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Background and aims Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been implemented widely in medical settings, with little attention focused on how well providers adhere to evidence-based service delivery in everyday practice. The purposes of this paper were to: (1) introduce a flexible, relatively simple methodology, the SBIRT Checklist for Observation in Real-time (SCORe), to assess adherence to evidence-based practice and provide preliminary evidence supporting its criterion validity; and (2) illustrate the feasibility and potential utility of the SCORe by analyzing observations of providers within four large-scale SBIRT programs in the United States. Methods Eighteen potential adherence judges were trained to recognize SBIRT service elements presented in realistic taped portrayals constructed to serve as criterion coding standards. Across the four SBIRT programs, 76 providers were observed performing 388 services in three types of medical settings; emergency departments ( n = 10), hospital out-patient/ambulatory clinics ( n = 16) and hospital in-patient settings ( n = 5). Results Across two exercises, trainees identified 81% of screening and 75% of brief intervention (BI) elements correctly; for the six FRAMES components (Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy), agreement ranged from 69% to 91%. Across programs, 56% of screening, 54% of brief intervention (BI) (81% of FRAMES) and 53% of referral to treatment elements were observed. Programs differed significantly in adherence [screening, P = 0.024; BI, P < 0.001; FRAMES, P < 0.001; referral to treatment (RT), P < 0.001]; medical setting differences were minimal. Conclusions The Screening, Brief Intervention and Referral to Treatment Checklist for Observation in Real-time provides a flexible method for assessing adherence to evidence-based Screening, Brief Intervention and Referral to Treatment service protocols. Preliminary evidence supports the criterion validity, feasibility and potential utility of the Screening, Brief Intervention and Referral to Treatment Checklist for Observation in Real-time protocol. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol's harm to others (AHTO) has become a key driver of national and international alcohol policy. This study aimed to produce a contemporary, comprehensive estimate of the correlates and harms from others' drinking in 2021 in Australia. Design, setting, participants and measurements: Across Australia, 2574 adults (1380 women; 1172 men) were sampled via two cross‐sectional survey modes: a random‐digit dial mobile phone sample of 1000 people and 1574 people from the Life in Australia™ panel survey. In 2021 participants were asked about harms they had experienced from the drinking of family, friends, co‐workers and the public in the past year. Applying combined sample weights from each mode, bivariable and adjusted multivariable logistic regressions were used to analyse differences in rates of AHTO by participant gender, age, residence in rural or metropolitan regions, country of birth, education and employment. Findings: In 2021, 23.6% reported being negatively affected by strangers' drinking and 21.3% by the drinking of someone they knew, with 34.3% reporting being negatively affected a lot or a little by either; 42.4% of respondents reported specific harms from strangers' drinking. Thus, 48.1% of respondents reported any harm (negative effects or specific harms) from others' drinking. Women, younger people, Australian‐born and heavier episodic drinkers reported significantly higher rates of AHTO compared with other respondents. Smaller percentages (7.5%) of participants reported being harmed substantially by others' drinking, including by people they knew (5.8%) or strangers (2.3%). Stratified analyses showed that heavier drinking, furloughed, younger men who were born overseas in English‐speaking countries were affected by others' drinking, whereas women were affected regardless of these factors (apart from age). Conclusions: More than one‐third of Australian adults appear to have been negatively affected by others' drinking in 2021, with women, younger people and heavier drinkers at greater risk. Substantial harm appears to be more likely to arise from the drinking of people Australians know than from strangers' drinking. [ABSTRACT FROM AUTHOR]

Commentary to: Should academic journals publish e ‐ cigarette research linked to tobacco companies? [ABSTRACT FROM AUTHOR]

Background and aims Substance use disorders are associated commonly with comorbid physical illness. There are fewer data on dental disease in these conditions, in spite of high rates of dry mouth (xerostomia), as well as the associated indirect or life-style effects such as poverty and lack of access to care. We compared the oral health of people with substance use disorders (SUDs) with non-using controls. Method This was a systematic search for studies from the last 35 years of the oral health of people reporting SUDs. We used MEDLINE, PsycInfo, OVID, Google Scholar, EMBASE and article bibliographies. Results were compared with the general population. Oral health was assessed in terms of dental caries and periodontal disease using the following standardized measures: the mean number of decayed, missing and filled teeth (DMFT) or surfaces (DMFS) and probing pocket depth. Non-carious tooth loss was assessed clinically. Results We identified 28 studies that had sufficient data for a meta-analysis, comprising 4086 SU patients and 28 031 controls. People with SUD had significantly higher mean scores for DMFT [mean difference = 5.15, 95% confidence interval (CI) = 2.61-7.69 and DMFS (mean difference = 17.83, 95% CI = 6.85-28.8]. They had more decayed teeth but fewer restorations, indicating reduced access to dental care. Patients with SUD also exhibited greater tooth loss, non-carious tooth loss and destructive periodontal disease compared to controls. Conclusion Patients with substance use disorders have greater and more severe dental caries and periodontal disease than the general population, but are less likely to have received dental care. [ABSTRACT FROM AUTHOR]

Aims Screening and brief intervention for harmful substance use in medical settings is being promoted heavily in the United States. To justify service provision fiscally, the field needs accurate estimates of the number and type of staff required to provide services, and thus the time taken to perform activities used to deliver services. This study analyzed the time spent in activities for the component services of the substance misuse Screening, Brief Intervention and Referral to Treatment (SBIRT) program implemented in emergency departments, in-patient units and ambulatory clinics. Design Observers timed activities according to 18 distinct codes among SBIRT practitioners. Setting Twenty-six US sites within four grantees. Participants Five hundred and one practitioner-patient interactions; 63 SBIRT practitioners. Measurements Timing of practitioner activities. Interventions Delivery of component services of SBIRT. Findings The mean (standard error) time to deliver services was 1:19 (0:06) for a pre-screen ( n = 210), 4:28 (0:24) for a screen ( n = 97) and 6:51 (0:38) for a brief intervention ( n = 66). Estimates of service duration varied by setting. Overall, practitioners spent 40% of their time supporting SBIRT delivery to patients and 13% of their time delivering services. Conclusions In the United States, support activities (e.g. reviewing the patient's chart, locating the patient, writing case-notes) for substance abuse Screening, Brief Intervention and Referral to Treatment require more staff time than delivery of services. Support time for screens and brief interventions in the emergency department/trauma setting was high compared with the out-patient setting. [ABSTRACT FROM AUTHOR]

Aims To conduct a cost-effectiveness analysis (CEA) comparing the delivery of brief intervention (BI) with brief treatment (BT) within Screening, Brief Intervention and Referral to Treatment (SBIRT) programs. Design Quasi-experimental differences in observed baseline characteristics between BI and BT patients were adjusted using propensity score techniques. Incremental comparison of costs and health outcomes associated with BI and BT. Setting Health-care settings in four US states participating in Substance Abuse and Mental Health Services Administration SBIRT grant programs. Participants Ninety patients who received BT and 878 who received BI. Measurements Per-patient cost of SBIRT, patient demographics and six measures of substance use: proportion using alcohol, proportion using alcohol to intoxication, days of alcohol use, days of alcohol use to intoxication, proportion using drugs and days using drugs. Findings BI and BT were associated with better outcomes. The cost of SBIRT was significantly higher for BT patients ($75.54 versus 16.32, 95% confidence interval, P < 0.01). BT would be cost-effective if the decision-maker had a willingness to pay of $8.90 for a 1 percentage point reduction in the probability of using any alcohol. For the other five outcomes, BT was less effective and more costly, and BI would be a better use of resources. Conclusions It might be cost-effective to offer brief treatment if the goal is to abstain from alcohol. However, the higher effectiveness of brief treatment for this outcome is associated with considerable uncertainty and, because both brief intervention and brief treatment improve all outcomes, brief treatment does not appear to be a good use of resources. [ABSTRACT FROM AUTHOR]

Background and Aims It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid-related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid-related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call-outs to opioid-related overdose incidents and the cumulative number of 'take-home naloxone' (THN) kits in issue; and is there evidence of an association between ambulance call-outs to opioid-related overdose incidents in early adopter (pilot) or later adopting (non-pilot) regions and the cumulative number of THN kits issued in those areas? Design Controlled time-series analysis. Setting Scotland, UK, 2008-15. Participants Pre-NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post-implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid-related overdose were recorded for the pre-NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post-implementation period (mean 24.8 attendances per week). Intervention Scotland's NNP; formally implemented on 1 April 2011. Measurements Primary outcome measure was weekly incidence (counts) of call-outs to opioid-related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further for a control group: weekly incidence (counts) of call-outs to heroin-related overdose in the London Borough area acquired from the London Ambulance Service. Findings There was no significant association between SAS call-outs to opioid-related overdose incidents and THN kits in issue for Scotland as a whole (coefficient 0.009, 95% confidence intervals = −0.01, 0.03, P = 0.39). In addition, the magnitude of association between THN kits and SAS call-outs did not differ significantly between pilot and non-pilot regions (interaction test, P = 0.62). Conclusions The supply of take-home naloxone kits through a National Naloxone Programme in Scotland was not associated clearly with a decrease in ambulance attendance at opioid-related overdose incidents in the 4-year period after it was implemented in April 2011. [ABSTRACT FROM AUTHOR]

Aims To compare the use of alternative nicotine products, smoking behavior and tobacco biomarker exposure in smokers unwilling to quit who were assigned randomly to normal nicotine content (NNC) cigarettes or very low nicotine content (VLNC) cigarettes. Design Randomized, parallel-arm 8-week study with assignment to VLNC (VLNC 1, n = 53) or NNC (NNC, n = 27) with access to non-cigarette combusted and non-combusted tobacco/nicotine products or to VLNC with access to only non-combusted products (VLNC2, n = 56). Setting Clinics in Minnesota, USA. Participants Smokers uninterested in quitting smoking with a mean [± standard deviation (SD)] age of 44 (± 14) years and smoking 16 (± seven) cigarettes/day; 51% female, 72% white. Measurements During the experimental period, the measures taken included: rate of alternative products used, amount of and abstinence from combusted tobacco used and tobacco exposure biomarkers. Findings There were higher rates of non-combusted alternative tobacco/nicotine product use in both VLNC conditions versus the NNC condition [rate ratio (RR) = 2.18, 95% confidence interval (CI) = 1.94, 2.46 and RR = 1.64, 95% CI = 1.46, 1.85, respectively] and in VLNC1 versus VLNC2 condition (RR = 1.33, 95% CI = 1.23, 1.44), accompanied by reduced biomarkers of exposure primarily in VLNC2 condition compared to NNC condition ( Ps < 0.05). Fewer combusted products were smoked at almost all visits ( Ps ≤ 0.02) and there were higher rates of abstinence for both VLNC conditions compared with the NNC condition (VLNC1 versus NNC: RR = 9.96, 95% CI = 5.01, 19.81; VLNC2 versus NNC: RR = 11.23, 95% CI = 5.74, 21.97). Conclusion The offer of, and instructions to use, reduced nicotine content cigarettes during an 8-week period led to greater use of alternative tobacco/nicotine products compared with continued use of normal nicotine cigarettes and also reductions in smoking rates. [ABSTRACT FROM AUTHOR]

Aims To examine the safety and effectiveness of buprenorphine + naloxone sublingual tablets (BUP, as Suboxone®) provided after administration of extended-release injectable naltrexone (XR-NTX, as Vivitrol®) to reduce cocaine use in participants who met DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. Methods This multi-centered, double-blind, placebo-controlled study, conducted under the auspices of the National Drug Abuse Treatment Clinical Trials Network, randomly assigned 302 participants at sites in California, Oregon, Washington, Colorado, Texas, Georgia, Ohio, New York and Washington DC, USA to one of three conditions provided with XR-NTX: 4 mg/day BUP (BUP4, n = 100), 16 mg/day BUP (BUP16, n = 100, or no buprenorphine (placebo; PLB, n = 102). Participants received pharmacotherapy for 8 weeks, with three clinic visits per week. Cognitive behavioral therapy was provided weekly. Follow-up assessments occurred at 1 and 3 months post-intervention. The planned primary outcome was urine drug screen (UDS)-corrected, self-reported cocaine use during the last 4 weeks of treatment. Planned secondary analyses assessed cocaine use by UDS, medication adherence, retention and adverse events. Results No group differences were found between groups for the primary outcome (BUP4 versus PLB, P = 0.262; BUP16 versus PLB, P = 0.185). Longitudinal analysis of UDS data during the evaluation period using generalized linear mixed equations found a statistically significant difference between BUP16 and PLB [ P = 0.022, odds ratio (OR) = 1.71] but not for BUP4 ( P = 0.105, OR = 1.05). No secondary outcome differences across groups were found for adherence, retention or adverse events. Conclusions Buprenorphine + naloxone, used in combination with naltrexone, may be associated with reductions in cocaine use among people who meet DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. [ABSTRACT FROM AUTHOR]

Background and Aims Despite ambiguous evidence for the effectiveness of alcohol screening with brief interventions (BI) in emergency departments (ED), ambition for their widespread implementation continues to grow. To clarify whether such an application of BI is justifiable, we conducted a systematic review and meta-analysis on studies testing the impact of BI on alcohol consumption. Methods We included peer-reviewed, randomized controlled studies investigating the effects of BI on alcohol consumption in injured and/or intoxicated patients, published January 2002-September 2015. Changes from baseline in consumption quantity, intensity and number of heavy drinking episodes were assessed at 3-, 6- and 12-month follow-up, resulting in nine separate random-effects meta-analyses of standardized mean differences (SMD). Moderation effects of intervention mode, length, type of interventionist, intensity of control intervention and study quality were assessed using subgroup comparisons and meta-regression. Results We considered 33 publications (28 separate studies) including 14 456 patients. Six of nine comparisons revealed small significant effects in favour of BI, with the highest SMD at 0.19 [95% confidence interval (CI) = 0.08-0.31]. No significant moderators could be identified, and statistical heterogeneity ( I2) was below 40%. Conclusions In a large meta-analysis of randomized controlled trials in emergency care settings, there was evidence for very small effects of brief interventions on alcohol consumption reductions. More intensive interventions showed no benefit over shorter approaches. Non-face-to-face interventions appear to be comparably effective, but this finding remains tentative due to the low number of non-face-to-face studies. [ABSTRACT FROM AUTHOR]

Background and Aims Flaws in previous studies mean that findings of J-shaped risk curves for gambling should be disregarded. The current study aims to estimate the shape of risk curves for gambling losses and risk of gambling-related harm (a) for total gambling losses and (b) disaggregated by gambling activity. Design Four cross-sectional surveys. Setting Nationally representative surveys of adults in Australia (1999), Canada (2000), Finland (2011) and Norway (2002). Participants A total of 10 632 Australian adults, 3120 Canadian adults, 4484 people aged 15-74 years in Finland and 5235 people aged 15-74 years in Norway. Measurements Problem gambling risk was measured using the modified South Oaks Gambling Screen, the NORC DSM Screen for Gambling Problems and the Problem Gambling Severity Index. Findings Risk curves for total gambling losses were estimated to be r-shaped in Australia {β losses = 4.7 [95% confidence interval (CI) = 3.8, 6.5], β losses2 = -7.6 (95% CI = -17.5, -4.5)}, Canada [β losses = 2.0 (95% CI = 1.3, 3.9), β losses2 = -3.9 (95% CI = -15.4, -2.2)] and Finland [β losses = 3.6 (95% CI = 2.5, 7.5), β losses2 = -4.4 (95% CI = -34.9, -2.4)] and linear in Norway [β losses = 1.6 (95% CI = 0.6, 3.1), β losses2 = -2.6 (95% CI = -12.6, 1.4)]. Risk curves for different gambling activities showed either linear, r-shaped or non-significant relationships. Conclusions Player loss-risk curves for total gambling losses and for different gambling activities are likely to be linear or r-shaped. For total losses and electronic gaming machines, there is no evidence of a threshold below which increasing losses does not increase the risk of harm. [ABSTRACT FROM AUTHOR]

Background and Aims Current pharmacotherapies for tobacco dependence are generally well tolerated, but have relatively high rates of relapse. They target primarily the brains' mesocorticolimbic 'reward' pathway. However, recent evidence suggests that the insular cortex, a central cerebral hemispheric region historically overlooked in addiction models, may also play an important role in cognitive and emotional processes that facilitate drug use. We examined whether insular versus non-insular damage from ischemic stroke attenuated acute withdrawal from cigarette smoking and reduced the likelihood of nicotine replacement therapy (NRT) use during hospitalization. Design Data were derived from a longitudinal study with 3 months' follow-up, beginning June 2013 and ending May 2014. Setting Three acute care hospitals in Rochester, NY, USA. Participants One-hundred and fifty-six current smokers hospitalized for acute ischemic stroke (38 with insular infarctions and 118 with non-insular infarctions, assessed by three neuroradiologists). Measurements The Wisconsin Smoking Withdrawal Scale (WSWS) and Minnesota Nicotine Withdrawal Scale (MNWS) were administered during hospitalization (a period of forced abstinence) to assess the frequency and severity of withdrawal symptoms. NRT use was also assessed during hospitalization. Findings On average, smokers with insular damage had a lower WSWS score during admission [mean = 5.89, standard deviation (SD) = 4.72] compared with those with non-insular damage (mean = 9.20, SD = 4.71; P < 0.001) [covariate-adjusted difference in means of -3.12, 95% confidence interval (CI) = -4.97, -1.27]. A similar difference was also noted when the MNWS was used ( P = 0.02). Furthermore, participants with insular lesions appeared to be less likely to use NRT during admission compared with those with non-insular lesions [odds ratio (OR) = 0.72, 95% CI = 0.32, 1.64]. Conclusions Current smokers with damage to their insular cortex brain region appear to experience fewer and less severe tobacco withdrawal symptoms, and appear to be less likely to require nicotine replacement therapy during hospitalization, compared with smokers with non-insular damage. These findings support the potential role of the insular cortex in regulating withdrawal during abstinence, a motivator responsible for the maintenance of addictive behaviors. [ABSTRACT FROM AUTHOR]

Aims Most people who quit smoking for a short term will return to smoking again in 12 months. We tested whether self-help booklets can reduce relapse in short-term quitters after receiving behavioural and pharmacological cessation treatment. Design A parallel-arm, pragmatic individually randomized controlled trial. Setting Smoking cessation clinics in England. Participants People who stopped smoking for 4 weeks after receiving cessation treatment in stop smoking clinics. Intervention Participants in the experimental group (n = 703) were mailed eight booklets, each of which taught readers how to resist urges to smoke. Participants in the control group (n = 704) received a leaflet currently used in practice. Measurements The primary outcome was prolonged, carbon monoxide-verified abstinence from months 4 to 12. The secondary outcomes included 7-day self#x02010;reported abstinence at 3 and 12 months. Mixed-effects logistic regression was used to estimate treatment effects and to investigate possible effect modifying variables. Findings There were no statistically significant differences between the groups in prolonged abstinence from months 4 to 12 (36.9% versus 38.6%; odds ratio 0.93, 95% confidence interval 0.75-1.16; P = 0.524). In addition, there were no significant differences between the groups in any secondary outcomes. However, people who reported knowing risky situations for relapse and using strategies to handle urges to smoke were less likely to relapse. Conclusions In people who stop smoking successfully with behavioural support, a comprehensive self-help educational programme to teach people skills to identify and respond to high-risk situations for return to smoking did not reduce relapse. [ABSTRACT FROM AUTHOR]

Aims Within a parent study examining ovarian hormone effects on smoking cessation in women, we conducted an exploratory short-term trial of varenicline versus transdermal nicotine patch. Design Double-blind double-dummy randomized trial. Setting Single-site out-patient research clinic in the United States. Participants Female smokers, ages 18-45 years and averaging ≥10 cigarettes per day for at least 6 months ( n = 140). Interventions Participants were randomized to receive a 4-week course of (a) varenicline tablets and placebo patches ( n = 67) or (b) placebo tablets and nicotine patches ( n = 73). Two brief cessation counseling sessions were provided for all participants. Measurements The outcome of primary clinical interest was 2-week end-of-treatment abstinence. Secondary outcomes included 1- and 4-week end-of treatment abstinence and abstinence at a post-treatment follow-up visit occurring 4 weeks after treatment conclusion. Breath carbon monoxide (≤ 10 parts per million) was used to confirm biochemically self-reported abstinence. Findings Two-week end-of-treatment abstinence was achieved by 37.3% (25 of 67) of varenicline participants and by 17.8% (13 of 73) of nicotine patch participants [odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.3-6.0, P = 0.011]. One-week (44.8 versus 20.6%, OR = 3.1, 95% CI = 1.5-6.6, P = 0.003) and 4-week (22.4 versus 9.6%, OR = 2.7, 95% CI = 1.0-7.2, P = 0.043) end-of-treatment abstinence similarly favored varenicline, although post-treatment follow-up Russell Standard abstinence was not significantly different between groups (23.9 versus 13.7%, OR = 2.0, 95% CI = 0.8-4.7, P = 0.126). Conclusion In an exploratory 4-week head-to-head trial in female smokers, varenicline, compared with nicotine patch, more than doubled the odds of end-of-treatment abstinence, although this diminished somewhat at post-treatment follow-up. [ABSTRACT FROM AUTHOR]

Aims To examine whether young adults' alcohol consumption during the course of an evening was affected by the number of friends present, and the interaction between participants' gender and number of friends present. Design Participants used the internet-based cellphone-optimized assessment technique (ICAT) to complete a series of cellphone questionnaires every Thursday, Friday and Saturday evening over five weekends. A multi-level growth curve model (hourly assessments, clustered within evenings, clustered within individuals) with time-invariant and time-varying covariates was estimated. Setting French-speaking Switzerland. Participants A total of 183 young adults (53.0% female, mean age = 23.1) who completed 7205 questionnaires on 1441 evenings. Measurements Alcohol consumption and number of friends present assessed at 8 p.m., 9 p.m., 10 p.m., 11 p.m. and midnight. Findings Drinking pace accelerated notably over the course of the evening on Saturdays ( b = 0.047; P < 0.01). Men consumed more alcohol than women, particularly at the beginning of the evening ( b = 0.152; P < 0.05). However, this effect was no longer significant when the impact of friends was accounted for ( b = 0.096; P = 0.139). The higher the number of friends present, the higher the number of drinks consumed at a given time during the course of the evening ( b = 0.070; P < 0.001). Cross-level interaction effects indicated that this relationship was stronger for men than women ( b = 0.027; P < 0.05). Conclusions Among young adults in Switzerland, the number of friends present is associated positively with hourly drinking frequency during the course of weekend evenings. The impact of the drinking group size on alcohol use is stronger for men than women. [ABSTRACT FROM AUTHOR]

Aims The Randomized Injectable Opioid Treatment Trial ( RIOTT) compared supervised injectable heroin ( SIH) and supervised injectable methadone ( SIM) with optimized oral methadone ( OOM) ( ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Design Multi-site randomized controlled trial ( RCT) comparing SIH versus OOM and SIM versus OOM. Setting Three supervised injectable opiate clinics in England. Participants Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment ( n = 127), randomized to either SIH( n = 43), SIM( n = 42) or OOM( n = 42). All received high levels of medical and psychosocial support. Measurements Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health ( SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [ SIH = odds ratio ( OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs ( SIH = mean change £-289.43; P < 0.001; SIM = mean change £-183.41; P < 0.001; OOM = mean change £-162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £-92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM ( SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Conclusions Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes. [ABSTRACT FROM AUTHOR]

Aim To investigate the characteristics of the different club drugs and associated high-risk sexual behaviours in China. Design Multicentre cross-sectional study. Setting Drug Detoxification and Rehabilitation Centres in six provinces, China. Participants A total of 1434 eligible club drug users were included. Measurements Participants were investigated by trained interviewers using a self-designed structured questionnaire to collect information on club drug use and associated behaviours. Findings Methamphetamine was the most commonly abused drug in participants (73.92%), who used it in their or their friends' homes by non-injection for the purpose of feeling euphoria. Among participants with sexual behaviours after club drug use, 75.21% reported having engaged in sex with multiple partners after club drug use during the past year and 79.84% had unprotected sex after using club drug during the past year. A two-level logistic model showed that male gender [adjusted odds ratio ( AOR) = 7.14; 95% confidence interval ( CI) = 4.17-12.5], unmarried ( AOR = 1.71, 95% CI = 1.04-2.79), long duration of club drug use during their life-time ( AOR = 1.76, 95% CI = 1.28-2.42) and severe acute intoxication after using club drugs during the past year ( AOR = 2.11, 95% CI = 1.07-4.15) were independent risk factors of multiple sex partners during the past year. Another two-level model showed that the club drug users who were female ( AOR = 1.79, 95% CI = 1.03-3.11) and had polydrug use during their lifetime ( AOR = 1.55, 95% CI = 1.01-2.34) had more risk for unprotected sex during the past year than without these characteristics. Conclusion High-risk sexual behaviours are common among club drug users in China. The prevention and intervention of club drug use could decrease the risk of sexual behaviours which further prevent HIV transmission and other sexually transmitted infections in China. [ABSTRACT FROM AUTHOR]

Aims To compare three missing data strategies: (i) the latent growth model that assumes the data are missing at random ( MAR) model; (ii) the Diggle- Kenward missing not at random ( MNAR) model, where dropout is a function of previous/concurrent urinalysis ( UA) submissions; and (iii) the Wu- Carroll MNAR model where dropout is a function of the growth factors. Design Secondary data analysis of a National Drug Abuse Treatment Clinical Trials Network trial that examined a 7-day versus 28-day taper (i.e. stepwise decrease in buprenorphine/naloxone) on the likelihood of submitting an opioid-positive UA during treatment. Setting 11 out-patient treatment settings in 10 US cities. Participants A total of 516 opioid-dependent participants. Measurements Opioid UAs provided across the 4-week treatment period. Findings The MAR model showed a significant effect ( B = −0.45, P < 0.05) of trial arm on the opioid-positive UA slope (i.e. 28-day taper participants were less likely to submit a positive UA over time) with a small effect size ( d = 0.20). The MNAR Diggle- Kenward model demonstrated a significant ( B = −0.64, P < 0.01) effect of trial arm on the slope with a large effect size ( d = 0.82). The MNAR Wu- Carroll model showed a significant ( B = −0.41, P < 0.05) effect of trial arm on the UA slope that was relatively small ( d = 0.31). Conclusions This performance comparison of three missing data strategies (latent growth model, Diggle- Kenward selection model, Wu- Carrol selection model) on sample data indicates a need for increased use of sensitivity analyses in clinical trial research. Given the potential sensitivity of the trial arm effect to missing data assumptions, it is critical for researchers to consider whether the assumptions associated with each model are defensible. [ABSTRACT FROM AUTHOR]