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Drugs / Substance Use Series: Policy/Harm to Young People
 
 
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from Jules: I report this in the context of today's national problem of IDU which although related to HCV & HIV transmission this part of the problem - HCV transmission gets neglected. The focus has been on the IDU problem among youth, particularly in the suburbs or rural areas, but that HCV transmission is simultaneously occurring & that there is a highly effective treatment, has getting essentially no discussion as it relates to the attention the IDU & Youth problem receives, neither from Congress, The White House and from the Press.
 
Series-
 
"During puberty, when young people are completing their education, transitioning into employment, and forming longer-term intimate relationships, a shift in emotional regulation and an increase in risky behaviour, including substance use, is seen......Scarce availability of research on interventions for problematic substance use in young people indicates the need to test interventions that are effective with adults in young people......Concerted efforts are needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people. "
 
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Drug policy: getting over the 20th century Editorial
 
The Series on Substance use in young people published in The Lancet Psychiatry takes a comprehensive and evidence-based look at the facts. The potential effects of substances on the developing brains-and lives-of young people are described, as are the global patterns of use. It is a complex and evolving picture. Current legal measures do not address this complexity: as Emily Stockings and colleagues point out, "only weak evidence is available to show that tough sanctions reduce criminal offending in general or drug use in particular". Moreover, "there are adverse health and social effects associated with the prohibition and widespread cultivation, manufacture, and trafficking of illicit drugs...[these] include the violence that occurs in drug markets in source countries and consumer drug markets". Drug use can cause profound harm, often to society's most vulnerable people. True, a hard line makes it clear that the government recognises the dangers of substance use. But the role of the law should be to mitigate harm, not to exacerbate it. Blanket bans do not make a problem go away; they merely change its form.
 
And so it remains, nationally and internationally (the UN Single Convention on Narcotic Drugs followed in 1961), albeit with variation in the harshness of the legal penalties involved, and the availability of health services to help users with harm minimisation or abstention.
 
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The increasing global health priority of substance use in young people
 
Summary

 
Substance use in young people (aged 10-24 years) might disrupt key periods of transition that occur as the adolescent brain undergoes cognitive and emotional development, and key psychosocial transitions are made. Adolescence is the peak time for initiation of substance use, with tobacco and alcohol usually preceding the use of illicit drugs. Substantial variation is noted between countries in the levels, types, and sequences of substance use in young people, indicating that a young person's use of substances depends on their social context, drug availability, and their personal characteristics. The Global Burden of Disease (GBD) 2013 study suggests that the burden attributable to substance use increases substantially in adolescence and young adulthood. In young men aged 20-24 years, alcohol and illicit substance use are responsible for 14% of total health burden. Alcohol causes most health burden in eastern Europe, and illicit drug burden is higher in the USA, Canada, Australia, New Zealand, and western Europe. Large gaps exist in epidemiological data about the extent of drug use worldwide and much of what we know about the natural history of substance use comes from cohort studies in high-income countries undertaken decades ago, which hinders effective global policy responses. In view of the global epidemiological transitions from diseases of poverty to non-communicable diseases, the burden of disease and health risks among adolescents and young adults is likely to change substantially, in ways that will no doubt see substance use playing an increasingly large part.
 
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Why young people's substance use matters for global health
 
Summary

 
During puberty, when young people are completing their education, transitioning into employment, and forming longer-term intimate relationships, a shift in emotional regulation and an increase in risky behaviour, including substance use, is seen. This Series paper considers the potential effects of alcohol, tobacco, and illicit drug use during this period on: social, psychological, and health outcomes in adolescence and young adulthood; role transitions, and later health and social outcomes of regular substance use initiated in adolescence; and the offspring of young people who use substances. We sourced consistent support for causal relations between substance use and outcomes and evidence of biological plausibility from different but complementary research designs. Many adverse health and social outcomes have been associated with different types of substance use. The major challenge lies in deciding which are causal. Furthermore, qualitatively different harms are associated with different substances, differences in life stage when these harms occur, and the quality of evidence for different substances and health outcomes varies substantially. The preponderance of evidence comes from a few high-income countries, thus whether the same social and health outcomes would occur in other countries and cultures is unclear. Nonetheless, the number of harms that are causally related to substance use in young people warrant high-quality research design interventions to prevent or ameliorate these harms.
 
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Prevention, early intervention, harm reduction, and treatment of substance use in young people
 
Summary

 
We did a systematic review of reviews with evidence on the effectiveness of prevention, early intervention, harm reduction, and treatment of problem use in young people for tobacco, alcohol, and illicit drugs (eg, cannabis, opioids, amphetamines, or cocaine). Taxation, public consumption bans, advertising restrictions, and minimum legal age are effective measures to reduce alcohol and tobacco use, but are not available to target illicit drugs. Interpretation of the available evidence for school-based prevention is affected by methodological issues; interventions that incorporate skills training are more likely to be effective than information provision-which is ineffective. Social norms and brief interventions to reduce substance use in young people do not have strong evidence of effectiveness. Roadside drug testing and interventions to reduce injection-related harms have a moderate-to-large effect, but additional research with young people is needed. Scarce availability of research on interventions for problematic substance use in young people indicates the need to test interventions that are effective with adults in young people. Existing evidence is from high-income countries, with uncertain applicability in other countries and cultures and in subpopulations differing in sex, age, and risk status. Concerted efforts are needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people.

 
 
 
 
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