In contrast, nationally 84% were consumers. With regard to cannabis specifically, 81% of arrests plus SCONs were cannabis consumers, compared with 88% nationally. In the ACT that year there were 431 arrests plus SCONs for cannabis offences, 134 arrests for amphetamine-type stimulants, 27 for heroin and other opioids, 19 for cocaine, 21 for steroids, 3 for hallucinogens and 14 for ‘other and unknown’.
 
Comparing these figures with those from five years earlier (the 2009-10 year) we observe substantial increases in the number of arrests. The total number of arrests rose by 41%. Cannabis arrests plus SCONs rose by 36%, amphetamine-type stimulants (including methamphetamine) by 34%, cocaine by 137% and steroids by 600%. The number of arrests for heroin and other opioids fell by 10%.
 
Australian Criminal Intelligence Commission 2016, Illicit drug data report 2014-15, ACIC, Canberra, https://www.acic.gov.au/publications/intelligence-products/illicit-drug-data-report , large file warning: 17 MB.
 
Comment: ATODA remains deeply concerned at the sharp increase in the number of arrests for drug-related offences, particularly since the vast majority in the year reported upon—74%—were arrests for consumer-type offences rather than provider-type offences. These concerns underpin ATODA’s call, in its 2016 Election Priorities Statement, for the incoming ACT Government to slow or, preferably, reverse this trend of increasing arrests of drug consumers, and to divert resources into diversion of consumers from the criminal justice system including through extending the Simple Cannabis Offence Notice scheme to cover all illicit drugs, not just cannabis.

Index

Note: Many of the items referenced below are available from the library of the Australian Drug Foundation.

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Research Findings

What are the policy and practices of NSW drug treatment providers in responding to the possession of illicit substances on premises?

What is the current status of prison-based needle and syringe programs (PNSPs) globally?

How effective are brief alcohol intervention in prisons?

How effective are drug and alcohol consultation services in hospital emergency departments?

How significant is the recent reduction in school students’ consumption of alcohol? What measures could be adopted to increase this reduction?

How effective are changes to trading hours of liquor licences in reducing alcohol-related harm?

To what extent are licensed venue lockouts, as a measure to reduce crime and improve health, replicable in different settings?

To what extent do restrictive alcohol polices reduce the risk of suicide?

Does a relationship exist between teenagers’ exposure to alcohol consumption in movies and the likelihood that they will start to drink alcohol?

How much does brand-specific television advertising of alcohol affect teenagers’ consumption of alcohol?

Did the increase in the alcopops tax lead to a change in the incidence of alcohol-related injuries?

What is the direction of, and how strong is, the association between socioeconomic status and smoking prevalence?

To what extent does the co-use of cannabis and tobacco increase the risk to health?

How safe and effective is it to use nicotine replacement therapy long-term?

How effective is the use of e-cigarettes as an aid to smoking cessation?

Is there a relationship between medical marijuana laws and the level of consumption of opioids?

How useful is the theory of change approach in designing and evaluation public health interventions?

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What are the policy and practices of NSW drug treatment providers in responding to the possession of illicit substances on premises?

Robert Stirling from the NSW Network of Alcohol and other Drugs Agencies (NADA) and Carolyn Day from the University of Sydney Medical School explored a topic with which many in the drug treatment sector have struggled: responding to the possession of illicit substances on the premises of drug treatment services. They point out that this is complex because treatment service providers ‘…are challenged by balancing duty-of-care and staff safety while attempting to provide a therapeutic environment’. The study assessed the policy and practice of non-government drug treatment services in NSW in responding to possession of illicit substances on their premises. This was done by means of survey of NSW drug treatment services that aimed to elicit information about existing policy and practices, and how often it occurred. In all, 51 responses were received and included in the analysis, 29 (57%) of which reported having a policy and/or procedure. ‘There was no statistically discernible difference between inpatient and outpatient settings, accreditation status of services or availability of a sharps disposal unit on the premises. However, services that reported a possession incident in the previous 12 months were more likely to report having a written policy than those that did not…’ The authors concluded that ‘…policy and practice in [the services] vary greatly, with many services reporting no documented policy to guide staff. The findings suggest the need to develop organisational policy to support service providers in responding to possession of illicit substances on premises.’
 
Stirling, R & Day, C 2016, ‘The policy and practices of New South Wales drug treatment providers in responding to the possession of illicit substances on premises’, Drug and Alcohol Review, vol. 35, no. 5, pp. 644-9.
 

Comment: It is concerning to see the high proportion of treatment services that did not have formal, written policies and procedures relating to the possession of illicit drugs on the treatment premises. This raises issues including related to accreditation and governance.
 

What is the current status of prison-based needle and syringe programs (PNSPs) globally?

ABSTRACT

Aims: In most countries, the spread of HIV and hepatitis C in prisons is clearly driven by injecting drug use with many infected prisoners who are unaware of their infection status. Despite many studies confirming the facts about risk behaviour and the prison setting as a risk environment for maintaining or taking up of risk behaviour, little progress has been made around effective and efficient infectious prophylaxis by means of prison-based needle and syringe programs and associated education. The aim of this contribution is to study why effective and efficient prevention models applied in the community (like PNSP) are very rarely implemented in prison settings.

Findings: Only approximately 60 out of more than 10,000 prisons worldwide provide needle exchange in prisons. A United Nations Office on Drugs and Crime (UNODC) handbook on the implementation of prison-based needle exchange has been elaborated to better inform and guide officials in the Ministries of Justice, Health and people in charge of healthcare in prisons. It integrates the views and experiences of many experts throughout the world.

Conclusions: The key problem apart from political problems in implementing prison-based needle and syringe programmes (PNSP) remains the lack of guarantee of confidentiality to prisoners. This is hindering prisoners from participating in the programmes continuously. The second problem is that HIV/AIDS and opioid consumption are no longer the key drivers of the debate around drugs and infectious diseases in prisons, but instead new psychoactive substances (NPS) and steroids have become issues. In many countries, the HIV rate among drug using prisoners is lower compared 20 years ago (e.g. Western Europe). While hepatitis C is by far the most prevalent infectious disease, it has been neglected by policy makers. It has been difficult to develop momentum to legitimise concerted action to prevent the spread of infectious diseases. The handbook of the UNODC aims to serve as a basis for the implementation of PNSPs.
 
Stöver, H & Hariga, F 2016, ‘Prison-based needle and syringe programmes (PNSP) – still highly controversial after all these years’, Drugs: education, prevention and policy, vol. 23, no. 2, pp. 103-12.
 
Comment: This depressing overview is timely considering the 20 September 2016 announcement by the ACT Justice and Community Safety Directorate that the correction officers at the Alexander Maconochie Centre voted to reject an NSP in the prison (click here for further information). ATODA continues to be deeply concerned that decisions on the implementation of this health promotion initiative of demonstrated efficacy, one which has been shown to have few or no adverse consequences, are made by prison officers with no expertise in health promotion. In ATODA’s view, this constitutes a significant failure of the ACT Government to act on its duty of care towards the prisoners, the prison officers and the broader community. 

The UNODC handbook referred to is United Nations Office on Drugs and Crime 2014, A handbook for starting and managing needle and syringe programmes in prisons and other closed settings, UNODC, Vienna, https://www.unodc.org/unodc/en/hiv-aids/new/publications_prisons.html.
 

How effective are brief alcohol intervention in prisons?

ABSTRACT

Aims: There is evidence that alcohol is strongly correlated with offending. This qualitative study explored the views of staff on the efficacy of alcohol brief interventions within a prison setting. The perceptions of prisoners in relation to non-dependent drinking were also examined.

Methods: Nine prisons in one English region took part in this research. Five focus groups with 25 prisoners were undertaken with prisoners alongside focus group discussions with 30 professionals. Discussions were recorded using shorthand notation and the main themes were thematically mapped using visual mapping techniques.

Findings: The use of the Alcohol Use Disorder Identification Test (AUDIT) was perceived as problematic. Prisoner drinking norms differed widely from community consumption patterns. There were also operational issues that reduced the salience of a brief intervention for prisoners.

Conclusions: The delivery of screening and brief interventions within a prison setting is highly nuanced and fraught with inconsistencies. Despite these challenges, there are opportunities to develop coherent and tailored brief interventions for a custodial environment that should focus on developing three key areas around: (a) interventions for the point of release; (b) enhanced content around family impact and offending; and (c) forward-looking goal-setting as motivational tools to facilitate change.
 
Sondhi, A, Birch, J, Lynch, K, Holloway, A & Newbury-Birch, D 2016, ‘Exploration of delivering brief interventions in a prison setting: a qualitative study in one English region’, Drugs: education, prevention and policy, online ahead of print.

How effective are drug and alcohol consultation services in hospital emergency departments?

Hospital drug and alcohol consultation liaison (CL) services are specialist drug and alcohol services operating in hospital settings. A recent study showed that more than one-third (35%) of people presenting to NSW hospitals have a drug and alcohol problem and need some degree of intervention. (Butler, K et al. 2016, ‘The hidden costs of drug and alcohol use in hospital emergency departments’, Drug and Alcohol Review, vol. 35, no. 3, pp. 359-66.) A recent evaluation of the CL services demonstrated that specialist drug and alcohol services operating in hospital settings ‘…are low-cost interventions that produce cost savings to hospitals, through a reduction in future presentations’. However ‘There is unmet need for drug and alcohol CL services, as only one-quarter of people requiring intensive intervention are currently referred to and treated by CL services’ and ‘expanding CL services to fill current unmet need could deliver a range of benefits to patients and hospitals’.
 
Butler, K, Reeve, R, Viney, R & Burns, L 2016, ‘Estimating prevalence of drug and alcohol presentations to hospital emergency departments in NSW, Australia: impact of hospital consultation liaison services’, Public Health Research & Practice, vol. 26, no. 4, pp. e2641642, open access http://www.phrp.com.au/issues/september-2016-volume-26-issue-4/estimating-prevalence-of-drug-and-alcohol-presentations-to-hospital-emergency-departments-in-nsw-australia-impact-of-hospital-consultation-liaison-services/


How significant is the recent reduction in school students’ consumption of alcohol? What measures could be adopted to increase this reduction?

The New South Wales School Students Health Behaviours Survey (2014) found that ‘a substantial reduction in students aged 12–17 years reporting that they had ever consumed alcohol, from 82.7% in 2005 to 65.1% in 2014’. This paper points out that ‘Similar downward trends are reported nationally and internationally. Although overall consumption is declining, national recommendations maintain that it is safest for young people to not drink at all; however, 17% of all young people in Australia consumed alcohol in the past 7 days, with 6% consuming at a significant risk of harm. The factors that influence young people’s uptake of alcohol are complex, including biological and broader social factors’. The researchers identified ‘some of the diverse influences on young people’s alcohol consumption, and policies and programs that support healthy behaviours’. These include taxation, restrictions on the availability of alcohol, liquor accords, identity scanners and the responsible service of alcohol, ‘although the evidence supporting [some of] these measures is not strong’. The paper points out that ‘The NSW Ministry of Health will comprehensively outline its emerging priorities to address alcohol and other drug use in young people in the Alcohol & Other Drug Strategic Plan 2016–2021, which is expected to be released in late 2016. The plan will outline actions for:

•     Keeping people healthy and out of hospital
•     Providing high-quality treatment and integrated clinical care
•     Building the capacity of the system and prevention.’

 
Moore, R, Whitlam, G, Harrold, T & Lewis, N 2016, ‘The drinking habits of youth in NSW, Australia: latest data and influencing factors’, Public Health Research & Practice, vol. 26, no. 4, pp. e2641641, open access http://www.phrp.com.au/issues/september-2016-volume-26-issue-4/the-drinking-habits-of-nsw-youth-latest-data-and-influencing-factors.


How effective are changes to trading hours of liquor licences in reducing alcohol-related harm?

A systematic review of the literature on the impact of policies that extended or restricted trading hours published between January 2005 and December 2015 found that ‘The literature provides broadly consistent evidence that reducing the permissible trading hours of late-night venues is an effective way to reduce alcohol-related harm (particularly violence)’. The researchers concluded that ‘A series of robust, well-designed studies from Australia demonstrate that reducing the hours during which on-premise (sic) alcohol outlets can sell alcohol late at night can substantially reduce rates of violence. Increasing trading hours tends to result in higher rates of harm, while restricting trading hours tends to reduce harm. The Australian studies are supported by research from Norway, Canada and the US, with the only exception being somewhat inconsistent findings from a relaxation of restrictions in England and Wales. The evidence of effectiveness is strong enough to consider restrictions on late-trading hours for bars and pubs as a key approach to reducing late-night violence in Australia’.
 
Wilkinson, C, Livingston, M & Room, R 2016, ‘Impacts of changes to trading hours of liquor licences on alcohol-related harm: a systematic review 2005–2015’, Public Health Research & Practice, vol. 26, no. 4, pp. e2641644, open access http://www.phrp.com.au/issues/september-2016-volume-26-issue-4/impacts-of-changes-to-trading-hours-of-liquor-licenses-on-alcohol-related-harm-a-systematic-review-2005-2015/
 
Comment: ATODA noted with concern the statement, by the ACT Government in the early stage of the 2016 election campaign, that it is has "ruled out making changes to last drinks or closing times - now and in the future". We hope that the incoming government will look closely at the research evidence for this harm-reduction intervention and return to its earlier approach of basing alcohol policy on sound evidence, rather than on popularism


To what extent are licensed venue lockouts, as a measure to reduce crime and improve health, replicable in different settings?

Under a lockout pilot in Surfers Paradise, patrons could not enter or re-enter licensed venues after 3 am, while patrons inside at this time could stay until the venue closed. An evaluation of the pilot used police and ambulance data to examine the impact of tourism seasons and the lockout on rates of crime, violence, injury and intoxication. Additional analyses were conducted to explore the spatial and temporal changes in crime over time. The study revealed that ‘Both police and ambulance data showed that the lockout introduction had no statistically significant impact on rates of crime, violence, head and neck injuries, and intoxication over the 2 years following lockout. Hot spot maps indicated limited spatial shift of crime within Surfers Paradise following the lockout introduction, with evidence of a temporary intensification of crime in already established hot spots. We found a moderate statistically significant change in the 24 h distribution of crime after the lockout implementation, suggesting temporal displacement of crime. Results support the small existing body of evidence on lockouts that indicates they are largely ineffective in reducing crime and injuries in entertainment districts’. The researchers concluded ‘As multi-pronged strategies that include a lockout gain in popularity, further investigation should focus on identifying the key drivers of successful interventions such as the Newcastle strategy [follow-up evaluations of liquor licence reforms in Newcastle showed the reduced assault rate was sustained up to seven years], to better refine these interventions for replication and evaluation elsewhere’.
 
de Andrade, D, Homel, R & Townsley, M 2016, ‘Trouble in paradise: the crime and health outcomes of the Surfers Paradise licensed venue lockout’, Drug and Alcohol Review, vol. 35, no. 5, pp. 564-72.
 
Comment: This study adds to the body of evidence showing that lockouts, on their own, are not effective instruments for creating significant reductions in alcohol-related harms, including violence. In contrast, early closing, whether alone or in combination with lockouts, have great promise. ATODA advocates for further restrictions in alcohol trading hours for both on-licence and off-licence traders.

To what extent do restrictive alcohol polices reduce the risk of suicide?

A review of the international literature on the relationship between alcohol policies and suicide between 1999 and 2014 found that, ‘Although inconsistency remained, the published literature in general supported the protective effect of restrictive alcohol policies on reducing suicide as well as the decreased level of alcohol involvement among suicide decedents…This review summarizes a number of studies that suggest restrictive alcohol policies may contribute to suicide prevention on a general population level and to a reduction of alcohol involvement among suicide deaths’. The researchers concluded that, ‘By making alcohol less available, it is possible to reduce the average risk of suicide especially those where alcohol is involved’.
 
Xuan, Z, Naimi, TS, Kaplan, MS, Bagge, CL, Few, LR, Maisto, S, Saitz, R & Freeman, R 2016, ‘Alcohol policies and suicide: a review of the literature’, Alcoholism: Clinical and Experimental Research, online ahead of print.


Does a relationship exist between teenagers’ exposure to alcohol consumption in movies and the likelihood that they will start to drink alcohol?

ABSTRACT

Objectives: To investigate the hypothesis that exposure to alcohol consumption in movies affects the likelihood that low-risk adolescents will start to drink alcohol.

Methods: Longitudinal study of 2346 adolescent never drinkers who also reported at baseline intent to not to do so (sic) in the next 12 months (mean age 12.9 years, SD = 1.08). Recruitment was carried out in 2009 and 2010 in 112 state-funded schools in Germany, Iceland, Italy, Netherlands, Poland, and Scotland. Exposure to movie alcohol consumption was estimated from 250 top-grossing movies in each country in the years 2004 to 2009. Multilevel mixed-effects Poisson regressions assessed the relationship between baseline exposure to movie alcohol consumption and initiation of trying alcohol, and binge drinking (>/= 5 consecutive drinks) at follow-up.

Results: Overall, 40% of the sample initiated alcohol use and 6% initiated binge drinking by follow-up. Estimated mean exposure to movie alcohol consumption was 3653 (SD = 2448) occurrences. After age, gender, family affluence, school performance, TV screen time, personality characteristics, and drinking behavior of peers, parents, and siblings were controlled for, exposure to each additional 1000 movie alcohol occurrences was significantly associated with increased relative risk for trying alcohol, incidence rate ratio = 1.05 (95% confidence interval, 1.02-1.08; P = .003), and for binge drinking, incidence rate ratio = 1.13 (95% confidence interval, 1.06-1.20; P < .001).

Conclusions: Seeing alcohol depictions in movies is an independent predictor of drinking initiation, particularly for more risky patterns of drinking. This result was shown in a heterogeneous sample of European youths who had a low affinity for drinking alcohol at the time of exposure.
 
Hanewinkel, R, Sargent, JD, Hunt, K, Sweeting, H, Engels, RCME, Scholte, RHJ, Mathis, F, Florek, E & Morgenstern, M 2014, ‘Portrayal of alcohol consumption in movies and drinking initiation in low-risk adolescents’, Pediatrics, vol. 133, no. 6, pp. 973-82.


How much does brand-specific television advertising of alcohol affect teenagers’ consumption of alcohol?

Researchers in the USA investigated the relationship between the quantity of brand-specific alcohol advertising exposure by teenager drinkers and the quantity of brand-specific alcohol they consumed. The study used the Alcohol Brand Research Among Underage Drinkers US national sample of over one thousand people aged from 13 to 20, to examine ‘…the relationship between the teenagers’ aggregated past-year exposure to advertising…for 61 alcohol brands that advertised on the 20 most popular nonsports television programs viewed by underage youth and their aggregated total consumption of those same brands during the past 30 days’. The findings were that, ‘Among the sample of young drinkers, the median number of drinks consumed in the past 30 days was 5 drinks, with an interquartile range of 24 drinks. After weighting, the 61 brands advertised on those programs accounted for 46.9% of all alcohol consumption reported by the sample of underage drinkers’. The researchers concluded that, ‘Among underage youth, the quantity of brand-specific advertising exposure is positively associated with the total quantity of consumption of those advertised brands, even after controlling for the consumption of non-advertised brands’.
 
Naimi, TS, Ross, CS, Siegel, MB, DeJong, W & Jernigan, DH 2016, ‘Amount of televised alcohol advertising exposure and the quantity of alcohol consumed by youth’, J Stud Alcohol Drugs, vol. 77, no. 5, pp. 723-9.


Did the increase in the alcopops tax lead to a change in the incidence of alcohol-related injuries?

Researchers based at the National Drug Research Institute examined the impact of a tax increase on ready-to-drink beverages (the “alcopops” tax) on male injuries presenting to emergency departments in Western Australia and Victoria during times when the injuries were likely to be highly alcohol related. (Females’ presentations to the emergency departments were not included in the study as the method used—selecting high and low alcohol-related times and days as a surrogate or proxy for the incidence of alcohol-related injuries—has been validated in males but not in females.) They found that ‘Risk of injury during high alcohol-related times (incident rate ratio [IRR, a measure of probability of the event occurring]) was lower among Western Australian 12- to 15-year-olds beginning from the year of the tax increase and continued throughout. Lower IRRs were also apparent for 15- to 19-year-olds, although some delay was implicated. There was no change for 12- to 15-year-old Victorians, but immediate declines were evident for 15- to 19-year-olds. To a lesser extent, delayed effects were also indicated for 20- to 29-year-olds in both states. There was no evidence of a change in injury risk during high alcohol-related times among the oldest age group (35–39 years)’. They concluded that ‘Previous research on beverage-specific taxes has suggested that they may increase alcohol-related harms among the target group. This study found no evidence of increased injury during high alcohol-related times associated with the alcopops tax in two states. Evidence of reduced harm was apparent, however, and strongest for Western Australian males aged 19 years and younger. These outcomes are consistent with documented national reductions in alcopops sales’.
 
Lensvelt, E, Liang, W, Gilmore, W, Gordon, E, Hobday, M & Chikritzhs, T 2016, ‘Effect of the Australian “Alcopops Tax” on alcohol-related emergency department presentations for injury in two states’, Journal of Studies on Alcohol and Drugs, vol. 77, no. 5, pp. 730-9.


What is the direction of, and how strong is, the association between socioeconomic status and smoking prevalence?

Researchers based in South America undertook a systematic review and meta-analysis of the association between low socioeconomic status and higher smoking prevalence. The objective was to assess the strength of this association in the global population. Their main finding was ‘…a robust association between higher prevalence of cigarette smoking and lower income levels. This finding was consistent for most geographical regions, and especially evident for countries with low mortality according to the WHO classification. ‘The association was also clear among adults and for both genders. A clear gradient of smoking prevalence across income strata was also found. When reviewing studies by decade, only those performed since 1990 showed a strong association. The inverse association among smoking and income level was observed in studies of adults and elderly subjects; however, this was not the case for studies assessing subjects younger than 15 years old. ‘Regarding continents, the association was statistically significant for North and South America, Europe and Asia; however, there was no significant association for Oceania…In this region most of the studies came from Australia and New Zealand, both of which having low smoking prevalence. One plausible explanation is that these countries were the first to implement effective and equity-promoting tobacco control measures. Innovative tobacco control measures as plain packaging have been recently introduced in the region and their effectiveness is an interesting subject for future research’. They commented on the implications of the research: ‘This unique updated systematic review shows a consistent inverse dose-response relationship between cigarette smoking and income level, present among most geographical areas and country characteristics. Public health measures should take into account this potential inequity and consider special efforts directed to disadvantaged populations’.
 
Casetta, B, Videla, AJ, Bardach, A, Morello, P, Soto, N, Lee, K, Camacho, PA, Hermoza Moquillaza, RV & Ciapponi, A 2016, ‘Association between cigarette smoking prevalence and income level: a systematic review and meta-analysis’, Nicotine & Tobacco Research, online ahead of print.
 
Comment: ATODA continues to be concerned about the equity aspects of current tobacco control programs and policies owing to their potential to provide greater benefits to the more well-off people in our community than to the most disadvantaged. For this reason, we support smoking cessation and tobacco control policies that target specific disadvantaged, high smoking prevalence, population groups, including people experiencing alcohol and other drug use disorders, prisoners and people experiencing mental illness.

To what extent does the co-use of cannabis and tobacco increase the risk to health?

A literature review of the toxicant exposure associated with co-use of cannabis and tobacco, included co-use via electronic nicotine delivery systems (ENDS/e-cigarettes), found that ‘Co-use may pose additive risk for toxicant exposure as certain co-users (e.g., blunt users) tend to have higher breath carbon monoxide levels and cannabis smoke can have higher levels of some carcinogens than tobacco smoke. Cannabis use via ENDS is low and occurs primarily among established tobacco or cannabis users, but its incidence may be increasing and expanding to tobacco/cannabis naïve individuals. There are several methodological issues across co-use research including varying definitions of co-use, sample sizes, lack of control for important covariates (e.g., time since last cigarette), and inconsistent measurement of outcome variables’. The researchers concluded that ‘There are some known additive risks for toxicant exposure as a result of co-use. Research utilizing consistent methodologies is needed to further establish the additive risk of co-use. Future research should also be aware of novel technologies (e.g., ENDS) as they likely alter some toxicant exposure when used alone and with cannabis.
 
Meier, E & Hatsukami, DK 2016, ‘A review of the additive health risk of cannabis and tobacco co-use’, Drug & Alcohol Dependence, vol. 166, pp. 6-12.

How safe and effective is it to use nicotine replacement therapy long-term?

A study of the prevalence and impact of long-term use of nicotine replacement therapy (NRT) in UK Stop-Smoking Services (SSS) followed up SSS clients abstinent four weeks post-quit date and at twelve months. The study found that, ‘Among those who had used NRT during their initial quit attempt…6.0% …were still using NRT at one year, significantly more ex-smokers than relapsed smokers’. The researchers concluded that ‘Long-term NRT use is uncommon in SSS clients, particularly among relapsed smokers. Its use is associated with continued high intake of nicotine among ex-smokers but does not increase nicotine intake in smokers. It does not appear to affect stress response’. They drew attention to the implications of these findings: ‘Little is known about the long-term effects of Nicotine Replacement Therapy…Given an increasing shift towards harm reduction in tobacco control, reducing the harm from combustible products by complete or partial substitution with non-combustible products, more data on long-term use are needed. This study shows that in the context of stop smoking services, clients rarely use products for up to a year and that NRT use does not affect users’ stress response. Ex-smokers using NRT long-term can completely replace nicotine from cigarettes with nicotine from NRT; long-term NRT use by continuing smokers does not increase nicotine intake. Long-term NRT appears to be a safe and effective way to reduce exposure to combustible nicotine’.
 
Shahab, L, Dobbie, F, Hiscock, R, McNeill, A & Bauld, L 2016, ‘Prevalence and impact of long-term use of nicotine replacement therapy in UK Stop-Smoking Services: findings from the ELONS study’, Nicotine & Tobacco Research, online ahead of print.
 
Comment: ATODA has expressed concern, in the past, that Australian Therapeutic Goods regulations require NRT to be used for short-term smoking cessation attempts only, not for longer-term maintenance of non-smoking status. We believe that this should be reconsidered in light of the research evidence about the effectiveness of tobacco harm reduction strategies, and the apparent minimal adverse health consequences of long-term nicotine consumption.

How effective is the use of e-cigarettes as an aid to smoking cessation?

A longitudinal study of over 2,000 US smokers examined the relationship between long-term use of e-cigarettes and smoking cessation. At the two-year follow-up point, ‘43.7% of baseline dual users [people consuming both tobacco cigarettes and e-cigarettes] were still using e-cigarettes. Long-term e-cigarette users had a higher quit attempt rate than short-term or non-users…and a higher cessation rate…The difference in cessation rate between long-term users and non-users remained significant after adjusting for baseline variables…as did the difference between long-term users and short-term users…The difference in cessation rate between short-term users and non-users was not significant…Among those making a quit attempt, use of e-cigarettes as a cessation aid surpassed that of FDA-approved pharmacotherapy.’ The researchers concluded that ‘Short-term e-cigarette use was not associated with a lower rate of smoking cessation. Long-term use of e-cigarettes was associated with a higher rate of quitting smoking’.
 
Zhuang, Y-L, Cummins, SE, Y Sun, J & Zhu, S-H 2016, ‘Long-term e-cigarette use and smoking cessation: a longitudinal study with US population’, Tobacco Control, vol. 25, no. Suppl 1, pp. i90-i5, open access http://tobaccocontrol.bmj.com/content/25/Suppl_1/i90.full .

Is there a relationship between medical marijuana laws and the level of consumption of opioids?

A study conducted in the USA, where 25 states plus DC have legalised medical marijuana programs, assessed the association between the presence of medical marijuana laws (MMLs) and the likelihood of a positive opioid test, an indicator for prior use of an opioid. The researchers analysed the 1999-2013 road traffic Fatality Analysis Reporting System data from 18 states that tested for alcohol and other drugs in at least 80% of drivers who died within one hour of crashing. Within-state and between-state comparisons assessed opioid positivity among drivers crashing in states with an operational MML (i.e., allowances for home cultivation or active dispensaries) versus drivers crashing in states before a future MML was operational. They found ‘Among our sample of 68 394 deceased drivers, approximately 41.8% were fatally injured in states that had an operational MML, 25.4% died in states before an operational law went into effect, and 32.8% died in states that had never passed an MML. The mean age of all deceased drivers was approximately 41 years, and most (> 75%) were male. There was also a relatively stable level of alcohol involvement across MML status…Our findings among those aged 21 to 40 years are consistent with previous findings that MMLs are associated with a 25% reduction in the annual rate of opioid overdose and that states permitting medical marijuana dispensaries experience a slight decrease in opioid treatment admissions and in opioid overdose mortality’. They concluded that, ‘Because of the uniqueness of our sample, it is worth noting again that our outcome is opioid positivity (i.e., prior opioid use), which is not necessarily indicative of driving impairment. This study was not designed to assess whether opioids increase crash risk. Instead, we assessed whether, among comparable samples, implementing an operational MML was associated with reductions in opioid positivity. Although previous studies have suggested that MMLs are associated with decreased opioid overdose mortality rates at the state level, our study suggests 1 plausible mechanism underlying this association: in states with MMLs, fewer individuals are using opioids. If these laws are actually causing reductions in opioid use—an explanation consistent with our results—then the hypothesis that MMLs reduce opioid-related overdoses and treatment admissions is more plausible’.
 
Kim, JH, Santaella-Tenorio, J, Mauro, C, Wrobel, J, Cerdà, M, Keyes, KM, Hasin, D, Martins, SS & Li, G 2016, 'State medical marijuana laws and the prevalence of opioids detected among fatally injured drivers', American Journal of Public Health, vol. 106, no. 11, pp. 2032-7, open access http://ajph.aphapublications.org/doi/full/10.105/AJPH.16.303426.


How useful is the theory of change approach in designing and evaluating public health interventions?

ABSTRACT

Background: Despite the increasing popularity of the theory of change (ToC) approach, little is known about the extent to which ToC has been used in the design and evaluation of public health interventions. This review aims to determine how ToCs have been developed and used in the development and evaluation of public health interventions globally.

Methods: We searched for papers reporting the use of ‘theory of change’ in the development or evaluation of public health interventions in databases of peer-reviewed journal articles such as Scopus, Pubmed, PsychInfo, grey literature databases, Google and websites of development funders. We included papers of any date, language or study design. Both abstracts and full text papers were double screened. Data were extracted and narratively and quantitatively summarised.

Results: A total of 62 papers were included in the review. Forty-nine (79 %) described the development of ToC, 18 (29 %) described the use of ToC in the development of the intervention and 49 (79 %) described the use of ToC in the evaluation of the intervention. Although a large number of papers were included in the review, their descriptions of the ToC development and use in intervention design and evaluation lacked detail.

Conclusions: The use of the ToC approach is widespread in the public health literature. Clear reporting of the ToC process and outputs is important to strengthen the body of literature on practical application of ToC in order to develop our understanding of the benefits and advantages of using ToC. We also propose a checklist for reporting on the use of ToC to ensure transparent reporting and recommend that our checklist is used and refined by authors reporting the ToC approach.
 
Breuer, E, Lee, L, De Silva, M & Lund, C 2016, ‘Using theory of change to design and evaluate public health interventions: a systematic review’, Implementation Science, vol. 11, p. 63.
 
Comment: This paper includes a valuable checklist of topics that can usefully be included in a ToC report, under the following headings:
1. Is the ToC approach defined?
2. Is the ToC development process described?
3. Is the resultant ToC (or a summary thereof) depicted in a diagrammatic form and does it include..?
4. Is the process of intervention development from the ToC described?
5. Is the way in which the ToC was used to develop and implement the evaluation described?
 
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New Reports

Australian Institute of Health & Welfare 2016, Tobacco indicators: measuring midpoint progress—reporting under the National Tobacco Strategy 2012–2018, Drug Statistics Series no. 30, cat. no. PHE 210, Australian Institute of Health & Welfare, Canberra, http://aihw.gov.au/publication-detail/?id=60129557116.
 
Australian Institute of Health & Welfare 2016, Trends in alcohol availability, use and treatment 2003-04 to 2014-15 Drug treatment Series no. 28, Cat. no. HSE 179, AIHW, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129557147 .
 
Lee, N & Newton, N 2016, ‘Ex-ice users lecturing school kids isn’t the answer to preventing drug use’, The Conversation, 09 September 2016, https://theconversation.com/ex-ice-users-lecturing-school-kids-isnt-the-answer-to-preventing-drug-use-64753 .
 
The Kirby Institute 2016, Hepatitis B and C in Australia Annual Surveillance Report Supplement 2016, The Kirby Institute, UNSW, Sydney, http://kirby.unsw.edu.au/news/australia-sees-groundbreaking-roll-out-hep-c-cure-enhanced-prevention-efforts-still-needed