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

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

 

In the October 2015 issue


ACT Research Spotlight

Research Findings

New Reports
 

The September 2015 issue of the ATODA Research eBulletin summarised a journal article authored by researchers from the Centre for Automotive Safety Research at the University of Adelaide on the extent to which both alcohol and cannabis are implicated in South Australian road crashes: Baldock, MRJ & Lindsay, VL 2014, ‘Examination of the role of the combination of alcohol and cannabis in South Australian road crashes’, Traffic Injury Prevention, vol. 16, no. 5, pp. 443-9. ATODA’s comment on the article included the statement that ‘…although this approach to law enforcement has been used for over a decade in Australia, there has been no evaluation of its impacts on road safety’. ATODA’s statement that ‘there has been no evaluation of its impacts on road safety’ reflected the fact that we are not aware of any published epidemiological research that demonstrates what impact roadside oral fluid drug testing has had, over the past decade, on the incidence of motor vehicle crashes, injuries and fatalities.
 
We have been contacted by Professor Max Cameron from the Monash University Accident Research Centre about this statement. Professor Cameron is a leading road safety research scholar with an impressive track record of publications and contributions to road safety policy and practice in Australia and abroad. He gave a presentation titled ‘Random drug testing in Australia, analogies with RBT, and likely effects with increased intensity levels’ at the 20th International Council on Alcohol, Drugs and Traffic Safety Conference, Brisbane, 25-28 August 2013, http://www.icadtsinternational.com/documents/?page=5&category=20th_T2013_Brisbane. Furthermore, he generously accepted ATODA’s invitation to present the paper at our 2014 Annual Conference.
 
Professor Cameron points out that, in stating that there has been no evaluation of the impacts of roadside drug testing on road safety in Australia, we are implying that no evidence exists that roadside testing for impairing drugs is effective in reducing road trauma. He reminded ATODA that his study does indeed present evidence of effectiveness. Cameron’s study ‘…aims to develop an analogy between RDT [random drug testing] and the early years of RBT [random breath testing] in Australia when intensity levels were low. This analogy is used to predict the likely effects on drug-driving among killed drivers as the number of random drug tests is increased’. The paper summarises data from studies of the presence of alcohol and other drugs in people killed or seriously injured in road crashes in Victoria and South Australia that lead to the conclusion that ‘there is a reasonable analogy between RDT and RBT’. ‘Diminishing-returns type relationships were found between the annual number of RDTs and the presence of impairing drugs in killed drivers. Although the ROFT [roadside oral fluid testing] equipment and associated Police testing time is currently expensive per test, the calibrated relationships suggested that current RDT rates per licensed driver could be increased to at least 10% per year before cost-effectiveness is in doubt.’
 
The paper concludes that ‘RDT has the potential to achieve significant general deterrence of drug-driving in a similar way as that achieved by best-practice RBT. While RDT is highly cost-effective at the modest levels of intensity that it is currently operated at in Australia, the analogy with RBT developed in this paper suggests that it will remain cost-effective if testing rates per licensed driver are increased up to 10% of drivers per year. However, to remain cost-effective at even higher testing rates per year, the cost per random drug test must be substantially decreased.’
 
ATODA welcomes these positive findings about the potential cost-effectiveness of roadside oral fluid drug testing but notes that we still do not have direct evidence of its impact on road safety over the decade in which it has been implemented in Australia. This is in contrast to the situation with the introduction of random breath testing for drink-driving, the evaluation of which showed that, in NSW, the 1992 intervention ‘immediately reduced fatal crashes by 19.5% overall and by 30% during holiday periods’ (Homel, R 1994, ‘Drink-driving law enforcement and the legal blood alcohol limit in New South Wales’, Accident Analysis & Prevention, vol. 26, no. 2, pp. 147-55). Corresponding evidence regarding roadside drug testing would be helpful.


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Can cannabis be detected in non-smokers' saliva following exposure to second-hand cannabis smoke?

Noting the increasing use of high potency strains of cannabis, USA researchers evaluated human toxicology and subjective effects following passive exposure to cannabis smoke. ‘The study was designed to produce extreme cannabis smoke exposure conditions tolerable to drug-free nonsmokers. Six experienced cannabis users smoked cannabis cigarettes [5.3% Δ9-tetrahydrocannabinol (THC) in Session 1 and 11.3% THC in Sessions 2 and 3] in a closed chamber. Six nonsmokers were seated alternately with smokers during exposure sessions of 1 h duration. Sessions 1 and 2 were conducted with no ventilation and ventilation was employed in Session 3. Oral fluid, whole blood and subjective effect measures were obtained before and at multiple time points after each session.’ The study demonstrated that ‘extreme exposure to environmental cannabis smoke by nonsmokers situated in close proximity to smokers led to deposition of THC in oral fluid… tests of oral fluid and blood specimens from the participating smokers revealed significant correlations of THC in oral fluid with THC in concurrent blood specimens…Positive tests for THC in oral fluid and blood were obtained for nonsmokers up to 3 h following exposure. Ratings of subjective effects correlated with the degree of exposure. Subjective effect measures and amounts of THC absorbed by nonsmokers (relative to smokers) indicated that extreme secondhand cannabis smoke exposure mimicked, though to a lesser extent, active cannabis smoking…The amount of THC delivered to nonsmokers compared with cannabis smokers in these exposure conditions was low (<5%) for Sessions 1 and 3, but was substantially higher in Session 2 (6–18% of smokers' doses). Thus, in the most extreme exposure condition, the effects of passive exposure mimicked, to a lesser extent, active smoking effects.’ These findings led the researchers to suggest that ‘environmental exposure to cannabis smoke should be avoided by nonsmokers and potentially has implications for those who undergo drug testing and those engaged in safety-sensitive activities (e.g., driving). Extreme exposure of nonsmokers could lead to positive drug tests and drug-induced behavioral changes not unlike those produced by active cannabis smoking.’

Cone, EJ, Bigelow, GE, Herrmann, ES, Mitchell, JM, LoDico, C, Flegel, R & Vandrey, R 2015, ‘Nonsmoker exposure to secondhand cannabis smoke. III. Oral fluid and blood drug concentrations and corresponding subjective effects’, Journal of Analytical Toxicology, vol. 39, no. 7, pp. 497-509, open access http://jat.oxfordjournals.org/content/39/7/497.full.
 
Comment: the findings of this study suggest that public information programs about drug driving and roadside drug testing should include advice about the potential contamination of oral fluids from second-hand cannabis smoke.

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What are the effects of medicinal cannabis on driving performance?

Abstract: Medical marijuana remains a highly debated treatment regimen despite removal of state penalties against care providers prescribing the drug and patients treated with the drug in many areas of the USA. The utility of marijuana in specific medical conditions has been studied at length, but its effects on driving performance and risk of motor vehicle collision remain unclear. As with other medications that affect psychomotor function, the healthcare provider should be informed of the potential risks of driver safety prior to prescribing this psychotropic drug to give appropriate anticipatory guidance for appropriate use. The goal of this narrative review is to assess the current literature regarding marijuana as it relates to driving performance and traffic safety. With a foundation in the pharmacology of cannabinoids, we consider the limitations of testing cannabinoid and metabolite concentration. In addition, we will review studies on driving performance and epidemiological studies implicating marijuana in motor vehicle collisions. The increasing prevalence of medical marijuana laws in the USA suggests that clinicians should be aware of marijuana's influence on public safety. Patients should abstain from driving for 8h if they achieve a subjective ‘high’ from self-treatment with smoked marijuana and should be aware of the cumulative effects of alcohol and other psychoactive xenobiotics [foreign chemical substances found within the body].

Neavyn, MJ, Blohm, E, Babu, KM & Bird, SB 2014, ‘Medical marijuana and driving: a review’, J Med Toxicol, vol. 10, no. 3, pp. 269-79, open access http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141931/.
 
Comment: As Australia moves towards legislating to establish legal medicinal cannabis programs, attention will need to be placed on the potential adverse consequences of the programs, including driving under the influence of cannabis.

 
What evidence is available on the association between kava use and motor vehicle crashes?

Researchers based at the University of Auckland undertook a literature review of studies examining the association (if any) between kava use and motor vehicle crashes (MVCs), MVC-related injuries or driving performance. They found no studies that quantified the effects of kava on MVCs or related injury. They located four experimental studies using computer-based driving simulation that examined the effects of pharmacological doses of kavalactones on cognitive and visuo-motor performance. ‘While no statistically significant adverse changes attributable to kava were found, there was weak evidence of slowed reaction time. One study found the visuo-motor performance on driving simulation to be significantly impaired when kava was consumed with alcohol’. They concluded ‘With equivocal evidence limited to experimental studies using simulated driving settings, the contribution of kava to MVCs is unknown’, and stated that ‘The gap in knowledge regarding the potential risk of injuries associated with therapeutic and recreational use of kava requires priority attention’.

Wainiqolo, I, Kool, B, Nosa, V & Ameratunga, S 2015, ‘Is driving under the influence of kava associated with motor vehicle crashes? A systematic review of the epidemiological literature’, Australian and New Zealand Journal of Public Health, vol. 39, no. 5, pp. 495-9.
 
Comment: While only a small proportion of the Australian population uses kava, it would be beneficial to have more and better research into its impact on driving performance.

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What reforms are needed to improve access to hepatitis C virus treatment for people who inject drugs?

A team of international researchers reviewed the literature on hepatitis C virus (HCV) treatment barriers for people who inject drugs (PWID), in high- and middle-income countries, in the context of human rights. They explained that while PWID achieve adherence to and outcomes from HCV treatment comparable to other patients, ‘this population has been excluded from treatment by regulation or practice. Approval of safer and more effective oral HCV medicines should offer greater treatment options for PWID, although high medicine prices have led to continued treatment rationing and exclusion in developed countries. In middle-income countries (MICS), treatment is largely unavailable and unaffordable for most PWID’. They found that ‘Structural drivers of lack of treatment access for PWID include stigma in health settings; drug use status as a criterion for treatment exclusion; requirements for fees or registration by name as a drug user prior to treatment initiation; and incarceration/detention in prisons and rehabilitation centers where treatment is unavailable. High medicine prices force further exclusion of PWID, with cost containment masked as concern about treatment adherence. These barriers correlate to multiple rights violations, including of the rights to privacy; non-discrimination; health; freedom of information; fair trial; and freedom from cruel, inhuman and degrading treatment’.
They concluded that ‘Needed reforms include decriminalization of drug use, possession of drugs and drug injecting equipment; removal of exclusionary or discriminatory treatment protocols; approaches to strengthen links between health providers and increase participation of PWID in treatment design and implementation; and measures to increase transparency in government/pharmaceutical company negotiations and reduce treatment price’. The authors noted that ‘The Scottish national plan on hepatitis C, with its explicit commitment to reaching more PWID with HCV prevention, testing and treatment, is suggestive of how national health authorities can actively prioritize steps to increase HCV treatment for PWID. Egyptian negotiations to drive down the price of sofosbuvir are similarly instructive’.

Wolfe, D, Luhmann, N, Harris, M, Momenghalibaf, A, Albers, E, Byrne, J & Swan, T 2015, ‘Human rights and access to hepatitis C treatment for people who inject drugs’, International Journal of Drug Policy,vol. 26, no. 11, pp. 1072-80.
 
Comment: As the new, and more effective, treatments for HCV become available, the high cost means that discussions about rationing will inevitably arise. The human rights focused arguments, clearly explained in this article, should have prominence in those discussions.

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Are people more likely to die while on opioid substitution therapy if treated with methadone or buprenorphine?

A retrospective cohort study of all patients with opioid dependency in New South Wales who started a methadone or buprenorphine treatment episode from Aug 1, 2001, to Dec 31, 2010, compared crude mortality rates (CMRs) for all-cause and drug-related overdose mortality, and mortality rate ratios (MRRs) according to age, sex, period in or out of treatment, medication type, and in-treatment switching. The researchers ‘identified strong evidence that the risk of drug-related overdose during the first 4 weeks of treatment induction and stabilisation is almost five times higher, and all-cause mortality double, for patients inducted on to methadone than for those inducted on to buprenorphine. By contrast, if a patient switched to methadone after already having been stabilised on buprenorphine, there was no such comparative elevation in risk. These patients also had a reduced rate of mortality compared with those inducted on to a methadone-only treatment episode’. They concluded that, ‘In a setting with high risk of death in the first 4 weeks of opioid substitution therapy, buprenorphine seemed to reduce mortality in this period, but little difference between buprenorphine and methadone was noted thereafter or for in-treatment switching of medications. Cross-cohort corroboration of our findings and further assessment of the stepped treatment model is warranted.’

Kimber, J, Larney, S, Hickman, M, Randall, D & Degenhardt, L 2015, ‘Mortality risk of opioid substitution therapy with methadone versus buprenorphine: a retrospective cohort study’, Lancet Psychiatry,vol. 2, no. 10, pp.901-8.

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What is the current knowledge about HCV-related disease progression among people who inject drugs?

A systematic review and meta-analysis of the literature studied 21 reports of hepatitis C virus (HCV) disease progression rates among people who inject drugs (PWID). The researchers found that ‘Left untreated, PWID with chronic HCV infection will develop liver sequelae (including HCC [hepatocellular carcinoma]) in mid- to late-adulthood. Delaying treatment with the new drug regimens until advanced fibrosis develops prolongs the period of infectiousness to perhaps thirty years. Scaling up of effective HCV prevention and early engagement in care and treatment will facilitate the elimination [of] HCV as a source of serious disease in PWID’.

Smith, DJ, Combellick, J, Jordan, AE & Hagan, H 2015, ‘Hepatitis C virus (HCV) disease progression in people who inject drugs (PWID): a systematic review and meta-analysis’, International Journal of Drug Policy, vol. 26, no. 10, pp. 911-21.

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How serious a problem is codeine overdose deaths in Australia?

Researchers from NDARC, and their colleagues, undertook an analysis of National Coronial Information System data on deaths where codeine toxicity was determined to be an underlying or contributory cause of death, covering the period 2000-2013. The study revealed that ‘The rate of codeine-related deaths increased significantly between 2000 and 2009, from 3.5 to 8.7 deaths per million population. The increase was primarily driven by an increase in accidental deaths…Two distinct populations were detected. Those who had intentionally overdosed were more likely to be older, female and have a history of mental health problems; those who had accidentally overdosed were more likely to have a history of substance use problems, chronic pain and injecting drug use… High rates of prior comorbid mental health (53.6%), substance use (36.1%) and chronic pain (35.8%) problems were recorded for these [accidental] deaths’. The researchers concluded that ‘Codeine-related deaths (with and without other drug toxicity) are increasing as the consumption of codeine-based products increases. Educational messages are needed to better inform the public about the potential harms of chronic codeine use, especially in the context of polypharmacy’.

Roxburgh, A, Hall, WD, Burns, L, Pilgrim, J, Saar, E, Nielsen, S & Degenhardt, L 2015, ‘Trends and characteristics of accidental and intentional codeine overdose deaths in Australia’, Medical Journal of Australia, vol. 203, no. 7, pp. 299, open access https://www.mja.com.au/journal/2015/203/7/trends-and-characteristics-accidental-and-intentional-codeine-overdose-deaths
 
Comment: The Australian Therapeutic Goods Administration is recommended that common codeine-containing pharmaceutical products be rescheduled from ’pharmacist only medicine’ to ‘Prescription Only Medicine’. Although the proposal is based largely on the type of evidence presented in this paper about the risks of these preparations, the proposal is highly controversial.

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How much alcohol advertising are children and young adults exposed to when watching Australian television?

An examination of child, adolescent (0-17 years) and young adult (18-29 years) exposure to alcohol advertising for 2012 covered three televised sports in Australia: Australian Football League (AFL), cricket and the National Rugby League (NRL). Of a total of 3544 alcohol advertisements, 1942 were in AFL, 941 in cricket and 661 in NRL programs, representing 60% of all alcohol advertising in sport TV, and 15% of all alcohol advertisements on Australian TV. ‘These programs had a cumulative audience of 26.9 million children and adolescents, and 32 million young adults. Children and adolescents received 51 million exposures to alcohol advertising, with 47% of this exposure occurring during the daytime. Children and adolescents exposure to alcohol advertising was similar to young adults and peaked after 8.30pm.’
The conclusion of the study was that ‘Child and adolescent and young adult’s exposure to alcohol advertising is high when viewing sport TV in Australia in the daytime and night-time. Current alcohol advertising regulations are not protecting children and adolescents from exposure, particularly in prominent televised sports. The regulations should be changed to reduce children and adolescent excessive exposure to alcohol advertising when watching sport’.

Carr, S, O’Brien, KS, Ferris, J, Room, R, Livingston, M, Vandenberg, B, Donovan, RJ & Lynott, D 2015, ‘Child and adolescent exposure to alcohol advertising in Australia’s major televised sports’, Drug and Alcohol Review, online ahead of print, open access http://onlinelibrary.wiley.com/doi/10.1111/dar.12326/full.

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To what extent can liquor licensing restrictions reduce alcohol-related violence?

An examination of the effects on assault of a series of legislative reforms that restricted the trading hours and trading conditions of licensed premises in New South Wales covered reforms introduced between July 2008 and January 2012. The researchers estimated ‘the underlying long-term dynamics of the time series of police recorded domestic and non-domestic assaults occasioning actual bodily harm (ABH) and assaults occasioning grievous bodily harm (GBH) in NSW between January 1996 and December 2013’. They concluded that ‘Legislative reforms…to restrict trading hours and trading conditions of licensed alcohol premises appear to have reduced the number of police-recorded assaults of ABH and GBH by 31.27% and 39.70% respectively’.

Menéndez, P, Tusell, F & Weatherburn, D 2015, ‘The effects of liquor licensing restriction on alcohol-related violence in NSW, 2008–13’, Addiction, vol. 110, no. 10, pp. 1574-82.
 
Comment: This is yet another study demonstrating how restricting trading hours and enforcing other aspects of the operations of licensed premises can produce good public health outcomes. The ACT Government is currently considering a range of additional reforms of the type evaluated in this paper.

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What can be done to reduce methamphetamine-related harms in Australian Indigenous communities?

Abstract:
Crystal methamphetamine (commonly known as ‘ice’) use is currently a deeply concerning problem for some Australian Indigenous peoples and can cause serious harms to individual, families and communities. This paper is intended to support best practice responses by primary health-care staff working with Australian Indigenous people who use methamphetamine. It draws on a systematic search of relevant databases to identify literature from January 1999 to February 2014, providing an overview of prevalence, treatment, education and harm reduction, and community responses. The prevalence of methamphetamine use is higher in Indigenous than non-Indigenous communities, particularly in urban and regional settings. No evidence was identified that specifically related to effective treatment and treatment outcomes for Indigenous Australians experiencing methamphetamine dependence or problematic use. While studies involving methamphetamine users in the mainstream population suggest that psychological and residential treatments show short-term promise, longer-term outcomes are less clear. Community-driven interventions involving Indigenous populations in Australia and internationally appear to have a high level of community acceptability; however, outcomes in terms of methamphetamine use are rarely evaluated. Improved national data on prevalence of methamphetamine use among Indigenous people and levels of treatment access would support service planning. We argue for the importance of a strength-based approach to addressing methamphetamine use, to counteract the stigma and despair that frequently accompanies it.

MacLean, S, Harney, A & Arabena, K 2015, ‘Primary health-care responses to methamphetamine use in Australian Indigenous communities’, Australian Journal of Primary Health, online ahead of print.

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How effective is smoking cessation in decreasing mortality among older adults?
 
An international study to estimate the influence of smoking and smoking cessation on all-cause mortality in people 60 years and over included almost 500,000 participants. ‘Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs [relative mortality and mortality rate advancement periods] of 6.4…and 2.4…years, respectively. A clear positive dose-response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation’. The researchers concluded that ‘Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority’.

Muezzinler, A et al. 2015, ‘Smoking and all-cause mortality in older adults: results from the CHANCES Consortium’, American Journal of Preventive Medicine, online ahead of print.
 
Comment: This study is useful in its quantification of mortality risk across nations. Its finding of a clear positive dose-response relationship with respect to mortality provides further support for the importance of tobacco harm reduction and challenges findings from earlier, smaller studies that suggested that reducing but not eliminating cigarette smoking fails to produce health benefits.

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What evidence is available on the effectiveness of behavioural and pharmacotherapy interventions to help smokers to quit?

The U.S. Preventive Services Task Force (USPSTF) reviewed the evidence on interventions for tobacco smoking cessation that are relevant to primary care (behavioural interventions, pharmacotherapy, and complementary or alternative therapy) in adults, including pregnant women. The USPSTF recommends that ‘clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration-approved pharmacotherapy for cessation to adults who use tobacco…clinicians ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco’. However the USPSTF concludes that ‘the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant women…[and] that the current evidence is insufficient to recommend electronic nicotine delivery systems for tobacco cessation in adults, including pregnant women’. It recommends that ‘clinicians direct patients who smoke tobacco to other cessation interventions with established effectiveness and safety’.

Siu, AL, , for the U.S. Preventive Services Task Force 2015, ‘Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force Recommendation Statement for Interventions for Tobacco Smoking Cessation’, Annals of Internal Medicine, online ahead of print, open access http://annals.org/article.aspx?articleid=2443060&resultClick=3.

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Can smokers with chronic mental illness quit with standard cessation approaches with minimal effects on psychiatric symptoms?

Abstract:
The high prevalence of cigarette smoking and tobacco related morbidity and mortality in people with chronic mental illness is well documented. This review summarizes results from studies of smoking cessation treatments in people with schizophrenia, depression, anxiety disorders, and post-traumatic stress disorder. It also summarizes experimental studies aimed at identifying biopsychosocial mechanisms that underlie the high smoking rates seen in people with these disorders. Research indicates that smokers with chronic mental illness can quit with standard cessation approaches with minimal effects on psychiatric symptoms. Although some studies have noted high relapse rates, longer maintenance on pharmacotherapy reduces rates of relapse without untoward effects on psychiatric symptoms. Similar biopsychosocial mechanisms are thought to be involved in the initiation and persistence of smoking in patients with different disorders. An appreciation of these common factors may aid the development of novel tobacco treatments for people with chronic mental illness. Novel nicotine and tobacco products such as electronic cigarettes and very low nicotine content cigarettes may also be used to improve smoking cessation rates in people with chronic mental illness.

Tidey, JW & Miller, ME 2015, ‘Smoking cessation and reduction in people with chronic mental illness’, BMJ (British Medical Journal), vol. 351.

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What is the latest evidence on the potential role of psychedelic drugs in the treatment of mental illness and addiction?

Canadian researchers have called for continued medical research into psychedelic drugs. The key points of their article are ‘Medical interest in psychedelic drugs as treatments for illnesses such as anxiety, addiction and posttraumatic stress disorder has been renewed. Small-scale studies involving human participants in the United States, Europe and Canada are showing that such research can be conducted in a safe and scientifically rigorous manner. Preliminary findings show some successful results for these treatments, with significant clinical improvements and few—if any—serious adverse effects. The emerging results may have implications for future medical and neuroscientific research, medical education and training, and public policy’.

Tupper, KW, Wood, E, Yensen, R & Johnson, MW 2015, ‘Psychedelic medicine: a re-emerging therapeutic paradigm’, CMAJ,
online ahead of print.
 

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New Reports

Alcohol Advertising Review Board 2015, Alcohol Advertising Review Board Annual Report 2014-15, Alcohol Advertising Review Board, Perth, WA, http://www.alcoholadreview.com.au/news/annual-reports/.
 
Australian Institute of Health and Welfare 2015, Tobacco indicators baseline data: reporting under the National Tobacco Strategy 2012–2018, Drug Statistics Series no. 29, Cat. no. PHE 189, Australian Institute of Health and Welfare, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129552715.
 
Coghlan, S & Goldsmid, S 2015, Findings from the DUMA program: methamphetamine drug market trends, Research in Practice no. 43, Australian Institute of Criminology, Canberra, http://aic.gov.au/publications/current%20series/rip/41-60/rip43.html.
 
Fitzharris, M et al. 2015, Options to extend coverage of alcohol interlock programs, Publication no. AP-R495-15, Austroads Ltd, Sydney, https://www.onlinepublications.austroads.com.au/items/AP-R495-15.
 
Kleiman, MAR 2014, ‘Keynote address: driving impaired by drugs’, paper presented to 2nd International Drugs and Driving Symposium, Wellington, New Zealand, 12-13 November 2014, http://www.drugfoundation.org.nz/drugdriving2014/session2 and https://www.youtube.com/watch?v=voaoPaPYfHA.
 
New Zealand, Department of Prime Minister and Cabinet, Policy Advisory Group 2014, Tackling methamphetamine: an action plan, Department of Prime Minister and Cabinet, Wellington, NZ, http://www.beehive.govt.nz/sites/all/files/ActionPlan.pdf.
 
Nissen, LB 2014, Strengthening a social justice lens for addictions practice: exploration, reflections, possibilities, and a challenge to promote recovery among the most vulnerable, The ATTC Messenger, http://www.attcnetwork.org/find/news/attcnews/epubs/addmsg/August2014article.asp.
 
Pennay, A & Lee, N 2008, ‘Prevention and early intervention of methamphetamine-related harm’, Prevention Research Quarterly: current evidence evaluated, no. Issues Paper no. 6, open access http://www.druginfo.adf.org.au/attachments/344_PRQ06Sept08_final.pdf.
 
Queensland Government 2015, Ways to combat ice addiction in Queensland: discussion paper, Queensland Government, Brisbane, https://www.getinvolved.qld.gov.au/gi/consultation/2705/view.html.
 
Rolles, S 2015, Cannabis regulation in Colorado: early evidence defies the critics, Transform Drug Policy Foundation, http://www.tdpf.org.uk/blog/cannabis-regulation-colorado-early-evidence-defies-critics.
 
The Kirby Institute 2015, HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2015, The Kirby Institute, The University of New South Wales, Sydney, http://kirby.unsw.edu.au/news/australia-s-annual-report-card-hiv-hepatitis-and-sexually-transmissible-infections.
 
Various 2015, ‘The connection between family violence and alcohol and other drugs’, NADA Advocate, no. 3, http://nada.org.au/resources/nadapublications/nadaadvocate/.
 
Victorian Law Reform Commission 2015, Medicinal cannabis: report August 2015, Victorian Law Reform Commission, Melbourne, http://lawreform.vic.gov.au/all-projects/medicinal-cannabis.
 
Watkins, KE 2014, ‘California’s misguided approach [alcohol education programs for people with DUI convictions]’, The RAND Blog, http://www.rand.org/blog/2014/03/californias-misguided-approach.html
 
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