Real or fake? Sourcing and marketing of non-prescribed benzodiazepines amongst two samples of people who regularly use illicit drugs in Australia.

INTRODUCTION: There is concern around non-prescribed benzodiazepine use, particularly with increasing detections of counterfeit products containing high-risk novel compounds. The aims of this study were to investigate how and which non-prescribed benzodiazepines are being sourced; forms, appearance and packaging; and awareness of risks associated with non-prescribed benzodiazepines. METHODS: Data were collected from a sample of Australians who inject drugs or use ecstasy and/or other illicit stimulants on a monthly or more frequent basis, and who reported past 6-month use of non-prescribed benzodiazepines (n = 235 and n = 250, respectively). Data were collected on source, diversion from a known/trusted prescription, product name and aesthetic characteristics for the last non-prescribed benzodiazepine obtained. RESULTS: Amongst participants who injected drugs, 71% reported that their last non-prescribed benzodiazepines were diverted from a known/trusted prescription, compared to 59% of participants who used ecstasy/other stimulants. Sourcing via cryptomarkets was rare. Across both samples, the majority reported last obtaining substances sold/marketed as diazepam or alprazolam. Participants sourcing via non-diverted means were twice as likely to obtain alprazolam. Known sourcing of novel compounds was rare. Amongst participants who used ecstasy/other stimulants, 36% reported confidence in the content/dose of non-prescribed benzodiazepines even when the source is unknown. DISCUSSION AND CONCLUSIONS: Most participants obtained substances sold as classic/registered benzodiazepines, mostly via diverted prescriptions, with a substantial minority potentially unaware of counterfeits circulating. While diverted use undeniably presents risks, tightening of prescriptions in Australia could inadvertently lead to greater supply of novel benzodiazepines as seen internationally, reinforcing prioritisation of demand and harm reduction strategies.

Disruption to Australian heroin, methamphetamine, cocaine and ecstasy markets with the COVID-19 pandemic and associated restrictions.

BACKGROUND: Changes to drug markets can affect drug use and related harms. We aimed to describe market trends of heroin, methamphetamine, cocaine and ecstasy in Australia following the introduction of COVID-19 pandemic-associated restrictions. METHODS: Australians residing in capital cities who regularly inject drugs (n ∼= 900 each year) or regularly use ecstasy and/or other illicit stimulants (n ∼= 800 each year) participated in annual interviews 2014-2022. We used self-reported market indicators (price, availability, and purity) for heroin, crystal methamphetamine, cocaine, and ecstasy crystal to estimate generalised additive models. Observations from the 2014-2019 surveys were used to establish the pre-pandemic trend; 2020, 2021 and 2022 observations were considered immediate, short-term and longer-term changes since the introduction of pandemic restrictions. RESULTS: Immediate impacts on market indicators were observed for heroin and methamphetamine in 2020 relative to the 2014-2019 trend; price per cap/point increased (ß: A$9.69, 95% confidence interval [CI]: 2.25-17.1 and ß: A$40.3, 95% CI: 33.1-47.5, respectively), while perceived availability (adjusted odds ratio [aOR] for 'easy'/'very easy' to obtain: 0.38, 95% CI: 0.24-0.59 and aOR: 0.08, 95% CI: 0.03-0.25, respectively) and perceived purity (aOR for 'high' purity: 0.36, 95% CI: 0.23-0.54 and aOR: 0.33, 95% CI: 0.20-0.54, respectively) decreased. There was no longer evidence for change in 2021 or 2022 relative to the 2014-2019 trend. Changes to ecstasy and cocaine markets were most evident in 2022 relative to the pre-pandemic trend: price per gram increased (ß: A$92.8, 95% CI: 61.6-124 and ß: A$24.3, 95% CI: 7.93-40.6, respectively) and perceived purity decreased (aOR for 'high purity': 0.18, 95% CI: 0.09-0.35 and 0.57, 95% CI: 0.36-0.90, respectively), while ecstasy was also perceived as less easy to obtain (aOR: 0.18, 95% CI: 0.09-0.35). CONCLUSION: There were distinct disruptions to illicit drug markets in Australia after the COVID-19 pandemic began; the timing and magnitude varied by drug.

The impact of first and second eye cataract surgeries on falls: a prospective cohort study.

PURPOSE: The purpose of this study was to investigate the impact of the first and second eye cataract surgeries on the risk of falls in participants with bilateral cataract and to determine which changes in visual measures are associated with changes in the number of falls throughout the cataract surgery process. PATIENTS AND METHODS: Fifty-five older adults with bilateral cataract aged 55+ years were assessed at three time points during the cataract surgery process, and they completed a falls diary. Two separate generalized estimating equation-negative binomial models were undertaken to assess changes in the number of falls before first eye cataract surgery, between first and second eye surgeries, and after second eye cataract surgery and which changes in visual measures were associated with changes in the number of falls. RESULTS: After adjusting for potential confounding factors, the risk of falls decreased by 54% (incidence rate ratio (IRR) =0.458, 95% CI=0.215-0.974, p=0.04) after first eye cataract surgery only, compared with the period before first eye surgery. The risk of falls decreased by 73% (IRR =0.268, 95% CI =0.114-0.628, p=0.002) after second eye cataract surgery, compared with the period before first eye surgery. Improved binocular visual acuity (IRR =5.488, 95% CI =1.191-25.282, p=0.029) and contrast sensitivity (IRR =0.257, 95% CI =0.070-0.939, p=0.040) were associated with a decrease in the number of falls. CONCLUSION: The study found that first and second eye cataract surgeries reduced the risk of falls among a cohort of bilateral cataract patients with relatively good baseline vision. This suggests that timely first and second eye cataract surgeries could play an important role in reducing the burden due to falls among older adults with cataract.

First and second eye cataract surgery and driver self-regulation among older drivers with bilateral cataract: a prospective cohort study.

BACKGROUND: Driving a car is the most common form of transport among the older population. Common medical conditions such as cataract, increase with age and impact on the ability to drive. To compensate for visual decline, some cataract patients may self-regulate their driving while waiting for cataract surgery. However, little is known about the self-regulation practices of older drivers throughout the cataract surgery process. The aim of this study is to assess the impact of first and second eye cataract surgery on driver self-regulation practices, and to determine which objective measures of vision are associated with driver self-regulation. METHODS: Fifty-five older drivers with bilateral cataract aged 55+ years were assessed using the self-reported Driving Habits Questionnaire, the Mini-Mental State Examination and three objective visual measures in the month before cataract surgery, at least one to three months after first eye cataract surgery and at least one month after second eye cataract surgery. Participants' natural driving behaviour in four driving situations was also examined for one week using an in-vehicle monitoring device. Two separate Generalised Estimating Equation logistic models were undertaken to assess the impact of first and second eye cataract surgery on driver-self-regulation status and which changes in visual measures were associated with driver self-regulation status. RESULTS: The odds of being a self-regulator in at least one driving situation significantly decreased by 70% after first eye cataract surgery (OR: 0.3, 95% CI: 0.1-0.7) and by 90% after second eye surgery (OR: 0.1, 95% CI: 0.1-0.4), compared to before first eye surgery. Improvement in contrast sensitivity after cataract surgery was significantly associated with decreased odds of self-regulation (OR: 0.02, 95% CI: 0.01-0.4). CONCLUSIONS: The findings provide a strong rationale for providing timely first and second eye cataract surgery for older drivers with bilateral cataract, in order to improve their mobility and independence.

Do older drivers with bilateral cataract self-regulate their driving while waiting for first eye cataract surgery?

OBJECTIVES: To analyze the association between visual impairment and driver self-regulation among a cohort of older drivers waiting for first eye cataract surgery. METHODS: Ninety-six drivers with bilateral cataract aged 55+ years were assessed before first eye cataract surgery. Data collection consisted of a researcher-administered questionnaire, objective visual measures (visual acuity, contrast sensitivity and stereopsis), a visual attention test (the useful field of view test) and a cognitive test (the Mini-Mental State Examination). Driver self-regulation practices were collected using the Driving Habits Questionnaire and were also measured with an in-vehicle monitoring device. Characteristics of self-regulators and non-self-regulators were compared and a logistic regression model was used to examine the association between 3 objective visual measures and driver self-regulation status. RESULTS: After controlling for potential confounding factors, only binocular contrast sensitivity (p=0.01), age (p=0.03) and gender (p=0.03) were significantly associated with driver self-regulation status. The odds of participants with better contrast sensitivity scores (better vision) self-regulating their driving in at least 1 driving situation decreased (odds ratio [OR]: 0.01, 95% CI: 0.00-0.28) while those of increasing age reported an increased odds of self-regulating their driving (OR: 1.08, 95% CI: 1.01-1.15). The odds of males self-regulating their driving was decreased compared with females (OR: 0.28, 95% CI: 0.09-0.86). CONCLUSIONS: Worse binocular contrast sensitivity scores, increasing age and being female were significantly associated with driver self-regulation. The study highlighted that while self-regulation was common among cataract patients, a proportion of those with poor vision did not self-regulate. Further research should determine how cataract patients could benefit from self-regulation strategies while waiting for cataract surgery.

A validation study comparing self-reported travel diaries and objective data obtained from in-vehicle monitoring devices in older drivers with bilateral cataract.

BACKGROUND: Advances in technology have made it possible to examine real-world driving using naturalistic data obtained from in-vehicle monitoring devices. These devices overcome the weaknesses of self-report methods and can provide comprehensive insights into driving exposure, habits and practices of older drivers. AIM: The aim of this study is to compare self-reported and objectively measured driving exposure, habits and practices using a travel diary and an in-vehicle driver monitoring device in older drivers with bilateral cataract. METHODS: A cross-sectional study was undertaken. Forty seven participants aged 58-89 years old (mean=74.1; S.D.=7.73) were recruited from three eye clinics over a one year period. Data collection consisted of a cognitive test, a researcher-administered questionnaire, a travel diary and an in-vehicle monitoring device. Participants' driving exposure and patterns were recorded for one week using in-vehicle monitoring devices. They also completed a travel diary each time they drove a motor vehicle as the driver. Paired t-tests were used to examine differences/agreement between the two instruments under different driving circumstances. RESULTS: The data from the older drivers' travel diaries significantly underestimated the number of overall trips (p<0.001), weekend trips (p=0.002) and trips during peak hour (p=0.004). The travel diaries also significantly overestimated overall driving duration (p<0.001) and weekend driving duration (p=0.003), compared to the data obtained from the in-vehicle monitoring devices. No significant differences were found between instruments for kilometres travelled under any of the driving circumstances. CONCLUSIONS: The results of this study found that relying solely on self-reported travel diaries to assess driving outcomes may not be accurate, particularly for estimates of the number of trips made and duration of trips. The clear advantages of using in-vehicle monitoring devices over travel diaries to monitor driving habits and exposure among an older population are evident.

Bilateral cataract, crash risk, driving performance, and self-regulation practices among older drivers.

UNLABELLED: This comprehensive literature review summarizes published studies examining cataract and cataract surgery and driving outcomes to identify gaps in the literature that require further research. Six electronic databases were searched for articles published up to and including March 2015. Articles were reviewed if they included older drivers with cataract or drivers who had cataract surgery and at least 1 of the following driving outcomes: crash risk, driving self-regulation practices, and driving performance. There was consistent evidence that cataract negatively affects driving and that cataract surgery is beneficial to driving outcomes. Future research should examine the separate effects of first- and second-eye cataract surgery on crash risk, driving self-regulation, and driving performance. It should also determine how visual measures relate to driving performance among cataract patients so those most at risk for driving difficulties can be identified, advised, and possibly prioritized for surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

The Cataract Extraction and Driving Ability Research Study Protocol: characterisation of deficits in driving performance and self-regulation among older drivers with bilateral cataract.

PURPOSE: Cataract is one of the leading causes of visual impairment in Australia. As more older adults are driving, the number of people with cataract on the roads will increase. A greater understanding of the effects of cataract and cataract surgery on driving performance and driver self-regulation is essential to improve road safety. This proposed study will examine the effects of bilateral cataract surgery on driving outcomes including driving performance and driver self-regulation. METHODS: A 3-year prospective study will be undertaken in Western Australia (WA) and New South Wales (NSW). Three hundred participants (n=150 from WA and n=150 from NSW) aged >60 years with bilateral cataract will be assessed at three time points: the month before first-eye cataract surgery, 1-3 months after first-eye cataract surgery and 3 months after second-eye cataract surgery. Driving performance will be assessed using a driving simulator and driver self-regulation patterns measured using in-vehicle driver-monitoring devices. Objective visual measures, quality of life and self-reported driving difficulties will also be collected at the three assessments. CONCLUSIONS: The study results may impact on ophthalmology, optometry and general medical practices in terms of the driving advice provided to patients with bilateral cataract and those undergoing cataract surgery. The information gained from this study will allow these professionals to advise patients about specific driving difficulties they may face at different stages of cataract surgery and appropriate self-regulation practices. The results will be of use to licensing authorities in the assessment of 'fitness to drive'.