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  1. Article ; Online: Trends in smoking during pregnancy stratified by the use of opioid agonist therapy and the contribution of smoking to poor outcome in neonates prenatally exposed to opioid agonist treatment.

    Kelty, Erin / Havard, Alys / Preen, David B

    Archives of women's mental health

    2023  Volume 26, Issue 4, Page(s) 543–548

    Abstract: High rates of cigarette smoking have been observed in pregnant women on opioid agonist therapy (OAT). However, it is unclear if these rates have changed overtime in line with the general population and the degree to which smoking contributes to poor ... ...

    Abstract High rates of cigarette smoking have been observed in pregnant women on opioid agonist therapy (OAT). However, it is unclear if these rates have changed overtime in line with the general population and the degree to which smoking contributes to poor outcomes in neonates born to women on OAT. Women who gave birth in Western Australia (WA) between 2003 and 2018 were identified from whole-population midwives records. Linked records were used to identify women who had been dispensed OAT during pregnancy and those who had smoking during pregnancy. Temporal changes in smoking during pregnancy were examined for women on OAT (n = 1059) and women not on OAT (n = 397,175) using Joinpoint regression. In women treated with OAT during pregnancy, neonatal outcomes were compared between smoking and non-smoking women using generalised linear models. During the study period, 76.3% of women on OAT smoked during pregnancy compared with 12.0% of the general population. There was a decrease in the prevalence of smoking during pregnancy among women not on OAT (APC: - 5.7, 95%CI: - 6.3, - 5.2), but not in women on OAT (APC: 0.8, 95%CI: - 0.4, 2.1). For women receiving OAT, smoking was associated with an increased odds of low birth weight (OR: 1.57, 95%CI: 1.06, 2.32) and neonatal abstinence syndrome (OR: 1.34, 95%CI: 1.01, 1.78) compared with non-smoking. Despite reductions in the prevalence of smoking during pregnancy in the general population, similar reductions have not occurred in pregnant women on OAT. The high prevalence of smoking in pregnant women on OAT is contributing to poor neonatal outcomes.
    MeSH term(s) Infant, Newborn ; Pregnancy ; Female ; Humans ; Analgesics, Opioid/therapeutic use ; Methadone/therapeutic use ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/complications ; Opioid-Related Disorders/drug therapy ; Buprenorphine/therapeutic use ; Opiate Substitution Treatment ; Pregnancy Complications/drug therapy ; Pregnancy Complications/epidemiology ; Parturition
    Chemical Substances Analgesics, Opioid ; Methadone (UC6VBE7V1Z) ; Buprenorphine (40D3SCR4GZ)
    Language English
    Publishing date 2023-06-27
    Publishing country Austria
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1463529-X
    ISSN 1435-1102 ; 1434-1816
    ISSN (online) 1435-1102
    ISSN 1434-1816
    DOI 10.1007/s00737-023-01342-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Questions about the validity of the binge or heavy drinking criterion have implications for more than just treatment evaluation.

    Havard, Alys

    Addiction (Abingdon, England)

    2016  Volume 111, Issue 10, Page(s) 1731–1732

    Abstract: Commentary to: Questioning the validity of the 4+/5+ binge or heavy drinking criterion in college and clinical populations. ...

    Abstract Commentary to: Questioning the validity of the 4+/5+ binge or heavy drinking criterion in college and clinical populations.
    MeSH term(s) Binge Drinking ; Universities
    Language English
    Publishing date 2016-03-01
    Publishing country England
    Document type Journal Article ; Comment
    ZDB-ID 1141051-6
    ISSN 1360-0443 ; 0965-2140
    ISSN (online) 1360-0443
    ISSN 0965-2140
    DOI 10.1111/add.13294
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Tobacco use during pregnancy.

    Havard, Alys / Chandran, Jonathan James / Oei, Ju Lee

    Addiction (Abingdon, England)

    2022  Volume 117, Issue 6, Page(s) 1801–1810

    Abstract: The use of tobacco during pregnancy is the leading preventable cause of pregnancy complications and adverse birth outcomes. In high-income countries, around one in 10 pregnant women smokes tobacco, while smokeless tobacco is the primary form of tobacco ... ...

    Abstract The use of tobacco during pregnancy is the leading preventable cause of pregnancy complications and adverse birth outcomes. In high-income countries, around one in 10 pregnant women smokes tobacco, while smokeless tobacco is the primary form of tobacco used in many low- and middle-income countries. Although the risk of tobacco-related harms can be reduced substantially if mothers cease smoking in the first trimester of pregnancy, the proportion of women who successfully quit smoking during pregnancy remains modest. Psychosocial interventions are first-line treatment, with some high-quality evidence showing that counselling is effective in promoting smoking cessation among pregnant women. There is insufficient evidence regarding the efficacy and safety of smoking cessation pharmacotherapies when used during pregnancy, although in some countries nicotine replacement therapy is recommended for pregnant women who have been unable to quit without pharmacological assistance. E-cigarettes are increasingly being used as a smoking cessation aid in the general population of smokers, but more research is needed to determine if e-cigarettes are a safe and effective treatment option for pregnant women.
    MeSH term(s) Electronic Nicotine Delivery Systems ; Female ; Humans ; Pregnancy ; Pregnancy Complications/etiology ; Pregnancy Complications/therapy ; Smoking/therapy ; Smoking Cessation ; Nicotiana ; Tobacco Smoking ; Tobacco Use Cessation Devices/adverse effects
    Language English
    Publishing date 2022-01-25
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1141051-6
    ISSN 1360-0443 ; 0965-2140
    ISSN (online) 1360-0443
    ISSN 0965-2140
    DOI 10.1111/add.15792
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Agreement of acute serious events recorded across datasets using linked Australian general practice, hospital, emergency department and death data: implications for research and surveillance.

    Ahmed, Sarah / Pollack, Allan / Havard, Alys / Pearson, Sallie-Anne / Chidwick, Kendal

    International journal of population data science

    2023  Volume 6, Issue 1, Page(s) 2118

    Abstract: Introduction: Understanding the level of recording of acute serious events in general practice electronic health records (EHRs) is critical for making decisions about the suitability of general practice datasets to address research questions and ... ...

    Abstract Introduction: Understanding the level of recording of acute serious events in general practice electronic health records (EHRs) is critical for making decisions about the suitability of general practice datasets to address research questions and requirements for linking general practice EHRs with other datasets.
    Objectives: To examine data source agreement of five serious acute events (myocardial infarction, stroke, venous thromboembolism (VTE), pancreatitis and suicide) recorded in general practice EHRs compared with hospital, emergency department (ED) and mortality data.
    Methods: Data from 61 general practices routinely contributing data to the MedicineInsight database was linked with New South Wales administrative hospital, ED and mortality data. The study population comprised patients with at least three clinical encounters at participating general practices between 2019 and 2020 and at least one record in hospital, ED or mortality data between 2010 and 2020. Agreement was assessed between MedicineInsight diagnostic algorithms for the five events of interest and coded diagnoses in the administrative data. Dates of concordant events were compared.
    Results: The study included 274,420 general practice patients with at least one record in the administrative data between 2010 and 2020. Across the five acute events, specificity and NPV were excellent (>98%) but sensitivity (13%-51%) and PPV (30%-75%) were low. Sensitivity and PPV were highest for VTE (50.9%) and acute pancreatitis (75.2%), respectively. The majority (roughly 70-80%) of true positive cases were recorded in the EHR within 30 days of administrative records.
    Conclusion: Large proportions of events identified from administrative data were not detected by diagnostic algorithms applied to general practice EHRs within the specific time period. EHR data extraction and study design only partly explain the low sensitivities/PPVs. Our findings support the use of Australian general practice EHRs linked to hospital, ED and mortality data for robust research on the selected serious acute conditions.
    MeSH term(s) Humans ; Acute Disease ; Venous Thromboembolism ; Australia ; Pancreatitis ; General Practice ; Emergency Service, Hospital ; Hospitals
    Language English
    Publishing date 2023-01-24
    Publishing country Wales
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2399-4908
    ISSN (online) 2399-4908
    DOI 10.23889/ijpds.v8i1.2118
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Evaluating the accuracy of data extracted from electronic health records into MedicineInsight, a national Australian general practice database.

    Daniels, Benjamin / Havard, Alys / Myton, Rimma / Lee, Cynthia / Chidwick, Kendal

    International journal of population data science

    2022  Volume 7, Issue 1, Page(s) 1713

    Abstract: Introduction: MedicineInsight is a database containing de-identified electronic health records (EHRs) from over 700 Australian general practices. Previous research validated algorithms used to derive medical condition flags in MedicineInsight, but the ... ...

    Abstract Introduction: MedicineInsight is a database containing de-identified electronic health records (EHRs) from over 700 Australian general practices. Previous research validated algorithms used to derive medical condition flags in MedicineInsight, but the accuracy of data fields following EHR extractions from clinical practices and data warehouse transformation processes have not been formally validated.
    Objectives: To examine the accuracy of the extraction and transformation of EHR fields for selected demographics, observations, diagnoses, prescriptions, and tests into MedicineInsight.
    Methods: We benchmarked MedicineInsight values against those recorded in original EHRs. Forty-six general practices contributing data to MedicineInsight met our eligibility criteria, eight were randomly selected, and four agreed to participate. We randomly selected 200 patients >18 years of age within each participating practice from MedicineInsight. Trained staff reviewed the original EHRs for the selected patients and recorded data from the relevant fields. We calculated the percentage of agreement (POA) between MedicineInsight and EHR data for all fields; Cohen's Kappa for categorical and intra-class correlation (ICC) for continuous measures; and sensitivity, specificity, and positive and negative predictive values (PPV/NPV) for diagnoses.
    Results: A total of 796 patients were included in our analysis. All demographic characteristics, observations, diagnoses, prescriptions and random pathology test results had excellent (>90%) POA, Kappa, and ICC. POA for most recent pathology/imaging test was moderate (81%, [95% CI: 78% to 84%]). Sensitivity, specificity, PPV, and NPV were excellent (>90%) for all but one of the examined diagnoses which had a poor PPV.
    Conclusions: Overall, our study shows good agreement between the majority of MedicineInsight data and those from original EHRs, suggesting MedicineInsight data extraction and warehousing procedures accurately conserve the data in these key fields. Discrepancies between test data may have arisen due to how data from pathology, radiology and other imaging providers are stored in EHRs and MedicineInsight and this requires further investigation.
    MeSH term(s) Humans ; Electronic Health Records ; Australia ; Family Practice ; General Practice ; Records
    Language English
    Publishing date 2022-06-29
    Publishing country Wales
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2399-4908
    ISSN (online) 2399-4908
    DOI 10.23889/ijpds.v7i1.1713
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: The burden of prenatal and early life maternal substance use among children at risk of maltreatment: A systematic review.

    Powell, Madeleine / Pilkington, Rhiannon / Varney, Bianca / Havard, Alys / Lynch, John / Dobbins, Timothy / Oei, Ju Lee / Ahmed, Tasnia / Falster, Kathleen

    Drug and alcohol review

    2024  Volume 43, Issue 4, Page(s) 823–847

    Abstract: Issues: Although maternal substance use is a known risk factor for child maltreatment, evidence on the scale of substance use is needed to inform prevention responses. This systematic review synthesised prevalence estimates of maternal substance use ... ...

    Abstract Issues: Although maternal substance use is a known risk factor for child maltreatment, evidence on the scale of substance use is needed to inform prevention responses. This systematic review synthesised prevalence estimates of maternal substance use during pregnancy and early life among children at risk of maltreatment. Ovid, Pubmed, CINAHL, PsychInfo and ProQuest databases were searched. We included observational studies that sampled children at risk of maltreatment in high-income countries and reported information on maternal substance use during pregnancy and/or the child's first year of life. We extracted study characteristics and data to calculate prevalence, assessed risk of bias and conducted a narrative synthesis; there were insufficient comparable populations or outcomes to quantitatively synthesise results.
    Key findings: Thirty five of 14,084 titles were included. Fifteen studies had adequately sized and representative samples to estimate prevalence. Maternal substance use prevalence ranged from 2.4% to 40.6%. Maternal substance use was highest among infants referred to child protection at birth (40.6%) and children in out-of-home care (10.4% to 37.2%). Prevalence was higher when studies defined substance use more broadly and when maternal substance use was ascertained from both child and mother records.
    Implications: Supportive, coordinated responses to maternal substance use are needed from health and child protection services, spanning alcohol and other drug treatment, antenatal and postnatal care.
    Conclusions: Prenatal and early life maternal substance use is common among child maltreatment populations, particularly among younger children and those with more serious maltreatment.
    MeSH term(s) Humans ; Pregnancy ; Female ; Substance-Related Disorders/epidemiology ; Child Abuse/statistics & numerical data ; Child Abuse/psychology ; Prenatal Exposure Delayed Effects/epidemiology ; Risk Factors ; Child ; Infant ; Prevalence ; Mothers
    Language English
    Publishing date 2024-03-28
    Publishing country Australia
    Document type Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1080442-0
    ISSN 1465-3362 ; 0959-5236
    ISSN (online) 1465-3362
    ISSN 0959-5236
    DOI 10.1111/dar.13835
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Opioid analgesic exposure during the first trimester of pregnancy and the risk of major congenital malformations in infants: a systematic review and meta-analysis

    Varney, Bianca / Brett, Jonathan / Zoega, Helga / Gillies, Malcolm B / Powell, Madeline / Bateman, Brian T / Shand, Antonia W / Pearson, Sallie-Anne / Havard, Alys

    Anaesthesia

    2024  

    Abstract: Background: Prescribed opioid analgesics are frequently used to manage pain in pregnancy. However, the available literature regarding the teratogenic potential of opioid use during pregnancy has not been systematically summarised. This systematic review ...

    Abstract Background: Prescribed opioid analgesics are frequently used to manage pain in pregnancy. However, the available literature regarding the teratogenic potential of opioid use during pregnancy has not been systematically summarised. This systematic review and meta-analysis aimed to assess the quality of the evidence on these potential risks and calculate a pooled estimate of risk for any opioid analgesic and individual opioids.
    Methods: We searched PubMed, Embase and CINAHL for published studies assessing the risk of major congenital malformations in infants following first-trimester exposure to opioid analgesics compared with a reference group, excluding studies examining opioid agonist therapy or illicit opioid use. We assessed the risk of bias using the Risk of Bias in Non-Randomised Studies of Intervention tool. We pooled adjusted risk estimates from studies rated at serious risk of bias or better in a random-effects meta-analysis.
    Results: Of 12 identified studies, 11 were at high risk of bias (eight serious; three critical). Relative to unexposed infants, those exposed to any opioid use during the first trimester of pregnancy were not at an increased risk of major congenital malformations overall (relative risk 1.04, 95%CI 0.98-1.11); cardiovascular malformations (relative risk 1.07, 95%CI 0.96-1.20); or central nervous system malformations (relative risk 1.06, 95%CI 0.92-1.21). Raised risk estimates were observed for gastrointestinal malformations (relative risk 1.40, 95%CI 0.38-5.16) and cleft palate (relative risk 1.57, 95%CI 0.48-5.13) following any opioid exposure and atrial septal defects (relative risk 1.20, 95%CI 1.05-1.36) following codeine exposure.
    Conclusions: Although the meta-analysis did not indicate substantial increased risk for most malformations examined, this risk remains uncertain due to the methodological limitations of the included studies. Healthcare professionals and pharmaceutical regulators should be aware of the issues related to the quality of research in this field.
    Language English
    Publishing date 2024-05-07
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 80033-8
    ISSN 1365-2044 ; 0003-2409
    ISSN (online) 1365-2044
    ISSN 0003-2409
    DOI 10.1111/anae.16307
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Expanded access to publicly subsidised lisdexamfetamine treatment for adults with attention-deficit/hyperactivity disorder: An interrupted time-series analysis.

    Bruno, Claudia / Zoega, Helga / Gillies, Malcolm B / Havard, Alys / Coghill, David / Pearson, Sallie-Anne / Brett, Jonathan

    The Australian and New Zealand journal of psychiatry

    2023  Volume 57, Issue 7, Page(s) 1073–1076

    MeSH term(s) Adult ; Humans ; Lisdexamfetamine Dimesylate/therapeutic use ; Attention Deficit Disorder with Hyperactivity/drug therapy ; Central Nervous System Stimulants/therapeutic use ; Dextroamphetamine/therapeutic use ; Treatment Outcome ; Dose-Response Relationship, Drug ; Double-Blind Method
    Chemical Substances Lisdexamfetamine Dimesylate (SJT761GEGS) ; Central Nervous System Stimulants ; Dextroamphetamine (TZ47U051FI)
    Language English
    Publishing date 2023-04-25
    Publishing country England
    Document type Letter
    ZDB-ID 221140-3
    ISSN 1440-1614 ; 0004-8674
    ISSN (online) 1440-1614
    ISSN 0004-8674
    DOI 10.1177/00048674231170556
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Prevalence and Persistence of Prescription Opioid Use Following Hospital Discharge After Childbirth: An Australian Population-Based Cohort Study.

    Varney, Bianca / Zoega, Helga / Gillies, Malcolm Bjørn / Gisev, Natasa / Weston Shand, Antonia / Pearson, Sallie-Anne / Havard, Alys

    Anesthesia and analgesia

    2023  Volume 138, Issue 5, Page(s) 970–979

    Abstract: Background: Opioid analgesics are used for acute postpartum pain relief but carry risks, including persistent long-term opioid use. Our primary objective was to estimate the prevalence of persistent use following hospital discharge after childbirth.: ... ...

    Abstract Background: Opioid analgesics are used for acute postpartum pain relief but carry risks, including persistent long-term opioid use. Our primary objective was to estimate the prevalence of persistent use following hospital discharge after childbirth.
    Methods: We conducted a population-based cohort study of women discharged from public or private hospitals in New South Wales, Australia, between 2012 and 2018 following vaginal birth (VB) or cesarean delivery (CD). We used linked hospitalization and medicine dispensing data to calculate the prevalence of opioid use within 14 days of hospital discharge for childbirth using an external estimate of the total number of hospital admissions for childbirth per year as the denominator. Among women dispensed an opioid postdischarge, we estimated the prevalence of persistent use defined as ≥3 dispensings between 30- and 365-days postdischarge. To calculate the odds of persistent opioid use, we performed a series of logistic regressions each including a single characteristic of interest. Included characteristics were maternal and birth characteristics, maternal medical conditions, prior use of certain medicines, and the initial opioid dispensed following discharge for childbirth.
    Results: The final cohort comprised of 38,832 women who were dispensed an opioid in the 14 days following discharge after childbirth. Between 2012 and 2018, the prevalence of opioid use was increased following CD (public hospital 16.6%-21.0%; private hospital 9.8%-19.5%) compared with VB (public hospital 1.5%-1.5%; private hospital 1.2%-1.4%) and was higher following discharge from public hospitals compared with private. The most commonly dispensed opioids following discharge for childbirth were oxycodone (44.8%; 95% confidence interval [CI], 44.3-45.3), codeine (42.1%; 95% CI, 41.6-42.6), and tramadol (12.9%; 95% CI, 12.6-13.2). Among women dispensed an opioid, the prevalence of persistent opioid use was 5.4% (95% CI, 5.1-5.6). This prevalence was 11.4% (95% CI, 10.5-12.3) following a VB as compared with 4.3% (95% CI, 4.1-4.6) among those who underwent a CD ( P < .001). Characteristics associated with persistent opioid use included smoking during pregnancy, age <25 years, living in remote areas, discharged from a public hospital, history of opioid use disorder, other substance use disorder, mental health diagnosis, or prior use of prescription opioids, nonopioid analgesics, or benzodiazepines.
    Conclusions: The results of this cohort study indicate that Australian women have a higher prevalence of opioid use following CD compared to VB. One in 19 women dispensed an opioid postdischarge used opioids persistently. Careful monitoring of opioid therapy following childbirth is warranted, particularly among women with characteristics we identified as high risk for persistent opioid use.
    MeSH term(s) Pregnancy ; Humans ; Female ; Adult ; Analgesics, Opioid/adverse effects ; Patient Discharge ; Cohort Studies ; Prevalence ; Aftercare ; Pain, Postoperative/diagnosis ; Pain, Postoperative/drug therapy ; Pain, Postoperative/epidemiology ; Australia/epidemiology ; Opioid-Related Disorders/diagnosis ; Opioid-Related Disorders/epidemiology ; Drug Prescriptions ; Hospitals ; Retrospective Studies
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2023-06-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000006582
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Mortality during and after specialist alcohol and other drug treatment: Variation in rates according to principal drug of concern and treatment modality.

    Havard, Alys / Jones, Nicola / Bharat, Chrianna / Gisev, Natasa / Pearson, Sallie-Anne / Shakeshaft, Anthony / Farrell, Michael / Degenhardt, Louisa

    Drug and alcohol review

    2023  Volume 42, Issue 6, Page(s) 1461–1471

    Abstract: Introduction: For people accessing treatment for problems with drugs other than opioids, little is known about the relationship between treatment and mortality risk, nor how mortality risk varies across treatment modalities. We addressed these evidence ... ...

    Abstract Introduction: For people accessing treatment for problems with drugs other than opioids, little is known about the relationship between treatment and mortality risk, nor how mortality risk varies across treatment modalities. We addressed these evidence gaps by determining mortality rates during and after treatment for people accessing a range of treatment modalities for several drugs of concern.
    Methods: We conducted a cohort study using linked data on publicly funded specialist alcohol or other drug treatment service use and mortality for people receiving treatment in New South Wales between January 2012 and December 2018. We calculated and compared during-treatment and post-treatment crude mortality rates and age- and sex-standardised mortality rates, separately for each principal drug of concern and modality.
    Results: Over the study period, 45,026 people accessed treatment for problems with alcohol, 26,407 for amphetamine-type stimulants, 23,047 for cannabinoids and 21,556 for opioids. People treated for alcohol or opioid problems had higher crude mortality rates (1.48, 1.91, 1.09 per 100 person years, respectively) than those with problems with amphetamine-type stimulants or cannabinoids (0.46, 0.30 per 100 person years, respectively). Mortality rates differed according to treatment status and modality only among people with alcohol or opioid problems.
    Discussion and conclusions: The observed variation in mortality rates indicates there is scope to reduce mortality among people accessing treatment with alcohol or opioid problems. Future research on mortality among people accessing drug and alcohol treatment should account for the variation in mortality by drug of concern and treatment modality.
    MeSH term(s) Humans ; Analgesics, Opioid/therapeutic use ; Cohort Studies ; New South Wales/epidemiology ; Amphetamine ; Central Nervous System Stimulants ; Ethanol ; Cannabinoids
    Chemical Substances Analgesics, Opioid ; Amphetamine (CK833KGX7E) ; Central Nervous System Stimulants ; Ethanol (3K9958V90M) ; Cannabinoids
    Language English
    Publishing date 2023-04-25
    Publishing country Australia
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1080442-0
    ISSN 1465-3362 ; 0959-5236
    ISSN (online) 1465-3362
    ISSN 0959-5236
    DOI 10.1111/dar.13669
    Database MEDical Literature Analysis and Retrieval System OnLINE

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