In Progress
Acceptability, tolerability and safety of depot naltrexone in detoxified heroin users.Redefining and evaluating a kit for alcohol prevention and early intervention for the
Development of a sexual health and contraception intervention for pregnant women who are drug dependent.
Randomised double blinded trial comparing the effectiveness of intranasal and intramuscular Naloxone for the treatment of acute opioid overdose at the Sydney Medically Supervised Injecting Centre.
Professional strengths and needs of the NSW Aboriginal drug and alcohol Workforce
Optimising management of acute pain in opioid maintenance patients: A pilot laboratory randomised study.
Prevalence of QTc prolongation amongst patients of an Australian pharmacotherapy clinic on methadone or buprenorphine
Prescribed and illicit opiates in society survey
Validation study of the Drug Users Quality of Life Scale in Australia
Assessing the cost of Alcohol relate brain injury management in GSAHS central
Addiction pharmacotherapy in private rural general practice
The sexual health of women in drug and alcohol treatment
Improving parenting risk assessment in a "high risk" drug and alcohol abusing antenatal population
Offence-related debt among substance-using offenders
Stepped care for patients with alcoholism and panic disorder
Addressing opioid toxicity in the Opioid Treatment Program
Linkage studies on a cohort entering methadone and buprenorphine treatment
A randomised controlled trial of unsupervised buprenorphine-naxoline versus wait list control
An attachment-based group parenting intervention for substance dependent mothers and infants
Modification and validation of treatment outcome profile instrument under Australian conditions and evaluate implementation of outcome measurement in three opioid pharmacotherapy treatment services.
The effects of methadone, alone and in combination with alcohol and Alprazolma, on simulated driving performance
Investigating the effectiveness of delivering a brief intervention for cannabis users by mail and by internet.
Genetic determinants of the response to pharmacotherapy for alcohol dependence
Acceptability, tolerability and safety of depot naltrexone in detoxified heroin users.
Many opioid-dependent people seeking treatment want to achieve and sustain abstinence, particularly early in their addiction careers. Detoxification, however, is associated with high rates of relapse and with an increased risk of death due to overdose post-treatment. There are very limited options for heroin-dependent people seeking abstinence. This project will examine the acceptability, tolerability and safety of three months treatment (3 injections at monthly intervals) of Vivitrol®, in twelve opioid-dependent patients.
Redefining and evaluating a kit for alcohol prevention and early intervention for the
Alcohol problems have been identified by Indigenous Australian communities as a
pressing concern, with harmful impact on health and community life. NSW has the
largest Indigenous population in Australia, with a sizeable proportion living in Sydney. Yet little research has focused on prevention and early intervention for alcohol problems in the urban Indigenous setting. This project will aim to assess the suitability of an adapted form of the Drink-less brief alcohol intervention kit as an easy to use tool suited for use in the urban Aboriginal and Torres Strait Islander setting.
Development of a sexual health and contraception intervention for pregnant women who are drug dependent.
In a recent pilot study of 26 pregnant women in drug treatment less than one-third of the sample had planned their pregnancy. The predominant reason for the lack of planning was the false belief that they could not get pregnant and the limited use of contraception. This study will explore how best to integrate contraceptive education and services into the Drug Health clinic setting.
Randomised double blinded trial comparing the effectiveness of intranasal and intramuscular Naloxone for the treatment of acute opioid overdose at the Sydney Medically Supervised Injecting Centre.
The aim of this study is to determine whether naloxone, an opioid reversal agent, is as effective for the treatment of acute opioid overdose when administered via the IN route compared with the intramuscular route. This will be particularly relevant to ambulance officers and paramedics, as well as other emergency health care workers, such as in the hospital emergency department setting.
Professional strengths and needs of the NSW Aboriginal drug and alcohol Workforce
There is clear need to identify and clarify who the Aboriginal drug and alcohol workforce is in NSW for the purpose of understanding the level of stress, level of organisational and managerial support, current levels of or lack of qualifications, training needs, level of burnout and wellbeing, supervision arrangements and current strengths among all the NSW Aboriginal Drug and Alcohol Workforce. This project will assist in the development of a sustainable workforce plan for this sector.
Optimising management of acute pain in opioid maintenance patients: A pilot laboratory randomised study.
Acute pain is common. Untreated, it can result in physical and psychological complications, and in OST patients increased substance use. Guidelines
recommend high-dose opioids for severe pain in OST patients. The aim of this pilot study is to identify the efficacy of different pharmacological approaches for the management of experimentally induced nocioceptive pain in patients in methadone or buprenorphine (BPN) maintenance treatment.
Prevalence of QTc prolongation amongst patients of an Australian pharmacotherapy clinic on methadone or buprenorphine
There has been growing concern in the medical literature that methadone may increase the risk of cardiac rhythm abnormalities (in particular a prolongation of QTc). These rhythm abnormalities may in turn lead to sudden cardiac death. To date the prevalence of QTc prolongation in patients receiving methadone has not been measured in Australia. This study will document the prevalence of QTc prolongation in a pharmacotherapy clinic population and provide prospective data on the persistence of this abnormality when present in individuals in that population.
Prescribed and illicit opiates in society survey
The opiates involved in overdoses and abuse are increasingly Prescribed Opiate Analgesics (POAs). These drugs are principally sourced by doctor-shopping or diversion. Thirty-one per cent of Australians describe significant chronic pain. GPs commonly prescribe POAs. With an estimated average of thirteen POA dependent patients each GP must balance the management of pain with the risk and reality of addiction. Drug seeking patients can be difficult patients to deal with and POA requests to GPs are rarely refused. This survey looks to assess the theoretical knowledge and clinical management of the initiation, continuation and termination of POAs by GPs.
Validation study of the Drug Users Quality of Life Scale in Australia
Quality of Life (QoL) reflects the respondents' perceptions and reactions to their mental and physical health as well as to other relevant personal areas. This research project aims to test the reliability and validity of an English version of the Drug User Quality of Life Scale (DUQoL) among young substance users who present to a community mental health service in NSW. It is expected that this scientific endeavour will produce a valid and reliable tool for future research and clinical use in Australian health care settings
Assessing the cost of Alcohol relate brain injury management in GSAHS central
Alcohol Related Brain Injury (ARBI) affects up to 140,000 in NSW and it is a debilitating, isolating condition. It affects memory, decision making, and produces alterations in personality reducing the ability to live life with quality and safety. The aim of this study is to define the use of GSAHS resources along with associated health and welfare resources by ARBI patients residing in GSAHS Central & North Eastern sectors.
Addiction pharmacotherapy in private rural general practice
Despite the prevalence and severity of harms from opiate dependency there remains a significant shortfall in the number of Opiate Treatment Programme (OTP) General Practitioner (GP) prescribers to service this clientele (Hotham E 2005). Medical practitioners hold negative, stereotypical views about drug using patients, especially those using illicit drugs. This study aims to examine the effect of the presence of OTP patients on a Private Rural General Practice. It will investigate the impact of treating OTP patients on the economics of a practice and the impact of OTP patients on the waiting room ambience.
The sexual health of women in drug and alcohol treatment
At an international level there are calls for a greater focus on women and harm reduction. Female drug users have a unique set of issues which are not routinely assessed in drug treatment program. This study will explore the sexual health of women attending drug services for treatment of substance use and will investigate factors that contribute to sexual ill health. The study aims to assess the sexual and reproductive health needs of women attending Drug Health Services for treatment of their substance use.
Improving parenting risk assessment in a "high risk" drug and alcohol abusing antenatal population
Maternal substance abuse has been linked to parenting difficulties and poor emotional and behavioural outcomes in children. This group of parents have high involvement from child protective services and are at increased risk of child abuse and neglect. The main aims of this research project are to: 1) Implement a comprehensive mental health and psychosocial screening tool in a 'high-risk' substance abusing antenatal population. 2) Evaluate the use of the Parent Development Interview (PDI) [13] within this 'high-risk' antenatal population and examine the associations between parental reflective capacity and child protection outcome.
Offence-related debt among substance-using offenders
The effectiveness of alcohol and other drug (AOD) intervention services can be improved through awareness of and responsiveness to the risk factors associated with substance use, and the barriers to treatment engagement and compliance. Through a short addendum to the existing Connections Project (a through-care service for substance-using offenders) assessment questionnaire, this study aims to investigate the prevalence and nature of a little considered, although germane, barrier to engagement with AOD intervention among clients with a history of criminal offending: offense-related debt (accrued via fines, court costs, victims compensation etc) and associated sanctions (e.g., suspension of drivers' license or car registration, garnishing of salary, property seizure etc.).
Stepped care for patients with alcoholism and panic disorder
The proposed pilot study aims to determine the acceptability, feasibility, and potential efficacy of an integrated treatment approach for co-occurring alcohol dependence (AD) and panic disorder (PD). This is the first Australian trial to test an integrated treatment for the two disorders and the first internationally to test a theoretically-derived integrated treatment based on the complex causal relationship between panic and alcohol use.
Addressing opioid toxicity in the Opioid Treatment Program
Opioid treatment programs (OTPs) have been convincingly shown to reduce the morbidity and mortality associated with opioid dependence. In general, efforts are directed to achieve higher retention in treatment as this is associated with better health outcome. Accordingly, the number of participants on OTPs, the duration of treatment and their average ages are all increasing in NSW and elsewhere in Australia. This will be the first study in the world to systematically define the overall burden of opioid toxicity in a cohort of people on long-term and stable OTP. The study will define appropriate monitoring and management, strategies including indications for exiting maintenance treatment and inform further development of NSW and Commonwealth guidelines.
Linkage studies on a cohort entering methadone and buprenorphine treatment
This project studies compares important health outcomes (mortality, health care utilization, and pregnancy outcomes) associated with methadone and buprenorphine treatment. It uses at health records to identify risk factors for overdose in- and post-treatment, and uses data linkage to relate health outcomes to periods in and out of the two treatments. This allows a comparison of the mortality associated with the two forms of treatment, and identifies potential interventions to reduce risk
A randomised controlled trial of unsupervised buprenorphine-naxoline versus wait list control
Long waiting periods for opiate substation treatment are a substantial and chronic barrier for dependent users wanting to access treatment in the greater Newcastle region. This project will assess the efficacy of unsupervised dosing of buprenorphine - naloxone where patients attend a weekly clinic to collect their medication.
An attachment-based group parenting intervention for substance dependent mothers and infants
Parents with substance abuse problems have traditionally been difficult to engage in psychological interventions and parenting programs and their children are at risk of psychological and behavioural difficulties. Barriers to care have included the fear of child removal and lack of coordinated services to provide intervention for concurrent drug and alcohol, mental health and parenting concerns. The main aim of this research project is to evaluate the provision of a comprehensive attachment-based group parenting program focussed upon improving parental self-representation, emotional understanding and attachment relationship with their child. This project will provide evidence as to the efficacy of relational group interventions over traditional approaches for 'high-risk' substance abusing populations.
Modification and validation of treatment outcome profile instrument under Australian conditions and evaluate implementation of outcome measurement in three opioid pharmacotherapy treatment services.
The measurement of individual client and program outcomes for Opioid Pharmacotherapy treatment is an important, but hitherto lacking, component of treatment evaluation. The Treatment Outcome Profile Survey (TOPS) is a simple one page tool assessing the relevant domains of opioid treatment (substance use, health, psychosocial, crime and quality of life) that has been validated against gold standard measures, and with good psychometric properties. This project will validate the TOPS under Australian conditions, and examine implementation and feasibility issues in several OTPs across NSW.
The effects of methadone, alone and in combination with alcohol and Alprazolma, on simulated driving performance
Opiate treatment programs (OTPs) are core clinical programs of NSW Health. Methadone is the most commonly prescribed substitution therapy for opioid dependence such that in June 2006, approximately 16,000 clients in NSW were receiving methadone. It is important to note that methadone is dispensed daily from a limited number of locations so that transportation is a critical issue for those on methadone and for the program as a whole. The purpose of this project is to gain direct experimental evidence of the effect of methadone and other commonly taken substances on driving performance using a state-of-the-art driving simulator.
Investigating the effectiveness of delivering a brief intervention for cannabis users by mail and by internet.
This study will examine the feasibility and effectiveness of two innovative treatment approaches for cannabis users, mail and the internet. The study will help to develop knowledge around how to better engage cannabis users with treatment. The project will build on the NSW Health funded "state-wide program to reduce excessive drinking in the community: controlled drinking by correspondence" and the internet version of this initiative. The study could potentially generate new and low-cost treatment to improve outcomes among cannabis users.
Genetic determinants of the response to pharmacotherapy for alcohol dependence
This project will investigate pharmacotherapy treatment and build upon past research on this topic. The project will examine the involvement of genetics, specifically the gene ghrelin in alcohol dependence, as well as genetic markers for predicting response to naltrexone, acamprosate and baclofen. This project will add important to existing alcohol treatment research. This research will potentially lead to improved management strategies for alcohol dependence by allowing better and more cost-effective medicine selection for patients based on their genetic makeup, and potentially spare patients exposure to risks from ineffective medications.
For further information on these projects contact Tricia O’Riordan email: torio@doh.health.nsw.gov.au