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Background: There is significant interest in comparing countries on many different indicators of social problems and policies. Cross-national comparisons of drug prevalence and policies are often hampered by differences in the approach used to reach respondents and the methods used to obtain information in national surveys. The paper explores how much these differences could affect cross-country comparisons.Methods: This study reports prevalence of drug use according to the most recent national household survey and then adjusts estimates as if all national surveys used the same methodology. The analysis focuses on European countries for which the European Monitoring Centre for Drugs and Drug Addiction reports data, the United States, Canada, and Australia. Adjustment factors are based on US data.Findings: Adjusting for modality differences appears likely to modestly affect the rankings of countries by prevalence, but to an extent that could be important for comparisons. For example, general population surveys suggest that the US had some of the highest cannabis and cocaine prevalence rates circa 2012, but this is partially driven by the use of a modality known to produce higher prevalence estimates. This analysis shows that country rankings are partly an artifact of the mode of interview used in national general population surveys.Conclusions: Our preliminary efforts suggest that cross-national prevalence comparisons, policy analyses and, other projects such as estimating the global burden of disease could be improved by adjusting estimates from drug use surveys for differences in modality. Research is needed to create more authoritative adjustment factors. [ABSTRACT FROM AUTHOR]

Aims: The current burden of cannabis-related presentations to emergency health services is largely unknown. This paper presents data collected over a 13-year period in metropolitan Melbourne, Australia as part of the Ambo Project, a unique surveillance system that analyses and codes paramedic records for drug-related trends and harms.Methods: Cannabis-related ambulance attendances involving 15-59 year olds in metropolitan Melbourne were analysed retrospectively from 2000 to 2013 (n=10,531). Trends and attendance characteristics were compared among cannabis only (CO)-, cannabis and alcohol (CA)- and cannabis with polydrug use (CP)-related attendances. Changes in alcohol and drug involvements in cannabis-related attendances were explored.Results: Rates of cannabis-related ambulance attendances increased significantly over the study period. Increasing rate of attendances per 100,000 population per year changed from 0.6 (2000-2010) to 5.5 (2010-2013). This sharp change was driven by CO- and CP-related attendances (rate of CA-related attendance increased steadily). The highest increasing rate (15.6) was for CO-related attendances among 15-29 years old males (2010-2013). Crystal methamphetamine became the most common illicit co-intoxicant amongst cannabis presentations in 2013.Conclusions: Relative to the total drug-related burden on ambulance services, cannabis-related presentations appear to be a small but significant and increasing problem. Significant changes in trends across other drug involvement and demographic subgroups suggest a possible shift in the cannabis using population and/or a change in using behaviours. Public health strategies should raise awareness of the increased risk posed by cannabis polydrug use and high attendance subpopulations should be determined. [ABSTRACT FROM AUTHOR]

Background Overdose is a major cause of morbidity and mortality amongst opioid users. This paper reported recent non-fatal overdose amongst the Australian Treatment Outcome Study (ATOS) cohort at 11-year follow-up, and characteristics that predict recent overdose. Methods Longitudinal cohort, with 431 (70.1%) of the original 615 participants interviewed. Participants were administered the ATOS structured interview, addressing demographics, treatment history, drug use, heroin overdose, criminality, health and psychopathology. Findings Mean time since heroin initiation was 20.4 years. By 11-year follow-up, the proportion who had overdosed was 67.5%, and 24.4% had experienced five or more overdoses. In the 12 months preceding 11-year follow-up, 4.9% had overdosed (11.8% of those who had used heroin in that period). Of the 21 participants who had recently overdosed, 20 (95.2%) had overdosed previously, and 19 (90.5%) were not enrolled in a treatment programme at the time. Those who had recently overdosed reported higher levels of use of opiates other than heroin (57.1% vs 24.9%), benzodiazepines (61.9% vs 30.5%,), methamphetamine (38.1% vs 16.8%) and cocaine (19.0% vs 3.7%). They also had exhibited higher levels of heroin use and other drug use at baseline, 12 and 24 month follow-ups. Conclusions While the prevalence had declined, overdoses still occurred. A history of overdose and polydrug use patterns continued to provide strong markers for those at continued risk. [ABSTRACT FROM AUTHOR]

BACKGROUND: Alcohol and mental health disorders are highly prevalent in the general population, with co-occurrence recognised as a major public health issue. Socio-economic factors are frequently associated with both disorders but their temporal association is unclear. This paper examines the association between prenatal socio-economic disadvantage and comorbid alcohol and mental health disorders at young adulthood. METHODS: An unselected cohort of women was enrolled during early pregnancy in the large longitudinal Mater-University of Queensland Study of Pregnancy (MUSP), at the Mater Misericordiae Public Hospital in Brisbane, Australia. The mothers and their offspring were followed over a 21 year period. Offspring from the MUSP birth cohort who provided full psychiatric information at age 21 and whose mothers provided socioeconomic information at baseline were included (n=2399). Participants were grouped into no-disorder, mental health disorder only, alcohol disorder only or comorbid alcohol and mental health disorders according to DSM-IV diagnoses at age 21 as assessed by the Composite International Diagnostic Interview. We used multivariate logistic regression analysis to compare associations of disorder group with single measures of prenatal socio-economic disadvantage including family income, parental education and employment, and then created a cumulative scale of socioeconomic disadvantage. RESULTS: Greater socio-economic disadvantage was more strongly associated with comorbidity (OR 3.36; CI95 1.37, 8.24) than with single disorders. This relationship was not fully accounted for by maternal mental health, smoking and drinking during pregnancy. CONCLUSION: Multiple domains of socio-economic disadvantage in early life are associated with comorbid alcohol and mental health disorders. [ABSTRACT FROM AUTHOR]

Abstract: Background: This paper examines correlates of needle and other equipment sharing among injecting drug users (IDU) in regular heterosexual relationships. Methods: A cross-sectional survey collected data from people obtaining sterile needles and syringes from pharmacies in New South Wales, Australia. 181 IDU in regular heterosexual relationships provided information about their own drug and injecting practices and those of their partners. Results: Compared to female partners, male partners reported more frequent injecting, more commonly injected their partners, scored and prepared the drugs, and obtained the needles. Couples were less likely to share needles with each other if they reported a low-to-moderate connection with drug using networks compared to a moderate-to-high connection (AOR 0.4, 95% CI 0.19–0.95) or if the respondent partner reported sharing injecting equipment (needles and/or ancillary equipment) with friends in the last 6 months (AOR 3.2, 95% CI 1.34–7.86). Couples were more likely to share ancillary equipment with each other if they spent most or all of their injecting time together (AOR 4.1, 95% CI 1.40–11.31) or if the respondent reported sharing injecting equipment with friends (AOR 5.3, 95% CI 1.73–16.37). Couples with discordant hepatitis C status were no more or less likely than those with concordant status to share needles or ancillary injecting equipment. Conclusions: Injecting practices in regular heterosexual relationships do not appear to be organised around hepatitis C status but are influenced by gender, the couples’ connection with other IDU, and extent to which they share the equipment with those outside of their relationship. [Copyright &y& Elsevier]

Abstract: Background: Identifying cannabis users who are most at risk of driving under the influence of cannabis (DUIC) has important implications for drug treatment and prevention efforts. This paper examined correlates of DUIC among a purposive sample of recent cannabis users. Methods: Interviews were carried out among a cross-sectional sample of 320 Australian cannabis users. Past-year prevalence of DUIC (without using alcohol or other drugs) was regressed against a range of potential predictor variables. Results: Use of multiple drugs, believing that DUIC does not increase accident risk and cannabis dependence all predicted likelihood of DUIC. There was an interaction between age of first cannabis use and gender, whereby earlier onset cannabis use predicted DUIC but only among women. Conclusions: The correlates of drug driving reflected cannabis users’ beliefs about the dangers of cannabis use as well as their patterns of drug consumption. The emergence of cannabis dependence and age of onset as predictors of DUIC suggests a clearly defined role for treatment and prevention efforts in reducing the potential harms associated with DUIC. [Copyright &y& Elsevier]

Background: Cannabis is the most widely used illicit drug in developed countries, and has a significant impact on mental and physical health in the general population. However, the validity of common diagnostic schemes and their applicability to cannabis abuse and dependence is poorly understood. This paper describes a confirmatory factor analysis of the DSM-IV cannabis abuse and dependence criteria, using general population data. Methods: Data from cannabis users (n=722) were obtained from a cross-sectional study of a large and representative sample of the Australian general population. The DSM-IV criteria for cannabis abuse and dependence were assessed using the CIDI-AUTO. Results: Approximately, one in 12 Australians (7.1%) had used cannabis more than five times in the past 12 months and 56.5% of these reported at least one DSM-IV cannabis abuse or dependence criteria. Within the adult population, 2.2% met criteria for a cannabis use disorder (0.7% abuse and 1.5% dependence). Confirmatory factor analysis indicated that both a one- and two-factor model for cannabis use disorder provided an adequate fit to the data. However, the estimated correlation between the abuse and dependence factors in the two-factor model was extremely high (0.99). Conclusions: A one-factor model provided the most parsimonious model of the cannabis abuse and dependence criteria. [Copyright &y& Elsevier]

Background: There has been much research on the efficacy and effectiveness of opioid agonist treatment (OAT), but less on its implementation and sustainability. A challenge internationally has been recruiting and retaining prescribers. This paper aims to characterise the prescribers in terms of OAT prescribing behaviours.Methods: Retrospective cohort study in New South Wales, Australia. Participants were 2199 OAT prescribers between 1 st August 2001-19th September 2018.We examined trends in initiation and cessation of OAT prescribers. Adjusted hazard ratios were calculated to estimate prescriber retention, adjusting for year of initiation, practice type, client load and treatment prescribed.Results: The rate of prescribers ceasing OAT prescribing has been increasing over time: a prescriber who initiated between 2016-2017 had over four times the risk of cessation compared with one who initiated before 2001, AHR: 4.77; [3.67-6.21]. The highest prescriber cessation rate was in prescribers who had prescribed for shorter time periods. The annual percentage of prescribers who ceased prescribing among those who prescribed for ≤5 years increased from 3% in 2001 to 20 % in 2017. By 2017 more prescribers were discontinuing prescribing than new prescribers were starting. Approximately 87 % (n = 25,167) of OAT clients were under the care of 20 % of OAT prescribers (n = 202); half had been prescribing OAT for 17+ years.Conclusions: OAT prescribing is increasingly concentrated in a small group of mature prescribers, and new prescribers are not being retained. There is a need to identify and respond to the reasons that contribute to newer prescribers to cease prescribing and put in place strategies to increase retention and broaden the base of doctors involved in such prescribing. [ABSTRACT FROM AUTHOR]