NDARC would like to congratulate Baillee Farah, Leigh Coney and Bianca Varney for their PhD/Master’s completions. Baillee (supervisors: Dr Rachel Sutherland, Associate Professor Phillip Wadds, Dr Monica Barratt) and Leigh (supervisors: Associate Professor Amy Peacock, Dr Monica Barratt, Associate Professor Raimondo Bruno) both completed their projects at NDARC, while Bianca (supervisors: Associate Professor Alys Havard, Professor Helga Zoega, Professor Sallie Pearson) completed hers at PhD through the Medicines Intelligence Research Program at UNSW’s School of Population Health and has since taken up a postdoctoral position at NDARC.

Here are their thesis abstracts:

'Kicked out': Relational effects of patron eviction in Sydney’s nightlife (Baillee Farah)

Background: Regulating nightlife to reduce alcohol-related violence and harm has been a key urban governance concern in recent decades. The eviction of intoxicated and unruly patrons from licensed venues is a relatively common regulatory practice internationally and is required in Sydney, NSW by the Liquor Act 2007 (NSW). While literature on similar spatial exclusion policies (lockouts, banning, barring) have assessed their efficacy and deployment, there is limited research specifically exploring the implications of patron eviction practices. Objectives: This research investigated the un/intended outcomes of Sydney's nightlife eviction policies and practices through exploring (a) patron experiences of eviction from licensed venues while using substances, (b) how patron experiences of nightlife were mediated by eviction, and (c) how eviction mediated experiences of pleasure and harm. Method: 28 semi-structured, in-depth qualitative interviews were conducted with patrons (median age 24, range 18-41, 57% male) evicted from Sydney nightlife venues while using substances. The project utilised actor network and affect theory as its core organising framework, which enabled a relational analysis of the human and non-human actors that shape how nightlife eviction unfolded. Results: Participant experiences of eviction underscore the complex intra-actions between material (settings, substances) and immaterial (policies, cultures) assemblages in shaping experiences of pleasure and harm in nightlife. Patrons reported experiencing diverse and distinct harms (physical, psychological, emotional, social, and material) directly from eviction practices, showing how the enactment of current policies may increase rather than reduce harms. Evictions frequently disrupted patron self- and peer-care practices, particularly when patrons were heavily intoxicated and/or evicted alone. Pleasure and harm were further mediated by perceived fairness of eviction, driven by the inconsistent enforcement of intoxication, and use of excessive force/ abuse of power by security staff. Implications: This project documents how punitive security practices prioritising control and compliance lead to conflict and harm, while practices of harm reduction effectively balance commercial imperatives, patron wellbeing and pleasure, and risk reduction. Results indicate that regulatory imperatives and their enactment can undermine harm reduction efforts, emphasising the need for an ethos of harm reduction to underpin the way that nightlife venues are regulated to promote safe(r) leisure spaces.

See full thesis here

Clicks, Captchas, and Chemicals: Assessing the Risks and Benefits of Online Drug Purchasing Behaviours (Leigh Coney)

The rapid evolution of digital technology has transformed drug markets, particularly with the rise of cryptomarkets and social media platforms that facilitate online drug purchasing. This thesis explores the risks, benefits, and patterns associated with online drug engagement by addressing critical research gaps in this emerging area. Specifically, this thesis aims to: 1) identify patterns of seeking and sharing drug information online, and the drug use and sociodemographic characteristics associated with those profiles, among a sample of people interviewed who regularly use ecstasy and/or other illicit stimulants (n=690); 2) identify the relationships between cryptomarket use, social networks, and adverse drug events via an online survey of people who use MDMA, cocaine and/or LSD (n=23,053), examining how a lack of drug-using networks are associated with drug-related risks; and 3) compare strength and adulteration of drugs sourced from cryptomarkets versus offline markets, using data on MDMA, cocaine, LSD, and other substances submitted to drug checking services (n=62,596). Study 1 showed that diverse online engagement patterns, ranging from minimal to high engagement in seeking and sharing drug-related information online, with significant associations between high engagement and reported overdose. Study 2 showed that people who use cryptomarkets were less likely to have drug-using networks, heightening risks of having adverse events. Finally, the comparative analysis of drug checking data in study 3 showed that drugs sourced from cryptomarkets were higher strength than offline sources although variations exist by substance type. Overall, these findings highlight the need for tailored harm reduction strategies that consider both the unique risks and potential benefits associated with online drug engagement. For instance, incorporating real-time drug quality reporting systems, peer-led educational campaigns and platform/app- iv based notification systems could mitigate risks associated with variable substance quality and social isolation observed in these markets. Through examining the complexities of consumer behaviour, substance quality, and social dynamics within online drug markets, this thesis provides a foundation for more effective public health policies that leverage the digital environment to promote safety and reduce drug-related harms. The findings support a shift away from a one-size-fits-all approach toward more adaptive interventions that integrate the complexities of digital environments.

See full thesis here

Evaluating the use and safety of prescribed opioid analgesics during pregnancy and pregnancy-related periods using real-world data (Bianca Varney)

The use of prescribed opioid analgesics, medicines used to treat pain, has risen globally over the past two decades, including among women before, during, and after pregnancy. This increase has raised concerns as the effects of opioid analgesic use during these periods on maternal and infant health remain poorly understood. This thesis leverages real-world data to generate robust evidence on opioid analgesic use and safety during pregnancy and pregnancy-related periods. Chapter 1 examines the challenges in generating evidence on medicine safety and effectiveness during pregnancy. The chapter explores three key areas: first, how the complexities of medicine safety before, during and after pregnancy impact prescribing decisions; second, the potential of real-world data and perinatal pharmacoepidemiology to address current knowledge gaps; and third, the current evidence regarding opioid analgesic use and safety during pregnancy and related periods. In Chapter 2, analysis of national dispensing claims (2013-2020) from a 10% random sample of Australians showed that while prescription opioid analgesic use was common among women of reproductive age, most use was short-term, with overall prevalence declining over the study period. In Chapter 3, analysis of NSW linked health data (2012-2018) revealed higher opioid analgesic dispensing after hospital discharge for caesarean section versus vaginal births and in public versus private hospitals, although only a small proportion of these women exhibited persistent opioid use. In Chapter 4, a systematic review and meta-analysis of first-trimester opioid analgesic exposure found no substantial increased risk of congenital anomalies, though methodological limitations prevented definitive conclusions. However, the evidence for gastrointestinal anomalies, cleft palate, and atrial septal defect remains inconclusive. In Chapter 5, a target trial emulation investigating the impact of opioid analgesic use during pregnancy (which our post hoc analyses revealed was mostly short-term) found no meaningful increase in risk for most maternal and neonatal outcomes. However, signals for stillbirth and neonatal death remain inconclusive. Chapter 6 summarises the thesis findings, evaluates methodological strengths and limitations, and discusses the broader implications for future research, public health and clinical practice. The Chapter also identifies key research priorities to address remaining knowledge gaps about opioid analgesic use and safety in this understudied population.