Illicit Drug Reporting System Research Articles

COVID-19 vaccine acceptability among people in Australia who inject drugs: Update from the 2021 Illicit Drug Reporting System interviews.

People who inject drugs may be at higher risk of COVID‐19 transmission and more severe negative health outcomes following COVID‐19 infection. Early research on hypothetical COVID‐19 vaccines suggests this population may be less likely to accept vaccination. This commentary extends this research by presenting vaccine intention data from Illicit Drug Reporting System interviews conducted in June–July 2021, in the early stages of vaccine rollout, with people in Australia who inject drugs (N = 888). Half the sample (48%, n = 419) reported that they were hesitant to receive the COVID‐19 vaccine, with key barriers relating to vaccine safety and side effect concerns. This level of hesitancy is substantially higher than that of the general population at a similar time. While we note that the subsequent Delta variant‐driven third wave of cases in Australia and efforts to increase population vaccination coverage may have altered intent in this group, this level of hesitancy warrants a targeted strategy to mitigate vaccine‐related concerns and maximise uptake. Ideally, this should comprise an inclusive health response that is peer‐led, with peer‐based organisations ideally positioned to direct immunisation service delivery and provide vaccine‐related messaging.

Trends and characteristics of extra-medical use of quetiapine among people who regularly inject drugs in Australia, 2011–2018

Background and AimsThere are ongoing concerns regarding the extra-medical use of quetiapine and related harms. We aimed to investigate trends in quetiapine use and extra-medical use among people who regularly inject drugs (PWID) in Australia between 2011–2018, and examine changes in the characteristics associated with extra-medical use of quetiapine, comparing those reporting use in 2011 and 2018. MethodsThis study examines eight years of survey data (2011–2018; n = 7,135 PWID) from Australia’s Illicit Drug Reporting System. Linear regression was used to analyse trends over time, and multinomial logistic regression used to identify factors associated with extra-medical quetiapine use in 2011 and 2018. FindingsThe percentage of PWID reporting extra-medical quetiapine use decreased from 14.9 % in 2011 to 12.0 % in 2018; ranging between 10.5 %–15.8 % across years, and reported use was typically infrequent (less than once a month). In both 2011 and 2018, extra-medical quetiapine use was associated with use of benzodiazepines (2011 Adjusted Odds Ratio (AOR) 4.76, 95 % confidence interval (Cl) 2.31–9.82; 2018 AOR 3.10, 95 % Cl 1.84–5.23) and stimulants (2011 AOR 2.81, 95 % Cl 1.51–5.21; 2018 AOR 2.68, 95 % Cl 1.32–5.46) in the past six months. ConclusionsSlightly more than one in ten PWID reported extra-medical quetiapine use between 2011–2018. Overall, the frequency of extra-medical quetiapine use among PWID was low, however, individuals often engaged in polysubstance use that has the potential to cause other drug-related harms. Targeted harm-reduction interventions focused on polysubstance use are therefore warranted to reduce potential risks among this group.

Social domains of discrimination against people who inject drugs: Links with health and wellbeing

AimsPeople who inject drugs frequently experience discrimination. However, little is known about how discrimination experienced in different social domains is linked to health and wellbeing. DesignWe used data collected in 2016 from the Illicit Drug Reporting System (IDRS), an Australian survey of people who inject drugs. We used a modified version of the Discrimination Scale (DISC-12) to assess discriminatory behaviours in diverse social domains, including public institutions, neighbours, family and friends. We used the Kessler-10 scale, the Personal Wellbeing Index and specific items from the IDRS questionnaire to assess participants’ health and wellbeing. FindingsSixty three percent of participants who responded to the discrimination module included in the IDRS 2016 (N = 796) reported ever having experienced discrimination due to their injecting drug use and 53% reported having experienced discrimination in the past month. Discrimination in all social domains analysed was linked with poor health and wellbeing, except for housing. Self-reported mental health problems and poorer general health were most frequently associated with discrimination. Participants who experienced discrimination from friends were three times more likely to report mental health problems (AOR=3.0, CI95=1.5–6.0). ConclusionsThere are significant associations between the domains in which discrimination takes place and the health and wellbeing of people who inject drugs. Our findings highlighted the importance of assessing the social domains of discrimination in relation to mental health. Further research needs to assess not just whether a group or individual is discriminated against, but rather how they are likely to perceive this discrimination and how this experience can affect their life as a whole.

Opioid use and harms associated with a sustained-release tapentadol formulation: A post-marketing surveillance study

AimsA sustained-release formulation (SRF) of tapentadol has been marketed in Australia since February 2013. This study examined tapentadol SRF extra-medical use, attractiveness for extra-medical use, and associated harms in Australia. MethodsThis post-marketing study comprises analyses of Australian community sales data (2011–2017) for eleven pharmaceutical opioids (prescription and over-the-counter codeine disaggregated); calls to three poisons information centres (covering five of the eight jurisdictions in Australia) related to pharmaceutical opioids and coded by the centres as ‘misuse’ or ‘abuse’ (2011–2017); and interviews with people who inject drugs (n = 888) recruited as part of the Illicit Drug Reporting System (IDRS) from all Australian capital cities (2017). ResultsPopulation-level availability of tapentadol SRF increased from market launch, comprising the sixth largest market share of all opioid unit sales, and third greatest share in oral morphine equivalent milligrams sold, in December 2017. Lifetime tapentadol SRF use among the IDRS sample (n = 888) was low (1.5%; 95%CI 0.9–2.5), with few reporting past-6 month non-prescribed use or injection. Non-fatal overdose following tapentadol use was self-reported by less than 1% (95%CI 0.1-0.8). Between 2013–2017, 1.1% (n = 25) of pharmaceutical opioid ‘misuse/abuse’ calls were related to tapentadol, and predominantly the SRF. ConclusionsIncreasing utilisation of tapentadol sustained-release formulation was observed, along with indications of extra-medical use and harms associated with use, although on a smaller scale relative to other opioids. These findings need to be interpreted in the context of the low level of exposure to tapentadol sustained-release formulation among the sentinel population of people who inject drugs.

Drug sourcing and motivations among a sample of people involved in the supply of pharmaceutical drugs in Australia

BackgroundThe non-medical use (NMU) of pharmaceuticals is increasing internationally, along with mortality. Previous research indicates that end-users access pharmaceuticals through social networks, however little is known about supplier sources particularly outside the US. This study examined sourcing and motivations among a sample of people involved in pharmaceutical diversion and supply in Australia. MethodsSemi-structured, telephone interviews were conducted with 51 people involved in supplying pharmaceuticals in the previous six months. Multi-stage recruitment involved the distribution of flyers to participants of two Australian drug-monitoring programs: the Ecstasy and related Drugs Reporting System (capturing regular psycho-stimulant users) and the Illicit Drug Reporting System (capturing people who regularly inject drugs), followed by a screening of interested participants. Interviews were audio-recorded, transcribed and analysed using a mixed methods approach. First, correlates of drug sourcing and motivations were examined including demographics, frequency and quantity of supply. Second, thematic analysis of the qualitative data was undertaken on strategies for obtaining the drugs and motivating factors. ResultsDrug supplies were sourced from a variety of medical and non-medical sources, primarily legitimately obtained prescriptions (47%), friends or family (18%) and dealers (14%). Suppliers using medical sources were more likely to be unemployed/retired and reported supplying for therapeutic purposes, while suppliers using non-medical sources were more likely to be employed/students, earned higher incomes and reported supplying for recreational purposes. Those who sourced via doctor shopping (IRR = 47.5) and friends and family (IRR = 10.1) distributed higher quantities, while those who sourced legitimately obtained prescriptions (IRR = 0.1) and from illicit drug dealers (IRR = 0.0) distributed lower quantities. Similar proportions supplied for financial (65%) and altruistic (61%) reasons, however the latter supplied lower quantities (IRR = 0.1). ConclusionThis study offers novel insight into the diversion of pharmaceuticals from the supplier perspective. A nuanced policy approach is required to address varied supply practices by source and motive.

Differences in polysubstance use patterns and drug-related outcomes between people who inject drugs receiving and not receiving opioid substitution therapies.

To test if polysubstance use profiles and drug-related outcomes differ between those receiving and not receiving opioid substitution therapies (OST) among people who inject drugs (PWID). An annual cross-sectional, sentinel sample of PWID across Australia. Data came from 3 years (2011-13) of the Illicit Drug Reporting System (IDRS). A total of 2673 participants who injected drugs from the combined national IDRS samples of 2011 (n=868), 2012 (n=922) and 2013 (n=883). Latent class analysis (LCA) was used to summarize participants' self-reported use of 18 types of substances, with the resulting polysubstance use profiles then associated with participant experience of a number of drug-related outcomes. Polysubstance use profiles exhibiting a broad range of substance use were generally at increased risk of negative drug-related outcomes, whether or not participants were receiving OST, including thrombosis among OST receivers [odds ratio (OR)=2.13, 95% confidence intervals (CI)=1.09-4.17], injecting with used needles among OST receivers and non-receivers, respectively (OR=2.78, 95% CI=1.50-5.13; OR=2.15, 95% CI=1.34-3.45) and violent criminal offences among OST receivers and non-receivers, respectively (OR =2.30, 95% CI=1.16-4.58; OR=1.87, 95% CI=1.14-3.07). An important exception was non-fatal overdose which was related specifically to a class of PWID who were not receiving OST and used morphine frequently (OR=1.83, 95% CI=1.06-3.17) CONCLUSION: Regardless of opioid substitution therapies usage, people who inject drugs who use a broad-range of substances experience greater levels of injecting-related injuries and poorer health outcomes and are more likely to engage in criminal activity than other groups of people who inject drugs.

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

ObjectiveTo examine the rates and patterns of tobacco and e-cigarette use amongst two samples of illicit drug users in Australia. MethodData 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). ResultsTobacco 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. ConclusionThe 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.

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?

BackgroundThis 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. MethodsData 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. FindingsAmong 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. ConclusionThe 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.

The Potential Reach of Opioid Substitution Settings to Deliver HCV Care to People Who Inject Drugs in Australia

BackgroundRecent efforts in Australia to engage people who inject drugs (PWID) in hepatitis C (HCV) care have focussed on opioid substitution treatment (OST) services as a delivery site. This approach potentially excludes non-opioid using PWID. This study aimed to determine differences between those currently receiving OST and those not among a sample of PWID. MethodsAdditional questions on HCV testing were included in the 2013 Illicit Drug Reporting System (IDRS), an annual sentinel surveillance system. The IDRS recruits PWID in all Australian capital cities from a range of sources, predominantly needle and syringe programs. All participants are reimbursed AUD$40 for a ~45minute interview-administered survey. ResultsCurrent OST was reported by 44% of the total sample, and two-thirds reported an opioid as their drug of choice. Those participants who reported current OST were significantly more likely than those not in OST to report heroin as their drug of choice (65% vs. 43%, p<0.0.001) and the drug injected most often (53% vs. 30%, p<0.001). Compared to those in OST, those not in OST were more likely to report methamphetamine as their drug of choice (29% vs. 14%, p<0.001) or drug injected most often (33% vs. 17%, p<0.001). Current OST clients were more likely to have been tested for HCV antibodies (anti-HCV) than those not in OST (96% vs. 93%, p<0.05) and to report an anti-HCV positive result (75% vs. 64%, p<0.001). Those receiving OST were no more likely than those not to undergo further HCV-related testing (e.g. RNA) (62% vs. 56%, p=0.136). Both groups reported further HCV-related testing was undertaken primarily at a community general practice. DiscussionDespite a large proportion of current PWID receiving OST, there remains a substantial minority who are neither seeking nor eligible for treatment. Efforts to improve access to HCV care for PWID in Australia therefore need to be expanded beyond OST, especially given the large proportion of participants who reported inadequate HCV testing.

‘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.

Oral health-related quality of life among an Australian sample of people who inject drugs.

People who inject drugs (PWID) have poor oral health. However, their oral health-related quality of life (OHRQoL) is unknown. Our study was designed to measure the OHRQoL of PWID. The Oral Health Impact Profile-14 (OHIP-14) was administered to 794 PWID recruited in Australian capital cities as part of the 2013 Illicit Drug Reporting System (IDRS). Three OHIP-14 summary indicators were examined: "Prevalence" (proportion reporting ≥1 item at least "fairly often"), "severity" (mean total OHIP-14 score), and "extent" (number of impacts reported at least "fairly often"). Associations between "prevalence" and "extent" and variables drawn from the health, drug use, and social domains were investigated. All OHIP-14 summary indicators among IDRS participants were significantly higher than in the general Australian population. In multivariate analysis, the "prevalence" indicator was significantly and positively associated with female gender [adjusted odds ratio (AOR) = 1.75, 95% CI 1.27-2.38], those born in Australia (AOR = 2, 95% CI 1.25-3.23), not completing Year 10 compared with those who had completed Year 12 or a higher qualification (AOR = 1.59, 95% CI 1.03-2.44), and methadone treatment (AOR = 1.61, 95% CI 1.14-2.29). The "extent" indicator was significantly and positively associated with female gender [adjusted incidence rate ratio (AIRR) = 1.56, 95% CI 1.19-2.08], unemployment (AIRR = 1.59, 95% CI 1.01-2.44), and having an injecting career of 10-20 years (AIRR = 1.76, 95% CI 1.03-3.01). PWID have poorer OHRQoL than the Australian general population. Poor OHRQoL was particularly common in female PWID and those with longer injecting careers. Interventions to improve the oral health of PWID may improve their OHRQoL.

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

ObjectiveTo examine the prevalence, correlates and motivations for the commission of property and violent crime amongst a sample of people who inject drugs (PWID). MethodData were obtained from the 2013 Illicit Drug Reporting System (IDRS), which includes a cross-sectional sample of 887 PWID. ResultsEighteen 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). ConclusionCriminal 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.

Changes in Australian injecting drug users’ mental health problems and service uptake from 2006-2012

Purpose – The purpose of this paper is to assess changes in rates of mental health problems and service utilisation for Australian regular injecting drug users (IDUs) from 2006 to 2012. Design/methodology/approach – Data were taken from Illicit Drug Reporting System national surveys with 914 regular IDUs in 2006 and 883 in 2012. Changes in rates of self-reported mental health problems and service use were assessed. Findings – Rates of self-reported mental health problems increased from 38.3 per cent in 2006 to 43.7 per cent in 2012 – mainly due to increases in anxiety rates. Conversely, there was a decrease in mental health service use from 70.2 to 58.4 per cent by 2012. However, there was a proportional increase in the use of psychologists. These trends remained after controlling for socio-demographic and medical differences between the 2006/2012 samples. K10 scores for 2012 participants validated the use of the self-report measures. Practical implications – Reductions in stigma, improvements in mental health literacy, and modest increases in anxiety may explain increases in self-report of mental health problems. Stagnant service utilisation rates in an expanding population willing to self-report may explain decreasing service use. The introduction of key mental health reforms also may have contributed, particularly with the increase in psychologist access. This paper highlights the need for improved population monitoring of mental health in disadvantaged groups such as IDUs. Originality/value – This paper is the first to assess changes in mental health outcomes over time in Australian IDUs. This examination covered a critical era in the mental health landscape, with significant increases in public awareness campaigns and major mental health reforms.

'Trafficking' or 'personal use': do people who regularly inject drugs understand Australian drug trafficking laws?

Legal thresholds for drug trafficking, over which possession of an illicit drug is deemed 'trafficking' as opposed to 'personal use', are employed in all Australian states and territories excepting Queensland. In this paper, we explore the extent to which people who regularly inject drugs understand such laws. Participants from the seven affected states/territories in the 2012 Illicit Drug Reporting System (n = 823) were asked about their legal knowledge of trafficking thresholds: whether, if arrested, quantity possessed would affect legal action taken; and the quantities of heroin, methamphetamine, cocaine and cannabis that would constitute an offence of supply. Data were compared against the actual laws to identify the accuracy of knowledge by drug type and state, and sociodemographics, use and purchasing patterns related to knowledge. Most Illicit Drug Reporting System participants (77%) correctly said that quantity possessed would affect charge received. However, only 55.8% nominated any specific quantity that would constitute an offence of supply, and of those 22.6% nominated a wrong quantity, namely a quantity that was larger than the actual quantity for supply (this varied by state and drug). People who regularly inject drugs have significant gaps in knowledge about Australian legal thresholds for drug trafficking, particularly regarding the actual threshold quantities. This suggests that there may be a need to improve education for this population. Necessity for accurate knowledge would also be lessened by better design of Australian drug trafficking laws.

Monitoring drug markets in the Internet age and the evolution of drug monitoring systems in Australia

In Australia, drug monitoring systems have been in place for more than a decade allowing for the measurement of ongoing trends in drug use and the detection of new drugs. The Drug Trends Unit at the National Drug and Alcohol Research Centre monitors drugs through four separate systems. The Illicit Drug Reporting System (IDRS) measures the price, purity, and availability of drugs that are primarily injected. The Ecstasy and Related Drugs Reporting System (EDRS) monitors psychostimulants that are used recreationally. The National Illicit Drugs Indicator Project (NIDIP) analyzes indicator data including drug-related hospitalizations and deaths. Finally, the Drugs and Emerging Technologies Project (DNeT) analyzes the role of the Internet in the procurement and use of novel psychoactive substances. This paper provides an overview of each component of the system, demonstrating how the system has evolved over time.

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.

Public opinion and drug policy in Australia: Engaging the ‘affected community’

Policy should be informed by the people it directly affects; however, the voices of people who use illicit drugs have been marginalised from drug policy debate. In Australia, the majority of survey data regarding attitudes to drug policy are collected at the population level and the opinions of people who inject drugs remain underexplored. This study aimed to investigate how people who inject drugs perceive drug policy in Australia and whether these opinions differ from those of the broader general population. Drug-related policy questions were drawn from the National Drug Strategy Household Survey (NDSHS) and added to the 2011 Illicit Drug Reporting System (IDRS) Survey (n = 868). The results were analysed for the full IDRS sample and by recent drug use. IDRS responses were compared with the general population using the 2010 NDSHS. There was a high level of support among IDRS participants for measures to reduce the problems associated with heroin, but heterogeneity in levels of support for legalisation and penalties for sale/supply across different drug types. Differences between the opinions of the IDRS sample and the NDSHS sample were identified regarding support for harm reduction, treatment, legalisation and penalties for sale/supply. These findings provide a springboard for further investigation of the attitudes of people who use illicit drugs towards drug policy in Australia, and challenge us to conceptualise how the opinions of this community should be solicited, heard and balanced in drug policy processes.

Measuring research influence on drug policy: A case example of two epidemiological monitoring systems

BackgroundAssessing the extent to which drug research influences and impacts upon policy decision-making needs to go beyond bibliometric analysis of academic citations. Policy makers do not necessarily access the academic literature, and policy processes are largely iterative and rely on interactions and relationships. Furthermore, media representation of research contributes to public opinion and can influence policy uptake.In this context, assessing research influence involves examining the extent to which a research project is taken up in policy documents, used within policy processes, and disseminated via the media. MethodsThis three component approach is demonstrated using a case example of two ongoing illicit drug monitoring systems: the Illicit Drug Reporting System (IDRS) and the Ecstasy and related Drugs Reporting System (EDRS). Systematic searches for reference to the IDRS and/or EDRS within policy documents, across multiple policy processes (such as parliamentary inquiries) and in the media, in conjunction with analysis of the types of mentions in these three sources, enables an analysis of policy influence. The context for the research is also described as the foundation for the approach. ResultsThe application of the three component approach to the case study demonstrates a practical and systematic retrospective approach to measure drug research influence. For example, the ways in which the IDRS and EDRS were mentioned in policy documents demonstrated research utilisation. Policy processes were inclusive of IDRS and EDRS findings, while the media analysis revealed only a small contribution in the context of wider media reporting. ConclusionConsistent with theories of policy processes, assessing the extent of research influence requires a systematic analysis of policy documents and processes. Development of such analyses and associated methods will better equip researchers to evaluate the impact of research.

The use of alprazolam by people who inject drugs in Melbourne, Australia

In Australia, people who inject drugs (PWID) commonly report the use of benzodiazepines (BZDs). This paper explores the emerging use of alprazolam among PWID in Melbourne, Australia. This study reports on 3 years of data collected through the Victorian Illicit Drug Reporting System (2008-2010). Structured interviews were conducted with 451 PWID and analysed using odds ratios and χ(2)-tests for trends over time. While the proportion of PWID reporting recent BZD use remained stable over time, the proportion reporting alprazolam to be their most commonly used BZD fluctuated, peaking in 2009. Alprazolam users were significantly more likely to report using illicit BZDs and to report recent BZD injection compared with users of other BZDs. Alprazolam use was associated with the sale of drugs for cash, but not with other criminal activities. The fluctuations in alprazolam use over time may be reflective of medical practitioners ceasing to prescribe alprazolam in response to reports of associated harms; however, this may in turn be driving the illicit alprazolam market. While the data do not indicate a clear association between alprazolam use and harms, considering the potential severity of associated harms and the association between alprazolam use and anterograde amnesia, patterns of alprazolam use among PWID should be closely monitored. Potential changes to prescribing practice should consider unintended consequences, such as replacement with other BZD types, or illicitly obtained BZDs.

The Australian Illicit Drug Reporting System: Monitoring Trends in Illicit Drug Availability, Use and Drug-Related Harm in Australia 1996–2006

We describe trends in illicit drug use revealed by the Australian Illicit Drug Reporting System (IDRS) between 1996 and 2006. We begin by briefly outlining the rationale, development, and testing of the IDRS, which integrates information from: interviews with a sentinel population of injecting drug users (IDU); key experts in health and law enforcement; and indicators that include information on drug purity and price, plus indicators of drug-related harm, such as fatal and nonfatal overdoses. These sources of information are critically discussed at annual meetings of researchers, policy makers and practitioners in the field. We describe what the IDRS has revealed about the use of heroin, cocaine, methamphetamines, and injected pharmaceutical preparations (opioids and benzodiazepines) over the period 1996–2006. We also illustrate how IDRS data can be combined with pharmaceutical prescription data to evaluate the effectiveness of policies designed to reduce benzodiazepine injecting. We also very briefly describe recent experience with monitoring trends on “dance party” drug use that extends the methods of IDRS by combining data from interviews with party drug users, key experts, and leading indicators of drug use.