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Background: Australia introduced a prescription only policy for e‐cigarettes in 2011 to prevent uptake among youth while allowing smokers to access e‐cigarettes for cessation. This is one of the restrictive forms of regulation for e‐cigarettes recommended by the World Health Organisation. Aims: To assess whether the policy has prevented e‐cigarette youth uptake and facilitated smokers' access to e‐cigarettes for cessation; and to examine a proposed toughening of the policy. Methods: An analysis of survey and administrative data on e‐cigarette use and smoking and a critical analysis of the contents of submissions to parliamentary inquiries into the policy. Results: E‐cigarette use among youth and young adults has increased steeply since 2016 but very few of these products have been obtained through the prescription system, because medical authorities discourage their use. A policy change in 2021 to increase the prescription of e‐cigarettes has not reduced e‐cigarette use among youth and only marginally increased rates of prescribing. Australian policy makers have nonetheless tightened the prescription system by banning any use of e‐cigarettes unless prescribed by a doctor and dispensed by a pharmacist. Implications: Australia's tightened prescription policy for e‐cigarettes may reduce adolescent vaping but at the risk of reducing smokers' access to e‐cigarettes and increasing the size of the illicit market for combustible cigarettes and e‐cigarettes. A more effective policy would allow vapes to be sold as consumer products by licensed tobacconists under regulations that require prior product approval, plain packaging, bans on their promotion and enforced age restrictions on purchases. [ABSTRACT FROM AUTHOR]

Introduction: Cannabis use is highly prevalent in Australia, yet current survey metrics measure tetrahydrocannabinol (THC) exposure with limited accuracy. Often survey items measure cannabis quantity by assuming specific modes of use (i.e., 'how many joints do you use?'), which fail to capture variations in cannabis use and the diverse modes of use (e.g., joints, cones, spliffs). This study investigated how much cannabis is used in these modes of administration in an Australian sample. Methods: Participants (N = 31, Mage = 25.77; 51% university students) completed the Roll a Joint Paradigm in which they rolled joints, spliffs and packed cones as they would typically, using oregano as 'cannabis.' Participants then prepared each again but with cannabis of higher or lower potency. Results: The amount of cannabis used across different modes of administration was variable: joints (range 0.10–1.25 g), spliffs (range 0.12–1.21 g) and cones (range 0.03–0.41 g). Participants who used cannabis daily rolled three times the amount of cannabis into a joint. Discussion and Conclusions: The amount of cannabis used in common modes of administration may be highly variable. Daily use may be associated using larger quantities of cannabis. Titration attempts based on potency were not proportional or consistent across modes of administration. The results indicate people may adjust the quantity of cannabis based on perceived potency, however, not proportional to THC concentration. Inconsistency in the amount of cannabis used based on potency and within different modes of administration may represent a problem for self‐report metrics which ask participants to report cannabis use in joints. [ABSTRACT FROM AUTHOR]

Aim: To test if there was a reduction in alcohol consumption in wastewater samples in the Northern Territory of Australia after the implementation of a minimum unit alcohol price policy (MUP) in October 2018. Design, setting, cases: Between August 2016 and February 2020, wastewater samples were collected across 66 sites in the Northern Territory and all other states and territories in Australia. Samples were collected every 2 months in capital cities and every 4 months in regional places during this period. Overall, 4917 samples were taken (2816 before MUP and 2101 after). Measurements The number of standard drinks per 1000 people per day in the respective catchment areas was estimated based on the concentration of an alcohol‐specific metabolite, ethyl sulphate in the samples (using the excretion factor of ethyl sulphate, the flow of wastewater entering the wastewater treatment plants and the population of each wastewater catchment). Findings Results from a linear mixed model showed that there was a large drop in alcohol consumption immediately after the MUP in Northern Territory [estimated drop = 1231, 99% confidence interval (CI) = 830, 1633; 38.75%]. There was no significant drop in all other states/territories except for Queensland, which showed a significant but much smaller drop (estimated drop: 310; 99% CI = 114, 550). One year after the MUP, the drop narrowed to 520 (99% CI = 189, 851) and was no longer statistically significant in February 2020 (15 months after MUP; estimated drop = 283, 99% CI = −114, 681). Conclusions: Per‐capita consumption of alcohol appears to have decreased substantially in the Northern Territory of Australia immediately after the implementation of a minimum unit price but consumption steadily recovered and almost returned to the pre‐MUP consumption level after 15 months. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The potential for increased cannabis use by young people after legalisation remains a key concern of opponents of legalisation. This study used survey data to estimate how many young Australians may be prepared to use cannabis if it became legally available. Design and Methods: The study included 3052 youths (adolescents aged 12–17 and young adults aged 18–25 years) in Australia who participated in the 2016 National Drug Strategy Household Survey. Incident cases were estimated by multiplying the prevalence and estimated population sizes from the Australian Bureau of Statistics. Results: It was estimated that 17% of adolescents would try (13%) or use (4%), and 32% of young adults would try (15%) or use (17%) cannabis if it were legal. Among those who reported an intention to try it, 85% of adolescents and 59% of young adults had never used cannabis. These translate to 199 000 and 238 000 potential initiators, respectively. Among those with an intention to use cannabis, 21% of adolescents and 3% of young adults had never used cannabis. These translate to 14 000 adolescents and 12 000 young adults who intended to use cannabis if it were legal. Discussion and Conclusions: A substantial minority of young Australians say that they would use cannabis for the first time if it were legalised. A proportion of young people who have used cannabis also expressed an interest in increasing their use. Both would warrant special attention if cannabis were legalised. [ABSTRACT FROM AUTHOR]

Objective Although depression and chronic pain often coexist, few studies have examined antidepressant use among people with pain. This study examines the prevalence and characteristics associated with antidepressant use among people prescribed opioids for chronic noncancer pain (CNCP). Design Baseline data from a prospective cohort study. Setting Australian community. Subjects A total of 1166 people prescribed opioids for CNCP. Methods Baseline data collection consisted of a self-completed seven-day medication diary and telephone interview to collect information on sociodemographic characteristics and mental/physical health using validated questionnaires. Logistic regression was used to examine characteristics associated with antidepressant use, reporting adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results Of the 1166 participants, 668 (57.3%) were female, and the median (interquartile range) age was 59 (49–68) years. About half the cohort (N = 637, 54.6%) used antidepressants. Of these, 329 (51.7%) reported moderate to severe depression. Amitriptyline was the most commonly used antidepressant (17.3%). Factors independently associated with antidepressant use were being female (AOR = 1.47, 95% CI = 1.13–1.92), more years lived in pain (AOR = 1.01, 95% CI = 1.00–1.02), and use of nonopioid analgesics (AOR = 1.34, 95% CI = 1.01–1.78), benzodiazepines and related drugs (AOR = 1.84, 95% CI = 1.36–2.49), antiepileptics (AOR = 1.86, 95% CI = 1.38–2.51), and antipsychotics (AOR = 2.15, 95% CI = 1.22–3.77). Conclusions Antidepressant use is common among people with CNCP prescribed opioids. Those using antidepressants were more likely to use other psychotropic medicines concurrently, highlighting that they are a high-risk population requiring comprehensive assessment to optimize outcomes and reduce potential harms from polypharmacy. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: Studies have linked adolescent alcohol use with adverse consequences in adulthood, yet it is unclear how strong the associations are and to what extent they may be due to confounding. Our aim was to estimate the strength of association between different patterns of adolescent drinking and longer‐term psychosocial harms taking into account individual, family and peer factors. Design: Participant‐level data were integrated from four long‐running longitudinal studies: Australian Temperament Project, Christchurch Health and Development Study, Mater Hospital and University of Queensland Study of Pregnancy and Victorian Adolescent Health Cohort Study. Setting: Australia and New Zealand. Participants: Participants were assessed on multiple occasions between ages 13 and 30 years (from 1991 to 2012). Number of participants varied (up to n = 9453) by analysis. Measurements: Three patterns of alcohol use (frequent, heavy episodic and problem drinking) were assessed prior to age 17. Thirty outcomes were assessed to age 30 spanning substance use and related problems, antisocial behaviour, sexual risk‐taking, accidents, socio‐economic functioning, mental health and partner relationships. Findings: After covariate adjustment, weekly drinking prior to age 17 was associated with a two‐ to threefold increase in the odds of binge drinking [odds ratio (OR) = 2.14; 95% confidence interval (CI) = 1.57–2.90], drink driving (OR = 2.78; 95% CI = 1.84–4.19), alcohol‐related problems (OR = 3.04; 95% CI = 1.90–4.84) and alcohol dependence (OR = 3.30; 95% CI = 1.69–6.47) in adulthood. Frequency of drinking accounted for a greater proportion of the rate of most adverse outcomes than the other measures of alcohol use. Associations between frequent, heavy episodic and problem drinking in adolescence and most non‐alcohol outcomes were largely explained by shared risk factors for adolescent alcohol use and poor psychosocial functioning. Conclusions: Frequency of adolescent drinking predicts substance use problems in adulthood as much as, and possibly more than, heavy episodic and problem drinking independent of individual, family and peer predictors of those outcomes. [ABSTRACT FROM AUTHOR]

Background: There has been international concern over the rise in fatal pharmaceutical opioid overdose rates, driven by increased opioid analgesic prescribing. The current study aimed to examine trends in opioid overdose deaths by: 1) opioid type (heroin and pharmaceutical opioids); and 2) age, gender, and intent of the death assigned by the coroner.Methods: Analysis of data from the National Coronial Information System (NCIS) of opioid overdose deaths occurring between 2001 and 2012.Results: Deaths occurred predominantly (98%) among Australians aged 15-74 years. Approximately two-thirds of the decedents (68%) were male. The heroin overdose death rate remains unchanged over the period; these were more likely to occur among males. Pharmaceutical opioid overdose deaths increased during the study period (from 21.9 per million population in 2001-36.2), and in 2012 they occurred at 2.5 times the incident rate of heroin overdose deaths. Increases in pharmaceutical opioid deaths were largely driven by accidental overdoses. They were more likely to occur among males than females, and highest among Australians aged 45-54 years. Rates of fentanyl deaths in particular showed an increase over the study period (from a very small number at the beginning of the period) but in 2012 rates of morphine deaths were higher than those for oxycodone, fentanyl and tramadol.Conclusions: Given the increase in rates of pharmaceutical opioid overdose deaths, it is imperative to implement strategies to reduce pharmaceutical opioid-related mortality, including more restrictive prescribing practices and increasing access to treatment for opioid dependence. [ABSTRACT FROM AUTHOR]

Background: Heightened fiscal constraints, increases in the chronic disease burden and in consumer expectations are among several factors contributing to the global interest in evidence-informed health policy. The present article builds on previous work that explored how the Australian Federal Government applied five instruments of policy, or policy levers, to implement a series of reforms under the Australian National Mental Health Strategy (NMHS). The present article draws on theoretical insights from political science to analyse the relative successes and failures of these levers, as portrayed in formal government evaluations of the NMHS.Methods: Documentary analysis of six evaluation documents corresponding to three National Mental Health Plans was undertaken. Both the content and approach of these government-funded, independently conducted evaluations were appraised.Results: An overall improvement was apparent in the development and application of policy levers over time. However, this finding should be interpreted with caution due to variations in evaluation approach according to Plan and policy lever. Tabulated summaries of the success and failure of each policy initiative, ordered by lever type, are provided to establish a resource that could be consulted for future policy-making.Conclusions: This analysis highlights the complexities of health service reform and underscores the limitations of narrowly focused empirical approaches. A theoretical framework is provided that could inform the evaluation and targeted selection of appropriate policy levers in mental health. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Concerns about crystal methamphetamine use and harm have increased in multiple countries. This paper describes how changes in the availability and use of crystal methamphetamine have impacted on methamphetamine-related harms in Australia.Design and Methods: Data on methamphetamine use were obtained from population-level surveys, health service data and surveys of drug use among sentinel groups of ecstasy users and people who inject drugs. Data were obtained on seizures, arrests, clandestine laboratory detections, hospital separations, mental health unit admissions, drug telephone helpline calls and drug treatment episodes. Segmented linear regression models were fitted to identify changes in these series using log-transformed data where appropriate.Results: The availability of crystal methamphetamine has increased as evidenced by increased laboratory detections, domestic seizures and purity of the seized drug. Population surveys do not report an increase in the number of people who used at least once in the past year. However, more users report using crystal methamphetamine rather than lower-purity powder methamphetamine and more regular use. Indicators of methamphetamine-related harms have increased in parallel with this change. Amphetamine-related helpline calls, drug treatment, arrests and hospital admissions for amphetamine disorders and psychosis all peaked in the mid-2000s, declined for several years and have increased steeply since 2010.Discussion and Conclusions: The increased availability and use of crystal methamphetamine have been associated with increased regular use and harms. Treatment is required for those experiencing problems and the capacity of health services to provide care needs to be enhanced.[Degenhardt L, Sara G, Connor JP, McKetin R, Roxburgh A, Dobbins T, Farrell M, Burns L, Hall WD. Crystalline methamphetamine use and methamphetamine-related harms in Australia. Drug Alcohol Rev 2017;36:160-170]. [ABSTRACT FROM AUTHOR]

Introduction and Aims: This study investigated the extent to which parental monitoring and parental disapproval of alcohol use account for the association between country of birth and adolescent alcohol use.Design and Methods: The sample consisted of 10 273 adolescents from grades 7 (Mean age = 12.5 years), 9 (14.5 years) and 11 (16.4 years) in Victoria, Australia. Participants completed a questionnaire during class time. Mediation analyses were performed to examine the extent to which parental monitoring and parental disapproval of alcohol use accounted for variations in past 30 day alcohol use between Australian-born and immigrant adolescents.Results: Alcohol use in the past 30 days ranged from 8.0% to 44.4% for participants from different countries/regions of birth. Those born in Asia (odds ratio 0.20-0.51, P < 0.05) and Africa (odds ratio 0.45, P < 0.01) were much less likely to have consumed alcohol compared to those born in Australia. Adolescents from these two regions (except for Western Asia) reported higher levels of parental monitoring and parental disapproval of alcohol use (P < 0.05). Higher levels of parental monitoring and parental disapproval of alcohol use partially mediated the association between birth place and alcohol use (P < 0.05).Discussion and Conclusions: There were large variations in alcohol use between Australian-born and immigrant adolescents from different countries/regions. Adolescents from Asia or Africa were much less likely to consume alcohol, and this protective effect was partially accounted for by parental monitoring and disapproval of alcohol use.[Chan GCK, Kelly AB, Connor JP, Hall WD, Young RM, Williams JW. Does parental monitoring and disapproval explain variations in alcohol use among adolescents from different countries of birth? Drug Alcohol Rev 2016;35:741-749]. [ABSTRACT FROM AUTHOR]

Background: Skog's collectivity theory of alcohol consumption predicted that changes in alcohol consumption would synchronize across all types of drinkers in a population. The aim of this paper is examine this theory in the Australian context. We examined whether there was a collective change in alcohol use in Australia from 2001 to 2013, estimated alcohol consumption in non-high risk and high risk drinkers, and examined the trends in alcohol treatment episodes. Methods: Data from the 2001-2013 National Drug Strategy Household Surveys (N =127,916) was used to estimate the prevalence and alcohol consumption of abstainers, high risk drinkers and frequent heavy episodic drinkers. Closed treatment episodes recorded in the Alcohol and Other Drug Treatment Services National Minimum Dataset (N= 608,367) from 2001 to 2013 were used to examine the trends of closed alcohol treatment episodes. Results: The prevalence of non-drinkers (abstainers) decreased to the lowest level in 2004 (15.3%) and rebounded steadily thereafter (20.4% in 2013; p < .001). Correspondingly, the per capita consumption of high risk drinkers (2 standard drinks or more on average per day) increased from 20.7 L in 2001 to peak in 2010 (21.5 L; p = .020). Non-high risk drinkers' consumption peaked in 2004 (2.9 L) and decreased to 2.8 L in 2013 (p < .05). There were decreases in alcohol treatment episodes across nearly all birth cohorts in recent years. Conclusion: These findings are partially consistent with and support Skog's collectivity theory. There has been a turnaround in alcohol consumption after a decade-long uptrend, as evident in the collective decreases in alcohol consumption among nearly all types of drinkers. There was also a turnaround in rate of treatment seeking, which peaked at 2007 and then decreased steadily. The timing of this turnaround differs with level of drinking, with non-high risk drinkers reaching its peak consumption in 2004 and high risk drinkers reaching its peak consumption in 2010. [ABSTRACT FROM AUTHOR]

Purpose: Alcohol use is more prevalent in rural than urban areas in adult populations. Few studies have focused on adolescent drinking. This study investigated if adolescents in regional and rural areas of Australia were more likely to drink alcohol and if there were differences in parental drinking and alcohol supply across regions. Methods: A subsample from the National Drug Strategy Household Survey 2013, the largest nationally representative household survey on drug use in Australia, was used for this study. Participants who were aged 12‐17 (N = 1,159) and participants who indicated they were parents or guardians of a dependent child (N = 7,059) were included in the analyses. Key measures were adolescent and parental alcohol use, parental supply of alcohol, and drinking location. Findings: Compared to those living in major cities, adolescents from inner regional and rural areas were at 85% and 121% higher odds, respectively, of obtaining their first alcohol from parents, and at 131% and 287% higher odds of currently obtaining their alcohol from their parents. Those from rural areas were at 126% higher odds of drinking in the past 12 months. Parents from inner regional and rural areas were at 45% and 63% higher odds, respectively, of heavy drinking; at 27% and 52% higher odds of weekly drinking; and at 26% and 37% higher odds of drinking at home. Conclusions: Adolescents from rural areas were at higher risk of alcohol use. Parents in rural areas were more likely to use alcohol in ways that encourage adolescent drinking. [ABSTRACT FROM AUTHOR]

Background: Most adolescents begin alcohol consumption during adolescence, heavy alcohol use by adolescents is common, and alcohol-related harm amongst adolescents is a major public health burden. Parents are a common source of alcohol amongst adolescents, but little is known about how parental supply of alcohol has changed over recent years. This study examines national trends in parental supply of alcohol to adolescent children in Australia since 1998.Methods: Six Australian National Drug Strategy Household Surveys (1998-2013) yielded rates of parental supply of current and first ever alcohol consumed. Lifetime and current alcohol use were also estimated. The surveys were conducted for households across all Australian states and territories. Surveyed adolescents were aged 14-17 years (N = 7357, 47.6 % male). Measures included the reported source of currently consumed alcohol and first ever alcoholic beverage (parents/friends/others), lifetime alcohol use, number of standard alcohol units consumed on drinking days, and frequency of alcohol use. Corrected Pearson chi-squared tests were used to compare survey years.Results: There was a significant drop in parental supply of current alcohol use from 21.3 % in 2004 to 11.79 % in 2013 (p < .001). The lower prevalence of parental supply coincided with legislative changes on parental supply of alcohol to adolescents, but causality cannot be established because of the variation in the timing and reach of parental supply legislation, and small samples in some states. There were downward trends in adolescent experimentation, quantity and frequency of alcohol use across years, with the largest drop in alcohol use in 2010 and 2013.Conclusions: In Australia, there has been a substantial reduction in parental supply of alcohol to adolescents from 2010, and this factor may partially account for reductions in adolescent alcohol use. [ABSTRACT FROM AUTHOR]

Background: There are limited longitudinal data on the associations between different social contexts of alcohol use and risky adolescent drinking.Methods: Australian prospective longitudinal cohort of 1943 adolescents with 6 assessment waves at ages 14-17 years. Drinkers were asked where and how frequently they drank. Contexts were: at home with family, at home alone, at a party with friends, in a park/car, or at a bar/nightclub. The outcomes were prevalence and incidence of risky drinking (≥5 standard drinks (10g alcohol) on a day, past week) and very risky drinking (>20 standard drinks for males and >11 for females) in early (waves 1-2) and late (waves 3-6) adolescence.Results: Forty-four percent (95 % CI: 41-46 %) reported past-week risky drinking on at least one wave during adolescence (waves 1-6). Drinking at a party was the most common repeated drinking context in early adolescence (28 %, 95 % CI 26-30 %); 15 % reported drinking repeatedly (3+ times) with their family in early adolescence (95 % CI: 14-17 %). For all contexts (including drinking with family), drinking 3+ times in a given context was associated with increased the risk of risky drinking in later adolescence. These effects remained apparent after adjustment for potential confounders (e.g. for drinking with family, adjusted RR 1.9; 95 % CI: 1.5-2.4). Similar patterns were observed for very risky drinking.Conclusions: Our results suggest that consumption with family does not protect against risky drinking. Furthermore, parents who wish to minimise high risk drinking by their adolescent children might also limit their children's opportunities to consume alcohol in unsupervised settings. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, mental health reform in Australia has received unprecedented government attention. This study explored how five policy levers (organisation, regulation, community education, finance and payment) were used by the Australian Federal Government to implement mental health reforms.Methods: Australian Government publications, including the four mental health plans (published in 1992, 1998, 2003 and 2008) were analysed according to policy levers used to drive reform across five priority areas: [1] human rights and community attitudes; [2] responding to community need; [3] service structures; [4] service quality and effectiveness; and [5] resources and service access.Results: Policy levers were applied in varying ways; with two or three levers often concurrently used to implement a single initiative or strategy. For example, changes to service structures were achieved using various combinations of all five levers. Attempts to improve service quality and effectiveness were instead made through a single lever-regulation. The use of some levers changed over time, including a move away from prescriptive, legislative use of regulation, towards a greater focus on monitoring service standards and consumer outcomes.Conclusions: Patterns in the application of policy levers across the National Mental Health Strategy, as identified in this analysis, represent a novel way of conceptualising the history of mental health reform in Australia. An improved understanding of the strategic targeting and appropriate utilisation of policy levers may assist in the delivery and evaluation of evidence-based mental health reform in the future. [ABSTRACT FROM AUTHOR]

Objective To estimate the percentage of Australians with a mental disorder who received treatment for that disorder each year between 2006-07 and 2009-10. Methods We used: (1) epidemiological survey data to estimate the number of Australians with a mental disorder in any year; (2) a combination of administrative data on people receiving mental health care from the Commonwealth and State and Territories and epidemiological data to estimate the number receiving treatment; and (3) uncertainty modelling to estimate the effects of sampling error and assumptions on these estimates. Results The estimated population treatment rate for mental disorders in Australia increased from 37% in 2006-07 to 46% in 2009-10. The model estimate for 2006-07 (37%) was very similar to the estimated treatment rate in the 2007 National Survey of Mental Health and Wellbeing (35%), the only data available for external comparison. The uncertainty modelling suggested that the increased treatment rates over subsequent years could not be explained by sampling error or uncertainty in assumptions. Conclusions The introduction of the Commonwealth's Better Access initiative in November 2006 has been the driver for the increased the proportion of Australians with mental disorders who received treatment for those disorders over the period from 2006-07 to 2009- 10. [ABSTRACT FROM AUTHOR]

Objective The social gradient in smoking contributes substantially to the health gap between the rich and poor. Passive smoking by children is associated with increased risk of more severe asthma, respiratory diseases and infections, middle ear disease and Sudden Infant Death Syndrome. This study examined trends in the social gradient of children's exposure to secondhand smoke in Australian households between 2001 and 2010. Design Series of cross-sectional national household surveys. Results Between 2001 and 2010, the proportion of Australian households containing a child aged under 15 years and a smoker declined by 22%. However, there was no change in the most disadvantaged households, with half of these households still containing at least one smoker in 2010. There was a social gradient in outdoor smoking in all survey years but the prevalence of outdoor-only smoking increased in all socioeconomic groups by around 50% between 2001 and 2010. The presence of a child aged 5 years or younger in the household increased the chances that smokers only smoked outdoors. Conclusions Children's exposure to indoor smoking in households that contain a smoker is declining in all socioeconomic groups but the social class differentials in such exposure remain. The proportion of children who live with a smoker declined in all social groups except the most disadvantaged households, with half of these households still containing a smoker in 2010. More needs to be done to reduce secondhand smoke exposure of children in socially disadvantaged households. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims We used epidemiological modelling to assess whether nicotine vaccines would be a cost-effective way of preventing smoking uptake in adolescents. Design, Setting, Participants and Measurements We built an epidemiological model using Australian data on age-specific smoking prevalence; smoking cessation and relapse rates; life-time sex-specific disability-adjusted life years lived for cohorts of 100 000 smokers and non-smokers; government data on the costs of delivering a vaccination programme by general practitioners; and a range of plausible and optimistic estimates of vaccine cost, efficacy and immune response rates based on clinical trial results. We first estimated the smoking uptake rates for Australians aged 12-19 years. We then used these estimates to predict the expected smoking prevalence in a birth cohort aged 12 in 2003 by age 20 under (i) current policy and (ii) different vaccination scenarios that varied in cost, initial vaccination uptake, yearly re-vaccination rates, efficacy and a favourable vaccine immune response rate. Findings Under the most optimistic assumptions, the cost to avert a smoker at age 20 was $44 431 [95% confidence interval (CI) $40 023-49 250]. This increased to $296 019 (95% CI $252 307-$355 930) under more plausible scenarios. The vaccine programme was not cost-effective under any scenario. Conclusions A preventive nicotine vaccination programme is unlikely to be cost-effective. The total cost of a universal vaccination programme would be high and its impact on population smoking prevalence negligible. For these reasons, such a programme is unlikely to be publicly funded in Australia or any other developed country. [ABSTRACT FROM AUTHOR]

This paper reports data from semi-structured interviews on how 26 Australian civil servants, ministers and ministerial advisors find and evaluate researchers with whom they wish to consult or collaborate. Policymakers valued researchers who had credibility across the three attributes seen as contributing to trustworthiness: competence (an exemplary academic reputation complemented by pragmatism, understanding of government processes, and effective collaboration and communication skills); integrity (independence, ''authenticity'', and faithful reporting of research); and benevolence (commitment to the policy reform agenda). The emphases given to these assessment criteria appeared to be shaped in part by policymakers' roles and the type and phase of policy development in which they were engaged. Policymakers are encouraged to reassess their methods for engaging researchers and to maximise information flow and support in these relationships. Researchers who wish to influence policy are advised to develop relationships across the policy community, but also to engage in other complementary strategies for promoting research-informed policy, including the strategic use of mass media. [ABSTRACT FROM AUTHOR]

Context: Public health researchers make a limited but important contribution to policy development. Some engage with policy directly through committees, advisory boards, advocacy coalitions, ministerial briefings, intervention design consultation, and research partnerships with government, as well as by championing research-informed policy in the media. Nevertheless, the research utilization literature has paid little attention to these diverse roles and the ways that policymakers use them. This article describes how policymakers use researchers in policymaking and examines how these activities relate to models of research utilization. It also explores the extent to which policymakers' accounts of using researchers concur with the experiences of 'policy-engaged' public health researchers. Methods: We conducted semi-structured interviews with thirty-two Australian civil servants, parliamentary ministers, and ministerial advisers identified as 'research-engaged' by public health researchers. We used structured and inductive coding to generate categories that we then compared with some of the major research utilization models. Findings: Policymakers were sophisticated and multifaceted users of researchers for purposes that we describe as Galvanizing Ideas, Clarification and Advice, Persuasion, and Defense. These categories overlapped but did not wholly fit with research utilization models. Despite the negative connotation, 'being used' was reported as reciprocal and uncompromising, although researchers and policymakers were likely to categorize these uses differently. Policymakers countered views expressed by some researchers. That is, they sought robust dialogue and creative thinking rather than compliance, and they valued expert opinion when research was insufficient for decision making. The technical/political character of policy development shaped the ways in which researchers were used. Conclusions: Elucidating the diverse roles that public health researchers play in policymaking, and the multiple ways that policymakers use these roles, provides researchers and policymakers with a framework for negotiating and reflecting on activities that may advance the public health goals shared by both. [ABSTRACT FROM AUTHOR]

The article presents a study on the prevalence of psychological distress and affective disorders among smokers and cannabis-dependent people in Australia from 1997 to 2007. The researchers interviewed English-speaking Australians living in private dwellings, who were asked if they currently or formerly smoked tobacco. They found that elevated psychological distress and affective disorders were more common among current tobacco smokers than never-smokers in the surveys conducted in 1997 and 2007.

The article presents a study on the healthcare trend in Australia which involves the prescription of anti-Parkinsonian drugs (APD) from 1995 to 2009. The study analyzed the databases of the Medicare Australia and Drug Utilisation Sub-Committee (DUSC) for prescription data of dispensed APD from 1995. It has been found that there is a slow increase in the amount of dispensed levodopa and that levodopa + benserazide is increasing at a faster rate than levodopa + carbidopa.

Doubt about the relevance, appropriateness and transparency of peer review has promoted the use of citation metrics as a viable adjunct or alternative in the assessment of research impact. It is also commonly acknowledged that research metrics will not replace peer review unless they are shown to correspond with the assessment of peers. This paper evaluates the relationship between researchers' influence as evaluated by their peers and various citation metrics representing different aspects of research output in 6 fields of public health in Australia. For four fields, the results showed a modest positive correlation between different research metrics and peer assessments of research influence. However, for two fields, tobacco and injury, negative or no correlations were found. This suggests a peer understanding of research influence within these fields differed from visibility in the mainstream, peer-reviewed scientific literature. This research therefore recommends the use of both peer review and metrics in a combined approach in assessing research influence. Future research evaluation frameworks intent on incorporating metrics should first analyse each field closely to determine what measures of research influence are valued highly by members of that research community. This will aid the development of comprehensive and relevant frameworks with which to fairly and transparently distribute research funds or approve promotion applications. [ABSTRACT FROM AUTHOR]

The article discusses a study that examined age and sex differences in the leading causes of prevalent disability in young Australians, analyzing data from the 2003 Australian Burden of Disease and Injury Study. One of the results revealed that anxiety and depression, along with attention deficit hyperactivity disorder (ADHD) and autism, cause more prevalent years lived with disability (PYLD) in 10-24-year-old males. Another is that anorexia nervosa and bulimia are the second leading cause of mental disability in young females.

This paper models the predicted impact of tobacco price increases proposed in the United States and Australia during 2009 on smoking prevalence in 2010 while taking account of the effects of financial stress among smokers on cessation rates. Two models of smoking prevalence were developed for each country. In model 1, prevalence rates were determined by price elasticity estimates. In model 2 price elasticity was moderated by financial stress. Each model was used to estimate smoking prevalence in 2010 in Australia and the United States. Proposed price increases resulted in a 1.89% and 7.84% decrease in smoking participation among low socio-economic status (SES) groups in the United States and Australia, respectively. Model 1 overestimated the number of individuals expected to quit in both the United States (0.13% of smokers) and Australia (0.36% of smokers) by failing to take account of the differential effects of the tax on financially stressed smokers. The proportion of low-income smokers under financial stress increased in both countries in 2010 (by 1.06% in the United States and 3.75% in Australia). The inclusion of financial stress when modelling the impact of price on smoking prevalence suggests that the population health returns of increased cigarette price will diminish over time. As it is likely that the proportion of low-income smokers under financial stress will also increase in 2010, future population-based approaches to reducing smoking will need to address this factor. [ABSTRACT FROM AUTHOR]

This article discusses a study on the trend in per capita consumption (PCC) of alcohol for Australians aged 15 years and older. The study used data from catalogues of the Australian Bureau of Statistic and reports from the World Advertising Research Centre. It found increasing consumption of alcohol in the country. It attributed the trend to an increase in the alcohol content and market share of wine.

Aims To examine trends in patterns of cannabis use and related harm in the Australian population between 1993 and 2007. Design Analysis of prospectively collected data from: (1) the National Drug Strategy Household Survey (NDSHS) and Australian Secondary Student Alcohol and Drug Survey (ASSADS); (2) the National Hospital Morbidity Database (NHMD); and (3) the Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS-NMDS). Participants Australians aged 14 years and over from the general population; students aged 12–17 years; public and private hospital in-patients; public and private in-patients and out-patients attending for drug treatment. Measurement Prevalence of 12-month cannabis use among the general population and secondary students. Proportions in the general population by age group reporting: daily cannabis use; difficulties in controlling cannabis use; and heavy cannabis use on each occasion. Number of hospital and treatment presentations for cannabis-related problems. Findings Prevalence of past-year cannabis use has declined in the Australian population since the late 1990s. Among those reporting past-year use, daily use is prevalent among 40–49-year-olds, while heavy patterns of use are prevalent among 14–19-year-olds. Hospital presentations for cannabis-related problems reflect similar trends. Past-year cannabis use has decreased among the 10–19-year age group, but those who are daily users in this age group report using large quantities of cannabis. Conclusions Despite declines in the prevalence of cannabis use, continued public health campaigns warning of the harms associated with cannabis use are essential, aimed particularly at users who are already experiencing problems. The increasing demand for treatment for cannabis problems in Australia suggests the need for more accessible and more effective interventions for cannabis use disorders. [ABSTRACT FROM AUTHOR]

Introduction and Aims. There has been little research published on the use of smokeless tobacco (SLT) in Australia. This study aimed to determine the prevalence of SLT use and the potential for harm reduction in current SLT users and smokers. Design and Methods. We undertook secondary analysis of data from a national household survey of drug use and surveyed 108 Australian SLT users about their patterns of SLT use and tobacco smoking. Results. The low prevalence of SLT use in the past year in Australia (0.57%; 95% confidence interval 0.48–0.66) might reflect the difficulty in importing these products. Prevalence of recent use was highest among males aged 18–29 who were current weekly smokers. US style oral snuffs were the most popular SLT products in Australia. Most of those surveyed were introduced to SLT by a personal contact and about half had used SLT to quit smoking. Australians who import SLT pay per can AU$21.30 on average and face substantial delays before receiving the product. Discussion and Conclusions. Cost and poor access present a substantial barrier to SLT use as a tobacco harm reduction measure for Australian smokers. Permitting low nitrosamine varieties of SLT to be sold in Australia might reduce harm in current SLT users and provide a viable alternative to cigarettes for some current smokers. [Gartner CE, Hall WD. Smokeless tobacco use in Australia. Drug Alcohol Rev 2009] [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the sociodemographic variation in antidepressant utilization in Australia between 2003 and 2005. Antidepressant prescription was analyzed based on the Pharmaceutical Benefits Scheme, and according to sex, age, geographical area and socioeconomic status. The study found that antidepressant use increases with age and is higher among females. Study authors claimed that such findings reflect the sociodemographic differences in affective disorder prevalence.

This paper outlines the major policy challenges in reducing cannabis-related harm in Australia. The first is uncertainty about the health effects of cannabis, especially in young people. The second is uncertainty about the extent and severity of harms attributed to cannabis prohibition by its critics. The paper summarises and briefly states the extent of these putative harms to the degree that the data allow. The third challenge is a consequence of the first two, and the very different weightings that proponents of more liberal or restrictive policies give to harms arising from cannabis use and those arising from prohibition, namely, strong disagreements within the community about how we should respond to cannabis use by young people. In the face of such disagreement the formulation of cannabis policy necessitates a political compromise. The compromise that has emerged is a continued prohibition of cannabis production, sale and use, combined with either civil penalties for use in some states and reduced penalties or diversion in others. It concludes with suggestions about what needs to be learned about the health effects of cannabis use and the costs and benefits of cannabis prohibition if we are to develop policies that are more effective in reducing harms caused by cannabis use.[Hall WD. Challenges in reducing cannabis-related harm in Australia. Drug Alcohol Rev 2009;28:110–116] [ABSTRACT FROM AUTHOR]

Aims To describe the formulation of a National Cannabis Strategy in Australia in 2006 and discuss the contribution that research evidence has made to its development. Methods A description of trends in cannabis use in Australia and policy responses to it from the early 1970s to the present, with an analysis of the evidence and arguments that have been used to support competing policies towards cannabis use. Results In 1977 an Australian Senate Committee recommended that a national cannabis policy should be developed that removed criminal penalties for personal possession and use. The arguments for the recommendation echoed those used to support similar earlier recommendations made in Canada, the Netherlands, the United Kingdom and the United States in the late 1960s and early 1970s. They were reiterated by a National Cannabis Task Force in 1994, but a national cannabis strategy was not developed until 2006. By default, the strategy supported continued prohibition on the production and sale of cannabis, and left penalties for cannabis use to state governments. It advocated public education campaigns to discourage young people, especially those at high risk, from initiating cannabis use, and to reduce the progression to regular use among young people who had used cannabis. It also supported efforts to reduce the availability of cannabis and to improve treatment for problem cannabis users. The research evidence which was cited as motivating the development of a national cannabis policy was epidemiological data on rising rates of use among young people, and emerging evidence from longitudinal studies in Australian and New Zealand that some adolescent cannabis users experienced harm as a result of their use. Conclusions The impact that research evidence has had on Australian cannabis policy over the past three decades has, as in many comparable countries, been constrained by the limited policy options under consideration, and by the fact that interpretation of the evidence has been contested by advocates of the limited policy options under debate. [ABSTRACT FROM AUTHOR]

Objective. To compare the usage of bupropion hydrochloride and nicotine replacement in Australia between 2001 and 2005. Design and Setting. We analysed aggregate data on the utilisation of: (1) bupropion under the Pharmaceutical Benefit Scheme (PBS) between 2001 and 2005; (2) bupropion and nicotine replacement therapy (NRT) on the Repatriation Pharmaceutical Benefit Scheme (RPBS) between 1995 and 2005; and (3) NRT aggregate sales data from GlaxoSmithKline for 2001 - 05. The National Drug Strategy Household Survey (NDSHS) 2004 was used to estimate the proportion of smokers who received a bupropion prescription in each year. Main Outcome Measures. Numbers of annual prescriptions for bupropion on the PBS and buproprion and NRT on the RPBS; annual sales figures on NRT patches (2001 - 05); and the estimated proportion of Australian smokers who used bupropion in 2003. Results. The number of bupropion prescriptions on the PBS peaked at 351 772 in 2001 (costing the PBS $83 million). This declined by 72% to 97 173 in 2005 (a cost of $12 million). The estimated percentage of smokers in Australia who used bupropion in a year fell from 11% in 2001 to 3.6% in 2005. The annual number of bupropion prescriptions on the RPBS fell from 3786 in 2001 to 1173 in 2005, while there was no change in the number of NRT prescriptions (3793 in 2001 and 3886 in 2005). Sales data from the leading market supplier of NRT also indicated that NRT use continued to grow in Australia while bupropion use declined. Conclusions. Bupropion usage has fallen by 72% since a peak in the year of first listing on the PBS, while the utilisation of NRTs appears to have increased, despite the price differential in favour of bupropion. Implications. Given the greater interest among smokers in NRT than bupropion (and evidence of the effectiveness and cost-effectiveness of NRT), the Australian government should reconsider its decision not to list NRT on the PBS. [Lutsenko H, Doran CM, Hall WD. Australian smokers' use of bupropion and nicotine replacement therapies and their relation to reimbursement, Australia 2001 - 05. Drug Alcohol Rev 2008;27:160 - 164] [ABSTRACT FROM AUTHOR]

The article presents a study of the health effects of snus. Snus is a Swedish smokeless tobacco that has been cited as a possible means of tobacco harm and smoking reduction. The researchers examined the population health effects of snus use in Australia. Life tables were used to find the adjusted life expectancy for nonsmokers and tobacco users. The study found that there was little difference in health-adjusted life expectancy for smokers who quit tobacco use and those who switched to snus use. The authors conclude that smokers who have been using cigarettes and switch to snus can experience health gains. The article argues that allowing the sale of snus would produce a net benefit, in spite of any nonsmoking users who might take up the product.

Abstract Objective: To examine the association between trends in antidepressant prescribing and suicide rates in Australia for 1991-2000. Design: Analysis of databases of suicide and rates of antidepressant prescribing according to age and sex. Setting Australian Bureau of Statistics data, sales data from the Australian pharmaceutical industry, prescribing data in general practice. Subjects: Men and women aged 15 years and over in 10 year age groups. Main outcome measures: Trends in suicide rates and trends in antidepressant prescribing. Association measured by Spearman's rank correlations. Results: While overall national rates of suicide did not fall significantly, incidence decreased in older men and women and increased in younger adults. In both men (r[s]=-0.91; P < 0.01) and women (r[s]=- 0.76; P < 0.05) the higher the exposure to antidepressants the larger the decline in rate of suicide. Conclusions: Changes in suicide rates and exposure to antidepressants in Australia for 1991-2000 are significantly associated. This effect is most apparent in older age groups, in which rates of suicide decreased substantially in association with exposure to antidepressants. The increase in antidepressant prescribing may be a proxy marker for improved overall management of depression. If so, increased prescribing of selective serotonin reuptake inhibitors in general practice may have produced a quantifiable benefit in population mental health. INSETS: What is already known on this topic;What this study adds. [ABSTRACT FROM AUTHOR]

The article discusses the increase in excise tax on ready-to-drink (RTD) spirit-based beverages or alcopops tax in Australia. The purpose of raising the alcopops tax is discussed, including the growing concern of the high rate of alcohol consumption among young people. Results of the 2008 Australian Secondary Students' Alcohol and Drug Survey (ASSADS) are discussed. The article cites the need for a comprehensive approach if a pricing strategy will be used to lessen alcohol consumption.

The article discusses a study by Linda J. Cobiac and colleagues which offered cost-efficient methods of reforming alcohol regulation in Australia. Included in a package of cost-efficient interventions were volumetric taxation, prohibitions on alcohol advertising and random breath testing (RBT). The National Preventative Health Taskforce (NPHT) recommended a tiered volumetric approach that involved tax increases, aimed at granting economic incentives for the manufacturing and use of beverages with low levels of alcohol.

The article looks at ways to lessen deaths related to alcohol-related road accidents among young adults in Australia. It is said that raising the minimum legal drinking age (MLDA) to 21 years is one strategy that has not been addressed in the country. Cost-effective rules for lowering alcohol-related risks are cited which include alcohol tax changes and prohibitions on advertising of such beverage. Also stated are the advantages of a proposal to broaden alcohol zero-tolerance policies for drivers, who received new licenses, until the age of 22.

Background: Although much is known about the correlates of heroin overdose, less is known about pharmaceutical opioid (PO) overdose. This study aimed to examine correlates of opioid overdose deaths by opioid and compare correlates between opioids.Methods: Analysis of opioid overdose deaths in Australia between 2000-2015, extracted from the National Coronial Information System (NCIS). The NCIS is an online database of deaths reportable to the coroner, and contains coroner's findings, autopsy and toxicology reports. Deaths were categorized into mutually exclusive groups: 1) Heroin deaths; and 2) PO deaths (excluding heroin). PO deaths were examined by individual opioid.Results: There were 10,795 opioid overdose deaths over the study period. Relative to deaths occurring in major cities, deaths in regional/remote areas had 15.2 (95 % CI: 11.5-20.2) times the risk of being attributed to pharmaceutical fentanyl than heroin. Relative to deaths among people without a recorded history of chronic pain, deaths among people with a recorded history of chronic pain had a 1.9-10.7-fold increased risk of the death being attributed to POs than heroin. Deaths among people with a recorded history of substance use problems where the opioid was injected prior to death had 7.2 and 1.7 times the risk of being attributed to methadone and pharmaceutical fentanyl (respectively) than heroin.Conclusions: Findings suggest the need to: educate PO consumers about the risks of overdose at the time of prescribing; increase coverage and engagement in opioid dependence treatment (particularly in regional/remote areas); and increase uptake of take-home naloxone to reduce opioid overdose mortality. [ABSTRACT FROM AUTHOR]

In the past decade alcohol-related harm in Australia has risen while per capita consumption has remained relatively stable. This result is explained by an ageing population and changing drinking patterns, increased numbers of abstainers and more binge drinkers. [ABSTRACT FROM AUTHOR]

The article examines methamphetamine residues in wastewater from two Queensland cities to monitor illicit drug use in the population. Using liquid chromatography and mass spectrometry, findings showed that methamphetamine consumption was higher in the metropolitan city than in the regional city while levels in both locations increased significantly between 2009 and 2015. Findings highlights the potential value of wastewater analysis in collecting data on illicit drug use.

The author explores the regulation of smokeless forms of tobacco like low-nitrosamine smokeless tobacco (SLT) and electronic nicotine delivery systems (ENDS) or e-cigarettes in Australia. It notes the concern about the possible increased use of such products, which are reportedly at much lower levels than those of illicit drugs such as ecstasy and cocaine. It also mentions that the most harmful tobacco products, the conventional cigarettes, are available in most Australian retail environments.

The article discusses how to reduce the misuse of pharmaceutical opioids like oxycodone in Australia. It claims that since the early 1990s, the sustained-release opioid drugs have been utilized to treat all types of chronic pain, such as chronic non-cancer pain, particularly in such developed countries as Australia, Canada and Great Britain. One of the tips to minimize the misuse of the drugs is that doctors and patients should be informed about the risks of drug dependence and overdose.

The article proposes a more democratic method of assessing the track records of researchers in Australia. It shows how to ensure a better match between reviewer expertise and grant applicant. It is suggested that all researchers submitting grant applications should be mandated to rank the track records of a reasonable number of their peers. It recommends the provision of links to publications, citations and grant successes to assist in the ranking process.

The author discusses the need for tobacco sales data in Australia to monitor trends in tobacco use and evaluate the effectiveness of the proposed tobacco control interventions. Because of Australia's geographic isolation, an accurate estimate of total tobacco consumption in Australia can be evaluated. He points to the tobacco industry's capability to mobilize retailers to lobby against tobacco control strategies. He notes that the tobacco industry should provide governments with data on sales since it is harmful to population health and less regulated.

A response from the authors of the article "Estimating the number of regular and dependent methamphetamine users in Australia, 2002-2014" in the 2016 issue is presented.

Objective: To estimate the number of regular and dependent methamphetamine users in Australia.Design: Indirect prevalence estimates were made for each year from 2002-03 to 2013-14. We applied multiplier methods to data on treatment episodes for amphetamines (eg, counselling, rehabilitation, detoxification) and amphetamine-related hospitalisations to estimate the numbers of regular (at least monthly) and dependent methamphetamine users for each year. Dependent users comprised a subgroup of those who used the drug regularly, so that estimates of the sizes of these two populations were not additive.Results: We estimated that during 2013-14 there were 268 000 regular methamphetamine users (95% CI, 187 000-385 000) and 160 000 dependent users (95% CI, 110 000-232 000) aged 15-54 years in Australia. This equated to population rates of 2.09% (95% CI, 1.45-3.00%) for regular and 1.24% (95% CI, 0.85-1.81%) for dependent use. The rate of dependent use had increased since 2009-10 (when the rate was estimated to be 0.74%), and was higher than the previous peak (1.22% in 2006-07). The highest rates were consistently among those aged 25-34 years, in whom the rate of dependent use during 2012-2013 was estimated to be 1.50% (95% CI, 1.05-2.22%). There had also been an increase in the rate of dependent use among those aged 15-24 years (in 2012-13 reaching 1.14%; 95% CI, 0.80-1.69%).Conclusions: There have been increases over the past 12 years in the numbers of regular and dependent methamphetamine users in Australia. Our estimates suggest that the most recent numbers are the highest for this period, and that the increase has been most marked among young adults (those aged 15-34 years).Implications: There is an increasing need for health services to engage with people who have developed problems related to their methamphetamine use. [ABSTRACT FROM AUTHOR]

The article discusses the increase in excise tax, imposed by the Australian government in April 2008, on ready-to-drink (RTD) spirit-based products, such as alcopops, as an evidence-based strategy in reducing excessive RTD consumption among young people. According to the authors, there is evidence that increasing the cost of alcohol affects the alcohol consumption in the country. Some critics have argued that the RTD excise tax will not reduce alcohol consumption by young people because they will just switch to other beverages.

Objectives: To examine trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths.Design and Setting: Analysis of prospectively collected data from the National Coronial Information System on deaths where codeine toxicity was determined to be an underlying or contributory cause of death. The study period was 2000-2013.Main Outcome Measures: Population-adjusted numbers (per million persons) of (1) codeine-related deaths, classified by intent (accidental or intentional); and (2) heroin- and Schedule 8 opioid-related deaths (as a comparator).Results: The overall rate of codeine-related deaths increased from 3.5 per million in 2000 to 8.7 per million in 2009. Deaths attributed to accidental overdoses were more common (48.8%) than intentional deaths (34.7%), and their proportion increased during the study period. High rates of prior comorbid mental health (53.6%), substance use (36.1%) and chronic pain (35.8%) problems were recorded for these deaths. For every two Schedule 8 opioid-related deaths in 2009, there was one codeine-related death. Most codeine-related deaths (83.7%) were the result of multiple drug toxicity.Conclusions: Codeine-related deaths (with and without other drug toxicity) are increasing as the consumption of codeine-based products increases. Educational messages are needed to better inform the public about the potential harms of chronic codeine use, especially in the context of polypharmacy. [ABSTRACT FROM AUTHOR]

Introduction: Defining drug-related mortality is complex as these deaths can include a wide range of diseases and circumstances. This paper outlines a method to identify deaths that are directly due to fatal opioid toxicity (i.e. overdose), utilising coronial data.Materials and Methods: The National Coronial Information System (NCIS), an online coronial database containing information on all deaths that are reported to a coroner in Australia, is used to develop methods to more accurately identify opioid overdose deaths. The NCIS contains demographic information, Medical Cause of Death, and associated documentation on toxicology, clinical and police investigations.Results: Identifying overdose deaths using the coroner determined Medical Cause of Death provided greater capture, and specificity, of opioid overdose deaths. Distinguishing morphine from heroin-related deaths presented challenges, requiring analysis of clinical and investigative information in addition to toxicology results. One-quarter of the deaths attributed to morphine were recorded to heroin as a result of further investigation. There was also some underestimation of codeine-related deaths. Access to clinical and investigative information also yields important information in relation to comorbid conditions among these decedents, such as history of chronic pain, substance use issues and mental health problems.Conclusions: Reliance on toxicology results alone leads to an underestimate of heroin-related deaths. Differentiating between heroin and pharmaceutical opioid (e.g. morphine) overdose deaths has important public health and policy implications, particularly in relation to prescribing practices and development of a strategic response. Understanding comorbidities among these decedents is also important in efforts to reduce preventable causes of death such as opioid overdose. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the non-medical use of prescription stimulants in Australia.