The burden is higher for some population groups 

Males experienced around three-quarters of the total burden from alcohol use and illicit drug use in Australia in 2011. Compared to females, males experienced a greater proportion of burden due to alcohol use for most associated diseases, but most notably from Homicide and violence (27%, compared with 10% for females) and from Other unintentional injuries (23%, compared with 7.2% for females). 

The burden from alcohol use and illicit drug use (calculated separately) varied according to where a person lived and their socioeconomic position. Age-standardised rates were higher in: 

  • The lowest socioeconomic group (1.9 times and 2.6 times as high for alcohol use and illicit drug use, respectively), when compared with the highest socioeconomic group 
  • Very remote areas (2.4 times as high) for alcohol use, when compared with Major cities 
  • Remote and Very remote areas for illicit drug use compared with Major cities and regional areas 

Transmission of other bloodborne infections, particularly HIV and hepatitis B virus (HBV), is also increasing among injection-drug users, albeit at a slower rate. The opioid epidemic has also been linked to increasing rates of syphilis and other sexually transmitted infections, microbial endocarditis, and other infections associated with unsafe drug injection.3

The social and economic costs of the HCV epidemic could be staggering. Most injection-drug users who become infected with HCV do so as young adults. Such people are at risk for chronic hepatitis C and could face years of hefty health care expenses; left untreated, they may transmit HCV to others. The cost of caring for people with HCV places further strain on an already fragile health care system. Furthermore, because young adults are entering their most productive years, HCV will affect the economic productivity of the country for years to come. (DACA Comment – What is not included in this concerning report is that much of the increase in STI’s is not only due to the misuse of injecting equipment, but unsafe sexual activity engaged in whilst on the illicit drug, be it opioids or ATS. The ‘band aid’ of trying ‘manage’ the ‘disease’ of drug use with mechanisms that do not lead to exit from drug use, only add a further burden of disease and a comorbid condition, which is yet another epidemiological short coming of Harm Reduction ONLY ideologies and practices!) 

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BACKGROUND: Despite public awareness that tobacco secondhand smoke (SHS) is harmful, many people still assume that marijuana SHS is benign. Debates about whether smoke-free laws should include marijuana are becoming increasingly widespread as marijuana is legalized and the cannabis industry grows. Lack of evidence for marijuana SHS causing acute cardiovascular harm is frequently mistaken for evidence that it is harmless, despite chemical and physical similarity between marijuana and tobacco smoke. We investigated whether brief exposure to marijuana SHS causes acute vascular endothelial dysfunction.

METHODS AND RESULTS: We measured endothelial function as femoral artery flow-mediated dilation (FMD) in rats before and after exposure to marijuana SHS at levels similar to real-world tobacco SHS conditions. One minute of exposure to marijuana SHS impaired FMD to a comparable extent as impairment from equal concentrations of tobacco SHS, but recovery was considerably slower for marijuana. Exposure to marijuana SHS directly caused cannabinoid-independent vasodilation that subsided within 25 minutes, whereas FMD remained impaired for at least 90 minutes. Impairment occurred even when marijuana lacked cannabinoids and rolling paper was omitted. Endothelium-independent vasodilation by nitroglycerin administration was not impaired. FMD was not impaired by exposure to chamber air.

CONCLUSIONS: One minute of exposure to marijuana SHS substantially impairs endothelial function in rats for at least 90 minutes, considerably longer than comparable impairment by tobacco SHS. Impairment of FMD does not require cannabinoids, nicotine, or rolling paper smoke. Our findings in rats suggest that SHS can exert similar adverse cardiovascular effects regardless of whether it is from tobacco or marijuana.

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JACC: Journal of the American College of Cardiology - Key Summary

  • Patients aged ≤50 years presenting with their first myocardial infarction were retrospectively analyzed to evaluate the prevalence of cocaine and marijuana use and the impact on clinical outcomes. The prevalence of the use of cocaine and/or marijuana was 10.7%. Compared with patients without a history substance use, those using cocaine and/or marijuana had…a significantly higher rate of tobacco use. There was a significant association between the use of cocaine and/or marijuana and elevated cardiovascular and all-cause mortality risk.
  • Approximately 10% of patients presenting with myocardial infarction at age ≤50 years are cocaine and/or marijuana users, and this substance use is associated with an increased mortality risk. Young adults presenting with a first myocardial infarction should be screened for substance use to allow intervention in order to prevent future cardiac events

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Abstract – Mayo Clinic

The opioid crisis that exists today developed over the past 30 years. The reasons for this are many. Good intentions to improve pain and suffering led to increased prescribing of opioids, which contributed to misuse of opioids and even death. Following the publication of a short letter to the editor in a major medical journal declaring that those with chronic pain who received opioids rarely became addicted, prescriber attitude toward opioid use changed. Opioids were no longer reserved for treatment of acute pain or terminal pain conditions but now were used to treat any pain condition. Governing agencies began to evaluate doctors and hospitals on their control of patients' pain. Ultimately, reimbursement became tied to patients' perception of pain control. As a result, increasing amounts of opioids were prescribed, which led to dependence. When this occurred, patients sought more in the form of opioid prescriptions from providers or from illegal sources. Illegal, unregulated sources of opioids are now a factor in the increasing death rate from opioid overdoses. Stopping the opioid crisis will require the engagement of all, including health care providers, hospitals, the pharmaceutical industry, and federal and state government agencies.

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