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Tonin FS, Alves da Costa F, Fernandez-Llimos F. Impact of harm minimization interventions on reducing blood-borne infection transmission and some injecting behaviors among people who inject drugs: an overview and evidence gap mapping. Addict Sci Clin Pract 2024; 19:9. [PMID: 38310293 PMCID: PMC10838443 DOI: 10.1186/s13722-024-00439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND This study aimed to synthetize the evidence on the effectiveness of harm minimization interventions on reducing blood-borne infection transmission and injecting behaviors among people who inject drugs (PWID) through a comprehensive overview of systematic reviews and evidence gap mapping. METHODS A systematic review was conducted with searches in PubMed and Scopus to identify systematic reviews assessing the impact of interventions aimed at reducing the harms associated with injectable drug use. The overall characteristics of the studies were extracted and their methodological quality was assessed using AMSTAR-2. An evidence gap map was constructed, highlighting the most frequently reported outcomes by intervention (CRD42023387713). RESULTS Thirty-three systematic reviews were included. Of these, 14 (42.2%) assessed the impact of needle/syringe exchange programs (NSEP) and 11 (33.3%) examined opioid agonist therapy (OAT). These interventions are likely to be associated with reductions of HIV/HCV incidence (10-40% risk reduction for NSEP; 50-60% for OAT) and sharing injecting paraphernalia (50% for NSEP, 25-85% for OAT), particularly when combined (moderate evidence). Behavioral/educational interventions were assessed in 12 reviews (36.4%) with most authors in favor/partially in favor of the use of these approaches (moderate evidence). Take-home naloxone programs and supervised-injection facilities were each assessed in two studies (6.1%), which reported inconclusive results (limited/inconsistent evidence). Most authors reported high levels of heterogeneity and risk of bias. Other interventions and outcomes were inadequately reported. Most systematic reviews presented low or critically low quality. CONCLUSION The evidence is sufficient to support the effectiveness of OAT, NSEP and their combination in reducing blood-borne infection transmission and certain injecting behaviors among PWID. However, evidence of other harm minimizations interventions in different settings and for some outcomes remain insufficient.
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Affiliation(s)
- Fernanda S Tonin
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, Lisbon, Portugal.
| | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit, (UCIBIO-i4HB) Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Tomko C, Schneider KE, Rouhani S, Urquhart GJ, Nyeong Park J, Morris M, Sherman SG. Identifying pathways to recent non-fatal overdose among people who use opioids non-medically: How do psychological pain and unmet mental health need contribute to overdose risk? Addict Behav 2022; 127:107215. [PMID: 34953432 DOI: 10.1016/j.addbeh.2021.107215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Significant associations exist between psychological pain, unmet mental health need, and frequency and severity of substance use among people who use drugs (PWUD), but no studies have analyzed the relationship of these variables to non-fatal overdose. METHODS We conducted a cross-sectional survey of people who used opioids non-medically in Baltimore, Maryland (n = 563) as part of a broader harm reduction-focused evaluation (PROMOTE). The outcome was self-reported recent (past 6 months) non-fatal overdose; exposures of interest were recent self-reported unmet mental health need, experiencing daily "long-lasting psychological or mental pain" (vs. < daily), and daily multi-opioid use (vs. none/one opioid used). Path analysis was used to model direct relationships between these variables, personal characteristics (race, gender, experiencing homelessness, drug injection) and overdose. RESULTS 30% of the sample had experienced a recent non-fatal overdose, 46% reported unmet mental health need, 21% reported daily psychological pain, and 62% used multiple types of opioids daily. After adjusting for covariates, daily multi-opioid use (aOR = 1.78, p = 0.03) and unmet mental health need (aOR = 2.05, p = 0.01) were associated with direct, significant increased risk of recent overdose. Significant pathways associated with increased odds of unmet mental health need included woman gender (aOR = 2.23, p = 0.003) and daily psychological pain (aOR = 4.14, p = 0.002). In turn, unmet mental health need associated was with greater odds of daily multi-opioid use (aOR = 1.57, p = 0.05). DISCUSSION Unmet mental heath need and daily psychological pain are common experiences in this sample of PWUD. Unmet mental health need appears on several pathways to overdose and associated risk factors; improving access to mental healthcare for PWUD (particularly women) expressing need may be an important harm reduction measure.
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Affiliation(s)
- Catherine Tomko
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States.
| | - Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Saba Rouhani
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Glenna J Urquhart
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Miles Morris
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, United States
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Searby A, Burr D, McGrath I. The demographic profile of alcohol and other drug (AOD) nurses in Australia: Experienced, highly qualified… and endangered? Collegian 2022. [DOI: 10.1016/j.colegn.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martignetti L, Sun W. Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review. Cureus 2022; 14:e21461. [PMID: 35223245 PMCID: PMC8858082 DOI: 10.7759/cureus.21461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/02/2022] Open
Abstract
The purpose of this review is to examine the existing literature about facilitators and barriers influencing equitable access to naloxone programs by individuals who use opioids. A total of 49 published articles were examined, which generated four overarching themes:(1) Stigma as a barrier to access; (2) Lack of a wide range of stakeholder perspectives; (3) Need for a comprehensive understanding of factors affecting equitable access to naloxone programs; (4) Facilitators to increase the access of community naloxone programs. Our review highlighted the importance of advocacy in practice, education, administration, and policy to address the health inequities that exist in naloxone distribution programs. Advocacy activities involve the need for health care professionals to engage in social justice practice through evidence-based informed research about the facts of opioid use; challenging the stigma toward victim-blaming against naloxone users; as well as promoting program development and health policy to bring about equitable access to naloxone programs by marginalized and socially disadvantaged populations.
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Walker S, Dietze P, Poznyak V, Campello G, Kashino W, Dzhonbekov D, Kiriazova T, Nikitin D, Terlikbayeva A, Nevendorff L, Busse A, Krupchanka D. More than saving lives: Qualitative findings of the UNODC/WHO Stop Overdose Safely (S-O-S) project. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103482. [PMID: 35042142 DOI: 10.1016/j.drugpo.2021.103482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Stop Overdose Safely (S-O-S) initiative-developed in compliance with WHO guidelines-aims to prevent opioid overdose deaths. Under the umbrella of this initiative a multi-country project was implemented in Kazakhstan, Kyrgyzstan, Tajikistan, and Ukraine, that involved overdose recognition and response training, including the provision of take-home naloxone (THN). More than 14,000 potential overdose witnesses were trained and more than 16,000 THN kits were distributed across the participating countries. This paper reports on the qualitative component of an evaluation aiming to understand the views and experiences of S-O-S project participants. METHODS Data were drawn from focus group discussions with 257 project participants from across all four countries, including people who use and inject drugs, and others likely to witness an opioid overdose. Data were analysed thematically. RESULTS Findings revealed how past experiences of trauma and loss related to overdose death were common, as was appreciation and gratitude for the opportunity to participate in the S-O-S training. Participants described how they shared knowledge and skills with others. Empowerment and destigmatising narratives featured prominently, and highlighted how for people who use drugs, feeling valued and cared about-not only by families and friends, but by health care providers, and sometimes police-was a positive outcome of their participation. Nevertheless, findings also revealed how real experiences of fear regarding police intervention was a barrier to carrying naloxone and intervening when faced with an overdose situation. CONCLUSION Our analysis found that the S-O-S project produced positive outcomes that go well beyond saving lives. Despite identifying barriers to THN uptake, our findings support a growing body of evidence that broad access to THN as part of a continuum of care can enhance the health and wellbeing of people who use drugs and their communities, in low- to middle-income countries.
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Affiliation(s)
- Shelley Walker
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia.
| | - Paul Dietze
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne Victoria, 3004, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia
| | - Vladimir Poznyak
- Alcohol, Drugs and Addictive Behaviours Unit, Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Giovanna Campello
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | - Wataru Kashino
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | | | - Tetiana Kiriazova
- Ukrainian Institute on Public Health Policy, 5 Biloruska Street, Office 20, 27, Kyiv, 04050, Ukraine
| | - Danil Nikitin
- Global Research Institute (GLORI) Foundation, 125 Suyumbaev Street Bishkek, 720011, Kyrgyzstan
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia (GHRCCA), 38B Shashkina Street, Almaty, Kazakhstan
| | - Laura Nevendorff
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia
| | - Anja Busse
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | - Dzmitry Krupchanka
- Alcohol, Drugs and Addictive Behaviours Unit, Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
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Black E, Monds LA, Chan B, Brett J, Hutton JE, Acheson L, Penm J, Harding S, Strumpman D, Demirkol A, Lintzeris N. Overdose and take-home naloxone in emergency settings: A pilot study examining feasibility of delivering brief interventions addressing overdose prevention with 'take-home naloxone' in emergency departments. Emerg Med Australas 2022; 34:509-518. [PMID: 35021268 DOI: 10.1111/1742-6723.13925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Although most unintentional opioid deaths in Australia are attributed to pharmaceutical opioids, take-home naloxone (THN) programmes have to date predominantly targeted people using illicit opioids in drug treatment and harm reduction settings. We sought to examine the feasibility of delivering THN brief interventions (THN-BIs) with intranasal naloxone in EDs. METHODS This pilot feasibility study was conducted across three major metropolitan EDs in Sydney and Melbourne. ED staff were surveyed about their perspectives regarding THN before completing a 30-min training programme in THN-BI delivery. Patients presenting with opioid overdose or considered high risk for future overdose were eligible to receive the THN-BI. Staff survey responses were compared between hospitals and provider types using one-way analysis of variances. Patient demographic and clinical characteristics were extracted from medical records and compared between hospitals and overdose type using Fisher's exact test and one-way analysis of variances. RESULTS One hundred and twenty-two ED staff completed the survey. One hundred and ten (90.2%) agreed that EDs should provide THN-BIs, whereas 23 (19.2%) identified time constraints and 17 (12.9%) felt uncomfortable discussing overdose with patients. Fifty-seven patients received the THN-BI, with the majority (n = 50, 87.7%) having presented following opioid overdose. The median age was 44 years and 40 (71.4%) were men. Two-thirds of the overdoses (n = 31, 66.0%) were attributed to heroin with one-third (n = 16, 34%) being attributed to pharmaceutical opioids. CONCLUSIONS ED-based delivery of THN-BIs can reach a wide range of individuals at-risk of overdose. The present study supports the feasibility of THN interventions in EDs and underscores the importance of addressing implementation barriers including staff training.
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Affiliation(s)
- Eleanor Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
| | - Lauren A Monds
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Specialty of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Betty Chan
- Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jonathan Brett
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Jennie E Hutton
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Liam Acheson
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.,National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.,Pharmacy Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sally Harding
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Dana Strumpman
- Pharmacy Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Apo Demirkol
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Specialty of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
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7
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Conway A, Valerio H, Peacock A, Degenhardt L, Hayllar J, Harrod ME, Henderson C, Read P, Gilliver R, Christmass M, Dunlop A, Montebello M, Whitton G, Reid D, Lam T, Alavi M, Silk D, Marshall AD, Treloar C, Dore GJ, Grebely J. Non-fatal opioid overdose, naloxone access, and naloxone training among people who recently used opioids or received opioid agonist treatment in Australia: The ETHOS Engage study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103421. [PMID: 34452808 DOI: 10.1016/j.drugpo.2021.103421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/07/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Overdose is a major cause of morbidity and mortality among people who use opioids. Naloxone can reverse opioid overdoses and can be distributed and administered with minimal training. People with experience of overdose are a key population to target for overdose prevention strategies. This study aims to understand if factors associated with recent non-fatal opioid overdose are the same as factors associated with naloxone access and naloxone training in people who recently used opioids or received opioid agonist treatment (OAT). METHODS ETHOS Engage is an observational study of people who inject drugs in Australia. Logistic regression models were used to estimate odds ratios for non-fatal opioid overdose, naloxone access and naloxone training. RESULTS Between May 2018-September 2019, 1280 participants who recently used opioids or received OAT were enrolled (62% aged >40 years; 35% female, 80% receiving OAT, 62% injected drugs in the preceding month). Recent opioid overdose (preceding 12 months) was reported by 7% of participants, lifetime naloxone access by 17%, and lifetime naloxone training by 14%. Compared to people receiving OAT with no additional opioid use, recent opioid, benzodiazepine (preceding six months), and hazardous alcohol use was associated with recent opioid overdose (aOR 3.91; 95%CI: 1.68-9.10) and lifetime naloxone access (aOR 2.12; 95%CI 1.29-3.48). Among 91 people who reported recent overdose, 65% had never received take-home naloxone or naloxone training. CONCLUSIONS Among people recently using opioids or receiving OAT, benzodiazepine and hazardous alcohol use is associated with non-fatal opioid overdose. Not all factors associated with non-fatal overdose correspond to factors associated with naloxone access. Naloxone access and training is low across all groups. Additional interventions are needed to scale up naloxone provision.
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Affiliation(s)
- A Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.
| | - H Valerio
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - A Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, Tasmania, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - J Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - M E Harrod
- NSW Users and AIDS Association, NSW, Australia
| | - C Henderson
- NSW Users and AIDS Association, NSW, Australia
| | - P Read
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Kirketon Road Centre, Sydney, NSW, Australia
| | - R Gilliver
- Kirketon Road Centre, Sydney, NSW, Australia
| | - M Christmass
- Next Step Drug and Alcohol Services, Mental Health Commission, WA, Australia; National Drug Research Institute, Curtin University, WA, Australia
| | - A Dunlop
- Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute & University of Newcastle, Newcastle, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - M Montebello
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - G Whitton
- Drug Health Service, South West Sydney LHD, NSW, Australia
| | - D Reid
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - T Lam
- Drug Health, Western Sydney Local Health District, Sydney, NSW, Australia
| | - M Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - D Silk
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - A D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - G J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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McMillan SS, Chan H, Hattingh LH. Australian Community Pharmacy Harm-Minimisation Services: Scope for Service Expansion to Improve Healthcare Access. PHARMACY 2021; 9:pharmacy9020095. [PMID: 33926030 PMCID: PMC8167599 DOI: 10.3390/pharmacy9020095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 11/16/2022] Open
Abstract
Community pharmacies are well positioned to participate in harm-minimisation services to reduce harms caused by both licit and illicit substances. Considering developments in pharmacist practices and the introduction of new professional pharmacy services, we identified a need to explore the contemporary role of community pharmacy in harm minimisation. Semi-structured interviews were undertaken to explore the opinions of stakeholders, pharmacy staff, and clients about the role of community pharmacy in harm minimisation, including provision of current services, experiences, and expectations. Participants (n = 28) included 5 stakeholders, 9 consumers, and 14 staff members from seven community pharmacies. Three over-arching themes were identified across the three participants groups: (i) scope and provision, (ii) complexity, and (iii) importance of person-centred advice and support in relation to community pharmacy harm minimisation services. Community pharmacies are valuable healthcare destinations for delivery of harm minimisation services, with scope for service expansion. Further education, support, and remuneration are needed, as well as linkage to other sector providers, in order to ensure that pharmacists and pharmacy staff are well equipped to provide a range of harm minimisation services.
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Affiliation(s)
- Sara S. McMillan
- Gold Coast Campus, School of Pharmacy and Pharmacology, Griffith University, Southport 4215, Australia;
| | - Hidy Chan
- The Pharmacy Guild of Australia, Queensland Branch, Brisbane 4000, Australia;
| | - Laetitia H. Hattingh
- Gold Coast Campus, School of Pharmacy and Pharmacology, Griffith University, Southport 4215, Australia;
- Gold Coast Hospital and Health Service, Southport 4215, Australia
- Correspondence:
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Prevalence and correlates of multiple non-fatal opioid overdoses among people who inject drugs who utilise needle syringe programs in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103245. [PMID: 33840562 DOI: 10.1016/j.drugpo.2021.103245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Non-fatal overdose (NFOD) is a major cause of morbidity among people who inject drugs (PWID) and multiple NFOD is associated with increased risk of fatal overdose. Despite this, few studies have examined the prevalence and correlates of drug-specific multiple NFOD. The current study aimed to determine the prevalence and correlates of recent multiple non-fatal opioid overdose (NFOOD) among PWID who access needle syringe programs (NSPs) in Australia. METHODS The Australian Needle and Syringe Program Survey is conducted annually and was conducted at 46 sites across Australia in 2019. Participation involves completion of a self-administered questionnaire and a capillary dried blood spot for HIV and hepatitis C virus testing. In 2019, respondents who reported a minimum of one NFOOD in the previous 12 months (recent NFOOD) were asked to complete supplementary questions regarding their last NFOOD. Bivariate and multivariate logistic regression were used to determine factors independently associated with multiple recent NFOOD. RESULTS A total of 222 respondents reported recent NFOOD. Respondents were predominantly male (59%), one third (39%) were aged less than 39 years and 73% reported last injecting heroin at their last NFOOD. One in two respondents (48%, n = 107) reported multiple opioid overdoses (median 3, interquartile range 2-5). The odds of reporting multiple NFOOD were higher among respondents who reported injecting in a public location at their last NFOOD (adjusted odds ratio [AOR] 2.10, 95% CI 1.14-3.90, p = 0.018) and benzodiazepine use in the 12 h prior to NFOOD (AOR 2.74, 95% CI 1.50-4.99, p = 0.001). CONCLUSIONS Multiple NFOOD was prevalent among PWID who utilised NSPs who reported recent NFOOD. Public injecting and benzodiazepine use were associated with increased risk of multiple NFOOD, and there is a need for interventions specifically targeting PWID who report these high risk injecting practices.
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10
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Rudisill TM, Ashraf AJ, Linn HI, Sayres S, Jeffries JE, Gurka KK. Facilitators, barriers and lessons learnt from the first state-wide naloxone distribution conducted in West Virginia. Inj Prev 2020; 27:369-374. [PMID: 32873604 DOI: 10.1136/injuryprev-2020-043666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Overdose education and naloxone distribution programmes are known to reduce opioid-related deaths. A state-wide naloxone distribution effort of 8250 rescue kits was undertaken by government, community and university partners in West Virginia in 2016-2017. The purpose of this study was to discern the barriers, facilitators and lesson learnt from implementing this endeavour in a rural state with the highest opioid overdose fatality rate in the US. METHODS Structured interviews (n=26) were conducted among both internal and external stakeholders. Those who participated were >18 years of age and were the lead representative from agencies that either received naloxone (ie, external stakeholders) or helped implement the distribution (ie, internal stakeholders). The interviews followed standardised scripts and lasted approximately 40 min. Sessions were audio-recorded and transcribed. Qualitative content analysis was performed by two researchers to determine themes surrounding facilitators or barriers to programme implementation. RESULTS The primary facilitators reported by stakeholders included collaborative partnerships, ease of participating in the programme, being established in prevention efforts, demand for naloxone and the need for personal protection from overdose. The primary barriers identified by stakeholders included bureaucracy/policy/procedures of their organisation or agency, stigma, logistical or planning issues, problems with reporting, lack of communication post distribution and sustainability. Numerous lessons were learnt. CONCLUSIONS Based on the implementation of the programme in 87 organisations, including law enforcement and fire departments, the impact of facilitators outweighed that of barriers. These findings may inform others planning to conduct a similar, large-scale project.
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Affiliation(s)
- Toni Marie Rudisill
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
| | - Alexandria J Ashraf
- School of Public Health, Health Research Center, Robert C Byrd Health Science Center, West Virginia University, Morgantown, West Virginia, USA
| | - Herbert I Linn
- School of Public Health, Health Research Center, Robert C Byrd Health Science Center, West Virginia University, Morgantown, West Virginia, USA
| | - Sheena Sayres
- Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - James E Jeffries
- West Virginia Department of Health and Human Resources, Bureau for Public Health, Office of Maternal, Child and Family Health, Charleston, West Virginia, USA
| | - Kelly K Gurka
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
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Moradmand-Badie B, Tran L, Oikarainen N, Degenhardt L, Nielsen S, Roberts J, Ward S, Bowman J, Larney S. Feasibility and acceptability of take-home naloxone for people released from prison in New South Wales, Australia. Drug Alcohol Rev 2020; 40:98-108. [PMID: 32808357 DOI: 10.1111/dar.13144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIMS To assess the feasibility and acceptability of a take-home naloxone program for people with a history of opioid use released from prison in New South Wales, Australia. DESIGN AND METHODS Cross-sectional interviews with people with a history of opioid use who were recently released from prison (n = 105), and semi-structured interviews with key clinical and operational staff of Justice Health and Forensic Mental Health Network and Corrective Services NSW (n = 9). RESULTS Among people with a history of opioid use who had recently left prison, there was very high awareness of the elevated risk of overdose following release from prison (95%) and the potential for naloxone to reverse an opioid overdose (97%). Participants considered that their personal risk of overdose was low, despite ongoing opioid use being common. Participants were largely supportive of take-home naloxone, but the majority (83%) stated that proactively obtaining naloxone would be a low priority for them following release. Key informants were supportive of introducing naloxone training and supply and identified barriers to implementation, including adequate resourcing, identifying the population for training, and developing an appropriate model of training and implementation. DISCUSSION AND CONCLUSION There was widespread support for naloxone training in custody and distribution at release among people recently released from prison and key stakeholders in health-care provision and prisons administration. As proactively accessing naloxone is a low priority for patients, naloxone supply at release may be more effective than programs that refer releasees to local pharmacies, but developing a sustainable supply model requires consideration of several barriers.
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Affiliation(s)
| | - Lucy Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Noora Oikarainen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Jillian Roberts
- Drug and Alcohol Service, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Stephen Ward
- Drug and Alcohol Strategic Operations, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Julia Bowman
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia.,School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal and Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
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12
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Jones JD, Campbell AN, Brandt L, Castillo F, Abbott R, Comer SD. Intervention in an opioid overdose event increases interest in treatment among individuals with opioid use disorder. Subst Abus 2020; 42:407-411. [PMID: 32814002 DOI: 10.1080/08897077.2020.1809607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study sought to explore whether intervening in suspected cases of opioid overdose alters interest in treatment for opioid use disorder (OUD). Data were collected as a part of a trial comparing the effects of different overdose education and naloxone distribution (OEND) training curricula on overdose outcomes. Methods: Following OEND training, participants completed four in-person follow-up visits at 1-, 3-, 6- and 12-months. Participants were also regularly contacted to inquire about overdose events they responded to, witnessed, or experienced themselves. Other assessments included the Addiction Severity Index that queries participants' perceived importance of drug treatment on a scale of: 0 (Not at All) to 4 (Extremely). For the current secondary data analysis, treatment importance was assessed at the time points most immediately preceding and following participant intervention in an overdose event using naloxone. Results: The sample reported a mean duration of opioid use of 14.9 (± 11.5) years, with 67% having witnessed an overdose event prior to the study. Of the 321 enrolled, 92 participants used naloxone in response to 166 suspected cases of an opioid overdose. For the entire sample, mean treatment importance did not significantly change throughout the study. Among participants who utilized naloxone, treatment importance increased following the event (Before: 3.03, After: 3.39, p = 0.02). Due to the amount of time between the overdose event and assessment of post-event treatment importance (40.5 days, ±40.2), the current study most likely underestimates this effect. Conclusions: The current study suggests that responding to an overdose event increases interest in OUD treatment. Currently only considered an acute intervention to reduce overdose morbidity and mortality, OEND may have the potential to increase enrollment in medications to treat OUD. However, a prospective investigation needs to determine if the impact of an overdose event could be utilized to increase treatment engagement.
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Affiliation(s)
- Jermaine D Jones
- Division on Substance Use Disorders, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Aimee N Campbell
- Division on Substance Use Disorders, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Laura Brandt
- Division on Substance Use Disorders, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Felipe Castillo
- Division on Substance Use Disorders, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca Abbott
- Division on Substance Use Disorders, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Sandra D Comer
- Division on Substance Use Disorders, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
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13
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The missing link: Incorporating behaviour change theories in overdose education and naloxone distribution programs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102853. [PMID: 32688261 DOI: 10.1016/j.drugpo.2020.102853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/23/2022]
Abstract
Current rates of opioid-related mortality have been increasing globally. An effective harm reduction program consists of overdose education and naloxone distribution (OEND) programs. Incorporating both education and naloxone administration, OENDs have been reported to improve knowledge, self-efficacy and have resulted in multiple overdose reversals. Similarly effective has been the incorporation of Behaviour Change Theories within harm reduction programs. Although limited, literature that does exist surrounding this intersection, explains how theories such as social cognitive theory and the transtheoretical model have proven to reduce harms relating to injection drug use. Engaging with participants at multiple levels while using a context-dependent and iterative approach have been documented strengths of behaviour change theories with respect to minimizing substance use behaviours. This commentary argues for the potential benefit, incorporating behaviour change theories in OENDs has in reducing opioid-related overdoses.
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14
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Gilliver R, Kearley J, Read P. Preparing for a syndemic: incorporating opioid overdose management into routine care for people who inject drugs initiating hepatitis C treatment. Intern Med J 2020; 50:382-383. [DOI: 10.1111/imj.14755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/28/2019] [Accepted: 06/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Rosie Gilliver
- Kirketon Road CentreSouth Eastern Sydney Local Health District Sydney New South Wales Australia
| | - John Kearley
- Kirketon Road CentreSouth Eastern Sydney Local Health District Sydney New South Wales Australia
| | - Phillip Read
- Kirketon Road CentreSouth Eastern Sydney Local Health District Sydney New South Wales Australia
- Kirby InstituteUNSW Australia Sydney New South Wales Australia
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15
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O’Keefe D, Ritter A, Stoove M, Hughes C, Dietze P. Harm reduction programs and policy in Australia: barriers and enablers to effective implementation. SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2020. [DOI: 10.1024/0939-5911/a000641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract. Background: Harm reduction is an integral component of Australia’s overall national drug policy. Harm reduction policy and interventions can be applied to any legal or illegal drug to mitigate harm without necessarily reducing use, but harm reduction is traditionally conceptualised in relation to injecting drug use. Early and comprehensive adoption of many innovative harm reduction interventions has meant that Australia has had significant success in reducing a number of drug related harms, avoided disease epidemics experienced in other countries, and established programs and practices that are of international renown. However, these gains were not easily established, nor necessarily permanent. Aim: In this paper we explore the past and present harm reduction policy and practice contexts that normalised and facilitated harm reduction as a public health response, as well as those converse contexts currently creating opposition to additional or expanded interventions. Importantly, this paper discusses the intersection between various interventions, such as needle and syringe distribution and drug treatment programs. Finally, we detail some of the practical lessons that have been learned via the Australian experience, with the hope that these lessons will assist to inform and improve international harm reduction implementation.
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Affiliation(s)
- Daniel O’Keefe
- Burnet Institute
- School of Public Health and Preventive Medicine, Monash University
| | - Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, University of New South Wales
| | - Mark Stoove
- Burnet Institute
- School of Public Health and Preventive Medicine, Monash University
| | - Chad Hughes
- Burnet Institute
- School of Public Health and Preventive Medicine, Monash University
| | - Paul Dietze
- Burnet Institute
- School of Public Health and Preventive Medicine, Monash University
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16
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Lintzeris N, Monds LA, Bravo M, Read P, Harrod ME, Gilliver R, Wood W, Nielsen S, Dietze PM, Lenton S, Shanahan M, Jauncey M, Jefferies M, Hazelwood S, Dunlop AJ, Greenaway M, Haber P, Ezard N, Malcom A. Designing, implementing and evaluating the overdose response with take-home naloxone model of care: An evaluation of client outcomes and perspectives. Drug Alcohol Rev 2019; 39:55-65. [PMID: 31774221 DOI: 10.1111/dar.13015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Lauren A Monds
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Maria Bravo
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Phillip Read
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Rosie Gilliver
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | - William Wood
- Medically Supervised Injecting Centre, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Paul M Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
| | - Simon Lenton
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Meryem Jefferies
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug Health, Western Sydney Local Health District, Sydney, Australia
| | - Susan Hazelwood
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, Australia
| | - Adrian J Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug and Alcohol Services, Hunter New England Local Health District, Newcastle, Australia
| | | | - Paul Haber
- Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - Nadine Ezard
- NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia.,Drug and Alcohol Services, St. Vincent's Local Health Network, Sydney, Australia.,National Centre for Clinical Research in Emerging Drugs, Sydney, Australia
| | - Annie Malcom
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.,NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
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17
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The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:172-184. [DOI: 10.1016/j.drugpo.2019.07.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
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18
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Young S, Williams S, Otterstatter M, Lee J, Buxton J. Lessons learned from ramping up a Canadian Take Home Naloxone programme during a public health emergency: a mixed-methods study. BMJ Open 2019; 9:e030046. [PMID: 31662368 PMCID: PMC6830612 DOI: 10.1136/bmjopen-2019-030046] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study describes the 2016 expansion of the British Columbia Take Home Naloxone (BCTHN) programme quantitatively and explores the challenges, facilitators and successes during the ramp up from the perspectives of programme stakeholders. DESIGN Mixed-methods study. SETTING The BCTHN programme was implemented in 2012 to reduce opioid overdose deaths by providing naloxone kits and overdose recognition and response training in BC, Canada. An increase in the number of overdose deaths in 2016 in BC led to the declaration of a public health emergency and a rapid ramp up of naloxone kit production and distribution. BCTHN distributes naloxone to the five regional health authorities of BC. PARTICIPANTS Focus groups and key informant interviews were conducted with 18 stakeholders, including BC Centre for Disease Control staff, urban and rural site coordinators, and harm reduction coordinators from the five regional health authorities across BC. PRIMARY AND SECONDARY OUTCOME MEASURES Take Home Naloxone (THN) programme activity, qualitative themes and lessons learnt were identified. RESULTS In 2016, BCTHN responded to a 20-fold increase in demand of naloxone kits and added over 300 distribution sites. Weekly numbers of overdose events and overdose deaths were correlated with increases in THN kits ordered the following week, during 2013-2017. Challenges elicited include forecasting demand, operational logistics, financial, manpower and policy constraints. Facilitators included outsourcing kit production, implementing standing orders and policy changes in naloxone scheduling, which allowed for easier hiring of staff, reduced paperwork and expanded client access. CONCLUSION For THN programmes preparing for potential increases in naloxone demand, we recommend creating an online database, implementing standing orders and developing online training resources for standardised knowledge translation to site staff and clients.
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Affiliation(s)
- Sympascho Young
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sierra Williams
- Harm Reduction, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Michael Otterstatter
- Harm Reduction, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Lee
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane Buxton
- Harm Reduction, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Olsen A, Dwyer R, Lenton S. Take-home naloxone in Australia and beyond. Drug Alcohol Rev 2018; 37:437-439. [PMID: 29744978 DOI: 10.1111/dar.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Olsen
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Simon Lenton
- National Drug Research Institute, Curtin University, Perth, Australia
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20
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Dwyer R, Olsen A, Fowlie C, Gough C, van Beek I, Jauncey M, Lintzeris N, Oh G, Dicka J, Fry CL, Hayllar J, Lenton S. An overview of take-home naloxone programs in Australia. Drug Alcohol Rev 2018; 37:440-449. [PMID: 29744980 DOI: 10.1111/dar.12812] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/06/2018] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Robyn Dwyer
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Centre for Cultural Diversity and Wellbeing, Victoria University, Melbourne, Australia.,National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Anna Olsen
- Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
| | - Carrie Fowlie
- Alcohol, Tobacco and Other Drug Association ACT, Canberra, Australia
| | - Chris Gough
- Canberra Alliance for Harm Minimisation and Advocacy, Canberra, Australia
| | | | | | - Nicholas Lintzeris
- Drug and Alcohol Services, South East Sydney Local Health District, NSW Health, Sydney, Australia
| | - Grace Oh
- Alcohol and Other Drug and Prevention Services - WA Mental Health Commission, Perth, Australia
| | - Jane Dicka
- Harm Reduction Victoria, Melbourne, Australia
| | - Craig L Fry
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Jeremy Hayllar
- Metro North Hospital and Health Service Alcohol and Drug Service, Queensland Health, Brisbane, Australia
| | - Simon Lenton
- National Drug Research Institute, Curtin University, Melbourne, Australia
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21
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Nielsen S, Larney S, Farrell M. Commentary on McDonald et al. (2018): Intranasal naloxone-from the laboratory to the real world. Addiction 2018; 113:494-495. [PMID: 29423984 DOI: 10.1111/add.14087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 10/31/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,South Eastern Sydney Local Health District Drug and Alcohol Services, Surry Hills, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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22
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Dietze PM, Draper B, Olsen A, Chronister KJ, van Beek I, Lintzeris N, Dwyer R, Nelson M, Lenton S. Does training people to administer take-home naloxone increase their knowledge? Evidence from Australian programs. Drug Alcohol Rev 2018; 37:472-479. [DOI: 10.1111/dar.12680] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/10/2017] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Paul M. Dietze
- Behaviours and Health Risks Program; Burnet Institute; Melbourne Australia
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Bridget Draper
- Behaviours and Health Risks Program; Burnet Institute; Melbourne Australia
| | - Anna Olsen
- Research School of Population Health; Australian National University; Canberra Australia
| | - Karen J. Chronister
- South Eastern Sydney Local Health District; Sydney Australia
- Kirby Institute, UNSW Sydney; Sydney Australia
| | - Ingrid van Beek
- South Eastern Sydney Local Health District; Sydney Australia
- Kirby Institute, UNSW Sydney; Sydney Australia
| | - Nicholas Lintzeris
- South Eastern Sydney Local Health District; Sydney Australia
- Division Addiction Medicine; University of Sydney; Sydney Australia
| | - Robyn Dwyer
- Social Studies of Addiction Concepts; National Drug Research Institute, Curtin University; Melbourne Australia
- Centre for Cultural Diversity and Wellbeing; Victoria University; Melbourne Australia
- Centre for Alcohol Policy Research; Curtin University; Melbourne Australia
| | - Marina Nelson
- National Drug Research Institute; Curtin University; Perth Australia
| | - Simon Lenton
- National Drug Research Institute; Curtin University; Perth Australia
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23
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Dietze PM, Stare M, Cogger S, Nambiar D, Olsen A, Burns L, Lenton S. Knowledge of naloxone and take-home naloxone programs among a sample of people who inject drugs in Australia: Variations across capital cities. Drug Alcohol Rev 2017; 37:457-463. [DOI: 10.1111/dar.12644] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 10/11/2017] [Accepted: 11/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Paul M. Dietze
- Centre for Research Excellence into Injecting Drug Use and Burnet Institute; Melbourne Australia
- School of Public Health and Preventive Medicine, Monash University; Melbourne Victoria
| | | | - Shelley Cogger
- Centre for Research Excellence into Injecting Drug Use and Burnet Institute; Melbourne Australia
| | - Dhanya Nambiar
- Centre for Research Excellence into Injecting Drug Use and Burnet Institute; Melbourne Australia
- School of Public Health and Preventive Medicine, Monash University; Melbourne Victoria
| | - Anna Olsen
- Australian National University; Canberra Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre; Sydney Australia
| | - Simon Lenton
- National Drug Research Institute; Curtin University; Perth Australia
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24
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Rzasa Lynn R, Galinkin JL. Naloxone dosage for opioid reversal: current evidence and clinical implications. Ther Adv Drug Saf 2017; 9:63-88. [PMID: 29318006 DOI: 10.1177/2042098617744161] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 11/03/2017] [Indexed: 12/18/2022] Open
Abstract
Opioid-related mortality is a growing problem in the United States, and in 2015 there were over 33,000 opioid-related deaths. To combat this mortality trend, naloxone is increasingly being utilized in a pre-hospital setting by emergency personnel and prescribed to laypersons for out-of-hospital administration. With increased utilization of naloxone there has been a subsequent reduction in mortality following an opioid overdose. Reversal of opioid toxicity may precipitate an opioid-withdrawal syndrome. At the same time, there is a risk of inadequate response or re-narcotization after the administration of a single dose of naloxone in patients who have taken large doses or long-acting opioid formulations, as the duration of effect of naloxone is shorter than that of many opioid agonists. As out-of-hospital use of this medication is growing, so too is concern about effective but safe dosing.
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Affiliation(s)
| | - J L Galinkin
- University of Colorado at Denver, Anschutz Medical Campus, 13123 East 16th Avenue, B090, Aurora, CO 80045-0508, USA
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25
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Farrugia A, Fraser S, Dwyer R. Assembling the Social and Political Dimensions of Take-Home Naloxone. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/0091450917723350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adrian Farrugia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Suzanne Fraser
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Robyn Dwyer
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia
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26
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Affiliation(s)
| | - Suzanne Nielsen
- Drug and Alcohol Services South Eastern Sydney Local Health District, Sydney
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27
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Nolan S, Buxton J, Dobrer S, Dong H, Hayashi K, Milloy MJ, Kerr T, Montaner J, Wood E. Awareness, Possession, and Use of Take-Home Naloxone Among Illicit Drug Users, Vancouver, British Columbia, 2014-2015. Public Health Rep 2017; 132:563-569. [PMID: 28750193 DOI: 10.1177/0033354917717230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Although take-home naloxone (THN) programs are integral in strategies to prevent overdose deaths among opioid users, the uptake of THN among people who use drugs (PWUD) (including non-opioid users) is unknown. The objectives of this study were to determine awareness, possession, and use of THN among PWUD in Vancouver, Canada, and identify barriers to adopting this strategy. METHODS From December 1, 2014, to May 29, 2015, participants in 2 prospective cohort studies of PWUD in Vancouver completed a standardized questionnaire, which asked about awareness, possession, and use of THN; sociodemographic characteristics; and drug use patterns. We conducted multivariable logistic regression analyses to determine factors independently associated with awareness and possession of THN. RESULTS Of 1137 PWUD, 727 (64%) reported at least 1 previous overdose ever, and 220 (19%) had witnessed an overdose in the previous 6 months. Although 769 (68%) participants overall reported awareness of THN, only 88 of 392 (22%) opioid users had a THN kit, 18 (20%) of whom had previously administered naloxone. Factors that were positively associated with awareness of THN included witnessing an overdose in the previous 6 months (adjusted odds ratio [aOR] = 2.23; 95% confidence interval [CI], 1.49-3.34; P < .001), possession of THN (aOR = 1.85; 95% CI, 1.11-3.06; P = .02), younger age (aOR = 1.02; 95% CI, 1.01-1.04; P = .003), white race (aOR = 1.67; 95% CI, 1.27-2.19; P < .001), hepatitis C infection (aOR = 1.63; 95% CI, 1.13-2.36; P = .01), residing in Vancouver's Downtown Eastside neighborhood (aOR = 1.93; 95% CI, 1.47-2.53; P < .001), and at least daily heroin injection (aOR = 1.69; 95% CI, 1.09-2.62; P < .02). CONCLUSION Efforts to improve knowledge of and participation in the THN program may contribute to reduced opioid overdose mortality in Vancouver.
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Affiliation(s)
- Seonaid Nolan
- 1 British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada.,2 Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jane Buxton
- 3 BC Centre for Disease Control, Vancouver, British Columbia, Canada.,4 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabina Dobrer
- 1 British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Huiru Dong
- 1 British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kanna Hayashi
- 1 British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada.,2 Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - M J Milloy
- 1 British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada.,2 Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- 1 British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada.,2 Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Julio Montaner
- 1 British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada.,2 Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Evan Wood
- 1 British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada.,2 Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
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28
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Pricolo A, Nielsen S. Naloxone rescheduling in Australia: Processes, implementation and challenges with supply of naloxone as a ‘pharmacist only’ over-the-counter medicine. Drug Alcohol Rev 2017; 37:450-453. [DOI: 10.1111/dar.12547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Suzanne Nielsen
- National Drug and Alcohol Centre; University of New South Wales; Sydney Australia
- Drug and Alcohol Services; South Eastern Sydney Local Health District; Sydney Australia
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29
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Nielsen S, Peacock A, Lintzeris N, Bruno R, Larance B, Degenhardt L. Knowledge of Opioid Overdose and Attitudes to Supply of Take-Home Naloxone Among People with Chronic Noncancer Pain Prescribed Opioids. PAIN MEDICINE 2017; 19:533-540. [DOI: 10.1093/pm/pnx021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills, New South Wales, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills, New South Wales, Australia
- Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia
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