ORCID Profile
0000-0001-6673-833X
Current Organisations
Stanford University
,
University of Tasmania
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Environmental Monitoring | Environmental Chemistry (incl. Atmospheric Chemistry) | Environmental and Occupational Health and Safety | Other Chemical Sciences | Health Information Systems (incl. Surveillance) | Environmental Science and Management |
ANZSRC Socio-Economic Objective (SEO)
Expanding Knowledge in the Environmental Sciences | Public Health (excl. Specific Population Health) not elsewhere classified | Expanding Knowledge in the Chemical Sciences | Environmental Health
Related Links
Publications
Sexual and injecting risk behaviours among regular ecstasy users
Publisher: Elsevier BV
Date: 02-2010
DOI: 10.1016/J.ADDBEH.2009.09.001
Abstract: Substance users may be at a heightened risk for the transmission of HIV and other blood-borne viral infections (BBVI) through injecting drug use or risky sexual behaviours. The current study aimed to investigate the engagement in BBVI-risk behaviours among a sentinel group of regular ecstasy users in Australia, with a particular focus on sexual practices and describe the occurrence of BBVI testing among this group. Participants were regular ecstasy users recruited across Australia in 2007 who were administered a structured interview that contained questions regarding substance use, sexual behaviours and occurrence of BBVI testing. Results indicate high levels of unprotected sex in the past 6 months (77% reported inconsistent condom use with a regular partner 54% with a casual partner). Half the s le reported never having an HIV test. Unprotected sex was associated with being heterosexual despite this, heterosexuals were also less likely to report HIV testing status. These data suggest that targeted health promotion messages may be needed for this group of predominantly young, heterosexual substance users who may fall out of the reach of traditional messages.
Association between purity of drug seizures and illicit drug loads measured in wastewater in a South East Queensland catchment over a six year period
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.SCITOTENV.2018.04.192
Abstract: This study aimed to examine associations between the annual average purity of seized illicit drugs and their corresponding load measured in wastewater. Daily loads (averaging 81 s les/year) and purity of seized meth hetamine (average 287 s les/year), cocaine (50/year) and MDMA (70/year) were collected from a catchment that serviced approximately 220,000 persons in Queensland, Australia during 2010-2015. Using regression models for mass load and purity data, we found a strong linear increase in the mass load of meth hetamine detected across study years (363-1126 mg/1000 people/day, R
Typology of alcohol consumers in five Australian nighttime entertainment districts
Publisher: Wiley
Date: 14-12-2016
DOI: 10.1111/DAR.12370
Abstract: Understanding how types of alcohol consumers differ is important for public policy targeted at reducing adverse events. The aims of the present study were to identify typologies of alcohol consumers in Australian nighttime entertainment districts based on risk factors for harm and to examine variation between the identified groups in drinking setting and harms. Street-intercept surveys were conducted with 5556 alcohol consumers in and around licensed venues in five Australian cities between November 2011 and June 2012. Latent class analysis identified groups based on age and sex, and blood alcohol concentration, pre-drinking, energy drink use and illicit drug use during that night. Four classes were identified: general patron group (33%), young pre-drinker group (27%), intoxicated male pre-drinker group (31%) and intoxicated illicit drug male group (9%). The proportion of the general patron group interviewed decreased over the night, while the other groups increased (particularly in regional cities). As compared with the general patron group, the remaining three groups reported increased odds of being involved in aggression and any alcohol-related injuries in the past 3 months, with highest rates of harm amongst the intoxicated illicit drug male group. Alcohol consumers in nighttime entertainment districts are not a homogeneous group. One-third have a low likelihood of risky consumption practices however, representation of this consumer class diminishes throughout the night. Elevated harms amongst groups characterised by certain risk factors (e.g. pre-drinking and illicit drug use) emphasise the importance of addressing these behaviours in public policy. [Peacock A, Norman T, Bruno B, Pennay, Droste N, Jenkinson R, Quinn B, Lubman DI, Miller P. Typology of alcohol consumers in five Australian nighttime entertainment districts. Drug Alcohol Rev 2016 :539-548].
Verbal learning and memory in cannabis and alcohol users
Publisher: Frontiers Media SA
Date: 08-12-2017
Adolescent substance use and educational attainment: An integrative data analysis comparing cannabis and alcohol from three Australasian cohorts
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.DRUGALCDEP.2015.08.034
Abstract: The relative contributions of cannabis and alcohol use to educational outcomes are unclear. We examined the extent to which adolescent cannabis or alcohol use predicts educational attainment in emerging adulthood. Participant-level data were integrated from three longitudinal studies from Australia and New Zealand (Australian Temperament Project, Christchurch Health and Development Study, and Victorian Adolescent Health Cohort Study). The number of participants varied by analysis (N=2179-3678) and were assessed on multiple occasions between ages 13 and 25. We described the association between frequency of cannabis or alcohol use prior to age 17 and high school non-completion, university non-enrolment, and degree non-attainment by age 25. Two other measures of alcohol use in adolescence were also examined. After covariate adjustment using a propensity score approach, adolescent cannabis use (weekly+) was associated with 1½ to two-fold increases in the odds of high school non-completion (OR=1.60, 95% CI=1.09-2.35), university non-enrolment (OR=1.51, 95% CI=1.06-2.13), and degree non-attainment (OR=1.96, 95% CI=1.36-2.81). In contrast, adjusted associations for all measures of adolescent alcohol use were inconsistent and weaker. Attributable risk estimates indicated adolescent cannabis use accounted for a greater proportion of the overall rate of non-progression with formal education than adolescent alcohol use. Findings are important to the debate about the relative harms of cannabis and alcohol use. Adolescent cannabis use is a better marker of lower educational attainment than adolescent alcohol use and identifies an important target population for preventive intervention.
The Subjective Physiological, Psychological, and Behavioral Risk-Taking Consequences of Alcohol and Energy Drink Co-Ingestion
Publisher: Wiley
Date: 15-08-2012
DOI: 10.1111/J.1530-0277.2012.01820.X
Abstract: The increasingly popular practice among adolescents and young adults of consuming alcohol mixed with energy drinks (AmED) has raised concern regarding potential increases in maladaptive drinking practices, negative psychological and physiological intoxication side effects, and risky behavioral outcomes. Comparison of user types has revealed that AmED users report engaging in more risk-taking behavior relative to alcohol users. However, the comparative likelihood of risk-taking according to session type (i.e., AmED vs. alcohol session) remains relatively unknown. Thus, this study was designed with the aim of establishing the subjective physiological, psychological, and behavioral risk-taking outcomes of AmED consumption relative to alcohol consumption for AmED users drawn from the community. Between May and June 2011, 403 Australians aged 18 to 35 who had consumed AmED and alcohol only in the preceding 6 months completed a 10- to 30-minute online survey about their use of these substances. Despite participants consuming a significantly greater quantity of alcohol in AmED sessions compared to alcohol sessions, the odds of participants experiencing disinhibition and engaging in 26 risk behaviors were significantly lower during AmED sessions relative to alcohol sessions. Similarly, the odds of experiencing several physiological (i.e., speech and walking difficulties, nausea, and slurred speech) and psychological (i.e., confusion, exhaustion, sadness) sedation outcomes were less during AmED sessions compared to alcohol sessions. However, the odds of enduring physiological (i.e., heart palpitations, sleep difficulties, agitation, tremors, jolt and crash episodes, and increased speech speed) and psychological (i.e., irritability and tension) outcomes potentially related to overstimulation were significantly greater during AmED sessions than alcohol sessions. Co-ingestion may provide a double-edged effect. The increased stimulation from energy drinks (EDs) may negate some intoxication-related sedation side effects by increasing alertness. However, it could also lead to negative physiological side effects associated with overstimulation. Notwithstanding any stimulatory effects of EDs, risk and negative effects of excessive alcohol consumption were present in both session types. However, the odds of engaging in risk-taking were less during AmED sessions relative to alcohol sessions. Objective measurement of behavioral risk-taking via laboratory-based measures could confirm the causal relationship between AmED and risk-taking.
Evaluation of Monitoring Schemes for Wastewater-Based Epidemiology to Identify Drug Use Trends Using Cocaine, Methamphetamine, MDMA and Methadone
Publisher: American Chemical Society (ACS)
Date: 13-04-2016
Abstract: Wastewater-based epidemiology is increasingly being used as a tool to monitor drug use trends. To minimize costs, studies have typically monitored a small number of days. However, cycles of drug use may display weekly and seasonal trends that affect the accuracy of monthly or annual drug use estimates based on a limited number of s les. This study aimed to rationalize s ling methods for minimizing the number of s les required while maximizing information about temporal trends. A range of s ling strategies were examined: (i) targeted days (e.g., weekends), (ii) completely random or stratified random s ling, and (iii) a number of s ling strategies informed by known weekly cycles in drug use data. Using a time-series approach, analysis was performed for four drugs (MDMA, meth hetamine, cocaine, methadone) collected through a continuous s ling program over 14 months. Results showed, for drugs with weekly cycles (MDMA, meth hetamine and cocaine in this s le), s ling strategies which made use of those weekly cycles required fewer s les to obtain similar information as s ling 5 days per week and had better accuracy than stratified random s ling techniques.
The characteristics of a cohort who tamper with prescribed and diverted opioid medications
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.JSAT.2015.06.001
Abstract: To describe the methods and baseline characteristics of a cohort of people who t er with pharmaceutical opioids, formed to examine changes in opioid use following introduction of Reformulated OxyContin®. Participants were 606 people from three Australian jurisdictions who reported past month injecting, snorting, chewing or smoking of a pharmaceutical opioid and had engaged in these practices at least monthly in the past 6 months. Baseline interviews were conducted prior to introduction of Reformulated OxyContin® in April 2014. Patterns of opioid use and cohort characteristics were examined according to whether participants were prescribed opioid medications, or exclusively used erted medication. The cohort reported high levels of moderate/severe depression (61%), moderate/severe anxiety (43%), post-traumatic stress disorder (42%), chronic pain or disability (past 6 months, 54%) and pain (past month, 47%). Lifetime use of oxycodone, morphine, opioid substitution medications and codeine were common. Three-quarters (77%) reported ICD-10 lifetime pharmaceutical opioid dependence and 40% current heroin dependence. Thirteen percent reported past year overdose, and 70% reported at least one past month opioid injection-related injury or disease. The cohort displayed complex clinical profiles, but participants currently receiving opioid substitution therapy who were also prescribed other opioids particularly reported a wide range of risk behaviors, despite their health service engagement. Findings highlight the heterogeneity in the patterns and clinical correlates of opioid use among people who t er with pharmaceutical opioids. Targeted health interventions are essential to reduce the associated harms.
Multiply disadvantaged: Health and service utilisation factors faced by homeless injecting drug consumers in Australia
Publisher: Wiley
Date: 18-03-2015
DOI: 10.1111/DAR.12257
Abstract: Homelessness status is strongly correlated with higher rates of substance use. Few studies, however, examine the complex relationship between housing status and substance use in people who inject drugs (PWID). This study extends previous research by comparing the physical and mental health status and service utilisation rates between stably housed and homeless PWID. A cross-sectional s le of 923 PWID were recruited for the 2012 Illicit Drug Reporting System. Multivariate models were generated addressing associations between homelessness and the domains of demographics substance use and health status, service utilisation and criminal justice system contact, with significant correlates entered into a final multivariate model. Two-thirds of the PWID s le were male. The median age was 39 years and 16% identified as Indigenous. Almost one-quarter (23%) reported that they were homeless. Homeless PWID were significantly more likely to be unemployed [adjusted odds ratio (AOR) 2.83, 95% confidence interval (CI) 1.26, 6.34], inject in public (AOR 2.01, 95% CI 1.38, 3.18), have poorer mental health (AOR 0.98, 95% CI 0.97, 1.00), report schizophrenia (AOR 2.31, 95% CI 1.16, 4.60) and have a prison history (AOR 1.53, 95% CI 1.05, 2.21) than stably housed PWID. Findings highlight the challenge of mental health problems for homeless PWID. Our results demonstrate that further research that evaluates outcomes of housing programs accommodating PWID, particularly those with comorbid mental health disorders, is warranted. Results also emphasise the need to better utilise integrated models of outreach care that co-manage housing and mental health needs.
Determining clinical cutoff scores for the Australian Treatment Outcomes Profile psychological health, physical health and quality of life questions.
Publisher: Wiley
Date: 29-06-2002
DOI: 10.1111/DAR.13346
Abstract: The Australian Treatment Outcomes Profile (ATOP) is a brief instrument that measures self‐reported substance use, health, and wellbeing in the previous 28 days for people in alcohol and other drug treatment. Previous studies have established the concurrent validity, inter‐rater, and test–retest reliability of the tool. The current study sought to identify recommended cutoff scores for ATOP items for psychological health, physical health and quality of life that identify clients reporting clinically significant problems warranting further assessment and/or intervention, compared to cutoffs used by ‘gold‐standard’ measures for these domains. Clients attending for treatment for problems with opioid ( n = 144) or alcohol use ( n = 134) completed the ATOP and comparison standardised questionnaires (Kessler‐10, Short Form Survey 12 and the Personal Wellbeing Index) with a researcher. Receiver operating characteristics analysis, along with clinician perspectives, were used to recommend cutoff scores for ATOP items indicative of clinically significant problems. A cutoff score of 5 or less out of 10 was identified as an optimal pragmatic cutoff for ATOP items relating to psychological health, physical health and quality of life items with regards to balancing sensitivity, specificity, and application in a treatment setting. The recommended clinical cutoffs will support clinicians and treatment services to identify clients who require further assessment and follow up for their psychological health, physical health and quality of life. The current study provides further evidence for the utility of the ATOP for in idual clinical review, service planning and research.
Health and social characteristics of clients reporting amphetamine type substance use at entry to public alcohol and other drug services in New South Wales, Australia, 2016–2019
Publisher: Wiley
Date: 16-12-2022
DOI: 10.1111/DAR.13588
Abstract: Amphetamine type substances (ATS) are commonly used by Australian alcohol and other drug service entrants. We describe demographic characteristics, patterns of ATS and other substance use, health and social conditions among clients entering New South Wales (NSW) public alcohol and other drug services. Retrospective cohort of 13,864 records across six health districts (2016–2019) for clients seeking substance use treatment. These districts service approximately 44% of the NSW population aged 15 years and over. Multivariate analysis was conducted on a subs le for whom full data were available ( N = 9981). Data included NSW Minimum Data Set for drug and alcohol treatment services and Australian Treatment Outcomes Profile items. Over the preceding 4 weeks, 77% ( n = 10,610) of clients ( N = 13,864) reported no recent ATS use, 15% ( n = 2109) reported ‘low frequency’ (1–12 days) and 8% ( n = 1145) ‘high frequency’ (13–28 days) use. ATS use was most common among people attending for ATS or opioids as primary drug of concern. A multinomial regression ( N = 9981) identified that clients reporting recent arrest (aOR 1.74, 95% CI 1.36, 2.24), higher cannabis use frequency (aOR 1.01, 95% CI 1.00, 1.02), lower opioid use frequency (aOR 0.98, 95% CI 0.97, 0.99) and poorer quality of life (aOR 0.91, 95% CI 0.86, 0.97) were more likely to report ‘high frequency’ rather than ‘low frequency’ ATS use. People who use ATS experience health and social issues that may require targeted responses. These should be integrated across all services, not only for clients with ATS as principal drug of concern.
Trends in methamphetamine use, markets and harms in Australia, 2003–2019
Publisher: Wiley
Date: 23-05-2022
DOI: 10.1111/DAR.13468
Abstract: To describe trends in meth hetamine use, markets and harms in Australia from 2003 to 2019. Data comprised patterns of use and price from sentinel s les of people who inject drugs and who use MDMA/other illicit stimulants and population‐level hetamine‐related police seizures, arrests, hospitalisations, treatment episodes and deaths from approximately 2003 to 2019. Bayesian autoregressive time‐series models were analysed for: no change constant rate of change and change over time differing in rate after one to three changepoints. Related indicators were analysed post hoc with identical changepoints. The percentage of people who inject drugs reporting weekly use increased from 2010 to 2013 onwards, while use among s les of people who regularly use ecstasy and other illicit stimulants decreased. Seizures and arrests rose steeply from around 2009/10 to 2014/15 and subsequently plateaued. Price increased ($15.9 [95% credible interval, CrI $9.9, $28.9] per point of crystal per year) from around 2009 to 2011, plateauing and then declining from around 2017. Hospitalisation rates increased steeply from around 2009/10 until 2015/16, with a small subsequent decline. Treatment also increased (19.8 episodes [95% CrI 13.2, 27.6] with hetamines as the principal drug of concern per 100 000 persons per year) from 2010/11 onwards. Deaths involving hetamines increased (0.285 per 100 000 persons per year) from 2012 until 2016. These findings suggest that problematic meth hetamine use and harms escalated from 2010 to 2012 onwards in Australia, with continued demand and a sustained market for meth hetamine. [Correction added on 30 May 2022, after first online publication: In the Abstract under ‘Discussion and Conclusions’ ‘onwards’ has been added after … 2010 to 2012].
Trajectories of alcohol-induced blackouts in adolescence: early risk factors and alcohol use disorder outcomes in early adulthood
Publisher: Wiley
Date: 02-2021
DOI: 10.1111/ADD.15415
Abstract: Experience of alcohol‐induced memory blackouts in adolescence may be an important risk factor for later harms. This longitudinal study (i) modelled trajectories of alcohol‐related blackouts throughout adolescence, (ii) explored early‐adolescent predictors of blackout trajectories and (iii) examined the association between blackout trajectories and alcohol use disorder (AUD) symptoms. Longitudinal study in which data from six annual surveys of a longitudinal cohort of Australian adolescents were used to model latent class growth trajectories of blackouts, adjusting for alcohol consumption frequency and typical quantity. Regression models were used to determine whether parent, child and peer factors at baseline (mean age = 12.9) predicted profiles of blackout trajectory membership and whether blackout trajectories predicted meeting criteria for AUD in early adulthood (mean age = 19.8). Australian adolescents ( n = 1821 mean age = 13.9–18.8 years). Alcohol‐related blackouts, alcohol consumption frequency, typical consumption quantity and DSM‐5 AUD in early adulthood were all self‐reported. We identified a three‐class solution: delayed alcohol initiation, rare blackouts ( n = 701 38.5%) early initiation, rare blackouts ( n = 869 47.7%) and early initiation, increasing blackouts ( n = 251 13.8%). Female sex was associated with increased risk of early initiation, increasing blackouts relative to delayed initiation, rare blackouts [relative risk ratio (RRR) = 3.90 99.5% confidence interval (CI) = 1.96, 7.76] and relative to early initiation, rare blackouts (RRR = 2.89 99.5% CI = 1.42, 5.87). Early initiation, rare blackouts [odds ratio (OR) = 1.96 99.5% CI = 1.17, 3.29] and early initiation, increasing blackouts (OR = 4.93 99.5% CI = 2.32, 10.48) were each associated with increased odds of meeting criteria for AUD in early adulthood relative to delayed initiation, rare blackouts. Early initiation, increasing blackouts was associated with increased odds of meeting criteria for AUD in early adulthood relative to early initiation, rare blackouts (OR = 2.51 99.5% CI = 1.18, 5.38). Females in Australia appear to be at higher risk of adolescent alcohol‐related blackouts independent of alcohol consumption levels and age of initiation. Alcohol‐related blackouts may be associated with later alcohol use disorder.
Mixing alcohol and energy drinks: associations with risk-taking, alcohol consumption and motivations in a New Zealand sample
Publisher: Informa UK Limited
Date: 18-09-2020
Prevalence and correlates of suicidal thoughts and suicide attempts in people prescribed pharmaceutical opioids for chronic pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Sleep Quality Among People Living With Chronic Noncancer Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2016
Estimating daily and diurnal variations of illicit drug use in Hong Kong: A pilot study of using wastewater analysis in an Asian metropolitan city
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.FORSCIINT.2013.09.003
Abstract: The measurement of illicit drug metabolites in raw wastewater is increasingly being adopted as an approach to objectively monitor population-level drug use, and is an effective complement to traditional epidemiological methods. As such, it has been widely applied in western countries. In this study, we utilised this approach to assess drug use patterns over nine days during April 2011 in Hong Kong. Raw wastewater s les were collected from the largest wastewater treatment plant serving a community of approximately 3.5 million people and analysed for excreted drug residues including cocaine, ketamine, meth hetamine, 3,4-methylenedioxymeth hetamine (MDMA) and key metabolites using liquid chromatography coupled with tandem mass spectrometry. The overall drug use pattern determined by wastewater analysis was consistent with that have seen amongst people coming into contact with services in relation to substance use among our target drugs, ketamine (estimated consumption: 1400-1600 mg/day/1000 people) was the predominant drug followed by meth hetamine (180-200 mg/day/1000 people), cocaine (160-180 mg/day/1000 people) and MDMA (not detected). The levels of these drugs were relatively steady throughout the monitoring period. Analysing s les at higher temporal resolution provided data on diurnal variations of drug residue loads. Elevated ratios of cocaine to benzoylecgonine were identified unexpectedly in three s les during the evening and night, providing evidence for potential dumping events of cocaine. This study provides the first application of wastewater analysis to quantitatively evaluate daily drug use in an Asian metropolitan community. Our data reinforces the benefit of wastewater monitoring to health and law enforcement authorities for strategic planning and evaluation of drug intervention strategies.
Postexercise facilitation appears durable in normal subjects
Publisher: Wiley
Date: 04-2001
DOI: 10.1046/J.1440-1819.2001.00804.X
Abstract: Transcranial magnetic stimulation (TMS) was used to study the postexercise facilitation of 11 normal subjects on eight occasions. Between in iduals, there was almost a sixfold difference in facilitation. The greatest positive percentage change for any in idual was 61%, and the greatest negative percentage change was 51%. The results suggest that facilitation is a durable in idual characteristic of normal subjects. Serial studies may therefore be indicated in monitoring in iduals suffering relapsing conditions.
Routine opioid outcome monitoring in community pharmacy: Pilot implementation study protocol
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.SAPHARM.2018.10.024
Abstract: Increases in opioid use and related harms such as mortality are occurring in many high income countries. Community pharmacists are often in contact with patients at risk of opioid-related harm and represent an ideal point for intervention. Best practice in monitoring opioid-related outcomes involves assessing analgesia, pain functioning, mood, risks and harms associated with opioid use. Community pharmacists are well-placed to undertake these tasks. Our pilot study will test the implementation of a computer-facilitated screening and brief intervention (SBI). The SBI will support pharmacist identification of opioid-related problems and provide capacity for brief intervention including verbal reinforcement of tailored information sheets, supply of naloxone and referral back to the opioid prescriber. The SBI utilises software that embeds study procedures into dispensing workflow and assesses opioid outcomes with domains aligned with a widely accepted clinical framework. We will recruit and train 75 pharmacists from 25 pharmacies to deliver the Routine Opioid Outcome Monitoring (ROOM) SBI. Pharmacists will complete the SBI with up to 500 patients in total (20 per pharmacy). Data will be collected on pharmacists' knowledge and confidence through pre- and post-intervention online surveys. Data on feasibility, acceptability and implementation outcomes, including naloxone supply, will also be collected. Our study will examine changes in pharmacists' knowledge and confidence to deliver the SBI. Through the implementation pilot, we will establish the feasibility and acceptability of a pharmacist SBI that aims to improve monitoring and clinical management of patients who are prescribed opioids.
Cannabis use in patients 3 months after ceasing nabiximols for the treatment of cannabis dependence: Results from a placebo-controlled randomised trial
Publisher: Elsevier BV
Date: 10-2020
Energy drinks, alcohol and cardiovascular functioning
Publisher: Elsevier BV
Date: 04-2018
Landscape of X chromosome inactivation across human tissues
Publisher: Springer Science and Business Media LLC
Date: 12-10-2017
DOI: 10.1038/NATURE24265
Abstract: X chromosome inactivation (XCI) silences transcription from one of the two X chromosomes in female mammalian cells to balance expression dosage between XX females and XY males. XCI is, however, incomplete in humans: up to one-third of X-chromosomal genes are expressed from both the active and inactive X chromosomes (Xa and Xi, respectively) in female cells, with the degree of ‘escape’ from inactivation varying between genes and in iduals 1,2 . The extent to which XCI is shared between cells and tissues remains poorly characterized 3,4 , as does the degree to which incomplete XCI manifests as detectable sex differences in gene expression 5 and phenotypic traits 6 . Here we describe a systematic survey of XCI, integrating over 5,500 transcriptomes from 449 in iduals spanning 29 tissues from GTEx (v6p release) and 940 single-cell transcriptomes, combined with genomic sequence data. We show that XCI at 683 X-chromosomal genes is generally uniform across human tissues, but identify ex les of heterogeneity between tissues, in iduals and cells. We show that incomplete XCI affects at least 23% of X-chromosomal genes, identify seven genes that escape XCI with support from multiple lines of evidence and demonstrate that escape from XCI results in sex biases in gene expression, establishing incomplete XCI as a mechanism that is likely to introduce phenotypic ersity 6,7 . Overall, this updated catalogue of XCI across human tissues helps to increase our understanding of the extent and impact of the incompleteness in the maintenance of XCI.
Refining the excretion factors of methadone and codeine for wastewater analysis - Combining data from pharmacokinetic and wastewater studies
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.ENVINT.2016.05.033
Abstract: Analysing drug residues in wastewater (wastewater analysis) to monitor the consumption of those drugs in the population has become a complementary method to epidemiological surveys. In this method, the excretion factor of a drug (or the percentage of drug metabolites excreted through urine) is a critical parameter for the back-estimation of the consumption of a drug. However, this parameter is usually derived from a small database of human pharmacokinetic studies. This is true for methadone and codeine, the two most commonly used opioids and also common substances of abuse. Therefore, we aimed to refine the current excretion factors used for estimating methadone and codeine by analysing published data from the literature on the excretion of methadone, its main metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), and codeine. Our review included both human drug pharmacokinetic studies and wastewater analysis studies. We found that while the commonly used excretion factor of methadone (~27.5%) was relatively accurate, the excretion factor of EDDP, a better biomarker for methadone consumption in sewer epidemiology, should be twice that of methadone (i.e. 55%) instead of the current equal or half values. For codeine, the excretion factor should be ~30% instead of 63.5% or 10% as previously used in wastewater analysis studies. Data from wastewater analysis studies could be used in this way to refine the excretion factors of the drugs of interest.
Spatial variations in the consumption of illicit stimulant drugs across Australia: A nationwide application of wastewater-based epidemiology
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.SCITOTENV.2016.05.207
Abstract: Obtaining representative information on illicit drug use and patterns across a country remains difficult using surveys because of low response rates and response biases. A range of studies have used wastewater-based epidemiology (WBE) as a complementary approach to monitor community-wide illicit drug use. In Australia, no large-scale WBE studies have been conducted to date to reveal illicit drug use profiles in a national context. In this study, we performed the first Australia-wide WBE monitoring to examine spatial patterns in the use of three illicit stimulants (cocaine, as its human metabolite benzoylecgonine meth hetamine and 3,4-methylendioxymeth hetamine (MDMA)). A total of 112 daily composite wastewater s les were collected from 14 wastewater treatment plants across four states and two territories. These covered approximately 40% of the Australian population. We identified and quantified illicit drug residues using liquid chromatography coupled with tandem mass spectrometry. There were distinctive spatial patterns of illicit stimulant use in Australia. Multivariate analyses showed that consumption of cocaine and MDMA was higher in the large cities than in rural areas. Also, cocaine consumption differed significantly between different jurisdictions. Meth hetamine consumption was more similar between urban and rural locations. Only a few cities had elevated levels of use. Extrapolation of the WBE estimates suggested that the annual consumption was 3tonnes for cocaine and 9tonnes combined for meth hetamine and MDMA, which outweighed the annual seizure amount by 25 times and 45 times, respectively. These ratios imply the difficulty of detecting the trafficking of these stimulants in Australia, possibly more so for meth hetamine than cocaine. The obtained spatial pattern of use was compared with that in the most recent national household survey. Together both WBE and survey methods provide a more comprehensive evaluation of drug use that can assist governments in developing policies to reduce drug use and harm in the communities.
Combining transdermal and breath alcohol assessments, real‐time drink logs and retrospective self‐reports to measure alcohol consumption and intoxication across a multi‐day music festival
Publisher: Wiley
Date: 10-11-2021
DOI: 10.1111/DAR.13215
Abstract: Comprehensively investigating alcohol‐related behaviours in the context of a dynamic multi‐day alcohol‐licensed event is important for understanding and minimising patron risk. We aimed to assess the measurement utility of implementing a multi‐dimensional alcohol assessment battery using biometric data collection, real‐time drink logs and retrospective self‐report measures over the course of a 4‐day music festival. Fourteen adults participated ( n = 7 male, mean age 21.9 years). Breath and transdermal alcohol concentration (BrAC and TAC, respectively) were measured using breathalysers and transdermal alcohol bracelets. A real‐time drink log was completed via smartphones on initiating each drink, and a retrospective questionnaire was administered up to twice daily throughout the event (6 timepoints total). While almost all participants (92.9%) logged significantly fewer drinks in real‐time than they retrospectively reported via the twice‐daily questionnaires, logs provided important contextual information including the types of drinks consumed and drinking intensity. Compared to BrAC, TAC provided a better understanding of the time course of intoxication, indicating highest alcohol consumption outside of static BrAC assessment windows. However, BrAC provided a better assessment of present state: all participants were 0.00% BrAC at departure despite over two‐fifths (42.9%) of the s le's last TAC reading exceeding 0.00%. As standalone assessments, each method possessed limitations. As a combined battery, they were successfully administered simultaneously, resulting in a more comprehensive overview of alcohol consumption/intoxication over the prolonged drinking session. However, the marked burden of simultaneous administration should be considered, and measures should be chosen judiciously based on research needs.
Effectiveness and framing of pharmaceutical opioid abuse-deterrent formulations
Publisher: Wiley
Date: 14-02-2019
DOI: 10.1111/ADD.14556
Inhibiting automatic negative social responses in alcohol intoxication: interactions with theory of mind ability and level of task guidance
Publisher: Springer Science and Business Media LLC
Date: 02-2018
DOI: 10.1007/S00213-018-4838-3
Abstract: Alcohol intoxication is associated with socially disinhibited behaviours that may reflect impaired social cognitive abilities that guide social behaviour. The effects of alcohol on social cognition and how this may contribute to disinhibited behaviour are poorly understood. The aim of this study was to examine whether intoxicated in iduals could inhibit automatic negative responses to negative social information, whether these difficulties were reliant on theory of mind (ToM) ability and whether intoxicated in iduals were able to adjust verbal responses when provided with guidelines about how to respond. Sixty-four participants aged between 18 and 34 (balanced for gender) consumed a beverage containing either placebo or alcohol calculated to achieve a target BrAC of 0.080%, before completing a Flanker task, a go/no-go task and a novel measure of social disinhibition, the social disinhibition task. Results indicate that alcohol-intoxicated in iduals can inhibit negative responses to negative social information, but display difficulty inhibiting negative responses to social information that requires ToM. They also suggest that people under the influence of moderate-to-high-dose alcohol can adjust their responses when provided with specific guidelines on how to respond. These findings may have important implications for understanding negative alcohol-related behaviours and promote the consideration of social context, social pressure and social cognitive abilities in the development of public policy and targeted interventions to prevent alcohol-related antisocial behaviours.
Factors associated with the development of depression in chronic non-cancer pain patients following the onset of opioid treatment for pain
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JAD.2015.05.049
Abstract: Pharmaceutical opioid prescription rates are increasing globally, however knowledge of their long-term effects on mental health, in particular depression remains limited. This study aimed to identify factors associated with the onset of depression post-opioid use that differ to factors associated with depression post-pain. Participants (N = 1418) were a national s le prescribed opioids for chronic non-cancer pain. Age at onset of depression, pain and commencement of opioid medications were collected via structured interview. Six in 10 (61%) reported lifetime depression of those, almost half developed depression after pain and after they started opioid medications (48%). Variables associated with post-opioid depression included lower pain self-efficacy and poorer social support, younger onset of opioid use, and difficulties and concerns with opioid medications. The findings highlight the importance of monitoring for the emergence of mood dysfunction, particularly for those starting opioids for pain at a younger age, and consideration of psychological treatments that address self-efficacy that appears to be associated with post-opioid depression.
Guilt-proneness is associated with the use of protective behavioral strategies during episodes of alcohol use
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.ADDBEH.2017.12.027
Abstract: Shame and guilt are closely related emotions with erging implications for the development, and potential treatment, of substance use disorders. Accumulating research indicates that a guilt-prone affect style buffers in iduals against the development of problematic alcohol use, while shame-proneness appears to offer no protective function. However, little is known about the manner in which guilt-prone in iduals avoid the experience of alcohol use-related harms. The present study aimed to extend the shame, guilt, and substance use literature by examining whether these two self-conscious affect styles are differentially related to the use of protective behavioral strategies which reduce the risk of harms during drinking episodes. Participants (N=281 female n=207) completed pen-and-paper measures of shame and guilt-proneness, level of alcohol use, and the habitual use of protective behavioral strategies during drinking episodes. Part-correlation analysis isolated shame-free guilt and guilt-free shame residuals in exploring relationships between self-conscious affect style and the use of protective behavioral strategies during drinking episodes. Guilt-proneness was consistently associated with the routine use of protective behavioral strategies during episodes of alcohol intake. In contrast, shame-proneness was unrelated to the use of such protective and harm avoidance strategies when drinking. Findings provide additional support for the argument that guilt and shame need to be considered separately in both research and substance use treatment settings.
Typology of Alcohol Mixed with Energy Drink Consumers: Motivations for Use
Publisher: Wiley
Date: 18-05-2015
DOI: 10.1111/ACER.12729
Abstract: Previous research on alcohol mixed with energy drinks (AmED) has shown that use is typically driven by hedonistic, social, functional, and intoxication-related motives, with differential associations with alcohol-related harm across these constructs. There has been no research looking at whether there are subgroups of consumers based on patterns of motivations. Consequently, the aims were to determine the typology of motivations for AmED use among a community s le and to identify correlates of subgroup membership. In addition, we aimed to determine whether this structure of motivations applied to a university student s le. Data were used from an Australian community s le (n = 731) and an Australian university student s le (n = 594) who were identified as AmED consumers when completing an online survey about their alcohol and ED use. Participants reported their level of agreement with 14 motivations for AmED use latent classes of AmED consumers were identified based on patterns of motivation endorsement using latent class analysis. A 4-class model was selected using data from the community s le: (i) taste consumers (31%): endorsed pleasurable taste (ii) energy-seeking consumers (24%): endorsed functional and taste motives (iii) hedonistic consumers (33%): endorse pleasure and sensation-seeking motives, as well as functional and taste motives and (iv) intoxication-related consumers (12%): endorsed motives related to feeling in control of intoxication, as well as hedonistic, functional, and taste motives. The consumer subgroups typically did not differ on demographics, other drug use, alcohol and ED use, and AmED risk taking. The patterns of motivations for the 4-class model were similar for the university student s le. This study indicated the existence of 4 subgroups of AmED consumers based on their patterns of motivations for AmED use consistently structured across the community and university student s le. These findings lend support to the growing conceptualization of AmED consumers as a heterogeneous group in regard to motivations for use, with a hierarchical and cumulative class order in regard to the number of types of motivation for AmED use. Prospective research may endeavor to link session-specific motives and outcomes, as it is apparent that primary consumption motives may be fluid between sessions.
The prevalence and correlates of chronic pain and suicidality in a nationally representative sample
Publisher: SAGE Publications
Date: 19-02-2015
Abstract: Research suggests that people suffering from chronic pain have elevated rates of suicidality. With an ageing population, more research is essential to gain a better understanding of this association. To document the prevalence and correlates of chronic pain and suicide, and estimate the contribution of chronic pain to suicidality. Data from the 2007 Australian National Survey of Mental Health and Wellbeing, a nationally representative household survey on 8841 people, aged 16–85 years, was analysed. The odds of lifetime and past 12-month suicidality were two to three times greater in people with chronic pain. Sixty-five percent of people who attempted suicide in the past 12 months had a history of chronic pain. Chronic pain was independently associated with lifetime suicidality after controlling for demographic, mental health and substance use disorders. Health care professionals need to be aware of the risk of suicidality in patients with chronic pain, even in the absence of mental health problems.
Concerns and help-seeking among patients using opioids for management of chronic noncancer pain
Publisher: Oxford University Press (OUP)
Date: 11-05-2019
DOI: 10.1093/PM/PNY078
Abstract: The safety and efficacy of long-term opioid treatment for chronic noncancer pain (CNCP) remains controversial. This study examined whether patients who report problematic opioid use sought help and/or perceived barriers to help-seeking. Data were collected from 1,086 people prescribed opioids for CNCP via a large prospective cohort called the Pain and Opioids IN Treatment (POINT) study. Patients' characteristics and help-seeking were examined according to scores on the Prescribed Opioids Difficulties Scale (PODS). Participants scoring "intermediate" (17%) or "high" (30%) on the PODS were younger and reported more complex pain presentations, higher opioid doses, poorer physical health, moderate to severe anxiety and depression, aberrant behavior, past month opioid use disorder and help-seeking (compared with the "low" PODS group, 53%). One-quarter (26%) had sought help, most commonly from a primary care physician, specialist pain clinic, family member artner, counselor sychologist, and the Internet. Participants in the "high" PODS group were more likely to have sought help from an alcohol or other drug service, addiction specialist, or drug information helpline. Common barriers to help-seeking were desire for self-management and concern that their opioid treatment may be discontinued. Although 35% met criteria for likely opioid use disorder, only 4.8% reported lifetime treatment with methadone or buprenorphine participants' ratings indicated significant perceived stigma associated with these medications. The PODS is effective in identifying patients who are concerned about their opioid use. Strategies to address stigma related to drug treatment, including better integration of primary health, specialist pain, and addiction services, are important in reducing opioid-related harm.
The effects of ‘ecstasy’ (MDMA) on visuospatial memory performance: findings from a systematic review with meta-analyses
Publisher: Wiley
Date: 03-2012
DOI: 10.1002/HUP.1270
Abstract: To review, with meta-analyses where appropriate, performance differences between ecstasy (3,4-methylenedioxymeth hetamine) users and non-users on a wider range of visuospatial tasks than previously reviewed. Such tasks have been shown to draw upon working memory executive resources. Abstract databases were searched using the United Kingdom National Health Service Evidence Health Information Resource. Inclusion criteria were publication in English language peer-reviewed journals and the reporting of new findings regarding human ecstasy-users' performance on visuospatial tasks. Data extracted included specific task requirements to provide a basis for meta-analyses for categories of tasks with similar requirements. Fifty-two studies were identified for review, although not all were suitable for meta-analysis. Significant weighted mean effect sizes indicating poorer performance by ecstasy users compared with matched controls were found for tasks requiring recall of spatial stimulus elements, recognition of figures and production/reproduction of figures. There was no evidence of a linear relationship between estimated ecstasy consumption and effect sizes. Given the networked nature of processing for spatial and non-spatial visual information, future scanning and imaging studies should focus on brain activation differences between ecstasy users and non-users in the context of specific tasks to facilitate identification of loci of potentially compromised activity in users.
Parents who supply sips of alcohol in early adolescence: A prospective study of risk factors
Publisher: American Academy of Pediatrics (AAP)
Date: 26-02-2016
Abstract: Parents are a major supplier of alcohol to adolescents, often initiating use with sips. Despite harms of adolescent alcohol use, research has not addressed the antecedents of such parental supply. This study investigated the prospective associations between familial, parental, peer, and adolescent characteristics on parental supply of sips. Participants were 1729 parent-child dyads recruited from Grade 7 classes, as part of the Australian Parental Supply of Alcohol Longitudinal Study. Data are from baseline surveys (Time 1) and 1-year follow-up (Time 2). Unadjusted and adjusted logistic regressions tested prospective associations between Time 1 familial, parental, peer, and adolescent characteristics and Time 2 parental supply. In the fully adjusted model, parental supply was associated with increased parent-report of peer substance use (odds ratio [OR] = 1.20, 95% confidence ratio [CI], 1.08-1.34), increased home alcohol access (OR = 1.07, 95% CI, 1.03-1.11), and lenient alcohol-specific rules (OR=0.88, 95% CI, 0.78-0.99). Parents who perceived that their child engaged with substance-using peers were more likely to subsequently supply sips of alcohol. Parents may believe supply of a small quantity of alcohol will protect their child from unsupervised alcohol use with peers. It is also possible that parental perception of peer substance use may result in parents believing that this is a normative behavior for their child's age group, and in turn that supply is also normative. Further research is required to understand the impacts of such supply, even in small quantities, on adolescent alcohol use trajectories.
Trends in reports of driving following illicit drug consumption among regular drug users in Australia, 2007–2013: Has random roadside drug testing had a deterrent effect?
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.AAP.2017.05.008
Abstract: Driving following illicit drug consumption ('drug-driving') is a potential road safety risk. Roadside drug testing (RDT) is conducted across Australia with the dual aims of prosecuting drivers with drugs in their system and deterring drug-driving. We examined trends over time in self-reported past six-month drug-driving among sentinel s les of regular drug users and assessed the impact of experiences of RDT on drug-driving among these participants. Data from 1913 people who inject drugs (PWID) and 3140 regular psychostimulant users (RPU) who were first-time participants in a series of repeat cross-sectional sentinel studies conducted in Australian capital cities from 2007 to 2013 and reported driving in the past six months were analysed. Trends over time were assessed using the χ The percentage of participants reporting recent (past six months) drug-driving decreased significantly over time among both s les (PWID: 83% [2007] vs. 74% [2013], p<0.001 RPU: 72% vs. 56%, p<0.001), but drug-driving remained prevalent. Lifetime experience of RDT increased significantly over time (PWID: 6% [2007] vs. 32% [2013], p<0.001 RPU: 2% vs. 11%, p<0.001). There were no significant associations between experiencing RDT and drug-driving among either PWID or RPU. Although there is some evidence that drug-driving among key risk groups of regular drug users is declining in Australia, possibly reflecting a general deterrent effect of RDT, experiencing RDT appears to have no specific deterrent effect on drug-driving. Further intervention, with a particular focus on changing attitudes towards drug-driving, may be needed to further reduce this practice among these groups.
Day-by-day variation in affect, arousal and alcohol consumption in young adults
Publisher: Wiley
Date: 15-01-2015
DOI: 10.1111/DAR.12238
Abstract: Alcohol consumption has a well-established relationship with mood, with higher positive and negative affect predicting alcohol use. More recently, researchers have explored whether alcohol consumption occurs as a response to affect variability as an attempt to self-medicate and stabilise affect. Studies have revealed a positive association between alcohol use and intra- and inter-in idual affect variability in clinical and university student s les however not much is known of this relationship among the general community. Ecological Momentary Assessment (EMA) methods were used to investigate the relationship between affect and arousal variability and alcohol use in 53 community volunteers. Participants self-reported affect and arousal at three to five randomly timed moments throughout the day, as well as every time they drank. On a day-to-day basis, higher positive affect was associated with increased alcohol consumption. When analyses were restricted to self-reported affect prior to alcohol consumption, only increased arousal and decreased variability in arousal predicted the likelihood of alcohol consumption. Mean level of arousal was associated with the extent of alcohol consumed. In this moderate drinking s le day-to-day affect and arousal, and arousal variability, were associated with alcohol consumption. Analyses restricted to pre-drinking observations provide further evidence that self-medication accounts of alcohol consumption may explain drinking initiation but that the relationship between affect factors and drinking behaviour may change around the point of first drink.
Trends and characteristics of extra-medical use of quetiapine among people who regularly inject drugs in Australia, 2011–2018
Publisher: Elsevier BV
Date: 04-2021
MDMA: Neurohormonal, Neurocognitive, and Psychobiological Aspects of Recreational Ecstasy
Publisher: Bentham Science Publishers Ltd.
Date: 28-09-2009
Correlates of treatment engagement and client outcomes: results of a randomised controlled trial of nabiximols for the treatment of cannabis use disorder
Publisher: Springer Science and Business Media LLC
Date: 08-10-2022
DOI: 10.1186/S13011-022-00493-Z
Abstract: There is increasing interest and evidence for the use of cannabinoid medications in the treatment of cannabis use disorder, but little examination of the correlates of successful treatment. This paper is a secondary analysis of a randomised placebo-controlled trial of nabiximols for the treatment of cannabis use disorder (CUD), aiming to identify which client and treatment characteristics impact treatment engagement and outcomes. Bayesian multiple regression models were used to examine the impact of age, gender, duration of regular cannabis use, daily quantity of cannabis, cannabis use problems, self-efficacy for quitting, sleep, mental health, pain measures, and treatment group upon treatment engagement (retention, medication dose, and counselling participation) and treatment outcomes (achieving end-of-study abstinence, and a 50% or greater reduction in cannabis use days) among the 128 clients participating in the 12-week trial. Among the treatment factors, greater counselling attendance was associated with greater odds of abstinence and ≥ 50% reduction in cannabis use nabiximols with greater odds of ≥ 50% reduction and attending counselling, and reduced hazard of treatment dropout and higher dose with lower odds of ≥ 50% reduction. Among the client factors, longer duration of regular use was associated with higher odds of abstinence and 50% reduction, and lower hazard of treatment dropout greater quantity of cannabis use with reduced hazard of dropout, greater odds of attending counselling, and higher average dose greater pain at baseline with greater odds of ≥ 50% reduction and higher average dose and more severe sleep issues with lower odds of ≥ 50% reduction. Males had lower odds of attending counselling. These findings suggest that counselling combined with agonist pharmacotherapy may provide the optimal treatment for cannabis use disorder. Younger clients, male clients, and clients with sleep issues could benefit from extra support from treatment services to improve engagement and outcomes. Australian New Zealand Clinical Trials Registry (ACTRN12616000103460) www.anzctr.org.au
Trends in methamphetamine and opioid use among clients of needle‐syringe programs in Queensland, Australia: 2007–2015
Publisher: Wiley
Date: 02-2019
DOI: 10.1111/DAR.12908
Impact of Removing Nonprescription Codeine in Australia: Protocol for a Prospective Cohort Study
Publisher: JMIR Publications Inc.
Date: 13-03-2020
DOI: 10.2196/15540
Abstract: On February 1, 2018, Australia rescheduled codeine to a prescription-only medication. Many concerns were associated with this change, including increased financial costs, reduced service accessibility, the potential for poorer pain management, and a decline in physical and mental health if codeine could not be accessed. In the research literature, there is limited knowledge about the long-term consequences of rescheduling pharmaceutical opioids and, as Australia has followed many countries in implementing a restriction on codeine, further study of these consequences is critical. The goal of this study was to examine the impact of rescheduling codeine from an over-the-counter (OTC) product to a prescription-only medicine on the primary measures of codeine use and dependence in a prospective cohort of people who are frequent consumers of OTC codeine. Secondary measures included pain and self-efficacy, health service use, and mental health. The Codeine Cohort study aimed to recruit 300 participants in Australia who regularly (at least a few times per week for the past 6 months) used OTC codeine. Using an online survey, participants were followed up at three time points (February 2018, June 2018, and February 2019) after codeine was rescheduled. All four waves of data collection are complete, with the final round of data collection finalized in August 2019. Data analyses are yet to be completed. Information on demographics, codeine use and dependence, physical and mental health, medication use, and health service use will be analyzed using mixed models. Results of this study will provide insight into the effectiveness of regulatory restriction in curtailing nonmedical use of and harms associated with codeine. Additionally, results will explore positive and negative outcomes of codeine rescheduling for in idual patients, which informs health professionals who support patients who use codeine and further community education. DERR1-10.2196/15540
Preliminary Development of a Brief Cannabis Use Disorder Screening Tool: The Cannabis Use Disorder Identification Test Short-Form
Publisher: Mary Ann Liebert Inc
Date: 12-2016
Association of parental supply of alcohol with adolescent drinking, alcohol-related harms, and alcohol use disorder symptoms: a prospective cohort study
Publisher: Elsevier BV
Date: 02-2018
Commentary on Fidler etal. (2011): Identifying quitters who are at increased risk of relapse - where to from here?
Publisher: Wiley
Date: 07-02-2011
Patterns of use and motivations for consuming alcohol mixed with energy drinks
Publisher: American Psychological Association (APA)
Date: 2013
DOI: 10.1037/A0029985
Abstract: Use of alcohol mixed with energy drinks (AmED) is an increasingly prevalent trend. However, recent research has suggested that AmED use may result in increased alcohol consumption and engagement in risk behavior postingestion. Although the majority of research has been focused on AmED use outcomes, there is a current paucity of data on the patterns of AmED use and motives for consumption. Four hundred and three participants from an Australian community s le (n = 244 women) ages 18-35 who had consumed alcohol mixed simultaneously with energy drinks (ED) in the preceding 6 months completed an online survey regarding use of EDs, alcohol, and AmED. Although AmED sessions occurred relatively infrequently compared to alcohol sessions, the alcohol and ED quantity consumed in AmED sessions was significantly greater than recommended intake. Reports of AmED use context indicated that participants typically consumed AmED while engaging in heavy drinking in public venues. However, the primary motives for AmED use related to the situational context of use, functional and hedonistic outcomes, as well as the pleasurable taste few participants reported using AmED to increase alcohol intake, to mask intoxication, to hide alcohol's flavor, or to simulate an illicit drug "high." AmED users may be coingesting in a context and at a quantity that enhances the possibility of risky alcohol outcomes, despite predominantly consuming AmED for the taste and the functional and hedonistic outcomes. Strong endorsement of motives relating to ease of access and low cost price suggests that alcohol policy reform in relation to licensing restrictions may be necessary to minimize the risk of harm.
High Motivation for Alcohol: What are the Practical Effects of Energy Drinks on Alcohol Priming?
Publisher: Wiley
Date: 05-11-2013
DOI: 10.1111/ACER.12021
Abstract: While several researchers have proposed a causal relationship between alcohol mixed with energy drink (AmED) consumption and subsequent alcohol intake, there is a dearth of research exploring the potential mechanisms underpinning this association. Marczinski and colleagues (in press) report the results of a double-blind, placebo-controlled, between-groups study assessing whether an initial AmED dose primes an increased motivation to drink relative to alcohol alone. Participants (n = 80) received either alcohol (0.91 ml/kg vodka), energy drink (ED 1.82 ml/kg Red Bull(®) ), AmED, or a placebo beverage and then self-reported their motivation to drink via the Desire-for-Drug scale. Subjective ratings of "desire more alcohol" were significantly higher than predrink in the placebo, alcohol, and AmED conditions, with this effect apparent at more time points in the AmED condition. While it was concluded that EDs may increase alcohol priming, between-condition analyses revealed that ratings did not differ significantly in AmED and alcohol conditions, with moderate magnitude treatment effects at most, and ratings of desire generally closer to 0 (absence of desire) than 100 (very much desire). While the study by Marczinski and colleagues fills an important gap in the literature, direct measurement of AmED priming's effect on subsequent alcohol consumption using a within-subjects design and appropriate statistical comparison is required to (i) establish the practical implications of these results for AmED consumers and (ii) discount any in idual differences in such priming effects.
Moody booze: Introducing the special section on affect regulation and substance use
Publisher: Wiley
Date: 23-10-2015
DOI: 10.1111/DAR.12349
Parental supply of sips and whole drinks of alcohol to adolescents and associations with binge drinking and alcohol-related harms: A prospective cohort study
Publisher: Elsevier BV
Date: 10-2020
Alprazolam prescribing in Tasmania: a two-fold intervention designed to reduce inappropriate prescribing and concomitant opiate prescription
Publisher: SAGE Publications
Date: 2009
DOI: 10.1080/10398560902998626
Abstract: Objective: The population rate of alprazolam prescribing in Tasmania has been more than double that of national rates. Serious adverse events have been observed through co-administration of opioid medications with alprazolam. A two-fold intervention, comprising GP education coupled with changes to prescribing regulations, was designed with the intention to decrease inappropriate prescribing of alprazolam and thereby reduce adverse outcomes. The aim of this study was to assess the impact of the intervention on prescribing rates. Method: We measured the number of alprazolam prescriptions for the years prior to and the year following the intervention. Health Insurance Commission data were utilized to enable comparison of subsidized prescription rates for alprazolam in Tasmania, and compared with national data. Participants were registered medical practitioners in Tasmania who were potential prescribers of alprazolam. The interventions were three GP Education Meetings during June 2007, one in each of the major regions of Tasmania, regarding evidence-based interventions for panic disorder. Changes to regulatory procedures to minimize co-prescription of alprazolam with opioids was implemented in September 2007. Results: A reduction in alprazolam prescribing in Tasmania occurred after the interventions. Conclusion: Education can be an effective strategy to influence prescribing behaviour of doctors. It is likely that this effect can be augmented by adoption of more stringent regulatory requirements.
Systematic and day-to-day effects of chemical-derived population estimates on wastewater-based drug epidemiology
Publisher: American Chemical Society (ACS)
Date: 26-12-2015
DOI: 10.1021/ES503474D
Abstract: Population size is crucial when estimating population-normalized drug consumption (PNDC) from wastewater-based drug epidemiology (WBDE). Three conceptually different population estimates can be used: de jure (common census, residence), de facto (all persons within a sewer catchment), and chemical loads (contributors to the s led wastewater). De facto and chemical loads will be the same where all households contribute to a central sewer system without wastewater loss. This study explored the feasibility of determining a de facto population and its effect on estimating PNDC in an urban community over an extended period. Drugs and other chemicals were analyzed in 311 daily composite wastewater s les. The daily estimated de facto population (using chemical loads) was on average 32% higher than the de jure population. Consequently, using the latter would systemically overestimate PNDC by 22%. However, the relative day-to-day pattern of drug consumption was similar regardless of the type of normalization as daily illicit drug loads appeared to vary substantially more than the population. Using chemical loads population, we objectively quantified the total methodological uncertainty of PNDC and reduced it by a factor of 2. Our study illustrated the potential benefits of using chemical loads population for obtaining more robust PNDC data in WBDE.
Geographic variation in health service use and perceived access barriers for Australian adults with chronic non-cancer pain receiving opioid therapy
Publisher: Oxford University Press (OUP)
Date: 10-06-2016
DOI: 10.1093/PM/PNW109
Abstract: Rates of chronic non-cancer pain are increasing worldwide, with concerns regarding poorer access to specialist treatment services in remote areas. The current study comprised the first in-depth examination of use and barriers to access of health services in Australia according to remoteness. A cohort of Australian adults prescribed pharmaceutical opioids for chronic non-cancer pain (n = 1,235) were interviewed between August 2012 and April 2014, and grouped into 'major city' (49%), 'inner regional' (37%), and 'outer regional/remote' (14%) according to the Australian Standard Geographical Classification based on postcode. Multinomial logistic regression analyses were conducted to determine geographical differences in socio-demographic and clinical characteristics, health service use, and perceived barriers to health service access. The 'inner regional group' and 'outer regional/remote group' were more likely to be male (relative risk ratio (RRR)=1.38,95%CI 1.08-1.77 and RRR = 1.60, 95%CI 1.14-2.24) and have no private health insurance (RRR = 1.53, 95%CI 1.19-1.97 and RRR = 1.65, 95%CI 1.16-2.37) than the 'major city group' (49%). However, the 'inner regional group' reported lower pain severity and better mental health relative to the 'major city group' = 0.92, 95%CI 0.86-0.98 and RRR = 1.02, 95%CI 1.01-1.03, respectively). Although rates of health service access were generally similar, the 'outer regional/remote group' were more likely to report client-practitioner communication problems (RRR = 1.57, 95%CI 1.03-2.37), difficulties accessing specialists (RRR = 1.56, 95%CI 1.01-2.39), and perception of practitioner lack of confidence in prescribing pain medication (RRR = 1.73, 1.14-2.62), relative to both groups. Perceived communication, access, and financial barriers to healthcare indicate the need for increased efforts to address geographic inequality in pain treatment.
Co‐ingestion of energy drinks with alcohol and other substances among a sample of people who regularly use ecstasy
Publisher: Wiley
Date: 21-03-190728634
DOI: 10.1111/DAR.12343
Abstract: Despite the potential harms of mixing unregulated drugs with energy drinks (ED), research to date has primarily been focused on EDs co-ingested with alcohol. Consequently, the aim of the present study was to explore the rate of use, harms and correlates of EDs co-ingested with alcohol and other drugs among a s le of people who regularly use illicit stimulant drugs. In 2010, 693 Australians who regularly used ecstasy completed a 1-h interview about their past six-month ED and drug use. Three-quarters of the s le (77%) had recently consumed EDs with other substances, primarily alcohol (70%) and ecstasy (57%). People who consumed ED with alcohol versus those who had consumed ED with ecstasy and with alcohol (only 8% reported only consuming ED with ecstasy) had similar profiles in regards to demographics, drug use, mental health and drug-related problems. Primary motives for consuming ED with alcohol included increased alertness (59%), the taste (25%), to party for longer (23%) and to combat fatigue (16%). One-half (52%) and one-quarter (27%) of participants who consumed EDs with alcohol and with ecstasy respectively had recently experienced adverse outcomes post-consumption, primarily headaches (24% and 11%) and heart palpitations (21% and 14%). Co-ingestion of EDs with licit and illicit drugs is common among people who regularly use ecstasy and related drugs. Adverse outcomes of co-ingestion suggest that targeted education regarding negative interactive drug effects is crucial for harm reduction. [Peacock A, Sindicich N, Dunn M, Whittaker E, Sutherland R, Entwistle G, Burns L, Bruno R. Co-Ingestion of Energy Drinks with Alcohol and Other Substances among a S le of People Who Regularly Use Ecstasy. Drug Alcohol Rev 2016 :352-358].
Effectiveness of and challenges faced by surveillance systems
Publisher: Wiley
Date: 09-2019
DOI: 10.1002/DTA.333
Abstract: Drug information or surveillance systems have been developed in an attempt to measure illicit drug use and predict new trends. In Australia, three systems are specifically designed to monitor drug use trends and related harm. These systems have their own strengths and weaknesses. This perspective offers a discussion of these facets. A series of case studies is used to highlight how surveillance systems can be effective in detecting and monitoring trends of use while highlighting the challenges these systems face. As indicated by the case study of ecstasy, such surveillance systems are effective and can provide unique information when a drug is detected and becomes 'established' in the market but the methodology of these systems is challenged when new drug classes emerge rapidly, as is illustrated by emerging psychotropic substances such as mephedrone.
Early Adolescent Alcohol Use: Are Sipping and Drinking Distinct?
Publisher: Wiley
Date: 06-08-2015
DOI: 10.1111/ACER.12826
Abstract: Sipping alcohol is common during early adolescence, but research has ignored the distinction between sipping and drinking whole alcohol beverages, conflating the 2, or else simply classifying "sippers" as abstainers. Research has not addressed whether sippers are different to drinkers, in relation to variables known to be associated with adolescent alcohol consumption, or considered whether sipping and drinking behaviors may have quite different associations. Parent-child dyads (N = 1,823) were recruited in 3 states from Australian grade 7 classes. Multinomial logistic analyses compared adolescents who had only had a sip/taste of alcohol (sippers) with adolescents who had consumed at least a whole drink (drinkers) in the past 6 months. The multivariate model assessed a broad range of demographics, parenting practices, peer influences, and adolescent externalizing and internalizing behaviors, and controlled for school clustering. Compared to drinkers, sippers were less likely to come from 1-parent households (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.35 to 0.98) less likely to come from low-socioeconomic status (SES) households (OR = 0.54, 95% CI: 0.31 to 0.94) more likely to come from families where parents provide stricter alcohol-specific rules (OR = 1.21, 95% CI: 1.11 to 1.32), stricter monitoring of the child's activities (OR = 1.10, 95% CI: 1.04 to 1.16), more consistent parenting practices (OR = 1.13, 95% CI: 1.05 to 1.23), and more positive family relationships (OR = 1.56, 95% CI: 1.02 to 2.43) and report having fewer substance-using peers (OR = 0.80, 95% CI: 0.70 to 0.91) and greater peer disapproval of any substance use (OR = 1.30, 95% CI: 1.19 to 1.42). After adjustment for confounders, the associations with household composition and SES were no longer significant, but the familial and peer associations remained significant in the multivariate analysis, χ(2) (40) = 1,493.06, p < 0.001. Sipping alcohol has different associations with known predictors of adolescent alcohol use than drinking whole beverages, and sipping may be a distinct or separable behavior. Future research should better define quantities of early consumption and assess the relationship between early sipping and drinking on long-term outcomes separately.
Prevalence and associations of quetiapine fumarate misuse among an Australian national city sample of people who regularly inject drugs
Publisher: Wiley
Date: 25-11-2014
DOI: 10.1111/ADD.12395
Nature versus intensity of intoxication: Co-ingestion of alcohol and energy drinks and the effect on objective and subjective intoxication
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.DRUGALCDEP.2017.08.013
Abstract: We report a series of studies examining the effect of alcohol mixed with energy drinks (AmEDs) versus alcohol on objective intoxication (breath alcohol concentration BrAC), intensity, and nature of intoxication. We also aimed to disentangle the role of energy drink (ED) ingredients in any effects. Three within-subject double-blind placebo-controlled studies measured BrAC, subjective intoxication and impairment ('intensity of intoxication'), stimulation and sedation ('nature of intoxication') following administration of ED, Cola, Caffeine+Sugar, and Placebo with alcohol (Study 1, n=18) ED, Caffeine-only, Sugar-only and Placebo with alcohol (Study 2, n=20) and ED and Placebo with alcohol (Study 3, n=27). Significant moderate-to-large magnitude BrAC decrements and delayed time to peak BrAC were observed after ED administration versus Placebo. However, no meaningful BrAC differences between ED and other active conditions were observed in Study 1 and 2. After BrAC adjustment, moderate-to-large magnitude reductions in intoxication and impairment ratings were observed after ED versus Placebo on the ascending limb in all studies and at peak in Study 2 and 3. No meaningful differences were observed in intoxication and impairment ratings between ED and Caffeine+Sugar and Cola conditions (Study 1) ratings were lower after ED versus Sugar-only (Study 2). Stimulation and sedation ratings did not differ between ED and Placebo. Reductions in objective intoxication and perceived intensity of intoxication, but not nature of intoxication, were observed after AmED consumption. However, effects may be common to alcohol mixers containing sugars (objective intoxication) and caffeine (intensity of intoxication) and specific to a laboratory setting.
A nationwide study of the extent and factors associated with fentanyl use in Australia
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.SAPHARM.2017.04.002
Abstract: To examine fentanyl utilisation in the Australian community and determine the geographic and socio-demographic factors associated with higher rates of fentanyl utilisation. National sales data (supplied by IMS Health) were used to estimate fentanyl utilisation (in pack sales and milligrams) in Australia during 2013, mapped to Australian Bureau of Statistics (ABS) Statistical Local Areas (SLAs) and Remoteness Areas. Socio-demographic characteristics and total population estimates of SLAs were obtained from the ABS. SLA-level data on sex, age distribution, income, occupations involving physical labour and number of pharmacies, were included in linear regression analyses to examine their association with fentanyl use. An estimated 12.3 kg (or 859,518 packs) of fentanyl was sold across Australia in 2013, equating to an average of 0.55 mg erson over the year. Transdermal patches accounted for the majority (99% 850,923 packs) of fentanyl sales. South Australia had the highest rate of utilisation per person. Rates of fentanyl utilisation were higher among more remote areas in three jurisdictions. Overall, higher utilisation rates were observed in SLAs that were less populated (β 0.12 p < 0.001) and those with a higher proportion of older people (β 0.12 p < 0.001), low-income households (β 0.12 p < 0.001) and people working in jobs requiring physical labour (β 0.08 p < 0.05). Transdermal fentanyl patches account for the majority of fentanyl utilisation in the Australian community. There is marked variation in fentanyl utilisation across geographic areas, with higher use apparent in areas with a higher proportion of older people and indicators of greater socio-economic disadvantage.
A National Wastewater Monitoring Program for a better understanding of public health: A case study using the Australian Census
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.ENVINT.2018.12.003
Abstract: Wastewater contains a large range of biological and chemical markers of human activity and exposures. Through systematic collection and analysis of these markers within wastewater s les it is possible to measure the public health of whole populations. The analysis of effluent and biosolids can also be used to understand the release of chemicals from wastewater treatment plants into the environment. Wastewater analysis and comparison with catchment specific data (e.g. demographics) however remains largely unexplored. This manuscript describes a national wastewater monitoring study that combines influent, effluent and biosolids s ling with the Australian Census. An archiving program allows estimation of per capita exposure to and consumption of chemicals, public health information, as well as per capita release of chemicals into the environment. The paper discusses the study concept, critical steps in setting up a coordinated national approach and key logistical and other considerations with a focus on lessons learnt and future applications. The unique combination of archived s les, analytical data and associated census-derived population data will provide a baseline dataset that has wide and potentially increasing applications across many disciplines that include public health, epidemiology, criminology, toxicology and sociology.
Eye movement and visual motion perception in schizophrenia I: Apparent motion evoked smooth pursuit eye movement reveals a hidden dysfunction in smooth pursuit eye movement in schizophrenia
Publisher: Springer Science and Business Media LLC
Date: 19-06-2007
DOI: 10.1007/S00221-007-1000-6
Abstract: To date, smooth pursuit eye movement in schizophrenia has only been investigated using a target stimulus in continuous motion. However, smooth pursuit can also be evoked by an oscillating jumping dot that appears to be in apparent motion and although there is no continuous motion on the retinal surface this apparently moving stimulus can effortlessly elicit smooth-pursuit eye movement. In the first of two experiments smooth pursuit eye movement was evoked by target stimuli in continuous (real) motion at seven target velocities from 5.0 to 35.0 deg/s, and in a second experiment it was measured in response to an oscillating jumping dot in apparent motion at eight target velocities from 5.0 to 25.0 deg/s in a group with mixed-symptoms in schizophrenia and in a control group. The results of Experiment 1 provided no evidence for a dysfunction in continuous motion evoked smooth pursuit eye movement in the group with schizophrenia. However, following the removal of saccadic eye movements in smooth pursuit, the group with schizophrenia showed significantly lower smooth pursuit eye velocity at target velocities from 20.0 to 35.0 deg/s. The results of Experiment 2 revealed that apparent motion evoked smooth pursuit eye velocity in the group with schizophrenia was significantly lower in comparison with normal observers at all target velocities up to 25.0 deg/s with the inclusion or exclusion of saccadic eye movements. The findings demonstrate that overall smooth pursuit eye movement evoked in response to a continuous (real) motion target in the group with schizophrenia may nevertheless contain a hidden temporal resolution and integration dysfunction that is revealed when smooth pursuit eye movement is evoked in response to an oscillating jumping dot in apparent motion. The findings also demonstrate that normal smooth pursuit eye movement in normal observers can be made to resemble the dysfunctional smooth pursuit eye movement that is naturally found in some people with schizophrenia by using a target stimulus in apparent motion.
Self-reported risk-taking behavior during matched-frequency sessions of alcohol versus combined alcohol and energy drinks consumption: Does co-ingestion increase risk-taking?
Publisher: Wiley
Date: 04-2015
DOI: 10.1111/ACER.12700
Abstract: Emerging evidence indicates that consumers of alcohol mixed with energy drink (AmED) self-report lower odds of risk-taking after consuming AmED versus alcohol alone. However, these studies have been criticized for failing to control for relative frequency of AmED versus alcohol-only consumption sessions. These studies also do not account for quantity of consumption and general alcohol-related risk-taking propensity. The aims of the present study were to (i) compare rates of risk-taking in AmED versus alcohol sessions among consumers with matched frequency of use and (ii) identify consumption and person characteristics associated with risk-taking behavior in AmED sessions. Data were extracted from 2 Australian community s les and 1 New Zealand community s le of AmED consumers (n = 1,291). One-fifth (21% n = 273) reported matched frequency of AmED and alcohol use. The majority (55%) of matched-frequency participants consumed AmED and alcohol monthly or less. The matched-frequency s le reported significantly lower odds of engaging in 18 of 25 assessed risk behaviors in AmED versus alcohol sessions. Similar rates of engagement were evident across session type for the remaining behaviors, the majority of which were low prevalence (reported by <15%). Regression modeling indicated that risk-taking in AmED sessions was primarily associated with risk-taking in alcohol sessions, with increased average energy drink (ED) intake associated with certain risk behaviors (e.g., being physically hurt, not using contraception, and driving while over the legal alcohol limit). Bivariate analyses from a matched-frequency s le align with past research showing lower odds of risk-taking behavior after AmED versus alcohol consumption for the same in iduals. Multivariate analyses showed that risk-taking in alcohol sessions had the strongest association with risk-taking in AmED sessions. However, hypotheses of increased risk-taking post-AmED consumption were partly supported: Greater ED intake was associated with increased likelihood of specific behaviors, including drink-driving, sexual behavior, and aggressive behaviors in the matched-frequency s le after controlling for alcohol intake and risk-taking in alcohol sessions. These findings highlight the need to consider both personal characteristics and beverage effects in harm reduction strategies for AmED consumers.
Pharmaceutical drugs: The delicate balance between reducing pain and reducing harm
Publisher: Wiley
Date: 05-2011
Correlates of indicators of potential extra‐medical opioid use in people prescribed opioids for chronic non‐cancer pain
Publisher: Wiley
Date: 16-12-2019
DOI: 10.1111/DAR.13021
Abstract: The opioid-related behaviours in treatment (ORBIT) scale are a measure of recent indicators of potential extra-medical opioid use. Indicators of potential extra-medical opioid use are ergent practices among people prescribed opioids that may place them at risk of harm. This study aimed to examine the correlates of indicators of potential extra-medical opioid use in people prescribed opioids for chronic non-cancer pain (CNCP). The Pain and Opioids IN Treatment (POINT) study is a prospective cohort study of people prescribed opioids for CNCP in Australia. People prescribed opioids solely for opioid dependence were excluded. This cross-sectional study utilised logistic regression to determine the characteristics associated with reporting any indicators of potential extra-medical opioid use. Of the 1505 participants, 38% reported at least one indicator of potential extra-medical opioid use, most commonly asking for an increase in prescribed opioid dose (21%) and early prescription renewal (12%). Indicators of potential extra-medical opioid use were associated with younger age (adjusted odds ratio [AOR] = 0.98 95% confidence interval [CI] = 0.92, 0.99), male sex (AOR = 1.53 95% CI = 1.15, 2.04), lifetime pharmaceutical opioid use disorder (AOR = 1.87 95% CI = 1.31, 2.66) and lifetime illicit drug use disorder (AOR = 1.72 95% CI = 1.18, 2.52). Over one-third of the POINT cohort reported one or more indicators of potential extra-medical opioid use. Lifetime substance use disorders were associated these ergent practices, highlighting the importance of clinical monitoring and patient education for this patient group. Longitudinal studies are needed to investigate whether indicators of potential extra-medical opioid use predict opioid use disorders in this population.
Concordance of ICD-11 and DSM-5 definitions of alcohol and cannabis use disorders: a population survey
Publisher: Elsevier BV
Date: 07-2016
The Australian drug harms ranking study
Publisher: SAGE Publications
Date: 13-05-2019
Abstract: The aim of the current study was to review drug harms as they occur in Australia using the Multi-criteria Decision Analysis (MCDA) methodology adopted in earlier studies in other jurisdictions. A facilitated workshop with 25 experts from across Australia, was held to score 22 drugs on 16 criteria: 9 related to harms that a drug produces in the in idual and 7 to harms to others. Participants were guided by facilitators through the methodology and principles of MCDA. In open discussion, each drug was scored on each criterion. The criteria were then weighted using a process of swing weighting. Scoring was captured in MCDA software tool. MCDA modelling showed the most harmful substances to users were fentanyls (part score 50), heroin (part score 45) and crystal meth hetamine (part score 42). The most harmful substances to others were alcohol (part score 41), crystal meth hetamine (part score 24) and cigarettes/tobacco (part score 14). Overall, alcohol was the most harmful drug when harm to users and harm to others was combined. A supplementary analysis took into consideration the prevalence of each substance in Australia. Alcohol was again ranked the most harmful substance overall, followed by cigarettes, crystal meth hetamine, cannabis, heroin and pharmaceutical opioids. The results of this study make an important contribution to the emerging international picture of drug harms. They highlight the persistent and pervasive harms caused by alcohol. Policy implications and recommendations are discussed. Policies to reduce harm from alcohol and meth hetamine should be a priority.
A cross‐sectional analysis of over‐the‐counter codeine use among an A ustralian sample of people who regularly inject drugs
Publisher: Wiley
Date: 10-06-2013
DOI: 10.1111/DAR.12059
Abstract: The study aims to examine the medical and non-medical use of over-the-counter (OTC) codeine combination drugs in a s le of people who inject drugs and to examine risk factors associated with exceeding the recommended dose of OTC codeine, including the experience of pain. This study analysed annual survey data from a convenience s le of people who inject drugs in Australia who are interviewed for the Illicit Drug Reporting System. People who have injected drugs (n = 902) on at least a monthly basis in the preceding six months across Australia were interviewed. Participants were asked about their use of OTC codeine and their experience of pain. One third (35%) of participants had used OTC codeine in the preceding six months and 52% (95% confidence interval 48.7-55.3) of this group had exceeded the recommended dose on their last occasion of use. This clearly places them at increased risk of harms associated with toxicity from the accompanying analgesic found in combination codeine products. Multivariate analyses demonstrated that those exceeding the recommended codeine dose of OTC codeine were more likely to be experiencing moderate to very severe pain. There is a need to evaluate the approach to pain management in this population. Greater pharmacist involvement, real-time monitoring of sales, the development of screening tools to identify those at risk of harm and further education of primary care practitioners could be beneficial in reducing the risk of harm associated with these medications for all users of OTC codeine, including people who inject drugs.
The extent and correlates of community-based pharmaceutical opioid utilisation in Australia
Publisher: Wiley
Date: 19-01-2016
DOI: 10.1002/PDS.3931
Abstract: There has been concern regarding the increasing use of opioids and related harm. We present data on opioid utilisation across Australia and consider sociodemographic factors that may affect utilisation rates. IMS Health national sales data for over-the-counter (codeine) and prescription opioids (buprenorphine, codeine, dextropropoxyphene, fentanyl, hydromorphone, methadone, morphine, oxycodone, tapentadol and tramadol) were used to estimate total utilisation rates in the community during 2013, mapped to Statistical Local Areas (SLAs) and Remoteness Areas. All opioid amounts were measured in pack sales and milligrammes then converted to oral morphine equivalent milligrammes (OME mg) for comparison across opioids. Data on the demographic characteristics of SLAs were obtained from the ABS (sex and age distribution, income and levels of physical labour) and other sources (number of pharmacies in SLAs) and were included in linear regression analyses. In 2013, an estimated 10 747 kg (OME) of opioids were sold across Australia, equating to 481 OME mg per person. There was considerable geographic variation in opioid utilisation, with higher rates of use in rural and regional areas. Geographic areas that were less populated, had more men and older people, proportionally more low-income earning households and greater proportions in jobs requiring physical labour had higher utilisation rates. Substantial geographic variation in opioid utilisation was identified, with areas outside of major cities having higher rates of utilisation of all types of opioids. Prescription monitoring and best practice interventions aimed at improving opioid use need to have a particular focus on areas outside of major cities. Copyright © 2016 John Wiley & Sons, Ltd.
Pharmaceutical Opioid Use Patterns and Indicators of Extramedical Use and Harm in Adults With Chronic Noncancer Pain, 2012-2018
Publisher: American Medical Association (AMA)
Date: 09-04-2021
Awareness of energy drink intake guidelines and associated consumption practices: A cross-sectional study
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Modulation of the endocannabinoid system by sex hormones: Implications for posttraumatic stress disorder
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.NEUBIOREV.2018.07.006
Abstract: The endocannabinoid system is an increasingly recognised pharmacological target for treating stress and anxiety disorders, including post-traumatic stress disorder (PTSD). Recent preclinical developments have implicated the endocannabinoid system in stress responses, emotional memories and fear extinction, all critical to PTSD aetiology. However, preclinical research in endocannabinoid biology has neglected the influential role of sex hormone differences on PTSD symptomology, which is particularly important given that PTSD is twice as common in women as in men. In this review, we compile and consider the evidence that the endocannabinoid system is influenced by ovarian hormones, with application to stress disorders such as PTSD. It is clear that therapeutic modulation of the endocannabinoid system needs to be approached with awareness of ovarian hormonal influences, and knowledge of these influences may enhance treatment outcomes for female PTSD populations.
Trends in cocaine use, markets and harms in Australia, 2003–2019
Publisher: Wiley
Date: 24-02-2021
DOI: 10.1111/DAR.13252
Abstract: This paper aims to describe cocaine use, markets and harms in Australia from 2003 to 2019. Outcome indicators comprised prevalence of use from triennial household surveys patterns of use from annual surveys of sentinel s les who use stimulants and cocaine‐related seizures, arrests, hospitalisations, deaths and treatment episodes. Bayesian autoregressive time‐series analyses were conducted to estimate trend over time: Model 1, no change Model 2, constant rate of change and Model 3, change over time differing in rate after one change point. Past‐year population prevalence of use increased over time. The percentage reporting recent use in sentinel s les increased by 6.1% (95% credible interval [CrI 95% ] 1.2%,16.9% Model 3) per year from around 2017 (48%) until the end of the series (2019: 67%). There was a constant annual increase in number of seizures (count ratio: 1.1, CrI 95% 1.1,1.2) and arrests (1.2, CrI 95% 1.1,1.2), and percentage reporting cocaine as easy to obtain in the sentinel s les (percent increase 1.2%, CrI 95% 0.5%,1.8% Model 2). Cocaine‐related hospitalisation rate increased from 5.1 to 15.6 per 100 000 people from around 2011–2012 to 2017–2018: an annual increase of 1.3 per 100 000 people (CrI 95% 0.8,1.8 Model 3). While the death rate was low (0.23 cocaine‐related deaths per 100 000 people in 2018 Model 2), treatment episodes increased from 3.2 to 5.9 per 100 000 people from around 2016–2017 to 2017–2018: an annual increase of 2.9 per 100 000 people (CrI 95% 1.6,3.7 Model 3). Cocaine use, availability and harm have increased, concentrated in recent years, and accompanied by increased treatment engagement.
The Pain and Opioids IN Treatment study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-0212
Pain, alcohol use disorders and risky patterns of drinking among people with chronic non-cancer pain receiving long-term opioid therapy
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.DRUGALCDEP.2016.02.048
Abstract: The utilisation of pharmaceutical opioids has increased internationally, and there is evidence of increasing risky alcohol consumption with ageing. This study examines the patterns and correlates of risky drinking among people with chronic non-cancer pain (CNCP) prescribed opioids, and the associations between alcohol consumption and pain. The Pain and Opioids IN Treatment cohort comprises 1514 people in Australia prescribed pharmaceutical opioids for CNCP. Participants reported lifetime, past year and past month alcohol use, as well as mental and physical health, other substance use, pain characteristics, and current opioid dose. Less than one-tenth of the s le were 'lifetime abstainers' (7%) 34% were 'former drinkers' 34% were 'non-risky drinkers' (i.e., past 12 month use ≤4 standard drinks) 16% were 'occasional risky drinkers' and 8% were 'regular risky drinkers' (i.e., ≥weekly use of >4 standard drinks). Males reported greater levels of alcohol use, and a third (33%) of the total s le reported a lifetime alcohol use disorder. Controlling for demographics, mental health, physical health and substance use disorder history, 'former drinkers' (cf. 'non-risky drinkers') reported higher pain severity and interference ratings, and lower pain coping. 'Occasional risky drinkers' and 'regular risky drinkers' (cf. 'non-risky drinkers') reported higher levels of pain interference. Among people with CNCP, those who abstained from alcohol or drank at risky levels reported poorer pain outcomes compared with moderate drinkers. Early identification and intervention for risky drinking among people is critical, particularly given the risks associated with co-administration of alcohol and opioids.
Perceptions of injectable opioid agonist treatment (iOAT) among people who regularly use opioids in Australia: findings from a cross-sectional study in three Australian cities.
Publisher: Wiley
Date: 23-11-2020
DOI: 10.1111/ADD.15297
Abstract: Not all people experiencing opioid dependence benefit from oral opioid agonist treatment. The aim of this study was to examine perceptions of (supervised) injectable opioid agonist treatment (iOAT) (described as ‘an opioid similar to heroin self‐injected at a clinic several times a day’) among people who regularly use opioids and determine how common iOAT eligibility criteria accord with interest in iOAT. Cross‐sectional survey Sydney, Melbourne and Hobart, Australia A total of 344 people (63% male) who use opioids regularly and had ever injected opioids, interviewed December 2017–March 2018. The mean age of participants was 41.5 years [standard deviation (SD) = 8.5]. Primary outcome measures were interest in iOAT, factors associated with interest and the proportion of participants who would be eligible using common criteria from trials and guidelines. We examined willingness to travel for iOAT, medication preferences and perspectives on whom should receive iOAT. Overall, 53% of participants ( n = 182) believed that iOAT would be a good treatment option for them. Participants who believed that iOAT was a good treatment option for them were more likely to be male [adjusted odds ratio (aOR) = 1.76, 95% confidence interval (CI) = 1.10–2.82], have used heroin in the past month (aOR = 6.03, 95% CI = 2.86–12.71), currently regularly inject opioids (aOR = 1.84, 95% CI = 1.16–2.91) and have met ICD‐10 criteria for opioid dependence (aOR = 3.46, 95% CI = 1.65–7.24). Those interested in iOAT had commenced more treatment episodes (aOR =1.06, 95% CI = 1.00–1.12). Among those interested in iOAT ( n = 182), 26% ( n = 48) met common eligibility criteria for iOAT. Interest in injectable opioid agonist treatment does not appear to be universal among people who regularly use opioids. Among study participants who expressed interest in injectable opioid agonist treatment, most did not meet common eligibility criteria.
Monitoring the Internet for emerging psychoactive substances available to Australia
Publisher: Wiley
Date: 06-05-2013
DOI: 10.1111/DAR.12049
Abstract: Novel psychoactive substances are increasingly available, both in traditional storefronts and via the Internet. While some use of such substances has been captured in Australian consumer surveys and wastewater analyses, there is little information about the products that are available to Australia via the Internet. Systematic monthly Internet monitoring for emerging psychoactive substances was conducted between July 2011 and July 2012. Webstores identified through searches were examined to determine if they sold stimulant or psychedelic emerging psychoactive substances to Australia. Internet search numbers for these products were examined over time using commercial tools. In 12 months, 43 unique webstores were identified selling to Australia, averaging two new webstores per month however, two-fifths had closed within six months. Over 200 unique chemically unspecified products sold by purported effect (e.g. 'charge') were identified over 12 months, averaging 10 new products per month. Almost half of these products had disappeared from the market within six months. Eighty-six unique chemically specified products (e.g. methylenedioxypyrovalerone) were identified over 12 months, averaging four new novel substances per month. Once released, these products typically remained available, with almost 90% still available for purchase over a 6-month period. Almost 40 000 searches for these products emanated from Australia per month. This market is fast paced as retailers strive to beat both regulatory processes and competitors. Ongoing attention to these markets, incorporating surveillance of both Internet and traditional storefronts, is crucial as several of the substances identified have demonstrated potential for health and neurological harm.
A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine
Publisher: Frontiers Media SA
Date: 23-12-2019
Is khat use disorder a valid diagnostic entity?
Publisher: Wiley
Date: 02-06-2016
DOI: 10.1111/ADD.13421
Abstract: This study aimed to validate the presence of a khat use disorder syndrome using DSM-5 criteria and to examine its relationship with increased experience of harms. Cross-sectional, purposive s le of current khat-chewers, recruited from khat markets and cafes. Participants were recruited from the general community and from Adama Science and Technology University in Ethiopia. A total of 400 current khat consumers aged 16 and above were recruited between September 2014 and January 2015 MEASURES: Survey comprising current clinical symptoms (using a modified Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV), and validated measures of health, psychological distress, quality of life and academic functioning. A third [35.5% 95% confidence interval (CI) = 31.0-40.3] of respondents reported daily khat use and a quarter (25.4% 95% CI = 21.4-30.0) using three times or more per week. Using DSM-5 criteria, 10.5% (95% CI = 7.9-13.9) were categorized as experiencing mild, 8.8% (95% CI = 6.4-12.0) moderate and 54.5% (95% CI = 49.6-59.3) severe khat use disorder. Confirmatory factor analysis demonstrated a good fit of symptoms to a single underlying construct, consistent with other substance use disorders. In iduals categorized as experiencing khat use disorder demonstrated significantly greater frequency [odds ratio (OR) = 45.29 95% CI = 10.97-19.01) and quantity of khat use (OR = 2.35 95% CI = 1.29-4.29). They also demonstrated increased financial problems associated with use, greater problems with academic functioning and higher rates of self-reported mental health problems, higher psychological distress and poorer quality of life. Treatment access was poor, with only one-third (32.9%) of in iduals with khat use disorder reporting life-time access, near-exclusively related to help-seeking from friends and relatives. The construct of a substance use disorder syndrome for khat using DSM-5 criteria appears valid and performs in a manner consistent with other substances of dependence. In iduals with khat use disorder experience substantial problems in association with khat use. Despite this, there are low levels of help-seeking for these problems.
Assessing driving-relevant attentional impairment after a multiday drinking session: A two-phase pilot study
Publisher: Wiley
Date: 04-2022
DOI: 10.1111/ACER.14788
Abstract: The possibility of residual impairment of cognitive performance after multiday drinking sessions is particularly important given the potential for the deleterious effects of fatigue and hangover. This pilot study aimed to devise a methodology to compare sober performance on driving‐relevant attentional tasks at the end of a 4‐day music festival with performance at varying levels of the breath–alcohol curve. Fifty‐two participants completed selective and sustained attention tasks at a breath alcohol concentration (BrAC) of 0.00%, 0.05%, and 0.08% following acute dosing in a controlled laboratory setting. A subset of participants ( n = 13) were then tested at the conclusion of a 4‐day music festival at 0.00% BrAC, with task performance compared with laboratory results. During the laboratory phase, sustained attention was poorer at the 0.05% ascending timepoint only (compared to 0.00% BrAC). During the festival phase, participants made a greater number of errors on the selective attention task predeparture than at 0.00% and 0.05% BrAC in the laboratory. Sustained attention performance was poorer while intoxicated in the laboratory. Our findings suggest that the absence of blood alcohol acutely may not be indicative of unimpaired cognitive performance and that other factors related to multiday drinking may produce driving‐related attentional deficits. The findings reinforce the need to measure attentional performance in real‐world drinking contexts despite the methodological complexities of doing so. A larger study is warranted to replicate the findings and should include attentional measures that either are more sensitive to the effects of acute alcohol intoxication than those in our study or are based on a driving simulator.
Behavioral measures of state impulsivity and their psychometric properties: A systematic review
Publisher: Elsevier BV
Date: 12-2018
Prescription of opioid analgesics and related harms in Australia
Publisher: AMPCo
Date: 09-2011
DOI: 10.5694/MJA10.11450
Abstract: To document trends in: (i) prescribing of morphine and oxycodone (ii) hospital separations for overdose (iii) presentations for treatment of problems associated with these drugs and (iv) oxycodone-related mortality data in Australia. Cross-sectional study analysing prescriptions for morphine and oxycodone based on figures adjusted using Australian Bureau of Statistics estimated resident population and prospectively collected data from: (i) the National Hospital Morbidity Database on hospital separations primarily attributed to poisoning with opioids other than heroin ("other opioids") (ii) the Alcohol and Other Drug Treatment National Minimum Data Set for treatment episodes where morphine or oxycodone were the primary or other drugs of concern (iii) the National Coronial Information System on deaths where oxycodone was the underlying cause of death or a contributory factor. Population-adjusted numbers of (i) prescriptions for morphine and oxycodone by 10-year age group, (ii) hospital separations for "other opioid" poisoning, and (iii) treatment episodes related to morphine or oxycodone and (iv) number of oxycodone-related deaths. Prescriptions for morphine declined, while those for oxycodone increased. Prescriptions for both were highest among older Australians. Hospital separations for "other opioid" poisoning doubled between the financial years 2005-06 and 2006-07. Treatment episodes for morphine remained stable, while those for oxycodone increased. There were 465 oxycodone-related deaths recorded during 2001-2009. Oxycodone prescriptions in Australia have increased, particularly among older Australians. The increase may, in part, reflect appropriate prescribing for pain among an ageing population. However we are unable to differentiate non-medical use from appropriate prescribing from this data. In comparison to heroin, the morbidity and mortality associated with oxycodone is relatively low in Australia. There is a continued need for comprehensive training of general practitioners in assessing patients with chronic non-malignant pain and prescribing of opioids for these patients, to minimise the potential for harms associated with use of these medications.
Detecting impairment: Sensitive cognitive measures of dose-related acute alcohol intoxication
Publisher: SAGE Publications
Date: 17-02-2015
Abstract: The cognitive impairment that results from acute alcohol intoxication is associated with considerable safety risks. Other psychoactive substances, such as medications, pose a similar risk to road and workplace safety. However, there is currently no legal limit for operating vehicles or working while experiencing drug-related impairment. The current study sought to identify a brief cognitive task sensitive to a meaningful degree of impairment from acute alcohol intoxication to potentially stand as a reference from which to quantify impairment from other similar substances. A placebo-controlled single-blind crossover design was employed to determine the relative sensitivity of four commonly-administered cognitive tasks (Compensatory Tracking Task, Digit Symbol Substitution Test, Brief Stop Signal Task and Inspection Time Task) to alcohol-related impairment in male social drinkers at ~0.05% ascending breath alcohol concentration (BrAC), ~0.08% peak BrAC and 0.05% descending BrAC. The Inspection Time Task was identified as the most sensitive task, detecting a medium to large magnitude increase in impairment ( g ≈ 0.60) at 0.05% ascending and descending BrAC, and a large magnitude effect size ( g = 0.80) at 0.08% peak BrAC. The remaining tasks failed to demonstrate sensitivity to dose-dependent and limb-dependent changes in alcohol-induced impairment. The Inspection Time Task was deemed the most sensitive task for screening alcohol-related impairment based on the present results. Confirmation of equivalence with other drug-related impairment and sensitivity to alcohol-induced impairment in real-world settings should be established in future research.
Jurisdictional differences in opioid use, other licit and illicit drug use, and harms associated with substance use among people who tamper with pharmaceutical opioids
Publisher: Wiley
Date: 18-06-2015
DOI: 10.1111/DAR.12279
Abstract: The harms associated with non-medical use of pharmaceutical opioid analgesics are well established however, less is known about the characteristics and drug-use patterns of the growing and hidden populations of people using pharmaceutical opioids illicitly, including the frequency of pharmaceutical opioid injection. This paper aimed to undertake a detailed examination of jurisdictional differences in patterns of opioid use among a cohort of people who regularly t er with pharmaceutical opioids in Australia. Data were drawn from the National Opioid Medications Abuse Deterrence study. The cohort was recruited from New South Wales (NSW n = 303), South Australia (SA n = 150) and Tasmania (TAS n = 153) to participate in face-to-face structured interviews collecting data on use of pharmaceutical opioids, benzodiazepines, other sedative drugs and illicit substances, as well as the harms associated with substance use. TAS participants reported greater use and injection of certain pharmaceutical opioids (particularly morphine and methadone tablets), and limited heroin use, with lower rates of engagement in opioid substitution treatment, compared with NSW participants. NSW participants were more socially disadvantaged and more likely to report risky injecting behaviours and injecting-related injuries and diseases compared with SA and TAS participants. SA participants reported greater rates of pain conditions, greater use of pain-based services, as well as broader use of pharmaceutical opioids in regards to forms and route of administration, compared with NSW participants. Distinct jurisdictional profiles were evident for people who t er with pharmaceutical opioids, potentially reflecting jurisdictional differences in prescribing regulatory mechanisms and addiction treatment models.
Use of alcohol swabs to clean injecting sites among people who regularly inject drugs in Australia
Publisher: Wiley
Date: 11-12-2020
DOI: 10.1111/DAR.13006
Abstract: Cleaning drug injection sites with alcohol swabs prior to injecting reduces risk of abscesses and other skin and soft tissue infections (SSTI). Better understanding of swabbing behaviours can inform interventions to improve injecting hygiene. We aimed to determine the socio-demographic, drug use and injecting risk exposure correlates of swabbing prior to injecting and reasons for not swabbing. The Illicit Drug Reporting System recruited participants who had injected drugs at least monthly in the past six months in June-July 2017 from all Australian capital cities via needle and syringe programs and word-of-mouth. A structured interview was used to collect information on drug use and related behaviour, as well as swabbing practices. Logistic regression was used to identify factors associated with not swabbing at last injection. Of 853 respondents, one-quarter (26%) reported that they did not swab prior to their last injection. In adjusted analyses, crystal meth hetamine as the last drug injected, past month receptive or distributive syringe sharing, and past month re-use of one's own needle were significantly associated with not swabbing at last injection. Among participants who did not swab at last injection, swabbing was frequently considered unnecessary and a small number disliked using alcohol swabs. Efforts are needed to increase awareness of the importance of injecting hygiene in preventing SSTI. Interventions to increase swabbing should be included as part of a wider package of injecting hygiene education, particularly in light of associations with receptive and/or distributive syringe sharing.
Challenges and opportunities in using wastewater analysis to measure drug use in a small prison facility
Publisher: Wiley
Date: 10-2016
DOI: 10.1111/DAR.12156
Abstract: Wastewater analysis (WWA) is intended to be a direct and objective method of measuring substance use in large urban populations. It has also been used to measure prison substance use in two previous studies. The application of WWA in this context has raised questions as to how best it might be used to measure illicit drug use in prisons, and whether it can also be used to measure prescription misuse. We applied WWA to a small regional prison to measure the use of 12 licit and illicit substances. We attempted to measure the non-medical use of methadone and buprenorphine and to compare our findings with the results of the prison's mandatory drug testing (MDT). Representative daily composite s les were collected for two periods of 12 consecutive days in May to July 2013 and analysed for 18 drug metabolites. Prescription data and MDT results were obtained from the prison and compared with the substance use estimates calculated from WWA data. Daily use of meth hetamine, methadone, buprenorphine and codeine was detected, while sporadic detection of ketamine and methylone was also observed. Overall buprenorphine misuse appeared to be greater than methadone misuse. Compared with MDT, WWA provides a more comprehensive picture of prison substance use. WWA also has the potential to measure the misuse of medically prescribed substances. However, a great deal of care must be exercised in quantifying the usage of any substance in small populations, such as in prisons.
Definition matters: assessment of tolerance to the effects of alcohol in a prospective cohort study of emerging adults
Publisher: Wiley
Date: 12-07-2022
DOI: 10.1111/ADD.15991
Abstract: Tolerance to the effects of alcohol is an important element in the diagnosis of alcohol use disorders (AUD) however, there is ongoing debate about its utility in the diagnosis AUD in adolescents and young adults. This study aimed to refine the assessment of tolerance in young adults by testing different definitions of tolerance and their associations with longitudinal AUD outcomes. Prospective cohort study. Australia. A contemporary cohort of emerging adults across Australia ( n = 565, mean age = 18.9, range = 18–21 at baseline). Clinician‐administered Structured Clinical Interview for DSM‐IV Research Version (SCID‐IV‐RV) assessed for AUD criteria across five interviews, at 6‐month intervals over 2.5 years. Tolerance definitions were operationalized using survey‐type response (yes/no), clinician judgement (SCID‐IV‐RV), different initial drinking quantity and percentage increase thresholds and average heavy consumption metrics. AUD persistence was operationalized by the number of times AUD was present across the 2.5‐year study period ( n = 491), and new‐onset AUD was operationalized as any new incidence of AUD during the follow‐up period ( n = 461). The (i) SCID‐IV‐RV clinician judgement [odds ratio (OR) = 2.50, P = 0.005], (ii) an initial drinking quantity threshold of four to five drinks and 50% minimum increase (OR = 2.48, P = 0.007) and (iii) 50% increase only (OR = 2.40, P = 0.005) were the tolerance definitions more strongly associated with any new onset of AUD throughout the four follow‐up time‐points than other definitions. However, these definitions were not associated with persistent AUD ( P s 0.05). Average heavy consumption definitions of tolerance were most strongly associated with persistent AUD (OR = 6.66, P = 0.001 OR = 4.65, P = 0.004) but not associated with new‐onset AUD ( P s 0.05). Initial drink and percentage change thresholds appear to improve the efficacy of change‐based tolerance as an indicator for new‐onset alcohol use disorder diagnosis in self‐report surveys of young adults. When predicting persistent alcohol use disorder, average heavy consumption‐based indicators appear to be a better way to measure tolerance than self‐reported change‐based definitions.
Adherence to the caffeine intake guideline during pregnancy and birth outcomes: A prospective cohort study
Publisher: MDPI AG
Date: 07-03-2018
DOI: 10.3390/NU10030319
An ecological study of the extent and factors associated with the use of prescription and over-the-counter codeine in Australia
Publisher: Springer Science and Business Media LLC
Date: 22-12-2016
DOI: 10.1007/S00228-015-1995-8
Abstract: The extent and factors associated with codeine use in the community remain poorly understood despite the widespread global use of codeine. The aim of this study was to examine the use of prescription and over-the-counter (OTC) codeine in Australia and identify the geographic and socio-demographic characteristics associated with prescription and OTC codeine use. National sales data for prescription and OTC codeine (supplied by IMS Health) were used to estimate codeine utilisation (in pack sales and milligrammes) in Australia during 2013, mapped to Australian Bureau of Statistics (ABS) Statistical Local Areas (SLAs) and Remoteness Areas. Socio-demographic characteristics and total population estimates of SLAs were obtained from the ABS. SLA-level data on sex, age distribution, income, occupations involving physical labour and number of pharmacies were included in linear regression analyses to examine their association with total, prescription and OTC codeine use. In total, 27,780,234 packs of codeine were sold in Australia during 2013, equating to 12,376 kg. OTC codeine preparations accounted for 15,490,207 packs (55.8 %) or 4967.30 kg (40.1 %). Nationally, an estimated 1.24 packs (or 554.10 mg) of codeine were sold per person utilisation was higher in more remote areas. SLAs with a higher percentage of low-income earning households had the highest rates of prescription codeine use (β 0.16, p < 0.001), whereas SLAs with a higher percentage of males had the highest rates of OTC codeine use (β 0.22, p < 0.001). Codeine use is common in Australia, with clear distinctions in the geographic and socio-demographic characteristics associated with prescription and OTC codeine use.
What do we know about alcohol mixed with energy drink (AmED) use in Australia? Expanding local evidence
Publisher: The Sax Institute
Date: 2018
DOI: 10.17061/PHRP2831817
Abstract: Despite continued health concerns associated with the practice of consuming alcohol mixed with energy drinks (AmED), few Australian studies have examined the popularity of this combination or attempted to characterise AmED consumers. The purpose of this paper is to replicate two previously used survey approaches to consolidate a national picture of AmED consumption in Australia. The survey approaches used were: an online survey with a convenience s le of New South Wales (NSW), Australia, residents (n = 1931 63.7% female median age 23.0 years) and street intercept surveys in regional and metropolitan entertainment precincts in NSW (n = 1265 58.2% male median age 21.0 years). Analyses explored the rates and frequency of AmED use across both s les, and the sociodemographic and substance use predictors of AmED consumption in the past 12 months. More than 90% of participants in both s les reported alcohol consumption in the past 12 months, with approximately 40% of current drinkers also reporting AmED use in the past 12 months. Three-quarters of participants interviewed in entertainment precincts reported alcohol consumption in the previous 12 hours, with one in six of these also reporting AmED consumption in the past 12 hours. AmED users across both s les were more likely than alcohol-only consumers to be younger and male, and to report riskier substance use practices. Health promotion activities are warranted to promote awareness of energy drink guidelines, and the potential harms of exceeding these guidelines, among alcohol consumers. In addition, health workers should consider enquiring about AmED use as an indicator of risk related to substance use.
Injection of Pharmaceuticals Designed for Oral Use: Harms Experienced and Effective Harm Reduction Through Filtration
Publisher: Springer International Publishing
Date: 2017
Abstract: Several pharmaceutical products are liable to 'abuse' or use outside their prescription, which frequently involves their injection. Ex les are slow-release forms of morphine and oxycodone, and sublingual buprenorphine. During injection preparation, the drug is extracted into water, after crushing and heating the tablet if considered necessary. Since these products are designed for oral administration, they can contain excipients (ingredients other than the drug) which are poorly soluble, resulting in suspension of particles in the injection solution. Injected particles are able to produce medical complications such as the blockage of small blood vessels leading to ischaemia (inadequate blood flow) and tissue damage. Filtration can be used to remove particles from the suspension including bacteria if the porosity is small enough (0.2 μm). However, filters are liable to blockage when overloaded, especially if the pore size is small. This problem can be minimised by using a larger pore size (e.g. 5-10 μm), but the resulting filtrate will contain many residual small particles. The use of two filters, coarse and fine, either sequentially or in a double membrane device, enables removal of the majority of particles as well as bacteria, although not quite meeting pharmaceutical standards for safe injection. Although not yet evaluated by a clinical trial, this highly effective filtration process would be expected to greatly reduce the risk of vascular and related complications, as well as non-viral infections. Careful technique ensures that drug is not lost by filtration, a priority for most drug consumers. Practical issues that affect acceptability of filtration by injecting drug users, including ease of use and cost, will need to be considered. However, given the laboratory evidence demonstrating the effectiveness of filters it is time to consider these tools as essential for safe injection as sterile needles/syringes for the world's approximately 16 million people who inject drugs.
Choosing a Cut-Off on the Severity of Dependence Scale for Ecstasy Use
Publisher: Bentham Science Publishers Ltd.
Date: 29-03-2011
Profiles of illicit drug use during annual key holiday and control periods in Australia: wastewater analysis in an urban, a semi-rural and a vacation area
Publisher: Wiley
Date: 05-12-2013
DOI: 10.1111/ADD.12006
Abstract: To examine changes in illicit drug consumption between peak holiday season (23 December-3 January) in Australia and a control period two months later in a coastal urban area, an inland semi-rural area and an island populated predominantly by vacationers during holidays. Analysis of representative daily composite wastewater s les collected from the inlet of the major wastewater treatment plant in each area. Three wastewater treatment plants. Wastewater treatment plants serviced approximately 350, 000 persons in the urban area, 120,000 in the semi-rural area and 1100-2400 on the island. Drug residues were analysed using liquid chromatography coupled to a tandem mass spectrometer. Per capita drug consumption was estimated. Changes in drug use were quantified using Hedges' g. During the holidays, cannabis consumption in the semi-rural area declined (g = -2.8) as did meth hetamine (-0.8), whereas cocaine (+1.5) and ecstasy (+1.6) use increased. In the urban area, consumption of all drugs increased during holidays (cannabis +1.6, cocaine +1.2, ecstasy +0.8 and meth hetamine +0.3). In the vacation area, meth hetamine (+0.7), ecstasy (+0.7) and cocaine (+1.1) use increased, but cannabis (-0.5) use decreased during holiday periods. While the peak holiday season in Australia is perceived as a period of increased drug use, this is not uniform across all drugs and areas. Substantial declines in drug use in the semi-rural area contrasted with substantial increases in urban and vacation areas. Per capita drug consumption in the vacation area was equivalent to that in the urban area, implying that these locations merit particular attention for drug use monitoring and harm minimisation measures.
Benzodiazepine Use among Chronic Pain Patients Prescribed Opioids: Associations with Pain, Physical and Mental Health, and Health Service Utilization
Publisher: Oxford University Press (OUP)
Date: 02-2015
DOI: 10.1111/PME.12594
Abstract: Benzodiazepines (BZDs) are commonly used by chronic pain patients, despite limited evidence of any long-term benefits and concerns regarding adverse events and drug interactions, particularly in older patients. This article aims to: describe patterns of BZDs use the demographic, physical, and mental health correlates of BZD use and examine if negative health outcomes are associated with BZD use after controlling for confounders. A national s le of 1,220 chronic noncancer pain (CNCP) patients prescribed long-term opioids. We report on baseline data from a prospective cohort study comparing four groups based on their current BZD use patterns. General demographics, pain, mental and physical comorbidity, and health service utilization were examined. One-third (N = 398, 33%) of participants reported BZD use in the past month, and 17% (N = 212) reported daily BZD use. BZD use was associated with: 1) greater pain severity, pain interference with life, and lower feelings of self-efficacy with respect to their pain 2) being prescribed "higher-risk" (>200 mg oral morphine equivalent) doses of opioids 3) using antidepressant and/or antipsychotic medications 4) substance use (including more illicit and injection drug use, alcohol use disorder, and daily nicotine use) and 5) greater mental health comorbidity. After controlling for differences in demographic characteristics, physical and mental health, substance use, and opioid dose, BZD use was independently associated with greater past-month use of emergency health care such as ambulance or accident and emergency services. CNCP patients using BZDs daily represent a high-risk group with multiple comorbid mental health conditions and higher rates of emergency health care use. The high prevalence of BZD use is inconsistent with guidelines for the management of CNCP or chronic mental health conditions.
New applications of wastewater analyses for assessing substance use
Publisher: Wiley
Date: 03-2016
DOI: 10.1111/DAR.12386
Adolescent alcohol use trajectories: Risk factors and adult outcomes
Publisher: American Academy of Pediatrics (AAP)
Date: 10-2020
Abstract: Adolescents often display heterogenous trajectories of alcohol use. Initiation and escalation of drinking may be important predictors of later harms, including alcohol use disorder (AUD). Previous conceptualizations of these trajectories lacked adjustment for known confounders of adolescent drinking, which we aimed to address by modeling dynamic changes in drinking throughout adolescence while adjusting for covariates. Survey data from a longitudinal cohort of Australian adolescents (n = 1813) were used to model latent class alcohol use trajectories over 5 annual follow-ups (mean age = 13.9 until 17.8 years). Regression models were used to determine whether child, parent, and peer factors at baseline (mean age = 12.9 years) predicted trajectory membership and whether trajectories predicted self-reported symptoms of AUD at the final follow-up (mean age = 18.8 years). We identified 4 classes: abstaining (n = 352) late-onset moderate drinking (n = 503) early-onset moderate drinking (n = 663) and early-onset heavy drinking (n = 295). Having more alcohol-specific household rules reduced risk of early-onset heavy drinking compared with late-onset moderate drinking (relative risk ratio: 0.31 99.5% confidence interval [CI]: 0.11–0.83), whereas having more substance-using peers increased this risk (relative risk ratio: 3.43 99.5% CI: 2.10–5.62). Early-onset heavy drinking increased odds of meeting criteria for AUD in early adulthood (odds ratio: 7.68 99.5% CI: 2.41–24.47). Our study provides evidence that parenting factors and peer influences in early adolescence should be considered to reduce risk of later alcohol-related harm. Early initiation and heavy alcohol use throughout adolescence are associated with increased risk of alcohol-related harm compared with recommended maximum levels of consumption (late-onset, moderate drinking).
Associations between alcohol consumption and cardio-metabolic risk factors in young adults
Publisher: Oxford University Press (OUP)
Date: 08-2017
Abstract: Introduction The benefits of alcohol consumption for cardiovascular and metabolic health may have been overstated due to inappropriate comparisons with abstainers and inadequate control for confounding factors including physical activity and mental health. We examined alcohol consumption and cardio-metabolic health in a cohort of young Australian adults overcoming these limitations. Methods Cross-sectional data of a cohort of 2200 participants (age range 25-36 years) from the 2004-06 Childhood Determinants of Adult Health were used. Alcohol consumption was assessed from questionnaire and cardio-metabolic risk factors were measured in clinics. Linear and log binomial regression were used to examine total alcohol consumption (categories: none 0 g/day light >0-10 g/day [reference] moderate >10-20 g/day heavy >20-30 g/day very heavy >30 g/day) against dichotomous metabolic syndrome and its components: waist circumference, triglycerides, high-density lipoprotein cholesterol, blood pressure and glucose. Covariates included socio-demographics, smoking, diet, physical activity, fitness, depression and anxiety. Results Of the 2220 participants (48% males, mean (standard deviation) age 29.5 (2.5) years), most were classified in the 'light drinking' group (54.2%), less were in the 'non-drinking' (13.2%), 'heavy' (5.2%) or 'very heavy' (5.5%) drinking groups. Only moderate drinking was associated with a significantly lower prevalence of metabolic syndrome (prevalence ratio = 0.64, p < 0.05) compared with light drinking. Higher levels of alcohol consumption were associated with higher high-density lipoprotein cholesterol (β = 0.05, p
Parental supply of alcohol and alcohol consumption in adolescence: Prospective cohort study
Publisher: Cambridge University Press (CUP)
Date: 05-10-2017
DOI: 10.1017/S0033291716002373
Abstract: Parents are a major supplier of alcohol to adolescents, yet there is limited research examining the impact of this on adolescent alcohol use. This study investigates associations between parental supply of alcohol, supply from other sources, and adolescent drinking, adjusting for child, parent, family and peer variables. A cohort of 1927 adolescents was surveyed annually from 2010 to 2014. Measures include: consumption of whole drinks binge drinking ( standard drinks on any occasion) parental supply of alcohol supply from other sources child, parent, family and peer covariates. After adjustment, adolescents supplied alcohol by parents had higher odds of drinking whole beverages [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.33–2.45] than those not supplied by parents. However, parental supply was not associated with bingeing, and those supplied alcohol by parents typically consumed fewer drinks per occasion (incidence rate ratio 0.86, 95% CI 0.77–0.96) than adolescents supplied only from other sources. Adolescents obtaining alcohol from non-parental sources had increased odds of drinking whole beverages (OR 2.53, 95% CI 1.86–3.45) and bingeing (OR 3.51, 95% CI 2.53–4.87). Parental supply of alcohol to adolescents was associated with increased risk of drinking, but not bingeing. These parentally-supplied children also consumed fewer drinks on a typical drinking occasion. Adolescents supplied alcohol from non-parental sources had greater odds of drinking and bingeing. Further follow-up is necessary to determine whether these patterns continue, and to examine alcohol-related harm trajectories. Parents should be advised that supply of alcohol may increase children's drinking.
Trajectories of parental and peer supply of alcohol in adolescence and associations with later alcohol consumption and harms: A prospective cohort study
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.DRUGALCDEP.2022.109533
Abstract: Supply of alcohol to adolescents is associated with increased alcohol consumption and harms including alcohol use disorder (AUD). We aimed to identify: (1) trajectories of alcohol supply to adolescents (2) sociodemographic characteristics associated with supply trajectory (3) patterns of alcohol consumption by supply trajectory and (4) supply trajectory associations with adverse alcohol outcomes. We used Australian longitudinal survey data (N = 1813) to model latent trajectories of parent and peer alcohol supply over five annual follow-ups (Waves 2-6 M We identified five alcohol supply classes: (1) minimal supply (n = 739, 40.8%) (2) early parent sips, late peer arent whole drinks (n = 254, 14.0%) (3) late peer arent whole drinks (n = 419, 23.1%) (4) early parent sips, mid peer arent whole drinks (n = 293, 16.2%) (5) early peer arent whole drinks (n = 108, 6.0%). Compared to minimal supply, the other classes were 2.7-12.9 times as likely to binge drink, 1.6-3.0 times as likely to experience alcohol-related harms, and 2.1-8.6 times as likely to report AUD symptoms at age 19. Earlier supply of whole drinks, particularly from peers, was associated with increased risk of early adulthood adverse alcohol outcomes. While minimal supply represented the lowest risk, supplying sips only in early-mid adolescence and delaying supply of whole drinks until late adolescence is likely to be less risky than earlier supply of whole drinks.
Impact of Removing Nonprescription Codeine in Australia: Protocol for a Prospective Cohort Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 18-07-2019
Abstract: n February 1, 2018, Australia rescheduled codeine to a prescription-only medication. Many concerns were associated with this change, including increased financial costs, reduced service accessibility, the potential for poorer pain management, and a decline in physical and mental health if codeine could not be accessed. In the research literature, there is limited knowledge about the long-term consequences of rescheduling pharmaceutical opioids and, as Australia has followed many countries in implementing a restriction on codeine, further study of these consequences is critical. he goal of this study was to examine the impact of rescheduling codeine from an over-the-counter (OTC) product to a prescription-only medicine on the primary measures of codeine use and dependence in a prospective cohort of people who are frequent consumers of OTC codeine. Secondary measures included pain and self-efficacy, health service use, and mental health. he Codeine Cohort study aimed to recruit 300 participants in Australia who regularly (at least a few times per week for the past 6 months) used OTC codeine. Using an online survey, participants were followed up at three time points (February 2018, June 2018, and February 2019) after codeine was rescheduled. ll four waves of data collection are complete, with the final round of data collection finalized in August 2019. Data analyses are yet to be completed. Information on demographics, codeine use and dependence, physical and mental health, medication use, and health service use will be analyzed using mixed models. esults of this study will provide insight into the effectiveness of regulatory restriction in curtailing nonmedical use of and harms associated with codeine. Additionally, results will explore positive and negative outcomes of codeine rescheduling for in idual patients, which informs health professionals who support patients who use codeine and further community education. ERR1-10.2196/15540
Changes in mental health and help-seeking among young Australian adults during the COVID-19 pandemic: a prospective cohort study
Publisher: Cambridge University Press (CUP)
Date: 10-05-2021
DOI: 10.1017/S0033291721001963
Abstract: Young people may have elevated risk for poorer mental health during the coronavirus disease 2019 (COVID-19) pandemic, yet longitudinal studies documenting this impact are lacking. This study assessed changes in mental health and help-seeking since COVID-19 restrictions in young Australians, including gender differences. Data were drawn from a recent subs le ( n = 443 60% female M age = 22.0) of a prospective cohort originally recruited in secondary school to complete annual surveys. The subs le completed an additional COVID-19 survey during COVID-19 restrictions (May–June 2020), which was compared to responses from their latest annual survey (August 2019–March 2020). Mixed effect models with time and gender as the primary predictors were conducted for: (i) scores on the Patient Health Questionnaire Depression 9-item (PHQ-9) and Generalised Anxiety Disorder 7-item (GAD-7) modules assessed before and during COVID-19 restrictions, and (ii) self-reported help-seeking from a health professional in February 2020, and the month preceding May–June 2020. Mean symptom scores increased from before to during COVID-19 restrictions on the PHQ-9 (coefficient: 1.29 95% CI 0.72–1.86) and GAD-7 (0.78 95% CI 0.26–1.31), but there was no increase in help-seeking over time (odds ratio 0.50 95% CI 0.19–1.32). There was no evidence of differential changes by gender. This study found increases in depression and anxiety symptoms but not greater help-seeking among young Australian adults during the first wave of the pandemic. Increasing availability and awareness of accessible treatment options and psychoeducation is critical, as well as further research into risk and protective factors to help target treatment to this vulnerable age group.
Monitoring temporal changes in use of two cathinones in a large urban catchment in Queensland, Australia
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.SCITOTENV.2015.12.038
Abstract: Wastewater analysis was used to examine prevalence and temporal trends in the use of two cathinones, methylone and mephedrone, in an urban population (>200,000 people) in South East Queensland, Australia. Wastewater s les were collected from the inlet of the sewage treatment plant that serviced the catchment from 2011 to 2013. Liquid chromatography coupled with tandem mass spectrometry was used to measure mephedrone and methylone in wastewater s le using direct injection mode. Mephedrone was not detected in any s les while methylone was detected in 45% of the s les. Daily mass loads of methylone were normalized to the population and used to evaluate methylone use in the catchment. Methylone mass loads peaked in 2012 but there was no clear temporal trend over the monitoring period. The prevalence of methylone use in the catchment was associated with the use of MDMA, the more popular analogue of methylone, as indicated by other complementary sources. Methylone use was stable in the study catchment during the monitoring period whereas mephedrone use has been declining after its peak in 2010. More research is needed on the pharmacokinetics of emerging illicit drugs to improve the applicability of wastewater analysis in monitoring their use in the population.
Evaluation of Peakmaster for computer‐aided multivariate optimisation of a CE separation of 17 antipsychotic drugs using minimal experimental data
Publisher: Wiley
Date: 03-2009
Abstract: The computer-assisted development of a CE method for compliance monitoring of a group of 17 antipsychotic drugs (chlorpromazine hydrochloride, clozapine, droperidol, flupenthixol dihydrochloride, fluphenazine dihydrochloride, haloperidol, pimozide, thioridazine hydrochloride, trifluoperazine dihydrochloride, prochlorperazine dimaleate, amisulpride, aripiprazole, olanzapine, quetiapine fumarate, risperidone, ziprasidone, and zuclopenthixol dihydrochloride) was performed. Peakmaster, a free simulation program for CE, was employed in a multivariate optimisation approach to determine suitable BGE conditions with minimal experimentation. However, analyte input parameters (pK(a) and limiting ionic mobility) were not included within the software and required determination. Limiting ionic mobility was determined experimentally, while pK(a) values were calculated using ACD Labs software. A modified chromatographic response factor, which identified the BGE providing the greatest resolution between each pair of peaks within 10 min, was used and determined a pH 2.5 and an ionic strength of 50 mM as optimal. Marked disparities were apparent between experimentally determined and computer-simulated results, due to error associated with pK(a) values calculated using ACD Labs. These results confirm that Peakmaster analyses are highly sensitive to pK(a) values, especially where the pH of the BGE is in the proximity of the analyte pK(a) but also that Peakmaster does allows a rational approach to dramatically reduce the amount of experimental work required for multivariate optimisation of conditions for CE.
Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study
Publisher: Elsevier BV
Date: 07-2018
Cognitive, physical, and mental health outcomes between long-term cannabis and tobacco users
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.ADDBEH.2017.12.009
Abstract: Cannabis intoxication adversely affects health, yet persistent effects following short-term abstinence in long-term cannabis users are unclear. This matched-subjects, cross-sectional study compared health outcomes of long-term cannabis and long-term tobacco-only users, relative to population norms. Nineteen long-term (mean 32.3years of use, mean age 55.7years), abstinent (mean 15h) cannabis users and 16 long-term tobacco users (mean 37.1years of use, mean age 52.9years), matched for age, educational attainment, and lifetime tobacco consumption, were compared on measures of learning and memory, response inhibition, information-processing, sustained attention, executive control, and mental and physical health. Cannabis users exhibited poorer overall learning and delayed recall and greater interference and forgetting than tobacco users, and exhibited poorer recall than norms. Inhibition and executive control were similar between groups, but cannabis users had slower reaction times during information processing and sustained attention tasks. Cannabis users had superior health satisfaction and psychological, somatic, and general health than tobacco users and had similar mental and physical health to norms whilst tobacco users had greater stress, role limitations from emotional problems, and poorer health satisfaction. Long-term cannabis users may exhibit deficits in some cognitive domains despite short-term abstinence and may therefore benefit from interventions to improve cognitive performance. Tobacco alone may contribute to adverse mental and physical health outcomes, which requires appropriate control in future studies.
Simultaneous quantification of endocannabinoids, oleoylethanolamide and steroid hormones in human plasma and saliva
Publisher: Elsevier BV
Date: 09-2020
Changes in illicit drug use and markets with the COVID-19 pandemic and associated restrictions: findings from the Ecstasy and Related Drugs Reporting System, 2016–20
Publisher: Wiley
Date: 16-07-2022
DOI: 10.1111/ADD.15620
Abstract: To describe (i) self‐reported changes in drug use and (ii) trends in price, perceived availability, and perceived purity of illicit drugs, among people who regularly use ecstasy/ 3,4‐methylenedioxymeth hetamine (MDMA) and other illicit stimulants in Australia following COVID‐19 and associated restrictions. Annual interviews with cross‐sectional sentinel s les conducted face‐to‐face in 2016–19 and via video conferencing or telephone in 2020. Data were collected via an interviewer‐administered structured questionnaire. Australian capital cities. Australians aged 16 years or older who used ecstasy/MDMA and other illicit stimulants on a monthly or more frequent basis and resided in a capital city, recruited via social media and word‐of‐mouth ( n ~ 800 each year). Key outcome measures were self‐reported illicit drug market indicators (price, purity and availability) and, in 2020 only, perceived change in drug use (including alcohol and tobacco) since March 2020 and reasons for this change. For most drugs, participants reported either no change or a reduction in their use since COVID‐19 restrictions were introduced. Ecstasy/MDMA was the drug most frequently cited as reduced in use ( n = 552, 70% of those reporting recent use), mainly due to reduced opportunities for socialization. While market indicators were largely stable across most drugs, the odds of perceiving MDMA capsules as ‘high’ in purity decreased compared with 2016–19 [adjusted odds ratio (aOR) = 0.72, 95% confidence interval (CI) = 0.53–0.99], as did perceiving them as ‘easy’ to obtain (aOR = 0.42, CI = 0.26–0.67). The odds of perceiving cocaine and meth hetamine crystal as ‘easy’ to obtain also decreased (aOR = 0.67, CI = 0.46–0.96 and aOR = 0.12, CI = 0.04–0.41, respectively). After COVID‐19‐related restrictions were introduced in Australia, use of ecstasy/MDMA, related stimulants and other licit and illicit drugs mainly appeared to remain stable or decrease, primarily due to impediments to socialization.
Risk and benefit perceptions of party drug use
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/J.ADDBEH.2005.04.003
Abstract: A cross-sectional survey of 372 regular ecstasy users was conducted to examine the benefits and risks perceived to be associated with the use of party drugs. A wide range of benefits and risks were reported across six drug types with some considered drug-specific. Commonly perceived risks included physical and psychological harms that were consistent with current harm reduction messages. Harm reduction c aigns may need to acknowledge benefits of drug use to ensure health promotion messages are considered credible and acceptable to users.
Is Mindfulness a Noticeable Quality? Development and Validation of the Observed Mindfulness Measure
Publisher: Springer Science and Business Media LLC
Date: 17-11-2021
New psychoactive substance use among regular psychostimulant users in Australia, 2010–2015
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.DRUGALCDEP.2016.01.024
Abstract: To examine the rates and patterns of new psychoactive substance (NPS) use amongst regular psychostimulant users (RPU) in Australia. Data were obtained from the 2010-2015 Ecstasy and related Drugs Reporting System (EDRS), which comprised a total cross-sectional s le of 4122RPU. Recent use of 'any' NPS increased from 33% in 2010 to 40% in 2015, although trends of use differed significantly across NPS classes. The correlates associated with NPS use also varied across NPS classes: frequent (i.e. weekly or more) ecstasy users were more likely to report recent phenethylamine use LSD users were more likely to report recent phenethylamine and tryptamine use and daily cannabis users were more likely to report recent synthetic cannabinoid use than RPU who had not used NPS. 'Poly' NPS consumers were found to be a particularly high risk group and were significantly more likely to be younger, male, report daily cannabis use, report weekly or more ecstasy use, report recent LSD use, have higher levels of poly drug use, have overdosed on any drug in the past year, and to have engaged in past month criminal activity. NPS use has been established as a significant and ongoing practice amongst our s le of RPU. It appears that RPU seek out NPS with similar properties to the illicit drugs that they are already consuming, with poly NPS consumers found to be a particularly high risk group.
Mood, sleep and pain comorbidity outcomes in cannabis dependent patients: Findings from a nabiximols versus placebo randomised controlled trial
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.DRUGALCDEP.2022.109388
Abstract: Mood, sleep and pain problems are common comorbidities among treatment-seeking cannabis-dependent patients. There is limited evidence suggesting treatment for cannabis dependence is associated with their improvement. This study explored the impact of cannabis dependence treatment on these comorbidities. This is a secondary analysis from a 12-week double-blind placebo-controlled trial testing the efficacy of a cannabis agonist (nabiximols) against placebo in reducing illicit cannabis use in 128 cannabis-dependent participants. Outcome measurements including DASS-21 (Depression, Anxiety, and Stress subscales) Insomnia Severity Index (ISI) and Brief Pain Inventory (BPI), were performed at weeks 0, 4, 8, 12 and 24. Each was analysed as continuous outcomes and as binary cases based on validated clinical cut-offs. Among those whose DASS and ISI scores were in the moderate to severe range at baseline, after controlling for cannabis use, there was a gradual decrease in severity of symptoms over the course of the trial. BPI decreased significantly until week 12 and then rose again in the post-treatment period during weeks 12-24. Neither pharmacotherapy type (nabiximols vs placebo) nor number of counselling sessions contributed significant explanatory power to any of the models and were excluded from the final analyses for both continuous and categorical outcomes. Participants in this trial who qualified as cases at baseline had elevated comorbidity symptoms. There was no evidence that nabiximols treatment is a barrier to achieving reductions in the comorbid symptoms examined. Cannabis dependence treatment reduced illicit cannabis use and improved comorbidity symptoms, even when complete abstinence was not achieved.
Recreational 3,4-methylenedioxymethamphetamine or ‘ecstasy’: Current perspective and future research prospects
Publisher: SAGE Publications
Date: 29-06-2017
Abstract: The purpose of this article is to debate current understandings about the psychobiological effects of recreational 3,4-methylenedioxymeth hetamine (MDMA or ‘ecstasy’), and recommend theoretically-driven topics for future research. Recent empirical findings, especially those from novel topic areas were reviewed. Potential causes for the high variance often found in group findings were also examined. The first empirical reports into psychobiological and psychiatric aspects from the early 1990s concluded that regular users demonstrated some selective psychobiological deficits, for instance worse declarative memory, or heightened depression. More recent research has covered a far wider range of psychobiological functions, and deficits have emerged in aspects of vision, higher cognitive skill, neurohormonal functioning, and foetal developmental outcomes. However, variance levels are often high, indicating that while some recreational users develop problems, others are less affected. Potential reasons for this high variance are debated. An explanatory model based on multi-factorial causation is then proposed. A number of theoretically driven research topics are suggested, in order to empirically investigate the potential causes for these erse psychobiological deficits. Future neuroimaging studies should study the practical implications of any serotonergic and/or neurohormonal changes, using a wide range of functional measures.
Measuring Alcohol Use-Related Shame and Guilt: Development and Validation of the Perceptions of Drinking Scale
Publisher: Informa UK Limited
Date: 15-11-2020
Parental supply of alcohol as a predictor of adolescent alcohol consumption patterns: A prospective cohort
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.DRUGALCDEP.2019.06.031
Abstract: Recent research has not supported the idea that parental supply of alcohol to adolescents prevents later alcohol-related harm. Yet the specific role of parental supply in shaping patterns of drinking over time remains unclear. This study investigated the role of parental supply of alcohol in patterns of drinking across adolescence, and assessed whether that role remained consistent over time. Using a longitudinal cohort of 1927 adolescents (mean age 12.9 years), recruited in 2010 and 2011 from schools across Australia and followed up annually until 2016, we assessed three outcomes using mixed-effect negative binomial regression: frequency of consumption, typical quantity consumed, and overall alcohol consumption in the year (frequency * quantity). Child, parental, familial, and peer confounders of adolescent alcohol consumption were measured and adjusted for in the analyses. Parental supply was associated with greater overall consumption in earlier adolescence: Grade 7-8 (incidence rate ratio [IRR]: 3.61 95% CI: 2.55, 5.12 no supply IRR: 1.00), Grade 8-9 (IRR: 4.84 95% CI: 3.66, 6.39 no supply IRR: 1.44) and Grade 9-10 (IRR: 8.33 95% CI: 6.28, 11.05 no supply IRR: 4.75). Alcohol consumption continued to increase in later adolescence regardless of whether parental supply occurred. Parental supply of alcohol was associated with increased alcohol consumption by their children during early adolescence. While parental supply appears to have less impact on drinking in later adolescence, there was no evidence to suggest it is protective. Parents should be advised to avoid supplying children with alcohol, particularly in early adolescence.
Commentary on “Sex differences in the effect of cannabinoid type 1 receptor deletion on locus coeruleus-norepinephrine neurons and corticotropin releasing factor-mediated responses”
Publisher: Wiley
Date: 03-2019
DOI: 10.1111/EJN.14371
Combined use of alcohol and energy drinks: Dose relationship with self-reported physiological stimulation and sedation side effects
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.ADDBEH.2017.02.031
Abstract: Negative physiological stimulation and sedation side effects are experienced by a significant proportion of consumers who consume alcohol mixed with energy drinks (AmED). Few studies have compared the frequency of side effects between sessions of AmED and sessions of alcohol only within-subject, and none have explored a dose relationship. Explore the occurrence of self-reported physiological stimulant and sedative side effects between sessions of AmED and alcohol only, and at varying ED dosage levels within AmED sessions. A convenience s le of 2953 residents of New South Wales, Australia completed an online survey. N=731 AmED users reported daily caffeine intake, typical alcohol and AmED consumption, and past 12-month experience of physiological stimulation and sedation side effects during AmED and alcohol only sessions. Within-subject analyses compared occurrence of side effects between session types. Hierarchical binary logistic regression analyses explored the association of ED dose during AmED sessions with the experience of physiological side effects. There were greater odds of most stimulant side effects, and lower odds of sedation side effects, during AmED sessions compared to alcohol only sessions. Compared to one ED, consumption of three or more EDs was significantly associated with the majority of both stimulant and alcohol intoxication side effects after controlling for demographics and consumption covariates. AmED is associated with perceived changes in physiological stimulant and sedation side effects of alcohol. Experience of side effects is positively associated with ED dosage. Future research should account for varying ED dosage, and reflect real world consumption levels.
Randomised controlled trial (RCT) of daily aerobic exercise for inpatient cannabis withdrawal: A study protocol
Publisher: Elsevier BV
Date: 10-2017
Substance Use and Sex Index (SUSI): First stage development of an assessment tool to measure behaviour change in sexualised drug use for substance use treatment studies
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DRUGPO.2018.03.020
Abstract: Existing tools for measuring blood-borne virus (BBV) and sexually transmitted infection (STI) transmission risk behaviours in substance use interventions have limited capacity to assess risk behaviours across varied social, cultural and epidemiological contexts have not evolved alongside HIV treatment and prevention innovations or accounted for sexual contexts of drug use including among a range of lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) sub-communities. The Substance Use and Sex Index (SUSI) is a new brief, simple tool being developed to assess change in HIV and STI risk behaviours for substance use treatment studies. A 26-item questionnaire was piloted online among community volunteers (n = 199). Concurrent and predictive validity were assessed against risk-taking (RT-18) and STI testing items (Gay Community Periodic Surveys). The developed scale comprised nine items measuring: condomless penile (anal or vaginal) sex, unprotected oral sex, shared toy use, bloodplay, chemsex (consumption of drugs for the facilitation of sex), trading sex for drugs, being 'too out of it' to protect self, injecting risk and group sex. Factor-analytic approaches demonstrated that items met good fit criteria for a single scale. Significant, moderate magnitude, positive relationships were identified between total SUSI score and both RT-18 risk-taking and recent STI testing. Qualitative feedback underscored the importance of culturally-embedded question formulation. The results support the conceptual basis for the instrument, highlighting the need for further scale content refinement to validate the tool and examine sensitivity to change. SUSI is a step towards improving outcome measurement of HIV/BBV/STI transmission risk behaviours in substance use treatment studies with greater inclusiveness of experiences across different population groups.
The prevalence of pain and analgesia use in the Australian population: Findings from the 2011 to 2012 Australian National Health Survey
Publisher: Wiley
Date: 12-09-2017
DOI: 10.1002/PDS.4301
Abstract: Opioid analgesic use and associated adverse events have increased over the last 15 years, including in Australia. Whether this is associated with increased chronic pain prevalence in the Australian population is unknown. This study aimed to estimate (1) the prevalence of chronic pain and analgesia use in the Australian population by age and sex (2) the severity of pain in the population with chronic pain by sex and (3) the distribution of recent pain severity in those using analgesia by age and sex. This study used cross-sectional, nationally representative data collected by the Australian Bureau of Statistics 2011 to 2012 National Health Survey. A total of n = 20 426 participants were included with an overall response rate of 84.8%. Weighting procedures were applied to obtain population estimates, confidence intervals, and when testing for statistical significance. The prevalence of chronic and reoccurring pain (over a 6-month period) was 15.4% (2.75 million) for Australians aged ≥15 years. Prevalence increased with age for both sexes. Significantly more females reported moderate-to-very severe pain overall (P < 0.001), and within most age groups. Recent use of opioid analgesia was reported by 12.0% of males and 13.4% of females with chronic pain. Chronic pain and opioid analgesic use are important public health issues in Australia. Study estimates of chronic pain and recent pain were no greater than earlier estimates. The acknowledged increase of opioid use in the literature thus appears consistent with changing treatment and/or prescribing patterns over time. Sex differences regarding pain prevalence, severity, and opioid use were apparent.
Investigating the role of serotonin in visual orientation processing using an 'ecstasy' (MDMA)-based research model
Publisher: S. Karger AG
Date: 2009
DOI: 10.1159/000253556
Abstract: i Aims/Objectives: /i A growing body of evidence suggests that regular ‘ecstasy’ (3,4-methylenedioxymeth hetamine) use causes lasting changes to central serotonergic functioning in humans, including in the occipital lobe. Serotonin may play a role in visual orientation processing, mediated in the occipital lobe, via lateral inhibition. The tilt aftereffect is an illusion apparent following adaptation to stimuli angled 5–50° from vertical and thought to be affected by lateral inhibition between occipital neurons. A recent study identified an enhanced tilt aftereffect among ecstasy users, but only in a subset that were recently abstinent from hetamines. The current study examined the effects of ecstasy use, cannabis use and their interacting effect on the magnitude of the tilt aftereffect among participants with no recent history of hetamine consumption. i Materials and Methods: /i Eleven ecstasy users, 15 cannabis users, 15 ecstasy plus cannabis users and 15 drug-naïve controls were compared on the magnitude of the tilt aftereffect elicited following adaptation to stimuli angled 15, 30, 40 or 60° from vertical. i Results: /i At a 40° adaptation condition, ecstasy users had a greater magnitude of the tilt aftereffect compared to those that had not taken the drug. Additionally, the extent of ecstasy use was positively associated with the magnitude of the tilt aftereffect generated following 15, 30 and 40° adaptation conditions, but not at 60°. i Conclusions: /i Given that lateral inhibition mediates the tilt aftereffect following adaptation to 5–50°, the findings of a relationship between ecstasy use and tilt magnitude at the 15–40° but not 60° adaptation conditions support a role for serotonin in visual orientation processing via lateral inhibition.
Cohort protocol paper: The Pain and Opioids In Treatment (POINT) study
Publisher: Springer Science and Business Media LLC
Date: 20-03-2014
A Systematic Review and Meta-Analysis of Cognitive Performance among People with Chronic Use of Opioids for Chronic Non-Cancer Pain
Publisher: Oxford University Press (OUP)
Date: 27-01-2021
DOI: 10.1093/PM/PNAB005
Abstract: Opioids, often prescribed for chronic non-cancer pain, may adversely affect cognition. Research has not been synthesized in recent years, during which time academic interest has increased. This study presents meta-analyses on cognitive performance in people taking opioids for chronic non-cancer pain (CNCP). We ran systematic literature searches in EMBASE, Medline, and PsycINFO. Eligible studies included people taking opioids for CNCP, an opioid-free group (i.e., case-control) or session (e.g., pre-post), and objective cognitive assessments. Using random-effects meta-analyses, we computed pooled effect sizes for differential task performance for each study design across five domains (motor performance, attention, working memory, executive functions, memory). Seventeen studies were included. Case-control studies covered three control types (healthy, CNCP, taper-off). Pre-post studies were grouped into five follow-ups (four to six and six to nine weeks three, six, and 12 months). Effect sizes ranged from 0.02–0.62. Cases showed small magnitude impairments in attention and memory compared with healthy controls. Although limited by small s le sizes, there was no clear evidence of impairment in cases compared with opioid-free controls with CNCP. Cases showed some cognitive improvements from opioid-free baseline to follow-up. Effects were strongest for attention and working memory and were apparent from four weeks to six months follow-up. Other effects were small and nonsignificant. Opioid therapy for CNCP did not worsen cognitive performance and improved it for some domains. People who take opioids for CNCP may evidence deficits in attention and memory, but this is unlikely to translate to global impairment and likely relates to pain more so than opioids.
The Epidemiology of Ecstasy Use and Harms in Australia
Publisher: S. Karger AG
Date: 2009
DOI: 10.1159/000253553
Abstract: i Aims: /i This paper examines the epidemiology of ecstasy use and harm in Australia using multiple data sources. i Design: /i The data included (1) Australian Customs Service 3,4-methylenedioxymeth hetamine (MDMA) detections (2) the National Drug Strategy Household and Australian Secondary Student Alcohol and Drug Surveys (3) data from Australia’s ecstasy and Related Drugs Reporting System (4) the number of recorded police incidents for ecstasy possession and distribution collated by the N.S.W. Bureau of Crime Statistics and Research (5) the number of calls to the Alcohol and Drug Information Service and Family Drug Support relating to ecstasy (6) the Alcohol and Other Drug Treatment Services National Minimum Dataset on number of treatment episodes for ecstasy, and (7) N.S.W. Division of Analytical Laboratories toxicology data on number of deaths where MDMA was detected. i Findings: /i Recent ecstasy use among adults in the general population has increased, whereas among secondary students it has remained low and stable. The patterns of ecstasy consumption among regular ecstasy users have changed over time. Polydrug use and use for extended periods of time ( h) remain common among this group. Frequent ecstasy use is associated with a range of risk behaviours and other problems, which tend to be attributed to a number of drugs along with ecstasy. Few ecstasy users present for treatment for problems related to their ecstasy consumption. i Conclusions: /i Messages and interventions to reduce the risks associated with polydrug use and patterns of extended periods of use are clearly warranted. These messages should be delivered outside of traditional health care settings, as few of these users are engaged with such services.
Can the severity of dependence scale be usefully applied to 'ecstasy'?
Publisher: S. Karger AG
Date: 2009
DOI: 10.1159/000253550
Abstract: i Background/Aims: /i Although use of ‘ecstasy’ (drugs sold as containing 3,4-methylenedioxymeth hetamine) is prevalent, it is typically infrequent, and treatment presentations involving ecstasy as a principal problem drug are relatively rare. Human case reports and animal literature suggest dependence potential, although there may be some unique aspects to this syndrome for ecstasy in comparison to other substances. The Severity of Dependence Scale (SDS) was examined to determine whether this could usefully identify ‘dependent’ ecstasy consumers. i Methods: /i We conducted a cross-sectional survey of 1,658 frequent (at least monthly) ecstasy consumers across Australia, assessing drug use, associated harms and risk behaviours. Dependence was evaluated with the SDS, using a cut-off of ≥4 to identify potential ‘dependence’. i Results: /i One fifth of the participants were screened as potentially dependent. These in iduals used ecstasy more frequently, in greater amounts, engaged more extensively in risk behaviours and reported greater role interference than other participants. These findings were independent of meth hetamine use or dependence. The underlying structure of the ecstasy SDS was bifactorial. i Conclusions: /i The SDS has demonstrated construct validity as a screening tool to identify ecstasy users at elevated risk of experiencing adverse consequences, including features of dependence. The underlying structure of dependence symptoms differs for ecstasy compared to other drug classes, and some dependent consumers use the drug infrequently. The unique neurotoxic potential and entactogenic effects of ecstasy may require a distinct nosological classification for the experience of dependence associated with the drug.
Validation of the owls, a screening tool for measuring prescription opioid use disorder in primary care
Publisher: Oxford University Press (OUP)
Date: 31-08-2020
DOI: 10.1093/PM/PNAA275
Abstract: The OWLS is a screening tool for prescription opioid use disorder designed for use in primary care. This study aimed to confirm the optimal wording, scoring methods, and cutoff for the OWLS. Cross-sectional analysis of an online s le. Participants comprised those with chronic noncancer pain who regularly used prescription opioids. Eligible participants self-completed an online version of the OWLS prescription opioid use disorder screening tool and the Composite International Diagnostic Interview Substance Abuse module. Receiver operating characteristics were calculated for three scoring methods for the OWLS, and these were compared with DSM-5 classification of any use disorder and moderate to severe opioid use disorder. Among the s le (N = 324), utilizing scoring method (i) (i.e., positive endorsement ≥ response option “a little bit”) and a cutoff of 3 increased the percentage of correctly classified participants, with concurrent increases in specificity and decreases in false discovery rate, and false positive rate. OWLS utilizing scoring method (i) with a cutoff of 3 was shown to be the optimal version and scoring method of this tool. This represents a time-efficient, simple scoring method, allowing for quick and accurate screening for opioid use disorder to occur.
What predicts pharmacists’ engagement with opioid-outcome screening? Secondary analysis from an implementation study in community pharmacy
Publisher: Springer Science and Business Media LLC
Date: 12-06-2020
Age of Alcohol Initiation and Progression to Binge Drinking in Adolescence: A Prospective Cohort Study
Publisher: Wiley
Date: 21-11-2017
DOI: 10.1111/ACER.13525
Abstract: Early alcohol initiation is common and has been associated with the development of alcohol problems. Yet, past research on the association of age of initiation with later problem drinking has produced inconsistent findings. Using prospective data from the Australian Parental Supply of Alcohol Longitudinal Study cohort, this study examined age of alcohol initiation, and of first drunkenness, and associations with subsequent drinking in adolescence. A total of 1,673 parent-child dyads recruited through Australian secondary schools completed annual surveys for 5 years (grades 7 to 11). Limiting the s le to those adolescents who had initiated alcohol use by age 17 (n = 839), multinomial logistic regression models were used to examine associations between (i) age of initiation to alcohol use (consuming at least 1 full serve) and (ii) age of first drunkenness, and 2 outcomes: (i) binge drinking (consuming >4 standard drinks on a single occasion), and (ii) the total number of alcoholic drinks consumed in the past year, adjusted for a range of potential child, parent, family, and peer covariates. Fifty percent of adolescents reported alcohol use and 36% reported bingeing at wave 5 (mean age 16.9 years), and the mean age of initiation to alcohol use for drinkers was 15.1 years. Age of initiation was significantly associated with binge drinking and total quantity of alcohol consumed in unadjusted and adjusted models. Age of first drunkenness was associated with total quantity of alcohol consumed in unadjusted models but not adjusted models and was not associated with subsequent bingeing. Initiating alcohol use earlier in adolescence is associated with an increased risk of binge drinking and higher quantity of consumption in late secondary school, supporting an argument for delaying alcohol initiation for as long as possible to reduce the risk for problematic use in later adolescence and the alcohol-related harms that may accompany this use.
I like the old stuff better than the new stuff? Subjective experiences of new psychoactive substances
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.DRUGPO.2016.11.004
Abstract: Over the past decade, monitoring systems have identified the rapid emergence of new psychoactive substances (NPS). While the use of many NPS is minimal and transitory, little is known about which products have potential for capturing the attention of significant proportions of the drug consuming market. The aim of this study was to explore self-reported experiences of three commonly used NPS classes within the Australian context (synthetic cathinones, hallucinogenic phenethylamines and hallucinogenic tryptamines) relative to traditional illicit drug counterparts. Frequent psychostimulant consumers interviewed for the Australian Ecstasy and related Drugs Reporting System (EDRS) (n=1208) provided subjective ratings of the pleasurable and negative (acute and longer-term) effects of substances used in the last six months on the last occasion of use, and the likelihood of future use. Stimulant-type NPS (e.g., mephedrone, methylone) were rated less favourably than ecstasy and cocaine in terms of pleasurable effects and likelihood of future use. DMT (a hallucinogenic tryptamine) showed a similar profile to LSD in terms of pleasurable effects and the likelihood of future use, but negative effects (acute and comedown) were rated lower. Hallucinogenic phenethylamines (e.g., 2C-B) showed a similar negative profile to LSD, but were rated as less pleasurable and less likely to be used again. The potential for expanded use of stimulant-type NPS may be lower compared to commonly used stimulants such as ecstasy and cocaine. In contrast, the potential of DMT may be higher relative to LSD given the comparative absence of negative effects.
Pharmaceutical Opioid Use and Dependence among People Living with Chronic Pain: Associations Observed within the Pain and Opioids in Treatment (POINT) Cohort
Publisher: Oxford University Press (OUP)
Date: 09-2015
DOI: 10.1111/PME.12773
Abstract: There is increasing concern about the appropriateness of prescribing pharmaceutical opioids for chronic non-cancer pain (CNCP), given the risks of problematic use and dependence. This article examines pharmaceutical opioid dose and dependence and examines the correlates of each. Baseline data were obtained from a national s le of 1,424 people across Australia (median 58 years, 55% female and experiencing pain for a median of 10 years), who had been prescribed opioids for CNCP. Current opioid consumption was estimated in oral morphine equivalent (OME mg per day), and ICD-10 pharmaceutical opioid dependence was assessed using the Composite International Diagnostic Interview. Current opioid consumption varied widely: 8.8% were taking = 200 mg OME. Greater daily OME consumption was associated with higher odds of multiple physical and mental health issues, aberrant opioid use, problems associated with opioid medication and opioid dependence. A significant minority, 8.5%, met criteria for lifetime ICD-10 pharmaceutical opioid dependence and 4.7% met criteria for past year ICD-10 pharmaceutical opioid dependence. Multivariate analysis found past-year dependence was independently associated with being younger, exhibiting more aberrant behaviors and having a history of benzodiazepine dependence. In this population of people taking opioids for CNCP, consumption of higher doses was associated with increased risk of problematic behaviors, and was more likely among people with a complex profile of physical and mental health problems.
Diversion of prescribed opioids by people living with chronic pain: Results from an A ustralian community sample
Publisher: Wiley
Date: 20-11-2013
DOI: 10.1111/DAR.12084
Abstract: There has been an increase in prescription of opioids for chronic non-cancer pain, and concern exists over possible ersion of prescription opioids to the illicit marketplace. Recent media coverage suggests that elderly patients sell their prescribed opioids for additional income. This study investigated the extent to which an Australian community s le of chronic pain patients prescribed opioids reported supplying their prescribed opioids to others. Participants living with chronic non-cancer pain and prescribed opioids for their pain (n=952) were recruited across Australia via advertisements at pharmacies. A telephone interview included questions about their pain condition and opioid medication. Participants had been living with pain for a mean of 14.2 years most common conditions included chronic back/neck problems and arthritis/rheumatism. Around half (43%) were currently prescribed one opioid, and 55% had been prescribed 2-5 opioids the most common was oxycodone. Forty-two participants (4%) reported ever supplying prescribed opioids to another person one participant reported receiving payment. Participants who supplied opioids to others were younger (odds ratio 0.97, 95% confidence interval 0.95-0.99) and engaged in a greater number of aberrant behaviours relating to their opioid medication (odds ratio 1.77, 95% confidence interval 1.45-2.17), including t ering with doses, taking opioids by alternative routes, seeing doctors to obtain extra opioids and refilling prescriptions early. Few people with chronic non-cancer pain ert their opioids to others. Media reports of elderly patients selling their opioids to supplement their income may be reflective of exceptional cases. Future studies may investigate the extent to which other patient groups ert prescription opioids to the illicit marketplace.
Cannabinoid polymorphisms interact with plasma endocannabinoid levels to predict fear extinction learning
Publisher: Hindawi Limited
Date: 20-06-2021
DOI: 10.1002/DA.23170
Cognitive impairment following consumption of alcohol with and without energy drinks
Publisher: Wiley
Date: 04-2015
DOI: 10.1111/ACER.12680
Abstract: The aim of this study was to assess the relative effects of alcohol mixed with energy drink (AmED) versus alcohol alone on cognitive performance across the ascending and descending breath alcohol concentration (BrAC) limb using doses similar to real-world intake. Using a single-blind, placebo-controlled, crossover design, 19 participants completed 4 sessions where they received: (i) placebo, (ii) alcohol, (iii) AmED 500 ml energy drink (ED), and (iii) AmED 750 ml ED. Performance on measures of psychomotor function (Compensatory Tracking Task [CTT]), information processing (Digit Symbol Substitution Task [DSST] Inspection Time Task [ITT]), and response inhibition (Brief Stop-Signal Task [Brief SST]) was assessed at ~0.05% ascending BrAC, ~0.08% peak BrAC, and ~0.05% descending BrAC. The ITT and Brief SST showed no differential effect of AmED versus alcohol (gs < 0.30 and gs 0.45 and gs > 0.37, respectively). A moderate magnitude decrease in DSST errors was also observed after AmED relative to alcohol at 0.050% ascending target BrAC (gs > 0.43). Changes in cognitive function after AmED administration were dependent on the degree of intoxication, BrAC curve limb, and ED volume. Co-administration of ED doses which matched (500 ml) and exceeded (500 ml) maximum daily intake guidelines with alcohol decreased impairment of psychomotor function and global information processing after alcohol consumption. These results cannot be necessarily interpreted to suggest that people are less impaired after AmED, as behavior is the result of coordination of multiple cognitive functions, and reduced impairment on one aspect of cognition may not translate into global improvements.
Validation of the Australian Treatment Outcomes Profile for use in clients with cannabis dependence
Publisher: Wiley
Date: 04-03-2020
DOI: 10.1111/DAR.13050
Commentary on Ort etal. (2014): What next to deliver on the promise of large scale sewage-based drug epidemiology?
Publisher: Wiley
Date: 08-07-2014
DOI: 10.1111/ADD.12651
Effect on the emotions of healthy individuals of slow repetitive transcranial magnetic stimulation applied to the prefrontal cortex
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2001
DOI: 10.1097/00124509-200109000-00007
Abstract: Recent studies indicate that both slow and fast repetitive transcranial magnetic stimulation (rTMS) have a mood-elevating effect in major depressive episodes. The effect of slow rTMS on the emotions of healthy in iduals has not been examined. We studied the effects of slow rTMS applied to the left and right prefrontal cortex (PFC) of 18 healthy in iduals. Active and sham stimulation was applied to both sides of all in iduals. Stimulation was with a 9-cm figure-of-eight coil at the following parameters: 110% of motor threshold, 1 Hz, single train of 500 stimuli. Depression, happiness, irritability, and anxiety were measured before and 5, 30, and 240 min after stimulation using visual analogue scales. A sleep questionnaire was completed the morning after each stimulation session. A new method of providing sham was used. Slow rTMS applied to the PFC did not produce significant changes in the emotions of healthy in iduals nor was sleep influenced. In conclusion, slow rTMS at these parameters applied to the PFC does not produce significant changes in the emotions of healthy in iduals.
The overall effect of parental supply of alcohol across adolescence on alcohol-related harms in early adulthood—a prospective cohort study
Publisher: Wiley
Date: 06-03-2020
DOI: 10.1111/ADD.15005
Alcohol use and risk taking among regular ecstasy users
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/10826080500411528
Abstract: We examine alcohol use in conjunction with ecstasy use and risk-taking behaviors among regular ecstasy users in every capital city in Australia. Data on drug use and risks were collected in 2004 from a national s le of 852 regular ecstasy users (persons who had used ecstasy at least monthly in the preceding 6 months). Users were grouped according to their typical alcohol use when using ecstasy: no use, consumption of between one and five standard drinks, and consumption of more than five drinks ("binge" alcohol use). The s le was young, well educated, and mainly working or studying. Approximately two thirds (65%) of the regular ecstasy users reported drinking alcohol when taking ecstasy. Of these, 69% reported usually consuming more than five standard drinks. Those who did not drink alcohol were more disadvantaged, with greater levels of unemployment, less education, higher rates of drug user treatment, and prison history. They were also more likely than those who drank alcohol when using ecstasy to be drug injectors and to be hepatitis C positive. Excluding alcohol, drug use patterns were similar between groups, although the no alcohol group used cannabis and meth hetamine more frequently. Binge drinkers were more likely to report having had three or more sexual partners in the past 6 months and were less likely to report having safe sex with casual partners while under the influence of drugs. Despite some evidence that the no alcohol group were more entrenched drug users, those who typically drank alcohol when taking ecstasy were as likely to report risks and problems associated with their drug use. It appears that regular ecstasy users who binge drink are placing themselves at increased sexual risk when under the influence of drugs. Safe sex messages should address the sexual risk associated with substance use and should be tailored to reducing alcohol consumption, particularly targeting "heavy" alcohol users. The study's limitations are noted.
Measuring spatial and temporal trends of nicotine and alcohol consumption in Australia using wastewater-based epidemiology.
Publisher: Wiley
Date: 26-02-2018
DOI: 10.1111/ADD.14157
Abstract: Tobacco and alcohol consumption remain priority public health issues world-wide. As participation in population-based surveys has fallen, it is increasingly challenging to estimate accurately the prevalence of alcohol and tobacco use. Wastewater-based epidemiology (WBE) is an alternative approach for estimating substance use at the population level that does not rely upon survey participation. This study examined spatio-temporal patterns in nicotine (a proxy for tobacco) and alcohol consumption in the Australian population via WBE. Daily wastewater s les (n = 164) were collected at 18 selected wastewater treatment plants across Australia, covering approximately 45% of the total population. Nicotine and alcohol metabolites in the s les were measured using liquid chromatography-tandem mass spectrometry. Daily consumption of nicotine and alcohol and its associated uncertainty were computed using Monte Carlo simulations. Nation-wide daily average and weekly consumption of these two substances were extrapolated using ordinary least squares and mixed-effect models. Nicotine and alcohol consumption was observed in all communities. Consumption of these substances in rural towns was three to four times higher than in urban communities. The spatial consumption pattern of these substances was consistent across the monitoring periods in 2014-15. Nicotine metabolites significantly reduced by 14-25% (P = 0.001-0.008) (2014-15) in some catchments. Alcohol consumption remained constant over the studied periods. Strong weekly consumption patterns were observed for alcohol but not nicotine. Nation-wide, the daily average consumption per person (aged 15-79 years) was estimated at approximately 2.5 cigarettes and 1.3-2.0 standard drinks (weekday-weekend) of alcohol. These estimates were close to the sale figure and apparent consumption, respectively. Wastewater-based epidemiology is a feasible method for objectively evaluating the geographic, temporal and weekly profiles of nicotine and alcohol consumption in different communities nationally.
Parent characteristics associated with approval of their children drinking alcohol from ages 13 to 16 years: prospective cohort study
Publisher: Elsevier BV
Date: 08-2018
Abstract: We investigated parent sociodemographic and drinking characteristics in relation to whether they approved of their children drinking at ages 13, 14, 15 and 16 years. We collected data annually from 2010-2014, in which 1,927 parent-child dyads, comprising school students (mean age 12.9 years at baseline) and one of their parents, participated. Our operational definition of parental approval of children drinking was based on the behaviour of parents in pre-specified contexts, reported by children. We measured parents' drinking with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scale and performed logistic regression to estimate associations between exposures and each wave of outcomes. Parents' approval of their children's drinking increased from 4.6% at age 13 years to 13% at age 16 years and was more common in parents of daughters than parents of sons (OR 1.62 95%CI: 1.23 to 2.12). Parents in low-income families (OR 2.67 1.73 to 4.12), single parents (OR 1.62 1.17 to 2.25), parents with less than a higher school certificate (OR 1.54 1.07 to 2.22), and parents who drank more heavily (OR 1.17 1.09 to 1.25) were more likely to approve of their child drinking. Socially disadvantaged parents were more likely to approve of their children drinking alcohol. Implications for public health: The findings identify high-risk groups in the population and may help explain the socioeconomic gradients in alcohol-related morbidity and mortality seen in many countries.
Valid Points, But the Trends Remain: A Response to Rossheim, Suzuki, and Thombs (In Press)
Publisher: Wiley
Date: 29-07-2013
DOI: 10.1111/ACER.12202
The sources of pharmaceuticals for problematic users of benzodiazepines and prescription opioids
Publisher: AMPCo
Date: 03-2013
DOI: 10.5694/MJA13.11331
Abstract: • Guidelines reflecting contemporary clinical practice in the management of Buruli ulcer (Mycobacterium ulcerans infection) in Australia were published in 2007. • Management has continued to evolve, as new evidence has become available from randomised trials, case series and increasing clinical experience with oral antibiotic therapy. • Therefore, guidelines on the diagnosis, treatment and prevention of Buruli ulcer in Australia have been updated. They include guidance on the new role of antibiotics as first-line therapy the shortened duration of antibiotic treatment and the use of all-oral antibiotic regimens the continued importance, timing and role of surgery the recognition and management of paradoxical reactions during antibiotic treatment and updates on the prevention of disease.
Eye movement and visual motion perception in schizophrenia II: global coherent motion as a function of target velocity and stimulus density
Publisher: Springer Science and Business Media LLC
Date: 14-06-2007
DOI: 10.1007/S00221-007-1003-3
Abstract: Coherent global motion is a compelling illusion of visual motion that is seen as the result of spatially and successively presented stimuli that are, in fact, stationary. In the present study the threshold perception of global coherent motion was measured using random-dot kinematograms in a group of normal observers and a group with mixed symptoms in schizophrenia who also participated in a companion study on smooth pursuit eye movement (Slaghuis et al. in Exp Brain Res, 2007). The velocity of coherent motion target stimuli was produced by varying the spatial step-size (Deltas) between dots to create three target velocities (6.0, 12.0 and 24.0 deg/s) which were measured at three target stimulus densities (100, 200, and 400 dots/deg(2)). A staircase procedure was used to determine the threshold for the number of target dots that was needed to move in the same direction to detect the direction of motion and which were plotted amongst a field of randomly moving visual noise dots. The findings demonstrate that in comparison with normal observers, the threshold for the perception of coherent motion in the group with schizophrenia was significantly higher at the lowest target velocity of 6.0 deg/s but not at target velocities of 12.0 and 24.0 deg/s. Stimulus density was found to have a significant effect on the perception of coherent motion, but it had no differential effect on performance in the groups. An examination of relationships between coherent motion and smooth pursuit eye movement in the companion study (Slaghuis et al. in Exp Brain Res, 2007) revealed significant, negative, correlations between coherent motion and apparent motion smooth pursuit eye velocity at target velocities of 6.0, 12.0 and 24.0 deg/s in the group with schizophrenia, but no such relationship was found in normal observers. It was concluded that the significant reduction in sensitivity for the perception of coherent motion at the lowest target velocity of 6.0 deg/s in the group with schizophrenia is consistent with an impairment in the detection of visual motion at a local level and in parallel for all parts of the image at striate and extrastiate levels of visual processing.
Young adults who mix alcohol with energy drinks: Typology of risk-taking behaviour
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.ADDBEH.2015.02.012
Abstract: Contrary to predictions, several studies have shown that people who consume alcohol mixed with energy drinks (AmED) display low odds of risk-taking during AmED versus alcohol drinking sessions. However, these results are based on treating AmED consumers as a homogeneous group. The aim of the present study was to determine typologies of AmED risk-taking behaviour amongst consumers, as well as identifying correlates of AmED risk-taking class membership. AmED consumers (N=403) completed an online survey where they reported whether they had engaged in risk behaviours in the preceding six months during AmED and alcohol drinking sessions. Latent class models were estimated based on AmED risk-taking data univariate multinomial logistic regression was conducted to determine correlates of class membership. A 3-class model was selected based on fit and parsimony, identifying: 1) Low risk-taking consumers (38%): low probability of any AmED risk behaviours 2) disinhibited intake consumers (48%): high probability of drinking and spending more than intended and 3) high risk-taking consumers (14%): high probability of most AmED risk behaviours assessed. The latter two groups had significantly higher odds of being male and reporting hazardous alcohol use, more frequent AmED use, greater alcohol and ED intake in AmED sessions, and higher trait impulsivity scores. The latter two groups also reported significantly greater odds of risk-taking behaviours regardless of whether consuming alcohol only or AmED. AmED consumers are not a homogeneous group in regard to their risk-taking behaviours post-consumption. High likelihood of risk-taking behaviour in AmED sessions, as well as elevated risk-taking in alcohol drinking sessions, highlights the need for targeted harm minimisation policies and programmes for a significant minority of consumers.
Knowledge of opioid overdose and attitudes to supply of take-home naloxone among people with chronic noncancer pain prescribed opioids
Publisher: Oxford University Press (OUP)
Date: 13-03-2018
DOI: 10.1093/PM/PNX021
Abstract: Take-home naloxone (THN) is recommended in response to pharmaceutical opioid-related mortality. Some health professionals are reluctant to discuss THN for fear of causing offense. The aims of this study were to assess knowledge of opioid overdose and attitudes toward THN for opioid overdose reversal in people with chronic noncancer pain (CNCP). Prospective cohort study. Australia, September to October 2015. A subset of participants (N = 208) from a cohort of people prescribed restricted opioids for CNCP. Questions added in the two-year telephone interviews examined knowledge of overdose symptoms and attitudes toward community supply of naloxone. Associations with overdose risk factors and naloxone supply eligibility criteria with attitudes toward naloxone were explored. Fourteen percent reported ever experiencing opioid overdose symptoms. Participants correctly identified fewer than half of the overdose signs and symptoms. After receiving information on naloxone, most participants (60%), thought it was a "good" or "very good" idea. Few participants reported that they would be "a little" (N = 21, 10%) or "very" offended (N = 7, 3%) if their opioid prescriber offered them naloxone. Positive attitudes toward THN were associated with male gender (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.09-3.50), past year cannabis use (OR = 2.52, 95% CI = 1.03-6.16), and past year nicotine use (OR = 2.11, 95% CI = 1.14-3.91). Most participants had positive attitudes toward THN but low knowledge about opioid overdose symptoms. Strategies for educating patients and their caregivers on opioid toxicity are needed. THN may be best targeted toward those with risk factors in terms of overdose prevention and acceptability.
Filtration of crushed tablet suspensions has potential to reduce infection incidence in people who inject drugs
Publisher: Wiley
Date: 06-09-2015
DOI: 10.1111/DAR.12196
Abstract: The medical complications of injecting preparations from crushed tablets can be severe, and most can be attributed to the injection of insoluble particles and micro-organisms. Previously we have shown that most of the particles can be removed by filtration, but it was not known whether bacteria could also be filtered in the presence of a high particle load. This study aims to determine the feasibility of filtration to remove bacteria from injections prepared from tablets. Injections were prepared from crushed slow-release morphine tablets, in mixed bacterial suspensions of Staphylococcus aureus, Streptococcus pyogenes and Pseudomonas aeruginosa. The injection suspensions were passed through syringe filters of porosity 0.45 or 0.20 μm, or combined 0.8 then 0.2 μm, and the bacterial load was counted. Bacterial concentrations in unfiltered injections were 2.5-4.3 × 10(6) colony forming units mL(-1) . Both the 0.20 and 0.45 μm filters blocked unless a prefilter (cigarette filter) was used first. The 0.2 μm filter and the combined 0.8/0.2 μm filter reduced the bacteria to the limit of detection (10 colony forming units mL(-1) ) or below. Filtration through a 0.45 μm filter was slightly less effective. Use of a 0.2 μm filter, together with other injection hygiene measures, offers the prospect of greatly reducing the medical complications of injecting crushed tablets and should be considered as a highly effective harm reduction method. It is very likely that these benefits would also apply to other illicit drug injections, although validation studies are needed.
Implementing real-time prescription drug monitoring: Are we ready?
Publisher: Wiley
Date: 09-2014
DOI: 10.1111/DAR.12195
Pharmaceutical opioid analgesic and heroin dependence: How do treatment‐seeking clients differ in Australia?
Publisher: Wiley
Date: 05-2011
DOI: 10.1111/J.1465-3362.2011.00302.X
Abstract: Non-prescribed use of pharmaceutical opioid analgesics (POA) has been escalating internationally. In Australia, few studies have examined if POA users have similar characteristics and treatment needs to heroin users. The aim of this study was to compare those presenting for treatment where heroin versus POA were the primary drugs of concern. A convenience s le of 192 treatment entrants were recruited from alcohol and drug treatment services in four Australian jurisdictions. A structured interview collected data on demographic characteristics, substance use, self-perceived mental and physical health, crime and harms resulting from drug use. Multivariate analyses were performed to identify characteristics which may differentiate those seeking treatment for heroin compared with POA. Most treatment entrants s led reported a history of injection drug use and use of both heroin and POA. However, those with primary POA problems were less likely to report an overdose history (adjusted odds ratio 0.90, 95% confidence interval 0.81-0.99) and more likely to initiate opioid use for pain (adjusted odds ratio 2.52, 95% confidence interval 1.04-6.12) than those with primary heroin problems. Latent Class Analysis found that, while most of the POA group were similar to heroin users in demographics, health and injecting drug use, there was a small, distinct group of primary POA problem users that did not typically inject and who commonly initiated opioid use for pain and also experienced elevated physical and mental health disability. While some differences existed, this study of Australian treatment seekers found many similar characteristics between those with primary problems with heroin and POA. Few non-injecting POA were recruited in this s le. This finding contrasts with reports of a growing population of opioid-dependent people with characteristics that are distinct from traditional opioid-dependent populations, which may reflect the orientation of current treatment systems in Australia towards injection drug users.
Aggression in the Australian night time economy: A comparison of alcohol only versus alcohol and illicit drug consumption
Publisher: Wiley
Date: 23-10-2019
DOI: 10.1111/DAR.12998
Abstract: Associations between substance use and aggression may be lified by simultaneous alcohol and illicit drug use. This study aims to compare differences in involvement in past aggression between people who use different substances while accounting for broader risk propensity. Self-reported data on past three-month involvement in verbal and physical aggression (victim or perpetrator) were drawn from interviews conducted in night-time entertainment districts in seven Australian cities (n = 5078). Using inverse probability of treatment weighting techniques, participants who reported alcohol versus alcohol and illicit drug use on the night of interview (including ecstasy, cannabis and other illicit stimulant subgroups) were weighted on the basis of drug use risk covariates (e.g. alcohol consumed, gender) to determine differences in involvement in aggression involvement. After weighting for covariates, in iduals who reported consuming any illicit drug + alcohol and ecstasy + alcohol combinations were more likely to be involved in physical (33% and 105%, respectively) and verbal (36% and 116%, respectively) aggression in the previous 3-months when compared to those who consumed alcohol only. Cannabis + alcohol and other illicit stimulant + alcohol combinations were no more likely to be involved in either forms of aggression. The likelihood of having been involved in past aggressive incidents was higher among those who reported any illicit drug + alcohol and ecstasy + alcohol combinations than those who reported alcohol exclusively, after accounting for covariates. These findings highlight in iduals that may benefit most from the development of tailored health promotion reventative safety interventions in night-time settings.
Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic noncancer pain: Do different measures identify the same patients?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-03-2016
DOI: 10.1097/J.PAIN.0000000000000548
Abstract: The International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM) are routinely used in diagnosing illicit substance use disorders, but for people taking prescribed opioids they remain controversial. In pain medicine, the concept of “Addiction” is preferred with reduced emphasis on tolerance and withdrawal. This article examines the prevalence and characteristics of pharmaceutical opioid dependence/disorder according to ICD, DSM, and the pain medicine concept of “Addiction,” among chronic noncancer pain (CNCP) patients prescribed opioids. In the current study, we used data from a national s le of 1134 people prescribed opioids for CNCP. Past 12-month “Addiction” (based on Pain Medicine definition), DSM, and ICD dependence definitions were assessed using the Composite International Diagnostic Interview. Twenty-four percent of the cohort met the criteria for “Addiction,” 18% for DSM-5 use disorder and 19% for ICD-11 dependence. There was “substantial” concordance between “Addiction” and both DSM-5 use disorder and ICD-11 dependence, although concordance was much greater with ICD-11 dependence (kappa = 0.63 and 0.79, respectively). Participants meeting the criteria for “Addiction” only were older, less likely to engage in nonadherent behaviours, self-reported fewer problems or concerns with their medication, and had lower rates of psychological distress than those who also met the DSM-5 and ICD-11 criteria. The definition of “Addiction” captures a larger group of patients than other classification systems and includes people with fewer “risk” behaviours. Despite removal of tolerance and withdrawal for prescribed opioid use for DSM-5, we found that “Addiction” was more closely related to an ICD-11 diagnosis of pharmaceutical opioid dependence.
Agreement between definitions of pharmaceutical opioid use disorders and dependence in people taking opioids for chronic non-cancer pain (POINT): a cohort study
Publisher: Elsevier BV
Date: 04-2015
Khat withdrawal symptoms among chronic khat users following a quit attempt: An ecological momentary assessment study
Publisher: American Psychological Association (APA)
Date: 05-2018
DOI: 10.1037/ADB0000368
Abstract: Research reports show increased prevalence of habitual khat chewing among various parts of the community in Ethiopia. Some users experience problems controlling their use withdrawal symptoms may be adding to difficulties with reducing or ceasing use. We aimed to describe the nature and the time course of any withdrawal syndrome in relation to the cessation of khat use over the first 2 weeks of a quit attempt. Fifty-nine participants between the ages of 18 and 35 and who have already chewed ≥1 bundle of khat in their life with a chewing frequency of ≥3 days per week were recruited from Adama Science and Technology University c us. Participants were predominantly male (n = 45, 75%) and had the mean age of 24.8 years (range = 20-32 SD = 2.8). Participants used smart phones to monitor withdrawal symptoms and cravings. The total assessments were ided in to 3 prequit and 14 postquit days. The development of withdrawal symptoms was evident, and all withdrawal symptoms followed similar overall patterns, with salient elevations after the quit day and curvatures around the first week of postquit period. Depression, craving, nervousness, tiredness, restlessness, poor motivation, irritability, and negative affect substantially increased and reached peak on the first week around Day 7 and remained higher compared with the level at baseline indicating the persistence and severity of these symptoms over time. In addition, craving, irritability, and restlessness had significantly reverted to their baseline level during the second week of the postquit duration. We have demonstrated low rates of success during unaided quite attempts from khat and that the withdrawal syndrome is not trivial. Interventions are necessary to support in iduals during the period of increased symptoms of dysphoria and to reduce the risk of relapse. (PsycINFO Database Record
Comparison of unlimited numbers of rapid transcranial magnetic stimulation (rTMS) and ECT treatment sessions in major depressive episode
Publisher: Oxford University Press (OUP)
Date: 06-2000
The rise of new psychoactive substance use in Australia
Publisher: Wiley
Date: 05-03-2014
DOI: 10.1002/DTA.1626
Abstract: New Psychoactive Substances are now a feature of Australia's recreational drug market. Little is known, however, about the prevalence of use, the characteristics of people who use them and the relationship between the NPS and ecstasy markets. This study examined the prevalence and correlates of NPS use amongst a group of regular ecstasy users in Australia. Participants were recruited if they had used ecstasy at least six times in the previous six months, lived in a capital city and were over 16 years of age. Purposive s ling was used, recruiting through universities and colleges, word of mouth and street press. 654 participants were recruited in 2013. Respondents who had used an NPS in the past six months were compared to those who had not. NPS were used by 44% of the total s le. In 2013 2C-I (14%) and 2C-B (8%) were the most prevalent NPS. Respondents in the NPS group were younger and reported more frequent use of more types of drugs. They were also more likely to rate the purity of ecstasy as low relative to those in the no NPS group. NPS are now an established part of Australia's recreational drug scene and NPS with hallucinogenic effects are now used most commonly. Monitoring systems need to develop capacity to monitor this highly dynamic market.
Validity and reliability of the computer-administered routine opioid outcome monitoring (ROOM) tool
Publisher: Oxford University Press (OUP)
Date: 23-10-2020
DOI: 10.1093/PM/PNAA297
Abstract: The Routine Opioid Outcome Monitoring (ROOM) tool measures outcomes with opioids using an established framework which includes domains such as pain, mood, opioid use disorder, alcohol use, and constipation. This study aims to validate and establish the test-retest reliability of the computer-administered ROOM tool. Cross-sectional analysis of an online s le. Participants comprised those with chronic noncancer pain who regularly used prescription opioids. Participants self-completed the online ROOM tool along with other validated measures (validation questionnaire), and those who were agreeable also completed the online test-retest questionnaire approximately two weeks later. Subcomponents of the ROOM tool (i.e., pain, mood, alcohol use, opioid use disorder, and constipation) were validated against longer measures of the same construct using Pearson correlation coefficients. Intraclass correlation coefficients were used to assess the stability of the ROOM tool over time. A total of 324 participants completed the validation questionnaire, of whom 260 also completed the test-retest questionnaire. The opioid use disorder domain showed good sensitivity (73.6) and specificity (75.8) against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, any opioid use disorder. All ROOM components showed moderate correlation (r = 0.55–0.73) with their longer counterparts. Test-retest reliability was fair (0.58–0.75), indicating that responses were relatively stable over time. Reliability did vary, however, based on the components being measured and how certain tools were scored. The computer-administered ROOM tool is a valid approach for brief monitoring of outcomes with prescribed opioids in primary care settings and appears to be acceptable to people who are using prescribed opioids for chronic pain.
Clinical correlates and outcomes associated with pregabalin use among people prescribed opioids for chronic non‐cancer pain: A five‐year prospective cohort study
Publisher: Wiley
Date: 26-01-2021
DOI: 10.1111/BCP.14715
Abstract: Pregabalin has become widely used as an alternative to opioids in treating certain types of chronic non‐cancer pain, but few studies have examined its clinical efficacy outside trials. We address this gap by examining the utilization, correlates and clinical outcomes of pregabalin use among an Australian community‐based cohort of people prescribed opioids for chronic non‐cancer pain. Through a five‐year prospective cohort study ( n = 1514) we examined associations between pregabalin use and pain severity and interference, mental health, opioid dose and past month use of ambulance and emergency department services. We used fixed‐effects regression models to examine within‐participant differences, and random‐effects regression models to examine within‐ and between‐participant differences in clinical outcomes. In an analysis of cases with complete data over five‐years ( n = 896), the prevalence of pregabalin use ranged from 16% at cohort entry to 29% at 36‐ and 48‐months, and 46% reported pregabalin use at any time during the five years. Pregabalin use was associated with greater pain severity and interference and greater use of high‐risk opioid doses ( oral morphine equivalents/day). Pregabalin use was not associated with changes in mental health symptoms, ambulance or emergency department attendance in the fixed or random effects models. Pregabalin use was common, but for most people use was not associated with clinically meaningful improvements in pain or functioning.
Risk factors for indicators of opioid-related harms amongst people living with chronic non-cancer pain: Findings from a 5-year prospective cohort study
Publisher: Elsevier BV
Date: 11-2020
Estimating the proportion of prescription opioids that is consumed by people who inject drugs in Australia
Publisher: Wiley
Date: 25-07-2013
DOI: 10.1111/DAR.12066
Abstract: To estimate the contribution that people who inject drugs (PWID) make to population-level use of prescription opioids in Australia. Data on prescriptions of oxycodone, morphine and methadone tablets were obtained for New South Wales, Victoria, Tasmania and Queensland, and time series analyses used to characterise the trends from 2002 to 2010. Estimates of the number of PWID were combined with data on their levels, frequency and typical doses of morphine, methadone tablet (only prescribed in Australia for pain) and oxycodone from 2004 to 2010. Estimated consumption per 1000 PWID and per 1000 persons aged 20-69 years was contrasted and the proportion of total consumption accounted for by PWID estimated. Morphine prescribing declined oxycodone prescribing increased. PWID had far higher rates of prescription opioid consumption (defined daily doses per 1000) than the general population. Tasmania had highest use of prescribed opioids. PWID contribution to morphine consumption in Tasmania increased to 28% (range 22-37%) in 2010 elsewhere, PWID contribution was lower (midpoints of 2-12%, 2010). Methadone tablet use was less elevated compared with the general population. With the exception of Tasmania, PWID were estimated to consume less than 5% of oxycodone. PWID use prescription opioids at high levels and can account for a significant proportion of consumption. Increased oxycodone prescribing in Australia has not been driven by PWID. Opioid substitution therapy and other effective treatments need to be more available and attractive to PWID.
Development of a brief tool for monitoring aberrant behaviours among patients receiving long-term opioid therapy: The Opioid-Related Behaviours In Treatment (ORBIT) scale
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.DRUGALCDEP.2015.11.026
Abstract: Early identification of problems is essential in minimising the unintended consequences of opioid therapy. This study aimed to develop a brief scale that identifies and quantifies recent aberrant behaviour among erse patient populations receiving long-term opioid treatment. 40 scale items were generated via literature review and expert panel (N=19) and tested in surveys of: (i) N=41 key experts, and (ii) N=426 patients prescribed opioids >3 months (222 pain patients and 204 opioid substitution therapy (OST) patients). We employed item and scale psychometrics (exploratory factor analyses, confirmatory factor analyses and item-response theory statistics) to refine items to a brief scale. Following removal of problematic items (poor retest-reliability or wording, semantic redundancy, differential item functioning, collinearity or rarity) iterative factor analytic procedures identified a 10-item unifactorial scale with good model fit in the total s le (N=426 CFI=0.981, TLI=0.975, RMSEA=0.057), and among pain (CFI=0.969, TLI=0.960, RMSEA=0.062) and OST subgroups (CFI=0.989, TFI=0.986, RMSEA=0.051). The 10 items provided good discrimination between groups, demonstrated acceptable test-retest reliability (ICC 0.80, 95% CI 0.60-0.89 Cronbach's alpha=0.89), were moderately correlated with related constructs, including opioid dependence (SDS), depression and stress (DASS subscales) and Social Relationships and Environment domains of the WHO-QoL, and had strong face validity among advising clinicians. The Opioid-Related Behaviours In Treatment (ORBIT) scale is brief, reliable and validated for use in erse patient groups receiving opioids. The ORBIT has potential applications as a checklist to prompt clinical discussions and as a tool to quantify aberrant behaviour and assess change over time.
Development of a brief patient-administered screening tool for prescription opioid dependence for primary care settings
Publisher: Oxford University Press (OUP)
Date: 07-10-2020
DOI: 10.1093/PM/PNZ213
Abstract: To develop a short, patient-administered screening tool that will allow for earlier assessment of prescription opioid dependence (often referred to as addiction) in primary care settings. Cross-sectional analysis (N = 1,134) from the two-year time point of the Pain and Opioids IN Treatment (POINT) cohort was used in the scale development. Participants who completed two-year interviews in the POINT study, a prospective cohort study that followed people with chronic noncancer pain over a five-year period, and who were prescribed strong opioids for a minimum of six weeks at baseline. An advisory committee provided advice on wording and content for screening in primary care settings. Univariate logistic regression identified in idual items that were significantly associated with meeting ICD-11 criteria for prescription opioid dependence. Exploratory and confirmatory factor analysis (EFA and CFA) were conducted, and items were reduced to identify a small item set that were discriminative and shared a simple underlying structure. Sixty-four variables associated with ICD-11 criteria for prescription opioid dependence were initially identified. Four rounds of EFA were performed, resulting in five items remaining. CFA identified two possible four-item combinations, with the final combination chosen based on greater item endorsement and the results of goodness-of-fit indices. Addressing prescription opioid dependence is an important part of the global public health challenge surrounding rising opioid-related harm. This study addresses an important initial requisite step to develop a brief screening tool. Further studies are required to validate the tool in clinical settings.
Are shame and guilt personality styles associated with different alcohol use-related outcome expectancies?
Publisher: Informa UK Limited
Date: 14-09-2022
Chloroform-based liquid-liquid extraction and LC–MS/MS quantification of endocannabinoids, cortisol and progesterone in human hair
Publisher: Elsevier BV
Date: 07-2021
Clinical Significance and Outcomes in Trial of Nabiximols for Treatment of Cannabis Dependence - Reply
Publisher: American Medical Association (AMA)
Date: 2020
Nabiximols for the Treatment of Cannabis Dependence: A Randomized Clinical Trial
Publisher: American Medical Association (AMA)
Date: 09-2019
Changes in non-opioid substitution treatment episodes for pharmaceutical opioids and heroin from 2002 to 2011
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.DRUGALCDEP.2015.02.004
Abstract: There has been a well-documented increase in the non-medical use of pharmaceutical opioids (PO) worldwide. However, there has been little detailed examination of treatment demand, or the characteristics of those presenting for treatment, particularly for treatments other than opioid substitution. Data from closed drug and alcohol treatment episodes from the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS, representing non-opioid substitution treatment) in Australia for 2002-2003 to 2010-2011 were examined. In the four jurisdictions where detailed data were available, episodes where heroin was the principal drug of concern were compared to episodes for the four most frequently reported pharmaceutical opioids (morphine, codeine, fentanyl and oxycodone). In 2002-2003, most (93%) opioid treatment was related to heroin with seven percent of all opioid treatment episodes reporting a PO as the principal drug of concern. In 2010-2011, 20% of all opioid treatment episodes were attributed to POs. Distinct changes over time were observed for different opioids. There was an increase in the average age at the start of treatment for heroin and oxycodone episodes, and a reduction in the proportion of females for codeine episodes, with 67% in 2002-2003 compared with 44% in 2010-2011. Codeine and oxycodone episodes had the lowest current or past injection rates. Clear differences were observed over time and between different opioids. Monitoring these emerging patterns will be important to inform treatment needs, particularly in light of different patterns of poly drug use, different routes of administration and changing demographic characteristics.
The association between parental supply of alcohol and supply from other sources to young people: a prospective cohort
Publisher: Wiley
Date: 24-03-2020
DOI: 10.1111/ADD.15033
Stopping khat use: Predictors of success in an unaided quit attempt
Publisher: Wiley
Date: 30-10-2018
DOI: 10.1111/DAR.12622
Abstract: Despite the adverse effects of khat use and chewers interest in cessation, there are few studies that have reported on the outcome of khat cessation attempts, and limited resources available for potential quitters. We used electronic diaries to monitor the outcomes of an unassisted quit attempt among daily and near daily khat consumers, and examine predictors of success. Sixty participants between the ages of 18 and 35 years who regularly chewed khat and who were attempting to quit were purposively recruited from an Ethiopian University c us. Real-time prospective daily recording of khat use was obtained for an average of 10 days prior to quit day (range 6-13) and 28 post-quit days (range 9-31), using an electronic diary. Almost all (95%) achieved initial abstinence. Of these, 80% reached at least seven continuous days of abstinence 7% maintained continuous abstinence for 28 days post-quit. While 93% lapsed (average 11 days post-quit, SD = 7), only a smaller proportion relapsed (41%: chewed for at least three consecutive days after at least 5 days of abstinence). No demographic factors were predictive of successful abstinence. Regular khat chewers have difficulties in maintaining abstinence despite having motivation and desire to quit. This implies that treatment aids may be needed to assist chewers' in their quit attempts. Controlled experimental trial through the use of available low cost quit aids and behavioural resources is crucial in order to increase success rates for those seeking to desist from khat use.
Routine opioid outcome monitoring in community pharmacy: Outcomes from an open-label single-arm implementation-effectiveness pilot study
Publisher: Elsevier BV
Date: 12-2020
Using the Severity of Dependence Scale to screen for DSM‐5 khat use disorder
Publisher: Wiley
Date: 03-2018
DOI: 10.1002/HUP.2653
Abstract: This study aimed to determine the efficacy of the Severity of Dependence Scale (SDS) as a screening tool for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-defined khat use disorder. Cross-sectional, purposive s le of past-year khat consumers aged 16 and above were recruited from khat markets and cafes from university and general community in Adama, Ethiopia. Participants self-completed a survey comprising current substance use disorder. The SDS formed a unifactorial structure, consistent with the dependence construct. Almost three quarters (73%) of the s le were identified as experiencing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition khat use disorder. The SDS demonstrated excellent discrimination (area under the curve = 0.92) and an optimal cut-off as a score of 3 or greater, with sensitivity of 81% and specificity of 96%. This classification validly identified a group with more frequent and higher dose khat use than participants that did not screen positive. Although khat is a mild stimulant, there is clear evidence that some consumers are both concerned with their use and experience problems associated with their use. Consistent with its application for other drugs, the SDS is a brief and simple screening tool that appears to validly identify in iduals experiencing a khat use disorder syndrome and experiencing high rates of adverse consequences in association with use.
The experience of physiological and psychosocial alcohol-related harms across adolescence and its association with alcohol use disorder in early adulthood: A prospective cohort study.
Publisher: Wiley
Date: 12-2021
DOI: 10.1111/ACER.14726
Abstract: Different forms of alcohol-related harm (e.g., hangovers, fighting) may confer differential risk of clinically relevant alcohol problems. We examine: (i) patterns of transition in experiencing alcohol-related harms across adolescence (ii) whether factors in early adolescence predict transition patterns and (iii) whether transition patterns predict later alcohol use disorder (AUD) symptoms. We used a longitudinal Australian cohort (n = 1828) to model latent class transition patterns of alcohol-related harms across three timepoints (M Five transition patterns characterized most of the cohort (n ≈ 1609, 88.0%): (i) minimal harms (n ≈ 381, 20.8%) (ii) late physiological harms (n ≈ 702, 38.4%) (iii) early physiological harms (n ≈ 226, 12.4%) (iv) late all harms (n ≈ 131, 7.2%) and (v) gradual all harms (n ≈ 169, 9.2%). With late physiological harms as the reference, females had increased risk of experiencing early physiological harms (relative risk [RR]: 2.15 99.5% CI: 1.19, 3.90). Late all harms (RR: 1.71 CI: 1.19, 2.47) and gradual all harms (RR: 1.84 CI: 1.37, 2.47) were each associated with increased odds of meeting criteria for AUD, even when patterns of alcohol consumption are considered. Adolescents display heterogeneous transition patterns across physiological and psychosocial alcohol-related harms. Females are at greater risk of experiencing early physiological harms. Experience of both physiological and psychosocial harms in late adolescence is an important and potentially modifiable precursor to clinically relevant alcohol problems in early adulthood.
Refining the estimation of illicit drug consumptions from wastewater analysis: Co-analysis of prescription pharmaceuticals and uncertainty assessment
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.WATRES.2011.05.042
Abstract: Wastewater analysis is a promising monitoring tool to estimate illicit drug consumption at the community level. The advantage of this technique over traditional surveys and other surveillance methods has been emphasized in recent studies. However, there are methodological challenges that can affect reliability. The objectives of this study were to systematically reduce and assess uncertainties associated with s ling (through a stringent optimization of the s ling method) and the back calculation of per capita drug consumption (through a refined estimation of the number of people actively contributing to the wastewater in a given period). We applied continuous flow-proportional s ling to ensure the collection of representative raw wastewater s les. Residues of illicit drugs, opioids, prescription pharmaceuticals and one artificial sweetener were analyzed by liquid chromatography coupled with tandem mass spectrometry. A parameter estimating the number of people actively contributing to wastewater over a given period was calculated from the measured loads of prescription pharmaceuticals, their annual consumption and relative excretion data. For the calculation of substance loads in sewage, uncertainties were propagated considering five in idual components: s ling, chemical analysis, flow measurements, excretion rates and the number of people contributing to the wastewater. The daily consumption per 1000 inhabitants was estimated to be almost 1000 mg for cannabis and several hundred mg for cocaine, meth hetamine and ecstasy. With the best s ling practice and current chemical analysis, we calculated the remaining uncertainty to be in the range of 20-30% (relative standard deviation, RSD) for the estimation of consumed drug masses in the catchment RSDs for the per capita consumption were lower (14-24%), as one of the biggest uncertainty components (i.e. error in flow measurements) cancels out in the proposed method for the estimation of the number of people contributing to the daily wastewater volume. In this study, we provide methodological improvements that substantially enhance the reliability of the estimation method--a prerequisite for the application of this technique to meaningfully assess changes in drug consumption and the success of drug intervention strategies in future studies.
Understanding an emerging treatment population: Protocol for and baseline characteristics of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence
Publisher: Wiley
Date: 02-10-2018
DOI: 10.1111/DAR.12859
Abstract: Despite large increases in pharmaceutical opioid dependence and related mortality, few studies have focused on the characteristics and treatment experiences of those with pharmaceutical opioid dependence. We describe the formation of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence and describe their baseline characteristics. People who had entered treatment for pharmaceutical opioid dependence (n = 108) were recruited through drug treatment services in New South Wales, Australia. We describe baseline characteristics of those that commenced pharmaceutical opioids for pain or other reasons and conducted a thematic analysis of responses regarding their treatment experience. Mean age was 41 years (SD 11), half were male (48%). Just over half reported lifetime heroin use (57%). Oxycodone (49%) and codeine (29%) were the most common opioids reported. Most (85%) reported past-year problematic pain, 38% reported chronic pain. Half (52%) reported moderate to severe depression symptoms. Most (66%) commenced opioids for pain, and this group were older, less likely to report a previous overdose and less likely to report use of illicit drugs compared to those commencing for other reasons. Five themes related to treatment expectations: (i) stigma (ii) the restrictive nature of treatment (iii) knowledge (iv) pain and (v) positive experience with buprenorphine. This study describes the complexities in an important emerging treatment population of pharmaceutical opioid-dependent people. Findings highlights that addressing knowledge and perceptions around treatment may be critical to address the rising mortality associated with pharmaceutical opioid dependence.
Endocannabinoid reactivity to acute stress: Investigation of the relationship between salivary and plasma levels
Publisher: Elsevier BV
Date: 02-2021
The expectancy valence model of the iowa gambling task: Can it produce reliable estimates for individuals?
Publisher: Elsevier BV
Date: 02-2015
Monitoring substance use in prisons: Assessing the potential value of wastewater analysis
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.SCIJUS.2014.06.006
Abstract: Prison substance use is a major concern for prison authorities and the wider community. Australia has responded to this problem by implementing the National Corrections Drug Strategy. Across Australia, the true extent of prison substance use cannot be determined. As a result, the effectiveness of the interventions employed as part of this strategy cannot be properly assessed. This has important implications for the allocation of corrective services resources and future policy development. This article explores the benefits and limitations, as well as the ethical and practical issues in using wastewater analysis (WWA) to measure levels of substance use in prisons. It reports results from the first application of WWA to an Australian prison, which supports the use of WWA in this context. Given the increasing concern for prescription misuse in prisons, we also highlight the novel use of WWA to measure the extent of prescription misuse by prisoners. The article concludes that as a result of its objectivity, sensitivity and cost-effectiveness, the use of WWA in prisons warrants further consideration in Australia.
Cocaine, MDMA and methamphetamine residues in wastewater: Consumption trends (2009–2015) in South East Queensland, Australia
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.SCITOTENV.2016.05.181
Abstract: Wastewater analysis, or wastewater-based epidemiology, has become a common tool to monitor trends of illicit drug consumption around the world. In this study, we examined trends in cocaine, 3,4-methylenedioxymeth hetamine (MDMA) and meth hetamine consumption by measuring their residues in wastewater from two wastewater treatment plants in Australia (specifically, an urban and a rural catchment, both in South East Queensland) between 2009 and 2015. With direct injection of the s les, target analytes were identified and quantified using liquid chromatography-mass spectrometry. Cocaine and MDMA residues and metabolites were mainly quantifiable in the urban catchment while meth hetamine residues were consistently detected in both urban and rural catchments. There was no consistent trend in the population normalised mass loads observed for cocaine and MDMA at the urban site between 2009 and 2015. In contrast, there was a five-fold increase in meth hetamine consumption over this period in this catchment. For meth hetamine consumption, the rural area showed a very similar trend as the urban catchment starting at a lower baseline. The observed increase in per capita loads of meth hetamine via wastewater analysis over the past six years in South East Queensland provides objective evidence for increased meth hetamine consumption in the Australian population while the use of other illicit stimulants remained relatively stable.
Contextualising psychological distress among regular ecstasy users: The importance of sociodemographic factors and patterns of drug use
Publisher: Wiley
Date: 05-2010
DOI: 10.1111/J.1465-3362.2009.00159.X
Abstract: Considerable concern has been raised about associations between ecstasy use and mental health. Studies of ecstasy users typically investigate varying levels of lifetime use of ecstasy, and often fail to account for other drug use and sociodemographic characteristics of participants, which may explain mixed findings. The current study aimed to examine the relationship between patterns of recent (last six months) ecstasy use and psychological distress among current, regular ecstasy users, controlling for sociodemographic risk factors and patterns of other drug use. Data were collected from regular ecstasy users (n = 752) recruited from each capital city in Australia as part of the Ecstasy and related Drugs Reporting System (EDRS). Psychological distress was assessed using the Kessler Psychological Distress Scale (K10). Data were analysed using multinomial logistic regression. Seven per cent of the s le scored in the 'high' distress category and 55% in the 'medium' distress category. Patterns of ecstasy use were not independently associated with psychological distress. The strongest predictors of distress were female sex, lower education, unemployment, 'binge' drug use including ecstasy (use for >48 h without sleep), frequent cannabis use and daily tobacco use. Regular ecstasy users have elevated levels of psychological distress compared with the general population however, ecstasy use per se was not independently related to such distress. Other factors, including sociodemographic characteristics and other drug use patterns, appear to be more important. These findings highlight the importance of targeting patterns of polydrug use in order to reduce drug-related harm among regular ecstasy users.
Monitoring drug markets in the Internet age and the evolution of drug monitoring systems in Australia
Publisher: Wiley
Date: 12-02-2014
DOI: 10.1002/DTA.1613
Abstract: In Australia, drug monitoring systems have been in place for more than a decade allowing for the measurement of ongoing trends in drug use and the detection of new drugs. The Drug Trends Unit at the National Drug and Alcohol Research Centre monitors drugs through four separate systems. The Illicit Drug Reporting System (IDRS) measures the price, purity, and availability of drugs that are primarily injected. The Ecstasy and Related Drugs Reporting System (EDRS) monitors psychostimulants that are used recreationally. The National Illicit Drugs Indicator Project (NIDIP) analyzes indicator data including drug-related hospitalizations and deaths. Finally, the Drugs and Emerging Technologies Project (DNeT) analyzes the role of the Internet in the procurement and use of novel psychoactive substances. This paper provides an overview of each component of the system, demonstrating how the system has evolved over time.
Exercise increases plasma THC concentrations in regular cannabis users
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.DRUGALCDEP.2013.07.031
Abstract: The major psychoactive ingredient of cannabis, Δ(9)-tetrahydrocannabinol (THC) accumulates in fat tissue from where it slowly diffuses back into blood. THC pre-treated rats can show elevated plasma cannabinoid levels when subjected to conditions that promote fat utilization, such as fasting. Here we examine whether fasting and exercise increase plasma THC concentrations in regular cannabis users. Fourteen regular cannabis users completed 35 min of exercise on a stationary bicycle in either a fed or overnight fasted state. Plasma cannabinoid levels were assessed prior to exercise, immediately post-exercise and 2h post-exercise. Plasma s les were also analyzed for indices of lipolysis (free fatty acids (FFA) and glycerol). Exercise induced a small, statistically significant increase in plasma THC levels accompanied by increased plasma FFA and glycerol levels. Exercise-induced increases in plasma THC concentrations were positively correlated with body mass index. Fasting induced a significant increase in plasma FFA levels, and a lowering of blood glucose, but did not significantly alter plasma cannabinoid levels. Here we demonstrate that exercise enhances plasma THC levels in regular cannabis users. The lack of a fasting effect may reflect the modest duration of fasting used which was associated with only a modest increase in fat utilization relative to exercise. Overall, these results suggest that exercise may elevate blood THC levels by releasing dormant THC from fat stores. These data suggest the interpretation of blood THC levels in roadside and workplace tests might be complicated by recent exercise.
Shame and guilt-proneness: Divergent implications for problematic alcohol use and drinking to cope with anxiety and depression symptomatology
Publisher: Elsevier BV
Date: 10-2012
Chronic pain, pain severity and analgesia use in Australian women of reproductive age
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.WOMBI.2018.06.013
Abstract: The increasing prevalence and adverse outcomes associated with opioid analgesia use in women of reproductive age have become a significant public health issue internationally, with use during pregnancy potentially affecting maternal and infant health outcomes. This study aims to provide national estimates of chronic pain, pain severity and analgesia use in Australian women of reproductive age by pregnancy status. Data were obtained from the Australian Bureau of Statistics 2011-12 National Health Survey (n=20,426). Weighting was applied to s le data to obtain population estimates. For this study data were analysed for pregnant (n=166, N=192,617) and non-pregnant women (n=4710, N=5,256,154) of reproductive age (15-49 years). Chronic or reoccurring pain was reported in 5.1% of pregnant women and 9.7% of non-pregnant women, and 0.7% and 2.6% of pregnant and non-pregnant women reported recent opioid analgesia use respectively. Moderate-to-very severe pain was more common in pregnant than non-pregnant women taking opioid analgesics, and no pain and very mild-to-mild pain in non-pregnant women. Approximately 1 in 20 pregnant Australian women have chronic or reoccurring pain. Opioid analgesia was used by around 1% of Australian pregnant women during a two-week period, with use associated with moderate-to-very severe pain. Given that the safety of many analgesic medications in pregnancy remains unknown, pregnant women and health professionals require accurate, up-to-date information on the risks and benefits of analgesic use during pregnancy. Further evidence on the decision-making processes of pregnant women with pain should assist health professionals maximise outcomes for mothers and infants.
Pill testing or drug checking in Australia: Acceptability of service design features
Publisher: Wiley
Date: 20-06-2018
DOI: 10.1111/DAR.12576
Abstract: This study aimed to determine design features of a drug-checking service that would be feasible, attractive and likely to be used by Australian festival and nightlife attendees. Web survey of 851 Australians reporting use of psychostimulants and/or hallucinogens and attendance at licensed venues past midnight and/or festivals in the past year (70% male median age 23 years). A drug-checking service located at festivals or clubs would be used by 94% a fixed-site service external to such events by 85%. Most (80%) were willing to wait an hour for their result. Almost all (94%) would not use a service if there was a possibility of arrest, and a majority (64%) would not use a service that did not provide in idual feedback of results. Drug-checking results were only slightly more attractive if they provided comprehensive quantitative results compared with qualitative results of key ingredients. Most (93%) were willing to pay up to $5, and 68% up to $10, per test. One-third (33%) reported willingness to donate a whole dose for testing: they were more likely to be male, younger, less experienced, use drugs more frequently and attend venues/festivals less frequently. In this s le, festival- or club-based drug-checking services with low wait times and low cost appear broadly attractive under conditions of legal amnesty and in idualised feedback. Quantitative analysis of ecstasy pills requiring surrender of a whole pill may appeal to a minority in Australia where pills are more expensive than elsewhere. [Barratt MJ, Bruno R, Ezard N, Ritter A. Pill testing or drug checking in Australia: Acceptability of service design features. Drug Alcohol Rev 2017 :000-000].
Perception of intoxication in a field study of the night-time economy: Blood alcohol concentration, patron characteristics, and event-level predictors
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.ADDBEH.2017.08.018
Abstract: Determine the relationship of subjective intoxication to blood alcohol concentration (BAC) and examine whether patron and event-level characteristics modify the relationship of BAC to subjective intoxication. An in-situ systematic random s le of alcohol consumers attending night-time entertainment districts between 10pm and 3am on Friday and Saturday nights in five Australian cities completed a brief interview (n=4628). Participants reported age, sex, and pre-drinking, energy drink, tobacco, illicit stimulant and other illicit drug use that night, and their subjective intoxication and BAC were assessed. Male and female drinkers displayed equally low sensitivity to the impact of alcohol consumption when self-assessing their intoxication (BAC only explained 19% of variance). The marginal effect of BAC was not constant. At low BAC, participants were somewhat sensitive to increases in alcohol consumption, but at higher BAC levels that modest sensitivity dissipated (actual BAC had less impact on self-assessed intoxication). The slope ultimately leveled out to be non-responsive to additional alcohol intake. Staying out late, pre-drinking, and being young introduced biases resulting in higher self-assessed intoxication regardless of actual BAC. Further, both energy drinks and stimulant use modified the association between BAC and perceived intoxication, resulting in more compressed changes in self-assessment as BAC varies up or down, indicating less ability to perceive differences in BAC level. The ability of intoxicated patrons to detect further intoxication is impaired. Co-consumption of energy drinks and/or stimulant drugs is associated with impaired intoxication judgment, creating an additional challenge for the responsible service and consumption of alcohol.
The effect of the ecstasy 'come-down' on the diagnosis of ecstasy dependence
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.DRUGALCDEP.2014.02.697
Abstract: The existence of an ecstasy-dependence syndrome is controversial. We examined whether the acute after-effects of ecstasy use (i.e. the 'come-down') falsely lead to the identification of ecstasy withdrawal and the subsequent diagnosis of ecstasy dependence. The Structured Clinical Interview for DSM-IV-TR Disorders: Research Version (SCID-RV) was administered to 214 Australian ecstasy users. Ecstasy withdrawal was operationalised in three contrasting ways: (i) as per DSM-IV criteria (ii) as the expected after-effects of ecstasy (a regular come-down) or (iii) as a substantially greater or longer come-down than on first use (intense come-down). These definitions were validated against frequency of ecstasy use, readiness to change and ability to resist the urge to use ecstasy. Confirmatory factor analyses were used to see how they aligned with the overall dependence syndrome. Come-down symptoms increased the prevalence of withdrawal from 1% (DSM-IV criterion) to 11% (intense come-downs) and 75% (regular come-downs). Past year ecstasy dependence remained at 31% when including the DSM-IV withdrawal criteria and was 32% with intense come-downs, but increased to 45% with regular come-downs. Intense come-downs were associated with lower ability to resist ecstasy use and loaded positively on the dependence syndrome. Regular come-downs did not load positively on the ecstasy-dependence syndrome and were not related to other indices of dependence. The acute after-effects of ecstasy should be excluded when assessing ecstasy withdrawal as they can lead to a false diagnosis of ecstasy dependence. Worsening of the ecstasy come-down may be a marker for dependence.
Transition to and from injecting drug use among regular ecstasy users
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.ADDBEH.2010.06.007
Abstract: There is a scant amount of research investigating injecting drug use among people not selected on the basis of their injecting behaviour, and less attention has been given to stimulant users who may have a different experience with injecting drug use than opioid users who are more commonly studied. The current study aimed to investigate initiation to, and transition from, injecting drug use among a sentinel s le of regular ecstasy users in Australia. Participants were regular ecstasy users recruited across Australia in 2007 who were administered a structured interview that contained questions regarding initiation to injecting, reasons for injecting cessation, and likelihood of future injecting. Among those with a history of injecting drug use, injecting first occurred at a similar age to that of first ecstasy use. The majority did not inject themselves at the first occasion, and two-fifths were under the influence of other drugs at the time. Two-fifths of injectors had not injected in the past 6 months, with many relating this to concerns surrounding stigma. Route of drug administration is clearly not static, and the findings from this study suggest that some who have ceased injecting may still be at risk for future injecting.
Effect of filtration on morphine and particle content of injections prepared from slow-release oral morphine tablets
Publisher: Springer Science and Business Media LLC
Date: 12-2009
Abstract: Injections of mixtures prepared from crushed tablets contain insoluble particles which can cause embolisms and other complications. Although many particles can be removed by filtration, many injecting drug users do not filter due to availability, cost or performance of filters, and also due to concerns that some of the dose will be lost. Injection solutions were prepared from slow-release morphine tablets (MS Contin ® ) replicating methods used by injecting drug users. Contaminating particles were counted by microscopy and morphine content analysed by liquid chromatography before and after filtration. Unfiltered tablet extracts contained tens of millions of particles with a range in sizes from 5 μm to 400 μm. Cigarette filters removed most of the larger particles ( 50 μm) but the smaller particles remained. Commercial syringe filters (0.45 and 0.22 μm) produced a dramatic reduction in particles but tended to block unless used after a cigarette filter. Morphine was retained by all filters but could be recovered by following the filtration with one or two 1 ml washes. The combined use of a cigarette filter then 0.22 μm filter, with rinses, enabled recovery of 90% of the extracted morphine in a solution which was essentially free of tablet-derived particles. Apart from overdose and addiction itself, the harmful consequences of injecting morphine tablets come from the insoluble particles from the tablets and microbial contamination. These harmful components can be substantially reduced by passing the injection through a sterilizing (0.22 μm) filter. To prevent the filter from blocking, a preliminary coarse filter (such as a cigarette filter) should be used first. The filters retain some of the dose, but this can be recovered by following filtration with one or two rinses with 1 ml water. Although filtration can reduce the non-pharmacological harmful consequences of injecting tablets, this remains an unsafe practice due to skin and environmental contamination by particles and microorganisms, and the risks of blood-borne infections from sharing injecting equipment.
Motivations for new psychoactive substance use among regular psychostimulant users in Australia
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.DRUGPO.2016.12.021
Abstract: Examine the motivations for new psychoactive substance (NPS) use amongst a s le of regular psychostimulant users (RPU) in Australia, and determine whether motivations differ across substances. Data were obtained from 419 RPU interviewed for the 2014 Ecstasy and related Drugs Reporting System who reported lifetime NPS use. Based on the most recent NPS used, motivations for use were rated on an 11-point scale (0 'no influence'-10 'maximum influence'). For NPS overall, value for money was found to be the most highly endorsed motivation for use, scoring a median of five out of ten. However, there was substantial variation in motivations for use across substance types. Availability (i.e. no other drug was available to me at the time 6/10) was the most highly endorsed motivation for the use of synthetic cathinones, which was significantly higher than reported for DMT. Perceived legality and availability were the most highly endorsed motivations for synthetic cannabinoids (5/10) perceived legality scored higher for synthetic cannabinoids than for all the other NPS, whilst in regards to availability synthetic cannabinoids scored significantly higher than DMT only. Value for money was the most highly endorsed motivation for NBOMe (8/10) and 2C-family substances (5/10) in regards to NBOMe this scored significantly higher than all other NPS. Short effect duration was the most highly endorsed motivation for DMT (7/10), which was significantly higher than for all other NPS. Synthetic cathinones and cannabinoids appear to be largely motivated by 'opportunistic' reasons (i.e. availability, legality), while NBOMe, 2C-family substances and DMT appear to be motivated by particular desirable qualities of a substance (i.e. value for money, short effect duration). Providing a nuanced understanding of why in iduals use particular NPS improves our ability to understand the NPS phenomenon and to tailor harm reduction messages to the appropriate target groups.
Assessing the concurrent validity, inter-rater reliability and test-re-test reliability of the Australian Treatment Outcomes Profile (ATOP) in alcohol and opioid treatment populations.
Publisher: Wiley
Date: 04-01-2021
DOI: 10.1111/ADD.15331
Cohort profile: The Australian parental supply of alcohol longitudinal study (APSALS)
Publisher: Oxford University Press (OUP)
Date: 06-05-2017
DOI: 10.1093/IJE/DYV051
Abstract: The Australian Parental Supply of Alcohol Longitudinal Study (APSALS) was established in 2010 to investigate the short- and long-term associations between exposure to early parental alcohol provision, early adolescent alcohol initiation, subsequent alcohol use and alcohol-related harms, controlling for a wide range of parental, child, familial, peer and contextual covariates. The cohort commenced with 1927 parent-child dyads comprising Australian Grade 7 school students (mean age = 12.9 years, range = 10.8-15.7 years), and a parent/guardian. Baseline, 1- and 2-year follow-up data have been collected, with > 90% retention, and a 3-year follow-up is under way. The data collected include child, familial, parental and peer factors addressing demographics, alcohol use and supply, parenting practices, other substance use, adolescent behaviours and peer influences. The cohort is ideal for prospectively examining predictors of initiation and progression of alcohol use, which increases markedly through adolescence.
Energy drink use frequency among an international sample of people who use drugs: Associations with other substance use and well-being
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.DRUGALCDEP.2017.01.010
Abstract: The study aims were to identify: i.) energy drink (ED), caffeine tablet, and caffeine intranasal spray use amongst a s le who report drug use, and ii.) the association between ED use frequency and demographic profile, drug use, hazardous drinking, and wellbeing. Participants (n=74,864) who reported drug use completed the online 2014 Global Drug Survey. They provided data on demographics, ED use, and alcohol and drug use, completed the Alcohol Use Disorders Identification Test (AUDIT) and Personal Wellbeing Index (PWI), and reported whether they wished to reduce alcohol use. Lifetime ED, caffeine tablet and intranasal caffeine spray use were reported by 69.2%, 24.5% and 4.9%. Median age of ED initiation was 16 years. For those aged 16-37, median years using EDs increased from 4 to 17 years of consumption, where it declined thereafter. Greater ED use frequency was associated with: being male under 21 years of age studying and past year caffeine tablet/intranasal spray, tobacco, cannabis, hetamine, MDMA, and cocaine use. Past year, infrequent (1-4days) and frequent (≥5days) past month ED consumers reported higher AUDIT scores and lower PWI scores than lifetime abstainers past month consumers were less likely to report a desire to reduce alcohol use. ED use is part of a complex interplay of drug use, alcohol problems, and poorer personal wellbeing, and ED use frequency may be a flag for current/future problems. Prospective research is required exploring where ED use fits within the trajectory of other alcohol and drug use.
'High' risk? A systematic review of the acute outcomes of mixing alcohol with energy drinks
Publisher: Wiley
Date: 14-07-2014
DOI: 10.1111/ADD.12622
Abstract: Alcohol mixed with energy drinks (AmED) is a relatively new consumption trend generating increasing concern regarding potential adverse effects. Despite the political and health imperative, there has been no systematic and independent synthesis of the literature to determine whether or not AmED offers additional harms relative to alcohol. The aim of this study was to review the evidence about whether co-consumption of energy drinks and alcohol, relative to alcohol alone, alters: (i) physiological, psychological, cognitive and psychomotor outcomes (ii) hazardous drinking practices and (iii) risk-taking behaviour. Pubmed, PsycInfo and Embase databases were searched until May 2013 for papers outlining descriptive, observational analytical and human experimental studies which compared target outcomes for AmED versus alcohol consumers (between-subjects), or AmED versus alcohol consumption (within-subjects). Odds ratios were calculated for target outcomes following screening, data extraction and quality assessment. Data were extracted from 19 papers. Analyses typically revealed increased odds of self-reported stimulation-based outcomes and decreased odds of sedation-based physiological and psychological outcomes relative to when alcohol was consumed alone, as indicated by rigorous cross-sectional descriptive research. These findings typically have not been reflected in experimental research, due possibly to the low doses administered relative to typical self-reported 'real-life' intake. AmED consumers generally report more hazardous alcohol consumption patterns and greater engagement in risk-taking behaviour than alcohol consumers. While most studies had equivocal findings, two studies showed lower odds of risk-taking behaviour for AmED relative to alcohol drinking sessions but limitations with respect to the outcome measures used restrict conclusions with regard to the behavioural outcomes of AmED use. Mixing alcohol with energy drinks may exert a dual effect, increasing stimulation-based effects and reducing sedation-based outcomes the clinical severity and dose threshold has not been established. At this stage it is unclear whether these changes in the nature of intoxication translate into greater alcohol intake and risk-taking behaviour.
Evaluating the potential impact of a reformulated version of oxycodone upon tampering, non-adherence and diversion of opioids: The National Opioid Medications Abuse Deterrence (NOMAD) study protocol
Publisher: Wiley
Date: 30-10-2015
DOI: 10.1111/ADD.12746
Abstract: A new oxycodone formulation (Reformulated OxyContin® was released in Australia, early 2014. It was developed as a t er-resistant ('abuse-deterrent') formulation of the drug. We summarize methods used in the National Opioid Medication Abuse Deterrence (NOMAD) study, which will examine: (i) whether there is a reduction in extra-medical use (including via t ering) of OxyContin® following the introduction of Reformulated OxyContin® (ii) potential changes in extra-medical use of non-abuse-deterrent forms of oxycodone, other pharmaceutical opioids and illicit drugs (iii) whether methods of t ering with Reformulated OxyContin® become widespread over time (iv) Reformulated OxyContin®'s attractiveness on the illicit market and (v) sales, prescriptions and harms related to OxyContin® and other drugs. There are three major components. First, analyses of existing routine data sources such as: pharmaceutical sales prescribing data data on drug overdose deaths and survey data on drug use in the general population and among people who inject drugs secondly, specific data on OxyContin® collected through the Illicit Drug Reporting System and thirdly, a prospective cohort of n = 606 people who regularly misuse or t er with pharmaceutical opioids was formed prior to the introduction of Reformulated OxyContin®, followed-up twice post-release to examine potential changes after Reformulated OxyContin®'s introduction. The study's strengths lie in varied data collections interrupted time-series analysis and prospective cohort. To our knowledge, this is one of the most comprehensive and transparently conducted studies conducted to date of the potential impact of an opioid medication upon use, t ering and ersion. Results have the potential to inform policymakers, clinicians, consumers and researchers alike.
Profile and correlates of injecting-related injuries and diseases among people who inject drugs in Australia
Publisher: Elsevier BV
Date: 11-2020
The impact of alcohol and energy drink consumption on intoxication and risk-taking behavior
Publisher: Wiley
Date: 12-03-2013
DOI: 10.1111/ACER.12086
Abstract: It has been argued that consuming alcohol mixed with energy drinks (AmED) causes a subjective underestimation of intoxication and an increased level of risk-taking behavior. To date, however, there is mixed support for AmED-induced reductions in perceived intoxication, and no objective assessment of risk-taking following AmED consumption. Consequently, the present study aimed to determine the effect of alcohol and energy drink (ED) consumption on subjective measures of intoxication and objective measures of risk-taking. Using a placebo-controlled, single-blind, cross-over design, participants (n = 28) attended 4 sessions in which they were administered, in counterbalanced order: 0.5 g/kg alcohol, 3.57 ml/kg ED, AmED, and a placebo beverage. Participants completed the Biphasic Alcohol Effects Scale and a Subjective Effects Scale at baseline and 30 and 125 minutes postbeverage administration risk-taking was measured using the Balloon Analogue Risk Task (BART). Participants reported greater subjective intoxication, impairment, and sedation after active relative to placebo alcohol consumption, with no interactive AmED effects. However, a significant moderate magnitude increase in stimulation ratings was observed in the AmED relative to alcohol, ED, and placebo conditions. There was no independent effect of alcohol, or interactive effect with ED, on the BART. A significant, yet small magnitude, increase in risk-taking was evident in active relative to placebo ED conditions. The interactive effect of AmED appears restricted to perceived stimulation, with alcohol-induced increases in subjective intoxication occurring regardless of presence or absence of ED. Engagement in risk-taking behavior was only increased by ED consumption however, this effect was only of small magnitude at these doses, alcohol consumption, with or without EDs, did not affect risk-taking. Further research assessing the dose-dependent effects of AmED on objectively measured risk-taking behavior could clarify whether the ED effect increases with higher doses and whether an interactive effect is observed with higher alcohol doses.
Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys
Publisher: Wiley
Date: 09-12-2019
DOI: 10.1111/ADD.14482
Attitudes in Australia on the upscheduling of over‐the‐counter codeine to a prescription‐only medication
Publisher: Wiley
Date: 08-06-2017
DOI: 10.1111/DAR.12568
Abstract: In December 2016, the Australian Therapeutic Goods Administration announced that over-the-counter (OTC) codeine would be available by prescription-only in February 2018. Prior to this announcement, the authors aimed to evaluate attitudes among Australian codeine consumers, pharmacists and general medical practitioners (GP) towards the proposed upscheduling of OTC codeine. Public Therapeutic Goods Administration submissions on codeine upscheduling were assessed, and a brief questionnaire was developed to assess the common issues raised. Participants (354 codeine consumers 220 pharmacists 120 GPs) completed a web-based questionnaire. Comparisons of attitudes on specific statements related to codeine upscheduling were made between consumers who were in support and those who opposed the proposal and between pharmacists and GPs. Regression models were conducted to examine correlates of attitudes towards codeine restriction. Most consumer, pharmacist and a third of GP respondents opposed the upscheduling of codeine. Consumers, on average, questioned whether the proposed intervention would address the intended targets of minimising codeine-related side effects and risk of codeine dependence. Like consumers, pharmacists indicated concern around whether codeine restriction would address concerns of associated harm and dependence, as well as the burden regular GP appointments would create in terms of finances for consumers and time for GPs. GPs themselves, did not support these views. Consumer responses identify key targets for educational c aigns when codeine is rescheduled, particularly around effective alternatives to OTC codeine. Additionally, contrasting views of pharmacists and GPs reinforce the importance of pharmacovigilance in evaluating the effectiveness of codeine restriction, once implemented. [McCoy J, Bruno R, Nielsen S. Attitudes in Australia on the upscheduling of over-the-counter codeine to a prescription-only medication. Drug Alcohol Rev 2017 :000-000].
A review of caffeine use as a risk or protective factor for women's health and pregnancy
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2017
The effect of a potentially tamper-resistant oxycodone formulation on opioid use and harm: main findings of the National Opioid Medications Abuse Deterrence (NOMAD) study
Publisher: Elsevier BV
Date: 02-2018
Randomised Controlled Trial (RCT) of cannabinoid replacement therapy (Nabiximols) for the management of treatment-resistant cannabis dependent patients: A study protocol
Publisher: Springer Science and Business Media LLC
Date: 18-05-2018
Is ecstasy a drug of dependence?
Publisher: Elsevier BV
Date: 02-2010
DOI: 10.1016/J.DRUGALCDEP.2009.09.009
Abstract: This paper examines the evidence for an MDMA or "ecstasy" dependence syndrome. Animal evidence suggests that MDMA may be a less potent reinforcer than other drugs, but that it does have dependence potential. This suggests that (a) ecstasy dependence might be less likely than dependence upon other drugs and (b) factors related to the behavioural and psychological aspects of reward and dependence may make a relatively greater contribution for ecstasy than for other drugs, where physically centred (and better understood) features of dependence may be more salient. Human evidence supports this proposition. Some people report problems with their use, but the literature suggests that physical features play a more limited role than psychological ones. Tolerance is apparent, and withdrawal is self-reported, but it is unclear whether these reports distinguish sub-acute effects of ecstasy intoxication from symptoms reflective of neuroadaptive processes underlying a "true" withdrawal syndrome. Studies examining the structure of dependence upon ecstasy suggest it may be different from drugs such as alcohol, meth hetamine and opioids. Consistent with studies of hallucinogens, a two-factor structure has been identified with factors suggestive of "compulsive use" and "escalating use". Regardless of the nature of any dependence syndrome, however, there is evidence to suggest that a minority of ecstasy users become concerned about their use and seek treatment. Further controlled studies are required to investigate this phenomenon.
Cannabinoid interventions for PTSD: Where to next?
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.PNPBP.2019.03.017
Abstract: Cannabinoids are a promising method for pharmacological treatment of post-traumatic stress disorder (PTSD). Despite considerable research devoted to the effect of cannabinoid modulation on PTSD symptomology, there is not a currently agreed way by which the cannabinoid system should be targeted in humans. In this review, we present an overview of recent research identifying neurological pathways by which different cannabinoid-based treatments may exert their effects on PTSD symptomology. We evaluate the strengths and weaknesses of each of these different approaches, including recent challenges presented to favourable options such as fatty acid amide hydrolase (FAAH) inhibitors. This article makes the strengths and challenges of different potential cannabinoid treatments accessible to psychological researchers interested in cannabinoid therapeutics and aims to aid selection of appropriate tools for future clinical trials.
LiMA: A study protocol for a randomised, double-blind, placebo controlled trial of lisdexamfetamine for the treatment of methamphetamine dependence
Publisher: BMJ
Date: 07-2018
DOI: 10.1136/BMJOPEN-2017-020723
Abstract: Meth hetamine dependence is a growing public health concern. There is currently no pharmacotherapy approved for meth hetamine dependence. Lisdexamfetamine (LDX) dimesylate, used in the treatment of attention-deficit hyperactivity disorder and binge eating disorder, has potential as an agonist therapy for meth hetamine dependence, and possible benefits of reduced risk of aberrant use due to its novel formulation. A double-blind randomised controlled trial will be used to evaluate the efficacy of LDX in reducing meth hetamine use. The target s le is 180 participants with meth hetamine dependence of ≥2 years, using ≥14 days out of the previous 28, who have previously attempted but not responded to treatment for meth hetamine use. Participants will be randomly assigned to receive either a 15-week intervention consisting of induction (1 week of 150 mg LDX or placebo), maintenance (12 weeks of 250 mg LDX or placebo) and reduction (1 week of 150 mg LDX or placebo and 1 week of 50 mg LDX or placebo). All participants will be given access to four sessions of cognitive–behavioural therapy as treatment as usual and receive a 4-week follow-up appointment. The primary outcomes are efficacy (change from baseline in days of meth hetamine use by self-report for the last 28 days at week 13 and urinalyses confirmation of meth hetamine use) and safety (treatment-related adverse events). Secondary outcomes are total number of days of self-report meth hetamine use over the 12-week active treatment, longest period of abstinence during treatment period, percentage of achieving ≥21 days abstinence, craving, withdrawal, dependence, retention, bloodborne virus transmission risk behaviour, criminal behaviour, as well measures of abuse liability, physical and mental health, other substance use, cognitive performance, psychosocial functioning, treatment retention and satisfaction. Additionally, the study will assess the cost-effectiveness of LDX relative to the placebo control. The study has been approved by the Human Research Ethics Committee of St. Vincent’s Hospital, Sydney, Australia (HREC/16/SVH/222). Contact the corresponding author for the full trial protocol. ACTRN12617000657325 Pre-results.
A prospective cohort study evaluating the impact of upscheduling codeine in Australia among frequent users of codeine
Publisher: Wiley
Date: 26-10-2021
DOI: 10.1111/ADD.15683
Abstract: To evaluate and document the impacts of re‐scheduling codeine to a prescription‐only medication in Australia in February 2018. Prospective cohort study. Participants completed an on‐line survey with a range of outcome measures at four time‐points, once before codeine was re‐scheduled (November 2017) and three times after the event: 1 month after (February 2018), 4 months after (June 2018) and 12 months after (February 2019). Australia. Participants were 260 Australians aged 18 years and above who reported regular over‐the‐counter (OTC) codeine use and, at the time of the study, were not engaged in treatment for codeine dependence. Survey measures included estimates of daily average codeine use (mg) and overall daily average opioid use [calculated using an oral morphine equivalent daily dose (OMEDD, mg)], opioid use disorder with regard to codeine use (using a modified Alcohol Use Disorder and Associated Disabilities Interview Schedule‐IV), pain and pain self‐efficacy, anxiety and depression and health service use. A reduction in total daily codeine use (mg) from 64.3 mg [95% confidence interval (CI) = 46.7–81.9] in November 2017 (baseline) to 27.6 mg (95% CI = 19.2–36.0) in February 2019 (final time‐point) was observed. A decline in the proportion of participants who met criteria for an opioid use disorder was also evident, with 51.2% ( n = 133) at baseline relative to 33.3% ( n = 58) at the 12‐month follow‐up. This study had an overall participant retention rate of 67% at the final time‐point. Re‐scheduling codeine in Australia has been accompanied by significant reductions in codeine use and prevalence rates of opioid use disorder in a cohort of in iduals who regularly use the medication, without apparent adverse impacts on pain or measures of anxiety and depression.
Health service utilisation by people living with chronic non-cancer pain: Findings from the Pain and Opioids in Treatment (POINT) study
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15047
Abstract: Objective The aims of the present study were to describe the use, and barriers to the use, of non-medication pain therapies and to identify the demographic and clinical correlates of different non-opioid pain treatments. Methods The study was performed on a cohort (n = 1514) of people prescribed pharmaceutical opioids for chronic non-cancer pain (CNCP). Participants reported lifetime and past month use of healthcare services, mental and physical health, pain characteristics, current oral morphine equivalent daily doses and financial and access barriers to healthcare services. Results Participants reported the use of non-opioid pain treatments, both before and after commencing opioid therapy. Services accessed most in the past month were complementary and alternative medicines (CAMs 41%), physiotherapy (16%) and medical and/or pain specialists (15%). Higher opioid dose was associated with increased financial and access barriers to non-opioid treatment. Multivariate analyses indicated being younger, female and having private health insurance were the factors most commonly associated with accessing non-opioid treatments. Conclusions Patients on long-term opioid therapy report using multiple types of pain treatments. High rates of CAM use are concerning given limited evidence of efficacy for some therapies and the low-income status of most people with CNCP. Financial and insurance barriers highlight the importance of considering how different types of treatments are paid for and subsidised. What is known about the topic? Given concerns regarding long-term efficacy, adverse side-effects and risk of misuse and dependence, prescribing guidelines recommend caution in prescribing pharmaceutical opioids in cases of CNCP, typically advising a multidisciplinary approach to treatment. There is a range of evidence supporting different (non-drug) treatment approaches for CNCP to reduce pain severity and increase functioning. However, little is known about the non-opioid treatments used among those with CNCP and the demographic and clinical characteristics that may be associated with the use of different types of treatments. Understanding the use of non-drug therapy among people with CNCP is crucial given the potential to improve pain control for these patients. What does this paper add? The present study found that a wide range of non-opioid treatments was accessed by the study s le, both before and after commencing opioids, indicating that in this s le opioids were not the sole strategy used for pain management. The most common treatment (other than opioids) was CAM, reported by two-fifths of the s le. Having private health insurance was associated with increased use of non-opioid treatments for pain, highlighting the importance of considering how treatments are paid for and potential financial barriers to effective treatments. What are the implications for practitioners? Patients’ beliefs and financial barriers may affect the uptake of different treatments. Many patients may be using complementary and alternative approaches with limited evidence to support their use, highlighting the need for clinicians to discuss with patients the range of prescribed and non-prescribed treatments they are accessing and to help them understand the benefits and risks of treatments that have not been tested sufficiently, or have inconsistent evidence, as to their efficacy in improving pain outcomes.
An investigation of factors associated with depressive symptoms among a sample of regular ecstasy consumers
Publisher: S. Karger AG
Date: 2010
DOI: 10.1159/000306592
Abstract: i Aims/Objectives: /i Methylenedioxymeth hetamine affects the central serotonergic system, and there is some evidence for an association between ecstasy use (drugs sold as methylenedioxymeth hetamine) and depression. The aim of the present study was to investigate the incidence of self-reported depression and associated help-seeking among a s le of regular ecstasy users. A further aim was to examine the correlates of depressive symptomatology in this population. i Materials and Methods: /i 100 regular ecstasy consumers (at least monthly use) were interviewed as part of the Ecstasy and Related Drug Reporting System in Tasmania, Australia. Participants were also administered epidemiological measures of depression (Center for Epidemiological Studies Depression Scale) and psychological distress (Kessler Psychological Distress Scale). i Results: /i One quarter (23%) of participants self-reported recent experience of depression, a rate notably greater than the general population. However, only one third of these participants had attended a health professional for this issue. A range of drug use factors (e.g. frequency and quantity of ecstasy use, frequent cannabis or meth hetamine use, intravenous drug use, polydrug use, binge drug use, harmful alcohol use, and elevated psychological dependence scores for ecstasy and meth hetamine) were associated with high levels of depressive symptomatology. i Conclusion: /i These findings are consistent with an association between depressive symptomatology and ecstasy and other drug use. Harm reduction strategies which target drug use factors such as those identified in this study may also aid in the reduction of the experience of depression. Considering the low levels of help-seeking among this population, improving awareness and access to information and treatment for depression may also be important.
Prime Time for In Situ Measurement: What Are the Drivers and Implications of Energy Drink Co-Ingestion on Alcohol Priming?
Publisher: Wiley
Date: 18-08-2016
DOI: 10.1111/ACER.13179
Typology of new psychoactive substance use among the general Australian population
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.DRUGALCDEP.2018.03.034
Abstract: The aim of this study was to examine the typology of Australian illicit drug consumers to determine whether those who use new psychoactive substances (NPS) differ from those using other illicit substances. Data were from the 2013 National Drug Strategy Household Survey, a representative population study analyses were limited to participants reporting past year illicit drug use (including NPS n = 3309). Latent class analysis identified groups based on past year substance use, and a weighted multivariable, multinomial regression model was used to examine characteristics associated with group membership. Six consumer typologies were identified: cannabis consumers (46%), pharmaceutical consumers (21%), ecstasy and cocaine consumers (19%), hetamine and cannabis consumers (7%), polysubstance consumers (6%), and inhalant consumers (2%). Sixteen participants (total s le: 0.07% NPS consumers: 5.7%) reported exclusive NPS use. Synthetic cannabinoid receptor agonist use was highest among hetamine and cannabis consumers and polysubstance consumers other NPS use was highest among polysubstance consumers. Polysubstance consumers were younger than all other groups, and more likely to engage in dangerous activities while under the influence of substances, inject drugs and report hazardous alcohol consumption. Amphetamine and cannabis consumers were more likely to report trouble ceasing their drug use. We found no distinct profile of NPS-only consumers however, NPS use was a marker for more problematic patterns of use. Our findings suggest that specialised NPS interventions or harm reduction messages may not be required in the Australian context rather, they could be based upon existing responses to drug use.
Study protocol: A dose-escalating, phase-2 study of oral lisdexamfetamine in adults with methamphetamine dependence
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Assessing the validity of the Australian Treatment Outcomes Profile for telephone administration in drug health treatment populations
Publisher: Wiley
Date: 12-05-2020
DOI: 10.1111/DAR.13088
Gender differences in the supply of alcohol to adolescent daughters and sons
Publisher: Informa UK Limited
Date: 04-07-2021
Patterns and correlates of prescribed and non‐prescribed pregabalin use among a sample of people who inject drugs in Australia
Publisher: Wiley
Date: 17-06-2020
DOI: 10.1111/DAR.13083
Parental supply of alcohol in childhood and risky drinking in adolescence: Systematic review and meta-analysis
Publisher: MDPI AG
Date: 09-03-2017
The epidemiology of methamphetamine use and harm in Australia
Publisher: Wiley
Date: 05-2008
DOI: 10.1080/09595230801950572
Abstract: There has been considerable media attention recently upon possible increases in meth hetamine use in Australia. Much of this debate has focused upon extreme cases of problematic crystal meth hetamine use, without reference to the broader population context. This paper provides data on meth hetamine use in Australia, and documents trends in meth hetamine-related harms. Data used were from: (1) Australian Customs Service drug detections (2) Australian Crime Commission drug seizure, arrest and clandestine laboratory detections data (3) National Drug Strategy Household Survey (NDSHS) and Australian Secondary Student Alcohol and Drug Survey (ASSADS) (4) data from the Illicit Drug Reporting System (IDRS) and Ecstasy and related Drug Reporting System (EDRS) and (5) data from NSW Emergency Department Information System, National Hospital Morbidity Database and Australian Bureau of Statistics causes of death databases. There appears to have been an increase in both importation and local manufacture of meth/ hetamine. Population data show that meth/ hetamine use remains low and stable. However, clear increases in crystal meth hetamine use have occurred among sentinel groups of regular drug users. Frequent crystal use among regular injecting drug users is associated with earlier initiation to injecting, greater injection risk behaviours and more extensive criminal activity. In recent years, indicators of meth/ hetamine-related harm have stabilised, following steady increases in earlier years. Some meth hetamine users experience significant problems related to their use harms are particularly prevalent among regular IDU. Meth hetamine users, however, are a erse group, and strategies need to be appropriately targeted towards different kinds of users.
The introduction of a potentially abuse deterrent oxycodone formulation: Early findings from the Australian National Opioid Medications Abuse Deterrence (NOMAD) study
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.DRUGALCDEP.2015.02.038
Abstract: There is increasing concern about t ering of pharmaceutical opioids. We describe early findings from an Australian study examining the potential impact of the April 2014 introduction of an abuse-deterrent sustained-release oxycodone formulation (Reformulated OxyContin(®)). Data on pharmaceutical opioid sales drug use by people who inject drugs regularly (PWID) client visits to the Sydney Medically Supervised Injecting Centre (MSIC) and last drug injected by clients of inner-Sydney needle-syringe programmes (NSPs) were obtained, 2009-2014. A cohort of n=606 people t ering with pharmaceutical opioids was formed pre-April 2014, and followed up May-August 2014. There were declines in pharmacy sales of 80mg OxyContin(®) post-introduction of the reformulated product, the dose most commonly erted and injected by PWID. Reformulated OxyContin(®) was among the least commonly used and injected drugs among PWID. This was supported by Sydney NSP data. There was a dramatic reduction in MSIC visits for injection of OxyContin(®) post-introduction of the new formulation (from 62% of monthly visits pre-introduction to 5% of visits, August 2014). The NOMAD cohort confirmed a reduction in OxyContin(®) use/injection post-introduction. Reformulated OxyContin(®) was cheaper and less attractive for t ering than Original OxyContin(®). These data suggest that, in the short term, introduction of an abuse-deterrent formulation of OxyContin(®) in Australia was associated with a reduction in injection of OxyContin(®), with no clear switch to other drugs. Reformulated OxyContin(®), in this short follow-up, does not appear to be considered as attractive for t ering.
Antidepressant Use among People Prescribed Opioids for Chronic Noncancer Pain
Publisher: Oxford University Press (OUP)
Date: 12-03-2019
DOI: 10.1093/PM/PNZ009
Abstract: Although depression and chronic pain often coexist, few studies have examined antidepressant use among people with pain. This study examines the prevalence and characteristics associated with antidepressant use among people prescribed opioids for chronic noncancer pain (CNCP). Baseline data from a prospective cohort study. Australian community. A total of 1166 people prescribed opioids for CNCP. Baseline data collection consisted of a self-completed seven-day medication diary and telephone interview to collect information on sociodemographic characteristics and mental hysical health using validated questionnaires. Logistic regression was used to examine characteristics associated with antidepressant use, reporting adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Of the 1166 participants, 668 (57.3%) were female, and the median (interquartile range) age was 59 (49–68) years. About half the cohort (N = 637, 54.6%) used antidepressants. Of these, 329 (51.7%) reported moderate to severe depression. Amitriptyline was the most commonly used antidepressant (17.3%). Factors independently associated with antidepressant use were being female (AOR = 1.47, 95% CI = 1.13–1.92), more years lived in pain (AOR = 1.01, 95% CI = 1.00–1.02), and use of nonopioid analgesics (AOR = 1.34, 95% CI = 1.01–1.78), benzodiazepines and related drugs (AOR = 1.84, 95% CI = 1.36–2.49), antiepileptics (AOR = 1.86, 95% CI = 1.38–2.51), and antipsychotics (AOR = 2.15, 95% CI = 1.22–3.77). Antidepressant use is common among people with CNCP prescribed opioids. Those using antidepressants were more likely to use other psychotropic medicines concurrently, highlighting that they are a high-risk population requiring comprehensive assessment to optimize outcomes and reduce potential harms from polypharmacy.
Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia
Publisher: Wiley
Date: 30-07-2016
DOI: 10.1111/DAR.12315
Abstract: Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of codeine dependence. Given the lower potency of codeine it cannot be assumed that buprenorphine dose requirements for heroin dependence will generalise to codeine. This is the first study to examine buprenorphine treatment for codeine dependence. Retrospective case series of 19 codeine-dependent treatment entrants who received sublingual buprenorphine maintenance treatment through six specialist inpatient and outpatient treatment centres. Baseline codeine doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes after 28 days of buprenorphine treatment. A significant linear relationship was found between initial codeine dose and dose of buprenorphine given at days 7 and 28 for the codeine dose range of 50-960 mg day With increasing presentations relating to codeine dependence, these findings provide important guidance to clinicians. Buprenorphine doses were consistently higher than doses estimated based on the dose of codeine consumed, and were comparable with doses used in the treatment of dependence with heroin and more potent prescription opioids. [Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug Alcohol Rev 2015].
Experience of adjunctive cannabis use for chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.DRUGALCDEP.2014.11.031
Abstract: There is increasing debate about cannabis use for medical purposes, including for symptomatic treatment of chronic pain. We investigated patterns and correlates of cannabis use in a large community s le of people who had been prescribed opioids for chronic non-cancer pain. The POINT study included 1514 people in Australia who had been prescribed pharmaceutical opioids for chronic non-cancer pain. Data on cannabis use, ICD-10 cannabis use disorder and cannabis use for pain were collected. We explored associations between demographic, pain and other patient characteristics and cannabis use for pain. One in six (16%) had used cannabis for pain relief, 6% in the previous month. A quarter reported that they would use it for pain relief if they had access. Those using cannabis for pain on average were younger, reported greater pain severity, greater interference from and poorer coping with pain, and more days out of role in the past year. They had been prescribed opioids for longer, were on higher opioid doses, and were more likely to be non-adherent with their opioid use. Those using cannabis for pain had higher pain interference after controlling for reported pain severity. Almost half (43%) of the s le had ever used cannabis for recreational purposes, and 12% of the entire cohort met criteria for an ICD-10 cannabis use disorder. Cannabis use for pain relief purposes appears common among people living with chronic non-cancer pain, and users report greater pain relief in combination with opioids than when opioids are used alone.
Trends in PIEDs use among male clients of needle–syringe programs in Queensland, Australia; 2007–2015
Publisher: Elsevier BV
Date: 08-2017
Sipping, Drinking, and Early Adolescent Alcohol Consumption: A Cautionary Note
Publisher: Wiley
Date: 02-2015
DOI: 10.1111/ACER.12613
Abstract: Epidemiological studies report markedly varying rates of adolescent alcohol involvement. Despite being a common adolescent behavior, a potential cause of this variation is that consumption of sips is either not measured or not distinguished from consumption of whole beverages. Participants were 1,843 grade 7 adolescents recruited across 49 Australian secondary schools (M age = 12.4, SD = 0.5). Quantity and frequency of lifetime and past 6-month consumption were assessed, distinguishing between sipping and drinking. For comparison with international population surveys, quantity was reported as any consumption, sipping only, and drinking only. Combining sipping and drinking into a single category, lifetime consumption was reported by 67.3% of the present s le. Distinguishing lifetime consumption by sipping and drinking: only 7.8% of adolescents had consumed a whole beverage the remaining 59.6% had only sipped. Consumption of whole beverages was mostly limited to 1 to 2 drinks (84.2% of drinkers). Sipping and drinking were also infrequent: 78.2% of sipping and 60.4% of drinking, occurred less than monthly. Heavy episodic consumption was uncommon (1.2% of the s le). When other population studies were inspected, a clear trend for higher drinking rates were found in those studies where sipping was counted as drinking and vice versa. Consumption of whole beverages appears infrequent in early adolescence, as sipping, but not drinking, was common in our s le. Comparing the present data with international population consumption measures highlights the need to more precisely measure and report adolescent consumption, particularly in relation to sipping.
Perceptions of extended‐release buprenorphine injections for opioid use disorder among people who regularly use opioids in Australia
Publisher: Wiley
Date: 05-02-2020
DOI: 10.1111/ADD.14941
Abstract: To examine perceptions of extended‐release (XR) buprenorphine injections among people who regularly use opioids in Australia. Cross‐sectional survey prior to implementation. XR‐buprenorphine was registered in Australia in November 2018. Sydney, Melbourne and Hobart. Participants A total of 402 people who regularly use opioids interviewed December 2017 to March 2018. Primary outcome concerned the proportion of participants who believed XR‐buprenorphine would be a good treatment option for them, preferred weekly versus monthly injections and perceived advantages/disadvantages of XR‐buprenorphine. Independent variables concerned the demographic characteristics and features of current opioid agonist treatment (OAT medication‐type, dose, prescriber/dosing setting, unsupervised doses, out‐of‐pocket expenses and travel distance). Sixty‐eight per cent [95% confidence interval (CI) = 63–73%] believed XR‐buprenorphine was a good treatment option for them. They were more likely to report being younger [26–35 versus 55 years odds ratio (OR) = 3.16, 95% CI = 1.12–8.89 P = 0.029], being female (OR = 1.67, 95% CI = 1.04–2.69 P = 0.034), 10 years school education (OR = 1.87, 95% CI = 1.12–3.12 P = 0.016) and past‐month heroin (OR = 1.81, 95% CI = 1.15–2.85 P = 0.006) and meth hetamine use (OR = 1.90, 95% CI = 1.20–3.01 P = 0.006). Fifty‐four per cent reported no preference for weekly versus monthly injections, 7% preferred weekly and 39% preferred monthly. Among OAT recipients ( n = 255), believing XR‐buprenorphine was a good treatment option was associated with shorter treatment episodes (1–2 versus ≥ 2 years OR = 3.93, 95% CI = 1.26–12.22 P = 0.018), fewer unsupervised doses (≤ 8 doses past‐month versus no take‐aways OR = 0.50 95% CI = 0.27–0.93 P = 0.028) and longer travel distance (≥ 5 versus 5 km OR = 2.10, 95% CI = 1.20–3.65 P = 0.009). Sixty‐nine per cent reported ‘no problems or concerns’ with potential differences in availability, flexibility and location of XR‐buprenorphine. Among regular opioid users in Australia, perceptions of extended‐release buprenorphine as a good treatment option are associated with being female, recent illicit drug use and factors relating to the (in)convenience of current opioid agonist treatment.
Alprazolam use among a sample of Australians who inject drugs: Trends up to six years post regulatory changes
Publisher: Elsevier BV
Date: 05-2020
Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment
Publisher: Wiley
Date: 19-01-2017
DOI: 10.1002/PDS.4168
Abstract: To assess how well the defined daily dose (DDD) metric reflects opioid utilisation among chronic non-cancer pain patients. Descriptive, cross-sectional study, utilising a 7-day medication diary. Community-based treatment settings, Australia. A s le of 1101 people prescribed opioids for chronic non-cancer pain. Opioid dose data was collected via a self-completed 7-day medication diary capturing names, strengths and doses of each medication taken in the past week. Median daily dose was calculated for each opioid. Comparisons were made to the World Health Organization's (WHO) DDD metric. WHO DDDs ranged from 0.6 to 7.1 times the median opioid doses used by the s le. For transdermal fentanyl and oral hydromorphone, the median dose was comparable with the DDD. The DDD for methadone was 0.6 times lower than the median doses used by this s le of chronic pain patients. In contrast, the DDD for oxycodone and transdermal buprenorphine, the most commonly used strong opioids for chronic pain in Australia, was two to seven times higher than actual doses used. For many opioids, there are key differences between the actual doses used in clinical practice and the WHO's DDDs. The interpretation of opioid utilisation studies using population-level DDDs may be limited, and a recalibration of the DDD for many opioids or the reporting of opioid utilisation in oral morphine equivalent doses is recommended. Copyright © 2017 John Wiley & Sons, Ltd.
Alcohol use among young Australian adults in May–June 2020 during the COVID-19 pandemic: a prospective cohort study
Publisher: Wiley
Date: 24-06-0006
DOI: 10.1111/ADD.15599
Abstract: To estimate change in young people's alcohol consumption during COVID‐19 restrictions in Australia in early‐mid 2020, and test whether those changes were consistent by gender and level of consumption prior to the pandemic. Prospective longitudinal cohort. Secondary schools in New South Wales, Tasmania and Western Australia. Subs le of a cohort ( n = 443) recruited in the first year of secondary school in 2010–11. Analysis data included three waves collected in September 2017–July 2018, September 2018–May 2019 and August 2019–January 2020), and in May–June 2020. The primary predictors were time, gender and level of consumption prior to the pandemic. Outcome variables, analysed by mixed‐effects models, included frequency and typical quantity of alcohol consumption, binge drinking, peak consumption, alcohol‐related harm and drinking contexts. Overall consumption (frequency × quantity) during the restrictions declined by 17% [incidence rate ratio (IRR) = 0.83 95% confidence interval (CI) = 0.73, 0.95] compared to February 2020, and there was a 35% decline in the rate of alcohol‐related harms in the same period (IRR = 0.66 95% CI = 0.54, 0.79). Changes in alcohol consumption were largely consistent by gender. From a survey of secondary school students in Australia, there is evidence for a reduction in overall consumption and related harms during the COVID‐19 restrictions.
The impact of comorbid cannabis and methamphetamine use on mental health among regular ecstasy users
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.ADDBEH.2012.04.012
Abstract: Residual effects of ecstasy use induce neurotransmitter changes that make it biologically plausible that extended use of the drug may induce psychological distress. However, there has been only mixed support for this in the literature. The presence of polysubstance use is a confounding factor. The aim of this study was to investigate whether regular cannabis and/or regular meth hetamine use confers additional risk of poor mental health and high levels of psychological distress, beyond regular ecstasy use alone. Three years of data from a yearly, cross-sectional, quantitative survey of Australian regular ecstasy users was examined. Participants were ided into four groups according to whether they regularly (at least monthly) used ecstasy only (n=936), ecstasy and weekly cannabis (n=697), ecstasy and weekly meth hetamine (n=108) or ecstasy, weekly cannabis and weekly meth hetamine (n=180). Self-reported mental health problems and Kessler Psychological Distress Scale (K10) were examined. Approximately one-fifth of participants self-reported at least one mental health problem, most commonly depression and anxiety. The addition of regular cannabis and/or meth hetamine use substantially increases the likelihood of self-reported mental health problems, particularly with regard to paranoia, over regular ecstasy use alone. Regular cannabis use remained significantly associated with self reported mental health problems even when other differences between groups were accounted for. Regular cannabis and meth hetamine use was also associated with earlier initiation to ecstasy use. These findings suggest that patterns of drug use can help identify at risk groups that could benefit from targeted approaches in education and interventions. Given that early initiation to substance use was more common in those with regular cannabis and meth hetamine use and given that this group had a higher likelihood of mental health problems, work around delaying onset of initiation should continue to be a priority.
Driving under the influence among frequent ecstasy consumers in Australia: Trends over time and the role of risk perceptions
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.DRUGALCDEP.2014.09.015
Abstract: Driving under the influence (DUI) of alcohol and illicit drugs is a serious road safety concern. This research aimed to examine trends in DUI across time and changes in attitudes towards the risks (crash and legal) associated with DUI among regular ecstasy users (REU) interviewed in Australia. Participants were regular (at least monthly) ecstasy users surveyed in 2007 (n=573) or 2011 (n=429) who had driven a car in the last six months. Face to face interviews comprised questions about recent engagement of DUI and roadside breath (alcohol) and saliva (drug) testing. Participants also reported the risk of crash and of being apprehended by police if DUI of alcohol, cannabis, ecstasy, and meth hetamine. There were significant reductions in DUI of psychostimulants (ecstasy, meth hetamine, cocaine, LSD) but not alcohol or cannabis between 2007 and 2011. This was accompanied by increased experience of roadside saliva testing and increases in crash and legal risk perceptions for ecstasy and meth hetamine, but not alcohol or cannabis. When the relationship between DUI and risk variables was examined, low crash risk perceptions were associated with DUI of all substances and low legal risk perceptions were associated with DUI of ecstasy. The observed reduction in DUI of psychostimulants among frequent ecstasy consumers may be related to increased risk awareness stemming from educational c aigns and the introduction of saliva testing on Australian roads. Such countermeasures may be less effective in relation to deterring or changing attitudes towards DUI of cannabis and alcohol among this group.
Profile and correlates of colorimetric reagent kit use among people who use ecstasy/MDMA and other illegal stimulants in Australia
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.DRUGPO.2021.103334
Abstract: Colorimetric reagent kits can provide information about the compounds present in drug s les. This study aimed to identify patterns and correlates of colorimetric reagent kit use, as well as behavioural outcomes of testing, amongst people who use illegal stimulants in a context that lacks permanent government-sanctioned drug checking services. Australians residing in capital cities who reported regularly using ecstasy/MDMA and/or other illegal stimulants ≥monthly in the past six months were recruited via social media and word-of-mouth from April-July 2019 (N = 792). Participants were asked about testing the contents and/or purity of illegal drugs, and features of last colorimetric reagent kit use. Logistic regression identified correlates of last using a kit (referent: no use of drug checking technology to test drug contents urity in the past year). Over one-third (36%) reported testing drug contents and/or purity of this group, 86% had last used a colorimetric reagent kit. On the last occasion, 52% reported someone else had conducted testing 58% said testing occurred <24 h before planned drug use and 24% reported testing for quantity of a substance. Correlates of drug checking comprised: being younger, male, past six-month use of new psychoactive substances, accessing community-based health services for alcohol or other drug reasons, selling drugs for cash profit, obtaining information from peers who had tried the drug, and searching online for reports of the drug by st /appearance. The majority (84%) tested a substance they had been sold and/or given as MDMA of these, 87% detected MDMA. Of those who expected and detected MDMA, 29% and 11% reported results to their peers and dealer, respectively. People who use ecstasy/MDMA and/or other illegal stimulants seek out objective information about substance contents. In countries that lack permanent government-sanctioned drug checking services, it is important to acknowledge that people already engage in drug checking but with suboptimal technologies and without tailored specialist advice and education.
Associations of borderline personality with pain, problems with medications and suicidality in a community sample of chronic non-cancer pain patients prescribed opioids for pain
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.GENHOSPPSYCH.2015.05.004
Abstract: Borderline personality disorder (BPD) is common in patients with chronic non-cancer pain (CNCP). BPD patients often report worse pain and are more likely to abuse opioid medication. Although the prevalence of suicidality is high in both CNCP patients and those with BPD, no studies have examined the interrelationship of BPD, CNCP and suicidality. This article aims to examine the prevalence and associations of BPD in a large community s le of CNCP patients and the association with medication problems and suicidality. Data from a national s le of 978 CNCP patients prescribed pharmaceutical opioids for CNCP. The screener from the International Classification of Diseases, version 10, International Personality Disorder Examination was used to identify patients with symptoms of BPD. One in five CNCP patients (19.1%) screened positive for BPD. BPD was associated with a number of demographic and clinical features, such as daily benzodiazepine use, and was independently associated with lifetime pharmaceutical opioid dependence [odds ratio (OR) 2.49, 95% confidence interval (95% CI) 1.42-4.38], past 12-month suicidal thoughts (OR 2.9, 95% CI 1.90-4.39) and lifetime suicide attempts (OR 3.19, 95% CI 2.16-4.72). BPD symptoms were prevalent among people prescribed opioids for CNCP and are associated with a number of adverse consequences. Further, those screening positive were at elevated risk of suicidal behaviors. Careful opioid prescription monitoring and appropriate referrals by clinicians are warranted in BPD with CNCP.
Self-reported physiological and psychological side-effects of an acute alcohol and energy drink dose
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.APPET.2014.01.003
Abstract: There have been repeated calls from health professionals and policy-makers to clarify the side-effects of the increasingly popular consumption trend of alcohol mixed with energy drinks (AmED). There is a dearth of research assessing the differential effects of AmED relative to alcohol by comparing self-reported psychological and physiological outcomes whilst under the influence of these substances. The aim of the present study was to examine the acute effects of a moderate alcohol and energy drink (ED) dose on self-reported psychological and physiological outcomes. Using a single-blind, placebo-controlled, crossover design, 28 adults completed four sessions where they were administered: (i) 0.50g/kg alcohol, (ii) 3.57mL/kg ED, (iii) AmED, and (iv) placebo. Participants independently completed the Profile of Mood States and a Somatic Symptom Scale at baseline and at 30 and 125min after beverage administration. Breath alcohol concentration peaked at .068% and .067% in the alcohol and AmED conditions, respectively. There were no interactive alcohol and ED effects on self-reported psychological outcomes. Treatment effects for physiological outcomes generally only related to alcohol or ED administration, with the exception of a moderate magnitude decrease in heart palpitation ratings following alcohol relative to AmED. Decreased muscular tension ratings were evident when the two constituents were consumed separately relative to placebo. The results provide evidence of few subjective changes in physiological and psychological state after consuming AmED relative to alcohol. The majority of treatment-based changes arose from the independent effects of alcohol or ED, rather than being modified by their interaction. However, research extending into higher dosage domains is required to increase outcome generalisability for consumers in the night-time economy.
New psychoactive substances: challenges for drug surveillance, control, and public health responses
Publisher: Elsevier BV
Date: 11-2019
The metabolomic signatures of alcohol consumption in young adults
Publisher: Oxford University Press (OUP)
Date: 11-03-2020
Abstract: Metabolomic analysis may help us to understand the association between alcohol consumption and cardio-metabolic health. We aimed to: (i) replicate a previous study of alcohol consumption and metabolic profiles, (ii) examine associations between types of alcoholic beverages and metabolites and (iii) include potential confounders not examined in previous studies. Cross-sectional data of 1785 participants (age 26–36 years, 52% women) from the 2004–2006 Childhood Determinants of Adult Health study were used. Consumption of beer, wine and spirits was assessed by questionnaires. Metabolites were measured by a high-throughput nuclear magnetic resonance platform and multivariable linear regression examined their association with alcohol consumption (combined total and types) adjusted for covariates including socio-demographics, health behaviours and mental health. Alcohol consumption was associated with 23 out of 37 lipids, 12 out of 16 fatty acids and six out of 20 low-molecular-weight metabolites independent of confounders with similar associations for combined total alcohol consumption and different types of alcohol. Many metabolites (lipoprotein lipids in high-density lipoprotein (HDL) subclasses, HDL cholesterol, apolipoprotein A-1, phosphotriglycerides, total fatty acids, monounsaturated fatty acids, omega-3 fatty acids) had positive linear associations with alcohol consumption but some showed negative linear (low-density lipoprotein particle size, omega-6 fatty acids ratio to total fatty acids, citrate) or U-shaped (lipoprotein lipids in very-low-density lipoprotein (VLDL) subclasses, VLDL triglycerides) associations. Our results were similar to those of the only previous study. Associations with metabolites were similar for total and types of alcohol. Alcohol consumption in young adults is related to a erse range of metabolomic signatures associated with benefits and harms to health.
Effects of parental alcohol rules on risky drinking and related problems in adolescence: Systematic review and meta-analysis
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.DRUGALCDEP.2017.05.011
Abstract: It is unclear what effect parents' rules about their children's alcohol use have on drinking in adolescence. This review and meta-analysis investigated associations between prospectively measured parental alcohol rules and later adolescent risky drinking. Using the PRISMA guidelines, we searched eight electronic databases for a variety of terms up to 10 September 2016. We imposed no restrictions on publication year. We assessed the risk of bias and conducted a meta-analysis. We identified 13 eligible studies in four groups of specific exposures for meta-analysis. The pooled overall estimate showed that when parents set rules concerning alcohol, their children were less likely to develop risky drinking and related problems (OR=0.64, 95% CI=0.48, 0.86). Pooled estimates illustrate that parental alcohol rules were significantly negatively associated with adolescent risky drinking and related problems (OR=0.73, 95% CI=0.53, 0.99), as was parental approval of alcohol use (inverse OR=0.41, 95% CI=0.34, 0.50). Neither parental permissiveness (inverse OR=0.83, 95% CI=0.59, 1.19) nor parental disapproval of alcohol use (OR=0.49, 95% CI=0.20, 1.20) was significantly associated with alcohol-related problems. However, the small number of studies and variability in the point estimates in these latter two groups of studies limits inferences. Parents' restrictiveness of their children's drinking was associated with lower risky drinking, but the risk of bias in the existing literature precludes strong inferences about the association. Further longitudinal studies with prospective measurement of parent behaviour, low attrition, and control for likely confounders, are needed.
Same-day use of opioids and other central nervous system depressants amongst people who tamper with pharmaceutical opioids: A retrospective 7-day diary study
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.DRUGALCDEP.2016.07.003
Abstract: The aims were to determine: (i) quantity and frequency of same-day use of opioids with benzodiazepines and/or alcohol amongst people who regularly t er with pharmaceutical opioids and (ii) socio-demographic, mental health, harms and treatment profile associated with same-day use of high doses. The cohort (n=437) completed a retrospective 7-day diary detailing opioid, benzodiazepine, and alcohol intake. Oral morphine equivalent (OME) units and diazepam equivalent units (DEU) were calculated, with >200mg OME, >40mg DEU and >4 standard alcoholic drinks (each 10g alcohol) considered a "high dose". One-half (47%) exclusively consumed opioids without benzodiazepines/alcohol 26% had days of opioid use with and without benzodiazepines/alcohol and 26% always used opioids and benzodiazepines/alcohol. Same-day use of opioids with benzodiazepines/alcohol typically occurred on 1-3days in the past week. Six in ten (61%) participants reported high dose opioid use on at least one day one in five (20%) reported high dose opioid and high dose benzodiazepine/alcohol use on at least one day. The latter group were more likely to use prescribed opioid substitution therapy, often alongside erted pharmaceutical opioids. Socio-demographic and clinical profiles did not vary according to high dose opioid, alcohol and benzodiazepine use, and there was no association with harms. Same-day use of opioids with benzodiazepines/alcohol, and high dose combinations, are common amongst people who t er with pharmaceutical opioids. Assessment of concomitant benzodiazepine/alcohol use during opioid therapy, implementation of real-time prescription monitoring systems, and research to clarify upper safe limits for polydrug depressant use, are potential implications.
A systematic review of event-level measures of risk-taking behaviors and harms during alcohol intoxication
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.ADDBEH.2019.106101
Abstract: Alcohol intoxication is associated with transient increases in risk-taking behaviors which can lead to harm. Certain assessment and intervention evaluation approaches require measurement of risk behaviors and associated harms at the event-level (i.e., within a single drinking session). This systematic review aimed to identify measures solely assessing risk-taking behaviors and harms while intoxicated and identify evidence of their reliability and validity. EMBASE, Medline, PsycINFO, and PsycTESTs were searched for articles published between 1997 and 2019. Articles were selected based on use of a scale with one or more items measuring risk-taking behaviors and harms (to the in idual or others around them) occurring while intoxicated. Additional searches were run to identify studies reporting estimates of reliability and validity for identified measures. Nineteen measures were identified containing at least one relevant item. Most measures indexed both acute and chronic risk behaviors and consequences, mainly with the intent of screening for established patterns of problematic use. No in idual measure was identified exclusively quantifying risk-taking behavior and harms which had occurred within a drinking session (with the exception of one scale measuring tendency to engage in risk behaviors), yet three measures had a subscale meeting this criterion. These measures demonstrated good validity and reliability. This gap represents an opportunity for scale development, designed for use in ecological momentary assessment and evaluation of structural interventions targeting risk behaviors and harms whilst intoxicated.
Targeting at-risk samples through brief face-to-face interviews in night-time entertainment precincts
Publisher: Informa UK Limited
Date: 04-12-2018
Parent hazardous drinking and their children’s alcohol use in early and mid-adolescence: prospective cohort study
Publisher: Oxford University Press (OUP)
Date: 08-03-2019
Abstract: Why adolescents’ drinking is associated with their parents’ drinking remains unclear. We examined associations in a prospective cohort study, adjusting for socio-demographic characteristics and family factors. We recruited 1927 children from grade 7 classes (mean age 13 years), and one of their parents, in three Australian states, contacted participants annually from 2010 to 2014, and analysed data from assessments at ages 13, 14, 15 and 16 years. We used the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) subscale to identify hazardous drinking in parents (score ≥5) and children (score ≥3) and constructed mixed-effect logistic regression models, accounting for clustering within school and adjusting for likely confounders. We evaluated the sensitivity of estimates by imputing missing values assuming the data were missing at random vs. missing not at random. Parent hazardous drinking predicted mid-adolescent hazardous drinking, e.g. 15 years olds whose parents [adjusted odds ratio (aOR) 2.00 95% confidence interval 1.51–2.64] or parents’ partners (aOR 1.94 1.48–2.55) were hazardous drinkers had higher odds of being hazardous drinkers at age 16. The magnitude of univariate associations changed little after adjusting for covariates, and sensitivity analyses confirmed the robustness of the association, across a wide range of assumptions about the missing data. The associations between parents’ and their adolescent children’s hazardous drinking are unlikely to be due to confounding by socio-demographic and family factors. Parents should be encouraged, and supported by public policy, to reduce their own alcohol consumption in order to reduce their children’s risk of becoming hazardous drinkers.
Chronic cannabis use and ERP correlates of visual selective attention during the performance of a flanker go/nogo task
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.BIOPSYCHO.2015.07.013
Abstract: The aim of the study was to investigate the relationship between chronic cannabis use and visual selective attention by examining event-related potentials (ERPs) during the performance of a flanker go/nogo task. Male participants were 15 chronic cannabis users (minimum two years use, at least once per week) and 15 drug naive controls. Cannabis users showed longer reaction times compared to controls with equivalent accuracy. Cannabis users also showed a reduction in the N2 'nogo effect' at frontal sites, particularly for incongruent stimuli, and particularly in the right hemisphere. This suggests differences between chronic cannabis users and controls in terms of inhibitory processing within the executive control network, and may implicate the right inferior frontal cortex. There was also preliminary evidence for differences in early selective attention, with controls but not cannabis users showing modulation of N1 litude by flanker congruency. Further investigation is required to examine the potential reversibility of these residual effects after long-term abstinence and to examine the role of early selective attention mechanisms in more detail.
How does the use of multiple needles/syringes per injecting episode impact on the measurement of individual level needle and syringe program coverage?
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.DRUGPO.2017.05.055
Abstract: Recent work by McCormack et al. (2016) showed that the inclusion of syringe stockpiling improves the measurement of in idual-level syringe coverage. We explored whether including the use of a new parameter, multiple sterile syringes per injecting episode, further improves coverage measures. Data comes from 838 people who inject drugs, interviewed as part of the 2015 Illicit Drug Reporting System. Along with syringe coverage questions, the survey recorded the number of sterile syringes used on average per injecting episode. We constructed three measures of coverage: one adapted from Bluthenthal et al. (2007), the McCormack et al. measure, and a new coverage measure that included use of multiple syringes. Predictors of multiple syringe use and insufficient coverage (<100% of injecting episodes using a sterile syringe) using the new measure, were tested in logistic regression and the ability of the measures to discriminate key risk behaviours was compared using ROC curve analysis. 134 (16%) participants reported needing multiple syringes per injecting episode. Women showed significantly increased odds of multiple syringe use, as did those reporting injection related injuries/diseases and injecting of opioid substitution drugs or pharmaceutical opioids. Levels of insufficient coverage across the three measures were substantial (20%-28%). ROC curve analysis suggested that our new measure was no better at discriminating injecting risk behaviours than the existing measures. Based on our findings, there appears to be little need for adding a multiple syringe use parameter to existing coverage formulae. Hence, we recommend that multiple syringe use is not included in the measurement of in idual-level syringe coverage.
Cognitive training and remediation interventions for substance use disorders: A Delphi consensus study
Publisher: Cold Spring Harbor Laboratory
Date: 31-07-2022
DOI: 10.1101/2022.07.28.22278144
Abstract: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this h ers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. Delphi approach with two sequential phases: survey development and iterative surveying of experts. Online study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n=53) identified via recommendations from the Steering Committee and a systematic review. Survey with 67 items covering four key areas of intervention development, i.e., targets, intervention approaches, active ingredients, and modes of delivery. Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions, and social processing as key targets of interventions (ii) cognitive bias modification, contingency management, emotion regulation training, and cognitive remediation as preferred approaches (iii) practice, feedback, difficulty-titration, bias-modification, goal setting, strategy learning, and meta-awareness as active ingredients and (iv) both addiction treatment workforce and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. Expert recommendations on cognitive training and remediation for SUD highlight the relevance of targeting implicit biases, reward, emotion regulation, and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.
Post-marketing studies of pharmaceutical opioid abuse-deterrent formulations: a framework for research design and reporting
Publisher: Wiley
Date: 07-09-2019
DOI: 10.1111/ADD.14380
New psychoactive substances: Purchasing and supply patterns in Australia
Publisher: Wiley
Date: 05-2017
DOI: 10.1002/HUP.2577
Abstract: To examine the purchasing and supply patterns of new psychoactive substance (NPS) consumers in Australia. Data were obtained from a self-selected s le of 296 past-year NPS consumers, with comparisons made across dimethyltryptamine (n = 104), 2C-x (n = 59), NBOMe (n = 27), and synthetic cannabinoid (n = 22) users. Most consumers (58%) nominated a friend as their main NPS source, and almost half (46%) reported that they had supplied NPS to others in the past year (predominantly "social supply"). However, when comparisons were made across NPS, NBOMe users were more likely to nominate a dealer (30%) or online marketplace (22%) as their main source and to report: supplying NPS to others (63%) supplying to strangers (29%) and acquaintances (24%) and supplying NPS for cash profit (29%). Similarly, NPS consumers who nominated online markets as their main NPS source (9% n = 26) were more likely to have supplied NPS to others (risk ratio [RR] 1.57) supplied to strangers (RR 6.05) and acquaintances (RR 12.11) sold NPS for cash profit (RR 4.36) and to have exchanged NPS for something else (RR 3.27) than those who reported alternative primary sources. NBOMe consumers and those who nominated online markets as their main NPS source reported greater engagement with for-profit supply it is unclear if these in iduals have "drifted" into dealing or if they were already engaged in such activities.
Dopamine, endocannabinoids and their interaction in fear extinction and negative affect in PTSD
Publisher: Elsevier BV
Date: 03-2021
A typology of people who tamper with pharmaceutical opioids: responses to introduction of a tamper-resistant formulation of controlled-release oxycodone
Publisher: Wiley
Date: 30-09-2015
DOI: 10.1002/PDS.3883
Abstract: In April 2014, a t er-resistant controlled-release oxycodone formulation was released in Australia. We aimed to determine whether there are latent classes of people who t er with pharmaceutical opioids based on frequency of opioid and illicit drug use, the demographic and clinical profiles of these groups, and if there were changes in use and harms following the introduction. A prospective cohort of 606 people who regularly t er with pharmaceutical opioids was interviewed January to March 2014 (Wave 1) and May to August 2014 (Wave 2). Latent class analysis identified groups based on non-prescribed opioid, illicit drug and prescribed opioid substitution therapy (OST) use at Wave 1. Regression models examined whether group membership predicted use and harms at Wave 2. Four groups were identified: frequent OST group (39%), mixed OST/heroin group (7%), infrequent pharmaceutical opioid and heroin group (44%) and frequent oxycodone group (25%). Compared with the frequent OST group, the infrequent pharmaceutical opioid/heroin group was more likely to report non-everyday pain and risky alcohol use, and the frequent oxycodone group had higher odds of homelessness. At Wave 2, oxycodone use decreased across groups (odds ratios (OR) ≤ 0.18, p < 0.001, particularly for the frequent oxycodone group: OR ≤ 0.05, p < 0.001), with reductions in days of use (g ≥ 0.35, p < 0.050). Non-prescribed pharmaceutical opioid use, illicit drug use and harms remained stable or decreased. Despite heterogeneity among people who t er with pharmaceutical opioids, the t er-resistant formulation was followed by reductions in oxycodone t ering among high-frequency and low-frequency users. There was no evidence of increased use of other opioids or illicit drugs.
Residual effects of ecstasy (3,4-methylenedioxymethamphetamine) on low level visual processes
Publisher: Wiley
Date: 03-2012
DOI: 10.1002/HUP.2218
Abstract: 'Ecstasy' (3,4-methylenedioxymeth hetamine) induces impaired functioning in the serotonergic system, including the occipital lobe. This study employed the 'tilt aftereffect' paradigm to operationalise the function of orientation-selective neurons among ecstasy consumers and controls as a means of investigating the role of reduced serotonin on visual orientation processing. The magnitude of the tilt aftereffect reflects the extent of lateral inhibition between orientation-selective neurons and is elicited to both 'real' contours, processed in visual cortex area V1, and illusory contours, processed in V2. The magnitude of tilt aftereffect to both contour types was examined among 19 ecstasy users (6 ecstasy only 13 ecstasy-plus-cannabis users) and 23 matched controls (9 cannabis-only users 14 drug-naive). Ecstasy users had a significantly greater tilt magnitude than non-users for real contours (Hedge's g = 0.63) but not for illusory contours (g = 0.20). These findings provide support for literature suggesting that residual effects of ecstasy (and reduced serotonin) impairs lateral inhibition between orientation-selective neurons in V1, which however suggests that ecstasy may not substantially affect this process in V2. Multiple studies have now demonstrated ecstasy-related deficits on basic visual functions, including orientation and motion processing. Such low-level effects may contribute to the impact of ecstasy use on neuropsychological tests of visuospatial function.
Safety and tolerability of oral lisdexamfetamine in adults with methamphetamine dependence: a phase-2 dose-escalation study
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJOPEN-2020-044696
Abstract: To examine the safety of an agonist-type treatment, lisdexamfetamine (LDX), at 250 mg/day among adults with meth hetamine (MA) dependence. A dose-escalating, phase-2, open-label, single-group study of oral LDX at two Australian drug treatment services. The study was conducted at two Australian stimulant use disorder treatment clinics. There were 16 participants: at least 18 years old, MA dependent for at least the preceding 2 years using ICD-10 criteria, reporting use of MA on at least 14 of the preceding 28 days. Daily, supervised LDX of 100–250 mg, single-blinded to dose, ascending-descending regimen over 8 weeks (100–250 mg over 4 weeks followed by 4-week dose reduction regimen, 250–100 mg). Participants were followed through to week 12. Primary outcomes were safety, drug tolerability and regimen completion at the end of week 4. Participants were followed to week 12. Secondary outcomes included: change in MA use craving withdrawal severity of dependence risk behaviour change in other substance use medication acceptability potential for non-prescription use adherence and neurocognitive functioning. Fourteen of 16 participants (87.5%) completed escalation to 250 mg/day. Two participants withdrew from the trial in the first week: one relocated away from the study site, the other self-withdrew due to a possible, known side effect of LDX (agitation). There was one serious adverse event of suicidal ideation which resolved. All other adverse events were mild or moderate in severity and known side effects of LDX. No participant was withdrawn due to adverse events. MA use decreased from a median of 21 days (IQR: 16–23) to 13 days (IQR: 11–17) over the 4-week escalation period (p=0.013). LDX at a dose of up to 250 mg/day was safe and well tolerated by study participants, warranting larger trials as a pharmacotherapy for MA dependence. ACTRN12615000391572.
Factors associated with driving under the influence of alcohol and drugs among an Australian sample of regular ecstasy users
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.DRUGALCDEP.2008.08.012
Abstract: The aim of the present study was to investigate factors associated with driving under the influence (DUI) of alcohol and other drugs (ecstasy, cannabis and meth hetamine) among a group of regular ecstasy users. Participants were those who participated in the Australian Ecstasy and related Drug Reporting System (EDRS) in 2007 and had recently driven a motor vehicle (n=573). Participants were administered a semi-structured face-to-face interview which included questions about ecstasy and other drug use, associated health-related issues, and risk behaviours. Close to half of those who were current consumers of ecstasy, cannabis, and meth hetamine had recently driven under the influence of these drugs, while two-fifths of current alcohol users reported recent drink driving. Frequency of use for each substance was the most significant correlate of DUI of alcohol, cannabis, and meth hetamine, suggesting that interventions targeting high frequency and problematic drug use may be useful in reducing the occurrence of DUI for these substances. Low perception of the likelihood of having an accident was the most significant correlate of DUI of ecstasy and also related significantly to DUI of other substances. Perceptions of low likelihood of being apprehended by police and demographic characteristics such as younger age and male sex were also weakly associated with DUI. Together these findings have important implications for targeted interventions aimed at reducing the occurrence of DUI among regular drug users.
Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series
Publisher: Wiley
Date: 07-06-2016
DOI: 10.1111/DAR.12418
Abstract: Use of opioid agonist treatments for prescription opioid (PO) dependence is rapidly increasing. Current guidelines are based on research with heroin users. This study aimed to examine methadone and buprenorphine dose requirements for PO-dependent people. A retrospective case series of PO-dependent patients entering methadone and buprenorphine treatment. Daily oral morphine equivalent (OME) doses at baseline were calculated using standard dose conversion calculations. Dose conversion tables were used to estimate opioid agonist doses, based on starting dose of PO. Baseline methadone and buprenorphine dose at days 7 and 28 were examined. Linear models were fit to the data. Participants (n = 44) were 67% male, mean age 41 years (SD 10 years) 69% reported a pain condition. The methadone group (n = 21) had a mean PO dose of 704.5 mg OME (SD 783.5 mg) prior to treatment, and mean methadone dose of 45.3 mg (SD 13.1 mg) at day 7 and 61.6 mg (SD 20.8 mg) at day 28. The buprenorphine group (n = 23) had a mean PO dose of 771.7 mg OME (SD 867.7 mg) prior to treatment, with a mean dose of 14.6 mg (SD 8.3 mg) at day 7 and 18.1 (SD 8.9 mg) at day 28. Linear relationships were not found between OME and opioid agonist dose. Opioid agonist dosages varied substantially between in iduals, and from predicted dosages based on dose conversion tables. Use of conversion tables to guide selection of opioid agonist dosage may compromise patient safety. [Nielsen S, Bruno R, Degenhardt L, Demirkol A, Lintzeris N. Opioid agonist doses for oxycodone and morphine dependence: Findings from a retrospective case series Drug Alcohol Rev 2017 :311-316].
The use of paracetamol (acetaminophen) among a community sample of people with chronic non-cancer pain prescribed opioids
Publisher: Hindawi Limited
Date: 13-08-2015
DOI: 10.1111/IJCP.12716
Abstract: The regular use of simple analgesics in addition to opioids such as paracetamol (or acetaminophen) is recommended for persistent pain to enhance analgesia. Few studies have examined the frequency and doses of paracetamol among people with chronic non-cancer pain including use above the recommended maximum daily dose. To assess (i) the prevalence of paracetamol use among people with chronic non-cancer pain prescribed opioids, (ii) assess the prevalence of paracetamol use above the recommended maximum daily dose and (iii) assess correlates of people who used paracetamol above the recommended maximum daily dose including: age, gender, income, education, pain severity and interference, use of paracetamol/opioid combination analgesics, total opioid dose, depression, anxiety, pain self-efficacy or comorbid substance use, among people prescribed opioids for chronic non-cancer pain. This study draws on baseline data collected for the Pain and Opioids IN Treatment (POINT) study and utilises data from 962 interviews and medication diaries. The POINT study is national prospective cohort of people with chronic non-cancer pain prescribed opioids. Participants were recruited from randomly selected pharmacies across Australia. Sixty-three per cent of the participants had used paracetamol in the past week (95% CI = 59.7-65.8). Among the paracetamol users 22% (95% CI = 19.3-24.6) had used paracetamol/opioid combination analgesics and 4.8% (95% CI = 3.6-6.3) had used paracetamol above the recommended maximum daily dose (i.e. > 4000 mg/day). Following binomial logistic regression (χ(2) = 25.98, df = 10, p = 0.004), people who had taken above the recommended maximum daily dose were less likely to have low income (AOR = 0.52, 95% CI = 0.27-0.99), more likely to use paracetamol/opioid combination analgesics (AOR = 2.01, 95% CI = 1.02-3.98) and more likely to take a higher opioid dose (AOR = 1.00, 95% CI = 1.00-1.01). The majority of people with chronic non-cancer pain prescribed opioids report using paracetamol appropriately. High income, use of paracetamol/opioid combination analgesics and higher opioid dose were independently associated with paracetamol use above the recommended maximum daily dose.
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Start Date: 04-2016
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Funder: Australian Research Council
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