PubMed Health⌕ Search

Biomedical subjects

Stuart Gilmour

Publications and source records attributed to Stuart Gilmour.

18 recordsLinked to original sources
PubMed2006

Determining a cut-off on the Severity of Dependence Scale (SDS) for alcohol dependence.

Optimal cut-off points on the Severity of Dependence Scale (SDS) indicative of clinically significant dependence have been determined for a range of substance types. This study aims to determine a cut-off point on SDS that discriminates between the presence and absence of a DSM-IV diagnosis of alcohol dependence. A structured interview was administered to 90 alcohol users in Sydney, Australia. Receiver Operating Characteristic curve analysis confirmed the utility of the SDS-alcohol for characterising and diagnosing persons with respect to their alcohol-dependent status to an accuracy of 85%. A SDS score of 3 or above was determined as optimal for characterising alcohol dependence. Evidence is also provided confirming that the SDS-alcohol is a valid, reliable uni-dimensional scale for measuring alcohol dependence. It has been demonstrated that the SDS-alcohol can be used to characterise an individual's alcohol-dependent status. A cut-off value for SDS-alcohol provides additional meaning and value to the scale for clients and clinicians and will enable researchers to characterise the prevalence of alcohol dependence in their target populations.

Alcoholism↗
PubMed2006

Identification and quantification of change in Australian illicit drug markets.

BACKGROUND: In early 2001 Australia experienced a sudden reduction in the availability of heroin which had widespread effects on illicit drug markets across the country. The consequences of this event, commonly referred to as the Australian 'heroin shortage', have been extensively studied and there has been considerable debate as to the causes of the shortage and its implications for drug policy. This paper aims to investigate the presence of these epidemic patterns, to quantify the scale over which they occur and to estimate the relative importance of the 'heroin shortage' and any epidemic patterns in the drug markets. METHOD: Key indicator data series from the New South Wales illicit drug market were analysed using the statistical methods Principal Component Analysis and SiZer. RESULTS: The 'heroin shortage' represents the single most important source of variation in this illicit drug market. Furthermore the size of the effect of the heroin shortage is more than three times that evidenced by long-term 'epidemic' patterns. CONCLUSION: The 'heroin shortage' was unlikely to have been a simple correction at the end of a long period of reduced heroin availability, and represents a separate non-random shock which strongly affected the markets.

Amphetamine↗
PubMed2006

The "lessons" of the Australian "heroin shortage".

Heroin use causes considerable harm to individual users including dependence, fatal and nonfatal overdose, mental health problems, and blood borne virus transmission. It also adversely affects the community through drug dealing, property crime and reduced public amenity. During the mid to late 1990s in Australia the prevalence of heroin use increased as reflected in steeply rising overdose deaths. In January 2001, there were reports of an unpredicted and unprecedented reduction in heroin supply with an abrupt onset in all Australian jurisdictions. The shortage was most marked in New South Wales, the State with the largest heroin market, which saw increases in price, dramatic decreases in purity at the street level, and reductions in the ease with which injecting drug users reported being able to obtain the drug. The abrupt onset of the shortage and a subsequent dramatic reduction in overdose deaths prompted national debate about the causes of the shortage and later international debate about the policy significance of what has come to be called the "Australian heroin shortage". In this paper we summarise insights from four years' research into the causes, consequences and policy implications of the "heroin shortage".

Adolescent↗
PubMed2006

The Adolescent Cannabis Problems Questionnaire (CPQ-A): psychometric properties.

Despite the widespread use of cannabis among young people, little research attention has been given to the development of psychometrically sound measures specific to cannabis related problems in this group. The aim of this study was to explore the reliability, validity and factor structure of a multi-dimensional measure of cannabis-related problems among adolescents. The Adolescent Cannabis Problems Questionnaire (CPQ-A) was developed as an assessment tool and treatment outcome measure. A stratified sample of 100 young people (aged 14-18 years) who had used cannabis in the past 90 days were administered the CPQ-A on two occasions 1 week apart. Exploratory factor analysis revealed three factors accounting for 63% of total variance with alpha coefficients of 0.88, 0.72 and 0.73. The CPQ-A was reliable with test-retest correlation for the total CPQ-A being 0.91. CPQ-A score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria reported. The findings show promise for the CPQ-A as a reliable, valid and potentially clinically useful measure of cannabis related problems among young people.

Adolescent↗
PubMed2006

Using intervention time series analyses to assess the effects of imperfectly identifiable natural events: a general method and example.

BACKGROUND: Intervention time series analysis (ITSA) is an important method for analysing the effect of sudden events on time series data. ITSA methods are quasi-experimental in nature and the validity of modelling with these methods depends upon assumptions about the timing of the intervention and the response of the process to it. METHOD: This paper describes how to apply ITSA to analyse the impact of unplanned events on time series when the timing of the event is not accurately known, and so the problems of ITSA methods are magnified by uncertainty in the point of onset of the unplanned intervention. RESULTS: The methods are illustrated using the example of the Australian Heroin Shortage of 2001, which provided an opportunity to study the health and social consequences of an abrupt change in heroin availability in an environment of widespread harm reduction measures. CONCLUSION: Application of these methods enables valuable insights about the consequences of unplanned and poorly identified interventions while minimising the risk of spurious results.

Australia↗
PubMed2006

Examining links between cocaine use and street-based sex work in New South Wales, Australia.

We examined potential links between cocaine use and street-based sex work in New South Wales (NSW), Australia, following reports of increased cocaine use among injection drug users (IDU). Police data on prostitution and possession/use of cocaine was analysed using time series analysis. Interviews with key informants and IDU were also conducted, and data on cocaine use from ongoing monitoring systems targeted at IDU were analysed. There was a clear increase in cocaine use among IDU which occurred in 2001. This occurred at the same time as an increase in prostitution offenses. Qualitative data suggested that a greater number of primary heroin users were engaging in street-based sex work, which was driven in part by the increases in cocaine use among this group. Subsequent reductions in cocaine availability led to decreased cocaine use and possession offenses, along with reductions in prostitution offenses.

Cocaine-Related Disorders↗
PubMed2006

Hair analysis underestimates heroin use in prisoners.

The value of hair analysis in measuring treatment outcome was examined in a randomised controlled trial (RCT) of an Australian state prison-based methadone programme between 1997 and 1998 (n = 382 male prisoners). Hair samples were analysed for morphine using immunoassay techniques. Agreement between hair analysis and self-report was tested using kappa, McNemar's test of symmetry and Pearson's correlation coefficient r. Hair analysis based on immunoassay was inadequate as the primary outcome measure for the RCT but had value in supplementing self-reported heroin use. There was a modest correlation (r = 0.31, p < 0.001) between self-reported frequency of heroin use and morphine concentrations in hair. Sectional hair analysis, a reflection of duration of drug use, was uninformative and generally impractical due to the length of hair sections needed.

Adolescent↗
PubMed2006

A systematic review of school-based studies involving alcohol and the community.

OBJECTIVE: To describe and critique methodological aspects of school-based interventions that involve a broader community initiative. METHODS: An electronic search of 11 databases and manual search of references for intervention studies published in peer-reviewed journals from January 2000 to August 2004. To be included in the review, alcohol needed to be a primary focus of the study, the intervention to be school based and include grades between five and 12, and the intervention needed to involve the community. RESULTS: Sixteen articles were selected for inclusion in the review. Methodologically, several studies excluded reporting important details (e.g. follow-up periods unclear), process measures were ignored by some studies (e.g. exposure to intervention), and some employed less than optimal outcome measures (such as attitudes and knowledge). Student education, some form of parental involvement and researchers providing resources to the school, were the most frequently employed intervention strategies. CONCLUSIONS: There is a clear need to conduct more rigorous evaluation studies and to increase reporting standards for school-based interventions. There is also tentative scope to include the community more broadly, rather than focus on established relationships within the school environment. IMPLICATIONS: As evidence suggests, there is limited effectiveness in school-based interventions. It may be beneficial to do lowest-cost interventions that have some evidence for effect, complemented by strategies identified by expert opinion, until further rigorous evidence arises.

Adolescent↗
PubMed2005

The Cannabis Problems Questionnaire: factor structure, reliability, and validity.

AIM: To develop a multi-dimensional valid and reliable measure of cannabis-related problems. METHOD: The Cannabis Problems Questionnaire (CPQ) was developed from the Alcohol Problems Questionnaire to measure cannabis treatment outcome. The CPQ was administered on two occasions 1 week apart to a stratified sample of adults who had used cannabis at least once in the previous 3 months. Exploratory factor analyses were conducted and the relationship between items of the CPQ and measures of daily use and dependence assessed. The reliability of the CPQ was also assessed using a test-retest and inter-rater reliability methodology. RESULTS: Exploratory factor analyses revealed a three factor solution best described the data accounting for 57% of the variance in the larger item set. The CPQ is highly reliable with test-retest tetrachoric correlations of between 0.92 and 1.00 and inter-rater reliability correlations between 0.74 and 1.00. The total CPQ score classified DSM-IV cannabis dependence with 84% specificity and sensitivity and daily cannabis use with 83% specificity and 55% sensitivity. CONCLUSIONS: The 22-item CPQ is a valid, reliable and sensitive measure of cannabis-related problems for use with clinical and research populations of current cannabis users.

Adolescent↗
PubMed2005

The Severity of Dependence Scale (SDS) in an adolescent population of cannabis users: reliability, validity and diagnostic cut-off.

The Severity of Dependence Scale (SDS) is a five-item scale that has been reported to be a reliable and valid screening instrument for dependence and a measure of dependence severity in adults across several substance classes. To date no data have been reported on its performance in a population of adolescent cannabis users. The current study assessed the psychometric properties of the SDS in a community sample of 14-18-year-old adolescent cannabis users (n=100). Internal consistency (alpha=0.83) and test-retest coefficients (ICC=0.88) were high and a principal components analysis of the scale found all items to load on a single factor. Total SDS score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria met, indicating good concurrent validity. Receiver Operating Characteristic curve analysis was used to determine the most appropriate SDS cut-off score for use as an indicator of cannabis dependence, with optimal discrimination at an SDS score of 4. These findings indicate that the SDS is a reliable and valid measure of severity of cannabis dependence among adolescents, has high diagnostic utility, and that an SDS score of 4 may be indicative of cannabis dependence.

Adolescent↗
PubMed2005

Age differentials in the impacts of reduced heroin: effects of a "heroin shortage" in NSW, Australia.

BACKGROUND: This paper uses a unique event, the Australian heroin shortage, to see whether an abrupt, substantial and sustained change in heroin supply had different effects on harms related to heroin use among younger and older heroin users. METHOD: Indicator data were examined by age group on the number of persons entering treatment for heroin and amphetamine dependence, arrests for heroin use/possession and number of drug related deaths in NSW, Australia. Data were analysed using times series analysis. RESULTS: There was a 41% reduction in the number of new registrations for opioid pharmacotherapy per month among 25-34 year olds, and a 26% reduction among 15-24 year olds, but no apparent changes among older age groups. Similarly, reductions in the number of non-pharmacological heroin treatment episodes were most pronounced among younger age groups. There was a 49% reduction in the number of heroin possession/use offences among those aged 15-24 years, compared to declines of 31-40% among older age groups. Declines in heroin related deaths were greatest among 15-24 year olds (65% reduction). There was no change in other drug related deaths in any age group. CONCLUSIONS: A reduction in heroin supply was followed by greater reductions in heroin related harms among younger than older people, across a number of outcome domains.

Adolescent↗
PubMed2005

The impact of changes to heroin supply on blood-borne virus notifications and injecting related harms in New South Wales, Australia.

BACKGROUND: In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'. This 'shortage has been linked to a decrease in needle and syringe output and therefore possibly a reduction in injecting drug use. We aimed to examine changes, if any, in blood-borne viral infections and presentations for injecting related problems related to injecting drug use following the reduction heroin availability in Australia, in the context of widespread harm reduction measures. METHODS: Time series analysis of State level databases on HIV, hepatitis B, hepatitis C notifications and hospital and emergency department data. Examination of changes in HIV, hepatitis B, hepatitis C notifications and hospital and emergency department admissions for injection-related problems following the onset of the heroin shortage; non-parametric curve-fitting of number of hepatitis C notifications among those aged 15-19 years. RESULTS: There were no changes observed in hospital visits for injection-related problems. There was no change related to the onset heroin shortage in the number of hepatitis C notifications among persons aged 15-19 years, but HCV notifications have subsequently decreased in this group. No change occurred in HIV and hepatitis B notifications. CONCLUSION: A marked reduction in heroin supply resulted in no increase in injection-related harm at the community level. However, a delayed decrease in HCV notifications among young people may be related. These changes occurred in a setting with widespread, publicly funded harm reduction initiatives.

Adolescent↗
PubMed2005

Cycling in and out of treatment; participation in methadone treatment in NSW, 1990-2002.

BACKGROUND: There are few descriptions of patterns of long-term participation in methadone treatment. There has been progressive expansion of methadone maintenance treatment (MMT) in Australia in the last 15 years, and by international standards Australia has a high participation rate in MMT, and has accumulated extensive data on participation. AIM: (1) To analyse predictors of retention in treatment (a proxy measure of treatment effectiveness) in three cohorts of people entering public and private methadone treatment, in 1990, 1995, and 2000 in the state of New South Wales (NSW), and to compare retention rates with those reported from recent clinical trials; and (2) to describe the pattern of participation in subsequent treatment and predictors of re-entry. METHOD: Sequential first admissions to MMT for the month of February during 1990, 1995, and 2000, were identified from the NSW Health database. Initial treatment setting (public or private) was identified. Pattern of subsequent participation in treatment of all subjects was also extracted. Descriptive statistics were generated, and predictors of retention in treatment and re-entry to treatment were analysed. RESULTS: The sample comprised 342 subjects commencing in private and 135 in public settings. Retention did not differ between settings. At 6 months, 51% in the current study were retained, compared to 48% in pooled clinical trials from Australia. There was a significant cohort effect; at 3 months retention was significantly better in the 1990 cohort, but by 12 months, differences between the year-cohorts were not statistically significant. Most people who left treatment dropped out; two-thirds subsequently re-entered MMT, often having multiple episodes. Participation in non-continuous treatment was around 45% for the 5 years after first entering treatment. Using multiple logistic regression, the significant predictors of re-entry to treatment were age, and duration of first treatment episode; specifically, older people and those with >12 months continuous treatment were significantly less likely to re-enter. CONCLUSION: Retention in treatment in practice, across a range of settings, appears comparable to treatment delivered in clinical trials. Participants cycle in and out of treatment, and this recycling appears to have increased as the program has expanded and access to treatment has increased.

Adult↗
PubMed2005

Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime?

BACKGROUND: A sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU) in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide. METHODS: Data on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS). Monthly NSW Police incident data on arrests for cocaine possession/use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing. RESULTS: There was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults. CONCLUSION: The increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime.

Cocaine-Related Disorders↗
PubMed2005

The impact of a reduction in drug supply on demand for and compliance with treatment for drug dependence.

BACKGROUND: In early 2001, Australia experienced a sudden, dramatic and sustained decrease in heroin availability that was accompanied by sharp increases in price and decreases in street level purity--the so-called "heroin shortage". These unprecedented changes occurred in a context of widespread treatment availability, which made it possible for the first time to examine the impact of a sharp reduction in heroin supply in New South Wales (NSW) on entry to and adherence with treatment for heroin dependence. Given the evidence of drug substitution by some users, the current paper also examines the effects of the shortage on entry to treatment for other forms of drug dependence. METHODS: Interrupted time-series analysis of the number of persons entering opioid pharmacotherapy and other treatment modalities in NSW for heroin dependence and for the treatment for other types of drug dependence. FINDINGS: The heroin shortage was associated with a reduction in the number of younger persons entering opioid pharmacotherapy. There was a dramatic decrease in the number of persons entering heroin withdrawal or "assessment only" treatment episodes. There appear to have been small improvements in adherence to and retention in heroin treatment after the reduction in heroin supply. Relatively small increases were observed in numbers being treated for cocaine dependence. CONCLUSIONS: In the context of good treatment provision, a reduction in heroin supply appeared to produce modest improvements in intermediate outcomes. Supply and demand reduction measures, when both are implemented successfully, may be complementary.

Cocaine↗
PubMed2005

The effect of a reduction in heroin supply on fatal and non-fatal drug overdoses in New South Wales, Australia.

OBJECTIVE: To examine the impact of a sudden and dramatic decrease in heroin availability, concomitant with increases in price and decreases in purity, on fatal and non-fatal drug overdoses in New South Wales, Australia. DESIGN AND SETTING: Time-series analysis was conducted where possible on data on overdoses collected from NSW hospital emergency departments, the NSW Ambulance Service, and all suspected drug-related deaths referred to the NSW Coroner's court. MAIN OUTCOME MEASURES: The number of suspected drug-related deaths where heroin and other drugs were mentioned; ambulance calls to suspected opioid overdoses; and emergency department admissions for overdoses on heroin and other drugs. RESULTS: Both fatal and non-fatal heroin overdoses decreased significantly after heroin supply reduced; the reductions were greater among younger age groups than older age groups. There were no clear increases in non-fatal overdoses with cocaine, methamphetamines or benzodiazepines recorded at hospital emergency departments after the reduction in heroin supply. Data on drug-related deaths suggested that heroin use was the predominant driver of drug-related deaths in NSW, and that when heroin supply was reduced overdose deaths were more likely to involve a wider combination of drugs. CONCLUSION: A reduction in heroin supply reduced heroin-related deaths, and did not result in a concomitant increase, to the same degree, in deaths relating to other drugs. Younger people were more affected by the reduction in supply.

Adolescent↗
PubMed2004

Clearance of hepatitis C virus after newly acquired infection in injection drug users.

A retrospective cohort of injection drug users with newly acquired hepatitis C virus (HCV) infection was established to examine viral clearance. Newly acquired HCV infection was defined by anti-HCV antibody seroconversion within a 2-year interval. Stored serum samples were tested for HCV RNA, with viral clearance defined as >/=2 consecutive negative HCV RNA test results after infection. Ninety-nine cases of HCV infection were identified; 57 had >/=2 HCV RNA test results after infection. Viral clearance occurred in 24 (42%) cases, with Kaplan-Meier estimated probabilities of 23%, 38%, and 40% at 6, 12, and 24 months, respectively.

Adolescent↗