Publications by authors named "Rebecca McKetin"

106 Publications

N-acetylcysteine (NAC) for methamphetamine dependence: A randomised controlled trial.

EClinicalMedicine 2021 Aug 13;38:101005. Epub 2021 Jul 13.

Deakin University, School of Medicine, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia.

Background: Methamphetamine dependence is a significant global health concern for which there are no approved medications. The cysteine prodrug, N-acetylcysteine (NAC), has been found to ameliorate glutamate dysregulation in addiction, and to reduce craving for methamphetamine and other drugs. We evaluated the efficacy and safety of NAC as a pharmacotherapy for methamphetamine dependence.

Methods: A parallel double-blind randomised placebo-controlled trial of people dependent on methamphetamine recruited from Geelong, Melbourne and Wollongong, Australia, between July 2018 and December 2019. Participants were randomised to receive either 12 weeks of oral NAC (2400 mg/day) or matched placebo, delivered as a take-home medication. The primary outcome was methamphetamine use, measured in two ways: (a) change in days of use in the past 4 weeks from baseline to weeks 4, 8 and 12, assessed using the Timeline Followback; and (b) methamphetamine-positive oral fluid samples taken weekly. Analyses were intention-to-treat and based on imputed data. Secondary outcomes were craving, severity of dependence, withdrawal severity and psychiatric symptoms (depression, suicidality, hostility and psychotic symptoms). Significance levels were  < 0.025 for primary outcomes and  < 0.01 for secondary outcomes. Adverse events were compared between groups by system organ class. The study was prospectively registered, ACTRN12618000366257.

Results: Participants ( = 153; 59% male, mean [SD] age 38 [8]) were randomised to placebo ( = 77) or NAC ( = 76). Both groups had a median (IQR) of 24 (15-28) days of methamphetamine use in the 4 weeks prior to baseline. Both groups significantly reduced methamphetamine use (mean [SE] reduction of 7.3 [1.2]) days for placebo, 6.8 [1.2] for NAC) but NAC did not reduce days of methamphetamine use more than placebo (group difference of 0.5 days, 97.5% CI -3.4-4.3). There was no significant effect of NAC on methamphetamine-positive oral fluid samples (placebo 79%, NAC 76%; mean difference -2.6, 97.5% CI -12.6-7.4). NAC did not significantly reduce craving, severity of dependence, withdrawal, suicidality, depression, hostility or psychotic symptoms relative to placebo. Adverse events did not differ significantly between placebo and NAC groups.

Interpretation: These findings suggest that take-home oral NAC has no significant effect on methamphetamine use or most clinically related outcomes amongst people who are dependent on the drug.
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http://dx.doi.org/10.1016/j.eclinm.2021.101005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283342PMC
August 2021

Methamphetamine use and psychotic symptoms: findings from a New Zealand longitudinal birth cohort.

Psychol Med 2021 Jun 17:1-8. Epub 2021 Jun 17.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Background: This study examined the association between methamphetamine use and psychotic symptoms in a New Zealand general population birth cohort (n = 1265 at birth).

Methods: At age 18, 21, 25, 30, and 35, participants reported on their methamphetamine use and psychotic symptoms in the period since the previous interview. Generalized estimating equations modelled the association between methamphetamine use and psychotic symptoms (percentage reporting any symptom, and number of symptoms per participant). Confounding factors included childhood individual characteristics, family socioeconomic circumstances and family functioning. Long term effects of methamphetamine use on psychotic symptoms were assessed by comparing the incidence of psychotic symptoms at age 30-35 for those with and without a history of methamphetamine use prior to age 30.

Results: After adjusting for confounding factors and time-varying covariate factors including concurrent cannabis use, methamphetamine use was associated with a modest increase in psychosis risk over five waves of data (adjusted odds ratio (OR) 1.33, 95% confidence interval (CI) 1.03-1.72 for the percentage measure; and IRR 1.24, 95% CI 1.02-1.50 for the symptom count measure). The increased risk of psychotic symptoms was concentrated among participants who had used at least weekly at any point (adjusted OR 2.85, 95% CI 1.21-6.69). Use of methamphetamine less than weekly was not associated with increased psychosis risk. We found no evidence for a persistent vulnerability to psychosis in the absence of continuing methamphetamine use.

Conclusion: Methamphetamine use is associated with increased risk of psychotic symptoms in the general population. Increased risk is chiefly confined to people who ever used regularly (at least weekly), and recently.
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http://dx.doi.org/10.1017/S0033291721002415DOI Listing
June 2021

Cognitive insight, medication adherence and methamphetamine cessation in people enrolled in a pharmacotherapy trial for methamphetamine use.

J Subst Abuse Treat 2021 May 15;130:108473. Epub 2021 May 15.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Background: The current study examined correlates of cognitive insight in people enrolled in a methamphetamine pharmacotherapy trial; whether cognitive insight at the start of the trial predicted medication adherence and reductions in methamphetamine use during the trial; and, whether insight would remain stable over the trial or improve with reductions in methamphetamine use.

Methods: A subset of people enrolled in a 12-week randomised placebo-controlled pharmacotherapy trial for methamphetamine dependence completed the Beck Cognitive Insight Scale, comprising subscales for Self-Reflection and Self-Certainty, at baseline (n = 152) and at week 12 (n = 79). Medication adherence was expressed as the percentage of non-missed doses measured using eCAP™ technology. Methamphetamine use days were assessed using the Timeline Followback.

Results: At baseline, greater Self-Reflection was correlated with more severe methamphetamine withdrawal, and hostility, whereas Self-Certainty was correlated with less education and longer duration of methamphetamine use. No relationship was found between BCIS subscales at baseline and medication adherence (Self-Reflection b[SE] = -0.73 [0.43] p = .09; Self-Certainty b[SE] = -0.31 [0.48] p = .52,). Neither BCIS subscale was predictive of reduced methamphetamine use at 12 weeks (Self-Reflection b[SE] = 0.001 [0.01] p = .95 Self-Certainty b[SE] = -0.003 [0.01], p = .74). Self-Reflection decreased over the trial (t = 3.42, p = .001) but this was unrelated to change in methamphetamine use (Self-Reflection, b[SE] = -1.68 [1.16] p = .15) Change in methamphetamine use was found to be a significant predictor of Self-Certainty at 12 weeks (b [SE] = -2.71 [1.16] p = .02).

Conclusions: We found no evidence that cognitive insight predicted medication adherence or methamphetamine reduction in people engaged in this trial. Ongoing or increased methamphetamine use predicted increased Self-Certainty at 12 weeks.
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http://dx.doi.org/10.1016/j.jsat.2021.108473DOI Listing
May 2021

Household surveys and the case of the Australian methamphetamine situation.

Authors:
Rebecca McKetin

Addiction 2021 Mar 22. Epub 2021 Mar 22.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

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http://dx.doi.org/10.1111/add.15480DOI Listing
March 2021

Corrigendum to 'Is there a discrete negative symptom dimension in people who use methamphetamine?'Comprehensive Psychiatry 93 (2019) 27-32.

Compr Psychiatry 2021 Feb 26:152231. Epub 2021 Feb 26.

National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, NSW 2031, Australia.

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http://dx.doi.org/10.1016/j.comppsych.2021.152231DOI Listing
February 2021

Trends in treatment episodes for methamphetamine smoking and injecting in Australia, 2003-2019.

Drug Alcohol Rev 2021 Feb 28. Epub 2021 Feb 28.

National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.

Introduction: We examined trends in Australian treatment episodes for smoking and injecting methamphetamine from 2003 to 2019.

Methods: Data from the Alcohol and Other Drug Treatment National Minimum Data Set, where amphetamines were the principal drug of concern, were analysed from 2003 to 2019. Rates were calculated per 100 000 population aged 10-100 years. Joinpoint software was used to identify changepoints and estimate the annual percentage change (APC) in the rate of treatment episodes. Treatment episode characteristics were compared for smoking versus injecting in 2019.

Results: The rate of treatment episodes for methamphetamine increased from 77 to 262 per 100 000 population between 2003 and 2019 (average APC 8%, P < 0.001), this being due to treatment episodes for smoking methamphetamine (average APC 32%, P < 0.001) with no significant increase in treatment episodes for injecting methamphetamine (average APC 3%). Treatment episodes for smoking increased sharply from 2003 to 2008 (APC 72%, P < 0.001) and again from 2010 to 2016 (APC 46%, P < 0.001), this upward trend being attenuated between 2016 and 2019 (APC 7%, P = 0.012). Treatment episodes for methamphetamine smoking (cf. injecting) involved younger clients (median age 30 vs. 35 years, P < 0.001) who were more likely to receive assessment or case management only (37% vs. 29%, P < 0.001).

Discussion And Conclusions: Increased methamphetamine treatment episodes in Australia since 2003 are due mostly to smoking the drug, this occurring among younger cohort who receive less substantive treatment than clients who inject methamphetamine.
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http://dx.doi.org/10.1111/dar.13258DOI Listing
February 2021

A latent class analysis of psychiatric symptom profiles associated with past-month methamphetamine use.

Psychiatry Res 2021 04 27;298:113760. Epub 2021 Jan 27.

National Drug and Alcohol Research Centre, University of New South Wales, 22 King Street, Randwick, NSW 2031, Australia.

We explored latent psychiatric symptom profiles associated with methamphetamine use, and examined how these corresponded to diagnoses of schizophrenia (SZ) and methamphetamine-associated psychosis (MAP). We assessed psychiatric symptoms among 160 people who had used methamphetamine in the past month. Psychiatric symptoms were defined as a score of 4+ on Brief Psychiatric Rating Scale (BPRS) items. Diagnoses were made using the Composite International Diagnostic Interview (CIDI). Participants were defined as having MAP if they met symptom criteria for SZ, but symptoms were considered to be always the result of substance use. Latent class analysis identified three classes. Class one (44% of participants) had a low probability of most BPRS symptoms; 4% met criteria for SZ, 51% for MAP. Class two (31% of participants) had a higher probability hallucinations and suspiciousness (37-46%); 72% met criteria for MAP, and 7% for SZ. Class three (25% of participants) had the highest probability for all positive psychotic symptoms (hallucinations, suspiciousness, grandiosity, unusual thought content; 32-82%), and reported activation, conceptual disorganisation, and tension (35% met criteria for SZ and 17% for MAP). We found three distinct classes of psychiatric symptom profiles, two of which showed partial alignment with diagnostic constructs of SZ and MAP.
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http://dx.doi.org/10.1016/j.psychres.2021.113760DOI Listing
April 2021

A prospective cohort of people who use methamphetamine in Melbourne and non-metropolitan Victoria, Australia: Baseline characteristics and correlates of methamphetamine dependence.

Drug Alcohol Rev 2020 Nov 11. Epub 2020 Nov 11.

Burnet Institute, Melbourne, Australia.

Introduction And Aims: Limited research has investigated methamphetamine use and related harms in rural and regional Australia. We investigated whether people who used methamphetamine in non-metropolitan Victoria differed in their sociodemographics and were more likely to be methamphetamine-dependent than those recruited in Melbourne.

Design And Methods: We used baseline data from an ongoing prospective cohort study, 'VMAX'. Participants were recruited from Melbourne and three non-metropolitan Victorian regions. Sequential multivariable logistic regression of nested models assessed unadjusted and adjusted associations between residential locations and methamphetamine dependence.

Results: The sample mostly (77%) comprised people who used methamphetamine via non-injecting means (N = 744). Thirty-nine percent were female. Melbourne-based participants were less likely than non-metropolitan participants to identify as Aboriginal and Torres Strait Islander, be heterosexual, have children and be unemployed. More frequent methamphetamine use (adjusted odds ratio 1.22, 95% confidence interval 1.12-1.34) and using crystal methamphetamine versus 'speed' powder (adjusted odds ratio 2.38, 95% confidence interval 1.26-3.64) were independently (P < 0.05) associated with being classified as methamphetamine-dependent. A significantly higher percentage of participants in every non-metropolitan region were classified as methamphetamine-dependent vs. those in Melbourne, but this relationship was attenuated when adjusting for methamphetamine use frequency and primary form used. Despite 65% of participants being classified as methamphetamine-dependent, less than half had recently (past year) accessed any professional support for methamphetamine, with minimal variation by recruitment location.

Discussions And Conclusions: VMAX participants in non-metropolitan Victoria were more likely to be methamphetamine-dependent than those living in Melbourne. Unmet need for professional support appears to exist among people using methamphetamine across the state, regardless of geographical location.
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http://dx.doi.org/10.1111/dar.13194DOI Listing
November 2020

When the evidence is not enough: is it time to rethink trial design?

Addiction 2021 04 6;116(4):711-712. Epub 2020 Oct 6.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

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http://dx.doi.org/10.1111/add.15273DOI Listing
April 2021

Clinical and demographic characteristics of people who smoke versus inject crystalline methamphetamine in Australia: Findings from a pharmacotherapy trial.

Drug Alcohol Rev 2020 Oct 6. Epub 2020 Oct 6.

Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia.

Introduction And Aims: There has been a rapid increase in smoking crystalline methamphetamine in Australia. We compare the clinical and demographic characteristics of those who smoke versus inject the drug in a cohort of people who use methamphetamine.

Design And Methods: Participants (N = 151) were dependent on methamphetamine, aged 18-60 years, enrolled in a pharmacotherapy trial for methamphetamine dependence, and reported either injecting (n = 54) or smoking (n = 97) methamphetamine. Measures included the Timeline Followback, Severity of Dependence Scale, Amphetamine Withdrawal Questionnaire, Craving Experience Questionnaire and the Brief Psychiatric Rating Scale (symptoms of depression, hostility, psychosis and suicidality). Simultaneous regression was used to identify independent demographic correlates of smoking methamphetamine and to compare the clinical characteristics of participants who smoked versus injected.

Results: Compared to participants who injected methamphetamine, those who smoked methamphetamine were younger and less likely to be unemployed, have a prison history or live alone. Participants who smoked methamphetamine used methamphetamine on more days in the past 4 weeks than participants who injected methamphetamine (26 vs. 19 days, P = 0.001); they did not differ significantly in their severity of methamphetamine dependence, withdrawal, craving or psychiatric symptoms (P > 0.05). After adjustment for demographic differences, participants who smoked had lower craving [b (SE) = -1.1 (0.5), P = 0.021] and were less likely to report psychotic symptoms [b (SE) = -1.8 (0.7), P = 0.013] or antidepressant use [b (SE) = -1.1 (0.5), P = 0.022].

Discussion And Conclusions: Smoking crystalline methamphetamine is associated with a younger less marginalised demographic profile than injecting methamphetamine, but a similarly severe clinical profile.
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http://dx.doi.org/10.1111/dar.13183DOI Listing
October 2020

The contribution of methamphetamine use to crime: Evidence from Australian longitudinal data.

Drug Alcohol Depend 2020 11 30;216:108262. Epub 2020 Aug 30.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Background: To quantify the extent to which methamphetamine use is associated with increases in crime net of any premorbid risk of criminality among people who use the drug.

Methods: Four one-month data panels from 469 participants dependent on methamphetamine were drawn from the MATES cohort (N = 501). Odds ratios for within-person effects were extracted from a random intercept logistic regression model for crime during periods of methamphetamine use compared to no use. Effects were adjusted for time-varying measures of age, other substance use, and socio-economic disadvantage (income, unemployment and unstable accommodation). Involvement in crime (property crime, drug dealing, fraud, violent crime) and days of methamphetamine in the past month were assessed using the Opiate Treatment Index.

Results: Crime was more likely during months when participants used methamphetamine compared to when they did not (OR 13.2 95% CI 8.5-20.6; AOR 4.7 95% CI 2.8-8.0), this reflecting more property crime (OR 10.6 95% CI 6.3-18.0; AOR 5.5 95% CI 2.8-10.8), violent crime (OR 8.2 95% CI 4.2-15.9; AOR 3.4 95% CI 1.5-8.0), fraud (OR 3.4, 95% CI 2.0-5.8; AOR 1.7 95% CI 0.8-3.3) and dealing drugs (OR 18.2 95% CI 10.2-32.5; AOR 5.9 95% CI 3.0-11.9), although the adjusted relationship for fraud was not significant. Effects were dose related.

Conclusions: The use of methamphetamine was associated with significant increases in crime beyond premorbid risk for criminality. Crime is a likely social consequence of methamphetamine use and efforts are needed to reduce this impact.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108262DOI Listing
November 2020

The Short Barriers Questionnaire (SBQ): Validity, factor structure and correlates in an out-of-treatment sample of people dependent on methamphetamine.

J Subst Abuse Treat 2020 09 11;116:108029. Epub 2020 May 11.

Longitudinal and Lifecourse Studies, Australian Institute of Family Studies, Southbank, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia.

Introduction And Aims: We validate a brief questionnaire to assess barriers to help-seeking for illicit substance use, and explore the factor structure and correlates of scale scores, among people dependent on methamphetamine.

Design And Methods: We administered a modified version of 27 items from the Barriers Questionnaire to 145 adults who had used methamphetamine in the past month and who screened positive for methamphetamine dependence on the Mini International Neuropsychiatric Interview. We used an exploratory factor analysis to identify the scale's dimensions. We examined correlates of the scale scores, their internal consistency, and their concurrent validity against help-seeking intentions on the General Help Seeking Questionnaire (GHSQ).

Results: A three factor model (χ = 308.6 ; RMSEA 0.08 [95% CI 0.06-0.09]; comparative fit index = 0.92) identified low perceived need for treatment (9 items), stigma (6 items), and apprehension about treatment (7 items) with Eigenvalues of 5.7, 3.8 and 2.3 respectively. The final 22-item scale had good internal consistency (Cronbach's alpha 0.83) and correlated negatively with help-seeking intentions on the GHSQ (r = -0.24 p < .001) and positively with the GHSQ item, "I would not seek help from anyone" (r = 0.38 p < .001). The scale dimensions of low perceived need, stigma, and apprehension had adequate to good internal consistency (Cronbach's alpha of 0.83, 0.79 and 0.69 respectively) but only low perceived need for treatment correlated significantly with the GHSQ scores. Low perceived need was also related to less severe methamphetamine dependence, not having children, and not having received professional help for methamphetamine use. Stigma was associated with specific demographics (being employed, having children), polysubstance use, and having attended sessions with a counselor or psychologist. Apprehension was associated with poor mental health, more severe substance use, being a woman, and having received help from an ambulance.

Discussion And Conclusions: This short version of the Barriers Questionnaire (the Short Barriers Questionnaire; SBQ) is an internally consistent and valid scale for assessing low perceived need for treatment among people who use methamphetamine. Further work is needed to capture and validate other barriers to help-seeking for this population.
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http://dx.doi.org/10.1016/j.jsat.2020.108029DOI Listing
September 2020

Insight in substance use disorder: A systematic review of the literature.

Addict Behav 2020 12 13;111:106549. Epub 2020 Jul 13.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Insight refers to a person's understanding of themselves and the world around them. Recent literature has explored people's insight into their substance use disorder (SUD) and how this is linked to treatment adherence, abstinence rates, and comorbid mental health symptoms. The aim of this systematic review was to synthesise and critically examine the existing literature on insight in SUD. Five academic databases (Medline, PsychINFO, SCOPUS, CINAHL, Web of Science) were searched for key terms related to insight and substance use. Included studies were on humans aged 18 years or over with SUD that examined the relationship between substance use and insight using a quantifiable measure of insight. Of 10,067 identified papers, 20 met the inclusion criteria, employing 13 different measures of insight. The most commonly used measure was the Hanil Alcohol Insight Scale (HAIS) which was the only measure designed for a substance use population and was specific to alcohol use. Based on a pooled sample from five studies (n = 585), 57% of participants had poor insight, 36% had fair insight, and 7% had good insight on the HAIS. Better insight was generally related to negative consequences from substance use, better treatment adherence and maintaining abstinence. Insight appears to be an important factor to consider within SUD. Exploring the most appropriate way to measure insight and assess its role in SUD has implications for intervention design, and engaging and maintaining people with SUD in treatment.
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http://dx.doi.org/10.1016/j.addbeh.2020.106549DOI Listing
December 2020

Survey methods and characteristics of a sample of Aboriginal and Torres Strait Islander and non-Indigenous people who have recently used methamphetamine: the NIMAC survey.

Drug Alcohol Rev 2020 09 22;39(6):646-655. Epub 2020 Jun 22.

Infectious Diseases Aboriginal Health Research, Aboriginal Health Equity Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.

Introduction And Aims: There is a need for detailed information on methamphetamine use in Aboriginal and Torres Strait Islander communities. We describe a national survey on methamphetamine use among Aboriginal and Torres Strait Islander people and non-Indigenous people.

Design And Methods: Participants aged 16 years or older who reported using methamphetamine in the past year were recruited for a cross-sectional survey through 10 Aboriginal Community Controlled Organisations. Surveys were completed anonymously on electronic tablets. Measures included the Australian Treatment Outcomes Profile, the Severity of Dependence Scale, subscales from Opiate Treatment Index and the Kessler 10. A Chronic Stress Scale was used to assess culturally situated chronic stress factors.

Results: Of the 734 participants, 416 (59%) were Aboriginal or Torres Strait Islander and 331 (45%) were female. In the previous year, most participants reported smoking (48.7%) or injecting (34%) methamphetamine and 17.4% reported daily use. Aboriginal and Torres Strait Islander people did not differ significantly from non-Indigenous participants on methamphetamine use patterns (age at first use, frequency of use, main mode of use, injecting risk, poly drug use). Aboriginal and Torres Strait Islander participants felt less able to access health care (32% vs. 48%, P < 0.001), including mental health services (19% vs. 29%, P < 0.002), were less likely to report a mental health diagnosis (50% vs. 60%, P < 0.002) and were more likely to turn to family for support (52% vs. 34%, P < 0.001).

Discussion And Conclusions: We recruited and surveyed a large sample of Aboriginal and Torres Strait Islander people from which we can derive detailed comparative data on methamphetamine use and related health service needs for Aboriginal and Torres Strait Islander and non-Indigenous Australians.
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http://dx.doi.org/10.1111/dar.13085DOI Listing
September 2020

Survey methods and characteristics of a sample of Aboriginal and Torres Strait Islander and non-Indigenous people who have recently used methamphetamine: the NIMAC survey.

Drug Alcohol Rev 2020 09 22;39(6):646-655. Epub 2020 Jun 22.

Infectious Diseases Aboriginal Health Research, Aboriginal Health Equity Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.

Introduction And Aims: There is a need for detailed information on methamphetamine use in Aboriginal and Torres Strait Islander communities. We describe a national survey on methamphetamine use among Aboriginal and Torres Strait Islander people and non-Indigenous people.

Design And Methods: Participants aged 16 years or older who reported using methamphetamine in the past year were recruited for a cross-sectional survey through 10 Aboriginal Community Controlled Organisations. Surveys were completed anonymously on electronic tablets. Measures included the Australian Treatment Outcomes Profile, the Severity of Dependence Scale, subscales from Opiate Treatment Index and the Kessler 10. A Chronic Stress Scale was used to assess culturally situated chronic stress factors.

Results: Of the 734 participants, 416 (59%) were Aboriginal or Torres Strait Islander and 331 (45%) were female. In the previous year, most participants reported smoking (48.7%) or injecting (34%) methamphetamine and 17.4% reported daily use. Aboriginal and Torres Strait Islander people did not differ significantly from non-Indigenous participants on methamphetamine use patterns (age at first use, frequency of use, main mode of use, injecting risk, poly drug use). Aboriginal and Torres Strait Islander participants felt less able to access health care (32% vs. 48%, P < 0.001), including mental health services (19% vs. 29%, P < 0.002), were less likely to report a mental health diagnosis (50% vs. 60%, P < 0.002) and were more likely to turn to family for support (52% vs. 34%, P < 0.001).

Discussion And Conclusions: We recruited and surveyed a large sample of Aboriginal and Torres Strait Islander people from which we can derive detailed comparative data on methamphetamine use and related health service needs for Aboriginal and Torres Strait Islander and non-Indigenous Australians.
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http://dx.doi.org/10.1111/dar.13085DOI Listing
September 2020

Methamphetamine use, health and criminal justice system outcomes: A systematic review.

Drug Alcohol Rev 2020 07 24;39(5):505-518. Epub 2020 Mar 24.

Centre for Health Services Research, School of Population and Global Health, University of Western Australia, Perth, Australia.

Issues: Methamphetamine use is a problem for health and criminal justice systems (CJS) worldwide. Methamphetamine is used at higher rates in CJS-involved populations than the general community. This systematic review synthesises the evidence for health and CJS outcomes post-CJS contact for people reporting pre-CJS methamphetamine use.

Approach: Academic databases were searched to identify peer-reviewed original studies using a longitudinal design that investigated associations between pre-CJS methamphetamine use and health and criminal justice outcomes after CJS contact. Identified studies were screened in two stages: title and abstract, then full-text. Data from the included studies were extracted and analysed. Results are reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Key Findings: Nine studies met the inclusion criteria: five investigated health and four investigated CJS outcomes. Pre-CJS methamphetamine use was associated with subsequent hospitalisation for drug-induced psychosis, increased risk of recidivism and higher crime costs after CJS contact. Pre-CJS methamphetamine use was not associated with subsequent hospitalisation for non-drug induced psychosis or post-release mortality.

Implications: Current evidence suggests that pre-CJS contact methamphetamine use increases the risk of subsequent drug-induced psychosis and recidivism. There is a need for more longitudinal research that measures mediators and moderators of health and criminal justice outcomes after CJS contact, to inform targeted prevention.

Conclusion: Methamphetamine use is a major problem that is contributing to serious mental illness and recidivism among CJS-involved populations. Prioritising treatment during CJS contact is recommended. Further research to identify key opportunities during health service and CJS contact for intervention is needed.
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http://dx.doi.org/10.1111/dar.13062DOI Listing
July 2020

Direction of the relationship between methamphetamine use and positive psychotic symptoms in regular methamphetamine users: evidence from a prospective cohort study.

Br J Psychiatry 2020 Jan 17:1-7. Epub 2020 Jan 17.

Professor and Consultant Physician in Internal Medicine and Addiction Medicine, Centre for Youth Substance Abuse Research, School of Psychology, The University of Queensland; and Disciplines of Psychiatry and Addiction Medicine, Faculty of Medicine, University of Sydney, Australia.

Background: Methamphetamine has been consistently associated with positive psychotic symptoms, but little is known about whether the reverse also occurs.

Aims: This study determined whether the relationship between methamphetamine use and positive psychotic symptoms is bidirectional over 12 months. The impact of lifetime psychotic disorders and methamphetamine dependence on these relationships was also examined.

Method: A total of 201 regular (at least monthly) primary methamphetamine users were recruited from free needle and syringe programmes in three Australian cities. Data on the frequency of methamphetamine and other drug use (from Timeline Followback inteviews) and the severity of positive psychotic symptoms (using the Brief Psychiatric Rating Scale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews (mean of 9.14/11 (s.d. = 3.16) follow-ups completed). Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders.

Results: The mean age of participants was 31.71 years (s.d. = 8.19) and 39% (n = 77) were women. At baseline 55% (n = 110) were dependent on methamphetamine and 51% (n = 102) had a lifetime psychotic disorder. Cross-lagged dynamic panel models found a significant bidirectional relationship between psychotic symptoms and methamphetamine use (Comparative Fit Index (CFI) = 0.94, standardised root mean square residual (SRMR) = 0.05, root mean square error of approximation (RMSEA) = 0.05, 95% CI 0.04-0.06). The magnitude of the relationship in each direction was similar, and the presence of methamphetamine dependence or a lifetime psychotic disorder did not have an impact on results.

Conclusions: A dynamic, bidirectional relationship between methamphetamine and psychotic symptoms of similar magnitude in each direction was found over 1 year. This suggests integrated treatments that target methamphetamine, psychotic symptoms and their interrelationship may be of most benefit.
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http://dx.doi.org/10.1192/bjp.2019.263DOI Listing
January 2020

Methamphetamine use and violence: Findings from a longitudinal birth cohort.

Drug Alcohol Depend 2020 02 23;207:107826. Epub 2019 Dec 23.

Department of Psychological Medicine, University of Otago Wellington, New Zealand.

Aims: Evidence linking illicit methamphetamine use to violence perpetration and victimisation comes primarily from cross-sectional studies. These associations have not previously been studied in a longitudinal general population sample.

Design: Longitudinal birth cohort.

Setting And Participants: General population sample (n = 1265) born in Christchurch, New Zealand in 1977.

Measurements: Participants were asked at age 21, 25, 30 and 35 about their frequency of methamphetamine use, and violence perpetration or victimization since the last interview. Violence was measured both in general, and within intimate partner relationships in particular. Logistic generalised estimating equations modelled the association between methamphetamine exposure and violence outcomes within each age period, adjusting for confounding factors and time-dynamic covariate factors. The dose-response profiles were explored via associations between heaviest methamphetamine use frequency from age 18-35 and violence outcomes in that period.

Findings: 28 % of participants reported using methamphetamine at least once between age 18 and 35. Compared to no use, a history of any methamphetamine use in each age period was associated with an increased adjusted risk of violence perpetration (OR 1.60; 1.01-2.54), intimate partner violence perpetration (OR 1.55, 95 % CI 1.04-2.30), and violence victimization (OR 1.57, 1.00-2.47). Evidence for an association with intimate partner violence victimization was inconclusive (OR 1.09, 0.80-1.49). There was a dose response relationship whereby those who had used methamphetamine at least weekly at any time from age 18-35 had substantially elevated adjusted odds of violence involvement compared to people who used but less often, or had never used.

Conclusions: Methamphetamine use is an independent risk factor for violence perpetration and victimisation in the general population.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.107826DOI Listing
February 2020

Emotion Recognition and Impulsive Choice in Relation to Methamphetamine Use and Psychosis Symptoms.

Front Psychiatry 2019 13;10:889. Epub 2019 Dec 13.

Turning Point, Eastern Health, Richmond, VIC, Australia.

The cognitive profiles of people with methamphetamine use disorder are characterized by impulsivity and impairment in social cognition. However, previous studies have not fully accounted for the presence and impact of co-occurring mental health problems on these domains. For instance, psychotic symptoms are commonly experienced by people who use methamphetamine and may influence cognitive performance. We aimed to examine decision making and emotion recognition in individuals with methamphetamine use, compared to healthy controls, to map the nature and degree of impairments in relation to the presence of psychotic symptoms. In this naturalistic study, we assessed reward-based decision-making and facial emotion recognition across three groups, methamphetamine-using individuals with (MAP, n = 29) and without psychotic symptoms (MNP, n = 70), and healthy controls (HC, n = 32). In comparison to healthy controls, methamphetamine-using individuals presented with poorer performance on tasks of decision-making and emotion recognition. Emotion recognition was impaired across all methamphetamine-using individuals, with significantly poorer recognition of anger and sadness in those with psychotic symptoms. We found specific impairments in emotion recognition in relation to psychotic symptoms in people who use methamphetamine regularly. This builds on previous evidence on cognitive profiles in methamphetamine use disorder, highlighting the need to assess co-morbid mental health and psychotic symptoms. Our finding that methamphetamine-using individuals with psychotic symptoms present with particular difficulties recognizing anger has implications for frontline clinicians.
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http://dx.doi.org/10.3389/fpsyt.2019.00889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923220PMC
December 2019

Better Health Choices: Feasability and preliminary effectiveness of a peer delivered healthy lifestyle intervention in a community mental health setting.

Addict Behav 2020 04 4;103:106249. Epub 2019 Dec 4.

Neami National, Victoria, Australia.

Background: To reduce smoking and improve other health behaviours of people living with severe mental illness, healthy lifestyle interventions have been recommended. One approach to improving the availability of these types of interventions is to utilise the mental health peer workforce. The current study aimed to evaluate the feasibility of peer-workers facilitating a telephone delivered healthy lifestyle intervention within community based mental health settings. The study also examined preliminary outcomes of the intervention.

Methods: The study was conducted as a randomised controlled feasibility trial. In addition to treatment as usual, participants randomised to the Treatment Condition were offered BHC. This was an 8-session telephone delivered coaching intervention that encouraged participants to decrease their smoking, increase their intake of fruit and vegetables, and reduce their leisure screen time. Participants in the waitlist Control Condition continued to complete treatment as usual. All participants were engaged with Neami National, an Australian community mental health organisation. Peer-workers were also current employees of Neami National.

Results: Forty-three participants were recruited. The average number of sessions completed by participants in the Treatment Condition was 5.7 (SD = 2.6; out of 8-sessions). Seventeen participants (77%) completed at least half of the sessions, and nine participants (40%) completed all eight sessions. Participant satisfaction was high, with all participants followed up rating the quality of the service they received as 'good' or 'excellent'. When compared to the Control Condition, people in the Treatment Condition demonstrated greater treatment effects on smoking and leisure screen time. There was only a negligible effect on servings of fruit and vegetable.

Conclusions: Results were promising regarding the feasibility of peer-workers delivering BHC. Good retention rates and high consumer satisfaction ratings in the Treatment Condition demonstrated that peer-workers were capable of delivering the intervention to the extent that consumers found it beneficial. The current results suggest that a sufficiently powered, peer delivered randomised controlled trial of BHC is warranted.

Study Registration: Australian New Zealand Clinical Trials Registry (ANZCTR; Trial ID ACTRN123615000564550).
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April 2020

Mental health outcomes associated with of the use of amphetamines: A systematic review and meta-analysis.

EClinicalMedicine 2019 Nov 17;16:81-97. Epub 2019 Oct 17.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Background: The use of amphetamines is a global public health concern. We summarise global data on use of amphetamines and mental health outcomes.

Methods: A systematic review and meta-analysis (CRD 42017081893). We searched Medline, EMBASE, PsycInfo for methamphetamine or amphetamine combined with psychosis, violence, suicidality, depression or anxiety. Included studies were human empirical cross-sectional surveys, case-control studies, cohort studies and randomised controlled trials that assessed the association between methamphetamine and one of the mental health outcomes. Random effects meta-analysis was used to pool results for any use of amphetamines and amphetamine use disorders.

Findings: 149 studies were eligible and 59 were included in meta-analyses. There was significant heterogeneity in effects. Evidence came mostly from cross-sectional studies. Any use of amphetamines was associated with higher odds of psychosis (odds ratio [OR] = 2.0, 95%CI 1.3-3.3), violence (OR = 2.2, 95%CI 1.2-4.1; adjusted OR [AOR] = 1.4, 95%CI 0.8-2.4), suicidality OR = 4.4, 95%CI 2.4-8.2; AOR = 1.7, 95%CI 1.0-2.9) and depression (OR = 1.6, 95%CI 1.1-2.2; AOR = 1.3, 95%CI 1.2-1.4). Having an amphetamine use disorder was associated with higher odds of psychosis (OR = 3.0, 95%CI 1.9-4.8; AOR = 2.4, 95%CI 1.6-3.5), violence (OR = 6.2, 95%CI 3.1-12.3), and suicidality (OR = 2.3, 95%CI 1.8-2.9; AOR = 1.5, 95%CI 1.3-1.8).

Interpretation: Methamphetamine use is an important risk factor for poor mental health. High quality population-level studies are needed to more accurately quantify this risk. Clinical responses to methamphetamine use need to address mental health harms.
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http://dx.doi.org/10.1016/j.eclinm.2019.09.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6890973PMC
November 2019

Mental health outcomes associated with of the use of amphetamines: A systematic review and meta-analysis.

EClinicalMedicine 2019 Nov 17;16:81-97. Epub 2019 Oct 17.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Background: The use of amphetamines is a global public health concern. We summarise global data on use of amphetamines and mental health outcomes.

Methods: A systematic review and meta-analysis (CRD 42017081893). We searched Medline, EMBASE, PsycInfo for methamphetamine or amphetamine combined with psychosis, violence, suicidality, depression or anxiety. Included studies were human empirical cross-sectional surveys, case-control studies, cohort studies and randomised controlled trials that assessed the association between methamphetamine and one of the mental health outcomes. Random effects meta-analysis was used to pool results for any use of amphetamines and amphetamine use disorders.

Findings: 149 studies were eligible and 59 were included in meta-analyses. There was significant heterogeneity in effects. Evidence came mostly from cross-sectional studies. Any use of amphetamines was associated with higher odds of psychosis (odds ratio [OR] = 2.0, 95%CI 1.3-3.3), violence (OR = 2.2, 95%CI 1.2-4.1; adjusted OR [AOR] = 1.4, 95%CI 0.8-2.4), suicidality OR = 4.4, 95%CI 2.4-8.2; AOR = 1.7, 95%CI 1.0-2.9) and depression (OR = 1.6, 95%CI 1.1-2.2; AOR = 1.3, 95%CI 1.2-1.4). Having an amphetamine use disorder was associated with higher odds of psychosis (OR = 3.0, 95%CI 1.9-4.8; AOR = 2.4, 95%CI 1.6-3.5), violence (OR = 6.2, 95%CI 3.1-12.3), and suicidality (OR = 2.3, 95%CI 1.8-2.9; AOR = 1.5, 95%CI 1.3-1.8).

Interpretation: Methamphetamine use is an important risk factor for poor mental health. High quality population-level studies are needed to more accurately quantify this risk. Clinical responses to methamphetamine use need to address mental health harms.
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http://dx.doi.org/10.1016/j.eclinm.2019.09.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6890973PMC
November 2019

A Web-Based Therapeutic Program (We Can Do This) for Reducing Methamphetamine Use and Increasing Help-Seeking Among Aboriginal and Torres Strait Islander People: Protocol for a Randomized Wait-List Controlled Trial.

JMIR Res Protoc 2019 Jul 26;8(7):e14084. Epub 2019 Jul 26.

Infectious Diseases Aboriginal Health, Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, Australia.

Background: Methamphetamine use is of deep concern to Aboriginal and Torres Strait Islander communities, but access to culturally appropriate treatment resources and services is limited. Web-based programs have potential as flexible and cost-effective additions to the range of treatment options available to Aboriginal people. The We Can Do This online intervention is designed to incorporate evidence-based therapies in a culturally relevant format using narratives from Aboriginal people to contextualize the therapeutic content.

Objective: The goal of the research will be to test the effectiveness of the online intervention in a wait-list controlled randomized trial across multiple sites in urban, regional, and remote locations.

Methods: Participants will be Aboriginal and Torres Strait Islander people aged 16 years and over who have used methamphetamine at least weekly for the previous 3 months. They will be recruited online and via health services. During the intervention phase, participants will have access to the online intervention for 6 weeks with optional telephone or face-to-face support provided by participating health services. The primary outcome measure will be the number of days the participant used methamphetamine over the past 4 weeks compared to wait-list controls, assessed at baseline, 1, 2, and 3 months. Secondary outcomes will include help-seeking, readiness to change, severity of dependence, and psychological distress. Any important changes to the protocol will be agreed upon by the trial management committee and communicated to all relevant parties, including trial site representatives and the trial registry.

Results: Recruitment will commence in July 2019, and results are expected in early 2021. This research is funded by National Health and Medical Research Council project grant #1100696. The primary sponsor for the trial is the South Australian Health and Medical Research Institute. A trial management committee with representation from the participating health services, chief investigators, other Aboriginal experts, and consumers will oversee procedures, trial conduct, analysis, and reporting of the results.

Conclusions: The trial of this online intervention builds on existing research supporting the effectiveness of Web-based therapies for a range of psychological and other health-related issues including substance use. If successful, the We Can Do this online intervention will increase the range of options available to Aboriginal people seeking to reduce or stop methamphetamine use. It may provide a pathway into treatment for people who may otherwise be disengaged with health services for a range of reasons and will be a culturally appropriate, evidence-based resource for health practitioners to offer their clients.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000134123p; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=376088&isReview=true.

International Registered Report Identifier (irrid): PRR1-10.2196/14084.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786845PMC
July 2019

Measuring cognitive insight in people with problematic substance use: An exploration of the factor validity of the Beck Cognitive Insight Scale.

Drug Alcohol Rev 2019 09 23;38(6):622-629. Epub 2019 Jul 23.

IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Melbourne, Australia.

Introduction And Aims: Insight is a multi-dimensional construct that predicts treatment outcomes of people with mental illness. Research into insight in substance dependent populations is limited and measures of cognitive insight have not been validated for this population.

Design And Methods: A cross sectional survey was conducted with residents of nine residential substance dependence treatment facilities in Australia. Cognitive insight was assessed using the Beck Cognitive Insight Scale (BCIS). Psychological distress was assessed using the Kessler 6 (K6).

Results: Participants (N = 312) were primarily male (68.6%), with an average age of 37.51 years (SD = 9.85). Methamphetamine (45.2%) and alcohol (35.9%) were the primary substances of use. A confirmatory factor analysis confirmed the two-factor model of the BCIS (CMIN/DF = 2.91, CFI = 0.84). Removing two items from the Self-Reflection subscale improved model fit (CMIN/DF = 2.71, CFI = 0.84, Χ = 76.43, P < 0.02). Internal consistency analyses indicated acceptable internal reliability (Self-Reflection α = 0.73, Self-Certainty α = 0.72, composite α = 0.75). Self-Certainty scores were significantly higher for participants with a self-reported psychotic disorder (M = 14.95 vs. M = 13.04, P = 0.007). Self-Reflection scores were higher for people experiencing psychological distress (M = 17.57 vs. M = 15.95, P = 0.001).

Discussion And Conclusions: We found that a 12-item version of the BCIS had good psychometric properties in this substance-using population. Further research is needed to explore whether insight can predict treatment outcomes for substance use.
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http://dx.doi.org/10.1111/dar.12966DOI Listing
September 2019

Is there a discrete negative symptom syndrome in people who use methamphetamine?

Compr Psychiatry 2019 08 28;93:27-32. Epub 2019 Jun 28.

National Drug Research Institute, Curtin University, GPO Box 1987, Perth, WA 6845, Australia; National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, NSW 2031, Australia. Electronic address:

Background: Positive psychotic symptoms have consistently been associated with methamphetamine use but the presence of a negative symptom cluster remains unclear. We used exploratory factor analysis to examine whether a discrete negative syndrome could be delineated among methamphetamine users, and to examine the clinical correlates of this syndrome.

Method: Participants (N = 154) were people who used methamphetamine at least monthly and did not meet DSM-IV diagnostic criteria for lifetime schizophrenia. Scores on the Brief Psychiatric Rating Scale for the past month were subject to exploratory factor analysis. Latent class analysis was applied to resultant factor scores to determine whether negative and positive factors were experienced by the same participants. Past-month substance use measures were days of use for each drug type and methamphetamine dependence assessed using the Severity of Dependence Scale.

Results: We articulated a three-factor model including 'positive/activation symptoms' (e.g. suspiciousness, hallucinations, conceptual disorganisation, tension), 'affective symptoms' (e.g. depression, anxiety) and 'negative symptoms' (e.g. blunted affect, motor retardation). Positive-activation and affective symptoms (but not negative symptoms) were positively correlated with past month days of methamphetamine use (r = 0.16; r = 0.25) and severity of dependence (r = 0.24; r = 0.41). Negative symptoms were correlated with heroin (r = 0.24) and benzodiazepine use (r = 0.21). Latent class analysis revealed a three-class model comprising a positive-symptom class (44%, high positive-activation, low negative symptoms), a negative-symptom class (31%, low positive-activation, high negative symptoms), and a low-symptom class (38%, low on all factors).

Conclusions: A negative symptom syndrome exists among people who use methamphetamine, but this appears related to polysubstance use rather than forming a part of the psychotic syndrome associated with methamphetamine use. Overlooking the role of polysubstance use on negative symptoms may conflate the profiles of methamphetamine-associated psychosis and schizophrenia.
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http://dx.doi.org/10.1016/j.comppsych.2019.06.002DOI Listing
August 2019

Comment on Zang et al 2019: The importance of distinguishing between psychotic and general psychiatric symptoms in the context of methamphetamine use.

Addict Biol 2020 03 13;25(2):e12776. Epub 2019 Jun 13.

National Drug Research Institute (NDRI), Curtin University, Perth, Australia.

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March 2020

A study protocol for the N-ICE trial: A randomised double-blind placebo-controlled study of the safety and efficacy of N-acetyl-cysteine (NAC) as a pharmacotherapy for methamphetamine ("ice") dependence.

Trials 2019 Jun 4;20(1):325. Epub 2019 Jun 4.

IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia.

Background: There are currently no approved pharmacotherapies for managing methamphetamine dependence. N-acetylcysteine (NAC) has been found to reduce the craving for methamphetamine and other drugs, but its effect on methamphetamine use and other clinically related endpoints are uncertain. The N-ICE trial is evaluating the safety and efficacy of NAC as a take-home pharmacotherapy for methamphetamine dependence.

Methods/design: This is a two-arm parallel double-blind placebo-controlled three-site randomised trial (ratio 1:1) using permuted block randomisation, with variable block sizes. It is stratified by site, sex and whether the methamphetamine is injected or not. Participants (N = 180; 60 per site) need to be dependent on methamphetamine, interested in reducing their methamphetamine use and not currently receiving treatment for substance use disorders. The trial is being conducted in outpatient settings in Melbourne, Geelong and Wollongong, Australia. Participants will receive either 2400 mg oral NAC or a matched placebo, delivered as a take-home medication for 12 weeks. Two 600 mg capsules are self-administered in the morning and two more in the evening. Adherence is being monitored using eCAP™ medication bottle lids, which record the date and time of each occasion the bottle is opened. The primary outcome is methamphetamine use during the 12-week trial medication period, measured as (a) days of use, assessed using the timeline followback, and (b) methamphetamine-positive saliva tests, taken weekly. Secondary measures include weekly assessment of methamphetamine craving, severity of methamphetamine dependence, methamphetamine withdrawal symptoms and psychiatric symptoms (depression, suicidality, psychotic symptoms and hostility). Adverse events are monitored at each weekly assessment. Tolerability is assessed using the Treatment Satisfaction Questionnaire for Medication.

Discussion: The N-ICE trial is the first clinical trial to assess whether NAC can reduce methamphetamine use. This trial will improve our understanding of the potential utility of NAC in managing methamphetamine dependence and clinically related outcomes. If found to be effective, take-home NAC could be a potentially scalable and affordable pharmacotherapy option for treating methamphetamine dependence.

Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12618000366257 . Registered on 29 May 2018.
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http://dx.doi.org/10.1186/s13063-019-3450-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549263PMC
June 2019

Health-related quality of life among people who use methamphetamine.

Drug Alcohol Rev 2019 07 30;38(5):503-509. Epub 2019 May 30.

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Introduction And Aims: We assessed health-related quality of life amongst people who use methamphetamine, examined how this related to different patterns of methamphetamine use and what other factors were associated with decrements in quality of life in this sample.

Design And Methods: A cross-sectional survey of 169 at least monthly methamphetamine users. Health utility scores were derived using the Assessment of Quality of Life - 4D for the past month (0 reflects death and 1 represents full health; the population mean Assessment of Quality of Life score in Australia is 0.81). Dependence on methamphetamine was a score of 4+ on the Severity of Dependence Scale. Other measures included days of methamphetamine use and other substance use in the past month, injecting methamphetamine, demographics, psychiatric symptoms (score of 4+ on the Brief Psychiatric Rating Scale items) and a lifetime DSM-IV diagnosis of schizophrenia.

Results: The mean utility score was 0.52 (95% confidence interval 0.48-0.56). Methamphetamine dependence was associated with lower utility (-0.10, P = 0.003) after adjustment for other univariate correlates of utility. Other factors independently associated with lower utility were being a woman (-0.14, P < 0.001), depression (-0.10, P = 0.008), self-neglect (-0.08, P = 0.035), schizophrenia (-0.17, P = 0.003) and fewer years of schooling (0.02 per year, P = 0.037).

Discussion And Conclusions: We found poor quality of life in this sample of methamphetamine users relative to the general population, this being associated with both dependence on methamphetamine and other factors, particularly poor mental health. We also found poorer health amongst women.
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http://dx.doi.org/10.1111/dar.12934DOI Listing
July 2019

A Systematic Review of the Symptom Profile and Course of Methamphetamine-Associated Psychosis.

Subst Use Misuse 2019 29;54(4):549-559. Epub 2019 Jan 29.

c National Drug and Alcohol Research Centre , University of New South Wales , Randwick , Australia.

Objectives: The psychiatric symptom profile of methamphetamine-associated psychosis (MAP) has varied considerably across studies of different research designs. We performed a systematic review to examine the available evidence for specific psychotic symptoms associated with MAP, including the clinical course and longitudinal changes in this symptom profile.

Methods: Five key electronic databases were searched to identify studies that examined the symptom profile or clinical course of MAP in individuals identified as having MAP. The reporting of specific psychiatric symptoms, and duration of symptoms where available, was recorded for each study.

Results: Ninety-four articles were identified (n = 7387), including case-control (k = 29), cross-sectional (k = 20), experimental (k = 6), case report (k = 29), and longitudinal (k = 20) studies. Persecutory delusions, auditory and visual auditory hallucinations were by far the most commonly reported symptoms (reported in 65-84% of studies). Hostility, conceptual disorganization, and depression were reported in a large proportion of studies (31-53%). Negative symptoms were mostly absent (<20%). The median percentage of participants with persistent psychotic symptoms (>1 month duration) across studies was 25% (excluding case reports).

Conclusion: Persecutory delusions, auditory and visual hallucinations, hostility, depression and conceptual disorganization are central to MAP, whereas negative psychotic symptoms are typically absent. An overrepresentation of institutionalized or male participants may have overemphasized negative symptoms and underreported affective symptoms in past research. Symptoms of MAP may persist beyond one month after drug cessation in some individuals. Clinicians are encouraged to manage affective symptoms in MAP individuals, and monitor for the development of chronic psychotic symptoms.
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http://dx.doi.org/10.1080/10826084.2018.1521430DOI Listing
January 2020
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