NEW PSYCHOACTIVE SUBSTANCES IN AUSTRALIA Rachel Sutherland BSocSc (Hons, Criminology) A thesis in fulfilment of the requirements for the degree of Doctor of Philosophy National Drug and Alcohol Research Centre School of Public Health and Community Medicine Faculty of Medicine University of New South Wales November 2018 i THESIS/DISSERTATION SHEET Surname/Family Name Sutherland Given Name/s Rachel Anne Abbreviation for degree as give in the University calendar PhD Faculty Medicine School School of Public Health and Community Medicine Thesis Title New psychoactive substances in Australia Abstract 350 words maximum: (PLEASE TYPE) Over the past decade, countries worldwide have observed the rapid emergence of substances collectively referred to as ‘new psychoactive substances’ (NPS). To date, hundreds of NPS have been identified; however, for the most part very little is known about these substances. The exponential growth of NPS, combined with uncertainty regarding potential harms, has generated considerable concern amongst policy makers and there is international consensus regarding the need for ongoing monitoring and research into the NPS market. However, much of the research conducted in this area originates from Europe and the United States, with Australian-specific studies relatively scarce. This thesis aimed to address this gap in Australian specific studies using two data sources: the 2013 National Drug Strategy Household Survey (NDSHS: a general population prevalence survey) and the Ecstasy and related Drugs Reporting System (EDRS: a national survey of high frequency psychostimulant consumers). Specifically, this thesis aimed to: 1) determine if there was a distinct group of exclusive Australian NPS consumers; 2) examine rates of use of different classes of NPS amongst people who use other illicit substances; 3) examine the motivations associated with NPS use; and 4) explore the purchasing and supply patterns of NPS consumers. A number of key findings emerged from this thesis. Firstly, using data from the NDSHS, it was found that there is no distinct group of exclusive Australian NPS consumers; rather they primarily consist of people using a range of illicit substances. Secondly, using data from the EDRS, it was found that the NPS market is highly dynamic, with the consumption of particular NPS classes changing over time. Thirdly, NPS use appears to be a marker for higher engagement in substance use, and as such, higher rates of drug-related risk behaviours. Finally, the collective findings of this thesis illustrate the heterogeneity of NPS consumers. Taken together, these findings suggest that specialised NPS interventions may be unnecessary; rather, existing health services should screen for and be equipped to deal with NPS-related presentations. Furthermore, the diverse and rapidly changing nature of the NPS market demonstrate the need for international collaboration, combined with a rapidly responsive health framework. Declaration relating to disposition of project thesis/dissertation I hereby grant to the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or in part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all property rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstracts International (this is applicable to doctoral theses only). 31 August 2018 Signature …….……………………...…….… Witness Signature Date The University recognises that there may be exceptional circumstances requiring restrictions on copying or conditions on use. Requests for restriction for a period of up to 2 years must be made in writing. Requests for a longer period of restriction may be considered in exceptional circumstances and require the approval of the Dean of Graduate Research. FOR OFFICE USE Date of completion of requirements for Award: ONLY ii DECLARATIONS Originality statement I hereby declare that this submission is my own work and to the best of my knowledge contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution, except where due acknowledgement is made in this thesis. Any contribution made to the research by others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my own work, except to the extent that assistance from others in the project’s design and conception or in style, presentation and linguistic expression is acknowledged. Rachel Sutherland August 2018 iii Copyright I hereby grant the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all proprietary rights, known as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstract International (this is applicable to doctoral theses only). I have either used no substantial portions of copyright material in my thesis or I have obtained permission to use copyright material; where permission has not been granted I have applied/will apply for a partial restriction of the digital copy of my thesis or dissertation. Rachel Sutherland August 2018 Authenticity statement I certify that the Library deposit digital copy is a direct equivalent of the final officially approved version of my thesis. No emendation of content has occurred and if there are any minor variations in formatting, there are the result of the conversion to digital format. Rachel Sutherland August 2018 iv Supervisor statement I hereby certify that all co-authors of the published papers agree to Rachel Sutherland submitting those papers as part of her Doctoral Thesis. Thesis by publication statement Four papers are included in this thesis by publication. They have all been accepted to be published in peer-reviewed journals. Lucinda Burns August 2018 v Inclusion of publications statement UNSW is supportive of candidates publishing their research results during their candidature as detailed in the UNSW Thesis Examination Procedure. Publications can be used in their thesis in lieu of a Chapter if: • The student contributed greater than 50% of the content in the publication and is the “primary author”, ie. the student was responsible primarily for the planning, execution and preparation of the work for publication • The student has approval to include the publication in their thesis in lieu of a Chapter from their supervisor and Postgraduate Coordinator. • The publication is not subject to any obligations or contractual agreements with a third party that would constrain its inclusion in the thesis Please indicate whether this thesis contains published material or not. ☐ This thesis contains no publications, either published or submitted for publication Some of the work described in this thesis has been published and it has been ☐ documented in the relevant Chapters with acknowledgement This thesis has publications (either published or submitted for publication) incorporated ☒ into it in lieu of a chapter and the details are presented below CANDIDATE’S DECLARATION I declare that: • I have complied with the Thesis Examination Procedure • where I have used a publication in lieu of a Chapter, the listed publication(s) below meet(s) the requirements to be included in the thesis. Name Signature Date (dd/mm/yy) Rachel Sutherland 17 August 2018 Postgraduate Coordinator’s Declaration I declare that: • the information below is accurate • where listed publication(s) have been used in lieu of Chapter(s), their use complies with the Thesis Examination Procedure • the minimum requirements for the format of the thesis have been met. PGC’s Name PGC’s Signature Date (dd/mm/yy) Husna Razee 22 August 2018 vi Details of publication #1: Full title: Typology of new psychoactive substance use among the general Australian population Authors: Rachel Sutherland, Amy Peacock, Amanda Roxburgh, Monica J. Barratt, Lucinda Burns & Raimondo Bruno Journal or book name: Drug and Alcohol Dependence Volume/page numbers: 188; 126-134 Date accepted/ published: 3 May 2018 Status Published x Accepted and In In progress press (submitted) The Candidate’s Contribution to the Work The candidate performed the data analysis, interpreted the data, wrote the manuscript and was the corresponding author. Location of the work in the thesis and/or how the work is incorporated in the thesis: This paper is included as the second chapter in the thesis and uses general population data to determine if there is a distinct group of exclusive NPS consumers. Primary Supervisor’s Declaration I declare that: • the information above is accurate • this has been discussed with the PGC and it is agreed that this publication can be included in this thesis in lieu of a Chapter • All of the co-authors of the publication have reviewed the above information and have