SCs most frequently result in tachycardia, agitation and nausea. These symptoms typically resolve with symptomatic care, including intravenous fluids, benzodiazepines and anti-emetics, and may not require inpatient care. Severe adverse events (stroke, seizure, myocardial infarction, rhabdomyolysis, AKI, psychosis and hyperemesis) and associated deaths manifest less commonly. Precise estimates of their incidence are difficult to calculate due to the lack of widely available, rapid laboratory confirmation, the variety of SC compounds and the unknown number of exposed individuals. Long-term consequences of SCs use are currently unknown.
Results. The median duration of synthetic cannabinoid use was 6 months (IQR 2-10), 35% reported use weekly or more often and 7% reported daily use. Reasons for first use included curiosity (50%), legality (39%), availability (23%), recreational effects (20%), therapeutic effects (9%), non-detection in standard drug screening assays (8%) and to aid the reduction or cessation of cannabis use (5%). Users reported buying a median of 3 g (IQR 3-6) and paying a median of AU$60 (IQR 37-90). Most (68%) reported at least one side-effect during their last session of use, including decreased motor co-ordination (39%), fast or irregular heartbeat (33%), dissociation (22%), dizziness (20%), paranoia (18%) and psychosis (4%). 4 respondents reported seeking help. A greater number of side-effects were reported by males
Background/Aim:
The aim of the current study was to review drug harms as they occur in Australia using the Multi-criteria Decision Analysis (MCDA) methodology adopted in earlier studies in other jurisdictions.
Method:
A facilitated workshop with 25 experts from across Australia, was held to score 22 drugs on 16 criteria: 9 related to harms that a drug produces in the individual and 7 to harms to others. Participants were guided by facilitators through the methodology and principles of MCDA. In open discussion, each drug was scored on each criterion. The criteria were then weighted using a process of swing weighting. Scoring was captured in MCDA software tool.
Results:
MCDA modelling showed the most harmful substances to users were fentanyls (part score 50), heroin (part score 45) and crystal methamphetamine (part score 42). The most harmful substances to others were alcohol (part score 41), crystal methamphetamine (part score 24) and cigarettes/tobacco (part score 14). Overall, alcohol was the most harmful drug when harm to users and harm to others was combined. A supplementary analysis took into consideration the prevalence of each substance in Australia. Alcohol was again ranked the most harmful substance overall, followed by cigarettes, crystal methamphetamine, cannabis, heroin and pharmaceutical opioids.
Conclusions:
The results of this study make an important contribution to the emerging international picture of drug harms. They highlight the persistent and pervasive harms caused by alcohol. Policy implications and recommendations are discussed. Policies to reduce harm from alcohol and methamphetamine should be a priority.
Online purposive samples have unknown biases and may not strictly be used to make inferences about wider populations, yet such inferences continue to occur. We compared the demographic and drug use characteristics of Australian ecstasy users from a probability (National Drug Strategy Household Survey, n ¼ 726) and purposive sample (online survey conducted as part of a mixed-methods study of online drug discussion, n ¼ 753) using nonparametric (bootstrap) and meta-analysis techniques. We found significant differences in demographics and drug use prevalence. Ideally, online
Welcome to the Harm Reduction Digest, where in each regular edition of Thug and Alcohol Review invited co‐authors will contribute to pieces on the theory and practice of harm reduction. While the focus of subsequent HR Digests will be accounts of the practice of harm reduction interventions, programmes and policies from around the world, it was decided that the first Digest ought to address the definition of Harm Reduction. Consequently the style of this digest is probably more formal than most that will follow it. Many of you will have read DAR's special issue on harm reduction (1995, 14(3)) where Alex Wodak, Bill Saunders, Patricia Erickson, Eric Single and Nick Heather all addressed the issue of definition in their respective contributions. Since this there have been a handful of papers and reports which have also grappled with the issue of definition. Co‐author of this piece is Professor Eric Single, from the Department of Public Health Sciences at the University of Toronto. Eric addressed issues around the definition of harm reduction in the 1996 Dorothy Black lecture in London and, with Professor Timothy Rohl, as independent evaluators of Australia's National Drug Strategy, wrote on the topic in their report ‘Mapping the Future’.
Dr Barratt is an NHMRC Postdoctoral Fellow conducting research into the social and public health implications of internet technologies for people who use illicit and emerging psychoactive drugs.
In the context of high levels of drug access, supply and diversity occurring within a community regulated environment online, the impacts of cryptomarkets upon drug use trajectories are complex, often posing new challenges for self-control, yet not always leading to harmful outcomes. A major policy challenge is how to provide support for harm reduction in these highly volatile settings.
Though a small minority of participants reported having purchased drugs online in the preceding six months, these appeared to be a more 'entrenched' group of consumers, with more diverse substance use and rates of criminal activity. For consumers in the current sample reporting recent dark net usage, country borders are now less of a significant barrier to purchase and there is a wider range of substances available than ever before.
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