ORCID Profile
0000-0001-5942-0550
Current Organisation
UNSW Sydney
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Cultural Studies | Sociology and Social Studies of Science and Technology | Culture, Gender, Sexuality
Expanding Knowledge through Studies of Human Society | Specific Population Health (excl. Indigenous Health) not elsewhere classified | Recreation |
Publisher: Wiley
Date: 07-2007
DOI: 10.1080/09595230701373891
Abstract: The introduction of buprenorphine - naloxone in Australia in April 2006 has permitted the revision of takeaway policies in many states and has introduced the possibility of unsupervised treatment. This study explored the implications of the introduction of buprenorphine - naloxone in terms of cost to patients through a survey of pharmacists' intended pricing practices. The aim of the research was to examine the intentions of pharmacists in relation to fees for buprenorphine - naloxone and study the potential implications to patients when compared with the existing fee structure for methadone and for buprenorphine alone. A self-complete questionnaire was mailed to every community pharmacy in New South Wales (NSW) (n = 593) dispensing methadone or buprenorphine to people with opioid dependence. A response rate of 68.6% (n = 407) was achieved after three mailouts. The majority of pharmacies charged a flat weekly fee for methadone (92.2% mean = $31.90) and buprenorphine (74.8% mean = $31.00). The mean intended fees for buprenorphine - naloxone according to different dosing and takeaway regimens ranged from $19.19 per week for no supervised doses and fortnightly takeaways to a $30.88 per week flat fee. There appeared to be little variation in fee structure irrespective of the takeaway regimen, until reaching the 2 weeks' unsupervised dose regimen. This study highlights the importance of the early dissemination of unambiguous information regarding the introduction of a new medication, especially where supervised dispensing through community pharmacies is essential to the provision of treatment. The potential impact upon the successful rollout of a new treatment paradigm that was developed to benefit stable patients in the community may be jeopardised when such processes are not followed.
Publisher: BMJ
Date: 14-11-2013
Publisher: Wiley
Date: 31-03-2011
DOI: 10.1111/J.1465-3362.2011.00288.X
Abstract: Mephedrone (4-methylmethcathinone) is a synthetic stimulant that has recently emerged as a recreational drug. There is currently no Australian data on prevalence and patterns of mephedrone use. This paper aims to explore patterns of mephedrone use among a large s le of same-sex attracted young people in Sydney, Australia. An online survey was conducted with 572 same-sex attracted men (n= 318) and women (n = 254) aged 18 to 25 years, who lived or regularly spent time in Sydney. Data on mephedrone were collected as part of a larger study exploring sexuality and nightlife. Mephedrone had been used by 4.0% (n = 23) of respondents, 2.1% (n = 12) in the preceding 6 months, 1.4% (n = 8) in the preceding month. Typical routes of use were intranasal (n = 8) and ingestion (n = 6). No respondent reported ever injecting mephedrone. Three respondents reported polydrug use with mephedrone. The most common contexts of use were respondents' homes or friends' homes (n = 8) and gay bars and clubs (n = 7). This paper reports low levels of mephedrone use among a large s le of same-sex attracted young people. The proportion of respondents who had used mephedrone was much lower than reported in recent UK research. This may suggest that mephedrone has not infiltrated the Australian market to the same extent as in Europe. However, data from annual surveillance of drug users are required to better determine this.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2008
DOI: 10.1007/S11096-008-9257-9
Abstract: To explore consumer satisfaction with, and experiences of, a range of issues associated with the delivery of opioid substitution treatment at community pharmacies in New South Wales, Australia. 50 community pharmacies providing opioid substitution treatment in New South Wales. Self-completion survey completed by 508 clients during supervised dosing. Satisfaction with opioid substitution treatment delivery at community pharmacies. Sixty-one percent of participants reported being satisfied with their treatment programme. Participants expressed a high level of satisfaction with most aspects of opioid substitution treatment delivery at their pharmacy (aggregate mean = 8.1/10 10 = excellent). However, participants were less satisfied with the level of privacy afforded at the pharmacy. Thirty-four percent reported that they were made to wait longer than other customers, and 25% reported that the pharmacy staff did not treat them the same as other customers. However, 87% reported that they felt welcomed by the pharmacy staff. Twenty-three percent of clients were currently in debt to the pharmacy for nonpayment of dispensing fees. The mean amount of current debt was $71.75, equivalent to approximately 2 weeks of pharmacy dispensing fees. Community pharmacies providing opioid substitution treatment in New South Wales appear to be providing a level of service that is satisfactory to the clients of those services. However, many participants were concerned about a lack of privacy, the high cost of treatment, and being treated differently to other customers.
Publisher: Wiley
Date: 07-08-2013
DOI: 10.1111/J.1465-3362.2012.00494.X
Abstract: The findings of Australian drug surveys are typically not stratified by sexual orientation, despite the higher prevalence of drug use generally reported among gay and bisexual men. This paper aims to examine trends in drug use among gay and bisexual men in eastern Australia between 2004 and 2011. Data from the cross-sectional, ongoing Gay Community Periodic Surveys (GCPS) were used to analyse drug trends among gay and bisexual men in Sydney, Melbourne and Queensland. Between 2004 and 2011, 45,273 eligible questionnaires were completed. There was a downward trend in recent drug use (previous 6 months) between 2004 and 2011 from 62.2% to 57.5%. However, this trend was not found among men in Queensland, bisexual men, men aged over 40 years or HIV-positive men. Club drug use peaked in 2006 (45.1%), before steadily declining to 32.4% in 2011. There were significant reductions in use of ecstasy, meth hetamine, ketamine and cannabis, increased use of cocaine, gamma hydroxybutyrate, erectile dysfunction medications, amyl nitrite and lysergic acid diethylamide, and no change in heroin use. Recent injecting drug use fluctuated over time but experienced an overall downward trend from 5.5% in 2004 to 4.0% in 2011. Drug use trends among gay and bisexual men in Australia are broadly consistent with downward and upward drug trends reported in other Australian drug surveys. The risks associated with drug use in this population and high rates of use supports the ongoing role of the GCPS in monitoring drug trends among homosexually active men.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.DRUGPO.2016.01.003
Abstract: Gay and bisexual men typically report high rates of illicit drug use, including meth hetamine use. This paper aimed to analyse trends in crystal meth hetamine ('crystal') and powder meth hetamine ('speed') use among gay and bisexual men in Australia, and characterise the sociodemographic, drug use, and sexual risk practices of men who reported crystal use. The Gay Community Periodic Surveys, routinely conducted behavioural surveillance surveys of gay men in Australia, were analysed to examine trends in recent crystal and speed use during 2005-14 (any use in the previous 6 months), and trends in regular crystal and speed use during 2007-14 (at least monthly use in the previous 6 months). Covariates of recent and regular crystal use were analysed using 2014 data. Speed use declined from 25.0% to 10.2% during 2005-14 (p-trend <.001), while regular speed use declined from 7.0% to 2.3% during 2007-14 (p-trend <.001). Any crystal use declined from 15.6% to 11.4% during 2005-14 (p-trend <.001) and increased during 2010-14 (from 9.6% in 2010 p-trend <.001). Regular crystal use declined from 6.1% to 4.0% during 2007-14 (p-trend <.001) and remained stable during 2010-14 (3.9% in 2010 p-trend=.64). Participants who reported regular crystal use were more likely than men who used crystal less frequently to have used gamma-hydroxybutyrate, used party drugs for sex, and to have injected drugs in the previous 6 months. High rates of crystal use and injecting were reported among HIV-positive participants. Rates of both crystal and speed use, despite fluctuations, were consistently high throughout the study period. The high rates of crystal use and associations with potentially risky sexual practices indicate that gay and bisexual men should be a particular focus for targeted harm reduction and combined harm reduction and sexual health services.
Publisher: Wiley
Date: 07-2009
DOI: 10.1111/J.1465-3362.2009.00049.X
Abstract: Public clinics in New South Wales (NSW), Australia play a central role in inducting and stabilising opioid dependent clients onto treatment before transfer to a community pharmacy. Clinical assessment of stability is a vital skill in ensuring that clients are appropriately and effectively transferred. A two-hour clinical training program was delivered to staff at 31 public clinics, that aimed to improve staff confidence in assessing client stability, and skills in negotiating the transfer of clients to community pharmacies. Pre- and post-training evaluation was conducted examining self-ratings of confidence and ability in the assessment of client stability, and the perceived utility of a clinical algorithm to improve assessments. Follow-up was conducted 3 to 6 months post-training assessing in idual and clinic level changes in clinical practice. 205 staff completed pre- and post-training questionnaires. Staff demonstrated a moderate level of self-reported baseline knowledge and skills in assessing client stability (mean = 6.5 1 = poor 10 = excellent) that improved when re-assessed following the training (mean = 8.0). 76 staff responded to the follow-up questionnaire. > or = 75% reported some level of improvement in their approach to clinical practice regarding stability assessment, and 59% reported being more effective in identifying clients appropriate for community pharmacy transfer. Of 19 public clinics, 14 reported an increased focus on stability assessment. Nine clinics reported barriers to achieving changes in clinical practice. This evaluation demonstrates that it is possible to implement a targeted clinical training package to staff that translates into positive changes in clinical practice.
Publisher: Wiley
Date: 05-05-2021
DOI: 10.1111/DAR.13303
Abstract: Substance use disorders are more prevalent among lesbian, gay, bisexual, transgender and queer (LGBTQ) people than among their heterosexual and cisgender peers. There has been limited alcohol and other drug (AOD) treatment research with LGBTQ people outside of North America. This study aimed to examine the treatment outcomes of clients attending a LGBTQ‐specific AOD counselling service in Australia (ACON's Substance Support Service) and compare their client profile and treatment outcomes with LGBTQ and non‐LGBTQ clients of similar mainstream services. This study was a retrospective analysis of the health records of 284 ACON clients and 1011 clients of five mainstream services in 2016–2018. Clients completed clinical interviews at treatment entry and periodically throughout treatment and completed measures of substance use, severity of dependence, psychological distress and quality of life. Most ACON clients were seeking treatment for meth hetamine (58%) and alcohol use (26%). Among ACON clients, there were reductions in past month days of substance use and severity of dependence between treatment entry and counselling sessions 4, 8 and 12 (all P 0.001). There were statistically significant reductions in psychological distress and improved quality of life among ACON clients. Despite ACON and the mainstream services having similar treatment approaches, their client profiles were markedly different in terms of sociodemographic characteristics, substance use and source of referral, which precluded comparison of treatment outcomes. ACON's clients showed reduced substance use and improved psychosocial wellbeing during treatment. The findings support the provision of LGBTQ‐specific AOD services.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DRUGPO.2018.03.020
Abstract: Existing tools for measuring blood-borne virus (BBV) and sexually transmitted infection (STI) transmission risk behaviours in substance use interventions have limited capacity to assess risk behaviours across varied social, cultural and epidemiological contexts have not evolved alongside HIV treatment and prevention innovations or accounted for sexual contexts of drug use including among a range of lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) sub-communities. The Substance Use and Sex Index (SUSI) is a new brief, simple tool being developed to assess change in HIV and STI risk behaviours for substance use treatment studies. A 26-item questionnaire was piloted online among community volunteers (n = 199). Concurrent and predictive validity were assessed against risk-taking (RT-18) and STI testing items (Gay Community Periodic Surveys). The developed scale comprised nine items measuring: condomless penile (anal or vaginal) sex, unprotected oral sex, shared toy use, bloodplay, chemsex (consumption of drugs for the facilitation of sex), trading sex for drugs, being 'too out of it' to protect self, injecting risk and group sex. Factor-analytic approaches demonstrated that items met good fit criteria for a single scale. Significant, moderate magnitude, positive relationships were identified between total SUSI score and both RT-18 risk-taking and recent STI testing. Qualitative feedback underscored the importance of culturally-embedded question formulation. The results support the conceptual basis for the instrument, highlighting the need for further scale content refinement to validate the tool and examine sensitivity to change. SUSI is a step towards improving outcome measurement of HIV/BBV/STI transmission risk behaviours in substance use treatment studies with greater inclusiveness of experiences across different population groups.
Publisher: Springer Science and Business Media LLC
Date: 11-02-2020
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1111/J.1753-6405.2007.00137.X
Abstract: To determine current methadone takeaway storage practice among patients receiving supervised methadone treatment and takeaway doses at community pharmacies. A cross-sectional survey was conducted in 2006 in Sydney, New South Wales. It addressed: safe storage of methadone takeaways knowledge of risk of methadone ingestion by small children and information provision from health care providers about the safe storage of methadone. Eighty-seven patients participated in the survey. The majority stored their methadone takeaways in a cupboard (48%) or secure cabinet (34%). All but one participant were aware of the risks of methadone ingestion by small children. Eighty-seven per cent had discussed safe storage of takeaways with a health professional. Most patients receiving methadone takeaways store them safely and are aware of the risk that methadone ingestion poses to children. Clinicians should ensure patients are adequately informed about safe takeaway storage and the risk of methadone ingestion by children.
Publisher: Informa UK Limited
Date: 24-10-2020
DOI: 10.1080/02791072.2019.1683260
Abstract: Self-administration of very low doses of psychedelic drugs to improve mental health and wellbeing and enhance cognitive function, known as microdosing, has received recent media attention, but little research has been conducted. We conducted a content analysis of discussions about microdosing from the online forum Reddit. We examined motivations, dosing practices, and perceived benefits and limitations of microdosing. Motivations included self-management of mental health issues, improvement of psychosocial wellbeing, and cognitive enhancement. Self-reported benefits included cognitive and creative enhancement, reduced depression and anxiety, enhanced self-insight and mindfulness, improved mood and attitude toward life, improved habits and health behaviors, and improved social interactions and interpersonal connections. Perceived limitations included issues related to dosing, adverse physical effects, taking illegal substances, limited or no mental health or cognitive improvement, increased anxiety, unpleasant "off" days, only short-term benefits, and concerns about dependence and drug-related risks. Standard doses of psychedelic drugs provided in therapeutic settings have potential as novel treatments for some mental health conditions, but clinical research is needed to understand if this is also the case for microdosing. In the meantime, harm reduction resources should be developed and made available to provide the best available information on the safer use of self-administered psychedelics.
Publisher: Informa UK Limited
Date: 05-03-2019
Publisher: Wiley
Date: 04-2018
DOI: 10.1002/JIA2.25104
Publisher: Public Library of Science (PLoS)
Date: 16-02-2017
Publisher: Informa UK Limited
Date: 05-11-2013
DOI: 10.3109/10826084.2012.733904
Abstract: This study aimed to determine whether the lesbian and gay "scene" of bars and nightclubs is a more common site for club drug use than other bars and clubs. A cross-sectional, online survey was conducted with 254 same-sex attracted women and 318 men aged 18-25 in Sydney, Australia. Drug use was more likely in those who attended any venue type more frequently. Men, but not women, were more likely to report drug use in lesbian and gay venues than other venues. Club drug use may be more normalized within the lesbian and gay scene than elsewhere, particularly among young men. The study's limitations are noted.
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.DRUGPO.2007.11.002
Abstract: This study explored the attitude towards, and experiences of, injection site examination among injecting drug users in opioid treatment and the potential impact of this routine examination on information disclosure and future injection practices. A self-complete, anonymous, cross-sectional questionnaire was used with 153 patients recruited from three public clinics in Sydney, Australia. The vast majority (97%) had ever injected in their upper limb, 19% in their leg, 16% in their neck, and 7% in their groin. The majority were 'happy to have their sites inspected' (78%), and felt it was an 'appropriate part of routine examination' (72%). Seventy-seven percent said they would be more honest about recent injecting, and 25% would inject in other sites if upper limb inspection occurred at every clinical review. The examination of injecting sites can provide useful corroboration of self-reported injecting drug use and an opportunity to offer harm reduction advice. The inspection of injecting sites was acceptable to most patients and should form part of routine clinical reviews.
Publisher: Wiley
Date: 11-2009
Publisher: Informa UK Limited
Date: 16-01-2019
DOI: 10.1080/10826084.2018.1552302
Abstract: Gay and bisexual men (GBM) report distinctive patterns and contexts of drug use, yet little has been published about their attitudes toward drug use. We developed measures of attitudes and perceived social norms toward drug use, and examined covariates of more accepting attitudes and norms among GBM in Australia. We analyzed baseline data from the Following Lives Undergoing Change (Flux) study. Flux is an online prospective observational study of drug use among Australian GBM. We used principal components factor analysis to generate two attitudinal scales assessing "drug use for social and sexual enhancement" and "perceptions of drug risk." A third perceived social norms scale examined "acceptability of drug use among gay friends." Among 2,112 participants, 61% reported illicit drug use in the preceding six months. Stronger endorsement of drug use for social and sexual engagement and lower perceptions of drug risk were found among men who were more socially engaged with other gay men and reported regular drug use and drug use for sex. In multivariate analyses, all three scales were associated with recent drug use (any use in the previous six months), but only the drug use for social and sexual enhancement scale was associated with regular (at least monthly) use. Drug use and sex are difficult to disentangle for some GBM, and health services and policies could benefit from a better understanding of attitudinal and normative factors associated with drug use in gay social networks, while recognizing the role of pleasure in substance use.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DRUGPO.2018.02.021
Abstract: Gay and bisexual men (GBM) often use illicit drugs to enhance sexual pleasure, commonly referred to as 'chemsex' or 'party n play'. In particular, the use of meth hetamine and Viagra™, and other erectile dysfunction medications, both together and separately are strongly predictive of subsequent HIV infection. Truvada™, as pre-exposure prophylaxis (PrEP), virtually eliminates HIV transmission during condomless anal intercourse (CLAI). HIV-negative GBM in intensive sex partying networks may be adding PrEP to their drug regimen to actively reduce the possibility of HIV transmission during chemsex. We describe the prevalence and context of concurrent use of meth hetamine, Truvada™ (or its generic formulations), and Viagra™ or other erectile dysfunction medication (collectively, MTV). The Following Lives Undergoing Change study is an online prospective observational study of licit and illicit drug use among Australian GBM. Between January and July 2017, 1831 GBM provided details about their use of MTV. Binary logistic multiple regression analysis were used to estimate adjusted odds ratios (aOR) and associated 95% confidence intervals (95%CI). Concurrent MTV use was reported by 6.0% of participants 3.1% used meth hetamine and Viagra™ or other erectile dysfunction medication ('MV only') and 11.2% used Truvada™ as PrEP ('T only'). In multivariate analysis, compared to use of 'MV only', MTV was independently associated with CLAI with casual partners (aOR = 6.78 %CI = 1.42-32.34) and 'fuckbuddies' (aOR = 3.47 %CI = 1.41-8.56) in the previous six months. Compared to use of 'T only', MTV was independently associated with being older (aOR = 3.95 %CI = 1.55-10.03) and engaging in group sex (aOR = 3.31 %CI = 1.82-6.00). Greater social engagement with other gay men (aOR = 1.44 %CI = 1.18-1.76) and having more sexual partners (aOR = 2.30 %CI = 1.10-4.82) were independently associated with use of MTV compared to use of 'MV only' or 'T only'. GBM in intensive sex partying networks are increasingly adding PrEP alongside other drugs they use to enhance sexual experiences. Interventions that promote the use of PrEP during chemsex could mitigate HIV risk.
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.DRUGPO.2019.11.008
Abstract: In recent years there has been growing media attention on microdosing psychedelics (e.g., LSD, psilocybin). This refers to people routinely taking small doses of psychedelic substances to improve mental health and wellbeing, or to enhance cognitive performance. Research evidence is currently limited. This paper examines microdosing motivations, dosing practices, perceived short-term benefits, unwanted effects, and harm reduction practices. An international online survey was conducted in 2018 examining people's experiences of using psychedelics. Eligible participants were aged 16 years or older, had used psychedelics and could comprehend written English. This paper focuses on 525 participants who were microdosing psychedelics at the time of the survey. Participants were primarily motivated to microdose to improve mental health (40%), for personal development (31%) and cognitive enhancement (18%). Most were microdosing with psilocybin (55%) or LSD/1P-LSD (48%). Principal components analysis generated three factors examining perceived short-term benefits of microdosing: improved mood and anxiety, enhanced connection to others and environment, and cognitive enhancement and three factors examining negative and potentially unwanted effects: stronger-than-expected psychedelic effects, anxiety-related effects, and physical adverse effects. Most participants (78%) reported at least one harm reduction practice they routinely performed while microdosing. Our findings suggest that people microdosing are commonly doing so as a self-managed therapy for mental health, either as an alternative or adjunct to conventional treatments. This is despite psychedelics remaining prohibited substances in most jurisdictions. Recent findings from clinical trials with standard psychedelic doses for depression and anxiety suggest that a neurobiological effect beyond placebo is not unreasonable. Randomised controlled trials are needed, complemented by mixed methods social science research and the development of novel resources on microdosing harm reduction.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.DRUGPO.2007.03.002
Abstract: This study aimed to investigate the prevalence of ersion and injection of methadone and buprenorphine among clients receiving opioid pharmacotherapy treatment at community pharmacies in New South Wales (NSW), Australia. A multi-site cross-sectional survey design was utilised using a self-complete questionnaire. Participants were 508 clients receiving supervised methadone (n=442) and buprenorphine (n=66) at 50 community pharmacies. Participants were surveyed about whether they had erted their currently prescribed pharmacotherapy, whether they had injected methadone or buprenorphine, the frequency, desirability and duration of action of injecting, and the ease of availability of street-purchased pharmacotherapies. The prevalence of recent ersion was more than 10 times higher among those receiving buprenorphine compared to methadone, with 23.8% of buprenorphine-maintained participants reporting erting their dose in the preceding 12 months. Seventeen percent of methadone clients had injected methadone in the preceding 12 months compared with 9.1% of buprenorphine clients over the same time period. The higher prevalence of buprenorphine ersion compared to methadone ersion is likely to be due to its sublingual tablet formulation and difficulty associated with supervising its consumption compared to that of an oral liquid. Methadone ersion is also less prevalent likely due to the high levels of methadone take away provision, which also helps to explain the higher levels of recent methadone injecting compared to buprenorphine injecting. A clearer understanding of the motivations for ersion and injection of opioid pharmacotherapies, and the relationship between them is required.
Publisher: Informa UK Limited
Date: 21-12-2010
DOI: 10.3109/10826080903080664
Abstract: A survey of 448 clients receiving opioid treatment in public clinics in Australia was conducted during 2005, exploring ersion and injection of supervised methadone and buprenorphine, frequency and reported effects of injecting, and the cost and availability of street-purchased pharmacotherapies. The rates of ersion in the preceding 12 months were over three times higher among participants receiving supervised buprenorphine (15.3%) than among those receiving supervised methadone (4.3%). While 26.5% of participants currently prescribed buprenorphine had ever injected buprenorphine, 65.9% of those prescribed methadone reported ever injecting methadone. The majority of participants did not appear to have extensive experience of injecting their medication and most expressed a preference for taking it as directed. Further research is required to determine the optimal approach for the supervised administration of buprenorphine that maximizes the benefits of treatment and minimizes harm and the risk of ersion. The study's limitations are noted.
Publisher: Elsevier BV
Date: 2011
DOI: 10.1016/J.DRUGPO.2010.08.001
Abstract: This study aimed to investigate patient perspectives regarding coming off maintenance opioid substitution treatment (OST). The study explored previous experiences, current interest and concerns about stopping treatment, and perceptions of how and when coming off treatment should be supported. A cross-sectional survey was used. Participants were 145 patients receiving OST at public opioid treatment clinics in Sydney, Australia. Sixty-two percent reported high interest in coming off treatment in the next 6 months. High interest was associated with having discussed coming off treatment with a greater number of categories of people (OR=1.72), not citing concern about heroin relapse (OR=3.18), and shorter duration of current treatment episode (OR=0.99). Seventy-one percent reported previous withdrawal attempts and 23% had achieved opioid abstinence for ≥3 months following a previous withdrawal attempt. Attempts most commonly involved jumping off (59%), and doctor-controlled (52%) or self-controlled (48%) gradual reduction. For future attempts respondents were most interested in doctor-controlled (68%) or self-controlled (41%) gradual reduction. Concerns regarding coming off treatment included withdrawal discomfort (68%), increased pain (50%), and relapse to heroin use (48%). While some patients may require lifetime maintenance, the issue of coming off treatment is important to many patients and should be discussed regularly throughout treatment and where appropriate supported by a menu of clinical options.
Publisher: Wiley
Date: 07-2008
DOI: 10.1080/09595230802093745
Abstract: Clients in opioid substitution therapy often have considerable unmet health-care needs. The current study aimed to explore health problems related to opioid substitution therapy among clients on methadone and buprenorphine treatment. A self-complete, cross-sectional survey conducted among 508 patients receiving methadone and buprenorphine treatment at community pharmacies in New South Wales (NSW), Australia. The most common problems for which participants had ever sought help were dental (29.9%), constipation (25.0%) and headache (24.0%). The most common problems for which participants would currently like help were dental (41.1%), sweating (26.4%) and reduced sexual enjoyment (24.2%). There were no significant differences between those currently on methadone and those currently on buprenorphine for any of the health problems explored, nor differences for gender or treatment duration. Participants on methadone doses 100 mg or above were significantly more likely to want help currently for sedation. The considerable unmet health care needs among participants in this study suggest that treatment providers should consider improving the detection and response to common health problems related to opioid substitution therapy.
Publisher: Springer Science and Business Media LLC
Date: 16-01-2013
DOI: 10.1007/S10461-013-0409-0
Abstract: Injecting drug use is commonly reported among gay and bisexual men in Australia. We examined the prevalence and covariates of injecting drug use among men participating in the Sydney Gay Community Periodic Survey between 2004-06 and 2011. In 2004-06, data was collected about which drugs were injected, while in 2011, data was collected about hepatitis C (HCV) and esoteric sexual practices. In 2004-06, 5.6 % of men reported injecting drugs in the previous 6 months 3.4 % reported meth hetamine injection and 0.4 % heroin injection. In 2011, men who injected drugs were less likely to be employed full-time, and more likely to be HCV-positive, HIV-positive, to have used party drugs for sex, and to have engaged in esoteric sexual practices. The strong associations between injecting drug use, sexual risk practices and blood-borne virus infection suggests the need for combined sexual health and harm reduction services for gay and bisexual men who inject drugs.
Publisher: Wiley
Date: 11-2013
DOI: 10.1111/DAR.12004
Abstract: Substance use and substance use problems are often more prevalent in same-sex attracted young people (SSAY), yet little to date has been published about substance use and problems in this population in Australia. This paper aimed to characterise patterns of alcohol use, club drug use and dependence, injecting drug use and engagement with treatment services, comparing lesbians, gay men, bisexual women and bisexual men. A cross-sectional, online survey was conducted with 572 SSAY in Sydney, aged 18 to 25 years. The Alcohol Use Disorders Identification Test--Consumption questions (AUDIT-C) assessed hazardous alcohol use, and the Severity of Dependence Scale assessed club drug dependence. Seventy per cent of respondents had AUDIT-C scores indicative of hazardous alcohol use, and 29% of respondents had used club drugs in the previous 6 months. Multivariate logistic regression showed that male respondents had a lower odds of hazardous alcohol use (adjusted odds ratio = 0.6, 95% confidence interval 0.4-0.9), but a higher odds of recent club drug use (adjusted odds ratio = 1.8, 95% confidence interval 1.2-2.7). Meth hetamine dependence was reported among half of respondents who reported use in the previous 6 months. Bisexual women were more likely than other respondents to have sought treatment for alcohol and other drug use, and overall treatment utilisation was low (6%). This study reports high rates of drinking and club drug use, and a possible underutilisation of alcohol and other drug treatment. The findings suggest that SSAY in Sydney may be at a high risk of alcohol- and drug-related harm.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Informa UK Limited
Date: 06-07-2009
DOI: 10.1080/10550880903028841
Abstract: This study aimed to identify the practices of community pharmacists regarding the provision of buprenorphine for opioid dependence and explore behaviors pharmacists considered indicative of buprenorphine ersion. A cross-sectional survey of 669 community pharmacists authorized to dispense buprenorphine or methadone was conducted in New South Wales and Victoria, Australia. There was wide variation between pharmacies in the level of supervision provided during supervised buprenorphine dosing and a lack of clarity between pharmacists regarding what behaviors are ex les of buprenorphine ersion. Compared to New South Wales, a higher proportion of Victorian pharmacists detected 1 or more episodes of buprenorphine ersion in the past year (65% vs. 28% p < .001) and in the past month (20% vs. 7% p < .001). Detection of buprenorphine ersion was associated with the administration of crushed tablets (odds ratio = 2.77), broken tablets (odds ratio = 2.69), and having more buprenorphine clients (odds ratio = 1.24). Future research investigating the prevalence of buprenorphine ersion should include a clear definition of what behaviors constitute ersion.
Publisher: Elsevier BV
Date: 04-2020
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/SH13042
Abstract: Background: In recent years there has been an increase in the incidence of acute hepatitis C virus (HCV) in men who have sex with men (MSM). The aim of the present study was to examine the prevalence of HIV/HCV co-infection among MSM in Sydney, and to compare sexual and drug use risk practices of HIV/HCV co-infected MSM with HIV and HCV mono-infected MSM. Methods: Data were collected from gay and other homosexually active men as part of the ongoing Gay Community Periodic Surveys (GCPS). The analysis herein presents findings from the Sydney GCPS in August 2011, which collected data on HCV for the first time. The survey was completed by 2009 respondents. Results: Three per cent of respondents self-reported being HCV positive (representing 9.0% of HIV-positive men and 1.9% of HIV-negative men). Overall, 1.2% of respondents reported being HIV/HCV co-infected. HIV/HCV co-infected men were more likely than HCV or HIV mono-infected men to report several sexual and drug use practices that may increase the risk of blood-borne virus transmission. Conclusions: Consistent with other research, we found a higher prevalence of HCV among HIV-positive than HIV-negative men. Several risk practices were more commonly reported among HIV/HCV co-infected men. These findings, and the increasing incidence of HCV in MSM, reinforce the need for routine HCV screening in this population.
Publisher: Informa UK Limited
Date: 28-01-2009
DOI: 10.1080/10550880802545036
Abstract: This study aimed to develop a better understanding of the motives for suspected buprenorphine ersion during supervised dosing. Structured interviews were conducted with clients after 71 episodes of ersion at 3 opioid substitution treatment clinics in Sydney, Australia. Interviews were conducted by the clinic manager. An equivalent number of suspected episodes involved ersion via removal of buprenorphine from the mouth (n = 35), and secretion of buprenorphine in the mouth (n = 32). Denial of ersion occurred in 45% of suspected episodes and was significantly associated with secretion of buprenorphine in the mouth (P < .0001), suggesting a possible misunderstanding between clinicians and clients to what constitutes ersion. Motivations for ersion included "stockpiling" for later sublingual use (n = 15), discarding buprenorphine (n = 11), and giving it to another person (n = 5). A consistent definition of ersion of supervised dosed of buprenorphine is required. Diversion of supervised doses may represent a single episode of nonadherence to dosing instructions or more significant ambivalence over treatment. Responses to suspected ersion should aim to minimise harm and maximise treatment outcomes.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/SH12097
Abstract: Background Although half of the HIV notifications among Aboriginal and Torres Strait Islander people (‘Indigenous Australians’) are attributed to homosexual transmission, there has been little research examining sexual and drug use risk practices among Indigenous Australian men who have sex with men (MSM). Methods: Respondents were Indigenous Australian (n = 1278) and Anglo-Australian men (n = 24 002) participating in the routine cross-sectional Gay Community Periodic Surveys conducted in Australia from 2007 to 2011. Sociodemographic characteristics, sexual risk practices, drug use, HIV testing and HIV status of Indigenous and Anglo-Australian men were compared and evaluated to discover whether Indigenous status was independently associated with HIV risk practices. Results: Although an equivalent proportion of Indigenous and Anglo-Australian men reported being HIV-positive (9.6%), Indigenous MSM were more likely to report unprotected anal intercourse with casual partners in the previous 6 months (27.9% v. 21.5% Adjusted odds ratio (AOR) = 1.29, 95% confidence interval (CI): 1.11–1.49). Indigenous men were more likely than Anglo-Australian men to report use of several specific drugs and twice as likely to report injecting drug use in the previous 6 months (8.8% v. 4.5% AOR = 1.43, 95% CI: 1.11–1.86). Conclusions: Despite a higher proportion of Indigenous men reporting sexual and drug use practices that increase the risk of HIV transmission, there were no differences in the HIV status of Indigenous and Anglo-Australian men. However, the elevated rates of risk practices suggest that Indigenous MSM should remain a focus for HIV prevention, care and support.
Publisher: Wiley
Date: 11-2008
DOI: 10.1080/09595230801935706
Abstract: A consumer satisfaction survey was conducted among clients receiving methadone or buprenorphine treatment for opioid dependence. The survey aimed to assess client perceptions across a number of treatment domains, including the clinic environment, service provision, clinical relationships, medication and treatment outcomes. Participants were 432 clients receiving treatment at nine public clinics in New South Wales, Australia. An interviewer-administered questionnaire was utilised, designed by the researchers. Participation was voluntary and anonymous. All participants received $10 remuneration. Seventy-eight per cent of participants were on methadone treatment. Overall satisfaction with treatment was high (mean: 3.8 very satisfied = 5). Participants were mainly satisfied with service provided by the clinic, although had concerns over the inflexibility associated with the clinic atmosphere, frequency of clinic attendance, dosing hours and lack of takeaway doses. While relationships with prescribers and case managers were rated positively, 16% and 21% of participants wanted to see their prescriber and case manager more often, respectively 53% reported that they did not have input into their care plan. Regarding the helpfulness of case managers in assisting clients with problems experienced in identified domains of case management (e.g. drug use, physical and mental health, psychosocial supports), the mean rating was 5.2 (excellent = 10). While participants reported being mainly satisfied with their treatment, results must be viewed within the context of what a consumer reasonably expects to receive from a service. The concept of 'expectation' and 'relative experience' is crucial in measuring consumer satisfaction among pharmacotherapy consumers.
Publisher: Wiley
Date: 11-01-2010
DOI: 10.1111/J.1360-0443.2009.02774.X
Abstract: To explore service provision and the range of problems that New South Wales (NSW) and Victoria (VIC) community pharmacists providing opioid substitution treatment (OST) have experienced with clients and prescribers. ross-sectional postal survey. All community pharmacies providing OST in NSW (n = 593) and VIC (n = 393), Australia. Completed questionnaires were received from 669 pharmacists (68% response rate). The questionnaire addressed pharmacy characteristics, recent problems experienced with clients including refusal to dose, provision of credit for dispensing fees, termination of treatment, responses of pharmacists to problems experienced with clients, as well as problems experienced with OST prescribers. In the preceding month, 41% of pharmacists had refused to dose a client for any reason, due most commonly to expired prescriptions (29%), or > or issed doses (23%). Terminating a client's treatment in the past month was reported among 14% of respondents, due most commonly to inappropriate behaviour and missed doses. Treatment termination was reported by a significantly higher proportion of pharmacists in VIC (P < 0.001). Treatment termination in last month was predicted having more clients (P < 0.001), the provision of buprenorphine treatment (P = 0.008), having a separate dosing area (P = 0.021), and being a female pharmacist (P = 0.013). Past month refusal to dose was predicted by the pharmacy being in VIC (P < 0.001) and having more clients (P < 0.001). Problems experienced most commonly in the past month with prescribers were difficulty contacting prescriber (21%) and provision of takeaway doses to clients considered unstable by the pharmacist (19%) (higher in VIC: both P < 0.001). This study highlights the range of problems experienced by community pharmacists in the delivery of OST and the consequences for people in treatment. Particular attention should be focused upon considering number of clients per pharmacy and improving professional communication between pharmacists and prescribers.
Publisher: Informa UK Limited
Date: 02-10-2017
Location: Germany
Start Date: 2017
End Date: 07-2020
Amount: $358,500.00
Funder: Australian Research Council
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