Rachel Sutherland

A systematic review of methamphetamine precursor regulations

AIMS To assess the effectiveness of methamphetamine precursor regulations in reducing illicit methamphetamine supply and use. METHODS A systematic review of 12 databases was used to identify studies that had evaluated the impact of methamphetamine precursor regulations on methamphetamine supply and/or use. The guidelines of the Effective Practice and Organization of Care Group (EPOC) of The Cochrane Collaboration were used to determine which study designs were included and assess their quality. RESULTS Ten studies met the inclusion criteria. These studies evaluated 15 interventions (13 regulations and two related interdiction efforts), all of which were located in North America. Interventions had consistent impacts across various indicators of methamphetamine supply and use. Seven of the 15 interventions produced reductions in methamphetamine indicators (ranging from 12% to 77%). Two of the largest impacts were seen following interdiction efforts, involving the closure of rogue pharmaceutical companies. There was no evidence of a shift into other types of drug use, or injecting use, although the impact on the synthetic drug market was not examined. Null effects were related largely to the existence of alternative sources of precursor chemicals or the availability of imported methamphetamine. CONCLUSIONS Methamphetamine precursor regulations can reduce indicators of methamphetamine supply and use. Further research is needed to determine whether regulations can be effective outside North America, particularly in developing countries, and what impact they have on the broader synthetic drug market. Improved data on precursor diversion are needed to facilitate the evaluation of precursor regulations.

Examining the opinions of people who use drugs towards drug policy in Australia

Aims: This study aimed to investigate whether there is heterogeneity of opinion about drug policies amongst people with different experiences of drug use, so as to stimulate discussion about how the diverse perspectives of people who use drugs can be meaningfully included in policy deliberation. Methods: The views of people who inject drugs were compared with the views of people who regularly use 3,4-methylendioxymethamphetamine (MDMA), using data obtained from two Australian surveys (the Ecstasy and Related Drugs Reporting System and the Illicit Drug Reporting System). Support for drug-related policies (including treatment, harm reduction and drug legalisation) was examined using questions from the National Drug Strategy Household Survey. The extent to which demographic variables and/or drug use experience accounted for differences of opinion amongst the two samples was also explored. Findings: There were significant differences between the views of IDRS and EDRS participants, about legalisation, and a range of harm reduction and treatment interventions. The heterogeneity in support for the legalisation of different drugs could be accounted for by recent experience of use, over and above demographic differences between people who inject drugs and people who regularly use MDMA. Conclusions: These findings speak to the diversity of attitudes and experiences amongst people who use drugs, and reinforce the need to better represent a diversity of opinion in drug policy deliberation and challenge stereotypical perceptions which stigmatise people who use drugs.

Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia

INTRODUCTION AND AIMS The purpose of this study was to document treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program (STP) in Australia. DESIGN AND METHODS Clients attending the STP for methamphetamine use (n = 105) were assessed on entry to the service and at 3 (n = 86) and 6 months (n = 83) after starting treatment. At each interview methamphetamine use (days of use, severity of dependence), other drug use and health and social functioning (HIV risk behaviour, crime, disability, psychotic symptoms and hostility) were assessed for the past month. RESULTS Participants received a median of six counselling sessions (interquartile range 1-11) over a period of 89 days (interquartile range 41-148 days). Past month methamphetamine use fell from 79% at treatment entry to 53% at the 3-month follow-up (P < 0.001) and 55% at the 6-month follow-up (P < 0.001). There were statistically significant reductions in psychotic symptoms, hostility and disability associated with poor mental health. There was no change in other drug use, crime or HIV risk behaviour. Reductions in methamphetamine were more common among younger participants, those who had no history of drug treatment and those without concurrent heroin use. DISCUSSION AND CONCLUSIONS Methamphetamine users entering the STP showed reductions in methamphetamine use and improvements in their mental health after treatment. Improved treatment responses are needed to address polydrug use and other harms within in this population.

I like the old stuff better than the new stuff? Subjective experiences of new psychoactive substances

BACKGROUND Over the past decade, monitoring systems have identified the rapid emergence of new psychoactive substances (NPS). While the use of many NPS is minimal and transitory, little is known about which products have potential for capturing the attention of significant proportions of the drug consuming market. The aim of this study was to explore self-reported experiences of three commonly used NPS classes within the Australian context (synthetic cathinones, hallucinogenic phenethylamines and hallucinogenic tryptamines) relative to traditional illicit drug counterparts. METHODS Frequent psychostimulant consumers interviewed for the Australian Ecstasy and related Drugs Reporting System (EDRS) (n=1208) provided subjective ratings of the pleasurable and negative (acute and longer-term) effects of substances used in the last six months on the last occasion of use, and the likelihood of future use. RESULTS Stimulant-type NPS (e.g., mephedrone, methylone) were rated less favourably than ecstasy and cocaine in terms of pleasurable effects and likelihood of future use. DMT (a hallucinogenic tryptamine) showed a similar profile to LSD in terms of pleasurable effects and the likelihood of future use, but negative effects (acute and comedown) were rated lower. Hallucinogenic phenethylamines (e.g., 2C-B) showed a similar negative profile to LSD, but were rated as less pleasurable and less likely to be used again. CONCLUSION The potential for expanded use of stimulant-type NPS may be lower compared to commonly used stimulants such as ecstasy and cocaine. In contrast, the potential of DMT may be higher relative to LSD given the comparative absence of negative effects.

New psychoactive substances: Purchasing and supply patterns in Australia

To examine the purchasing and supply patterns of new psychoactive substance (NPS) consumers in Australia.

Motivations, substance use and other correlates amongst property and violent offenders who regularly inject drugs.

OBJECTIVE To examine the prevalence, correlates and motivations for the commission of property and violent crime amongst a sample of people who inject drugs (PWID). METHOD Data were obtained from the 2013 Illicit Drug Reporting System (IDRS), which includes a cross-sectional sample of 887 PWID. RESULTS Eighteen percent of PWID had committed a property offence and 3% had committed a violent offence in the month preceding interview. Opioid dependence (AOR 2.57, 95% CI 1.29-5.10) and age (AOR 0.96, 95% CI 0.93-0.99) were found to be the strongest correlates of property crime. The majority of property offenders (75%) attributed their offending to financial reasons, however those under the influence of benzodiazepines were proportionately more likely to nominate opportunistic reasons as the main motivation for their last offence. Stimulant dependence (AOR 5.34, 95% CI 1.91-14.93) was the only significant correlate of past month violent crime, and the largest proportion of violent offenders (47%) attributed their offending to opportunistic reasons. The majority of both property (71%) and violent offenders (73%) reported being under the influence of drugs the last time they committed an offence; the largest proportion of property offenders reported being under the influence of benzodiazepines (29%) and methamphetamine (24%), whilst violent offenders mostly reported being under the influence of heroin and alcohol (32% respectively). CONCLUSION Criminal motivations, substance use and other correlates vary considerably across crime types. This suggests that crime prevention and intervention strategies need to be tailored according to individual crime types, and should take into account self-reported criminal motivations, as well as specific risk factors that have been shown to increase the likelihood of offending.

“Just Doing a Favor for a Friend”: The Social Supply of Ecstasy Through Friendship Networks

The current project focused on the “not for profit” supply of illicit drugs within social networks. The aims of the study were to (a) explore the characteristics of social supply of ecstasy and the typical ways in which social dealing occurs, and (b) explore the benefits of social supply as perceived by those who engage in social supply. Overall, the results suggest that social supply of ecstasy occurs in dense, closely knit friendship networks and that mutual supply may be common. Users within friendship networks source ecstasy independently and concurrently supply to members of the group to ensure consistent supply of quality product and to minimize risks of health harms and criminal justice consequences. Social dealing produces little or no financial profit, yet the majority of participants in this study purchased ecstasy in amounts that expose them to significant criminal justice penalties.

Co-ingestion of energy drinks with alcohol and other substances among a sample of people who regularly use ecstasy

INTRODUCTION AND AIMS Despite the potential harms of mixing unregulated drugs with energy drinks (ED), research to date has primarily been focused on EDs co-ingested with alcohol. Consequently, the aim of the present study was to explore the rate of use, harms and correlates of EDs co-ingested with alcohol and other drugs among a sample of people who regularly use illicit stimulant drugs. DESIGN AND METHODS In 2010, 693 Australians who regularly used ecstasy completed a 1-h interview about their past six-month ED and drug use. RESULTS Three-quarters of the sample (77%) had recently consumed EDs with other substances, primarily alcohol (70%) and ecstasy (57%). People who consumed ED with alcohol versus those who had consumed ED with ecstasy and with alcohol (only 8% reported only consuming ED with ecstasy) had similar profiles in regards to demographics, drug use, mental health and drug-related problems. Primary motives for consuming ED with alcohol included increased alertness (59%), the taste (25%), to party for longer (23%) and to combat fatigue (16%). One-half (52%) and one-quarter (27%) of participants who consumed EDs with alcohol and with ecstasy respectively had recently experienced adverse outcomes post-consumption, primarily headaches (24% and 11%) and heart palpitations (21% and 14%). DISCUSSION AND CONCLUSIONS Co-ingestion of EDs with licit and illicit drugs is common among people who regularly use ecstasy and related drugs. Adverse outcomes of co-ingestion suggest that targeted education regarding negative interactive drug effects is crucial for harm reduction. [Peacock A, Sindicich N, Dunn M, Whittaker E, Sutherland R, Entwistle G, Burns L, Bruno R. Co-Ingestion of Energy Drinks with Alcohol and Other Substances among a Sample of People Who Regularly Use Ecstasy. Drug Alcohol Rev 2016;35:352-358].

Tobacco and e-cigarette use amongst illicit drug users in Australia

OBJECTIVE To examine the rates and patterns of tobacco and e-cigarette use amongst two samples of illicit drug users in Australia. METHOD Data were obtained from the 2015 Illicit Drug Reporting System (IDRS) and the 2015 Ecstasy and Related Drugs Reporting System (EDRS). These studies comprised cross-sectional samples of 888 people who inject drugs (PWID) and 763 regular psychostimulant users (RPU). RESULTS Tobacco was consumed by the majority of both samples, however, use in the 6 months preceding interview was significantly higher amongst PWID (92.2%) than RPU (82.4% [OR 2.53 95% CI 1.86-3.44]). Inversely, PWID were less likely to have a history of e-cigarette use: 31.5% of PWID reported lifetime use of e-cigarettes (vs. 57.0% of RPU [OR 0.35 95% CI 0.28-0.42]) and 18.1% reported use in the 6 months preceding interview (vs. 33.7% of RPU [OR 0.44 95% CI 0.35-0.55]). PWID were more than three times as likely than RPU to report using e-cigarettes as a smoking cessation tool (OR 3.09 95% CI 2.03-4.71), but were less likely to use e-liquids that contained nicotine (OR 0.52 95% CI 0.32-0.83). Higher levels of poly drug use, daily tobacco use, recent use of synthetic cannabinoids and employment status were found to be significantly associated with e-cigarette use. CONCLUSION The use of e-cigarettes was relatively common amongst Australian samples of PWID and RPU. Whilst the majority of PWID reported using e-cigarettes as a smoking cessation tool, it appears that RPU are using them for experimental or recreational purposes.

Typology of new psychoactive substance use among the general Australian population

AIM The aim of this study was to examine the typology of Australian illicit drug consumers to determine whether those who use new psychoactive substances (NPS) differ from those using other illicit substances. METHODS Data were from the 2013 National Drug Strategy Household Survey, a representative population study; analyses were limited to participants reporting past year illicit drug use (including NPS; n = 3309). Latent class analysis identified groups based on past year substance use, and a weighted multivariable, multinomial regression model was used to examine characteristics associated with group membership. RESULTS Six consumer typologies were identified: cannabis consumers (46%), pharmaceutical consumers (21%), ecstasy and cocaine consumers (19%), amphetamine and cannabis consumers (7%), polysubstance consumers (6%), and inhalant consumers (2%). Sixteen participants (total sample: 0.07%; NPS consumers: 5.7%) reported exclusive NPS use. Synthetic cannabinoid receptor agonist use was highest among amphetamine and cannabis consumers and polysubstance consumers; other NPS use was highest among polysubstance consumers. Polysubstance consumers were younger than all other groups, and more likely to engage in dangerous activities while under the influence of substances, inject drugs and report hazardous alcohol consumption. Amphetamine and cannabis consumers were more likely to report trouble ceasing their drug use. CONCLUSION We found no distinct profile of NPS-only consumers; however, NPS use was a marker for more problematic patterns of use. Our findings suggest that specialised NPS interventions or harm reduction messages may not be required in the Australian context; rather, they could be based upon existing responses to drug use.