Angela Rintoul

Increasing deaths involving oxycodone, Victoria, Australia, 2000–09

Objective In light of an emerging epidemic identified in the United States and Canada, to identify trends in fatal drug toxicity involving oxycodone and the demographic characteristics and indicators of socioeconomic disadvantage of the deceased. Study design Population-based observational study in Victoria, Australia. Population Decedents whose death was reported to the Victorian Coroner between 2000 and 2009 and where oxycodone was detected. Main outcome measures Association between supply of oxycodone and deaths. Demographic characteristics of decedents. Rate ratios of the rural or metropolitan location and socioeconomic indicators of disadvantage of the deceased. Results Supply to Victoria has increased nine-fold from 7.5 mg per capita in 2000 to 67.5 mg per capita in 2009. Detection of oxycodone in deaths reported to the Victorian Coroner has increased from 4 (0.08/100 000 population) in 2000 to 97 (1.78/100 000 population) in 2009—a 21-fold increase in deaths. Of the 320 cases described, 53.8% (172) were the result of drug toxicity. Of these, 52.3% were unintentional and 19.8% intentional self-harm; the remaining 27.9% are either still under investigation by the coroner or intent is unknown. Drug toxicity deaths were overrepresented in both rural areas and areas indexed with high levels of disadvantage. Conclusions The substantial increase in the number of deaths involving oxycodone is strongly and significantly associated with the increase in supply. Most drug toxicity deaths involving oxycodone were unintentional. This newly identified trend in fatalities in Victoria supports concerns that a pattern of increasing deaths involving oxycodone is emerging globally.

Modelling vulnerability to gambling related harm: How disadvantage predicts gambling losses

Electronic gambling machines (EGMs) are ubiquitous in social venues such as hotels and clubs in most Australian states, and account for 55% of total gambling expenditure in Australia; they are also associated with most gambling derived harm. Because of the difficulty of assessing the prevalence of problem gambling and the incidence of gambling derived harms, gambling expenditure (i.e., the losses of those gambling) is often used in gambling research as a proxy indicator of harm. This study examines the relationship between socioeconomic disadvantage (measured by the Australian Bureau of Statistics SEIFA Index of Relative Socioeconomic Disadvantage [IRSD]), and EGM losses at the suburban level across a major Australian city. It develops a predictive spatial model of gambling vulnerability and presents the output visually. The findings reveal increasing levels of loss as disadvantage increases across IRSD quintiles. The highest mean annual EGM losses of

What is the evidence for harm minimisation measures in gambling venues

849 per adult (95% CI

Recent increase in detection of alprazolam in Victorian heroin-related deaths.

AU749–963) occurred in areas classified in IRSD Quintile 1, the most disadvantaged areas; in the least disadvantaged areas, mean annual losses were

Analysis of EGM licensing decisions by the gambling regulator, Victoria, Australia

298 per adult (CI

Responsible gambling codes of conduct: lack of harm minimisation intervention in the context of venue self-regulation

260 –

On gambling research, social science, and the consequences of commercial gambling

342). The density of EGMs confounds the relationship between losses and disadvantage. In this model, 40% of the apparent effect of disadvantage is explained by the density of EGMs. The vulnerability surface reflects socioeconomic patterns across Melbourne. EGM vulnerability is clustered (Morans Index 0.52; p < 0.001). High levels of EGM density in disadvantaged areas are contributing to a disproportionate share of EGM losses in already disadvantaged neighbourhoods. Regulation of EGMs could be improved to better protect vulnerable neighbourhoods from EGM harm.

Systematic postmarketing surveillance needed for misused psychoactive pharmaceutical drugs

The use of electronic gambling machines (EGMs) in Australia and New Zealand constitutes the largest sector of the gambling industry....

House edge: hold percentage and the cost of EGM gambling

Objectives: To examine the rate of detection of alprazolam among cases of heroin‐related death (HRD) in Victoria, including the relationship between alprazolam supply and HRDs.

Prescription opioid deaths: we need to treat sick populations, not just sick individuals

Abstract Gambling expansion is commonly justified in public discourse by claims of community benefit, increased employment and capital investment. Compared to other jurisdictions, the Electronic Gambling Machine (EGM) license process in Victoria, Australia, is relatively transparent and amenable to analysis. This article describes research that assessed factors relevant to EGM license decisions made by Victoria’s gambling regulator between 2007 and 2014. During the period under review, the regulator granted 144 of 154 applications, finding that approving these applications would not be detrimental to relevant communities. Most commonly cited factors supporting approvals were commitments to undertake capital works, contribute to community purposes and increase employment. The regulator overwhelmingly agreed that supportive factors would balance harms, such as problem gambling, high levels of expenditure or socio-economic disadvantage. This research demonstrates the difficulty of balancing apparently quantifiable benefits against less readily measurable gambling-related harms in regulatory decision-making. The study found that harms were poorly conceived and understood inadequately and supportive factors frequently overstated. This process may lead to unnecessarily high levels of community harm, contradicting the purposes of the relevant legislation. The article suggests that better, more consistently applied principles are required to ensure the more rigorous scrutiny of supportive factors and improved understanding of gambling harms.