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Emerging trends in drug use, harms and markets: Findings from Drug Trends 2025

Rachel Sutherland, Haniene Tayeb, Antonia Karlsson, Julia Uporova, Udesha Chandrasena, Olivia Price, Agata Chrzanowska, Lily Palmer, Nicola Man, Raimondo Bruno, Paul Dietze, Simon Lenton, Caroline Salom, Louisa Degenhardt, Michael Farrell, Amy Peacock

Findings from the 2025 Illicit Drug Reporting System interviews (a sentinel sample of people who inject drugs) and the 2025 Ecstasy and Related Drug Reporting System interviews (a sentinel sample of people who use stimulants) will be presented for the first time. These two crucial monitoring systems have been running for approximately two decades across Australia. Historical trends, as well as highlights from 2025, will be discussed in the context of shaping responses to drug related harms in Australia. Given the dynamic nature of drug use and drug markets, understanding and mapping evolving trends is vital.��

Importance of an evidence-based approach to eliminating HCV and implications for tackling wider drug-related harms in Scotland

Professor Sharon Hutchinson

Scotland has been at the forefront of international efforts to eliminate hepatitis C virus (HCV) as a public health problem. An evidence-based approach has been adopted to inform and evaluate the national strategy, which has focused the scale-up of HCV direct-acting antiviral (DAA) treatment alongside high-coverage harm reduction interventions on people who inject drugs (PWID), the predominant group at risk of infection in Scotland and other high-income countries. Evaluation of the national strategy has involved the development of public health surveillance systems monitoring infection, disease and intervention coverage, including serial sero-behavioural surveys of PWID and data-linkage of administrative data (including HCV test/treatment, drug service including opioid agonist therapy prescribing, hospital admission and death records) combined with statistical and mathematical modelling. Over a period when HCV treatment was scaled-up in Scotland through delivery of DAAs in drug services, prisons and other community settings, major reductions in the prevalence and incidence of HCV infection have been estimated among PWID. This yields compelling evidence of ‘treatment as prevention’ and that the WHO HCV elimination targets and goal are within reach. While major progress has been achieved in eliminating HCV over the past decade, drug-related deaths (DRD) have however more than doubled in Scotland.�� With the highest recorded DRD population rate in Europe (at 250-300 per million population in 2021-22), Scottish Parliament declared it a national public health emergency. Drawing on and adapting public health monitoring and evaluation methods developed for HCV elimination, we demonstrate early insights on the epidemiology of DRDs to inform the national response and motivate discussion on what further lessons could be applied to the prevention of wider drug related harms.�� ��

How can monitoring off-premise alcohol pricing inform best practice alcohol policy in Australia? Findings from a pricing surveillance program

Peacock, A., Miller M., Livingston, M., Callinan, S., Jiang, H., Kowalski M., Taylor, N., Clifford, S., Wright, C., Sadaphale, V., & Man, N.

Introduction and Aims: Alcohol pricing policies are some of the most cost-effective strategies for reducing alcohol-related harm. The World Health Organization recommends regular reviews of pricing practices to enable interventions to reduce harmful use of alcohol. In Australia, there is no stipulation for the alcohol industry to publicly report on alcohol pricing at the product level. This presentation will overview our program of work capturing off-premise alcohol pricing over time, illustrating how these data can be used to show: i) current pricing practices, ii) role of cheap and other novel (e.g., zero-alcohol) products, iii) how industry changes pricing within Australia’s existing taxation structure, and iv) how pricing changes with policy change.����

Methods: Data comprise all alcoholic products available on the websites of major off-premise alcohol retailers across select locations in New South Wales and Northern Territory, collected on a monthly to quarterly basis from July 2023. Multi-level models were used to measure price differences between products, locations and over time.����

Results: Market pricing by product type and over time and geography will be briefly overviewed. We will also present findings on how product promotions (specifically volumetric discounting) drive cheap alcohol availability; emergence and pricing of novel alcohol products (zero-alcohol products); change in alcohol pricing following excise tax indexation; and changes in price following repeal of minimum unit pricing policy in the Northern Territory.����

Conclusions: Monitoring pricing shows the ready availability of cheap alcohol, including cheap cask wine following repeal of minimum unit pricing in Northern Territory. Various evidence-informed policy options could be considered, including a more uniform volumetric tax that sets a common excise rate at the federal level, and locally-tailored options at the jurisdictional level.�� ��

Disclosures: Funding was received from NSW Health for a component of the work related specifically to NSW. The National Drug and Alcohol Research Centre is funded by the Australian Government Department of Health and Aged Care under the Drug and Alcohol Program. AP is supported by a National Health and Medical Research Council (NHMRC) Investigator Fellowship (#1174630). The content is solely the responsibility of the authors and does not necessarily represent the official views of any funding body.����

Evaluating the impacts of the repeal of the Northern Territory Minimum Unit Price policy on off-premise alcohol pricing

Mia Miller

Introduction: The Northern Territory (NT) has the highest rates of alcohol harm in Australia. A minimum unit price (MUP) policy of $1.30 per standard drink was implemented in the NT in 2018 to reduce the availability of cheap alcohol. Despite evidence of its efficacy in decreasing alcohol consumption and harms, the MUP was repealed on 1 March 2025. This study aims to determine the immediate impacts of the MUP repeal on alcohol price in Darwin, NT, including the proportion of products available <1.30 per standard drink and any shifts in the overall price distribution of alcohol

Methods: Data were obtained for all available alcohol products on the websites of three major alcohol retailers in the last week of months October 2024 through March 2025. The proportion of products available in March 2025 < $1.30 per standard drink by product type was computed. A mixed-effects quantile regression was undertaken to test for significant differences in the 10th, median and 90th percentile prices in March 2025 compared to previous months.����

Results: 75 wines and one cider were available <$1.30 per standard drink, including 24 wine products in vessels ≥1L (constituting 75% of all wine products ≥1L) in March 2025. The overall price distribution of alcohol shifted, with beer, spirits and wine all significantly cheaper in March 2025 compared to February 2025. Analyses will be updated to include April and July 2025 results.��

Implications: The MUP repeal resulted both in an immediate increase in the availability of cheap alcohol products and a downward shift in the overall price of alcohol in the market. Ongoing monitoring of alcohol pricing and any corresponding shifts in consumption and harm is necessary. In the absence of MUP, other evidence-based, population-level alcohol policies should be prioritised for implementation in the NT.��

Insights from Australian drug alerts in 2024: High-dose MDMA and the challenge of alert thresholds

Stassi Kypri, Harriet MacDonald, Ed Broadbent, Sebastian Baird, Brendan Clifford, Krista J Siefried, Nadine Ezard, John Gobeil on behalf of the PRN Advisory group and Jack Freestone

Introduction: In 2024, 47 unique drug-alerts reporting 92 substance detections were issued across NSW, the ACT, VIC, QLD, and SA. The most frequent were alerts for pressed MDMA tablets exceeding 150mg freebase (15 alerts; 31%), followed by nitazenes (12 alerts; 25%) and heroin detected in substances thought to be either cocaine or methamphetamine (4 alerts; 8%). Concurrently, concerns around ‘alert fatigue’ and the appropriateness of existing thresholds at which to issue alerts regarding high-dose MDMA have prompted calls for a deeper understanding of the practices behind issuing such alerts.����

Aims: Explore key considerations and processes for issuing drug alerts and examine the appropriateness and utility of using a 150mg freebase threshold to trigger high-dose MDMA alerts.��

Methods: 15 key informants from drug checking services, drug user organisations, and government health departments were surveyed, with seven also participating in a focus group. Surveys and focus groups explored protocols and perspectives around issuing drug alerts, with a focus on high-dose MDMA alerts. Data were analysed descriptively.�� ��

Results: Key informants widely considered 150mg freebase an appropriate threshold at which to issue high-dose MDMA alerts. However, participants also narrated drawbacks associated with the inflexibility of thresholds and their inability to account for contextual nuances or market trends. Participants discussed the value of a national real-time repository of data on the contents, dosage and purity of analytically tested substances.����

Implications for policy and practice: Further monitoring of market norms, consumer practices and a repository of real-time data on substances that have been tested or detected in Australia may improve risk communications related to MDMA and a range of other substances.�� Nitazenes continue to grow as a public health concern and opportunities for public health responses to emerging drug-related concerns are expanding as more jurisdictions develop alert systems, reinforcing the need for inter-sectoral and inter-jurisdictional collaboration. �� ����  ��

Associated risk factors when injecting alone, among national samples of people who regularly inject drugs, 2020-2025

Antonia Karlsson, Amy Peacock, Julia Uporova, Olivia Price, Udesha Chandrasena, Haniene Tayeb, Raimondo Bruno, Paul Dietze, Simon Lenton, Caroline Salom, Louisa Degenhardt, Michael Farrell, Rachel Sutherland

Introduction: People who inject drugs alone are at increased risk of mortality and morbidity, particularly in relation to overdose, as they typically consume substances in the absence of any public health interventions. Such individuals tend to be more vulnerable and experience heightened harms�� and stigma related to drug use. ��

Aims: This research aims to examine the percentage of IDRS participants who reported injecting alone the last time they injected, as well as risk factors associated with those who reported injecting alone.����

Methods: Data were obtained from the Illicit Drug Reporting System (IDRS). The IDRS consists of an annual survey of people who regularly inject drugs, recruited from all capital cities of Australia. Descriptives and binary logistic regression analyses were performed to determine the sociodemographic, drug use and health factors associated with participants who report injecting alone, the last time they injected a drug.����

Results: Data collection is currently underway for the 2025 IDRS, and will be finalised by the end of July 2025. However, between 2020 and 2024, findings identified that almost half the national IDRS samples reported injecting alone the last time they injected a drug, ranging between 44% in 2021 and 49% in 2020 and 2024. In 2024, being male, experiencing any injection-related injuries or diseases and reuse of own needles were associated with increased odds of injecting alone when they last injected a drug. Conversely, participants who reported being unemployed at the time of interview, those who had used heroin in the six months prior, and those who had committed any crime in the past month, were less likely to report injecting alone when they last injected a drug.�� ��

No statistically significant relationship was found between injecting alone when they last injected a drug and past six month methamphetamine use, any needle sharing, past 12 month utilisation of drug checking services, past 12 month obtainment of naloxone, current drug treatment, any past 12 month overdose and experiencing any mental health problems.����

Implications: Injecting alone was relatively common amongst sentinel samples of people who inject drugs. Our findings suggest that people who inject drugs alone may engage in a range of risk behaviours (e.g., reuse of own needles), suggesting that education campaigns may benefit from recognising these broader risk environments.����

Does the trend in methamphetamine load in wastewater predict methamphetamine-related hospitalisations and deaths?

Nicola Man, Agata Chrzanowska, Ben Tscharke, Wayne Hall, Jochen Mueller, Cobus Gerber, Rachel Sutherland, Caroline Salom, Simon Lenton, Raimondo Bruno, Richard Bade, Jake W O’Brien, Emma L Keller, Bradley Simpson, Rory Verhagen, Phong Thai, Kevin Thomas, Michael Farrell, Amy Peacock

Introduction: Australasia has one of the highest prevalence of amphetamine-type stimulant (ATS) use. Australia’s ATS market has been dominated by methamphetamine since the 1990s. Wastewater data may serve as an indicator of emerging trends in methamphetamine-related harms.��

Aims: To determine whether the trend in detected methamphetamine in wastewater improves prediction of trends in methamphetamine-induced hospitalisations and deaths.��

Methods: Count of ATS-induced hospitalisations and deaths from National Hospital Morbidity Database and Cause Of Death Unit Record File in Australia, nationally, and by jurisdiction and/or capital cities at annual, 4-monthly and 2-monthly intervals between August 2016 and March 2021 were fitted in an ARIMA model. Two sets of models were fitted: with wastewater load of methamphetamine as a predictor (wastewater model), and without wastewater data (base model). Model fit was assessed using corrected Akaike’s information criterion (AICc). One-year forecasting accuracy (RMSE) was computed by comparing with observed data to March 2022.����

Results: The wastewater model had a better fit to the observed deaths data than the corresponding base model for capital cities at annual (AICc=-3.7 versus 57.7), 4-monthly (115.1 versus 122.9) and 2-monthly (206.0 versus 208.9) intervals. The model fit was variable or poor for jurisdiction-level disaggregation. Forecasting performance was better with the wastewater model for capital cities at 4-monthly (RMSE=4.7 versus 16.0) and 2-monthly (6.1 versus 8.6) intervals but not annually (35.0 versus 0.2) as the predicted deaths was higher than reported. The observed deaths were within the 95% prediction intervals in the 4-monthly and 2-monthly wastewater models. National-level findings were similar to the capital cities. Results for hospitalisations will be available at the symposium.��

Implications for Practice or Policy: Wastewater data could be useful for modelling national trends in methamphetamine-related harms in Australia. Models for finer levels of geographical disaggregation and for other drugs may be further investigated.��

Disclosure of Interest Statement: Drug Trends and the National Drug and Alcohol Research Centre are funded by the Australian Government Department of Health and Aged Care under the Drug and Alcohol Program. AP (#1174630) and RS (#1197241) are supported by National Health and Medical Research Council (NHMRC) Investigator Fellowships. RB (Richard Bade) is the recipient of an Australian Research Council (ARC) Discovery Early Career Award (project number DE220100381). JWO is the recipient of an NHMRC Emerging Leadership Fellowship (EL1 2009209). The Queensland Alliance for Environmental Health Sciences, The University of Queensland acknowledges the financial support of Queensland Health Australia and the Australian Criminal Intelligence Commission. The University of South Australia acknowledges the financial support of the Australian Criminal Intelligence Commission.��

Does the use of quit-smoking medicines in early pregnancy increase the risk of adverse outcomes for the mother or baby? A multi-national cohort study

Dr Duong (Danielle) Tran

Introduction: Quit-smoking medicines, including nicotine replacement therapy (NRT), varenicline, and bupropion, are the most effective strategies for smoking cessation. However, evidence on their safety during pregnancy remains limited.

Aims: To examine whether using a quit-smoking medicine in early pregnancy increases the risk of adverse outcomes for the mother or baby compared to maternal smoking alone.��

Methods: We linked all pregnancies resulting in a birth (2002-2020) in New South Wales (NSW), New Zealand, Norway, and Sweden to prescription medicine dispensing, hospital, and death records. The study included pregnancies among mothers who smoked in early pregnancy. We defined use of a quit-smoking medicine in early pregnancy as any dispensing of the medicine between gestational weeks 7 and 19. Comparison pregnancies involved dispensing of a quit-smoking medicine two to six months before conception only. We used propensity score matching (1:10) to address confounding and calculated hazard ratios (HR) with 95% confidence intervals for a range of adverse maternal and baby outcomes. We will combine country-specific estimates via meta-analysis.

Results: NSW analyses included 569 pregnancies exposed to NRT, 207 to varenicline, and 46 to bupropion. Compared to the matched group, there were no significant differences in the proportion with any adverse outcome for mother or baby following exposure to NRT (38.1% vs 33.8%, HR 0.99, 95%CI 0.81-1.20), varenicline (31.9% vs 31.3%, HR 0.96, 0.72-1.28) or bupropion (34.8% vs 29.1%, HR 1.07, 0.55-2.10). NRT and varenicline analyses showed no increased risks of specific outcomes including pre-term birth, emergency caesarean section, baby small for gestational age, or severe complications. Analyses from other countries are underway.��

Implications: These preliminary results suggest that using NRT or varenicline in early pregnancy may not increase the risk of adverse maternal or neonatal outcomes compared to tobacco smoke.

PsiMA trial of psilocybin-assisted psychotherapy for methamphetamine use disorder

Jonathan Brett, Elizabeth Knock, Krista J Siefried, Gill Bedi, Richard O Day, Nadine Ezard, Margaret Ross, Paul Liknaitzky, Joga Chaganti, Steven Albert, Toby Lea, Sebastian Job

Introduction: There are few effective treatments for methamphetamine use disorder, despite increasing global demand. We assessed the safety and feasibility of outpatient psilocybin-assisted psychotherapy for methamphetamine use disorder.�� ��

Method: Participants (n = 15) were ≥25 years old, seeking treatment for methamphetamine use, using methamphetamine ≥4 days/month, and without serious mental illness or medical contraindications. Participants received 3 preparatory psychotherapy sessions over 2 weeks before a single psilocybin dosing session (25mg oral), followed by 2 integration psychotherapy sessions over 1 week. Psychotherapy included elements of motivational enhancement and acceptance and commitment therapy. Participants were followed for 90 days post psilocybin-assisted psychotherapy session. Primary endpoints were safety and feasibility, and secondary endpoints included methamphetamine and other drug use, drug craving, depression, anxiety, stress and quality of life.����

Findings: Of 56 pre-screened individuals, 15 were eligible and enrolled into the study. Fourteen participants completed the study intervention and 13 completed 90-day post-dose follow-up. No serious adverse events (AEs) occurred, and the 7 treatment-related AEs were self-limiting and mild to moderate in severity. AEs included hypertension during the dosing session and headache (n=4), nausea (n=1) and noise sensitivity (n=1) within the week following the dose. Methamphetamine use (over the prior 28 days) decreased from screening (median 12 days, IQR 7-16, n=15) to day 28 (median 0 days, IQR 0-2, n=13) and day 90 (median 2 days, IQR 1-4, n=14) post psilocybin. Methamphetamine craving decreased while quality of life, depression, anxiety, and stress improved from baseline to day 28 and 90 follow-up.��

Conclusions: Psilocybin assisted psychotherapy for methamphetamine use disorder was feasible to implement in an outpatient setting, did not appear to generate safety concerns, and demonstrated signals of effectiveness warranting further investigation.�� ��

Implications for Practice or Policy: Larger definitive studies should be performed to determine the safety, efficacy and cost effectiveness of this intervention.����

The Tina Trial: A phase 3 randomised double-blind placebo-controlled trial of mirtazapine as a pharmacotherapy for methamphetamine use disorder

Rebecca McKetin, Lucy Saunders, Long Nguyen, Gregory Dore, Steven Shoptaw, Michael Farrell, Louisa Degenhardt, Peter J. Kelly, Tayla J. Degan, Alyna Turner, Philip J. Clare, Olivia M. Dean, Shalini Arunogiri, Samantha ColledgeFrisby, Juanita Koeijers, David GoodmanMeza, Barbara Sinclair, David Reid, Harry Hill, Jeremy Hayllar, Michael Christmass, Frank Cordaro, Robert Lundin, Willy Liaw, Danica Liu, Ellie Holyoak, Brian TidFung Wu, Joel Keygan, Ava Kontogiannis, Lily Palmer, Caity Morrison, Anna Wrobel, Bec Hyland, Gift Kiden, Vanessa Romeo, Marianne Byrne, Noni O’Dea and Michael Berk

Introduction: There are no approved pharmacotherapies for methamphetamine use disorder. Two phase 2 randomised controlled trials have found mirtazapine, a tetracyclic antidepressant, to be effective in reducing methamphetamine use. We conducted a phase 3 trial to determine the effectiveness and safety of mirtazapine as an outpatient pharmacotherapy for methamphetamine use disorder in Australia.��

Method: A multi-site phase 3 randomised, double-blind, placebo-controlled parallel trial. Participants were randomly allocated (1:1) to receive either mirtazapine (30 mg/day for 12 weeks) or matched placebo, delivered as take-home medication. Recruitment involved social media, flyers and word-of-mouth. Participants were enrolled via alcohol and other drug treatment services in Townsville, Geelong, Perth, Brisbane, Wollongong and Adelaide. The primary outcome was self-reported days of methamphetamine use. Secondary outcomes were methamphetamine-negative oral fluid samples, depressive symptoms, sleep quality, HIV risk behaviour and quality of life.����

Key Findings: 1,267 people were phone screened for the trial and 477 people attended a face-to-face eligibility assessment. Of the 344 randomised participants, 339 received the intervention. Randomised participants used methamphetamine on a median of 24 days in the past 4 weeks (interquartile range 18-28 days); 53% usually smoked and 46% usually injected methamphetamine; 55% had never received formal drug treatment for their methamphetamine use. Follow-up assessments were conducted at 4 weeks (n = 315, 93%), 8 weeks (n = 300, 89%) and 12 weeks (n = 293, 86%). Results will be available to be presented.��

Discussions and Conclusions: This trial will provide definitive evidence on the safety and effectiveness of mirtazapine as a pharmacotherapy for methamphetamine use disorder when delivered as an outpatient medication in routine clinical practice.��

Implications for Practice or Policy: The successful conduct of the Tina Trial has demonstrated that capacity exists within Australia to conduct later-stage clinical trials for methamphetamine pharmacotherapies.����

Does diverting minor drug offenders reduce recidivism? Cannabis cautioning in Australia

Anaïs Henneguelle and Don Weatherburn

Aim: To see whether diversion of minor drug offenders from criminal prosecution reduces the risk of further offending.

Methods:��We exploit the staged roll-out of a policy implemented in the State of New South Wales (Australia) in 2000, which gave police the discretion to formally caution rather than charge adults detected for use and/or possession of cannabis. We use the exogenous variation in the timing of the policy implementation as an instrument in a 2SLS (linear probability model) analysis to identify the effect of cannabis cautioning on risk of re-offending. A series of checks are carried out to test the robustness of the findings obtained via the linear probability model.��

Results: Being given a cannabis caution rather than being prosecuted for cannabis possession reduces recidivism at 5 years by about 16 percentage points, on average.��

Conclusions: The adoption of alternatives to prosecution for minor drug offences is more likely to enhance public safety rather than reduce it.��

Characterising same-day alcohol delivery sales in New South Wales

Michala Kowalski, Nic Taylor

Introduction: Same-day alcohol delivery services have attracted policymakers’ attention in the last few years as an area of concern. However, it is unclear whether same-day alcohol delivery services have a similar risk profile to the risk profile associated with other kinds of packaged alcohol sales.����

Aims: Here, we aim to assess the sales patterns associated with same-day delivery alcohol sales within NSW, to establish whether their risk profile is similar to the risk profile of in-person or delayed packaged alcohol sales or the risk profile of on-premise alcohol sales.�� ��

Method: We conducted a comparative analysis of alcohol sales data from four different data sources:����

1. Biannual aggregate sales figures provided by same-day delivery alcohol retailers to the Independent Liquor and Gaming Authority, from July 2021 through June 2024.����
2. Hourly sales figures provided by on-premise alcohol retailers in Kings Cross to the Independent Liquor and Gaming Authority, January 2014 through April 2018.����
3. Aggregate national sales figures of packaged alcohol retailers and on-premise alcohol retailers collected by market research firm Euromonitor International, from 2014 through 2024.��
4. Aggregate national sales estimates of packaged alcohol retailers calculated by the Australian Institute for Health & Welfare, from 2013/2014 through 2023/2024.��

We calculated the ratio of alcohol sales by type of drink to establish the predominant drink type profile in each dataset and compare the drink type profiles across the different datasets.����

Results: Preliminary results indicate that same-day delivery alcohol sales patterns may more closely resemble the sales patterns of on-premises alcohol outlets, particularly with regards to the sale of spirits and premixed spirits.����

Implications for Policy: Based on preliminary results same-day delivery alcohol sales patterns, and therefore risk profiles more closely resemble the alcohol sales patterns and risk profiles associated with on-premise alcohol sales. Continued collection of retail sales may be warranted.��

Disclosure of Interest Statement: The National Drug and Alcohol Research Centre and The National Drug Research Institute are funded by the Australian Government Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian government. The authors have never received any funding from the alcohol industry.��

Evidence-Based Practice in the Australian Alcohol and Other Drug Workforce: A Cross-Sectional Survey ��

Lucinda Flood, Brendan Clifford, Krista Siefried, Kathryn Fletcher, Carolyn Mazariego, Dora Karavasilis

Introduction: Understanding the barriers and facilitators to evidence-based practice (EBP) is crucial for translating research into practice. This study aimed to explore potential barriers and facilitators to EBP in the Australian AOD sector.  ��

Methods: A national cross-sectional online survey using the Evidence-Based-Practice Inventory (EBPI) was distributed to Australian AOD professionals via email. The EBPI examined attitudes, subjective norms, perceived behavioural control, decision making and intention/behaviour towards EBP.  ��

The EBPI Likert scores for each of these dimensions were dichotomised into positive scores and negative scores. Univariate logistic regressions were used to examine relationships between respondents' workplace characteristics and EBPI scores. ��

Results: The survey was completed by 110 respondents. Overall, there was a positive response to EBP within all 5 dimensions. The highest scoring positive items within the EBPI identified favourable attitudes towards EBP (97%) supportive management (85%) and workplace culture (88%), and the perceived capacity to enact EBP (95%). The lowest scoring EBPI items included perceived lack of autonomy to individualise EBP (16%), challenges in staying current with research (19%), competing clinical priorities (21%) preference for obtaining information from colleagues (35%) and using clinical experience (24%) rather than quantitative data (36%). Several workplace characteristics increased the likelihood of a positive EBPI score in at least three of the five dimensions, despite not being statistically significant. ��

Discussions and Conclusions: Frontline professionals in the Australian AOD sector had an overall positive understanding, perception, and application of EBP. ��

Implications for Practice or Policy: The overall positive perception of EBP could be leveraged to address views that EBP does not account for clinician experience and the need to individualise EBP within Australian AOD services. Difficulty keeping up with latest AOD research indicates the need for protected research and education time, and innovating on strategies for research dissemination, such as clinical champions and communities of practice. ��

Disclosure of Interest Statement: This study was completed for a Master of Public Health research project with ���������¼�, Sydney. This study was funded by the National Centre for Clinical Research on Emerging Drugs (NCCRED). NCCRED receives funding from the Commonwealth Department of Health and Aged Care, Australia. The authors declare no other conflicts of interest. ��

Health, social and recidivism outcomes among people who have been incarcerated in New South Wales, Australia: The Prison Outcomes STudy (POST)

Santo T Jr, Bharat C, Farrell M, Doyle M, Stone J, Hickman M1, Martinello M, Weatherburn D, Dean K, Coyte J, Macdonald C, Harrod M E, Grant L, Larman G, Vickerman P, McGrath C, Thompson P, Churchill A, Dore G, Degenhardt L

Introduction: People who experience incarceration face disproportionate drug-related, mental health and social harms, yet data on post-release care remain limited. The Prison Outcomes STudy (POST) is a data linkage study that aims to quantify post-release health and social outcomes, assess access to and effectiveness of treatment and services for drug dependence and serious mental illness, and project the impact of expanding intervention coverage.��

Methods: The POST cohort was established using linked administrative data for all adults (≥18 years) admitted to full-time custody in New South Wales (NSW) between 2000 and 2022. Custody records were probabilistically linked to 15 health, justice and mortality datasets. We report baseline sociodemographic and custody characteristics and the frequency of key post-release events, including adverse health and social outcomes and service engagement for drug dependence and mental health, stratified by sex. The study protocol outlines cohort construction, linkage processes, outcome definitions and planned analyses that will support future evaluations and modelling, including analyses focused on priority subpopulations.��

Results: The cohort includes 200,486 adults, 15% of whom were women (n = 30,457), incarcerated since 2000 at a median age of 30 years (IQR 23–39) at first reception. The median number of custodial episodes was 2 (IQR 1–4) and the median duration per episode was 5 days (IQR 1–104). Participants contributed 2,229,633 person-years of follow-up, with 12% (person-years = 257,852) spent in custody. Emergency department presentations were recorded for 81% of the cohort (n = 162,315), and 6.7% (n = 13,394) died during follow-up. Service engagement included contact with community mental health services for 48% (n = 95,563) and alcohol and other drug treatment for 27% (n = 54,100).��

Implications: People leaving prison often face major health problems and limited support. This study highlights the urgent need to improve treatment for mental illness and drug use after release. Improving access to mental health and drug treatment could enhance outcomes and reduce reoffending. Future research using POST will explore how different types of support can reduce harm and improve outcomes for people returning to the community.��

An Australia-wide analysis (2014 – 2024) of prescription benzodiazepine use across age and sex

Masako Araki, Alys Havard, Duong Tran, Malcolm B. Gillies, Julia Lappin, Sallie-Anne Pearson, Juliana de Oliveira Costa

Introduction: The risk of harms from benzodiazepine use increases with long-term use and concurrent medicines, particularly among young people and older adults. However, contemporary Australian data on prescription benzodiazepine initiation and patterns of use are limited.��

Aims: We described trends (2014–2024) in prescription benzodiazepine initiation, according to medicine category, sex and age. We also quantified duration of use and concurrent psychoactive medicine use among people initiating benzodiazepines in 2023.

Methods: We analysed a 10% random sample of nationwide Pharmaceutical Benefits Scheme dispensing records. We quantified the number of people per year initiating benzodiazepines (no benzodiazepine dispensings in the 12 months prior) by category (anxiolytics or sedative-hypnotics), sex and age group (10–14, 15–18, 19–24, 25–39, 40–64, ⩾65 years). Among people initiating benzodiazepines in 2023, we calculated the number of dispensings in the subsequent 12 months. We defined concurrent use of psychoactive medicines as a dispensing within ±30 days of benzodiazepine initiation, and calculated the proportion with concurrent use for each psychoactive class.��

Results:��From 2014 to 2024, benzodiazepine initiation declined overall from female from 51.3 to 39.7 (–22.6%) and male from 34.5 to 24.8 per 1,000 (–28.1%), yet remained more frequent among females than males (female/male ratio 1.6) and highest in those aged 65+ (62.6 per 1,000 females, 42.8 per 1,000 males). There was a decline in the trend of sedative-hypnotic initiation across ages, whereas anxiolytic initiation remained stable among younger females and mid-aged adults. Among 74719 initiators in 2023, one-third had ≥2 dispensings, and half were dispensed concurrent psychoactive medicines, most often SSRIs, opioids and lithium (19.8%, 17.5%, 12.9%).

Implications:��Although initiation of prescription benzodiazepines declined, current levels remained high as did the prevalence of repeated dispensings and concurrent psychoactive medicine use. To reduce harm, guidance tailored to these patterns is needed.����

The association of mental disorders on OAT retention: A systematic review and meta-analysis

Tran L.T, McKetin R, Clark B, Macdonald C, Zahra E, Degenhardt L

Introduction: Comorbid substance use disorders and mental disorders (SUD-MD) are associated with poorer treatment completion. It has been previously suggested that treating opioid use disorder (OUD) with pharmacology, such as opioid agonist therapy (OAT), may reduce the retention gap between people with OUD-MD and OUD only.����

Aim: Noting the high OUD-MD prevalence, we aimed to evaluate the impact of mental health comorbidities on OAT retention through a systematic review and meta-analyses.����

Methods: PubMed, EMBASE and PsycINFO databases were searched for studies reporting buprenorphine and methadone treatment retention outcomes among people with OUD. Included studies reported on treatment retention at any time point among participants with OUD-MD and OUD only. Baseline MD groupings were any mental disorders, mood disorders (e.g., depression), anxiety disorders (e.g., PTSD), psychotic disorders (e.g., schizophrenia), ADHD and personality disorders. Pooled risk ratios (RR) for buprenorphine and methadone treatment retention were estimated through STATA 18.��

Results: 48 cohorts were identified, with 54% being buprenorphine cohorts. Any MH disorder analyses on 12-month buprenorphine (k=9) and methadone (k=6) retention had the highest number of included studies, with no significant impact on retention. Compared to people without these specific diagnoses, people with mood disorders (k=1, RR12m: 1.28, RR24m: 1.35) or personality disorders (k=3, RR12m: 1.17, RR24m: 1.22) were significantly less likely to be in buprenorphine treatment at 12 and 24 months (p<.05). However, people with personality disorders were more likely to be in methadone treatment at 24 months (k=1, RR: 0.83, p<.05).����

Discussion and Conclusions: This systematic review synthesises and evaluated global evidence of mental health comorbidity on treatment retention for the first time. Our results indicate that the impact of MH on OAT retention is greatest at 24 months. However, the small number of cohorts contributing to the majority of analyses should be noted.����

Disclosure of Interest: NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Programme. Work on this review was also supported by the ASCEND NHMRC Program (grant APP1150078). LTT is supported by NHMRC PhD and NDARC Higher Degree Research Scholarships. LD has received investigator-initiated untied educational grants for studies of opioid medications in Australia from Indivior and Seqirus in the past 3 years. LD is supported by an NHMRC Investigator (Leadership L3).��

Are methamphetamine users at increased risk of physical violence? Results from a nationally representative sample

Christel Macdonald, Rebecca McKetin & Don Weatherburn

Background and aims: No previous study using a nationally representative survey has examined the association between methamphetamine use and violent victimisation. The aim of the current study was to fill this gap in research.����

Methods: Using data from the Household, Income and Labour Dynamics in Australia Survey (HILDA) in 2017 and 2021, we analysed data from 18,805 individuals aged 15 years or over. The dependent variable was whether a respondent reported having been a victim of violence in the past 12 months. The main independent variable of interest was the frequency of methamphetamine use in the past 12 months (less than monthly vs. monthly or more often). Co-variates included age, gender, financial stress, personal stress, social isolation, cocaine use and risky drinking. Analyses were stratified by gender.��

Findings: 284 respondents reported methamphetamine use in the past year, of whom 53 reported victimisation. The odds of being a victim of violence in the preceding 12 months were higher for those who used methamphetamine every few months (aOR 3.10; 95% CI 1.84 – 5.19) and once a month or more often (aOR 5.98; 95% CI 3.53 – 10.11) than those who did not use methamphetamine. Among women, the odds of being a victim of violence in the preceding 12 months were higher for those who used methamphetamine every few months (aOR 6.43; 95% CI 3.31 – 12.49) or at least once a month (aOR 11.39; 95% CI 5.37 – 24.16) than for those who did not use methamphetamine. We only observed a significant effect of methamphetamine use frequency and violence victimisation in men that used at least once a month (aOR 3.67 95% CI 1.70 – 7.93). Higher risks of violent victimisation was also associated with being aged 15-26, risky drinking (aOR 1.70; 95% CI 1.14 – 2.54), financial stress (aOR 3.99; 95% CI 3.01 – 5.30), personal stress (aOR 3.19; 95% CI 2.43 – 4.20) and social isolation (aOR 2.23; 95% CI 1.72 – 2.89).����

Implications: Methamphetamine use is associated with an elevated risk of being a victim of violence and this risk is higher for women compared to men. Contextual factors like stress, isolation and risky drinking contribute to this risk.��

Working with multicultural communities to advance equity in alcohol and other drug (AOD) service delivery: Practice-based insights from Western and Southwestern Sydney

Nirekha De Silva (Odyssey House NSW), Teguh Syahbahar (Odyssey House NSW), David Kelly (Odyssey House NSW), Dennis Kaip (Odyssey House NSW), Winifred Asare-Doku (NDARC), Stella Settumba Stolk (NDARC) Catherine Foley (NDARC)��

The intersection of cultural identity, systemic marginalization, and health inequity presents unique challenges for Culturally and Linguistically Diverse (CALD) communities in accessing alcohol and other drug (AOD) services. Despite increasing policy commitments to equity and inclusion, many CALD populations remain underrepresented in treatment data, underserved by mainstream services, and overlooked in sector-wide research. This presentation draws on practice-based evidence from the Odyssey Multicultural Program in Western Sydney to examine how community-informed strategies can enhance service accessibility, engagement, and outcomes for CALD communities affected by AOD use.��

Using a qualitative practice inquiry approach, the presentation outlines field-based strategies developed through sustained engagement with multicultural and multifaith communities. These include informal partnerships with cultural brokers, the use of narrative-informed brief interventions sensitive to cultural meaning-making, and the integration of family and community networks into the support continuum. These approaches have shown promise in reducing service disengagement, supporting early help-seeking, and fostering culturally meaningful recovery pathways.��

The analysis is framed within the context of health equity and structural competency, highlighting how culturally responsive AOD practice can function as both a therapeutic and a structural injustice act. The presentation concludes by identifying key implications for research translation, including the need for culturally disaggregated data, investment in multilingual peer workforces, and ethical frameworks for community-led co-design in the AOD sector.��

Toward evidence-guided strategies for whole-person treatment for methamphetamine use

Professor Steven Shoptaw

This talk presents recent evidence of acute and chronic biologic and neuropsychiatric effects of methamphetamine. This includes findings on inflammation in gut and in circulating blood, on pulmonary arterial hypertension and on cognition and decision making.  Findings are brought forward to consider opportunities and challenges to scaling up integrated care strategies for methamphetamine treatment, which in future may be fielded from primary care and specialty care settings, especially infectious diseases, pulmonary, and psychiatry.  ��