Tobacco/nicotine harm reduction among people with a history of illicit drug use

Tobacco use is the leading cause of preventable morbidity and mortality globally. While the prevalence of daily tobacco use among the Australian general population halved between 1991 (24%) and 2019 (11%), approximately 80% of Australians who inject drugs use tobacco daily. Interventions to reduce tobacco use among people who use drugs are urgently needed. Behavioural interventions and nicotine replacement therapy (NRT; e.g., nicotine-containing gum and lozenges) are known to be effective in supporting reduction or cessation of tobacco use and are supported under Medicare and the Pharmaceutical Benefits Scheme, but little is known about their acceptability or the potential barriers and enablers to access among people who use drugs.

This study aims to better understand the experiences of people who have a history of illicit drug use with respect to current tobacco/nicotine use, their positive and/or negative experiences and outcomes of tobacco use and cessation, and uptake of available support to reduce or cease tobacco/nicotine use.

Further topics of investigation may include examining:

• prevalence of tobacco smoking and use of vapes
• exploration of motivations and intentions to reduce or cease tobacco/nicotine use
• barriers/enablers accessing harm reduction/health services and social supports for reduction/cessation of tobacco/nicotine
• the role tobacco/nicotine has in people’s lives and relative importance of continuing/cessation
• prioritisation of reduction/cessation of tobacco in policies or guidelines that focus on the health of people who use illicit drugs.

The study will use the Burnet SuperMIX study, a longitudinal cohort study of people who use drugs. Opportunities exist for both qualitative and quantitative research, including:

• Conducting in-depth interviews with participants of the SuperMIX study, to better understand their experiences as someone who injects drugs and uses tobacco/nicotine
• Analysis of longitudinal SuperMIX survey data - to characterise a qualitative research sample and/or understand/compare differences between selected variables
• Potential for analysis of additional datasets including VMAX (longitudinal cohort of people who use methamphetamine, PATH (longitudinal cohort study of men released from prison), Illicit Drug reporting System and Ecstasy and Related Drugs Reporting System (annual cross sectional surveys) EDRS to derive a pooled estimate of tobacco/vaping prevalence.