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Acheson LS, Clay S, McKetin R, Lintzeris N, Dunlop A, Brett J, Christmass M, Rodgers C, Shoptaw S, Farrell M, Ezard N, Siefried KJ. Participant experiences in a pilot study for methamphetamine withdrawal treatment: Implications for retention. Int J Drug Policy 2024; 126:104383. [PMID: 38479162 DOI: 10.1016/j.drugpo.2024.104383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/21/2024] [Accepted: 03/03/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION There is little knowledge of the perspectives of people who use methamphetamine and have participated in clinical trials, and none for interventions not intended to address abstinence. A better understanding of these experiences could lead to more patient centred clinical trial design. This study seeks to understand the experiences of people who completed a clinical trial of lisdexamfetamine for the treatment of acute methamphetamine withdrawal. METHODS Thematic analysis of open-ended, semi-structured interviews with eight people who participated in an inpatient clinical trial of lisdexamfetamine for acute methamphetamine withdrawal. Interviews were conducted between days 3 and 6 of admission to an inner-city Sydney hospital. RESULTS Participants described how research procedures, the research setting, and the investigational product affected their experiences while enrolled in a clinical trial. Of particular importance to participants were transparent and low burden trial procedures, a welcoming trial environment, trusting relationships and effective communication, which were linked with the participants' subsequent decision to remain enrolled in the trial. DISCUSSION The experiences of participants in this clinical trial can be distilled into four meta-themes: agency, caring-trust, safety, and communication. Participants spontaneously linked these experiences with a capacity to remain enrolled in the study. By considering the experiences of trial participants in clinical trial design, researchers can improve the experiences of future trial participants and facilitate their choice to remain enrolled in clinical trials.
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Affiliation(s)
- Liam S Acheson
- The National Drug and Alcohol Research Centre (NDARC), University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia; Alcohol and Drug Service, St Vincent's Hospital Sydney, 390 Victoria St Darlinghurst, NSW 2010, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia.
| | - Simon Clay
- The National Drug and Alcohol Research Centre (NDARC), University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre (NDARC), University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia
| | - Nicholas Lintzeris
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, Australia; Drug and Alcohol Services, South East Sydney Local Health District, 591 S Dowling St, Surry Hills, NSW 2010, Australia; Specialty of Addiction Medicine, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Adrian Dunlop
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Lookout Rd, New Lambton Heights, NSW 2305, Australia; School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, NSW 2308, Australia
| | - Jonathan Brett
- Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, 390 Victoria St Darlinghurst, NSW 2010, Australia; St. Vincent's Clinical School, The University of New South Wales, 390 Victoria St Darlinghurst, NSW 2010, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Services, 32 Moore St, East Perth, WA, 6004, United States; National Drug Research Institute, Curtin University, Kent St, Bentley WA 6102, United States
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital Sydney, 390 Victoria St Darlinghurst, NSW 2010, Australia
| | - Steve Shoptaw
- Department of Family Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Michael Farrell
- The National Drug and Alcohol Research Centre (NDARC), University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital Sydney, 390 Victoria St Darlinghurst, NSW 2010, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia; New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, Australia
| | - Krista J Siefried
- The National Drug and Alcohol Research Centre (NDARC), University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia; Alcohol and Drug Service, St Vincent's Hospital Sydney, 390 Victoria St Darlinghurst, NSW 2010, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o University of New South Wales, 22-32 King St, Randwick, NSW 2031, Australia
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Harris O, Siefried KJ, Chiew A, Jamshidi N, Chung DT, Moore N, Nic Ionmhain U, Roberts DM, Ezard N, Brett J. Trends in reported GHB-related presentations to Sydney emergency departments between 2012 and 2021. Emerg Med Australas 2024. [PMID: 38558322 DOI: 10.1111/1742-6723.14402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES In overdose, gamma-hydroxybutyrate (GHB) and its precursors can cause decreased levels of consciousness, coma and death. Here, we aim to describe reported exposure to GHB at four EDs in Sydney, New South Wales (NSW), Australia. METHODS We searched the ED databases of four Sydney metropolitan hospitals for presentations relating to GHB exposure between 2012 and 2021. We calculated annual number of presentations stratified by hospital, age, sex, mode of arrival and triage category. RESULTS A total of 3510 GHB-related presentations to ED were recorded across the four hospitals. Data for all hospitals were only available from 2015 onwards and between 2015 and 2021; there was a 114% increase in annual presentations (from 228 to 487). Males represented 68.7% of all presentations and the median age was 31 years (range 16-74 years). There was an increase in the proportion of female presentations between 2012 and 2021 (from 27.9% to 37.9%) along with the severity of presentation over the same period, with the proportion of presentations with a triage category 1 increasing from 19.7% to 34.5%. CONCLUSIONS Increases in recorded absolute number and severity of GHB-related presentations to Sydney EDs are a major public health concern. There may also be shifts in the demographics of those with GHB-related presentations. Renewed efforts are required to understand the drivers of these increases to optimally target harm reduction approaches.
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Affiliation(s)
- Oliver Harris
- St Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Krista J Siefried
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs of Concern (NCCRED), c/o The University of New South Wales, Sydney, New South Wales, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
| | - Angela Chiew
- Toxicology Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Nazila Jamshidi
- Drug Health Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Clinical Pharmacology and Drug Health Services, Sydney Local Health Districy, Sydney, New South Wales, Australia
| | - Daniel T Chung
- Toxicology Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Nicholas Moore
- Clinical Toxicology & Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Una Nic Ionmhain
- Clinical Toxicology & Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Darren M Roberts
- Drug Health Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- New South Wales Poison's Information Centre, Sydney Children's Hospital Weastmead, Sydney, New South Wales, Australia
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs of Concern (NCCRED), c/o The University of New South Wales, Sydney, New South Wales, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
- Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
| | - Jonathan Brett
- St Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
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Acheson LS, Gordon C, McKetin R, Brett J, Christmass M, Rodgers C, Lintzeris N, Dunlop A, Farrell M, Shoptaw S, Ezard N, Siefried KJ. Measuring Objective and Subjective Sleep during Lisdexamfetamine Treatment of Acute Methamphetamine Withdrawal: A Feasibility Study. Eur Addict Res 2024; 30:121-125. [PMID: 38498995 DOI: 10.1159/000536328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/21/2023] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Sleep disturbance is common during methamphetamine (MA) use and withdrawal; however, the feasibility of combined subjective-objective measurement of sleep-wake has not been shown in this population. Actigraphy is a well-established, non-invasive measure of sleep-wake cycles with good concordance with polysomnography. This study aimed to investigate the feasibility and utility of using actigraphy and sleep diaries to investigate sleep during MA withdrawal. METHODS We conducted a feasibility and utility study of actigraphy and sleep diaries during a clinical trial of lisdexamfetamine for MA withdrawal. Participants were inpatients for 7 days, wore an actigraph (Philips Actiwatch 2) and completed a modified Consensus Sleep Diary each morning. Participants were interviewed between days 3-5. RESULTS Ten participants (mean age 37 years, 90% male) were enrolled. No participant removed the device prematurely. Participants interviewed (n = 8) reported that the actigraph was not difficult or distracting to wear or completion of daily sleep diary onerous. Actigraphic average daily sleep duration over 7 days was 568 min, sleep onset latency 22.4 min, wake after sleep onset (WASO) 75.2 min, and sleep efficiency 83.6%. Sleep diaries underreported daily sleep compared with actigraphy (sleep duration was 56 min (p = 0.008) and WASO 47 min (p < 0.001) less). Overall sleep quality was 4.4 on a nine-point Likert scale within the diary. CONCLUSIONS Continuous actigraphy is feasible to measure sleep-wake in people withdrawing from MA, with low participant burden. We found important differences in self-reported and actigraphic sleep, which need to be explored in more detail.
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Affiliation(s)
- Liam S Acheson
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Gordon
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Brett
- Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Services, Perth, Washington, Australia
- National Drug Research Institute, Curtin University, Perth, Washington, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
- Drug and Alcohol Services, Sydney, New South Wales, Australia
- Specialty of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrian Dunlop
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
- Drug and Alcohol Clinical Services, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael Farrell
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
| | - Steven Shoptaw
- Department of Family Medicine, The University of California Los Angeles, Los Angeles, California, USA
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o 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
| | - Krista J Siefried
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, New South Wales, Australia
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Sharafi H, Bakouni H, McAnulty C, Drouin S, Coronado-Montoya S, Bahremand A, Bach P, Ezard N, Le Foll B, Schütz CG, Siefried KJ, Tardelli VS, Ziegler D, Jutras-Aswad D. Prescription psychostimulants for the treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of randomized placebo-controlled trials. Addiction 2024; 119:211-224. [PMID: 37880829 DOI: 10.1111/add.16347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND AND AIMS There is currently no standard of care for pharmacological treatment of amphetamine-type stimulant (ATS) use disorder (ATSUD). This systematic review with meta-analysis (PROSPERO CRD42022354492) aimed to pool results from randomized placebo-controlled trials (RCTs) to evaluate efficacy and safety of prescription psychostimulants (PPs) for ATSUD. METHODS Major indexing sources and trial registries were searched to include records published before 29 August 2022. Eligible studies were RCTs evaluating efficacy and safety of PPs for ATSUD. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool. Risk ratio (RR) and risk difference were calculated for random-effect meta-analysis of dichotomous variables. Mean difference and standardized mean difference (SMD) were calculated for random-effect meta-analysis of continuous variables. RESULTS Ten RCTs (n = 561 participants) were included in the meta-analysis. Trials studied methylphenidate (n = 7), with daily doses of 54-180 mg, and dextroamphetamine (n = 3), with daily doses of 60-110 mg, for 2-24 weeks. PPs significantly decreased end-point craving [SMD -0.29; 95% confidence interval (CI) = -0.55, -0.03], while such a decrease did not reach statistical significance for ATS use, as evaluated by urine analysis (UA) (RR = 0.93; 95% CI = 0.85-1.01). No effect was observed for self-reported ATS use, retention in treatment, dropout following adverse events, early-stage craving, withdrawal and depressive symptoms. In a sensitivity analysis, treatment was associated with a significant reduction in UA positive for ATS (RR = 0.89; 95% CI = 0.79-0.99) after removing studies with a high risk of bias. In subgroup analyses, methylphenidate and high doses of PPs were negatively associated with ATS use by UA, while higher doses of PPs and treatment duration (≥ 20 weeks) were positively associated with longer retention. CONCLUSIONS Among individuals with amphetamine-type stimulant use disorder, treatment with prescription psychostimulants may decrease ATS use and craving. While effect size is limited, it may increase with a higher dosage of medications.
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Affiliation(s)
- Heidar Sharafi
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Hamzah Bakouni
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Christina McAnulty
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Sarah Drouin
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Stephanie Coronado-Montoya
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Arash Bahremand
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Paxton Bach
- Department of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, St Paul's Hospital, Vancouver, Canada
| | - Nadine Ezard
- National Centre for Clinical Research on Emerging Drugs (NCCRED), University of New South Wales, Sydney, Australia
- St Vincent's Hospital Sydney Alcohol and Drug Service, Darlinghurst, Australia
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, Australia
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| | - Christian G Schütz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Krista J Siefried
- National Centre for Clinical Research on Emerging Drugs (NCCRED), University of New South Wales, Sydney, Australia
- St Vincent's Hospital Sydney Alcohol and Drug Service, Darlinghurst, Australia
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, Australia
| | - Vitor S Tardelli
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Daniela Ziegler
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
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Bascombe F, Siefried KJ, Clifford B, Child S, Loos R, Sgouras H, Stevens L, Wilson H, Ezard N. Methamphetamine and emerging drugs of concern: A training needs analysis of Australian alcohol and other drug helplines. Drug Alcohol Rev 2023; 42:1744-1753. [PMID: 37452757 DOI: 10.1111/dar.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/25/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Fielding greater than 100,000 calls annually, telephone helplines are an important point of entry to alcohol and other drug (AOD) support and services in Australia. Methamphetamine and emerging drugs can present a particular challenge for this workforce. We sought to identify training needs for these services, so that appropriate targeted resources can be developed. METHODS We distributed an anonymous, online, cross-sectional survey to helpline staff from New South Wales, Queensland, South Australia, Victoria and Western Australia. Based on the WHO Hennessy-Hicks training needs analysis tool, participants were asked: to rate on a 7-point likert scale the importance of a topic to their practice and how well they perform in relation to the topic; open-ended questions specifying their own self-perceived training needs; and demographic data. RESULTS Of 50 participants, 29 completed the full survey (median age 49 [IQR 30-57.5]; median time working in AOD sector 6 years [IQR 1-20]). The results identified a need for: practical community-informed population relevant information for culturally and linguistically diverse populations and Aboriginal and Torres Strait Islander peoples for calls relating to methamphetamine and emerging drugs of concern; training and resources with a particular focus on families and friends of people who use methamphetamine and emerging drugs; and readily accessible up-to-date information on new and emerging drugs and treatment of related disorders. DISCUSSION AND CONCLUSIONS This training needs analysis provides a structured approach to supporting the first-line AOD counsellors to provide up-to-date and accurate information to assist Australians seeking information, support and advice.
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Affiliation(s)
- Florence Bascombe
- The National Centre for Clinical Research on Emerging Drugs, Sydney, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Krista J Siefried
- The National Centre for Clinical Research on Emerging Drugs, Sydney, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Brendan Clifford
- The National Centre for Clinical Research on Emerging Drugs, Sydney, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Stacey Child
- Alcohol and Drug Support Service, Mental Health Commission, Perth, Australia
| | - Rick Loos
- Telephone and Online Services, Turning Point, Eastern Health, Melbourne, Australia
| | - Hazel Sgouras
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
| | - Lynn Stevens
- Alcohol and Drug Information Service, Drug and Alcohol Service SA, Adelaide, Australia
| | - Hollie Wilson
- Adis 24/7 Alcohol and Drug Support, Queensland Health, Brisbane, Australia
| | - Nadine Ezard
- The National Centre for Clinical Research on Emerging Drugs, Sydney, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Black E, Bruno R, Mammen K, Mills L, Siefried KJ, Deacon RM, Shakeshaft A, Dunlop AJ, Ezard N, Montebello M, Childs S, Reid D, Holmes J, Lintzeris N. Substance use, socio-demographic characteristics, and self-rated health of people seeking alcohol and other drug treatment in New South Wales: baseline findings from a cohort study. Med J Aust 2023; 219:218-226. [PMID: 37449648 DOI: 10.5694/mja2.52039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate the demographic characteristics, substance use, and self-rated health of people entering treatment in New South Wales public health services for alcohol, amphetamine-type stimulants, cannabis, cocaine, or opioids use, by principal drug of concern. DESIGN Baseline findings of a cohort study; analysis of data in patient electronic medical records and NSW minimum data set for drug and alcohol treatment services. SETTING, PARTICIPANTS People completing initial Australian Treatment Outcomes Profile (ATOP) assessments on entry to publicly funded alcohol and other drug treatment services in six NSW local health districts/networks, 1 July 2016 - 30 June 2019. MAIN OUTCOME MEASURES Socio-demographic characteristics, and substance use and self-rated health (psychological, physical, quality of life) during preceding 28 days, by principal drug of concern. RESULTS Of 14 087 people included in our analysis, the principal drug of concern was alcohol for 6051 people (43%), opioids for 3158 (22%), amphetamine-type stimulants for 2534 (18%), cannabis for 2098 (15%), and cocaine for 246 (2%). Most people commencing treatment were male (9373, 66.5%), aged 20-39 years (7846, 50.4%), and were born in Australia (10 934, 86.7%). Polysubstance use was frequently reported, particularly by people for whom opioids or amphetamine-type stimulants were the principal drugs of concern. Large proportions used tobacco daily (53-82%, by principal drug of concern group) and reported poor psychological health (47-59%), poor physical health (32-44%), or poor quality of life (43-52%). CONCLUSIONS The prevalence of social disadvantage and poor health is high among people seeking assistance with alcohol, amphetamine-type stimulants, cannabis, cocaine, or opioids use problems. Given the differences in these characteristics by principal drug of concern, health services should collect comprehensive patient information during assessment to facilitate more holistic, tailored, and person-centred care.
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Affiliation(s)
- Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- Central Clinical School, the University of Sydney, Sydney, NSW
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- The University of Tasmania, Hobart, TAS
| | - Kristie Mammen
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
| | - Llewellyn Mills
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- Central Clinical School, the University of Sydney, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
| | - Krista J Siefried
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, NSW
| | - Rachel M Deacon
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- Central Clinical School, the University of Sydney, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- The Poche Centre for Indigenous Health, the University of Queensland, Brisbane, QLD
| | - Adrian J Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW
- The University of Newcastle, Newcastle, NSW
- Hunter Medical Research Institute, Newcastle, NSW
| | - Nadine Ezard
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, NSW
| | - Mark Montebello
- Central Clinical School, the University of Sydney, Sydney, NSW
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- Drug and Alcohol Services, North Sydney Local Health District, Sydney, NSW
| | - Steven Childs
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- Drug and Alcohol Services, Central Coast Local Health District, Gosford, NSW
| | - David Reid
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
- Drug and Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW
| | - Jennifer Holmes
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
- Central Clinical School, the University of Sydney, Sydney, NSW
- NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW Ministry of Health, Sydney, NSW
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Freestone J, Ezard N, Bourne A, Brett J, Roberts DM, Hammoud M, Nedanoski A, Prestage G, Siefried KJ. Understandings, attitudes, practices and responses to GHB overdose among GHB consumers. Harm Reduct J 2023; 20:121. [PMID: 37660058 PMCID: PMC10475182 DOI: 10.1186/s12954-023-00857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Gamma-hydroxybutyrate (GHB) is used at disproportionately high rates within sexuality and gender diverse communities and carries a high risk of overdose. GHB overdose can result in death. Internationally, recent increases in GHB overdoses have been observed. Coronial reviews of GHB-related death highlight the pivotal roles that bystanders to GHB overdose play in preventing fatality. No research has examined, in detail, how bystanders respond to GHB overdose. This qualitative study was conducted among people who use GHB and explored how they responded upon witnessing a GHB overdose experienced by someone else. METHODS Interviews were conducted with 31 sexuality and gender diverse Australian residents reporting three or more occasions of GHB use in the previous 12 months. Participants were asked questions about witnessed GHB overdose, their actions and decision-making processes throughout overdose. Data were analysed thematically. RESULTS Participants described witnessing GHB overdose, commonly in private settings involving sexualized GHB use. Variable definitions of GHB overdose were reported, ranging from GHB-induced symptoms of distress to comatose intoxication. Drastic actions to keep someone alert and responsive post-GHB ingestion were reported; these included the administration of stimulant substances and citrus. Decisions to call or not call for emergency medical services (EMS) were influenced by many circumstantial variables. In most instances, an EMS call was resisted and response practices deviated from established first aid protocols. CONCLUSIONS GHB overdose prevention and response training programs targeting people who use GHB are urgently required. These education interventions ought to address inaccuracies that inform street remedies for GHB overdose, teach people how to safely check breathing and response, promote basic first aid principles and address barriers to contacting EMS.
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Affiliation(s)
- Jack Freestone
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia.
- ACON, 414 Elizabeth Street, Surry Hills, NSW, 2010, Australia.
| | - Nadine Ezard
- National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, 2052, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, 2052, Australia
| | - Adam Bourne
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
- Australian Research Centre for Sex Health and Society, La Trobe University, Building NR6., Bundoora, VIC, 3086, Australia
| | - Jonathan Brett
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
| | - Darren M Roberts
- Edith Collins Centre, Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - Mohamed Hammoud
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | | | - Garrett Prestage
- The Kirby Institute, University of New South Wales Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | - Krista J Siefried
- National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, 2052, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, 2010, Australia
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, 2052, Australia
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8
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Clifford B, Van Gordon K, Magee F, Malone V, Siefried KJ, Graham D, Ezard N. "There's a big tag on my head": exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia. BMC Health Serv Res 2023; 23:162. [PMID: 36793060 PMCID: PMC9933255 DOI: 10.1186/s12913-023-09125-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Australia has a high prevalence of regular use of methamphetamine. While half of people who use methamphetamine regularly are women, they make up only one third of people seeking treatment for methamphetamine use disorder. There is a lack of qualitative research into the facilitators and barriers to treatment for women who use methamphetamine regularly. The study seeks a better understanding of the experiences and treatment preferences of women who use methamphetamine, to inform person-centred changes in practice and policy that break down barriers to treatment. METHODS We conducted semi-structured interviews with 11 women who frequently use methamphetamine (at least once a week), and who are not engaged in treatment. Women were recruited from health services surrounding a stimulant treatment centre at an inner-city hospital. Participants were asked about their methapmhetamine use and health service needs and preferences. Thematic analysis was completed using Nvivo® software. RESULTS Three themes were developed from participants' responses around experiences of regular methamphetamine use and treatment needs: 1. Resistance of stigmatised identity including dependence; 2. Interpersonal violence; 3. Institutionalised stigma. A fourth set of themes on service delivery preferences were also elicited, including continuity of care, integrated health care, and provision of non-judgmental services. CONCLUSION Gender-inclusive health care services for people who use methamphetamine should actively work to address stigma, support a relational approach to assessment and treatment, and seek to provide structurally competent health care that is trauma and violence informed, and integrated with other services. Findings may also have application for substance use disorders other than methamphetamine.
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Affiliation(s)
- Brendan Clifford
- Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia. .,National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales, Australia. .,Drug and Alcohol Clinical Research and Improvement Network, Sydney, New South Wales, Australia. .,National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia.
| | - Kate Van Gordon
- Victor Medical Centre, Victor Harbor, South Australia Australia
| | - Fiona Magee
- grid.477714.60000 0004 0587 919XSouth Eastern Sydney Local Health District, Sydney, New South Wales Australia
| | - Victoria Malone
- grid.437825.f0000 0000 9119 2677Alcohol & Drug Service, St Vincent’s Hospital Sydney, Sydney, New South Wales Australia
| | - Krista J. Siefried
- grid.437825.f0000 0000 9119 2677Alcohol & Drug Service, St Vincent’s Hospital Sydney, Sydney, New South Wales Australia ,grid.508539.2National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - Duncan Graham
- grid.508539.2National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales Australia
| | - Nadine Ezard
- grid.437825.f0000 0000 9119 2677Alcohol & Drug Service, St Vincent’s Hospital Sydney, Sydney, New South Wales Australia ,grid.508539.2National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales Australia ,Drug and Alcohol Clinical Research and Improvement Network, Sydney, New South Wales Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia
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9
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Aung HL, Siefried KJ, Gates TM, Brew BJ, Mao L, Carr A, Cysique LA. Meaningful cognitive decline is uncommon in virally suppressed HIV, but sustained impairment, subtle decline and abnormal cognitive aging are not. EClinicalMedicine 2023; 56:101792. [PMID: 36618901 PMCID: PMC9813694 DOI: 10.1016/j.eclinm.2022.101792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND High antiretroviral therapy (ART) coverage and viral suppression among people with HIV (PWH) in Australia provide a unique context to study individual cognitive trajectories, cognitive aging and factors associated with longitudinal cognitive function during chronic and stable HIV disease. METHODS Participants from the Predictors of Adherence to Antiretroviral Therapy study (n = 457, recruited between September 2013 and November 2015, median age = 52 years, and all with HIV RNA <50 copies mL) completed a cognitive assessment with CogState Computerized Battery (CCB) at baseline, Month-12, and Month-24. Demographics, psycho-social and socioeconomic factors, healthcare seeking behaviors, HIV disease characteristics and comorbidities were assessed. The CCB data were corrected for age, sex and practice effect and averaged into a global z-score (GZS). Cognitive impairment was defined with the global deficit score method (GDS>0.5). Meaningful cognitive change was statistically defined (decline or improvement versus stability, i.e., 90% CI, that is p < 0.05, 2-tailed) using a novel evidence-based change score: the linear mixed-effect regression (LMER)-based GZS change score. A separate LMER model with a top-down variable selection approach identified the independent effects of age and other demographic, HIV disease characteristics, socioeconomic and health-related factors on the demographically corrected GZS. The combined definitions of change and cross-sectional impairment enabled the identification of cognitive trajectories. FINDINGS At Month-12 and Month-24, 6% and 7% showed meaningful cognitive decline and 4% and 3% improved respectively. Only 1% showed sustained decline. Incident impairment due to subtle cognitive decline (i.e., below the threshold of meaningful cognitive decline) was 31% and 25% at Month-12 and Month-24, while 14% showed sustained impairment (i.e., cognitively impaired at all study visits). Older age (≥50 years) and time interaction was associated with lower demographically corrected GZS (β = -0.31, p < 0.001). Having a regular relationship, excellent English proficiency, and perceived stigma (avoidance) were associated with higher GZS (all p < 0.05). Relying on government subsidy, severe depression, and lower belief in ART necessity and higher concerns were associated with lower GZS (all p < 0.05). No HIV disease characteristics had a significant effect. INTERPRETATIONS Meaningful cognitive decline was not different from normal expectation in chronic stable HIV disease. Despite this, subtle cognitive decline, sustained cognitive impairment, and greater than normative-age cognitive aging were evident. FUNDING Funding for the PAART study was provided in part by unrestricted educational grants from Gilead Sciences (www.gilead.com) (Grant Number: IN-AU-264- 0131), the Balnaves Foundation (www.balnavesfoundation.com), the Victorian Department of Health and Human Services (Australia) (www.dhs.vic.gov.au/home), Western Australia Health (www.health.wa.gov.au), the ACT Ministry of Health (Australia) (www.health.act.gov.au), and in-kind support from the Queensland Department of Health (Australia) (www.health.qld.gov.au), and NHMRC Partnership grant APP1058474 (PI: Carr, Andrew).
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Affiliation(s)
- Htein Linn Aung
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine, UNSW, Australia
| | - Krista J. Siefried
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Immunology and HIV Unit, St Vincent's Hospital, Sydney, Australia
- The National Centre for Clinical Research on Emerging Drugs, Sydney, Australia
| | - Thomas M. Gates
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Australia
| | - Bruce J. Brew
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine, UNSW, Australia
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Australia
- Faculty of Medicine, University of Notre Dame, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Andrew Carr
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Immunology and HIV Unit, St Vincent's Hospital, Sydney, Australia
| | - Lucette A. Cysique
- St Vincent's Centre for Applied Medical Research, Sydney, Australia
- Departments of Neurology and HIV Medicine, St Vincent's Hospital, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Corresponding author. School of Psychology, The University of New South Wales, Matthews Building, Room 1012, 11 Botany Street, Sydney, NSW, 2052, Australia.
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10
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Black E, Mammen K, Deacon RM, Ezard N, Mills L, Dunlop AJ, Montebello M, Reid D, Childs S, Bruno R, Shakeshaft A, Siefried KJ, Farrell M, Holmes J, Lintzeris N. Health and social characteristics of clients reporting amphetamine type substance use at entry to public alcohol and other drug services in New South Wales, Australia, 2016-2019. Drug Alcohol Rev 2023; 42:389-400. [PMID: 36524444 PMCID: PMC10107800 DOI: 10.1111/dar.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Amphetamine type substances (ATS) are commonly used by Australian alcohol and other drug service entrants. We describe demographic characteristics, patterns of ATS and other substance use, health and social conditions among clients entering New South Wales (NSW) public alcohol and other drug services. METHODS Retrospective cohort of 13,864 records across six health districts (2016-2019) for clients seeking substance use treatment. These districts service approximately 44% of the NSW population aged 15 years and over. Multivariate analysis was conducted on a subsample for whom full data were available (N = 9981). Data included NSW Minimum Data Set for drug and alcohol treatment services and Australian Treatment Outcomes Profile items. RESULTS Over the preceding 4 weeks, 77% (n = 10,610) of clients (N = 13,864) reported no recent ATS use, 15% (n = 2109) reported 'low frequency' (1-12 days) and 8% (n = 1145) 'high frequency' (13-28 days) use. ATS use was most common among people attending for ATS or opioids as primary drug of concern. A multinomial regression (N = 9981) identified that clients reporting recent arrest (aOR 1.74, 95% CI 1.36, 2.24), higher cannabis use frequency (aOR 1.01, 95% CI 1.00, 1.02), lower opioid use frequency (aOR 0.98, 95% CI 0.97, 0.99) and poorer quality of life (aOR 0.91, 95% CI 0.86, 0.97) were more likely to report 'high frequency' rather than 'low frequency' ATS use. DISCUSSION AND CONCLUSIONS People who use ATS experience health and social issues that may require targeted responses. These should be integrated across all services, not only for clients with ATS as principal drug of concern.
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Affiliation(s)
- Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health DistrictSydneyAustralia
- Specialty of Addiction MedicineThe University of SydneySydneyAustralia
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Kristie Mammen
- Drug and Alcohol Services, South Eastern Sydney Local Health DistrictSydneyAustralia
| | - Rachel M. Deacon
- Drug and Alcohol Services, South Eastern Sydney Local Health DistrictSydneyAustralia
- Specialty of Addiction MedicineThe University of SydneySydneyAustralia
| | - Nadine Ezard
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- Alcohol and Drug Service, St Vincent's HospitalSydneyAustralia
- National Centre for Clinical Research on Emerging DrugsSydneyAustralia
- NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Ministry of HealthSydneyAustralia
| | - Llewellyn Mills
- Drug and Alcohol Services, South Eastern Sydney Local Health DistrictSydneyAustralia
- Specialty of Addiction MedicineThe University of SydneySydneyAustralia
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Adrian J. Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Ministry of HealthSydneyAustralia
- Drug and Alcohol Clinical Services, Hunter New England Local Health DistrictNewcastleAustralia
- School of Medicine and Public HealthCollege of Health & Wellbeing, University of NewcastleNewcastleAustralia
- HMRI Healthcare Transformation Research ProgramNewcastleAustralia
| | - Mark Montebello
- Specialty of Addiction MedicineThe University of SydneySydneyAustralia
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Ministry of HealthSydneyAustralia
- Drug and Alcohol Services, North Sydney Local Health DistrictSydneyAustralia
| | - David Reid
- NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Ministry of HealthSydneyAustralia
- Drug and Alcohol Services, Illawarra and Shoalhaven Local Health DistrictWollongongAustralia
| | - Steven Childs
- NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Ministry of HealthSydneyAustralia
- Drug and Alcohol Services, Central Coast Local Health DistrictGosfordAustralia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- School of Psychological SciencesUniversity of TasmaniaHobartAustralia
| | | | - Krista J. Siefried
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- Alcohol and Drug Service, St Vincent's HospitalSydneyAustralia
- National Centre for Clinical Research on Emerging DrugsSydneyAustralia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Jennifer Holmes
- Centre for Alcohol and other Drugs, NSW Ministry of HealthSydneyAustralia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health DistrictSydneyAustralia
- Specialty of Addiction MedicineThe University of SydneySydneyAustralia
- Drug and Alcohol Services, Illawarra and Shoalhaven Local Health DistrictWollongongAustralia
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11
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Acheson LS, Williams BH, Farrell M, McKetin R, Ezard N, Siefried KJ. Pharmacological treatment for methamphetamine withdrawal: A systematic review and meta-analysis of randomised controlled trials. Drug Alcohol Rev 2023; 42:7-19. [PMID: 35862266 PMCID: PMC10083934 DOI: 10.1111/dar.13511] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/08/2022] [Accepted: 06/21/2022] [Indexed: 01/10/2023]
Abstract
ISSUES Cessation of methamphetamine use may result in a characteristic withdrawal syndrome, no medication has been approved for this indication. This systematic review aims to assess the efficacy of pharmacotherapy for methamphetamine withdrawal, the first comprehensive meta-analysis since 2008. APPROACH MEDLINE (1966-2020), CINAHL (1982-2020), PsychINFO (1806-2020) and EMBASE (1947-2020) were systematically searched. Studies were included if they were randomised controlled trials (RCT) investigating pharmacological treatments for methamphetamine withdrawal, reviewing outcomes of treatment discontinuation, mental health outcomes, withdrawal symptoms (including craving) and patient safety. The relative risk (RR) and weighted mean difference (MD) were used to meta-analyse dichotomous and continuous data respectively, with 95% confidence intervals. Risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments were conducted. KEY FINDINGS Nine RCTs of six medications (n = 242 participants) met inclusion criteria, however, only six trials of four medications (n = 186) could be meta-analysed. Mean sample size across studies was 27 participants, and 88% of participants were male. The quality of evidence in this review varies from low to very low on GRADE assessments. Amineptine may reduce discontinuation rates (RR 0.22, 95% confidence interval [CI] 0.07, 0.72, p = 0.01), and improve global state (MD -0.49, 95% CI -0.80, -0.17), compared with placebo, however, this medication is no longer approved. No other medications improved any domain when compared with placebo. Due to lack of reporting safety profiles could not be established. CONCLUSIONS There is insufficient evidence to indicate any medication is effective for the treatment of methamphetamine withdrawal. The poor quality of the evidence indicates a need for better powered, high-quality trials.
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Affiliation(s)
- Liam S Acheson
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Centre for Clinical Research on Emerging Drugs, c/o UNSW Sydney, Sydney, Australia
| | - Benjamin H Williams
- Department of Psychiatry, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
| | - Michael Farrell
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nadine Ezard
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Centre for Clinical Research on Emerging Drugs, c/o UNSW Sydney, Sydney, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Krista J Siefried
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Centre for Clinical Research on Emerging Drugs, c/o UNSW Sydney, Sydney, Australia
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12
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Freeman G, Siefried KJ, Roberts DM, Rodgers C, Nic Ionmhain U, Ramanathan J, Ezard N, Brett J. Phenobarbital to manage severe gamma-hydroxybutyrate withdrawal: A case series. Drug Alcohol Rev 2023; 42:27-32. [PMID: 36269081 DOI: 10.1111/dar.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/05/2022] [Accepted: 09/13/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Management of a withdrawal syndrome following cessation of regular gamma-hydroxybutyrate (GHB) use, and its precursors, can represent a clinical challenge due to rapid onset delirium and/or seizures. Severe GHB withdrawal can be characterised by persistent or worsening features despite increasing benzodiazepine doses and regular baclofen. Barbiturates, such as phenobarbital, are an appealing option in this context due to their unique GABA-A receptor action. CASE SERIES This series describes the use of phenobarbital in 13 cases, 12 patients, across two hospitals in Sydney, Australia, with persistent or progressive GHB withdrawal despite benzodiazepine-based management. A median cumulative dose of oral diazepam prior to commencing phenobarbital was 120 mg (range 80-255 mg). The median time from the last GHB use to the first dose of phenobarbital was 24 h (range 7-57 h). Eight cases received phenobarbital orally on a general ward and 5 intravenously in intensive care units. An improvement in GHB withdrawal symptoms was observed after phenobarbital in all cases and there were no adverse events related to phenobarbital. DISCUSSION AND CONCLUSION This case series suggests that phenobarbital for the management of benzodiazepine-resistant GHB withdrawal can be safe, even in general inpatient settings, and may avert the progression of delirium. Most data on the management of GHB withdrawal comes from case reports or series, such as this one. This highlights the need for prospective trials to establish an evidence base for therapeutic approaches, including validated measures of withdrawal severity and more information relating to the safe and effective dosing of phenobarbital.
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Affiliation(s)
- Georgia Freeman
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
| | - Krista J Siefried
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,National Centre for Clinical Research on Emerging Drugs of Concern, c/o UNSW, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Darren M Roberts
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, Australia.,Drug Health, Royal Prince Alfred Hospital, Sydney, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
| | - Una Nic Ionmhain
- Liverpool Hospital, Sydney, Australia.,South West Sydney Clinical School, UNSW Sydney, Sydney, Australia
| | | | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,National Centre for Clinical Research on Emerging Drugs of Concern, c/o UNSW, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,New South Wales Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Jonathan Brett
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, Australia
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13
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Acheson LS, Ezard N, Lintzeris N, Dunlop A, Brett J, Rodgers C, Gill A, Christmass M, McKetin R, Farrell M, Shoptaw S, Siefried KJ. Lisdexamfetamine for the treatment of acute methamphetamine withdrawal: A pilot feasibility and safety trial. Drug Alcohol Depend 2022; 241:109692. [PMID: 36399936 DOI: 10.1016/j.drugalcdep.2022.109692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is no effective treatment for methamphetamine withdrawal. This study aimed to determine the feasibility and safety of a tapering dose of lisdexamfetamine for the treatment of acute methamphetamine (MA) withdrawal. METHODS Open-label, single-arm pilot study, in an inpatient drug and alcohol withdrawal unit assessing a tapering dose of oral lisdexamfetamine dimesylate commencing at 250 mg once daily, reducing by 50 mg per day to 50 mg on Day 5. Measures were assessed daily (days 0-7) with 21-day telephone follow-up. Feasibility was measured by the time taken to enrol the sample. Safety was the number of adverse events (AEs) by system organ class. Retention was the proportion to complete treatment. Other measures included the Treatment Satisfaction Questionnaire for Medication (TSQM), the Amphetamine Withdrawal Questionnaire and craving (Visual Analogue Scale). RESULTS Ten adults seeking inpatient treatment for MA withdrawal (9 male, median age 37.1 years [IQR 31.7-41.9]), diagnosed with MA use disorder were recruited. The trial was open for 126 days; enroling one participant every 12.6 days. Eight of ten participants completed treatment (Day 5). Two participants left treatment early. There were no treatment-related serious adverse events (SAEs). Forty-seven AEs were recorded, 17 (36%) of which were potentially causally related, all graded as mild severity. Acceptability of the study drug by TSQM was rated at 100% at treatment completion. Withdrawal severity and craving reduced through the admission. CONCLUSION A tapering dose regimen of lisdexamfetamine was safe and feasible for the treatment of acute methamphetamine withdrawal in an inpatient setting.
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Affiliation(s)
- Liam S Acheson
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia; Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia.
| | - Nadine Ezard
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia; Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia; New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia
| | - Nicholas Lintzeris
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia; The Langton Centre, South East Sydney Local Health District, Sydney, Australia; Discipline of Addiction Medicine, the University of Sydney, Sydney, Australia
| | - Adrian Dunlop
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia; School of Medicine and Public Health, the University of Newcastle, Newcastle, Australia
| | - Jonathan Brett
- Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia; St. Vincent's Clinical School, the University of New South Wales, Sydney, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
| | - Anthony Gill
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Services, Perth, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
| | - Michael Farrell
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
| | - Steve Shoptaw
- Department of Family Medicine, The University of California Los Angeles, Los Angeles, USA
| | - Krista J Siefried
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia; Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia
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14
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Acheson LS, Ezard N, Lintzeris N, Dunlop A, Brett J, Rodgers C, Gill A, Christmass M, McKetin R, Farrell M, Shoptaw S, Siefried KJ. Trial protocol of an open label pilot study of lisdexamfetamine for the treatment of acute methamphetamine withdrawal. PLoS One 2022; 17:e0275371. [PMID: 36190973 PMCID: PMC9529099 DOI: 10.1371/journal.pone.0275371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Methamphetamine (MA) use disorder is an important public health concern. MA withdrawal is often the first step in ceasing or reducing use. There are no evidence-based withdrawal treatments, and no medication is approved for the treatment of MA withdrawal. Lisdexamfetamine (LDX) dimesilate, used in the treatment of attention deficit hyperactivity disorder and binge eating disorder has the potential as an agonist therapy to ameliorate withdrawal symptoms, and improve outcomes for patients. Methods A single arm, open-label pilot study to test the safety and feasibility of LDX for the treatment of MA withdrawal. Participants will be inpatients in a drug and alcohol withdrawal unit, and will receive a tapering dose of LDX over five days: 250mg LDX on Day 1, reducing by 50mg per day to 50mg on Day 5. Optional inpatient Days 6 and 7 will allow for participants to transition to ongoing treatment. Participants will be followed-up on Days 14, 21 and 28. All participants will also receive standard inpatient withdrawal care. The primary outcomes are safety (measured by adverse events, changes in vital signs, changes in suicidality and psychosis) and feasibility (the time taken to enrol the sample, proportion of screen / pre-screen failures). Secondary outcomes are acceptability (treatment satisfaction questionnaire, medication adherence, concomitant medications, qualitative interviews), retention to protocol (proportion retained to primary and secondary endpoints), changes in withdrawal symptoms (Amphetamine Withdrawal Questionnaire) and craving for MA (visual analogue scale), and sleep outcomes (continuous actigraphy and daily sleep diary). Discussion This is the first study to assess lisdexamfetamine for the treatment of acute MA withdrawal. If safe and feasible results will go to informing the development of multi-centre randomised controlled trials to determine the efficacy of the intervention.
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Affiliation(s)
- Liam S. Acheson
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
- Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia
- * E-mail:
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, Australia
| | - Nicholas Lintzeris
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, Australia
- The Langton Centre, South East Sydney Local Health District, Sydney, Australia
- Discipline of Addiction Medicine, the University of Sydney, Sydney, Australia
| | - Adrian Dunlop
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, Australia
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
- School of Medicine and Public Health, the University of Newcastle, Newcastle, Australia
| | - Jonathan Brett
- Clinical Pharmacology and Toxicology, St Vincent’s Hospital Sydney, Sydney, Australia
- St. Vincent’s Clinical School, the University of New South Wales, Sydney, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia
| | - Anthony Gill
- Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Services, Perth, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
| | - Michael Farrell
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
| | - Steve Shoptaw
- Department of Family Medicine, The University of California Los Angeles, Los Angeles, California, United States of America
| | - Krista J. Siefried
- The National Drug and Alcohol Research Centre (NDARC), the University of New South Wales, Sydney, Australia
- Alcohol and Drug Service, St Vincent’s Hospital Sydney, Sydney, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, Australia
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Freestone J, Prestage G, Bourne A, Ezard N, Race K, Nedanoski A, Murray J, Siefried KJ. Controlling for pleasure and risk: The experiences of sexuality and gender diverse people who use GHB. International Journal of Drug Policy 2022; 105:103747. [DOI: 10.1016/j.drugpo.2022.103747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Page R, Healey A, Siefried KJ, Harrod ME, Franklin E, Peacock A, Barratt MJ, Brett J. Barriers to help-seeking among music festival attendees in New South Wales, Australia. Drug Alcohol Rev 2022; 41:1322-1330. [PMID: 35604869 PMCID: PMC9545606 DOI: 10.1111/dar.13479] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 12/01/2022]
Abstract
Introduction Prompt help‐seeking behaviour by music festival attendees can reduce risks associated with drug use; however, little is known about perceived barriers to help‐seeking when experiencing or witnessing illness at music festivals. We explored potential barriers and their association with festivalgoer characteristics. Methods We conducted an on‐site cross‐sectional survey of attendees at New South Wales music festivals in 2019/2020. Perceived barriers to help‐seeking in the hypothetical event of the respondent or a friend becoming unwell at the festival were assessed, and regression analyses were conducted to identify characteristics associated with these barriers. Results Across six festivals, 1229 people were surveyed and four‐fifths (83.2%) reported ≥1 barrier: 32.7% fear of getting in trouble with the police, 20.6% not knowing where to find help, 17.2% not knowing how unwell someone might be and 15.3% concern about friends or relatives finding out. In multivariable analyses, people of diverse sexuality and people using drugs that day had greater odds of reporting fear of trouble with the police. People reporting drug use that day had lower odds of reporting not knowing where to find help. Men, gender‐diverse people and people using drugs that day had greater odds of reporting concern about friends or relatives finding out. Discussion and Conclusions Our data substantiate concerns regarding policing strategies and their impact on festivals. Initiatives to support conversations about drugs with friends and families may be best targeted to younger people and those from gender‐diverse backgrounds.
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Affiliation(s)
- Robert Page
- Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Healey
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Krista J Siefried
- Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,National Centre for Clinical Research on Emerging Drugs, Sydney, Australia
| | | | - Erica Franklin
- New South Wales Users and AIDS Association, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Monica J Barratt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, Australia
| | - Jonathan Brett
- Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia
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Healey A, Siefried KJ, Harrod ME, Franklin E, Peacock A, Barratt MJ, Brett J. Correlates of higher-risk drug-related behaviours at music festivals in New South Wales, Australia. Drug Alcohol Rev 2021; 41:320-329. [PMID: 34793619 DOI: 10.1111/dar.13404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/05/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There are few contemporary data on illicit drug use at music festivals. We describe drug use patterns and prevalence of specific higher-risk drug-related behaviours, and their associations with festivalgoer characteristics. METHODS We approached attendees at six major music festivals in New South Wales, Australia, from November 2019 to March 2020. Participants self-completed an anonymous survey on prior and intended drug use and associated higher-risk behaviours; double dropping; higher-volume ethanol alongside drug use; higher quantity 3,4-methylenedioxymethamphetamine (MDMA); mixing stimulants; and preloading. Logistic regression and UpSet analyses were performed to identify festivalgoer characteristics and the intersection of high-risk behaviours, respectively. RESULTS Of 1229 participants, 372 (30.3%) used or planned to use drugs at the festival. In multivariable analyses, men and those purchasing drugs both inside and outside the venue had greater odds of engaging in higher-risk behaviours. Of those using MDMA, 47.9% reported double dropping. People using drugs for the first time had 3.3 (95% confidence interval 1.2-8.7) greater odds of higher-volume ethanol alongside drug use. People reporting that police/police dog presence influenced their decision to take drugs had 2.2 (95% confidence interval 1.4-3.6) greater odds of preloading. In UpSet analysis, preloading was the most common intersection (17% of those using drugs). DISCUSSIONS AND CONCLUSIONS Engagement in the five higher-risk drug behaviours was common, particularly amongst males and those using drugs for the first time, while police/police dog presence appeared to influence higher-risk behaviours amongst festival attendees. This information can be used to inform harm reduction advice, public health and law enforcement strategies.
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Affiliation(s)
- Amy Healey
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Krista J Siefried
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,National Centre for Clinical Research on Emerging Drugs, UNSW Sydney, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Erica Franklin
- DanceWize NSW, New South Wales Users Association, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,School of Psychology, University of Tasmania, Hobart, Australia
| | - Monica J Barratt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, Australia
| | - Jonathan Brett
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia
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Brett J, Siefried KJ, Healey A, Harrod ME, Franklin E, Barratt MJ, Masters J, Nguyen L, Adiraju S, Gerber C. Wastewater analysis for psychoactive substances at music festivals across New South Wales, Australia in 2019-2020. Clin Toxicol (Phila) 2021; 60:440-445. [PMID: 34542387 DOI: 10.1080/15563650.2021.1979233] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Implementation of wastewater surveillance at music festivals has been limited to date. We aimed to use wastewater analysis and a self-report survey to determine the range of psychoactive substances being used during a music festival season in New South Wales, Australia. METHODS We sampled six single-day music festivals requiring a music festival license in New South Wales from March 2019 to March 2020; between 15% and 100% of portaloos (temporary, un-fixed toilet facilities) were sampled at each festival. Samples were screened for 98 psychoactive substances and/or their metabolites with results qualitatively expressed as detection frequencies for each substance at each festival and across all festivals. We compared these data with the results of surveys of self-reported drug use at four of the six festivals. RESULTS Festival attendance ranged from 6200 to 14,975 people. Amphetamine, cocaine, ketamine, methylone, MDMA, MDA, alprazolam, diazepam, etizolam, oxazepam and temazepam were found in almost all samples from all festivals. Ethylone, mephedrone and methcathinone were also found in over 50% of festivals. A norfentanyl (a fentanyl metabolite) and n-ethylpentylone were found at 2/6 and 1/6 festivals. No festival survey participant reported intentionally taking cathinones. DISCUSSION The detection frequency for cathinones was higher than expected relative to recent other data sources and this may represent adulteration or substitution. Similarly, the appearance of etizolam may be related to the use of counterfeit alprazolam. The detection of highly toxic substances such as N-ethylpentylone and norfentanyl may warrant public health alerts. CONCLUSION If provided close to real time, wastewater analysis at festivals could be complemented with information sources such as drug checking, on-site surveys, medical presentations and intelligence from peer networks to feed into early warning systems, public health alerts and peer-based harm reduction education during the festival season.
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Affiliation(s)
- Jonathan Brett
- Clinical Pharmacology and Toxicology Department, St Vincent's Hospital, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital, Sydney, Australia
| | - Krista J Siefried
- Alcohol and Drug Service, St Vincent's Hospital, Sydney, Australia.,National Centre for Clinical Research on Emerging Drugs, c/o the University of New South Wales, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Healey
- Clinical Pharmacology and Toxicology Department, St Vincent's Hospital, Sydney, Australia
| | - Mary Ellen Harrod
- DanceWize NSW, New South Wales Users and AIDS Association, Surry Hills, Australia
| | - Erica Franklin
- DanceWize NSW, New South Wales Users and AIDS Association, Surry Hills, Australia
| | - Monica J Barratt
- Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, New South Wales, Australia
| | - Jem Masters
- Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Lynn Nguyen
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Santosh Adiraju
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Cobus Gerber
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
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Acheson LS, Siefried KJ, Clifford B, Murray E, Steele M, Clague L, Malone V, Roberts DM, Ferguson LJ, Matthews GV, Ezard N. One-third of people who inject drugs are at risk of incomplete treatment for Staphylococcus aureus bacteraemia: a retrospective medical record review. Int J Infect Dis 2021; 112:63-65. [PMID: 34520844 DOI: 10.1016/j.ijid.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
Staphylococcus aureus bacteraemia (SAB) is often a complication of injecting drug use, and is associated with high morbidity and mortality. This article reports the first audit of inpatient parenteral treatment of SAB completion among people who inject drugs (PWID) in Australia. Of 198 patients admitted with SAB, 106 were analysed. Twelve PWID had an inpatient stay <14 days compared with seven non-PWID (34% vs 10%; P=0.002). Sixteen PWID experienced discharge against medical advice compared with zero non-PWID (46% vs 0%; P<0.001). Re-admission to hospital within 28 days was 2.5 times greater among PWID than non-PWID (31% vs 15%; P=0.026). Methadone dose <60 mg/day was associated with premature discharge in opioid-dependent PWID receiving methadone (n=21, 100% vs 31%; P=0.012).
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Affiliation(s)
- Liam S Acheson
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.
| | - Krista J Siefried
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; National Centre for Clinical Research on Emerging Drugs, UNSW Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Brendan Clifford
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; University of Sydney, Camperdown, NSW, Australia
| | - Emily Murray
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; University of Notre Dame, Sydney, Australia
| | - Maureen Steele
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Liesa Clague
- University of Newcastle, Callaghan, NSW, Australia
| | | | - Darren M Roberts
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | | | - Gail V Matthews
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Nadine Ezard
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; National Centre for Clinical Research on Emerging Drugs, UNSW Sydney, NSW, Australia
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Siefried KJ, Ezard N, Christmass M, Haber P, Ali R, The Nccred Methamphetamine And Emerging Drugs Clinical Research Network Working Group. A clinical research priority setting study for issues related to the use of methamphetamine and emerging drugs of concern in Australia. Drug Alcohol Rev 2021; 41:309-319. [PMID: 34237176 PMCID: PMC9290984 DOI: 10.1111/dar.13350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/01/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study aimed to gather a range of opinions, including those of affected people (consumers, concerned others) to identify clinical research priorities for methamphetamine and emerging drugs of concern in Australia, to guide the work of the National Centre for Clinical Research on Emerging Drugs (NCCRED). METHODS A priority setting study was conducted (February-March 2019) in four phases: online stakeholder survey, thematic analysis of responses, rapid literature review, expert panel ranking of priorities against predetermined criteria. RESULTS Forty-seven respondents completed the survey, including people identifying as one or more of: researcher (53%, n = 25), clinician (45%; n = 21), family/friend/caregiver of someone who uses methamphetamine/emerging drugs (15%, n = 7) and consumer of methamphetamine/emerging drugs (13%, n = 6). Expert panel, evidence-informed top-ranked clinical research priorities for methamphetamine were: strategies to overcome barriers to intervention uptake, pilot medication trials for adults seeking treatment, and communication strategies regarding evidence-based treatments. For emerging drugs of concern, top-ranked priorities were: piloting community-located drug checking, feasibility of social media/other opportunities to alert consumers of emerging risks, GHB overdose and withdrawal management, and impacts of an early warning information system on reducing harms. DISCUSSION AND CONCLUSIONS We demonstrate feasibility of a structured, collaborative clinical research priority setting process. Results have informed the establishment of NCCRED; using the identified priorities to guide seed funding, fellowships/scholarships and research programs. Broader uptake of this methodology by policymakers/research funders would assist to embed areas of concern identified by affected communities and other stakeholders in research prioritisation.
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Affiliation(s)
- Krista J Siefried
- The National Centre for Clinical Research on Emerging Drugs, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nadine Ezard
- The National Centre for Clinical Research on Emerging Drugs, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia.,The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Services, Mental Health Commission, Perth, Australia.,National Drug Research Institute, Curtin University, Perth, Australia
| | - Paul Haber
- Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine University of Sydney, Sydney, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Robert Ali
- School of Medicine, Adelaide University, Adelaide, Australia
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Ezard N, Clifford B, Dunlop A, Bruno R, Carr A, Liu Z, Siefried KJ, Lintzeris N. Safety and tolerability of oral lisdexamfetamine in adults with methamphetamine dependence: a phase-2 dose-escalation study. BMJ Open 2021; 11:e044696. [PMID: 34006547 PMCID: PMC8137170 DOI: 10.1136/bmjopen-2020-044696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine the safety of an agonist-type treatment, lisdexamfetamine (LDX), at 250 mg/day among adults with methamphetamine (MA) dependence. DESIGN A dose-escalating, phase-2, open-label, single-group study of oral LDX at two Australian drug treatment services. SETTING The study was conducted at two Australian stimulant use disorder treatment clinics. PARTICIPANTS There were 16 participants: at least 18 years old, MA dependent for at least the preceding 2 years using ICD-10 criteria, reporting use of MA on at least 14 of the preceding 28 days. INTERVENTIONS Daily, supervised LDX of 100-250 mg, single-blinded to dose, ascending-descending regimen over 8 weeks (100-250 mg over 4 weeks; followed by 4-week dose reduction regimen, 250-100 mg). Participants were followed through to week 12. OUTCOMES Primary outcomes were safety, drug tolerability and regimen completion at the end of week 4. Participants were followed to week 12. Secondary outcomes included: change in MA use; craving; withdrawal; severity of dependence; risk behaviour; change in other substance use; medication acceptability; potential for non-prescription use; adherence and neurocognitive functioning. RESULTS Fourteen of 16 participants (87.5%) completed escalation to 250 mg/day. Two participants withdrew from the trial in the first week: one relocated away from the study site, the other self-withdrew due to a possible, known side effect of LDX (agitation). There was one serious adverse event of suicidal ideation which resolved. All other adverse events were mild or moderate in severity and known side effects of LDX. No participant was withdrawn due to adverse events. MA use decreased from a median of 21 days (IQR: 16-23) to 13 days (IQR: 11-17) over the 4-week escalation period (p=0.013). CONCLUSIONS LDX at a dose of up to 250 mg/day was safe and well tolerated by study participants, warranting larger trials as a pharmacotherapy for MA dependence. TRIAL REGISTRATION NUMBER ACTRN12615000391572.
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Affiliation(s)
- Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- National Centre for Clinical Research on Emerging Drugs, C/O University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- National Drug and Alcohol Research Centre, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Drug and Alcohol Clinical Research and Improvement Network, C/O South East Sydney Local Health District, Sydney, New South Wales, Australia
| | - Brendan Clifford
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- Susan Wakil School of Nursing & Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Research and Improvement Network, C/O South East Sydney Local Health District, Sydney, New South Wales, Australia
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle Faculty of Health, Callaghan, New South Wales, Australia
| | - Raimondo Bruno
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew Carr
- Centre for Applied Medical Research, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Zhixin Liu
- Centre for Applied Medical Research, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- Mark Wainwright Analytical Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Krista J Siefried
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- National Centre for Clinical Research on Emerging Drugs, C/O University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- National Drug and Alcohol Research Centre, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Clinical Research and Improvement Network, C/O South East Sydney Local Health District, Sydney, New South Wales, Australia
- Division of Addiction Medicine, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The Langton Centre, South East Sydney Local Health District, Sydney, New South Wales, Australia
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Siefried KJ, Kerr S, Richardson R, Mao L, Rule J, McAllister J, de Wit J, Carr A. Socioeconomic and psychosocial factors are associated with poor treatment outcomes in Australian adults living with HIV: a case-control study. Sex Health 2020; 16:548-553. [PMID: 31514798 DOI: 10.1071/sh18138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 04/16/2019] [Indexed: 11/23/2022]
Abstract
Background A substantial minority of patients living with HIV refuse or cease antiretroviral therapy (ART), have virological failure (VF) or develop an AIDS-defining condition (ADC) or serious non-AIDS event (SNAE). It is not understood which socioeconomic and psychosocial factors may be associated with these poor outcomes. METHODS Thirty-nine patients with poor HIV treatment outcomes, defined as those who refused or ceased ART, had VF or were hospitalised with an ADC or SNAE (cases), were compared with 120 controls on suppressive ART. A self-report survey recorded demographics, physical health, life stressors, social supports, HIV disclosure, stigma or discrimination, health care access, treatment adherence, side effects, health and treatment perceptions and financial and employment status. Socioeconomic and psychosocial covariates significant in bivariate analyses were assessed with conditional multivariable logistic regression, adjusted for year of HIV diagnosis. RESULTS Cases and controls did not differ significantly with regard to sex (96.2% (n = 153) male) or age (mean (± s.d.) 51 ± 11 years). Twenty cases (51%) had refused or ceased ART, 35 (90%) had an HIV viral load >50 copies mL-1, 12 (31%) were hospitalised with an ADC and five (13%) were hospitalised with a new SNAE. Three covariates were independently associated with poor outcomes: foregoing necessities for financial reasons (adjusted odds ratio (aOR) 3.1, 95% confidence interval (95% CI) 1.3-7.6, P = 0.014), cost barriers to accessing HIV care (aOR 3.1, 95% CI 1.0-9.6, P = 0.049) and lower quality of life (aOR 3.8, 95% CI 1.5-9.7, P = 0.004). CONCLUSIONS Despite universal health care, socioeconomic and psychosocial factors are associated with poor HIV outcomes in adults in Australia. These factors should be addressed through targeted interventions to improve long-term successful treatment.
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Affiliation(s)
- Krista J Siefried
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia; and National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW 2052, Australia; and Corresponding author.
| | - Stephen Kerr
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - Robyn Richardson
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - John Rule
- National Association of People with HIV Australia, 1 Erskineville Road, Newtown, NSW 2042, Australia; and School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - John McAllister
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - John de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia; and Department of Interdisciplinary Social Science, Utrecht University, PO Box 80125, 3508 TC Utrecht, The Netherlands
| | - Andrew Carr
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
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Abstract
BACKGROUND Stimulant drugs are second only to cannabis as the most widely used class of illicit drug globally, accounting for 68 million past-year consumers. Dependence on amphetamines (AMPH) or methamphetamine (MA) is a growing global concern. Yet, there is no established pharmacotherapy for AMPH/MA dependence. A comprehensive assessment of the research literature on pharmacotherapy for AMPH/MA dependence may inform treatment guidelines and future research directions. METHODS We systematically reviewed the peer-reviewed literature via the electronic databases PubMed, EMBASE, CINAHL and SCOPUS for randomised controlled trials reported in the English language examining a pharmacological treatment for AMPH/MA dependence or use disorder. We included all studies published to 19 June 2019. The selected studies were evaluated for design; methodology; inclusion and exclusion criteria; sample size; pharmacological and (if included) psychosocial interventions; length of follow-up and follow-up schedules; outcome variables and measures; results; overall conclusions and risk of bias. Outcome measures were any reported impact of treatment related to AMPH/MA use. RESULTS Our search returned 43 studies that met our criteria, collectively enrolling 4065 participants and reporting on 23 individual pharmacotherapies, alone or in combination. Disparate outcomes and measures (n = 55 for the primary outcomes) across studies did not allow for meta-analyses. Some studies demonstrated mixed or weak positive signals (often in defined populations, e.g. men who have sex with men), with some variation in efficacy signals dependent on baseline frequency of AMPH/MA use. The most consistent positive findings have been demonstrated with stimulant agonist treatment (dexamphetamine and methylphenidate), naltrexone and topiramate. Less consistent benefits have been shown with the antidepressants bupropion and mirtazapine, the glutamatergic agent riluzole and the corticotropin releasing factor (CRF-1) antagonist pexacerfont; whilst in general, antidepressant medications (e.g. selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants [TCAs]) have not been effective in reducing AMPH/MA use. CONCLUSIONS No pharmacotherapy yielded convincing results for the treatment of AMPH/MA dependence; mostly studies were underpowered and had low treatment completion rates. However, there were positive signals from several agents that warrant further investigation in larger scale studies; agonist therapies show promise. Common outcome measures should include change in use days. Future research must address the heterogeneity of AMPH/MA dependence (e.g. coexisting conditions, severity of disorder, differences between MA and AMPH dependence) and the role of psychosocial intervention.
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Affiliation(s)
- Krista J Siefried
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), Sydney, NSW, Australia.
- St Vincent's Hospital Alcohol and Drug Service, Darlinghurst, 390 Victoria St, 2010, Sydney, NSW, Australia.
- The University of New South Wales, National Drug and Alcohol Research Centre (NDARC), Sydney, NSW, Australia.
| | - Liam S Acheson
- St Vincent's Hospital Alcohol and Drug Service, Darlinghurst, 390 Victoria St, 2010, Sydney, NSW, Australia
| | - Nicholas Lintzeris
- Division of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, NSW, Australia
| | - Nadine Ezard
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), Sydney, NSW, Australia
- St Vincent's Hospital Alcohol and Drug Service, Darlinghurst, 390 Victoria St, 2010, Sydney, NSW, Australia
- The University of New South Wales, National Drug and Alcohol Research Centre (NDARC), Sydney, NSW, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, NSW, Australia
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