Paul G. Royall, Patrick Courtney, Christine Goodair, Caroline S. Copeland
Background and aims
Opioids are now the most cited class in fatal overdoses. However, the antidote for opioid overdose—naloxone—is not always readily available. Our aim was to evaluate the feasibility of naloxone transit via drone to provide rapid access at the point of care.
Methods and findings
Real-world data pertaining to opioid overdoses, which occurred in the Teesside area of the UK 2015–2019, were extracted from the National Programme on Substance Abuse Deaths (NPSAD). The original locations of these opioid overdoses were used to compare the projected response times of ambulances with that of drones when considering the impacts of actual traffic and weather conditions, respectively; 58 cases were identified where a bystander—who could have called for and administered emergency naloxone—was likely present.
Results
In 78% of cases (n = 45/58) a class C1 commercial-off-the-shelf drone carrying naloxone could have reached the overdose location in 7 min—the benchmark time for the arrival of emergency services for Category 1 calls in England. With the implementation of recent advances in drone engineering, such as increased speeds and temperature-controlled cargo cradles, it is estimated that 98% of overdoses could have been reached in this timeframe (n = 57/58). Ambulances were able to reach a significantly lower number of cases in 7 min, even when considering best-case scenario traffic conditions (14%, n = 8/58, χ2P < 0.001).
Conclusions
This study provides proof-of-concept that, in the Teesside area of the UK, drones are more likely than ambulance to get naloxone to the site of an opioid overdose in 7 min.
背景和目的：阿片类药物现在是致命过量用药中被引用最多的一类。然而，阿片类药物过量的解药纳洛酮并不总是现成的。我们的目的是评估纳洛酮通过无人机转运的可行性，以在护理点提供快速通道。方法和发现：2015-2019年发生在英国蒂赛德地区的阿片类药物过量的真实世界数据来自国家药物滥用死亡计划（NPSAD）。在分别考虑实际交通和天气条件的影响时，使用这些阿片类药物过量的原始位置来比较救护车和无人机的预计响应时间；在58例病例中，一名本可以呼叫并使用紧急纳洛酮的旁观者可能在场。结果：78%的病例（n = 45/58）一架携带纳洛酮的C1级商用现成无人机可能在7分钟内到达服药过量地点，这是英国1类呼叫紧急服务到达的基准时间。随着无人机工程的最新进展，如速度的提高和温度控制的货物托架的实施，据估计，98%的过量使用可能在这段时间内达到（n = 57/58）。即使考虑到最佳情况下的交通条件，救护车也能在7分钟内达到显著较低的病例数（14%，n = 8/58，χ2 P 结论：这项研究提供了概念证明，在英国蒂赛德地区，无人机比救护车更有可能在7分钟内将纳洛酮送到阿片类药物过量的部位。
{"title":"An evaluation of naloxone transit for opioid overdose using drones: A case study using real-world coroner data","authors":"Paul G. Royall, Patrick Courtney, Christine Goodair, Caroline S. Copeland","doi":"10.1111/add.16361","DOIUrl":"10.1111/add.16361","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Opioids are now the most cited class in fatal overdoses. However, the antidote for opioid overdose—naloxone—is not always readily available. Our aim was to evaluate the feasibility of naloxone transit via drone to provide rapid access at the point of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and findings</h3>\u0000 \u0000 <p>Real-world data pertaining to opioid overdoses, which occurred in the Teesside area of the UK 2015–2019, were extracted from the National Programme on Substance Abuse Deaths (NPSAD). The original locations of these opioid overdoses were used to compare the projected response times of ambulances with that of drones when considering the impacts of actual traffic and weather conditions, respectively; 58 cases were identified where a bystander—who could have called for and administered emergency naloxone—was likely present.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 78% of cases (<i>n</i> = 45/58) a class C1 commercial-off-the-shelf drone carrying naloxone could have reached the overdose location in 7 min—the benchmark time for the arrival of emergency services for Category 1 calls in England. With the implementation of recent advances in drone engineering, such as increased speeds and temperature-controlled cargo cradles, it is estimated that 98% of overdoses could have been reached in this timeframe (<i>n</i> = 57/58). Ambulances were able to reach a significantly lower number of cases in 7 min, even when considering best-case scenario traffic conditions (14%, <i>n</i> = 8/58, χ<sup>2</sup> <i>P</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study provides proof-of-concept that, in the Teesside area of the UK, drones are more likely than ambulance to get naloxone to the site of an opioid overdose in 7 min.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"379-385"},"PeriodicalIF":6.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16361","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41186284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lauren J. Scott, Mira Hidajat, Elizabeth J. Burns, Cathy Ure, Suzy C. Hargreaves, Suzanne Audrey, Margaret Coffey, Susan Hare, Noemia Siqueira, Steve Parrott, Penny A. Cook, Frank de Vocht
<div> <section> <h3> Background and Aim</h3> <p>Drinking alcohol may cause harm to an individual's health and social relationships, while a drinking culture may harm societies as it may increase crime rates and make an area feel less safe. Local councils in Greater Manchester, UK, developed the Communities in Charge of Alcohol (CICA) intervention, in which volunteers were trained to give alcohol-related advice to the public and taught how to influence policies to restrict when, where and how alcohol is sold. As part of a larger study, the aim of the current project is to measure the impact of CICA on health and crime outcomes at the lower super output (LSOA) geographical aggregation.</p> </section> <section> <h3> Design</h3> <p>Quantitative evaluation using four time series analytic methods (stepped-wedge design, and comparisons to local controls, national controls and synthetic controls) with findings triangulated across these methods. A cost–benefit analysis was carried out alongside the effectiveness analysis.</p> </section> <section> <h3> Setting and Participants</h3> <p>The general public in Greater Manchester, UK, between 2010 and 2020.</p> </section> <section> <h3> Measurements</h3> <p>The primary outcome of interest was alcohol-related hospital admissions. Secondary outcomes were accident and emergency (A&E) attendances, ambulance callouts, recorded crimes and anti-social behaviour incidents.</p> </section> <section> <h3> Findings</h3> <p>Triangulation of the results did not indicate any consistent effect on area-level alcohol-related hospital admissions, A&E attendances, ambulance callouts, reported crimes or anti-social behaviour associated with the implementation of CICA. The primary stepped-wedge analysis indicated an increase in alcohol-related hospital admissions following the implementation of CICA of 13.4% (95% confidence interval −3.3%, +30.1%), which was consistent with analyses based on other methods with point estimates ranging from +3.4% to 16.4%.</p> </section> <section> <h3> Conclusion</h3> <p>There is no evidence of a measurable impact of the Communities in Charge of Alcohol (CICA) programme on area-level health and crime outcomes in Greater Manchester, UK, within 3 years of the programme start. The increase in alcohol-related hospital admissions was likely the result of other temporal trends rather than the CICA pro
{"title":"Does a local Alcohol Health Champion programme have a measurable impact on health and crime outcomes? A natural experiment evaluation of Communities in Charge of Alcohol (CICA) based on triangulation of methods","authors":"Lauren J. Scott, Mira Hidajat, Elizabeth J. Burns, Cathy Ure, Suzy C. Hargreaves, Suzanne Audrey, Margaret Coffey, Susan Hare, Noemia Siqueira, Steve Parrott, Penny A. Cook, Frank de Vocht","doi":"10.1111/add.16363","DOIUrl":"10.1111/add.16363","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Drinking alcohol may cause harm to an individual's health and social relationships, while a drinking culture may harm societies as it may increase crime rates and make an area feel less safe. Local councils in Greater Manchester, UK, developed the Communities in Charge of Alcohol (CICA) intervention, in which volunteers were trained to give alcohol-related advice to the public and taught how to influence policies to restrict when, where and how alcohol is sold. As part of a larger study, the aim of the current project is to measure the impact of CICA on health and crime outcomes at the lower super output (LSOA) geographical aggregation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Quantitative evaluation using four time series analytic methods (stepped-wedge design, and comparisons to local controls, national controls and synthetic controls) with findings triangulated across these methods. A cost–benefit analysis was carried out alongside the effectiveness analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and Participants</h3>\u0000 \u0000 <p>The general public in Greater Manchester, UK, between 2010 and 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>The primary outcome of interest was alcohol-related hospital admissions. Secondary outcomes were accident and emergency (A&E) attendances, ambulance callouts, recorded crimes and anti-social behaviour incidents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Triangulation of the results did not indicate any consistent effect on area-level alcohol-related hospital admissions, A&E attendances, ambulance callouts, reported crimes or anti-social behaviour associated with the implementation of CICA. The primary stepped-wedge analysis indicated an increase in alcohol-related hospital admissions following the implementation of CICA of 13.4% (95% confidence interval −3.3%, +30.1%), which was consistent with analyses based on other methods with point estimates ranging from +3.4% to 16.4%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is no evidence of a measurable impact of the Communities in Charge of Alcohol (CICA) programme on area-level health and crime outcomes in Greater Manchester, UK, within 3 years of the programme start. The increase in alcohol-related hospital admissions was likely the result of other temporal trends rather than the CICA pro","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 3","pages":"499-508"},"PeriodicalIF":6.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16363","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41186286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dominic Oliver, Amir Englund, Edward Chesney, Lucy Chester, Jack Wilson, Simina Sovi, Stina Wigroth, John Hodsoll, John Strang, Robin M. Murray, Tom P. Freeman, Paolo Fusar-Poli, Philip McGuire
<div> <section> <h3> Aims</h3> <p>To test how attentional bias and explicit liking are influenced by delta-9-tetrahydrocannabinol (THC) and whether these effects are moderated by cannabidiol (CBD).</p> </section> <section> <h3> Design</h3> <p>Double-blind, randomised, within-subjects cross-over study.</p> </section> <section> <h3> Setting</h3> <p>NIHR Wellcome Trust Clinical Research Facility at King's College Hospital, London, United Kingdom.</p> </section> <section> <h3> Participants/Cases</h3> <p>Forty-six infrequent cannabis users (cannabis use <1 per week).</p> </section> <section> <h3> Intervention(s)</h3> <p>Across four sessions, participants inhaled vaporised cannabis containing 10 mg of THC and either 0 mg (0:1 CBD:THC), 10 mg (1:1), 20 mg (2:1) or 30 mg (3:1) of CBD, administered in a randomised order and counter-balanced across participants (a total of 24 order groups).</p> </section> <section> <h3> Measurements</h3> <p>Participants completed two tasks: (1) Attentional Bias (AB), comparing reaction times toward visual probes presented behind 28 target stimuli (cannabis/food) compared with probes behind corresponding non-target (neutral) stimuli. Participants responding more quickly to probes behind target than non-target stimuli would indicate greater attentional bias to cannabis/food; (2) Picture Rating (PR), where all AB stimuli were rated on a 7-point pleasantness scale, measuring explicit liking.</p> </section> <section> <h3> Findings</h3> <p>During the AB task, participants were more biased toward cannabis stimuli in the 0:1 condition compared with baseline (mean difference = 12.2, 95% confidence intervals [CIs] = 1.20–23.3, <i>d</i> = 0.41, <i>P</i> = 0.03). No other significant AB or PR differences were found between cannabis and food stimuli between baseline and 0:1 condition (<i>P</i> > 0.05). No significant CBD effect was found on AB or PR task performance at any dose (<i>P</i> > 0.05). There was additionally no cumulative effect of THC exposure on AB or PR outcomes (<i>P</i> > 0.05).</p> </section> <section> <h3> Conclusions</h3> <p>A double-blind, randomised, cross-over study among infrequent cannabis users found
{"title":"Cannabidiol does not attenuate acute delta-9-tetrahydrocannabinol-induced attentional bias in healthy volunteers: A randomised, double-blind, cross-over study","authors":"Dominic Oliver, Amir Englund, Edward Chesney, Lucy Chester, Jack Wilson, Simina Sovi, Stina Wigroth, John Hodsoll, John Strang, Robin M. Murray, Tom P. Freeman, Paolo Fusar-Poli, Philip McGuire","doi":"10.1111/add.16353","DOIUrl":"10.1111/add.16353","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To test how attentional bias and explicit liking are influenced by delta-9-tetrahydrocannabinol (THC) and whether these effects are moderated by cannabidiol (CBD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Double-blind, randomised, within-subjects cross-over study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>NIHR Wellcome Trust Clinical Research Facility at King's College Hospital, London, United Kingdom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants/Cases</h3>\u0000 \u0000 <p>Forty-six infrequent cannabis users (cannabis use <1 per week).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention(s)</h3>\u0000 \u0000 <p>Across four sessions, participants inhaled vaporised cannabis containing 10 mg of THC and either 0 mg (0:1 CBD:THC), 10 mg (1:1), 20 mg (2:1) or 30 mg (3:1) of CBD, administered in a randomised order and counter-balanced across participants (a total of 24 order groups).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Participants completed two tasks: (1) Attentional Bias (AB), comparing reaction times toward visual probes presented behind 28 target stimuli (cannabis/food) compared with probes behind corresponding non-target (neutral) stimuli. Participants responding more quickly to probes behind target than non-target stimuli would indicate greater attentional bias to cannabis/food; (2) Picture Rating (PR), where all AB stimuli were rated on a 7-point pleasantness scale, measuring explicit liking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>During the AB task, participants were more biased toward cannabis stimuli in the 0:1 condition compared with baseline (mean difference = 12.2, 95% confidence intervals [CIs] = 1.20–23.3, <i>d</i> = 0.41, <i>P</i> = 0.03). No other significant AB or PR differences were found between cannabis and food stimuli between baseline and 0:1 condition (<i>P</i> > 0.05). No significant CBD effect was found on AB or PR task performance at any dose (<i>P</i> > 0.05). There was additionally no cumulative effect of THC exposure on AB or PR outcomes (<i>P</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A double-blind, randomised, cross-over study among infrequent cannabis users found ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"322-333"},"PeriodicalIF":6.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16353","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41186285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael McGrath, Mark Stare, Phyllis Chua, Rowan Ogeil, Ziad Nehme, Debbie Scott, Dan I. Lubman
Background and Aims
Public health measures introduced to contain the spread of the SARS-CoV-2 virus likely affected opioid supply and demand, as well as the patterns and contexts of opioid use. We measured opioid-related harms during the first 2 years of COVID-19 restrictions in Victoria, Australia.
Design
We adopted an interrupted time series analysis design using interventional autoregressive integrated moving average (ARIMA) models. Opioid-related ambulance attendance data between January 2015 and March 2022 were extracted from the National Ambulance Surveillance System.
Setting
Victoria, Australia.
Participants
Patients (≥15 years) attended to by an ambulance for opioid-related harms.
Measurements
Monthly opioid-related ambulance attendances for three drug types: heroin, prescription opioids and opioid agonist therapy (OAT) medications.
Findings
The monthly rate of heroin-related attendances fell by 26% immediately after the introduction of COVID-19 restrictions. A reduced rate of heroin-related attendances was observed during COVID-19 restrictions, resulting in 2578 averted heroin-related attendances. There was no change in the rate of attendances for extra-medical OAT medications or prescription opioids.
Conclusions
Strict COVID-19 restrictions in Victoria, Australia appear to have resulted in a substantial reduction in heroin-related ambulance attendances, perhaps because of border closures and restrictions on movement affecting supply, changing patterns of drug consumption, and efforts to improve access to OAT. Despite policy changes allowing longer OAT prescriptions and an increased number of unsupervised doses, we found no evidence of increased harms related to the extra-medical use of these medications.
{"title":"Opioid-related ambulance attendances during the first 2 years of the COVID-19 pandemic in Victoria, Australia","authors":"Michael McGrath, Mark Stare, Phyllis Chua, Rowan Ogeil, Ziad Nehme, Debbie Scott, Dan I. Lubman","doi":"10.1111/add.16360","DOIUrl":"10.1111/add.16360","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Public health measures introduced to contain the spread of the SARS-CoV-2 virus likely affected opioid supply and demand, as well as the patterns and contexts of opioid use. We measured opioid-related harms during the first 2 years of COVID-19 restrictions in Victoria, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>We adopted an interrupted time series analysis design using interventional autoregressive integrated moving average (ARIMA) models. Opioid-related ambulance attendance data between January 2015 and March 2022 were extracted from the National Ambulance Surveillance System.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Victoria, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Patients (≥15 years) attended to by an ambulance for opioid-related harms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Monthly opioid-related ambulance attendances for three drug types: heroin, prescription opioids and opioid agonist therapy (OAT) medications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The monthly rate of heroin-related attendances fell by 26% immediately after the introduction of COVID-19 restrictions. A reduced rate of heroin-related attendances was observed during COVID-19 restrictions, resulting in 2578 averted heroin-related attendances. There was no change in the rate of attendances for extra-medical OAT medications or prescription opioids.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Strict COVID-19 restrictions in Victoria, Australia appear to have resulted in a substantial reduction in heroin-related ambulance attendances, perhaps because of border closures and restrictions on movement affecting supply, changing patterns of drug consumption, and efforts to improve access to OAT. Despite policy changes allowing longer OAT prescriptions and an increased number of unsupervised doses, we found no evidence of increased harms related to the extra-medical use of these medications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"348-355"},"PeriodicalIF":6.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16360","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41186288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sally Olderbak, Justin Möckl, Jakob Manthey, Sara Lee, Jürgen Rehm, Eva Hoch, Ludwig Kraus
Aims
To measure the current trends of cannabis use in Germany, measure trends in the proportion of heavy cannabis users and estimate future cannabis use rates.
Design
Repeated waves of the Epidemiological Survey on Substance Abuse, a cross-sectional survey conducted between 1995 and 2021 with a two-stage participant selection strategy where respondents completed a survey on substance use delivered through the post, over the telephone or on-line.
Setting
Germany.
Participants/cases
German-speaking participants aged between 18 and 59 years living in Germany who self-reported on their cannabis use in the past 12 months (n = 78 678). With the application of a weighting scheme, the data are nationally representative.
Measurements
Questions on the frequency of cannabis use in the past 12 months and self-reported changes in frequency of use due to the COVID-19 pandemic.
Findings
The prevalence of past 12-month cannabis users increased from 4.4% [95% confidence interval (CI) = 3.7, 5.1] in 1995 to 10.0% (95% CI = 8.9, 11.3) in 2021. Modeling these trends revealed a significant increase that accelerated over the past decade. The proportion of heavy cannabis users [cannabis use (almost) daily or at least 200 times per year] among past-year users has remained steady from 1995 (11.4%, 95% CI = 7.7, 16.5) to 2018 (9.5%, 95% CI = 7.6, 11.9), but significantly increased to 15.7% (95% CI = 13.1, 18.8) in 2021 during the COVID-19 pandemic. Extrapolating from these models, the prevalence of 12-month cannabis users in 2024 is expected to range between 10.4 and 15.0%, while the proportion of heavy cannabis users is unclear.
Conclusions
Trends from 1995 to 2021 suggest that the prevalence of past 12-month cannabis users in Germany will continue to increase, with expected rates between 10.4 and 15.0% for the German-speaking adult population, and that at least one in 10 cannabis users will continue to use cannabis heavily (almost daily or 200 + times in the past year).
{"title":"Trends and projection in the proportion of (heavy) cannabis use in Germany from 1995 to 2021","authors":"Sally Olderbak, Justin Möckl, Jakob Manthey, Sara Lee, Jürgen Rehm, Eva Hoch, Ludwig Kraus","doi":"10.1111/add.16356","DOIUrl":"10.1111/add.16356","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To measure the current trends of cannabis use in Germany, measure trends in the proportion of heavy cannabis users and estimate future cannabis use rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Repeated waves of the Epidemiological Survey on Substance Abuse, a cross-sectional survey conducted between 1995 and 2021 with a two-stage participant selection strategy where respondents completed a survey on substance use delivered through the post, over the telephone or on-line.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Germany.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants/cases</h3>\u0000 \u0000 <p>German-speaking participants aged between 18 and 59 years living in Germany who self-reported on their cannabis use in the past 12 months (<i>n</i> = 78 678). With the application of a weighting scheme, the data are nationally representative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Questions on the frequency of cannabis use in the past 12 months and self-reported changes in frequency of use due to the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The prevalence of past 12-month cannabis users increased from 4.4% [95% confidence interval (CI) = 3.7, 5.1] in 1995 to 10.0% (95% CI = 8.9, 11.3) in 2021. Modeling these trends revealed a significant increase that accelerated over the past decade. The proportion of heavy cannabis users [cannabis use (almost) daily or at least 200 times per year] among past-year users has remained steady from 1995 (11.4%, 95% CI = 7.7, 16.5) to 2018 (9.5%, 95% CI = 7.6, 11.9), but significantly increased to 15.7% (95% CI = 13.1, 18.8) in 2021 during the COVID-19 pandemic. Extrapolating from these models, the prevalence of 12-month cannabis users in 2024 is expected to range between 10.4 and 15.0%, while the proportion of heavy cannabis users is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Trends from 1995 to 2021 suggest that the prevalence of past 12-month cannabis users in Germany will continue to increase, with expected rates between 10.4 and 15.0% for the German-speaking adult population, and that at least one in 10 cannabis users will continue to use cannabis heavily (almost daily or 200 + times in the past year).</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"311-321"},"PeriodicalIF":6.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41186289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Greta A. Bushnell, Moira A. Rynn, Tobias Gerhard, Katherine M. Keyes, Deborah S. Hasin, Magdalena Cerdá, Abner Nyandege, Mark Olfson
Background and Aims
Benzodiazepines (BZDs) carry a risk for drug overdose and are prescribed alone or simultaneously with selective-serotonin reuptake inhibitors (SSRIs) for the treatment of anxiety and depression in young adults. We aimed to measure risks of drug overdose following BZD treatment initiation, and simultaneous BZD and SSRI initiation, compared with SSRI treatment alone in young adults with depression or anxiety.
Design, Setting, Participants
The cohort study used administrative databases covering privately (MarketScan, 1/1/2009–12/31/2018) and publicly (Medicaid, 1/1/2015–12/31/2016) insured young adults (18–29 years) in the United States. Those with depression or anxiety diagnoses newly initiating BZD or SSRI treatment (without BZD or SSRI prescriptions in prior year) were included. Simultaneous “BZD + SSRI” initiation was defined as starting BZD and SSRI treatment on the same day. The cohorts included 604 664 privately insured young adults (BZD = 22%, BZD + SSRI = 10%, SSRI = 68%) and 110 493 publicly insured young adults (BZD = 23%, BZD + SSRI = 5%, SSRI = 72%).
Measurements
Incident medically treated drug overdose events were identified from emergency department and inpatient encounters (ICD poisoning codes) within 6 months of treatment initiation. Crude and propensity-score adjusted cumulative incidence and hazard ratios (HR) were estimated. Sub-analyses evaluated drug overdose intent.
Findings
Adjusted HRs of drug overdose for BZD vs. SSRI treatment was 1.36 (95% confidence interval [CI]:1.23–1.51) in privately and 1.59 (95%CI:1.37–1.83) in publicly insured young adults. The adjusted HRs of drug overdose for BZD + SSRI treatment vs. SSRI treatment were 1.99 (95%CI:1.77–2.25) in privately and 1.98 (95%CI:1.47–2.68) in publicly insured young adults.
Conclusions
Among young adults in the United States, initiating benzodiazepine treatment for anxiety and depression, alone or simultaneously with selective-serotonin reuptake inhibitors (SSRI), appears to have an increased risk of medically treated drug overdose compared with SSRI treatment alone. These associations were observed in publicly and privately insured individuals.
{"title":"Drug overdose risk with benzodiazepine treatment in young adults: Comparative analysis in privately and publicly insured individuals","authors":"Greta A. Bushnell, Moira A. Rynn, Tobias Gerhard, Katherine M. Keyes, Deborah S. Hasin, Magdalena Cerdá, Abner Nyandege, Mark Olfson","doi":"10.1111/add.16359","DOIUrl":"10.1111/add.16359","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Benzodiazepines (BZDs) carry a risk for drug overdose and are prescribed alone or simultaneously with selective-serotonin reuptake inhibitors (SSRIs) for the treatment of anxiety and depression in young adults. We aimed to measure risks of drug overdose following BZD treatment initiation, and simultaneous BZD and SSRI initiation, compared with SSRI treatment alone in young adults with depression or anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, Setting, Participants</h3>\u0000 \u0000 <p>The cohort study used administrative databases covering privately (MarketScan, 1/1/2009–12/31/2018) and publicly (Medicaid, 1/1/2015–12/31/2016) insured young adults (18–29 years) in the United States. Those with depression or anxiety diagnoses newly initiating BZD or SSRI treatment (without BZD or SSRI prescriptions in prior year) were included. Simultaneous “BZD + SSRI” initiation was defined as starting BZD and SSRI treatment on the same day. The cohorts included 604 664 privately insured young adults (BZD = 22%, BZD + SSRI = 10%, SSRI = 68%) and 110 493 publicly insured young adults (BZD = 23%, BZD + SSRI = 5%, SSRI = 72%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Incident medically treated drug overdose events were identified from emergency department and inpatient encounters (ICD poisoning codes) within 6 months of treatment initiation. Crude and propensity-score adjusted cumulative incidence and hazard ratios (HR) were estimated. Sub-analyses evaluated drug overdose intent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Adjusted HRs of drug overdose for BZD vs. SSRI treatment was 1.36 (95% confidence interval [CI]:1.23–1.51) in privately and 1.59 (95%CI:1.37–1.83) in publicly insured young adults. The adjusted HRs of drug overdose for BZD + SSRI treatment vs. SSRI treatment were 1.99 (95%CI:1.77–2.25) in privately and 1.98 (95%CI:1.47–2.68) in publicly insured young adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among young adults in the United States, initiating benzodiazepine treatment for anxiety and depression, alone or simultaneously with selective-serotonin reuptake inhibitors (SSRI), appears to have an increased risk of medically treated drug overdose compared with SSRI treatment alone. These associations were observed in publicly and privately insured individuals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"356-368"},"PeriodicalIF":6.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41186287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oliver Grundmann, Albert Garcia-Romeu, Christopher R. McCurdy, Abhisheak Sharma, Kirsten E. Smith, Marc T. Swogger, Stephanie T. Weiss
<p>The Southeast Asian plant kratom (<i>Mitragyna speciosa</i> Korth.) has garnered growing popularity among North American consumers as a herbal product used for recreational, performance enhancement and self-treatment purposes. Scientifically, there has also been substantial interest in studying kratom and its constituents as a possible therapy for several conditions, including pain, mood, fatigue and substance use disorders (SUDs) [<span>1</span>]. Pre-clinical animal studies, human surveys and clinical case reports indicate that kratom has potential therapeutic effects as well as possible abuse and dependence potential, consistent with its complex opioidergic, adrenergic and serotonergic pharmacology [<span>2</span>].</p><p>Kratom is not federally recognized as a dietary supplement, and is therefore largely unregulated. Native kratom leaf material contains up to 2% of the major indole alkaloid mitragynine by weight. In addition, more than 50 other indole and oxindole alkaloids, some with known pharmacological effects, are present in lesser, but potentially significant, amounts [<span>3</span>].</p><p>Recently, there is a growing and concerning commercial trend in Western countries towards the production and marketing of kratom extract products created via extraction of kratom leaves using organic solvents. This enrichment process can increase the mitragynine concentration to 40% or higher in such products. Of great concern from a public health perspective, commercial kratom extract products lack data regarding their safety, efficacy and abuse potential. In addition, the formulation of concentrated kratom extracts as capsules, tablets, liquid shots or gummies circumvents kratom’s natural self-limiting qualities (e.g. unpleasant taste) and reduces the volume of product needed to achieve an effect, thereby raising the risk of users ingesting larger amounts of alkaloids with potentially toxic effects.</p><p>History has shown us that developing enriched natural-product elixirs or purified active agents, as with cocaine from the coca shrub and morphine from the opium poppy, can be both a blessing and a curse: a blessing in that some of these concentrates can be medically useful to improve quality of life for patients suffering from a variety of disorders and a curse of increased risk. Concentrated kratom extracts are analogous to these previous historical examples. They may provide benefit to some, but they may result in unpredictable adverse effects and other potential harms resulting from dependence and drug–drug interactions.</p><p>As researchers studying the therapeutic potential of kratom, while also desiring to reduce possible associated harms, we strongly recommend that kratom in its native form as the unadulterated fresh or dried leaf material remains available to consumers with proper oversight and regulation, including clear labeling describing the amount of mitragynine per dose, recommended maximum daily doses, potential for drug interac
{"title":"Not all kratom is equal: The important distinction between native leaf and extract products","authors":"Oliver Grundmann, Albert Garcia-Romeu, Christopher R. McCurdy, Abhisheak Sharma, Kirsten E. Smith, Marc T. Swogger, Stephanie T. Weiss","doi":"10.1111/add.16366","DOIUrl":"10.1111/add.16366","url":null,"abstract":"<p>The Southeast Asian plant kratom (<i>Mitragyna speciosa</i> Korth.) has garnered growing popularity among North American consumers as a herbal product used for recreational, performance enhancement and self-treatment purposes. Scientifically, there has also been substantial interest in studying kratom and its constituents as a possible therapy for several conditions, including pain, mood, fatigue and substance use disorders (SUDs) [<span>1</span>]. Pre-clinical animal studies, human surveys and clinical case reports indicate that kratom has potential therapeutic effects as well as possible abuse and dependence potential, consistent with its complex opioidergic, adrenergic and serotonergic pharmacology [<span>2</span>].</p><p>Kratom is not federally recognized as a dietary supplement, and is therefore largely unregulated. Native kratom leaf material contains up to 2% of the major indole alkaloid mitragynine by weight. In addition, more than 50 other indole and oxindole alkaloids, some with known pharmacological effects, are present in lesser, but potentially significant, amounts [<span>3</span>].</p><p>Recently, there is a growing and concerning commercial trend in Western countries towards the production and marketing of kratom extract products created via extraction of kratom leaves using organic solvents. This enrichment process can increase the mitragynine concentration to 40% or higher in such products. Of great concern from a public health perspective, commercial kratom extract products lack data regarding their safety, efficacy and abuse potential. In addition, the formulation of concentrated kratom extracts as capsules, tablets, liquid shots or gummies circumvents kratom’s natural self-limiting qualities (e.g. unpleasant taste) and reduces the volume of product needed to achieve an effect, thereby raising the risk of users ingesting larger amounts of alkaloids with potentially toxic effects.</p><p>History has shown us that developing enriched natural-product elixirs or purified active agents, as with cocaine from the coca shrub and morphine from the opium poppy, can be both a blessing and a curse: a blessing in that some of these concentrates can be medically useful to improve quality of life for patients suffering from a variety of disorders and a curse of increased risk. Concentrated kratom extracts are analogous to these previous historical examples. They may provide benefit to some, but they may result in unpredictable adverse effects and other potential harms resulting from dependence and drug–drug interactions.</p><p>As researchers studying the therapeutic potential of kratom, while also desiring to reduce possible associated harms, we strongly recommend that kratom in its native form as the unadulterated fresh or dried leaf material remains available to consumers with proper oversight and regulation, including clear labeling describing the amount of mitragynine per dose, recommended maximum daily doses, potential for drug interac","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 1","pages":"202-203"},"PeriodicalIF":6.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16366","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41181437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background and Aims</h3> <p>Fathers' parental leave has been associated with decreased risks of alcohol-related hospitalizations and mortality. Whether this is attributable to the health protections of parental leave itself (through stress reduction or behavioral changes) or to selection into leave uptake remains unclear, given that fathers are more likely to use leave if they are in better health. Using the quasi-experimental variation of a reform incentivizing fathers' leave uptake (the 1995 <i>Father's quota</i> reform), this study aimed to assess whether fathers' parental leave influences alcohol-related morbidity and mortality.</p> </section> <section> <h3> Design</h3> <p>Quasi-experimental interrupted time series and instrumental variable analyses.</p> </section> <section> <h3> Setting</h3> <p>Sweden.</p> </section> <section> <h3> Participants</h3> <p>Fathers of singleton children born from January 1992 to December 1997 (<i>n</i> = 220 412).</p> </section> <section> <h3> Measurements</h3> <p>Exposure was indicated by the child's birthdate before or after the reform and used to instrument fathers' 2- and 8-year parental leave uptake. Outcomes included fathers' hospitalization rates for acute alcohol-related (intoxication; mental and behavioral disorders) and chronic alcohol-related diagnoses (cardiovascular, stomach and other diseases; liver diseases), as well as alcohol-related mortality, up to 2, 8 and 18 years after the first child's birthdate.</p> </section> <section> <h3> Findings</h3> <p>In interrupted time series analyses, fathers of children born after the reform exhibited immediate decreases in alcohol-related hospitalization rates up to 2 (incidence rate ratio [IRR] = 0.66, 95% confidence interval [CI] = 0.51–0.87), 8 (IRR = 0.74, 95% CI = 0.57–0.96) and 18 years after birth (IRR = 0.72, 95% CI = 0.54–0.96), particularly in acute alcohol-related hospitalization rates, compared with those with children born before. No changes were found for alcohol-related mortality. Instrumental variable results suggest that alcohol-related hospitalization decreases were driven by fathers' parental leave uptake (e.g. 2-year hospitalizations: IRR = 0.16, 95% CI = 0.03–0.84).</p> </section> <section> <h3> Conclusions</h3> <p>In Swe
{"title":"Alcohol-related morbidity and mortality by fathers' parental leave: A quasi-experimental study in Sweden","authors":"Helena Honkaniemi, Sol Pía Juárez","doi":"10.1111/add.16354","DOIUrl":"10.1111/add.16354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Fathers' parental leave has been associated with decreased risks of alcohol-related hospitalizations and mortality. Whether this is attributable to the health protections of parental leave itself (through stress reduction or behavioral changes) or to selection into leave uptake remains unclear, given that fathers are more likely to use leave if they are in better health. Using the quasi-experimental variation of a reform incentivizing fathers' leave uptake (the 1995 <i>Father's quota</i> reform), this study aimed to assess whether fathers' parental leave influences alcohol-related morbidity and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Quasi-experimental interrupted time series and instrumental variable analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Fathers of singleton children born from January 1992 to December 1997 (<i>n</i> = 220 412).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Exposure was indicated by the child's birthdate before or after the reform and used to instrument fathers' 2- and 8-year parental leave uptake. Outcomes included fathers' hospitalization rates for acute alcohol-related (intoxication; mental and behavioral disorders) and chronic alcohol-related diagnoses (cardiovascular, stomach and other diseases; liver diseases), as well as alcohol-related mortality, up to 2, 8 and 18 years after the first child's birthdate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>In interrupted time series analyses, fathers of children born after the reform exhibited immediate decreases in alcohol-related hospitalization rates up to 2 (incidence rate ratio [IRR] = 0.66, 95% confidence interval [CI] = 0.51–0.87), 8 (IRR = 0.74, 95% CI = 0.57–0.96) and 18 years after birth (IRR = 0.72, 95% CI = 0.54–0.96), particularly in acute alcohol-related hospitalization rates, compared with those with children born before. No changes were found for alcohol-related mortality. Instrumental variable results suggest that alcohol-related hospitalization decreases were driven by fathers' parental leave uptake (e.g. 2-year hospitalizations: IRR = 0.16, 95% CI = 0.03–0.84).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In Swe","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"301-310"},"PeriodicalIF":6.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41093032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Shield <i>et al</i>. [<span>1</span>] draw upon the recent redevelopment of the Canadian Low Risk Drinking Guidelines to formulate some key principles that, they argue, should underpin future guidelines work internationally. This is an admirable attempt to further earlier work by Holmes <i>et al</i>. [<span>2</span>] arguing for increasing rigour and transparency in the guidelines setting process and offers much food for thought.</p><p>Fundamentally, the setting of guidelines is concerned with risk, with (i) accurately estimating via sophisticated epidemiology and modelling the risks of various outcomes (often mortality) associated with drinking, (ii) determining some level of population risk considered acceptable and (iii) communicating these risks to the population. Much of the energy in the various guidelines committees in recent decades has been focused upon (i), which has led to substantial improvements in our understanding of the population impacts of alcohol e.g. [<span>3, 4</span>], although there remains ongoing debate and uncertainty in key areas [<span>5</span>].</p><p>Strikingly little research has been conducted on either (ii) or (iii). It is remarkable that guidelines committees have, from at least the 2009 Australian guidelines [<span>6</span>], relied upon a 1969 analysis of risk acceptability by Starr [<span>7</span>], which has since been critiqued and expanded upon in a large body of work examining risk perception and acceptability [<span>8, 9</span>]. Research has demonstrated clearly that risk perceptions and acceptability vary markedly among different risks, depending upon factors including familiarity, immediacy, personal experience and perceived benefits (among many others) [<span>10</span>]. Further, there are clear and predictable variations in risk acceptability between subpopulations, based on gender, age, living situation and more [<span>11-13</span>]. Surprisingly little work has followed to situate alcohol epidemiology within these broader literatures on risk. Thus, our reliance upon relatively simplistic risk thresholds (1/100 in the recent Australian and UK guidelines) seems arbitrary.</p><p>This supports the argument put forward by Shield <i>et al</i>. that providing a continuum of risk is a more appropriate approach to guideline development, letting individuals make their own, informed decisions about risk acceptability by providing a range of risk thresholds or a continuous risk function. This is, however, obviously contingent upon (iii), the communication and understanding of risk by the general public. The Canadian guidelines provide a good example of the challenges here, with the relatively sophisticated risk continuum simplified throughout hundreds of media articles into a single guideline of two drinks per week [<span>14, 15</span>]. Our understanding of how best to communicate the risks that underpin drinking guidelines remains poor, despite potential lessons from a substantial broader research field [
{"title":"Improving the epidemiology of low-risk drinking guidelines is not enough","authors":"Michael Livingston","doi":"10.1111/add.16358","DOIUrl":"10.1111/add.16358","url":null,"abstract":"<p>Shield <i>et al</i>. [<span>1</span>] draw upon the recent redevelopment of the Canadian Low Risk Drinking Guidelines to formulate some key principles that, they argue, should underpin future guidelines work internationally. This is an admirable attempt to further earlier work by Holmes <i>et al</i>. [<span>2</span>] arguing for increasing rigour and transparency in the guidelines setting process and offers much food for thought.</p><p>Fundamentally, the setting of guidelines is concerned with risk, with (i) accurately estimating via sophisticated epidemiology and modelling the risks of various outcomes (often mortality) associated with drinking, (ii) determining some level of population risk considered acceptable and (iii) communicating these risks to the population. Much of the energy in the various guidelines committees in recent decades has been focused upon (i), which has led to substantial improvements in our understanding of the population impacts of alcohol e.g. [<span>3, 4</span>], although there remains ongoing debate and uncertainty in key areas [<span>5</span>].</p><p>Strikingly little research has been conducted on either (ii) or (iii). It is remarkable that guidelines committees have, from at least the 2009 Australian guidelines [<span>6</span>], relied upon a 1969 analysis of risk acceptability by Starr [<span>7</span>], which has since been critiqued and expanded upon in a large body of work examining risk perception and acceptability [<span>8, 9</span>]. Research has demonstrated clearly that risk perceptions and acceptability vary markedly among different risks, depending upon factors including familiarity, immediacy, personal experience and perceived benefits (among many others) [<span>10</span>]. Further, there are clear and predictable variations in risk acceptability between subpopulations, based on gender, age, living situation and more [<span>11-13</span>]. Surprisingly little work has followed to situate alcohol epidemiology within these broader literatures on risk. Thus, our reliance upon relatively simplistic risk thresholds (1/100 in the recent Australian and UK guidelines) seems arbitrary.</p><p>This supports the argument put forward by Shield <i>et al</i>. that providing a continuum of risk is a more appropriate approach to guideline development, letting individuals make their own, informed decisions about risk acceptability by providing a range of risk thresholds or a continuous risk function. This is, however, obviously contingent upon (iii), the communication and understanding of risk by the general public. The Canadian guidelines provide a good example of the challenges here, with the relatively sophisticated risk continuum simplified throughout hundreds of media articles into a single guideline of two drinks per week [<span>14, 15</span>]. Our understanding of how best to communicate the risks that underpin drinking guidelines remains poor, despite potential lessons from a substantial broader research field [","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 1","pages":"20-21"},"PeriodicalIF":6.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41090439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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