Initiation of drug dealing among a prospective cohort of street-involved youth

Experiencing homelessness and progression through the HIV cascade of care among people who use drugs

OBJECTIVE

To investigate the longitudinal association between periods of homelessness and progression through the HIV cascade of care among people who use drugs (PWUD) with universal access to no-cost HIV treatment and care.

DESIGN

Prospective cohort study.

METHODS

Data were analysed from the ACCESS study, including systematic HIV clinical monitoring and a confidential linkage to comprehensive antiretroviral therapy (ART) dispensation records. We used cumulative link mixed-effects models to estimate the longitudinal relationship between periods of homelessness and progression though the HIV cascade of care.

RESULTS

Between 2005 and 2019, 947 people living with HIV were enrolled in the ACCESS study and 304 (32.1%) reported being homeless at baseline. Homelessness was negatively associated with overall progression through the HIV cascade of care [adjusted partial proportional odds ratio (APPO) = 0.56, 95% confidence interval (CI): 0.49-0.63]. Homelessness was significantly associated with lower odds of progressing to each subsequent stage of the HIV care cascade, with the exception of initial linkage to care.

CONCLUSIONS

Homelessness was associated with a 44% decrease in the odds of overall progression through the HIV cascade of care, and a 41-54% decrease in the odds of receiving ART, being adherent to ART and achieving viral load suppression. These findings support calls for the integration of services to address intersecting challenges of HIV, substance use and homelessness among marginalized populations such as PWUD.

How do Past, Present and Future Weigh into Trajectories of Precarity? The Time Perspectives of Young Psychoactive Substance Users Living in Situations of Social Precarity in Montreal

Young psychoactive substance users in social precarity are vulnerable to a range of health and social issues. Time perspective is one aspect to consider in supporting change. This study draws on the views expressed by young adults to portray their subjective experience of time, how this perception evolves and its implications for their substance use and socio-occupational integration trajectories. The sample includes 23 young psychoactive substance users (M = 24.65 years old; 83% male) in social precarity frequenting a community-based harm reduction centre. Thematic analysis of the interviews reveals the past to be synonymous with disappointment and disillusionment, but also a constructive force. Participants expressed their present-day material and human needs as well as their need for recognition and a sense of control over their own destiny. Their limited ability to project into the future was also discussed. Avenues on how support to this population might be adapted are suggested.

Drug Dealing and Gun Carrying go Hand in Hand: Examining How Juvenile Offenders' Gun Carrying Changes Before and After Drug Dealing Spells across 84 Months

OBJECTIVES

This study aims to examine whether periods of marijuana and other illicit drug dealing ("spells" of dealing) are associated with changes in young male offenders' gun carrying behavior.

METHODS

This paper uses 84 months of data from a sample of 479 serious juvenile male offenders who were assessed every six months for three years and then annually for four years. At each assessment, participants reported on engagement in illicit behaviors, including drug dealing and gun carrying, in each month since the prior interview. We used fixed effects models to assess within-individual changes in participants' gun carrying immediately before, during, and right after a dealing spell, while controlling for relevant time varying confounds (e.g., gang involvement, exposure to violence). Additionally, we tested moderation by type of drug sold.

RESULTS

There was a slight increase in gun carrying right before a drug dealing spell (OR = 1.3-1.4), then a more pronounced increase in gun carrying during the months of a drug dealing spell (OR = 8.0-12.8). Right after a dealing spell ends, youths' gun carrying dropped dramatically, but remained significantly elevated relative to their baseline levels (OR = 2.6-2.8). The association between drug dealing spells and increases in gun carrying was stronger when participants dealt hard drugs (e.g., cocaine, heroin) relative to marijuana.

CONCLUSIONS

These results suggest that designing and implementing programs to prevent the initiation of drug dealing and decrease involvement in drug dealing may help to substantially reduce illegal gun carrying and firearm violence among delinquent males.

Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework

Policy Points This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug-related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies.

CONTEXT

Drug overdose is the leading cause of injury-related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction.

METHODS

In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The "continuum of overdose risk" framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally.

FINDINGS

De-escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction.

CONCLUSIONS

Without recognizing the full drug-use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.

Cocaine and methamphetamine: Pharmacology and dental implications

BACKGROUND

Epidemiological studies have shown that illicit drug use is a persistent and growing problem in our society. Methamphetamine and cocaine are at the top of the list of stimulants commonly abused. There is a need for a disease-targeted approach to the dental management of clients who use these drugs.

METHODS

A review of the literature was conducted to identify the most up-to-date information for the diagnosis and treatment of dental clients who abuse methamphetamine and cocaine. Databases in the University of Toronto library system were searched for peer-reviewed articles, written in English, and containing data relevant to clinical decision making. Textbooks were chosen from a list of reference materials provided by the National Dental Examination Board. All cited articles were published within the past 5 years.

RESULTS AND DISCUSSION

There is robust literature on the treatment of individual signs and symptoms associated with methamphetamine and cocaine use. However, there is a dearth of information on the comprehensive, client-centred oral health care that these individuals require.

CONCLUSION

This article reviews the best practices to guide the clinician from the initial oral diagnosis appointment to the maintenance of care, including the pharmacological actions of these drugs of abuse, the specific challenges faced in providing care for this client population, and scientifically based treatment considerations to maximize prognosis.

Prevalence and correlates of selling illicit cannabis among people who use drugs in Vancouver, Canada: A ten-year prospective cohort study

BACKGROUND

The illicit selling and use of cannabis is prevalent among marginalized people who use illicit drugs (PWUD). Given that participation in illicit drug markets has been previously associated with a range of health and social harms, we sought to examine the predictors of selling cannabis among PWUD in Vancouver, Canada, a setting with a de facto legalized cannabis market, on the eve of the planned implementation of legalized non-medical cannabis including measures to regulate the existing illicit market.

METHODS

Multivariable generalized estimating equations (GEE) logistic regression was used to analyze longitudinal factors associated with selling illicit cannabis among three prospective cohorts of PWUD between September 2005 and May 2015.

RESULTS

Among the 3258 participants included in this study, 328 (10.1%) reported selling illicit cannabis at baseline, and 46 (5.1%) initiated cannabis selling over the study period. In the multivariable analysis of the whole sample, factors significantly associated with selling cannabis included cannabis use (Adjusted Odds Ratio [AOR] = 4.05), dealing other drugs (AOR = 3.87), being male (AOR = 1.83), experiencing violence (AOR = 1.40), non-medical prescription opioid use (AOR = 1.32), non-custodial involvement in the criminal justice system (AOR = 1.31), being stopped by police (AOR = 1.30), crack use (AOR = 1.25), homelessness (AOR = 1.23), age (AOR = 0.96 per year) and participation in sex work (AOR = 0.67) (all p < 0.05). The subanalyses indicated that dealing drugs other than cannabis, cannabis use, and non-custodial involvement in the criminal justice system were the only factors significantly associated with selling cannabis in all four subgroups.

CONCLUSION

These findings support existing evidence indicating that selling illicit cannabis is often a survival-driven strategy to support the basic needs and substance use of some PWUD. Our findings suggest jurisdictions with planned or impending cannabis legalization and regulation should consider the vulnerability of PWUD when seeking to eradicate illicit cannabis markets, for example, in setting criminal penalties for selling cannabis outside of regulatory frameworks.

The characteristics and patterns of utilization of healthcare services among Omanis with substance use disorders attending therapy for cessation

BACKGROUND

It is indicated that Oman is witnessing an increase in issues pertinent to alcohol and psychoactive substance use.

AIM

The aim of this study was to identify the characteristics of Omanis with substance use disorder attending a specialized hospital in Oman and the pattern of their utilization of healthcare services. A related aim was to ascertain the age group most vulnerable to alcohol and substance use in Oman.

METHOD

A cross-sectional study was conducted in a tertiary care center specialized for treatment of those engaging in substance use in Oman. The participants in the study were selected from a convenience sample among patients seeking consultation at the center for alcohol and substance use. A six-part questionnaire was designed to obtain information regarding socio-demographic background, clinical history, healthcare utilization and perceived hurdles to access. Chi-square analyses were used to evaluate the significance of differences among categorical data. Logistic regression modelling was used to obtain measures of association after adjusting for confounding factors.

RESULTS

Among the patients (n = 293) seeking cessation therapy, 99% were male and less than 30 years of age. Peer influences on the initiation of substance use were significant. Most patients had a history of polysubstance use, including intravenous substance use. Cannabis and alcohol were the first substances consumed by most patients and Hepatitis C and psychiatric disorders were found to be the most common co-morbidities. The participants that reported use of cannabis and benzodiazepines were more likely to perceive "improvement" upon receiving treatment.

CONCLUSION

This study indicated that males below 30 years of age with a history of polysubstance use were likely to attend a hospital specialized in treating substance use disorder in Oman. This study identified information regarding socio-demographic background, risk factors and perceived hurdles to healthcare that could serve as groundwork for further studies conducted on newly emerging issues of substance use in Oman.

Socioeconomic factors associated with cessation of injection drug use among street-involved youth

Background

Although the initiation of injection drug use has been well characterized among at-risk youth, factors that support or impede cessation of injection drug use have received less attention. We sought to identify socioeconomic factors associated with cessation of injection drug use among street-involved youth.

Methods

From September 2005 to May 2015, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada. Multivariate extended Cox regression was utilized to identify socioeconomic factors associated with cessation of injection drug use for six months or longer among youth who were actively injecting.

Results

Among 383 participants, 171 (44.6%) youth reported having ceased injection (crude incidence density 22 per 100 person-years; 95% confidence interval [CI], 19–26) at some point during study follow-up. Youth who had recently dealt drugs (adjusted hazard ration [AHR], 0.50; 95% CI, 0.29–0.87), engaged in prohibited street-based income generation (AHR, 0.41; 95% CI, 0.24–0.69), and engaged in illegal income generating activities (AHR, 0.19; 95% CI, 0.06–0.61) were significantly less likely to report cessation of injection drug use.

Conclusions

Our findings suggest that socioeconomic factors, in particular engagement in prohibited street-based and illegal income generating activities, may pose barriers to ceasing injection drug use among this population. Effort to improve access to stable and secure income, as well as employment opportunities may assist youth in transitioning away from injection drug use.

Trial registration

Our study is not a randomized controlled trial; thus the trial registration is not applicable.

The costs of crime associated with stimulant use in a Canadian setting

BACKGROUND

Costs attributable to criminal activity are a major component of the economic burden of substance use disorders, yet there is a paucity of empirical evidence on this topic. Our aim was to estimate the costs of crime associated with different forms and intensities of stimulant use.

METHODS

Retrospective cohort study, including individuals from three prospective cohorts in Vancouver, Canada, measured biannually (2011-2015), reporting stimulant use at baseline assessment. Monthly crime costs included policing, court, corrections, and criminal victimization (2016 CAD). We estimated monthly crime costs associated with mutually exclusive categories of crack, cocaine, methamphetamine, and polystimulant use, stratified by daily/non-daily use, relative to stimulant abstinence, as well as the independent effects of treatment (opioid agonist (OAT) and other addiction treatment). We used a two-part model, capturing the probability of criminal activity and costs of crime with generalized linear logistic and gamma regression models, respectively, controlling for age, gender, education, homelessness, mental health issues, employment, prior incarceration, alcohol and opioid use.

RESULTS

The study sample included 1599 individuals (median age 39, 65.9% male) assessed over 5299 biannual interviews. Estimates of associated monthly crime costs ranged from $5449 [95% C.I.: $2180, $8719] for non-daily polystimulant use, to $8893 [$4196, $13,589] for daily polystimulant use. Cost differences between daily/non-daily use, injection/non-injection, and stimulant type were not statistically significant. Drug treatment was not associated with lower monthly crime costs in our sample.

CONCLUSIONS

Substantial crime-related costs were associated with stimulant use, emphasizing the urgency for development and implementation of efficacious treatment regimens.