Jason P. Connor’s research while affiliated with The University of Queensland and other places

Introduction Preliminary evidence supports the use of patient‐reported outcome measures (PROM) and feedback for enhancing client outcomes in alcohol and other drug (AOD) treatment. However, successful implementation remains challenging. This mixed‐methods study applied the Consolidated Framework for Implementation Research (CFIR) framework to examine inner setting and staff characteristics that act as barriers and facilitators to the implementation of PROMs in AOD treatment. Methods To understand CFIR‐informed barriers and facilitators to implement PROMs in AOD treatment, qualitative interviews were conducted with N = 23 AOD counsellors. A separate quantitative survey was conducted with N = 108 AOD counsellors. Results Four qualitative themes emerged: (i) PROMs and feedback are valuable to AOD treatment; (ii) counsellor resistance towards PROMs and feedback is a barrier to successful implementation; (iii) competing interests and logistical issues are barriers to the implementation of PROMs and feedback; and (iv) PROMs are a burden to clients that may serve to disengage them from treatment. Survey results indicated a positive association between leadership support (CFIR inner setting construct) and counsellor knowledge and beliefs regarding PROMs and feedback (CFIR staff characteristics construct; β = 0.35, 95% CI [0.13, 0.60]). Findings demonstrated a positive association between available PROMs resources (CFIR inner setting construct) and both knowledge and beliefs regarding PROMs and feedback ( β = 0.31, 95% CI [0.14, 0.48]) and self‐efficacy to implement PROMs and feedback (CFIR staff characteristics construct; β = 0.18, 95% CI [0.04, 0.32]). Discussion and Conclusions Findings point to the critical need to adopt a whole‐of‐organisation approach to foster buy‐in for PROMs and feedback to support successful implementation.

Background Opioid medications are important for pain management, but many patients progress to unsafe medication use. With few personalized and accessible behavioral treatment options to reduce potential opioid-related harm, new and innovative patient-centered approaches are urgently needed to fill this gap. Objective This study involved the first phase of co-designing a digital brief intervention to reduce the risk of opioid-related harm by investigating the lived experience of chronic noncancer pain (CNCP) in treatment-seeking patients, with a particular focus on opioid therapy experiences. Methods Eligible patients were those aged between 18 and 70 years with CNCP at a clinically significant level of intensity (a score of ≥4 of 10). Purposive sampling was used to engage patients on public hospital waitlists via mail or through the treating medical specialist. Participants (N=18; n=10 women; mean age 49.5 years, SD 11.50) completed semistructured telephone interviews. Interviews were transcribed verbatim, thematically analyzed using grounded theory, and member checked by patients. Results Eight overarching themes were found, listed in the order of their prominence from most to least prominent: limited treatment collaboration and partnership; limited biopsychosocial understanding of pain; continued opioid use when benefits do not outweigh harms; a trial-and-error approach to opioid use; cycles of hopefulness and hopelessness; diagnostic uncertainty; significant negative impacts tied to loss; and complexity of pain and opioid use journeys. Conclusions The findings of this study advance progress in co-designing digital brief interventions by actively engaging patient partners in their lived experiences of chronic pain and use of prescription opioid medications. The key recommendations proposed should guide the development of personalized solutions to address the complex care needs of patients with CNCP.

\\Background: Cannabis vaping, and co-use with cannabis smoking, can exacerbate the risks of developing respiratory diseases and cannabis dependence. This study aims to examine the mental health profiles and sociodemographic correlates of adults who vape cannabis and engage in dual cannabis use (vaping/ smoking), compared to those who smoke cannabis. \\Methods: The most recent, cross-sectional wave of the Population Assessment of Tobacco and Health Study (Wave 6) was used in this study. Data were restricted to adults (18 + years) who currently use cannabis (n = 7,178). Participants were classified as ‘cannabis smoking only,’ ‘cannabis vaping only,’ ‘dual-use,’ or ‘other cannabis use methods only.’ Multinomial logistic regression was used to examine the sociodemographic, internalizing and externalizing symptom factors of cannabis vaping and dual-use compared to cannabis smoking. \\Results: Over 56 % of participants currently smoked cannabis only, 9.1 % vaped cannabis only, while 20.0 % were engaging in dual-use. Adults experiencing severe externalizing symptoms (vs. mild symptoms) had higher odds of engaging in dual-use than smoking cannabis only (OR = 1.89, 99.5 %CI: 1.48, 2.40). Those with White racial background (vs. African-American background) (OR = 3.90, 99.5 %CI: 2.31, 6.58) and earning a higher income (vs. lower income) (OR = 2.56, 99.5 %CI: 1.79, 3.66) had higher odds of currently vaping cannabis only, compared to smoking cannabis only. \\Conclusions: Our study has identified that mental health plays a significant role in cannabis use patterns, particularly with externalizing symptoms which are related to aggression and diagnoses of attention deficit disorders. This highlights the need for healthcare and mental health providers to address mental health symptoms when managing adult cannabis use.

Background and aims: Social media vaping awareness campaigns can potentially reduce youth vaping prevalence but creating effective campaign materials is time-consuming and resource-intensive. Artificial Intelligence (AI) offers capabilities for rapidly producing materials at scale, however, little is known about how youth perceive AI-generated multimedia materials combining images and text. This two-phase qualitative study explores whether, and how, AI-generated vaping awareness materials can deter youth vaping.Methods: In Phase 1, two focus groups with adolescents in Queensland, Australia (n=10 total; mean age:16.3) evaluated 120 AI-generated materials created with an automated-AI framework (zero-shot prompting, single-prompt usage, automatic text-image integration). Participants sorted materials into “effective” or “ineffective” categories and suggested improvements. Using this feedback, 25 new materials were developed through an AI-co-design framework (few-shot prompting, iterative prompting, manual text-image integration). In Phase 2, semi-structured interviews with young adults (n=9, mean age:23) identified effective material characteristics. Both phases used inductive thematic analysis.Results: Participants in Phase 1 identified limitations in materials developed with an automated-AI framework: misaligned text-image combinations, artificial imagery, unrealistic vaping devices and inauthentic language. Phase 2 revealed six characteristics of effective materials: (1) visual appeal, (2) immediate consequences, (3) relevant to youth, (4) clear calls to action, (5) avoid ambiguity/fearmongering, and (6) tailor to diverse youth. Conclusions: AI can generate individual text and image components for health promotion campaigns, but automated-AI multimedia material development is unlikely to succeed. Effective implementation will require co-designing with young people to guide material refinement and design integration.

Introduction Routine outcome monitoring (ROM) and feedback is an evidence‐supported strategy for evaluating alcohol and other drug (AOD) treatment outcomes. However, the implementation of ROM and feedback into AOD services remains a significant challenge. Research aimed at understanding client perspectives on ROM and feedback is needed to facilitate successful implementation. This study examined experiences with and perceptions of ROM and feedback in a sample of clients receiving AOD treatment. Methods Interviews and online surveys were conducted with N = 26 people (13 male; M age = 36.12 years, SD = 10.29) enrolled in an AOD treatment program in Australia. Data analysis of the transcripts was guided by thematic analysis, while descriptive statistics were used to analyse quantitative survey data. Results Four major themes were identified in the qualitative data: (i) ROM and feedback is valuable to AOD treatment; (ii) clear and concise outcome measures with an integrated feedback loop are vital to reliable ROM; (iii) desire for visual and verbal feedback that highlights progress; and (iv) ROM and feedback can be emotionally challenging. Discussion and Conclusions Participants valued ROM when it was clearly integrated within AOD treatment and they received feedback on their responses. Potential facilitators to implementing and improving the provision of ROM and feedback in AOD treatment include: (i) a clear, treatment‐based rationale to foster client buy‐in for ROM and maximise AOD treatment benefit; (ii) brief outcome measure surveys; and (iii) graphical visualisations of ROM feedback.

Background and Aims Between 2018 and 2020, Australia implemented major policy changes to improve the quality and safety of opioid prescribing, with a specific focus on oxycodone. This study used wastewater‐based epidemiology to assess the efficacy of Australia's regulatory reforms by measuring change in consumption of oxycodone via exploratory analysis. Design, setting, participants, measurements Wastewater analysis data on oxycodone consumption was from the National Wastewater Drug Monitoring Program. The program captures data from more than 50 wastewater treatment plant catchments across Australia, equivalent to more than 50% of the national population. Geographic trend analyses were conducted for both major cities and regional areas within all states and territories of Australia over a 6‐year period between 2017 and 2023. Findings Oxycodone consumption showed a statistically significant increase nationally from 78 mg/day/1000 people (95% confidence interval [CI] = 71, 84) in 2017 to 120 mg/day/1000 people in August 2019 (95% CI = 110, 120), an increase of 52% (95% CI = 42, 62, P < 0.0001). From August 2019 to December 2020, there was a statistically significant decrease from 120 to 65 mg/day/1000 people (95% CI = 60, 71), a decrease of 45% (95% CI = 40, 51), followed by a modest 2.4% increase to the end of the study period in April 2023 (95% CI [2.0,2.7]). Conclusions A 45% reduction in oxycodone consumption in Australia from 2019 to 2020 coincided with national policy changes that aimed to reduce consumption of prescription opioids. The overall declining trend in consumption was suggestive of the effectiveness of national interventions in reducing pharmaceutical opioid use. Wastewater‐based epidemiology provides an effective approach for assessing the effectiveness of controlled substances policy changes.