"There's a big tag on my head": exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia.

BACKGROUND: Australia has a high prevalence of regular use of methamphetamine. While half of people who use methamphetamine regularly are women, they make up only one third of people seeking treatment for methamphetamine use disorder. There is a lack of qualitative research into the facilitators and barriers to treatment for women who use methamphetamine regularly. The study seeks a better understanding of the experiences and treatment preferences of women who use methamphetamine, to inform person-centred changes in practice and policy that break down barriers to treatment. METHODS: We conducted semi-structured interviews with 11 women who frequently use methamphetamine (at least once a week), and who are not engaged in treatment. Women were recruited from health services surrounding a stimulant treatment centre at an inner-city hospital. Participants were asked about their methapmhetamine use and health service needs and preferences. Thematic analysis was completed using Nvivo® software. RESULTS: Three themes were developed from participants' responses around experiences of regular methamphetamine use and treatment needs: 1. Resistance of stigmatised identity including dependence; 2. Interpersonal violence; 3. Institutionalised stigma. A fourth set of themes on service delivery preferences were also elicited, including continuity of care, integrated health care, and provision of non-judgmental services. CONCLUSION: Gender-inclusive health care services for people who use methamphetamine should actively work to address stigma, support a relational approach to assessment and treatment, and seek to provide structurally competent health care that is trauma and violence informed, and integrated with other services. Findings may also have application for substance use disorders other than methamphetamine.

Understandings, attitudes, practices and responses to GHB overdose among GHB consumers.

BACKGROUND: Gamma-hydroxybutyrate (GHB) is used at disproportionately high rates within sexuality and gender diverse communities and carries a high risk of overdose. GHB overdose can result in death. Internationally, recent increases in GHB overdoses have been observed. Coronial reviews of GHB-related death highlight the pivotal roles that bystanders to GHB overdose play in preventing fatality. No research has examined, in detail, how bystanders respond to GHB overdose. This qualitative study was conducted among people who use GHB and explored how they responded upon witnessing a GHB overdose experienced by someone else. METHODS: Interviews were conducted with 31 sexuality and gender diverse Australian residents reporting three or more occasions of GHB use in the previous 12 months. Participants were asked questions about witnessed GHB overdose, their actions and decision-making processes throughout overdose. Data were analysed thematically. RESULTS: Participants described witnessing GHB overdose, commonly in private settings involving sexualized GHB use. Variable definitions of GHB overdose were reported, ranging from GHB-induced symptoms of distress to comatose intoxication. Drastic actions to keep someone alert and responsive post-GHB ingestion were reported; these included the administration of stimulant substances and citrus. Decisions to call or not call for emergency medical services (EMS) were influenced by many circumstantial variables. In most instances, an EMS call was resisted and response practices deviated from established first aid protocols. CONCLUSIONS: GHB overdose prevention and response training programs targeting people who use GHB are urgently required. These education interventions ought to address inaccuracies that inform street remedies for GHB overdose, teach people how to safely check breathing and response, promote basic first aid principles and address barriers to contacting EMS.

Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic.

The impact of COVID-19 across health services, including treatment services for people who use drugs, is emerging but likely to have a high impact. Treatment services for people who use drugs provide essential treatment services including opiate agonist treatment and needle syringe programmes alongside other important treatment programmes across all substance types including withdrawal and counselling services. Drug and alcohol hospital consultation-liaison clinicians support emergency departments and other services provided in hospital settings in efficiently managing patients who use drugs and present with other health problems.COVID-19 will impact on staff availability for work due to illness. Patients may require home isolation and quarantine periods. Ensuring ongoing supply of opiate treatment during these periods will require significant changes to how treatment is provided. The use of monthly depot buprenorphine as well as moving from a framework of supervised dosing will be required for patients on sublingual buprenorphine and methadone. Ensuring ready access to take-home naloxone for patients is crucial to reduce overdose risks. Delivery of methadone and buprenorphine to the homes of people with confirmed COVID-19 infections is likely to need to occur to support home isolation.People who use drugs are likely to be more vulnerable during the COVID-19 epidemic, due to poorer health literacy and stigma and discrimination towards this group. People who use drugs may prioritise drug use above other health concerns. Adequate supply of clean injecting equipment is important to prevent outbreaks of blood-borne viruses. Opiate users may misinterpret SARS-CoV2 symptoms as opiate withdrawal and manage this by using opioids. Ensuring people who use drugs have access to drug treatment as well as access to screening and testing for SARS-CoV2 where this is indicated is important.

Controlling for pleasure and risk: The experiences of sexuality and gender diverse people who use GHB.

BACKGROUND: GHB is used among some sexuality and gender diverse populations at elevated rates, however little qualitative research has explored GHB use among these populations with regards to diverse contexts, settings, practices, and experiences of use. Internationally, harms relating to GHB overdose appear to be increasing. Research outlining consumers' experiences of GHB-related pleasures and their strategies to reduce harms may inform GHB education and intervention responses. METHODS: N = 31 participants reporting three or more occasions of GHB use within the previous 12 months were recruited via digital advertising and snowball methods. Semi-structured interviews were conducted, data were transcribed and analysed in NVivo using a thematic framework analysis. Emergent themes were charted, and divergences and convergences were considered with regards to the sexuality and gender identities of participants. RESULTS: Pleasures associated with GHB were described in relation to the sensation of the GHB high and experiences of intimacy, and connection. GHB was used to enhance socialising and sex in domestic, private, and commercial venues. Participants prioritised terminology of 'control' when describing their practices associated with GHB dosing, measuring, timing and peer moderation. Most participants reported personal experience of GHB overdose with loss of consciousness. CONCLUSION: Participants' near-ubiquitous experience of GHB overdose highlights ongoing education needs around overdose prevention. Efforts must target people new to GHB use who appeared particularly susceptible to overdose. Inconsistencies in understandings around GHB overdose, the perceived severity of overdose and the differences between GHB and its precursors GBL and 1,4-BD, highlight potential focus areas of future education responses. Further research is required to better understand consumers' experiences of sexual violence in the context of GHB use.

A Web-Based Therapeutic Program (We Can Do This) for Reducing Methamphetamine Use and Increasing Help-Seeking Among Aboriginal and Torres Strait Islander People: Protocol for a Randomized Wait-List Controlled Trial.

BACKGROUND: Methamphetamine use is of deep concern to Aboriginal and Torres Strait Islander communities, but access to culturally appropriate treatment resources and services is limited. Web-based programs have potential as flexible and cost-effective additions to the range of treatment options available to Aboriginal people. The We Can Do This online intervention is designed to incorporate evidence-based therapies in a culturally relevant format using narratives from Aboriginal people to contextualize the therapeutic content. OBJECTIVE: The goal of the research will be to test the effectiveness of the online intervention in a wait-list controlled randomized trial across multiple sites in urban, regional, and remote locations. METHODS: Participants will be Aboriginal and Torres Strait Islander people aged 16 years and over who have used methamphetamine at least weekly for the previous 3 months. They will be recruited online and via health services. During the intervention phase, participants will have access to the online intervention for 6 weeks with optional telephone or face-to-face support provided by participating health services. The primary outcome measure will be the number of days the participant used methamphetamine over the past 4 weeks compared to wait-list controls, assessed at baseline, 1, 2, and 3 months. Secondary outcomes will include help-seeking, readiness to change, severity of dependence, and psychological distress. Any important changes to the protocol will be agreed upon by the trial management committee and communicated to all relevant parties, including trial site representatives and the trial registry. RESULTS: Recruitment will commence in July 2019, and results are expected in early 2021. This research is funded by National Health and Medical Research Council project grant #1100696. The primary sponsor for the trial is the South Australian Health and Medical Research Institute. A trial management committee with representation from the participating health services, chief investigators, other Aboriginal experts, and consumers will oversee procedures, trial conduct, analysis, and reporting of the results. CONCLUSIONS: The trial of this online intervention builds on existing research supporting the effectiveness of Web-based therapies for a range of psychological and other health-related issues including substance use. If successful, the We Can Do this online intervention will increase the range of options available to Aboriginal people seeking to reduce or stop methamphetamine use. It may provide a pathway into treatment for people who may otherwise be disengaged with health services for a range of reasons and will be a culturally appropriate, evidence-based resource for health practitioners to offer their clients. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619000134123p; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=376088&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/14084.

A managed alcohol program in Sydney, Australia: Acceptability, cost-savings and non-beverage alcohol use.

INTRODUCTION AND AIMS: Managed alcohol programs (MAPs) are a novel harm reduction intervention for people who experience long-term homelessness and severe long-term alcohol dependence. MAPs provide regulated amounts of alcohol onsite under supervision. Preliminary international evidence suggests that MAPs are associated with improvements such as reduced non-beverage alcohol consumption and decreases in some alcohol-related harms. There are currently no MAPs in Australia. We aimed to assess the feasibility of a MAP in inner-Sydney. DESIGN AND METHODS: A survey among eligible homeless alcohol-dependent residents of an inner-Sydney short-stay alcohol withdrawal service occurred in 2014 to assess acceptability. Administrative data were analysed to ascertain estimates of cost-savings for a MAP based in Sydney. RESULTS: Fifty-one eligible participants were surveyed. More than one-quarter (28%) reported consumption of non-beverage alcohol. A residential model received greatest support (76%); the majority (75%) of participants indicated a willingness to pay at least 25% of their income to utilise a MAP. Hospital and crisis accommodation cost-savings were conservatively estimated at AUD$926 483.40 and AUD$347 574.00, respectively per year for a 15-person residential MAP. DISCUSSION AND CONCLUSIONS: Our findings demonstrate the acceptability of a MAP in Sydney among a target population sample, with the implementation of a residential MAP likely to produce significant cost-savings. A trial of a Sydney MAP evaluating the impact on health and social outcomes, including a comprehensive economic evaluation, is strongly recommended.