National Documentation Centre on Drug Use
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Effects of different exercise types on craving in substance use disorder patients with drug dependence -network meta-analysis and dose-response relationships based on frequentist and Bayesian models.
No full textBACKGROUND: Exercise interventions have been shown to effectively reduce drug craving and improve physical and mental health in patients with substance use disorders (SUDs). However, the optimal type and amount of exercise needed to maximize these benefits for SUDs is not fully understood and warrants further investigation.
METHODS: A comprehensive search strategy was implemented in four electronic databases (i.e., PubMed, Web of Science, CNKI, and EMBASE) to identify randomized controlled trials examining the impact of exercise on craving in individuals with substance use disorders. Network meta-analysis and dose-response modeling were employed to assess the specific benefits of exercise on craving.
RESULTS: The analysis incorporated a total of 30 randomized controlled trials, encompassing a total of 1,717 subjects. These subjects were comprised of 1,258 male participants (73.26%) and 459 female participants (26.73%). The results of the meta-analysis demonstrated that there was a low grade GRADE evidence suggesting that, in comparison with the control group, aerobic exercise (SMD= -0.73, 95%CI: -1.06 to -0.41), high-intensity interval exercise (SMD= -2.19, 95%CI: -3.90 to -0.49), and aerobic combined with resistance exercise (SMD= -1.96, 95%CI: -2.92 to -1.00) were more effective than the control group. Subgroup analyses revealed positive effects of acute aerobic exercise (SMD= -0.23, 95%CI: -0.41 to -0.04, I²=22%) and long-term aerobic exercise (SMD= -0.46, 95%CI: -0.72 to -0.21, I²=0%) on cravings. Furthermore, the results found that Taijiquan significantly reduced drug craving (SMD= -0.47, 95%CI: -0.70 to -0.24, I²=0%) in the subjects. The dosage analysis revealed that the effective range of total exercise for reducing craving in individuals with substance use disorder was from 20 to 320 METs-min/week (SMD= -0.58, 95%CI: -0.8 to -0.28 to SMD= -0.72, 95%CI: -0.91 to -0.46). The optimal form of exercise was determined to be aerobic exercise, with an optimal exercise dose of 180 METs-min/week, which resulted in an estimated mean difference of -1.46 (95%CI: -2.04 to -0.96). The regression analysis results indicated that the impact of exercise on subjects' cravings may be influenced by their age level (β= -0.995, 95%CI: -2.002 to -0.011).
CONCLUSION: Aerobic exercise has been recognized as the most effective form of exercise for alleviating drug cravings in individuals with substance use disorders (SUDs). Research indicates that the exercise dose for SUDs exhibits characteristics of low-dose effectiveness and plateaus in its effects. The optimal total intervention dose is best sustained at 180 METs-min/week, which is equivalent to three 60-minute sessions of moderate-intensity aerobic exercise each week
Identifying victims of human trafficking across the island of Ireland: Who counts? Who’s counting? Who wants to be counted?
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Reduction in sugar intake after the introduction of minimum unit pricing for alcohol in Scotland: a difference-in-differences analysis.
No full textBACKGROUND: In 2018, Scotland introduced a minimum unit pricing (MUP) policy to remove very-low-cost alcoholic drinks from the market in an effort to reduce the adverse impacts of excessive alcohol consumption. Any increased spending on alcohol may be associated with reduced food and lower diet quality.
OBJECTIVES: This study aimed to estimate the relationship between MUP and dietary energy, nutrients, and diet quality.
METHODS: Difference-in-differences analyses were conducted on household-level purchase data, collected by Kantar Worldpanel (KWP) over 53 wk before and 54 wk after the implementation of MUP, from 1987 households in Scotland and 6064 households in the north of England. The Poisson pseudomaximum likelihood regression model with household fixed effects was used, with estimates adjusted for age of main shopper, household composition, duration of KWP participation, total spending on nonfood items, and month of the year. Primary outcomes were dietary energy, energy density, Diet Quality Index, and foods and nutrients relevant to the Scottish dietary goals after adjustment to per adult-equivalent values. Secondary outcomes explored the differential effects of MUP by area-level deprivation and levels of alcohol purchase.
RESULTS: The introduction of MUP in Scotland was associated with a 1.6% [95% confidence interval (CI): 0.02%, 3.16%] reduction in the purchase of sugar from food and beverages or 8 g per adult equivalent per week. This reduction was partly a result of a 16.6% (95% CI: 7.15%, 25.96%) reduction in sugar from alcoholic drinks purchased. No other significant associations were found. Households from more deprived areas, and households with greater alcohol purchases, had greater levels of sugar reduction from alcohol.
CONCLUSIONS: MUP in Scotland is associated with small, but beneficial, statistically significant reductions in the purchase of sugar. There is no significant change in overall diet quality
A multisite pilot type 2 hybrid implementation-effectiveness trial of a community pharmacist-led model of collaborative care for Medication Assisted Treatment for Opioid Dependence: outcomes of the EPIC-MATOD trial.
No full textBACKGROUND: Australia faces a critical challenge with access to opioid dependence treatment, particularly in regional areas where treatment shortages are amplified.
OBJECTIVE(s): To assess outcomes of a collaborative care model for opioid dependence treatment where community pharmacists work to their full scope of practice, in partnership with prescribers.
METHODS: Community pharmacists and prescribers were recruited from the south-eastern suburbs of Melbourne, Victoria, Australia, to take part in a prospective, multisite, Type 2 hybrid implementation-effectiveness trial. Patients received collaborative prescriber/pharmacist care over a 6-month period, with outcomes compared to a non-randomised comparison group receiving usual care. Data was collected using a mixed methods approach with outcomes mapped to the RE-AIM framework. A health economics evaluation established time and costs associated with collaborative care.
RESULTS: Collaborative care provided comparable outcomes on retention in treatment (97.2 %, 35/36) compared to the control cohort (89.8 %, 44/49) with no significant differences between groups on substance use or mental or physical health outcomes. Collaborative care was associated with significant increases in treatment satisfaction and quality adjusted life years (QALYs) and was cost-effective when compared to treatment as usual. The model was implemented with relatively high fidelity, with high levels of satisfaction among pharmacists, prescribers, and patients. Considerations for broader implementation included pharmacist workload, the need for secure communication software, and a mechanism to remunerate pharmacists for their time providing clinical care.
CONCLUSION: Pharmacist-led collaborative care for opioid dependence is feasible and acceptable and can provide an at least equivalent standard of care to usual care. Further research is required to establish how collaborative care can maximise prescriber capacity at scale.
CLINICAL TRIAL REGISTRATION
ACTRN12621000871842
Safer inhalation devices: a rapid Health Impact Assessment of a harm reduction pilot for people who smoke crack cocaine.
No full textBACKGROUND: People who smoke crack cocaine face significant health risks, including communicable diseases and damage to respiratory health, particularly when using shared or homemade equipment. Despite this, there are currently no targeted harm reduction interventions in Wales for this population. This unique study demonstrates how Health Impact Assessment (HIA) can be used as a process to highlight the wider impacts of a proposed harm reduction pilot of the provision of safer inhalation devices (SIDs) in Wales, and how it has informed future actions and implementation of the scheme.
METHODS: A participatory HIA was conducted using a structured process facilitated by the Wales Health Impact Assessment Support Unit (WHIASU). Stakeholder engagement included a workshop involving service providers, public health professionals, and individuals with lived experience of crack cocaine use. The process utilised HIA checklists to systematically assess the potential health, social, and economic impacts of implementing a SIDs pilot, as well as unintended consequences.
RESULTS: The HIA identified a range of positive impacts associated with SIDs, including reduced risk of infections, decreased use of unsafe inhalation equipment, and increased service engagement. Participants emphasised the intervention's potential to reduce stigma and enhance trust, particularly for women, parents, and individuals with a history of adverse childhood experiences. Challenges were also recognised, including potential service strain, funding sustainability, and access barriers for rural populations. Suggested mitigations included mobile outreach and home delivery models. The HIA also highlighted the importance of including lived and living experience to inform future monitoring and service design.
CONCLUSION: This HIA underscores the potential value of an SID pilot in Wales as a means of addressing a critical service gap and reducing health inequalities among people who smoke crack cocaine. It demonstrates the utility of HIA in identifying both potential positive and negative impacts, and in shaping harm reduction strategies that are inclusive, and evidence informed. The findings provide a foundation for pilot implementation and evaluation, as well as a model for integrating HIA into broader public health initiatives and holistic harm reduction services