National Documentation Centre on Drug Use
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Cannabis-based medicines for chronic neuropathic pain in adults.
No full textRATIONALE: Estimates of the population prevalence of chronic pain with neuropathic components range from 6% to 10%. Current pharmacological treatments for neuropathic pain help only a minority. New treatments are needed. Cannabis is increasingly promoted in the media as a treatment for chronic pain. This is an update of a review first published in 2018.
OBJECTIVES: To assess the benefits and harms of cannabis-based medicines (herbal, plant-based, synthetic) compared to placebo or conventional drugs for chronic neuropathic pain conditions in adults.
SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and three trial registries, together with reference checking. The latest search date was 29 January 2025.
ELIGIBILITY CRITERIA: We selected randomised, double-blind controlled trials of medical cannabis, plant-derived and synthetic cannabinoids, against placebo or any other active treatment for chronic neuropathic pain conditions in adults, with a treatment duration of at least two weeks. We excluded studies whose double-blind duration was less than two weeks and studies which did not explicitly state that the pain was of a neuropathic nature.
OUTCOMES: Critical outcomes were the number of participants reporting pain relief of at least 50%, a Patient Global Impression of Change (PGIC) rating of 'much' or 'very much' improved, serious adverse events, and withdrawals due to adverse events.
RISK OF BIAS: We assessed the risk of bias (RoB) for seven outcomes reported in three summary of findings tables using the Cochrane RoB 1 tool.
SYNTHESIS METHODS: We synthesised results for each outcome using meta-analysis with a random-effects model by calculating absolute risk differences (RD) and standardised mean differences (SMD) with 95% confidence intervals (CI) for dichotomous outcomes and continuous outcomes, respectively. We used GRADE to assess the certainty of evidence for prespecified outcomes.
INCLUDED STUDIES: We included six new studies involving 450 participants, along with 15 studies involving 1737 participants from the 2018 review, for a total of 21 studies with 2187 participants. The studies ranged from two to 26 weeks in duration. Sample sizes ranged from 18 to 339 participants. Participants' mean age ranged from 34 to 61 years, and the proportion of women ranged from 0% to 90%. Five studies included participants with central neuropathic pain, 14 studies included participants with peripheral neuropathic pain, and two studies included both types. Seven studies administered tetrahydrocannabinol (THC)-dominant medicines; nine studies, balanced THC and cannabidiol (CBD) medicines; and five studies, CBD-dominant medicines. Twenty studies compared cannabis-based medicine to placebo, and one study's comparator was dihydrocodeine. We judged the overall risk of bias to be low in six studies, unclear in 10 studies, and high in five studies.
SYNTHESIS OF RESULTS: THC-dominant medicines versus placebo. There is no clear evidence for an effect on pain relief of at least 50% (RD 0.14, 95% CI -0.07 to 0.37; 7 studies, 534 participants), PGIC rating of 'much' or 'very much' improved (RD 0.17, 95% CI -0.24 to 0.58; 2 studies, 72 participants), withdrawals due to adverse events (RD 0.03, 95% CI -0.02 to 0.08; 6 studies, 511 participants), serious adverse events (RD 0.02, 95% CI -0.01 to 0.06; 7 studies, 537 participants), pain relief of at least 30% (RD 0.16, 95% CI -0.08 to 0.40; 7 studies, 566 participants), and psychiatric disorder-related adverse events (RD 0.01, 95% CI -0.01 to 0.03; 4 studies, 368 participants), all with very low-certainty evidence. They may increase nervous system adverse events (RD 0.25, 95% CI 0.14 to 0.37; 5 studies, 439 participants; low-certainty evidence). THC/CBD-balanced medicines versus placebo. There is no clear evidence for an effect on pain relief of at least 50% (RD 0.04, 95% CI 0.00 to 0.08; 8 studies, 746 participants) and serious adverse events (RD 0.01, 95% CI -0.02 to 0.03; 11 studies, 1449 participants), both with very low-certainty evidence. The evidence is very uncertain about the effect on nervous system-related (RD 0.39, 95% CI 0.23 to 0.55; 11 studies, 1445 participants) and psychiatric disorder-related adverse events (RD 0.08, 95% CI 0.03 to 0.13; 9 studies, 1375 participants), both very low-certainty evidence. They may increase PGIC ratings of 'much' or 'very much' improved (RD 0.07, 95% CI 0.02 to 0.11; 7 studies, 1145 participants), pain relief of at least 30% (RD 0.07, 95% CI 0.02 to 0.12; 10 studies, 1285 participants), and withdrawals due to adverse events (RD 0.05, 95% CI 0.02 to 0.09; 11 studies, 1449 participants), all with low-certainty evidence, though these effects were not clinically relevant. CBD-dominant medicines versus placebo. There is no clear evidence for an effect on pain relief of at least 50% (RD -0.08, 95% CI -0.20 to 0.05; 5 studies, 208 participants; very low-certainty evidence). They may increase or decrease PGIC ratings of 'much' or 'very much' improved (RD -0.03, 95% CI -0.22 to 0.16; 2 studies, 79 participants), withdrawals due to adverse events (RD 0.02, 95% CI -0.03 to 0.06; 5 studies, 213 participants), serious adverse events (RD 0.02, 95% CI -0.03 to 0.06; 5 studies, 213 participants), pain relief of at least 30% (RD -0.04, 95% CI -0.17 to 0.09; 5 studies, 218 participants), nervous system-related adverse events (RD -0.03, 95% CI -0.10 to 0.03; 5 studies, 208 participants), and psychiatric disorder-related adverse events (RD -0.01, 95% CI -0.06 to 0.04; 5 studies, 208 participants), all with low-certainty evidence.
AUTHORS' CONCLUSIONS: There is no clear evidence for an effect of THC-dominant medicines on pain relief of 50% or greater, PGIC ratings of 'much' or 'very much' improved, withdrawals due to adverse events, and serious adverse events (very low-certainty evidence). There is no clear evidence for an effect of THC/CBD-balanced medicines on pain relief of 50% or greater and serious adverse events (very low-certainty evidence). They may increase PGIC ratings of 'much' or 'very much' improved, and withdrawals due to adverse events (low-certainty evidence). There is no clear evidence for an effect of CBD-dominant medicines on pain relief of 50% or greater (very low-certainty evidence). They may increase or decrease PGIC ratings of 'much' or 'very much' improved, serious adverse events, and withdrawals due to adverse events (low-certainty evidence).
FUNDING: No funding.
REGISTRATION: DOI 2018 review: 10.1002/14651858.CD012182.pub2
Drug and Alcohol Information System overview of initial assessments for specialist drug and alcohol treatment 2024/25.
No full textA web of interference: how Big Alcohol undermined health policy and polluted public discourse in 2025.
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Characteristics of methamphetamine-related deaths in the United Kingdom, 1997-2024.
No full textBACKGROUND AND AIMS: People who use methamphetamine have a standardised mortality ratio 6.8 times greater than the general population, with several countries reporting concerning increases in methamphetamine-related mortality over the past decade. Methamphetamine use in the United Kingdom (UK) has been reported as largely confined to communities of men who have sex with men (MSM) with no previous large-scale studies describing mortality associated with methamphetamine. We aimed to determine trends and case characteristics of methamphetamine-related deaths in the UK.
DESIGN: Retrospective cohort study.
SETTING: Coronial records submitted to the National Programme on Substance Use Mortality (NPSUM) in the UK, 1997-2024.
CASES: Decedents for whom methamphetamine was determined as implicated in death following coronial investigation.
MEASUREMENTS: Information was available on decedent sociodemographics, characteristics of death and drugs implicated in death.
FINDINGS: 136 decedents had methamphetamine implicated in death. The number of deaths per year were observed to be higher over time since the first death recorded in 2006 (2005-2010, 8 deaths; 2011-2015, 24 deaths; 2016-2020, 47 deaths; 2021-2024, 57 deaths). Decedents were predominantly male (n = 124, 91%) of White ethnicity (n = 68, 50%) with a mean age of 41.5 years (standard deviation 10.4; range 18-71); 77% had a history of substance dependence, 48% of which involved injecting drug use, and 88% had a history of a mental disorder. The median blood methamphetamine concentration detected at post-mortem was 0.83 mg/l (interquartile range 0.26, 2.5). Multiple drug toxicity was implicated in the majority of cases (n = 88, 65%), the most common implicated other drugs being cocaine (n = 27, 20%), gamma-hydroxybutyrate (n = 20, 15%), opioids (n = 20, 15%), benzodiazepines (n = 18, 13%), mephedrone (n = 13, 10%) and ketamine (n = 12, 8%). Accidental poisoning was the most common direct cause of death (n = 89, 65%), with other causes including intentional poisoning, cardiovascular disease, aspiration pneumonia and ischemic bowel disease.
CONCLUSIONS: Over the past two decades there appears to have been an increase in the number of methamphetamine-related deaths in the UK. These deaths largely involve polysubstance use within an overwhelmingly male population with a high prevalence of substance dependence and mental health disorders
Seanad Éireann debate – Commencement matters, departmental strategies [National Drugs Strategy].
No full textSystem dynamics modelling methods for public health policy evaluation: a systematic literature review focussing on mental health and substance use disorders.
No full textBACKGROUND: In public health, simulation models are important tools for policy evaluations, and the nature of the problems these models address is complex. System dynamics (SD) modelling is acknowledged as a methodology for complex systems, but there is limited insight in the development and application of SD models for noncommunicable diseases (NCDs) and lifestyle-related risk factors. Therefore, this review investigates how these SD models are developed and utilised to project health outcomes and evaluate policy interventions.
METHODS: Relevant studies were identified through a systematic search strategy. Studies were selected based on eligibility criteria, and data were extracted in two phases: (1) extraction of study characteristics, and (2) detailed examination of applied methods for a subset of included studies focussing on mental health and substance use disorders. For the second phase, data extraction was stratified according to steps of the modelling cycle, and the reporting quality of each study was assessed.
RESULTS: In phase 1, 63 studies were included, mainly on mental health and substance use disorders (27%), obesity (17%), and diabetes (13%), with the number of studies increasing over time. In phase 2, 17 studies on mental health and substance use disorders were included. These studies commonly used dedicated software for SD modelling for the mathematical formulation and computerisation of their models. However, in 76% of these studies, the underlying mathematical equations were not shared, and in 82%, the models were not openly accessible. A (slight) majority of studies validated model outcomes against empirical data (65%), and performed sensitivity analysis (53%). Few studies reported model verification (18%) and face validation of model outcomes (18%).
CONCLUSIONS: SD models are increasingly developed for NCDs and lifestyle-related risk factors, and particularly applied to mental health and substance use disorders. This review offers insights into applied techniques for developing SD models for mental health and substance use disorders, and shows that steps of the modelling cycle are reported on with considerable variation. Although studies frequently report on certain aspects of testing and validation, many report incompletely on other activities of the modelling cycle, and the models sometimes lack transparency. Improving this would enhance the credibility of SD modelling in public health
Mental health challenges in the Irish thoroughbred horse breeding industry: prevalence and associated risk factors.
No full textThe thoroughbred horse breeding industry contributes significantly to the Irish economy. However, staff shortages threaten the economic sustainability of the industry, as well as the welfare of both horses and workers. Previous research on the staffing crisis faced by the broader horseracing industry has highlighted mental health concerns as a factor. Furthermore, the influence of workplace context on mental health has been widely recognised in organisational psychology. The aim of this study was to assess prevalence rates of Common Mental Disorders (CMDs) in Irish thoroughbred horse breeding and associated occupational risk factors. Thoroughbred breeders and stud farm staff (N = 105) were recruited through key industry organisations for a survey consisting of four sections including demographic and lifestyle, mental health, occupational risk factors, and wellbeing at work. CMD prevalence encompassed depression, anxiety, psychological distress and substance use. Occupational risk factors including career dissatisfaction, job control and workplace bullying were assessed to explore associations. Descriptive statistics estimated prevalence, while inferential analyses explored associations between demographic and occupational factors. Breeding staff reported high rates of depression (50%), psychological distress (44.3%), anxiety (34.9%), and hazardous alcohol consumption (45.3%). Low job control, bullying, injuries, and career dissatisfaction were each associated with increased CMD prevalence. Women and younger staff were at an increased risk of bullying, CMDs, and lower wellbeing. This is the first study to assess CMD prevalence and risk factors in thoroughbred breeding in Ireland. High prevalence rates of CMDs and staff leaving intentions are influenced by occupational factors in thoroughbred breeding