Andrew Smirnov

Using population screening for recruitment of young adults engaged in illicit drug use: Methodological issues and sampling outcomes

Social stigma, legal sanctions and the associated lack of sampling frames create barriers to the probabilistic sampling of those engaged in a variety of behaviour, including illicit drug use. We used a novel sampling approach to recruit respondents into a longitudinal study examining amphetamine-type stimulant use. A young adult population was screened for lifetime drug use to create a sampling frame of amphetamine-type stimulant users and non-users. We posted 12,118 screening questionnaires to a random selection of young adults listed on the electoral roll for Brisbane and the Gold Coast, Australia (N=107,275). Using a small pre-paid incentive and intensive telephone and postal reminders we attained a screening response rate of 49.9%. Eligible amphetamine-type stimulant users (used ecstasy or methamphetamine⩾3 times in past 12 months) and non-users (never used ecstasy or methamphetamine) were identified by screening responses. About two-thirds of each selected group took part in the longitudinal study. Comparisons with large-scale population survey data suggest the sample was broadly representative of young adult amphetamine-type stimulant users in Australia.

Willingness to cooperate with police: A population-based study of Australian young adult illicit stimulant users:

While procedural justice has been highlighted as a key strategy for promoting cooperation with police, little is known about this model’s applicability to subgroups engaged in illegal behaviour, such as illicit drug users. This study compares willingness to cooperate with police and belief in police legitimacy, procedural justice and law legitimacy among a population-based sample of Australian young adult amphetamine-type stimulant (ATS; i.e. ecstasy and methamphetamine) users and non-users. We then examine predictors of willingness to cooperate among ATS users. ATS users were significantly less willing to cooperate with police and had significantly lower perceptions of police legitimacy, procedural justice and law legitimacy, compared to non-users. However, belief in police legitimacy independently predicted willingness to cooperate among ATS users. We set out to discuss the implications of these findings for policing, including the role of procedural justice in helping police deliver harm reduction strategies.

Social Contacts and Ecstasy Offers: Findings of a Population-Based Study

Abstract Ecstasy (MDMA) use is relatively common among young adults in many developed countries. However, little is known about how young non-users are first introduced to Ecstasy, including the relative contribution of peer networks and individual risk factors. We assess the role of social contact with Ecstasy-using peers in regard to young adults’ exposure to offers of Ecstasy, using data from the Natural History Study, a population-based study conducted in Australia. Population screening of young adults (19- to 23-year-olds) identified a sample of young Ecstasy users (N = 315) and a comparison group of Ecstasy-naïve participants (N = 199). Two outcomes are considered: being exposed to any Ecstasy offers and being exposed to > 3 offers. Extensive social contact with Ecstasy users was defined as knowing >10 Ecstasy users. Of the Ecstasy-naïve young adults, >40% had ever received Ecstasy offers. Extensive social contact with Ecstasy users independently predicted exposure to multiple (> 3) Ecstasy offers for Ecstasy-naïve young adults. These findings indicate that Ecstasy offers are widespread among users and non-users of Ecstasy. For non-users, exposure to Ecstasy offers occurs through social contact with drug-using peers independently of individual risk factors. The pervasiveness of Ecstasy offers suggests that universal education concerning Ecstasy use is required.

Use and misuse of opioid replacement therapies: a Queensland study.

Buprenorphine/naloxone has recently been introduced in Australia and is available for unsupervised dosing within Queensland. A retrospective observational study of data collected during 2000–2007 for clients obtaining injecting equipment from the Brisbane Harm Reduction Centre in Queensland is presented. The numbers of service occasions and needles and syringes were used as surrogate drug use measures. Buprenorphine and naloxone were misused at lower rates when compared with buprenorphine and methadone. Furthermore, the misuse of opioid replacement therapies represented less than 5% of all illicit opioid injections. Implications and study limitations are discussed.

Engagement with different nightlife venues and frequent ecstasy use in a young adult population

Abstract Aims: Little is known about the possible influence of different social settings on changes in patterns of ecstasy use over time. This study explores the relationship between engagement with different types of nightlife venues and subsequent frequent ecstasy use in an Australian young adult population sample. Methods: Longitudinal data are from a population-derived sample of Australian young adult ecstasy users (n = 265). Attendance at four types of venues (nightclubs, electronic dance music events/music festivals, venues playing live music, and pubs/bars) was measured at 6 months. Frequency of recent ecstasy use (last 12 months) was measured at 12 and 30 months. A prediction model of frequent ecstasy use at 30 months was developed using Poisson regression reporting adjusted relative risk. Findings: Regular attendance at nightclubs (≥monthly, adjusted relative risk 6.21, confidence interval 2.30–16.76) was associated with frequent ecstasy use at 30 months, independently of ecstasy use expectancies, ecstasy availability, ecstasy and methamphetamine dependence, frequent use of methamphetamine and alcohol, and other dimensions of ecstasy involvement (i.e. length of ecstasy use career and lifetime ecstasy consumption). Conclusions: Compared with attendees of other venues, nightclub attendees may be a special priority group for ecstasy harm and demand reduction interventions.

Predictors of Aggressive Behavior While under the Influence of Illicit Drugs among Young Adult Methamphetamine Users

ABSTRACT Background: Prior research indicates that patterns of combined alcohol and methamphetamine use may be associated with experiencing subjective feelings of aggression or hostility during methamphetamine use episodes. Objectives: This study examines whether subjective effects of methamphetamine use (i.e., aggression or hostility and paranoia) are associated with aggressive behavior while under the influence of any illicit drugs, controlling for combined alcohol and methamphetamine use and a number of other potential predictors. Methods: Data from a population-based sample of Australian young adult methamphetamine users (n = 101) collected in 2010 was analyzed. A prediction model of aggressive behavior under the influence of illicit drugs was developed using penalized maximum likelihood logistic regression. Results: Over one-third (34.7%) of methamphetamine users had engaged in verbal and/or physical aggression under the influence of illicit drugs in the last 12 months. In the prediction model, recurrent feelings of aggression or hostility attributed to methamphetamine use (≥3 times in the last 12 months) were associated with aggressive behavior (adjusted odds ratio 4.95, 95% confidence interval 1.67, 14.69). This association was independent of methamphetamine-attributed paranoia, combined alcohol and methamphetamine use, methamphetamine, ecstasy, cocaine, and cannabis use patterns, heavy episodic drinking, gender, and age. No association was found for combined alcohol and methamphetamine use. Conclusions: These findings indicate a link between methamphetamine-related subjective feelings of aggression or hostility and self-reported aggressive behavior while under the influence of illicit drugs. This suggests that subjective feelings of aggression or hostility may distinguish those who are involved in aggression from other methamphetamine users.

When knowledge and experience do not help: a study of nonfatal drug overdoses

&NA; With recent increases in overdose deaths in Australia, there is renewed interest in understanding the factors that contribute to overdose. We examine the experiences of persons who report a nonfatal drug overdose. Fifty people who inject drugs (PWID) and who had accidently overdosed in the past 12 months were recruited and interviewed at 1 of 4 Needle and Syringe Program sites during September and October 2013. Participants were typically male, middle-aged, with long injecting histories. Half of the participants reported mainly injecting pharmaceutical opioids. Most overdoses occurred at home with others present. An ambulance was called for only 38% of cases and 26% were admitted to a hospital emergency department. Police were seldom involved, and there were no complaints about the involvement of police at the time of the overdose. Participants commonly had a history of overdosing, and most were on prescription medications for physical and/or mental health problems. Poly drug use was common for those reporting an accidental overdose. Benzodiazepines (eg, Xanax or Valium) were implicated in just over half of the overdoses. Most of those reporting a recent overdose also report a past history of previous overdoses. Most of those reporting a previous overdose continue to use substances in ways they are aware contribute to the risk of an overdose.

Predictors of Hazardous Alcohol Consumption Among Young Adult Amphetamine-Type Stimulant Users

Background: Very high levels of alcohol consumption have been observed in young adult amphetamine-type stimulant (i.e., ecstasy and methamphetamine) users. The reasons for this association are poorly understood. Objective: To examine predictors of hazardous alcohol consumption in a sample of young adult amphetamine-type stimulant users after 30 months of follow-up, controlling for potential confounders. Method: Analysis of longitudinal data from a population-derived sample of Australian young adult amphetamine-type stimulant users (n = 292). A prediction model of alcohol use at 30 months was developed using generalized linear latent and mixed modeling (GLLAMM). Results: Concurrently using ecstasy (Adjusted Odds Ratio [AOR] = 2.67, 95% Confidence Interval [CI] = [1.41, 5.07]), frequently attending nightclubs (AOR = 2.53, 95% CI = [1.04, 6.16]), high baseline alcohol use patterns (AOR = 2.06, 95% CI = [1.32, 3.20]), and being male (AOR = 3.60, 95% CI = [1.48, 8.78]) were associated with an increased likelihood of hazardous alcohol use at 30 months. Conclusion: Concurrent, but not baseline, ecstasy use was associated with hazardous alcohol use, suggesting that combined use of these substances may have an instrumental role in terms of the social functions of drug use (e.g., increasing capacity to drink). Integration of educational interventions concerning alcohol and stimulants is warranted.

Psychological Distress and Drug Use Patterns of Young Adult Ecstasy Users: A Complementary Analysis of Australian Datasets

We examine psychological distress (PD) in young adult Ecstasy users in relation to age of initiation and frequency of use of Ecstasy, cannabis, alcohol, and tobacco. Using two Australian community samples, we assess whether different sampling methods produce comparable estimates of these associations. The Natural History Study of Drug Use (NHSDU; N = 339) in 2009 used population sampling and the 2009 Ecstasy and Related Drug Reporting System (EDRS; N = 359) used purposive sampling. Participants, aged 19–23 years, were recurrent Ecstasy users. PD was assessed using Kessler 10 in the EDRS and Hospital Anxiety Depression Scale in the NHSDU. In both samples, PD was associated with daily tobacco use and early drug initiation, but not frequent Ecstasy use. One-third smoke tobacco daily. Study limitations and implications are noted.

Young Adult Stimulant Users' Exposure to Injecting Drug Use and Reasons for Never Injecting

Abstract presented at the Australasian Professional Society on Alcohol and other Drugs Conference 2013, 24-27 November 2013, Brisbane, Australiapresented at the Australasian Professional Society on Alcohol and other Drugs Conference 2013, 24-27 November 2013, Brisbane, AustraliaAbstract presented at the Australasian Professional Society on Alcohol and other Drugs Conference 2013, 24-27 November 2013, Brisbane, AustraliaAbstract presented at the Australasian Professional Society on Alcohol and other Drugs Conference 2013, 24-27 November 2013, Brisbane, AustraliaAbstract presented at the Australasian Professional Society on Alcohol and other Drugs Conference 2013, 24-27 November 2013, Brisbane, Australia