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Martin FS, Gosse M, Whelan E. 'Planning for a healthy baby and a healthy pregnancy': A critical analysis of Canadian clinical practice guidelines for the treatment of opioid dependence during pregnancy. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:514-533. [PMID: 37843508 DOI: 10.1111/1467-9566.13721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/06/2023] [Indexed: 10/17/2023]
Abstract
As opioid fatalities rise in North America, the need to improve the supports available to those who are dependent on opioids and pregnant has become more urgent. This paper discusses the social organisation of drug treatment supports for those who are pregnant, using Canadian clinical practice guidelines (CPGs) for methadone maintenance treatment (MMT) as a case study. Pregnant patients are a priority population for MMT, both in Canada and internationally; the regulatory bodies that oversee MMT in Canada are the provincial Colleges of Physician and Surgeons and Health Canada. The paper analyses MMT CPGs published by these agencies, comparing their general recommendations to those specific to pregnant patients. We demonstrate that the guidelines address few treatment considerations for pregnant patients, other than improved birth outcomes and child welfare, despite acknowledging their more complex needs. Drawing on social science studies of gender and drugs, we argue that MMT CPGs therefore perpetuate the intensified surveillance and foetal prioritisation that have long generated barriers to care for opiate-dependent pregnant patients. We also discuss how and why the CPGs ultimately only reinforced these current limitations in the drug treatment sector.
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Affiliation(s)
- Fiona S Martin
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Meghan Gosse
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emma Whelan
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
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Brener L, Cama E, Broady T, Harrod ME, Holly C, Caruana T, Beadman K, Treloar C. Experiences of stigma and subsequent reduced access to health care among women who inject drugs. Drug Alcohol Rev 2024. [PMID: 38271084 DOI: 10.1111/dar.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Research into stigma and injecting drug use has typically involved predominantly male participants, with limited research about the unique experience of women who inject drugs. METHODS This study used survey methods to assess reduced access to health care due to stigma among a sample of women who inject drugs. Women (n = 232) completed a survey as part of a broader national study of people who inject drugs. RESULTS Only 46 (19.9%) women reported that they had not experienced any injecting drug use-related stigma in the past year and most commonly noted 'sometimes' experiencing injecting-related stigma (36.8%) with more than 75% of women reporting that health workers had treated them negatively because of their injecting drug use. Most women undertook strategies to prevent experiencing stigma, such as not disclosing drug use to a health worker (81.3%), not attending follow-up appointments (76.7%) and delaying accessing health care (76.8%). Women with lower levels of personal wellbeing, who had experienced poorer treatment by health workers, had engaged in greater past month injecting, were employed and identified as lesbian, gay, bisexual, transgender or queer (LGBTQ) reported more reduced access to health care. DISCUSSION AND CONCLUSIONS Stigma has concerning health care implications for women who inject drugs and this research highlights the importance of understanding the impact of stigma in impeding health care access. Public health interventions should focus on addressing the systemic factors that reduce health care access for women who inject and take account of the impact of stigma in diminishing the quality and accessibility of health care for this group.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Goldenberg SM, Perry C, Watt S, Bingham B, Braschel M, Shannon K. Violence, policing, and systemic racism as structural barriers to substance use treatment amongst women sex workers who use drugs: Findings of a community-based cohort in Vancouver, Canada (2010-2019). Drug Alcohol Depend 2022; 237:109506. [PMID: 35753282 PMCID: PMC9381028 DOI: 10.1016/j.drugalcdep.2022.109506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite a high prevalence of substance use among women sex workers (SWs), rigorous social epidemiologic data on substance use treatment experiences among SWs remains limited. Given these gaps and the disproportionate burden of criminalization borne by Indigenous SWs, we evaluated (1) structural correlates of unsuccessful attempts to access substance use treatment; and (2) the interaction between policing and Indigenous ancestry on unsuccessful attempts to access treatment among SWs who use drugs. METHODS Prospective data were from an open community-based cohort of women SWs (2010-2019) in Vancouver, Canada. Bivariate and multivariable logistic regression with generalized estimating equations(GEE) assessed correlates of unsuccessful attempts to access treatment. A multivariable GEE confounder model examined the interaction between Indigenous ancestry and policing on unsuccessful attempts to access treatment. RESULTS Amongst 645 SWs who used drugs, 32.1 % reported unsuccessful attempts to access substance use treatment during the 9.5-year study. In multivariable GEE analysis, unsuccessful substance use treatment access was associated with identifying as a sexual/gender minority (AOR: 1.90, 95 %CI:1.37-2.63), opioid use (AOR: 1.43, 95 %CI: 1.07-1.91), and exposure to homelessness (AOR: 1.72; 95 %CI:1.33-2.21), police harassment (AOR: 1.48, 95 %CI:1.03-2.13), workplace violence (AOR: 1.80, 95 %CI: 1.31-2.49) and intimate partner violence (AOR: 2.11, 95 %CI:1.50-2.97). In interaction analysis, Indigenous SWs who experienced police harassment faced the highest odds of unsuccessful attempts to access substance use treatment (AOR: 2.59, 95 %CI:1.65-4.05). CONCLUSION Findings suggest a need to scale-up culturally-safe, trauma-informed addictions, gender-based violence, and sex worker services, alongside dismantling of systemic racism across and beyond health and addictions services.
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Affiliation(s)
- Shira M. Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, USA,Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Chelsey Perry
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Sarah Watt
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Brittany Bingham
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada,Division of Social Medicine, Department of Medicine, University of British Columbia, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada,Division of Social Medicine, Department of Medicine, University of British Columbia, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Russell L, Gajwani R, Turner F, Minnis H. Gender, Addiction, and Removal of Children Into Care. Front Psychiatry 2022; 13:887660. [PMID: 35722570 PMCID: PMC9201045 DOI: 10.3389/fpsyt.2022.887660] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Parental addiction can result in harm to children and removal of children by the Local Authority. Less is known about the impact of removal of children on their parents and whether gender has a role in this process. METHODS Data on 736 service users were obtained from the caseloads of 8 nurses and 12 social care workers from an Alcohol and Drug Recovery Service in Scotland. Gender differences in prevalence/patterns of child removal, associations between child removal and parental factors and the relationship between removal and suicidality were examined. RESULTS Mothers were more likely to have had one or more children removed compared to fathers (56.6 vs. 17.7%; p < 0.001) and were more likely to have a series of individual child removals (22.5 vs. 4.3%; p = 0.014). In addition to female gender, younger age, drug use, mental health and suicide attempts were also associated with child removal. Mothers who had children removed and women who were not mothers were more likely to have made an attempt to end their lives than women who had children but had not had them removed. CONCLUSION Gender differences were apparent in prevalence and patterns of child removal. Mothers were six times more likely to have children removed compared to fathers. Child removal occurred alongside other risk factors suggesting that families need holistic support for their multiple areas of need. Services should be aware of the link between child removal and suicide and provide additional support to mothers during and after removal.
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Affiliation(s)
- Lynda Russell
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ruchika Gajwani
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Fiona Turner
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Helen Minnis
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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White NJ. Producing gender-blind drug knowledge and representations in prison spaces. DRUGS AND ALCOHOL TODAY 2021. [DOI: 10.1108/dat-11-2020-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to examine knowledge production and problem representation with regard to new psychoactive substances (NPS) in Her Majesty’s Chief Inspector of Prisons (HMCIP) annual reports.
Design/methodology/approach
Seven annual reports published by HMCIP for England and Wales between 2014 and 2020 have been systematically reviewed drawing on thematic analysis.
Findings
This paper demonstrates how framing in HMCIP annual reports produced a characterisation of NPS in prisons that inadvertently obstructed gender-sensitive knowledge production and problem representation. The framing formalised knowledge silences about spice in women’s prisons.
Originality/value
HMCIP annual reports monitor drugs in prisons and this affects how these spaces are represented to government and other stakeholders. This paper provides theoretical and practical insights into how gender-blind knowledge is produced by discussing examples of gender-blind drug representations in a specific policy context.
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Canfield M, Norton S, Downs J, Gilchrist G. Parental status and characteristics of women in substance use treatment services: Analysis of electronic patient records. J Subst Abuse Treat 2021; 127:108365. [PMID: 34134870 DOI: 10.1016/j.jsat.2021.108365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/03/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many women receiving substance use treatment services are mothers. Despite this, research has not proved whether substance use treatment services are addressing the specific needs of mothers. This study explored differences in sociodemographic, psychological, patterns of substance use, and treatment characteristics between mothers and women without children, and between mothers whose children were in alternative care. METHOD The study extracted data from electronic patient records (EPRs) of women who attended South London and Maudsley (SLaM) National Health Services (NHS) Foundation Trust addiction services between 2013 and 2020 (N = 4370). RESULTS The study identified 1730 participants (39.6%) as mothers, of whom 1340 (77.4%) had dependent children. The average number of births was 1.83 (SD = 1.0). Of the participants, 54.3% of mothers did not disclose whether their dependent child(ren) was under their care and 37.5% of mothers indicated that at least one of their child(ren) was in alternative care. Alcohol was the most reported type of substance used in the past 28 days. Mothers also highly reported suicide attempts and hospitalization due to mental health problems. Compared to women without children, mothers were more likely to be young, experience housing problems, use opioids and/or crack-cocaine in the past 28 days and experience lifetime domestic violence victimizations. Mothers were also less likely to have alcohol-related problems, experience overdose, and social isolation than women without children. CONCLUSION The study highlights the need for substance use services to invest in approaches to improve mothers' disclosure of parenting and childcare issues. It also demonstrates that EPRs can identify key characteristics of mothers.
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Affiliation(s)
- Martha Canfield
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Sam Norton
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Andersson C, Wincup E, Best D, Irving J. Gender and recovery pathways in the UK. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1852180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Catrin Andersson
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, UK
| | | | - David Best
- College of Business, Law and Social Science, University of Derby, One Friar Gate Square, Derby, UK
| | - Jamie Irving
- Department of Law and Criminology, Sheffield Hallam University, Sheffield, UK
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Mburu G, Ayon S, Mahinda S, Kaveh K. Determinants of Women's Drug Use During Pregnancy: Perspectives from a Qualitative Study. Matern Child Health J 2020; 24:1170-1178. [PMID: 32754861 PMCID: PMC7419458 DOI: 10.1007/s10995-020-02910-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Drug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in Kenya, where illicit drug use is on the rise. In this paper, we report factors influencing women's decisions to use drugs during pregnancy. METHODS In 2015, we conducted in-depth interviews and focus group discussions with 45 women who inject drugs and five key stakeholders involved in provision of services to people who use drugs in coastal Kenya. Inductive thematic analysis was conducted to draw out themes related to key determinants of drug use during pregnancy. RESULTS Four key themes emerged outlining determinants of drug use during pregnancy: (i) the use of drugs to cope with the stress of unexpected pregnancy, (ii) the continued drug use during pregnancy to manage withdrawal, (iii) the dual effect of pregnancy on drug use either as a facilitator or as a moderator of drug use, and (iv) the role of male intimate partner in influencing women's drug use during pregnancy. CONCLUSION Our paper reports women's drug use during pregnancy and the factors influencing this phenomenon. To safeguard the health and well-being of pregnant women and their unborn children, there is a need for education and awareness raising, implementing couple-based harm reduction approaches to leverage on positive male influences, improving availability of drug treatment, and provision of family planning interventions for women who use drugs.
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Affiliation(s)
- Gitau Mburu
- Centre for Global Health Policy, University of Sussex, Falmer, UK.
| | | | | | - Khoshnood Kaveh
- School of Public Health, Yale University, New Haven, CT, USA
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Khajedaluee M, Rezaee SA, Valizadeh N, Hassannia T, Paykani T. Concordance assessment between self-reports of substance use and urinalysis: A population-based study in Mashhad, Iran. J Ethn Subst Abuse 2020; 21:538-552. [PMID: 32677552 DOI: 10.1080/15332640.2020.1785362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few studies have addressed the validity of self-reports of substance use in Iran. This study was conducted to evaluate concordance between self-reported data on drug use and urinalysis results in an adult population in Mashhad as the second most populous city in Iran. METHODS This population-based study recruited 2142 Mashhad residents aged over 16 years. The data were obtained from a study conducted in 2015 on the prevalence of chronic kidney disease (CKD) in an adult population in Mashhad. The participants were selected using multistage stratified cluster sampling. To evaluate the validity, the participants' responses to a single-question screening test of drug use were compared with their urinalysis results. The sensitivity, specificity, and positive and negative predictive values of the self-reports were also assessed. RESULTS The prevalence of drug use was found to be 2.33% (95% CI: 1.75-3.09) based on the self-reported data and 17.74% (95% CI: 16.15-19.43) based on the urinalysis results. Opioids were the most prevalent form of drug used and the self-reports indicated low validity (sensitivity = 12.63%, 95% CI: 9.54-16.49). The women were found more predisposed than the men to misreporting their drug use. DISCUSSION In line with other studies in Iran, the validity of the self-reports of drug use was found to be low. Policymakers should therefore avoid relying only on self-reported data to evaluate the effectiveness of interventions and preventive strategies.It is recommended that further in-depth studies be conducted to address the factors affecting the validity of self-reports in Iranian populations.
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Affiliation(s)
- Mohammad Khajedaluee
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Abdolrahim Rezaee
- Immunology Research Center, Inflammation and Inflammatory Diseases division, Medical School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Valizadeh
- Immunology Research Center, Inflammation and Inflammatory Diseases division, Medical School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tahereh Hassannia
- Internal Medicine Department, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Toktam Paykani
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
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Moreland A, Hartley C, DelMas S, McRae-Clark A. Examining Stressors and Available Parenting Resources for Opioid-Using Mothers: Qualitative Findings from an Inpatient Substance Use Treatment Program. Community Ment Health J 2020; 56:426-434. [PMID: 31630288 PMCID: PMC7885178 DOI: 10.1007/s10597-019-00478-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/24/2019] [Indexed: 11/28/2022]
Abstract
Given the alarming opioid epidemic, high prevalence of parents involved in substance use treatment programs for opioid use disorder, and critical role that parenting stress plays on opioid use and relapse, the current study examines stressors experienced by mothers enrolled in substance use treatment. Specifically, interviews were conducted with mothers with opioid use disorder (OUD) enrolled in an inpatient substance use treatment program, to identify common themes and develop recommendations related to interventions targeting common stressors among this population. A significant number of parent-related, substance use-related, and other stressors were present prior to and during substance use treatment; with more stressors reported during treatment than prior to treatment. Mothers with OUD reported that they would be interested in receiving parenting services, but that relevant parenting resources were not offered during substance use treatment.
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Affiliation(s)
- A Moreland
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - C Hartley
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - S DelMas
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - A McRae-Clark
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, 29425, USA
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11
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Farkouh A, Riedl T, Gottardi R, Czejka M, Kautzky-Willer A. Sex-Related Differences in Pharmacokinetics and Pharmacodynamics of Frequently Prescribed Drugs: A Review of the Literature. Adv Ther 2020; 37:644-655. [PMID: 31873866 DOI: 10.1007/s12325-019-01201-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 01/07/2023]
Abstract
While there is considerable evidence about sex-related differences between men and women in drug metabolism, efficacy and safety of frequently prescribed drugs such as analgesics, tranquillizers, statins and beta-blockers, clinicians' awareness of the implications on dosing and adverse event monitoring in routine practice is inadequate. Some drugs are more effective in men than women (e.g. ibuprofen) or vice versa (e.g. opioids, benzodiazepine), typically owing to pharmacodynamic causes. The 5-hydroxytryptamine (5-HT) receptor 3 antagonist alosetron is approved for women only since it largely lacks efficacy in men. For statins, equal efficacy was demonstrated in secondary prevention of cardiovascular events, but primary prevention is still under debate. For some drugs (e.g. paracetamol, metoprolol), women are at significantly higher risk of adverse effects. Therefore, considering sex-specific features in clinical trials and therapeutic guidelines is warranted to ensure efficacy and safety of medicines.
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Affiliation(s)
- André Farkouh
- Department of Pharmaceutical Chemistry, Division of Clinical Pharmacy and Diagnostics, Faculty of Life Sciences, University of Vienna, Vienna, Austria.
| | - Thomas Riedl
- Apotheke Zum Engel, Public Pharmacy, Krems-Stein, Austria
| | - Roman Gottardi
- Department of Cardiovascular Surgery, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Martin Czejka
- Department of Pharmaceutical Chemistry, Division of Clinical Pharmacy and Diagnostics, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Wincup E. Women as vulnerable subjects: A gendered reading of the English and Irish drug strategies. Addict Behav 2019; 98:105995. [PMID: 31288126 DOI: 10.1016/j.addbeh.2019.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/30/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
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13
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Khazaee-Pool M, Pashaei T, Nouri R, Taymoori P, Ponnet K. Understanding the relapse process: exploring Iranian women's substance use experiences. Subst Abuse Treat Prev Policy 2019; 14:27. [PMID: 31215472 PMCID: PMC6582531 DOI: 10.1186/s13011-019-0216-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 06/07/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Relapse is one of the main challenges that must be tackled in the drug addiction treatment. Different factors contribute to the relapse process but it remains unclear how relapse occursin women. Describing the relapse phenomenon in women might be of interest to practitioners and academics. The aim of this study was to explore the relapse experiences of Iranian women with a substance use disorder. METHODS Qualitative in-depth interviews were conducted with women with a substance use disorder. The interviews contained open-ended questions regarding relapse experiences during previous treatment. Interviews were digitally recorded. Data were analyzed using the content analysis method. RESULTS In total, 20 women who use drugs took part in the study. The mean age of the women was 34.57 (age range = 9.6 years), and the minimum age of participants was 23 years. The following five main themes were explored: socioeconomic backgrounds, physical complications of drug withdrawal, psychological burden of drug withdrawal, family atmosphere, and cultural factors. The findings highlighted the different treatment needs in women with a substance use disorder. CONCLUSIONS Based on the interviews, it seems necessary to develop female-specific comprehensive treatment programs by putting more emphasis on pain treatment intervention, relapse prevention, the diagnosis and treatment of mental disorders, couples counseling, and financial support. Furthermore, policymakers should be committed to providing a nonjudgmental social environment to remove or reduce stigma of women with drug use problems.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Public Health, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
- Health Sciences Research Center, Addiction Research Institutes, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Pashaei
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
- Department of public health,Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Roghayeh Nouri
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Parvaneh Taymoori
- Department of public health,Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
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Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya. Addict Behav 2019; 93:20-28. [PMID: 30682678 DOI: 10.1016/j.addbeh.2019.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Gender dynamics and interpersonal relations within intimate partnerships are known to determine health behaviors, including substance use, within couples. In addition, influence from intimate partners may occur in the context of wider social ecological determinants of health behavior. The aim of this study was to document the role of intimate partners in influencing injecting drug use among women in Kenya, where injecting drug use is on the rise. METHODS We performed secondary data analysis of an existing dataset from a 2015 qualitative study involving 45 women who inject drugs and 5 key stakeholders in coastal Kenya. Primary data had been collected via a combination of in-depth interviews and focus group discussions exploring sexual, reproductive, drug use, and other social contexts of women who inject drugs. The process by which intimate partners influenced women's initiation of drug use, transition to injecting practices, and maintenance of injecting drug use were identified using thematic analysis. RESULTS Boyfriends and intimate either facilitated or restrained women's drug-injecting. On the one hand, young women's entry into drug use was prompted by relationship problems, or a need to acquiesce with their drug-using boyfriends. Once women started injecting, intimate partners facilitated ongoing drug-injecting by financing the acquisition of drugs, peddling drugs to their women, or sharing their drugs with their women. The social capital that peddlers held insulated women from police arrests, and encouraged women to seek and sustain intimate relations with well-connected peddlers. Men's influences over women were driven by an underlying patriarchal drug acquisition and economic power. On the other hand, boyfriends and intimate partners who were non-injectors or non-drug users sought to moderate women's injecting drug use by encouraging them to inject less, to smoke or snort instead of injecting, or to enroll into rehabilitation. These moderating influences were most prominent when couples were pregnant. Despite men being a source of practical and emotional support, women were frequently unable limit or alter their injecting drug use, due to its addictive nature. Men's disagreement with women's ongoing injecting strained relationships, and occasionally led to separation. CONCLUSIONS Some boyfriends facilitated women's injecting drug use, while others moderated it, supporting assertions that intimate relationships can both be a site of injecting risks or protection. At the micro-level, these findings highlight an opportunity for couple-based interventions, leveraging on non-drug injecting males as a resource to support women adopt safer injecting practices. At a macro level, incorporating livelihood interventions into harm reduction programs is required in order to mitigate economic-based influence of male intimate partners on women's injecting drug use. At both levels, gender transformative approaches are essential. To gain a comprehensive understanding of women's injecting drug use, future studies drug use should explore women's contexts beyond micro influences and consider their wider macro-structural determinants.
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Measham FC. Drug safety testing, disposals and dealing in an English field: Exploring the operational and behavioural outcomes of the UK’s first onsite ‘drug checking’ service. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 67:102-107. [DOI: 10.1016/j.drugpo.2018.11.001] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 01/13/2023]
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Martin FS. Engaging with motherhood and parenthood: A commentary on the social science drugs literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:147-153. [PMID: 30630710 DOI: 10.1016/j.drugpo.2018.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/01/2022]
Abstract
The majority of qualitative social scientific research on the topic of parenthood and substance use focuses on mothers who use illicit drugs and their experiences of social marginalization and stigmatization. This commentary argues that new and important insights might be gained about parenting in the context of substance use by engaging more closely with everyday experiences of mothering and with contemporary theorising around motherhood and parenthood. Drawing on recent sociological studies of family life influenced by late-modern individualism and by new expert attention on the quality of parent-child relationships, the commentary proposes directions for future social research on the identities and experiences of mothers and fathers who use alcohol and other drugs.
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Affiliation(s)
- Fiona S Martin
- Department of Sociology and Social Anthropology, Dalhousie University, Canada.
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17
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Ndimbii J, Ayon S, Abdulrahman T, Mahinda S, Jeneby F, Armstrong G, Mburu G. Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in coastal Kenya: Findings from a qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 18:48-55. [DOI: 10.1016/j.srhc.2018.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 09/25/2018] [Accepted: 10/05/2018] [Indexed: 11/25/2022]
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18
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Jeal N, Patel R, Redmond NM, Kesten JM, Ramsden S, Macleod J, Coast J, Telfer M, Wilcox D, Nowland G, Horwood J. Drug use in street sex workers (DUSSK) study protocol: a feasibility and acceptability study of a complex intervention to reduce illicit drug use in drug-dependent female street sex workers. BMJ Open 2018; 8:e022728. [PMID: 30391916 PMCID: PMC6231566 DOI: 10.1136/bmjopen-2018-022728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/05/2018] [Accepted: 09/25/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Poor health of sex workers continues to be a source of international concern. Sex work is frequently linked with problematic drug use and drug-dependent sex workers typically work on the street, experiencing the greatest risks to health compared with the general population. Street sex workers (SSWs) are much more likely to have experienced incidences of physical and sexual assault, increasing their risk of developing post-traumatic stress disorder (PTSD). We have developed a novel complex intervention designed to reduce illicit drug use in drug-dependent female SSWs which involves: female SSW drug treatment groups (provided by a specialist charity) in a female SSW setting (female sex worker charity premises) provided by female-only staff, PTSD care with eye movement desensitisation and reprocessing (EMDR) therapy provided by female staff from National Health Service (NHS) mental health services. METHODS AND ANALYSIS A mixed methods study investigating the feasibility and acceptability of this intervention to inform the design of a future randomised controlled trial. The study aims to recruit up to 30 participants from November 2017 to March 2018 at a single site, with the intervention being delivered until December 2018. It will gather quantitative data using questionnaires and group attendance. Drug treatment group observations and in-depth interviews undertaken with up to 20 service users and 15 service providers to examine experiences and acceptability of the intervention. Study feasibility will be assessed by evaluating the recruitment and retention of participants to the intervention; the feasibility of NHS and third sector organisations working closely to coordinate care for a SSW population; the potential for specialist NHS mental health services to screen and provide EMDR therapy for drug-dependent SSWs and potential costs of implementing the intervention. ETHICS AND DISSEMINATION This study was approved by South West-Frenchay Research Ethics Committee (REC reference: 17/SW/0033; IRAS ID: 220631) and the Health Research Authority (HRA). Findings will be disseminated through research conferences and peer-reviewed journals.
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Affiliation(s)
- Nicola Jeal
- University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rita Patel
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
| | - Niamh M Redmond
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
| | - Joanna M Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Sophie Ramsden
- University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
| | - John Macleod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna Coast
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
- Health Economics at Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - David Wilcox
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | | | - Jeremy Horwood
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust (UHBT), Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Mburu G, Ndimbii J, Ayon S, Mlewa O, Mbizvo M, Kihara C, Ragi A. Contraceptive Use Among Women Who Inject Drugs: Motivators, Barriers, and Unmet Needs. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23293691.2018.1463737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gitau Mburu
- Division of Health Research, University of Lancaster, United Kingdom
| | | | | | | | | | - Cecilia Kihara
- International HIV/AIDS Alliance, Brighton, United Kingdom
| | - Allan Ragi
- Kenya AIDS NGO Consortium, Nairobi, Kenya
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Neale J, Tompkins CNE, Marshall AD, Treloar C, Strang J. Do women with complex alcohol and other drug use histories want women-only residential treatment? Addiction 2018; 113:989-997. [PMID: 29368436 PMCID: PMC6221094 DOI: 10.1111/add.14131] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/06/2017] [Accepted: 12/04/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Women-only addiction services tend to be provided on a poorly evidenced assumption that women want single-sex treatment. We draw upon women's expectations and experiences of women-only residential rehabilitation to stimulate debate on this issue. METHODS Semi-structured interviews were undertaken with 19 women aged 25-44 years [currently in treatment (n = 9), successfully completed treatment (n = 5), left treatment prematurely (n = 5)]. All had histories of physical or sexual abuse, and relapses linked to relationships with men. Interviews were audio-recorded, transcribed verbatim, coded and analysed inductively following Iterative Categorization. FINDINGS Women reported routinely that they had been concerned, anxious or scared about entering women-only treatment. They attributed these feelings to previous poor relationships with women, being more accustomed to male company and negative experiences of other women-only residential settings. Few women said that they had wanted women-only treatment, although many became more positive after entering the women-only service. Once in treatment, women often explained that they felt safe, supported, relaxed, understood and able to open up and develop relationships with other female residents. However, they also described tensions, conflicts, mistrust and social distancing that undermined their treatment experiences. CONCLUSIONS Women who have complex histories of alcohol and other drug use do not necessarily want or perceive benefit in women-only residential treatment.
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Affiliation(s)
- Joanne Neale
- National Addiction CentreKing's College LondonLondonUK,Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | | | | | - Carla Treloar
- Centre for Social Research in HealthUniversity of New South WalesSydneyAustralia
| | - John Strang
- National Addiction CentreKing's College LondonLondonUK
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Mburu G, Ayon S, Tsai AC, Ndimbii J, Wang B, Strathdee S, Seeley J. "Who has ever loved a drug addict? It's a lie. They think a 'teja' is as bad person": multiple stigmas faced by women who inject drugs in coastal Kenya. Harm Reduct J 2018; 15:29. [PMID: 29801494 PMCID: PMC5970466 DOI: 10.1186/s12954-018-0235-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A tenth of all people who inject drugs in Kenya are women, yet their social contexts and experiences remain poorly understood. This paper reports how multiple forms of stigma are experienced by women who inject drugs in coastal Kenya and the impact that they have on their ability to access essential health services. METHODS In 2015, in-depth interviews and focus group discussions were held with 45 women who inject drugs in two coastal towns. These data were supplemented with in-depth interviews with five individual stakeholders involved in service provision to this population. Data were analyzed thematically using NVivo. RESULTS Women who inject drugs experience multiple stigmas, often simultaneously. These included the external stigma and self-stigma of injection drug use, external gender-related stigma of being a female injecting drug user, and the external stigma of being HIV positive (i.e., among those living with HIV). Stigma led to rejection, social exclusion, low self-esteem, and delay or denial of services at health facilities. CONCLUSION HIV and harm reduction programs should incorporate interventions that address different forms of stigma among women who inject drugs in coastal Kenya. Addressing stigma will require a combination of individual, social, and structural interventions, such as collective empowerment of injecting drug users, training of healthcare providers on issues and needs of women who inject drugs, peer accompaniment to health facilities, addressing wider social determinants of stigma and discrimination, and expansion of harm reduction interventions to change perceptions of communities towards women who inject drugs.
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Affiliation(s)
- Gitau Mburu
- Division of Health Research, Lancaster University, Lancaster, UK.
| | | | - Alexander C Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, The Massachusetts General Hospital, Boston, USA
| | | | | | - Steffanie Strathdee
- Division of Global Public Health, University of California San Diego School of Medicine, San Diego, USA
| | - Janet Seeley
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Thomas N, Bull M. Representations of women and drug use in policy: A critical policy analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 56:30-39. [PMID: 29547767 DOI: 10.1016/j.drugpo.2018.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 10/17/2022]
Abstract
Contemporary research in the drugs field has demonstrated a number of gender differences in patterns and experiences of substance use, and the design and provision of gender-responsive interventions has been identified as an important policy issue. Consequently, whether and how domestic drug policies attend to women and gender issues is an important question for investigation. This article presents a policy audit and critical analysis of Australian national and state and territory policy documents. It identifies and discusses two key styles of problematisation of women's drug use in policy: 1) drug use and its effect on women's reproductive role (including a focus on pregnant women and women who are mothers), and 2) drug use and its relationship to women's vulnerability to harm (including violent and sexual victimisation, trauma, and mental health issues). Whilst these are important areas for policy to address, we argue that such representations of women who use drugs tend to reinforce particular understandings of women and drug use, while at the same time contributing to areas of 'policy silence' or neglect. In particular, the policy documents analysed are largely silent about the harm reduction needs of all women, as well as the needs of women who are not mothers, young women, older women, transwomen or other women deemed to be outside of dominant normative reproductive discourse. This analysis is important because understanding how women's drug use is problematised and identifying areas of policy silence provides a foundation for redressing gaps in policy, and for assessing the likely effectiveness of current and future policy approaches.
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Affiliation(s)
- Natalie Thomas
- Griffith Criminology Institute, Griffith University, Brisbane, Australia; Faculty of Humanities, Arts and Social Sciences, University of New England, Armidale, Australia.
| | - Melissa Bull
- Griffith Criminology Institute, Griffith University, Brisbane, Australia
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Ramiro FDS, Padovani RDC, Fidalgo TM, Tucci AM. Women Crack Users, Pregnancy and Motherhood: Potential Periods for Health Care. PSICOLOGIA: TEORIA E PESQUISA 2018. [DOI: 10.1590/0102.3772e34425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract This study aimed to understand how women report their behaviors concerning drug use during pregnancy and breastfeeding. This is a qualitative study, conducted in the metropolitan area of Santos. Twelve women who have used crack were interviewed through a semistructured interview. The interviews were analyzed from the perspective of content analysis. Our data indicate that pregnancy is a critical time to sensitize these women and try to lessen the damage and the risks associated with the use of crack among them.
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Martinez-Merino N, Martín-González N, Usabiaga O, Martos-Garcia D. Physical activity practiced by incarcerated women: A systematic review. Health Care Women Int 2017; 38:1152-1169. [DOI: 10.1080/07399332.2017.1368515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nagore Martinez-Merino
- Physical and Sport Education Department, Faculty of Education & Sport, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - Nerian Martín-González
- PhD student at the Physical and Sport Department, University of the Basque Country, UPV-EHU, Faculty of Sport & Education, Vitoria-Gasteiz, Spain
| | - Oidui Usabiaga
- Lecturer at the Physical and Sport Department, Faculty of Sport & Education, University of the Basque Country, UPV-EHU, Vitoria-Gasteiz, Spain
| | - Daniel Martos-Garcia
- Department of Teaching of Music Plastic and Corporal Expression, Faculty of Teacher Training, University of Valencia, València, Spain
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25
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Jeal N, Macleod J, Salisbury C, Turner K. Identifying possible reasons why female street sex workers have poor drug treatment outcomes: a qualitative study. BMJ Open 2017; 7:e013018. [PMID: 28336736 PMCID: PMC5372151 DOI: 10.1136/bmjopen-2016-013018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIMS To explore street sex workers (SSWs) views and experiences of drug treatment, in order to understand why this population tend to experience poor drug treatment outcomes. DESIGN In-depth interviews. SETTING Bristol, UK. PARTICIPANTS 24 current and exited SSWs with current or previous experience of problematic use of heroin and/or crack cocaine. FINDINGS Participants described how feeling unable to discuss their sex work in drug treatment groups undermined their engagement in the treatment process. They outlined how disclosure of sex work resulted in stigma from male and female service users as well as adverse interactions with male service users. Participants highlighted that non-disclosure meant they could not discuss unresolved trauma issues which were common and which emerged or increased when they reduced their drug use. As trauma experiences had usually involved men as perpetrators participants said it was not appropriate to discuss them in mixed treatment groups. SSWs in recovery described how persistent trauma-related symptoms still affected their lives many years after stopping sex work and drug use. Participants suggested SSW-only services and female staff as essential to effective care and highlighted that recent service changes were resulting in loss of trusted staff and SSW-only treatment services. This was reported to be reducing the likelihood of SSWs engaging in drug services, with the resultant loss of continuity of care and reduced time with staff acting as barriers to an effective therapeutic relationship. CONCLUSIONS SSWs face many barriers to effective drug treatment. SSW-only treatment groups, continuity of care with treatment staff and contact with female staff, particularly individuals who have had similar lived experience, could improve the extent to which SSWs engage and benefit from drug treatment services. Service engagement and outcomes may also be improved by drug services that include identification and treatment of trauma-related symptoms.
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Affiliation(s)
- Nikki Jeal
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
| | - John Macleod
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
| | - Chris Salisbury
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Katrina Turner
- Centre for Academic Primary Care School of Social & Community Medicine Bristol, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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26
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Shahram SZ, Bottorff JL, Kurtz DLM, Oelke ND, Thomas V, Spittal PM. Understanding the Life Histories of Pregnant-Involved Young Aboriginal Women With Substance Use Experiences in Three Canadian Cities. QUALITATIVE HEALTH RESEARCH 2017; 27:249-259. [PMID: 27401489 DOI: 10.1177/1049732316657812] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Despite attention paid to substance use during pregnancy, understandings of young Aboriginal women's experiences based on their perspectives have been virtually absent in the published literature. This study's objective was to understand the life experiences of pregnant-involved young Aboriginal women with alcohol and drugs. Semi-structured interviews to gather life histories were conducted with 23 young Aboriginal women who had experiences with pregnancy, and alcohol and drug use. Transcribed interviews were analyzed for themes to describe the social and historical contexts of women's experiences and their self-representations. The findings detail women's strategies for survival, inner strength, and capacities for love, healing, and resilience. Themes included the following: intersectional identities, life histories of trauma (abuse, violence, and neglect; intergenerational trauma; separations and connections), the ever-presence of alcohol and drugs, and the highs and lows of pregnancy and mothering. The findings have implications for guiding policy and interventions for supporting women and their families.
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Affiliation(s)
- Sana Z Shahram
- The University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Addictions Research of BC, University of Victoria, British Columbia, Canada
| | - Joan L Bottorff
- The University of British Columbia, Kelowna, British Columbia, Canada
- Australian Catholic University, Melbourne, Australia
| | - Donna L M Kurtz
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Nelly D Oelke
- The University of British Columbia, Kelowna, British Columbia, Canada
- Department of Community Health Services, Cumming School of Medicine, University of Alberta, Alberta, Canada
| | - Victoria Thomas
- Wuikinuxv Nation, Vancouver, British Columbia, Canada
- The Cedar Project, Vancouver, British Columbia, Canada
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27
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Haritavorn N. I am just a 'maae' (mother): experiences of mothers injecting drugs in Thailand. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:1167-1179. [PMID: 27417684 DOI: 10.1111/1467-9566.12448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mothers who use drugs face much discriminatory action as society in general finds female drug users' modes of caring for their children unacceptable. In this article, I explore the ways in which Thai women's injecting practices revolve around the role of mother 'maae' and the ways they employ tactics to challenge the motherhood discourse. This article draws on in-depth interviews with 30 Thai mothers injecting drugs. Thai mothers injecting drugs struggled with stigma and self-blame. They internalise the values of the mother 'maae', that is, what the mother is supposed to be; attempting to combine their drug use with their parental responsibilities. Having a child is treated as a means for many women to manage the hostile social impacts of being an addict mother as well as anxieties about the future of their children. To maintain identity as a mother, as gender norms dictates, the mothers employ several tactics to defend that identity from the threats. In conclusion, the findings have implications for harm reduction and reproductive services for women using drugs in Thailand; health care providers need to appreciate the ramifications of the lived experiences of the women who take drugs.
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Lyons T, Shannon K, Richardson L, Simo A, Wood E, Kerr T. Women Who Use Drugs and Have Sex with Women in a Canadian Setting: Barriers to Treatment Enrollment and Exposure to Violence and Homelessness. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1403-1410. [PMID: 26014823 PMCID: PMC4662642 DOI: 10.1007/s10508-015-0508-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 05/29/2023]
Abstract
Individuals who use illicit drugs and belong to a sexual minority group often contend with elevated risks for adverse health outcomes. However, little is known about women who use drugs and have sex with women. We therefore sought to identify sociodemographic, substance use patterns, and exposures to social-structural factors associated with reporting sexual activity among women participating in three open prospective cohort studies of individuals who use illicit drugs in Vancouver, Canada. Generalized estimating equations were used to identify substance use patterns, violence, and other social and structural drivers of health-related harm among women who reported having sex with women (WSW) between December 2005 and May 2012. In multivariate analyses, younger age (adjusted odds ratio [AOR] 2.89; 95 % confidence interval [CI] 1.81, 4.60), violence (AOR 1.78; 95 % CI 1.22, 2.59), and homelessness (AOR 1.42; 95 % CI 1.00, 2.02) were associated with WSW. WSW were also less likely to report enrollment in addiction treatment (AOR 0.68; 95 % CI 0.46, 0.99). In a second model, sexual violence (AOR 3.47; 95 % CI 2.08, 5.78) in the previous 6 months was also found to be positively associated with WSW. These findings indicate a critical need for more thorough understandings of the intersections between sexual relationships, exposure to violence, and enrollment in addiction treatment among women who use illicit drugs, as well as the development of programs to address the unique needs of this population.
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Affiliation(s)
- Tara Lyons
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6Z 1Y6, Canada
| | - Lindsey Richardson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Sociology, University of British Columbia, 6303 Northwest Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Annick Simo
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Department of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Fonti S, Davis D, Ferguson S. The attitudes of healthcare professionals towards women using illicit substances in pregnancy: A cross-sectional study. Women Birth 2016; 29:330-5. [DOI: 10.1016/j.wombi.2016.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/15/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
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Abstract
Purpose
– The purpose of this paper is to provide a gendered reading of the 2010 UK drug strategy and draw out the implications of the new recovery paradigm for female drug users.
Design/methodology/approach
– The paper explores the concept of recovery at a theoretical level, uncovering the taken-for-granted assumptions in the three overarching principles: freedom from dependence; well-being; and citizenship. It also analyses the available quantitative and qualitative evidence on women’s access to recovery capital to explore the role gender might play in the journey to recovery.
Findings
– Strategic thinking around recovery in the UK is largely silent on gender. However, close scrutiny of the available, albeit limited, evidence base on female drug users and feminist scholarship on the principles of well-being and citizenship suggests the need to understand recovery against a backdrop of the social and normative context of women’s lives.
Originality/value
– Recent analyses of contemporary UK drug policy have focused on the conflation of recovery with abstinence and the displacement of the harm reduction agenda. They have failed to draw out the implications for particular groups of drug users such as women. The pursuit of recovery-based drug policy is not peculiar to the UK so the paper offers a case study of its gendered application in a particular national context.
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West BS, Abramovitz D, Staines H, Vera A, Patterson TL, Strathdee SA. Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities. J Urban Health 2016; 93:141-54. [PMID: 26696001 PMCID: PMC4794460 DOI: 10.1007/s11524-015-9995-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We know little about predictors of injection drug cessation and relapse among female sex workers who inject drugs (FSW-PWID) at the US-Mexico border. Among HIV-negative FSW-PWID taking part in a behavioral intervention study in Tijuana and Ciudad Juárez, Cox regression was used to identify predictors of time to first cessation of injection, which was defined as reporting not having injected drugs for a period of 4 months or longer, and among that subset, we examined predictors of time to injection relapse. Among 440 women, 84 (19%) reported ceasing injection during follow-up (median time to cessation = 9.3 months); of these, 30 (35%) reported relapse to injection (median time to relapse = 3.5 months). The rate of injection cessation was lower for women reporting trading sex prior to age 18 (adj. hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.41-1.01), ever being sexually abused (adj. HR = 0.44, 95% CI = 0.27-0.71), and a higher number of vaginal sex acts with casual clients (adj. HR = 0.99 per transaction, 95% CI = 0.98-1.00). The rate of cessation was higher for women who spent more hours on the streets on a typical day (adj. HR = 1.04/h, 95% CI = 1.01-1.08) and who lived in Tijuana vs. Ciudad Juárez (adj. HR = 2.15, 95% CI = 1.14-4.07). The rate of relapse was higher among women reporting regular drug use with clients (adj. HR = 2.17, 95% CI = 0.96-4.89) and those scoring higher on a risk injection index (adj. HR = 2.04, 95% CI = 1.15-3.61). The rate of relapse was lower for FSW-PWID with higher than average incomes (adj. HR = 0.40, 95% CI = 0.18-0.89). These findings have important implications for the scale-up of methadone maintenance treatment programs (MMTPs) in Mexico and indicate a need for gender-specific programs that address sexual abuse experiences and economic vulnerabilities faced by FSW-PWID.
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Affiliation(s)
- Brooke S West
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA, 92093-0507, USA.
| | - Daniela Abramovitz
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA, 92093-0507, USA
| | - Hugo Staines
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA, 92093-0507, USA
| | - Thomas L Patterson
- Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, Chihuahua, Mexico
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA, 92093-0507, USA
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Vanthuyne A, Mundt-Leach R, Boyd A, Broughton S, Pittrof R. Sexual and reproductive healthcare provided onsite in an inner-city community drug and alcohol service. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2016; 42:152-4. [PMID: 26769726 DOI: 10.1136/jfprhc-2014-101126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/14/2015] [Indexed: 11/04/2022]
Affiliation(s)
- An Vanthuyne
- ST6 in Sexual and Reproductive Health, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Rosie Mundt-Leach
- Head of Nursing, Addictions Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Alastair Boyd
- Associate Specialist in Addiction Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephanie Broughton
- Blood Borne Viruses CNS, Health Inclusion Team, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Rudiger Pittrof
- Consultant in Sexual Health and HIV, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
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Azim T, Bontell I, Strathdee SA. Women, drugs and HIV. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26 Suppl 1:S16-21. [PMID: 25277726 PMCID: PMC4498573 DOI: 10.1016/j.drugpo.2014.09.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/01/2014] [Accepted: 09/05/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Women who use drugs, irrespective of whether these are injected or not, are faced with multiple issues which enhance their vulnerability to HIV. METHODS In this commentary, we explore the HIV risks and vulnerabilities of women who use drugs as well as the interventions that have been shown to reduce their susceptibility to HIV infection. RESULTS Women who inject drugs are among the most vulnerable to HIV through both unsafe injections and unprotected sex. They are also among the most hidden affected populations, as they are more stigmatized than their male counterparts. Many sell sex to finance their own and their partner's drug habit and often their partner exerts a significant amount of control over their sex work, condom use and injection practices. Women who use drugs all over the world face many different barriers to HIV service access including police harassment, judgmental health personnel and a fear of losing their children. CONCLUSION In order to enable these women to access life-saving services including needle-syringe and condom programs, opioid substitution therapy and HIV testing and treatment, it is essential to create a conducive environment and provide tailor-made services that are adapted to their specific needs.
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Affiliation(s)
- Tasnim Azim
- Centre for HIV and AIDS, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
| | - Irene Bontell
- Centre for HIV and AIDS, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh; Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
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Stresses, strengths, and experiences of mothers engaged in methadone maintenance treatment. J Addict Nurs 2014; 25:139-47. [PMID: 25202811 DOI: 10.1097/jan.0000000000000038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although methadone maintenance treatment (MMT) is the intervention of choice for addiction, unfortunately, mothers are less likely to engage in care. Greater understanding of how mothers experience the addiction and the recovery process is needed to develop strategies to effectively engage mothers in MMT. This mixed method study applied quantitative and qualitative approaches with a sample of 12 mothers who were engaged in MMT for 3 or more months. Although the results showed stresses of high depression and difficult life circumstance scores, the mothers had strengths that included positive social support and family functioning. Inductive analysis of transcribed interviews identified three themes that explained how mothers experienced addiction and recovery: diminished maternal identity, choice for mothering, and redefined maternal identity. During addiction, mothers described a sense of diminished maternal identity with two subthemes of diminished performed mothering and interrupted mothering. With the second theme, choice for mothering, mothers described making the choice to attend MMT for their children. The third theme, redefined maternal identity, consisted of two subthemes that reflected potential outcomes of MMT and addiction recovery. Whereas most mothers described positive, restored maternal identity, two mothers of older children noted continued diminished maternal identity with persistence of negative mother-child relationships despite maternal addiction recovery. Recommendations are made to assist service providers to consider maternal identity within the recovery process.
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Martin FS, Aston S. A “Special Population” with “Unique Treatment Needs”: Dominant Representations of “Women's Substance Abuse” and Their Effects. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/009145091404100304] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A number of studies suggest that the lack of “gender sensitive” drug treatment services for women represents a pressing social problem, second only to the problem of “women's substance abuse” itself. This article interrogates these “problem representations” by asking on what basis they are considered uniquely problematic. Through a critical analysis of research on women published between 1990–2012 in relevant high impact journals, the article identifies a dominant view of women in the drug field as a “special population” with “unique treatment needs.” The article suggests that this view not only reinforces a limited understanding of the harms associated with women's substance abuse, but might also paradoxically enable programs and services for women to remain as “add-ons” and/or narrow the range of “gender sensitive” approaches adopted.
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Bertoni N, Burnett C, Cruz MS, Andrade T, Bastos FI, Leal E, Fischer B. Exploring sex differences in drug use, health and service use characteristics among young urban crack users in Brazil. Int J Equity Health 2014; 13:70. [PMID: 25181954 PMCID: PMC4243730 DOI: 10.1186/s12939-014-0070-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/25/2014] [Indexed: 12/12/2022] Open
Abstract
Introduction Studies have shown important gender differences among drug (including crack) users related to: drug use patterns; health risks and consequences; criminal involvement; and service needs/use. Crack use is prevalent in Brazil; however, few comparative data by sex exist. We examined and compared by sex key drug use, health, socio-economic indicators and service use in a bi-city sample of young (18–24 years), regular and marginalized crack users in Brazil. Methods Study participants (total n = 159; n = 124 males and n = 35 females) were recruited by community-based methods from impoverished neighborhoods in Rio de Janeiro and Salvador. Assessments occurred by an anonymous interviewer-administered questionnaire and serum collection for blood-borne virus testing between November 2010 and June 2011. Descriptive statistics and differences for key variables by sex were computed; in addition, a ‘chi-squared automatic interaction detector’ (‘CHAID’) analysis explored potential primary factors differentiating male and female participants. Results Most participants were non-white, and had low education and multiple income sources. More women had unstable housing and income from sex work and/or panhandling/begging, whereas more men were employed. Both groups indicated multi-year histories of and frequent daily crack use, but virtually no drug injection histories. Men reported more co-use of other drugs. More women were: involved in sex-for-drug exchanges; Blood-Borne Virus (BBV) tested and HIV+. Both groups reported similar physical and mental health patterns; however women more commonly utilized social or health services. The CHAID analysis identified sex work; paid work; begging/panhandling; as well as physical and mental health status (all at p < 0.05) as primary differentiating factors by sex. Conclusions Crack users in our study showed notable differences by sex, including socio-economic indicators, drug co-use patterns, sex risks/work, BBV testing and status, and service utilization. Results emphasize the need for targeted special interventions and services for males and female crack users in Brazil.
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Haritavorn N. Surviving in two worlds: Social and structural violence of Thai female injecting drug users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:116-23. [DOI: 10.1016/j.drugpo.2013.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 09/11/2013] [Accepted: 09/24/2013] [Indexed: 11/16/2022]
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Letourneau N, Campbell MA, Woodland J, Colpitts J. Supporting mothers' engagement in a community-based methadone treatment program. Nurs Res Pract 2013; 2013:987463. [PMID: 23738065 PMCID: PMC3664499 DOI: 10.1155/2013/987463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/19/2012] [Accepted: 03/31/2013] [Indexed: 01/22/2023] Open
Abstract
Unmanaged maternal opioid addiction poses health and social risks to both mothers and children in their care. Methadone maintenance treatment (MMT) is a targeted public health service to which nurses and other allied health professionals may refer these high risk families for support. Mothers participating in MMT to manage their addiction and their service providers were interviewed to identify resources to maximize mothers' engagement in treatment and enhance mothers' parenting capacity. Twelve mothers and six service providers were recruited from an outpatient Atlantic Canadian methadone treatment program. Two major barriers to engagement in MMT were identified by both mothers and service providers including (1) the lack of available and consistent childcare while mothers attended outpatient programs and (2) challenges with transportation to the treatment facility. All participants noted the potential benefits of adding supportive resources for the children of mothers involved in MMT and for mothers to learn how to communicate more effectively with their children and rebuild damaged mother-child relationships. The public health benefits of integrating parent-child ancillary supports into MMT for mothers are discussed.
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Affiliation(s)
- Nicole Letourneau
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, AB, Canada T2N 1N4
| | - Mary Ann Campbell
- Department of Psychology, University of New Brunswick, Saint John Campus, P.O. Box 5050, Saint John, NB, Canada E2L 4L5
| | - Jennifer Woodland
- Department of Psychology, University of New Brunswick, Saint John Campus, P.O. Box 5050, Saint John, NB, Canada E2L 4L5
| | - Jennifer Colpitts
- Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, NB, Canada E3B 5A3
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Edelman NL, Patel H, Glasper A, Bogen-Johnston L. Understanding barriers to sexual health service access among substance-misusing women on the South East coast of England. ACTA ACUST UNITED AC 2013; 39:258-63. [PMID: 23349534 DOI: 10.1136/jfprhc-2012-100507] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Evidence suggests substance-misusing women (SMW) experience disproportionate sexual health morbidity and poor uptake of interventions including contraception and cervical screening, yet there has been little investigation of sexual health service access issues for this population. METHODS Twenty women with problem drug use in Hastings in South East England, UK participated in a one-to-one interview with a researcher to explore experiences and beliefs surrounding access to a range of sexual health service interventions. Transcripts were open-coded and themes were elicited and organised concerning barriers to access. RESULTS Drug-use lifestyles, trauma and low self-worth framed the lives of SMW and hindered sexual health service access through: depleted practical and emotional resources to enable attendance; high perceived emotional cost of discussing sexual histories, and coping with tests and unfavourable results; and low anticipated value of sexual health interventions due to low perception and minimisation of risk and perceived incompatibility between drug use and sexual well-being. CONCLUSIONS A range of practical, social and emotional barriers to sexual health service access exist for this population, presenting a context from within which use of services may come at considerable personal cost to SMW. Interventions addressing anticipated stigma and emotional, hygiene and fiscal concerns are warranted for this population.
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Affiliation(s)
- Natalie Lois Edelman
- Senior Research Fellow, Centre for Health Research, University of Brighton, Falmer, UK
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Henderson J, Milligan K, Niccols A, Thabane L, Sword W, Smith A, Rosenkranz S. Reporting of feasibility factors in publications on integrated treatment programs for women with substance abuse issues and their children: a systematic review and analysis. Health Res Policy Syst 2012; 10:37. [PMID: 23217025 PMCID: PMC3547724 DOI: 10.1186/1478-4505-10-37] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 11/28/2012] [Indexed: 11/16/2022] Open
Abstract
Background Implementation of evidence-based practices in real-world settings is a complex process impacted by many factors, including intervention, dissemination, service provider, and organizational characteristics. Efforts to improve knowledge translation have resulted in greater attention to these factors. Researcher attention to the applicability of findings to applied settings also has increased. Much less attention, however, has been paid to intervention feasibility, an issue important to applied settings. Methods In a systematic review of 121documents regarding integrated treatment programs for women with substance abuse issues and their children, we examined the presence of feasibility-related information. Specifically, we analysed study descriptions for information regarding feasibility factors in six domains (intervention, practitioner, client, service delivery, organizational, and service system). Results On average, fewer than half of the 25 feasibility details assessed were included in the documents. Most documents included some information describing the participating clients, the services offered as part of the intervention, the location of services, and the expected length of stay or number of sessions. Only approximately half of the documents included specific information about the treatment model. Few documents indicated whether the intervention was manualized or whether the intervention was preceded by a standardized screening or assessment process. Very few provided information about the core intervention features versus the features open to local adaptation, or the staff experience or training required to deliver the intervention. Conclusions As has been found in reviews of intervention studies in other fields, our findings revealed that most documents provide some client and intervention information, but few documents provided sufficient information to fully evaluate feasibility. We consider possible explanations for the paucity of feasibility information and provide suggestions for better reporting to promote diffusion of evidence-based practices.
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Affiliation(s)
- Joanna Henderson
- Child, Youth and Family Program, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Breckenridge J, Salter M, Shaw E. Use and abuse: understanding the intersections of childhood abuse, alcohol and drug use and mental health. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/17523281.2012.703224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Palamar JJ, Kiang MV, Halkitis PN. Predictors of Stigmatization Towards Use of Various Illicit Drugs Among Emerging Adults. J Psychoactive Drugs 2012; 44:243-51. [DOI: 10.1080/02791072.2012.703510] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lazuardi E, Worth H, Saktiawati AMI, Spooner C, Padmawati R, Subronto Y. Boyfriends and injecting: the role of intimate male partners in the life of women who inject drugs in Central Java. CULTURE, HEALTH & SEXUALITY 2012; 14:491-503. [PMID: 22468728 DOI: 10.1080/13691058.2012.671960] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The international literature shows that HIV-risk behaviour for women mostly occurs in the context of intimate relationships. Power imbalances in the social, economic and cultural spheres put women at risk. This paper addresses the roles of male partners in women's engagement in drug-use behaviour and drug-related HIV-risk behaviour in Indonesia. Data were gathered through in-depth interviews with 19 women who had injected drugs in the previous month in three sites in central Java. Most of the women had male partners who also injected drugs. Results show that male partners play a significant role in the initiation of drug use, the provision of drugs, injecting behaviour and in the constitution of women injectors' social networks. These findings suggest the need to develop couple-based interventions and to facilitate women-only groups as part of HIV prevention.
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Affiliation(s)
- Elan Lazuardi
- Centre for Tropical Medicine - Research Collaboration Unit, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Fischer JA, Clavarino AM, Najman JM. Drug, sex and age differentials in the use of Australian publicly funded treatment services. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2012; 6:13-21. [PMID: 22879751 PMCID: PMC3411539 DOI: 10.4137/sart.s8561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Context: Little is known about the proportion of the Australian population using alcohol or other drugs who may seek treatment. There is a need to have some additional estimates of population morbidity which reflect harms associated with use. Objective: To determine Australian population rates of publicly funded community based specialised alcohol and other drug treatment and in-patient hospital care by those ‘at risk’, by drug type, sex and age. Design and setting: The design is secondary data analysis of publicly available datasets. We use the latest available complete data on Australian general population incidence of alcohol, cannabis amphetamines and ecstasy use (2007 National Drug Strategy Household Survey) and nationally collected administrative data on publicly funded specialised alcohol and other drug treatment services (2006–2007 Alcohol and Other Drug Treatment Services National Minimum Dataset) and public hospitals (2006–2007 National Hospital Morbidity Minimum Dataset) to calculate rates of drug treatment and in-patient hospital care per 1000 Australians. ‘At risk’ for alcohol is defined as being at risk of short term harm, as defined by the National Health and Medical Research Council (2001). ‘At risk’ for illicit drugs is defined as those exposed to potential harm through at least weekly use of cannabis, amphetamines and ecstasy use. Results: Risky alcohol consumption followed by recent cannabis use appears to lead to most harm. Greater harm seems to be experienced by males rather than females. Younger adults (15–19 years) and older adults (40+ years) seem also to experience the highest rates of harm. Conclusions: It is possible to derive population estimates of harms associated with licit and illicit drugs use. Treatment rates vary across drug type, gender and age. Alcohol and cannabis are the substances whose use leads to the greatest demand for services. Ecstasy appears to generate few presentations for treatment. Publicly available data can be used to estimate harms associated with the use of particular substances. Such estimates are best interpreted in the light of other ways of estimating harms.
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Affiliation(s)
- Jane Anne Fischer
- School of Pharmacy, Pharmacy Australia Centre for Excellence, The University of Queensland, Woolloongabba, Queensland, 4102, Australia
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Finfgeld-Connett D, Johnson ED. Substance abuse treatment for women who are under correctional supervision in the community: a systematic review of qualitative findings. Issues Ment Health Nurs 2011; 32:640-8. [PMID: 21932926 PMCID: PMC3190982 DOI: 10.3109/01612840.2011.584363] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This systematic review was conducted to more fully analyze qualitative research findings relating to community-based court-supervised substance abuse treatment for women and to make recommendations regarding treatment enhancement. Five reports of qualitative research met the inclusion criteria. Findings from these reports were extracted and analyzed using constant comparative methods. Women who are referred to court-sanctioned substance abuse treatment programs may initially be reluctant to participate. Once engaged, however, they advocate for a full complement of well-financed comprehensive services. To optimize treatment effectiveness, women recommend gender-specific programs in which ambivalence is diminished, hope is instilled, and care is individualized.
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Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes. Harm Reduct J 2009; 6:32. [PMID: 19930575 PMCID: PMC2789048 DOI: 10.1186/1477-7517-6-32] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 11/20/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are associated with positive outcomes. A qualitative meta-synthesis was conducted to provide insight into the processes that contribute to recovery in integrated programs and women's perceptions of benefits for themselves and their children. METHODS A comprehensive search of published and unpublished literature to August 2009 was carried out for narrative reports of women's experiences and perceptions of integrated treatment programs. Eligibility for inclusion in the meta-synthesis was determined using defined criteria. Quality assessment was then conducted. Qualitative data and interpretations were extracted from studies of adequate quality, and were synthesized using a systematic and iterative process to create themes and overarching concepts. RESULTS A total of 15 documents were included in the meta-synthesis. Women experienced a number of psychosocial processes during treatment that played a role in their recovery and contributed to favourable outcomes. These included: development of a sense of self; development of personal agency; giving and receiving of social support; engagement with program staff; self-disclosure of challenges, feelings, and past experiences; recognizing patterns of destructive behaviour; and goal setting. A final process, the motivating presence of children, sustained women in their recovery journeys. Perceived outcomes included benefits for maternal and child well-being, and enhanced parenting capacity. CONCLUSION A number of distinct but interconnected processes emerged as being important to women's addiction recovery. Women experienced individual growth and transformative learning that led to a higher quality of life and improved interactions with their children. The findings support the need for programs to adopt practices that focus on improving maternal health and social functioning in an environment characterized by empowerment, safety, and connections. Women's relationships with their children require particular attention as positive parenting practices and family relationships can alter predispositions toward substance use later in life, thereby impacting favourably on the cycle of addiction and dysfunctional parenting.
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