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Erinoso O, Daugherty R, Kirk MR, Harding RW, Etchart H, Reyes A, Page K, Fiuty P, Wagner KD. Safety strategies and harm reduction for methamphetamine users in the era of fentanyl contamination: A qualitative analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104456. [PMID: 38761461 DOI: 10.1016/j.drugpo.2024.104456] [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: 12/20/2023] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION In the United States, methamphetamine use is increasing and the context of its use has changed, with reports of illicitly manufactured fentanyl being mixed with methamphetamine (either deliberately or inadvertently). We explore risk-mitigating actions taken by people who use drugs to protect their health when using methamphetamine in that context. METHODS We conducted qualitative interviews with 48 adults (18+) who used methamphetamine in the past three months at two sites in Nevada, USA and two sites in New Mexico, USA. Interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Respondents described two rationales for employing harm reduction strategies. First, to prevent harm from methamphetamine containing illicit fentanyl, and second, to maintain their general wellbeing while using methamphetamine. Regarding methamphetamine containing illicit fentanyl, our findings highlight how respondents employ primary strategies like buying from trusted sources and secondary strategies such as spotting and selective use of harm reduction tools (i.e., fentanyl test strips) to reduce risks. To maintain their general wellbeing, participants reduced their use of methamphetamine as reasonably as possible, and used other substances like marijuana and alcohol alongside methamphetamine to counter the unwanted side effects of methamphetamine (i.e., hallucinations and paranoia). Use of these harm reduction strategies varied within situational and social contexts, and respondents usually developed these strategies based on their lived experiences. CONCLUSION Our findings uniquely demonstrate that people who use methamphetamine prioritize community driven, trust-based strategies within their social networks to mitigate risks in a fentanyl-contaminated drug environment. Additionally, our results indicate that harm reduction behaviors are influenced by multilevel risk environments, which include social, physical, economic, and political factors. Overall, these results highlight the potential for targeted interventions at the network level, which are responsive to complexities and shifts in drug market dynamics- such as illicit fentanyl in methamphetamine.
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Affiliation(s)
- Olufemi Erinoso
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Robbie Daugherty
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Mia R Kirk
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Robert W Harding
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Haley Etchart
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Andres Reyes
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM, United States
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM, United States
| | - Phillip Fiuty
- New Mexico Health, Albuquerque, New Mexico, United States
| | - Karla D Wagner
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States.
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Kennedy MC, Dong H, Tobias S, Buxton JA, Lysyshyn M, Tupper KW, Ti L. Fentanyl Concentration in Drug Checking Samples and Risk of Overdose Death in Vancouver, Canada. Am J Prev Med 2024; 66:10-17. [PMID: 37633426 DOI: 10.1016/j.amepre.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION The proliferation of fentanyl and its analogs in illegal, unregulated drug markets remains a major driver of the overdose crisis in North America. Drug checking services have been implemented as a harm reduction strategy to address the crisis. However, little is known about their potential utility as a mechanism for monitoring population-level risk of overdose stemming from changing fentanyl concentration in unregulated drugs over time. Therefore, this study assessed the relationship between median fentanyl concentration in expected opioid drug checking samples and the death rate due to illicit drug toxicity over time in Vancouver, Canada. METHODS Monthly population-based rates of death due to illicit drug toxicity were drawn from provincial coroner records. Monthly median percent fentanyl concentration was calculated using a validated quantification model from point-of-care Fourier-transform infrared spectra among expected opioid samples that tested positive for fentanyl at community drug checking services. A time-series analysis using generalized additive modeling was conducted to examine the association between monthly median fentanyl concentration and monthly death rate due to illicit drug toxicity, controlling for calendar month. Analyses were conducted in 2021-2022. RESULTS Between January 2019 and October 2020, 577 deaths due to illicit drug toxicity occurred in Vancouver, and the observed monthly rate ranged from 1.75 to 7.65 deaths per 100,000 population. A significant, positive association was observed between monthly median fentanyl concentration and monthly death rate due to illicit drug toxicity, adjusting for calendar month (chi-square=52.21, p<0.001). CONCLUSIONS Findings suggest a role for point-of-care drug checking as a tool for monitoring evolving overdose risk at the population level.
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Affiliation(s)
- Mary Clare Kennedy
- School of Social Work, Faculty of Health and Social Development, The University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel Tobias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane A Buxton
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Lysyshyn
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Kenneth W Tupper
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; School of Child and Youth Care, Faculty of Human and Social Development, University of Victoria, Victoria, British Columbia, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Reid MC, Oliphant-Wells T, Moreno C, Ketchum J, Fitzpatrick T, McMahan VM, Glick SN. High levels of interest in access to free safer smoking equipment to reduce injection frequency among people who inject drugs in Seattle, Washington. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100163. [PMID: 37214756 PMCID: PMC10193167 DOI: 10.1016/j.dadr.2023.100163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/24/2023]
Abstract
Background Drug use route transition interventions promote safer consumption by facilitating a switch from injection to safer routes such as smoking or oral consumption. Methods We performed a descriptive analysis using data from questions about "free, clean equipment for smoking" heroin, methamphetamine and/or crack from the Seattle 2018 National HIV Behavioral Surveillance survey of people who inject drugs (N = 555). We estimated the proportion of respondents with access to free safer smoking equipment, and among these participants, the proportion who reported that this access reduced their injection frequency. Among respondents without access to free safer smoking equipment, we described the proportion who were interested in getting access, and whether they thought this access would reduce their injection frequency. Results Among participants who reported prior year heroin (n = 495), methamphetamine (n = 372), or crack (n = 88) injection, 11%, 11% and 12% reported access to free safer smoking equipment, respectively. Of those with access, the proportion that reported that access reduced their injection frequency ranged from 12% to 44%. Among participants without access, 28% who used heroin, 45% who used methamphetamine, and 49% who used crack were interested in access. Of interested participants, a majority reported that they thought this access would reduce their frequency of injection. Conclusions Access to free safer smoking equipment was limited. Many participants were interested in getting free safer smoking equipment and reported that this access may reduce their injection frequency. Safer smoking equipment is a harm reduction strategy that should be available to reduce risks from opioid and stimulant injection.
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Affiliation(s)
- Molly C. Reid
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | | | - Jake Ketchum
- Public Health - Seattle & King County, Seattle, WA, USA
| | | | | | - Sara N. Glick
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Public Health - Seattle & King County, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
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May T, Dawes J, Fancourt D, Burton A. A qualitative study exploring the impact of the COVID-19 pandemic on People Who Inject Drugs (PWID) and drug service provision in the UK: PWID and service provider perspectives. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103752. [PMID: 35653821 PMCID: PMC9135844 DOI: 10.1016/j.drugpo.2022.103752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND People Who Inject Drugs (PWID) are subject to distinct socio-structural inequalities that can expose them to high risks of COVID-19 transmission and related health and social complications. In response to COVID-19 mitigation strategies, these vulnerabilities are being experienced in the context of adapted drug treatment service provision, including reduced in-person support and increased regulatory flexibility in opioid substitution therapy (OST) guidelines. This study aimed to explore the longer-term impact of the pandemic on the health and wellbeing of PWID in the UK, including provider and client experiences of treatment changes. METHODS Interviews were conducted with 19 PWID and 17 drug treatment providers between May and September 2021, recruited from drug and homelessness charities providing treatment services and healthcare in the UK. Data were analysed using reflexive thematic analysis. RESULTS Most participants expressed ongoing fears of COVID-19 transmission, although socio-structural inequalities limited the contexts in which physical distancing could be practised. In addition, virus mitigation strategies altered the risk environment for PWID, resulting in ongoing physical (e.g. changing drug use patterns, including transitions to crack cocaine, benzodiazepine and pregabalin use) and socio-economic harms (e.g. limited opportunities for sex work engagement and income generation). Finally, whilst clients reported some favourable experiences from service adaptations prompted by COVID-19, including increased regulatory flexibility in OST guidelines, there was continued scepticism and caution among providers toward sustaining any treatment changes beyond the pandemic period. CONCLUSIONS Whilst our findings emphasize the importance of accessible harm reduction measures attending to changing indices of drug-related harm during this period, there is a need for additional structural supports to ensure pre-existing disparities and harms impacting PWID are not exacerbated further by the conditions of the pandemic. In addition, any sustained policy and service delivery adaptations prompted by COVID-19 will require further attention if they are to be acceptable to both service users and providers.
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Affiliation(s)
- Tom May
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, United Kingdom
| | - Jo Dawes
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, United Kingdom
| | - Daisy Fancourt
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, United Kingdom
| | - Alexandra Burton
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, United Kingdom.
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Papamihali K, Collins D, Karamouzian M, Purssell R, Graham B, Buxton J. Crystal methamphetamine use in British Columbia, Canada: A cross-sectional study of people who access harm reduction services. PLoS One 2021; 16:e0252090. [PMID: 34038452 PMCID: PMC8153500 DOI: 10.1371/journal.pone.0252090] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/09/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Increased use of crystal methamphetamine ("crystal meth") has been observed across North America and international jurisdictions, including a notable increase in the presence of methamphetamines in illicit drug toxicity deaths in British Columbia (BC), Canada. We used data from a cross-sectional survey and urine toxicology screening to report the prevalence, correlates, and validity of self-reported crystal meth use among clients of harm reduction sites in BC. MATERIALS AND METHODS Survey data were collected from 1,107 participants across 25 communities in BC, through the 2018 and 2019 Harm Reduction Client Survey. We described reported substance use and used a multivariate logistic regression model to characterize crystal meth use. Urine samples provided by a subset of participants were used to derive validity of self-reported three-day crystal meth use compared to urine toxicology screening. RESULTS Excluding tobacco, crystal meth was the most frequently reported substance used in the past three days in 2018 and 2019 (59.7% and 71.7%, respectively). Smoking was the dominant route of administration for crystal meth, crack, heroin, and fentanyl. Multivariate analysis determined significantly higher odds of crystal meth use among those who used opioids (Adjusted Odds Ratio [AOR] = 3.13), cannabis (AOR = 2.10), and alcohol (1.41), and among those who were not regularly housed (AOR = 2.08) and unemployed (AOR = 1.75). Age ≥50 was inversely associated with crystal meth use (AOR = 0.63). Sensitivity of self-reported crystal meth use was 86%, specificity was 86%, positive predictive value was 96%, and negative predictive value was 65%. CONCLUSIONS Crystal meth was the most commonly used substance among clients of harm reduction sites in BC in 2018 and 2019, and was frequently used concurrently with opioids. Comparison to urine samples demonstrated high validity of self-reported crystal meth use. Understanding evolving patterns of substance use will be imperative in tailoring harm reduction and substance use services for individuals that use crystal meth.
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Affiliation(s)
- Kristi Papamihali
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Dylan Collins
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Karamouzian
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Roy Purssell
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Drug and Poison Information Centre, Vancouver, British Columbia, Canada
| | - Brittany Graham
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jane Buxton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Pisarski K. A Narrative Review of the Recent 'Ice' Epidemic: An Australian Perspective. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:11782218211010502. [PMID: 33958872 PMCID: PMC8064659 DOI: 10.1177/11782218211010502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/14/2021] [Indexed: 11/25/2022]
Abstract
Background: The use of methamphetamine or amphetamine stimulant drugs has been identified by authoritative public health bodies as a global health issue, with a worrying trend towards production and consumption of a higher purity crystalline form methamphetamine (ice) over the past decade. This trend has been well documented within Australia, resulting in a public perception of there being an ‘ice’ epidemic in regional/rural areas. Considering the illicit nature of ice, monitoring it is challenging and as such little information is available regarding the actual extent of methamphetamine use, harms and patterns in regional/remote Australia. Aim: To collate the available literature regarding methamphetamine use in regional/rural Australia and identify gaps in the literature. Methods: A literature search was conducted by searching 6 databases (PUBMED, Medline, CINAHL, EMBASE, PsycINFO and SCOPUS) following which exclusion/inclusion criteria were applied. Included papers were appraised with the Joanna Briggs Institute Critical appraisal tools and synthesised in light of the sociocultural, ethnic and geographic differences in methamphetamine use in Australia. Results: Regarding rural/regional Australia there is a significant lack of research into methamphetamine use, patterns and epidemiology since the rise of crystalline methamphetamine in 2013. The existing literature available suggests great variability in methamphetamine harms in rural communities. This can be a double-edged sword however, as the introduction of ice into a remote/rural community may result in greater harms if it becomes ingrained in local customs. Similarly, there is a lack of research into the specific factors within Indigenous communities leading to an increased rate of methamphetamine use amongst members. Recommendation: Future research should address the causes of variance in methamphetamine harms in rural/remote regions. Although the scope of this paper was the Australian context, a wider international approach may yield useful information.
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Affiliation(s)
- Konrad Pisarski
- Division of Tropical Health & Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Faculty of Medicine, University of Queensland, Herston, St Lucia, QLD, Australia
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A rapid review of the impacts of "Big Events " on risks, harms, and service delivery among people who use drugs: Implications for responding to COVID-19. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103127. [PMID: 33549464 PMCID: PMC7816610 DOI: 10.1016/j.drugpo.2021.103127] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND "Big Events" are major disruptions to physical, political, and economic environments that can influence vulnerability to drug-related harms. We reviewed the impacts of Big Events with relevance to the COVID-19 pandemic on drug-related risk and harms and access to drug treatment and harm reduction services. METHODS We conducted a rapid review of quantitative, qualitative, and mixed methods literature relating to the following Big Events: respiratory infection pandemics, natural disasters, financial crises, and heroin shortages. Included studies reported data on changes to risks, harms, and/or service provisioning for people who use illicit drugs (other than cannabis) in the context of these Big Events. Searches were conducted in PubMed in May 2020, and two reviewers screened studies for inclusion. Peer-reviewed studies published in English or French were included. We used a narrative synthesis approach and mapped risk pathways identified in the literature. RESULTS No studies reporting on respiratory infection pandemics were identified. Twelve studies reporting on natural disaster outcomes noted marked disruption to drug markets, increased violence and risk of drug-related harm, and significant barriers to service provision caused by infrastructure damage. Five studies of the 2008 global financial crisis indicated increases in the frequency of drug use and associated harms as incomes and service funding declined. Finally, 17 studies of heroin shortages noted increases in heroin price and adulteration, potentiating drug substitutions and risk behaviors, as well as growing demand for drug treatment. CONCLUSION Current evidence reveals numerous risk pathways and service impacts emanating from Big Events. Risk pathway maps derived from this literature provide groundwork for future research and policy analyses, including in the context of the COVID-19 pandemic. In light of the findings, we recommend responding to the pandemic with legislative and financial support for the flexible delivery of harm reduction services, opioid agonist treatment, and mental health care.
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Lopez AM, Dhatt Z, Howe M, Al-Nassir M, Billing A, Artigiani E, Wish ED. Co-use of methamphetamine and opioids among people in treatment in Oregon: A qualitative examination of interrelated structural, community, and individual-level factors. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 91:103098. [PMID: 33476863 DOI: 10.1016/j.drugpo.2020.103098] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/21/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rates of methamphetamine use and methamphetamine-related deaths have increased steadily in the United States in recent years. Methamphetamine is increasingly present in opioid-related deaths. An initial study of de-identified urine specimens (n = 102) collected at a drug treatment program between 2017 and 2018 indicated that 61% of specimens contained methamphetamine; of the specimens containing methamphetamine, people were, on average, five years younger than those who tested negative for methamphetamine; and non-fentanyl opioids were more than three times as common in methamphetamine positive specimens. The National Drug Early Warning System (NDEWS) Coordinating Center initiated a HotSpot Study to assess whether there was an emerging dynamic in the area, or if enhanced data collection could give insights into the co-use of methamphetamine and opioids. METHODS A qualitative study, grounded in principles of rapid ethnographic assessment and a social science/anthropological framework was conducted and used methodological complementarity to contextualize results from the initial urinalysis study. Targeted sampling was conducted at two treatment sites. Program staff and patients were recruited to participate in focus groups and semi-structured interviews to assess structural, community, and individual-level factors impacting methamphetamine and opioid co-use. RESULTS Within our broader framework of structural, community, and individual-level factors intersecting co-use, our data yielded three sub-themes: 1) the circulation of stigma regarding methamphetamine use was consistently described by both patients and staff and this intersected structural changes in treatment policy and suggested compounded stigma; 2) community-level factors and temporality were important for understanding patterns of methamphetamine use and for further interpreting the initial urinalysis; 3) patient rationales regarding the co-use of methamphetamine and opioids included strategies to mitigate the harms of heroin, as well as to detox or titrate the effects of heroin. CONCLUSION AND IMPLICATIONS Using an ethnographically-oriented and social science/anthropological approach and methodological complementarity to contextualize the prior urinalysis study demonstrates how behavioral variables cannot be abstracted from larger socio-structural and community contexts which impact people's decision-making process regarding co-use of methamphetamine and opioids. Further, by grounding our analysis in the meaning-centered and experiential narratives of people who use drugs, our research demonstrates the importance of considering the expertise of people who co-use opioids and methamphetamine as central for informing future sustainable program planning to address co-use that also accounts for the interrelationship between structural, community, and individual-level factors.
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Affiliation(s)
- Andrea M Lopez
- Department of Anthropology, University of Maryland, 1111Woods Hall, 4302 Chapel Lane, College Park, MD 20742, USA.
| | - Zena Dhatt
- Department of Anthropology, University of Maryland, 1111Woods Hall, 4302 Chapel Lane, College Park, MD 20742, USA
| | - Mary Howe
- Homeless Youth Alliance, PO Box 170427, San Francisco, CA 94117, USA
| | - Marwa Al-Nassir
- Center for Substance Abuse Research, University of Maryland, College Park, USA
| | - Amy Billing
- Center for Substance Abuse Research, University of Maryland, College Park, USA
| | - Eleanor Artigiani
- Center for Substance Abuse Research, University of Maryland, College Park, USA
| | - Eric D Wish
- Center for Substance Abuse Research, University of Maryland, College Park, USA
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Gaines TL, Wagner KD, Mittal ML, Bowles JM, Copulsky E, Faul M, Harding RW, Davidson PJ. Transitioning from pharmaceutical opioids: A discrete-time survival analysis of heroin initiation in suburban/exurban communities. Drug Alcohol Depend 2020; 213:108084. [PMID: 32544797 PMCID: PMC7371530 DOI: 10.1016/j.drugalcdep.2020.108084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/01/2020] [Accepted: 05/09/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Research identifying pathways to heroin use has typically been conducted among urban populations. This study examined heroin initiation following pharmaceutical opioid use in three suburban/exurban Southern California counties. METHODS Interviewer-administered surveys collected data among 330 participants (65.9 % male; 63.9 % non-Hispanic white) whose initial use of any opioid was a pharmaceutical opioid. Retrospective discrete-time survival analysis identified predictors of heroin initiation, measured as self-reported age of first heroin use. RESULTS Median age of first pharmaceutical opioid use was 17 years; 50.6 % initially acquired pharmaceutical opioids from an illicit source, 56.7 % first used pharmaceutical opioids for recreational purposes, and 86 % initiated heroin use. Average time from first pharmaceutical opioid use to first heroin use was 8.2 years. Drug/alcohol treatment (adjusted Hazard Ratio [aHR]: 0.67, 95 % CI: 0.50, 0.88) was associated with delayed time to heroin initiation. Obtaining opioids from non-medical sources (aHR: 2.21, 95 % CI: 1.55, 3.14) was associated with accelerated time to heroin initiation. Reporting supply problems with obtaining pharmaceutical opioids (e.g., unable to acquire pharmaceutical opioids) was associated with accelerated time to heroin initiation, but the magnitude of this effect was dependent on one's history of methamphetamine use (p < 0.05). CONCLUSIONS Time to heroin initiation following pharmaceutical opioid use was accelerated among those reporting supply problems and delayed among those with exposure to substance use treatment. Interventions interrupting supply of opioids might benefit from coordination with evidence-based medication-assisted treatment to minimize the risk of transitioning to heroin use, particularly among those with a long history of non-prescribed pharmaceutical opioid use.
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Affiliation(s)
- T L Gaines
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0507, La Jolla, CA 92093-0507, USA.
| | - K D Wagner
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - M L Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0507, La Jolla, CA 92093-0507, USA
| | - J M Bowles
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St. Toronto, Ontario, M5B 3M6, Canada
| | - E Copulsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive #0507, La Jolla, CA 92093-0507, USA
| | - M Faul
- Health Systems and Trauma Systems Branch, Mailstop F-62, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - R W Harding
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - P J Davidson
- Division of Infectious Diseases and 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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10
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Mei DS, Cai YJ, Wang FM, Ma BM, Liu HF, Zhou WH, Xu JP. Reciprocal Substitution Between Methamphetamine and Heroin in Terms of Reinforcement Effects in Rats. Front Psychiatry 2020; 11:750. [PMID: 32848928 PMCID: PMC7411143 DOI: 10.3389/fpsyt.2020.00750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
Heroin and methamphetamine are both popular illicit drugs in China. Previous clinical data showed that habitual users of either heroin or methamphetamine abuse the other drug for substitution in case of unavailability of their preferred drug. The present study aimed to observe whether heroin can substitute the methamphetamine reinforcement effect in rats, and vice versa. Rats were trained to self-administer heroin or methamphetamine (both 50 μg/kg/infusion) under an FR1 reinforcing schedule for 10 days. After having extracted the dose-effect curve of the two drugs, we administered methamphetamine at different doses (12.5-200 μg/kg/infusion) to replace heroin during the period of self-administration, and vice versa. The heroin dose-effect curve showed an inverted U-shaped trend, and the total intake dose of heroin significantly increased when the training dose increased from 50 to 100 or 200 μg/kg/infusion. Following replacement with methamphetamine, the total dose-effect curve shifted leftwards and upwards. By contrast, although the dose-effect curve of methamphetamine also showed an inverted U-shaped trend, the total dose of methamphetamine significantly decreased when the training dose decreased from 50 to 25 μg/kg/infusion; conversely, when the methamphetamine training dose increased, the total dose did not change significantly. The total dose-effect curve shifted rightwards after heroin was substituted with methamphetamine. Although heroin and methamphetamine had their own independent reward effects, low doses of methamphetamine can replace the heroin reward effect, while high doses of heroin can replace the methamphetamine reward effect. These results demonstrated that heroin and methamphetamine can substitute each other in terms of reinforcement effects in rats.
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Affiliation(s)
- Di-Sen Mei
- Neuropharmacology and Drug Discovery Group, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China.,Zhejiang Provincial Key Lab of Addiction, Ningbo University School of Medicine, Ningbo, China
| | - Yu-Jia Cai
- Zhejiang Provincial Key Lab of Addiction, Ningbo University School of Medicine, Ningbo, China
| | - Fang-Min Wang
- Zhejiang Provincial Key Lab of Addiction, Ningbo University School of Medicine, Ningbo, China
| | - Bao-Miao Ma
- Zhejiang Provincial Key Lab of Addiction, Ningbo University School of Medicine, Ningbo, China
| | - Hui-Fen Liu
- Zhejiang Provincial Key Lab of Addiction, Ningbo University School of Medicine, Ningbo, China.,Laboratory of Behavioral Neuroscience, Ningbo Addiction Research and Treatment Center, Ningbo University School of Medicine, Ningbo, China
| | - Wen-Hua Zhou
- Zhejiang Provincial Key Lab of Addiction, Ningbo University School of Medicine, Ningbo, China.,Laboratory of Behavioral Neuroscience, Ningbo Addiction Research and Treatment Center, Ningbo University School of Medicine, Ningbo, China
| | - Jiang-Ping Xu
- Neuropharmacology and Drug Discovery Group, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
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Ti L, Dong H, Day A, McKendry R, DeBeck K, Bingham B, Milloy MJ, Barrios R, Hayashi K. Longitudinal migration patterns from an open illicit drug scene among people who use illicit drugs in Vancouver, Canada. J Subst Abuse Treat 2019; 107:17-23. [PMID: 31757260 PMCID: PMC6892597 DOI: 10.1016/j.jsat.2019.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 09/23/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022]
Abstract
The objective of this study was to identify migration patterns from an open illicit drug scene (the Downtown Eastside [DTES] neighborhood) and describe factors associated with these migration patterns. Data were derived from three cohorts of people who use illicit drugs in Vancouver, Canada. Defined using latent class growth analysis, we identified four distinct migration trajectory groups: 1) consistently living in the DTES (47.8%); 2) early migration out, with a median time of migrating out of DTES of 5.3 months (21.5%); 3) late migration out, with a median time of migrating out of DTES of 38.0 months (20.1%); and 4) frequent revisit back-and-forth to DTES (10.6%). In a multivariable model, compared to the "consistently living in the DTES" group, factors associated with the "frequent revisit" group included being enrolled in non-pharmacological addiction treatment and having an HCV-positive serostatus. Factors associated with the "early migration out" group included being enrolled in detoxification or in other non-pharmacological addiction treatment, later calendar year, being on income assistance, living in a single room occupancy hotel, and having an HCV-positive serostatus. These findings point to the need for appropriate distribution of services in order to meet the needs of this population.
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Affiliation(s)
- Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Andrew Day
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Rachael McKendry
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada
| | - Brittany Bingham
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Rolando Barrios
- Vancouver Coastal Health Authority, 520 West 6th Avenue, Vancouver, BC V5Z 1A1, Canada; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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12
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Melo JS, Mittal ML, Horyniak D, Strathdee SA, Werb D. Injection Drug Use Trajectories among Migrant Populations: A Narrative Review. Subst Use Misuse 2018; 53:1558-1570. [PMID: 29364762 PMCID: PMC6033671 DOI: 10.1080/10826084.2017.1416404] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dual epidemics of injection drug use and blood-borne disease, characterized as "syndemics," are present in a range of settings. Behaviors that drive such syndemics are particularly prevalent among mobile drug-using populations, for whom cross-border migration may pose additional risks. OBJECTIVES This narrative review aims to characterize the risk factors for injection drug use initiation associated with migration, employing a risk environment framework and focusing on the San Diego-Tijuana border region as the most dynamic example of these phenomena. METHODS Based on previous literature, we divide migration streams into three classes: intra-urban, internal, and international. We synthesized existing literature on migration and drug use to characterize how mobility and migration drive the initiation of injection drug use, as well as the transmission of hepatitis and HIV, and to delineate how these might be addressed through public health intervention. RESULTS Population mixing between migrants and receiving communities and the consequent transmission of social norms about injection drug use create risk environments for injection drug use initiation. These risk environments have been characterized as a result of local policy environments, injection drug use norms in receiving communities, migration-related stressors, social dislocation, and infringement on the rights of undocumented migrants. CONCLUSION Policies that exacerbate risk environments for migrants may inadvertently contribute to the expansion of epidemics of injection-driven blood-borne disease. Successful interventions that address emerging syndemics in border regions may therefore need to be tailored to migrant populations and distinguish between the vulnerabilities experienced by different migration classes and border settings.
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Affiliation(s)
- Jason S Melo
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA
| | - Maria Luisa Mittal
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,b School of Medicine, Universidad Xochicalco , Tijuana , Baja California , Mexico
| | - Danielle Horyniak
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,c Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,d School of Public Health and Preventive Medicine, Monash University , Melbourne , Victoria , Australia
| | - Steffanie A Strathdee
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA
| | - Dan Werb
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,e Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada
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13
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Su S, Zhang L, Cheng F, Li S, Li S, Jing J, Fairley CK, Chen L, Zhao J, Mao L. Association between recreational drug use and sexual practices among people who inject drugs in Southwest China: a cross-sectional study. BMJ Open 2018; 8:e019730. [PMID: 29961003 PMCID: PMC6042564 DOI: 10.1136/bmjopen-2017-019730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe the differences in sexual practices among individuals with various drug administration patterns. SETTING A detoxification centre in Southwest China, a part of the Chinese national sentential surveillance network for hepatitis C virus (HCV), HIV and syphilis infections, was recruited. PARTICIPANTS A total of 610 newly enrolled injection drug users (IDUs) from detoxification centre were included during 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Self-reported sexual activities, drug-related practices and laboratory-confirmed HCV, HIV and syphilis infection status were collected. RESULTS Of the 610 IDU, 295 (48.4%) used heroin only, 277 (45.4%) poly-drug users reported the mixed use of synthetic drugs (SDs) with heroin and 38 (6.2%) used SDs only. The average daily drug injection frequency for poly-drug users (3.3±1.2 times) was the highest, followed by heroin-only (2.2±0.8 times) and SD-only users (1.2±0.4 time). SD-only drug users reported the highest proportion (86.8%) of engaging in sexual activities in the previous month, with more than half (54.5%) reporting any condomless sex. A higher frequency of daily injecting in heroin-only users was significantly correlated with the less likelihood of sex, condomless sex in the past month, having sex with fixed partners, condomless commercial sex in the previous 12 months (all p<0.01). In poly-drug users, who injected drugs two times per day was associated with the highest proportion of people who engaged in sex and commercial sex (p<0.05). For SD-only users, increased drug use was not associated with reducing sexual risk (p>0.05). Different patterns of HCV, HIV and syphilis infections prevalence rates were shown among the IDU depending on the roles and length of exposure. CONCLUSIONS The daily drug injecting frequency of heroin-only and poly-drug users was negatively associated with sexual activities, but SD-only users kept a high frequent engagement in sex. The interventions for relevant diseases should adapt to characteristics of IDU.
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Affiliation(s)
- Shu Su
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lei Zhang
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Research Center for Public Health, Tsinghua University, Beijing, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Feng Cheng
- Research Center for Public Health, Tsinghua University, Beijing, China
| | - Shunxiang Li
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Shifu Li
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jun Jing
- Research Center for Public Health, Tsinghua University, Beijing, China
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Christopher Kincaid Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Liang Chen
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jinxian Zhao
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Limin Mao
- Center for Social Research in Health, Faculty of Arts and Social Science, University of New South Wales, Sydney, New South Wales, Australia
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14
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Alavi M, Grebely J, Hajarizadeh B, Amin J, Larney S, Law MG, George J, Degenhardt L, Dore GJ. Mortality trends among people with hepatitis B and C: a population-based linkage study, 1993-2012. BMC Infect Dis 2018; 18:215. [PMID: 29743015 PMCID: PMC5944091 DOI: 10.1186/s12879-018-3110-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 04/24/2018] [Indexed: 01/16/2023] Open
Abstract
Background This study evaluated cause-specific mortality trends including liver-related mortality among people with a hepatitis B virus (HBV) and hepatitis C virus (HCV) notification in New South Wales, Australia. Methods Notifications 1993-2012 were linked to cause-specific mortality records 1993-2013. Results Among 57,929 and 92,474 people with a HBV and HCV notification, 4.8% and 10.0% died since 1997. In early 2010s, 28% and 33% of HBV and HCV deaths were liver-related, 28% and 17% were cancer-related (excluding liver cancer), and 5% and 15% were drug-related, respectively. During 2002-2012, annual HBV-related liver death numbers were relatively stable (53 to 68), while HCV-related liver death numbers increased considerably (111 to 284). Age-standardised HBV-related liver mortality rates declined from 0.2 to 0.1 per 100 person-years (PY) (P < 0.001); however, HCV-related rates remained stable (0.2 to 0.3 per 100 PY, P = 0.619). In adjusted analyses, older age was the strongest predictor of liver-related mortality [birth earlier than 1945, HBV adjusted hazard ratio (aHR) 28.1, 95% CI 21.0, 37.5 and; HCV aHR 31.9, 95% CI 26.8, 37.9], followed by history of alcohol-use disorder (HBV aHR 7.0, 95% CI 5.5, 8.8 and; HCV aHR 8.3, 95% CI 7.6, 9.1). Conclusions Declining HBV-related liver mortality rates and stable burden suggest an impact of improved antiviral therapy efficacy and uptake. In contrast, the impact of interferon-containing HCV treatment programs on liver-related mortality individual-level risk and population-level burden has been limited. These findings also highlight the importance of HBV/HCV public health interventions that incorporate increased antiviral therapy uptake, and action on health risk behaviors. Electronic supplementary material The online version of this article (10.1186/s12879-018-3110-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maryam Alavi
- Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia.
| | - Jason Grebely
- Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
| | - Behzad Hajarizadeh
- Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
| | - Janaki Amin
- Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia.,Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew G Law
- Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
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15
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Guise A, Horyniak D, Melo J, McNeill R, Werb D. The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis. Addiction 2017; 112:2098-2111. [PMID: 28734128 PMCID: PMC5673537 DOI: 10.1111/add.13957] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/03/2017] [Accepted: 07/14/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We reviewed and synthesized existing qualitative scientific literature systematically to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. METHODS We searched six databases (Medline, Embase, PsychINFO, CINAHL, IBSS and SSCI) systematically, along with a manual search, including key journals and subject experts. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes throughout studies. RESULTS From 1731 initial results, 41 studies reporting data from 1996 participants were included. We developed eight descriptive themes and two analytical (higher-order) themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity and coping with pain and trauma. CONCLUSIONS Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual harms through behavior change.
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Affiliation(s)
- Andy Guise
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA,Division of Health and Social Care, King’s College London, Addison House, Guy’s campus, London, UK
| | - Danielle Horyniak
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA,Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne VIC 3004, Australia,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne VIC 3004, Australia
| | - Jason Melo
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA
| | - Ryan McNeill
- British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, British Columbia Canada,Division of AIDS, Department of Medicine, University of British Columbia, 2775 Laurel St, Vancouver, British Columbia Canada
| | - Dan Werb
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA,International Centre for Science in Drug Policy, St. Michael’s Hospital, 30 Bond St, Toronto, Canada
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16
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Kelly PJ, Robinson LD, Baker AL, Deane FP, McKetin R, Hudson S, Keane C. Polysubstance use in treatment seekers who inject amphetamine: Drug use profiles, injecting practices and quality of life. Addict Behav 2017; 71:25-30. [PMID: 28242532 DOI: 10.1016/j.addbeh.2017.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/21/2017] [Accepted: 02/08/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The injection of amphetamine is becoming increasingly common. However, there has been a lack of research examining people who inject amphetamine as the primary drug of use, limiting the potential to ensure services address the unique needs of this group. The current study used latent class analysis to identify classes of polydrug use among people who report injecting amphetamine during the past 12months. It also examined differences between classes and drug use patterns, injecting practices, quality of life and psychological distress. METHODS Participants who were attending non-government specialist alcohol and other drug treatment across New South Wales, Australia and had identified amphetamine as their principle drug of concern and reported injecting amphetamine in the previous 12months were included in the current study (N=827). Latent class analysis was performed to identify polydrug profiles of participants. RESULTS The large majority of people in the current study (85%) demonstrated low probability of heroin or other opiate use. Three distinct classes of polydrug use were identified: (1) Low-polydrug (n=491), (2) Opiates-polydrug (n=123), and (3) Alcohol-polydrug (n=213). There was a trend for the Low-polydrug class to demonstrate better functioning and safer injecting practices than the Opiates-polydrug and Alcohol-polydrug classes. CONCLUSION The results suggest that the majority of people accessing treatment who inject amphetamine as their primary drug of choice have a low probability of heroin or other opiate use. It is important that future research consider whether traditional harm minimisation strategies are appropriate for people who primarily inject amphetamine.
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Affiliation(s)
- Peter J Kelly
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Australia; Centre for Health Initiatives, University of Wollongong, Australia.
| | - Laura D Robinson
- Centre for Health Initiatives, University of Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Frank P Deane
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Australia
| | - Rebecca McKetin
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Australia
| | - Suzie Hudson
- Network of Alcohol and other Drugs Agencies (NADA), Australia
| | - Carol Keane
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Australia; Centre for Health Initiatives, University of Wollongong, Australia
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17
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Flynn KC, Hoffer LD. Transitioning illicit drug preferences and emerging user identities in Ohio: The proliferation of methamphetamine use among African Americans. J Ethn Subst Abuse 2017; 18:67-88. [PMID: 28678637 DOI: 10.1080/15332640.2017.1325809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Understanding the social dynamics of local methamphetamine markets is critical to improving community health and reducing social costs associated with illicit drug use. We examine a local drug market in Summit County, Ohio, wherein methamphetamine users ascribe themselves different ethnic identities from those long associated with the drug elsewhere in the United States. Qualitative interviews with 52 study participants demonstrate that very poor and homeless White males and females are now using methamphetamine; however, even more surprising is that 31 of the participants identified themselves as poor or homeless, male or female African, Native, biracial, or multiracial Americans. The drug use trajectory of these 31 participants in particular involved a transition from a historical preference for crack to a present one for methamphetamine and, in some cases, a preference for concurrent use of methamphetamine and heroin. Many of these methamphetamine users also emphasized their ethnic identity to distinguish themselves as nonproducers of methamphetamine in comparison to Whites, who are commonly associated with methamphetamine production. Findings appear to suggest an emergent means of identity management resulting from the ethnic diversity of users in this methamphetamine market. These findings may have relevance in other communities with similar demographics and drug markets and may hold important implications for drug treatment, policy-making, and law enforcement professionals' work associated with methamphetamine users, producers, and distributors.
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Affiliation(s)
| | - Lee D Hoffer
- a Case Western Reserve University , Cleveland , Ohio
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18
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Hines LA, Lynskey M, Morley KI, Griffiths P, Gossop M, Powis B, Strang J. The relationship between initial route of heroin administration and speed of transition to daily heroin use. Drug Alcohol Rev 2017; 36:633-638. [PMID: 28470826 DOI: 10.1111/dar.12560] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND AIMS The effect of heroin administration route on speed of transition to regular use is unknown. This paper aims to determine whether the speed of transition from initiation of heroin use to daily heroin use differs by route of administration (injecting, chasing/inhaling or snorting). DESIGN AND METHODS Privileged access interviewer survey of purposively selected sample of 395 current people who use heroin (both in and not in treatment) in London, UK (historical sample from 1991). Data on age and year of initiation, time from initiation to daily use and routes of administration were collected by means of a structured questionnaire. Generalised ordered logistic models were used to test the relationship between route of initial administration of heroin and speed of transition to daily heroin use. Analyses were adjusted for gender, ethnicity, daily use of other drug(s) at time of initiation, year of initiation and treatment status at interview. RESULTS After adjustment, participants whose initial administration route was injecting had a 4.71 (95% confidence interval 1.34-16.5) increase in likelihood of progressing to daily use within 1-3 weeks of initiation, compared to those whose initial administration route was non-injecting. DISCUSSION AND CONCLUSIONS The speed of transition from first use to daily heroin use is faster if the individual injects heroin at initiation of use. Those who initiate heroin use through injecting have a shorter time frame for intervention before drug use escalation. [Hines LA, Lynskey M, Morley KI, Griffiths P, Gossop M, Powis B, Strang J. The relationship between initial route of heroin administration and speed of transition to daily heroin use. Drug Alcohol Rev 2017;00:000-000].
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Affiliation(s)
- Lindsey A Hines
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Lynskey
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katherine I Morley
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Griffiths
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Michael Gossop
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Beverly Powis
- National Offender Management Service, Wolverhampton, UK
| | - John Strang
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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19
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Sturman N, Saiepour N. Eligibility for opiate substitution therapy in recently released prisoners with high-risk amphetamine use, and their perceptions of its effectiveness. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1246622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nancy Sturman
- Discipline of General Practice, School of Medicine, Royal Brisbane Hospital, University of Queensland, Herston, Brisbane, Australia
| | - Nargess Saiepour
- School of Public Health, Royal Brisbane Hospital, University of Queensland, Herston, Brisbane, Australia
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20
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O'Keefe D, Scott N, Aitken C, Dietze P. Individual-level needle and syringe coverage in Melbourne, Australia: a longitudinal, descriptive analysis. BMC Health Serv Res 2016; 16:411. [PMID: 27542604 PMCID: PMC4992312 DOI: 10.1186/s12913-016-1668-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/12/2016] [Indexed: 12/23/2022] Open
Abstract
Background Coverage is used as one indicator of needle and syringe program (NSP) effectiveness. At the individual level, coverage is typically defined as an estimate of the proportion of a person who injects drugs’ (PWID) injecting episodes that utilise a sterile syringe. In this paper, we explore levels of individual syringe coverage and its changes over time. Methods Data were extracted from 1889 interviews involving 502 participants drawn from the Melbourne drug user cohort study (MIX). We asked questions relating to participants syringe acquisition, distribution and injecting frequency within the two weeks before interview. We created a dichotomous coverage variable that classified participants as sufficiently (≥100 %) covered if all their injecting episodes utilised at least one sterile syringe, and insufficiently (<100 %) covered if not. We categorised participants as “consistently covered” if they were sufficiently covered across interviews; as “consistently uncovered” if they were insufficiently covered across interviews; and “inconsistently covered” if they oscillated between coverage states. Chi-square statistics tested proportions of insufficient coverage across sub-groups using broad demographic, drug use and service utilisation domains. Logistic regression tested predictors of insufficient coverage and inconsistently covered categorisation. Results Across the sample, levels of insufficient coverage were substantial (between 22–36 % at each interview wave). The majority (50 %) were consistently covered across interviews, though many (45 %) were inconsistently covered. We found strong statistical associations between insufficient coverage and current hepatitis C virus (HCV) infection (RNA+). Current prescription of opioid substitution therapy (OST) and using NSPs as the main source of syringe acquisition were protective against insufficient coverage. Conclusion Insufficient coverage across the sample was substantial and mainly driven by those who oscillated between states of coverage, suggesting the presence of temporal factors. We recommend a general expansion of NSP services and OST prescription to encourage increases in syringe coverage. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1668-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel O'Keefe
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia. .,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Nick Scott
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Campbell Aitken
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Paul Dietze
- Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
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