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Introduction and Aims: Cleaning drug injection sites with alcohol swabs prior to injecting reduces risk of abscesses and other skin and soft tissue infections (SSTI). Better understanding of swabbing behaviours can inform interventions to improve injecting hygiene. We aimed to determine the socio-demographic, drug use and injecting risk exposure correlates of swabbing prior to injecting and reasons for not swabbing., Design and Methods: The Illicit Drug Reporting System recruited participants who had injected drugs at least monthly in the past six months in June-July 2017 from all Australian capital cities via needle and syringe programs and word-of-mouth. A structured interview was used to collect information on drug use and related behaviour, as well as swabbing practices. Logistic regression was used to identify factors associated with not swabbing at last injection., Results: Of 853 respondents, one-quarter (26%) reported that they did not swab prior to their last injection. In adjusted analyses, crystal methamphetamine as the last drug injected, past month receptive or distributive syringe sharing, and past month re-use of one's own needle were significantly associated with not swabbing at last injection. Among participants who did not swab at last injection, swabbing was frequently considered unnecessary and a small number disliked using alcohol swabs., Discussion and Conclusions: Efforts are needed to increase awareness of the importance of injecting hygiene in preventing SSTI. Interventions to increase swabbing should be included as part of a wider package of injecting hygiene education, particularly in light of associations with receptive and/or distributive syringe sharing., (© 2019 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Designs: Take-home naloxone (THN) interventions are an effective response to preventing overdose deaths, however uptake across Australia remains limited. This project designed, implemented and evaluated a model of care targeting opioid users attending alcohol and other drug (AOD) treatment, needle and syringe programs (NSP) and related health services targeting people who inject drugs., Design and Methods: Service providers, consumers and regulators collaboratively designed a THN brief intervention (ORTHN, Overdose Response with Take-Home Naloxone) involving client education and supply of naloxone in pre-filled syringes, delivered by nursing, allied health and NSP workers. ORTHN interventions were implemented in over 15 services across New South Wales, Australia. The evaluation included client knowledge, attitudes, substance use and overdose experiences immediately before and 3 months after ORTHN intervention in a subsample of participants., Results: Six hundred and sixteen interventions were delivered, with 145 participants recruited to the research subsample, of whom 95 completed the three-month follow up. Overdose-related attitudes amongst participants improved following ORTHN, with no evidence of increased substance use or failure to implement other 'first responses' (e.g. calling an ambulance). Nine participants (10%) reversed an overdose using THN in the follow-up period. Participants identified a willingness to access THN from a range of services. While a minority (16%) indicated they were unwilling to pay for THN, the median price that participants were willing to pay was $AUD20 (IQR $10.40)., Discussion and Conclusions: The ORTHN model of care for THN appears an effective way to disseminate THN to people who use opioids attending AOD, NSP and related health-care settings., (© 2019 Australasian Professional Society on Alcohol and other Drugs.)

Objectives: Exploration of experience of harms due to another person's drinking within a demographic particularly vulnerable to these consequences. Importance of study: Largest sampling of young Australian risky drinkers, who are underrepresented in general population surveys. The range of harms due to others' drinking reported here is more comprehensive than documented elsewhere., Study Type: Cross-sectional self-report survey., Methods: Participants were 14-19 years old and screened as being within the riskiest-drinking 25% for their age cohort. The convenience sample of 3465 was recruited primarily by social media advertising. Face-to-face interviews were conducted in all eight Australian capital cities (n = 596), supplemented by online surveys (n = 2869). Past 12-month experience of 13 harms due to others' drinking was assessed by age, gender and perpetrator., Results: Females were more likely to experience seven harms, mainly characterised by fear and harassment, including being harassed or bothered at a party or some other private setting (41% vs 34% of males, p < 0.001), being given unwanted sexual attention (71% vs 47%, p < 0.001) and being put in fear (33% vs 20%, p < 0.001). Males were more likely to experience three harms, characterised by aggression: being yelled at, criticised or verbally abused (38% vs 33% of females, p = 0.002), being pushed or shoved (42% vs 28%, p < 0.001) and being physically hurt (17% vs 11%, p < 0.001). Teenagers of a legal alcohol-purchase age were more likely to experience harassment in public settings (49% vs 32-34%, p < 0.001) and unwanted sexual attention (66% vs 51-59%, p < 0.001) compared with younger teenagers. Seven of the harms studied were more likely (p < 0.01) to be perpetrated by people the respondents knew, and five (those associated with fear and aggression) were more likely to be perpetrated by strangers., Conclusion: Young people who are risky drinkers commonly experience multiple harms from others' drinking. Many of these alcohol harms to others are reported here for the first time, as previous studies of adolescent drinking have focused almost exclusively on the harms young people have experienced from their own drinking. This refocusing on the harms caused by the drinking of others may prompt greater community concern and concomitant calls for better alcohol regulation., Competing Interests: None declared.

Introduction: Arguments both for and against the legalization of cannabis often include the issue of youth protection. At the time of writing 5-years after the implementation of the Coloradan recreational cannabis market (CRCM), no statistically significant increase in consumption had been identified. This paper aimed to provide a thick descriptive account of youth prevention objectives stipulated in the pre-implementation phase of the CRCM and compare these with the real-world experience of regulators and other stakeholders involved with market implementation., Methodology and Methods: A qualitative descriptive methodology was used that involved the following methods: document analysis, deductive coding, thematic analysis, and thick description. Two data sets relevant to youth protection in the context of a legal cannabis market in Colorado were examined. Data set 1 (DS1) examined government documents (n = 13) related to the pre-implementation phase from November 2012 - December 2013. Data set 2 (DS2) consisted of semi-structured face-to-face interviews conducted with key stakeholders (n = 32) in 2016 and 2017., Results: Five themes emerged including advertising restrictions (DS1), education (DS1), appropriation of funds (DS2), impact assessment (DS2), and evolving messages in prevention education campaigns (DS2)., Discussion: Multiple lessons for other jurisdictions were highlighted in the study., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Increases in opioid use and related harms such as mortality are occurring in many high income countries. Community pharmacists are often in contact with patients at risk of opioid-related harm and represent an ideal point for intervention. Best practice in monitoring opioid-related outcomes involves assessing analgesia, pain functioning, mood, risks and harms associated with opioid use. Community pharmacists are well-placed to undertake these tasks., Objectives: Our pilot study will test the implementation of a computer-facilitated screening and brief intervention (SBI). The SBI will support pharmacist identification of opioid-related problems and provide capacity for brief intervention including verbal reinforcement of tailored information sheets, supply of naloxone and referral back to the opioid prescriber. The SBI utilises software that embeds study procedures into dispensing workflow and assesses opioid outcomes with domains aligned with a widely accepted clinical framework., Methods: We will recruit and train 75 pharmacists from 25 pharmacies to deliver the Routine Opioid Outcome Monitoring (ROOM) SBI. Pharmacists will complete the SBI with up to 500 patients in total (20 per pharmacy). Data will be collected on pharmacists' knowledge and confidence through pre- and post-intervention online surveys. Data on feasibility, acceptability and implementation outcomes, including naloxone supply, will also be collected., Project Impact: Our study will examine changes in pharmacists' knowledge and confidence to deliver the SBI. Through the implementation pilot, we will establish the feasibility and acceptability of a pharmacist SBI that aims to improve monitoring and clinical management of patients who are prescribed opioids., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: With the growth of legal cannabis markets there has been recognition of the adverse impacts of certain cannabis growing practices, notably, use of harmful chemicals. A major concern has been the use of Plant Growth Regulators (PGRs) which limit plant size and stimulate bud production. These chemicals, many of which have been banned from food crops, have been found unlisted in cannabis growing nutrients sold online or in hydroponic stores. This study describes the cannabis growing practices used by small-scale recreational cannabis growers and specifically their self-reported use of chemicals., Methods: Web survey data from 1722 current and recent cannabis growers in Australia, Denmark, and the UK, who were asked about their cannabis growing practices, including the use of fertilizers and supplements., Results: Overall 44% of the sample reported using any chemical fertilizers, supplements or insecticides. Logistic regression indicated that the unique predictor of the use of chemicals was growing hydroponically., Conclusion: Problems associated with product labeling and uncertainty regarding product constituents made it difficult for growers and the researchers to determine which products likely contained PGRs or other harmful chemicals. There is a need for further research to analyze constituents of chemical products marketed to cannabis growers., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Introduction and Aims: The term 'double dropping' refers to a person consuming two drugs simultaneously, typically two ecstasy pills. This practice has been reported in numerous countries, including Australia; however, the prevalence and correlates of double dropping among ecstasy users is unknown. Double dropping is particularly risky when adulteration of 'ecstasy' with novel substances and higher dosages of MDMA in pure ecstasy pills have both been increasingly reported. This paper investigates the prevalence and correlates of double dropping in a purposive sample of Australian festival-goers who used ecstasy at the last festival they attended., Design and Methods: A web survey was completed by almost 2000 Australian festival-goers. The analytic sample (n = 777) was 59% male and had a median age of 20 years (interquartile range 19-23)., Results: Almost half (48%) of respondents who used ecstasy pills reported double dropping in association with the last festival attended. Multivariable logistic regression found respondents who were younger, male, more frequent ecstasy users, more frequent festival-goers, had a preference for electronic dance music, attended a multi-day festival and used ecstasy in pill form were at greater odds of reporting double dropping at the last festival attended., Discussion and Conclusions: Double dropping was a commonly reported practice among festival-goers in this purposive sample. While this practice may reflect historically low-dose ecstasy pills in Australia, the changing contexts of novel drugs and increasing MDMA purity may warrant consideration of harm-reduction interventions and drug-checking services which could help festival-goers make more informed decisions about drug dosage., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)

Study Objectives: We aimed to explore symptoms of insomnia in a group of youths characterized as engaging in risky drinking, their use of drugs as sleep/ wake aids, and the relationships between alcohol and other drug use and insomnia., Methods: Face-to-face interviews were conducted with 596 Australian 14 to 19-year-olds identified as engaging in regular risky drinking. They completed the Insomnia Severity Index and were assessed for recent alcohol and other drug use, including drugs used specifically as sleep aids or to stay awake. Alcohol-related problems, emotional distress, self-control, and working outside of traditional hours were also assessed using validated scales., Results: More than one-third of the study participants (36%) reported moderate to very severe sleep-onset insomnia, and 39% screened positive for clinical insomnia using adolescent criteria. Three-fourths used drugs in the past 2 weeks to regulate their sleep cycle (65% used stimulants to stay awake, mainly caffeine, and 32% used a depressant to get to sleep, mainly cannabis). Regression analyses showed that after controlling for variables such as sex, emotional distress, self-control, alcohol use problems, and past 6-month illicit or non-prescribed drug use, those who used drugs specifically to get to sleep or to stay awake were 2.0 ( P < .001) and 1.7 ( P = .02) times more likely to report clinical insomnia, respectively., Conclusions: Insomnia was commonly reported in this community sample of adolescents characterized as engaging in risky drinking. Those with symptoms of insomnia appeared to be managing their sleep-related symptoms through alcohol and other drug use, which may have further exacerbated their sleep issues., (© 2018 American Academy of Sleep Medicine.)

Objectives: We investigated young people's exposure to alcohol advertising, their intentions to consume and purchase alcohol products following the viewing of advertisements, and whether they perceived the actors in the advertisements as being under the age of 25 years., Methods: Face-to-face interviews were completed with 351 risky drinking 16-19-year-old Australians, with a sub-sample (n=68) responding to a range of alcohol advertisements in an in-depth interview., Results: Participants were exposed to alcohol advertisements from an average of seven specific contexts in the past 12 months, with younger adolescents more likely to recall TV and outdoor billboards (n=351). Positive perception of advertisements was associated with increased intention to use and to purchase advertised products (n=68). A liqueur advertisement actor was perceived by 94% as being under 25 years-old, and almost 30% thought the advertisement was marketed at people younger than 18 years of age., Conclusions: Young people's perceptions of alcohol advertising are not necessarily in line with expert/industry assessment; products are sometimes marketed in a way that is highly appealing to young people. Greater appeal was associated with increased intention to consume and to purchase products. Implications for public health: These results indicate deficiencies in the effectiveness of current advertising codes in regard to protecting the health and wellbeing of adolescents., (© 2018 The Authors.)

Introduction and Aims: Take-home naloxone (THN) programs have been operating in Australia since 2012 in a variety of settings. We examine whether THN programs were effective in increasing knowledge about opioid overdose and appropriate responses in program participants., Design and Methods: Data were obtained from pre- and post-training questionnaires administered as part of the early evaluations of THN naloxone programs operated in Sydney (n = 67), Melbourne (n = 280), Perth (n = 153) and Canberra (n = 183). Pooled data from comparable items, analysed in the domains specified in previously-developed evaluation scales, were compared using repeated-measures analysis of variance and random effects logistic regression. Results pre- and post-training were compared as well as results across sites., Results: High levels of knowledge about overdose risks and signs and appropriate actions to take were observed at baseline and this generally improved over time. No substantial differences were identified across cities. Knowledge also increased with participant age but the improvements over time were similar in each age group. There were small differences by participant gender with knowledge generally higher among females., Discussion and Conclusions: THN programs are effective in improving knowledge related to overdose response. Major improvements in knowledge were limited to overdose recognition and effect of naloxone suggesting that education may best be focused on overdose signs and the use of naloxone among populations accessed through these programs. A focus on younger people also appears warranted. Further work is needed to understand the impact of training and knowledge on actual behaviours around overdose events., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Take-home naloxone (THN) programs commenced in Australia in 2012 in the Australian Capital Territory and programs now operate in five Australian jurisdictions. The purpose of this paper is to record the progress of THN programs in Australia, to provide a resource for others wanting to start THN projects, and provide a tool for policy makers and others considering expansion of THN programs in this country and elsewhere., Design and Methods: Key stakeholders with principal responsibility for identified THN programs operating in Australia provided descriptions of program development, implementation and characteristics. Short summaries of known THN programs from each jurisdiction are provided along with a table detailing program characteristics and outcomes., Results: Data collected across current Australian THN programs suggest that to date over 2500 Australians at risk of overdose have been trained and provided naloxone. Evaluation data from four programs recorded 146 overdose reversals involving naloxone that was given by THN participants., Discussion and Conclusions: Peer drug user groups currently play a central role in the development, delivery and scale-up of THN in Australia. Health professionals who work with people who use illicit opioids are increasingly taking part as alcohol and other drug-related health agencies have recognised the opportunity for THN provision through interactions with their clients. Australia has made rapid progress in removing regulatory barriers to naloxone since the initiation of the first THN program in 2012. However, logistical and economic barriers remain and further work is needed to expand access to this life-saving medication., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Take-home naloxone (THN) programs targeting people who inject drugs (PWID) have been running in some Australian states and territories since 2012. In this study, we aimed to determine the extent to which PWID in the capital cities of all Australian states and territories are aware of naloxone and THN programs, whether awareness of these programs has changed over time., Design and Methods: Data were obtained from cross-sectional surveys of a total of 2088 PWID conducted annually as part of the Illicit Drug Reporting System from 2013 to 2015. Specific questions about THN added to the survey in 2013 allowed assessment of the extent to which sampled PWID were aware of naloxone and its function and THN programs in Australia and whether they had participated in a THN program. These main outcomes were examined over time and across states and territories using a mix of descriptive statistics and logistic regression., Results: Over 80% of the sample reported having heard of naloxone across survey years. Less than half of the participants reported having heard of THN programs in 2013 (35%), but this increased to just over (52%) half in 2015 (P < 0.01). Changes over time differed across cities with increases in reports of having heard of THN occurring over time most clearly in those cities with operational THN programs., Discussion and Conclusions: Around half of the PWID sampled for this study are aware of THN programs. Further work is needed to ensure widespread awareness of THN programs which should include implementing THN in all Australian states and territories., (© 2017 Australasian Professional Society on Alcohol and other Drugs.)

Introduction: Cyclists have a high mortality and morbidity per mile travelled compared with car occupants, a figure that is likely to increase if campaigns to increase active travel are successful. Concerns about safety is the leading factor limiting cycling for children., Objective: This review brings together a paediatric perspective based on the developmental readiness of children and young people and a public health approach to reducing injuries, to produce a practical agenda for improving the safety of cycling for children., Method: Selective literature review., Results: While most sports realise the importance of practice and training to create mastery of the game, similar thinking has not been consistently applied to cycling proficiency, so many children do not have an opportunity to master cycling before riding on the roads., Conclusions: The aim should be to minimise road traffic injuries involving children and young people in ways that create cobenefits for other members of society, increasing opportunities for active travel, reducing air pollution, creating more green space to play and reducing dependence on motor vehicles.Changes in legislation are required now to enable younger children to cycle on pavements while learning to ride and improvements in road design to separate cyclists from motor vehicles especially routes to school for older children., Competing Interests: Competing interests: None declared.

Objective: Despite declines in Australian alcohol consumption, youth alcohol related harms remain prevalent. These alcohol-related consequences appear to be driven by a subset of risky drinkers who engage in 'high intensity' drinking episodes and are underrepresented in national health surveys. This project aims to investigate high risk drinking practices and alcohol-related harms amongst young people not otherwise recorded in existing data., Methods: A community sample of the heaviest drinking 20-25% 16-19 year olds were surveyed across three Australian states (n=958; 80% metropolitan). We examined the context of their last risky drinking session through online and face-to-face surveys., Results: Males consumed a mean of 17 and females 14 standard drinks, and 86% experienced at least one alcohol-related consequence during this session. More than a quarter of the face-to-face sample had Alcohol Use Disorders Identification Test (AUDIT) scores indicative of alcohol dependence. Indications of dependence were 2.3 times more likely among those who felt uncomfortable about seeking alcohol treatment, and less likely if harm reduction strategies were frequently used while drinking., Conclusions: It is clear this underrepresented population experiences substantial acute and potentially chronic consequences., Implications: Within the context of increasing alcohol-related harms among young Australians, the understanding of this group's drinking habits should be prioritised., (© 2016 The Authors.)

Background: Cryptomarkets are digital platforms that use anonymising software (e.g. Tor) and cryptocurrencies (e.g. Bitcoin) to facilitate peer-to-peer (P2P) trade of goods and services. Their emergence has facilitated access to a wide range of high-quality psychoactive substances, according to surveys of users. In this paper, we ask the question 'How does changing access to drugs through cryptomarkets affect the drug use and harm trajectories of their users?', Methods: We conducted a digital ethnography spanning 2012-2014, a period that included the seizure of the original Silk Road marketplace and forum by law enforcement. Using encrypted online chat, we interviewed 17 people who reported using Silk Road to purchase illicit drugs. The interviews were in-depth and unstructured, and also involved the use of life history timelines to trace trajectories. Transcripts were analysed thematically using NVivo., Results: For some, Silk Road facilitated initiation into drug use or a return to drug use after cessation. Typically, participants reported experiencing a glut of drug consumption in their first months using Silk Road, described by one participant as akin to 'kids in a candy store'. There was evidence that very high availability reduced the need for drug hoarding which helped some respondents to moderate use and feel more in control of purchases made online. Cryptomarket access also appeared to affect solitary and social drug users differently. Most participants described using other cryptomarkets after the closure of Silk Road, albeit with less confidence., Conclusion: In the context of high levels of drug access, supply and diversity occurring within a community regulated environment online, the impacts of cryptomarkets upon drug use trajectories are complex, often posing new challenges for self-control, yet not always leading to harmful outcomes. A major policy challenge is how to provide support for harm reduction in these highly volatile settings., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Pre-drinking has been linked to subsequent heavy drinking and the engagement in multiple risky behaviors., Objectives: The present study examined a group of adolescents who recently had a "big night out" to determine whether there were differences in their pre-drinking behavior based on age, gender, geographic location, and social setting., Methods: Participants (n = 351, aged 16-19) representing the heaviest 20-25% of drinkers in their age group were recruited using nonrandom sampling from metropolitan (Melbourne, Sydney, Perth) or regional (Bunbury) locations across Australia and administered a survey by a trained interviewer., Results: Almost half the sample pre-drank (n = 149), most commonly at a friend's house. Those aged 18-19 were more likely to pre-drink, and did so at higher quantities compared to their younger counterparts. Males and females reported similar pre-drinking duration, quantity and amount spent on alcohol. Compared to those in cities, regional participants consumed greater quantities over longer periods of time. Two-thirds of participants consumed alcohol in excess of national guidelines during their pre-drinking session. These participants were more likely to nominate price as a motivation to pre-drink and were less likely to report that someone else provided them alcohol., Conclusions: This study sheds light on the pre-drinking habits of a population of young risky drinkers, and highlights the need for policy makers to address this form of drinking to reduce alcohol-related harm among young people.

Background: For almost a century, the cultivation, sale and use of recreational cannabis has been prohibited by law in most countries. Recently, however, under ballot initiatives four states in the US have legalised commercial, non-medical (recreational) cannabis markets. Several other states will initiate similar ballot measures attached to the 2016 election that will also appoint a new President. As the first state to implement the legislation in 2014, Colorado is an important example to begin investigating early consequences of specific policy choices while other jurisdictions consider their own legislation although the empirical evidence base is only beginning to accrue., Method: This paper brings together material sourced from peer reviewed academic papers, grey literature publications, reports in mass media and niche media outlets, and government publications to outline the regulatory model and process in Colorado and to describe some of the issues that have emerged in the first 20 months of its operation., Results: These issues include tension between public health and profit, industry and investment, new methods of consumption, the black market and product testing., Conclusion: The paper concludes that, while it is too early to determine the impact of the scheme, and noting that it includes some features designed to mitigate adverse impacts, it faces major challenges. Not least of these are the lack of an effective overarching federal regulatory structure, as a consequence of the federal prohibition on cannabis, combined with a rapidly growing cannabis industry which, like other industries, will seek to exploit loopholes to maximise profit., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Issue: Since the mid-1990s, there have been calls to make naloxone, a prescription-only medicine in many countries, available to heroin and other opioid users and their peers and family members to prevent overdose deaths., Context: In Australia there were calls for a trial of peer naloxone in 2000, yet at the end of that year, heroin availability and harm rapidly declined, and a trial did not proceed. In other countries, a number of peer naloxone programs have been successfully implemented. Although a controlled trial had not been conducted, evidence of program implementation demonstrated that trained injecting drug-using peers and others could successfully administer naloxone to reverse heroin overdose, with few, if any, adverse effects., Approach: In 2009 Australian drug researchers advocated the broader availability of naloxone for peer administration in cases of opioid overdose. Industrious local advocacy and program development work by a number of stakeholders, notably by the Canberra Alliance for Harm Minimisation and Advocacy, a drug user organisation, contributed to the rollout of Australia's first prescription naloxone program in the Australian Capital Territory (ACT). Over the subsequent 18 months, prescription naloxone programs were commenced in four other Australian states., Implications: The development of Australia's first take-home naloxone program in the ACT has been an 'ice-breaker' for development of other Australian programs. Issues to be addressed to facilitate future scale-up of naloxone programs concern scheduling and cost, legal protections for lay administration, prescribing as a barrier to scale-up; intranasal administration, administration by service providers and collaboration between stakeholders., (© 2014 Australasian Professional Society on Alcohol and other Drugs.)

Background: How cannabis cultivation is dealt with under various examples of cannabis legalization or regulation is an important consideration in design of such schemes. This study aimed to (i) investigate support among current or recent cannabis growers, for various potential policy options for cannabis cultivation if prohibition were repealed, and (ii) explore the support for these options across countries, scale of growing operations, demographics, drug use and cannabis supply involvement variables., Methods: This study utilized data from the online web survey of largely 'small-scale' cannabis cultivators, aged 18yrs and over, in eleven countries conducted by the Global Cannabis Cultivation Research Consortium (GCCRC). Data from 1722 current and recent cannabis growers in Australia, Denmark and the UK, who were all asked about policy, were included in the analysis. It investigated support for various frameworks for cultivation: (no regulation (free market); adult only; growing licenses; restrictions on plant numbers; licensed business-only sale; approved commercial growing; etc.). Among current growers, support for these options were compared across countries, across scale of growing operations, and by demographics, drug use and crime variables., Results: Although there were some between country differences in support for the various policy options, what was striking was the similarity of the proportions for each of the eight most popular policy options. Among current growers, many of these positions were predicted by demographic, drug use and cannabis growing variables which were conceptually congruent with these positions., Conclusion: The results have relevance for the provisions regarding cannabis cultivation in the design of new non-prohibitionist models of cannabis which are increasingly under consideration. It should be of interest to policy makers, drug policy researchers, law enforcement and cannabis cultivators., (Copyright © 2014 Elsevier B.V. All rights reserved.)

New Psychoactive Substances are now a feature of Australia's recreational drug market. Little is known, however, about the prevalence of use, the characteristics of people who use them and the relationship between the NPS and ecstasy markets. This study examined the prevalence and correlates of NPS use amongst a group of regular ecstasy users in Australia. Participants were recruited if they had used ecstasy at least six times in the previous six months, lived in a capital city and were over 16 years of age. Purposive sampling was used, recruiting through universities and colleges, word of mouth and street press. 654 participants were recruited in 2013. Respondents who had used an NPS in the past six months were compared to those who had not. NPS were used by 44% of the total sample. In 2013 2C-I (14%) and 2C-B (8%) were the most prevalent NPS. Respondents in the NPS group were younger and reported more frequent use of more types of drugs. They were also more likely to rate the purity of ecstasy as low relative to those in the no NPS group. NPS are now an established part of Australia's recreational drug scene and NPS with hallucinogenic effects are now used most commonly. Monitoring systems need to develop capacity to monitor this highly dynamic market., (Copyright © 2014 John Wiley & Sons, Ltd.)

In 2007, a young woman, Annabel Catt, died after consuming a capsule sold as "ecstasy" that contained para-methoxyamphetamine. In this paper, we describe how this death was depicted in online drug-user communities and illustrate how the meanings of drug use are negotiated in online settings. News articles, public online discussions, and online fieldwork formed the data. This paper demonstrates how dominant drug discourses may be resisted by drug users, drawing on theories of health resistance and Kane Race's concept of counterpublic health. Online environments may offer ways of engaging people who use drugs that acknowledge both pleasure and safety. The study's limitations are noted.

Aim: To determine whether declines in the prevalence of cannabis use in Australia have been accompanied by changes in age of onset of cannabis use., Design: A retrospective cohort study. To account for right censoring error we contrasted the mean age of onset for comparable age groups across the four surveys conducted from 1998 to 2007. Kaplan-Meier failure graphs were used to describe how the cumulative risk of first use of cannabis varied across birth cohorts born from 1947 to 1993., Setting: Australian data collected in the nationally representative, triennial, National Drug Strategy Household Surveys (NDSHS) PARTICIPANTS: A total of 88,268 Australian household residents aged 14 years and older., Measurements: Life-time use of cannabis and age of first use., Findings: For respondents under the age of 20 years, mean age of first use of cannabis has increased from 14.6 years in 1998 to 15.2 years in 2007., Conclusions: The decline in cannabis use prevalence that has occurred since 1998 in Australia has been accompanied by an increase in age of first use among those aged under 20 years., (© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.)

Aim: To investigate whether affective disorders, anxiety disorders and alcohol use disorders may increase the risk of subsequently developing drug (non-alcohol-related) dependence and/or drug (non-alcohol-related) harmful use., Setting and Design: A retrospective cohort study based on nationally representative household survey data collected from the 2007 National Survey of Mental Health and Wellbeing (MHW)., Measurement: The MHW survey applied the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (WMH-CIDI 3.0) to collect information on ICD-10 mental disorder diagnoses. Ages at first onset for mental disorders and harmful drug use were used to reconstruct the cohort according to definition of exposure, time at risk and outcome., Participants: A total of 8841 Australian adults aged 18-85 years who were included in the 2007 MHW survey., Findings: Participants with affective disorders and anxiety disorders were at higher risk of drug harmful use and drug dependence, and the effects did not vary by the length of time respondents had been exposed to mental disorders., Conclusion: It is uncertain whether experience of affective disorders and anxiety disorders, possibly prior to the disorder being identified by the individual or a health worker, may lead to self-medication with psychoactive substances or whether common genetic factors linking mental disorder and drug use disorders are the underlying cause. Symptoms of mental health disorders should alert health-care providers to the possibility of drug use disorder comorbidity and the need for early intervention, especially among young males., (© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.)

This study investigated the association between presence of mental illness, detected by an increased level of Kessler Psychological Distress Scale score, and prevalence of exposure to opportunity to obtain illicit drugs among adolescents and young adults aged 12-24 years using data collected by the 2007 Australian National Drug Strategy Household Survey (N = 2,663). Adolescents and young adults with mental illness have increased prevalence of exposure to drug use opportunity. Higher exposure to opportunity to obtain illicit drugs among people with pre-existing mental illness may further contribute to the co-existence of drug dependence and other mental disorders that are frequently reported in the literature.

Issues: A strong body of evidence guides clinical responses to alcohol and tobacco dependence and there is an emerging evidence base informing responses to cannabis dependence. Nevertheless, there are still important gaps in the evidence base., Approach: Three researchers, with backgrounds in alcohol, tobacco and cannabis research examine current clinical research and practice to identify potential future priorities for clinical research., Key Findings: Clinical outcomes will be improved by research that enhances engagement and retention of a broader range of consumers, especially underrepresented and disadvantaged populations who may not respond as well to mainstream interventions. Research might focus on innovative client recruitment approaches, varying treatment intensity, use of new technology and assertive outreach. Assessment of treatment outcome will be enhanced by strategies that facilitate longer-term follow up of participants, adoption of shared measures of non-abstinent outcomes and extending the focus and outcome measures beyond drug use. Translation of research into clinical strategies will be enhanced by improving links between theory and interventions, increased attention on factors that influence treatment fidelity, designing treatment studies that are relevant to a variety of clinical settings, focussing on clinician characteristics as treatment variables and developing methodologies that address the capacity of participants to discriminate between placebo and pharmacotherapy., Implications: A range of future research priorities have been identified that have the potential to better engage and retain clients in a range of treatment settings and enhance translation of research findings into improved treatment outcomes.

Aims: To describe the development and enactment of the Western Australian (WA) Cannabis Infringement Notice scheme and reflect on the lessons for researchers and policy-makers interested in the translation of policy research to policy practice., Methods: An insiders' description of the background research, knowledge transfer strategies and political and legislative processes leading to the enactment and implementation of the WA Cannabis Control Act 2003. Lenton and Allsop were involved centrally in the process as policy-researcher and policy-bureaucrat., Results: In March 2004, Western Australia became the fourth Australian jurisdiction to adopt a 'prohibition with civil penalties' scheme for possession and cultivation of small amounts of cannabis. We reflect upon: the role of research evidence in the policy process; windows for policy change; disseminating findings when apparently no one is listening; the risks and benefits of the researcher as advocate; the differences between working on the inside and outside of government; and the importance of relationships, trust and track record., Conclusions: There was a window of opportunity and change was influenced by research that was communicated by a reliable and trusted source. Those who want to conduct research that informs policy need to understand the policy process more clearly, look for and help create emerging windows that occur in the problem and political spheres, and make partnerships with key stakeholders in the policy arena. The flipside of the process is that, when governments change, policy born in windows of opportunity can be a casualty.

Aim: This paper presents qualitative data from an in-depth interview study of 40 repeat drink drivers in Perth Western Australia to inform countermeasures for these high risk offenders., Background: Licence sanctions are effective countermeasures for most drink drivers but the small group of repeat offenders are less responsive. Many choose to drive whilst unlicensed as the probability of detection is low and the social and economic costs of not driving can be high. This undermines other drink drive countermeasures., Results: Most respondents who had had their licence suspended admitted to driving whilst under suspension. Employment and social factors were key themes emerging in respondents' accounts of driving whilst under licence suspension., Conclusions: Whilst a range of enforcement countermeasures are needed to deter drunk and unlicensed driving, this study suggests that where possible we aim to keep offenders within the system that consists of formal laws and informal social controls, rather than apply penalties in ways that undermine adherence to the law by increasing unlicensed driving. Allowing for interlock installation early in the driving suspension period, and allowing fines to offset cost of interlock installation and monitoring, may maximise community benefit and reduce unlicensed driving., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Where authorized access to needles and syringes from exchanges and pharmacies is limited, secondary exchange (SE) can provide an important source of sterile injecting equipment. Interventions can be developed to use SE to facilitate needle and syringe exchange programs to reach a wider population of drug injectors. Yet in a context such as Western Australia, where needles and syringes are available to drug injectors from many authorized sources, the added benefit of SE is unknown. This review of data and literature conducted in October 2003 shows potential benefits but also concerns about undermining vulnerable public and political support for authorized needle provision schemes that has been nurtured and supported over a number of years.

'Marginal deterrence' refers to deterrence of a more harmful act because its expected sanction exceeds that for a less harmful act. 'Legitimacy of the law' predicts that laws perceived as fair will generate compliance and laws perceived as unfair will generate defiance. The introduction of the Cannabis Infringement Notice (CIN) scheme in Western Australia provided an opportunity to test these theories by assessing whether perceptions of certainty, severity and fairness of punishments dictated by the CIN scheme would affect how regular cannabis users intended to obtain cannabis after legislative change. One hundred Perth residents (mean age 32.2 years; two-thirds male) who reported using cannabis at least once a week were given semi-structured interviews before the CIN scheme came into effect. There was limited opportunity for the CIN scheme to effect marginal deterrence, as most of the sample were already purchasing or growing within the lower penalty thresholds. However, of the minority who were purchasing and growing outside the CIN scheme, a significant proportion reported intending to change their behaviour to fit within the scheme, including the only purchaser of more than 30 g and six of 14 non-hydroponic growers of three or more plants. Perceived certainty, severity and fairness of penalties were not as important in determining purchasing and growing behaviour as factors such as 'meeting needs', 'cost' and 'preference'. The results suggest that under the CIN scheme, marginal deterrence and legitimacy will probably play only a small or selective role in decisions about obtaining cannabis, although in some areas, such as the numbers of non-hydroponic plants, marginal deterrence may be evident.

The effect on the cannabis market is one area of interest in the evaluation of the new 'prohibition with civil penalties' scheme for minor cannabis offences in WA. One goal of the scheme is to reduce the proportion of cannabis consumed that is supplied by large-scale suppliers that may also supply other drugs. As part of the pre-change phase of the evaluation, 100 regular (at least weekly) cannabis users were given a qualitative and quantitative interview covering knowledge and attitudes towards cannabis law, personal cannabis use, market factors, experience with the justice system and impact of legislative change. Some 85% of those who commented identified the changes as having little impact on their cannabis use. Some 89% of the 70 who intended to cultivate cannabis once the CIN scheme was introduced suggested they would grow cannabis within the two non-hydroponic plant-limit eligible for an infringement notice under the new law. Only 15% believed an increase in self-supply would undermine the large scale suppliers of cannabis in the market and allow some cannabis users to distance themselves from its unsavoury aspects. Only 11% said they would enter, or re-enter, the cannabis market as sellers as a result of the scheme introduction. Most respondents who commented believed that the impact of the legislative changes on the cannabis market would be negligible. The extent to which this happens will be addressed in the post-change phase of this research. Part of the challenge in assessing the impact of the CIN scheme on the cannabis market is that it is distinctly heterogeneous.

Western Australia (WA) became the fourth Australian jurisdiction to adopt a prohibition with civil penalties scheme for minor cannabis offences when its Cannabis Infringement Notice (CIN) scheme became law on 22 March 2004. Previous criminological research has demonstrated the importance of public attitudes towards the law in determining the effectiveness of legislation. This survey represents the first phase of a pre-post study that attempted to gauge public attitudes towards the legal status of cannabis, the proposed legislative reforms surrounding the drug and their likely effects. A random telephone survey of 809 members of the WA population was conducted prior to the implementation of the new laws with a view to exploring contemporary views of the existing legal status of cannabis, attitudes to the proposed legislative model and respondent perceptions of its likely effects. Despite cannabis being viewed negatively by large numbers of the sample, criminal penalties for minor cannabis offences were viewed as inappropriate and ineffective. Once explained, the proposed civil penalty scheme was viewed as 'a good idea' by 79% of the sample, despite significant differences due to personal experience of cannabis use, political affiliation, religiosity and age of offspring. Most believed that the legislative change would not result in changes to levels of cannabis use (70%) or ease of obtaining cannabis (59%). These data suggest that prior to its implementation the new legislation was highly acceptable to the majority of the community. These baseline data will be compared with data to be collected at the post-change phase of the study to allow empirical observations of attitudinal and behavioural changes occurring in the community.

Western Australia (WA) became the fourth Australian jurisdiction to adopt a prohibition with civil penalties scheme for minor cannabis offences when its Cannabis Infringement Notice (CIN) scheme came into effect on 22 March 2004. This study, part of the pre--post evaluation of the legislative reforms, aimed to measure the impact of the changes on attitudes and drug use of school children. A self-completion survey was conducted of 2,638 students in years 9 and 12 from a selection of 11 government secondary schools in Perth. The students knew more about the risks and harms associated with cannabis than they did about prevalence of use and cannabis law. Half the year 12s and 28% of the year 9s had used the drug. Only 32% of students understood the term 'prohibition with civil penalties'. Once explained, 70% of those who had never used the drug said they would not try it if such a scheme were introduced, 5% said they would try it and 24% did not know. Significantly more (11%) said that they would try the drug if it were legalized. Although the CIN scheme applies only to adults there was a concern that such a change would indirectly affect cannabis use by children. This pre-change study suggests this is unlikely, but this will be monitored in the post-change phase of the research.

Prevention activity often occurs at different levels of community and social network. At the smallest level it could occur among a group of drug users and their peers, at the largest level, it could take the form of international drug treaties and conventions. Clearly, there are a number of ways of facilitating changes at these different levels of community and social network. This paper describes a framework that has been used by the National Drug Research Institute. It is useful in explaining that various prevention activities can operate at different community levels and in different contexts, and describes their mechanisms of action. The framework borrows from, and adapts, the 'alcohol prevention conceptual model' of Holder and the 'conditional matrix' of Strauss and Corbin. The framework is limited in that it is not a fully conceptualized, data-based or theory-driven model that specifies how its elements relate to one another. Despite these limitations it has proved to be useful in planning, understanding and describing prevention activity.

Windows of opportunity for changing drug laws open infrequently and they often close without legislative change being affected. In this paper the author, who has been intimately involved in the process, describes how evidence-based recommendations to 'decriminalize' cannabis have recently been progressed through public debate and the political process to become law in Western Australia (WA). The Cannabis Control Bill 2003 passed the WA Parliament on 23 September. The Bill, the legislative backing behind the Cannabis Infringement Notice (CIN) Scheme, came into effect on 22 March 2004. This made WA the fourth Australian jurisdiction, after South Australia, the Australian Capital Territory and the Northern Territory, to adopt a prohibition with civil penalties scheme for minor cannabis offences. This paper describes some of the background to the scheme, the process by which it has become law, the main provisions of the scheme and its evaluation. It includes reflections on the role of politics and the press in the process. The process of implementation and evaluation are outlined by the author, foreshadowing an ongoing opportunity to understand the impact of the change in legislation.