Our monthly ACT ATOD Research eBulletin is a concise summary of newly-published research findings and other research activities of particular relevance to ATOD and allied workers in the ACT.

Its contents cover research on demand reduction, harm reduction and supply reduction; prevention, treatment and law enforcement. ATODA's Research eBulletin is a resource for keeping up-to-date with the evidence base underpinning our ATOD policy and practice.

 

IN THE AUGUST 2012 ISSUE


ACT Research Spotlight

Canberra Research Collaboration

New Centres of Research Excellence Announced

Research Findings

New Reports

 

 

Note: Most of the reports and research items referenced below are available from the Alcohol and Other Drug Council of Australia’s National Drugs Sector Information Service (NDSIS).

Is there an association between cannabis use in adolescence and mental disorders in early adulthood?

By means of a 15-year representative longitudinal cohort study in Victoria, Australian researchers examined the association between cannabis use in adolescence and mental disorders at age 29. They found ‘There were no consistent associations between adolescent cannabis use and depression at age 29 years. Daily cannabis use was associated with anxiety disorder at 29 years…as was cannabis dependence…Among weekly+ adolescent cannabis users, those who continued to use cannabis use at 29 years remained at significantly increased odds of anxiety disorder’. They concluded that ‘Regular (particularly daily) adolescent cannabis use is consistently associated with anxiety, but not depressive disorder, in adolescence and late young adulthood, even among regular users who then cease using the drug. It is possible that early cannabis exposure causes enduring mental health risks in the general cannabis using adolescent population’.

Degenhardt, L, Coffey, C, Romaniuk, H, Swift, W, Carlin, JB, Hall, WD & Patton, GC 2012, ‘The persistence of the association between adolescent cannabis use and common mental disorders into young adulthood’, Addiction, online ahead of print.

Comment: This article adds to the evidence base about the importance of prevention programs and, especially, screening and early interventions, to limit the number of young cannabis users moving to frequent (e.g. daily) use of the drug.

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How likely is it that people who are prescribed opioid analgesics for pain relief will develop dependence on the drugs?

A systematic review by Italian researchers analysed data from seventeen studies involving over eighty-eight thousand participants. ‘Most studies included adult patients with chronic non-malignant pain, two also included patients with cancer pain; only one included patients with a previous history of dependence’. The researchers concluded that ‘The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence’.

Minozzi, S, Amato, L & Davoli, M 2012, ‘Development of dependence following treatment with opioid analgesics for pain relief: a systematic review’, Addiction, online ahead of print.

Comment: This is a pleasing and somewhat surprising finding considering research from the USA on what many characterise as an epidemic of dependence and overdose deaths among opioid analgesic users there. Perhaps it reflects the delays that occur between the initiation of an epidemic and the publication of a substantial body of evidence describing and analysing it?

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What factors associated with therapeutic communities and their clients are likely to contribute to better outcomes for the clients?

A year-long study of 191 clients of the We Help Ourselves drug treatment programs in Sydney aimed to ascertain the association between baseline client characteristics, drug use and psychopathology on length of stay, treatment completion and early separation in drug free therapeutic communities. The study showed that ‘The median length of stay was 39 days. A total of 17% of treatment entrants dropped out in the first week, and 34% successfully completed the treatment program’. People who had recently been released from prison or who had low expectations of success for the treatment were more likely to drop out. People who successfully completed the program were more likely to be male, and to have experienced fewer stressful life events. ‘Drug use and psychopathology were not related to length of stay, early separation or treatment completion.’ The researchers concluded that ‘The fact that neither psychopathology or primary problem drug was related to treatment indicates that these should not be seen as poor prognostic indicators for treatment success in a drug free treatment setting’.

Darke, S, Campbell, G & Popple, G 2012, ‘Retention, early dropout and treatment completion among therapeutic community admissions’, Drug and Alcohol Review, vol. 31, no. 1, pp. 64-71.

Comment: Matching clients to treatment modalities is one of the great challenges in our field. This study adds to our knowledge in this area.

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What guidance does the World Health Organization provide on the prevention of hepatitis B and C among people who inject drugs?

This WHO Guidance states ‘The “silent epidemic” of viral hepatitis affects a large part of the world’s population without due attention from the health sector. Now, however, co-infection with HIV and viral hepatitis is increasingly recognized as a considerable public health problem. It is estimated that 240 million people are chronically infected with hepatitis B…and 170 million are chronically infected with hepatitis C…These numbers far exceed the number of people living with HIV, estimated at 34 million. People who inject drugs (PWID) are a key population affected by HBV and HCV. There are approximately 16 million people who inject drugs in 148 countries…In 2011 it was estimated that 1.2 million people who inject drugs are infected with HBV and 10 million people who inject drugs are infected with HCV’.

The five recommendations of the Guidance are:

1. It is suggested to offer people who inject drugs the rapid hepatitis B vaccination regimen.
2. It is suggested to offer people who inject drugs incentives to increase uptake and completion of the hepatitis B vaccine schedule.
3. It is suggested that needle and syringe programs also provide low dead-space syringes for distribution to people who inject drugs.
4. Psychosocial interventions are not suggested for people who inject drugs to reduce the incidence of viral hepatitis.
5. It is suggested to offer peer interventions to people who inject drugs to reduce the incidence of viral hepatitis

World Health Organization 2012, Guidance on prevention of viral hepatitis B and C among people who inject drugs, WHO/HIV/2012.18, World Health Organization, Geneva

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Is the time right to reform Australia’s drug laws?

Dr Alex Wodak, Emeritus Consultant to the Alcohol and Drug Service at St Vincent’s Hospital, Sydney, in his editorial in a forthcoming issue of the Medical Journal of Australia, calls for drug law reform in this country. He states ‘Illicit drug use should be viewed primarily as a health and social problem’, and advocates increasing funding for health and social measures ‘towards the levels now spent on drug law enforcement. The additional funding could be used in the community and in prisons to expand the capacity and broaden the range of high-quality drug treatments, while also expanding harm reduction measures such as needle and syringe programs and medically supervised injecting centres’. He explains ‘Change should be cautious and rigorously evaluated. Reform will only happen when supported by the community and enacted by politicians with the courage to accept the evidence…Drug treatment should become like any other part of the health system and cease being an adjunct to the criminal justice system’. He concludes ‘Having reduced some drug-related harms it is time to start trying to reduce the harms of our drug laws’.

Wodak, AD 2012, ‘The need and direction for drug law reform in Australia’, Medical Journal of Australia, online ahead of print.

Comment: The drug law reform movement, of which the author is a prominent member, seems to be gathering strength both in Australia and in other parts of the world. The fact that the MJA commissioned Wodak to write this editorial demonstrates how drug law reform is being advocated for in mainstream settings, not simply among the drug law reform movement’s own members.

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What does the Czech Republic have to teach the rest of the world about policy on illicit drugs?

‘In the early post-Soviet period, Czech authorities, unlike their counterparts in some former Eastern Bloc countries, turned away from repressive drug policies and developed approaches to illicit drugs that balanced new freedoms with state authority. The end of Soviet rule meant that drug markets and the use of a wide range of new drugs attained a magnitude and visibility not previously known to Czech society. From an early stage, some pioneering health professionals with expertise in drug addiction saw that the new drug situation would require greatly expanded services for drug users and collaboration between civil society and government to achieve this expansion. They were able to influence the new government and steer it toward drug policy that would define drug use as a multisectoral problem, not an issue for policing alone. The report A Balancing Act: Policymaking on Illicit Drugs in the Czech Republic traces the development of drug policy in the Czech Republic from the post-Soviet period to the present day. The report examines the impact of the Czech Republic’s evidence based approach to drug policy, compares the country’s path on drug policy to that of its neighbour Slovakia and discusses challenges to maintaining this approach in the future.’

Csete, J 2012, A balancing act: policymaking on illicit drugs in the Czech Republic, Open Society Foundations, Global Drug Policy Program, New York

Comment: Many people are familiar with the processes and promising outcomes of more rational approaches to drug policy and its enforcement in nations like the Netherlands and Portugal. This report provides useful information covering the reforms implemented in the Czech Republic.

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What are the principles on which the United States drug policy is currently based?

The United States Office of National Drug Control Policy has affirmed that ‘The three United Nations drug control conventions are the foundation of the global effort to reduce drug use and its consequences’. In order to implement the conventions in the 21st century, it has committed itself to ten principles and encouraged other nations to do the same:

1. Ensure balanced, compassionate, and humane drug policies.
2. Integrate prevention, treatment, and recovery support services into public health systems.
3. Protect human rights.
4. Reduce drug use to reduce drug consequences.
5. Support and expand access to medication-assisted therapies.
6. Reform criminal justice systems to support both public health and public safety.
7. Disrupt drug trafficking.
8. Address the drug problem as a shared responsibility.
9. Support the UN drug conventions.
10. Protect citizens from drugs.

Office of National Drug Control Policy (USA) 2012, Principles of modern drug policy, Office of National Drug Control Policy, viewed 05 July 2012

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Is there a relationship between tobacco use and social disadvantage?

The July 2012 international journal Drug and Alcohol Review is a special issue on ‘Tackling Tobacco Use in Socially Disadvantaged Groups: A Time for Action’. The editorial by Bonevski and Baker discusses ‘Tobacco smoking as a social justice issue: advances in research’. They point out that ‘Smoking has been found to be the strongest mediator of social inequality in all-cause mortality when a range of health behaviours are considered’. They summarise the contents of the journal, referring to articles on the prevalence of tobacco smoking among socially disadvantaged groups such as Aboriginal and Torres Strait Islanders people, prisoners, young people in custody, and people in residential drug and alcohol rehabilitation. The journal also includes reports on smoking cessation programs targeting prisoners, homeless people and clients of social and community service organisations. The editors point out that ‘One of the key recommendations made by the World Health Organization Commission on the Social Determinants of Health is “Focusing public health interventions such as smoking cessation programs and alcohol reduction on reducing the social gradient”’. They conclude the editorial on a positive note: ‘This special issue provides cause for optimism by showcasing advances made in meeting that recommendation’.

Bonevski, B & Baker, A 2012, ‘Tobacco smoking as a social justice issue: advances in research’, Drug and Alcohol Review, vol. 31, no. 5, pp. 599-601.

Comment: For some years the relationships between health problems and social disadvantage, linked to knowledge about the social determinants of health and health gradients, have been prominent in other parts of the health sector but have received insufficient attention in the substance abuse field. This special issue of Drug and Alcohol Review is a welcome contribution to redressing this deficiency. The ACT and national drug strategies do not, at present, pay sufficient attention to dealing with social disadvantage as a drug intervention, partly because many of the most effective interventions addressing social disadvantage lie outside what most people conceive to be the boundaries of the drug sector.

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Has there been any research into the effectiveness of anti-tobacco mass media campaigns with socially disadvantaged groups?

‘In order to avoid exacerbating smoking-related health inequalities, mass media campaigns must have equal or greater impact with lower socioeconomic groups’, however an analysis of relevant studies from western countries found that ‘few studies have assessed the effectiveness of anti-tobacco mass media campaigns with socially disadvantaged in a methodologically rigorous way’. The researchers state ‘Methodological rigour of evaluations in this field must be improved to aid understanding regarding the effectiveness of mass media campaigns in driving cessation among disadvantaged groups’.

Guillaumier, A, Bonevski, B & Paul, C 2012, ‘Anti-tobacco mass media and socially disadvantaged groups: a systematic and methodological review’, Drug and Alcohol Review, vol. 31, no. 5, pp. 698-708.

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Is smoking a serious health problem for people in residential rehabilitation services?

A recent study examined smoking behaviours of people being treated in residential rehabilitation services, and rates of other potentially modifiable health risk factors for the development of cardiovascular disease (CVD) and cancer. People attending Australian Salvation Army residential substance abuse treatment services were surveyed and their rates of smoking, exercise, dietary fat intake, body mass index and depression were compared with representative community populations. The research revealed that ‘When compared with the Australian population, participants were much more likely to be current smokers. They also showed higher rates of dietary fat intake, and having had a previous diagnosis of a depressive disorder. Encouragingly, participants were more likely to be engaging in regular exercise. Over a third of all smokers reported having increased their smoking since attending the residential program, with correlational analysis suggesting that nicotine dependence was increasing the longer participants were in treatment’. The researchers concluded that ‘People attending substance abuse treatment show extremely high rates of smoking (77%). With the large majority of participants showing multiple risk factors for CVD, it is important that residential services consider strategies to address smoking and the other potentially modifiable health risk factors in an integrated fashion.’

Kelly, PJ, Baker, AL, Deane, FP, Kay-Lambkin, FJ, Bonevski, B & Tregarthen, J 2012, ‘Prevalence of smoking and other health risk factors in people attending residential substance abuse treatment’, Drug and Alcohol Review, vol. 31, no. 5, pp. 638-44.

Comment: We have long known that the prevalence of smoking among people in residential drug abuse treatment programs is high, but it is particularly disturbing to read that their smoking actually increases while in treatment programs. This fact, along with the other risk factors identified, highlight the need for drug treatment services to deal with a range of co-morbidities, and that any treatment service that fails to actively promote smoking cessation is not adequately meeting its duty of care. It reminds us of the fact that drug dependent people are far more likely to die from a tobacco-related diseases than from drug dependence.

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Can physical activity help people with psychotic and substance use disorders to stop smoking?

‘In Australia, 73% of men and 50% of women with psychotic disorders smoke…Smoking rates tend to be higher for people with substance use disorders, with smoking rates for people attending substance abuse treatment of 74% to 98%’. The authors of this article point out that, in spite of the high rates of smoking among these two groups, ‘the focus of treatment and research has tended to be on substances other than tobacco. A range of harm-reduction strategies is needed, including long-term nicotine maintenance, smokeless tobacco and “clean” nicotine products’. This group of researchers recently ‘successfully piloted healthy lifestyles intervention…among overweight smokers with severe mental disorders. The intervention was associated with reductions in weight and smoking’. They conclude ‘For those who cannot or will not quit, assistance in reducing smoking should be given. Interventions for smoking among people with mental health/substance use problems may best be delivered by addressing multiple health-risk behaviours, especially physical activity, around the same time’.

Baker, AL, Callister, R, Kelly, PJ & Kypri, K 2012, ‘“Do more, smoke less!” Harm reduction in action for smokers with mental health/substance use problems who cannot or will not quit’, Drug and Alcohol Review, vol. 31, no. 5, pp. 714-17.

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Does the introduction of responsible beverage service programs reduce violence?

A ‘multi-component Responsible Beverage Service (RBS) program has been disseminated in Swedish municipalities since 1996 with the aim of reducing violence associated with alcohol consumption at on-licensed premises. An analysis of the effect of the program on police-recorded assaults found that ‘Each extension of the program, by one component, was associated with a significant 3.1% reduction in assaults. However, this effect was mainly seen in smaller municipalities. Of the different components of the program, the presence of a community coalition steering group had a significant effect on assaults. No significant effect was found regarding RBS training or supervision of on-licensed premises’. The researchers concluded that ‘Multi-component Responsible Beverage Service programs can have a significant effect on police-recorded assaults even when implemented on a large scale in many communities’.

Trolldal, B, Brännström, L, Paschall, MJ & Leifman, H 2012, ‘Effects of a multi-component responsible beverage service program on violent assaults in Sweden’, Addiction, online ahead of print.

Comment: This study adds to the body of evidence about the potential effectiveness of responsible serving of alcohol initiatives. An additional consideration is the relatively poor results from voluntary, industry self-regulated, responsible service of alcohol programs. Regulatory action is required to ensure such programs are properly implemented over the long term.

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Does methamphetamine use affect driving?

A research study in Sydney compared methamphetamine (METH) and a control group of non-users on driving simulator performance. The results were ‘METH users, most of whom met the criteria for METH dependence, were significantly more likely to speed and to weave from side to side when driving. They also left less distance between their vehicle and oncoming vehicles when making a right-hand turn. This risky driving was not associated with current blood levels of METH or its principal metabolite, amphetamine, which varied widely within the METH group. Other drugs were detected (principally low levels of THC or MDMA) in some METH users, but at levels that were unlikely to impair driving performance. There were higher levels of impulsivity and antisocial personality disorder in the METH-using cohort. The researchers concluded ‘These findings confirm indications from epidemiological studies of an association between METH use and impaired driving ability’.

Bosanquet, D, Macdougall, HG, Rogers, SJ, Starmer, GA, McKetin, R, Blaszczynski, A & McGregor, IS 2012, ‘Driving on ice: impaired driving skills in current methamphetamine users’, Psychopharmacology, online ahead of print.

Comment: While a number of studies, like this one, have demonstrated an association between recent methamphetamine use and impaired capacity to drive, this important study appears to have found that there is no clear dose/response relationship. This suggests that the confounders the researchers have identified, such as impulsivity and antisocial personality disorder, may be more important determinants of crash risk than methamphetamine use itself. The study's findings provide further evidence challenging the likelihood that roadside drug testing of motor vehicle drivers will have any beneficial impacts on road safety.

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Could the world of sport learn from harm reduction in the illicit drugs field?

In an article published just before the London Olympics began, researchers from Switzerland pointed out that ‘The current anti-doping policy (“war on doping”) resembles the ‘war on drugs’ in several aspects, including a zero-tolerance approach, ideology encroaching on human rights and public health principles, high cost using public money for repression and control, and attempts to shape internationally harmonized legal frameworks to attain its aim. Furthermore, even if for different reasons, both wars seem not to be able to attain their objectives, and possibly lead to more harm to society than they can prevent’. They ‘describe current anti-doping policy, reflect on its multiple unplanned consequences, and end with a discussion, if lessons learned from harm reduction experiences in the illicit drugs field could be applied to anti-doping’.

Kayser, B & Broers, B 2012, ‘The Olympics and harm reduction?’ Harm Reduction Journal, vol. 9, no. 1, p. 33

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Is there an association between drug use and self-harm?

Researchers from the ANU undertook a study of the predictors of self-harm using a random sample of adults living in the ACT and Queanbeyan beginning in 1999-2002, with the cohorts re-interviewed in 2003-2006 and 2007-2010. They used the term self-harm (SH) to refer to ‘all non-suicidal self injury that is not a form of culturally accepted body modification…Self-cutting is typically the most commonly reported form of SH’. Their findings ‘suggest that self-harm is fairly prevalent in the Australian general population; 8.2% of participants reported past year self-harm’. They concluded that ‘Self-harm in young and middle-aged adults appears to be associated with current smoking, marijuana and “dependent” alcohol use. Other independent predictors include younger age, male gender, bisexual orientation, financial strain, education level, psychological distress, adverse life events and sexual abuse by a parent’.

Moller, CI, Tait, RJ & Byrne, DG 2012, ‘Self-harm, substance use and psychological distress in the Australian general population’, Addiction, vol. online ahead of print.

Comment: This paper is one of the many products of the ANU’s important Personality & Total Health (PATH) Through Life project that was established in 1999 to redress the lack of longitudinal research on the factors that influence the development of and recovery from mental disorders (including drug abuse) over the adult age span. For further information on the study see here

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How much do Canberrans spend on alcohol and tobacco each week?

On average in 2009-10, households in Canberra spent $37 on alcoholic beverages and $11 on tobacco products each week, compared to $236 on food and non-alcoholic beverages. The average for all Australian capital cities was $33 expenditure on alcoholic beverages, $12 on tobacco products and $217 on food and non-alcoholic beverages.

AIHW 2012, Australia's food & nutrition 2012, Cat. no. PHE 163, AIHW, Canberra, Large file warning: 11 MB.

AIHW 2012, Australia’s food & nutrition 2012: in brief, Cat. no. PHE 164, AIHW, Canberra, Large file warning: 8 MB.

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New Reports

European Monitoring Centre for Drugs and Drug Addiction 2012, Guidelines for the evaluation of drug prevention: a manual for programme planners and evaluators, 2nd edn, EMCDDA Manuals No. 8, European Monitoring Centre for Drugs and Drug Addiction, Lisbon

Arora, S & Burns, L 2012, ACT trends in ecstasy and related drug markets 2011: findings from the Ecstasy and Related Drugs Reporting System (EDRS), Australian Drug Trends Series no. 84, National Drug and Alcohol Research Centre, University of New South Wales, Sydney

Arora, S & Burns, L 2012, Australian Capital Territory drug trends 2011: findings from the Illicit Drug Reporting System (IDRS), Australian Drug Trends Series no. 75, National Drug and Alcohol Research Centre, University of New South Wales, Sydney

Sindicich, N & Burns, L 2012, Australian trends in ecstasy and related drug markets 2011: findings from the Ecstasy and Related Drugs Reporting System (EDRS), Australian Drug Trends Series no. 82, National Drug and Alcohol Research Centre, University of New South Wales, Sydney

Stafford, J & Burns, L 2012, Australian drug trends 2011: findings of the Illicit Drug Reporting System (IDRS), Australian Drug Trends Series no. 73, National Drug and Alcohol Research Centre, University of New South Wales, Sydney

Stoicescu, C (ed.) 2012, The global state of harm reduction 2012: towards an integrated response, Harm Reduction International, London, Large file warning: 14 MB.

Rosmarin, A & Eastwood, N 2012, A quiet revolution: drug decriminalisation policies in practice across the globe, Release, London

Rolles, S, Murkin, G, Powell, M, Kushlick, D & Slater, J 2012, The alternative World Drug Report: counting the costs of the war on drugs, Transform Drug Policy Foundation, London

McDonald, D 2012, The extent and nature of alcohol, tobacco and other drug use, and related harms, in the Australian Capital Territory, July 2012, Fourth edition, ACT Government Health Directorate, Canberra

Loxley, W, Chikritzhs, T & Catalano, P 2011 (released 1 Aug 2012), National Alcohol Sales Data Project, stage 2, final report, Drug and Alcohol Office, Western Australia & National Drug Research Institute

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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