Australian’s cocaine use is at record levels. Large increases occurred between 2016–2019, with significant increases predominately found among employed Australians. Patterns, and prevalence of ...workers’ cocaine use were examined using the 2016 and 2019 National Drug Strategy Household Survey data via frequency analyses. Logistic regression modelling identified predictors of employed Australian’s: cocaine use (2019); and increased use over time (2016–2019). Workers’ cocaine use increased 63% between 2016–2019 (3.8%–6.2%). Predictors of use, and increased use, were age, marital status, state, remoteness, smoking status, alcohol use, and cocaine approval level. Income and psychological distress predicted cocaine use in 2019 only. Highest prevalence in 2019 occurred among workers who approved of regular cocaine use (47.9%), currently smoked (14.9%), were very highly distressed (14.0%), risky alcohol consumers (13.7%), and aged 18–24 years (13.9%). Numerous individual-level characteristics influence workers’ cocaine use. Workplace cultural norms and substance use climates may facilitate increased cocaine use. The workplace is a powerful setting for cocaine prevention and intervention efforts. Potential strategies include targeting social norms, shifting positive drug use workplace cultures, and providing health and safety training focussing on the risk of use to self and co-workers whilst also examining demographic subgroups’ motivations for use.
Following changes to drug criminalization policies, we re-examine the epidemiology of drug arrests among people who use drugs (PWUD) in the U.S.
Serial cross-sectional data from the National Survey ...on Drug Use and Health (2015–2019) were utilized. Past-year illicit drug use (excluding cannabis) and drug arrests were described by year, area of residence, drug use characteristics and participant demographics. Adjusted associations between race and drug arrest were estimated using multivariable logistic regression.
Past-year illicit drug use remained consistent over time and was highest among non-Hispanic (NH) white respondents. Of those reporting past-year illicit drug use (n = 25,429), prevalence of drug arrests remained stable over time overall and in metro areas while increasing in non-metro areas. Arrests were elevated among NH Black participants and those with lower income, unemployment, housing transience, non-metro area residence, polysubstance use, history of drug injection, substance use dependence and past-year drug selling. Adjusted odds of drug arrest remained significantly higher among NH Black individuals aOR 1.92, 95% CI 1.30, 2.84.
Despite recent shifts away from punitive drug policies, we detected no reduction in drug arrests nationally and increasing prevalence in non-metro areas. Despite reporting the lowest level of illicit substance use and drug selling, NH Black individuals had significantly increased odds of arrest across years. Findings highlight the need for further examination of policy implementation and policing practices in different settings, with more research focused non-metro areas, to address enduring structural racism in drug enforcement and its consequences for health.
•Arresting people who use drugs exacerbates health risks and racial disparities.•Several policies have been implemented to prevent low-level drug arrests in the US.•We re-examine the epidemiology of drug arrests using nationally representative data.•We observed no overall reductions and persisting racial disparities in arrest.•Findings show enduring structural racism in drug enforcement, despite policy reforms.
Background and Aims
Studies often rely upon self‐report and biological testing methods for measuring illicit drug use, although evidence for their agreement is limited to specific populations and ...self‐report instruments. We aimed to examine comprehensively the evidence for agreement between self‐reported and biologically measured illicit drug use among all major illicit drug classes, biological indicators, populations and settings.
Methods
We systematically searched peer‐reviewed databases (Medline, Embase and PsycINFO) and grey literature. Included studies reported 2 × 2 table counts or agreement estimates comparing self‐reported and biologically measured use published up to March 2022. With biological results considered to be the reference standard and use of random‐effect regression models, we evaluated pooled estimates for overall agreement (primary outcome), sensitivity, specificity, false omission rates (proportion reporting no use that test positive) and false discovery rates (proportion reporting use that test negative) by drug class, potential consequences attached to self‐report (i.e. work, legal or treatment impacts) and time‐frame of use. Heterogeneity was assessed by inspecting forest plots.
Results
From 7924 studies, we extracted data from 207 eligible studies. Overall agreement ranged from good to excellent (> 0.79). False omission rates were generally low, while false discovery rates varied by setting. Specificity was generally high but sensitivity varied by drug, sample type and setting. Self‐report in clinical trials and situations of no consequences was generally reliable. For urine, recent (i.e. past 1–4 days) self‐report produced lower sensitivity and false discovery rates than past month. Agreement was higher in studies that informed participants biological testing would occur (diagnostic odds ratio = 2.91, 95% confidence interval = 1.25–6.78). The main source of bias was biological assessments (51% studies).
Conclusions
While there are limitations associated with self‐report and biological testing to measure illicit drug use, overall agreement between the two methods is high, suggesting both provide good measures of illicit drug use. Recommended methods of biological testing are more likely to provide reliable measures of recent use if there are problems with self‐disclosure.
This study examined the relationship between sexual identities and perception of risks associated with illicit drug use among a nationally representative sample of US adults.
We analyzed data from ...five waves of the National Survey on Drug Use and Health (NSDUH 2015-2019), with 205,418 adult participants. Six survey questions assessing participants’ perceptions of the risks associated with illicit drug use (LSD, heroin, and cocaine) were subjected to principal component analysis. Sex-stratified ordered logistic regressions were used to explore potential disparities in perceptions regarding the risk associated with illicit drug use among sexual minority identifiers.
Among male participants, approximately 11.3% and 1.8% of them perceived illicit drug use as moderate and low risks, respectively. About 6.0% of female participants perceived illicit drug use as moderate risks, and 1.1% of female participants perceived it as low risk. The sex-stratified regression models demonstrated that participants who identified as lesbian/gay or bisexual all had higher odds of reporting low perception of illicit drug use risks as compared to their heterosexual counterparts (all p < 0.01).
Illicit drug use prevention strategies should consider risk perception disparities by sexual minority populations.
Trouble seems to be characteristic of contemporary politics and life. From the environment to the pandemic, crises of political credibility around the world, conflict on social media and the drama of ...so-called “cancel culture”, avoiding or settling trouble seems more unimaginable than ever. Yet, as the theme of this conference makes clear, trouble is not always negative, especially when posed in verb form. To trouble preconceptions, orthodoxies or alienating norms can be productive, exciting and transformative. This is as much the case in research as in any other area of life. Troubling our founding assumptions, our research questions, our theories and methods is the way we move forward, even if it is not always easy or immediately rewarding. In this keynote presentation I will reflect on my own engagements with forms of scholarly trouble, drawing on the work of Donna Haraway in her book Staying with the trouble (2018) to identify key ways in which we as researchers may “embrace trouble” in useful and productive ways. Thinking through some central propositions articulated by Haraway in her engagement with other scholars, such as the importance of storytelling, the value of grieving, and the uses of response-ability, I will offer a range of examples drawn from my own work in critical drug studies and ontopolitical research to highlight the promises and pitfalls of trouble. In doing so, I aim to acknowledge the opportunities I have enjoyed over the years to be part of the innovative and courageous field of critical drug studies, of which the Contemporary Drug Problems conference is also an important part.
Objective
The unprecedented rise in synthetic drugs, many containing unknown toxic agents, has made timely analytical diagnosis more difficult, and has reduced the confidence of clinicians providing ...ED management to this population of patients. This has also impacted the quality of evidence informing harm reduction responses. The Emerging Drugs Network of Australia (EDNA) brings together emergency physicians, toxicologists and forensic laboratories to establish a standardised ED toxicosurveillance system in Australia.
Methods
Blood analysis of intoxicated patients will be conducted by forensic laboratories to enable precise identification of the substances causing acute toxicity. This will be linked with clinical data collected at the time of ED presentation to enable analysis of the clinical effects and outcomes associated with different illicit and emerging drugs. Toxicological and clinical data collected across sentinel sites will align with a nationally endorsed minimum dataset.
Results
EDNA's collaborative network will establish a national system of surveillance and reporting of illicit and emerging drugs causing acute toxicity. Standardisation of data collection recorded in a national clinical registry will provide more robust data on epidemiology and associated harms. This will facilitate the translation of clinical and toxicological evidence into timely, appropriate harm reduction and policy.
Conclusion
Our work represents a collaborative response to calls for more sophisticated data on emerging drug trends in Australia. EDNA will improve coordination between clinicians and analytical services by way of its standardised approach to surveillance and reporting.
The Emerging Drugs Network of Australia (EDNA) brings together emergency physicians, toxicologists and forensic laboratories to establish a standardised ED toxicosurveillance system in Australia. Standardisation of data collection recorded in a national clinical registry will provide more robust data on epidemiology and associated harms. This will facilitate the translation of clinical and toxicological evidence into timely, appropriate harm reduction and policy.
Recently, a mathematical model describing the illicit drug consumption in a population consisting of drug users and non-users has been proposed. The model describes the dynamics of non-users, ...experimental users, recreational users, and addict users within a population. The aim of this work is to propose a modified version of this model by analogy with the classical predator-prey models, in particular considering non-users as prey and users as predator. Hence, our model includes a stabilizing effect of the growth rate of the prey, and a destabilizing effect of the predator saturation. Functional responses of Verhulst and of Holling type II have been used for modeling these effects. To forecast the marijuana consumption in the states of Colorado and Washington, we used data from Hanley (2013) and a genetic algorithm to calibrate the parameters in our model. Assuming that the population of non-users increases in proportion with the demography, and following the seminal works of Sir Robert May (1976), we use the growth rate of non-users as the main bifurcation parameter. For the state of Colorado, the model first exhibits a limit cycle, which agrees quite accurately with the reported periodic data in Hanley (2013). By further increasing the growth rate of non-users, the population then enters into two chaotic regions, within which the evolution of the variables becomes unpredictable. For the state of Washington, the model also exhibits a periodic solution, which is again in good agreement with observed data. A chaotic region for Washington is likewise observed in the bifurcation diagram. Our research confirms that mathematical models can be a useful tool for better understanding illicit drug consumption, and for guiding policy-makers towards more effective policies to contain this epidemic.
Purpose of Review
Supervised drug consumption facilities (SCFs) have increasingly been implemented in response to public health and public order concerns associated with illicit drug use. We ...systematically reviewed the literature investigating the health and community impacts of SCFs.
Recent Findings
Consistent evidence demonstrates that SCFs mitigate overdose-related harms and unsafe drug use behaviours, as well as facilitate uptake of addiction treatment and other health services among people who use drugs (PWUD). Further, SCFs have been associated with improvements in public order without increasing drug-related crime. SCFs have also been shown to be cost-effective.
Summary
This systematic review suggests that SCFs are effectively meeting their primary public health and order objectives and therefore supports their role within a continuum of services for PWUD. Additional studies are needed to better understand the potential long-term health impacts of SCFs and how innovations in SCF programming may help to optimize the effectiveness of this intervention.
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