Search

Co-administering cannabis with tobacco (i.e. co-administration of the substances mixed together) is a common practice among cannabis users, but the consequences of this practice are not well understood. This study examines the relationship between co-administering cannabis with tobacco and the long-term frequency of cannabis use in a young adult population group with high rates of cannabis and tobacco use. The data are from an Australian prospective population-based study of young adults who recurrently used amphetamine-type stimulants (ATS). The mean age of participants was 20.8 years at baseline, sample size (n = 277), and 47% were female. We examined the frequency and quantity of cannabis consumption over 4 ½ years. Negative binomial regression analysis was conducted to examine the frequency of cannabis use at 12-month follow-up and at 4 ½ years, with co-administering practices as the predictor. At every time interval, participants who always co-administered their cannabis with tobacco used cannabis on more days in the last month than those who only sometimes co-administered, rarely co-administered, or never co-administered these substances (p < 0.001). Sometimes co-administering cannabis with tobacco at baseline predicted more frequent cannabis use at 12-month follow-up (adjusted IRR: 2.25, 95% CI: 1.05, 4.78), independently of the baseline frequency of cannabis use. However, levels of co-administering cannabis with tobacco at 12-month follow-up (rarely, sometimes, and always) did not predict high levels of cannabis use at 4 ½ years follow-up after adjusting for cannabis use at 12-month follow-up. Among people who use ATS and cannabis, frequent cannabis use may be a marker of the practice of co-administering cannabis with tobacco, and can be used to target tobacco cessation interventions in these populations. [ABSTRACT FROM AUTHOR]

Background: Buprenorphine and buprenorphine/naloxone (BNX) were developed to improve the safety profile of opioid substitution treatment (OST) and reduce diversion and injection, yet continue to be injected, despite the risk of harm. Previous studies examining injection of these substances have relied on self-reported injection and overdose. Using data from the Uniting Medically Supervised Injecting Center (MSIC) in Sydney, this study aimed to assess the overdose risk associated with the use of buprenorphine and BNX and identify factors associated with injecting. Methods: Client data routinely collected from MSIC, a drug consumption room where clients can legally inject drugs under supervision, was used. Odds ratios (OR) to assess the risk of overdose and their associated 95% confidence intervals (95%CI) were calculated and compared to other substances. Univariate analysis using χ-square and multivariate logistic regressions were used to determine characteristics associated with buprenorphine and BNX injection. Results: Data from 1,020,782 injections by 15,832 individuals were analyzed. Risk of overdose was low for buprenorphine compared to other substances (OR 0.16; 95%CI: 0.07–0.19) and no overdoses occurred when BNX was injected. Injection of both buprenorphine and BNX was associated with male gender, homelessness, no income/reliance upon government payments, and prior imprisonment. Conclusions: Buprenorphine and BNX continue to be injected, albeit in small numbers. This is the first study to report on injection and overdose risk using direct observation, and has confirmed the lower overdose risk. MSIC clients who inject buprenorphine and BNX tend to be marginalized and may benefit from targeted harm reduction measures. [ABSTRACT FROM AUTHOR]

Background: Prior research indicates that patterns of combined alcohol and methamphetamine use may be associated with experiencing subjective feelings of aggression or hostility during methamphetamine use episodes. Objectives: This study examines whether subjective effects of methamphetamine use (i.e., aggression or hostility and paranoia) are associated with aggressive behavior while under the influence of any illicit drugs, controlling for combined alcohol andmethamphetamine use and a number of other potential predictors. Methods: Data from a population-based sample of Australian young adult methamphetamine users (n = 101) collected in 2010 was analyzed. A prediction model of aggressive behavior under the influence of illicit drugs was developed using penalized maximum likelihood logistic regression. Results: Over one-third (34.7%) of methamphetamine users had engaged in verbal and/or physical aggression under the influence of illicit drugs in the last 12 months. In the prediction model, recurrent feelings of aggression or hostility attributed to methamphetamine use (≥3 times in the last 12 months) were associated with aggressive behavior (adjusted odds ratio 4.95, 95% confidence interval 1.67, 14.69). This association was independent of methamphetamine-attributed paranoia, combined alcohol and methamphetamine use, methamphetamine, ecstasy, cocaine, and cannabis use patterns, heavy episodic drinking, gender, and age. No association was found for combined alcohol andmethamphetamine use. Conclusions: These findings indicate a link between methamphetamine-related subjective feelings of aggression or hostility and self-reported aggressive behavior while under the influence of illicit drugs. This suggests that subjective feelings of aggression or hostility may distinguish those who are involved in aggression from other methamphetamine users. [ABSTRACT FROM AUTHOR]

Background: People who inject drugs (PWID) are at disproportionately high risk of suicidal behaviors, as are individuals who report same-sex attraction or experience. However, there is little evidence of compounded risk of suicide for individuals who report same-sex sexual intercourse (SSI) and are PWID. Objectives: To explore the associations of lifetime intentional overdose amongst a cohort of PWID, with particular attention to those reporting SSI. Methods: The sample included 529 participants, from an ongoing cohort of 757 PWID. An “ever” SSI variable was created for participants who reported sexual intercourse with a same-sex partner at any longitudinal interview. We explored the adjusted associations between SSI and lifetime intentional overdose using logistic regression. Results: Ninety-one (17%) participants reported ever experiencing an intentional overdose. Forty-one (8%) participants reported SSI at any interview. Three hundred and sixty (68%) participants reported diagnosis of a mental health condition. Diagnosis of a mental health condition (AOR = 2.02, 95% CIs: 1.14, 3.59) and SSI (AOR = 2.58, 95% CIs: 1.22, 5.48) significantly increased the odds of lifetime intentional overdose. Conclusions/Importance: We found a heightened risk of intentional overdose amongst PWID reporting SSI, after controlling for diagnosis of a mental health condition. Services need to be aware of this heightened risk and target interventions appropriately. [ABSTRACT FROM AUTHOR]

Background: Although people who inject drugs (PWID) have been described as frequent users of emergency services, the majority of research is cross-sectional and involves records from a single emergency department (ED). Objectives: We describe characteristics of state-wide ED presentations in a cohort of PWID, and compare presentation rates to the general population. We also examine characteristics associated with frequent ED use. Methods: We used data from a retrospective linkage of public ED presentations from a cohort of 678 PWID between January 2008 and June 2013. Common principal diagnoses were described using the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) chapter headings. The ED presentation trend was estimated using negative-binomial regression. Characteristics associated with frequent use of EDs were identified using generalized estimating equations (GEEs). Results: There were 3437 presentations over 4163.5 person-years (PY) and the most common principal diagnosis was injury, poisoning and other externalities (19%). ED presentations increased by 4% every six months (95% confidence interval (CI) 0.1%-0.8%) and were three times greater than the general population. A quarter (24%) of the cohort presented frequently, and they were more likely to have noninjury-related diagnoses and be aged below 30 years, and less likely to have nonurgent presentations and be male. Conclusions: PWID use EDs at a higher rate than the general population, and typically present with injuries and mental and behavioral disorders. Referrals to drug treatment, mental health, and social support services can improve patient care and reduce the burden on EDs. [ABSTRACT FROM AUTHOR]

Background: Clinical studies of alcohol and drug treatment outcomes frequently apply participant eligibility criteria (EC), which may exclude real-world treatment seekers, impairing the representativeness of studied samples. Some research exists on the impact of EC on alcohol treatment seekers. Little is known about drug treatment and country differences. Objectives: We tested and compared the degree to which commonly used EC exclude real-world treatment seekers with problem alcohol and drug use in Sweden and Australia, and compared the impact of EC on outcomes. Methods: Two large naturalistic and comparative service user samples were used. Respondents were recruited in Stockholm County (n = 1,865; data collection 2000–2002), and Victoria and Western Australia (n = 796; in 2012–2013). Follow-up interviews were conducted after 1 year. Cross-tabulations, Chi-square (χ2) tests and logistic regressions were used. Results: Percentages of the samples excluded by individual EC ranged from 5% (lack of education/literacy) to 70% (social instability) among Swedish alcohol cases and from 2% (low alcohol problem severity) to 69% (psychiatric medication) among Australian counterparts; and from 2% (age 60+ years) to 82% (social instability) among Swedish drug cases and from 1% (age 60+ years) to 67% (psychiatric medication) among Australian counterparts. Country differences and differences across substances appeared independent of country effect. Co-morbid psychiatric medication, noncompliance, poly drug use, and low education EC caused positive 1-year outcome bias; whereas female sex and old age introduced negative outcome bias. Conclusions/Importance: Commonly used EC exclude large proportions of treatment seekers. This may impair generalizability of clinical research, and the effects of many EC differ by country and drug type. [ABSTRACT FROM AUTHOR]

Background: 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. Objectives: To investigate the correlates of drugs used in the Australian NTE relating to demographics, alcohol use, and experience of harm. Methods: 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. Results: Ecstasy was most commonly reported (4.0%), followed by cannabis (2.9%), methamphetamine (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. Methamphetamine 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. [ABSTRACT FROM AUTHOR]

Background: Tobacco use and heavy alcohol consumption occur more frequently in socioeconomically disadvantaged groups. Little is known about the sociodemographic and psychosocial factors associated with use of alcohol and tobacco in disadvantaged groups in comparison to low-risk users. Objectives: This study aimed to compare the characteristics of low-risk users with: disadvantaged smokers only; disadvantaged heavy drinkers only; and disadvantaged concurrent smokers and heavy drinkers. Methods: A cross-sectional survey of socioeconomically disadvantaged adult clients attending a community welfare agency assessed tobacco use, alcohol use, demographic, and psychosocial variables. Multivariable analysis using multinomial logistic regression was carried out. Results: The sample consisted of 835 participants; 40% (n = 331) were concurrent users, 31% were smokers only (n = 252), 11% were heavy drinkers only (n = 93), and 18% were low-risk users (n = 149). Compared with those who neither smoked nor consumed alcohol heavily, concurrent users were more likely to be younger, have only some contact with family, have more friends and family who were smokers, have no fixed home address, live alone, and have higher levels of financial stress. Most of these factors were shared by individuals who were smokers only. Factors associated with heavy drinkers only were frequent contact with family and having more friends and family who were smokers. Conclusion: Among those Australians who suffer severe economic hardship, being a concurrent smoker and heavy drinker appears to be associated with more isolated living conditions and financial stress but some contact with family. [ABSTRACT FROM AUTHOR]

Background: People who inject drugs (PWID) are a key population engaging in pharmaceutical opioid analgesic (PO) use, yet little is known about patterns of illicit PO use among this group. Objectives: The aims of this research were to measure the prevalence and frequency of lifetime and past-month illicit PO use and injection in a sample of regular PWID, to examine patterns of past-month illicit PO use within individuals over time, and to identify factors independently associated with past-month illicit PO use. Methods: Data were drawn from a prospective cohort study of regular PWID (N = 666) in Melbourne, Australia. Data from five waves of annual data collection (including baseline) were analyzed descriptively and using generalized estimating equations (GEE). Results: At baseline, 59% of participants reported lifetime illicit PO use and 20% reported past-month use, predominantly through injecting. Most illicit PO users at baseline transitioned to nonuse of illicit POs across the study period. In multivariable GEE analysis, factors associated with past-month illicit PO use included past-year arrest [adjusted odds ratio (AOR): 1.39], opioids other than heroin as drug of choice (AOR: 5.14), experiencing poorer physical health (AOR: 0.98) and a range of other drug use variables. Conclusions: We found little evidence of ongoing illicit PO use among those followed up, with illicit PO use linked to polydrug use more broadly. Nonetheless, trends in illicit PO use among PWID should continue to be monitored and harm reduction interventions implemented to reduce the associated public health risks. [ABSTRACT FROM AUTHOR]

Objectives: The current study had two aims. First, to develop a moral disengagement scale contextualized to underage drinking. Second, to investigate Bandura's (1986) self-regulatory model within the context of underage drinking. Method: Two different samples of students participated in the study. The first sample included 619 (362 females) adolescents (Mage = 15.3 years, SD = 1.09 years) and the second sample 636 (386 females) adolescents (Mage = 15.3 years, SD = 1.03 years). Students in the first sample completed the Underage Drinking Disengagement Scale (UDDS), and measures of engagement in underage drinking and heavy episodic drinking. Students in the second sample completed these measures as well as scales of general moral disengagement, personal standards, and anticipatory guilt associated with underage drinking. Results: For the UDDS, exploratory and confirmatory factor analyses verified a single factor structure. The UDDS was more strongly associated with engagement in underage drinking and heavy episodic drinking than a general measure of moral disengagement. A moderated mediation analysis revealed that adolescents who negatively evaluated underage drinking reported more anticipatory guilt, and more anticipatory guilt was associated with less engagement in underage drinking and less heavy episodic drinking. This relationship was weaker at high compared to low levels of underage drinking disengagement. Conclusions/Importance: Understanding how adolescents self-regulate their drinking, and ways that such self-regulation may be deactivated or disengaged, may help identify those adolescents at increased risk of drinking underage and of engaging in heavy episodic drinking. [ABSTRACT FROM AUTHOR]

Background: Both Reinforcement Sensitivity Theory and Social Cognitive Theory have been applied to understanding drinking behavior. We propose that theoretical relationships between these models support an integrated approach to understanding alcohol use and misuse. Objectives: We aimed to test an integrated model in which the relationships between reward sensitivity and drinking behavior (alcohol consumption, alcohol-related problems, and symptoms of dependence) were mediated by alcohol expectancies and drinking refusal self-efficacy. Methods: Online questionnaires assessing the constructs of interest were completed by 443 Australian adults (M age = 26.40, sd = 1.83) in 2013 and 2014. Results: Path analysis revealed both direct and indirect effects and implicated two pathways to drinking behavior with differential outcomes. Drinking refusal self-efficacy both in social situations and for emotional relief was related to alcohol consumption. Sensitivity to reward was associated with alcohol-related problems, but operated through expectations of increased confidence and personal belief in the ability to limit drinking in social situations. Conversely, sensitivity to punishment operated through negative expectancies and drinking refusal self-efficacy for emotional relief to predict symptoms of dependence. Conclusions: Two pathways relating reward sensitivity, alcohol expectancies, and drinking refusal self-efficacy may underlie social and dependent drinking, which has implications for development of intervention to limit harmful drinking. [ABSTRACT FROM AUTHOR]

Background: Alcohol disproportionately affects socially disadvantaged groups including Aboriginal and Torres Strait Islander Australians. Methods to assess alcohol intake for disadvantaged communities need to be able to capture variable or episodic drinking. The ability of a seven-day diary to capture typical consumption for a predominantly Aboriginal sample has not been assessed. Objective: One aim of this paper was to examine agreement between a seven-day retrospective diary and 'usual' drinking assessed by a modified version of the Alcohol Use Disorders Identification Test question 3 (AUDIT-3m; two questions). Other aims were to describe drinking patterns as reported in the seven-day diary. Method: In 2012, consecutive adults attending an Aboriginal Community Controlled Health Service completed a cross-sectional health risk survey on a touch screen laptop ( n = 188). Alcohol consumption questions included the retrospective diary and AUDIT-3m. Agreement was assessed using weighted kappa analysis. Results: There was good agreement between the two measures of consumption; however, the AUDIT-3m questions identified more current drinkers. Respondents who were drinkers (54%) tended to consume large amounts per drinking occasion: almost half (46%) of diary completers reported nine or more standard drinks on at least one occasion in the last week. Conclusions: The seven-day diary did not adequately capture variability in alcohol consumption common among this sample. Although the AUDIT-3m appeared acceptable, alternative approaches to assess usual or risky alcohol consumption, such as asking about specific drinking occasions, or allowing participants to respond in non-standard drink sizes, also need to be considered for indigenous and other disadvantaged communities. [ABSTRACT FROM AUTHOR]

Body mass index (BMI) of a sample of people who regularly inject drugs ( N = 781) was examined to gauge the impact of specific types of drug use. Cross-sectional interviews were undertaken in 2010 as part of a national monitoring program funded by the Australian Government. Latent class analysis identified three groups of drug users, with heroin users at 3.4 times the risk of being underweight compared with amphetamine users, and amphetamine users were at almost twice the odds of being obese compared with lower level morphine users. Nutrition should play a part in harm minimization. [ABSTRACT FROM AUTHOR]

We examine psychological distress (PD) in young adult Ecstasy users in relation to age of initiation and frequency of use of Ecstasy, cannabis, alcohol, and tobacco. Using two Australian community samples, we assess whether different sampling methods produce comparable estimates of these associations. The Natural History Study of Drug Use (NHSDU; N = 339) in 2009 used population sampling and the 2009 Ecstasy and Related Drug Reporting System (EDRS; N = 359) used purposive sampling. Participants, aged 19-23 years, were recurrent Ecstasy users. PD was assessed using Kessler 10 in the EDRS and Hospital Anxiety Depression Scale in the NHSDU. In both samples, PD was associated with daily tobacco use and early drug initiation, but not frequent Ecstasy use. One-third smoke tobacco daily. Study limitations and implications are noted. [ABSTRACT FROM AUTHOR]

This study used the Resilient Families baseline survey to examine associations between the connectedness of parents within the school and parents' rules regarding their children's use of alcohol, prior participation in parenting education, and parents' demographic characteristics. The study involved parents of Year 7 students (mean age 12 years) at secondary schools in Melbourne, Australia ( N = 1,238; 2004). Most parents (54%) had no connections with parents of other children in their child's school year. Allowing children to have sips of alcohol or drinks on special occasions was reported by 23% and 6% of parents, respectively, but neither was significantly associated with parental connectedness. [ABSTRACT FROM AUTHOR]

Visitors to a popular online drug forum completed an online survey between November 2011 and January 2012, which covered (1) demographic characteristics, (2) substance use (including nonmedical prescription opioid use), (3) forum activity, and (4) harm reduction beliefs. The study sample ( N = 897) primarily included Caucasian males in their twenties from the United States, the United Kingdom, Australia, and Canada. The practice of harm reduction was overwhelmingly endorsed by participants. Current nonmedical prescription opioid users reported more activity in forums and past substance abuse treatment. The study's implications and limitations are noted and future research is suggested. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]