Service providers' experience of methamphetamine and the portrayal of the 'ice epidemic' in remote Australia.

OBJECTIVE: To contrast service providers' perceptions about crystalline methamphetamine (henceforth, ice) use and harm with information communicated in media reports and politicians' statements. DESIGN: In-depth semi structured interviews with service providers about the nature and extent of ice use in the local community and its impact on individual services, clients and town life. Interviews were transcribed verbatim, manually analysed and coded around key themes, interpreted and independently cross-checked for context and accuracy. SETTING: Two remote towns located in different states and territories operating as service hubs to very remote communities. PARTICIPANTS: Twenty-seven key service providers representing local organisations that engage with ice users and/or their families. RESULTS: First, compared with alcohol, ice use and ice-related harm were insignificant at the two sites. Ice users were primarily high-earning and -functioning non-Australian Aboriginal tradesmen, and to a lesser extent, professionals and secondary school students. There were few Australian Aboriginal users. Ice was used to 'party', keep alert, and escape psychological distress. Second, the 'Ice Destroys Lives' campaign and references to an 'ice epidemic' amplified public anxiety about ice and ice-related harm in the surveyed communities. Third, the attention on ice distracted from the more extensive harm arising from alcohol use in their communities. CONCLUSION: The respondents questioned the notion of an 'ice epidemic' and the use of federal funding for ice-related initiatives in remote communities, especially while general alcohol and other drug services were under-resourced.

Quantifying the societal cost of methamphetamine use to Australia.

Globally, there are increasing concerns about the harms associated with methamphetamine use. This paper i) reports on the results of a cost-of-illness (CoI) study that quantified the social costs associated with methamphetamine use in Australia and, ii) drawing on examples from this study, critically examines the general applicability of CoI studies for the alcohol and other drug field. A prevalence approach was used to estimate costs in 2013/2014, the most recent year for which reasonably comprehensive data were available. The value selected for a statistical life-year in our central estimate was AUD 281,798. Other costs were estimated from diverse sources. Total cost was estimated at AUD 5023.8 million in 2013/14 (range, AUD 2502.3 to AUD 7016.8 million). The greatest cost areas were crime including costs related to policing, courts, corrections and victims of crime (AUD 3244.5 million); followed by premature death (AUD 781.8 million); and, workplace costs (AUD 289.4 million). The social costs of methamphetamine use in Australia in 2013/14 are high, and the identification of crime and premature mortality as the largest cost areas is similar to USA findings and represents important areas for prevention and cost remediation. However, caution is required in interpreting the findings of any CoI study, as there is uncertainty associated with estimates owing to data limitations. Moreover, CoI estimates on their own do not identify which, if any, of the costs are avoidable (with drug substitution being a particular problem) nor do they shed light on the effectiveness of any potential interventions. We also recognise that data limitations prevent some costs from being estimated at all.

Demonstrating Impact: Lessons Learned from the Queensland Aboriginal and Islander Health Council's AOD-Our-Way Program.

In this paper, we describe the innovative way in which the Queensland Aboriginal and Islander Health Council uses "clicker technology" to gather data to report on the key performance indicators of its "AOD-our-way" program, and how, with the subsequent combination of those data with other performance measures, it was possible to go beyond the initial evaluation. The paper also illustrates how the application of survey research methods could further enable enhanced reporting of program outcomes and impacts in an Indigenous context where Indigenous community controlled organisations want to build the evidence base for the issues they care about and ultimately drive their own research agendas.

Idarubicin Dose Escalation During Consolidation Therapy for Adult Acute Myeloid Leukemia.

Purpose Higher doses of the anthracycline daunorubicin during induction therapy for acute myeloid leukemia (AML) have been shown to improve remission rates and survival. We hypothesized that improvements in outcomes in adult AML may be further achieved by increased anthracycline dose during consolidation therapy. Patients and Methods Patients with AML in complete remission after induction therapy were randomly assigned to receive two cycles of consolidation therapy with cytarabine 100 mg/m2 daily for 5 days, etoposide 75 mg/m2 daily for 5 days, and idarubicin 9 mg/m2 daily for either 2 or 3 days (standard and intensive arms, respectively). The primary end point was leukemia-free survival (LFS). Results Two hundred ninety-three patients 16 to 60 years of age, excluding those with core binding factor AML and acute promyelocytic leukemia, were randomly assigned to treatment groups (146 to the standard arm and 147 to the intensive arm). Both groups were balanced for age, karyotypic risk, and FLT3-internal tandem duplication and NPM1 gene mutations. One hundred twenty patients in the standard arm (82%) and 95 patients in the intensive arm (65%) completed planned consolidation ( P < .001). Durations of severe neutropenia and thrombocytopenia were prolonged in the intensive arm, but there were no differences in serious nonhematological toxicities. With a median follow-up of 5.3 years (range, 0.6 to 9.9 years), there was a statistically significant improvement in LFS in the intensive arm compared with the standard arm (3-year LFS, 47% [95% CI, 40% to 56%] v 35% [95% CI, 28% to 44%]; P = .045). At 5 years, the overall survival rate was 57% in the intensive arm and 47% in the standard arm ( P = .092). There was no evidence of selective benefit of intensive consolidation within the cytogenetic or FLT3-internal tandem duplication and NPM1 gene mutation subgroups. Conclusion An increased cumulative dose of idarubicin during consolidation therapy for adult AML resulted in improved LFS, without increased nonhematologic toxicity.