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DeBeck K, Kendall P, Fast D, Pilarinos A. The authors respond to comments on the use of secure care in youth. CMAJ 2019; 191:E199-E200. [PMID: 30782647 PMCID: PMC6379169 DOI: 10.1503/cmaj.71589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kora DeBeck
- Assistant professor, School of Public Policy, Simon Fraser University, Research Scientist, BC Centre on, Substance Use, Vancouver, BC
| | - Perry Kendall
- Clinical professor, School of Population and Public Health, University of British, Columbia, Vancouver, BC; Former BC, Provincial Medical Health Officer
| | - Danya Fast
- Assistant professor, Department of Medicine, University of British Columbia, Research Scientist, BC Centre on, Substance Use, Vancouver, BC
| | - Andreas Pilarinos
- PhD student, Interdisciplinary Studies, Graduate Program, University of British, Columbia; Research Assistant, BC Centre, on Substance Use, Vancouver, BC
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Bastani P, Marshall BD, Rahimi-Movaghar A, Noroozi A. The risk environments of people who use drugs accessing two harm reduction centers in Tehran, Iran: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 63:90-96. [DOI: 10.1016/j.drugpo.2018.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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Bastos FI. Políticas de drogas no Brasil contemporâneo: aportes da ciência, da clínica e do liberalismo moderno. CAD SAUDE PUBLICA 2019; 35:e00125519. [DOI: 10.1590/0102-311x00125519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/03/2019] [Indexed: 11/22/2022] Open
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104
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Klimas J, Fairgrieve C, Tobin H, Field C, O'Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018; 12:CD009269. [PMID: 30521696 PMCID: PMC6517179 DOI: 10.1002/14651858.cd009269.pub4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Problem alcohol use is common among people who use illicit drugs (PWID) and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opioid overdose in PWID. OBJECTIVES To assess the effectiveness of psychosocial interventions to reduce alcohol consumption in PWID (users of opioids and stimulants). SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO, from inception up to August 2017, and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; and 2) online registers of clinical trials: Current Controlled Trials, ClinicalTrials.gov, Center Watch and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA We included randomised controlled trials comparing psychosocial interventions with other psychosocial treatment, or treatment as usual, in adult PWIDs (aged at least 18 years) with concurrent problem alcohol use. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included seven trials (825 participants). We judged the majority of the trials to have a high or unclear risk of bias.The psychosocial interventions considered in the studies were: cognitive-behavioural coping skills training (one study), twelve-step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol-related harm. The results were as follows.Comparison 1: cognitive-behavioural coping skills training versus twelve-step programme (one study, 41 participants)There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low.Comparison 2: brief intervention versus treatment as usual (three studies, 197 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI -0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI -0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants)More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate.Comparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index-alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. AUTHORS' CONCLUSIONS We found low to very low-quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment-only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies.
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Affiliation(s)
- Jan Klimas
- BC Centre for Excellence in HIV/AIDSBC Centre on Substance Use611 Powell StreetVancouverBCCanadaV6A 1H2
- School of Medicine, University College DublinHealth Science Centre, Belfield, UCDDublinIrelandD4
| | - Christopher Fairgrieve
- BC Centre for Excellence in HIV/AIDSBC Centre on Substance Use611 Powell StreetVancouverBCCanadaV6A 1H2
| | - Helen Tobin
- University College DublinSchool of MedicineDublinIreland
| | - Catherine‐Anne Field
- National University of Ireland GalwayCollege of Medicine, Nursing, & Health Sciences, School of Health SciencesGalwayIreland
| | - Clodagh SM O'Gorman
- Faculty of Education and Health Sciences, University of LimerickGraduate Entry Medical SchoolLimerickIreland
- Graduate Entry Medical School, University of LimerickDepartment of PaediatricsLimerickIreland
| | - Liam G Glynn
- Graduate Entry Medical School, University of LimerickGeneral PracticeLimerickIreland
| | - Eamon Keenan
- Health Service ExecutiveAddiction ServicesBridge House, Cherry Orchard HospitalBallyfermotDublinIreland10
| | - Jean Saunders
- Graduate Entry Medical School, University of LimerickStatistical Consulting Unit/ Applied Biostatistics Consulting Centre /CSTARLimerickIreland
| | - Gerard Bury
- University College DublinSchool of MedicineDublinIreland
| | - Colum Dunne
- Faculty of Education and Health Sciences, University of LimerickGraduate Entry Medical SchoolLimerickIreland
- Faculty of Education and Health Sciences, University of LimerickCentre for Interventions in Infection, Inflammation & Immunity (4i)LimerickIreland
| | - Walter Cullen
- University College DublinSchool of MedicineDublinIreland
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105
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Christopher PP, Anderson B, Stein MD. Civil commitment experiences among opioid users. Drug Alcohol Depend 2018; 193:137-141. [PMID: 30384320 PMCID: PMC6239959 DOI: 10.1016/j.drugalcdep.2018.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Civil commitment is an increasingly used policy intervention to combat the opioid epidemic. Yet little is known about persons who get committed and outcomes following commitment for opioid use. In the current cross-sectional study, we compared the characteristics of persons with and without a history of civil commitment, and the correlates of post-commitment abstinence. METHODS Between October 2017 and May 2018, we surveyed consecutive persons entering a brief, inpatient opioid detoxification (n = 292) regarding their lifetime experiences with civil commitment for opioid use. RESULTS Participants averaged 34.6 years of age, 27.1% were female, and 78.1% were White. Seventy-eight (26.7%) experienced civil commitment for opioid use at least once in their lifetime. Committed individuals had significantly higher rates of fentanyl, heroin, and injection drug use, drug overdoses, past incarceration, current criminal justice involvement, and past medication treatment for opioid use (p < .05). The average time to relapse following commitment was 72 days, although 33.8% relapsed on the same day of their release. Longer post-commitment abstinence was significantly associated with post-commitment medication treatment, higher perceived procedural justice (i.e., fairness) during the commitment hearing, positive attitude and higher motivation at the end of commitment, and improvement in attitude during commitment (p < .05). CONCLUSION Opioid users who experience civil commitment constitute an especially high risk group. A positive commitment experience and post-commitment medication treatment are associated with longer post-commitment abstinence.
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Affiliation(s)
- Paul P Christopher
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence RI 02912 United States.
| | - Bradley Anderson
- General Medicine Unit, Butler Hospital, Providence RI United States
| | - Michael D Stein
- Department of Health Law, Policy & Management, School of Public Health, Boston University, United States
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106
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Liu L, Hsiao SC. Chinese Female Drug Users' Experiences and Attitudes With Institutional Drug Treatment. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:4221-4235. [PMID: 29478389 DOI: 10.1177/0306624x18758894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
With its rapid economic growth and the increased influence of Western culture, China has become a drug-consuming country. Forty-six semistructured interviews were conducted in a compulsory drug treatment institution to document Chinese female drug users' experiences with and attitudes toward two mandated treatment modalities: vocational training and educational activities. Detainees required to participate in first institutional treatment showed enthusiasm and had more positive attitudes; those who had entered the compulsory treatment facilities 2 or more times generally had a negative outlook on their pursuit of abstinence. Although female detainees achieved detoxification in the institution, many relapsed upon release to their community, indicating the institutional compulsory treatment model's failure to ensure long-term abstinence. By revealing four main flaws of the current institutional compulsory treatment, this study indicates the need for a comprehensive treatment system that combines improvements to institutional treatment and development of community-based treatment to address different stages of abstinence.
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Affiliation(s)
- Liu Liu
- 1 Nanjing University, Nanjing, China
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107
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Murphy A, Lubman DI, McKie S, Bijral PS, Peters LA, Faiz Q, Holmes SE, Anderson IM, Deakin B, Elliott R. Time-dependent neuronal changes associated with craving in opioid dependence: an fMRI study. Addict Biol 2018; 23:1168-1178. [PMID: 28940758 PMCID: PMC6120475 DOI: 10.1111/adb.12554] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 12/11/2022]
Abstract
Relapse after initially successful treatment is a significant problem facing the treatment of opioid dependence. Evidence suggests craving elicited by re‐exposure to drug cues may precipitate relapse. Attempts to identify neural biomarkers of cue‐elicited craving have yielded inconsistent findings. We aimed to apply a novel continuous functional magnetic resonance imaging technique to follow the minute‐to‐minute evolution of brain responses, which correlate with the waxing and waning of craving. Newly detoxified male opioid‐dependent patients and healthy control participants attended two separate, counterbalanced, functional magnetic resonance imaging scanning sessions during which they viewed a 10‐minute video (drug cue or neutral cue) followed by 5 minutes of fixation. Participants rated the intensity of their craving throughout each session. We hypothesized that subcortical/ventral prefrontal cortex (PFC) regions and dorsal PFC regions would show different associations with craving reflecting their putative roles in appetitive processing versus cognitive control. Compared with controls, drug cue (minus neutral cue) video recruited the left amygdala and was temporally correlated with craving. In contrast, dorsal anterior cingulate blood‐oxygen‐level‐dependent signal time course was higher than controls only during a period after cue exposure when craving levels were declining. Against expectations, neither the ventral striatum nor ventral PFC was significantly recruited by drug cue exposure. Findings suggest that the amygdala has a central role in craving, whereas the dorsal anterior cingulate may control craving in treatment‐seeking patients. Time course analysis yielded new insights into the neural substrates of craving that could objectively validate development of psychological and pharmacological approaches to sustained abstinence.
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Affiliation(s)
- Anna Murphy
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
- Department of Biological Sciences; University of Huddersfield; UK
| | - Dan I. Lubman
- Turning Point; Eastern Health; Australia
- Eastern Health Clinical School; Monash University; Australia
| | - Shane McKie
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
| | - Prun S. Bijral
- Chapman-Barker Unit; Greater Manchester West NHS Foundation Trust; UK
- Change, Grow, Live; UK
| | - Lesley A. Peters
- Pennine Care NHS Foundation Trust; UK
- DISC, My Recovery Tameside; UK
| | - Qasim Faiz
- Chapman-Barker Unit; Greater Manchester West NHS Foundation Trust; UK
- Pennine Care NHS Foundation Trust; UK
| | - Sophie E. Holmes
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
- Department of Psychiatry; Yale University School of Medicine; West Haven CT USA
| | - Ian M. Anderson
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
| | - Bill Deakin
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
- Greater Manchester Mental Health NHS Foundation Trust; UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
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108
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An Exploration of the Relational Autonomy of People with Substance Use Disorders: Constraints and Limitations. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9957-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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109
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Lunze K, Lermet O, Andreeva V, Hariga F. Compulsory treatment of drug use in Southeast Asian countries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:10-15. [PMID: 29966803 DOI: 10.1016/j.drugpo.2018.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 04/28/2018] [Accepted: 06/11/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several Southeast Asian countries have implemented compulsory drug detention centres in which people who use or are suspected of using drugs, mainly amphetamine-type stimulants, are confined without their consent and in most cases without due process and clinical evaluation of their substance use disorder. Given these facilities' lack of access to evidence-based drug dependence treatment, and the human rights implications of peoples' arbitrary detention under the pretext of "treatment", international organizations have called for their closure. The aim of this study was to estimate recent numbers of compulsory drug treatment centres and of people in these centres in the region. METHODS We conducted an analysis of cross-sectional governmental data collected from seven countries in the region with compulsory drug detention centres, namely Cambodia, China, Lao PDR, Malaysia, the Philippines, Thailand and Viet Nam. We computed descriptive data provided by government representatives for the period between 2012 and 2014. RESULTS The total number of people in compulsory detention centres overall decreased by only 4% between 2012 and 2014. In 2014, over 450,000 people were detained in 948 facilities in the seven countries. While only two countries decreased the number of compulsory detention centres, most countries increased the number of people detained. CONCLUSIONS In spite of international calls for the closure of compulsory detention centres, the number of facilities and detained people remained high in the seven countries included in the analysis. These officially reported figures are concerning regarding access to effective drug dependence treatment and given the potential for additional human rights abuses within compulsory detention centers. Further concerted policy and advocacy efforts should support transition of treatment for people with drug dependence towards human rights-based and evidence-based drug dependence treatment. Expansion of existing drug and HIV services in the community rather than compulsory treatment modalities will effectively address the region's drug and HIV burden.
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Affiliation(s)
- Karsten Lunze
- Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave. Crosstown 2079, Boston, MA, 02118, USA.
| | - Olivier Lermet
- United Nations Office on Drugs and Crime, Regional Office for Southeast Asia and the Pacific, UN Secretariat Building, 3rd Floor, Rajdamnern Nok Avenue, Bangkok, 10200, Thailand.
| | - Vladanka Andreeva
- UNAIDS, Regional Support Team, Asia and the Pacific, UN Building Room 906, Rajadamnern Nok Avenue, 10200, Bangkok, Thailand.
| | - Fabienne Hariga
- United Nations Office on Drugs and Crime, Room D1426, P.O Box 500 A-1400 Vienna, Austria.
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110
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Rafful C, Orozco R, Rangel G, Davidson P, Werb D, Beletsky L, Strathdee SA. Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs. Addiction 2018; 113:1056-1063. [PMID: 29333664 PMCID: PMC5938130 DOI: 10.1111/add.14159] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/04/2017] [Accepted: 01/05/2018] [Indexed: 01/22/2023]
Abstract
AIM To assess the effect of involuntary drug treatment (IDT) on non-fatal overdose among people who inject drugs (PWID). DESIGN Longitudinal study. SETTING Tijuana, Mexico. PARTICIPANTS Baseline sample of 671 PWID included 258 (38.4%) women and 413 (61.6%) men. MEASUREMENTS Primary independent variables were reported recent (i.e. past 6 months) non-fatal overdose event (dependent variable) and IDT. Substance use the day of the non-fatal overdose was also examined. FINDINGS From 2011 to 2017, 213 participants (31.7%) reported a recent non-fatal overdose and 103 (15.4%) reported recent IDT. Heroin, in combination with methamphetamine and tranquilizers, were the drugs most reported at the day of the event. IDT significantly increased the odds of reporting a non-fatal overdose event [adjusted odds ratio (aOR) = 1.76; 95% confidence interval (CI) = 1.04-2.96]. Odds of non-fatal overdose also increased independently for each additional injection per day (aOR = 1.05; 95% CI = 1.02-1.08), recent tranquilizer use (aOR = 1.92; 95% CI = 1.41-2.61) and using hit doctors (aOR = 1.68; 95% CI = 1.29-2.18) and decreased with age (aOR = 0.97 per year, 95% CI = 0.95-0.99). CONCLUSIONS Recent involuntary drug treatment in Mexico is a risk factor for non-fatal drug overdose.
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Affiliation(s)
- Claudia Rafful
- Division of Global Public Health, School of Medicine, University of California, San Diego,School of Public Health, San Diego State University,Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | | | - Gudelia Rangel
- Secretariat of Health, Mexico,Mexico-United States Border Health Commission, Mexico
| | - Peter Davidson
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | - Dan Werb
- Division of Global Public Health, School of Medicine, University of California, San Diego,Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Leo Beletsky
- Division of Global Public Health, School of Medicine, University of California, San Diego,School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Steffanie A. Strathdee
- Division of Global Public Health, School of Medicine, University of California, San Diego,Corresponding author: Steffanie A. Strathdee, Ph.D., Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive. La Jolla, CA 92093-0507, USA, Tel: +1(858)822-1952; Fax: +1(858)534-7566,
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111
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Bazazi AR. Commentary on Rafful et al. (2018): Unpacking involuntary interventions for people who use drugs. Addiction 2018; 113:1064-1065. [PMID: 29732697 PMCID: PMC7006027 DOI: 10.1111/add.14202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
Involuntary interventions for substance use disorders are less effective and potentially more harmful than voluntary treatment, and involuntary centers often serve as venues for abuse. Scaling up voluntary, evidence-based, low-barrier treatment options might invalidate the perceived necessity of involuntary interventions, and could go a long way toward reducing overdose risk.
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Affiliation(s)
- Alexander R. Bazazi
- Yale School of Public Health, Department of Epidemiology
of Microbial Diseases, New Haven, CT, USA.,Yale School of Medicine, Section of Infectious Diseases,
AIDS Program, New Haven, CT, USA
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112
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Bhalla IP, Cohen N, Haupt CE, Stith K, Zhong R. The Role of Civil Commitment in the Opioid Crisis. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:343-350. [PMID: 30146976 DOI: 10.1177/1073110518782943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article seeks to shed light on civil commitment in the context of the opioid crisis, to sketch the existing legal landscape surrounding civil commitment, and to illustrate the relevant medical, ethical, and legal concerns that policymakers must take into account as they struggle to find appropriate responses to the crisis.
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Affiliation(s)
- Ish P Bhalla
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Nina Cohen
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Claudia E Haupt
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Kate Stith
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Rocksheng Zhong
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
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113
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Formica SW, Apsler R, Wilkins L, Ruiz S, Reilly B, Walley AY. Post opioid overdose outreach by public health and public safety agencies: Exploration of emerging programs in Massachusetts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:43-50. [DOI: 10.1016/j.drugpo.2018.01.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 01/01/2018] [Accepted: 01/02/2018] [Indexed: 02/01/2023]
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114
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Yangyuen S, Kanato M, Mahaweerawat U. Associations of the Neighborhood Environment With Substance Use: A Cross-sectional Investigation Among Patients in Compulsory Drug Detention Centers in Thailand. J Prev Med Public Health 2018; 51:23-32. [PMID: 29397643 PMCID: PMC5797718 DOI: 10.3961/jpmph.17.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/07/2017] [Indexed: 12/27/2022] Open
Abstract
Objectives To identify the associations of characteristics of the neighborhood environment with substance abuse among clients receiving treatment for drug abuse in Thailand. Methods A cross-sectional study was conducted of 1128 drug addicts from 28 neighborhoods who were receiving treatment at all 7 compulsory drug detention centers in Thailand. A trained interviewer conducted structured interviews with the subjects about substance use and the perceived neighborhood environment in their community. A multilevel logistic regression model was applied to estimate the effects of the neighborhood environment on substance use. Results The majority of participants, 53.8% only used methamphetamine pills, 31.3% used other illicit drugs as well as methamphetamine pills, and 14.9% used an illicit drug other than methamphetamine. Three neighborhood characteristics were associated with substance use. A 1-unit increase in the perceived neighborhood cohesion score was associated with a 15% reduction in methamphetamine pill use and an 11% reduction of the use of both methamphetamine pills and another illicit drug. Conversely, a 1-unit increase in perceived neighborhood crime predicted 19 and 14% increases in the use of methamphetamine pills and the use of both methamphetamine pills and another illicit drug, respectively. In addition, a 1-unit increase in the scores for stigma surrounding addiction corresponded to a 25% increase of the use of methamphetamine pills and a 12% increase in the use of both methamphetamine pills and another illicit drug. Conclusions Substance use among drug addicts was influenced by characteristics of the neighborhood environment. Therefore, prevention and intervention strategies should be designed based on a consideration of the impact of neighborhood context on substance use behaviors.
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Affiliation(s)
| | - Manop Kanato
- Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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115
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Malta M. Human rights and political crisis in Brazil: Public health impacts and challenges. Glob Public Health 2018; 13:1577-1584. [PMID: 29368578 DOI: 10.1080/17441692.2018.1429006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In 31 August 2016, Brazilian president Dilma Rousseff was impeached and replaced by her vice president Michel Temer. Herein, we examine how the conservative agenda of Mr Temer and his supporters is influencing key decisions in the human rights and public health arena in Brazil. The government's austerity agenda includes severe cuts in critical areas such as health, education and science, jeopardising well-known strategies such as the Brazilian Public Health System (SUS) and nationwide cash transfer program, 'Bolsa Familia' - both benefited millions and were the largest of their kind in the world. Mr Temer's decisions show not only severe cuts in critical areas but also a political agenda that clearly demonstrates a broad shift away from the progressivism and social agenda presented and supported by its predecessors. Most vulnerable groups such as the LGBTQ community, women, people who use drugs and disenfranchised communities have been severely affected. Mr Temer's administration is putting Brazil far from its once nationwide goal to foster free and universal health care access and social equity for all its citizens. The near future for Brazil is unknown, but both national and international communities anticipate severe problems within the national human rights arena, if nothing changes. ABBREVIATIONS CCT: Conditional Cash Transfer; LGBTQ: Lesbian, Gay, Bisexual, Transgender and Queer (and/or Questioning); SUS: Brazilian Public Health System.
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Affiliation(s)
- Monica Malta
- a Social Science Department , Sergio Arouca National School of Public Health (ENSP/FIOCRUZ) , Rio de Janeiro , Brazil.,b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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116
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Brown AM, Bohler R. Achieving a 15% Relapse Rate: A Review of Collegiate Recovery and Physician Health Programs. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1424595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Austin M Brown
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, Georgia
| | - Robert Bohler
- Center for Addiction Recovery, Georgia Southern University, Statesboro, Georgia
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117
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Kerr T, Small W, Ayutthaya PPN, Hayashi K. Experiences with compulsory drug detention among people who inject drugs in Bangkok, Thailand: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 52:32-38. [PMID: 29227881 DOI: 10.1016/j.drugpo.2017.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas Kerr
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada.
| | - Will Small
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | | | - Kanna Hayashi
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
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118
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Wegman MP, Altice FL, Kaur S, Rajandaran V, Osornprasop S, Wilson D, Wilson DP, Kamarulzaman A. Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study. Lancet Glob Health 2017; 5:e198-e207. [PMID: 27964869 PMCID: PMC5657487 DOI: 10.1016/s2214-109x(16)30303-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/29/2016] [Accepted: 10/18/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Detention of people who use drugs into compulsory drug detention centres (CDDCs) is common throughout East and Southeast Asia. Evidence-based pharmacological therapies for treating substance use disorders, such as opioid agonist treatments with methadone, are generally unavailable in these settings. We used a unique opportunity where CDDCs coexisted with voluntary drug treatment centres (VTCs) providing methadone in Malaysia to compare the timing and occurrence of opioid relapse (measured using urine drug testing) in individuals transitioning from CDDCs versus methadone maintenance in VTCs. METHODS We did a parallel, two-arm, prospective observational study of opioid-dependent individuals aged 18 years and older who were treated in Malaysia in the Klang Valley in two settings: CDDCs and VTCs. We used sequential sampling to recruit individuals. Assessed individuals in CDDCs were required to participate in services such as counselling sessions and manual labour. Assessed individuals in VTCs could voluntarily access many of the components available in CDDCs, in addition to methadone therapy. We undertook urinary drug tests and behavioural interviews to assess individuals at baseline and at 1, 3, 6, 9, and 12 months post-release. The primary outcome was time to opioid relapse post-release in the community confirmed by urinary drug testing in individuals who had undergone baseline interviewing and at least one urine drug test (our analytic sample). Relapse rates between the groups were compared using time-to-event methods. This study is registered at ClinicalTrials.gov (NCT02698098). FINDINGS Between July 17, 2012, and August 21, 2014, we screened 168 CDDC attendees and 113 VTC inpatients; of these, 89 from CDDCs and 95 from VTCs were included in our analytic sample. The baseline characteristics of the two groups were similar. In unadjusted analyses, CDDC participants had significantly more rapid relapse to opioid use post-release compared with VTC participants (median time to relapse 31 days [IQR 26-32] vs 352 days [256-unestimable], log rank test, p<0·0001). VTC participants had an 84% (95% CI 75-90) decreased risk of opioid relapse after adjustment for control variables and inverse propensity of treatment weights. Time-varying effect modelling revealed the largest hazard ratio reduction, at 91% (95% CI 83-96), occurs during the first 50 days in the community. INTERPRETATION Opioid-dependent individuals in CDDCs are significantly more likely to relapse to opioid use after release, and sooner, than those treated with evidence-based treatments such as methadone, suggesting that CDDCs have no role in the treatment of opioid-use disorders. FUNDING The World Bank Group, Doris Duke Charitable Foundation, National Institute on Drug Abuse, Australian National Health & Medical Research Council, National Institute of Mental Health, and the University of Malaya-Malaysian Ministry of Higher Education High Impact Research Grant.
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Affiliation(s)
- Martin P Wegman
- Yale University School of Medicine, New Haven, CT, USA; Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; University of Florida College of Medicine, Gainesville, FL, USA
| | - Frederick L Altice
- Yale University School of Medicine, New Haven, CT, USA; Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | | | - Vanesa Rajandaran
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Adeeba Kamarulzaman
- Yale University School of Medicine, New Haven, CT, USA; Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Bergenstrom A, Vumbaca G. Compulsory drug detention centres: time to question their continued use? LANCET GLOBAL HEALTH 2017; 5:e123-e124. [DOI: 10.1016/s2214-109x(16)30352-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
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Bastos FIP. Entre as asperezas do cotidiano e o brilho fácil: o manejo cotidiano do uso prejudicial de drogas. CAD SAUDE PUBLICA 2017; 33:e00097017. [DOI: 10.1590/0102-311x00097017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 11/21/2022] Open
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Pearlman J. Combatting Massachusetts's Opioid Epidemic: Reducing the Social Stigma of Addiction Through Increased Access to Voluntary Treatment Services and Expansion of Mandatory Clinician Education Programs. AMERICAN JOURNAL OF LAW & MEDICINE 2016; 42:835-857. [PMID: 29086651 DOI: 10.1177/0098858817701962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Julie Pearlman
- J.D. candidate, Boston University School of Law, 2017; B.A. Political Science, University of Rochester, 2012
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Wild TC, Yuan Y, Rush BR, Urbanoski KA. Client Engagement in Legally-Mandated Addiction Treatment: A Prospective Study Using Self-Determination Theory. J Subst Abuse Treat 2016; 69:35-43. [DOI: 10.1016/j.jsat.2016.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/26/2016] [Accepted: 06/06/2016] [Indexed: 11/29/2022]
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Southeast Asia in focus: stemming the reawakening of prohibitionism. J Int AIDS Soc 2016; 19:21279. [PMID: 27349912 PMCID: PMC4923264 DOI: 10.7448/ias.19.1.21279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 11/13/2022] Open
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Lunze K, Idrisov B, Golichenko M, Kamarulzaman A. Mandatory addiction treatment for people who use drugs: global health and human rights analysis. BMJ 2016; 353:i2943. [PMID: 27284009 PMCID: PMC6884099 DOI: 10.1136/bmj.i2943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Karsten Lunze
- Boston University School of Medicine, Boston, MA, USA
| | - Bulat Idrisov
- Boston University School of Medicine, Boston, MA, USA
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