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Lafferty L, Altice FL, Leone F, Stoové M, Lloyd AR, Hajarizadeh B, Kronfli N. Using nominal group technique with people who are incarcerated in Canadian federal prisons to identify barriers and solutions to improving Prison Needle Exchange Program uptake. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 131:104549. [PMID: 39141957 DOI: 10.1016/j.drugpo.2024.104549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Prison needle exchange programs (PNEPs) are a critical component for harm reduction in prisons. Little is known about the PNEP access barriers for people who are incarcerated, but the low uptake in the Canadian program highlights these constraints. We aimed to identify the barriers and potential solutions for increasing PNEP coverage in the nine Canadian federal prisons where they operate. METHODS Eighteen focus groups were conducted in nine prisons using nominal group technique (NGT) with two stakeholders: peer advocates and people who use or identified as potential users of the PNEP. NGT uses a round-robin technique followed by generating a list of barriers to PNEP enrolment within their prison. Participants then allocated votes to rank the highest priority barriers, followed by an identical process to generate solutions to address the top three barriers. Interview transcripts describing participant narratives during this process were de-identified and coded to generated themes. Barriers and solutions receiving >10 % of votes within respective participant groups, alongside associated narratives, are discussed more fully. RESULTS Fear of repercussions due to drug use, lack of confidentiality, and fear of being targeted and sanctioned by correctional authorities were perceived by both stakeholder groups as the top barriers inhibiting PNEP enrolment. Stigma (peer advocates) and the application process for the program (PNEP users) were also ranked as a priority. Proposed solutions included education and external oversight of PNEP (i.e., not via correctional officers) by both groups. Peer advocates regarded improving participant confidentiality and a supervised/safe injection site as potential enablers for program participation, while PNEP users identified wrap-around services as likely to improve access. CONCLUSION Barriers to increasing PNEP coverage in Canadian federal prisons proposed by participants highlight the importance of trust and perceived repercussions surrounding program participation. These barriers and proposed solutions highlight a need for changes in implementation to PNEP delivery if the potential health benefits of PNEPs are to be realised.
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Affiliation(s)
- Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney NSW 2052, Australia; The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth, Sydney NSW 2052, Australia
| | - Frederick L Altice
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College St., Suite 323, New Haven, CT 06510, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06510, USA; Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederic Leone
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3004, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Andrew R Lloyd
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth, Sydney NSW 2052, Australia
| | - Behzad Hajarizadeh
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth, Sydney NSW 2052, Australia
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada.
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2
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Palis H, Haywood B, McDougall J, Xavier CG, Desai R, Tobias S, Burgess H, Ferguson M, Liu L, Kinniburgh B, Slaunwhite AK, Crabtree A, Buxton JA. Factors associated with obtaining prescribed safer supply among people accessing harm reduction services: findings from a cross-sectional survey. Harm Reduct J 2024; 21:5. [PMID: 38184576 PMCID: PMC10771687 DOI: 10.1186/s12954-024-00928-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/03/2024] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND With growing rates of unregulated drug toxicity death and concerns regarding COVID-19 transmission among people who use drugs, in March 2020, prescribed safer supply guidance was released in British Columbia. This study describes demographic and substance use characteristics associated with obtaining prescribed safer supply and examines the association between last 6-month harm reduction service access and obtaining prescribed safer supply. METHODS Data come from the 2021 Harm Reduction Client Survey administered at 17 harm reduction sites across British Columbia. The sample included all who self-reported use of opioids, stimulants, or benzodiazepines in the prior 3 days (N = 491), given active use of these drugs was a requirement for eligibility for prescribed safer supply. The dependent variable was obtaining a prescribed safer supply prescription (Yes vs. No). The primary independent variables were access to drug checking services and access to overdose prevention services in the last 6 months (Yes vs. No). Descriptive statistics (Chi-square tests) were used to compare the characteristics of people who did and did not obtain a prescribed safer supply prescription. Multivariable logistic regression models were run to examine the association of drug checking services and overdose prevention services access with obtaining prescribed safer supply. RESULTS A small proportion (n = 81(16.5%)) of the sample obtained prescribed safer supply. After adjusting for gender, age, and urbanicity, people who reported drug checking services access in the last 6 months had 1.67 (95% CI 1.00-2.79) times the odds of obtaining prescribed safer supply compared to people who had not contacted these services, and people who reported last 6 months of overdose prevention services access had more than twice the odds (OR 2.08 (95% CI 1.20-3.60)) of prescribed safer supply access, compared to people who did not access these services. CONCLUSIONS Overall, the proportion of respondents who received prescribed safer supply was low, suggesting that this intervention is not reaching all those in need. Harm reduction services may serve as a point of contact for referral to prescribed safer supply. Additional outreach strategies and service models are needed to improve the accessibility of harm reduction services and of prescribed safer supply in British Columbia.
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Affiliation(s)
- Heather Palis
- Department of Psychiatry, University of British Columbia, 255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.
| | - Beth Haywood
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Jenny McDougall
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
- Coalition of Substance Users of the North (CSUN), Quesnel, Canada
| | - Chloé G Xavier
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Roshni Desai
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Samuel Tobias
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Heather Burgess
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
- Public Health Agency of Canada, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Max Ferguson
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Lisa Liu
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Brooke Kinniburgh
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Amanda K Slaunwhite
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Alexis Crabtree
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Jane A Buxton
- Department of Psychiatry, University of British Columbia, 255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
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3
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Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
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Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
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4
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Ballard AM, Falk D, Greenwood H, Gugerty P, Feinberg J, Friedmann PD, Go VF, Jenkins WD, Korthuis PT, Miller WC, Pho MT, Seal DW, Smith GS, Stopka TJ, Westergaard RP, Zule WA, Young AM, Cooper HLF. Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis. Harm Reduct J 2023; 20:157. [PMID: 37880724 PMCID: PMC10601138 DOI: 10.1186/s12954-023-00892-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Research conducted in urban areas has highlighted the impact of housing instability on people who inject drugs (PWID), revealing that it exacerbates vulnerability to drug-related harms and impedes syringe service program (SSP) use. However, few studies have explored the effects of houselessness on SSP use among rural PWID. This study examines the relationship between houselessness and SSP utilization among PWID in eight rural areas across 10 states. METHODS PWID were recruited using respondent-driven sampling for a cross-sectional survey that queried self-reported drug use and SSP utilization in the prior 30 days, houselessness in the prior 6 months and sociodemographic characteristics. Using binomial logistic regression, we examined the relationship between experiencing houselessness and any SSP use. To assess the relationship between houselessness and the frequency of SSP use, we conducted multinomial logistic regression analyses among participants reporting any past 30-day SSP use. RESULTS Among 2394 rural PWID, 56.5% had experienced houselessness in the prior 6 months, and 43.5% reported past 30-day SSP use. PWID who had experienced houselessness were more likely to report using an SSP compared to their housed counterparts (adjusted odds ratio [aOR] = 1.24 [95% confidence intervals [CI] 1.01, 1.52]). Among those who had used an SSP at least once (n = 972), those who experienced houselessness were just as likely to report SSP use two (aOR = 0.90 [95% CI 0.60, 1.36]) and three times (aOR = 1.18 [95% CI 0.77, 1.98]) compared to once. However, they were less likely to visit an SSP four or more times compared to once in the prior 30 days (aOR = 0.59 [95% CI 0.40, 0.85]). CONCLUSION This study provides evidence that rural PWID who experience houselessness utilize SSPs at similar or higher rates as their housed counterparts. However, housing instability may pose barriers to more frequent SSP use. These findings are significant as people who experience houselessness are at increased risk for drug-related harms and encounter additional challenges when attempting to access SSPs.
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Affiliation(s)
- April M Ballard
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
- School of Public Health, Georgia State University, 140 Decatur Street SE, Atlanta, GA, 30303, USA.
| | - Dylan Falk
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Harris Greenwood
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Paige Gugerty
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Judith Feinberg
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Peter D Friedmann
- Office of Research, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Vivian F Go
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wiley D Jenkins
- School of Medicine, Southern Illinois University, Carbondale, IL, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - William C Miller
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mai T Pho
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - David W Seal
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Gordon S Smith
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Ryan P Westergaard
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - April M Young
- College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY, 40536, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
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5
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MacIsaac MB, Whitton B, Hubble A, Cogger S, Penn M, Weeks A, Elmore K, Pemberton D, Anderson J, Howard R, McKeever U, Papaluca T, Hellard ME, Stoove M, Wilson D, Pedrana A, Doyle J, Clark N, Holmes J, Thompson AJ. Eliminating hepatitis C in Australia: a novel model of hepatitis C testing and treatment for people who inject drugs at a medically supervised injecting facility. Med J Aust 2023; 218:256-261. [PMID: 36919230 DOI: 10.5694/mja2.51885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To evaluate the feasibility of testing and treating people who inject drugs at a supervised injecting facility for hepatitis C virus (HCV) infection. DESIGN Retrospective cohort study. SETTING, PARTICIPANTS People who inject drugs who attended the Melbourne supervised injecting facility, 30 June 2018 - 30 June 2020. MAIN OUTCOME MEASURES Proportion of people tested for hepatitis C; proportions of people positive for anti-HCV antibody and HCV RNA, and of eligible people prescribed direct-acting antiviral (DAA) treatment; sustained virological response twelve weeks or more after treatment completion. RESULTS Of 4649 people who attended the supervised injecting facility during 2018-20, 321 were tested for hepatitis C (7%); 279 were anti-HCV antibody-positive (87%), of whom 143 (51%) were also HCV RNA-positive. Sixty-four of 321 had previously been treated for hepatitis C (20%), 21 had clinically identified cirrhosis (7%), eight had hepatitis B infections (2%), and four had human immunodeficiency virus infections (1%). In multivariate analyses, people tested for hepatitis C were more likely than untested clients to report psychiatric illness (adjusted odds ratio [aOR], 9.65; 95% confidence interval [CI], 7.26-12.8), not have a fixed address (aOR, 1.59; 95% CI, 1.18-2.14), and to report significant alcohol use (aOR, 1.57; 95% CI, 1.06-2.32). The median number of injecting facility visits was larger for those tested for hepatitis C (101; interquartile range [IQR], 31-236) than for those not tested (20; IQR, 3-90). DAA treatment was prescribed for 126 of 143 HCV RNA-positive clients (88%); 41 of 54 with complete follow-up data were cured (76%). CONCLUSIONS People who attend supervised injecting facilities can be tested and treated for hepatitis C on site. Models that provide streamlined, convenient hepatitis C care promote engagement with treatment in a group in which the prevalence of hepatitis C is high.
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Affiliation(s)
- Michael B MacIsaac
- St Vincent's Hospital Melbourne, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| | | | | | | | | | | | | | | | | | | | | | - Timothy Papaluca
- St Vincent's Hospital Melbourne, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| | - Margaret E Hellard
- The Burnet Institute, Melbourne, VIC.,Monash University, Melbourne, VIC.,Alfred Health, Melbourne, VIC
| | - Mark Stoove
- The Burnet Institute, Melbourne, VIC.,Monash University, Melbourne, VIC
| | | | - Alisa Pedrana
- The Burnet Institute, Melbourne, VIC.,Monash University, Melbourne, VIC
| | - Joseph Doyle
- The Burnet Institute, Melbourne, VIC.,Alfred Health, Melbourne, VIC
| | - Nico Clark
- North Richmond Community Health, Melbourne, VIC.,The Royal Melbourne Hospital, Melbourne, VIC
| | - Jacinta Holmes
- St Vincent's Hospital Melbourne, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| | - Alexander J Thompson
- St Vincent's Hospital Melbourne, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
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6
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Batty EJ, Ibragimov U, Fadanelli M, Gross S, Cooper K, Klein E, Ballard AM, Young AM, Lockard AS, Oser CB, Cooper HLF. A qualitative analysis of rural syringe service program fidelity in Appalachian Kentucky: Staff and participant perspectives. J Rural Health 2023; 39:328-337. [PMID: 36117151 PMCID: PMC10484119 DOI: 10.1111/jrh.12715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE As drug-related epidemics have expanded from cities to rural areas, syringe service programs (SSPs) and other harm reduction programs have been slow to follow. The recent implementation of SSPs in rural areas demands attention to program fidelity based on core components of SSP success. METHODS Semistructured interviews conducted with clients and staff at 5 SSPs in 5 counties within 2 Central Appalachian health districts. Interviews covered fidelity of SSP implementation to 6 core components: (1) meet needs for harm reduction supplies; (2) education and counseling for sexual, injection, and overdose risks; (3) cooperation between SSPs and local law enforcement; (4) provide other health and social services; (5) ensure low threshold access to services; and (6) promote dignity, the impact of poor fidelity on vulnerability to drug-related harms, and the risk environment's influence on program fidelity. We applied thematic methods to analyze the data. FINDINGS Rural SSPs were mostly faithful to the 6 core components. Deviations from core components can be attributed to certain characteristics of the local rural risk environment outlined in the risk environment model, including geographic remoteness, lack of resources and underdeveloped infrastructure, and stigma against people who inject drugs (PWID) CONCLUSIONS: As drug-related epidemics continue to expand outside cities, scaling up SSPs to serve rural PWID is essential. Future research should explore whether the risk environment features identified also influence SSP fidelity in other rural areas and develop and test strategies to strengthen core components in these vulnerable areas.
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Affiliation(s)
- E J Batty
- Department of Sociology, University of Kentucky, Lexington, Kentucky, USA
| | - U Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - M Fadanelli
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - S Gross
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - K Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - E Klein
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - A M Ballard
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - A M Young
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - A S Lockard
- Kentucky River District Health Department, Hazard, Kentucky, USA
| | - C B Oser
- Department of Sociology, University of Kentucky, Lexington, Kentucky, USA
| | - H L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
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7
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Abstract
Although many of the tenets of harm reduction have been around for centuries and more traditional harm reduction services such as syringe services programs have been in existence for decades, there has been a recent increase in interest and acceptance of harm reduction as an essential component of a public health approach to substance use. This article provides an overview of harm reduction and its application to alcohol, tobacco, and drug use. It discusses the importance of integrating harm reduction principles and services with traditional psychiatric, medical, and addiction treatment programs.
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Affiliation(s)
- Avinash Ramprashad
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 701 W Pratt St, 2nd Floor Suite 289, Baltimore, MD 21201, USA
| | - Gregory Malik Burnett
- Center for Addiction Medicine, University of Maryland Midtown Campus, 827 Linden Avenue 4th Floor, Suite 405, Baltimore MD 21201 USA; Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 22 S. Greene Street S-1-D-04, Baltimore, MD 21201, USA.
| | - Christopher Welsh
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 22 S. Greene Street S-1-D-04, Baltimore, MD 21201, USA
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8
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Armoon B, Griffiths MD, Bayani A, Mohammadi R, Ahounbar E. Prevalence and associates of non-fatal overdose among people who inject drugs in Saveh, Iran. Addict Sci Clin Pract 2022; 17:42. [PMID: 35927753 PMCID: PMC9351099 DOI: 10.1186/s13722-022-00325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background As a public health issue, non-fatal overdose (NFOD) is highly prevalent among people who inject drugs (PWID). This can lead to an elevated risk of future overdose, causing various harms including possible death. It is essential to improve knowledge concerning this problem and its associated risk factors to inform overdose prevention and assistance programs. The primary aim of the present study was to determine the prevalence of NFOD and associated risk factors among PWID in Saveh, Iran. Methods In the present cross-sectional study, 272 PWID living in Saveh, Iran were interviewed face-to-face using a structured survey. Data concerning socio-demographics, substance use, risky behaviors, and services utilization data were collected. The outcome variable (i.e., NFOD) was assessed by answering “Yes” to the question: “In the past three months, have you ever overdosed (at least once) by accident?” Results The prevalence of NFOD among PWID in the past three months was 54%. The characteristics and behaviors that were associated with an increased risk of experiencing NFOD in the past three months were being of older age (AOR = 5.2, p < 0.05), drug use initiation under the age of 22 years (AOR = 7.8, p < 0.05), being an alcohol user (AOR = 3.0, p < 0.05), and being a simultaneous multiple drug user (AOR = 5.8, p < 0.05). Also, more recent initiates to injecting (< 2 years) had an increased risk of experiencing a non-fatal overdose in the past three months. Findings also indicated that those who (i) attended a needle and syringe program (AOR: 0.3, p < 0.05), (ii) were visited by a general practitioner (AOR: 0.03, p < 0.05), and (iii) received a psychosocial intervention (AOR: 0.1, p < 0.05) were 0.3, 0.03 and 0.1 times less likely to report non-fatal overdosing than other participants, respectively. Conclusions The results indicate that intervention and prevention initiatives seeking to reduce NFOD among PWID should not only be focused on the primary drug used but also the use of alcohol and polysubstance use. Specific and tailored psychological interventions combined with pharmacotherapy may be highly beneficial for PWID who experience more severe types of substance use, including alcohol use disorders and/or polysubstance abuse.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran. .,School of Nursing and Midwifery, Saveh University of Medical Sciences, Shahid Beheshti Blvd, Shahid Fahmideh Blvd, 4th floor, Saveh, Markazi Province, Iran.
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.,Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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9
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Tran V, Reid SE, Roxburgh A, Day CA. Assessing Drug Consumption Rooms and Longer Term (5 Year) Impacts on Community and Clients. Risk Manag Healthc Policy 2021; 14:4639-4647. [PMID: 34815725 PMCID: PMC8604650 DOI: 10.2147/rmhp.s244720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) provide a safe environment in which people who inject drugs (PWIDs) can inject under hygienic and supervised conditions. Numerous reviews have documented the benefits of these facilities; however, there is a lack of clarity surrounding their long-term effects. PURPOSE To conduct, with a systematic approach, a literature review, of published peer-reviewed literature assessing the long-term impacts of DCRs/SIFs. METHODS A systematic search of the PubMed and Embase database was performed using the keywords: ("SUPERVISED" OR "SAFE*") AND ("CONSUMPTION" OR "INJECT*" OR "SHOOTING") AND ("FACILITY*" OR "ROOM*" OR "GALLERY*" OR "CENTRE*" OR "CENTER*" OR "SITE*"). Included studies were original articles reporting outcomes for five or more years and addressed at least one of the following client or community outcomes; (i) drug-related harms; (ii) access to substance use treatment and other health services; (iii) impact on local PWID population; (iv) impact on public drug use, drug-related crime and violence; and (v) local community attitudes to DCRs. RESULTS Four publications met our inclusion criteria, addressing four of the five outcomes. Long-term data suggested that while the health of PWID naturally declined over time, DCRs/SIFs helped reduce injecting-related harms. The studies showed that DCRs/SIFs facilitate drug treatment, access to health services and cessation of drug injecting. Local residents and business owners reported less public drug use and public syringe disposal following the opening of a DCR/SIF. CONCLUSION Long-term evidence on DCRs/SIFs is consistent with established short-term research demonstrating the benefits of these facilities. A relative paucity of studies was identified, with most evidence originating from Sydney and Vancouver. The overall body of evidence would be improved by future studies following outcomes over longer periods and being undertaken in a variety of jurisdictions and models of DCRs/SIFs.
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Affiliation(s)
- Vincent Tran
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon E Reid
- Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Roxburgh
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
- National Drug and Alcohol Research Centre, UNSW, Randwick, New South Wales, Australia
- Monash Addiction Research Centre, Monash University, Clayton, Victoria, Australia
| | - Carolyn A Day
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, New South Wales, Australia
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10
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Whiteside B, Dunn M. The print media's construction of the 'drug problem' in Victorian newspapers: The case of North Richmond Community Health's medically supervised injecting room. Drug Alcohol Rev 2021; 41:818-829. [PMID: 34674323 DOI: 10.1111/dar.13392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The media's influence on policy has been widely documented. This study sought to investigate how Melbourne's medically supervised injecting room (MSIR) was represented in the print media. METHODS A qualitative discourse analysis of Victorian print media (n = 441 items) representation of MSIR was conducted. Constructivist Grounded Theory guided the sampling strategy and coding while the discourse analysis was informed by Bacchi's approach to policy analysis, 'What's the problem represented to be?'. Print news media was gathered from Factiva and Newsbank databases from January 2016 to June 2020. RESULTS The media's representation of the 'drug problem' of overdose was identified by a range of actors in support and opposition of the facility. In attributing the concept of 'drug use' to the 'drug problem' items most frequently suggest it is the 'choice' of the individual to inject illicit drugs. The voices of people who inject drugs (PWID) were largely silenced in the print news media and to re-conceptualise the 'drug problem' to be a 'health problem' would aid in the support for the harm reduction strategy. The research highlighted 'dividing practices' (residents vs. PWID) and the portrayal of PWID that translate to the lived effects of PWID. DISCUSSION AND CONCLUSIONS The print news media did not directly influence the establishment of the Melbourne MSIR. However, the representation of PWID in the print media must be further investigated for the successful establishment of future harm reduction strategies.
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Affiliation(s)
- Bianca Whiteside
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Matthew Dunn
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
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11
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Macias-Konstantopoulos W, Heins A, Sachs CJ, Whiteman PJ, Wingkun NJG, Riviello RJ. Between Emergency Department Visits: The Role of Harm Reduction Programs in Mitigating the Harms Associated With Injection Drug Use. Ann Emerg Med 2021; 77:479-492. [PMID: 33579588 DOI: 10.1016/j.annemergmed.2020.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/05/2020] [Accepted: 11/12/2020] [Indexed: 01/29/2023]
Abstract
Injection drug use is a major public health problem in the United States. Cocaine, heroin, and methamphetamine are the most commonly injected illicit drugs, whereas opioids are responsible for the majority of overdose fatalities. Although recent emergency department (ED) efforts have focused on expanding capacity for buprenorphine induction for opioid use disorder treatment, the injection of illicit drugs carries specific health risks that require acknowledgment and management, particularly for patients who decline substance use treatment. Harm reduction is a public health approach that aims to reduce the harms associated with a health risk behavior, short of eliminating the behavior itself. Harm-reduction strategies fundamental to emergency medicine include naloxone distribution for opioid overdose. This clinical Review Article examines the specific health complications of injection drug use and reviews the evidence base for 2 interventions effective in reducing morbidity and mortality related to drug injection, irrespective of the specific drug used, that are less well known and infrequently leveraged by emergency medicine clinicians: syringe service programs and supervised injection facilities. In accordance with the recommendations of health authorities such as the Centers for Disease Control and Prevention, emergency clinicians can promote the use of harm-reduction programs in the community to reduce viral transmission and other risks of injection drug use by providing patients with information about and referrals to these programs after injection drug use-related ED visits.
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Affiliation(s)
| | - Alan Heins
- Department of Emergency Medicine, University of South Alabama College of Medicine, Mobile, AL
| | - Carolyn J Sachs
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Paula J Whiteman
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Neil-Jeremy G Wingkun
- Department of Emergency Medicine, University of Texas MD Anderson Cancer Center and Houston Methodist Hospital, Houston, TX
| | - Ralph J Riviello
- Department of Emergency Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX
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12
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Noroozi M, Higgs P, Bayani A, Armoon B, Astaneh AN, Moghaddam LF, Askari M. Non -fatal overdose among people who inject drugs in Tehran, Iran. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:80. [PMID: 33054806 PMCID: PMC7559998 DOI: 10.1186/s13011-020-00323-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND With increasing frequencies of non-fatal overdose in people who inject drugs (PWID), it is essential to improve our knowledge about associated risk factors for overdose to inform overdose prevention and assistance programs. The aim of present study was to determine the prevalence of non-fatal overdose and the associated risk factors among PWID in Tehran, Iran. METHODS Snowball sampling was used to collect data from 465 participants in Tehran using a cross-sectional survey. Consenting participants who reported drug injecting in the past month and were able to speak and comprehend Farsi enough to respond to survey questions were interviewed. The endpoint of interest was non-fatal overdose in the previous 6 months, or answering "Yes" to the question: "In the last six months, have you ever overdosed by accident? (at least once)". We used STATA v. 14 for this analysis. Statistical significance was defined as p < 0.05 for all analyses. RESULTS Of 465 PWIDs who participated in this study, all were male, and about half had less than a high school education. The prevalence of self-reported non-fatal overdose in the past 6 months was 38% (CI95%: 34, 43%). Our findings indicate that characteristics and behaviors that were associated with an increased risk of experiencing an overdose in the past 6 months were drug use initiation under 22 years (AOR =2.2, P < 0.05), using methamphetamine (AOR =2.8, P < 0.05), and using multiple drugs at the same time (AOR =2.1, P < 0.05). Also, more recent initiates to injecting (< 2 years) had an increased risk of experiencing an overdose in the past 6 months. The odds of experiencing a non-fatal overdose among PWIDs who regularly attended NSP were 0.6 times less than for those who did not attend regularly (OR = 0.6,95% CI: 0.2-0.9). CONCLUSION Methamphetamine and alcohol use were the most significant association for non-fatal overdose among PWIDs. Our results indicate that intervention and prevention initiatives seeking to reduce overdoses among PWIDs should not only be focused on the primary drug used but also the use of alcohol and poly-drug use.
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Affiliation(s)
- Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
| | - Ali Nazeri Astaneh
- Department of Psychiatry, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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13
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Packer S, Pichon B, Thompson S, Neale J, Njoroge J, Kwiatkowska RM, Oliver I, Telfer M, Doumith M, Buunaaisie C, Heinsbroek E, Hopewell-Kelly N, Desai M, Hope V, Williams OM, Kearns A, Hickman M, Gobin M. Clonal expansion of community-associated meticillin-resistant Staphylococcus aureus (MRSA) in people who inject drugs (PWID): prevalence, risk factors and molecular epidemiology, Bristol, United Kingdom, 2012 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 30940316 PMCID: PMC6446509 DOI: 10.2807/1560-7917.es.2019.24.13.1800124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: In 2015, Bristol (South West England) experienced a large increase in cases of meticillin-resistant Staphylococcus aureus (MRSA) infection in people who inject drugs (PWID). Aim: We aimed to characterise and estimate the prevalence of MRSA colonisation among PWID in Bristol and test evidence of a clonal outbreak. Methods: PWID recruited through an unlinked-anonymous community survey during 2016 completed behavioural questionnaires and were screened for MRSA. Univariable logistic regression examined associations with MRSA colonisation. Whole-genome sequencing used lineage-matched MRSA isolates, comparing PWID (screening and retrospective bacteraemia samples from 2012-2017) with non-PWID (Bristol screening) in Bristol and national reference laboratory database samples. Results: The MRSA colonisation prevalence was 8.7% (13/149) and was associated with frequently injecting in public places (odds ratio (OR): 5.5; 95% confidence interval (CI):1.34–22.70), recent healthcare contact (OR: 4.3; 95% CI: 1.34–13.80) and injecting in groups of three or more (OR: 15.8; 95% CI: 2.51–99.28). People reporting any one of: injecting in public places, injection site skin and soft tissue infection or hospital contact accounted for 12/13 MRSA positive cases (sensitivity 92.3%; specificity 51.5%). Phylogenetic analysis identified a dominant clade associated with infection and colonisation among PWID in Bristol belonging to ST5-SCCmecIVg. Conclusions: MRSA colonisation in Bristol PWID is substantially elevated compared with general population estimates and there is evidence of clonal expansion, community-based transmission and increased infection risk related to the colonising strain. Targeted interventions, including community screening and suppression therapy, education and basic infection control are needed to reduce MRSA infections in PWID.
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Affiliation(s)
- Simon Packer
- Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | - Bruno Pichon
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Stephen Thompson
- Public health laboratory Bristol, Public Health England, Bristol, United Kingdom
| | - Jane Neale
- Bristol Drugs Project, Bristol, United Kingdom
| | - Jacquelyn Njoroge
- Blood Borne Virus Section, HIV & STI Department, National Infection Service, Public Health England, London, United Kingdom
| | - Rachel M Kwiatkowska
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, United Kingdom.,Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | - Isabel Oliver
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, United Kingdom.,Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | | | - Michel Doumith
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | | | - Ellen Heinsbroek
- Blood Borne Virus Section, HIV & STI Department, National Infection Service, Public Health England, London, United Kingdom
| | | | - Monica Desai
- Blood Borne Virus Section, HIV & STI Department, National Infection Service, Public Health England, London, United Kingdom
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom.,Blood Borne Virus Section, HIV & STI Department, National Infection Service, Public Health England, London, United Kingdom
| | - Owen Martin Williams
- Public health laboratory Bristol, Public Health England, Bristol, United Kingdom
| | - Angela Kearns
- Authors contributed equally to the work and share last authorship.,Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Mathew Hickman
- Authors contributed equally to the work and share last authorship.,School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.,NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, United Kingdom
| | - Maya Gobin
- Authors contributed equally to the work and share last authorship.,Field Epidemiology Service, Public Health England, Bristol, United Kingdom
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14
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Maisa A, Semple S, Griffiths A, Ngui SL, Verlander NQ, McCaughey C, Doherty L, Jessop L. Risk behaviours of homeless people who inject drugs during an outbreak of hepatitis C, Northern Ireland, 2016-2017. J Viral Hepat 2019; 26:1377-1387. [PMID: 31328838 DOI: 10.1111/jvh.13184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/25/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022]
Abstract
From July to August 2016, 4 homeless people who injected drugs (PWID) with acute or recent hepatitis C virus (HCV) infection were reported in Belfast. A multidisciplinary team including public health, homeless and addiction services undertook an investigation to identify risk behaviours and interrupt transmission chains. Recent HCV cases were defined as negative test within the previous year, or reported injecting for less than 1 year; acute cases had tested negative within the previous 6 months. Contacts in the injecting networks of cases were identified for testing. We undertook a cross-sectional survey using structured questionnaires to elicit risk behaviours for PWID and compare behaviours between self-reported hepatitis C positive and negative subjects. During the outbreak investigation until December 2017, 156 PWID were tested and 45 (29%) cases identified, including 7 (16%) recent and 13 (29%) acute infections. 68 PWID, including 12 cases, were interviewed. All respondents reported using heroin, with 76% injecting once or more daily. Sharing was reported for spoons (58%) and filters (53%), but also needles (27%) and syringes (29%). Hepatitis C positive individuals had higher odds to be injecting in public toilets (AOR 17, 95% CI 0.71-400, P < .05) when compared with hepatitis C negative individuals. Hepatitis C positive individuals were more likely to inject in public spaces, but all respondents indicated concerning risk behaviours. We recommend active surveillance with ongoing testing, expanding existing harm reduction programmes and access to bespoke services.
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Affiliation(s)
- Anna Maisa
- Public Health Agency, Health Protection Service Northern Ireland, Belfast, Northern Ireland.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Susan Semple
- Homeless Public Health Nursing Service, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Alison Griffiths
- Public Health Agency, Health Protection Service Northern Ireland, Belfast, Northern Ireland
| | - Siew Lin Ngui
- Virus Reference Department, National Infection Service, Public Health England, Colindale, London, UK
| | - Neville Q Verlander
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Conall McCaughey
- Regional Virus Laboratory, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Lorraine Doherty
- Public Health Agency, Health Protection Service Northern Ireland, Belfast, Northern Ireland
| | - Lucy Jessop
- Public Health Agency, Health Protection Service Northern Ireland, Belfast, Northern Ireland
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15
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Smith P, Favril L, Delhauteur D, Vander Laenen F, Nicaise P. How to overcome political and legal barriers to the implementation of a drug consumption room: an application of the policy agenda framework to the Belgian situation. Addict Sci Clin Pract 2019; 14:40. [PMID: 31672169 PMCID: PMC6823966 DOI: 10.1186/s13722-019-0169-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For more than 30 years, drug consumption rooms (DCRs) have been implemented in Western countries. DCRs are supported by a large body of evidence about public safety and public health effectiveness. However, a political consensus has never been achieved in Belgium on amending the existing law that explicitly penalises the supply of a room for facilitating drug use. Despite this adverse legal and policy framework, a DCR opened in the city of Liège in 2018. In this case report, we applied the theoretical framework proposed by Shiffman and Smith for policy agenda setting, in order to describe and assess how political and legal barriers were overcome in the process of opening the DCR. CASE PRESENTATION For some years, fieldworkers and some city policymakers argued for DCR implementation in Belgium, but without gaining the support of the national authorities, mainly for ideological reasons. In order to address this debate, a feasibility study of DCR implementation in Belgian cities was commissioned. At the national level, an institutional debate took place about the political responsibility for DCRs as a public health intervention, as health care is mainly a matter of regional policy. The lack of consensus led to a situation of political deadlock. Meanwhile, the publication of the study report and the context of local elections offered an opportunity for Liège authorities to reignite the local debate on DCRs. At the local level, law enforcement, care professionals, residents, users, and the press were all involved in the implementation process. Therefore, a local consensus was formed and despite the absence of any national legal change, the DCR opened 1 month before the local elections. It has been working without major medical or legal incident since then. Incidentally, the mayor of Liège was re-elected. CONCLUSIONS Although the lack of a legal framework may engender instability and affect longer-term effectiveness, the DCR implementation in Liège was successful and was based on a local consensus and effective communication rather than on an appropriate legal framework. The experience provides lessons for other cities that are considering opening a DCR despite an adverse legal and political context.
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Affiliation(s)
- Pierre Smith
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30, 1200, Brussels, Belgium.
| | - Louis Favril
- Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | | | - Freya Vander Laenen
- Institute for International Research on Criminal Policy (IRCP), Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30, 1200, Brussels, Belgium
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16
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Belackova V, Salmon AM, Day CA, Ritter A, Shanahan M, Hedrich D, Kerr T, Jauncey M. Drug consumption rooms: A systematic review of evaluation methodologies. Drug Alcohol Rev 2019; 38:406-422. [PMID: 30938025 DOI: 10.1111/dar.12919] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 01/27/2023]
Abstract
ISSUES Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. APPROACH Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded. KEY FINDINGS Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on blood-borne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'. IMPLICATIONS Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities. CONCLUSIONS Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted.
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Affiliation(s)
| | - Allison M Salmon
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Carolyn A Day
- Central Clinical School, Addiction Medicine, University of Sydney, Royal Prince Albert Hospital, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, UNSW Sydney, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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17
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Overdose mortality rates in Croatia and factors associated with self-reported drug overdose among persons who inject drugs in three Croatian cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 64:95-102. [PMID: 30641451 DOI: 10.1016/j.drugpo.2018.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 10/21/2018] [Accepted: 11/26/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Drug overdose is the major cause of morbidity and mortality among persons who inject drugs (PWID). We assessed factors associated with the non-fatal drug overdose among PWID in three Croatian cities and national trends of overdose-related mortality (OM), and rates of uptake of opioid agonist drug treatment (OAT). METHODS We used a respondent-driven sampling method to recruit 830 PWID in Zagreb, Split and Rijeka in 2014/2015. Participants completed behavioural questionnaires that included questions about overdose history, and we used Poisson regression to assess factors associated with self-reported overdose. We used joinpoint regression to calculate national trends of OM from 2001 to 2015 and rates of uptake of drug treatment from 2005 to 2015. RESULTS Lifetime prevalence of self-reported drug overdose in our RDS sample was 45.2%, while 4.1% of PWID reported overdose in the past 12 months; PWID who injected more than one type of drug in the past 12 months (adjusted prevalence ratio [aPR] = 4.56, 95% confidence intervals [CI] = 1.35-15.38) compared to injecting only heroin, and those enrolled in OAT (aPR = 1.94, 95% CI = 1.01-3.74) were more likely to report overdose in the past 12 months. We observed an increase in annual percent change (APC) of the national OM rates from 2001 to 2007 (APC = 22.5%, 95% CI = 16.3-29.0) and a decline from 2007 to 2015 (APC = -8.0%, 95% CI = -5.3- -10.5). The national rates of drug treatment enrollment increased from 2005 to 2010 (APC = 12.0%, 95% CI = 10.3-13.8), mostly due to increase in provision of buprenorphine from 2005 to 2008 (APC = 130.4%, 95% CI = 102.1-162.7). CONCLUSION Injecting more than one type of drugs and enrollment in OAT while still injecting drugs was positively associated with non-fatal overdose in our sample. To further reduce OM in Croatia we suggest improvements in coverage and delivery of OAT and establishment of provision of naloxone for PWID.
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18
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Mittal ML, Guise A, Rafful C, Gonzalez-Zuñiga P, Davidson P, Vashishtha D, Strathdee SA, Werb D. "Another Person Was Going to Do It": The Provision of Injection Drug Use Initiation Assistance in a High-Risk U.S.-Mexico Border Region. Subst Use Misuse 2019; 54:2338-2350. [PMID: 31389282 PMCID: PMC6883155 DOI: 10.1080/10826084.2019.1648514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Persons who inject drugs (PWID) play a key role in assisting others' initiation into injection drug use (IDU). We aimed to explore the pathways and socio-structural contexts for this phenomenon in Tijuana, Mexico, a border setting marked by a large PWID population with limited access to health and social services. Methods: Preventing Injecting by Modifying Existing Responses (PRIMER) is a multi-cohort study assessing socio-structural factors associated with PWID assisting others into initiating IDU. Semi-structured qualitative interviews in Tijuana included participants ≥18 years old, who reported IDU within the month prior to cohort enrollment and ever initiating others into IDU. Purposive sampling ensured a range of drug use experiences and behaviors related to injection initiation assistance. Thematic analysis was used to develop recurring and significant data categories. Results: Twenty-one participants were interviewed (8 women, 13 men). Broadly, participants considered public injection to increase curiosity about IDU. Many considered transitioning into IDU as inevitable. Emergent themes included providing assistance to mitigate overdose risk and to protect initiates from being taken advantage of by others. Participants described reluctance in engaging in this process. For some, access to resources (e.g., shared drugs or a monetary fee) was a motivator to initiate others. Conclusion: In Tijuana, public injection and a lack of harm reduction services are perceived to fuel the incidence of IDU initiation and to incentivize PWID to assist in injection initiation. IDU prevention efforts should address structural factors driving PWID participation in IDU initiation while including PWID in their development and implementation.
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Affiliation(s)
- Maria L Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Facultad de Medicina, Universidad Xochicalco, Tijuana, Mexico
| | - Andrew Guise
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Division of Health and Social Care Research, King's College, London, UK
| | - Claudia Rafful
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
| | - Patricia Gonzalez-Zuñiga
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Peter Davidson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Devesh Vashishtha
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
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19
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Belackova V, Salmon AM, Schatz E, Jauncey M. Drug consumption rooms (DCRs) as a setting to address hepatitis C - findings from an international online survey. HEPATOLOGY, MEDICINE AND POLICY 2018; 3:9. [PMID: 30288332 PMCID: PMC6103962 DOI: 10.1186/s41124-018-0035-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 07/27/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prevalence of Hepatitis C Virus (HCV) among people who inject drugs (PWID) is high. Risky injecting behaviours have been found to decrease in drug consumption rooms (DCRs) and supervised injecting facilities (SIFs), yet HCV prevention and treatment in these settings have not been extensively explored. METHODS To determine the range and scope of HCV prevention and treatment options in these services, we assessed DCR/SIF operational features, their clients' characteristics and the HCV-related services they provide. A comprehensive online survey was sent to the managers of the 91 DCRs/SIFs that were operating globally as of September 2016. A descriptive cross-country analysis of the main DCR/SIF characteristics was conducted and bivariate logistic models were used to assess factors associated with enhanced HCV service provision. RESULTS Forty-nine valid responses were retrieved from DCRs/SIFs in all countries where they were established at the time of the survey (Australia, Canada, Denmark, France, Germany, Luxembourg, Netherlands, Norway, Spain and Switzerland). Internationally, the operational capacities of DCRs/SIFs varied in terms of funding, location, size and staffing, but their clients all shared common features of vulnerability and marginalisation. Estimated HCV prevalence rates were around 60%. Among a range of health and social services and referrals to other programs, most DCRs/SIFs provided HCV testing onsite (65%) and/or offered liver monitoring or disease management (54%). HCV treatment onsite was offered or was planned to be offered by 21% of DCRs/SIFs. HCV testing onsite was associated with provision of other services addressing blood-borne diseases and HCV treatment was linked to the provision of OST. HCV disease management was associated with employing a nurse at a DCR/SIF and HCV treatment was associated with employing a medical doctor. CONCLUSIONS DCRs/SIFs offer easy-to-access HCV-related services for PWID. The availability of onsite medical professionals and provision of support and education to non-medical staff are key to enhanced provision of HCV-related services in DCRs/SIFs. Funding and support for HCV treatment at the community level, via low-threshold services such as DCRs/SIFs, are worthy of action.
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Affiliation(s)
- Vendula Belackova
- Uniting Sydney Medically Supervised Injecting Centre (MSIC), Sydney, Australia
| | - Allison M. Salmon
- Uniting Sydney Medically Supervised Injecting Centre (MSIC), Sydney, Australia
| | - Eberhard Schatz
- Correlation network, Foundation De Regenboog Groep, Amsterdam, The Netherlands
| | - Marianne Jauncey
- Uniting Sydney Medically Supervised Injecting Centre (MSIC), Sydney, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW Australia
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20
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Palis H, Marchand K, Karamouzian M, MacDonald S, Harrison S, Guh D, Lock K, Brissette S, Anis AH, Krausz M, Marsh DC, Schechter MT, Oviedo-Joekes E. The association between nicotine dependence and physical health among people receiving injectable diacetylmorphine or hydromorphone for the treatment of chronic opioid use disorder. Addict Behav Rep 2018; 7:82-89. [PMID: 29892701 PMCID: PMC5993889 DOI: 10.1016/j.abrep.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 03/25/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION People with chronic opioid use disorder often present to treatment with individual and structural vulnerabilities and remain at risk of reporting adverse health outcomes. This risk is greatly compounded by tobacco smoking, which is highly prevalent among people with chronic opioid use disorder. Despite the known burden of tobacco smoking on health, the relationship between nicotine dependence and health has not been studied among those receiving injectable opioid agonist treatment. As such, the present study aims to explore the association between nicotine dependence and physical health among participants of the Study to Assess Longer-Term Opioid Medication Effectiveness (SALOME) at baseline and six-months. METHODS SALOME was a double-blind phase III clinical trial testing the non-inferiority of injectable hydromorphone to injectable diacetylmorphine for chronic opioid use disorder. Participants reporting tobacco smoking were included in a linear regression analysis of physical health at baseline (before receiving treatment) and at six-months. RESULTS At baseline, nicotine dependence score, lifetime history of emotional, physical, or sexual abuse and prior month safe injection site access were independently and significantly associated with physical health. At six-months nicotine dependence score was the only variable that maintained this significant and independent association with physical health. CONCLUSIONS Findings indicate that after six-months, the injectable treatment effectively brought equity to patients' physical health status, yet the association with nicotine dependence remained. Findings could inform whether the provision of treatment for nicotine dependence should be made a priority in settings where injectable opioid agonist treatment is delivered to achieve improvements in overall physical health in this population.
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Affiliation(s)
- Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haft-Bagh Highway, Kerman, Iran
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Daphne Guh
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Kurt Lock
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Suzanne Brissette
- Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, CHUM Montréal, Montréal, QC H2X 3J4, Canada
| | - Aslam H. Anis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - David C. Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada
| | - Martin T. Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
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21
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León C, Cardoso LJP, Johnston S, Mackin S, Bock B, Gaeta JM. Changes in public order after the opening of an overdose monitoring facility for people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:90-95. [PMID: 29294417 DOI: 10.1016/j.drugpo.2017.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/22/2017] [Accepted: 12/08/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND In the face of an increasingly fatal opioid crisis, Boston Health Care for the Homeless Program (BHCHP) opened the Supportive Place for Observation and Treatment (SPOT), a unique low-threshold harm reduction program for monitoring people who have injected drugs and are at imminent risk of overdose. This study examines the impact of the opening of the SPOT program on measures of injection drug-related public order in the neighborhood surrounding the facility. METHODS Data was collected at 10 weeks prior and 12 weeks post SPOT implementation on: number of over-sedated individuals in public, publicly discarded syringes, publicly discarded injection-related litter, and instances of active injection drug use or exchange of drugs. Changes were evaluated using Poisson log-linear regression models. Potential confounders such as weather and police presence were measured and controlled for. RESULTS The average number of over-sedated individuals observed in public significantly decreased by 28% (4.3 [95% Confidence Interval (CI) 2.7-6.9] v 3.1 [CI 1.4-6.8]) after SPOT opened. The opening of SPOT did not have a significant effect on the other measures of public order. The daily average number of publicly discarded syringes (28.5 [CI 24.5-33.1] v 28.4 [CI 22.0-36.5]), pieces of publicly discarded injection-related litter (376.3 [CI 358.6-394.8] v 375.0 [CI 345.8-406.6]), and observed instances of active use or exchange of drugs (0.2 [CI 0.1-0.9] v 0.1 [CI 0.0-0.1]) were not statistically significantly different after the opening of SPOT. CONCLUSIONS The opening of SPOT was associated with a significant decrease in observed over-sedated individuals. Other measures of injection-drug related public order did not improve or worsen with the opening of SPOT, however, they have been shown to improve with the implementation of a supervised injection facility.
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Affiliation(s)
- Casey León
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA.
| | - Lena J P Cardoso
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Salem Johnston
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Sarah Mackin
- Boston Public Health Commission, 774 Albany Street, Boston, MA, 02118, USA
| | - Barry Bock
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Jessie M Gaeta
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA; Boston Medical Center, Section of General Internal Medicine, Boston, MA 02118, USA
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León C, Cardoso L, Mackin S, Bock B, Gaeta JM. The willingness of people who inject drugs in Boston to use a supervised injection facility. Subst Abus 2017; 39:95-101. [PMID: 28799847 DOI: 10.1080/08897077.2017.1365804] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND In Massachusetts, the number of opioid-related deaths has increased 350% since 2000. In the setting of increasing overdose deaths, one potential intervention is supervised injection facilities (SIFs). This study explores willingness of people who inject drugs in Boston to use a SIF and examines factors associated with willingness. METHODS A cross-sectional survey of a convenience sample of 237 people who inject drugs and utilize Boston's needle exchange program (NEP). The drop-in NEP provides myriad harm reduction services and referrals to addiction treatment. The survey was mostly self-administered (92%). RESULTS Results showed positive willingness to use a SIF was independently associated with use of heroin as main substance (odds ratio [OR]: 5.47; 95% confidence interval [CI]: 1.9-15.4; P = .0004), public injection (OR: 5.09; 95% CI: 1.8-14.3; P = .002), history of seeking substance use disorder (SUD) treatment (OR: 4.99; 95% CI: 1.2-21.1; P = .05), having heard of SIF (OR: 4.80; 95% CI: 1.6-14.8; P = .004), Hispanic ethnicity (OR: 4.22; 95% CI: 0.9-18.8; P = .04), frequent NEP use (OR: 4.18; 95% CI: 1.2-14.7; P = .02), current desire for SUD treatment (OR: 4.15; 95% CI: 1.2-14.7; P = .03), hepatitis C diagnosis (OR: 3.68; 95% CI: 1.2-10.1; P = .02), posttraumatic stress disorder (PTSD) diagnosis (OR: 3.27; 95% CI: 1.3-8.4; P = .01), report of at least 1 chronic medical diagnosis (hepatitis C, human immunodeficiency virus [HIV], hypertension, or diabetes) (OR: 3.27; 95% CI: 1.2-8.9; P = .02), and comorbid medical and mental health diagnoses (OR: 2.93; 95% CI: 1.2-7.4; P = .02). CONCLUSIONS Most respondents (91.4%) reported willingness to use a SIF. Respondents with substance use behavior reflecting high risk for overdose were significantly more likely to be willing to use a SIF. Respondents with behaviors that contribute to public health burden of injection drug use were also significantly more likely to be willing to use a SIF. Results indicate that this intervention would be well utilized by individuals who could most benefit from the model. As part of a broader public health approach, SIFs should be considered to reduce opioid overdose mortality, decrease public health burden of the opioid crisis, and promote access to addiction treatment and medical care.
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Affiliation(s)
- Casey León
- a Boston Health Care for the Homeless Program , Boston , Massachusetts , USA
| | - Lena Cardoso
- a Boston Health Care for the Homeless Program , Boston , Massachusetts , USA
| | - Sarah Mackin
- b Boston Public Health Commission , Boston , Massachusetts , USA
| | - Barry Bock
- a Boston Health Care for the Homeless Program , Boston , Massachusetts , USA
| | - Jessie M Gaeta
- a Boston Health Care for the Homeless Program , Boston , Massachusetts , USA.,c Section of General Internal Medicine, Boston Medical Center , Boston , Massachusetts , USA
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Davis SM, Daily S, Kristjansson AL, Kelley GA, Zullig K, Baus A, Davidov D, Fisher M. Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis. Harm Reduct J 2017; 14:25. [PMID: 28514954 PMCID: PMC5436422 DOI: 10.1186/s12954-017-0156-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/08/2017] [Indexed: 12/16/2022] Open
Abstract
Background Previous research on the effectiveness of needle exchange programs (NEP) in preventing hepatitis C virus (HCV) in people who inject drugs (PWID) has shown mixed findings. The purpose of this study was to use the meta-analytic approach to examine the association between NEP use and HCV prevention in PWIDs. Methods Study inclusion criteria were (1) observational studies, (2) PWIDs, (3) NEP use, (4) HCV status ascertained by serological testing, (5) studies published in any language since January 1, 1989, and (6) data available for measures of association. Studies were located by searching four electronic databases and cross-referencing. Study quality was assessed using the Newcastle Ottawa (NOS) scale. A ratio measure of association was calculated for each result from cohort or case–control studies and pooled using a random effects model. Odds ratio (OR) and hazard ratio (HR) models were analyzed separately. Results were considered statistically significant if the 95% confidence interval (CI) did not cross 1. Heterogeneity was estimated using Q and I2 with alpha values for Q ≤ 0.10 considered statistically significant. Results Of the 555 citations reviewed, 6 studies containing 2437 participants were included. Studies had an average NOS score of 7 out of 9 (77.8%) stars. Concerns over participant representativeness, unclear adjustments for confounders, and bias from participant nonresponse and loss to follow-up were noted. Results were mixed with the odds ratio model indicating no consistent association (OR, 0.51, 95% CI, 0.05–5.15), and the hazard ratio model indicating a harmful effect (HR, 2.05, 95% CI, 1.39–3.03). Substantial heterogeneity (p ≤ 0.10) and moderate to large inconsistency (I2 ≥ 66%) were observed for both models. Conclusions The impact of NEPs on HCV prevention in PWIDs remains unclear. There is a need for well-designed research studies employing standardized criteria and measurements to clarify this issue. Trial registration PROSPERO CRD42016035315 Electronic supplementary material The online version of this article (doi:10.1186/s12954-017-0156-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen M Davis
- School of Medicine, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9149, Morgantown, WV, 26506-9149, USA.
| | - Shay Daily
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Alfgeir L Kristjansson
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - George A Kelley
- Department of Biostatistics, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Keith Zullig
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Adam Baus
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Danielle Davidov
- School of Medicine, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9149, Morgantown, WV, 26506-9149, USA.,Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Melanie Fisher
- Department of Medicine, Section of Infectious Diseases, West Virginia University, PO Box 9163, Morgantown, WV, 26506, USA
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Irwin A, Jozaghi E, Weir BW, Allen ST, Lindsay A, Sherman SG. Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility. Harm Reduct J 2017; 14:29. [PMID: 28532488 PMCID: PMC5441005 DOI: 10.1186/s12954-017-0153-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/05/2017] [Indexed: 12/14/2022] Open
Abstract
Background In Baltimore, MD, as in many cities throughout the USA, overdose rates are on the rise due to both the increase of prescription opioid abuse and that of fentanyl and other synthetic opioids in the drug market. Supervised injection facilities (SIFs) are a widely implemented public health intervention throughout the world, with 97 existing in 11 countries worldwide. Research has documented the public health, social, and economic benefits of SIFs, yet none exist in the USA. The purpose of this study is to model the health and financial costs and benefits of a hypothetical SIF in Baltimore. Methods We estimate the benefits by utilizing local health data and data on the impact of existing SIFs in models for six outcomes: prevented human immunodeficiency virus transmission, Hepatitis C virus transmission, skin and soft-tissue infection, overdose mortality, and overdose-related medical care and increased medication-assisted treatment for opioid dependence. Results We predict that for an annual cost of $1.8 million, a single SIF would generate $7.8 million in savings, preventing 3.7 HIV infections, 21 Hepatitis C infections, 374 days in the hospital for skin and soft-tissue infection, 5.9 overdose deaths, 108 overdose-related ambulance calls, 78 emergency room visits, and 27 hospitalizations, while bringing 121 additional people into treatment. Conclusions We conclude that a SIF would be both extremely cost-effective and a significant public health and economic benefit to Baltimore City.
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Affiliation(s)
- Amos Irwin
- Law Enforcement Action Partnership, Silver Spring, MD, USA. .,Criminal Justice Policy Foundation, Silver Spring, MD, USA.
| | - Ehsan Jozaghi
- British Columbia Centre for Disease Control, University of British Columbia, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Baltimore, MD, USA
| | - Brian W Weir
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Lindsay
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G Sherman
- Criminal Justice Policy Foundation, Amherst College, Silver Spring, MD, USA
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25
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Bouvier BA, Elston B, Hadland SE, Green TC, Marshall BDL. Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study. Harm Reduct J 2017; 14:13. [PMID: 28219388 PMCID: PMC5319157 DOI: 10.1186/s12954-017-0139-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 02/09/2017] [Indexed: 12/14/2022] Open
Abstract
Background Supervised injection facilities (SIFs) are legally sanctioned environments for people to inject drugs under medical supervision. SIFs currently operate in ten countries, but to date, no SIF has been opened in the USA. In light of increasing overdose mortality in the USA, this study evaluated willingness to use a SIF among youth who report non-medical prescription opioid (NMPO) use. Methods Between January 2015 and February 2016, youth with recent NMPO use were recruited to participate in the Rhode Island Young Adult Prescription Drug Study (RAPiDS). We explored factors associated with willingness to use a SIF among participants who had injected drugs or were at risk of initiating injection drug use (defined as having a sex partner who injects drugs or having a close friend who injects). Results Among 54 eligible participants, the median age was 26 (IQR = 24–28), 70.4% were male, and 74.1% were white. Among all participants, when asked if they would use a SIF, 63.0% answered “Yes”, 31.5% answered “No”, and 5.6% were unsure. Among the 31 participants reporting injection drug use in the last six months, 27 (87.1%) reported willingness to use a SIF; 15 of the 19 (78.9%) who injected less than daily reported willingness, while all 12 (100.0%) of the participants who injected daily reported willingness. Compared to participants who were unwilling or were unsure, participants willing to use a SIF were also more likely to have been homeless in the last six months, have accidentally overdosed, have used heroin, have used fentanyl non-medically, and typically use prescription opioids alone. Conclusions Among young adults who use prescription opioids non-medically and inject drugs or are at risk of initiating injection drug use, more than six in ten reported willingness to use a SIF. Established risk factors for overdose, including homelessness, history of overdose, daily injection drug use, heroin use, and fentanyl misuse, were associated with higher SIF acceptability, indicating that young people at the highest risk of overdose might ultimately be the same individuals to use the facility. Supervised injection facilities merit consideration to reduce overdose mortality in the USA. Electronic supplementary material The online version of this article (doi:10.1186/s12954-017-0139-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin A Bouvier
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Beth Elston
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Scott E Hadland
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Department of Health Policy & Management, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.,Department of Emergency Medicine, Boston University School of Medicine, 771 Albany Street, Room 1208, Boston, MA, 02118, USA.,The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI, 02903, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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Suzuki J, El-Haddad S. A review: Fentanyl and non-pharmaceutical fentanyls. Drug Alcohol Depend 2017; 171:107-116. [PMID: 28068563 DOI: 10.1016/j.drugalcdep.2016.11.033] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fentanyl and non-pharmaceutical fentanyls (NPFs) have been responsible for numerous outbreaks of overdoses all over the United States since the 1970s. However, there has been a growing concern in recent years that NPFs are contributing to an alarming rise in the number of opioid-related overdoses. METHODS The authors conducted a narrative review of the published and grey literature on fentanyl and NPFs in PubMed, Google Scholar, and Google using the following search terms: "fentanyl", "non-pharmaceutical fentanyl", "fentanyl analogs", "fentanyl laced heroin" and "fentanyl overdose". References from relevant publications and grey literature were also reviewed to identify additional citations for inclusion. RESULTS The article reviews the emergence and misuse of fentanyl and NPFs, their clinical pharmacology, and the clinical management and prevention of fentanyl-related overdoses. CONCLUSIONS Fentanyl and NPFs may be contributing to the recent rise in overdose deaths in the United States. There is an urgent need to educate clinicians, researchers, and patients about this public health threat.
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Affiliation(s)
- Joji Suzuki
- Brigham and Women's Hospital, 60 Fenwood Rd., Boston, MA 02115, United States; Brigham and Women's Faulkner Hospital, 1153 Centre St., Boston, MA 02130, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States.
| | - Saria El-Haddad
- Brigham and Women's Hospital, 60 Fenwood Rd., Boston, MA 02115, United States; Brigham and Women's Faulkner Hospital, 1153 Centre St., Boston, MA 02130, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
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Thakarar K, Weinstein ZM, Walley AY. Optimising health and safety of people who inject drugs during transition from acute to outpatient care: narrative review with clinical checklist. Postgrad Med J 2016; 92:356-63. [PMID: 27004476 PMCID: PMC4967553 DOI: 10.1136/postgradmedj-2015-133720] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/29/2016] [Indexed: 12/20/2022]
Abstract
The opioid epidemic in the USA continues to worsen. Medical providers are faced with the challenge of addressing complications from opioid use disorders and associated injection drug use. Unsafe injection practices among people who inject drugs (PWID) can lead to several complications requiring acute care encounters in the emergency department and inpatient hospital. Our objective is to provide a narrative review to help medical providers recognise and address key health issues in PWID, who are being released from the emergency department and inpatient hospital. In the midst of rises in overdose deaths and infections such as hepatitis C, we highlight several health issues for PWID, including overdose and infection prevention. We provide a clinical checklist of actions to help guide providers in the care of these complex patients. The clinical checklist includes strategies also applicable to low-resource settings, which may lack addiction treatment options. Our review and clinical checklist highlight key aspects of optimising the health and safety of PWID.
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Affiliation(s)
- Kinna Thakarar
- Department of Medicine/Infectious Diseases, Maine Medical Center, Portland, Maine, USA
| | - Zoe M Weinstein
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
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Jozaghi E, Jackson A. Examining the potential role of a supervised injection facility in Saskatoon, Saskatchewan, to avert HIV among people who inject drugs. Int J Health Policy Manag 2015; 4:373-9. [PMID: 26029896 DOI: 10.15171/ijhpm.2015.73] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/25/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Research predicting the public health and fiscal impact of Supervised Injection Facilities (SIFs), across different cities in Canada, has reported positive results on the reduction of HIV cases among People Who Inject Drugs (PWID). Most of the existing studies have focused on the outcomes of Insite, located in the Vancouver Downtown Eastside (DTES). Previous attention has not been afforded to other affected areas of Canada. The current study seeks to address this deficiency by assessing the cost-effectiveness of opening a SIF in Saskatoon, Saskatchewan. METHODS We used two different mathematical models commonly used in the literature, including sensitivity analyses, to estimate the number of HIV infections averted due to the establishment of a SIF in the city of Saskatoon, Saskatchewan. RESULTS Based on cumulative cost-effectiveness results, SIF establishment is cost-effective. The benefit to cost ratio was conservatively estimated to be 1.35 for the first two potential facilities. The study relied on 34% and 14% needle sharing rates for sensitivity analyses. The result for both sensitivity analyses and the base line estimates indicated positive prospects for the establishment of a SIF in Saskatoon. CONCLUSION The opening of a SIF in Saskatoon, Saskatchewan is financially prudent in the reduction of tax payers' expenses and averting HIV infection rates among PWID.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
| | - Asheka Jackson
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
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Jozaghi E, Carleton R, Andresen MA. Utility of the theory of planned behaviour for predicating needle sharing among injection drug users. JOURNAL OF SUBSTANCE USE 2015. [DOI: 10.3109/14659891.2015.1009507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend 2014; 145:48-68. [PMID: 25456324 DOI: 10.1016/j.drugalcdep.2014.10.012] [Citation(s) in RCA: 313] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Supervised injection services (SISs) have been developed to promote safer drug injection practices, enhance health-related behaviors among people who inject drugs (PWID), and connect PWID with external health and social services. Nevertheless, SISs have also been accused of fostering drug use and drug trafficking. AIMS To systematically collect and synthesize the currently available evidence regarding SIS-induced benefits and harm. METHODS A systematic review was performed via the PubMed, Web of Science, and ScienceDirect databases using the keyword algorithm [("supervised" or "safer") and ("injection" or "injecting" or "shooting" or "consumption") and ("facility" or "facilities" or "room" or "gallery" or "centre" or "site")]. RESULTS Seventy-five relevant articles were found. All studies converged to find that SISs were efficacious in attracting the most marginalized PWID, promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency. SISs were not found to increase drug injecting, drug trafficking or crime in the surrounding environments. SISs were found to be associated with reduced levels of public drug injections and dropped syringes. Of the articles, 85% originated from Vancouver or Sydney. CONCLUSION SISs have largely fulfilled their initial objectives without enhancing drug use or drug trafficking. Almost all of the studies found in this review were performed in Canada or Australia, whereas the majority of SISs are located in Europe. The implementation of new SISs in places with high rates of injection drug use and associated harms appears to be supported by evidence.
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Affiliation(s)
- Chloé Potier
- Department of Addiction Medicine, CHRU de Lille, Univ Lille Nord de France, F-59037 Lille, France; University of Lille 2, Faculty of Medicine, F-59045 Lille, France.
| | - Vincent Laprévote
- CHU Nancy, Maison des Addictions, Nancy F-54000, France; CHU Nancy, Centre d'Investigation Clinique CIC-INSERM 9501, Nancy F-54000, France
| | - Françoise Dubois-Arber
- Institute of Social and Preventive Medicine, University Hospital Center and University of Lausanne, Chemin de la Corniche 10, 1010 Lausanne, Switzerland
| | - Olivier Cottencin
- Department of Addiction Medicine, CHRU de Lille, Univ Lille Nord de France, F-59037 Lille, France; University of Lille 2, Faculty of Medicine, F-59045 Lille, France
| | - Benjamin Rolland
- Department of Addiction Medicine, CHRU de Lille, Univ Lille Nord de France, F-59037 Lille, France; University of Lille 2, Faculty of Medicine, F-59045 Lille, France
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Jozaghi E, Reid AA, Andresen MA, Juneau A. A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa, Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:31. [PMID: 25091704 PMCID: PMC4123501 DOI: 10.1186/1747-597x-9-31] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/28/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Supervised injection facilities (SIFs) are venues where people who inject drugs (PWID) have access to a clean and medically supervised environment in which they can safely inject their own illicit drugs. There is currently only one legal SIF in North America: Insite in Vancouver, British Columbia, Canada. The responses and feedback generated by the evaluations of Insite in Vancouver have been overwhelmingly positive. This study assesses whether the above mentioned facility in the Downtown Eastside of Vancouver needs to be expanded to other locations, more specifically that of Canada's capital city, Ottawa. METHODS The current study is aimed at contributing to the existing literature on health policy by conducting cost-benefit and cost-effective analyses for the opening of SIFs in Ottawa, Ontario. In particular, the costs of operating numerous SIFs in Ottawa was compared to the savings incurred; this was done after accounting for the prevention of new HIV and Hepatitis C (HCV) infections. To ensure accuracy, two distinct mathematical models and a sensitivity analysis were employed. RESULTS The sensitivity analyses conducted with the models reveals the potential for SIFs in Ottawa to be a fiscally responsible harm reduction strategy for the prevention of HCV cases--when considered independently. With a baseline sharing rate of 19%, the cumulative annual cost model supported the establishment of two SIFs and the marginal annual cost model supported the establishment of a single SIF. More often, the prevention of HIV or HCV alone were not sufficient to justify the establishment cost-effectiveness; rather, only when both HIV and HCV are considered does sufficient economic support became apparent. CONCLUSIONS Funded supervised injection facilities in Ottawa appear to be an efficient and effective use of financial resources in the public health domain.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
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The association between law enforcement encounters and syringe sharing among IDUs on skid row: a mixed methods analysis. AIDS Behav 2013; 17:2637-43. [PMID: 23620243 DOI: 10.1007/s10461-013-0488-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The legal environment is one factor that influences injection drug users' (IDUs) risk for HIV and other bloodborne pathogens such as hepatitis C virus (HCV). We examined the association between law enforcement encounters (i.e., arrests and citations) and receptive syringe sharing among IDUs in the context of an intensified policing effort. We conducted a mixed methods analysis of 30 qualitative and 187 quantitative interviews with IDUs accessing services at a Los Angeles, CA syringe exchange program from 2008 to 2009. Qualitative findings illustrate concerns related to visibility, drug withdrawal, and previous history of arrest/incarceration. In quantitative analysis, the number of citations received, current homelessness, and perceiving that being arrested would be a "big problem" were independently associated with recent syringe sharing. Findings illustrate some of the unintended public health consequences associated with intensified street-level policing, including risk for HIV and HCV transmission.
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Leung LTF, Ti L, Hayashi K, Suwannawong P, Kaplan K, Wood E, Kerr T. Health and safety risks associated with public injecting among people who inject drugs in Bangkok, Thailand. Drug Alcohol Rev 2013; 32:582-7. [DOI: 10.1111/dar.12060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 05/16/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Leslie Tze Fung Leung
- British Columbia Centre for Excellence in HIV/AIDS; St. Paul's Hospital; Vancouver Canada
- Faculty of Medicine; University of British Columbia; Vancouver Canada
| | - Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS; St. Paul's Hospital; Vancouver Canada
- School of Population & Public Health; University of British Columbia; Vancouver Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS; St. Paul's Hospital; Vancouver Canada
- Interdisciplinary Studies Graduate Program; University of British Columbia; Vancouver Canada
| | - Paisan Suwannawong
- Mitsampan Harm Reduction Center/Thai AIDS Treatment Action Group; Bangkok Thailand
| | - Karyn Kaplan
- Mitsampan Harm Reduction Center/Thai AIDS Treatment Action Group; Bangkok Thailand
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS; St. Paul's Hospital; Vancouver Canada
- Faculty of Medicine; University of British Columbia; Vancouver Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS; St. Paul's Hospital; Vancouver Canada
- Faculty of Medicine; University of British Columbia; Vancouver Canada
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Semaan S, Leinhos M, Neumann MS. Public health strategies for prevention and control of HSV-2 in persons who use drugs in the United States. Drug Alcohol Depend 2013; 131:182-97. [PMID: 23647730 DOI: 10.1016/j.drugalcdep.2013.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 03/21/2013] [Accepted: 03/21/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Herpes simplex virus type 2 (HSV-2) affects HIV acquisition, transmission, and disease progression. Effective medications for genital herpes and for HIV/AIDS exist. Parenteral transmission of HIV among persons who inject drugs is decreasing. Reducing sexual transmission of HIV and HSV-2 among persons who use drugs (PWUD; i.e., heroin, cocaine, "speedball", crack, methamphetamine through injection or non-injection) necessitates relevant services. METHODS We reviewed HSV-2 sero-epidemiology and HSV-2/HIV associations in U.S.-based studies with PWUD and the general literature on HSV-2 prevention and treatment published between 1995 and 2012. We used the 6-factor Kass framework to assess relevant HSV-2 public health strategies and services in terms of their goals and effectiveness; identification of, and minimization of burdens and concerns; fair implementation; and fair balancing of benefits, burdens, and concerns. RESULTS Eleven studies provided HSV-2 serologic test results. High HSV-2 sero-prevalence (range across studies 38-75%) and higher sero-prevalence in HIV-infected PWUD (97-100% in females; 61-74% in males) were reported. Public health strategies for HSV-2 prevention and control in PWUD can include screening or testing; knowledge of HSV-2 status and partner disclosure; education, counseling, and psychosocial risk-reduction interventions; treatment for genital herpes; and HIV antiretroviral medications for HSV-2/HIV co-infected PWUD. CONCLUSIONS HSV-2 sero-prevalence is high among PWUD, necessitating research on development and implementation of science-based public health interventions for HSV-2 infection and HSV-2/HIV co-infections, including research on effectiveness and cost-effectiveness of such interventions, to inform development and implementation of services for PWUD.
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Affiliation(s)
- Salaam Semaan
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Office of the Director, 1600 Clifton Road, NE, E-07, Atlanta, GA 30333, United States.
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Jozaghi E, Reid AA, Andresen MA. A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Montreal, Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:25. [PMID: 23837814 PMCID: PMC3710233 DOI: 10.1186/1747-597x-8-25] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 07/03/2013] [Indexed: 11/16/2022]
Abstract
Background This paper will determine whether expanding Insite (North America’s first and only supervised injection facility) to more locations in Canada such as Montreal, cost less than the health care consequences of not having such expanded programs for injection drug users. Methods By analyzing secondary data gathered in 2012, this paper relies on mathematical models to estimate the number of new HIV and Hepatitis C (HCV) infections prevented as a result of additional SIF locations in Montreal. Results With very conservative estimates, it is predicted that the addition of each supervised injection facility (up-to a maximum of three) in Montreal will on average prevent 11 cases of HIV and 65 cases of HCV each year. As a result, there is a net cost saving of CDN$0.686 million (HIV) and CDN$0.8 million (HCV) for each additional supervised injection site each year. This translates into a net average benefit-cost ratio of 1.21: 1 for both HIV and HCV. Conclusions Funding supervised injection facilities in Montreal appears to be an efficient and effective use of financial resources in the public health domain.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada V5A 1S6.
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Unick GJ, Rosenblum D, Mars S, Ciccarone D. Intertwined epidemics: national demographic trends in hospitalizations for heroin- and opioid-related overdoses, 1993-2009. PLoS One 2013; 8:e54496. [PMID: 23405084 PMCID: PMC3566161 DOI: 10.1371/journal.pone.0054496] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 12/14/2012] [Indexed: 11/18/2022] Open
Abstract
The historical patterns of opiate use show that sources and methods of access greatly influence who is at risk. Today, there is evidence that an enormous increase in the availability of prescription opiates is fuelling a rise in addiction nationally, drawing in new initiates to these drugs and changing the geography of opiate overdoses. Recent efforts at supply-based reductions in prescription opiates may reduce harm, but addicted individuals may switch to other opiates such as heroin. In this analysis, we test the hypothesis that changes in the rates of Prescription Opiate Overdoses (POD) are correlated with changes in the rate of heroin overdoses (HOD). ICD9 codes from the Nationwide Inpatient Sample and population data from the Census were used to estimate overall and demographic specific rates of POD and HOD hospital admissions between 1993 and 2009. Regression models were used to test for linear trends and lagged negative binomial regression models were used to model the interrelationship between POD and HOD hospital admissions. Findings show that whites, women, and middle-aged individuals had the largest increase in POD and HOD rates over the study period and that HOD rates have increased in since 2007. The lagged models show that increases in a hospitals POD predict an increase in the subsequent years HOD admissions by a factor of 1.26 (p<0.001) and that each increase in HOD admissions increase the subsequent years POD by a factor of 1.57 (p<0.001). Our hypothesis of fungibility between prescription opiates and heroin was supported by these analyses. These findings suggest that focusing on supply-based interventions may simply lead to a shift in use to heroin rather minimizing the reduction in harm. The alternative approach of using drug abuse prevention resources on treatment and demand-side reduction is likely to be more productive at reducing opiate abuse related harm.
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Affiliation(s)
- George Jay Unick
- School of Social Work, University of Maryland, Baltimore, MD, USA.
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Broadhead RS, Borch C, van Hulst Y, Gauchat G, Tehrani S, Stringer KL, Heckathorn DD, Altice FL. Relying on Injection Drug Users to Access and Adhere to HIV Therapeutics. JOURNAL OF DRUG ISSUES 2012. [DOI: 10.1177/0022042612446581] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Results are presented of enrolling HIV+ active-injection drug users (IDUs) into a peer-driven intervention (PDI) to improve their adherence to medical care. Using respondent-driven sampling (RDS), which evolved out of the PDI model, the authors recruited and tested 1,097 IDUs, of whom 145 were confirmed to be HIV+. Despite promises of confidentiality, increased social supports, and direct cash rewards for participating, only 78 (54%) of the HIV+ IDUs enrolled in the subsequent adherence study. Correlates of participation as well as interviews with respondents who declined participating are presented. The seemingly negative findings have important implications for future adherence studies. RDS provided a powerful mechanism for recruiting HIV+ IDUs. But selection biases were revealed to favor sicker yet more socially connected respondents, which resulted in more conservative outcomes with regard to social supports and positive health-seeking behaviors. The analysis may help streamline future efforts using the PDI, which harnesses IDUs’ abilities to help one another, by underscoring some of the mechanism’s limitations.
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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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