1
|
McKetin R, Clay S. Virtual contingency management, what is it worth and who will pay for it? Addiction 2024; 119:1517-1518. [PMID: 38752258 DOI: 10.1111/add.16535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 08/03/2024]
Affiliation(s)
- Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Simon Clay
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Jones JD, Chaple M, Rozen S, DelaCuesta C, Sosa ES, Bryant K. Empirical assessment of wounds among people who use substances. Drug Alcohol Depend 2024; 262:111375. [PMID: 38971028 DOI: 10.1016/j.drugalcdep.2024.111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Wounds are a significant source of morbidity among people who use substances (PWUS). This project sought to identify the incidence and severity of wounds among PWUS in the South Bronx, a region of New York City with one of the highest morbidities of substance use disorder. METHODS This study recruited PWUS within the past 30 days. Research staff were trained to document the presence and severity of wounds. The primary outcome measure was the incidence of wounds. Acceptability of on-the-street wound care was assessed by the number of participants encountered. The association between participant characteristics and wounds was also evaluated. RESULTS In total, 586 PWUS were assessed (19.4 % female: 69 % Hispanic; 23 % Black; 5 % White). Heroin (65.7 %) and psychostimulants (58.3 %) were the most commonly used drugs. Approximately 23 % of outreach recipients disclosed a wound. Among those with a wound, 60.9 % reported one wound, 27.8 % had two wounds, and 11.3 % had three or more wounds. Small wounds (approximately the size of a cherry) were the most common (78.6 %). Recent use of stimulants or heroin, along with intravenous use of any substance were significantly associated with having a wound. CONCLUSIONS This study found that drug-related wounds were common among PWUS. Toxicology data from other sources indicate that xylazine was present in the NYC market at the time, though its prevalence among the current sample is difficult to determine. The occurrence and severity of substance-related wounds in NYC should continue to be monitored as a function of changes in the xylazine adulteration.
Collapse
Affiliation(s)
- Jermaine D Jones
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Michael Chaple
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Stephanie Rozen
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States
| | - Courtney DelaCuesta
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Emely Santiago Sosa
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Kellie Bryant
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States
| |
Collapse
|
3
|
Sundaram G, Sato T, Goodman-Meza D, Haddad M, Thakarar K, Feinberg J, Springer SA, Barton K, Butler N, Eaton EF, Wurcel AG. Perspectives on benefits and risks of creation of an "injection drug use" billing code. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209392. [PMID: 38735482 DOI: 10.1016/j.josat.2024.209392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024]
Abstract
People with substance use disorder (SUD) face barriers to prevention and treatment services, increasing risk for hospitalization and death. Injection drug use (IDU) can lead to an increased risk of overdose and infections. However, identifying people who inject drugs (PWID) within healthcare systems is challenging. International Classification of Disease (ICD-10) codes are used for billing and tracking healthcare utilization. In this commentary, experts in the field weigh the benefits and risks of creating an IDU-specific ICD-10 code. Potential benefits include earlier identification, better access to health services, and improved systems of resource allocation. Potential risks include further stigmatization of PWID and, if not tied to financial reimbursement, low rates of code utilization. As the current systems of identifying PWID are lacking, we feel that a guided operationalization of an ICD code to identify PWID could improve quantitative and epidemiological research accuracy and, therefore, support the health and well-being of PWID.
Collapse
Affiliation(s)
- Gayathri Sundaram
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Taisuke Sato
- Tufts Medical Center, Boston, MA, United States of America
| | - David Goodman-Meza
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Marwan Haddad
- Center for Key Populations, Community Health Center, Inc., Middletown, CT, United States of America
| | - Kinna Thakarar
- Tufts University School of Medicine, Boston, MA, United States of America; Maine Health Institute of Research, Portland, ME, United States of America; Maine Medical Center, Portland, ME, United States of America; Maine Medical Partners Adult Infectious Diseases, South Portland, ME, United States of America; West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Judith Feinberg
- West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Sandra A Springer
- Yale University School of Medicine, New Haven, CT, United States of America; Yale University School of Public Health, New Haven, CT, United States of America
| | - Kerri Barton
- Harm Reduction Program Coordinator, Portland Public Health, Portland, ME, United States of America
| | - Nikki Butler
- Maine Access Points, Portland, ME, United States of America
| | - Ellen F Eaton
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Alysse G Wurcel
- Tufts University School of Medicine, Boston, MA, United States of America; Tufts Medical Center, Boston, MA, United States of America.
| |
Collapse
|
4
|
Dickson MF, Annett J, Walker M, Leukefeld C, Webster JM, Levi MM, Tillson M, Staton M. Overdose Experiences Among a Sample of Women in Jail with Opioid Use Disorder. Subst Use Misuse 2024:1-10. [PMID: 39069728 DOI: 10.1080/10826084.2024.2383982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background: Previous non-fatal overdose may increase risk of overdose fatality for women reentering the community following incarceration, but pre-incarceration overdose experiences are understudied. This study describes the prevalence and correlates of non-fatal overdose prior to jail among women with opioid use disorder (OUD). Methods: Women (N = 700) were randomly selected from eight Kentucky jails, screened for OUD, and interviewed as part of the NIDA-funded Kentucky Justice Community Opioid Innovation Network (JCOIN) trial. Descriptive statistics were used to examine women's prior overdose experiences, while bivariate analyses and logistic regression were used to identify correlates of overdose in the 90 days prior to jail. Results: Analyses found that 55.4% of women had overdosed in their lifetime, and 21.4% overdosed in the 90 days prior to jail. Of those who overdosed in the 90 days prior to jail, heroin (80.7%) was the most-commonly used drug prior to overdose, 35.2% received emergency, medically-attended services post-overdose, and 92.4% were administered naloxone - primarily by acquaintances. Overdosing in the 90 days prior to jail was positively correlated with identifying as a sexual minority, being from an urban community, childhood victimization, as well as recent heroin, fentanyl, and injection drug use. Conclusions: Findings indicate that prior overdose is common among jailed women with OUD, and although naloxone was often administered, few women received medically-attended services post-overdose. Results highlight the importance of distributing naloxone to community members and women reentering the community from jail, and suggest additional research is needed to understand factors inhibiting medical care following an overdose.
Collapse
Affiliation(s)
- Megan F Dickson
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jaxin Annett
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY, USA
| | - Meghan Walker
- University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - Carl Leukefeld
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - J Matthew Webster
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Mary M Levi
- Department of Psychology, University of Kentucky College of Arts and Sciences, Lexington, KY, USA
| | - Martha Tillson
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY, USA
| | - Michele Staton
- University of Kentucky Center on Drug and Alcohol Research, Lexington, KY, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| |
Collapse
|
5
|
Gaber SN, Franck J, Widing H, Hällgren J, Mattsson E, Westman J. Excess mortality among people in homelessness with substance use disorders: a Swedish cohort study. J Epidemiol Community Health 2024; 78:473-478. [PMID: 38772698 PMCID: PMC11287526 DOI: 10.1136/jech-2023-220989] [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: 06/12/2023] [Accepted: 12/03/2023] [Indexed: 05/23/2024]
Abstract
BACKGROUND People in homelessness have an increased risk of substance use disorders (SUDs) and poor health outcomes. This cohort study aimed to investigate the association between homelessness and mortality in people with SUDs, adjusting for age, sex, narcotic use, intravenous drug use and inpatient care for SUDs. METHODS Data from the Swedish National Addiction Care Quality Register in the Stockholm region were used to analyse mortality risk in people with SUDs (n=8397), including 637 in homelessness, 1135 in precarious housing and 6625 in stable housing, at baseline. HRs and CIs were calculated using Cox regression. RESULTS Mortality was increased for people in homelessness (HR 2.30; 95% CI 1.70 to 3.12) and precarious housing (HR 1.23; 95% CI 0.86 to 1.75) compared with those in stable housing. The association between homelessness and mortality decreased (HR 1.27; 95% CI 0.91 to 1.78) after adjusting for narcotic use (HR 1.28; 95% CI 1.00 to 1.63), intravenous drug use (HR 1.98; 95% CI 1.52 to 2.58) and inpatient care for SUDs (HR 1.96; 95% CI 1.57 to 2.45). Standardised mortality ratios (SMRs) showed that mortality among people in homelessness with SUDs was 13.6 times higher than the general population (SMR=13.6; 95% CI 10.2 to 17.9), and 3.7 times higher in people in stable housing with SUDs (SMR=3.7; 95% CI 3.2 to 4.1). CONCLUSION Homelessness increased mortality, but the risk decreased after adjusting for narcotic use, intravenous drug use and inpatient care for SUDs. Interventions are needed to reduce excess mortality among people in homelessness with SUDs.
Collapse
Affiliation(s)
- Sophie Nadia Gaber
- Department of Healthcare Sciences, Marie Cederschiöld högskola-Campus Ersta, Stockholm, Sweden
- Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
- Faculty of Brain Sciences, Division of Psychiatry, University College London, London, UK
| | - Johan Franck
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Härje Widing
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Hällgren
- Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
| | - Elisabet Mattsson
- Department of Healthcare Sciences, Marie Cederschiöld högskola-Campus Ersta, Stockholm, Sweden
- Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
| | - Jeanette Westman
- Department of Healthcare Sciences, Marie Cederschiöld högskola-Campus Ersta, Stockholm, Sweden
- Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
6
|
Sutherland R, King C, Karlsson A, Treloar C, Broady T, Chandrasena U, Salom C, Dietze P, Peacock A. Stigma, and factors associated with experiencing stigma, while visiting health-care services among samples of people who use illegal drugs in Australia. Drug Alcohol Rev 2024; 43:1264-1279. [PMID: 38644679 DOI: 10.1111/dar.13846] [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: 09/25/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION People who inject drugs experience stigma across multiple settings, including when accessing health-care services, however, comparatively little is known about experiences of stigma towards other groups of people who use illegal drugs. This paper examines experience of, and factors associated with, stigma among two samples of people who use illegal drugs when visiting both specialist alcohol and other drug (AOD) and general health-care services. METHODS Australians who regularly (i.e., ≥monthly) inject drugs (n = 879; illicit drug reporting system [IDRS]) or use ecstasy and/or other illegal stimulants (n = 700; ecstasy and related drugs reporting system [EDRS]) were surveyed between April and July 2022 about past 6-month experience of stigma in the above services. Multi-variable regression analyses were performed to determine the socio-demographic, drug use and health factors associated with stigma. RESULTS Experiences of stigma in general health-care services were more common among IDRS (40%) than EDRS (24%; p < 0.001) participants, however, experiences were comparable in specialist AOD health-care settings (22% and 20%, respectively; p = 0.687). Gender identity and experiencing high psychological distress were associated with experiencing stigma across both samples. Past-year overdose was associated with experiencing stigma among the IDRS sample, while unstable housing and incomplete high school education were associated with experiencing stigma in the EDRS sample. DISCUSSION AND CONCLUSIONS Experiences of stigma when accessing health-care services are relatively common across different populations of people who use illegal drugs. Our findings highlight the multiple and intersecting dimensions of stigma and provide further support for recent calls for a universal precautions approach to stigma in health care.
Collapse
Affiliation(s)
- Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Cate King
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Antonia Karlsson
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Udesha Chandrasena
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Caroline Salom
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Paul Dietze
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Psychology, University of Tasmania, Hobart, Australia
| |
Collapse
|
7
|
Hui J, Reddon H, Fairbairn N, Choi J, Milloy MJ, Socias ME. Prevalence and Correlates of Heavy Alcohol use among People Living with HIV who use Unregulated Drugs in Vancouver, Canada. AIDS Behav 2024; 28:2427-2437. [PMID: 38662276 DOI: 10.1007/s10461-024-04341-y] [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] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
Among people living with HIV (PLWH), heavy alcohol use is associated with many negative health consequences. However, the impacts of heavy alcohol use are not well described for PLWH who use drugs. Thus, we investigated the prevalence and correlates of heavy alcohol use among a cohort of people who use drugs (PWUD) living with HIV in Vancouver, Canada. We accessed data from an ongoing community-recruited prospective cohort of PLWH who use drugs with linked comprehensive HIV clinical monitoring data. We used generalized linear mixed-effects modeling to identify factors longitudinally associated with periods of heavy alcohol use between December 2005 and December 2019. Of the 896 participants included, 291 (32.5%) reported at least one period with heavy alcohol use. Periods of recent incarceration (Adjusted Odds Ratio [AOR] = 1.48, 95% Confidence Interval [CI]: 1.01-2.17), encounters with police (AOR = 1.87, 95% CI: 1.37-2.56), and older age (AOR = 1.05, 95% CI: 1.02-1.07) were positively associated with heavy alcohol use. Engagement in drug or alcohol treatment (AOR = 0.54, 95% CI: 0.42-0.70) and male gender (AOR = 0.46; 95% CI: 0.27-0.78) were negatively associated with heavy alcohol use. We observed that heavy alcohol use was clearly linked to involvement with the criminal justice system. These findings, together with the protective effects of substance use treatment, suggest the need to expand access for drug and alcohol treatment programs overall, and in particular through the criminal justice system to reduce alcohol-related harms among PLWH who use drugs.
Collapse
Affiliation(s)
- Jeremy Hui
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Hudson Reddon
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - JinCheol Choi
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - M-J Milloy
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Maria Eugenia Socias
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| |
Collapse
|
8
|
Burnett DP, Trikalinos TA, Kiluk BD, Ray L, Misquith C, Magill M. A Descriptive Review and Meta-Regression Study of Demographic and Study Context Factors in US Clinical Trials of Cognitive Behavioral Interventions for Alcohol or Other Drug Use. Subst Use Misuse 2024:1-11. [PMID: 38946162 DOI: 10.1080/10826084.2024.2369167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Objectives. Cognitive-Behaviorally Based Interventions (CBIs) are evidence-based treatments for alcohol and other drug (AOD) use with potential variable effectiveness by population sub-groups. This study used evidence synthesis to examine treatment effect by demographic and study context factors in clinical trials of CBI for AOD. Methods. Studies were systematically identified, and their characteristics and outcome data were extracted and summarized. Standardized mean differences were calculated for within- and between-condition effects on substance use outcomes. Demographic and study context moderators were identified during data acquisition and several sensitivity analyses were conducted. Results. The sample included K = 29 trials and a total of 15 study-level moderators were examined. Information on participants' age, biological sex, and race were reported in at least 26 trials, but information on gender identity, sexual orientation, and ethnicity were reported infrequently or in non-inclusive ways. The mean between-condition effect size was small and moderately heterogenous (d = 0.158, 95% CI = 0.079, 0.238, I2 = 46%) and the mean within-condition effect size was large and showed high heterogeneity (dz = 1.147, 95% CI = 0.811, 1.482, - I2 = 96%). The specific drug targeted in the study and whether biological assay-based outcomes were used moderated between-condition CBI efficacy and the inclusion of co-occurring mental health conditions and study publication date moderated within-condition CBI effects. Conclusions. Results provide preliminary data on study context factors associated with effect estimates in United States based clinical trials of CBI for AOD.
Collapse
Affiliation(s)
- Don-Pierre Burnett
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - Brian D Kiluk
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lara Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
| | - Chelsea Misquith
- School of Public Health, Brown University, Providence, Rhode Island, USA
- University Library, Brown University, Providence RI
| | - Molly Magill
- School of Public Health, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
9
|
Kim C, Han K, Trinkoff AM, Baek H. Workplace access, burnout, and prescription drug misuse among Korean hospital nurses: a cross-sectional study. BMC Nurs 2024; 23:368. [PMID: 38824580 PMCID: PMC11143750 DOI: 10.1186/s12912-024-02042-4] [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: 02/05/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Prescription drug misuse has been identified as a global issue of concern. Nurses' prescription drug misuse is linked to personal health problems and impaired nursing care. This study explored the level of South Korean hospital nurses' prescription drug misuse and examined associations with workplace access and burnout. METHODS This cross-sectional study used data from 1142 nurses working in South Korean hospital settings. Nurses completed the online survey anonymously. Descriptive analysis, logistic regression, and Shapley value assessment were conducted. RESULTS Pain relievers (44.2%), IV drips (26.8%), and antibiotics (13.5%) were the most commonly misused drugs among hospital nurses. Accessibility in the workplace was high, with nurses reporting frequent administration of IV drips, pain relievers, and antibiotics and perceiving these drugs as easily accessible. Logistic regression demonstrated that perceived availability was significantly related to misuse across all drug types. Burnout was associated with IV drips, sleeping pills, and steroids, increasing the likelihood of misuse. Shapley feature importance analysis highlighted perceived availability as the most influential factor for IV drips, pain relievers, and steroids, while burnout emerged as crucial for antibiotics and sleeping pills. Notably, age played a significant role in appetite suppressant misuse, distinguishing it from other drugs. CONCLUSION Our results revealed that workplace access and burnout are associated with nurses' prescription drug misuse. Effective educational strategies are essential for enhancing nurses' willingness to seek help for personal health issues. Hospital organizations play a crucial role in facilitating access to healthcare and fostering a supportive environment for nurses to seek treatment when necessary. Additionally, governmental policies should prioritize the implementation of active surveillance systems to monitor medication usage in healthcare settings, thereby mitigating drug misuse among healthcare professionals. By addressing these issues, we can ensure the well-being of nurses and promote a safer healthcare environment.
Collapse
Affiliation(s)
- Chaehee Kim
- Graduate School Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Kihye Han
- College of Nursing, Chung-Ang University, Seoul, South Korea.
| | | | - Hyang Baek
- University of Maryland School of Nursing, Baltimore, MD, USA
| |
Collapse
|
10
|
Price O, Dietze P, Maher L, Dore GJ, Sutherland R, Salom C, Bruno R, Crawford S, Degenhardt L, Larney S, Peacock A. High COVID-19 vaccine uptake following initial hesitancy among people in Australia who inject drugs. Vaccine 2024; 42:2877-2885. [PMID: 38519346 DOI: 10.1016/j.vaccine.2024.03.051] [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: 07/31/2023] [Revised: 01/29/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Previous studies have reported high COVID-19 vaccine hesitancy among people who inject drugs. We aimed to examine COVID-19 vaccine coverage, motivations and barriers to vaccination, and factors associated with uptake among this population in Australia, 1.5 years after vaccine rollout commenced. METHODS In June-July 2022, 868 people (66.0 % male, mean age 45.6 years) who regularly inject drugs and reside in an Australian capital city reported the number of COVID-19 vaccine doses they had received and their primary motivation (if vaccinated) or barrier (if unvaccinated) to receive the vaccine. We compared vaccine uptake to Australian population estimates and used logistic regression to identify factors associated with ≥ 2 dose and ≥ 3 dose uptake. RESULTS Overall, 84.1 % (n = 730) had received at least one COVID-19 vaccine dose, 79.6 % (n = 691) had received ≥ 2 doses, and 46.1 % (n = 400) had received ≥ 3 doses. Participants were less likely to be vaccinated than the Australian general population (prevalence ratio: 0.82, 95 % confidence interval [CI]: 0.76-0.88). Key motivations to receive the vaccine were to protect oneself or others from COVID-19, while barriers pertained to vaccine or government distrust. Opioid agonist treatment (adjusted odds ratio [aOR]: 2.49, 95 % CI: 1.44-4.42), current seasonal influenza vaccine uptake (aOR: 6.76, 95 % CI: 3.18-16.75), and stable housing (aOR: 1.58, 95 % CI: 1.02-2.80) were associated with receipt of at least two vaccine doses. Participants aged ≥ 40 years (versus < 40 years; aOR: 1.66, 95 % CI: 1.10-2.53) or who reported a chronic health condition (aOR: 1.71, 95 % CI: 1.18-2.47) had higher odds of receiving at least three vaccine doses. CONCLUSION We observed higher COVID-19 vaccine uptake than expected given previous studies of vaccine acceptability among people who inject drugs. However, it was lower than the general population. People who inject drugs and reside in unstable housing are a subpopulation that require support to increase vaccine uptake.
Collapse
Affiliation(s)
- Olivia Price
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.
| | - Paul Dietze
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; Disease Elimination Program, Burnet Institute, Melbourne, Australia; National Drug Research Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Caroline Salom
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; School of Psychological Science, University of Tasmania, Hobart, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Sarah Larney
- Department of Family Medicine and Emergency Medicine, Universite de Montreal, Montreal, Canada; Centre de Recherche du CHUM, Montreal, Canada
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| |
Collapse
|
11
|
Farooq A, Valerio H, Wheeler A, Martinello M, Henderson C, Silk D, Degenhardt L, Read P, Dore GJ, Grebely J, Cunningham EB. Needle and syringe sharing among people who have recently injected drugs in Australia: The ETHOS Engage Study. Drug Alcohol Rev 2024. [PMID: 38630939 DOI: 10.1111/dar.13828] [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: 06/29/2023] [Revised: 01/01/2024] [Accepted: 02/10/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Understanding needle/syringe sharing is crucial for reducing hepatitis C virus (HCV) infection and reinfection. This study aimed to assess the prevalence and factors associated with needle/syringe sharing among people who inject drugs in Australia, including those previously receiving HCV treatment. METHODS The ETHOS Engage study was an observational cohort study which collected self-reported survey data on demographic and drug use information from people who inject drugs attending drug treatment clinics and needle and syringe programs over two waves between May 2018 and June 2021. Logistic regression was used to identify factors associated with needle/syringe sharing. RESULTS Overall, 1555/2395 people enrolled in ETHOS Engage (65%) injected drugs in the past month. Among these, 432 (28%) reported needle/syringe sharing in the past month and 276 (18%) reported receptive sharing. Factors associated with receptive sharing included younger age (adjusted odds ratio [aOR] 1.72; 95% confidence interval [CI] 1.28-2.30), recent incarceration (aOR 2.04; 95% CI 1.40-2.94), more frequent injecting (≥daily vs. less than weekly; aOR 2.59; 95% CI 1.75-3.84) and unstable housing (aOR 1.78; 95% CI 1.26-2.52). Among 560 participants with prior HCV treatment, 87 (16%) reported receptive sharing with younger age (aOR 2.42; 95% CI 1.45-4.05) and daily or greater injection frequency (aOR 2.51; 95% CI 1.31-4.83) associated with receptive sharing. DISCUSSION AND CONCLUSIONS Needle/syringe sharing was common among this population accessing harm reduction services. This study identifies high-risk populations with needle/syringe sharing. Research is needed to optimise HCV treatment to ensure people with ongoing risk behaviours receive adequate harm reduction following treatment to prevent reinfection.
Collapse
Affiliation(s)
| | | | | | | | | | - David Silk
- The Kirby Institute, UNSW, Sydney, Australia
| | | | - Phillip Read
- The Kirby Institute, UNSW, Sydney, Australia
- Kirketon Road Centre, Sydney, Australia
| | | | | | | |
Collapse
|
12
|
Joyce LR, Crossin R, Jin S, Young W, Mulder R. Presence of alcohol and other drug use within youth mental health presentations to the emergency department: A single-site retrospective observational study. Emerg Med Australas 2024; 36:213-220. [PMID: 37899072 DOI: 10.1111/1742-6723.14333] [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: 05/10/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Youth mental health is a growing issue, which can be worsened by alcohol and other drug (AOD) use. The present study aimed to characterise the association of AOD use in youth presenting to an ED with a mental health crisis. METHODS A retrospective observational study of paediatric patients presenting with mental health concerns to a tertiary ED in New Zealand in 2019-2020, with an examination of use of alcohol or other drugs before presentation. RESULTS There were 842 ED presentations, made up of 491 unique individuals, examined from the 2-year period. Overdose (63.1%) was the most common reason for presentation, with 39.9% of overdoses involving prescription-only medications, 36.7% over-the-counter, and 20.0% a combination. Seventy-four (8.8%) presentations had documented use of alcohol or other drugs (excluding those taken in overdose) before arrival, with alcohol (51 presentations), followed by cannabis (19 presentations), being the most commonly recorded drugs used. Concurrent AOD use was not associated with any significant difference in triage, length of stay or admission status. CONCLUSION In New Zealand, it is not legal to sell alcohol to persons under 18 years; however, this was the most commonly identified drug impacting on youth mental health presentations. There is a known association between alcohol use and adverse mental health symptoms; therefore, efforts to decrease access to alcohol in this age group must continue, and harm reduction interventions to reduce clinically significant overdoses recommended.
Collapse
Affiliation(s)
- Laura R Joyce
- Department of Surgery and Critical Care, University of Otago, Christchurch, New Zealand
- Emergency Department, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Rose Crossin
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Sangjun Jin
- Resident Medical Officer Unit, Te Whatu Ora, Waikato, New Zealand
| | - William Young
- Specialist Mental Health Services, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| |
Collapse
|
13
|
Won NY, Jabot B, Wang A, Palamar JJ, Cottler LB. Willingness to provide a hair sample for drug testing: results from an anonymous multi-city intercept survey. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:261-268. [PMID: 38547406 PMCID: PMC11052666 DOI: 10.1080/00952990.2024.2309654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/21/2024] [Indexed: 04/28/2024]
Abstract
Background: Hair provision for drug testing can provide secondary measurement to complement self-reported drug use data, thereby providing a more accurate representation of an individual's drug use. Understanding factors associated with hair provision offers valuable insights into recruitment methods.Objective: To identify demographic and drug-related correlates of providing hair samples in a multi-site venue-intercept study.Methods: We utilized venue-intercept sampling for our Rapid Street Reporting study across 12 US cities between January and November 2022. Participants reported past 12-month drug use and were asked if they would provide a hair sample. We conducted multivariable (generalized linear model with logit link) analyses on demographics and drug use characteristics correlated to hair provision for drug testing.Results: Among 3,045 participants, 55.8% were male, 13.6% provided hair samples. Compared to males, those identifying as "other gender" had higher odds of hair collection (adjusted odds ratio = 2.24, 95% confidence interval: 1.28-3.80). Participants identifying as Black (aOR = 0.32, CI: 0.23-0.45) or "other race" (aOR = 0.50, 95% CI: 0.29-0.80) had lower odds of providing hair than those identifying as White. All levels of reported drug use - one drug (aOR=1.50, 95% CI: 1.15-1.96), two-three drugs (aOR=1.51, 95% CI: 1.11-2.05), four or more (aOR = 2.13, 95% CI: 1.50-3.01) - had higher odds of providing hair samples than those reporting no drug use. Similar associations applied to reporting cannabis use with or without another drug (aOR = 1.52-1.81, 95% CI: 1.15-2.38).Conclusion: Differential hair provision based on participant sex, race/ethnicity, and drug use may introduce biases in drug testing, limiting generalizability to individuals from minority backgrounds.
Collapse
Affiliation(s)
- Nae Y. Won
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Brittney Jabot
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Anna Wang
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J. Palamar
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|
14
|
Kalicum J, Nyx E, Kennedy MC, Kerr T. The impact of an unsanctioned compassion club on non-fatal overdose. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104330. [PMID: 38395656 DOI: 10.1016/j.drugpo.2024.104330] [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: 11/29/2023] [Revised: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES In 2022, the Drug User Liberation Front opened an unsanctioned compassion club in Vancouver where members could purchase illicit drugs that had been rigorously tested to ensure quality and a lack of potentially fatal contaminants. We sought to evaluate the impact of access to this novel safer supply intervention on non-fatal overdose. METHODS Data were obtained from 47 club members via surveys completed at 3-month intervals between August 2022 and October 2023. We conducted multivariable generalized estimating equations (GEE) analyses to examine the association between club enrolment and the outcomes of: (1) any non-fatal overdose; and (2) any non-fatal overdose involving naloxone administration. RESULTS The final sample, including 47 study participants, contributed a total of 225 observations and 44.4 person-years of follow-up during the study, and a median follow-up duration of 12.2 months (quartile 1 - 3: 10.4 - 14.7) per participant. In multivariable GEE analyses, enrolment in the compassion club was associated with reduced likelihood of non-fatal overdose (Adjusted Odds Ratio [AOR] = 0.51, 95% Confidence Interval (CI): 0.26 - 0.99) and non-fatal overdose involving naloxone administration (AOR = 0.37, 95% CI: 0.16 - 0.84) after adjusting for potential confounders. DISCUSSION In this study, enrolment in an unsanctioned compassion club was found to be associated with reductions in any type of non-fatal overdose and non-fatal overdose involving naloxone administration. These findings highlight the need for ongoing research on safer supply interventions, as well as the potential of non-medicalized compassion clubs to complement existing safer supply programming and reduce overdose events.
Collapse
Affiliation(s)
- Jeremy Kalicum
- Drug Users Liberation Front, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Eris Nyx
- Drug Users Liberation Front, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Mary Clare Kennedy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; University of British Columbia - Okanagan School of Social Work, Vancouver, BC, Canada
| | - Thomas Kerr
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada.
| |
Collapse
|
15
|
Sharafi H, Bakouni H, McAnulty C, Drouin S, Coronado-Montoya S, Bahremand A, Bach P, Ezard N, Le Foll B, Schütz CG, Siefried KJ, Tardelli VS, Ziegler D, Jutras-Aswad D. Prescription psychostimulants for the treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of randomized placebo-controlled trials. Addiction 2024; 119:211-224. [PMID: 37880829 DOI: 10.1111/add.16347] [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: 05/29/2023] [Accepted: 08/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND AND AIMS There is currently no standard of care for pharmacological treatment of amphetamine-type stimulant (ATS) use disorder (ATSUD). This systematic review with meta-analysis (PROSPERO CRD42022354492) aimed to pool results from randomized placebo-controlled trials (RCTs) to evaluate efficacy and safety of prescription psychostimulants (PPs) for ATSUD. METHODS Major indexing sources and trial registries were searched to include records published before 29 August 2022. Eligible studies were RCTs evaluating efficacy and safety of PPs for ATSUD. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool. Risk ratio (RR) and risk difference were calculated for random-effect meta-analysis of dichotomous variables. Mean difference and standardized mean difference (SMD) were calculated for random-effect meta-analysis of continuous variables. RESULTS Ten RCTs (n = 561 participants) were included in the meta-analysis. Trials studied methylphenidate (n = 7), with daily doses of 54-180 mg, and dextroamphetamine (n = 3), with daily doses of 60-110 mg, for 2-24 weeks. PPs significantly decreased end-point craving [SMD -0.29; 95% confidence interval (CI) = -0.55, -0.03], while such a decrease did not reach statistical significance for ATS use, as evaluated by urine analysis (UA) (RR = 0.93; 95% CI = 0.85-1.01). No effect was observed for self-reported ATS use, retention in treatment, dropout following adverse events, early-stage craving, withdrawal and depressive symptoms. In a sensitivity analysis, treatment was associated with a significant reduction in UA positive for ATS (RR = 0.89; 95% CI = 0.79-0.99) after removing studies with a high risk of bias. In subgroup analyses, methylphenidate and high doses of PPs were negatively associated with ATS use by UA, while higher doses of PPs and treatment duration (≥ 20 weeks) were positively associated with longer retention. CONCLUSIONS Among individuals with amphetamine-type stimulant use disorder, treatment with prescription psychostimulants may decrease ATS use and craving. While effect size is limited, it may increase with a higher dosage of medications.
Collapse
Affiliation(s)
- Heidar Sharafi
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Hamzah Bakouni
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Christina McAnulty
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Sarah Drouin
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Stephanie Coronado-Montoya
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Arash Bahremand
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Paxton Bach
- Department of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, St Paul's Hospital, Vancouver, Canada
| | - Nadine Ezard
- National Centre for Clinical Research on Emerging Drugs (NCCRED), University of New South Wales, Sydney, Australia
- St Vincent's Hospital Sydney Alcohol and Drug Service, Darlinghurst, Australia
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, Australia
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| | - Christian G Schütz
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Krista J Siefried
- National Centre for Clinical Research on Emerging Drugs (NCCRED), University of New South Wales, Sydney, Australia
- St Vincent's Hospital Sydney Alcohol and Drug Service, Darlinghurst, Australia
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, Australia
| | - Vitor S Tardelli
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Daniela Ziegler
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| |
Collapse
|
16
|
German D, Genberg B, Sugarman O, Saloner B, Sawyer A, Glick JL, Gribbin M, Flynn C. Reported xylazine exposure highly associated with overdose outcomes in a rapid community assessment among people who inject drugs in Baltimore. Harm Reduct J 2024; 21:18. [PMID: 38254198 PMCID: PMC10804796 DOI: 10.1186/s12954-024-00940-z] [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: 10/18/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Addressing xylazine harms are now a critical harm reduction priority, but relatively little epidemiological information exists to determine prevalence, magnitude, and correlates of xylazine use or related outcomes. METHODS We conducted a rapid behavioral survey among people who inject drugs (n = 96) in Baltimore November-December 2022. Using a novel indicator of self-reported presumed xylazine effects, we examined prevalence and sociodemographic correlates of past year presumed xylazine effects and association with overdose and wound-related outcomes. Chi-square and descriptive statistics were used to examine bivariate associations overall and separately for those who reported xylazine by name and by reported fentanyl use frequency. RESULTS Almost two-thirds (61.5%) reported experiencing xylazine effects. There were no differences by socio-demographics, but xylazine effects were more commonly reported among those who reported injecting alone (66% vs 38%%, p < 0.007) and daily fentanyl use (47% vs 24% p < 0.003). Those reporting xylazine exposure was three times as likely to report overdose (32% vs 11%, p < 0.03) and twice as likely to have used naloxone (78% vs 46%, p < 0.003). They also more commonly reported knowing someone who died of an overdose (92% vs 76%, p < 0.09) and to report an abscess requiring medical attention (36% vs 19%, p < 0.80). These associations were higher among respondents who specifically named xylazine and those who used fentanyl more frequently, but fentanyl frequency did not fully explain the heightened associations with xylazine effects. CONCLUSIONS This study provides insight into the scope of xylazine exposure and associated health concerns among community-based PWID and suggests measures that may be instrumental for urgently needed research.
Collapse
Affiliation(s)
- Danielle German
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Becky Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Olivia Sugarman
- Department of Health, Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Brendon Saloner
- Department of Health, Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Sawyer
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, 21205, USA
| | | | - Colin Flynn
- Maryland Department of Health, Baltimore, MD, USA
| |
Collapse
|
17
|
Watson DP, Ray B, Phalen P, Duhart Clarke SE, Taylor L, Swartz J, Gastala N. Fentanyl Exposure and Detection Strategies Utilized by Clinical Trial Participants Seeking Linkage to Opioid Use Disorder Treatment at a Syringe Service Program. J Med Toxicol 2024; 20:13-21. [PMID: 38048033 PMCID: PMC10774457 DOI: 10.1007/s13181-023-00979-7] [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: 08/11/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
INTRODUCTION The USA continues to face a fentanyl-driven overdose epidemic. Prior research has demonstrated users of illicit opioids are concerned about fentanyl exposure and overdose, but the strategies they report using to detect fentanyl's presence lack empirical support. This study compares self-report and biologically detected fentanyl use and investigates overdose risk and risk reduction behaviors among a sample of high-risk people who use opioids. METHODS Structured enrollment interviews conducted as part of a larger clinical trial assessed self-reported fentanyl exposure as well as strategies used to determine believed fentanyl exposure and prevent overdose among 240 participants enrolled at a Chicago, IL syringe service program. Urinalysis measured actual fentanyl exposure. RESULTS Most participants identified as African American (66.7%) and had considerable overdose experience (76.7% lifetime and 48% in the past year). Most also tested positive for fentanyl (93.75%) despite reporting no past year use of fentanyl or fentanyl-adulterated drugs (64.17%). The most utilized approaches reported for identifying fentanyl exposure were stronger effects of the drug (60.7%), sight or taste (46.9%), and being told by someone using the same drugs (34.2%). Few participants (14%) reported using fentanyl test strips. No significant associations were identified between self-report and urinalysis measures or urinalysis results and risk reduction strategies. CONCLUSION This study adds to prior fentanyl exposure risk research. The disconnect between participants' fentanyl detection methods and reported overdose experiences supports the need for more research to identify and understand factors driving access and use of overdose prevention resources and strategies.
Collapse
Affiliation(s)
- Dennis P Watson
- Chestnut Health Systems, Lighthouse Institute, 221 W Walton Street, Chicago, IL, 60610, USA.
| | - Bradley Ray
- RTI International, 3040 Cornwallis Road, Research Triangle Park, Chapel Hill, NC, 27709, USA
| | - Peter Phalen
- Department of Psychiatry, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD, 21201, USA
| | - Sarah E Duhart Clarke
- RTI International, 3040 Cornwallis Road, Research Triangle Park, Chapel Hill, NC, 27709, USA
| | - Lisa Taylor
- Chestnut Health Systems, Lighthouse Institute, 221 W Walton Street, Chicago, IL, 60610, USA
| | - James Swartz
- Jane Addams College of Social Work, The University of Illinois at Chicago, 1040 W Harrison Street, Chicago, IL, 60607, USA
| | - Nicole Gastala
- Department of Family Medicine, Mile Square Health Centers, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| |
Collapse
|
18
|
Sevigny EL, Potter G, Wilkins C, Barratt MJ, Søgaard TF, Hakkarainen P, Grigg J, Roustide MJ. Conflict and social control among cannabis growers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104292. [PMID: 38104014 DOI: 10.1016/j.drugpo.2023.104292] [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: 08/27/2023] [Revised: 11/01/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
AIMS Illegal drug markets are often assumed to be violent and predatory due to the absence of third-party enforcement. While cannabis markets are generally considered to be relatively more peaceful, there has been little investigation of the levels of conflict and victimization among small-scale cannabis growers, particularly under different cannabis policy and enforcement settings. This paper explores prevalence and predictors of conflict and social control among small-scale cannabis growers. METHODS The data were obtained from an online convenience survey of small-scale cannabis growers from 13 countries (Austria, Canada, Denmark, Finland, France, Germany, Israel, New Zealand, Portugal, Switzerland, United Kingdom, United States, and Uruguay) from August 2020 to September 2021 (N = 5667). Key measures collected included the types of victimization due to cannabis growing, the perpetrators of these predatory actions, reasons for the conflict, and the grower's response to being victimized. Multivariate logistic regression models were used to identify predictors of different types of victimization and social control responses among cannabis cultivators. RESULTS Most growers (76 %) never directly experienced violence or other victimization related to their cannabis cultivation. However, about one-quarter of growers had been victimized at some point, mostly involving theft, with physical violence rare. Growing outdoors, growing with others, growing more plants, and being a more seasoned grower increased the risk of victimization. Growers who were motivated by profit were more susceptible to theft. Surprisingly, growers in legal recreational jurisdictions experienced greater levels of theft and violent victimization than growers in illegal jurisdictions. Nonviolent social control responses predominated among the growers, mostly characterized by toleration but also avoidance and negotiation. CONCLUSION While most growers reported no victimization, a substantial minority did so, largely theft rather than violence, and typically did not report employing retaliatory violence. Social control responses were mostly nonviolent. These findings varied under different cannabis policy and enforcement environments. Cannabis legalization does not eliminate opportunities for theft and violence related to cannabis cultivation.
Collapse
Affiliation(s)
- Eric L Sevigny
- Department of Criminal Justice and Criminology, Georgia State University, 55 Park Place NE, Atlanta GA 30303, USA.
| | - Gary Potter
- Law School, Lancaster University, Lancaster, UK
| | - Chris Wilkins
- SHORE & Whariki Research Centre, Massey University, Auckland, New Zealand
| | - Monica J Barratt
- Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, Vic, Australia; National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia
| | | | - Pekka Hakkarainen
- Alcohol, Drugs and Tobacco Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jodie Grigg
- National Drug Research Institute and enAble Instutute, Curtin University, Perth, Australia
| | - Marie Jauffret Roustide
- Centre d'étude des mouvements sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France; Baldy Center on Law and Social Policy, Buffalo, NY, USA; British Columbia Center on Substance Use, Vancouver, Canada; Institut Interuniversitaire sur les Dépendances, Montréal, Canada
| |
Collapse
|
19
|
Austin A, Favril L, Craft S, Thliveri P, Freeman TP. Factors associated with drug use in prison: A systematic review of quantitative and qualitative evidence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104248. [PMID: 37952319 DOI: 10.1016/j.drugpo.2023.104248] [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: 07/14/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND About a third of people use drugs during their incarceration, which is associated with multiple adverse health and criminal justice outcomes. Many studies have examined factors associated with in-prison drug use, but this evidence has not yet been systematically reviewed. We aimed to systematically review and synthesise the evidence on factors related to drug use in prison. METHODS Three databases (PubMed, PsycINFO and Embase) were systematically searched as well as grey literature, for quantitative, qualitative and mixed-methods studies examining factors related to drug use inside prison. We excluded studies that did not explicitly measure in prison drug use or only measured alcohol and/or tobacco use. Study quality was assessed using the Newcastle Ottawa Scale (NOS) for quantitative studies and Critical Appraisal Skills Programme (CASP) for qualitative studies. The review was prospectively registered on PROSPERO (CRD42021295898). RESULTS Fifty-four studies met the inclusion criteria, reporting data on 26,399 people in prison. Most studies were of low or moderate-quality, and all used self-report to assess drug use. In quantitative studies, studies found that previous criminal justice involvement, poor prison conditions, pre-prison drug use and psychiatric diagnosis were positively associated with drug use in prison. In qualitative studies, reasons for drug use were closely linked to the prison environment lacking purposeful activity and the social context of the prison whereby drug use was seen as acceptable, necessary for cohesion and pressurised. CONCLUSION In the first systematic review of factors associated with drug use in prison, key modifiable risk factors identified from quantitative and qualitative studies were psychiatric morbidity and poor prison conditions. Non-modifiable factors included previous drug use and criminal history linked to substance use. Our findings indicate an opportunity to intervene and improve the prison environment to reduce drug use and associated adverse outcomes.
Collapse
Affiliation(s)
- Alice Austin
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Louis Favril
- Faculty of Law and Criminology, Ghent University, Belgium
| | - Sam Craft
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Phoebe Thliveri
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK.
| |
Collapse
|
20
|
Palamar JJ, Salomone A, Massano M, Cleland CM. Trends in reported and biologically confirmed drug use among people who use ecstasy in the nightclub/festival-attending population, 2016-2022. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100198. [PMID: 38023341 PMCID: PMC10665664 DOI: 10.1016/j.dadr.2023.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023]
Abstract
Background Nightclub/festival attendees are a population with high rates of party drug use, but research is needed to determine whether there have been shifts in unintended drug exposure in this population (e.g., via adulterants) to inform prevention and harm reduction efforts. Methods Adults entering nightclubs and festivals in New York City were asked about past-year drug use in 2016 through 2022, with a subset providing a hair sample for testing. We focused on the 1943 who reported ecstasy use (of which 247 had a hair sample analyzed) and compared trends in self-reported drug use, drug positivity, and adjusted prevalence (adjusting for unreported use). Results MDMA positivity decreased from 74.4 % to 42.3 %, and decreases occurred regarding detection of synthetic cathinones ("bath salts"; a 100.0 % decrease), MDA (a 76.9 % decrease), amphetamine (an 81.3 % decrease), methamphetamine (a 64.2 % decrease), and ketamine (a 33.4 % decrease) (ps < .05). Although prevalence of MDA and synthetic cathinone use was comparable between self-report and adjusted report in 2022, gaps in prevalence were wider in 2016 (ps < .01). Adjusted prevalence of synthetic cathinone use decreased more across time than prevalence based on self-report (a 79.4 % vs. 69.1 % decrease) and adjusted report for MDA use decreased more than prevalence based on self-report (a 50.6 % vs. 38.9 % decrease). Conclusions Combining self-report and toxicology tests helped us determine that decreases in drug use/exposure were steeper regarding adjusted prevalence. Underreported drug exposure-possibly due to exposure to adulterants-appears to have had less of an effect on prevalence in 2022 than it did in 2016.
Collapse
Affiliation(s)
- Joseph J. Palamar
- NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University, New York, NY, USA
| | - Alberto Salomone
- Department of Chemistry, University of Turin, Turin, Italy
- Centro Regionale Antidoping, Orbassano (TO), Italy
| | - Marta Massano
- Department of Chemistry, University of Turin, Turin, Italy
| | - Charles M. Cleland
- NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University, New York, NY, USA
| |
Collapse
|
21
|
Craft S, Austin A, Tooth T, Glover C, Garrett T, Blagbrough IS, Sunderland P, Pudney CR, Freeman TP. Synthetic cannabinoid use in an adult male prison in the UK. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104219. [PMID: 37813081 DOI: 10.1016/j.drugpo.2023.104219] [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: 07/06/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Synthetic cannabinoids (i.e. Spice) are a major public health problem in UK prisons, however, research in this area is limited. Here we aimed to draw comparisons between people with and without experience of using synthetic cannabinoids in prison, to characterise the features of, and motivations for use within this setting and evaluate support for different treatment interventions. METHOD Questionnaires were administered to 122 people in a category-B prison for adult males in England between July 2022 and March 2023. Participants were asked questions related to their sociodemographic and custodial characteristics, use of synthetic cannabinoids (and other drugs) inside and outside of prison and psychological distress was measured via the Brief Symptom Inventory (BSI-18). Those that had ever used synthetic cannabinoids in prison completed additional questions related to features of use, motivations for use and support for various interventions. RESULTS In total 46.7 % (n = 57) of participants reported use of synthetic cannabinoids in prison and this group experienced significantly greater levels of psychological distress compared to those reporting no use (mean (± standard deviation) BSI-18 scores = 23.7 (±16.7) vs 12.8 (±13.6), p < 0.001). Participants mostly reported using paper-based preparations (77.4 %) and use via e-cigarettes (75.9 %). The most strongly endorsed motivations for use included to alleviate boredom (91.1 % strongly agree/agree), to make the sentence pass faster (89.3 % strongly agree/agree) and to cope with stress (80.4 % strongly agree/agree). The interventions that received most support were strategies to better manage time and medication to manage withdrawal. CONCLUSIONS The use of synthetic cannabinoids in UK prisons typically involves the use of paper-based preparations via e-cigarettes, and use is associated with greater levels of psychological distress. Motivations for use were mostly pragmatic (e.g. to alleviate boredom or cope with stress) and interventions should prioritise increasing the time individuals spend out of cells and in meaningful activity.
Collapse
Affiliation(s)
- Sam Craft
- Addiction and Mental Health Group, Department of Psychology, University of Bath, UK.
| | - Alice Austin
- Addiction and Mental Health Group, Department of Psychology, University of Bath, UK
| | - Tom Tooth
- HM Prison and Probation Service (HMPPS), London, UK
| | - Catherine Glover
- Royal College of General Practitioners Secure Environments Group, London, UK
| | - Tina Garrett
- Office of Health Improvements and Disparities (OHID), London, UK
| | | | | | | | - Tom P Freeman
- Addiction and Mental Health Group, Department of Psychology, University of Bath, UK
| |
Collapse
|
22
|
Migchels C, Zerrouk A, Crunelle CL, Matthys F, Gremeaux L, Fernandez K, Antoine J, van den Brink W, Vanderplasschen W. Patient Reported Outcome and Experience Measures (PROMs and PREMs) in substance use disorder treatment services: A scoping review. Drug Alcohol Depend 2023; 253:111017. [PMID: 37995391 DOI: 10.1016/j.drugalcdep.2023.111017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Substance use disorders (SUD) pose significant challenges for healthcare systems, and there is a need to monitor the provision of effective, individualized care to persons accessing treatment. Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) are increasingly used in healthcare services to measure treatment outcomes and quality of care as perceived by patients, and to guide service improvement. OBJECTIVES This review aims to identify and characterize international developments regarding the use and systematic implementation of PROMs and PREMs in SUD treatment services. METHODS A scoping review was conducted searching multiple databases to identify studies on the use and routine implementation of PROMs and PREMs in SUD treatment services. RESULTS 23 articles were selected, all dating from 2016 onwards. There was large variation in the patient-reported measures that were used, how they were developed and how and when patient-reported data were collected. Treatment providers identified leadership support, the presence of an integrated electronic patient record, and regular feedback to be the most important facilitators of successful implementation of patient-reported measures into clinical practice, whilst treatment dropout and burden to staff and patients were the most important barriers to consider. CONCLUSIONS PROMs and PREMs are increasingly used in SUD treatment services, but guidance is needed to support researchers and clinicians in selecting and implementing valid, meaningful, and comparable measures if we want to understand the effects of PROM and PREM data collection and feedback on treatment quality and results.
Collapse
Affiliation(s)
- Charlotte Migchels
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Psychiatry, Laarbeeklaan 101, Brussels, Belgium.
| | - Amine Zerrouk
- Department of Special Needs Education, Ghent University (UGent), Ghent, Belgium
| | - Cleo L Crunelle
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Psychiatry, Laarbeeklaan 101, Brussels, Belgium
| | - Frieda Matthys
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Psychiatry, Laarbeeklaan 101, Brussels, Belgium
| | - Lies Gremeaux
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Kim Fernandez
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Jérôme Antoine
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Wim van den Brink
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
| | | |
Collapse
|
23
|
Gibbs D, King C, Hughes C, Peacock A, Grigg J, Yuen WS, Sutherland R. Comparing police use of drug detection dogs amongst injecting and non-injecting groups of people who regularly use drugs in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104223. [PMID: 37844521 DOI: 10.1016/j.drugpo.2023.104223] [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: 06/05/2023] [Revised: 09/24/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Drug detection dogs are utilised across multiple settings, however existing literature focuses predominantly on festival-based encounters. We compare drug dog encounters in non-festival settings among two samples of people who regularly use drugs, and investigate factors associated with witness only versus stop and/or search encounters. METHODS Australians who regularly (i.e., ≥monthly) use ecstasy and/or other illegal stimulants (n = 777; Ecstasy and Related Drugs Reporting System (EDRS)) or inject illegal drugs (n = 862; Illicit Drugs Reporting System (IDRS)) were surveyed between April-June, 2019. Univariable regression analyses were used to test for differences in drug dog encounters between samples, and to identify factors associated with a more intensive drug dog encounter (namely those that involved a stop and/or search). RESULTS People who inject drugs were less likely to witness drug dogs than those who regularly use ecstasy and/or other illegal stimulants (odds ratio (OR) 0.46; 95 % CI 0.30-0.69). They were significantly more likely than EDRS participants to report being stopped and searched (3.29; 1.68-6.44) however. Among those carrying drugs at their last stop and/or search encounter, the majority of both samples reported that their drugs were not detected by police. IDRS participants aged 35-49 were more likely to report a stop and/or search encounter than those aged 17-34; no significant associations were found among the EDRS sample. CONCLUSIONS Despite participants who use ecstasy and/other stimulants being more likely than those who regularly inject drugs to report encountering drug dogs in non-festival settings, participants who inject drugs were more likely to report an intensive or invasive drug dog encounter and/or receiving a formal criminal justice consequence. This study reinforces questions about the efficacy and appropriateness of drug dog operations.
Collapse
Affiliation(s)
- Daisy Gibbs
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
| | - Cate King
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Caitlin Hughes
- College of Business, Government, and Law, Flinders University, Adelaide, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; School of Psychology, University of Tasmania, Hobart, Australia
| | - Jodie Grigg
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Wing See Yuen
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | | |
Collapse
|