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Whittaker R, Midtbø JE, Kløvstad H. Monitoring Progress Towards the Elimination of Hepatitis C as a Public Health Threat in Norway: A Modelling Study Among People Who Inject Drugs and Immigrants. J Infect Dis 2024; 230:e700-e711. [PMID: 38537267 PMCID: PMC11420790 DOI: 10.1093/infdis/jiae147] [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: 11/17/2023] [Accepted: 03/26/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND The global incidence target for the elimination of hepatitis C among people who inject drugs (PWID) is <2/100. In Norway, the hepatitis C epidemic is concentrated in PWID. Immigrants are the second most important risk group for chronic infection. We modelled the incidence of hepatitis C among active PWID, and the prevalence of chronic infection among active PWID, ex-PWID, and immigrants in Norway to 2022. METHODS We built a stochastic compartmental model, which was informed using data from national data sources, literature, and expert opinion. We report median values with 95% credible intervals (CrI). RESULTS The model estimated 30 (95% Crl, 13-52) new infections among active PWID in 2022, or 0.37/100 (95% Crl, 0.17-0.65), down from a peak of 726 (95% Crl, 506-1067) in 2000. Across all groups, the model estimated 3202 (95% Crl, 1273-6601) chronically infected persons in 2022. Results were robust in sensitivity analyses. CONCLUSIONS Norway provides an example of the feasibility of hepatitis C elimination in a setting with a concentrated epidemic, high coverage of harm reduction services, and no treatment restrictions. Continued momentum is needed to further reduce the transmission and burden of hepatitis C in Norway.
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Affiliation(s)
- Robert Whittaker
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Jørgen E Midtbø
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | - Hilde Kløvstad
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
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Spencer H, Gregoire D, Leichtling G, Herink M, Seaman A, Korthuis PT, Cook R. Harm Reduction in Peer-Assisted Telemedicine for Hepatitis C: Secondary Outcomes of a Randomized Controlled Trial. Viruses 2024; 16:1455. [PMID: 39339931 PMCID: PMC11437492 DOI: 10.3390/v16091455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/07/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Hepatitis C (HCV) treatment for people who use drugs (PWUD) decreases injection drug use and injection equipment sharing. We examined changes in injection drug use and injection equipment sharing following HCV treatment in a randomized trial comparing peer-assisted telemedicine for HCV treatment (TeleHCV) versus peer-assisted usual care in rural PWUD. We hypothesize that TeleHCV reduces risky behaviors and peers facilitate this change. We used mixed-effects logistic regression to describe participant-level (n = 203) associations between both injection drug use and injection equipment sharing and randomized groups, frequency of peer contact, HCV treatment initiation, HCV cure, and time. Risky behaviors were surveyed at baseline and 12 and 36 weeks after HCV treatment completion. Injection drug use declined more over time in TeleHCV participants vs. control at 12 weeks (adjusted odds ratio [aOR] = 0.42, 95% CI 0.20-0.87, p = 0.02) and 36 weeks (aOR = 0.48, 95% CI 0.21-1.08, p = 0.076). Injection drug use decreased more with a greater number of peer interactions, with reductions among participants in the 3rd quartile exceeding those in the 1st quartile of peer interactions at 12 weeks (aOR = 0.75, 95% CI 0.57-0.99, p = 0.04). Similarly, injection equipment sharing decreased over time, with reductions among participants in the 3rd quartile exceeding those in the 1st quartile of peer interactions at 36 weeks (aOR = 0.08, 95% CI 0.01-0.97, p = 0.047). Peer-assisted telemedicine for HCV treatment decreases injection drug use and injection equipment sharing; peers contribute to this effect.
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Affiliation(s)
- Hunter Spencer
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Devin Gregoire
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | | | - Megan Herink
- College of Pharmacy, Oregon State University, Corvallis, OR 97331, USA
| | - Andrew Seaman
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Central City Concern, Portland, OR 97209, USA
| | - P Todd Korthuis
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ryan Cook
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR 97239, USA
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Macdonald C, Macpherson G, Leppan O, Tran LT, Cunningham EB, Hajarizadeh B, Grebely J, Farrell M, Altice FL, Degenhardt L. Interventions to reduce harms related to drug use among people who experience incarceration: systematic review and meta-analysis. Lancet Public Health 2024; 9:e684-e699. [PMID: 39214637 DOI: 10.1016/s2468-2667(24)00160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/26/2024] [Accepted: 07/04/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Mortality, suicide, self-harm, and substance use are elevated among people who are incarcerated. There is a wide range of heterogeneous interventions aimed at reducing these harms in this population. Previous reviews have focused on specific interventions or limited their findings to drug use and recidivism and have not explored interventions delivered after release from prison. Our aim is to examine the effect of interventions delivered to people who use drugs during incarceration or after release from incarceration, on a wide range of outcomes. METHODS In this systematic review and meta-analysis, we searched Embase, MEDLINE, and PsycINFO databases up until Sept 12, 2023 for studies published from Jan 1, 1980 onwards. All studies evaluating the effectiveness of any intervention on drug use, recidivism outcomes, sexual or injecting risk behaviours, or mortality among people who use psychoactive drugs and who were currently or recently incarcerated were included. Studies without a comparator or measuring only alcohol use were excluded. Data extracted from each study included demographic characteristics, interventions, and comparisons. Pooled odds ratios and risk ratios were calculated using random-effects meta-analyses. FINDINGS We identified 126 eligible studies (47 randomised controlled trials and 79 observational studies) encompassing 18 interventions; receiving opioid-agonist treatment (OAT) in prison reduced the risk of death in prison (one study; hazard ratio 0·25; 95% CI 0·13-0·48), whereas receiving OAT in the first 4 weeks following release reduced risk of death in the community (two studies; relative risk 0·24; 95% CI 0·15-0·37). Therapeutic community interventions reduced re-arrest at 6-12 months (six studies; odds ratio [OR] 0·72; 95% CI 0·55-0·95) and reincarceration at 24 months (two studies; OR 0·66; 95% CI 0·48-0·96). There was scarce evidence that OAT and syringe service provision are effective in reducing injecting risk behaviours and needle and syringe sharing. INTERPRETATION There are effective interventions to reduce mortality and recidivism for people who use drugs who have been incarcerated. Nonetheless, there are also substantial gaps in the research examining the effect of interventions on risk behaviours and mortality during incarceration and a need for randomised designs examining outcomes for people who use drugs after release. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Christel Macdonald
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Georgina Macpherson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Oscar Leppan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Evan B Cunningham
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
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Eustaquio PC, Smyth J, Salisi JA. The Risks for HIV and Sexually Transmitted Infections Among Men Who Have Sex with Men Who Engage in Chemsex in Low- and Middle-Income Countries: A Mixed Methods Systematic Review and Meta-Analysis. AIDS Behav 2024; 28:3060-3079. [PMID: 38878136 DOI: 10.1007/s10461-024-04393-0] [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] [Accepted: 05/24/2024] [Indexed: 09/12/2024]
Abstract
Chemsex, the use of drugs during and/or prior to sex, has been found to increase the risk of HIV and sexually transmitted infections (STI) among men who have sex with men (MSM). Many studies and reviews on chemsex were focused among MSM in high-income countries (HIC), with less attention given to understanding chemsex in low- and middle-income countries (LMIC). We estimated the prevalence of chemsex and its association with sexual risk behaviors, HIV, and STI among MSM in LMIC. We searched MEDLINE, Embase, GlobalHealth, PsychINFO, and CINAHL for quantitative, qualitative, and mixed-methods studies describing chemsex and its association with sexual risk behaviors, HIV, and STI among MSM in LMIC, published January 1, 2000-October 15, 2023. We used the Mixed Methods Appraisal Tool to assess study quality. We developed a narrative review and performed meta-analysis using a random effects model and the DerSimonian and Laird approach (PROSPERO #CRD42022339663). Thirty-two studies from LMIC, particularly from Asia, Africa, Latin America, and the Middle East, were included. MSM who engaged in chemsex had higher prevalence of condomless anal intercourse, group sex, having multiple sexual partners, and of HIV and STI compared to MSM who did not. We estimated a pooled prevalence for recent chemsex (≤ 12 months) of 16% (95% CI 11%-22%, τ = 0.01, I2 = 99.07%, p < 0.01). Chemsex and its associated behaviors are associated with HIV and STI among MSM in LMIC. Integration of harm reduction and sexual health services and structural changes could prevent HIV and STI prevention among MSM who engage in chemsex in LMIC.
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Affiliation(s)
- Patrick C Eustaquio
- School of Public Health, Imperial College London, London, W2 1PG, UK.
- LoveYourself Inc, 3rd floor, 715-A Shaw Boulevard, Barangay Wack-wack, Mandaluyong, Metro Manila, 1552, Philippines.
| | - Jamie Smyth
- School of Public Health, Imperial College London, London, W2 1PG, UK
- Royal Free London National Health Service Foundation Trust, London, NW3 2QG, UK
| | - James A Salisi
- Independent consultant in Atlanta, Atlanta, Georgia, USA
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Martinello M, Matthews GV. Reinfection After Hepatitis C Virus Treatment-Keep Testing, Keep Treating. JAMA Netw Open 2024; 7:e2430290. [PMID: 39186277 DOI: 10.1001/jamanetworkopen.2024.30290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Affiliation(s)
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, Australia
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Markoulidakis A, Hickman M, McAuley A, Barnsdale LR, Welton NJ, Glancy M, Shivaji T, Collins C, Lang J, de Wit F, Hunt G, Wilkinson L, Fraser R, Yeung A, Horsburgh K, Priyadarshi S, Hutchinson SJ, Jones HE. Prevalence of opioid dependence in Scotland 2015-2020: A multi-parameter estimation of prevalence (MPEP) study. Addiction 2024; 119:1410-1420. [PMID: 38631671 DOI: 10.1111/add.16500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND AIMS Drug-related deaths in Scotland more than doubled between 2011 and 2020. To inform policymakers and understand drivers of this increase, we estimated the number of people with opioid dependence aged 15-64 from 2014/15 to 2019/20. DESIGN We fitted a Bayesian multi-parameter estimation of prevalence (MPEP) model, using adverse event rates to estimate prevalence of opioid dependence jointly from Opioid Agonist Therapy (OAT), opioid-related mortality and hospital admissions data. Estimates are stratified by age group, sex and year. SETTING Scotland, 2014/15 to 2019/20. PARTICIPANTS People with opioid dependence and potential to benefit from OAT, whether ever treated or not. Using data from the Scottish Public Health Drug Linkage Programme, we identified a baseline cohort of individuals who had received OAT within the last 5 years, and all opioid-related deaths and hospital admissions (whether among or outside of this cohort). MEASUREMENTS Rates of each adverse event type and (unobserved) prevalence were jointly modelled. FINDINGS The estimated number and prevalence of people with opioid dependence in Scotland in 2019/20 was 47 100 (95% Credible Interval [CrI] 45 700 to 48 600) and 1.32% (95% CrI 1.28% to 1.37%). Of these, 61% received OAT during 2019/20. Prevalence in Greater Glasgow and Clyde was estimated as 1.77% (95% CrI 1.69% to 1.85%). There was weak evidence that overall prevalence fell slightly from 2014/15 (change -0.07%, 95% CrI -0.14% to 0.00%). The population of people with opioid dependence is ageing, with the estimated number of people aged 15-34 reducing by 5100 (95% CrI 3800 to 6400) and number aged 50-64 increasing by 2800 (95% CrI 2100 to 3500) between 2014/15 and 2019/20. CONCLUSIONS The prevalence of opioid dependence in Scotland remained high but was relatively stable, with only weak evidence of a small reduction, between 2014/15 and 2019/20. Increased numbers of opioid-related deaths can be attributed to increased risk among people with opioid dependence, rather than increasing prevalence.
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Affiliation(s)
- Andreas Markoulidakis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Public Health Scotland, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew McAuley
- Public Health Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Megan Glancy
- Public Health Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | | | | | | | | | - Rosalyn Fraser
- Public Health Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Alan Yeung
- Public Health Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Saket Priyadarshi
- Alcohol and Drug Recovery Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sharon J Hutchinson
- Public Health Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Stewardson AJ, Davis JS, Dunlop AJ, Tong SYC, Matthews GV. How I manage severe bacterial infections in people who inject drugs. Clin Microbiol Infect 2024; 30:877-882. [PMID: 38316359 DOI: 10.1016/j.cmi.2024.01.022] [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: 10/16/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Injecting drug use is a risk factor for severe bacterial infection, but there is limited high-quality evidence to guide clinicians providing care to people who inject drugs. Management can be complicated by mistrust, stigma, and competing patient priorities. OBJECTIVES To review the management of severe infections in people who inject drugs, using an illustrative clinical scenario of complicated Staphylococcus aureus bloodstream infection. SOURCES The discussion is based on recent literature searches of relevant topics. Very few randomized clinical trials have focussed specifically on the management of severe bacterial infections among people who inject drugs. Most recommendations are, therefore, based on observational studies, extrapolation from other patient groups, and the experience and opinions of the authors. CONTENT We discuss evidence and options regarding the following management issues for severe bacterial infections among people who inject drugs: initial management of sepsis; indications for surgical management; assessment and management of substance dependence; approaches to antibiotic administration following clinical stability; opportunistic health promotion; and secondary prevention of bacterial infections. Throughout, we highlight the importance of harm reduction and strategies to optimize patient engagement in care through a patient-centred approach. IMPLICATIONS We advocate for a multi-disciplinary trauma-informed approach to the management of severe bacterial infection among people who inject drugs. We emphasize the need for pragmatic trials to inform management guidelines, including those that are co-designed with the community. In particular, research is needed to establish the comparative effectiveness, safety, and cost-effectiveness of inpatient intravenous antibiotics vs. early oral antibiotic switch, outpatient parenteral therapy, and long-acting lipoglycopeptide antibiotics in this scenario.
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Affiliation(s)
- Andrew J Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Joshua S Davis
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Infection Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Adrian J Dunlop
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; NSW Drug and Alcohol Clinical Research and Improvement Network, Sydney, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; St Vincent's Hospital, Sydney, NSW, Australia
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Santo T, Gisev N, Campbell G, Colledge-Frisby S, Wilson J, Tran LT, Lynch M, Martino-Burke D, Taylor S, Degenhardt L. Prevalence of comorbid substance use disorders among people with opioid use disorder: A systematic review & meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104434. [PMID: 38677160 DOI: 10.1016/j.drugpo.2024.104434] [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: 01/17/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Comorbid substance use disorders (SUDs) among people with opioid use disorder (OUD) contribute to poor clinical outcomes, including overdose and mortality. We present the first systematic review and meta-analysis to estimate the prevalence of specific non-opioid SUDs among people with OUD. METHODS We searched Embase, PsycINFO, and MEDLINE from 1990 to 2022 for studies that used Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria to assess the prevalence of non-opioid SUDs among individuals with OUD. We used random-effects meta-analyses with 95% Confidence Intervals (CIs) to pool current and lifetime prevalence estimates separately. Meta-regressions and stratified meta-analyses were used to examine differences in prevalence estimates by sample characteristics and methodological factors. RESULTS Of the 36,971 publications identified, we included data from 194 studies and 77,212 participants with OUD. The prevalence of any comorbid SUD among people with OUD was 59.5% (95%CI 49.1-69.5%) for current non-opioid SUDs, with 72.0% (95%CI 52.5-87.9%) experiencing a comorbid SUD in their lifetime. Of the studies that examined current comorbid SUDs, cocaine use disorder (30.5%, 95%CI 23.0-38.7%) was most common, followed by alcohol (27.1%, 95%CI 24.4- 30.0%), cannabis (22.7%, 95%CI 19.0-26.6%), sedative (16.1%, 95%CI 13.1-19.3%), and methamphetamine (11.4%, 95%CI 6.8-17.1%) use disorders. Substantial heterogeneity (I2>90%) across estimates was observed. Substantial heterogeneity (I2>90%) was observed across estimates, with significant variations in prevalence identified across geographic locations, recruitment settings, and other study-level factors. CONCLUSION Findings from this study emphasize the importance of comorbid SUD treatment access for people with OUD. Our estimates can inform the provision of treatment and harm reduction strategies for people with OUD and specific subpopulations.
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Affiliation(s)
- Thomas Santo
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia.
| | - Natasa Gisev
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia; School of Psychology, University of Queensland, St. Lucia, Queensland, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia; National Drug Research Institute, Curtin University, Melbourne, Australia; Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Jack Wilson
- Matilda Centre, The University of the Sydney, Sydney, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
| | - Michelle Lynch
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
| | - Daniel Martino-Burke
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
| | - Sophia Taylor
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia
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Webb P, Ireland J, Colledge-Frisby S, Peacock A, Leung J, Vickerman P, Farrell M, Hickman M, Grebely J, Degenhardt L. Patterns of drug use among people who inject drugs: A global systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104455. [PMID: 38796926 DOI: 10.1016/j.drugpo.2024.104455] [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: 12/11/2023] [Revised: 03/28/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND A better understanding of global patterns of drug use among people who inject drugs can inform interventions to reduce harms related to different use profiles. This review aimed to comprehensively present the geographical variation in drug consumption patterns among this population. METHODS Systematic searches of peer reviewed (PsycINFO, Medline, Embase) and grey literature published from 2008-2022 were conducted. Data on recent (past year) and lifetime drug use among people who inject drugs were included. Data were extracted on use of heroin, amphetamines, cocaine, benzodiazepines, cannabis, alcohol, and tobacco; where possible, estimates were disaggregated by route of administration (injecting, non-injecting, smoking). National estimates were generated and, where possible, regional, and global estimates were derived through meta-analysis. RESULTS Of 40,427 studies screened, 394 were included from 81 countries. Globally, an estimated 78.1 % (95 %CI:70.2-84.2) and 71.8 % (65.7-77.2) of people who inject drugs had recently used (via any route) and injected heroin, while an estimated 52.8 % (47.0-59.0) and 19.8 % (13.8-26.5) had recently used and injected amphetamines, respectively. Over 90 % reported recent tobacco use (93.5 % [90.8-95.3]) and recent alcohol use was 59.1 % (52.6-65.6). In Australasia recent heroin use was lowest (49.4 % [46.8-52.1]) while recent amphetamine injecting (64.0 % [60.8-67.1]) and recent use of cannabis (72.3 % [69.9-74.6]) were higher than in all other regions. Recent heroin use (86.1 % [78.3-91.4]) and non-injecting amphetamine use (43.3 % [38.4-48.3]) were highest in East and Southeast Asia. Recent amphetamine use (75.8 % [72.7-78.8]) and injecting heroin use (84.8 % (81.4-87.8) were highest in North America while non-injecting heroin use was highest in Western Europe (45.0 % [41.3-48.7]). CONCLUSION There is considerable variation in types of drugs and routes of administration used among people who inject drugs. This variation needs to be considered in national and global treatment and harm reduction interventions to target the specific behaviours and harms associated with these regional profiles of use.
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Affiliation(s)
- Paige Webb
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
| | - Jeremy Ireland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; National Drug Research Institute (NDRI) Melbourne, Curtin University, Melbourne, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Australia
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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10
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Greenwald ZR, Werb D, Feld JJ, Austin PC, Fridman D, Bayoumi AM, Gomes T, Kendall CE, Lapointe-Shaw L, Scheim AI, Bartlett SR, Benchimol EI, Bouck Z, Boucher LM, Greenaway C, Janjua NZ, Leece P, Wong WWL, Sander B, Kwong JC. Validation of case-ascertainment algorithms using health administrative data to identify people who inject drugs in Ontario, Canada. J Clin Epidemiol 2024; 170:111332. [PMID: 38522754 DOI: 10.1016/j.jclinepi.2024.111332] [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: 11/23/2023] [Revised: 02/12/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES Health administrative data can be used to improve the health of people who inject drugs by informing public health surveillance and program planning, monitoring, and evaluation. However, methodological gaps in the use of these data persist due to challenges in accurately identifying injection drug use (IDU) at the population level. In this study, we validated case-ascertainment algorithms for identifying people who inject drugs using health administrative data in Ontario, Canada. STUDY DESIGN AND SETTING Data from cohorts of people with recent (past 12 months) IDU, including those participating in community-based research studies or seeking drug treatment, were linked to health administrative data in Ontario from 1992 to 2020. We assessed the validity of algorithms to identify IDU over varying look-back periods (ie, all years of data [1992 onwards] or within the past 1-5 years), including inpatient and outpatient physician billing claims for drug use, emergency department (ED) visits or hospitalizations for drug use or injection-related infections, and opioid agonist treatment (OAT). RESULTS Algorithms were validated using data from 15,241 people with recent IDU (918 in community cohorts and 14,323 seeking drug treatment). An algorithm consisting of ≥1 physician visit, ED visit, or hospitalization for drug use, or OAT record could effectively identify IDU history (91.6% sensitivity and 94.2% specificity) and recent IDU (using 3-year look back: 80.4% sensitivity, 99% specificity) among community cohorts. Algorithms were generally more sensitive among people who inject drugs seeking drug treatment. CONCLUSION Validated algorithms using health administrative data performed well in identifying people who inject drugs. Despite their high sensitivity and specificity, the positive predictive value of these algorithms will vary depending on the underlying prevalence of IDU in the population in which they are applied.
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Affiliation(s)
- Zoë R Greenwald
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
| | - Jordan J Feld
- Department of Medicine, University of Toronto, Toronto, Canada; Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Canada; University Health Network, Toronto, Canada
| | - Peter C Austin
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Ahmed M Bayoumi
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of General Internal Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto Canada
| | - Tara Gomes
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; Ontario Drug Policy Research Network, Toronto, Canada
| | - Claire E Kendall
- ICES, Toronto, Canada; Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada
| | - Ayden I Scheim
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Eric I Benchimol
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada; Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Zachary Bouck
- Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, Montreal, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Canada; Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation & Outcome Sciences, St Paul's Hospital Vancouver, Vancouver, Canada
| | - Pamela Leece
- Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - William W L Wong
- ICES, Toronto, Canada; School of Pharmacy, University of Waterloo, Kitchener, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada
| | - Beate Sander
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada; Public Health Ontario, Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; University Health Network, Toronto, Canada; Public Health Ontario, Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
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11
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Malme KB, Stene-Johansen K, Klundby I, Backe Ø, Foshaug T, Greve MH, Pihl CM, Finbråten AK, Dalgard O, Midgard H. Virologic Response and Reinfection Following HCV Treatment among Hospitalized People Who Inject Drugs: Follow-Up Data from the OPPORTUNI-C Trial. Viruses 2024; 16:858. [PMID: 38932151 PMCID: PMC11209464 DOI: 10.3390/v16060858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Treatment of hepatitis C among people who inject drugs (PWID) may be complicated by loss to follow-up and reinfection. We aimed to evaluate sustained virologic response (SVR) and reinfection, and to validate complete pharmacy dispensation as a proxy for cure among PWID enrolled in a trial of opportunistic HCV treatment. Data were obtained by reviewing the electronic patient files and supplemented by outreach HCV RNA testing. Reinfection was defined based on clinical, behavioral, and virological data. Intention to treat SVR ≥ 4 within 2 years after enrolment was accomplished by 59 of 98 (60% [95% CI 50-70]) during intervention conditions (opportunistic treatment) and by 57 of 102 (56% [95% CI 46-66]) during control conditions (outpatient treatment). The time to end of treatment response (ETR) or SVR ≥ 4 was shorter among intervention participants (HR 1.55 [1.08-2.22]; p = 0.016). Of participants with complete dispensation, 132 of 145 (91%) achieved ETR or SVR > 4 (OR 12.7 [95% CI 4.3-37.8]; p < 0.001). Four cases of reinfection were identified (incidence 3.8/100 PY [95% CI 1.0-9.7]). Although SVR was similar, the time to virologic cure was shorter among intervention participants. Complete dispensation is a valid correlate for cure among individuals at risk of loss to follow-up. Reinfection following successful treatment remains a concern.
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Affiliation(s)
- Kristian Braathen Malme
- Department of Infectious Diseases, Akershus University Hospital, 1478 Lørenskog, Norway;
- Institute of Clinical Medicine, University of Oslo, 0371 Oslo, Norway
| | | | - Ingvild Klundby
- Department of Microbiology, Oslo University Hospital, 0424 Oslo, Norway
| | - Øystein Backe
- Agency for Social and Welfare Services, 0182 Oslo, Norway; (Ø.B.); (T.F.)
| | - Tarjei Foshaug
- Agency for Social and Welfare Services, 0182 Oslo, Norway; (Ø.B.); (T.F.)
| | | | | | - Ane-Kristine Finbråten
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, 0456 Oslo, Norway;
- Department of Infectious Diseases, Oslo University Hospital, 0424 Oslo, Norway
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, 1478 Lørenskog, Norway;
- Institute of Clinical Medicine, University of Oslo, 0371 Oslo, Norway
| | - Håvard Midgard
- Department of Gastroenterology, Oslo University Hospital, 0424 Oslo, Norway;
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12
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Mudiope P, Mutamba BB, Komuhangi L, Nangendo J, Alamo S, Mathers B, Makumbi F, Wanyenze R. Retention of people who inject drugs enrolled in a 'medications for opioid use disorder' (MOUD) programme in Uganda. Addict Sci Clin Pract 2024; 19:39. [PMID: 38750568 PMCID: PMC11094991 DOI: 10.1186/s13722-024-00468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Injection Drug use is associated with increased HIV risk behaviour that may result in the transmission of HIV and poor access to HIV prevention and treatment. In 2020, Uganda introduced the 'medication for opioid use disorder (MOUD) treatment' for People who inject drugs (PWID). We analysed the 12-month retention and associated factors among PWID enrolled on MOUD treatment in Kampala, Uganda. METHODS We conducted a retrospective analysis of 343 PWID with OUD who completed 14 days of methadone induction from September 2020 to July 2022. Retention was defined as the number of individuals still in the programme divided by the total number enrolled, computed at 3-, 6-, 9-, and 12 months using lifetable and Kaplan-Meier survival analyses. Cox proportional regression analyses were conducted to assess factors associated with retention in the programme in the first 12 months. RESULTS Overall, 243 (71%) of 343 participants stabilized at a methadone dose of 60 mg or more. The majority of participants were males (n = 284, 82.8%), and the median (interquartile range, IQR) age was 31 (26-38) years. Most participants (n = 276, 80.5%) lived 5 km or more away from the MOUD clinic. Thirty (8.8%) were HIV-positive, 52 (15.7%) had a major mental illness and 96 (27.9%) had a history of taking alcohol three months before enrollment. The cumulative retention significantly declined from 83.4% (95%CI = 79.0-87.0) at 3months to 71.9% (95%CI = 67.2-76.6) at 6months, 64% 95%CI = 58.7-68.9) at 9months, and 55.2%; 95% CI (49.8-60.3% at 12months. The 12-month retention was significantly higher for participants on methadone doses of 60 mg or more (adj.HR = 2.1, 95%CI = 1.41-3.22), while participants resident within 5 km of the MOUD clinic were 4.9 times more likely to be retained at 12 months, compared to those residing 5 km or more, (adj. HR = 4.81, 95%CI = 1.54-15). Other factors, including predisposing, need, and enabling factors, were not associated with retention. CONCLUSION Our study demonstrates acceptable 12-month retention rates for people who inject drugs, comparable to previous studies done in both developing and developed countries. Sustaining and improving retention may require enhanced scaling up of MOUD dose to an optimal level in the first 14 days and reducing the distance between participant locale and MOUD clinics.
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Affiliation(s)
- Peter Mudiope
- Makerere University School of Public Health, Kampala, Uganda.
| | | | - Liz Komuhangi
- Butabika National Referral Mental Hospital, Kampala, Uganda
| | - Joan Nangendo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Stella Alamo
- United States of America Centers for Disease Control and Prevention, Kampala, Uganda
| | - Bradley Mathers
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | | | - Rhoda Wanyenze
- Makerere University School of Public Health, Kampala, Uganda
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13
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Yeung A, Wilkinson M, Bishop J, Taylor B, Palmateer N, Barnsdale L, Lang J, Cameron C, McCormick D, Clusker T, McAuley A, Hutchinson S. SARS-CoV-2 vaccine uptake and risks of severe COVID-19 disease among people prescribed opioid agonist therapy in Scotland. J Epidemiol Community Health 2024; 78:380-387. [PMID: 38594065 DOI: 10.1136/jech-2023-221602] [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: 10/27/2023] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND There is limited evidence quantifying the risk of severe COVID-19 disease among people with opioid dependence. We examined vaccine uptake and severe disease (admission to critical care or death with COVID-19) among individuals prescribed opioid agonist therapy (OAT). METHOD A case-control design was used to examine vaccine uptake in those prescribed OAT compared with the general population, and the association between severe disease and OAT. In both analyses, 10 controls from the general population were matched (to each OAT recipient and COVID-19 case, respectively) according to socio-demographic factors. Conditional logistic regression was used to estimate rate ratios (RR) for severe disease. RESULTS Vaccine uptake was markedly lower in the OAT cohort (dose 1: 67%, dose 2: 53% and dose 3: 31%) compared with matched controls (76%, 72% and 57%, respectively). Those prescribed OAT within the last 5 years, compared with those not prescribed, had increased risk of severe COVID-19 (RR 3.38, 95% CI 2.75 to 4.15), particularly in the fourth wave (RR 6.58, 95% CI 4.20 to 10.32); adjustment for comorbidity and vaccine status attenuated this risk (adjusted RR (aRR) 2.43, 95% CI 1.95 to 3.02; wave 4 aRR 3.78, 95% CI 2.30 to 6.20). Increased risk was also observed for those prescribed OAT previously (>3 months ago) compared with recently (aRR 1.74, 95% CI 1.11 to 2.71). CONCLUSIONS The widening gap in vaccine coverage for those prescribed OAT, compared with the general population, is likely to have exacerbated the risk of severe COVID-19 in this population over the pandemic. However, continued OAT use may have provided protection from severe COVID-19 among those with opioid dependence.
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Affiliation(s)
- Alan Yeung
- Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| | - Max Wilkinson
- Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| | | | | | - Norah Palmateer
- Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| | | | | | | | | | | | - Andrew McAuley
- Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| | - Sharon Hutchinson
- Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
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14
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Puljević C, Tscharke B, Wessel EL, Francis C, Verhagen R, O'Brien JW, Bade R, Nadarajan D, Measham F, Stowe MJ, Piatkowski T, Ferris J, Page R, Hiley S, Eassey C, McKinnon G, Sinclair G, Blatchford E, Engel L, Norvill A, Barratt MJ. Characterising differences between self-reported and wastewater-identified drug use at two consecutive years of an Australian music festival. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 921:170934. [PMID: 38360330 DOI: 10.1016/j.scitotenv.2024.170934] [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: 12/01/2023] [Revised: 01/24/2024] [Accepted: 02/10/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND In the context of drug prohibition, potential adulteration and variable purity pose additional health risks for people who use drugs, with these risks often compounded by the outdoor music festival environment. Ahead of the imminent implementation of drug checking services in Queensland, Australia, this study aims to characterise this problem using triangulated survey and wastewater data to understand self-reported and detected drug use among attendees of a multi-day Queensland-based music festival in 2021 and 2022. METHODS We administered an in-situ survey focusing on drug use at the festival to two convenience samples of 136 and 140 festival attendees in 2021 and 2022 respectively. We compared survey findings to wastewater collected concurrently from the festival's site-specific wastewater treatment plant, which was analysed using Liquid Chromatography Tandem Mass Spectrometry. RESULTS Most survey respondents (82 % in 2021, 92 % in 2022) reported using or intending to use an illicit drug at the festival. Some respondents reported potentially risky drug use practices such as using drugs found on the ground (2 % in 2021, 4 % in 2022). Substances detected in wastewater but not surveys include MDEA, mephedrone, methylone, 3-MMC, alpha-D2PV, etizolam, eutylone, and N,N-dimethylpentylone. CONCLUSION Many substances detected in wastewater but not self-reported in surveys likely represent substitutions or adulterants. These findings highlight the benefits of drug checking services to prevent harms from adulterants and provide education on safer drug use practices. These findings also provide useful information on socio-demographic characteristics and drug use patterns of potential users of Queensland's future drug checking service.
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Affiliation(s)
- Cheneal Puljević
- The Loop Australia, Australia; School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Benjamin Tscharke
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Australia
| | - Ellen Leslie Wessel
- The Loop Australia, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Rory Verhagen
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Australia
| | - Jake W O'Brien
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Australia
| | - Richard Bade
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Australia
| | - Dhayaalini Nadarajan
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Australia
| | - Fiona Measham
- The Loop Australia, Australia; Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, United Kingdom; The Loop Drug Checking Service, United Kingdom
| | - M J Stowe
- The Loop Australia, Australia; The Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | - Timothy Piatkowski
- The Loop Australia, Australia; School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Jason Ferris
- The Loop Australia, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Robert Page
- The Loop Australia, Australia; National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia; Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
| | | | - Christopher Eassey
- The Loop Australia, Australia; National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia
| | | | | | | | | | | | - Monica J Barratt
- The Loop Australia, Australia; National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia; Social Equity Research Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, Vic, Australia
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15
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Sabin K, Burke-Shyne N, Yang T. Repeated surveys of people who inject drugs: The exception, not the rule. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104388. [PMID: 38584005 DOI: 10.1016/j.drugpo.2024.104388] [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: 08/29/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024]
Abstract
HIV surveillance is the continuous, systematic collection, analysis and interpretation of HIV-related data needed for the planning, implementation, and evaluation of the HIV response. Some communities are affected by HIV more than others and require more focused responses; one of these communities are people who inject drugs (PWID.) We reviewed HIV surveillance among PWID across all countries. We identified countries with specific repeated surveys among PWID using data submitted to the UNAIDS Global AIDS Monitoring system, supplemented by national reports from countries that do not report to UNAIDS. Countries with four or more surveys since 2011, with at least one since 2017, were sent a brief survey to ask the use and relevance of the collected data for their respective HIV responses and the challenges they foresaw. Thirty-two countries were polled, of which 17 responded. Respondents highlighted the utility of the surveys to measure HIV prevalence, antiretroviral treatment and other service use. Future funding and maintaining capacity to implement surveys are current or coming challenges.
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Affiliation(s)
- Keith Sabin
- UNAIDS, 20, Avenue Appia, CH 1211 Geneva, Switzerland; Harm Reduction International, London, UK.
| | | | - Titi Yang
- UNAIDS, 20, Avenue Appia, CH 1211 Geneva, Switzerland
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16
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Parmar A, Chakraborty R, Balhara YPS. Current status of harm reduction in India: Are we doing enough? Indian J Psychiatry 2024; 66:388-391. [PMID: 38778856 PMCID: PMC11107929 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_963_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Arpit Parmar
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Radhika Chakraborty
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Yatan P. S. Balhara
- National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India
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17
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Young AM, Havens JR, Cooper HLF, Fallin-Bennett A, Fanucchi L, Freeman PR, Knudsen H, Livingston MD, McCollister KE, Stone J, Vickerman P, Freeman E, Jahangir T, Larimore E, White CR, Cheatom C, Community Staff K, Design Team K. Kentucky Outreach Service Kiosk (KyOSK) Study protocol: a community-level, controlled quasi-experimental, type 1 hybrid effectiveness study to assess implementation, effectiveness and cost-effectiveness of a community-tailored harm reduction kiosk on HIV, HCV and overdose risk in rural Appalachia. BMJ Open 2024; 14:e083983. [PMID: 38431295 PMCID: PMC10910671 DOI: 10.1136/bmjopen-2024-083983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Many rural communities bear a disproportionate share of drug-related harms. Innovative harm reduction service models, such as vending machines or kiosks, can expand access to services that reduce drug-related harms. However, few kiosks operate in the USA, and their implementation, impact and cost-effectiveness have not been adequately evaluated in rural settings. This paper describes the Kentucky Outreach Service Kiosk (KyOSK) Study protocol to test the effectiveness, implementation outcomes and cost-effectiveness of a community-tailored, harm reduction kiosk in reducing HIV, hepatitis C and overdose risk in rural Appalachia. METHODS AND ANALYSIS KyOSK is a community-level, controlled quasi-experimental, non-randomised trial. KyOSK involves two cohorts of people who use drugs, one in an intervention county (n=425) and one in a control county (n=325). People who are 18 years or older, are community-dwelling residents in the target counties and have used drugs to get high in the past 6 months are eligible. The trial compares the effectiveness of a fixed-site, staffed syringe service programme (standard of care) with the standard of care supplemented with a kiosk. The kiosk will contain various harm reduction supplies accessible to participants upon valid code entry, allowing dispensing data to be linked to participant survey data. The kiosk will include a call-back feature that allows participants to select needed services and receive linkage-to-care services from a peer recovery coach. The cohorts complete follow-up surveys every 6 months for 36 months (three preceding kiosk implementation and four post-implementation). The study will test the effectiveness of the kiosk on reducing risk behaviours associated with overdose, HIV and hepatitis C, as well as implementation outcomes and cost-effectiveness. ETHICS AND DISSEMINATION The University of Kentucky Institutional Review Board approved the protocol. Results will be disseminated in academic conferences and peer-reviewed journals, online and print media, and community meetings. TRIAL REGISTRATION NUMBER NCT05657106.
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Affiliation(s)
- April M Young
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah L F Cooper
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Laura Fanucchi
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Patricia R Freeman
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky, USA
| | - Hannah Knudsen
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Melvin D Livingston
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Kathryn E McCollister
- Division of Health Services Research and Policy, University of Miami, Coral Gables, Florida, USA
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Edward Freeman
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
| | - Tasfia Jahangir
- Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Elizabeth Larimore
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Carol R White
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, Kentucky, USA
| | | | - KyOSK Community Staff
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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18
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Stowe MJ, Gatonye R, Maharjan I, Kehinde S, Arya S, Valderrábano JH, Mcbride A, Scheibein F, Igonya EK, Fast D. The war on drugs is a war on us: young people who use drugs and the fight for harm reduction in the Global South. Harm Reduct J 2024; 21:43. [PMID: 38368391 PMCID: PMC10874574 DOI: 10.1186/s12954-023-00914-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 02/19/2024] Open
Abstract
In the Global South, young people who use drugs (YPWUD) are exposed to multiple interconnected social and health harms, with many low- and middle-income countries enforcing racist, prohibitionist-based drug policies that generate physical and structural violence. While harm reduction coverage for YPWUD is suboptimal globally, in low- and middle-income countries youth-focused harm reduction programs are particularly lacking. Those that do exist are often powerfully shaped by global health funding regimes that restrict progressive approaches and reach. In this commentary we highlight the efforts of young people, activists, allies, and organisations across some Global South settings to enact programs such as those focused on peer-to-peer information sharing and advocacy, overdose monitoring and response, and drug checking. We draw on our experiential knowledge and expertise to identify and discuss key challenges, opportunities, and recommendations for youth harm reduction movements, programs and practices in low- to middle-income countries and beyond, focusing on the need for youth-driven interventions. We conclude this commentary with several calls to action to advance harm reduction for YPWUD within and across Global South settings.
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Affiliation(s)
- M-J Stowe
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
- South African Network of People Who Use Drugs (SANPUD), Cape Town, South Africa.
- Community Orientated Substance Use Program, University of Pretoria, Pretoria, South Africa.
| | - Rita Gatonye
- Women in Response to HIV/AIDS and Drug Addiction, Umuahia, Nigeria
| | | | - Seyi Kehinde
- Youth RISE Nigeria, Federal Capital Territory, Nigeria
| | - Sidarth Arya
- State Drug Dependence Treatment Centre, Institute of Mental Health, Pt B.D.S University of Health Sciences, Rohtak, India
| | | | - Angela Mcbride
- South African Network of People Who Use Drugs (SANPUD), Cape Town, South Africa
| | - Florian Scheibein
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | | | - Danya Fast
- University of British Columbia and British Columbia Centre On Substance Use, Vancouver, Canada
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19
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Lancaster KE, Stockton M, Remch M, Wester CW, Nash D, Brazier E, Adedimeji A, Finlayson R, Freeman A, Hogan B, Kasozi C, Kwobah EK, Kulzer JL, Merati T, Tine J, Poda A, Succi R, Twizere C, Tlali M, Groote PV, Edelman EJ, Parcesepe AM. Availability of substance use screening and treatment within HIV clinical sites across seven geographic regions within the IeDEA consortium. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104309. [PMID: 38228025 PMCID: PMC10939808 DOI: 10.1016/j.drugpo.2023.104309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Overwhelming evidence highlights the negative impact of substance use on HIV care and treatment outcomes. Yet, the extent to which alcohol use disorder (AUD) and other substance use disorders (SUD) services have been integrated within HIV clinical settings is limited. We describe AUD/SUD screening and treatment availability in HIV clinical sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. METHODS In 2020, 223 IeDEA HIV clinical sites from 41 countries across seven geographic regions completed a survey on capacity and practices related to management of AUD/ SUD. Sites provided information on AUD and other SUD screening and treatment practices. RESULTS Sites were from low-income countries (23%), lower-middle-income countries (38%), upper-middle income countries (17%) and high-income counties (23%). AUD and SUD screening using validated instruments were reported at 32% (n=71 located in 12 countries) and 12% (n=27 located in 6 countries) of the 223 sites from 41 countries, respectively. The North American region had the highest proportion of clinics that reported AUD screening (76%), followed by East Africa (46%); none of the sites in West or Central Africa reported AUD screening. 31% (n=69) reported both AUD screening and counseling, brief intervention, psychotherapy, or Screening, Brief Intervention, and Referral to Treatment; 8% (n=18) reported AUD screening and detox hospitalization; and 10% (n=24) reported both AUD screening and medication. While the proportion of clinics providing treatment for SUD was lower than those treating AUD, the prevalence estimates of treatment availability were similar. CONCLUSIONS Availability of screening and treatment for AUD/SUD in HIV care settings is limited, leaving a substantial gap for integration into ongoing HIV care. A critical understanding is needed of the multilevel implementation factors or feasible implementation strategies for integrating screening and treatment of AUD/SUD into HIV care settings, particularly for resource-constrained regions.
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Affiliation(s)
| | - Melissa Stockton
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Molly Remch
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Denis Nash
- City University of New York (CUNY), New York, NY, USA
| | - Ellen Brazier
- City University of New York (CUNY), New York, NY, USA
| | | | | | - Aimee Freeman
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Breanna Hogan
- Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Judiacel Tine
- Centre Hospitalier National Universitaire de Fann, Dakar, Senagal
| | - Armel Poda
- Université Polytechnique de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Regina Succi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Christelle Twizere
- Centre National de Référence en Matière de VIH/SIDA au Burundi, Bujumbura, Burundi
| | - Mpho Tlali
- University of Cape Town, Cape Town, South Africa
| | - Per von Groote
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
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Marks LR, Durkin MJ, Ayres K, Ellis M. Drug preparation, injection-related infections, and harm reduction practices among a national sample of individuals entering treatment for opioid use disorder. Harm Reduct J 2024; 21:16. [PMID: 38243269 PMCID: PMC10799462 DOI: 10.1186/s12954-024-00939-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The rise in injection drug use in the USA has led to an increase in injection site infections. We performed a national survey of people who use drugs to evaluate common drug use preparation, harm reduction practices, and experiences with injection site infections. METHODS A survey was disseminated to members of the Survey of Key Informants' Patients Program from 2021 to 2022 and distributed to patients 18 years or older newly entering one of 68 substance use disorder treatment programs across the USA with a primary diagnosis of an opioid use disorder. Participants were surveyed about practices when preparing and using drugs, along with self-reported infections and drug use complications. RESULTS 1289 participants responded to the survey. Sexually transmitted infections were common, with 37.6% reporting ever having had any sexually transmitted infection. Injection-associated infections had affected 63.4% of participants who had ever used injection drugs. Many respondents reported not seeking professional medical assistance for infection management, including 29% draining abscesses without seeking medical care and 22.8% obtaining antibiotics through non-healthcare sources. Non-sterile injection practices included sharing needles with others who were febrile or ill (18%), using needles previously used to drain wounds/abscesses (9.9%) for subsequent injection drug use, and licking needles (21.2%). CONCLUSION Patients entering treatment for opioid use disorder reported a high burden of infectious diseases. A number of easily-modifiable high risk behaviors for developing injection-related infections were identified. Efforts are needed to disseminate targeted harm reduction education to PWID on how to reduce their risks for injection-related infections.
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Affiliation(s)
- Laura R Marks
- Division of Infectious Disease, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, USA.
| | - Michael J Durkin
- Division of Infectious Disease, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, USA
| | - Kelly Ayres
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Ellis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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21
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Dumchev K, Kovtun O, Salnikov S, Titar I, Saliuk T. Integrated biobehavioral surveillance among people who inject drugs in Ukraine, 2007-2020. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104319. [PMID: 38216437 DOI: 10.1016/j.drugpo.2024.104319] [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: 06/27/2023] [Revised: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Repeated integrated biobehavioral surveys (IBBS) have been implemented among people who inject drugs (PWID) in Ukraine to monitor the trends in key epidemiologic and programmatic indicators. METHODS The study analyzed seven PWID IBBS rounds from 2007 to 2020 in seven Ukrainian cities. Participants were recruited using respondent-driven sampling, tested for HIV and anti-HCV antibodies, and completed a structured questionnaire. Composite weights (based on individual sampling probability and population size) were applied to generate point estimates and confidence intervals for HIV and HCV prevalence, injection risk behaviors, prevention service coverage, and HIV treatment cascade. Multi-level regression assessed temporal trends in these indicators in 2007-2020. RESULTS The samples consisted of 1587 participants in 2007, 1905 in 2008/9, 3066 in 2011, 2846 in 2013, 2699 in 2015, 2798 in 2017, and 3651 in the 2020 rounds. HIV prevalence decreased from 27% to 19% overall, and among PWID younger than 25 from 10.5% to 5.5%. Anti-HCV prevalence increased from 50% to 73% overall but decreased from 58% to 27% in the younger subgroup. Past-30-days injection risk behaviors consistently decreased, reaching a minimum of 38% for any risk in 2020. HIV treatment cascade indicators and coverage with opioid agonist treatment substantially improved in the last three rounds. Harm reduction services coverage fluctuated, declining from 52% to 33% in the last three rounds. CONCLUSIONS This analysis demonstrates the potential of repeated IBBS for monitoring the HIV epidemic and program coverage. We confirmed a sustained decline in overall HIV and HCV transmission, likely driven by reduced risky injection practices among PWID. The impact of harm reduction services requires further study. HIV status awareness and treatment coverage among PWID markedly increased, reaching the national average, possibly indicating the success of case-finding and linkage-to-care interventions. The upcoming IBBS round in Ukraine will also assess the impact of the war on service provision, risk behavior, and HIV transmission among PWID.
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Affiliation(s)
| | | | - Serhii Salnikov
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Ivan Titar
- Public Health Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
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22
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Bharat C, Chidwick K, Gisev N, Farrell M, Ali R, Degenhardt L. Trends in use of medicines for opioid agonist treatment in Australia, 2013-2022. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104255. [PMID: 38029481 DOI: 10.1016/j.drugpo.2023.104255] [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: 07/19/2023] [Revised: 09/26/2023] [Accepted: 10/29/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND There are limited longitudinal data on national patterns of opioid agonist treatment (OAT). This study describes 10-year trends in the sales of OAT medicines in Australia. METHODS A descriptive and time-series analysis of methadone, sublingual (SL) buprenorphine (+/-naloxone), and long-acting injectable (LAI) buprenorphine sold in Australia between 2013 and 2022 was performed. Total units sold were converted into an estimate of the number of clients that could be treated over a 28-day period with that amount of medicine ('client-months'). RESULTS Between January 2013 and December 2022, the estimated number of client-months on: any OAT increased by 50 % to 53,501, methadone decreased (-8.5%), SL buprenorphine increased (+78%), and LAI buprenorphine increased substantially after September 2019. In January 2013, 78 % of OAT client-months received methadone. By December 2022, 48 % received methadone, 26 % SL buprenorphine, and 26 % LAI buprenorphine. Between 2013 to 2022, OAT client-months per capita were highest in the state of New South Wales. Over the study period, greater increases in OAT were observed in very remote areas (88%) compared to major cities (53%). The number of client-months in non-community pharmacy settings remained stable from 2013 to 2019/20, before increasing markedly. The introduction of LAI buprenorphine was associated with an immediate, sustained increase of 1,636 OAT client-months, and further increases of 190 OAT client-months each month. CONCLUSION Patterns of OAT have shifted over the last 10-years with buprenorphine (SL/LAI) now the most common OAT used in Australia. The introduction of LAI buprenorphine has expanded OAT access, particularly in non-community pharmacy settings, and in remote areas.
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Affiliation(s)
- Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW, Australia.
| | - Kendal Chidwick
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW, Australia
| | - Robert Ali
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW, Australia
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23
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Tookes HE, Bartholomew TS, Sugar SES, Plesons MD, Bluthenthal RN, Wenger LD, Patel SV, Kral AH, Lambdin BH. Updates on syringe coverage and service uptake among needle and syringe programs in the United States, 2019-2020. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104289. [PMID: 38071932 PMCID: PMC10878422 DOI: 10.1016/j.drugpo.2023.104289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND As injection drug use has increased in the US, so too has the prevalence of receptive syringe sharing. Since the 1980s, Needle and Syringe Programs (NSPs) have been an important source of clean injection equipment and disposal of used syringes. This study reports national syringe coverage and examines the impact of program attributes on organizational-level service uptake, defined as number of syringes distributed per participant contact per year. METHODS In 2019 and 2020, we administered an annual cross-sectional survey to NSPs operating in the US (n = 260). A national estimate of coverage was calculated by dividing the total number of syringes distributed by the 2019 and 2020 population estimate of people who inject drugs (PWID). Frequency distributions and percentages were calculated for categorical variables (e.g., funding, census region, distribution policy/modality), and median and interquartile ranges (IQR) were calculated for continuous variables (e.g., participant contacts, syringes distributed). Bivariate and multivariable mixed effects logistic regression models were used to estimate the odds ratio associated with organizational characteristics on increasing service uptake at the NSP level. RESULTS From 2019 to 2020, the total number of participant contacts by NSPs increased from 871,976 to 898,891, and the number of syringes distributed increased from 92,648,529 to 113,071,748. The national coverage estimate increased from 29.5 (95 % CI = 15.0, 58.2) to 35.8 (95 % CI = 18.2, 70.6) syringes per PWID. Fifty-eight percent of NSPs increased service uptake in 2020 as compared to the previous year. NSPs that received government funding and NSPs that changed to a less restrictive syringe distribution policy were more likely to increase service uptake (aOR 1.80, 95 % CI = 1.01, 3.22 and aOR 3.33, 95 % CI = 1.11, 9.94, respectively). Syringe distribution modalities also diversified, with more NSPs reaching participants via backpacking/outreach, fixed site pop-ups, mobile delivery, mail-based delivery, leaving supplies out, and secondary distribution. CONCLUSION Both governmental investment in harm reduction programming and needs-based distribution of syringes increased service uptake and thus should be expanded and sustained to reduce harms associated with injection drug use.
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Affiliation(s)
- Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Sabrina E Soto Sugar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marina D Plesons
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | | | | | - Alex H Kral
- RTI International, Berkeley, CA, United States
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24
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Whiteside B, Dunn M. Voices represented and voices silenced: Represented voices in the media coverage of the implementation of a supervised injecting facility. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104213. [PMID: 37776603 DOI: 10.1016/j.drugpo.2023.104213] [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: 12/02/2022] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Victoria's first medically supervised injecting room (MSIR) has remained controversial despite mounting evidence in support of the facility. The opposition to a policy idea is subject to a myriad of factors including the media. Favouring the opinions of various actors, the media are a fundamental element of the narrative formation process. In this article, we examine the voices represented and voice silenced in print news media and the possible effects of such reporting. METHODS A quantitative content and qualitative thematic analysis of Victorian print media (n=645) focusing on the implementation and continued operation of North Richmond Community Health's medically supervised injecting room was conducted. RESULTS The representations of the MSIR were debated by three predominant actors - politicians, public, and residents. Politicians largely relied on the 'saving lives' rhetoric when supporting the facility. In addition, competing representations of 'public amenity' were presented by both advocates and proponents of the MSIR. We found the voices of people who inject drugs were inadequately represented within the data. Instead, overdose statistics were featured as were discursive descriptions of people who inject drugs such as 'addicts', 'junkies', and 'druggies'. CONCLUSION Despite people who inject drugs being the population the MSIR is designed to benefit, their experiences and voices were lacking, highlighting social power structures, denying the silenced power, and obstructing social change. Overdose rates were consistently presented as numbers, negating personal experiences and lacking meaningful debate. Further, negative discourse referring to people who inject drugs may have implications regarding internalised and externalised stigma and drug policy.
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Affiliation(s)
- Bianca Whiteside
- School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia; Institute for Health Transformation, Faculty of Health, Deakin University, Australia.
| | - Matthew Dunn
- School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia; Institute for Health Transformation, Faculty of Health, Deakin University, Australia
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25
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Febres-Cordero S, Shasanmi-Ellis RO, Sherman ADF. Labeled as "drug-seeking": nurses use harm reduction philosophy to reflect on mending mutual distrust between healthcare workers and people who use drugs. Front Public Health 2023; 11:1277562. [PMID: 37908688 PMCID: PMC10614634 DOI: 10.3389/fpubh.2023.1277562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction Over 50 years of approaching drug use from the "War on Drugs" has led to ignoring the systemic structural and social determinants of health, enforced drug use stigma, and damaging stereotypes of people who use drugs or are labeled as "drug-seeking," and sorely failed to support those needing assistance. On philosophy of harm reduction and power People who use drugs are often disenfranchised and pathologized by being labeled as "a drug addict," which then serves as a rationalization for mistreatment by healthcare providers. This is in opposition to a harm-reduction approach. Harm reduction philosophy is an epistemic valuation necessary for drug use stigma and our moral obligation to reduce harm from interlocking systems of power that perpetuate harm. On drug-seeking mistrust and human rights We have encountered many clients who use drugs that report harmful interactions with healthcare providers. Harm reduction is an issue of health equity, social justice, and fundamental human rights. This paper presents three vignettes, the author's experiences of being labeled as-and advocating for family members labeled as "drug-seeking." Discussion To better serve as healthcare providers, workers must be equipped to work with people who use drugs and reinforce the social justice commitment against medical stigma, neglect, racism, and inadequate pain coverage and withdrawal treatment. Nurses and our epistemic lens can meet the challenge of complex intersectional issues affecting our use of power to develop more just and equitable health systems and advance our rebuilding of a trusting relationship with the people we serve.
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26
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Conway A, Krawczyk N, McGaffey F, Doyle S, Baaklini V, Marshall AD, Treloar C, Davis CS, Colledge-Frisby S, Grebely J, Cerdá M. Typology of laws restricting access to methadone treatment in the United States: A latent class analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104141. [PMID: 37540917 DOI: 10.1016/j.drugpo.2023.104141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND In the United States, methadone treatment for opioid use disorder is only available at opioid treatment programs (OTPs). In addition to federal regulations, states can enact laws which shape access to OTPs. We aimed to define classes of states according to restrictiveness of state OTP laws and examine population characteristics associated with class membership. METHODS A set of laws was extracted from a database of statutes and regulations governing OTPs in 49 states and the District of Columbia as of June 2021. Latent class analysis of laws was used to estimate the probability of class membership for each state. Class-weighted multinomial logistic regression analysis assessed state-level correlates of class membership and adjusted Relative Risk Ratio (aRRR) and 95% confidence intervals (95%CI) were generated. RESULTS States (n = 50) were assigned to three classes; Class 1) High restrictiveness on patient experience, low restrictiveness on access to service (n = 13); Class 2) Medium restrictiveness on patient experience, high restrictiveness on access to service (n = 14); Class 3) Low restrictiveness on patient experience, low restrictiveness on access to service (n = 23). States with a higher probability of membership in Classes with higher restrictiveness had higher rates of unemployment (Class 1 vs Class 3, aRRR:1.24; 95%CI:1.06-1.45), and Black residents (Class 2 vs Class 3, aRRR:1.10; 95%CI:1.04-1.15), and lower likelihood of Medicaid coverage of methadone (Class 1 vs Class 3, aRRR:0.25; 95%CI:0.07-0.88). States with a higher probability of membership in Classes with higher restrictiveness also had higher rates of potential indicators for opioid use disorder treatment need, including rates of opioid dispensing (Class 1 vs Class 3, aRRR:1.06; 95%CI:1.02-1.10, Class 2 vs Class 3, aRRR:1.07; 95%CI:1.03-1.11) and HIV diagnoses attributed to injection (Class 1 vs Class 3, aRRR:3.92; 95%CI:1.25-12.22). CONCLUSIONS States with indicators of greater potential need for opioid use disorder treatment have the most restrictions, raising concerns about unmet treatment need.
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Affiliation(s)
- Anna Conway
- The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in Health, UNSW, Sydney, Australia.
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Sheri Doyle
- The Pew Charitable Trusts, Philadelphia, United States
| | | | - Alison D Marshall
- The Kirby Institute, UNSW, Sydney, Australia; Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Corey S Davis
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States; Network for Public Health Law, Los Angeles, United States
| | - Samantha Colledge-Frisby
- National Drug Research Institute, Curtin University, Melbourne, Australia; National Drug and Alcohol Research Centre, Burnet Institute, Melbourne, Australia
| | | | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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Piatkowski T, Puljevic C, Francis C, Ferris J, Dunn M. "They sent it away for testing and it was all bunk": Exploring perspectives on drug checking among steroid consumers in Queensland, Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104139. [PMID: 37481876 DOI: 10.1016/j.drugpo.2023.104139] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Research supports the feasibility and acceptance of drug checking among nightlife and festival attendees. Interest in expanding drug checking to other groups of people who use drugs, including those who inject drugs, has grown. However, understanding the acceptability and feasibility of drug checking among specific cohorts, like anabolic-androgenic steroids (AAS) consumers, remains a research gap. This study explores AAS consumers' perspectives on drug checking and service preferences, aiding the preparation for drug checking delivery in Queensland, Australia. METHODS A purposive sampling technique was used to recruit 15 AAS consumers (9 males, 6 females; Mage = 36.80 years, SD = 6.12) from Australia. One-on-one semi-structured qualitative interviews were conducted with questions exploring participants' views on drug checking/testing and their preferences for AAS analysis. Thematic analysis was conducted with final themes established through iterative consensus. RESULTS Consumers expressed frustration with the prevailing stereotypes, social stigma, and the perception of criminality associated with the use of AAS. There was a strong dependence on personal connections and trusted suppliers, with coaches exerting significant influence. Participants expressed concerns about the widespread availability of counterfeit products and underground operations. The act of using unknown AAS was likened to a game of Russian roulette, underscoring the importance of obtaining accurate information and access to reliable drug checking services. Consumers expressed a preference for a web-based platform that enables individuals to access their own test results while contributing to a comprehensive database of brand-specific testing outcomes. DISCUSSION AAS consumers recognise the significance of monitoring their AAS use and seek a service that can not only assist them in making informed decisions regarding AAS usage but also potentially contribute to the knowledge of the wider AAS-consuming community. These findings underscore the importance of tailored education, drug checking services, and harm reduction measures to address the diverse needs of AAS consumers.
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Affiliation(s)
- Timothy Piatkowski
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia; The Loop Australia, Australia.
| | - Cheneal Puljevic
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia; The Loop Australia, Australia
| | | | - Jason Ferris
- The Loop Australia, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Matthew Dunn
- The Loop Australia, Australia; School of Health and Social Development/Institute for Health Transformation, Deakin University, Geelong, Australia
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Macdonald V, Mathers B, Sabin K, Me A, Carpentier C, Niaz K, Mozalevskis A, Luhmann N, Ciupagea M, Soltani F, Verster A. New data confirm lack of progress in harm reduction after three decades of proven evidence of effectiveness. Addiction 2023; 118:1411-1413. [PMID: 37051682 DOI: 10.1111/add.16193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Virginia Macdonald
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Bradley Mathers
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Angela Me
- United Nations Office on Drugs and Crime, Vienna, Austria
| | | | - Kamran Niaz
- United Nations Office on Drugs and Crime, Vienna, Austria
| | - Antons Mozalevskis
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Fariba Soltani
- United Nations Office on Drugs and Crime, Vienna, Austria
| | - Annette Verster
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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Aghaei AM, Gholami J, Sangchooli A, Rostam-Abadi Y, Olamazadeh S, Ardeshir M, Baheshmat S, Shadloo B, Taj M, Saeed K, Rahimi-Movaghar A. Prevalence of injecting drug use and HIV, hepatitis B, and hepatitis C in people who inject drugs in the Eastern Mediterranean region: a systematic review and meta-analysis. Lancet Glob Health 2023; 11:e1225-e1237. [PMID: 37474230 DOI: 10.1016/s2214-109x(23)00267-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Considerable disease burden is attributed to injecting drug use (IDU). This regional systematic review and meta-analysis aimed to assess the prevalence of IDU and the characteristics of people who inject drugs in the 22 countries of the WHO Eastern Mediterranean region. METHODS We conducted a systematic review and meta-analysis on the prevalence of IDU, estimation of the population size of people who inject drugs, the characteristics of people who inject drugs, commonly injected drugs, the prevalence of HIV, hepatitis C virus, and hepatitis B virus in people who inject drugs, and opioid agonist treatment and needle and syringe programme services. We searched PubMed, Web of Science, Scopus, Embase, and the Index Medicus for the Eastern Mediterranean Region for documents published between Jan 1, 2010, and April 17, 2022, with no language restrictions. We also searched government reports, civil society information, and UN websites and databases for grey literature published between Jan 1, 2010, and April 17, 2022. Documents were eligible if they reported or estimated an indicator of interest, or reported enough data to permit calculation of the indicator. We extracted data from the eligible documents and calculated national and regional estimates. FINDINGS We identified 38 283 documents and included 201 documents in the systematic review. A total of 115 documents were included for the four outcomes for which meta-analyses were performed. The number of people who inject drugs was estimated as 864 597 (95% CI 641 909-1 205 255), amounting to a prevalence of 20·0 per 10 000 adults (95% CI 14·9-27·9) in the region. Among people who inject drugs, the prevalence of HIV was estimated as 19·22% (95% CI 12·86-26·36), hepatitis C virus as 44·82% (29·32-61·16), and hepatitis B virus as 2·66% (0·84-7·26). Countries varied greatly regarding the variables of interest and the availability of relevant data. Nine countries provided needle and syringe programme services and seven countries provided opioid agonist treatment services, mostly with very low, low, or unclear coverage. INTERPRETATION The prevalence of IDU in the Eastern Mediterranean region is lower than the global mean, particularly among women. The HIV infection rate is higher than the global mean, and the hepatitis C virus infection rate is lower than the global mean. Harm-reduction services are underdeveloped. Data collection on IDU and provision of services need improvement in the region. FUNDING World Health Organization. TRANSLATIONS For the Arabic, Farsi and French translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ardavan Mohammad Aghaei
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Arshiya Sangchooli
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasna Rostam-Abadi
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Sogol Olamazadeh
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ardeshir
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Baheshmat
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrang Shadloo
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshid Taj
- Mental Health and Substance Abuse Unit, Department of Non-Communicable Diseases and Mental Health, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Khalid Saeed
- Mental Health and Substance Abuse Unit, Department of Non-Communicable Diseases and Mental Health, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran.
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Fujita-Imazu S, Xie J, Dhungel B, Wang X, Wang Y, Nguyen P, Khin Maung Soe J, Li J, Gilmour S. Evolving trends in drug overdose mortality in the USA from 2000 to 2020: an age-period-cohort analysis. EClinicalMedicine 2023; 61:102079. [PMID: 37483548 PMCID: PMC10359729 DOI: 10.1016/j.eclinm.2023.102079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Drug overdose deaths in the USA have increased rapidly in the past 20 years, and understanding patterns and trends in mortality is essential to develop policy responses. This study aimed to determine whether cohort patterns in mortality due to drug overdose have changed in the past two decades and assess these patterns by race and sex. Methods The national records of accidental drug overdose death were extracted from Centers for Disease Control and Prevention, National Center for Health Statistics Mortality Data for 2000-2020. Age-period-cohort analysis was performed to examine independent effects of age, period and birth cohort on accidental drug overdose mortality. Findings The number of accidental drug overdose deaths increased by 622% between 2000 and 2020, and age-standardized mortality rates increased nearly four-fold in both men and women. Age-period-cohort decomposition found rapid increases in mortality since 2012 in men and women, with higher mortality risk in cohorts born after 1990. The fastest increase occurred in Black Americans since 2012, and Americans of all races born after 1975 had significantly higher mortality risk, with mortality risk increasing rapidly in more recent cohorts. The peak of mortality has shifted from the 40-59 age group to the 30-40 year age group in the past decade. Interpretation The burden of drug overdose mortality has shifted to younger Americans, and a new generation of Americans are at significantly higher and rapidly increasing risk of overdose death. Urgent action is needed to prevent an entire generation of young people being consigned to decades of preventable mortality. Funding None.
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Affiliation(s)
- Sayuri Fujita-Imazu
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Jinzhao Xie
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Bibha Dhungel
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Xinran Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yijing Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Phuong Nguyen
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
- Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - July Khin Maung Soe
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
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Colledge-Frisby S, Jones N, Degenhardt L, Hickman M, Padmanathan P, Santo T, Farrell M, Gisev N. Incidence of suicide and self-harm among people with opioid use disorder and the impact of opioid agonist treatment: A retrospective data linkage study. Drug Alcohol Depend 2023; 246:109851. [PMID: 37028102 PMCID: PMC10225170 DOI: 10.1016/j.drugalcdep.2023.109851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Rates of suicide and self-harm are elevated among people with opioid use disorder (OUD). This study examined incidence of self-harm and suicide among people who have entered OAT and assessed the impact of different OAT exposure periods on these events. METHOD We conducted a retrospective population-based cohort study of all OAT recipients (N = 45,664) in New South Wales, Australia (2002-2017), using linked administrative data. Incidence rates of self-harm hospitalisations and suicide deaths were estimated per 1000 person-years (PY). The first 28 days of an OAT episode, ≥ 29 days on OAT, the first 28 days off OAT, and ≥ 29 days off OAT (maximum four years post-OAT) were exposure periods. Poisson regression models with generalised estimating equations estimated the adjusted incidence rate ratios (ARR) of self-harm and suicide by OAT exposure periods, adjusting for covariates. RESULTS There were 7482 hospitalisations (4148 individuals) for self-harm and 556 suicides, equating to incidence rates of 19.2 (95% confidence intervals [CI]=18.8-19.7) and 1.0 (95%CI=0.9-1.1) per 1000 PY, respectively. Opioid overdose was implicated in 9.6% of suicides and 28% of self-harm hospitalisations. Compared to ≥ 29 days on OAT, the incidence rate of suicide was elevated in the 28 days following OAT cessation (ARR=17.4 [95%CI=11.7-25.9]), and the rate of self-harm hospitalisations was elevated during the first 28 days of OAT (ARR=2.2 [95%CI=1.9-2.6]) and the 28 days after leaving OAT (ARR=2.7 [95%CI=2.3-3.2]). CONCLUSIONS OAT may reduce suicide and self-harm risk among people with OUD; however, OAT initiation and cessation are critical periods for targeting self-harm and suicide prevention interventions.
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Affiliation(s)
- Samantha Colledge-Frisby
- National Drug Research Institute, Curtin University, Perth, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; The Burnet Institute, Melbourne, Australia.
| | - Nicola Jones
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Prianka Padmanathan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Thomas Santo
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Nelson EU. Harm reduction interventions for people who inject drugs. THE LANCET GLOBAL HEALTH 2023; 11:e632-e633. [PMID: 36996859 DOI: 10.1016/s2214-109x(23)00111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- Ediomo-Ubong Nelson
- Global Drug Policy Observatory, Swansea University, Swansea, UK; Centre for Research and Information on Substance Abuse, Uyo, Nigeria.
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33
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Degenhardt L, Webb P, Colledge-Frisby S, Ireland J, Wheeler A, Ottaviano S, Willing A, Kairouz A, Cunningham EB, Hajarizadeh B, Leung J, Tran LT, Price O, Peacock A, Vickerman P, Farrell M, Dore GJ, Hickman M, Grebely J. Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject drugs: a systematic review. THE LANCET GLOBAL HEALTH 2023; 11:e659-e672. [PMID: 36996857 DOI: 10.1016/s2214-109x(23)00057-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND People who inject drugs are exposed to various and changing risk environments and are at risk of multiple harms related to injecting drug use (IDU). We aimed to undertake a global systematic review of the prevalence of IDU, key IDU-related harms (including HIV, hepatitis C virus [HCV], and hepatitis B virus [HBV] infection and overdose), and key sociodemographic characteristics and risk exposures for people who inject drugs. METHODS We systematically searched for data published between Jan 1, 2017, and March 31, 2022, in databases of peer-reviewed literature (MEDLINE, Embase, and PsycINFO) and grey literature as well as various agency or organisational websites, and disseminated data requests to international experts and agencies. We searched for data on the prevalence, characteristics, and risks of people who inject drugs, including gender, age, sexuality, drug-use patterns, HIV, HCV, and HBV infections, non-fatal overdose, depression, anxiety, and injecting-related disease. Additional data were extracted from studies identified in our previous review. Meta-analyses were used to pool the data where multiple estimates were available for a country. We present country, regional, and global estimates for each variable examined. FINDINGS We screened 40 427 reports published between 2017 and 2022, and the 871 eligible reports identified were added to the 1147 documents from the previous review. Evidence of IDU was documented in 190 of 207 countries and territories, and 14·8 million people (95% uncertainty interval [UI] 10·0-21·7) aged 15-64 years globally were estimated to inject drugs. Existing evidence suggests that there might be 2·8 million (95% UI 2·4-3·2) women and 12·1 million (95% UI 11·0-13·3) men who inject drugs globally, and that 0·4% (95% CI 0·3-1·3) of people who inject drugs identify as transgender. The amount of available data on key health and social risks among people who inject drugs varied widely across countries and regions. We estimated that 24·8% (95% CI 19·5-31·6) of people who inject drugs globally had experienced recent homelessness or unstable housing, 58·4% (95% CI 52·0-64·8) had a lifetime history of incarceration, and 14·9% (95% CI 8·1-24·3) had recently engaged in sex work, with substantial geographical variation. Injecting and sexual risk behaviour varied considerably geographically, as did risks of harms. Globally, we estimated that 15·2% (95% CI 10·3-20·9) of people who inject drugs are living with HIV, 38·8% (95% CI 31·4-46·9) have current HCV infection, 18·5% (95% CI 13·9-24·1) have recently overdosed, and 31·7% (95% CI 23·6-40·5) have had a recent skin or soft tissue infection. INTERPRETATION IDU is being identified in a growing number of countries and territories that comprise more than 99% of the global population. IDU-related health harms are common, and people who inject drugs continue to be exposed to multiple adverse risk environments. However, quantification of many of these exposure and harms is inadequate and must be improved to allow for better targeting of harm-reduction interventions for these risks. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Paige Webb
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; National Drug Research Institute Melbourne, Curtin University, Melbourne, VIC, Australia
| | - Jeremy Ireland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Alice Wheeler
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sophie Ottaviano
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Alex Willing
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Abe Kairouz
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Evan B Cunningham
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Janni Leung
- National Centre For Youth Substance Use Research, University of Queensland, St Lucia, QLD, Australia
| | - Lucy T Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Olivia Price
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Gregory J Dore
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jason Grebely
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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