Brendan Quinn

'Wide-awake drunkenness'? Investigating the association between alcohol intoxication and stimulant use in the night-time economy

AIMS We tested whether patrons of the night-time economy who had co-consumed energy drinks or illicit stimulants with alcohol had higher blood alcohol concentration (BAC) levels than patrons who had consumed only alcohol. DESIGN Street intercept surveys (n = 4227) were undertaken between 9 p.m. and 5 a.m. over a period of 7 months. SETTING Interviews were undertaken with patrons walking through entertainment precincts, queuing to enter venues or exiting venues in five Australian cities. PARTICIPANTS The response rate was 92.1%; more than half the study sample was male (60.2%) and the median age was 23 years (range 18-72). MEASUREMENTS Data were collected on demographics, length of drinking session, venue types visited, types and quantity of alcohol consumed and other substance use. A BAC reading was recorded and a subsample of participants was tested for other drug use. FINDINGS Compared with the total sample (0.068%), illicit stimulant consumers (0.080%; P = 0.004) and energy drink consumers (0.074%; P < 0.001) had a significantly higher median BAC reading, and were more likely to engage in pre-drinking (65.6, 82.1 and 77.6%, respectively, P < 0.001) and longer drinking sessions (4, 5 and 4.5 hours, respectively, P < 0.001). However, stimulant use was not associated independently with higher BAC in the final multivariable model (illicit stimulants P = 0.198; energy drinks P = 0.112). Interaction analyses showed that stimulant users had a higher BAC in the initial stages of the drinking session, but not after 4-6 hours. CONCLUSIONS While stimulant use does not predict BAC in and of itself, stimulants users are more likely to engage in prolonged sessions of heavy alcohol consumption and a range of risk-taking behaviours on a night out, which may explain higher levels of BAC among stimulants users, at least in the initial stages of the drinking session.

The epidemiology of ecstasy use and harms in Australia

Aims:This paper examines the epidemiology of ecstasy use and harm in Australia using multiple data sources. Design: The data included (1) Australian Customs Service 3,4-methylenedioxymethamphetamine (MDMA) detections; (2) the National Drug Strategy Household and Australian Secondary Student Alcohol and Drug Surveys; (3) data from Australia’s ecstasy and Related Drugs Reporting System; (4) the number of recorded police incidents for ecstasy possession and distribution collated by the N.S.W. Bureau of Crime Statistics and Research; (5) the number of calls to the Alcohol and Drug Information Service and Family Drug Support relating to ecstasy; (6) the Alcohol and Other Drug Treatment Services National Minimum Dataset on number of treatment episodes for ecstasy, and (7) N.S.W. Division of Analytical Laboratories toxicology data on number of deaths where MDMA was detected. Findings: Recent ecstasy use among adults in the general population has increased, whereas among secondary students it has remained low and stable. The patterns of ecstasy consumption among regular ecstasy users have changed over time. Polydrug use and use for extended periods of time (>48 h) remain common among this group. Frequent ecstasy use is associated with a range of risk behaviours and other problems, which tend to be attributed to a number of drugs along with ecstasy. Few ecstasy users present for treatment for problems related to their ecstasy consumption. Conclusions: Messages and interventions to reduce the risks associated with polydrug use and patterns of extended periods of use are clearly warranted. These messages should be delivered outside of traditional health care settings, as few of these users are engaged with such services.

Methamphetamine use in Melbourne, Australia: baseline characteristics of a prospective methamphetamine-using cohort and correlates of methamphetamine dependence

Methamphetamine use is associated with numerous harms and consequently represents a significant impact on Australia’s treatment and health service sectors. This article presents baseline findings from the first cohort study of regular methamphetamine users conducted in Melbourne, describing associations between participant characteristics and behaviours and methamphetamine dependence. A total of 255 Melbourne-based, regular methamphetamine users were recruited during 2010 and administered a structured questionnaire. Most were male and Australian-born with a median age of 30 years. Sixty percent of the participants were classified as methamphetamine dependent using the Severity of Dependence Scale. The socio-demographic characteristics of these participants were generally comparable to non-methamphetamine-dependent participants; however, methamphetamine dependence was independently associated with experience of high levels of psychological distress during the previous month, current use of prescribed mental health medication and primarily injecting methamphetamine over other routes of administration. Polysubstance use was universal; many participants also reported recent use of cannabis and heroin. Despite the fundamentally different recruitment criteria, the socio-demographic characteristics of the community-recruited baseline sample reflect those of methamphetamine-using samples recruited in other Australian jurisdictions since the mid-1990s. This study provides important up-to-date data on methamphetamine use in Melbourne and is an important basis for understanding any future changes to patterns of methamphetamine use in this region.

A comparative study of blood alcohol concentrations in Australian night-time entertainment districts

INTRODUCTION AND AIMS There is little research describing how intoxication levels change throughout the night in entertainment districts. This research aims to describe levels of alcohol intoxication across multiple Australian metropolitan and regional nightlife districts. DESIGN AND METHODS This study was conducted in the night-time entertainment districts of three metropolitan cities (Sydney, Melbourne and Perth) and two regional cities (Wollongong and Geelong) in Australia. Data collection occurred approximately fortnightly in each city on a Friday or Saturday night between 8 pm and 5 am. Brief structured interviews (3-10 min) and breathalyser tests were undertaken in busy thoroughfares over six months. RESULTS Of the 7037 individuals approached to participate in the study, 6998 [61.8% male, mean age 24.89 years (standard deviation 6.37; range 18-73)] agreed to be interviewed. There was a linear increase in blood alcohol concentration (BAC) levels throughout the night. Post hoc testing revealed significantly more highly intoxicated participants (i.e. BAC above 0.10 mg of alcohol per 100 mL of blood) after midnight (P < 0.05). The overall mean BAC was 0.06 mg/100 mL. Men were more intoxicated than women earlier in the night, but gender differences disappeared by 3 am. There was no age differences in intoxication earlier in the night, but after midnight, patrons over the age of 21 showed increasing BAC levels. DISCUSSION AND CONCLUSIONS There is a consistent trend across the cities of high to very high levels of intoxication later in the night, with trends after midnight being significantly different to those before.

Factors associated with initiating someone into illicit drug injection

AIMS Most people who inject drugs (PWID) were first initiated into injection by a current PWID. Few studies have examined PWID who assist others into drug injection. Our goal is to describe the prevalence of and risk factors for initiating someone into injection in the last 12 months. METHODS We recruited a cross-sectional sample of PWID (N=605) in California from 2011 to 2013. We examined bivariate and multivariate risk factors for initiating someone into injection with a focus on behaviors that might encourage injection initiation such as injecting in front of non-PWID, describing how to inject to non-PWID, and willingness to initiate someone into drug injection. RESULTS Having initiated someone into injection was reported by 34% of PWID overall and 7% in the last 12 months. Forty-four PWID had assisted 431 people into injection in the past year. Factors independently associated with initiating someone into injection in the last 12 months were self-reported likelihood of initiating someone in the future (Adjusted Odds Ratio [AOR]=7.09; 95% Confidence Interval [CI]=3.40, 14.79), having injected another PWID in past month (AOR=4.05; 95% confidence interval [CI]=1.94, 8.47), having described how to inject to non-injectors (2.61; 95% CI=1.19, 5.71), and non-injection powder cocaine use in past month (AOR=4.97; 95% CI=2.08, 11.84) while controlling for study site. CONCLUSION Active PWID are important in facilitating the process of drug injection uptake. Interventions to reduce initiation should include efforts to change behaviors and intentions among PWID that are associated with injection uptake among others.

Global policy and access to new hepatitis C therapies for people who inject drugs

People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV). This review outlines policy recommendations made in the 2014 World Health Organisation (WHO) Guidelines on Screening, Care and Treatment of HCV and their relevance to PWID. It also canvasses issues that will affect translation of these global guidelines into practice. The first global HCV guidelines released by WHO have recently advocated targeted HCV testing for PWID, assessment of liver disease and support for alcohol reduction during care. They also strongly advocate treatment using currently licensed direct-acting antiviral agents for all individuals, in particular PWID as a key affected population. New HCV treatment regimens have the potential to cure more than 90% of treated individuals. Scaling-up treatment among PWID has the potential to improve individual and population health by reducing HCV transmission, improving quality of life and supporting behaviour modifications that lead to less risk-taking over time. PWID face several barriers to accessing HCV care and treatment that need to be overcome. Testing services need re-orientation toward PWID, individuals need to be informed of their results and provided with direct linkage to ongoing care. Health services need to provide care in the community using simpler, cheaper and more accessible modes of delivery. Healthcare costs and pharmaceutical costs need to be minimised so PWID, who are highly marginalised, can access HCV treatment. Sustained scale-up of treatment for PWID could simultaneously improve individual health and achieve the goal of eliminating HCV transmission among this high-risk and vulnerable group.

Factors associated with professional support access among a prospective cohort of methamphetamine users

Encouraging out-of-treatment methamphetamine users who engage in problematic use patterns to initiate access of drug treatment and other health and support services is a key focus of drug policy. We followed a community-recruited cohort (N = 255) of regular methamphetamine users in Melbourne, Australia, to investigate patterns of engagement with professional support for methamphetamine use and/or associated harms over 12 months. Multivariate logistic regression identified factors independently associated with initiating contact with services during follow-up. Generalised estimating equations identified factors associated with current (at the time of interview) service access. General practitioners were the most common source of professional support during follow-up (24%). Overall, service utilisation was associated with riskier methamphetamine use patterns (e.g., injecting), professional support access for other issues (e.g., mental health), and greater experience of methamphetamine-related harms (e.g., adverse social consequences). These findings provide insights to inform strategies that will improve treatment initiation and retention by methamphetamine users.

Factors associated with being asked to initiate someone into injection drug use

AIMS Injection drug use initiation typically involves an established person who injects drugs (PWID) helping the injection-naïve person to inject. Prior to initiation, PWID may be involved in behaviors that elevate injection initiation risk for non-injectors such as describing how to inject and injecting in front of injection-naïve people. In this analysis, we examine whether PWID who engage in either of these behaviors are more likely to be asked to initiate someone into drug injection. METHODS Interviews with PWID (N = 602) were conducted in California between 2011 and 2013. Multivariate analysis was conducted to determine factors associated with being asked to initiate someone. RESULTS The sample was diverse in terms of age, race/ethnicity, and drug use patterns. Seventy-one percent of the sample had ever been asked to initiate someone. Being asked to initiate someone was associated with having injected in front of non-injectors (Adjusted Odds Ratio [AOR] = 1.80, 95% Confidence Interval [CI] = 1.12, 2.91), having described injection to non-injectors (AOR = 3.63; 95% CI = 2.07, 6.36), and doing both (AOR = 9.56; 95% CI = 4.43, 20.65) as compared to doing neither behavior (referent). Being female (AOR = 1.73; 95% CI = 1.10, 2.73) and non-injection prescription drug misuse in the last 30 days (AOR = 1.69; 95% CI = 1.12, 2.53) were also associated with having been asked to initiate someone. CONCLUSION Reducing initiation into injection drug use is an important public health goal. Intervention development to prevent injection initiation should include established PWID and focus on reducing behaviors associated with requests to initiate injection and reinforcing refusal skills and intentions among established PWID.

'Ice epidemic'? Trends in methamphetamine use from three Victorian surveillance systems

Introduction and Aims: Victorian media have been reporting a widespread ‘ice crisis’. This concern arises predominantly from anecdotal information and data showing increasing rates of methamphetamine-related harms.We triangulate three data sources to investigate whether a possible increase in methamphetaminerelated harms has been driven by an actual increase in methamphetamine (speed powder/ice/crystal) use. Design and Methods: We analysed three, annual, cross-sectional Melbourne-based drug monitoring systems.The Big Day Out (BDO) surveys young people at a music festival. The Ecstasy and Related Drugs Reporting System (EDRS) targets regular psychostimulant users. The Illicit Drug Reporting System (IDRS) interviews people who inject drugs.Trends in prevalence were assessed using Chi test for trend. Trends in frequency of use were assessed using Poisson regression. Results: The percentages reporting recent methamphetamine use were 8% among BDO attendees (n/N = 825/9582), 75% among EDRS participants (n/N = 452/601) and 65% among IDRS participants (n/N = 587/898). The BDO found a non-linear decrease over time in the percentage recently using methamphetamine. EDRS and IDRS data showed no significant change in prevalence of use, but the EDRS showed an increase in frequency of use between 2008 and 2014 (P < 0.01). Discussion and Conclusions: These samples are not representative of the general population and are not reflective of rural populations. Methamphetamine use prevalence among the three serial cross-sectional samples remained stable from 2008–2013/14. Evidence of increasing use frequency may explain some trends in rising harms. Research that accurately characterises methamphetamine use will allow attention to focus on effectively preventing methamphetamine-related harms. Implications for Practice or Policy: While not wanting to underplay the potential adverse effects of methamphetamine use, it is important that government takes an evidence-based response to this issue. The media, policy makers, and practitioners should be aware that increased harm is not necessarily indicative of increased population-level methamphetamine use.

Syringe disposal among people who inject drugs in Los Angeles: The role of sterile syringe source

BACKGROUND Few recent studies have investigated the prevalence of improperly discarded syringes in community settings by people who inject drugs (PWID). We examined whether syringe source was associated with the act of improper syringe disposal and amount of syringes improperly disposed of among PWID in Los Angeles, California. METHODS A cross-sectional sample of PWID (N=412) was recruited and administered a structured questionnaire between July 2011 and April 2013. Descriptive analyses investigated syringe access and disposal practices among participants. Multivariate logistic regression analysis identified adjusted associations between syringe source (syringe exchange program [SEP] or pharmacy) and improper syringe disposal. RESULTS Most participants were male (69%), homeless (62%) and low-income earners (64%). The majority (87%) of the sample received syringes from a SEP in the past six months, with 26% having received syringes from pharmacies and 36% from unauthorised sources (e.g., friend, drug dealer). Of more than 30,000 used syringes reportedly disposed of by participants during the past 30 days, 17% were disposed of improperly. Two percent of participants disposed of any used syringes at pharmacies, compared to 68% who used SEPs for syringe disposal. Having received sterile syringes from a SEP was independently associated with lower odds of improper syringe disposal; however, purchasing sterile syringes from pharmacies was associated with significantly higher odds of improper syringe disposal. CONCLUSION In a city with both SEPs and pharmacies as syringe source and disposal options for PWID, these findings suggest that while pharmacies are selling syringes, they are not as readily involved in safe syringe disposal. Given limits on SEP availability and the large geographic size of Los Angeles County, augmenting current SEP services and providing other community disposal sites, including pharmacy disposal, processes could reduce improper syringe disposal among PWID in Los Angeles.