Aims Smoking prevalence is higher among people enrolled in addiction treatment compared with the general population, and very high rates of smoking are associated with opiate drug use and receipt of opiate replacement therapy (ORT). We assessed whether these findings are observed internationally. Methods PubMed, PsycINFO and the Alcohol and Alcohol Problems Science Database were searched for papers reporting smoking prevalence among addiction treatment samples, published in English, from 1987 to 2013. Search terms included tobacco use, cessation and substance use disorders using and/or Boolean connectors. For 4549 papers identified, abstracts were reviewed by multiple raters; 239 abstracts met inclusion criteria and these full papers were reviewed for exclusion. Fifty-four studies, collectively comprising 37 364 participants, were included. For each paper we extracted country, author, year, sample size and gender, treatment modality, primary drug treated and smoking prevalence. Results The random-effect pooled estimate of smoking across people in addiction treatment was 84% [confidence interval (CI) = 79, 88%], while the pooled estimate of smoking prevalence across matched population samples was 31% (CI = 29, 33%). The difference in the pooled estimates was 52% (CI = 48%, 57%, P < .0001). Smoking rates were higher in programs treating opiate use compared with alcohol use [odds ratio (OR) = 2.52, CI = 2.00, 3.17], and higher in ORT compared to out-patient programs (OR = 1.42, CI = 1.19, 1.68). Conclusions Smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics. Smoking rates are also higher in people being treated for opiate dependence compared with people being treated for alcohol use disorder.
Keywords: Addiction; co-substance use; global health; priority/special populations; smoking; surveillance and monitoring; tobacco
42. Impact of the introduction of standardised packaging on smokers' brand awareness and identification in Australia
James Balmford, Ron Borland and Hua-Hie Yong
Drug and Alcohol Review 2016:35(1);102-109
Introduction and Aims The introduction of standardised packaging (SP) in Australia in December 2012 has heightened interest in how image and branding might affect smoking. This paper tests the hypothesis that brand awareness and identification among smokers will decline after the introduction of SP. Design and Methods Longitudinal study of three waves of smokers in Australia, conducted between October 2011–February 2012 (pre-SP) (n = 1104), February–May 2013 (post-SP1) (n = 1093) and August–December 2014 (post-SP2) (n = 1090). We explored the extent of changes in two variables, brand awareness (noticing others with the brand of cigarettes you smoke) and brand identification (perceiving something in common among smokers of your brand), and examined change in a number of other measures of brand appeal, brand characteristics and determinants of brand choice.
Results Brand awareness ‘at least sometimes’ reduced from 45.3% pre-SP to 26.9% at post-SP2 [odds ratio (OR) 0.35 (0.27–0.45)]. Brand identification also decreased from 18.2% to 12.7% [OR 0.62 (0.42–0.91)]. Significant decline was also found in measures of perceived brand prestige [OR 0.51 (0.39–0.66)] and choice of brand for health reasons [OR 0.45 (0.32–0.63)]. Liking the look of the pack was strongly associated with brand identification, but only post-SP (P = 0.02 for interaction across the three waves). Discussion and Conclusions The introduction of SP of tobacco products in Australia has been associated with reductions in brand awareness and identification, and changes in related measures. The findings support the notion that SP has reduced the capacity for smokers to use pack branding to create and communicate a desired identity.
Keywords: Australia; plain packaging; tobacco; awareness; brand identification; longitudinal study
43. Community attitudes towards harm reduction services and a newly established needle and syringe automatic dispensing machine in an inner-city area of Sydney, Australia
Bethany White, Paul S. Haber, Carolyn A. Day
International Journal of Drug Policy 2016:27;121-126 Abstract
Background Automatic dispensing machines (ADMs) are an inexpensive method of increasing needle and syringe distribution to people who inject drugs but widespread implementation has been limited. The operation of ADMs in Australia has been met with apparent community opposition despite national data indicating support for harm reduction. Key community concerns include perceived increases in crime and drug use. This study aimed to examine community-level support for a newly implemented ADM in an inner-city Sydney area known for high levels of drug use.Methods Attitudes to harm reduction and ADMs were assessed via a brief face-to-face survey of local residents (n = 118) and businesses (n = 35) located within the vicinity of needle and syringe program (NSP) services including the ADM. Participation was voluntary and no reimbursement was provided. Univariate analysis assessed statistically significant differences between residents’ and businesses’ knowledge of, and support for, a range of harm reduction initiatives, both generally and in the local area. Univariate logistic regression models were used to determine factors associated with indicating support for an ADM locally.Results The response rate was higher among businesses (60%) compared to residents living in street-accessible dwellings (42%). Participants indicated support for fixed-site NSPs in general (83%) and locally (77%). Support for ADMs was slightly lower – 67% indicated support for ADMs generally and 60% locally. Negative opinions regarding ADMs (believing that they encourage drug use, attract drug users to the area and increase drug-related crime) were found to be significantly associated with a lower likelihood of indicating support for ADMs locally.
Conclusion Despite media reports suggesting widespread community concern, there was general community support for harm reduction, including ADMs. While it is important that harm reduction services are aware of community concerns and respond appropriately, such responses should be considered and interpreted against a broader backdrop of support.
44. Trust and people who inject drugs: The perspectives of clients and staff of Needle Syringe Programs
Carla Treloar, Jake Rance, Kenneth Yates, Limin Mao
International Journal of Drug Policy 2016:27;138-145
Aims Interest in health-care related trust is growing with the recognition that trust is essential for effective therapeutic encounters. While most trust-related research has been conducted with general patient groups, the experiences of people who inject drugs cannot be understood without acknowledging the critical role social stigma plays in shaping (mis)trust, both generally and in regards to health services specifically. This study examined the experiences of trust among clients and staff of Needle and Syringe Programs (NSPs) in one area of Sydney, Australia. Method In-depth interviews with 12 NSP staff and 31 NSP clients were conducted. Analysis was informed by a five component model of trust, with particular emphasis on the notion of “global trust” as encompassing experiences of stigma and other negative social processes related to injecting drug use. Participant experiences of trust in NSPs were compared with those within other drug-related health services. Particular attention was paid to understanding the relationship between ‘identity’ (as a drug user) and ‘legitimacy’ (as a service user) and the centrality of this relationship to the experience of global trust for PWID. Results Notions of identity and legitimacy were inextricably bound up with the stigmatisation of drug use, shaping participants’ experiences and accounts of trust in NSPs and drug treatment services. Client participants reported high levels of trust in NSPs, especially when compared with drug treatment services, describing being treated like “any other person” even when negotiating ‘sensitive’ issues. NSP staff participants described the establishment of trust as not only underpinning their work with clients but as something that required ongoing renewal and demonstration. Conclusion “Global trust” assists us to better understand the complex experiences shaping PWID decisions to engage with and trust health services. The high levels of trust reported between client and NSP need to be recognised as a valuable resource for the delivery of effective health care for people who inject drugs, including encouraging behaviours to support the prevention of blood-borne viruses.
Keywords: Needle and Syringe Program; Harm reduction; Australia; Qualitative research; Trust
NEW PSYCHOACTIVE SUBSTANCE
45. Next generation of novel psychoactive substances on the horizon – A complex problem to face
Jolanta B. Zawilska, Dariusz Andrzejczak
Drug and Alcohol Dependence 2015:157;1-17 Abstract
Background The last decade has seen a rapid and continuous growth in the availability and use of novel psychoactive substances (NPS) across the world. Although various products are labeled with warnings “not for human consumption”, they are intended to mimic psychoactive effects of illicit drugs of abuse. Once some compounds become regulated, new analogues appear in order to satisfy consumers’ demands and at the same time to avoid criminalization. This review presents updated information on the second generation of NPS, introduced as replacements of the already banned substances from this class, focusing on their pharmacological properties and metabolism, routes of administration, and effects in humans.Methods Literature search, covering years 2013–2015, was performed using the following keywords alone or in combination: “novel psychoactive substances”, “cathinones”, “synthetic cannabinoids”, “benzofurans”, “phenethylamines”, “2C-drugs”, “NBOMe”, “methoxetamine”, “opioids”, “toxicity”, and “metabolism”.Results More than 400 NPS have been reported in Europe, with 255 detected in 2012–2014. The most popular are synthetic cannabimimetics and psychostimulant cathinones; use of psychedelics and opioids is less common. Accumulating experimental and clinical data indicate that potential harms associated with the use of second generation NPS could be even more serious than those described for the already banned drugs.Conclusions NPS are constantly emerging on the illicit drug market and represent an important health problem. A significant amount of research is needed in order to fully quantify both the short and long term effects of the second generation NPS, and their interaction with other drugs of abuse.