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.
How can the term 'drinking culture' be defined?
A critical review of the meaning and connation of the term ‘drinking culture’ in social research on alcohol problems examined the international literature on the topic. The authors state that ‘Much of the alcohol research discussion on drinking culture has focussed on national drinking cultures in which the cultural entity of concern is the nation or society as a whole (macro-level). In this respect, there has been a comparative tradition concerned with categorising drinking cultures into typologies (e.g. “wet” and “dry” cultures). Although overtly focused on patterns of drinking and problems at the macro-level, this tradition also points to a multifaceted understanding of drinking cultures. Even though norms about drinking are not uniform within and across countries there has been relatively less focus in the alcohol research literature on cultural entities below the level of the culture as a whole (micro-level)’. They conclude by offering a working definition, which underscores the multidimensional and interactive nature of the drinking culture concept:
‘Drinking cultures are generally described in terms of the norms around patterns, practices, use-values, settings and occasions in relation to alcohol and alcohol problems that operate and are enforced (to varying degrees) in a society (macro-level) or in a subgroup within society (microlevel). Drinking culture also refers to the modes of social control that are employed to enforce norms and practices. Drinking culture may refer to the aspects concerned with drinking of a cultural entity primarily defined in terms of other aspects, or may refer to a cultural entity primarily defined around drinking. Drinking cultures are not homogeneous or static but are multiple and moving. As part of a network of other interacting factors (e.g. gender, age, social class, social networks, individual factors, masculinity, policy, marketing, global forces, place, etc.), drinking culture is thought to influence when, where, why and how people drink, how much they drink, their expectations about the effects of different amounts of alcohol, and the behaviours they engage in before, during and after drinking. The degree and nature of the influence that drinking cultures have on individuals is not inevitable but will depend on the configuration of factors in play in any given situation, and the nature of the relationships between the culture as a whole and smaller cultural entities’.
Savic, M, Room, R, Mugavin, J, Pennay, A & Livingston, M 2016, ‘
Defining “drinking culture”: a critical review of its meaning and connotation in social research on alcohol problems’, Drugs: education, prevention and policy, vol. 23, no. 4, pp. 270-82.
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How can drinking cultures and hegemonic masculinities in community sporting clubs be changed for the better?
A researcher based at the National Drug Research Institute in Perth presents a case study of a football club which is part of the Good Sports Program which was developed by the Australian Drug Foundation, sporting bodies and other stakeholders between 1996 and 1999 with implementation beginning in 2000. The Program is designed to change the drinking culture of sporting clubs. The researcher’s analysis of interview and field observation material ‘…traces interrelations between Program interventions, demographic and social changes, gender hierarchies, drinking settings and norms governing alcohol consumption within the club’. He demonstrates that ‘changes in the drinking culture of the clubrooms have occurred, and that the Good Sports Program played a role in this change. However, “bad behaviour”, “drink” and “trouble” remain features of other club settings. His conclusion is that ‘opportunities exist for further engagements with masculinities, and the socio-material networks that hold them in place, and that these engagements might open the way for more significant changes in the drinking cultures of male sporting clubs’.
Hart, A 2016, ‘
Good Sports, drinking cultures and hegemonic masculinities in a community sporting club case study’,
Drugs: education, prevention and policy, vol. 23, no. 4, pp. 302-11.
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What are the characteristics of young drinkers who engage in pre-drinking?
Abstract
Background: Pre-drinking has been linked to subsequent heavy drinking and the engagement in multiple risky behaviors.
Objectives: The present study examined a group of adolescents who recently had a “big night out” to determine whether there were differences in their pre-drinking behavior based on age, gender, geographic location, and social setting.
Methods: Participants (n = 351, aged 16-19) representing the heaviest 20-25% of drinkers in their age group were recruited using nonrandom sampling from metropolitan (Melbourne, Sydney, Perth) or regional (Bunbury) locations across Australia and administered a survey by a trained interviewer.
Results: Almost half the sample pre-drank (n = 149), most commonly at a friend’s house. Those aged 18-19 were more likely to pre-drink, and did so at higher quantities compared to their younger counterparts. Males and females reported similar pre-drinking duration, quantity and amount spent on alcohol. Compared to those in cities, regional participants consumed greater quantities over longer periods of time. Two-thirds of participants consumed alcohol in excess of national guidelines during their pre-drinking session. These participants were more likely to nominate price as a motivation to pre-drink and were less likely to report that someone else provided them alcohol.
Conclusions: This study sheds light on the pre-drinking habits of a population of young risky drinkers, and highlights the need for policy makers to address this form of drinking to reduce alcohol-related harm among young people.
Ogeil, RP, Lloyd, B, Lam, T, Lenton, S, Burns, L, Aiken, A, Gilmore, W, Chikritzhs, T, Mattick, R, Allsop, S & Lubman, DI 2016, ‘
Pre-drinking behavior of young heavy drinkers’, Substance Use and Misuse, vol. 51, no. 10, pp. 1297-306.
How would the provision of Needle and Syringe Programs in Australian prisons affect the spread of blood-borne viruses and the prison economy of needles and syringes?
A study funded by NSW Health and the National Health and Medical Research Council examined how this economy generates blood-borne virus (BBV) risk and risk mitigation opportunities for inmates. ‘Thirty inmates participated, including 10 women…. all of whom reported a history of injecting drug use, 14 had not been exposed to HCV at the time of interview, 8 had chronic HCV infection and 8 had incident infection. None had HIV infection…10 participants reported no recent injecting, six reported injecting at a frequency of less than monthly, three more frequently than monthly, three more than weekly, three daily and five more than daily as indicated by their responses to behavioural surveillance surveys. Participants were recruited from a total of 12 prisons (including all three female prisons in NSW)’. The findings included that ‘A needle/syringe was nominated as being typically priced in the “inside” prison economy at $100-$150, with a range of $50-$350. Purchase or hire of equipment was paid for in cash (including transactions that occurred outside prison) and in exchange for drugs and other commodities. A range of other resources was required to enable successful needle/syringe economies, especially relationships with visitors and other prisoners, and violence to ensure payment of debts. Strategies to mitigate BBV risk included retaining one needle/syringe for personal use while hiring out others, keeping drug use (and ownership of equipment) “quiet”, stealing used equipment from the prison health clinic, and manufacture of syringes from other items available in the prison’. The researchers concluded that‘The provision of prison NSP [Needle and Syringe Program] would disrupt the inside economies built around contraband needles/syringes, as well as minimise BBV risk. However, any model of prison NSP should be interrogated for any unanticipated markets that could be generated as a result of its regulatory practices’.
Treloar, C, McCredie, L & Lloyd, AR 2016, ‘The prison economy of needles and syringes: what opportunities exist for blood borne virus risk reduction when prices are so high?’, PLoS One, vol. 11, no. 9, pp. e0162399, open access
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0162399.
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How useful is hair analysis as a means of detecting the level and quantity of cannabis consumption?
Researchers in the United Kingdom collected hair samples from 136 subjects who were self-reported heavy, light or non-users of cannabis. They tested the samples in the laboratory using the method known as Gas Chromatography coupled to Tandem Mass Spectrometry (GC-MS/MS). ‘Sensitivity, specificity, positive predictive value and negative predictive value were calculated for five cannabinoids (tetrahydrocannabinol [THC], THC-OH, THC-COOH, cannabinol and cannabidiol). Samples also were segmented in 1 cm sections representing 1 month exposure and the correlation between amount of cannabinoid detected and self-reported cannabis consumption tested’. They found that ‘The sensitivity of THC detection in hair was 77% in heavy cannabis smokers compared to light and non-cannabis users, but fell to 55% in any cannabis users compared to non-cannabis users. Other metabolites had lower sensitivity and specificity. The concentration of cannabinoids detected in hair was poorly correlated with reported levels of cannabis consumption. When using THC as a marker to detect cannabis use comparing heavy and light smokers with non-smokers, the [positive predictive values] indicates that >90% are true positive values. Conversely, a negative result is more difficult to interpret, with the [negative predictive values] indicating that <60% with negative results are correctly identified as such’. Their conclusion was that ‘Hair analysis can be used as a qualitative indicator of heavy (daily or near daily) cannabis consumption within the past 3 months. However, this approach is unable to reliably detect light cannabis consumption or determine the quantity of cannabis used by the individual’.
Taylor, M, Lees, R, Henderson, G, Lingford-Hughes, A, Macleod, J, Sullivan, J & Hickman, M 2016, ‘Comparison of cannabinoids in hair with self-reported cannabis consumption in heavy, light and non-cannabis users’, Drug and Alcohol Review, vol. online ahead of print, open access
http://onlinelibrary.wiley.com/doi/10.1111/dar.12412/full.
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How prevalent is the use of new psychoactive substances among ecstasy users in Australia?
A study which analysed data collected in the Ecstasy and Related Drugs Reporting System examined the prevalence and correlates of new psychoactive substances (NPS) use amongst a group of regular ecstasy users in Australia. Participants were recruited if they had used ecstasy at least six times in the previous six months, lived in a capital city and were over 16 years of age. Respondents who had used an NPS in the past six months were compared to those who had not. The researchers found that ‘NPS were used by 44% of the total sample. In 2013 2C-I (14%) and 2C-B (8%) were the most prevalent NPS. Respondents in the NPS group were younger and reported more frequent use of more types of drugs. They were also more likely to rate the purity of ecstasy as low relative to those in the no NPS group’. The researchers concluded that ‘NPS are available in Australia and consistent with international findings, the specific types of substances used is highly dynamic. Given this, it is critical that drug monitoring systems have the capacity to detect these rapid changes and will need to incorporate technological measures including Internet use to do so. At this stage there is a trend in Australia and internationally towards use of NPS with hallucinogenic properties. The additional risks conferred by these substances would suggest urgent need for increased public education about the nature and potential impact of NPS including the uncertainty of content. Given the younger age at which ecstasy use commenced among those reporting NPS use, and the potential for access of these substances through the Internet by a large group of young people, research should be undertaken to develop an effective school based prevention campaign targeting NPS’.
Burns, L, Roxburgh, A, Matthews, A, Bruno, R, Lenton, S & Van Buskirk, J 2014, ‘
The rise of new psychoactive substance use in Australia’, Drug Testing and Analysis, vol. 6, no. 7-8, pp. 846-9.
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To what extent has the Therapeutic Goods Administration restricting of the sale of codeine reduced codeine misuse?
NSW researchers reviewed calls regarding codeine misuse made to the New South Wales Poisons Information Centre from 2004 to 2015 to quantify the average annual change in calls, and whether there was a significant change in trend at any time, including following the 2010 rescheduling of codeine-containing analgesics to sale by ‘Pharmacist Only’. The database contained 400 cases of codeine combination analgesic misuse over the 12 year period. ‘No significant change in trend was seen at any time, including following 2010 rescheduling. The median age of patients was 34 and 27 years for paracetamol/codeine and ibuprofen/codeine cases, respectively. Gender distribution was approximately equal. Clinical features reported were consistent with codeine, paracetamol and ibuprofen toxicity’. They concluded that ‘Misuse of codeine combination products appears to be increasing in Australia. Limited rescheduling in 2010 failed to curb this increase’.
Cairns, R, Brown, JA & Buckley, NA 2016, ‘
The impact of codeine re-scheduling on misuse: a retrospective review of calls to Australia’s largest poisons centre’, Addiction, vol. 111, no. 10, pp. 1848-53.
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What is known about smoking cessation programs for lesbian, gay, bisexual, transgender and intersex people?
A systematic review of evaluations of smoking cessation programs for lesbian, gay, bisexual, and transgender (LGBT) people examined 19 studies involving over 3,000 people. The researchers found that the ‘Overall quit rate was 61.0% at the end of interventions and stabilized at 38.6% at 3-6 months. All studies included gay men, 13 lesbians, 13 “LGBT”, 12 bisexual people, 5 transgender people, and none included intersex people. Transgender people comprised 3% of participants. Of programs open to women, 27.8% of participants were women. Cultural modifications were used by 17 (89.5%) studies, commonly meeting in LGBT spaces, discussing social justice, and discussing LGBT-specific triggers. Common [behavioural change techniques] included providing normative information, boosting motivation/self-efficacy, relapse prevention, social support, action planning, and discussing consequences’. The researchers concluded that ‘Quit rates were high…Existing programs may fail to reach groups other than gay men’. They stated that ‘Populations within LGBTI are not proportionally represented in smoking cessation research, and no study addressed intersex smoking. Overall, LGBT-targeted interventions appear to be effective, and simply having an LGBT-specific group may be more effective than groups for the general population’.
Berger, I & Mooney-Somers, J 2016, ‘
Smoking cessation programs for lesbian, gay, bisexual, transgender, and intersex people: a content-based systematic review’, Nicotine & Tobacco Research, online ahead of print.
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How strong is the association between smoking in movies and increased smoking uptake amongst young people?
A systematic review and meta-analysis aimed to quantify cross-sectional and longitudinal associations between exposure to smoking in movies and initiating smoking in adolescents. The studies demonstrated that ‘higher exposure…to smoking in movies was associated significantly with a doubling in risk of ever trying smoking…In eight longitudinal studies…higher exposure to smoking in movies was associated significantly with a 46% increased risk of initiating smoking’. The researchers stated ‘There are many means of preventing movie exposure among young people, including default 18 adult age classification of movies containing smoking; requiring movies with smoking content shown on television to be broadcast after peak viewing hours for young people; or defining tobacco content, whether branded or not, as advertising and hence subject to prohibition under advertising legislation in those countries where tobacco advertising is banned. The example set by India, of requiring anti-smoking messages to be shown before and during films containing smoking and subtitled health warnings to be shown during smoking scenes could also be applied more widely to both reduce the impact of the exposure, and discourage movie-makers from including tobacco content. The latter approaches may also help to reduce the impact of movies watched through online services. Whatever the solution, however, the evidence now available indicates that measures to protect young people from such imagery are long overdue’.
Leonardi-Bee, J, Nderi, M & Britton, J 2016, ‘
Smoking in movies and smoking initiation in adolescents: systematic review and meta-analysis’, Addiction, vol. 111, no. 10, pp. 1750-63.
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How can modern hepatitis C treatment be utilised to assist patients to cease smoking?
A study by researchers based in the United States analysed the responses to detailed questionnaires completed by a group of hepatitis C-infected and uninfected smokers receiving care at a clinic in the Bronx, New York. The smokers living with hepatitis C in the patient sample were middle-aged, ethnic/racial minority, with low educational attainment, high rates of unemployment, and heavy burdens of substance use and psychiatric disease. ‘PLHC [persons living with hepatitis C] smokers were highly motivated to quit, with 52.5% stating an intention to quit within 30 days. Most of the PLHC smokers had used cessation-directed pharmacotherapy, but almost none had tried a quitline or a quit smoking website. PLHC smokers scored higher on the intrapersonal locus of control subscale. Almost a quarter (22.5%) believed that smoking “helped fight the hepatitis C virus”’. The researchers concluded that ‘PLHC smokers have a high burden of psychiatric and substance use comorbidity. They exhibit characteristics that distinguish them from uninfected smokers, and many harbor false beliefs about imagined benefits of smoking. They are highly motivated to quit but underutilize cessation aids. Without aggressive intervention, smoking-related morbidity will likely mute the health benefits and longevity gains associated with hepatitis C treatment. Research such as this may prove useful in guiding the development of future tobacco treatment strategies’.
Shuter, J, Litwin, AH, Sulkowski, MS, Feinstein, A, Bursky-Tammam, A, Maslak, S, Weinberger, AH, Esan, H, Segal, KS & Norton, B 2016, ‘
Cigarette smoking behaviors and beliefs in persons living with hepatitis C’, Nicotine & Tobacco Research, online ahead of print.
Comment: The authors’ final point, ‘Without aggressive intervention, smoking-related morbidity will likely mute the health benefits and longevity gains associated with hepatitis C treatment’, is especially relevant in the ACT with the recently increased availability of effective hepatitis C treatment. It highlights the importance of ATODA’s ongoing work with the ACT drug treatment sector in promoting smoking cessation among their service users and staff.
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What do the latest systematic reviews say about e-cigarettes as aids to smoking cessation?
Two authoritative systematic reviews that assess the state of scientific knowledge about electronic nicotine delivery devices (ENDS/electronic cigarettes) have recently been published. One is a Cochrane Review by Hartmann-Boyce et al. Their plain language summary reads as follows:
"Can electronic cigarettes help people stop smoking, and are they safe to use for this purpose?
Background: Electronic cigarettes (ECs) are electronic devices that produce an aerosol (commonly referred to as vapour) that the user inhales. This vapour typically contains nicotine without most of the toxins smokers inhale with cigarette smoke. ECs have become popular with smokers who want to reduce the risks of smoking. This review aimed to find out whether ECs help smokers stop smoking, and whether it is safe to use ECs to do this."
"Study characteristics: This is an update of a previous review. The first review was published in 2014 and included 13 studies. For this update, we searched for studies published up to January 2016 and found 11 new studies. Only two of the included studies are randomized controlled trials and followed participants for at least six months. These provide the best evidence. The remaining 22 studies either did not follow participants for very long or did not put people into treatment groups so could not directly compare ECs with something else. These studies can tell us less about how ECs might help with quitting smoking but can tell us about short-term safety. The two randomized trials, conducted in New Zealand and Italy, compared ECs with and without nicotine. We judged these studies to be at low risk of bias. In one study, people wanted to quit smoking, while in the other study they did not. The trial in people who wanted to quit smoking also compared ECs to nicotine patches."
"Key results: Combined results from two studies, involving 662 people, showed that using an EC containing nicotine increased the chances of stopping smoking in the long term compared to using an EC without nicotine. We could not determine if EC was better than a nicotine patch in helping people stop smoking, because the number of participants in the study was low. More studies are needed to evaluate this effect. The other studies were of lower quality, but they supported these findings. None of the studies found that smokers who used EC short- to mid-term (for two years or less) had an increased health risk compared to smokers who did not use ECs."
"Quality of the evidence: The quality of the evidence overall is low because it is based on only a small number of studies, although these studies were well conducted. More studies of ECs are needed. Some are already underway."
The second review, by Malas et al., published in the journal Nicotine & Tobacco Research, covered 62 studies including the two randomised studies in the Cochrane review plus a range of quasi-experimental, observational studies. It reached similar conclusions:
"Conclusions: While the majority of studies demonstrate a positive relationship between e-cigarette use and smoking cessation, the evidence remains inconclusive due to the low quality of the research published to date. Well-designed randomized controlled trials and longitudinal, population studies are needed to further elucidate the role of e-cigarettes in smoking cessation.
Implications:…While inconclusive due to low quality, overall the existing literature suggests e-cigarettes may be helpful for some smokers for quitting or reducing smoking. However, more carefully designed and scientifically sound studies are urgently needed to establish unequivocally the long-term cessation effects of e-cigarettes and to better understand of how and when e-cigarettes may be helpful."
Hartmann-Boyce, J, McRobbie, H, Bullen, C, Begh, R, Stead, LF & Hajek, P 2016, ‘Electronic cigarettes for smoking cessation’, Cochrane Database Syst Rev, vol. 9, pp. Cd010216, open access
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010216.pub3/abstract.
Malas, M, van der Tempel, J, Schwartz, R, Minichiello, A, Lightfoot, C, Noormohamed, A, Andrews, J, Zawertailo, L & Ferrence, R 2016, ‘
Electronic cigarettes for smoking cessation: a systematic review’, Nicotine & Tobacco Research, vol. 18, no. 10, pp. 1926-36.
Comment: Readers confused about the conflicting media reports about the science underpinning the role of e-cigarettes for smoking cessation will find helpful this online newspaper article written by the lead author of the Cochrane review: Hartmann-Boyce, J 2016, ‘Why can’t scientists agree on e-cigarettes?’, The Guardian, 14 September 2016, https://www.theguardian.com/science/sifting-the-evidence/2016/sep/14/why-cant-scientists-agree-on-e-cigarettes-vaping . ‘As a Cochrane review of e-cigarettes is published, its author asks why vaping devices have divided the academic community.’
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To what extent can e-cigarettes be useful in assisting people to quit smoking and reduce their risk of cardiovascular disease?
Writing in a recent issue of the journal Trends in Cardiovascular Medicine, the authors state that ‘The cardiovascular safety of nicotine is an important question in the current debate on the benefits vs. risks of electronic cigarettes and related public health policy. Nicotine exerts pharmacologic effects that could contribute to acute cardiovascular events and accelerated atherogenesis [fatty matter on the walls of arteries] experienced by cigarette smokers. Studies of nicotine medications and smokeless tobacco indicate that the risks of nicotine without tobacco combustion products (cigarette smoke) are low compared to cigarette smoking, but are still of concern in people with cardiovascular disease. Electronic cigarettes deliver nicotine without combustion of tobacco and appear to pose low-cardiovascular risk, at least with short-term use, in healthy users’. They conclude that, ‘While the role of e-cigarettes for smoking cessation is not established, it is clear that some smokers do quit successfully by using e-cigarettes. For smokers who present to physicians expressing interest in using e-cigarettes to quit smoking, we endorse the statement of the American Heart Association: “If a patient has failed initial treatment, has been intolerant to or refuses to use conventional smoking cessation medications, and wishes to use e-cigarettes to aid quitting, it a reasonable to support the attempt”. For patients with cardiovascular disease in particular, we recommend that when they are confident that they no longer need to use e-cigarettes to keep from smoking, that they discontinue e-cigarette use’.
Benowitz, NL & Burbank, AD 2016, ‘
Cardiovascular toxicity of nicotine: implications for electronic cigarette use’, Trends in Cardiovascular Medicine, vol. 26, no. 6, pp. 515-23.
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What evidence is available on the effectiveness of e-cigarettes in smoking abstinence or reduction?
A randomised trial conducted in New York City analysed the effect of e-cigarettes (ECs) on smoking abstinence and reduction. ‘Subjects were randomized to receive 3-weeks of either disposable 4.5% nicotine EC (intervention) or placebo EC. The primary outcome was self-reported reduction of at least 50% in the number of CPDs [cigarettes per day] smoked at week 3 (end of treatment) compared to baseline…The logistic regression analysis showed that using a greater number of ECs, treatment condition and higher baseline readiness to quit were significantly associated with achieving at least 50% reduction in CPDs at the end of treatment’. The researchers concluded that ‘A diverse young adult sample of current everyday smokers, who were not ready to quit, was able to reduce smoking with the help of ECs. Further study is needed to establish the role of both placebo and nicotine containing ECs in increasing both reduction and subsequent cessation’.
Tseng, T-Y, Ostroff, JS, Campo, A, Gerard, M, Kirchner, T, Rotrosen, J & Shelley, D 2016, ‘
A randomized trial comparing the effect of nicotine versus placebo electronic cigarettes on smoking reduction among young adult smokers’, Nicotine & Tobacco Research, vol. 18, no. 10, pp. 1937-43.
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New Reports
Australian Institute of Health & Welfare 2016, Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011—summary report Australian Burden of Disease Study series no. 4. BOD 5, Australian Institute of Health & Welfare, Canberra, http://aihw.gov.au/publication-detail/?id=60129556205.
Australian Institute of Health and Welfare 2016, Australia’s Health 2016, Australian Institute of Health and Welfare, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129555544 and Australia’s Health 2016 - in brief http://www.aihw.gov.au/publication-detail/?id=60129555545.
Australian Institute of Health and Welfare 2016, Exploring drug treatment and homelessness in Australia: 1 July 2011 to 30 June 2014, cat. no. CSI 23, AIHW, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129556009.
Callinan, I 2016, Review of Amendments to the Liquor Act 2007 (NSW), 2 vols., Justice NSW, Sydney, http://www.justice.nsw.gov.au/Pages/media-news/media-releases/2016/Callinan-Report-Released.aspx.
Dyke, H 2016, Why is doping wrong anyway?, The Conversation, http://theconversation.com/why-is-doping-wrong-anyway-63057.
Foundation for Alcohol Research and Education (FARE) 2016, Correcting the Sydney lockout myths, FARE, Canberra, http://fare.org.au/2016/08/correcting-the-sydney-lockout-myths/.
Friel, S 2016, Social determinants – how class and wealth affect our health, The Conversation, 02 September 2016, http://theconversation.com/social-determinants-how-class-and-wealth-affect-our-health-64442.
Government of Canada 2016, Toward the legalization, regulation and restriction of access to marijuana - discussion paper, http://healthycanadians.gc.ca/health-system-systeme-sante/consultations/legalization-marijuana-legalisation/document-eng.php.
Haigh, G 2016, ‘The doctor who is besting big tobacco’, Guardian Weekly, 19 Aug 2016, pp. 26-30.
Hartmann-Boyce, J 2016, ‘Why can’t scientists agree on e-cigarettes?’, The Guardian, 14 September 2016, https://www.theguardian.com/science/sifting-the-evidence/2016/sep/14/why-cant-scientists-agree-on-e-cigarettes-vaping.
Lefkovits, ZG 2016, A Public Health and Legislative Consideration of Methods to Reduce Drug-Related Harm in the Victorian Party Scene: On-Site Pill Testing, Market Monitoring and Publication of Police Drug Seizure Data. A pill too hard to swallow?, A Report Prepared for the Victorian Parliamentary Internship Program on behalf of Colleen Hartland MLC , Greens Member for the Western Metropolitan Region., Parliament of Victoria, Melbourne, http://pilltestingsaveslives.org.au/wp-content/uploads/sites/77/2016/08/Pill-Testing-Report.pdf.
Nelson, M, Lenton, S, Dietze, P, Olsen, A & Agramunt, S 2016, Evaluation of the WA Peer Naloxone Project – final report, National Drug Research Institute, Curtin University, Perth, WA, http://ndri.curtin.edu.au/local/docs/pdf/publications/wa_peer_naloxone_project.pdf.
Pennington Institute 2016, Australia’s Annual Overdose Report 2016, a Penington Institute report, Pennington Institute, Melbourne, http://www.penington.org.au/overdoseday/.
Public Health England 2016, Understanding and preventing drug-related deaths. The report of a national expert working group to investigate drug-related deaths in England, Public Health England, London, https://www.gov.uk/government/news/new-recommendations-to-address-deaths-from-drug-misuse-published.
Ramirez, A, Berning, A, Carr, K, Scherer, M, Lacey, JH, Kelley-Baker, T & Fisher, DA 2016, Marijuana, other drugs, and alcohol use by drivers in Washington State, report no. DOT HS 812 299, National Highway Traffic Safety Administration, Washington, DC, http://www.nhtsa.gov/staticfiles/nti/pdf/812299-WashingtonStatedrugstudy.pdf.
Rowe, J & Harris, L 2016, Get Up, Stand Up - giving people the means to respond to opioid overdose, School of Global, Urban and Social Studies RMIT University, Melbourne.
The Law Library of Congress 2016, Decriminalization of narcotics, The Law Library of Congress, Global Legal Research Center, Washington, D.C., https://www.loc.gov/law/help/decriminalization-of-narcotics/index.php.
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