Optimizing Digital Tools for the Field of Substance Use and Substance Use Disorders: Backcasting Exercise.

BACKGROUND: Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities. OBJECTIVE: This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030. METHODS: A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders' collaborative engagement during the 2022 Lisbon Addiction Conference. RESULTS: The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis. CONCLUSIONS: The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones.

Mortality in the SuperMIX cohort of people who inject drugs in Melbourne, Australia: a prospective observational study.

AIMS: To measure mortality rates and factors associated with mortality risk among participants in the SuperMIX study, a prospective cohort study of people who inject drugs. DESIGN: A prospective observational study using self-reported behavioural and linked mortality data. SETTING: Melbourne, Australia. PARTICIPANTS/CASES: A total of 1209 people who inject drugs (67% male) followed-up between 2008 and 2019 for 6913 person-years (PY). MEASUREMENTS: We linked participant identifiers from SuperMIX to the Australian National Death Index and estimated all-cause and drug-related mortality rates and standardized mortality ratios (SMRs). We used Cox regression to examine associations between mortality and fixed and time-varying socio-demographic, alcohol and other drug use and health service-related exposures. FINDINGS: Between 2008 and 2019 there were 76 deaths in the SuperMIX cohort. Of those with a known cause of death (n = 68), 35 (51%) were drug-related, yielding an all-cause mortality rate of 1.1 per 100 PY [95% confidence interval (CI) = 0.88-1.37] with an estimated SMR of 16.64 (95% CI = 13.29-20.83) and overall accidental drug-induced mortality rate of 0.5 per 100 PY (95% CI = 0.36-0.71). Reports of recent use of ambulance services [adjusted hazard ratio (aHR) = 3.77, 95% CI =1.78-7.97] and four or more incarcerations (aHR = 2.78, 95% CI = 1.55-4.99) were associated with increased mortality risk. CONCLUSIONS: In Melbourne, Australia, mortality among people who inject drugs appears to be positively associated with recent ambulance attendance and experience of incarceration.

Profile and correlates of colorimetric reagent kit use among people who use ecstasy/MDMA and other illegal stimulants in Australia.

BACKGROUND: Colorimetric reagent kits can provide information about the compounds present in drug samples. This study aimed to identify patterns and correlates of colorimetric reagent kit use, as well as behavioural outcomes of testing, amongst people who use illegal stimulants in a context that lacks permanent government-sanctioned drug checking services. METHODS: Australians residing in capital cities who reported regularly using ecstasy/MDMA and/or other illegal stimulants ≥monthly in the past six months were recruited via social media and word-of-mouth from April-July 2019 (N = 792). Participants were asked about testing the contents and/or purity of illegal drugs, and features of last colorimetric reagent kit use. Logistic regression identified correlates of last using a kit (referent: no use of drug checking technology to test drug contents/purity in the past year). RESULTS: Over one-third (36%) reported testing drug contents and/or purity; of this group, 86% had last used a colorimetric reagent kit. On the last occasion, 52% reported someone else had conducted testing; 58% said testing occurred <24 h before planned drug use; and 24% reported testing for quantity of a substance. Correlates of drug checking comprised: being younger, male, past six-month use of new psychoactive substances, accessing community-based health services for alcohol or other drug reasons, selling drugs for cash profit, obtaining information from peers who had tried the drug, and searching online for reports of the drug by stamp/appearance. The majority (84%) tested a substance they had been sold and/or given as MDMA; of these, 87% detected MDMA. Of those who expected and detected MDMA, 29% and 11% reported results to their peers and dealer, respectively. CONCLUSION: People who use ecstasy/MDMA and/or other illegal stimulants seek out objective information about substance contents. In countries that lack permanent government-sanctioned drug checking services, it is important to acknowledge that people already engage in drug checking but with suboptimal technologies and without tailored specialist advice and education.

Are there differences in individual-level needle and syringe coverage across Australian jurisdictions related to program policy? A preliminary analysis.

INTRODUCTION AND AIMS: Services provided by needle and syringe programs (NSP) within Australia are easily accessible by international standards. However, important variation in NSP policy remains across Australian jurisdictions. The potential impacts of these variations on program operation for clients have not been systematically analysed in Australia. In this paper we conduct a preliminary examination to compare individual-level syringe coverage between and within Australian capital cities. DESIGN AND METHODS: Participants were 2498 people who inject drugs (PWID) recruited from all Australian capital cities as part of the annual Illicit Drug Reporting System PWID survey over the period 2014-2016. Insufficient coverage was defined when <100% of a participant's injecting episodes were 'covered' by sterile needles and syringes. We report the percentage of insufficient coverage for each capital city for each year, and present descriptive statistics for coverage parameters, and an alternative measure for insufficient coverage, as Supporting Information. RESULTS: Differences in behaviours that have the potential to impact syringe coverage were highly variable over time and place leading to variations in levels of insufficient coverage between and within all cities. Overall, insufficient coverage was most evident in larger cities where insufficient coverage varied between 19% and 23% (Sydney) over time, compared to smaller cities with variation from 9% to 12% (Adelaide). DISCUSSION AND CONCLUSIONS: We found no consistent pattern of differences in individual-level needle and syringe coverage between and within Australian capital cities. Further work is needed to fully evaluate whether policy variation between Australian jurisdictions impacts on NSP coverage.

Auditory event-related potentials differ in dyslexics even when auditory psychophysical performance is normal.

Developmental dyslexia is characterized by a phonological processing deficit and impaired low-level auditory processing may contribute to this problem. However, this remains controversial because not all dyslexic individuals show psychophysical deficits on auditory processing tasks; hence it has been argued that auditory processing deficits are not a causal factor in dyslexia. Because behavioral psychophysical tasks include both bottom-up processing and top-down strategies, dyslexics' successful coping strategies may positively influence their performance on auditory behavioral measures. Therefore we have studied whether dyslexics who perform adequately on auditory psychophysical tasks nevertheless show electrophysiological evidence of impaired auditory processing. We compared auditory event-related mismatch negativity (MMN) potentials to frequency modulated (FM) tones at 5, 20 and 240 Hz between dyslexic adults and controls. Groups were matched for age, cognitive ability and psychophysical FM detection thresholds. The dyslexic group showed significantly smaller MMNs in the 20 Hz FM condition in both the early (150-300 ms, P=0.010) and late (300-500 ms, P=0.049) time frames. A 2-way ANOVA showed a significant group by FM rate interaction (P=0.012). There were no significant differences between the groups in the 5 Hz or 240 Hz conditions. The magnitude of the 20 Hz FM MMN correlated with the degree of discrepancy between cognitive and literacy skills (0.66, P=0.003) in the entire group. Thus, even among compensated dyslexics with above-average cognitive abilities and adequate performance on auditory psychophysical tasks, the MMN responses of some dyslexic adults were found to be abnormal.

The syntrophin-dystrobrevin subcomplex in human neuromuscular disorders.

The syntrophins and alpha-dystrobrevin form a subcomplex with dystrophin at the skeletal muscle membrane, and are also highly concentrated at the neuromuscular synapse. Here we demonstrate that the different syntrophins and alpha-dystrobrevin isoforms have distinct expression patterns during human skeletal muscle development, and are differentially affected by loss of dystrophin anchorage and denervation in human neuromuscular disease. During normal fetal development, and in Duchenne muscular dystrophy and denervation disorders, alpha1-syntrophin and alpha-dystrobrevin are absent or markedly reduced at the sarcolemmal membrane. beta1-Syntrophin is the predominant syntrophin isoform expressed at the muscle membrane during development, and it undergoes upregulation in response to loss of alpha1-syntrophin in Duchenne muscular dystrophy and in denervation. Upregulation of beta1-syntrophin in neuromuscular disorders is associated with re-expression of the fetal nicotinic acetylcholine receptor gamma-subunit, cardiac actin, and neonatal myosin, suggesting reversion of muscle fibers to an immature phenotype. We show that denervation specifically affects expression of the syntrophin-dystrobrevin subcomplex and does not affect levels or localization of other members of the dystrophin-associated protein complex. Our results confirm that dystrophin is required for anchorage of the syntrophin-dystrobrevin subcomplex and suggest that expression of the syntrophin-dystrobrevin complex may be independently regulated through neuromuscular transmission.

Auditory processing efficiency and temporal resolution in children and adults.

Children have higher auditory backward masking (BM) thresholds than adults. One explanation for this is poor temporal resolution, resulting in difficulty separating brief or rapidly presented sounds. This implies that the auditory temporal window is broader in children than in adults. Alternatively, elevated BM thresholds in children may indicate poor processing efficiency. In this case, children would need a higher signal-to-masker ratio than adults to detect the presence of a signal. This would result in poor performance on a number of psychoacoustic tasks but would be particularly marked in BM due to the compressive nonlinearity of the basilar membrane. The objective of the present study was to examine the competing hypotheses of "temporal resolution" and "efficiency" by measuring BM as a function of signal-to-masker interval in children and adults. The children had significantly higher thresholds than the adults at each of the intervals. Subsequent modeling and analyses showed that the data for both children and adults were best fitted using the same, fixed temporal window. Therefore, the differences in BM threshold between adults and children were not due to differences in temporal resolution but to reduced detection efficiency in the children.

Phonological categorization of vowels: a mismatch negativity study.

There is electrophysiological evidence that phonological categorization has occurred within 100-200 ms post stimulus onset for the syllables /tae/ and /dae/, which vary in voice onset time. Using a similar paradigm, this study investigated when phonological categorization occurred for the contrast between /I/ and /epsilon/, using synthesized speech tokens that differed in the frequency of the first formant. Here we show that phonological categorization of these tokens has not occurred 100-200 ms after stimulus onset. However, the presence of a late mismatch negativity (350 ms after stimulus onset) indicated that phonological categorization had taken place by this time.