ABSTRACT Background Since the early 1990s there have been calls to make the opioid antagonist naloxone more widely available including through take‐home naloxone (THN) programs where naloxone is made available to potential overdose witnesses such as people who use opioids, their peers and family members. A THN program was established in the Australian Capital Territory in 2012 with similar programs established in other Australian jurisdictions shortly thereafter. They were established in the context of an increasing trend in overdose deaths, but unlike parts of North America, no opioid crisis had been declared. Objective This paper tracks the development of THN in Australia from a small‐scale program in one jurisdiction through to THN availability across the country at no charge. Methods Using a narrative approach, we describe the role of people who use drugs, clinicians, researchers, health officials and policy advocates in shaping THN policy and practice in Australia. Results Utilising partnership, piloting, evaluation and policy diffusion, a coalition of across‐sector stakeholders, committed to evidence‐based expansion of THN in Australia, led to widespread support that contributed to policy changes impacting a variety of settings, services and target groups. Conclusion Although a public health opioid overdose emergency has not been declared in Australia, it has been possible to advocate for the establishment of THN and develop an evidence base and advocacy coalition that has led to a nationwide free naloxone program and empowering those most at risk of opioid overdose‐related harms.
ABSTRACT Introduction Alcohol is responsible for substantial health loss and economic costs. This study aimed to estimate the health gains and health system costs of reducing alcohol consumption in Aotearoa New Zealand (A‐NZ). Methods This study used the New Zealand Alcohol Intervention Model (NZ‐AIM) to estimate the impacts of: (i) a 30% reduction in alcohol consumption from a comprehensive intervention package; and (ii) the elimination of alcohol use. NZ‐AIM uses an open cohort approach that replicates the 2018 population by ethnicity (Māori/non‐Māori), age and sex. Results Both elimination of alcohol consumption and a comprehensive intervention package result in large health gains for our open cohort over the next 60 years: 876,000HALYs (95% UI 432,000 to 1,233,000) and 512,000 HALYs (95% UI 358,000 to 637,000), respectively. With no discounting, the health system cost savings over 60 years are substantial: 2018NZ$3694million (95% UI −$1059m to $8682m) for elimination and $13million (95% UI −$1345m to $1606m) for the intervention package. In the first decade, the intervention package accrues NZ$552m (95% UI 362m to 737m) savings to the health system. Health system cost savings are sensitive to the discount rate and to whether costs associated with increased longevity are included. Discussion and Conclusions The potential health gains and health system cost savings from the elimination or a reduction of alcohol consumption in Aotearoa New Zealand are large. The health system cost savings are substantial in the first few decades and then increase due to increased longevity. The findings provide additional evidence to support implementation of alcohol interventions aligning with the World Health Organization's SAFER framework.
ABSTRACT Introduction Sexual harassment is experienced by 50% of nightlife patrons and disproportionately more by LGBTQIA+ (i.e., lesbian, gay, bisexual, transgender, queer, intersex, asexual) patrons. The present study investigated its association with pre‐drinking in Australian nightlife. Method An online survey assessing pre‐drinking behaviours and various forms of sexual harassment was completed by a sample of 958 individuals aged 18–65 years. Results Pre‐drinking volume ( r = 0.11, p < 0.01) and pre‐drinking frequency ( r = 0.16, p < 0.001) were significantly associated with sexual harassment. Females reported pre‐drinking more frequently than males [ χ 2 (16) = 12.30, p = 0.02], females reported greater sexual harassment than males [ χ 2 (1) = 47.13, p < 0.001, OR = 0.38] and heterosexual individuals reported higher sexual harassment than non‐heterosexual individuals [ χ 2 (4) = 34.51, p < 0.001, OR = 0.43]. Demographic variables accounted for 16% of the variance in sexual harassment frequency [ R 2 = 0.16, F (5, 170) = 6.31, p < 0.001], with only gender ( β = −0.35, t = −4.91, p < 0.001) making a unique contribution, accounting for 12% of the variance. Discussion and Conclusions The relationship between sexual harassment, pre‐drinking, gender and sexuality is complex. The present study did not find that sexually diverse individuals engaged in more pre‐drinking behaviours than heterosexual individuals, nor that LGBTQIA+ individuals report greater rates of sexual harassment than individuals identifying as heterosexual. However, women reported a larger number of sexual harassment experiences. Using these findings to inform interventions to reduce sexual harassment is indicated.
ABSTRACT Introduction Multiple jurisdictions report disproportionately elevated rates of drug‐related harm in urban settings, alongside unique treatment needs in rural populations. We examined differences in case characteristics, circumstances of death and implicated drugs among individuals dying from drug‐related causes, stratified by rural or urban setting, and determined changes in the proportion of deaths between settings over time. Methods Retrospective registry‐based analysis of coronial records of individuals who died from drug‐related causes, submitted to the National Programme on Substance Use Mortality in the UK, 1997–2026. UK Government Rural–Urban Classification methodology dichotomised cases using postcode at date of death. Results Overall, 39,975 decedents died, 36,350 (90.9%) in urban settings. The urban percentage decreased significantly over the study period from 96.6% in 1999 to 92.3% in 2025 (AAPC −0.34%, 95% CI −0.47% to −0.15%, p = 0.002). Accidental poisoning was the most common direct cause of death in both rural (45.5%) and urban (54.8%) settings, while intentional self‐poisoning was more common rurally (17.3% vs. 9.5%). Opioids were the most frequently implicated drug group in both rural (61.1%) and urban (65.4%) settings. The median number of drugs implicated did not differ significantly between settings (both 2, IQR 1–3), but rural decedents had a significantly higher median number of prescribed implicated drugs (1, IQR 0–2 vs. 0, IQR 0–2). Discussion and Conclusions Over three decades, approximately one in 11 UK drug‐related deaths occurred rurally. Intentional self‐poisoning was substantially more common in rural fatalities, and opioids were the leading implicated drug group across both settings.
ABSTRACT Introduction Intimate partner violence (IPV) is common among men with alcohol use disorder (AUD), yet the relative contributions of psychiatric comorbidity, personality disorders and dependence severity remain uncertain. We explored the prevalence and correlates of IPV perpetration among treatment‐seeking men with AUD. Methods In this cross‐sectional study, 100 consecutive men with AUD attending a tertiary psychiatry service in North India were assessed using the Severity of Alcohol Dependence Questionnaire (SADQ), Mini International Neuropsychiatric Interview, Millon Clinical Multiaxial Inventory‐III and the World Health Organization Domestic Violence Questionnaire. Multivariable logistic regression identified independent correlates of IPV; exploratory analyses examined IPV prevalence across combinations of dependence severity, psychiatric comorbidity and personality disorders. Results Forty‐one percent reported IPV perpetration in the preceding 12 months. Psychiatric comorbidity (adjusted odds ratio 6.66, 95% confidence interval 2.10, 21.11), personality disorder (adjusted odds ratio 6.26, 95% confidence interval 1.79, 21.92) and alcohol‐use duration > 10 years (adjusted odds ratio 5.96, 95% confidence interval 1.55, 22.84) were independently associated with IPV; SADQ severity was not (adjusted odds ratio 2.34, p = 0.062). IPV prevalence was highest among participants with both psychiatric comorbidity and personality disorder (21 of 22; 95.5%). Among those with psychiatric comorbidity, IPV prevalence was consistently high (75%–77%) across SADQ severity categories. Discussion and Conclusions Psychiatric comorbidity and personality disorders were more strongly associated with IPV perpetration than dependence severity. Routine psychiatric assessment may help identify patients at elevated IPV risk. Prospective studies are needed to establish temporal relationships and whether treating comorbid conditions reduces IPV.
