Wole Akosile

Substance use among children and adolescents is a significant public health concern, with early initiation linked to adverse mental health, developmental, and longer-term health outcomes. In the South Pacific, substance use is shaped by distinct socio-cultural, economic, geographic, and structural conditions, including traditional practices such as betel nut use and the challenges of delivering services across island communities. Although research has examined substance use among young people in the region, the literature remains heterogeneous and fragmented. No comprehensive synthesis has yet focused specifically on children and adolescents across South Pacific nations. This systematic review will synthesise evidence on the prevalence, patterns, and determinants of substance use and SUDs among children and adolescents in South Pacific countries. Searches will be conducted across MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library for publications from 2000 to 2026. Grey literature in region-focused repositories will also be searched. Observational studies reporting quantitative data on substance use among people aged 10–18 years will be included. Two reviewers will independently screen studies, extract data, and assess methodological quality using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. If sufficiently comparable data are available, meta-analysis will be conducted using random-effects models; otherwise, findings will be synthesised narratively.

Objective: To argue that contemporary addiction psychiatry, particularly in private and mixed-sector practice, is best understood as an integrative clinical craft rather than a narrow detoxification or prescribing role. Conclusions: Addiction psychiatrists increasingly work in rooms where trauma, ambivalence, psychiatric comorbidity, physical illness, family distress, medication complexity, social adversity, and crisis arrive together. Good care requires more than technical knowledge. It requires trauma-informed engagement, careful listening, psychotherapy fluency, formulation, medical competence, boundaries and system navigation, and social formulation. Private-sector settings can make a useful contribution to training because they often provide continuity, planned care, multidisciplinary work, outpatient follow-up, exposure to newer treatments, and the everyday realities of private practice. Psychiatric training should therefore move beyond episodic exposure to withdrawal management and help trainees develop the relational, social, medical, and practical skills needed for integrated addiction care.

Post-traumatic stress disorder (PTSD) remains inadequately treated by existing pharmacological and psychological interventions, prompting growing interest in psychedelic-assisted psychotherapy. Although randomised controlled trials have evaluated several psychedelic agents for PTSD, to our knowledge, no prior PTSD-specific synthesis has quantitatively examined multiple agent classes within a single review framework. This systematic review and meta-analysis searched PsycINFO, CINAHL, Embase, MEDLINE, and clinical trial registries to identify RCTs of psychedelic-assisted psychotherapy for PTSD. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and random-effects meta-analyses were conducted for efficacy outcomes; safety and therapeutic protocols were synthesised narratively. Eleven RCTs involving 358 participants met inclusion criteria, evaluating MDMA, ketamine, and cannabidiol, of which eight contributed to meta-analyses. MDMA-assisted psychotherapy demonstrated a significant moderate-to-large reduction in PTSD symptom severity with negligible heterogeneity, and participants were significantly more likely to achieve clinical response and loss of PTSD diagnosis. The pooled effect for ketamine was small and non-significant, and a single cannabidiol trial showed no clear benefit. All agents were generally well tolerated. MDMA-assisted psychotherapy showed a promising efficacy signal for PTSD symptom reduction, although safety data were heterogenous and remain insufficient for strong comparative conclusions. Evidence for ketamine and cannabidiol remains too limited to support clinical implementation and it is noted that the current evidence base is dominated by MDMA trials. Further adequately powered trials with standardised outcomes and direct comparative studies across agents are needed.

Background: This review examines the prevalence of substance abuse and related disorders in South Pacific nations. Methods: The review focused on data included in reports published since 2000 from countries like Samoa, Papua New Guinea, Fiji, and French Polynesia, excluding Hawaii, New Zealand, Australia, and American Samoa. Prevalence studies indexed in Medline, CINAHL, PsycInfo, Embase, and Cochrane were screened and retrieved. Joanna Briggs Institute critical appraisal tools were used to assess included studies. Results: Ten studies with diverse methods, such as national surveys, were analysed. Results show high variability in prevalence across countries, sexes, and ethnicities. Notably, tobacco and betel nut use are prevalent. Indigenous populations and men face higher SUD burdens. Discussion: inconsistencies in study methods and reliance on self-reporting limit direct comparison. Data on co-occurring disorders and polysubstance use are limited, highlighting research gaps. The review emphasises the need for culturally sensitive, standardised research to monitor emerging trends like synthetic drug use. Policy suggestions call for targeted interventions and improved surveillance to reduce disparities and support vulnerable populations in Pacific Island communities.