The following abstracts are cited from published journal articles recently added to the repository of the HRB National Drugs Library at www.drugsandalcohol.ie

POLICY AND LEGISLATION

Irish general practitioner attitudes toward decriminalisation and medical use of cannabis: results from a national survey

Crowley D, Collins C, Delargy I, Laird E and Van Hout MC (2017) Harm Reduction Journal 14 (1): 4

http://www.drugsandalcohol.ie/26675/

Governmental debate in Ireland on the de facto decriminalisation of cannabis and legalisation for medical use is ongoing. A cannabis-based medicinal product (Sativex®) has recently been granted market authorisation in Ireland. This unique study aimed to investigate Irish general practitioner (GP) attitudes toward decriminalisation of cannabis and assess levels of support for use of cannabis for therapeutic purposes (CTP).

Conclusion: The majority of Irish GPs do not support the present Irish governmental drug policy of decriminalisation of cannabis but do support the legalisation of cannabis for therapeutic purposes. Male GPs and those with higher levels of addiction training are more likely to support a more liberal drug policy approach to cannabis for personal use. A clear majority of GPs expressed significant concerns regarding both the mental and physical health risks of cannabis use. Ongoing research into the health and other effects of drug policy changes on cannabis use is required.

Potential impact of minimum unit pricing for alcohol in Ireland: evidence from the National Alcohol Diary Survey

Cousins G, Mongan D, Barry J, Smyth B, Rackard, M and Long J (2016) Alcohol and Alcoholism 51 (6): 734-740

http://www.drugsandalcohol.ie/26346/ 

One of the main provisions of the Irish Public Health (Alcohol) Bill is the introduction of a minimum unit price (MUP) for alcohol in Ireland, set at €1.00/standard drink. We sought to identify who will be most affected by the introduction of a MUP, examining the relationship between harmful alcohol consumption, personal income, place of purchase and price paid for alcohol.

Conclusion: Heavy drinkers, men and those on low income seek out the cheapest alcohol. The introduction of a MUP in Ireland is likely to target those suffering the greatest harm, and reduce alcohol-attributable mortality in Ireland. Further prospective studies are needed to monitor consumption trends and associated harms following the introduction of minimum unit pricing of alcohol.

PREVALENCE AND CURRENT SITUATION

Medicines containing codeine: perspectives of medical professionals in the Republic of Ireland

Foley M, Carney T, Harris R, Fitzpatrick E, Rapca-Veillet A and Van Hout, MC (2017) Irish Journal of Medical Science, Early online

The aim of the study was to examine prescribing professional's perceptions on prescribed and OTC (over the counter) medicines, containing codeine in the Republic of Ireland. A secondary aim was to examine perceptions on codeine dependence, screening and treatment.

Conclusion: Policy should examine the need for greater public health awareness on codeine use and should examine the role of OTC and internet sales in the development of dependence. Further consideration should be given to training and support for those who prescribe addictive medicines in practice.

Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis

Popova S, Lange S, Probst C, Gmel Gt and Jehm J (2017)The Lancet Global Health, Early online

http://www.drugsandalcohol.ie/26659/

Alcohol use during pregnancy is the direct cause of fetal alcohol syndrome (FAS). We aimed to estimate the prevalence of alcohol use during pregnancy and FAS in the general population and, by linking these two indicators, estimate the number of pregnant women that consumed alcohol during pregnancy per one case of FAS.

Conclusion: Alcohol use during pregnancy is common in many countries and as such, FAS is a relatively prevalent alcohol-related birth defect. More effective prevention strategies targeting alcohol use during pregnancy and surveillance of FAS are urgently needed.

Oral cancer incidence and survival rates in the Republic of Ireland, 1994-2009

Ali H, Sinnott SJ, Corcoran P, Deady S, Sharp L and Kabir Z (2016) BMC Cancer 16 (950)

http://www.drugsandalcohol.ie/26605/

Oral cancer is a significant public health problem world-wide and exerts high economic, social, psychological, and physical burdens on patients, their families, and on their primary care providers. We set out to describe the changing trends in incidence and survival rates of oral cancer in Ireland between 1994 and 2009.

Conclusion: Oral cancer increased significantly in both sexes between 1999 and 2009 in Ireland. Our analyses demonstrate the influence of measured factors such as smoking, time of diagnosis and age on observed trends. Unmeasured factors such as alcohol use, HPV and dietary factors may also be contributing to increased trends. Several of these are modifiable risk factors which are crucial for informing public health policies, and thus more research is needed.

A typology of alcohol consumption among young people – A narrative synthesis

Davoren MP, Cronin M, Perry IJ, Demant J, Shiely F and O'Connor K (2016) Addiction Research & Theory 24 (4): 261-273

http://www.drugsandalcohol.ie/25207/

Currently, alcohol consumption levels are significantly higher among younger age groups. However, previous research has noted the diversity of motivations and patterns. These patterns of drinking have yet to be synthesised into a typology. The aim of the current study was to synthesise information from studies that produced types of alcohol consumption among young people.

Conclusion: Currently, policy makers are attempting to combat the high levels of harmful alcohol consumption among young people. The current typology provides guidance for targeted interventions in addition to a practical analytic tool in future research.

Depressive symptoms, college adjustment and peer support among undergraduate nursing and midwifery students

Horgan A, Sweeney J, Behan L and McCarthy G (2016) . Journal of Advanced Nursing 72 (12): 3081-3092

http://www.drugsandalcohol.ie/26414/

This study aimed to identify levels of depressive symptoms, social and personal college adjustment and peer support among nursing and midwifery students. The alcohol consumption of participants had a statistically significant relationship with depressive symptoms with higher consumption rates having a positive impact on symptoms.

Conclusion: The mental health of undergraduates undertaking professional healthcare studies needs to be a key research, educational and clinical priority. High rates of adjustment and mental health difficulties, particularly in the second year of the programme need to be examined and more effective interventions developed.

New psychoactive substances (NPS) on cryptomarket fora: an exploratory study of characteristics of forum activity between NPS buyers and vendors

Van Hout MC and Hearne E (2016) International Journal of Drug Policy, Early online

http://www.drugsandalcohol.ie/26618/

The continual diversification of new psychoactive substances (NPS) circumventing legislation creates a public health and law enforcement challenge, and one particularly challenged by availability on Hidden Web cryptomarkets.

Conclusion: Continued monitoring of new trends in NPS within Surface Web and cryptomarkets are warranted. A particular focus on the rising market in prescribed benzodiazepine and Z-hypnotic drugs should be included.

Association between victimization by bullying and direct self injurious behavior among adolescence in Europe: a ten-country study.

Brunstein Klomek A, Snir A, Apter A et al. (2016) European Child and Adolescent Psychiatry, 25 (11): 1183-1193

http://www.drugsandalcohol.ie/26347/

Previous studies have examined the association between victimization by bullying and both suicide ideation and suicide attempts. The current study examined the association between victimization by bullying and direct-self-injurious behavior (D-SIB) among a large representative sample of male and female adolescents in Europe.

Conclusion: This large-scale study has clearly demonstrated the cross-sectional association between specific types of victimization with self-injurious behavior among adolescents and what may be part of the risk and protective factors in this complex association.

Alcohol consumption among university students: a typology of consumption to aid the tailoring of effective public health policy.

Davoren MP, Cronin M, Perry IJ and O'Connor K (2016) BMJ Open 6 (11): e011815

http://www.drugsandalcohol.ie/26485/

Tailoring public health policy to effectively tackle alcohol use is crucial. Using Q-methodology, the current study aims to develop a typology of alcohol consumption in the Irish university student population.

Conclusion: This is the first study to propose ideal types of alcohol consumption among a university student population. Further research is required to investigate the degree to which each of these ideal types is subscribed. However, this typology, in addition to informing public policy and strategies, will be a valuable analytic tool in future research.

The epidemiology of emergency in-patient hospitalisations among those with ‘no fixed abode’ (homeless) 2005-2014: What lessons can be learnt

O'Farrell A, Evans DS and Allen M (2016)Irish Medical Journal 109 (9)

http://www.drugsandalcohol.ie/26253/ 

Estimates show that homelessness is increasing in Ireland. This study analysed the epidemiology of emergency hospitalisations among those experiencing homelessness between 2005-2014.

Conclusion: The health of homeless people is a fundamental issue that needs addressing. Access to, and use of, community and preventative services is needed to reduce utilisation of emergency hospital services.

Cocaine use in young adults: correlation with early onset cannabis, alcohol and tobacco use

Smyth BP, Hannigan A and Cullen W (2016) Irish Medical Journal 109 (9)

http://www.drugsandalcohol.ie/26254/

There is ongoing debate regarding the relationship between early tobacco, alcohol and cannabis use and later cocaine abuse. We utilised data from two Irish national general population surveys.

Conclusion: Analysis indicated that being single, earlier age of first alcohol use, and history of cannabis use were significant independent predictors of lifetime use of cocaine. The substance use route to cocaine use in this Irish sample is quite typical of that seen internationally. Those who commence alcohol use in the early teenage years are more likely to use cocaine subsequently, even after controlling for early onset cannabis use and other socio-demographic characteristics. This suggests that policies which delay age of first drinking may possibly also curtail cocaine use.

RESPONSES

Smokers and ex-smokers have shared differences in the neural substrates for potential monetary gains and losses

Nestor L, McCabe E, Jones J, Clancy L and Garavan H (2016) Addiction Biology, Early online.

http://www.drugsandalcohol.ie/26590/

Despite an increased understanding of nicotine addiction, there is a scarcity of research comparing the neural correlates of non-drug reward between smokers and ex-smokers.

Conclusion: The results suggest that smoking may sensitize striato-orbitofrontal circuitry subserving motivational processes for loss avoidance and reward gain in nicotine addiction

Tailoring a brief intervention for illicit drug use and alcohol use in Irish methadone maintained opiate dependent patients: a qualitative process.

Darker CD, Sweeney B, Keenan E, Whiston L, Anderson R and Barry J (2016) BMC Psychiatry, 16, (373)

http://www.drugsandalcohol.ie/26362/

The World Health Organization (WHO) recommend the tailoring of a brief intervention (BI) programme of research to ensure that it is both culturally and contextually appropriate for the country and the environment in which it is being tested. The current study developed a tailored BI for illicit drug use and alcohol use to a methadone maintained opioid dependent polydrug using cohort of patients.

Conclusion: The research team was faithful to WHO recommendations to tailor BI programmes that are culturally and contextually appropriate to the treatment cohort and clinical environment. Outcome data from the cluster RCT have demonstrated that the tailored intervention was effective.

Quality assurance in drug demand reduction in European countries: an overview

Ferri M, Dias S, Bo A, Ballotta D, Simon R and Carra G (2016) Drugs: Education Prevention and Policy, Early online

http://www.drugsandalcohol.ie/26376/

The EMCDDA, through its network of National Focal Points, collects information on the quality assurance systems for drugs-related interventions across European countries. European National Drug Strategies include recommendations for systems and approaches for the assurance of the quality of interventions.

Conclusion: Although the evidence base for interventions in drug demand reduction is becoming available and accepted, attention needs to be given to implementation issues. The European countries are rapidly moving towards paying greater attention to the quality of interventions.

Mastery matters: consumer choice, psychiatric symptoms and problematic substance use among adults with histories of homelessness

Greenwood RM and Manning RM (2016) Health and Social Care in the Community, Early online

http://www.drugsandalcohol.ie/26426/

Previous research demonstrated the importance of consumer choice and mastery to residential stability and psychiatric functioning for adults with histories of homelessness.  In the present study, we investigated whether these relationships hold, even in the context of problem-related substance misuse.

Conclusion: Our findings confirm that consumer choice in housing and services is important to homeless services users' recovery experiences. Because of its relationship with mastery, consumer choice in housing and services protects homeless services users' psychiatric functioning, especially when substance use-related choices have had negative consequences. Our findings suggest that if homeless services take away consumer choice when substance use causes problems, they may actually undermine, rather than foster, service users' psychiatric functioning.

Feasibility of alcohol screening among patients receiving opioid treatment in primary care

Henihan AM, McCombe G, Klimas J,Swan D, Leahy D, Anderson R, Bury G, Dunne C, Keenan E, Lambert J, Maher D, O'Gorman CSM, O'Toole TP, Saunders J, Shorter GW, Smyth BP, Kaner E and Cullen W (2016) BMC Family Practice, 17 (153)

http://www.drugsandalcohol.ie/26360/

Identifying and treating problem alcohol use among people who also use illicit drugs is a challenge. Primary care is well placed to address this challenge but there are several barriers which may prevent this occurring. The objective of this study was to determine if a complex intervention designed to support screening and brief intervention for problem alcohol use among people receiving opioid agonist treatment is feasible and acceptable to healthcare providers and their patients in a primary care setting.

Conclusion: Alcohol screening among people receiving opioid agonist treatment in primary care seems feasible. A definitive trial is needed. Such a trial would require over sampling and greater support for participating practices to allow for challenges in recruitment of patients and practices.

General practice - A key route for distribution of naloxone in the community

Klimas J, Tobin H, Egan M, Tomas B and Bury G (2016) International Journal of Drug Policy 38: 1-3

http://www.drugsandalcohol.ie/26393/

Heroin use continues to drive opioid-related overdoses and mortality globally. Not-as-prescribed use of prescription opioids increases the number of victims of this epidemic. Naloxone has been shown to reduce mortality in overdose among people who use heroin and other opioids; however, its administration in a number of countries, including Ireland, is limited to paramedics and health professionals, despite proven effectiveness of overdose education and naloxone distribution (OEND) programmes by trained lay-people worldwide

Conclusion: A key finding of this study is the very limited exposure of GP trainees to substance misuse roles during their training in GP. In Ireland, more patients with opiate dependency die from opiate overdose each year than all those who die in road accidents. The extent of this crisis is not reflected by the preparation currently offered to future GPs in their training. Re-evaluation of the role of GP postgraduate training as part of OEND must now become a priority.

The role of alcohol dependency in deaths among people with epilepsy recorded by the National Drug-Related Deaths Index (NDRDI) in Ireland, 2004-2013

Lynn E, Lyons S, Langan Y, Craig S and Doherty C (2016)Seizure 45: 52-55.

http://www.drugsandalcohol.ie/26487/

The aim of this study was to investigate deaths among individuals with epilepsy recorded on the National Drug-Related Deaths Index (NDRDI).

Conclusion: The high percentage of individuals with a diagnosis of alcohol dependency that died as a result of epilepsy and who have no antiepileptic drugs in their system at the time of their death, highlights the need for preventative measures for this at-risk group.

Mindfulness training as a clinical intervention with homeless adults: a pilot study

Maddock A, Hevey D and Eidenmueller K (2016) International Journal of Mental Health and Addiction, Early online

http://www.drugsandalcohol.ie/26368/

The prevalence of mental health and addiction issues in the homeless population is very high. Mindfulness based interventions have been shown to have positive impacts on anxiety, depression and addiction in various populations.

Conclusion: The qualitative data highlighted how mindfulness skills can easily be taught to this population, and through the use of these skills, participants were able to develop enhanced coping skills, mindful traits, well-being and an improved capacity to deal with their mental health and addiction issues. This study gives support to the promising potential of mindfulness interventions being implemented by mental health care professionals with homeless service users.

A review of a GP registrar-run mobile health clinic for homeless people

O'Carroll A, Irving N, O'Neill J and Flanagan E (2016) Irish Journal of Medical Science, Early online

http://www.drugsandalcohol.ie/26435/

Homeless people have excessively high morbidity and mortality rates, yet they face barriers accessing primary care. A mobile health clinic, staffed by GP registrars, was developed to provide services to homeless people, particularly rough sleepers and sex workers.

Conclusion: A GP Registrar-run Mobile Health Clinic achieved its aims of improving access to primary care for rough sleepers and sex workers, and challenging stereotypes of GP Registrars.

The effectiveness of functional family therapy for adolescent behavioral and substance misuse problems: a meta-analysis.

Hartnett D, Carr A, Hamilton E and O'Reilly G (2016) Family Process, Early online

http://www.drugsandalcohol.ie/26269/

A systematic review of published and unpublished English language articles identified 14 studies containing 18 comparisons between functional family therapy (FFT) and another condition in the treatment of adolescent disruptive behavior and substance use disorders

Conclusion: Results provide support for the effectiveness of FFT compared with untreated controls and well-defined ALTs, such as cognitive behavior therapy, other models of family therapy, and individual and group therapy for adolescents.

Progressive white matter impairment as a predictor of outcome in a cohort of opioid-dependent patient's post-detoxification

Ivers JH, Fitzgerald J, Whelan C, Sweeney B, Keenan E, Fagan A, McMarrow J, Meany J, Barry J and Frodl (2016) Addiction Biology, Early online

http://www.drugsandalcohol.ie/26275/

The main aims of this study were to: (1) assess the association between white matter impairment and duration of dependence; (2) examine whether this impairment correlates with treatment outcome measures in opioid-dependent patients post-detoxification.

Conclusion: The longer the subjects were dependent on opioids, the more widespread and severely the white-matter integrity was disrupted. A general linear model was used to examine patients who relapsed compared to those who were abstinent at follow-up. No statistical difference was found between groups (p > 0.05). Partial correlations were performed to investigate the relationship between clinical outcome measures (physical health, psychological well-being and quality of life and hope for the future) and white-matter microstructural differences. Significant correlations were found between AD in the posterior corona radiata (L) and MD in the superior longitudinal fasciculus and a clinical measure for HOPE at 9-month follow-up.

Overview of harm reduction in prisons in seven European countries

Sander G, Scandurra A, Kamenska A, MacNamara C, Kalpaki C, Bessa CF,Laso GN, Parisi G, Varley L, Wolny M, Moudatsou M, Pontes NH, Mannix-McNamara P, Libianchi S and Antypas T (2016) Harm Reduction Journal 13 (1): 28.

http://www.drugsandalcohol.ie/26224/

This article provides a brief overview of harm reduction in prisons in Catalonia (Spain), Greece, Ireland, Italy, Latvia, Poland, and Portugal. While each country provides a wide range of harm reduction services in the broader community, the majority fail to provide these same services or the same quality of these services, in prison settings, in clear violation of international human rights law and minimum standards on the treatment of prisoners.

Conclusion: Where harm reduction services have been available and easily accessible in prison settings for some time, better health outcomes have been observed, including significantly reduced rates of HIV and HCV incidence. While the provision of harm reduction in each of these countries' prisons varies considerably, certain key themes and lessons can be distilled, including around features of an enabling environment for harm reduction, resource allocation, collection of disaggregated data, and accessibility of services.

Diageo's 'stop out of control drinking' campaign in Ireland: an analysis

Petticrew M Fitzgerald N, Durand MA, Knai, C, Davoren MP and Perry IJ (2016) PLoS ONE 11(9) e0160379

http://www.drugsandalcohol.ie/26170/

It has been argued that the alcohol industry uses corporate social responsibility activities to influence policy and undermine public health, and that every opportunity should be taken to scrutinise such activities. This study analyses a controversial Diageo-funded ‘responsible drinking’ campaign (“Stop out of Control Drinking”, or SOOCD) in Ireland. The study aims to identify how the campaign and its advisory board members frame and define (i) alcohol-related harms, and their causes, and (ii) possible solutions.

Conclusion: The ‘Stop Out of Control Drinking’ campaign frames alcohol problems and solutions in ways unfavourable to public health, and closely reflects other Diageo Corporate Social Responsibility activity, as well as alcohol and tobacco industry strategies more generally. This framing, and in particular the framing of alcohol harms as a behavioural issue, with the implication that consumption should be guided only by self-defined limits, may not have been recognised by all board members. It suggests a need for awareness-raising efforts among the public, third sector and policymakers about alcohol industry strategies.

Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

O'Donnell MJ, Chin SL Rangarajan S et al (2016) Lancet 388 (10046): 761-75.

http://www.drugsandalcohol.ie/26164/

Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke.

Conclusion: Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke.