ACT ATOD Sector Research eBulletin - April 2016
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.


 



Apology

The March ACT ATOD Sector Research ebulletin was mistakenly sent on Friday 29 April as the April 2016 issue. The content has been corrected and is now being re-issued. ATODA apologises for the mistake.



8th ACT Alcohol Tobacco and Other Drug Sector Conference

This year's conference will be held as a Canberra Satellite of the 10th Annual Conference of the International Society for the Study of Drug Policy (ISSDP). The conference is a unique opportunity for the ACT sector to access world-leading expertise on key international, national and ACT sector priorities.

Who should attend:
The conference is for anyone working in or involved with the sector, including:
  • Workers and Practitioners
  • People who use drugs, service users and friends/families
  • Managers and Executives
  • Researchers
  • Policy makers and Advisors
  • Community members and media
Topics:
The conference will be a unique opportunity to engage with ISSDP scholars and to consider their international experience in the ACT and Australian context, particularly following the implications of the April 2016 United Nations General Assembly Special Session (UNGASS) on drugs. Some key topics include:
  • What is drug policy and why does it matter?
  • A global movement towards harm reduction
  • Cannabis regulation and law reform: what can be learnt from the USA's research experience?

Speakers will include:
  • Mr Simon Corbell MLA, ACT Minister for Health
  • Professor Alex Stevens, University of Kent, UK & ISSDP President
  • Professor Beau Kilmer, RAND, USA
  • Professor Priscilla Hunt, RAND, USA

Date: Friday 20 May 2016
Time: 9am - 4pm
Venue: National Portrait Gallery, King Edward Terrace, Parkes
Cost: ATODA and ISSDP members: $90, non-member: $150, ATODA individual membership fee + registration: $112, Service users/consumers and friends/families: free (limited numbers)
For more information and for individual registration: visit www.atoda.org.au, the Eventbrite webpage, email info@atoda.org.au or call (02) 6255 4070

Notes: Places are limited. Group Bookings can be made. Invoices available from ATODA.
 

Sydney ISSDP 2016 Conference

The ISSDP is a society of scholars committed to advancing drug policy research. The ISSDP’s objectives are to: be a forum for high quality drug policy analysis; develop relations among drug policy analysts and thus strengthen the field; develop the scientific base for policy decisions; and improve the interface between researchers and policy makers. 

The ISSDP achieves this through its annual scholarly international conference, which is being held for the first time in Australia from 16-18 May 2016 in Sydney.

The conference will be hosted by the Drug Policy Modelling Program (DPMP) which is part of the National Drug and Alcohol Research Centre (NDARC), UNSW Australia.
 
The ISSDP Conference is a unique occasion to present your latest findings to an intellectually engaged, diverse and dedicated scholarly community, and to immerse yourself in the state of the art research across the full spectrum of drug policy research, with the participation of leading international scholars.

For further information and registration visit: www.issdp2016.com

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ACT Research Spotlights

Latest data from the National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection
 
The NOPSAD collection provides information on a snapshot day in June 2015 on clients receiving opioid pharmacotherapy treatment, the doctors prescribing opioid pharmacotherapy drugs, and the dosing points that clients attend to receive their medication.
 
Nationally, 48,522 clients received treatment on the snapshot day, 2 in 3 were male, the median age was 40 years, 1 in 10 identified as being Aboriginal and/or Torres Strait Islander, heroin was the most common opioid drug of dependence for which treatment was sought and 2 in 3 were treated with methadone. The treatment rate has been stable since 2003 in the range 19-21 clients per 10,000 population.
 
With respect to the ACT specifically:
  • There were 978 clients receiving treatment on the snapshot day in 2015, 6% more than at the same time the previous year and 28% more than a decade earlier, 2005.
  • This is 25 per 10,000 population, 25% higher than the national rate of 20 per 10,000 and the highest rate of any state or territory except for NSW (26/10,000).
  • Therapeutic drug type: methadone 79%, buprenorphine-naloxone 20% and buprenorphine 1%.
  • Dosing point: pharmacy 72%, public clinic 17% and correctional facility 11%.
  • Demographics: females 35% and males 65%. Median age 39 years. Indigenous clients 10%, 138 per 10,000 population, non-Indigenous 90%, 23 per 10,000 population, by far the highest Indigenous rate in the nation.
Source: Australian Institute of Health and Welfare 2016, National opioid pharmacotherapy statistics (NOPSAD) 2015, cat. no. WEB 100, AIHW, Canberra, http://www.aihw.gov.au/alcohol-and-other-drugs/nopsad/ .
 

Index
Note: Many of the items referenced below are available from the Library of the Australian Drug Foundation http://primoapac01.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=ADF .

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Research Findings


How could scientific evidence and public health approaches be brought to bear on international policy on the control of illicit drugs?

Do 'moderate' drinkers really have reduced mortality risk?
 
How effective are national survey data as a measure of trends in population alcohol consumption in Australia?

How easy is it for underage adolescents to purchase alcohol in Australia?


What does the literature tell us about parental provision of alcohol to children and adolescents?

What do we know about interventions for homeless alcohol-abusing adults?


To what extent is treatment for alcohol use disorder associated with reductions in criminal offending?

What is the relationship between alcohol policies and impaired driving?

How useful is wastewater analysis in providing data on illicit drug consumption?

How effective are peer-led interventions in preventing tobacco, alcohol and other drug among young people?

To what extent has drug use changed among adolescents in residential treatment in Australia in recent years?

How feasible would it be to provide drug checking services where consumers could have their drugs identified and analysed for purity?
 
How far can e-cigarettes contribute to, or detract from, smoking cessation?

How could tobacco manufacturers be made responsible for collecting and disposing tobacco product waster?


Is there sound evidence of the effectiveness of take-home naloxone programs in the absence of controlled trials?

What are the opportunities and barriers to hepatitis C testing and treatment in prisons?

 

How could scientific evidence and public health approaches be brought to bear on international policy on the control of illicit drugs?

Earlier this month the member states of the UN met to consider global policy on the so-called controlled drugs. The previous UN General Assembly Special Session on drugs in 1998 ‘endorsed drug-control policies with the goal of prohibiting all use, possession, production, and trafficking of illicit drugs’. As a contribution to this event, the Johns Hopkins–Lancet Commission on Drug Policy and Health has ‘sought to examine the emerging scientific evidence on public health issues arising from drug-control policy and to inform and encourage a central focus on public health evidence and outcomes in drug-policy debates’. The Commission’s report lists some of the harmful consequences of current policy on illicit drugs. These include: violence and insecurity in communities affected by drug transit and sales; injection of drugs with contaminated equipment leading to HIV exposure and viral hepatitis transmission; excessive use of incarceration as a drug control measure; lethal drug overdoses; and aggressive and harmful practices targeting people who grow crops used in the manufacture of drugs.

The Commission makes several recommendations to the UN member states under the following headings: decriminalise minor drug offences—use, possession, and petty sale; reduce the violence and other harms of drug policing; make harm reduction measures a central pillar of health systems and drug policy; invest in treatment for HIV, HCV infection, tuberculosis, and drug dependence; ensure access to controlled drugs; formulate policies that do not harm women; integrate health concerns into supply-chain efforts; improve UN governance of drug policy; include health, human rights, and development in metrics to judge success of drug policy; better and broader research on drugs and drug policy; and scientific approach to regulatory experiment.
They conclude ‘We urge health professionals in all countries to inform themselves and join debates on drug policy at all levels…it is possible to have drug policy that contributes to the health and wellbeing of humankind, but not without bringing to bear the evidence of the health sciences and the voices of health professionals’.

Csete, J, Kamarulzaman, A, Kazatchkine, M, Altice, F, Balicki, M, Buxton, J, Cepeda, J, Comfort, M, Goosby, E, Goulão, J, Hart, C, Kerr, T, Lajous, AM, Lewis, S, Martin, N, Mejía, D, Camacho, A, Mathieson, D, Obot, I, Ogunrombi, A, Sherman, S, Stone, J, Vallath, N, Vickerman, P, Zábranský, T & Beyrer, C 2016, ‘Public health and international drug policy’, The Lancet, online ahead of print, open access http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2900619-X/abstract

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Do 'moderate' drinkers really have reduced mortality risk?

Abstract:
Previous meta-analyses of cohort studies indicate a J-shaped relationship between alcohol consumption and all cause mortality, with reduced risk for low-volume drinkers. However, low-volume drinkers may appear healthy only because the “abstainers” with whom they are compared are biased toward ill health. The purpose of this study was to determine whether misclassifying former and occasional drinkers as abstainers and other potentially confounding study characteristics underlie observed positive health outcomes for low volume drinkers in prospective studies of all-cause mortality. A systematic review and meta-regression analysis of studies investigating alcohol use and mortality risk after controlling for quality-related study characteristics was conducted in a population of 3,998,626 individuals, among whom 367,103 deaths were recorded. Without adjustment, meta-analysis of all 87 included studies replicated the classic J-shaped curve, with low-volume drinkers (1.3-24.9 g ethanol per day) having reduced mortality risk (RR = 0.86, 95% CI [0.83, 0.90]). Occasional drinkers (<1.3 g per day) had similar mortality risk (RR = 0.84, 95% CI [0.79, 0.89]), and former drinkers had elevated risk (RR = 1.22, 95% CI [1.14, 1.31]). After adjustment for abstainer biases and quality-related study characteristics, no significant reduction in mortality risk was observed for low-volume drinkers (RR = 0.97, 95% CI [0.88, 1.07]). Analyses of higher-quality bias-free studies also failed to find reduced mortality risk for low-volume alcohol drinkers. Risk estimates for occasional drinkers were similar to those for low- and medium-volume drinkers. Estimates of mortality risk from alcohol are significantly altered by study design and characteristics. Meta-analyses adjusting for these factors find that low-volume alcohol consumption has no net mortality benefit compared with lifetime abstention or occasional drinking. These findings have implications for public policy, the formulation of low-risk drinking guidelines, and future research on alcohol and health.

Stockwell, TR, Zhao, J, Panwar, S, Roemer, A, Naimi, TS & Chikritzhs, TN 2016, ‘Do “moderate” drinkers have reduced mortality risk? A systematic review and meta-analysis of alcohol consumption and all-cause mortality’, Journal of Studies on Alcohol and Drugs, vol. 77, no. 2. 

Comment: This research group (that includes prominent Australian scholars) have presented a compelling argument that the long-held perception that moderate drinking produces health benefits is wrong. This high quality study has concluded that ‘low-volume alcohol consumption has no net mortality benefit compared with lifetime abstention or occasional drinking’. Based on that, in ATODA’s view public health and clinical health messages should no longer mention actual or possible health benefits from any level of alcohol consumption. 

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How effective are national survey data as a measure of trends in population alcohol consumption in Australia?

An analysis of data from the National Drug Strategy Household Survey (NDSHS) from 2001 to 2013 assessed the accuracy of the NDSHS at capturing trends in alcohol consumption at the population level, using Australian Bureau of Statistics (ABS) apparent per capita alcohol consumption (which is based on the production and importation of alcoholic beverages) as a benchmark. The researchers found that ‘The NDSHS survey estimates still track apparent consumption well, which increases between 2001 and 2007 and then declines to 2013. Since 2007, survey estimates show a 10.5% decline in per capita alcohol consumption, compared with 8.9% in ABS data. Two-thirds of the decline came from reductions in drinking among respondents under 30.’ They concluded that ‘NDSHS data provide reasonably accurate estimates of trends in Australian population alcohol consumption. Survey data are critical to understanding the composition of overarching trends, with these analyses demonstrating substantial variation by age. Implications: Survey data are a crucial tool in monitoring Australian alcohol consumption, despite their inherent limitations’.

Livingston, M & Dietze, P 2016, ‘National survey data can be used to measure trends in population alcohol consumption in Australia’, Australian and New Zealand Journal of Public Health, online ahead of print.
 
How easy is it for underage adolescents to purchase alcohol in Australia?

A study was undertaken which sought to estimate the extent to which adolescents who appeared underage were successfully able to purchase alcohol from packaged liquor outlets in Australia, and to identify store and sales characteristics associated with illegal purchasing. Individuals who were perceived to look under the age of 18 (‘confederates’) were recruited to purchase alcohol. Purchase surveys were conducted in 2012 at packaged liquor outlets in 28 urban and rural communities in Western Australia, Queensland and Victoria. The study found that ‘Confederates successfully purchased alcohol at 60% (95% CI: 55–66) of outlets. The density of general alcohol outlets in the surrounding area and the type of liquor outlet were predictors of successful alcohol purchases; however, this was moderated by the state in which the purchase was made. Regional geographical location was also found to predict underage alcohol purchase. The majority of alcohol sales outlets in Australia breach regulations prohibiting sales to underage youth’. The researchers concluded ‘Consistent enforcement of policies across the states of Australia, and reducing the number of alcohol outlets, will help prevent alcohol outlets illegally selling alcohol to underage adolescents’.

Rowland, BC, Hall, JK, Kremer, PJ, Miller, PG & Toumbourou, JW 2016, ‘Underage purchasing of alcohol from packaged liquor outlets: an Australian study’, Health Promotion International, online ahead of print.

Comment: In various submissions, ATODA has urged the ACT government to conduct this type of controlled purchases by under-age people as a way of monitoring the extent of this practice and of gaining evidence to prosecute liquor outlets that breach the law.

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What does the literature tell us about parental provision of alcohol to children and adolescents?

A review of the literature on parental provision of alcohol to children and teenagers conducted by an Australian researcher examined it ‘through the lens of the Theory of Planned Behavior: attitudes, subjective norms and perceived behavioral control...The Theory of Planned Behavior (TPB) suggests the proximal determinant of volitional behavior is the intention to engage in that behavior, the TPB includes considerations of perceptions of control over performance of the behaviour’. The researchers found that ‘The majority of studies show parents generally believe that it is acceptable, and perhaps even desirable, to allow children to commence drinking alcohol prior to reaching the legal drinking age…for most parents, this is an acceptance of providing alcohol for children to consume only at home or under parental supervision (to “teach” them to drink responsibly); however, for a substantial number of parents this extends to provision of alcohol to take to parties or other social events, based on the belief that this gives parents a degree of control over what and how much their child is drinking. However, parents do not appear to be aware of the substantial, and growing, evidence base which suggests early initiation to alcohol is associated with increased, rather than reduced, alcohol consumption and related harms’.

Jones, SC 2015, ‘Parental provision of alcohol: a TPB-framed review of the literature’, Health Promotion International, online ahead of print.

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What do we know about interventions for homeless alcohol-abusing adults?

Researchers undertook a systematic review of the published research evidence covering interventions with alcohol-abusing homeless adults. They found only 17 studies from three continents that met the inclusion criteria. A meta-analysis of pre- and post-intervention effects on alcohol use across the 17 studies found highly significant effects…A smaller subset of studies (n=10), where the same specific alcohol use outcome measurement was employed across all studies, also showed highly significant pre-post intervention effects... They concluded that ‘There is a relative paucity of research into alcohol abusing homeless adults, which has implications for evidence-based practice’. Furthermore, ‘Results indicate that a range of interventions were effective in reducing alcohol use and abuse within samples of homeless participants, although short-term effects are more apparent than longer term ones.’

Adams-Guppy, JR & Guppy, A 2016, ‘A systematic review of interventions for homeless alcohol-abusing adults’, Drugs: education, prevention and policy, vol. 23, no. 1, pp. 15-30.

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To what extent is treatment for alcohol use disorder associated with reductions in criminal offending?

An English national study looked at changes in criminal offending following treatment for alcohol use disorder (AUD). It covered all adults treated for AUD by all publicly funded treatment services during April 2008-March 2009. The outcome measure was ‘the count of recordable criminal offences during two-year follow-up after admission’. The study found that ‘Twenty-two percent of the cohort committed one or more offences in the two years pre-treatment…During follow-up, the number of offenders and offences fell by 23.5% and 24.0%, respectively…a lower number of offences was associated with: completing treatment…receiving inpatient detoxification…or community pharmacological therapy…Reconviction was reduced in the sub-population characterised by driving offences…but was relatively high amongst acquisitive (…58.3% reconvicted) and violent offending sub-populations (…77.6% reconvicted). The conclusions were that ‘Reduced offending was associated with successful completion of AUD treatment and receiving inpatient and pharmacological therapy, but not enrolment in psychological and residential interventions. Treatment services (particularly those providing psychological therapy and residential care) should be alert to offending, especially violent and acquisitive crime, and enhance crime reduction interventions’.

Willey, H, Eastwood, B, Gee, IL & Marsden, J 2016, ‘Is treatment for alcohol use disorder associated with reductions in criminal offending? A national data linkage cohort study in England’, Drug and Alcohol Dependence, vol. 161, pp. 67-76.

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What is the relationship between alcohol policies and impaired driving?

A study undertaken in the United States aimed to test the hypotheses that stronger policy environments are associated with less impaired driving and that driving-oriented and drinking-oriented policy subgroups are independently associated with impaired driving. ‘State-level data on 29 policies in 50 states from 2001-2009 were used as lagged exposures in generalized linear regression models to predict self-reported impaired driving’. The researchers created ‘Alcohol Policy Scale scores representing the alcohol policy environment…by summing policies weighted by their efficacy and degree of implementation by state-year. Past-30-day alcohol-impaired driving from 2002-2010 was obtained from the Behavioral Risk Factor Surveillance System surveys’. They found that ‘Higher Alcohol Policy Scale scores are strongly associated with lower state-level prevalence and individual-level risk of impaired driving. After accounting for driving-oriented policies, drinking-oriented policies had a robust independent association with reduced likelihood of impaired driving. Reduced binge drinking mediates the relationship between drinking-oriented policies and impaired driving, and driving-oriented policies reduce the likelihood of impaired driving among binge drinkers’. They concluded ‘Efforts to reduce alcohol-impaired driving should focus on reducing excessive drinking in addition to preventing driving among those who are impaired’.

Xuan, Z, Blanchette, JG, Nelson, TF, Heeren, TC, Nguyen, TH & Naimi, TS 2015, ‘Alcohol policies and impaired driving in the United States: effects of driving- vs. drinking-oriented policies’, International Journal of Alcohol and Drug Research, vol. 4, no. 2, pp. 119-30, open access http://ijadr.org/index.php/ijadr/article/view/205 .

Comment: In the injury prevention and control field within public health we usually focus on the causal factors that are most proximate to the injury-causing incident, in this case road crashes. Random breath testing is an example. This US study is particularly important, however, as it shows that alcohol policies far upstream from drink driving, such as taxation and limiting alcohol availability, have positive outcomes in terms of impaired driving prevalence. This has huge policy implications considering the human and financial costs of impaired driving to the community.

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How useful is wastewater analysis in providing data on illicit drug consumption?

An analysis was undertaken of methamphetamine residues in wastewater samples from the inlets of two treatment plants in south-east Queensland, one of which served a coastal metropolitan city that included entertainment precincts and the other a major inland regional city. The researchers found that ‘Methamphetamine consumption (measured in milligrams per day per 1000 inhabitants) was higher in the metropolitan city than in the regional city, and levels in both locations increased significantly between 2009–2010 and 2015…Consumption increased 4.8 times in the metropolitan area between 2009 and 2015, and 3.4 times in the regional city between 2010 and 2015’. They commented ‘These results demonstrate the potential value of wastewater analysis in providing timely data on trends in illicit drug consumption in the population of urban and regional cities’.

Lai, FY, O’Brien, J, Thai, PK, Hall, WD & Mueller, JF 2016, ‘Trends in methamphetamine residues in wastewater in metropolitan and regional cities in south-east Queensland, 2009-2015’, Medical Journal of Australia, vol. 204, no. 4, pp. 151-2.

Comment: To date it has been generally accepted by AOD experts, based on self-report household survey data, that the prevalence of methamphetamine use has remained fairly stable in Australia over the last decade, accompanied by a shift from the predominant use of the powder (speed) form of the drug to the crystalline (ice) form. This is inconsistent, however, with public perceptions of trends. The Queensland waste-water study is important as it demonstrates substantial increases in methamphetamine use in recent years. The finding has significant implications for the new national ‘Ice Strategy’ the design of which reflected the earlier, probably false, perception of stable prevalence of use of the drug.

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How effective are peer-led interventions in preventing tobacco, alcohol and other drug use among young people?

Researchers based in the United Kingdom conducted a systematic review and meta-analysis of the scientific literature on peer-led interventions to prevent tobacco, alcohol and/or other drug use among young people aged 11–21 years. Their ļ¬ndings suggested that ‘…peer interventions have a role to play in preventing tobacco, alcohol and possibly also cannabis use during adolescence. The pooling of nine studies incorporating over 13 700 young people in 220 schools suggested that weekly or less frequent smoking was lower among those who received a peer-led intervention compared to control…while pooling of six studies provided weak evidence supporting an association between peer-led interventions and lower odds of alcohol use…Meta-analysis of three studies including 976 young people in 38 schools also suggested that peer-led interventions reduced cannabis use…No studies were found that targeted other illicit drug use’. They concluded ‘Peer interventions may be effective in preventing tobacco, alcohol and possibly cannabis use among adolescents, although the evidence base is limited overall, and is characterized mainly by small studies of low quality’.

MacArthur, GJ, Harrison, S, Caldwell, DM, Hickman, M & Campbell, R 2016, ‘Peer-led interventions to prevent tobacco, alcohol and/or drug use among young people aged 11–21 years: a systematic review and meta-analysis’, Addiction, vol. 111, no. 3, pp. 391-407.

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To what extent has drug use changed among adolescents in residential treatment in Australia in recent years?

A study of drug use among adolescents admitted to residential treatment in Australia included almost 1,000 in NSW and the ACT over the period July 2009 to December 2014. The researchers found that ‘The mean age of the study population was 16.6 years and 72.6% were male. Over a third (37.2%) were referred by juvenile justice staff or self-reported criminal activity. Methamphetamine was the only drug to show an upward trend in the reporting of drug of greatest concern, from 10.8% in 2009 to 48.4% in 2014…and in current use of drug at admission, from 28.8% in 2009 to 59.4% in 2014…Trends in methamphetamine use remained significant after controlling for sociodemographic characteristics. Alcohol, cannabis and tobacco use remain high, with 64.1% of participants reporting currently using alcohol, 85.2% cannabis and 72.7% tobacco in 2014. Among 321 participants reporting current methamphetamine use, those reporting inhaling smoke or vapour increased from 12.5% in 2009 to 85.5% in 2014…Different forms of methamphetamine were not recorded; however, ice is commonly inhaled, which suggests that the main form used by participants has changed. There were associations between methamphetamine use and number of places lived and enrolment in a special class at school, suggesting that young people who may have learning difficulties or unstable accommodation may be at a higher risk of methamphetamine use or that use may result in learning issues and unstable accommodation’.

Nathan, S, Bethmont, A, Rawstorne, PR, Ferry, M & Hayen, A 2016, ‘Trends in drug use among adolescents admitted to residential treatment in Australia’, Medical Journal of Australia, vol. 204, no. 4, pp. 149-50.

Comment: Here is another study providing evidence of increased prevalence of use of methamphetamine in Australia in recent years.

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How feasible would it be to provide drug checking services where consumers could have their drugs identified and analysed for purity?

‘Several European countries now provide drug analysis services, whereby individuals submit samples of their drugs to have their contents identified and analysed for purity. The results are provided to the consumer. The analytical facility can be based either on-site (eg, at large parties or festivals) or off-site. In some of the European services, brief health interventions aimed at reducing harm are offered to consumers simultaneously. Fast turn-around drug analysis services may have reduced harms resulting from recent episodes of mass intoxications at festival settings by: identifying the NPS [new psychoactive substance] and other contents of the pills or powders; monitoring NPS availability and use trends to enable an effective public health response; identifying emerging hazards from specific NPS and the formulations available; improving the knowledge base for effective clinical management of acute and chronic presentations; providing an opportunity for users to seek help, obtain health information to reduce potential harms and to offer options for individual behaviour change; and providing intelligence that could influence supply dynamics…

‘A network of 26 drug-checking sites in the Netherlands is incorporated into the Ministry of Health as part of a national surveillance system. This service offers immediate results of quick office tests to potential users, with intervention and referral if necessary. Subsequently, samples are sent for more accurate spectrometric analysis, and results are available within a week. Most importantly, results are incorporated into the national surveillance system and are monitored for trends in emerging substances, and results are used to inform public policy and practice. While the direct prevention of deaths has not been documented, dangerous pills or powders identified by checking systems in the Netherlands have quickly disappeared from the Dutch markets following the launch of warning campaigns.

‘Discovering new compounds that endanger life is unlikely to benefit the user after he or she has taken the drug except in ruling out other causes for developing severe syndromes. However, as more becomes known about the psychopharmacology of specific compounds, best-practice treatment algorithms can be created. If backed up by a sensible brief intervention, such a service might see users of drugs more engaged in caring for their health, recognising problem substance use, and seeking help. From a public health perspective, information on new compounds can be used to monitor emerging trends and inform prevention activities…

‘In addition, handling materials that are suspected of being illegal substances is prohibited by law; there are harm-reduction services currently operating in Australia that have been provided with an exemption for service staff and clients, such as Sydney’s medically supervised injecting centre. Therefore, providing a drug-checking service would not require a radical shift in national drug policy, but would require cooperation between health and police stakeholders’.

Butterfield, RJ, Barratt, MJ, Ezard, N & Day, RO 2016, ‘Perspective: drug checking to improve monitoring of new psychoactive substances in Australia’, Medical Journal of Australia, vol. 204, no. 4, pp. 144-5.

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How far can e-cigarettes contribute to, or detract from, smoking cessation?

A recently-published Letter to the Editor of Addiction from leading tobacco control researchers provides information on the estimated population level impacts of e-cigarettes on smoking cessation in England. The authors found that:
  1. At the start of 2014 there were approximately 8.46 million adult smokers in England…
  2. The percentage of smokers in 2014 who reported that they had tried to stop at least once is estimated at 37.3% (3.16 million people)
  3. The percentage of those who tried to quit who used an e-cigarette (and not a prescription medicine or behavioural support) in 2014 was 28.2%...
  4. The expected long-term (1 year) success rates of a quit attempt made without assistance or using a licensed nicotine product (LNP) bought from a shop is approximately 5%
  5. Evidence from RCTs [randomised controlled trials] and from surveys in England indicate that using an e-cigarette in a quit attempt increases the probability of success on average by approximately 50% compared with using no aid or LNP bought from a shop—similar to use of a licensed medicine with limited behavioural support but less than medication plus specialist behavioural support
  6. Therefore, it is estimated that 2.5% of the smokers who used an e-cigarette in their quit attempt in England (22 000 people) succeeded who would have failed if they had used nothing or LNP bought from a shop.
West, R, Shahab, L & Brown, J 2016, ‘Estimating the population impact of e-cigarettes on smoking cessation in England’, Addiction, online ahead of print.

Comment: The research evidence shows significant potential benefits derived from the use of e-cigarettes (and other forms of ANDS: alternative nicotine delivery systems) as smoking cessation devices, and the low levels of harms compared with the use of tobacco products. Policy settings that conflate ANDS and tobacco products fail to reflect adequately the scientific evidence.
 
In ATODA’s view, Australian and ACT policy should reflect the scientific evidence, and should show leadership to begin enabling ANDS in the suite of smoking cessation options.


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How could tobacco manufacture be made responsible for collecting and disposing tobacco product waste?

Abstract:
Cigarette butts and other postconsumer products from tobacco use are the most common waste elements picked up worldwide each year during environmental cleanups. Under the environmental principle of Extended Producer Responsibility, tobacco product manufacturers may be held responsible for collection, transport, processing and safe disposal of tobacco product waste (TPW). Legislation has been applied to other toxic and hazardous postconsumer waste products such as paints, pesticide containers and unused pharmaceuticals, to reduce, prevent and mitigate their environmental impacts. Additional product stewardship (PS) requirements may be necessary for other stakeholders and beneficiaries of tobacco product sales and use, especially suppliers, retailers and consumers, in order to ensure effective TPW reduction. This report describes how a Model Tobacco Waste Act may be adopted by national and subnational jurisdictions to address the environmental impacts of TPW. Such a law will also reduce tobacco use and its health consequences by raising attention to the environmental hazards of TPW, increasing the price of tobacco products, and reducing the number of tobacco product retailers.

Curtis, C, Novotny, TE, Lee, K, Freiberg, M & McLaughlin, I 2016, ‘Tobacco industry responsibility for butts: a Model Tobacco Waste Act’, Tobacco Control, online ahead of print.

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Is there sound evidence of the effectiveness of take-home naloxone programs in the absence of controlled trials?


The authors of this British study point out that ‘fatal outcome of opioid overdose, once detected, is preventable through timely administration of the antidote naloxone. Take-home naloxone provision directly to opioid users for emergency use has been implemented recently in more than 15 countries worldwide, albeit mainly as pilot schemes and without formal evaluation. This systematic review assesses the effectiveness of take-home naloxone, with two specific aims: (1) to study the impact of take-home naloxone distribution on overdose-related mortality; and (2) to assess the safety of take-home naloxone in terms of adverse events.’ The researchers searched for English-language peer-reviewed publications (randomized or observational trials) ‘and evaluated the studies found using the nine Bradford Hill criteria for causation, devised to assess a potential causal relationship between public health interventions and clinical outcomes when only observational data are available.’ 22 observational studies but no controlled trials were found that met the eligibility criteria. A narrative synthesis (rather than a meta-analysis) was undertaken owing to the variability in size and quality of the included studies. The researchers concluded that ‘From eligible studies, we found take-home naloxone met all nine Bradford Hill criteria. The additional five World Health Organization criteria were all either met partially (two) or fully (three). Even with take-home naloxone administration, fatal outcome was reported in one in 123 overdose cases (0.8%; 95% confidence interval = 0.4, 1.2)…Take-home naloxone programmes are found to reduce overdose mortality among programme participants and in the community and have a low rate of adverse events.

McDonald, R & Strang, J 2016, ‘Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria’, Addiction, online ahead of print.

Comment: The ACT’s take-home naloxone program, Australia’s first, was evaluated by independent, external evaluators. They also used the Bradford Hill criteria to assess the strength of the evidence about the effectiveness of these programs, concluding that the evidence is strong. See Olsen, A, McDonald, D, Lenton, S & Dietze, P 2014, ‘Evidence for take-home naloxone programs: a Bradford Hill analysis’, Drug & Alcohol Review, vol. 33 (Suppl. 1), pp. 49-50,and Olsen, A, McDonald, D, Lenton, S & Dietze, P 2015, Independent evaluation of the ‘Implementing Expanded Naloxone Availability in the ACT (I-ENAACT)’ Program, 2011-2014; final report, Centre for Research Excellence into Injecting Drug Use (CREIDU), Melbourne, http://health.act.gov.au/datapublications/reports/alcohol-tobacco-and-other-drugs/naloxone .

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What are the opportunities and barriers to hepatitis C testing and treatment in prisons?

A national needs assessment of hepatitis C in Australian prisons found that ‘Of more than 50,000 individuals put in in custody in Australian prisons in 2013, approximately 8,000 individuals were HCV antibody positive, yet only 313 prisoners received antiviral treatment. The barriers identified to assessment and treatment at the prisoner-level included: fear of side effects and the stigma of being identified to custodial authorities as HCV infected and a likely injecting drug user. Prisoners who came forward may be considered unsuitable for treatment because of prevalent mental health problems and ongoing injecting drug use. Provision of specialist hepatitis nurses and consultants were the most frequently recommended approaches to how prison hepatitis services could be improved’. The researchers concluded that ‘Ready access to skilled nursing and medical staff as well as direct acting antiviral therapies will allow the prison-sector to make a major contribution to control of the growing burden of HCV disease…In Australia, and globally, the custodial setting provides a key public health opportunity to manage the HCV epidemic. If matched by a commitment to invest in hepatitis service development from policy makers and providers, the advent of DAA [Direct Acting Antiviral] therapies offers considerable promise for improved health outcomes for both prisoners and the community as a whole’.

Mina, MM, Herawati, L, Butler, T & Lloyd, A 2016, ‘Hepatitis C in Australian prisons: a national needs assessment’, International Journal of Prisoner Health, vol. 12, no. 1, pp. 3-16.

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New Reports

Andres, D 2016, ‘Clandestine laboratories’, ACT Population Health Bulletin, vol. 5, no. 1, pp. 19-20, http://www.health.act.gov.au/healthy-living/population-health#Bulletin.
 
Australian Institute of Health and Welfare 2016, National opioid pharmacotherapy statistics (NOPSAD) 2015, cat. no. WEB 100, AIHW, Canberra, http://www.aihw.gov.au/alcohol-and-other-drugs/nopsad/.
 
Bewley-Taylor, D, Jelsma, M & Blickman, T 2016, The rise and decline of cannabis prohibition, Transnational Institute (TNI), Amsterdam, https://www.tni.org/en/publication/the-rise-and-decline-of-cannabis-prohibition.
 
Cohen, R, Miller, A, Lipsky, R, Katz, M, McCurdie, A, Ge, C, Sheppard, C, Hodgson, D, Alishah, H & Liu, J 2016, Medicinal cannabis in Australia: science, regulation & industry. A White Paper developed by The University of Sydney Community Placement Program in Partnership with MGC Pharmaceuticals, MCG Pharma, The University of Sydney & BuddingTech, Sydney, http://mgcpharma.com.au/ .
 
European Monitoring Centre for Drugs and Drug Addiction 2016, Emergency department-based brief interventions for individuals with substance-related problems: a review of effectiveness, EMCDDA Papers, Publications Office of the European Union, Luxembourg, Luxembourg, http://www.emcdda.europa.eu/publications/papers/2016/emergency-department-based-brief-interventions .
 
Thompson, AJV 2016, ‘Australian recommendations for the management of hepatitis C virus infection: a consensus statement’, Medical Journal of Australia, vol. 204, no. 7, https://www.mja.com.au/journal/2016/204/7/australian-recommendations-management-hepatitis-c-virus-infection-consensus .
 
United Nations Office on Drugs and Crime 2016, Terminology and information on drugs, 3rd edn, UNODC, Vienna, http://www.unodc.org/unodc/en/scientists/terminology-and-information-on-drugs_new.html .
 
Whittall, I, Kite, L & Rockliff, S 2015, Road Transport (Alcohol and Drugs) Act 1977, Report on analytical findings, February 2015, ACT Government Analytical Laboratory, Canberra, http://www.health.act.gov.au/research-publications/reports/road-transport-alcohol-and-drugs-act-1977-report-analytical-findings .


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The Alcohol Tobacco and Other Drug Association ACT (ATODA) is the peak body representing the non-government and government alcohol, tobacco and other drug (ATOD) sector in the Australian Capital Territory (ACT). ATODA seeks to promote health through the prevention and reduction of the harms associated with ATOD. 

Views expressed in the ACT ATOD Sector eBulletin do not necessarily reflect the opinion of the Alcohol Tobacco and Other Drug Association ACT. Not all third-party events or information included in the eBulletin are endorsed by the ACT ATOD Sector or the Alcohol Tobacco and Other Drug Association ACT. No responsibility is accepted by the Alcohol Tobacco and Other Drug Association ACT or the editor for the accuracy of information contained in the eBulletin or the consequences of any person relying upon such information. To contact us please email ebulletin@atoda.org.au or call (02) 6255 4070.