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102. Modeling the population‐level impact of opioid agonist treatment on mortality among people accessing treatment between 2001 and 2020 in New South Wales, Australia

Author

Chaillon, Antoine, primary, Bharat, Chrianna, additional, Stone, Jack, additional, Jones, Nicola, additional, Degenhardt, Louisa, additional, Larney, Sarah, additional, Farrell, Michael, additional, Vickerman, Peter, additional, Hickman, Matthew, additional, Martin, Natasha K., additional, and Bórquez, Annick, additional

Published
2021
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114. Modelling the impact of opioid agonist treatment upon multiple mortality outcomes in people who inject drugs: a three-setting analysis

Author

Stone, Jack, Degenhardt, Louisa, Grebely, Jason, Larney, Sarah, Altice, Frederick L., Smyrnov, Pavlo, Rahimi-Movaghar, Afarin, Alavi, Maryam, Young, April M., Havens, Jennifer R., Miller, William C, Hickman, Matthew, and Vickerman, Peter

Subjects
Adult, Male, Suicide Prevention, food and beverages, HIV Infections, Iran, Middle Aged, Models, Theoretical, Opioid-Related Disorders, Hepatitis C, Article, United States, Analgesics, Opioid, Suicide, Prisons, otorhinolaryngologic diseases, Humans, Female, Drug Overdose, Substance Abuse, Intravenous, Ukraine
Abstract

Opioid agonist treatment (OAT) reduces many of the harms associated with opioid dependence. We use mathematical modelling to comprehensively evaluate the overall health benefits of OAT in people who inject drugs in Perry County (KY, USA), Kyiv (Ukraine), and Tehran (Iran).We developed a dynamic model of HIV and hepatitis C virus (HCV) transmission, incarceration, and mortality through overdose, injury, suicide, disease-related and other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated preventable drug-related deaths (deaths due to HIV, HCV, overdose, suicide, or injury) averted over 2020-40 for four scenarios, added incrementally, compared with a scenario without OAT: existing OAT coverage (setting-dependent; community 4-11%; prison 0-40%); scaling up community OAT to 40% coverage; increasing average OAT duration from 4-14 months to 2 years; and scaling up prison-based OAT.Drug-related harms contributed differentially to mortality across settings: overdose contributed 27-47% (range of median projections) of preventable drug-related deaths over 2020-40, suicide 6-17%, injury 3-17%, HIV 0-59%, and HCV 2-18%. Existing OAT coverage in Tehran (31%) could have a substantial effect, averting 13% of preventable drug-related deaths, but will have negligible effect (averting2% of preventable drug-related deaths) in Kyiv and Perry County due to low OAT coverage (4%). Scaling up community OAT to 40% could avert 12-24% of preventable drug-related deaths, including 13-22% of overdose deaths, with greater effect in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have a significant additional effect, averting 27-51% of preventable drug-related deaths.OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics in people who inject drugs. Maximising these effects requires research and investment into achieving higher coverage and provision and longer retention of OAT in prisons and the community.UK National Institute for Health Research, US National Institute on Drug Abuse.

Published
2021

116. Association between supply source and vulnerability markers to cannabis-related harms: a cross-sectional study

Author

Drouin, Sarah, Kaur, Navdeep, Rizkallah, Élie, Conus, Florence, Larney, Sarah, and Jutras-Aswad, Didier

Abstract

Following cannabis legalization, some Canadian provinces created government-operated stores (e.g. Société québécoise du cannabis, SQDC) to distribute and sale cannabis and protect public health. However, little information exists on cannabis-related harms as a function of supply source. This study analyses data from the Quebec cannabis survey conducted between February 11th and June 9th 2019 in 1836 adult (>18 years old) cannabis users. Binary logistic regressions were used to evaluate the association between seven vulnerability markers to cannabis-related harms and supply source. Individuals who bought their cannabis at the SQDC (46%) had similar profile compared with individuals who bought their cannabis elsewhere (54%) in terms of psychological distress (adjusted odds ratio [aOR]=1.0; 95% confidence interval [CI]=0.3-3.8, p=0.991), risky motor driving (aOR=0.9, 95% CI=0.3-3.4, p=0.913), other substance co-use (aOR=0.8, 95% CI=0.2-3.9, p=0.765), problematic cannabis use (aOR=0.5, 95% CI=0.1-1.6, p=0.230), use to deal with negative affect (aOR=0.6, 95% CI=0.2-2.5, p=0.499) and cannabis use frequency (aOR=0.5, 95% CI=0.1-1.7, p=0.238). However, individuals who did not bought their cannabis at the SQDC had increased odds of ignoring the cannabinoid content of their cannabis product compared with those who bought their cannabis from SQDC (aOR=4.1, 95% CI=1.1-15.4, p=0.035). This result is coherent with SQDC's objective to inform cannabis users on their products, including the content and ratio of cannabinoids. More research is needed to see if this lower vulnerability marker translates into fewer negative consequences from cannabis use.Poster presented at the 22nd congress of students, fellows and residents of the Research Centre of the Centre hospitalier de l'Université de Montréal, Montreal (Canada), May 5-6 2021.

Published
2021
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126. Factors associated with violent victimisation among homeless adults in Sydney, Australia

Author

Larney, Sarah, Conroy, Elizabeth, Mills, Katherine L., Burns, Lucy, and Teesson, Maree

Subjects
Violence -- Research, Homeless persons -- Crimes against, Homeless persons -- Drug use, Health
Abstract

Objective: To determine the prevalence and correlates of violent victimisation among homeless people in inner-Sydney. Method: Cross-sectional design. Clients of a shelter for homeless, substance-using adults were interviewed about their drug use, mental health and violent victimisation in the previous 12 months. Logistic regression was used to identify factors associated with victimisation. Results: Participants reported complex drug use histories and high levels of depression, post-traumatic stress disorder (PTSD) and schizophrenia or other psychotic disorders. Forty-eight per cent of participants reported past year victimisation. In univariate analyses, being female, schizophrenia/psychotic disorder, PTSD, depression and regular use of psychostimulants were associated with increased risk of victimisation. In multivariate analyses, regular use of psychostimulants (odds ratio [95% CI] 5.07 [1.53-1 6.84]), schizophrenia or other psychotic disorder (3.13 [1.24-7.9], and depression (2.65 [1.07-6.59]) were associated with increased risk of victimisation. Conclusions and implications: This sample of homeless, substance-using adults experienced high levels of violence. People with poor mental health and regular psychostimulant users were at greater risk of victimisation. A longitudinal study to determine whether victimisation prolongs homelessness is warranted. Clinical staff working with homeless populations need to be aware of the likelihood of past and future victimisation and its effects on mental health. Homeless persons may benefit from learning to identify risk situations for victimisation and how to deescalate potentially violent situations. Key words: homeless persons, violence, crime victims. doi: 10.1111/j.1753-6405.2009.00406.x

Published
2009

127. The association between involuntary alcohol treatment and subsequent emergency department visits and hospitalizations: a Bayesian analysis of treated patients and matched controls.

Author

Vuong, Thu, Gillies, Malcolm, Larney, Sarah, Montebello, Mark, and Ritter, Alison

Subjects
REHABILITATION of people with alcoholism, INVOLUNTARY treatment, HOSPITAL emergency services, SOCIAL support, MEDICAL care use
Abstract

Background and aims: Many nations have provisions for involuntary treatment of alcohol dependence where the person is at serious risk of harm to themselves. To date, there has been little thorough evaluation of its effectiveness. This study aimed to determine if there were differences between involuntary and voluntary treatment for alcohol dependence on subsequent emergency and hospital care. Design A retrospective cohort design using linked routinely collected administrative data on health‐care utilization. Setting: Hospital and community‐based alcohol treatment, New South Wales, Australia. Participants: A total of 231 patients who were involuntarily treated for alcohol dependence and 231 matched controls who received treatment as usual within the period May 2012 to April 2018. Intervention and comparator: Involuntary treatment comprised a 28‐day mandated hospital admission which included supervised withdrawal, comprehensive assessment, rehabilitation and support followed by voluntary aftercare support for up to 6 months. Treatment as usual comprised three not mutually exclusive forms of intensive voluntary alcohol treatment: withdrawal management, rehabilitation and pharmacotherapies for alcohol dependence. Measurements Outcome measures: changes in the number of emergency department (ED) visits and number of unplanned hospital admissions 12 months before and 12 months after completion of index treatment. Findings Both groups showed a reduction in ED visits (incidence rate ratio (IRR) = 0.56, 95% credible intervals (CrI) = 0.39–0.78) and unplanned hospital admissions (IRR = 0.49, 95% CrI = 0.37–0.65). There was no statistically significant difference between the two groups (IRR = 0.77, 95% CrI = 0.58–1.03 for ED visits and IRR = 0.79, 95% CrI = 0.62–1.01 for hospital admissions). The Bayes factors were 0.925 and 0.936 for ED visits and unplanned hospital admissions, respectively, interpreted as weak evidence in support of the null hypothesis of no difference between the interventions. Conclusions: Involuntary treatment of alcohol dependence was associated with reduced health service utilization in the year following treatment, and the outcomes did not differ from those of a matched control group. [ABSTRACT FROM AUTHOR]

Published
2022
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129. Association between opioid agonist therapy use and HIV testing uptake among people who have recently injected drugs: a systematic review and meta‐analysis

Author

Ferraro, Claire F., primary, Stewart, Daniel E., additional, Grebely, Jason, additional, Tran, Lucy T., additional, Zhou, Shally, additional, Puca, Carla, additional, Hajarizadeh, Behzad, additional, Larney, Sarah, additional, Santo, Thomas, additional, Higgins, Julian P. T., additional, Vickerman, Peter, additional, Degenhardt, Louisa, additional, Hickman, Matthew, additional, and French, Clare E., additional

Published
2021
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131. The mortality after release from incarceration consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis

Author

Borschmann, Rohan, Tibble, Holly, Spittal, Matthew J., Preen, David, Pirkis, Jane, Larney, Sarah, Rosen, David L., Young, Jesse T., Love, Alexander D., Altice, Frederick L., Binswanger, Ingrid A., Bukten, Anne, Butler, Tony, Chang, Zheng, Chen, Chuan-Yu, Clausen, Thomas, Christensen, Peer Brehm, Culbert, Gabriel J., Degenhardt, Louisa, Dirkzwager, Anja J. E., Dolan, Kate, Fazel, Seena, Fischbacher, Colin, Giles, Margaret, Graham, Lesley, Harding, David, Huang, Yen-Fang, Huber, Florence, Karaminia, Azar, Borschmann, Rohan, Tibble, Holly, Spittal, Matthew J., Preen, David, Pirkis, Jane, Larney, Sarah, Rosen, David L., Young, Jesse T., Love, Alexander D., Altice, Frederick L., Binswanger, Ingrid A., Bukten, Anne, Butler, Tony, Chang, Zheng, Chen, Chuan-Yu, Clausen, Thomas, Christensen, Peer Brehm, Culbert, Gabriel J., Degenhardt, Louisa, Dirkzwager, Anja J. E., Dolan, Kate, Fazel, Seena, Fischbacher, Colin, Giles, Margaret, Graham, Lesley, Harding, David, Huang, Yen-Fang, Huber, Florence, and Karaminia, Azar

Abstract

Introduction More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. Objectives To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. Methods We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. Results The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. Conclusions The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population.

Published
2020

144. Association Between Opioid Agonist Therapy and Testing, Treatment Uptake, and Treatment Outcomes for Hepatitis C Infection Among People Who Inject Drugs: A Systematic Review and Meta-analysis

Author

Grebely, Jason, primary, Tran, Lucy, additional, Degenhardt, Louisa, additional, Dowell-Day, Alexander, additional, Santo, Thomas, additional, Larney, Sarah, additional, Hickman, Matthew, additional, Vickerman, Peter, additional, French, Clare, additional, Butler, Kerryn, additional, Gibbs, Daisy, additional, Valerio, Heather, additional, Read, Phillip, additional, Dore, Gregory J, additional, and Hajarizadeh, Behzad, additional

Published
2020
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147. The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis

Author

Borschmann, Rohan, primary, Tibble, Holly, additional, Spittal, Matthew J, additional, Preen, David, additional, Pirkis, Jane, additional, Larney, Sarah, additional, Rosen, David L, additional, Young, Jesse T, additional, Love, Alexander D, additional, Altice, Frederick L, additional, Binswanger, Ingrid A, additional, Bukten, Anne, additional, Butler, Tony, additional, Chang, Zheng, additional, Chen, Chuan-Yu, additional, Clausen, Thomas, additional, Christensen, Peer Brehm, additional, Culbert, Gabriel J, additional, Degenhardt, Louisa, additional, Dirkzwager, Anja J.E., additional, Dolan, Kate, additional, Fazel, Seena, additional, Fischbacher, Colin, additional, Giles, Margaret, additional, Graham, Lesley, additional, Harding, David, additional, Huang, Yen-Fang, additional, Huber, Florence, additional, Karaminia, Azar, additional, Kouyoumdjian, Fiona G, additional, Lim, Sungwoo, additional, Møller, Lars, additional, Moniruzzaman, Akm, additional, Morenoff, Jeffrey, additional, O'Moore, Eamonn, additional, Pizzicato, Lia N, additional, Pratt, Daniel, additional, Proescholdbell, Scott F, additional, Ranapurwala, Shabbar I, additional, Shanahan, Meghan E, additional, Shaw, Jenny, additional, Slaunwhite, Amanda, additional, Somers, Julian M, additional, Spaulding, Anne C, additional, Stern, Marc F, additional, Viner, Kendra M, additional, Wang, Nadia, additional, Willoughby, Melissa, additional, Zhao, Bin, additional, and Kinner, Stuart A, additional

Published
2020
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148. Perceptions of extended‐release buprenorphine injections for opioid use disorder among people who regularly use opioids in Australia

Author

Larance, Briony, primary, Degenhardt, Louisa, additional, Grebely, Jason, additional, Nielsen, Suzanne, additional, Bruno, Raimondo, additional, Dietze, Paul, additional, Lancaster, Kari, additional, Larney, Sarah, additional, Santo, Thomas, additional, Shanahan, Marian, additional, Memedovic, Sonja, additional, Ali, Robert, additional, and Farrell, Michael, additional

Published
2020
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