Investigating Differences Between Drugs Used in the Australian Night-Time Economy: Demographics, Substance Use, and Harm

Preloading with drugs before entry to the nighttime entertainment district: presentation, intoxication rates, and effects of police presence during assessment

BACKGROUND

Past research has either focused on alcohol or drug preloading before a night out, but not on the interaction between them. With increased risks of harm through interaction effects, we wished to build upon previous research in this area. We sought to determine who drug preloads, why do people engage in this practice, what drug/s are people using, and how inebriated they are as they enter the NED. Additionally, we examined what impact varying levels of police presence has on the collections of sensitive data in this context.

METHODS

We captured estimates of drug and alcohol preloading from 4723 people entering nighttime entertainment districts (NEDs) in Queensland, Australia. Data collection occurred under three varying conditions of police presence (i.e., no police present, police present but not engaging with participants, and police engaging with participants).

RESULTS

People who admitted to preloading drugs were found to be younger in age than non-drug admitters, more likely to be male than female, use one type of drug (mostly stimulants) rather than multiple (if we exclude alcohol), significantly more intoxicated upon arrival, and more subjectively affected from their use of alcohol and drugs as Breath Approximated Alcohol Concertation levels increased. People were more likely to admit having used drugs in the absence of police, but this had only a small effect.

CONCLUSIONS

People who drug preload are a vulnerable subset of the youth population that is susceptible to experiencing harms in this context. As they drink more alcohol, they experience higher affects than those who do not report to also take drugs. Police engagement through service rather than force may mitigate some risks. Further enquiry is needed to better understand those who engage in this practice and to have quick, cheap, objective tests of what drugs these people are using.

Adverse outcomes of GHB use: Analysis of ambulance attendances in metropolitan and regional Victoria

BACKGROUND

Gamma-hydroxybutyrate (GHB) use and attributable harms have been increasing in Australia, however changes over time, including the impact of COVID-19 lockdowns and restrictions on harms requiring an ambulance attendance, are unknown. This study utilised a novel population-based surveillance system to identify the types of GHB-related harms between January 2018 and 31 December 2021 in Victoria, Australia.

METHODS

A cross-sectional, retrospective analysis of all GHB-related ambulance attendances between January 2018 and 31 December 2021 in Victoria, Australia was undertaken. Paramedic clinical notes and Glasgow Coma Scale scores were used to assess conscious state. Event codes were classified using dispatch information available in the database. Crude rates (per 100,000 population) and descriptive analyses were calculated for metropolitan and regional settings. Adjusted Odds ratios (aOR) with 95% confidence intervals [95% CI] were used to assess the relationship between GCS severity and polysubstance combinations with GHB.

RESULTS

There were 6,836 ambulance attendances for GHB recorded during the study period. A statistically significant increase in GHB-related attendance numbers was observed State-wide in 2019 (n = 1,402, p<0.001) and 2020 (n = 2,622, p<0.001), when comparing year on year attendances. While both numbers and rates (per 100,000 population) of GHB-related attendances were significantly lower in regional areas, significant increases were evident in both metropolitan and regional areas in 2019 and 2020 (both p<0.001). Attendances involving GHB and alcohol had higher odds of a severe GCS score (aOR:1.25; 95%: 1.04-1.49; p<0.019). A high proportion of GHB-attendances involved harms of significant concern including: overdose (56%) and a loss of, or altered state of consciousness (45%).

CONCLUSIONS

We observed increases in GHB-related ambulance attendances over time in both metropolitan and regional areas, placing a significant burden on ambulance services. Our study demonstrates the value of using ambulance surveillance to obtain representative data on acute GHB-related harms.

Illicit drug use and male barroom aggression among members of the Australian construction industry: Associations with personality and masculinity factors

Introduction

Illicit drug use has been found to increase the risks of male barroom aggression (MBA). Personality traits such as dispositional aggressiveness have been associated with illicit substance use and aggressive behaviour, along with social normative masculinity factors. The present study assessed the relationships between illicit drug use, key personality (trait aggression, impulsivity, narcissism) and masculinity (conformity to masculine norms, male honour) variables with physical MBA perpetration and victimisation among male Australian construction workers.

Methods

A purposive, high‐risk sample of male construction workers aged 18–69 years (n = 476, M_age = 25.90 years, SD_age = 9.44) completed interviews at their place of work or training.

Results

Participants reported high rates of both physical MBA perpetration (21%; n = 100) and victimisation (31.1%; n = 148) as well as any illicit drug use (33.61%; n = 160). Logistic regressions revealed the use of amphetamine‐type stimulants (methamphetamine, ecstasy) was associated with violence perpetration, even after accounting for high‐intensity drinking (HID) which was the strongest predictor of MBA involvement. Trait variables (Trait Physical aggressiveness, narcissism) and the masculine norm CMNI Violence were also risk factors for MBA perpetration while CMNI Playboy was protective against MBA.

Discussion and Conclusions

The use of amphetamine‐type stimulants is a risk‐factor for MBA perpetration, as are key personality traits such as aggressiveness and narcissism. Most aspects of masculinity, including male honour, were either unrelated to or protective against involvement in physical violence in bars, clubs or pubs.

Interaction of Energy Drinks with Prescription Medication and Drugs of Abuse

In recent years, the consumption of energy drinks (EDs) has become increasingly popular, especially among adolescents. Caffeine, a psychostimulant, is the main compound of EDs which also contain other substances with pharmacological effects. This review aims to compile current evidence concerning the potential interactions between EDs, medicines, and drugs of abuse as they are frequently consumed in combination. The substances involved are mainly substrates, inductors or inhibitors of CYP1A2, psychostimulants, alcohol and other depressant drugs. Furthermore, intoxications reported with EDs and other substances have also been screened to describe acute toxicity. The results of our review show that the consumption of both EDs alone and in combination is not as safe as previously thought. Health professionals and consumers need to be aware of the potential interactions of these drinks as well as the absence of long-term safety data.

A Proposal for a Taxonomy of Pre-Loading

Background: Pre-loading of alcohol and other drugs has become a prevalent start to nights out in many countries. Studies into pre-loading have been using different operational definitions and descriptions, leading to confusion and debate in the research literature. Purpose/Objective: We wish to propose a full taxonomy so that research into preloading, of any substances, can be specific and standardized. Methods: We address this problem by analyzing (1) terminology used throughout the literature, (2) the evolving nature of this phenomenon, and (3) the operational components comprising this substance use practice. Additionally, we provide a context and rationale for how we view pre-loading in relation to the broader event-level session. Results: Our results propose a full operational definition and taxonomy of pre-loading to be used, and built upon, by researchers. We also provide a visual representation of pre-loading within an event-level session and provide a method to facilitate consistency across cultures. Conclusions: We propose that this system will lead to greater specificity and higher reliability in the interpretation of research results.

Nightlife scene involvement and patterns of prescription drug misuse

INTRODUCTION AND AIMS

Participation in nightlife influences a range of health behaviours. Participants in various nightlife scenes have increasingly adopted prescription drug misuse into their substance use repertoires.

DESIGN AND METHODS

With 404 young adults recruited via time-space sampling in New York, we examine the relationship of nightlife participation-measured by number of scenes and the number of nights out in nightlife scenes-to prescription drug misuse during the past 3 months. Outcomes included frequency of misuse, escalation to non-oral consumption, polydrug use, social problems and symptoms of dependence.

RESULTS

Negative binomial regressions indicate nightlife participation is associated with increased frequency of misuse measured by number of scenes (incidence rate ratio = 1.114, P < 0.05) and number of nights out (incidence rate ratio = 1.009, P < 0.001). Logistic regression models show nightlife participation is associated with increased odds of non-oral use (adjusted odds ratio; AOR = 1.334, P < 0.01) and polydrug use (AOR = 1.776, P < 0.001) measured by number of scenes, and non-oral use (AOR = 1.021, P < 0.001) and polydrug use (AOR = 1.023, P < 0.001) as measured by number of nights out. Nightlife participation is not associated with prescription drug problems or symptoms of dependence. Frequency of participation is associated with peer norms favourable to prescription drugs (B = 0.003, P < 0.01).

DISCUSSION AND CONCLUSIONS

Nightlife participation has implications for prescription drug misuse. While shaping how often and in what manner young people consume prescription drugs, nightlife participation is not associated with harms experienced. Given the significance of the prescription drug trend in many world regions, these results suggest that increasing participation in nightlife shapes patterns of drug use, but in ways that do not lead to reported problems.

Aggression in the Australian night time economy: A comparison of alcohol only versus alcohol and illicit drug consumption

INTRODUCTION AND AIMS

Associations between substance use and aggression may be amplified by simultaneous alcohol and illicit drug use. This study aims to compare differences in involvement in past aggression between people who use different substances while accounting for broader risk propensity.

DESIGN AND METHODS

Self-reported data on past three-month involvement in verbal and physical aggression (victim or perpetrator) were drawn from interviews conducted in night-time entertainment districts in seven Australian cities (n = 5078). Using inverse probability of treatment weighting techniques, participants who reported alcohol versus alcohol and illicit drug use on the night of interview (including ecstasy, cannabis and other illicit stimulant subgroups) were weighted on the basis of drug use risk covariates (e.g. alcohol consumed, gender) to determine differences in involvement in aggression involvement.

RESULTS

After weighting for covariates, individuals who reported consuming any illicit drug + alcohol and ecstasy + alcohol combinations were more likely to be involved in physical (33% and 105%, respectively) and verbal (36% and 116%, respectively) aggression in the previous 3-months when compared to those who consumed alcohol only. Cannabis + alcohol and other illicit stimulant + alcohol combinations were no more likely to be involved in either forms of aggression.

DISCUSSION AND CONCLUSIONS

The likelihood of having been involved in past aggressive incidents was higher among those who reported any illicit drug + alcohol and ecstasy + alcohol combinations than those who reported alcohol exclusively, after accounting for covariates. These findings highlight individuals that may benefit most from the development of tailored health promotion/preventative safety interventions in night-time settings.

Comparing levels of blood alcohol concentration and indicators of impairment in nightlife patrons

INTRODUCTION AND AIMS

Breathalyser estimate of blood alcohol concentration (BAC) is widely used as an objective intoxication measure, but is not always practical in nightlife contexts. This study uses in situ data collected in nightlife environments to explore how four measures of intoxication are related so as to inform the development of a more practical and reliable method of differentiating intoxication for people working in the night-time economy.

DESIGN AND METHODS

Nightlife patron interviews were conducted in five Australian cities. Participants completed demographic questions and were asked about current session (past 12 h) alcohol use, and four different measures of intoxication were assessed: BAC, participant's self-reported intoxication (0-10), interviewer rating of the participant's intoxication (0-10) and interviewer-rated number of the participants' of physical signs of intoxication.

RESULTS

A total of 7028 patrons were surveyed and n = 5273 included in analysis. Mean age was 23.9 years (SD = 6.36); 61.5% were male. There was a significant difference in occurrence of all observable intoxication symptoms across differing levels of BAC (P < 0.001). All visible symptoms became more common as intoxication increased, except for talking very quickly/talkative and giggly symptoms. As BAC levels increase, the extent of the disagreement between self-rated and interviewer-rated intoxication measures widens. Exhibiting four or more visible intoxication symptoms emerged as a reliable method for observers to identify intoxicated patrons.

DISCUSSION AND CONCLUSIONS

As BAC increases, people become worse at estimating their own intoxication, but sober observers remain relatively accurate. Findings provide support for efforts to strengthen and enforce responsible service of alcohol.

The need for accuracy and validity in research on nightlife and drinking: A commentary on Devilly et al. and recommendations for future research

Research on nightlife and drinking faces many unique challenges, and validity in research is an important concern. A recent publication by Devilly et al. entitled "SmartStart: Results of a large point of entry study into preloading alcohol and associated behaviours" contains definitions and assumptions about prior work that require more careful consideration. Important issues include: using a definition of pre-drinking which is the same as previous work so that valid comparison can be made, reporting of blood alcohol concentration (BAC) levels that comply with other work, accurate reporting of response rates, and careful consideration of sampling approaches to maximise ethical integrity. Ensuring consistency of definition and accurate representation of previous literature regarding BAC, pre-drinking and energy drink use, is important for supplying the broader community with reliable information on which policy decisions can be made.