1
|
Janssen E, Vuolo M. Correlates of Stimulant Use among People Who Use Heroin Undergoing Treatment in Out-Patient Facilities in France, 2010-2020. Subst Use Misuse 2024; 59:353-361. [PMID: 37859423 DOI: 10.1080/10826084.2023.2270682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: Polydrug use has been implicated in driving a "fourth wave" of the overdose crisis in North America, specifically through concurrent use of stimulants and opioids, especially fentanyl. In France, however, heroin has historically been and remains the easiest-to-access opioid, accounting for most drug treatment demand. Whether similar polydrug use is increasing in Western Europe remains understudied, despite severe health implications and potential inadequate public health responses.Methods: We take advantage of a nation-wide dataset containing information on all patients serviced in treatment centers in France from 2010 to 2020. We conduct Poisson regression to determine the main predictors of stimulant use among people who use heroin (PWUH) and opioids (PWUO) generally.Results: Heroin remains the primary opioid within drug treatment in France. A decreasing number of out-patients seeking treatment for heroin use has been accompanied by an increasing trend of stimulant use over time, most commonly with powder cocaine. Our results suggest a significant increase of crack cocaine use among the most vulnerable PWUH. Concurrent use of stimulants among PWUH was positively associated with use of alcohol, cannabis, unprescribed psychotropics and hallucinogens, and negatively with tobacco. Similar results were found for all in-treatment PWUO.Conclusions: Our results uncover heterogeneity in the profiles of PWUH that should be fully acknowledged to ensure better efficiency in substance use clinical practices and policy, while simultaneously drawing attention to trends in concurrent opioid-stimulant use outside North America. We advocate for an extension of the generalized risk framework and its implementation in prevention programs.
Collapse
Affiliation(s)
- Eric Janssen
- French Monitoring Centre on Drugs and Drug Addiction (Observatoire Français des Drogues et des Tendances Addictives - OFDT), Paris, France
| | - Michael Vuolo
- Department of Sociology, Ohio State University, Columbus, OH, USA
| |
Collapse
|
2
|
Edmundson C, Croxford S, Emanuel E, Njoroge J, Ijaz S, Hope V, Phipps E, Desai M. Recent increases in crack injection and associated risk factors among people who inject psychoactive drugs in England and Wales. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104262. [PMID: 38030466 DOI: 10.1016/j.drugpo.2023.104262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/03/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Crack use is higher in the United Kingdom (UK) than other European countries. Crack is a stimulant with a short half-life, requiring frequent injection to maintain its euphoric effects, thus increasing the risk of blood borne viruses (BBVs) and skin and soft tissue infections (SSTIs). We assessed trends in the prevalence of current crack injection among people who inject drugs (PWID) and investigated harms and other factors associated with its use. METHODS We used data from the annual Unlinked Anonymous Monitoring Survey of PWID, which recruits people who have ever injected psychoactive drugs through specialist services. Participants provide a biological sample and self-complete a questionnaire. We included participants from England and Wales who had injected in the past month. We examined trends in crack injection over time (2011-2021) and factors associated with crack injection using multivariable logistic regression (2019-2021). RESULTS The proportion of people self-reporting crack injection in the past month almost doubled between 2011-2020/21, from 34 % (416/1237) to 57 % (483/850). Crack injection was more frequently reported by males than females (adjusted odds ratio 1.46, 95 % confidence interval: 1.15-1.87) and injected alongside heroin (6.67, 4.06-10.97) more frequently than alone. Crack injection was independently associated with injecting equipment sharing (1.64, 1.30-2.07), groin injection (2.03, 1.60-2.56) in the past month, overdosing in the past year (1.90, 1.42-2.53), homelessness in the past year (1.42, 1.14-1.77) and ever having hepatitis C infection (1.64, 1.31-2.06). CONCLUSION Crack injection has increased significantly over the past decade in England and Wales. People injecting crack are more likely to engage in behaviours that increase the risk of BBV and SSTI acquisition, such as needle/syringe sharing, groin injection and polydrug use. Harm reduction and drug treatment services should adapt to support the needs of this growing population of people injecting stimulants.
Collapse
Affiliation(s)
- Claire Edmundson
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Sara Croxford
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK; St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Rd, Rainhill, Prescot, L35 5DR, UK
| | - Eva Emanuel
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Jacquelyn Njoroge
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Samreen Ijaz
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Vivian Hope
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK; Public Health Institute, Liverpool John Moores University, Henry Cotton Building 15-21 Webster St, Liverpool, L3 2ET, UK
| | - Emily Phipps
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Monica Desai
- National Infection Service, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| |
Collapse
|
3
|
Donnadieu H, Quillet C, D'Ottavi M, Castellani J, Debellefontaine A, Guichard S, Baglioni R, Langendorfer N, Faucherre V, Hanslik B, Tuaillon E, Laureillard D, Nagot N. Community-based respondent-driven sampling as a strategy for drug use surveillance in a large French urban area. Harm Reduct J 2023; 20:82. [PMID: 37386636 DOI: 10.1186/s12954-023-00814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Understanding drug use and behavior within the PWUD population is crucial to adapt harm reduction and prevention strategies, and provide improved addiction and medical treatment. However, in most countries such as France, the knowledge of drug use behaviors is likely biased as it originates from addiction centers which are attended by only an unknown proportion of PWUD. The objectives of this study were to describe drug use behavior in a population of active PWUD in the urban area of Montpellier, South of France. METHODS We implemented a community-based respondent-driven sampling survey (RDSS), a validated strategy to obtain a representative sample of a population, to recruit PWUD in the city. Adult individuals reporting frequent psychoactive drug use other than cannabis, with confirmation by urine test, were eligible. Beside HCV and HIV testing, trained peers interviewed participants on their drug consumption and behavior using standardized questionnaires. Fifteen seeds launched the RDSS. RESULTS During the 11 weeks of the RDSS, 554 actives PWUD were consecutively included. They were mostly men (78.8%), had a median age of 39 years, and only 25.6% had a stable living place. On average, participants consumed 4.7 (± 3.1) different drugs, and 42.6% smoked free-base cocaine. Unexpectedly, heroin and methamphetamine were consumed by 46.8% and 21.5% of participants, respectively. Among the 194 participants injecting drugs, 33% declared sharing their equipment. CONCLUSION This RDSS highlighted a high consumption of heroin, crack and methamphetamine in this PWUD population. These unexpected results can be explained by low attendance to addiction centers, the source of drug use reports. Despite free care and risk reduction equipment in the city, sharing was very frequent among injectors, challenging the current program of harm reduction.
Collapse
Affiliation(s)
- Hélène Donnadieu
- Department of Addiction Medicine, Montpellier University Hospital, 80 Rue Augustin Fliche, 34090, Montpellier, France.
- Pathogenesis and Control of Chronic and Emerging Infections, Etablissement Français du Sang, INSERM, University of Antilles-Guyane, University of Montpellier, 60 Rue de Navacelles, 34394, Montpellier, France.
| | - Catherine Quillet
- Pathogenesis and Control of Chronic and Emerging Infections, Etablissement Français du Sang, INSERM, University of Antilles-Guyane, University of Montpellier, 60 Rue de Navacelles, 34394, Montpellier, France
| | - Morgana D'Ottavi
- Pathogenesis and Control of Chronic and Emerging Infections, Etablissement Français du Sang, INSERM, University of Antilles-Guyane, University of Montpellier, 60 Rue de Navacelles, 34394, Montpellier, France
| | - Joëlle Castellani
- Pathogenesis and Control of Chronic and Emerging Infections, Etablissement Français du Sang, INSERM, University of Antilles-Guyane, University of Montpellier, 60 Rue de Navacelles, 34394, Montpellier, France
| | - Anne Debellefontaine
- Pathogenesis and Control of Chronic and Emerging Infections, Etablissement Français du Sang, INSERM, University of Antilles-Guyane, University of Montpellier, 60 Rue de Navacelles, 34394, Montpellier, France
- AXESS, Harm Reduction Center, SOS Solidarités, 66 Avenue Charles Flahaut, 34090, Montpellier, France
| | - Sylvain Guichard
- Association of Marginality and Drug Addiction (AMT), 10 Boulevard Victor Hugo, 34000, Montpellier, France
| | - René Baglioni
- Department of Addiction Medicine, Montpellier University Hospital, 80 Rue Augustin Fliche, 34090, Montpellier, France
| | - Nicolas Langendorfer
- Department of Addiction Medicine, Montpellier University Hospital, 80 Rue Augustin Fliche, 34090, Montpellier, France
| | - Vincent Faucherre
- Department of Addiction Medicine, Montpellier University Hospital, 80 Rue Augustin Fliche, 34090, Montpellier, France
| | - Bertrand Hanslik
- Department of Addiction Medicine, Montpellier University Hospital, 80 Rue Augustin Fliche, 34090, Montpellier, France
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic and Emerging Infections, Etablissement Français du Sang, INSERM, University of Antilles-Guyane, University of Montpellier, 60 Rue de Navacelles, 34394, Montpellier, France
| | - Didier Laureillard
- Pathogenesis and Control of Chronic and Emerging Infections, Etablissement Français du Sang, INSERM, University of Antilles-Guyane, University of Montpellier, 60 Rue de Navacelles, 34394, Montpellier, France
- Department of Infectious Diseases, Caremeau University Hospital, Place du Professeur Robert Debré, 30029, Nîmes, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Etablissement Français du Sang, INSERM, University of Antilles-Guyane, University of Montpellier, 60 Rue de Navacelles, 34394, Montpellier, France
| |
Collapse
|
4
|
Steenbeek R, Emke E, Vughs D, Matias J, Boogaerts T, Castiglioni S, Campos-Mañas M, Covaci A, de Voogt P, Ter Laak T, Hernández F, Salgueiro-González N, Meijer WG, Dias MJ, Simões S, van Nuijs ALN, Bijlsma L, Béen F. Spatial and temporal assessment of crack cocaine use in 13 European cities through wastewater-based epidemiology. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 847:157222. [PMID: 35901880 DOI: 10.1016/j.scitotenv.2022.157222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Already in early 2000s, concerns have been growing in the EU about increasing use of cocaine and it is estimated that below 1 % of the population administer the drug by smoking crack cocaine. New available data suggests an increase in the use of crack cocaine and an increase in the number of crack cocaine users entering treatment has been reported in several European countries. Robust estimations of crack cocaine use are however not available yet. The use of crack cocaine has long been associated with severe adverse socio-economic conditions as well as mental health problems, such as suicide ideation and depression. The aim of this study was to assess spatial trends in population-normalized mass loads of crack cocaine biomarkers (i.e., anhydroecgonine and anhydroecgonine methyl ester) in 13 European cities in six countries (the Netherlands, Belgium, Ireland, Portugal, Spain and Italy). Furthermore, temporal trends over a five-year period were evaluated through the analysis of historic samples collected in the Netherlands. Finally, the stability of the crack cocaine biomarkers in wastewater was investigated through batch experiments. The samples were analyzed with a new developed and validated hydrophilic interaction liquid chromatography coupled to mass spectrometry method. Targeted crack cocaine biomarkers were found in all cities. Also, crack cocaine biomarker was detected in wastewater from 2017 to 2021 in the Netherlands, but no significance between the years were found. With respect to biomarker in-sample stability, AEME was found to be stable in wastewater. This study assessed crack cocaine use for the first time on a broad scale, both temporal and in cities across Europe, with wastewater-based epidemiology and it shows the importance of wastewater analysis to monitor community loads of crack cocaine use.
Collapse
Affiliation(s)
- Ruud Steenbeek
- KWR Water Research Institute, Nieuwegein, the Netherlands.
| | - Erik Emke
- KWR Water Research Institute, Nieuwegein, the Netherlands
| | - Dennis Vughs
- KWR Water Research Institute, Nieuwegein, the Netherlands
| | - João Matias
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Tim Boogaerts
- Toxicological Center, University of Antwerp, Antwerp, Belgium
| | - Sara Castiglioni
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Marina Campos-Mañas
- Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain
| | - Adrian Covaci
- Toxicological Center, University of Antwerp, Antwerp, Belgium
| | - Pim de Voogt
- KWR Water Research Institute, Nieuwegein, the Netherlands
| | - Thomas Ter Laak
- KWR Water Research Institute, Nieuwegein, the Netherlands; Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, the Netherlands
| | - Félix Hernández
- Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain
| | - Noelia Salgueiro-González
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Wim G Meijer
- UCD School of Biomolecular and Biomedical Science, University College Dublin, Ireland
| | - Mario J Dias
- National Institute of Legal Medicine and Forensic Sciences, Lisbon, Portugal
| | - Susana Simões
- National Institute of Legal Medicine and Forensic Sciences, Lisbon, Portugal
| | | | - Lubertus Bijlsma
- Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain
| | - Frederic Béen
- KWR Water Research Institute, Nieuwegein, the Netherlands
| |
Collapse
|
5
|
Goulian A, Jauffret-Roustide M, Dambélé S, Singh R, Fullilove RE. A cultural and political difference: comparing the racial and social framing of population crack cocaine use between the United States and France. Harm Reduct J 2022; 19:44. [PMID: 35550157 PMCID: PMC9096779 DOI: 10.1186/s12954-022-00625-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Andrew Goulian
- Columbia University, Mailman School of Public Health, New York, USA.
| | - Marie Jauffret-Roustide
- CEMS, Inserm U1276, CNRS UMR 8044, EHESS, Paris, France.,British Columbia Centre on Substance Use (BCCSU), Vancouver, Canada.,Baldy Center for Law and Social Policy, Buffalo University of Social Sciences, New York, USA.,Institut Convergences Migrations, Campus Condorcet, Aubervilliers, France
| | - Sayon Dambélé
- Agence Nationale de L'Inclusion Économique et Sociale, Conakry, Guinea
| | - Rajvir Singh
- Columbia University, Mailman School of Public Health, New York, USA.,Rural Workforce Agency Victoria, Melbourne, Australia
| | | |
Collapse
|
6
|
Jangal C, Lovera M, Dambélé S, Jauffret-Roustide M. Sociological and spatial dynamics of an evolving Parisian open drug scene: the case of the “Colline du Crack”. DRUGS AND ALCOHOL TODAY 2021. [DOI: 10.1108/dat-02-2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
In November 2019, an open drug scene, commonly called “Colline du crack” and located in Paris was forcibly closed after 10 years of existence. This paper aims to understand how that space has evolved over the years to become a major hub for drug use.
Design/methodology/approach
The authors used a qualitative approach that included interviews with 52 people who use drugs (PWUD) and 54 field professionals and ethnographic observations. The authors asked questions about the evolution of the major sites of crack visibility in Paris and about social representations related to these spaces. They compared their datas with datas drawn from gray literature.
Findings
La Colline emerged on an isolated slope, away from police repression and local anti-crack organizations. In the beginning, it was a discrete, communal space regulated by PWUD. Starting in 2015, social transformations in the neighborhood turned la Colline into a central hub for dealing and using crack. La Colline became an open scene which led to its evacuation in 2019.
Originality/value
This paper contributes to literature on community building of drug consumers. The authors are also using a wide variety of methodological tools.
Collapse
|