Uptake of hepatitis C treatment among people who inject drugs attending Needle and Syringe Programs in Australia, 1999-2011.

The majority of new and existing cases of hepatitis C virus (HCV) infection occur among people who inject drugs (PWID). Despite safe and efficacious HCV antiviral therapy, uptake remains low in this population. This study examined trends in HCV treatment uptake among a large national sample of PWID attending Australian Needle and Syringe Programs between 1999 and 2011. Annual cross-sectional sero-surveys conducted among PWID since 1995 involve completion of a self-administered questionnaire and provision of a dried blood spot for HCV antibody testing. Multivariate logistic regression identified variables independently associated with HCV treatment uptake among 9478 participants with both self-reported and serologically confirmed prior HCV infection. Between 1999 and 2011, the proportion currently receiving treatment increased from 1.1% to 2.1% (P < 0.001), while the proportion having ever received treatment increased from 3.4% to 8.6% (P < 0.001). Men were significantly more likely than women to have undertaken HCV treatment (P = 0.002). Among men, independent predictors of HCV treatment uptake were homosexual identity and older age; among women, independent predictors included homosexual identity and an incarceration history. Despite increases in HCV treatment among Australian PWID between 1999 and 2011, uptake remains low. Strategies are required to increase the proportion of PWID assessed and treated for HCV infection to address the increasing burden of disease. Specific approaches that target women may also be warranted. Continued surveillance of HCV treatment uptake among PWID will be important to monitor the roll-out of simple, safe and more effective HCV treatments expected to be available in the future.

Validation of the amphetamine dependence syndrome and the SAmDQ.

The severity of Amphetamine Dependence Questionnaire (SAmDQ) was administered to 132 subjects who were amphetamine dependent by DSM-III-R criteria. The structural characteristics of the questionnaire were examined and findings compared with those reported previously for both the SAmDQ and its forebear, the SODQ. There was a high degree of consistency in the present psychometric analyses and those reported earlier; and comparisons between samples of differing dependence severities indicated that the SAmDQ is capable of discriminating between these groups. The findings support the existence of an amphetamine dependence syndrome, and help to explicate the dimensions underlying such a syndrome and the characteristics of the population in which it may be manifest.

Choosing a cut-off on the Severity of Dependence Scale (SDS) for amphetamine users.

In order to ascertain a cut-off score on the Severity of Dependence Scale (SDS) which is indicative of clinically significant amphetamine dependence, 327 regular amphetamine users were administered the SDS, along with the "Disorders resulting from the use of psychoactive substances" section of the Composite International Diagnostic Interview (CIDI) for DSM-III-R. Receiver operating characteristic (ROC) analysis was used in order to determine which cut-off score on the SDS allowed the best trade-off between sensitivity and specificity, when calibrated against the presence or absence of a DSM-III-R diagnosis of severe amphetamine dependence. Results suggest that the SDS has high diagnostic utility, and that a score of greater than four on the scale is indicative of problematic amphetamine use.

The applicability of the dependence syndrome to amphetamine.

While current psychiatric taxonomies recognise a classification of amphetamine dependence, derived from the notion of an alcohol dependence syndrome, little research has validated that such a condition exists for this drug. Current amphetamine users (N = 331), were interviewed using the World Health Organization operationalisation of DSM-III-R substance dependence criteria, and a measure of the psychological components of dependence. Structural analyses indicated that a unidimensional dependence syndrome as assessed by DSM-III-R and DSM-IV criteria exists for amphetamine, and that physiological, psychological and behavioural indicators were all important in accounting for the variance in responses. It was demonstrated that the concept of a dependence syndrome is applicable to amphetamine, and that the inclusion of the amphetamine dependence syndrome in DSM-III-R and DSM-IV is valid.

Amphetamine-related harms and treatment preferences of regular amphetamine users in Sydney, Australia.

Amphetamines remain a popular illicit drug among young adults in Australia and a number of other countries, particularly by injection. A significant increase in the number of people presenting to drug treatment services with a primary amphetamine problem in Australia and the US has occurred in recent years. A survey of 200 regular amphetamine users was conducted in Sydney to determine the treatment issues and preferences of this population. Substantial harm associated with the use of this drug was found, most notably psychological problems, physical health problems, dependence and financial problems. A perceived need for amphetamine-specific treatment was evident. Popular treatment options requested by users included pharmacotherapies, natural therapies and counselling. While regular amphetamine users can attend existing treatment services, the efficacy of these treatments for amphetamine problems has not been evaluated. There is also a need to develop and evaluate amphetamine-specific interventions in order to attract this population into treatment.

Ecstasy use in Australia: patterns of use and associated harm.

This study explored patterns of ecstasy use and associated harm through the administration of a structured interview schedule to 329 ecstasy users, recruited from three Australian cities. A broad range of ecstasy users were interviewed, but on the whole, the sample was young, relatively well educated and most were employed or students. Patterns of use were varied, although extensive polydrug use was the norm. High rates of intravenous drug use were recorded, which may relate to an over-representation of chaotic intravenous polydrug users. Subjects had experienced an average of eight physical and four psychological side-effects, which they attributed to their ecstasy use in the preceding 6 months. Approximately 40% of the sample also reported financial, relationship and occupational problems. Young, female, polydrug users and those who binged on ecstasy for 48 h or more appeared most at risk of experiencing harm that they related to their ecstasy use. One-fifth of the sample had received treatment for an ecstasy-related problem, most often from a GP or natural therapist, and 7% were currently in treatment. One quarter wanted to reduce their use because of financial, relationship and psychological problems. A total of 15% wanted formal treatment for an ecstasy-related problem and 85% requested more information. These results have implications for the development of policies to respond to drug use among this population.

Cue reactivity in dependent amphetamine users: can monistic conditioning theories advance our understanding of reactivity?

Forty-eight dependent injecting amphetamine users (AUs) and 48 controls were exposed to an amphetamine-related video and three affective control videos, and their amphetamine-related responses (amphetamine symptoms, withdrawal symptoms, and for AUs, "positive" and "negative" craving, based on the desire for positive and negative reinforcement, respectively) were recorded after each one. Both groups responded to the amphetamine video with increased withdrawal symptoms relative to control videos, suggesting that drug-related cues have significant unconditioned aversive properties. Between-group differences in amphetamine symptoms were evident only after the amphetamine video, supporting a conditioned drug agonistic model of cue reactivity. Among AUs, both positive and negative craving increased significantly after the amphetamine video, providing prima facie evidence for both conditioned withdrawal and conditioned drug agonistic accounts of cue reactivity. However, the lack of consistent and strong correlations between the two types of craving and the affective states hypothesized to induce such craving cannot be accommodated by the dominant models of the role of conditioning in maintaining addictive behaviours. This suggests a need to build upon theories of cue reactivity which predict conditioned responses to be either drug-like or drug-opposite.

Prevalences and correlates of non-viral injecting-related injuries and diseases in a convenience sample of Australian injecting drug users.

BACKGROUND: The prevalences and correlates of non-viral injecting-related injuries and diseases (IRIDs) in Australian injecting drug users (IDUs) remain unknown. METHODS: A cross-sectional survey of IDUs was conducted in six sites across Australia's eastern states to investigate IRID experience among Australian IDU. Correlates of IRIDs were explored using logistic and negative binomial regression analyses. RESULTS: 393 IDUs were recruited. Lifetime experience of non-serious IRIDs was common (e.g., 'dirty hit' 68%); potentially serious and serious IRIDs were less commonly experienced (e.g., abscess 16%; gangrene <1%). Factors independently associated with potentially serious or serious IRIDs in the previous 12 months were: injecting in sites other than arms (Adjusted Odds Ratio 3.0, 95% confidence interval 1.7-5.4), injecting non-powder drug forms (5.0, 2.2-11.2), unstable accommodation (2.0, 1.1-3.5), being aged 25 years or older (4.3, 1.7-10.6) and not always washing hands before injection (9.3, 2.1-41.8). Factors independently associated with multiple IRIDs in the preceding 12 months were using three or more injecting sites (Adjusted Incidence Rate Ratio 1.5, 95% CI 1.1-2.0), injecting in sites other than arms (1.7, 1.3-2.2), using non-powder drug forms (1.9, 1.4-2.5), injecting daily or more often (1.7, 1.3-2.2), current pharmacotherapy experience (1.5, 1.1-1.9), and not always washing hands before injecting (1.9, 1.2-2.9). DISCUSSION: Some IRIDs are widespread among Australian IDUs. Observed associations, particularly the protective effect of handwashing, have useful public health implications.

Force system developed from closed coil springs.

The present paper provides data on load-deflection rate and maximal force generated for 19 coil springs. The force level at activation and deactivation was registered at intervals of 5 mm between 0 and 100 per cent extension. Ten springs of each type were analysed. The following questions were answered. How many of the springs exhibited the behaviour of a superelastic spring and how many types of springs differed significantly from each other with respect to force deflection rate and maximal force level at 100 per cent extension? Of the products tested only the springs from GAC exhibited the behaviour characteristic of the superelastic wire. The 19 products could, from a clinical point of view, be classified into four different groups with regard to force deflection rate and five groups with regard to maximal force. The variation within each product also differed between the products with the lowest intra-product variation seen in the TP springs. In light of the present findings it is obvious that manufacturers' information was not satisfactory. The need for more thorough user information is stressed.