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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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Jackson LA, Dechman M, Mathias H, Gahagan J, Morrison K. Safety and danger: Perceptions of the implementation of harm reduction programs in two communities in Nova Scotia, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:360-371. [PMID: 34060676 DOI: 10.1111/hsc.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/28/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
People who use substances (PWUS), and specifically individuals who use injection drugs and/or smoke crack cocaine, experience risks which harm reduction programmes can help reduce. Prior to implementing harm reduction programmes, however, it is critical to understand how programme users and others in the community perceive the programmes as their perceptions may influence implementation. A mixed-methods study asked PWUS and key informants about their perceptions of implementing five harm reduction programmes in their communities, including perceptions of the advantages of the programmes, where best to locate them, and community support. Questionnaires were administered to 160 PWUS, and qualitative interviews were conducted with 11 purposefully sampled key informants. Data were collected in one medium-size and one small-size community/municipality in Nova Scotia, Canada, during 2017-2018. SPSS was used to generate descriptive statistics and means from the quantitative data, and the qualitative data were analysed for key themes using thematic analysis. Both PWUS and key informants perceived numerous advantages of the harm reduction programmes, but some key informants suggested that there might be potential opposition to the implementation of additional needle distribution and disposal programmes in some locations and potential opposition to safer consumption sites. Further research is needed to understand why these programmes were viewed as potentially generating opposition, but findings suggest that a key factor is the association of the programmes with 'danger' because the programmes are directly linked with criminalized drug use. In contrast, the three other programmes are linked to 'safety' because naloxone saves lives, peer navigation programmes support access to existing programmes and detoxification programmes are associated with safety through the reduction/elimination of drug use. Legalization/decriminalization of drugs might help to change the association of some programmes with 'danger' and therefore help support the implementation of harm reduction programmes that appear to be perceived by some as linked to danger.
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Affiliation(s)
- Lois A Jackson
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Margaret Dechman
- School of Arts and Social Sciences, Cape Breton University, Sydney, Nova Scotia, Canada
| | - Holly Mathias
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jacqueline Gahagan
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kirk Morrison
- Department of Sociology, Brock University, St. Catharines, Ontario, Canada
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3
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Armoon B, SoleimanvandiAzar N, Rostami M, Higgs P, Bayani A, Bayat AH, Mohammadi R, Ahounbar E, Fattah Moghaddam L. Drug type and risk behaviors associated with non-fatal overdose among people who use drugs: a systematic review and meta-analysis. J Addict Dis 2021; 40:114-125. [PMID: 34286664 DOI: 10.1080/10550887.2021.1950262] [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] [Indexed: 01/11/2023]
Abstract
The present study aimed to determine the association between drug type, risk behaviors and non-fatal overdose among people who use drugs (PWUD). We searched for studies in English published before February 1, 2021, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with non-fatal overdose among PWUD. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. After a detailed assessment of over 13,845 articles, a total of 49 studies met the eligibility criteria. We found that non-injection opioid use, heroin injection, cocaine use, concurrent use of buprenorphine and benzodiazepines, benzodiazepine use, incarceration, injecting drugs, and duration of injecting were associated with greater odds of non-fatal overdose among PWUD. The findings of the current meta-analysis support the requirement to improve suitable harm reduction strategies for drug users, such as peer-based overdose management, and further focusing on the need to balance the current emphasis on enforcement-based responses to illegal drug use with health-related interventions.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Neda SoleimanvandiAzar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Rostami
- Department of Counseling, Faculty of Humanities and Social Sciences, University of Kurdistan, Kurdistan, Iran
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Azadeh Bayani
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elahe Ahounbar
- Substance Abuse and Dependence Research Center, The University of Social Welfare and Rehabilitation Sciences, 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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4
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“…I can use any syringe I find”: contextual determinants of HIV risk in public injecting settings in Nigeria. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-05-2020-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to explore the contextual determinants of HIV risk among people who inject drugs (PWID) in public settings in Nigeria.
Design/methodology/approach
In-depth, individual interviews were conducted with 29 street-based PWID recruited through snowball sampling in Uyo, Nigeria. Interviews were tape-recorded, transcribed, coded and analysed hematically.
Findings
Homelessness and withdrawal pains encouraged consumption of drugs in public spaces (e.g. bunks, public parks). Conversely, the benefits of participation in street drug-use scenes, including reciprocity norms that guarantee free drugs during withdrawal and protection during overdose, fostered a preference for public injecting. Although participants recognized the need to inject with sterile syringes, scarcity of syringes compelled them to improvise with old syringes or share syringes, increasing risk for HIV transmission. HIV risk was exacerbated by unlawful and discriminatory policing practices, which deterred possession of syringes and encouraged risky behaviours such as rushing injection and sharing of equipment.
Practical implications
Contextual factors are key determinants of HIV risk for street-based PWID. Implementation of needle and syringe programmes as well as reforming legal frameworks and policing practices to support harm reduction are needed responses.
Originality/value
This is one of very few qualitative studies that explore risk factors for HIV transmission among PWID in West Africa. The focus on scarcity of sterile syringes and HIV risk is unique and has important policy implications.
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Kerman N, Manoni-Millar S, Cormier L, Cahill T, Sylvestre J. "It's not just injecting drugs": Supervised consumption sites and the social determinants of health. Drug Alcohol Depend 2020; 213:108078. [PMID: 32485658 DOI: 10.1016/j.drugalcdep.2020.108078] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/24/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND People who inject drugs are highly vulnerable to social determinants of health (SDOH) inequities, such as homelessness, food insecurity, lack of social support, and poor access to healthcare. Supervised consumption sites (SCSs) have been developed to reduce harms associated with injection drug use but their social impacts remain largely unknown. This study explored service users' experiences with SCSs and how their service use affected their SDOH. METHODS A qualitative descriptive study design was used. Participants were recruited from an SCS in Ottawa, Canada. Data were collected using in-depth interviews (n = 21). Data analysis involved two cycles of coding that were visibly presented in an analytic matrix. Member checking of the findings was then completed using two focus groups (n = 7). RESULTS Five themes were identified with regard to how SCSs impacted the SDOH: (1) social connectedness and community, (2) emotional support and stress reduction, (3) safety and security, (4) current shelter statuses and search for housing, and (5) health service access and use. The perceived effects of SCSs in these domains were mostly positive, though the importance of being vigilant and cautious when using the services was also expressed by participants. CONCLUSIONS SCSs represent a potential downstream intervention to addressing some of the SDOH inequities experienced by people who inject drugs. In particular, the findings indicate that SCSs can be a bridge to rebuilding service users' connections with the healthcare system and an important service in efforts to prevent unsheltered homelessness.
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Affiliation(s)
- Nick Kerman
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada.
| | - Stéphanie Manoni-Millar
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada
| | - Luc Cormier
- Oasis Program, Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - Tali Cahill
- Oasis Program, Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7, Canada
| | - John Sylvestre
- Centre for Research on Educational and Community Services, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada
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6
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Trayner KMA, McAuley A, Palmateer NE, Goldberg DJ, Shepherd SJ, Gunson RN, Tweed EJ, Priyadarshi S, Milosevic C, Hutchinson SJ. Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102663. [PMID: 31981949 PMCID: PMC8330401 DOI: 10.1016/j.drugpo.2020.102663] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/27/2019] [Accepted: 01/02/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Whilst injecting drugs in public places is considered a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking and none have examined this in the context of an ongoing HIV outbreak (located in Glasgow, Scotland). We aimed to: 1) estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections (SSTI). METHODS Cross-sectional, bio-behavioural survey (including dried blood spot testing to determine HIV and HCV infection) of 1469 current PWID (injected in last 6 months) recruited by independent interviewers from 139 harm reduction services across Scotland during 2017-18. Primary outcomes were: injecting in a public place (yes/no); HIV infection; current HCV infection; self-reported overdose in the last year (yes/no) and SSTI the last year (yes/no). Multi-variable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and drug-related harms (HIV, current HCV, overdose and SSTI). RESULTS Prevalence of public injecting was 16% overall in Scotland and 47% in Glasgow city centre. Factors associated with increased odds of public injecting were: recruitment in Glasgow city centre (aOR=5.45, 95% CI 3.48-8.54, p<0.001), homelessness (aOR=3.68, 95% CI 2.61-5.19, p<0.001), high alcohol consumption (aOR=2.42, 95% CI 1.69-3.44, p<0.001), high injection frequency (≥4 per day) (aOR=3.16, 95% CI 1.93-5.18, p<0.001) and cocaine injecting (aOR=1.46, 95% CI 1.00 to 2.13, p = 0.046). Odds were lower for those receiving opiate substitution therapy (OST) (aOR=0.37, 95% CI 0.24 to 0.56, p<0.001) and older age (per year increase) (aOR=0.97, 95% CI 0.95 to 0.99, p = 0.013). Public injecting was associated with an increased risk of HIV infection (aOR=2.11, 95% CI 1.13-3.92, p = 0.019), current HCV infection (aOR=1.49, 95% CI 1.01-2.19, p = 0.043), overdose (aOR=1.59, 95% CI 1.27-2.01, p<0.001) and SSTI (aOR=1.42, 95% CI 1.17-1.73, p<0.001). CONCLUSIONS These findings highlight the need to address the additional harms observed among people who inject in public places and provide evidence to inform proposals in the UK and elsewhere to introduce facilities that offer safer drug consumption environments.
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Affiliation(s)
- Kirsten M A Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | - David J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | | | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | - Emily J Tweed
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Catriona Milosevic
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
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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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8
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Mazhnaya A, Tobin KE, Owczarzak J. Association between injection in public places and HIV/HCV risk behavior among people who use drugs in Ukraine. Drug Alcohol Depend 2018; 189:125-130. [PMID: 29913323 DOI: 10.1016/j.drugalcdep.2018.04.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND In Eastern Europe and Central Asia new HIV infections occur at a high rate among people who inject drugs (PWID). Injection risk behavior may be associated with injecting in public places. However, there is a lack of studies exploring this association in Ukraine, which has an HIV prevalence 21-42% among PWID. METHODS Data came from a baseline survey of PWID recruited to participate in a behavioral HIV prevention intervention. The association between HIV/HCV injection risk behavior and place of injection (private vs. public) was assessed using multivariable Poisson regression with robust variance estimate. RESULTS Most of the sample was male (73%), > 30 years (56%), and reported opioids as their drug of choice (55%). One in six participants (15.8%, n = 57) reported using a syringe after somebody, and 70% (n = 253) reported injecting in public places within last 30-days. In the adjusted model, injection risk behavior was associated with injecting in public places (PrR: 4.24, 95% CI: 1.76-10.20), unstable housing situation (PrR: 2.46, 95% CI:1.26-4.83), higher than secondary education (PrR:1.82, 95%CI:1.04-3.16), injecting with a sex partner day (PrR:2.13, 95% CI:1.28-3.56), and injecting with a stranger (PrR: 1.47, 95% CI: 0.93-2.31). CONCLUSIONS Injecting in a public place is associated with increased prevalence of risky behavior. Therefore, understanding and addressing place-based context should be part of the national strategy to fight HIV and HCV in Ukraine. National programs would benefit from expanding models to include contextual and structural determinants of health.
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Affiliation(s)
- Alyona Mazhnaya
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Karin E Tobin
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
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9
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Tweed EJ, Rodgers M, Priyadarshi S, Crighton E. "Taking away the chaos": a health needs assessment for people who inject drugs in public places in Glasgow, Scotland. BMC Public Health 2018; 18:829. [PMID: 29973179 PMCID: PMC6030790 DOI: 10.1186/s12889-018-5718-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public injecting of recreational drugs has been documented in a number of cities worldwide and was a key risk factor in a HIV outbreak in Glasgow, Scotland during 2015. We investigated the characteristics and health needs of people involved in this practice and explored stakeholder attitudes to new harm reduction interventions. METHODS We used a tripartite health needs assessment framework, comprising epidemiological, comparative, and corporate approaches. We undertook an analysis of local and national secondary data sources on drug use; a series of rapid literature reviews; and an engagement exercise with people currently injecting in public places, people in recovery from injecting drug use, and staff from relevant health and social services. RESULTS Between 400 and 500 individuals are estimated to regularly inject in public places in Glasgow city centre: most experience a combination of profound social vulnerabilities. Priority health needs comprise addictions care; prevention and treatment of blood-borne viruses; other injecting-related infections and injuries; and overdose and drug-related death. Among people with lived experience and staff from relevant health and social care services, there was widespread - though not unanimous - support for the introduction of safer injecting facilities and heroin-assisted treatment services. CONCLUSIONS The environment and context in which drug consumption occurs is a key determinant of harm, and is inextricably linked to upstream social factors. Public injecting therefore requires a multifaceted response. Though evidence-based interventions exist, their implementation internationally is variable: understanding the attitudes of key stakeholders provides important insights into local facilitators and barriers. Following this study, Glasgow plans to establish the world's first co-located safer injecting facility and heroin-assisted treatment service.
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Affiliation(s)
- Emily J Tweed
- Directorate of Public Health, NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G11 0SX, UK. .,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - Mark Rodgers
- NHS Greater Glasgow and Clyde, JB Russell House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G11 0SX, UK.,School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Saket Priyadarshi
- NHS Greater Glasgow and Clyde Addictions Services, Festival Business Centre, 150 Brand Street, Glasgow, G51 1DP, UK
| | - Emilia Crighton
- Directorate of Public Health, NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G11 0SX, UK
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10
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Toledo L, Góngora A, Bastos FIPM. [On the sidelines of society: crack use, deviation, criminalization and social exclusion - a narrative review]. CIENCIA & SAUDE COLETIVA 2018; 22:31-42. [PMID: 28076527 DOI: 10.1590/1413-81232017221.02852016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/01/2016] [Indexed: 12/12/2022] Open
Abstract
The article comprises a narrative review of the scientific literature, aiming to identify and discuss the contexts of vulnerability and social exclusion faced by users of crack cocaine and other substances who live on the sidelines of society in the Brazilian and international context. The paper summarizes insights from different theoretical frameworks, focusing on an integrated perspective of substance use and abuse, with an emphasis on the use of crack and its inter-relationships with social vulnerability, marginalization, social exclusion and deviation. In a first step, broad aspects of qualitative research on drugs are outlined. The subsequent section highlights issues associated with exclusion and social vulnerability of crack users, followed by an assessment of the main associations mentioned in the literature on drug use and criminal involvement. Finally, the concept of "sidelines of society" is discussed, as exemplified by situations and events experienced by users of crack and other substances, as mentioned in the literature.
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Affiliation(s)
- Lidiane Toledo
- Programa de Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Andrés Góngora
- Programa de Pós-Graduação em Antropologia Social, Museu Nacional, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Francisco Inácio P M Bastos
- Programa de Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil. .,Departamento de Informações em Saúde, Centro de Informação Científica e Tecnológica, Fiocruz. Rio de Janeiro RJ Brasil
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11
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Melo J, Garfein R, Hayashi K, Milloy M, DeBeck K, Sun S, Jain S, Strathdee S, Werb D. Do law enforcement interactions reduce the initiation of injection drug use? An investigation in three North American settings. Drug Alcohol Depend 2018; 182:67-73. [PMID: 29169035 PMCID: PMC6219752 DOI: 10.1016/j.drugalcdep.2017.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevention of drug injecting is often cited as a justification for the deployment of law enforcement and for the continuation of drug criminalization policies. We sought to characterize the impact of law enforcement interactions on the risk that people who inject drugs (PWID) report assisting others with injection initiation in three North American countries. METHODS Cross-sectional data from PWID participating in cohort studies in three cities (San Diego, USA; Tijuana, Mexico; Vancouver, Canada) were pooled (August 2014-December 2016). The dependent variable was defined as recently (i.e., past six months) providing injection initiation assistance; the primary independent variable was the frequency of recent law enforcement interactions, defined categorically (0 vs. 1 vs. 2-5 vs. ≥6). We employed multivariable logistic regression analyses to assess this relationship while controlling for potential confounders. RESULTS Among 2122 participants, 87 (4.1%) reported recently providing injection initiation assistance, and 802 (37.8%) reported recent law enforcement interactions. Reporting either one or more than five recent interactions with law enforcement was not significantly associated with injection initiation assistance. Reporting 2-5 law enforcement interactions was associated with initiation assistance (Adjusted Odds Ratio=1.74, 95% Confidence Interval: 1.01-3.02). CONCLUSIONS Reporting interactions with law enforcement was not associated with a reduced likelihood that PWID reported initiating others into injection drug use. Instead, we identified a positive association between reporting law enforcement interactions and injection initiation assistance among PWID in multiple settings. These findings raise concerns regarding the effectiveness of drug law enforcement to deter injection drug use initiation.
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Affiliation(s)
- J.S. Melo
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - R.S. Garfein
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - K. Hayashi
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - M.J. Milloy
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada,Division of AIDS, Department of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - K. DeBeck
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z1Y6, Canada
| | - S. Sun
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - S. Jain
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - S.A. Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - D. Werb
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA,Centre for Urban Health Solutions, St Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada,Corresponding author at: Division of Global Public Health, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA. (D. Werb)
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12
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Vallance K, Pauly B, Wallace B, Chow C, Perkin K, Martin G, Zhao J, Stockwell T. Factors associated with public injection and nonfatal overdose among people who inject drugs in street-based settings. DRUGS-EDUCATION PREVENTION AND POLICY 2017. [DOI: 10.1080/09687637.2017.1351524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kate Vallance
- Centre for Addictions Research of BC, University of Victoria, Victoria, Canada
| | - Bernie Pauly
- Centre for Addictions Research of BC, University of Victoria, Victoria, Canada
| | - Bruce Wallace
- School of Social Work, University of Victoria, Victoria, Canada
| | | | - Kathleen Perkin
- Centre for Addictions Research of BC, University of Victoria, Victoria, Canada
| | - Gina Martin
- School of Medicine, University of St. Andrews, St. Andrews, UK
| | - Jinhui Zhao
- Centre for Addictions Research of BC, University of Victoria, Victoria, Canada
| | - Tim Stockwell
- Centre for Addictions Research of BC, University of Victoria, Victoria, Canada
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13
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Voon P, Ti L, Dong H, Milloy MJ, Wood E, Kerr T, Hayashi K. Risky and rushed public crack cocaine smoking: the potential for supervised inhalation facilities. BMC Public Health 2016; 16:476. [PMID: 27266703 PMCID: PMC4895970 DOI: 10.1186/s12889-016-3137-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/19/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite the multitude of public health and community harms associated with crack cocaine use, little is known about factors associated with smoking crack in public and related risks such as rushed public crack smoking. METHODS Data were derived from two prospective cohort studies of people who use illicit drugs in Vancouver, Canada between 2010 and 2014. Multivariable generalized estimating equations were used to identify the prevalence and correlates of public crack smoking and rushed public crack smoking. RESULTS In total, 1085 participants who had smoked crack in the prior six months were eligible for the analysis, of which 379 (34.9 %) reported always or usually smoking crack in public in the previous six months at some point during the study period. Factors positively and independently associated with public crack smoking included public injection drug use (adjusted odds ratio [AOR]: 5.42, 95 % confidence interval [CI]: 3.76-7.82), homelessness (AOR: 3.48, 95 % CI: 2.77-4.36), at least daily crack use (AOR: 2.69, 95 % CI: 2.19-3.31), crack pipe sharing (AOR: 1.98, 95 % CI: 1.60-2.46), drug dealing (AOR: 1.59, 95 % CI: 1.30-1.94), recent incarceration (AOR: 1.47, 95 % CI: 1.09-1.98), noticing police presence when buying or using drugs (AOR: 1.30, 95 % CI: 1.06-1.60), and younger age (AOR: 1.03, 95 % CI: 1.01-1.04). Rushed public crack smoking, which was reported by 216 (28.8 %) of 751 participants who had smoked crack in public at least once during the study period, was positively and independently associated with homelessness (AOR: 2.61, 95 % CI: 1.96-3.49), at least daily crack use (AOR: 1.48, 95 % CI: 1.11-1.98), crack pipe sharing (AOR: 1.44, 95 % CI: 1.10-1.89), drug dealing (AOR: 1.39, 95 % CI: 1.04-1.86), and younger age (AOR: 1.02, 95 % CI: 1.01-1.04). CONCLUSIONS A high prevalence of public crack smoking and rushed public crack smoking was observed in this setting. These findings point to the need for implementing and evaluating evidence-based public health interventions, such as supervised inhalation facilities, to reduce the risks and harms associated with smoking crack in public.
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Affiliation(s)
- Pauline Voon
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6Z 1Z3, Canada
| | - Lianping Ti
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Huiru Dong
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - M-J Milloy
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Thomas Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kanna Hayashi
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1080 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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14
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Treloar C, Mao L, Wilson H. Beyond equipment distribution in Needle and Syringe Programmes: an exploratory analysis of blood-borne virus risk and other measures of client need. Harm Reduct J 2016; 13:18. [PMID: 27246345 PMCID: PMC4886397 DOI: 10.1186/s12954-016-0107-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/18/2016] [Indexed: 01/14/2023] Open
Abstract
Background Despite high levels of equipment distribution through Needle and Syringe Programmes (NSPs) in Australia, the levels of reuse of equipment among people who inject drugs remain concerning. This paper used an exploratory analysis to examine the needs of NSP client that could be addressed by NSPs to enhance service impact and blood-borne virus risk practices. Methods People who inject drugs were recruited from six NSP sites in Sydney, Australia, to undertake a self-completed survey. Results Using the responses of 236 NSP client participants, three factors were identified in an exploratory factor analysis: recent risky injection (Eigenvalue 3.63, 20.2 % of variance); disadvantage and disability (Eigenvalue 2.26, 12.5 % of variance); and drug use milieu (Eigenvalue 1.50, 8.4 % of variance). To understand the distribution of these factors, the standardised factor scores were dichotomised to explore those participants with ‘above average’ vulnerability on each factor. A small group of NSP clients reported a cluster of vulnerability measures. Most participants (55.5 %) reported vulnerability on none or only one factor, indicating that 45.5 % could be considered as having double (35.6 %) or triple (8.9 %) vulnerability. Conclusions These results challenge NSPs to understand the heterogeneity among their client group and develop programmes that respond to their clients’ range of needs beyond those immediately associated with blood-borne virus (BBV) risk. This paper contributes to the growing evidence base regarding the need for BBV prevention efforts to examine strategies beyond equipment distribution.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia.
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia
| | - Hannah Wilson
- Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia
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15
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Risk environments facing potential users of a supervised injection site in Ottawa, Canada. Harm Reduct J 2015; 12:49. [PMID: 26493319 PMCID: PMC4618881 DOI: 10.1186/s12954-015-0083-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/13/2015] [Indexed: 01/07/2023] Open
Abstract
Background Supervised injection sites (SISs) have been effective in reducing health risks among people who inject drugs (PWID), including those who face issues of homelessness, mental health illness, interactions with local policing practices, and HIV infection. We investigate the risk behaviours and risk environments currently faced by potential users of an SIS in Ottawa to establish the need for such a service and to contribute to the design of an SIS that can address current health risks and reduce harm. Methods The PROUD cohort is a community-based participatory research (CBPR) project that examines the HIV risk environment among people who use drugs in Ottawa. From March to October 2013, 593 people who reported using injection drugs or smoking crack cocaine were enrolled through street-based recruitment in the ByWard Market neighbourhood, an area of the city with a high concentration of public drug use and homelessness. Participants completed a demographic, behavioural, and risk environment questionnaire and were offered HIV point-of-care testing. We undertook descriptive and univariate analyses to estimate potential use of an SIS by PWID in Ottawa and to explore risk behaviours and features of the risk environment faced by potential users of the service. Results Of those participants who reported injecting drugs in the previous 12 months (n = 270), 75.2 % (203) reported a willingness to use an SIS in Ottawa. Among potential SIS users, 24.6 % had recently injected with a used needle, 19.0 % had trouble accessing new needles, 60.6 % were unstably housed, 49.8 % had been redzoned by the police, and 12.8 % were HIV positive. Participants willing to use an SIS more frequently injected in public (OR = 1.98, 95 % CI = 1.06–3.70), required assistance to inject (OR = 1.84, 95 % CI = 1.00–3.38), were hepatitis C positive (OR = 2.13, 95 % CI = 1.16–3.91), had overdosed in the previous year (OR = 2.00, 95 % CI = 1.02–3.92), and identified as LGBTQ (OR = 5.61, 95 % CI = 1.30–24.19). Conclusion An SIS in Ottawa would be well-positioned to reach its target group of highly marginalized PWID and reduce drug-related harms. The application of CBPR methods to a large-scale quantitative survey supported the mobilization of communities of PWID to identify and advocate for their own service needs, creating an enabling environment for harm reduction action.
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16
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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: 311] [Impact Index Per Article: 31.1] [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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17
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Wilson H, Brener L, Mao L, Treloar C. Perceived discrimination and injecting risk among people who inject drugs attending Needle and Syringe Programmes in Sydney, Australia. Drug Alcohol Depend 2014; 144:274-8. [PMID: 25236889 DOI: 10.1016/j.drugalcdep.2014.08.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous research indicates that stigma and discrimination have negative consequences for both healthcare delivery and for health outcomes of people who inject drugs (PWID). Also important but not as well researched is the association between perceived discrimination and increased engagement in risky behaviours. This research aimed to explore whether perceived discrimination from workers in Needle and Syringe programmes (NSPs) is associated with increased engagement in injecting risk practices such as the sharing of injecting equipment. METHOD Convenience sampling was used across eight NSP sites within Western Sydney, Australia. All clients who attended one of the NSPs were eligible to participate. RESULTS A total of 236 clients completed the survey. Perceived discrimination from NSP staff was found to be significantly associated with some injecting risk practices. Respondents who reported greater perceived discrimination from NSP staff were significantly more likely to report being injected by someone else after they had injected themselves (OR 1.2, 95%CI 1.1-1.3) and reusing a needle or syringe (OR 1.1, 95%CI 1.0-1.3) in the last month. Although clients reported perceiving more discrimination from general health workers than from NSP workers (12.8 vs. 10.2, t=7.739, df=226, p<0.001), perceived discrimination from general health workers was not associated with increased injecting risk practices. CONCLUSIONS The findings of this study suggest that NSP workers need to be aware that although they work in a model that is usually non-judgemental, their clients may still have a heightened sensitivity to discrimination which can then have consequences for on-going engagement in risk practices.
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Affiliation(s)
- Hannah Wilson
- Centre for Social Research in Health, Level 3 Goodsell Building, UNSW, Sydney 2052, NSW, Australia
| | - Loren Brener
- Centre for Social Research in Health, Level 3 Goodsell Building, UNSW, Sydney 2052, NSW, Australia.
| | - Limin Mao
- Centre for Social Research in Health, Level 3 Goodsell Building, UNSW, Sydney 2052, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, Level 3 Goodsell Building, UNSW, Sydney 2052, NSW, Australia
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18
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Lazarus L, Shaw A, LeBlanc S, Martin A, Marshall Z, Weersink K, Lin D, Mandryk K, Tyndall MW. Establishing a community-based participatory research partnership among people who use drugs in Ottawa: the PROUD cohort study. Harm Reduct J 2014; 11:26. [PMID: 25307356 PMCID: PMC4203893 DOI: 10.1186/1477-7517-11-26] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/22/2014] [Indexed: 11/12/2022] Open
Abstract
Background Grounded in a community-based participatory research (CBPR) framework, the PROUD (Participatory Research in Ottawa: Understanding Drugs) Study aims to better understand HIV risk and prevalence among people who use drugs in Ottawa, Ontario. The purpose of this paper is to describe the establishment of the PROUD research partnership. Methods PROUD relies on peers’ expertise stemming from their lived experience with drug use to guide all aspects of this CBPR project. A Community Advisory Committee (CAC), comprised of eight people with lived experience, three allies and three ex-officio members, has been meeting since May 2012 to oversee all aspects of the project. Eleven medical students from the University of Ottawa were recruited to work alongside the committee. Training was provided on CBPR; HIV and harm reduction; and administering HIV point-of-care (POC) tests so that the CAC can play a key role in research design, data collection, analysis, and knowledge translation activities. Results From March-December 2013, the study enrolled 858 participants who use drugs (defined as anyone who has injected or smoked drugs other than marijuana in the last 12 months) into a prospective cohort study. Participants completed a one-time questionnaire administered by a trained peer or medical student, who then administered an HIV POC test. Recruitment, interviews and testing occurred in both the fixed research site and various community settings across Ottawa. With consent, prospective follow-up will occur through linkages to health care records available through the Institute for Clinical and Evaluation Sciences. Conclusion The PROUD Study meaningfully engaged the communities of people who use drugs in Ottawa through the formation of the CAC, the training of peers as community-based researchers, and integrated KTE throughout the research project. This project successfully supported skill development across the team and empowered people with drug use experience to take on leadership roles, ensuring that this research process will promote change at the local level. The CBPR methods developed in this study provide important insights for future research projects with people who use drugs in other settings.
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Affiliation(s)
- Lisa Lazarus
- Ottawa Hospital Research Institute, 216 Murray Street, Ottawa, ON K1N 5N1, Canada.
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McCutcheon JM, Morrison MA. Injecting on the Island: a qualitative exploration of the service needs of persons who inject drugs in Prince Edward Island, Canada. Harm Reduct J 2014; 11:10. [PMID: 24593319 PMCID: PMC3975878 DOI: 10.1186/1477-7517-11-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 02/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated the service needs of persons who inject drugs (PWID) who live in less populated regions of Canada. With access to fewer treatment and harm reduction services than those in more urban environments, the needs of PWID in smaller centres may be distinct. As such, the present study examined the needs of PWID in Prince Edward Island (PEI), the smallest of Canada's provinces. METHODS Eight PWID were interviewed about the services they have accessed, barriers they faced when attempting to access these services, and what services they need that they are not currently receiving. RESULTS Participants encountered considerable barriers when accessing harm reduction and treatment services due to the limited hours of services, lengthy wait times for treatment, and shortage of health care practitioners. They also reported experiencing considerable negativity from health care practitioners. Participants cited incidences of stigmatisation, and they perceived that health care practitioners received insufficient training related to drug use. Recommendations for the improvement of services are outlined. CONCLUSIONS The findings indicate that initiatives should be developed to improve PWID's access to harm reduction and treatment services in PEI. Additionally, health care practitioners should be offered sensitisation training and improved education on providing services to PWID. The findings highlight the importance of considering innovative alternatives for service provision in regions with limited resources.
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Affiliation(s)
- Jessica M McCutcheon
- Department of Psychology, University of Saskatchewan, 9 Campus Drive, Arts Building, Saskatoon, Saskatchewan S7N 5A5, Canada.
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20
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Havinga P, van der Velden C, de Gee A, van der Poel A. Differences in sociodemographic, drug use and health characteristics between never, former and current injecting, problematic hard-drug users in the Netherlands. Harm Reduct J 2014; 11:6. [PMID: 24524263 PMCID: PMC3926265 DOI: 10.1186/1477-7517-11-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 01/30/2014] [Indexed: 01/15/2023] Open
Abstract
Background Injecting drug users are at increased risk for harmful effects compared to non-injecting drug users. Some studies have focused on differences in characteristics between these two groups (e.g., housing, overall health). However, no study has investigated the specific Dutch situation which in the last years has seen a decrease in homelessness among problematic hard-drug users and an increasing focus on physical health in low-threshold addiction care. The purpose of this study was to determine differences in sociodemographic, drug use and health characteristics between never-injecting (NIDUs), former-injecting (FIDUs) and current-injecting drug users (IDUs) and describe injecting practices. Methods A total of 202 problematic hard-drug users (NIDU = 64; FIDU = 76; IDU = 62) were recruited from 22 low-threshold care facilities, including drug consumption rooms, methadone maintenance treatment, heroin-assisted therapy, day shelter and/or night shelter, supported housing and day activity centres. Data were collected on-site through structured face-to-face interviews. Results Results indicate that IDUs represented a separate group of problematic hard-drug users, with distinct sociodemographic and drug use characteristics. Overall, IDUs appeared to be the group with least favourable characteristics (unstable housing/homelessness, illegal activities, polydrug use) and NIDUs appeared to have the most favourable characteristics (stable housing, help with debts, less polydrug use). The FIDU group lies somewhere in between. The three groups did not differ significantly in terms of health. Regarding injecting practices, results showed that majority of IDUs had injected drugs for over 10 years and IDUs injected heroin, cocaine, amphetamine and/or methadone in the past 6 months. Sharing syringes was not common. A quarter reported public injecting. Conclusions Unstable housing and homelessness are related to (former) injecting drug use, and stable housing is related to never-injecting drug use. Our study suggests that the number of ‘new’ IDUs is low. However, public injecting among IDUs is not uncommon and is associated with unstable housing. This emphasizes the potential of housing projects as a component of harm reduction measures. Therefore, prevention of (risks associated with) injecting drug use and supported housing programmes for problematic hard-drug users deserve the continuous attention of policymakers and professionals in low-threshold addiction care.
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Affiliation(s)
| | | | | | - Agnes van der Poel
- Network of Infectious Diseases and Harm Reduction, Trimbos Institute, P,O, Box 725, Utrecht 3500, AS, The Netherlands.
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21
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DeBeck K, Wood E, Qi J, Fu E, McArthur D, Montaner J, Kerr T. Socializing in an open drug scene: the relationship between access to private space and drug-related street disorder. Drug Alcohol Depend 2012; 120:28-34. [PMID: 21764528 PMCID: PMC3202661 DOI: 10.1016/j.drugalcdep.2011.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 06/13/2011] [Accepted: 06/14/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Limited attention has been given to the potential role that the structure of housing available to people who are entrenched in street-based drug scenes may play in influencing the amount of time injection drug users (IDU) spend on public streets. We sought to examine the relationship between time spent socializing in Vancouver's drug scene and access to private space. METHODS Using multivariate logistic regression we evaluated factors associated with socializing (three+ hours each day) in Vancouver's open drug scene among a prospective cohort of IDU. We also assessed attitudes towards relocating socializing activities if greater access to private indoor space was provided. RESULTS Among our sample of 1114 IDU, 43% fit our criteria for socializing in the open drug scene. In multivariate analysis, having limited access to private space was independently associated with socializing (adjusted odds ratio: 1.80, 95% confidence interval: 1.28-2.55). In further analysis, 65% of 'socializers' reported positive attitudes towards relocating socializing if they had greater access to private space. CONCLUSION These findings suggest that providing IDU with greater access to private indoor space may reduce one component of drug-related street disorder. Low-threshold supportive housing based on the 'housing first' model that include safeguards to manage behaviors associated with illicit drug use appear to offer important opportunities to create the types of private spaces that could support a reduction in street disorder.
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Affiliation(s)
- Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, Division of AIDS, Department of Medicine, University of British Columbia
| | - Jiezhi Qi
- British Columbia Centre for Excellence in HIV/AIDS
| | - Eric Fu
- British Columbia Centre for Excellence in HIV/AIDS
| | | | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Division of AIDS, Department of Medicine, University of British Columbia
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, Division of AIDS, Department of Medicine, University of British Columbia
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Parkin S, Coomber R. Injecting drug user views (and experiences) of drug-related litter bins in public places: a comparative study of qualitative research findings obtained from UK settings. Health Place 2011; 17:1218-27. [PMID: 21865072 DOI: 10.1016/j.healthplace.2011.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/09/2011] [Accepted: 08/03/2011] [Indexed: 11/28/2022]
Abstract
This paper provides a comparative study of qualitative research concerning drug-related litter in community settings (associated with illicit drug use/rs) and of the modes of intervention (noted by municipal authorities in two different UK settings) aimed at reducing harm associated with this contemporary public health issue. More specifically, the paper focuses upon the views and experiences of 51 injecting drug users regarding DRL-bin provision, service uptake and connected events in the relevant settings. Comparative analysis of these qualitative experiences appears to confirm Fitzpatrick and LaGory's concept of 'place matters' in any consideration of applied, low threshold, health intervention. Accordingly, street-based, drug-related intervention within public settings needs to be culturally, environmentally, spatially and geographically relevant to the intended target population in order to have any meaningful benefit (e.g. reduced opportunities for needlestick injury in community settings), impact (e.g. improved community safety) and related outcome (e.g. service uptake by injecting drug users).
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Affiliation(s)
- Stephen Parkin
- Drug and Alcohol Research Unit, School of Social Science and Social Work, Faculty of Health, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK.
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Debeck K, Wood E, Zhang R, Buxton J, Montaner J, Kerr T. A dose-dependent relationship between exposure to a street-based drug scene and health-related harms among people who use injection drugs. J Urban Health 2011; 88:724-35. [PMID: 21533961 PMCID: PMC3157498 DOI: 10.1007/s11524-011-9575-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
While the community impacts of drug-related street disorder have been well described, lesser attention has been given to the potential health and social implications of drug scene exposure on street-involved people who use illicit drugs. Therefore, we sought to assess the impacts of exposure to a street-based drug scene among injection drug users (IDU) in a Canadian setting. Data were derived from a prospective cohort study known as the Vancouver Injection Drug Users Study. Four categories of drug scene exposure were defined based on the numbers of hours spent on the street each day. Three generalized estimating equation (GEE) logistic regression models were constructed to identify factors associated with varying levels of drug scene exposure (2-6, 6-15, over 15 hours) during the period of December 2005 to March 2009. Among our sample of 1,486 IDU, at baseline, a total of 314 (21%) fit the criteria for high drug scene exposure (>15 hours per day). In multivariate GEE analysis, factors significantly and independently associated with high exposure included: unstable housing (adjusted odds ratio [AOR] = 9.50; 95% confidence interval [CI], 6.36-14.20); daily crack use (AOR = 2.70; 95% CI, 2.07-3.52); encounters with police (AOR = 2.11; 95% CI, 1.62-2.75); and being a victim of violence (AOR = 1.49; 95 % CI, 1.14-1.95). Regular employment (AOR = 0.50; 95% CI, 0.38-0.65), and engagement with addiction treatment (AOR = 0.58; 95% CI, 0.45-0.75) were negatively associated with high exposure. Our findings indicate that drug scene exposure is associated with markers of vulnerability and higher intensity addiction. Intensity of drug scene exposure was associated with indicators of vulnerability to harm in a dose-dependent fashion. These findings highlight opportunities for policy interventions to address exposure to street disorder in the areas of employment, housing, and addiction treatment.
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Affiliation(s)
- Kora Debeck
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Parkin S, Coomber R. Public injecting drug use and the social production of harmful practice in high-rise tower blocks (London, UK): a Lefebvrian analysis. Health Place 2011; 17:717-26. [PMID: 21440483 DOI: 10.1016/j.healthplace.2011.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 01/28/2011] [Accepted: 02/01/2011] [Indexed: 02/03/2023]
Abstract
This paper presents, qualitative findings relating to specific environments hitherto unrecognised as settings used for the injecting-use of illicit drugs in an urban setting. This concerns the temporary appropriation of communal space within high-rise social-housing by injecting drug users (IDU); specifically those settings used by tower-block residents for garbage disposal ('bin chute rooms'). These environments were found to be used on daily, habitual bases by all IDU interviewed during the study. Such settings were found to contribute to a wide range of injecting-related harm and hazard. These findings further debate concerning the negative effect of place on health risk in the context of 'public' injecting drug use. These results are situated within Lefebvre's theoretical framework concerning the 'production of space'. It is contended that the 'representational spaces' shaped by IDU creates a dialectic between wider 'spatial practice' and 'representations of space'. Accordingly, it is further suggested that particular 'spaces' of harm reduction (such as 'safer injecting facilities') should be considered in UK settings in order to address injecting-related harm.
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Affiliation(s)
- Stephen Parkin
- Drug and Alcohol Research Unit, School of Social Science and Social Work, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, UK.
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Pearson M, Parkin S, Coomber R. Generalizing Applied Qualitative Research on Harm Reduction: The Example of a Public Injecting Typology. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/009145091103800104] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The small sample sizes and context-bound findings of qualitative research are commonly viewed as significant factors that limit its use (or “transferability”) in settings other than those in which the research was originally conducted. This perceived limitation is of particular importance in a field such as harm reduction where small sample sizes may be the only realistic option for studying the behavior of hard to reach groups. In this article we use Miles and Huberman's (1994) structured method of appraising qualitative research for its transferability to other settings. We consider the extent to which a typology (based on ethnographic field research into public injecting sites) can be used effectively by practitioners in settings other than those in which the original research was conducted. Through appraising the strengths and weaknesses of this research, we demonstrate that contextualized qualitative findings can enable the transferability of qualitative research findings and be of significant applied value for harm reduction services.
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DeBeck K, Buxton J, Kerr T, Qi J, Montaner J, Wood E. Public crack cocaine smoking and willingness to use a supervised inhalation facility: implications for street disorder. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2011; 6:4. [PMID: 21345231 PMCID: PMC3049126 DOI: 10.1186/1747-597x-6-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/23/2011] [Indexed: 11/30/2022]
Abstract
Background The health risks of crack cocaine smoking in public settings have not been well described. We sought to identify factors associated with public crack smoking, and assess the potential for a supervised inhalation facility to reduce engagement in this behavior, in a setting planning to evaluate a medically supervised crack cocaine smoking facility. Methods Data for this study were derived from a Canadian prospective cohort of injection drug users. Using multivariate logistic regression we identified factors associated with smoking crack cocaine in public areas. Among public crack smokers we then identified factors associated with willingness to use a supervised inhalation facility. Results Among our sample of 623 people who reported crack smoking, 61% reported recently using in public locations. In multivariate analysis, factors independently associated with public crack smoking included: daily crack cocaine smoking; daily heroin injection; having encounters with police; and engaging in drug dealing. In sub analysis, 71% of public crack smokers reported willingness to use a supervised inhalation facility. Factors independently associated with willingness include: female gender, engaging in risky pipe sharing; and having encounters with police. Conclusion We found a high prevalence of public crack smoking locally, and this behavior was independently associated with encounters with police. However, a majority of public crack smokers reported being willing to use a supervised inhalation facility, and individuals who had recent encounters with police were more likely to report willingness. These findings suggest that supervised inhalation facilities offer potential to reduce street-disorder and reduce encounters with police.
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Affiliation(s)
- Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
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Marshall BDL, Kerr T, Qi J, Montaner JSG, Wood E. Public injecting and HIV risk behaviour among street-involved youth. Drug Alcohol Depend 2010; 110:254-8. [PMID: 20456875 PMCID: PMC2905504 DOI: 10.1016/j.drugalcdep.2010.01.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 01/02/2010] [Accepted: 01/06/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although street-involved youth who inject illicit drugs are known to be at an increased risk of HIV and other adverse health outcomes, little is known about public injecting among this population and how injecting in public environments may impact HIV risk behaviour. METHODS We used data derived from a study of 560 street-involved youth in Vancouver, Canada to examine the factors associated with injecting in public environments among youth who reported injecting drugs in the past 6 months. RESULTS At baseline, 162 (28.9%) reported injecting drugs in the past 6 months. Among injectors, the 124 (76.5%) participants who reported injecting in public were more likely to be homeless (odds ratio [OR]=6.39, p<0.001), engage in unprotected intercourse (OR=3.09, p=0.004), deal drugs (OR=2.26, p=0.032), smoke crack cocaine (OR=3.00, p=0.005), inject heroin (OR=3.48, p=0.001), drop used syringes outdoors (OR=8.44, p<0.001), share syringes (OR=4.43, p=0.004), and were less likely to clean injection sites >75% of the time (OR=0.36, p=0.008). The majority (62.1%) reported feeling rushed while injecting in public. CONCLUSIONS Youth who inject in public are significantly more likely to engage in sexual and injection-related risk behaviour. Given the known elevated rates of HIV infection and other harms among this population, youth-focused interventions that target both sexual and drug-related risks associated with public drug-using environments are in urgent need of evaluation.
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Affiliation(s)
- Brandon DL Marshall
- British Columbia Centre for Excellence in HIV/ AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6, School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/ AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6, Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Jiezhi Qi
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, CANADA, V6T 1Z3
| | - Julio SG Montaner
- British Columbia Centre for Excellence in HIV/ AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6, Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/ AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6, Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
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Parkin S, Coomber R. Fluorescent blue lights, injecting drug use and related health risk in public conveniences: Findings from a qualitative study of micro-injecting environments. Health Place 2010; 16:629-37. [DOI: 10.1016/j.healthplace.2010.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 01/18/2010] [Accepted: 01/25/2010] [Indexed: 10/19/2022]
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Briggs D, Rhodes T, Marks D, Kimber J, Holloway G, Jones S. Injecting drug use and unstable housing: Scope for structural interventions in harm reduction. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630802697685] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Rachlis BS, Wood E, Zhang R, Montaner JS, Kerr T. High rates of homelessness among a cohort of street-involved youth. Health Place 2009; 15:10-7. [PMID: 18358759 PMCID: PMC2606292 DOI: 10.1016/j.healthplace.2008.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 01/18/2008] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
Abstract
Using multivariate logistic regression, we examined the prevalence and correlates of homelessness among youth enrolled in a community-recruited prospective cohort known as the At-Risk Youth Study (ARYS), between September 2005 and October 2006. Of 478 individuals included in this analysis, 132 (27.6%) were female and 120 (25.1%) self-identified as Aboriginal. The median age was 22 (IQR: 20-24). In total, 284 (56.9%) participants reported baseline homelessness, with most living either at no fixed address, on the street, or in a hostel or shelter. Factors associated with homelessness included public injecting, frequent crack use, experienced violence, having less than a high-school education, and not having been in any addiction treatment. Homeless individuals were at-risk for various adverse health outcomes. These findings indicate the need for additional interventions, including residential addiction treatment, to address homelessness and drug use among youth.
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Affiliation(s)
- Beth S. Rachlis
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Ruth Zhang
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Julio S.G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
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Rhodes T, Watts L, Davies S, Martin A, Smith J, Clark D, Craine N, Lyons M. Risk, shame and the public injector: A qualitative study of drug injecting in South Wales. Soc Sci Med 2007; 65:572-85. [PMID: 17475383 DOI: 10.1016/j.socscimed.2007.03.033] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Indexed: 11/22/2022]
Abstract
Drug injecting in public places is associated with elevated health harm among injecting drug users (IDUs). Yet there is little research exploring the lived experience of injecting in public places, and specifically, a need to explore the interplay of public injecting environments, risk practices and social marginalisation. We undertook 49 qualitative interviews with IDUs in South Wales, UK, in six locations. Analyses focused on injectors' narratives of injecting in public places and risk identity. Findings show how the lived experience of public injecting feeds a pervasive sense of risk and 'otherness' among street injectors, in which public injecting environments act as contextual amplifiers of social marginalisation. Injecting in public places was characterised by urgency associated with a fear of interruption, a need to maintain privacy to prevent public exposure, and an awareness or sense of shame. We argue that daily interactions involving public exposure of injecting status, combined with the negative social meanings ascribed to public places used for injection, are experienced as potentially degrading to one's sense of self. We conclude that the public injecting environment is experienced in the context of other forms of public shaming in the lives of street injectors, and is thus productive of symbolic violence. This highlights tensions between strategies seeking to create safer communities and environmental interventions seeking to reduce drug-related health harm, including recent innovations such as the 'drug consumption room' (DCR).
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Affiliation(s)
- Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK.
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Public injecting and willingness to use a drug consumption room among needle exchange programme attendees in the UK. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:62-5. [PMID: 17689345 DOI: 10.1016/j.drugpo.2006.11.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 11/30/2006] [Accepted: 11/30/2006] [Indexed: 11/23/2022]
Abstract
This study examines the prevalence of public injecting and willingness to use drug consumption rooms (DCRs) among UK needle exchange programme (NEP) attendees. Three hundred and one injecting drug users (IDUs) were surveyed using a brief questionnaire across five NEPs in London and Leeds between April and June 2005. Injection in a public place in the past week was reported by 55% of the sample and 84% reported willingness to use a DCR if it was available. Public injecting was positively associated with insecure housing (AOR=2.1, CI 1.2-3.5, p=0.009), unsafe needle and syringe disposal in the past month (AOR=3.6, CI 1.9-6.9, p<0.001) and willingness to use DCR (AOR=2.7, CI 1.3-5.4, p=0.006). Public injecting was negatively associated with being aged more than 30 years (AOR=0.4, CI 0.3-0.7, p=0.003) and living in close proximity (within 0.5 miles/0.8 km) of the usual place of drug purchase (AOR=0.6, CI 0.3-0.9, p=0.02). Our findings suggest that recent public injecting is prevalent among UK NEP attendees and the majority would be willing to use DCRs if available. It is also probable that if such services were located close to key drug markets they would engage vulnerable IDU sub-populations such as young people and the insecurely housed and reduce their levels of public injecting and unsafe needle/syringe disposal. Targeted pilot implementation of DCRs in the UK is recommended.
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Rhodes T, Kimber J, Small W, Fitzgerald J, Kerr T, Hickman M, Holloway G. Public injecting and the need for 'safer environment interventions' in the reduction of drug-related harm. Addiction 2006; 101:1384-93. [PMID: 16968336 DOI: 10.1111/j.1360-0443.2006.01556.x] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND One key structural dimension in the distribution of drug-related harm associated with injecting drug use is the injecting environment. Epidemiological evidence associates elevated blood-borne viral risk with injecting in 'public' and 'semipublic' environments. Yet the quality of evidence on public injecting and related viral risk is variable, and is lacking in many countries such as the United Kingdom. AIM This commentary considers the micro-injecting environment as a critical dimension of risk, exploring the need for 'safer injecting environment interventions'. METHODS We draw upon published research evidence and qualitative case examples. RESULTS We note the limits in epidemiological evidence on public injecting and emphasize the need for ethnographic research to determine the 'social relations' of how drug users and risk practices interact with injecting environments. We identify three main forms of 'safer environment intervention': purpose-built drug consumption rooms; interventions within existing spatial relations; and spatial programming and urban design. While drug consumption rooms find evidence-based support, they are not a panacea. We emphasize the potential of interventions embedded within existing spatial and social relations. These include low-cost pragmatic interventions enhancing facilities and safety at public and semipublic injecting sites and, primarily, peer-based interventions, including peer-supervised injecting sites. We caution against spatial programming and urban design interventions which can cause the displacement of socially marginalized populations and the redistribution of harm. CONCLUSIONS Public health interventions in the addictions field have in the past focused upon individual behavioural change at the cost of social interventions and environmental change. We wish to focus greater attention on reducing risks related to public injecting and encourage greater debate on 'safer environment interventions' in harm reduction.
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Affiliation(s)
- Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.
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Fischer B, Cruz MF, Rehm J. Illicit opioid use and its key characteristics: a select overview and evidence from a Canadian multisite cohort of illicit opioid users (OPICAN). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2006; 51:624-34. [PMID: 17052030 DOI: 10.1177/070674370605101002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study). METHOD We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample (n=679) was collected in 2002. RESULTS Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine-crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in CONCLUSIONS Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.
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Affiliation(s)
- Benedikt Fischer
- Public Health and Policy Unit, Centre for Addictions Research of British Columbia, Victoria.
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