Met and unmet need for dental services among active drug users in Miami, Florida

Facilitators and Barriers to Health Seeking among People Who Use Drugs in the Sunyani Municipality of Ghana: An Exploratory Study

Drug use is one of the global public health issues, and its accompanying disorders have consequences on people's mental, physical, and environmental health. Nevertheless, the majority of people who use drugs have never been treated for drug dependence and other health conditions whilst others discontinue their treatment for drug use disorder. Using the health belief model, the study aimed at exploring facilitators and barriers to health-seeking among people who use drugs in the Sunyani Municipality of Ghana. A descriptive study design was used, employing a qualitative approach. In-depth interviews were conducted with a total of 22 participants, including two key informants (male and female). The first group of participants was recruited from the ghetto (an area in the municipality where people who use drugs are usually located). The other group of participants was recruited using hospital-based records. The interview data were transcribed, coded, and analysed for the generation of themes with the aid of Nvivo version 12 pro. The results showed that people who use drugs face health challenges such as drug dependence, malaria, lungs and breathing complications, cardiovascular complications, and skin complications. People who use drugs experienced poor perceived quality of life and low health status. Health-seeking behaviours of interviewees were influenced by the perceived benefit, perceived severity, cues to action, among others. Multiple sources of healthcare were used by the people who use drugs. Whereas ease of communication, perceived severity, benefit, among others were facilitators to their health-seeking behaviours, cost, dwindling social support, lack of knowledge of the condition, and fear of arrest by law enforcement agencies also served as barriers to seeking healthcare at the orthodox health facilities. This paper suggests a holistic approach to help improve the health and health-seeking behaviours of people who use drugs. The researchers wish to indicate that an earlier version of this manuscript has been presented at the University of Ghana as a thesis.

Is there an association between drug use and oral health conditions?

Data sources Databases searched included PsycINFO, PubMed, SciELO, Scopus and Web of Science.Study selection Cross-sectional, longitudinal and retrospective studies that compared caries, periodontal disease or tooth loss in people who use drugs as compared to those who do not. Studies that included psychiatric populations and alcohol or tobacco users were not included in the review. Qualitative studies, in vitro investigations, animal studies, reviews, case reports and series, letters to editor and conference abstracts were also excluded. The authors included only English studies published before 1 July 2019. Two independent reviewers screened the papers on title and abstract and then full text. In case of disagreements, these were discussed between the two reviewers and a third one was consulted if needed.Data extraction and synthesis Two reviewers extracted the data and contacted the primary authors for necessary clarifications, if needed. The unweighted kappa was applied to examine inter-examiner agreement. The Joanna Briggs Institute Critical Appraisal Checklist for observational studies was used to critically appraise the studies. The study selection results were presented through a flowchart. For the meta-analysis, the authors considered adjusted data. In some cases, crude estimates were used. Heterogeneity was estimated using the I2 statistic. The 'meta' package was used for the meta-analysis.Results Ten studies were included in the meta-analysis. Drug use was associated with higher risk of periodontal disease (OR 1.44; 95% CI 0.8-2.6) and higher DMFT index (OR 4.11; 95% CI 2.07-8.15).Conclusions The review showed high risk of periodontal disease and caries among people who use drugs. The authors concluded that this association may be explained by irregular tooth brushing and long history of drug use. It is important to develop programmes that aim to improve oral hygiene practices among people who use drugs.

Assessment of oral health status and treatment needs of drug abusers in Bhubaneswar city: A cross-sectional study

Introduction:

Oral health of drug abusers has received less attention. Drug users may also have special needs in relation to receiving dental care. Evaluation of the oral health status of drug abusers is important as in India, where the disease burden is enormous, and availability of curative treatment is quite inadequate, preventive approach shall prove to be better than curative treatment.

Aim:

To determine the oral health status and treatment needs of drug abusers residing in rehabilitation centers in Bhubaneswar.

Materials and Methods:

A cross-sectional study was conducted in the drug de-addiction cum rehabilitation centers in Bhubaneswar city, Odisha. A self-administered questionnaire was used to record oral health practices of the inmates and the type of drugs used by them in the past. Oral health was recorded using modified WHO 2013 pro forma. Mann–Whitney U-test and Kruskal–Wallis test were applied to find any significant differences between different variables in groups.

Results:

All the participants were male and alcohol was the most commonly used drug, followed by tobacco and ganja. The horizontal brushing technique was the most widely used technique. Mean decayed, missing, and filled teeth (DMFT) score was recorded to be 1.48. Leukoplakia, acute necrotizing ulcerative gingivitis, candidiasis, and ulceration were among the few oral lesions found in the inmates. Around 67.66% of inmates exhibited erosion of the enamel surface, while 6.59% had signs of enamel fracture. Statistically, significant difference was found for the types of drugs used and DMFT score and type of drug used and dental erosion.

Conclusion:

Oral health status of drug users is poor and needs immediate attention. Oral health education needs to be imparted among them. The government needs to enforce the establishment of dental clinics in these centers so that the oral health of these people can be taken care of.

The need for further oral health research surrounding the provision of dental treatment for people with drug dependency

The aim of this article is to highlight the need for further research in providing dental care for people with drug dependency. The association between people who misuse substances and dental disease is widely known occurrence, yet there have been few studies conducted in the UK surrounding this issue due to the nature of the cohort. Further to this, there are a multitude of barriers to accessing/seeking dental care that exist for those with drug dependency. Going forward, there is a need for the development of a new service model where dental care is part of a multidisciplinary team working towards treating people with drug dependency in a holistic way.

Dentists' intentions to manage drug users: Role of theory of planned behaviour and continuing education

OBJECTIVES

To assess dentists' intention to manage drug users (DUs) and to evaluate the role of the theory of planned behavior (TPB) and continuing education (CE) in explaining this intention.

MATERIALS AND METHODS

A cross-sectional study was conducted in 2017, including dentists from three major Saudi cities. A questionnaire assessed personal and professional background and components of TPB: attitude, perceived social norms, perceived control and intention to manage DUs. Respondents expressed their agreement on a scale from 1 (disagree) to 7 (agree). Receiving CE to manage DUs was also assessed. Adjusted linear regression was used to assess the impact of the TPB constructs and receiving CE on dentists' intention.

RESULTS

Response rate = 72% (255/354), mean (SD) age = 35.2 (11.9). The mean (SD) for positive intention to manage DUs = 5.34 (1.37), negative attitude = 4.03 (1.10), positively perceived norms = 5.78 (1.06) and perception of no control = 4.45 (1.08). Only 9% received CE to manage DUs. Positive intention was associated with perception of positive norms (B = 0.73, 95% CI = 0.59, 0.87) and perception of no control (B = -0.47, 95% CI = -0.63, -0.32) but not with receiving CE (P = 0.58).

CONCLUSION

In major Saudi cities, dentists' intention to manage DUs was positive and was explained by TPB components: perception of norms and perception of control. Modified and targeted CE is needed to address this problem.

Oral health status and its determinants among opiate dependents: a cross-sectional study

Background

In addition to numerous general health problems, drug dependents manifest various oral health disorders. Our aim was to investigate the oral health status and its determinants among in-treatment opiate dependents.

Methods

As part of a comprehensive cross-sectional survey on opiate dependents admitted to methadone maintenance centers in Tehran, Iran, we conducted a clinical study in two centers from different socioeconomic areas. A trained dentist conducted face to face interviews and clinical oral examinations based on World Health Organization (WHO) criteria for Decayed, Missing, Filled Teeth (DMFT) index and Community Periodontal Index (CPI) on volunteer patients. Student’s t-test, Mann-Whitney U, Kruskal Wallis, and Chi² tests, in addition to linear and logistic regression models served for statistical analysis (p < 0.05).

Results

A total of 217 patients (98% men), with a mean age of 43.6 years (SD 12.3) participated in the study. Opium was the main drug of abuse reported by 70% of the participants followed by crystalline heroin (22%). Of the participants, 24.4% were totally edentulous. The mean DMFT score of participants was 20.3 (SD 7.8). Missing teeth comprised the main part of the index followed by decayed and filled teeth. Older patients (p < 0.001) and the patients with a lower socioeconomic status (p = 0.01) had higher DMFT scores. None of the dentate patients had a healthy periodontium. Maximum CPI mostly consisted of shallow pockets (66%) followed by calculus in 15%, deep pockets in 11%, and bleeding in 8% of the participants. Older participants (p = 0.02) and those who started drug abuse at a younger age (p = 0.01) were more likely to develop periodontal pockets.

Conclusions

Opiate dependents had a poor oral health status in terms of the dentition status and periodontal health. Missing teeth comprised the main part of their dental caries history and none had a healthy periodontium. Oral health care should be integrated into the package of general health services available in treatment centers.

A Comparison of Methamphetamine Users to a Matched NHANES Cohort: Propensity Score Analyses for Oral Health Care and Dental Service Need

Dental problems are among the most frequently reported health issues of drug users. This study describes, among the largest population of methamphetamine (MA) users to date (N = 459, including both HIV-negative and HIV-positive participants) oral hygiene practice, dental care access, and dental quality of life. A matched control group from the Third National Health and Nutrition Examination Survey was utilized. Findings conclusively establish that MA users have severe oral health deficits compared to the general population: they are 3.5 times more likely to experience painful toothaches, 6.6 times to experience difficulty eating, and 8.6 times to be self-conscious due to dental appearance. HIV-positive users were more likely to have regular dental visits than HIV-negative users. Severity of use (both high-frequency use as well as injection as the method) was associated with poorer oral health care. Despite the magnitude of the need, few MA users receive the needed care.

Correlates of Cervical Cancer Screening Among Adult Latino Women: A 5-Year Follow-Up

BACKGROUND

Latinas have the highest incidence rates of cervical cancer in the United States, and Latinas in the United States are less likely to utilize cervical cancer screening.

METHOD

We used secondary data analysis of a non-clinical convenience sample (n=316 women at baseline; n=285 at five-year follow-up) to examine correlates of cervical cancer screening among adult Latina women. Univariate and multiple logistic regression models using Generalized Estimated Equations (GEE) algorithm were utilized to assess the influence of the independent variables.

RESULTS

Women who reported their main healthcare source as community health clinics, women who were sexually active, and women who reported that a healthcare provider discussed HIV prevention with them were more likely to report having a cervical cancer screening (aOR=2.06; CI=1.20, 3.52).

CONCLUSION

The results suggest a need for continued efforts to ensure that medically underserved women (e.g., Latina women) receive counseling and education about the importance of preventive cancer screening.

Addictive behaviors and healthcare renunciation for economic reasons in a French population-based sample

BACKGROUND

Healthcare renunciation for economic reasons is a major health concern, but it has been scarcely investigated among drug users, even if drug users constitute a vulnerable population in need of medical care. This study investigated associations of healthcare renunciation for economic reasons and addictive behaviors (alcohol, tobacco, cannabis, illicit drug use, and gambling) in a population-based sample of adults living in France, a country with universal health coverage.

METHODS

Data were collected using the 2014 Health Barometer, a French cross-sectional survey conducted among a random representative sample of the general population aged 18-64 (n=12,852). Measures included healthcare renunciation, substance use (alcohol, tobacco, cannabis, and other illicit drugs) and gambling. Experimental/recreational and heavy/chronic use were assessed. Logistic regressions were used to test the relationship between healthcare renunciation and addictive behaviors, controlling for relevant covariates.

RESULTS

A total of 25% of the participants had renounced care at least once in the previous twelve months. Most variables of drug use were significantly associated with increased healthcare renunciation. This was the case for heavy/hazardous use and experimental/recreational use. Regular gambling was not associated with healthcare renunciation, but disordered gambling was.

CONCLUSION

This study showed that addictive behaviors, including substance use and gambling, were part of the burden of vulnerability of people who forgo care. Therefore, drug use and gambling patterns should be a focus in the development of policies to reduce health inequalities, not only for heavy and chronic drug users.

“I'm a Health Nut!” Street Drug Users' Accounts of Self-Care Strategies

This qualitative study analyzes data from in-depth interviews to describe self-care strategies among chronic and injecting drug users. While the types of strategies varied from participant to participant, the theme of proactive self-care remained strong throughout the data. Researchers identified five self-care domains discussed by the study participants. The self-care domains include strategies to improve nutrition, increase physical activity, address medical concerns, regulate substance use, and reduce sexual risk. Overall, these data indicate that chronic drug users are actively involved in managing and improving their health and attempt to take self-protective actions, even while continuing to engage in active drug use. These findings are particularly relevant for primary care providers, walk-in clinics, drug treatment programs, outreach workers and those engaged in harm reduction efforts. Recognizing that drug users are actively involved in taking care of their health can be an important strategy to build into any intervention or risk reduction program.

Oral health-related quality of life among an Australian sample of people who inject drugs

OBJECTIVES

People who inject drugs (PWID) have poor oral health. However, their oral health-related quality of life (OHRQoL) is unknown. Our study was designed to measure the OHRQoL of PWID.

METHODS

The Oral Health Impact Profile-14 (OHIP-14) was administered to 794 PWID recruited in Australian capital cities as part of the 2013 Illicit Drug Reporting System (IDRS). Three OHIP-14 summary indicators were examined: "Prevalence" (proportion reporting ≥1 item at least "fairly often"), "severity" (mean total OHIP-14 score), and "extent" (number of impacts reported at least "fairly often"). Associations between "prevalence" and "extent" and variables drawn from the health, drug use, and social domains were investigated.

RESULTS

All OHIP-14 summary indicators among IDRS participants were significantly higher than in the general Australian population. In multivariate analysis, the "prevalence" indicator was significantly and positively associated with female gender [adjusted odds ratio (AOR) = 1.75, 95% CI 1.27-2.38], those born in Australia (AOR = 2, 95% CI 1.25-3.23), not completing Year 10 compared with those who had completed Year 12 or a higher qualification (AOR = 1.59, 95% CI 1.03-2.44), and methadone treatment (AOR = 1.61, 95% CI 1.14-2.29). The "extent" indicator was significantly and positively associated with female gender [adjusted incidence rate ratio (AIRR) = 1.56, 95% CI 1.19-2.08], unemployment (AIRR = 1.59, 95% CI 1.01-2.44), and having an injecting career of 10-20 years (AIRR = 1.76, 95% CI 1.03-3.01).

CONCLUSIONS

PWID have poorer OHRQoL than the Australian general population. Poor OHRQoL was particularly common in female PWID and those with longer injecting careers. Interventions to improve the oral health of PWID may improve their OHRQoL.

The oral health of heroin drug users: case study in Bosnia and Herzegovina

BACKGROUND

Injection drug use is a major public health problem. Oral health problems and the appearance of dental disease among injection drug users (IDUs) are caused by their lifestyle. The aim of the present study was to examine the relations between socioeconomic factors, drug use, and oral hygiene habits on the oral health of heroin drug users.

METHODS

A cross-sectional survey on oral health was carried out as part of UNICEF's research on the biological and behaviours survey among injection drug users in Sarajevo, Banja Luka and Zenica in Bosnia and Herzegovina. A sample of 519 IDUs participated in the survey. Respondent Driven Sampling (RDS) was used to obtain the sample. The data were obtained through face-to-face interviews using a structured questionnaire related to socio-demographic characteristics, duration of drug injection, frequency of drug injection in the last month and oral health.

RESULTS

Older participants (OR = 1.06; 95% CI = 1.02 -1.10), part-time employment (OR = 3.57; 95% CI = 1.02 - 12.20) and unemployment (OR = 3.23; 95% CI = 1.23 - 8.33) in comparison to full-time employment as the referent category, and longer duration of drug injection (OR = 1.06; 95% CI = 1.003 - 1.12) were predictors of bad oral health. A higher level of education (OR = 0.56; 95% CI = 0.39 - 0.79), more frequent tooth brushing (OR = 0.59; 95% CI = 0.49 - 0.71), and regular dental checkups (OR = 3.30; 95% CI = 1.42 - 7.67) were predictors of good oral health.

CONCLUSIONS

Socioeconomic characteristics of IDUs as well as their lifestyles may contribute to oral health problems. Heroin drug users have specific dental needs, and programmes to improve their oral health should be an integral part of strategies to prevent addictions including treatments and harm reduction programmes.

Dental profile of a community of recovering drug addicts: Biomedical aspects. Retrospective cohort study

Objectives: to obtain a biomedical oral profile of a community of adult drug addicts in treatment by analysing their dental health, with a view to determining whether the state of their oral health could be attributed primarily to their lifestyle and the direct consequences of drug abuse on their overall condition, rather than to the effects of the drugs used. Experimental Design: the study was conducted under the terms of an agreement between the Complutense University of Madrid’s (UCM) Odontology Faculty and the City of Madrid’s Substance Abuse Institute. Seventy drug addicts and 34 control group subjects were examined. The study assessed oral hygiene habits, systemic pathology, type of drugs used and the duration of use, oral pathology, oral health indices, risk of caries based on saliva tests, oral candidiasis and periodontal microbiology. Results: statistically significant differences (p<0.05) were found between the test and control groups for practically all the variables analysed. In the drug users group, dental hygiene was wanting, systemic and oral pathology prevailed and the decayed/missing/filled teeth or surface (DMFT/S) indices denoted very poor buccodental health. The saliva tests showed a substantial risk of caries and candidiasis rates were high. By contrast, with a single exception, the microbiological studies detected no statistically significant difference between drug users and control groups periodontal flora. Conclusions: drug-dependent patients had poor oral health and a significant increase in oral pathology, essentially caries and periodontal disease. Their risk of caries was high and the presence of candidiasis was representative of their poor general and oral health. Drug users’ poor buccodental condition was more closely related to lifestyle than to drug abuse itself.

Key words:Buccal, dental, drug addicts.

Determinants of physician utilization, emergency room use, and hospitalizations among populations with multiple health vulnerabilities

Understanding the factors that influence differing types of health care utilization within vulnerable groups can serve as a basis for projecting future health care needs, forecasting future health care expenditures, and influencing social policy. In this article the Behavioral Model for Vulnerable Populations is used to evaluate discretionary (physician visits) and non-discretionary (emergency room visits, and hospitalizations) health utilization patterns of a sample of 1466 respondents with one or more vulnerable health classification. Reported vulnerabilities include: (1) persons with substance disorders; (2) homeless persons; (3) persons with mental health problems; (4) victims of violent crime; (5) persons diagnosed with HIV/AIDS; (6) and persons in receipt of public benefits. Hierarchical logistic regression is used on three nested models to model factors that influence physician visits, emergency room visits, and hospitalizations. Additionally, bivariate logistic regression analyses are completed using a vulnerability index to evaluate the impact of increased numbers of vulnerability on all three forms of health care utilization. Findings from this study suggest the Behavioral Model of Vulnerable Populations be employed in future research regarding health care utilization patterns among vulnerable populations. This article encourages further research investigating the cumulative effect of health vulnerabilities on the use of non-discretionary services so that this behavior could be better understood and appropriate social policies and behavioral interventions implemented.

Health and oral health care needs and health care-seeking behavior among homeless injection drug users in San Francisco

Few existing studies have examined health and oral health needs and treatment-seeking behavior among the homeless and injection drug users (IDUs). This paper describes the prevalence and correlates of health and oral health care needs and treatment-seeking behaviors in homeless IDUs recruited in San Francisco, California, from 2003 to 2005 (N = 340). We examined sociodemographic characteristics, drug use patterns, HIV status via oral fluid testing, physical health using the Short Form 12 Physical Component Score, self-reported needs for physical and oral health care, and the self-reported frequency of seeking medical and oral health care. The sample had a lower health status as compared to the general population and reported a frequent need for physical and oral health care. In bivariate analysis, being in methadone treatment was associated with care-seeking behavior. In addition, being enrolled in Medi-Cal, California's state Medicaid program, was associated with greater odds of seeking physical and oral health care. Methamphetamine use was not associated with higher odds of needing oral health care as compared to people who reported using other illicit drugs. Homeless IDUs in San Francisco have a large burden of unmet health and oral health needs. Recent cuts in Medi-Cal's adult dental coverage may result in a greater burden of oral health care which will need to be provided by emergency departments and neighborhood dental clinics.

Use of Mental Health Services among People with Co-Occurring Disorders and other Mental Health co-morbidities: Employing the Behavioral Model of Vulnerable Populations

BACKGROUND: Persons with mental disorders frequently have other co-occurring problems such as substance related disorders and HIV/AIDS. Individuals with co-occurring medical and mental disorders encounter great obstacles to receiving mental health services. AIMS: This paper uses the Behavioral Model of Vulnerable Populations to evaluate use of mental health services among groups with co-occurring disorders (CODs) and other co-morbid relationships. The association between receipt of mental health treatment and traditional/vulnerable predisposing, enabling, and need factors are examined. METHODS: Bivariate analysis and two-stage hierarchical logistic regression were completed. RESUTLS: A sample of 553 persons who reported mental health problems within the past year had one or more of the following vulnerabilities: (1) substance disorders; (2) homelessness; (3) victims of violent crime; (4) diagnosed with HIV/AIDS; (5) recipient of public benefits; and 31.3% reported having received some form of mental health treatment. Both traditional and vulnerable characteristics are significant predictors of receipt of mental health treatment. Vulnerable predictors indicated decreased odds of receiving mental health treatment were associated with injection and chronic drug use, (OR = .42, CI: .22 - .77) and (OR = .38, CI: .22 - .64) respectively. CONCLUSION: The Behavioral Model of Vulnerable Populations could be employed in future research of CODs and other co-morbid group's utilization of mental health treatment.

Drug users: oral health-related attitudes and behaviours

AIM

Explore oral health-related attitudes and behaviours of drug users.

DESIGN

Qualitative study using focus groups and semi-structured interviews.

SETTING

Facilities for treatment and recovery of drug users in South London.

PARTICIPANTS

Twenty-six male and 14 female recovering drug users.

RESULTS

Participants described many changes in lifestyle associated with drug use including the physical effects of drugs, dietary habits, organisational and time constraints and unfavourable social conditions, which were not conducive to oral health. There was considerable health consciousness. They associated general health problems and problems with teeth, gums and oral soft tissues to both direct and indirect effects of drug use. Use of dental services was inhibited by low priority for oral health relative to the need to obtain and use drugs, experientially induced fear of dentists, the acceptability of dental services, needle-phobia, ability to self-medicate and organisational factors in their lifestyles.

CONCLUSIONS

The lifestyles of drug users may contribute to oral health problems and low use of services. Drug users therefore comprise a group with special dental needs and need greater access to dental care than most people. Much of this care could be provided in general practice where appropriate dental care can contribute to recovery from drug use.

Current Physical Health Problems and their Predictors Among a Community Sample of Crack-Cocaine Smokers in Ohio

The harmful effects of nonmedical cocaine use are well documented, but the overall health of people involved with crack is less well understood. This cross-sectional study describes the nature and extent of current health problems in a community sample of 430 crack smokers in Dayton, Ohio. Two-thirds of the sample reported one or more current physical health problems. The estimated annualized incidence of acute health problems was 152.6 conditions/100 persons/year. The estimated prevalence of chronic problems ranged from a low of 30.2 conditions/1000 persons for diabetes to a high of 223.2 conditions/1000 persons for anemias. Cardiovascular problems were common. Even though the results cannot prove a cause and effect relationship between crack use and health problems, they do suggest that crack users experienced higher than usual rates of problems, when compared with data from the National Health Interview Survey. The results of a cumulative logistic regression analysis suggest that men were significantly less likely, and older users more likely, to have health problems. Neither duration of crack use nor frequency of use of any drug predicted health problems. Incorporating assessments of physical problems as well as a mechanism for their treatment into the regimen of drug abuse treatment programs should be considered.