Lucinda Burns

Neonatal Abstinence Syndrome and High School Performance

BACKGROUND AND OBJECTIVES: Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal abstinence syndrome (NAS) (International Statistical Classification of Disease and Related Problems [10th Edition], Australian Modification, P96.1). METHODS: Linked analysis of health and curriculum-based test data for all children born in the state of New South Wales (NSW), Australia, between 2000 and 2006. Children with NAS (n = 2234) were compared with a control group matched for gestation, socioeconomic status, and gender (n = 4330, control) and with other NSW children (n = 598 265, population) for results on the National Assessment Program: Literacy and Numeracy, in grades 3, 5, and 7. RESULTS: Mean test scores (range 0–1000) for children with NAS were significantly lower in grade 3 (359 vs control: 410 vs population: 421). The deficit was progressive. By grade 7, children with NAS scored lower than other children in grade 5. The risk of not meeting minimum standards was independently associated with NAS (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 2.2–2.7), indigenous status (aOR, 2.2; 95% CI, 2.2–2.3), male gender (aOR, 1.3; 95% CI, 1.3–1.4), and low parental education (aOR, 1.5; 95% CI, 1.1–1.6), with all Ps < .001. CONCLUSIONS: A neonatal diagnostic code of NAS is strongly associated with poor and deteriorating school performance. Parental education may decrease the risk of failure. Children with NAS and their families must be identified early and provided with support to minimize the consequences of poor educational outcomes.

Consensus diagnostic criteria for fetal alcohol spectrum disorders in Australia: A modified Delphi study

Objective To evaluate health professionals agreement with components of published diagnostic criteria for fetal alcohol spectrum disorders (FASD) in order to guide the development of standard diagnostic guidelines for Australia. Design A modified Delphi process was used to assess agreement among health professionals with expertise or experience in FASD screening or diagnosis. An online survey, which included 36 Likert statements on diagnostic methods, was administered over two survey rounds. For fetal alcohol syndrome (FAS), health professionals were presented with concepts from the Institute of Medicine (IOM), University of Washington (UW), Centers for Disease Control (CDC), revised IOM and Canadian diagnostic criteria. For partial FAS (PFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD), concepts based on the IOM and the Canadian diagnostic criteria were compared. Setting/participants 130 Australian and 9 international health professionals. Results Of 139 health professionals invited to complete the survey, 103 (74.1%) responded, and 74 (53.2%) completed one or more questions on diagnostic criteria. We found consensus agreement among participants on the diagnostic criteria for FAS, with the UW criteria most commonly endorsed when compared with all other published criteria for FAS. When health professionals were presented with concepts based on the Canadian and IOM diagnostic criteria, we found consensus agreement but no clear preference for either the Canadian or IOM criteria for the diagnosis of PFAS, and no consensus agreement on diagnostic criteria for ARND. We also found no consensus on the IOM diagnostic criteria for ARBD. Conclusions Participants indicated clear support for use of the UW diagnostic criteria for FAS in Australia. These findings should be used to develop guidelines to facilitate improved awareness of, and address identified gaps in the infrastructure for, FASD diagnosis in Australia.

Drug testing in sport: The attitudes and experiences of elite athletes

BACKGROUNDnThis study aimed to investigate, among a sample of elite Australian athletes, the extent to which this group supports drug testing as a deterrent to drug use.nnnMETHODnData was collected from a convenience sample of (n=974) elite Australian athletes who self-completed a questionnaire, and semi-structured telephone surveys with key experts.nnnRESULTSnThe athletes surveyed endorsed testing for banned substances as an effective way of deterring drug use; believed that the current punishments for being caught using a banned substance was of the appropriate severity; and indicated that there should be separate policies regarding illicit drug (ID) and performance-enhancing drug (PED) use.nnnCONCLUSIONnA large proportion of elite athletes in Australia endorse drug testing as an effective means of deterring drug use. They perceive a difference between being detected using a PED and an ID and believe that penalties should reflect this difference. Future research may wish to investigate attitudes towards newer methods employed to detection drug use.

Who sells what? Country specific differences in substance availability on the Agora cryptomarket

BACKGROUNDnTo date monitoring of cryptomarkets operating on the dark net has largely focused on market size and substance availability. Less is known of country specific differences in these indicators and how they may corroborate population prevalence estimates for substance use in different countries.nnnMETHODSnAll substance listings from the cryptomarket Agora were recorded over seven time points throughout February and March 2015. Agora was chosen due to its size as the second largest cryptomarket operating and the level of detail of information provided in individual substance listings. Data were collated and the number of unique sellers selling each substance by country of origin was analysed.nnnRESULTSnAn average of 14,456.7 substance listings were identified across sampled days from 868.7 unique sellers. The top five countries by number of listings were the USA, United Kingdom, Australia, China and the Netherlands, collectively accounting for 61.8% of all identified listings and 68% of all unique sellers. Australia was over represented in terms of sellers per capita, while China was over represented in new psychoactive substance (NPS) listings. When examined by number of listings per seller, the Netherlands and China stood out as particularly large, likely due to these countries role in the local production of various illicit and new psychoactive substances.nnnCONCLUSIONSnNumbers of sellers by country of origin appear to be influenced by several factors. Australias overrepresentation in sellers per capita may indicate its relative geographical isolation and the potential for profit margins from selling online, while Chinas overrepresentation in NPS listings may reflect domestic production of these substances. Continued monitoring will provide enhanced understanding of the increasingly complex and globalised nature of illicit drug markets.

Crystalline methamphetamine use and methamphetamine-related harms in Australia

INTRODUCTION AND AIMSnConcerns about crystal methamphetamine use and harm have increased in multiple countries. This paper describes how changes in the availability and use of crystal methamphetamine have impacted on methamphetamine-related harms in Australia.nnnDESIGN AND METHODSnData on methamphetamine use were obtained from population-level surveys, health service data and surveys of drug use among sentinel groups of ecstasy users and people who inject drugs. Data were obtained on seizures, arrests, clandestine laboratory detections, hospital separations, mental health unit admissions, drug telephone helpline calls and drug treatment episodes. Segmented linear regression models were fitted to identify changes in these series using log-transformed data where appropriate.nnnRESULTSnThe availability of crystal methamphetamine has increased as evidenced by increased laboratory detections, domestic seizures and purity of the seized drug. Population surveys do not report an increase in the number of people who used at least once in the past year. However, more users report using crystal methamphetamine rather than lower-purity powder methamphetamine and more regular use. Indicators of methamphetamine-related harms have increased in parallel with this change. Amphetamine-related helpline calls, drug treatment, arrests and hospital admissions for amphetamine disorders and psychosis all peaked in the mid-2000s, declined for several years and have increased steeply since 2010.nnnDISCUSSION AND CONCLUSIONSnThe increased availability and use of crystal methamphetamine have been associated with increased regular use and harms. Treatment is required for those experiencing problems and the capacity of health services to provide care needs to be enhanced.[Degenhardt L, Sara G, Connor JP, McKetin R, Roxburgh A, Dobbins T, Farrell M, Burns L, Hall WD. Crystalline methamphetamine use and methamphetamine-related harms in Australia. Drug Alcohol Rev 2017;36:160-170].

Opioid substitution therapy as a strategy to reduce deaths in prison: retrospective cohort study

Objectives To describe deaths in prison among opioid-dependent people, and examine associations between receipt of opioid substitution therapy (OST) and risk of death in prison. Design Retrospective cohort study. Setting Adult prisons in New South Wales (NSW), Australia. Participants 16u2005715 opioid-dependent people who were received to prison between 2000 and 2012. Interventions Opioid substitution therapy. Primary outcome measures Natural and unnatural (suicide, drug-induced, violent and other injury) deaths in prison. Results Cohort members were in prison for 30u2005998 person-years (PY), during which time there were 51 deaths. The all-cause crude mortality rate (CMR) in prison was 1.6/1000 PY (95% CI 1.2 to 2.2/1000 PY), and the unnatural death CMR was 1.1/1000 PY (95% CI 0.8 to 1.6/1000 PY). Compared to time out of OST, the hazard of all-cause death was 74% lower while in OST (adjusted HR (AHR): 0.26; 95% CI 0.13 to 0.50), and the hazard of unnatural death was 87% lower while in OST (AHR: 0.13; 95% CI 0.05 to 0.35). The all-cause and unnatural death CMRs during the first 4u2005weeks of incarceration were 6.6/1000 PY (95% CI 3.8 to 10.6/1000 PY) and 5.5/1000 PY (95% CI 2.9 to 9.4/1000 PY), respectively. Compared to periods not in OST, the hazard of all-cause death during the first 4u2005weeks of incarceration was 94% lower while in OST (AHR: 0.06; 95% CI 0.01 to 0.48), and the hazard of unnatural death was 93% lower while in OST (AHR: 0.07; 95% CI 0.01 to 0.53). Conclusions Mortality of opioid-dependent prisoners was significantly lower while in receipt of OST.

Characterising dark net marketplace purchasers in a sample of regular psychostimulant users

BACKGROUNDnThe past five years has seen a proliferation in marketplaces operating on the dark net selling licit and illicit substances. While monitoring systems have investigated the specific substances for sale on these marketplaces, less is known about consumer motivations for accessing these marketplaces and factors associated with their use.nnnMETHODSnAn Australian national sample (n=800) recruited on the basis of regular psychostimulant use was recruited and asked about purchasing substances from dark net marketplaces and the reasons for doing so. Respondents who had purchased any drug from a dark net marketplace in the preceding year were compared to those who had not in terms of demographic information and factors including drug use, criminal activity, and sexual and mental health.nnnRESULTSnNine percent (n=68) of the sample had purchased from dark net markets in the past year. MDMA, LSD and cannabis were the three most commonly purchased substances, and the main benefits cited for purchasing online were the better quality and lower cost of drugs available. Controlling for other factors, participants who purchased from dark net marketplaces in the past year tended to be younger, more likely to be involved in recent property crime and to have used more classes of drugs in the preceding six months, specifically psychedelics and new psychoactive drugs.nnnCONCLUSIONSnThough a small minority of participants reported having purchased drugs online in the preceding six months, these appeared to be a more entrenched group of consumers, with more diverse substance use and rates of criminal activity. For consumers in the current sample reporting recent dark net usage, country borders are now less of a significant barrier to purchase and there is a wider range of substances available than ever before.

Trends and characteristics of accidental and intentional codeine overdose deaths in Australia

Objectives: To examine trends in codeine‐related mortality rates in Australia, and the clinical and toxicological characteristics of codeine‐related deaths.

New psychoactive substance use among regular psychostimulant users in Australia, 2010–2015

OBJECTIVEnTo examine the rates and patterns of new psychoactive substance (NPS) use amongst regular psychostimulant users (RPU) in Australia.nnnMETHODnData were obtained from the 2010-2015 Ecstasy and related Drugs Reporting System (EDRS), which comprised a total cross-sectional sample of 4122RPU.nnnRESULTSnRecent use of any NPS increased from 33% in 2010 to 40% in 2015, although trends of use differed significantly across NPS classes. The correlates associated with NPS use also varied across NPS classes: frequent (i.e. weekly or more) ecstasy users were more likely to report recent phenethylamine use; LSD users were more likely to report recent phenethylamine and tryptamine use; and daily cannabis users were more likely to report recent synthetic cannabinoid use than RPU who had not used NPS. Poly NPS consumers were found to be a particularly high risk group and were significantly more likely to be younger, male, report daily cannabis use, report weekly or more ecstasy use, report recent LSD use, have higher levels of poly drug use, have overdosed on any drug in the past year, and to have engaged in past month criminal activity.nnnCONCLUSIONnNPS use has been established as a significant and ongoing practice amongst our sample of RPU. It appears that RPU seek out NPS with similar properties to the illicit drugs that they are already consuming, with poly NPS consumers found to be a particularly high risk group.

Elite athletes' estimates of the prevalence of illicit drug use: evidence for the false consensus effect.

INTRODUCTION AND AIMSnThe false consensus effect (FCE) is the tendency for people to assume that others share their attitudes and behaviours to a greater extent than they actually do. The FCE has been demonstrated for a range of health behaviours, including substance use. The study aimed to explore the relationship between elite athletes engagement in recreational drug use and their consensus estimates (the FCE) and to determine whether those who engage in the behaviour overestimate the use of others around them.nnnDESIGN AND METHODnThe FCE was investigated among 974 elite Australian athletes who were classified according to their drug use history.nnnRESULTSnParticipants tended to report that there was a higher prevalence of drug use among athletes in general compared with athletes in their sport, and these estimates appeared to be influenced by participants drug use history. While overestimation of drug use by participants was not common, this overestimation also appeared to be influenced by athletes drug use history.nnnDISCUSSION AND CONCLUSIONSnThe results suggest that athletes who have a history of illicit drug use overestimate the prevalence of drug use among athletes. These findings may be helpful in the formulation of normative education initiatives.