Drug Treatment Services Research Articles

An Exploration of Organizational Characteristics and Training Adoption in Irish Community Drug Treatment Services.

Changes in patterns of drug use and population needs necessitate the adoption of new technologies. Despite high failure rates in adopting new technologies acquired in training, little is known about the process that can support successful change. This study explores the impact that staff and service characteristics have on the process of training adoption in Irish opiate substitution therapy services, with a specific focus on the concept of organizational readiness to change. A cross-sectional survey was conducted on a convenience sample of 132 staff members across 12 services in Ireland. The relationship between staff demographics, their perceptions of organizational readiness to change, burnout, and a four-stage process of training adoption were considered. Discipline, job tenure, and educational levels are important predictors of engagement in the adoption process. Staff in services with higher institutional needs, greater pressures for change, and poorer resources were less likely to be exposed to, or adopt, training. Having lower levels of stress and more influence with peers was associated with better adoption of training. Planners and service managers need to carefully consider the composition or dynamics of services when initiating change. Organizational readiness to change and staff characteristics as measured by instruments used in this study are important determinants of the process of innovation or training adoption and provide a good basis for developing further understanding of how treatment services work. This article expands on results from previous studies conducted in the United States to a European context.

The HIV pre-exposure prophylaxis continuum of care among women who inject drugs: A systematic review

IntroductionPeople who inject drugs have a substantial risk for HIV infection, especially women who inject drugs (WWID). HIV pre-exposure prophylaxis (PrEP), a highly-effective HIV prevention drug, is uncommonly studied among WWID, and we aimed to synthesize existing knowledge across the full PrEP continuum of care in this population.MethodsWe systematically searched for peer-reviewed literature in three electronic databases, conference abstracts from three major HIV conferences, and gray literature from relevant sources.Eligibility criteria included quantitative, qualitative or mixed-methods studies with primary data collection reporting a PrEP-related finding among WWID, and published in English or Spanish between 2012 and 2021. The initial search identified 2,809 citations, and 32 were included. Data on study characteristics and PrEP continuum of care were extracted, then data were analyzed in a narrative review.ResultsOur search identified 2,809 studies; 32 met eligibility requirements. Overall, awareness, knowledge, and use of PrEP was low among WWID, although acceptability was high. Homelessness, sexual violence, unpredictability of drug use, and access to the healthcare system challenged PrEP usage and adherence. WWID were willing to share information on PrEP with other WWID, especially those at high-risk of HIV, such as sex workers.ConclusionsTo improve PrEP usage and engagement in care among WWID, PrEP services could be integrated within gender-responsive harm reduction and drug treatment services. Peer-based interventions can be used to improve awareness and knowledge of PrEP within this population. Further studies are needed on transgender WWID as well as PrEP retention and adherence among all WWID.

Intersecting substance use treatment and harm reduction services: exploring the characteristics and service needs of a community-based sample of people who use drugs

BackgroundSubstance use treatment and harm reduction services are essential components of comprehensive strategies for reducing the harms of drug use and overdose. However, these services have been historically siloed, and there is a need to better understand how programs that serve people who use drugs (PWUD) are integrating these services. In this study, we compared treatment and harm reduction services offered by a multistate sample of substance use service providers and assessed how well they align with characteristics and needs of clients they serve early in the COVID-19 pandemic.MethodsWe recruited a convenience sample of programs that deliver harm reduction and/or treatment services in ten US states. Program directors participated in a survey assessing the services offered at their program. We also recruited clients of these programs to participate in a survey assessing a range of sociodemographic and health characteristics, substance use behaviors, and health service utilization. We then cross-compared client characteristics and behaviors relative to services being offered through these programs.ResultsWe collected and analyzed data from 511 clients attending 18 programs that we classified as either offering treatment with medications for opioid use disorder (MOUD) (N = 6), syringe service programs (SSP) (N = 8), or offering both MOUD and SSP (N = 4). All programs delivered a range of treatment and harm reduction services, with MOUD & SSP programs delivering the greatest breadth of services. There were discrepancies between services provided and characteristics and behaviors reported by clients: 80% of clients of programs that offered MOUD without SSP actively used drugs and 50% injected drugs; 40% of clients of programs that offered SSP without MOUD sought drug treatment services. Approximately half of clients were unemployed and unstably housed, but few programs offered direct social services.ConclusionsIn many ways, existing programs are not meeting the service needs of PWUD. Investing in innovative models that empower clients and integrate a range of accessible and flexible treatment, harm reduction and social services can pave the way for a more effective and equitable service system that considers the long-term health of PWUD.

Drug analysis of residues from used syringes collected at a syringe exchange programme in Gothenburg, Sweden

To study drug content in syringes collected from a needle and syringe exchange programme in Gothenburg, Sweden. Needle and syringe exchange programmes (NEPs) are available in many cities both in Sweden and internationally for individuals who inject drugs. Their main objective is to prevent the spread of bloodborne viruses such as hepatitis C virus and HIV via needle and syringe sharing. Knowledge of which drugs are injected by the visitors of these programmes is of great importance for health promotion and drug prevention, such as planning and design of harm reduction measures, treatment of substance use disorders, adjustment of the hospital laboratories’ range of analyses and detection of unknown NPSs. There are a few international studies of drug content in used syringes, showing that the substances injected vary greatly both over time and regarding geographical region. So far, no corresponding studies have been carried out in Sweden. This study aimed to assess drug content in disposed syringes in the NEP in Sweden's second largest city, Gothenburg. A total of 2250 syringes were collected during one week in November 2021 of which 150 were randomly selected. The syringes were rinsed with methanol, and the extract was analysed for presence of drugs using liquid chromatography coupled to high-resolution mass spectrometry. To distinguish between main drugs and impurities in syringes containing more than one drug, a dose-adjusted comparison of the concentrations in the extract was performed. Drugs were detected in 149 out of 150 analysed syringes (99%), and 6% of these contained more than one drug. Amphetamine was the most common (81%) followed by buprenorphine (7%) and heroin (6%). Other findings consisted of sedatives (alprazolam and zopiclone, in total 5%), other stimulants apart from amphetamine (MDMA and methylphenidate, in total 2%), and androgenic anabolic steroids (trenbolone and testosterone, in total 4%). In addition, low levels of cocaine, lisdexamphetamine, MDA, methamphetamine, gabapentin and pregabalin were detected. Many syringes also contained suspected adulterants such as caffeine, phenacetin, phenazone and paracetamol and natural or synthetic by-products such as acetylcodeine, noscapine and N-formylamphetamine. In Gothenburg, the main drug detected in disposed syringes was amphetamine, in contrast to previous studies in other European cities where heroin and cocaine are the most commonly injected drugs. Knowledge of drug content in syringes from needle exchange programmes is useful to adapt local harm reduction and drug treatment services. However, further studies are needed to gain a deeper insight into drug injection patterns in Sweden.

Evaluation of the move to remote delivery of drug and alcohol services during the COVID-19 pandemic: A study protocol.

Background:Substance misuse is a significant global health concern. In the UK, the prevalence of substance misuse has increased over the past decade and the number of alcohol and drug related deaths are increasing. Individuals with substance dependency issues are entitled to access treatment services. However, the COVID-19 pandemic created significant challenges for public services, including drug and alcohol treatment, and resulted in significant service reconfiguration and a shift from in-person to remote delivery. This study aims to evaluate the delivery of drug and alcohol services in a large metropolitan area in Northern England during the COVID-19 pandemic. It aims to understand the impact of service reconfiguration for services, staff and service users, and to use this understanding to inform the future optimised design of services.Design and methods:The study has five workstreams within a mixed methods framework: (1) Systematic review of literature; (2) Qualitative process evaluation with service providers (digital timelines, focus groups and interviews); (3) Qualitative process evaluation with service users (interviews, focus groups, text based conversations and case studies); (4) Quantitative outcomes and health economic analysis; and (5) Data synthesis and dissemination.Expected Impact of the study for Public Health:The breadth of the study, its novel nature, and the importance of substance misuse as a public health issue, mean that this study will provide valuable findings for those who commission, deliver and use drug and alcohol treatment services nationally and internationally. There will also be important learning for the effective remote delivery of services in sectors beyond drug and alcohol treatment.

A case study: using an appreciative inquiry model to co-produce a gender-informed women’s only access to drug and alcohol treatment space

Purpose This study aims to report on the experience of using a strengths-based, solution-focused methodology for co-producing a gender-informed drug treatment service using an appreciative inquiry (AI) model (Cooperrider and Srivastva, 1987). Design/methodology/approach An AI model was used to facilitate a series of six workshops. Participants had a mixture of lived experience (n = 4, experience of accessing drug and alcohol services) and learned experience (n = 3, practitioners from a local drug service), with co-facilitators from Fulfilling Lives Lambeth, Southwark and Lewisham (n = 2). The aim of the workshops was to understand barriers, identify solutions and co-create a service design offer. Data for this paper was collected using a series of focus groups, reflection logs and surveys, which sought to understand participants’ perceptions of using this model and the impact it had on them. Data was analysed manually using coded thematic analysis (Braun and Clarke, 2006). Findings Participants successfully co-created a women’s access to drug and alcohol service design and recommendations. Participants found the process of using the model a very positive experience with benefits, including increased self-esteem, group cohesion and balanced power. This study provides evidence of the AI model as an effective, practical tool for co-production work. Originality/value This case study considers a shift in approach to co-producing services with both lived and learned experience, which moves away from problem-focused consultations, towards solution-focused co-design. Consequently, providing evidence to support such a change.

A qualitative study exploring the impact of the COVID-19 pandemic on People Who Inject Drugs (PWID) and drug service provision in the UK: PWID and service provider perspectives.

BackgroundPeople Who Inject Drugs (PWID) are subject to distinct socio-structural inequalities that can expose them to high risks of COVID-19 transmission and related health and social complications. In response to COVID-19 mitigation strategies, these vulnerabilities are being experienced in the context of adapted drug treatment service provision, including reduced in-person support and increased regulatory flexibility in opioid substitution therapy (OST) guidelines. This study aimed to explore the longer-term impact of the pandemic on the health and wellbeing of PWID in the UK, including provider and client experiences of treatment changes.MethodsInterviews were conducted with 19 PWID and 17 drug treatment providers between May and September 2021, recruited from drug and homelessness charities providing treatment services and healthcare in the UK. Data were analysed using reflexive thematic analysis.ResultsMost participants expressed ongoing fears of COVID-19 transmission, although socio-structural inequalities limited the contexts in which physical distancing could be practised. In addition, virus mitigation strategies altered the risk environment for PWID, resulting in ongoing physical (e.g. changing drug use patterns, including transitions to crack cocaine, benzodiazepine and pregabalin use) and socio-economic harms (e.g. limited opportunities for sex work engagement and income generation). Finally, whilst clients reported some favourable experiences from service adaptations prompted by COVID-19, including increased regulatory flexibility in OST guidelines, there was continued scepticism and caution among providers toward sustaining any treatment changes beyond the pandemic period.ConclusionsWhilst our findings emphasize the importance of accessible harm reduction measures attending to changing indices of drug-related harm during this period, there is a need for additional structural supports to ensure pre-existing disparities and harms impacting PWID are not exacerbated further by the conditions of the pandemic. In addition, any sustained policy and service delivery adaptations prompted by COVID-19 will require further attention if they are to be acceptable to both service users and providers.

Understanding Vietnam’s drug policy for amphetamine-type stimulants misuse

IntroductionThe emergence of widespread amphetamine-type stimulants (ATSs) usage has created significant challenges for drug control and treatment policies in Southeast Asian countries. This study analyses the development of drug policies and examines current treatment program constraints in Vietnam to deal with ATS misuse. The aim was to gain insights that may be useful for national and international drug-related policy development and revision.MethodsA desk review of national policy documents and 22 in-depth key informant interviews were conducted from 2019 to 2021. Thematic content analysis was employed to identify key themes and their connections.ResultsAnalysis identified Vietnam’s 30-year history of developing policies and formulating strategies to reduce supply, demand, and harm from illicit drugs. With the increasing number of people who use ATS (PWUA), Vietnam has recently promoted harsh policy and law enforcement to deter drug use and supply. This policy trend prevails in many Asian countries. The three main constraints in dealing with ATS misuse emerged from punitive and restrictive drug policies. First, the general public believed that Centre-based compulsory treatment (CCT) is the only appropriate treatment for all types of illicit drug addiction despite its low-quality service provision. The rigid drug policy has led to social persuasion with impractical expectations for CCT effectiveness. Second, the emphasis on punishment and detention has hampered new drug treatment service development in Vietnam. CCT has become monopolistic in the context of impoverished services. Third, people who use drugs tend to hide their needs and avoid formal treatment and support services, resulting in declined social coherence.ConclusionWhile new drugs are constantly evolving, the current law enforcement approach potentially constrains expertise to adopt effective treatment services. This study suggests that the top-down policing mechanism presently hinders the development of an appropriate intervention strategy for ATS misuse and diminishes social support to service providers.

Risk of adverse events after covid-19 in Danish children and adolescents and effectiveness of BNT162b2 in adolescents: cohort study

ObjectivesTo assess the risk of acute and post-acute adverse events after SARS-CoV-2 infection in children and adolescents in Denmark and to evaluate the real world effectiveness of the BNT162b2 mRNA...

Behavioral activation for depression delivered by drug and alcohol treatment workers: A pilot randomized controlled trial

BackgroundOne in two patients seeking help for substance use disorders (SUDs) has clinically significant depression symptoms. This co-occurrence impairs treatment outcomes, but limited evaluation of the implementation of evidence-based interventions has taken place. MethodsThis pilot randomized controlled trial (RCT) assessed the feasibility and potential efficacy of a brief, protocol-driven behavioral activation (BA) intervention delivered by drug and alcohol workers in a community drug and alcohol treatment (CDAT) service. Eligible participants (n = 34) were randomly allocated to either BA (n = 17) or treatment as usual (n = 17) and assessed at baseline and 6-, 12-, and 24-week follow-up. Feasibility outcomes were participant engagement and worker protocol adherence. The primary pilot outcome was severity of depression symptoms (PHQ-9) at 12-week follow-up. Secondary outcomes included percent days abstinent (PDA) in the past month, severity of dependence (SDS), anxiety symptoms (GAD-7), and valued living (VQ) at all follow-up points. ResultsFifty-nine percent of BA participants attended at least one session and there was 95% adherence to the treatment protocol. BA was associated with significantly reduced depression at 12-week follow-up (PHQ-9 mean difference − 5.69, 95% CI –10.07 to −1.31). BA participants had significantly greater improvements in PDA (mean difference 17.9, 95% CI 0.99 to 34.82) and VQ-Progress (mean difference 5.34, 95% CI 1.47 to 9.22) at 6-week follow-up and PDA (mean difference 27.69, 95% CI 4.44 o 50.95) at 12-week follow-up. The study found no significant between-group differences at 24-week follow-up. ConclusionBA implemented by drug and alcohol treatment workers in CDAT appears feasible and may add clinical benefit to usual care for SUD patients with elevated depressive symptoms accessing CDAT. Fully powered RCTs are warranted to better investigate the replicability of these preliminary findings. Methodological limitations are discussed and suggestions for future research are provided.

Access to drug treatment services in Nigeria: the challenge of the addiction workforce

ABSTRACT Objective: To examine the condition of the addictionworkforce in Nigeria vis-a-vis its size and composition, certification ofaddiction professionals and other factors influencing access to drug treatmentservices in Nigeria.Methods: Participants for this study were 17 malesand 13 females aged between 31 and 58 years drawn from people attending trainingon Universal Treatment Curriculum (UTC 6, 7 & 8) at Nassarawa State University,Keffi, Nigeria.Results:Participants identified lack of trained addiction workforce as a factor withthe highest weight in affecting access to drug treatment services in Nigeria. Ananalysis of the treatment teams showed that they are mainly made-up of thefollowing professions: Psychiatrists, Psychologists, Medical doctors, Nurses,Social workers and counsellors and only a team from one treatment center thathas a record of a member that has completed training in Universal TreatmentCurriculum (UTC).Conclusion: The study revealedthat while the prevalence of drug addiction is high, the size of addictionworkforce to address the addiction problem is too small and professionallyunder-trained. In view of the this the researcher recommends that coursesleading to professional training in SUD treatment should be introduced inhigher institutions of learning such as schools of nursing and universities.This is to produce an adequate addiction work force. Furthermore, effortsshould also be made to see that a system of taking a UTC certification examsonline through CBT is introduced in Nigeria. This will address the continuedwaiting for those who have completed the UTC training but are kept waiting for apaper and pencil exam.

Health service utilisation and access for people who inject drugs during COVID-19.

IntroductionThe wide‐spread implementation of interventions to limit transmission and public health consequences of COVID‐19 in the Australian state of Victoria had flow‐on consequences for people who use and inject drugs. Consequences included the interruption of illicit drug supply and drug procurement, and the disruption to the delivery of health services. To inform strategies that can minimise the adverse outcomes of similar future disruptive events, this study explored how COVID‐19 restrictions impacted access to harm reduction and drug treatment services for people who inject drugs in Melbourne, Victoria.MethodsQualitative semi‐structured interviews were conducted via an online calling app, with 11 participants of a broader cohort study (the SuperMIX study) in April 2020. Interviews were focused on participants experiences of accessing and using harm reduction and drug treatment services. Data were thematically analysed using a process of blended coding.ResultsFindings revealed how disruptions in the delivery of harm reduction and drug treatment services—in response to COVID‐19 restrictions—created barriers accessing sterile injecting equipment, increased risk of arrest by police and exacerbated social isolation. Participants reported difficulties adapting to changes in services access, with some increases in injecting risk behaviours. However, improvements in opioid agonist therapy prescriptions were noted as a beneficial outcome.DiscussionBy examining the impacts of COVID‐19 and the resultant restrictions on people who inject drugs' access to health services in Melbourne, Victoria, findings provide guidance for future responses to the unanticipated large‐scale effects of the COVID‐19 pandemic, and similar disruptive events.

Overdose prevention centres in the UK

Overdose prevention centres in the UK

Outcomes of a single-arm implementation trial of extended-release subcutaneous buprenorphine depot injections in people with opioid dependence.

Opioid agonist treatment (OAT) is an effective intervention for opioid dependence. Extended-release buprenorphine injections (BUP-XR) may have additional potential benefits over sublingual buprenorphine. This single-arm trial evaluated outcomes among people receiving 48 weeks of BUP-XR in diverse community healthcare settings in Australia, permitting examination of outcomes when BUP-XR is delivered in standard practice. Participants were recruited from a network of specialist public drug treatment services, primary care and some private practices in three states. Following a minimum 7 days on 8-32 mg of sublingual buprenorphine (±naloxone), participants received monthly subcutaneous BUP-XR injections administered by a healthcare practitioner and completed monthly research interviews. The primary endpoint was retention in treatment at 48 weeks. Participants (n=100) were 28% women, mean age 44 years with a long history of OAT (median 5.8 years); heroin was the most common opioid of concern (58%). Treatment retention at 24 and 48 weeks was 86% and 75%, respectively. Participants with past-month injecting drug use (OR 0.23; 95%CI: 0.09-0.61) or heroin use (OR 0.23; 95%CI: 0.08-0.65) at baseline had lower odds of being retained in treatment to 48 weeks. Reductions in multiple forms of extra-medical drug use were observed. Improvements in quality of life, participation in employment, and treatment satisfaction measures were also observed. This real-world implementation study of BUP-XR demonstrated high retention and treatment satisfaction. This study provides important additional data on the uptake and experience of clients, with relevance for policy makers, health service planners, administrators, and practitioners. Indivior. ClinicalTrials.gov Identifier: NCT03809143.

The National Quality Framework: The Benchmark for the Alcohol and Other Drug Sector in Australia.

A National Quality Framework, developed by the Australian Government Department of Health, currently in a transitional phase, has been introduced to improve the quality of alcohol and other drug treatment services and provide a nationally consistent approach to treatment quality in the sector in Australia. This article examines how the National Quality Framework aims to achieve these goals. The article draws on the theory of quality frameworks to demonstrate how quality of treatment services may be improved under the National Quality Framework. The most difficult challenge for the National Quality Framework will be to deliver a nationally consistent approach to improving quality under the current structural arrangements for monitoring and enforcement of the framework.

Setting up a drug treatment service in a COVID-protect hotel in inner London

At the start of the UK's COVID-19 lockdown, the government announced an ‘Everyone In’ strategy to get homeless people off the streets and into accommodation. An Inner London borough opened a hotel to house up to 100 homeless people to address their health needs. Local healthcare providers were asked to provide in-reach services. This article describes the setting up and delivery of a drug treatment service to provide substitute opioid therapy. Thirty-five people were taken into drug treatment in the hotel between April and December 2020. During this time various challenges had to be addressed including same-day prescribing, delivering and supervising controlled drugs and responding to drug dealing in the hotel. Partnership work between the different healthcare providers was essential for the success of this project and offers a model that could be used going forward to deliver comprehensive wrap-around services to hard-to-engage individuals with multiple health needs.

Application of Therapeutic Architectural Principles in the Design of Drug Rehabilitation Centre for Nigeria

In order to achieve lifetime abstinence from illicit drugs and psychoactive substances, drug de-addiction and rehabilitation now endeavors to provide emotional support along with medical care, rather than aiming at removal of physical dependences on drugs only. When a drug addict is released from a Detention Camp, he/she is reintegrated back to the society as liability with high temptation to relapse, due to the ineffectiveness of the detention strategy and gross inadequacy of drug treatment and rehabilitation services in Nigeria, as Programs like Detoxification, Psychotherapy and Meditation are absent. The purpose of this study therefore is to explore the principles of therapeutic architecture towards designing a therapeutic environment, with a view to support the new treatment trend for drug addicts and thugs in Bauchi state- Nigeria. The method applied in this study is basically qualitative, using Multiple Case Study approach. Cross Case Analysis was used to analyze the data collected. This study identified 12 principles of Therapeutic Architecture and was able to determine the best mode of application for the design of the Rehabilitation Centre. The findings of this study showcase Architecture in aiding therapy for drug addicts and thugs, by creating a therapeutic environment that addresses the problem of relapse and inadequacy of the treatment facility in the study area, which ensures reintegration of addicts back to the society within the shortest possible time with minimal professional intervention.

The impact of disinvestment on alcohol and drug treatment delivery and outcomes: a systematic review

BackgroundIn the context of substantial financial disinvestment from alcohol and drug treatment services in England, our aim was to review the existing evidence of how such disinvestments have impacted service delivery, uptake, outcomes and broader health and social implications.MethodsWe conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42020187295), searching bibliographic databases and grey literature. Given that an initial scoping search highlighted a scarcity of evidence specific to substance use treatment, evidence of disinvestment from publicly funded sexual health and smoking cessation services was also included. Data on disinvestment, political contexts and impacts were extracted, analysed, and synthesized thematically.ResultsWe found 20 eligible papers varying in design and quality including 10 related to alcohol and drugs services, and 10 to broader public health services. The literature provides evidence of sustained disinvestment from alcohol and drug treatment in several countries and a concurrent decline in the quantity and quality of treatment provision, but there was a lack of methodologically rigorous studies investigating the impact of disinvestment.ConclusionsThis review identified a paucity of scientific evidence quantifying the impacts of disinvestment on alcohol and drug treatment service delivery and outcomes. As the global economy faces new challenges, a stronger evidence base would enable informed policy decisions that consider the likely public health impacts of continued disinvestment.

Impact of COVID-19 on drug use disorders and provision of drug related interventions in prison

Abstract Introduction With the emergence of the COVID-19 epidemic, most European countries implemented measures to prevent the spread of infections inside prison, including: use of personal protective equipment (PPE), hygiene practices, limits to mobility, reduction of overcrowding. Their implementation affected the drug related interventions. The EMCDDA has conducted a rapid assessment to evaluate the impact of those measures on the provision of drug treatment and harm reduction services in the European prisons of 15 countries between March and June 2020. Methods The study was based on a mixed method approach that triangulated the results of an on-line survey, the outcome of a focus group with prison and drugs experts and case studies from four European countries. Results and discussion Most countries reported a reduction in the provision of drug treatment and, to a lesser extent, of harm reduction interventions inside prison during the early phase of the pandemic. The drug services tried to adapt to the new context. Innovations were introduced, including the use of telemedicine in counselling and pharmacological treatment, a better partnership between security and health staff and a more individualised approach to drug treatment. Concerns were expressed around reduction of some interventions, such as group-based interventions, services provided by external agencies, interventions in preparation for release, continuity of care and possible reduction in testing and treatment of drug related infections such as HIV, HCV and HBV due to the priority given to the COVID-19 emergence. Conclusions With the emergence of COVID-19, drug services had to address various challenges, making efforts to maintain the provision of drug-related interventions inside prison, while introducing the COVID-19 containment measures. Ensuring the equivalence and continuity of health care provision for those in prison with drug problem remains of central importance.

Barbiturate-related hospitalisations, drug treatment episodes, and deaths in Australia, 2000-2018.

To determine the characteristics and population rates of barbiturate-related hospitalisations, treatment episodes, and deaths in Australia, 2000-2018. Analysis of national data on barbiturate-related hospitalisations (National Hospital Morbidity Database, 1999-2000 to 2017-18), drug treatment episodes (Alcohol and Other Drug Treatment Services National Minimum Data Set, 2002-03 to 2017-18), and deaths (National Coronial Information System, 2000-01 to 2016-17). Population rates directly age-standardised to the 2001 Australian standard population; average annual percentage change (AAPC) in rates estimated by Joinpoint regression. We identified 1250 barbiturate-related hospitalisations (791 cases of deliberate self-harm [63%]), 993 drug treatment episodes (195 cases with barbiturates as the principal drug of concern [20%]), and 511 deaths during the respective analysis periods. The barbiturate-related hospitalisation rate declined from 0.56 in 1999-2000 to 0.14 per 100000 population in 2017-18 (AAPC, -6.0%; 95% CI, -7.2% to -4.8%); the declines in hospitalisations related to accidental poisoning (AAPC, -5.8%; 95% CI, -9.1% to -2.4%) and intentional self-harm (AAPC, -5.6%; 95% CI, -6.9% to -4.2%) were each statistically significant. Despite a drop from 0.67 in 2002-03 to 0.23 per 100000 in 2003-04, the drug treatment episode rate did not decline significantly (AAPC, -6.7%; 95% CI, -16% to +4.0%). The population rate of barbiturate-related deaths increased from 0.07 in 2000-01 to 0.19 per 100000 population in 2016-17 (AAPC, +9.3%; 95% CI, +6.2-12%); the rate of intentional self-harm deaths increased (AAPC, +11%; 95% CI, +7.4-15%), but not that of accidental deaths (AAPC, -0.3%; 95% CI, -4.1% to +3.8%). While prescribing and community use of barbiturates has declined, the population rate of intentional self-harm using barbiturates has increased. The major harm associated with these drugs is now suicide.