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ACT ATOD Sector Research eBulletin - March 2012
Our monthly ACT ATOD Research eBulletin is a concise summary of newly-published research findings and other research activities of particular relevance to ATOD and allied workers in the ACT.

Its contents cover research on demand reduction, harm reduction and supply reduction; prevention, treatment and law enforcement. ATODA's Research eBulletin is a resource for keeping up-to-date with the evidence base underpinning our ATOD policy and practice.




 
 


ACT Research Spotlight
 
We're Struggling in Here!
The Phase 2 Study into the Needs of Aboriginal and Torres Strait Islander People in the ACT Alexander Maconochie Centre and the Needs of their Families

By Nerelle Poroch with support from Kacey Boyd, Julie Tongs, Peter Sharp, Eddie Longford, Steven Keed - Winnunga Nimmityjah Aboriginal Health Service
 
This report was released in February 2012 and aims to promote a better understanding of the case management and needs of Aboriginal and Torres Strait Islander prisoners and released prisoners and their families, following a model of holistic health service delivery.

Findings:

What are the specific health and social and emotional wellbeing needs of the Aboriginal people in the AMC and are they being met?

The following concerns were raised by the AMC respondents interviewed:
  • There are delays and problems with the paper work necessary to consult a doctor in the AMC.
  • There are delays in seeing a dentist.
  • There are delays in reciving medication on entry to the AMC.
  • There is uncertainty about consulting medical practitioners outside the AMC.
  • There is reluctance to consult non-Aboriginal, non-Winnunga professionals for mental health assistance.

What are the specific health and social and emotional wellbeing needs required by the family when a family member is in the AMC and on release, and are they being met?
  • Respondents indicated that assistance was provided to their families by various support organisations but there is a strong reliance on Winnunga medical and dental, and social and emotional wellbeing services.
  • Young mothers coping alone in the community when a family member is in the AMC can experience financial and psychological difficulties of bringing up children alone.
  • Grandmothers who are caring for grandchildren when a family member is in the AMC struggle financially and psychologically and suffer ill health.
  • There is a high rate of Aboriginal family members being turned away from visiting family members, which they find very stressful in the absence of counselling from the ALO or an Aboriginal staff member.
  • Overwhelming consensus from all respondents that the ACTION Bus timetable is inadequate for visiting purposes.
  • The needs of families when a family member is released from the AMC are significant and complex.

The report recommends the introduction of the following AMC initiatives in relation to drug and alcohol issues:
  • Tobacco programs
  • Pre and post test counselling for blood borne virus testing
  • Blood borne virus testing on admission, three months post admission and at discharge for all prisoners
  • Professional tattooing and piercing program
  • Literacy and Numeracy Programs
  • Provision of bleach and education on its use
  • Needle and Syringe Program
  • Provision of Naloxone on release from the AMC.

For information about the report contact Dr Nerelle Poroch at Winnunga Nimmityjah Aboriginal Health Service at Nerelle.Poroch@winnunga.org.au


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Establishing a Canberra collaboration, such as a Centre

for Drug Research, Policy and Practice in the ACT
 
Stakeholders are progressing a proposal to expand and strengthen alcohol, tobacco and other drug (ATOD) research in the ACT and region, and enhance ATOD policy and its implementation, through establishing a structured collaboration, such as a Centre for ATOD Research, Policy and Practice in the ACT.
 
In late 2011 a discussion paper was developed and distributed to identified researchers based within the ACT.  A workshop was then held with cross-institutional researchers, practitioners and policy makers in the ACT.  At the workshop it was agreed to progress establishing a collaboration, such as a Centre for Drug Research, Policy and Practice in the ACT.  Participants included representatives from the Australian National University, University of Canberra, Australian Catholic University, ACT Government Health Directorate, ATODA and the ATOD sector. For more information please see the briefing. If you are interested in being involved please email Carrie Fowlie, Executive Officer, ATODA on carrie@atoda.org.au or (02) 6255 4070.

Recent activities of the collaboration:

Submission to the ACT Budget Consultation
The Canberra Collaboration was identified as a funding priority for the ACT ATOD sector and was included in ATODA's submission to the public ACT Budget 2012 - 2013 consultation process.
Download the submission.


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Research Findings

Are smokeless tobacco and e-cigarettes less harmful to health than smoking tobacco?
How harmful for children is exposure to second-hand smoke in cars?
How effective are nicotine replacement therapies?
Is there a problem in Australia of caffeine poisoning resulting from energy drinks?
How should governments respond to legal highs?
Is there a link between heavy use of cannabis and motor vehicle accidents?
The ‘gateway theory’ assessed: are young people who use cannabis more likely to move to other illicit drugs than non-cannabis users?
Does cannabis use cause lung disease?
How can people who undergo opioid detoxification be encouraged to move into long-term treatment?
How effective are behavioural interventions in preventing hepatitis C infection amongst people who inject drugs?
What can be done to reduce illicit methamphetamine use in Australia?
What can be done to reduce prescription drug misuse?
Can we believe what we read in the Australian media about crime rates in our society?


Note: Most of the reports and research items referenced below are available from the Alcohol and Other Drug Council of Australia’s National Drugs Sector Information Service (NDSIS) http://ndsis.adca.org.au. NDSIS also provides, at its DrugFields professional development website, Research in Brief summaries of studies conducted at the National Drug and Alcohol Research Centre, University of NSW, Sydney; visit http://www.drugfields.org.au/research-in-brief.


Are smokeless tobacco and e-cigarettes less harmful to health than smoking tobacco?

A review and analysis of the literature on tobacco harm reduction compared studies from Norway, Sweden and North America. It found that smokeless tobacco (ST) use is associated with minimal risks for cancer and for myocardial infarction. Studies from Sweden document that ST use is not associated with benign gastrointestinal disorders and chronic inflammatory diseases. ST use during pregnancy removes the highest risks for the developing baby…associated with smoking. The researchers note that ST use has been a key factor in the declining rates of smoking and of smoking-related diseases in Sweden and Norway. For other countries, the potential population health benefits of ST are far greater than the potential risks… ST use is not a gateway to smoking in Sweden, nor in the U.S. In fact, there is evidence that the opposite is true: ST users may play a protective role against subsequent cigarette smoking.

E-cigarettes are another form of tobacco harm reduction. They are battery-powered devices that vaporize a mixture of water, propylene glycol, nicotine and flavorings…activated when the user inhales through the mouthpiece of the device. Users of e-cigarettes are not exposed to the many toxicants, carcinogens and abundant free radicals formed when tobacco is burned…e-cigarette use emulates successfully the cigarette handling rituals and cues of cigarette smoking, which produces suppression of craving and withdrawal that is not entirely attributable to nicotine delivery.

Rodu, B 2011, The scientific foundation for tobacco harm reduction, 2006-2011, Harm Reduction Journal, vol. 8, p. 19.

Comment: the sale of smokeless tobacco products is prohibited in Australia: http://www.productsafety.gov.au/content/index.phtml/itemId/974258

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How harmful for children is exposure to second-hand smoke in cars?

A study in the United Kingdom measured levels of fine particulate matter in the rear passenger area of cars where smoking does and does not take place during typical real-life car journeys…Fine particulate matter (PM(2.5)) was used as a marker of secondhand smoke and was measured and logged every minute of each car journey undertaken by smoking and non-smoking study participants. The monitoring instrument was located at breathing zone height in the rear seating area of each car. Participants were asked to carry out their normal driving and smoking behaviours over a 3-day period. The researchers found that PM(2.5) concentrations in cars where smoking takes place are high and greatly exceed international indoor air quality guidance values. Children exposed to these levels of fine particulate are likely to suffer ill-health effects. There are increasing numbers of countries legislating against smoking in cars and such measures may be appropriate to prevent the exposure of children to these high levels of secondhand smoke.

Semple, S, Apsley, A, Galea, KS, Maccalman, L, Friel, B & Snelgrove, V 2012, Secondhand smoke in cars: assessing childrens potential exposure during typical journey conditions, Tobacco Control, Online First, http://tobaccocontrol.bmj.com/content/early/2012/01/04/tobaccocontrol-2011-050197.short?g=w_tobaccocontrol_ahead_tab.

Comment: the ACT has passed legislation that makes it an offence to smoke in a motor vehicle when children aged under 16 are present. This provision will be enforced from 1 May 2012: http://health.act.gov.au/c/health?a=sp&did=10152911 .

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How effective are nicotine replacement therapies?

Two recent studies have found that smokers do not need nicotine replacement therapies (NRT) to quit smoking. Researchers at the Harvard School of Public Health and the University of Massachusetts studied the attempts of 787 Massachusetts smokers to quit and found the use of NRT had no effect on their success. A study published in the Annual Review of Public Health argues that rather than helping smokers quit, the widespread marketing of nicotine replacement therapy had reduced expectations about how difficult it was to quit.
Ross Mackenzie from Macquarie University, writing in The Conversation, states that, in Australia, the use of public funds to provide such therapies [as NRT] to the population at large is of questionable value…In the past two decades Australia has enacted legislative restrictions on public smoking, bans on tobacco advertising and promotion, and regular tax increases on tobacco products. And its these initiatives that are responsible for driving our national smoking rate down to 17%, one of the lowest in the world. This is where future anti-tobacco funding and public policy efforts should be directed.

MacKenzie, R 2012, Chew on this, smokers: nicotine replacement therapies rarely work, The Conversation, http://theconversation.edu.au/chew-on-this-smokers-nicotine-replacement-therapies-rarely-work-4954.

Comment: it is desirable to have a range of treatment modalities available to assist people to overcome substance use disorders. Both self-help and medically-assisted approaches work, and should be available.

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Is there a problem in Australia of caffeine poisoning resulting from energy drinks?

A study of calls to the NSW Poisons Information Centre found that calls regarding toxicity from energy drinks related to accidental ingestion in young children, and recreational use in adolescents. The researchers state It is concerning that the trend of misuse and toxicity appears to be increasing among teenagers and that the number of energy drink units ingested far exceeds recommended maximum levels… The variety of symptoms reported in our study was consistent with caffeine overdose and, potentially, stimulant misuse. Nearly 60% of calls reporting recreational use came from [hospital emergency departments], suggesting that hospitalisation is warranted in a significant proportion of cases. Although it occurred in a minority of subjects, serious toxicity leading to cardiac complications (coronary ischaemia, arrhythmias) and neurological complications (hallucinations, psychosis, seizures) is of grave concern both to the community and clinicians. They conclude Reports of caffeine toxicity from energy drink consumption are increasing, particularly among adolescents, warranting review and regulation of the labelling and sale of these drinks. Educating adolescents and increasing the communitys awareness of the hazards from energy drinks is of paramount importance.

Gunja, N & Brown, J 2012, Energy drinks: health risks and toxicity, Medical Journal of Australia, vol. 196, no. 1, pp. 46-9.

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How should governments respond to legal highs?

A recent article in the leading journal Addiction states that The rapid emergence of myriad substances openly marketed as “legal highs” is straining traditional drug control systems which require time and basic scientific data on harms to react, presenting governments with the dilemma of no response or a disproportionate response. Some countries have side-stepped this using novel policy and legislative approaches. The authors reviewed the various approaches to legislation that aim to stop the open sale of new psychoactive substances in the European Union (EU). They found that Some countries have designed new catch-all control systems, or faster systems to classify substances as drugs. Others have enforced consumer safety or medicines legislation to stop the open sale of these products. The latter originate from harmonization of the internal market of the EU. Rigorous, objective evaluation is required, but first results suggest that these have been effective, while avoiding criminalization of users. They conclude that Every EU country should have existing laws for protecting public health that can be applied swiftly yet proportionately to new drugs appearing on the open market with minimum political involvement. It seems the key is the speed, not the weight, of response. Given support for their enforcement mechanisms, these systems might be as effective and more efficient than the old ones.

Hughes, B & Winstock, AR 2012, Controlling new drugs under marketing regulations, Addiction, Early View (Online Version of Record published before inclusion in an issue).

Comment: despite calls in Australia to manage emerging psychoactive drugs such as synthetic cannabinoids like ‘Kronic’ through medicines or food safety strategies, we use the traditional, law enforcement approach of declaring these drugs to be prohibited, thus criminalising users and suppliers.

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Is there a link between heavy use of cannabis and motor vehicle accidents?

Research reported in the British Medical Journal sought to examine whether the acute consumption of cannabis (cannabinoids) by drivers increases the risk of a motor vehicle collision. Their meta-analysis of studies from several countries found that Driving under the influence of cannabis was associated with a significantly increased risk of motor vehicle collisions compared with unimpaired driving. The relative risk from pooling the data in the studies was 1.92, i.e. people who had been smoking cannabis has a probability of being in a crash about twice that of people who had not recently consumed the drug. They conclude that Acute cannabis consumption is associated with an increased risk of a motor vehicle crash, especially for fatal collisions. This information could be used as the basis for campaigns against drug impaired driving, developing regional or national policies to control acute drug use while driving, and raising public awareness.

Asbridge, M, Hayden, JA & Cartwright, JL 2012, Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis, BMJ: British Medical Journal, vol. 344, p. e536, http://www.bmj.com/content/344/bmj.e536.

See associated editorial: Hall, W 2012, Driving while under the influence of cannabis: it is currently unclear whether roadside drug testing reduces cannabis impaired driving, BMJ: British Medical Journal, vol. 344, p. e595, http://www.bmj.com/content/344/bmj.e595.

Comment: Driving with any detectable level of THC, the impairing constituent of cannabis, is an offence in the ACT. Public education campaigns on the danger of driving within three or four hours of smoking cannabis are needed. Note that this is a study of the relative risk of collision while driving after consuming cannabis. It does not tell us the absolute risk.

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The ‘gateway theory’ assessed: are young people who use cannabis more likely to move to other illicit drugs than non-cannabis users?

A study involving almost 30,000 French teenagers examined the influence of cannabis use patterns on the probability of initiation with other illicit drugs (OID). It found that The risk for OID initiation appeared 21 times higher among cannabis experimenters and 124 times higher among daily cannabis users than among non-users. Tobacco and alcohol use were associated with a greater risk of moving on to cannabis initiation. The researchers concluded that The results of this study provide a confirmation of a stage process in drug use, mediated by cannabis and liable to lead to OID experiment…OID experiment could be a consequence of initial opportunity to use the more accessible illicit drug, cannabis.

Mayet, A, Legleye, S, Falissard, B & Chau, N 2012, Cannabis use stages as predictors of subsequent initiation with other illicit drugs among French adolescents: use of a multi-state model, Addictive Behaviors, vol. 37, no. 2, pp. 160-6.

Comment: the gateway hypothesis is still a matter of dispute. It is difficult for studies of this type to control for the diverse antecedents of drug use, and to tease out which ones are causative, and to what extent. Nonetheless, this study provides further support for initiatives to prevent or delay the uptake of cannabis use among young people.

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Does cannabis use cause lung disease?

A study of over 5,000 people in four US cities measured pulmonary function and smoking over 20 years. The researchers found that occasional use of marijuana for pain control, appetite, mood, and management of other chronic symptoms… may not be associated with adverse consequences on pulmonary function. It is more difficult to estimate the potential effects of regular heavy use, because this pattern of use is relatively rare in our study sample; however, our findings do suggest an accelerated decline in pulmonary function with heavy use and a resulting need for caution and moderation when marijuana use is considered’.

Pletcher, MJ et al. 2012, Association between marijuana exposure and pulmonary function over 20 years, JAMA: Journal of the American Medical Association, vol. 307, no. 2, pp. 173-81.

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How can people who undergo opioid detoxification be encouraged to move into long-term treatment?

    Researchers in the United States examined ‘the degree to which intensive role induction (IRI) administered either alone or in combination with case management (IRI + CM) would produce greater adherence to the detoxification regimen, detoxification completion, and initiation of outpatient treatment compared to standard clinic treatment (ST)’. Intensive role induction is as ‘a strategy adapted from a single-session intervention previously shown to facilitate engagement of substance-dependent patients in drug-free treatment’. ‘Overall, IRI participants enjoyed the most positive outcomes relative to ST participants on measures of engagement during and following detoxification. Specifically, IRI participants, compared to ST participants, on average attended more counseling sessions during detoxification, were more likely to complete detoxification, rated their counselors more favorably, and remained in treatment for a longer period following detoxification. IRI + CM was not found to be similarly effective. Specifically, the only significant effect for IRI + CM, compared to ST participants, was for greater counseling session attendance during detoxification.

The researchers concluded that an easily administered psychosocial intervention can be effective for enhancing patient involvement in detoxification as well as their transition to long-term treatment following detoxification. Intensive role induction, a brief (i.e., 5-session) intervention was found to be easily adopted by existing counselor staff and readily integrated into routine treatment. Thus, IRI is appropriate for use in typical community-based drug treatment programs and appears capable of increasing patient engagement in those settings.

Katz, EC, Brown, BS, Schwartz, RP, OGrady, KE, King, SD & Gandhi, D 2011, Transitioning opioid-dependent patients from detoxification to long-term treatment: efficacy of intensive role induction, Drug and Alcohol Dependence, vol. 117, no. 1, pp. 24-30.

Comment: much of the contemporary disappointment with withdrawal programs reflects the fact that, in too many cases, insufficient attention is given to continuing care, including actively managing the transition from withdrawal interventions to active treatment. This study illustrates the effectiveness of well-managed continuing care interventions.

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How effective are behavioural interventions in preventing hepatitis C infection amongst people who inject drugs?

A systematic review to determine whether behavioural interventions are effective in preventing transmission of hepatitis C virus (HCV) amongst people who inject drugs [PWID] evaluated six randomised controlled trials of peer educator training and counselling interventions for reducing HCV transmission amongst this group. The researchers commented Due to the small number of trials identified, the small number of participants involved in the three trials that measured HCV incidence in total relative to the number required to detect an effect, and variation in measures of injecting risk behaviours and injection frequency, it is difficult to assess whether such interventions are effective means of reducing HCV incidence in PWID. However, the studies that were identified suggest that at least in isolation, behavioural interventions are unlikely to have a considerable impact on rates of HCV transmission.’

Sacks-Davis, R, Horyniak, D, Grebely, J & Hellard, M 2011, Behavioural interventions for preventing hepatitis C infection in people who inject drugs: A global systematic review, International Journal of Drug Policy, In Press.

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What can be done to reduce illicit methamphetamine use in Australia?

A National Drug Law Enforcement Research Fund monograph notes that Illicit methamphetamine use is a continuing and significant policy problem for Australia. It evaluates Project STOP documenting the creation, nature and characteristics of partnerships between the police and third parties that seek to reduce sales of pseudoephedrine and control the methamphetamine problem in Queensland and Victoria. Recommendations of the report include the adoption Australia-wide of measures including the introduction of requirements for the mandatory recording of identification details of customers who purchase or attempt to purchase pseudoephedrine products…the organisational framework of police organisations supports the building of third-party policing partnerships…law enforcement operational strategies maximise the potential role of third-party partnerships in combating illicit methamphetamine problems…[and] greater consistency is achieved among the state and federal governments in their approach to the control of methamphetamines and precursors.

Ransley, J, Mazerolle, L, Manning, M, McGuffog, I, Drew, JM & Webster, J 2011, Reducing the methamphetamine problem in Australia: evaluating innovative partnerships between police, pharmacies and other third parties, Monograph Series no. 39, National Drug Law Enforcement Research Fund, Canberra, http://www.ndlerf.gov.au/pub/Monograph_39.pdf.

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What can be done to reduce prescription drug misuse?

The US Centers for Disease Control and Prevention report that In 2007, approximately 27,000 unintentional drug overdose deaths occurred in the United States, one death every 19 minutes. Prescription drug abuse is the fastest growing drug problem in the United States. They explain that the increase in unintentional drug overdose death rates is largely the result of increased use of opioid analgesics. ‘Since 2003, more overdose deaths have involved opioid analgesics than heroin and cocaine combined’, the authors state. The report recommends the development of a national approach to deal with the problem, noting that any policy must balance the desire to minimize abuse with the need to ensure legitimate access to these medications, and its implementation must bring together a variety of federal, state, local, and tribal groups. The Administrations plan for addressing prescription drug abuse, Epidemic: Responding to America’s Prescription Drug Abuse Crisis, which was released in April 2011, includes four components: education, tracking and monitoring, proper medication disposal, and enforcement.

Centers for Disease Control and Prevention (USA) 2012, CDC Grand Rounds: prescription drug overdoses — a U.S. epidemic, MMWR: Morbidity and Mortality Weekly Report, vol. 61, no. 01, pp. 10-3.

Comment: Australia does not, at present, have such a high proportion of opioid overdoses and deaths attributable to prescription drugs as in the USA. Heroin, usually in combination with other central nervous system depressants, continues to be the main opioid of concern. Nonetheless, rates of prescribing pharmaceutical opioid is rising in this nation, meaning that we need to look out for changes in patterns of opioid-related illness and death.

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Can we believe what we read in the Australian media about crime rates in our society?

A recent BOCSAR Crime and Justice Bulletinpoints out that The misuse of crime statistics by the media has impeded rational debate about law and order. It explains that, Between 2000 and 2009, the Australian national murder rate fell by 39 per cent, the national robbery rate fell by 43 per cent, the national burglary rate fell by 55 per cent, the national motor vehicle theft rate fell by 62 per cent and all forms of other theft fell by 39 per cent [Australian Bureau of Statistics 2010, Recorded Crime - Victims 2009, Cat. No. 4510.0, Australian Bureau of Statistics, Canberra.]… Australia is now into its 11th straight year of falling or stable crime rates. Property crime rates in some States are lower than theyve been in more than 20 years…You might think this a cause for celebration but the vast majority of Australians still think crime is going up...The reason for this is fairly clear. Most people get their information about crime from the media-and large sections of the media habitually distort, misrepresent and exaggerate the facts on crime.
The publication is designed to promote a better understanding of the uses and abuses of crime statistics amongst students, journalists and the interested public by describing the main uses of crime statistics, coupled with analysis and examples of common abuses.

Weatherburn, D 2011, Uses and abuses of crime statistics, Crime and Justice Bulletin, Contemporary Issues in Crime and Justice Number 153, Bureau of Crime Statistics and Research, Sydney, http://www.bocsar.nsw.gov.au/lawlink/bocsar/ll_bocsar.nsf/vwFiles/CJB153.pdf/$file/CJB153.pdf.

Comment: this Crime & Justice Bulletin should be mandatory reading for anyone using statistics on drugs and crime, as well as for advocacy groups and people working in and with the media.

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New Reports

The Kirby Institute, The University of NSW 2011, HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2011, The Kirby Institute, the University of New South Wales, Sydney, http://www.med.unsw.edu.au/nchecrweb.nsf/page/Annual+Surveillance+Reports .

Australian Bureau of Statistics 2011, Crime victimisation, Australia, 2010-11, Australian Bureau of Statistics, Canberra, www.abs.gov.au/ausstats/abs@.nsf/mf/4530.0 .

Australian Bureau of Statistics 2011, Australian standard classification of drugs of concern, 2011, cat. no. 1248.0, Australian Bureau of Statistics, Canberra, http://www.abs.gov.au/ausstats/abs@.nsf/mf/1248.0 .


For information on other reports, please visit the Did you see that report? page at the website of the National Drugs Sector Information Service:  http://ndsis.adca.org.au/report.php.


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Contact ATODA:

Phone: (02) 6255 4070
Fax: (02) 6255 4649
Email: info@atoda.org.au
Mail: PO Box 7187,
Watson ACT 2602
Visit: 350 Antill St. Watson

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The Alcohol Tobacco and Other Drug Association ACT (ATODA) is the peak body representing the non-government and government alcohol, tobacco and other drug (ATOD) sector in the Australian Capital Territory (ACT). ATODA seeks to promote health through the prevention and reduction of the harms associated with ATOD. 

Views expressed in the ACT ATOD Sector eBulletin do not necessarily reflect the opinion of the Alcohol Tobacco and Other Drug Association ACT. Not all third-party events or information included in the eBulletin are endorsed by the ACT ATOD Sector or the Alcohol Tobacco and Other Drug Association ACT. No responsibility is accepted by the Alcohol Tobacco and Other Drug Association ACT or the editor for the accuracy of information contained in the eBulletin or the consequences of any person relying upon such information. To contact us please email ebulletin@atoda.org.au or call (02) 6255 4070.








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