Showing papers by "Wayne Hall published in 2016"
TL;DR: Substantial variation is noted between countries in the levels, types, and sequences of substance use in young people, indicating that a young person's use of substances depends on their social context, drug availability, and their personal characteristics.
329 citations
TL;DR: Funding is needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people, with uncertain applicability in other countries and cultures and in subpopulations differing in sex, age, and risk status.
259 citations
TL;DR: In this article, the authors reviewed the drug policy literature to identify plausible effects of legalizing adult recreational use on cannabis price and availability, factors that may increase or limit these effects, and indicators of cannabis use and cannabis-related harm that can be monitored to assess the effects of these policy changes.
Abstract: BACKGROUND AND AIMS: Since 2012 four US states have legalized the retail sale of cannabis for recreational use by adults and more are likely to follow. This report aimed to (1) briefly describe the regulatory regimes so far implemented; (2) outline their plausible effects on cannabis use and cannabis-related harm; and (3) suggest what research is needed to evaluate the public health impact of these policy changes. METHOD: We reviewed the drug policy literature to identify: (1) plausible effects of legalizing adult recreational use on cannabis price and availability; (2) factors that may increase or limit these effects; (3) pointers from studies of the effects of legalizing medical cannabis use; and (4) indicators of cannabis use and cannabis-related harm that can be monitored to assess the effects of these policy changes. RESULTS: Legalization of recreational use will probably increase use in the long run but the magnitude and timing of any increase is uncertain. It will be critical to monitor: cannabis use in household and high school surveys; cannabis sales; the number of cannabis plants legally produced; and the THC content of cannabis. Indicators of cannabis-related harms that should be monitored include: car crash fatalities and injuries; emergency department presentations; presentations to addiction treatment services; and the prevalence of regular cannabis use among young people in mental health services and the criminal justice system. CONCLUSIONS: Plausible effects of legalizing recreational cannabis use in the USA include substantially reducing the price of cannabis and increasing heavy use and some types of cannabis-related harm among existing users. In the longer term it may also increase the number of new users.This article is protected by copyright. All rights reserved. Language: en
251 citations
TL;DR: A key research priority is to improve the diagnosis and treatment of most affected people who have comorbid mental and other drug use disorders.
250 citations
TL;DR: In 2013, an estimated 10·08 million DALYs were attributable to previous exposure to HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) via IDU, a four-times increase since 1990 as mentioned in this paper.
Abstract: Summary Background Previous estimates of the burden of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. We aimed to provide these estimates as part of the Global Burden of Disease (GBD) Study 2013. Methods We modelled the burden of HBV and HCV (including cirrhosis and liver cancer burden) and HIV at the country, regional, and global level. We extracted United Nations data on the proportion of notified HIV cases by transmission route, and estimated the contribution of injecting drug use (IDU) to HBV and HCV disease burden by use of a cohort method that recalibrated individuals' history of IDU, and accumulated risk of HBV and HCV due to IDU. We estimated data on current IDU from a meta-analysis of HBV and HCV incidence among injecting drug users and country-level data on the incidence of HBV and HCV between 1990 and 2013. We calculated estimates of burden of disease through years of life lost (YLL), years of life lived with disability (YLD), deaths, and disability-adjusted life-years (DALYs), with 95% uncertainty intervals (UIs) calculated for each metric. Findings In 2013, an estimated 10·08 million DALYs were attributable to previous exposure to HIV, HBV, and HCV via IDU, a four-times increase since 1990. In total in 2013, IDU was estimated to cause 4·0% (2·82 million DALYs, 95% UI 2·4 million to 3·8 million) of DALYs due to HIV, 1·1% (216 000, 101 000–338 000) of DALYs due to HBV, and 39·1% (7·05 million, 5·88 million to 8·15 million) of DALYs due to HCV. IDU-attributable HIV burden was highest in low-to-middle-income countries, and IDU-attributable HCV burden was highest in high-income countries. Interpretation IDU is a major contributor to the global burden of disease. Effective interventions to prevent and treat these important causes of health burden need to be scaled up. Funding Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.
205 citations
TL;DR: The number of harms that are causally related to substance use in young people warrant high-quality research design interventions to prevent or ameliorate these harms.
201 citations
01 Mar 2016
TL;DR: This publication builds on contributions from a broad range of experts and researchers from different parts of the world and aims to present the current knowledge on the impact of nonmedical cannabis use on health.
Abstract: Cannabis is globally the most commonly used psychoactive substance under international control. In 2013, an estimated 181.8 million people aged 15-64 years used cannabis for nonmedical purposes globally (uncertainty estimates 128.5–232.1 million) (UNODC, 2015). There is an increasing demand of treatment for cannabis use disorders and associated health conditions in high- and middle-income countries, and there has been increased attention to the public health aspects of cannabis use and related disorders in international drug policy dialogues.
This publication builds on contributions from a broad range of experts and researchers from different parts of the world. It aims to present the current knowledge on the impact of nonmedical cannabis use on health.
193 citations
TL;DR: It is argued that the use of food addiction as a diagnostic category is premature and the potential positive and negative clinical, social, and public policy implications of describing obesity as a food addiction that require further investigation.
Abstract: There is a growing view that certain foods, particularly those high in refined sugars and fats, are addictive and that some forms of obesity can usefully be treated as a food addiction. This perspective is supported by a growing body of neuroscience research demonstrating that the chronic consumption of energy-dense foods causes changes in the brain's reward pathway that are central to the development and maintenance of drug addiction. Obese and overweight individuals also display patterns of eating behavior that resemble the ways in which addicted individuals consume drugs. We critically review the evidence that some forms of obesity or overeating could be considered a food addiction and argue that the use of food addiction as a diagnostic category is premature. We also examine some of the potential positive and negative clinical, social, and public policy implications of describing obesity as a food addiction that require further investigation.
141 citations
TL;DR: The number of regular and dependent methamphetamine users in Australia is estimated to be between 1,000 and 2,000 per year, depending on whether they are regular or dependent on the drug.
Abstract: 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. Language: en
97 citations
TL;DR: A systematic review on e-mental health service use for depressive and anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base found that e- mental health services are predominantly used by females, and those who are more educated and socioeconomically advantaged.
Abstract: Background: Growing evidence attests to the efficacy of e-mental health services. There is less evidence on how to facilitate the safe, effective, and sustainable implementation of these services. Objective: We conducted a systematic review on e-mental health service use for depressive and anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base. Methods: Following the PRISMA protocol, we identified research (1) conducted in Australia, (2) on e-mental health services, (3) for depressive or anxiety disorders, and (4) on e-mental health usage, such as barriers and facilitators to use. Databases searched included Cochrane, PubMed, PsycINFO, CINAHL, Embase, ProQuest Social Science, and Google Scholar. Sources were assessed according to area and level of policy relevance. Results: The search yielded 1081 studies; 30 studies were included for analysis. Most reported on self-selected samples and samples of online help-seekers. Studies indicate that e-mental health services are predominantly used by females, and those who are more educated and socioeconomically advantaged. Ethnicity was infrequently reported on. Studies examining consumer preferences found a preference for face-to-face therapy over e-therapies, but not an aversion to e-therapy. Content relevant to governance was predominantly related to the organizational dimensions of e-mental health services, followed by implications for community education. Financing and payment for e-services and governance of the information communication technology were least commonly discussed. Conclusions: Little research focuses explicitly on policy development and implementation planning; most research provides an e-services perspective. Research is needed to provide community and policy-maker perspectives. General population studies of prospective treatment seekers that include ethnicity and socioeconomic status and quantify relative preferences for all treatment modalities are necessary. [J Med Internet Res 2016;18(1):e10]
81 citations
TL;DR: In this article, the authors performed the first Australia-wide WBE monitoring to examine spatial patterns in the use of three illicit stimulants (cocaine, as its human metabolite benzoylecgonine; methamphetamine; and 3,4-methylendioxymethamphetamine (MDMA)).
TL;DR: It is argued that it is too early to see the full effects of legalised cannabis policies on use and harm because several factors could delay the full commercialisation of a legal cannabis industry.
TL;DR: A cumulative risk score can accurately predict which adolescents in the general population will develop persistent substance dependence in adulthood.
Abstract: Background To our knowledge, there are no universal screening tools for substance dependence that (1) were developed using a population-based sample, (2) estimate total risk briefly and inexpensively by incorporating a relatively small number of well-established risk factors, and (3) aggregate risk factors using a simple algorithm. We created a universal screening tool that incorporates these features to identify adolescents at risk for persistent substance dependence in adulthood. Method Participants were members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972–1973 and followed prospectively to age 38 years, with 95% retention. We assessed a small set of childhood and adolescent risk factors: family history of substance dependence, childhood psychopathology (conduct disorder, depression), early exposure to substances, frequent substance use in adolescence, sex, and childhood socioeconomic status. We defined the outcome (persistent substance dependence in adulthood) as dependence on one or more of alcohol, tobacco, cannabis, or hard drugs at ⩾3 assessment ages: 21, 26, 32, and 38 years. Results A cumulative risk index, a simple sum of nine childhood and adolescent risk factors, predicted persistent substance dependence in adulthood with considerable accuracy (AUC = 0.80). Conclusions A cumulative risk score can accurately predict which adolescents in the general population will develop persistent substance dependence in adulthood.
TL;DR: In this article, the authors examined trends in cocaine, 3,4-methylenedioxymethamphetamine (MDMA) and methamphetamine consumption by measuring their residues in wastewater from two wastewater treatment plants in Australia (specifically, an urban and a rural catchment, both in South East Queensland).
01 Jan 2016
TL;DR: In this article, the authors considered the potential eff ects of alcohol, tobacco, and illicit drug use during this period on: social, psychological, and health outcomes in adolescence and young adulthood; role transitions, and later health and social outcomes of regular substance use initiated in adolescence; and the off spring of young people who use substances.
Abstract: During puberty, when young people are completing their education, transitioning into employment, and forming longer-term intimate relationships, a shift in emotional regulation and an increase in risky behaviour, including substance use, is seen. This Series paper considers the potential eff ects of alcohol, tobacco, and illicit drug use during this period on: social, psychological, and health outcomes in adolescence and young adulthood; role transitions, and later health and social outcomes of regular substance use initiated in adolescence; and the off spring of young people who use substances. We sourced consistent support for causal relations between substance use and outcomes and evidence of biological plausibility from diff erent but complementary research designs. Many adverse health and social outcomes have been associated with diff erent types of substance use. The major challenge lies in deciding which are causal. Furthermore, qualitatively diff erent harms are associated with diff erent substances, diff erences in life stage when these harms occur, and the quality of evidence for diff erent substances and health outcomes varies substantially. The preponderance of evidence comes from a few high-income countries, thus whether the same social and health outcomes would occur in other countries and cultures is unclear. Nonetheless, the number of harms that are causally related to substance use in young people warrant high-quality research design interventions to prevent or ameliorate these harms.
TL;DR: 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.
Abstract: 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. 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. 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. 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.
TL;DR: In this paper, a content analysis was conducted to identify how smartphones are being used in these fields and to highlight the ethical issues raised by these studies, including personal information, geo-location, physiological activity, self-reports of mood and cravings, and the consumption of illicit drugs, alcohol and nicotine.
TL;DR: In this article, the excretion factors of methadone, its main metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), and codeine were used to refine the current excretion factor.
TL;DR: Students who choose coping responses that do not moderate stress where possible, may cause themselves additional distress and avoid learning more effective coping responses, and assisting students who may be inclined to use prescription stimulants for cognitive enhancement may reduce possible drug-related harms.
Abstract: Background: There are reports that some university students are using prescription stimulants for non-medical ‘pharmaceutical cognitive enhancement (PCE)’ to improve alertness, focus, memory, and mood in an attempt to manage the demands of study at university. Purported demand for PCEs in academic contexts have been based on incomplete understandings of student motivations, and often based on untested assumptions about the context within which stimulants are used. They may represent attempts to cope with biopsychosocial stressors in university life by offsetting students’ inadequate coping responses, which in turn may affect their cognitive performance. This study aimed to identify (a) what strategies students adopted to cope with the stress of university life and, (b) to assess whether students who have used stimulants for PCE exhibit particular stress or coping patterns. Methods: We interviewed 38 university students (with and without PCE experience) about their experience of managing student life, specifically their educational values, study habits and achievement, stress management, getting assistance, competing activities and responsibilities, health habits, and cognitive enhancement practices. All interview transcripts were coded into themes and analysed. Results: Our thematic analysis revealed that, generally, self-rated coping ability decreased as students’ self-rated stress level increased. Students used emotion- and problem-focused coping for the most part and adjustment-focused coping to a lesser extent. Avoidance, an emotion-focused coping strategy, was the most common, followed by problem-focused coping strategies, the use of cognition on enhancing substances, and planning and monitoring of workload. PCE users predominantly used avoidant emotion-focused coping strategies until they no longer mitigated the distress of approaching deadlines resulting in the use of prescription stimulants as a substance-based problem-focused coping strategy. Conclusion: Our study suggests that students who choose coping responses that do not moderate stress, where possible, may cause themselves additional distress and avoid learning more effective coping responses. Helping students to understand stress and coping, and develop realistic stress appraisal techniques, may assist students in general to maintain manageable distress levels and functioning. Furthermore, assisting students who may be inclined to use prescription stimulants for cognitive enhancement may reduce possible drug-related harms.
TL;DR: Trials of harm reduction options, such as nicotine replacement therapy and electronic cigarettes (e-cigarettes), are proposed as long-term substitutes for cigarettes in smokers with serious mental illness who are unable to quit smoking.
TL;DR: Despite removal of tolerance and withdrawal for prescribed opioid use for DSM-5, it was found that “Addiction” was more closely related to an ICD-11 diagnosis of pharmaceutical opioid dependence.
Abstract: The International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM) are routinely used in diagnosing illicit substance use disorders, but for people taking prescribed opioids they remain controversial. In pain medicine, the concept of "Addiction" is preferred with reduced emphasis on tolerance and withdrawal. This article examines the prevalence and characteristics of pharmaceutical opioid dependence/disorder according to ICD, DSM, and the pain medicine concept of "Addiction," among chronic noncancer pain (CNCP) patients prescribed opioids. In the current study, we used data from a national sample of 1134 people prescribed opioids for CNCP. Past 12-month "Addiction" (based on Pain Medicine definition), DSM, and ICD dependence definitions were assessed using the Composite International Diagnostic Interview. Twenty-four percent of the cohort met the criteria for "Addiction," 18% for DSM-5 use disorder and 19% for ICD-11 dependence. There was "substantial" concordance between "Addiction" and both DSM-5 use disorder and ICD-11 dependence, although concordance was much greater with ICD-11 dependence (kappa = 0.63 and 0.79, respectively). Participants meeting the criteria for "Addiction" only were older, less likely to engage in nonadherent behaviours, self-reported fewer problems or concerns with their medication, and had lower rates of psychological distress than those who also met the DSM-5 and ICD-11 criteria. The definition of "Addiction" captures a larger group of patients than other classification systems and includes people with fewer "risk" behaviours. Despite removal of tolerance and withdrawal for prescribed opioid use for DSM-5, we found that "Addiction" was more closely related to an ICD-11 diagnosis of pharmaceutical opioid dependence.
TL;DR: This study is one of the first to comprehensively examine general and pain-specific risk factors for suicidality in a large chronic pain sample in which suicidal ideation was common and a low pain self-efficacy score was the only factor independently associated past 12-month ideation-to-action.
Abstract: OBJECTIVES: The main objectives of the paper were (1) to examine the prevalence of suicidality in a large community-based chronic pain sample taking prescribed opioids for chronic pain; and (2) to examine general and pain-specific factors that predict such ideation, and the transition from ideation to making a suicide attempt (ideation-to-action). METHODS: Baseline data from the Pain and Opioids IN Treatment (POINT) study with a cohort of 1514 community-based people prescribed opioids for chronic non-cancer pain across Australia. RESULTS: Past 12 month suicidal ideation was reported by 36.5% of the cohort and 16.4% had made a lifetime suicide attempt (2.5% in the last 12 mo), after the onset of their pain condition. Suicidal ideation in the past 12 months was independently associated with a past suicide attempt (AOR 4.82, 95%CI 2.43-9.56) and past 12 month depression (AOR 4.07, 95%CI 1.88-8.78). Only a lower pain-self efficacy score was independently associated with past 12 month ideation-to-action (AOR 0.98, 95%CI0.88-0.99). Notably, only general suicide risk factors were associated with 12 month suicidal ideation; but for past-year ideation-to-action, pain specific factors also had independent associations. DISCUSSION: The study is one of the first to comprehensively examine general and pain-specific risk factors for suicidality in a large chronic pain sample in which suicidal ideation was common. A low pain self-efficacy score was the only factor independently associated past 12 month ideation-to-action. Language: en
TL;DR: The authors 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, and found that adolescents from rural areas were at higher risk of alcohol use compared to those living in major cities.
Abstract: 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
TL;DR: This research presents a novel probabilistic procedure that allows for direct measurement of the response of the immune system to earthquake-triggered landsliding.
TL;DR: Among people with CNCP, those who abstained from alcohol or drank at risky levels reported poorer pain outcomes compared with moderate drinkers.
TL;DR: This article examined the national trends in parental supply of alcohol to adolescent children in Australia since 1998 and found a significant drop in current alcohol use from 21.3% in 2004 to 11.79% in 2013 (p < 0.001).
Abstract: 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. 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. 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. 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.
TL;DR: Methylone use was stable in the study catchment during the monitoring period whereas mephedrone use has been declining after its peak in 2010, and more research is needed on the pharmacokinetics of emerging illicit drugs to improve the applicability of wastewater analysis in monitoring their use in the population.
01 Jan 2016
TL;DR: In this paper, the excretion factor of methadone, its main metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), and codeine was analyzed in wastewater analysis studies.
Abstract: Analysing drug residues in wastewater (wastewater analysis) to monitor the consumption of those drugs in the population has become a complementary method to epidemiological surveys. In this method, the excretion factor of a drug (or the percentage of drug metabolites excreted through urine) is a critical parameter for the back-estimation of the consumption of a drug. However, this parameter is usually derived from a small database of human pharmacokinetic studies. This is true for methadone and codeine, the two most commonly used opioids and also common substances of abuse. Therefore, we aimed to refine the current excretion factors used for estimating methadone and codeine by analysing published data from the literature on the excretion of methadone, its main metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), and codeine. Our review included both human drug pharmacokinetic studies wastewater analysis studies. We found that while the commonly used excretion factor of methadone (~27.5%) was relatively accurate, the excretion factor of EDDP, a better biomarker for methadone consumption in sewer epidemiology, should be twice that of methadone (i.e. 55%) instead of the current equal or half values. For codeine, the excretion factor should be ~30% instead of 63.5% or 10% as previously used in wastewater analysis studies. Data from wastewater analysis studies could be used in this way to refine the excretion factors of the drugs of interest.
TL;DR: Compared with MDT, WWA provides a more comprehensive picture of prison substance use and has the potential to measure the misuse of medically prescribed substances.
Abstract: Wastewater analysis (WWA) is intended to be a direct and objective method of measuring
substance use in large urban populations. It has also been used to measure prison substance use in
two previous studies. The application of WWA in this context has raised questions as to how best it
might be used to measure illicit drug use in prisons, and whether it can also be used to measure
prescription misuse. We applied WWA to a small regional prison to measure the use of 12 licit and
illicit substances. We attempted to measure the non-medical use of methadone and buprenorphine and to compare our findings with the results of the prison’s mandatory drug testing (MDT). Design and Methods. Representative daily composite samples were collected for two periods of 12 consecutive days in May to July 2013 and analysed for 18 drug metabolites. Prescription data and MDT results were obtained from the prison and compared with the substance use estimates calculated from WWA data. Results. Daily use of methamphetamine, methadone, buprenorphine and codeine was detected, while sporadic detection of ketamine and methylone was also observed. Overall buprenorphine misuse appeared to be greater than methadone misuse. Discussion and Conclusions. Compared with MDT, WWA provides a more comprehensive picture of prison substance use. WWA also has the potential to measure the misuse of medically prescribed substances. However, a great deal of care must be exercised in quantifying the usage of any substance in small populations, such as in prisons.
01 Jan 2016
Abstract: We did a systematic review of reviews with evidence on the effectiveness of prevention, early intervention, harm reduction, and treatment of problem use in young people for tobacco, alcohol, and illicit drugs (eg, cannabis, opioids, amphetamines, or cocaine). Taxation, public consumption bans, advertising restrictions, and minimum legal age are effective measures to reduce alcohol and tobacco use, but are not available to target illicit drugs. Interpretation of the available evidence for school-based prevention is affected by methodological issues; interventions that incorporate skills training are more likely to be effective than information provision-which is ineffective. Social norms and brief interventions to reduce substance use in young people do not have strong evidence of effectiveness. Roadside drug testing and interventions to reduce injection-related harms have a moderate-to-large effect, but additional research with young people is needed. Scarce availability of research on interventions for problematic substance use in young people indicates the need to test interventions that are effective with adults in young people. Existing evidence is from high-income countries, with uncertain applicability in other countries and cultures and in subpopulations differing in sex, age, and risk status. Concerted efforts are needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people.