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.
Commentary: ‘New amendments to child welfare policy in New South Wales turn a spotlight on parents who use drugs and raise concerns about adequate provision of services for families facing issues with alcohol and other drug use. Sections of the new legislation are explicitly focused on parents who use illicit drugs, expanding the reach of child protection services over expectant parents during pregnancy. This targeting of women who are “addicted” highlights the ambiguous scientific and moral attention to drug use in pregnancy. It also raises practical questions about the potential for the legislation to increase stigma towards drug use and disproportionately affect vulnerable and disadvantaged families.’
, Drug Alcohol Rev, vol. 34, no. 1, pp. 27-30.
New hepatitis C treatments
Researchers noted that the ‘Treatment of injecting drug users (IDU) for hepatitis C virus (HCV) infection may prevent onward transmission. Treating individuals who often share injecting equipment is most likely to prevent new infections. However, these high-risk IDU are also more likely to become re-infected than low-risk IDU.’ Given this, they used statistical modelling to investigate to which group treatment is most appropriately targeted. The benefits assessed from the treatment were the probability for the treated person to become and remain uninfected, as well as the expected number of prevented infections to others (i.e. a they aimed to determine the total expected decrease in chronic hepatitis C infections). The modelling led to the conclusion that ‘When more than half of all exchanged syringes in a population of injecting drug users (IDU) are contaminated by hepatitis C virus, it is most efficient to treat low-risk IDU first. Below this threshold, it is most efficient to treat high-risk IDU first.’
de Vos, AS, Prins, M & Kretzschmar, MEE 2015, ‘
Hepatitis C virus treatment as prevention among injecting drug users: who should we cure first?’, Addiction, online ahead of print.
Comment: it is a sad and, for many people, disappointing fact that the new, highly effective medications for treating hepatitis C infections will need to be rationed for financial reasons. Decision-makers will need to determine which population groups are the highest priority to receive these medications. This is in part a value decision and in part one which should be informed by scientific evidence such as provided in this paper.
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Which drugs are the most toxic?
Abstract: A comparative risk assessment of drugs including alcohol and tobacco using the margin of exposure (MOE) approach was conducted. The MOE is defined as ratio between toxicological threshold (benchmark dose) and estimated human intake. Median lethal dose values from animal experiments were used to derive the benchmark dose. The human intake was calculated for individual scenarios and population-based scenarios. The MOE was calculated using probabilistic Monte Carlo simulations. The benchmark dose values ranged from 2 mg/kg bodyweight for heroin to 531 mg/kg bodyweight for alcohol (ethanol). For individual exposure the four substances alcohol, nicotine, cocaine and heroin fall into the “high risk” category with MOE < 10, the rest of the compounds except THC fall into the “risk” category with MOE < 100. On a population scale, only alcohol would fall into the “high risk” category, and cigarette smoking would fall into the “risk” category, while all other agents (opiates, cocaine, amphetamine-type stimulants, ecstasy, and benzodiazepines) had MOEs > 100, and cannabis had a MOE > 10,000. The toxicological MOE approach validates epidemiological and social science-based drug ranking approaches especially in regard to the positions of alcohol and tobacco (high risk) and cannabis (low risk).
Lachenmeier, DW & Rehm, J 2015, ‘Comparative risk assessment of alcohol, tobacco, cannabis and other illicit drugs using the margin of exposure approach’, Sci. Rep., vol. 5, open access
http://www.nature.com/srep/2015/150130/srep08126/full/srep08126.htm .
Comment: We are currently in the process of developing a new National Drug Strategy for Australia. If this process operates rationally, it will include a discussion of which drugs in which population groups should receive priority attention. Studies such as this, documenting the relative risks of various drug types, can inform that policy work.
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Which treatment for opioid dependence, buprenorphine or methadone, has the higher retention rates?
Researchers investigated the factors associated with the risk of leaving first treatment for opioid dependence in NSW, using a linkage study of opioid substitution therapy (OST) treatment, court, custody and mortality data. During the period of the study (it covered 2001-2010) there were 15,600 treatment entrants with 46% commenced buprenorphine and 54% commenced methadone. The proportion entering buprenorphine increased over time. The researchers found that ‘Those starting buprenorphine switched medications more frequently and had more subsequent treatment episodes. Buprenorphine retention was also poorer. On average, 44% spent 3+ months in treatment compared with 70% of those commencing methadone; however, buprenorphine retention for first-time entrants improved over time, whereas methadone retention did not. Multivariable Cox models indicated that in addition to sex, age, treatment setting and criminographic variables, the risk of leaving a first treatment episode was greater on any given day for those receiving buprenorphine, and was dependent on the year treatment was initiated. There was no interaction between any demographic variables and medication received, suggesting no clear evidence of any particular groups for whom each medication might be better suited in terms of improving retention.’ This led them to conclude that ‘Although retention rates for buprenorphine treatment have improved in New South Wales, Australia, individuals starting methadone treatment still show higher retention rates.’
Burns, L, Gisev, N, Larney, S, Dobbins, T, Gibson, A, Kimber, J, Larance, B, Mattick, RP, Butler, T & Degenhardt, L 2015,
‘A longitudinal comparison of retention in buprenorphine and methadone treatment for opioid dependence in New South Wales, Australia’, Addiction, vol. 110, no. 4, pp. 646-55.
Does naltrexone have potential for the treatment of opioid users being released from prison?
A pilot study was conducted in New York City to investigate the feasibility and effectiveness of extended-release naltrexone (XR-NTX) as relapse prevention among opioid dependent male adults leaving a large urban jail. The research participants were 34 opioid dependent adult males with no interest in methadone or buprenorphine treatment. They received a counselling and referral intervention and were randomized to XR-NTX (n = 17) or no medication (n = 17) within a week of release from jail. The research team found that ‘Acceptance of XR-NTX was high; 15 of 17 initiated treatment. Rates of the primary outcome of week 4 opioid relapse were lower among XR-NTX participants: 38% vs. 88%…; more XR-NTX urine samples were negative for opioids, 59% vs. 24%…;there were no significant differences in the remaining secondary outcomes, including rates of IVDU, cocaine use, re-incarceration, and overdose.’ While acknowledging that this was just a small pilot study with some limitations in its design, the researchers concluded that ‘Extended-release naltrexone is associated with significantly lower rates of opioid relapse among men in the USA following release from jail when compared with a no medication treatment-as-usual condition.’
Lee, JD, McDonald, R, Grossman, E, McNeely, J, Laska, E, Rotrosen, J & Gourevitch, MN 2015,
‘Opioid treatment at release from jail using extended-release naltrexone: a pilot proof-of-concept randomized effectiveness trial’, Addiction, online ahead of print.
Comment: As reported in previous issues of the Research eBulletin, we do not yet have sufficient evidence to support the long-term use of slow-release naltrexone in the treatment of opioid dependence; for further information visit the ATODA website. However, this pilot study is useful in adding to the evidence base.
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How important is drug use, compared with other factors, as an antecedent or cause of violent offending?
Australian researchers have pointed out that ‘It remains unclear whether violent offending among injecting drug users (IDU) is the direct result of drug use factors or whether they are predisposed to violent behaviour from childhood’. This led them ‘to identify substance use and early-life correlates of lifetime violent offending among IDUs and to determine what risks contributed to recent violent offending’. The research involved face-to-face interviews with 300 community-based regular injecting drug users. They found that 34% of the participants had committed violence in the preceding 12 months, 42% more than 12 months ago and 24% had never been violent. ‘Predispositional and substance use risk profiles were poorer among IDUs who had been violent, but many of these risks were even more prevalent and severe among those who had been violent in the past 12 months. Multinomial logistic regression found that IDUs who had been violent in the past 12 months had greater polysubstance and higher trait aggressive personalities than the other IDUs, whereas they were further differentiated from non-recent violent IDUs in having more involvement in drug dealing and more likely to screen positive for conduct disorder.’ This led the researchers to conclude that ‘Drug use factors alone did not adequately explain the likelihood of violent offending among IDUs. Instead, there appeared to be complex interactions between early-life risks and substance use which created a liability to violent offending, and the level of exposure to these risks appeared to explain differences in violent offending patterns.’
Torok, M, Darke, S, Kaye, S & Shand, F 2015,
‘The association of early-life and substance use risks to violent offending among injecting drug users’, Drug Alcohol Rev, vol. 34, no. 1.
To what extent do YouTube music videos expose adolescence to tobacco and alcohol content?
YouTube music videos are particularly popular among adolescents. British researchers undertook a content analysis of alcohol, tobacco and electronic cigarette imagery in the UK Top 40 YouTube music videos and conducted a national on-line survey of adolescent viewing of the 32 most popular high-content videos. 2,068 adolescents aged 11–18 years completed the on-line survey. The researchers quantify the amount of alcohol, tobacco and electronic cigarette use, implied use, paraphernalia or branding in music videos and proportions and estimated numbers of adolescents who had watched the videos. They found that alcohol imagery appeared in 45% of all the videos, tobacco in 22% and electronic cigarettes in 2%. Alcohol branding appeared in 7% of videos, tobacco branding in 4% and electronic cigarette branding in 1%. The most frequently observed alcohol, tobacco and electronic cigarette brands were, respectively, Absolut Tune, Marlboro and E-Lites. At least one of the 32 most popular music videos containing alcohol or tobacco content had been seen by 81% of adolescents surveyed, and of these 87% had re-watched at least one video. These findings led the researchers to conclude that ‘Popular YouTube music videos watched by a large number of British adolescents, particularly girls, include significant tobacco and alcohol content, including branding.’
Cranwell, J, Murray, R, Lewis, S, Leonardi-Bee, J, Dockrell, M & Britton, J 2015, ‘
Adolescents’ exposure to tobacco and alcohol content in YouTube music videos’, Addiction, vol. 110, no. 4, pp. 703-11.
Is it time to change the default for tobacco treatment?
The leading journal Addiction has a segment called ‘For debate’. Two scholars from the University of Kansas, USA, have contributed this thoughtful debating point about how we should intervene to further reduce tobacco use and dependence:
Abstract: The World Health Organization estimates that 1 billion people will die from tobacco-related illnesses this century. Most health-care providers, however, fail to treat tobacco dependence. This may be due in part to the treatment ‘default’. Guidelines in many countries recommend that health-care providers: (i) ask patients if they are ‘ready’ to quit using tobacco; and (ii) provide treatment only to those who state they are ready to quit. For other health conditions—diabetes, hypertension, asthma and even substance abuse—treatment guidelines direct health-care providers to identify the health condition and initiate evidence-based treatment. As with any medical care, patients are free to decline—they can ‘opt out’ from care. If patients do nothing, they will receive care. For tobacco users, however, the treatment default is often that they have to ‘opt in’ to treatment. This drastically limits the reach of tobacco treatment because, at any given encounter, a minority of tobacco users will say they are ready to quit. As a result, few are offered treatment. It is time to change the treatment default for tobacco dependence. All tobacco users should be offered evidence-based care, without being screened for readiness as a precondition for receiving treatment. Opt-out care for tobacco dependence is warranted because changing defaults has been shown to change choices and outcomes for numerous health behaviors, and most tobacco users want to quit; there is little to no evidence supporting the utility of assessing readiness to quit, and an opt-out default is more ethical.
Richter, KP & Ellerbeck, EF 2015,
‘It’s time to change the default for tobacco treatment’, Addiction, vol. 110, no. 3, pp. 381-6.
Comment: The conclusion reached in this paper is in-line with recommendations made in the recent ATODA report, Reducing smoking in the ACT among Aboriginal and Torres Strait Islander women who are pregnant or who have young children. The ATODA report recommends that smoking cessation advice and support should be offered to all pregnant women at every engagement with a health professional. Pregnant women should then opt-out of smoking cessation treatment.
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What is the latest evidence on the relationship between tobacco smoking and mortality in Australia?
The 45 and Up Study is a longitudinal study of people aged 44 years older, sampled from the NSW population. It has been running long enough that is now providing valuable epidemiological information in diverse areas. Researchers, including those based at the ANU, have conducted the first large-scale quantitative study of the relationship between tobacco smoking and mortality in Australia in the context of the high levels of smoking prevalence in the past and the rapid fall to approximately 13% at present. They found that 5,593 deaths occurred during the follow-up period; 7.7% of participants were current smokers and 34.1% past smokers at baseline. The death rate in current smokers was 2.96 the rate of never-smokers. The rate was similar in men and women and according to birth cohort. The death rates ‘increased with increasing smoking intensity, with around two- and four-fold increases in mortality in current smokers of ≤14 (mean 10/day) and ≥25 cigarettes/day, respectively, compared to never-smokers. Among past smokers, mortality diminished gradually with increasing time since cessation and did not differ significantly from never-smokers in those quitting prior to age 45. Current smokers are estimated to die an average of 10 years earlier than non-smokers.’ The research team concluded that, ‘In Australia, up to two-thirds of deaths in current smokers can be attributed to smoking. Cessation reduces mortality compared with continuing to smoke, with cessation earlier in life resulting in greater reductions.’
Banks, E, Joshy, G, Weber, MF, Liu, B, Grenfell, R, Egger, S, Paige, E, Lopez, AD, Sitas, F & Beral, V 2015, ‘Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence’, BMC Medicine, vol. 13, no. 1, open access
http://www.biomedcentral.com/1741-7015/13/38.
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How strong is the evidence about the impacts of raising the minimum age for legal access to tobacco products?
The prestigious Institute of Medicine in the USA as recently published an authoritative report on this topic. These are its key conclusions:
- Increasing the minimum age of legal access to tobacco products will likely prevent or delay initiation of tobacco use by adolescents and young adults.
- Although changes in the minimum age of legal access to tobacco products will directly pertain to individuals who are 18 or older, the largest proportionate reduction in the initiation of tobacco use will likely occur among adolescents of ages 15 to 17 years.
- The impact on the initiation of tobacco use of raising the minimum age of legal access to tobacco products to 21 will likely be substantially higher than raising it to 19, but the added effect of raising the minimum wage beyond aged 21 to age 25 will likely be considerably smaller.
- Based on the modelling, raising the minimum age of legal access to tobacco products, particularly to ages 21 and 25, will likely lead to substantial reductions in smoking prevalence.
- Based on the modelling, raising the minimum age of legal access to tobacco products will likely lead to substantial reductions in smoking-related mortality.
- Based on a review of the literature, raising the minimum age of legal access to tobacco products will likely immediately improve the health of adolescents and young adults by reducing the number of those with smoking-caused diminished health status. As the initial birth cohorts affected by the policy change age into adulthood, the benefits of the reductions of the intermediate and long-term adverse health effects will also begin to manifest. Raising the minimum age of legal access to tobacco products will also likely reduce exposure to secondhand smoke and the prevalence of other tobacco products, further reducing their associated adverse health effects, both immediate and over time.
- Based on a review of the literature and on the modelling, an increase in the minimum age of legal access to tobacco products will likely improve maternal, fetal, and infant outcomes by reducing the likelihood of maternal and paternal smoking.
‘Although the full benefits of preventing initiation of tobacco use will take decades to accrue, some direct health benefits, including those from reduced secondhand smoke exposure, will be immediate. Perhaps the greatest uncertainty in the committee’s assessment is the currently unpredictable effects of the marketing and use of ENDS and other novel tobacco products. However, in the absence of transformative changes in the tobacco market, social norms and attitudes, or the epidemiology of tobacco use, the committee is reasonably confident that raising the [minimum legal age] will reduce tobacco initiation, particularly among adolescents 15 to 17 years of age, will improve health across the lifespan, and will save lives’ (p. S-9).
IOM (Institute of Medicine) 2015, Public health implications of raising the minimum age of legal access to tobacco products, Committee on the Public Health Implications of Raising the Minimum Age for Purchasing Tobacco Products, National Academies Press, Washington, DC,
http://www.nap.edu/catalog.php?record_id=18997.
Comment: Australia’s National tobacco Strategy 2012-2018 has as key targets to be attained by 2018, reducing the national adult daily smoking rate to 10 % of the population and halving the Aboriginal and Torres Strait Islander adult daily smoking rate. While the first of these targets may well be achieved on average, it will leave significant population groups with smoking prevalence far greater than 10%. Perhaps consideration needs to be given to raising the legal tobacco purchasing age as part of the mix of strategies?
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What impact does the availability of high potency cannabis have on the prevalence of psychotic disorders?
It has long been argued that a relationship exists between the increasing potency of cannabis in many Western countries and an increasing prevalence of psychotic disorders, but the evidence for this hypothesis has been weak or absent. British researchers investigated ‘…how frequent use of skunk-like (high-potency) cannabis in south London affected the association between cannabis and psychotic disorders’. They studied data from patients aged 18-65 years presenting to health services with first-episode psychosis, and from population controls recruited from the same area of south London. They calculated the proportion of new cases of psychosis attributable to different types of cannabis use in south London. They found that, ‘The risk of individuals having a psychotic disorder showed a roughly three-times increase in users of skunk-like cannabis compared with those who never used cannabis…Use of skunk-like cannabis every day conferred the highest risk of psychotic disorders compared with no use of cannabis [adjusted odd ratio 5·4]. The population attributable fraction of first-episode psychosis for skunk use for our geographical area was 24…, possibly because of the high prevalence of use of high-potency cannabis (218 [53%] of 410 patients) in our study.’ (The population attributable fraction is the proportion by which the risk in the exposed would fall if the exposure were eliminated.) The conclude that ‘The ready availability of high potency cannabis in south London might have resulted in a greater proportion of first onset psychosis cases being attributed to cannabis use than in previous studies.’
Di Forti, M et al. 2015, ‘Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study’, The Lancet Psychiatry, online ahead of print, open access
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2900117-5/fulltext .
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What are the impacts of therapeutic cannabis programs on public health?
Abstract: Objective: Although cannabis is an illegal drug, ‘medical marijuana programs’ (MMPs) have proliferated (e.g., in Canada and several US states), allowing for legal cannabis use for therapeutic purposes. While both health risks and potential therapeutic benefits for cannabis use have been documented, potential public health impacts of MMPs—also vis-à-vis other psychoactive substance use—remain under-explored.
Methods: We briefly reviewed the emerging evidence on MMP participants’ health status, and specifically other psychoactive substance use behaviors and outcomes.
Results: While data are limited in amount and quality, MMP participants report improvements in overall health status, and specifically reductions in levels of risky alcohol, prescription drug and — to some extent—tobacco or other illicit drug use; at the same time, increases in cannabis use and risk/problem patterns may occur.
Conclusion: MMP participation may positively impact—for example, by way of possible ‘substitution effects’ from cannabis use—other psychoactive substance use and risk patterns at a scale relevant for public health, also influenced by the increasing population coverage of MMPs. Yet, net overall MMP-related population health effects need to be more rigorously and comprehensively assessed, including potential increases in cannabis use related risks and harms.
Fischer, B, Murphy, Y, Kurdyak, P, Goldner, E & Rehm, J 2015, ‘Medical marijuana programs - why might they matter for public health and why should we better understand their impacts?’, Preventive Medicine Reports, vol. 2, pp. 53-6, open access
http://www.sciencedirect.com/science/article/pii/S2211335514000278.
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How feasible is it to implement ‘last drinks’ data collections in hospital emergency departments as a tool for understanding the alcohol/violence links?
Abstract: Objective: The present study summarises the methodology and findings of a pilot project designed to measure the sources and locations of alcohol-related harm by implementing anonymised ‘last drinks’ questions in the ED of a rural community.
Methods: ‘Last drinks’ questions were added to computerised triage systems at South West Healthcare ED in rural Warrnambool, Victoria, from 1 November 2013 to 3 July 2014. For all injury presentations aged 15 years or older, attendees were asked whether alcohol was consumed in the 12 h prior to injury, how many standard drinks were consumed, where they purchased most of the alcohol and where they consumed the last alcoholic drink.
Results: From 3692 injury attendances, 10.8% (n = 399) reported consuming alcohol in the 12 h prior to injury. ‘Last drinks’ data collection was 100% complete for participants who reported alcohol use prior to injury. Approximately two-thirds (60.2%) of all alcohol-related presentations had purchased their alcohol at packaged liquor outlets. During high-alcohol hours, alcohol-related injuries accounted for 36.1% (n = 101) of all ED injury presentations, and in total 41.7% of alcohol-related attendances during these hours reported consuming last drinks at identifiable hotels, bars, nightclubs or restaurants, or identifiable public areas/events.
Conclusions: This pilot demonstrates the feasibility and reliability of implementing sustainable ‘last drinks’ data collection methods in the ED, and the ability to effectively map the source of alcohol-related ED attendances in a rural community.
Miller, P, Droste, N, Baker, T & Gervis, C 2015, ‘
Last drinks: a study of rural emergency department data collection to identify and target community alcohol-related violence’, Emergency Medicine Australasia, online ahead of print.
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What roles might GPs have in advising patients about personal vaporisers as tools for smoking cessation?
In the USA and many other parts of the world nicotine-containing electronic cigarettes are legally sold, and widely used as a safer form of injecting nicotine than cigarette smoking, or as an aid to smoking cessation. The research evidence is still inconclusive as to their effectiveness as a smoking cessation aid. American researchers investigated doctor-patient communications regarding electronic cigarettes, and doctors’ attitudes towards these products. They found that ‘Nearly two-thirds (65%) of physicians reported being asked about e-cigarettes by their patients, and almost a third (30%) reported that they have recommended e-cigarettes as a smoking cessation tool. Male physicians were significantly more likely to endorse a harm reduction approach [than female physicians].’
Steinberg, MB, Giovenco, DP & Delnevo, CD 2015, ‘
Patient–physician communication regarding electronic cigarettes’, Preventive Medicine Reports, vol. 2, pp. 96-8.
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Are systematic reviews of systematic reviews a useful approach?
The monthly ATODA Research eBulletins make extensive use of systematic reviews of the research evidence. This is because, while the findings of single studies are often informative, systematically reviewing a number of studies, addressing a particular area, is potentially more informative and useful in guiding policy and practice. Researchers at the Institute of Education at University College London draw attention to the fact that, ‘When swift, accurate appraisal of evidence is required to inform policy concerning broad research questions, and budgetary constraints limit the employment of large research teams, researchers face a significant challenge which is sometimes met by reviewing existing systematic reviews.’ Reviews of reviews (RoRs) are also called ‘umbrella reviews’, ‘overviews of reviews’, or ‘meta-reviews’. The authors apply the widely accepted criteria of quality, consistency, selection of data, applicability & generalisability, and costs & cost effectiveness, to assess the usefulness of reviews of reviews. They conclude that ‘Prominent advantages of RoRs lie in their capacity to supply a broad overview of evidence, to identify gaps in the evidence base where no systematic reviews have been conducted, and to prioritise research questions appropriate for systematic review…So we must conclude that RoRs are a useful means of mediating policy-relevant evidence at speed…Though uncomfortable for reviewers, the synthesis and mediation of knowledge across broad topic areas is something that is necessary and desirable in the policy-making process; reviewing reviews is one way of performing this task in a systematic, transparent and accountable way.’
Caird, J, Sutcliffe, K, Kwan, I, Dickson, K & Thomas, J 2015, ‘Mediating policy-relevant evidence at speed: are systematic reviews of systematic reviews a useful approach?’, Evidence & Policy: A Journal of Research, Debate and Practice, vol. 11, no. 1, pp. 81-97.
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New Reports
Australian Crime Commission 2015, The Australian methamphetamine market: the national picture, Australian Crime Commission, Canberra, www.crimecommission.gov.au/publications/intelligence-products/unclassified-strategic-assessments/australian-methylamphetamine.
Belackova, V, Ritter, A, Shanahan, M, Chalmers, J, Hughes, C, Barratt, MJ & Lancaster, K 2015, Medicinal cannabis in Australia – framing the regulatory options Drug Policy Modelling Program, Sydney, https://ndarc.med.unsw.edu.au/resource/medicinal-cannabis-australia-framing-regulatory-options.
Closing the Gap Clearinghouse (AIHW & AIFS) 2015, Fetal alcohol spectrum disorders: a review of interventions for prevention and management in Indigenous communities, Australian Institute of Health and Welfare & Australian Institute of Family Studies, Canberra & Melbourne, http://www.aihw.gov.au/closingthegap/publications/.
Department for Work and Pensions, United Kingdom 2015, Understanding the costs and savings to public services of different treatment pathways for clients dependent on opiates, DWP ad hoc research report no. 17, Department for Work and Pensions, London, https://www.gov.uk/government/publications/understanding-the-costs-and-savings-to-public-services-of-different-treatment-pathways-for-clients-dependent-on-opiates.
Donnelly, N, Menéndez, P & Mahoney, N 2014, The effect of liquor licence concentrations in local areas on rates of assault in New South Wales, Crime and Justice Bulletin no. 181, NSW Bureau of Crime Statistics and Research, http://www.bocsar.nsw.gov.au/Documents/CJB181.pdf
Gilmore, W, Liang, W, Catalano, P, Pascal, R, Broyd, A, Lensvelt, E, Kirby, G & Chikritzhs, T 2015, Off-site outlets and alcohol-related harm, Monograph no. 56, National Drug Law Enforcement Research Fund, Canberra, http://ndlerf.gov.au/publications/monographs.
Hari, J 2015, ‘The likely cause of addiction has been discovered, and it is not what you think’, Huffington Post, no. 20 January 1015, http://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html.
Hirono, K, Haigh, F, Gleeson, D, Harris, P & Thow, AM 2015, Negotiating healthy trade in Australia: health impact assessment of the proposed Trans-Pacific Partnership Agreement. , Centre for Health Equity Training Research and Evaluation, part of the Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW, Liverpool, NSW, http://hiaconnect.edu.au/research-and-publications/tpp_hia/.
Hughes, C 2015, The Australian (Illicit) Drug Policy Timeline 1985-2015, Drug Policy Modelling Program, University of NSW, https://ndarc.med.unsw.edu.au/resource/australian-illicit-drug-policy-timeline-1985-2015.
International Narcotics Control Board 2015, Report of the International Narcotics Control Board for 2014, E/INCB/2007/1, United Nations, New York, http://www.incb.org/incb/en/news/AR2014/annual_report_2014.html.
Laslett, A, Mugavin, J, Jiang, H, Manton, E, Callinan, S, MacLean, S & Room, R 2015, The hidden harm: alcohol’s impact on children and families, Foundation for Alcohol Research and Education (FARE), Canberra, http://www.fare.org.au/hto2015/.
Miller, P 2015, FactCheck: can you change a violent drinking culture by changing how people drink?, The Conversation, 10 March 2015, http://theconversation.com/factcheck-can-you-change-a-violent-drinking-culture-by-changing-how-people-drink-38426.
Miller, P, Chikritzhs, T & Toumbourou, J 2015, Interventions for reducing alcohol supply, alcohol demand and alcohol-related harm, Monograph no. 57, National Drug Law Enforcement Research Fund, Canberra, http://ndlerf.gov.au/publications/monographs.
National Health and Medical Research Council 2015, NHMRC CEO Statement: electronic cigarettes (e-cigarettes), NHMRC, Canberra.
Radio Australia 2015, Fact check: no proof the death penalty prevents crime, http://www.radioaustralia.net.au/international/2015-02-26/fact-check-no-proof-the-death-penalty-prevents-crime/1419211.
World Health Organization 2015, WHO calls for worldwide use of ‘smart’ syringes, WHO, Geneva, http://who.int/mediacentre/news/releases/2015/injection-safety/en/?utm_source=WHO+List&utm_campaign=3a8f780b5e-26_February_20152_25_2015&utm_medium=email&utm_term=0_823e9e35c1-3a8f780b5e-232629485.
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