ISSUES:In Australia, detections of novel benzodiazepines (NBZ) and related overdoses have increased markedly over the last five years. This review summarises Australian peer-reviewed literature and NBZ-related drug alerts, outlines the pharmacology of commonly detected NBZs and discusses approaches to harm reduction, managing toxicity, dependence and withdrawal. APPROACH:Australian peer-reviewed articles published between January 2020 and June 2025 were identified via Embase, PubMed, Scopus and PsycINFO. Drug alerts from this period were retrieved from an Australian online repository. Data were extracted, coded and synthesised. Global literature on the pharmacology associated with commonly detected NBZs in Australia, was retrieved via Google Scholar as were sources on benzodiazepine-related harm reduction and clinical management and narratively summarised. KEY FINDINGS:Between 2020 and 2025, NBZs were frequently detected from data from emergency department, forensic, drug checking and coronial sources. The most common were etizolam, clonazolam, clobromazolam, bromazolam, flualprazolam and flubromazolam. Twenty-three NBZ-related alerts were issued over this period, with nearly half of these (n = 11) issued between January and June of 2025. Health responses are hindered by limited pharmacological data, detection challenges and little research on the experiences of consumers. IMPLICATIONS:To inform interventions spanning harm reduction and clinical management, future research must develop understandings of the pharmacology of NBZs and the experiences of people who source NBZs from unregulated markets. CONCLUSION:NBZs were consistently detected across Australian coronial, toxicological, forensic and drug checking data sources from 2020 to 2025. Their emergence represents a public health concern, worthy of ongoing attention and response.
STUDY QUESTION:Is male infertility independently associated with an increased risk of incident hypertension, ischemic and non-ischemic heart disease, diabetes, and/or cerebrovascular disease? SUMMARY ANSWER:Fathers diagnosed with male infertility have a modestly increased risk of heart disease, diabetes, and hypertension compared with fertile fathers, after controlling for measured confounders; however, some important confounders remain inadequately measured. WHAT IS KNOWN ALREADY:Cohort studies suggest that infertile men have an increased risk of incident cardiometabolic diseases, including diabetes, hypertension, heart disease, and cerebrovascular disease, although findings are mixed. The reasons for this association are unclear, but cardiometabolic conditions and male infertility share a wide range of shared etiological factors including age, chronic conditions such as obesity and obstructive sleep apnea, cancers and their treatments, environmental exposures such as pollution and pesticides, lifestyle factors such as smoking and cardiorespiratory fitness, autoimmune conditions such as lupus and Hashimoto's thyroiditis, as well as congenital conditions such as cystic fibrosis and muscular dystrophy. STUDY DESIGN, SIZE, DURATION:Our population-based cohort study included 445 909 men whose partner conceived a child between January 2009 and September 2016 in New South Wales (NSW), Australia. We excluded men with a diagnosis of infertility prior to 2009, men who were under the age of 14 at the time of the child's conception, and men diagnosed with cardiometabolic conditions in the 6.5 years prior to their index date. The index date was the later of the date of the child's conception or the date of the vasectomy for fertile men or the date of diagnosis of infertility for infertile men, i.e. the time when the exposure status was determined. From the index date, we followed participants for 5 years up until the latest available date of September 2021. PARTICIPANTS/MATERIALS, SETTINGS, METHODS:The study was conducted in NSW, Australia. We determined infertility status by a diagnosis of male infertility in the Australian and New Zealand Assisted Reproduction Database, hospital records, or a record of fertility-related procedures. We assessed the following outcomes: incident hypertension, ischemic and non-ischemic heart disease, all heart disease, diabetes, and cerebrovascular disease. We calculated age-standardized prevalence rates at baseline. We mapped potential confounding pathways using directed acyclic graphs and controlled for measured confounders using inverse probability of treatment weighting and g-computation. We estimated adjusted marginal risk ratios (aRR) and adjusted marginal risk differences (aRD) using robust Poisson regression. MAIN RESULTS AND THE ROLE OF CHANCE:The number of events and 5-year crude incidence rate for the outcomes were: hypertension (events: 17 433, fertile: 41.09 per 1000 population, infertile: 70.03 per 1000 population), all heart disease (events: 15 549, fertile: 36.44 per 1000 population, infertile: 59.88 per 1000 population), ischemic heart disease (events: 12 628 fertile: 29.24 per 1000 population, infertile: 47.1 per 1000 population), non-ischemic heart disease (events: 5183, fertile: 11.69 per 1000 population, infertile: 20.24 per 1000 population), cerebrovascular disease (events: 512, fertile: 1.14 per 1000 population, infertile: 1.78 per 1000 population) and diabetes (events: 7064, fertile: 16.05 per 1000 population, infertile: 27.59 per 1000 population). Compared with fertile men, men diagnosed with infertility demonstrated increased risk of incident disease for: hypertension aRR = 1.20 (95% CI 1.11-1.31, P < 0.001), aRD = 1.1% (95% CI: 0.6%-1.6%, P < 0.001); all heart disease aRR = 1.20 (95% CI 1.09-1.31, P < 0.001), aRD =0.9% (95% CI: 0.4%-1.4%, P < 0.001); non-ischemic heart disease aRR = 1.26 (95% CI 1.08-1.48, P = 0.004), aRD = 0.4% (95% CI: 0.1%-0.7%, P = 0.009); ischemic heart disease aRR = 1.13 (95% CI 1.02-1.25, P = 0.020), aRD = 0.4% (95% CI: 0.1%-0.7%, P = 0.028); and diabetes aRR = 1.28 (95% CI 1.12-1.46, P < 0.001), aRD 0.6% (0.2%-0.9%, P = 0.001). There was no significant difference in the incidence of cerebrovascular disease, aRR = 1.0 (95% CI 0.56-1.80, P = 0.996), aRD = 0.0% (95% CI: -0.1% to 0.1%, P = 0.996). These results remained consistent in sensitivity analyses, including an expanded exposure definition of infertility, a 10-year follow-up period, changing the outcomes of people who died in follow-up, and using an alternative index date. LIMITATIONS, REASONS FOR CAUTION:The cohort includes men who fathered a child, so men who did not seek to, or were unable to, have a child, and men with poor access to the reproductive healthcare may not be included. This may generate selection effects, biasing the estimates toward the null. We were unable to adequately control for several confounders, including important lifestyle factors like smoking, diet, cardiorespiratory fitness, and alcohol intake, due to data limitations, which may bias estimates away from the null. It appears plausible that a combination of unmeasured and inadequately measured confounders may attenuate the observed estimates. WIDER IMPLICATIONS OF THE FINDINGS:These findings suggest that male infertility may serve as an early indicator for a slightly heightened cardiometabolic risk, specifically relating to hypertension, diabetes, and various forms of heart disease. Our study is the largest on this topic, with extensive control for confounders. Our findings align with published research, indicating that men diagnosed with infertility have a slightly higher risk of incident diabetes, hypertension, and heart disease. From a public health perspective, fertility treatment may be an opportunity for earlier detection and intervention to help prevent the onset of cardiometabolic conditions in men diagnosed with infertility, particularly given that men generally have low rates of contact with the health system. STUDY FUNDING/COMPETING INTEREST(S):The PhD candidacy of J.M. is supported by Medical Research Future Fund (MRFF) Emerging Priorities and Consumer Driven Research initiative: EPCD000007, 2020. M.K.O'B. and G.M.C. declare receiving payment to their institution by the same MRFF grant. G.M.C. reports receiving funding from an Australian MRFF grant paid to UNSW to support this work, and J.M. reports receiving PhD funding from the same MRFF grant. C.V. declares an unpaid role on Human Reproduction's Editorial Board, and paid employment at the University of New South Wales (UNSW) until January 2023. The National Perinatal Epidemiology and Statistics Unit (NPESU), which belongs to UNSW, is custodian of the Australian and New Zealand Assisted Reproduction Database (ANZARD). Data from ANZARD were used in this study. G.M.C. also declares paid employment from UNSW. The remaining authors have nothing to declare. TRIAL REGISTRATION NUMBER:N/A.
INTRODUCTION:Drug alerts are sometimes issued when samples are found to exceed a pre-determined dose threshold. In Australia, it is common for alerts to be issued when MDMA pills contain ≥ 150 mg of MDMA free-base or 179 mg hydrochloride. Nineteen such alerts were issued in Australia in 2024, raising concerns that repeat alerts may lose impact over time. This study examined experts' viewpoints on the appropriateness and utility of using a 150 mg threshold to trigger high-dose MDMA alerts. METHODS:Fifteen participants responsible for the design and dissemination of drug-alerts in Australia completed an online survey and seven participated in a focus group. The survey and focus group elicited reflections on the use of thresholds when issuing alerts about high-dose MDMA. Data were thematically analysed using a qualitative description methodology. RESULTS:Although thresholds are binary and cannot account for evolving trends in MDMA manufacture or consumption, most agreed that 150 mg free-base is a reasonable threshold for issuing alerts. It was noted that 150 mg of MDMA may cause harm, that high-dose alerts are contingent on a threshold, and that thresholds enable rapid communications. Due to Australia's limited capacity to monitor community perceptions of alerts, there was little evidence to justify a change in the threshold. DISCUSSION AND CONCLUSIONS:Notifying communities about products containing ≥ 150 mg MDMA remains a harm-reduction priority. Establishing a database containing dosage and purity results for all analytically tested samples and increasing efforts to monitor community responses to and perceptions of drug alerts may improve future risk communication.
INTRODUCTION:Harms associated with meth/amphetamine use increase with cumulative exposure and overlap with age-related health conditions. Understanding demographic shifts in drug treatment populations is required to ensure services meet evolving needs. METHODS:We analysed data from the Australian Institute of Health and Welfare's Alcohol and Other Drug Treatment Services National Minimum Data Set, including all treatment episodes where meth/amphetamine was the primary drug of concern from 2003-04 (first data available) to 2023-24. Weighted linear regression assessed changes in age distribution over time. RESULTS:The analysis included 697,280 treatment episodes, 35% (n = 245,782) of whom were female. In 2003-04, people aged 20-29 years were the largest group accessing treatment (n = 6835, 48%), but by 2023-24 those aged 30-39 were the largest group seeking treatment for meth/amphetamine use (n = 258,063, 39%, p < 0.001). Over the last 20 years, the most pronounced increases occurred among adults over the age of 50 years, with treatment episodes increasing 16-fold (from 64 to 4313, p < 0.001) among those aged 50-59 and 13-fold (from 11 to 609, p < 0.001) among those aged 60 years and over. DISCUSSION AND CONCLUSIONS:The population seeking treatment for meth/amphetamine use disorder is ageing, outpacing the general Australian population. The absence of policies and practice guidance for management of meth/amphetamine use disorder and coexisting conditions among older people represents a critical gap. Treatment services must adapt to provide age-appropriate care for older Australians, as the proportion of people over the age of 50 accessing treatment continues to grow.
Sexual consent has become an increasing focus in public, policy, and legal discussions. However, such discussions rarely account for sexual subcultures among gay, bisexual, and other men who have sex with men (GBM). Between June 2021 and June 2022, participants were asked whether “During the past three months, has anyone tried to make you have sex or tried to have sex with you in ways that you didn’t want?” Of 967 participants, 12.2
