Congratulations to Angelos Hatzakis and colleagues for winning the 2016 EMCDDA Scientific Award (Category: Population-based and Epidemiology Research) for their paper, "Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece: the ARISTOTLE programme." The paper was published in the September 2015 issue of Addiction and can be accessed here.
We welcome suggestions and contributions from our readers. Send your material to John Witton, News and Notes Editor, Addiction, National Addiction Centre PO48, 4 Windsor Walk, London SE5 8AF. Fax +44 (0)20 7848 5966;
Public Health England (PHE), which advises the UK government on public health issues, has published a review of the evidence on alcohol harm and its impact in England. The report says that 10 million people in England are drinking at levels that increase their risk of health harm and that alcohol is the leading risk factor for ill-health, early mortality and disability amongst those aged 15 – 49. The review also evaluates the effectiveness and cost-effectiveness of policy approaches for reducing alcohol-related harm, including taxation and price regulation, market regulation and reducing the hours of alcohol outlets. Professor Sir Ian Gilmore, chairman of the Alcohol Health Alliance UK, said in the Telegraph: "This report provides yet more evidence of the effectiveness of raising the price of the cheapest alcohol to tackle alcohol-related harm.” A government spokesperson commented: "The issue of minimum unit pricing is under review while we await the outcome of the court case in Scotland."
The New York Times reports that the Food and Drug Administration (FDA) has approved a phase 3 trial to confirm the effectiveness of MDMA for post-traumatic stress disorder (PTSD) and compare it to the best current treatments for the disorder. The Multidisciplinary Association for Psychedelic Studies (MAPS), the nonprofit research and educational organization that advocates the legal medical use of MDMA, LSD and cannabis, will raise the $20 million to fund the research. The trial is expected to involve at least 230 patients. MAPS has already sponsored six Phase 2 studies treating a total of 130 PTSD patients and plans to make MDMA into a FDA-approved prescription medicine by 2021.
The Telegraph reports that in November the UK court of appeal upheld legislation that forces all tobacco products to use plain packaging. The judges ruled that the health secretary had “lawfully exercised his powers” in introducing the legislation. The decision follows the failed court attempt by the companies to challenge the legislation in May 2016, one month after the legislation came into effect. Deborah Arnott, the chief executive of Ash, said: “This is a victory for public health and another crushing defeat for the tobacco industry. This ruling should also encourage other countries to press ahead with standardised packaging, now that the industry’s arguments have yet again been shown to be without foundation.” The tobacco companies have the option of continuing their challenge through the UK’s Supreme Court.
In his preface to Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, the Surgeon General, Vivek H. Murthy, writes: “Fifty years ago, the landmark Surgeon General’s report on the dangers of smoking began a half century of work to end the tobacco epidemic and saved millions of lives…. I am issuing a new call to action to end the public health crisis of addiction.” He adds, “It’s time to change how we view addiction, not as a moral failing but as a chronic illness that must be treated with skill, urgency and compassion.” The extensive report summarizes the effects of alcohol and drugs and the research evidence on prevention and treatment. In a press call following the report’s release, Murthy said, “What many people don’t recognize is that alcohol causes more deaths and costs us more in terms of financial resources than any other substances,” and that “in the report, we lay out the evidence for various strategies for reducing alcohol misuse and alcohol use disorders.” According toThe New York Times, Democratic senator Edward J. Markey commented: “The deaths caused by prescription drug, heroin and fentanyl overdoses are growing exponentially every year, yet this report fails to provide any detailed road map for how best to curb opioid addiction.” Senator Markey added, “The magnitude of the opioid epidemic demanded a far more detailed discussion.”
Scientific American reports that in October the US Drug Enforcement Agency (DEA) withdrew its emergency plan to put the medicinal plant preparation kratom into Schedule 1 of the Controlled Substance Act, the schedule for substances considered to have no currently accepted medical use and a high risk of abuse. Used over the centuries in South East Asia, kratom has been more recently used in the US by people seeking to withdraw from opioids and to control chronic pain. Public protests followed the announcement of the proposed scheduling of kratom, and prominent members of the US Congress wrote to the DEA criticizing the ban and calling for the agency to allow a period for public comment. This is the first time the DEA has reversed a move to use its emergency scheduling powers. The six week consultation period ended in December and the Food and Drug Administration (FDA) will be responsible for conducting an evaluation of kratom’s medical and scientific potential.
Voters in California, USA passed Proposition 56 to raise the cigarette tax by US$2 per pack (with increases on e-cigarettes and other tobacco products) in November. The effect of the price increase has been projected to cut smoking prevalence from the current 9.4 percent of California’s population to 7.1 percent by 2020. The proceeds of the taxation will be used to fund health care for the poorer people in California and boost the funding of California’s tobacco control programme.
Led by the Western Australia (WA) Health Drug and Alcohol Office and Western Australian Substance Users Association (WASUA), the WA Peer Naloxone Project trained heroin users, their families and friends in how to prevent overdoses by administering naloxone. An evaluation of the training found that 32 of the 153 people trained to use naloxone reported overdose reversals in follow-up interviews.
A European Monitoring Centre on Drugs and Drug Abuse (EMCDDA) report provides an update on infectious diseases related to injecting drug use in Europe up until June 2016. Hepatitis C virus (HCV) is the most prevalent blood-borne virus infection among people who inject. While there is a continuing decline in the number of new HIV infections attributed to injecting drug use in the European Union, the number of new HIV cases and the levels of prevalence among people who inject drugs remain high in a number of countries, particularly Estonia, Latvia and Lithuania. Local HIV outbreaks among groups of injectors in Dublin (Ireland), Glasgow (United Kingdom) and Luxembourg were reported. The report notes that many of the newly infected people in these places were in contact with drug treatment services, “but continued to experience various health problems, marginalisation and criminal justice issues.”
BBC News reports that the Court of Session in Edinburgh, Scotland’s highest court, ruled in October against a challenge by the Scotch Whisky Association (SWA) and wine makers to the Scottish government’s plans to introduce minimum unit pricing (MUP) of alcohol. The MUP policy was passed by the Scottish parliament in 2012 but the policy had been challenged by the SWA, claiming that it was a breach of European Union trade law. The SWA’s challenge reached the European Court of Justice (ECJ) that ruled in December 2015 that it was for the national court to decide if MUP was a proportionate policy under EU law. The ECJ also said that in reaching a decision, the national court should consider whether measures such as increased taxation on alcoholic drinks would be as effective as MUP while being less restrictive of trade in those products within the European Union. In its ruling, the Court of Session said: "The advantage of the proposed minimum pricing system, so far as protecting health and life was concerned, was that it was linked to the strength of the alcohol,” adding “there was evidence which demonstrated that the alternative of increased tax, with or without a prohibition on below cost sales, would be less effective than minimum pricing."
An executive order (EO) banning smoking was ready to be signed by the Philippines president, Rodrigo Duterte, at the end of October, according to Reuters. The Philippines is a signatory of the World Health Organization (WHO) Framework Convention on Tobacco Control and already has a law banning smoking in public places, However the EO deals with outstanding issues such as the definition of "public places" and the kinds of tobacco products that will be banned. The Department of Health Secretary, Paulyn Ubial, said the proposed new initiative replicates rules currently observed in Davao City, where Duterte was mayor before becoming president. Under the EO, smoking cigarettes, tobacco, shisha pipes, e-cigarettes, or similar devices will be prohibited in public places, including in public vehicles. Local governments are expected to set the penalties for offences. Penalties for breaking the anti-smoking law in Davao City include a 5,000 Philippine peso (US$103) fine or four months in prison. The move comes as the law on graphic health warnings on cigarette packs was fully implemented in the Philippines on 4 November.
The mayor of Paris, Anne Hidalgo, and Health Minister Marisol Touraine opened France’s first drug consumption room in Paris in October. The facility is located near the Gare du Nord, a busy station where drug-related activity is common, and is opening for a six-year test period. A second facility was opened in Strasbourg in north-east France in November and there are plans to open another in Bordeaux in the south-west of the country. Ms Anne Hidalgo said she felt “very moved and very proud because what’s being done here is necessary, necessary for the people who are in complete disarray, because they know they have a door they can enter.” The facility has a dozen cubicles and the annual running cost is estimated at €1.2m (£1.1m; US$1.3m) and will be funded from France’s health care budget.
The Guardian reports that Iraq’s parliament passed a new law on 23 October prohibiting the sale, production, or importation of alcohol. Offenders will have to pay a fine of 10-25 million dinars ($8,500 - $21,000). Alcohol is not widely available in Iraq, but Baghdad and some regional cities have a number of small alcohol shops and bars.The law was an unexpected addition to a wider bill on municipalities’ income which sought to impose taxes on the alcohol shops and restaurants serving alcohol, and was not given a major debate. Mahmoud al-Hassan, head of the legal panel of parliament, said the law was "necessary to preserve Iraq’s identity as a Muslim country." Supporters of the law say it aligns with the Iraqi constitution, which forbids passage of any law that contradicts Islam. Opponents of the law cite the constitution’s provisions for the protection of religious minorities' rights and customs, with Iraq’s Christian community particularly against the move. One commentator, Kirk Sowell, the publisher of the newsletter Inside Iraqi Politics, suggested that the executive branch of the Iraqi government could move to have the law overturned on procedural or other grounds, and Iraq’s Supreme Court could strike down the law.
On US Election Day, California, Massachusetts, Nevada and Maine voted to legalize recreational cannabis use. Proposition 64 in California, the Adult Use of Marijuana Act, allows those over 21 to use cannabis recreationally. There will be an initial 15 percent sales tax and a tax on cultivation. Tax receipts are earmarked for further research on cannabis and enforcing the act’s regulations. The act also restricts marketing toward minors and allows for resentencing and the expungement of records for prior cannabis convictions. Three other states, Florida, Arkansas and North Dakota, passed proposals to legalize the medical use of cannabis. Montana voted to ease restrictions on its medical cannabis system. One commentator, Jessica Rabe from a global brokerage company, told Forbes that California’s legislation will “put pressure on the government to reclassify or deschedule the drug to help ‘cannabusinesses’ better conduct their operations with more access to banking services.”
A World Health Organization (WHO) report on electronic nicotine delivery systems (ENDS) was presented to the Conference of the Parties to the WHO Framework Convention on Tobacco Control (WHO FCTC) in Delhi in November. The report was a response to a request from the preceding WHO FCTC conference, which asked for an update on the research evidence of the health impact of e-cigarettes, their potential role in smoking cessation and their impact on tobacco control efforts. The report also outlines some policy options to achieve the objectives for the prevention and control of ENDS. Among the report’s proposals are that countries might want to ban ENDS from all public places where smoking is not allowed, require health warnings about the chemicals in them, include information on the addictive potential of nicotine and ban any claims that ENDS assist smoking cessation unless “a specialized governmental agency has approved them.” In The Guardian, Professor John Britton, director of the UK Centre for Tobacco and Alcohol Studies, commented that the WHO report was unbalanced and “there is nothing saying e-cigarettes are allowing hundreds of thousands of people to stop smoking.”
DrugScience, an independent science-led drugs charity based in the UK, prepared a “pre-review” of the research on cannabis for the World Health Organization Expert Committee on Drug Dependence (ECDD) meeting in November. DrugScience noted that cannabis and cannabis resin have never been evaluated by WHO since it was given the mandate in 1948 to review psychoactive substances under the international drug treaties. In the preface to the report Michel D. Kazatchkine, Commissioner of The Global Commission on Drug Policy, writes: “In the eighty years since cannabis and cannabis resin were last reviewed by the Health Committee of the League of Nations in 1935, both the social context of cannabis use and the science of drug dependence have dramatically changed. Yet, cannabis and cannabis resin continue to remain under the strictest control regime possible under the Single Convention, without a valid scientific re-assessment of this decision.” DrugScience aimed to get its pre-review onto the agenda of the ECDD meeting so that the ECDD could decide to conduct a Critical Review of cannabis in its next meeting, which could then lead to scheduling recommendations to the Commission on Narcotic Drugs.
The UK Medicines and Healthcare Products Regulatory Agency (MHRA) has sent letters to cannabidiol (CBD) producers and distributors in the UK telling them that they must cease to sell, supply, promote, advertise or process orders for CBD products within 28 days. In a statement released on 7 October the MHRA said, "we have come to the opinion that products containing cannabidiol (CBD) are a medicine. Products for therapeutic use must have a medicines’ licence before they can be legally sold or supplied in the UK. Products will have to meet safety, quality and effectiveness standards to protect public health.” CBD has been increasing in popularity to help with a range of medical conditions but there have been concerns about the unregulated CBD market for some time. Volteface reports that until now CBD products could be sold so long as they did not make any medical claims about the product, but there have been examples of suppliers breaching this condition as well as providing poor quality products. Peter Carroll of the End our Pain campaign, a UK medical cannabis patient advocacy group, said “we agree that there is a need for more control in the CBD market to protect people from unscrupulous suppliers and to make sure that people understand what they are taking.” He added that “we fear that today’s sudden move will cause huge distress to people who rely on these products. It will drive many people to look for CBD on the black market. It is a sledgehammer to crack a nut.” The MHRA’s definition of CBD as a medicinal product makes CBD an exception to The Misuse of Drugs Regulations 2001, which says that cannabis has no medicinal value.
While Colombia’s government and the country’s second largest left-wing rebel group, the Ejército de Liberación Nacional (ELN), have announced the date for formal peace talks to begin, InSight Crime reports increased ELN activity in coca growing areas of Colombia. InSight Crime suggests that ELN is moving into the coca growing areas of the country relinquished by the Revolutionary Armed Forces of Colombia (FARC) as part of the peace-seeking process in the country. According to InSight Crime, locals in the department of Cordoba say the ELN is offering to buy up farmers' supply of coca leaves at a higher price than was paid by the FARC. The Colombian Attorney General’s office has said that ELN is increasing its presence in the department of Nariño, an area that had been under control of a FARC unit with links to the illicit drug trade. This follows reports earlier in 2016 that the ELN has already occupied FARC territory in the departments of Valle del Cauca, Cauca and Chocó.
Plain packaging of cigarette and tobacco products will come into effect in Ireland in May 2017. The Irish Times reports that the Irish Minister for Health, Simon Harris, has introduced the Health (Miscellaneous Provisions) Bill in the Irish parliament. This bill amends sections of the Public Health (Standardised Packaging of Tobacco) Act 2015 relating to the regulation of the appearance of tobacco packaging. The Bill will allow the Minister to prescribe “the colour of the outer and inner surfaces of tobacco packaging, the form and manner of barcodes and the manner in which a name may be printed on tobacco products.” Mr Harris said that health warnings with graphic images of the consequences of smoking will feature prominently on the new packaging.
Findings from the British Social Attitudes Survey 2015 found that three quarters of the public supported minimum unit pricing (MUP) for alcohol products. Forty-six percent of people think that MUP would be effective in reducing young people’s drinking, while 36% think MUP would be effective in reducing heavy drinking. Over three-quarters of people believe that the amount of alcohol drivers are allowed to drink should be reduced. The Telegraph reports that the government has said there are no plans to lower the current limit for drivers in England and Wales of 80mg per 100ml of blood.
A World Health Organization (WHO) report provides a comprehensive picture of alcohol consumption and alcohol-attributable mortality in the WHO European Region during the period 1990–2014. The data presented show that, although alcohol consumption has been decreasing in the WHO European Region as a whole over the period, it continues to be a major risk factor for mortality. The overall alcohol-attributable mortality burden has increased slightly since 1990, largely as a result of the increased mortality burden in eastern European countries. The report outlines a range of evidence-based policy responses but concludes that “despite the existence and promotion of traditional evidence-based and cost-effective interventions, some rethinking seems necessary on introducing additional alcohol policies.”
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