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INTRODUCTION Substance use disorders are more prevalent among lesbian, gay, bisexual, transgender and queer (LGBTQ) people than among their heterosexual and cisgender peers. There has been limited alcohol and other drug (AOD) treatment research with LGBTQ people outside of North America. This study aimed to examine the treatment outcomes of clients attending a LGBTQ-specific AOD counselling service in Australia (ACON's Substance Support Service) and compare their client profile and treatment outcomes with LGBTQ and non-LGBTQ clients of similar mainstream services. METHODS This study was a retrospective analysis of the health records of 284 ACON clients and 1011 clients of five mainstream services in 2016-2018. Clients completed clinical interviews at treatment entry and periodically throughout treatment and completed measures of substance use, severity of dependence, psychological distress and quality of life. RESULTS Most ACON clients were seeking treatment for methamphetamine (58%) and alcohol use (26%). Among ACON clients, there were reductions in past month days of substance use and severity of dependence between treatment entry and counselling sessions 4, 8 and 12 (all P

Introduction and Aims Gay and other homosexually active men (hereafter ‘gay men’) are at elevated risk of becoming infected with hepatitis C virus (HCV) via injecting drug use and sexual risk practices. This paper aimed to measure HCV knowledge among gay men in Australia and whether knowledge differed according to HCV risk. Design and Methods In 2013, a cross-sectional, online survey of 405 Australian gay men explored the social aspects of HCV. Bivariate and multivariate linear regressions were used to examine factors associated with higher HCV knowledge. Results The mean age of respondents was 39.2 years (SD = 13.3), and most men (75.3%) were born in Australia. According to self-report, 32.1% were HIV-positive, 3.0% were HCV-positive and 8.9% were HIV/HCV co-infected. The mean number of correct HCV knowledge items was 8.2 (SD = 3.9; range 0–15). In a multivariate analysis, higher HCV knowledge was associated with higher educational attainment, being HCV-positive, being HIV-positive and injecting drug use. Discussion and Conclusions HCV knowledge among gay men was moderately good, although knowledge of testing, treatment and natural history of HCV was generally quite poor. Encouragingly, higher knowledge was reported among men at highest HCV risk. Viral hepatitis and HIV organisations, together with general practitioners and other health services, should continue to target gay men at a high risk of acquiring HCV with education and health promotion. [Lea T, Hopwood M, Aggleton P. Hepatitis C knowledge among gay and other homosexually active men in Australia. Drug Alcohol Rev 2015]

Introduction and Aims International research has shown that gay, bisexual and other homosexually active men (hereafter ‘gay men’) report disproportionately higher rates of risky alcohol use and associated problems compared with heterosexual men. However, little is known about alcohol use among this population in Australia. This study aimed to examine rates of risky alcohol use among a community-based sample of gay men in Sydney and characteristics of men reporting high-risk alcohol use and adverse consequences. Design and Methods A cross-sectional survey of gay men was conducted in Sydney in August 2013 as part of the ongoing Gay Community Periodic Surveys (n = 1546 eligible respondents). The Alcohol Use Disorders Identification Test–Consumption questions were used to assess alcohol use in the previous 12 months. Results Nine percent of respondents were categorised as abstinent from alcohol, 33% as low-risk drinkers, 42% as moderate-risk drinkers and 16% as high-risk drinkers. In separate multivariate logistic regression analyses, high-risk drinking and reporting ≥4 adverse alcohol consequences were associated with younger age, being Australian-born, recruitment from licensed premises and having met men for sex at gay bars and dance parties. Fifty-eight percent of high-risk drinkers reported a desire to reduce their alcohol use. Discussion and Conclusions In this community-based sample of gay men, we found high levels of moderate- to high-risk alcohol use. The results suggest that gay men should be a priority population for health promotion campaigns and treatment services. [Lea T, Ryan D, Prestage G, Zablotska I, Mao L, de Wit J, Holt M. Alcohol use among a community-based sample of gay men: Correlates of high-risk use and implications for service provision. Drug Alcohol Rev 2015;34:349–357]

INTRODUCTION AND AIMS: Substance use and substance use problems are often more prevalent in same-sex attracted young people (SSAY), yet little to date has been published about substance use and problems in this population in Australia. This paper aimed to characterise patterns of alcohol use, club drug use and dependence, injecting drug use and engagement with treatment services, comparing lesbians, gay men, bisexual women and bisexual men. DESIGN AND METHODS: A cross-sectional, online survey was conducted with 572 SSAY in Sydney, aged 18 to 25 years. The Alcohol Use Disorders Identification Test-Consumption questions (AUDIT-C) assessed hazardous alcohol use, and the Severity of Dependence Scale assessed club drug dependence. RESULTS: Seventy per cent of respondents had AUDIT-C scores indicative of hazardous alcohol use, and 29% of respondents had used club drugs in the previous 6 months. Multivariate logistic regression showed that male respondents had a lower odds of hazardous alcohol use (adjusted odds ratio = 0.6, 95% confidence interval 0.4-0.9), but a higher odds of recent club drug use (adjusted odds ratio = 1.8, 95% confidence interval 1.2-2.7). Methamphetamine dependence was reported among half of respondents who reported use in the previous 6 months. Bisexual women were more likely than other respondents to have sought treatment for alcohol and other drug use, and overall treatment utilisation was low (6%). DISCUSSION AND CONCLUSIONS: This study reports high rates of drinking and club drug use, and a possible underutilisation of alcohol and other drug treatment. The findings suggest that SSAY in Sydney may be at a high risk of alcohol- and drug-related harm. Language: en

Introduction and Aims The findings of Australian drug surveys are typically not stratified by sexual orientation, despite the higher prevalence of drug use generally reported among gay and bisexual men. This paper aims to examine trends in drug use among gay and bisexual men in eastern Australia between 2004 and 2011. Design and Methods Data from the cross-sectional, ongoing Gay Community Periodic Surveys (GCPS) were used to analyse drug trends among gay and bisexual men in Sydney, Melbourne and Queensland. Between 2004 and 2011, 45 273 eligible questionnaires were completed. Results There was a downward trend in recent drug use (previous 6 months) between 2004 and 2011 from 62.2% to 57.5%. However, this trend was not found among men in Queensland, bisexual men, men aged over 40 years or HIV-positive men. Club drug use peaked in 2006 (45.1%), before steadily declining to 32.4% in 2011. There were significant reductions in use of ecstasy, methamphetamine, ketamine and cannabis, increased use of cocaine, gamma hydroxybutyrate, erectile dysfunction medications, amyl nitrite and lysergic acid diethylamide, and no change in heroin use. Recent injecting drug use fluctuated over time but experienced an overall downward trend from 5.5% in 2004 to 4.0% in 2011. Discussion and Conclusions Drug use trends among gay and bisexual men in Australia are broadly consistent with downward and upward drug trends reported in other Australian drug surveys. The risks associated with drug use in this population and high rates of use supports the ongoing role of the GCPS in monitoring drug trends among homosexually active men.

Aims To explore service provision and the range of problems that New South Wales (NSW) and Victoria (VIC) community pharmacists providing opioid substitution treatment (OST) have experienced with clients and prescribers. Design Cross-sectional postal survey. Setting All community pharmacies providing OST in NSW (n = 593) and VIC (n = 393), Australia. Participants Completed questionnaires were received from 669 pharmacists (68% response rate). Measurements The questionnaire addressed pharmacy characteristics, recent problems experienced with clients including refusal to dose, provision of credit for dispensing fees, termination of treatment, responses of pharmacists to problems experienced with clients, as well as problems experienced with OST prescribers. Findings In the preceding month, 41% of pharmacists had refused to dose a client for any reason, due most commonly to expired prescriptions (29%), or ≥3 missed doses (23%). Terminating a client's treatment in the past month was reported among 14% of respondents, due most commonly to inappropriate behaviour and missed doses. Treatment termination was reported by a significantly higher proportion of pharmacists in VIC (P

Introduction and Aims. Public clinics in New South Wales (NSW), Australia play a central role in inducting and stabilising opioid dependent clients onto treatment before transfer to a community pharmacy. Clinical assessment of stability is a vital skill in ensuring that clients are appropriately and effectively transferred. A two-hour clinical training program was delivered to staff at 31 public clinics, that aimed to improve staff confidence in assessing client stability, and skills in negotiating the transfer of clients to community pharmacies. Design and Methods. Pre- and post-training evaluation was conducted examining self-ratings of confidence and ability in the assessment of client stability, and the perceived utility of a clinical algorithm to improve assessments. Follow-up was conducted 3 to 6 months post-training assessing individual and clinic level changes in clinical practice. Results. 205 staff completed pre- and post-training questionnaires. Staff demonstrated a moderate level of self-reported baseline knowledge and skills in assessing client stability (mean = 6.5; 1 = poor; 10 = excellent) that improved when re-assessed following the training (mean = 8.0). 76 staff responded to the follow-up questionnaire. ≥ 75% reported some level of improvement in their approach to clinical practice regarding stability assessment, and 59% reported being more effective in identifying clients appropriate for community pharmacy transfer. Of 19 public clinics, 14 reported an increased focus on stability assessment. Nine clinics reported barriers to achieving changes in clinical practice. Discussion and Conclusions. This evaluation demonstrates that it is possible to implement a targeted clinical training package to staff that translates into positive changes in clinical practice.[Winstock AR, Lea T. Evaluation of a training program to improve clinicians' assessment of patient stability. Drug Alcohol Rev 2009;28:353–359]

The introduction of buprenorphine - naloxone in Australia in April 2006 has permitted the revision of takeaway policies in many states and has introduced the possibility of unsupervised treatment. This study explored the implications of the introduction of buprenorphine - naloxone in terms of cost to patients through a survey of pharmacists' intended pricing practices. The aim of the research was to examine the intentions of pharmacists in relation to fees for buprenorphine - naloxone and study the potential implications to patients when compared with the existing fee structure for methadone and for buprenorphine alone.A self-complete questionnaire was mailed to every community pharmacy in New South Wales (NSW) (n = 593) dispensing methadone or buprenorphine to people with opioid dependence. A response rate of 68.6% (n = 407) was achieved after three mailouts.The majority of pharmacies charged a flat weekly fee for methadone (92.2%; mean = $31.90) and buprenorphine (74.8%; mean = $31.00). The mean intended fees for buprenorphine - naloxone according to different dosing and takeaway regimens ranged from $19.19 per week for no supervised doses and fortnightly takeaways to a $30.88 per week flat fee. There appeared to be little variation in fee structure irrespective of the takeaway regimen, until reaching the 2 weeks' unsupervised dose regimen.This study highlights the importance of the early dissemination of unambiguous information regarding the introduction of a new medication, especially where supervised dispensing through community pharmacies is essential to the provision of treatment. The potential impact upon the successful rollout of a new treatment paradigm that was developed to benefit stable patients in the community may be jeopardised when such processes are not followed.

Introduction and Aims.Mephedrone (4-methylmethcathinone) is a synthetic stimulant that has recently emerged as a recreational drug. There is currently no Australian data on prevalence and patterns of mephedrone use. This paper aims to explore patterns of mephedrone use among a large sample of same-sex attracted young people in Sydney, Australia. Design and Methods.An online survey was conducted with 572 same-sex attracted men (n = 318) and women (n = 254) aged 18 to 25 years, who lived or regularly spent time in Sydney. Data on mephedrone were collected as part of a larger study exploring sexuality and nightlife. Results.Mephedrone had been used by 4.0% (n = 23) of respondents, 2.1% (n = 12) in the preceding 6 months, 1.4% (n = 8) in the preceding month. Typical routes of use were intranasal (n = 8) and ingestion (n = 6). No respondent reported ever injecting mephedrone. Three respondents reported polydrug use with mephedrone. The most common contexts of use were respondents' homes or friends' homes (n = 8) and gay bars and clubs (n = 7). Discussion and Conclusions.This paper reports low levels of mephedrone use among a large sample of same-sex attracted young people. The proportion of respondents who had used mephedrone was much lower than reported in recent UK research. This may suggest that mephedrone has not infiltrated the Australian market to the same extent as in Europe. However, data from annual surveillance of drug users are required to better determine this.[Lea T, Reynolds R, De Wit J. Mephedrone use among same-sex attracted young people in Sydney, Australia. Drug Alcohol Rev 2011;30:438–440]