2024 |
Kendurkar A, Wilson J, Sunderland M, Dunlop A, Hayes C, Marel C, Mills KL, 'Is post-traumatic stress disorder a risk factor for development of opioid use disorder among individuals with chronic non-cancer pain? A systematic review', British Journal of Pain, 18 70-81 (2024) [C1]
Introduction: There is emerging evidence that posttraumatic-stress disorder may have mediating effects in development of chronic-non-cancer-pain and opioid-use-disorder independen... [more]
Introduction: There is emerging evidence that posttraumatic-stress disorder may have mediating effects in development of chronic-non-cancer-pain and opioid-use-disorder independently, but its impact on the development of opioid-use-disorder in people with chronic-non-cancer pain is still unclear. Objectives: (i) Estimate the risk of opioid-use-disorder among individuals with chronic-non-cancer-pain and posttraumatic-stress disorder, relative to those with chronic-non-cancer-pain only, and (ii) identify potential correlates of opioid-use-disorder among people with chronic-non-cancer-pain and posttraumatic-stress disorder. Methods: This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Longitudinal, epidemiological, cohort, follow-up, retrospective, prospective and cross-sectional studies reporting measures of variance on the likelihood of developing opioid-use-disorder with posttraumatic-stress disorder among individuals with chronic-non-cancer-pain were identified from six-electronic databases (Medline, Embase, Evidence-based Medicine reviews, PsycINFO, Scopus and Web of Science) until December 2022. Results: Three out of the four studies, which met the selection criteria for this analysis reported statistically significant positive association between risk of developing opioid-use-disorder with posttraumatic-stress disorder among chronic-non-cancer-pain cohort (unadjusted Relative-Risk range: 1.51¿5.27) but this association was not evident in the fourth study (adjusted Relative-Risk: 0.96; statistically non-significant), when adjusted for sociodemographic variables. The increased risk was noted particularly with females and chronic musculoskeletal pain conditions. Conclusions: Posttraumatic-stress disorder can increase the risk of development of opioid-use-disorder among people with chronic-non-cancer-pain and a better understanding of this relationship will help to predict and prevent the development of opioid-use-disorder and may also help in reducing the disability and burden associated with chronic-non-cancer-pain. Perspective: This review quantifies the risk of developing opioid-use-disorder in the context of posttraumatic-stress disorder among individuals with chronic-non-cancer-pain. Awareness and subsequent practice change will reduce the increasing global burden associated with the chronic-non-cancer-pain.
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2024 |
Stewardson AJ, Davis JS, Dunlop AJ, Tong SYC, Matthews GV, 'How I manage severe bacterial infections in people who inject drugs.', Clin Microbiol Infect, (2024) [C1]
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2024 |
Cheng Q, Valerio H, Cunningham EB, Shih STF, Silk D, Conway A, et al., 'Health-Related Quality of Life of People Who Inject Drugs: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study', Value in Health, 27 216-225 (2024)
Objectives: There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We evaluated the HRQoL and associated factors among a cohort ... [more]
Objectives: There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We evaluated the HRQoL and associated factors among a cohort of PWID in Australia. Methods: Participants were enrolled in an observational cohort study (the Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study) from May 2018 to September 2019 (wave 1) and November 2019 to June 2021 (wave 2). Participants completed the EQ-5D-5L survey at enrolment. Two-part models were used to assess the association of clinical and socioeconomic characteristics with EQ-5D-5L scores. Results: Among 2395 participants (median age, 43 years; 66% male), 65% reported injecting drug use in the past month, 20% had current hepatitis C virus (HCV) infection, and 68% had no/mild liver fibrosis (F0/F1). Overall, the mean EQ-5D-5L and EQ-visual analog scale scores were 0.78 and 57, respectively. In adjusted analysis, factors associated with significantly lower EQ-5D-5L scores include older ages, female (marginal effect = -0.03, P =.014), being homeless (marginal effect = -0.04, P =.040), and polysubstance use (marginal effect = -0.05, P <.001). Factors associated with significantly higher EQ-5D-5L scores were being Aboriginal/Torres Strait Islander (marginal effect = 0.03, P =.021) and recent injecting drug use in the past 12 months. Current HCV infection and liver fibrosis stage were not associated with reduced HRQoL among the study participants. Conclusions: PWID experienced a lower HRQoL compared with the general population. Further research is needed to understand HRQoL in this population to facilitate the development of multifaceted care models for PWID beyond HCV cure and inform health economic analyses for identifying optimal health strategies for PWID.
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2024 |
Stirling R, Hudson S, Ross J, Deans E, Tibbetts J, Day C, et al., 'Understanding the research capacity of alcohol and other drugs services in New South Wales, Australia.', Drug Alcohol Rev, 43 265-277 (2024) [C1]
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2023 |
Little S, White B, Moensted M, Butler K, Howard M, Roberts J, Dunlop A, 'Health and correctional staff acceptability of depot buprenorphine in NSW prisons.', Int J Drug Policy, 114 103978 (2023) [C1]
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2023 |
Black E, Mammen K, Deacon RM, Ezard N, Mills L, Dunlop AJ, et al., 'Health and social characteristics of clients reporting amphetamine type substance use at entry to public alcohol and other drug services in New South Wales, Australia, 2016 2019', Drug and Alcohol Review, 42 389-400 (2023) [C1]
Introduction: Amphetamine type substances (ATS) are commonly used by Australian alcohol and other drug service entrants. We describe demographic characteristics, patterns of ATS a... [more]
Introduction: Amphetamine type substances (ATS) are commonly used by Australian alcohol and other drug service entrants. We describe demographic characteristics, patterns of ATS and other substance use, health and social conditions among clients entering New South Wales (NSW) public alcohol and other drug services. Methods: Retrospective cohort of 13,864 records across six health districts (2016¿2019) for clients seeking substance use treatment. These districts service approximately 44% of the NSW population aged 15 years and over. Multivariate analysis was conducted on a subsample for whom full data were available (N¿=¿9981). Data included NSW Minimum Data Set for drug and alcohol treatment services and Australian Treatment Outcomes Profile items. Results: Over the preceding 4 weeks, 77% (n¿=¿10,610) of clients (N¿=¿13,864) reported no recent ATS use, 15% (n¿=¿2109) reported ¿low frequency¿ (1¿12 days) and 8% (n¿=¿1145) ¿high frequency¿ (13¿28 days) use. ATS use was most common among people attending for ATS or opioids as primary drug of concern. A multinomial regression (N¿=¿9981) identified that clients reporting recent arrest (aOR 1.74, 95% CI 1.36, 2.24), higher cannabis use frequency (aOR 1.01, 95% CI 1.00, 1.02), lower opioid use frequency (aOR 0.98, 95% CI 0.97, 0.99) and poorer quality of life (aOR 0.91, 95% CI 0.86, 0.97) were more likely to report ¿high frequency¿ rather than ¿low frequency¿ ATS use. Discussion and Conclusions: People who use ATS experience health and social issues that may require targeted responses. These should be integrated across all services, not only for clients with ATS as principal drug of concern.
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2023 |
Leung J, Chiu V, Man N, Yuen WS, Dobbins T, Dunlop A, et al., 'All-cause and cause-specific mortality in individuals with an alcohol-related emergency or hospital inpatient presentation: A retrospective data linkage cohort study.', Addiction, 118 1751-1762 (2023) [C1]
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2023 |
Black E, Bruno R, Mammen K, Mills L, Siefried KJ, Deacon RM, et al., 'Substance use, socio-demographic characteristics, and self-rated health of people seeking alcohol and other drug treatment in New South Wales: baseline findings from a cohort study.', Med J Aust, 219 218-226 (2023) [C1]
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2023 |
Deacon RM, Mills L, Bruno R, Mammen K, Dunlop A, Childs S, et al., 'Identifying thresholds for clinically meaningful change among clients of drug and alcohol services using the Australian Treatment Outcomes Profile.', Addiction, 118 2457-2465 (2023) [C1]
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2023 |
Gisev N, Pearson SA, Dobbins T, Buizen L, Murphy T, Wilson A, et al., 'Cohort profile: POPPY II - A population-based cohort examining the patterns and outcomes of prescription opioid use in New South Wales, Australia', BMJ Open, 13 (2023) [C1]
Purpose The POPPY II cohort is an Australian state-based cohort linking data for a population of individuals prescribed opioid medicines, constructed to allow a robust examination... [more]
Purpose The POPPY II cohort is an Australian state-based cohort linking data for a population of individuals prescribed opioid medicines, constructed to allow a robust examination of the long-term patterns and outcomes of prescription opioid use. Participants The cohort includes 3 569 433 adult New South Wales residents who initiated a subsidised prescription opioid medicine between 2003 and 2018, identified through pharmacy dispensing data (Australian Pharmaceutical Benefits Scheme) and linked to 10 national and state datasets and registries including rich sociodemographic and medical services data. Findings to date Of the 3.57 million individuals included in the cohort, 52.7% were female and 1 in 4 people were aged =65 years at the time of cohort entry. Approximately 6% had evidence of cancer in the year prior to cohort entry. In the 3 months prior to cohort entry, 26.9% used a non-opioid analgesic and 20.5% used a psychotropic medicine. Overall, 1 in 5 individuals were initiated on a strong opioid (20.9%). The most commonly initiated opioid was paracetamol/codeine (61.3%), followed by oxycodone (16.3%). Future plans The POPPY II cohort will be updated periodically, both extending the follow-up duration of the existing cohort, and including new individuals initiating opioids. The POPPY II cohort will allow a range of aspects of opioid utilisation to be studied, including long-term trajectories of opioid use, development of a data-informed method to assess time-varying opioid exposure, and a range of outcomes including mortality, transition to opioid dependence, suicide and falls. The duration of the study period will allow examination of population-level impacts of changes to opioid monitoring and access, while the size of the cohort will also allow examination of important subpopulations such as people with cancer, musculoskeletal conditions or opioid use disorder.
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2023 |
Wand H, Reilly R, McKetin R, Quinn B, Roe Y, Conigrave K, et al., 'Investigating associations between methamphetamine use, mental health and risky sexual behaviours amongst Aboriginal and Torres Strait Islander peoples', Mental Health and Prevention, 30 (2023) [C1]
Aboriginal and Torres Strait Islander communities have expressed significant concern about methamphetamine use and its associated harms. Additionally, there has been an increase i... [more]
Aboriginal and Torres Strait Islander communities have expressed significant concern about methamphetamine use and its associated harms. Additionally, there has been an increase in sexually transmitted infection (STI) notifications among Aboriginal and Torres Strait Islander people in recent years. This cross-sectional study explored associations between high STI risk sexual behaviour (HSRSB), methamphetamine and mental health among Aboriginal and Torres Strait Islander people who use methamphetamine. Multivariate logistic regression and population attributable risk that accounts for the correlation structures were used. Participants were 224 Aboriginal and Torres Strait Islander men (52%) and 209 women (48%). Those who used methamphetamine weekly or more were more than twice as likely to engage in HSRSB, compared to those who used methamphetamine less frequently (i.e. > weekly) (aOR: 2.10, 95% CI: 1.13, 3.90, and 2.73, 95% CI: 1.52, 4.93 for males and females respectively). Among other drugs, using ecstasy was also significantly associated with HSRSB in both genders (aOR: 3.97, 95% CI: 1.17, 13.42 and aOR: 5.32, 95% CI: 2.05, 13.82 for males and females). The combined impact of mental health conditions was substantially higher among females than males (PAR%: 46% and 27%, respectively). The findings may inform the targeting of health promotion programs for STI prevention towards those at higher risk due to methamphetamine use and mental health issues.
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2023 |
Cheng Q, Cunningham EB, Shih S, Amin J, Bruneau J, Artenie AA, et al., 'Patient-Reported Outcomes During and After Hepatitis C Virus Direct-Acting Antiviral Treatment Among People Who Inject Drugs.', Value Health, 26 883-892 (2023) [C1]
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Nova |
2023 |
Doherty E, Wiggers J, Wolfenden L, Tully B, Lecathelinais C, Attia J, et al., 'Differential effectiveness of a practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: Exploratory subgroup analyses within a randomised stepped-wedge controlled trial.', Midwifery, 116 103528 (2023) [C1]
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2023 |
Anagnostou N, Archuleta S, Athan E, Barina L, Best E, Bloomfield M, et al., 'The
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2023 |
Jackson MA, Brown AL, Baker AL, Bonevski B, Haber P, Bonomo Y, et al., 'Tobacco treatment incorporating contingency management, nicotine replacement therapy, and behavioral counseling for pregnant women who use substances: a feasibility trial.', Front Psychiatry, 14 1207955 (2023) [C1]
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2022 |
Dunlop AJ, White B, Roberts J, Cretikos M, Attalla D, Ling R, et al., 'Treatment of opioid dependence with depot buprenorphine (CAM2038) in custodial settings', ADDICTION, 117 382-391 (2022) [C1]
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2022 |
Yuen WS, Leung J, Man N, Chiu V, Gisev N, Livingston M, et al., 'Age at first alcohol-related hospital separation or emergency department presentation and rate of re-admission: A retrospective data linkage cohort of young Australians', DRUG AND ALCOHOL REVIEW, 41 1577-1588 (2022) [C1]
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Nova |
2022 |
Mammen K, Mills L, Deacon RM, Bruno R, Dunlop A, Holmes J, et al., 'Determining clinical cutoff scores for the Australian Treatment Outcomes Profile psychological health, physical health and quality of life questions.', Drug Alcohol Rev, 41 106-113 (2022) [C1]
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Nova |
2022 |
Skelton E, Lum A, Robinson M, Dunlop A, Guillaumier A, Baker A, et al., 'A pilot randomised controlled trial of abrupt versus gradual smoking cessation in combination with vaporised nicotine products for people receiving alcohol and other drug treatment.', Addictive behaviors, 131 107328 (2022) [C1]
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Nova |
2022 |
Jackson MA, Buykx P, Brown AL, Baker AL, Dunlop AJ, Gould GS, 'Using mixed methods to establish tobacco treatment acceptability from the perspective of clients and clinicians of antenatal substance use services', ADDICTION SCIENCE & CLINICAL PRACTICE, 17 (2022) [C1]
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2022 |
Jackson MA, Baker AL, Gould GS, Brown AL, Dunlop AJ, McCarter K, 'Smoking cessation interventions for pregnant women attending treatment for substance use disorders: A systematic review.', Addiction, 117 847-860 (2022) [C1]
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Nova |
2022 |
Valerio H, Alavi M, Conway A, Silk D, Treloar C, Martinello M, et al., 'Declining prevalence of current HCV infection and increased treatment uptake among people who inject drugs: The ETHOS Engage study', INTERNATIONAL JOURNAL OF DRUG POLICY, 105 (2022) [C1]
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2022 |
Montebello M, Jefferies M, Mills L, Bruno R, Copeland J, McGregor I, et al., 'Mood, sleep and pain comorbidity outcomes in cannabis dependent patients: Findings from a nabiximols versus placebo randomised controlled trial.', Drug Alcohol Depend, 234 109388 (2022) [C1]
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2022 |
Acheson LS, Ezard N, Lintzeris N, Dunlop A, Brett J, Rodgers C, et al., 'Trial protocol of an open label pilot study of lisdexamfetamine for the treatment of acute methamphetamine withdrawal', PLOS ONE, 17 (2022)
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2022 |
Szewczyk Z, Reeves P, Kingsland M, Doherty E, Elliott E, Wolfenden L, et al., 'Cost, cost-consequence and cost-effectiveness evaluation of a practice change intervention to increase routine provision of antenatal care addressing maternal alcohol consumption.', Implement Sci, 17 14 (2022) [C1]
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2022 |
Lum A, Skelton E, Robinson M, Guillaumier A, Wynne O, Gartner C, et al., 'Barriers and facilitators to using vaporised nicotine products as smoking cessation aids among people receiving treatment for substance use disorder', ADDICTIVE BEHAVIORS, 124 (2022) [C1]
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Nova |
2022 |
Tsang TW, Kingsland M, Doherty E, Anderson AE, Tully B, Crooks K, et al., 'Predictors of alcohol use during pregnancy in Australian women.', Drug Alcohol Rev, 41 171-181 (2022) [C1]
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Nova |
2022 |
McKenzie CRL, Davis J, Dunlop AJ, 'E-cigarette or vaping product use-associated lung injury in an adolescent', MEDICAL JOURNAL OF AUSTRALIA, 216 (2022)
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2022 |
Conway A, Valerio H, Alavi M, Silk D, Treloar C, Hajarizadeh B, et al., 'A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study', VIRUSES-BASEL, 14 (2022) [C1]
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2022 |
Mills L, Dunlop A, Montebello M, Copeland J, Bruno R, Jefferies M, et al., 'Correlates of treatment engagement and client outcomes: results of a randomised controlled trial of nabiximols for the treatment of cannabis use disorder', SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY, 17 (2022) [C1]
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Nova |
2022 |
Marshall AD, Conway A, Cunningham EB, Valerio H, Silk D, Alavi M, et al., 'Willingness of people who inject drugs to participate in a randomised controlled trial involving financial incentives to initiate hepatitis C treatment.', Drug Alcohol Depend, 235 109438 (2022) [C1]
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2022 |
Acheson LS, Ezard N, Lintzeris N, Dunlop A, Brett J, Rodgers C, et al., 'Lisdexamfetamine for the treatment of acute methamphetamine withdrawal: A pilot feasibility and safety trial', DRUG AND ALCOHOL DEPENDENCE, 241 (2022) [C1]
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Nova |
2022 |
Doherty E, Kingsland M, Elliott EJ, Tully B, Wolfenden L, Dunlop A, et al., 'Practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: a randomised stepped-wedge controlled trial', BMC PREGNANCY AND CHILDBIRTH, 22 (2022) [C1]
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Nova |
2022 |
Tsang TW, Kingsland M, Doherty E, Wiggers J, Attia J, Wolfenden L, et al., 'Effectiveness of a practice change intervention in reducing alcohol consumption in pregnant women attending public maternity services', SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY, 17 (2022) [C1]
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Nova |
2022 |
Wheeler A, Valerio H, Cunningham EB, Martinello M, Barocas JA, Colledge-Frisby S, et al., 'Prevalence and factors associated with hospitalisation for bacterial skin infections among people who inject drugs: The ETHOS Engage Study', Drug and Alcohol Dependence, 237 (2022) [C1]
Background: Injecting-related skin and soft tissue infections (SSTIs) are a preventable cause of inpatient hospitalisation among people who inject drugs (PWID). This study aimed t... [more]
Background: Injecting-related skin and soft tissue infections (SSTIs) are a preventable cause of inpatient hospitalisation among people who inject drugs (PWID). This study aimed to determine the prevalence of hospitalisation for SSTIs among PWID, and identify similarities and differences in factors associated with hospitalisation for SSTIs versus non-bacterial harms related to injecting drug use. Methods: We performed cross-sectional analyses of baseline data from an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Logistic regression models were used to identify factors associated with self-reported hospitalisation for (1) SSTIs (abscess and/or cellulitis), and (2) non-bacterial harms related to injecting drug use (e.g., non-fatal overdose; hereafter referred to as non-bacterial harms), both together and separately. Results: 1851 participants who injected drugs in the previous six months were enrolled (67% male; 85% injected in the past month; 42% receiving opioid agonist treatment [OAT]). In the previous year, 40% (n = 737) had been hospitalised for drug-related causes: 20% (n = 377) and 29% (n = 528) of participants were admitted to hospital for an SSTI and non-bacterial harm, respectively. Participants who were female (adjusted odds ratio [aOR]: 1.53, 95% CI: 1.19¿1.97) or homeless (aOR: 1.59, 95% CI: 1.16¿2.19) were more likely to be hospitalised for an SSTI, but not a non-bacterial harm. Both types of hospitalisation were more likely among people recently released from prison. Conclusions: Hospitalisation for SSTIs is common among PWID. Community-based interventions to prevent SSTIs and subsequent hospitalisation among PWID will require targeting of at-risk groups, including women, people experiencing homelessness, and incarcerated people upon prison release.
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Nova |
2022 |
Farrell M, Shahbazi J, Byrne M, Grebely J, Lintzeris N, Chambers M, et al., 'Outcomes of a single-arm implementation trial of extended-release subcutaneous buprenorphine depot injections in people with opioid dependence', International Journal of Drug Policy, 100 (2022) [C1]
Background: Opioid agonist treatment (OAT) is an effective intervention for opioid dependence. Extended-release buprenorphine injections (BUP-XR) may have additional potential ben... [more]
Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: Indivior. Trial registration: ClinicalTrials.gov Identifier: NCT03809143
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2022 |
Ling R, White B, Roberts J, Cretikos M, Howard M, Haber PS, et al., 'Depot buprenorphine as an opioid agonist therapy in New South Wales correctional centres: a costing model', BMC HEALTH SERVICES RESEARCH, 22 (2022) [C1]
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Nova |
2022 |
Doherty E, Wiggers J, Nathan N, Hall A, Wolfenden L, Tully B, et al., 'Iterative delivery of an implementation support package to increase and sustain the routine provision of antenatal care addressing alcohol consumption during pregnancy: study protocol for a stepped-wedge cluster trial', BMJ OPEN, 12 (2022)
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2021 |
Conway A, Valerio H, Peacock A, Degenhardt L, Hayllar J, Harrod ME, et al., 'Non-fatal opioid overdose, naloxone access, and naloxone training among people who recently used opioids or received opioid agonist treatment in Australia: The ETHOS Engage study.', Int J Drug Policy, 96 103421 (2021) [C1]
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2021 |
Farhoudian A, Radfar SR, Ardabili HM, Rafei P, Ebrahimi M, Zonoozi AK, et al., 'A Global Survey on Changes in the Supply, Price, and Use of Illicit Drugs and Alcohol, and Related Complications During the 2020 COVID-19 Pandemic', Frontiers in Psychiatry, 12 (2021) [C1]
Background and Aims: COVID-19 has infected more than 77 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populati... [more]
Background and Aims: COVID-19 has infected more than 77 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populations, including people with substance use disorders (SUDs). Quarantines, travel bans, regulatory changes, social distancing, and ¿lockdown¿ measures have affected drug and alcohol supply chains and subsequently their availability, price, and use patterns, with possible downstream effects on presentations of SUDs and demand for treatment. Given the lack of multicentric epidemiologic studies, we conducted a rapid global survey within the International Society of Addiction Medicine (ISAM) network in order to understand the status of substance-use patterns during the current pandemic. Design: Cross-sectional survey. Setting: Worldwide. Participants: Starting on April 4, 2020 during a 5-week period, the survey received 185 responses from 77 countries. Measurements: To assess addiction medicine professionals' perceived changes in drug and alcohol supply, price, use pattern, and related complications during the COVID-19 pandemic. Findings: Participants reported (among who answered ¿decreased¿ or ¿increased¿) a decrease in drug supply (69.0%) and at the same time an increase in price (95.3%) globally. With respect to changes in use patterns, an increase in alcohol (71.7%), cannabis (63.0%), prescription opioids (70.9%), and sedative/hypnotics (84.6%) use was reported, while the use of amphetamines (59.7%), cocaine (67.5%), and opiates (58.2%) was reported to decrease overall. Conclusions: The global report on changes in the availability, use patterns, and complications of alcohol and drugs during the COVID-19 pandemic should be considered in making new policies and in developing mitigating measures and guidelines during the current pandemic (and probable future ones) in order to minimize risks to people with SUD.
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2021 |
Jackson MA, Brown AL, Johnston J, Clancy R, McGregor I, Bruno R, et al., 'The use and effects of synthetic cannabinoid receptor agonists by New South Wales cannabis treatment clients.', Journal of cannabis research, 3 33 (2021) [C1]
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Nova |
2021 |
Iversen J, Peacock A, Price O, Byrne J, Dunlop A, Maher L, 'COVID-19 vaccination among people who inject drugs: Leaving no one behind', DRUG AND ALCOHOL REVIEW, 40 517-520 (2021)
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2021 |
Radfar SR, De Jong CAJ, Farhoudian A, Ebrahimi M, Rafei P, Vahidi M, et al., 'Reorganization of Substance Use Treatment and Harm Reduction Services During the COVID-19 Pandemic: A Global Survey', Frontiers in Psychiatry, 12 (2021) [C1]
Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their servi... [more]
Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic. Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health responses were categorized around (1) managerial measures and systems, (2) logistics, (3) service providers, and (4) vulnerable groups. Results: Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. Fifty-seven percent of overdose prevention interventions and 81% of outreach services were also negatively impacted. Conclusions: Participants reported that SUD treatment and harm-reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we highlight several issues and complications resulting from the pandemic concerning people with SUDs that should be tackled more efficiently during the future waves or similar pandemics. The issues and potential strategies comprise the following: (1) helping policymakers to generate business continuity plans, (2) maintaining the use of evidence-based interventions for people with SUDs, (3) being prepared for adequate medication supplies, (4) integrating harm reduction programs with other treatment modalities, and (5) having specific considerations for vulnerable groups such as immigrants and refugees.
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2021 |
Skelton E, Guillaumier A, Tzelepis F, Walsberger S, Paul CL, Dunlop AJ, et al., 'Alcohol and other drug health-care providers and their client's perceptions of e-cigarette use, safety and harm reduction', DRUG AND ALCOHOL REVIEW, 40 998-1002 (2021) [C1]
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Nova |
2021 |
Louie E, Morley KC, Giannopoulos V, Uribe G, Wood K, Marel C, et al., 'Implementation of a Multi-Modal Training Program for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings: Pathways to Comorbidity Care (PCC)', JOURNAL OF DUAL DIAGNOSIS, 17 304-312 (2021) [C1]
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2021 |
Cunningham EB, Hajarizadeh B, Amin J, Hellard M, Bruneau J, Feld JJ, et al., 'Reinfection Following Successful Direct-acting Antiviral Therapy for Hepatitis C Virus Infection among People Who Inject Drugs', Clinical Infectious Diseases, 72 1392-1400 (2021) [C1]
Background: The aim of this analysis was to calculate the incidence of hepatitis C virus (HCV) reinfection and associated factors among 2 clinical trials of HCV direct-acting anti... [more]
Background: The aim of this analysis was to calculate the incidence of hepatitis C virus (HCV) reinfection and associated factors among 2 clinical trials of HCV direct-acting antiviral treatment in people with recent injecting drug use or currently receiving opioid agonist therapy (OAT). Methods: Participants who achieved an end-of-treatment response in 2 clinical trials of people with recent injecting drug use or currently receiving OAT (SIMPLIFY and D3FEAT) enrolled between March 2016 and February 2017 in 8 countries were assessed for HCV reinfection, confirmed by viral sequencing. Incidence was calculated using person-time of observation and associated factors were assessed using Cox proportional hazard models. Results: Seventy-three percent of the population at risk of reinfection (n = 177; median age, 48 years; 73% male) reported ongoing injecting drug use. Total follow-up time at risk was 254 person-years (median, 1.8 years; range, 0.2-2.8 years). Eight cases of reinfection were confirmed for an incidence of 3.1/100 person-years (95% confidence interval [CI], 1.6-6.3) overall and 17.9/100 person-years (95% CI, 5.8-55.6) among those who reported sharing needles/syringes. Younger age and needle/syringe sharing were associated with HCV reinfection. Conclusions: These data demonstrate the need for ongoing monitoring and improved strategies to prevent HCV reinfection following successful treatment among people with ongoing injecting drug use to achieve HCV elimination. Clinical Trials Registration: NCT02336139 and NCT02498015.
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2021 |
Barnett A, Savic M, Lintzeris N, Bathish R, Arunogiri S, Dunlop AJ, et al., 'Tracing the affordances of long-acting injectable depot buprenorphine: A qualitative study of patients' experiences in Australia', DRUG AND ALCOHOL DEPENDENCE, 227 (2021) [C1]
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2021 |
Dunlop AJ, Lokuge B, Lintzeris N, 'Opioid prescribing in Australia: too much and not enough', MEDICAL JOURNAL OF AUSTRALIA, 215 117-118 (2021)
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2021 |
Best E, Lokuge B, Dunlop A, Dunford A, 'Unmet need for postpartum long-acting reversible contraception in women with substance use disorders and/or socioeconomic disadvantage', Australian and New Zealand Journal of Obstetrics and Gynaecology, 61 304-309 (2021) [C1]
Background: In Australia, it is estimated that 30% of pregnancies are unintended and 25% of pregnancies end in abortion. Unintended pregnancy can be particularly problematic for w... [more]
Background: In Australia, it is estimated that 30% of pregnancies are unintended and 25% of pregnancies end in abortion. Unintended pregnancy can be particularly problematic for women with substance use disorders (SUD) and/or socioeconomic disadvantage. Long-acting reversible contraception (LARC) including progestogen implants and intrauterine devices (IUD) are safe, affordable and extremely effective in decreasing rates of unintended pregnancy, yet are currently underutilised in Australia. Aims: To determine the current rate of unintended pregnancy, contraception counselling and postpartum LARC use in women who attend an antenatal clinic for SUD and/or socioeconomic disadvantage in pregnancy. We hypothesise that there is an unmet need for contraception in this population. Materials and Methods: We conducted a retrospective audit of women who birthed in a tertiary hospital in 2018 with SUD and/or additional social support needs. We recorded the rate of unintended pregnancy, the occurrence of antenatal and postpartum contraception counselling and the rate of immediate postpartum LARC uptake through review of our electronic medical database. Results: Of the 210 women in our study population, we identified a high proportion of unintended pregnancies (64%), a low rate of antenatal (11%) and postpartum (35%) contraception counselling, and a low uptake of immediate postpartum LARC use (3.3%), confirming an unmet need for contraception. Conclusions: Further intervention is required to enhance the access to immediate postpartum LARC and reduce the risk and health burden of unintended pregnancy.
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Nova |
2021 |
Deacon RM, Mammen K, Bruno R, Mills L, Dunlop A, Holmes J, et al., 'Assessing the concurrent validity, inter-rater reliability and test-re-test reliability of the Australian Treatment Outcomes Profile (ATOP) in alcohol and opioid treatment populations', ADDICTION, 116 1245-1255 (2021) [C1]
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Nova |
2021 |
Lintzeris N, Dunlop AJ, Haber PS, Lubman DI, Graham R, Hutchinson S, et al., 'Patient-Reported Outcomes of Treatment of Opioid Dependence With Weekly and Monthly Subcutaneous Depot vs Daily Sublingual Buprenorphine A Randomized Clinical Trial', JAMA NETWORK OPEN, 4 (2021) [C1]
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Nova |
2021 |
Valerio H, Alavi M, Silk D, Treloar C, Martinello M, Milat A, et al., 'Progress towards Elimination of Hepatitis C Infection among People Who Inject Drugs in Australia: The ETHOS Engage Study', Clinical Infectious Diseases, 73 E69-E78 (2021) [C1]
Background: Evaluating progress towards hepatitis C virus (HCV) elimination is critical. This study estimated prevalence of current HCV infection and HCV treatment uptake among pe... [more]
Background: Evaluating progress towards hepatitis C virus (HCV) elimination is critical. This study estimated prevalence of current HCV infection and HCV treatment uptake among people who inject drugs (PWID) in Australia. Methods: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage is an observational study of PWID attending drug treatment clinics and needle and syringe programs (NSPs). Participants completed a questionnaire including self-reported treatment history and underwent point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick; Cepheid). Results: Between May 2018 and September 2019, 1443 participants were enrolled (64% injected drugs in the last month, 74% receiving opioid agonist therapy [OAT]). HCV infection status was uninfected (28%), spontaneous clearance (16%), treatment-induced clearance (32%), and current infection (24%). Current HCV was more likely among people who were homeless (adjusted odds ratio, 1.47; 95% confidence interval, 1.00-2.16), incarcerated in the previous year (2.04; 1.38-3.02), and those injecting drugs daily or more (2.26; 1.43-2.42). Among those with previous chronic or current HCV, 66% (n = 520/788) reported HCV treatment. In adjusted analysis, HCV treatment was lower among females (.68;. 48-.95), participants who were homeless (.59;. 38-.96), and those injecting daily or more (.51;. 31-.89). People aged =45 years (1.46; 1.06-2.01) and people receiving OAT (2.62; 1.52-4.51) were more likely to report HCV treatment. Conclusions: Unrestricted direct-acting antiviral therapy access in Australia has yielded high treatment uptake among PWID attending drug treatment and NSPs, with a marked decline in HCV prevalence. To achieve elimination, PWID with greater marginalization may require additional support and tailored strategies to enhance treatment.
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Nova |
2021 |
Ezard N, Clifford B, Dunlop A, Bruno R, Carr A, Liu Z, et al., 'Safety and tolerability of oral lisdexamfetamine in adults with methamphetamine dependence: a phase-2 dose-escalation study', BMJ OPEN, 11 (2021) [C1]
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Nova |
2020 |
Tremain D, Freund M, Wolfenden L, Bowman J, Dunlop A, Bartlem K, et al., 'The provision of preventive care for modifiable health risk behaviours by clinicians within substance use treatment settings: A systematic review', PREVENTIVE MEDICINE, 130 (2020) [C1]
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Nova |
2020 |
Hindson J, Hanstock T, Dunlop A, Kay-Lambkin F, 'Internet-Delivered Tobacco Treatment for People Using Cannabis: A Randomized Trial in Two Australian Cannabis Clinics.', JMIR formative research, 4 (2020) [C1]
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Nova |
2020 |
Osborne SR, 'The Spinifex Network engages place-based researchers to identify research priorities to improve the health and wellbeing of communities living in regional, rural and remote Australia', MEDICAL JOURNAL OF AUSTRALIA, 213 S3-+ (2020)
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2020 |
Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, et al., 'Rapid realist review of opioid tapering in the context of long term opioid use for non-cancer pain in rural areas', MEDICAL JOURNAL OF AUSTRALIA, 213 S27-S32 (2020) [C1]
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Nova |
2020 |
Bajis S, Grebely J, Hajarizadeh B, Applegate T, Marshall AD, Ellen Harrod M, et al., 'Hepatitis C virus testing, liver disease assessment and treatment uptake among people who inject drugs pre- and post-universal access to direct-acting antiviral treatment in Australia: The LiveRLife study', JOURNAL OF VIRAL HEPATITIS, 27 281-293 (2020) [C1]
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2020 |
Tremain D, Freund M, Bowman J, Wolfenden L, Wye P, Dunlop A, et al., 'Substance use treatment clinician attitudes to care for chronic disease health risk behaviours and associations of attitudes with care provision', Drug and Alcohol Review, 39 232-237 (2020) [C1]
Introduction and Aims: People who use substances have a high prevalence of modifiable chronic disease health risk behaviours. Preventive care to address such risks has not traditi... [more]
Introduction and Aims: People who use substances have a high prevalence of modifiable chronic disease health risk behaviours. Preventive care to address such risks has not traditionally been provided during substance use treatment. This study aimed to assess clinicians' attitudes towards preventive care and their association with care provision. Design and Methods: A cross-sectional study utilising computer-assisted telephone interviews was undertaken with clinicians (n = 54) of community-based substance use treatment services in one health district, Australia. Clinicians indicated their agreement with 10 attitudinal statements regarding their perceived role and self-efficacy in providing preventive care and perceptions of client interest in modifying behaviours. Logistic regression analyses examined the association between clinician attitudinal items and self-reported care provision. Results: Fifty-four clinicians (74%) agreed to participate. The most positive attitudes were preventive care being part of their role (100%), and they have the knowledge and skills to provide preventive care (100%). The least favourable attitude was clients were interested in changing their health risk behaviours (60%). Clinicians who reported that preventive care left little time to undertake acute care were more likely to assess for smoking (OR 8.06 [95% CI 1.31, 49.46]) and less likely to provide brief advice for all risks combined (OR 0.11 [95% CI 0.02, 0.63]). Discussion and Conclusions: Overall, clinicians reported positive attitudes regarding the preventive care provision for modifiable health risk behaviours in substance use treatment settings. Further research is required to investigate why, despite such positive attitudes, clinicians in substance use treatment settings do not routinely provide preventive care.
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Nova |
2020 |
Osborne SR, Alston LV, Bolton KA, Whelan J, Reeve E, Wong Shee A, et al., 'Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia', Medical Journal of Australia, 213 S3-S32.e1 (2020) [C1]
Chapter 1: Retail initiatives to improve the healthiness of food environments in rural, regional and remote communities: Objective: To synthesise the evidence for effectiveness of... [more]
Chapter 1: Retail initiatives to improve the healthiness of food environments in rural, regional and remote communities: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. Study design: Rapid review of articles published between January 2000 and May 2020. Data sources: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. Data synthesis: Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding. Conclusion: Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. Chapter 2: Which interventions best support the health and wellbeing needs of rural populations experiencing natural disasters?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. Study design: We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. Data sources: We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. Data synthesis: Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle. Conclusion: There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people¿s health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. Chapter 3: The impact of bushfire on the wellbeing of children living in rural and remote Australia: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia. Study design: Literature review completed u...
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2020 |
Dunlop A, Lokuge B, Masters D, Sequeira M, Saul P, Dunlop G, et al., 'Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic', HARM REDUCTION JOURNAL, 17 (2020) [C1]
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Nova |
2020 |
Roberts J, White B, Attalla D, Ward S, Dunlop AJ, 'RAPID UPSCALE OF DEPOT BUPRENORPHINE (CAM2038) IN CUSTODIAL SETTINGS DURING THE EARLY COVID-19 PANDEMIC IN NEW SOUTH WALES, AUSTRALIA', ADDICTION, 116 426-427 (2020)
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2020 |
Mills L, Lintzeris N, Bruno R, Montebello M, Dunlop A, Deacon RM, et al., 'Validation of the Australian Treatment Outcomes Profile for use in clients with cannabis dependence', Drug and Alcohol Review, 39 356-364 (2020) [C1]
Introduction and Aims: The Australian Treatment Outcomes Profile (ATOP) was developed as a clinical tool for monitoring the substance use, health and wellbeing of clients in alcoh... [more]
Introduction and Aims: The Australian Treatment Outcomes Profile (ATOP) was developed as a clinical tool for monitoring the substance use, health and wellbeing of clients in alcohol and other drug treatment. This is the first psychometric validation of the ATOP in a cannabis-dependent treatment population. Design and Methods: A total of 128 individuals with cannabis dependence enrolled in an outpatient randomised controlled trial were administered the ATOP and gold-standard health and wellbeing questionnaires once by clinicians and once by researchers at baseline. Concurrent validity was assessed by testing ATOP Psychological Health, Physical Health and Quality of Life questions against concurrently administered gold-standard questionnaires: the Short Form 36 Health Survey (SF-36), the 21-item Depression, Anxiety and Stress Scale (DASS-21) and the Sheehan Disability Scale (SDS). Interrater reliability was tested by comparing clinician-administered ATOP items at the medical screening interview to the same ATOP items administered by researchers at baseline. Results: ATOP Psychological Health showed moderate to strong correlations with SF-36 Mental Components, SF-36 Mental Health and DASS-21 scores (r = 0.40¿0.52) and ATOP Physical Health with SF-36 Physical Components and SF-36 General Health scores (r = 0.36¿0.67). The ATOP Quality of Life scale showed moderate agreement with the SDS and six-dimensional health state short form scales (r = 0.38¿0.40). ATOP substance use, employment, education and child care items showed good to excellent interrater reliability (Krippendorff's a = 0.62¿0.81), and tobacco use, Psychological Health, Physical Health and Quality of Life showed fair to moderate interrater reliability (Krippendorff's a = 0.42¿0.53). Discussion and Conclusions: The ATOP appears to be valid and reliable when tested in a population with cannabis-dependence, justifying its widespread use in clinical settings.
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Nova |
2020 |
Grebely J, Read P, Cunningham EB, Weltman M, Matthews GV, Dunlop A, et al., 'Elbasvir and grazoprevir for hepatitis C virus genotype 1 infection in people with recent injecting drug use (DARLO-C): An open-label, single-arm, phase 4, multicentre trial.', Health Sci Rep, 3 e151 (2020) [C1]
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2020 |
Lintzeris N, Mills L, Dunlop A, Copeland J, Mcgregor I, Bruno R, et al., 'Cannabis use in patients 3 months after ceasing nabiximols for the treatment of cannabis dependence: Results from a placebo-controlled randomised trial', Drug and Alcohol Dependence, 215 (2020) [C1]
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Nova |
2020 |
Newman-Morris V, Simpson K, Gray KM, Perry N, Dunlop A, Newman LK, 'Evaluation of early relational disturbance in high-risk populations: Borderline personality disorder features, maternal mental state, and observed interaction', INFANT MENTAL HEALTH JOURNAL, 41 793-810 (2020) [C1]
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Nova |
2020 |
Reilly R, Wand H, McKetin R, Quinn B, Ezard N, Dunlop A, et al., 'Survey methods and characteristics of a sample of Aboriginal and Torres Strait Islander and non-Indigenous people who have recently used methamphetamine: the NIMAC survey', Drug and Alcohol Review, 39 646-655 (2020) [C1]
Introduction and Aims: There is a need for detailed information on methamphetamine use in Aboriginal and Torres Strait Islander communities. We describe a national survey on metha... [more]
Introduction and Aims: There is a need for detailed information on methamphetamine use in Aboriginal and Torres Strait Islander communities. We describe a national survey on methamphetamine use among Aboriginal and Torres Strait Islander people and non-Indigenous people. Design and Methods: Participants aged 16 years or older who reported using methamphetamine in the past year were recruited for a cross-sectional survey through 10 Aboriginal Community Controlled Organisations. Surveys were completed anonymously on electronic tablets. Measures included the Australian Treatment Outcomes Profile, the Severity of Dependence Scale, subscales from Opiate Treatment Index and the Kessler 10. A Chronic Stress Scale was used to assess culturally situated chronic stress factors. Results: Of the 734 participants, 416 (59%) were Aboriginal or Torres Strait Islander and 331 (45%) were female. In the previous year, most participants reported smoking (48.7%) or injecting (34%) methamphetamine and 17.4% reported daily use. Aboriginal and Torres Strait Islander people did not differ significantly from non-Indigenous participants on methamphetamine use patterns (age at first use, frequency of use, main mode of use, injecting risk, poly drug use). Aboriginal and Torres Strait Islander participants felt less able to access health care (32% vs. 48%, P ' 0.001), including mental health services (19% vs. 29%, P ' 0.002), were less likely to report a mental health diagnosis (50% vs. 60%, P ' 0.002) and were more likely to turn to family for support (52% vs. 34%, P ' 0.001). Discussion and Conclusions: We recruited and surveyed a large sample of Aboriginal and Torres Strait Islander people from which we can derive detailed comparative data on methamphetamine use and related health service needs for Aboriginal and Torres Strait Islander and non-Indigenous Australians.
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Nova |
2020 |
Guillaumier A, Skelton E, Shakeshaft A, Farrell M, Tzelepis F, Walsberger S, et al., 'Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster-randomized controlled trial', Addiction, 115 1345-1355 (2020) [C1]
Aim: Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compar... [more]
Aim: Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7-day point prevalence abstinence (PPA) at 8¿weeks follow-up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8¿weeks and 6.5¿months follow-up. Design: Cluster-randomized controlled trial, with AOD service as unit of randomization, conducted January 2015¿March 2016. Setting: Thirty-two eligible services (provided face-to-face client sessions to =¿50 clients/year) in Australia were randomized to control (usual care; n¿=¿15) or intervention (n¿=¿17) groups by an independent blinded biostatistician. Participants: Eligible participants (= 16¿years, current smoker) completed surveys at the service at baseline (n¿=¿896) and telephone follow-up surveys (conducted by blinded assessors) at 8¿weeks (n¿=¿471; 53%) and 6.5¿months (n¿=¿427; 48%). Intervention: Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care. Measurements: Primary outcome was biochemically verified 7-day PPA at 8-week follow-up. Secondary outcomes included verified and self-reported prolonged abstinence, self-reported 7-day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention-to-treat analyses were performed, assuming missing participants were not abstinent. Findings: At 8¿weeks, the findings in verified 7-day PPA between groups [2.6 versus 1.8%, odds ratio (OR)¿=¿1.72, 95% confidence interval (CI)¿=¿0.5¿5.7, P¿=¿0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8¿weeks [incidence rate ratio (IRR)¿=¿0.88, 95% CI¿=¿0.8¿0.95, P¿=¿0.001] but were similar at 6.5 months (IRR¿=¿0.96, 95% CI¿=¿0.9¿1.02, P¿=¿0.240) follow-up. At both follow-ups the intervention group reported higher rates of NRT use. Conclusions: Integrating smoking cessation treatment into addiction services did not significantly improve short-term abstinence from smoking.
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Nova |
2020 |
Deacon RM, Mammen K, Holmes J, Dunlop A, Bruno R, Mills L, et al., 'Assessing the validity of the Australian Treatment Outcomes Profile for telephone administration in drug health treatment populations', Drug and Alcohol Review, 39 441-446 (2020) [C1]
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Nova |
2020 |
Lintzeris N, Monds LA, Bravo M, Read P, Harrod ME, Gilliver R, et al., 'Designing, implementing and evaluating the overdose response with take-home naloxone model of care: An evaluation of client outcomes and perspectives', DRUG AND ALCOHOL REVIEW, 39 55-65 (2020) [C1]
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2020 |
Reeves P, Szewczyk Z, Kingsland M, Doherty E, Elliott E, Dunlop A, et al., 'Protocol for an economic evaluation and budget impact assessment of a randomised, stepped-wedge controlled trial for practice change support to increase routine provision of antenatal care for maternal alcohol consumption', Implementation Science Communications, 1 (2020)
Background: Antenatal clinical practice guidelines recommend routine assessment of women¿s alcohol consumption during pregnancy. The delivery of advice and referral when necessary... [more]
Background: Antenatal clinical practice guidelines recommend routine assessment of women¿s alcohol consumption during pregnancy. The delivery of advice and referral when necessary are also recommended. However, evidence suggests there are barriers to the uptake of best-care guidelines. Effective, cost-effective and affordable implementation strategies are needed to ensure the intended benefits of guidelines are realised through addressing identified barriers. This paper describes the protocol for evaluating the efficiency and affordability of a practice change intervention compared to the usual practice in an implementation trial. Methods: The effectiveness of the intervention will be evaluated in a stepped-wedge randomised controlled implementation trial, conducted in an Australian setting. An economic evaluation will be conducted alongside the trial to assess intervention efficiency. A budget impact assessment will be conducted to assess affordability. The prospective trial-based economic evaluation will identify, measure and value key resource and outcome impacts arising from the multi-strategy practice change intervention compared with usual practice. The evaluation will comprise (i) cost-consequence analyses, where a scorecard approach will be used to show the costs and benefits given the multiple primary outcomes included in the trial, and (ii) cost-effectiveness analyses, where the primary outcome will be incremental cost per percent increase in participants reporting receipt of antenatal care for maternal alcohol consumption consistent with the guideline recommendations. Intervention affordability will be evaluated using budget impact assessment and will estimate the financial implications of adoption and diffusion of this implementation strategy from the perspective of relevant fundholders. Results will be extrapolated to estimate the cost and cost-effectiveness of rolling out the model of care. Discussion: Uptake of clinical guidelines requires practice change support. It is hypothesized that the implementation strategy, if found to be effective, will also be cost-effective, affordable and scalable. This protocol describes the economic evaluation that will address these hypotheses. Trial registration: Australian and New Zealand Clinical Trials Registry, ACTRN12617000882325 . Registered on 16 June 2017
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2020 |
Skelton E, Silberberg L, Guillaumier A, Dunlop AJ, Wilkinson RB, Bonevski B, 'Electronic cigarettes: Ever use, current use and attitudes among alcohol and other drug clients', Drug and Alcohol Review, 39 7-11 (2020) [C1]
Introduction and Aims: Electronic cigarettes (e-cigarettes) are becoming popular and may be a potential harm reduction and quit smoking aid for people who use other drugs. Data on... [more]
Introduction and Aims: Electronic cigarettes (e-cigarettes) are becoming popular and may be a potential harm reduction and quit smoking aid for people who use other drugs. Data on e-cigarette use and perceptions among people who use drugs is limited. The current study examines tobacco smoking status, use and attitudes towards e-cigarettes among people in drug and alcohol treatment. Design and Methods: Data were collected through a standardised Patient Experience Tracking System device installed in the waiting room of six drug and alcohol clinical service programs located within one area health service in New South Wales, Australia during April to June 2017. Participants were clients of participating services aged 18 years and older. Results: Five hundred and eleven participants completed the survey, 85% were current smokers, 9% were ex-smokers and 6% were non-smokers. Over half of all participants (53%) had tried e-cigarettes in their lifetime, 26% reported current use and 77% of those were using them with nicotine. Just less than half of all participants believed that e-cigarettes were helpful for quitting or cutting down smoking tobacco cigarettes (48%). More than half of all respondents (59%) believed that tobacco cigarettes were more harmful than e-cigarettes (59%) and believed that e-cigarettes were an acceptable quit smoking aid for patients of drug and alcohol services (64%). Discussion and Conclusions: Most participants were current tobacco smokers and had tried an e-cigarette though a minority were currently using e-cigarettes. Participant attitudes were favourable towards the use of e-cigarettes as quit smoking aids.
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Nova |
2020 |
Stuart AM, Baker AL, Denham AMJ, Lee NK, Hall A, Oldmeadow C, et al., 'Psychological treatment for methamphetamine use and associated psychiatric symptom outcomes: A systematic review', Journal of Substance Abuse Treatment, 109 61-79 (2020) [C1]
Background: Regular methamphetamine use is associated with increased rates of psychiatric symptoms. Although there has been a substantial body of research reporting on the effecti... [more]
Background: Regular methamphetamine use is associated with increased rates of psychiatric symptoms. Although there has been a substantial body of research reporting on the effectiveness of psychological treatments for reducing methamphetamine use, there is a paucity of research examining the effects of these treatments on co-occurring psychiatric symptoms. We addressed this gap by undertaking a systematic review of the evidence of the effectiveness of psychological treatments for methamphetamine use on psychiatric symptom outcomes in randomized controlled trials. Methods: A narrative synthesis of studies was conducted following the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to inform methodology. Eight electronic peer-reviewed databases were searched. Ten eligible studies were assessed. Results: Most studies found an overall reduction in levels of methamphetamine use and psychiatric symptoms among samples as a whole. Although brief interventions were effective, there is evidence that more intensive interventions have greater impact on methamphetamine use and/or psychiatric symptomatology. Intervention attendance was variable. Conclusions: The evidence suggests that a variety of psychological treatments are effective in reducing levels of methamphetamine use and improving psychiatric symptoms. Future research should consider how psychological treatments could maximize outcomes in the co-occurring domains of methamphetamine use and psychiatric symptoms, with increasing treatment attendance as a focus. PROSPERO registration number: CRD42016043657.
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Nova |
2020 |
Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, et al., 'Rapid realist review of opioid tapering in the context of long term opioid use for non-cancer pain in rural areas', MEDICAL JOURNAL OF AUSTRALIA, 213 S27-S32 (2020)
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2020 |
Jackson MA, Brown AL, Baker AL, Dunlop AJ, Dunford A, Gould GS, 'Intensive Behavioural and Pharmacological Treatment for Tobacco Dependence in Pregnant Women with Complex Psychosocial Challenges: A Case Report', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 17 (2020)
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2019 |
Jackson MA, Baker AL, McCarter KL, Brown AL, Gould GS, Dunlop AJ, 'Interventions for pregnant women who use tobacco and other substances: a systematic review protocol', BMJ OPEN, 9 (2019)
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2019 |
Frost M, Bailey GL, Lintzeris N, Strang J, Dunlop A, Nunes EV, et al., 'Long-term safety of a weekly and monthly subcutaneous buprenorphine depot (CAM2038) in the treatment of adult out-patients with opioid use disorder', Addiction, 114 1416-1426 (2019) [C1]
Aims: To assess the long-term safety of subcutaneous buprenorphine (CAM2038) weekly and monthly depots. Design: Phase 3, open-label, observational, multi-centre 48-week trial (Cli... [more]
Aims: To assess the long-term safety of subcutaneous buprenorphine (CAM2038) weekly and monthly depots. Design: Phase 3, open-label, observational, multi-centre 48-week trial (ClinicalTrials.gov NCT02672111). Setting: Twenty-six out-patient sites (United States, United Kingdom, Hungary, Denmark, Sweden, Germany, Australia) between 14¿December 2015 and 12¿April 2017. Participants: Two hundred and twenty-eight adults with opioid use disorder; 227 received CAM2038 (37 initiated onto CAM2038 and 190 converted from sublingual buprenorphine). Interventions: CAM2038 weekly (8, 16, 24 or 32¿mg) or monthly (64, 96, 128 or 160¿mg) with flexible dosing and individualized titration utilizing multiple CAM2038 weekly and monthly doses. Measurements: Safety variables, urine toxicology samples and self-reported illicit opioid use were collected at each visit. Participants were administered a patient satisfaction survey at months 6 and 12, completed by 162 of 227 (71.4%) participants. Findings: The study treatment period was completed by 167 of 227 (73.6%) participants. At least one treatment-emergent adverse event (TEAE) was reported by 143 of 227 (63.0%) participants, of whom 60 of 227 (26.4%) reported as being drug-related. Most of the TEAEs, reported by 128 of 227 (56.4%) of participants, were mild or moderate in intensity. Injection-site reactions were reported by 46 of 227 (20.3%) participants, with most [45 of 46 (97.8%)] reported as mild to moderate. Five participants (2.2%) discontinued the study drug due to a TEAE, two cases (0.9%) of which were injection-site-related. No serious adverse events were attributed to the study drug. Among those remaining in the study, the percentage of opioid-negative urine tests combined with self-reports was 63.0% (17 of 27) in new-to-treatment participants and 82.8% (111 of 134) for those converted from sublingual buprenorphine. Participants reported high levels of satisfaction with CAM2038. Conclusions: Subcutaneous buprenorphine delivered weekly or monthly (CAM2038) was well tolerated, with a systemic safety profile consistent with the known profile of sublingual buprenorphine. CAM2038 weekly and monthly was associated with high retention rates and low levels of illicit opioid use throughout this study.
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Nova |
2019 |
Lintzeris N, Bhardwaj A, Mills L, Dunlop A, Copeland J, McGregor I, et al., 'Nabiximols for the Treatment of Cannabis Dependence: A Randomized Clinical Trial', JAMA Internal Medicine, 179 1242-1253 (2019) [C1]
Importance: There are no effective medications for treating dependence on cannabis. Objective: To examine the safety and efficacy of nabiximols in the treatment of patients with c... [more]
Importance: There are no effective medications for treating dependence on cannabis. Objective: To examine the safety and efficacy of nabiximols in the treatment of patients with cannabis dependence. Design, Setting, and Participants: This parallel double-blind randomized clinical trial comparing nabiximols with placebo in a 12-week, multisite outpatient study recruited participants from February 3, 2016, to June 14, 2017, at 4 outpatient specialist alcohol and drug treatment services in New South Wales, Australia. Participants had cannabis dependence (as defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) and were seeking treatment, were nonresponsive to prior treatment attempts, were 18 to 64 years of age, had no other substance use disorder, had no severe medical or psychiatric conditions, were not pregnant, were not mandated by a court to undergo treatment, and provided informed consent. Results for primary efficacy measures and all secondary outcomes were obtained using a modified intention-to-treat data set. Interventions: Participants received 12-week treatment involving weekly clinical reviews, structured counseling, and flexible medication doses - up to 32 sprays daily (tetrahydrocannabinol, 86.4 mg, and cannabidiol, 80 mg), dispensed weekly. Main Outcomes and Measures: Primary outcome was self-reported number of days using illicit cannabis during the 12-week period. Other outcomes included alternate cannabis use parameters (periods of abstinence, withdrawal, cravings, and problems), safety parameters (adverse events and aberrant medication use), health status, other substance use, and treatment retention. Results: A total of 128 participants (30 women and 98 men; mean [SD] age, 35.0 [10.9] years) were randomized and received at least 1 dose of study medication. Participants had used a mean (SD) of 2.3 (2.1) g of cannabis on a mean (SD) of 25.7 (4.5) days in the past 28 days. Treatment retention was comparable for the 2 groups (placebo, 30 of 67 participants [44.8%]; nabiximols, 30 of 61 participants [49.2%]), and both groups used similar mean (SD) doses (placebo, 18.5 [9.5] sprays daily; nabiximols, 17.6 [9.5] sprays daily, equivalent to a mean [SD] of 47.5 [25.7] mg of tetrahydrocannabinol and 44.0 [23.8] mg of cannabidiol). For the primary end point, the placebo group reported significantly more days using cannabis during the 12 weeks (mean [SD], 53.1 [33.0] days) than the nabiximols group (mean [SD], 35.0 [32.4] days; estimated difference, 18.6 days; 95% CI, 3.5-33.7 days; P =.02). Both groups showed comparable improvements in health status, with no substantial changes in other substance use. Medication was well tolerated with few adverse events. Conclusions and Relevance: This study demonstrates that cannabinoid agonist treatment, in this case using nabiximols, in combination with psychosocial interventions is a safe approach for reducing cannabis use among individuals with cannabis dependence who are seeking treatment. Trial Registration: anzctr.org.au Identifier: ACTRN12616000103460.
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Nova |
2019 |
Doherty E, Wiggers J, Wolfenden L, Anderson AE, Crooks K, Tsang TW, et al., 'Antenatal care for alcohol consumption during pregnancy: Pregnant women's reported receipt of care and associated characteristics', BMC Pregnancy and Childbirth, 19 1-17 (2019) [C1]
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Nova |
2019 |
Kwon JA, Dore GJ, Grebely J, Hajarizadeh B, Guy R, Cunningham EB, et al., 'Australia on track to achieve WHO HCV elimination targets following rapid initial DAA treatment uptake: A modelling study', JOURNAL OF VIRAL HEPATITIS, 26 83-92 (2019)
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2019 |
Jackson MA, Brown AL, Baker AL, Gould GS, Dunlop AJ, 'The Incentives to Quit tobacco in Pregnancy (IQuiP) protocol: Piloting a financial incentive-based smoking treatment for women attending substance use in pregnancy antenatal services', BMJ Open, 9 (2019)
Introduction While tobacco smoking prevalence is falling in many western societies, it remains elevated among high-priority cohorts. Rates up to 95% have been reported in women wh... [more]
Introduction While tobacco smoking prevalence is falling in many western societies, it remains elevated among high-priority cohorts. Rates up to 95% have been reported in women whose pregnancy is complicated by other substance use. In this group, the potential for poor pregnancy outcomes and adverse physical and neurobiological fetal development are elevated by tobacco smoking. Unfortunately, few targeted and effective tobacco dependence treatments exist to assist cessation in this population. The study will trial an evidence-based, multicomponent tobacco smoking treatment tailored to pregnant women who use other substances. The intervention comprises financial incentives for biochemically verified abstinence, psychotherapy delivered by drug and alcohol counsellors, and nicotine replacement therapy. It will be piloted at three government-based, primary healthcare facilities in New South Wales (NSW) and Victoria, Australia. The study will assess the feasibility and acceptability of the treatment when integrated into routine antenatal care offered by substance use in pregnancy antenatal services. Methods and analysis The study will use a single-arm design with pre-post comparisons. One hundred clients will be recruited from antenatal clinics with a substance use in pregnancy service. Women must be <33 weeks' gestation, =16 years old and a current tobacco smoker. The primary outcomes are feasibility, assessed by recruitment and retention and the acceptability of addressing smoking among this population. Secondary outcomes include changes in smoking behaviours, the comparison of adverse maternal outcomes and neonatal characteristics to those of a historical control group, and a cost-consequence analysis of the intervention implementation. Ethics and dissemination Protocol approval was granted by Hunter New England Human Research Ethics Committee (Reference 17/04/12/4.05), with additional ethical approval sought from the Aboriginal Health and Medical Research Council of NSW (Reference 1249/17). Findings will be disseminated via academic conferences, peer-reviewed publications and social media. Trial registration number Australia New Zealand Clinical Trial Registry (Ref: ACTRN12618000576224).
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2019 |
Reilly R, McKetin R, Wand H, Butt J, Smout M, Ezard N, et al., 'A Web-Based Therapeutic Program (We Can Do This) for Reducing Methamphetamine Use and Increasing Help-Seeking Among Aboriginal and Torres Strait Islander People: Protocol for a Randomized Wait-List Controlled Trial', JMIR RESEARCH PROTOCOLS, 8 (2019)
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2018 |
Tremain D, Freund M, Wye P, Bowman J, Wolfenden L, Dunlop A, et al., 'Providing routine chronic disease preventive care in community substance use services: A pilot study of a multistrategic clinical practice change intervention', BMJ Open, 8 (2018) [C1]
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Nova |
2018 |
Bhardwaj AK, Allsop DJ, Copeland J, McGregor IS, Dunlop A, Shanahan M, et al., 'Randomised Controlled Trial (RCT) of cannabinoid replacement therapy (Nabiximols) for the management of treatment-resistant cannabis dependent patients: a study protocol', BMC PSYCHIATRY, 18 (2018)
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2018 |
Grebely J, Conway B, Cunningham EB, Fraser C, Moriggia A, Gane E, et al., 'Paritaprevir, ritonavir, ombitasvir, and dasabuvir with and without ribavirin in people with HCV genotype 1 and recent injecting drug use or receiving opioid substitution therapy', INTERNATIONAL JOURNAL OF DRUG POLICY, 62 94-103 (2018)
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2018 |
Johnson NA, Kypri K, Latter J, Dunlop A, Brown A, Saitz R, et al., 'Effect of electronic brief intervention on uptake of specialty treatment in hospital outpatients with likely alcohol dependence: Pilot randomized trial and qualitative interviews.', Drug and alcohol dependence, 183 253-260 (2018) [C1]
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Nova |
2018 |
Magin P, Tapley A, Dunlop AJ, Davey A, van Driel M, Holliday E, et al., 'Changes in Australian Early-Career General Practitioners Benzodiazepine Prescribing: a Longitudinal Analysis', Journal of General Internal Medicine, 33 1676-1684 (2018) [C1]
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Nova |
2018 |
Gisev N, Pearson S-A, Dobbins T, Currow DC, Blyth F, Larney S, et al., 'Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol', BMJ OPEN, 8 (2018)
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2018 |
Lintzeris N, Monds LA, Rivas C, Leung S, Dunlop A, Newcombe D, et al., 'Transferring Patients From Methadone to Buprenorphine: The Feasibility and Evaluation of Practice Guidelines', JOURNAL OF ADDICTION MEDICINE, 12 234-240 (2018)
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2018 |
Nielsen S, Lintzeris N, Murnion B, Degenhardt L, Bruno R, Haber P, et al., 'Understanding an emerging treatment population: Protocol for and baseline characteristics of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence', Drug and Alcohol Review, 37 887-896 (2018) [C1]
Introduction and Aims: Despite large increases in pharmaceutical opioid dependence and related mortality, few studies have focused on the characteristics and treatment experiences... [more]
Introduction and Aims: Despite large increases in pharmaceutical opioid dependence and related mortality, few studies have focused on the characteristics and treatment experiences of those with pharmaceutical opioid dependence. We describe the formation of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence and describe their baseline characteristics. Design and Methods: People who had entered treatment for pharmaceutical opioid dependence (n = 108) were recruited through drug treatment services in New South Wales, Australia. We describe baseline characteristics of those that commenced pharmaceutical opioids for pain or other reasons and conducted a thematic analysis of responses regarding their treatment experience. Results: Mean age was 41 years (SD 11), half were male (48%). Just over half reported lifetime heroin use (57%). Oxycodone (49%) and codeine (29%) were the most common opioids reported. Most (85%) reported past-year problematic pain, 38% reported chronic pain. Half (52%) reported moderate to severe depression symptoms. Most (66%) commenced opioids for pain, and this group were older, less likely to report a previous overdose and less likely to report use of illicit drugs compared to those commencing for other reasons. Five themes related to treatment expectations: (i) stigma; (ii) the restrictive nature of treatment; (iii) knowledge; (iv) pain; and (v) positive experience with buprenorphine. Discussion and Conclusions: This study describes the complexities in an important emerging treatment population of pharmaceutical opioid-dependent people. Findings highlights that addressing knowledge and perceptions around treatment may be critical to address the rising mortality associated with pharmaceutical opioid dependence.
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Nova |
2018 |
Grebely J, Dalgard O, Conway B, Cunningham EB, Bruggmann P, Hajarizadeh B, et al., 'Sofosbuvir and velpatasvir for hepatitis C virus infection in people with recent injection drug use (SIMPLIFY): an open-label, single-arm, phase 4, multicentre trial', LANCET GASTROENTEROLOGY & HEPATOLOGY, 3 153-161 (2018)
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2018 |
Robinson M, Wilkinson RB, Fletcher R, Bruno R, Baker AL, Maher L, et al., 'Alcohol Text Messages: A Developmental Study', International Journal of Mental Health and Addiction, 16 1125-1139 (2018) [C1]
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Nova |
2018 |
Ezard N, Dunlop A, Hall M, Ali R, McKetin R, Bruno R, et al., 'LiMA: a study protocol for a randomised, double-blind, placebo controlled trial of lisdexamfetamine for the treatment of methamphetamine dependence', BMJ OPEN, 8 (2018)
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2018 |
Johnson NA, Kypri K, Saunders JB, Saitz R, Attia J, Latter J, et al., 'Effect of electronic screening and brief intervention on hazardous or harmful drinking among adults in the hospital outpatient setting: A randomized, double-blind, controlled trial', Drug and Alcohol Dependence, 191 78-85 (2018) [C1]
Background: Most trials of electronic alcohol screening and brief intervention (e-SBI) have been conducted in young people. The aim of this study was to evaluate the effect of e-S... [more]
Background: Most trials of electronic alcohol screening and brief intervention (e-SBI) have been conducted in young people. The aim of this study was to evaluate the effect of e-SBI in adults with hazardous or harmful drinking. Methods: This individually randomized, parallel, two-group, double-blind controlled trial was conducted in the outpatient department of a large public hospital in Australia. Consenting adults who scored 5¿9 on the AUDIT-C (837/3225; 26%) were randomized in a 1:1 ratio by computer to screening alone (442/837; 53%) or to 10 min of assessment and personalized feedback on their alcohol consumption (comparisons with medical guidelines and age and sex-specific norms), peak blood alcohol concentration, expenditure on alcohol, and risk of alcohol dependence (395/837; 47%). The two primary outcomes, assessed six months after randomization, were the number of standard drinks (10 g ethanol) consumed by participants in the last seven days and their AUDIT score. Results: 693/837 (83%) and 635/837 (76%) participants were followed-up at 6 and 12 months, respectively. There was no statistically significant difference between the groups in the median number of standard drinks consumed in the last seven days (intervention: 12; control: 10.5; rate ratio, 1.12 [95% confidence interval, 0.96¿1.31]; P =.17) or in their median AUDIT score (intervention: 7; control: 7; mean difference, 0.28 [-0.42 to 0.98]; P =.44). Conclusion: These results do not support the implementation of an e-SBI program comprising personalized feedback and normative feedback for adults with hazardous or harmful drinking in the hospital outpatient setting.
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Nova |
2018 |
Kingsland M, Doherty E, Anderson AE, Crooks K, Tully B, Tremain D, et al., 'A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy: research protocol for a randomised stepped-wedge cluster trial', IMPLEMENTATION SCIENCE, 13 (2018)
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Nova |
2018 |
Cunningham EB, Amin J, Feld JJ, Bruneau J, Dalgard O, Powis J, et al., 'Adherence to sofosbuvir and velpatasvir among people with chronic HCV infection and recent injection drug use: The SIMPLIFY study', International Journal of Drug Policy, 62 14-23 (2018) [C1]
Background: This study investigated treatment adherence among people with recent injecting drug use in a study of sofosbuvir/velpatasvir therapy for HCV infection. Methods: SIMPLI... [more]
Background: This study investigated treatment adherence among people with recent injecting drug use in a study of sofosbuvir/velpatasvir therapy for HCV infection. Methods: SIMPLIFY is an international open-label, single-arm multicentre study that recruited participants with recent injecting drug use (previous six months) and chronic HCV genotype (G) 1¿6 infection between March and October 2016 in seven countries (19 sites). Participants received sofosbuvir/velpatasvir once-daily for 12 weeks administered in a one-week electronic blister pack (records the time and date of each dose) for 12 weeks. We evaluated non-adherence (<90% adherent) as measured by electronic blister-pack assessed using logistic regression and generalised estimating equations (continuous) with detailed analyses of dosing dynamics. Results: Among 103 participants, 97% (n = 100) completed treatment. Median adherence to therapy was 94%. Overall, 32% (n = 33) were considered non-adherent (<90% adherence). Adherence significantly decreased over the course of therapy. Recent stimulant injecting (cocaine and/or amphetamines) at treatment initiation and during treatment was independently associated with non-adherence. Inconsistent dose timing (standard deviation of daily dose timing of =240 min) was also independently associated with non-adherence to therapy. Factors associated with inconsistent dose timing included lower levels of education and recent stimulant injecting. SVR was similar among adherent and non-adherent populations (94% vs. 94%, P = 0.944). Conclusion: This study demonstrated high adherence to once-daily sofosbuvir/velpatasvir therapy among a population of people with recent injecting drug use. Recent stimulant injecting prior to and during DAA therapy and inconsistent dose-timing during treatment was associated with non-adherence. However, there was no impact of non-adherence on response to therapy, suggesting that adherence is not a significant barrier to successful DAA therapy in people with recent injecting drug use.
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Nova |
2017 |
Ordean A, Graves L, Chisamore B, Greaves L, Dunlop A, 'Prevalence and Consequences of Perinatal Substance Use-Growing Worldwide Concerns', SUBSTANCE ABUSE-RESEARCH AND TREATMENT, 11 (2017)
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2017 |
Tremain D, Freund M, Wolfenden L, Wye P, Bowman J, Dunlop A, et al., 'Modifiable health risk behaviours and attitudes towards behaviour change of clients attending community-based substance use treatment services', Drug and Alcohol Review, 36 369-377 (2017) [C1]
Introduction and Aims: Health risk behaviours, such as smoking, nutrition and physical inactivity, are significant contributors to chronic disease for people with substance use di... [more]
Introduction and Aims: Health risk behaviours, such as smoking, nutrition and physical inactivity, are significant contributors to chronic disease for people with substance use disorders. This study reports the prevalence of these behaviours amongst substance use treatment clients, their attitudes towards modifying such behaviours and the acceptability of receiving support to do so. Client characteristics associated with risk status and interest in modifying behaviours were examined. Design and Methods: A cross-sectional survey was undertaken with clients of 15 community substance use treatment services within in New South Wales, Australia. Data for the study were collected via computer assisted telephone interviews. Results: Of those contactable and eligible, 386 (71%) clients completed the survey. Clients reported a high prevalence of smoking (80%), insufficient fruit and/or vegetable consumption (89%) and insufficient physical activity (31%). Overall, 51¿69% of clients reported considering modifying their health risk behaviours and 88¿97% thought it was acceptable to be provided preventive care to address such behaviours. Younger clients were more likely to smoke (18¿34 years (odds ratio [OR] = 4.6 [95% confidence interval [CI] = 1.9, 11.3]); 35¿54 years (OR = 2.6 [95% CI = 1.2, 5.7])) and be interested in increasing vegetable consumption (18¿34 years (OR = 4.4 [95% CI = 1.3, 14.8]); 35¿54 years (OR = 8.0 [95% CI = 2.5, 25.4])) than older clients (=55 years). Discussion and Conclusions: There is a high prevalence of health risk behaviours amongst clients of community substance use treatment services. However, contrary to commonly cited barriers to care provision, clients are interested in modifying their risk behaviours and report that receiving preventive care to address these behaviours is acceptable. [Tremain D, Freund M, Wolfenden L, Wye P, Bowman J, Dunlop A, Gillham K, Bartlem K, McElwaine K, Gow B, Wiggers J. Modifiable health risk behaviours and attitudes towards behaviour change of clients attending community-based substance use treatment services. Drug Alcohol Rev 2017;36:369¿377.].
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Nova |
2017 |
Dunlop AJ, Brown AL, Oldmeadow C, Harris A, Gill A, Sadler C, et al., 'Effectiveness and cost-effectiveness of unsupervised buprenorphine-naloxone for the treatment of heroin dependence in a randomized waitlist controlled trial', Drug and Alcohol Dependence, 174 181-191 (2017) [C1]
Background Access to opioid agonist treatment can be associated with extensive waiting periods with significant health and financial burdens. This study aimed to determine whether... [more]
Background Access to opioid agonist treatment can be associated with extensive waiting periods with significant health and financial burdens. This study aimed to determine whether patients with heroin dependence dispensed buprenorphine-naloxone weekly have greater reductions in heroin use and related adverse health effects 12-weeks after commencing treatment, compared to waitlist controls and to examine the cost-effectiveness of this strategy. Methods An open-label waitlist RCT was conducted in an opioid treatment clinic in Newcastle, Australia. Fifty patients with DSM-IV-TR heroin dependence (and no other substance dependence) were recruited. The intervention group (n = 25) received take-home self-administered sublingual buprenorphine-naloxone weekly (mean dose, 22.7 ± 5.7 mg) and weekly clinical review. Waitlist controls (n = 25) received no clinical intervention. The primary outcome was heroin use (self-report, urine toxicology verified) at weeks four, eight and 12. The primary cost-effectiveness outcome was incremental cost per additional heroin-free-day. Results Outcome data were available for 80% of all randomized participants. Across the 12-weeks, treatment group heroin use was on average 19.02 days less/month (95% CI -22.98, -15.06, p < 0.0001). A total 12-week reduction in adjusted costs including crime of $A5,722 (95% CI 3299, 8154) in favor of treatment was observed. Excluding crime, incremental cost per heroin-free-day gained from treatment was $A18.24 (95% CI 4.50, 28.49). Conclusion When compared to remaining on a waitlist, take-home self-administered buprenorphine-naloxone treatment is associated with significant reductions in heroin use for people with DSM-IV-TR heroin dependence. This cost-effective approach may be an efficient strategy to enhance treatment capacity.
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Nova |
2017 |
Skelton E, Tzelepis F, Shakeshaft A, Guillaumier A, Dunlop A, McCrabb S, et al., 'Smoking cessation care provision in Australian alcohol and other drug treatment services: A cross-sectional survey of staff self-reported practices', Journal of Substance Abuse Treatment, 77 101-106 (2017) [C1]
Introduction Clinical practice guidelines recommend alcohol and other drug (AOD) services assess client's smoking status and offer smoking cessation care (SCC) to all smokers... [more]
Introduction Clinical practice guidelines recommend alcohol and other drug (AOD) services assess client's smoking status and offer smoking cessation care (SCC) to all smokers. The aim of this study was to examine Australian AOD program staff report of recommended SCC practices: assessment and recording of smoking status; and the provision of 9 types of SCC. The study also assessed how the decision to provide SCC is made and the AOD program service and AOD staff characteristics associated with the provision of SCC. Methods Between July¿October 2014, treatment staff from 31 Australian AOD services participated in an online cross-sectional survey. In addition, a site contact at each service was interviewed to gather service related data. Results Overall, 362 AOD program staff participated (response rate¿=¿57%) and 62% estimated that client smoking status was recorded for the ¿majority or all¿ of their clients. About a third (33%) reported that they ¿always¿ provide verbal advice to their clients to quit smoking, 18% ¿always¿ offered free or subsidized NRT and 16% ¿always¿ followed-up to check on client quit progress. Thirty percent reported that the decision to provide SCC was made on a client by client basis and 26% offered SCC only when the client requested assistance. Government-managed services, age and gender of AOD program staff were significantly associated with the provision of SCC. Conclusion Most AOD program staff report that smoking status is recorded for the majority of their clients however, the frequency with which SCC practices are delivered is low and the decision to provide care is arbitrary.
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Nova |
2017 |
Scott AJ, Dunlop AJ, Brown A, Sadler C, Isbister GK, 'The prevalence of QT prolongation in a population of patients with substance use disorders', Drug and Alcohol Review, 36 239-244 (2017) [C1]
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Nova |
2017 |
Holliday SM, Morgan S, Tapley A, Henderson KM, Dunlop AJ, van Driel ML, et al., 'The pattern of anxiolytic and hypnotic management by Australian general practice trainees', Drug and Alcohol Review, 36 261-269 (2017) [C1]
Introduction and Aims: Guidelines recommend anxiolytics and hypnotics (A/H) as second-line, short-term medications. We aimed to establish prevalence and associations of A/H prescr... [more]
Introduction and Aims: Guidelines recommend anxiolytics and hypnotics (A/H) as second-line, short-term medications. We aimed to establish prevalence and associations of A/H prescribing by Australian general practice (GP) trainees. Design and Methods: A cross-sectional analysis from a cohort study of vocational trainees from four GP Regional Training Providers during 2010¿2013. General practice trainees act as independent practitioners (including for prescribing purposes) while having recourse to advice from a GP supervisor. Practice and trainee demographic data were collected as well as patient, clinical and educational data from 60 consecutive consultations of each trainee each training term. Analysis was at the level of individual problem managed, with the outcome factor being prescription of any anxiolytic or hypnotic. Results: Overall, 645 registrars (response rate 94.0%) prescribed 68 582 medications in 69 621 consultations (with 112 890 problems managed). A/Hs were prescribed for 1.3% of problems managed and comprised 2.2% of all prescriptions. They were prescribed particularly for insomnia (28.2%) or anxiety (21.8%), but also for many ¿off-label¿ indications. Significant associations of A/H prescriptions were: patient-level (greater age, Aboriginal and Torres Strait Islander status, English-speaking background, being new to the trainee but not to the practice); trainee-level (male) and consultation-level (longer duration, pre-existing problem, specialist referral not being made). Prescribing was significantly lower in one of the four Regional Training Providers. Discussion and Conclusions: GP trainees, inconsistent with most guideline recommendations, prescribe A/Hs mainly as maintenance therapy to unfamiliar and older patients. Our results suggest that changes in management approaches are needed which may be facilitated by support for psychotherapeutic training. [Holliday SM, Morgan S, Tapley A, Henderson KM, Dunlop AJ, van Driel ML, Spike NA, McArthur LA, Ball J, Oldmeadow CJ, Magin PJ. The pattern of anxiolytic and hypnotic management by Australian general practice trainees. Drug Alcohol Rev 2017;36:261-269].
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Nova |
2017 |
Holliday S, Hayes C, Dunlop A, Morgan S, Tapley A, Henderson K, et al., 'Protecting Pain Patients. The Evaluation of a Chronic Pain Educational Intervention.', Pain medicine (Malden, Mass.), 18 2306-2315 (2017) [C1]
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Nova |
2017 |
Isbister GK, Brown AL, Gill A, Scott AJ, Calver L, Dunlop AJ, 'QT interval prolongation in opioid agonist treatment: analysis of continuous 12-lead electrocardiogram recordings', British Journal of Clinical Pharmacology, 83 2274-2282 (2017) [C1]
Aims: Methadone is a widely used opioid agonist treatment associated with QT prolongation and torsades de pointes. We investigated the QT interval in patients treated with methado... [more]
Aims: Methadone is a widely used opioid agonist treatment associated with QT prolongation and torsades de pointes. We investigated the QT interval in patients treated with methadone or buprenorphine using continuous 12-lead Holter recordings. Methods: We prospectively made 24-h Holter recordings in patients prescribed methadone or buprenorphine, compared to controls. After their normal dose a continuous 12-lead Holter recorder was attached for 24¿h. Digital electrocardiograms were extracted hourly from the Holter recordings. The QT interval was measured automatically (H-scribe software, Mortara Pty Ltd) and checked manually. The QT interval was plotted against heart rate (HR) on the QT nomogram to determine abnormality. Demographics, dosing, medical history and laboratory investigations were recorded. Results: There were 58 patients (19 methadone, 20 buprenorphine and 19 control); median age 35¿years (20¿56¿years); 33 males. Baseline characteristics were similar. Median dose of methadone was 110¿mg¿day¿1 (70¿170¿mg¿day¿1) and buprenorphine was 16¿mg¿day¿1 (12¿32¿mg¿day¿1). Seven participants had abnormal QT intervals. There was a significant difference in the proportion of prescribed methadone with abnormal QT intervals, 7/19 (37%; 95% confidence interval: 17¿61%), compared to controls 0/19 (0%; 95% confidence interval: 0¿21%; P¿=¿0.008), but no difference between buprenorphine and controls (0/20). QT vs. HR plots showed patients prescribed methadone had higher QT-HR pairs over 24¿h compared to controls. There was no difference in dose for patients prescribed methadone with abnormal QT intervals and those without. Conclusions: Methadone is associated with prolonged QT intervals, but there was no association with dose. Buprenorphine did not prolong the QT interval. Twenty four-hour Holter recordings using the QT nomogram is a feasible method to assess the QT interval in patients prescribed methadone.
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Nova |
2017 |
Fraser S, Pienaar K, Dilkes-Frayne E, Moore D, Kokanovic R, Treloar C, Dunlop A, 'Addiction stigma and the biopolitics of liberal modernity: A qualitative analysis', INTERNATIONAL JOURNAL OF DRUG POLICY, 44 192-201 (2017)
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2017 |
Stuart A, Baker AL, Bowman J, McCarter K, Denham AMJ, Lee N, et al., 'Protocol for a systematic review of psychological treatment for methamphetamine use: an analysis of methamphetamine use and mental health symptom outcomes', BMJ OPEN, 7 (2017)
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2017 |
Holliday SM, Hayes C, Dunlop AJ, Morgan S, Tapley A, Henderson KM, et al., 'Does brief chronic pain management education change opioid prescribing rates? A pragmatic trial in Australian early-career general practitioners', Pain, 158 278-288 (2017) [C1]
We aimed to evaluate the effect of pain education on opioid prescribing by early-career general practitioners. A brief training workshop was delivered to general practice registra... [more]
We aimed to evaluate the effect of pain education on opioid prescribing by early-career general practitioners. A brief training workshop was delivered to general practice registrars of a single regional training provider. The workshop significantly reduced hypothetical opioid prescribing (in response to paper-based vignettes) in an earlier evaluation. The effect of the training on actual prescribing was evaluated using a nonequivalent control group design nested within the Registrar Clinical Encounters in Training (ReCEnT) cohort study: 4 other regional training providers were controls. In ReCEnT, registrars record detailed data (including prescribing) during 60 consecutive consultations, on 3 occasions. Analysis was at the level of individual problem managed, with the primary outcome factor being prescription of an opioid analgesic and the secondary outcome being opioid initiation. Between 2010 and 2015, 168,528 problems were recorded by 849 registrars. Of these, 71% were recorded by registrars in the nontraining group. Eighty-two percentages were before training. Opioid analgesics were prescribed in 4382 (2.5%, 95% confidence interval [CI]: 2.40-2.63) problems, with 1665 of these (0.97%, 95% CI: 0.91-1.04) representing a new prescription. There was no relationship between the training and total prescribing after training (interaction odds ratio: 1.01; 95% CI: 0.75-1.35; P value 0.96). There was some evidence of a reduction in initial opioid prescriptions in the training group (interaction odds ratio: 0.74; 95% CI: 0.48-1.16; P value 0.19). This brief training package failed to increase overall opioid cessation. The inconsistency of these actual prescribing results with hypothetical prescribing behavior suggests that reducing opioid prescribing in chronic noncancer pain requires more than changing knowledge and attitudes.
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Nova |
2017 |
Kevin RC, Allsop DJ, Lintzeris N, Dunlop AJ, Booth J, McGregor IS, 'Urinary cannabinoid levels during nabiximols (Sativex
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Nova |
2017 |
Fortier E, Alavi M, Bruneau J, Micallef M, Perram J, Sockalingam S, et al., 'Depression, Anxiety, and Stress among People with Chronic Hepatitis C Virus Infection and a History of Injecting Drug Use in New South Wales, Australia', Journal of Addiction Medicine, 11 10-18 (2017) [C1]
Objective: The aims of this study were to assess symptoms of depression, anxiety, and stress and associated sociodemographic factors among people living with chronic hepatitis C v... [more]
Objective: The aims of this study were to assess symptoms of depression, anxiety, and stress and associated sociodemographic factors among people living with chronic hepatitis C virus (HCV) infection with a history of injecting drug use and to assess the association between symptoms of depression, anxiety, or stress and HCV treatment intent, specialist assessment, or treatment uptake. Methods: The Enhancing Treatment for Hepatitis C in Opioid Substitution Settings was an observational cohort study evaluating the provision of HCV assessment and treatment among people with chronic HCV and a history of injecting drug use, recruited from 9 community health centers and opioid substitution therapy (OST) clinics (New South Wales, Australia). Symptoms were assessed using the Depression Anxiety Stress Scales (DASS-21). Analyses were performed using logistic regression. Results: Among 415 participants (mean age 41 years, 71% male), 47%, 52%, and 36% demonstrated moderate to extremely severe symptoms of depression, anxiety, and stress, respectively. In adjusted analyses, depression symptoms were associated with recent injecting drug use [adjusted odds ratio (aOR) 1.63, 95% confidence interval (CI) 1.07-2.49), whereas stress symptoms were associated with unemployment (aOR 2.99, 95% CI 1.09-8.15) and not living with a spouse or other relatives/friends (aOR 1.55, 95% CI 1.01-2.39). Symptoms of depression, anxiety, or stress or having a history of treated mental illness were not independently associated with HCV treatment intent, specialist assessment, or treatment uptake. Conclusions: Findings suggest a need for improved interventions and care regarding mental health among people living with chronic HCV with a history of injecting drug use, but suggest that symptoms of depression, anxiety, and stress should not be immediate contraindications to HCV assessment and treatment.
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Nova |
2017 |
Grebely J, Dalgard O, Cunningham EB, Hajarizadeh B, Foster GR, Bruggmann P, et al., 'Efficacy of response-guided directly observed pegylated interferon and self-administered ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: The ACTIVATE study', International Journal of Drug Policy, 47 177-186 (2017) [C1]
Background There are few data on treatment for hepatitis C virus (HCV) infection among people with ongoing injecting drug use. This study evaluated the efficacy of response-guided... [more]
Background There are few data on treatment for hepatitis C virus (HCV) infection among people with ongoing injecting drug use. This study evaluated the efficacy of response-guided therapy for chronic HCV genotypes 2/3 infection among people with ongoing injecting drug use or receiving opioid substitution therapy (OST). A secondary aim was to identify predictors of HCV treatment response. Methods ACTIVATE was a multicentre clinical trial recruited between 2012 and 2014. Participants with genotypes 2/3 were treated with directly observed peg-interferon alfa-2b and self-administered ribavirin for 12 (undetectable HCV RNA at week 4) or 24 weeks (detectable HCV RNA at week 4). Participants were recruited from drug treatment clinics, private practices, hospital clinics and community clinics in Australia, Canada, and five countries in Europe. The primary study outcome was sustained virological response (SVR, undetectable HCV RNA >12 weeks post-treatment). Results Among 93 people with ongoing injecting drug use or receiving OST treated for HCV genotype 2/3, 59% had recently (past month) injected drugs, 77% were receiving OST and 56% injected drugs during therapy. Overall SVR was 66% (61/93). SVR was 84% in those with undetectable HCV RNA at week 4 (12 weeks) compared to 38% in those without (24 weeks). In adjusted analysis, cirrhosis vs. no/mild fibrosis [adjusted OR (aOR) 0.33, 95% CI 0.13, 0.86] predicted reduced SVR, while response at week 4 was associated with increased SVR [aOR 8.11, 95% CI 2.73, 24.10]. Recent injecting drug use at baseline or during therapy was not associated with SVR. Conclusion This study demonstrates that people with recent injecting drug use or OST with chronic HCV can achieve responses to interferon-based therapy similar to other populations, despite injecting drugs prior to or during therapy. Cirrhosis was predictive of reduced response to HCV therapy, while response at week 4 (despite shortened therapy) was predictive of improved response.
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Nova |
2017 |
Midgard H, Hajarizadeh B, Cunningham EB, Conway B, Backmund M, Bruggmann P, et al., 'Changes in risk behaviours during and following treatment for hepatitis C virus infection among people who inject drugs: The ACTIVATE study', International Journal of Drug Policy, 47 230-238 (2017) [C1]
Background The risk of hepatitis C virus (HCV) reinfection due to continued injecting risk behaviours might remain a barrier to HCV treatment among people who inject drugs. We aim... [more]
Background The risk of hepatitis C virus (HCV) reinfection due to continued injecting risk behaviours might remain a barrier to HCV treatment among people who inject drugs. We aimed to evaluate changes in risk behaviours during and following HCV treatment among people with ongoing injecting drug use or receiving opioid substitution treatment (OST). Methods ACTIVATE was an international multicentre clinical trial conducted between 2012 and 2014. Participants with HCV genotypes 2/3 infection were treated with peg-interferon/ribavirin for 12 or 24 weeks and completed a self-administered behavioural questionnaire at each study visit. The impact of time in treatment and follow-up on longitudinally measured recent (past month) behavioural outcomes was evaluated using generalized estimating equations. Results Among 93 enrolled participants (83% male, median age 41 years), 55 (59%) had injected in the past month. Any injecting drug use decreased during HCV treatment and follow-up (OR 0.89 per incremental study visit; 95% CI 0.83¿0.95). No significant changes were found in =daily injecting (OR 0.98; 95% CI 0.89¿1.07), use of non-sterile needles (OR 0.94; 95% CI 0.79¿1.12), sharing of injecting paraphernalia (OR 0.87; 95% CI 0.70¿1.07) or non-injecting drug use (OR 1.01; 95% CI 0.92¿1.10). Hazardous alcohol use decreased throughout (OR 0.56; 95% CI 0.40¿0.77) and OST increased between enrolment and end of treatment (OR 1.48; 95% CI 1.07¿2.04). Conclusions Recent injecting drug use and hazardous alcohol use decreased, while OST increased during and following HCV treatment among participants with ongoing injecting drug use. These findings support further expansion of HCV care among PWID.
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Nova |
2017 |
Cunningham EB, Hajarizadeh B, Dalgard O, Amin J, Hellard M, Foster GR, et al., 'Adherence to response-guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: the ACTIVATE study', BMC INFECTIOUS DISEASES, 17 (2017) [C1]
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Nova |
2017 |
Skelton E, Bonevski B, Tzelepis F, Shakeshaft A, Guillaumier A, Dunlop A, et al., 'Tobacco smoking policies in Australian alcohol and other drug treatment services, agreement between staff awareness and the written policy document', BMC Public Health, 17 (2017) [C1]
Background: Comprehensive smoke-free policy in the alcohol and other drug (AOD) setting provides an opportunity to reduce tobacco related harms among clients and staff. This study... [more]
Background: Comprehensive smoke-free policy in the alcohol and other drug (AOD) setting provides an opportunity to reduce tobacco related harms among clients and staff. This study aimed to examine within AOD services: staff awareness of their service's smoking policy compared to the written policy document and staff and service factors associated with accurate awareness of a total ban and perceived enforcement of a total ban. Methods: An audit of written tobacco smoking policy documents and an online cross-sectional survey of staff from 31 Australian AOD services. In addition, a contact at each service was interviewed to gather service-related data. Results: Overall, 506 staff participated in the survey (response rate: 57%). Nearly half (46%) perceived their service had a total ban with 54% indicating that this policy was always enforced. Over one-third (37%) reported a partial ban with 48% indicating that this policy was always enforced. The audit of written policies revealed that 19 (61%) services had total bans, 11 (36%) had partial bans and 1 (3%) did not have a written smoking policy. Agreement between staff policy awareness and their service's written policy was moderate (Kappa 0.48) for a total ban and fair (Kappa 0.38) for a partial ban. Age (1 year increase) of staff was associated with higher odds of correctly identifying a total ban at their service. Conclusions: Tobacco smoking within Australian AOD services is mostly regulated by a written policy document. Staff policy awareness was modest and perceived policy enforcement was poor.
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Nova |
2017 |
Sara G, Lappin J, Dobbins T, Dunlop AJ, Degenhardt L, 'Escalating patterns of emergency health care prior to first admission with amphetamine psychosis: A window of opportunity?', Drug and Alcohol Dependence, 180 171-177 (2017) [C1]
Aim To describe health service contact in the two years prior to a first hospital admission with amphetamine-related psychosis, and to identify possible opportunities for early in... [more]
Aim To describe health service contact in the two years prior to a first hospital admission with amphetamine-related psychosis, and to identify possible opportunities for early intervention. Method Routine health data collections were used to identify 6130 persons aged 16¿65 who had a first hospital admission with amphetamine-related psychosis in New South Wales (NSW), Australia, between 2005 and 2016. Health service contacts in the two years prior to first admission were identified, using public hospital, emergency department and community mental health data. Prior care was compared to 41,444 people with first psychosis admissions without amphetamine diagnoses. Results Two thirds of people with amphetamine-related psychosis had health service contact in the two years prior to their first psychosis admission. Of these, 45% had ED contacts and 30% had prior general hospital admissions. The likelihood of contact escalated throughout the two years prior to admission. Prior substance-related conditions, infectious diseases, injuries and accidents were common. Compared to other first psychosis admissions, people with amphetamine-related psychoses were less likely to have prior specialised mental health care (OR 0.84, 95% CI 0.78, 0.89) and more likely to have prior general health care (OR 1.40, 95% CI 1.29, 1.51). Conclusion Emergency departments and units treating people with infectious diseases or injuries should consider strategies to detect amphetamine and other substance use. Early detection and referral to specialist mental health or drug and alcohol care may prevent some amphetamine-related psychoses.
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Nova |
2017 |
Skelton E, Tzelepis F, Shakeshaft A, Guillaumier A, Dunlop A, McCrabb S, et al., 'Addressing tobacco in Australian alcohol and other drug treatment settings: a cross-sectional survey of staff attitudes and perceived barriers', SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY, 12 (2017) [C1]
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Nova |
2016 |
Mitchell J, Dunlop A, 'Alcohol consumption: monitoring, regulation and impact on public health', PUBLIC HEALTH RESEARCH & PRACTICE, 26 (2016)
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2016 |
Hamilton M, Dunlop AJ, '"Ice" (crystal methamphetamine): concerns and responses', MEDICAL JOURNAL OF AUSTRALIA, 204 136-137 (2016)
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2016 |
Dunlop AJ, Newman LK, 'ADHD and psychostimulants - overdiagnosis and overprescription', MEDICAL JOURNAL OF AUSTRALIA, 204 139-139 (2016)
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2016 |
Hamilton M, Dunlop AJ, '"Ice" (crystal methamphetamine): concerns and responses There is no cause to feel impotent, despite disturbing media reports about methamphetamine', MEDICAL JOURNAL OF AUSTRALIA, 204 136-+ (2016)
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2016 |
Dunlop AJ, Newman LK, 'ADHD and psychostimulants - overdiagnosis and overprescription Careful assessment and universal precautions are necessary', MEDICAL JOURNAL OF AUSTRALIA, 204 139-+ (2016)
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2016 |
Lintzeris N, Monds L, Rivas G, Leung S, Dunlop AJ, Newcombe D, et al., 'TRANSFERRING PATIENTS FROM METHADONE TO BUPRENORPHINE: THE DEVELOPMENT AND EVALUATION OF PRACTICE GUIDELINES', DRUG AND ALCOHOL REVIEW, 35 50-51 (2016) |
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2016 |
Tremain D, Freund M, Wye P, Wolfenden L, Bowman J, Dunlop A, et al., 'Provision of Chronic Disease Preventive Care in Community Substance Use Services: Client and Clinician Report', Journal of Substance Abuse Treatment, 68 24-30 (2016) [C1]
Introduction: People with substance use problems have a higher prevalence of modifiable health risk behaviors. Routine clinician provision of preventive care may be effective in r... [more]
Introduction: People with substance use problems have a higher prevalence of modifiable health risk behaviors. Routine clinician provision of preventive care may be effective in reducing such health behaviors. This study aimed to examine clinician provision of preventive care to clients of community substance use treatment services. Methods: A cross-sectional survey was undertaken with 386 clients and 54 clinicians of community substance use treatment services in one health district in New South Wales, Australia. Client- and clinician-reported provision of three elements of care (assessment, brief advice and referral) for three health risk behaviors (tobacco smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity) was assessed, with associations with client characteristics examined. Results: Provision was highest for tobacco smoking assessment (90% client reported, 87% clinician reported) and brief advice (79% client reported, 80% clinician reported) and lowest for fruit and vegetable consumption (assessment 23%, brief advice 25%). Few clients reported being offered a referral (<. 10%). Assessment of physical activity and brief advice for all behaviors was higher for clients residing in rural/remote areas. Conclusion: Assessment and brief advice were provided to the majority of clients for smoking, but sub-optimally for the other behaviors. Further investigation of barriers to the provision of preventive care within substance use treatment settings is required, particularly for referral to ongoing support.
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Nova |
2016 |
Johnson NA, Kypri K, Latter J, Attia J, McEvoy M, Dunlop A, Scott R, 'Genetic feedback to reduce alcohol consumption in hospital outpatients with risky drinking: Feasibility and acceptability', Public Health Research and Practice, 26 (2016) [C1]
Objective: There have been no trials in healthcare settings of genetic susceptibility feedback in relation to alcohol consumption. The purpose of this study was to determine the f... [more]
Objective: There have been no trials in healthcare settings of genetic susceptibility feedback in relation to alcohol consumption. The purpose of this study was to determine the feasibility and acceptability of conducting a full-scale randomised trial estimating the effect of personalised genetic susceptibility feedback on alcohol consumption in hospital outpatients with risky drinking. Methods: Outpatients =18 years of age who reported drinking more than 14 standard drinks in the past week or in a typical week were asked to provide a saliva sample for genetic testing. Genetic susceptibility feedback was posted to participants 6 months after recruitment. The co-primary outcomes were the proportion of participants who (i) provided a saliva sample that could be genotyped, and (ii) spoke with a genetic counsellor. Secondary outcomes included changes in patients' weekly alcohol consumption; scores on scales measuring readiness to change, importance of changing and confidence in ability to change drinking habits; knowledge about which cancers are alcohol-attributable; and acceptability of the saliva collection procedure and the genetic-feedback intervention. McNemar's test and paired t-tests were used to test for differences between baseline and follow-up in proportions and means, respectively. Results: Of 100 participants who provided a saliva sample, 93 had adequate DNA for at least one genotyping assay. Three participants spoke to a genetic counsellor. Patients' readiness to change their drinking, their views on the importance of changing and their stated confidence in their ability to change increased between baseline and follow-up. There was no increase in patients' knowledge about alcohol-attributable cancers nor any reduction in how much alcohol they drank 4 months after receiving the feedback. Most participants (80%) were somewhat comfortable or very comfortable with the process used to collect saliva, 84% understood the genetic feedback, 54% found it useful, 10% had sought support to reduce their drinking after receiving the feedback, and 37% reported that the feedback would affect how much they drink in the future. Conclusion: Results of this study suggest it would be feasible to conduct a methodologically robust trial estimating the effect of genetic susceptibility feedback on alcohol consumption in hospital outpatients with risky drinking.
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Nova |
2016 |
Ezard N, Dunlop A, Clifford B, Bruno R, Carr A, Bissaker A, Lintzeris N, 'Study protocol: a dose-escalating, phase-2 study of oral lisdexamfetamine in adults with methamphetamine dependence', BMC PSYCHIATRY, 16 (2016)
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2016 |
Larance B, Bruno R, Lintzeris N, Degenhardt L, Black E, Brown A, et al., 'Development of a brief tool for monitoring aberrant behaviours among patients receiving long-term opioid therapy: The Opioid-Related Behaviours In Treatment (ORBIT) scale', Drug and Alcohol Dependence, 159 42-52 (2016) [C1]
Background: Early identification of problems is essential in minimising the unintended consequences of opioid therapy. This study aimed to develop a brief scale that identifies an... [more]
Background: Early identification of problems is essential in minimising the unintended consequences of opioid therapy. This study aimed to develop a brief scale that identifies and quantifies recent aberrant behaviour among diverse patient populations receiving long-term opioid treatment. Method: 40 scale items were generated via literature review and expert panel (N= 19) and tested in surveys of: (i) N= 41 key experts, and (ii) N= 426 patients prescribed opioids >3 months (222 pain patients and 204 opioid substitution therapy (OST) patients). We employed item and scale psychometrics (exploratory factor analyses, confirmatory factor analyses and item-response theory statistics) to refine items to a brief scale. Results: Following removal of problematic items (poor retest-reliability or wording, semantic redundancy, differential item functioning, collinearity or rarity) iterative factor analytic procedures identified a 10-item unifactorial scale with good model fit in the total sample (N= 426; CFI = 0.981, TLI = 0.975, RMSEA = 0.057), and among pain (CFI = 0.969, TLI = 0.960, RMSEA = 0.062) and OST subgroups (CFI = 0.989, TFI = 0.986, RMSEA = 0.051). The 10 items provided good discrimination between groups, demonstrated acceptable test-retest reliability (ICC 0.80, 95% CI 0.60-0.89; Cronbach's alpha = 0.89), were moderately correlated with related constructs, including opioid dependence (SDS), depression and stress (DASS subscales) and Social Relationships and Environment domains of the WHO-QoL, and had strong face validity among advising clinicians. Conclusions: The Opioid-Related Behaviours In Treatment (ORBIT) scale is brief, reliable and validated for use in diverse patient groups receiving opioids. The ORBIT has potential applications as a checklist to prompt clinical discussions and as a tool to quantify aberrant behaviour and assess change over time.
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Nova |
2016 |
Bonevski B, Guillaumier A, Shakeshaft A, Farrell M, Tzelepis F, Walsberger S, et al., 'An organisational change intervention for increasing the delivery of smoking cessation support in addiction treatment centres: study protocol for a randomized controlled trial', TRIALS, 17 (2016)
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Nova |
2016 |
Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, et al., 'Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia', Drug and Alcohol Review, 35 70-75 (2016) [C1]
Introduction and Aims: Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of codeine dependence. Given the lower pote... [more]
Introduction and Aims: Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of codeine dependence. Given the lower potency of codeine it cannot be assumed that buprenorphine dose requirements for heroin dependence will generalise to codeine. This is the first study to examine buprenorphine treatment for codeine dependence.Design and Methods: Retrospective case series of 19 codeine-dependent treatment entrants who received sublingual buprenorphine maintenance treatment through six specialist inpatient and outpatient treatment centres. Baseline codeine doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes after 28 days of buprenorphine treatment.Results: A significant linear relationship was found between initial codeine dose and dose of buprenorphine given at days 7 and 28 for the codeine dose range of 50-960 mg day-1 (mean: 564 mg; 95% confidence interval 431-696 mg). Median buprenorphine dose was 12.0 mg (interquartile range 9.5 mg, range 4-32 mg) at day 7 and 16.0 mg (interquartile range 13.5 mg, range 4-32 mg) at day 28. Buprenorphine doses received were markedly higher than estimated codeine doses based on standard dose conversion tables.Discussion and Conclusions: With increasing presentations relating to codeine dependence, these findings provide important guidance to clinicians. Buprenorphine doses were consistently higher than doses estimated based on the dose of codeine consumed, and were comparable with doses used in the treatment of dependence with heroin and more potent prescription opioids. [Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug Alcohol Rev 2015].
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Nova |
2016 |
Wilson AJ, Bonevski B, Dunlop A, Shakeshaft A, Tzelepis F, Walsberger S, et al., ''The lesser of two evils': A qualitative study of staff and client experiences and beliefs about addressing tobacco in addiction treatment settings', Drug and Alcohol Review, 35 92-101 (2016) [C1]
Introduction and Aims: The aim of this study was to explore beliefs about tobacco dependence treatment from the perspective of staff and clients in addiction treatment settings.De... [more]
Introduction and Aims: The aim of this study was to explore beliefs about tobacco dependence treatment from the perspective of staff and clients in addiction treatment settings.Design and Methods: A qualitative study was conducted between August and November 2013 using grounded theory methodology. Participants were recruited from four government-funded drug and alcohol services in a regional centre of New South Wales, Australia. Treatment centre staff (n=10) were interviewed using a semistructured interview guide and two focus groups (n=5 and n=6) were held with clients of the same treatment centres.Results: Both clients and staff wish to do more about tobacco use in addiction treatment services, but a number of barriers were identified. Staff barriers included lack of time, tobacco-permissive organisational culture, lack of enforcement of smoke-free policies, beliefs that tobacco is not a treatment priority for clients and that clients need to smoke as a coping strategy, and perceptions that treatment was either ineffective or not used by clients. Clients reported smoking as a habit and for enjoyment or stress relief, seeing staff smoking, nicotine replacement therapy unaffordability and perceptions that nicotine replacement therapy may be addictive, and inability to relate to telephone cessation counselling as barriers to quitting smoking.Discussion and Conclusions: Client and staff perceptions and attitudes about the treatment of tobacco, particularly those relating telephone support and nicotine replacement therapy, provided information, which will inform the design of smoking cessation programs for addiction treatment populations. [Wilson AJ, Bonevski B., Dunlop A., Shakeshaft A, Tzelepis F., Walsberger S., Farrell M., Kelly PJ, Guillaumier A. 'The lesser of two evils': A qualitative study of staff and client experiences and beliefs about addressing tobacco in addiction treatment settings. Drug Alcohol Rev 2015].
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Nova |
2016 |
Grebely J, Alavi M, Micallef M, Dunlop AJ, Balcomb AC, Phung N, et al., 'Treatment for hepatitis C virus infection among people who inject drugs attending opioid substitution treatment and community health clinics: The ETHOS Study', Addiction, 111 311-319 (2016) [C1]
Aims: To estimate adherence and response to therapy for chronic hepatitis C virus (HCV) infection among people with a history of injecting drug use. A secondary aim was to identif... [more]
Aims: To estimate adherence and response to therapy for chronic hepatitis C virus (HCV) infection among people with a history of injecting drug use. A secondary aim was to identify predictors of HCV treatment response. Design: Prospective cohort recruited between 2009 and 2012. Participants were treated with peg-interferon alfa-2a/ribavirin for 24 (genotypes 2/3, G2/3) or 48weeks (genotype 1, G1). Setting: Six opioid substitution treatment (OST) clinics, two community health centres and one Aboriginal community-controlled health organization providing drug treatment services in New South Wales, Australia. Participants: Among 415 people with a history of injecting drug use and chronic HCV assessed by a nurse, 101 were assessed for treatment outcomes (21% female). Measurements: Study outcomes were treatment adherence and sustained virological response (SVR, undetectable HCV RNA >24weeks post-treatment). Findings: Among 101 treated, 37% (n=37) had recently injected drugs (past 6months) and 62% (n=63) were receiving OST. Adherence =80% was 86% (n=87). SVR was 74% (75 of 101), with no difference observed by sex (males: 76%, females: 67%, P=0.662). In adjusted analysis, age <35 (versus =45years) [adjusted odds ratio (aOR)=5.06, 95% confidence interval (CI)=1.47, 17.40] and on-treatment adherence =80% independently predicted SVR (aOR=19.41, 95% CI=3.61, 104.26]. Recent injecting drug use at baseline was not associated with SVR. Conclusions: People with a history of injecting drug use and chronic hepatitis C virus attending opioid substitution treatment and community health clinics can achieve adherence and responses to interferon-based therapy similar to other populations, despite injecting drugs at baseline. Younger age and adherence are predictive of improved response to hepatitis C virus therapy.
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Nova |
2016 |
Dunlop AJ, 'Commentary on Smith et al. (2016): Gabapentin-looks like a drug that can be misused..., probably is a drug that can be misused', ADDICTION, 111 1175-1176 (2016)
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2015 |
Johnson NA, Kypri K, Latter J, McElduff P, Attia J, Saitz R, et al., 'Effect of telephone follow-up on retention and balance in an alcohol intervention trial', Preventive Medicine Reports, 2 746-749 (2015) [C1]
Objectives: Telephone follow-up is not currently recommended as a strategy to improve retention in randomized trials. The aims of this study were to estimate the effect of telepho... [more]
Objectives: Telephone follow-up is not currently recommended as a strategy to improve retention in randomized trials. The aims of this study were to estimate the effect of telephone follow-up on retention, identify participant characteristics predictive of questionnaire completion during or after telephone follow-up, and estimate the effect of including participants who provided follow-up data during or after telephone follow-up on balance between randomly allocated groups in a trial estimating the effect of electronic alcohol screening and brief intervention on alcohol consumption in hospital outpatients with hazardous or harmful drinking. Method: Trial participants were followed up 6. months after randomization (June-December 2013) using e-mails containing a hyperlink to a web-based questionnaire when possible and by post otherwise. Telephone follow-up was attempted after two written reminders and participants were invited to complete the questionnaire by telephone when contact was made. Results: Retention before telephone follow-up was 62.1% (520/837) and 82.8% (693/837) afterward: an increase of 20.7% (173/837). Therefore, 55% (95% CI 49%-60%) of the 317 participants who had not responded after two written reminders responded during or after the follow-up telephone call. Age. <. 55. years, a higher AUDIT-C score and provision of a mobile/cell phone number were predictive of questionnaire completion during or after telephone follow-up. Balance between randomly allocated groups was present before and after inclusion of participants who completed the questionnaire during or after telephone follow-up. Conclusion: Telephone follow-up improved retention in this randomized trial without affecting balance between the randomly allocated groups.
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Nova |
2015 |
Marshall AD, Micallef M, Erratt A, Telenta J, Treloar C, Everingham H, et al., 'Liver disease knowledge and acceptability of non-invasive liver fibrosis assessment among people who inject drugs in the drug and alcohol setting: The LiveRLife Study', International Journal of Drug Policy, 26 984-991 (2015) [C1]
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Nova |
2015 |
Pienaar K, Fraser S, Kokanovic R, Moore D, Treloar C, Dunlop A, 'New narratives, new selves: Complicating addiction in online alcohol and other drug resources', Addiction Research and Theory, 23 499-509 (2015) [C1]
Within the expansive qualitative literature on alcohol and other drug (AOD) use, knowledge of lived experiences of AOD addiction is limited. Much of the existing scholarship reifi... [more]
Within the expansive qualitative literature on alcohol and other drug (AOD) use, knowledge of lived experiences of AOD addiction is limited. Much of the existing scholarship reifies addiction as a calamitous state, and pathologises those believed to be experiencing it. Such research discounts the many ways people live with regular AOD use and is unable to tell us much about how addiction emerges through, rather than precedes, peoples experiences and understandings of it. This article draws on the theoretical literature on the production of social problems and the concept of "ontological politics" to introduce an innovative approach to understanding lived experiences of AOD addiction. Applying this literature to a critical analysis of personal narratives from two Australian AOD websites, we demonstrate how addiction is conceived narrowly in these narratives as a disorder of compulsion, amenable to treatment. Not only does this conception reproduce unhelpful assumptions about addiction, it also reifies it as a stable, unified entity, the boundaries of which are fixed. Against this familiar account, we conceive addiction as an emergent, fiercely contested phenomenon, constituted in part through the very measures designed to treat it. This shift in focus allows an innovation in engaging with addiction, which is being pursued in a new Australian research project: the development of a public website presenting lived experiences of addiction that will be (1) a means of challenging existing public discourses, and (2) an intervention in the social production of addiction. The article concludes by considering the politics of this approach and how it might reshape addiction.
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Nova |
2015 |
Keats J, Micallef M, Grebely J, Hazelwood S, Everingham H, Shrestha N, et al., 'Assessment and delivery of treatment for hepatitis C virus infection in an opioid substitution treatment clinic with integrated peer-based support in Newcastle, Australia', International Journal of Drug Policy, 26 999-1006 (2015) [C1]
Background: Among people who inject drugs (PWID), the prevalence of hepatitis C virus (HCV) infection is high; however HCV treatment uptake remains low. New models of care are nee... [more]
Background: Among people who inject drugs (PWID), the prevalence of hepatitis C virus (HCV) infection is high; however HCV treatment uptake remains low. New models of care are needed to address the growing burden of HCV-related disease in PWID and to understand the barriers to assessment and treatment of HCV. This study evaluated assessment and treatment for HCV infection among PWID attending an opioid substitution treatment (OST) clinic with an integrated peer support worker model. Methods: Clients with a history of IDU and chronic HCV infection, attending the Newcastle Pharmacotherapy Service, Newcastle Australia, were recruited as part of a multisite prospective observational study (the ETHOS Cohort). Additional chart review was conducted for clients not enrolled in the ETHOS Cohort. A peer support worker was introduced to complement and extend services offered by the clinical team. Client contacts and assessments with a nurse and/or peer worker were evaluated, including those who commenced HCV treatment. Results: A total of 1447 clients attended the OST service during February 2009 and June 2014. Of these, 378 (26%) were assessed by a nurse and 242 (17%) by a clinician. HCV treatment was commenced by 20 (5%) participants and 15 (75%) achieved a sustained virological response (SVR). During May 2009 and July 2011, 332 nurse contacts and 726 peer worker contacts were evaluated. The nurse-led contacts were related to HCV treatment (50%) and review of pathology tests (34%), whereas peer worker contacts included discussion about HCV treatment (75%), education, counselling and/or support (53%) and general discussion about HCV infection (59%). Conclusion: These data demonstrate that peer support workers facilitate broader discussion about HCV treatment, education and/or support, allowing nurses to focus on HCV-related assessment and treatment. HCV treatment uptake was very low in this cohort, but SVR was high. The integration of peer support workers in treatment programs within OST clinics may address barriers to HCV care, but further studies are needed to assess their impact on assessment and treatment outcomes.
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Nova |
2015 |
Alavi M, Micallef M, Fortier E, Dunlop AJ, Balcomb AC, Day CA, et al., 'Effect of treatment willingness on specialist assessment and treatment uptake for hepatitis C virus infection among people who use drugs: The ETHOS study', Journal of Viral Hepatitis, 22 914-925 (2015) [C1]
Among people who inject drugs (PWID) with chronic HCV, the association between HCV treatment willingness and intent, and HCV specialist assessment and treatment were evaluated. Th... [more]
Among people who inject drugs (PWID) with chronic HCV, the association between HCV treatment willingness and intent, and HCV specialist assessment and treatment were evaluated. The Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) is a prospective observational cohort. Recruitment was through six opioid substitution treatment clinics, two community health centres and one Aboriginal community controlled health organisation in Australia. Analyses were performed using logistic regression. Among 415 participants (mean age 41 years, 71% male), 67% were 'definitely willing' to receive HCV treatment and 70% reported plans to initiate therapy 12 months postenrolment. Those definitely willing to receive HCV treatment were more likely to undergo specialist assessment (64% vs 32%, P < 0.001) and initiate therapy (36% vs 9%, P < 0.001), compared to those with lower treatment willingness. Those with early HCV treatment plans were more likely to undergo specialist assessment (65% vs 27%, P < 0.001) and initiate therapy (36% vs 5%, P < 0.001), compared to those without early plans. In adjusted analyses, HCV treatment willingness independently predicted specialist assessment (aOR 3.06, 95% CI 1.90, 4.94) and treatment uptake (aOR 4.33, 95% CI 2.14, 8.76). In adjusted analysis, having early HCV treatment plans independently predicted specialist assessment (aOR 4.38, 95% CI 2.63, 7.29) and treatment uptake (aOR 9.79, 95% CI 3.70, 25.93). HCV treatment willingness was high and predicted specialist assessment and treatment. Strategies for enhanced HCV care should be developed with an initial focus on people willing to receive treatment and to increase treatment willingness among those less willing.
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Nova |
2015 |
Perry N, Newman LK, Hunter M, Dunlop A, 'Improving antenatal risk assessment in women exposed to high risks', CLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY, 20 84-105 (2015) [C1]
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Nova |
2015 |
Hayes C, Holliday S, Magin P, Dunlop A, 'The evaluation of a brief educational pain management intervention amongst Australian GP registrars.', Drug and Alcohol Review, (2015)
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2015 |
Fortier E, Alavi M, Micallef M, Dunlop AJ, Balcomb AC, Day CA, et al., 'The effect of social functioning and living arrangement on treatment intent, specialist assessment and treatment uptake for hepatitis C virus infection among people with a history of injecting drug use: The ETHOS study', International Journal of Drug Policy, 26 1094-1102 (2015) [C1]
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Nova |
2015 |
Nielsen S, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N, 'Comparing treatment-seeking codeine users and strong opioid users: Findings from a novel case series', Drug and Alcohol Review, 34 304-311 (2015) [C1]
Introduction and Aims: Few studies have described those seeking treatment for codeine dependence. This study aimed to compare patients presenting for treatment where either codein... [more]
Introduction and Aims: Few studies have described those seeking treatment for codeine dependence. This study aimed to compare patients presenting for treatment where either codeine or a strong pharmaceutical opioid (oxycodone or morphine) was the principal drug of concern to understand if codeine users may have unique treatment needs. Design and Methods: Retrospective case review of 135 patients from three geographical areas in New South Wales, Australia. Cases where the principal drug of concern was codeine (n=53) or a strong pharmaceutical opioid (oxycodone or morphine, n=82) were compared. Differences in demographic characteristics, pain history, mental health, substance use history and, subsequently, the treatment that was received were examined. Results: People whose principal drug of concern was codeine were more likely to be female (66% vs. 37%, P<0.001), employed (43% vs. 22%, P<0.01) and use only one pharmaceutical opioid (91% vs. 49%, P<0.001). There was no difference in age between the codeine group (mean 38.6 years) and the strong opioid group (39.3 years). Opioid substitution therapy was the most common treatment received by both groups although codeine patients were more likely to be treated with buprenorphine than methadone (odds ratio=7.7, 95% confidence interval 2.2-27.2, P<0.001) and more likely to attempt withdrawal (odds ratio=2.6, 95% confidence interval 1.2-5.3, P=0.010). Discussion and Conclusions: There are important differences between codeine-dependent patients and strong prescription opioid-dependent patients. Further work should explore the outcomes of withdrawal versus maintenance treatment for codeine users.
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Nova |
2015 |
Holliday S, Morgan S, Tapley A, Dunlop A, Henderson K, van Driel M, et al., 'The Pattern of Opioid Management by Australian General Practice Trainees', Pain Medicine (United States), 16 1720-1731 (2015) [C1]
Objective: With escalating opioid prescribing come individual and public health harms. To inform quality improvement measures, understanding of opioid prescribing is essential. We... [more]
Objective: With escalating opioid prescribing come individual and public health harms. To inform quality improvement measures, understanding of opioid prescribing is essential. We aimed to establish consultation-level prevalence and associations of opioid prescribing. Design: A cross-sectional secondary analysis from a longitudinal multisite cohort study of general practitioner (GP) vocational trainees: "Registrar Clinical Encounters in Training." Setting: Four of Australia's seventeen GP Regional Training Providers, during 2010-13. Subjects: GP trainees. Methods: Practice and trainee demographic data were collected as well as patient, clinical and educational data of 60 consecutive consultations of each trainee, each training term. Outcome factors were any opioid analgesic prescription and initial opioid analgesic prescription for a specific problem for the first time. Results: Overall, 645 trainees participated. Opioids comprised 4.3% prescriptions provided for 3.8% of patients. Most frequently prescribed were codeine (39.9%) and oxycodone (33.4%). Prescribing was for acute pain (29.3%), palliative care (2.6%) or other indications (68.1%). Most prescribing involved repeat prescriptions for pre-existing problems (62.7% of total). Other associations included older patients; prescriber and patient male gender; Aboriginal/Torres Strait Islander status; rural and disadvantaged locations; longer consultations; and generation of referrals, follow-up, and imaging requests. Opioid initiation was more likely for new patients with new problems, but otherwise associations were similar. Trainees rarely reported addiction risk-mitigation strategies. Conclusions: Most opioids were prescribed as maintenance therapy for non-cancer pain. Demographic associations with opioid analgesic prescribing resemble those presenting for opioid dependency treatment. Our findings should inform measures by regulators and medical educators supporting multimodal pain management.
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Nova |
2015 |
Lintzeris N, Copeland J, Dunlop A, McGregor IS, Allsop DJ, 'Cannabinoid Replacement Therapy (CRT): Nabiximols (Sativex) as a Novel Treatment for Cannabis Withdrawal', Clinical Pharmacology and Therapeutics, 97 571-574 (2015) [C1]
Cannabis is a common recreational drug that is generally considered to have low addictive potential. However, an increasing number of cannabis users are seeking treatment for depe... [more]
Cannabis is a common recreational drug that is generally considered to have low addictive potential. However, an increasing number of cannabis users are seeking treatment for dependence on the drug. There is interest in using agonist (substitution) pharmacotherapies to treat cannabis dependence and here we outline a novel approach involving a buccal spray (nabiximols) that contains tetrahydrocannabinol (THC) and cannabidiol (CBD). We review recent research with nabiximols and highlight findings relevant to clinical practice.
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Nova |
2014 |
Burns L, Breen C, Dunlop AJ, 'Prevention of fetal alcohol spectrum disorders must include maternal treatment', Medical Journal of Australia, 200 392 (2014) [C3]
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2014 |
Treloar C, Rance J, Dore GJ, Grebely J, 'Barriers and facilitators for assessment and treatment of hepatitis C virus infection in the opioid substitution treatment setting: insights from the ETHOS study', JOURNAL OF VIRAL HEPATITIS, 21 560-567 (2014)
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2014 |
Allsop DJ, Dunlop AJ, Sadler C, Rivas GR, McGregor LS, Copeland J, 'Changes in cigarette and alcohol use during cannabis abstinence', DRUG AND ALCOHOL DEPENDENCE, 138 54-60 (2014) [C1]
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Nova |
2014 |
Johnson NA, Kypri K, Latter J, McElduff P, Saunders JB, Saitz R, et al., 'Prevalence of unhealthy alcohol use in hospital outpatients', Drug and Alcohol Dependence, 144 270-273 (2014) [C1]
Background: Few studies have examined the prevalence of unhealthy alcohol use in the hospital outpatient setting. Our aim was to estimate the prevalence of unhealthy alcohol use a... [more]
Background: Few studies have examined the prevalence of unhealthy alcohol use in the hospital outpatient setting. Our aim was to estimate the prevalence of unhealthy alcohol use among patients attending a broad range of outpatient clinics at a large public hospital in Australia. Methods: Adult hospital outpatients were invited to complete the Alcohol Use Disorders Identification Test Consumption questions (AUDIT-C) using an iPad as part of a randomised trial testing the efficacy of alcohol electronic screening and brief intervention. Unhealthy alcohol use was defined as an AUDIT-C score =5 among men and =4 among women. Results: Sixty percent (3616/6070) of invited hospital outpatients consented, of whom 89% (3206/3616) provided information on their alcohol consumption (either reported they had not consumed any alcohol in the last 12 months or completed the AUDIT-C). The prevalence of unhealthy alcohol use was 34.7% (95% confidence interval [CI]: 33.0-36.3%). The prevalence among men aged 18-24 years, 25-39 years, 40-59 years and 60 years and older, was 74.4% (95% CI: 68.4-80.4%), 54.3% (95% CI: 48.7-59.8%), 44.1% (95% CI: 39.9-48.3%), and 27.0% (95% CI: 23.6-30.4%), respectively (43.1% overall; 95% CI: 40.8-45.5%). The prevalence among women aged 18-24 years, 25-39 years, 40-59 years, and 60 years and older, was 48.6% (95% CI: 39.2-58.1%), 36.9% (95% CI: 31.2-42.6%), 25.2% (95% CI: 21.5-29.0%) and 14.5% (95% CI: 11.7-17.3%), respectively (24.9% overall; 95% CI: 22.7-27.1%). Conclusion: A large number of hospital outpatients who are not currently seeking treatment for their drinking could benefit from effective intervention in this setting.
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Nova |
2014 |
Allsop DJ, Copeland J, Lintzeris N, Dunlop AJ, Montebello M, Sadler C, et al., 'Nabiximols as an Agonist Replacement Therapy During Cannabis Withdrawal A Randomized Clinical Trial', JAMA PSYCHIATRY, 71 281-291 (2014) [C1]
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Nova |
2014 |
Treloar C, Rance J, Haber P, Bath N, Day C, Dore G, et al., 'How to build trustworthy hepatitis C services in an opioid treatment clinic? A qualitative study of clients and health workers in a co-located setting', International Journal of Drug Policy, 25 865-870 (2014) [C1]
Background: Given the increasing burden of hepatitis C (HCV) related liver disease, innovative health care models are required to extend the reach of HCV care and treatment. Opioi... [more]
Background: Given the increasing burden of hepatitis C (HCV) related liver disease, innovative health care models are required to extend the reach of HCV care and treatment. Opioid substitution treatment (OST) clinics are places of high HCV prevalence. The OST clinic is a complex environment, quite distinct to other health care settings, with punitive regulations and practices, and a client population likely to be mistrustful of systems of authority. Nonetheless, trust is widely documented as essential to effective therapeutic encounters. This paper examines what is required to develop a trustworthy service in a place, the OST clinic, described by some critics as a site of "social control". Methods: In-depth interviews were conducted with 57 clients and 19 staff from four NSW pilot clinics participating in the Australian ETHOS study. Results: Interview data were examined using Hall's framework of trust, involving five principle domains: fidelity, competence, honest, confidentiality and global trust. 'Honesty' was found to be key to participants' establishing trust in the co-located service and its staff. However, the clinic site was also found to be a place of rationed trust, in which the themes of OST as "ruling peoples' lives" and the fear of repercussions resulting from perceived transgressions against clinic rules, threatened to over-ride or undermine the development of trust in HCV services. Client participants described trusting health workers "to a point". They expressed concerns about the fidelity of co-located HCV and OST services and described fears of "institutionalised lies" and breaches of confidentiality. Anxieties around the latter revealed a sense of "us and them" held by some clients, one in which health workers were perceived to "stick together" by putting their own interests before those of the clients. Discussion: Although the co-location of HCV and opioid treatments makes intuitive policy sense, HCV health workers in the OST space may be seen as representatives of a deeply mistrusted system. For the effective development of a trustworthy HCV care service, policy and practice activities are required to engender trust through clearly articulated explanations of service boundaries and the promotion of "success stories" through trusted peer networks.
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Nova |
2014 |
Ryan A, Holmes J, Hunt V, Dunlop A, Mammen K, Holland R, et al., 'Validation and implementation of the Australian Treatment Outcomes Profile in specialist drug and alcohol settings', DRUG AND ALCOHOL REVIEW, 33 33-42 (2014) [C1]
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Nova |
2014 |
Newman L, Perry N, Brown A, Murray E, Byrne J, Dunlop A, 'PARENTING WITH FEELING: GROUP PARENTING INTERVENTION FOR SUBSTANCE DEPENDENT PARENTS AND THEIR INFANTS', DRUG AND ALCOHOL REVIEW, 33 48-48 (2014) [E3]
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2013 |
Johnson NA, Kypri K, Saunders JB, Saitz R, Attia J, Dunlop A, et al., 'The hospital outpatient alcohol project (HOAP): protocol for an individually randomized, parallel-group superiority trial of electronic alcohol screening and brief intervention versus screening alone for unhealthy alcohol use.', Addict Sci Clin Pract, 8 14 (2013) [C3]
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Nova |
2013 |
Magin P, Holliday S, Dunlop A, Ewald B, Dunbabin J, Henry J, et al., 'Discomfort sharing the general practice waiting room with mentally ill patients: a cross-sectional study', FAMILY PRACTICE, 30 190-196 (2013) [C1]
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Nova |
2013 |
Holliday S, Hayes C, Dunlop A, 'Opioid use in chronic non-cancer pain Part 2: Prescribing issues and alternatives', Australian Family Physician, 42 104-111 (2013) [C2]
Background: Managing pain requires time and effort to attend to its biopsychosocial characteristics. This requires proper planning and a whole-of-practice approach. Objective: Thi... [more]
Background: Managing pain requires time and effort to attend to its biopsychosocial characteristics. This requires proper planning and a whole-of-practice approach. Objective: This article describes how to prepare your practice for quality chronic pain care, and details a non-judgemental and effective management approach, including the minimisation of opioid harms. Discussion: It is helpful to have a consistent, whole-of-practice approach when a patient new to the practice presents with a compelling case for opioids. Assessing patients with chronic pain includes a full medical history and detailed examination according to a biopsychosocial approach and applying 'universal precautions' to make a misuse risk assessment. A management plan should consider a range of non-opioid modalities, with a focus on active rather than passive strategies. Integrated multidisciplinary pain services have been shown to improve pain and function outcomes for patients with complex chronic pain issues, but access is often limited. Time-limited opioid use is recommended with initial and regular monitoring, including pain and function scores, urine toxicology, compliance with regulatory surveillance systems and assessment for adverse reactions and drug related aberrant behaviours. When ceasing prescribing, opioids should be weaned slowly, except in response to violence or criminal activity.
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Nova |
2013 |
Holliday S, Hayes C, Dunlop A, 'Opioid use in chronic non-cancer pain: Part 1: Known knowns and known unknowns', Australian Family Physician, 42 98-102 (2013) [C2]
Background: Opioids have a critical, time-limited role in our management of acute and terminal pain and an open-ended role in our management of opioid dependency. They also have a... [more]
Background: Opioids have a critical, time-limited role in our management of acute and terminal pain and an open-ended role in our management of opioid dependency. They also have a use in the management of chronic non-cancer pain. Objective: To provide an understanding of what is known, and what is not known, about the use of opioids in chronic non-cancer pain using an evidence-based approach. Discussion: For chronic non-cancer pain, the evidence base for the long-term use of opiates is mediocre, with weak support for minimal improvements in pain measures and little or no evidence for functional restoration. Much research and professional education in this field has been underwritten by commercial interests. Escalating the prescribing of opioids has been repeatedly linked to a myriad of individual and public harms, including overdose deaths. Many patients on long-term opioids may never be able to taper off them, despite their associated toxicities and lack of efficacy. Prescribers need familiarity with good opioid care practices for evidencebased indications. Outside these areas, in chronic non-cancer pain, the general practitioner needs to use time and diligence to implement risk mitigation strategies. However, if a GP believes chronic non-cancer pain management requires opioids, prescribing must be both selective and cautious to allow patients to maintain, or regain, control of their pain management.
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Nova |
2013 |
Lintzeris N, Leung SY, Dunlop AJ, Larance B, White N, Rivas GR, et al., 'A randomised controlled trial of sublingual buprenorphine-naloxone film versus tablets in the management of opioid dependence', DRUG AND ALCOHOL DEPENDENCE, 131 119-126 (2013) [C1]
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Nova |
2013 |
Ling S, Curtis J, Brighton R, Dunlop A, 'An examination of barriers to Nurse Practitioner endorsement in senior rural drug and alcohol nurses in New South Wales', COLLEGIAN, 20 79-86 (2013) [C1]
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Nova |
2013 |
McKetin R, Dunlop AJ, Holland RM, Sutherland RA, Baker AL, Salmon AM, Hudson SL, 'Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia', DRUG AND ALCOHOL REVIEW, 32 80-87 (2013) [C1]
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Nova |
2013 |
Alavi M, Grebely J, Micallef M, Dunlop AJ, Balcomb AC, Day CA, et al., 'Assessment and Treatment of Hepatitis C Virus Infection Among People Who Inject Drugs in the Opioid Substitution Setting: ETHOS Study', CLINICAL INFECTIOUS DISEASES, 57 S62-S69 (2013) [C1]
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Nova |
2013 |
Nielsen S, Larance B, Lintzeris N, Black E, Bruno R, Murnion B, et al., 'Correlates of pain in an in-treatment sample of opioid-dependent people', Drug and Alcohol Review, 32 489-494 (2013) [C1]
Introduction and Aims: The limited literature on pain in opioid-treatment samples indicates that it is highly prevalent. Understanding the implications of pain on treatment outcom... [more]
Introduction and Aims: The limited literature on pain in opioid-treatment samples indicates that it is highly prevalent. Understanding the implications of pain on treatment outcomes is important, particularly in light of ageing opioid-treatment cohorts. This study explores correlates of pain, including aberrant behaviours related to prescribed opioids. Our hypothesis is that pain may increase aberrant opioid-related behaviours, including illicit substance use, among opioid-dependent people. Design and Methods: We examined pain in methadone or buprenorphine patients (n=141) from three treatment services. Measures included basic demographics, Brief Pain Inventory, general mental health, physical health and quality of life measures, pain history and treatments, and an aberrant opioid-related behaviour scale. Univariate and multivariate analyses were used to examine correlates of pain. Results: Forty percent reported current pain, measured with the first question of the Brief Pain Inventory. Correlates of pain were depression ratings [adjusted odds ratio (OR) 2.24, 95% confidence interval (CI) 1.04, 4.83], anxiety ratings (adjusted OR 4.29, 95% CI 1.88, 9.80) and self-reported health ratings (adjusted OR 0.35, 95% CI 0.16, 0.76). Contrary to our hypothesis, pain was not associated with greater use of illicit opioids, nor any aberrant opioid-related behaviours. Pain was comparable among methadone and buprenorphine patients. Discussion and Conclusions: The lack of association with pain and aberrant behaviours suggest that it should not be assumed that those in opioid treatment misuse medications in response to pain. The high prevalence of depression/anxiety symptoms indicates a need for further work with larger samples to explore pain and co-morbidity among opioid-dependent people. [Nielsen S, Larance B, Lintzeris N, Black E, Bruno R, Murnion B, Dunlop A, Degenhardt L. Correlates of pain in an in-treatment sample of opioid-dependent people. Drug Alcohol Rev 2013;32:489-494] © 2013 Australasian Professional Society on Alcohol and other Drugs.
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Nova |
2013 |
Holliday S, Magin P, Oldmeadow C, Attia J, Dunbabin J, Henry J, et al., 'An examination of the influences on New South Wales general practitioners regarding the provision of opioid substitution therapy', Drug and Alcohol Review, 32 495-503 (2013) [C1]
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Nova |
2013 |
Holliday S, Magin P, Dunbabin J, Oldmeadow C, Henry J-M, Lintzeris N, et al., 'An Evaluation of the Prescription of Opioids for Chronic Nonmalignant Pain by Australian General Practitioners', PAIN MEDICINE, 14 62-74 (2013) [C1]
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Nova |
2012 |
Holliday SM, Magin PJ, Dunbabin JS, Ewald BD, Henry J-M, Goode SM, et al., 'Waiting room ambience and provision of opioid substitution therapy in general practice', Medical Journal of Australia, 196 391-394 (2012) [C1]
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Nova |
2012 |
Dunlop AJ, 'Counselling during substitution treatment: Not enough is too much?', Addiction, 107 954-956 (2012) [C3]
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2012 |
Baker AL, Thornton LK, Hides L, Dunlop AJ, 'Treatment of cannabis use among people with psychotic disorders: A critical review of randomised controlled trials', Current Pharmaceutical Design, 18 4923-4937 (2012) [C1]
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Nova |
2012 |
Calver L, Dunlop AJ, Isbister GK, 'Individual patient assessment of methadone-induced QT prolongation with digital holter recording', Journal of Addiction Medicine, 6 92-93 (2012) [C3]
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Nova |
2011 |
Miller P, Dunlop AJ, 'Rhetoric, reality and research: What they mean for achieving the best possible treatment system for addiction-related problems', International Journal of Drug Policy, 22 196-197 (2011) [C3]
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2011 |
Burns L, Black E, Powers JR, Loxton DJ, Elliott E, Shakeshaft A, Dunlop AJ, 'Geographic and maternal characteristics associated with alcohol use in pregnancy', Alcoholism: Clinical and Experimental Research, 35 1230-1237 (2011) [C1]
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Nova |
2011 |
Dunlop AJ, 'Harms: How much, how many, how often?', Drug and Alcohol Review, 30 332-333 (2011) [C3]
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2010 |
Powers JR, Loxton DJ, Burns LA, Shakeshaft A, Elliott EJ, Dunlop AJ, 'Assessing pregnant women's compliance with different alcohol guidelines: An 11-year prospective study', Medical Journal of Australia, 192 690-693 (2010) [C1]
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Nova |
2010 |
Hudson SL, Dunlop A, 'ADOPTING A STEPPED CARE APPROACH IN WORKING WITH STIMULANT USERS', DRUG AND ALCOHOL REVIEW, 29 5-6 (2010) |
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2010 |
Everingham H, Hazelwood S, Tierney R, Grebely J, Gillman A, Crawford S, et al., 'PRESENTER 4: PEER-BASED SUPPORT FOR HCV ASSESSMENT AT HUNTER PHARMACOTHERAPY', DRUG AND ALCOHOL REVIEW, 29 22-22 (2010) |
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2010 |
Dunlop A, Ritter A, Templeman D, Berends L, Linzteris N, 'SYMPOSIUM - NATIONAL HOSPITALS AND HEALTHCARE REFORM AND DRUG AND ALCOHOL TREATMENT: THE GREAT LEAP FORWARD OR STUCK IN THE BACKBLOCKS?', DRUG AND ALCOHOL REVIEW, 29 23-24 (2010) |
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2009 |
Lee N, Pennay A, Hester R, Ferris J, Dunlop A, 'DOUBLE-BLIND PLACEBO-CONTROLLED PILOT TRIAL OF MODAFINIL FOR METHAMPHETAMINE WITHDRAWAL', DRUG AND ALCOHOL REVIEW, 28 A75-A75 (2009) |
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2009 |
Pennay A, Lee N, Ferris J, Hester R, Dunlop A, 'TREATMENT FOR METHAMPHETAMINE WITHDRAWAL', DRUG AND ALCOHOL REVIEW, 28 A78-A78 (2009) |
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2009 |
Higgs P, Jordens J, Maher L, Dunlop A, 'Vietnamese-Australian heroin users' perspectives on the role of the family in treatment', DRUGS-EDUCATION PREVENTION AND POLICY, 16 409-421 (2009)
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2007 |
Dunlop A, 'Prenatal exposure to Drugs/Alcohol', DRUG AND ALCOHOL REVIEW, 26 685-685 (2007) |
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2007 |
Bell J, Shanahan M, Mutch C, Rea F, Ryan A, Batey R, et al., 'A randomized trial of effectiveness and cost-effectiveness of observed versus unobserved administration of buprenorphine-naloxone for heroin dependence', ADDICTION, 102 1899-1907 (2007)
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Nova |
2007 |
Nielsen S, Dietze P, Dunlop A, Muhleisen P, Lee N, Taylor D, 'Buprenorphine supply by community pharmacists in Victoria, Australia: perceptions, experiences and key issues identified', DRUG AND ALCOHOL REVIEW, 26 143-151 (2007)
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2007 |
Nielsen S, Dietze P, Lee N, Dunlop A, Taylor D, 'Concurrent buprenorphine and benzodiazepines use and self-reported opioid toxicity in opioid substitution treatment', ADDICTION, 102 616-622 (2007)
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Nova |
2004 |
Sun ZF, Larsen CT, Dunlop A, Huang FF, Pierson FW, Toth TE, Meng XJ, 'Genetic identification of avian hepatitis E virus (HEV) from healthy chicken flocks and characterization of the capsid gene of 14 avian HEV isolates from chickens with hepatitis-splenomegaly syndrome in different geographical regions of the United States', JOURNAL OF GENERAL VIROLOGY, 85 693-700 (2004)
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2002 |
Lintzeris N, Dunlop A, Muhleisen P, Ritter A, 'Training primary health care professionals to prvide Buprenorphine and LAAM treatment', Substance Abuse, 23 245-254 (2002)
This paper describes the development and implementation of training programs for primary care medical practitioners and pharmacists in the delivery of buprenorphine and LAAM treat... [more]
This paper describes the development and implementation of training programs for primary care medical practitioners and pharmacists in the delivery of buprenorphine and LAAM treatment in the management of opiate dependence. Separate training programs were developed for each medication. Each training package included learning objectives, training materials, and assessment instruments. Findings of the evaluation of these initiatives and the subsequent Australian postregistration training program for buprenorphine are described. © 2002 Taylor & Francis Group, LLC.
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2002 |
Clark N, Lintzeris N, Gijsbers A, Whelan G, Dunlop A, Ritter A, Ling W, 'LAAM maintenance vs methadone maintenance for heroin dependence.', Cochrane database of systematic reviews (Online), (2002)
BACKGROUND: LAAM and methadone are both full mu opiate agonists and have been shown to reduce dependence on heroin when given continuously under supervised dosing conditions. LAAM... [more]
BACKGROUND: LAAM and methadone are both full mu opiate agonists and have been shown to reduce dependence on heroin when given continuously under supervised dosing conditions. LAAM has a long duration of action requiring dosing every two or three days compared to methadone which requires daily dosing. LAAM is not as widely available internationally as methadone, and may be withdrawn from the market following ten cases of life-threatening cardiac arrhythmias and an association with QT prolongation. OBJECTIVES: To compare the efficacy and acceptability of LAAM maintenance with methadone maintenance in the treatment of heroin dependence. SEARCH STRATEGY: We searched MEDLINE (January 1966 to August 2000), PsycINFO (1887 to August 2000), EMBASE (January 1985 to August 2000), and the Cochrane Controlled Trials Register (Issue 2 2000). In addition we hand searched NIDA monographs until August 2000 and searched reference lists of articles. SELECTION CRITERIA: All randomised controlled trials, controlled clinical trials and controlled prospective studies comparing LAAM and methadone maintenance for the treatment of heroin dependence and measuring outcomes of efficacy or acceptability were included. DATA COLLECTION AND ANALYSIS: Data on retention in treatment, heroin use, side-effects and mortality were collected by two reviewers independently. A meta-analysis was performed using RevMan. Discrepancies were resolved by consensus. MAIN RESULTS: Eighteen studies, (15 RCTs, 3 Controlled prospective studies) met the inclusion criteria for the review. Three were excluded from the meta-analysis due to lack of data on retention, heroin use or mortality. Cessation of allocated medication (11 studies, 1473 participants) was greater with LAAM than with methadone, (RR 1.36, 95%CI 1.07-1.73, p=0.001, NNT=7.7 (or 8)). Non-abstinence was less with LAAM (5 studies, 983 participants; RR 0.81, 95%CI 0.72-0.91, p=0.0003, NNT=9.1 (or 10)). In 10 studies (1441 participants) there were 6 deaths from a range of causes, 5 in participants assigned to LAAM (RR 2.28 (95%CI 0.59-8.9, p=0.2). other relevant outcomes, such as quality of life and criminal activity could not be analysed because of lack of information in the primary studies. REVIEWER'S CONCLUSIONS: LAAM appears more effective than methadone at reducing heroin use. More LAAM patients than methadone ceased their allocated medication during the studies, but many transferred to methadone and so the significance of this is unclear. There was no difference in safety observed, although there was not enough evidence to comment on uncommon adverse events.
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2001 |
Higgs P, Maher L, Jordens J, Dunlop A, Sargent P, 'Harm reduction and drug users of Vietnamese ethnicity', DRUG AND ALCOHOL REVIEW, 20 239-245 (2001)
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2001 |
Higgs P, Maher L, Jordens J, Dunlop A, Sargent P, 'Harm reduction and drug users of Vietnamese ethnicity', Drug and Alcohol Review, 20 239-245 (2001)
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Nova |
1996 |
Lintzeris N, Holgate F, Dunlop A, 'Addressing dependent amphetamine use: A place for prescription', DRUG AND ALCOHOL REVIEW, 15 189-195 (1996)
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