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The use of frequency-based criteria to detect harmful substance use in adolescents is rare despite its potential to identify young people at risk. We compared high school students who use high amounts of substances to students with lower levels (or nil) of use across health and well-being indicators to explore the feasibility of this kind of categorization. Based on survey questions from Youth'12, a cross-sectional adolescent health survey involving 3% (8,500) of New Zealand high school students, we selected criteria indicative of substance use that would warrant specialist alcohol and other drugs (AOD) treatment. Two sets of "high-use" criteria (e.g., drinking "alcohol most days a week or more") for both older and younger adolescents were selected. Eleven percent of students met criteria for "high use," with higher rates in males and older students. Rates of high use were similar across high-, medium- and low-deprivation neighborhoods. Binge alcohol use (9.2%) was the predominant form of "high use." Students with "high use" reported poorer health outcomes across numerous areas including mental health, physical health, risk behaviors, and access to health care. Only 5% of "high-use" students had accessed an AOD service. The wide range of negative health outcomes associated with a high level of substance use suggests that brief screening focusing on the level of substance use may help in identifying young people at risk. Simple and brief processes may improve the uptake and implementation of screening in primary care and other settings, and further research in this area is recommended.

Responding to serious behaviour problems requires new practice answers and emphases. Best practice principles and a developmental perspective indicate that the family should be the focus of preventative work. The Incredible Years parent training series is described as an important example of an empirically-supported programme that is presently being used in Tauranga and elsewhere in New Zealand. Impediments to prevention efforts are discussed and arguments are made regarding the relevance and significance of preventative strategies.

This study used data gathered over the course of a New Zealand longitudinal study (N = 924) to examine the relationships between measures of parental bonding and attachment in adolescence (age 15-16) and later personal adjustment (major depression; anxiety disorder; suicidal behaviour; illicit drug abuse/dependence; crime) assessed up to the age of 30. Key findings included: 1) There were significant (p less than 0.05) and pervasive associations between all measures of attachment and bonding and later outcomes. 2) Structural equation modelling showed that all measures of bonding and attachment loaded on a common factor reflecting the quality of parent/child relationships in adolescence. 3) After adjustment for covariates there were modest relationships ([beta] = 0.16-0.17) between the quality of parent/child relationships in adolescence factor and later adjustment. The study findings suggest that the quality of parent/child relationships in adolescence is modestly related to later psychosocial functioning in adulthood. (Contains 2 tables and 1 figure.)

A qualitative analysis of the accounts of 29 adults who grew up in a controversial New Zealand community identified positive and negative experiences and their psychological implications. In addition to highly publicized child sexual abuse that occurred at Centrepoint, children also experienced parental neglect, psychological manipulation, illegal drug use and stigma from the broader society. These factors created an adverse matrix that facilitated sexual abuse. Positive experiences included support for vulnerable families and children, recreational activities, and the opportunity to develop communication skills. While there may be positive experiences for children living in intentional communities such as this one, it is important to be aware of the potential for psychological harm to children in communities with powerful, shared systems of belief, skepticism about the broader society, and strong dynamics of dependence. These findings may have implications for other similar communities operating elsewhere in the world. (Contains 1 footnote.)

Anonymous self-report health and wellbeing surveys were completed by alternative education (AE) students in the Auckland and Northland regions of New Zealand, and 11 semi structured interviews were conducted with key informants about their perceptions of health issues for AE students. Both groups reported concerning health-risk behaviours among AE students, including drug and alcohol abuse, depressive symptoms and dangerous driving. Health services have consistently failed to engage AE students in effective primary and preventative care that includes their whanau/family. Significant changes to the current New Zealand health system are required to provide appropriate and effective health care for students attending AE facilities. (Contains 1 table.)

Methamphetamine has become a drug of concern in many countries. This qualitative study reports on the historical and current psychological and physical health of a group of methamphetamine users in Auckland, New Zealand in 2004, most of whom were in drug treatment. Participants reported they had experienced a range of physical health problems including those relating to lack of eating, skin problems, and cardiovascular and respiratory issues. Psychological problems included hallucinatory experiences, lack of sleep, feelings and acts of aggression and poor self-esteem. SF-36 results indicated that current health status was perceived as generally "good", possibly due to many having stopped using the drug. Many participants were poly drug users so attribution to methamphetamine use remains problematic. Despite this, and the limitations of a small, urban, New Zealand population, this study adds to the body of quantitative research in this area.

Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression. [ABSTRACT FROM AUTHOR]

Background and Aim: Children and adolescents account for approximately 14% of inflammatory bowel disease (IBD) diagnoses. At an appropriate age and level of development adolescents with IBD have their care transferred from the pediatric to adult clinical team during a process termed "transition". The study aim was to survey pediatric gastroenterologists throughout Australasia to identify commonality in the transition process to contribute to standardized guideline development. Methods: A descriptive survey captured key variables: transition clinic format, process and infrastructure, transition assessments, and guidelines. The survey was distributed electronically to 59 Pediatric Gastroenterologists throughout Australasia in January 2023. Results: Seventeen (29%) clinicians completed the survey: Australia 13 (76%). New Zealand 4 (24%). Thirteen (76%) respondents had access to a dedicated IBD transition clinic. Adolescents attended transition clinics 1–7 times, and the main processes transferred were: prescription provision, biologic appointments, and adult team contacts. Transition was first discussed age 13–15 years (53%), or 16–18 years (47%), with the main discussion topics including: continuing adherence (88%), smoking (59%), alcohol use (59%), recreational drug use (59%). Transition readiness assessments were done infrequently (24%). The minority (24%) used formal guidelines to inform the transition process, but 15 (88%) considered the development of a standardized Australasian guideline as beneficial/extremely beneficial. Conclusions: This survey highlighted that transition care for adolescents with IBD is variable across Australasia. Australasian guideline development may optimize the transition process for adolescents with IBD and improve their longitudinal outcomes. [ABSTRACT FROM AUTHOR]

Global evidence suggests that experiences of access to Needle Exchange services are gendered and that women who inject drugs (WWID) access needle exchange services differently to men. Despite being a significant proportion of injecting drug users, women's voices and experiences have often been silenced in studies around harm reduction service provision, hampering the development of harm reduction services for WWID. This article highlights the experiences of four women and one trans man who have previously injected drugs, in accessing needle exchange programmes (NEPs) in a New Zealand context. Semi-structured qualitative interviews were carried out with five participants and thematic analysis of the interviews produced three core themes: how stigma permeates WWIDs' lives; barriers in accessing needle exchange services; and how experiences within a drugs context are gendered. Stigma was an overwhelming issue affecting WWID which also acted as a barrier to their access of NEPs. The WWID in our study in terms of Goffman's original theorizing were "doubly discredited" as well as "precariously discreditable" due to their gender and injection drug using status. The participants keenly felt their stigmatized status through interactions with pharmacy-based needle exchange staff, perceiving that pharmacy staff viewed them as more contaminated than their male counterparts. Gendered relationships were also noted in injection practices, although initiation for this group of WWID was done by intimate partners as well as friends, dispelling the stereotype of WWID as passive victims. Some participants also learnt to self-inject which gave them a sense of empowerment and freedom as they did not have to rely on others to help them. The social structures that support stigmatizing tropes about WWID need to be addressed as well as more local interventions to prevent stigma in NEPs, alongside women focused services. [ABSTRACT FROM AUTHOR]

In this article the concepts of statist medicine and subaltern therapeutics are used to provide insight into the debates over the therapeutic use of marijuana in cases of serious or terminal illness. In 2015 medical marijuana gained public attention in Aotearoa New Zealand as cases of people facing life-threatening conditions who wished to use marijuana for therapeutic purposes were given voice in the popular media. In Aotearoa New Zealand marijuana use is illegal for recreational purposes, but theoretically patients with particular conditions could gain access to medicinal forms of marijuana if health professionals, the Ministry of Health and the relevant government minister approved. This approval process is embedded within statist medicine's regulatory regimes, where access can be provided on condition that the medication meets standards of safety and efficacy. Patients faced with the difficulty of negotiating the processes of statist medicine to access medical marijuana often reverted to illegal means of accessing the plant. Access to illegal forms of marijuana for medical purposes could be through 'green fairies', people who provided the plant for therapeutic purposes in a way that was distant from the criminalised recreational use of the drug obtained through 'dealers'. The process of the state, patients and marijuana providers negotiating the regulation of therapeutic uses of marijuana provides insights into the role of statist medicine and subaltern therapeutics. The case of medical marijuana alerts us to the possibilities of other subaltern therapeutic practices that operate beyond the gaze of the state. [ABSTRACT FROM AUTHOR]

Background: Few countries have developed detailed legislative proposals for legalizing cannabis. New Zealand recently released the Cannabis Legalization and Control Bill (CLCB) that will be the subject of a referendum in September 2020. Aims: To assess the CLCB, drawing on emerging evidence from cannabis legalization overseas, public health research on alcohol and tobacco and the attempt to establish a regulated market for 'legal highs' in New Zealand. Discussion: The CLCB proposes a strictly regulated commercial cannabis market that resembles the Canadian approach, but notably without on‐line sales or regional heterogeneity in retail distribution. The objective of the CLCB of lowering cannabis use over time appears at odds with the largely commercial cannabis sector that will focus on expanding sales. The CLCB includes provision for home cultivation and social benefit operators, but it is not clear what priority these operators will receive. A potency cap of 15% tetrahydrocannabinol (THC) for cannabis plants is included, and this is at the high end of black‐market cannabis. The proposed progressive product tax based on THC will be challenging to implement. There is no formal minimum price, but rather discretionary powers to raise the excise if the price drops too much. The CLCB includes a comprehensive ban on advertising, but non‐conventional on‐line promotion will be difficult to suppress. The central government cannabis authority is tasked with developing local retail outlet policies. We caution against the temptation to employ an interim regulatory regime following a positive referendum result, because a partially regulated market will expose users to health risks and undermine public support. Conclusions: New Zealand's Cannabis Legalization and Control Bill's objective of reducing cannabis use via a commercial market will be challenging to achieve. The bill could be strengthened with formal minimum pricing, lower potency cap and greater clarity concerning social benefit operators and the role of local government. [ABSTRACT FROM AUTHOR]

Background and objectives: Sleep-disordered breathing (SDB) affects up to one third of women during late pregnancy and is associated with adverse pregnancy outcomes, including hypertension, diabetes, impaired fetal growth, and preterm birth. However, it is unclear if SDB is associated with late stillbirth (≥28 weeks' gestation). The aim of this study was to investigate the relationship between self-reported symptoms of SDB and late stillbirth. Methods: Data were obtained from five case-control studies (cases 851, controls 2257) from New Zealand (2 studies), Australia, the United Kingdom, and an international study. This was a secondary analysis of an individual participant data meta-analysis that investigated maternal going-to-sleep position and late stillbirth, with a one-stage approach stratified by study and site. Inclusion criteria: singleton, non-anomalous pregnancy, ≥28 weeks' gestation. Sleep data ('any' snoring, habitual snoring ≥3 nights per week, the Berlin Questionnaire [BQ], sleep quality, sleep duration, restless sleep, daytime sleepiness, and daytime naps) were collected by self-report for the month before stillbirth. Multivariable analysis adjusted for known major risk factors for stillbirth, including maternal age, body mass index (BMI kg/m2), ethnicity, parity, education, marital status, pre-existing hypertension and diabetes, smoking, recreational drug use, baby birthweight centile, fetal movement, supine going-to-sleep position, getting up to use the toilet, measures of SDB and maternal sleep patterns significant in univariable analysis (habitual snoring, the BQ, sleep duration, restless sleep, and daytime naps). Registration number: PROSPERO, CRD42017047703. Results: In the last month, a positive BQ (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.02–2.04), sleep duration >9 hours (aOR 1.82, 95% CI 1.14–2.90), daily daytime naps (aOR 1.52, 95% CI 1.02–2.28) and restless sleep greater than average (aOR 0.62, 95% CI 0.44–0.88) were independently related to the odds of late stillbirth. 'Any' snoring, habitual snoring, sleep quality, daytime sleepiness, and a positive BQ excluding the BMI criterion, were not associated. Conclusion: A positive BQ, long sleep duration >9 hours, and daily daytime naps last month were associated with increased odds of late stillbirth, while sleep that is more restless than average was associated with reduced odds. Pregnant women may be reassured that the commonly reported restless sleep of late pregnancy may be physiological and associated with a reduced risk of late stillbirth. [ABSTRACT FROM AUTHOR]

Future research on cannabis and methamphetamine use in New Zealand must make an explicit commitment to be of benefit to Māori, and implement Kaupapa Māori-consistent research approaches. This was the finding of a Kaupapa Māori review which analysed 30 literature sources, the majority of which were journal articles. Research mainly utilised quantitative survey data collection methods, focused on large population groups and investigated individual characteristics of cannabis and/or methamphetamine users. A general population approach was taken in most articles, with Māori only briefly mentioned, or differences in drug use assessed between Māori and others. The value of focusing on drug use, rather than drug users, was highlighted in more recent research either led by Māori or undertaken with a critical lens. [ABSTRACT FROM AUTHOR]

The authors discuss the failure of a referendum to legalize cannabis in New Zealand in 2020. They state that there were questions on if the Cannabis Legalization and Control Bill (CLCB) would have been able to reduce cannabis use over time through a commercial market and question if the referendum's defeat was due to concerns about cannabis legalization in general or about concerns about the CLCB. They comment on how the black market can pressure legal competition to lower prices.

Commentary is provided regarding the article "Assessing New Zealand’s cannabis legalisation and control bill: prospects and challenges" by C. Wilkins and M. Rychert which appears in the sale issue of the journal. The regulation of retail cannabis markets is addressed, along with public health concerns, private profits, and cannabis salespeople who are known as budtenders. New Zealand's Cannabis Regulation Authority and compliance are assessed.

Issues: Indigenous peoples of Australia, New Zealand, Canada and the United States experience a disproportionately high burden of harms from substance misuse. Research is therefore required to improve our understanding of substance use in Indigenous populations and provide evidence on strategies effective for reducing harmful use.Approach: A search of 13 electronic databases for peer-reviewed articles published between 1993 and 2014 focusing on substance use and Indigenous peoples of Australia, New Zealand, Canada and the United States. Relevant abstracts were classified as data or non-data based research. Data-based studies were further classified as measurement, descriptive or intervention and their trends examined by country and drug type. Intervention studies were classified by type and their evaluation designs classified using the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist.Key Findings: There was a statistically significant increase from 1993 to 2014 in the percentage of total publications that were data-based (P < 0.001). Overall, data-based publications were mostly descriptive for all countries (84-93%) and drug types (74-95%). There were fewer measurement (0-4%) and intervention (0-14%) publications for all countries and the percentage of these did not change significantly over time. Forty-two percent of intervention studies employed an EPOC evaluation design.Implications: Strategies to increase the frequency and quality of measurement and intervention research in the Indigenous drug and alcohol field are required.Conclusion: The dominance of descriptive research in the Indigenous drug and alcohol field is less than optimal for generating evidence to inform Indigenous drug and alcohol policy and programs. [Clifford A, Shakeshaft A. A bibliometric review of drug and alcohol research focused on Indigenous peoples of Australia, New Zealand, Canada and the United States. Drug Alcohol Rev 2017;36:509-522]. [ABSTRACT FROM AUTHOR]

In New Zealand, the debates surrounding legal highs have been developing for approximately a decade. New Zealand’s historical grappling with the problem of legal highs reflects a global problem in addressing the issues related to new psychoactive substances. The focus of this article is the prohibition of BZP-based party pills under the Misuse of Drugs (Classification of BZP) Amendment Act, 2008 (hereafter the 2008 Act). This article reports on a qualitative study of the banning of BZP-based party pills in New Zealand, using thematic analysis of the discourses contained in the 2007 Parliamentary Bill readings of the 2008 Act. Six key themes were identified from the bill readings: prohibition is not an effective way to deal with drug use; BZP has a ‘gateway effect’; availability and accessibility means young people can access BZP-PPs too readily; young people are at risk; BZP has contributed to establishing a pill popping culture in New Zealand; and BZP has the potential for harm/has a moderate risk of harm. The thematic analysis revealed that evidence was often not fully represented in parliamentary debates, and that many of the concerns raised about BZPPs could have been dealt with through regulation rather than prohibition. A punitive moral populism aimed at drug use and drug users was also identified, driven by fears of drug using groups, and the symbolism associated with drug use. [ABSTRACT FROM AUTHOR]

The addition of the protecting group di-tert-butyldicarbonate to an illicit drug, such as methamphetamine, forms a new N-tert-butoxycarbonyl (t-BOC) derivative. By altering the chemical structure in this way, concealment of the drug can be achieved as routine detection techniques may not be able to identify the new substance. A recent seizure of a liquid at the New Zealand border was found to contain t-BOC-methamphetamine, indicating the use of this new concealment technique for the distribution and importation of illicit drugs. [ABSTRACT FROM AUTHOR]

Salvia divnorum(an intense hallucinogen) is currently illegal in New Zealand under the 2014 Psychoactive Substances Amendment Act. Despite this, there is a scarcity of research surroundingSalvia divinorumand its effects in a New Zealand context. To explore the experiences ofSalvia divinorumusers, an anonymous questionnaire was advertised through flyers placed in locations where young adults congregate. A total of 393 people took part in the online questionnaire in 2010–2011, while salvia was legally available in New Zealand; 167 respondents had used salvia. Thematic analysis was used to analyze the resulting open-ended questionnaire data and three key themes were identified: the effects of salvia; the importance of set and setting; salvia use and pleasure/not-pleasure. Recreational use of salvia was situated within a broader drug landscape, with participants being drug experienced and “drug wise” (Measham, Aldridge, and Parker 2001). Use of salvia also appeared to be intermittent, with its use referred to as a novel experience. Thus, the recent criminalization of salvia under the 2014 Act may see a significant decline in use as experienced drug users look elsewhere for novel drug experiences. [ABSTRACT FROM PUBLISHER]

Background: Some commentators have suggested legal highs (LH) might reduce existing illegal drug use and contribute to lower drug-related harm. However, no studies have specifically investigated substitution between LH and other drugs.Aims: To explore the extent to which police detainees substitute LH for illegal drugs.Method: A total of 848 detainees at four central police stations were interviewed about their drug and LH use. Detainees were asked what impact their LH use had on their other drug use (i.e., 'no change', 'more', 'less' or 'stopped'). The detainees were placed into four groups: (i) no LH use; (ii) LH use and 'no change' in drug use; (iii) LH use and 'more' drug use; (iv) LH use and 'less' or 'stopped' drug use. Demographics and levels of drug use in the past month were compared between groups.Results: Ninety-six percent of the LH using detainees had used synthetic cannabinoids (SC), and, of those who reported substituting a drug, 94% had substituted (natural) cannabis. Overall, 54% of the detainee sample had not used SC, 34% had used SC but not changed their cannabis use, 9% had used SC and used 'less' or 'stopped' cannabis use, and 3% had used SC and used 'more' cannabis. The SC users were more likely to have recently been in drug treatment. All those who used SC had higher cannabis consumption regardless of substitution behaviour. The SC users who used 'more' cannabis also used more methamphetamine and ecstasy.Conclusion: Twenty percent of those who used SC and cannabis reported reducing or stopping their cannabis use while 6% increased their cannabis use, suggesting a modest overall reduction in cannabis use. Further research is required to quantify the magnitude of substitution changes, the impact on drug-related harm, and extent to which substitution occurs for other LH and other populations. [ABSTRACT FROM AUTHOR]

Background: The relative contributions of cannabis and alcohol use to educational outcomes are unclear. We examined the extent to which adolescent cannabis or alcohol use predicts educational attainment in emerging adulthood.Methods: Participant-level data were integrated from three longitudinal studies from Australia and New Zealand (Australian Temperament Project, Christchurch Health and Development Study, and Victorian Adolescent Health Cohort Study). The number of participants varied by analysis (N=2179-3678) and were assessed on multiple occasions between ages 13 and 25. We described the association between frequency of cannabis or alcohol use prior to age 17 and high school non-completion, university non-enrolment, and degree non-attainment by age 25. Two other measures of alcohol use in adolescence were also examined.Results: After covariate adjustment using a propensity score approach, adolescent cannabis use (weekly+) was associated with 1½ to two-fold increases in the odds of high school non-completion (OR=1.60, 95% CI=1.09-2.35), university non-enrolment (OR=1.51, 95% CI=1.06-2.13), and degree non-attainment (OR=1.96, 95% CI=1.36-2.81). In contrast, adjusted associations for all measures of adolescent alcohol use were inconsistent and weaker. Attributable risk estimates indicated adolescent cannabis use accounted for a greater proportion of the overall rate of non-progression with formal education than adolescent alcohol use.Conclusions: Findings are important to the debate about the relative harms of cannabis and alcohol use. Adolescent cannabis use is a better marker of lower educational attainment than adolescent alcohol use and identifies an important target population for preventive intervention. [ABSTRACT FROM AUTHOR]

A questionnaire on substance abuse was distributed electronically to the heads of 185 Australian and New Zealand College of Anaesthetists accredited anaesthesia departments in Australia and New Zealand. The response rate was 57%. From January 2004 to December 2013, 61 cases of substance abuse were identified, giving an estimated incidence of 1.2 cases per 1000 anaesthetist years. Of 44 detailed reports completed, the majority were aged between 30 and 49 years, were male and of specialist grade. However, when corrected for gender and grade, the estimated overall incidence was higher in females and twice as high for trainees compared with specialists. When compared with prior surveys, the pattern of substance abuse in Australia and New Zealand appears to have changed significantly, with a notable increase in propofol and alcohol abuse and a decrease in reported cases of opioid abuse. Common presenting features of abuse included intoxication and witnessed abuse. Seventy percent of cases had more than one comorbid condition, most frequently either mental health or family problems. Only 32% of abusers had made a long-term recovery within the specialty. Death was the eventual outcome in 18% overall, with a particularly high mortality associated with propofol abuse (45%). Trainee suicide from all causes was reported at three times the rate of specialists. The findings indicate that substance abuse remains a significant problem in Australia and New Zealand and is associated with a significant mortality rate. [ABSTRACT FROM AUTHOR]

Background Legal highs containing benzylpiperazine (BZP) were widely sold in New Zealand until BZP was prohibited in 2008. We examined the impact the prohibition had on the availability and price of BZP over following years. Methods Two national population surveys of BZP use were conducted in 2006 and 2009. Four annual targeted surveys of frequent drug users (FDU) were conducted from 2007–2010. Availability and price measures were obtained. Inflation-adjusted real retail prices were calculated. Other drug markets were monitored as quasi-controls. Results The proportion of BZP users from the general population who considered the availability of BZP to be ‘very easy’ declined from 76% in 2006 to 21% in 2009. The proportion who thought BZP had become ‘harder’ to obtain increased from 5% in 2006 to 71% in 2009. The proportion who reported the price of BZP was ‘higher’ increased from 27% in 2006 to 51% in 2009. FDU who considered the availability of BZP to be ‘very easy’ declined from 98% in 2007 to 15% in 2008, and then increased to 42% by 2010. The real retail price of a BZP tablet increased from $9.86 in 2007 to $15.83 in 2010. The proportion who considered the price of BZP to be ‘increasing’ rose from 3% in 2007 to 47% in 2010. Conclusions The availability of BZP declined immediately following its prohibition. Availability recovered in subsequent years, but not to the pre-prohibition legal level. The price of BZP increased slowly over a number of years following the prohibition. [ABSTRACT FROM AUTHOR]

Commentary is provided regarding the article "Assessing New Zealand’s Cannabis Legalisation and Control Bill: prospects and challenges" by C. Wilkins and M. Rychert which appears in the same issue of the journal. Cannabis safety and active ingredients such as cannabidiol (CBD) and Δ9‐tetrahydrocannabinol (THC) are examined, along with legal cannabis markets and product labeling. Harm reduction is also assessed.

INTRODUCTION: The misuse of prescription drugs for their psychoactive effects is an international problem. To date, there is a paucity of quantitative data on prescription drug misuse (PdM) in new Zealand, especially data investigating the experiences of general practitioners (GPs). AIM: To quantify GPs' experiences regarding PdM in new Zealand in terms of the extent of the problem, challenges faced, problem drugs, and actions taken by GPs once PdM is suspected. METHOD: A cross-sectional postal survey of a random sample of 300 GPs in new Zealand was undertaken. RESULTS: A 45.7% response rate was achieved. Approximately two-thirds of GPs (65.9%) had diagnosed at least one patient with a PdM problem in the last 12 months. Thirty percent of respondents indicated that they had been faced with at least one challenge in the past 12 months, with 'verbal threats' being the most common of these (16.3%). Benzodiazepines and opioids were identified as the most problematic drug classes. The action usually taken by the greatest number of GPs once they suspected PdM was to 'document it' (97.9%) followed closely by 'suggest an alternative drug' (96.7%) and 'refrain from prescribing the drug' (91.9%). DISCUSSION: PdM is an issue for GPs. The findings from this study have highlighted the need for further research into this concerning issue, specifically further quantification of the size of the problem in the new Zealand general population. There is also a need for the development and implementation of interventions to help minimise and better manage PdM in new Zealand. [ABSTRACT FROM AUTHOR]

Background. There is a widely held expectation that GPs will routinely use opportunities to provide opportunistic screening and brief intervention for alcohol and other drug (AOD) abuse, a major cause of preventable death and morbidity.Aim. To explore how opportunities arise for AOD discussion in GP consultations and how that advice is delivered.Design. Analysis of video-recorded primary care consultationsSetting. New Zealand General Practice.Methods. Interactional content analysis of AOD consultations between 15 GP’s and 56 patients identified by keyword search from a bank of digital video consultation recordings.Results. AOD-related words were found in almost one-third (56/171) of the GP consultation transcripts (22 female and 34 male patients). The AOD dialogue varied from brief mention to pertinent advice. Tobacco and alcohol discussion featured more often than misuse of anxiolytics, night sedation, analgesics and caffeine, with only one direct enquiry about other (unspecified) recreational drug use. Discussion was associated with interactional delicacy on the part of both doctor and patient, manifested by verbal and non-verbal discomfort, use of closed statements, understatement, wry humour and sudden topic change.Conclusions. Mindful prioritization of competing demands, time pressures, topic delicacy and the acuteness of the presenting complaint can impede use of AOD discussion opportunities. Guidelines and tools for routine screening and brief intervention in primary care do not accommodate this reality. Possible responses to enhance AOD conversations within general practice settings are discussed. [ABSTRACT FROM PUBLISHER]

Rationale: 'Party Pills' containing benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP) have been used in a recreational context since the 1990s and, prior to April 2008, were legally available in New Zealand. Taken together, they have been reported to produce a 'high' similar to that produced by 3,4-methylenedioxymethamphetamine (MDMA). Objectives: There has been little research on the subjective effects of piperazines in humans. The purpose of this study is to further investigate the subjective and physiological responses following an oral dose of BZP combined with TFMPP in males. Methods: In a randomised, double-blind, placebo-controlled study the subjective and physiological effects of BZP/TFMPP were investigated in 36 healthy, non-smoking males (mean age 22 ± 4 years). Participants were tested before and approximately 120 min after administration of a single dose of placebo ( n = 16) or 100/30 mg BZP/TFMPP ( n = 20). Participants were required to comment on the subjective effects using three rating scales-the Addiction Research Centre Inventory (ARCI), the Visual Analogue Scale (VAS) and the Profile of Mood States (POMS). Participants' blood pressure, heart rate and body temperature were also measured. Results: Statistical analysis using repeated-measures analysis of variance (ANOVA) and planned comparisons revealed that BZP/TFMPP significantly increases blood pressure and heart rate ( p < 0.05). Likewise, the subjective rating scales revealed that BZP/TFMPP has significant dexamphetamine-like effects, increases dysphoria and feelings of self-confidence ( p < 0.05). Conclusion: These physiological and subjective data reflect clear similarities between the effects of BZP/TFMPP and commonly known stimulants such as dexamphetamine and MDMA. [ABSTRACT FROM AUTHOR]

Over the last decade, New Zealand has led the world in the legal sale and uncontrolled use of the recreational drug benzylpiperazine (BZP), the active ingredient of 'party pills'. One survey found that 40% of 18-29-year-olds admitted to using BZP-based party pills while, in another study, 44% of first-year university students had used the drug. During the period it was legally available for sale, BZP usage in New Zealand far exceeded the usage of any illicit drugs other than cannabis. In 2005 the New Zealand government created legislation intended to regulate the drug, but as potential health risks from BZP consumption became apparent, subsequent legislation was introduced to prohibit the substance. In 2008, the sale and possession of BZP was criminalized, with the result that (a) some users possibly switched to other illegal drugs, and (b) a market developed for alternative party pills that are BZP-free but contain unregulated substances that may themselves pose a health risk. The following review briefly covers the scientific and legal background of benzylpiperazine with particular reference to New Zealand, the country in which it was most popular. [ABSTRACT FROM AUTHOR]

Objective The aim of this research was to describe the types of prescription medicines being imported into New Zealand. Setting Imported medicines intercepted at the international mail centre in Auckland and referred to the New Zealand Medicines and Medical Devices Safety Authority (Medsafe) between July and December 2007 were studied. Method During the study 3,918 prescription medicine imports were intercepted and entered into a database by Medsafe. These were categorised according to the country the medicines were posted from and medicine related details such as brand, active ingredient(s), route of administration, strength and quantity imported. Researchers systematically categorised medicines by therapeutic indications, dosage form, whether these medicines were available in New Zealand and if they were subsidised by the New Zealand government. Main outcome measure Types of medicines imported into New Zealand and whether or not they were legally available and subsidised by the government. Results Medicines were most commonly imported from India and China. Seventy eight percent of the total medicines imported were already available in New Zealand, and of these almost half were subsidised by the government. Antibiotics contributed to a significant proportion of the total subsidised medicines imported, the most common being amoxicillin. Four of the five most commonly imported medicines could be considered 'lifestyle' medicines (sildenafil, tadalafil, finasteride and sibutramine). 'High risk' medicines were identified-for example medicines used in the treatment of tuberculosis, malignant diseases and mental health disorders. Conclusion This study is the first of its kind in New Zealand to explore the types of prescription medicines imported into the country. The majority of imported medicines were classified as 'lifestyle' medicines. The study findings also identified possible negative public health implications associated with some of the imported prescription medicines, for example resistance associated with the importation of antibiotics. [ABSTRACT FROM AUTHOR]

In light of current initiatives to increase hepatitis C treatment uptake amongst current and former injectors, this article aims to explore the barriers and facilitators to treatment uptake from the patient's perspective. Semistructured interviews were conducted with people living with hepatitis C in Auckland, New Zealand and Sydney, Australia in 2004 and 2006. This article explores in detail one significant issue that has not so far been addressed in the social research literature about decision making for hepatitis C treatment. This is the concern expressed by a quarter of the 34 ex-injecting participants regarding the potential for hepatitis C treatment to cause a relapse to injecting drug use. The connection between hepatitis C treatment and relapse to injecting drug use is supported by a substantial clinical literature. Thus the proposed expansion of hepatitis C treatment into alcohol and other drug settings needs to be undertaken with caution. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Onset and lifetime use of drugs have not previously been reported for all adult ages in New Zealand. This paper reports such results and, for people born in New Zealand, compares age of onset across ethnic groups. Design and Methods. A nationally representative cross-sectional survey was carried out in 2003–2004, with oversampling of Māori and Pacific people. Participants were aged 16 years or more, living in permanent private dwellings. In the Composite International Diagnostic Interview (CIDI 3.0), participants were asked if they had ever used drugs (alcohol, tobacco and five groups of other drugs) and the age of first use (except for tobacco). Estimates are weighted. Results. The response rate of 73.3% yielded 12 992 interviews. The percentage of participants who had ever used drugs was: 94.6% for alcohol, 50.8% for tobacco and 42.6% for any extramedical drug, including 41.6% for cannabis, 4.2% for cocaine and 2.9% for opioids. Use was much more common in recent cohorts for extramedical drugs. The median age of onset in each age cohort was always lowest for alcohol, then cannabis, then opioids, then cocaine. Among those born in New Zealand, Māori were more at risk of use than ‘Others’ with the lowest risk for Pacific people. Discussion and Conclusions. Interventions to prevent or to delay the onset of drug use need to occur before and during adolescence. The major cohort differences and the widespread experience of cannabis use help to explain the diversity of opinion in New Zealand about how to deal with this drug.[Wells JE, McGee MA, Baxter J, Agnew F, Kokaua J for the New Zealand Mental Health Survey Research Team. Onset and lifetime use of drugs in New Zealand: Results from Te Rau Hinengaro: The New Zealand Mental Health Survey 2003–2004. Drug Alcohol Rev 2009;28:166–174] [ABSTRACT FROM AUTHOR]

Background: A national referendum to legalise recreational cannabis use and supply in New Zealand via the Cannabis Legalisation and Control Bill (CLCB) was recently narrowly defeated. Understanding the underlying factors for this result can inform the cannabis legalisation debate in other countries.Aims: To investigate predictors of voter support for and opposition to the CLCB.Method: A representative population panel of 1,022 people completed an online survey of intended voting on the CLCB referendum, which included questions on demographics, drug use history, medicinal cannabis, perceptions of the health risk and moral views of cannabis use, political affiliation, religiosity, community size and reading of the CLCB. Regression models were developed to predict support for the CLCB, with additional predictor variables added over successive iterations.Results: The most robust predictors of support for the CLCB were use of and policy support for medicinal cannabis use, voting for a left-wing political party, having a positive moral view of cannabis use, living in a small town and having read the CLCB. Predictors of opposing the CLCB were voting for right-wing parties, considering "frequent" cannabis use to be a high health risk, and lifetime use of other drugs. Age, ethnicity, education, employment status, religiosity and lifetime cannabis use were not significant predictors after controlling for other variables.Conclusions: Support for cannabis legalization was not based on broad demographics, but rather specific views concerning the medicinal benefit, morality of cannabis use, health risk of frequent cannabis use, political party affiliation, and knowledge of the proposed regulatory controls of the CLCB. The influence of moral views of cannabis use on voting behaviour suggest the need to debate the right to use cannabis. The importance of knowledge of the proposed regulatory controls of the CLCB on voting underlines the need to raise awareness of proposed regulatory controls during debate. [ABSTRACT FROM AUTHOR]

Abstract: Background: In epidemiology, it always has been important to study local area patterns of disease occurrence. New methods to quantify local area and household clustering of disease emerged late in the 19th century and were refined during the 20th century. Nonetheless, multi-level models to estimate local area clustering of illegal drug use did not appear until the 1990s, and to date, there is just one study with estimates of local neighbourhood clustering of cannabis use, based on a United States sample. Here, seeking the first replication of that single prior study, we estimate the degree to which cannabis use might cluster within neighbourhoods of New Zealand (NZ), and we also study higher level clustering and suspected individual-level determinants of recent cannabis use. Methods: A national probability community sample (n =12,992) of adults aged 16 years or more with standardized assessment of cannabis use. Alternating logistic regression produced estimates for cannabis clustering. Results: In NZ, use of cannabis was common: 41.6% had ever used it and 13.1% had used it in the past year. There was clustering within the smallest local areas (pairwise odds ratio=1.3–1.5) but not within larger government districts (PWOR=1.02). Age, male sex, ethnicity, education, and marital status were all associated with cannabis use, but did not account for observed clustering. Conclusions: Neighborhood clustering of recent cannabis use has emerged in New Zealand, as in the US. Standard individual-level characteristics explain only some of this clustering. Other explanations must be sought, perhaps including personal networks and local supply. [Copyright &y& Elsevier]

Six criteria described in the New Zealand Misuse of Drugs Act and used by the Expert Advisory Committee on Drugs (EACD) for determining the risk of a drug to public health were examined in relation to ethanol, using γ-hydroxybutyric acid (GHB) as a comparator drug. GHB is an ideal candidate for use as a comparator because it is a sedative substance very similar to ethanol and has been previously investigated by the EACD using these six criteria. GHB was subsequently classified as a Class B1 drug under the Misuse of Drugs Act, that is, as a prohibited drug of high risk to public health. The dangerousness level of ethanol was found to be at least similar to that of GHB in this analysis. This highlights a major discrepancy in public policy. [ABSTRACT FROM AUTHOR]