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Aims Increased potency and contamination of cannabis have been linked in the public domain to adverse mental health outcomes. This paper reviews the available international evidence on patterns of cannabis potency and contamination and potential associated harms, and discusses their implications for prevention and harm reduction measures. Methods A systematic literature search on cannabis potency and contamination was conducted. Results Cannabis samples tested in the United States, the Netherlands, United Kingdom and Italy have shown increases in potency over the last 10 years. Some countries have not shown significant increases in potency, while other countries have not monitored potency over time. While there are some grounds to be concerned about potential contaminants in cannabis, there has been no systematic monitoring. Conclusion Increased potency has been observed in some countries, but there is enormous variation between samples, meaning that cannabis users may be exposed to greater variation in a single year than over years or decades. Claims made in the public domain about a 20- or 30-fold increase in cannabis potency and about the adverse mental health effects of cannabis contamination are not supported currently by the evidence. Systematic scientific testing of cannabis is needed to monitor current and ongoing trends in cannabis potency, and to determine whether cannabis is contaminated. Additionally, more research is needed to determine whether increased potency and contamination translates to harm for users, who need to be provided with accurate and credible information to prevent and reduce harms associated with cannabis use.
McLaren,J Swift,W Dillon,P Allsop,S
National Drug and Alcohol Research Centre, University of New South Wales, Australia.
Aim The concurrent, construct and discriminative validity of the World Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were examined in a multi-site international study. Participants One thousand and 47 participants, recruited from drug treatment (n = 350) and primary health care (PHC) settings (n = 697), were administered a battery of instruments. Measurements Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsley Addiction Profile (MAP). Findings Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-Lite (r = 0.76-0.88), SDS (r = 0.59), AUDIT (r = 0.82) and RTQ (r = 0.78); and significantly greater ASSIST scores for those with MINI-Plus diagnoses of abuse or dependence (P < 0.001). Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems (r = 0.48-0.76). Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. Receiver operating characteristic (ROC) analysis was used to establish cut-off scores with suitable specificities (50-96%) and sensitivities (54-97%) for most substances. Conclusions The findings demonstrated that the ASSIST is a valid screening test for identifying psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use.
Humeniuk,R Ali,R Babor,TF Farrell,M Formigoni,ML Jittiwutikarn,J de-Lacerda,RB Ling,W Marsden,J Monteiro,M Nhiwatiwa,S Pal,H Poznyak,V Simon,S
Drug and Alcohol, Services Council, Adelaide, Australia.
Aim To (i) compare the Yesterday method with other methods of assessing alcohol use applied in the 2004 Australian National Drug Strategy Household Survey (NDSHS) in terms of extent of under-reporting of actual consumption assessed from sales data; and (ii) illustrate applications of the Yesterday method as a means of variously measuring the size of an Australian ’standard drink’, the extent of risky/high-risk alcohol use, unrecorded alcohol consumption and beverage-specific patterns of risk in the general population. Setting The homes of respondents who were eligible and willing to participate. Participants A total of 24 109 Australians aged 12 years and over. Design The 2004 NDSHS assessed drug use, experiences and attitudes using a ‘drop and collect’ self-completion questionnaire with random sampling and geographic (State and Territory) and demographic (age and gender) stratification. Measures Self-completion questionnaire using quantity-frequency (QF) and graduated-frequency (GF) methods plus two questions about consumption ‘yesterday’: one in standard drinks, another with empirically based estimates of drink size and strength. Results The Yesterday method yielded an estimate of 12.8 g as the amount of ethanol in a typical Australian standard drink (versus the official 10 g). Estimated coverage of the 2003-04 age 12+ years per-capita alcohol consumption in Australia (9.33 ml of ethanol) was 69.17% for GF and 64.63% for the QF when assuming a 12.8 g standard drink. Highest coverage of 80.71% was achieved by the detailed Yesterday method. The detailed Yesterday method found that 60.1% of Australian alcohol consumption was above low-risk guidelines; 81.5% for 12-17-year-olds, 84.8% for 18-24-year-olds and 88.8% for Indigenous respondents. Spirit-based drinks and regular strength beer were most likely to be drunk in this way, low- and mid-strength beer least likely. Conclusions Compared to more widely used methods, the Yesterday method minimizes under-reporting of overall consumption and provides unique data of public health significance. It also provides an empirical basis for taxing alcoholic beverages in accordance with their contributions to harm and can be used to complement individual-level measures such as QF and GF.
Stockwell,T Zhao,J Chikritzhs,T Greenfield,TK
Centre for Addictions Research of BC, University of Victoria, BC, Canada, and National Drug Research Institute, Curtin University, Perth, WA, Australia.
Aims To examine the long-term effects of childhood smoking experimentation and exposure to parental smoking on adult smoking risk. Methods Data were from a 20-year follow-up of 9-15-year-olds who completed questionnaires in the 1985 Australian Schools Health and Fitness Survey (n = 6559). The relative risks (RR) of adult current smoking in 2004-05 for childhood exposure to smoking experimentation (never, a few puffs, < 10 cigarettes, > 10 cigarettes) and parental smoking (none, father, mother, both parents) in 1985, with adjustment for confounders, were estimated by log binomial modelling. Analyses were stratified by age (9-13 and 14-15 years) and sex. Findings Participation at follow-up was 54% (n = 3559). Childhood smoking experimentation increased the risk of being a current smoker particularly for 14-15-year-old experimenters of more than 10 cigarettes [males, RR 2.72, 95% confidence interval (CI) 1.74-4.25; females, RR 6.39, 95% CI 2.85-14.33]. Parental smoking was associated with adult current smoking risk, particularly for 9-13-year-olds with two smoking parents (males, RR 1.53, 95% CI 1.19-1.96; females, RR 1.99, 95% CI 1.52-2.61) and older males with smoking mothers (RR 1.82, 95% CI 1.22-2.73). Parental smoking was not associated with childhood smoking experimentation. Conclusions These findings suggest that any childhood smoking experimentation increases the risk of being a smoker 20 years later. As exposure to parental smoking predicted current smoking, parents should be aware of the association between their own smoking behaviour and that of their children.
Paul,SL Blizzard,L Patton,GC Dwyer,T Venn,A
Menzies Research Institute, University of Tasmania, Australia.
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.
Hall,WD
University of Queensland, Australia.
Aims To examine the relationship between Australian workers’ patterns of alcohol consumption and absenteeism. Design A secondary analysis of the 2001 National Drug Strategy Household Survey data. Setting Australia 2001. Participants A total of 13 582 workers aged >/=14 years. Measurements Alcohol consumption levels associated with National Health and Medical Research Council (NHMRC) guidelines for short- and long-term harm were identified and compared with self-reported measures of absenteeism due to alcohol use and due to any illness/injury. Findings More than 40% of the Australian work-force consumed alcohol at risky or high-risk levels at least occasionally. High-risk drinkers were up to 22 times more likely to be absent from work due to their alcohol use compared to low-risk drinkers. Short-term high-risk drinkers were also significantly more likely to be absent from work due to any illness or injury than employed low-risk drinkers. Young employees and males were more likely to report alcohol-related absenteeism compared to older workers and females. Conclusions The relationship between workers’ alcohol consumption patterns and absenteeism is more substantial than previously recognized or documented. Alcohol-related absenteeism is not restricted to small numbers of chronic heavy drinkers, but also involves the much larger number of risky non-dependent drinkers who drink less frequently at risky levels. To improve workers’ health and wellbeing and enhance productivity and economic prosperity, appropriate education, prevention and policy strategies are warranted and necessitate revision of previously narrow approaches undertaken with work-place programmes.
Roche,AM Pidd,K Berry,JG Harrison,JE
National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia.
After oral administration, the majority of drug molecules are absorbed across the small intestine and enter the systemic circulation via the portal vein and the liver. For some highly lipophilic drugs (typically log P > 5, lipid solubility > 50 mg/g), however, association with lymph lipoproteins in the enterocyte leads to transport to the systemic circulation via the intestinal lymph. The attendant delivery benefits associated with lymphatic drug transport include a reduction in first-pass metabolism and lymphatic exposure to drug concentrations orders of magnitude higher than that attained in systemic blood. In the current review we briefly describe the mechanisms by which drug molecules access the lymph and the formulation strategies that may be utilised to enhance lymphatic drug transport. Specific focus is directed toward recent advances in understanding regarding the impact of lipid source (both endogenous and exogenous) and intracellular lipid trafficking pathways on lymphatic drug transport and enterocyte-based first-pass metabolism.
Natalie L. Trevaskisa William N. Charmana Christopher J.H. PorteraEmail:chris.porter@vcp.monash.edu.au
[a]Department of Pharmaceutics, Victorian College of Pharmacy, Monash University, 381 Royal Parade, Parkville, Victoria, 3052 Australia
Lipid-based delivery systems are finding increasing application in the oral delivery of poorly water-soluble, lipophilic drugs. Whilst lipidic dose forms may improve oral bioavailability via several mechanisms, enhancement of gastrointestinal solubilisation remains argueably the most important method of absorption enhancement. This review firstly describes the mechanistic rationale which underpins the use of lipid-based delivery systems to enhance drug solubilisation and briefly reviews the available literature describing increases in oral bioavailability after the administration of lipid solution, suspension and self-emulsifying formulations. The use of in vitro methods including dispersion tests and more complex models of in vitro lipolysis as indicators of potential in vivo performace are subsequently described, with particular focus on recent data which suggests that the digestion of surfactants present in lipid-based formulations may impact on formulation performance. Finally, a series of seven guiding principles for formulation design of lipid-based delivery systems are suggested based on an analysis of recent data generated in our laboratories and elsewhere.
Christopher J.H. PorteraEmail:Chris.Porter@vcp.monash.edu.au Colin W. Poutonb Jean F. Cuinea William N. Charmana
[a]Department of Pharmaceutics, Victorian College of Pharmacy, Monash University (Parkville campus), Parkville, Victoria 3052, Australia;[b]Department of Pharmaceutical Biology, Victorian College of Pharmacy, Monash University (Parkville campus), Parkville, Victoria 3052, Australia
Oral lipid-based drug delivery systems may include a broad range of oils, surfactants, and cosolvents. This diversity makes comparison of lipid-based formulations difficult. Although the relationship between formulation and drug absorption is understood at a conceptual level, performance in vivo cannot be predicted with confidence at present. The Lipid Formulation Classification System (LFCS) identifies the factors which are likely to affect performance in vivo. There is now a need to establish performance criteria which will facilitate in vitro–in vivo correlation studies. In this review we discuss the properties of excipients, and identify criteria for selection of excipients for lipid-based formulations. Excipients are discussed in the context of the LFCS, our existing knowledge of the fate of these materials during dispersion and digestion, and the likely consequences of their use in formulations. We outline the formulation strategies that can be used for each type of lipid formulation, and suggest a framework for the in vitro testing of each type. Finally we address the choice of lipid formulations in relation to the physicochemical properties of the drug.
Colin W. PoutonaEmail:colin.pouton@vcp.monash.edu.au Christopher J.H. Porterb
[a]Department of Pharmaceutical Biology, Victorian College of Pharmacy, Monash University (Parkville Campus), 381 Royal Parade Parkville, Victoria 3052, Australia;[b]Department of Pharmaceutics, Victorian College of Pharmacy, Monash University (Parkville Campus), 381 Royal Parade Parkville, Victoria 3052, Australia
AIMS: A large number of studies have found links between alcohol outlet densities and assault rates in local areas. This study tests a variety of specifications of this link, focusing in particular on the possibility of a non-linear relationship. DESIGN: Cross-sectional data on police-recorded assaults during high alcohol hours, liquor outlets and socio-demographic characteristics were obtained for 223 postcodes in Melbourne, Australia. These data were used to construct a series of models testing the nature of the relationship between alcohol outlet density and assault, while controlling for socio-demographic factors and spatial auto-correlation. Four types of relationship were examined: a normal linear relationship between outlet density and assault, a non-linear relationship with potential threshold or saturation densities, a relationship mediated by the socio-economic status of the neighbourhood and a relationship which takes into account the effect of outlets in surrounding neighbourhoods. FINDINGS: The model positing non-linear relationships between outlet density and assaults was found to fit the data most effectively. An increasing accelerating effect for the density of hotel (pub) licences was found, suggesting a plausible upper limit for these licences in Melbourne postcodes. CONCLUSIONS: The study finds positive relationships between outlet density and assault rates and provides evidence that this relationship is non-linear and thus has critical values at which licensing policy-makers can impose density limits.
Livingston,M
AER Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Fitzroy, Australia. michaell@turningpoint.org.au