This edition of Policy Talk reviews current knowledge of new psychoactive substances, a category of substances that is challenging government controls across the world, and compares how health authorities are responding to the challenges, with special reference to Australia and New Zealand.

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New psychoactive drugs: No easy answer

This May, Colombia’s largest guerrilla group, the Revolutionary Armed Forces of Colombia (FARC), will be 50 years old. Of all armed conflicts in the world that claim 1,000 or more lives a year, the one in Latin America’s third most populous country is the oldest. In 2012, the Colombian government and the FARC began their fourth attempt to negotiate an end to the fighting. This time, the talks are beginning to stick: negotiators in Havana, Cuba have gotten significantly further than ever before. It is not unreasonable to expect an accord by the end of 2014.

The Havana talks have an agenda covering five substantive topics or political reforms, plus a discussion of how to operationalize what has been agreed. As of April 2014, after 21 ten-day rounds of talks, negotiators have reached agreement on two of these five substantive topics, and are nearing accord on a third.

Ending 50 years of conflict : The challenges ahead and the U.S. role in Colombia

The 2014 Global Drug Survey (GDS2014) conducted during November / December 2013 was the biggest survey of current drug use ever conducted. Published in 8 languages and promoted through media partners in 17 countries, it received almost 80,000 responses. The results from each participating country were released through media partners on April 14th 2014 along with some key global comparisons.

Participating countries included USA, UK, Australia, Germany, France, Republic of Ireland, Scotland, Belgium, the Netherlands, Denmark, New Zealand, Hungary, Spain, Portugal, Switzerland, Mexico, Slovenia and Brazil.

Please click here to read the full survey.

The global drug survey 2014 findings

The authors evaluated the impact on crime of a localized policing experiment that depenalized the possession of small quantities of cannabis in the London borough of Lambeth.

impact the demand for cannabis in Lambeth as users move there to purchase cannabis;

enable the Lambeth police to reallocate effort towards other types of crime.

The authors investigated whether the depenalization policy impacts the level and composition of crime, using administrative records on criminal offences by drug type, and for seven types of nondrug crime. They found that depenalization in Lambeth led to significant increases in cannabis possession offences that persisted well after the policy experiment ended. They found evidence that the policy caused the police to reallocate effort towards crimes related to the supply of Class-A drugs, as well as reallocating effort towards non-drug crime: there are significant reductions in five types of non-drug crime, and significant improvements in police effectiveness against such crimes as measured by arrest and clear-up rates.

Crime and the depenalisation of cannabis possession: Evidence from a policing experiment

The National Advisory Committee on Drugs (NACD)* was established in July 2000 to advise the Government in relation to the prevalence, prevention, treatment/rehabilitation and consequences of problem drug use in Ireland, based on the analysis of research findings and information. The Committee oversees the delivery of a work programme on the extent, nature, causes and effects of drug use in Ireland.

A Steering Group, set up under the auspices of the former National Drug Strategy Team, carried out an assessment of the need for prison-based needle exchange in Ireland in 2009. The primary conclusions were that prison needle-exchange constitutes a viable, effective means of addressing the drug problem and associated health risks within Irish prisons. However, it was acknowledged that data measuring the prevalence of drug use, including intravenous drug use, among the prison population is either dated or based on a proxy approach. The Steering Group therefore recommended that a study should be carried out to measure the extent of drug use, including intravenous drug use, and the prevalence of blood-borne viruses among the prisoner population before consideration is given to introducing needle exchange into a prison setting.

The study aimed to estimate the prevalence of drug use, including intravenous drug use, among the prisoner population in Ireland in order to determine the need for drug treatment and harm reduction (including needle exchange) services in Irish prisons.

Study on the prevalence of drug use, including intravenous drug use, and blood-borne viruses among the Irish prisoner population

Deaths in prison are a serious public health issue, raising questions as to the quality of care and supervision provided by correctional authorities. Reflecting such concerns, deaths in prison usually result in extensive postmortem inquiries and may also lead to litigation against correctional authorities and healthcare providers.

Unnatural deaths in prison are of particular concern due to their preventable nature. Unnatural deaths include suicides, violent or drug-induced deaths and other injury-related deaths. Studies in developed countries have found that unnatural deaths comprise 48–59% of all deaths in prison, with suicide being the most common cause of unnatural death. These figures suggest considerable opportunities to reduce unnatural deaths in prison.

Opioid-dependent people commonly experience imprisonment and there are several reasons to believe that opioid-dependent prisoners may be at particular risk of unnatural death in prison. Drug withdrawal has been implicated as a possible trigger for suicide in the first days of incarceration. Additionally, use of illicitly obtained opioids while in prison carries with it the risk of overdose. To the best of our knowledge, deaths in prison specifically among opioid-dependent people have not been described previously. Furthermore, no studies have considered whether treatment for opioid dependence during incarceration reduces mortality risk, as it does among opioid-dependent people residing in the community. In this study, we describe deaths in prison in a cohort of opioid-dependent people and examine whether receiving opioid substitution therapy (OST) reduces the risk of death in prison.

Opioid substitution therapy as a strategy to reduce deaths in prison: Retrospective cohort study

Opioid dependence is a complex, relapsing condition requiring a model of treatment and care much like any other chronic health problem. The Ministry of Health’s investment in opioid substitution treatment (OST) has ensured that people with opioid dependence have access to a comprehensive treatment package that provides them with the opportunity to recover their health and wellbeing.

Specialist OST services are specified by the Minister of Health under section 24 Misuse of Drugs Act 1975 and notified in the 

. Specialist services are the entry point for all people requiring OST unless there are exceptional circumstances and subject to the approval of the Director of Mental Health.

This document provides clinical and procedural guidance for specialist services and primary care providers who deliver OST.

New Zealand practice guidelines for opioid substitution treatment

Poor adherence to treatment diminishes its individual and public health benefit. Financial incentives, provided on the condition of treatment attendance, could address this problem. Injecting drug users are a high-risk group for hepatitis B virus (HBV) infection and transmission, but adherence to vaccination programmes is poor. We aimed to assess whether contingency management delivered in routine clinical practice increased the completion of HBV vaccination in individuals receiving opioid substitution therapy.

Modest financial incentives delivered in routine clinical practice significantly improve adherence to, and completion of, HBV vaccination programmes in patients receiving opioid substitution therapy. Achievement of this improvement in routine clinical practice should now prompt actual implementation. Drug treatment providers should employ contingency management to promote adherence to vaccination programmes. The effectiveness of routine use of contingency management to achieve long-term behaviour change remains unknown.

Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence

The Inter-American Commission for Human Rights (IACHR) celebrated, for the first time, on March 25 a public hearing to analyze the severe impact that drug policies have had on human rights. The hearing raised the need to review the approach of current drug policies, highlighting the need for these to put human rights and reduction of violence as its core objectives.

Drug policies and human rights before the IACHR

Although the fact of prohibition itself raises prices far above those likely to pertain in legal markets, there is little evidence that raising the risk of arrest, incarceration or seizure at different levels of the distribution system will raise prices at the targeted level, let alone retail prices. The number of studies available is small; they use a great variety of outcome and input measures and they all face substantial conceptual and empirical problems.

Given the high human and economic costs of stringent enforcement measures, particularly incarceration, the lack of evidence that tougher enforcement raises prices call into question the value, at the margin, of stringent supply-side enforcement policies in high-enforcement nations.

 for more information on the study. (restricted access)

Does tougher enforcement make drugs more expensive?

According to recent estimates, more than 185 million people around the world have been infected with the hepatitis C virus (HCV), of whom 350 000 die each year. One third of those who become chronically infected are predicted to develop liver cirrhosis or hepatocellular carcinoma. Despite the high prevalence of disease, most people infected with the virus are unaware of their infection. For many who have been diagnosed, treatment remains unavailable. Treatment is successful in the majority of persons treated, and treatment success rates among patients treated in low- and middle-income countries are similar to those in high-income countries.

These are the first guidelines dealing with hepatitis C treatment produced by the World Health Organization (WHO) and complement existing guidance on the prevention of transmission of blood borne viruses, including HCV. They are intended for policy-makers, government officials, and others working in low- and middle income countries who are developing programmes for the screening, care and treatment of persons with HCV infection. These guidelines serve as a framework that can allow the expansion of clinical services to patients with HCV infection, as they provide key recommendations in these areas and discuss considerations for implementation. The guidelines are also intended for health-care providers who care for persons with HCV infection in low- and middle-countries and provide them guidance in the management of patients infected with HCV.

Guidelines for the screening, care and treatment of people with hepatitis C infection

This report by the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) presents the findings of a literature review to identify the most frequently occurring patterns of use and their relation to harm in users of opioids, powder and crack cocaine, and meth/amphetamine. The behavioural factors that were studied included: frequency of use, duration of use, routes of administration, drug type, dose, severity of dependence, and (the presence of) polydrug use.

Research on stimulants covers a relatively broad spectrum of patterns and severity, and thus
provides some indications of the levels of use that are more harmful than others. Similar
evidence is relatively scarce for opioids, where the overwhelming majority of studies
concentrate only on the most risky injecting and addictive use.

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