Showing papers in "Drug and Alcohol Review in 2022"

Changes in alcohol use during the COVID‐19 pandemic in Europe: A meta‐analysis of observational studies

Abstract: Abstract Issues Numerous studies have examined the impact of the COVID‐19 pandemic on alcohol use changes in Europe, with concerns raised regarding increased use and related harms. Approach We synthesised observational studies published between 1 January 2020 and 31 September 2021 on self‐reported changes in alcohol use associated with COVID‐19. Electronic databases were searched for studies evaluating individual data from European general and clinical populations. We identified 646 reports, of which 56 general population studies were suitable for random‐effects meta‐analyses of proportional differences in alcohol use changes. Variations by time, sub‐region and study quality were assessed in subsequent meta‐regressions. Additional 16 reports identified were summarised narratively. Key Findings Compiling reports measuring changes in overall alcohol use, slightly more individuals indicated a decrease than an increase in their alcohol use during the pandemic [3.8%, 95% confidence interval (CI) 0.00–7.6%]. Decreases were also reported more often than increases in drinking frequency (8.0%, 95% CI 2.7–13.2%), quantity consumed (12.2%, 95% CI 8.3–16.2%) and heavy episodic drinking (17.7%, 95% CI 13.6–21.8%). Among people with pre‐existing high drinking levels/alcohol use disorder, high‐level drinking patterns appear to have solidified or intensified. Implications Pandemic‐related changes in alcohol use may be associated with pre‐pandemic drinking levels. Increases among high‐risk alcohol users are concerning, suggesting a need for ongoing monitoring and support from relevant health‐care services. Conclusion Our findings suggest that more people reduced their alcohol use in Europe than increased it since the onset of the pandemic. However high‐quality studies examining specific change mechanisms at the population level are lacking.

A critical analysis of 'Electronic cigarettes and health outcomes: Systematic review of global evidence'.

Abstract: Dr Colin Mendelsohn was a Board Member of the Australian Tobacco Harm Reduction Association (ATHRA), a registered health promotion charity, from October 2017 to January 2020 and Dr Alex Wodak is a Board Member of ATHRA. ATHRA accepted unconditional seed funding from the vape retail industry to get established. Funding ceased in March 2019. Drs Colin Mendelsohn and Alex Wodak were Directors of ATHRA in March 2018 when it received a donation from Knowledge Action Change Communications, a private sector public health agency in the UK. The donation was sourced from a surplus arising from the Global Forum on Nicotine conference in May 2017. Knowledge Action Change Communications is legally separate from Knowledge Action Change (KAC). KAC has received two grants from tobacco companies: (i) In 2012, KAC received a small development research grant from Nicoventures (owned at the time by British American Tobacco) for evaluating the use of a nicotine delivery device in Scottish Prisons. The study was conducted in conjunction with the Scottish Prison Service. This funding was publicly declared. (ii) In 2018, The Foundation for a Smoke-Free World provided a grant specifically for the preparation of The Global State of Tobacco Harm Reduction report, an international review of tobacco harm reduction and the regulations involved. The Foundation for a Smoke-Free World is funded by an annual grant from Philip Morris International. Under the Foundation's bylaws and pledge agreement, Philip Morris International and the tobacco industry are precluded from having any influence over how the Foundation spends its funds or focuses its activities. Dr Colin Mendelsohn is the author of Stop Smoking Start Vaping, published by Aurora Press. He has never received payments from electronic cigarette or tobacco companies. Dr Alex Wodak has never received payments from electronic cigarette or tobacco companies. Professors Wayne Hall and Ron Borland have no interests to declare.

Getting high for likes: Exploring cannabis-related content on TikTok.

Abstract: INTRODUCTION With over 1 billion monthly users globally, a third of whom are under 14 years, TikTok's popularity is indisputable. Publicly available cannabis-related content on this platform may influence perceptions of cannabis use. We aimed to examine how cannabis-related videos are portrayed on TikTok. METHODS Data were collected from TikTok using hashtag-based keywords on cannabis-related videos (n = 1377). Seven researchers documented video metrics (i.e. views, likes, comments) and independently coded videos for sentiment and theme. RESULTS After removing duplicates and non-related content, the final sample contained 881 videos. These videos had a median view count of 518 700 (SD = ±1 082 905), median likes count of 99 900 (SD = ±206 647) and median comment count of 931 (SD = ±2977). Many videos portrayed cannabis use positively (54.14%; collectively viewed 417 million times), with 15.84% of this subset actively depicting cannabis or administration products. The thematic analysis identified seven non-mutually exclusive themes. Content portraying cannabis use as entertaining or humorous accounted for 71.74% of videos, with a further 42.90% discussing personal cannabis use experiences and 24.63% promoting the social and cultural acceptability of cannabis use. DISCUSSION AND CONCLUSIONS Our sample revealed over half of videos portrayed cannabis use positively and none were age restricted. All were publicly accessible through standard web and smartphone applications. With previous research demonstrating that exposure to cannabis-related content can influence adolescents' attitudes and problematic cannabis use, it is important more effective age restrictions and regulations are introduced to social media platforms.

Interrupted time series analysis of Canadian legal cannabis sales during the COVID‐19 pandemic

Abstract: Abstract Introduction There were repeated reports of increased cannabis sales, use and health impacts in Canada during the COVID‐19 pandemic. However, it was unclear whether the increases were due to pandemic effects or industry expansion. Methods We performed interrupted time series regressions of monthly per capita legal cannabis sales from March 2019 to February 2021, first with national averages, then with provincial/territorial data after adjusting for store density. We considered two interruption alternatives: January 2020, when product variety increased; and March 2020, when pandemic restrictions began. Results The provincial/territorial regression with the January interruption explained R 2 = 69.6% of within‐jurisdiction variation: baseline monthly per capita sales growth averaged $0.21 (95% confidence interval [CI] 0.15, 0.26), sales immediately dropped in January by $1.02 (95% CI −1.67, −0.37), and monthly growth thereafter increased by $0.16 (95% CI 0.06, 0.25). With the March interruption, the regression instead explained 68.7% of variation: baseline sales growth averaged $0.14 (95% CI 0.06, 0.22), there was no immediate drop and growth thereafter increased by $0.22 per month (95% CI 0.08, 0.35). Discussion and Conclusions Increasing cannabis sales during the pandemic was consistent with pre‐existing trends and increasing store numbers. The extra increased growth was more aligned with January's new product arrivals than with March's pandemic measures, though the latter cannot be ruled out. We found little evidence of pandemic impacts on Canada's aggregate legal cannabis sales. We therefore caution against attributing increased population‐level cannabis use or health impacts primarily to the pandemic.

Correlates of e-cigarette use before and after comprehensive regulatory changes and e-liquid flavour ban among general population.

Abstract: INTRODUCTION In 2016, the Finnish Tobacco Act was revised to harmonise e-cigarette regulations with the EU Tobacco Products Directive. Unlike before, the sale of nicotine-containing e-liquids was allowed while additional national regulations included, for example, a ban for other than unflavoured and tobacco-flavoured e-liquids. This study examines the correlates of e-cigarette use before and after the comprehensive regulatory change, and characteristics and correlates of flavoured e-cigarette use after the flavour ban in the general Finnish population. METHODS Repeated cross-sectional population-based drug surveys for 15-69-year-olds in 2014 (n = 3485; 50% response rate) and in 2018 (n = 3229; 46%). Correlates of e-cigarette use were studied with logistic regression models. RESULTS Current e-cigarette use remained infrequent (approximately 2%) and the correlates of e-cigarette use varied only slightly between the study years. In 2018, of past-year e-cigarette users (n = 316), 43% used unflavoured e-liquids, 24% used tobacco and 43% used other flavours, fruits being the most common. In univariate models, demographic variables, smoking and e-cigarette use-related factors were associated with flavoured e-cigarette use. In multivariable models, those who used e-cigarettes to experiment used unflavoured e-cigarettes more likely than other than tobacco flavours (odds ratio 3.00, 95% confidence interval 1.15-7.82). DISCUSSION AND CONCLUSIONS In Finland, the regulated entry of nicotine-containing e-liquids to retail sales has not led to increased e-cigarette use in the general population. After the flavour ban, other than tobacco-flavoured e-cigarette use still occurs. The use of flavoured e-cigarettes is associated with reasons for e-cigarette use. Flavoured e-cigarette use and its correlates warrant further monitoring.

Alcohol minimum unit pricing and people experiencing homelessness: A qualitative study of stakeholders' perspectives and experiences

Abstract: Abstract Introduction Minimum unit pricing (MUP) may reduce harmful drinking in the general population, but there is little evidence regarding its impact on marginalised groups. Our study is the first to explore the perceptions of MUP among stakeholders working with people experiencing homelessness following its introduction in Scotland in May 2018. Methods Qualitative semi‐structured interviews were conducted with 41 professional stakeholders from statutory and third sector organisations across Scotland. We explored their views on MUP and its impact on people experiencing homelessness, service provision and implications for policy. Data were analysed using thematic analysis. Results Participants suggested that the introduction of MUP in Scotland had negligible if any discernible impact on people experiencing homelessness and services that support them. Most service providers felt insufficiently informed about MUP prior to its implementation. Participants reported that where consequences for these populations were evident, they were primarily anticipated although some groups were negatively affected. People experiencing homelessness have complex needs in addition to alcohol addiction, and changes in the way services work need to be considered in future MUP‐related discussions. Discussion and Conclusions This study suggests that despite initial concerns about potential unintended consequences of MUP, many of these did not materialise to the levels anticipated. As a population‐level health policy, MUP is likely to have little beneficial impact on people experiencing homelessness without the provision of support to address their alcohol use and complex needs. The additional needs of certain groups (e.g., people with no recourse to public funds) need to be considered.

Trends in methamphetamine use, markets and harms in Australia, 2003-2019.

Abstract: INTRODUCTION To describe trends in methamphetamine use, markets and harms in Australia from 2003 to 2019. METHODS Data comprised patterns of use and price from sentinel samples of people who inject drugs and who use MDMA/other illicit stimulants and population-level amphetamine-related police seizures, arrests, hospitalisations, treatment episodes and deaths from approximately 2003 to 2019. Bayesian autoregressive time-series models were analysed for: no change; constant rate of change; and change over time differing in rate after one to three changepoints. Related indicators were analysed post hoc with identical changepoints. RESULTS The percentage of people who inject drugs reporting weekly use increased from 2010 to 2013 onwards, while use among samples of people who regularly use ecstasy and other illicit stimulants decreased. Seizures and arrests rose steeply from around 2009/10 to 2014/15 and subsequently plateaued. Price increased ($15.9 [95% credible interval, CrI $9.9, $28.9] per point of crystal per year) from around 2009 to 2011, plateauing and then declining from around 2017. Hospitalisation rates increased steeply from around 2009/10 until 2015/16, with a small subsequent decline. Treatment also increased (19.8 episodes [95% CrI 13.2, 27.6] with amphetamines as the principal drug of concern per 100 000 persons per year) from 2010/11 onwards. Deaths involving amphetamines increased (0.285 per 100 000 persons per year) from 2012 until 2016. DISCUSSION AND CONCLUSIONS These findings suggest that problematic methamphetamine use and harms escalated from 2010 to 2012 in Australia, with continued demand and a sustained market for methamphetamine.

The who and what of women's drinking: Examining risky drinking and associated socio-demographic factors among women aged 40-65 years in Australia.

Abstract: INTRODUCTION Recent trends in Australian national survey data show an increase in alcohol use among middle-aged people, amidst declines in alcohol use among other population groups. There is limited research, however, on middle-aged women's alcohol use. This study aimed to examine patterns in alcohol use among Australian women aged 40-65 and the associated sociodemographic and contextual factors. METHODS Cross-sectional data from six waves of the National Drug Strategy Household Survey (2001-2019). We estimated the prevalence of long-term risky drinking (>2 Australian standard drinks per day) and risky-single occasion drinking (>5 Australian standard drinks on one occasion) among middle-aged women. Logistic regression models were estimated using 2019 data to examine demographic characteristics and contextual factors associated with alcohol use. RESULTS Since 2001, there has been a statistically significant increase in long-term risky drinking and risky-single occasion drinking amongst middle-aged women in Australia. Educational attainment, marital status and employment status were negatively associated with risky drinking, whereas rurality, age and location of use were positively associated with risky drinking. Beverage type was both positively and negatively associated with risky drinking. DISCUSSION AND CONCLUSIONS Given the significant increase in alcohol use amongst middle-aged women in Australia, prevention efforts are needed for this group, which may focus in particular on home drinking and the impact of rurality on alcohol use.

Prevalence and correlates of cannabis use disorder among Australians using cannabis products to treat a medical condition.

Abstract: INTRODUCTION Prior research has examined the prevalence and correlates of cannabis use disorder (CUD) in people who use cannabis; however, these are poorly described for people using cannabis for medical reasons. METHODS Data came from a 2018 to 2019 online, anonymous, cross-sectional survey of Australians reporting using either illicit or licit cannabis for medical reasons within the past year. Included were questions on demographics, current and lifetime patterns of cannabis use, clinical conditions for which medical cannabis was used, and individual criteria for CUD and cannabis withdrawal syndrome. Bayesian Horseshoe logistic regression models were used to identify covariates associated with meeting CUD DSM-5 conditions for any-CUD (≥2/11 criteria) and moderate-severe-CUD (≥4/11). RESULTS A total of 905 participants were included in the analysis. The majority (98%) used illicit cannabis products. Criteria for any-CUD criteria were met by 290 (32.0%), and 117 (12.9%) met criteria for moderate-severe-CUD. Tolerance (21%) and withdrawal (35%) were the most commonly met criteria. Correlates with the strongest association with CUD were inhaled route of administration [odds ratio (OR) = 2.96, 95% credible interval 1.11, 7.06], frequency of cannabis use (OR = 1.24, 1.11-1.35), proportion of cannabis for medical reasons (OR = 0.83, 0.74, 0.94), frequency of tobacco use (OR = 1.10, 1.03, 1.17), age (OR = 0.75, 0.64, 0.90) and pain as main clinical indication (OR = 0.58, 0.36, 1.00). DISCUSSION AND CONCLUSIONS Prevalence of CUD in medical cannabis users appears comparable to 'recreational' users, with many similar correlates. CUD was associated with using cannabis to treat mental health rather than pain conditions and inhaled over other routes of administration.

Examining the cost and impact of dosing fees among clients in opioid agonist treatment: Results from a cross‐sectional survey of Australian treatment clients

Abstract: Abstract Introduction Opioid agonist treatment (OAT) clients frequently bear costs associated with their treatment, including dosing fees. This study aimed to explore the financial and social impact of dosing fees upon clients. Methods Cross‐sectional survey of people who use opioids regularly (N = 402) between December 2017 and March 2018, conducted in Australia. Dosing fees were calculated and expressed as percentage of income, by OAT type. Consequences and strategies for difficulties making payments were examined as proportions. Results A total of N = 360 participants had ever been in OAT and N = 245 participants currently engaged in OAT reported data on dosing fees, of them 53% (n = 129) reported paying dosing fees. Compared to clients with high levels of dosing supervision, those with moderate or low levels of supervision were more likely to pay dosing fees. The median 28‐day dosing fee was AUD$110 (interquartile range AUD$80); median 28‐day income was AUD$1520 (interquartile range AUD$700). For those who paid dosing fees, the fee comprised <10% of total monthly income for 70% of participants; however, 23% of participants paid fees comprising 10% to <20%, and 7% of participants paid fees comprising 20% or more of monthly income. Among those that had ever been in OAT, 72% experienced difficulties in paying treatment costs; 36% left treatment earlier than intended and 25% had been excluded due to payment difficulties. Discussion and Conclusions Negative consequences of treatment costs to clients, particularly dosing fees, are evident. These costs impact treatment access and retention that may negatively impact clients' physical health, mental health and social wellbeing.

Mapping the research addressing prescription drug monitoring programs: A scoping review.

Abstract: ISSUES Prescription drug monitoring programs are a harm minimisation intervention and clinical decision support tool that address the public health concern surrounding prescription drug misuse. Given the large number of studies published to date and the ongoing implementation of these programs, it is important to map the literature and identify areas for further research to improve practice. APPROACH A scoping review was undertaken to identify the research on prescription drug monitoring programs published between January 2015 and April 2021. KEY FINDINGS A total of 153 citations were included in this scoping review. The majority of the studies originated from the USA and were quantitative. Results on program effectiveness are mixed and mainly examine their association with opioid-related outcomes. Unintended consequences are revealed in the literature and this review also highlights barriers to program use. IMPLICATIONS Overall, findings are mixed despite the large number of studies published to date. Mapping the literature identifies priority areas for further research that can advise policymakers and clinicians on practice improvement. CONCLUSION Results on prescription drug monitoring program effectiveness are mixed and mainly examine their association with opioid-related outcomes. This review highlights barriers to prescription drug monitoring program effectiveness related to program use and system integration. Further research is needed in these areas to improve prescription drug monitoring program use and patient outcomes.

Health service utilisation and access for people who inject drugs during COVID‐19

Abstract: Abstract Introduction The wide‐spread implementation of interventions to limit transmission and public health consequences of COVID‐19 in the Australian state of Victoria had flow‐on consequences for people who use and inject drugs. Consequences included the interruption of illicit drug supply and drug procurement, and the disruption to the delivery of health services. To inform strategies that can minimise the adverse outcomes of similar future disruptive events, this study explored how COVID‐19 restrictions impacted access to harm reduction and drug treatment services for people who inject drugs in Melbourne, Victoria. Methods Qualitative semi‐structured interviews were conducted via an online calling app, with 11 participants of a broader cohort study (the SuperMIX study) in April 2020. Interviews were focused on participants experiences of accessing and using harm reduction and drug treatment services. Data were thematically analysed using a process of blended coding. Results Findings revealed how disruptions in the delivery of harm reduction and drug treatment services—in response to COVID‐19 restrictions—created barriers accessing sterile injecting equipment, increased risk of arrest by police and exacerbated social isolation. Participants reported difficulties adapting to changes in services access, with some increases in injecting risk behaviours. However, improvements in opioid agonist therapy prescriptions were noted as a beneficial outcome. Discussion By examining the impacts of COVID‐19 and the resultant restrictions on people who inject drugs' access to health services in Melbourne, Victoria, findings provide guidance for future responses to the unanticipated large‐scale effects of the COVID‐19 pandemic, and similar disruptive events.

A qualitative meta-synthesis of pregnant women's experiences of accessing and receiving treatment for opioid use disorder.

Abstract: ISSUES Addressing opioid use disorder (OUD) among pregnant women is of growing importance, and substance use treatment positively impacts outcomes for mother and baby. Understanding substance use treatment experiences is important to improve access, and retention, and no review or synthesis of research addressing the treatment experiences of pregnant women exists. APPROACH Thus, a qualitative meta-synthesis was conducted, which investigated the psychological motivators and barriers of pregnant women with OUD trying to access treatment and their perceptions of treatment. KEY FINDINGS A total of 3844 articles were retrieved from the literature search. Nine articles met eligibility criteria, were appraised, then synthesised using a comparative thematic approach. Four themes: (i) Embodied Experiences; (ii) Institutional Pressures; (iii) Social Context; and (iv) Reconstructing Selves; indicate that women with OUD are motivated to engage in treatment to pursue the safety and custody of the unborn baby and to pursue and enact the changes necessary to claim 'normal' parenthood status. Pregnant women describe psychological and relational barriers to engaging in treatment, including anxieties about the baby's health, fears of authorities' involvement, stigma and experiencing relationships with treatment providers as constrictive or invalidating. IMPLICATIONS Identity theory's concepts of identity verification, closed environments and master status identities illuminate the findings. Implications include recognising the salience of bodily experiences, providing medication-assisted treatment support groups and promoting validating relationships in treatment using strengths-based approaches. CONCLUSIONS Pregnant women face unique psychological challenges in accessing and engaging in substance use treatment for OUD.

COVID‐19 vaccination coverage and vaccine hesitancy among people with opioid use disorder in Barcelona, Spain

Abstract: Abstract Introduction People with substance use disorders are considered a priority group for SARS‐CoV‐2 vaccination as they are at elevated risk of COVID‐19 and its severe complications. However, data are scarce about vaccination coverage in a real‐world setting. Methods A descriptive study was conducted in people with opioid use disorder (OUD) from three public centres for outpatient drug addiction treatment in Barcelona, Spain, who received brief medical advice and were referred to vaccination clinic sites. Results Three hundred and sixty‐two individuals were included: 277 (77%) were men with a mean age of 48.1 ± 8.9 years and 77% were Spanish. Most (90%) participants engaged in polysubstance use and all individuals were on opioid agonist therapy. Psychiatric comorbidity was present in 56% subjects and 32% individuals had ≥1 chronic disease, 30% had HIV and 13% hepatitis C. There were 258 fully vaccinated individuals (71%; 95% confidence interval [CI] 67, 76). Age (odds ratio [OR] 1.04; 95% CI 1.01, 1.08; P < 0.01) and Charlson Comorbidity Index (OR 1.67; 95% CI 1.11, 2.5; P < 0.01) were associated with full vaccination. The vaccination hesitancy causes cited were complacency (53, 51%), convenience (40, 39%) and confidence (11, 10%). Discussion and Conclusions More than two‐thirds of our sample of people with OUD were fully vaccinated. Complacency and convenience represented a significant barrier to complete vaccination among people with OUD on opioid agonist therapy referred to vaccination clinic sites. Additional measures are necessary to increase vaccination, especially for younger individuals and those with less medical comorbidity. Integrating vaccination services in drug outpatient centres could be a useful alternative.

Kamini, a little recognised source of illicit opioid: A case series of 12 patients.

Abstract: INTRODUCTION This case series describes 12 patients who developed opioid use disorder after ingesting a prohibited, imported herbal product, Kamini, which contains Papaver somniferum. They appeared unaware of the risk of dependence from Kamini and most had struggled to manage their use for many months before presenting for treatment. METHODS After two cases were presented at a clinical meeting, a chart review was conducted of cases across four public opioid treatment clinics in south-east Queensland with about 1500 patients registered, identifying 10 further cases. RESULTS Twelve patients presented with features of opioid withdrawal, seeking treatment after use of Kamini for periods between 6 months and 8 years. Eleven patients were born in India. Nine patients stabilised on buprenorphine maintenance treatment, three of whom commenced long-acting injectable buprenorphine. One patient left after 1 day and subsequently began methadone treatment with a private prescriber. Two patients on smaller doses and shorter-term use undertook withdrawal with prescribed (off-label) trans-dermal buprenorphine. One patient, initially lost to follow-up, later stabilised on long-acting injectable buprenorphine. Reasons for presenting included supply shortages and financial distress during the COVID-19 pandemic. DISCUSSION AND CONCLUSION Kamini represents an illicit source of non-prescription opioid in Australia. Although classified as an illegal import by the Therapeutic Goods Administration, patients confirm that it is readily available in Brisbane. Targeted efforts are needed to prevent further patients developing opioid dependence from use of Kamini and also to highlight treatment options for those seeking to stop Kamini use.

Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta‐analysis of randomised controlled trials

Abstract: Abstract Issues Cessation of methamphetamine use may result in a characteristic withdrawal syndrome, no medication has been approved for this indication. This systematic review aims to assess the efficacy of pharmacotherapy for methamphetamine withdrawal, the first comprehensive meta‐analysis since 2008. Approach MEDLINE (1966–2020), CINAHL (1982–2020), PsychINFO (1806–2020) and EMBASE (1947–2020) were systematically searched. Studies were included if they were randomised controlled trials (RCT) investigating pharmacological treatments for methamphetamine withdrawal, reviewing outcomes of treatment discontinuation, mental health outcomes, withdrawal symptoms (including craving) and patient safety. The relative risk (RR) and weighted mean difference (MD) were used to meta‐analyse dichotomous and continuous data respectively, with 95% confidence intervals. Risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments were conducted. Key Findings Nine RCTs of six medications (n = 242 participants) met inclusion criteria, however, only six trials of four medications (n = 186) could be meta‐analysed. Mean sample size across studies was 27 participants, and 88% of participants were male. The quality of evidence in this review varies from low to very low on GRADE assessments. Amineptine may reduce discontinuation rates (RR 0.22, 95% confidence interval [CI] 0.07, 0.72, p = 0.01), and improve global state (MD −0.49, 95% CI −0.80, −0.17), compared with placebo, however, this medication is no longer approved. No other medications improved any domain when compared with placebo. Due to lack of reporting safety profiles could not be established. Conclusions There is insufficient evidence to indicate any medication is effective for the treatment of methamphetamine withdrawal. The poor quality of the evidence indicates a need for better powered, high‐quality trials.

Exploring the medical cannabis prescribing behaviours of New Zealand physicians

Abstract: Abstract Introduction Many countries are changing their regulations for prescribing medical cannabis. As gatekeepers, physicians significantly impact patient access to cannabis treatments. It is important to explore how physicians view prescribing cannabis in terms of their existing beliefs, knowledge, possible concerns and personal perceptions. Methods Individual, semi‐structured telephone interviews were undertaken with 14 New Zealand physicians from various specialties. The interviews were thematically analysed using a phenomenological approach. Results The physician–patient relationship was of extreme importance in making prescription decisions, driven largely by trust in the patient. Barriers to prescribing included concern over possible side effects, the quality and standardisation of medication, uncertainty about indications and equity concerns from the high cost for lower socio‐economic patients. Some physicians held concerns over their liability and risks to their reputation if issues arose for patients. Discussion and Conclusion The way physicians regard prescribing medical cannabis is based on their personal beliefs and knowledge built up over their medical career. It is important that these are taken into consideration in the design of future guidelines to help alleviate uncertainties and reduce barriers for informed prescribing. While our research and previous research find that physicians generally will follow clinical guidelines based on institutional logics (i.e. the standardised approach to medicine), we find that physicians often allow their personal construals to determine their perceptions and prescribing behaviour to a considerable extent when they practice medicine. Our findings have implications for Continuing Medical Education, marketing and regulation for medical cannabis, especially about the wording of guideline adherence.

Change in alcohol outcome expectancies from childhood to emerging adulthood: A meta-analysis of longitudinal studies.

Abstract: ISSUES Knowledge on the development of alcohol outcome expectancies (AOE) is relevant because AOE predict change in drinking behaviours. The present meta-analysis integrates results of longitudinal studies on change in AOE from childhood to emerging adulthood (age 23/24). APPROACH A systematic search in electronic databases identified 64 studies that were analysed with three-level meta-analyses. KEY FINDINGS AOE about positive and social consequences tended to increase, on average, from childhood to middle or late adolescence, respectively. In contrast, negative AOE declined over time. Change in positive, social and tension reduction AOE were described as an inverted u-shaped curve. The strongest increase of more than two standard deviation units was observed with regard to social AOE between the age of 7 and 16, followed by small decline in the transition to emerging adulthood. IMPLICATIONS The meta-analysis found evidence for strong increases of positive AOE from childhood to middle or late adolescence. CONCLUSIONS The results inform about reasonable age-ranges for expectancy-challenging interventions. To obtain a clearer picture of change in AOE beyond adolescence, longitudinal research is needed on younger children and beyond college age.

Changes in health harms due to cannabis following legalisation of non-medical cannabis in Canada in context of cannabis commercialisation: A scoping review.

Abstract: ISSUE On 17 October 2018, Canada legalised non-medical cannabis. Critically, the cannabis market in Canada has changed considerably since legalisation. In this scoping review, we identified available evidence on changes in cannabis-related health harms following legalisation and contextualised findings based on legal market indicators. APPROACH Electronic searches were conducted to identify studies that compared changes in cannabis-related health harms pre- and post-legalisation. We contextualised each study by the mean per capita legal cannabis stores and sales during the study period and compared study means to per capita stores and sales on October 2021-3 years following legalisation. IMPLICATIONS AND CONCLUSIONS Some measures of cannabis harms have increased since legalisation but studies to date have captured periods of relatively low market maturity. Longer-term monitoring of health harms as the market continues to expand is indicated.

Case series on treatment of dependence to Kamini Vidrawan Ras with opioid substitution therapy

Abstract: Introduction A cohort of clients was recognised attending an addiction medicine clinic with similar presentations of opioid dependence from use of a rarely known Ayurvedic medication in a specific ethnic community. This retrospective case series was completed to promote wider recognition and further understanding of dependence on Kamini Vidrawan Ras (Kamini). Methods A retrospective file audit of the electronic medical record for clients of an addiction medicine outpatient clinic with a history of dependent use of Kamini identified 12 clients meeting inclusion criteria. Results All 12 clients were male, aged 27–41 years, all but one of north Indian origin, predominantly employed and predominantly (but not exclusively) without significant other substance use history. All 12 clients were treated with opioid substitution therapy. Discussion and Conclusions This case series highlights an opioid dependence syndrome resulting from use of an Ayurvedic medicine by men from a specific area of India, highlighting a potential adverse effect of traditional medicines in ongoing use by migrant and ethnic populations that have emigrated to Australia.

Online SMART Recovery mutual support groups: Characteristics and experience of adults seeking treatment for methamphetamine compared to those seeking treatment for other addictive behaviours

Abstract: Abstract Introduction The COVID‐19 pandemic prompted the transition of Australian Self‐Management and Recovery Training (SMART) Recovery mutual support groups to virtual delivery. This study examined the self‐reported experience of online SMART Recovery groups for people seeking support for methamphetamine use (alone or in combination with other behaviours) compared to those who did not endorse methamphetamine use as a reason for seeking support. Methods An online survey invitation was embedded in the post‐group exit page. Items assessed participant demographic characteristics, experience, engagement and perceived contribution of the online group to recovery. Unique responses (n = 1414) were analysed using chi‐square. Results After alcohol, methamphetamine use was the second most common behaviour to prompt online SMART Recovery group attendance (n = 205, 14.5%). People attending for methamphetamine use were more likely to endorse multiple addictive behaviours (n = 137, 66.8% vs. n = 371, 30.7%, p < 0.001). Irrespective of whether people attended for methamphetamine use or not, participant ratings of experience, engagement and perceived contribution to recovery were positive and largely comparable. People attending for methamphetamine use were significantly less likely to set a 7‐day plan (72.7% vs. 81.9%; χ 2 = 9.47, p = 0.002). Discussion and Conclusions Findings support the acceptability of online SMART Recovery groups for people experiencing addictive behaviours, including methamphetamine use. To maximise the benefits of these groups, further evidence on how best to support people to develop a change plan within a time‐limited, online group setting is needed. Online mutual support groups may help to reach and support people who might not otherwise engage in treatment and support, including people who use methamphetamine.

Social recovery in substance use disorder: A metasynthesis of qualitative studies

Abstract: Abstract Issues In substance use disorder, connection to social communities plays a significant role in the recovery process. The aim here has been to identify and synthesise the qualitative research examining the process of social recovery from a first‐person perspective and how social communities assist in this process. Approach Metasynthesis using the following databases: CINAHL, Embase, MEDLINE, PsycINFO, Scopus, SocIndex and Web of Science. The search returned 6913 original articles, of which 18 met the following criteria: examining the experience of social recovery from a first‐person perspective and how social communities support this process, age of 18+, recovery of at least 12 months, in an English‐language peer‐reviewed journal. Review protocol registration: PROSPERO (CRD42020190159). Key Findings The persons in recovery emphasised communities that they perceived as being safe and non‐stigmatising. These are qualities that contributed to positive self‐change, and these communities were perceived as suitable arenas in which to confront responsibility and trust. Additionally, participants found that their relationship skills were improving due to the new social bonds forged in these communities. A sense of citizenship was gained along with a regaining of social dignity through voluntary work and giving back to society. Implications The pivotal role of the social community identified in this review underscores the importance of recognising and supporting persons in recovery's needs when connecting with such communities Conclusion We propose a four‐stage model to guide research into social recovery from a first‐person perspective and how social communities support this process.

Nationwide Alcohol-related visits In Singapore's Emergency departments (NAISE): A retrospective population-level study from 2007 to 2016.

Abstract: INTRODUCTION Excessive alcohol consumption is associated with increased morbidity and mortality, and its societal impact is substantial. The Nationwide Alcohol-related visits In Singapore Emergency departments study aims to characterise trends in ED visits involving acute and chronic alcohol consumption between 2007 and 2016. METHODS Data from the Singapore Ministry of Health, comprising all ED visits in Singapore from 2007 to 2016, were used. The data were aggregated by year and analysed for changes in prevalence and rates of ED visits for acute and chronic alcohol consumption, broken down by age, gender and ethnicity. RESULTS Over the study period, the number of ED visits involving alcohol consumption increased 98.3%, from 2236 in 2007 to 4433 in 2016. During the same period, the rate per 100 000 population increased 62.4% from 48.7 to 79.1, and total ED-related costs rose by 140%, from 528 680 to 1 269 638 SGD. The increase in alcohol-related visits rates and costs was higher than non-alcohol-related visits rates and costs, which increased by 12.1% and 115% respectively. While trends in acute and chronic alcohol-related ED visits stayed stable amongst women, they rose substantially in men. Older men aged 50-69 show the highest rates and rate of increase for both acute and chronic alcohol-related ED visits. DISCUSSION AND CONCLUSIONS Alcohol-related visits contributed disproportionately to the increasing number of ED visits in Singapore between 2007 and 2016. Older men form the demographic with the highest rates and increase in rates of alcohol-related ED visits and form a potential group for targeted intervention.

Characteristics of fatal tapentadol-related toxicity in Australia.

Abstract: INTRODUCTION Tapentadol is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe pain. The study aimed to determine the characteristics of Australian toxicity deaths related to tapentadol. METHODS All cases in which tapentadol use was coded contributory to death (n = 159) were retrieved from the National Coronial Information System (1 July 2000-31 December 2020). RESULTS The mean age was 48.5 (18-81) and 56% were female. Documented histories of problems with chronic pain (66%), mental health (60.4%), substance use (44%) and injecting drug use (23.3%) were common. The majority of deaths were deemed unintentional (76.1%) and in 18.9% pre-existing disease was co-contributory. The median peripheral blood tapentadol concentration was 1.00 mg L-1 (0.02-47.00), and the median aortic concentration was 2.05 mg L-1 (0.10-30.00). In all cases, psychoactive drugs other than tapentadol were also detected, most commonly antidepressants (72.3%), opioids (66.7%), hypnosedatives (64.2%) and gabapentinoids (43.4%). Of cases where autopsies were conducted, 27.7% were diagnosed with cardiomegaly and 18.5% with severe coronary artery stenosis. Pulmonary oedema (68.1%), aspiration of vomitus (39.5%) and acute pneumonia (26.9%) were common. DISCUSSION AND CONCLUSIONS The typical tapentadol-related toxicity death involved unintentional death in the presence of multiple drugs, although a notable minority were intentional self-harm. Multiple morbidities were common. The identification and characteristics of these cases indicate that the adverse event profile of tapentadol needs to be considered in the setting of polypharmacy.

Ambulance attendance for substance and/or alcohol use in a pandemic: Interrupted time series analysis of incidents

Abstract: Abstract Introduction The ambulance attendance for substance and/or alcohol use in a pandemic (ASAP) study explores incidents during the COVID‐19 lockdown in the East Midlands region of the United Kingdom (23 March–4 July 2020). Method Retrospective cross‐sectional count per day of ambulance attendances from the East Midlands Ambulance Service Trust. Ambulance attendances relating to alcohol or other drug use in the year prior, during lockdown and weeks following, were examined using interrupted time series analysis by patient demographics and geographical location. Results A total of 36 104 records were identified (53.7% male, 84.5% ethnicity classified as White, mean age 38.4 years). A significant drop in the number of attendances per day at the start of lockdown (−25.24, confidence interval − 38.16, −12.32) was observed, followed by a gradual increase during the ongoing lockdown period (0.36, confidence interval 0.23, 0.46). Similar patterns were found across genders, age groups 16–64 and urban/rural locations. Discussion and Conclusion The pattern of ambulance attendances for alcohol or other drug use changed during the COVID‐19 lockdown period. Lockdown significantly affected the use of ambulances for incidents involving alcohol or other drug use, impacting on health‐care services. Further research into hazardous use of alcohol or other drugs during the lockdown periods is needed to inform policy, planning and public health initiatives.

Intoxication related to substances use in patients presenting to Ain Shams University Poisoning Treatment Center, Cairo, Egypt (2015-2019).

Abstract: INTRODUCTION Illicit drug use may result in several emergencies. Hospital emergency data can help to detect new patterns of substance use and high-risk trends of drug use. This epidemiological study aimed to investigate the pattern and outcome of cases with substance use intoxication who presented to Ain Shams University Poisoning Treatment Centre, Cairo, Egypt. METHODS This retrospective study included all cases of acute intoxication due to use/misuse of substances who presented to the centre during the period (2015-2019). RESULTS The study included 11 281 cases; young adults (aged 20-40 years) represented the greatest proportion of cases (6519, 57.8%). Males were the predominant gender in all age groups (representing 79.2% of the cases). Tramadol was the most common substance of exposure in all age groups except for children and adolescents where cannabis was the most common one. There were 162 fatalities (1.4% of all cases) and opioids had the greatest case fatality rate. DISCUSSION AND CONCLUSIONS Tramadol was the most used drug that resulted in acute intoxication, followed by cannabis. A total of 43.6% of the cases of acute intoxications were due to recreational use/misuse of prescription drugs.

Nicotine vaping was not the cause of e-cigarette, or vaping, product use-associated lung injury in the United States.

Abstract: EVALI (E-cigarette, or Vaping, product use-Associated Lung Injury) was an outbreak of severe and sometimes fatal lung injury in North America between mid-2019 and early 2020 [1]. It occurred among young people who vaped black-market tetrahydrocannabinol (THC) oils contaminated with vitamin E acetate (VEA). Fourteen percent of EVALI cases reported vaping nicotine only [1]. This finding has been used to make the claim that nicotine products can cause EVALI. Australian health departments, for example, have warned about a link between nicotine vaping products and the outbreak of EVALI [2, 3]. Media reports still link EVALI to nicotine vaping in an alarming way [4]. This messaging shapes public perceptions of the risks of vaping nicotine and adversely influences public policy on e-cigarettes [5]. Vaping is the most popular aid for quitting or reducing smoking in Australia [6], the United Kingdom [7] and the United States [8] and is more effective than nicotine replacement therapy [9]. There are likely to be substantial benefits for public health if more Australian smokers switched to vaping nicotine [10]. However, unfounded claims about a link with EVALI and restrictive Australian policies justified by this claim reduce the uptake of e-cigarettes in Australia to the detriment of public health.

Smashing the liquor machine: A global history of prohibition MARK LAWRENCE SCHRAD New York: Oxford University Press, 2021 ISBN: 9780190841577, 736 pp. Price: £26.99.

Abstract: Drug and Alcohol ReviewVolume 41, Issue 4 p. 1003-1003 Critique Smashing the liquor machine: A global history of prohibition MARK LAWRENCE SCHRAD New York: Oxford University Press, 2021 ISBN: 9780190841577, 736 pp. Price: £26.99 Robin Room, Robin Room orcid.org/0000-0002-5618-385X Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, SwedenSearch for more papers by this author Robin Room, Robin Room orcid.org/0000-0002-5618-385X Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, SwedenSearch for more papers by this author First published: 01 May 2022 https://doi.org/10.1111/dar.13460Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume41, Issue4May 2022Pages 1003-1003 RelatedInformation

Impact of the ‘10,000 lives’ program on Quitline referrals, use and outcomes by demography and Indigenous status

Abstract: Abstract Introduction In November 2017, Central Queensland Public Health Unit launched the ‘10,000 Lives’ initiative to reduce smoking prevalence in Central Queensland. The program partnered with local champions and other programs (e.g. ‘Deadly Choices’) to promote the use of smoking cessation services (e.g. Quitline) in Central Queensland. This study assesses the program's impact on Quitline use by participant demographics and Indigenous status. Methods We compared the number of referred individuals who participated in and completed the Quitline program, and quit smoking during 26‐months before (July 2015 to August 2017) and after (November 2017 to December 2019) the ‘10,000 Lives’ launch. We conducted an interrupted time series analysis of monthly referrals to and use of Quitline for Aboriginal and Torres Strait Islander peoples. Results Overall, 3207 individuals were referred to Quitline during the 26‐months‐post‐launch compared to 1594 during 26‐months‐pre‐launch period of ‘10,000 Lives’. The number of referred individuals who completed Quitline program increased by 330.7% and quit smoking by 308.3% in post‐launch period. The increase was substantially higher among aged 45+ years, females and Aboriginal and Torres Strait Islander peoples. The result for referrals and use of Quitline was validated by interrupted time series analysis for Aboriginal and Torres Strait Islander peoples. Discussion and Conclusions The ‘10,000 Lives’ collaborative approach to partner with local champions and targeted smoking cessation programs was effective in increasing the use of Quitline and smoking cessation among all demographic groups, including Aboriginal and Torres Strait Islander peoples. This approach can be used in other regions to address higher smoking prevalence.

The 'wounded soul': What alcoholism means to participants of a women-only Alcoholics Anonymous meeting in São Paulo, Brazil.

Abstract: INTRODUCTION Female alcoholism is a public health problem for which membership in Alcoholics Anonymous (AA) groups is an effective treatment. As AA is predominantly attended by men in Brazil, the aim of this article is to understand the meaning of this problem and the experience of AA meetings for women. METHODS A qualitative ethnographic study was conducted between August and September 2019 and included 15 participants of a women-only AA meeting in the city of São Paulo, Brazil. Data were collected by means of direct participant observation, records in field diaries, ethnographic interviews and records of experience sharing between the women during the AA meetings. RESULTS An intelligible, interpretative and comprehensive synthesis of the data collected resulted in two categories: 'Alcohol, Alcoholism and Gender' and 'What AA means to women'. The first category allowed alcoholism to be analysed as a disease associated with gender asymmetries. The second category permitted an assessment to be made of how women-only AA meetings served to provide alcoholic women with a safe and morally privileged place in which they could share their experiences and treat their addiction. DISCUSSION AND CONCLUSIONS Alcoholism in women is marked by social stigma, making it difficult to find women willing to share their experiences and participate in qualitative research on this important issue in public health. In these women-only meetings, they shared their experiences, and alcoholism is referred to as a 'wounded soul' that causes deep anguish often experienced in the isolation of their own homes.