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Yearly adult per capita consumption of alcohol in China between 2016 and 2019 decreased by 2.4 L of pure alcohol, or 33%. According to the World Health Organization, this decrease in consumption was accompanied by reductions in alcohol-attributable mortality of 23% between 2015 and 2019. This paper examines the contribution of alcohol control policies in China to these public health gains. A systematic search of the literature was conducted on alcohol control policies and their effectiveness in China as part of a larger search of all countries in WHO Western Pacific Region. In addition to articles on empirical evidence on the impact of such alcohol control policies, we also searched for reviews. The plausibility of changes of traditional alcohol control policies (taxation increases, availability restrictions, restriction on advertisement and marketing, drink-driving laws, screening and brief interventions) in explaining reductions of consumption levels and attributable mortality rates was explored. There was some progress in the successful implementation of strict drink-driving policies, which could explain reductions in traffic injuries, including fatalities. Other traditional alcohol control policies seem to have played a minimal role in reducing alcohol consumption and attributable harms during the time period 2016–2019. However, an anti-corruption campaign was extensive enough to have substantially contributed to these reductions. The campaign prohibited the consumption of alcoholic beverages in everyday life of government officials and thus contributed to a de-normalization of alcohol. While this anti-corruption campaign was the only policy to potentially explain marked decreases in levels of alcohol consumption and attributable mortality, more detailed research is required to determine exactly how the campaign achieved these decreases. • China had decreases of alcohol consumption and attributable mortality since 2016. • Cardiovascular and digestive diseases were the main causes of death responsible. • None of the classic alcohol control policies seem to be able to explain these decreases. • Economic explanations also fail to explain the changes. • A massive anti-corruption campaign denormalized alcohol use and offers a likely explanation. [ABSTRACT FROM AUTHOR]

Acute alcohol intoxication is a contributing factor in firearm-involved suicides. However, knowledge of the relationship between alcohol intoxication and firearm-involved suicide by age and sex (defined herein as the biological sex of the decedent) is limited. The purpose of the current study was to evaluate the sex- and age group-specific relationship between alcohol intoxication and firearm-involved suicide. Data from the National Violent Death Reporting System, 2003–2020, on suicide decedents (18+ years of age) were utilized. Age-group- and sex-specific multivariate binary logistic regression analyses were conducted. Statistical analyses were performed in 2023. Alcohol intoxication (i.e., having a blood alcohol concentration of 0.08 g/dL or more) was significantly associated with using a firearm as the method of suicide for young (18–34 years; relative risk (RR)=1.31, 95% CI: 1.22–1.40) and middle-aged (35–64 years; RR=1.34, 95% CI: 1.27–1.39) females but not among older females (65+ years; RR=1.01, 95% CI: 0.87–1.17). Among males, the association was significant for all age-groups (young: RR=1.28, 95% CI: 1.25–1.30; middle-aged: RR=1.17, 95% CI: 1.15–1.19; and older: RR=1.04, 95% CI: 1.01–1.07). Among males of all ages and young and middle-aged females, alcohol intoxication was associated with increased risk of suicide by firearm—an extremely lethal method that accounts for a majority of suicides in the U.S.—compared to their non-intoxicated counterparts. Interventions targeting excessive alcohol consumption may be effective in reducing suicide mortality rates. [ABSTRACT FROM AUTHOR]

Most epidemiological research on alcohol as a risk factor is based on the assumption that outcomes are linked to pattern and level of alcohol exposure, where different beverages are converted into grams of ethanol. This review examines this basic assumption, that alcohol has the same impact, independent of beverage type. We conducted a systematic search on comparative research of beverage-specific alcohol exposure and consequences. Research was divided by methodology (survey, case-control, cohort, time-series analyses, interventional research). Overall, many studies showed higher risks for spirits compared to beer or wine; however, most research was not controlled adequately for confounders such as patterns of drinking. While there is no conclusive evidence for spirits being associated with more harm, given the same pattern and level of alcohol exposure, some evidence supports for certain outcomes such as injuries and poisonings, a potential excess risk with spirits consumption due to rapid ethanol intake and intoxication. Accordingly, encouraging people to opt for beverages with lower alcohol content via taxation strategies has the potential to reduce alcohol-attributable harm. This does not necessarily involve switching beverage type, but also can achieved within the same beverage category, by shifting from higher to lower concentration beverages. [ABSTRACT FROM AUTHOR]

Cannabis policies are changing globally, and medical marijuana programs are part of these changes. Drawing from the examples of two high-income (Canada, an early adopter of medical marijuana, and Germany, a late adopter) and one middle-income (Thailand) countries, we illustrate two main pressures underlying these recent changes. First, in many high-income countries, cannabis has been used to self-medicate for different ailments and diseases, even though there is no evidence of effectiveness for many of these conditions. Second, the cannabis industry is pressuring governments and decision-makers to allow for medical marijuana use with lenient regulations-without specifying medical conditions (indications) and requiring only a prescription from a health professional to obtain it. As a result, demand is likely to increase, even in countries with low prevalence of use. Cannabis policy-makers need to consider a balance between the medical benefits of medical marijuana and the potential public health consequences and cost. [ABSTRACT FROM AUTHOR]

• There is more psychiatric comorbidity in people with PD who use cannabis. • There are more incident substance use disorders in people with PD who use cannabis. • Rates of incident opioid use disorders are higher among people with PDs who use cannabis. • Cannabis use and PD generally have no interaction. Both personality disorders (PD) and cannabis use are highly comorbid with various psychiatric disorders. While previous research indicates specific interactions between cannabis use and schizotypal PD associated with schizophrenia, research into cannabis use among individuals with other PDs and the development of several additional psychiatric disorders is scarce. We explored the prevalence and incidence of psychiatric disorders among individuals with PDs who use cannabis, and whether individuals with PDs who use cannabis are at increased risk for developing psychiatric disorders compared to cannabis users without a PD. Finally, we examined the interaction effect between cannabis use and personality disorders on comorbid psychiatric disorders. Data from 34,653 participants in waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed. Our findings indicate that individuals with PDs who used cannabis were at increased odds for developing substance use disorders (including opioid use disorder), but not other comorbid psychiatric disorders, at 3-year follow up. No significant interaction effects were generally found between cannabis use and PD. These findings suggest that aside from specific substance use disorders, individuals with PDs are not at an increased risk for developing other psychiatric disorders following cannabis use. [ABSTRACT FROM AUTHOR]

Background: Population-based data regarding the epidemiology of hallucinogen use and co-occurring psychiatric disorders is largely absent from the literature. We aim to present findings on the prevalence, sociodemographic correlates, psychiatric comorbidity, treatment utilization, social support and associated disability of hallucinogen use using nationally representative data.Method: We analyzed data from the National Epidemiologic Study on Alcohol and Related Conditions-III (2011-2012, N = 36,309). We conducted multivariate logistic regression analyses in unadjusted and adjusted models in order to explore the odds of psychiatric disorders and associated disability among hallucinogen users.Results: Prevalence of twelve-month and lifetime hallucinogen use was 0.62% and 9.32%, respectively. Hallucinogen use was found to be significantly associated with mood disorders, anxiety disorders, eating disorders, personality disorders and substance use disorders. Following adjustment, significant associations were retained with several substance use disorders (adjusted odds ratio (AOR) for heroin use disorder = 4.89 (95% CI, 1.90-12.58), personality disorders (AOR = 2.10 (95% CI, 1.81-2.44)), Post-Traumatic Stress Disorder (AOR = 1.86, 95% CI 1.00-3.45) and past suicide attempts (AOR = 1.49, 95% CI 1.21-1.85).Conclusions: Lifetime hallucinogen use in the US is prevalent and highly comorbid with other substance use and psychiatric disorders. Hallucinogen Use Disorder is relatively uncommon, with a low risk of development following exposure to hallucinogens. There are significant associations between hallucinogen use and substance use disorders, personality disorders, PTSD and past suicide attempts. The evolving therapeutic utility of this class of substances requires further assessment of short- and long-term risks of use, before large scale clinical application is pursued. [ABSTRACT FROM AUTHOR]

Background: Consumption of unrecorded alcohol (alcohol that is not taxed and reflected in official statistics, but consumed as a beverage) has been identified as one of the main contributors to alcohol-attributable premature mortality in Russia. The problem was highlighted by a recent a mass poisoning with surrogate alcohol occurred in the Siberian city of Irkutsk.Methods: Based on key publications and legislative documents, a narrative review was undertaken about alcohol-related harm reduction policies in Russia for the period between 2005 and 2017, as well as the impact of these policies on the recorded and unrecorded alcohol consumption and alcohol market.Results: Various policy measures mainly targeting availability and price of recorded and unrecorded alcohol have been introduced since 2005, which generally coincided with the decreases in alcohol-related mortality observed at that time. However, regulations on medicinal and cosmetic products have remained inconsistent providing the foundations for the continued existence of a legal industry of surrogates with broad availability and misuse.Conclusion: The Russian experiences of introducing alcohol policies demonstrate that there are effective measures to reduce unrecorded alcohol consumption and attributable harm. The government's multi-level strategy of alcohol consumption and harm reduction should be pursued stringently and all the possible loop-holes for producers, sellers and distributors of illegal and/or unrecorded alcohol should be eliminated or at least critically reduced. [ABSTRACT FROM AUTHOR]

Background Major Depressive Disorder (MDD) and Bipolar Disorder (BPD) are the most severe mood disorders globally. Previous reports indicate high co-occurrence of cannabis use and cannabis use disorders (CUDs) associated with both disorders, yet studies comparing patterns of cannabis use between individuals with MDD and BPD are scarce. Methods Data were drawn from Wave 1 (2001–2002) of the National Epidemiologic survey on Alcohol and Related Conditions (NESARC). Cannabis users who qualified for a diagnosis of past-year MDD (N = 217) were compared to those with BPD (N = 168) in frequency and daily dose of cannabis use, rates of comorbid psychiatric disorders including specific criteria of CUDs, treatment utilization and suicidality. Results Among past-year cannabis users, individuals with BPD reported using cannabis more frequently and smoking more joints per day compared to those with MDD. They were also more likely to suffer from comorbid personality disorders and qualify for specific CUD-criteria, including use in physically hazardous situations and unsuccessful efforts to control substance use. Conclusions Our results indicate that individuals with BPD may present more intensive patterns of cannabis use compared to those with MDD. This may have potential effects on the course of BPD and should be further explored in longitudinal studies. [ABSTRACT FROM AUTHOR]

Background: Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist.Methods: A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486).Results: Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate.Conclusions: Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions. [ABSTRACT FROM AUTHOR]

Alcohol has a direct toxic impact on the heart, and while there is an ICD code for alcoholic cardiomyopathy, the burden of alcohol-attributable cardiomyopathy is not clear. For the usual estimation of this burden via population-attributable fractions, one would need to determine the risk relationships, i.e., average risk associated with different dimensions of alcohol exposure. The most important among these risk relationships is the dose-response relationship with different levels of average alcohol consumption. To establish risk relationships, we systematically searched for all studies on dose-response relationships, directly and indirectly, via reviews. The results did not permit computation of pooled estimates through meta-analyses. There were clear indications that heavy drinking (≥80 g per day) over several years was linked to high risk of cardiomyopathy, with greater lifetime exposure of alcohol linked to higher risks. Some studies indicated potential effects of patterns of drinking as well. As such, the global quantification of alcohol-attributable cardiomyopathy will have to rely on other methods than those used conventionally. [ABSTRACT FROM AUTHOR]

Cannabis use has been reported to affect the course of various psychiatric disorders, however its effect on the course of major depressive disorder (MDD) is not yet clear. We used data from Wave 1 and Wave 2 of the National Epidemiologic survey on Alcohol and Related Conditions (NESARC). Individuals with baseline MDD (N=2,348) were included in the study. Cannabis users without a Cannabis Use Disorder (CUDs) and individuals with a CUD were compared to nonusers using linear and logistic regression analyses controlling for sociodemographics, psychiatric disorders and substance use disorders at baseline. No differences were found in rates of remission between the groups. Level of cannabis use was associated with significantly more depressive symptoms at follow-up, particularly anhedonia, changes in body weight, insomnia or hypersomnia and psychomotor problems. After adjusting for baseline confounding factors, no associations were found between cannabis use and suicidality, functionality and quality of life. We conclude that many of the associations between cannabis use and a more severe course of MDD do not seem to be attributed to cannabis use itself but to associated sociodemographic and clinical factors. Further longitudinal studies using depression severity indices are required. [ABSTRACT FROM AUTHOR]

The term "harm per litre" has been increasingly used in alcohol research in recent years as a concept and a comparative measure of alcohol-attributable harm in comparisons between environments, circumstances, and patterns of drinking. This essay discusses the origins of the term in connection with analyses in terms of patterns as well as levels of drinking and with concerns about differential harms from drinking different beverage types. Also discussed is the term's current primary usage, in the context of epidemiological concerns about differentially severe harms for poorer persons who drink. It is noted that these same concerns have been discussed, particularly in Britain, using the phrase "alcohol harm paradox". "Harm per litre" was initially most often used in comparisons between rates of alcohol-attributable harm by beverage type. After 2010, the expression was applied more broadly, particularly after its use in various World Health Organization-related discussions and documents. In addition, and especially from 2018 onwards when most of the papers using this term were published, it has been used in comparisons by socioeconomic status at the individual level, and by level of socioeconomic development at the country level. Almost all the findings indicate that people with lower socioeconomic status, and countries with lower average income, e.g., low income and lower-middle income countries, incur considerably higher harm per litre (with harm being expressed in disease burden and mortality) than upper middle-income and high-income countries. "Harm per litre" is a practicable and easy-to-understand concept to compare groups of individuals or countries, and to quantify health inequalities. The next important step will need to be elucidating a better causal understanding of the processes underlying these inequalities, with an emphasis on factors which can be most easily changed by interventions. [ABSTRACT FROM AUTHOR]

Cannabis Policy Framework respond to select issues from Kalant's Commentary (in this issue). [ABSTRACT FROM AUTHOR]

Background: Many population-based alcohol control policies are postulated to work via changes in adult alcohol per capita consumption (APC). However, since APC is usually assessed on a yearly basis, often there are not enough data to conduct interrupted time-series or other controlled analyses. The current dataset, with 21 years of observation from four countries (Estonia, Latvia, Lithuania, and Poland), had sufficient power to test for average effects and potential interactions of the World Health Organization's (WHO) three "best buys" for alcohol control: taxation increases leading to a decrease in affordability; reduced availability (via a decrease in opening hours of at least 20 %); and advertising and marketing restrictions. We postulated that the former two would have immediate effects, while the latter would have mid- to long-term effects.Methods: Linear regression analysis.Results: Taxation increases and availability reductions in all countries were associated with an average reduction in APC of 0.83 litres (ℓ) of pure alcohol per year (95 % confidence interval: -1.21 ℓ, -0.41 ℓ) in the same year, with no significant differences between countries. Restrictions on advertising and/or marketing had no significant immediate associations with APC (average effect 0.04 ℓ per year; 95 % confidence interval: -0.65 ℓ, 0.73 ℓ). Several sensitivity analyses corroborated these main results.Conclusions: The WHO "best buy" alcohol control policies of taxation increases and availability restrictions worked as postulated in these four northeastern European Union countries. [ABSTRACT FROM AUTHOR]

Background: National epidemiological surveys have reported increased rates of cannabis use and cannabis use disorders (CUDs) among individuals with mental illness. However, this subject has not been sufficiently investigated, particularly given limitations in diagnostic tools used and lack of data pertaining to frequency of cannabis used. Objectives: To examine the prevalence of cannabis use and CUDs among individuals with a wide range of mental illness. Method: We analyzed data on 43,070 respondents age 18 and above from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey conducted from 2001 to 2002. Main outcome measures included rates of cannabis use by frequency (at least weekly and less than weekly use) and DSM-IV CUDs according to the number and type of axis I and axis II psychiatric diagnoses, assessed by the Alcohol Use Disorders and Associated Disabilities Interview Schedule-IV. We estimated the proportion of cannabis used by individuals with mental illness using reported daily dose and frequency of cannabis used by individuals with and without mental illness. Results: Rates of weekly cannabis use, less than weekly cannabis use and CUDs among individuals with 12-month mental illness were 4.4%, 5.4% and 4.0%, respectively, compared to 0.6%, 1.1% and 0.4%, respectively, among individuals without any 12-month mental illness (P < 0.0001 for all comparisons). The odds ratio for cannabis use among individuals with 12-month mental illness vs. respondents without any mental illness was 2.5, and the odds of having a CUD among individuals with 12-month mental illness were 3.2, after adjusting for sociodemographic variables and additional substance use disorders. Cannabis use and CUDs were particularly associated with bipolar disorder, substance use disorders and specific (anti-social, dependant and histrionic) personality disorders. Persons with a mental illness in the past 12 months represented 72% of all cannabis users and we estimated they consumed 83% of all cannabis consumed by this nationally representative sample. Conclusions: The current study provides further evidence of the strong association between cannabis use and a broad range of primary mental illness. This emphasizes the importance of proper screening for frequent cannabis use and CUDs among individuals with primary mental illness and focusing prevention and treatment efforts on this population. [ABSTRACT FROM AUTHOR]

Summary: Liver diseases contribute markedly to the global burden of mortality and disease. This paper provides an overview from a global perspective of the contribution of alcohol to liver diseases. The Global Burden of Disease study methodology was used to estimate the burden of alcohol-attributable liver cirrhosis and alcohol-attributable liver cancer in 2010 as measured by deaths and disability adjusted life years (DALYs). This methodology estimates attributable fractions based on alcohol exposure distribution and relative risks associated with different levels of drinking. Globally, in 2010, alcohol-attributable liver cirrhosis was responsible for 493,300 deaths (156,900 female deaths and 336,400 male deaths) and 14,544,000 DALYs (4,112,000 DALYs for women and 10,432,000 DALYs for men), representing 0.9% (0.7% for women and 1.2% for men) of all global deaths and 0.6% (0.4% for women and 0.8% for men) of all global DALYs, and 47.9% of all liver cirrhosis deaths (46.5% for women and 48.5% for men) and 46.9% of all liver cirrhosis DALYs (44.5% for women and 47.9% for men). Alcohol-attributable liver cancer was responsible for 80,600 deaths (14,800 female deaths and 65,900 male deaths) and 2,142,000 DALYs (335,000 DALYs for women and 1,807,000 DALYs for men). The burden of alcohol-attributable liver cirrhosis and liver cancer is high and entirely preventable. Interventions to reduce alcohol consumption are recommended as a population health priority and may range from taxation increases for alcoholic beverages to increases in screening and treatment rates for alcohol use disorders. [ABSTRACT FROM AUTHOR]

Abstract: Nonmedical prescription opioid use (NMPOU) has become a substantial public health concern in North America. Existing epidemiological data suggest an association between NMPOU and mental health or pain symptoms in different populations, although these correlations are not systematically assessed. To address this gap, a systematic search, review, and meta-analysis were completed separately for both mental health problem symptoms and pain in general population samples reporting NMPOU. Overall, 9 unique epidemiological studies were identified and included in the review. The pooled prevalence of any mental health symptoms in general population samples reporting NMPOU was 32% (95% confidence interval [CI]: 24–40). Specifically, the pooled prevalence of depression was 17% (95% CI: 14–19) and the prevalence of anxiety in general population samples of NMPOU was 16% (95% CI: 1–30) The pooled prevalence of pain in the population of interest was found to be 48% (95% CI: 37–59). This systematic review found evidence for disproportionately high prevalence levels of mental health problems and pain among general population samples reporting NMPOU. While the data reviewed cannot interpret dynamics of potential causality, these findings have implications for interventions for NMPOU, as well as medical practice involving prescription opioids. Perspective: This systematic review and meta-analysis found evidence for disproportionately elevated rates of select mental health and pain problems in epidemiological studies based on general population samples reporting NMPOU. While causality cannot be established, these comorbidities may influence NMPOU behavior and hence ought to be considered in preventive and treatment interventions. [Copyright &y& Elsevier]

Abstract: Background: Alcohol causes a considerable criminal burden on the Canadian society. The purpose of this study is to estimate the avoidable burden and avoidable costs of alcohol-attributable criminality in Canada for the year 2002. Methods: The impact of the following six alcohol policy interventions relative to baseline costs obtained from the Second Canadian Cost Study (a cost-of-illness study) were modelled: taxation increases, lowering the blood alcohol concentration (BAC) legal limit from 0.08% to 0.05%, zero BAC restriction for all drivers under the age of 21, increasing the minimum legal drinking age (MLDA) from 19 to 21 years, a Safer Bars intervention, and brief interventions. In addition to the six interventions that reduce alcohol consumption, we also modelled one intervention that could increase alcohol consumption and alcohol-attributable costs: the change from a government monopoly to privatized alcohol sales. The effect of these interventions was modelled for the Canadian population older than 15 years of age with the exception of BAC restriction and MLDA, which were modelled for the age group 19–21. Results: Results revealed that the intervention which appears to be most effective in preventing drinking and driving incidents in Canada was lowering the BAC level. This intervention was estimated to reduce this type of alcohol-attributable crime compared with the baseline scenario by 19.1%. The Safer Bars programme was found to be the most effective measure to avoid homicide and other violent crimes (reductions of 3.4% were observed). Brief interventions were observed as the most effective measure to avoid other alcohol-attributable criminal activities, estimated at reducing them by 2.6%. The results also indicated that substantial increases in all types of criminality examined in this study could occur if all Canadian provinces were to privatize alcohol sales. Conclusion: This study demonstrates that the implementation of proven effective population-based interventions can reduce alcohol-attributable criminal burden and its costs to the Canadian society to a considerable degree. [Copyright &y& Elsevier]

Abstract: There is a lack of knowledge regarding the composition, production, distribution, and consumption of artisanal alcohol, particularly in the developing world. In Nahualá, an indigenous Mayan municipality located in highland Guatemala, heavy alcohol consumption appears to have had a significant negative impact on health, a major role in cases of violence and domestic abuse, and a link to street habitation. Cuxa, an artisanally, as well as commercially produced sugarcane alcohol, is widely consumed by heavy drinkers in this community. Cuxa samples from all distribution points in the community were obtained and chemically analyzed for health-relevant constituents and contaminants including methanol, acetaldehyde, higher alcohols, and metals. From those, only acetaldehyde was confirmed to be present in unusually high levels (up to 126g/hl of pure alcohol), particularly in samples that were produced clandestinely. Acetaldehyde has been evaluated as “possibly carcinogenic” and has also been identified as having significant human exposure in a recent risk assessment. This study explores the reasons for the elevated levels of acetaldehyde, through both sampling and analyses of raw and intermediary products of cuxa production, as well as interviews from producers of the clandestine alcohol. For further insight, we experimentally produced this alcohol in our laboratory, based on the directions provided by the producers, as well as materials from the town itself. Based on these data, the origin of the acetaldehyde contamination appears to be due to chemical changes induced during processing, with the major causative factors consisting of poor hygiene, aerobic working conditions, and inadequate yeast strains, compounded by flawed distillation methodology that neglects separation of the first fractions of the distillate. These results indicate a preventable public health concern for consumers, which can be overcome through education about good manufacturing practices, as well as financial incentives to separate the acetaldehyde-rich fractions during distillation. [Copyright &y& Elsevier]

Abstract: Background: The objective of this paper is to empirically determine a categorization of illegal opioid users in Canada in order to describe and analyze drug use patterns within this population. Methods: Drug use patterns of 679 eligible illegal opioid users outside treatment from the OPICAN study, a pan-Canadian cohort (recruited March to December, 2002) involving the cities of Toronto, Montreal, Vancouver, Edmonton and Quebec City, were empirically examined using latent class analysis. These latent classes were then further analyzed for associations using chi-square and t-test statistics. Findings: The opioid and other drug user sample surveyed were categorized into three latent classes. Class 1 (N =256) was characterized by the use of Tylenol 3 and benzodiazepines along with high levels of depression and self-reported pain. Class 2 (N =68) was described by the non-injection use of both heroin and crack while having a high level of homelessness. Class 3 (N =344) was shown to consist of injection drug users of heroin and cocaine exhibiting the highest levels of HIV and Hepatitis C infections amongst the classes. Conclusions: Using latent class analysis we found distinct patterns of drug use amongst illegal opioid users differing in terms of type of drugs co-used, social context, and co-morbid pathologies. These data may be useful as the empirical basis for the planning of specific prevention and treatment interventions. [Copyright &y& Elsevier]

Abstract: Background: Alcohol and tobacco are responsible for a significant amount of burden of disease, but some diseases may be a result of the interaction between these two risk factors. Methods: Systematic literature review identified articles on the interaction of alcohol and smoking on a number of outcomes related to both risk behaviours. Results: The interaction of smoking and alcohol significantly increases risk for aerodigestive cancers, and may increase risk for traffic injury and fire injury, but there were very few quality studies on injury. The indication that the cardioprotective effect of alcohol on coronary heart disease is only valid for smokers, but this result is inconclusive because of small evidence base. Conclusions: The interaction between smoking and alcohol consumption seems to be responsible for a significant amount of disease. Unfortunately, little is known on the mechanisms and details of this interaction on disease outcomes. Future studies, especially for coronary heart disease and injury outcomes, are warranted. [Copyright &y& Elsevier]

Abstract: Background:: A major goal of heroin-assisted treatment in Switzerland has been to reduce the drug-related mortality of heroin users. Therefore, a continuous monitoring of deaths under treatment is essential. Aims:: To assess mortality of participants in heroin-assisted treatment in Switzerland over a 7-year period from 1994 to 2000, and to compare this mortality to the general population and to other populations of opioid users, as reported in the literature. Method:: Estimation of person years under heroin-assisted treatment from the complete case registry of heroin-assisted treatment in Switzerland. Estimation of standardized mortality ratios comparing the population in treatment to the Swiss population (standardized to the year 2000). Results:: Over the 7-year period, the crude death rate of patients in heroin-assisted treatment, and including one month after discharge from treatment, was 1% per year. The standardized mortality ratio for the entire observation period was 9.7 (95% C.I. 7.3–12.8), with females having higher standardized mortality ratios (SMR 17.2) than males (SMR 8.4). There was no clear time trend. Conclusion:: Mortality in heroin-assisted treatment was low compared to the mortality rate of Swiss opioid users 1990s (estimated to be between 2.5 and 3%). It was also low compared to mortality rates of opioid users in other maintenance treatments in other countries as reported in the literature. The SMR was also lower than that reported in the only meta-analysis in the literature: 13.2 (95% C.I. 12.3–14.1). The low mortality rate is all the more noteworthy as heroin-assisted treatment in Switzerland included only refractory opioid addicts with existing severe somatic and/or mental problems. Declaration of interest:: No conflicts of interest declared [Copyright &y& Elsevier]

Abstract: Based on a systematic literature search and an expert survey, publications after 1990 on prevalence of alcohol use disorders (AUD) in EU countries and Norway were reviewed. The search was restricted to studies using the DSM-IIIR or DSM-IV, or ICD-10, plus validated instruments to assess AUD. Using only representative general population surveys, the weighted median estimates for 12-month prevalence rates for dependence alone are 6.1% for males (arithmetic mean 5.0%; interquartile range 0.4% to 7.5%) and 1.1% for females (arithmetic mean 1.4%; interquartile range 0.1% to 2.1%). Results thus showed, that AUD constitute a high burden of disease in Europe, but there was high variability of prevalence. Men have higher prevalence rates of AUD than women. No clear pictures emerged with respect to age and AUD prevalence, or with respect to urban vs. rural and AUD prevalence. The discussion highlights potential explanations for the high variability of prevalence between countries, and the fact, that AUD constitute only a small part of all alcohol-related harm. [Copyright &y& Elsevier]

Abstract: Objective: To estimate the prevalence of drug use disorders in the European Union and Norway. Method: Based on a systematic literature search and an expert survey, publications after 1990 on prevalence of drug use disorders (DUD, defined as drug dependence and drug abuse or harmful use) in EU countries and Norway were reviewed. The search included both direct estimations based on general population surveys using the DSM-IIIR, DSM-IV, or ICD-10 definitions of DUD; and indirect estimates based on other epidemiological methods, such as multiplier procedures based on treatment or legal data and capture–recapture techniques. The indirect methods did not use diagnostic criteria, but criteria based on duration and pattern of use, labelled as problematic drug use as a meaningful approximation. Results: The majority of DUD as estimated from direct methods using general population surveys were cannabis use disorders, usually not included in indirect estimates. The prevalence of thus defined disorders can be as high as 3%. For disorders other than cannabis use disorders (i.e. opioid, cocaine and amphetamine use disorders), indirect estimates of prevalence were consistently higher than those based on direct estimates, and ranged between 0.3% and 0.9% in European Union countries and Norway. Men have higher prevalence rates of DUD than women, but the difference was much less pronounced in general population surveys. Younger age (18–25 years) is the age group with the highest estimates. Conclusion: General population surveys typically result in a serious underestimation of the prevalence of DUD other than cannabis use disorders, because many people with DUD are not reached by these surveys (hidden populations). Based on the more valid indirect estimates, it is concluded that problem drug use constitutes a relatively high burden of disease and social problems in Europe. [Copyright &y& Elsevier]

Background: The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise taxes has been that doing so could potentially result in an increase in unrecorded consumption. This contribution examines whether increases in taxation have in fact led to increases in consumption of unrecorded alcohol, and whether these increases in unrecorded alcohol should be considered to be a barrier to raising taxes. A second aim is to outline mitigation strategies to reduce unrecorded alcohol use.Methods: Narrative review of primary and secondary research, namely case studies and narrative and systematic reviews on unrecorded alcohol use worldwide.Results: Unrecorded alcohol consumption did not automatically increase with increases in taxation and subsequent price increases of registered commercial alcohol. Instead, the level of unrecorded consumption depended on: a) the availability and type of unrecorded alcohol; b) whether such consumption was non-stigmatized; c) the primary population groups which consumed unrecorded alcohol before the policy change; and d) the policy measures taken. Mitigation strategies are outlined.Conclusions: Potential increases in the level of unrecorded alcohol consumption should be considered in the planning and implementation of substantial increases in alcohol taxation. However, unrecorded consumption should not be considered to be a principal barrier to implementing tax interventions, as evidence does not indicate an increase in consumption if mitigation measures are put in place by governments. [ABSTRACT FROM AUTHOR]

Background: In the 1920s, eight of nine Canadian provinces legalized alcohol sales, ending prohibition in favor of government control. Much has been written about the rise and fall of Prohibition in North America, but there is little work examining these events in the light of current drug policy debates. This paper attempts to fill some of these gaps.Methods: The aims of this paper are primarily exploratory and descriptive. Following a literature review, it draws from secondary and some primary sources to explore the debate around ending alcohol prohibition (i.e. legalizing its distribution) in Ontario between 1920 and 1927. It then uses material drawn from a comprehensive search of the Canadian House of Commons debates on cannabis legalization between 2016 and 2018 to draw parallels with the debates around alcohol legalization in Ontario about 90 years earlier.Results: While alcohol and cannabis legalization occurred in very different social and political contexts, there are similarities in both the arguments in favor of ending prohibition (ineffectiveness at preventing consumption and collateral social harms) and post-legalization debates around regulation (most notably the optimal way to replace the illicit market).Conclusion: The Canadian cannabis legalization debates of the 2010s echo the alcohol legalization debates of the 1920s in remarkable and relevant ways. Ultimately the most striking parallel may be the extent to which the political leaders advocating for legalization emphasized that their policy was not liberalization, but more effective control. [ABSTRACT FROM AUTHOR]

Thailand enacted its first-ever alcohol control law in February of 2008. The process, from its inception to enactment, took a total of two years and eight months. Using an historical analysis approach, the authors describe the policy advocates' activities aimed at gaining acceptance for the alcohol control policy, and provide advice for policy advocates attempting to pass similar laws in other countries. The advocacy process went through three distinct stages: an agenda-setting stage, followed by a policy-formulation stage and a legitimization stage. The agenda-setting stage involved educating the public about the harmful use of alcohol and its effect on society; during the second stage, an appropriate policy response was drafted and, lastly, during the legitimization phase, policy advocates navigated the political landscape in order to win final approval for the proposed policy. A tri-party coalition strategy (known as the 'triangle that moves the mountain' strategy) was employed which synchronized the work of three forces, each representing one of the three points of a triangle-of policy, knowledge, and civic expertise-coupled with media advocacy activities in order to increase the public and government acceptance of the proposed law. The public's view of the proposed law was critical to influence politicians to favour its adoption. While the knowledge and civic forces play a larger role during the agenda-setting and policy-formulation stages, the policy force was more active during the legitimization stage. Lastly, having a funding agency in place, such as Thai Health in this example, to provide a sustained source of funds for health promotion initiatives was critically important for policy advocates. Economic growth is an important determinant of increased consumption of alcohol per capita, and Thailand's experience of passing its first alcohol control law may serve as a useful guide for other low- or middle-income countries wishing to put a national alcohol control law in place. [ABSTRACT FROM AUTHOR]

In 2016, alcohol consumption was one of the leading risk factors for cancer development and cancer death globally, causing an estimated 376 200 cancer deaths, representing 4.2% of all cancer deaths, and 10.3 million cancer disability-adjusted life years lost, representing 4.2% of all cancer disability-adjusted life years lost. The impact of alcohol consumption on cancer in 2016 varied by age group; the proportion of cancer deaths attributable to alcohol consumption ranged from 13.9% of cancer deaths among people aged 30–34 years to 2.7% of cancer deaths among people aged 80–84 years. The burden of cancers caused by alcohol consumption might be decreased through (i) individual-level and societal-level interventions that reduce alcohol consumption, and (ii) measures that target those risk factors that interact with alcohol consumption to increase the risk of cancer or that directly affect the risk of alcohol-related cancers. [ABSTRACT FROM AUTHOR]

The following viewpoint updates on very recent developments regarding policies for unrecorded surrogate alcohol consumption in Russia. It is outlined how and why the current lack of an appropriate legal framework and poor enforcement of existing measures can potentially increase mortality among the most vulnerable populations of heavy drinkers. [ABSTRACT FROM AUTHOR]

• Less than weekly cannabis use during youth was significantly associated with health service use for mood and anxiety disorders (MADs). • Weekly or more cannabis use was not significantly associated with MAD health service use. • Interaction analyses suggested no effect modification by sex or age (additive or multiplicative). Epidemiologic research suggests a modest association between youth cannabis use and mood and anxiety disorders (MADs). However, current evidence is based mostly on cohort studies using data from the 20th century when cannabis was significantly less potent than today. We linked population-based survey data from 2009 to 2012 with administrative records of health services covered under universal healthcare up to 2017. The cohort included youth aged 12 to 24 years at baseline living in Ontario, Canada with no prior MAD health service use (n = 8,252). We conducted a multivariable Cox model to estimate the association between cannabis use frequency (never,

Background: Numerous interventions aimed at addressing the Canadian 'opioid crisis' have been implemented. However, no empirical estimaes of the number of people with problematic prescription opioid (PO) use exist to inform and guide intervention system needs.Methods: The annual numbers of Canadian adults (≥ 15 years) with PO misuse and/or use disorders ('addiction') were estimated by combining data on the prevalence and associated 95% Confidence Intervals (CIs) of PO use in the Canadian population, obtained from national surveys, with PO misuse and use disorders transition probabilities, obtained from high-quality studies in recent meta-analyses. Uncertainty Intervals (UI) were estimated using Monte Carlo simulations.Results: Population estimates of PO use were highest in 2008, with 5,967,046 (95% CI: 5,635,543-6,326,173) people using POs (representing 21.6% of adults), and lowest in 2015, with 3,941,935 (95% CI: 3,580,842-4,272,937) people using POs (13.1%). Furthermore, PO misuse and use disorders were highest in 2008, with 1,408,223 (95% UI: 878,686-1,951,211; 5.1% of adults) and 525,100 (95% UI 258,288-801,472; 1.9%) people with PO misuse and use disorders respectively. These numbers declined to 930,297 (95% UI: 576,083-1,295,310; 3.1% of adults) and 346,890 (95% UI: 168,310-532,941; 1.2%) people with PO misuse and use disorders, respectively, in 2015.Conclusion: While seemingly declining over-time, the crude population estimates for problematic PO use were high, likely outweighing current intervention capacities. Furthermore, these estimates do not account for the delay of onset and duration of PO misuse and disorders. Thus, more rigorous problem population estimates should be generated to guide interventions. [ABSTRACT FROM AUTHOR]

Background: Though high rates of co-occurring cannabis use and depression are well-documented, data regarding the association between cannabis use and dysthymia is scarce. The aim of this cross-sectional study was to explore clinical correlations of cannabis use among individuals with dysthymia, as well as the changes in the association between cannabis use and dysthymia across six decades of birth cohorts.Methods: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013; N = 36,309). Participants were divided into six birth cohorts (1940s-1990s), based on their decade of birth, and individuals with dysthymia were further categorized by 3 levels of lifetime cannabis use: non-users, non-CUD users, and CUD-users. We compared rates of co-occurring psychiatric and substance use disorders among cannabis users vs non-users and conducted logistic regression analyses in order to determine the odds of dysthymia among cannabis users across six decades.Results: Rates of several psychiatric disorders, such as personality disorders, and substance use disorders were higher among individuals with dysthymia who used cannabis compared to those who did not. The interaction between cannabis use (without a CUD) and birth cohort was associated with a decrease in the odds of dysthymia (OR=0.90, 95% CI 0.84-0.97) and remained significant after controlling for confounding variables. Similar changes over time were not demonstrated for CUD users.Limitations: Likelihood for recall bias and misclassification based on cross-sectional nature of the study and on respondents' self-reports of symptoms throughout their lifetime.Conclusions and Implications: Our study's findings demonstrate that the association between cannabis use (but not CUDs) and dysthymia has weakened over time. These findings highlight the need for further research examining changes over time in the relationship between cannabis use and associated psychiatric disorders. [ABSTRACT FROM AUTHOR]

The objective was to obtain the first ever estimates of the prevalence of binge drinking (defined as four or more standard drinks per occasion) during pregnancy among the general population by country and World Health Organization region. A comprehensive systematic literature search was conducted, followed by country-specific random-effects meta-analyses for those countries with two or more empirical studies. For the remaining countries, the prevalence was predicted via a multilevel fractional response regression model, using country-specific indicators. Regional averages were then estimated. Lastly, the proportion of pregnant women who binge drank during pregnancy out of all women who used any amount of alcohol during pregnancy was estimated for each country. The African Region was estimated to have the highest prevalence of binge drinking during pregnancy, while the Western Pacific Region had the lowest estimated prevalence. The findings indicate that a large portion of pregnancies that are alcohol exposed are being exposed to the most detrimental pattern of drinking – binge drinking. [ABSTRACT FROM AUTHOR]

Background: The level of alcohol consumption and related burden in a country are strongly impacted by the prevalence of abstinence from alcohol use. The objective of this study was to characterize the association of lifetime abstinence from alcohol use with economic wealth (as measured in the gross domestic product [GDP]) and Muslim religion on a country level.Methods: An ecological study was performed using aggregate data of 183 countries for the year 2010. Lifetime abstinence among men and women was predicted using fractional response regression models with the natural logarithm of GDP-PPP (purchasing power parity) and the proportion of Muslim population as predictors. The models were further adjusted by the country's median age and World Health Organization region. Precision of prediction was investigated.Results: Descriptive analyses showed a strong negative association between GDP-PPP and lifetime abstinence in countries without a Muslim majority and a GDP-PPP up to 20,000 international dollars. Regression models confirmed the negative association with GDP-PPP and showed a strong positive association between lifetime abstinence and the proportion of Muslim population. Stratified sensitivity analyses showed that in countries without a Muslim majority only GDP-PPP showed a statistically significant association whereas in Muslim majority countries only the proportion of Muslims was associated with the prevalence of lifetime abstinence.Conclusions: Particularly in countries with a lower GDP and without Muslim majority the prevalence of lifetime abstinence from alcohol use is strongly negatively associated with GDP-PPP. Future research should analyze the accordance in trends of GDP and lifetime abstinence over time. [ABSTRACT FROM AUTHOR]

Alcohol is an important risk factor contributing to the burden of chronic diseases and injuries, but is also associated with some health benefits. This study estimates risks and benefits associated with moderate consumption of alcohol in terms of mortality for Canada in 2002 by age and sex. Distribution of exposure was taken from a Canadian survey and corrected for per capita consumption from production and sales data; risk relationships were taken from published literature to calculate alcohol-attributable fractions for moderate consumption. If moderate consumption is based on average volume alone, 866 net deaths in 2002 among those younger than 70 years of age were due to moderate consumption of alcohol (1.3% of all the deaths in this age group, consisting of 1653 deaths caused and 787 deaths prevented). When heavy drinking episodes were excluded, the net effect was beneficial (55 prevented deaths, 0.09% of all deaths); the net burden was higher for younger ages and the net benefits for older ages. The net impact of average moderate alcohol consumption on mortality depends on patterns of drinking. Beneficial net effects are seen only when heavy drinking occasions are excluded. Policies should strive to reduce the burden of moderate alcohol consumption while preserving the beneficial impacts. [Copyright &y& Elsevier]

Background: There is currently no pharmacological treatment approved for cannabis dependence. In this proof of concept study, we assessed the feasibility/effects of fixed and self-titrated dosages of Sativex (1:1, Δ(9)-tetrahydrocannabinol (THC)/cannabidiol (CBD)) on craving and withdrawal from cannabis among nine community-recruited cannabis-dependent subjects.Methods: Participants underwent an 8-week double-blind placebo-controlled trial (an ABACADAE design), with four smoke as usual conditions (SAU) (A) separated by four cannabis abstinence conditions (B-E), with administration of either self-titrated/fixed doses of placebo or Sativex (up to 108 mg THC/100 mg CBD). The order of medication administration during abstinence conditions was randomized and counterbalanced. Withdrawal symptoms and craving were assessed using the Cannabis Withdrawal Scale (CWS), Marijuana Withdrawal Checklist (MWC) and Marijuana Craving Questionnaire (MCQ). Medication use was assessed during the study by means of self-reports, vial weight control, toxicology and metabolite analysis. Cannabis use was assessed by means of self-reports.Results: High fixed doses of Sativex were well tolerated and significantly reduced cannabis withdrawal during abstinence, but not craving, as compared to placebo. Self-titrated doses were lower and showed limited efficacy as compared to high fixed doses. Participants reported a significantly lower "high" following Sativex or placebo as compared to SAU conditions. Cannabis/medication use along the study, as per self-reports, suggests compliance with the study conditions.Conclusions: The results found in this proof of concept study warrant further systematic exploration of Sativex as a treatment option for cannabis withdrawal and dependence. [ABSTRACT FROM AUTHOR]

The cross-sectional association between cannabis use and anxiety disorders is well documented, yet less is known about the longitudinal association between the two. This study explored the association between cannabis use, cannabis use disorders (CUDs) and anxiety disorders in a 3-year prospective study. Data was drawn from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Anxiety disorders, including generalized anxiety disorder, social anxiety, panic disorder and specific phobias, were controlled for at baseline. Initiation of cannabis use was defined as any cannabis use by former lifetime abstainers in the time period between baseline and follow-up, CUDs were defined as a diagnosis of cannabis abuse or dependence. Results indicate that cannabis use was not associated with increased incidence of any anxiety disorder (Adjusted Odds Ratio (AOR)=1.12(0.63–0.98)). Though heavy cannabis use was associated with increased incidence of social anxiety in most models, this was not fully retained in the final adjusted model (AOR=1.98(0.99–1.98)). Investigation of the association between baseline CUDs and anxiety disorders at follow-up revealed similar results. Any baseline anxiety disorder was not associated with future initiation of cannabis use (AOR=1.03(0.62–1.69)) or onset of a CUD (AOR=0.68(0.41–1.14)), yet individuals with baseline panic disorder were more prone to initiate cannabis use at follow-up (AOR=2.2(1.15–4.18)), possibly as a means of self-medication. Our findings suggest that cannabis use and CUDs are not associated with increased incidence of most anxiety disorders and inversely, most anxiety disorders are not associated with increased incidence of cannabis use or CUDs. [ABSTRACT FROM AUTHOR]

The risks associated with substance use can be framed in many ways. In Canada, the consumption of psychoactive substances has at various times been considered a moral, criminal, or medical issue. In the past decade, substance use has increasingly been framed as a public health issue. This study sought to trace the historical development and evolution of the concept of a public health approach to substance use in Canada through a critical review of the academic literature. Critical review is a method designed to systematically search a body of literature, take stock of its evolution and current state, identify conceptual contributions, and compare schools of thought. Systematic searches were conducted in February and March 2023 in five English-language databases (CINAHL, Medline, PsycInfo, Scopus, Web of Science) and three French-language databases (Cairn.info, Érudit, SDM Repère). Eligible articles were written in English or French by a first author based in Canada, focused primarily on substance use, and published in 2020 or earlier. 64 articles, published between 1896 and 2020, were synthesized. We found that while public health has been used as a framing for substance use in Canada for at least 120 years, what that means and what it implies for public policy has changed over time. During the first several decades covered in this review, we periodically see the emergence of new conceptualizations of the problem of substance use and its framing as a public health issue. For example, between the 1890s and 1980s, the dominant view of alcohol evolves from that of a social problem, to a disease, to a population health issue. In the 1990s we see the last of these paradigmatic shifts. From that point onwards, the dominant conceptualization is one that prioritizes drug policy harms over drug harms; correspondingly, proposed solutions center on harm reduction, regulation, and policy reform. Beginning in the 2000s, we see detailed proposals for a comprehensive public health framework to substance use, with authors setting out to define the premises, objectives, and components of such a framework. Overall we found a gradual convergence towards a potential Canadian model for a public health approach to substance use: a model based on principles including human rights and equity, in which psychoactive substances are neither criminalized nor commercialized, but rather strictly regulated, proportionately to the risks they pose, in a manner that optimizes the health of the population. At present, governments across Canada appear to be moving in the opposite direction: drug policy is leaning further into criminalization for already illicit substances and further into commercialization for legal ones. Treating psychoactive substances as either the objects of criminal law or as harmless commodities are both associated with harm. It is incumbent on the public health sector to demonstrate that there are less harmful alternatives. [ABSTRACT FROM AUTHOR]

Introduction The relationship between the onset of smoking and the onset of depression among adolescents has been well document, but the mechanisms underlying the relationship are unclear. This paper uses an empirical method to assess potential intermediate variables in the pathway between changes in depressive symptoms and cigarette smoking in a longitudinal cohort of adolescents. Methods 837 participants from a cohort in Montreal, Canada who had not smoked and did not have elevated depressive symptoms at baseline were followed for five years from 1999 to 2003. The role of a set of 15 variables previously identified in the literature as potential confounders were systematically evaluated as predictors of exposure and outcome, for attenuation of the association by more than 10%, and for intra-individual change in the variable after onset of exposure. Results The magnitude of the association between smoking and depressive symptoms was fully attenuated after adjustment for all variables included indiscriminately. A concept map was developed detailing the empirical associations between the variables within this data set. Stress, worry about weight, and worry about parents were identified as intermediate variables for both smoking predicting depressive symptoms and depressive symptoms predicting smoking. Cox regressions with appropriate confounders maintained statistical significance. Conclusion Cigarette smoking is associated with higher depressive symptoms prior to and after inclusion of empirical confounders. Inclusion of intermediate variables in multivariable models can lead to the erroneous conclusion that there is no association between smoking and depression. [ABSTRACT FROM AUTHOR]

Background: The association between cannabis use and mood disorders is well documented, yet evidence regarding causality is conflicting. This study explored the association between cannabis use, major depressive disorder (MDD) and bipolar disorder (BPD) in a 3-year prospective study.Methods: Data was drawn from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). MDD and BPD were controlled at baseline and defined as meeting full criteria in the 12 months prior to the follow-up. Initiation of cannabis use was defined as any cannabis used by former lifetime abstainers in the time period between baseline and follow-up.Results: Cannabis use was not significantly associated with increased incidence of MDD (Adjusted Odds Ratio (AOR) for daily use=0.58(0.22-1.51)). Weekly to almost daily cannabis use was associated with increased incidence of BPD ((AOR for weekly to daily use=2.47(1.03-5.92)); daily use was not (AOR=0.52(0.17-1.55)). Baseline MDD was associated with initiation of cannabis use (AOR=1.72(1.1-2.69)). A crude association between baseline BPD and incidence of cannabis use was not maintained in adjusted models (AOR=0.61(0.36-1.04)).Limitations: Lack of information regarding frequency of cannabis use at follow-up and limitations regarding generalization of the results.Conclusions: Our findings do not support a longitudinal association between cannabis use and incidence of MDD. Results regarding the association between cannabis use and incidence of BPD are conflicting and require further investigation. Baseline MDD, but not BPD, may be associated with future initiation of cannabis use. This may have implications for clinical, social and legislative aspects of cannabis use. [ABSTRACT FROM AUTHOR]

Abstract: Background: According to the World Health Organization, the public health impact of illicit alcohol and informally produced alcohol should be reduced. This paper summarizes and evaluates the evidence base about policy and intervention options regarding unrecorded alcohol consumption. Methods: A systematic review of the literature using electronic databases. Results: The literature on unrecorded consumption was sparse with less than 30 articles about policy options, mostly based on observational studies. The most simplistic option to reduce unrecorded consumption would be to lower recorded alcohol prices to remove the economic incentive of buying unrecorded alcohol. However, this may increase the net total alcohol consumption, making it an unappealing public health policy option. Other policy options largely depend on the specific sub-group of unrecorded alcohol. The prohibition of toxic compounds used to denature alcohol (e.g. methanol) can improve health outcomes associated with surrogate alcohol consumption. Cross-border shopping can be reduced by either narrowing the tax differences, or stricter control. Actions limiting illegal trade and counterfeiting include introduction of tax stamps and electronic surveillance systems of alcohol trade. Education campaigns might increase the awareness about the risks associated with illegal alcohol. The most problematic category appears to be the home and small-scale artisanal production, for which the most promising option is to offer financial incentives to the producers for registration and quality control. Conclusion: Even though there are suggestions and theories on how to reduce unrecorded alcohol consumption, there is currently no clear evidence base on the effectiveness or cost effectiveness of available policy options. In addition, the differences in consumption levels, types of unrecorded alcohol, culture and tradition point to different measures in different parts of the world. Thus, the recommendation of a framework for moving forward in decision making currently seems premature. Instead, there is a need for systematic research. [Copyright &y& Elsevier]

Background: Depressive disorders (DD) and alcohol use disorders (AUD) frequently co-occur. They are key to understanding the current increases in "deaths of despair" among individuals with lower socioeconomic status (SES). The aim of this study was to assess the prospective bidirectional associations between AUD and DD, as well as the effect of SES on these two conditions.Methods: The National Epidemiologic Survey on Alcohol and Related Conditions is a cohort study representative of the US adult population, which began in 2001-2002, with follow-up interviews conducted 3 years later. SES was primarily operationalized as educational attainment. AUD, DD, and their levels of severity were defined according to the DSM-5 criteria.Results: The risk of developing an incident DD increased gradually with the recency and the severity of AUD at baseline, but the converse was not observed. Lower SES was an independent risk for incident AUD or DD. SES did not modify the prospective association between AUD and DD.Limitations: The absence of interaction between SES and moderate or severe AUD for the incident DD must be considered with caution due to the limited number of DD cases reported in these AUD categories.Conclusions: This result is consistent with a causal relationship between AUD and DD, and suggests that therapeutic interventions for AUD may also have beneficial effects to lower DD rates. The independent effects of a lower SES and AUD on DD may result in a vulnerable population cumulating disorders with heavy consequences on health and social well-being. [ABSTRACT FROM AUTHOR]

Despite a marked reduction in new cases of cirrhosis caused by HCV infection, over 500,000 new cirrhosis cases in this category were estimated globally in 2019. This contribution quantifies the relationship between alcohol use and the progression of liver disease in people with HCV infections. The causal impact of different levels of alcohol use on cirrhosis has previously been established. The quantification of this relationship was undertaken based on a systematic search of the literature and a meta-analysis. We limited our search to longitudinal and case-control studies with biologically verified outcomes. Different sensitivity analyses were conducted to check on key assumptions and on the generalizability of the relationship. Alcohol use has a dose-dependent relationship with incident cirrhosis, which is linear on the log-linear level, and thus exponential on the level of odds ratios or other risk indicators. Each standard drink of 12 grams of pure alcohol per day increases the risk by about 11%. The results were stable regardless of the statistical model used, level of adjustment, quality of the study, or outcome (i.e. , cirrhosis, decompensated cirrhosis, liver-related death). Alcohol use has a marked impact on the progression of HCV infections to cirrhosis and more severe liver outcomes. Alcohol consumption has a significant impact on the progression of liver disease in people with HCV infections. Each alcoholic drink per day is associated with an increase in the risk of cirrhosis of 11%. [Display omitted] • Alcohol use has a dose-dependent relationship with incident HCV-related cirrhosis. • The risk of liver disease progression rises already at low levels of consumption. • Each alcoholic drink per day increases the risk of cirrhosis by about 11%. [ABSTRACT FROM AUTHOR]