Robert J. Tait

A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment

Abstract Context: Synthetic cannabinoids (SCs) such as “Spice”, “K2”, etc. are widely available via the internet despite increasing legal restrictions. Currently, the prevalence of use is typically low in the general community (<1%) although it is higher among students and some niche groups subject to drug testing. Early evidence suggests that adverse outcomes associated with the use of SCs may be more prevalent and severe than those arising from cannabis consumption. Objectives: To identify systematically the scientific reports of adverse events associated with the consumption of SCs in the medical literature and poison centre data. Method: We searched online databases (Medline, PsycInfo, Embase, Google Scholar and Pubmed) and manually searched reference lists up to December 2014. To be eligible for inclusion, data had to be from hospital, emergency department, drug rehabilitation services or poison centre records of adverse events involving SCs and included both self-reported and/or analytically confirmed consumption. Results: From 256 reports, we identified 106 eligible studies including 37 conference abstracts on about 4000 cases involving at least 26 deaths. Major complications include cardiovascular events (myocardial infarction, ischemic stroke and emboli), acute kidney injury (AKI), generalized tonic-clonic seizures, psychiatric presentations (including first episode psychosis, paranoia, self-harm/suicide ideation) and hyperemesis. However, most presentations were not serious, typically involved young males with tachycardia (≈37–77%), agitation (≈16–41%) and nausea (≈13–94%) requiring only symptomatic care with a length of stay of less than 8 hours. Conclusions: SCs most frequently result in tachycardia, agitation and nausea. These symptoms typically resolve with symptomatic care, including intravenous fluids, benzodiazepines and anti-emetics, and may not require inpatient care. Severe adverse events (stroke, seizure, myocardial infarction, rhabdomyolysis, AKI, psychosis and hyperemesis) and associated deaths manifest less commonly. Precise estimates of their incidence are difficult to calculate due to the lack of widely available, rapid laboratory confirmation, the variety of SC compounds and the unknown number of exposed individuals. Long-term consequences of SCs use are currently unknown.

Adolescent substance use and educational attainment: An integrative data analysis comparing cannabis and alcohol from three Australasian cohorts

BACKGROUNDnThe relative contributions of cannabis and alcohol use to educational outcomes are unclear. We examined the extent to which adolescent cannabis or alcohol use predicts educational attainment in emerging adulthood.nnnMETHODSnParticipant-level data were integrated from three longitudinal studies from Australia and New Zealand (Australian Temperament Project, Christchurch Health and Development Study, and Victorian Adolescent Health Cohort Study). The number of participants varied by analysis (N=2179-3678) and were assessed on multiple occasions between ages 13 and 25. We described the association between frequency of cannabis or alcohol use prior to age 17 and high school non-completion, university non-enrolment, and degree non-attainment by age 25. Two other measures of alcohol use in adolescence were also examined.nnnRESULTSnAfter covariate adjustment using a propensity score approach, adolescent cannabis use (weekly+) was associated with 1½ to two-fold increases in the odds of high school non-completion (OR=1.60, 95% CI=1.09-2.35), university non-enrolment (OR=1.51, 95% CI=1.06-2.13), and degree non-attainment (OR=1.96, 95% CI=1.36-2.81). In contrast, adjusted associations for all measures of adolescent alcohol use were inconsistent and weaker. Attributable risk estimates indicated adolescent cannabis use accounted for a greater proportion of the overall rate of non-progression with formal education than adolescent alcohol use.nnnCONCLUSIONSnFindings are important to the debate about the relative harms of cannabis and alcohol use. Adolescent cannabis use is a better marker of lower educational attainment than adolescent alcohol use and identifies an important target population for preventive intervention.

A Web-Based Intervention for Users of Amphetamine-Type Stimulants: 3-Month Outcomes of a Randomized Controlled Trial

Background Among illicit drugs, the prevalence of amphetamine-type stimulant (ATS) use is second only to cannabis. Currently, there are no approved pharmacotherapies for ATS problems, but some face-to-face psychotherapies are effective. Web-based interventions have proven to be effective for some substance use problems, but none has specifically targeted ATS users. Objective The objective of the study was to evaluate the effectiveness of a Web-based intervention for ATS problems on a free-to-access site compared with a waitlist control group. Methods We used a randomized controlled trial design. The primary outcome measure was self-reported ATS use in the past three months assessed using the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST). Other measures included quality of life (EUROHIS score), psychological distress (K-10 score), days out of role, poly-drug use, general help-seeking intentions, actual help-seeking, and “readiness to change”. The intervention consisted of three fully automated, self-guided modules based on cognitive behavioral therapy and motivation enhancement. The analysis was an intention-to-treat analysis using generalized estimating equation models, with a group by time interaction as the critical assessment. Results We randomized 160 people (intervention n=81, control n=79). At three months, 35/81 (43%) intervention and 45/79 (57%) control participants provided follow-up data. In the intervention group, 51/81 (63%) completed at least one module. The only significant group by time interaction was for days out of role. The pre/post change effect sizes showed small changes (range d=0.14 to 0.40) favoring the intervention group for poly-drug use, distress, actual help-seeking, and days out of role. In contrast, the control group was favored by reductions in ATS use, improvements in quality of life, and increases in help-seeking intentions (range d=0.09 to 0.16). Conclusions This Web-based intervention for ATS use produced few significant changes in outcome measures. There were moderate, but nonsignificant reductions in poly-drug use, distress, days partially out of role, and increases in help-seeking. However, high levels of participant attrition, plus low levels of engagement with the modules, preclude firm conclusions being drawn on the efficacy of the intervention and emphasize the problems of engaging this group of clients in a fully automated program. Trial Registration Australian and New Zealand Clinical Trials Registry: ACTRN 12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000947909 (Archived by WebCite at http://www.webcitation.org/6SHTxEnzP).

Six-Month Outcomes of a Web-Based Intervention for Users of Amphetamine-Type Stimulants: Randomized Controlled Trial

Background The use of amphetamine-type stimulants (ATS) places a large burden on health services. Objective The aim was to evaluate the effectiveness of a self-guided Web-based intervention (“breakingtheice”) for ATS users over 6 months via a free-to-access site. Methods We conducted a randomized trial comparing a waitlist control with a fully automated intervention containing 3 modules derived from cognitive behavioral therapy and motivation enhancement. The main outcome was self-reported ATS use in the past 3 months assessed at 3- and 6-month follow-ups using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Secondary outcomes were help-seeking intentions (general help-seeking questionnaire), actual help seeking (actual help-seeking questionnaire), psychological distress (Kessler 10), polydrug use (ASSIST), quality of life (European Health Interview Survey), days out of role, and readiness to change. Follow-up data were evaluated using an intention-to-treat (ITT) analysis with a group by time interaction. Results We randomized 160 people (intervention: n=81; control: n=79). At 6 months, 38 of 81 (47%) intervention and 41 of 79 (52%) control participants provided data. ATS scores significantly declined for both groups, but the interaction effect was not significant. There were significant ITT time by group interactions for actual help seeking (rate ratio [RR] 2.16; d=0.45) and help-seeking intentions (RR 1.17; d=0.32), with help seeking increasing for the intervention group and declining for the control group. There were also significant interactions for days completely (RR 0.50) and partially (RR 0.74) out of role favoring the intervention group. However, 37% (30/81) of the intervention group did not complete even 1 module. Conclusions This self-guided Web-based intervention encouraged help seeking associated with ATS use and reduced days out of role, but it did not reduce ATS use. Thus, this program provides a means of engaging with some sections of a difficult-to-reach group to encourage treatment, but a substantial minority remained disengaged. Trial Registration Australian and New Zealand Clinical Trials Registry: ACTRN12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343307 (Archived by WebCite at http://www.webcitation.org/6Y0PGGp8q).

Breakingtheice: A protocol for a randomised controlled trial of an internet-based intervention addressing amphetamine-type stimulant use

BackgroundThe prevalence of amphetamine-type stimulant use is greater than that of opioids and cocaine combined. Currently, there are no approved pharmacotherapy treatments for amphetamine-type stimulant problems, but some face-to-face psychotherapies are of demonstrated effectiveness. However, most treatment services focus on alcohol or opioid disorders, have limited reach and may not appeal to users of amphetamine-type stimulants. Internet interventions have proven to be effective for some substance use problems but none has specifically targeted users of amphetamine-type stimulants.Design/methodThe study will use a randomized controlled trial design to evaluate the effect of an internet intervention for amphetamine-type stimulant problems compared with a waitlist control group. The primary outcome will be assessed as amphetamine-type stimulant use (baseline, 3 and 6u2009months). Other outcomes measures will include ‘readiness to change’, quality of life, psychological distress (K-10 score), days out of role, poly-drug use, help-seeking intention and help-seeking behavior. The intervention consists of three modules requiring an estimated total completion time of 90 minutes. The content of the modules was adapted from face-to-face clinical techniques based on cognitive behavior therapy and motivation enhancement. The target sample is 160 men and women aged 18 and over who have used amphetamine-type stimulants in the last 3u2009months.DiscussionTo our knowledge this will be the first randomized controlled trial of an internet intervention specifically developed for users of amphetamine-type stimulants. If successful, the intervention will offer greater reach than conventional therapies and may engage clients who do not generally seek treatment from existing service providers.Trial registrationAustralian and New Zealand Clinical Trials Registry (http://www.anzctr.org.au/) ACTRN12611000947909

How alcohol marketing engages users with alcohol brand content on Facebook: an Indian and Australian perspective

Abstract Little work has been conducted to understand how alcohol marketers engage users with their brands’ Facebook pages in India and Australia. We aimed to evaluate and compare (i) the types of marketing techniques alcohol marketers utilize to facilitate user engagement on their brands’ Facebook pages and (ii) the extent to which users engage with these techniques in two diverse national contexts. We identified the ten most popular alcohol brands on Facebook in India and Australia based on the number of ‘likes’ for each official brand site. Brand websites and data analytic sources were accessed to collect metrics relating to number of likes, frequency of posts made by alcohol marketers on their brand websites and the resulting comments from fans, and messages relating to responsible drinking. The identified brands accrued substantial user engagement (e.g. Budweiser beer attracted 12.8 million likes in Australia and Foster’s beer 802,807 likes in India). The strategies employed were a mix of country-specific (e.g. India: inspirational talks and livelihood skills vs. Australia: posts related to the brand’s tradition or heritage) and generic approaches (e.g. alcohol sponsorship of sport, music, and fashion, offering consumption suggestions, organizing competitions, giveaways, and use of memes). This cross-national comparison illustrates that alcohol marketing on Facebook is user-focused and flexible, works with specific national contexts, and capitalizes on the cultural meanings users invoke in their interactions with sites. The study results also demonstrate the potential for brands to engage those under the legal drinking age by delivering alcohol content on Facebook.

How can data harmonisation benefit mental health research? An example of The Cannabis Cohorts Research Consortium

Peter Butterworth is supported by ARC nFuture Fellowship (FT130101444). Louisa nDegenhardt is supported by an NHMRC nPrincipal Research Fellowship (APP1041742). nDelyse Hutchinson is supported by a ViceChancellor’s nPostdoctoral Fellowship from nthe University of New South Wales. Richard nP Mattick is supported by an NHMRC nPrincipal Research Fellowship (APP1045318). nCraig Olsson is supported by an Australian nResearch Council Principal Research nFellowship (DP 1311459). George Patton is nsupported by an NHMRC Senior Principal nResearch Fellowship (APP1019887).

Adverse adult consequences of different alcohol use patterns in adolescence: an integrative analysis of data to age 30 years from four Australasian cohorts: Adult outcomes of alcohol use in adolescence

BACKGROUND AND AIMSnStudies have linked adolescent alcohol use with adverse consequences in adulthood, yet it is unclear how strong the associations are and to what extent they may be due to confounding. Our aim was to estimate the strength of association between different patterns of adolescent drinking and longer-term psychosocial harms taking into account individual, family and peer factors.nnnDESIGNnParticipant-level data were integrated from four long-running longitudinal studies: Australian Temperament Project, Christchurch Health and Development Study, Mater Hospital and University of Queensland Study of Pregnancy and Victorian Adolescent Health Cohort Study.nnnSETTINGnAustralia and New Zealand.nnnPARTICIPANTSnParticipants were assessed on multiple occasions between ages 13 and 30xa0years (from 1991 to 2012). Number of participants varied (up to nxa0=xa09453) by analysis.nnnMEASUREMENTSnThree patterns of alcohol use (frequent, heavy episodic and problem drinking) were assessed prior to age 17. Thirty outcomes were assessed to age 30 spanning substance use and related problems, antisocial behaviour, sexual risk-taking, accidents, socio-economic functioning, mental health and partner relationships.nnnFINDINGSnAfter covariate adjustment, weekly drinking prior to age 17 was associated with a two- to threefold increase in the odds of binge drinking [odds ratio (OR)xa0=xa02.14; 95% confidence interval (CI)xa0=xa01.57-2.90], drink driving (ORxa0=xa02.78; 95% CIxa0=xa01.84-4.19), alcohol-related problems (ORxa0=xa03.04; 95% CIxa0=xa01.90-4.84) and alcohol dependence (ORxa0=xa03.30; 95% CIxa0=xa01.69-6.47) in adulthood. Frequency of drinking accounted for a greater proportion of the rate of most adverse outcomes than the other measures of alcohol use. Associations between frequent, heavy episodic and problem drinking in adolescence and most non-alcohol outcomes were largely explained by shared risk factors for adolescent alcohol use and poor psychosocial functioning.nnnCONCLUSIONSnFrequency of adolescent drinking predicts substance use problems in adulthood as much as, and possibly more than, heavy episodic and problem drinking independent of individual, family and peer predictors of those outcomes.

‘Making the invisible visible’ through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study

BackgroundScreening and brief interventions (SBI) for alcohol related problems have been shown to be effective in health settings such as general practice or emergency departments. Recent data from the United Kingdom and New Zealand suggest that SBI can be delivered through community pharmacies, but this approach has not been tested in Australia. This study assesses the feasibility of delivering alcohol SBI via community pharmacists.MethodWe recruited five pharmacies and developed an SBI training package to be delivered by pharmacy staff, who screened consumers and delivered the brief intervention where appropriate. Consumers also completed a questionnaire on the process. At three months consumers were telephoned to enable ‘retention’ to be quantified. After completing recruitment, a semi-structured interview was conducted with pharmacists on the process of delivering the intervention, potential improvements and sustainability.ResultsFifty consumer participants were screened, ten from each pharmacy. There were 28 (57xa0%) men and 21 (43xa0%) women with one not responding. Most (67xa0%) were aged 25–55 years. Their AUDIT scores had a range of 0 to 39 (mean 10.9, SD 9.8) with 11 categorised as ‘hazardous (8–15)’, four as ‘harmful (16–19)’ and eight as ‘probably dependent (20+)’ consumers of alcohol. Reactions to the process of SBI were generally favourable: for example 75xa0% agreed that it was either appropriate or very appropriate being asked about their alcohol consumption. With respect to follow-up interviews, 23 (46xa0%) agreed that they could be contacted, including five from the highest AUDIT category. Subsequently 11 (48xa0%) were contactable at three months. Three of the five non-low risk drinkers had reduced their level of risk over the three months. Ten pharmacists participated in semi-structured telephone interviews. Overall these pharmacists were positive about the intervention and five main themes emerged from the interviews: 1) flexibility applied in recruitment of participants, 2) easiness in use of AUDIT score to facilitate discussions, 3) perceived positive intervention impact, 4) enhanced role of community pharmacists and 5) facilitators and challenges experienced.ConclusionsPharmacy-based SBI appears to be acceptable to consumers and feasible for pharmacy staff to deliver. Challenges remain in translating this potential into actual services.

Alcohol‐related victimisation: Differences between sexual minorities and heterosexuals in an Australian national sample

INTRODUCTION AND AIMSnAlcohol-related violence and other types of victimisation are prevalent, but unevenly distributed across the population. The study investigated the relationship between alcohol-related victimisation and sexual orientation (heterosexual, homosexual, bisexual, other) in a national sample.nnnDESIGN AND METHODSnThe study used cross-sectional data from the 2010 Australian National Drug Strategy Household Survey. Logistic regression was used to assess the association of sexual orientation with three types of victimisation (verbal abuse, physical abuse and feeling threatened by a person intoxicated on alcohol in the last 12 months) and controlled for probable confounding variables.nnnRESULTSnOf 24,u2009858 eligible respondents aged 14 years or older, 26.8% experienced victimisation. Less than 30% of heterosexual men and women suffered victimisation compared with nearly 50% of gay men and bisexual women. Controlling for alcohol, tobacco and illicit drug use, age group, mental health, Indigenous status and socioeconomic factors, logistic regression, stratified by gender, found that the odds of both verbal [adjusted odds ratio (AOR)u2009=u20091.52] and physical abuse (AOR=2.04) were greatest for lesbians, while gay men had the greatest odds (AOR=2.25) of feeling threatened.nnnDISCUSSION AND CONCLUSIONSnAcross all types of victimisation, some or all sexual minority groups had increased odds of being victimised in the last 12 months compared with their heterosexual counterparts. The pattern of results shows the importance of disaggregating sexual minority status in considering the impact of alcohol-related victimisation and in developing interventions or policies.