Trends and characteristics of accidental and intentional codeine overdose deaths in Australia

Examines trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths. Abstract Objectives: To examine trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths. Design and setting: Analysis of prospectively collected data from the National Coronial Information System on deaths where codeine toxicity was determined to be an underlying or contributory cause of death. The study period was 2000–2013. Main outcome measures: Population-adjusted numbers (per million persons) of (1) codeine-related deaths, classified by intent (accidental or intentional); and (2) heroin- and Schedule 8 opioid-related deaths (as a comparator). Results: The overall rate of codeine-related deaths increased from 3.5 per million in 2000 to 8.7 per million in 2009. Deaths attributed to accidental overdoses were more common (48.8%) than intentional deaths (34.7%), and their proportion increased during the study period. High rates of prior comorbid mental health (53.6%), substance use (36.1%) and chronic pain (35.8%) problems were recorded for these deaths. For every two Schedule 8 opioid-related deaths in 2009, there was one codeine-related death. Most codeine-related deaths (83.7%) were the result of multiple drug toxicity. Conclusions: Codeine-related deaths (with and without other drug toxicity) are increasing as the consumption of codeine-based products increases. Educational messages are needed to better inform the public about the potential harms of chronic codeine use, especially in the context of polypharmacy

Symptom screening scales for detecting major depressive disorder in children and adolescents: A systematic review and meta-analysis of reliability, validity and diagnostic utility

Background Depression symptom screening scales are often used to determine a clinical diagnosis of major depressive disorder (MDD) in prevention research. The aim of this review is to systematically examine the reliability, validity and diagnostic utility of commonly used screening scales in depression prevention research among children and adolescents

The influence of personality disorder on the future mental health and social adjustment of young adults:a population-based cohort study

BackgroundExisting knowledge about the consequences of personality disorders (PD) is substantially derived from the study of clinical populations. This paper reports findings from a large, population-based, longitudinal study of the long-term mental health and social consequences of PD.MethodsCommunity-based, longitudinal study of a stratified random sample of 1635 non-treatment seeking young adults recruited from Victoria, Australia. Presence and severity of PD was assessed at age 24 years, using a semi-structured, informant-based interview (the Standardised Assessment of Personality). Psychosocial outcomes were assessed at age 35 years.OutcomesAt age 24 years, 28% (n=458) of the sample had either personality difficulties or PD. The severity of PD was associated with absence of a degree or vocational qualification, the presence of common mental disorders and cigarette smoking. At age 35 years, PD severity was independently associated with not being in a relationship (adjusted odds ratio (aOR) for the effect of complex and severe PD vs. no PD or personality difficulty: 2.05, 95% CI: 1·21-3·45), increased odds of an anxiety disorder (aOR: 2·27, 95% CI: 1·20-4·28) and major depression (aOR: 2·23, 95% CI: 1·24-4·01).InterpretationThe presence of PD predicts the occurrence of later anxiety and depression, as well as the absence of long-term relationships, effects that are not attributable to pre-existing common mental disorder. The study provides strong support for including PD in global studies of the burden of mental disorders.FundingThe research was supported by grants from Australia’s National Health and Medical Research Council (NH&MRC) and Victoria’s Operational Infrastructure Support Program

La política antidrogas: nuevos horizontes de cambio en el control de la oferta y la demanda

96 p.De acuerdo con la Organización Mundial de la Salud (OMS, 1994) una sustancia o droga psicoactiva es aquella que, al ingerirse, afecta procesos mentales, como la cognición o la memoria. El término es asemejado generalmente con el de psicotrópico y ambas expresiones refieren al grupo de sustancias, legales e ilegales, de interés para la política en materia de drogas. En general, la literatura refiere con el término psicotrópico, a medicamentos utilizados principalmente en el tratamiento de los trastornos mentales, como los ansiolíticos, sedantes, antidepresivos, anti maníacos y neurolépticos. Bajo la categoría de sustancias psicotrópicas se encuentran los estupefacientes, acepción utilizada para referirse a sustancias cuya acción sedante, analgésica, narcótica y euforizante puede conducir al acostumbramiento y a la toxicomanía, por lo cual tienen un elevado potencial de abuso y / o dependencia psíquica/física. Entre ellos, se cuentan los estimulantes -cocaína, cafeína, nicotina-, los alucinógenos -Peyote y Psilocybes, los opiáceos -morfina, heroína-, y los sedantes/hipnóticos -alcohol- (OMS, 1994).Prólogo Introducción Capítulo 1. El panorama global: evolución reciente del fenómeno del consumo de sustancias psicoactivas Capítulo 2. La junta internacional de fiscalización de estupefacientes y la eficacia de la política antidrogas: el caso colombiano Capítulo 3. Hacia nuevos horizontes del análisis de política antidrogas Conclusiones Bibliografí

A typology of predictive risk factors for non-adherent medication-related behaviors among chronic non-cancer pain patients prescribed opioids: a cohort study

Background: There has been no previous prospective examination of the homogeneity of chronic non-cancer pain (CNCP) patients in risk factors for non-adherent opioid use

Monograph No. 10: DATA SOURCES ON ILLICIT DRUG USE AND HARM IN AUSTRALIA

This Monograph (No. 10) provides a description and review of the routinely-collected data sources available in Australia that capture information on illicit drug use and related harms. Based on work undertaken at the National Drug and Alcohol Research Centre and Turning Point Alcohol and Drug Centre, it is intended as a reference document to provide interested persons with a guide to the type and nature of the information available in Australia. It reviews available data across four main domains; patterns and prevalence of use, health consequences, market characteristics and drug crime. For a review of information available on the economic aspects of illicit drug use and harm see Monograph 09 of this series

Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort of young adults

Context: Prospective cohort studies have identified an association between cannabis use and later psychosis-related outcomes, but concerns remain about unmeasured confounding variables. The use of sibling pair analysis reduces the influence of unmeasured residual confounding

Drug use and risk behaviours among injecting drug users: a comparison between sex workers and non-sex workers in Sydney, Australia

BACKGROUND: This paper examines the differences in demographics, drug use patterns and self reported risk behaviours between regular injecting drug users (IDU) who report engaging in sex work for money or drugs and regular injecting drug users who do not. METHODS: Cross sectional data collected from regular IDU interviewed as part of the New South Wales (NSW) Illicit Drug Reporting System (IDRS) in 2003 were analysed. RESULTS: IDU who reported engaging in sex work were more likely to be female, and identify as being of Aboriginal and/or Torres Strait Islander descent. They initiated injecting drug use at a significantly younger age and were more likely to report injection related problems than IDU who had not engaged in sex work. There were no differences in the drug classes used, but findings suggested that the sex workers tended to be more frequent users of crystalline methamphetamine (ice) and benzodiazepines. CONCLUSION: The similarities between these groups were more striking than the differences. Further research, examining a larger sample is needed to clarify whether injecting drug users who are sex workers have heavier use patterns

The effect of person, treatment and prescriber characteristics on retention in opioid agonist treatment:a 15-year retrospective cohort study

AbstractBackground and Aims: There is limited evidence on the relationship between retention in opioid agonist treatment for opioid dependence and characteristics of treatment prescribers. This study estimated retention in buprenorphine and methadone treatment and its relationship with person, treatment, and prescriber characteristics. Design: Retrospective longitudinal study.Setting: New South Wales, Australia.Participants: People entering the opioid agonist treatment program for the first time between August 2001 and December 2015.Measurements: Time in opioid agonist treatment (primary outcome) was modelled using a generalised estimating equation model to estimate associations with person, treatment, and prescriber characteristics. Findings: The impact of medication type on opioid agonist treatment retention reduced over time; risk of leaving treatment when on buprenorphine compared with methadone was higher among those that entered treatment earlier (e.g. 2001-2003: OR 1.59, 95% CI 1.44-1.74) and lowest among those that entered most recently (2013-2015: OR 1.24, 95% CI 1.12-1.37). In adjusted analyses, risk of leaving was reduced among people whose prescriber had longer tenure of prescribing (e.g. 3 versus 8 years: OR 0.94, 95% CI 0.93-0.95) compared with prescribers with shorter tenure. Aboriginal and Torres Strait Islander people, being of younger age, past-year psychosis disorder, and having been convicted of more criminal charges in the year prior to treatment entry were associated with increased risk of leaving treatment. Conclusion: In New South Wales, Australia, retention in buprenorphine treatment for opioid dependence, compared with methadone, has improved over time since its introduction in 2001. Opioid agonist treatment (OAT) retention is affected not only by characteristics of the person and his or her treatment, but also of the prescriber, with those of longer prescribing tenure associated with increased retention of people in OAT. <br/