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.

 

In the August 2015 issue


ACT Research Spotlight

Research Findings

New Reports
 

How effective are household products in disinfecting syringes contaminated with HCV?

An assessment of the effectiveness of disinfecting syringes contaminated with hepatitis C virus (HCV) involved rinsing 1 mL insulin syringes with fixed needles and 1 mL tuberculin syringes with detachable needles with water, Clorox bleach, hydrogen peroxide, ethanol, isopropanol (rubbing alcohol solvent), Lysol, or Dawn Ultra dishwashing soap at different concentrations. Syringes were either immediately tested for viable virus or stored at 4 degrees C, 22 degrees C, and 37 degrees C for up to 21 days before viral infectivity was determined. The researchers found that ‘Most products tested reduced HCV infectivity to undetectable levels in insulin syringes. Bleach eliminated HCV infectivity in both syringes. Other disinfectants produced virus recovery ranging from high (5% ethanol, 77% +/- 12% HCV-positive syringes) to low (1:800 Dawn Ultra, 7% +/- 7% positive syringes) in tuberculin syringes’. The researchers concluded that ‘Household disinfectants tested were more effective in fixed-needle syringes (low residual volume) than in syringes with detachable needles (high residual volume). Bleach was the most effective disinfectant after 1 rinse, whereas other diluted household products required multiple rinses to eliminate HCV. Rinsing with water, 5% ethanol (as in beer), and 20% ethanol (as in fortified wine) was ineffective and should be avoided. Our data suggest that rinsing of syringes with household disinfectants may be an effective tool in preventing HCV transmission in [people who inject drugs] when done properly’.

Binka, M, Paintsil, E, Patel, A, Lindenbach, BD & Heimer, R 2015, ‘Disinfection of syringes contaminated with hepatitis C virus by rinsing with household products’, Open Forum Infectious Diseases, vol. 2, no. 1, p. ofv017, open access http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438897/.
 
Comment: The topic of using bleach and other products for cleaning syringes as a strategy for reducing BBV transmission risk is one that has been active for many years. Some contradictions exist in the evidence base about the effectiveness of bleach, in particular, and this uncertainty is carried through into policy and practice in some settings such as prisons. It is clear that correctional authorities need to rely on the best evidence available to underpin interventions that aim to minimise BBV transmission in custody.

 back to top

How significant are blood-borne viruses as a a cause of death among opioid dependent people?

A group of Australia researchers conducted a large-scale population-based observational study of opioid dependent people receiving opioid substitution treatment (OST) in NSW over the period 1993 to 2007. They quantified the burden of six major causes of death related to hepatitis C (HCV), hepatitis B (HBV) and human immunodeficiency virus (HIV) infection. They found that ‘An HCV notification was associated with higher hazards for accidental drug overdose (1.7-fold), death due to unintentional injury (1.4-fold) and cancer (2.0-fold). Although our estimates are imprecise, mortality from liver disease was higher among those with either HCV (5.9-fold) or HIV (11-fold) notifications, and markedly higher (15-fold) among those with both. An HBV notification was associated with higher hazards for death due to unintentional injury (2.1-fold), cancer (2.8-fold) and liver disease (2.1-fold). The hazard for cardiovascular-related mortality was increased 4-fold in those with an HIV notification. On the other hand, a BBV [blood-borne virus] notification was not associated with suicide risk. BBVs are known to precipitate chronic disease and it is also established that high-risk behaviours, particularly injection drug use, precipitate the incidence of BBVs. Our findings indicate that BBVs are also a marker of risk for preventable premature death due to unintentional injury. We attribute these associations to high-risk behaviours and environments, some of which are likely to be related to socioeconomic deprivation. Although HBV and HIV prevalence was low in our cohort, half of the OST registrants were notified with HCV by the end of the study period, thus strategies to prevent HCV infection and to identify, treat and educate those with an HCV must be enhanced and maintained’.
They concluded that, ‘Among OST registrants, BBVs are a direct cause of death and also a marker of behaviours that can result in unintended death. Ongoing and enhanced BBV prevention strategies and treatment, together with targeted education strategies to reduce risk, are justified’.

Vajdic, CM et al. 2015, ‘The impact of blood-borne viruses on cause-specific mortality among opioid dependent people: an Australian population-based cohort study’, Drug and Alcohol Dependence, vol. 152, pp. 264-71.

 back to top

How serious a problem is hepatitis C virus infection in NSW prisons?

A prospective cohort study conducted in prisons in NSW aimed to document the relationships between injecting drug use, imprisonment and hepatitis C virus (HCV) infection. Over 200 HCV seronegative prisoners with a life-time history of injecting drug use (IDU) were enrolled and followed prospectively by interview and tested for past or present HCV infection regularly for up to four years when in prison. The researchers found that ‘Almost half the cohort reported IDU during follow-up (103 subjects; 49.1%) and 65 (31%) also reported sharing of the injecting apparatus. There were 38 HCV incident cases in 269.94 person-years (py) of follow-up with an estimated incidence of 14.08 per 100 py…Incident infection was associated independently with Indigenous background, injecting daily or more and injecting heroin…Bleach-cleansing of injecting equipment and opioid substitution treatment were not associated with a significant reduction in incidence’.
 
The researchers state that ‘The findings highlight the many challenges remaining in establishing effective prevention strategies for HCV infection in the prison context, given the crowded conditions, uncontrolled exposure to violence and illicit drugs, separation from family networks and emotional deprivation. Improved and multi-faceted interventions are needed to reduce HCV transmission, potentially including access to needle and syringe exchange programmes, improved opioid substitution treatments, and even treatment-as-prevention programmes with the new direct acting antivirals…Ongoing surveillance of risk behaviours and infection rates, and further research to inform the effectiveness of HCV prevention measures in prisons, are warranted’.

Luciani, F et al. 2014, ‘A prospective study of hepatitis C incidence in Australian prisoners’, Addiction, vol. 109, no. 10, pp. 1695-706.
 
How effective are mindfulness-based interventions in smoking cessation?

Researchers from Brazil conducted a systematic literature review on the effects of mindfulness-based interventions for the treatment of smoking. They explained that ‘Mindfulness-based practices emphasize a modification of the relationship between the client and his or her internal experiences. The strategies to modify such experiences are the central mechanism for therapeutic change, whereas the processes of acceptance and mindfulness are the major mediators of change’. All the articles they analysed ‘…reported promising results, especially for smoking cessation, relapse prevention, number of cigarettes smoked, the moderation of mindfulness on the strength of relationship between craving and smoking, and the development of coping strategies to deal with triggers to smoke’. They concluded that ‘Mindfulness appears to induce positive effects on mental health, which might contribute to the maintenance of tobacco abstinence’.

de Souza, ICW et al. 2015, ‘Mindfulness-based interventions for the treatment of smoking: a systematic literature review’, Journal of Alternative and Complementary Medicine, vol. 21, no. 3, pp. 129-40.

 back to top

Why are people with psychotic illness more likely to smoke cigarettes than the general population?

A systematic review and meta-analysis of studies in which rates of smoking were reported in people with psychotic disorders were compared with controls aimed to test four hypotheses: ‘First, that an excess of tobacco use is already present in people presenting with their first episode of psychosis. Second, that daily tobacco use is associated with an increased risk of subsequent psychotic disorder. Third, that daily tobacco use is associated with an earlier age at onset of psychotic illness. Fourth, that an earlier age at initiation of smoking is associated with an increased risk of psychotic disorder’. The analysis revealed that ‘…daily use of tobacco was associated with an earlier onset of psychosis compared with non-smokers…Possible reasons for taking up smoking early could be related to self-medication for symptoms of anxiety or isolated psychosis and might be shared with other risk factors for psychosis, such as early life stressors or living in an urban setting. Therefore, for individuals at increased risk, smoking could have an additive effect’. The researchers concluded that ‘Daily tobacco use is associated with increased risk of psychosis and an earlier age at onset of psychotic illness. The possibility of a causal link between tobacco use and psychosis merits further examination’.

Gurillo, P et al.  2015, ‘Does tobacco use cause psychosis? Systematic review and meta-analysis’, The Lancet Psychiatry, online ahead of print, open access http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2815%2900152-2/abstract.

 back to top

What are the benefits of proving medically assisted training in the use of e-cigarettes as an aid to smoking cessation?

Abstract:
The electronic cigarette (e-cig) has gained popularity as an aid in smoking cessation programs mainly because it maintains the gestures and rituals of tobacco smoking. However, it has been shown in inexperienced e-cig users that ineffective nicotine delivery can cause tobacco craving that could be responsible for unsuccessful smoking reduction/cessation. Moreover, the incorrect use of an e-cig could also lead to potential nicotine overdosage and intoxication. Medically assisted training on the proper use of an e-cig plus behavioral support for tobacco dependence could be a pivotal step in avoiding both issues. We performed an eight-month pilot study of adult smokers who started e-cig use after receiving a multi-component medically assisted training program with monitoring of nicotine intake as a biomarker of correct e-cig use. Participants were tested during follow-up for breath carbon monoxide (CO), plasma cotinine and trans-3’-hydroxycotinine, and number of tobacco cigarettes smoked. At the end of the first, fourth, and eighth month of follow-up, 91.1, 73.5, and 76.5% of participants respectively were e-cig users (‘only e-cig’ and ‘dual users’). They showed no significant variation in plasma cotinine and trans-3’-hydroxycotinine with respect to the start of the study when they smoked only tobacco cigarettes, but a significant reduction in breath CO. The proposed medically assisted training program of e-cig use led to a successful nicotine intake, lack of typical cigarette craving and overdosage symptoms and a significant decrease in the biomarker of cigarette combustion products.

Pacifici, R et al. 2015, ‘Successful nicotine intake in medical assisted use of e-cigarettes: a pilot study’, International Journal of Environmental Research and Public Health, vol. 12, no. 7, pp. 7638-46.
 
Comment: ATODA is awaiting decisions by the ACT Government on its current enquiry into e-cigarettes in the ACT. This study is one of many that demonstrates the effectiveness of nicotine-containing e-cigarettes as an aid to smoking cessation.

 back to top

Has Australia alcohol consumption increased or decreased this century?

Data from the 2001 and 2011-2012 waves of the Australian National Health Survey were analysed to determine whether alcohol consumption in Australia has changed over this period. This analysis revealed ‘a decline between the two surveys in the proportion drinking at the low-risk level, with increases in both the medium- and high-risk categories’. It also showed that ‘tertiary qualifications, employment and white-collar occupations were associated with lower daily levels of alcohol consumption’.
The researchers concluded that ‘Our analysis of the data…suggests that the consumption of alcohol in Australia has increased in recent years. A sex difference in alcohol consumption by adults was evident in both surveys. Based on the 2011–2012 survey, the prevalence of alcohol intake among those aged 15–19 years was significantly higher than in adults. Moreover, relatively disadvantaged people reported higher consumption levels, and they also spent a somewhat larger proportion of their household budget on alcohol’.

Yusuf, F & Leeder, SR 2015, ‘Making sense of alcohol consumption data in Australia’, Medical Journal of Australia, vol. 203, no. 3, pp. 128-30, open access https://www.mja.com.au/journal/2015/203/3/making-sense-alcohol-consumption-data-australia.
 
Comment: This is a particularly important paper as it challenges existing understanding that Australia’s per capita level of alcohol consumption has fallen in recent years. That has been a consistent finding of the AIHW National Drug Strategy Household Survey. The authors of this paper addressed that inconsistency directly. They point to the low response rate of the NDS survey—about half that of the National Health Survey—and important methodological differences, with the NHS taking a sounder approach than the NDS survey. This is an important issue that needs further exploration.

 back to top

What evidence is there that consumption of alcohol contributes to weight gain?

A review of the literature on the association between light-to-moderate alcohol consumption and increase in body weight found that, ‘In general, recent prospective studies show that light-to-moderate alcohol intake is not associated with adiposity gain while heavy drinking is more consistently related to weight gain. Experimental evidence is also mixed and suggests that moderate intake of alcohol does not lead to weight gain over short follow-up periods. However, many factors can explain the conflicting findings and a better characterization of individuals more likely to gain weight as a result of alcohol consumption is needed. In particular, individuals who frequently drink moderate amounts of alcohol may enjoy a healthier lifestyle in general that may protect them from weight gain. In conclusion, despite the important limitations of current studies, it is reasonable to say that alcohol intake may be a risk factor for obesity in some individuals, likely based on a multitude of factors, some of which are discussed herein’.

Traversy, G & Chaput, J-P 2015, ‘Alcohol consumption and obesity: an update’, Current Obesity Reports, vol. 4, no. 1, pp. 122-30.

 back to top

What are the global health impacts of AOD use?

An international team led by Australian researchers write that ‘Addictive behaviours are among the greatest scourges on humankind. It is important to estimate the extent of the problem globally and in different geographical regions. Such estimates are available, but there is a need to collate and evaluate these to arrive at the best available synthetic figures. Addiction has commissioned this paper as the first of a series attempting to do this.’ Using a wide range of information sources, the researchers identified that ‘An estimated 4.9% of the world's adult population (240 million people) suffer from alcohol use disorder (7.8% of men and 1.5% of women), with alcohol causing an estimated 257 disability-adjusted life years lost per 100 000 population. An estimated 22.5% of adults in the world (1 billion people) smoke tobacco products (32.0% of men and 7.0% of women). It is estimated that 11% of deaths in males and 6% of deaths in females each year are due to tobacco. Of “unsanctioned psychoactive drugs”, cannabis is the most prevalent at 3.5% globally, with each of the others at < 1%; 0.3% of the world's adult population (15 million people) inject drugs. Use of unsanctioned psychoactive drugs accounts for an estimated 83 disability-adjusted life years lost per 100 000 population. Global estimates of problem gambling are not possible, but in countries where it has been assessed the prevalence is estimated at 1.5%.’ This led them to conclude that ‘Tobacco and alcohol use are by far the most prevalent addictive behaviours and cause the large majority of the harm. However, the quality of data on prevalence and addiction-related harms is mostly low, and comparisons between countries and regions must be viewed with caution. There is an urgent need to review the quality of data on which global estimates are made and coordinate efforts to arrive at a more consistent approach.’

Gowing, LR, Ali, RL, Allsop, S, Marsden, J, Turf, EE, West, R & Witton, J 2015, ‘Global statistics on addictive behaviours: 2014 status report’, Addiction, vol. 110, no. 6, pp. 904-19.

 back to top

How justifiable and necessary are Australian deemed supply laws for illicit drug trafficking offences?

Drug Policy Modelling Program researchers at the University of NSW explored the rationale for the widespread adoption of Australian deemed supply laws for illicit drug trafficking offences, and the extent to which they are justifiable and necessary. They undertook a legal and historical analysis of data sourced from legislation, parliamentary records (Hansard), case law, published research on international drug law, research on drug user behaviour and their own experience in the prosecution of drug offenders. Their analysis showed that ‘Australian deemed supply laws were introduced to overcome perceived difficulties in the prosecution and sanction of drug traffickers. Yet such laws conflict with the dominant international practice that sanctions trafficking without the use of deemed supply provisions. They contribute towards harms to users and miscarriages of justice and increase pressure to use police and prosecutorial discretion in ways that may ultimately adversely affect community confidence in the administration of the criminal law’. They concluded that the laws ‘should be subject to legislative review and/or, preferably, abolition from Australian drug trafficking law’.

Hughes, CE, Cowdery, N & Ritter, A 2015, ‘Deemed supply in Australian drug trafficking laws: a justifiable legal provision?’, Current Issues in Criminal Justice, vol. 27, no. 1, pp. 1-20.
 
Comment: Over many years successive ACT Governments have committed themselves to implementing policies that are based on good evidence as to effectiveness, and compliance with human rights. This study challenges the appropriateness of the current ACT deemed supply legislation. ATODA hopes that the ACT Government critically examines its policy and practice in this regard in the light of the findings of this important DPMP study.

 back to top

Are young people who participate in sport more or less likely to use alcohol and illicit drugs than those who are not involved in sport?

A systematic review of the literature on the association between sport participation, on the one hand, and alcohol and illicit drug use, on the other, found that ‘sport participation is associated with alcohol use, with 82% of the included studies (14/17) showing a significant positive relationship. Sport participation, however, appears to be related to reduced illicit drug use, especially use of non-cannabis related drugs. Eighty percent of the studies found sport participation associated with decreased illicit drug use, while 50% of the studies found negative association between sport participation and marijuana use. Further investigation revealed that participation in sports reduced the risk of overall illicit drug use, but particularly during high school; suggesting that this may be a critical period to reduce or prevent the use of drugs through sport. Future research must better understand what conditions are necessary for sport participation to have beneficial outcomes in terms of preventing alcohol and/or illicit drug use. This has been absent in the extent literature and will be central to intervention efforts in this area’.

Kwan, M et al. 2014, ‘Sport participation and alcohol and illicit drug use in adolescents and young adults: a systematic review of longitudinal studies’, Addictive Behaviors, vol. 39, no. 3, pp. 497-506, open access http://www.sciencedirect.com/science/article/pii/S0306460313003766.

 back to top

How much is spent annually in Australia on AOD treatment?
 
A study conducted by the Australian Drug Policy Modelling Program estimated annual health expenditure on alcohol and other drug (AOD) treatment in Australia and documented a methodology for future estimates. The researchers estimated that the total expenditure was AUD$1.2 billion in 2012/2013. They found that the states and territories accounted for 51% of the total, the Commonwealth 31% and private sources 18%, and that AOD treatment represented 0.8% of total health-care spending. They concluded that ‘The higher proportion of expenditure in AOD treatment programs outside hospitals is consistent with the community-focused models of care for AOD treatment. The Commonwealth’s investment in AOD treatment funding resides predominantly in its dedicated AOD treatment grant programs. The analysis of health expenditure does not tell us whether the investment mix is effective in reducing AOD-related harm and producing positive health outcomes, but it provides the basis for analysis of the distributions of expenditure between funding sources and assessment of AOD treatment spending relative to all health areas, and creates a base for tracking trends over time’.

Ritter, A, Chalmers, J & Berends, L 2015, ‘Health expenditure on alcohol and other drug treatment in Australia (2012/2013)’, Drug and Alcohol Review, vol. 34, no. 4, pp. 397-403.

 back to top

What is the state of Australian research on AOD use and impacts among lesbian, gay, bisexual and transgender people?

The July 2015 issue of Drug and Alcohol Review contains three articles on AOD use and impacts among Australian lesbian, gay, bisexual and transgender (LGBT) people. They are accompanied by an editorial by Professor Alison Ritter who explains that, in each of the articles, the authors find higher levels of AOD consumption or rates of harm among LGBT people than in the general population. She goes onto argue: ‘However, we need to know more than this. While harms are arguably more important than consumption patterns per se, we are still missing research on one particular type of harm, that of rates of substance abuse disorders or ‘dependence’ in LGBT populations. Internationally, as at 2012, there were 12 published studies on the prevalence of alcohol use disorders among LGBT and 15 studies of substance use disorders. There has been no published Australian research that I am aware of. If we want to intervene with these population groups in terms of substance use treatment, then we need to know more about dependence problems (rather than how much people consume).’ With respect to treatment, she explains that ‘Existing international LGBT treatment research has shown that there is an important distinction between LGBT-specific substance abuse treatment that is tailored and adapted for this population versus treatment that is sensitive to LGBT needs, without special tailoring. There appears to be support for LGBT-specific tailored treatments, notably in the context of methamphetamine abuse for gay men. More commonly, the research to date suggests similar or in some instances better treatment outcomes for LGBT irrespective of whether the program was specifically tailored. Although in Australia there are a number of both LGBT-specific and LGBT-sensitive services, notably those run through AIDS Councils, these are rarely evaluated, or the subject of clinical trials. In the absence of Australian LGBT treatment research, we remain unable to effectively advocate for appropriate treatment services. Hopefully these three papers are the beginning of a burgeoning research effort focused on improving our understanding of and responses to the needs of LGBT people.’

Ritter, A 2015, ‘New Australian lesbian, gay, bisexual and transgender research—and the need for more’, Drug and Alcohol Review, vol. 34, no. 4, pp. 347-8.

 back to top

What methods are most effective in assessing and communicating drug alerts among people who use drugs to limit drug-related harms?

Regional health bodies in British Columbia, Canada, issue drug alerts to the public when health risks associated with drug quality are identified, such as increased illicit drug deaths, overdoses or other harms. Because there is a lack of evidence-based guidelines for producing timely, effective public health alerts to mitigate these harms, researchers from the British Columbia Center for Disease Control conducted a study using questionnaires and in-depth focus groups with 32 people who use drugs to ascertain ‘(1) the practices used by people who use drugs (PWUD) to assess the quality of street drugs and reduce harms from adulterants and (2) how drug alerts could be better communicated to PWUD’. They found that ‘the most effective and trusted information about drug quality was primarily from: (a) trusted, reputable dealers or (b) peer-based social networks. Most PWUD thought information received through health service providers was not timely and did not discuss drug quality with them. A number of concrete guidelines were suggested by participants to improve the effectiveness of drug alert modes and methods of communication in the community, including the use of language on drug alert postings that implies harm, indicates what drug effects to look for, and suggests appropriate responses to overdose, such as the use of naloxone. Participants also emphasized the need to date posters and remove them in a timely manner so as to not desensitize the community to such alerts’. The researchers concluded that, ‘Since it is difficult to control adulteration practices in an unregulated drug market, this study suggests methods of effectively producing and communicating drug alerts among PWUD to mitigate harms associated with drug use’.

Soukup-Baljak, Y, Greer, AM, Amlani, A, Sampson, O & Buxton, JA 2015, ‘Drug quality assessment practices and communication of drug alerts among people who use drugs’, International Journal of Drug Policy, online ahead of print.
 
Comment: So far as ATODA is aware, there have not been any systematic studies in Australia of the most appropriate ways of alerting people who use drugs to changes in drug markets that could adversely affect them. In the absence of local information, it would seem prudent for drug policy workers and people involved in drug service delivery, including peer programs, to reflect on the findings of this Canadian study and identify its implications for the ACT. ATODA has long been concerned that the ACT does not have a sufficiently coherent, well-resourced early warning and response system covering problematic changes in local drug markets.

 back to top

To what extent has the emergence of prevention science narrowed the development of policy on drugs?

Background: This article critically examines the political dimension of prevention science by asking how it constructs the problems for which prevention is seen as the solution and how it enables the monitoring and control of these problems. It also seeks to examine how prevention science has established a sphere for legitimate political deliberation and which kinds of statements are accepted as legitimate within this sphere.
Methods: The material consists of 14 publications describing and discussing the goals, concepts, promises and problems of prevention science. The analysis covers the period from 1993 to 2012.
Results: The analysis shows that prevention science has established a narrow definition of “prevention”, including only interventions aimed at the reduction of risks for clinical disorders. In publications from the U.S. National Institute of Drug Abuse, the principles of prevention science have enabled a commitment to a zero-tolerance policy on drugs. The drug using subject has been constructed as a rational choice actor lacking in skills in exerting self-control in regard to drug use. Prevention science has also enabled the monitoring and control of expertise, risk groups and individuals through specific forms of data gathering. Through the juxtaposition of the concepts of “objectivity” and “morality”, prevention science has constituted a principle of delineation, disqualifying statements not adhering to the principles of prevention science from the political field, rendering ethical and conflictual dimensions of problem representations invisible.
Conclusion: The valorisation of scientific accounts of drugs has acted to naturalise specific political ideals. It simultaneously marginalises the public from the public policy process, giving precedence to experts who are able to provide information that policy-makers are demanding. Alternative accounts, such as those based on marginalisation, poverty or discrimination are silenced within prevention science.

Roumeliotis, F 2015, ‘Politics of prevention: the emergence of prevention science’, International Journal of Drug Policy, vol. 26, no. 8, pp. 746-54.

 back to top

New Reports

Bainbridge, R, McCalman, J, Clifford, A & Tsey, K 2015, Cultural competency in the delivery of health services for Indigenous people, Australian Institute of Health and Welfare & Australian Institute of Family Studies, Canberra & Melbourne, http://www.aihw.gov.au/closingthegap/publications/.
 
Butler, K & Burns, L 2015, Injecting risk practices and Hepatitis C, IDRS Drug Trends Bulletin, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, https://ndarc.med.unsw.edu.au/resource/injecting-risk-practices-and-hepatitis-c.
 
European Monitoring Centre for Drugs and Drug Addiction 2015, Alternatives to punishment for drug-using offenders, Publications Office of the European Union, Luxembourg, http://www.emcdda.europa.eu/publications/emcdda-papers/alternatives-to-prison.
 
International Centre for the Prevention of Crime (ICPC) 2015, Prevention of drug-related crime report, International Centre for the Prevention of Crime (ICPC), Montreal, http://www.crime-prevention-intl.org/en/welcome/publications-events/article/rapport-sur-la-prevention-de-la-criminalite-liee-a-la-consommation-de-drogue-1.html.
 
Legislative Assembly for the Australian Capital Territory, Standing Committee on Health, Ageing, Community and Social Services 2015, Inquiry into exposure draft of the Drugs of Dependence (Cannabis Use for Medical Purposes) Amendment Bill 2014 and related discussion paper, Legislative Assembly for the ACT, Canberra, http://tinyurl.com/oqf5934.
 
National Alcohol & Drug Knowledgebase 2015, ‘Cannabis’, http://nadk.flinders.edu.au/kb/cannabis (new section on cannabis launched in late July).
 
Parliament of the Commonwealth of Australia, House of Representatives Standing Committee on Health 2015, The silent disease, inquiry into hepatitis C in Australia, Parliament of the Commonwealth of Australia, Canberra, http://www.aph.gov.au/Parliamentary_Business/Committees/House/Health/Hepatitis_C_in_Australia/Report.
 
Parliament of the Commonwealth of Australia, Senate Legal and Constitutional Affairs Committee 2015, Regulator of Medicinal Cannabis Bill 2014, Parliament of the Commonwealth of Australia, Canberra. http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/Medicinal_Cannabis_Bill/Report.
 
 back to top