INTRODUCTION:The availability of no- and low-alcohol (NOLO) products could lead to reduced consumption of full-strength alcohol, although concerns exist about their marketing and links to full-strength alcohol brands. This study examines how NOLO beer and cider products are structured, categorised and presented, relative to their full-strength alcohol counterparts, within online alcohol retailers in New Zealand. METHODS:Between July-September 2024 an observational audit was conducted of three nationwide online alcohol retailers (two supermarkets, one liquor retailer). Retailer websites were assessed under relevant search and browsing conditions, examining the availability, visibility and co-presentation of NOLO and full-strength alcohol products, the proportion of NOLO brands with a full-strength alcohol variant and the visibility of information about alcohol content. RESULTS:Full-strength alcohol products appeared on two of the three retailers' home pages, whereas NOLOs were absent. NOLOs comprised 7%-9% of beers/ciders offered. Between 2% and 11% of full-strength alcohol beers/ciders were miscategorised as NOLOs. Searches using NOLO-related terms returned 11%-100% full-strength alcohol products. NOLO products were less prominent than full-strength alcohol products across browsing and search conditions, and usually lower cost. Most NOLOs (83%-92%) were line extensions of full-strength alcohol brands. Between 14% and 33% of NOLO products lacked clear alcohol content information. DISCUSSION AND CONCLUSION:Inconsistencies in the categorisation, presentation and labelling of NOLO and full-strength alcohols were observed in all three online alcohol retailers. These features shape how consumers will encounter alcohol products online and may contribute to consumer confusion. Policy measures to improve the clarity and consistency of online alcohol retail presentation are warranted.
INTRODUCTION:Medicinal cannabis prescribing in Australia has increased markedly, including for psychiatric indications where evidence of benefit is limited and of low certainty. The rise of highly commercialised prescribing models has raised concerns regarding patient safety, particularly for those with pre-existing psychiatric or addiction vulnerabilities. CASE PRESENTATION:This case series describes three young men (aged 20-24) with psychiatric disorders and substance use vulnerabilities who were prescribed medicinal cannabis. The cases illustrate potential iatrogenic harms, including cannabinoid hyperemesis syndrome, cannabis use disorder, paranoia, affective instability and the delaying of other treatment. In two cases, prescribing continued despite emerging adverse outcomes or a formal request for cessation of prescribing from an addiction specialist. DISCUSSION AND CONCLUSION:These cases highlight the potential iatrogenic harms associated with the current medicinal cannabis prescribing practices in Australia, especially among those with psychiatric and substance use vulnerabilities. More rigorous, evidence-aligned prescribing, clearer exclusion criteria and a lower threshold for discontinuation when harms emerge are needed.
ABSTRACT Issues Rising opioid‐related harms and persistent barriers to opioid dependence treatment (ODT) access present critical challenges across Australia and internationally. Pharmacotherapy remains the most effective treatment for opioid use disorder, yet systemic gaps in workforce availability and service models limit reach and sustainability. Using Victoria as a case example, this review examines models with broad relevance to other Australian jurisdictions. Approach We conducted a rapid review of academic (PubMed, Ovid MEDLINE, ProQuest, Google Scholar) and grey literature published from January 2019–31 August 2025. Eligible studies described innovative ODT models including organisational redesign, expanded workforce roles and technology‐enabled approaches. Key Findings Fifty‐six publications were clustered into organisational (e.g., mobile outreach, emergency department initiation, low threshold rapid access clinics), workforce (nurse practitioner prescribing, pharmacist–prescriber collaboration) and telehealth‐enabled models. Studies primarily measured critical short‐term outcomes such as retention (up to 12 months), with limited longitudinal outcome data available. Implications Workforce development is critical, particularly through nurse practitioner expansion and pharmacist collaborative care, supported by sustainable funding and training pipelines. Telehealth and hybrid models can enhance accessibility while leveraging existing community infrastructure. Future research should prioritise patient‐reported outcomes, cost‐effectiveness and longer‐term evaluations of novel care models. Conclusion This rapid review highlights innovative ODT approaches with potential to address access and workforce challenges. Staged implementation, supported by investment in infrastructure and evaluation, represents a timely opportunity for reform with relevance across Australia.
INTRODUCTION:Injection drug use is an emerging challenge in Fiji and the Pacific region, where injection-related infections may contribute substantially to morbidity, mortality and healthcare burden. However, data on the epidemiology and outcomes of these infections remain limited. METHODS:We conducted an observational cross-sectional study among people who inject drugs admitted to hospital with infections over a 6-month period. Data on infection type, injecting practices, substance use history, and relevant clinical and demographic variables were collected using a structured questionnaire and medical record review. RESULTS:Of the 128 participants, 76% were males. The majority were of iTaukei ethnicity (95%). Most were in the 18-25-year-old age range. The predominant infection was HIV (n = 97, 76%) and 42 (33%) patients had a positive blood culture. Staphylococcus aureus was the most common bacterial pathogen identified. Median length of stay was 10 days (interquartile range 6-14 days) with 31% in-hospital mortality. DISCUSSION AND CONCLUSIONS:This study highlights the high burden of acute infections and associated morbidity and mortality among people who inject drugs in Fiji, compounded by social vulnerabilities and limited access to harm reduction services. The findings underscore the urgent need for integrated patient-centred interventions, including hospital management, community harm reduction and strengthened surveillance to improve health outcomes in this population.
INTRODUCTION:Methamphetamine use and related mortality have increased worldwide, yet forensic data from Turkey remain limited. METHODS:This retrospective cross-sectional autopsy study investigated the demographic, toxicological and medicolegal characteristics of methamphetamine-related deaths in Zonguldak, Turkey, between 2015 and 2025. Among the 1863 forensic autopsies, 30 cases with analytically confirmed methamphetamine positivity were included. RESULTS:The mean age was 33.4 ± 8.7 years and 90.0% of the cases were male. The highest annual proportion of forensic autopsies with methamphetamine detected was observed in 2023. Accidental death was the most common manner of death and methamphetamine toxicity was the leading cause of death. All natural deaths were attributed to cardiovascular disease. Polydrug use was present in 56.7% of the cases. DISCUSSION AND CONCLUSIONS:Our findings indicate that methamphetamine-related deaths in Turkey share demographic and forensic characteristics with international reports and underscore the growing medicolegal and public health burden associated with stimulant use.
INTRODUCTION:Women who use performance and image-enhancing drugs (PIED) face distinct health risks, yet little is known about how they engage with healthcare or seek support. This study explored how women who use PIEDs navigate healthcare, with a focus on engagement, disclosure and stigma. METHOD:An interpretative phenomenological analysis was undertaken, involving semi-structured interviews with nine women with current/historical experience of PIED use, and engagement in regular weight training. Interviews explored health monitoring, support-seeking, and experiences with healthcare services and providers in the context of their PIED use. RESULTS:Participants described healthcare experiences ranging from respectful, supportive care to dismissal, judgement and clinical uncertainty. Three interrelated themes were identified: (i) participants' proactive engagement in health monitoring and healthcare to manage risks associated with PIED use; (ii) systemic barriers and knowledge gaps within healthcare, which made appropriate care difficult to access and navigate and, at times, shifted the burden of expertise onto participants within clinical encounters; and (iii) the importance of non-judgemental care, with stigma and fear of judgement shaping disclosure, trust and help-seeking. DISCUSSION AND CONCLUSIONS:This study provides an in-depth qualitative account of how women who use PIEDs engage with and navigate healthcare. Despite strong health motivation and proactive risk management, participants often encountered structural and interpersonal barriers to care. Respectful, non-judgemental interactions were central to positive healthcare engagement and sometimes more influential than clinical expertise alone. Findings highlight the need for improved professional education and gender-sensitive, harm-reduction-oriented resources to support women who use PIEDs.
Many veterans seek alcohol and other drug (AOD) care in mainstream services, where veteran status is not routinely identified. This limits the sector's capacity to recognise veterans' needs, plan appropriate responses and assess outcomes. This commentary examines the implications of the Royal Commission into Defence and Veteran Suicide for Australia's AOD sector. It argues that embedding veteran identification within existing accreditation processes under the AOD National Quality Framework offers a practical means of strengthening military cultural capability and improving responsiveness to veterans' needs. Although this approach does not resolve all structural challenges, it provides a concrete starting point for improving recognition and care for veterans within Australia's AOD treatment system.
INTRODUCTION:Effects of lockdowns on alcohol use and smoking remain unclear. By exploiting the variation in regional COVID-19 lockdowns in two Chilean regions, we examined their effect on alcohol use and smoking in two university communities. METHODS:We conducted a quasi-experimental study in university communities in two Chilean regions, Coquimbo and Araucanía. Participants were a longitudinal cohort (n = 896) assessed seven times from July 2020 ( t 1 ) to April 2021 ( t 7 ). Outcomes were weekly grams of alcohol use, heavy episodic drinking (HED) and cigarettes smoked per day. RESULTS:Lockdown between t 1 and t 3 was associated with an increase of 15.6 g of alcohol used per week (95% confidence interval 1.8; 29.3) and an increase of 0.3 daily cigarettes smoked (95% confidence interval 0.003; 0.5) at t 3 (September 2020), compared to the absence of lockdown. When lockdown reversed at t 5 , we found weak evidence of a reduction in alcohol use and smoking in the region under lockdown. We did not observe changes in HED during the study period. DISCUSSION AND CONCLUSIONS:COVID-19 lockdown appears to result in an initial relative increase in weekly volume of alcohol use and cigarette smoking compared to a region affected by the COVID-19 pandemic but without lockdown. We did not find evidence of changes in HED. TRIAL REGISTRATION:ClinicalTrials.gov, identifier NCT05069090.
INTRODUCTION:The Australian Treatment Outcomes Profile (ATOP) is a brief clinical tool assessing substance use, health and well-being used in Australian alcohol and other drug treatment services. It is validated for use with clients using alcohol, opioids and cannabis, but not yet for clients who primarily use methamphetamine. METHODS:An embedded validation study was undertaken in treatment-seeking adults enrolled in a randomised double-blind placebo-controlled trial of lisdexamfetamine for methamphetamine dependence with sites in New South Wales, South Australia and Victoria. Participant demographics were collected during study screening. The ATOP and comparators (Time Line Follow Back, Opiate Treatment Index, Depression Anxiety Stress Scale, WHOQOL-BREF and Personal Wellbeing Index) were collected at baseline. Continuous ATOP items were analysed using Pearson's correlation coefficient, and dichotomous items were analysed using Fleiss's κ. Agreement was rated as strong where measures were ≥ 0.50, moderate where agreement was 0.30-0.49, and weak where < 0.30. RESULTS:One hundred and eighteen study participants (2018-2020) had data for concurrent validity analysis. Strong validity was demonstrated for physical health, psychological health, quality of life, injecting drug use and crime items, and for days of use for amphetamines, alcohol, cannabis and cocaine. There was weak validity for days of use for benzodiazepines. Heroin use days and other opioid use days were endorsed by fewer than five participants and were therefore unable to be assessed. DISCUSSION AND CONCLUSIONS:The ATOP is valid for use in a treatment-seeking methamphetamine-dependent population, expanding the range of tools for assessment and standardised outcome monitoring across different settings and services.
INTRODUCTION:Older adults exhibit unique risks associated with poor mental health and substance use. The Beyond 50 study is a longitudinal cohort investigating the determinants of healthy ageing, including relationships between physical and psychosocial health and substance use. We aim to characterise the Beyond 50 cohort and explore patterns of physical and psychosocial health and substance use. METHODS:Baseline data collection was completed between September 2023 and August 2024. Annual follow-up data collection commenced in September 2024. Descriptive statistics will be used to characterise the cohort at the time of baseline survey completion. RESULTS:Of the 1059 participants, the mean age was 61 years (standard deviation 0.2 years) and 46.8% were female. Just over half (52.4%, n = 555) received a positive screen for potentially hazardous alcohol consumption (past 12-month use), 8.7% (n = 92) reported recent tobacco use, 3.7% (n = 39) reported recent cannabis use and 5.5% (n = 58) reported other nonmedical substance use. Twelve percent (n = 134) screened positive for the symptoms of moderate to severe anxiety, 16.4% (n = 174) screened positive for the symptoms of moderate to severe depression, 15.7% (n = 166) were moderately to severely lonely and 22.6% (n = 239) reported being dissatisfied with their social relationships. DISCUSSION AND CONCLUSION:The Beyond 50 cohort displays high rates of alcohol use, with levels of social isolation, loneliness, anxiety and depression comparable to the broader Victoria population. This lends to the cohort's ability to provide further insight into factors that affect healthy ageing and will allow for detailed analysis into the impacts of various physical and psychosocial factors on overall health and wellbeing.
INTRODUCTION:Co-use of tobacco and cannabis is common among young adults and is associated with higher dependence and quitting difficulties. Little is known about the preference for simultaneous or sequential dual cessation in this population. We aimed to explore preferences for the timing of dual cessation and the methods most likely to be used by young adults who co-use. METHODS:Data came from an online nationwide cross-sectional survey of people co-using tobacco and cannabis in France. Preferences for the timing of dual cessation were modelled using binary logistic and multinomial regressions among participants aged 18-30 years. We also described cessation methods (for tobacco and cannabis separately) previously tried and those considered likely to be used in future quit attempts. RESULTS:Among 357 young adults (54.9% men; median age 24), those using tobacco daily and cannabis ≥ 20 days/month had a 56% lower likelihood of preferring simultaneous over sequential cessation (adjusted odds ratio 0.44 [0.21-0.90], p = 0.024) compared with participants with the least frequent co-use. Participants who perceived their tobacco use as more harmful than their cannabis use were more likely to prefer quitting tobacco first. Across past and future attempts, the most cited methods for both substances were sport, cannabidiol, electronic cigarettes and nicotine replacement therapy. DISCUSSION AND CONCLUSIONS:Simultaneous cessation appeared more acceptable to young adults with lower-risk co-use patterns. Overall, the likelihood of using recommended cessation methods was low. Further research is needed to develop effective and acceptable sequential cessation strategies for young adults who co-use these substances.
INTRODUCTION:Substance use and related mental illness contribute substantially to Australia's disease burden, with disproportionately high impacts in rural areas where access to specialist care is limited. Understanding local service challenges is critical to improving care delivery and guiding contextually relevant research. The aims of this study were to identify: (i) practice challenges; (ii) practice improvement priorities; and (iii) research priorities among rural drug and alcohol clinicians in Western NSW Local Health District. METHODS:A pragmatic qualitative study was conducted using structured focus groups informed by a modified Delphi approach. Three focus groups (two in-person, one online) were held with 16 clinicians from diverse drug and alcohol programs. Discussions were guided by regional treatment data and a clinician workforce survey. Data were audio-recorded, transcribed and analysed using deductive qualitative content analysis, with findings validated through participant member checking. RESULTS:Four themes were identified. Service gaps and access barriers included fragmented mental health and drug and alcohol systems, transport limitations, stigma and cultural safety concerns for Aboriginal clients. Workforce and training needs reflected staff shortages, limited preparation for integrated care and insufficient support for vicarious trauma. Technology and innovation were viewed as promising, particularly telehealth, but were constrained by cost, policy and implementation uncertainty. Research priorities focused on developing and evaluating integrated care models, virtual and brief interventions, culturally responsive services, workforce wellbeing and social determinants including housing, transport and stigma. DISCUSSION AND CONCLUSIONS:Persistent structural and workforce challenges shape rural service delivery. Addressing these requires pragmatic, locally grounded research and stronger partnerships between health services and universities to support implementation of context-specific solutions.
INTRODUCTION:Alcohol consumption often leads to harm to individuals other than the drinker. Yet, few studies have quantified an exposure-response gradient using "nominated" drinkers' alcohol volume and their heavy episodic drinking (HED) frequency to predict harm-type burden and overall severity among people harmed by someone else's alcohol use. We examined these dose-response relationships across sociodemographic groups. METHODS:Data were drawn from the cross-sectional Australian 2021 Alcohol's Harm to Others (AHTO) Survey. A total of 2574 adults (18+ years) participated, of whom 554 reported harm from another person's drinking in the past 12 months. Respondents identified the person who harmed them the most (the "nominated drinker") and reported on the person's weekly alcohol volume and frequency of HED. Harms experienced included an overall harm score (0-10 scale) and a count of 14 specific harms. RESULTS:There was a significant positive dose-response relationship between the nominated drinker's alcohol consumption (both weekly volume and frequency of HED) and the degree of harm experienced by respondents. Although subgroup analyses suggested stronger effects among women, younger respondents, and when the drinker was a (former) partner, these differences were not statistically significant. DISCUSSION AND CONCLUSIONS:Greater alcohol consumption and more frequent HED are associated with more severe harms to others, regardless of respondents' sociodemographic background. A clear dose-response relationship exists between alcohol consumption by a known drinker and harm to others. The dose-response gradient was stronger at higher exposure levels, suggesting that reducing very frequent heavy drinking may yield disproportionately larger reductions in AHTO burden.
INTRODUCTION:Smartphone delivery of contingency management (CM) could overcome barriers to dissemination of this effective treatment for methamphetamine use. We quantified help-seeking intentions for CM and preferences for smartphone versus in-person delivery of CM amongst people who used methamphetamine. METHODS:An open web-based cross-sectional survey of 220 Australian residents who had used methamphetamine weekly or more often in the past year was conducted. Help-seeking intentions for CM were compared to other available treatment options using the General Help Seeking Questionnaire. Preferences for three CM models: in-person voucher-based CM, in-person prize-based CM and a smartphone-delivered model of CM, were sought, along with preferences for other aspects of CM delivery. RESULTS:Help-seeking intentions were similar for CM and other treatment options (82% vs. 76%-81% likely to seek help). Smartphone delivery of CM was preferred by 43% of participants (cf. 27% for in-person voucher CM and 30% for in-person prize draw CM). Overall, other preferences were for a fixed (predictable) reinforcement schedule (78%), cash (53%) or gift card (40%) rewards rather than merchandise (7%), and adjunctive support (78%) - mostly counselling (50%) and withdrawal management (43%). Participants wanted a median minimum payment of $69 (interquartile range $58-$77) to start CM, and a minimal median potential earnings of $4000 (interquartile range $3600-$4500) over a 12-week program. DISCUSSION AND CONCLUSIONS:We found strong potential demand for smartphone-delivered CM, although adjunctive counselling and withdrawal management would be needed and incentives may need to be larger than those used in conventional CM models.
People from culturally and linguistically diverse (CALD) backgrounds are recognised as a priority population in Australia's National Drug Strategy due to their potential vulnerability to alcohol and other drug (AOD)-related harms. National data consistently report low levels of AOD use and treatment utilisation among CALD populations. This discrepancy is likely due in part to limitations in data capture, such as the narrow definitions of CALD variables used, as well as issues of underreporting. Current reporting does not always align with Australian Bureau of Statistics standards and may also fail to capture the complexity and diversity of CALD communities. While improving data collection is essential, data alone will not address barriers to treatment engagement or ensure tailored, culturally responsive care. This editorial argues for two complementary actions: strengthening the collection of CALD data in national datasets and developing a tailored and adaptable AOD treatment framework, co-designed with CALD communities.
INTRODUCTION:Long-acting injectable buprenorphine (LAIB) is increasingly used in the Criminal Justice System (CJS) for treating people with opioid use disorder; however, little is known about these patients' experiences. We aimed to understand the perspectives of participants commenced on LAIB in prison as a part of the Understanding NSW Long-Active Opioids in Custody-Treatment (UNLOC-T) study. METHODS:Results of an open-ended survey administered by UNLOC-T researchers underwent analysis. Participants were adults, recruited November 2018-July 2019, with moderate-severe opioid use disorder and ≥ 6 months remaining on their sentence. We conducted a thematic analysis using a pragmatic, descriptive coding approach. RESULTS:Sixty-seven participants were included, of which 82% were male. Five primary themes were identified that described participants' experiences and highlighted issues that can directly inform service delivery: medication effectiveness, social and relational considerations, dosing frequency, financial aspects, and health and wellbeing. There was considerable variation in participant perspectives within themes. DISCUSSION AND CONCLUSIONS:Perspectives on LAIB are diverse, suggesting a need to individualise treatment and ensure person-centered care. While LAIB offers benefits to warrant including it as a treatment option, challenges remain. Future research into LAIB in the CJS would allow for triangulation, as well as further exploration of ongoing acceptability in the post-release period. Our findings could help to improve the way LAIB is offered as a treatment option or delivered to people in the CJS. There are also lessons for prescribers in counselling and tailoring treatment, and broader policy considerations around access to treatment formulations and patient autonomy.
