A qualitative study of reasons for seeking and ceasing opioid substitution treatment in prisons in New South Wales, Australia.

INTRODUCTION AND AIMS: Opioid substitution treatment (OST) reduces drug-related harms in custody and after release. However, OST providers in prisons have reported that some patients prefer to cease treatment prior to release, placing them at risk of fatal overdose. We aimed to examine reasons for seeking OST in custody, and intentions regarding continuation or cessation of treatment prior to and following release. DESIGN AND METHODS: This qualitative study employed semi-structured interviews with opioid-dependent people currently incarcerated in New South Wales, Australia. RESULTS: Of 46 participants, 27 were currently in OST. Reported benefits of OST included withdrawal management and avoidance of high-risk injecting. Over a third of participants in OST stated their intention to withdraw from OST prior to release. Reasons included concerns that attending community OST clinics could lead to drug use or offending, family opposition, inconvenience of clinic attendance, stigma and a perception that prison provided an opportunity to withdraw from OST more easily than in the community. Nineteen participants had already ceased OST in custody or had declined it, citing preferences to 'be clean' and the long-term nature of OST. DISCUSSION AND CONCLUSIONS: Balancing the preference of many patients to cease OST prior to release against patient safety post-release is a substantial challenge for opioid treatment providers in correctional settings. These findings indicate the need for research on how best to attract and retain opioid-dependent prisoners in treatment and the need to provide other interventions for prisoners uninterested in post-release OST, such as take-home naloxone. [Larney S, Zador D, Sindicich N, Dolan K. A qualitative study of reasons for seeking and ceasing opioid substitution treatment in prisons in New South Wales, Australia. Drug Alcohol Rev 2017;36:305-310].

Characterising dark net marketplace purchasers in a sample of regular psychostimulant users.

BACKGROUND: The past five years has seen a proliferation in marketplaces operating on the 'dark net' selling licit and illicit substances. While monitoring systems have investigated the specific substances for sale on these marketplaces, less is known about consumer motivations for accessing these marketplaces and factors associated with their use. METHODS: An Australian national sample (n=800) recruited on the basis of regular psychostimulant use was recruited and asked about purchasing substances from dark net marketplaces and the reasons for doing so. Respondents who had purchased any drug from a dark net marketplace in the preceding year were compared to those who had not in terms of demographic information and factors including drug use, criminal activity, and sexual and mental health. RESULTS: Nine percent (n=68) of the sample had purchased from dark net markets in the past year. MDMA, LSD and cannabis were the three most commonly purchased substances, and the main benefits cited for purchasing online were the better quality and lower cost of drugs available. Controlling for other factors, participants who purchased from dark net marketplaces in the past year tended to be younger, more likely to be involved in recent property crime and to have used more classes of drugs in the preceding six months, specifically psychedelics and 'new psychoactive drugs'. CONCLUSIONS: Though a small minority of participants reported having purchased drugs online in the preceding six months, these appeared to be a more 'entrenched' group of consumers, with more diverse substance use and rates of criminal activity. For consumers in the current sample reporting recent dark net usage, country borders are now less of a significant barrier to purchase and there is a wider range of substances available than ever before.

Co-ingestion of energy drinks with alcohol and other substances among a sample of people who regularly use ecstasy.

INTRODUCTION AND AIMS: Despite the potential harms of mixing unregulated drugs with energy drinks (ED), research to date has primarily been focused on EDs co-ingested with alcohol. Consequently, the aim of the present study was to explore the rate of use, harms and correlates of EDs co-ingested with alcohol and other drugs among a sample of people who regularly use illicit stimulant drugs. DESIGN AND METHODS: In 2010, 693 Australians who regularly used ecstasy completed a 1-h interview about their past six-month ED and drug use. RESULTS: Three-quarters of the sample (77%) had recently consumed EDs with other substances, primarily alcohol (70%) and ecstasy (57%). People who consumed ED with alcohol versus those who had consumed ED with ecstasy and with alcohol (only 8% reported only consuming ED with ecstasy) had similar profiles in regards to demographics, drug use, mental health and drug-related problems. Primary motives for consuming ED with alcohol included increased alertness (59%), the taste (25%), to party for longer (23%) and to combat fatigue (16%). One-half (52%) and one-quarter (27%) of participants who consumed EDs with alcohol and with ecstasy respectively had recently experienced adverse outcomes post-consumption, primarily headaches (24% and 11%) and heart palpitations (21% and 14%). DISCUSSION AND CONCLUSIONS: Co-ingestion of EDs with licit and illicit drugs is common among people who regularly use ecstasy and related drugs. Adverse outcomes of co-ingestion suggest that targeted education regarding negative interactive drug effects is crucial for harm reduction. [Peacock A, Sindicich N, Dunn M, Whittaker E, Sutherland R, Entwistle G, Burns L, Bruno R. Co-Ingestion of Energy Drinks with Alcohol and Other Substances among a Sample of People Who Regularly Use Ecstasy. Drug Alcohol Rev 2016;35:352-358].

Tobacco and e-cigarette use amongst illicit drug users in Australia.

OBJECTIVE: To examine the rates and patterns of tobacco and e-cigarette use amongst two samples of illicit drug users in Australia. METHOD: Data were obtained from the 2015 Illicit Drug Reporting System (IDRS) and the 2015 Ecstasy and Related Drugs Reporting System (EDRS). These studies comprised cross-sectional samples of 888 people who inject drugs (PWID) and 763 regular psychostimulant users (RPU). RESULTS: Tobacco was consumed by the majority of both samples, however, use in the 6 months preceding interview was significantly higher amongst PWID (92.2%) than RPU (82.4% [OR 2.53 95% CI 1.86-3.44]). Inversely, PWID were less likely to have a history of e-cigarette use: 31.5% of PWID reported lifetime use of e-cigarettes (vs. 57.0% of RPU [OR 0.35 95% CI 0.28-0.42]) and 18.1% reported use in the 6 months preceding interview (vs. 33.7% of RPU [OR 0.44 95% CI 0.35-0.55]). PWID were more than three times as likely than RPU to report using e-cigarettes as a smoking cessation tool (OR 3.09 95% CI 2.03-4.71), but were less likely to use e-liquids that contained nicotine (OR 0.52 95% CI 0.32-0.83). Higher levels of poly drug use, daily tobacco use, recent use of synthetic cannabinoids and employment status were found to be significantly associated with e-cigarette use. CONCLUSION: The use of e-cigarettes was relatively common amongst Australian samples of PWID and RPU. Whilst the majority of PWID reported using e-cigarettes as a smoking cessation tool, it appears that RPU are using them for experimental or recreational purposes.

Multiply disadvantaged: Health and service utilisation factors faced by homeless injecting drug consumers in Australia.

INTRODUCTION AND AIMS: Homelessness status is strongly correlated with higher rates of substance use. Few studies, however, examine the complex relationship between housing status and substance use in people who inject drugs (PWID). This study extends previous research by comparing the physical and mental health status and service utilisation rates between stably housed and homeless PWID. DESIGN AND METHODS: A cross-sectional sample of 923 PWID were recruited for the 2012 Illicit Drug Reporting System. Multivariate models were generated addressing associations between homelessness and the domains of demographics; substance use; and health status, service utilisation and criminal justice system contact, with significant correlates entered into a final multivariate model. RESULTS: Two-thirds of the PWID sample were male. The median age was 39 years and 16% identified as Indigenous. Almost one-quarter (23%) reported that they were homeless. Homeless PWID were significantly more likely to be unemployed [adjusted odds ratio (AOR) 2.83, 95% confidence interval (CI) 1.26, 6.34], inject in public (AOR 2.01, 95% CI 1.38, 3.18), have poorer mental health (AOR 0.98, 95% CI 0.97, 1.00), report schizophrenia (AOR 2.31, 95% CI 1.16, 4.60) and have a prison history (AOR 1.53, 95% CI 1.05, 2.21) than stably housed PWID. DISCUSSION AND CONCLUSIONS: Findings highlight the challenge of mental health problems for homeless PWID. Our results demonstrate that further research that evaluates outcomes of housing programs accommodating PWID, particularly those with comorbid mental health disorders, is warranted. Results also emphasise the need to better utilise integrated models of outreach care that co-manage housing and mental health needs.

Motivations, substance use and other correlates amongst property and violent offenders who regularly inject drugs.

OBJECTIVE: To examine the prevalence, correlates and motivations for the commission of property and violent crime amongst a sample of people who inject drugs (PWID). METHOD: Data were obtained from the 2013 Illicit Drug Reporting System (IDRS), which includes a cross-sectional sample of 887 PWID. RESULTS: Eighteen percent of PWID had committed a property offence and 3% had committed a violent offence in the month preceding interview. Opioid dependence (AOR 2.57, 95% CI 1.29-5.10) and age (AOR 0.96, 95% CI 0.93-0.99) were found to be the strongest correlates of property crime. The majority of property offenders (75%) attributed their offending to financial reasons, however those under the influence of benzodiazepines were proportionately more likely to nominate opportunistic reasons as the main motivation for their last offence. Stimulant dependence (AOR 5.34, 95% CI 1.91-14.93) was the only significant correlate of past month violent crime, and the largest proportion of violent offenders (47%) attributed their offending to opportunistic reasons. The majority of both property (71%) and violent offenders (73%) reported being under the influence of drugs the last time they committed an offence; the largest proportion of property offenders reported being under the influence of benzodiazepines (29%) and methamphetamine (24%), whilst violent offenders mostly reported being under the influence of heroin and alcohol (32% respectively). CONCLUSION: Criminal motivations, substance use and other correlates vary considerably across crime types. This suggests that crime prevention and intervention strategies need to be tailored according to individual crime types, and should take into account self-reported criminal motivations, as well as specific risk factors that have been shown to increase the likelihood of offending.

'Trafficking' or 'personal use': do people who regularly inject drugs understand Australian drug trafficking laws?

INTRODUCTION AND AIMS: Legal thresholds for drug trafficking, over which possession of an illicit drug is deemed 'trafficking' as opposed to 'personal use', are employed in all Australian states and territories excepting Queensland. In this paper, we explore the extent to which people who regularly inject drugs understand such laws. DESIGN AND METHODS: Participants from the seven affected states/territories in the 2012 Illicit Drug Reporting System (n = 823) were asked about their legal knowledge of trafficking thresholds: whether, if arrested, quantity possessed would affect legal action taken; and the quantities of heroin, methamphetamine, cocaine and cannabis that would constitute an offence of supply. Data were compared against the actual laws to identify the accuracy of knowledge by drug type and state, and sociodemographics, use and purchasing patterns related to knowledge. RESULTS: Most Illicit Drug Reporting System participants (77%) correctly said that quantity possessed would affect charge received. However, only 55.8% nominated any specific quantity that would constitute an offence of supply, and of those 22.6% nominated a wrong quantity, namely a quantity that was larger than the actual quantity for supply (this varied by state and drug). DISCUSSION AND CONCLUSIONS: People who regularly inject drugs have significant gaps in knowledge about Australian legal thresholds for drug trafficking, particularly regarding the actual threshold quantities. This suggests that there may be a need to improve education for this population. Necessity for accurate knowledge would also be lessened by better design of Australian drug trafficking laws.

Emerging psychoactive substance use among regular ecstasy users in Australia.

BACKGROUND: The past decade has seen the development of an array of emerging psychoactive substances (EPS), however, there is minimal information on the extent of their use outside Europe. This study aimed to determine the extent of use of EPS from stimulant (such as mephedrone) and psychedelic classes (such as 5-methoxy-dimethyltryptamine [5-MeO-DMT]) among an Australian sample of regular ecstasy users (REU). Further, to determine if consumers of these drugs represent a distinct subgroup of REU. METHODS: Australian national cross-sectional surveys of 693 regular (at least monthly) ecstasy users conducted during 2010. RESULTS: More than one quarter (28%) of REU had used an EPS in the past six months, most commonly from the stimulant class (20%, typically mephedrone, 17%) rather than the psychedelic class (13%). Demographics and risk behaviours of REU that used stimulant EPS were largely no different from non-EPS consuming REU. Those using psychedelic EPS were distinct, initiating ecstasy use earlier, more frequently using multiple substances (cannabis, inhalants, GHB, ketamine) and more commonly experiencing legal, psychological and social problems. CONCLUSIONS: Psychedelic EPS use appears largely restricted to a distinct subset of REU with high-level non-injecting polydrug use, but use appears generally limited. The demographic similarity of stimulant EPS consumers with 'mainstream' REU, in conjunction with positive responses to the psychoactive effects of these drugs and declining ecstasy purity, suggests strong potential for stimulant EPS to expand further into ecstasy markets. Such drugs may have a greater public health impact than ecstasy, and merit careful monitoring into the future.

Examining supply changes in Australia's cocaine market.

INTRODUCTION AND AIMS: Media attention to cocaine use and supply has increased following some of the largest cocaine seizures in Australia's history. Whether there has been an expansion in supply remains unclear. This paper examines the evidence behind assertions of increased supply in Australia and the scale and nature of any apparent increase, using proxy indicators of cocaine importation, distribution and use. DESIGN AND METHODS: Eight proxies of cocaine importation, distribution and use were adopted, including amount of importation, mode of importation and supply flows to Australia. Each proxy indicator was sourced using publicly available and Australia-wide data, including information on the total weight of border seizures, mode of detection and country of embarkation of individual seizures. Data permitting, trends were examined for up to a 12 year period (1997-1998 to 2009-2010). RESULTS: Since 2006-2007 there was evidence of increased cocaine importation, albeit less than between 1998-1999 and 2001-2002. There were further signs that the 2006-2007 expansion coincided with a diversification of trafficking routes to and through Australia (beyond the traditional site of entry-Sydney) and shifts in the geographic distribution of use. DISCUSSION AND CONCLUSIONS: The congruity between indicators suggests that there has been a recent expansion in cocaine supply to and distribution within Australia, but that the more notable shift has concerned the nature of supply, with an apparent growth in importation and distribution beyond New South Wales. The diversification of cocaine supply routes may increase risks of market entrenchment and organised crime throughout Australia.

Hypnosis and thought suppression - more data: a brief communication.

This study hypothesized that hypnosis would enhance thought suppression by minimizing the effect of cognitive load. Twenty-eight high and 29 low hypnotizable hypnotized participants received the cognitive load of learning a 6-digit number. Participants then received either a suppression instruction or no instruction for a personal memory of a failure experience. Thought-suppression effectiveness was indexed by measures of self-report monitoring, competition of scrambled sentences, and facial electromyography. Low hypnotizable participants who received the suppression instruction displayed postsuppression rebound on the sentence-unscrambling task. In contrast, high hypnotizable participants did not display any rebound effects. These findings support the proposition that hypnosis facilitates thought suppression.