4/15/2020 0 Comments MUSIC FESTIVAL ATTENDEES’ ILLICIT DRUG USE, KNOWLEDGE AND PRACTICES REGARDING DRUG CONTENT AND PURITY: A CROSS SECTIONAL SURVEYDay, N., Criss J., Griffiths, B., Gujral, S.K., John-Leader, F., Johnson, J., & Pit, S. (2018). Music festival attendees’ illicit drug use, knowledge and practices regarding drug content and purity: A cross-sectional survey. Harm Reduction Journal, 15(1), 1-8. doi: 10.1186/s12954- 017-0205-7 From herein referred to as the ‘study’ Illicit drug use is high in festival attendees and drug testing has been shown to reduce harm in other countries. In this essay I will focus on critically appraising the strengths and weakness of the study utilising Greenhalgh’s five question process (Greenhalgh, Bidewell, Crisp, Lambros, & Warland, 2017, pp. 27-28), CASP (Critical skills appraisal program, 2019), and the Joanna Briggs Institute Critical Appraisal tools (Joanna Briggs Institute, 2019). I will review authorship, critically appraise the aims, design, methods, results and limitations of the research and describe factors affecting the implementation of the findings into the case scenario provided. All authors have relevant expertise, having affiliations with academic or health-based government institutions. The collaboration of authors adds to the quality of the study as it reduces the risk of lack of expertise. Jennifer Johnston has also published previous research about pill testing (Johnston, et al., 2006) and brings this knowledge to this study. A conflict of interest is defined by Oxford (English Oxford Living Dictionaries, 2019) specifically in relation to research, as a situation in which a author is in a position to gain personal benefit from decisions made or actions taken from the results of the paper. The authors declare there are no competing interests although concern could be raised as to whether reflexivity (Greenhalgh,Bidewell, Crisp, Lambros, & Warland, 2017, p. 39) was used to ensure their own ideas on the drug testing debate did not influence the data analysis, in particular Franklin John-Leader’s affiliation with a harm reduction and health promotion program. There is a sense that the study is building proof supporting the use of drug testing in response to the Australian Senate calling for more evidence to substantiate its efficacy. The abstract and title clearly describe the four study aims - to investigate the proportion of illicit drug use in young people; the patterns of illicit drug use in young people; the young people’s attitudes towards drug checking at festivals; and the potential impact of drug checking on intended use behaviour. The rationale for the study was highlighted in relation to the reduction of harm from use of compromised drugs. Australia has a high rate of illicit drug use in those attending music festivals. Local research would add value by building on previous research and identifying whether overseas findings were applicable here. As mentioned in the study, utilisation of these services along with information raising awareness of harmful drugs, has resulted in a decline of these products on the market in many European countries, but Australia’s lack of evidence has created a gap that this study addresses. According to National Collaborating Centre for Methods and Tools (Robinson, Saldanha, & Mckoy, 2011) a research gap is where there is missing or insufficient information that limits forming conclusions within that area or topic. The authors undertook a cross-sectional survey for their primary study working with a representative sample of a larger group at a single point in time. (Greenhalgh, Bidewell, Crisp, Lambros, & Warland, 2017). The survey was predominantly quantitative with one supplementary, open-ended qualitative question for the drug users in the group. Greenhalgh (2017, p.30) defines results from descriptive or inferential studies that are given in numbers and analysed statistically asquantitative. This method gives strength and reliability through repeating number results. The open- ended, embedded question enabled qualitative data, which supplemented elements of the research question. (Greenhalgh, Bidewell, Crisp, Lambros, & Warland, 2017, p. 100) The design was appropriate, pilot tested and justified for the research aims of the study. The authors accessed their sample through an established sexual health promotion stall at a two-day festival. The festival venue was appropriate but surveying only the patrons of the stall may diminish the randomness strength of the pool sample to only those interested in sexual health. 642 visibly sober participants were recruited during daylight hours to reduce the potential of intoxication. I am sceptical that this is an appropriate recruitment method as it may be biased towards non-drug users who are more likely to be around during the day and potentially contain intoxicated participants who are visibly sober. The strength of the data collected was enhanced by using a valid, ethically approved, piloted survey tool and evaluated using Likert scales that are designed to establish participants’ feelings or positions (Grove & Gray, 2019), thematic analysis of the free text data to draw out broad themes to allocate for coding (Greenhalgh, Bidewell, Crisp, Lambros, & Warland, 2017), and the statistical significance was calculated using p-values. The aims were answered by the study but the first, second, and fourth aims were answered specifically for festival attendees as opposed to young people in general. The authors have determined some limitations to their study which include the small size and disproportionate number of female participants. Other limitations may be the single instance of data collection, addressing a particular stall demographic, questionable proportion of drug users and possible intoxication. A limitation in the results analysis may be that it is more relevant to assess the attitudes towards drug testing specifically for the users and not just the whole study sample. Emily’s mother is worried that drug testing at the festival her daughter will be attending will encourage her daughter to use illicit drugs. The clinical question from this case may be ‘Does the presence of illicit drug testing increase the usage of illicit drugs taking in music festival attendees?’ The appraised study (Day, et al., 2018) does not directly answer this question but could inform future research into its effects on usage. The potential organisational barriers - factors preventing successful implementation of evidence (Hoffmann, Bennett, & Del Mar, 2017) in the uptake of the finding into practice may be lack of government support which would equate to lack of resources such as money, time and skill building. There is also a cultural barrier that such support would be perceived as advocating drug usage. This is the concern of Emily’s mother on an individual level. Other individual barriers may be lack of knowledge of the testing, the festival goers’ time to have the test and the lack of confidence in the research or testing process. The authors’ recommendations to contribute this information to the drug testing debate, increased understanding in the potential harm reduction and sharing current knowledge with parents and young people may promote research in this area to give Emily’s mother the answer she is after. Other enabling factors that might increase the likelihood of its success (Hoffmann, Bennett, & Del Mar, 2017) on an organisational level would be also for increased education about the potential harm reduction, more support for further research and open discussion and sharing on a government and community level. In this article, knowledge and practice in regard to drug content and purity has gone a long way. The study was conducted by a good number of knowledgeable authors, contained clear aims and justifications, an appropriate design, and ethical and piloted methods that were strengths that created the desired findings. Some limitations were mentioned around potential conflict of interest and bias, but the biggest problem was around population sampling. I wonder if perhaps assessing the attitudes towards drug testing of the same people in varied situations may offer different choices. For example, if participants were intoxicated or asked the questions away from the festival, would they still provide the same answers? I would classify this study as high quality, but surmise it is not in a situation to fully apply into clinical practice. REFERENCES
Critical skills appraisal program. (2019, May 20). Retrieved from Critical skills appraisal program: http://www.casp-uk.net/ Day, N., Criss, J., Griffiths, B., Gujral, S. K., John-Leader, F., Johnston, J., & Pit, S. (2018). Music festival attendees’ illicit drug use, knowledge and practices regarding drug content and purity: A cross-sectional survey. Harm Reduction Journal, 15(1). English Oxford Living Dictionaries. (2019, 05 20). Retrieved from English Oxford Living Dictionaries: https://en.oxforddictionaries.com/definition/conflict_of_interest Greenhalgh, T. M., Bidewell, J., Crisp, E., Lambros, A., & Warland, J. (2017). Understanding Research Methods for evidence-based practice in health. Wiley. Grove, S. K., & Gray, J. R. (2019). Understanding Nursing Research: building on Evidence-based Practice. Missouri, USA: Elsevier. Hoffmann, T., Bennett, S., & Del Mar, C. (2017). Evidence-Based Practice Across Health Professions, Third Edition. Chatswood: Elsevier Australia. Joanna Briggs Institute. (2019, May 20). Retrieved from Joanna Briggs Institute: https://www.joannabriggs.org/critical_appraisal_tools Johnston, J., Barratt, M. J., Fry, C. L., Kinner, S., Stoové, M., Degenhardt, L., . . . Bruno, R. (2006, December). A survey of regular ecstasy users’ knowledge and practices around determining pill content and purity: Implications for policy and practice. International Journal of Drug Policy, 17(6), 464-472. Robinson, K. A., Saldanha, I. J., & Mckoy, N. A. (2011, May 20). Frameworks for determining research gaps during systematic reviews. Methods Future Research Needs Report No. 2. (A. f. Quality, Producer, & Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. HHSA 290-2007-10061-I) Retrieved May 2018, from National Collaborating Centre for Methods and Tools: https://www.nccmt.ca/knowledge- repositories/search/118
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