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Journal ArticleDOI

Household surveys and the case of the Australian methamphetamine situation.

22 Mar 2021-Addiction (John Wiley & Sons, Ltd)-Vol. 116, Iss: 10, pp 2610-2611
About: This article is published in Addiction.The article was published on 2021-03-22 and is currently open access. It has received 2 citations till now.
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TL;DR: For example, the authors found that the lifetime prevalence of meth/amphetamine decreased from 6.1% (95% CI = 5.3-6.9) to 1.7% between 2001 and 2019, while negative attitudes towards methylamphetamine and d-amphetamine increased.
Abstract: To test (1) if there was a change in self-reported lifetime prevalence of meth/amphetamine use by birth cohort and (2) if the extent of under-reporting of meth/amphetamine use was associated with the proportion of the population who nominated meth/amphetamine as a drug problem.Observational study using seven waves of repeated cross-sectional nationally representative household surveys between 2001 and 2019.Australia.Participants were from three birth cohorts: 1951-60 (age 68-77 at the 2019 survey; n = 29 458; 55% female), 1961-1970 (age 58-67; n = 29 859; 57% female) and 1971-1980 (age 48-57; n = 28 758; 59% female). Data were weighted to align the sample to the Australian population.Past year meth/amphetamine use; under-reporting of lifetime meth/amphetamine use in each birth cohort, year and survey stratum (operationalised as the difference between self-reported lifetime prevalence in 2001 and that of each subsequent year); proportion of the population who nominated meth/amphetamine as a drug problem in each birth cohort, year and survey stratum. Under-reporting was regressed on the proportion of people holding negative attitude towards meth/amphetamine. Survey year and birth cohort were adjusted for.Between 2001 and 2019, the lifetime prevalence of meth/amphetamine decreased from 6.1% (95% CI = 5.3-6.9) to 1.7% (95% CI = 1.2-2.2) in the 1951-1960 birth cohort (p < 0.001), from 13.0% (95% CI = 12.0-14.1) to 4.4% (95% CI = 3.7-5.2) in the 1961-1970 birth cohort (p < 0.001) and from 21.4% (95% CI = 19.9-22.9) to 11.2% (95% CI = 10.0-12.4) in the 1971-1980 birth cohort (p < 0.001). The proportion who nominated meth/amphetamine as a 'drug problem' increased significantly in all three cohorts (all p < 0.001) and the degree of under-reporting of meth/amphetamine use was significantly associated with proportion of people who nominated meth/amphetamine as the 'drug problem' (b = 0.09, SE = 0.01, p < 0.001).In Australia, the actual prevalence of lifetime meth/amphetamine use may be two- to fourfold higher than that estimated in the most recent national household surveys (2019). The level of under-reporting is strongly associated with increasing negative attitudes towards methylamphetamine and d-amphetamine use over the same period.

4 citations

References
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Journal ArticleDOI
TL;DR: The increased availability and use of crystal methamphetamine have been associated with increased regular use and harms in Australia and the capacity of health services to provide care needs to be enhanced.
Abstract: Introduction and Aims Concerns about crystal methamphetamine use and harm have increased in multiple countries. This paper describes how changes in the availability and use of crystal methamphetamine have impacted on methamphetamine-related harms in Australia. Design and Methods Data on methamphetamine use were obtained from population-level surveys, health service data and surveys of drug use among sentinel groups of ecstasy users and people who inject drugs. Data were obtained on seizures, arrests, clandestine laboratory detections, hospital separations, mental health unit admissions, drug telephone helpline calls and drug treatment episodes. Segmented linear regression models were fitted to identify changes in these series using log-transformed data where appropriate. Results The availability of crystal methamphetamine has increased as evidenced by increased laboratory detections, domestic seizures and purity of the seized drug. Population surveys do not report an increase in the number of people who used at least once in the past year. However, more users report using crystal methamphetamine rather than lower-purity powder methamphetamine and more regular use. Indicators of methamphetamine-related harms have increased in parallel with this change. Amphetamine-related helpline calls, drug treatment, arrests and hospital admissions for amphetamine disorders and psychosis all peaked in the mid-2000s, declined for several years and have increased steeply since 2010. Discussion and Conclusions The increased availability and use of crystal methamphetamine have been associated with increased regular use and harms. Treatment is required for those experiencing problems and the capacity of health services to provide care needs to be enhanced.[Degenhardt L, Sara G, Connor JP, McKetin R, Roxburgh A, Dobbins T, Farrell M, Burns L, Hall WD. Crystalline methamphetamine use and methamphetamine-related harms in Australia. Drug Alcohol Rev 2017;36:160–170]

123 citations

Journal ArticleDOI
TL;DR: Investigation of methamphetamine-related harms in Victoria finds that for a given amount spent, methamphetamine purchase power has increased and the presence of extreme purity variations may challenge individuals' control of consumption.
Abstract: AIMS: Methamphetamine related harms in Victoria have recently increased, in the context of stable or declining use prevalence. We determine how changes in price and purity of methamphetamine compared to other drugs such as heroin may, in part, explain these divergent patterns. METHODS: Detailed methamphetamine and heroin purchase price data from 2152 participant interviews from the Melbourne Injecting Drug User cohort study were used to generate drug price series for the period January 2009 - June 2013. Data on drug purity from 8818 seizures made within Victoria were used to generate drug purity series over the same period. Purity-adjusted price data for methamphetamine and heroin were obtained for the period 2009-2013 by combining the two datasets. RESULTS: While the average purity of heroin seizures remained consistent and low, the average purity of powder and of crystal methamphetamine seizures increased from 12% (95%CI 10-14%) to 37% (20-54%) and 21% (95%CI 18-23%) to 64% (60-68%) respectively. Crystal methamphetamine purity was bimodal, with observations generally less than 20% or greater than 70%. The average unadjusted price per gram for heroin decreased from $374 (95%CI $367-381) to $294 ($280-308), powder methamphetamine didn't change significantly from $252 (95%CI $233-271), and crystal methamphetamine increased substantially from $464 (95%CI $416-511) in 2009 to $795 ($737-853) in 2011. This increase was offset by an even greater increase in purity, meaning the average purity-adjusted price per gram declined. Furthermore, pure prices of both methamphetamine forms were similar, whereas their unadjusted prices were not. The pure price of heroin fluctuated with no ongoing trends. CONCLUSIONS: Decreases in methamphetamine purity-adjusted price along with the bimodality of crystal methamphetamine purity may account for some of the recent increase in methamphetamine related harm. For a given amount spent, methamphetamine purchase power has increased and the presence of extreme purity variations may challenge individuals' control of consumption. Language: en

65 citations

Journal ArticleDOI
TL;DR: It is argued that the decline in lifetime prevalence with age cannot be explained by period or cohort effects or be due to a survivor effect, and are likely due toA variety of other factors, such as study design, forgetting, or reframing.
Abstract: Many cross-sectional surveys in psychiatric epidemiology report estimates of lifetime prevalence, and the results consistently show a declining trend with age for such disorders as depression and anxiety. In a closed cohort with no mortality, lifetime prevalence should increase or remain constant with age. For mortality to account for declining lifetime prevalence, mortality rates in those with a disorder must exceed those without a disorder by a sufficient extent that more cases would be removed from the prevalence pool than are added by new cases, and this is unlikely to occur across most of the age range. We argue that the decline in lifetime prevalence with age cannot be explained by period or cohort effects or be due to a survivor effect, and are likely due to a variety of other factors, such as study design, forgetting, or reframing. Further, because lifetime prevalence is insensitive to changes in treatment effectiveness or demand for services, it is a parameter that should be dropped from the lexicon of psychiatric epidemiology.

56 citations

Journal ArticleDOI
TL;DR: In this article, an alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained, and the alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three-quarters and perhaps much more.
Abstract: Background Globally, heroin and other opioids account for more than half of deaths and years-of-life-lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations. GPS-based estimates are also ubiquitous for cocaine and methamphetamine, so insights pertaining to GPS for estimating heroin use are also relevant for those drug markets. Analysis Four sources of potential errors in NSDUH are assessed: selective non-response, small sample size, sampling frame omissions and under-reporting. An alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained. Other approaches to prevalence estimation are discussed. Findings Under-reporting and selective non-response in NSDUH are likely to lead to substantial underestimation. Small sample size leads to imprecise estimates and erratic year-to-year fluctuations. The alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three-quarters and perhaps much more. Implications GPS, even those as strong as NSDUH, are doomed by their nature to estimate poorly a rare and stigmatized behavior concentrated in a hard-to-track population. Although many European nations avoid reliance upon these surveys, many others follow the US model. Better estimation requires models that draw upon a variety of data sources, including GPS, to provide credible estimates. Recent methodological developments in selected countries can provide guidance. Journals should require researchers to critically assess the soundness of GPS estimates for any stigmatized drug-related behaviors with low prevalence rates.

54 citations

Journal ArticleDOI
TL;DR: Rapid increases in the quantum of media reporting stigmatising a drug (through its construction as an 'epidemic') accompanying increased general public concerns about the drug may increase the tendency to under-report lifetime use.

47 citations