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 2014 issue


ACT Research Spotlight

ACT ATOD Sector Conference

Research Findings

New Reports
 

Do legal medicinal cannabis programs encourage teenagers to use cannabis?
 
A paper published by the US National Bureau of Economic Research reports on an analysis of data from national and state Youth Risk Behavior Surveys, the National Longitudinal Survey of Youth 1997 and the Treatment Episode Data Set, to estimate the relationship between medicinal cannabis laws and cannabis use. The researchers concluded that ‘Our results are not consistent with the hypothesis that the legalization of medical marijuana caused an increase in the use of marijuana among high school students. In fact, estimates from our preferred specification are small, consistently negative, and are never statistically distinguishable from zero’.
 
Anderson, DM, Hansen, B & Rees, DI 2014, Medical marijuana laws and teen marijuana use, National Bureau of Economic Research (U.S.A.), Cambridge, MA, http://www.nber.org/papers/w20332).

 back to top


Why do people use medicinal cannabis?

Abstract:
‘Since 1996, more than 20 states and the District of Columbia have legislated medical marijuana laws. Relatively little is known about the identity of medical marijuana users, and specifically, what medical conditions they claim to have, although the initial campaigns to pass such legislation had been particularly associated with cancer, AIDS, and glaucoma patients. Past studies (most of which are focused on Californian data) find that medical marijuana users identify a diverse variety of medical conditions, and that those with cancer, HIV/AIDS and glaucoma made up only a small percentage of authorized users. This study seeks to contribute to this field of research by taking a more comprehensive approach, by examining the stated medical conditions of marijuana users from every state where the information is available. It records the medical conditions of nearly 230,000 individuals across seven states. The data sets that make up this study were provided by the Health or the Public Health Departments of seven U.S. States: Arizona, Colorado, Montana, Nevada, New Mexico, Oregon and Rhode Island. Our findings suggest that a very small proportion of medical marijuana patients report having serious medical conditions (i.e. HIV/AIDS, glaucoma, cancer, Alzheimer’s), while almost all (91%) of medical marijuana users report using marijuana to alleviate severe or chronic pain. Our results are consistent with past research that found that only a small minority of medical marijuana users report serious, life-threatening illnesses. The implications of these findings are that, although the political campaigns to pass such referenda and legislation often revolved around the needs of the terminally ill, the reality is that most people who utilize such programs do not suffer from serious medical conditions, and that state officials should inform the public about who may utilize such a program if enacted. These findings may indicate the need to develop stricter guidelines to ensure that medical marijuana is not diverted to young people, especially given recent research showing that it is.’
 
Sabet, K & Grossman, E 2014, ‘Why do people use medical marijuana? The medical conditions of users in seven U.S. states’, Journal of Global Drug Policy and Practice, vol. 8, no. 2, free full text http://www.globaldrugpolicy.org/Issues/Vol%208%20Issue%202/Why%20Do%20People%20Use%20Medical%20Marijuana.pdf.
 
Comment: This article is helpful for policy-makers and others contemplating introducing a legal compassionate medicinal cannabis program. It highlights how many of the US approaches are seriously flawed, enabling people to access cannabis through legal dispensaries for health conditions that do not respond well to the drug. In other words, some of the US approaches blur medicinal and recreational use. Note that the study reported upon here was conducted by reputable researchers, although published in Drug Free America’s online journal (see Wikipedia’s description at http://en.wikipedia.org/w/index.php?title=Journal_of_Global_Drug_Policy_and_Practice&oldid=606471297).
 
Pre-Conference Public Forum: To support the community to engage with the evidence base in considering options for medicinal cannabis in the ACT a pre-conference public forum will be held on Tuesday 23 September 2014 at the ACT Legislative Assembly. To register or for further details please contact ATODA.

 back to top


How effective are dedicated cannabis-only treatment clinics? 

Six dedicated cannabis-only treatment clinics were established in NSW between 2003 and 2009: in Western Sydney (Sydney West Area Health Service), The Central Coast (North Sydney Central Coast Area Health Service, The Central West (Greater Western Area Health Service), Sutherland (South Eastern Sydney Illawarra Area Health Service), the North Coast of NSW and the Hunter. All operate at multiple sites (e.g. outreach) as well as at their base sites, and offer services to people over the age of sixteen who wish to quit or reduce their cannabis use. A study of data from the New South Wales Alcohol and Other Drug Treatment Services Minimum Dataset from July 2003 to June 2008 found that clients treated in cannabis clinics were older than those treated at non-dedicated clinics, ‘…had shorter episode durations…and were more likely to be naïve to treatment…[and] Indigenous Australian treatment seekers were more likely to complete cannabis treatment in a dedicated cannabis clinic’. The researchers concluded that ‘Cannabis clinics have attracted groups traditionally difficult to attract and retain in treatment. As the cohort of daily cannabis users age, it is important that service models are attractive to older clients, new to treatment’.
 
Copeland, J & Allsop, D 2014, ‘Dedicated “cannabis only” treatment clinics in New South Wales, Australia: client and treatment characteristics and associations with first-time treatment seeking’, Drug and Alcohol Review, online ahead of print.
  

Can wastewater analysis be used effectively to monitor prisoner drug use? 
 
The authors point out that ‘Prison substance use is a major concern for prison authorities and the wider community. Australia has responded to this problem by implementing the National Corrections Drug Strategy. Across Australia, the true extent of prison substance use cannot be determined. As a result, the effectiveness of the interventions employed as part of this Strategy cannot be properly assessed. This has important implications for the allocation of corrective services resources and future policy development.’ As a consequence, Tasmanian-based researchers and colleagues trialled using wastewater analysis in an Australian prison. ‘Wastewater samples were taken from a small regional prison with a total population of approximately 400 inmates (male and female). Samples were collected from a sewer that drained multiple parts of the prison (but excluded areas housing female inmates).’ The study investigated the ethical and practical issues in using wastewater analysis to measure levels of illicit and pharmaceutical drug use in the prison, the first such study in Australia. It quantified the amount of cannabis, methamphetamine, codeine and methadone in the wastewater. The article concludes that, ‘…as a result of its objectivity, sensitivity and cost-effectiveness, the use of [wastewater analysis] in prisons warrants further consideration in Australia’.
 
van Dyken, E, Thai, P, Lai, FY, Ort, C, Prichard, J, Bruno, R, Hall, W, Kirkbride, P & Mueller, JF 2014, ‘Monitoring substance use in prisons: assessing the potential value of wastewater analysis’, Science & Justice, online ahead of print.
 
Comment: As the authors have demonstrated, wastewater analysis has great potential for monitoring prisoners’ drug use. It could form a valuable and cost-effective part of a strategy to monitor and evaluate the introduction of an NSP into the Alexander Maconochie Centre, and drug supply reduction strategies within the prison.

 back to top


How likely is it that woman on opioid treatment programs have been involved with the child protection system? 

A large sample of mothers on the opioid treatment program (OTP) in Sydney were interviewed with regard to ‘…their characteristics, the extent and nature of their involvement with the child protection system, the parenting-related interventions provided and their views of their own parenting’. The researchers found that ‘The 171 mothers were disadvantaged and marginalised and had 302 children under the age of 16 years, 99 of whom were in out-of-home care. Nearly half the children in care…had been removed at the time of their birth, and half…had been removed from a mother who was on an OTP at the time. Among the younger children (age 1–2 years), higher proportions had been removed at birth than among the older children. None of the 32 mothers who had a child removed at birth and then gave birth subsequently retained care of their new baby. Women often chose to enter treatment (63.6%) for child-related reasons (35%) and attempted to shield their children from their substance use. Few health services were provided to them outside the availability of OTP’. The researchers commented that ‘Entering treatment presents an opportunity for improving outcomes for these women and their children and to reduce future involvement with the child protection system’.
 
Taplin, S & Mattick, RP 2014, ‘The nature and extent of child protection involvement among heroin-using mothers in treatment: high rates of reports, removals at birth and children in care’, Drug and Alcohol Review, online ahead of print.
 
Comment: Lead author Dr Stephanie Taplin, is Canberra-based and the Associate Director of the Institute of Child Protection Studies at the Australian Catholic University.
 

 back to top

How effective are public health interventions in reducing alcohol consumption among pregnant women? 

A literature review that sought to determine whether interventions can be successful in reducing alcohol consumption among pregnant women identified only seven articles published world-wide on this topic. The researchers found that ‘Interventions included multimedia and educational interventions. Improvements in knowledge were reported in six studies, whereas one study found contradictory results. Four studies used alcohol consumption rates as an outcome measure, and although a reduction in consumption was reported, the results were non-significant…The effectiveness of public health interventions that aim to increase awareness and reduce alcohol consumption among pregnant women cannot be assessed because of the paucity of studies’.
 
Crawford-Williams, F, Fielder, A, Mikocka-Walus, A & Esterman, A 2014, ‘A critical review of public health interventions aimed at reducing alcohol consumption and/or increasing knowledge among pregnant women’, Drug and Alcohol Review, online ahead of print.
 

 back to top

Are young people who identify as lesbian, gay or bisexual more likely to drink alcohol than their heterosexual peers, and is this associated with depression?

A longitudinal study in the United Kingdom assessed the extent to which the association between sexual orientation and problematic alcohol use is explained by depressed mood among adolescents. It showed that ‘…self-identified sexual minority adolescents at age 15 are more likely to engage in alcohol problem use 3 years later than their heterosexual peers. Moreover, depressed mood explained 21% of the association between sexual orientation at age 15 and alcohol problem use at age 18. Indeed, sexual minority adolescents were more likely to experience depressed mood at age 16 which, subsequently, predicted greater alcohol problem use 2 years later.’ The researchers state that ‘…the study emphasizes that this group should be screened for depressed mood and offered depression interventions, if necessary, in order to reduce the risk of developing alcohol problem use. Additionally, it may be necessary to promote zero-tolerance policies in schools to reduce minority victimization while providing support resources on site (e.g. mental health providers).’
 
Pesola, F, Shelton, KH & van den Bree, MBM 2014, ‘Sexual orientation and alcohol problem use among UK adolescents: an indirect link through depressed mood’, Addiction, vol. 109, no. 7, pp. 1072-80.
 
Comment: Although conducted in the UK, the findings of this study are probably transferrable to the Australian context. They provide useful guidance to service providers in contact with young people.

 back to top


Is there an association between self-harm in adolescence and substance use in adulthood?

The Victorian Adolescent Health Cohort Study is a fifteen-year prospective cohort study of a random sample of almost 2,000 Victorian secondary school students. It examined whether adolescents who self-harm are at increased risk of heavy and dependent substance use in adulthood. ‘Data pertaining to self-harm and substance use was obtained at seven waves of follow-up, from mean age 15.9 years to mean age 29.1 years.’ The study findings were that ‘Substance use and self-harm were strongly associated during the adolescent years…Moreover, adolescent self-harmers were at increased risk of substance use and dependence syndromes in young adulthood. Self-harm predicted a four-fold increase in the odds of multiple dependence syndromes’. The researchers concluded that ‘This level of substance misuse is likely to contribute substantially to the premature mortality and disease burden experienced by individuals who self-harm’.
 
Moran, P, Coffey, C, Romaniuk, H, Degenhardt, L, Borschmann, R & Patton, GC 2014, ‘Substance use in adulthood following adolescent self-harm: a population-based cohort study’, Acta Psychiatrica Scandinavica, online ahead of print.

 back to top


What is the risk of hepatitis C infection from a single occasion of sharing injecting equipment, and what are the implications?

The authors, from the University of NSW and Imperial College, London, remind us that ‘Shared injecting apparatus during drug use is the premier risk factor for hepatitis C virus (HCV) transmission’, and set out ‘To estimate the per-event probability of HCV infection during a sharing event, and the transmission probability of HCV from contaminated injecting apparatus’, as the per-event probability had not been previously determined. The study was conducted in a cohort of 500 prisoners in 26 NSW correctional centres who had reported a lifetime history of injecting drug use and had a negative HCV antibody test within the previous 12 months. The detainees provided information on the frequency of injecting drugs and sharing injecting equipment, as well as other risk behaviours. The study revealed that ‘The best estimate of the per-event probability of infection was 0.57%...A sensitivity analysis on the likely effect of under-reporting of sharing of the injecting apparatus indicated that the per event infection probability may be as low as 0.17%...The transmission probability was similarly shown to range up to 6%, dependent on the presumed prevalence of the virus in injecting equipment.’
 
These findings led the authors to conclude that ‘The transmission probability of HCV during a sharing event is small. Hence, strategies to reduce the frequency and sharing of injecting equipment are required, as well as interventions focused on decreasing the per event risk’. Furthermore, ‘Given the low per-event risk of infection, this analysis suggests that an important strategy to reduce HCV transmission would be to reduce the number of sharing events, in addition to employing strategies aimed at reducing the per-event risk (e.g., by bleaching). This may be accomplished by implementing needle/syringe exchange programs, intensive rehabilitation, bleach and other decontamination strategies, or by increasing coverage of opioid substitution programs…These transmission estimates will inform planning and evaluation of prevention strategies for the HCV epidemic in both community and custodial settings’.
 
Boelen, L et al. on behalf of the HITS investigators 2014, ‘Per-event probability of hepatitis C infection during sharing of injecting equipment’, PLoS One, vol. 9, no. 7, p. e100749, free full text http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0100749.
 
Comment: This important research is part of the larger Hepatitis C Incidence and Transmission Study in prisons (HITS-p). In demonstrating that the risk of transmitting HCV through sharing injecting equipment and environments in prison is low, these findings should help prison health planners better focus on preventive interventions that can be effective in reducing the number of occasions of sharing.

 back to top


Can hepatitis C virus infection be eradicated in people who inject drugs? 

This article forms part of a symposium on ‘Hepatitis C: next steps toward global eradication’. The authors (who are based at The Kirby Institute, UNSW) point out that ‘People who inject drugs (PWID) represent the core of the hepatitis C virus (HCV) epidemic in many countries and HCV-related disease burden continues to rise. There are compelling data demonstrating that with the appropriate programs, treatment for HCV infection among PWID is successful, with responses to therapy similar those observed in large randomized controlled trials in non-PWID. However, assessment and treatment for HCV infection lags far behind the numbers who could benefit from therapy, related to systems-, provider- and patient-related barriers to care. The approaching era of interferon-free directly acting antiviral therapy has the potential to provide one of the great advances in clinical medicine. Simple, tolerable and highly effective therapy will likely address many of these barriers, thereby enhancing the numbers of PWID cured of HCV infection.’ They then discuss ‘…why we should strive for the eradication of HCV infection among PWID, whether eradication of HCV infection among PWID is feasible, components that would be needed to achieve eradication of HCV infection in PWID, potential settings and strategies required to establish programs targeted towards eradicating HCV infection among PWID and the feasibility of eradication versus elimination of HCV infection among PWID.’ The authors emphasise that ‘Harm reduction and HCV treatment as prevention provide a basis for eradication’ and ‘Although eradication should be strived for, elimination is more feasible’.
 
Grebely, J & Dore, GJ 2014, ‘Can hepatitis C virus infection be eradicated in people who inject drugs?’, Antiviral Research, vol. 104, pp. 62-72.
 
Comment: In this context, ‘eradication’ refers to the reduction of HCV to zero new cases globally. ‘Elimination’ refers to the reduction if the incidence to zero in a particular geographical area, but continuing measures are required to prevent recurrence of disease transmission there. The article forms part of the contemporary discussion of ‘treatment as prevention’—an approach that some authorities find troubling.

 back to top


Which drug group is more strongly associated with binge drinking: stimulants or cannabis?

An on-line survey of 18- to 30-year old Australians compared binge drinking last Saturday night (five or more drinks) by participants who took stimulants (ecstasy, cocaine, amphetamine or methamphetamine) or cannabis last Saturday night. The researchers found that ‘Young adult ecstasy users who took stimulants (ecstasy, methamphetamine, amphetamine and/or cocaine) last Saturday night were three times more likely to binge drink than their ecstasy-using peers who were not intoxicated with stimulants. They also drank at excessive levels, consuming a median of 20 drinks last Saturday night (cf. 10 drinks among ecstasy users who had not taken stimulants last Saturday night). This would equate to drinking at least two bottles of table wine, or almost a full bottle of spirits, during the 12-h period from Saturday 6pm to Sunday 6am. Cannabis intoxication was unrelated to binge drinking among either cannabis users or ecstasy users. These findings suggest that stimulant use is a complement to heavy drinking among young adults.’ The researchers’ conclusion was that ‘Stimulant intoxication, but not cannabis intoxication, is associated with binge drinking among young adults, compounding already high rates of binge drinking among people who use these drugs’.
 
McKetin, R, Chalmers, J, Sunderland, M & Bright, DA 2014, ‘Recreational drug use and binge drinking: stimulant but not cannabis intoxication is associated with excessive alcohol consumption’, Drug and Alcohol Review, online ahead of print.
 
Comment: Lead author Dr Rebecca McKetin, is Canberra-based at the Research School of Population Health, Australian National University.

 back to top


What impact lowering the age at which people can purchase alcohol have on alcohol-related road crashes involving young people?

The minimum legal purchase age for alcohol in New Zealand was lowered from 20 to 18 in December 1999. An analysis by New Zealand researchers of the long term effect of this change found that ‘…lowering the minimum purchase age in New Zealand has had a long-term impact on drivers experiencing alcohol-involved crashes among the age group directly affected: those aged 18 to 19 years. Although the odds of a driver aged 18 to 19 years experiencing an alcohol-involved crash resulting in an injury or fatality were similar to the odds of the age control group before the law change, their odds became significantly higher following the law change. The main effect was found in the short term (2000-2005); however, the higher odds were maintained in the long term (2006-2010)’. The researchers concluded that ‘Lowering the purchase age for alcohol was associated with a long-term impact on alcohol-involved crashes among drivers aged 18 to 19 years. Raising the minimum purchase age for alcohol would be appropriate.’
 
Huckle, T & Parker, K 2014, ‘Long-term impact on alcohol-involved crashes of lowering the minimum purchase age in New Zealand’, American Journal of Public Health, vol. 104, no. 6, pp. 1087-91.

 back to top


Is violent behaviour more common in the vicinity of off-licence liquor outlets than near those located in neater neighbourhoods?

Researchers in the United States examined whether immediate environment, business practice, staff, and patron characteristics of off-premise alcohol outlets are associated with simple and aggravated assault density. They hypothesised that ‘There are a number of characteristics of the immediate physical environment in which off-premise alcohol outlets are embedded that may be associated with violence: proximity of on-premise alcohol outlets to public transportation stations and other alcohol outlets, the presence of physical and social disorder (e.g. presence of garbage, litter, or empty beer bottles in the street or gutter to indicate physical disorder, and adults loitering or drinking alcohol in public to indicate social disorder),  the density of pro-social places (e.g. schools, churches, libraries, and recreational centers, and location of on-premise alcohol outlets (e.g. located on established commercial streets).’ The research site was Bloomington, Indiana, a non-metropolitan college town in midwestern USA with a population of approximately 8,000 in 2010.
They found ‘…limited effects of immediate environment, business practice, staff, and patron characteristics on simple assault density and no effect on aggravated assault density. Only two out of 17 characteristics were associated with simple assault density (i.e. nearby library and male patrons)’. Their conclusion was that ‘Our findings suggest that where the off-premise outlets are located, how well the immediate environment is maintained, what types of beverages the outlets sell, who visits them, and who works there matter little in their association with violence. This suggests the importance of outlet density itself as a primary driver of any association with violence. Public policies aimed at reducing alcohol outlet density or clustering may be useful for reducing violence’.
 
Snowden, AJ & Pridemore, WA 2014, ‘Off-premise alcohol outlet characteristics and violence’, The American Journal of Drug and Alcohol Abuse, vol. 40, no. 4, pp. 327-35.
 
Comment: Although it is hard to know the extent to which this USA study applies in Australia, it provides further confirmation that off-licence alcohol outlet density, as such, is a key driver of alcohol-related violence. This type of evidence can support objections to the proliferation of take-away bottle shops.
 
A review of the Liquor Act 2010 was conducted at the end of 2013. The ACT Government response is pending.

 back to top


How effective are interventions designed to encourage heroin users to change from injecting to inhaling the drug?
 
The available data suggest that the risk of accidental overdose when smoking heroin is substantially reduced compared to injecting a substance of unknown purity and quality. Moreover, the risk of transmitting HIV, Hepatitis B or C via blood contact is considerably reduced when smoking heroin rather than when injecting it intravenously.’ A multi-centre survey in drug consumption rooms in five German cities examined the extent to which a change in the consumption method can be supported by making new equipment for drug use available. Participants received ‘SMOKE-IT!’ packs that contained new heroin smoking foils, as well as information about inhaling practices. The quantitative data collection was aided by a written questionnaire completed at three different stages in 2012. The findings of the survey were that ‘The vast majority of the 165 respondents favoured using the foils from the “SMOKE-IT!” packs (82.5%). The survey shows that two-thirds of the sample used the SMOKE-IT foils for inhaling instead of injecting. Almost six out of ten said that smoking was healthier than injecting. Thirty-five percent of the participants named the reduced risk of a hepatitis or HIV infection as a particularly important factor. A third of the respondents used the smoking foils to avoid the danger of an overdose’. The researchers concluded that ‘Targeted media and personal intervention in association with the dispensation of attractive drug use equipment can motivate opiate users to change their method of drug use. The main reason for inhalative use is that it is significantly less dangerous, measured by the indicators “overdose” and “viral infections”. All drop-in centres should expand their syringe-exchange services to include the dispensation of smoking foils’.
 
Stöver, HJ & Schaffer, D 2014, ‘SMOKE IT! Promoting a change of opiate consumption pattern - from injecting to inhaling’, Harm Reduction Journal, vol. 11, no. 1, p. 18.
 
Comment: Way back in 1997 Dr Alex Wodak published a paper titled ‘Injecting nation: achieving control of hepatitis C in Australia’. It introduced the acronym NIROA meaning non-injecting routes of administration, arguing that NIROA is achievable, could help control hepatitis C and reduce the incidence of drug overdose deaths. Unfortunately, Australia’s public health community has not been as active as their colleagues abroad in promoting NIROA relating to illicit opioids. This German study might encourage us to revisit NIROA?

 back to top

To what extent do people who inject drugs understand Australian drug trafficking laws?

A Drug Policy Modelling Program project examined the extent to which people who regularly inject drugs understand legal thresholds for drug trafficking, over which possession of an illicit drug is deemed ‘trafficking’ as opposed to possession for ‘personal use’. The researchers found that ‘Most Illicit Drug Reporting System participants (77%) correctly said that quantity possessed would affect charge received. However, only 55.8% nominated any specific quantity that would constitute an offence of supply, and of those 22.6% nominated a wrong quantity, namely a quantity that was larger than the actual quantity for supply’. They concluded that ‘People who regularly inject drugs have significant gaps in knowledge about Australian legal thresholds for drug trafficking, particularly regarding the actual threshold quantities. This suggests that there may be a need to improve education for this population. Necessity for accurate knowledge would also be lessened by better design of Australian drug trafficking laws’.
 
Hughes, CE, Ritter, A, Cowdery, N & Sindicich, N 2014, ‘“Trafficking” or “personal use”: do people who regularly inject drugs understand Australian drug trafficking laws?’, Drug and Alcohol Review, online ahead of print.
 
Comment: On 17 April 2014, changes announced by the Attorney General Simon Corbell MLA to the Criminal Code (Controlled Drugs) Legislation Amendment Regulation 2014 came into effect. The changes are adjusting some of the legal thresholds that differentiate between personal use offences and trafficking offences for some drugs, moving to a mixed weight assessment of prohibited drug quantities and banning a range of new psychoactive substances.
 
Legal thresholds set a total weight limit for a drug. Possession under that threshold weight is assumed to be for personal use and above it for trafficking. The ACT thresholds for MDMA and cocaine had been set too low, putting Canberrans possessing small quantities of these drugs simply for personal use at risk of being charged with trafficking. Meanwhile, the thresholds for heroin and methamphetamine needed to be reduced to ensure that drug traffickers were not being treated simply as drug users. No change has been made to the thresholds for cannabis. The new thresholds more closely align with drug use and purchasing patterns in the ACT. They also give the police, the prosecution, the judiciary, people who use illicit drugs, and the public greater confidence that the penalties match the seriousness of the offences.

 back to top

What is the latest evidence on the health aspects of nicotine-containing electronic cigarettes?
 
A review of the literature on the use, content and safety of electronic cigarettes (EC), and on their effects on users, assessed their potential for harm or benefit and identified evidence that can guide policy work in this area. It revealed that ‘EC aerosol can contain some of the toxicants present in tobacco smoke, but at levels which are much lower. Long-term health effects of EC use are unknown but compared with cigarettes, EC are likely to be much less, if at all, harmful to users or bystanders. EC are increasingly popular among smokers, but to date there is no evidence of regular use by never-smokers or by non-smoking children. EC enable some users to reduce or quit smoking…In the United Kingdom, where the use of EC to assist smoking cessation has now overtaken use of NRT [nicotine replacement therapy], and detailed figures are available on month-to-month changes in smoking behaviour, the rise in EC use has been accompanied by an increase in successful quit attempts and a continuing decrease in smoking prevalence.’
 
The researchers conclude that ‘Allowing EC to compete with cigarettes in the market-place might decrease smoking-related morbidity and mortality. Regulating EC as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on current evidence. Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to EC as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use.’
 
Hajek, P, Etter, J-F, Benowitz, N, Eissenberg, T & McRobbie, H 2014, ‘Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit’, Addiction, online ahead of print, free full text in August 2014: http://onlinelibrary.wiley.com/doi/10.1111/add.12659/abstract
 
Comment: This is a well-balanced review published in the world’s leading ATOD journal, Addiction. As such, its conclusions about what advice health professionals might give to people asking about the use of e-cigs are helpful, as are its suggestions to policy-makers about the implications of the evidence. Note that it remains illegal, throughout Australia, to sell e-cigs containing nicotine and, in some jurisdictions, it is illegal to possess such products.

 back to top

Are we getting closer to a useful way of understanding ‘recovery’?
 
The idea of recovery has long been at the core of AOD treatment and, in recent years, the recovery movement has sought to give the concept greater prominence, and to highlight its implications for policy, funding, practice, etc. The authors highlight the diversity, and looseness, of many of the existing definitions of ‘recovery’, and aim in this article ‘…to stimulate further thought and debate by offering a theoretical basis for, and description of, the recovery construct that we hope enhances clarity and measurability, and stimulates further discussion. To accomplish this goal, we review current definitions of the recovery construct and offer a simplified bi-axial formulation and definition grounded in stress and coping theory…which mirrors, conceptually, original formulations of the addiction syndrome…’.
 
The definition presented is ‘Recovery is a dynamic process characterized by increasingly stable remission resulting in and supported by increased recovery capital and enhanced quality of life’. These two axes are described as follows: ‘…the key substance-related component, “remission”, is placed on one axis (defined broadly along a timeline of early remission, stable remission, sustained remission etc.); on the other axis, similar to Edwards and Gross’ (1976) formulation of the addiction syndrome, is placed the positive related consequences ensuing from, as well as supporting, the achievement of these levels of remission’. The article points to aspects missing from this approach, while expressing hope that it helps to clarify and operationalise the recovery concept.
 
Kelly, JF & Hoeppner, B 2014, ‘A biaxial formulation of the recovery construct’, Addiction Research & Theory, online ahead of print.
 
Comment: The controversy surrounding the recovery movement, observed in Australia in recent years, seems to be in remission. This article is helpful in presenting a solid way of thinking about recovery and its components, building on established stress and coping theory.

 back to top

New Reports

Australian Institute of Health and Welfare 2014, National Drugs Strategy Household Surveys: highlights from the 2013 survey, Australian Institute of Health and Welfare, http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/ .
Media release http://www.aihw.gov.au/media-release-detail/?id=60129548108
 
Cook, C, Bridge, J, McLean, S, Phelan, M & Barrett, D 2014, The funding crisis for harm reduction: donor retreat, government neglect and the way forward, International Harm Reduction Association, http://www.ihra.net/files/2014/07/20/Funding_report_%C6%92_WEB_(2).pdf .
 
Gao, C, Ogeil, R & Lloyd, B 2014, Alcohol’s burden of disease in Australia, FARE and VicHealth in collaboration with Turning Point, Canberra.
http://www.turningpoint.org.au/site/DefaultSite/filesystem/documents/EMBARGO-FARE-Alcohol-Burden-of-disease-Report.pdf
 
Higgins, D & Davis, K 2014, Law and justice: prevention and early intervention programs for Indigenous youth, Closing the Gap Clearinghouse Resource Sheet no. 34, Australian Institute of Health and Welfare & Australian Institute of Family Studies, Canberra & Melbourne.
http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129548207
 
Hughes, C, Payne, J, Macgregor, S & Pockley, K 2014, ‘A beginner’s guide to drugs and crime: does one always lead to the other?’, Of Substance, vol. 12, no. 2, pp. 26-9, http://www.ofsubstance.org.au/magazine/latest-issue/1331-july-2014-vol-12-no-2
 
Comment: Dr Jason Payne, is a Senior Lecturer at the ANU College of Arts and Social Sciences
 
Hutchinson, D, Mattick, R, Braunstein, D, Maloney, E & Wilson, J 2014, The impact of alcohol use disorders on family life: a review of the empirical literature, Technical Report no. 325, National Drug & Alcohol Research Centre, UNSW, Sydney, https://ndarc.med.unsw.edu.au/resource/impact-alcohol-use-disorders-family-life-review-empirical-literature
 
Iversen, J, Chow, S & Maher, L 2014, Australian NSP Survey National Data Report 2009– 2013, The Kirby Institute, University of New South Wales, Sydney, http://kirby.unsw.edu.au/surveillance/australian-nsp-survey-national-data-report-2009%E2%80%93-2013
 
Open Society Foundations 2014, To protect and serve: how police, sex workers, and people who use drugs are joining forces to improve health and human rights, Open Society Foundations, New York, http://www.opensocietyfoundations.org/reports/protect-and-serve
 
Pennay, A, Manton, E, Savic, M, Livingston, M, Matthews, S & Lloyd, B 2014, Prohibiting public drinking in an urban area: determining the impacts on police, the community and marginalised groups, Monograph Series no. 49, National Drug Law Enforcement Research Fund, Canberra, http://ndlerf.gov.au/publications/monographs
 
Sindicich, N, Grigg, J & Burns, L 2014, Contamination or excess? Stimulant overdose in regular psychostimulant users, EDRS Drug Trends Bulletin, National Drug and Alcohol Research Centre, Sydney, https://ndarc.med.unsw.edu.au/resource/contamination-or-excess-stimulant-overdose-regular-psychostimulant-users
 
The Kirby Institute 2014, HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2013, The Kirby Institute, The University of New South Wales, Sydney, https://kirby.unsw.edu.au/news/annual-hiv-surveillance-report-2014
 
World Health Organization 2014, Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, World Health Organization, Geneva, http://www.who.int/hiv/pub/guidelines/keypopulations/en/
 
Comment: We note the new recommendation:
 
‘People likely to witness an opioid overdose should have access to naloxone and be instructed in its use for emergency management of suspected opioid overdose’ (p. xviii).
 
 back to top