title: Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non-Indigenous people who inject drugs.
abstract: Despite over-representation of Indigenous Australians in sentinel studies of injecting drug use, little is known about relevant patterns of drug use and dependence. This study compares drug dependence and possible contributing factors in Indigenous and non-Indigenous Australians who inject drugs.
  
  
  
  Respondent-driven sampling was used in major cities and 'peer recruitment' in regional towns of Queensland to obtain a community sample of Indigenous (n = 282) and non-Indigenous (n = 267) injectors. Data are cross sectional. Multinomial models were developed for each group to examine types of dependence on injected drugs (no dependence, methamphetamine-dependent only, opioid-dependent only, dependent on methamphetamine and opioids).
  
  
  
  Around one-fifth of Indigenous and non-Indigenous injectors were dependent on both methamphetamine and opioids in the previous 12 months. Psychological distress was associated with dual dependence on these drugs for Indigenous [adjusted relative risk (ARR) 4.86, 95% confidence interval (CI) 2.08-11.34] and non-Indigenous (ARR 4.14, 95% CI 1.59-10.78) participants. Unemployment (ARR 8.98, 95% CI 2.25-35.82) and repeated (> once) incarceration as an adult (ARR 3.78, 95% CI 1.43-9.97) were associated with dual dependence for Indigenous participants only. Indigenous participants had high rates of alcohol dependence, except for those dependent on opioids only.
  
  
  
  The drug dependence patterns of Indigenous and non-Indigenous people who inject drugs were similar, including the proportions dependent on both methamphetamine and opioids. However, for Indigenous injectors, there was a stronger association between drug dependence and contextual factors such as unemployment and incarceration. Expansion of treatment options and community-level programs may be required. [Smirnov A, Kemp R, Ward J, Henderson S, Williams S, Dev A, Najman J M. Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non-Indigenous people who inject drugs. Drug Alcohol Rev 2016;35:611-619].
authors.affiliation: The University of Queensland, School of Public Health, Queensland Alcohol and Drug Research and Education Centre, Brisbane, Australia. a.smirnov@uq.edu.au.|Communicable Diseases Unit, Chief Health Officer Branch, Department of Health, Queensland Government, Brisbane, Australia. a.smirnov@uq.edu.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smirnov
authors.affiliation: Communicable Diseases Unit, Chief Health Officer Branch, Department of Health, Queensland Government, Brisbane, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Kemp
authors.affiliation: South Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Ward
authors.affiliation: The University of Queensland, School of Public Health, Queensland Alcohol and Drug Research and Education Centre, Brisbane, Australia.
authors.forename: Suzanna
authors.initials: S
authors.lastname: Henderson
authors.affiliation: Queensland Aboriginal and Islander Health Council, Brisbane, Australia.
authors.forename: Sidney
authors.initials: S
authors.lastname: Williams
authors.affiliation: Communicable Diseases Unit, Chief Health Officer Branch, Department of Health, Queensland Government, Brisbane, Australia.
authors.forename: Abhilash
authors.initials: A
authors.lastname: Dev
authors.affiliation: The University of Queensland, School of Public Health, Queensland Alcohol and Drug Research and Education Centre, Brisbane, Australia.|The University of Queensland, School of Social Science, Brisbane, Australia.
authors.forename: Jake M
authors.initials: JM
authors.lastname: Najman
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D003430:Cross-Sectional Studies; D055030:Drug Users; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D006801:Humans; D008297:Male; D008694:Methamphetamine; D008875:Middle Aged; D015995:Prevalence; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors; D012752:Shame; D013315:Stress, Psychological / Q000523:psychology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D055815:Young Adult
chemical_list: D008694:Methamphetamine
keywords: Australia; Indigenous population; intravenous drug abuse; social determinants of health; substance dependence