1
|
Chappuy M, Lack P, David B, Penavayre G, Thabourey D, Landulpho M, Plasse A, Icard C, Bailly F, Boutahra F, Pradat P, Maynard M, Jauffret-Roustide M, de Ternay J, Rolland B. Willingness to use a drug consumption room among people who use drugs in Lyon, France, a city with no open scene of drug use (the TRABOUL survey). Harm Reduct J 2023; 20:149. [PMID: 37845698 PMCID: PMC10580523 DOI: 10.1186/s12954-023-00887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Drug consumption rooms (DCRs) have been developed in cities with open drug scenes, with the aim to reduce drug-related harm. In Lyon, France's second-largest city, there is no distinct drug use area, which raised doubts regarding the need for a DCR. METHODS We conducted a face-to-face survey of 264 people who use drugs (PWUDs), recruited in harm reduction or addiction treatment centers, in the streets or in squats. We assess their willingness to use a DCR, and we collected sociodemographic and medical features. Bivariable comparisons and analyses adjusted for sociodemographic parameters explored the association between willing to use a DCR and other variables, thus providing crude (ORs) and adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). RESULTS In total, 193 (73.1%) PWUDs accepted to participate (mean age 38.5 ± 9.3 years; 80.3% men). Among them, 64.2% declared willing to use a DCR. Being treatment-seeker (aOR 0.20, 95% CI [0.08-0.51]; p < 0.001) and not living alone (aOR 0.29; 95% CI [0.10-0.86], p = 0.025) were negatively associated with willing to use a DCR. By contrast, receiving precarity social insurance (aOR 4.12; 95% CI [1.86-9.14], p < 0.001), being seropositive for hepatitis C (aOR 3.60; 95% CI [1.20-10.84], p = 0.022), being cannabis user (aOR 2.45; 95% CI [1.01-5.99], p = 0.049), and reporting previous problems with residents (aOR 5.99; 95% CI [2.16-16.58], p < 0.001) or with the police (aOR = 4.85; 95% CI [1.43-16.39], p = 0.011) were positively associated. CONCLUSIONS PWUDs, especially the most precarious ones, largely supported the opening of a DCR in Lyon, a city with no open drug scene.
Collapse
Affiliation(s)
- Mathieu Chappuy
- Service d'Hépatologie et d'Addictologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon K, 5 Place d'Arsonval, 69002, Lyon, France
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier, Bron, France
- Service Pharmaceutique, Hospices Civils de Lyon, Lyon, France
| | - Philippe Lack
- Service d'Hépatologie et d'Addictologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Baptiste David
- Service d'Hépatologie et d'Addictologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | | | | | | | - Christophe Icard
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier, Bron, France
| | - François Bailly
- Service d'Hépatologie et d'Addictologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Pierre Pradat
- Centre de Recherche Clinique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Marianne Maynard
- Centre de Recherche Clinique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Marie Jauffret-Roustide
- Centre d'Étude Des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France
- British Columbia Center on Substance Use (BCCSU), British Columbia University, Vancouver, Canada
- Baldy Center on Law and Social Policy, Buffalo University, Buffalo, USA
| | - Julia de Ternay
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon K, 5 Place d'Arsonval, 69002, Lyon, France
- Univ. Lyon, UCBL1, INSERM U1028, CNRS UMR5292, CRNL, PSYR2, Lyon, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon K, 5 Place d'Arsonval, 69002, Lyon, France.
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier, Bron, France.
- Univ. Lyon, UCBL1, INSERM U1028, CNRS UMR5292, CRNL, PSYR2, Lyon, France.
| |
Collapse
|
2
|
Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study. PLoS Med 2019; 16:e1002964. [PMID: 31770391 PMCID: PMC6879115 DOI: 10.1371/journal.pmed.1002964] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) experience elevated rates of premature mortality. Although previous studies have demonstrated the role of supervised injection facilities (SIFs) in reducing various harms associated with injection drug use, including accidental overdose death, the possible impact of SIF use on all-cause mortality is unknown. Therefore, we examined the relationship between frequent SIF use and all-cause mortality among PWID in Vancouver, Canada. METHODS AND FINDINGS Data were derived from 2 prospective cohort studies of PWID in Vancouver, Canada, between December 2006 and June 2017. Every 6 months, participants completed questionnaires that elicited information regarding sociodemographic characteristics, substance use patterns, social-structural exposures, and use of health services including SIFs. These data were confidentially linked to the provincial vital statistics database to ascertain mortality rates and causes of death. We used multivariable extended Cox regression analyses to estimate the independent association between frequent (i.e., at least weekly) SIF use and all-cause mortality. Of 811 participants, 278 (34.3%) were women, and the median age was 39 years (IQR 33-46) at baseline. In total, 432 (53.3%) participants reported frequent SIF use at baseline, and 379 (46.7%) did not. At baseline, frequent SIF users were on average younger than nonfrequent users, and a higher proportion of frequent SIF users than nonfrequent users were unstably housed, resided in the Downtown Eastside neighbourhood, injected in public, had a recent non-fatal overdose, used prescription opioids at least daily, injected heroin at least daily, injected cocaine at least daily, and injected crystal methamphetamine at least daily. A lower proportion of frequent SIF users than nonfrequent users were HIV positive and enrolled in addiction treatment at baseline. The median duration of follow-up among study participants was 72 months (IQR 24-123). In total, 112 participants (13.8%) died during the study period, yielding a crude mortality rate of 22.7 (95% CI 18.7-27.4) deaths per 1,000 person-years. The median years of potential life lost per death was 34 (IQR 27-42) years. In a time-updated multivariable model, frequent SIF use was inversely associated with risk of all-cause mortality after adjusting for potential confounders, including age, sex, HIV seropositivity, unstable housing, at least daily cocaine injection, public injection, incarceration, enrolment in addiction treatment, and calendar year of interview (adjusted hazard ratio 0.46, 95% CI 0.26-0.80, p = 0.006). The main study limitations are the limited generalizability of findings due to non-random sampling, the potential for reporting biases due to reliance on some self-reported information, and the possibility that residual confounding influenced findings. CONCLUSIONS We observed a high burden of premature mortality among a community-recruited cohort of PWID. Frequent SIF use was associated with a lower risk of death, independent of relevant confounders. These findings support efforts to enhance access to SIFs as a strategy to reduce mortality among PWID. Further analyses of individual-level data are needed to determine estimates of, and potential causal pathways underlying, associations between SIF use and specific causes of death.
Collapse
|
3
|
"Beyond Safer Injecting"-Health and Social Needs and Acceptance of Support among Clients of a Supervised Injecting Facility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112032. [PMID: 31181648 PMCID: PMC6603933 DOI: 10.3390/ijerph16112032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/17/2022]
Abstract
Health and social issues in aging populations of people who inject drugs (PWID) tend to aggregate, despite risky injecting practices decreasing with age. Identifying needs and avenues of support is becoming increasingly important. We described the health and social situation among clients of a long-running supervised injecting facility (SIF) in Sydney, Australia. An interviewer-administered survey (n = 182) assessed current housing status, employment, physical and mental health, incarceration history, drug use, engagement in drug treatment, health service utilization, and willingness to accept support. Results were compared to the information provided at initial visit. Up to half of the participants transitioned between lower- and higher-risk health and social indicators over time. Willingness to accept support was greatest amongst those with higher self-perceived need. Support for mental health was a low priority, despite the high self-reporting of mental health issues. SIF clients are open to support for health and social issues, despite ongoing active drug use. Lower-threshold services such as SIFs are well-positioned to recognize and respond to deteriorating health and social issues for PWID. Facilitating care and treatment remains a challenge when the services to which people are being referred are higher-threshold with a more rigid approach.
Collapse
|
4
|
Belackova V, Salmon AM, Day CA, Ritter A, Shanahan M, Hedrich D, Kerr T, Jauncey M. Drug consumption rooms: A systematic review of evaluation methodologies. Drug Alcohol Rev 2019; 38:406-422. [PMID: 30938025 DOI: 10.1111/dar.12919] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 01/27/2023]
Abstract
ISSUES Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. APPROACH Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded. KEY FINDINGS Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on blood-borne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'. IMPLICATIONS Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities. CONCLUSIONS Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted.
Collapse
Affiliation(s)
| | - Allison M Salmon
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Carolyn A Day
- Central Clinical School, Addiction Medicine, University of Sydney, Royal Prince Albert Hospital, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, UNSW Sydney, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| |
Collapse
|
5
|
León C, Cardoso LJP, Johnston S, Mackin S, Bock B, Gaeta JM. Changes in public order after the opening of an overdose monitoring facility for people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:90-95. [PMID: 29294417 DOI: 10.1016/j.drugpo.2017.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/22/2017] [Accepted: 12/08/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND In the face of an increasingly fatal opioid crisis, Boston Health Care for the Homeless Program (BHCHP) opened the Supportive Place for Observation and Treatment (SPOT), a unique low-threshold harm reduction program for monitoring people who have injected drugs and are at imminent risk of overdose. This study examines the impact of the opening of the SPOT program on measures of injection drug-related public order in the neighborhood surrounding the facility. METHODS Data was collected at 10 weeks prior and 12 weeks post SPOT implementation on: number of over-sedated individuals in public, publicly discarded syringes, publicly discarded injection-related litter, and instances of active injection drug use or exchange of drugs. Changes were evaluated using Poisson log-linear regression models. Potential confounders such as weather and police presence were measured and controlled for. RESULTS The average number of over-sedated individuals observed in public significantly decreased by 28% (4.3 [95% Confidence Interval (CI) 2.7-6.9] v 3.1 [CI 1.4-6.8]) after SPOT opened. The opening of SPOT did not have a significant effect on the other measures of public order. The daily average number of publicly discarded syringes (28.5 [CI 24.5-33.1] v 28.4 [CI 22.0-36.5]), pieces of publicly discarded injection-related litter (376.3 [CI 358.6-394.8] v 375.0 [CI 345.8-406.6]), and observed instances of active use or exchange of drugs (0.2 [CI 0.1-0.9] v 0.1 [CI 0.0-0.1]) were not statistically significantly different after the opening of SPOT. CONCLUSIONS The opening of SPOT was associated with a significant decrease in observed over-sedated individuals. Other measures of injection-drug related public order did not improve or worsen with the opening of SPOT, however, they have been shown to improve with the implementation of a supervised injection facility.
Collapse
Affiliation(s)
- Casey León
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA.
| | - Lena J P Cardoso
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Salem Johnston
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Sarah Mackin
- Boston Public Health Commission, 774 Albany Street, Boston, MA, 02118, USA
| | - Barry Bock
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Jessie M Gaeta
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA; Boston Medical Center, Section of General Internal Medicine, Boston, MA 02118, USA
| |
Collapse
|
6
|
Toth EC, Tegner J, Lauridsen S, Kappel N. A cross-sectional national survey assessing self-reported drug intake behavior, contact with the primary sector and drug treatment among service users of Danish drug consumption rooms. Harm Reduct J 2016; 13:27. [PMID: 27717366 PMCID: PMC5055654 DOI: 10.1186/s12954-016-0115-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
Abstract
Background Drug consumption rooms (DCRs) have been implemented worldwide as a harm-reducing strategy. In 2012, Denmark passed legislation allowing establishment of DCRs. The aim of this study was to identify characteristics and gain knowledge of the way service users use the DCRs including bridge building to specialized health care. Associations between nationality, opioid substitution treatment (OST), drug intake method, and response to staff advice on harm-reducing education was investigated, as well as service user’s reasons for using the DCRs, and their perceptions of safety and trust in the DCRs. Methods A survey questionnaire sampled 154 participants of DCRs. Convenience sampling was used. Key variables covered demographics, drug intake mode, educational advice received in the DCR, and opinions about and role of the DCRs for the service users. Results Only 10 % of the participants were under the age of 30, 30 % between 30 and 39 years, 36 % between 40 and 49 years, and 24 % age 50 or more. A total of 60 % of the participants had encountered drugs before they were 19 years old. Female participants were 25 %, and 73 % were Danish citizens, 8 % were non-Danish EU citizens, and 18 % were non-EU citizens. As drug intake method, 63 % injected drugs in a vein, 7 % sniffed, and 37 % smoked. Of drugs used in the DCR, 49 % used cocaine, 41 % heroin, 16 % a mix of heroin and cocaine, and 16 % used methadone. Participants who smoked drugs made significantly less use of drug rehabilitation than participants who sniffed or injected drugs. There was a similar rate of advice on OST across nationality. Participants accepted staff education on hygienic measures and safe injection practices and found it useful. Participants felt safe and trusted staff and bridge building to specialized health care took place in the DCR. Conclusions Staff of Danish DCRs educate service users on health related issues and harm-reducing interventions. A subgroup who smoke and a subgroup of nationality other than Danish are underserved and have less likely been in OST. More research on these groups is needed. Electronic supplementary material The online version of this article (doi:10.1186/s12954-016-0115-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eva Charlotte Toth
- Department of Nursing, Metropolitan University College, Copenhagen, Denmark.
| | - Jette Tegner
- Department of Nursing, Metropolitan University College, Copenhagen, Denmark
| | | | - Nanna Kappel
- Department of Nursing, Metropolitan University College, Copenhagen, Denmark
| |
Collapse
|
7
|
Kappel N, Toth E, Tegner J, Lauridsen S. A qualitative study of how Danish drug consumption rooms influence health and well-being among people who use drugs. Harm Reduct J 2016; 13:20. [PMID: 27306441 PMCID: PMC4910234 DOI: 10.1186/s12954-016-0109-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/04/2016] [Indexed: 11/30/2022] Open
Abstract
Background Drug use contributes to higher rates of morbidity and mortality among people who use drugs compared to the general population. In 2012, Danish politicians passed a law that allowed drug consumption rooms (DCRs) to operate; among the objectives were to improve the well-being of vulnerable citizens and to reduce the number of overdoses. Five Danish DCRs are currently being operated. This article presents results from a national investigation focused on assessing the impact of Danish drug consumption rooms on the health and well-being of DCR clients and factors facilitating the acceptance of DCR clients in order to improve their health and refer them onward to social and health service providers. Methods We conducted 250 h of participant observation in the DCRs, followed by in-depth qualitative interviews with 42 DCR clients and 25 staff members. Field notes and interviews were analysed and coded, and themes have been developed. Results DCR clients experienced a sense of social acceptance while inside DCRs. Members of staff conveyed a welcoming, non-judgemental attitude, and DCR clients were predominantly satisfied with the facilities. They prioritized forging relations with drug users so as to foster a sense of social acceptance within DCRs. The primary goal of staff members is to prevent overdoses by informing clients about strong drugs and by intervening in cases of intoxication. DCRs provide security to clients. In cases of health-related problems, DCR clients were referred to local health clinics. Members of the staff build bridges for DCR clients by guiding them towards drug treatment programmes and services in the social and the health sectors. Conclusions The study reveals a consistency between DCR clients and staff members with respect to appraisal of the importance of DCRs. Both clients and staff agreed that DCRs provide a safe haven in the environment in which DCR clients often live and that staff members’ approach to clients with the intention of promoting acceptance clears the path for the prevention and treatment of overdoses and providing referrals to healthcare facilities, to drug treatment centres and to social services.
Collapse
Affiliation(s)
- Nanna Kappel
- Department of Nursing, Metropolitan University College, Copenhagen, Denmark.
| | - Eva Toth
- Department of Nursing, Metropolitan University College, Copenhagen, Denmark
| | - Jette Tegner
- Department of Nursing, Metropolitan University College, Copenhagen, Denmark
| | | |
Collapse
|
8
|
Drug consumption rooms and the role of politics and governance in policy processes. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:972-7. [DOI: 10.1016/j.drugpo.2014.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 12/18/2013] [Accepted: 01/13/2014] [Indexed: 11/18/2022]
|
9
|
Viazov S, Ross SS, Kyuregyan KK, Timm J, Neumann-Haefelin C, Isaeva OV, Popova OE, Dmitriev PN, El Sharkawi F, Thimme R, Michailov MI, Roggendorf M. Hepatitis C virus recombinants are rare even among intravenous drug users. J Med Virol 2010; 82:232-8. [PMID: 20029799 DOI: 10.1002/jmv.21631] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Systematic studies of the circulation of hepatitis C virus (HCV) recombinants in different parts of the world have been initiated only recently, and no detailed information on this subject is available. The aim of the current investigation was to determine the frequency of HCV recombinants in intravenous drug users (IVDU) from two European countries. HCV RNA from serum samples was tested by RT-PCR with primers derived from the core and NS5B regions with subsequent sequencing and genotype assignment. The 118 samples from Germany (100%) and 45 out of 47 (96%) sera from Russia demonstrated concordant genotyping results. In the two genotype discrepant sera from Russia 2k/1b recombinants were identified. In order to test the hypothesis that the individuals from the IVDU group might be multiply exposed to various genotypes, 145 out of 165 genotyped serum samples, which were found to be positive for anti-NS4 antibodies, were serotyped with the Murex HCV serotyping kit that is based on detection of antibodies to type-specific peptides derived from the NS4 proteins of different HCV genotypes. Discrepancy in genotype and serotype attributions was observed in 11% cases. Retesting of 99 type 1a or 3a samples with a set of type- and subtype-specific primers revealed the presence of a mixed infection only in one case (1a/3a). Thus, the cases of the mixed infection with different HCV genotypes as well as the recombinant forms of HCV are very rare even in such a highly exposed group as IVDU.
Collapse
Affiliation(s)
- Sergei Viazov
- Institute of Virology, Essen University Hospital, Essen, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|