National Documentation Centre on Drug Use
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Analysis of rapid onset heroin overdose cases from a supervised injecting facility in Melbourne, Australia.
No full textAIMS: To characterise the clinical condition of rapid onset heroin overdose cases, and to determine the incidence and characteristics of such cases.
DESIGN: A retrospective cohort study of witnessed heroin overdose cases over a 12-month period (1 July 2023 to 30 June 2024).
SETTING: The Medically Supervised Injecting Room in Melbourne, Australia.
CASES: Individuals who experienced a rapid onset overdose. A control group of standard onset cases amongst those same individuals was used for comparison.
MEASUREMENTS: The severity of acute opioid toxicity for rapid versus standard onset heroin overdose cases, using a clinical severity scale regularly used at the Medically Supervised Injecting Room.
FINDINGS: From a total of 1727 heroin overdoses, 202 were identified as rapid onset cases that occurred amongst a cohort of 98 individuals. There were 997 standard overdoses from 75 individuals from this same cohort used as a control. Rapid onset overdoses presented with greater severity of respiratory depression. Forty-one percent (n = 82) of cases required positive pressure ventilation, including 19% (n = 38) classified as Grade 2 severity and 22% (n = 44) classified as Grade 3a severity. The standardised rate of rapid overdoses was approximately doubled on High overdose risk days (0.151/overdose) compared with that on Low overdose risk days (0.077/overdose).
CONCLUSION: Rapid onset heroin overdoses typically present as medical emergencies involving severe respiratory depression shortly after heroin administration. Some people appear more likely to experience a rapid onset overdose than others, but factors for this are unclear. Rapid onset heroin overdoses also more commonly occur on some days compared with others, which may indicate an interrelationship between personal risk and the unregulated drug market. Rapid onset overdose cases may play a substantial role in hypoxic-related morbidity and mortality associated with heroin overdoses
Effectiveness of psychosocial interventions for adults with substance use disorder that have a co-occurring common mental health disorder: an umbrella review.
No full textISSUES: People with substance use disorders can have co-occurring mental disorders.
APPROACH: An umbrella review was conducted to identify evidence of the effectiveness of psychosocial interventions for adults (aged 18+) with substance use disorders and co-occurring common mental health disorders. Systematic reviews were sought of randomised controlled trials of psychosocial interventions compared to each other, treatment as usual or wait-list. Five databases were systematically searched in February 2024. Data, including critical appraisal (Joanna Briggs Institute Checklist), were extracted by one reviewer and checked by another. Data were discussed in a narrative review.
KEY FINDINGS: Of 5420 unique records, 28 systematic reviews were included. The methodological quality of the reviews was good. Most reviews focused on depression, anxiety or post-traumatic stress disorder. There was much heterogeneity between reviews, and randomised controlled trials within reviews. Most of the interventions and many of the treatment-as-usual comparators resulted in significant improvement in substance use and mental health disorders. Results suggested integrated (co-ordinated) treatment for co-occurring diagnosis patients was better than treating one condition alone, and usually better than parallel uncoordinated services. There was limited evidence assessing sequential treatment, but this suggested similar effectiveness to integrated treatment.
IMPLICATIONS: Implications for current practise could not be recommended due to heterogeneity. Improvement shown by all types of psychosocial intervention including active comparators precluded recommending one type of intervention over another.
CONCLUSION: Further research is needed comparing integrated with parallel or sequential treatment, with follow-up of 6 months or longer, and sample size large enough to encompass dropout
Interventions to change vaping harm perceptions and associations between harm perceptions and vaping and smoking behaviours: a systematic review.
No full textAIMS: To synthesize and describe the evidence from among young people and adults to assess: (i) what interventions have been effective in changing vaping harm perceptions; and (ii) to what extent vaping harm perceptions predict any changes in vaping and smoking behaviours.
METHODS: Systematic review searching five databases (Embase, PsycINFO, Medline, CINAHL, Scopus) from January 2007 to January 2023. Eligible studies reported quantitative data with >1 time point among young people (sample majority aged <18 years) or adults (sample majority aged ≥18 years). Interventions were considered if they communicated vaping harms, categorized as relative (vaping vs smoking) or absolute (vaping vs not vaping). Outcomes were changes in: (i) vaping (absolute, relative) or nicotine harm perceptions; (ii) vaping or smoking behaviours. Evidence was synthesized narratively.
RESULTS: Eighty-five articles were included, of which 46 assessed interventions to change vaping harm perceptions and 39 assessed associations between harm perceptions and subsequent vaping/smoking behaviours. All studies among young people and most among adults were from the USA. Interventions aimed at young people typically communicated that vaping and nicotine are harmful/addictive (absolute harms), often in the form of educational programmes and media campaigns. Interventions aimed at adults typically communicated that vaping is harmful but less harmful than smoking (relative harms), often via written materials and educational workshops. In addition to methodological and analytical heterogeneity, risk of bias was high; hence findings should be interpreted with caution. Generally, interventions appeared to be effective in changing perceptions that reflected the intervention content among young people (12/14 studies) and adults (24/32 studies), at least in the short-term (38/46 studies only assessed the outcome pre- and immediately post-intervention). Interventions communicating that vaping is harmful and addictive (absolute harms) increased perceptions that vaping is harmful and addictive among young people (12/14) and adults (16/23 studies) and also increased the misperception that vaping is as harmful as smoking (relative harm) among young people (2/2 studies) and adults (5/8 studies). There was also some evidence that both absolute and relative harm perceptions predicted vaping and smoking behaviours, such that perceiving vaping as harmful deterred vaping among both young people (8/9 studies) and adults (4/7 studies), while misperceiving vaping as equally/more harmful than smoking prevented adults from quitting smoking (5/6 studies).
CONCLUSIONS: Interventions to change vaping harm perceptions appear to be effective. Vaping harm perceptions appear to predict vaping and smoking behaviours
Navigating surveillance: the experience of prenatal women who use or who are in treatment for using drugs.
No full textThere is little knowledge of how women who use and are in treatment for using drugs in the perinatal period experience multidisciplinary services prenatally. This study used qualitative longitudinal methods to explore women’s experiences of care in four sites in England and Scotland. Thirty-six women who used and were in treatment for drug use (opioid, stimulants, and benzodiazepines) were recruited via maternity services. Framework analysis was used to manage the data and data were coded thematically. The profile of research participants included experiences of a range of cooccurring physical and mental health problems. Most women for whom this was not their first maternity, had had previous children removed from their care. The findings focus on women’s experiences of surveillance and uncertainty surrounding referrals to social services, social work assessments and possible removal of babies. Research participants reported managing the conceptual entanglement of treatment for opioid use with illicit drug use. Participants described being subject to multi-agency monitoring and there were few examples of trauma-informed care at the point of delivery. Findings have implications for how multi agency services engage with women who use drugs and call for approaches that are responsive to their needs and those of their babies
Polysubstance use in early adulthood and associated factors in the Republic of Ireland: an analysis of a nationally representative cohort.
No full textAlcohol use disorder and co-occurring mental illness among older adults in low-and middle-income countries: a narrative systematic review.
No full textMerchant’s Quay: Temporary supervised drug injection facility in Dublin to become permanent.
No full textMerchant’s Quay service had permission to operate until June but has now secured permanent status
