Amanda Roxburgh

Burnet Institute

Background Compared to the general population, people who inject drugs have poor health and wellbeing. Longitudinal studies can provide insight into factors driving these worse health outcomes but are subject to methodological challenges, such as cohort attrition. The aim of this study was to assess and characterise attrition in a prospective cohor...

Introduction Supervised injecting facilities (SIF) have been shown to reduce negative outcomes experienced by people who inject drugs. They are often subject to intense public and media scrutiny. This article aimed to explore population attitudes to SIFs and how these changed over time in Australia. Methods Data were drawn from the National Drug S...

Introduction The Sydney Medically Supervised Injecting Centre provides a safe, non‐judgemental space where people can inject pre‐obtained substances under the supervision of trained staff. This article describes an unusual incident occurring at the Medically Supervised Injecting Centre in January 2023. Case Presentation Two regular male clients at...

Introduction People who inject drugs are 13 times more likely to die by suicide than the general population. Guidelines for responding to risk in this population are limited. Harm reduction services attended by people who inject drugs require targeted strategies to address the complexities of suicide risk among this population. Methods Co‐design,...

Background Compared to the general population, people who inject drugs have poor health and wellbeing. Longitudinal studies can provide insight into factors driving these worse health outcomes but are subject to methodological challenges, such as cohort attrition. The aim of this study was to assess and characterise attrition in a prospective cohor...

Background Increasing overdose deaths attributable to illicitly manufactured fentanyl and fentanyl analogues in North America has driven international concern about the expansion of these substances into drug markets elsewhere. This paper investigates 20-year trends in fentanyl deaths in Australia, distinguishing between deaths attributable to phar...

Aim To differentiate the severity of acute opioid toxicity and describe both the clinical and physiological features associated with heroin overdose in a cohort of witnessed overdose cases. Methods Witnessed heroin overdose cases over a 12-month period (30 June 2018 – 30 June 2019) at the Medically Supervised Injecting Room (MSIR) in Melbourne, Au...

The COVID-19 crisis has had profound impacts on health service provision, particularly those providing client facing services. Supervised injecting facilities and drug consumption rooms across the world have been particularly challenged during the pandemic, as have their client group—people who consume drugs. Several services across Europe and Nort...

Introduction and Aims: People who inject drugs are 13 times more likely than the general population to die by suicide, yet strategies for assessing acute risk are far from clear. Given the unique setting of MSIC, traditional suicide risk assessment poses significant challenges. We report on efforts to develop a more targeted suicide assessment and...

Introduction and Aims: There is little evidence about how to optimally assess and manage suicide risk for people who inject drugs (PWID), especially within harm reduction services. This review aimed to synthesise the evidence on suicide prevention, assessment, and management in alcohol and other drug (AOD) service settings. https://doi.org/10.1111...

Background: Drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) provide a safe environment in which people who inject drugs (PWIDs) can inject under hygienic and supervised conditions. Numerous reviews have documented the benefits of these facilities; however, there is a lack of clarity surrounding their long-term effects. Pu...

Summary of recommendations and levels of evidence Chapter 2: Screening and assessment for unhealthy alcohol use Screening • Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). • Quantit...

Aims: To determine trends in 3,4 methylenedioxymethamphetamine (MDMA)-related death rates across Australia, Finland, Portugal and Turkey and to analyse causes of death across countries; and 3. analyse the toxicology of deaths across countries. Design: Analysis of MDMA-related deaths extracted from a national coronial database in Australia (2001-...

Background: MDMA markets have undergone substantial changes internationally, with increasing manufacture of high purity MDMA recorded. This study examined trends in MDMA-related deaths in Australia, investigating characteristics, circumstances and toxicology of these deaths. Methods: Analysis of MDMA-related deaths in Australia between 2001 and...

Background: Although much is known about the correlates of heroin overdose, less is known about pharmaceutical opioid (PO) overdose. This study aimed to examine correlates of opioid overdose deaths by opioid and compare correlates between opioids. Methods: Analysis of opioid overdose deaths in Australia between 2000-2015, extracted from the Nati...

Background: In many countries, sexual minority women smoke at higher rates than their heterosexual counterparts. Analyses tend to combine lesbian and bisexual women, preventing an understanding of relevant factors associated with smoking for each group. This analysis used a representative sample of the Australian population to compare tobacco use...

Aim: The aim of this study was to examine the typology of Australian illicit drug consumers to determine whether those who use new psychoactive substances (NPS) differ from those using other illicit substances. Methods: Data were from the 2013 National Drug Strategy Household Survey, a representative population study; analyses were limited to pa...

Introduction: Defining drug-related mortality is complex as these deaths can include a wide range of diseases and circumstances. This paper outlines a method to identify deaths that are directly due to fatal opioid toxicity (i.e. overdose), utilising coronial data. Materials and methods: The National Coronial Information System (NCIS), an online...

Background: There has been international concern over the rise in fatal pharmaceutical opioid overdose rates, driven by increased opioid analgesic prescribing. The current study aimed to examine trends in opioid overdose deaths by: 1) opioid type (heroin and pharmaceutical opioids); and 2) age, gender, and intent of the death assigned by the coron...

Background: Pharmaceutical opioid overdose rates have increased in recent years. The current study aimed to compare rates per 1000 injections of non-fatal overdose after heroin or oxycodone injection, and their comparative clinical severity. Methods: Analysis of prospectively collected data from the Sydney Medically Supervised Injecting Centre (...

Objective: To examine fentanyl utilisation in the Australian community and determine the geographic and socio-demographic factors associated with higher rates of fentanyl utilisation. Methods: National sales data (supplied by IMS Health) were used to estimate fentanyl utilisation (in pack sales and milligrams) in Australia during 2013, mapped to...

Introduction: Online drug markets operating on the 'darknet' ('cryptomarkets') facilitate the trade of illicit substances at an international level. The present study assessed the longitudinal impact on cryptomarket trading of two major disruptions: a large international law enforcement operation, 'Operation Onymous'; and the closure of the larges...

Background: The potential of methamphetamine, and high-potency crystal methamphetamine in particular, to precipitate psychotic symptoms and psychotic illness is the subject of much speculation internationally. Established psychotic illness is disabling for individuals and costly to society. The aim of this study was to investigate whether use of c...

The authors regret that there is an inconsistency between figures presented in the abstract and those reported in the text of the manuscript. Specifically, the abstract states that 68 out of 800 participants in the sample reported recent darknet use, while the manuscript states that 66 of the 745 participants reported recent darknet use. The latter...

The National Illicit Drug Indicators Project (2016 Report). Funded by the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund.

Background: To date monitoring of cryptomarkets operating on the dark net has largely focused on market size and substance availability. Less is known of country specific differences in these indicators and how they may corroborate population prevalence estimates for substance use in different countries. Methods: All substance listings from the...

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 s...

Objective: To estimate the number of regular and dependent methamphetamine users in Australia. Design: Indirect prevalence estimates were made for each year from 2002-03 to 2013-14. We applied multiplier methods to data on treatment episodes for amphetamines (eg, counselling, rehabilitation, detoxification) and amphetamine-related hospitalisatio...

Objective: To examine the rates and patterns of new psychoactive substance (NPS) use amongst regular psychostimulant users (RPU) in Australia. Method: Data were obtained from the 2010-2015 Ecstasy and related Drugs Reporting System (EDRS), which comprised a total cross-sectional sample of 4122RPU. Results: Recent use of 'any' NPS increased fro...

Background: The past five years has seen a proliferation in marketplaces operating on the 'dark net' selling licit and illicit substances. While monitoring systems have investigated the specific substances for sale on these marketplaces, less is known about consumer motivations for accessing these marketplaces and factors associated with their use...

Background: International research assessing differences in the prevalence of alcohol and other drug (AOD) use among Lesbian Gay Bisexual and Transgender (LGBTI) and heterosexual populations shows elevated prevalence rates of substance use among LGBTI people. To date no research has been published investigating these differences at a population le...

Objectives: To examine trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths. Design and setting: Analysis of prospectively collected data from the National Coronial Information System on deaths where codeine toxicity was determined to be an underlying or contributory...

Homelessness status is strongly correlated with higher rates of substance use. Few studies, however, examine the complex relationship between housing status and substance use in people who inject drugs (PWID). This study extends previous research by comparing the physical and mental health status and service utilisation rates between stably housed...

There has been a well-documented increase in the non-medical use of pharmaceutical opioids (PO) worldwide. However, there has been little detailed examination of treatment demand, or the characteristics of those presenting for treatment, particularly for treatments other than opioid substitution. Data from closed drug and alcohol treatment episodes...

New Psychoactive Substances are now a feature of Australia's recreational drug market. Little is known, however, about the prevalence of use, the characteristics of people who use them and the relationship between the NPS and ecstasy markets. This study examined the prevalence and correlates of NPS use amongst a group of regular ecstasy users in Au...

In Australia, drug monitoring systems have been in place for more than a decade allowing for the measurement of ongoing trends in drug use and the detection of new drugs. The Drug Trends Unit at the National Drug and Alcohol Research Centre monitors drugs through four separate systems. The Illicit Drug Reporting System (IDRS) measures the price, pu...

Energy drinks and energy 'shots' have become increasingly popular in recent years. Many people consume them with the belief that the beverage will assist in endurance, concentration and stamina. To better understand any potential for harm when young people drink alcohol and energy drinks together, NSW Health commissioned independent research. The T...

Introduction and AimsThe study aims to examine the medical and non-medical use of over-the-counter (OTC) codeine combination drugs in a sample of people who inject drugs; and to examine risk factors associated with exceeding the recommended dose of OTC codeine, including the experience of pain. Design and Methods This study analysed annual survey d...

Introduction and aims: The study aims to quantify trends in fentanyl prescribing and fentanyl mortality in Australia within the context of concern among health professionals concerning increasing accessibility of fentanyl, and the harms that may arise as a result. Design and methods: This paper presents data on prescribing patterns of fentanyl b...

Objective: Residual effects of ecstasy use induce neurotransmitter changes that make it biologically plausible that extended use of the drug may induce psychological distress. However, there has been only mixed support for this in the literature. The presence of polysubstance use is a confounding factor. The aim of this study was to investigate wh...

To document trends in: (i) prescribing of morphine and oxycodone; (ii) hospital separations for overdose; (iii) presentations for treatment of problems associated with these drugs; and (iv) oxycodone-related mortality data in Australia. Cross-sectional study analysing prescriptions for morphine and oxycodone based on figures adjusted using Australi...

Drug information or surveillance systems have been developed in an attempt to measure illicit drug use and predict new trends. In Australia, three systems are specifically designed to monitor drug use trends and related harm. These systems have their own strengths and weaknesses. This perspective offers a discussion of these facets. A series of cas...

To examine trends in patterns of cannabis use and related harm in the Australian population between 1993 and 2007. Analysis of prospectively collected data from: (1) the National Drug Strategy Household Survey (NDSHS) and Australian Secondary Student Alcohol and Drug Survey (ASSADS); (2) the National Hospital Morbidity Database (NHMD); and (3) the...

This paper examines the epidemiology of ecstasy use and harm in Australia using multiple data sources. The data included (1) Australian Customs Service 3,4-methylenedioxymethamphetamine (MDMA) detections; (2) the National Drug Strategy Household and Australian Secondary Student Alcohol and Drug Surveys; (3) data from Australia's ecstasy and Related...

Aetiological fractions are often used as an indirect measure of morbidity and mortality related to a specific risk factor. Aetiological fractions previously used in Australia for cocaine-related antenatal haemorrhage and low birth weight newborns have relied on risk ratios calculated from US-based studies. As outlined in this paper, there are sever...

To examine age-related differences in drug use and risk among regular injecting drug users (IDU) in Australia. Cross-sectional data from the 2006 Illicit Drug Reporting System were examined for age-related differences in demographic characteristics, drug use history and current use patterns and self-reported risk behaviours. IDU under 25 years of a...

This study examines drug use and dependence and associated risks among female street-based sex workers. Cross-sectional data collected from 72 women between April and August 2005 in Sydney, Australia, via face-to-face interviews. The average age was 34 years. Risk factors associated with developing problematic drug use were prevalent. Child sexual...

There has been considerable media attention recently upon possible increases in methamphetamine use in Australia. Much of this debate has focused upon extreme cases of problematic crystal methamphetamine use, without reference to the broader population context. This paper provides data on methamphetamine use in Australia, and documents trends in me...

To estimate the total hospital costs of drug-related separations in Australia from 1999/2000 to 2004/05, and separate costs for the following illicit drug classes: opioids, amphetamine, cannabis and cocaine. Australian hospital separations between 1999/2000 to 2004/05 from the National Hospital Morbidity Dataset (NHMD) with a principal diagnosis of...

This study assessed the impact on benzodiazepine injection among IDU in Sydney of removing temazepam gel capsule preparations from the Australian market. Several data sources were used: (1) data from the NSW Illicit Drug Reporting System (IDRS) (an annual, cross-sectional survey of regular IDU in Sydney) for the period 1996 - 2005; (2) data from in...

To examine (a) numbers of alcohol and drug-related hospital separations, 1999-2005; (b) demographics of these separations; (c) principal diagnoses co-occurring with drug-related problems; (d) length of hospital stay. Data from the National Hospital Morbidity Database (NHMD) were analysed. Hospital separations where alcohol, opioids, amphetamine, ca...

The Illicit Drug Reporting System (IDRS) is intended to serve as a strategic early warning system, identifying emerging trends of local and national concern in illicit drug markets. The IDRS consists of three components: interviews with injecting drug users (IDU); interviews with key experts (KE), professionals who have regular contact with illicit...

identifying emerging trends of local and national concern in illicit drug markets. The IDRS consists of three components: interviews with a sentinel group of people who regularly inject drugs (PWID; also known as injecting drug users; IDU1), conducted in the capital cities of Australia; interviews with key experts (KE), professionals who have regul...

The Australian Drug Trends in Ecstasy and Related Drug Markets 2007 report presents the findings from the fifth year in which data have been collected in all states and territories in Australia on the markets for ecstasy and related drugs (ERDs). The Ecstasy and Related Drugs Reporting System (EDRS; formerly the Party Drugs Initiative, or PDI) is t...

To examine trends in hospital separations related to "drug-induced" psychosis for cannabis and methamphetamine, in the context of patterns of cannabis and methamphetamine use in the Australian population. Analysis of prospectively collected data from the National Hospital Morbidity Database on hospital separations primarily attributed to drug-induc...

This paper examines population trends in morphine prescriptions in Australia, and contrasts them with findings from annual surveys with regular injecting drug users (IDU). Data on morphine prescriptions from 1995 to 2003 were obtained from the Drug Monitoring System (DRUMS) run by the Australian Government Department of Health and Ageing. Data coll...

This paper examines rates of exposure to work-related violence and other trauma, and the prevalence of lifetime and current posttraumatic stress disorder (PTSD) among female street-based sex workers. It also investigates associations between current PTSD symptoms and: demographic characteristics, psychiatric comorbidity, injecting and sex risk beha...

To examine the characteristics of deaths in Australia where opioids, cocaine or amphetamines were mentioned, taking into account changes in the use and availability of these drugs in recent years. Data were analysed from the Australian Bureau of Statistics and Causes of Death dataset between 1997 and 2002 on all deaths in which cocaine, amphetamine...

Previous research has found that female injecting drug users (IDU) are younger and more likely to be involved in risky behaviours such as needle sharing and sex work than male IDU. Aboriginal female drug users, in particular, are over-represented in IDU and prison populations. These factors place female IDU at increased risk of health problems and...

Background This paper examines the differences in demographics, drug use patterns and self reported risk behaviours between regular injecting drug users (IDU) who report engaging in sex work for money or drugs and regular injecting drug users who do not. Methods Cross sectional data collected from regular IDU interviewed as part of the New South W...

To assess the effect of a restriction on publicly subsidised temazepam 10 mg capsules upon the injection of benzodiazepines by injecting drug users (IDUs). Cross-sectional study of regular IDUs targeting periods before and after the policy change. Analysis of prescription data, including time-series analysis. Drug services in the capital cities of...

The aim of this study was to examine changes in drug use patterns among groups of injecting drug users (IDU) who remained in the drug market during a period of reduced heroin availability in NSW, Australia. Cross-sectional data collected from regular IDU interviewed as part of the NSW Illicit Drug Reporting System (IDRS) between 1996-2003 were anal...

The Illicit Drug Reporting System (IDRS) is a national illicit drug monitoring system intended to serve as a strategic early warning system, identifying emerging trends of local and national concern in illicit drug markets. The IDRS consists of three components: interviews with injecting drug users (IDU); interviews with key informants (KIs), profe...

The Illicit Drug Reporting System (IDRS) monitors illicit drug markets across Australia. The IDRS consists of three components: (1) interviews with injecting drug users (IDU); (2) interviews with key informants, professionals who have regular contact with illicit drug users through their work; and (3) analysis and examination of indicator data sour...