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Ospina-Escobar A, Cervantes CAD. Trends in drug overdose deaths in Mexico (1999-2019). A national descriptive analysis and interstate comparison. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104464. [PMID: 38843735 DOI: 10.1016/j.drugpo.2024.104464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/24/2024] [Accepted: 05/16/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND We assess trends in overdose mortality rates in Mexico from 1999 to 2019 and identify the states with the highest overdose mortality rates over time. METHODS The analysis using mortality statistics examined deaths related to drug use. We estimated general overdose mortality rates at the national and state levels and calculated specific mortality rates associated with opioid and stimulant use using central rate estimation. We used joinpoint regression to analyse national and state-specific trends in overdose mortality from 1999 to 2019. FINDINGS Nationally, the general overdose mortality rate increased annually by 10.49 % (p < 0.01, CI=11.4-18.9) from 2015 to 2019. The northern states of Baja California and Chihuahua were the states with the higher annual increases (18.6 %, p < 0.01, CI=4.2-29.6; and 15.6 %, p < 0.01, CI=12.9-19.7, respectively). By substance type, the national opioid-related mortality rate increased by 29.82 % per year from 2014 to 2019 (p < 0.01; CI=20.1-40.3), compared with an annual decrease of 11.43 % in the previous period (2005-2014) (p < 0.01; CI=-14.7- 8.0). Baja California was the state with the highest rise in opioid-related mortality from 2013 to 2019, with an annual increase of 15.84 % (p < 0.01; CI=1.4-32.3). Stimulant-related mortality increased by 21.79 % per year since 2013 (p < 0.01; CI=16.9-26.9), but it was not possible to calculate state-level trends. CONCLUSIONS Drug-related mortality rates have increased in Mexico since 2015, particularly in the northern states of Baja California, Chihuahua, Sonora and Sinaloa. Improving harm reduction programmes and local surveillance of fatal and non-fatal overdoses is essential to address the silent escalation of overdose mortality.
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Affiliation(s)
- Angélica Ospina-Escobar
- Consejo Nacional de Ciencia y Tecnología, Programa Investigadoras e Investigadores por México, Aguascalientes, Mexico.
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Bazzi AR, Valasek CJ, Stamos-Buesig T, Eger WH, Harvey-Vera A, Vera CF, Syvertsen JL, Storholm ED, Bartholomew TS, Tookes HE, Strathdee SA, Pines HA. Health, harm reduction, and social service providers' perspectives on the appropriateness and feasibility of peer distribution of HIV self-test kits among people who use drugs. Harm Reduct J 2024; 21:29. [PMID: 38311717 PMCID: PMC10838430 DOI: 10.1186/s12954-024-00950-x] [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: 10/10/2023] [Accepted: 01/26/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND People who use drugs (PWUD) experience elevated HIV risk and numerous barriers to facility-based HIV testing. HIV self-testing (HIVST) could circumvent many of those barriers and is acceptable among PWUD, yet HIVST implementation for PWUD is limited. Service providers' perspectives on specific HIVST delivery strategies could help increase availability for PWUD. METHODS From April-November 2021, we interviewed 16 health, harm reduction, and social service providers working with PWUD in San Diego, CA. Interviews and rapid thematic analysis explored perspectives on HIVST's utility and appropriateness, as well as the feasibility of and anticipated challenges with specific HIVST delivery strategies, including peer or secondary distribution. RESULTS Participants viewed HIV as a significant threat to PWUD health and confirmed the presence of numerous barriers to local facility-based HIV testing. Participants viewed HIVST as a promising and potentially empowering solution. Based on community familiarity with secondary distribution of harm reduction supplies (i.e., naloxone) and information, participants viewed secondary distribution of HIVST kits as an appropriate and feasible strategy for increasing the reach of HIVST, but also described potential barriers (e.g., engaging socially disconnected individuals, ensuring linkages to services following HIVST) and provided suggestions for alternative HIVST kit delivery models (e.g., harm reduction vending machines). CONCLUSIONS Service providers viewed secondary distribution of HIVST kits among PWUD as promising, appropriate, and feasible, yet specialized efforts may be needed to reach the most marginalized individuals and ensure consistent provision of educational information and referral supports that maximize the impact of this approach.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA.
- School of Public Health, Boston University, Boston, MA, USA.
| | - Chad J Valasek
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - William H Eger
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Alicia Harvey-Vera
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Carlos F Vera
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jennifer L Syvertsen
- Department of Anthropology, University of California, Riverside, Riverside, CA, USA
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, USA
| | | | - Hansel E Tookes
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Heather A Pines
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Public Health, San Diego State University, San Diego, USA
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Karamouzian M, Cui Z, Hayashi K, DeBeck K, Reddon H, Buxton JA, Kerr T. Longitudinal polysubstance use patterns and non-fatal overdose: A repeated measures latent class analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024:104301. [PMID: 38182524 PMCID: PMC11222307 DOI: 10.1016/j.drugpo.2023.104301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 11/06/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Polysubstance use (PSU) is common among people who use opioids (PWUO) and has been associated with drug-related harms. We aimed to identify latent longitudinal PSU classes among a cohort of PWUO and characterize non-fatal overdose risks among different sub-classes over time. METHODS We used longitudinal data (2005-2018) from three ongoing prospective cohorts of people who use drugs in Vancouver, Canada. The primary outcome of interest was self-reported non-fatal overdose during the past six months. The primary exposure of interest was longitudinal PSU patterns among PWUO, obtained from repeated measures latent class analysis (RMLCA) of weekly substance use-related outcome indicators. Multivariable generalized estimating equations models were built to assess the association between latent PSU class membership and non-fatal overdose, adjusting for potential sociodemographic, behavioural, and structural confounders. RESULTS 2627 PWUO were included in the analysis, and 1094 (41.6 %) had experienced at least one non-fatal overdose during the study period. RMLCA revealed five distinct latent longitudinal PSU classes, including low/infrequent use (Class 1; 30 %), primarily opioid and methamphetamine use (Class 2; 22 %), primarily cannabis use (Class 3; 15 %), primarily opioid and crack use (Class 4; 29 %), and frequent PSU (Class 5; 4 %). In comparison with Class 1 (low), membership in all latent PSU classes except Class 3 (cannabis) was associated with increased odds of non-fatal overdose: Class 2 (opioids + meth) vs. Class 1 (Adjusted odds ratios [aOR] = 2.20, 95 % confidence intervals [CI]: 1.51-3.22), Class 4 (opioids + crack) vs. Class 1 (aOR = 1.06, 95 % CI: 0.85-1.33), and Class 5 (frequent) vs. Class 1 (aOR = 2.39, 95 % CI: 1.92-2.97). CONCLUSION Our findings highlighted the heterogeneous characteristics of PWUO in terms of patterns of PSU and non-fatal overdose risk. The diverse nature of PWUO and the potential additive or multiplicative impact of using several substances on overdoses should be reflected across the substance use treatment continuum and care provision.
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Affiliation(s)
- Mohammad Karamouzian
- Centre on Drug Policy Evaluation, Saint Michael's Hospital, Toronto, ON M5B 1T8, Canada; British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, Burnaby, BC V6B 5K3, Canada
| | - Hudson Reddon
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
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Pines HA, Eger WH, Skaathun B, Vera CF, Harvey-Vera A, Rangel G, Strathdee SA, Bazzi AR. Willingness to use and distribute HIV self-testing kits among people who inject drugs in the San Diego-Tijuana border region. Harm Reduct J 2024; 21:4. [PMID: 38172795 PMCID: PMC10765917 DOI: 10.1186/s12954-023-00922-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND HIV self-testing (HIVST) could increase HIV testing access among people who inject drugs (PWID), and secondary distribution (i.e., peer-delivery) of HIVST kits in PWID social networks could further expand coverage. We assessed willingness to use and distribute HIVST kits among PWID in the San Diego-Tijuana border region. METHODS From 2020 to 2021, HIV-negative PWID in San Diego, USA, and Tijuana, Mexico, completed surveys and provided data on individual (N = 539) and social network (N = 366) characteristics. We used modified Poisson regression to examine the effects of individual and social network characteristics on willingness to use and distribute HIVST kits. RESULTS Most participants were willing to use (81%) and distribute (81%) HIVST kits. At the individual level, prior HIV testing was positively associated with willingness to use (adjusted prevalence ratio [aPR] = 1.24, 95% confidence interval [CI] 1.10-1.40) and distribute (aPR = 1.27, 95% CI 1.12-1.43) HIVST kits, while perceiving oneself to be at higher HIV risk than others was negatively associated with willingness to use HIVST kits (aPR = 0.83, 95% CI 0.74-0.93). At the network level, willingness to distribute HIVST kits was positively associated with network size (aPR = 1.04 per member, 95% CI 1.01-1.08) and greater proportions of one's network encouraging them to use drugs (aPR = 1.29, 95% CI 1.16-1.44) and having a history of homelessness (aPR = 1.51, 95% CI 1.31-1.74) or detention/arrest (aPR = 1.57, 95% CI 1.36-1.82), and negatively associated with a greater proportion of one's network including "very close" persons (aPR = 0.80, 95% CI 0.69-0.94). CONCLUSIONS We found high potential for HIVST kits and their secondary distribution to increase HIV testing among PWID who face the greatest barriers to facility-based testing.
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Affiliation(s)
- Heather A Pines
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - William H Eger
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Britt Skaathun
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Carlos F Vera
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alicia Harvey-Vera
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Gudelia Rangel
- Mexico Section of the US-Mexico Border Health Commission, Tijuana, Baja California, Mexico
- El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
| | | | - Angela R Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- School of Public Health, Boston University, Boston, MA, USA
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Lorvick J, Hemberg J, George MJ, Piontak J, Comfort ML. Understanding polysubstance use at the daily and event levels: protocol for a mixed-methods qualitative and ecological momentary assessment study in a community-based sample of people who use illicit drugs in Oakland, California, USA. BMJ Open 2023; 13:e075380. [PMID: 37699625 PMCID: PMC10503366 DOI: 10.1136/bmjopen-2023-075380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Polysubstance use is extremely common among people who use illicit opioids in the USA. It is associated with poor substance use treatment outcomes, infectious disease risk and alarming rates of drug overdose. Nearly all extant literature examines polysubstance use over broad time frames, such as 30 days or 6 months. However, both substance use and overdose risk are episodic. To build a stronger understanding of polysubstance use and overdose risk, we need to expand the knowledge base to include daily-level and event-level data that examine how substances are used together, in which combinations and in which contexts. The study described in this protocol will use qualitative and ecological momentary assessment (EMA) methods to examine polysubstance use and overdose risk on a daily and event level. METHODS AND ANALYSIS This is a mixed-methods observational study with three phases. The first phase is formative, consisting of qualitative interviews with people who use multiple substances (N=20), to inform the development of items for the EMA component. The second phase is EMA data collection with people who use multiple substances (N=120), three times daily for 28 days. The third phase consists of mixed-methods inquiries with a subset of participants (N=20), using participant-level EMA data and qualitative techniques to build a nuanced understanding of the motivations and contexts of polysubstance use in everyday life. Analytical induction methods will be used to interpret qualitative data. Hierarchical linear modelling methods will be used to analyse EMA data. ETHICS AND DISSEMINATION This research has been reviewed and approved by the Institutional Review Board at RTI International (#MOD00001782 for EMA procedures and #MOD00001241 for qualitative procedures). Participants engage in an informed consent procedure for each component of the study. Data will be managed and shared per the National Institutes of Health extramural data sharing policy.
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Affiliation(s)
- Jennifer Lorvick
- Community Health and Implementation Research Program, RTI International, Berkeley, California, USA
| | - Jordana Hemberg
- Community Health and Implementation Research Program, RTI International, Berkeley, California, USA
| | - Madeleine J George
- Health of Populations Program, RTI International, Research Triangle Park, North Carolina, USA
| | - Joy Piontak
- Health of Populations Program, RTI International, Research Triangle Park, North Carolina, USA
| | - Megan L Comfort
- Transformative Research Unit for Equity, RTI International, Berkeley, CA, USA
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Rammohan I, Jain S, Sun S, Marks C, Milloy MJ, Hayashi K, DeBeck K, González-Zúñiga P, Strathdee S, Werb D. Latent polydrug use patterns and the provision of injection initiation assistance among people who inject drugs in three North American settings. Drug Alcohol Rev 2023; 42:1504-1516. [PMID: 37321850 PMCID: PMC10524861 DOI: 10.1111/dar.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/17/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION We sought to identify latent profiles of polysubstance use patterns among people who inject drugs in three distinct North American settings, and then determine whether profile membership was associated with providing injection initiation assistance to injection-naïve persons. METHODS Cross-sectional data from three linked cohorts in Vancouver, Canada; Tijuana, Mexico; and San Diego, USA were used to conduct separate latent profile analyses based on recent (i.e., past 6 months) injection and non-injection drug use frequency. We then assessed the association between polysubstance use patterns and recent injection initiation assistance provision using logistic regression analyses. RESULTS A 6-class model for Vancouver participants, a 4-class model for Tijuana participants and a 4-class model for San Diego participants were selected based on statistical indices of fit and interpretability. In all settings, at least one profile included high-frequency polysubstance use of crystal methamphetamine and heroin. In Vancouver, several profiles were associated with a greater likelihood of providing recent injection initiation assistance compared to the referent profile (low-frequency use of all drugs) in unadjusted and adjusted analyses, however, the inclusion of latent profile membership in the multivariable model did not significantly improve model fit. DISCUSSION AND CONCLUSIONS We identified commonalities and differences in polysubstance use patterns among people who inject drugs in three settings disproportionately impacted by injection drug use. Our results also suggest that other factors may be of greater priority when tailoring interventions to reduce the incidence of injection initiation. These findings can aid in efforts to identify and support specific higher-risk subpopulations of people who inject drugs.
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Affiliation(s)
- Indhu Rammohan
- Centre on Drug Policy and Evaluation, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, United States
| | - Shelly Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, United States
| | - Charles Marks
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, United States
- School of Community Health Sciences, University of Reno, Reno, United States
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Patricia González-Zúñiga
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, United States
| | - Steffanie Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, United States
| | - Dan Werb
- Centre on Drug Policy and Evaluation, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, United States
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Shrader CH, Borquez A, Vasylyeva TI, Chaillon A, Artamanova I, Harvey-Vera A, Vera CF, Rangel G, Strathdee SA, Skaathun B. Network-level HIV risk norms are associated with individual-level HIV risk and harm reduction behaviors among people who inject drugs: a latent profile analysis. AIDS Behav 2023; 27:484-495. [PMID: 35939177 PMCID: PMC9358371 DOI: 10.1007/s10461-022-03783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
The COVID-19 related U.S.-Mexico border-crossing restrictions disrupted social networks and HIV harm reduction services among people who inject drugs (PWID) in San Diego and Tijuana. We assessed associations of descriptive network norms on PWID's HIV vulnerability during this period. Between 10/2020 and 10/2021, 399 PWID completed a behavioral and egocentric questionnaire. We used Latent Profile Analysis to categorize PWID into network norm risk profiles based on proportions of their network (n = 924 drug use alters) who injected drugs and engaged in cross-border drug use (CBDU), among other vulnerabilities. We used logistic and linear regressions to assess network profile associations with individual-level index of HIV vulnerability and harm reduction behaviors. Fit indices specified a 4-latent profile solution of descriptive network risk norms: lower (n = 178), moderate with (n = 34) and without (n = 94) CBDU and obtainment, and higher (n = 93). Participants in higher risk profiles reported more HIV vulnerability behaviors and fewer harm reduction behaviors. PWID's gradient of HIV risk was associated with network norms, warranting intervention on high-vulnerability networks when services are limited.
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Affiliation(s)
- Cho-Hee Shrader
- ICAP at Columbia University, New York, NY United States of America
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Tetyana I. Vasylyeva
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Irina Artamanova
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Alicia Harvey-Vera
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
- Facultad de Medicina, Universidad Xochicalco Campus Tijuana, Tijuana, Baja California Mexico
- Mexican Section, United States-Mexico Border Health Commission, Tijuana, Baja California Mexico
| | - Carlos F. Vera
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Gudelia Rangel
- Mexican Section, United States-Mexico Border Health Commission, Tijuana, Baja California Mexico
- Departmento de Estudios de Población, El Colegio de la Frontera Norte, Tijuana, Baja California Mexico
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA United States of America
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HIV and Substance Use in Latin America: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127198. [PMID: 35742448 PMCID: PMC9222977 DOI: 10.3390/ijerph19127198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/13/2022]
Abstract
This scoping review aims to explore the interplay between substance use (SU) and HIV in Latin America (LA). Database searches yielded 3481 references; 196 were included. HIV prevalence among people who used substances (PWUS) ranged from 2.8–15.2%. SU definitions were variable throughout studies, and thus data were not easily comparable. In 2019, only 2% of new HIV infections were attributed to injection drug use (IDU) in LA. Factors associated with HIV among PWUS included being female, IDU and homelessness, and PWUS were likely to engage in risky sexual behaviors, start antiretroviral treatment late, have poor adherence, have treatment failure, be lost to follow-up, have comorbidities, and experience higher mortality rates and lower quality of life, as has been reported in PLWH with SU in other regions. Five intervention studies were identified, and only one was effective at reducing HIV incidence in PWUS. Interventions in other regions have varying success depending on context-specific characteristics, highlighting the need to conduct more research in the LA region. Though progress has been made in establishing SU as a major concern in people living with HIV (PLWH), much more is yet to be done to reduce the burden of HIV and SU in LA.
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Karamouzian M, Pilarinos A, Hayashi K, Buxton JA, Kerr T. Latent patterns of polysubstance use among people who use opioids: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103584. [DOI: 10.1016/j.drugpo.2022.103584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 02/07/2023]
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Rivera Saldana CD, Beletsky L, Borquez A, Kiene SM, Strathdee SA, Zúñiga ML, Martin NK, Cepeda J. Impact of cumulative incarceration and the post-release period on syringe-sharing among people who inject drugs in Tijuana, Mexico: a longitudinal analysis. Addiction 2021; 116:2724-2733. [PMID: 33620749 PMCID: PMC8380753 DOI: 10.1111/add.15445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/14/2020] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Syringe-sharing among people who inject drugs, which can occur during incarceration and post-release, has been linked with increased risk of blood-borne infections. We aimed to investigate the cumulative effect of repeated incarceration and the post-release period on receptive syringe-sharing. DESIGN Ongoing community-based cohort, recruited through targeted sampling between 2011 and 2012 with 6-month follow-ups. SETTING Tijuana, Mexico. PARTICIPANTS Sample of 185 participants (median age 35 years; 67% female) with no history of incarceration at study entry, followed to 2017. MEASUREMENTS Cumulative incarceration and post-release period were constructed from incarceration events reported in the past 6 months for each study visit. Receptive syringe-sharing in the past 6 months was assessed as a binary variable. We used logistic regression with generalized estimating equations to examine the association between cumulative incarceration events and the post-release period with receptive syringe-sharing over time. Missing data were handled through multiple imputation. FINDINGS At baseline, 65% of participants engaged in receptive syringe-sharing in the prior 6 months. At follow-up, 150 (81%) participants experienced a total of 358 incarceration events [median = 2, interquartile range (IQR) = 1-3]. The risk of receptive syringe-sharing increased with the number of repeated incarcerations. Compared with never incarcerated, those with one incarceration had 1.28 [95% confidence interval (CI) = 0.97-1.68] higher adjusted odds of syringe-sharing; two to three incarcerations, 1.42 (95% CI = 1.02-1.99) and more than three incarcerations, 2.10 (95% CI = 1.15-3.85). Participants released within the past 6 months had 1.53 (95% CI = 1.14-2.05) higher odds of sharing syringes compared with those never incarcerated. This post-release risk continued up to 1.5 years post-incarceration (adjusted odds ratio = 1.41, 95% CI = 1.04-1.91), but then waned. CONCLUSIONS A longitudinal community cohort study among people who inject drugs suggested that the effects of incarceration on increased injecting risk, measured through syringe-sharing, are cumulative and persist during the post-release period.
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Affiliation(s)
- Carlos D. Rivera Saldana
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, MA, 02115, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - Susan M. Kiene
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, CA, 92182, United States
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- Population Health Sciences, University of Bristol, Bristol BS8 1QU, United Kingdom
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
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11
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Najman JM. Co-using drugs-what do we need to know? Addiction 2021; 116:1634-1635. [PMID: 33559244 DOI: 10.1111/add.15419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jake M Najman
- School of Public Health, University of Queensland, Australia
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12
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Rivera Saldana CD, Abramovitz D, Meacham MC, Gonzalez-Zuniga P, Rafful C, Rangel G, Strathdee SA, Cepeda J. Risk of non-fatal overdose and polysubstance use in a longitudinal study with people who inject drugs in Tijuana, Mexico. Drug Alcohol Rev 2021; 40:1340-1348. [PMID: 34042226 DOI: 10.1111/dar.13305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/01/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Among people who inject drugs (PWID), polysubstance use has been associated with fatal and non-fatal overdose (NFOD). However, the risk of overdose due to the cumulative number of various recently used drug types remains unexplored. We estimated the risk of NFOD for different polysubstance use categories among PWID in Tijuana, Mexico. METHODS Data came from 661 participants followed for 2 years in Proyecto El Cuete-IV, an ongoing prospective cohort of PWID. A multivariable Cox model was used to assess the cumulative impact of polysubstance use on the time to NFOD. We used the Cochran-Armitage test to evaluate a dose-response relationship between number of polysubstance use categories and NFOD. RESULTS We observed 115 NFOD among 1029.2 person-years of follow-up (incidence rate: 11.2 per 100 person-years; 95% confidence interval [CI] 9.3-13.3). Relative to those who used one drug class, the adjusted hazard ratio of NFOD for individuals reporting using two drug classes was 1.11 (95% CI 0.69-1.79), three drug classes was 2.00 (95% CI 1.16-3.44) and for those reporting three compared to two was 1.79 (95% CI 1.09-2.97). A significant Cochran-Armitage trend test (P < 0.001) suggested a dose-response relationship. DISCUSSION AND CONCLUSIONS Polysubstance use was associated with increased risk of NFOD with a dose-response relationship over 2 years. We identified a subgroup of PWID at high risk of NFOD who reported concurrent use of opioids, stimulants and benzodiazepines. Prioritising tailored harm reduction and overdose prevention interventions for PWID who use multiple substances in Tijuana is needed.
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Affiliation(s)
- Carlos D Rivera Saldana
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA.,School of Public Health, San Diego State University, San Diego, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Meredith C Meacham
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, USA
| | - Patricia Gonzalez-Zuniga
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Claudia Rafful
- Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico.,Global Mental Health Research Center, National Institute of Psychiatry, Mexico City, Mexico.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Gudelia Rangel
- Department of Population Studies, The College of the Northern Border, Tijuana, Mexico.,United States-Mexico Border Health Commission, Tijuana, Mexico
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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13
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Compton WM, Valentino RJ, DuPont RL. Polysubstance use in the U.S. opioid crisis. Mol Psychiatry 2021; 26:41-50. [PMID: 33188253 PMCID: PMC7815508 DOI: 10.1038/s41380-020-00949-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/04/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Interventions to address the U.S. opioid crisis primarily target opioid use, misuse, and addiction, but because the opioid crisis includes multiple substances, the opioid specificity of interventions may limit their ability to address the broader problem of polysubstance use. Overlap of opioids with other substances ranges from shifts among the substances used across the lifespan to simultaneous co-use of substances that span similar and disparate pharmacological categories. Evidence suggests that nonmedical opioid users quite commonly use other drugs, and this polysubstance use contributes to increasing morbidity and mortality. Reasons for adding other substances to opioids include enhancement of the high (additive or synergistic reward), compensation for undesired effects of one drug by taking another, compensation for negative internal states, or a common predisposition that is related to all substance consumption. But consumption of multiple substances may itself have unique effects. To achieve the maximum benefit, addressing the overlap of opioids with multiple other substances is needed across the spectrum of prevention and treatment interventions, overdose reversal, public health surveillance, and research. By addressing the multiple patterns of consumption and the reasons that people mix opioids with other substances, interventions and research may be enhanced.
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Affiliation(s)
- Wilson M Compton
- U.S. Department of Health and Human Service, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
| | - Rita J Valentino
- U.S. Department of Health and Human Service, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
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14
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Jain JP, Strathdee SA, West BS, Gonzalez-Zuniga P, Rangel G, Pitpitan EV. Sex differences in the multilevel determinants of injection risk behaviours among people who inject drugs in Tijuana, Mexico. Drug Alcohol Rev 2020; 39:898-907. [PMID: 32794626 PMCID: PMC7959186 DOI: 10.1111/dar.13134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS HIV and hepatitis C virus transmission among people who inject drugs (PWID) is fuelled by personal and environmental factors that vary by sex. We studied PWID in Mexico to identify sex differences in multilevel determinants of injection risk. DESIGN AND METHODS From 2011 to 2013, 734 PWID (female: 277, male: 457) were enrolled into an observational cohort study in Tijuana. Participants completed interviews on injection and sexual risks. Utilising baseline data, we conducted multiple generalised linear models stratified by sex to identify factors associated with injection risk scores (e.g. frequency of injection risk behaviours). RESULTS For both sexes, difficult access to sterile syringes was associated with elevated injection risk (b = 1.24, 95% confidence interval [CI] 1.16-1.33), using syringes from a safe source (e.g. needle exchange programs) was associated with lower injection risk (b = 0.87, 95% CI 0.82-0.94), and for every one-unit increase in safe injection self-efficacy we observed a 20% decrease in injection risk (b = 0.80, 95% CI 0.76-0.84). Females had a higher safe injection self-efficacy score compared to males (median 2.83, interquartile range 2.2-3 vs. median 2.83, interquartile range 2-3; P = 0.01). Among females, incarceration (b = 1.22, 95% CI 1.09-1.36) and police confiscation of syringes in the past 6 months (b = 1.16, 95% CI 1.01-1.33) were associated with elevated injection risk. Among males, sex work (b = 1.16, 95% CI 1.04-1.30) and polysubstance use in the past 6 months (b = 1.22, 95% CI 1.13-1.31) were associated with elevated injection risk. DISCUSSION AND CONCLUSIONS Interventions to reduce HIV and hepatitis C virus transmission among PWID in Tijuana should be sex-specific and consider multilevel determinants of injection risk to create safer drug use environments.
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Affiliation(s)
- Jennifer P Jain
- School of Medicine, University of California, San Diego, San Diego, USA
- School of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Brooke S West
- School of Social Work, Columbia University, New York, USA
| | | | - Gudelia Rangel
- United States-Mexico Border Health Commission and El Colegio de la Frontera Norte, Tijuana, Mexico
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Liu Y, Vaddiparti K, Cheong J, Cottler LB. Identification of Typologies of Cocaine Use Based on Quantity, Frequency, and Duration of Use: A Latent Profile Analysis. J Addict Med 2020; 15:211-218. [PMID: 33009168 DOI: 10.1097/adm.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We identified the patterns of cocaine use during individuals' heaviest use period by considering quantity, frequency, and duration simultaneously and examined the correlates and risk profile for these patterns. METHODS Latent profile analysis was conducted among the 3117 individuals who reported lifetime use of cocaine in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) with quantity, frequency, and duration used as indicators. Logistic regression analyses examined factors associated with subtype membership based on patterns of cocaine use and the relationships between these patterns and cocaine use disorder (CocUD) and its severity. RESULTS Four patterns were identified: a "low use" class (72.6%), a "moderate use" class (8.2%), a "daily use" class (17.9%), and a "very high quantity use" class (1.3%). Relative to non-Hispanic White and the "low use" class, non-Hispanic Black was associated with increased odds to be in the "moderate use" and "daily use" classes. Higher prevalence of smoking crack cocaine and poly-route use was observed among the "very high quantity use" class relative to other classes; increased risk of using other substances was associated with the "daily use" class. Higher levels of cocaine use were associated with higher risks of CocUD and worse severity compared to the "low use" class. CONCLUSIONS People who use cocaine are heterogeneous with different patterns of use and risks of CocUD. Reducing cocaine smoking and poly-route of use should be placed as the same priority as decreasing very high quantity of use in interventions.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL (YL, KV, LBC); Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL (JWC)
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16
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Towards Targeted Interventions in Low- and Middle-Income Countries: Risk Profiles of People Who Inject Drugs in Haiphong (Vietnam). BIOMED RESEARCH INTERNATIONAL 2020; 2020:8037193. [PMID: 32964044 PMCID: PMC7502134 DOI: 10.1155/2020/8037193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/29/2023]
Abstract
People who inject drugs (PWID) are a dominant risk group afflicted by blood-borne viruses, mental health disorders, and social precariousness. Risk reduction interventions are administered to PWID regardless of their characteristics or specific risks. The objective of this cross-sectional analysis was to empirically identify profiles of PWID regarding their drug use, risk behaviors, and mental health in order to tailor adapted interventions taking into account limited access to comprehensive care in middle-income countries. PWID were recruited using respondent-driven sampling. PWID with urine testing positive for heroin or methamphetamine and manifesting recent skin injection marks were enrolled. Classification of participants was based on drug use, injection, risky sexual behavior, and mental health data. This was subjected to multiple correspondence analysis followed by hierarchical cluster analysis combined with K-means methodology. From October 2016 to January 2017, 1490 participants were recruited of which 1383 were eligible and enrolled. HCV prevalence was 70.5% and HIV prevalence 29.4%. The cluster analysis identified five distinct profiles: profile 1: recent injection practices and high alcohol consumption, profile 2: at-risk injection and sexual behaviors with precarious situations, profile 3: no sexual activity and older age, profile 4: frequent injections with high methamphetamine use, and profile 5: stable partnerships and less frequent injections. Our study has identified profiles of PWID at particularly high risks, and they should thus be targeted for interventions tailored to their specific risks.
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Cepeda JA, Vickerman P, Bruneau J, Zang G, Borquez A, Farrell M, Degenhardt L, Martin NK. Estimating the contribution of stimulant injection to HIV and HCV epidemics among people who inject drugs and implications for harm reduction: A modeling analysis. Drug Alcohol Depend 2020; 213:108135. [PMID: 32603976 PMCID: PMC7829087 DOI: 10.1016/j.drugalcdep.2020.108135] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Stimulants, such as amphetamines and cocaine, are widely injected among people who inject drugs (PWID). Systematic reviews indicate stimulant injection is associated with HIV and HCV among PWID. Using these associations, we estimated the contribution of stimulant injection to HIV and HCV transmission among PWID. METHODS We modeled HIV and HCV transmission among PWID, incorporating excess injecting and sexual risk among PWID who inject stimulants. We simulated three illustrative settings with different stimulants injected, prevalence of stimulant injecting, and HIV/HCV epidemiology. We estimated one-year population attributable fractions of stimulant injection on new HIV and HCV infections, and impact of scaling up needle-syringe programs (NSP). RESULTS In low prevalence settings of stimulant injection (St. Petersburg-like, where 13 % inject amphetamine), 9% (2.5-97.5 % interval [95 %I]: 6-15 %) and 7% (95 %I 4-11 %) of incident HIV and HCV cases, respectively, could be associated with stimulant injection in the next year. With moderate stimulant injection (Montreal-like, where 34 % inject cocaine), 29 % (95 %I: 19-37 %) and 19 % (95 %I: 16-21 %) of incident HIV and HCV cases, respectively, could be associated with stimulant injection. In high-burden settings like Bangkok where 65 % inject methamphetamine, 23 % (95%I:10-34%) and 20 % (95%I: 9-27%) of incident HIV and HCV cases could be due to stimulant injection. High-coverage NSP (60 %) among PWID who inject stimulants could reduce HIV (by 22-65 %) and HCV incidence (by 7-11 %) in a decade. DISCUSSION Stimulant injection contributes substantially to HIV and HCV among PWID. NSP scale-up and development of novel interventions among PWID who inject stimulants are warranted.
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Affiliation(s)
- Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, USA.
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Julie Bruneau
- Department of Family Medicine, Université de Montréal, Montréal, QC, Canada
| | - Geng Zang
- Department of Family Medicine, Université de Montréal, Montréal, QC, Canada
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, USA; Population Health Sciences, Bristol Medical School, University of Bristol, UK
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18
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Cepeda JA, Bórquez A, Magana C, Vo A, Rafful C, Rangel G, Medina‐Mora ME, Strathdee S, Martin NK. Modelling integrated antiretroviral treatment and harm reduction services on HIV and overdose among people who inject drugs in Tijuana, Mexico. J Int AIDS Soc 2020; 23 Suppl 1:e25493. [PMID: 32562375 PMCID: PMC7305416 DOI: 10.1002/jia2.25493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/02/2020] [Accepted: 03/31/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The HIV epidemic in Tijuana, Mexico is concentrated in key populations, including people who inject drugs (PWID). However, HIV interventions among PWID are minimal, and federal funding was provided for compulsory abstinence programmes associated with HIV and overdose. Alternatively, opioid agonist therapy reduces overdose, reincarceration, HIV, while improving antiretroviral therapy (ART) outcomes. We assessed potential impact and synergies of scaled-up integrated ART and opioid agonist therapy, compared to scale-up of each separately, and potential harms of compulsory abstinence programmes on HIV and fatal overdose among PWID in Tijuana. METHODS We developed a dynamic model of HIV transmission and overdose among PWID in Tijuana. We simulated scale-up of opioid agonist therapy from zero to 40% coverage among PWID. We evaluated synergistic benefits of an integrated harm reduction and ART scale-up strategy (40% opioid agonist therapy coverage and 10-fold ART recruitment), compared to scale-up of each intervention alone or no scale-up of low coverage ART and no harm reduction). We additionally simulated compulsory abstinence programmes (associated with 14% higher risk of receptive syringe sharing and 76% higher odds of overdose) among PWID. RESULTS Without intervention, HIV incidence among PWID could increase from 0.72 per 100 person-years (PY) in 2020 to 0.92 per 100 PY in 2030. Over ten years, opioid agonist therapy scale-up could avert 31% (95% uncertainty interval (UI): 18%, 46%) and 22% (95% UI: 10%, 28%) new HIV infections and fatal overdoses, respectively, with the majority of HIV impact from the direct effect on HIV transmission due to low ART coverage. Integrating opioid agonist therapy and ART scale-up provided synergistic benefits, with opioid agonist therapy effects on ART recruitment/retention averting 9% more new infections compared to ART scale-up alone. The intervention strategy could avert 48% (95% UI: 26%, 68%) of new HIV infections and one-fifth of fatal overdoses over ten years. Conversely, compulsory abstinence programmes could increase HIV and overdoses. CONCLUSIONS Integrating ART with opioid agonist therapy could provide synergistic benefits and prevent HIV and overdoses among PWID in Tijuana, whereas compulsory abstinence programmes could cause harm. Policymakers should consider the benefits of integrating harm reduction and HIV services for PWID.
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Affiliation(s)
- Javier A Cepeda
- Division of Infectious Diseases and Global Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Christopher Magana
- Division of Infectious Diseases and Global Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Anh Vo
- Division of Infectious Diseases and Global Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Claudia Rafful
- Faculty of PsychologyUniversidad Nacional Autonoma de MexicoMexico CityMexico
- Center on Global Mental Health ResearchNational Institute on Psychiatry Ramón de la Fuente MuñizMexico CityMexico
- Centre on Drug Policy EvaluationSt. Michael’s HospitalTorontoCanada
| | - Gudelia Rangel
- Comisión de Salud Fronteriza México‐Estados UnidosTijuanaMexico
- El Colegio de la Frontera NorteTijuanaMexico
| | - María E Medina‐Mora
- Center on Global Mental Health ResearchNational Institute on Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Steffanie Strathdee
- Division of Infectious Diseases and Global Public HealthUniversity of California San DiegoSan DiegoCAUSA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public HealthUniversity of California San DiegoSan DiegoCAUSA
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
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Lake S, Nosova E, Buxton J, Walsh Z, Socías ME, Hayashi K, Kerr T, Milloy MJ. Characterizing motivations for cannabis use in a cohort of people who use illicit drugs: A latent class analysis. PLoS One 2020; 15:e0233463. [PMID: 32437443 PMCID: PMC7241718 DOI: 10.1371/journal.pone.0233463] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022] Open
Abstract
Background Cannabis use is common among marginalized people who use illicit drugs (PWUD) but reasons for use remain poorly investigated. We sought to explore how different intentions for cannabis use relate to social, structural, and behavioural factors among PWUD in Vancouver, Canada. Methods We used data from cannabis-using participants in two community-recruited prospective cohort studies of PWUD. Using latent class analysis, we identified discrete cannabis-using groups based on self-reported intentions for use. Generalized estimating equations were used to examine correlates of class membership. Results Between June 2016 and December 2018, 2,686 observations from 897 participants cannabis-using PWUD were analyzed. Four latent classes of cannabis use emerged: Class 1 (31.6%), characterized by non-medical purposes; Class 2 (37.5%), characterized by non-pain therapeutic use (e.g., stress, nausea/loss of appetite, and insomnia); characterized by Class 3 (21.9%) predominantly pain relief; and Class 4 (9.0%), characterized by a wide range of therapeutic uses in addition to pain management, including insomnia, stress, nausea/loss of appetite, and harm reduction. Class-specific structural, substance-, and health-related differences were observed, including indicators of better physical and mental health among the “recreational” class, despite evidence of more structural vulnerabilities (e.g., homelessness, incarceration). Conclusions Our findings demonstrate a wide spectrum of motivations for cannabis use among PWUD. We observed important health-related differences between latent classes, demonstrating possible unmet healthcare needs among PWUD reporting therapeutic cannabis use. These findings inform ongoing policy surrounding access to cannabis for harm reduction purposes and applications of medical cannabis for PWUD.
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Affiliation(s)
- Stephanie Lake
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Jane Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - M. Eugenia Socías
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M. J. Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
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20
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Bartholomew TS, Tookes HE, Bullock C, Onugha J, Forrest DW, Feaster DJ. Examining risk behavior and syringe coverage among people who inject drugs accessing a syringe services program: A latent class analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102716. [PMID: 32146348 DOI: 10.1016/j.drugpo.2020.102716] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/16/2020] [Accepted: 02/23/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Injection drug use (IDU) remains a significant public health problem. IDU has been associated closely with the opioid crisis; driving overdose, HIV, and Hepatitis C (HCV) infection nationwide. Syringe services programs (SSPs) remain pivotal evidence-based interventions to reduce harm and engage subgroups of people who inject drugs (PWID). This study aims to provide policy considerations from the IDEA SSP, the first legal SSP in the state of Florida. METHODS We performed a latent class analysis on patterns of substance use among participants (N = 982) newly enrolled in a syringe services program (SSP). Associations between classes of substance use and sociodemographic variables, risky injection and sex behaviors, HIV/HCV status and syringe coverage were analyzed using the R3STEP and BCH 3-step procedures in latent class regression. RESULTS We found a three-class solution: Heroin-Dominant class (73.9%), Methamphetamine-Dominant class (9.5%) and Heroin/Cocaine class (16.6%). Compared to Heroin-Dominant class, the Heroin/Cocaine class were more likely to report homelessness, sharing works, unprotected sex, public injection, and to be HCV positive. Compared to both Heroin-Dominant and Heroin/Cocaine classes, the Methamphetamine-Dominant class were more likely to be male, Hispanic, gay or bisexual orientation, HIV positive, to report unprotected sex and sex with PWID. In addition, the lowest and highest syringe coverage were among those in the Heroin/Cocaine and Methamphetamine-Dominant classes, respectively. CONCLUSION Existing interventions among this population to mitigate infectious disease risk, such as SSPs, can be a used to engage differing PWID populations. However, multi-component, targeted preventive interventions and need-based syringe distribution policies are required to further reduce HIV and HCV risk among various PWID populations.
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Affiliation(s)
- Tyler S Bartholomew
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Hansel E Tookes
- Division of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Corinne Bullock
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jason Onugha
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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Liu S, Vivolo-Kantor A. A latent class analysis of drug and substance use patterns among patients treated in emergency departments for suspected drug overdose. Addict Behav 2020; 101:106142. [PMID: 31639639 PMCID: PMC11218817 DOI: 10.1016/j.addbeh.2019.106142] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Polysubstance use and misuse can increase risks for nonfatal and fatal drug overdose. To categorize drugs used in combination in nonfatal overdoses, we analyzed data from emergency department (ED) overdose-related visits in 18 states funded by CDC's Enhanced State Opioid Overdose Surveillance (ESOOS) program. METHODS From 2017 to 2018, 120,706 ED visits included at least one hospital discharge code indicating acute drug poisoning for opioids, stimulants, hallucinogens, cannabis, anti-depressants, sedatives, alcohol, benzodiazepines, or other psychotropic drugs. Latent class analyses were conducted to determine the groupings of drug combinations in overdose visits. RESULTS Latent class analyses indicated a model of 5 classes - mostly heroin overdose (42.5% of visits); mostly non-heroin opioid overdose/use (27.3%); opioid, polysubstance (11.0%); female, younger (<25 years), other non-opioid drugs (10.5%); female, older (>55 years), benzodiazepine (8.0%). Findings indicated that heroin continues to be a large burden to EDs, yet EDs are also seeing overdose survivors with polydrug toxicity. CONCLUSIONS Medication-assisted treatment could be initiated in the emergency department following overdose for patients with opioid use disorder, and post-overdose protocols, such as naloxone provision and linkage to treatment and harm reduction services, have the potential to prevent future overdose for those at risk.
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Affiliation(s)
- Stephen Liu
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA.
| | - Alana Vivolo-Kantor
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA
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Schneider KE, O'Rourke A, White RH, Park JN, Musci RJ, Kilkenny ME, Sherman SG, Allen ST. Polysubstance use in rural West Virginia: Associations between latent classes of drug use, overdose, and take-home naloxone. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 76:102642. [PMID: 31918401 DOI: 10.1016/j.drugpo.2019.102642] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/01/2019] [Accepted: 12/18/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Rural communities in the United States have been disproportionately affected by the opioid crisis. Little research has explored the relationship between polysubstance use and overdose experiences among people who inject drugs (PWID) in rural communities. We sought to identify classes of polysubstance drug use among rural PWID and evaluate the associations between polysubstance drug use classes, recent overdose experiences, and receipt of take-home naloxone (THN). METHODS We surveyed 420 PWID (June-July 2018) who had injected drugs in the previous 6 months in Cabell County, West Virginia. Participants were recruited from the local syringe services program and through street-based recruitment. We conducted a latent class analysis using 9 measures of injection and non-injection drug use and tested for associations with having experienced an overdose in the past 6 months and having received THN in the past 6 months. RESULTS We identified four substance use classes in our sample: polydrug/polyroute use (35.0% of the sample), polyroute stimulant/injection opioid use (33.3%), polyroute stimulant use (20.3%), and injection opioid use (11.3%). Overall, 42.6% of the sample had experienced an overdose in the past 6 months. The classes differed in terms of overdose (χ=91.53, p<0.001), with the polydrug/polyroute use class having the highest probability of overdose and the polyroute stimulants class having the lowest. Only 46.5% of participants had received THN, and probabilities differed between classes (χ=21.93, p<0.001). The polyroute stimulants/injection opioid use and polydrug/polyroute use classes had the highest levels of THN receipt while the polyroute stimulants use class had the least. CONCLUSION Among rural PWID in West Virginia, polysubstance use was prevalent and associated with overdose and THN acquisition. These analyses demonstrate the importance of scaling up naloxone distribution in rural settings. Overdose prevention initiatives are reaching persons at high risk of overdose, but expansion of services is needed.
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Affiliation(s)
- Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, HH886, Baltimore, MD 21205, USA.
| | - Allison O'Rourke
- DC Center for AIDS Research, Department of Psychology, George Washington University, 2125G St. NW, Washington, DC 20052, USA.
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA.
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA.
| | - Raschelle J Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, HH886, Baltimore, MD 21205, USA.
| | - Michael E Kilkenny
- Cabell-Huntington Health Department, 703 7th Ave, Huntington, WV 25701, USA.
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA.
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Baltimore, MD 21205, USA.
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Marks C, Zúñiga ML. CAM Practices and Treatment Adherence Among Key Subpopulations of HIV+ Latinos Receiving Care in the San Diego-Tijuana Border Region: A Latent Class Analysis. Front Public Health 2019; 7:179. [PMID: 31316963 PMCID: PMC6610997 DOI: 10.3389/fpubh.2019.00179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 06/13/2019] [Indexed: 11/13/2022] Open
Abstract
Latinos living in the United States-Mexico border region bear a disproportionate HIV/AIDS burden compared to individuals living in the interior of both nations and face a constellation of barriers that determine their ability to access and adhere to HIV care. Use of complementary and alternative medicine (CAM) may be associated with suboptimal treatment adherence. Sociodemographic factors, health practices, and social determinants of health unique to the border region may further contribute to health disparities that undermine care engagement and continuity. Improved understanding of HIV-positive Latino subgroups and their risk profiles can lead to more effective, targeted clinical and public health interventions. We undertook this study to identify and characterize distinct classes of HIV-positive Latinos in the San Diego-Tijuana border region, differentiated by HIV and border-related factors, utilizing latent class analysis. We investigated relationships between class membership and CAM utilization and self-reported antiretroviral therapy (ART) adherence. Five distinct classes were identified with unique demographic, HIV risk, and border mobility profiles. CAM was recently used by nearly half of each class, though there were significant differences in the proportion of CAM use by class ranging from 44.4 to 90.9%. As well, all classes were currently receiving ART at similarly high rates and ART adherence outcomes were not significantly different based on class. Findings highlight the significant use of CAM by all HIV-positive Latinos in the border region and imply the need for a research framework which appropriately acknowledges the heterogeneous nature of this population, such as intersectionality. Further research is recommended into understanding how patients integrate CAM into HIV treatment and the risks and benefits of incorporating CAM into HIV treatment.
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Affiliation(s)
- Charles Marks
- School of Social Work, San Diego State University, San Diego, CA, United States
- SDSU-UCSD Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, United States
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, CA, United States
- SDSU-UCSD Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, United States
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Abstract
Polydrug use among university students may be a predictor for established patterns of multiple substance use and potentially entail long-term health problems. This study examined the types of polydrug use among Spanish students in health sciences. Undergraduate students (n = 968), aged 18-38 years (M = 21.09 years, SD = 4.10), completed the survey. A percentage of 44.3% of the participants were classified as polydrug users. Type A users (alcohol and cigarettes) made up 17.8% of the participants surveyed, whereas 20.1% were Type B (cannabis with cigarettes and/or alcohol), and a further 5.7% were Type C (cannabis with cigarettes and/or alcohol, plus at least another kind of illegal drug). Type A was the most common type among women, whereas Type C was the most common among men. Type B use was higher among women 18-19 years old than among women 25-29 years old, whereas there were no female Type C users younger than 20 years old. Weekend consumption was higher, than weekday consumption, across all polydrug user types and substances. These results suggest that the prevalence of polydrug use among Spanish students in health sciences was similar to students in other disciplines, with Type B as the most prevalent among healthcare and nonhealthcare students. Taking into account the differences based on gender, age, and time of consumption, a specific approach to the different typologies of polydrug users might be a vital step in the successful development of preventive interventions tailored to the changing reality of psychoactive substance use.
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Mittal ML, Guise A, Rafful C, Gonzalez-Zuñiga P, Davidson P, Vashishtha D, Strathdee SA, Werb D. "Another Person Was Going to Do It": The Provision of Injection Drug Use Initiation Assistance in a High-Risk U.S.-Mexico Border Region. Subst Use Misuse 2019; 54:2338-2350. [PMID: 31389282 PMCID: PMC6883155 DOI: 10.1080/10826084.2019.1648514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Persons who inject drugs (PWID) play a key role in assisting others' initiation into injection drug use (IDU). We aimed to explore the pathways and socio-structural contexts for this phenomenon in Tijuana, Mexico, a border setting marked by a large PWID population with limited access to health and social services. Methods: Preventing Injecting by Modifying Existing Responses (PRIMER) is a multi-cohort study assessing socio-structural factors associated with PWID assisting others into initiating IDU. Semi-structured qualitative interviews in Tijuana included participants ≥18 years old, who reported IDU within the month prior to cohort enrollment and ever initiating others into IDU. Purposive sampling ensured a range of drug use experiences and behaviors related to injection initiation assistance. Thematic analysis was used to develop recurring and significant data categories. Results: Twenty-one participants were interviewed (8 women, 13 men). Broadly, participants considered public injection to increase curiosity about IDU. Many considered transitioning into IDU as inevitable. Emergent themes included providing assistance to mitigate overdose risk and to protect initiates from being taken advantage of by others. Participants described reluctance in engaging in this process. For some, access to resources (e.g., shared drugs or a monetary fee) was a motivator to initiate others. Conclusion: In Tijuana, public injection and a lack of harm reduction services are perceived to fuel the incidence of IDU initiation and to incentivize PWID to assist in injection initiation. IDU prevention efforts should address structural factors driving PWID participation in IDU initiation while including PWID in their development and implementation.
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Affiliation(s)
- Maria L Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Facultad de Medicina, Universidad Xochicalco, Tijuana, Mexico
| | - Andrew Guise
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Division of Health and Social Care Research, King's College, London, UK
| | - Claudia Rafful
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
| | - Patricia Gonzalez-Zuñiga
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Peter Davidson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Devesh Vashishtha
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
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Rafful C, Orozco R, Rangel G, Davidson P, Werb D, Beletsky L, Strathdee SA. Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs. Addiction 2018; 113:1056-1063. [PMID: 29333664 PMCID: PMC5938130 DOI: 10.1111/add.14159] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/04/2017] [Accepted: 01/05/2018] [Indexed: 01/22/2023]
Abstract
AIM To assess the effect of involuntary drug treatment (IDT) on non-fatal overdose among people who inject drugs (PWID). DESIGN Longitudinal study. SETTING Tijuana, Mexico. PARTICIPANTS Baseline sample of 671 PWID included 258 (38.4%) women and 413 (61.6%) men. MEASUREMENTS Primary independent variables were reported recent (i.e. past 6 months) non-fatal overdose event (dependent variable) and IDT. Substance use the day of the non-fatal overdose was also examined. FINDINGS From 2011 to 2017, 213 participants (31.7%) reported a recent non-fatal overdose and 103 (15.4%) reported recent IDT. Heroin, in combination with methamphetamine and tranquilizers, were the drugs most reported at the day of the event. IDT significantly increased the odds of reporting a non-fatal overdose event [adjusted odds ratio (aOR) = 1.76; 95% confidence interval (CI) = 1.04-2.96]. Odds of non-fatal overdose also increased independently for each additional injection per day (aOR = 1.05; 95% CI = 1.02-1.08), recent tranquilizer use (aOR = 1.92; 95% CI = 1.41-2.61) and using hit doctors (aOR = 1.68; 95% CI = 1.29-2.18) and decreased with age (aOR = 0.97 per year, 95% CI = 0.95-0.99). CONCLUSIONS Recent involuntary drug treatment in Mexico is a risk factor for non-fatal drug overdose.
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Affiliation(s)
- Claudia Rafful
- Division of Global Public Health, School of Medicine, University of California, San Diego,School of Public Health, San Diego State University,Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | | | - Gudelia Rangel
- Secretariat of Health, Mexico,Mexico-United States Border Health Commission, Mexico
| | - Peter Davidson
- Division of Global Public Health, School of Medicine, University of California, San Diego
| | - Dan Werb
- Division of Global Public Health, School of Medicine, University of California, San Diego,Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Leo Beletsky
- Division of Global Public Health, School of Medicine, University of California, San Diego,School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Steffanie A. Strathdee
- Division of Global Public Health, School of Medicine, University of California, San Diego,Corresponding author: Steffanie A. Strathdee, Ph.D., Division of Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive. La Jolla, CA 92093-0507, USA, Tel: +1(858)822-1952; Fax: +1(858)534-7566,
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27
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Burgos JL, Cepeda JA, Kahn JG, Mittal ML, Meza E, Lazos RRP, Vargas PC, Vickerman P, Strathdee SA, Martin NK. Cost of provision of opioid substitution therapy provision in Tijuana, Mexico. Harm Reduct J 2018; 15:28. [PMID: 29792191 PMCID: PMC5967039 DOI: 10.1186/s12954-018-0234-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/13/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mexico recently enacted drug policy reform to decriminalize possession of small amounts of illicit drugs and mandated that police refer identified substance users to drug treatment. However, the economic implications of drug treatment expansion are uncertain. We estimated the costs of opioid substitution therapy (OST) provision in Tijuana, Mexico, where opioid use and HIV are major public health concerns. METHODS We adopted an economic health care provider perspective and applied an ingredients-based micro-costing approach to quantify the average monthly cost of OST (methadone maintenance) provision at two providers (one private and one public) in Tijuana, Mexico. Costs were divided by type of input (capital, recurrent personnel and non-personnel). We defined "delivery cost" as all costs except for the methadone and compared total cost by type of methadone (powdered form or capsule). Cost data were obtained from interviews with senior staff and review of expenditure reports. Service provision data were obtained from activity logs and senior staff interviews. Outcomes were cost per OST contact and cost per person month of OST. We additionally collected information on patient charges for OST provision from published rates. RESULTS The total cost per OST contact at the private and public sites was $3.12 and $5.90, respectively, corresponding to $95 and $179 per person month of OST. The costs of methadone delivery per OST contact were similar at both sites ($2.78 private and $3.46 public). However, cost of the methadone itself varied substantially ($0.34 per 80 mg dose [powder] at the private site and $2.44 per dose [capsule] at the public site). Patients were charged $1.93-$2.66 per methadone dose. CONCLUSIONS The cost of OST provision in Mexico is consistent with other upper-middle income settings. However, evidenced-based (OST) drug treatment facilities in Mexico are still unaffordable to most people who inject drugs.
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Affiliation(s)
- Jose Luis Burgos
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA
| | - Javier A Cepeda
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA.
| | - James G Kahn
- Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Maria Luisa Mittal
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA
| | | | | | | | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Steffanie A Strathdee
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA
| | - Natasha K Martin
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA.,School of Social and Community Medicine, University of Bristol, Bristol, UK
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28
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Abstract
Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39-4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98-21.78), heroin (AOR = 4.00, 95% CI = 1.88-8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16-3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting.
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Meacham MC, Roesch SC, Strathdee SA, Gaines TL. Perceived Treatment Need and Latent Transitions in Heroin and Methamphetamine Polydrug Use among People who Inject Drugs in Tijuana, Mexico. J Psychoactive Drugs 2017; 50:62-71. [PMID: 28960166 DOI: 10.1080/02791072.2017.1370747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
People who inject drugs (PWID) in Tijuana, Mexico, use heroin and/or methamphetamine. While polydrug use is associated with HIV risk behavior, less is known about the stability of polydrug use patterns over time and how polydrug use is related to perceived treatment need. Within a cohort of PWID in Tijuana (N = 735) we sought to (1) characterize subgroups of polydrug and polyroute use from baseline to six months; (2) determine the probabilities of transitioning between subgroups; and (3) examine whether self-reported need for help for drug use modified these transition probabilities. Latent transition analysis (LTA) identified four latent statuses: heroin-only injection (38% at both baseline and follow-up); co-injection of heroin with methamphetamine (3% baseline, 15% follow-up); injection of heroin and methamphetamine (37% baseline, 32% follow-up); and polydrug and polyroute users who injected heroin and both smoked and injected methamphetamine (22% baseline, 14% follow-up). Heroin-only injectors had the highest probability of remaining in the same latent status at follow-up. The majority reported great or urgent need for treatment (51%) and these PWID had greater odds of transitioning to a higher-risk status at follow-up, emphasizing the need for evidence-based drug treatment options for PWID.
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Affiliation(s)
- Meredith C Meacham
- a Postdoctoral Fellow, Department of Psychiatry , University of California, San Francisco , San Francisco , CA , USA.,b Doctoral Student, School of Public Health , San Diego State University , San Diego , CA , USA.,c Doctoral Student, Division of Global Public Health , Department of Medicine, University of California , San Diego, La Jolla , CA , USA
| | - Scott C Roesch
- d Professor, Department of Psychology , San Diego State University , San Diego , CA , USA
| | - Steffanie A Strathdee
- e Professor, Division of Global Public Health, Department of Medicine , University of California , San Diego, La Jolla , CA , USA
| | - Tommi L Gaines
- f Assistant Professor, Division of Global Public Health, Department of Medicine , University of California , San Diego, La Jolla , CA , USA
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Zhang M, Lv D, Zhou W, Ji L, Zhou B, Chen H, Gu Y, Zhao J, He J. The levels of triglyceride and total cholesterol in methamphetamine dependence. Medicine (Baltimore) 2017; 96:e6631. [PMID: 28422859 PMCID: PMC5406075 DOI: 10.1097/md.0000000000006631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The serum triglyceride (TG) and total cholesterol (TC) levels have been reported altered in the traditional drug-dependence (such as marijuana and heroin). However, studies assessing the relationships among serum TC, TG, and methamphetamine (MA)-dependence have not been described well. In this study, our aim is to explore the serum TG and TC levels in large sample of MA-dependent patients. A retrospective study was conducted in 938 MA-dependent patients who were recruited between February 2, 2008 and March 11, 2013, with social characteristics and drug-dependence history (duration of MA use, routes of drug administration, and daily dose were collected). Then, the serum levels of TC, TG, glucose (GLU), body mass index (BMI), and blood pressure were measured among the participants. Meanwhile, 985 age- and gender-matched healthy people in the physical examination center were selected as control group. Compared with the control group, significant decreases of TC, TG, GLU, and BMI were observed in MA-dependent patients (P < 0.05). Besides, we found that the daily dose of MA use was associated with TC (β = -0.079, P = 0.015) and the duration of MA use was independently related to BMI (β = -0.071, P = 0.031). This study demonstrated that the levels of TC, TG, GLU, and BMI factors altered in the MA-dependent patients. In addition, there is a negative association between MA dependence and TC and BMI.
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Affiliation(s)
| | - Dezhao Lv
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wu Zhou
- Department of Clinical Laboratory
| | - Lili Ji
- Department of Clinical Laboratory
| | | | - Han Chen
- Department of Clinical Laboratory
| | - Yingying Gu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiyun Zhao
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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