Search

Introduction: Strong patient interest in the use of medicinal cannabis to treat various clinical indications has sparked global legislative changes. Practitioners are vital in implementing regulatory changes and facilitating patient access to medicinal cannabis, however, little is currently known about the factors influencing practitioners' uptake. Recent rapid increases in practitioner applications to prescribe medicinal cannabis in Australia provides a unique backdrop to examine the current factors influencing prescribing behaviours. This qualitative study examined Australian practitioners' perspectives on prescribing medicinal cannabis to provide a comprehensive exploration of the potential factors influencing uptake in clinical practice., Methods: Seventeen semi-structured interviews were conducted with Australian health-care practitioners. Transcripts were analysed using the Framework approach to thematic analysis and cross-mapped to appropriate domains of the Theoretical Domains Framework., Results: We identified four themes related to the barriers and facilitators to prescribing medicinal cannabis: (i) clinical capabilities needed to prescribe; (ii) prescribing an unapproved therapeutic good; (iii) negative attitudes towards prescribers in the medical community; and (iv) divergent beliefs about clinical utility., Discussion and Conclusions: Practitioners face multiple pervasive barriers to prescribing medicinal cannabis. Beliefs about clinical utility appear to be highly influential in shaping prescribing behaviours. Moreover, our findings suggest that a medicinal cannabis 'specialisation' has emerged within the Australian medical community. Findings demonstrate that a range of complex and multifaceted factors influence practitioners' medicinal cannabis prescribing behaviours. We highlight several considerations for policy and practice to support safe and appropriate patient access to medicinal cannabis in this emerging area of clinical practice., (© 2024 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction: The novel coronavirus (COVID-19) pandemic necessitated the rapid uptake of telehealth to deliver treatment for alcohol and other drug (AOD) concerns. However, little is known about how the move from in-person to telehealth delivery impacted clients' experience of care. This qualitative study aimed to explore experiences of telehealth among people receiving alcohol and other drug treatment during the COVID-19 pandemic, and their preferences regarding future telehealth care., Methods: Participants were aged 34-66 years (M = 44 years, 60% male) and were recruited from Victorian AOD treatment services and consumer networks. A total of 20 semi-structured interviews were analysed using thematic analysis., Results: Three themes were identified: (i) experiences of the practical impacts of telehealth; (ii) experiences of telehealth interactions; and (iii) preferences for future telehealth. Contextual factors, including location and socioeconomic status, were found to impact clients' ability to access reliable telehealth with sufficient privacy. While telehealth was generally associated with increased treatment engagement (for a typically stigmatised population), participants noted varying effects on the therapeutic alliance. Although in-person treatment was generally favoured, participants often valued telehealth as a modality to provide empathic care during the pandemic. Participants expressed a preference for a hybrid treatment model in the future, in which they could choose a combination of telehealth and in-person services., Conclusion: Client and clinician information and training are vital to improve the future delivery of telehealth for AOD treatment., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction: People who use prescription opioids to manage non-cancer chronic pain are particularly vulnerable to opioid-related policy change. This study aims to better understand what prescription opioids provide this population, what concerns they have in the context of new and changing opioid policies, such as the recently implemented prescription drug monitoring program in Victoria, Australia, their experiences of prescription opioid use, chronic pain and what they would like their healthcare to look like., Methods: Semi-structured interviews were conducted with 30 people who use opioids to manage chronic non-cancer pain., Results: Prescription opioids played an important role in supporting quality of life and mental health. However, experiences of stigma and lack of empathy from healthcare providers were common. Participants sought accurate information about their medications and expressed a desire for shared decision-making in healthcare., Discussion and Conclusion: Prescription opioids can play an important role in pain management as well as social and psychological functioning for people living with non-cancer chronic pain. Opioid-related policy changes to medication availability need to consider the potential impacts that reducing, limiting or discontinuing opioids may have on this population. Including the voices of people who use prescription opioids to manage non-cancer chronic pain in respectful, compassionate and meaningful ways., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction: There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long-established, less is known about how specific aspects of service delivery impact treatment-seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery., Methods: Thirty-nine semi-structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health-care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment-seeking., Results: Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment-seeking and engagement. Within broader health-care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment-seeking., Discussion and Conclusions: Results suggest opportunities to engage and undertake needs-based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health-care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care., (© 2022 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction: The COVID-19 pandemic and associated social restrictions have profoundly shaped the routines, practices and space-times of alcohol and other drug (AOD) consumption. As a part of these transformations, video conferencing services (e.g. Zoom, Whereby) have emerged as popular mediums for socialising and AOD consumption. In this article, we adopt a more-than-human theoretical framework to explore how these online contexts re-shape experiences of AOD consumption., Methods: Data were gathered using a case-study approach, guided by principles of digital ethnography. We 'staged' the online gatherings of three established friendship clusters of adults in Melbourne, Australia, and drew on a discussion guide to elicit accounts of past online AOD encounters during the COVID-19 pandemic. Our thematic analysis was sensitised to the dynamic composition of these encounters and the kinds of relations, practices and affects they enabled and constrained., Results: Composed via video conferencing services, AOD consumption afforded distinct pleasures, including enhanced sociality, excitement and momentary reprieves from isolation. Importantly, these effects were not uniform or stable. Participants also navigated various constraints of online AOD consumption while establishing for themselves what substances and associated practices 'fit' within these novel encounters., Discussion and Conclusions: Our study conveys the importance of digitally-mediated AOD consumption as a site of socialising and pleasure. In so doing, it demonstrates the ways in which AOD consumption was drawn on in the everyday negotiation of health and wellbeing under lockdown conditions. We call for research and policy approaches that are sensitive to the affirmative potentials of digitally=mediated AOD encounters., (© 2021 Australasian Professional Society on Alcohol and other Drugs.)

In light of the recent announcement from the Victorian (Australia) state government that they are moving to decriminalise public drunkenness and replace it with a 'health-based response', it is timely to reflect on a number of important considerations identified from the academic literature on this topic. We briefly review a number of models of health-care delivery that have been utilised in other jurisdictions, and suggest there are opportunities at a more principled level to respond more adequately to the decriminalisation of public drunkenness in Victoria (and elsewhere). First, embedding research and evaluation, particularly that draws on the needs, views and experiences of those who are deemed to be drunk in public, is essential from the outset, and must be ongoing to enable the continual refinement of models of care. Second, significant funding and intersectoral support are needed to ensure that the laws are not tokenistic and do not remain the responsibility of police. Third, there are opportunities to put policies and principles in place to ensure that police do not use more coercive powers to address concerns around public drunkenness. Most importantly, state-wide education and training efforts are needed alongside the repeal of the law to ensure that emergency services and health-care workers (as well as the community), have a good understanding of the contexts and needs of people who are considered drunk in public, and consequently treat them with care and respect., (© 2020 Australasian Professional Society on Alcohol and other Drugs.)