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Borge TC, Muller AE. Overdosevarslingssystemer – en kartleggingsoversikt med maskinlæring. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:443-462. [PMID: 37969899 PMCID: PMC10634385 DOI: 10.1177/14550725221143180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 11/17/2023] Open
Abstract
Bakgrunn: Helsedirektoratet ønsker å vurdere muligheten for å etablere et nasjonalt overdosevarslingssystem (OVS) for å kunne varsle brukere om økt overdosefare. OVS som system forstås her som et sett med sammenhengende elementer som fungerer som en helhet, der hensikten er tidlig oppdagelse av økt overdoserisiko kombinert med rask varsling til de som står i fare for overdoser. Metode: Vi utførte en kartleggingsoversikt over forskning om varslingssystemer for økt overdosefare. Mål 1 var å kartlegge eksisterende forskning om effekten av et OVS (antall brukere nådd, antall overdoser, varslingshurtighet). Mål 2 var å kartlegge eksisterende forskning som kunne belyse brukeres erfaringer med slike systemer. Resultater: Vi brukte flere maskinlæringsfunksjoner for å identifisere og vurdere totalt 4102 referanser fra litteratursøk gjennomført i mars/april 2022, hvorav 11 studier oppfylte inklusjonskriteriene. Effekt av OVS på antall overdoser var ikke mulig å skille fra eksisterende overdoseforebyggende tiltak. OVS’er varslet skadereduksjonsgrupper eller erfaringskonsulenter så tidlig som fire timer etter innmeldt/oppdaget fare. Antall brukere varslet ble i stor grad ikke rapportert, antageligvis fordi data om dette ikke ble innsamlet. Fra syv kvalitative studier ble mønstre i hovedfunn sett på tvers, som omhandlet preferanser for språkbruk og innhold, hvor varslinger burde komme fra, og prinsippene bak dem. Konklusjon: Vi identifiserte lite empirisk forskning om eksisterende OVS’er, særlig relatert til effekt av slike systemer. Uten tilstrekkelig forskningsgrunnlag om effekt må vi være forsiktige med å trekke konklusjoner om hvilke typer OVS’er som bør og ikke bør innføres i Norge. Opprettelse av et OVS trenger ikke nødvendigvis innebære etablering av en ny infrastruktur, men heller være snakk om at to godt utviklede, eksisterende systemer – systemer for overvåking og skadereduksjonstiltak – kan kobles sammen.
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Stein MD, Kenney SR, Anderson BJ, Bailey GL. Perceptions about fentanyl-adulterated heroin and overdose risk reduction behaviors among persons seeking treatment for heroin use. J Subst Abuse Treat 2019; 104:144-147. [PMID: 31370978 DOI: 10.1016/j.jsat.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fentanyl-adulterated heroin supply chains are increasing risks for fatal overdose in the U.S. OBJECTIVE The current study examined the use of overdose risk reduction behaviors among persons seeking treatment for heroin use and whether perceptions about the presence of fentanyl in one's heroin are associated with overdose risk reduction behaviors. METHOD We recruited persons with opioid use disorder entering a managed withdrawal program. We used multiple linear regression to estimate the adjusted associations of participant characteristics and perception of fentanyl exposure with the frequency of engaging in each of five overdose reduction behaviors. RESULTS Participants (n = 239; 75.3% male, 81.2% White, 67% injectors) estimated that 69.2% of the heroin they use contains fentanyl, and 94.6% knew that fentanyl increases overdose risk. Approximately 30% of respondents reported usually or always making sure others are around when they use heroin, carrying naloxone, taking "tester" doses of heroin or intentionally using in reduced amounts. While a majority of the sample reported never carrying naloxone or taking tester doses, and 70.2% reported never making sure that others around them carry naloxone, 84.5% had implemented one or more behavior at least rarely. Past month injection drug use was associated with making sure others are around, but perceptions about fentanyl in one's heroin were not associated with use of harm reduction behaviors. CONCLUSIONS In this sample of people who use heroin, although overdose risk reduction behaviors were not usually used, a majority had tried at least one behavior. That perceived exposure to fentanyl-adulterated heroin was not associated with the use of such behaviors provides important implications for public health education and intervention programming.
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Affiliation(s)
- Michael D Stein
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America; Boston University School of Public Health, Boston, MA 02118, United States of America
| | - Shannon R Kenney
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America; Warren Alpert Medical School of Brown University, Providence, RI 02912, United States of America.
| | - Bradley J Anderson
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America
| | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, RI 02912, United States of America; Stanley Street Treatment and Resources, Inc., Fall River, MA 02720, United States of America
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Rouhani S, Park JN, Morales KB, Green TC, Sherman SG. Harm reduction measures employed by people using opioids with suspected fentanyl exposure in Boston, Baltimore, and Providence. Harm Reduct J 2019; 16:39. [PMID: 31234942 PMCID: PMC6591810 DOI: 10.1186/s12954-019-0311-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Exposure to potent synthetic opioids such as illicitly manufactured fentanyl (IMF) has fueled the escalating overdose crisis in the USA, particularly in the east coast. Drug checking services, which allow people who use drugs (PWUD) to learn about the contents of their drugs, remain limited and even criminalized in many states. Further, there is a persistent belief that PWUD are not willing or able to change their behaviors despite being aware of their potential exposure to fentanyl through drug use. METHODS We conducted a multi-site cross-sectional study among PWUD to assess what behaviors, if any, were employed in the case of suspected fentanyl exposure, and the correlates of engaging in harm reduction behaviors (HRB). PWUD (N = 334) were recruited in Boston (n = 80), Providence (n = 79), and in Baltimore (n = 175). At the time of the survey, no legal drug checking services were available in these cities. RESULTS The majority of PWUD (84%) expressed concern about fentanyl. Among those who suspected fentanyl exposure prior to using their drugs (n = 196), 39% reported employing HRB including using less of the drug (12%) or abstaining altogether (10%), using more slowly (5%), and doing a tester shot (5%). In adjusted logistic regression models, the odds (aOR) of practicing HRB after suspecting fentanyl exposure were increased among PWUD who were non-White (aOR 2.1; p = 0.004) and older (aOR 1.52 per decade of age; p < 0.001). Daily injection (aOR 0.50; p < 0.001), using drugs in public (aOR 0.58; p = 0.001), using drugs alone (aOR 0.68; p < 0.001), and experiencing multiple recent overdoses (aOR 0.55; p < 0.001) were associated with decreased odds of practicing HRB. CONCLUSIONS These data illustrate that PWUD employ a number of practices to reduce overdose risk in a context of unknown drug purity and content. Results may also guide efforts to identify early adopters of drug checking services and engage them in peer-outreach to target the most socially and structurally vulnerable PWUD, who are not reporting behavior change, with harm reduction messaging.
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Affiliation(s)
- Saba Rouhani
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Kenneth B Morales
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Traci C Green
- Miriam Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
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Bardwell G, Boyd J, Arredondo J, McNeil R, Kerr T. Trusting the source: The potential role of drug dealers in reducing drug-related harms via drug checking. Drug Alcohol Depend 2019; 198:1-6. [PMID: 30856370 PMCID: PMC6467706 DOI: 10.1016/j.drugalcdep.2019.01.035] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Drug checking technologies (DCTs) have been implemented as a response to the ongoing opioid overdose epidemic. We examined the level of trust people who use drugs (PWUD) have in their drug dealers as well as their perspectives on the potential for drug dealers to use DCTs to provide knowledge of drug contents to their customers. METHODS We conducted one-to-one qualitative semi-structured interviews with 20 PWUD in Vancouver, Canada's Downtown Eastside. Participants were purposively recruited from ongoing cohort studies of PWUD and were required to currently be using stimulants and/or opioids. RESULTS Most participants discussed having a high level of trust for their drug dealers based on length of relationships, drug supply consistencies, and communication. Given this, participants did not identify drug checking as a priority. However, participants discussed a lower level of trust when buying drugs from an unfamiliar source. Participants also discussed how DCTs would provide knowledge to drug dealers about drug contents and how communicating test results to customers could be a risk reduction measure. Participants described privacy concerns that drug dealers might experience as well as the lack of concern that some drug dealers have about their drug supply. CONCLUSIONS Future drug checking programming should consider ways to engage drug dealers to test their supplies and develop communication strategies to more accurately inform PWUD of drug contents and avert risks associated with using them. Additionally, drug policies that address the effects of criminalization should be considered to lessen potential barriers to DCT use by drug dealers.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Jade Boyd
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Jaime Arredondo
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Ryan McNeil
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Thomas Kerr
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
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Waye KM, Yedinak JL, Koziol J, Marshall BDL. Action-focused, plain language communication for overdose prevention: A qualitative analysis of Rhode Island's overdose surveillance and information dashboard. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:86-93. [PMID: 30384027 DOI: 10.1016/j.drugpo.2018.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/10/2018] [Accepted: 08/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In 2015, the state of Rhode Island reported the fifth highest drug overdose mortality rate in the United States. In response to this crisis, Rhode Island created a statewide, publicly accessible drug surveillance and information system, www.PreventOverdoseRI.org (PORI). Alongside near real-time overdose surveillance data, PORI provides plain language materials and resources regarding overdose prevention, recognition and response. We sought to determine how people who use drugs (PWUD) perceive and utilize overdose prevention material, and to evaluate PORI's action-based, plain language content. METHODS We conducted 21 semi-structured qualitative interviews with PWUD from February-June 2017 in the state of Rhode Island. Data were audio-recorded, transcribed, coded in NVivo (Version 11), and key themes were developed. RESULTS Participants viewed online health promotion and harm reduction materials as a useful approach for overdose prevention. Information displayed as accessible, action-driven statements was seen as most desirable for learning and dissemination. After viewing overdose prevention material, participants reported feeling better prepared for responding to an accidental overdose and motivated to share the infographics and website to other people either at risk for or likely to witness an overdose. CONCLUSION Action-focused, plain language approaches for overdose prevention materials can be of particular use for public health campaigns addressing opioid overdose crises. Overdose prevention health campaigns should incorporate evidence-based testing to ensure that outreach material is grounded in plain language techniques.
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Affiliation(s)
- Katherine M Waye
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Jennifer Koziol
- Rhode Island Department of Health, 3 Capitol Hill, Providence, RI, 02908 USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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Dunleavy K, Munro A, Roy K, Hutchinson S, Palmateer N, Knox T, Goldberg D, Hope V, Campbell J, Hamilton E, Liddell D, Penrice G, Taylor A. Spore forming bacteria infections and people who inject drugs: Implications for harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:45-54. [DOI: 10.1016/j.drugpo.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/17/2017] [Accepted: 12/05/2017] [Indexed: 11/28/2022]
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Klimas J, Wood E, Nosova E, Milloy MJ, Kerr T, Hayashi K. Prevalence of Heavy Alcohol Use Among People Receiving Methadone Following Change to Methadose. Subst Use Misuse 2018; 53:270-275. [PMID: 28605308 PMCID: PMC5726952 DOI: 10.1080/10826084.2017.1302960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND A recent switch in methadone formulation from methadone (1 mg/mL) to Methadose (10 mg/mL) in British Columbia (BC), Canada, was associated with increased reports of opioid withdrawal and increases in illicit opioid use. Impacts on other forms of drug use have not been assessed. Since alcohol use is common among people receiving Medication-Assisted Treatment (MAT), we assessed if switch was associated with increased prevalence of heavy alcohol use. METHODS Drawing on data from two open prospective cohort studies of people who inject drugs in Vancouver, BC, generalized estimating equations (GEE) model examined relationship between methadone formulation change and heavy alcohol use, defined by National Institute for Alcohol Abuse and Alcoholism (NIAAA). A sub-analysis examined relationship with heavier drinking defined as at least eight drinks per day on average in last six months. RESULTS Between June 2013 and May 2015, a total of 787 participants on methadone were eligible for the present analysis, of which 123 (15.6%) reported heavy drinking at least once in last six months. In an unadjusted GEE model, Methadose use was not significantly associated with an increased likelihood of heavy drinking [Odds Ratio (OR) = 1.03; 95% Confidence interval (CI) = 0.87-1.21]. Methadose use was not significantly associated with an increased likelihood of drinking at least eight drinks daily on average (OR = 1.09, 95% CI = 0.72-1.65). CONCLUSIONS Despite reported changes in opioid use patterns coinciding with the change, there appeared to be no effect of the methadone formulation change on heavy drinking in this setting.
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Affiliation(s)
- Jan Klimas
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- School of Medicine, University College Dublin, Coombe Healthcare Centre, Dolphins barn, Dublin 8, Ireland
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Ekaterina Nosova
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, CANADA, V5A 1S6
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Markwick N, McNeil R, Anderson S, Small W, Kerr T. Communicating risk in the context of methadone formulation changes: A qualitative study of overdose warning posters in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:178-81. [PMID: 26644025 DOI: 10.1016/j.drugpo.2015.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 10/27/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Nicole Markwick
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6T 1Z1, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada
| | - Ryan McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6T 1Z1, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Solanna Anderson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6T 1Z1, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6T 1Z1, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6T 1Z1, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
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Soukup-Baljak Y, Greer AM, Amlani A, Sampson O, Buxton JA. Drug quality assessment practices and communication of drug alerts among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015. [PMID: 26205676 DOI: 10.1016/j.drugpo.2015.06.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Regional health bodies in British Columbia (BC) issue drug alerts to the public when health risks associated with drug quality are identified, such as increased illicit drug deaths, overdoses or other harms. There is a lack of evidence-based guidelines for producing timely, effective public health alerts to mitigate these harms. This study sought to understand (1) the practices used by people who use drugs (PWUD) to assess the quality of street drugs and reduce harms from adulterants and (2) how drug alerts could be better communicated to PWUD. METHODS Guided by interpretive and descriptive methodology, this study consisted of brief questionnaires and in-depth focus groups with 32 PWUD. RESULTS Findings suggest the most effective and trusted information about drug quality was primarily from: (a) trusted, reputable dealers or (b) peer-based social networks. Most PWUD thought information received through health service providers was not timely and did not discuss drug quality with them. A number of concrete guidelines were suggested by participants to improve the effectiveness of drug alert modes and methods of communication in the community, including the use of language on drug alert postings that implies harm, indicates what drug effects to look for, and suggests appropriate responses to overdose, such as the use of naloxone. Participants also emphasized the need to date posters and remove them in a timely manner so as to not desensitize the community to such alerts. CONCLUSION Since it is difficult to control adulteration practices in an unregulated drug market, this study suggests methods of effectively producing and communicating drug alerts among PWUD to mitigate harms associated with drug use.
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Affiliation(s)
- Yuko Soukup-Baljak
- BC Center for Disease Control, 655 12th Avenue West, Vancouver, British Columbia V5Z 4R4, Canada
| | - Alissa M Greer
- BC Center for Disease Control, 655 12th Avenue West, Vancouver, British Columbia V5Z 4R4, Canada.
| | - Ashraf Amlani
- BC Center for Disease Control, 655 12th Avenue West, Vancouver, British Columbia V5Z 4R4, Canada
| | - Olivia Sampson
- BC Center for Disease Control, 655 12th Avenue West, Vancouver, British Columbia V5Z 4R4, Canada
| | - Jane A Buxton
- BC Center for Disease Control, 655 12th Avenue West, Vancouver, British Columbia V5Z 4R4, Canada
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“It's Russian roulette”: Adulteration, adverse effects and drug use transitions during the 2010/2011 United Kingdom heroin shortage. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:51-8. [DOI: 10.1016/j.drugpo.2014.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 09/16/2014] [Accepted: 09/21/2014] [Indexed: 11/22/2022]
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Kerr T, Small W, Hyshka E, Maher L, Shannon K. 'It's more about the heroin': injection drug users' response to an overdose warning campaign in a Canadian setting. Addiction 2013; 108:1270-6. [PMID: 23551565 PMCID: PMC3913056 DOI: 10.1111/add.12151] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/20/2012] [Accepted: 02/07/2013] [Indexed: 11/26/2022]
Abstract
AIMS To assess heroin injectors' perceptions of and responses to a warning issued by public health officials regarding high-potency heroin and increases in fatal overdoses. DESIGN Semi-structured qualitative interviews. SETTING Vancouver, Canada. PARTICIPANTS Eighteen active heroin injectors. MEASUREMENTS Semi-structured interview guide focussing on heroin injectors' perceptions of and responses to the overdose warning, including reasons for failing to adhere to risk reduction recommendations. FINDINGS Although nearly all participants were aware of the warning, their recollections of the message and the timing of its release were obscured by on-going social interactions within the drug scene focussed on heroin quality. Many injection drug users reported seeking the high potency heroin and nearly all reported no change in overdose risk behaviours. Responses to the warning were shaped by various social, economic and structural forces that interacted with individual behaviour and undermined efforts to promote behavioural change, including sales tactics employed by dealers, poverty, the high cost and shifting quality of available heroin, and risks associated with income-generating activities. Individual-level factors, including emotional suffering, withdrawal, entrenched injecting routines, perceived invincibility and the desire for intense intoxication also undermined risk reduction messages. CONCLUSIONS Among heroin injectors in British Columbia, a 2011 overdose warning campaign appeared to be of limited effectiveness and also produced unintended negative consequences that exacerbated overdose risk.
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Affiliation(s)
- Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Elaine Hyshka
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada,Addiction and Mental Health Research Lab, School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa Maher
- The Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, NSW, Australia
| | - Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Dietze P. Commentary on Kerr et al. (2013): advertising high-potency heroin. Addiction 2013; 108:1277-8. [PMID: 23745748 DOI: 10.1111/add.12223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul Dietze
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic., 3004, Australia.
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