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Marshall BDL, Milloy MJ, Wood E, Galea S, Kerr T. Temporal and geographic shifts in urban and nonurban cocaine-related fatal overdoses in British Columbia, Canada. Ann Epidemiol 2012; 22:198-206. [PMID: 22266349 DOI: 10.1016/j.annepidem.2011.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/13/2011] [Accepted: 12/30/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Illicit drug overdose is a leading cause of premature mortality. We sought to examine fatal overdose trends from 2001 to 2005 in urban and nonurban areas of British Columbia, Canada. METHODS We conducted a review of all provincial coroner files in which drug overdose was the cause of death between January 1, 2001, and December 31, 2005. We compared cocaine and non-cocaine-related overdoses and examined temporal changes in cocaine-related mortality rates in urban and nonurban areas. Multilevel mixed effects models were used to determine the independent risk factors for cocaine-related death. Spatial analyses were conducted to identify clusters of these cases. RESULTS During the study period, 904 illicit drug overdoses were recorded, including 369 (40.8%) in nonurban areas and 532 (58.9%) related to cocaine consumption. In a multilevel model, we observed a significant interaction (p = .010) between population density and year, indicating a considerable and differential increase in the likelihood of cocaine-related deaths in nonurban areas. Cocaine-related deaths were clustered in the southeast region of the province. CONCLUSIONS Cocaine-related overdoses in nonurban areas should be a public health concern. Evidence-based interventions to reduce the risks associated with cocaine consumption and reach drug users in nonurban settings are needed.
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Affiliation(s)
- Brandon D L Marshall
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
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152
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Rees KA, McLaughlin PA, Osselton MD. Validation of a Gas Chromatography–Ion Trap-Tandem Mass Spectrometry Assay for the Simultaneous Quantification of Cocaine, Benzoylecgonine, Cocaethylene, Morphine, Codeine, and 6-Acetylmorphine in Aqueous Solution, Blood, and Skeletal Muscle Tissue. J Anal Toxicol 2012; 36:1-11. [DOI: 10.1093/jat/bkr006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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153
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A 25-year follow-up of patients admitted to methadone treatment for the first time: mortality and gender differences. Addict Behav 2011; 36:1184-90. [PMID: 21835551 DOI: 10.1016/j.addbeh.2011.07.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 07/06/2011] [Accepted: 07/15/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION We conducted a follow-up study to evaluate the outcome of a heroin-dependent population 25 years after their first enrollment in methadone maintenance treatment (MMT). We assessed mortality in the sample plus actual drug use, treatment, and medical factors associated with drug dependence, focusing on possible gender differences. METHODS Prospective follow-up study of 214 heroin-dependent patients consecutively admitted for MMT between 1980 and 1984 in the Asturias Public Health Service. The standardized mortality ratio (SMR) and 95% confidence interval (CI) were calculated. An ad-hoc protocol on drug misuse and treatment, drug-related morbidity and Clinical Global Impression (CGI) scores were assessed in the survivors' sample. RESULTS Information was received on 159 subjects, 106 of whom were deceased. Men accounted for 76.2% of the study cohort. Over the 25-year follow-up period, the SMR was 22.51 (95% CI=22.37-22.64). In the survivors sample, 39.6% were still enrolled in MMT; human immunodeficiency virus (HIV) was diagnosed in 47.2% and hepatitis B/C in 81.1%; current heroin use was reported by 22.6%. There were no gender differences in mortality or HIV and hepatitis B/C status. None of the female survivors were using heroin at the 25-year follow-up compared with 31.1% of males. CONCLUSIONS This study confirms the high mortality of heroin addicts even after enrollment in MMT. Severity of the addiction in terms of mortality was similar in both genders. Women who survived the 25-year follow-up were more likely to have stopped using heroin than men.
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154
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Ramo DE, Grov C, Delucchi K, Kelly BC, Parsons JT. Cocaine use trajectories of club drug-using young adults recruited using time-space sampling. Addict Behav 2011; 36:1292-300. [PMID: 21907497 PMCID: PMC3184016 DOI: 10.1016/j.addbeh.2011.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 08/09/2011] [Accepted: 08/18/2011] [Indexed: 12/31/2022]
Abstract
Cocaine is the most widely used club drug. Yet, little is known about how patterns of cocaine use vary over time among young adults of diverse gender and sexual identities. This study used latent class growth analysis to identify trajectories of cocaine use over a year and explored individual and substance use factors associated with these trajectories. A sample of 400 young adults (mean age=23.9 years) with recent club drug use were recruited from New York City bars and nightclubs using time-space sampling. Participants completed quantitative measures at baseline, 4-, 8- and 12-months follow-up. A 4-class model fit the data best. Patterns were: Consistent use (48%), Inconsistent use (14%), Decreasing Likelihood of use (28%), and Consistent non-use (11%). Those most likely to be in the Consistent use class had the highest frequency of baseline club drug dependence (χ2 (3, 397)=15.1, p<.01), cocaine dependence (χ2 (3, 397) = 18.9, p<.01), recent alcohol use (χ2 (3, 397)=12.48, p<.01), and drug sensation-seeking (χ2 (3, 397)=9.03, p<.01). Those most likely to be in the Consistent Non-use class had the highest frequency of baseline marijuana use (χ2 (3, 397)=2.71, p<.05). Contrary to hypotheses, there were no differences in most-likely trajectory class by gender/sexual-orientation, age, ethnicity, education, employment status, or income. Findings highlight the diversity of cocaine use patterns over time among young adults, and the personal and substance use characteristics that are associated with each.
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Affiliation(s)
- Danielle E. Ramo
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, TRC 0984, San Francisco, CA 94143, USA, 401 Parnassus Avenue, TRC 0984, San Francisco, CA 94143, USA
| | - Christian Grov
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, 2900 Bedford Ave., Brooklyn, NY. 11210
- The Center for HIV/AIDS Educational Studies and Training (CHEST), 250 West 26 Street, #300, New York, NY. 10001
| | - Kevin Delucchi
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, TRC 0984, San Francisco, CA 94143, USA, 401 Parnassus Avenue, TRC 0984, San Francisco, CA 94143, USA
| | - Brian C. Kelly
- The Center for HIV/AIDS Educational Studies and Training (CHEST), 250 West 26 Street, #300, New York, NY. 10001
- Department of Sociology, Purdue University, 700 State Street, West Lafayette, IN 47907, USA
| | - Jeffrey T. Parsons
- The Center for HIV/AIDS Educational Studies and Training (CHEST), 250 West 26 Street, #300, New York, NY. 10001
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, New York, 10065, USA
- Social-Personality Doctoral Subprogram, Graduate Center of the City University of New York, 695 Park Avenue, New York, NY 10065, USA
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155
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Bohnert ASB, Roeder KM, Ilgen MA. Suicide attempts and overdoses among adults entering addictions treatment: comparing correlates in a U.S. National Study. Drug Alcohol Depend 2011; 119:106-12. [PMID: 21715108 DOI: 10.1016/j.drugalcdep.2011.05.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 05/27/2011] [Accepted: 05/30/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Suicide attempts and non-fatal overdoses are both associated with substance use. The aim of the present study was to examine correlates of suicide attempts and non-fatal overdoses simultaneously among individuals seeking addictions treatment. METHODS A large U.S. national sample of individuals entering addictions treatment participated in a cross-sectional survey (n=5892). Multinomial logistic regression modeling tested the adjusted associations of violence, injection drug use, specific substances, and depressive symptoms with a four-category outcome variable based on prior histories of suicide attempt and non-fatal overdose (neither, suicide attempt only, overdose only, both), adjusting for demographic and treatment characteristics. RESULTS Sexual and physical victimization was associated with suicide attempts with or without overdoses (ORs 1.25-2.84), while perpetrating violence was associated with having experienced either or both outcomes (ORs 1.25-1.56). Depressive symptoms had a stronger association with suicide attempts (OR=3.05) than overdoses (OR=1.29). Injection drug use was associated with overdoses with or without suicide attempts (ORs 2.65-3.22). Individuals seeking treatment for marijuana use were less likely have overdosed or attempted suicide (ORs 0.39-0.67), while individuals seeking treatment for heroin use were more likely to have overdosed (OR=1.46). Seeking treatment for use of more than one substance was associated with overdose and overdose and suicide attempt (ORs 1.58-2.51), but not suicide attempt alone. CONCLUSIONS The present findings indicate that suicide and overdose are connected yet distinct problems. Individuals who have had a history of both may be a group with particularly poor psychological functioning as well as more severe drug-related problems.
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Affiliation(s)
- Amy S B Bohnert
- Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Department of Veterans Affairs, Ann Arbor, MI 48105, USA.
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156
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Jones AW, Holmgren A, Ahlner J. Heroin poisoning deaths with 6-acetylmorphine in blood: demographics of the victims, previous drug-related offences, polydrug use, and free morphine concentrations in femoral blood. Forensic Toxicol 2011. [DOI: 10.1007/s11419-011-0123-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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157
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Marasovic Susnjara I, Definis Gojanovic M, Vodopija D, Capkun V, Smoljanovic A. Influence of war on quantitative and qualitative changes in drug-induced mortality in Split-Dalmatia County, Croatia. Croat Med J 2011; 52:629-36. [PMID: 21990081 PMCID: PMC3195972 DOI: 10.3325/cmj.2011.52.629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aim To study drug-induced mortality and characteristics of overdose deaths in the war (1991-1995), pre-war (1986-1990), and post-war period (1996-2000) in Split-Dalmatia County. Methods We retrospectively searched through Databases of the Department of Forensic Medicine, University Hospital Split, the national register of death records, the archives of the Split-Dalmatia County Police, and the Register of Treated Drug Addicts of the Croatian National Institute of Public Health, covering the period from 1986 to 2000, according to drug poisoning codes IX and X of the International Classification of Diseases. The indicators were statistically analyzed. Results There were 146 registered drug-induced deaths, with 136 (93%) deceased being men. The median age of all cases was 27 years (interquartile range 8). Most of them were single (70.6%), unemployed (44.6%), and secondary school graduates (69.2%). In the war period, there were 4.8 times more deaths than in the pre-war period (P = 0.014), and in the post-war period there were 5.2 times more deaths than in the pre-war period (P = 0.008). The most common site of death was the deceased person’s home. The toxicological analyses showed that 59 (61%) deaths were heroin related, alcohol use was found in 62 cases (42.5%), and multi-substance use was found in more than a half of the cases. In 133 (91.1%) cases, deaths were classified as unintentional, whereas 13 (8.9%) were classified as suicides. Conclusion The war, along with other risk factors, contributed to unfavorable developments related to drug abuse in Split-Dalmatia County, including the increase in the drug-induced mortality rate.
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158
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Hakansson A, Schlyter F, Berglund M. Associations between polysubstance use and psychiatric problems in a criminal justice population in Sweden. Drug Alcohol Depend 2011; 118:5-11. [PMID: 21419580 DOI: 10.1016/j.drugalcdep.2011.02.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 02/08/2011] [Accepted: 02/08/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Polysubstance use is common in substance users, and may complicate their clinical course. This study, in a criminal justice setting in Sweden, examines the association between the number of concurrently used substance types and psychiatric symptoms during 30 days before incarceration, while controlling for background variables such as family history (drug and alcohol problems, psychiatric problems, criminality), demographic data and history of emotional, physical or sexual abuse. METHODS The data material comprised 5659 criminal justice clients reporting a substance use problem, examined with the Addiction Severity Index. Variables were compared in a multinomial regression analysis, comparing clients reporting one (n=1877), two (n=1408), three (n=956), four (n=443) and five or more (n=167) substance types. RESULTS The 30-day prevalence of most psychiatric symptoms included in the study (depression, anxiety, cognitive problems, hallucinations, difficulty controlling violent behaviour, suicidal ideation, suicide attempts) was higher in individuals with a higher number of concurrent substance types used. In multinomial regression analysis, while controlling for background variables, these associations remained for concurrent suicidal ideation, cognitive problems, hallucinations and violent behaviour, with the latter two being associated with the higher numbers of substance types. Binge alcohol drinking, tranquilizers, opioids and the number of substance types reported were associated with several of the psychiatric symptoms. CONCLUSIONS In the present criminal justice setting in Sweden, the use of multiple substance types and concurrent psychiatric symptoms appear to be associated, and a sub-group reporting particularly high numbers of concurrent substance types are particularly likely to report potentially severe psychiatric problems.
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Affiliation(s)
- A Hakansson
- Clinical Alcohol Research, Lund University, Malmö, Sweden.
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159
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Walton G, Co SJ, Milloy MJ, Qi J, Kerr T, Wood E. High prevalence of childhood emotional, physical and sexual trauma among a Canadian cohort of HIV-seropositive illicit drug users. AIDS Care 2011; 23:714-21. [PMID: 21390877 DOI: 10.1080/09540121.2010.525618] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The psychosocial impacts of various types of childhood maltreatment on vulnerable illicit drug-using populations remain unclear. We examined the prevalence and correlates of antecedent emotional, physical and sexual abuse among a community-recruited cohort of adult HIV-seropositive illicit drug users. METHODS We estimated the prevalence of childhood abuse at baseline using data from the Childhood Trauma Questionnaire, a 28-item validated instrument used to retrospectively assess childhood maltreatment. Logistic regression was used to estimate relationships between sub-types of childhood maltreatment with various social-demographic, drug-using and clinical characteristics. RESULTS Overall, 233 HIV-positive injection drug users (IDU) were included in the analysis, including 83 (35.6%) women. Of these, moderate or severe emotional childhood abuse was reported by 51.9% of participants, emotional neglect by 36.9%, physical abuse by 51.1%, physical neglect by 46.8% and sexual abuse by 41.6%. In multivariate analyses, emotional, physical and sexual abuses were independently associated with greater odds of recent incarceration. Emotional abuse and neglect were independently associated with a score of ≥16 on the Centre for Epidemiologic Studies Depression Scale. There was no association between any form of childhood maltreatment and clinical HIV variables, including viral load, CD4+ count and history of antiretroviral therapy use. CONCLUSION These findings underscore the negative impact of childhood maltreatment on social functioning and mental health in later life. Given the substantial prevalence of childhood maltreatment among this population, there is a need for evidence-based resources to address the deleterious effect it has on the health and social functioning of HIV-positive IDU.
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Affiliation(s)
- Georgia Walton
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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160
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Zamparutti G, Schifano F, Corkery JM, Oyefeso A, Ghodse AH. Deaths of opiate/opioid misusers involving dihydrocodeine, UK, 1997-2007. Br J Clin Pharmacol 2011; 72:330-7. [PMID: 21235617 PMCID: PMC3162662 DOI: 10.1111/j.1365-2125.2011.03908.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 12/18/2010] [Indexed: 01/04/2023] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Dihydrocodeine (DHC) is an opioid analgesic sometimes prescribed as an alternative to other medications (e.g. methadone and buprenorphine) for opioid misuse. Its effectiveness is, however, still controversial. DHC prescription rates seem to be related to levels of DHC fatalities, possibly in relation to levels of disregard of the availability of supervised or interval dispensing of opioids, but no large-scale analysis of DHC fatalities has been carried out. We analysed here involvement of DHC in fatalities that occurred between 1997 and 2007 among individuals with a history of opiate/opioid misuse reported to the National Programme on Substance Abuse Deaths (np-SAD). WHAT THIS STUDY ADDS DHC, either alone or in combination, was identified in 584 fatalities. Typical cases identified were males in their early thirties. In accidental overdoses, DHC, which had been prescribed to 45% of the victims, was typically identified in combination with other drugs, such as heroin/morphine, methadone and hypnotics/sedatives. Both paracetamol and antidepressants were more typically identified in combination with DHC in suicides. Opiate/opioid misusers should be educated about risks associated with polydrug intake and prescribers should carefully consider a pharmacological intervention alternative to DHC (e.g. methadone, buprenorphine) when managing and treating opiate addiction. AIMS Although its effectiveness is somewhat controversial, it appears that dihydrocodeine (DHC) is still prescribed in the UK as an alternative to both methadone and buprenorphine for the treatment of opiate addiction. METHODS Data covering the period 1997-2007 voluntarily supplied by coroners were analysed. All cases pertaining to victims with a clear history of opiate/opioid misuse and in which DHC, either on its own or in combination, was identified at post-mortem toxicology and/or implicated in death, were extracted from the database. RESULTS Dihydrocodeine, either alone or in combination, was identified in 584 fatalities meeting the selection criteria. In 44% of cases it was directly implicated in the cause of death. These cases represented about 6.8% of all opiate/opioid-related deaths during this period. Typical DHC cases identified were White males in their early thirties. Accidental deaths (96%) were likely to involve DHC in combination with other psychoactives, mainly heroin/morphine, hypnotics/sedatives and methadone. Both paracetamol and antidepressants were found in proportionately more suicide cases than in accidental overdoses. DHC had been prescribed to the decedent in at least 45% of cases. CONCLUSIONS Opiate/opioid misusers should be educated about risks associated with polydrug intake. More in particular, co-administration of DHC with heroin, methadone and benzodiazepines may increase the risk of accidental fatal overdose. Prescribers should carefully consider pharmacological intervention alternative to DHC (e.g. methadone, buprenorphine) when managing and treating opiate addiction. More resources are required to do prospective research in this area.
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Affiliation(s)
- Giuliano Zamparutti
- Department of Addiction, ASL N° 4, and Department of Psychiatry, University of Udine Medical School UdineItaly
| | | | - John M Corkery
- International Centre for Drug Policy; St George's, University of LondonLondon, UK
| | - Adenekan Oyefeso
- International Centre for Drug Policy; St George's, University of LondonLondon, UK
| | - A Hamid Ghodse
- International Centre for Drug Policy; St George's, University of LondonLondon, UK
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161
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Self-administration of cocaine and remifentanil by monkeys: choice between single drugs and mixtures. Psychopharmacology (Berl) 2011; 215:281-90. [PMID: 21191570 PMCID: PMC3107981 DOI: 10.1007/s00213-010-2131-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 12/01/2010] [Indexed: 10/18/2022]
Abstract
RATIONALE Cocaine and opioids are often co-abused. As yet, however, there is no clear evidence that the drugs interact to make the mixture a more effective reinforcer. OBJECTIVE The present study examined the relative reinforcing potency and maximum effectiveness of the cocaine-opioid combination in monkeys given a choice between cocaine-opioid mixtures and the single-component drugs. METHOD Rhesus monkeys were allowed to choose between injections of cocaine (100 μg/kg/inj) and other doses of cocaine (10-560 μg/kg/inj) or remifentanil (0.03-3.0 μg/kg/inj). A dose-addition model was used to select dose combinations for mixtures of cocaine and remifentanil predicted to be equivalent to 100 μg/kg/inj of cocaine in reinforcing effect if the drugs were additive. The monkeys were then allowed to choose between (a) cocaine and mixtures predicted to be equivalent to 100 μg/kg/inj of cocaine, (b) increasing doses of the mixtures and the single-component drugs, and (c) cocaine or remifentanil at doses that were in the highest safe range. RESULTS Generally, monkeys preferred the mixtures over 100 μg/kg/inj of cocaine, evidence for superadditivity. However, preferences for the mixture ceased when relatively high doses of single-component drugs were offered as alternatives. When doses within the mixture were raised and offered with relatively high doses of the single drugs, there was no clear preference for either option. The highest dose of remifentanil was chosen over the highest dose of cocaine by all monkeys. CONCLUSION The current results indicate that cocaine-opioid combinations can be super-additive in terms of potency, but are not, at maximum, more effective than the single-component drugs.
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Abstract
AIMS In this study we examine whether the recent, sharp increase in mortality in the United States due to accidental poisoning since 2000 is the result of the aging of the baby boom cohort or, instead, a historical trend apparent among decedents of all ages. DESIGN We conducted an age-period-cohort analysis using data from the US Vital Statistics and the US Census covering the period 1968-2007. SETTING AND PARTICIPANTS The United States population aged 15-64 years. MEASUREMENTS Cause of death and demographic data as recorded on death certificates. FINDINGS The increase in mortality due to accidental poisoning since the year 2000 stems primarily from a historical period effect across all ages for whites, but results in large part from a rate spike in the baby boom cohort among blacks. For all demographic groups baby boomers had higher odds of death due to accidental poisoning than the cohorts that came before and after them. Historical influences acting across all ages led to an increase in accidental poisoning mortality that was almost 10-fold for whites and threefold for blacks over the study period. CONCLUSIONS While the recent, sharp increase in accidental poisoning mortality stems in part from the aging of the baby boom cohort, substantially more of the increase results from influences unique to recent years that have affected all age groups. These results point to the need to bolster overdose prevention programs and policies as the historical increase in accidental poisoning mortality appears to continue unabated.
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Affiliation(s)
- Richard Miech
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA.
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163
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Carter GT, Flanagan AM, Earleywine M, Abrams DI, Aggarwal SK, Grinspoon L. Cannabis in palliative medicine: improving care and reducing opioid-related morbidity. Am J Hosp Palliat Care 2011; 28:297-303. [PMID: 21444324 DOI: 10.1177/1049909111402318] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Unlike hospice, long-term drug safety is an important issue in palliative medicine. Opioids may produce significant morbidity. Cannabis is a safer alternative with broad applicability for palliative care. Yet the Drug Enforcement Agency (DEA) classifies cannabis as Schedule I (dangerous, without medical uses). Dronabinol, a Schedule III prescription drug, is 100% tetrahydrocannabinol (THC), the most psychoactive ingredient in cannabis. Cannabis contains 20% THC or less but has other therapeutic cannabinoids, all working together to produce therapeutic effects. As palliative medicine grows, so does the need to reclassify cannabis. This article provides an evidence-based overview and comparison of cannabis and opioids. Using this foundation, an argument is made for reclassifying cannabis in the context of improving palliative care and reducing opioid-related morbidity.
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Affiliation(s)
- Gregory T Carter
- Hospice Services, Providence Medical Group, Olympia, WA 98531, USA.
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164
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Nonmedical Use of Prescription Drugs and HIV Risk Behavior in Gay and Bisexual Men. Sex Transm Dis 2011; 38:105-10. [DOI: 10.1097/olq.0b013e3181f0bc4b] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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166
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Liang LJ, Huang D, Brecht ML, Hser YI. Differences in Mortality among Heroin, Cocaine, and Methamphetamine Users: A Hierarchical Bayesian Approach. JOURNAL OF DRUG ISSUES 2010; 40:121-140. [PMID: 21052518 PMCID: PMC2967031 DOI: 10.1177/002204261004000107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies examining differences in mortality among long-term drug users have been limited. In this paper, we introduce a Bayesian framework that jointly models survival data using a Weibull proportional hazard model with frailty, and substance and alcohol data using mixed-effects models, to examine differences in mortality among heroin, cocaine, and methamphetamine users from five long-term follow-up studies. The traditional approach to analyzing combined survival data from numerous studies assumes that the studies are homogeneous, thus the estimates may be biased due to unobserved heterogeneity among studies. Our approach allows us to structurally combine the data from different studies while accounting for correlation among subjects within each study. Markov chain Monte Carlo facilitates the implementation of Bayesian analyses. Despite the complexity of the model, our approach is relatively straightforward to implement using WinBUGS. We demonstrate our joint modeling approach to the combined data and discuss the results from both approaches.
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Affiliation(s)
- Li-Jung Liang
- Department of Medicine Statistics Core, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
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167
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Milloy MJ, Wood E, Reading C, Kane D, Montaner J, Kerr T. Elevated overdose mortality rates among First Nations individuals in a Canadian setting: a population-based analysis. Addiction 2010; 105:1962-70. [PMID: 20825372 DOI: 10.1111/j.1360-0443.2010.03077.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To determine the total burden of illicit drug overdose mortality over the study period in the province of British Columbia and investigate possible population-level determinants by estimating rates among subgroups including First Nations individuals. DESIGN Review of coroner case files. SETTING The province of British Columbia, Canada. PARTICIPANTS Individuals dying from an illicit drug overdose between 2001 and 2005. MEASUREMENTS Age-adjusted mortality rates, standardized mortality ratios (SMR) and years of potential life lost (YPLL), stratified by major population groups. FINDINGS Over the study period, 909 individuals died from illicit drug overdoses, including 104 (11.4%) First Nations individuals. Compared to the general population, First Nations males and females suffered from substantially elevated SMR and YPLL. In a multivariate logistic regression analysis, First Nations deaths were significantly more likely to be among women, related to injection drug use and to have occurred in the Downtown Eastside area of Vancouver, the local epicentre of human immunodeficiency virus infection and open drug use (all P< 0.05). CONCLUSIONS This report found highly elevated overdose death rates and levels of premature mortality among First Nations Canadians in British Columbia compared to the general population. While previously unidentified, these findings are consistent with the poorer population health profile of First Nations Canadians. Although further research is needed to identify the causes of the elevated death rates, our findings support increased availability of evidence-based overdose prevention measures.
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Affiliation(s)
- M-J Milloy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, British Columbia
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168
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Bohnert ASB, Roeder K, Ilgen MA. Unintentional overdose and suicide among substance users: a review of overlap and risk factors. Drug Alcohol Depend 2010; 110:183-92. [PMID: 20430536 DOI: 10.1016/j.drugalcdep.2010.03.010] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 10/19/2022]
Abstract
Substance use is a risk factor for suicide, suicide attempts, and fatal and non-fatal overdose, but to date, little has been done to integrate the research on suicidal behavior and overdose among substance users. This study reviews the literature on suicide and overdose among substance users with the goal of illuminating the similarities and differences between these two events. A structured review resulted in 15 articles (describing 14 unique studies) published between 1990 and 2010 that examined both overdose and suicide in samples of substance users. There is some evidence that substance users who attempt suicide are more likely to report an overdose and vice versa. This relationship may be partially explained by the fact that overdose is a common method of suicide. The results of the literature review also indicate that substance users with a history of both events may represent a group with particularly poor psychological and social functioning and severe drug-related problems. Further research is needed to understand the overlap of, and differences between, suicide and accidental overdose among individuals who misuse substances, particularly individuals who primarily use substances other than heroin. An improved understanding of the interrelationships between suicide and unintentional overdose among individuals who use alcohol or drugs is necessary to guide the development of effective prevention and intervention approaches.
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Affiliation(s)
- Amy S B Bohnert
- Serious Mental Illness Treatment Research and Evaluation Center, Department of Veterans Affairs, 2215 Fuller Road (11H), Ann Arbor, MI 48105, USA.
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169
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Hartzler B, Donovan DM, Huang Z. Comparison of opiate-primary treatment seekers with and without alcohol use disorder. J Subst Abuse Treat 2010; 39:114-23. [PMID: 20598831 DOI: 10.1016/j.jsat.2010.05.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 04/19/2010] [Accepted: 05/05/2010] [Indexed: 01/22/2023]
Abstract
Many persons seeking opiate treatment present with complex clinical challenges, which may be exacerbated by alcohol misuse. This report details secondary data analyses aggregating treatment-seeking samples across 10 National Institute on Drug Abuse (NIDA) Clinical Trials Network treatment trials to examine alcohol-related characteristics of opiate-primary (OP) clients and compare broad pretreatment characteristics of those with and without an alcohol use disorder (AUD). Analysis of this aggregate OP client sample (n = 1,396) indicated that 38% had comorbid AUD and that a history of alcohol treatment episodes and recent alcohol problems were common. Further, comparisons of OP clients with and without AUD revealed the former were more likely to have had a history of pervasive difficulties in psychosocial functioning. Findings suggest the need for detection of and intervention for alcohol misuse at the outset of opiate treatment and support for the practice of availing medical, psychological, case management, and other support services.
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Affiliation(s)
- Bryan Hartzler
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105-4631, USA.
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170
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Kral AH, Wenger L, Carpenter L, Wood E, Kerr T, Bourgois P. Acceptability of a safer injection facility among injection drug users in San Francisco. Drug Alcohol Depend 2010; 110:160-3. [PMID: 20303679 PMCID: PMC2885552 DOI: 10.1016/j.drugalcdep.2010.02.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 02/04/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Research has shown that safer injection facilities (SIFs) are successful at reducing public nuisance and enhancing public health. Since 2007 support for implementation of a SIF in San Francisco has been building. The objective of this study is to assess the acceptability of a SIF among injection drug users (IDUs) in San Francisco. METHODS IDUs were recruited in San Francisco using targeted sampling and interviewed using a quantitative survey (N=602). We assessed the prevalence of willingness to use a SIF as well as correlates of willingness among this group. RESULTS Eighty-five percent of IDUs reported that they would use a SIF, three quarters of whom would use it at least 3 days per week. In multivariate analysis, having injected in public and having injected speedballs were associated with intent to use a SIF. The majority of IDUs reported acceptability of many potential rules and regulations of a pilot SIF, except video surveillance, and being required to show identification. CONCLUSIONS Building on the success of SIFs in various international settings, IDUs in San Francisco appear interested in using a SIF should one be implemented.
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Affiliation(s)
- Alex H. Kral
- Urban Health Program, RTI International, San Francisco Regional Office, 114 Sansome Street Suite 500, San Francisco, CA 94104, USA, Department of Family and Community Medicine, University of California, San Francisco, USA
| | - Lynn Wenger
- Urban Health Program, RTI International, San Francisco Regional Office, 114 Sansome Street Suite 500, San Francisco, CA 94104, USA
| | - Lisa Carpenter
- Urban Health Program, RTI International, San Francisco Regional Office, 114 Sansome Street Suite 500, San Francisco, CA 94104, USA
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z 1Y6, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada, V6Z 1Y6, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Philippe Bourgois
- Department of Anthropology, University of Pennsylvania, 415 Anthropology Museum, 3260 South Street, Philadelphia PA 19104-6398, USA
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171
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Sternfeld I, Perras N, Culross PL. Development of a coroner-based surveillance system for drug-related deaths in Los Angeles county. J Urban Health 2010; 87:656-69. [PMID: 20440654 PMCID: PMC2900566 DOI: 10.1007/s11524-010-9455-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Existing data sources do not provide comprehensive and timely information to adequately monitor drug-related mortality in Los Angeles County. To fill this gap, a surveillance system using coroner data was developed to examine patterns in drug-related deaths. The coroner provided data on all injury deaths in Los Angeles County. A list of keywords that indicate a death was caused by drug use was developed. The cause of death variables in the coroner data were searched for mentions of one of the keywords; if a keyword was detected, that death was classified as drug related. The effectiveness of the keyword list in classifying drug-related deaths was evaluated by matching records in the coroner death data to records in the state death files. Then, the drug-related deaths identified using the keywords were compared to drug-related deaths in the state mortality files identified using International Classification of Death codes. Toxicological test results were used to categorize drug-related deaths based on the type and legality of the drug(s) ingested. Mortality rates were calculated for each category of drug and legal status and for different demographic groups. Compared to the gold standard state mortality files, the coroner data had a sensitivity of 95.6% for identifying drug-related deaths. Over three quarters of all drug-related deaths tested positive for opiates and/or stimulants. Males, Whites, and 35-54-year-olds each accounted for more than half of all drug-related deaths. The surveillance of drug-related deaths using coroner data has several advantages: data are available in a timely fashion, the data include information about the specific substances each victim ingested, and the data can be broken down to compare mortality among specific subpopulations.
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Affiliation(s)
- Isabelle Sternfeld
- Injury & Violence Prevention Program, Los Angeles County Department of Public Health, 3530 Wilshire Blvd., Ste. 800, Los Angeles, CA, 90010, USA.
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172
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Bohnert ASB, Prescott MR, Vlahov D, Tardiff KJ, Galea S. Ambient temperature and risk of death from accidental drug overdose in New York City, 1990-2006. Addiction 2010; 105:1049-54. [PMID: 20219056 PMCID: PMC2898915 DOI: 10.1111/j.1360-0443.2009.02887.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mortality increases as ambient temperature increases. Because cocaine affects core body temperature, ambient temperature may play a role in cocaine-related mortality in particular. The present study examined the association between ambient temperature and fatal overdoses over time in New York City. METHODS Mortality data were obtained from the Office of the Chief Medical Examiner for 1990 to 2006, and temperature data from the National Oceanic and Atmospheric Association. We used generalized additive models to test the relationship between weekly average temperatures and counts of accidental overdose deaths in New York City, controlling for year and average length of daylight hours. RESULTS We found a significant relation between ambient temperature and accidental overdose fatality for all models where the overdoses were due in whole or in part to cocaine (all P < 0.05), but not for non-cocaine overdoses. Risk of accidental overdose deaths increased for weeks when the average temperature was above 24 degrees Celsius. CONCLUSIONS These results suggest a strong relation between temperature and accidental overdose mortality that is driven by cocaine-related overdoses rising at temperatures above 24 degrees Celsius; this is a substantially lower temperature than prior estimates. To put this into perspective, approximately 7 weeks a year between 1990 and 2006 had an average weekly temperature of 24 or above in New York City. Heat-related mortality presents a considerable public health concern, and cocaine users constitute a high-risk group.
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Affiliation(s)
- Amy S B Bohnert
- VA National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA.
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173
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Darke S, Duflou J, Torok M. The comparative toxicology and major organ pathology of fatal methadone and heroin toxicity cases. Drug Alcohol Depend 2010; 106:1-6. [PMID: 19720472 DOI: 10.1016/j.drugalcdep.2009.07.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 07/16/2009] [Accepted: 07/16/2009] [Indexed: 11/16/2022]
Abstract
In order to determine the comparative toxicology and systemic disease of cases of death due to methadone and heroin toxicity, 1193 coronial cases of opioid overdose that occurred in New South Wales, Australia between 1 January 1998 and 31 December 2007 were inspected. These comprised 193 cases in which cause of death involved methadone toxicity (METH) and 1000 cases in which cause of death involved heroin toxicity in the absence of methadone (HER). METH cases were significantly more likely to have benzodiazepines (63.7% vs. 32.2%), and less likely to have alcohol (23.6% vs. 42.7%) detected. METH cases were significantly more likely to be diagnosed with pre-existing systemic pathology (94.3% vs. 79.9%), and multiple organ system pathology (68.8% vs. 41.4%). Specifically, METH cases were more likely to have cardiac (58.9% vs. 34.5%), pulmonary (53.6% vs. 30.9%), hepatic (80.7% vs. 62.8%) and renal (25.0% vs. 9.5%) disease. Given the notable differences in toxicology and disease patterns, great caution appears warranted in prescribing benzodiazepines to methadone users, and regular physical examinations of methadone treatment patients would appear clinically warranted.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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174
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Andresen MA, Boyd N. A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:70-6. [DOI: 10.1016/j.drugpo.2009.03.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 01/27/2009] [Accepted: 03/27/2009] [Indexed: 11/30/2022]
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175
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Kerr D, Kelly AM, Dietze P, Jolley D, Barger B. Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction 2009; 104:2067-74. [PMID: 19922572 DOI: 10.1111/j.1360-0443.2009.02724.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Traditionally, the opiate antagonist naloxone has been administered parenterally; however, intranasal (i.n.) administration has the potential to reduce the risk of needlestick injury. This is important when working with populations known to have a high prevalence of blood-borne viruses. Preliminary research suggests that i.n. administration might be effective, but suboptimal naloxone solutions were used. This study compared the effectiveness of concentrated (2 mg/ml) i.n. naloxone to intramuscular (i.m.) naloxone for suspected opiate overdose. METHODS This randomized controlled trial included patients treated for suspected opiate overdose in the pre-hospital setting. Patients received 2 mg of either i.n. or i.m. naloxone. The primary outcome was the proportion of patients who responded within 10 minutes of naloxone treatment. Secondary outcomes included time to adequate response and requirement for supplementary naloxone. Data were analysed using multivariate statistical techniques. RESULTS A total of 172 patients were enrolled into the study. Median age was 29 years and 74% were male. Rates of response within 10 minutes were similar: i.n. naloxone (60/83, 72.3%) compared with i.m. naloxone (69/89, 77.5%) [difference: -5.2%, 95% confidence interval (CI) -18.2 to 7.7]. No difference was observed in mean response time (i.n.: 8.0, i.m.: 7.9 minutes; difference 0.1, 95% CI -1.3 to 1.5). Supplementary naloxone was administered to fewer patients who received i.m. naloxone (i.n.: 18.1%; i.m.: 4.5%) (difference: 13.6%, 95% CI 4.2-22.9). CONCLUSIONS Concentrated intranasal naloxone reversed heroin overdose successfully in 82% of patients. Time to adequate response was the same for both routes, suggesting that the i.n. route of administration is of similar effectiveness to the i.m. route as a first-line treatment for heroin overdose.
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Affiliation(s)
- Debra Kerr
- Victoria University, School of Nursing and Midwifery, St Albans, Victoria, Australia.
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176
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Sanders B, Lankenau SE, Jackson-Bloom J, Hathazi D. Multiple drug use and polydrug use amongst homeless traveling youth. J Ethn Subst Abuse 2009; 7:23-40. [PMID: 19842299 DOI: 10.1080/15332640802081893] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diverse forms of drug use are an emerging theme within research on young people and substance use. This manuscript, based on a three city study of health risks amongst young injection drug users, explores multiple drug use and polydrug use amongst a subset of homeless youth referred to as "travelers." In particular, we outline characteristics of homeless traveler youths and the various ways in which they practiced multiple drug use and polydrug use. From here, we discuss some theoretical and public health implications of multiple drug use and polydrug use amongst this particular population.
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Affiliation(s)
- Bill Sanders
- Department of Pediatrics, University of Southern California, Division of Research on Children, Youth and Families, Saban Research Institute, Childrens Hospital Los Angeles, 6430 West Sunset Boulevard, Suite 1500, Hollywood, CA 90028, USA.
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177
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Kaye S, Darke S, Duflou J. Methylenedioxymethamphetamine (MDMA)-related fatalities in Australia: demographics, circumstances, toxicology and major organ pathology. Drug Alcohol Depend 2009; 104:254-61. [PMID: 19604654 DOI: 10.1016/j.drugalcdep.2009.05.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 05/12/2009] [Accepted: 05/13/2009] [Indexed: 11/17/2022]
Abstract
AIM To examine the demographic characteristics, circumstances, toxicology and major organ pathology of MDMA-related deaths in Australia. METHODS Retrospective review of cases in which MDMA was a cause of death, as identified from the National Coronial Information System. RESULTS 82 cases over a 5-year period were identified. The majority of decedents were male (83%), with a median age of 26 years. Deaths were predominantly due to drug toxicity (82%), with MDMA the sole drug causing death in 23% of cases, and combined drug toxicity in 59% of cases. The remaining deaths (18%) were primarily due to pathological events/disease or injury, with MDMA a significant contributing condition. Cardiovascular pathology, typically atherosclerosis, was detected in 58% of decedents, with moderate-severe atherosclerosis in 23% of cases. The prevalence of such pathology is higher than that expected among similarly aged members of the general population. Cerebrovascular pathology, primarily cerebral haemorrhage and hypoxic damage, was present in 12% of cases. CONCLUSIONS MDMA has contributed to a clinically significant number of deaths in Australia. The prevalence of cardiovascular pathology was similar to that among methamphetamine and cocaine fatalities. Whilst cardiovascular pathology may reflect the use of other stimulants, the cardiotoxic properties of MDMA have been well-documented. Future studies examining MDMA-related morbidity and mortality in the context of other risk factors are recommended. Overall, the current study highlights the need to educate users about the potential harms of MDMA use, particularly that in conjunction with other stimulants, opioids and alcohol, which are known to increase overall toxicity.
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Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.
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178
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Klein H, Elifson KW, Sterk CE. Young adult Ecstasy users' enhancement of the effects of their Ecstasy use. J Psychoactive Drugs 2009; 41:113-20. [PMID: 19705673 DOI: 10.1080/02791072.2009.10399904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study examines drug effect-enhancing behaviors practiced by young adult users of the drug, Ecstasy. Between August 2002 and August 2004, 283 face-to-face interviews were conducted with active Ecstasy users. Study participants were recruited in the Atlanta, Georgia metropolitan area using a targeted sampling approach. The large majority of study participants (87%) engaged in at least one behavior specifically designed to bolster the effects of their Ecstasy use, with 61% of the study participants reporting having engaged in at least three such behaviors during the past 30 days. Taking steps to boost one's Ecstasy-related high was associated with binging on Ecstasy and a variety of adverse outcomes, such as experiencing a greater number of negative consequences resulting from Ecstasy use and experiencing more Ecstasy-related drug dependency symptoms. Multivariate analysis revealed several factors associated with greater involvement in effects-boosting behaviors, including race (not being African American), spending time with other drug users, using Ecstasy for its touch-enhancing qualities, enjoyment of the music-and-Ecstasy-use experience, and childhood maltreatment experiences. The implications of these findings for treatment, prevention, and intervention for drug problems among Ecstasy users are discussed.
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Affiliation(s)
- Hugh Klein
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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179
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Clausen T, Waal H, Thoresen M, Gossop M. Mortality among opiate users: opioid maintenance therapy, age and causes of death. Addiction 2009; 104:1356-62. [PMID: 19426288 DOI: 10.1111/j.1360-0443.2009.02570.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS This study investigates how age of opioid users is related to causes of death prior to, during and after opioid maintenance treatment (OMT), and estimates risks of death from various causes in relation to age. DESIGN, SETTING AND PARTICIPANTS Data on all opiate dependents in Norway (1997-2003) who applied for and were accepted for OMT (n = 3789) were cross-linked with the Norwegian death register. The total observation time was 10 934 person-years. FINDINGS A total of 213 deaths was recorded. Of these, 73% were subject to autopsy, and causes of death were known for 208 cases: the overall death rate was 1.9%. Deaths were due to drug overdose (54%), somatic (32%) and traumatic causes (14%). Overdose deaths among all age groups were reduced during OMT but age had a differential effect upon risk when out of treatment. Younger opioid users were at greater risk of overdose before entering treatment; older users were at greater risk after leaving treatment. Older OMT patients were at higher risk of both somatic and traumatic deaths, and deaths during OMT were most likely to be due to somatic causes. CONCLUSIONS The high rates of overdose prior to and after treatment emphasize the need to provide rapid access to OMT, to retain patients in treatment and to re-enrol patients. The high prevalence among older patients of deaths due to somatic causes has implications for screening, treatment and referral, and may also lead to increased treatment costs.
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Affiliation(s)
- Thomas Clausen
- University of Oslo, Medical Faculty, Institute of Psychiatry, Norwegian Centre for Addiction Research (SERAF), Oslo, Norway.
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180
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Milloy MJS, Kerr T, Mathias R, Zhang R, Montaner JS, Tyndall M, Wood E. Non-Fatal Overdose Among a Cohort of Active Injection Drug Users Recruited from a Supervised Injection Facility. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 34:499-509. [DOI: 10.1080/00952990802122457] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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181
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Bohnert ASB, Tracy M, Galea S. Circumstances and witness characteristics associated with overdose fatality. Ann Emerg Med 2009; 54:618-24. [PMID: 19540622 DOI: 10.1016/j.annemergmed.2009.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 04/22/2009] [Accepted: 05/05/2009] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE Emergency physicians have an opportunity to provide overdose fatality prevention interventions to individuals at risk for experiencing or witnessing an overdose to reduce fatality. The present study uses data about the most recent overdose observed by a sample of inner-city drug users to determine the circumstances of overdose that are associated with overdose fatality. METHODS Participants (n=690) aged 18 years or older were recruited with targeted street outreach. All participants had used heroin or cocaine in the previous 2 months and had witnessed at least 1 overdose. Survey data included the circumstances of the last overdose witnessed, including actions taken, drug use behavior, the location of the event, and whether or not the overdose was fatal (the outcome measure). RESULTS One hundred fifty-two (21.7%) of the witnessed overdoses were fatal. Witness powdered cocaine use (adjusted odds ratio=1.6; 95% confidence interval [CI] 1.0 to 2.6) and injection drug history (adjusted odds ratio=0.5; 95% CI 0.3 to 0.9) were associated with the last witnessed overdose being fatal. Witnessed overdoses that occurred in public or abandoned buildings compared with homes were more likely to be fatal (adjusted odds ratio=1.9; 95% CI 1.0 to 3.5), as were overdoses in which witnesses sought outside medical help (adjusted odds ratio=1.5; 95% CI 1.0 to 2.1). CONCLUSION Future prevention interventions may fruitfully target users of powdered cocaine, drug users without a history of injecting, and individuals who use drugs in public or abandoned buildings for brief interventions on responding when witnessing an overdose to reduce mortality.
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Affiliation(s)
- Amy S B Bohnert
- VA National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA.
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182
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Buxton JA, Skutezky T, Tu AW, Waheed B, Wallace A, Mak S. The context of illicit drug overdose deaths in British Columbia, 2006. Harm Reduct J 2009; 6:9. [PMID: 19480677 PMCID: PMC2694163 DOI: 10.1186/1477-7517-6-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 05/29/2009] [Indexed: 12/02/2022] Open
Abstract
Background Illicit drug overdose deaths (IDD) relate to individual drug dose and context of use, including use with other drugs and alcohol. IDD peaked in British Columbia (BC) in 1998 with 417 deaths, and continues to be a public health problem. The objective of this study was to examine IDD in 2006 in BC by place of residence, injury and death, decedents' age and sex and substances identified. Methods IDD data was obtained through the BC Coroners Office and entered into SPSS (version 14). Fisher's exact and Pearson's χ2 were used for categorical data; Mann-Whitney U-test for continuous variables. Rates were calculated using 2006 population estimates. Results We identified 223 IDD in BC; 54 (24%) occurred in Vancouver. Vancouver decedents (compared to those occurring outside Vancouver) were older (mean age 43.9 vs. 39.2 years; p < 0.01) and more likely to be male (90.7% vs. 77.5%; p = 0.03). Provincially Aboriginal ethnicity was reported for 19 deaths; 13 (30.2%) of 43 females and 6 (3.3%) of 180 males (p = < 0.001). Cocaine was identified in 80.3%, opiates 59.6%, methadone 13.9%, methamphetamine/amphetamine 6.3%, and alcohol in 22.9% of deaths. Poly-substance use was common, 2 substances were identified in 43.8% and 3 or more in 34.5% of deaths. Opiates were more frequently identified in Vancouver compared to outside Vancouver (74.1% vs. 55.0%) p = 0.015. Conclusion Collaboration with the Coroner's office allowed us to analyze IDD in detail including place of death; cocaine, opiates and poly-substance use were commonly identified. Poly-substance use should be explored further to inform public health interventions.
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Affiliation(s)
- Jane A Buxton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
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183
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Darke S, Williamson A, Ross J, Teesson M. Non-fatal heroin overdose, treatment exposure and client characteristics: Findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Rev 2009; 24:425-32. [PMID: 16298837 DOI: 10.1080/09595230500286005] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The relationship between treatment exposure, drug use, psychosocial variables and non-fatal heroin overdose was examined among a cohort of 495 heroin users, re-interviewed at 12 months. The 12-month overdose rate declined from 24% to 12%, and the proportion administered naloxone declined from 15% to 7%. There were significant reductions in overdose among those who entered maintenance therapies (22% to 4%) and residential rehabilitation (33% vs. 19%) at baseline, but not among those who entered detoxification or were not entering treatment. The total number of treatment days received over the follow-up period was associated independently with a reduced risk of overdose. Each extra treatment day was associated with a 1% reduction in risk of overdose over the follow-up period. By contrast, more treatment episodes were associated with an increased risk of overdose (OR 1.62). Other independent predictors of overdose over follow-up were more extensive polydrug use (OR 1.40), and having overdosed in the year preceding the study (OR 7.87).
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Australia.
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184
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Pulido J, Teresa Brugal M, de la Fuente L, Ballesta R, Barrio G, Bravo MJ, Domingo-Salvany A, Castellano Y, Fernández F. Metodología de reclutamiento y características de una cohorte de jóvenes consumidores habituales de cocaína de tres ciudades españolas (Proyecto Itínere-cocaína). GACETA SANITARIA 2009; 23:200-7. [DOI: 10.1016/j.gaceta.2008.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 05/21/2008] [Indexed: 11/28/2022]
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185
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Hedden SL, Malcolm RJ, Latimer WW. Differences between adult non-drug users versus alcohol, cocaine and concurrent alcohol and cocaine problem users. Addict Behav 2009; 34:323-6. [PMID: 19059733 DOI: 10.1016/j.addbeh.2008.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 10/03/2008] [Accepted: 11/14/2008] [Indexed: 11/17/2022]
Abstract
Concurrent drug use is a serious public health concern with significant morbidity and mortality associated with the combined use of alcohol and cocaine. Multinomial logistic regression was used to assess differences between non-drug users and alcohol, cocaine and concurrent problem users incorporating data from the 2005 National Survey on Drug Use and Health. Results demonstrated that alcohol and cocaine use is associated with mental health disturbance, other drug use and adverse social consequences. Furthermore, concurrent users were more likely to report cigarette and marijuana use as well as lifetime STDs and arrest for breaking the law. Study results have implications for planning prevention and treatment services differentially for alcohol, cocaine and concurrent users and support the need for more intense resources allocated to the prevention and treatment of the concurrent use of alcohol and cocaine.
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Affiliation(s)
- Sarra L Hedden
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 2213 McElderry Street, Fourth Floor, Suite 400, Baltimore, MD 21205, USA.
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186
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Grov C, Kelly BC, Parsons JT. Polydrug use among club-going young adults recruited through time-space sampling. Subst Use Misuse 2009; 44:848-64. [PMID: 19444726 PMCID: PMC2683356 DOI: 10.1080/10826080802484702] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Club Drugs and Health Project was supported by a grant from the National Institute on Drug Abuse (R01-DA014925-02, Jeffrey T. Parsons, Principal Investigator). Christian Grov was supported as a postdoctoral fellow in the Behavioral Sciences training in drug abuse research program sponsored by Public Health Solutions and the National Development and Research Institutes, Inc. (NDRI) with funding from the National Institute on Drug Abuse (T32 DA07233). The authors recognize the contributions of the Club Drug and Health Project team-Michael Adams, Virginia Andersen, Anthony Bamonte, Jessica Colon, Armando Fuentes, Sarit A. Golub, Chris Hietikko, Eda Inan, Juline Koken, Jose E. Nanin, Anthony Surace, Julia Tomassilli, Jon Weiser, Brooke E. Wells, and the recruitment team. An earlier version of this paper was presented at the 2008 meeting of the College on Problems of Drug Dependence (CPDD). Though some researchers have indicated club drug users are more likely to be polydrug users, there remains little known about the prevalence and specific combinations of the substances they use. Between 2004 and 2006, and using time-space sampling, a stratified sample of 400, 18-29-year-old New York City club-going, drug-using young adults were recruited into the Club Drugs and Health Project. Most participants (91.7%) had engaged in polydrug usage and 1,670 combinations of drugs were reported. Ecstasy (86.6% of users) and cocaine (85.7% of users) were the two most-frequently reported club drugs used in combination with other substances. In terms of poly-club drug combinations, ecstasy appeared to be the "universal compliment" as this drug was most often cited in combinations with other club drugs (specifically ecstasy + ketamine, ecstasy + cocaine, ecstasy + gamma hydroxybutyrate or GHB). Other frequently cited drug combinations included cocaine and marijuana, ecstasy and marijuana, LSD and marijuana, and cocaine and alcohol. These data highlight the need to develop drug health-education and prevention messages targeted at polydrug usage.
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Affiliation(s)
- Christian Grov
- Center for HIV/AIDS Educational Studies and Training, New York, USA
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187
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Kelly BC, Parsons JT. Predictors and comparisons of polydrug and non-polydrug cocaine use in club subcultures. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2008; 34:774-81. [PMID: 19016183 DOI: 10.1080/00952990802455451] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND/OBJECTIVES Club drug users have been shown to tend towards patterns of polydrug use, which has been linked to adverse health outcomes, such as impaired mental health, overdose, dependence, infectious disease exposure, and decreased cognitive functioning. METHODS We analyzed data from the Club Drugs and Health Project, a study designed to examine the patterns and contexts of club drug use among young adults. Four-hundred recent club drug users were recruited through time-space sampling. RESULTS Among recent cocaine users (n = 361), 61.2% were polydrug users. Male gender was predictive of polydrug cocaine use (OR = 1.66). Gay, lesbian, and bisexual (GLB) sexual orientation, White race, and Non-Latino ethnicity were not. No differences in mental health factors were found between cocaine polydrug users and users of only cocaine. However, polydrug users were significantly more likely to score high on drug-related sensation seeking as well as to use drugs to deal with unpleasant emotions and to have pleasant times with others. CONCLUSIONS Prevention and intervention efforts should account for contextual and motivational factors in attempting to reduce polydrug use and its negative effects.
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Affiliation(s)
- Brian C Kelly
- Department of Sociology, Purdue University, West Lafayette, Indiana 47907, USA.
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188
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Strang J, Manning V, Mayet S, Best D, Titherington E, Santana L, Offor E, Semmler C. Overdose training and take-home naloxone for opiate users: prospective cohort study of impact on knowledge and attitudes and subsequent management of overdoses. Addiction 2008; 103:1648-57. [PMID: 18821875 DOI: 10.1111/j.1360-0443.2008.02314.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To examine the impact of training in overdose management and naloxone provision on the knowledge and confidence of current opiate users; and to record subsequent management of overdoses that occur during a 3-month follow-up period. DESIGN Repeated-measures design to examine changes in knowledge and confidence immediately after overdose management training; retention of knowledge and confidence at 3 months; and prospective cohort study design to document actual interventions applied at post-training overdose situations. METHOD A total of 239 opiate users in treatment completed a pre-training questionnaire on overdose management and naloxone administration and were re-assessed immediately post-training, at which point they were provided with the take-home emergency supply of naloxone. Three months later they were re-interviewed. RESULTS Significant improvements were seen in knowledge of risks of overdose, characteristics of overdose and appropriate actions to be taken; and in confidence in the administration of naloxone. A 78% follow-up rate was achieved (186 of 239) among whom knowledge of both the risks and physical/behavioural characteristics of overdose and also of recommended management actions was well retained. Eighteen overdoses (either experienced or witnessed) had occurred during the 3 months between the training and the follow-up. Naloxone was used on 12 occasions (a trained client's own supply on 10 occasions). One death occurred in one of the six overdoses where naloxone was not used. Where naloxone was used, all 12 resulted in successful reversal. CONCLUSIONS With overdose management training, opiate users can be trained to execute appropriate actions to assist the successful reversal of potentially fatal overdose. Wider provision may reduce drug-related deaths further. Future studies should examine whether public policy of wider overdose management training and naloxone provision could reduce the extent of opiate overdose fatalities, particularly at times of recognized increased risk.
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Affiliation(s)
- John Strang
- National Addiction Centre (Institute of Psychiatry/The Maudsley), Addiction Sciences Building, Denmark Hill, London, UK.
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189
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Paulozzi LJ, Xi Y. Recent changes in drug poisoning mortality in the United States by urban-rural status and by drug type. Pharmacoepidemiol Drug Saf 2008; 17:997-1005. [DOI: 10.1002/pds.1626] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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190
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Green TC, Grau LE, Blinnikova KN, Torban M, Krupitsky E, Ilyuk R, Kozlov A, Heimer R. Social and structural aspects of the overdose risk environment in St. Petersburg, Russia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 20:270-6. [PMID: 18774283 DOI: 10.1016/j.drugpo.2008.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 07/08/2008] [Accepted: 07/10/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND While overdose is a common cause of mortality among opioid injectors worldwide, little information exists on opioid overdoses or how context may influence overdose risk in Russia. This study sought to uncover social and structural aspects contributing to fatal overdose risk in St. Petersburg and assess prevention intervention feasibility. METHODS Twenty-one key informant interviews were conducted with drug users, treatment providers, toxicologists, police, and ambulance staff. Thematic coding of interview content was conducted to elucidate elements of the overdose risk environment. RESULTS Several factors within St. Petersburg's environment were identified as shaping illicit drug users' risk behaviours and contributing to conditions of suboptimal response to overdose in the community. Most drug users live and experience overdoses at home, where family and home environment may mediate or moderate risk behaviours. The overdose risk environment is also worsened by inefficient emergency response infrastructure, insufficient cardiopulmonary or naloxone training resources, and the preponderance of abstinence-based treatment approaches to the exclusion of other treatment modalities. However, attitudes of drug users and law enforcement officials generally support overdose prevention intervention feasibility. Modifiable aspects of the risk environment suggest community-based and structural interventions, including overdose response training for drug users and professionals that encompasses naloxone distribution to the users and equipping more ambulances with naloxone. CONCLUSION Local social and structural elements influence risk environments for overdose. Interventions at the community and structural levels to prevent and respond to opioid overdoses are needed for and integral to reducing overdose mortality in St. Petersburg.
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Affiliation(s)
- Traci C Green
- Department of Epidemiology and Public Health, Yale School of Medicine, PO Box 208034, 60 College Street, New Haven, CT 06520-8034, USA.
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191
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Kaye S, Darke S, Duflou J, McKetin R. Methamphetamine-related fatalities in Australia: demographics, circumstances, toxicology and major organ pathology. Addiction 2008; 103:1353-60. [PMID: 18855825 DOI: 10.1111/j.1360-0443.2008.02231.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To examine the demographic characteristics, circumstances of death, toxicological results and major organ pathology of methamphetamine-related deaths in Australia. DESIGN Retrospective review of coronial files. SETTING Australia. METHODS Cases in which methamphetamine was listed as a cause of death were identified from the National Coronial Information System (NCIS). FINDINGS A total of 371 cases were identified. The mean age of decedents was 32.7 years; 77% were male and 35% were employed. Route of administration was predominantly by injection (89%). Drugs other than methamphetamine were detected in 89% of cases, most commonly benzodiazepines (41%) and morphine (36%). The median blood methamphetamine concentration was 0.2 mg/l (range 0.02-15.0 mg/l). Deaths were overwhelmingly accidental, with 14% determined to be suicides, and occurred in a private home (71%). Cardiovascular pathology, typically coronary artery atherosclerosis, was detected in 54% of decedents. Cerebrovascular pathology, most commonly cerebral haemorrhage and hypoxia, was present in 20% of cases. CONCLUSIONS Methamphetamine has contributed to a substantial number of deaths in Australia. Users need to be informed of the potential harms of methamphetamine use, particularly those associated with the cardiotoxicity of methamphetamine and the use of methamphetamine in conjunction with other drugs.
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Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Australia.
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192
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Spoth RL, Randall GK, Trudeau L, Shin C, Redmond C. Substance use outcomes 51/2 years past baseline for partnership-based, family-school preventive interventions. Drug Alcohol Depend 2008; 96:57-68. [PMID: 18434045 PMCID: PMC2848484 DOI: 10.1016/j.drugalcdep.2008.01.023] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 11/20/2007] [Accepted: 01/27/2008] [Indexed: 11/25/2022]
Abstract
This article reports adolescent substance use outcomes of universal family and school preventive interventions 5(1/2) years past baseline. Participants were 1677 7th grade students from schools (N=36) randomly assigned to the school-based Life Skills Training plus the Strengthening Families Program: For Parents and Youth 10-14 (LST+SFP 10-14), LST-alone, or a control condition. Self-reports were collected at baseline, 6 months later following the interventions, then yearly through the 12th grade. Measures included initiation-alcohol, cigarette, marijuana, and drunkenness, along with a Substance Initiation Index (SII)-and measures of more serious use-frequency of alcohol, cigarette, and marijuana use, drunkenness frequency, monthly poly-substance use, and advanced poly-substance use. Analyses ruled out differential attrition. For all substance initiation outcomes, one or both intervention groups showed significant, positive point-in-time differences at 12th grade and/or significant growth trajectory outcomes when compared with the control group. Although no main effects for the more serious substance use outcomes were observed, a higher-risk subsample demonstrated significant, positive 12th grade point-in-time and/or growth trajectory outcomes for one or both intervention groups on all measures. The observed pattern of results likely reflects a combination of predispositions of the higher-risk subsample, the timing of the interventions, and baseline differences between experimental conditions favoring the control group.
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193
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Coffin PO, Tracy M, Bucciarelli A, Ompad D, Vlahov D, Galea S. Identifying Injection Drug Users at Risk of Nonfatal Overdose. Acad Emerg Med 2008. [DOI: 10.1111/j.1553-2712.2007.tb01846.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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194
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Green TC, Heimer R, Grau LE. Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. Addiction 2008; 103:979-89. [PMID: 18422830 PMCID: PMC3163671 DOI: 10.1111/j.1360-0443.2008.02182.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS This study assessed overdose and naloxone administration knowledge among current or former opioid abusers trained and untrained in overdose-response in the United States. DESIGN AND PARTICIPANTS Ten individuals, divided equally between those trained or not trained in overdose recognition and response, were recruited from each of six sites (n = 62). SETTING US-based overdose training and naloxone distribution programs in Baltimore, San Francisco, Chicago, New York and New Mexico. MEASUREMENTS Participants completed a brief questionnaire on overdose knowledge that included the task of rating 16 putative overdose scenarios for: (i) whether an overdose was occurring and (ii) if naloxone was indicated. Bivariate and multivariable analyses compared results for those trained to untrained. Responses were also compared to those of 11 medical experts using weighted and unweighted kappa statistics. FINDINGS Respondents were primarily male (72.6%); 45.8% had experienced an overdose and 72% had ever witnessed an overdose. Trained participants recognized more opioid overdose scenarios accurately (t(60) = 3.76, P < 0.001) and instances where naloxone was indicated (t(59) = 2.2, P < 0.05) than did untrained participants. Receipt of training and higher perceived competency in recognizing signs of an opioid overdose were associated independently with higher overdose recognition scores. Trained respondents were as skilled as medical experts in recognizing opioid overdose situations (weighted kappa = 0.85) and when naloxone was indicated (kappa = 1.0). CONCLUSIONS Results suggest that naloxone training programs in the United States improve participants' ability to recognize and respond to opioid overdoses in the community. Drug users with overdose training and confidence in their abilities to respond may effectively prevent overdose mortality.
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Affiliation(s)
- Traci C Green
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA.
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195
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Beynon CM, McMinn AM, Marr AJE. Factors predicting drop out from, and retention in, specialist drug treatment services: a case control study in the North West of England. BMC Public Health 2008; 8:149. [PMID: 18460202 PMCID: PMC2409325 DOI: 10.1186/1471-2458-8-149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 05/06/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the United Kingdom (UK), the National Treatment Agency for Substance Misuse (NTA) considers retention to be the best available measure of drug treatment effectiveness. Accordingly, the NTA has set local treatment systems the annual target of retaining 75% of clients for 12 weeks or more, yet little assessment of this target or factors that improve retention has occurred. This study aims to quantify the proportion of people retained in treatment for 12 weeks in the North West of England and to identify factors associated with premature drop out. METHODS The North West National Drug Treatment Monitoring System (NDTMS) was used to identify treatment durations for everyone beginning a treatment episode between 1st April 2005 and 31st March 2006 (N = 16626). Odds ratios, chi-square and logistic regression analyses compared clients retained for 12 weeks to clients whose discharge record showed they had prematurely dropped out before 12 weeks. Individuals with other outcomes were excluded from analyses. RESULTS 75% of clients (N = 12230) were retained for 12 weeks and 10% (N = 1649) dropped out prematurely. Multivariate analysis showed drop out was more likely among Asian drug users (adjusted odds ratio 1.52, 95% CI 1.12 to 2.08) than their white equivalents. Drop out was more likely among residents of Cumbria and Lancashire (adjusted odds ratio 1.80, 95% CI 1.51 to 2.15) and Greater Manchester (adjusted odds ratio 2.00, 95% CI 1.74 to 2.29) than Cheshire and Merseyside and less likely among alcohol users (adjusted odds ratio 0.73, 95% CI 0.59 to 0.91). A significant interaction between age and deprivation was observed. For those aged 18 to 24 years and 25 to 34 years, drop out was significantly more likely among those living in affluent areas. For those in the older age groups the converse effect was observed. CONCLUSION In combination, the drug treatment systems of the North West achieved the Government's retention target in 2005/06. A number of factors associated with drop out were identified; these should be considered in strategies that aim to improve retention. Drop out and retention are measures that capture the joint effect of many factors. Further work is required to evaluate the effect of deprivation.
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Affiliation(s)
- Caryl M Beynon
- Centre for Public Health, Liverpool John Moores University, Liverpool, L3 2AY, UK.
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196
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Death of a female addict due to heroin and cocaine overdoses: a case report with multiparameter evaluation. Forensic Toxicol 2008. [DOI: 10.1007/s11419-008-0042-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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197
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Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev 2008; 27:253-62. [PMID: 18368606 DOI: 10.1080/09595230801923702] [Citation(s) in RCA: 441] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
ISSUES The major physical and psychological health effects of methamphetamine use, and the factors associated with such harms. APPROACH Comprehensive review. KEY FINDINGS Physical harms reviewed included toxicity and mortality, cardiovascular/cerebrovascular pathology, dependence and blood-borne virus transmission. Psychological harms include methamphetamine psychosis, depression, suicide, anxiety and violent behaviours. IMPLICATIONS While high-profile health consequences, such as psychosis, are given prominence in the public debate, the negative sequelae extend far beyond this. This is a drug class that causes serious heart disease, has serious dependence liability and high rates of suicidal behaviours. CONCLUSION The current public image of methamphetamine does not portray adequately the extensive, and in many cases insidious, harms caused.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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198
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Factors associated with history of non-fatal overdose among opioid users in the Swedish criminal justice system. Drug Alcohol Depend 2008; 94:48-55. [PMID: 18082338 DOI: 10.1016/j.drugalcdep.2007.10.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 10/03/2007] [Accepted: 10/03/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Overdose (OD) is a common cause of death in opioid users. Also, many current opioid users report a history of non-fatal OD. The present study aimed to identify factors associated with a history of non-fatal OD. METHODS A sample of 7085 Swedish criminal justice clients with alcohol or drug misuse was assessed, using the Addiction Severity Index. Subjects reporting use of opioids during the 30 days prior to incarceration were included (n=1113). Relevant variables of misuse pattern, heredity, psychiatric symptoms and previous criminal charges were analysed in a logistic regression model. RESULTS A history of non-fatal OD was reported by 55% (n=604). The estimated contribution to the variance in OD history was 25% for variables describing misuse pattern, compared to 10% for psychiatric symptoms, 8% for heredity, and 8% for previous criminal charges. The final model included the following variables: history of injection drug use (OR 3.28), history of heroin use (OR 2.87), history of suicide attempt (OR 1.92), history of tranquilliser use (OR 1.91), being born in Sweden or other Nordic countries (OR 1.74), difficulty in controlling violent behaviour (OR 1.68), and paternal alcohol problems (OR 1.57). CONCLUSIONS Suicide attempts and difficulty in controlling violent behaviour were associated with history of non-fatal OD, independent of variables of misuse pattern. This may indicate a possible association with impulse control disturbances, and may have clinical applications. Country of birth and heredity of alcohol problems also had some influence. As expected, severity of misuse most strongly contributed to history of non-fatal OD.
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199
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Kelly BC, Parsons JT. Prescription drug misuse among club drug-using young adults. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2008; 33:875-84. [PMID: 17994483 DOI: 10.1080/00952990701667347] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Nonmedical prescription (Rx) drug use has recently increased, particularly among young adults. Using time-space sampling to generate a probability-based sample of club-going young adults (18-29), 400 subjects provided data on Rx drug misuse. Club-going young adults misuse Rx drugs at high rates. An overwhelming majority of the sample indicated lifetime use of pain killers, sedatives, and stimulants. A majority indicated recent pain killer use. Variations by gender and sexuality exist in this population. Young lesbian/bisexual women emerged as the group most likely to abuse Rx drugs. Research into the contexts influencing these patterns is imperative.
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Affiliation(s)
- Brian C Kelly
- Department of Sociology and Anthropology, Purdue University, West Lafayette, Indiana, USA
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200
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Shah NG, Lathrop SL, Reichard RR, Landen MG. Unintentional drug overdose death trends in New Mexico, USA, 1990-2005: combinations of heroin, cocaine, prescription opioids and alcohol. Addiction 2008; 103:126-36. [PMID: 18028518 DOI: 10.1111/j.1360-0443.2007.02054.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS To determine the contribution of heroin, prescription opioids, cocaine and alcohol/drug combinations to the total overdose death rate and identify changes in drug overdose patterns among New Mexico subpopulations. DESIGN We analyzed medical examiner data for all unintentional drug overdose deaths in New Mexico during 1990-2005. Age-adjusted drug overdose death rates were calculated by sex and race/ethnicity; we modeled overall drug overdose death adjusting for age and region. FINDINGS The total unintentional drug overdose death rate in New Mexico increased from 5.6 per 100 000 in 1990 to 15.5 per 100 000 in 2005. Deaths caused by heroin, prescription opioids, cocaine and alcohol/drug combinations together ranged from 89% to 98% of the total. Heroin caused the most deaths during 1990-2005, with a notable rate increase in prescription opioid overdose death during 1998-2005 (58%). During 1990-2005, the 196% increase in single drug category overdose death was driven by prescription opioids alone and heroin alone; the 148% increase in multi-drug category overdose death was driven by heroin/alcohol and heroin/cocaine. Hispanic males had the highest overdose death rate, followed by white males, white females, Hispanic females and American Indians. The most common categories causing death were heroin alone and heroin/alcohol among Hispanic males, heroin/alcohol among American Indian males and prescription opioids alone among white males and all female subpopulations. CONCLUSIONS Interventions to prevent drug overdose death should be targeted according to use patterns among at-risk subpopulations. A comprehensive approach addressing both illicit and prescription drug users, and people who use these drugs concurrently, is needed to reduce overdose death.
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Affiliation(s)
- Nina G Shah
- Epidemiology and Response Division, New Mexico Department of Health, Santa Fe, NM 87502-6110, USA.
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