Drug and alcohol review
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Drug and alcohol review · Apr 2018
Cannabis use among two national samples of Aboriginal and Torres Strait Islander tobacco smokers.
There is a concern that cannabis use is an important barrier to reducing Aboriginal and Torres Strait Islander smoking. We investigate the associations of cannabis use and tobacco smoking and quitting in two large national samples. ⋯ We did not find consistent evidence in this setting that cannabis use is an obstacle to quitting tobacco smoking. Nevertheless, we would still recommend that clinicians counselling Aboriginal and Torres Strait Islander tobacco smokers about quitting talk about cannabis use because its use is common and almost all mix it with tobacco.
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Drug and alcohol review · Apr 2018
Intravenous fentanyl use among people who inject drugs in Australia.
There is a current epidemic of pharmaceutical opioid (PO) misuse, particularly fentanyl and fentanyl analogues, globally. Fentanyl is a highly potent synthetic opioid with rapid onset and significantly higher risk of overdose compared with other opioids. Contexts and correlates of fentanyl use among people who inject drugs (PWID) in Australia are under-researched. ⋯ Fentanyl injectors in Australia are significantly more likely to identify as Indigenous, report frequent injection, inject in public and experience overdose. Increased access to harm reduction interventions, including naloxone distribution, wheel filters and supervised injection facilities, are likely to benefit this population.
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Drug and alcohol review · Apr 2018
Pharmaceutical opioid use and harm in Australia: The need for proactive and preventative responses.
There are parallels between the North American experience of escalating pharmaceutical opioid utilisation and harm and the trends being observed in Australia. In Australia, opioid utilisation has increased dramatically over the past two decades. There have been significant shifts away from the predominant prescribing of 'weak' and short-acting opioids, to 'strong' and long-acting opioids, for an increasing range of chronic pain indications. ⋯ Potentially abuse-deterrent opioid formulations have entered the Australian market, with studies suggesting that these formulations are less likely to be tampered with by people who inject drugs; but to date, there have been limited impacts on opioid utilisation and harm. Additional strategies may include enhancing access to effective approaches to pain management and opioid dependence, and scaling-up naloxone provision. There is a unique opportunity for a proactive and preventative response to pharmaceutical opioids in Australia, to avoid experiencing the scale of problems seen elsewhere.
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Drug and alcohol review · Apr 2018
Revisiting the 'paradigm shift' in opioid use: Developments and implications 10 years later.
A decade ago, we queried the unfolding of a 'paradigm shift' in illicit opioid use in North America, specifically involving a shift away from heroin to prescription opioid (PO) use. Today, this situation is more acute than ever, with prescription opioid misuse, morbidity and mortality amounting to one of the most severe substance use-related public health crises ever, now even impacting life expectancy in key population segments. Despite medical system-based PO dispensing and practices being recognised as core drivers of the PO crisis, effective policy measures have been long absent or limited-including those to reduce medical PO use to levels supported by best evidence for pain care. ⋯ Lessons for policy hence need to be urgently identified and applied for the future. [Fischer B, Rehm J. Revisiting the 'paradigm shift' in opioid use: Developments and implications 10 years later. Drug Alcohol Rev 2017;00:000-000].