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.
ACT Health Minister Simon Corbell MLA spoke about the impact of research and evidence in informing key legislative and policy decisions of the ACT Government. In terms of evidence informed legislative change, specific reference was made to:
Evidence informed policy change was further illustrated by Minister Corbell in outlining the ACT Government’s response to increasing demand for specialist alcohol and other drug services. In the upcoming
will be allocated over four years to strengthen drug treatment capacity in the ACT. Click
Professor Stevens, University of Kent, spoke about what defines drug policy and why it matters. He highlighted the current international controversy surrounding harm reduction as it pertains to drug policy, noting that harm reduction is an accepted concept across many areas of public health. He further noted that the scrutiny has meant that drug harm reduction initiatives are generally well researched.
Professor Stevens spoke about drug policy as social policy, highlighting that the first study looking at socio-economic impacts and disadvantage as key factors influencing drug use was published in 1961. Numerous studies in recent years have gone on to link higher rates of drug use with social factors such as income inequality, high urbanisation, racial segregation and discrimination. Professor Stevens concluded by defining drug policy as ‘all the things we do that affect drug use and harms whether we expect them to or not’. His points in relation to the impact of stigma, discrimination and marginalisation were reinforced by the following presentation by Mr Sione Crawford, illustrating how these impacts are felt and experienced at an individual level by consumers.
In the wake of the successful passage of the Australian federal Narcotic Drug Amendment Act in February 2016 – enabling cultivation and supply of cannabis for medical purposes – Professors Hunt and Kilmer from RAND spoke about the status of various medical and recreational cannabis law reform initiatives across the US.
They shared some key lessons learned from research in the US to inform cannabis law reform initiatives in Australia including:
How common is it for people who inject drugs to stockpile syringes, and how can this be used to reduce risky behaviours?
In a study which was part of the Illicit Drug Reporting System, Australian researchers determined ‘the extent of stockpiling in a sample of Australian PWIDs [people who inject drugs] and assessed whether including stockpiling enhances NSP [needle and syringe program] coverage measures’. They found ‘PWIDs reported syringes procured and given away, total injections in the last month, and syringes currently stockpiled in 2014. They calculated NSP coverage with and without stockpiling to determine proportional change in adequate NSP coverage. They conducted receiver operating characteristic curve analysis to determine whether inclusion of stockpiled syringes in the measure improved sensitivity in discriminating cases and noncases of risky behaviors. Three-quarters of the sample reported syringe stockpiling, and stockpiling was positively associated with nonindigenous background, stable accommodation, no prison history, longer injecting careers, and more frequent injecting. Compared with previous measures, their measure was significantly better at discriminating cases of risky behaviors’. They concluded that ‘Our results could inform NSP policy to loosen restricted-exchange practice, allowing PWIDs greater flexibility in syringe procurement practices, promoting greater NSP coverage, and reducing PWIDs’ engagement in risky behaviors’.
McCormack, AR, Aitken, CK, Burns, LA, Cogger, S & Dietze, PM 2016, ‘
Syringe stockpiling by persons who inject drugs: an evaluation of current measures for needle and syringe program coverage’,
American Journal of Epidemiology, online ahead of print.
Comment: The very welcome May 2016 initiative of the ACT Government to legalise peer distribution of sterile injecting equipment resulted, in part, from the body of research (to which this article belongs) that demonstrates how people who inject drugs care about the health of themselves and their peers, and sometimes engage in syringe stockpiling as part of their pro-health behaviours.
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What has been the effect of the use of drug detection dogs as a tool for illicit drug policing on NSW streets?
A recently published article written by researchers at the Drug Policy Modelling Program provides an historical and descriptive account of the introduction and development of the use of drug detection dogs as a tool for street-level illicit drug policing in NSW. It describes the legal and political context in which drug detection dogs emerged and gained prominence. The authors state that ‘The introduction of drug detection dogs was contingent on the political imperatives at work throughout the 1990s in NSW, and the increased salience of both policing and illicit drugs issues at this time. In documenting the emergence of the use of drug detection dogs from the early 2000s, and the associated legal challenges and rapid legislative responses, the role of third sector organisations and the media in generating debate is notable. Debates concerning the dogs’ effectiveness emerged in the mid- to late-2000s, giving rise to anomalies between policy and evidence’. Concerns raised include ‘the impact that the use of drug detection dogs on the streets of Kings Cross would have for harm minimisation policy and services such as the Medically Supervised Injecting Centre. It was feared that clients might be deterred from entering the Centre…due to the presence of drug detection dogs on the streets outside’. In 2013 concerns were raised about ‘police powers and the disproportionate targeting of the gay and lesbian community when the use of drug detection dogs...following incidents throughout the Mardi Gras festival’.
They comment ‘The more recent legislative developments and public and political debate about drug detection dogs from 2012 to 2014 can be seen in light of this history. By taking a different view which situates decisions and events in their historical and political context, we begin to see the dynamic processes and contingency involved in the development and implementation of particular illicit drugs policing policies over time’.
Lancaster, K, Hughes, C & Ritter, A 2016, ‘“
Drug dogs unleashed”: an historical and political account of drug detection dogs for street-level policing of illicit drugs in New South Wales, Australia’,
Australian & New Zealand Journal of Criminology, online ahead of print.
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Is injectable hydromorphone as effective as injectable pharmaceutical heroin for the treatment of long-term severe opioid use disorder?
Many studies have demonstrated that diacetylmorphine hydrochloride, the active ingredient in heroin, is effective in treating people with long-term severe opioid use disorders who have not responded adequately to methadone or buprenorphine. Canadian researchers implemented a randomised controlled trial in which people who injected illicit heroin were randomly assigned to receive either pharmaceutical grade heroin or hydromorphone.
Over the six months that the trial was conducted, ‘noninferiority [of hydromorphone compared with pharmaceutical heroin] was demonstrated for days of street heroin use in the per-protocol analysis but not in the intent-to-treat analysis. Noninferiority was also demonstrated for total days of any street opioid use in both analyses and hydromorphone had significantly fewer related adverse events.’ This led the researchers to conclude that ‘In jurisdictions where diacetylmorphine is currently unavailable or in patients in whom it is contraindicated or unsuccessful, hydromorphone could be offered as an alternative’.
Oviedo-Joekes, E
et al. 2016, ‘Hydromorphone compared with diacetylmorphine for long-term opioid dependence: a randomized clinical trial’,
JAMA Psychiatry, online ahead of print, open access
http://archpsyc.jamanetwork.com/article.aspx?articleid=2512237.
Comment: Currently, in Australia, hydromorphone can be prescribed as an analgesic but not for the treatment of opioid use disorders. For a number of years the ACT Alcohol, Tobacco and Other Drug Strategy has included supporting an Australian trial of hydromorphone treatment among people who have not benefited from standard treatment for opioid use disorders. The evidence from this Canadian study is compelling. It helps build the case for adding hydromorphone to the list of drugs currently used in the ACT’s opioid substitution treatment program, given that it is not possible, at present, to prescribe pharmaceutical grade heroin in the ACT, despite the conclusive evidence of its treatment effectiveness.
How effective is extended-release naltrexone treatment in preventing relapse to opioid use by criminal justice offenders?
A randomised trial was conducted in five sites in the USA to assess the effectiveness of extended-release naltrexone for the prevention of relapse to opioid dependence by people involved with the criminal justice system. ‘A total of 153 participants were assigned to extended-release naltrexone and 155 to usual treatment. During the 24-week treatment phase, participants assigned to extended-release naltrexone had a longer median time to relapse than did those assigned to usual treatment…At week 78 (approximately 1 year after the end of the treatment phase), rates of opioid-negative urine samples were equal…The rates of other prespecified secondary outcome measures--self-reported cocaine, alcohol, and intravenous drug use, unsafe sex, and reincarceration--were not significantly lower with extended-release naltrexone than with usual treatment. Over the total 78 weeks observed, there were no overdose events in the extended-release naltrexone group and seven in the usual-treatment group’. The researchers concluded that ‘In this trial involving criminal justice offenders, extended-release naltrexone was associated with a rate of opioid relapse that was lower than that with usual treatment. Opioid-use prevention effects waned after treatment discontinuation’.
Lee, JD
et al. 2016, ‘
Extended-release naltrexone to prevent opioid relapse in criminal justice offenders’,
New England Journal of Medicine, vol. 374, no. 13, pp. 1232-42.
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How effective would opioid overdose prevention programs be within residential treatment programs?
Abstract
Background: Patients with opioid use disorders are at an increased risk for overdose death if they had a previous overdose, have co-occurring medical and psychiatric co-morbidity and are high dose opioid users transitioning to relative abstinence or abstinence, i.e. those individuals discharging from drug treatment programs. Despite the success of opioid overdose prevention programs utilising naloxone, residential substance abuse treatment centers often emphasise abstinence-based care for those suffering from addiction and do not adopt harm-reduction approaches such as naloxone education and distribution. This performance improvement project reports the implementation of an opioid overdose prevention program provided to patients and their family members in a residential treatment setting.
Methods: Opioid dependent inpatients (N = 47) along with their family members received overdose prevention training consistent with guidelines established by the Harm Reduction Coalition. Patient family members were queried regarding their awareness of past opioid overdose by the patient. A pre and post training questionnaire based on a 5 point Likert scale assessing ability to recognise overdose, fear of overdose, comfort in assisting with overdose, perception of life-threatening nature of addiction and the value of overdose management was administered. Pre and post scores for each Likert scale were analysed using paired two-tailed t-tests.
Results: Thirty-two percent (32%) of patient family members were aware that the patient had a prior overdose. Statistically significant improvements in the ability of patients and families to recognise an opioid overdose as well as in their comfort to assist with an overdose were demonstrated. The pre- and post-education responses were both notably high for perceived value in learning about overdose and prevention.
Conclusions: Implementation of opioid overdose prevention programs within residential treatment programs, sober living homes and therapeutic communities would be well received and is strongly encouraged.
Pade, P, Fehling, P, Collins, S & Martin, L 2016, ‘
Opioid overdose prevention in a residential care setting: naloxone education and distribution’,
Substance Abuse, online ahead of print.
Comment: The ACT has successfully rolled out its community-based take-home naloxone program. ATODA, CAHMA and others are exploring other opioid overdose prevention opportunities in the ACT, and this could well include prevention programs, of which naloxone could be a part, in residential drug treatment settings.
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How likely are people who use heroin to die prematurely?
Using data from the Australian Treatment Outcome Study cohort over the period 2001-2015, Australian researchers studied mortality rates of 615 people who use heroin. They found that ‘At 2015, 72 (11.7%) of the cohort were deceased…Neither age nor gender associated with mortality…The most common mortality cause was opioid overdose (52.8%)…Accidental overdose…and suicide…accounted for three quarters of YPLL [years of potential life lost] where cause of death was known’. The researchers concluded that ‘YPLL associated with heroin use was a quarter of a century, or close to half a century, depending on the criteria used. Given the prominent role of overdose and suicide, the majority of these fatalities, and the associated YPLL, appear preventable’.
Darke, S, Marel, C, Mills, KL, Ross, J, Slade, T & Tessso, M 2016, ‘
Years of potential life lost amongst heroin users in the Australian Treatment Outcome Study cohort, 2001-2015’, Drug and Alcohol Dependence, vol. 162, pp. 206-10.
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To what extent are e-cigarettes beneficial for people with asthma who formerly smoked tobacco?
Italian researchers undertook a long term prospective assessment of objective and subjective asthma outcomes as well as safety and tolerability in this group of electronic cigarette (EC) users with asthma. They found ‘Eighteen ECs users with mild to moderate asthma were followed up prospectively. Complete data was obtained from sixteen EC users and two relapsers. Significant and stable improvements in respiratory symptoms, lung function, AHR, ACQ, and tobacco consumption were observed in the 16 ECs users with asthma, but no significant changes in exacerbation rates were reported. Similar findings were found in the dual users [asthmatic EC users who are reducing tobacco smoking]’. They concluded ‘This prospective study confirms that EC use ameliorates objective and subjective asthma outcomes and shows that these beneficial effects may persist in the long term. EC use can reverse harm from tobacco smoking in asthma patients who smoke. The evidence-based notion that substitution of conventional cigarettes with EC is unlikely to raise significant respiratory concerns, can improve counseling between physicians and their asthmatic patients who are using or intend to use ECs’.
Polosa, R, Morjaria, JB, Caponnetto, P, Caruso, M, Campagna, D, Amaradio, MD, Ciampi, G, Russo, C & Fisichella, A 2016, ‘
Persisting long term benefits of smoking abstinence and reduction in asthmatic smokers who have switched to electronic cigarettes’,
Discovery Medicine, vol. 21, no. 114, pp. 99-108.
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Is there a role for differential taxes for different risks related to tobacco consumption?
The authors of this Perspective point out that, ‘In a January 2014 report that marked the 50th anniversary of the first Surgeon General's Report on Smoking and Health, acting U.S. Surgeon General Boris Lushniak concluded that the enormous toll of tobacco-induced disease and death is overwhelmingly the result of combustible tobacco use, specifically cigarette smoking. He called for a rapid reduction in the use of combustible products to reduce the related burden of illness. We believe this goal could be achieved by imposing differential taxes on nicotine products—including sharply increased taxes on combustible products’. They point out that, with the rapid uptake of electronic nicotine delivery systems (ENDS, including e-cigarettes) in the USA, some states in that country have introduced ENDS-specific taxes. This leads the authors to suggest that ‘…it’s time to rethink the idea that similar taxes are best practice. We believe that national, state, and local policymakers should consider an approach that differentially taxes nicotine products in order to maximize incentives for tobacco users to switch from the most harmful products to the least harmful ones. Sizable public health benefits could derive from current cigarette smokers’ switching to ENDS and other noncombustible products, including nicotine-replacement therapies (as the one type of nicotine product demonstrated to be safe, nicotine-replacement therapy should not be subject to any excise tax).
The authors acknowledge that there are potential problems with this approach: ‘Decades ago, proposals were floated to tax cigarettes at different rates on the basis of tar and nicotine content. The United Kingdom and New York City adopted this approach, briefly levying special taxes on high-tar cigarettes. As evidence grew that cigarettes with lower tar and nicotine levels were no less dangerous, however, public health authorities realized that a differential taxation strategy was undesirable. Yet today the science supporting a difference in risk between combustible and noncombustible tobacco products is well established.’ They concluded that ‘We believe that implementing differential taxes on nicotine-yielding products on the basis of degree of risk could substantially expedite the move away from cigarette smoking that has occurred during the past half-century, especially now that there are nicotine-yielding products that pose dramatically less danger than combustible tobacco products...Failure to seriously entertain a differential taxation approach may contribute to the prolongation of the epidemic of disease and death caused by smoking.’
Chaloupka, FJ, Sweanor, D & Warner, KE 2015, ‘
Differential taxes for differential risks--toward reduced harm from nicotine-yielding products’,
New England Journal of Medicine, vol. 373, no. 7, pp. 594-7.
Comment: The ACT Government recently legislated to treat ENDS as if they are combustible tobacco products, despite the fact that nicotine-containing ENDS are illegal in the ACT as elsewhere in Australia. In ATODA’s view, this conservative approach fails to adequately acknowledge the evidence about the population health benefits of electronic nicotine delivery systems and the policy instruments available for using them for tobacco smoking cessation, as suggested in this Perspective.
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To what extent can a selective, personality-targeted prevention program reduce alcohol-related harms among adolescent school students?
A randomised controlled trial assessed the effectiveness of Preventure, a selective personality-targeted prevention program, in reducing the uptake of alcohol, the harmful use of alcohol, and alcohol-related harms over a three year period. It involved students from 14 NSW schools who had been screened as high-risk on one of four personality profiles (anxiety sensitivity, negative thinking, impulsivity and sensation seeking). They were assessed five times over a three-year period on frequency of drinking, binge drinking and alcohol-related harms. The findings were that, relative to the students in the control group, those in the Preventure group ‘…displayed significantly reduced growth in their likelihood to consume alcohol…to binge drink…and to experience alcohol-related harms’. The researchers concluded that ‘Findings from this study support the use of selective personality-targeted preventive interventions in reducing the uptake of alcohol, alcohol misuse, and related harms over the long term. This trial is the first to demonstrate the effects of a selective alcohol prevention program over a 3-year period and the first to demonstrate the effects of a selective preventive intervention in Australia’.
Newton, NC, Conrod, PJ, Slade, T, Carragher, N, Champion, KE, Barrett, EL, Kelly, EV, Nair, NK, Stapinski, L & Teesson, M 2016, ‘
The long-term effectiveness of a selective, personality-targeted prevention program in reducing alcohol use and related harms: a cluster randomized controlled trial’,
Journal of Child Psychology and Psychiatry, online ahead of print.
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How widespread is the use of new psychoactive substances by secondary school students in Australia, and what measures could be implemented to minimise increasing use?
A cross-sectional survey was conducted in Australia in 2014 using data collected from over one thousand students from eleven secondary schools. Students completed a self-report questionnaire assessing new psychoactive substances (NPS) use and knowledge, beliefs and intentions to use these substances. NPS users were compared with non-users and illicit drug users, who had not used NPS, in terms of gender, binge drinking, tobacco use, psychological distress and self-efficacy to resist peer pressure. ‘3% reported having ever tried NPS, 2.4% had used synthetic cannabis and 0.4% had used a synthetic stimulant. Analyses revealed that NPS users were more likely to have had an episode of binge drinking in the past 6 months, tried tobacco and had higher levels of psychological distress and lower perceived self-efficacy to resist peer pressure than non-users, but did not significantly differ from users of other illicit drugs.’ The researchers concluded that ‘NPS use appears to be uncommon among Australian school students. Although adolescents that do use these substances did not differ from students that had used traditional illicit drugs, both appear to be higher-risk groups of students than non-users. Their findings suggest that universal education about NPS be incorporated into existing drug prevention programmes, and that targeted NPS prevention may also be warranted among high-risk adolescents’.
Champion, KE, Teesson, M & Newton, NC 2016, ‘
Patterns and correlates of new psychoactive substance use in a sample of Australian high school students’,
Drug and Alcohol Review, vol. 35, no. 3, pp. 338-44.
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How effective are childhood psychosocial interventions in reducing adolescent delinquency, substance use, and antisocial behaviour?
A randomised controlled trial in Zurich, Switzerland, involved 56 schools and 1,675 children. It examined the long-term effects of two childhood universal prevention programs on adolescent delinquency, substance use, and antisocial behaviour: the social-emotional skills program Promoting Alternative Thinking Strategies (PATHS) and the cognitive-behavioral parenting program Triple P. These programs were implemented at ages 7 and 8 years and outcomes were measured at ages 13 and 15 years. The researchers found that ‘Across 13 outcomes related to delinquency, substance use, and antisocial behavior at ages 13 and 15 years, only two non-negligible effects were found. The first was a reduced prevalence of police contacts in the PATHS condition…The second was a difference in competent conflict resolution skills in the combined PATHS + Triple P condition compared to the context…but in the unexpected direction: participants in the combined treatment appeared to be less competent than their control group peers’. The researchers concluded that ‘Even “evidence-based” interventions may have few long-term effects on delinquency, substance use, and antisocial behavior. Our findings add to the small literature on the long-term effectiveness of early universal prevention in field settings’.
Averdijk, M, Zirk-Sadowski, J, Ribeaud, D & Eisner, M 2016, ‘
Long-term effects of two childhood psychosocial interventions on adolescent delinquency, substance use, and antisocial behavior: a cluster randomized controlled trial’,
Journal of Experimental Criminology, vol. 12, no. 1, pp. 21-47.
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How can the knowledge of experts contribute to the development of policy options in relation to methamphetamine consumption and dependency?
A group of researchers based in Australia sought to ‘capture and synthesise the unique knowledge of experts so that choices regarding policy measures to address methamphetamine consumption and dependency in Australia can be strengthened’. They examined ‘perceptions of the: (1) influence of underlying factors that impact on the methamphetamine problem; (2) importance of various models of intervention that have the potential to affect the success of policies; and (3) efficacy of alternative pseudoephedrine policy options…Seventy experts from five groups (i.e. academia (18.6%), government and policy (27.1%), health (18.6%), pharmaceutical (17.1%) and police (18.6%)) in Australia participated in the survey’.
The researchers concluded that ‘A majority of respondents believed that genetic, biological, emotional, cognitive and social factors are the most influential explanatory variables in terms of methamphetamine consumption and dependency. Most experts support the use of preventative mechanisms to inhibit drug initiation and delayed drug uptake. Compared to other policies, Project STOP (which aims to disrupt the initial diversion of pseudoephedrine) appears to be a more preferable preventative mechanism to control the production and subsequent sale and use of methamphetamine. This regulatory civil law lever engages third parties in controlling drug-related crime. The literature supports third-party partnerships as it engages experts who have knowledge and expertise with respect to prevention and harm minimisation’.
Manning, M, Wong, GTW, Ransley, J & Smith, C 2016, ‘
Analysing pseudoephedrine/methamphetamine policy options in Australia using multi-criteria decision modelling’,
International Journal of Drug Policy, online ahead of print.
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How common is it for people to consume energy drinks at the same time as alcohol and drugs, and how likely is this to be harmful?
An Australian study explored the rate of use, harms and correlates of energy drinks (EDs) co-ingested with alcohol and other drugs among a sample of people who regularly use illicit stimulant drugs. The researchers interviewed nearly 700 people who regularly use ecstasy, assessing their use of EDs and drugs over the past six months. They found that ‘Three-quarters of the sample (77%) had recently consumed EDs with other substances, primarily alcohol (70%) and ecstasy (57%). People who consumed ED with alcohol versus those who had consumed ED with ecstasy and with alcohol (only 8% reported only consuming ED with ecstasy) had similar profiles in regards to demographics, drug use, mental health and drug-related problems. Primary motives for consuming ED with alcohol included increased alertness (59%), the taste (25%), to party for longer (23%) and to combat fatigue (16%). One-half (52%) and one-quarter (27%) of participants who consumed EDs with alcohol and with ecstasy respectively had recently experienced adverse outcomes post-consumption, primarily headaches (24% and 11%) and heart palpitations (21% and 14%).’ The researchers concluded that ‘Co-ingestion of EDs with licit and illicit drugs is common among people who regularly use ecstasy and related drugs. Adverse outcomes of co-ingestion suggest that targeted education regarding negative interactive drug effects is crucial for harm reduction’.
Peacock, A, Sindicich, N, Dunn, M, Whittaker, E, Sutherland, R, Entwistle, G, Burns, L & Bruno, R 2016, ‘
Co-ingestion of energy drinks with alcohol and other substances among a sample of people who regularly use ecstasy’,
Drug and Alcohol Review, vol. 35, no. 3, pp. 352-8.
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What is the prevalence of AOD problems among patients presenting to hospital emergency departments, and to what extent does this impose additional costs on the health system?
A study was undertaken over ten days in eight NSW public hospitals to determine the prevalence of alcohol and other drug (AOD) problems and to estimate patterns of utilisation of hospital services, costs of presentations, and admissions for patients with AOD problems. The researchers found that ‘One-third (35%) of the total sample were identified as having problematic AOD use with one in five of these patients requiring a high level of intervention. Those patients requiring a high level of intervention present more often and cost more per presentation. If admitted they were more likely to have longer stays and were also more likely to be admitted to a psychiatric ward and have a longer stay in the ward’. The researchers concluded that ‘This study demonstrates a need for AOD interventions in the emergency department setting, both because it represents an opportunity for intervention in a population in which problems with substance use is highly prevalent, and because there is evidence that AOD imposes additional costs on the health system’.
Butler, K, Reeve, R, Arora, S, Viney, R, Goodall, S, van Gool, K & Burns, L 2016, ‘T
he hidden costs of drug and alcohol use in hospital emergency departments’,
Drug and Alcohol Review, vol. 35, no. 3, pp. 359-66.
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What is the evidence with regard to the use of opioids for chronic non-cancer pain in general medical practice?
A recent article in the
Medical Journal of Australia provides a brief overview of the current evidence to guide opioid use for chronic non-cancer pain in general practice. The authors explain that, ‘as pain becomes chronic, evidence to support ongoing prescription of opioids is lacking. There is increasing pressure to ensure that prescribing opioid analgesics is minimised to reduce not only the risk of dependence and illicit diversion but also the potential harms associated with tolerance, side effects and complications. Frameworks for considering opioid prescribing include assessing suitability of the patient for opioids; initiating a trial of therapy; and monitoring long term use. There is limited evidence of the long term efficacy of opioids for chronic non-cancer pain, and documented clinical consequences beyond addiction include acceleration of loss of bone mineral density, hypogonadism and an association with increased risk of acute myocardial infarction’. They point out that ‘Careful clinical selection of patients can help optimise the evidence-based use of opioids for chronic non-cancer pain’, and recommend that clinicians ‘only treat pain that has been as well defined as possible when non-opioid therapies have not been effective; consider referral to specialist services for assessment if doses are above 100 mg oral morphine equivalent per 24 hours or the duration of therapy is longer than 4 weeks; limit prescribing to only one practitioner; [and] seek an agreement with the patient for the initiation and potential withdrawal of opioids if the therapeutic trial is not effective’.
Currow, DC, Phillips, J & Clark, K 2016, ‘Using opioids in general practice for chronic non-cancer pain: an overview of current evidence’,
Medical Journal of Australia, vol. 204, no. 8, pp. 305-9, open access
https://www.mja.com.au/journal/2016/204/8/using-opioids-general-practice-chronic-non-cancer-pain-overview-current-evidence.
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'Contingency management works, clients like it, and it is cost-effective'
This is the title of an editorial in a recent issue of
The American Journal of Drug and Alcohol Abuse in which the editors introduce two research papers on contingency management as a treatment modality. They point out that ‘Contingency management (CM) programs that arrange reinforcement of biologically verified abstinence are among the most powerful treatments for a wide range of substance use disorders. Nevertheless, these programs are underutilized despite solid scientific support for their ability to produce clinically meaningful reductions in substance use. To better understand this trend, a considerable amount of research, including their own, has focused on evaluating treatment providers’ utilization and opinion of CM approaches.’
Kirby, KC, Benishek, LA & Tabit, MB 2016, ‘
Contingency management works, clients like it, and it is cost-effective’,
The American Journal of Drug and Alcohol Abuse, online ahead of print.
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New Reports
Australian Bureau of Statistics 2016, National Aboriginal and Torres Strait Islander Social Survey, 2014-15 Australian Bureau of Statistics, http://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0.
Australian Institute of Health & Welfare 2016, Chronic disease risk factors, AIHW, http://www.aihw.gov.au/chronic-diseases/risk-factors/.
Ferris, J, Devaney, M, Sparkes-Carroll, M & Davis, G 2015, A national examination of random breath testing and alcohol-related traffic crash rates (2000-2015), Foundation for Alcohol Research and Education, Canberra, http://www.fare.org.au/2015/03/a-national-examination-of-random-breath-testing-and-alcohol-related-traffic-crash-rates-2000-2012/.
Grigg, J, Lenton, S, Scott, J & Barratt, M 2015, Social supply of cannabis in Australia, Monograph no. 59, National Drug Law Enforcement Research Fund, Canberra, http://ndlerf.gov.au/publications/monographs.
McFadden Consultancy 2016, Research report: The New Zealand Drug Harm Index 2016, Ministry of Health, Wellington, NZ, http://www.health.govt.nz/publication/research-report-new-zealand-drug-harm-index-2016.
Mendelsohn, C 2016, Australia’s prohibition of e-cigarettes is out of step with the evidence, The Conversation, 2 May, https://theconversation.com/australias-prohibition-of-e-cigarettes-is-out-of-step-with-the-evidence-58725.
Miller, P, Curtis, A, Chikritzhs, T, Allsop, S & Toumbourou, J 2015, Interventions for reducing alcohol supply, alcohol demand and alcohol-related harms, Research Bulletin no. 3, National Drug Law Enforcement Research Fund, Canberra, http://www.ndlerf.gov.au/publications.
Positive Choices 2016, School-based drug prevention: what works?, University of NSW, https://positivechoices.org.au/teachers/drug-prevention-what-works.
Royal College of Physicians 2016, Nicotine without smoke: tobacco harm reduction, Royal College of Physicians, London, https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0.
United Nations General Assembly 2016, UNGASS April 2016, Outcome document: Our joint commitment to effectively addressing and countering the world drug problem United Nations, New York, https://www.incb.org/documents/News/A_S-30_L.1.pdf.
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