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.
The Symposium was held on Thursday 27 November 2014 at the ANU Commons Function Centre. It aimed to gather ACT-based cross-institutional researchers, services workers, policy makers and consumers to showcase recent ACT ATOD research activities.
The research presented is aligned with key ATOD sector and ACT Government policy priorities including:
The Symposium also included a panel and workshop focused on better understanding the use of, and our responses to, crystalline methamphetamines in the ACT. The symposium ended with a networking lunch to exchange ideas and support future collaborations.
What evidence is there that vigorous law enforcement against drug sellers increases drug prices?
A literature review focused on the price effects of tougher enforcement, such as raising the risk that a drug dealer is incarcerated. The reviewers found that ‘Although the fact of prohibition itself raises prices far above those likely to pertain in legal markets, there is little evidence that raising the risk of arrest, incarceration or seizure at different levels of the distribution system will raise prices at the targeted level, let alone retail prices’. They concluded that ‘Given the high human and economic costs of stringent enforcement measures, particularly incarceration, the lack of evidence that tougher enforcement raises prices call into question the value, at the margin, of stringent supply-side enforcement policies in high-enforcement nations’. They commented ‘In the absence of evidence that enforcement can raise prices—or that price increases are actually welfare enhancing across a range of interventions—some wealthy societies should probably spend less on enforcement at the margin, particularly enforcement measures that bring high social costs in other domains’.
Pollack, HA & Reuter, P 2014, ‘Does tougher enforcement make drugs more expensive?
, vol. 109, no. 12, pp. 1959-66.
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Is a combination of amphetamine and benzodiazepines likely to be more impairing for drivers, compared with the presence of only one of the substances?
Norwegian researchers compared the impairment of drivers where a combination of amphetamines and benzodiazepines was detected, in blood, with cases where only one of the two drug groups was detected. ‘During the study period, 13,225 cases, from suspected drunk or drugged drivers, were received for toxicological analysis. Of these cases, 196 contained benzodiazepines only, 322 contained amphetamine only, and 899 contained benzodiazepines and amphetamine in combination’. The study showed that ‘the number of drivers being judged as impaired…was higher if a combination of benzodiazepines and amphetamines was detected in blood, compared with when either benzodiazepines or amphetamines were detected alone. Also, a relation between concentrations of benzodiazepines and impairment was observed, but no such relationship could be revealed for the amphetamines’. The researchers concluded that ‘during real-life driving, those influenced by both amphetamines and benzodiazepines are more impaired… compared with those influenced by either drug alone, although the combined group showed lower drug concentrations’.
Høiseth, G, Andås, H, Bachs, L & Mørland, J 2014, ‘Impairment due to amphetamines and benzodiazepines, alone and in combination
’, Drug and Alcohol Dependence
, vol. 145, pp. 174-9.
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What was the impact of setting quantitative limits for drug driving offences in Norway?
A study in Norway investigated whether the implementation of legislative limits for drugs in drivers affected the number of blood samples taken from suspected drugged drivers, drug identification and the number of expert witness statement requests for the courts. ‘Norway has practiced a per se law for driving under the influence of alcohol in whole blood since 1936. Initially the legal limit was 0.05%, but it was reduced to 0.02% in 2001. Graded sanctions are given; drivers are sentenced to conditioned imprisonment for driving with BACs [blood alcohol concentrations] between 0.05% and 0.12% and unconditioned imprisonment for BACs above 0.12%.’ The researchers found that ‘The number of blood samples taken in suspected DUID [driving under the influence of drugs] cases increased by 20% after introduction of legislative limits (3320 cases in 2010 and 3970 in 2013). The number of samples with at least one drug above the per se limit corresponding to BAC of 0.02% increased by 17% (from 2646 in 2010 to 3090 in 2013), whereas the number of expert witness statements was reduced by the half (from 63.4% in 2010 and 28.7% in 2013)’.
They concluded ‘The introduction of legislative per se limits for drugged driving and legislative limits corresponding to BACs at 0.02%, 0.05% and 0.12% has been successful, and the experience is that alcohol and non-alcohol drugs can be handled similarly. The DUI legislation now signals that driving under the influence of psychoactive drugs is not compatible with safe driving, in the same way as for alcohol. It is likely that the new legislation leads to more convictions in court. The deterrent effect of the per se law would probably had been better if it had been widely published through information campaigns’.
Vindenes, V, Boix, F, Koksæter, P, Strand, MC, Bachs, L, Mørland, J & Gjerde, H 2014, ‘Drugged driving arrests in Norway before and after the implementation of per se law
’, Forensic Science International
, vol. online ahead of print.
What is the relative cost-effectiveness of needle-syringe programs, opioid substitution therapy and antiretroviral therapy for people living with HIV ?
HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term.
Wilson, DP, Donald, B, Shattock, AJ, Wilson, D & Fraser-Hurt, N 2014, ‘The cost-effectiveness of harm reduction’, International Journal of Drug Policy
, online ahead of print, open access http://www.ijdp.org/article/S0955-3959(14)00311-9/abstract
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What evidence is there that supervised injection services foster drug use and drug trafficking?
A systematic review of the literature aimed to collect and synthesize the currently available evidence regarding supervised injection services (SIS)-induced benefits and harm. Of the 75 articles examined, all found that ‘SISs were efficacious in attracting the most marginalized PWID [people who inject drugs], promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency. SISs were not found to increase drug injecting, drug trafficking or crime in the surrounding environments. SISs were found to be associated with reduced levels of public drug injections and dropped syringes. Of the articles, 85% originated from Vancouver or Sydney’. The researchers concluded ‘SISs have largely fulfilled their initial objectives without enhancing drug use or drug trafficking. Almost all of the studies found in this review were performed in Canada or Australia, whereas the majority of SISs are located in Europe. The implementation of new SISs in places with high rates of injection drug use and associated harms appears to be supported by evidence’.
Potier, C, Laprévote, V, Dubois-Arber, F, Cottencin, O & Rolland, B 2014, Supervised injection services: what has been demonstrated? A systematic literature review
, Drug and Alcohol Dependence
, vol. 145, pp. 48-68.
What proportion of presentations to emergency departments is alcohol-related?
A survey of patients at emergency departments (EDs) of 106 hospitals in Australia and New Zealand was conducted at 02:00 local time on 14 December 2013. Of the 2,766 patients in EDs at the study time ‘395 were presenting for alcohol-related reasons; 13.8%...in Australia and 17.9%...in New Zealand. The distribution was skewed left, with proportions ranging from 0 to 50% and a median of 12.5%. Nine Australian hospitals and one New Zealand hospital reported that more than a third of their ED patients had alcohol-related presentations; the Northern Territory (38.1%) and Western Australia (21.1%) reported the highest proportions of alcohol-related presentations…Our finding that one in seven patients in EDs in Australia and one in six in New Zealand present for reasons related to alcohol consumption indicates that previous research has underestimated the amount of alcohol-related harm presenting to Australasian EDs…the much higher prevalence in major referral compared with urban district hospitals in Australia was expected, although it is of interest that this pattern was not repeated in New Zealand’.
The researchers commented ‘The contemporary discourse and policy response to alcohol misuse in the Australasian community emphasises law enforcement and regulatory initiatives. Our study draws attention to the important reality that alcohol misuse also has a significant impact on the health care system, as reflected in the very high prevalence of alcohol-related presentations in some EDs. As alcohol-related harm is an entirely preventable condition, and when hospitals in multiple jurisdictions report more than a third of their ED workload is due to this single cause, we contend that this represents a strong case for preventive public health interventions as a key component of a broad policy response to this issue’.
Egerton-Warburton, D, Gosbell, A, Wadsworth, A, Fatovich, DM & Richardson, DB 2014, ‘Survey of alcohol-related presentations to Australasian emergency departments
’, Medical Journal of Australia
, vol. 201, no. 10, pp. 584-7.
To what extent are people who drink alcohol excessively alcohol dependent?
Analysis of data from the US National Survey on Drug Use and Health in 2009, 2010, and 2011 assessed drinking patterns (i.e., past-year drinking, excessive drinking, and binge drinking) by socio-demographic characteristics and alcohol dependence. The researchers found that ‘Excessive drinking, binge drinking, and alcohol dependence were most common among men and those aged 18 to 24. Binge drinking was most common among those with annual family incomes of [US]$75,000 or more, whereas alcohol dependence was most common among those with annual family incomes of less than [US]$25,000. The prevalence of alcohol dependence was 10.2% among excessive drinkers, 10.5% among binge drinkers, and 1.3% among non-binge drinkers. A positive relationship was found between alcohol dependence and binge drinking frequency’. The researchers concluded that ‘Most excessive drinkers (90%) did not meet the criteria for alcohol dependence. A comprehensive approach to reducing excessive drinking that emphasizes evidence-based policy strategies and clinical preventive services could have an impact on reducing excessive drinking in addition to focusing on the implementation of addiction treatment services’.
They commented ‘These findings emphasize the usefulness of screening for binge-level alcohol consumption to identify excessive drinking among adults, including those who are alcohol-dependent. The relatively low prevalence of alcohol dependence among people who drink excessively also suggests that most people who are screened for excessive drinking in clinical settings will probably not need to be referred for specialized treatment’.
Esser, MB, Hedden, SL, Kanny, D, Brewer, RD, Gfroerer, JC & Naimi, TS 2014, ‘Prevalence of alcohol dependence among US adult drinkers, 2009-2011’, Preventing Chronic Disease
, vol. 11, p. E206, open access http://www.cdc.gov/pcd/issues/2014/14_0329.htm
Comment: The finding that most people who drink at problematic levels are not alcohol-dependent, and hence do not need intensive, long-term treatment, supports the value of boosting community-based screening, brief interventions and referral to other appropriate interventions.
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How appropriate is Australian policy with regard to fetal alcohol spectrum disorder?
A comprehensive article on alcohol use during pregnancy and considerations for Australian policy covers topics including a review of the international research, fetal alcohol spectrum disorders (FASD) in the Australian context, policy comparisons and funding considerations, and community health costs of FASD.
The author concludes that, ‘With some exceptions, the history of Australian women’s alcohol use, and therefore the potential for alcohol exposed pregnancies, is relatively recent, starting around the late 1960s and increasing to current times. This 50-year period of potential and probable alcohol affected pregnancies will have resulted in an increasing prevalence of FASD, leading to current patterns where one in every two births have some level of alcohol exposure and therefore some risk of FASD. In addition to financial impact, FASD represents a loss of potential for individuals, family, and community. FASDs are preventable, so this period of probable effect represents a period of lost opportunity for public health action to reduce the impact of alcohol use during pregnancy. Australian women are still drinking, often to high-risk levels during pregnancy, and part of this is due to conflicting and inadequate information, intervention and public health planning, programming and policy that considers not only women, but also their partners, their families, their friends, and Australia’s social acceptance of alcohol use generally. FASD can be difficult to diagnose and, in relation to other countries, has only recently been identified as a public health issue in Australia. This may be due to its sensitive etiology and perhaps also with the potentially high public health prevention costs that would result if the issue was more widely recognized. However, the process has started and Australia now needs to move decisively forward through a high level of multidisciplinary collaboration and commitment between government, health professionals, researchers and effected families and communities and requires action at multiple levels along with adequate public funding’.
McBride, N 2014, 'Alcohol use during pregnancy: considerations for Australian policy
’, Social Work in Public Health
, vol. 29, no. 6, pp. 540-8.
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What does the latest randomised controlled trial of e-cigarettes tell us about their effectiveness for smoking cessation?
Smoking reduction remains a pivotal issue in public health policy, but quit rates obtained with traditional quit-smoking therapies remain disappointingly low. Tobacco Harm Reduction (THR), aiming at less harmful ways of consuming nicotine, may provide a more effective alternative. One promising candidate for THR are electronic cigarettes (e-cigs). The aim of this study was to investigate the efficacy of second-generation e-cigs both in terms of acute craving-reduction in the lab and in terms of smoking reduction and experienced benefits/complaints in an eight-month Randomized Controlled Trial (RCT).
RCT [randomised controlled trial] with three arms.
Participants (N = 48) unwilling to quit smoking were randomized into two e-cig groups and one control group. During three lab sessions (over two months) participants, who had been abstinent for four hours, vaped/smoked for five minutes, after which we monitored the effect on craving and withdrawal symptoms. eCO and saliva cotinine levels were also measured. In between lab sessions, participants in the e-cig groups could use e-cigs or smoke ad libitum, whereas the control group could only smoke. After the lab sessions, the control group also received an e-cig. The RCT included several questionnaires, which repeatedly monitored the effect of ad libitum e-cig use on the use of tobacco cigarettes and the experienced benefits/complaints up to six months after the last lab session.
From the first lab session on, e-cig use after four hours of abstinence resulted in a reduction in cigarette craving which was of the same magnitude as when a cigarette was smoked, while eCO was unaffected. After two months, we observed that 34% of the e-cig groups had stopped smoking tobacco cigarettes, versus 0% of the control group. After five months, the e-cig groups demonstrated a total quit-rate of 37%, whereas the control group showed a quit rate of 38% three months after initiating e-cig use. At the end of the eight-month study, 19% of the e-cig groups and 25% of the control group were totally abstinent from smoking, while an overall reduction of 60% in the number of cigarettes smoked per day was observed (compared to intake). eCO levels decreased, whereas cotinine levels were the same in all groups at each moment of measurement. Reported benefits far outweighed the reported complaints.
In a series of controlled lab sessions with e-cig naive tobacco smokers, second generation e-cigs were shown to be immediately and highly effective in reducing abstinence induced cigarette craving and withdrawal symptoms, while not resulting in increases in eCO. Remarkable (>50 pc) eight-month reductions in, or complete abstinence from tobacco smoking was achieved with the e-cig in almost half (44%) of the participants.
Adriaens, K, Van Gucht, D, Declerck, P & Baeyens, F 2014, ‘Effectiveness of the electronic cigarette: an eight-week Flemish study with six-month follow-up on smoking reduction, craving and experienced benefits and complaints’, International Journal of Environmental Research and Public Health
, vol. 11, no. 11, pp. 11220-48, open access http://www.mdpi.com/1660-4601/11/11/11220
Comment: On 22 Nov 14 Simon Chapman, Professor in Public Health at the University of Sydney, a long-time opponent of e-cigarettes, tweeted a link to this article and commented that ‘Evidence firming on #ecigs as highly effective in smoking cessation’.
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How do awareness of and use of e-cigarettes differ between countries?
A team of international researchers analysed data from adult current and former smokers participating in the International Tobacco Control (ITC) surveys from 10 countries. Surveys were administered via telephone, face-to-face interviews, or the web. Survey questions included socio-demographic and smoking-related variables, and questions about e-cigarette awareness, trial and current use. Their findings were that ‘There was considerable cross-country variation by year of data collection and for awareness of e-cigarettes (Netherlands (2013: 88%), Republic of Korea (2010: 79%), United States (2010: 73%), Australia (2013: 66%), Malaysia (2011: 62%), United Kingdom (2010: 54%), Canada (2010: 40%), Brazil (2013: 35%), Mexico (2012: 34%), and China (2009: 31%)), in self-reports of ever having tried e-cigarettes (Australia, (20%), Malaysia (19%), Netherlands (18%), United States (15%), Republic of Korea (11%), United Kingdom (10%), Mexico (4%), Canada (4%), Brazil (3%), and China (2%)), and in current use (Malaysia (14%), Republic of Korea (7%), Australia (7%), United States (6%), United Kingdom (4%), Netherlands (3%), Canada (1%), and China (0.05%). They concluded that ‘The cross-country variability in awareness, trial, and current use of e-cigarettes is likely due to a confluence of country-specific market factors, tobacco control policies and regulations (e.g., the legal status of e-cigarettes and nicotine), and the survey timing along the trajectory of e-cigarette awareness and trial/use in each country. These ITC results constitute an important snapshot of an early stage of what appears to be a rapid progression of global e-cigarette use’.
The relative position of Australia can be summarised as follows:
- Awareness of e-cigarettes (Netherlands (2013: 88%), Republic of Korea (2010: 79%), United States (2010: 73%), Australia (2013: 66%), Malaysia (2011: 62%), United Kingdom (2010: 54%), Canada (2010: 40%), Brazil (2013: 35%), Mexico (2012: 34%), and China (2009: 31%))
- Self-reports of ever having tried e-cigarettes (Australia, (20%), Malaysia (19%), Netherlands (18%), United States (15%), Republic of Korea (11%), United Kingdom (10%), Mexico (4%), Canada (4%), Brazil (3%), and China (2%))
- Current use of e-cigarettes (Malaysia (14%), Republic of Korea (7%), Australia (7%), United States (6%), United Kingdom (4%), Netherlands (3%), Canada (1%), and China (0.05%)).
Gravely, S, Fong, GT, Cummings, KM, Yan, M, Quah, ACK, Borland, R, Yong, H-H, Hitchman, SC, McNeill, A, Hammond, D, Thrasher, JF, Willemsen, MC, Seo, HG, Jiang, Y, Cavalcante, T, Perez, C, Omar, M & Hummel, K 2014, ‘Awareness, trial, and current use of electronic cigarettes in 10 countries: findings from the ITC Project’, International Journal of Environmental Research and Public Health
, vol. 11, no. 11, pp. 11691-704, open access http://www.mdpi.com/1660-4601/11/11/11691/htm#sthash.OKgaZlva.dpuf
Comment: The finding that e-cigarette use in Australia was marginally higher than the USA, despite it being illegal to sell nicotine-containing e-cigarettes in this country, is surprising. It may be in part an artefact of the different years of data collection between the two nations. Nonetheless, this study highlights the penetration of e-cigarettes into Australia (and other nations), along with the need to establish viable regulatory schemes that minimise the likelihood of adverse consequences flowing from e-cigarette use, and maximise the likelihood that they contribute positively to rates of tobacco smoking cessation.
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How easy is it to assess the effect of medical marijuana laws on marijuana use?
A study of the effects of medical marijuana laws (MMLs) on marijuana use in the United States found that ‘…not all MMLs are created equally. There are important nuances to these policies that have differential effects on marijuana consumption, particularly heavy users and youth. Contrary to expectations, we do find that in general MML policies either have no impact on recreational marijuana use or are associated with reduced marijuana consumption, depending on the population and behavior assessed…analyses show that states that allow dispensaries face a greater risk of increased recreational use and related negative consequences relative to other MML policy frameworks. In particular, marijuana dependence, as indicated by noncriminal justice referrals to treatment, can be higher in states that legally protect dispensaries for both adults and youth. On the other hand, we also find inconsistent evidence regarding the effect of home cultivation allowances and registration requirements on recreational marijuana use, which appears to depend on the data set, subpopulation, and specific margin of use…The results in this paper provide some additional insight into the inconsistent findings in the literature related to MML policies in general’.
Pacula, RL, Powell, D, Heaton, P & Sevigny, EL 2014, ‘Assessing the effects of medical marijuana laws on marijuana use: the devil is in the details
’, Journal of Policy Analysis and Management
, online ahead of print.
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What effect do medical marijuana laws have on potency?
Marijuana potency has risen dramatically over the past two decades. In the United States, it is unclear whether state medical marijuana policies have contributed to this increase.
Employing a differences-in-differences model within a mediation framework, we analyzed data on n = 39,157 marijuana samples seized by law enforcement in 51 U.S. jurisdictions between 1990 and 2010, producing estimates of the direct and indirect effects of state medical marijuana laws on potency, as measured by Δ9-tetrahydrocannabinol [THC] content.
We found evidence that potency increased by a half percentage point on average after legalization of medical marijuana, although this result was not significant. When we examined specific medical marijuana supply provisions, results suggest that legal allowances for retail dispensaries had the strongest influence, significantly increasing potency by about one percentage point on average. Our mediation analyses examining the mechanisms through which medical marijuana laws influence potency found no evidence of direct regulatory impact. Rather, the results suggest that the impact of these laws occurs predominantly through a compositional shift in the share of the market captured by high-potency sinsemilla.
Our findings have important implications for policymakers and those in the scientific community trying to understand the extent to which greater availability of higher potency marijuana increases the risk of negative public health outcomes, such as drugged driving and drug-induced psychoses. Future work should reconsider the impact of medical marijuana laws on health outcomes in light of dramatic and ongoing shifts in both marijuana potency and the medical marijuana policy environment.
Sevigny, EL, Pacula, RL & Heaton, P 2014, ‘The effects of medical marijuana laws on potency’, International Journal of Drug Policy
, vol. 25, no. 2, pp. 308-19, open access http://www.ijdp.org/article/S0955-3959%2814%2900006-1/abstract
Comment: This article, and the preceding one, demonstrate the strength of American research on medical marijuana, providing sound guidance to the Australian policy workers and legislators currently developing policy options for legal medicinal cannabis provision in Australia.
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To what extent does tobacco smoking affect alcohol withdrawal?
‘Given the multiple molecular targets for alcohol in the brain and numerous constituents of tobacco smoke, it is likely that the neurobiology of this comorbidity is complex. However, the γ-aminobutyric acid (GABA) system may be an important point of convergence of the effects of tobacco smoke and alcohol in the brain.’ A parallel study in alcohol-dependent humans and nonhuman primates [rhesus monkeys] aimed to identify the impact of tobacco smoke and nicotine on the neuroadaptations in the GABA-ergic system that occur during alcohol withdrawal.
The researchers found ‘that tobacco smoking, but not nicotine consumption, blocks the recovery of GABAA receptors during extended alcohol withdrawal and that sustained elevations in GABAA receptor levels in alcohol-dependent smokers are associated with alcohol and cigarette cravings, possibly contributing to continued smoking’.
Cosgrove, KP, McKay, R, Esterlis, I, Kloczynski, T, Perkins, E, Bois, F, Pittman, B, Lancaster, J, Glahn, DC, O’Malley, S, Carson, RE & Krystal, JH 2014, ‘Tobacco smoking interferes with GABAA receptor neuroadaptations during prolonged alcohol withdrawal
’, Proceedings of the National Academy of Sciences
, online ahead of print.
Comment: This study provides insights into the biological pathways that underpin the observations of treatment personnel and researchers about the value of smoking cessation programs as an integral part of alcohol withdrawal programs, and the treatment for alcohol dependence.
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What evidence is there that women progress through milestones of drug use differently from men?
Background: Available evidence indicates women with substance use disorders may experience more rapid progression through usage milestones (telescoping). The few investigations of sex differences in treatment-seeking populations often focus on single substances and typically do not account for significant polysubstance abuse. The current study examined sex differences in a heterogeneous sample of treatment seeking polysubstance users. We examined patterns of drug use, age at drug use milestones (e.g., initial use, regular use), and progression rates between milestones. Nicotine and alcohol use were also evaluated.
Methods: Participants (n = 543; 288 women) completed personal histories of substance use, including chronicity, frequency, and regularity, as well as inventories assessing affect, and intellectual ability.
Results: Rates of drug use and milestone ages varied by sex and specific drug. Analyses suggested pronounced telescoping effects for pain medication and marijuana, with women progressing more rapidly through usage milestones.
Conclusions: Our data were generally supportive of telescoping effects, although considerable variance in progression measures was noted. The contrast between the marked telescoping observed in pain medication use and the absence of telescoping in other opioids was of particular interest. The discrepancy in telescoping effects, despite shared pharmacologies, suggests the need for further work examining underlying psychosocial factors. These results highlight that the specific sample population, substance, and outcome measure should be carefully considered when interpreting sex differences in substance use.
Lewis, B, Hoffman, LA & Nixon, SJ 2014, ‘Sex differences in drug use among polysubstance users’, Drug and Alcohol Dependence, vol. 145, pp. 127-33.
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What is the evidence that recent cocaine use is associated with an increased risk of sudden cardiovascular death?
Spanish researchers investigated whether recent cocaine use was associated with sudden cardiovascular death (SCVD) in individuals aged between 15 and 49 years, by means of autopsies performed in Biscay, Spain, during the period from 1 January 2003 to 31 December 2009. Medico-legal sudden deaths not due to cardiovascular diseases (SnoCVD) were used as the control group. They found ‘Recent cocaine use was significantly higher in the SCVD group (27 of 311 subjects, 9%) than in the SnoCVD group (three of 126 subjects, 2%)…Compared with the estimated data in the general population, the prevalence of recent cocaine use was 13–58 times higher in people with SCVD’. They concluded ‘Recent cocaine use is associated significantly with an increased risk for sudden cardiovascular death in people aged 15–49 years’.
Morentin, B, Ballesteros, J, Callado, LF & Meana, JJ 2014, 'Recent cocaine use is a significant risk factor for sudden cardiovascular death in 15–49-year-old subjects: a forensic case–control study’, Addiction, vol. 109, no. 12, pp. 2071-8.
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Australian Institute of Health & Welfare 2014, Fetal alcohol spectrum disorders: strategies to address information gaps, cat. no. PER 67, Australian Institute of Health & Welfare, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129549095.
Australian Institute of Health and Welfare 2014, National Drug Strategy Household Survey detailed report 2013, Drug Statistics Series no. 28, cat. no. PHE 183, Australian Institute of Health and Welfare, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129549469.
---- 2014, National Drug Strategy Household Survey detailed report 2013: supplementary tables, Australian Institute of Health and Welfare, Canberra, http://www.aihw.gov.au/publication-detail/?id=60129549469&tab=3.
Lee, NK, Cameron, J, Battams, S & Roche, A 2014, Alcohol education for Australian schools: a review of the evidence, National Centre for Education and Training on Addiction, Adelaide, http://nceta.flinders.edu.au/download_file/view/836/436/.
Teesson, M, Darke, S & Marel, C 2014, Landmark findings on long term outcomes of heroin use and treatment, November 2014, http://connections.edu.au/researchfocus/landmark-findings-long-term-outcomes-heroin-use-and-treatment.
United Kingdom, Home Office and The Rt Hon Lynne Featherstone MP 2014, Drugs: international comparators, Home Office, London, https://www.gov.uk/government/publications/drugs-international-comparators.
Wan, W-Y, Weatherburn, D, Wardlaw, G, Sarafidis, V & Sara, G 2014, Supply-side reduction policy and drug-related harm, NSW Bureau of Crime Statistics and Research, Sydney, http://www.bocsar.nsw.gov.au/agdbasev7wr/bocsar/documents/pdf/20141127_supplycontrol.pdf (3.1 MB).
World Health Organization 2014, Community management of opioid overdose, World Health Organization, Geneva, open access http://www.who.int/substance_abuse/publications/management_opioid_overdose/en/.
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