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What is the prevalence of and trend in opioid use disorder in the United States from 2010 to 2019? Using multiplier approaches to estimate prevalence for an unknown population size. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100052. [PMID: 35783994 PMCID: PMC9248998 DOI: 10.1016/j.dadr.2022.100052] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Opioid-related overdose deaths have increased since 2010 in the U.S., but information on trends in opioid use disorder (OUD) prevalence is limited due to unreliable data. Multiplier methods are a classical epidemiological technique to estimate prevalence when direct estimation is infeasible or unreliable. We used two different multiplier approaches to estimate OUD prevalence from 2010 to 2019. First, we estimated OUD in National Survey on Drug Use and Health (NSDUH), and based on existing capture-recapture studies, multiplied prevalence by 4.5x. Second, we estimated the probability of drug poisoning death among people with OUD (Meta-analysis indicates 0.52/100,000), and divided the number of drug poisoning deaths in the US by this probability. Estimates were weighted to account for increase in drug-related mortality in recent years due to fentanyl. Estimated OUD prevalence was lowest when estimated in NSDUH with no multiplier, and highest when estimated from vital statistics data without adjustment. Consistent findings emerged with two methods: NSDUH data with multiplier correction, and vital statistics data with multiplier and adjustment. From these two methods, OUD prevalence increased from 2010 to 2014; then stabilized and slightly declined annually (survey data with multiplier, highest prevalence of 4.0% in 2015; death data with a multiplier and correction, highest prevalence of 2.35% in 2016). The number of US adolescent and adult individuals with OUD in 2019 was estimated between 6.7-7.6 million. When multipliers and corrections are used, OUD may have stabilized or slightly declined after 2015. Nevertheless, it remains highly prevalent, affecting 6-7 million US adolescents and adults.
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McGrew KM, Garwe T, Jafarzadeh SR, Drevets DA, Zhao YD, Williams MB, Carabin H. Misclassification Error-Adjusted Prevalence of Injection Drug Use Among Infective Endocarditis Hospitalizations in the United States: A Serial Cross-Sectional Analysis of the 2007-2016 National Inpatient Sample. Am J Epidemiol 2021; 190:588-599. [PMID: 32997130 DOI: 10.1093/aje/kwaa207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 11/13/2022] Open
Abstract
Administrative health databases have been used to monitor trends in infective endocarditis hospitalization related to nonprescription injection drug use (IDU) using International Classification of Diseases (ICD) code algorithms. Because no ICD code for IDU exists, drug dependence and hepatitis C virus (HCV) have been used as surrogate measures for IDU, making misclassification error (ME) a threat to the accuracy of existing estimates. In a serial cross-sectional analysis, we compared the unadjusted and ME-adjusted prevalences of IDU among 70,899 unweighted endocarditis hospitalizations in the 2007-2016 National Inpatient Sample. The unadjusted prevalence of IDU was estimated with a drug algorithm, an HCV algorithm, and a combination algorithm (drug and HCV). Bayesian latent class models were used to estimate the median IDU prevalence and 95% Bayesian credible intervals and ICD algorithm sensitivity and specificity. Sex- and age group-stratified IDU prevalences were also estimated. Compared with the misclassification-adjusted prevalence, unadjusted estimates were lower using the drug algorithm and higher using the combination algorithm. The median ME-adjusted IDU prevalence increased from 9.7% (95% Bayesian credible interval (BCI): 6.3, 14.8) in 2008 to 32.5% (95% BCI: 26.5, 38.2) in 2016. Among persons aged 18-34 years, IDU prevalence was higher in females than in males. ME adjustment in ICD-based studies of injection-related endocarditis is recommended.
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Rich AJ, Lachowsky NJ, Sereda P, Cui Z, Wong J, Wong S, Jollimore J, Raymond HF, Hottes TS, Roth EA, Hogg RS, Moore DM. Estimating the Size of the MSM Population in Metro Vancouver, Canada, Using Multiple Methods and Diverse Data Sources. J Urban Health 2018; 95:188-195. [PMID: 28631060 PMCID: PMC5906378 DOI: 10.1007/s11524-017-0176-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV globally, regionally in Canada, and locally in Vancouver. Lack of reliable population size estimates of MSM impedes effective implementation of health care services and limits our understanding of the HIV epidemic. We estimated the population size of MSM residing in Metro Vancouver drawing on four data sources: the Canadian Community Health Survey (CCHS), a cross-sectional bio-behavioural MSM survey, HIV testing services data from sexually transmitted infection (STI) clinics serving MSM, and online social networking site Facebook. Estimates were calculated using (1) direct estimates from the CCHS, (2) "Wisdom of the Crowds" (WOTC), and (3) the multiplier method using data from a bio-behavioural MSM survey, clinic-based HIV testing, and online social media network site Facebook. Data sources requiring greater public disclosure of sexual orientation resulted in our mid-range population estimates (Facebook 23,760, CCHS 30,605). The WOTC method produced the lowest estimate, 10,000. The multiplier method using STI clinic HIV testing data produced the largest estimate, 41,777. The median of all estimates was 27,183, representing 2.9% of the Metro Vancouver census male adult population, with an interquartile range of 1.1-4.5%. Using multiple data sources, our estimates of the MSM population in Metro Vancouver are similar to population prevalence estimates based on population data from other industrialized nations. These findings will support understanding of the HIV burden among MSM and corresponding public health and health services planning for this key population.
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Affiliation(s)
- Ashleigh J Rich
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Nathan J Lachowsky
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Paul Sereda
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
| | - Zishan Cui
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | | | | | - Travis Salway Hottes
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- University of Toronto, Toronto, ON, Canada
| | - Eric A Roth
- Department of Anthropology, Faculty of Social Sciences, University of Victoria, Victoria, BC, Canada
- Centre for Addictions Research BC, Victoria, BC, Canada
| | - Robert S Hogg
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, 505-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
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Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, Holtzman D. Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014. Am J Public Health 2018; 108:175-181. [PMID: 29267061 PMCID: PMC5846578 DOI: 10.2105/ajph.2017.304132] [Citation(s) in RCA: 485] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare US trends in rates of injection drug use (IDU), specifically opioid injection, with national trends in the incidence of acute HCV infection to assess whether these events correlated over time. METHODS We calculated the annual incidence rate and demographic and risk characteristics of reported cases of acute HCV infection using surveillance data from 2004 to 2014 and the annual percentage of admissions to substance use disorder treatment facilities reporting IDU for the same time period by type of drug injected and demographic characteristics. We then tested for trends. RESULTS The annual incidence rate of acute HCV infection increased more than 2-fold (from 0.3 to 0.7 cases/100 000) from 2004 to 2014, with significant increases among select demographic subgroups. Admissions for substance use disorder attributed to injection of heroin and prescription opioid analgesics increased significantly, with an almost 4-fold increase in prescription opioid analgesic injection. Significant increases in opioid injection mirrored those for reported cases of acute HCV infection among demographic subgroups. CONCLUSIONS These findings strongly suggest that the national increase in acute HCV infection is related to the country's opioid epidemic and associated increases in IDU.
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Affiliation(s)
- Jon E Zibbell
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Alice K Asher
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Rajiv C Patel
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Ben Kupronis
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Kashif Iqbal
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - John W Ward
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
| | - Deborah Holtzman
- Jon E. Zibbell is with the Behavioral and Urban Health Program, RTI International, Atlanta, GA. Alice K. Asher is with the Epidemiology, Surveillance and Prevention among Substance users Unit, Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA. Rajiv C. Patel is a second year Medical Student with Virginia Commonwealth University, Richmond, VA. Ben Kupronis is with the Epidemiology and Surveillance Branch, Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention. Kashif Iqbal is with the Epidemiology Branch, Division of HIV/AIDS Prevention, NCHHSTP, Centers for Disease Control and Prevention. John W. Ward and Deborah Holtzman are with the Division of Viral Hepatitis, NCHHSTP, Centers for Disease Control and Prevention
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5
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Janssen E. Estimating the number of people who inject drugs: a proposal to provide figures nationwide and its application to France. J Public Health (Oxf) 2017; 40:e180-e188. [DOI: 10.1093/pubmed/fdx059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 05/10/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- Eric Janssen
- Department of General Population Surveys, French Monitoring Centre for Drugs and Drug Addictions (Observatoire Français des Drogues et Toxicomanies - OFDT), 3 Avenue du Stade de France, La Plaine Saint Denis Cedex, France
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6
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Wiessing L, Ferri M, Běláčková V, Carrieri P, Friedman SR, Folch C, Dolan K, Galvin B, Vickerman P, Lazarus JV, Mravčík V, Kretzschmar M, Sypsa V, Sarasa-Renedo A, Uusküla A, Paraskevis D, Mendão L, Rossi D, van Gelder N, Mitcheson L, Paoli L, Gomez CD, Milhet M, Dascalu N, Knight J, Hay G, Kalamara E, Simon R, Comiskey C, Rossi C, Griffiths P. Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study. Harm Reduct J 2017; 14:19. [PMID: 28431584 PMCID: PMC5401609 DOI: 10.1186/s12954-017-0141-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/04/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND AIMS Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.
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Affiliation(s)
- Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Vendula Běláčková
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- National Institute for Mental Health, Prague, Czech Republic
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Patrizia Carrieri
- Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
- ORS PACA, Marseille, France
| | - Samuel R. Friedman
- Institute of Infectious Disease Research, National Development and Research Institutes, New York, USA
| | - Cinta Folch
- Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, The University of New South Wales (UNSW), Sydney, Australia
| | | | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jeffrey V. Lazarus
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Barcelona Institute of Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- National Institute for Mental Health, Prague, Czech Republic
- National Monitoring Centre for Drugs and Addiction, Prague, Czech Republic
| | - Mirjam Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Vana Sypsa
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ana Sarasa-Renedo
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Spanish Field Epidemiology Training Program (PEAC), National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Dimitrios Paraskevis
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Luis Mendão
- Group of Activists on Treatments (GAT), Lisbon, Portugal
| | - Diana Rossi
- Intercambios Civil Association and University of Buenos Aires, Buenos Aires, Argentina
| | - Nadine van Gelder
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Luke Mitcheson
- Alcohol, Drug, and Tobacco Division, Health and Wellbeing Directorate, Public Health England, London, UK
| | - Letizia Paoli
- Leuven Institute of Criminology (LINC), Faculty of Law, University of Leuven, Leuven, Belgium
- Centre for Global Governance Studies (GSS), Leuven, Belgium
| | - Cristina Diaz Gomez
- French Monitoring Centre for Drugs and Drug Addiction (OFDT), Saint-Denis, France
| | - Maitena Milhet
- French Monitoring Centre for Drugs and Drug Addiction (OFDT), Saint-Denis, France
| | - Nicoleta Dascalu
- The Romanian Association Against AIDS (ARAS), Bucharest, Romania
| | | | - Gordon Hay
- Public Health Institute, Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK
| | - Eleni Kalamara
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | - Roland Simon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
| | | | - Carla Rossi
- Centro Studi Statistici e Sociali CE3S, Rome, Italy
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal
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Trend Analyses of Users of a Syringe Exchange Program in Philadelphia, Pennsylvania: 1999-2014. AIDS Behav 2016; 20:2922-2932. [PMID: 27066985 DOI: 10.1007/s10461-016-1393-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examines trends of injection drug users' (IDUs) use of a Philadelphia, Pennsylvania, syringe exchange program (SEP) from 1999 to 2014, including changes in demographics, drug use, substance abuse treatment, geographic indicators, and SEP use. Prevention Point Philadelphia's SEP registration data were analyzed using linear regression, Pearson's Chi square, and t-tests. Over time new SEP registrants have become younger, more racially diverse, and geographically more concentrated in specific areas of the city, corresponding to urban demographic shifts. The number of new registrants per year has decreased, however syringes exchanged have increased. Gentrification, cultural norms, and changes in risk perception are believed to have contributed to the changes in SEP registration. Demographic changes indicate outreach strategies for IDUs may need adjusting to address unique barriers for younger, more racially diverse users. Implications for SEPs are discussed, including policy and continued ability to address current public health threats.
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8
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Gelpí-Acosta C, Pouget ER, Reilly KH, Hagan H, Neaigus A, Wendel T, Marshall D. Time Since Migration and HIV Risk Behaviors Among Puerto Ricans Who Inject Drugs in New York City. Subst Use Misuse 2016; 51:870-81. [PMID: 27100322 PMCID: PMC4862909 DOI: 10.3109/10826084.2016.1155616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Among people who inject drugs (PWID) in the United States, those who initiated drug injection in Puerto Rico (immigrant Puerto Rican PWID) engage in more injection and sexual risk behaviors, and have higher HIV incidence than non-Hispanic whites. OBJECTIVE Understand the persistence of these HIV behaviors. METHODS In a cross-sectional study conducted in New York City (NYC) in 2012 (National HIV Behavioral Surveillance), PWID aged ≥18 years were recruited using Respondent-Driven Sampling, interviewed, and tested for HIV. Participants were categorized into 5 different groups: (1) US-born non-Hispanic PWID, (2) US-born Puerto Rican PWID, (3) recent immigrant Puerto Rican PWID (≤3 years in NYC), (4) medium-term immigrant Puerto Rican PWID (>3 and ≤10 years in NYC), and (5) long-term immigrant Puerto Rican PWID (>10 years in NYC). We examined the relationship between time since migrating on sexual and injection risk behaviors among immigrant Puerto Rican PWID, compared with U.S.-born Puerto Rican PWID and US-born non-Hispanic PWID. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression. RESULTS A total of 481 PWID were recruited. In adjusted analyses using US-born non-Hispanic PWID as the comparison group, syringe sharing was significantly more likely among medium-term immigrants; and unprotected sex with casual partners was more likely among recent and long-term immigrants. CONCLUSIONS The risk-acculturation process for immigrant Puerto Rican PWID may be nonlinear and may not necessarily lead to risk reduction over time. Research is needed to better understand this process.
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Affiliation(s)
- C Gelpí-Acosta
- LaGuardia Community College, City University of New York, 31-10 Thomson Avenue C-459-VV, Long Island City, NY 11101, U.S
| | - ER Pouget
- National Development and Research Institutes, Inc. 71 West 23 Street, 4 Floor, New York, NY 10010, U.S
| | - KH Reilly
- New York City Department of Health and Mental Hygiene, HIV Epidemiology and Field Services Program, Gotham Center 42-09 28 Street, 22 Floor, Long Island City, NY 11101, U.S
| | - H Hagan
- College of Nursing, New York University, 726 Broadway, 10th floor, New York, NY 10003, U.S
| | - A Neaigus
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168 Street, New York, NY 10032, U.S
| | - T Wendel
- Saint Ann’s Corner of Harm Reduction, 886 Westchester Ave, Bronx, NY 10459, U.S
| | - D Marshall
- John Jay College of Criminal Justice, New York, NY, USA 10019-1093, U.S
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9
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Friedman SR, Tempalski B, Brady JE, West BS, Pouget ER, Williams LD, Des Jarlais DC, Cooper HLF. Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:11-6. [PMID: 27198555 DOI: 10.1016/j.drugpo.2016.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
Abstract
This paper reviews and then discusses selected findings from a seventeen year study about the population prevalence of people who inject drugs (PWID) and of HIV prevalence and mortality among PWID in 96 large US metropolitan areas. Unlike most research, this study was conducted with the metropolitan area as the level of analysis. It found that metropolitan area measures of income inequality and of structural racism predicted all of these outcomes, and that rates of arrest for heroin and/or cocaine predicted HIV prevalence and mortality but did not predict changes in PWID population prevalence. Income inequality and measures of structural racism were associated with hard drug arrests or other properties of policing. These findings, whose limitations and implications for further research are discussed, suggest that efforts to respond to HIV and to drug injection should include supra-individual efforts to reduce both income inequality and racism. At a time when major social movements in many countries are trying to reduce inequality, racism and oppression (including reforming drug laws), these macro-social issues in public health should be both addressable and a priority in both research and action.
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Affiliation(s)
- Samuel R Friedman
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA.
| | - Barbara Tempalski
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Joanne E Brady
- NORC at the University of Chicago, 4350 East-West Hwy, Bethesda, MD 20814 USA
| | - Brooke S West
- Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA 92093-0507, USA
| | - Enrique R Pouget
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Leslie D Williams
- National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA
| | - Don C Des Jarlais
- Psychiatry and Preventive Medicine, Icahn School of Medicine at Mount Sinai., 39 Broadway, Suite 530, New York, NY 10006, USA
| | - Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA
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Roy É, Arruda N, Bruneau J, Jutras-Aswad D. Epidemiology of Injection Drug Use: New Trends and Prominent Issues. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:136-44. [PMID: 27254088 PMCID: PMC4813418 DOI: 10.1177/0706743716632503] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
After more than 30 years of research, numerous studies have shown that injection drug use is associated with a wide range of adverse health outcomes such as drug overdoses, drug-related suicidal behaviours, comorbid psychiatric disorders, bloodborne pathogens and other infectious diseases, and traumas. This review explores new trends and prominent issues associated with injection drug use. The dynamic nature of injection drug use is underlined by examining its recent trends and changing patterns in Canada and other "high-income countries." Three research topics that could further contribute to the development of comprehensive prevention and intervention strategies aimed at people who inject drugs are also discussed: risk behaviours associated with the injection of prescription opioids, binge injection drug use, and mental health problems as determinants of injection risk behaviours.
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Affiliation(s)
- Élise Roy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québc, Canada Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Nelson Arruda
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québc, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Québc, Canada Department of Family Medicine, Université de Montréal, Montréal, Québc, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Québc, Canada Department of Psychiatry, Université de Montréal, Montréal, Québc, Canada
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11
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Deren S, Gelpí-Acosta C, Albizu-García CE, González Á, Des Jarlais DC, Santiago-Negrón S. Addressing the HIV/AIDS epidemic among Puerto Rican people who inject drugs: the need for a multiregion approach. Am J Public Health 2014; 104:2030-6. [PMID: 25211722 DOI: 10.2105/ajph.2014.302114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue. Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence. These disparities should be addressed by the development of a federally supported Northeast-Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions.
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Affiliation(s)
- Sherry Deren
- Sherry Deren is with the Center for Drug Use and HIV Research, College of Nursing, New York University, New York, NY. Camila Gelpí-Acosta is a postdoctoral fellow at National Development and Research Institutes (NDRI), New York, NY. Carmen E. Albizu-García is with the Graduate School of Public Health, University of Puerto Rico, San Juan. At the time of writing, Ángel González and Salvador Santiago-Negrón were with the Administración de Servicios de Salud Mental y Contra la Adicción (ASSMCA; Mental Health and Anti-addiction Services Administration), San Juan. Don C. Des Jarlais is with Mount Sinai Beth Israel, New York, NY
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12
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Pouget ER, West BS, Tempalski B, Cooper HL, Hall HI, Hu X, Friedman SR. Persistent racial/ethnic disparities in AIDS diagnosis rates among people who inject drugs in U.S. metropolitan areas, 1993-2007. Public Health Rep 2014; 129:267-79. [PMID: 24791025 PMCID: PMC3982550 DOI: 10.1177/003335491412900309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES We estimated race/ethnicity-specific incident AIDS diagnosis rates (IARs) among people who inject drugs (PWID) in U.S. metropolitan statistical areas (MSAs) over time to assess the change in disparities after highly active antiretroviral therapy (HAART) dissemination. METHODS We compared IARs and 95% confidence intervals (CIs) for black/African American and Hispanic/Latino PWID with those of white PWID in 93 of the most populous MSAs. We selected two three-year periods from the years immediately preceding HAART (1993-1995) and the years with the most recent available data (2005-2007). To maximize stability, we aggregated data across three-year periods, and we aggregated data for black/African American and Hispanic/Latino PWID for most comparisons with data for white PWID. We assessed disparities by comparing IAR 95% CIs for overlap. RESULTS IARs were significantly higher for black/African American and Hispanic/Latino PWID than for white PWID in 81% of MSAs in 1993-1995 and 77% of MSAs in 2005-2007. MSAs where disparities became non-significant over time were concentrated in the West. Significant differences were more frequent in comparisons between black/African American and white PWID (85% of MSAs in 1993-1995, 79% of MSAs in 2005-2007) than in comparisons between Hispanic/Latino and white PWID (53% of MSAs in 1993-1995, 56% of MSAs in 2005-2007). IARs declined modestly across racial/ethnic groups in most MSAs. CONCLUSIONS AIDS diagnosis rates continue to be substantially higher for black/African American and Hispanic/Latino PWID than for white PWID in most large MSAs. This finding suggests a need for increased targeting of prevention and treatment programs, as well as research on MSA-level conditions that may serve to maintain the disparities.
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Affiliation(s)
| | - Brooke S. West
- National Development and Research Institutes, Inc., New York, NY
| | | | | | - H. Irene Hall
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Xiaohong Hu
- Centers for Disease Control and Prevention, Atlanta, GA
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13
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Friedman SR, West BS, Tempalski B, Morton CM, Cleland CM, Des Jarlais DC, Hall HI, Cooper HLF. Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals? Ann Epidemiol 2014; 24:304-11. [PMID: 24529517 DOI: 10.1016/j.annepidem.2014.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/09/2014] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE We focus on a little-researched issue-how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals? METHODS Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992-1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006-2008, with appropriate socioeconomic controls. RESULTS Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes. CONCLUSIONS Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations.
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Affiliation(s)
- Samuel R Friedman
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Brooke S West
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY
| | - Barbara Tempalski
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY
| | - Cory M Morton
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY
| | | | | | - H Irene Hall
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hannah L F Cooper
- Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
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Tempalski B, Pouget ER, Cleland CM, Brady JE, Cooper HLF, Hall HI, Lansky A, West BS, Friedman SR. Trends in the population prevalence of people who inject drugs in US metropolitan areas 1992-2007. PLoS One 2013; 8:e64789. [PMID: 23755143 PMCID: PMC3673953 DOI: 10.1371/journal.pone.0064789] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 04/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) have increased risk of morbidity and mortality. We update and present estimates and trends of the prevalence of current PWID and PWID subpopulations in 96 US metropolitan statistical areas (MSAs) for 1992-2007. Current estimates of PWID and PWID subpopulations will help target services and help to understand long-term health trends among PWID populations. METHODOLOGY We calculated the number of PWID in the US annually from 1992-2007 and apportioned estimates to MSAs using multiplier methods. We used four types of data indicating drug injection to allocate national annual totals to MSAs, creating four distinct series of component estimates of PWID in each MSA and year. The four component estimates are averaged to create the best estimate of PWID for each MSA and year. We estimated PWID prevalence rates for three subpopulations defined by gender, age, and race/ethnicity. We evaluated trends using multi-level polynomial models. RESULTS PWID per 10,000 persons aged 15-64 years varied across MSAs from 31 to 345 in 1992 (median 104.4) to 34 to 324 in 2007 (median 91.5). Trend analysis indicates that this rate declined during the early period and then was relatively stable in 2002-2007. Overall prevalence rates for non-Hispanic black PWID increased in 2005 as compared to other racial/ethnic groups. Hispanic prevalence, in contrast, declined across time. Importantly, results show a worrisome trend in young PWID prevalence since HAART was initiated--the mean prevalence was 90 to 100 per 10,000 youth in 1992-1996, but increased to >120 PWID per 10,000 youth in 2006-2007. CONCLUSIONS Overall, PWID rates remained constant since 2002, but increased for two subpopulations: non-Hispanic black PWID and young PWID. Estimates of PWID are important for planning and evaluating public health programs to reduce harm among PWID and for understanding related trends in social and health outcomes.
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Affiliation(s)
- Barbara Tempalski
- Institute for AIDS Research, National Development and Research Institutes, Inc.-NDRI, New York, New York, United States of America.
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