Shelley Cogger

Heavy alcohol consumption among marginalised African refugee young people in Melbourne, Australia: motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking

ABSTRACT Objective. Little is known about substance use among resettled refugee populations. This study aimed to describe motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking among marginalised African refugee young people in Melbourne, Australia. Design. Face-to-face interviews were conducted with 16 self-identified African refugees recruited from street-based settings in 2012–2013. Interview transcripts were analysed inductively to identify key themes. Results. Participants gathered in public spaces to consume alcohol on a daily or near-daily basis. Three key motivations for heavy alcohol consumption were identified: drinking to cope with trauma, drinking to cope with boredom and frustration and drinking as a social experience. Participants reported experiencing a range of health and social consequences of their alcohol consumption, including breakdown of family relationships, homelessness, interpersonal violence, contact with the justice system and poor health. Strategies for managing drinking included attending counselling or residential detoxification programmes, self-imposed physical isolation and intentionally committing crime in order to be incarcerated. Conclusion. These findings highlight the urgent need for targeted harm reduction education for African young people who consume alcohol. Given the importance of social relationships within this community, use of peer-based strategies are likely to be particularly effective. Development and implementation of programmes that address the underlying health and psychosocial causes and consequences of heavy alcohol use are also needed.

Longitudinal changes in psychological distress in a cohort of people who inject drugs in Melbourne, Australia

BACKGROUND Previous research into psychological distress among people who inject drugs (PWID) is predominantly cross-sectional; we determined longitudinal predictors of change in psychological distress among a cohort of PWID. METHOD We examined Kessler Psychological Distress Scale (K10) scores from 564 PWID (66% male) enrolled in the Melbourne Injecting Drug User Cohort Study. Gender-stratified linear models with fixed effects for each participant were used to examine correlates of change in individual K10 scores. Further linear regressions of adjusted K10 scores were used to measure correlations between demographic variables. RESULTS Participants reported higher K10 scores (higher psychological distress) than the general Australian population (mean K10 scores 23.4 (95%CI 22.6-24.2) and 14.5 (95%CI 14.3-14.7) respectively). The cohorts mean K10 score did not significantly differ over time, but individual variations were common. Women reported higher K10 scores than men (mean baseline K10 scores 25.2 (95%CI 23.9-26.6) and 22.4 (95%CI 21.5-23.3) respectively), however no significant differences remained after controlling for temporal factors. Key predictors of increases in K10 scores were being the victim of an assault in the past six months (P<0.001 for women and men) and intentionally overdosing in the past 12 months (P=.010 for women and P<0.001 for men). CONCLUSIONS PWID experience higher levels of psychological distress than the general population. Temporal rather than individual factors may account for the higher levels of psychological distress reported among women. Interventions to reduce rates of assault and/or intentional overdose should be explored to reduce high levels of psychological distress among PWID.

Multiply disadvantaged: Health and service utilisation factors faced by homeless injecting drug consumers in Australia

INTRODUCTION AND AIMS Homelessness status is strongly correlated with higher rates of substance use. Few studies, however, examine the complex relationship between housing status and substance use in people who inject drugs (PWID). This study extends previous research by comparing the physical and mental health status and service utilisation rates between stably housed and homeless PWID. DESIGN AND METHODS A cross-sectional sample of 923 PWID were recruited for the 2012 Illicit Drug Reporting System. Multivariate models were generated addressing associations between homelessness and the domains of demographics; substance use; and health status, service utilisation and criminal justice system contact, with significant correlates entered into a final multivariate model. RESULTS Two-thirds of the PWID sample were male. The median age was 39 years and 16% identified as Indigenous. Almost one-quarter (23%) reported that they were homeless. Homeless PWID were significantly more likely to be unemployed [adjusted odds ratio (AOR) 2.83, 95% confidence interval (CI) 1.26, 6.34], inject in public (AOR 2.01, 95% CI 1.38, 3.18), have poorer mental health (AOR 0.98, 95% CI 0.97, 1.00), report schizophrenia (AOR 2.31, 95% CI 1.16, 4.60) and have a prison history (AOR 1.53, 95% CI 1.05, 2.21) than stably housed PWID. DISCUSSION AND CONCLUSIONS Findings highlight the challenge of mental health problems for homeless PWID. Our results demonstrate that further research that evaluates outcomes of housing programs accommodating PWID, particularly those with comorbid mental health disorders, is warranted. Results also emphasise the need to better utilise integrated models of outreach care that co-manage housing and mental health needs.

'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.

Experiences of and Attitudes Toward Injecting Drug Use Among Marginalized African Migrant and Refugee Youth in Melbourne, Australia

Little is known about injecting drug use (IDU) among people from culturally and linguistically diverse backgrounds in Australia. We interviewed 18 young people of African ethnicity (6 current/former injectors, 12 never injectors) about exposure and attitudes to IDU. Exposure to IDU was common, with IDU characterized as unnatural, risky and immoral. IDU was highly stigmatized and hidden from family and friends. There is a need for culturally appropriate programs to promote open dialogue about substance use to reduce stigma and prevent African youth who may use illicit drugs from becoming further marginalized.

Can differences in the type, nature or amount of polysubstance use explain the increased risk of non-fatal overdose among psychologically distressed people who inject drugs?

BACKGROUND This study investigates whether the type, nature or amount of polysubstance use can explain the increased risk of non-fatal overdose among people who inject drugs with severe psychological distress. METHODS Data came from three years (2011-2013) of the Illicit Drug Reporting System (IDRS), an annual sentinel sample of injecting drug users across Australia (n=2673). Structural Equation Modelling (SEM) was used on 14 drug types to construct five latent factors, each representing a type of polysubstance use. Tests of measurement invariance were carried out to determine if polysubstance use profiles differed between those with and without severe psychological distress. Next, we regressed non-fatal overdose on the polysubstance use factors with differences in the relationships tested between groups. FINDINGS Among those with severe psychological distress a polysubstance use profile characterised by heroin, oxycodone, crystal methamphetamine and cocaine use was associated with greater risk of non-fatal overdose. Among those without severe psychological distress, two polysubstance use profiles, largely characterised by opioid substitution therapies and prescription drugs, were protective against non-fatal overdose. CONCLUSION The types of polysubstance use profiles did not differ between people who inject drugs with and without severe psychological distress. However, the nature of use of one particular polysubstance profile placed the former group at a strongly increased risk of non-fatal overdose, while the nature of polysubstance use involving opioid substitution therapies was protective only among the latter group. The findings identify polysubstance use profiles of importance to drug-related harms among individuals with psychological problems.

How does the use of multiple needles/syringes per injecting episode impact on the measurement of individual level needle and syringe program coverage?

BACKGROUND Recent work by McCormack et al. (2016) showed that the inclusion of syringe stockpiling improves the measurement of individual-level syringe coverage. We explored whether including the use of a new parameter, multiple sterile syringes per injecting episode, further improves coverage measures. METHODS Data comes from 838 people who inject drugs, interviewed as part of the 2015 Illicit Drug Reporting System. Along with syringe coverage questions, the survey recorded the number of sterile syringes used on average per injecting episode. We constructed three measures of coverage: one adapted from Bluthenthal et al. (2007), the McCormack et al. measure, and a new coverage measure that included use of multiple syringes. Predictors of multiple syringe use and insufficient coverage (<100% of injecting episodes using a sterile syringe) using the new measure, were tested in logistic regression and the ability of the measures to discriminate key risk behaviours was compared using ROC curve analysis. RESULTS 134 (16%) participants reported needing multiple syringes per injecting episode. Women showed significantly increased odds of multiple syringe use, as did those reporting injection related injuries/diseases and injecting of opioid substitution drugs or pharmaceutical opioids. Levels of insufficient coverage across the three measures were substantial (20%-28%). ROC curve analysis suggested that our new measure was no better at discriminating injecting risk behaviours than the existing measures. CONCLUSION Based on our findings, there appears to be little need for adding a multiple syringe use parameter to existing coverage formulae. Hence, we recommend that multiple syringe use is not included in the measurement of individual-level syringe coverage.

Knowledge of naloxone and take-home naloxone programs among a sample of people who inject drugs in Australia: Variations across capital cities: Naloxone knowledge

INTRODUCTION AND AIMS Take-home naloxone (THN) programs targeting people who inject drugs (PWID) have been running in some Australian states and territories since 2012. In this study, we aimed to determine the extent to which PWID in the capital cities of all Australian states and territories are aware of naloxone and THN programs, whether awareness of these programs has changed over time. DESIGN AND METHODS Data were obtained from cross-sectional surveys of a total of 2088 PWID conducted annually as part of the Illicit Drug Reporting System from 2013 to 2015. Specific questions about THN added to the survey in 2013 allowed assessment of the extent to which sampled PWID were aware of naloxone and its function and THN programs in Australia and whether they had participated in a THN program. These main outcomes were examined over time and across states and territories using a mix of descriptive statistics and logistic regression. RESULTS Over 80% of the sample reported having heard of naloxone across survey years. Less than half of the participants reported having heard of THN programs in 2013 (35%), but this increased to just over (52%) half in 2015 (P < 0.01). Changes over time differed across cities with increases in reports of having heard of THN occurring over time most clearly in those cities with operational THN programs. DISCUSSION AND CONCLUSIONS Around half of the PWID sampled for this study are aware of THN programs. Further work is needed to ensure widespread awareness of THN programs which should include implementing THN in all Australian states and territories.

The role of respect in interactions with police among substance-using African refugee young people in Melbourne, Australia

ABSTRACT Racialized policing and substance use are major issues faced by African young people in Australia. In-depth interviews with 18 refugee young people who use alcohol and/or drugs examined interactions with police. Status respect and human respect played important roles in interactions with police. Participants felt unfairly targeted by police and reported that they were disrespected by police through the use of discriminatory language, failing to differentiate between individuals leading to a sense of loss of self-identity, and stereotyping. Development and implementation of programs focusing on building mutual understanding and respect is needed to improve relations between refugee-background youth and police.

Behavioural research to inform understanding of hepatitis C resistance.

Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, SACYL & IECSCYL, 47005 Valladolid, Spain (JFB-M, DA-O, RA, JME, ET); Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valladolid, SACYL, Valladolid, Spain (DA-O); and Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, SACYL, Valladolid, Spain (ET)