Search

Background Aims Methods Results Implications 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.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.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.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.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]

The World Health Organization (WHO) has released its ninth report on the global implementation of tobacco control measures. While progress has been made in reducing tobacco-related disease and disability, the implementation of WHO's recommended measures has been mixed, even in high-income countries. By the end of 2022, 71% of the global population lived in countries that had implemented at least one of the recommended measures. However, there are still challenges in fully implementing smokefree policies and enforcing compliance. Additionally, only a quarter of high-income countries have implemented bans on tobacco advertising, promotion, and sponsorship. More efforts are needed to provide smoking cessation services and monitor tobacco use, especially in light of the COVID-19 pandemic. The report also highlights the disappointing decision by the newly elected government of New Zealand to repeal laws aimed at reducing smoking rates. Overall, tobacco smoking remains the leading preventable cause of premature mortality globally, and more countries need to adopt cost-effective measures such as increased tobacco taxation. [Extracted from the article]

The article discusses the need for more research on how to prevent vaping among young people. While many countries have implemented regulations to reduce the use of Electronic Nicotine Delivery Systems (ENDS) by youth, such as sales bans, there is little evidence to support the effectiveness of these policies. Bans on ENDS sales have had little effect on youth usage rates, and countries with different policy approaches have seen an increase in ENDS use among adolescents. The article emphasizes the importance of evidence-based policies and the need for more research to inform effective strategies for reducing youth vaping. [Extracted from the article]

An editorial is presented on witnessing an enthusiastic revival of research into the therapeutic potential of psychedelic drugs. Topics include high scientific standards requiring clinical research in other areas also be applied to the evaluation of psychedelic medicines; and effect of psilocybin and methylenedioxymethamphetamine on mental, behavioral, or developmental disorders.

An editorial is presented in which the authors discusses errors with medical cannabis and marijuana research funded by the cannabis industry, including in regard to medical marijuana's putative role in lessening opioid overdose deaths in the US. An overview of the role that the mass media plays in publicizing inaccurate cannabis research

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: In order to understand and measure the policy impact of research we need a definition of research impact that is suited to the task. This article systematically reviewed both peer-reviewed and grey literature for definitions of research impact to develop a definition of research impact that can be used to investigate how public health research influences policy.Method: Keyword searches of the electronic databases Web of Science, ProQuest, PubMed, EMBASE, CINAHL, Informit, PsycINFO, The Cochrane Database of Systematic Reviews and Google Scholar were conducted between August 2015 and April 2016. Keywords included 'definition' and 'policy' and 'research impact' or 'research evidence'. The search terms 'health', public health' or 'mental health' and 'knowledge transfer' or 'research translation' were used to focus the search on relevant health discipline approaches. Studies included in the review described processes, theories or frameworks associated with public health, health services or mental health policy.Results: We identified 108 definitions in 83 publications. The key findings were that literature on research impact is growing, but only 23% of peer-reviewed publications on the topic explicitly defined the term and that the majority (76%) of definitions were derived from research organisations and funding institutions. We identified four main types of definition, namely (1) definitions that conceptualise research impacts in terms of positive changes or effects that evidence can bring about when transferred into policies (example Research Excellence Framework definition), (2) definitions that interpret research impacts as measurable outcomes (Research Councils UK), and (3) bibliometric and (4) use-based definitions. We identified four constructs underpinning these definitions that related to concepts of contribution, change, avenues and levels of impact.Conclusion: The dominance of bureaucratic definitions, the tendency to discuss but not define the concept of research impact, and the heterogeneity of definitions confirm the need for conceptual clarity in this area. We propose a working definition of research impact that can be used in a range of health policy contexts. [ABSTRACT FROM AUTHOR]

In this Perspective, Wayne D. Hall & Michael Farrell discuss the current need for alternative strategies in the rising opioid crisis in the US and the necessity to fund evidence-based treatment initiatives to reduce the death toll. [ABSTRACT FROM AUTHOR]

The article presents the results of the Global Burden Disease (GBD) Study of 2010. It looks into illicit drugs such as heroin, amphetamines, and benzodiazapines and the global dependence on them. It discusses the indicators of drug dependence, disability-adjusted life year (DALY), and treatment approaches of drug disorders. The prevalence of illicit drug dependence, direct burden of drug use disorders, and trends are also featured.

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]

An editorial is presented in which the authors discuss a study concerning whether the use and health effects of cannabis by adolescents can be predicted in U.S. states that have legalized cannabis for adult use, and point to an article published in the journal about the subject.

Background Clinicians who prescribe chronic opioid therapy are concerned about identifying patients who are at-risk for misusing, abusing, or diverting (i.e. selling) their pain medications. Experts have specifically recommended using clinical assessment tools as part of a comprehensive plan for mitigating opioid-related risks. These tools are typically short, standardized questionnaires that screen for the presence or absence of putatively aberrant medication-related behaviors thought to be predictive of addiction. Interestingly, these tools remain wholly unregulated by the Food and Drug Administration ( FDA) or other authorities. Objective This paper reviews how these instruments are used and the normative assumptions informing their use, fully appreciating that these screening tools do not have the power to diagnose illness or an addiction disorder. Conclusion We conclude that these clinical assessment tools should be regulated because, as we will argue, any screening tool that can assess patients for the potential for opioid-related aberrant behaviors are powerful instruments that merit additional scrutiny and oversight-perhaps by the FDA and other regulatory agencies. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To stimulate debate by examining ethical issues raised by Project Prevention, a US-based organization that offers $US300 to addicted individuals who agree to either undergo surgical sterilization or use long-acting forms of contraception. Method An analysis of key ethical questions raised by Project Prevention. Results The important issues for debate are: (i) what are the reproductive rights of drug-using women; (ii) does a substantial cash incentive undermine the ability of addicted women to make free and informed decisions about long-term contraception; and (iii) how can we best assist addicted women to access good reproductive health care and obtain treatment for their addiction? Conclusions We need more research on ways in which small non-cash incentives for reversible methods of contraception could be used in a morally acceptable and effective way to promote the sexual, reproductive and general health of addicted women. [ABSTRACT FROM AUTHOR]

Objectives: To use data from the 1997 and 2007 National Surveys of Mental Health and Well-Being (NSMHWB) to assess whether Australian smokers in 2007 have higher rates of mental distress and social disadvantage than smokers in 1997. Method: We compared symptoms of mental distress and social disadvantage in Australian smokers in the 1997 and 2007 National Surveys of Mental Health and Well-Being (N = 10 373 in 1997 and N = 8135 in 2007). Both surveys used multistage probability samples of Australians living in private dwellings. Participants were classified into smokers and non-smokers (which included former and never smokers). We used the Kessler 10 (K10) symptom score to classify smokers into three levels of psychological distress (low, medium or high) and socioeconomic disadvantage was measured using an area-based index of relative disadvantage converted into quintiles. We used logistic regressions to: (i) examine associations between smoking status (smoker/non-smoker) and psychological distress and socioeconomic disadvantage in 1997 and 2007 surveys; and (ii) to test whether the prevalence of psychological distress and social disadvantage among smokers increased between 1997 and 2007. Results: Psychological distress and social disadvantage were more common among smokers than non-smokers in both surveys but there was no evidence that the prevalence of psychological distress or social disadvantage was more common among smokers in 2007 than in 1997. Conclusion: We find no evidence that the declining smoking prevalence in Australia (over the last decade) has been accompanied by a 'hardening' of continuing smokers in terms of rates of mental disorders and socioeconomic disadvantage. [ABSTRACT FROM AUTHOR]

The article discusses the use of genetic information to predict the risk of diseases and its impact on public health. It says that individual genetic variants can offer a reliable prediction of disease risks when results of multiple susceptibility alleles were merged statistically. It states that the predictive capacity of genetic tests depends on population and type of disease. It adds that genomic information must encourage behaviour change before it can be used in public health screening.

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]

The article discusses the research on cannabis use as a risk factor for psychosis. The authors note that from observational studies, cannabis use has been found to be associated with schizophrenia and psychosis. However, debates surfaced on the credibility of such observational studies, which resulted to the question of including a category of psychosis from cannabis use in the revision of the Global Burden of Disease (GBD).

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]

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]

Aim To assess the promise and risks of technological applications of genetic research on liability to develop nicotine dependence. Methods We reviewed (i) the evidence on the genetics of nicotine dependence; (ii) the technical feasibility of using genetic information to reduce smoking uptake and increase cessation; and (iii) policy and ethical issues raised by the uses of genetic information on addiction liability. Results (i) Despite evidence from twin studies that genes contribute to addiction susceptibility, research to date has not identified commonly occurring alleles that are strongly predictive of developing nicotine addiction. Nicotine addiction is likely to involve multiple alleles of small effect that interact with each other and with the environment. (ii) Population screening for susceptibility alleles is unlikely to be effective or cost-effective. Tailoring of smoking cessation treatments with genetic information is more plausible but results to date have been disappointing. Population health strategies such as increased taxation and reduced opportunities to smoke are more efficient in reducing cigarette smoking. Tobacco harm reduction policies applied to populations may also play a role in reducing tobacco-related harm. (iii) Future uses of genomic information on addiction risk will need to assess the risks of medicalising addiction (e.g. pessimism about capacity to quit) and community concerns about genetic privacy. Conclusions Nicotine genomics is a very new and underdeveloped field. On the evidence to date, its advocates would be wise to avoid extravagant claims about its preventive applications. [ABSTRACT FROM AUTHOR]

Objective To examine changes in age of tobacco experimentation and progression to daily smoking in men and women between birth cohorts that differ in exposure to public health programmes that aim to discourage smoking. Design Analysis of national cross-sectional household surveys of smoking patterns, conducted in Australia in 2001 and 2004. Setting and participants Australian adults aged 22 years and over in 2001 and 2004 who responded to the National Drug Strategy Household Survey. Main outcome measures Prevalence of tobacco experimentation and progression to daily smoking by age 21, estimated by sex and birth cohort. Odds of tobacco experimentation and progression to daily smoking by age 21 estimated by sex for each birth cohort, with corrections for the effects of ‘forward telescoping’ in recalling age of use. Results Sex differences in smoking prevalence are smaller in younger birth cohorts. Tobacco experimentation has increased among women, while progression to daily smoking has decreased among men. Conclusions Sex differences in smoking experimentation and progression to daily smoking have decreased in younger birth cohorts. However, a significant proportion of younger males and females continue to experiment with tobacco and become daily smokers despite strong public health efforts to discourage smoking. More research is needed to determine why sex differences in smoking behaviour are not evident in younger birth cohorts. [ABSTRACT FROM AUTHOR]

This section presents a debate on the issue of whether the health community promote smokeless tobacco or Swedish snus. Coral Gartner and Wayne Hall are convinced that smokers who switch to snus reduce their health risks. Simon Chapman and Becky Freeman believe that caution should be practiced in using snus.

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.

This paper identifies research priorities in evaluating the ways in which "genomic medicine"--the use of genetic information to prevent and treat disease--may reduce tobacco-related harm by: (1) assisting more smokers to quit; (2) preventing nonsmokers from beginning to smoke tobacco; and (3) reducing the harm caused by tobacco smoking. The method proposed to achieve the first aim is "pharmacogenetics", the use of genetic information to optimise the selection of smoking-cessation programmes by screening smokers for palymorphisms that predict responses to different methods of smoking cessation. This method competes with the development of more effective forms of smoking cessation that involve vaccinating smokers against the effects of nicotine and using new pharmaceuticals (such as cannabinoid antagonists and nicotine agonists). The second and third aims are more speculative. They include: screening the population for genetic susceptibility to nicotine dependence and intervening (eg, by vaccinating children and adolescents against the effects of nicotine) to prevent smoking uptake, and screening the population for genetic susceptibility to tobacco-related diseases. A framework is described for future research on these policy options. This includes: epidemiological modelling and economic evaluation to specify the conditions under which these strategies are cost-effective; and social psychological research into the effect of providing genetic information on smokers' preparedness to quit, and the general views of the public on tobacco smoking. [ABSTRACT FROM AUTHOR]

This paper reviews methods that can be used to assess the impact of medicine use on population health outcomes. In the absence of a gold standard, we argue that a convergence of evidence from different types of studies using multiple methods of independent imperfection provides the best bases for attributing improvements in health outcomes to the use of medicines. The major requirements are: good evidence that a safe and effective medicine is being appropriately prescribed; covariation between medicine use and improved health outcomes; and being able to discount alternative explanations of the covariation (via covariate adjustment, propensity analyses and sensitivity analyses), so that medicine use is the most plausible explanation of the improved health outcomes. The strongest possible evidence would be provided by the coherence of the following types of evidence: (1) individual linked data showing that patients are prescribed the medicine, there are reasonable levels of patient compliance, and there is a relationship between medicine use and health improvements that is not explained by other factors; (2) ecological evidence of improvements in these health outcomes in the population in which the medicine is used. Confidence in these inferences would be increased by: the replication of these results in comparable countries and consistent trends in population vital statistics in countries that have introduced the medicine; and epidemiological modelling indicating that changes observed in population health outcomes are plausible given the epidemiology of the condition being treated. [ABSTRACT FROM AUTHOR]

Objective: We review evidence on two claims that have been made about the effects of selective serotonin reuptake inhibitor (SSRI) antidepressants; that they have: (i) decreased suicide rates in the population; and (ii) increased suicide rates in some individuals early in treatment. Method: We critically review evidence in the English-speaking peer-reviewed medical literature on: (i) meta-analyses of randomized controlled trials (RCTs) of SSRIs; (ii) observational studies of suicide risk in patients prescribed SSRIs and other antidepressants; and (iii) ecological studies of correlations between population use of SSRI use and population suicide rates. Results: The largest and most recent meta-analyses of RCTs of SSRIs have found suggestive evidence that SSRIs increase suicidal ideation early in treatment compared with placebo. Observational studies have found an increased risk of self-harm within 9 days of an antidepressant drug being prescribed but the risk has been similar for the older tricyclic antidepressants and the SSRIs. Ecological studies in developed countries have found either that suicide rates have declined as SSRI use has increased, or have found no relationship between suicide rates and increased SSRI use. Conclusions: Meta-analyses of RCTs suggest that SSRIs increase suicide ideation compared with placebo but the observational studies suggest that SSRIs do not increase suicide risk more than older antidepressants. If SSRIs increase suicide risk in some patients, the number of additional deaths is very small because ecological studies have generally found that suicide mortality has declined (or at least not increased) as SSRI use has increased. [ABSTRACT FROM AUTHOR]

The article addresses the claims made with respect to the effects of selective serotonin-reuptake inhibitor (SSRI) antidepressant on suicide risk. One claim is that increased SSRI use has reduced suicide rates, and the other is that SSRIs increase suicide risk in some patients early in treatment. The author considers imperfect evidence from a range of studies of different types. The effectiveness of SSRIs for treating depression in adults has been shown in randomized trials. However, these trials have not provided assessment of their effect on suicide risk. Meta-analysis studies have found increased risk of suicidal ideation and self harm in patients that were given SSRIs as compared with others.

Objective: To review the evidence on the mental health and psychosocial consequences of rising rates of cannabis use among young people in developed countries. Method: This paper critically reviews epidemiological evidence on the following psychosocial consequences of adolescent cannabis use: cannabis dependence; the use of heroin and cocaine; educational underachievement; and psychosis. Leading electronic databases such as PubMed have been searched to identify large-scale longitudinal studies of representative samples of adolescents and young adults conducted in developed societies over the past 20 years. Results: Cannabis is a drug of dependence, the risk of which increases with decreasing age of initiation. Cannabis dependence in young people predicts increased risks of using other illicit drugs, underperforming in school, and reporting psychotic symptoms. Uncertainty remains about which of these relationships are causal although the evidence is growing that cannabis is a contributory cause of psychotic symptoms. Conclusions: We face major challenges in communicating with young people about the most probable risks of cannabis use (dependence, educational underachievement and psychosis) given uncertainties about these risks and polarized community views about the policies that should be adopted to reduce them. [ABSTRACT FROM AUTHOR]

The authors discuss the use of wastewater-based epidemiology to estimate the size of illicit psychoactive drug markets and evaluate the effectiveness of public health policies which aim to reduce the harm caused by licit and illicit drug use. Topics include a study by Burgard et al which focuses on the use of wastewater-based analysis to monitor the effects of legalized retail sales on cannabis consumption in Washington, and challenges associated with analyzing Tetrahydrocannabinol (THC) levels in wastewater.

Explains why it is unwise to use genetic and neurobiological knowledge to prevent cigarette smoking and tobacco-related disease. Genetics of smoking; Predictive testing for genetic risks of nicotine dependence; Preventive use of a nicotine vaccine.

Abstract: Tobacco harm reduction (THR) policies aim to reduce the prevalence of tobacco-related harm by encouraging smokers who are unable or unwilling to quit to adopt less harmful ways of obtaining nicotine, such as pharmaceutical nicotine and oral tobacco snuff. Proponents of THR argue that the effects of tobacco control policies have reduced smoking as much as they reasonably can and that we can best reduce tobacco-related harm by encouraging smokers to use these methods, which substantially reduce the health risks of smoking. Critics argue that THR policies will undermine the two traditional tobacco control goals of preventing the uptake of smoking by young people and encouraging smokers to quit. I assess the main arguments and evidence advanced for and against THR. [Copyright &y& Elsevier]

Current pharmacotherapies for psychiatric disorders are generally incompletely effective. Many patients do not respond well or suffer adverse reactions to these drugs, which can result in poor patient compliance and poor treatment outcome. Adverse drug reactions and non-response are likely to be influenced by genetic polymorphisms. Pharmacogenetics holds some promise for improving the treatment of mood disorders by utilising information about genetic polymorphisms to match patients to the drug therapy that is the most effective with the fewest side effects. Pharmacogenomics promises to facilitate the development of new drugs for treatment. However, these technologies raise many ethical, economic and regulatory issues that need to be addressed before they can be integrated into psychiatry, and medicine more generally. We discuss ethical and policy issues arising from pharmacogenetic testing and pharmacogenomics research, such as informed consent, privacy and confidentiality, research on vulnerable persons and discrimination; and economic viability of pharmacogenetics and pharmacogenomics. We conclude with recommendations for the regulation and distribution of pharmacogenetic testing services and pharmacogenomic drugs. [ABSTRACT FROM AUTHOR]

To summarize current knowledge about genetic susceptibility to mood disorders and examine ethical and policy issues that will need to be addressed if robustly replicated susceptibility alleles lead to proposals to screen and intervene with persons at increased genetic risk of developing mood disorders. Empirical studies and reviews of the genetics of unipolar and bipolar depression were collected via MEDLINE and psycINFO database searches. A number of candidate genes for depression have been identified, each of which increases the risk of mood disorders two- or threefold. None of the associations between these alleles and mood disorders have been consistently reported to date. Screening the population for genetic susceptibility to mood disorders is unlikely to be a practically useful policy (given plausible assumptions). Until there are effective treatments for persons at increased risk, screening is arguably unethical. Screening within affected families to advise on risks of developing depression would entail screening children and adolescents, raising potentially serious ethical issues of consent and stigmatization. Genetic research on depression should continue under appropriate ethical guidelines that protect the interests of research participants. [ABSTRACT FROM AUTHOR]

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]

Randomized controlled trials (RCTs) are considered the gold standard for causal inference. With a sufficient sample size, randomization removes confounding up to the time of randomization and allows the treatment effect to be isolated. However, RCTs may have limited generalizability and transportability and are often not feasible in addiction research due to ethical or logistical constraints. The importance of observational studies from real‐world settings has been increasingly recognized in research on health. This paper provides an overview of modern approaches to designing observational studies that enable causal inference. It illustrates three key techniques, Directed Acyclic Graphs (DAGs), modified Disjunctive Cause Criterion and Target Trial Emulation, and discusses the strengths and limitations of their applications. [ABSTRACT FROM AUTHOR]

Five-year standardized mortality rates for a cohort of elderly depressed patients in Perth, Western Australia, were greater than expected (M = 2.047, F = 1.658). These results were very similar to the 4-year rates in a London study (Murphy es al., 1988). as were the causes of death. There was a significantly greater chance of being alive at the end of 5 years if, on entry to the study, the patients were: female, less than 75 years of age. had no impairment of mobility, had a diagnosis of major depression with melancholia and psychosis, and had a good recovery from the depressive illness at the end of 12 months. Impairment of mobility was the best physical status indicator of subsequent mortality. Two measures of patient's sell-assessment of physical status were as good predictors of mortality as a physician assessment of health, other than impairment of mobility. [ABSTRACT FROM AUTHOR]

Examines the performance of the Alcohol Use Disorders Identification Test (AUDIT) in predicting alcohol-related harm over the full range of its scores using receiver operating characteristic analyses. Screening for hazardous alcohol intake in prim ary health care settings; Interview of a sample of ambulatory care patients; Use of a detailed assessment schedule.

Introduction: Substance use, including drugs, alcohol and smoking have a significant health, social and economic impact. We aim to assess the rate and factors associated with treatment access among individuals with high‐risk substance use. Method: This study is a cross‐sectional analysis of the 2019 Australian National Drug Strategy Household Survey (N = 22,015). Participants were persons with high‐risk substance use based on the Alcohol, Smoking and Substance Involvement Screening Test—Lite (ASSIST‐Lite) and current smokers. We measured self‐reports of past 12‐month engagement in a tobacco, alcohol or other drugs treatment program. Results: Overall, 0.4% had high‐risk drug use (0.3% cannabis, 0.1% meth/amphetamine or 0.1% opioids), 7.4% had high‐risk alcohol use, and 14.0% currently smoked. Among high‐risk users, past 12‐month treatment access rates were 50.6% [22.3–78.9%] for opioids, 27.1% [8.1–46.1%] for meth/amphetamine, 14.5% [4.3–24.7%] for cannabis, 9.6% [8.1–11.0%] for alcohol and 11.7% [10.6–12.9%] for current smoking. The primary source of treatment support was information and education (12.7% drugs, 4.6% alcohol, 4.0% smoking), followed by counselling (6.7% drugs, 4.5% alcohol, 3.0% smoking). Online or internet support was accessed by 5.9% (drug) and 1.6% (alcohol) people with high‐risk use. Psychological distress was associated with treatment access (drugs: odds ratio 3.03 [0.77–11.95], p = 0.111; alcohol: odds ratio 3.16 [2.20–4.56], p ≤ 0.001; smoking: odds ratio 1.95 [1.52–2.49], p ≤ 0.001). Discussion and Conclusions: The proportion of people engaging in risky substance use who had used treatment programs remains low, especially for alcohol. Public health strategies to scale up treatment access are warranted. [ABSTRACT FROM AUTHOR]

The author reflects on the need to asses the effectivity of neuropharmaceuticals in enhancing the cognitive functions and to be cautious on the use of such drugs. The author cites a report which showed that there was a limited proof of the ability of cognitive enhancer drugs, such as stimulants, and impact on long-term memory and verbal learning were less. The author notes the addiction to drugs, such as cocaine and amphetamines, which are known to improve cognition.

This article presents a clinical update on the treatment of people who are dependent on illicit opioids. This is a persistent problem and one that does not have a good record of being overcome. Various treatments are discussed from detoxification centers to methadone therapy. Methadone maintenance has been the only approved form of treatment in many countries but there is a wider choice of opioid agonists available. The use of 1-α-acetylmethadol (LAAM) is just as effective and the dosing frequency is less. Buprenorphine has been approved in some countries and it has less severe withdrawal symptoms than methadone. There is research being conducted on the use of codeine which looks promising.

The article comments on the use of surrogate and real outcomes in regulatory decisions about new cancer drugs. It discusses whether common intermediate outcomes for common cancers predict these outcomes well enough. It presents an industry perspective on the role of surrogate outcomes in oncology drug development. The legislative basis for funding medicines by the taxpayer through the Pharmaceutical Benefits Scheme in Australia is given.

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]

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]

The contribution that current patterns of cannabis use make to the burden of disease is very useful information, but it cannot decide policy. [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]

Background and Aims: Heated tobacco products (HTPs) are electronic devices that heat process tobacco to release an aerosol containing nicotine and other chemicals. Limited data exist on world‐wide HTP use prevalence. This meta‐analytic review estimated the prevalence of HTP use by country, World Health Organization (WHO) region, year, sex/gender and age. Methods: Five databases (Web of Science, Scopus, Embase, PubMed and PsycINFO) were searched between January 2015 and May 2022. Included studies reported the prevalence of HTP use in nationally representative samples post‐modern HTP device market entry (2015). A random‐effects meta‐analysis was used to estimate overall prevalence for life‐time, current and daily HTP use. Results: Forty‐five studies (n = 1 096 076) from 42 countries/areas from the European Region (EUR), Western Pacific Region (WPR), Region of the Americas (AMR) and African Region (AFR) met inclusion criteria. Estimated pooled prevalence for life‐time, current and daily HTP use was 4.87% [95% confidence interval (CI) = 4.16, 5.63], 1.53% (95% CI = 1.22, 1.87) and 0.79% (95% CI = 0.48, 1.18), respectively, across all years (2015–22). Life‐time HTP use prevalence significantly increased by 3.39% for WPR [0.52% (95% CI = 0.25, 0.88) in 2015 to 3.91% (95% CI = 2.30, 5.92) in 2019] and 5.58% for EUR [1.13% (95% CI = 0.59, 1.97) in 2016 to 6.98% (95% CI = 5.69, 8.39) in 2020]. Current HTP use increased by 10.45% for WPR [0.12% (95% CI = 0, 0.37) in 2015 to 10.57% (95% CI = 5.59, 16.88) in 2020] and 1.15% for EUR [0% (95% CI = 0, 0.35) in 2016 to 1.15% (95% CI = 0.87, 1.47) in 2020]. Meta‐regression revealed higher current HTP use in WPR [3.80% (95% CI = 2.88, 4.98)] compared with EUR [1.40% (95% CI = 1.09, 1.74)] and AMR [0.81% (95% CI = 0.46, 1.26)] and for males [3.45% (95% CI = 2.56, 4.47)] compared with females [1.82% (95% CI = 1.39, 2.29)]. Adolescents had higher life‐time HTP use prevalence [5.25% (95% CI = 4.36, 6.21) than adults [2.45% (95% CI = 0.79, 4.97)]. Most studies scored a low risk of sampling bias due to their nationally representative sampling. Conclusion: The prevalence of HTPs use increased in the EUR and WPR between 2015 and 2020, with nearly 5% of the included populations having ever tried HTP and 1.5% identifying as current users during the study period. [ABSTRACT FROM AUTHOR]

This review examines evidence for the effectiveness of cannabinoids in chronic noncancer pain (CNCP) and addresses gaps in the literature by: considering differences in outcomes based on cannabinoid type and specific CNCP condition; including all study designs; and following IMMPACT guidelines. MEDLINE, Embase, PsycINFO, CENTRAL, and clinicaltrials.gov were searched in July 2017. Analyses were conducted using Revman 5.3 and Stata 15.0. A total of 91 publications containing 104 studies were eligible (n = 9958 participants), including 47 randomised controlled trials (RCTs) and 57 observational studies. Forty-eight studies examined neuropathic pain, 7 studies examined fibromyalgia, 1 rheumatoid arthritis, and 48 other CNCP (13 multiple sclerosis-related pain, 6 visceral pain, and 29 samples with mixed or undefined CNCP). Across RCTs, pooled event rates (PERs) for 30% reduction in pain were 29.0% (cannabinoids) vs 25.9% (placebo); significant effect for cannabinoids was found; number needed to treat to benefit was 24 (95% confidence interval [CI] 15-61); for 50% reduction in pain, PERs were 18.2% vs 14.4%; no significant difference was observed. Pooled change in pain intensity (standardised mean difference: -0.14, 95% CI -0.20 to -0.08) was equivalent to a 3 mm reduction on a 100 mm visual analogue scale greater than placebo groups. In RCTs, PERs for all-cause adverse events were 81.2% vs 66.2%; number needed to treat to harm: 6 (95% CI 5-8). There were no significant impacts on physical or emotional functioning, and low-quality evidence of improved sleep and patient global impression of change. Evidence for effectiveness of cannabinoids in CNCP is limited. Effects suggest that number needed to treat to benefit is high, and number needed to treat to harm is low, with limited impact on other domains. It seems unlikely that cannabinoids are highly effective medicines for CNCP. [ABSTRACT FROM AUTHOR]

Issues: Established literature suggests that electronic cigarettes (EC) are more effective than traditional nicotine replacement therapies (NRT) as a smoking cessation aid, but the factors that mediate this difference remain poorly understood. We examine how adverse events (AE) associated with EC use relative to NRTs differ, with the view that differences in AEs experienced may drive differences in use and compliance. Approach: Papers for inclusion were identified via a three‐tiered search strategy. Eligible articles involved healthy participants and compared nicotine ECs to non‐nicotine ECs or NRTs and reported frequency of AE as an outcome. Random‐effects meta‐analyses were conducted to compare the likelihood for each of the AEs between nicotine ECs, non‐nicotine placebo ECs and NRTs. Key Findings: A total of 3756 papers were identified, of which 18 were meta‐analysed (10 cross‐sectional and 8 randomised controlled trials). Meta‐analytic results found no significant difference in the rates of reported AEs (i.e., cough, oral irritation, nausea) between nicotine ECs and NRTs, and between nicotine and non‐nicotine placebo ECs. Implications: The variation in the incidence of AEs likely does not explain user preferences of ECs to NRTs. Incidence of common AEs reported because of EC and NRT use did not differ significantly. Future work will need to quantify both the adverse and favourable effects of ECs to understand the experiential mechanisms that drive the high uptake of nicotine ECs relative to established NRTs. Conclusions: There is inconclusive evidence on the incidence of AEs experience when using ECs compared to NRTs, possibly given the small sample size of studies. [ABSTRACT FROM AUTHOR]