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This work applies propensity score matching to assess the impact of methamphetamine on mental health. Using Australian microdata from the 2013 National Drug Strategy Household Survey, Kessler scores of recent and non-recent methamphetamine users are analysed after controlling for confounding variables. The results support the decision to prepare frontline emergency service workers for the psychological issues present in those consuming methamphetamine. The results also highlight the importance for policy makers to develop effective harm reduction programmes. An estimate of the mental health costs associated with methamphetamine abuse is also presented, the findings of which strongly support additional government spending on harm reduction. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Methamphetamine (MA) use has increased markedly over the past decade, during which time there has been an increase in children in out of home care. This study explores whether MA use in parents attending residential treatment services for substance use issues is associated with higher proportions of children living out of the home.Design and Methods: Data were collected from individuals attending residential treatment centres provided by the Australian Salvation Army between 2009 and 2016. Centres provide residential alcohol and other substance use treatment in a modified therapeutic community. Trained staff administered sections of the Addiction Severity Index measuring substance use, legal and parenting status, and the Mental Health Screening Form-III at intake. Data were limited to those who had at least one child under 18 years; final sample size was 2964.Results: Of the 2964 parents, 36.3% nominated MAs use as a primary or secondary substance of use. Between 2011 and 2016, a significantly greater proportion of parents using MAs (86.1%), had at least one child not living at home compared to those using other substances (81.3%; χ2 =7.95, P = 0.005). The proportion of female parents increased significantly 14.7% (2009) to 37.9% (2016; χ2 = 51.54, P < 0.001). Also, more males (83.7%) than females (79.6%) had a child living out of home (χ2 = 11.23, P = 0.01).Discussion and Conclusions: Given that MA use can result in increased risks of violence and neglect the increase in parents using the substance is concerning. The growing number of mothers in treatment warrants further investigation, particularly as women face inherent difficulties in seeking treatment with dependent children. [ABSTRACT FROM AUTHOR]

Much research concerning drug use in the context of sexual activity among gay and bisexual men derives from public health scholarship. In this paper, we critically examine how the relationship between methamphetamine use and sexual risk practice is treated and understood in this body of research. While public health has made important contributions to establishing the link between methamphetamine use and sexual risk-taking, the precise nature of the relationship is not well defined. This creates space for ungrounded assumptions about methamphetamine use to take hold. We outline what appear to be two dominant interpretations of the methamphetamine/sexual practice relationship: the first proposes that methamphetamine has specific pharmacological properties which lead to sexual disinhibition, risky behaviour and poor health outcomes; the second proposes that methamphetamine attracts men who are already inclined toward highly sexualised interactions and risky practice, and that such men are likely to engage in these practices with or without drugs. We suggest that both interpretations are problematic in that they individualise and cast drug and sex practices as inherently risky and biopsychologically determined. We outline a more historically, socially and politically engaged way to understand methamphetamine use in the context of sexual activity by drawing on the concept of sex-based sociality and the ways in which gay and bisexual men may use methamphetamine and sex as social resources around which to build identities, establish relationships, participate in gay communities, and maximise pleasure while protecting themselves and others from harm. [ABSTRACT FROM AUTHOR]

Abstract: The study aimed to determine the clinical characteristics of fatal methamphetamine‐related stroke in Australia, 2009–2015. There were 38 cases, 60.5% male, with a mean age of 40.3 years. In no case was there evidence that this was the first time methamphetamine had been used by the decedent, and 52.6% had known histories of injecting drug use. The stroke was hemorrhagic in 37 of 38 cases. In 21.1% of cases, the stroke was purely parenchymal and, in 18.4%, involved purely the subarachnoid space. A ruptured berry aneurysm was present in 31.6% and in 68.8% of initial subarachnoid hemorrhages. There was evidence of systemic hypertension in 8 of 25 cases in which full autopsy findings were available. With increased use of methamphetamine, there is a high probability of increased hemorrhagic stroke incidence among young people. In cases of fatal hemorrhagic stroke among young cases presenting to autopsy, the possibility of methamphetamine use should be borne in mind. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Methamphetamine dependence is associated with heightened impulsivity and diminished quality of life, but the link between impulsivity and changes in quality of life during treatment has not been examined. We aimed to investigate how different elements of impulsivity predict change in quality of life in the 6 weeks after engaging in treatment. Design: Longitudinal, observational cohort study. Setting: Public and private detoxification and rehabilitation facilities in metropolitan Melbourne, Australia. Participants: One hundred and eight individuals with methamphetamine dependence (81 male) tested within 3 weeks of commencing treatment; 80 (74%) were followed‐up at 6 weeks. Measurements: The Continuous Performance Test‐2 measured impulsive action (cognitive and motor impulsivity); the Delay Discounting Task measured impulsive choice. Quality of life was measured with the World Health Organization Quality of Life Scale—Brief, which includes social, psychological, physical and environment domains. Control variables included age, gender, estimated IQ, depression severity score, methamphetamine dependence severity score, cannabis dependence severity score and treatment modality. Findings: We found that all three forms of impulsivity were significant predictors of change in the social domain: motor impulsivity (β = −0.54, P = 0.013), cognitive impulsivity (β = −0.46, P = 0.029) and impulsive choice (β = −0.26, P = 0.019). Change in the psychological domain was predicted significantly by motor impulsivity (β = −0.45, P = 0.046). Control variables of age and depression were associated significantly with changes in the physical domain. Conclusions: In Australian methamphetamine‐dependent individuals, elevated impulsivity predicts lower improvement of social and psychological quality of life in the first 6–9 weeks of treatment. [ABSTRACT FROM AUTHOR]

Aims To (1) assess trends in the number and mortality rates of methamphetamine-related death in Australia, 2009-15; (2) assess the characteristics and the cause, manner and circumstances of death; and (3) assess the blood methamphetamine concentrations and the presence of other drugs in methamphetamine-related death. Design Analysis of cases of methamphetamine-related death retrieved from the National Coronial Information System (NCIS). Setting Australia. Cases All cases in which methamphetamine was coded in the NCIS database as a mechanism contributing to death ( n = 1649). Measurements Information was collected on cause and manner of death, demographics, location, circumstances of death and toxicology. Findings The mean age of cases was 36.9 years, and 78.4% were male. The crude mortality rate was 1.03 per 100 000. The rate increased significantly over time ( P < 0.001), and at 2015 the mortality rate was 1.8 [confidence interval (CI) = 1.2-2.4] times that of 2009. Deaths were due to accidental drug toxicity (43.2%), natural disease (22.3%), suicide (18.2%), other accident (14.9%) and homicide (1.5%). In 40.8% of cases, death occurred outside the major capital cities. The median blood methamphetamine concentration was 0.17 mg/l, and cases in which only methamphetamine was detected had higher concentrations than other cases (0.30 versus 0.15 mg/l, P < 0.001). The median blood methamphetamine concentration varied within a narrow range (0.15-0.20 mg/l) across manner of death. In the majority (82.8%) of cases, substances other than methamphetamine were detected, most frequently opioids (43.1%) and hypnosedatives (38.0%). Conclusions Methamphetamine death rates doubled in Australia from 2009 to 2015. While toxicity was the most frequent cause, natural disease, suicide and accident comprised more than half of deaths. [ABSTRACT FROM AUTHOR]

Aim To examine the efficacy and safety of (1) midazolam-droperidol versus droperidol and (2) midazolam-droperidol versus olanzapine for methamphetamine-related acute agitation. Design and setting A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015. Participants Three hundred and sixty-one patients, aged 18-65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients. Intervention and comparator Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg-droperidol 5 mg combined, droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg or olanzapine 5 mg, respectively. Measurements The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated. Findings The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam-droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02-21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74-19.33]. The number of patients who experienced an adverse event (AE) in the midazolam-droperidol, droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation. Conclusion A midazolam-droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than droperidol or olanzapine alone. [ABSTRACT FROM AUTHOR]

Introduction: Illicit stimulants are often combined with alcohol in nightlife entertainment districts, an environment where aggressive behaviour commonly occurs. While alcohol and methamphetamine use are each associated with aggressive behaviour, relatively little is known about the impact of the combined use of alcohol and amphetamine-type stimulants (i.e., ecstasy [MDMA] and methamphetamine) on aggression.Method: Analysis of longitudinal data from a population-based sample of Australian young adult amphetamine-type stimulant users (n=248) to examine: (a) prevalence and timing of simultaneous alcohol and amphetamine-type stimulant use and (b) predictors of ecstasy- and methamphetamine-related aggression and hostility. Prediction models of ecstasy- and methamphetamine-related aggression and hostility were developed using multivariate logistic regression.Results: Simultaneous alcohol consumption and amphetamine-type stimulant use was prevalent, with drinking generally occurring before consuming amphetamine-type stimulants and while 'high'. Methamphetamine-related aggression and hostility was significantly associated with recurrent risky simultaneous methamphetamine and alcohol use (Adjusted Odds Ratio [AOR] 2.74, 95% CI 1.09-6.89), a high frequency and increasing use methamphetamine trajectory (AOR 7.23, 95% CI 1.27-41.03), and high trait aggression (AOR 5.78, 95% CI 2.53-13.20). In contrast, only trait aggression (moderate: AOR 3.01, 95% CI 1.55-5.84; high: AOR 5.02, 95% CI 2.38-10.61) was associated with ecstasy-related aggression and hostility.Conclusions: These findings indicate a link between risky patterns of simultaneous alcohol and methamphetamine use and methamphetamine-related aggression and hostility, independent of separate use of alcohol, methamphetamine and cannabis, trait aggression, psychosis, and gender. The policy challenges of amphetamine-type stimulant and alcohol use require a targeted, multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Methamphetamine dependence is a growing problem in Australia and globally. Currently, there are no approved pharmacotherapy options for the management of methamphetamine dependence. N-acetylcysteine is one potential pharmacotherapy option. It has received growing attention as a therapy for managing addictions because of its capacity to restore homeostasis to brain glutamate systems disrupted in addiction and thereby reduce craving and the risk of relapse. N-acetylcysteine also has antioxidant properties that protect against methamphetamine-induced toxicity and it may therefore assist in the management of the neuropsychiatric and neurocognitive effects of methamphetamine. This commentary overviews the actions of N-acetylcysteine and evidence for its efficacy in treating addiction with a particular focus on its potential utility for methamphetamine dependence. We conclude that the preliminary evidence indicates a need for full-scale trials to definitively establish whether N-acetylcysteine has a therapeutic benefit and the nature of this benefit, for managing methamphetamine dependence. [McKetin R, Dean O, Baker A. L, Carter G, Turner A, Kelly P. J, Berk M. A potential role for N-acetylcysteine in the management of methamphetamine dependence. Drug Alcohol Rev 2017;36:153-159]. [ABSTRACT FROM AUTHOR]

Wastewater analysis, or wastewater-based epidemiology, has become a common tool to monitor trends of illicit drug consumption around the world. In this study, we examined trends in cocaine, 3,4-methylenedioxymethamphetamine (MDMA) and methamphetamine consumption by measuring their residues in wastewater from two wastewater treatment plants in Australia (specifically, an urban and a rural catchment, both in South East Queensland) between 2009 and 2015. With direct injection of the samples, target analytes were identified and quantified using liquid chromatography-mass spectrometry. Cocaine and MDMA residues and metabolites were mainly quantifiable in the urban catchment while methamphetamine residues were consistently detected in both urban and rural catchments. There was no consistent trend in the population normalised mass loads observed for cocaine and MDMA at the urban site between 2009 and 2015. In contrast, there was a five-fold increase in methamphetamine consumption over this period in this catchment. For methamphetamine consumption, the rural area showed a very similar trend as the urban catchment starting at a lower baseline. The observed increase in per capita loads of methamphetamine via wastewater analysis over the past six years in South East Queensland provides objective evidence for increased methamphetamine consumption in the Australian population while the use of other illicit stimulants remained relatively stable. [ABSTRACT FROM AUTHOR]

Increasingly, governments and police agencies require evidence of effectiveness and efficiency with respect to law enforcement policies. The existing “what works” literature, specifically on drug law enforcement, focuses mainly on the effectiveness question when making complex choices between drug policy alternatives, but fails when it comes to incorporating empirical evidence and the experience of key experts in the decision-making process. In addition, little attempt has been made to employ sophisticated techniques to assist in complex policy decision making with respect to funding competing policing policy alternatives. We use the methamphetamine problem in Australia to illustrate a way of evaluating, using multi-criteria analysis, alternative policy options for developing better drug policy. [ABSTRACT FROM PUBLISHER]

Abstract: Encouraging out-of-treatment methamphetamine users who engage in problematic use patterns to initiate access of drug treatment and other health and support services is a key focus of drug policy. We followed a community-recruited cohort (N =255) of regular methamphetamine users in Melbourne, Australia, to investigate patterns of engagement with professional support for methamphetamine use and/or associated harms over 12months. Multivariate logistic regression identified factors independently associated with initiating contact with services during follow-up. Generalised estimating equations identified factors associated with current (at the time of interview) service access. General practitioners were the most common source of professional support during follow-up (24%). Overall, service utilisation was associated with riskier methamphetamine use patterns (e.g., injecting), professional support access for other issues (e.g., mental health), and greater experience of methamphetamine-related harms (e.g., adverse social consequences). These findings provide insights to inform strategies that will improve treatment initiation and retention by methamphetamine users. [Copyright &y& Elsevier]

Introduction and Aims. The purpose of this study was to document treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program (STP) in Australia. Design and Methods. Clients attending the STP for methamphetamine use (n = 105) were assessed on entry to the service and at 3 (n = 86) and 6 months (n = 83) after starting treatment. At each interview methamphetamine use (days of use, severity of dependence), other drug use and health and social functioning (HIV risk behaviour, crime, disability, psychotic symptoms and hostility) were assessed for the past month. Results. Participants received a median of six counselling sessions (interquartile range 1-11) over a period of 89 days (interquartile range 41-148 days). Past month methamphetamine use fell from 79% at treatment entry to 53% at the 3-month follow-up (P < 0.001) and 55% at the 6-month follow-up (P < 0.001). There were statistically significant reductions in psychotic symptoms, hostility and disability associated with poor mental health. There was no change in other drug use, crime or HIV risk behaviour. Reductions in methamphetamine were more common among younger participants, those who had no history of drug treatment and those without concurrent heroin use. Discussion and Conclusions. Methamphetamine users entering the STP showed reductions in methamphetamine use and improvements in their mental health after treatment. Improved treatment responses are needed to address polydrug use and other harms within in this population.[McKetin R, Dunlop AJ, Holland RM, Sutherland RA, Baker AL, Salmon AM, Hudson SL. Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia. Drug Alcohol Rev 2013;32:80-87] [ABSTRACT FROM AUTHOR]

Issues. Treatment seeking for methamphetamine withdrawal is low in Australia. Insufficient knowledge regarding the withdrawal syndrome of methamphetamine and the appropriate management of these symptoms may be a contributing factor to the low treatment attendance. Approach. A systematic review was performed using a range of electronic databases. Key Findings. Common methamphetamine withdrawal symptoms include symptoms relating to depression, agitation, cognitive impairment and fatigue. These symptoms may last anywhere from a few days to a few months. Methamphetamine withdrawal is most commonly undertaken in an outpatient setting, and psychosocial interventions remain the primary treatment approach in Australia. Two withdrawal scales (Amphetamine Withdrawal Questionnaire and Amphetamine Cessation Symptom Assessment) have been validated for the assessment of methamphetamine withdrawal. Only a small number of medications for methamphetamine withdrawal have been investigated, and to date no medications stand out over the others. Implications. Current recommendations for methamphetamine withdrawal tend to be based on clinical opinion and subsequently vary between settings. More research in the area is essential to ensure the development of more targeted, timely and effective withdrawal treatment interventions. Conclusion. The review exposed a lack of well-conducted research targeted towards the management of methamphetamine withdrawal. Further research is essential, and should focus on understanding the nature of methamphetamine withdrawal, its duration, course and effective treatment.[Pennay AE, Lee NK. Putting the call out for more research: The poor evidence base for treating methamphetamine withdrawal. Drug Alcohol Rev 2010] [ABSTRACT FROM AUTHOR]

Background: Australia has one of the highest rates of methamphetamine use in the world; however, treatment access for methamphetamine is comparatively low. This descriptive study aimed to identify patterns of treatment utilization and perceived barriers to accessing treatment among dependent methamphetamine users in the hope that such information will enable services to more appropriately respond to this group. Methods: One hundred and twenty-six methamphetamine users who had a current or past history of methamphetamine dependence were interviewed about their experiences of, and perceived barriers to, treatment. Results: Treatment utilization among methamphetamine users was reportedly low. One of the main reasons cited for not accessing treatment was that methamphetamine users did not perceive their drug use to be a problem (despite apparent levels of dependence). Self-detoxification with the use of other licit and illicit drugs was high among this group. Participants identified a lack of confidence in the ability of treatment services to address methamphetamine dependence and the 'opiate-centric' nature of treatment services as significant blocks to treatment entry. Suggestions for improvement by participants included operating specialist services for methamphetamine users, placing an emphasis on responsiveness and routinely involving case management services for this group. Discussion and Conclusions: To improve service delivery, treatment services should reorient their services to better address the needs of methamphetamine users by making small changes such as specific opening times for methamphetamine users or using a dedicated space for methamphetamine treatment. Alternative options such as online treatments and specialist methamphetamine clinics should be considered for methamphetamine users. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Despite the high prevalence of methamphetamine use and dependence in Australia, withdrawal treatment access for methamphetamine accounts for only 9.3% of total withdrawal treatment presentations. Furthermore, treatment completion for methamphetamine users is one of the lowest of all drugs. There is not a clear understanding for the reasons why methamphetamine withdrawal treatment presentations and efficacy is so low. This study examined the current practices and barriers to methamphetamine withdrawal treatment in Australia. Design and Methods. Twenty-four interviews were conducted with employees from alcohol and other drug services from around Australia. These services were questioned about a range of issues relating to methamphetamine withdrawal treatment including current treatment practices, perception of the effectiveness of current treatment and barriers to treatment. Results. The study found that current practices in the treatment of methamphetamine withdrawal are diverse and uncertain. Service providers identified a great number of barriers to the treatment of methamphetamine withdrawal that encompass personal, social, cultural and organisational barriers. Discussion and Conclusions. The results of this study suggest that alcohol and other drug service providers are not clear about the best way to respond to clients seeking methamphetamine withdrawal treatment. Furthermore, the study showed a general pessimism about withdrawal treatment for this group. Treatment services should consider improving withdrawal protocols, educating clinicians and reconsidering entry criteria to better respond to methamphetamine users who have made the important first step into withdrawal treatment.[Pennay AE, Lee NK. Barriers to methamphetamine withdrawal treatment in Australia: Findings from a survey of AOD service providers. Drug Alcohol Rev 2009] [ABSTRACT FROM AUTHOR]

Gay men's use of methamphetamine has aroused great anxiety. In some countries such as the USA and Australia as many as 40% of gay men use this drug, while use is lower in others such as the UK. However, across all these countries gay men's use of other substances such as alcohol, poppers and cannabis surpasses that of methamphetamine. Recent evidence from case-crossover studies suggests that use of not only methamphetamine but also of alcohol, cannabis, poppers, cocaine, amphetamines and Viagra is associated with increased risk behaviour during episodes of anal intercourse. However national drugs and alcohol strategies do not refer to gay men, drug treatment services tend to focus on opiates and do not target gay men, and HIV prevention for gay men rarely mentions use of substances other than methamphetamine. This is a missed opportunity given the evidence for the effectiveness or drug treatment and prevention interventions, and evidence that such interventions can be tailored to gay clients. [ABSTRACT FROM AUTHOR]

The article reports on results of a study of the representativeness of Australia's annual Needle and Syringe Program (NSP) Survey which forms the basis of HIV surveillance among injecting drug users (IDU). A description of the study design and methods is presented. The study showed that methamphetamine injectors were more likely to complete the survey as were those who had last injected an opioid maintenance pharmacotherapy or morphine.

The article explores whether there is substantial evidence-base for methamphetamine production, distribution and use in Australia. Methamphetamine production and use have been increasing in Australia, making it one of the most problematic drugs in the country. The author points that Australia has contributed significantly to the evidence-base for methamphetamine responses.

Factors associated with relapse to problematic alcohol or illicit drug use were examined in 104 clients enrolled in treatment programmes for substance disorders. Participants were assessed by retrospective self‐report questionnaires to explore the roles of family dysfunction, mood states, primary drug of dependence, demographic variables and various other factors in relation to relapse episodes. Consistent with previous studies, the most commonly cited reason for relapse was negative mood states, followed by external pressure to use, desire for positive mood states, and social/family problems. Reasons for relapse did not differ between clients whose primary drug of dependence was heroin, methamphetamine, or alcohol. Methamphetamine abusers and participants in the drug court programme had the fewest relapses. Co‐morbid psychological disorders were most commonly diagnosed in the alcoholic group, followed by the methamphetamine group and the heroin group. General family functioning retrospectively improved from time of last relapse to time of testing. Results are consistent with previous work and suggest that relapse factors are remarkably similar across different types of drug dependence. [ABSTRACT FROM AUTHOR]

Comments on the increasing concern in Europe, North America, and Australia about the rates of recreational methamphetamine use in the gay community. Introduction of methamphetamine-oriented HIV education programs in the United States; Psychological explanations of methamphetamine use and risky sex; Drug use among gay men.

Background: Crystal methamphetamine attracts an elevated level of negative attention in Australia and internationally, however there is a paucity of research into stigma and discrimination surrounding this drug. This study aimed to investigate and compare levels of public stigma, self-stigma and discrimination surrounding crystal methamphetamine use in a large sample of Australian residents.Methods: A cross-sectional online survey, open to all Australian residents aged 18 years and over, was conducted from November 2018 to March 2019 examining stigmatising attitudes towards people who use crystal methamphetamine. Respondents also reported any personal history of crystal methamphetamine use and experiences of discrimination. Multiple linear regression examined whether prior crystal methamphetamine use was associated with holding stigmatising attitudes. Covariates included in the analysis were presence of a family member or friend who uses crystal methamphetamine, knowledge about crystal methamphetamine, gender, age and region.Results: A total of 2108 Australian participants completed the study (mean age = 36.3 years; 59% females; 27% had used crystal methamphetamine). Many participants reported being discriminated against because of their crystal methamphetamine use. Stigmatising attitudes were prevalent, particularly among those who hadn't used crystal methamphetamine (p<.001). Others more likely to endorse stigmatising attitudes included females (p=.004 vs. males), individuals with less knowledge about crystal methamphetamine (p<.001) and those living in regional (p<.001) and rural/remote locations (p<.001) compared to metropolitan areas.Conclusion: Stigma and discrimination surrounding crystal methamphetamine use was common in this sample of Australian residents, with public stigma more prevalent than self-stigma. This highlights a need for stigma reduction initiatives. Given higher levels of knowledge were associated with less stigmatising attitudes, public education campaigns providing accurate, evidence-based information about crystal methamphetamine along with guidelines and support for accurate media reporting, present promising approaches to stigma reduction. Exploration of other stigma reduction initiatives is also vital to ensuring people who use crystal methamphetamine feel supported in seeking help. [ABSTRACT FROM AUTHOR]

In Australia, the crystalline form of methamphetamine ("crystal") is a commonly used illicit substance associated with sexual activity among gay and bisexual men. Attention to psychoactive substance use among this population is the subject of increasing global concern regarding the intentional and simultaneous combination of sex and drugs, often referred to as "chemsex". While not all gay and bisexual men who use psychoactive substances report problematic use, those who do often become representative of chemsex practices more generally, and the harms they experience become attributable to all men who use drugs for sex. The way in which these practices have been framed over the past few decades contributes to the rise of a narrow set of understandings of chemsex defined by the circumstances and behaviours presumed of drug-enhanced sexual activity. In effect, these understandings now align recognisable combinations of sexual and drug-using practices with assumed correlates of risk. The Crystal, Pleasures and Sex between Men study conducted 88 interviews with gay and bisexual men in four Australian cities between 2017 and 2018. Findings from the project revealed that men used crystal in a variety of settings and relations, which mediated their sexual practices and patterns of use. In looking at the wider context in which practices were associated with the combination of sex and drugs, we identified experiences that the contemporary discourse of chemsex-in its rhetorical proposition of at-risk behaviours and circumstances-may leave out of consideration. Our findings indicate that researchers should remain open to the variability and contingency of settings, relations and practices in gay and bisexual men's different networks when recommending public health responses to their engagement in drug-enhanced sexual activity. Accordingly, we seek to destabilise the definition of chemsex that precludes consideration of the influence of experiences beyond pre-determined risk parameters. [ABSTRACT FROM AUTHOR]

The article discusses the author's views about why more attention needs to be directed towards methamphetamine-related deaths, and it mentions the article "Rates, Characteristics and Circumstances of Methamphetamine-related Death in Australia: A National 7-year Study" by S. Darke and others which appears in the same issue of the journal. The acute toxic effects of methamphetamine use are examined, along with disease burden and cardiovascular disease risks.

A review of the article "Rates, Characteristics and Circumstances of Methamphetamine-related Death in Australia: A National 7-year Study" by D. Darke, S. Kaye, and J. Duflou, which appears in a 2017 issue of the journal, is presented.

An editorial is presented which addresses the need for an early assertive intervention to treat methamphetamine-related psychosis, and it mentions substance use prevention plans, mental health services, and the public health aspects of methamphetamine use and dependence in places such as Australia and the U.S. Crystal methamphetamine abuse and transient psychotic symptoms are examined, along with drug-induced psychoses and disorders such as schizophrenia.

The article examines methamphetamine residues in wastewater from two Queensland cities to monitor illicit drug use in the population. Using liquid chromatography and mass spectrometry, findings showed that methamphetamine consumption was higher in the metropolitan city than in the regional city while levels in both locations increased significantly between 2009 and 2015. Findings highlights the potential value of wastewater analysis in collecting data on illicit drug use.

The article discusses the need to create an appropriate inter-agency response to address the growing use of crystal methamphetamine or Ice in Australia. Topics discussed include the National Ice Task Force Report on patterns of increasing use of Ice from year 2000, and demographic data on Ice users. Also mentioned is the value of creating strategies to engage the government and social and medical establishments to improve frontline responses related to methamphetamine use.

Abstract: Aim and background. We estimated health service utilisation attributable to methamphetamine use, its national impact and examined other predictors of health service utilisation among dependent methamphetamine users. Method. Past year rates of health service utilisation (number of attendances for general hospitals, psychiatric hospitals, emergency departments, general practitioners, psychiatrists, counsellors or psychologists, and dentists) were estimated for three levels of methamphetamine use (no use, < weekly, ≥ weekly) using panel data from a longitudinal cohort of 484 dependent methamphetamine users from Sydney and Brisbane, Australia. Marginal rates for methamphetamine use were multiplied by 2013 prevalence estimates from the National Drug Strategy Household Survey. Covariates included other substance use, demographics, mental disorders and drug treatment. Findings. Health service use was high. More frequent methamphetamine use was associated with more frequent presentations to emergency departments (incidence rate ratios 1.3–2.1) and psychiatric hospitals (incidence rate ratios 5.3–8.3) and fewer presentations to general practitioners, dentists and counsellors. We estimate methamphetamine use accounted for between 28 400 and 80 900 additional psychiatric hospital admissions and 29 700 and 151 800 additional emergency department presentations in 2013. More frequent presentations to these services were also associated with alcohol and opioid use, comorbid mental health disorders, unemployment, unstable housing, attending drug treatment, low income and lower education. Conclusions. Frequent methamphetamine use has a significant impact on emergency medical and psychiatric services. Better provision of non‐acute health care services to address the multiple health and social needs of dependent methamphetamine users may reduce the burden on these acute care services. [McKetin R, Degenhardt L, Shanahan M, Baker AL, Lee NK, Lubman DI. Health service utilisation attributable to methamphetamine use in Australia: patterns, predictors and national impact. Drug Alcohol Rev 2017;00:000–000] [ABSTRACT FROM AUTHOR]

A response is provided to two additional articles which address the authors' article "Rates, Characteristics and Circumstances of Methamphetamine-related Death in Australia: A National 7-year Study" which appears in the same issue of the journal. Public health research in Australia is examined, along with cardiovascular disease, opioid-related deaths, and the associations between drugs, mortality, and morbidity. Research in methamphetamine users is assessed.

Introduces "Drug and Alcohol Review" magazine's first Asia Pacific column. Australian Prime Minister John Howard's policy announcement concerning the Australian National Council on Drugs; Opening of the University of Adelaide's Collaborating Centre for Research into the Treatment of Drugs and Alcohol Problems; Workshop held in Hanoi, Vietnam on the 'Management of methamphetamine users and opioid dependence in Asia'.