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 JULY 2012 ISSUE


ACT Research Spotlight

Canberra Research Collaboration

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) http://ndsis.adca.org.au.

Which policy initiatives can prevent or reduce the harm caused by illicit drug use?

‘Debates about which policy initiatives can prevent or reduce the damage that illicit drugs cause to the public good are rarely informed by scientific evidence. Fortunately, evidence-based interventions are increasingly being identified that are capable of making drugs less available, reducing violence in drug markets, lessening misuse of legal pharmaceuticals, preventing drug use initiation in young people, and reducing drug use and its consequences in established drug users. We review relevant evidence and outline the likely effects of fuller implementation of existing interventions. The reasoning behind the final decisions for action might be of a non-scientific nature, focused more on what the public and policy-makers deem of value. Nevertheless, important opportunities exist for science to inform these deliberations and guide the selection of policies that maximise the public good.’

Strang, J, Babor, T, Caulkins, J, Fischer, B, Foxcroft, D & Humphreys, K 2012, ‘Drug policy and the public good: evidence for effective interventions’, Lancet, vol. 379, no. 9810, pp. 71-83.

Comment: This article summarises the findings of the excellent book Babor, T et al. 2010, Drug policy and the public good, Oxford University Press, Oxford.

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What do Australians think about the legal status of drugs?

Analysis of data from a nationally representative survey of Australians (the 2010 NDS Household Survey) on the legal status of drugs reveals that Australians make a distinction between legalisation and decriminalisation options. When asked whether they think that the personal use of drugs should be made legal, ‘51% of Australians oppose the legalisation of cannabis for personal use. More than 80% of Australians oppose the legalisation of heroin and methamphetamine for personal use. More than 75% of Australians oppose the legalisation of ecstasy for personal use’. In contrast, ‘The vast majority of Australians support decriminalisation actions for cannabis use. Half of all Australians support decriminalisation actions for ecstasy use. Just under half of Australians support decriminalisation actions for heroin and methamphetamine use’.

Ritter, A & Matthew-Simmons, F 2012, What does the research evidence tell us about what Australians think about the legal status of drugs? , National Drug & Alcohol Research Centre, Sydney, http://www.dpmp.unsw.edu.au/DPMPWeb.nsf/resources/BULLETIN5/$file/DPMP+Bulletin+21.pdf

Comment: This secondary analysis of the NDS Household Survey literature reminds us of the importance of how survey questions are drafted. Often, how we ask the question determines the answers.

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How risky is drug injection in Australian prisons?

Interviews of over a thousand adult prisoners in Queensland found that 23% had injected drugs while in prison and that 13% had done so during their current sentence. Males, those who had been unemployed prior to being imprisoned, and those who had used three or more types of drugs prior to being imprisoned were more likely to have injected drugs while in prison. They were also more likely than other prisoners to have shared needles or syringes, to have received a tattoo while in prison, and to have been exposed to hepatitis C. The researchers concluded that ‘Drug injection in prison is common and, given the associations between in-prison drug injection and syringe sharing, unsafe tattooing and HCV exposure, poses a risk to both prisoner health and public health. There remains an urgent need to implement evidence-based infection control measures, including needle and syringe programs, within prison settings.’

Kinner, SA, Jenkinson, R, Gouillou, M & Milloy, MJ 2012, ‘High-risk drug-use practices among a large sample of Australian prisoners’, Drug and Alcohol Dependence, in press.

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How common is it for ex-prisoners to die from accidental drug-related causes?

Analysis of the Australian National Coroners’ Information System identified reportable deaths among ex-prisoners from 2000 to 2007. Coronial records for 388 deceased ex-prisoners reveal that 45% of these deaths were a result of accidental drug-related causes. The researchers found that ‘The majority of accidental drug-related deaths occurred in a home environment, and poly-substance use at or around the time of death was common, recorded in 72% of drug-related deaths. Ex-prisoners who died of accidental drug-related causes were on average younger and less likely to be Indigenous, born in Australia, married, or living alone at or around the time of death, compared with those who died from all other reportable causes’. They concluded that ‘Drug-related deaths are common among ex-prisoners and often occur in a home (vs. public) setting. They are often associated with use of multiple substances at or around the time of death, risky drug-use patterns, and even among this markedly disadvantaged group, extreme social disadvantage. These findings reflect the complex challenges facing prisoners upon release from custody and indicate a need to consider drug overdose within the wider framework of ex-prisoner experiences, so that preventive programmes can be appropriately structured and targeted’.

Andrews, JY & Kinner, SA 2012, ‘Understanding drug-related mortality in released prisoners: a review of national coronial records’, BMC Public Health, vol. 12, no. 1, p. 270.

Comment: This study confirms the findings of others that highlight the crucial need to invest in throughcare services for prisoners focusing on, among other things, their elevated risk of drug-related death.

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How likely is it that the shared use of drug preparation equipment leads to the transmission of hepatitis C?

Researchers in the United States examined ‘the associations between shared syringes and drug preparation equipment with HCV seroconversion using data from the HCV Synthesis Project, a systematic review and meta-analysis of published and unpublished research studies of HCV epidemiology and prevention in drug users throughout the world’. They found that syringe sharing, sharing drug preparation containers, sharing rinse water, combinations of this equipment, “backloading”, a syringe-mediated form of sharing prepared drugs’ were all associated with HCV seroconversion. Their conclusions were that ‘The risk of hepatitis C infection through shared syringes is dependent upon hepatitis C infection seroprevalence in the population. The risk of hepatitis C infection through shared drug preparation equipment is similar to that of shared syringes. Because the infection status of sharing partners is often unknown, it is important for injection drug users to consistently avoid sharing unsterile equipment used to prepare, divide or inject drugs and avoid backloading with an unsterile syringe’.

Pouget, ER, Hagan, H & Des Jarlais, DC 2012, ‘Meta-analysis of hepatitis C seroconversion in relation to shared syringes and drug preparation equipment, Addiction, vol. 107, no. 6, pp. 1057-65.

Comment: This study further strengthens the evidence base for peer education programs focusing on the dangers of contaminated injecting environments, as well as the dangers of sharing needles and syringes.

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Is it feasible for treatment teams to provide brief interventions to reduce alcohol consumption in conjunction with methadone treatment?

In view of the prevalence of problematic alcohol use among people receiving methadone treatment, and the prevalence of hepatitis C among this group, Irish researchers conducted an implementation study to determine whether it was feasible for treatment staff to deliver brief interventions (BI) within their regular clinical setting. They concluded that ‘It is feasible for a range of clinicians to screen for problem alcohol use and deliver BI within community methadone clinics. Opiate-dependent patients significantly reduced their alcohol consumption as a result of receiving a BI’.

Darker, CD, Sweeney, BP, El Hassan, HO, Smyth, BP, Ivers, J-HH & Barry, JM 2012, Brief interventions are effective in reducing alcohol consumption in opiate-dependent methadone-maintained patients: Results from an implementation study, Drug Alcohol Rev, vol. 31, no. 3, pp. 348-56.

Comment: OST clinicians are increasingly accepting that part of their duty of care towards their patients is providing stop smoking interventions. This study suggests that the initiative could be extended to include brief interventions on alcohol use.

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What is the most effective way for doctors to help their patients to stop smoking?

A meta-analysis of Cochrane Reviews of physician advice on smoking cessation found ‘There was strong evidence that offering either advice to stop smoking or assistance with stopping were effective in promoting quit attempts. Three trials show strong statistical evidence that offering support for cessation motivates an additional 40–60% of people to attempt cessation compared to being advised to stop smoking on medical grounds. In all three trials, cessation support was offered without screening for willingness to quit. The evidence that offering assistance led to increased abstinence in the long term was strong only for NRT [nicotine replacement therapy]…Both offering advice to stop smoking on medical grounds and support for cessation appear to increase the success rate of attempts to quit smoking’. The researchers conclude that ‘Physicians may be more effective in promoting attempts to stop smoking by offering assistance to all smokers than by advising smokers to quit and offering assistance only to those who express an interest in doing so’.

Aveyard, P, Begh, R, Parsons, A & West, R 2012, ‘Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance’, Addiction, vol. 107, no. 6, pp. 1066-73.

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Are people with substance use disorders more likely to suffer from post-traumatic stress disorder, depression, and to have suicidal tendencies?

Clients of substance use disorder (SUD) treatment services are more likely than members of the community at large to have been exposed to trauma and to suffer post-traumatic stress disorder (PTSD). Data were collected on the 304 patients admitted to a detoxification unit in Sydney over the period June 2008 to February 2009. Analysis of the data revealed that ‘Approximately 20% of inpatients experienced moderate to severe depressive symptoms, and 37% had a lifetime history of self-harm or attempted suicide. Approximately 80% of patients had experienced at least one traumatic event, most experiencing multiple traumas...Almost 45% of patients screened positive for current PTSD symptoms…. PTSD symptoms were associated with greater trauma exposure, younger age of first trauma, specific trauma types, moderate to severe depressive symptoms and a history of self-harm or attempted suicide. Despite their difficulties, patients with PTSD symptoms had high rates of retention in treatment’. The researchers recommended that ‘Patients entering treatment for SUDs should be assessed for PTSD, depression and suicidality. These conditions impact significantly on treatment outcomes, and require the development of appropriate treatment strategies’.

Dore, G, Mills, K, Murray, R, Teesson, M & Farrugia, P 2012, ‘Post-traumatic stress disorder, depression and suicidality in inpatients with substance use disorders, Drug and Alcohol Review, vol. 31, no. 3, pp. 294-302.

Comment: This Australian study highlights the importance of multiple co-morbiditied in SUD patients, and the need for treatment services to continue to build capacity to address service users’ diverse needs.

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What proportion of criminal behaviour is related to alcohol or drugs?

A recent report based on data from the Drug Use Monitoring in Australia (DUMA) program examines the extent to which criminal activity can be attributed to substance use. It uses ‘self-reported alcohol and drug attributions of 1,884 police detainees from nine separate data collection locations across Australia’. The report reveals that ‘Nearly half of all police detainees attributed their current offending to alcohol or drugs—alcohol being more frequently attributed to by detainees than all other drugs combined. Of the illicit drugs, heroin users were the most likely to attribute their offending to drug use, while cannabis users were among the least likely. Surprisingly, of those who attributed their offending to drug use, only 25 percent attributed their crimes to economic factors, such as the need to fund drug addictions, whereas being intoxicated or under the influence of drugs or alcohol were reported as the cause by as many as 40 percent’.

Payne, J & Gaffney, A 2012, How much crime is drug or alcohol related? Self-reported attributions of police detainees, Trends & Issues in Crime and Criminal Justice, no. 439, Australian Institute of Criminology, Canberra.

Comment: This study adds to our understanding of the drug-crime link, strengthening the evidence base for diverting drug-involved (including alcohol-involved) offenders away from the criminal justice system and into helping services.

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What do employers think of minimum qualifications for drug and alcohol workers?

Researchers from the National Centre for Education and Training on Addiction surveyed 186 AOD treatment agency managers across Australia to determine levels of satisfaction with and attitudes toward AOD Vocational Education and Training (VET) qualifications as a minimum qualification. They found that ‘Most managers were supportive of a minimum qualification strategy and deemed VET AOD qualifications sufficient as a minimum level qualification. However, over half indicated that the minimum qualification should be higher than certificate IV level. One in four managers were dissatisfied with VET provided by technical and further education colleges. When seeking to employ AOD specialist workers, most managers preferred those with university level qualifications rather than VET qualifications’. The researchers concluded that ‘VET has potential to meet the increasingly complex needs of AOD work by providing ongoing certificate and diploma level training and qualifications at the vocational graduate level. However, the relatively high levels of dissatisfaction with the VET sector, and concern regarding the ability of certificate IV level training to meet the needs of the AOD workforce, warrant attention. Improved linkages and relationships between the AOD field and the VET sector could increase the quality of training provided and may assist in addressing the AOD workforce development needs’.

Pidd, K, Roche, A, Duraisingam, V & Carne, A 2012, ‘Minimum qualifications in the alcohol and other drugs field: employers' views’, Drug and Alcohol Review, vol. 31, no. 4, pp. 514-22.

Comment: The ACT has been a leader in establishing a minimum qualifications strategy for staff in our sector. This study provides information that could assist in fine-tuning our MQS.

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How effective are the CLIMATE Schools drug prevention programs?

The CLIMATE Schools drug prevention programs are based on a harm-minimisation approach rather than abstinence, and have been developed in collaboration with teachers, students and relevant health and legal professionals. Three computer-delivered modules have been developed: on alcohol, on alcohol and cannabis, and on cannabis and psychostimulants. An evaluation of the three programs found that ‘school-based drug prevention programs based on a harm-minimisation approach and delivered by computer can offer an innovative new platform for the delivery of prevention education for both licit and illicit drugs in schools. The mode of delivery was certainly welcomed by both students and teachers, with the latter rating these programs to be superior to other drug prevention approaches and reporting that they would be likely to continue using these programs in the future. The CLIMATE drug prevention programs now offer a suite of sequential and developmentally appropriate interventions catering for both licit and illicit drug use’.

Vogl, L, Newton, N, Teesson, M, Swift, W, Karageorge, A, Deans, C, McKetin, R, Steadman, B, Jones, J, Dillon, P, Havard, A & Andrews, G 2012, Climate Schools: universal computer-based programs to prevent alcohol and other drug use in adolescence, National Drug & Alcohol Research Centre, UNSW, Sydney, http://ndarc.med.unsw.edu.au/resource/climate-schools-universal-computer-based-programs-prevent-alcohol-and-other-drug-use

Comment: For many years we have been pessimism about the capacity of school drug education programs to achieve worthwhile results. The CLIMATE Schools initiative, along with the WA-developed SHAHRP program (McBride, N et al. 2004, ‘Harm minimization in school drug education: final results of the School Health and Alcohol Harm Reduction Project (SHAHRP)’, Addiction, vol. 99, no. 3, pp. 278-91) have delivered fine outcomes by taking a pragmatic harm reduction, rather than abstinence, approach.

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What is the most effective way to reduce adolescent smoking?

A study conducted for the World Health Organization aimed to determine if disrupting the sale of tobacco to minors can be expected to reduce youth smoking. It involved a literature search of studies that evaluated the impact on youth tobacco use of efforts to disrupt the sale of tobacco to youths. The findings were ‘There was little evidence that merely enacting a law without sufficient enforcement had any impact on youth tobacco use. There was no evidence that merchant education programmes had any impact on youth older than 12 years of age. There was no evidence that enforcement efforts that failed to reduce the sale of tobacco to minors had any beneficial impact. All enforcement programmes that disrupted the sale of tobacco to minors reduced smoking among youth’. The researcher concluded ‘Government officials can expect that enforcement programmes that disrupt the sale of tobacco to minors will reduce adolescent smoking’.

Difranza, JR 2012, ‘Which interventions against the sale of tobacco to minors can be expected to reduce smoking?’, Tobacco Control, vol. 21, no. 4, pp. 436-42.

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What are synthetic cannabinoids and how dangerous are they?

A NCPIC bulletin on synthetic cannabinoids describes them as ‘a structurally diverse family of compounds with a large number of biological targets and can be classified into three groups: phytocannabinoids, endocannabinoids and synthetic cannabinoids…The effects of all three groups of cannabinoids reflect the areas of the brain with which they interact’. In 2011 the Ecstasy and Related Drugs Reporting System included questions about the use of synthetic cannabinoid products: only four people reported using K2/Spice, and 32 reported using some other cannabinoid in the previous 12 months.
The authors of the bulletin explain that ‘Synthetic cannabinoids are often classified as “research chemicals”. Research chemicals are experimental chemicals that are not approved for human consumption. The vast majority of these chemicals have only been recently synthesized and up until very recently, little, if any data have been available regarding their effects, adverse reactions, long-term damage, or dependence potential with regards to humans’. It appears that synthetic cannabinoids have been available in Australia but ‘It was not until early 2011, however, following the growing media interest in the product “Kronic”, that Australian authorities began to focus their attention on this rapidly emerging class of drugs’. Western Australian media reports claimed there is wide-spread use of these drugs by mine workers. ‘On 17 June, 2011, WA implemented a ban via state-specific legislation on seven synthetic cannabinoids…[and] On August 5, the WA Government banned 14 more synthetic cannabinoids’.
The authors conclude ‘Governments will continue to ban synthetic compounds that may present a risk to public health and safety but there is little doubt that the companies producing these products will continue to remain one step ahead, potentially developing compounds that may possibly be even more harmful than the originals’.

Dillon, P & Copeland, J 2012, Synthetic cannabinoids: the Australian experience, Bulletin series 13, National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, http://ncpic.org.au/ncpic/publications/bulletins/article/synthetic-cannabinoids-the-australian-experience

Comment: Australia has followed the lead of other nations in taking a knee-jerk response and simply criminalising the emerging synthetic cannabinoids. Little evidence exists indicating that they have considered the full range of options available for dealing with this problem, including options that are likely to be more effective than simple prohibition.

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How wide-spread is the use of emerging psychoactive substances in Australia?

Interviews were conducted in 2011 in all Australian capital cities as part of the Ecstasy and Related Drugs Reporting System (EDRS) to ‘determine the extent of use of EPS [emerging psychoactive substances] from stimulant (such as mephedrone) and psychedelic classes (such as 5-methoxy-dimethyltryptamine [5-MeO-DMT]) among an Australian sample of regular ecstasy users (REU). Further, to determine if consumers of these drugs represent a distinct subgroup of REU’. The researchers found that ‘stimulant EPS, most commonly mephedrone, are being consumed by approximately one-fifth of Australian REU. The characteristics of stimulant EPS consumers are not different to the majority of frequent ecstasy consumers, and…there is clear potential for stimulant EPS use to expand in these markets. In the event of an increase in use, it can be anticipated that there will be greater public health impacts relating to these drugs in comparison to ecstasy. Use of psychedelic EPS, by contrast, appears largely experimental and restricted to a distinct subset of individuals with high-level (typically non-injecting) polydrug use. While this group may be few in number, it is important to include them in health system interventions, particularly given high social and health harms identified in this group. Given the potential markets for, and health impacts of, these drugs, stimulant EPS should be incorporated in drug use and health monitoring systems’.

Bruno, R, Matthews, AJ, Dunn, M, Alati, R, McIlwraith, F, Hickey, S, Burns, L & Sindicich, N 2012, ‘Emerging psychoactive substance use among regular ecstasy users in Australia’, Drug and Alcohol Dependence, vol. 124, no. 1-2, pp. 19-25.

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Are drivers who are users of buprenorphine and methadone at increased risk of being involved in accidents?
A French study investigated the association between the risk of being responsible for a road traffic crash and the use of buprenorphine and methadone. Over seventy thousand drivers were ‘involved in an injurious crash in France over the July 2005-May 2008 period… The 196 drivers exposed to buprenorphine or methadone on the day of crash were young, essentially males, with an important co-consumption of other substances (alcohol and benzodiazepines). Injured drivers exposed to buprenorphine or methadone on the day of crash, had an increased risk of being responsible for the crash’. The researchers concluded ‘Users of methadone and buprenorphine were at increased risk of being responsible for injurious road traffic crashes. The increased risk could be explained by the combined effect of risky behaviors and treatments’.

Corsenac, P, Lagarde, E, Gadegbeku, B, Delorme, B, Tricotel, A, Castot, A, Moore, N, Philip, P, Laumon, B & Orriols, L 2012, ‘Road traffic crashes and prescribed methadone and buprenorphine: a French registry-based case-control study’, Drug and Alcohol Dependence, vol. 123, no. 1-3, pp. 91-7.

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New Reports

ANEX 2012, Australian drug policy: harm reduction and ‘new recovery’. (Discussion paper: draft for consultation), ANEX, Melbourne, www.anex.org.au/recovery/

Australian Injecting & Illicit Drug Users League (AIVL) 2012, 'New Recovery’, harm reduction & drug use: policy statement, Australian Injecting & Illicit Drug Users League (AIVL), Canberra, www.atoda.org.au/wp-content/uploads/AIVL-Research-Policy-Update-Special-Edition-Issue-9.pdf

Global Commission on Drug Policy 2012, Report of the Global Commission on Drug Policy: the War on Drugs and HIV/AIDS. How the criminalization of drug use fuels the global pandemic, Global Commission on Drug Policy, [Rio de Janeiro], www.globalcommissionondrugs.org/reports/

United Nations Office on Drugs and Crime 2012, UNODC and the promotion and protection of human rights 2012, UNODC, Vienna, www.unodc.org/unodc/en/frontpage/2012/May/unodc-intensifies-focus-on-human-rights.html

United Nations Office on Drugs and Crime 2012, World Drug Report 2012, UNODC, New York, www.unodc.org/unodc/en/data-and-analysis/WDR-2012.html , large file warning: 10.8 MB.

Australian Institute of Health and Welfare 2012, National Opioid Pharmacotherapy Statistics Annual Data collection: 2011 report, Drug Treatment series no. 15, cat. no. HSE 12, Australian Institute of Health and Welfare, Canberra, www.aihw.gov.au/publication-detail/?id=10737422012

National Indigenous Drug and Alcohol Committee 2012, Addressing the fetal alcohol spectrum disorder in Australia, National Indigenous Drug and Alcohol Committee, Canberra, www.nidac.org.au/index.php?option=com_content&view=article&id=90&Itemid=63 .

Lee, K, Freeburn, B, Ella, S, Miller, W, Perry, J & Conigrave, K (eds) 2012, Handbook for Aboriginal alcohol and drug work, University of Sydney, Sydney, NSW, http://ses.library.usyd.edu.au/handle/2123/8339

Burns, L, Black, E & Elliot, E (eds) 2009 (released 2012), Fetal alcohol spectrum disorders in Australia: an update, Intergovernmental Committee on Drugs Working Party on Fetal Alcohol Spectrum Disorders, Canberra, http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono-fasd

Sweeney, J & Payne, J 2012, Drug use among police detainees: a comparative analysis of DUMA and the US Arrestee Drug Abuse Monitoring program. Findings from the DUMA program, Research in Practice DUMA no. 27, Australian Institute of Criminology, Canberra, www.aic.gov.au/en/publications/current%20series/rip/21-40/rip27.aspx.

Australian Institute of Health & Welfare 2012, The mental health of prison entrants in Australia: 2010, Australian Institute of Health & Welfare, Canberra, http://aihw.gov.au/publication-detail/?id=10737422201.

For information on other reports, please visit the ‘Did you see that report?’ page at the website of the National Drugs Sector Information Service:  http://ndsis.adca.org.au/report.php

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