Should heroin be prescribed to heroin misusers? Yes

Some heroin addicts are very difficult to treat. Jürgen Rehm and Benedikt Fischer believe that maintenance with heroin is the way forward for this group, but Neil McKeganey argues that it is treating the effects of misuse not the addictio

Global monitoring of average volume of alcohol consumption

Summary: Objectives: To estimate the prevalence of different categories of average volume of alcohol consumption for World Health Organization (WHO) regions. To check how the monitored indicator of average volume relates to prevalence of alcohol dependence. To discuss conclusions for establishing a global monitoring system. Methods: Prevalence of different categories of average volume of alcohol consumption was estimated by a triangulation of survey results, production, and sales figures. The relation between average volume of consumption and prevalence of alcohol dependence was analysed by regression techniques. Results: Alcohol consumption varies widely by sex, age, and region. It can predict prevalence of dependence with about 74% of the variation of the latter explained. Conclusions: With current data, global monitoring of alcohol is possible. However, more and better surveys are necessary for the future. They should include, patterns of drinking to improve prediction of other health outcomes like coronary heart disease (CHD) and accident

The cost-effectiveness of improved brief interventions for tobacco cessation in Thailand

BackgroundThis study estimated the cost-effectiveness of four strategies enhancing the quality and accessibility of Brief Intervention (BI) service for smoking cessation in Thailand during 2022–2030: (1) current-BI (status quo), (2) the effective-training standard-BI, (3) the current-BI plus the village health volunteers (VHV) mobilization, and (4) the effective-training BI plus VHV mobilization.MethodsBy interviewing five public health officers, nine healthcare professionals aiding these services, and fifteen BI service experts, we explored the status quo situation of the Thai smoking cessation service system, including main activities, their quantity assumptions, and activities’ unit prices needed to operate the current cessation service system. Then, we modeled additional activities needed to implement the other three simulated scenarios. We estimated the costs and impacts of implementing these strategies over a nine-year operating horizon (2022–2030), covering 3 years of service system preparation and 6 years of full implementation. The modeled costs of these four strategies included intervention and program costs. The study focused on current smokers age 15 years or older. The assessed impact parameters encompassed smoking prevalence, deaths averted, and healthy life-years gained. An Incremental Cost-Effectiveness Analysis compared the four simulated strategies was employed. Data analysis was performed using the One Health Tool software, which the World Health Organization developed.ResultsThe findings of this investigation reveal that all three intervention strategies exhibited cost-effectiveness compared to the prevailing status quo. Among these strategies, Strategy 2, enhancing BI service quality, emerged as the most efficient and efficacious option. Therefore, the expansion of quality services should be synergistically aligned with augmented training, service delivery optimization, and managerial enhancements.ConclusionThis approach is particularly poised to enhance accessibility to and the efficacy of smoking cessation interventions across Thailand

Alcohol, No Ordinary Commodity: policy implications for Canada

Alcohol is a favorite psychoactive substance of Canadians. It is also a leading risk factor for death and disability, playing a causal role in a broad spectrum of health and social issues. Alcohol: No Ordinary Commodity is a collaborative, integrative review of the scientific literature. This paper describes the epidemiology of alcohol use and current state of alcohol policy in Canada, best practices in policy identified by the third edition of Alcohol: No Ordinary Commodity, and the implications for the development of effective alcohol policy in Canada. Best practices – strongly supported by the evidence, highly effective in reducing harm, and relatively low-cost to implement – have been identified. Measures that control affordability, limit availability, and restrict marketing would reduce population levels of alcohol consumption and the burden of disease attributable to it

Alcohol consumption and alcohol-attributable burden of disease in Switzerland, 2002

Summary: Objectives:: This analysis estimated alcohol-attributable burden of disease for Switzerland. Methods:: Exposure distributions were taken from the 2002 Swiss Health Survey and adjusted for per capita consumption. Risk relations were taken from meta-analyses. Mortality and burden of disease data were taken from the World Health Organization. Results:: Overall consumption and alcohol-attributable mortality and burden of disease in Switzerland were high compared to European and global averages, especially among women. Overall in Switzerland in 2002, 2016 deaths (5.2% of all deaths in men, 1.4% in women), 28,939 years of life lost (men: 10.5%, women: 4.9%) and 70,256 disability adjusted life years (men: 12.9%, women: 4.2%) were attributable to alcohol. These numbers are net numbers already incorporating the cardioprotective and other beneficial effects of alcohol. Conclusions:: Limitations of the approach used are discussed. In addition, questions of causality and confounding are addresse

Comparing alcohol consumption in central and eastern Europe to other European countries

Aims: To give an overview of the volume of alcohol consumption, beverage preference, and patterns of drinking among adults (people 15 years and older) in central and eastern Europe (Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, and Slovenia) and to compare it to southern and western Europe, Russia and Ukraine. Methods: Secondary data analysis. Consumption and preferred beverage type data for the year 2002 were taken from the WHO Global Status Report on Alcohol and the WHO Global Alcohol Database. Results: Average consumption in central and eastern Europe is high with a relatively large proportion of unrecorded consumption ranging from one litre in Czech Republic and Estonia to 10.5 l in Ukraine. The proportion of heavy alcohol consumption (more than 40 g of pure alcohol per day) among men was the lowest in Bulgaria (25.8%) and the highest in Czech Republic (59.4%). Among women, the lowest proportion of heavy alcohol consumption was registered in Estonia (4.0%) and the highest in Hungary (16.0%). Patterns of drinking are detrimental with a high proportion of binge drinking, especially in the group of countries traditionally drinking vodka. In most countries, beer is now the most prevalent alcoholic beverage. Conclusions: Other studies suggest that the population drinking levels found in central and eastern Europe are linked with higher levels of detrimental health outcomes. Known effective and cost-effective programs to reduce levels of risky drinking should, therefore, be implemented, which may, in turn, lead to a reduction of alcohol-attributable burden of diseas

Canadian Children and Youth in Care: The Cost of Fetal Alcohol Spectrum Disorder

BACKGROUND: A high prevalence of prenatal alcohol exposure has been reported among children in care and thus, the risk of fetal alcohol spectrum disorder (FASD) in this population is high. OBJECTIVE: The purpose of the current study was to estimate the number of children (0–18 years) in care with FASD and to determine the associated cost by age group, gender, and province/territory in Canada in 2011. METHODS: The prevalence of children in care by province/territory was obtained from the Canadian Child Welfare Research Portal, and the number of children in care with FASD for each province/territory was estimated from available epidemiological studies. In order to calculate the total cost per province/territory, the cost per individual per day, by age group, was applied to the respective number of children in care with FASD. RESULTS: The estimated number of children in care with FASD ranged from 2,225 to 7,620, with an annual cost of care ranging from $57.9 to$198.3 million Canadian dollars (CND). The highest overall cost ($29.5 to$101.1 million CND) was for 11–15 year-olds. CONCLUSION: The study findings can be used to demonstrate the substantial economic burden that FASD places on the child welfare system. Attention towards the needs of this population and prevention efforts to reduce FASD incidence in Canada, and other countries are urgently needed

Cost attributable to Fetal Alcohol Spectrum Disorder in the Canadian correctional system

AbstractPrenatal alcohol exposure is the leading identifiable cause of intellectual disability in the Western world and may result in Fetal Alcohol Spectrum Disorder (FASD). Individuals with FASD have a higher risk of being involved in the legal system, either as offenders or as victims. Therefore, the aim of the current study was to estimate the direct cost for youths (12–17years old) and adults (18+ years old) with FASD to the Canadian correctional system in 2011/2012. The prevalence of FASD in the Canadian correctional system, obtained from the current epidemiological literature, was applied to the average number of youths and adults in the correctional system in 2011/2012. The average daily cost for corrections was then applied to the estimated number of youths and adults with FASD in custody. The cost of corrections among youths with FASD in Canada in 2011/2012 was calculated to be approximately $17.5M Canadian dollars (CND;$13.6M CND for males and $3.8M CND for females) and among adults with FASD was estimated to be about$356.2M CND ($140M CND for provincial and territorial custody and$216.2M CND for federal custody). The study findings emphasize the need to raise awareness regarding the prevalence of FASD in the correctional system. It is crucial to incorporate FASD screening and intervention strategies as early as possible in the criminal justice process

Avoidable Portion of Tobacco-Attributable Acute Care Hospital Days and Its Cost Due to Implementation of Different Intervention Strategies in Canada

The impact of four effective population-based interventions, focusing on individual behavioural change and aimed at reducing tobacco-attributable morbidity, was assessed by modeling with respect to effects on reducing prevalence rates of cigarette smoking, population-attributable fractions, reductions of disease-specific morbidity and its cost for Canada. Results revealed that an implementation of a combination of four tobacco policy interventions would result in a savings of 33,307 acute care hospital days, which translates to a cost savings of about $37 million per year in Canada. Assuming 40% coverage rate for all individually based interventions, the two most effective interventions, in terms of avoidable burden due to morbidity, would be nicotine replacement therapy and physicians’ advice, followed by individual behavioural counselling and increasing taxes by 10%. Although a sizable reduction in the number of hospital days and accumulated costs could be achieved, overall these interventions would reduce less than 3% of all tobacco-attributable costs in Canada