16 results on '"Lucy Thi Tran"'
Search Results
2. All-Cause and Overdose Mortality Risk Among People Prescribed Opioids: A Systematic Review and Meta-analysis
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Sarah Larney, Amy Peacock, Emily Stockings, Damian Santomauro, Lucy Thi Tran, Thomas Santo, and Louisa Degenhardt
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medicine.medical_specialty ,Population ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Practice Patterns, Physicians' ,education ,education.field_of_study ,business.industry ,Mortality rate ,Opioid use disorder ,General Medicine ,Opioid-Related Disorders ,medicine.disease ,Analgesics, Opioid ,Clinical trial ,Anesthesiology and Pain Medicine ,Opioid ,Meta-analysis ,Relative risk ,Emergency medicine ,Neurology (clinical) ,Chronic Pain ,Drug Overdose ,business ,030217 neurology & neurosurgery ,medicine.drug ,Cohort study - Abstract
Objective To estimate all-cause and overdose crude mortality rates and standardized mortality ratios among people prescribed opioids for chronic noncancer pain and risk of overdose death in this population relative to people with similar clinical profiles but not prescribed opioids. Design Systematic review and meta-analysis. Methods Medline, Embase, and PsycINFO were searched in February 2018 and October 2019 for articles published beginning 2009. Due to limitations in published studies, we revised our inclusion criteria to include cohort studies of people prescribed opioids, excluding those studies where people were explicitly prescribed opioids for the treatment of opioid use disorder or acute cancer or palliative pain. We estimated pooled all-cause and overdose crude mortality rates using random effects meta-analysis models. No studies reported standardized mortality ratios or relative risks. Results We included 13 cohorts with 6,029,810 participants. The pooled all-cause crude mortality rate, based on 10 cohorts, was 28.8 per 1000 person-years (95% CI = 17.9–46.4), with substantial heterogeneity (I2 = 99.9%). The pooled overdose crude mortality rate, based on six cohorts, was 1.1 per 1000 person-years (95% CI = 0.4–3.4), with substantial heterogeneity (I2 = 99.5%), but indications for opioid prescribing and opioid exposure were poorly ascertained. We were unable to estimate mortality in this population relative to clinically similar populations not prescribed opioids. Conclusions Methodological limitations in the identified literature complicate efforts to determine the overdose mortality risk of people prescribed opioids. There is a need for large-scale clinical trials to assess adverse outcomes in opioid prescribing, especially for chronic noncancer pain.
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- 2020
3. Feasibility and acceptability of take‐home naloxone for people released from prison in New South Wales, Australia
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Lucy Thi Tran, Suzanne Nielsen, Noora Oikarainen, Sarah Larney, Julia Bowman, Louisa Degenhardt, Jillian Roberts, Banafsheh Moradmand-Badie, and Stephen Ward
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Health (social science) ,Narcotic Antagonists ,media_common.quotation_subject ,Population ,Medicine (miscellaneous) ,Prison ,Pharmacy ,Nursing ,Naloxone ,medicine ,Humans ,Justice (ethics) ,education ,media_common ,education.field_of_study ,business.industry ,Prisoners ,Opioid overdose ,Opioid-Related Disorders ,medicine.disease ,Mental health ,Cross-Sectional Studies ,Opioid ,Feasibility Studies ,Drug Overdose ,New South Wales ,business ,medicine.drug - Abstract
Introduction and aims To assess the feasibility and acceptability of a take-home naloxone program for people with a history of opioid use released from prison in New South Wales, Australia. Design and methods Cross-sectional interviews with people with a history of opioid use who were recently released from prison (n = 105), and semi-structured interviews with key clinical and operational staff of Justice Health and Forensic Mental Health Network and Corrective Services NSW (n = 9). Results Among people with a history of opioid use who had recently left prison, there was very high awareness of the elevated risk of overdose following release from prison (95%) and the potential for naloxone to reverse an opioid overdose (97%). Participants considered that their personal risk of overdose was low, despite ongoing opioid use being common. Participants were largely supportive of take-home naloxone, but the majority (83%) stated that proactively obtaining naloxone would be a low priority for them following release. Key informants were supportive of introducing naloxone training and supply and identified barriers to implementation, including adequate resourcing, identifying the population for training, and developing an appropriate model of training and implementation. Discussion and conclusion There was widespread support for naloxone training in custody and distribution at release among people recently released from prison and key stakeholders in health-care provision and prisons administration. As proactively accessing naloxone is a low priority for patients, naloxone supply at release may be more effective than programs that refer releasees to local pharmacies, but developing a sustainable supply model requires consideration of several barriers.
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- 2020
4. Responding to global stimulant use: challenges and opportunities
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Rebecca McKetin, Annick Borquez, Javier A. Cepeda, Emily Stockings, Louisa Degenhardt, Michael Farrell, Natasha K. Martin, Steve Shoptaw, Robert Ali, Marta Torrens, Lucy Thi Tran, and Jürgen Rehm
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Adult ,Male ,Adolescent ,medicine.medical_treatment ,Psychological intervention ,Contingency management ,HIV Infections ,030204 cardiovascular system & hematology ,Cocaine-Related Disorders ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cocaine ,Dopamine Uptake Inhibitors ,Environmental health ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Amphetamine ,Depression (differential diagnoses) ,business.industry ,Incidence ,Mental Disorders ,Amphetamines ,General Medicine ,Hepatitis C ,Middle Aged ,medicine.disease ,Mental health ,Stimulant ,Cardiovascular Diseases ,Virus Diseases ,Central Nervous System Stimulants ,Female ,business ,Psychosocial ,medicine.drug - Abstract
Summary We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.
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- 2019
5. Mortality among people with regular or problematic use of amphetamines: a systematic review and meta‐analysis
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Emily Stockings, Sarah Larney, Amy Peacock, Michael Farrell, Lucy Thi Tran, Damian Santomauro, Louisa Degenhardt, and Thomas Santo
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Risk ,Asia ,Amphetamine-Related Disorders ,030508 substance abuse ,Medicine (miscellaneous) ,Disease ,Scandinavian and Nordic Countries ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Homicide ,Humans ,Medicine ,030212 general & internal medicine ,Accidental Injuries ,business.industry ,Mortality rate ,Amphetamines ,Confidence interval ,Suicide ,Amphetamine ,Psychiatry and Mental health ,Cardiovascular Diseases ,Meta-analysis ,Accidental ,Relative risk ,North America ,Central Nervous System Stimulants ,0305 other medical science ,business ,Demography ,Cohort study - Abstract
Background and aims: Amphetamines are the second most commonly used class of illicit drugs. We aimed to produce pooled estimates of mortality risks among people with regular or dependent use of amphetamines, with a focus upon all-cause mortality as well as specific causes of death. Design: Systematic review and meta-analysis of cohorts of people with problematic use or dependence on amphetamines with data on all-cause or cause-specific mortality. Setting and participants: Of 4240 papers, 30 were eligible, reporting on 25 cohorts that measured all-cause mortality, drug poisoning, suicide, accidental injuries, homicide and cardiovascular mortality. Cohorts (n = 35-74 139) were in North America, several Nordic countries and Asia Pacific. Measurement: Titles/abstracts were independently screened by one reviewer and excluded those reviewed by a second reviewer. Full-text screening was by two reviewers with discrepancies resolved via a third reviewer. We extracted data on crude mortality rates (CMR) per 100 person-years (py), standardized mortality ratios (SMRs). We imputed SMRs where possible if not reported by study authors. We also calculated mortality relative risks. Data were pooled using random-effects models; potential reasons for heterogeneity were explored using subgroup analyses and meta-regressions. Findings: Twenty-three cohorts contributed data for the pooled all-cause CMR: 1.14 per 100 py [95% confidence interval (CI) = 0.92-1.42]. Pooled cause-specific mortality rates were: drug poisoning, 0.14 per 100 py (95% CI = 0.06-0.34); cardiovascular disease, 0.13 per 100 py (95% CI = 0.06-0.29); suicide, 0.20 per 100 py (95% CI = 0.07-0.55); accidental injury, 0.20 per 100 py (95% CI = 0.08-0.47) and homicide, 0.03 per 100 py (95% CI = 0.02-0.06). There was substantial heterogeneity for all pooled CMR estimates except homicide. The pooled all-cause SMR was 6.83 (95% CI = 5.27-8.84). Pooled cause-specific SMRS were: poisoning, 24.70 (95% CI = 16.67, 36.58); homicide, 11.90 (95% CI = 7.82-18.12); suicide, 12.20 (95% CI = 4.89-30.47); cardiovascular disease, 5.12 (95% CI = 3.74-7.00) and accidental injury, 5.12 (95% CI = 2.88-9.08). Conclusions: People with regular or dependent amphetamine use are at elevated risk of a range of causes of mortality compared with people without regular or dependent amphetamine use.
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- 2019
6. Association between opioid agonist therapy and testing, treatment uptake, and treatment outcomes for hepatitis C infection among people who inject drugs:A systematic review and meta-analysis
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Peter Vickerman, Clare E French, Jason Grebely, Behzad Hajarizadeh, Thomas Santo, Matthew Hickman, Heather Valerio, Phillip Read, Gregory J. Dore, Lucy Thi Tran, Sarah Larney, Kerryn Butler, Daisy Gibbs, Louisa Degenhardt, and Alexander Dowell-Day
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Microbiology (medical) ,medicine.medical_specialty ,Hepatitis C virus ,Treatment outcome ,medicine.disease_cause ,Antiviral Agents ,03 medical and health sciences ,0302 clinical medicine ,Opioid Agonist ,Internal medicine ,IDU ,Medicine ,Humans ,030212 general & internal medicine ,Substance Abuse, Intravenous ,PWID ,injecting drug use ,therapy ,business.industry ,Australia ,Hepatitis C ,Odds ratio ,Hepatitis C, Chronic ,medicine.disease ,Thailand ,Hcv elimination ,Confidence interval ,Analgesics, Opioid ,Europe ,Infectious Diseases ,Treatment Outcome ,Pharmaceutical Preparations ,Meta-analysis ,North America ,HCV ,care cascade ,030211 gastroenterology & hepatology ,business - Abstract
Background People who inject drugs (PWID) experience barriers to accessing testing and treatment for hepatitis C virus (HCV) infection. Opioid agonist therapy (OAT) may provide an opportunity to improve access to HCV care. This systematic review assessed the association of OAT and HCV testing, treatment, and treatment outcomes among PWID. Methods Bibliographic databases and conference presentations were searched for studies that assessed the association between OAT and HCV testing, treatment, and treatment outcomes (direct-acting antiviral [DAA] therapy only) among PWID (in the past year). Meta-analysis was used to pool estimates. Results Of 9877 articles identified, 22 studies conducted in Australia, Europe, North America, and Thailand were eligible and included. Risk of bias was serious in 21 studies and moderate in 1 study. Current/recent OAT was associated with an increased odds of recent HCV antibody testing (4 studies; odds ratio (OR), 1.80; 95% confidence interval [CI], 1.36–2.39), HCV RNA testing among those who were HCV antibody–positive (2 studies; OR, 1.83; 95% CI, 1.27–2.62), and DAA treatment uptake among those who were HCV RNA–positive (7 studies; OR, 1.53; 95% CI, 1.07–2.20). There was insufficient evidence of an association between OAT and treatment completion (9 studies) or sustained virologic response following DAA therapy (9 studies). Conclusions OAT can increase linkage to HCV care, including uptake of HCV testing and treatment among PWID. This supports the scale-up of OAT as part of strategies to enhance HCV treatment to further HCV elimination efforts.
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- 2021
7. Prevalence of mental disorders among people with opioid use disorder: A systematic review and meta-analysis
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Thomas, Santo, Gabrielle, Campbell, Natasa, Gisev, Daniel, Martino-Burke, Jack, Wilson, Samantha, Colledge-Frisby, Brodie, Clark, Lucy Thi, Tran, and Louisa, Degenhardt
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Stress Disorders, Post-Traumatic ,Pharmacology ,Psychiatry and Mental health ,Mental Disorders ,Prevalence ,Humans ,Pharmacology (medical) ,Comorbidity ,Opioid-Related Disorders ,Toxicology ,Anxiety Disorders - Abstract
Opioid use disorder (OUD) and mental disorders are major public health issues and comorbidity is common. Among people with OUD, comorbid mental disorders are associated with poorer health outcomes. To our knowledge, this is the first systematic review and meta-analysis to estimate prevalence of specific mental disorders among people with OUD.We searched Embase, MEDLINE, and PsycInfo from 1990 to 2021 for observational studies of depression, anxiety, post-traumatic stress disorder (PTSD), bipolar, personality, and other pre-specified mental disorders among people with OUD. We pooled current and lifetime estimates of each disorder using random-effects meta-analyses with 95% Confidence Intervals (CIs). Meta-regressions and stratified analyses were used to assess heterogeneity of prevalence estimates by methodological factors and sample characteristics.Of the 36,971 publications identified, we included data from 345 studies and 104,135 people with OUD in at least one pooled estimate. Among people with OUD, the prevalence of current depression was 36.1% (95%CI 32.4-39.7%), anxiety was 29.1% (95%CI 24.0-33.3%), attention-deficit/hyperactivity disorder was 20.9% (95%CI 15.7-26.2%), PTSD was 18.1% (95%CI 15.4-20.9%), and bipolar disorder was 8.7% (95%CI 6.7-10.7%). Lifetime prevalence of anti-social personality disorder was 33.6% (95%CI 29.1-38.0%) and borderline personality disorder was 18.2% (95% CI 13.4-23.1%). Sample characteristics and methodological factors, including sex, were associated with variance of multiple prevalence estimates.Our findings emphasise the need for access to mental disorder treatment among people with OUD. Specific mental disorder estimates may inform clinical guidelines, treatment services, and future research for people with OUD, including subpopulations with distinct treatment needs.
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- 2022
8. Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence: A Systematic Review and Meta-analysis
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Raimondo Maria Pavarin, Thomas Santo, Matthew Hickman, Roberto Muga, Chrianna Bharat, Julie Dupouy, Aileen Chen, Brodie Clark, Lucy Thi Tran, Erin Kelty, Bohdan Nosyk, Jeong Min, Louisa Degenhardt, Prianka Padmanathan, Gráinne Cousins, Luis Sordo, Jason Grebely, Michael Farrell, and Gabrielle Campbell
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medicine.medical_specialty ,Population ,Lower risk ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Cause of Death ,Opiate Substitution Treatment ,Medicine ,Humans ,education ,education.field_of_study ,business.industry ,Mortality rate ,Correction ,Opioid-Related Disorders ,030227 psychiatry ,Analgesics, Opioid ,Psychiatry and Mental health ,Observational Studies as Topic ,Meta-analysis ,business ,030217 neurology & neurosurgery ,Buprenorphine ,medicine.drug ,Methadone ,Cohort study - Abstract
Importance Mortality among people with opioid dependence is higher than that of the general population. Opioid agonist treatment (OAT) is an effective treatment for opioid dependence; however, there has not yet been a systematic review on the relationship between OAT and specific causes of mortality. Objective To estimate the association of time receiving OAT with mortality. Data Sources The Embase, MEDLINE, and PsycINFO databases were searched through February 18, 2020, including clinical trial registries and previous Cochrane reviews. Study Selection All observational studies that collected data on all-cause or cause-specific mortality among people with opioid dependence while receiving and not receiving OAT were included. Randomized clinical trials (RCTs) were also included. Data Extraction and Synthesis This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data on study, participant, and treatment characteristics were extracted; person-years, all-cause mortality, and cause-specific mortality were calculated. Crude mortality rates and rate ratios (RRs) were pooled using random-effects meta-analyses. Main Outcomes and Measures Overall all-cause and cause-specific mortality both by setting and by participant characteristics. Methadone and buprenorphine OAT were evaluated specifically. Results Fifteen RCTs including 3852 participants and 36 primary cohort studies including 749 634 participants were analyzed. Among the cohort studies, the rate of all-cause mortality during OAT was more than half of the rate seen during time out of OAT (RR, 0.47; 95% CI, 0.42-0.53). This association was consistent regardless of patient sex, age, geographic location, HIV status, and hepatitis C virus status and whether drugs were taken through injection. Associations were not different for methadone (RR, 0.47; 95% CI, 0.41-0.54) vs buprenorphine (RR, 0.34; 95% CI, 0.26-0.45). There was lower risk of suicide (RR, 0.48; 95% CI, 0.37-0.61), cancer (RR, 0.72; 95% CI, 0.52-0.98), drug-related (RR, 0.41; 95% CI, 0.33-0.52), alcohol-related (RR, 0.59; 95% CI, 0.49-0.72), and cardiovascular-related (RR, 0.69; 95% CI, 0.60-0.79) mortality during OAT. In the first 4 weeks of methadone treatment, rates of all-cause mortality and drug-related poisoning were almost double the rates during the remainder of OAT (RR, 2.01; 95% CI, 1.55-5.09) but not for buprenorphine (RR, 0.58; 95% CI, 0.18-1.85). All-cause mortality was 6 times higher in the 4 weeks after OAT cessation (RR, 6.01; 95% CI, 4.32-8.36), remaining double the rate for the remainder of time not receiving OAT (RR, 1.81; 95% CI, 1.50-2.18). Opioid agonist treatment was associated with a lower risk of mortality during incarceration (RR, 0.06; 95% CI, 0.01-0.46) and after release from incarceration (RR, 0.09; 95% CI, 0.02-0.56). Conclusions and Relevance This systematic review and meta-analysis found that OAT was associated with lower rates of mortality. However, access to OAT remains limited, and coverage of OAT remains low. Work to improve access globally may have important population-level benefits.
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- 2021
9. Prevalence of childhood maltreatment among people with opioid use disorder: A systematic review and meta-analysis
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Samantha Colledge, Gian Luca Di Tanna, Louisa Degenhardt, Lucy Thi Tran, Thomas Santo, Gabrielle Campbell, and Natasa Gisev
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Adult ,Male ,Population ,Psychological intervention ,Poison control ,Toxicology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Prevalence ,Medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Child Abuse ,Risk factor ,education ,Psychological abuse ,Child ,Pharmacology ,education.field_of_study ,business.industry ,Opioid-Related Disorders ,Psychiatry and Mental health ,Physical abuse ,Sexual abuse ,Meta-analysis ,Female ,business ,030217 neurology & neurosurgery ,Demography - Abstract
Background Experience of childhood maltreatment (CM) is a risk factor for opioid use disorder (OUD). CM is also associated with comorbid mental disorders and poor treatment outcomes among people with OUD. To our knowledge, this is the first systematic review and meta-analysis to estimate the prevalence of CM among people with OUD. Methods We searched MEDLINE, EMBASE, and PsycINFO to identify observational studies that evaluated CM among people with OUD from January 1990 to June 2020. Prevalence of each CM type, sample characteristics, and methodological factors were extracted from each eligible study. Random-effects meta-analyses were used to pool prevalence estimates. Stratified meta-analyses were used to assess heterogeneity. Results Of the 6,438 publications identified, 113 studies reported quantitative CM data among people with OUD and 62 studies (k = 62; N = 21,871) were included in primary analyses. Among people with OUD, the estimated prevalence of sexual abuse was 41% (95% CI 36–47%; k = 38) among women and 16% (95% CI 12–20%; k = 25) among men. Among all people with OUD, prevalence estimates were 38% (95% CI 33–44%; k = 48) for physical abuse, 43% (95% CI 38–49%; k = 31) for emotional abuse, 38% (95% CI 30–46%; k = 17) for physical neglect, and 42% (95% CI 32–51%; k = 17) for emotional neglect. Sex, history of injecting drug use, recruitment methods, and method of assessing CM were associated with substantial heterogeneity. Conclusions People with OUD frequently report the experience of CM, supporting the need for trauma-informed interventions among this population. Future research should consider the impact of CM on OUD presentations and when assessment is appropriate, use of validated instruments.
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- 2020
10. Association between opioid agonist therapy use and HIV testing uptake among people who have recently injected drugs: a systematic review and meta-analysis
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Matthew Hickman, Claire F Ferraro, Louisa Degenhardt, Carla Puca, Julian P T Higgins, Peter Vickerman, Behzad Hajarizadeh, Sarah Larney, Thomas Santo, Clare E French, Jason Grebely, Shally Zhou, Lucy Thi Tran, and Daniel E Stewart
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medicine.medical_specialty ,media_common.quotation_subject ,030508 substance abuse ,Medicine (miscellaneous) ,Reviews ,opioid agonist therapy ,HIV Infections ,PsycINFO ,Review ,HIV Testing ,methadone ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,systematic review ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Substance Abuse, Intravenous ,media_common ,injecting drug users ,Selection bias ,business.industry ,Confounding ,Odds ratio ,medicine.disease ,meta-analysis ,Analgesics, Opioid ,Psychiatry and Mental health ,Pharmaceutical Preparations ,meta‐analysis ,Meta-analysis ,HIV/AIDS ,Observational study ,0305 other medical science ,business ,Methadone ,medicine.drug - Abstract
BACKGROUND AND AIM: Globally, nearly one in five people who inject drugs (PWID) are living with HIV, and the rate of new HIV infections in PWID is increasing in some settings. Early diagnosis is crucial for effective HIV control. We reviewed the evidence on the association between opioid agonist therapy (OAT) and HIV testing uptake among PWID. METHODS: We conducted a systematic review searching MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and PsycINFO for studies published from January 2000 to March 2019. Reference lists and conference proceedings were hand-searched. Observational and intervention studies were eligible for inclusion. Risk of bias was assessed using the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool. Meta-analyses were conducted using random-effects models. RESULTS: Of 13 373 records identified, 11 studies from Australia, Europe, Malaysia and the United States were included. All studies had at least a serious risk of bias, largely due to confounding and selection bias, making it difficult to draw causal conclusions from the evidence. Ten studies provided data on the association between current OAT use and recent HIV testing. Six showed a positive association, while four provided little evidence of an association: pooled odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.28-2.27. Looking at having ever been on OAT and having ever been HIV tested, seven studies showed a positive association and three showed either weak or no evidence of an association: pooled OR = 3.82, 95% CI = 2.96-4.95. CONCLUSIONS: Opioid agonist therapy may increase uptake of HIV testing among people who inject drugs, providing further evidence that opioid agonist therapy improves the HIV treatment care cascade.
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- 2020
11. All-cause and cause-specific mortality among people with regular or problematic cocaine use:A systematic review and meta-analysis
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Amy Peacock, Thomas Santo, Emily Stockings, Louisa Degenhardt, Hayley E Jones, Lucy Thi Tran, Sarah Larney, and Damian Santomauro
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medicine.medical_specialty ,injury ,infectious disease ,Population ,030508 substance abuse ,Medicine (miscellaneous) ,cocaine ,Article ,03 medical and health sciences ,0302 clinical medicine ,Cocaine ,Cause of Death ,Acute care ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,education ,suicide ,Retrospective Studies ,education.field_of_study ,business.industry ,Mortality rate ,cardiovascular ,homicide ,Retrospective cohort study ,mortality ,Confidence interval ,Clinical trial ,Suicide ,Psychiatry and Mental health ,Standardized mortality ratio ,Meta-analysis ,0305 other medical science ,business ,Demography - Abstract
AimsTo estimate pooled all‐cause and cause‐specific mortality risk for people with regular or problematic cocaine use.MethodsSystematic review and meta‐analysis of prospective or retrospective cohort studies or clinical trials (n ≥30) of people with regular or problematic cocaine use with data on all‐cause or cause‐specific mortality. Of 2808 papers, 28 were eligible and reported on 21 cohorts, with a total 170 019 individuals. Cohorts identified based on acute care for drug poisoning or other severe health presentation were excluded. Title/abstract screening was conducted by one reviewer; a second reviewer independently checked 10% of excluded studies. Two reviewers conducted full‐text screening. Data were extracted by one reviewer and checked by a second. A customized review‐specific study reporting quality/risk of bias tool was used. Data on crude mortality rates (CMR) and standardized mortality ratios were extracted for both all‐cause and cause‐specific mortality. Standardized mortality ratios were imputed where not provided by the author using extracted data and information from the Global Burden of Disease Study 2017. Data were pooled using a random‐effects model.ResultsThe pooled all‐cause crude mortality rate was 1.24 per 100 person‐years [95% confidence interval (CI) = 0.86, 1.78; n = 16 cohorts], but with considerable heterogeneity (I2 = 98.8%). The pooled all‐cause standardized mortality ratio (SMR) was 6.13 (95% CI = 4.15, 9.05; n = 16 cohorts). Suicide (SMR = 6.26, 95% CI = 2.84, 13.80), accidental injury (SMR = 6.36, 95% CI = 4.18, 9.68), homicide (SMR = 9.38, 95% CI 3.45–25.48) and AIDS‐related mortality (SMR = 23.12, 95% CI = 11.30, 47.31) were all elevated compared with age and sex peers in the general population.ConclusionsThere are elevated rates of mortality among people with regular or problematic cocaine use for traumatic deaths and deaths attributable to infectious disease.
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- 2020
12. Injecting risk behaviours amongst people who inject drugs: A global multi-stage systematic review and meta-analysis
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Jason Grebely, Peter Vickerman, Lucy Thi Tran, Amy Peacock, Louisa Degenhardt, Sonja Memedovic, Matthew Hickman, Sarah Larney, Jack Stone, Adam Trickey, Janni Leung, and Samantha Colledge
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Virus transmission ,Psychological intervention ,030508 substance abuse ,Medicine (miscellaneous) ,HIV Infections ,03 medical and health sciences ,0302 clinical medicine ,Risk-Taking ,Harm Reduction ,Syringe sharing ,Environmental health ,Medicine ,Humans ,Needle Sharing ,030212 general & internal medicine ,Substance Abuse, Intravenous ,Syringe ,Harm reduction ,Risk behaviour ,business.industry ,Health Policy ,Multi stage ,Pharmaceutical Preparations ,Meta-analysis ,Female ,0305 other medical science ,business - Abstract
BackgroundInjecting risk behaviour, such as receptive sharing of injecting equipment and/or re-using one's equipment, is associated with bloodborne virus transmission and infections in people who inject drugs (PWID). We aimed to estimate prevalence and correlates of injecting risk behaviours amongst PWID.MethodsWe conducted a systematic review and meta-analyses to estimate country, regional, and global prevalences of injecting risk behaviours (including sharing or re-using needle/syringe and sharing other injecting equipment). Using meta-regression analyses, we determined associations between study- and country-level characteristics and receptive needle/syringe sharing.ResultsFrom 61,077 identified papers and reports and 61 studies from expert consutation, evidence on injecting risk behaviours was available for 464 studies from 88 countries. Globally, it is estimated that 17.9% (95%CI: 16.2–19.6%) of PWID engaged in receptive needle/syringe sharing at last injection, 23.9% (95%CI: 21.2–26.5%) in the past month, and 32.8% (95%CI: 28.6–37.0%) in the past 6–12 months. Receptive sharing of other injecting equipment was common. Higher prevalence of receptive needle/syringe sharing in the previous month was associated with samples of PWID with a lower proportion of females, shorter average injecting duration, a higher proportion with ≥daily injecting, and older studies. Countries with lower development index, higher gender inequality and lower NSP coverage had higher proportions reporting receptive needle/syringe sharing.ConclusionsHigh levels of injecting risk behaviours were observed amongst PWID globally, although estimates were only available for half of the countries with evidence of injecting drug use. There is a need for better capturing of injecting risk behaviours in these countries to inform implementation of harm reduction services and evaluate potential impacts of interventions to reduce risk.
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- 2020
13. All-Cause and Cause-Specific Mortality Among People Using Extramedical Opioids: A Systematic Review and Meta-analysis
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Matthew Hickman, Damian Santomauro, Sarah Larney, Emily Stockings, Lucy Thi Tran, Louisa Degenhardt, Janni Leung, Thomas Santo, and Amy Peacock
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education.field_of_study ,business.industry ,Mortality rate ,Population ,MEDLINE ,Poison control ,Opioid-Related Disorders ,030227 psychiatry ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Meta-analysis ,Cause of Death ,Injury prevention ,Medicine ,Humans ,Mortality ,education ,business ,030217 neurology & neurosurgery ,Cause of death ,Cohort study ,Demography ,Original Investigation - Abstract
Importance: Extramedical opioid use has escalated in recent years. A better understanding of cause-specific mortality in this population is needed to inform comprehensive responses.Objective: To estimate all-cause and cause-specific crude mortality rates (CMRs) and standardized mortality ratios (SMRs) among people using extramedical opioids, including age- and sex-specific estimates when possible.Data Sources: For this systematic review and meta-analysis, MEDLINE, PsycINFO, and Embase were searched for studies published from January 1, 2009, to October 3, 2019, and an earlier systematic review on this topic published in 2011.Study Selection: Cohort studies of people using extramedical opioids and reporting mortality outcomes were screened for inclusion independently by 2 team members.Data Extraction and Synthesis: Data were extracted by a team member and checked by another team member. Study quality was assessed using a custom set of items that examined risk of bias and quality of reporting. Data were pooled using random-effects meta-analysis models. Heterogeneity was assessed using stratified meta-analyses and meta-regression.Main Outcomes and Measures: Outcome measures were all-cause and cause-specific CMRs and SMRs among people using extramedical opioids compared with the general population of the same age and sex.Results: Of 8683 identified studies, 124 were included in this analysis (100 primary studies and 24 studies providing additional data for primary studies). The pooled all-cause CMR, based on 99 cohorts of 1 262 592 people, was 1.6 per 100 person-years (95% CI, 1.4-1.8 per 100 person-years), with substantial heterogeneity (I2 = 99.7%). Heterogeneity was associated with the proportion of the study sample that injected opioids or was living with HIV infection or hepatitis C. The pooled all-cause SMR, based on 43 cohorts, was 10.0 (95% CI, 7.6-13.2). Excess mortality was observed across a range of causes, including overdose, injuries, and infectious and noncommunicable diseases.Conclusions and Relevance: The findings suggest that people using extramedical opioids experience significant excess mortality, much of which is preventable. The range of causes for which excess mortality was observed highlights the multiplicity of risk exposures experienced by this population and the need for comprehensive responses to address these. Better data on cause-specific mortality in this population in several world regions appear to be needed.
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- 2019
14. Cannabinoids for the treatment of mental disorders - Author's reply
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Gabrielle Campbell, Michael Farrell, Nicola Black, Wayne Hall, Lucy Thi Tran, and Louisa Degenhardt
- Subjects
Psychiatry and Mental health ,medicine.medical_specialty ,business.industry ,Cannabinoids ,Mental Disorders ,medicine ,MEDLINE ,Humans ,Psychiatry ,business ,Biological Psychiatry - Published
- 2019
15. Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: A systematic review and meta-analysis
- Author
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Gabrielle Campbell, Louisa Degenhardt, Nicola Black, Wayne Hall, Emily Stockings, Dino Zagic, Lucy Thi Tran, and Michael Farrell
- Subjects
medicine.medical_specialty ,Anxiety ,Placebo ,Tourette syndrome ,Article ,law.invention ,Stress Disorders, Post-Traumatic ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Medicine ,Humans ,030212 general & internal medicine ,Psychiatry ,Biological Psychiatry ,business.industry ,Cannabinoids ,Depression ,Australia ,medicine.disease ,030227 psychiatry ,Clinical trial ,Psychiatry and Mental health ,Systematic review ,Attention Deficit Disorder with Hyperactivity ,Meta-analysis ,Observational study ,medicine.symptom ,Chronic Pain ,business ,Tourette Syndrome - Abstract
Summary Background Medicinal cannabinoids, including medicinal cannabis and pharmaceutical cannabinoids and their synthetic derivatives, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), have been suggested to have a therapeutic role in certain mental disorders. We analysed the available evidence to ascertain the effectiveness and safety of all types of medicinal cannabinoids in treating symptoms of various mental disorders. Methods For this systematic review and meta-analysis we searched MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Clinical Trials, and the Cochrane Database of Systematic Reviews for studies published between Jan 1, 1980, and April 30, 2018. We also searched for unpublished or ongoing studies on ClinicalTrials.gov, the EU Clinical Trials Register, and the Australian and New Zealand Clinical Trials Registry. We considered all studies examining any type and formulation of a medicinal cannabinoid in adults (≥18 years) for treating depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder, or psychosis, either as the primary condition or secondary to other medical conditions. We placed no restrictions on language, publication status, or study type (ie, both experimental and observational study designs were included). Primary outcomes were remission from and changes in symptoms of these mental disorders. The safety of medicinal cannabinoids for these mental disorders was also examined. Evidence from randomised controlled trials was synthesised as odds ratios (ORs) for disorder remission, adverse events, and withdrawals and as standardised mean differences (SMDs) for change in symptoms, via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. This study is registered with PROSPERO (CRD42017059372, CRD42017059373, CRD42017059376, CRD42017064996, and CRD42018102977). Findings 83 eligible studies (40 randomised controlled trials, n=3067) were included: 42 for depression (23 randomised controlled trials; n=2551), 31 for anxiety (17 randomised controlled trials; n=605), eight for Tourette syndrome (two randomised controlled trials; n=36), three for ADHD (one randomised controlled trial; n=30), 12 for post-traumatic stress disorder (one randomised controlled trial; n=10), and 11 for psychosis (six randomised controlled trials; n=281). Pharmaceutical THC (with or without CBD) improved anxiety symptoms among individuals with other medical conditions (primarily chronic non-cancer pain and multiple sclerosis; SMD −0·25 [95% CI −0·49 to −0·01]; seven studies; n=252), although the evidence GRADE was very low. Pharmaceutical THC (with or without CBD) worsened negative symptoms of psychosis in a single study (SMD 0·36 [95% CI 0·10 to 0·62]; n=24). Pharmaceutical THC (with or without CBD) did not significantly affect any other primary outcomes for the mental disorders examined but did increase the number of people who had adverse events (OR 1·99 [95% CI 1·20 to 3·29]; ten studies; n=1495) and withdrawals due to adverse events (2·78 [1·59 to 4·86]; 11 studies; n=1621) compared with placebo across all mental disorders examined. Few randomised controlled trials examined the role of pharmaceutical CBD or medicinal cannabis. Interpretation There is scarce evidence to suggest that cannabinoids improve depressive disorders and symptoms, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis. There is very low quality evidence that pharmaceutical THC (with or without CBD) leads to a small improvement in symptoms of anxiety among individuals with other medical conditions. There remains insufficient evidence to provide guidance on the use of cannabinoids for treating mental disorders within a regulatory framework. Further high-quality studies directly examining the effect of cannabinoids on treating mental disorders are needed. Funding Therapeutic Goods Administration, Australia; Commonwealth Department of Health, Australia; Australian National Health and Medical Research Council; and US National Institutes of Health.
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- 2019
16. Integrating HIV pre-exposure prophylaxis and harm reduction among men who have sex with men and transgender women to address intersecting harms associated with stimulant use: a modelling study
- Author
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Louisa Degenhardt, Annick Borquez, Michael Farrell, Lucy Thi Tran, Frederick L. Altice, Sherrie L Kelly, Rebecca McKetin, Javier A. Cepeda, Carlos F. Caceres, Natasha K. Martin, Alfonso Silva-Santisteban, Katherine M. Rich, and Kelika A. Konda
- Subjects
Male ,Supplement: Research Articles ,transgender women ,Anti-HIV Agents ,Substance-Related Disorders ,medicine.medical_treatment ,HIV pre‐exposure prophylaxis ,Psychological intervention ,Human immunodeficiency virus (HIV) ,men who have sex with men ,HIV Infections ,Disease ,purl.org/pe-repo/ocde/ford#3.03.08 [https] ,medicine.disease_cause ,Models, Biological ,Transgender Persons ,Transgender women ,Men who have sex with men ,modelling ,03 medical and health sciences ,Pre-exposure prophylaxis ,Sexual and Gender Minorities ,0302 clinical medicine ,Cocaine ,Harm Reduction ,Peru ,medicine ,Humans ,030212 general & internal medicine ,Homosexuality, Male ,suicide ,Harm reduction ,030505 public health ,Unsafe Sex ,business.industry ,Public Health, Environmental and Occupational Health ,virus diseases ,Stimulant ,Suicide ,Infectious Diseases ,HIV pre-exposure prophylaxis ,stimulants ,Central Nervous System Stimulants ,Female ,Pre-Exposure Prophylaxis ,0305 other medical science ,business ,Demography ,Research Article - Abstract
Introduction Among men who have sex with men (MSM) and transgender women (TW), stimulant use is high and has been associated with an increased risk of HIV infection, suicide and cardiovascular disease (CVD) mortality. We used epidemic modelling to investigate these intersecting health harms among MSM/TW in Lima, Peru and assess whether they could be mitigated by prioritizing HIV pre‐exposure prophylaxis (PrEP) and harm reduction interventions among MSM/TW who use stimulants. Methods We adapted a dynamic model of HIV transmission among MSM/TW in Lima to incorporate stimulant use and increased HIV risk, suicide and CVD mortality. Among 6% to 24% of MSM/TW using stimulants (mostly cocaine), we modelled an increased risk of unprotected anal sex (RR = 1.35 [95%CI: 1.17 to 1.57]) obtained from local data, and increased risk of suicide (SMR = 6.26 [95%CI: 2.84 to 13.80]) and CVD (SMR = 1.83 [95%CI: 0.39 to 8.57]) mortality associated with cocaine use based on a global systematic review. We estimated the proportion of health harms occurring among MSM/TW who use stimulants in the next year (01‐2020/01‐2021). We also investigated the 10‐year impact (01‐2020/01‐2030) of: (1) PrEP prioritization for stimulant‐using MSM/TW compared to random allocation, and (2) integrating PrEP with a theoretical intervention halving stimulant‐associated risk. Results MSM/TW in Lima will experience high HIV incidence, suicide mortality and CVD mortality (1.6/100 py, and 0.018/100 py, 0.13/100 py respectively) in 2020. Despite stimulant using MSM/TW comprising an estimated 9.5% (95%CI: 7.8 to 11.5) of all MSM/TW, in the next year, 11% 95%CI (i.e. 2.5% to 97.5% percentile) 10% to 13%) of new HIV infections, 39% (95%CI: 18% to 60%) of suicides and 15% (95%CI: 3% to 44%) of CVD deaths could occur among this group. Scaling up PrEP among all stimulant using MSM/TW could prevent 19% (95%CI: 11% to 31%) more HIV infections over 10 years compared to random allocation. Integrating PrEP and an intervention to halve stimulant‐associated risks could reduce new HIV infections by 20% (95%CI: 10% to 37%), suicide deaths by 14% (95%CI: 5% to 27%) and CVD deaths by 3% (95%CI: 0% to 16%) over a decade. Conclusions MSM/TW who use stimulants experience a disproportionate burden of health harms. Prioritizing PrEP based on stimulant use, in addition to sexual behaviour/gender identity criteria, could increase its impact. Integrated substance use, harm reduction, mental health and HIV care among MSM/TW is needed.
- Published
- 2019
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