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Lancaster K, Gendera S, Treloar C, Rhodes T, Shahbazi J, Byrne M, Nielsen S, Degenhardt L, Farrell M. Tinkering with care: Implementing extended-release buprenorphine depot treatment for opioid dependence. Int J Drug Policy 2024; 126:104359. [PMID: 38382354 DOI: 10.1016/j.drugpo.2024.104359] [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: 08/16/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
We examine how extended-release buprenorphine depot (BUP-XR) is put to use and made to work in implementation practices, attending to how care practices are challenged and adapted as a long-acting technology is introduced into service in opioid agonist treatment (OAT) in Australia. Our approach is informed by ideas in science and technology studies (STS) emphasising the irreducible entanglement of care practices and technology, and in particular the concept of 'tinkering' as a practice of adaptation. To make our analysis, we draw on qualitative interview accounts (n = 19) of service providers involved in BUP-XR implementation across five sites. Our analysis considers the disruptive novelty of BUP-XR. Tinkering to make a novel technology work in practice slows down the expectation of implementation in relation to transformative innovation, despite the promise of dramatic or rapid change. Tinkering allowed for more open relations, for new care practices that departed from the routine and familiar, opening potential for how BUP-XR could be put to use and made to work in its new situation, and as its situation evolved along-with its implementation. Flexibility and openness of altering relations was, however, at times, held in tension with inflexibility and closure. This analysis identifies a concern for what is made present and what is made absent in the altered care network affected by BUP-XR, with the multiple effects of supervised daily dosing practices thrown into relief as they become absented. Tinkering to implement BUP-XR locally connects with a broader assemblage of trial and movement in the constitution of treatment. The introduction of long-acting technologies prompts new questions about embedded implementation practices, including supervised dosing, urinalysis, the time and place of psychosocial support, and how other social aspects of care might be recalibrated in drug treatment.
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Affiliation(s)
- K Lancaster
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia; Goldsmiths, University of London, UK.
| | - S Gendera
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - C Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - T Rhodes
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia; London School of Hygiene and Tropical Medicine, UK
| | - J Shahbazi
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M Byrne
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - S Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Conway A, Valerio H, Peacock A, Degenhardt L, Hayllar J, Harrod ME, Henderson C, Read P, Gilliver R, Christmass M, Dunlop A, Montebello M, Whitton G, Reid D, Lam T, Alavi M, Silk D, Marshall AD, Treloar C, Dore GJ, Grebely J. Non-fatal opioid overdose, naloxone access, and naloxone training among people who recently used opioids or received opioid agonist treatment in Australia: The ETHOS Engage study. Int J Drug Policy 2021; 96:103421. [PMID: 34452808 DOI: 10.1016/j.drugpo.2021.103421] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/07/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Overdose is a major cause of morbidity and mortality among people who use opioids. Naloxone can reverse opioid overdoses and can be distributed and administered with minimal training. People with experience of overdose are a key population to target for overdose prevention strategies. This study aims to understand if factors associated with recent non-fatal opioid overdose are the same as factors associated with naloxone access and naloxone training in people who recently used opioids or received opioid agonist treatment (OAT). METHODS ETHOS Engage is an observational study of people who inject drugs in Australia. Logistic regression models were used to estimate odds ratios for non-fatal opioid overdose, naloxone access and naloxone training. RESULTS Between May 2018-September 2019, 1280 participants who recently used opioids or received OAT were enrolled (62% aged >40 years; 35% female, 80% receiving OAT, 62% injected drugs in the preceding month). Recent opioid overdose (preceding 12 months) was reported by 7% of participants, lifetime naloxone access by 17%, and lifetime naloxone training by 14%. Compared to people receiving OAT with no additional opioid use, recent opioid, benzodiazepine (preceding six months), and hazardous alcohol use was associated with recent opioid overdose (aOR 3.91; 95%CI: 1.68-9.10) and lifetime naloxone access (aOR 2.12; 95%CI 1.29-3.48). Among 91 people who reported recent overdose, 65% had never received take-home naloxone or naloxone training. CONCLUSIONS Among people recently using opioids or receiving OAT, benzodiazepine and hazardous alcohol use is associated with non-fatal opioid overdose. Not all factors associated with non-fatal overdose correspond to factors associated with naloxone access. Naloxone access and training is low across all groups. Additional interventions are needed to scale up naloxone provision.
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Affiliation(s)
- A Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.
| | - H Valerio
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - A Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, Tasmania, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - J Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - M E Harrod
- NSW Users and AIDS Association, NSW, Australia
| | - C Henderson
- NSW Users and AIDS Association, NSW, Australia
| | - P Read
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Kirketon Road Centre, Sydney, NSW, Australia
| | - R Gilliver
- Kirketon Road Centre, Sydney, NSW, Australia
| | - M Christmass
- Next Step Drug and Alcohol Services, Mental Health Commission, WA, Australia; National Drug Research Institute, Curtin University, WA, Australia
| | - A Dunlop
- Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute & University of Newcastle, Newcastle, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - M Montebello
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - G Whitton
- Drug Health Service, South West Sydney LHD, NSW, Australia
| | - D Reid
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - T Lam
- Drug Health, Western Sydney Local Health District, Sydney, NSW, Australia
| | - M Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - D Silk
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - A D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - G J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Borschmann R, Tibble H, Spittal MJ, Preen D, Pirkis J, Larney S, Rosen DL, Young JT, Love AD, Altice FL, Binswanger IA, Bukten A, Butler T, Chang Z, Chen CY, Clausen T, Christensen PB, Culbert GJ, Degenhardt L, Dirkzwager AJE, Dolan K, Fazel S, Fischbacher C, Giles M, Graham L, Harding D, Huang YF, Huber F, Karaminia A, Keen C, Kouyoumdjian FG, Lim S, Møller L, Moniruzzaman A, Morenoff J, O’Moore E, Pizzicato LN, Pratt D, Proescholdbell SK, Ranapurwala SI, Shanahan ME, Shaw J, Slaunwhite A, Somers JM, Spaulding AC, Stern MF, Viner KM, Wang N, Willoughby M, Zhao B, Kinner SA. The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis. Int J Popul Data Sci 2020; 5:1145. [PMID: 32935053 PMCID: PMC7473255 DOI: 10.23889/ijpds.v5i1.1145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. OBJECTIVES To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. METHODS We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. RESULTS The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. CONCLUSIONS The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population. KEY WORDS Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.
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Affiliation(s)
- R Borschmann
- Justice Health Unit, Centre for Health Equity, The University of Melbourne, 207 Bouverie street, Carlton 3010, Melbourne, Victoria, AUSTRALIA
| | - H Tibble
- Usher Institute of Population Health Sciences and Informatics, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - MJ Spittal
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - D Preen
- The University of Western Australia, School of Population and Global Health, Nedlands, AUSTRALIA
| | - J Pirkis
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - S Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - DL Rosen
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - JT Young
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - AD Love
- University of Melbourne, Melbourne School of Population Health, Melbourne, AUSTRALIA
| | - FL Altice
- Yale University School of Medicine and Public Health, New Haven, Connecticut, USA
| | - IA Binswanger
- Kaiser Permanente Colorado, Colorado Permanente Medical Group, USA
| | - A Bukten
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - T Butler
- University of New South Wales, Kirby Institute, Sydney, AUSTRALIA
| | - Z Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SWEDEN
| | - C-Y Chen
- National Yang-Ming University, Institute of Public Health, TAIWAN
| | - T Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - PB Christensen
- Department of Infectious Diseases, Odense University Hospital and Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, DENMARK
| | - GJ Culbert
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, USA
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - AJE Dirkzwager
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, NETHERLANDS
| | - K Dolan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, AUSTRALIA
| | - S Fazel
- University of Oxford, Department of Psychiatry, Medical Sciences Division, Oxford, ENGLAND
| | - C Fischbacher
- NHS National Services, Information Services Division, Edinburgh, SCOTLAND
| | - M Giles
- Edith Cowan University, School of Arts and Humanities, Joondalup, AUSTRALIA
| | - L Graham
- NHS National Services, Information Services Division, Edinburgh, SCOTLAND
| | - D Harding
- University of California Berkeley, USA
| | - Y-F Huang
- Taiwan Centers for Disease Control, Taipei, TAIWAN
| | - F Huber
- Cayenne General Hospital, COREVIH Guyane, and Reseau Kikiwi, Cayenne, French Guiana, FRANCE
| | - A Karaminia
- University of New South Wales, Sydney, AUSTRALIA
| | - C Keen
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - FG Kouyoumdjian
- McMaster University, Department of Family Medicine, Hamilton, Ontario, CANADA
| | - S Lim
- New York City Department of Health and Mental Hygiene, Bureau of Epidemiology Services, Division of Epidemiology, New York, USA
| | - L Møller
- World Health Organization, Division of Noncommunicable Diseases and Promoting Health through the Life-course, Marmorvej, DENMARK
| | - A Moniruzzaman
- Somers Research Group, Simon Fraser University, Burnaby, British Columbia, CANADA
| | - J Morenoff
- University of Michigan, Department of Sociology, USA
| | - E O’Moore
- Public Health England, London, ENGLAND
| | - LN Pizzicato
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - D Pratt
- University of Manchester, Division of Psychology and Mental Health, School of Health Sciences, Manchester, ENGLAND
| | - SK Proescholdbell
- North Carolina Department of Health and Human Services, North Carolina, USA
| | - SI Ranapurwala
- Department of Epidemiology, University of North Carolina at Chapel Hill, USA
| | - ME Shanahan
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, USA
| | - J Shaw
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, ENGLAND
| | - A Slaunwhite
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, CANADA
| | - JM Somers
- Somers Research Group, Simon Fraser University, Burnaby, British Columbia, CANADA
| | - AC Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - MF Stern
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - KM Viner
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - N Wang
- Institute of Public Health, National Yang-Ming University, TAIWAN
| | - M Willoughby
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, AUSTRALIA
| | - B Zhao
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, CANADA
| | - SA Kinner
- Murdoch Children’s Research Institute, Centre for Adolescent Health, Melbourne, Victoria, AUSTRALIA
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Jacka B, Larance B, Copeland J, Burns L, Farrell M, Jackson E, Degenhardt L. Health care engagement behaviors of men who use performance- and image-enhancing drugs in Australia. Subst Abus 2019; 41:139-145. [PMID: 31545138 DOI: 10.1080/08897077.2019.1635954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/25/2022]
Abstract
Background: Although people who inject performance- and image-enhancing drugs (PIEDs) report fewer unsafe injecting practices, stigma and discrimination may negatively impact their access to help and information. Engagement with health care services, compared with social networks (friends, relatives, and gym associates) and the Internet and media (steroid user forums, information sites, and magazines), may be important for harm minimization. Methods: A cross-sectional Internet or in-person survey of men who use PIEDs in Australia in 2014-2015 examined differences in sources for PIEDs, injecting equipment, and anabolic-androgenic steroids (AAS) information and factors associated with having periodical medical checks related to PIEDs issues using multivariate logistic regression. Results: In total, 267 men (mean age: 25 years, SD: 8.7 years; 246 of 267 [92%] reported recent AAS injection) were recruited. Most participants sourced injecting equipment from health professionals, PIEDs from their social networks, and AAS information from the Internet and media. Self-reported AAS knowledge was high and frequent. Higher income (adjusted odds ratio [AOR]: 2.04, 95% confidence interval [CI]: 1.03, 4.00), ≥2 different PIEDs used in addition to AAS (AOR: 1.94, 95% CI: 1.08, 3.49), and sourcing AAS information from health care professionals (AOR: 3.14, 95% CI: 1.81, 5.46) were independently associated with periodical medical checks. Participants nominated preference for improved health services through needle-syringe programs, primary care services, and peer educator support groups. Conclusion: Men who use PIEDs in Australia consider themselves well informed but tend to use Internet and media sources, providing potentially misleading or inaccurate information. Increasing trust between men who use PIEDs and health care providers may enable delivery of PIEDs-specific information to those at greatest need.
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Affiliation(s)
- B Jacka
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - B Larance
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - J Copeland
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - L Burns
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - M Farrell
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - E Jackson
- Nepean/Blue Mountains Sexual Health & HIV Clinics, Nepean Hospital, Kingswood, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Bui H, Zablotska-Manos I, Hammoud M, Jin F, Lea T, Bourne A, Iversen J, Bath N, Grierson J, Degenhardt L, Prestage G, Maher L. Prevalence and correlates of recent injecting drug use among gay and bisexual men in Australia: Results from the FLUX study. International Journal of Drug Policy 2018; 55:222-230. [DOI: 10.1016/j.drugpo.2018.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/12/2018] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
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Koenen KC, Ratanatharathorn A, Ng L, McLaughlin KA, Bromet EJ, Stein DJ, Karam EG, Ruscio AM, Benjet C, Scott K, Atwoli L, Petukhova M, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bunting B, Ciutan M, de Girolamo G, Degenhardt L, Gureje O, Haro JM, Huang Y, Kawakami N, Lee S, Navarro-Mateu F, Pennell BE, Piazza M, Sampson N, ten Have M, Torres Y, Viana MC, Williams D, Xavier M, Kessler RC. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol Med 2017; 47:2260-2274. [PMID: 28385165 PMCID: PMC6034513 DOI: 10.1017/s0033291717000708] [Citation(s) in RCA: 540] [Impact Index Per Article: 77.1] [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] [Indexed: 12/20/2022]
Abstract
BACKGROUND Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. METHODS Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. RESULTS The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed. CONCLUSIONS PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.
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Affiliation(s)
- K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - A. Ratanatharathorn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - L. Ng
- Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - K. A. McLaughlin
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - E. J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - D. J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - A. Meron Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C. Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - K. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - L. Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
| | - M. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - C. C.W. Lim
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
- Queensland Brain Institute, University of Queensland, St Lucia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - A. Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq
| | - J. Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Pompeu Fabra University (UPF); CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - B. Bunting
- School of Psychology, Ulster University, Londonderry, UK
| | - M. Ciutan
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - G. de Girolamo
- IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - L. Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - O. Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Y. Huang
- Institute of Mental Health, Peking University, Beijing, China
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - S. Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - F. Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud IMIB-Arrixaca; CIBERESP-Murcia, Murcia, Spain
| | - B.-E. Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - M. Piazza
- Universidad Cayetano Heredia, Lima, Peru
- National Institute of Health, Lima, Peru
| | - N. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - M. ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - D. Williams
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massaschusetts, USA
| | - M. Xavier
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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Cunningham E, Amin J, Bretana N, Luciani F, Degenhardt L, Larney S, Hajarizadeh B, Dore G, Lloyd A, Grebely J. P10 Injecting risk behaviours among people who inject drugs in an Australian prison setting, 2005–2014: the HITS-p study. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30751-2] [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] [Indexed: 11/27/2022] Open
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Alavi M, Amin J, Grebely J, Law M, Janjua N, Krajden M, Hajarizadeh B, George J, Matthews G, Larney S, Degenhardt L, Dore G. O23 Characterisation of populations with hepatitis C to improve access to antiviral therapy programs: a population-based linkage study. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30906-7] [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] [Indexed: 11/29/2022] Open
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Jacka B, Peacock A, Degenhardt L, Bruno R, Clare P, Kemp R, Dev A, Larance B. Trends in PIEDs use among male clients of needle-syringe programs in Queensland, Australia; 2007-2015. Int J Drug Policy 2017. [PMID: 28651113 DOI: 10.1016/j.drugpo.2017.05.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- B Jacka
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia; Kirby Institute, UNSW, Sydney, NSW, Australia
| | - A Peacock
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia; School of Medicine (Psychology), University of Tasmania, Tasmania Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - R Bruno
- School of Medicine (Psychology), University of Tasmania, Tasmania Australia
| | - P Clare
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - R Kemp
- Communicable Diseases Branch, Queensland Health, QLD, Australia
| | - A Dev
- Chief Medical Officer and Healthcare Regulation Branch, Queensland Health, QLD Australia
| | - B Larance
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia.
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10
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Mattick RP, Wadolowski M, Aiken A, Clare PJ, Hutchinson D, Najman J, Slade T, Bruno R, McBride N, Degenhardt L, Kypri K. Parental supply of alcohol and alcohol consumption in adolescence: prospective cohort study. Psychol Med 2017; 47:267-278. [PMID: 27702422 DOI: 10.1017/s0033291716002373] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Parents are a major supplier of alcohol to adolescents, yet there is limited research examining the impact of this on adolescent alcohol use. This study investigates associations between parental supply of alcohol, supply from other sources, and adolescent drinking, adjusting for child, parent, family and peer variables. METHOD A cohort of 1927 adolescents was surveyed annually from 2010 to 2014. Measures include: consumption of whole drinks; binge drinking (>4 standard drinks on any occasion); parental supply of alcohol; supply from other sources; child, parent, family and peer covariates. RESULTS After adjustment, adolescents supplied alcohol by parents had higher odds of drinking whole beverages [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.33-2.45] than those not supplied by parents. However, parental supply was not associated with bingeing, and those supplied alcohol by parents typically consumed fewer drinks per occasion (incidence rate ratio 0.86, 95% CI 0.77-0.96) than adolescents supplied only from other sources. Adolescents obtaining alcohol from non-parental sources had increased odds of drinking whole beverages (OR 2.53, 95% CI 1.86-3.45) and bingeing (OR 3.51, 95% CI 2.53-4.87). CONCLUSIONS Parental supply of alcohol to adolescents was associated with increased risk of drinking, but not bingeing. These parentally-supplied children also consumed fewer drinks on a typical drinking occasion. Adolescents supplied alcohol from non-parental sources had greater odds of drinking and bingeing. Further follow-up is necessary to determine whether these patterns continue, and to examine alcohol-related harm trajectories. Parents should be advised that supply of alcohol may increase children's drinking.
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Affiliation(s)
- R P Mattick
- National Drug and Alcohol Research Centre,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - M Wadolowski
- The Kirby Institute,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - A Aiken
- National Drug and Alcohol Research Centre,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - P J Clare
- National Drug and Alcohol Research Centre,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - D Hutchinson
- School of Psychology,Deakin University,Melbourne, VIC 3125,Australia
| | - J Najman
- Queensland Alcohol and Drug Research and Education Centre,University of Queensland,Brisbane, QLD 4072,Australia
| | - T Slade
- National Drug and Alcohol Research Centre,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - R Bruno
- School of Psychology,University of Tasmania,Hobart, TAS 7000,Australia
| | - N McBride
- National Drug Research Institute,Curtin University,GPO Box U1987,Perth, WA 6845,Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - K Kypri
- Centre for Clinical Epidemiology and Biostatistics,School of Medicine and Public Health,University of Newcastle,Newcastle, NSW 2308,Australia
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11
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Crist RC, Doyle GA, Nelson EC, Degenhardt L, Martin NG, Montgomery GW, Saxon AJ, Ling W, Berrettini WH. A polymorphism in the OPRM1 3'-untranslated region is associated with methadone efficacy in treating opioid dependence. Pharmacogenomics J 2016; 18:173-179. [PMID: 27958381 PMCID: PMC5468510 DOI: 10.1038/tpj.2016.89] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/07/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022]
Abstract
The mu-opioid receptor (MOR) is the primary target of methadone and buprenorphine. The primary neuronal transcript of the OPRM1 gene, MOR-1, contains a ~13kb 3′ untranslated region with five common haplotypes in European-Americans. We analyzed the effects of these haplotypes on the percentage of opioid positive urine tests in European-Americans (n = 582) during a 24-week, randomized, open-label trial of methadone or buprenorphine/naloxone (Suboxone) for the treatment of opioid dependence. A single haplotype, tagged by rs10485058, was significantly associated with patient urinalysis data in the methadone treatment group. Methadone patients with the A/A genotype at rs10485058 were less likely to have opioid-positive urine drug screens than those in the combined A/G and G/G genotypes group (Relative Risk = 0.76, 95% confidence intervals = 0.73–0.80, p = 0.0064). Genotype at rs10485058 also predicted self-reported relapse rates in an independent population of Australian patients of European descent (n = 1215) who were receiving opioid substitution therapy (p = 0.003). In silico analysis predicted that miR-95-3p would interact with the G, but not the A allele of rs10485058. Luciferase assays indicated miR-95-3p decreased reporter activity of constructs containing the G, but not the A allele of rs10485058, suggesting a potential mechanism for the observed pharmacogenetic effect. These findings suggest that selection of a medication for opioid dependence based on rs10485058 genotype might improve outcomes in this ethnic group.
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Affiliation(s)
- R C Crist
- Department of Psychiatry, Center for Neurobiology and Behavior, University of Pennsylvania School of Medicine, PA, Pennsylvania, USA
| | - G A Doyle
- Department of Psychiatry, Center for Neurobiology and Behavior, University of Pennsylvania School of Medicine, PA, Pennsylvania, USA
| | - E C Nelson
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - N G Martin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - G W Montgomery
- The University of Queensland, Herston, Queensland, Australia
| | - A J Saxon
- Veteran's Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - W Ling
- University of California, Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA, USA
| | - W H Berrettini
- Department of Psychiatry, Center for Neurobiology and Behavior, University of Pennsylvania School of Medicine, PA, Pennsylvania, USA
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12
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Larney S, Degenhardt L, Farrell M. Response to Bird et al.: The importance of post-release engagement in treatment in estimating impacts on post-release deaths. Addiction 2016; 111:560-1. [PMID: 26589456 DOI: 10.1111/add.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- S Larney
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia. .,Alpert Medical School, Brown University, Providence, RI, USA .
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - M Farrell
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
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13
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Werner KB, McCutcheon VV, Challa M, Agrawal A, Lynskey MT, Conroy E, Statham DJ, Madden PAF, Henders AK, Todorov AA, Heath AC, Degenhardt L, Martin NG, Bucholz KK, Nelson EC. The association between childhood maltreatment, psychopathology, and adult sexual victimization in men and women: results from three independent samples. Psychol Med 2016; 46:563-573. [PMID: 26688007 PMCID: PMC4804459 DOI: 10.1017/s0033291715002056] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childhood maltreatment (CM) has consistently been linked with adverse outcomes including substance use disorders and adult sexual revictimization. Adult sexual victimization itself has been linked with psychopathology but has predominately been studied in women. The current investigation examines the impact of CM and co-occurring psychopathology on adult sexual victimization in men and women, replicating findings in three distinct samples. METHOD We investigated the association between continuous CM factor scores and adult sexual victimization in the Childhood Trauma Study (CTS) sample (N = 2564). We also examined the unique relationship between childhood sexual abuse (CSA) and adult sexual victimization while adjusting for co-occurring substance dependence and psychopathology. We replicated these analyses in two additional samples: the Comorbidity and Trauma Study (CATS; N = 1981) and the Australian Twin-Family Study of Alcohol Use Disorders (OZ-ALC; N = 1537). RESULTS Analyses revealed a significant association with CM factor scores and adult sexual victimization for both men and women across all three samples. The CSA factor score was strongly associated with adult sexual victimization after adjusting for substance dependence and psychopathology; higher odds ratios were observed in men (than women) consistently across the three samples. CONCLUSIONS A continuous measure of CSA is independently associated with adult sexual trauma risk across samples in models that included commonly associated substance dependence and psychopathology as covariates. The strength of the association between this CSA measure and adult sexual victimization is higher in magnitude for men than women, pointing to the need for further investigation of sexual victimization in male community samples.
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Affiliation(s)
- K. B. Werner
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
| | - V. V. McCutcheon
- Alcoholism Research Center, Washington University School of Medicine, St Louis, MO, USA
| | - M. Challa
- University of Illinois–Chicago School of Medicine, Chicago, IL, USA
| | - A. Agrawal
- Alcoholism Research Center, Washington University School of Medicine, St Louis, MO, USA
| | - M. T. Lynskey
- Institute of Psychiatry, Psychology & Neuroscience, King’s College, London, UK
| | - E. Conroy
- Centre for Health Research, University of Western Sydney, Sydney, Australia
| | - D. J. Statham
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - P. A. F. Madden
- Alcoholism Research Center, Washington University School of Medicine, St Louis, MO, USA
| | - A. K. Henders
- National Drug and Alcohol Research Center, University of New South Wales, Sydney, Australia
| | - A. A. Todorov
- Alcoholism Research Center, Washington University School of Medicine, St Louis, MO, USA
| | - A. C. Heath
- Alcoholism Research Center, Washington University School of Medicine, St Louis, MO, USA
| | - L. Degenhardt
- National Drug and Alcohol Research Center, University of New South Wales, Sydney, Australia
| | - N. G. Martin
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K. K. Bucholz
- Alcoholism Research Center, Washington University School of Medicine, St Louis, MO, USA
| | - E. C. Nelson
- Alcoholism Research Center, Washington University School of Medicine, St Louis, MO, USA
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14
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Stockings EA, Degenhardt L, Dobbins T, Lee YY, Erskine HE, Whiteford HA, Patton G. Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention. Psychol Med 2016; 46:11-26. [PMID: 26315536 DOI: 10.1017/s0033291715001725] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [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] [Indexed: 12/31/2022]
Abstract
Depression and anxiety (internalizing disorders) are the largest contributors to the non-fatal health burden among young people. This is the first meta-analysis to examine the joint efficacy of universal, selective, and indicated preventive interventions upon both depression and anxiety among children and adolescents (5-18 years) while accounting for their co-morbidity. We conducted a systematic review of reviews in Medline, PsycINFO and the Cochrane Library of Systematic Reviews, from 1980 to August 2014. Multivariate meta-analysis examined the efficacy of preventive interventions on depression and anxiety outcomes separately, and the joint efficacy on both disorders combined. Meta-regressions examined heterogeneity of effect according to a range of study variables. Outcomes were relative risks (RR) for disorder, and standardized mean differences (Cohen's d) for symptoms. One hundred and forty-six randomized controlled trials (46 072 participants) evaluated universal (children with no identified risk, n = 54) selective (population subgroups of children who have an increased risk of developing internalizing disorders due to shared risk factors, n = 45) and indicated prevention (children with minimal but detectable symptoms of an internalizing disorder, n = 47), mostly using psychological-only strategies (n = 105). Reductions in internalizing disorder onset occurred up to 9 months post-intervention, whether universal [RR 0.47, 95% confidence interval (CI) 0.37-0.60], selective (RR 0.61, 95% CI 0.43-0.85) or indicated (RR 0.48, 95% CI 0.29-0.78). Reductions in internalizing symptoms occurred up to 12 months post-intervention for universal prevention; however, reductions only occurred in the shorter term for selective and indicated prevention. Universal, selective and indicated prevention interventions are efficacious in reducing internalizing disorders and symptoms in the short term. They might be considered as repeated exposures in school settings across childhood and adolescence. (PROSPERO registration: CRD42014013990.).
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Affiliation(s)
- E A Stockings
- National Drug and Alcohol Research Centre (NDARC),University of New South Wales (UNSW),Randwick,New South Wales,Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre (NDARC),University of New South Wales (UNSW),Randwick,New South Wales,Australia
| | - T Dobbins
- National Drug and Alcohol Research Centre (NDARC),University of New South Wales (UNSW),Randwick,New South Wales,Australia
| | - Y Y Lee
- Queensland Centre for Mental Health Research (QCMHR),The Park Centre for Mental Health,Wacol,Queensland,Australia
| | - H E Erskine
- Institute for Health Metrics and Evaluation (IHME),University of Washington,Seattle,Washington,USA
| | - H A Whiteford
- Institute for Health Metrics and Evaluation (IHME),University of Washington,Seattle,Washington,USA
| | - G Patton
- Centre for Adolescent Health,Murdoch Children's Research Institute (MCRI),Royal Children's Hospital,Parkville,Victoria,Australia
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15
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Hoban B, Larance B, Gisev N, Nielsen S, Cohen M, Bruno R, Shand F, Lintzeris N, Hall W, Farrell M, Degenhardt L. The use of paracetamol (acetaminophen) among a community sample of people with chronic non-cancer pain prescribed opioids. Int J Clin Pract 2015; 69:1366-76. [PMID: 26268890 DOI: 10.1111/ijcp.12716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 07/22/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The regular use of simple analgesics in addition to opioids such as paracetamol (or acetaminophen) is recommended for persistent pain to enhance analgesia. Few studies have examined the frequency and doses of paracetamol among people with chronic non-cancer pain including use above the recommended maximum daily dose. AIMS To assess (i) the prevalence of paracetamol use among people with chronic non-cancer pain prescribed opioids, (ii) assess the prevalence of paracetamol use above the recommended maximum daily dose and (iii) assess correlates of people who used paracetamol above the recommended maximum daily dose including: age, gender, income, education, pain severity and interference, use of paracetamol/opioid combination analgesics, total opioid dose, depression, anxiety, pain self-efficacy or comorbid substance use, among people prescribed opioids for chronic non-cancer pain. METHODS This study draws on baseline data collected for the Pain and Opioids IN Treatment (POINT) study and utilises data from 962 interviews and medication diaries. The POINT study is national prospective cohort of people with chronic non-cancer pain prescribed opioids. Participants were recruited from randomly selected pharmacies across Australia. RESULTS Sixty-three per cent of the participants had used paracetamol in the past week (95% CI = 59.7-65.8). Among the paracetamol users 22% (95% CI = 19.3-24.6) had used paracetamol/opioid combination analgesics and 4.8% (95% CI = 3.6-6.3) had used paracetamol above the recommended maximum daily dose (i.e. > 4000 mg/day). Following binomial logistic regression (χ(2) = 25.98, df = 10, p = 0.004), people who had taken above the recommended maximum daily dose were less likely to have low income (AOR = 0.52, 95% CI = 0.27-0.99), more likely to use paracetamol/opioid combination analgesics (AOR = 2.01, 95% CI = 1.02-3.98) and more likely to take a higher opioid dose (AOR = 1.00, 95% CI = 1.00-1.01). CONCLUSION The majority of people with chronic non-cancer pain prescribed opioids report using paracetamol appropriately. High income, use of paracetamol/opioid combination analgesics and higher opioid dose were independently associated with paracetamol use above the recommended maximum daily dose.
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Affiliation(s)
- B Hoban
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - B Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - N Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - S Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
- The Langton Centre, South East Sydney Local Health District (SESLHD), Drug and Alcohol Services, Surry Hills, NSW, Australia
| | - M Cohen
- St Vincent's Clinical School, UNSW Australia, Darlinghurst, NSW, Australia
| | - R Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of Tasmania, Hobart, TAS, Australia
| | - F Shand
- Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - N Lintzeris
- The Langton Centre, South East Sydney Local Health District (SESLHD), Drug and Alcohol Services, Surry Hills, NSW, Australia
- Sydney Medical School, Sydney University, Camperdown, NSW, Australia
| | - W Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - M Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
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16
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Winter RJ, Stoové M, Degenhardt L, Hellard ME, Spelman T, Jenkinson R, McCarthy DR, Kinner SA. Incidence and predictors of non-fatal drug overdose after release from prison among people who inject drugs in Queensland, Australia. Drug Alcohol Depend 2015; 153:43-9. [PMID: 26105708 DOI: 10.1016/j.drugalcdep.2015.06.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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: 03/12/2015] [Revised: 05/23/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Release from prison is a period of elevated risk for drug-related harms, particularly among people who inject drugs (PWID). Non-fatal overdose can cause serious morbidity and predicts future fatal overdose, however neither the incidence nor the risk factors for non-fatal overdose following release from prison are well understood. METHODS Structured health-related interviews were conducted with 1051 adult prisoners in Queensland, Australia prior to release and approximately 1, 3 and 6 months post-release. Incidence of self-reported overdose in the community was calculated for PWID and all prisoners for three discrete time periods. Negative binomial regression with robust error variance was used to identify pre-release predictors of overdose among PWID. RESULTS The incidence of reported overdose was highest between 1 and 3 months post-release (37.8 per 100 person-years (PY) among PWID; 24.5/100 PY among all ex-prisoners). In adjusted analyses, the risk of post-release non-fatal overdose was higher for PWID who reported: being unemployed for >6 months before prison, having been removed from family as a child, at least weekly use of benzodiazepines and/or pharmaceutical opiates in the 3 months prior to prison, and ever receiving opioid substitution therapy (OST). Pre-release psychological distress and a lifetime history of mental disorder also predicted overdose, whereas risky alcohol use in the year before prison was protective. CONCLUSIONS PWID have a high risk of overdose following release from prison. Imprisonment is an opportunity to initiate targeted preventive interventions such as OST, overdose prevention training and peer-delivered naloxone for those with a high risk profile.
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Affiliation(s)
- R J Winter
- Centre for Population Health, Burnet Institute, Australia; School of Public Health and Preventive Medicine, Monash University, Australia.
| | - M Stoové
- Centre for Population Health, Burnet Institute, Australia; School of Public Health and Preventive Medicine, Monash University, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - M E Hellard
- Centre for Population Health, Burnet Institute, Australia; School of Public Health and Preventive Medicine, Monash University, Australia
| | - T Spelman
- Centre for Population Health, Burnet Institute, Australia; School of Public Health and Preventive Medicine, Monash University, Australia; Victorian Infectious Diseases Service, Doherty Institute, Australia
| | - R Jenkinson
- Centre for Population Health, Burnet Institute, Australia; Australian Institute of Family Studies, Australia
| | - D R McCarthy
- Centre for Population Health, Burnet Institute, Australia
| | - S A Kinner
- School of Public Health and Preventive Medicine, Monash University, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia; School of Medicine, University of Queensland, Australia
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17
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Erskine HE, Moffitt TE, Copeland WE, Costello EJ, Ferrari AJ, Patton G, Degenhardt L, Vos T, Whiteford HA, Scott JG. A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med 2015; 45:1551-1563. [PMID: 25534496 PMCID: PMC5922255 DOI: 10.1017/s0033291714002888] [Citation(s) in RCA: 333] [Impact Index Per Article: 37.0] [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] [Indexed: 12/26/2022]
Abstract
BACKGROUND Mental and substance use disorders are common and often persistent, with many emerging in early life. Compared to adult mental and substance use disorders, the global burden attributable to these disorders in children and youth has received relatively little attention. METHOD Data from the Global Burden of Disease Study 2010 was used to investigate the burden of mental and substance disorders in children and youth aged 0-24 years. Burden was estimated in terms of disability-adjusted life years (DALYs), derived from the sum of years lived with disability (YLDs) and years of life lost (YLLs). RESULTS Globally, mental and substance use disorders are the leading cause of disability in children and youth, accounting for a quarter of all YLDs (54.2 million). In terms of DALYs, they ranked 6th with 55.5 million DALYs (5.7%) and rose to 5th when mortality burden of suicide was reattributed. While mental and substance use disorders were the leading cause of DALYs in high-income countries (HICs), they ranked 7th in low- and middle-income countries (LMICs) due to mortality attributable to infectious diseases. CONCLUSIONS Mental and substance use disorders are significant contributors to disease burden in children and youth across the globe. As reproductive health and the management of infectious diseases improves in LMICs, the proportion of disease burden in children and youth attributable to mental and substance use disorders will increase, necessitating a realignment of health services in these countries.
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Affiliation(s)
- H. E. Erskine
- School of Population Health, University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - T. E. Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Institute of Psychiatry, King’s College London, London, UK
| | - W. E. Copeland
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - E. J. Costello
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - A. J. Ferrari
- School of Population Health, University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - G. Patton
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - L. Degenhardt
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Health Policy, Programs, and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - T. Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - H. A. Whiteford
- School of Population Health, University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - J. G. Scott
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
- Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
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18
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Nielsen S, Roxburgh A, Bruno R, Lintzeris N, Jefferson A, Degenhardt L. Changes in non-opioid substitution treatment episodes for pharmaceutical opioids and heroin from 2002 to 2011. Drug Alcohol Depend 2015; 149:212-9. [PMID: 25707708 DOI: 10.1016/j.drugalcdep.2015.02.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 12/04/2014] [Revised: 01/27/2015] [Accepted: 02/03/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND There has been a well-documented increase in the non-medical use of pharmaceutical opioids (PO) worldwide. However, there has been little detailed examination of treatment demand, or the characteristics of those presenting for treatment, particularly for treatments other than opioid substitution. METHODS Data from closed drug and alcohol treatment episodes from the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS, representing non-opioid substitution treatment) in Australia for 2002-2003 to 2010-2011 were examined. In the four jurisdictions where detailed data were available, episodes where heroin was the principal drug of concern were compared to episodes for the four most frequently reported pharmaceutical opioids (morphine, codeine, fentanyl and oxycodone). RESULTS In 2002-2003, most (93%) opioid treatment was related to heroin with seven percent of all opioid treatment episodes reporting a PO as the principal drug of concern. In 2010-2011, 20% of all opioid treatment episodes were attributed to POs. Distinct changes over time were observed for different opioids. There was an increase in the average age at the start of treatment for heroin and oxycodone episodes, and a reduction in the proportion of females for codeine episodes, with 67% in 2002-2003 compared with 44% in 2010-2011. Codeine and oxycodone episodes had the lowest current or past injection rates. CONCLUSIONS Clear differences were observed over time and between different opioids. Monitoring these emerging patterns will be important to inform treatment needs, particularly in light of different patterns of poly drug use, different routes of administration and changing demographic characteristics.
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Affiliation(s)
- S Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales 2052, Australia; Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling St, Surry Hills 2010, Australia.
| | - A Roxburgh
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - R Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales 2052, Australia; School of Medicine, University of Tasmania, Level 1, Medical Science 1, 17 Liverpool Street, Hobart 7000, Australia
| | - N Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling St, Surry Hills 2010, Australia; University of Sydney, Department of Addiction Medicine, Missenden Road, Camperdown 2006, Australia
| | - A Jefferson
- Tobacco, Alcohol and Other Drugs Unit, Australian Institute of Health and Welfare, 1 Thynne Street, Fern Hill Park, Bruce 2617, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales 2052, Australia
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Charlson FJ, Baxter AJ, Dua T, Degenhardt L, Whiteford HA, Vos T. Excess mortality from mental, neurological and substance use disorders in the Global Burden of Disease Study 2010. Epidemiol Psychiatr Sci 2015; 24:121-40. [PMID: 25497332 PMCID: PMC6998140 DOI: 10.1017/s2045796014000687] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 01/08/2023] Open
Abstract
AIMS Mortality-associated burden of disease estimates from the Global Burden of Disease 2010 (GBD 2010) may erroneously lead to the interpretation that premature death in people with mental, neurological and substance use disorders (MNSDs) is inconsequential when evidence shows that people with MNSDs experience a significant reduction in life expectancy. We explore differences between cause-specific and excess mortality of MNSDs estimated by GBD 2010. METHODS GBD 2010 cause-specific death estimates were produced using the International Classification of Diseases death-coding system. Excess mortality (all-cause) was estimated using natural history models. Additional mortality attributed to MNSDs as underlying causes but not captured through GBD 2010 methodology is quantified in the comparative risk assessments. RESULTS In GBD 2010, MNSDs were estimated to be directly responsible for 840 000 deaths compared with more than 13 million excess deaths using natural history models. CONCLUSIONS Numbers of excess deaths and attributable deaths clearly demonstrate the high degree of mortality associated with these disorders. There is substantial evidence pointing to potential causal pathways for this premature mortality with evidence-based interventions available to address this mortality. The life expectancy gap between persons with MNSDs and the general population is high and should be a focus for health systems reform.
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Affiliation(s)
- F. J. Charlson
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - A. J. Baxter
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - T. Dua
- World Health Organization, Department of Mental Health and Substance Abuse, Geneva
| | - L. Degenhardt
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia
- University of Melbourne, Melbourne School of Population and Global Health, Victoria, Australia
| | - H. A. Whiteford
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
- University of Queensland, School of Population Health, Herston, Queensland, Australia
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - T. Vos
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
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20
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Moran P, Coffey C, Romaniuk H, Degenhardt L, Borschmann R, Patton GC. Substance use in adulthood following adolescent self-harm: a population-based cohort study. Acta Psychiatr Scand 2015; 131:61-8. [PMID: 24954250 PMCID: PMC4293154 DOI: 10.1111/acps.12306] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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] [Accepted: 06/02/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether adolescents who self-harm are at increased risk of heavy and dependent substance use in adulthood. METHOD Fifteen-year prospective cohort study of a random sample of 1943 adolescents recruited from secondary schools across the state of Victoria, Australia. Data pertaining to self-harm and substance use was obtained at seven waves of follow-up, from mean age 15.9 years to mean age 29.1 years. RESULTS Substance use and self-harm were strongly associated during the adolescent years (odds ratio (OR): 3.3, 95% CI 2.1-5.0). Moreover, adolescent self-harmers were at increased risk of substance use and dependence syndromes in young adulthood. Self-harm predicted a four-fold increase in the odds of multiple dependence syndromes (sex- and wave-adjusted OR: 4.2, 95% CI: 2.7-6.6). Adjustment for adolescent anxiety/depression attenuated but did not eliminate most associations. Adolescent substance use confounded all associations, with the exception of multiple dependence syndromes, which remained robustly associated with adolescent self-harm (fully adjusted odds ratio: 2.0, 95% CI: 1.2-3.2). CONCLUSION Adolescent self-harm is an independent risk factor for multiple dependence syndromes in adulthood. This level of substance misuse is likely to contribute substantially to the premature mortality and disease burden experienced by individuals who self-harm.
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Affiliation(s)
- P Moran
- King's College London, Health Services & Population Research Department, Institute of PsychiatryLondon, UK
| | - C Coffey
- Centre for Adolescent Health, Royal Children's Hospital Murdoch Children's Research InstituteParkville, Vic., Australia
| | - H Romaniuk
- Clinical Epidemiology & Biostatistics Unit and Centre for Adolescent Health, Royal Children's Hospital, Murdoch Children's Research Institute, University of MelbourneParkville, Vic., Australia,Department of Paediatrics, University of MelbourneParkville, Vic., Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, University of New South WalesSydney, NSW, Australia,School of Population and Global Health, University of MelbourneParkville, Vic., Australia
| | - R Borschmann
- King's College London, Health Services & Population Research Department, Institute of PsychiatryLondon, UK
| | - G C Patton
- Centre for Adolescent Health, Royal Children's Hospital Murdoch Children's Research InstituteParkville, Vic., Australia
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21
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Sordo L, Indave BI, Degenhardt L, Barrio G, Kaye S, Ruíz-Pérez I, Bravo MJ. A systematic review of evidence on the association between cocaine use and seizures. Drug Alcohol Depend 2013; 133:795-804. [PMID: 24051062 DOI: 10.1016/j.drugalcdep.2013.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 04/03/2013] [Revised: 07/25/2013] [Accepted: 08/22/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Institutional monographs/medical textbooks mention seizures as a neurological complication of cocaine, but no systematic reviews (SRs) have been published on this issue. We aimed to conduct a SR of the literature on the relationship between cocaine use and seizures and to summarize the biological plausibility of that relationship. METHODS The pathophysiological mechanisms that may underlie an association between cocaine and seizures were summarized; a SR was then performed using three databases (EMBASE, Medline, PsycINFO) and the Cochrane-library to search for published papers (1980-2012) aimed at quantifying the associations between cocaine use and seizures. The inclusion criteria for selection were: articles based on clinical trials, cohort, case-control (CC) or cross-sectional (CS) studies, participants ≥ 14 years old and not pregnant, and use of cocaine in the last 72 h. Information was extracted, evaluated and cross-checked independently by two researchers. RESULTS Of the 1243 potentially relevant articles initially identified; one CC and 22 CS studies were finally selected. The CC study did not find cocaine use to be a risk-factor for seizures. In addition to the limitations of the CS design, these studies had important methodological weaknesses and biases. CONCLUSIONS Despite its biological plausibility, no rigorous scientific evidence supports a causal relationship between cocaine use and seizures. The misinterpretation of the role of cocaine may have important implications in medical services. Well-conducted studies are urgently needed.
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Affiliation(s)
- L Sordo
- National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University, Madrid, Spain; Network Biomedical Research Centers, Epidemiology and Public Health (CIBERESP in Spanish), Spain.
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22
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Horyniak D, Dietze P, Degenhardt L, Higgs P, McIlwraith F, Alati R, Bruno R, Lenton S, Burns L. The relationship between age and risky injecting behaviours among a sample of Australian people who inject drugs. Drug Alcohol Depend 2013; 132:541-6. [PMID: 23664499 DOI: 10.1016/j.drugalcdep.2013.03.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 12/19/2012] [Revised: 03/28/2013] [Accepted: 03/30/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited evidence suggests that younger people who inject drugs (PWID) engage in high-risk injecting behaviours. This study aims to better understand the relationships between age and risky injecting behaviours. METHODS Data were taken from 11 years of a repeat cross-sectional study of sentinel samples of regular PWID (The Australian Illicit Drug Reporting System, 2001-2011). Multivariable Poisson regression was used to explore the relationship between age and four outcomes of interest: last drug injection occurred in public, receptive needle sharing (past month), experiencing injecting-related problems (e.g. abscess, dirty hit; past month), and non-fatal heroin overdose (past six months). RESULTS Data from 6795 first-time study participants were analysed (median age: 33 years, interquartile range [IQR]: 27-40; median duration of injecting: 13 years [IQR: 7-20]). After adjusting for factors including duration of injecting, each five year increase in age was associated with significant reductions in public injecting (adjusted incidence rate ratio [AIRR]: 0.90, 95% confidence interval [CI]: 0.88-0.92), needle sharing (AIRR: 0.84, 95% CI: 0.79-0.89) and injecting-related problems (AIRR: 0.96, 95% CI: 0.95-0.97). Among those who had injected heroin in the six months preceding interview, each five year increase in age was associated with an average 10% reduction in the risk of heroin overdose (AIRR: 0.90, 95% CI: 0.85-0.96). CONCLUSIONS Older PWID report significantly lower levels of high-risk injecting practices than younger PWID. Although they make up a small proportion of the current PWID population, younger PWID remain an important group for prevention and harm reduction.
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Affiliation(s)
- D Horyniak
- Centre for Population Health, Burnet Institute, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia.
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23
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Smith LW, Guy R, Degenhardt L, Richters J, Robbins S, Kaldor J, Lumby C, Skinner R, Liu B. P4.024 Do New Media Affect Adolescent Sexual Attitudes and Behaviours? A Systematic Review. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0922] [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] [Indexed: 11/04/2022]
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24
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Lintzeris N, Leung SY, Dunlop AJ, Larance B, White N, Rivas GR, Holland RM, Degenhardt L, Muhleisen P, Hurley M, Ali R. A randomised controlled trial of sublingual buprenorphine-naloxone film versus tablets in the management of opioid dependence. Drug Alcohol Depend 2013; 131:119-26. [PMID: 23317685 DOI: 10.1016/j.drugalcdep.2012.12.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/28/2012] [Accepted: 12/08/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Buprenorphine-naloxone sublingual film was introduced in 2011 in Australia as an alternative to tablets. This study compared the two formulations on subjective dose effects and equivalence, trough plasma levels, adverse events, patient satisfaction, supervised dosing time, and impact upon treatment outcomes (substance use, psychosocial function). METHODS 92 buprenorphine-naloxone tablet patients were recruited to this outpatient multi-site double-blind double-dummy parallel group trial. Patients were randomised to either tablets or film, without dose changes, over a 31 day period. RESULTS No significant group differences were observed for subjective dose effects, trough plasma buprenorphine or norbuprenorphine levels, adverse events and treatment outcomes. Buprenorphine-naloxone film took significantly less time to dissolve than tablets (173±71 versus 242±141s, p=0.007, F=7.67). CONCLUSIONS The study demonstrated dose equivalence and comparable clinical outcomes between the buprenorphine-naloxone film and tablet preparations, whilst showing improved dispensing times and patient ratings of satisfaction with the film.
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Affiliation(s)
- N Lintzeris
- Langton Centre, South Eastern Sydney Local Health District, NSW 2010, Australia.
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25
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Horyniak D, Nelson P, Cowie B, Hagan H, Jarlais DD, Degenhardt L, Kinner S. P2-416 Estimating the prevalence of hepatitis B infection among people who inject drugs: results from a global systematic review. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976l.46] [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] [Indexed: 11/04/2022]
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26
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Glantz MD, Anthony JC, Berglund PA, Degenhardt L, Dierker L, Kalaydjian A, Merikangas KR, Ruscio AM, Swendsen J, Kessler RC. Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits. Psychol Med 2009; 39:1365-1377. [PMID: 19046473 PMCID: PMC2705467 DOI: 10.1017/s0033291708004510] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although mental disorders have been shown to predict subsequent substance disorders, it is not known whether substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. Although experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigated this question in this study using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders. METHOD Data came from the National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey that retrospectively assessed lifetime history and age of onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios. RESULTS Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders). CONCLUSIONS Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.
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Affiliation(s)
- M D Glantz
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Bethesda, MD 20892, USA.
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Degenhardt L, Chiu WT, Conway K, Dierker L, Glantz M, Kalaydjian A, Merikangas K, Sampson N, Swendsen J, Kessler RC. Does the 'gateway' matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication. Psychol Med 2009; 39:157-167. [PMID: 18466664 PMCID: PMC2653272 DOI: 10.1017/s0033291708003425] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [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] [Indexed: 01/27/2023]
Abstract
BACKGROUND The 'gateway' pattern of drug initiation describes a normative sequence, beginning with alcohol and tobacco use, followed by cannabis, then other illicit drugs. Previous work has suggested that 'violations' of this sequence may be predictors of later problems but other determinants were not considered. We have examined the role of pre-existing mental disorders and sociodemographics in explaining the predictive effects of violations using data from the US National Comorbidity Survey Replication (NCS-R). METHOD The NCS-R is a nationally representative face-to-face household survey of 9282 English-speaking respondents aged 18 years and older that used the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) to assess DSM-IV mental and substance disorders. Drug initiation was estimated using retrospective age-of-onset reports and 'violations' defined as inconsistent with the normative initiation order. Predictors of violations were examined using multivariable logistic regressions. Discrete-time survival analysis was used to see whether violations predicted progression to dependence. RESULTS Gateway violations were largely unrelated to later dependence risk, with the exception of small increases in risk of alcohol and other illicit drug dependence for those who initiated use of other illicit drugs before cannabis. Early-onset internalizing disorders were predictors of gateway violations, and both internalizing and externalizing disorders increased the risks of dependence among users of all drugs. CONCLUSIONS Drug use initiation follows a strong normative pattern, deviations from which are not strongly predictive of later problems. By contrast, adolescents who have already developed mental health problems are at risk for deviations from the normative sequence of drug initiation and for the development of dependence.
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Affiliation(s)
- L Degenhardt
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, Australia.
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Affiliation(s)
- M Teesson
- National Drug and Alcohol Research Centre, University of New South Wales , Sydney, New South Wales
| | - L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales , Sydney, New South Wales
| | - H Proudfoot
- National Drug and Alcohol Research Centre, University of New South Wales , Sydney, New South Wales
| | - W Hall
- Office of Public Policy and Ethics, Institute for Molecular Bioscience, University of Queensland , Brisbane, Queensland, Australia
| | - M Lynskey
- Washington University in St Louis , MO, USA
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Degenhardt L, Hall W, Warner-Smith M. Using cohort studies to estimate mortality among injecting drug users that is not attributable to AIDS. Sex Transm Infect 2006; 82 Suppl 3:iii56-63. [PMID: 16735295 PMCID: PMC2576734 DOI: 10.1136/sti.2005.019273] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [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] [Accepted: 03/28/2006] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Injecting drug use (IDU) and associated mortality appear to be increasing in many parts of the world. IDU is an important factor in HIV transmission. In estimating AIDS mortality attributable to IDU, it is important to take account of premature mortality rates from other causes to ensure that AIDS related mortality among injecting drug users (IDUs) is not overestimated. The current review provides estimates of the excess non-AIDS mortality among IDUs. METHOD Searches were conducted with Medline, PsycINFO, and the Web of Science. The authors also searched reference lists of identified papers and an earlier literature review by English et al (1995). Crude mortality rates (CMRs) were derived from data on the number of deaths, period of follow up, and number of participants. In estimating the all-cause mortality, two rates were calculated: one that included all cohort studies identified in the search, and one that only included studies that reported on AIDS deaths in their cohort. This provided lower and upper mortality rates, respectively. RESULTS The current paper derived weighted mortality rates based upon cohort studies that included 179 885 participants, 1,219,422 person-years of observation, and 16,593 deaths. The weighted crude AIDS mortality rate from studies that reported AIDS deaths was approximately 0.78% per annum. The median estimated non-AIDS mortality rate was 1.08% per annum. CONCLUSIONS Illicit drug users have a greatly increased risk of premature death and mortality due to AIDS forms a significant part of that increased risk; it is, however, only part of that risk. Future work needs to examine mortality rates among IDUs in developing countries, and collect data on the relation between HIV and increased mortality due to all causes among this group.
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Affiliation(s)
- L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW 2052, Australia.
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Degenhardt L, Hall W, Lynskey M. Alcohol, cannabis and tobacco use among Australians: a comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis. Addiction 2001; 96:1603-14. [PMID: 11784457 DOI: 10.1046/j.1360-0443.2001.961116037.x] [Citation(s) in RCA: 230] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To compare relationships between alcohol, cannabis and tobacco and indicators of mental health problems in the general population. METHOD A survey of a nationally representative sample of 10 641 Australian adults (the National Survey of Mental Health and Well-Being (NSMHWB)) provided data on alcohol, cannabis and tobacco use and mental health (DSM-IV anxiety disorders, affective disorders, other substance use disorders and screening positively for psychosis). FINDINGS Alcohol showed a "J-shaped" relationship with DSM-IV affective and anxiety disorders: alcohol users had lower rates of these problems than non-users of alcohol, while those meeting criteria for alcohol dependence had the highest rates. Tobacco and cannabis use were both associated with increased rates of all mental health problems examined. However, after controlling for demographics, neuroticism and other drug use, cannabis was not associated with anxiety or affective disorders. Alcohol dependence and tobacco use remained associated with both of these indicators of mental health. All three types of drug use were associated with higher rates of other substance use problems, with cannabis having the strongest association. CONCLUSIONS The use of alcohol, tobacco and cannabis are associated with different patterns of co-morbidity in the general population.
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Affiliation(s)
- L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Abstract
This study examined if (1) there is an association in the general population between cannabis use, DSM-IV abuse and dependence, and other substance use and DSM-IV substance abuse/dependence; (2) if so, is it explained by demographic characteristics or levels of neuroticism? It used data from the Australian National Survey of Mental Health and Well-Being (NSMHWB), a stratified, multistage probability sample of 10,641 adults, representative of the general population. DSM-IV diagnoses of substance abuse and dependence were derived using the Composite International Diagnostic Interview (CIDI). There was a strong bivariate association between involvement with cannabis use in the past 12 months and other substance use, abuse and dependence. In particular, cannabis abuse and dependence were highly associated with increased risks of other substance dependence. These associations remained after including other variables in multiple regression. Cannabis use without disorder was strongly related to other drug use, an association that was not explained by other variables considered here. The high likelihood of other substance use and substance use disorders needs to be considered among persons seeking treatment for cannabis use problems.
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Affiliation(s)
- L Degenhardt
- National Drug and Alcohol Research Centre, University of NSW, Sydney 2052, Australia.
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Degenhardt L, Hall W, Adelstein BA. Ambulance calls to suspected overdoses: New South Wales patterns July 1997 to June 1999. Aust N Z J Public Health 2001; 25:447-50. [PMID: 11688626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
AIM Using data on New South Wales ambulance calls to suspected overdoses from July 1997 to June 1999 to: a) examine temporal and geographic trends in calls; and b) compare geographic patterns of fatal and non-fatal opioid overdose. METHOD The NSW Ambulance Service provided data on the occasions when an ambulance attended a person on whom the drug overdose/poisonings protocol was used, and to whom naloxone was administered. The geographic distribution of ambulance attendances was approximated to the Australian Bureau of Statistics Statistical Local Area (SLA) and Statistical Subdivision (SSD). Estimates of social disadvantage were correlated with the rate of ambulance attendances for each region. RESULTS 9,116 callouts were made. In cases with data on age and gender, 89% were aged 15-44 years, and 31% were female. South Sydney (n=1,819) and Liverpool (n=1,602) SLAs accounted for 37% of calls; the higher rates outside Sydney were in Newcastle, Orange and Kiama. There was a strong correlation between rates of ambulance callouts and fatal heroin overdoses. The number of calls increased from an average of 361 calls per month in 1997-98 to 399 in 1998-99. The majority of calls (54%) were made between midday and 9 pm. CONCLUSIONS Rates of ambulance attendance at suspected overdoses is a promising indicator that allows monitoring of trends and identification of areas with high rates of opioid use.
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Affiliation(s)
- L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales.
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Degenhardt L, Hall W. The relationship between tobacco use, substance-use disorders and mental health: results from the National Survey of Mental Health and Well-being. Nicotine Tob Res 2001; 3:225-34. [PMID: 11506766 DOI: 10.1080/14622200110050457] [Citation(s) in RCA: 182] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIMS To examine comorbidity between tobacco use, substance-use disorders and mental health problems among Australian adults aged 18 years and over. METHOD Data from the 1997 Australian National Survey of Mental Health and Well-being were analyzed. This survey was a stratified, multistage probability sample of 10,641 adults, representative of the Australian population. Univariate associations between tobacco use, substance use and mental health were examined, and then multivariate analyses were conducted to control for demographic characteristics, neuroticism, and other drug use. MEASUREMENTS Tobacco use status was defined as: never smoker, former smoker and current smoker. DSM-IV diagnoses of substance use, anxiety, and affective disorders were derived using the Composite International Diagnostic Interview (CIDI). Other measures included a screener for psychosis and measures of psychological distress and disability. FINDINGS Current tobacco use was strongly associated with abuse/dependence upon alcohol, cannabis, and other substances, and with higher rates of anxiety and affective disorders. Current smokers were more likely to screen positively for psychosis and reported greater psychological distress and disability than non-smokers and never smokers. These higher rates of other problems were not explained by differences in demographic characteristics, neuroticism scores, or by other drug use. Former smokers did not have higher rates of affective or anxiety disorders; however, they had higher rates of alcohol-use disorders, and of cannabis-use disorders after adjusting for covariates. CONCLUSIONS Current tobacco use is associated with a range of other substance-use and mental health problems. These are likely to reduce the success of attempts to quit smoking. The presence of these other problems needs to be considered when considering smoking-cessation treatment, and further research may provide information on more effective treatment strategies for persons with co-existing substance-use and mental health problems.
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Affiliation(s)
- L Degenhardt
- National Drug and Alcohol Research Centre, University of NSW, Sydney 2052, Australia.
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Degenhardt L, Hall W, Lynskey M. The relationship between cannabis use, depression and anxiety among Australian adults: findings from the National Survey of Mental Health and Well-Being. Soc Psychiatry Psychiatr Epidemiol 2001; 36:219-27. [PMID: 11515699 DOI: 10.1007/s001270170052] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aimed to examine the patterns of association between cannabis use, and anxiety and affective disorders, in the general population. METHOD Data from the Australian National Survey of Mental Health and Well-Being, a representative survey of Australians aged 18 years and over, were analysed to address the following questions: (1) is there an association between cannabis use, DSM-IV abuse and dependence, and DSM-IV affective and anxiety disorders; (2) if so, is it explained by: demographic characteristics, levels of neuroticism, or other drug use; and (3) does the presence of a comorbid affective or anxiety disorder affect the likelihood of treatment seeking among cannabis users? RESULTS There was a moderate univariate association between involvement with cannabis use in the past 12 months and the prevalence of affective and anxiety disorders. Among those with DSM-IV cannabis dependence, 14% met criteria for an affective disorder, compared to 6% of non-users; while 17% met criteria for an anxiety disorder, compared to 5% of non-users. These associations did not remain significant after including demographics, neuroticism and other drug use in multiple regressions. CONCLUSIONS Cannabis use did not appear to be directly related to depression or anxiety when account was taken of other drug use. However, the association between heavier involvement with cannabis use and affective and anxiety disorders has implications for the treatment of persons with problematic cannabis use.
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Affiliation(s)
- L Degenhardt
- National Drug and Alcohol Research Centre, University of NSW, Sydney, Australia
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Tabakoff B, Helander A, Conigrave KM, Martinez L, Hoffman PL, Whitfield J, Degenhardt L, Saunders J, Baron A, Glanz J. WHO/ISBRA Study on State and Trait Markers in Alcoholism. Alcohol Clin Exp Res 2001. [DOI: 10.1111/j.1530-0277.2001.tb02382.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tabakoff B, Helander A, Conigrave KM, Martinez L, Hoffman PL, Whitfield J, Degenhardt L, Saunders J, Barón A, Glanz J. WHP/ISBRA study on state and trait markers in alcoholism. Alcohol Clin Exp Res 2001; 25:99S-103S. [PMID: 11391057 DOI: 10.1097/00000374-200105051-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article represents the proceedings of a symposium at the 2000 ISBRA Meeting in Yokohama, Japan. The chair was Boris Tabakoff. The presentations were (1) Overview of the WHO/ISBRA study on state and trait markers in alcoholism, by Boris Tabakoff; (2) Biochemical markers of acute and chronic drinking: Results of the WHO/ISBRA study, by Anders Helander; (3) The impact of country of recruitment and body mass index on biological marker dose-response curves in the WHO/ISBRA Study, by Kate M. Conigrave; (4) Relationship of body water to carbohydrate-deficient transferrin measures, by Larry Martinez; and (5) Platelet adenylyl cyclase activity as a trait marker of alcohol dependence, by Paula L. Hoffman.
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Affiliation(s)
- B Tabakoff
- University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
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Degenhardt L, Hall W. The association between psychosis and problematical drug use among Australian adults: findings from the National Survey of Mental Health and Well-Being. Psychol Med 2001; 31:659-668. [PMID: 11352368 DOI: 10.1017/s0033291701003865] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present paper aimed to: (a) provide Australian estimates of the population-level association between psychotic 'caseness' and substance use; (b) examine liability to problematical substance use according to 'caseness' via the conditional prevalence (prevalence among users); and (c) examine associations between problematical substance use and the number of psychotic symptoms using ordinal logistic regression. METHOD Data were from the National Survey of Mental Health and Well-Being (NSMHWB), a stratified multi-stage probability sample of Australian adults, using a subset of persons under the age of 50 years (N = 6722). A screener assessed the presence of characteristic psychotic symptoms. Associations between 'case' status and DSM-IV alcohol, cannabis and other drug use disorders were examined. Ordinal logistic regressions predicting psychosis scores were carried out, including demographic, mental health and drug use variables. RESULTS Ninety-nine persons (1.2%) screened positively for psychosis. Regular tobacco, alcohol and cannabis use were much more common among persons screening positively, as were alcohol, cannabis and other drug use disorders. Among alcohol and cannabis users, psychosis 'cases' were much more likely to be dependent. Ordinal logistic regressions revealed that regular tobacco use, cannabis and alcohol dependence, and opiate abuse were predictors of psychosis scores. CONCLUSIONS The mental health risks of problematical substance use need to be disseminated to persons at risk of, or suffering from, psychotic illness, and to heavy substance users. Work is needed to develop effective treatment approaches for problematical substance use among persons with psychosis.
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Affiliation(s)
- L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Abstract
AIM To examine birth cohort trends in the prevalence of use and the age of initiation of use of: alcohol, tobacco, cannabis, amphetamines, LSD, and heroin. METHOD Data were taken from the 1998 National Drug Strategy Household Survey, a survey of a representative sample of Australians aged 14 years and over. Nine five-year cohorts were examined among persons born between 1940 and 1984. The weighted prevalence of use by ages 15 years, 21 years, and lifetime use, was estimated, as was the average age of first use among users. The significance of trends was tested using logistic regression (for lifetime use, use by 15 and 21 years) and linear regression (for age of first use). RESULTS Lifetime prevalence of alcohol and tobacco use was similar among all birth cohorts. The prevalence of illicit drug use--cannabis, amphetamines, LSD and heroin--increased with successive birth cohorts and more recent birth cohorts reported using licit and illicit drugs at a younger age. CONCLUSIONS More recent cohorts are more likely to use illicit drugs at some point in their lives. Greater numbers of persons from more recent birth cohorts may be at risk of developing substance-related problems.
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Affiliation(s)
- L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales.
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Abstract
OBJECTIVE This paper examines trends in the rate of suicide among young Australians aged 15-24 years from 1964 to 1997 and presents an age-period-cohort analysis of these trends. METHOD Study design consisted of an age-period-cohort analysis of suicide mortality in Australian youth aged between 15 and 24 for the years 1964-1997 inclusive. Data sources were Australian Bureau of Statistics data on: numbers of deaths due to suicide by gender and age at death; and population at risk in each of eight birth cohorts (1940-1944, 1945-1949, 1950-1954, 1955-1959, 1960-1964, 1965-1969, 1970-1974, and 1975-1979). Main outcome measures were population rates of deaths among males and females in each birth cohort attributed to suicide in each year 1964-1997. RESULTS The rate of suicide deaths among Australian males aged 15-24 years increased from 8.7 per 100,000 in 1964 to 30.9 per 100,000 in 1997, with the rate among females changing little over the period, from 5.2 per 100,000 in 1964 to 7.1 per 100,000 in 1997. While the rate of deaths attributed to suicide increased over the birth cohorts, analyses revealed that these increases were largely due to period effects, with suicide twice as likely among those aged 15-24 years in 1985-1997 than between 1964 and 1969. CONCLUSIONS The rate of youth suicide in Australia has increased since 1964, particularly among males. This increase can largely be attributed to period effects rather than to a cohort effect and has been paralleled by an increased rate of youth suicides internationally and by an increase in other psychosocial problems including psychiatric illness, criminal offending and substance use disorders.
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Affiliation(s)
- M Lynskey
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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Abstract
OBJECTIVE This study reports the prevalence and correlates of ICD-10 alcohol- and drug-use disorders in the National Survey of Mental Health and Wellbeing (NSMHWB) and discusses their implications for treatment. METHOD The NSMHWB was a nationally representative household survey of 10641 Australian adults that assessed participants for symptoms of the most prevalent ICD-10 and DSM-IV mental disorders, including alcohol- and drug-use disorders. RESULTS In the past 12 months 6.5% of Australian adults met criteria for an ICD-10 alcohol-use disorder and 2.2% had another ICD-10 drug-use disorder. Men were at higher risk than women of developing alcohol- and drug-use disorders and the prevalence of both disorders decreased with increasing age. There were high rates of comorbidity between alcohol- and other drug-use disorders and mental disorders and low rates of treatment seeking. CONCLUSIONS Alcohol-use disorders are a major mental health and public health issue in Australia. Drug-use disorders are less common than alcohol-use disorders, but still affect a substantial minority of Australian adults. Treatment seeking among persons with alcohol- and other drug-use disorders is low. A range of public health strategies (including improved specialist treatment services) are needed to reduce the prevalence of these disorders.
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Affiliation(s)
- M Teesson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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Abstract
OBJECTIVE This paper evaluates evidence for two hypotheses about the relationship between cannabis use and psychosis: (i) that heavy cannabis use causes a 'cannabis psychosis', i.e. a psychotic disorder that would not have occurred in the absence of cannabis use and which can be recognised by its pattern of symptoms and their relationship to cannabis use; and (ii) that cannabis use may precipitate schizophrenia, or exacerbate its symptoms. METHOD Literature relevant to drug use and schizophrenia is reviewed. RESULTS There is limited clinical evidence for the first hypothesis. If 'cannabis psychoses' exist, they seem to be rare, because they require very high doses of tetrahydrocannabinol, the prolonged use of highly potent forms of cannabis, or a preexisting (but as yet unspecified) vulnerability, or both. There is more support for the second hypothesis in that a large prospective study has shown a linear relationship between the frequency with which cannabis had been used by age 18 and the risk over the subsequent 15 years of receiving a diagnosis of schizophrenia. CONCLUSIONS It is still unclear whether this means that cannabis use precipitates schizophrenia, whether cannabis use is a form of 'self-medication', or whether the association is due to the use of other drugs, such as amphetamines, which heavy cannabis users are more likely to use. There is better clinical and epidemiological evidence that cannabis use can exacerbate the symptoms of schizophrenia.
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Affiliation(s)
- W Hall
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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Abstract
This paper compares data on rates of opiate overdose mortality in the UK and Australia between 1985 and 1995. Data on rates of ICD 9-coded overdose mortality were obtained from the Office of National Statistics in the UK and from the Australian Bureau of Statistics mortality register. The proportion of all deaths attributed to opioid overdose increased in both countries between 1985 and 1995. The proportion of all deaths attributed to opioid overdose was substantially higher in Australia than in the UK, but methadone appeared to contribute to more opioid overdose deaths in the UK (50%) than in Australia (18%). Given deficiencies in the available data, the reasons for these differences between the two countries are uncertain but a plausible hypothesis is that the greater availability and ease of access to methadone maintenance in the UK contributes to both the lower rate of opioid overdose mortality and the greater apparent contribution that methadone makes to opioid overdose deaths in that country.
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Affiliation(s)
- W Hall
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Hall W, Teesson M, Lynskey M, Degenhardt L. The 12-month prevalence of substance use and ICD-10 substance use disorders in Australian adults: findings from the National Survey of Mental Health and Well-Being. Addiction 1999; 94:1541-50. [PMID: 10790906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
AIMS To present the prevalence of substance use and ICD-10 substance use disorders in the adult Australian population using data from the National Survey of Mental Health and Well-Being (NSMHWB). DESIGN A cross-sectional survey assessing substance use and ICD substance use disorders (harmful use and dependence). SETTING AND PARTICIPANTS A household survey of a nationally representative sample of 10,641 Australian adults (aged 18 years or older). MEASUREMENTS Trained survey interviewers administered a structured interview based on the Composite International Diagnostic Interview (CIDI). FINDINGS In the past 12 months 6.5% of the sample had an ICD-10 alcohol use disorder (95% CI: 6.2, 6.9), and 2.2% had another drug use disorder (95% CI: 2.0, 2.4). More males than females had substance use disorders: 9.5% of males (95% CI: 8.5, 10.5) and 3.6% of females (95% CI: 3.2, 4.0) met criteria for an alcohol use disorder, and 3.2% of males (95% CI: 2.8, 3.6) and 1.3% of females (95% CI: 0.9, 1.7) met criteria for another drug use disorder within the past 12 months. The prevalence of substance use disorders decreased with increasing age: 10.5% of respondents aged 18-34 years met criteria for an alcohol use disorder and 4.8% met criteria for a drug use disorder. The rates of these disorders among those aged 55 years or older were 1.8% and 0.1%, respectively. Substance use disorders were more prevalent among the unemployed, those who had never married and those who were Australian-born. CONCLUSIONS The prevalence of substance use disorders in the Australian population is comparable to that in other English-speaking countries.
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Affiliation(s)
- W Hall
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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