Search

The obituary of Dr. James Rankin highlights his significant contributions to the field of alcohol and other drugs over a career spanning 60+ years. Dr. Rankin's work focused on developing effective prevention and treatment services for individuals with alcohol and drug problems. His pioneering efforts included establishing the first clinic for alcohol-related problems in a large public hospital in Australia, conducting research, and advocating for evidence-based policies. Dr. Rankin's impact extended beyond Australia, as he also held key positions in Canada, contributing to clinical services, research, and policy development in the field. His legacy is honored through various awards, orations, and services named in his honor. [Extracted from the article]

In Australia, nicotine vaping products are regulated as prescription‐only medicines which can only be sold from a pharmacy, with the aim of preventing youth access and allowing use by adult smokers with a doctor's support. The Therapeutic Goods Administration has acknowledged that this policy has not achieved its goals. Instead, a thriving black market has developed which sells unregulated vape products to children and adults. Very few adult vapers use the legal prescription pathway. Regulation should find the optimal balance between facilitating legal access for adult smokers while restricting access by youth. The preferred approach is a tightly regulated consumer model with nicotine vaping products sold by licenced retail outlets with strict age‐of‐sale verification. Regulations should be proportionate to risk and reflect the lower harms of vaping relative to smoking. A consumer model would bring Australia into line with other Western countries and improve population health. [ABSTRACT FROM AUTHOR]

MISCOMMUNICATION OF EVALI RISK BY HEALTH AUTHORITIES Some of the information from Australian governments about EVALI has been inaccurate and misleading. Nicotine vaping was not the cause of e-cigarette, or vaping, product use-associated lung injury in the United States In January 2020, the US Centers for Disease Control and Prevention (CDC) concluded that EVALI was strongly linked to vitamin E acetate [[12]]. EVALI (E-cigarette, or Vaping, product use-Associated Lung Injury) was an outbreak of severe and sometimes fatal lung injury in North America between mid-2019 and early 2020 [[1]]. [Extracted from the article]

The Australian Department of Health recently funded a review of vaping by Banks and colleagues that aimed to examine the 'contemporary evidence on the health outcomes of nicotine and non-nicotine e-cigarette use' and integrate this with "systematic reviews on smoking uptake and cessation" to guide the formulation of evidence-based policy and practice [1]. These have evaluated the net effects under a wide range of assumptions about rates of uptake among non-smokers, cessation rates and reduction in harm compared to smoking. 52 Summers JA, Ait Ouakrim D, Wilson N, Blakely T. Updated health and cost impacts of electronic nicotine delivery systems, using recent estimates of relative harm for vaping compared to smoking. The net effect is a function of the harm differential between vaping and smoking, its effectiveness as a cessation aid and uptake by smokers and non-smokers. [Extracted from the article]

Keywords: vaping; youth EN vaping youth 1301 1302 2 07/10/23 20230701 NES 230701 We thank Gartner [[1]] and Bullen et al. [[2]] for their thoughtful reflections on our commentary [[3]]. The New Zealand approach to NVP regulation has achieved a good balance between delivering benefits to adult smokers and restricting vaping uptake by youth. [Extracted from the article]

Issue. The prevalence of smoking among prisoners is exceptionally high and is often comorbid with alcohol and drug problems, mental illness and other health problems. This review paper summarises the literature and available research related to smoking prevalence and smoking cessation initiatives among prisoners and identifies areas of need for further research and intervention. Approach. This paper highlights three studies conducted in the New South Wales prison system which attempt to address these high rates of smoking including a feasibility study, a focus group study and a randomised controlled trial. Key Findings. The challenges of making systems-level changes to address these high rates of smoking are discussed including a recent National Summit on Tobacco Smoking in Prisons. Implications. Dissemination of research findings has assisted in highlighting the importance of tobacco smoking among prisoners and the need to develop culturally and setting appropriate smoking cessation initiatives for prisoners. Conclusions. As one of the most marginalised and socially disadvantaged populations in Australia, prisoners represent an important population to target for smoking cessation programs and interventions. This paper highlights a number of initiatives undertaken to address this problem and suggests directions for the future.[Richmond RL, Butler TG, Indig D, Wilhelm KA, Archer VA, Wodak AD. The challenges of reducing tobacco use among prisoners. Drug Alcohol Rev 2012;31:625-630] [ABSTRACT FROM AUTHOR]

Issues. Consumption of prescription opioid analgesics (POAs) in Australia has increased steadily in recent years, raising concerns of increasing harms including overdose and dependence, as has occurred in the USA. Approach. Exposition of the Royal Australasian College of Physicians Prescription Opioid Policy with reference to the published literature, drawing out principles for harm reduction for psychoactive pharmaceutical drugs. Key Findings. Complex professional, patient, regulatory and market factors influence health professionals balancing the benefits and harms of POAs. Owing to the potential for diversion, overlapping markets probably exist for pharmaceutical opioids used for populations with cancer pain, chronic non-cancer pain, and people dependent on pharmaceutical and illicit opioids (including those needing opioid substitution treatment). Attempts to reduce or restrict supply in one area may increase demand in others. There is a need to consider new harm reduction strategies for people with problematic pharmaceutical opioid use. These people are demographically not well characterised, and may be distinct from the more familiar population of injection drug users. Implications. Harm reduction is a valid approach for POAs. However, the role of health professionals as gatekeepers of opioid supply, the need to optimise health benefits of POAs, and the likely interplay of complex market forces among populations consuming opioids have no close parallel in harm reduction for other substances. This poses fundamentally different challenges. Conclusions. Reducing inappropriate supply and demand for POAs while maximising their benefits and minimising their harms may improve health outcomes.[Hallinan R, Osborn M, Cohen M, Dobbin M, Wodak A. Increasing the benefits and reducing the harms of prescription opioid analgesics. Drug Alcohol Rev 2011;30:315-323] [ABSTRACT FROM AUTHOR]

Introduction and Aims. In an era of health care rationalisation, residential detoxification services catering for drug- and alcohol-dependent homeless people are being closed. The principal findings of a recent evaluation of a non-medicated residential detoxification service are presented. The aims were to describe the characteristics of residents, their experience of admission, rates of withdrawal completion, referral patterns, staff and key informant perceptions of the service and its role within the wider treatment system. Design and Methods. A process evaluation was utilised incorporating interviews with residents (n = 80) and key informants (n = 13); a survey of all service staff (n = 10); and demographic and clinical data for all residents (n = 392) admitted over one calendar year. Results. Residents were heavily substance-dependent and marginalised, with many exhibiting substantial mental and physical health impairments. Polydrug use and frequent prior engagement with drug and alcohol services were common. The majority completed withdrawal and were referred to further treatment. Residents who presented for heroin and other opiate withdrawal were more likely than other residents to leave before completing treatment (odds ratio 2.47, 95% confidence interval 1.48 - 4.15). Information from key informants, service staff and residents converged in underscoring the important role performed by the service. Discussion and Conclusion. Out-patient detoxification for homeless and severely drug- and alcohol-dependent populations is unrealistic. For this group, access to residential detoxification is vital as it provides an environment where potentially serious medical and psychological complications can be managed. There continues to be a clear role for supervised withdrawal in such a setting. [Silins E, Sannibale C, Larney S, Wodak A, Mattick R. Residential detoxification: Essential for marginalised, severely alcohol- and drug-dependent individuals. Drug Alcohol Rev 2008;27:414-419] [ABSTRACT FROM AUTHOR]

Introduction and Aims. The study examines risk behaviours of the users of syringe dispensing machines (SDMs) and evaluates the usefulness of these machines in providing injecting drug users (IDUs) with sterile injecting equipment. Design and Methods. Self-administered questionnaires were used among users of SDMs in an Area Health Service of Sydney. Results. The majority of the 167 participants reported being happy with the quality of the SDM services. Problems identified with machines were that they were often broken or jammed (32.8% respondents), not in the right place (21.9%) or require money (16.7%). Just over half (50.9%) of the IDUs use SDMs only from 5 p.m. to 9 a.m., the time when almost all other outlets for accessing sterile injecting equipment remain closed. Relatively young IDUs (age ≤ 30 years) were more likely to prefer SDMs over staffed needle syringe programmes (NSPs) compared with older users (age > 30) and to identify stigma (a desire to hide their identity or not liking the way people treat them at staffed NSPs or chemists) as a main reason for using these machines. Primary users of SDMs do not differ from primary users of NSP/chemists in terms of sharing of needles. Those users who had shared in the last month were nearly four times as likely to have never used condoms in sexual encounters over that period (95% confidence interval: 1.2 - 14.5). Discussion and Conclusion. SDMs appear to complement other outlets of NSPs. Providing free-of-cost equipment from SDMs should be considered carefully, as needing money to buy equipment was a reason given for sharing of needles by 35% of those who shared. [Islam MM, Stern T, Conigrave KM, Wodak A. Client satisfaction and risk behaviours of the users of syringe dispensing machines: a pilot study. Drug Alcohol Rev 2008;27:13 - 19] [ABSTRACT FROM AUTHOR]

The value of hair analysis in measuring treatment outcome was examined in a randomised controlled trial (RCT) of an Australian state prison-based methadone programme between 1997 and 1998 ( n = 382 male prisoners). Hair samples were analysed for morphine using immunoassay techniques. Agreement between hair analysis and self-report was tested using kappa, McNemar's test of symmetry and Pearson's correlation coefficient r. Hair analysis based on immunoassay was inadequate as the primary outcome measure for the RCT but had value in supplementing self-reported heroin use. There was a modest correlation ( r = 0.31, p [ABSTRACT FROM AUTHOR]

Despite evidence of high rates of smoking among prisoners, there has been limited research that describes smoking patterns and risk factors associated with smoking in this group. This study describes inmate smokers and identifies factors associated with smoking in prison, using a survey comprising a cross-sectional random sample of inmates stratified by sex, age and Aboriginality. A total of 914 adult inmates (747 men, 167 women) were recruited from 29 New South Wales (Australia) correctional centres. Information on the prevalence of smoking, smoking history, smoking behaviours and other risk factors were collected. Of the participants, 79% were current smokers (78% men, 83% women). Younger inmates were more likely than older inmates to smoke (86% vs. 64%). Most individuals smoked between 11 and 20 cigarettes a day and a median of 50 grams per week. In the previous year, over half (52%) of current smokers had attempted to quit or reduce the amount they smoked. At the time of the survey, 58% of smokers had plans to quit; 21% within 3 months. Independent predictors of current smoking in the multivariate analysis were past use of cannabis and a history of illicit drug use. The prevalence of smoking in prison is extraordinarily high and exceeds that of the general community. Despite this, the majority of prisoners report plans to quit. Readily available smoking cessation advice, support and treatment are needed to assist those wanting to quit in this stressful environment. As the prevalence of smoking within the general community declines, assisting cessation in groups containing a disproportionate number of smokers will become increasingly important. Despite high levels of tobacco dependence, many prisoners intend to quit and health planners and custodial authorities need to encourage and support inmates who do attempt to quit. [Belcher JM, Butler T, Richmond RL, Wodak AD, Wilhelm K. Smoking and its correlates in an Australian prisoner population. Drug Alcohol Rev 2006;25:343 – 348] [ABSTRACT FROM AUTHOR]

In Australia, the prevalence of smoking is higher among certain sub-populations compared to the general population. These sub-populations include Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, as well as people with mental and substance use disorders and prisoners. The aims of this paper are to: describe the high prevalence of smoking among these particular sub-populations and harms associated with smoking; explore possible reasons for such high prevalence of smoking; review the evidence regarding the efficacy of existing smoking cessation interventions; and make recommendations for smoking interventions and further research among these groups. In addition to low socio-economic status, limited education and other factors, there are social, systems and psychobiological features associated with the high prevalence of smoking in these sub-groups. General population-based approaches to reducing smoking prevalence have been pursued for decades with great success and should be continued with further developments that aim specifically to affect Aboriginal and Torres Strait Islander people and some cultural groups. However, increasing attention, more specific targeting and flexible goals and interventions are also required for these and other distinct sub-populations with high smoking prevalence. Recommendations include: more funding and increased resources to examine the most appropriate education and treatment strategies to promote smoking cessation among people from Aboriginal and Torres Strait Islander and some culturally and linguistically diverse backgrounds; larger and better-designed studies evaluating smoking cessation/reduction interventions among distinct sub-groups; and system-wide interventions requiring strong leadership among clients and staff within mental health, drug and alcohol and prison settings. [Baker A, Ivers RG, Bowman J, Butler T, Kay-Lambkin FJ, Wye P, Walsh RA, Pulver LJ, Richmond R, Belcher J, Wilhelm K, Wodak A. Where there's smoke, there's fire: high prevalence of smoking among some sub-populations and recommendations for intervention . Drug Alcohol Rev 2006;25:85–96] [ABSTRACT FROM AUTHOR]

Drug consumption rooms (DCRs) have operated in Europe for more than 20 years. At the time of this study three Australian jurisdictions were considering trials of DCRs and little information about these services was available in the English literature. We surveyed 39 DCRs in the Netherlands, Germany, Switzerland and Spain in 1999?–?2000 regarding service delivery and perceived public health and amenity impact and 15 (40%) responded. The DCRs surveyed were professionally staffed, low threshold services which provided a range of health, psych-social, drug treatment and welfare services and referrals. No overdose deaths were reported and the estimated rate of non-fatal overdose ranged from 1 to 36 per 10,000 visits. These DCRs appeared to be achieving their service delivery objectives with few negative consequences. [ABSTRACT FROM AUTHOR]

Drug use by injection can cause problems specific to this form of administration. Problems include an increased risk of drug overdose, drug dependence, the transmission of HIV, hepatitis B and hepatitis C and vein damage. Shifting drug injectors from injecting to another route of administration may minimize these problems. The aims of the study were to develop and trial an intervention to assist willing injecting drug users (IDUs) to shift to non-injecting routes of administration (NIROA) and to explore the acceptability and practicality of facilitating NIROA. IDUs were assessed and suitable subjects entered a cognitive behavioural trial consisting of five 1-hour sessions of individual therapy with a registered psychologist. Forty-two subjects were assessed (22 males and 20 females). Thirty subjects entered treatment. The mean age was 36 years. Twenty-one subjects were followed-up at 3 months and 10 subjects at 6 months. At 3 and 6 months, the proportion of subjects who had commenced using NIROA was 30% and 50%, respectively. This pilot study showed that it was possible to assist a minority of drug injectors to move from injecting to the non-injecting administration of drugs. However, many of these appeared to be already motivated to cease using drugs and adopting NIROA was one way of assisting this. Poor follow-up rate, lack of control group, questions about cost-effectiveness and the impact of market factors which possibly constrain shifting to NIROA suggest that further research is needed before it could be said that NIROA should be recommended as a viable harm reduction strategy in the Australian context. [Dolan K, Clement N, Rouen D, Rees V, Shearer J, Wodak A. Can drug injectors be encouraged to adopt non-injecting routes of administration (NIROA) for drugs? Drug Alcohol Rev 2004;23:281-286]

At the commencement of the third millenium, the illicit use of amphetamines continues to be a growing problem in many countries around the world, yet treatment responses remain in need of further development. This is particularly true with regards to pharmacotherapy for amphetamine dependence. In this Harm Reduction Digest four authors who bring together considerable research and clinical experience in this area describe the nature of amphetamine-related problems and consider the role of amphetamine agonists in substitution therapy for amphetamine dependence. This is a timely paper which should be of interest to clinicians, researchers and regulators. [ABSTRACT FROM AUTHOR]

This study compares drug use, injecting and sexual risk-taking behaviour among pregnant injecting drug users (IDUs) enrolled in methadone maintenance treatment (MMT), non-pregnant women IDUs enrolled in MMT and women IDUs not enrolled in treatment. There was no significant difference between pregnant IDUs enrolled in MMT and women IDUs not enrolled in treatment in terms of their injecting risk-taking behaviour. Both groups reported significantly higher levels of injecting risk-taking behaviour compared to (non-pregnant) women enrolled in MMT. Pregnant women enrolled in MMT reported a significantly lower methadone dose compared to non-pregnant women in MMT. There was a trend for pregnant women enrolled in MMT to report a higher level of heroin use compared to non-pregnant women in MMT. The lack of evidence for a difference in level of injecting risk-taking behaviour between pregnant IDUs enrolled in MMT and women IDUs not enrolled in treatment suggests the need for additional strategies among pregnant IDUs to reduce IDU and injecting risk-taking behaviour. Possible strategies include maintenance on higher doses of methadone and the application of relapse prevention strategies. [ABSTRACT FROM AUTHOR]

Reports on news developments about drug and alcohol use in several countries as of September 2000. Launch of the 'National Alcohol Indicators Bulletin' by the National Drug Research Institute and Turning Point Foundation; Official drug policy of the Channel Islands; Differences between legal and illegal drugs.

One hundred and eighty-one inmates in AIDS education courses were surveyed about their risk behaviour and access to disinfectants for syringe cleaning in 1993. Overall, 40% of respondents reported HIV risk behaviour in prison. One-quarter of respondents reported injecting, of whom three-quarters reported sharing syringes in prison. Most respondents who shared syringes reported cleaning them with disinfectants (96%), even though only one-third reported having easy access to disinfectants. One-sixth of respondents reported sharing tattooing equipment, of whom two-thirds reported using a disinfectant to clean the tattoo needle. Few respondents reported fellatio (8%) or anal intercourse (4%) in prison. Although some respondents faced difficulty in obtaining disinfectants, almost all respondents cleaned syringes with bleach when sharing. High levels of risk behaviour in prison might be reduced by methadone maintenance and condom programmes. A trial of strict one-for-one syringe exchange warrants consideration. [ABSTRACT FROM AUTHOR]

Reports global developments of drug abuse. Announcement of Ansett Airlines on their plans of installing special disposal bins for used needles and syringes on the aircraft; Protest march of the cocaleros of Bolivia against illegal coca growing in the country; Seizure of heroin off the coast of northern South Wales.

Focuses on the cannabis policy in Australia. Annual turnover of the cannabis industry; Increase in the consumption of cannabis in the country; Health consequences of cannabis.

Editorial. Comments on various studies about the effectiveness of rapid detoxification and naltrexone for opioid dependence in Australia. Methods to ensure the benefits of naltrexone treatment; Issues on the ethics of naltrexone implants; Role of naltrexone implants in the treatment of opioid dependence.