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.
Publicly funded alcohol and other drug treatment services are available to people seeking treatment for their own drug use and people seeking assistance for someone else’s drug use. In the Australian Capital Territory, 10 publicly funded government and non-government drug treatment agencies provided 3,156 treatment episodes that were completed in 2010-2011. Some AIHW findings from 2010-2011 include:
AIHW 2013. '
'.
. Cat. no. HSE 132. Canberra: AIHW.
Stakeholders are progressing a proposal to expand and strengthen alcohol, tobacco and other drug (ATOD) research in the ACT and region, and enhance ATOD policy and its implementation, through establishing a structured collaboration, such as a Centre for ATOD Research, Policy and Practice in the ACT. For more information please see the
. If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on
Most of the reports and research items referenced below are available from the Alcohol and Other Drug Council of Australia’s
What do young Australians believe are likely to be the consequences of using illicit drugs?
Drug Policy Modelling Program researchers analysed data from the web-based Australian Drug Media Survey conducted in 2010 on the perceptions of Australians between the ages of 16 and 24 years on the likely outcomes, both positive and negative, of illicit drug use. They found that ‘Pleasure and concern about financial and school/work problems were perceived to be the most likely consequences to arise from illicit drug use (much more so than trouble with police)’. The researchers concluded that ‘…these results, although exploratory, provide a nuanced understanding of young people’s attitudes towards illicit drugs, and how these attitudes are shaped by the world around them. The results also represent a challenge for public policy, as these notions are largely marginalised from discourse about drug use’.
Lancaster, K & Hughes, C 2013, ‘
Buzzed, broke, but not busted: how young Australians perceive the consequences of using illicit drugs’,
Youth Studies Australia, vol. 32, no. 1, pp. 19-28.
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Will a ban on tobacco in prisons bring about an improvement in air quality?
The sale of tobacco was prohibited in New Zealand prisons from 1 June 2011 and the possession of tobacco was banned a month later. A team of New Zealand researchers studied the indoor air quality in a maximum-security prison before and after this policy was enforced. Their study showed ‘…a rapid and substantial improvement in indoor air quality after tobacco was banned at a prison’. They conclude ‘…that prisoners have reduced their smoking in line with the ban, and that a significant health hazard has been reduced for staff and prisoners alike’.
Thornley, S, Dirks, KN, Edwards, R, Woodward, A & Marshall, R 2013, ‘Indoor air pollution levels were halved as a result of a national tobacco ban in a New Zealand prison’,
Nicotine & Tobacco Research, vol. 15, no. 2, pp. 343-7.
Comment: The body of research evidence continues to accumulate showing that providing prisoners and prison staff with smoke-free environments is both feasible and health-promoting.
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Does an increase of weight following smoking cessation increases the risk of cardiovascular disease?
Although smoking cessation substantially reduces the risks of cardiovascular disease (CVD), associated weight increase is a concern for many smokers, especially for people with diabetes, since obesity is also a risk factor for CVD. A four-year study conducted in North America found that ‘The mean post-cessation weight gain varies between 3 and 6 kg…happens within 6 months after smoking cessation, and persists over time’. The researchers found ‘…smoking cessation was associated with a lower risk of CVD events among participants without diabetes, and weight gain that occurred following smoking cessation did not modify this association…There were qualitatively similar lower risks among participants with diabetes that did not reach statistical significance possibly because of limited study power’. They concluded ‘This supports a net cardiovascular benefit of smoking cessation, despite subsequent weight gain’.
Clair, C, Rigotti, NA, Porneala, B, Fox, CS, D’Agostino, RB, Pencina, MJ & Meigs, JB 2013, ‘Association of smoking cessation and weight change with cardiovascular disease among adults with and without diabetes’,
JAMA, vol. 309, no. 10, pp. 1014-21.
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Can recruitment strategies make smokers more likely to enter programs to help them quit smoking?
A recently-published Cochrane Review sought to answer this question: ‘A lot of time and money has been invested in programmes to help those who smoke to quit. However, there is currently not enough information about the best way to encourage smokers to enter these programmes. This review aims to identify whether certain recruitment strategies can help to increase the number of smokers enrolling into quit services. It also aims to determine whether these recruitment strategies have any impact on people successfully quitting smoking at six months or longer. This review covers 19 studies, with almost 15,000 participants, but the significant differences across these studies meant that we were unable to draw conclusive answers to our research questions. Our findings do, however, suggest that the following elements could result [in] more people joining quit smoking programmes: (1) recruitment strategies tailored to the individual; (2) proactive strategies; and (3) increased contact time with potential participants. This review also highlights the areas within this field that need more attention: identifying the elements of a recruitment strategy that are more likely to effectively engage smokers; whether or not elements of recruitment strategies have an impact on quit rates; and identifying those recruitment strategies (or different combinations of particular recruitment strategies with certain smoking cessation programmes) that work better for different population groups.’
Marcano Belisario, JS, Bruggeling, MN, Gunn, LH, Brusamento, S & Car, J 2012, ‘
Interventions for recruiting smokers into cessation programmes’,
Cochrane Database of Systematic Reviews, vol. 12, p. CD009187.
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What is the best way to help smokers who relapse during a smoking cessation program?
A team of researchers based mainly in Italy provide advice on ways to help smokers who relapse while on a quit smoking program. They present an algorithm of possible strategies and recommendations for assisting relapsing smokers, assuming that the treated smokers attempt to quit smoking and relapse a few days to weeks after their quitting date. They advise the use of tobacco harm reduction measures for people who refuse to try quitting again, and also for those who try again and experience a subsequent relapse: ‘The challenging path to successful smoking cessation runs via a constructive and supportive therapeutic alliance between the patient and a cessation specialist. The importance of forming this alliance stands in its potential to foster long-term treatment adherence and achieve optimal exploitation of individualized treatment plans.
‘However, realistic plans must also be taken into account that sustained cessation may not be achievable for many smokers, and alternative options should then be offered. Nicotine’s pleasurable effects can be controlled, and the detrimental effects of the delivery mechanism can be attenuated by providing nicotine from less hazardous sources. Thus, advising smokers who cannot (or do not want to) quit to switch to either low-nitrosamine snuff or electronic cigarette [
sic] could be an equally effective way to help smokers to become abstinent. This new emphasis on tobacco harm reduction as an exit strategy for smokers unable (or unwilling) to quit is a key paradigm shift in the management of relapse, which could save millions of lives world-wide’.
Caponnetto, P, Keller, E, Bruno, CM & Polosa, R 2013, ‘
Handling relapse in smoking cessation: strategies and recommendations’,
Internal and Emergency Medicine, vol. 8, no. 1, pp. 7-12.
Comment: Tobacco harm reduction needs greater emphasis in Australia than it now receives. By law, electronic cigarettes sold in this nation cannot contain nicotine, thus substantially reducing their effectiveness as an aid to quitting tobacco cigarette smoking.
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Are electronic cigarettes a safe and effective tool for smoking cessation?
A recently-published review sought to answer this question: ‘The need for novel and more effective approaches to tobacco control is unquestionable. The electronic cigarette is a battery-powered electronic nicotine delivery system that looks very similar to a conventional cigarette and is capable of emulating smoking, but without the combustion products accountable for smoking's damaging effects. Smokers who decide to switch to electronic cigarettes instead of continuing to smoke would achieve large health gains. The electronic cigarette is an emerging phenomenon that is becoming increasingly popular with smokers worldwide. Users report buying them to help quit smoking, to reduce cigarette consumption, to relieve tobacco withdrawal symptoms due to workplace smoking restrictions and to continue to have a “smoking” experience but with reduced health risks. The focus of the present article is the health effects of using electronic cigarettes, with consideration given to the acceptability, safety and effectiveness of this product to serve as a long-term substitute for smoking or as a tool for smoking cessation.’
Caponnetto, P, Campagna, D, Papale, G, Russo, C & Polosa, R 2012, ‘The emerging phenomenon of electronic cigarettes’,
Expert Review of Respiratory Medicine, vol. 6, no. 1, pp. 63-74.
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Can electronic cigarettes help smokers with schizophrenia to quit?
A study in Italy monitored possible modifications in smoking habits of 14 smokers (not intending to quit) with schizophrenia experimenting with the ‘Categoria’ electronic cigarette (e-cigarette) with a focus on smoking reduction and smoking abstinence. The study demonstrated that ‘…substantial and objective modifications in the smoking habits may occur in smokers with schizophrenia using e-cigarettes, with significant smoking reduction and smoking abstinence and no apparent increase in withdrawal symptoms and in positive and negative symptoms of schizophrenia. Chronic schizophrenic patients using e-cigarettes substantially decreased cigarette consumption with an overall quit rate in 2/14 (14.3%) at week-52. Moreover, at least 50% reduction in cigarette smoking was observed in 7/14 (50%) of participants. Overall, combined reduction and smoking abstinence was shown in 9/14 (64.3%) of participants’.
Caponnetto, P, Auditore, R, Russo, C, Cappello, GC & Polosa, R 2013, ‘Impact of an electronic cigarette on smoking reduction and cessation in schizophrenic smokers: a prospective 12-month pilot study’,
International Journal of Environmental Research and Public Health, vol. 10, no. 2, pp. 446-61.
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How safe are electronic cigarettes?
An editorial in a recent issue of the
Journal of Adolescent Health draws attention to some of the potential downsides of electronic cigarettes: ‘The nicotine content in e-cigarette products often does not match the advertised or labelled content, where products labelled no nicotine contained nicotine, or nicotine content amounts were higher or lower than labelled…Administration of an addictive drug at levels that are unintended may harm users and possibly encourage addiction. Moreover, there appears to be high variability in the quality of the products, in terms of device functioning, across, and even within, brands…E-cigarette cartridges may leak, creating the potential for dermal [skin] nicotine exposure and potential poisoning’.
The editorial writer warns that ‘There are many unanswered questions regarding e-cigarettes and their likely impact on public health. Population benefit or harm depends largely on public’s perception of the products and their patterns of use. Increased individual risks and population harm may result if dual use with other tobacco products is prevalent, or cessation is deterred by persons using e-cigarettes to circumvent successful tobacco control efforts, such as taxes and smoke-free laws…Studies conducted with e-cigarette users, mainly recruited through smoking cessation Web sites and e‑cigarette enthusiast Web sites, demonstrate that they perceive the products to be less toxic than tobacco cigarettes and have used them as a smoking cessation device or to avoid exposing others to tobacco smoke…However, the research on their efficacy for smoking cessation is in its infancy…Additional action should be taken to ensure e-cigarettes are not sold to youth and their appeal to youth and nonsmokers is minimized, such as enacting restrictions on health claims, explicit celebrity endorsements, and the elimination of the flavors. In addition, addressing smoking (and e-cigarette use) in the movies…and denormalization of tobacco and the tobacco industry may also have positive effects on preventing adolescent uptake of both tobacco and e-cigarettes’.
Grana, RA 2013, ‘Electronic cigarettes: a new nicotine gateway?’,
Journal of Adolescent Health, vol. 52, no. 2, pp. 135-6.
Comment: The author is correct in pointing to the urgent need for research into the health consequences of e-cigarette use. It is crucial, however, that careful net harm analyses be conducted to assess the impact of any negative consequences of using these products against the public and individual health benefits of use resulting from reduced tobacco cigarette smoking.
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Are people who are prescribed opioids more likely to be involved in motor vehicle accidents?
A population-based nested case-control study undertaken in Canada examined data on over half a million adults from Ontario aged 18 to 64 years who were eligible for prescription drug coverage under the Ontario Provincial Public Drug Program and who were prescribed opioid analgesics from 2003 to 2011. From this cohort, the researchers identified over 5,000 patients who visited an emergency department with an external cause of injury related to road trauma (defined as a motor vehicle crash). They observed that there was a significant association between opioid dose and road trauma among drivers. ‘Compared with very low opioid doses, drivers prescribed low doses had a 21% increased odds of road trauma…those prescribed moderate doses, 29% increased odds…those prescribed high doses, 42% increased odds…and those prescribed very high doses, 23% increased odds’. They concluded that ‘Among drivers prescribed opioids, a significant relationship exists between drug dose and risk of road trauma. This association is distinct and does not appear with passengers, pedestrians, and others injured in road trauma’.
Gomes, T, Redelmeier, DA, Juurlink, DN, Dhalla, IA, Camacho, X & Mamdani, MM 2013, ‘Opioid dose and risk of road trauma in Canada: a population-based study’,
JAMA Internal Medicine, vol. 173, no. 3, pp. 196-201.
Comment: This large study demonstrates how prescribed opioid painkillers can impair driving and contribute to motor vehicle crashes. It highlights the policy problem that we have in Australia of conducting oral fluid roadside drug testing that covers just three illegal drugs but does not cover prescribed opioids which have demonstrably high driving impairment risks.
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Can consumption of foods and beverages have an effect on subsequent drug testing of oral fluid?
A study conducted in the United Kingdom examined the effects of 19 different foods, beverages and vinegars on two oral fluid (saliva) test systems, the Concateno Certus and Orasure Intercept. ‘Results showed that intermittent presumptive positive results for amphetamine, methadone, opiates and cocaine could be detected following the consumption of coffee, Coke, fruit juice, oranges, spicy food and toothpaste using the Orasure system if specimens were not collected in accordance with the manufacturer's recommended collection procedure. Following the consumption of vinegar, presumptive positives were observed using the Orasure system for up to 30 min post-exposure. No presumptive positives were observed using the Concateno system. It is a widely held view that foods and beverages disperse from the mouth within 10–15 min after their consumption, and hence are unlikely to affect oral fluid drug tests. This study shows that vinegar can affect immunoassay screening for an extended period following its consumption.’
Reichardt, EM, Baldwin, D & Osselton, MD 2013, ‘Effects of oral fluid contamination on two oral fluid testing systems’,
Journal of Analytical Toxicology, online ahead of print.
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Is cannabis dependence among prisoners a serious problem and how should it be addressed?
A Research into Practice Brief published by the National Cannabis Prevention and Information Centre provides an overview of prevalence and concerns relating to cannabis use among prisoners. It shows that ‘…the prevalence rates of lifetime cannabis use among prison inmates are high, with many reporting use in the six months before being arrested… the majority of prisoners who reported using cannabis in the months prior to their incarceration used the drug daily’. The authors state that ‘…the link between the use of the drug and mental health problems is an issue that must continue to be considered and addressed appropriately…[and] up-to-date, high quality information on cannabis, the harms associated with its use, as well as treatment options needs to continue to be disseminated to those working with prison inmates to ensure that those who want assistance with their cannabis use are provided with best practice interventions that are the most likely to lead to successful outcomes and assist in reducing recidivism’.
Payne, J, Macgregor, S & McDonald, H 2013,
Prevalence and issues relating to cannabis use among prison inmates: key findings from Australian research since 2001, Research into Practice Brief 7, National Cannabis Prevention and Information Centre, University of New South Wales, Sydney.
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How can we reduce the risk of socially vulnerable young people being exposed to hepatitis C?
A study of socially disadvantaged young people (who had recently been homeless, been diagnosed with mental illness, had recently experience violence, or had contact with the criminal justice system) explains how the harms associated with hepatitis C could be reduced for this group. Firstly ‘…gaining better understanding about why methamphetamine use is common among vulnerable young people, and what meanings they attach to it, may allow the development of health promotion initiatives with messages about methamphetamine injecting that are specifically relevant to young people’. Secondly ‘The silence around hepatitis C among study participants suggests the need to not only improve their knowledge about what it is and how it affects the body, but also to find ways to make it relevant to them’. Finally ‘Participants’ dependence on youth services and their lack of knowledge about harm reduction services suggests the need for better linkage between youth and harm reduction services. This could take the form of outreach work conducted by the harm reduction sector, where staff who have expertise about harm reduction go to the places where young people are’.
Bryant, J, Ellard, J, Fisher, D & Treloar, C 2012,
The exposure and transition study: exposure to injecting and hepatitis C among young people at risk, National Centre in HIV Social Research, The University of New South Wales, Sydney.
Comment: It is disturbing to read that the young people studied tend to be using youth services but not drug harm reduction services and, through doing so, are at elevated risks of contracting hepatitis C. This has implications for how we operate both types of services, and the need to break down silos between the two.
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How commonly is heavy drinking associated with risky sexual behaviour among Australian high schools students?
A school-based study in 2008 of 450 Victorian year 11 students estimated the prevalence of sexual behaviour and alcohol use and examined the association between excessive alcohol use and risky sexual behaviour. It found that ‘Under half (44%) the students had sex in the past year, half (50%) had engaged in binge drinking in the past two weeks and 26% reported compulsive drinking in the past year. Of those who reported sex in the past year (n=197), 34% had sex without a condom at the last sexual encounter and 28% later regretted sex due to alcohol’. The researchers concluded that ‘Risky sex – multiple sexual partners and regretted sex due to alcohol – and excessive drinking are highly prevalent and co-associated among Victorian late secondary students’.
Agius, P, Taft, A, Hemphill, S, Toumbourou, J & McMorris, B 2013, ‘Excessive alcohol use and its association with risky sexual behaviour: a cross-sectional analysis of data from Victorian secondary school students’,
Australian and New Zealand Journal of Public Health, vol. 37, no. 1, pp. 76-82.
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New Reports
Food and Drug Administration (USA) 2012, Questions and answers: FDA approves a Risk Evaluation and Mitigation Strategy (REMS) for extended-release and long-acting (ER/LA) opioid analgesics.
Interagency Coordinating Committee on the Prevention of Underage Drinking (USA) 2012, Report to Congress on the prevention and reduction of underage drinking 2012, Interagency Coordinating Committee on the Prevention of Underage Drinking, Rockville, MD.
Miller, P 2013, Patron offending and intoxication in night-time entertainment districts (POINTED); final report, Monograph Series no. 46, National Drug Law Enforcement Research Fund, Canberra.
Miller, P, Tindall, J, Sønderlund, A, Groombridge, D, Lecathelinais, C, Gillham, K, McFarlane, E, Groot, Fd, Droste, N, Sawyer, A, Palmer, D, Warren, I & Wiggers, J 2012, Dealing with alcohol-related harm and the night-time economy (DANTE); final report, Monograph Series no. 43, National Drug Law Enforcement Research Fund, Canberra.
Substance Abuse & Mental Health Services Administration, Department of Health and Human Services (USA) 2013, Adults with mental illness or substance use disorder account for 40 percent of all cigarettes smoked, SAMHSA.
United Nations Office on Drugs and Crime 2013, International Standards on Drug Use Prevention, United Nations Office on Drugs and Crime.
United Nations Office on Drugs and Crime 2013, The challenge of new psychoactive substances: a report from the Global SMART Programme, March 2013, United Nations Office on Drugs and Crime, Vienna.
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/research-tools/did-you-see-that-report
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