Deborah Randall

Publications (8)25.09 Total impact

• Article: The contributions of viral hepatitis and alcohol to liver-related deaths in opioid-dependent people.

  Sarah Larney, Deborah Randall, Amy Gibson, Louisa Degenhardt
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  ABSTRACT: BACKGROUND: Mortality rates are elevated among heroin-dependent populations compared to the general population. Liver disease is emerging as an important contributor to mortality as the heroin-dependent population ages. Two major risk factors for liver disease are hepatitis C virus infection and chronic heavy alcohol use. Both of these are highly prevalent among heroin dependent people, but their relative contribution to liver-related mortality is poorly understood. METHODS: Data recording all prescriptions of opioid substitution treatment in New South Wales, Australia, 1997-2005, were linked to the National Death Index. Crude and standardised mortality rates and standardised mortality ratios were calculated for liver-related and other major causes of death. Frequency counts were obtained for viral hepatitis and alcohol mentions in underlying liver deaths. RESULTS: There were 208 underlying liver deaths for a CMR of 72.4 per 100,000py (95% CI 62.9, 82.9), and liver deaths occurred at 9.8 times the general population rate (95% CI 8.5, 11.2). There were increases in liver-related mortality over time. Viral hepatitis was mentioned in three-quarters (n=156, 76%), and alcohol in 43% (n=90) of underlying liver deaths. CONCLUSIONS: Liver-related deaths were shown to be increasing in this heroin-dependent population, and the majority of these deaths involved chronic viral hepatitis infection. Increased uptake of treatment for hepatitis C virus infection is crucial to reducing the burden of liver-related mortality in this population. Hepatitis B vaccination, and screening of OST patients for alcohol use disorders and delivery of brief interventions as clinically indicated may also be of benefit.
  Drug and alcohol dependence 12/2012; · 3.60 Impact Factor
• Article: The increasing mortality burden of liver disease among opioid-dependent people: cohort study.

  Amy Gibson, Deborah Randall, Louisa Degenhardt
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  ABSTRACT: Hepatitis C (HCV) infection is highly prevalent among injection drug users (IDUs) and likely to cause significant mortality over time, but little research attention has focused upon the magnitude of this risk, particularly among ageing users. This study examined trends over time in mortality attributed to liver disease, and in particular contrasting this with other more commonly studied causes of death [acquired immune deficiency syndrome (AIDS), suicide and overdose] among an ageing cohort of heroin-dependent people in Australia. Data linkage study of methadone treatment entrants with the National Deaths Index.  A cohort entering methadone treatment for heroin dependence in New South Wales, Australia, 1980-85.   A total of 2489 people entering methadone treatment for heroin dependence and 54,847 person-years (PY) of follow-up.   Linkage of data on all methadone entrants between 1980 and 1985 with data from the Australian National Deaths Index, linked using probabilistic record linkage software. There were 8.2 deaths per 1000 PY [95% confidence interval (CI) 7.5-9.0], with standardized mortality ratios (SMRs) of 4.6 (95% CI 4.2-5.0). Almost one in five (17%) of deaths were from underlying liver-related causes, most commonly viral hepatitis. The overall mortality rate for any liver cause was 1.4 deaths per 1000 PY (95% CI 1.1-1.7), 17 times higher than to the general population (95% CI 13.4-21.3), with relative elevations more marked for females (SMR 27.9; 95% CI 17.7-41.9) than males (SMR 14.5; 95% CI 10.8-19.0). Liver mortality increased over time, becoming the most common cause of death by the end of follow-up.   Liver disease has become the most common cause of mortality among ageing opioid-dependent people in an ageing Australian cohort. There is an imperative to reduce the long-term risks of HCV and other risks to the liver, including alcohol consumption, which are typically not the major clinical focus for this group.
  Addiction 07/2011; 106(12):2186-92. · 4.31 Impact Factor
• Article: Increasing cancer mortality among opioid-dependent persons in Australia: a new public health challenge for a disadvantaged population.

  Deborah Randall, Louisa Degenhardt, Claire M Vajdic, Lucy Burns, Wayne D Hall, Matthew Law, Tony Butler
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  ABSTRACT: To examine cancer mortality in a population-based cohort of opioid-dependent persons. New South Wales opioid substitution therapy (OST) program registrants from 1985 to 2005 (n=43,789) were probabilistically linked to the National Death Index. Crude and standardised mortality rates and standardised mortality ratios (SMRs) were calculated. The crude cancer mortality rate increased from 4 to 65 deaths per 100,000 person-years (p trend <0.001). Overall, OST registrants were 1.7 times more likely to die of cancer than the general population (SMR 95% CI 1.4-1.9). Site-specific SMRs were significantly elevated for lung cancer (3.6, 95% CI 2.8-4.6), liver cancer (6.9, 95% CI 4.3-10.5), and anogenital cancers (2.8, 95% CI 1.3-5.3), and significantly reduced for breast cancer (0.4, 95% CI 0.1-0.9). Cancer is an increasingly important cause of death among OST registrants as they live longer with their dependency. The site-specific excess deaths suggest the role of tobacco, alcohol, and infection with hepatitis C and human papillomavirus. The OST setting may be a useful setting for the delivery of programs aimed at detection of precursor lesions, reducing exposure to established carcinogens, and treatment for those with HCV infection. Such targeted steps are likely to reduce the future cancer burden in this population.
  Australian and New Zealand Journal of Public Health 06/2011; 35(3):220-5. · 1.20 Impact Factor
• Article: Mortality among clients of a state-wide opioid pharmacotherapy program over 20 years: risk factors and lives saved.

  Louisa Degenhardt, Deborah Randall, Wayne Hall, Matthew Law, Tony Butler, Lucy Burns
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  ABSTRACT: The small size of previous studies of mortality in opioid dependent people has prevented an assessment of the extent to which elevated mortality risks are consistent across time, clinical and/or patient groups. The current study examines reductions in mortality related to treatment in an entire treatment population. Data from the New South Wales (NSW) Pharmaceutical Drugs of Addiction System, recording every "authority to dispense" methadone or buprenorphine as opioid replacement therapy, 1985-2006, was linked with data from the National Deaths Index, a record of all deaths in Australia. Crude mortality rates and standardized mortality ratios were calculated according to age, sex, calendar year, period in- or out-of-treatment, medication type, previous treatment exposure and cause of death. Mortality among 42,676 people entering opioid pharmacotherapy was elevated compared to age and sex peers. Drug overdose and trauma were the major contributors. Mortality was higher out of treatment, particularly during the first weeks, and it was elevated during induction onto methadone but not buprenorphine. Mortality during these risky periods changed across time and treatment episodes. Overall, mortality was similarly reduced (compared to out-of-treatment) whether patients were receiving methadone or buprenorphine. It was estimated that the program produced a 29% reduction in mortality across the entire cohort. Mortality among treatment-seeking opioid-dependent persons is dynamic across time, patient and treatment variables. The comparative reduction in mortality during buprenorphine induction may be offset by the increased risk of longer out-of-treatment time periods. Despite periods of elevated risk, this large-scale provision of pharmacotherapy is estimated to have resulted in significant reductions in mortality.
  Drug and alcohol dependence 08/2009; 105(1-2):9-15. · 3.60 Impact Factor
• Article: Comparing retention in treatment and mortality in people after initial entry to methadone and buprenorphine treatment.

  James Bell, Lieu Trinh, Bethany Butler, Deborah Randall, George Rubin
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  ABSTRACT: AIM To compare retention in treatment and mortality among people entering methadone and buprenorphine treatment for opioid dependence. The Pharmaceutical Drugs of Abuse System (PHDAS) database records start- and end-dates of all episodes of methadone and buprenorphine treatment in New South Wales, and the National Death Index (NDI) records all reported deaths. Data linkage study. First entrants to treatment between June 2002 and June 2006 were identified from the PHDAS database. Retention in treatment was compared between methadone and buprenorphine. Names were linked to the NDI database, and 'good matches' were identified. Deaths were classified as occurring during induction, maintenance and either post-methadone or post-buprenorphine, depending on the latest episode of treatment prior to death. The numbers of inductions into treatment, of total person-years spent in each treatment, and person-years post-methadone or buprenorphine, were calculated. Risk of death in different periods, and different treatments, was analysed using Poisson regression. A total of 5992 people entered their first episode of treatment-3349 (56%) on buprenorphine, 2643 on methadone. Median retention was significantly longer in methadone (271 days) than buprenorphine (40 days). During induction, the risk of death was lower for buprenorphine (relative risk = 0.114, 95% confidence interval = 0.002-0.938, P = 0.02, Fisher's exact test). Risk of death was lowest during treatment, significantly higher in the first 12 months after leaving both methadone and buprenorphine. Beyond 12 months after leaving treatment, risk of death was non-significantly higher than during treatment. Buprenorphine was safer during induction. Despite shorter retention in treatment, buprenorphine maintenance was not associated with higher risk of death.
  Addiction 08/2009; 104(7):1193-200. · 4.31 Impact Factor
• Article: Opioid agonist pharmacotherapy in New South Wales from 1985 to 2006: patient characteristics and patterns and predictors of treatment retention.

  Lucy Burns, Deborah Randall, Wayne D Hall, Matthew Law, Tony Butler, James Bell, Louisa Degenhardt
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  ABSTRACT: The aims of this study were to: examine the number and characteristics of patients entering and re-entering opioid replacement treatment between 1985 and 2006, to examine select demographic and treatment correlates of leaving treatment between 1985 and 2000, and to compare retention rates in methadone and buprenorphine maintenance treatment from 2001 to 2006. A retrospective cohort study using register data from the Pharmaceutical Drugs of Addiction System. Opioid substitution treatment in New South Wales (NSW), Australia. A total of n = 42 690 individuals prescribed opioid replacement treatment between 1985 and 2006 in NSW. Client characteristics over time, retention in days in first treatment episode, number of episodes of treatment and proportion switching medication. Overall, younger individuals were significantly more likely to leave their first treatment episode than older individuals. In 2001-06, after controlling for age, sex and first administration point, the hazard of leaving treatment was 1.9 times for those on buprenorphine relative to those on methadone. Retention in treatment varied somewhat across historical time, with those entering during 1995-2000 more likely to leave at an earlier stage than those who entered before that time. Retention in treatment appears to fluctuate in inverse proportion to the availability of heroin. Individuals in contemporary treatment are older users with a lengthy treatment history. This study has provided population-level evidence to suggest that retention in methadone and buprenorphine differ in routine clinical practice. Future work might investigate ways in which patient adherence and retention may be improved.
  Addiction 07/2009; 104(8):1363-72. · 4.31 Impact Factor
• Article: Annual or biennial mammography screening for women at a higher risk with a family history of breast cancer: prognostic indicators of screen-detected cancers in New South Wales, Australia.

  Deborah Randall, Stephen Morrell, Richard Taylor, Wai Tak Hung
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  ABSTRACT: This study examined whether offering annual mammography screening for women with the risk factor of a family history of breast cancer resulted in more favorable prognostic indicators of diagnosed cancers than the usual approach of biennial screening. The study involved women aged 50-69 years with a family history of breast cancer, defined as having > or = 1 first-degree relative diagnosed with breast cancer, who were diagnosed with a screen-detected invasive breast cancer between 1998 and 2004 in BreastScreen New South Wales (n = 590). The women were grouped according to whether they screened in an area offering annual screening to women with a family history, or were offered the standard biennial screening. The odds of having favorable tumor size, grade, and nodal status prognosis were compared between these screening groups using logistic regression. A comparison group of women without a family history, all offered biennial screening, was also evaluated based on the same area groupings to examine whether any differences were due to the area, rather than the screening interval policy. Women with a family history who were offered annual screening at BreastScreen NSW were significantly more likely than those who were offered biennial screening to be diagnosed with a tumor < or = 20 mm in size (adjusted odds ratio (AOR) = 1.91, 95% CI: 1.21-3.02), and to have a node-negative tumor (AOR = 1.61, 95% CI: 1.03-2.50). There were also significantly higher odds of being diagnosed with tumors < or = 15 mm (p < 0.001) and < or = 10 mm in size (p = 0.011) in women offered annual screening. There was no significant difference in the odds of a Grade 1 tumor being detected (AOR = 1.26, 95% CI: 0.87-1.81), although the direction of the effect was consistent with that seen for size and nodal status. No significant differences were found in the comparison group of women without a family history. Offering annual screening for women aged 50-69 years with a family history of breast cancer significantly increased the odds of being diagnosed with a smaller, node-negative tumors. Further investigation is required to assess whether the improved prognostic indicators translate into significantly better mortality outcomes for women with a family history offered annually screening.
  Cancer Causes and Control 11/2008; 20(5):559-66. · 2.88 Impact Factor
• Article: Monitoring consumption of ‘extra’ foods in the Australian diet: Comparing two sets of criteria for classifying foods as ‘extras’

  Anna RANGAN, Debra HECTOR, Deborah RANDALL, Tim GILL, Karen WEBB
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  ABSTRACT: Aim:  To compare two systems which classify energy-dense, nutrient-poor ‘extra’ foods which can be used to monitor the contribution of these foods in the diets of Australian children. The aim is to develop consistent criteria that may be used to monitor trends in the consumption of ‘extra’ foods in dietary surveys and, for research purposes, to examine associations between ‘extra’ food consumption and weight gain.Methods:  The intake of ‘extra’ foods was investigated among 2- to 18-year-old children (n = 3007) who participated in the 1995 National Nutrition Survey. Two classification systems were used, both based on the Australian Guide to Healthy Eating: a simple food grouping system, and a more complex system based on specific fat and sugar cut-points applied to food subgroups.Results:  Both classification systems resulted in similar lists of commonly consumed ‘extra’ foods, and showed similar estimates for energy contribution from ‘extra’ foods, 41–42%, and similar, relatively low, contributions of micronutrients, 20–25%.Conclusion:  A relatively simple food grouping classification system may be useful to estimate total energy and nutrient intake from ‘extra’ foods. However, for more detailed food-specific analyses, a food criteria system based on cut-points may be preferred. Nationally consistent criteria are needed for classifying ‘extra’ foods for both monitoring and research purposes, to enable comparisons of dietary data from surveys over time, and to investigate associations between ‘extra’ food consumption and nutrition outcomes such as weight gain and body mass index.
  Nutrition &amp Dietetics 11/2007; 64(4):261 - 267. · 0.88 Impact Factor