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 AUGUST 2013 ISSUE 


ACT Research Spotlight

The Canberra Research Collaboration

Research Findings

New Reports
 

 

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Can drug testing actually encourage dangerous drug use?   

This study explored the impacts of the USA Government’s emergency scheduling of the synthetic cannabinoid K2 or ‘Spice’, taking into account the observation that ‘…the producers of these synthetic substances have altered their chemical compounds to remain legal and on the market. The investigators wanted to better understand the reasons people used these drugs and the possibility that USA drug policy may even encouraging their use. They surveyed 374 undergraduate students in a Southern California University and conducted 25 qualitative interviews of users who answered a newspaper or flyer advertisement.
 
The key finding was that ‘…most of the users in the qualitative sample sought a legal alternative to cannabis (their drug of choice) to avoid positive drug test screenings and criminal sanctions. Many were attending abstinence-only drug treatment programmes, under community corrections, or were seeking a career in the US military. These individuals were randomly drug tested and knew that the metabolites of synthetic cannabis are not detected in standard urine drug screenings…US drug policies – the prohibition of marijuana and the proliferation of drug testing – have led users to seek out legal highs.’ This is despite the fact that many of the drugs they were consuming as an alternative to cannabis have unknown risk profiles, or are known to be far more harmful than cannabis.
 
Perrone, D, Helgesen, RD & Fischer, RG 2013, ‘United States drug prohibition and legal highs: how drug testing may lead cannabis users to Spice’, Drugs: Education, Prevention, and Policy, vol. 20, no. 3, pp. 216-24.

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Does changing the classification of cannabis to more or less dangerous have an effect on the level of cannabis psychosis?
 
Abstract: ‘The UK Misuse of Drugs Act (1971) divided controlled drugs into three groups A, B and C, with descending criminal sanctions attached to each class. Cannabis was originally assigned by the Act to Group B but in 2004, it was transferred to the lowest risk group, Group C. Then in 2009, on the basis of increasing concerns about a link between high strength cannabis and schizophrenia, it was moved back to Group B. The aim of this study is to test the assumption that changes in classification lead to changes in levels of psychosis. In particular, it explores whether the two changes in 2004 and 2009 were associated with changes in the numbers of people admitted for cannabis psychosis… Hospital Episode Statistics admissions data was analysed covering the period 1999 through to 2010.
 
‘Results: There was a significantly increasing trend in cannabis psychosis admissions from 1999 to 2004. However, following the reclassification of cannabis from B to C in 2004, there was a significant change in the trend such that cannabis psychosis admissions declined to 2009. Following the second reclassification of cannabis back to class B in 2009, there was a significant change to increasing admissions.
 
‘Conclusion: This study shows a statistical association between the reclassification of cannabis and hospital admissions for cannabis psychosis in the opposite direction to that predicted by the presumed relationship between the two. However, the reasons for this statistical association are unclear. It is unlikely to be due to changes in cannabis use over this period. Other possible explanations include changes in policing and systemic changes in mental health services unrelated to classification decisions.’
 
Hamilton, I, Lloyd, C, Hewitt, C & Godfrey, C 2013, ‘Effect of reclassification of cannabis on hospital admissions for cannabis psychosis: a time series analysis’, The International journal on drug policy, online ahead of print.

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Do media campaigns prevent young people from using illicit drugs?

An analysis of 23 studies from the Cochrane Register aimed to assess the effectiveness of mass media campaigns in preventing or reducing the use of or intention to use illicit drugs amongst young people. The studies involved 188,934 young people and were conducted in the United States, Canada and Australia. ‘Self reported or biomarker-assessed illicit drug use was measured with an array of published and unpublished scales making comparisons difficult. Pooled results of five RCTs (N = 5470) show no effect of media campaign intervention…We also pooled five ITS [interrupted time series] studies (N = 26,405) focusing specifically on methamphetamine use. Out of four pooled estimates (two endpoints measured in two age groups), there was evidence of a reduction only in past-year prevalence of methamphetamine use among 12 to 17 years old. A further five studies…, which could not be included in meta-analyses, reported a drug use outcome with varied results including a clear iatrogenic effect in one case and reduction of use in another.’
 
The researchers concluded that ‘…the studies tested different interventions and used several questionnaires to interview the young people about the effects of having participated in the studies brought to them. As a result it was very difficult to reach conclusions and for this reason we are highlighting the need for further studies’.
 
Ferri, M, Allara, E, Bo, A, Gasparrini, A & Faggiano, F 2013, ‘Media campaigns for the prevention of illicit drug use in young people’, Cochrane Database Syst Rev, vol. 6, p. CD009287.

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What can be done to reduce hepatitis C virus transmission among people who inject drugs?

Abstract: ‘The hepatitis C virus (HCV) virus epidemic is ongoing in the United States and globally. Incidence rates remain high, especially in young adult injection drug users. New outbreaks of HCV in the United States among young adults, in predominantly suburban and rural areas, have emerged and may be fueling an increase in HCV. This paper discusses some key HCV prevention strategies that to date have not been widely researched or implemented, and wherein future HCV prevention efforts may be focused: (1) reducing sharing of drug preparation equipment; (2) HCV screening, and testing and counseling; (3) risk reduction within injecting relationships; (4) injection cessation and “breaks”; (5) scaled-up needle/syringe distribution, HCV treatment, and vaccines, according to suggestions from mathematical models; and (6) “combination prevention.” With ongoing and expanding transmission of HCV, there is little doubt that there is a need for implementing what is in the prevention “toolbox” as well as adding to it. Strong advocacy and resources are needed to overcome challenges to providing the multiple and comprehensive programs that could reduce HCV transmission and associated burden of disease worldwide in people who inject drugs.’
 
Page, K, Morris, MD, Hahn, JA, Maher, L & Prins, M 2013, ‘Injection drug use and hepatitis C virus infection in young adult injectors: using evidence to inform comprehensive prevention’, Clinical Infectious Diseases, vol. 57, supplement 2, pp. S32-S8.
 
Comment:

• A paper, Progressing a comprehensive response to blood-borne virus prevention, management and treatment, with a specific focus on hepatitis, in specialist ACT drug treatment and support services, has been developed through and is supported by the ACT ATOD Specialist Executive Group;
• The paper identifies actions that the group will be progressing, with a specific focus on hepatitis;
• A Working Group is leading this initiative; members include Directions, the ACT Hepatitis Resource Centre, ATODA and the Canberra Alliance for Harm Minimisation and Advocacy (CAHMA).

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Can the introduction of measures to reduce stigma towards people with HCV within health services lead to improved health outcomes?
 
A research project based at the National Centre in HIV Social Research examined the association between stigma towards people living with hepatitis C virus (HCV) and adverse health outcomes and access to health services. The researchers found that ‘the relationship between the person living with HCV and their health worker can work to ameliorate the effects of stigma’ and lead to ‘increased healthcare utilization and reduced risk behaviors’. They also investigated research into health service delivery ‘that acknowledges the importance of stigma and demonstrates ways to build positive, enabling relationships between patient, health worker, and health setting’.
 
The authors cite two models of HCV treatment in NSW which offer care beyond the traditional tertiary-hospital setting. One involves HCV treatment provided by community-based general practitioners. ‘Initial evaluations of this model show that patients’ decisions to undertake treatment in the community were underpinned by their ongoing relationship with and trust in their general practitioner, coupled with concerns about relocating care to an unknown hospital setting.’  The second involves the delivery of HCV care via opioid substitution therapy [OST] and community health clinics. ‘Evaluations of this model revealed a number of reasons as to why patients were attracted to a co-located treatment model (of HCV and OST services).’
 
Treloar, C, Rance, J & Backmund, M 2013, ‘Understanding barriers to hepatitis C virus care and stigmatization from a social perspective’, Clinical Infectious Diseases, vol. 57, suppl 2, pp. S51-S5.
 
Comment:

• A joint proposal has been developed between the University of Canberra, CAHMA, the Alcohol and Drug Service, ACT Health and ATODA to conduct a feasibility study. This would include the development of a training module to be delivered to healthcare workers providing opioid maintenance treatment to reduce stigma experienced by service consumers. 

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Has introducing plain packaging of cigarettes encouraged smokers to consider quitting?
 
The Cancer Council Victoria, as part of the 2012 Victorian Smoking and Health Survey which was conducted during the phase-in of plain packaged tobacco products, surveyed 536 cigarette smokers with a usual brand of whom 72% were smoking from a plain pack and 28% were smoking from a branded pack. The findings were that ‘Compared with branded pack smokers, smokers who were smoking from plain packs rated their cigarettes as being lower in quality and as tending to be less satisfying than 1 year ago…[and] plain pack smokers were more likely to think often or very often about quitting in the past week and to rate quitting as a higher priority in their lives, compared with branded pack smokers’. The researchers concluded that ‘The early indication is that plain packaging is associated with lower smoking appeal, more support for the policy and more urgency to quit among adult smokers’.
 
Wakefield, MA, Hayes, L, Durkin, S & Borland, R 2013, ‘Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study’, BMJ Open, vol. 3, no. 7, p. e003175.

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What types of treatments are most effective in helping people to stop smoking? 
 
‘Aims: The Cochrane Collaboration is an international not-for profit organisation which produces and disseminates systematic reviews of healthcare interventions. This paper is the first in a series of annual updates of Cochrane reviews on tobacco addiction interventions. It also provides an up-to-date overview of review findings in this area to date and summary statistics for cessation reviews in which meta-analyses were conducted.
 
‘Methods: In 2012, the Group published seven new reviews and updated 13 others. This update summarises and comments on these reviews. It also summarizes key findings from all the other reviews in this area.
 
‘Results: New reviews in 2012 found that in smokers using pharmacotherapy, behavioural support improves success rates…, and that combining behavioural support and pharmacotherapy aids. Updated reviews established mobile phones as potentially helpful in aiding cessation…found that cytisine…and low dose varenicline…aid smoking cessation, and that training health professionals in smoking cessation improves patient cessation rates…The updated reviews confirmed the benefits of NRT [nicotine replacement therapy], standard dose varenicline, and providing cessation treatment free of charge. Lack of demonstrated efficacy remained for partner support, expired-air carbon monoxide feedback and lung function feedback.
 
‘Conclusions: Cochrane systematic review evidence for the first time establishes the efficacy of behavioural support over and above pharmacotherapy, as well as the efficacy of cytisine, mobile phone technology, low dose varenicline and health professional training in promoting smoking cessation.’
 
Hartmann-Boyce, J, Stead, LF, Cahill, K & Lancaster, T 2013, ‘Efficacy of interventions to combat tobacco addiction: Cochrane update of 2012 reviews’, Addiction, online ahead of print.
 
Comment:

• ATODA has been advocating for subsidised NRT to be expanded to include service consumers of both non-government and government drug treatment and support services in the ACT. See ATODA's submission to the ACT Budget 2013-14. 
• Workers from the ATOD, mental health and youth sectors can access subsidised NRT through ATODA. For more information, visit ATODA's website 

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How much would the price of cigarettes have to increase before smokers would consider quitting?

Research undertaken by the Centre for Behavioural Research in Cancer, Cancer Council Victoria, using the Victorian Smoking and Health Survey, aimed to describe the critical price points for packs for smokers of each pack size, to calculate what this would equate to in terms of price per stick, and to ascertain whether price points varied by age, socio-economic status and heaviness of smoking. The investigators found that ‘Three-quarters of regular smokers of manufactured cigarettes could envisage their usual brand reaching a price at which they would seriously consider quitting. Analyses revealed that answers clustered around whole numbers, (AUD$15, $20, $25 and $30), with a median nominated price point of AUD$20 per pack. The median price point at which regular smokers would consider quitting was calculated to be 80 cents per stick, compared to the current median reported stick price of 60 cents. Of the smokers who nominated a price point, 60.1% indicated they would seriously consider quitting if the cost of their usual brand equated to 80 cents per stick or less; 87.5% would seriously consider quitting if sticks reached one dollar each.’
 
The researchers concluded ‘These results do suggest a potentially useful approach to setting taxes in Australia. If taxes can be set high enough to ensure that the cost of the smokers’ preferred packs exceeds critical price points, then it seems likely that more people would seriously attempt to quit than if the price increased to a level even slightly below the price points. Our study suggests that a tax increase large enough to ensure that a typical pack of 25 cigarettes in Australia cost at least AUD$20 would prompt more than 60% of smokers able to nominate a price point to seriously think about quitting, with particularly strong effects among low-SES smokers.’
 
Scollo, M, Hayes, L & Wakefield, M 2013, ‘What price quitting? The price of cigarettes at which smokers say they would seriously consider trying to quit’, BMC Public Health, vol. 13, no. 650.

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To what extent are recently released Australian prisoners at increased risk of non-fatal drug overdose?

‘Recently released prisoners are at markedly increased risk of death and drug-related causes predominate. Non-fatal overdose (NFOD) is considerably more common than fatal overdose, but has received relatively little research attention’. A survey of released prisoners in NSW and Queensland found that ‘Around a quarter of prisoners in both states reported experiencing at least one NFOD in their lifetime and as expected, these overdoses occurred primarily among injecting drug users (IDU). The prevalence of lifetime NFOD among prisoners with a history of IDU in NSW (44%) and Queensland (35%) is comparable with estimates from other international surveys of community IDU, with and without a history of incarceration’. The researchers concluded ‘The risk of NFOD among prisoners with a history of injecting drug use is high. An understanding of the risk factors for NFOD in this population can inform targeted, evidence-based interventions to reduce this risk’.
 
Moore, E, Winter, R, Indig, D, Greenberg, D & Kinner, SA 2013, ‘Non-fatal overdose among adult prisoners with a history of injecting drug use in two Australian states’, Drug and Alcohol Dependence, online ahead of print.
 
Comment:

• The ACT Opioid Overdose Prevention and Management program run by CAHMA includes take home prescription naloxone to eligible participants;
• Recently released prisoners are one target group of the program;
• CAHMA, ATODA and other stakeholders have advocated for the establishment of this program and for naloxone distribution and overdose education to be expanded into additional settings.

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Are long distance truck drivers who drink coffee more or less likely to crash?

A study conducted in NSW and WA from December 2008 to May 2011 examined 530 long distance drivers of commercial vehicles who were recently involved in a crash attended by police (cases) and 517 drivers who had not had a crash (controls) while driving a commercial vehicle in the past 12 months. The main outcome measure was the likelihood of a crash associated with the use of substances containing caffeine after adjustment for factors including age, health disorders, sleep patterns, and symptoms of sleep disorders as well as exposures such as kilometres driven, hours slept, breaks taken, and night driving schedules. The researchers found that ‘Forty three percent of drivers reported consuming substances containing caffeine, such as tea, coffee, caffeine tablets, or energy drinks for the express purpose of staying awake. Only 3% reported using illegal stimulants such as amphetamine (“speed”);…[MDMA] (ecstasy); and cocaine…drivers who consumed caffeinated substances for this purpose had a 63% reduced likelihood of crashing…compared with drivers who did not take caffeinated substances.’ 
 
Their conclusion was that ‘Caffeinated substances are associated with a reduced risk of crashing for long distance commercial motor vehicle drivers. While comprehensive mandated strategies for fatigue management remain a priority, the use of caffeinated substances could be a useful adjunct strategy in the maintenance of alertness while driving.’
 
Sharwood, LN, Elkington, J, Meuleners, L, Ivers, R, Boufous, S & Stevenson, M 2013, ‘Use of caffeinated substances and risk of crashes in long distance drivers of commercial vehicles: case-control study’, BMJ: British Medical Journal, vol. 346, p. f1140.

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Do compulsory motor vehicle ignition interlocks for drivers convicted of DUI for the first-time reduce the likelihood that they will reoffend?

‘To help combat the persistent problem of alcohol-impaired driving crashes, more than half of U.S. states require at least some convicted DUI [driving under the influence] offenders to be ordered to install interlocks. States initially passed laws requiring interlock orders only for repeat offenders or offenders with very high BACs [blood alcohol concentrations], typically 0.15 percent or higher, but increasingly states are extending interlock order requirements to cover all DUI convictions.’ In 2003 Washington State’s ignition interlock laws were changed, ‘moving issuance of interlock orders from courts to the driver licensing department in July 2003 and extending the interlock order requirement to first-time offenders with blood alcohol concentrations (BACs) below 0.15 percent’.
 
Researchers who examined the effect of these changes found that ‘the application of mandatory interlock orders can be effective, even among first-time offenders whose BACs exceed the legal threshold of 0.08 percent but are less than 0.15 percent. With the extension of mandatory interlock orders to this group of offenders, the rate at which they recidivated in the 2 years following their first arrest was reduced by 12 percent. Had all such offenders actually installed interlocks (instead of only the third that did so), the reduction in recidivism may have approached 50 percent.’ The researchers concluded that extending an interlock order requirement to all first-time DUI convictions in Washington State led to ‘a substantial reduction in recidivism among the cohort of affected offenders, even with relatively low interlock installation rates. It is likely that additional gains can be attained with higher rates. The higher the interlock installation rate, the lower the recidivism rate, suggesting that jurisdictions should seek ways to increase interlock installations. Jurisdictions also should reconsider policies that allow reducing DUI charges to other traffic offenses that do not have interlock requirements.’
 
McCartt, AT, Leaf, WA, Farmer, CM & Eichelberger, AH 2013, ‘Washington State’s alcohol ignition interlock law: effects on recidivism among first-time DUI offenders’, Traffic Injury Prevention, vol. 14, no. 3, pp. 215-29.
 
Comment:

• A new alcohol ignition interlock program was announced in the ACT Budget 2013/14, with legislation having passed earlier in the year;
• ATODA understands that the focus of the ACT program is on repeat and mid-high range BAC drink drivers;
• ATODA, and other stakeholders, have advocated for the establishment of an alcohol ignition interlock program for the ACT. See ATODA’s Budget 2013-14 Submission and its paper about the interlocks program. 

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Can cognitive behaviour therapy help people suffering from comorbid post-traumatic stress disorder and alcohol use disorder?

A study led by researchers based at the National Drug and Alcohol Research Centre aimed to test the efficacy of integrated cognitive behaviour therapy (CBT) for coexisting post-traumatic stress disorder (PTSD) and alcohol use disorders (AUD). A randomised controlled trial was conducted of 12 once-weekly individual sessions in clinics in Sydney of either integrated CBT for PTSD and AUD [IT, integrated therapy] or CBT for AUD plus supportive counselling. Sixty-two adults with concurrent PTSD and AUD participated in the study.
 
The researchers found that reductions in PTSD severity occurred in both groups. Participants who received integrated therapy (including one or more sessions of exposure therapy) exhibited a twofold greater rate of clinically significant change in PTSD severity at follow-up than did the participants who received CBT plus supportive counselling. The CBT plus supportive counselling participants showed larger reductions than integrated treatment participants in alcohol consumption, dependence and problems within the context of greater treatment from other services during follow-up.
 
They concluded ‘Individuals with severe and complex presentations of coexisting post-traumatic stress disorder (PTSD) and alcohol use disorders (AUD) can derive substantial benefit from cognitive behaviour therapy targeting AUD, with greater benefits associated with exposure for PTSD. Among individuals with dual disorders, these therapies can generate significant, well-maintained treatment effects on PTSD, AUD and psychopathology’.
 
Sannibale, C, Teesson, M, Creamer, M, Sitharthan, T, Bryant, RA, Sutherland, K, Taylor, K, Bostock-Matusko, D, Visser, A & Peek-O’Leary, M 2013, ‘Randomized controlled trial of cognitive behaviour therapy for comorbid post-traumatic stress disorder and alcohol use disorders’, Addiction, vol. 108, no. 8, pp. 1397-410.
 

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Are children with ADHD more likely to develop alcohol and drug disorder and to become dependent on tobacco in adolescence? 

A European study examined the relationship between a childhood diagnosis of attention deficit hyperactivity disorder (ADHD) and the development of later alcohol/drug use disorder including nicotine dependence. The study involved over a thousand participants in the Belgian, Dutch and German part of the International Multicenter ADHD Genetics (IMAGE) study. IMAGE families were identified through people with ADHD aged 5–17 years attending out-patient clinics, and control subjects from the same geographic areas.  The participants were re-assessed at a mean age of 16.4 years.
 
The researchers concluded that ‘A childhood diagnosis of attention deficit hyperactivity disorder is a risk factor for psychoactive substance use disorder and nicotine dependence in adolescence and comorbid conduct disorder, but not oppositional defiant disorder, further increases the risk of developing psychoactive substance use disorder and nicotine dependence’.
 
Groenman, AP, Oosterlaan, J, Rommelse, N, Franke, B, Roeyers, H, Oades, RD, Sergeant, JA, Buitelaar, JK & Faraone, SV 2013, ‘Substance use disorders in adolescents with attention deficit hyperactivity disorder: a 4-year follow-up study’, Addiction, vol. 108, no. 8, pp. 1503-11.

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Is cannabis getting stronger and does it matter?  

‘Recent analysis of the cannabinoid content of cannabis plants suggests a shift towards use of high potency plant material with high levels of Δ9-tetrahydrocannabinol (THC) and low levels of other phytocannabinoids, particularly cannabidiol (CBD). Use of this type of cannabis is thought by some to predispose to greater adverse outcomes on mental health and fewer therapeutic benefits. Australia has one of the highest per capita rates of cannabis use in the world yet there has been no previous systematic analysis of the cannabis being used.’
 
A team of Sydney-based researchers examined the cannabinoid content of 206 cannabis samples that had been confiscated by police from recreational users holding 15 g of cannabis or less, under the New South Wales Cannabis Cautioning scheme. A further 26 ‘Known Provenance’ samples were analysed that had been seized by police from larger indoor or outdoor cultivation sites rather than from street level users. ‘The “Cannabis Cautioning” samples showed high mean THC content (THC+THC-A = 14.88%) and low mean CBD content (CBD+CBD-A = 0.14%)’. The researchers state that ‘These analyses confirm global trends towards the dominance of THC content in contemporary cannabis, with these Australian data showing average values similar, if not slightly higher, than recent international studies’.
 
Swift, W, Wong, A, Li, KM, Arnold, JC & McGregor, IS 2013, ‘Analysis of cannabis seizures in NSW, Australia: cannabis potency and cannabinoid profile’, PLoS One, vol. 8, no. 7, p. e70052.

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New Reports

Australia, The Treasury 2013, Post-implementation review: 25 per cent tobacco excise increase, The Treasury, Canberra:
 

• Reveals that the 25% increase in tobacco excise in 2010 resulted in an 11% reduction in tobacco sales and reduced the number of smokers, with no evidence of any change in the tobacco black market.

 
Australian Institute of Health and Welfare 2013, Aboriginal and Torres Strait Islander Health Performance Framework 2012 report: Australian Capital Territory, cat. no. IHW 96, Australian Institute of Health and Welfare, Canberra. (Large file warning: 3MB)

• Includes under the Health Behaviours chapter tobacco use, risky and high-risk alcohol consumption, and health behaviours during pregnancy.

 
Australian Institute of Health & Welfare 2013, The health of Australia’s prisoners 2012, AIHW cat. no. PHE 170, Australian Institute of Health & Welfare, Canberra:
 

• ‘Prisoners have significant health issues, with high rates of mental health problems, communicable diseases, alcohol misuse, smoking and illicit drug use. 38% of prison entrants have ever been told they have a mental illness, 32% have a chronic condition. 84% are current smokers, but almost half of them would like to quit. 37% of prisoners about to be released said their health was a lot better than when they entered prison.’

 
Comment:

• The recently released ACT Government Future directions for tobacco reduction in the ACT 2013 – 2016 policy states ‘Having smoke-free correctional facilities would significantly benefit both detainees and staff’.
• ATODA has been advocating for workplace tobacco management policies to be implemented in the Alexander Maconochie Centre.

 
 
Roxburgh, A & Burns, L 2013, Drug-related hospital stays in Australia, 1993-2011, National Drug and Alcohol Research Centre, Sydney.
 

•  ‘Opioid-related separations have started to increase for the first time again since 2005/06, with an increase in presentations for other opioid poisoning (for substances including morphine, codeine and oxycodone) and for opioid dependence. These findings indicate the need to monitor prescription opioids and associated harms.
• ‘The number of amphetamine-related hospital separations recorded in 2010/11 (2,271) is the highest since 1993/94.
• ‘Patterns of amphetamine-related separations differ across jurisdictions, suggesting the need for local responses.
• ‘Cannabis-related separations recorded in 2010/11 were also the highest on record since 1993/94.’

 
United Nations Office on Drugs and Crime & World Health Organization 2013, Opioid overdose: preventing and reducing opioid overdose mortality, discussion paper, contribution of the United Nations Office on Drugs and Crime and the World Health Organization to improving responses by Member States to the increasing problem of opioid overdose  deaths, United Nations Office on Drugs and Crime and the World Health Organization .
 
World Health Organization 2013, WHO Report on the Global Tobacco Epidemic, 2013: enforcing bans on tobacco advertising, promotion and sponsorship, World Health Organization, Geneva.       

• Includes a special section on five years of progress

 
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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