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 long-running Personality and Total Health (PATH) Through Life project, a longitudinal study of people in Canberra and Queanbeyan that began in 1999, 4,160 people (84% of baseline) were re-interviewed after 8 years and 4,126 reported their self-harm status. Self-harm in the past year was reported by 8.2% of participants (males 9.3% and females 7.3%). Tobacco smoking, cannabis use and drinking alcohol at a level likely to cause dependence were independently predictive of past year self-harm.
The authors concluded that ‘Owing to the hidden nature of self-harming in non-clinical populations, its true burden is difficult to assess. Nevertheless, this analysis and other published community-based studies suggest that self-harm is reasonably prevalent in the general population. Substance use and negative affective states, such as depression and anxiety, are quite consistently associated with self-harm in non-clinical samples. These findings provide some guidance in identifying those in the general population who are at increased risk of self-harm. Reducing these risk factors could be an important strategy in preventing self-harm behaviour in the general population’ (p. 218).
Moller, CI, Tait, RJ & Byrne, DG 2013, ‘Self-harm, substance use and psychological distress in the Australian general population’,
, vol. 108, no. 1, pp. 211-20.
Stakeholders are progressing a proposal to expand and strengthen alcohol, tobacco and other drug (ATOD) research in the ACT and region, and enhance ATOD policy and its implementation, through establishing a structured collaboration, such as a Centre for ATOD Research, Policy and Practice in the ACT. For more information please see the
. If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on
Most of the reports and research items referenced below are available from the Alcohol and Other Drug Council of Australia’s
Does the provision of overdose education and nasal Naloxone distribution reduce opioid overdose death rates?
A US study evaluated the impact of state-supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilisation in Massachusetts. The program was implemented among opioid users at risk of overdose, social service agencies’ staff, and families and friends of opioid users in nineteen Massachusetts communities where there had been at least five fatal opioid overdoses in ea
ch of the years 2004 to 2006. OEND programs trained 2,912 potential bystanders who reported 327 rescues. ‘Of 327 rescue attempts using naloxone reported by 212 individuals, 87% (286/327) were reported by users. Most rescue attempts occurred in private settings. The rescuer and the person who overdosed were usually friends. Naloxone was successful in 98% (150/153) of the rescue attempts. For the three rescue attempts where naloxone was not successful, the people who overdosed received care from the emergency medical system and survived.’
‘Compared with no implementation, both low and high implementation of OEND were associated with lower rates of opioid related deaths from overdose, when adjusted for demographics, utilisation of addiction treatment, and doctor shopping...Rates of opioid related visits to an emergency department and admission to hospital were not significantly different in communities with low or high implementation of OEND.’
The researchers concluded that ‘This study provides strong support for the public health agency policy and community based organisation practice to implement and expand OEND programs as a key way to address the opioid overdose epidemic. Two features of the Massachusetts OEND programs that supported broad implementation include the use of an nasal naloxone delivery device and the use of a standing order issued by the health department, which allowed non-medical personnel to deliver OEND. These features may enable broader implementation with greater impact as more communities implement OEND.’
Walley, AY,
et al. 2013, ‘Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis’,
BMJ: British Medical Journal, vol. 346, no. 7894, p. f174.
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Does the provision of free stop-smoking treatments encourage more people to attempt to quit?
A program was introduced in the Netherlands in 2011 whereby financial reimbursement of pharmacology for smoking cessation was provided in combination with counselling. An evaluation of the impact of this program found that ‘In 2010, a total of 848 smokers started treatment. In 2011, 9091 smokers enrolled. In 2012, the number of enrollees dropped dramatically, even below the 2010 level. In addition, the proportion of smokers in the population dropped from 27.2% in 2010 to 24.7% in 2011’. The evaluator concluded ‘The introduction of a national reimbursement system in the Netherlands was associated with a more than 10-fold increase in telephone counselling for smoking cessation and suggests that reimbursement for smoking cessation contributed to improvements in public health’.
Willemsen, MC,
et al. 2013, ‘Population impact of reimbursement for smoking cessation: a natural experiment in the Netherlands’,
Addiction, vol. 108, no. 3, pp. 602-4.
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Does the introduction of smoke-free legislation reduce asthma in children?
Smoke-free legislation covering all enclosed public places and workplaces was implemented in England on July 1, 2007. A study using Hospital Episodes Statistics data from April 2002 to November 2010 looked at all children (aged ≤14 years) having an emergency hospital admission with a principal diagnosis of asthma. The findings were that ‘Before the implementation of the legislation, the admission rate for childhood asthma was increasing by 2.2% per year…After implementation of the legislation, there was a significant immediate change in the admission rate of −8.9%...and change in time trend of −3.4% per year…This change was equivalent to 6802 fewer hospital admissions in the first 3 years after implementation. There were similar reductions in asthma admission rates among children from different age, gender, and socioeconomic status groups and among those residing in urban and rural locations. The researcher concludes that ‘These findings confirm those from a small number of previous studies suggesting that the well-documented population health benefits of comprehensive smoke-free legislation appear to extend to reducing hospital admissions for childhood asthma’.
Millett, C,
et al. 2013, ‘Hospital admissions for childhood asthma after smoke-free legislation in England’,
Pediatrics, online ahead of print.
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What challenges are proposed to the effectiveness of population-based medical intervention for smoking cessation?
A study published in January this year that received widespread media attention across the globe aimed ‘To examine the population effectiveness of nicotine replacement therapies (NRTs), either with or without professional counselling, and provide evidence needed to better inform healthcare coverage decisions’. It was a prospective cohort study conducted in three waves on a probability sample of 787 Massachusetts adult smokers who had recently quit smoking. Its finding that ‘…persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts’ led the authors to recommend that ‘Cessation medication policy should be made in the larger context of public health, and increasing individual treatment coverage should not be at the expense of population evidence-based programs and policies’.
Alpert, HR,
et al. 2013, ‘A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation’,
Tobacco Control, vol. 22, no. 1, pp. 32-7.
Comment: This study is included here owing to the great degree of attention that it received in the media. Most reportage was on the theme that NRT is not better than non-medicated quitting when it comes to maintaining abstinence from tobacco. Commentaries on the article published at the journal’s website, and consultation with leading Australian tobacco researchers, suggest that the findings of this study are to be treated with caution. This reflects concerns with the study design including, especially, recall bias on the part of respondents. Taking the body of evidence as a whole, expert opinion remains firmly in support of NRT (especially nicotine patches) as an effective aid to quitting smoking and reducing the risk of relapse.
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How much does smoking reduce life expectancy?
Information obtained from interviews over the period 1997 to 2004 with over 200,000 people in the USA about their smoking histories was related to causes of death. This study revealed that ‘The overall mortality among smokers of both sexes in the United States is about three times as high as that among otherwise similar persons who never smoked, and the smokers lose, on average, at least a decade of life. The women in this cohort represent the first generation of women in the United States in which those who smoked began early in life and smoked for decades, and the risks of death for these women are about 50% greater than the risks reported in the 1980s studies’. The researcher points out ‘Because the absolute risks of continuing to smoke are large, the absolute benefits of cessation will also be large, particularly as death rates among those who have never smoked continue to fall…Cessation at around 40 years of age results in approximately a 90% reduction in the excess risk of death associated with continued smoking in later middle age and old age. That is not to say, however, that it is safe to smoke until 40 years of age and then stop, for the remaining excess risk of about 20%...is substantial; it means that about one in six of these former smokers who dies before the age of 80 years would not have died if their death rates had been similar to those for persons who had never smoked who were similar in educational levels, adiposity, and alcohol use’.
Jha, P,
et al. 2013, ‘21st-century hazards of smoking and benefits of cessation in the United States’,
New England Journal of Medicine, vol. 368, no. 4, pp. 341-50.
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How long can THC be detected in the blood of chronic daily cannabis smokers?
A strong evidence base exists showing that people who drive soon after smoked cannabis are at a higher risk of having a motor vehicle crash than drivers who have not consumed the drug, especially when they have also consumed alcohol. Insufficient data are available, however, to relate THC levels in blood and/or saliva to impairment levels. Accordingly, the ACT, the Australian states and the NT, along with a small number of overseas jurisdictions, have legislated to make it an offence to drive with any detectable level of THC in the body.
A key question is how long after consuming cannabis can it be detected in the body? This study, the first of its kind, involved placing 30 volunteer chronic daily cannabis smokers in a secure facility for a month and measuring blood THC levels over that time. While in the secure facility they had no access to the drug: they were totally abstinent for the full month.
The researchers found that the THC levels in the volunteers’ blood decreased gradually. Only 1 of 11 participants was negative at 26 days, 2 of 5 remained THC-positive (0.3 μg/L) for 30 days, and 5.0% of participants had THC ≥1.0 μg/L for 12 days. They concluded that ‘Cannabinoids can be detected in blood of chronic daily cannabis smokers during a month of sustained abstinence. This is consistent with the time course of persisting neurocognitive impairment reported in recent studies’.
Bergamaschi, MM,
et al. 2013, ‘Impact of prolonged cannabinoid excretion in chronic daily cannabis smokers’ blood on per se drugged driving laws’,
Clinical Chemistry, vol. 59, no. 3, pp. 519-26.
Comment: This study provides information to pass on to heavy, frequent cannabis smokers about the persistence of THC in their bodies, meaning that they are at risk of it being detected in roadside drug testing for long periods after consumption. It also implies that their risk of involvement in a motor vehicle crash remains elevated for some time after cessation of cannabis use.
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Do smoke-free policies in drinking venues reduce the likelihood of alcohol use disorders?
Researchers in the USA used data from the National Epidemiological Survey on Alcohol and Related Conditions to examine whether implementation of smoke-free legislation in bars and restaurants predicted changes in alcohol use disorders (AUD). They found that ‘Individuals in states that implemented smoke-free legislation in drinking venues had a higher likelihood of AUD remission compared to participants in states without such legislation. Among public drinkers, smoke-free legislation was associated with a greater likelihood of AUD remission and a lower likelihood of AUD onset. These findings were especially pronounced among smokers, men, and younger age groups’. They state ‘These results demonstrated the protective effects of smoke-free bar and restaurant policies on the likelihood of AUDs; furthermore, these findings call attention to an innovative legislative approach to decrease the morbidity and mortality associated with AUDs’.
Young-Wolff, KC,
et al. 2013, ‘Smoke-free policies in drinking venues predict transitions in alcohol use disorders in a longitudinal U.S. sample’,
Drug and Alcohol Dependence, vol. 128, no. 3, pp. 214-21.
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Has the time come to treat the alcoholic beverages industry the same as we treat the tobacco industry?
Over many years people engaged in policy work in the ATOD field have refused to negotiate with the tobacco industry about tobacco control policies—instead the controls are simply imposed upon them. In contrast, alcohol policy development has generally included negotiations with the alcoholic beverage industry groups, even to the extent of having them as full members of policy advisory committees.
This approach is now being challenged by prominent Australian researchers and advocates. In an opinion piece, Wayne Hall and Mike Daube have pointed to the many similarities between these two industries, similarities that work directly against the health and well-being of the Australian community. They point out that, ‘In Australia, the most effective and efficient ways to reduce alcohol-related harm—increasing taxation, and restricting availability and alcohol promotion—are politically unpopular. This mismatch between evidence and public support says much about the successful lobbying of the alcohol industry and its “independent” apologists…Around four-fifths of all alcohol consumed in Australia by people between the ages of 14 and 24 is used in ways that put drinkers and others’ health at risk. This is why the industry opposes policies that will reduce alcohol-related harm—they will also reduce their profits.
They go on to point out that the two industries are intertwined (tobacco manufacturers also own alcohol producers; overlapping board memberships) and that both use the tactic of funding so-called independent bodies such as DrinkWise to undermine evidence-based policies. They conclude
‘The road to effective tobacco control took over 60 years and had to happen in the face of concerted industry obfuscation of the health risks of smoking and opposition to effective public policies. Public health advocates have learned valuable lessons from that success that should reduce the time taken to introduce effective policies that will substantially reduce the major public health problems caused by alcohol use in Australia.’
Hall, W & Daube, MM 2013, ‘Big alcohol and big tobacco – boozem buddies? ‘,
The Conversation, 28 February,
https://theconversation.edu.au/big-alcohol-and-big-tobacco-boozem-buddies-9668.
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How aware are people of electronic cigarettes, and why do people use them?
An analysis of data from the International Tobacco Control Four-Country Survey from almost 6,000 smokers and former smokers in Canada, USA, United Kingdom and Australia examined patterns of electronic nicotine delivery systems (ENDS) awareness, use and beliefs regarding these products. ‘Overall, 46.6% were aware of ENDS (U.S.: 73%, UK: 54%, Canada: 40%, Australia: 20%); 7.6% had tried ENDS (16% of those aware of ENDS); and 2.9% were current users (39% of triers). Awareness of ENDS was higher among younger, non-minority smokers with higher incomes who were heavier smokers. Prevalence of trying ENDS was higher among younger, nondaily smokers with a high income and among those who perceived ENDS as less harmful than traditional cigarettes…79.8% reported using ENDS because they were considered less harmful than traditional cigarettes; 75.4% stated that they used ENDS to help them reduce their smoking; and 85.1% reported using ENDS to help them quit smoking. The researcher concludes that ‘Awareness of ENDS is high, especially in countries where they are legal (i.e., the U.S. and UK). Because the trial was associated with nondaily smoking and a desire to quit smoking, ENDS may have the potential to serve as a cessation aid’.
Adkison, SE,
et al. 2013, ‘Electronic nicotine delivery systems: international tobacco control four-country survey’,
American Journal of Preventive Medicine, vol. 44, no. 3, pp. 207-15.
Comment: The electronic cigarettes sold in Australia are prohibited, by law, from containing nicotine, in contrast to the situation abroad. It is understood that some Australian consumers illegally purchase nicotine-containing e-cigarettes over the internet and import them via the mail. The evidence is building as to the effectiveness of e-cigarettes that contain nicotine (and to a lesser degree those free of nicotine) as aids to quitting tobacco consumption and maintaining abstinence from tobacco cigarettes.
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Can synthetic cannabinoids cause kidney damage?
A recent
Morbidity and Mortality Weekly Report from the US Centers for Disease Control and Prevention states that ‘Most reports of adverse events related to SCs [synthetic cannabinoids]…have been neurologic, cardiovascular, or sympathomimetic’. It describes ‘Sixteen cases of acute kidney injury following exposure to SCs…identified in six states with illness onset during March 16-December 7, 2012. Patients ranged in age from 15 to 33 years; 15 were male, and none reported a history of kidney disease’. This has implications for public health practice, CDC reported: ‘Novel drugs of abuse are emerging continuously. SCs often are packaged in colorful wrappers bearing labels such as “not for human consumption” or “incense,” although health professionals and legal authorities know these products are smoked like marijuana. Law enforcement officials, public health officials, clinicians, scientists, and the members of the public should be aware of the potential for adverse health effects posed by SCs’.
Centers for Disease Control and Prevention (USA) 2012, ‘Acute kidney injury associated with synthetic cannabinoid use—multiple states, 2012’,
MMWR; Morbidity and Mortality Weekly Report, vol. 62, no. 6, pp. 93-8.
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Does increasing the price of alcohol reduce harms associated with high-intensity drinking?
An analysis of data on patterns of alcohol consumption and demographic data from the Australian National Drug Strategy Household Surveys of 2001, 2004 and 2007 revealed that ‘Australian drinkers achieved an average reduction in their overall level of alcohol consumption mostly by increasing the number of occasions on which they did not drink at all and by decreasing the number of occasions of low-intensity drinking, rather than by significantly reducing their frequency of moderate- and high-intensity drinking. For Australia, and countries with a similar pattern of predominant high-intensity drinking, taxation policies that increase the price of alcohol and are very efficient at decreasing harms associated with reduced average consumption may be relatively inefficient at decreasing alcohol harms associated with high-intensity drinking’. The analyst concludes that ‘complementary legislation, such as earlier closing times for venues that sell alcohol…may be required to curb the frequency of high-intensity consumption’.
Byrnes, J,
et al. 2013, ‘Can harms associated with high-intensity drinking be reduced by increasing the price of alcohol?’,
Drug and Alcohol Review, vol. 32, no. 1, pp. 27-30.
Comment: For some decades the key research evidence underpinning alcohol policies has been the single distribution theory which is based upon the strong relationship between the average (per capita) consumption of alcohol and the prevalence of heavy drinking in a society. The policy implication has been to act at the community level to move the consumption curve to the left, i.e. to reduce the average consumption level across society generally. Byrnes
et al.’s study is one of a number that challenges this assumption, giving support to policies that place more emphasis on patterns and places of drinking associated with alcohol-caused harms, rather than focusing primarily on reducing average consumption.
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Does alcohol increase the likelihood of dying from cancer?
Meta-analyses of alcohol-attributable cancer mortality and years of potential life lost in the USA found that ‘alcohol use accounted for approximately 3.5% of all cancer deaths, or about 19 500 persons, in 2009. It was a prominent cause of premature loss of life, with each alcohol-attributable cancer death resulting in about 18 years of potential life lost. Although cancer risks were greater and alcohol-attributable cancer deaths more common among persons who consumed an average of more than 40 grams of alcohol per day [four Australian standard drinks]…, approximately 30% of alcohol-attributable cancer deaths occurred among persons who consumed 20 grams or less of alcohol per day. About 15% of breast cancer deaths among women in the United States were attributable to alcohol consumption…[while] oral cavity and pharyngeal, laryngeal, and esophageal cancers account for the majority of alcohol-related cancer deaths among men’. The researchers conclude that ‘Reducing alcohol consumption is an important and underemphasized cancer prevention strategy’.
Nelson, DE,
et al. 2013, ‘Alcohol-attributable cancer deaths and years of potential life lost in the United States’,
American Journal of Public Health, vol. 103, no. 4, pp.642-48.
Comment: Following on from the insights derived from the previous item in this eBulletin, this study focusses on cancer risk at different levels of alcohol consumption. Were it also to take account of patterns of drinking, the relative risks observed could be even higher in some population groups.
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Do people who inject drugs have the same attitudes to drugs policy as the general community?
A Drug Policy Modelling Program project analysed data from the 2011 Australian Illicit Drug Reporting System Survey (IDRS) and the 2010 National Drug Strategy Household Survey (NDSHS) to investigate how people who inject drugs perceive drug policy in Australia and whether they have similar or different opinions to the broader general population. The study revealed that ‘There was a high level of support among IDRS participants for measures to reduce the problems associated with heroin, but heterogeneity in levels of support for legalisation and penalties for sale/supply across different drug types. Differences between the opinions of the IDRS sample and the NDSHS sample were identified regarding support for harm reduction, treatment, legalisation and penalties for sale/supply’. The researchers concluded that ‘These findings provide a springboard for further investigation of the attitudes of people who use illicit drugs towards drug policy in Australia, and challenge us to conceptualise how the opinions of this community should be solicited, heard and balanced in drug policy processes’.
Lancaster, K,
et al. 2013, ‘Public opinion and drug policy in Australia: engaging the “affected community”‘,
Drug and Alcohol Review, vol. 32, no. 1, pp. 60-6.
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How effective is outpatient counseling after treatment in reducing methamphetamine use and improving mental health?
The NSW Stimulant Treatment Program (STP) consists of two dedicated clinics which provide outpatient counselling, in conjunction with education and support for clients of methamphetamine treatment and their significant others. A study of outcomes for methamphetamine users who received outpatient counselling through the STP found that ‘There were statistically significant reductions in psychotic symptoms, hostility and disability associated with poor mental health. There was no change in other drug use, crime or HIV risk behaviour. Reductions in methamphetamine were more common among younger participants, those who had no history of drug treatment and those without concurrent heroin use’. The researchers recommended improved treatment responses to address polydrug use and other harms within in this population.
McKetin, R,
et al. 2013, ‘Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia’,
Drug and Alcohol Review, vol. 32, no. 1, pp. 80-7.
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New Reports
Alcohol Health Alliance UK 2013, Health First: an evidence-based alcohol strategy for the UK, University of Stirling, Stirling, UK.
Australian Bureau of Statistics 2013, Microdata: Australian Health Survey: first results, 2011-13, ABS, (includes data on alcohol consumption).
Australian National Council on Drugs 2013, Medication-Assisted Treatment for Opioid Dependence (MATOD), 1st Canberra Roundtable Report, August 2012, ANCD, Canberra,
FEAD: Film Exchange on Alcohol & Drugs 2012, Deborah Arnott, Dr Karl Fagerström: tobacco harm reduction, FEAD.
Victoria, Government 2013, Reducing the alcohol and drug toll: Victoria’s plan 2013 - 2017, Department of Health, Victoria, Melbourne.
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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