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.
This paper has been prepared by ACT Health to provide an overview of trends nationally and locally in relation to alcohol consumption and alcohol-related harm.
: ACT Health (2013).
was chosen by the Scientific Program Committee to reflect the changing times and increased pressures faced by the drug and alcohol sector.
The conference will feature an exciting program of international and national speakers, focusing on new treatments, prevention and policy in the areas of drug and alcohol research. With original and innovative work from the field, the program will encourage alternative presentation styles.
The 2014 Scientific Program Committee invites the submission of abstracts for original work in consideration for symposia at the 2014 APSAD Conference.
Key findings from the independent evaluation of the ‘Implementing Expanding Naloxone Availability in the ACT (I-ENAACT)’ Program, 2011-2013 were recently released and generated positive reactions in the media.
The ACT program provides comprehensive overdose management training and naloxone on prescription to be administered by trained peers or family members in the event of an opioid overdose.
The interim evaluation shows the effects of the ACT take-home naloxone program to be overwhelmingly positive. The final evaluation of the program will examine outcome data in more detail and consider key issues related to the remaining evaluation questions.
The ACT Government says a medication given by friends and family members to reverse heroin overdoses has almost certainly saved lives in the territory.
A program that helps family and friends bring heroin users back from the brink of fatal overdose has achieved ''overwhelmingly positive'' results, a review has found.
''The program actually works. Every time I see my kids looking at me and they see that I'm alive, they know and I know that this program works.'' These are the words of a man brought back from the brink of overdose as part of the territory's Naloxone program, launched in early 2012 to help save the lives of heroin users.
One of the key sources of information on alcohol and other drug treatment services is the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS). Publicly funded alcohol and other drug treatment services provide information on treatment episodes for the AODTS NMDS and the
auspices this data collection. The collection began in 2000 and these data have been used to inform state, territory and Australian government policies, a broad range of research activities and treatment service provision.
State, territory and Australian government stakeholders have approved enhancements to the collection, so from 2014 it will:
Some analyses described either require, or would be improved by, future data development activities for this collection.
. If you would like to provide feedback, email AIHW at aod@aihw.gov.au
: Australian Institute of Health and Welfare 2013.
. Drug Treatment Series no. 22. Cat. no. HSE 143 . Canberra: AIHW.
Most of the reports and research items referenced below are available from the Alcohol and Other Drug Council of Australia’s
Note 2: Brief summaries of other research findings are available from the NDSIS national ATOD workforce development portal
Drugfields: Research in Brief.
Please note, from 28 February 2014, all ADCA services will cease. Thus reference services and resources will no longer be available through the National Drugs Sector Information Service (NDSIS).
Would allowing people in opioid replacement treatment to share their methadone or buprenorphine with their partners improve the effectiveness of the treatment?
A study in Norway explored reported practices of, and motivations for, diversion of methadone and buprenorphine, in 12 prison inmates (mostly remandees) who were receiving opioid maintenance treatment [OMT]. They found that ‘All had experienced tight control regimes prior to imprisonment due to varying degrees of “non-compliance” and illicit drug use during treatment. Their acquired norm of sharing with others in a drug using community was maintained when entering OMT. Giving one’s prescription opioids to an individual in withdrawal was indeed seen as an act of helping, something that takes on particular significance for couples in which only one partner is included in OMT and the other is using illicit heroin. Individuals enrolled in OMT might thus be trapped between practicing norms of helping and sharing and adhering to treatment regulations. “Diversion”, as this term is conventionally used, is not typically understood as practices of giving and helping, but may nevertheless be perceived as such by those who undertake them’. They concluded that ‘As we see it, the need to sustain oneself as a decent person in one’s own eyes and those of others through practices such as sharing and helping should be recognized. Treatment providers should consider including couples in which both individuals are motivated for starting OMT’.
Havnes, IA, Clausen, T & Middelthon, A-L 2013, ‘“Diversion” of methadone or buprenorphine: “harm” versus “helping”‘,
Harm Reduction Journal, vol. 10, no. 1, p. 24, free full text at
http://www.harmreductionjournal.com/content/10/1/24.
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‘Addiction and the brain-disease fallacy’
Authors’ abstract:
The notion that addiction is a ‘brain disease’ has become widespread and rarely challenged. The brain disease model implies erroneously that the brain is necessarily the most important and useful level of analysis for understanding and treating addiction. This paper will explain the limits of over-medicalizing—while acknowledging a legitimate place for medication in the therapeutic repertoire—and why a broader perspective on the problems of the addicted person is essential to understanding addiction and to providing optimal care. In short, the brain disease model obscures the dimension of choice in addiction, the capacity to respond to incentives, and also the essential fact people use drugs for reasons (as consistent with a self-medication hypothesis). The latter becomes obvious when patients become abstinent yet still struggle to assume rewarding lives in the realm of work and relationships. Thankfully, addicts can choose to recover and are not helpless victims of their own ‘hijacked brains.’
Satel, S & Lilienfeld, SO 2013, ‘Addiction and the brain-disease fallacy’,
Frontiers in Psychiatry, vol. 4, p. 141, free full text
http://www.frontiersin.org/Journal/10.3389/fpsyt.2013.00141/abstract.
Comment: Research advances in neurobiology, particularly in the USA, are driving a return to the long-discredited ‘brain disease’ way of thinking about substance use disorders. Many commentators are concerned about the implications of this for treatment effectiveness and maintaining human rights.
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Does methamphetamine use increase violent behaviour?
An important study conducted in Sydney and Brisbane examined whether violent behaviour increases during periods of methamphetamine use and whether this is due to methamphetamine-induced psychotic symptoms. It involved nearly three hundred people who were methamphetamine dependent. Violent behaviour was defined as ‘severe hostility in the past month’. The researchers found that ‘There was a dose-related increase in violent behaviour when an individual was using methamphetamine compared with when they were not after adjusting for other substance use and socio-demographics …The odds of violent behaviour were further increased by psychotic symptoms…which accounted for 22-30% of violent behaviour related to methamphetamine use. Heavy alcohol consumption also increased the risk of violent behaviour…and accounted for 12-18% of the violence risk related to methamphetamine use’. The authors concluded that ‘There is a dose-related increase in violent behaviour during periods of methamphetamine use that is largely independent of the violence risk associated with psychotic symptoms’. Note that these findings apply to chronic, dependent methamphetamine users, not to recreational users.
McKetin, R, Lubman, DI, Najman, JM, Dawe, S, Butterworth, P & Baker, AL 2014, ‘Does methamphetamine use increase violent behaviour? Evidence from a prospective longitudinal study’,
Addiction, online ahead of print.
Comment: The authors’ conclusion, quoted above, is a particularly important new finding, drawing attention to the need to have violence management as part of treatment. Unanswered questions remain about violence among people consuming both alcohol and methamphetamine.
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How effective are computer and internet-based interventions in reducing cannabis use?
A meta-analysis of studies of computer and Internet-based interventions for the prevention and treatment of cannabis use assessed the effectiveness of this approach in reducing the frequency of cannabis use. The review ‘identified programs that were effective as preventive interventions, including one that was evaluated within a school setting…suggesting the potential for widespread dissemination. We also found evidence to support their use as “indicated prevention/treatment” including in a cohort with comorbid depression…an important consideration given the prevalence of comorbid substance use and other mental health problems…The use of online delivery has been shown to be cost-effective…with the potential for near zero marginal costs for additional users, although this needs further substantiation...Overall, low threshold Internet-based interventions demonstrate promise for reducing the frequency of cannabis use and the potential to improve accessibility to users’.
Tait, RJ, Spijkerman, R & Riper, H 2013, ‘Internet and computer based interventions for cannabis use: a meta-analysis’,
Drug and Alcohol Dependence, vol. 133, no. 2, pp. 295-304.
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How cost-effective are internet and telephone counselling treatment for smoking cessation?
Researchers in the USA conducted an economic evaluation of the effectiveness of three internet and telephone counselling treatments for smoking cessation: the iQUITT Study, a randomised trial comparing Basic Internet, Enhanced Internet and Enhanced Internet plus telephone counselling at 3, 6, 12 and 18 months. They found that ‘Overall, this study demonstrates that internet and combined internet and telephone treatments are cost-effective, with relatively modest costs per quitter. Increased adherence to each of the interventions—taking advantage of major interactive components—further improved cost-effectiveness. Different modes of intervention may appeal to different smokers and, therefore, it is difficult to recommend one modality over another based solely on moderate differences in cost per quit. However, the results support the inclusion of scalable smoking cessation interventions, similar to those used in this study, into the healthcare delivery system where broad access and adherence could save lives and unnecessary smoking-attributable costs’.
Graham, AL, Chang, Y, Fang, Y, Cobb, NK, Tinkelman, DS, Niaura, RS, Abrams, DB & Mandelblatt, JS 2013, ‘Cost-effectiveness of internet and telephone treatment for smoking cessation: an economic evaluation of The iQUITT Study’,
Tobacco Control, vol. 22, no. 6, p. e11.
Comment: A strong body of evidence now exists supporting the use of modern communication technologies to reach, and cost-effectively treat, potentially large numbers of people with substance use disorders. It could be that, in the not-too-distant future, drug treatment funding bodies will transfer funds from some low cost-effective, face-to-face, treatment modalities to the internet/telephone-based alternatives.
Is there a better way to deal with drug and alcohol offenders?
‘Several new paradigms for dealing with [alcohol and other drug] offenders have recently emerged and are expanding throughout the United States. All of these approaches involve utilizing swift, certain, and modest sanctions, rather than random and severe sanctions, which is the status quo’. The authors have examined three of these approaches - drug courts, Hawaii’s HOPE (Hawaii’s Opportunity Probation with Enforcement), and Dakota 24/7 – and provided guidelines for developing similar cost-effective programs. Elements include: every offender with (1) a demonstrated alcohol or drug misuse problem; or (2) who commits a serious felony or violent crime is required to participate; all participants are monitored with drug testing pre-trial; prior to sentencing, all offenders are evaluated for alcohol, drug and mental health issues using validated tools prior to sentencing; courts prioritise public safety and rehabilitation over longer-term incarceration; courts are educated about the value of community corrections, and provided with the technology necessary to put the ‘supervision’ in community corrections, and given the treatment tools necessary to make it work; every offender placed on supervised release is warned that every violation results in a brief period of imprisonment; offenders are expected to provide restitution for victims as required by law and political realities; and offenders are required to obtain and maintain employment and pay for their monitoring in exchange for the privilege of being on community release.
Sabet, K, Talpins, S, Dunagan, M & Holmes, E 2013, ‘Smart justice: a new paradigm for dealing with offenders’
Journal of Drug Policy Analysis, vol. 6, no. 1.
Comment: During 2013 US Professors Mark Kleiman and Beau Kilmer visited Canberra to discuss with policy-makers and AOD and criminal justice sector workers the conceptual and program advances being made in the USA towards implementing ‘smart justice’. Australia lags far behind, as illustrated by political enthusiasm (in some parts of this country) for mandatory minimum sentences of imprisonment, the antithesis of ‘smart justice’.
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What is the global prevalence and burden of illicit drug use and dependence?
Analysis of data from the Global Burden of Diseases, Injuries and Risk Factors Study 2010 found that ‘Illicit drug dependence directly accounted for 20.0 million DALYs [disability-adjusted life years]…in 2010, accounting for 0.8%...of global all-cause DALYs. Worldwide, more people were dependent on opioids and amphetamines than other drugs. Opioid dependence was the largest contributor to the direct burden of DALYs…The proportion of all-cause DALYs attributed to drug dependence was 20 times higher in some regions than others, with an increased proportion of burden in countries with the highest incomes. Injecting drug use as a risk factor for HIV accounted for 2.1 million DALYs…and as a risk factor for hepatitis C accounted for 502,000 DALYs…Countries with the highest rate of burden (>650 DALYs per 100,000 population) included the USA, UK, Russia and Australia.’ The reviewers state that ‘Illicit drug use is an important contributor to the global burden of disease. Efficient strategies to reduce disease burden of opioid dependence and injecting drug use, such as delivery of opioid substitution treatment and needle and syringe programmes, are needed to reduce this burden at a population scale’.
Degenhardt, L, Whiteford, HA, Ferrari, AJ, Baxter, AJ, Charlson, FJ, Hall, WD, Freedman, G, Burstein, R, Johns, N, Engell, RE, Flaxman, A, Murray, CJL & Vos, T 2013, ‘Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010’,
Lancet, vol. 382, no. 9904, pp. 1564-74.
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What is the global burden of disease attributable to mental and substance use disorders?
Analysis of data from the Global Burden of Diseases, Injuries and Risk Factors Study 2010 revealed that ‘In 2010, mental and substance use disorders accounted for 183.9 million DALYs…or 7.4%...of all DALYs worldwide. Such disorders accounted for 8.6 million YLLs [years of life lost]…and 175.3 million YLDs [years lived with a disability]…Mental and substance use disorders were the leading cause of YLDs worldwide…The burden of mental and substance use disorders increased by 37.6% between 1990 and 2010, which for most disorders was driven by population growth and ageing’. The analysts state that ‘our findings show the striking and growing challenge that these disorders pose for health systems in developed and developing regions. In view of the magnitude of their contribution, improvement in population health is only possible if countries make the prevention and treatment of mental and substance use disorders a public health priority’.
Whiteford, HA, Degenhardt, L, Rehm, J, Baxter, AJ, Ferrari, AJ, Erskine, HE, Charlson, FJ, Norman, RE, Flaxman, AD, Johns, N, Burstein, R, Murray, CJL & Vos, T 2013, ‘Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010’,
Lancet, vol. 382, no. 9904, pp. 1575-86.
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Is it easier to stop smoking with the assistance of behavioural support and medications than with no such aids?
A study in England of over ten thousand smokers who sought to stop smoking found that ‘The use of prescription medication in combination with specialized behavioural support during attempts to quit smoking was associated with the success of such attempts, as was the use of prescription medication with limited support. No such association was detected for NRT [nicotine replacement therapy] bought over the counter’. The conclusion of the researchers was that ‘smokers in England who use a combination of behavioural support and pharmacotherapy in their quit attempts have almost three times the odds of success than those who use neither pharmacotherapy nor behavioural support. Smokers who buy nicotine replacement therapy over the counter with no behavioural support have similar odds of success in stopping as those who stop without any aid’.
Kotz, D, Brown, J & West, R 2014, ‘“Real-world” effectiveness of smoking cessation treatments: a population study’,
Addiction, online ahead of print.
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Has the introduction of plain packaging of cigarettes led to an increase in people seeking to stop smoking?
A study in the ACT and NSW explored the association between the introduction in October 2012 of the plain packaging of tobacco products, and the number of phone calls to the smoking cessation helpline, and compared this to the impact of the introduction of graphic health warnings in March 2006. It found that ‘There was a 78% increase in the number of calls to the Quitline associated with the introduction of plain packaging…This peak occurred 4 weeks after the initial appearance of plain packaging and has been prolonged. The 2006 introduction of graphic health warnings had the same relative increase in calls…but the impact of plain packaging has continued for longer’. The researchers concluded ‘There has been a sustained increase in calls to the Quitline after the introduction of tobacco plain packaging. This increase is not attributable to anti-tobacco advertising activity, cigarette price increases nor other identifiable causes. This is an important incremental step in comprehensive tobacco control’.
Young, JM, Stacey, I, Dobbins, TA, Dunlop, S, Dessaix, AL & Currow, DC 2014, ‘Association between tobacco plain packaging and Quitline calls: a population-based, interrupted time-series analysis’,
Medical Journal of Australia, vol. 200, no. 1, pp. 29-32,
https://www.mja.com.au/journal/2014/200/1/association-between-tobacco-plain-packaging-and-quitline-calls-population-based.
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Are smokers more likely to hide their cigarette packets when in public places since the introduction of plain packaging?
In a study carried out in Melbourne and Adelaide between October and April 2011-2012 (before plain packaging) and 2012-2013 (after the introduction of plain packaging) researchers ‘counted patrons, smokers, and tobacco packs at cafés, restaurants, and bars with outdoor seating. Pack type (fully-branded, plain, or unknown) and orientation were noted. Rates of pack display, smoking, and pack orientation were analysed’. They found that ‘Pack display declined by 15%...driven by a 23% decline in active smoking…Low-SES areas evidenced the greatest increase in pack concealment and the greatest decline in face-up pack orientation’. The researchers concluded ‘Following Australia’s 2012 policy of plain packaging and larger pictorial health warnings on cigarette and tobacco packs, smoking in outdoor areas of cafés, restaurants, and bars and personal pack display (packs clearly visible on tables) declined. Further, a small proportion of smokers took steps to conceal packs that would otherwise be visible. Both are promising outcomes to minimise exposure to tobacco promotion’.
Zacher, M, Bayly, M, Brennan, E, Dono, J, Miller, C, Durkin, S, Scollo, M & Wakefield, M 2014, ‘Personal tobacco pack display before and after the introduction of plain packaging with larger pictorial health warnings in Australia: an observational study of outdoor café strips’,
Addiction, online ahead of print.
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How safe are e-cigarettes?
Authors’ abstract:
Despite the recent popularity of e-cigarettes, to date only limited data is available on their safety for both users and second-hand smokers. The present study reports a comprehensive inner and outer exposure assessment of e-cigarette emissions in terms of particulate matter (PM), particle number concentrations (PNC), volatile organic compounds (VOC), polycyclic aromatic hydrocarbons (PAH), carbonyls, and metals. In six vaping sessions nine volunteers consumed e-cigarettes with and without nicotine in a thoroughly ventilated room for two hours. We analysed the levels of e-cigarette pollutants in indoor air and monitored effects on FeNO release and urinary metabolite profile of the subjects. For comparison, the components of the e-cigarette solutions (liquids) were additionally analysed. During the vaping sessions substantial amounts of 1,2-propanediol, glycerine and nicotine were found in the gas-phase, as well as high concentrations of PM2.5 (mean 197 μg/m3). The concentration of putative carcinogenic PAH in indoor air increased by 20% to 147 ng/m3, and aluminium showed a 2.4-fold increase. PNC ranged from 48,620 to 88,386 particles/cm3 (median), with peaks at diameters 24–36 nm. FeNO increased in 7 of 9 individuals. The nicotine content of the liquids varied and was 1.2-fold higher than claimed by the manufacturer. Our data confirm that e-cigarettes are not emission-free and their pollutants could be of health concern for users and second-hand smokers. In particular, ultrafine particles formed from supersaturated 1,2-propanediol vapor can be deposited in the lung, and aerosolized nicotine seems capable of increasing the release of the inflammatory signalling molecule NO upon inhalation. In view of consumer safety, e-cigarettes and nicotine liquids should be officially regulated and labelled with appropriate warnings of potential health effects, particularly of toxicity risk in children.
Schober, W, Szendrei, K, Matzen, W, Osiander-Fuchs, H, Heitmann, D, Schettgen, T, Jörres, RA & Fromme, H 2013, ‘Use of electronic cigarettes (e-cigarettes) impairs indoor air quality and increases FeNO levels of e-cigarette consumers’,
International Journal of Hygiene and Environmental Health, online ahead of print.
Comment: It is pleasing to see more research published evaluating the health risks of e-cigarettes. The emerging body of evidence suggests that, while these products are not risk-free, the health risks associated with their use is a small fraction of the risks posed by tobacco use.
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Does treatment with a pharmaceutical cannabis extract reduce the severity of cannabis withdrawal symptoms?
No pharmaceutical products are approved in Australia for treating cannabis dependence or withdrawal. The cannabis extract nabiximols (Sativex) is used for treating multiple sclerosis and has been thought to be a potential medication for cannabis withdrawal. A study conducted at the National Cannabis Prevention and Information Centre (NCPIC) evaluated the safety and efficacy of nabiximols in treating cannabis withdrawal with 51 cannabis-dependent treatment seekers on a six-day regime of nabiximols or a placebo. The results were ‘Nabiximols treatment significantly reduced the overall severity of cannabis withdrawal relative to placebo…including effects on withdrawal-related irritability, depression, and cannabis cravings. Nabiximols had a more limited, but still positive, therapeutic benefit on sleep disturbance, anxiety, appetite loss, physical symptoms, and restlessness. Nabiximols patients remained in treatment longer during medication use…Both groups showed reduced cannabis use at follow-up’. The researchers concluded ‘In a treatment-seeking cohort, nabiximols attenuated cannabis withdrawal symptoms and improved patient retention in treatment. However, placebo was as effective as nabiximols in promoting long-term reductions in cannabis use following medication cessation. The data support further evaluation of nabiximols for management of cannabis dependence and withdrawal in treatment-seeking populations’.
Allsop, DJ, Copeland, J, Lintzeris, N & et al. 2014, ‘Nabiximols as an agonist replacement therapy during cannabis withdrawal: a randomized clinical trial’,
JAMA Psychiatry, online ahead of print.
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Is the rate of alcohol consumption by adolescents linked to the density of alcohol outlets in their neighbourhoods?
A 2009 study of a sample of secondary school students from Victoria examined whether the density of alcohol outlets was associated with the rate of the students’ alcohol consumption. Although the researchers found that a greater density of outlets was associated with an increased risk of alcohol consumption, the increases in the density of alcohol outlets were statistically significantly associated with increased risk of alcohol consumption only among adolescents between the ages of 12 years and 14 years.
Rowland, B, Toumbourou, JW, Satyen, L, Tooley, G, Hall, J, Livingston, M & Williams, J 2014, ‘Associations between alcohol outlet densities and adolescent alcohol consumption: A study in Australian students’,
Addictive Behaviors, vol. 39, no. 1, pp. 282-8.
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Is pre-drinking associated with high risk drinking?
Authors’ abstract:
Objective: Pre-drinking entails consuming alcohol before attending licensed venues. We examined the relationship between pre-drinking, intention to get drunk and high-risk drinking among Victorians aged 18–24 years, to consider whether reducing pre-drinking might ameliorate alcohol-related harm.
Methods: Variables within the 2009 Victorian Youth Alcohol and Drugs Survey (VYADS) dataset were analysed and compared with a thematic interpretation of research interviews involving 60 young adults living in Melbourne. High-risk drinking was defined as consuming 11 or more standard drinks in a session at least monthly.
Results: VYADS data show that pre-drinking was a significant predictor of high-risk drinking, even after intention to get drunk was controlled for. The most common explanation provided by interviewees for pre-drinking was because it is cheaper to purchase alcohol at bottle shops than at bars and clubs. This was particularly emphasised by those who drank at a high-risk level.
Conclusions: The study suggests that people pre-drink because they desire to be intoxicated, but also that pre-drinking patterns and product choices exacerbate the likelihood of high-risk drinking. Reducing availability of cheap packaged alcohol has potential to limit both pre-drinking and high-risk drinking among Victorian young adults.
Implications: The study adds weight to calls to implement minimum alcohol pricing in Australia.
MacLean, S & Callinan, S 2013, ‘“Fourteen Dollars for One Beer!” Pre-drinking is associated with high-risk drinking among Victorian young adults’,
Australian and New Zealand Journal of Public Health, vol. 37, no. 6, pp. 579-85, free full text
http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12138/full.
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How effective are phone calls and mobile phone messaging reminders in reducing non-attendance at healthcare appointments?
A 2013 update of a Cochrane systemic review of the effects of reminders in reducing non-attendance at healthcare appointments looked at eight trials involving over 6,000 participants. The findings were that ‘the attendance to appointment rates was 67.8% for the no reminders group, 78.6% for the mobile phone messaging reminders group and 80.3% for the phone call reminders group’. The researchers concluded that ‘mobile phone text messaging reminders increase attendance at healthcare appointments compared to no reminders, or postal reminders. Text messaging reminders were similar to telephone reminders in terms of their effect on attendance rates and cost less than telephone reminders’.
Gurol-Urganci, I, de Jongh, T, Vodopivec-Jamsek, V, Atun, R & Car, J 2013, ‘Mobile phone messaging reminders for attendance at healthcare appointments’, Cochrane Database of Systemic Reviews, vol. 12, p. CD007458,
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007458.pub3/abstract;jsessionid=A0812FA29182205CEBD8E533D21D3B6A.f02t02
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Is buprenorphine-naloxone soluble film more likely to be diverted and injected than other opioid substitution treatments?
Australian researchers compared the diversion and injection of the new formulation of buprenorphine, a buprenorphine-naloxone film product (BNX film), with buprenorphine-naloxone tablets (BNX tablets), mono-buprenorphine (BPN) and methadone (MET) in Australia. They found that ‘Among OST [opioid substitution treatment] clients, recent injecting of one’s medication was similar among clients in all OST types; weekly or more frequent injection of prescribed doses was reported by fewer BNX film clients…than BPN clients…, but at levels similar to those observed among MET and BNX tablet clients. The proportion of BNX film doses injected was lower than that for BPN and BNX tablets, and equivalent to that for MET. The majority of BNX film doses injected by OST clients were unsupervised doses, although some injection of supervised doses of BNX film did occur. The median price of all buprenorphine forms on the illicit market was the same’. They concluded ‘Non-adherence and diversion of the BNX film formulation was similar to MET and BNX tablet formulations; BPN had higher levels of all indicators of non-adherence and diversion’.
Larance, B, Lintzeris, N, Ali, R, Dietze, P, Mattick, R, Jenkinson, R, White, N & Degenhardt, L 2014, ‘The diversion and injection of a buprenorphine-naloxone soluble film formulation’, Drug and Alcohol Dependence, online ahead of print.
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What are the risk factors for relapse for people on buprenorphine maintenance?
American researchers examined the factors associated with relapse and retention during buprenorphine treatment in a sample of opioid dependent outpatients. They found ‘Patients with comorbid anxiety disorders, active benzodiazepine use (contrary to clinic policy), or active alcohol abuse, were significantly more likely to relapse. Patients who relapsed were also more likely to be on a higher buprenorphine maintenance dose’.
Ferri, M, Finlayson, AJR, Wang, L & Martin, PR 2014, ‘Predictive factors for relapse in patients on buprenorphine maintenance’, American Journal on Addictions, vol. 23, no. 1, pp. 62-7.
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Which type of psychoactive substance has the higher risk for fatal driving crashes: alcohol or illicits?
This USA study aimed to determine (a) whether among sober drivers (i.e. blood alcohol concentration (BAC) of zero), being drug positive increases the drivers’ risk of being killed in a fatal crash; (b) whether among drinking drivers (BAC greater than zero) being drug positive increases the drivers’ risk of being killed in a fatal crash; and (c) whether alcohol and other drugs interact in increasing fatal crash risk. It found that ‘For both sober and drinking drivers, being positive for a drug was found to increase the risk of being fatally injured. When the drug-positive variable was separated into marijuana and other drugs, only the latter was found to contribute significantly to crash risk. In all cases, the contribution of drugs other than alcohol to crash risk was significantly lower than that produced by alcohol.’ This led the authors to conclude that ‘Although overall, drugs contribute to crash risk regardless of the presence of alcohol, such a contribution is much lower than that by alcohol. The lower contribution of drugs other than alcohol to crash risk relative to that of alcohol suggests caution in focusing too much on drugged driving, potentially diverting scarce resources from curbing drunk driving.’
Romano, E, Torres-Saavedra, P, Voas, RB & Lace, JH 2014, ‘Drugs and alcohol: their relative crash risk’, Journal of Studies on Alcohol and Drugs, vol. 75, no. 1, pp. 56-64.
Comment: Policy-makers face challenges in setting priorities, particularly when there is insufficient money available to fund the full range of road safety initiatives. Since it is likely that the findings of this study are generalisable to Australia, it can provide guidance as to road safety priority-setting locally. Interventions of proven cost-effectiveness targeting drink driving produce better returns on investments than popular but unproven ones addressing drug driving.
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New Reports
ACT Government, Justice and Community Safety Directorate 2013, September 2013 quarter:
Statistical profile, ACT criminal justice, Justice and Community Safety Directorate,
http://www.justice.act.gov.au/criminal_and_civil_justice/criminal_justice_statistical_profiles .
Although reports in this series have been published for some years, their contents and formats have been substantially extended and improved commencing with the September 13 quarterly report.
Australian Bureau of Statistics 2013,
Australian Aboriginal and Torres Strait Islander Health Survey: first results, Australia, 2012-13 ABS,
http://www.abs.gov.au/ausstats/abs@.nsf/mf/4727.0.55.001.
Australian Library and Information Association 2013,
Worth every cent and more: an independent assessment of the return on investment of health libraries in Australia, ALIA, Deakin, ACT,
http://www.alia.org.au/sites/default/files/Worth-Every-Cent-and-More-FULL-REPORT.pdf.
Mathews, R & Legrand, T 2013,
Risk-based licensing and alcohol-related offences in the Australian Capital Territory, CEPS and FARE, Canberra,
http://www.fare.org.au/wp-content/uploads/2011/07/Risk-based-licensing-and-alcohol-related-offences-in-the-ACT-Final.pdf .
National Alliance for Action on Alcohol (NAAA) 2013,
Benchmarking Australian governments’ progress towards preventing and reducing alcohol-related harm: National Alcohol Policy Scorecard, 2013 results, NAAA, Melbourne,
http://www.actiononalcohol.org.au/downloads/alcohol-policy-scorecard-2013.pdf .
National Drug Strategy 2013,
National Pharmaceutical Drug Misuse Framework for Action (2012-2015): a matter of balance, National Drug Strategy, Canberra,
http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/drug-mu-frm-action .
National Health Performance Authority (Australia) 2013,
Tobacco smoking rates across Australia, 2011–12 (In Focus), National Health Performance Authority, Canberra,
http://www.myhealthycommunities.gov.au/publications .
Nicholas, R, Adams, V, Roche, A, White, M & Battams, S 2013,
A literature review to support the development of Australia’s alcohol and other drug workforce development strategy, National Centre for Education and Training on Addiction, Flinders University, Adelaide,
http://nceta.flinders.edu.au/files/6413/7938/7718/Literature_review_final.pdf.
Substance Abuse & Mental Health Services Administration, Department of Health and Human Services (USA) 2013,
Opioid Overdose Prevention Toolkit, SAMHSA,
http://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/SMA13-4742?WT.mc_id=EB_20131212_SAMHSAStore .
For information on other reports, please visit the ‘
Did you see that report?’ page at the website of the
National Drugs Sector Information Service.
Please note, from 28 February 2014, all ADCA services will cease. Thus reference services and resources will no longer be available through the National Drugs Sector Information Service (NDSIS).
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