Alison Ritter

The characteristics of heroin users entering treatment: findings from the Australian treatment outcome study (ATOS)

The current study aimed to describe the characteristics (demographics, drug use, mental and physical health) of entrants to treatment for heroin dependence in three treatment modalities; and to compare these characteristics with heroin users not in or seeking treatment. Participants were 825 current heroin users recruited from Sydney, Adelaide and Melbourne: 277 entering methadone/buprenorphine maintenance treatment (MT), 288 entering detoxification (DTX), 180 entering drug-free residential rehabilitation (RR) and 80 not in treatment (NT). Treatment entrants were generally long-term heroin users with previous treatment experience. The majority of the sample (55%) were criminally active in the month preceding interview. Injection-related health problems (74%) and a history of heroin overdose (58%) were commonly reported. There were high degrees of psychiatric co-morbidity, with 49% reporting severe psychological distress, 28% having current major depression, 37% having attempted suicide and 42% having a lifetime history of post-traumatic stress disorder. Personality disorders were also prevalent, with 72% meeting criteria for antisocial personality disorder and 47% screening positive for borderline personality disorder. Striking similarities were noted between the non-treatment and treatment groups in length of heroin use career, drug use and treatment histories.

A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs

Harm reduction is both a policy approach and used to describe a specific set of interventions. These interventions aim to reduce the harms associated with drug use. Employing a strict definition of harm reduction, evidence for the efficacy and effectiveness of alcohol, tobacco and illicit drug harm reduction interventions were reviewed. Systematic searches of the published literature were undertaken. Studies were included if they provided evaluation data (pre-post, or control group comparisons). More than 650 articles were included in the review. The majority of the literature concerned illicit drugs. For alcohol, harm reduction interventions to reduce road trauma are well-founded in evidence. Otherwise, there is limited research to support the efficacy and effectiveness of other alcohol harm reduction interventions. For tobacco, the area is controversial but promising new products that reduce the harms associated with smoking are being developed. In the area of illicit drugs there is solid efficacy, effectiveness and economic data to support needle syringe programmes and outreach programmes. There is limited published evidence to date for other harm reduction interventions such as non-injecting routes of administration, brief interventions and emerging positive evidence for supervised injecting facilities. There is sufficient evidence to support the wide-spread adoption of harm reduction interventions and to use harm reduction as an overarching policy approach in relation to illicit drugs. The same cannot be concluded for alcohol or tobacco. Research at a broad policy level is required, especially in light of the failure by many policy makers to adopt cost-effective harm reduction interventions.

How do drug policy makers access research evidence

BACKGROUND Policy decisions are informed by a number of factors: politics, ideology and values, perceived public opinion, and pragmatic constraints such as funding. Research evidence is also used to inform decision-making but must compete with these other inputs. Understanding how policy makers access research evidence may assist in encouraging greater use of this evidence. This study examined the sources of research evidence that Australian government drug policy makers accessed when faced with their most recent decision-making opportunity. METHOD Drug policy makers across health and police government portfolios were interviewed (n=31) and asked to report on the sources of research evidence used in their most recent decision-making. RESULTS Nine sources were reported, the most frequent of which were seeking advice from an expert and consulting technical reports. Accessing the internet, using statistical data and consulting policy makers in other jurisdictions were used in about half the cases. The least frequently used sources were academic literature, relying on internal expertise, policy documents and employing a consultant. CONCLUSION There is a tension between the type of information source most suited to policy makers--simple, single-message, summative and accessible--and the types of information produced and valued by researchers--largely academic publications that are nuanced and complex. Researchers need to consider the sources that policy makers use if they wish their research to be utilised as one part of policy making.

A randomised trial of the cost effectiveness of buprenorphine as an alternative to methadone maintenance treatment for heroin dependence in a primary care setting

AbstractBackground and aim: Buprenorphine offers an alternative to methadone in the treatment of heroin dependence, and has the advantage of allowing alternate-day dosing. This study is the first to examine the cost effectiveness of buprenorphine as maintenance treatment for heroin dependence in a primary care setting using economic and clinical data collected within a randomised trial. Study design and methods: The study was a randomised, open-label, 12-month trial of 139 heroin-dependent patients in a community setting receiving individualised treatment regimens of buprenorphine or methadone. Those who were currently on a methadone program (n = 57; continuing therapy subgroup) were analysed separately from new treatment recipients (n = 82; initial therapy subgroup). The study took a broad societal perspective and included health, crime and personal costs. Data on resource use and outcomes were a combination of clinical records and self report at interview. The main outcomes were incremental cost per additional day free of heroin use and per QALY. An analysis of uncertainty calculated the likelihood of net benefits for a range of acceptable money values of outcomes. All costs were in 1999 Australian dollars (

Naltrexone in the treatment of heroin dependence: relationship with depression and risk of overdose

A). Results: The estimated mean number of heroin-free days did not differ significantly between those randomised to methadone (225 [95% CI 91, 266]), or buprenorphine (222 [95% CI 194, 250]) over the year of the trial. Buprenorphine was associated with an average 0.03 greater QALYs over 52 weeks (not significant). The total cost was

The ethics of reimbursing injecting drug users for public health research interviews: what price are we prepared to pay?

A17 736 (95% CI −

The Reliability and Internal Validity of the Wisconsin Card Sorting Test

A2981,

Implementing Buprenorphine Treatment in Community Settings in Australia: Experiences from the Buprenorphine Implementation Trial

A38 364) with methadone and

The relationship between take-away methadone policies and methadone diversion

A11 916 (95% CI

Paying research participants: a study of current practices in Australia

A7697,