ORCID Profile
0000-0002-5705-2026
Current Organisations
University of Tasmania
,
University of New South Wales
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Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.DRUGPO.2015.05.023
Abstract: In April 2014, a t er-resistant controlled-release oxycodone formulation was introduced into the Australian market. This study aimed to identify the level and methods of t ering with reformulated oxycodone, demographic and clinical characteristics of those who reported t ering with reformulated oxycodone, and perceived attractiveness of original and reformulated oxycodone for misuse (via t ering). A prospective cohort of 522 people who regularly t ered with pharmaceutical opioids and had t ered with the original oxycodone product in their lifetime completed two interviews before (January-March 2014: Wave 1) and after (May-August 2014: Wave 2) introduction of reformulated oxycodone. Four-fifths (81%) had t ered with the original oxycodone formulation in the month prior to Wave 1 use and attempted t ering with reformulated oxycodone amongst the s le was comparatively low at Wave 2 (29% and 19%, respectively). Reformulated oxycodone was primarily swallowed (15%), with low levels of recent successful injection (6%), chewing (2%), drinking/dissolving (1%), and smoking (<1%). Participants who t ered with original and reformulated oxycodone were socio-demographically and clinically similar to those who had only t ered with the original formulation, except the former were more likely to report prescribed oxycodone use and stealing pharmaceutical opioid, and less likely to report moderate/severe anxiety. There was significant ersity in the methods for t ering, with attempts predominantly prompted by self-experimentation (rather than informed by word-of-mouth or the internet). Participants rated reformulated oxycodone as more difficult to prepare and inject and less pleasant to use compared to the original formulation. Current findings suggest that the introduction of the t er-resistant product has been successful at reducing, although not necessarily eliminating, t ering with the controlled-release oxycodone formulation, with lower attractiveness for misuse. Appropriate, effective treatment options must be available with increasing availability of abuse-deterrent products, given the reduction of oxycodone t ering and use amongst a group with high rates of pharmaceutical opioid dependence.
Publisher: Wiley
Date: 17-03-2022
DOI: 10.1111/DAR.13462
Abstract: Tapentadol is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe pain. The study aimed to determine the characteristics of Australian toxicity deaths related to tapentadol. All cases in which tapentadol use was coded contributory to death ( n = 159) were retrieved from the National Coronial Information System (1 July 2000–31 December 2020). The mean age was 48.5 (18–81) and 56% were female. Documented histories of problems with chronic pain (66%), mental health (60.4%), substance use (44%) and injecting drug use (23.3%) were common. The majority of deaths were deemed unintentional (76.1%) and in 18.9% pre‐existing disease was co‐contributory. The median peripheral blood tapentadol concentration was 1.00 mg L −1 (0.02–47.00), and the median aortic concentration was 2.05 mg L −1 (0.10–30.00). In all cases, psychoactive drugs other than tapentadol were also detected, most commonly antidepressants (72.3%), opioids (66.7%), hypnosedatives (64.2%) and gabapentinoids (43.4%). Of cases where autopsies were conducted, 27.7% were diagnosed with cardiomegaly and 18.5% with severe coronary artery stenosis. Pulmonary oedema (68.1%), aspiration of vomitus (39.5%) and acute pneumonia (26.9%) were common. The typical tapentadol‐related toxicity death involved unintentional death in the presence of multiple drugs, although a notable minority were intentional self‐harm. Multiple morbidities were common. The identification and characteristics of these cases indicate that the adverse event profile of tapentadol needs to be considered in the setting of polypharmacy.
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].
Publisher: Elsevier BV
Date: 11-2023
Publisher: Wiley
Date: 24-11-2022
DOI: 10.1111/DAR.13581
Abstract: With increased use, the number of cocaine‐related deaths has increased. We aimed to determine: (i) the toxicological profile of cocaine, metabolites and adulterants amongst three groups of cocaine‐related fatalities in which cocaine and/or metabolites were present in blood: (a) fatal toxicity, where cocaine only (CO) was present ( n = 48), (b) multiple drug toxicity (MDT) where other drugs were present ( n = 604), and (c) a comparison group of death from traumatic injury (TI, n = 232) (ii) the acute clinical presentation by group and (iii) cardiovascular disease by group. Retrospective study of cocaine‐related deaths in Australia, 2000–2021, from the National Coronial Information System. The parent drug cocaine was significantly more common, and had a higher median concentration, amongst the CO group (97.9%, 1.550 mg/L) than the MDT (68.9%, 0.09 mg/L) and TI (70.7%, 0.05 mg/L) groups respectively. Similarly large ratios between CO, MDT and TI were seen for benzoylecgonine (2.100, 0.510, 0.240 mg/L), methylecgonine (1.350, 0.140, 0.070 mg/L), lignocaine (1.200, 0.200, 0.150 mg/L) and levamisole (0.230, 0.045, 0.025 mg/L). The two toxicity groups had significantly higher proportions than the TI group for reports of sudden collapse, seizure, acute psychosis, hyperthermia and vomiting. In addition, CO had higher proportions than MDT and TI of sudden collapse. CO had significantly higher proportions of cardiomegaly and coronary artery disease than the TI group. Compared to MDT and TI cases, CO cases had higher cocaine concentrations, higher concentrations of adulterants, higher levels of cardiovascular disease and were more likely to suddenly collapse.
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.
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.DRUGPO.2019.102656
Abstract: People who inject drugs (PWID) are at elevated risk of HIV infection. Data on population sizes of PWID living with HIV are needed to inform the implementation of prevention, treatment and care programs. We estimated national population sizes of people who recently (past 12 months) injected drugs living with HIV and evaluated ecological associations with HIV prevalence in PWID. We used national data on the prevalence of injecting drug use and of HIV among PWID, derived from systematic reviews, to estimate national population sizes of PWID living with HIV. Uncertainty was estimated using Monte Carlo simulation with 100,000 draws. We extracted data on s le characteristics from studies of HIV prevalence among PWID, and identified national indicators that have been observed or hypothesised to be associated with HIV prevalence in PWID. We used linear regression to evaluate associations between these variables and HIV prevalence in PWID. Four countries comprised 55% of the estimated global population of PWID living with HIV: Russia (572,500 95% uncertainty interval (UI) 235,500-1,036,500) Brazil (462,000 95% UI 283,500-674,500) China (316,500 95% UI 171,500-493,500), and the United States (195,500 95% UI 80,000-343,000). Greater anti-HCV prevalence and national income inequality were associated with greater HIV prevalence in PWID. The countries with the largest populations of PWID living with HIV will need to dramatically scale up prevention, treatment and care interventions to prevent further increases in population size. The association between anti-HCV prevalence and HIV prevalence among PWID corroborates findings that settings with increasing HCV should implement effective interventions to prevent HIV outbreaks. The association between income inequality and HIV among PWID reinforces the need to implement structural interventions alongside targeted in idual-level strategies.
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.
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.
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.
Publisher: Wiley
Date: 21-02-2023
DOI: 10.1111/DAR.13621
Abstract: We aimed to describe COVID‐19 vaccination attitudes and identify potential facilitators for vaccine uptake among people who inject drugs. People who inject drugs were recruited from all eight Australian capital cities ( N = 884 65% male, mean age 44 years) and interviewed face‐to‐face or via telephone in June–July 2021. COVID‐19 and broader vaccination attitudes were used to model latent classes. Correlates of class membership were assessed through multinomial logistic regression. Probability of endorsing potential vaccination facilitators were reported by class. Three classes of participants were identified: ‘vaccine acceptant' (39%), ‘vaccine hesitant' (34%) and ‘vaccine resistant' (27%). Those in the hesitant and resistant groups were younger, more likely to be unstably housed and less likely to have received the current season influenza vaccine than the acceptant group. In addition, hesitant participants were less likely to report a chronic medical condition than acceptant participants. Compared to vaccine acceptant and hesitant participants, vaccine‐resistant participants were more likely to predominantly inject meth hetamine and to inject drugs more frequently in the past month. Both vaccine‐hesitant and resistant participants endorsed financial incentives for vaccination and hesitant participants also endorsed facilitators related to vaccine trust. People who inject drugs who are unstably housed or predominantly inject meth hetamine are subgroups that require targeted interventions to increase COVID‐19 vaccination uptake. Vaccine‐hesitant people may benefit from interventions that build trust in vaccine safety and utility. Financial incentives may improve vaccine uptake among both hesitant and resistant people.
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].
Publisher: Elsevier BV
Date: 11-2015
Publisher: Informa UK Limited
Date: 18-09-2020
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.
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.
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.
Publisher: MDPI AG
Date: 21-07-2022
Abstract: We carried out a scoping review to characterize the primary quantitative evidence addressing changes in key in idual/structural determinants of substance use risks and health outcomes over the first two waves of the COVID-19 pandemic in the United States (US). We systematically queried the LitCovid database for US-only studies without date restrictions (up to 6 August 2021). We extracted quantitative data from articles addressing changes in: (a) illicit substance use frequency/contexts/behaviors, (b) illicit drug market dynamics, (c) access to treatment and harm reduction services, and (d) illicit substance use-related health outcomes/harms. The majority of 37 selected articles were conducted within metropolitan locations and leveraged historical timeseries medical records data. Limited available evidence supported changes in frequency/behaviors/contexts of substance use. Few studies point to increases in fentanyl and reductions in heroin availability. Policy-driven interventions to lower drug use treatment thresholds conferred increased access within localized settings but did not seem to significantly prevent broader disruptions nationwide. Substance use-related emergency medical services’ presentations and fatal overdose data showed a worsening situation. Improved study designs/data sources, backed by enhanced routine monitoring of illicit substance use trends, are needed to characterize substance use-related risks and inform effective responses during public health emergencies.
Publisher: BMJ
Date: 08-2019
DOI: 10.1136/BMJOPEN-2019-030605
Abstract: The aims of this program of research are to use linked health and law enforcement data to describe in iduals presenting to emergency and inpatient healthcare services with an acute alcohol harm or problematic alcohol use measure their health service utilisation and law enforcement engagement and quantify morbidity, mortality, offending and incarceration. We will assemble a retrospective cohort of people presenting to emergency departments and/or admitted to hospitals between 1 January 2005 and 31 December 2014 in New South Wales, Australia with a diagnosis denoting an acute alcohol harm or problematic alcohol use. We will link these data with records from other healthcare services (eg, community-based mental healthcare data, cancer registry), mortality, offending and incarceration data sets. The four overarching areas for analysis comprise: (1) describing the characteristics of the cohort at their first point of contact with emergency and inpatient hospital services in the study period with a diagnosis indicating an acute alcohol harm and/or problematic alcohol use (2) quantifying health service utilisation and law enforcement engagement (3) quantifying rates of mortality, morbidity, offending and incarceration and (4) assessing predictors (eg, age, sex) of mortality, morbidity, offending and incarceration among this cohort. Ethics approval has been provided by the New South Wales Population and Health Services Research Ethics Committee. We will report our findings in accordance with the REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement and Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) where appropriate. We will publish data in tabular, aggregate forms only. We will not disclose in idual results. We will disseminate project findings at scientific conferences and in peer-reviewed journals. We will aim to present findings to relevant stakeholders (eg, addiction medicine and emergency medicine specialists, policy makers) to maximise translational impact of research findings.
Publisher: Elsevier BV
Date: 04-2018
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.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.JSAT.2018.02.001
Abstract: This was a national English observational cohort study to estimate the effectiveness of inpatient withdrawal (IW) and residential rehabilitation (RR) interventions for alcohol use disorder (AUD) using administrative data. All adults commencing IW and/or RR intervention for AUD between April 1, 2014 and March 31, 2015 reported to the National Drug Treatment Monitoring System (n=3812). The primary outcome was successful completion of treatment within 12months of commencement, with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression. The majority (70%, n=2682) received IW in their index treatment journey one-quarter (24%, n=915) received RR 6% (n=215) received both. Of treatment leavers, 59% achieved the SCNR outcome (IW: 57% RR: 64% IW/RR: 57%). Positive outcome for IW was associated with older age, being employed, and receiving community-based treatment prior to and subsequent to IW. Patients with housing problems were less likely to achieving the outcome. Positive outcome for RR was associated with paid employment, self/family eer referral, longer duration of RR treatment, and community-based treatment following discharge. Community-based treatment prior to entering RR, and receiving IW during the same treatment journey as RR, were associated with lower likelihood of SCNR. In this first national effectiveness study of AUD in the English public treatment system for alcohol-use disorders, 59% of patients successfully completed treatment within 12months and did not represent for more treatment within six months. Longer duration of treatment and provision of structured continuing care is associated with better treatment outcomes.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Wiley
Date: 11-2015
DOI: 10.1111/DAR.12367
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.
Publisher: Wiley
Date: 21-10-2023
DOI: 10.1111/ADD.16061
Abstract: The aim of this study is to examine age, period and birth cohort trends in the prevalence of any alcohol‐related risky behaviour and to compare these trends between men and women. We used an age–period–cohort analysis of repeated cross‐sectional survey data from the Australian National Drug Strategy Household Survey from 2001 to 2016. Participants were 121 281 people aged 14–80 years who reported consuming alcohol in the past 12 months. Any risky behaviour undertaken while under the influence of alcohol in the past 12 months (e.g. operating a motor vehicle) was measured: male or female. Controlling for age and cohort, cubic spline models showed that any alcohol‐related risky behaviour declined with time among participants who consumed alcohol [2016 versus 2007 rate ratio (RR) = 0.80, 95% confidence interval (CI) = 0.76–0.84]. Risky behaviour peaked in the 1954 birth cohort (1954 versus 1971 RR = 1.42, 95% CI = 1.30–1.55) and then steadily declined with more recent birth cohorts (2002 versus 1971 RR = 0.32, 95% CI = 0.27–0.39). Risky behaviour peaked at age 21 years, followed by steady decline and stabilization at approximately age 70 years. Males were overall twice as likely as females to report alcohol‐related risky behaviour (RR = 2.10, 95% CI = 1.84–2.39), but this effect was smaller in cohorts born after 1980 [1980 prevalence rate ratios (PRR) = 2.09, 95% CI = 1.81–2.43 2002 PRR = 1.31, 95% CI = 1.03–1.68]. Alcohol‐related risky behaviour in Australia has declined generally since 2001, with rates for recent cohorts having the sharpest decline. Risky behaviour remains most prevalent in young adults, and the male–female gap in risky behaviour is closing for more recent birth cohorts. These trends are consistent with alcohol consumption trends observed in Australia and world‐wide.
Publisher: Wiley
Date: 14-02-2019
DOI: 10.1111/ADD.14556
Publisher: Wiley
Date: 16-05-2023
DOI: 10.1111/ADD.16218
Abstract: Alcohol consumption is a leading risk factor for premature mortality globally, but there are limited studies of broader cohorts of people presenting with alcohol‐related problems outside of alcohol treatment services. We used linked health administrative data to estimate all‐cause and cause‐specific mortality among in iduals who had an alcohol‐related hospital inpatient or emergency department presentation. Observational study using data from the Data linkage Alcohol Cohort Study (DACS), a state‐wide retrospective cohort of in iduals with an alcohol‐related hospital inpatient or emergency department presentation. Hospital inpatient or emergency department presentation in New South Wales, Australia, between 2005 and 2014. Participants comprised 188 770 in iduals aged 12 and above, 66% males, median age 39 years at index presentation. All‐cause mortality was estimated up to 2015 and cause‐specific mortality (by those attributable to alcohol and by specific cause of death groups) up to 2013 due to data availability. Age‐specific and age–sex‐specific crude mortality rates (CMRs) were estimated, and standardized mortality ratios (SMRs) were calculated using sex and age‐specific deaths rates from the NSW population. There were 188 770 in iduals in the cohort (1 079 249 person‐years of observation) 27 855 deaths were recorded (14.8% of the cohort), with a CMR of 25.8 [95% confidence interval (CI) = 25.5, 26.1] per 1000 person‐years and SMR of 6.2 (95% CI = 5.4, 7.2). Mortality in the cohort was consistently higher than the general population in all adult age groups and in both sexes. The greatest excess mortality was from mental and behavioural disorders due to alcohol use (SMR = 46.7, 95% CI = 41.4, 52.7), liver cirrhosis (SMR = 39.0, 95% CI = 35.5, 42.9), viral hepatitis (SMR = 29.4, 95% CI = 24.6, 35.2), pancreatic diseases (SMR = 23.8, 95% CI = 17.9, 31.5) and liver cancer (SMR = 18.3, 95% CI = 14.8, 22.5). There were distinct differences between the sexes in causes of excess mortality (all causes fully attributable to alcohol female versus male risk ratio = 2.5 (95% CI = 2.0, 3.1). In New South Wales, Australia, people who came in contact with an emergency department or hospital for an alcohol‐related presentation between 2005 and 2014 were at higher risk of mortality than the general New South Wales population during the same period.
Publisher: Informa UK Limited
Date: 26-09-2017
DOI: 10.1080/10826084.2016.1214153
Abstract: Understanding the characteristics of drug users in the night-time economy (NTE), and whether particular drugs are associated with risky practices and experience of harm, is necessary to inform targeted policy responses in this context. To investigate the correlates of drugs used in the Australian NTE relating to demographics, alcohol use, and experience of harm. Patrons were interviewed in the NTE of five Australian cities in 2012-2013 (n = 7,028 61.9% male, median age 22 years). A custom designed survey gathered demographic data, alcohol, and substance use on the current night, and experience of harm in/around licensed venues in the past 3 months. Multivariate logistic regression analyses examined the correlates of drug use. Ecstasy was most commonly reported (4.0%), followed by cannabis (2.9%), meth hetamine (2.6%), and cocaine (1.6%). Ecstasy users were more likely to be younger and report energy drink consumption. Cannabis users were more likely to be male, and to have been involved in intoxication-related accidents/injuries and sexual aggression in/around licensed venues in the past 3 months. Meth hetamine users were more likely to have been interviewed later, and to have engaged in pre-drinking. Cocaine users were more likely to be male, aged 21 years or more, have a blood alcohol concentration of greater than 0.10%, and to have been involved in intoxication-related accidents/injuries in the past three months. Conclusions/Importance: We identified significant differences between types of drug users and the harms they experience, underscoring the need to develop innovative harm reduction policies in the NTE rather than blanket population-based approaches.
Publisher: Wiley
Date: 06-03-2020
DOI: 10.1111/ADD.15005
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.
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.
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.APPET.2012.12.021
Abstract: While the performance-enhancing effects of energy drinks are commonly attributed to caffeine, recent research has shown greater facilitation of performance post-consumption than typically expected from caffeine content alone. Consequently, the aim of the present study was to investigate the independent and combined effect of taurine and caffeine on behavioural performance, specifically reaction time. Using a double-blind, placebo-controlled, crossover, within-subjects design, female undergraduates (N=19) completed a visual oddball task and a stimulus degradation task 45min post-ingestion of capsules containing: (i) 80mg caffeine, (ii) 1000mg taurine, (iii) caffeine and taurine combined, and (iv) matched placebo. Participants completed each treatment condition, with sessions separated by a minimum 2-day washout period. Whereas no significant treatment effects were recorded for reaction time in the visual oddball task, facilitative caffeine effects were evident in the stimulus degradation task, with significantly faster reaction time in active relative to placebo caffeine conditions. Furthermore, there was a trend towards faster mean reaction time in the caffeine condition relative to the taurine condition and combined caffeine and taurine condition. Thus, treatment effects were task-dependent, in that independent caffeine administration exerted a positive effect on performance, and co-administration with taurine tended to attenuate the facilitative effects of caffeine in the stimulus degradation task only.
Publisher: BMJ
Date: 03-2018
DOI: 10.1136/BMJOPEN-2017-020006
Abstract: It has been argued that tapentadol may pharmacologically have lower abuse potential than other pharmaceutical opioids currently available. However, there has been no comprehensive triangulation of data regarding use and harms associated with this formulation. A sustained-release formulation (SRF) of tapentadol (Palexia) was released in Australia in 2011 and listed for public subsidy in 2013. We summarise here the methods of a postmarketing study which will measure postintroduction: (1) population level availability, (2) extramedical use and ersion, (3) attractiveness for extramedical use and (4) associated harms, of tapentadol compared against other pharmaceutical opioids. We evaluated key sources on pharmaceutical use and harms in Australia. This review indicateddata from four sources that disaggregate pharmaceutical opioid formulations and capture tapentadol SRF could be triangulated. These data sources comprised: (1) national pharmaceutical opioid community sales data from 2011 to 2017, (2) national pharmaceutical opioid poisonings reported to Poison Information Centres (PICs) from 2011 to 2017, (3) number of vendors on online marketplaces listing pharmaceutical opioids for sale and (4) data on pharmaceutical opioid extramedical use, attractiveness and harms from interviews with people who regularly inject drugs in Australia. Ethics approval is not required for use of pharmaceutical sales data. Ethics approval has been obtained for use of national pharmaceutical opioid poisonings reported to PICs (LNR/16/SCHN/44) and for use of online marketplace data and interview data from people who inject drugs (HC12086). Key findings will be published mid-2018 in a peer-reviewed academic journal, and presented at various conferences and professional meetings.
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.DRUGPO.2019.07.030
Abstract: People who inject drugs (PWID) are at an elevated risk of fatal overdose in the first year after experiencing a non-fatal event. Such non-fatal events may also result in overdose-related sequelae, ranging from physical injury to paralysis. Given variation in drug markets and treatment availability across countries and regions, we may see similar variations in non-fatal overdose prevalence. Monitoring non-fatal overdose prevalence among PWID is essential for informing treatment intervention efforts, and thus our review aims to estimate the global, regional, and national prevalence of non-fatal overdose, and determine characteristics associated with experiencing such an event. We conducted a systematic review and meta-analyses to estimate country, regional, and global estimates of recent and lifetime non-fatal overdose prevalence among PWID. Using meta-regression analyses we also determined associations between s le characteristics and non-fatal overdose prevalence. An estimated 3.2 (1.8-5.2) million PWID have experienced at least one overdose in the previous year. Among PWID, 20.5% (15.0-26.1%) and 41.5% (34.6-48.4%) had experienced a non-fatal event in the previous 12 months and lifetime respectively. Frequent injecting was strongly associated with PWID reporting recent and lifetime non-fatal overdose. Estimates of recent non-fatal overdose were particularly high in Asia and North America. Around one in five PWID are at an elevated risk of fatally overdosing every year, however there is substantial geographical variation. In countries with higher rates of non-fatal overdose there is need to introduce or mainstream overdose prevention strategies such as opioid agonist treatment and naloxone administration training programs.
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.DRUGALCDEP.2019.107697
Abstract: A sustained-release formulation (SRF) of tapentadol has been marketed in Australia since February 2013. This study examined tapentadol SRF extra-medical use, attractiveness for extra-medical use, and associated harms in Australia. This post-marketing study comprises analyses of Australian community sales data (2011-2017) for eleven pharmaceutical opioids (prescription and over-the-counter codeine disaggregated) calls to three poisons information centres (covering five of the eight jurisdictions in Australia) related to pharmaceutical opioids and coded by the centres as 'misuse' or 'abuse' (2011-2017) and interviews with people who inject drugs (n = 888) recruited as part of the Illicit Drug Reporting System (IDRS) from all Australian capital cities (2017). Population-level availability of tapentadol SRF increased from market launch, comprising the sixth largest market share of all opioid unit sales, and third greatest share in oral morphine equivalent milligrams sold, in December 2017. Lifetime tapentadol SRF use among the IDRS s le (n = 888) was low (1.5% 95%CI 0.9-2.5), with few reporting past-6 month non-prescribed use or injection. Non-fatal overdose following tapentadol use was self-reported by less than 1% (95%CI 0.1-0.8). Between 2013-2017, 1.1% (n = 25) of pharmaceutical opioid 'misuse/abuse' calls were related to tapentadol, and predominantly the SRF. Increasing utilisation of tapentadol sustained-release formulation was observed, along with indications of extra-medical use and harms associated with use, although on a smaller scale relative to other opioids. These findings need to be interpreted in the context of the low level of exposure to tapentadol sustained-release formulation among the sentinel population of people who inject drugs.
Publisher: Wiley
Date: 29-07-2013
DOI: 10.1111/ACER.12202
Publisher: Informa UK Limited
Date: 31-03-2016
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.
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.
Publisher: Wiley
Date: 23-03-2021
DOI: 10.1111/DAR.13282
Abstract: Awareness of hepatitis C virus (HCV) status among people who inject drugs is critical to ensure linkage to care and reduce transmission risk. Testing pathways, confusion about results and possible reinfection raise potential for discordance between perceived and actual HCV status among people who inject drugs. We evaluated self‐reported and serologically confirmed HCV status concordance among a s le of Australian people who inject drugs. Data were collected in May–June 2018 from participants in Canberra and Sydney, Australia, who had injected drugs at least monthly in the past 6 months. Participants completed a structured interview assessing self‐reported HCV status and provided a dried blood spot s le for HCV RNA testing. Of 103 participants, 95% self‐reported ever receiving antibody testing, 58% of whom reported having received RNA testing. Seventy‐three percent of participants reported never having been told that they had HCV, 18% reported current infection and 9% did not know their current status. According to dried blood spot RNA testing, 20% were currently infected. Over a quarter of the s le (28%, n = 29) did not accurately report their HCV status, half of whom were unaware of a current infection. With over one‐quarter of the s le in our study not accurately reporting their current HCV status, our findings reinforce the importance of regular testing for active infection, and the need for improved health literacy on HCV antibody and RNA test results, HCV status post‐treatment and reinfection risk.
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.
Publisher: Wiley
Date: 24-01-2023
DOI: 10.1111/DAR.13601
Abstract: Despite increasing evidence challenging the effectiveness and legality of police drug dog operations, these strategies remain common. We aimed to describe drug dog encounters at music festivals, behavioural adaptations taken in anticipation of their presence and consequences of encounters amongst a s le of people who regularly use MDMA/ecstasy. Data were collected via interviewer‐administered questionnaires in April–June 2019. Australians aged 16 years or older who used MDMA/ecstasy and/or other stimulants monthly in the last 6 months were recruited from capital cities via social media and word‐of‐mouth ( n = 797). Participants reported recent drug dog encounters, encounter settings and actions taken in anticipation of and in response to encounters. In this s le, encounters with drug dogs at festivals were common (60%), with most participants (92%) reporting anticipating the encounter. Most (86%) of this group reported behavioural adaptations to avoid a detection, with concealing drugs well (57%) and consuming prior to entering the festival (20%) most reported. Only 4% of those who expected drug dog presence chose not to carry or consume drugs. One‐quarter (26%) of those who reported an encounter were stopped by police and 4% were searched (bodily/bag search). Most participants anticipated drug dog presence at festivals, however, were not deterred from carrying or consuming drugs. Some reported adaptations to avoid detection may increase drug‐related health, social and legal harms. Our study suggests drug dog presence at festivals does not deter carriage/use of illegal drugs, and echoes concerns regarding the efficacy and appropriateness of this policing initiative.
Publisher: Wiley
Date: 25-07-2023
DOI: 10.1111/DAR.13722
Abstract: There is concern around non‐prescribed benzodiazepine use, particularly with increasing detections of counterfeit products containing high‐risk novel compounds. The aims of this study were to investigate how and which non‐prescribed benzodiazepines are being sourced forms, appearance and packaging and awareness of risks associated with non‐prescribed benzodiazepines. Data were collected from a s le of Australians who inject drugs or use ecstasy and/or other illicit stimulants on a monthly or more frequent basis, and who reported past 6‐month use of non‐prescribed benzodiazepines ( n = 235 and n = 250, respectively). Data were collected on source, ersion from a known/trusted prescription, product name and aesthetic characteristics for the last non‐prescribed benzodiazepine obtained. Amongst participants who injected drugs, 71% reported that their last non‐prescribed benzodiazepines were erted from a known/trusted prescription, compared to 59% of participants who used ecstasy/other stimulants. Sourcing via cryptomarkets was rare. Across both s les, the majority reported last obtaining substances sold/marketed as diazepam or alprazolam. Participants sourcing via non‐ erted means were twice as likely to obtain alprazolam. Known sourcing of novel compounds was rare. Amongst participants who used ecstasy/other stimulants, 36% reported confidence in the content/dose of non‐prescribed benzodiazepines even when the source is unknown. Most participants obtained substances sold as classic/registered benzodiazepines, mostly via erted prescriptions, with a substantial minority potentially unaware of counterfeits circulating. While erted use undeniably presents risks, tightening of prescriptions in Australia could inadvertently lead to greater supply of novel benzodiazepines as seen internationally, reinforcing prioritisation of demand and harm reduction strategies.
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.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Wiley
Date: 20-02-2022
DOI: 10.1111/DAR.13448
Abstract: People who inject drugs may be at higher risk of COVID‐19 transmission and more severe negative health outcomes following COVID‐19 infection. Early research on hypothetical COVID‐19 vaccines suggests this population may be less likely to accept vaccination. This commentary extends this research by presenting vaccine intention data from Illicit Drug Reporting System interviews conducted in June–July 2021, in the early stages of vaccine rollout, with people in Australia who inject drugs ( N = 888). Half the s le (48%, n = 419) reported that they were hesitant to receive the COVID‐19 vaccine, with key barriers relating to vaccine safety and side effect concerns. This level of hesitancy is substantially higher than that of the general population at a similar time. While we note that the subsequent Delta variant‐driven third wave of cases in Australia and efforts to increase population vaccination coverage may have altered intent in this group, this level of hesitancy warrants a targeted strategy to mitigate vaccine‐related concerns and maximise uptake. Ideally, this should comprise an inclusive health response that is peer‐led, with peer‐based organisations ideally positioned to direct immunisation service delivery and provide vaccine‐related messaging.
Publisher: Elsevier BV
Date: 08-2201
Publisher: Elsevier BV
Date: 08-2023
Publisher: Oxford University Press (OUP)
Date: 20-09-2020
DOI: 10.1093/PM/PNAA214
Abstract: To estimate all-cause and overdose crude mortality rates and standardized mortality ratios among people prescribed opioids for chronic noncancer pain and risk of overdose death in this population relative to people with similar clinical profiles but not prescribed opioids. Systematic review and meta-analysis. Medline, Embase, and PsycINFO were searched in February 2018 and October 2019 for articles published beginning 2009. Due to limitations in published studies, we revised our inclusion criteria to include cohort studies of people prescribed opioids, excluding those studies where people were explicitly prescribed opioids for the treatment of opioid use disorder or acute cancer or palliative pain. We estimated pooled all-cause and overdose crude mortality rates using random effects meta-analysis models. No studies reported standardized mortality ratios or relative risks. We included 13 cohorts with 6,029,810 participants. The pooled all-cause crude mortality rate, based on 10 cohorts, was 28.8 per 1000 person-years (95% CI = 17.9–46.4), with substantial heterogeneity (I2 = 99.9%). The pooled overdose crude mortality rate, based on six cohorts, was 1.1 per 1000 person-years (95% CI = 0.4–3.4), with substantial heterogeneity (I2 = 99.5%), but indications for opioid prescribing and opioid exposure were poorly ascertained. We were unable to estimate mortality in this population relative to clinically similar populations not prescribed opioids. Methodological limitations in the identified literature complicate efforts to determine the overdose mortality risk of people prescribed opioids. There is a need for large-scale clinical trials to assess adverse outcomes in opioid prescribing, especially for chronic noncancer pain.
Publisher: Wiley
Date: 02-2019
DOI: 10.1111/DAR.12908
Publisher: Springer International Publishing
Date: 2020
Publisher: SAGE Publications
Date: 2011
DOI: 10.2304/PLAT.2011.10.2.128
Abstract: Students' understanding of the nature of science (NOS), and the degree to which they perceive their discipline to be part of science, are critical to their academic development in psychology. In Study 1, 650 first-year psychology students from three universities in Australia completed the Psychology as a Science (PAS) questionnaire, an adjective checklist relating to science and psychology, and the Science Knowledge and Attitudes (SKA) scale. Results confirmed the limited value of the PAS to identify components of the NOS, but indicated that students view psychology to be a science within a few weeks of the commencement of their study at university. Three factors underlying the SKA scale were identified: naïve view of science (NVS), social and cultural perspective (SCP), and knowledge of refutability (KR). In Study 2, 622 students at the University of Tasmania completed the SKA and items relating to their beliefs about studying. Scores on the three factors were correlated with beliefs about studying, scores on KR increased with years of study, and scores on NVS decreased with years of study. These data suggest that our educational practices do in fact lead to appropriate changes in students' NOS understanding in a manner consistent with the learning outcomes underpinning psychology graduate attributes.
Publisher: Elsevier BV
Date: 03-2023
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.
Publisher: Wiley
Date: 03-2021
DOI: 10.1111/DAR.13273
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.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Wiley
Date: 24-03-2020
DOI: 10.1111/ADD.15033
Publisher: Wiley
Date: 07-07-2021
DOI: 10.1111/ADD.15154
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.
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].
Publisher: Wiley
Date: 09-11-2022
DOI: 10.1111/DAR.13399
Abstract: Vaccine acceptability is a key determinant of vaccination uptake. Despite being at risk of adverse outcomes from coronavirus‐19 disease (COVID‐19), COVID‐19 vaccine acceptability among people who inject drugs is unknown. We surveyed people who inject drugs in Melbourne, Australia to assess potential uptake of COVID‐19 vaccines prior to distribution. Cross‐sectional study, comprising interviewer‐administered structured telephone interviews completed from 30 November to 22 December 2020 in Melbourne, Australia. Participants were people aged 18 years or older who injected drugs at least monthly in the past 6 months and had resided in Melbourne in the past 12 months recruited via needle‐syringe programs and word‐of‐mouth. COVID‐19 hypothetical vaccine acceptability, participants' demographic, drug use and drug treatment characteristics. Fifty‐eight percent (57/99) of the s le reported that they would definitely or probably be vaccinated for COVID‐19, with the remainder indicating that they would not (22%) or were undecided (20%). Among those who indicated that they would definitely or probably not be vaccinated or were undecided ( n = 42), safety concerns were most often cited as a reason for not wanting to be vaccinated. Although a majority of s led people who inject drugs indicated that they would definitely or probably be vaccinated, efforts to reduce hesitancy and allay COVID‐19 vaccine safety concerns will be necessary to optimise vaccine uptake among this population.
Publisher: Alcohol Research Documentation, Inc.
Date: 03-2021
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.
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.
Publisher: American Medical Association (AMA)
Date: 05-2020
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.DRUGALCDEP.2019.107556
Abstract: New psychoactive stimulants and hallucinogens comprise a range of "designer drugs" that have risen to prominence in the 21 All cases in which new psychoactive stimulants were a mechanism contributory to death were retrieved from the National Coronial Information System (2000-2017). Information was collected on cause of death, demographics, drug use history, circumstances of death, toxicology and major organ pathology. 82 cases were identified. The mean age was 30.7yrs and 86.6% were male. Circumstances of death were: accidental drug toxicity (59.8%), traumatic accident (15.9%), suicide (12.2%) and natural disease (2.4%). The most common clinical presentation observed proximal to death was delirium (26.8%). Delirium was mostly frequently observed after phenethylamine consumption (72.2%). The most common cardiovascular diagnosis at autopsy was replacement fibrosis, indicative of previous ischemia (10.5%). New psychoactive stimulants and hallucinogens detected in toxicology were: cathinones (75.7%), phenethylamines (22.0%) and piperazines (6.1%). Other substances were present in 83.5% of cases, most commonly established controlled psychostimulants (58.2%). Acute toxicity was the most common cause of death, but more than a third of deaths were due to trauma. Cathinones were the most commonly detected of the new psychoactive stimulants and hallucinogens. Delirium was the most frequently reported clinical sign proximal to death and was strongly associated with the phenethylamines.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.DRUGALCDEP.2022.109292
Abstract: Aims: To determine 1. The characteristics of all recorded cases of fatal drug poisoning involving novel synthetic opioids (NSOs) in Australia 2. The toxicology of cases and 3. The major autopsy findings. Review of all fatal poisonings related to NSOs in Australia 2000-2021 identified in the National Coronial Information System. Thirty-one cases were identified, 96.8% due to unintentional drug toxicity. The mean age was 31.9 years and 87.1% were male. Only six were aged over forty. A history of substance use problems was documented in 80.6% and 58.1% had a history of injecting drug use. In 32.3% the final route of administration of a NSO was by non-injecting routes of administration. Ten NSOs were identified. Fentanyl analogues were present in 67.2%, most commonly furanylfenatyl (19.4%). Other NSO types were present in 39.7%, most commonly U-47700 (35.5%). Substances other than NSOs were present in 90.3%, most commonly benzodiazepines (67.7%) and other opioids (51.6%). A CNS depressant in addition to NSOs was present in 90.3%, and a new psychoactive substance other than a NSO in 25.8%. Pulmonary oedema was diagnosed in 82.6%, aspiration of vomitus in 30.4%, and acute bronchopneumonia in 17.4%. Ten NSOs were identified. Case characteristics suggest a younger cohort whose profile is more typical of use of other NPS than of the established opioids. A large proportion used NSOs by non-injecting routes of administration.
Publisher: Elsevier BV
Date: 2020
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.DRUGALCDEP.2019.107793
Abstract: A range of negative experiences and circumstances that are common among people who inject drugs (PWID) are risk factors for developing mental disorders. Despite this, there has been no systematic review of the prevalence of mental health indicators among PWID. Thus, we aimed to estimate the prevalence of depression, post-traumatic stress disorder (PTSD), suicidality and self-harm among PWID. We searched the peer-reviewed and grey literature for data on depression, PTSD, suicidality and non-suicidal self-harm among PWID from sources published from 2008-2018. We pooled estimates of depression and suicidality using random-effects meta-analysis and provided a narrative summary of estimates of PTSD and self-harm. We found 23 studies that reported on these mental health indicators among PWID. The pooled estimate for current severe depressive symptomology was 42.0 % (95 % confidence interval [CI] = 21.3, 62.8 %), and for a depression diagnosis was 28.7 % (95 % CI = 20.8, 36.6 %). With much variation, the pooled lifetime prevalence of a suicide attempt was 22.1 % (95 % CI = 19.3, 24.9 %). There were only two studies each that reported on PTSD and non-suicidal self-harm among PWID. Recent data investigating these mental health indicators among PWID was limited, particularly from low- and middle-income countries. Even so, estimates were high and call for further research into the epidemiology of such mental health disorders and self-harming behaviours, as well as the promotion of integrated mental health and substance dependence treatment. Finally, incorporating suicide prevention strategies into services accessed by PWID must be considered as a harm reduction priority.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.DRUGPO.2019.102619
Abstract: People who inject drugs (PWID) do so at varying frequencies. More frequent injecting is associated with skin and soft tissue infection, blood borne viruses, and overdose. The aims of this review are to estimate the prevalence of injecting frequency among PWID and compare these estimates to current needle-syringe distribution coverage estimates, and identify socio-demographic and risk characteristics, and harms associated with daily or more injecting. We conducted a systematic review of the peer-reviewed and grey literature from 2008 to 2018 and extracted needle-syringe distribution coverage data from a recent systematic review. We generated country-, region-, and global-level estimates of daily or more injecting. We also ran meta-regression analyses to determine associations between daily or more injecting and socio-demographic characteristics, injecting risk behaviour, non-fatal overdose, injection site skin infection, and blood borne virus prevalence. Our search resulted in 61,077 sources, from which 198 studies were eligible for inclusion in this review. There were 74 countries with estimates for injecting frequency. Globally, we estimated that 68.1% (95%CI 64.5-71.6%) of PWID, equating to approximately 10.5 (95% UI 6.8-15.0) million people, inject daily or more frequently. There was a higher percentage of participants reporting daily or more injecting among s les with shorter injecting careers, more male participants and higher reporting of opioids as their main drug injected. Daily or more injecting was also associated with s les reporting a higher prevalence of HIV and hepatitis C antibody (anti-HCV), non-fatal overdose, and receptive needle sharing in the previous month. WHO recently recommended a needle-syringe distribution target of 300 needles per PWID per year which is unlikely to be sufficient for the majority of PWID injecting daily or more who are out of drug treatment. The Australian National Drug and Alcohol Research Centre, Australian National Health and Medical Research Council, University of New South Wales.
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.
Publisher: Springer Science and Business Media LLC
Date: 28-09-2018
Publisher: Wiley
Date: 06-09-2022
DOI: 10.1111/ADD.16033
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.
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.
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DRUGALCDEP.2018.01.019
Abstract: This was a national English observational cohort study using administrative data to estimate the effectiveness of community pharmacological and psychosocial treatment for alcohol use disorder (AUD). All adults commencing AUD treatment in the community reported to the National Drug Treatment Monitoring System (April 1 2014-March 31 2015 N = 52,499). Past 28-day admission drinking pattern included drinks per drinking day (DDD): 0 ('Abstinent'), 1-15 ('Low-High'), 16-30 ('High-Extreme') and over 30 DDD ('Extreme'). The primary outcome was successful completion of treatment within 12 months of commencement with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression. The majority reported DDD in the 'Low-High' (n = 17,698, 34%) and 'High-Extreme' (n = 21,383, 41%) range. Smaller proportions were categorised 'Extreme' (n = 7759, 15%) and 'Abstinent' (n = 5661, 11%). Three-fifths (58%) achieved SCNR. Predictors of SCNR were older age, black/minority ethnic group, employment, criminal justice system referral, and longer treatment exposure. Predictors of negative outcome were AUD treatment history, lower socio-economic status, housing problems, and 'Extreme' drinking at admission. In addition to psychosocial interventions, pharmacological interventions and recovery support increased the likelihood of SCNR. Pharmacological treatment was only beneficial for the 'Low-High' groups with recovery support. Over half of all patients admitted for community AUD treatment in England are reported to successfully complete treatment within 12 months and are not re-admitted for further treatment in the following 6 months. Study findings underscore efforts to tailor AUD treatment to the severity of alcohol consumption and using recovery support.
Publisher: Informa UK Limited
Date: 17-08-2022
DOI: 10.1080/15563650.2021.1965159
Abstract: Gabapentinoids are centrally active GABA agonists whose use has increased substantially in the past decade. The current study aimed to provide a comprehensive clinical profile of a national case series of fatal poisonings related to gabapentinoids. Retrospective study of all deaths due to drug toxicity in Australia in which gabapentinoids were a contributory mechanism, retrieved from the National Coronial Information System (2000-2020). Information was collected on case characteristics, toxicology and major organ pathology. A total of 887 cases were identified, with a mean age of 45.7 years and 55.2% being male. Death was due to accidental toxicity in 81.3% of cases and intentional in 18.7%. Pre-existing disease was co-contributory to drug toxicity in 19.5%. Pregabalin was present in 92.9% of cases, with a median blood concentration of 7.6 mg/L (range 0.1-850.0 mg/L). Gabapentin was present in 7.2%, with a median blood concentration of 9.5 mg/L (range 0.5-1940.0 mg/L). Both pregabalin and gabapentin were present in five cases. No other gabapentinoids were detected. Drugs other than gabapentinoids were present in 99.8%, most frequently opioids (90.1%), hypnosedatives (76.9%) and antidepressants (60.5%). A body mass index in the obese range was seen in 45.4%. Clinically significant pre-existing disease was common, notably cardiomegaly (24.9%), emphysema (20.2%), nephrosclerosis (18.7%) and severe hepatic steatosis (11.7%). The concomitant use of other drugs was close to universal, with CNS depressants predominating. Mental health problems, chronic pain and substance misuse were prominent.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2020
Publisher: Elsevier BV
Date: 10-2020
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.
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.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.DRUGALCDEP.2016.11.029
Abstract: Non-viral injecting-related injuries and diseases (IRID), such as abscesses and vascular damage, can result in significant morbidity and mortality if untreated. There has been no systematic assessment of the prevalence of non-viral IRID among people who inject drugs this review aimed to address this gap, as well as identify risk factors for experience of specific IRID. We searched MEDLINE, Embase and CINAHL databases to identify studies on the prevalence of, or risk factors for, IRID directly linked to injecting in s les of people who inject illicit drugs. We included 33 studies: 29 reported IRID prevalence in people who inject drugs, and 17 provided data on IRID risk factors. Skin and soft tissue infections at injecting sites were the most commonly reported IRID, with wide variation in lifetime prevalence (6-69%). Female sex, more frequent injecting, and intramuscular and subcutaneous injecting appear to be associated with skin and soft tissue infections at injecting sites. Cleaning injecting sites was protective against skin infections. Other IRID included infective endocarditis (lifetime prevalence ranging from 0.5-12%) sepsis (2-10%) bone and joint infections (0.5-2%) and thrombosis and emboli (3-27%). There were significant gaps in the data, including a dearth of research on prevalence of IRID in low- and middle-income countries, and potential risk and protective factors for IRID. A consistent approach to measurement, including standardised definitions of IRID, is required for future research.
Publisher: Elsevier BV
Date: 09-2021
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.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Springer Science and Business Media LLC
Date: 30-04-2018
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.
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.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2017
Publisher: Elsevier BV
Date: 02-2018
Publisher: Wiley
Date: 28-02-2021
DOI: 10.1111/DAR.13258
Abstract: We examined trends in Australian treatment episodes for smoking and injecting meth hetamine from 2003 to 2019. Data from the Alcohol and Other Drug Treatment National Minimum Data Set, where hetamines were the principal drug of concern, were analysed from 2003 to 2019. Rates were calculated per 100 000 population aged 10–100 years. Joinpoint software was used to identify changepoints and estimate the annual percentage change (APC) in the rate of treatment episodes. Treatment episode characteristics were compared for smoking versus injecting in 2019. The rate of treatment episodes for meth hetamine increased from 77 to 262 per 100 000 population between 2003 and 2019 (average APC 8%, P 0.001), this being due to treatment episodes for smoking meth hetamine (average APC 32%, P 0.001) with no significant increase in treatment episodes for injecting meth hetamine (average APC 3%). Treatment episodes for smoking increased sharply from 2003 to 2008 (APC 72%, P 0.001) and again from 2010 to 2016 (APC 46%, P 0.001), this upward trend being attenuated between 2016 and 2019 (APC 7%, P = 0.012). Treatment episodes for meth hetamine smoking (cf. injecting) involved younger clients (median age 30 vs. 35 years, P 0.001) who were more likely to receive assessment or case management only (37% vs. 29%, P 0.001). Increased meth hetamine treatment episodes in Australia since 2003 are due mostly to smoking the drug, this occurring among younger cohort who receive less substantive treatment than clients who inject meth hetamine.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Wiley
Date: 04-06-2018
DOI: 10.1111/ADD.14234
Abstract: This review provides an up-to-date curated source of information on alcohol, tobacco and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future. Online data sources were identified through expert review. Data were obtained mainly from the World Health Organization, United Nations Office on Drugs and Crime and Institute for Health Metrics and Evaluation. In 2015, the estimated prevalence among the adult population was 18.4% for heavy episodic alcohol use (in the past 30 days) 15.2% for daily tobacco smoking and 3.8, 0.77, 0.37 and 0.35% for past-year cannabis, hetamine, opioid and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age-standardized prevalence of alcohol dependence was 843.2 per 100 000 people for cannabis, opioids, hetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100 000 people, respectively. High-income North America region had among the highest rates of cannabis, opioid and cocaine dependence. Attributable disability-adjusted life-years (DALYs) were highest for tobacco smoking (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance-attributable mortality rates were highest for tobacco smoking (110.7 deaths per 100 000 people), followed by alcohol and illicit drugs (33.0 and 6.9 deaths per 100 000 people, respectively). Attributable age-standardized mortality rates and DALYs for alcohol and illicit drugs were highest in eastern Europe attributable age-standardized tobacco mortality rates and DALYs were highest in Oceania. In 2015 alcohol use and tobacco smoking use between them cost the human population more than a quarter of a billion disability-adjusted life years, with illicit drugs costing further tens of millions. Europeans suffered proportionately more, but in absolute terms the mortality rate was greatest in low- and middle-income countries with large populations and where the quality of data was more limited. Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.
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.
Publisher: Wiley
Date: 30-08-2019
DOI: 10.1111/JVH.13187
Abstract: The World Health Organization (WHO) recently produced guidelines advising a treat-all policy for HCV to encourage widespread treatment scale-up for achieving HCV elimination. We modelled the prevention impact achieved (HCV infections averted [IA]) from initiating this policy compared with treating different subgroups at country, regional and global levels. We assessed what country-level factors affect impact. A dynamic, deterministic HCV transmission model was calibrated to data from global systematic reviews and UN data sets to simulate country-level HCV epidemics with ongoing levels of treatment. For each country, the model projected the prevention impact (in HCV IA per treatment undertaken) of initiating four treatment strategies either selected randomly (treat-all) or targeted among people who inject drugs (PWID), people aged ≥35, or those with cirrhosis. The IA was assessed over 20 years. Linear regression was used to identify associations between IA per treatment and demographic factors. Eighty-eight countries (85% of the global population) were modelled. Globally, the model estimated 0.35 (95% credibility interval [95%CrI]: 0.16-0.61) IA over 20 years for every randomly allocated treatment, 0.30 (95%CrI: 0.12-0.53) from treating those aged ≥35 and 0.28 (95%CrI: 0.12-0.49) for those with cirrhosis. Globally, treating PWID achieved 1.27 (95%CrI: 0.68-2.04) IA per treatment. The IA per randomly allocated treatment was positively associated with a country's population growth rate and negatively associated with higher HCV prevalence among PWID. In conclusion, appreciable prevention benefits could be achieved from WHO's treat-all strategy, although greater benefits per treatment can be achieved through targeting PWID. Higher impact will be achieved in countries with high population growth.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Wiley
Date: 23-08-2022
DOI: 10.1111/DAR.13529
Abstract: Alcohol is a leading risk factor for death and disease in young people. We compare age‐specific characteristics of young people who experience their first (‘index’) alcohol‐related hospitalisation or emergency department (ED) presentation, and whether age at index predicts 12‐month rates of readmission. We used a retrospective linked‐data cohort of 10,300 people aged 12–20 years with an index alcohol‐related hospital and/or ED record in New South Wales, Australia from 2005 to 2013. Age group (early adolescent [12–14 years], late adolescent [15–17 years], young adult [18–20 years]) and diagnosis fields were used in logistic regression analyses and to calculate incidence rates with adjustment for year of index event, sex, socioeconomic disadvantage and residence remoteness. People who experienced their index event in early adolescence (adjusted relative risk ratio [ARRR] 0.45 [95% confidence interval 0.39, 0.52]) or late adolescence (ARRR 0.82 [0.74, 0.90]) were less likely to be male compared to young adults. Early adolescents (ARRR 0.60 [0.51, 0.70]) and late adolescents (ARRR 0.84 [0.76, 0.93]) were less likely to have a hospitalisation index event. Early adolescents (adjusted incidence rate ratio 1.40 [1.15, 1.71]) and late adolescents (adjusted incidence rate ratio 1.16 [1.01, 1.34]) were more likely than young adults to have a subsequent 12‐month non‐poisoning injury ED presentation. We identified preventable hospital events in young people who have previously experienced an alcohol‐related ED presentation or hospitalisation, with age‐specific characteristics and outcomes that can be used to inform future health policy and service planning.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.DRUGALCDEP.2021.109050
Abstract: Understanding factors associated with engagement across the hepatitis C virus (HCV) cascade of care (CoC) among people who inject drugs (PWID) is critical for developing targeted interventions to enhance engagement and further HCV elimination efforts. We describe the CoC among Australian PWID, and identify factors associated with engagement at each stage. As part of the 2018 and 2019 Illicit Drug Reporting System, Australians who regularly inject drugs reported lifetime HCV antibody and RNA testing, treatment uptake and completion. Multivariable logistic regression identified characteristics associated with outcomes. Of 1499 participants, 87% reported antibody testing. Of those, 70% reported RNA testing, of whom 60% reported being RNA positive. Among those, 76% reported initiating treatment, 78% of whom completed. Incarceration history (adjusted odds ratio 1.90 95% confidence interval 1.28-2.82), current opioid agonist treatment (OAT) (1.99 1.14-3.47), and recent alcohol and other drug (AOD) counselling (2.22 1.27-3.88) were associated with antibody testing. Incarceration history (1.42 1.07-1.87), and current OAT (2.07 1.51-2.86) were associated with RNA testing. Current OAT (1.92 1.22-3.03) and recent AOD counselling (1.91 1.16-3.13) were associated with treatment uptake. Meth hetamine as drug injected most often in the last month was associated with reduced odds of antibody (0.41 0.25-0.66) and RNA testing (0.54 0.40-0.74), compared to heroin. CoC engagement amongst Australian PWID is encouraging, with AOD service engagement associated with testing and treatment. Further efforts to reach those not service engaged, particularly those not receiving OAT or who predominantly inject meth hetamine, are needed to achieve HCV elimination targets.
Publisher: Wiley
Date: 18-08-2016
DOI: 10.1111/ACER.13179
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.
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.
Publisher: Wiley
Date: 08-08-2021
DOI: 10.1111/DAR.13364
Abstract: We examine how smoking and injecting meth hetamine change over time and correlate with specific health and social outcomes. Panel data from a longitudinal cohort dependent on meth hetamine (N = 444 891 months). Random effects regression models examined the relationship between smoking and/or injecting meth hetamine and past month outcomes (substance use, ≥daily injection, needle/syringe sharing, psychological distress, poor mental and physical health, sexual behaviour, psychotic symptoms, violent behaviour and crime). Effects were adjusted for between‐group differences at baseline. At baseline, 56% of participants only injected meth hetamine in the past month, 18% only smoked and 26% both injected and smoked (concurrent injecting and smoking). Compared to injecting only, concurrent injecting and smoking was associated with more days of meth hetamine use (b = 1.3, P 0.001 adjusted [A] b = 1.2, P 0.001), more frequent injection [odds ratio (OR) 1.8, P = 0.013 adjusted OR (AOR) 1.6, P = 0.042], violent behaviour (OR 2.1, P = 0.001 AOR 1.8, P = 0.013] and crime (OR 3.1, P 0.001 AOR 2.5, P 0.001). Non‐injecting related outcomes did not differ significantly for only smoking versus only injecting. There was no significant transition from injecting meth hetamine at baseline to non‐injecting meth hetamine use at follow up, or from exclusively smoking meth hetamine at baseline to any meth hetamine injection at follow up. Efforts are needed to address heavier meth hetamine use, more frequent drug injection and elevated violent behaviour and crime among people who concurrently smoke and inject meth hetamine.
Publisher: Elsevier BV
Date: 12-2018
Publisher: Wiley
Date: 17-06-2020
DOI: 10.1111/DAR.13083
Publisher: Wiley
Date: 05-03-2018
DOI: 10.1111/DAR.12679
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.
Publisher: Wiley
Date: 17-10-2023
DOI: 10.1111/ADD.16055
Abstract: To (i) assess the population mortality rates of cocaine‐related deaths in Australia, 2000 to 2021 (ii) determine the circumstances of death and case characteristics and (iii) determine their toxicological profile. Retrospective study of cocaine‐related deaths in Australia, 2000 to 2021, retrieved from the National Coronial Information System. Australia‐wide. A total of 884 cases, mean age = 33.8 (SD, 10.0) years and 86.5% ( n = 765) male. Information was collected on characteristics, manner of death and toxicology. Only cases in which the presence of blood cocaine and/or metabolites were included. Population rates did not significantly increase during 2001–2011 (annual percentage change [APC] = 1.5 CI, −3.2, 6.5), but from 2012, there was a marked acceleration (APC = 20.0, 95% CI, 15.5, 25.3). Circumstances of death were unintentional drug toxicity (70.7%, n = 625), intentional self‐harm (17.8%, n = 157), traumatic accident (11.5%, n = 102). The proportion of cases constituted by unintentional toxicity declined across the study period (APC = −2.6 CI, −3.1, −2.1). There was a substantial decline in the proportion of cases with a history of injecting drug use (APC = −5.7 CI, −6.5, −4.9) and with a history of substance use problems (APC = −3.2 CI, −3.9, −2.5). Both cocaine (0.100 vs 0.050 mg/L, P 0.001) and benzoylecgonine (0.590 vs 0.240 mg/L, P 0.001) concentrations were higher amongst toxicity cases than in cases of death from traumatic injury. Cocaethylene was present in 26.4% ( n = 233), levamisole in 18.6% ( n = 164) and lignocaine in 11.5% ( n = 102). Psychoactive drugs in addition to cocaine were present in 92.9% ( n = 821), most commonly opioids (50.5%, n = 446), alcohol (47.1%, n = 416), hypnosedatives (43.2%, n = 382) and psychostimulants (30.3%, n = 268). There was a steady decline in the proportion of opioid positive cases (APC = −5.4 CI, −6.3, −4.5). There was a large increase in cocaine‐related deaths across Australia from 2000 to 2021. This was accompanied by changes in case profiles, with histories of injecting drug use and substance use problems, as well as recent opioid use, becoming less prominent.
Publisher: Wiley
Date: 28-08-2018
DOI: 10.1111/ADD.14393
Publisher: Wiley
Date: 18-11-2021
DOI: 10.1111/DAR.13404
Abstract: There are few contemporary data on illicit drug use at music festivals. We describe drug use patterns and prevalence of specific higher‐risk drug‐related behaviours, and their associations with festivalgoer characteristics. We approached attendees at six major music festivals in New South Wales, Australia, from November 2019 to March 2020. Participants self‐completed an anonymous survey on prior and intended drug use and associated higher‐risk behaviours double dropping higher‐volume ethanol alongside drug use higher quantity 3,4‐methylenedioxymeth hetamine (MDMA) mixing stimulants and preloading. Logistic regression and UpSet analyses were performed to identify festivalgoer characteristics and the intersection of high‐risk behaviours, respectively. Of 1229 participants, 372 (30.3%) used or planned to use drugs at the festival. In multivariable analyses, men and those purchasing drugs both inside and outside the venue had greater odds of engaging in higher‐risk behaviours. Of those using MDMA, 47.9% reported double dropping. People using drugs for the first time had 3.3 (95% confidence interval 1.2–8.7) greater odds of higher‐volume ethanol alongside drug use. People reporting that police olice dog presence influenced their decision to take drugs had 2.2 (95% confidence interval 1.4–3.6) greater odds of preloading. In UpSet analysis, preloading was the most common intersection (17% of those using drugs). Engagement in the five higher‐risk drug behaviours was common, particularly amongst males and those using drugs for the first time, while police olice dog presence appeared to influence higher‐risk behaviours amongst festival attendees. This information can be used to inform harm reduction advice, public health and law enforcement strategies.
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.
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.
Publisher: Elsevier BV
Date: 08-2017
Publisher: Elsevier BV
Date: 12-2017
Publisher: Elsevier BV
Date: 08-2019
Publisher: Wiley
Date: 27-01-2021
DOI: 10.1111/ADD.15239
Publisher: Elsevier BV
Date: 05-2020
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.
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.
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.
Publisher: Elsevier BV
Date: 11-2019
Publisher: Wiley
Date: 04-05-2023
DOI: 10.1111/ADD.16200
Abstract: Studies often rely upon self‐report and biological testing methods for measuring illicit drug use, although evidence for their agreement is limited to specific populations and self‐report instruments. We aimed to examine comprehensively the evidence for agreement between self‐reported and biologically measured illicit drug use among all major illicit drug classes, biological indicators, populations and settings. We systematically searched peer‐reviewed databases (Medline, Embase and PsycINFO) and grey literature. Included studies reported 2 × 2 table counts or agreement estimates comparing self‐reported and biologically measured use published up to March 2022. With biological results considered to be the reference standard and use of random‐effect regression models, we evaluated pooled estimates for overall agreement (primary outcome), sensitivity, specificity, false omission rates (proportion reporting no use that test positive) and false discovery rates (proportion reporting use that test negative) by drug class, potential consequences attached to self‐report (i.e. work, legal or treatment impacts) and time‐frame of use. Heterogeneity was assessed by inspecting forest plots. From 7924 studies, we extracted data from 207 eligible studies. Overall agreement ranged from good to excellent ( 0.79). False omission rates were generally low, while false discovery rates varied by setting. Specificity was generally high but sensitivity varied by drug, s le type and setting. Self‐report in clinical trials and situations of no consequences was generally reliable. For urine, recent (i.e. past 1–4 days) self‐report produced lower sensitivity and false discovery rates than past month. Agreement was higher in studies that informed participants biological testing would occur (diagnostic odds ratio = 2.91, 95% confidence interval = 1.25–6.78). The main source of bias was biological assessments (51% studies). While there are limitations associated with self‐report and biological testing to measure illicit drug use, overall agreement between the two methods is high, suggesting both provide good measures of illicit drug use. Recommended methods of biological testing are more likely to provide reliable measures of recent use if there are problems with self‐disclosure.
Publisher: MDPI AG
Date: 07-03-2018
DOI: 10.3390/NU10030319
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.
Publisher: Informa UK Limited
Date: 18-02-2020
Publisher: Wiley
Date: 28-07-2019
DOI: 10.1111/ADD.14706
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.
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.
Publisher: Wiley
Date: 13-12-2020
DOI: 10.1111/ADD.14823
Publisher: Informa UK Limited
Date: 04-12-2018
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.DRUGALCDEP.2021.109112
Abstract: Identifying differences in unintentional versus intentional drug poisoning deaths can inform targeted prevention. This study aimed to: compare unintentional versus intentional drug poisoning deaths by drug involvement, age and sex describe patterns of drug involvement by intent and describe common drug patterns by age and sex. Cases comprised deaths among Australians aged ≥15 where drug poisoning was the underlying cause (Cause of Death Unit Record File 2012-2016). Sex, age, and drug involvement were analysed by intent using logistic regression. Of 7994 deaths, 71% were unintentional and 24% intentional. Compared with unintentional deaths, intentional deaths were more likely among females (OR 1.31 [95% CI 1.16-1.48]) and those aged 55+ (1.50 [1.25-1.81] for 55-64 years 3.79 [3.07-4.66] for 65+ years, compared to 35-44 years), and were more likely to involve hypnosedatives (2.11 [1.87-2.39]), other psychotropic medicines (1.58 [1.39-1.78]), non-opioid analgesics and anaesthetics (1.48 [1.25-1.73]). Common unintentional profiles comprised: opioids (excluding heroin) heroin alcohol opioids with hypnosedatives opioids with hypnosedatives and other psychotropic medicines stimulants other psychotropic medicines and opioids with other psychotropic medicines. Unintentional deaths involving heroin or stimulants only had a greater proportion of males (79.0% and 83.4%, respectively) and younger in iduals aged 15-34 (30.3% and 39.5%, respectively). Common intentional profiles comprised: hypnosedatives other psychotropic medicines opioids (excluding heroin) hypnosedatives with other psychotropic medicines opioids with hypnosedatives and opioids with hypnosedatives and other psychotropic medicines. The demographic and drug involvement profile of intentional and unintentional deaths were distinct, suggesting different approaches to prevention are necessary.
Publisher: Oxford University Press (OUP)
Date: 06-02-2019
Abstract: Women-specific factors exist that increases vulnerability to drug-related harms from injection drug use, including blood-borne viruses (BBVs), but gender-based differences in BBV prevalence have not been systematically examined. We conducted meta-analyses to estimate country, regional, and global prevalence of serologically confirmed human immunodeficiency virus (HIV), hepatitis C virus (HCV based on detection of anti-HCV antibody), and hepatitis B virus (HBV based on detection of HBV surface antigen) in people who inject drugs (PWID), by gender. Gender-based differences in the BBV prevalence (calculated as the risk among women relative to the risk among men) were regressed on country-level prevalence and inequality measures (Gender inequality index, Human development index, Gini coefficient, and high, low or middle income of the country). Gender-based differences varied by countries and regions. HIV prevalence was higher among women than men in sub-Saharan Africa (relative risk [RR], 2.8 95% confidence interval [CI], 1.8–4.4) and South Asia (RR, 1.7 95% CI, 1.1–2.7) anti-HCV was lower among women in the Middle East and North Africa (RR, 0.6 95% CI, .5–.7) and East and Southeast Asia (RR, 0.8 95% CI, .7–.9). Gender-based differences varied with country-levels of the BBV prevalence in the general population, human development, and income distribution. HIV was more prevalent in women who inject drugs as compared to their male counterparts in some countries, but there is variation between and within regions. In countries where women are at higher risks, there is a need to develop gender-sensitive harm-reduction services for the particularly marginalized population of women who inject drugs.
Publisher: Wiley
Date: 05-2020
DOI: 10.1111/DAR.13079
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.FORSCIINT.2021.111140
Abstract: The study aimed to determine: 1. The characteristics of all recorded cases of fatal drug poisoning involving 'novel' benzodiazepines (NBZDs) in Australia 2. The toxicology of cases and 3. The major autopsy findings. Retrospective study of all deaths due to drug toxicity in Australia in which NBZDs were present in blood toxicology, retrieved from the National Coronial Information System (2000-2021). Information was collected on case characteristics, toxicology and major organ pathology. A total of 40 cases were identified, the first occurring in 2015, with a median age of 26.5 years and 87.5% being male. Death was due to accidental toxicity in 92.5% of cases. There were extensive histories of substance use problems (80.0%) and mental health problems (32.5%). Etizolam was the most common NBZD (87.5%), followed by flubromazolam (15.0%), with other NBZDs detected in 20.0% (delorazepam, diclazepam, flualprazolam, flubromazepam, lormetazepam). Multiple NBZDs were present in 27.5%. Other drugs were present in 97.5%, most commonly opioids (70.0%), registered benzodiazepines (62.5%), psychostimulants (45.0%) and gabapentinoids (32.5%). A CNS depressant other than a NBZD was detected in 95.0% (n = 38). Autopsies were conducted and available for 30 cases, with pulmonary oedema (76.7%, n = 23), aspiration of vomitus (46.7%, n = 14) and acute bronchopneumonia (36.7%, n = 11) the most common diagnoses. The 'typical' NBZD-related death was a young male who died due to accidental toxicity. Deaths most frequently involved etizolam and multiple substances, particularly depressants.
Publisher: Informa UK Limited
Date: 07-08-2019
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).
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.
Publisher: Elsevier BV
Date: 12-2023
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.DRUGALCDEP.2019.06.022
Abstract: Alcohol use is a leading risk factor for disease burden among youth. This study estimated sex differences in the prevalence of alcohol use and consequences among adolescents living in low and middle-income countries (LMIC). Multi-staged cross-sectional international standardized self-report questionnaires administered in the classroom. The Global school-based student health survey (GSHS) comprised adolescents from 68 LMIC between 2003-2014. 271,156 students aged 13-17 years old. Alcohol measures included: past month alcohol consumption, history of intoxication and alcohol-related problems. Regions were based on the World Health Organization definitions: Africa, America, Eastern Mediterranean, Europe, South-east Asia, and Western Pacific. Overall, males had higher odds of alcohol use (OR = 2.38 [1.91-2.96]), a history of intoxication (OR = 2.64 [2.11-3.31]), and alcohol-related problems (OR = 1.72 [1.41-2.10]) than females. All regions recorded overall greater odds of alcohol use by males versus females five regions (excluding Europe) recorded greater odds of intoxication in males and three regions (America, South-east Asia, and Western Pacific) recorded greater odds of alcohol-related problems amongst males. However, there were country-level differences - in some countries, adolescent drinking rates and consequences were comparable by sex. Countries with the highest odds of alcohol use among males compared to females were Indonesia, Myanmar, Cambodia, Tuvalu, Morocco, Senegal, Kiribati, and Thailand. Among adolescents living in LMIC, males had on average two-fold higher odds of drinking alcohol and experiencing adverse consequences. Growing affluence and improvements in sex equality in societies may increase the future prevalence of hazardous drinking in females in LMICs.
Publisher: Wiley
Date: 09-08-2018
DOI: 10.1111/ADD.14383
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.DRUGALCDEP.2018.04.016
Abstract: Dependence upon one substance may increase vulnerability for dependence on other substances. This study aimed to i) examine the association between opioid dependence and alcohol use and dependence and ii) identify demographic, mental health, substance use, and alcohol-related withdrawal, physical health complications, and treatment correlates of comorbid alcohol and opioid dependence versus the former only. In this case-control study, 1475 participants with opioid dependence recruited from opioid substitution therapy (OST) clinics and 516 non-opioid dependent matched participants completed a structured interview covering psychiatric history, substance dependence, child maltreatment, and history of alcohol use. Analyses were mainly concentrated on cases (n = 696) and controls (n = 194) reporting lifetime alcohol dependence. Cases with opioid dependence had higher rates of lifetime alcohol dependence than controls. Binary logistic regression analyses showed comorbid cases reported greater socio-economic disadvantage, poorer psychiatric history, greater incidence of dependence on other substances, earlier onset of regular drinking and alcohol dependence, and greater severity of alcohol dependence (relative to controls with alcohol dependence only). Comorbid cases were also more likely to report endorsement of certain DSM-IV criteria (i.e., legal problems due to alcohol and desire/inability to cut down use), specific withdrawal symptoms (e.g., tachycardia, hallucinations), using other substances to relieve withdrawal symptoms, and experiencing liver disease/jaundice. Rates of lifetime treatment engagement were low overall. Though strongly associated with alcohol dependence and alcohol-related harms, people with a history of opioid dependence have complex social and clinical backgrounds, which appear to be important factors associated with higher levels of alcohol dependence.
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.
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.
Publisher: Wiley
Date: 07-09-2019
DOI: 10.1111/ADD.14380
Publisher: Wiley
Date: 23-05-2022
DOI: 10.1111/DAR.13479
Abstract: Prompt help‐seeking behaviour by music festival attendees can reduce risks associated with drug use however, little is known about perceived barriers to help‐seeking when experiencing or witnessing illness at music festivals. We explored potential barriers and their association with festivalgoer characteristics. We conducted an on‐site cross‐sectional survey of attendees at New South Wales music festivals in 2019/2020. Perceived barriers to help‐seeking in the hypothetical event of the respondent or a friend becoming unwell at the festival were assessed, and regression analyses were conducted to identify characteristics associated with these barriers. Across six festivals, 1229 people were surveyed and four‐fifths (83.2%) reported ≥1 barrier: 32.7% fear of getting in trouble with the police, 20.6% not knowing where to find help, 17.2% not knowing how unwell someone might be and 15.3% concern about friends or relatives finding out. In multivariable analyses, people of erse sexuality and people using drugs that day had greater odds of reporting fear of trouble with the police. People reporting drug use that day had lower odds of reporting not knowing where to find help. Men, gender‐ erse people and people using drugs that day had greater odds of reporting concern about friends or relatives finding out. Our data substantiate concerns regarding policing strategies and their impact on festivals. Initiatives to support conversations about drugs with friends and families may be best targeted to younger people and those from gender‐ erse backgrounds.
Publisher: Elsevier BV
Date: 07-2018
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.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.ADDBEH.2015.01.034
Abstract: To examine the prevalence, correlates and motivations for the commission of property and violent crime amongst a s le of people who inject drugs (PWID). Data were obtained from the 2013 Illicit Drug Reporting System (IDRS), which includes a cross-sectional s le of 887 PWID. Eighteen percent of PWID had committed a property offence and 3% had committed a violent offence in the month preceding interview. Opioid dependence (AOR 2.57, 95% CI 1.29-5.10) and age (AOR 0.96, 95% CI 0.93-0.99) were found to be the strongest correlates of property crime. The majority of property offenders (75%) attributed their offending to financial reasons, however those under the influence of benzodiazepines were proportionately more likely to nominate opportunistic reasons as the main motivation for their last offence. Stimulant dependence (AOR 5.34, 95% CI 1.91-14.93) was the only significant correlate of past month violent crime, and the largest proportion of violent offenders (47%) attributed their offending to opportunistic reasons. The majority of both property (71%) and violent offenders (73%) reported being under the influence of drugs the last time they committed an offence the largest proportion of property offenders reported being under the influence of benzodiazepines (29%) and meth hetamine (24%), whilst violent offenders mostly reported being under the influence of heroin and alcohol (32% respectively). Criminal motivations, substance use and other correlates vary considerably across crime types. This suggests that crime prevention and intervention strategies need to be tailored according to in idual crime types, and should take into account self-reported criminal motivations, as well as specific risk factors that have been shown to increase the likelihood of offending.
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.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.DRUGALCDEP.2022.109494
Abstract: Injecting-related bacterial and fungal infections cause substantial illness and disability among people who use illicit drugs. Opioid agonist treatment (OAT) reduces injecting frequency and the transmission of blood borne viruses. We estimated the impact of OAT on hospitalisations for non-viral infections and examine trends in incidence over time. We conducted a retrospective cohort study using linked administrative data. The cohort included 47 163 in iduals starting OAT between August 2001 and December 2017 in New South Wales, Australia, with 454 951 person-years of follow-up. The primary outcome was hospitalisation for an injecting-related disease. The primary exposure was OAT status (out of OAT, first four weeks of OAT, and OAT retention [i.e., more than four weeks in treatment]). Covariates included demographic characteristics, year of hospitalisation, and recent clinical treatment. 9122 participants (19.3%) had at least one hospitalisation for any injecting-related disease. Compared to time out of treatment, retention on OAT was associated with a reduced rate of injecting-related diseases (adjusted rate ratio[ARR]=0.92 95%CI 0.87-0.97). The first four weeks of treatment was associated with an increased rate (ARR 1.53, 95%CI 1.38-1.70), which we believe is explained by referral pathways between hospital and community OAT services. The age-adjusted incidence rates of hospitalisations for any injecting-related disease increased from 34.8 (95% CI =30.2-40.0) per 1000 person-years in 2001 to 54.9 (95%CI=51.3-58.8) in 2017. Stable OAT is associated with reduced hospitalisations for injecting-related bacterial infections however, OAT appears insufficient to prevent these harms as the rate of these infections is increasing in Australia.
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.
No related grants have been discovered for Amy Peacock.