1
|
Ezell JM, Pho MT, Ajayi BP, Simek E, Shetty N, Goddard-Eckrich DA, Bluthenthal RN. Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model. Drug Alcohol Rev 2024. [PMID: 38646735 DOI: 10.1111/dar.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 04/23/2024]
Abstract
ISSUES To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. APPROACH Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. KEY FINDINGS Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. IMPLICATIONS There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. CONCLUSION There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.
Collapse
Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, USA
| | - Babatunde P Ajayi
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
| | - Elinor Simek
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Netra Shetty
- University of California Berkeley, Berkeley, USA
| | | | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
| |
Collapse
|
2
|
Hulme MC, Hayatbakhsh A, Brignall RM, Gilbert N, Costello A, Schofield CJ, Williamson DC, Kemsley EK, Sutcliffe OB, Mewis RE. Detection, discrimination and quantification of amphetamine, cathinone and nor-ephedrine regioisomers using benchtop 1 H and 19 F nuclear magnetic resonance spectroscopy. MAGNETIC RESONANCE IN CHEMISTRY : MRC 2023; 61:73-82. [PMID: 33786881 DOI: 10.1002/mrc.5156] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
Amphetamine and cathinone derivatives are abused recreationally due to the sense of euphoria they provide to the user. Methodologies for the rapid detection of the drug derivative present in a seized sample, or an indication of the drug class, are beneficial to law enforcement and healthcare providers. Identifying the drug class is prudent because derivatisation of these drugs, to produce regioisomers, for example, occurs frequently to circumvent global and local drug laws. Thus, newly encountered derivatives might not be present in a spectral library. Employment of benchtop nuclear magnetic resonance (NMR) could be used to provide rapid analysis of seized samples as well as identifying the class of drug present. Discrimination of individual amphetamine-, methcathinone-, N-ethylcathinone and nor-ephedrine-derived fluorinated and methylated regioisomers is achieved herein using qualitative automated 1 H NMR analysis and compared to gas chromatography-mass spectrometry (GC-MS) data. Two seized drug samples, SS1 and SS2, were identified to contain 4-fluoroamphetamine by 1 H NMR (match score median = 0.9933) and GC-MS (RRt = 5.42-5.43 min). The amount of 4-fluoroamphetamine present was 42.8%-43.4% w/w and 48.7%-49.2% w/w for SS1 and SS2, respectively, from quantitative 19 F NMR analysis, which is in agreement with the amount determined by GC-MS (39.9%-41.4% w/w and 49.0%-49.3% w/w). The total time for the qualitative 1 H NMR and quantitative 19 F NMR analysis is ~10 min. This contrasts to ~40 min for the GC-MS method. The NMR method also benefits from minimal sample preparation. Thus, benchtop NMR affords rapid, and discriminatory, analysis of the drug present in a seized sample.
Collapse
Affiliation(s)
- Matthew C Hulme
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
- MANchester DRug Analysis and Knowledge Exchange (MANDRAKE), Manchester Metropolitan University, Manchester, UK
| | - Armita Hayatbakhsh
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | | | - Nicolas Gilbert
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
- MANchester DRug Analysis and Knowledge Exchange (MANDRAKE), Manchester Metropolitan University, Manchester, UK
| | - Andrew Costello
- MANchester DRug Analysis and Knowledge Exchange (MANDRAKE), Manchester Metropolitan University, Manchester, UK
- Greater Manchester Police, Openshaw Complex, Manchester, UK
| | - Christopher J Schofield
- MANchester DRug Analysis and Knowledge Exchange (MANDRAKE), Manchester Metropolitan University, Manchester, UK
- Greater Manchester Police, Openshaw Complex, Manchester, UK
| | | | - E Kate Kemsley
- Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Oliver B Sutcliffe
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
- MANchester DRug Analysis and Knowledge Exchange (MANDRAKE), Manchester Metropolitan University, Manchester, UK
| | - Ryan E Mewis
- Department of Natural Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
- MANchester DRug Analysis and Knowledge Exchange (MANDRAKE), Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
3
|
The Funding is the Science: Racial Inequity of NIH Funding for Substance Use Disorder Topics Should Be Abolished. Drug Alcohol Depend 2021. [DOI: 10.1016/j.drugalcdep.2021.109163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
4
|
Rudolph AE, Young AM. Privacy and Confidentiality Considerations for Collecting HIV Risk Network Data among Men who Have Sex with Men and Implications for Constructing Valid Risk Networks. SOCIAL NETWORKS 2021; 67:47-54. [PMID: 34712004 PMCID: PMC8547314 DOI: 10.1016/j.socnet.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Studies aiming to construct risk networks have historically collected network members' names, demographic characteristics and relational data (i.e., type, strength, duration, frequency of interaction, and HIV-related risk behaviors between the pair). Due to difficulties in constructing risk networks stemming from partner anonymity and the use of nicknames, some studies also collect network members' screen names, phone numbers, physical attributes, and scars/tattoos to assist with entity resolution. In-depth interviews with 20 men who have sex with men and transgender women in Kentucky assessed privacy/confidentiality concerns as well as accuracy/recall issues associated with providing these details. Most preferred providing alters' nicknames/first names only or a first name with the first letter of the last name. Many perceived screen names, phone numbers, and scars/tattoos to be too personal/identifying. Willingness to provide more detailed information varied by relationship type/strength, which could influence the validity of the resulting network.
Collapse
Affiliation(s)
- Abby E. Rudolph
- Department of Epidemiology, Boston University School of Public Health, Boston MA
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia PA
| | - April M. Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington KY
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington KY
| |
Collapse
|
5
|
Shetty S, Malik AH, Ali A, Yang YC, Briasoulis A, Alvarez P. Characteristics, trends, outcomes, and costs of stimulant-related acute heart failure hospitalizations in the United States. Int J Cardiol 2021; 331:158-163. [PMID: 33535075 DOI: 10.1016/j.ijcard.2021.01.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/03/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Heart failure (HF) hospitalizations remains a significant burden on the health care system. Stimulants including cocaine, amphetamine and its derivatives are amongst the most used illegal substances in the United States. The information regarding stimulant-related HF hospitalizations is scarce. We sought to evaluate the characteristics and trends of stimulant-related HF hospitalizations in the United States and their associated outcomes and resource utilization. METHODS Using the National Inpatient Sample (NIS), we identified patients with a primary diagnosis of HF hospitalization. These hospitalizations were further divided into those with and without a concomitant diagnosis of stimulant (cocaine or amphetamine) dependence or abuse. Survey specific techniques were employed to compare trends in baseline characteristics, complications, procedures, outcomes and resource utilization between the two cohorts. RESULTS We identified 9,932,753 hospitalizations (weighted) with a primary diagnosis of heart failure, of those 138,438 (1.39%) had a diagnosis of active stimulant use. The proportion of stimulant-related HF hospitalization is on the rise (1.1% to 1.9%). Stimulant-related HF hospitalization was highest amongst age group 30-39 years and 7.9% of HF hospitalizations in this age group were due to stimulant use. The proportion of stimulant-related HF hospitalization for the White and Hispanic race has doubled from 2008 to 2017. Stimulant-related HF hospitalization is associated with increased incidence of in-hospital complications like cardiogenic shock, acute kidney injury and ventricular tachycardia. These patients have more than 7-fold higher discharge against medical advice. CONCLUSIONS Stimulant-related HF hospitalizations have been increasing. It is associate with significant morbidity burden and health care utilization.
Collapse
Affiliation(s)
- Suchith Shetty
- Department of Cardiology, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa, USA.
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Abbas Ali
- Department of Cardiology, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa, USA
| | - Ying Chi Yang
- Department of Cardiology, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa, USA
| | - Alexandros Briasoulis
- Department of Cardiology, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa, USA
| | - Paulino Alvarez
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
6
|
Lloyd Sieger MH. Reunification for young children of color with substance removals: An intersectional analysis of longitudinal national data. CHILD ABUSE & NEGLECT 2020; 108:104664. [PMID: 32799013 DOI: 10.1016/j.chiabu.2020.104664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND The opioid epidemic has resulted in increasing attention to the effect of parental substance use disorders on child welfare system involvement, including foster care utilization. Opioid use disorders are more common among whites than people of color, however. OBJECTIVE This study sought to determine number and proportion of children of color with substance removals and whether disparities exist in likelihood of reunification compared to white children. PARTICIPANTS & SETTING This study used U.S. Adoption and Foster Care Analysis and Reporting System (AFCARS) data to determine rates of foster care entries and outcomes between 2007-2017 across intersections of child race/ethnicity, age, and substance removal status. METHODS Survival analyses were employed to test the primary research questions. RESULTS During the 10 year period observed, the number and proportion of white children with substance removals (ages 0-4 and 5+) in foster care increased two- to three-fold compared to children of color with substance removals depending on child age. However, children of color, particularly ages 0-4, faced disadvantages respecting foster care outcomes. Results of the multivariate proportional hazards models revealed that reunification was significantly and substantially more likely for every group compared to young (0-4) children of color with substance removals. Further probing revealed that racial disparities were driven primarily by Black/African American children. CONCLUSIONS Children of color with substance removals, particularly Black/African American children, are at higher risk of poor child welfare outcomes compared to their white peers.
Collapse
Affiliation(s)
- Margaret H Lloyd Sieger
- University of Connecticut, School of Social Work, 38 Prospect Street, Room 310, Hartford, CT, 06105, United States.
| |
Collapse
|
7
|
Zilkha N, Barnea‐Ygael N, Keidar L, Zangen A. Increased relapse to cocaine-seeking in a genetic model for depression. Addict Biol 2020; 25:e12756. [PMID: 31062481 DOI: 10.1111/adb.12756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/21/2019] [Accepted: 03/18/2019] [Indexed: 12/20/2022]
Abstract
The greatest difficulty in treating cocaine addiction is the enormous rates of relapse, which occur despite immense negative consequences. Relapse risks are even greater in addicts with comorbid depression, perhaps because they use drugs to alleviate depressive symptoms. Only a few preclinical studies have examined this comorbidity, mostly exploring depressive-like effects following drug exposure. We examined rats from two different depression-like models: (a) chronic-mild-stress (CMS), which respond to antidepressant medications and (b) depressed-rat-line (DRL), a genetic model of selective breeding, which is less responsive to antidepressant medications. We tested addictive behaviors in a cocaine self-administration procedure, including the "conflict model," where drug-seeking and relapse encounter adverse consequences: an electrified grid in front of the drug-delivering lever. Following behavioral testing, we explored a potential association between behavioral outcomes and protein expression of brain-derived neurotrophic factor (BDNF). We found that DRL rats self-administer more cocaine compared with both CMS and controls, while CMS and control groups did not differ significantly. Notably, DRL but not CMS rats, displayed higher rates of relapse than controls, and expressed higher levels of BDNF in the prelimbic cortex (PLC). Potential translation of these results suggest that medication-resistant depressed patients tend to consume more drugs and are more susceptible to relapse. The increase in PLC BDNF levels is consistent with previous rat models of depression, and concomitantly, with its suggested role in promoting cocaine-seeking.
Collapse
Affiliation(s)
- Noga Zilkha
- Department of NeurobiologyWeizmann institute of Science Rehovot Israel
- Department of Life Sciences and the Zlotowski Center for NeuroscienceBen‐Gurion University Be'er Sheva Israel
| | - Noam Barnea‐Ygael
- Department of Life Sciences and the Zlotowski Center for NeuroscienceBen‐Gurion University Be'er Sheva Israel
| | - Liraz Keidar
- Department of NeurobiologyWeizmann institute of Science Rehovot Israel
| | - Abraham Zangen
- Department of Life Sciences and the Zlotowski Center for NeuroscienceBen‐Gurion University Be'er Sheva Israel
| |
Collapse
|
8
|
Ndanga M, Srinivasan S. Analysis of Hospitalization Length of Stay and Total Charges for Patients with Drug Abuse Comorbidity. Cureus 2019; 11:e6516. [PMID: 32025435 PMCID: PMC6988730 DOI: 10.7759/cureus.6516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Drug abuse has been on the increase over the last few years, contributing to the healthcare cost. An understanding of the overall impact of drug abuse hospitalizations is essential in combatting the drug abuse epidemic. Objective To evaluate inpatient outcomes of total charges and length of stay for patients with drug abuse comorbidity compared to non-drug abuse admissions. Method The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample data was utilized. Drug abuse comorbidity was used as defined by HCUP. Various descriptive and inferential analyses were performed on the filtered data sets for the years 2010 to 2014. Results The average hospitalization length of stay was 4.5 days for non-drug abuse and 5.5 days for drug abuse comorbidity (P < 0.001). Mean charges for drug abuse comorbidity were significant for claims to private insurance and Medicaid. Conclusion Total charges and length of stay are higher for drug abuse than non-drug abuse cases. The results will aid as a reference for resource allocation and policy changes. Further research is needed for alternative and innovative interventions for conditions that are identified to be co-existing with drug abuse comorbidity.
Collapse
Affiliation(s)
- Memory Ndanga
- Health Information Management, Rutgers University, Piscataway, USA
| | | |
Collapse
|
9
|
Woodhead EL, Booth BM, Timko C, Tjemsland A, Han X, Cucciare MA. Longitudinal Health Outcomes and Treatment Utilization Among Emerging, Early-Mid, and Older Rural Adults Using Stimulants. JOURNAL OF ADULT DEVELOPMENT 2018. [DOI: 10.1007/s10804-018-9309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
10
|
Flynn KC, Hoffer LD. Transitioning illicit drug preferences and emerging user identities in Ohio: The proliferation of methamphetamine use among African Americans. J Ethn Subst Abuse 2017; 18:67-88. [PMID: 28678637 DOI: 10.1080/15332640.2017.1325809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Understanding the social dynamics of local methamphetamine markets is critical to improving community health and reducing social costs associated with illicit drug use. We examine a local drug market in Summit County, Ohio, wherein methamphetamine users ascribe themselves different ethnic identities from those long associated with the drug elsewhere in the United States. Qualitative interviews with 52 study participants demonstrate that very poor and homeless White males and females are now using methamphetamine; however, even more surprising is that 31 of the participants identified themselves as poor or homeless, male or female African, Native, biracial, or multiracial Americans. The drug use trajectory of these 31 participants in particular involved a transition from a historical preference for crack to a present one for methamphetamine and, in some cases, a preference for concurrent use of methamphetamine and heroin. Many of these methamphetamine users also emphasized their ethnic identity to distinguish themselves as nonproducers of methamphetamine in comparison to Whites, who are commonly associated with methamphetamine production. Findings appear to suggest an emergent means of identity management resulting from the ethnic diversity of users in this methamphetamine market. These findings may have relevance in other communities with similar demographics and drug markets and may hold important implications for drug treatment, policy-making, and law enforcement professionals' work associated with methamphetamine users, producers, and distributors.
Collapse
Affiliation(s)
| | - Lee D Hoffer
- a Case Western Reserve University , Cleveland , Ohio
| |
Collapse
|
11
|
Sanchez K, Greer TL, Walker R, Carmody T, Rethorst CD, Trivedi MH. Racial and ethnic differences in treatment outcomes among adults with stimulant use disorders after a dosed exercise intervention. J Ethn Subst Abuse 2017; 16:495-510. [PMID: 28524806 DOI: 10.1080/15332640.2017.1317310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The current study examined differences in substance abuse treatment outcomes among racial and ethnic groups enrolled in the Stimulant Reduction Intervention using Dosed Exercise (STRIDE) trial, a multisite randomized clinical trial implemented through the National Institute on Drug Abuse's (NIDA's) Clinical Trials Network (CTN). STRIDE aimed to test vigorous exercise as a novel approach to the treatment of stimulant abuse compared to a health education intervention. A hurdle model with a complier average causal effects (CACE) adjustment was used to provide an unbiased estimate of the exercise effect had all participants been adherent to exercise. Among 214 exercise-adherent participants, we found significantly lower probability of use for Blacks (z = -2.45, p = .014) and significantly lower number of days of use for Whites compared to Hispanics (z = -54.87, p = <.001) and for Whites compared to Blacks (z = -28.54, p = <.001), which suggests that vigorous, regular exercise might improve treatment outcomes given adequate levels of adherence.
Collapse
Affiliation(s)
- Katherine Sanchez
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas
| | - T L Greer
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - R Walker
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - T Carmody
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - C D Rethorst
- b University of Texas Southwestern Medical Center , Dallas , Texas
| | - M H Trivedi
- b University of Texas Southwestern Medical Center , Dallas , Texas
| |
Collapse
|
12
|
Rudolph AE, Crawford ND, Latkin C, Lewis CF. Multiplex Relationships and HIV: Implications for Network-Based Interventions. AIDS Behav 2017; 21:1219-1227. [PMID: 27272657 DOI: 10.1007/s10461-016-1454-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The number of network members and the roles they play can influence risk behaviors and consequently intervention strategies to reduce HIV transmission. We recruited 652 people who use drugs (PWUD) from socially disadvantaged neighborhoods in New York City (07/2006-06/2009). Interviewer-administered surveys ascertained demographic, behavioral, and network data. We used logistic regression, stratified by exchange sex, to assess the relationship between HIV status and the number of network members with different roles, treated as independent and multiplex (i.e., drug + sex). Those with more multiplex risk ties were significantly more likely to be HIV positive, but only among those not reporting exchange sex (AOR = 3.2). Among those reporting exchange sex, men reporting recent male sex partners were more likely to report HIV positive status (AOR = 12.6). These data suggest that sex and drug relationships among PWUD are interrelated. Interventions that target multiplex rather than single-role relationships may be more effective in influencing behavior change.
Collapse
Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, T418E, Boston, MA, 02118-2526, USA.
| | - Natalie D Crawford
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Carl Latkin
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Crystal Fuller Lewis
- Division of Social Solutions and Services Research, Nathan Kline Institute, Orangeburg, NY, USA
- Department of Psychiatry, New York University School of Medicine, New York City, NY, USA
| |
Collapse
|
13
|
Cucciare MA, Han X, Curran GM, Booth BM. Associations Between Religiosity, Perceived Social Support, and Stimulant Use in an Untreated Rural Sample in the U.S.A. Subst Use Misuse 2016; 51:823-34. [PMID: 27096554 PMCID: PMC4962696 DOI: 10.3109/10826084.2016.1155611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Religiosity and perceived social support (SS) may serve as protective factors for more severe substance use in adults. OBJECTIVES This study sought to examine whether aspects of religiosity and SS are associated with longitudinal reductions in stimulant use over three years in an untreated sample of rural drug users. METHODS Respondent-driven sampling was used to recruit stimulant users (N = 710) from Arkansas, Kentucky, and Ohio. Follow-up interviews were conducted at 6-month intervals for 36 months. RESULTS Our bivariate findings indicate that higher religiosity was associated with lower odds and fewer days of methamphetamine and cocaine use. After controlling for covariates, higher religiosity was associated with fewer days of crack cocaine use, but more days of methamphetamine use among a small sample of users in the two final interviews. Higher SS from drug-users was also associated with higher odds and days of methamphetamine and powder cocaine use, while higher SS from nondrug users was associated with fewer days of methamphetamine use. CONCLUSIONS/IMPORTANCE Our bivariate findings suggest that higher levels of religiosity may be helpful for some rural individuals in reducing their drug use over time. However, our multivariate findings suggest a need for further exploration of the potential effects of religiosity on longer-term drug use, especially among those who continue to use methamphetamine and/or remain untreated. Our findings also highlight the potential deleterious effect of SS from drug users on the likelihood and frequency of methamphetamine and powder cocaine use over time among untreated rural drug users.
Collapse
Affiliation(s)
- Michael A Cucciare
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.,b Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,c VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Xiaotong Han
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.,c VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Geoffrey M Curran
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.,b Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,d Department of Pharmacy Practice , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Brenda M Booth
- a Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| |
Collapse
|
14
|
Amphetamine Abuse Related Acute Myocardial Infarction. Case Rep Cardiol 2016; 2016:7967851. [PMID: 26998366 PMCID: PMC4779519 DOI: 10.1155/2016/7967851] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 12/02/2022] Open
Abstract
Amphetamine abuse is a global problem. The cardiotoxic manifestations like acute myocardial infarction (AMI), heart failure, or arrhythmia related to misuse of amphetamine and its synthetic derivatives have been documented but are rather rare. Amphetamine-related AMI is even rarer. We report two cases of men who came to emergency department (ED) with chest pain, palpitation, or seizure and were subsequently found to have myocardial infarction associated with the use of amphetamines. It is crucial that, with increase in amphetamine abuse, clinicians are aware of this potentially dire complication. Patients with low to intermediate risk for coronary artery disease with atypical presentation may benefit from obtaining detailed substance abuse history and urine drug screen if deemed necessary.
Collapse
|
15
|
Quinn B, Stoové M, Dietze P. One-year changes in methamphetamine use, dependence and remission in a community-recruited cohort. JOURNAL OF SUBSTANCE USE 2015. [DOI: 10.3109/14659891.2015.1018972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
Jing L, Zhang Y, Li JX. Effects of the trace amine associated receptor 1 agonist RO5263397 on abuse-related behavioral indices of methamphetamine in rats. Int J Neuropsychopharmacol 2015; 18:pyu060. [PMID: 25522401 PMCID: PMC4360231 DOI: 10.1093/ijnp/pyu060] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Methamphetamine is a major drug of abuse with no effective pharmacotherapy available. Trace amine associated receptor 1 is implicated in cocaine addiction and represents a potential therapeutic target. However, the effects of trace amine associated receptor 1 agonists on addiction-related behavioral effects of methamphetamine are unknown. METHODS This study examined the effects of a trace amine associated receptor 1 agonist RO5263397 on methamphetamine-induced behavioral sensitization, methamphetamine self-administration, cue- and methamphetamine-induced reinstatement of drug seeking, and cue-induced reinstatement of sucrose-seeking behaviors in rats. Male Sprague-Dawley rats were used to examine the effects of methamphetamine alone and in combination with the trace amine associated receptor 1 agonist RO5263397 (3.2-10mg/kg). RESULTS RO5263397 dose-dependently attenuated the expression of behavioral sensitization to methamphetamine, reduced methamphetamine self-administration, and decreased both cue- and a priming dose of methamphetamine-induced reinstatement of drug-seeking behaviors. However, RO5263397 did not alter cue-induced reinstatement of sucrose-seeking behavior. CONCLUSIONS Taken together, trace amine associated receptor 1 agonists attenuate some abuse-related behavioral effects of methamphetamine, strongly suggesting that drugs activating trace amine associated receptor 1 may be potentially useful for the treatment of methamphetamine addiction and warrant further studies.
Collapse
Affiliation(s)
| | | | - Jun-Xu Li
- Department of Pharmacology and Toxicology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY (Drs Jing and Li); Department of Physiology and Pathophysiology, Tianjin Medical University, Tianjin, China (Dr Jing); Research Triangle Institute, Research Triangle Park, NC (Dr Zhang).
| |
Collapse
|
17
|
Sanchez K, Chartier KG, Greer TL, Walker R, Carmody T, Rethorst CD, Ring KM, Dela Cruz AM, Trivedi MH. Comorbidities and race/ethnicity among adults with stimulant use disorders in residential treatment. J Ethn Subst Abuse 2015; 14:79-95. [PMID: 25580933 DOI: 10.1080/15332640.2014.961109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Comorbid physical and mental health problems are associated with poorer substance abuse treatment outcomes; however, little is known about these conditions among stimulant abusers at treatment entry. This study compared racial and ethnic groups on baseline measures of drug use patterns, comorbid physical and mental health disorders, quality of life, and daily functioning among cocaine and stimulant abusing/dependent patients. Baseline data from a multi-site randomized clinical trial of vigorous exercise as a treatment strategy for a diverse population of stimulant abusers (N=290) were analyzed. Significant differences between groups were found on drug use characteristics, stimulant use disorders, and comorbid mental and physical health conditions. Findings highlight the importance of integrating health and mental health services into substance abuse treatment and could help identify potential areas for intervention to improve treatment outcomes for racial and ethnic minority groups.
Collapse
|
18
|
Borders TF, Booth BM, Stewart KE, Cheney AM, Curran GM. Rural/urban residence, access, and perceived need for treatment among African American cocaine users. J Rural Health 2014; 31:98-107. [PMID: 25213603 DOI: 10.1111/jrh.12092] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine how rural/urban residence, perceived access, and other factors impede or facilitate perceived need for drug use treatment, a concept closely linked to treatment utilization. STUDY DESIGN Two hundred rural and 200 urban African American cocaine users who were not receiving treatment were recruited via Respondent-Driven Sampling and completed a structured in-person interview. Bivariate and multivariate analyses were conducted to test the associations between perceived need and rural/urban residence, perceived access, and other predisposing (eg, demographics), enabling (eg, insurance), and health factors (eg, psychiatric distress). PRINCIPAL FINDINGS In bivariate analyses, rural relative to urban cocaine users reported lower perceived treatment need (37% vs 48%), availability, affordability, overall ease of access, and effectiveness, as well as lower perceived acceptability of residential, outpatient, self-help, and hospital-based services. In multivariate analyses, there was a significant interaction between rural/urban residence and the acceptability of religious counseling. At the highest level of acceptability, rural users had lower odds of perceived need (OR = 0.21); at the lowest level, rural users had higher odds of perceived need (OR = 3.97) than urban users. Among rural users, the acceptability of religious counseling was negatively associated with perceived need (OR = 0.65). Ease of access was negatively associated (OR = 0.71) whereas local treatment effectiveness (OR = 1.47) and the acceptability of hospital-based treatment (OR = 1.29) were positively associated with perceived need among all users. CONCLUSIONS Our findings suggest rural/urban disparities in perceived need and access to drug use treatment. Among rural and urban cocaine users, improving perceptions of treatment effectiveness and expanding hospital-based services could promote treatment seeking.
Collapse
Affiliation(s)
- Tyrone F Borders
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky
| | | | | | | | | |
Collapse
|
19
|
Kiluk BD, Babuscio TA, Nich C, Carroll KM. Smokers versus snorters: do treatment outcomes differ according to route of cocaine administration? Exp Clin Psychopharmacol 2013; 21:490-8. [PMID: 24364538 PMCID: PMC3943602 DOI: 10.1037/a0034173] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Smoking cocaine achieves maximal concentration and effect far more rapidly than through the intranasal ("snorting") route, and it is associated with greater propensity for dependence and more severe consequences. However, very little is known about differences in treatment outcome according to route of administration. This study compared treatment outcomes, such as frequency of cocaine use and Addiction Severity Index (ASI) composite scores, by primary route of cocaine administration (smoking vs. intranasal) among a pooled sample of 412 cocaine-dependent individuals participating in 1 of 5 randomized clinical trials. The majority (80%) reported smoking as their primary route of cocaine administration. Overall, results indicated better cocaine use outcomes both during the treatment phase and through a 12-month follow-up period for intranasal users compared to smokers, although not all differences reached statistical significance. Intranasal users remained in treatment longer, F(1, 408) = 3.55, p < .05, and showed a trend toward achieving longer periods of sustained abstinence within treatment, F(1, 378) = 2.68, p = .08, as well as less use over time during the follow-up period than smokers (Time × Route: t = 1.87, p = .06). Also, intranasal users' ASI cocaine composite score decreased more than smokers, but there were overall decreases in the other ASI domains for all participants over the course of the study period. These results suggest that intranasal users may achieve better cocaine use outcomes than smokers, yet this doesn't appear to translate to differential changes in the severity of problems experienced in other life areas.
Collapse
Affiliation(s)
| | | | - Charla Nich
- Yale School of Medicine, Department of Psychiatry
| | | |
Collapse
|
20
|
Abstract
OBJECTIVES We investigated possible associations between pain frequency and the 5 most common substance use disorders: alcohol abuse/dependence, cocaine abuse/dependence, methamphetamine abuse/dependence, opioid abuse/dependence, and marijuana abuse/dependence. METHODS We used data from the Rural Stimulant Study, a longitudinal (7 waves), observational study of at-risk stimulant users (cocaine and methamphetamine) in Arkansas and Kentucky (n=462). In fixed-effects logistic regression models, we regressed our measures of substance use disorders on the number of days with pain in the past 30 days and depression severity. RESULTS Time periods when individuals had 1 to 15 days [odds ratio (OR)=1.85, P<0.001] or 16+ days (OR=2.18, P<0.001) with pain in the past 30 days were more likely to have a diagnosis of alcohol abuse/dependence, compared with time periods when individuals had no days with pain. Compared with time periods when individuals had no pain days in the past 30 days, time periods when individuals had 16+ pain days were more likely to have a diagnosis of opioid abuse/dependence (OR=3.32, P=0.02). Number of days with pain was not significantly associated with other substance use disorders. DISCUSSION Pain frequency seems to be associated with an increased risk for alcohol abuse/dependence and opioid abuse/dependence in this population, and the magnitude of the association is medium to large. Further research is needed to investigate this in more representative populations and to determine causal relationships.
Collapse
Affiliation(s)
- Mark J. Edlund
- Behavioral Health Epidemiology, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194
| | - Mark D. Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6560 Seattle, WA 98195-6560
| | - Xiaotong Han
- Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, 4310 W Markham St Slot 755, Little Rock, AR 72205
| | - Brenda M. Booth
- Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences, 4310 W Markham St Slot 755, Little Rock, AR 72205
- Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, Bldg 58, North Little Rock, AR 72114
| |
Collapse
|
21
|
Quinn B, Stoové M, Dietze P. Factors associated with professional support access among a prospective cohort of methamphetamine users. J Subst Abuse Treat 2013; 45:235-41. [DOI: 10.1016/j.jsat.2013.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 02/11/2013] [Accepted: 02/13/2013] [Indexed: 11/28/2022]
|
22
|
Cheney AM, Curran GM, Booth BM, Sullivan S, Stewart K, Borders TF. The Religious and Spiritual Dimensions of Cutting Down and Stopping Cocaine Use: A Qualitative Exploration Among African Americans in the South. JOURNAL OF DRUG ISSUES 2013; 44:94-113. [PMID: 25364038 DOI: 10.1177/0022042613491108] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study qualitatively examines the religious and spiritual dimensions of cutting down and stopping cocaine use among African Americans in rural and urban areas of Arkansas. The analyses compare and contrast the narrative data of 28 current cocaine users living in communities where the Black church plays a fundamental role in the social and cultural lives of many African Americans, highlighting the ways that participants used religious symbols, idiomatic expression, and Biblical scriptures to interpret and make sense of their substance-use experiences. Participants drew on diverse religious and spiritual beliefs and practices, including participation in organized religion, reliance on a personal relationship with God, and God's will to cut down and stop cocaine use. Our findings suggest that culturally sensitive interventions addressing the influence of religion and spirituality in substance use are needed to reduce cocaine use and promote recovery in this at-risk, minority population.
Collapse
|
23
|
Borders TF, Stewart KE, Wright PB, Leukefeld C, Falck RS, Carlson RG, Booth BM. Risky sex in rural America: longitudinal changes in a community-based cohort of methamphetamine and cocaine users. Am J Addict 2013; 22:535-42. [PMID: 24131160 DOI: 10.1111/j.1521-0391.2013.12028.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 02/17/2012] [Accepted: 10/02/2012] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined the longitudinal associations between stimulant use and sexual behaviors. METHODS Data are from a 3-year community-based study of 710 rural stimulant users. Past 30-day crack cocaine, powder cocaine, and methamphetamine use and sexual behaviors (any sex, inconsistent condom use, and multiple sexual partners) were assessed through in-person interviews every 6 months. RESULTS GEE analyses revealed that the odds of having sex remained steady over time, with crack cocaine and methamphetamine use positively associated with having sex. The odds of multiple sexual partners declined, but the odds of inconsistent condom use remained steady over time. Crack cocaine use was positively associated with multiple sexual partners, whereas powder cocaine use was negatively associated with inconsistent condom use. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Many rural stimulant users could potentially benefit from safe sex educational programs. Such efforts could reduce the incidence of HIV and other STIs in rural America.
Collapse
Affiliation(s)
- Tyrone F Borders
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | | | | | | | | |
Collapse
|
24
|
Borders TF, Booth BM. Stimulant use trajectories and the longitudinal risk of heavy drinking: findings from a rural population-based study. Addict Behav 2012; 37:269-72. [PMID: 22112423 DOI: 10.1016/j.addbeh.2011.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 08/04/2011] [Accepted: 11/01/2011] [Indexed: 11/17/2022]
Abstract
The extant literature offers little information about the longitudinal course of alcohol use among stimulant users, particularly those in rural areas, but it is plausible that reductions in stimulant use are accompanied by increases in heavy drinking. The objective of this study was to examine the longitudinal relationships between heavy drinking days and latent trajectories of powder cocaine, crack cocaine, and methamphetamine use. Participants (n=710) were identified via Respondent-Driven Sampling in 3 rural communities in each of 3 states, with interviews conducted every 6 months over 3 years. Latent trajectory classes for powder cocaine, crack cocaine, and methamphetamine use were identified by conducting latent class growth analysis (LCGA). Generalized linear models (GLM) were conducted to examine how these latent classes were associated with the number of heavy drinking days in the past 30 days. Heavy drinking days did not significantly change over time when adjusting for covariates. Compared to those with a "fast low" trajectory of crack use, those with "steady high" and "declining" trajectories had more heavy drinking days. Compared to those with a "fast low" trajectory of powder cocaine use, those with a "steady moderate" trajectory had more heavy drinking days. Trajectories of methamphetamine use were not significantly associated with heavy drinking days. In conclusion, heavy alcohol use changes little over time among rural stimulant users. Many rural cocaine users could potentially benefit from interventions aimed at curtailing heavy drinking.
Collapse
Affiliation(s)
- Tyrone F Borders
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., #820, Little Rock, AR 72205-7199, United States.
| | | |
Collapse
|
25
|
Marshall BDL, Milloy MJ, Wood E, Galea S, Kerr T. Temporal and geographic shifts in urban and nonurban cocaine-related fatal overdoses in British Columbia, Canada. Ann Epidemiol 2012; 22:198-206. [PMID: 22266349 DOI: 10.1016/j.annepidem.2011.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/13/2011] [Accepted: 12/30/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Illicit drug overdose is a leading cause of premature mortality. We sought to examine fatal overdose trends from 2001 to 2005 in urban and nonurban areas of British Columbia, Canada. METHODS We conducted a review of all provincial coroner files in which drug overdose was the cause of death between January 1, 2001, and December 31, 2005. We compared cocaine and non-cocaine-related overdoses and examined temporal changes in cocaine-related mortality rates in urban and nonurban areas. Multilevel mixed effects models were used to determine the independent risk factors for cocaine-related death. Spatial analyses were conducted to identify clusters of these cases. RESULTS During the study period, 904 illicit drug overdoses were recorded, including 369 (40.8%) in nonurban areas and 532 (58.9%) related to cocaine consumption. In a multilevel model, we observed a significant interaction (p = .010) between population density and year, indicating a considerable and differential increase in the likelihood of cocaine-related deaths in nonurban areas. Cocaine-related deaths were clustered in the southeast region of the province. CONCLUSIONS Cocaine-related overdoses in nonurban areas should be a public health concern. Evidence-based interventions to reduce the risks associated with cocaine consumption and reach drug users in nonurban settings are needed.
Collapse
Affiliation(s)
- Brandon D L Marshall
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | | | | | | | | |
Collapse
|
26
|
Abstract
AIMS To assess the effectiveness of methamphetamine precursor regulations in reducing illicit methamphetamine supply and use. METHODS A systematic review of 12 databases was used to identify studies that had evaluated the impact of methamphetamine precursor regulations on methamphetamine supply and/or use. The guidelines of the Effective Practice and Organization of Care Group (EPOC) of The Cochrane Collaboration were used to determine which study designs were included and assess their quality. RESULTS Ten studies met the inclusion criteria. These studies evaluated 15 interventions (13 regulations and two related interdiction efforts), all of which were located in North America. Interventions had consistent impacts across various indicators of methamphetamine supply and use. Seven of the 15 interventions produced reductions in methamphetamine indicators (ranging from 12% to 77%). Two of the largest impacts were seen following interdiction efforts, involving the closure of rogue pharmaceutical companies. There was no evidence of a shift into other types of drug use, or injecting use, although the impact on the synthetic drug market was not examined. Null effects were related largely to the existence of alternative sources of precursor chemicals or the availability of imported methamphetamine. CONCLUSIONS Methamphetamine precursor regulations can reduce indicators of methamphetamine supply and use. Further research is needed to determine whether regulations can be effective outside North America, particularly in developing countries, and what impact they have on the broader synthetic drug market. Improved data on precursor diversion are needed to facilitate the evaluation of precursor regulations.
Collapse
Affiliation(s)
- Rebecca McKetin
- Centre for Mental Health Research, ANU College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australia.
| | | | | | | |
Collapse
|
27
|
Dias AC, Araújo MR, Dunn J, Sesso RC, de Castro V, Laranjeira R. Mortality rate among crack/cocaine-dependent patients: A 12-year prospective cohort study conducted in Brazil. J Subst Abuse Treat 2011; 41:273-8. [DOI: 10.1016/j.jsat.2011.03.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 02/28/2011] [Accepted: 03/28/2011] [Indexed: 11/30/2022]
|
28
|
Individual, social, and environmental factors associated with initiating methamphetamine injection: implications for drug use and HIV prevention strategies. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2011; 12:173-80. [PMID: 21274628 DOI: 10.1007/s11121-010-0197-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to determine the incidence and predictors of initiating methamphetamine injection among a cohort of injection drug users (IDU). We conducted a longitudinal analysis of IDU participating in a prospective study between June 2001 and May 2008 in Vancouver, Canada. IDU who had never reported injecting methamphetamine at the study's commencement were eligible. We used Cox proportional hazards models to identify the predictors of initiating methamphetamine injection. The outcome was time to first report of methamphetamine injection. Time-updated independent variables of interest included sociodemographic characteristics, drug use patterns, and social, economic and environmental factors. Of 1317 eligible individuals, the median age was 39.9 and 522 (39.6%) were female. At the study's conclusion, 200 (15.2%) participants had initiated injecting methamphetamine (incidence density: 4.3 per 100 person-years). In multivariate analysis, age (adjusted hazard ratio [aHR]: 0.96 per year older, 95%CI: 0.95-0.98), female sex (aHR: 0.58, 95%CI: 0.41-0.82), sexual abuse (aHR: 1.63, 95%CI: 1.18-2.23), using drugs in Vancouver's drug scene epicentre (aHR: 2.15 95%CI: 1.49-3.10), homelessness (aHR: 1.43, 95%CI: 1.01-2.04), non-injection crack cocaine use (aHR: 2.06, 95%CI: 1.36-3.14), and non-injection methamphetamine use (aHR: 3.69, 95%CI: 2.03-6.70) were associated with initiating methamphetamine injection. We observed a high incidence of methamphetamine initiation, particularly among young IDU, stimulant users, homeless individuals, and those involved in the city's open drug scene. These data should be useful for the development of a broad set of interventions aimed at reducing initiation into methamphetamine injection among IDU.
Collapse
|
29
|
Pope SK, Falck RS, Carlson RG, Leukefeld C, Booth BM. Characteristics of rural crack and powder cocaine use: gender and other correlates. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:491-6. [PMID: 21851207 DOI: 10.3109/00952990.2011.600380] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little is known about the relationship of gender with cocaine use in rural areas. This study describes these relationships among stimulant users residing in rural areas of Arkansas, Kentucky, and Ohio. OBJECTIVES Understanding the characteristics of crack and powder cocaine users in rural areas may help inform prevention, education, and treatment efforts to address rural stimulant use. METHODS Participants were 690 stimulant users, including 274 (38.6%) females, residing in nine rural counties. Cocaine use was measured by self-report of cocaine use, frequency of use, age of first use, and cocaine abuse/dependence. Powder cocaine use was reported by 49% of this sample of stimulant users and 59% reported using crack cocaine. FINDINGS Differing use patterns emerged for female and male cocaine users in this rural sample; females began using alcohol, marijuana, and cocaine at later ages than males but there were no gender differences in current powder cocaine use. Females reported more frequent use of crack cocaine and more cocaine abuse/dependence than males, and in regression analyses, female crack cocaine users had 1.8 times greater odds of reporting frequent crack use than male crack users. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE These findings suggest differing profiles and patterns of cocaine use for male and female users in rural areas, supporting previous findings in urban areas of gender-based vulnerability to negative consequences of cocaine use. Further research on cocaine use in rural areas can provide insights into gender differences that can inform development and refinement of effective interventions in rural communities.
Collapse
Affiliation(s)
- Sandra K Pope
- Division of Health Services, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | | | | | | | | |
Collapse
|
30
|
Dias AC, Vieira DL, Gomes LS, Araújo MR, Laranjeira R. Longitudinal Outcomes Among a Cohort of Crack Users After 12 Years from Treatment Discharge. J Addict Dis 2011; 30:271-80. [DOI: 10.1080/10550887.2011.581983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Andréa Costa Dias
- a National Institute on Alcohol and Drug Policies (INPAD), Department of Psychiatry , São Paulo Federal University , São Paulo, Brazil
| | - Denise Leite Vieira
- a National Institute on Alcohol and Drug Policies (INPAD), Department of Psychiatry , São Paulo Federal University , São Paulo, Brazil
| | - Luca Santoro Gomes
- a National Institute on Alcohol and Drug Policies (INPAD), Department of Psychiatry , São Paulo Federal University , São Paulo, Brazil
| | - Marcelo Ribeiro Araújo
- a National Institute on Alcohol and Drug Policies (INPAD), Department of Psychiatry , São Paulo Federal University , São Paulo, Brazil
| | - Ronaldo Laranjeira
- a National Institute on Alcohol and Drug Policies (INPAD), Department of Psychiatry , São Paulo Federal University , São Paulo, Brazil
| |
Collapse
|
31
|
Rudolph AE, Latkin C, Crawford ND, Jones KC, Fuller CM. Does respondent driven sampling alter the social network composition and health-seeking behaviors of illicit drug users followed prospectively? PLoS One 2011; 6:e19615. [PMID: 21573122 PMCID: PMC3089627 DOI: 10.1371/journal.pone.0019615] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 04/12/2011] [Indexed: 11/28/2022] Open
Abstract
Respondent driven sampling (RDS) was originally developed to sample and provide peer education to injection drug users at risk for HIV. Based on the premise that drug users' social networks were maintained through sharing rituals, this peer-driven approach to disseminate educational information and reduce risk behaviors capitalizes and expands upon the norms that sustain these relationships. Compared with traditional outreach interventions, peer-driven interventions produce greater reductions in HIV risk behaviors and adoption of safer behaviors over time, however, control and intervention groups are not similarly recruited. As peer-recruitment may alter risk networks and individual risk behaviors over time, such comparison studies are unable to isolate the effect of a peer-delivered intervention. This analysis examines whether RDS recruitment (without an intervention) is associated with changes in health-seeking behaviors and network composition over 6 months. New York City drug users (N = 618) were recruited using targeted street outreach (TSO) and RDS (2006–2009). 329 non-injectors (RDS = 237; TSO = 92) completed baseline and 6-month surveys ascertaining demographic, drug use, and network characteristics. Chi-square and t-tests compared RDS- and TSO-recruited participants on changes in HIV testing and drug treatment utilization and in the proportion of drug using, sex, incarcerated and social support networks over the follow-up period. The sample was 66% male, 24% Hispanic, 69% black, 62% homeless, and the median age was 35. At baseline, the median network size was 3, 86% used crack, 70% used cocaine, 40% used heroin, and in the past 6 months 72% were tested for HIV and 46% were enrolled in drug treatment. There were no significant differences by recruitment strategy with respect to changes in health-seeking behaviors or network composition over 6 months. These findings suggest no association between RDS recruitment and changes in network composition or HIV risk, which supports prior findings from prospective HIV behavioral surveillance and intervention studies.
Collapse
Affiliation(s)
- Abby E Rudolph
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
| | | | | | | | | |
Collapse
|
32
|
Kramer TL, Bell-Tolliver L, Tripathi SP, Booth BM. Stimulant use by young adult African Americans in a rural community: a pipeline to prison? Subst Use Misuse 2011; 46:716-27. [PMID: 21047150 PMCID: PMC3370429 DOI: 10.3109/10826084.2010.526981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The association between stimulant use and legal outcomes was examined in rural adults aged 18-21 years (n = 98) in the Mississippi River Delta of Arkansas from 2003 through 2008. Participants were interviewed at baseline and every 6 months for 2 years, using the Substance Abuse Outcomes Module, Addiction Severity Index, Short-Form 8 Health Survey, Brief Symptom Inventory, Patient Health Questionnaire depression screen, and an abbreviated antisocial personality disorder measure. More than three quarters were arrested before baseline; 47 were arrested over the next 2 years. Early arrest but not substance use was related to subsequent arrest. Limitations and implications for interventions are discussed.
Collapse
Affiliation(s)
- Teresa L Kramer
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
| | | | | | | |
Collapse
|
33
|
Kramer TL, Booth BM, Han X. Two-year trajectory of stimulant use in 18- to 21-year-old rural African Americans. Subst Abus 2010; 31:12-23. [PMID: 20391266 DOI: 10.1080/08897070903442509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little is known about stimulant use trajectories of rural African American youth. The purpose of the present study is to explore substance use over 24 months in 98 African Americans, ages 18 to 21, who used cocaine or methamphetamine 30 days prior to baseline. The majority was male, unemployed, and had not graduated from high school. At baseline, almost half of the participants met criteria for abuse/dependence of cocaine--the primary stimulant used--which decreased to 25% by the final follow-up. Similar decreases were noted in rates of alcohol and marijuana abuse/dependence, although monthly use remained high. Participants reported minimal utilization of mental health or substance abuse services, but demonstrated significant improvements on physical and mental health measures. In summary, cocaine use declined, but other substances were used at high rates, suggesting a significant need for intervention services that address multisubstance use in rural areas.
Collapse
Affiliation(s)
- Teresa L Kramer
- Division of Health Services Research, Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas 72205, USA.
| | | | | |
Collapse
|
34
|
Booth BM, Curran G, Han X, Wright P, Frith S, Leukefeld C, Falck R, Carlson RG. Longitudinal relationship between psychological distress and multiple substance use: results from a three-year multisite natural-history study of rural stimulant users. J Stud Alcohol Drugs 2010; 71:258-67. [PMID: 20230724 PMCID: PMC2841737 DOI: 10.15288/jsad.2010.71.258] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 06/24/2009] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Substance use is associated with poor mental health, but little is known regarding how use of multiple substances is associated with mental health, particularly longitudinally, in community studies. This article examines this issue in a large (N = 710), natural-history study of rural stimulant (cocaine and/or methamphetamine) users in three states. METHOD Respondent-driven sampling recruited recent (past-30-day) stimulant users in three counties each in Arkansas, Kentucky, and Ohio. Participants were interviewed every 6 months for 3 years. Mental health was measured by the Brief Symptom Inventory, and prior 6 months' substance use was measured for 17 possible substances. Data analysis used generalized estimating equations for longitudinal data with the Global Severity Index of the Brief Symptom Inventory as the dependent variable at each interview and substance use as predictor variables measured by number of substances used in the past 6 months and, separately, the 17 individual substances, adjusting for use of substance-use treatment, demographics, and recruitment site. RESULTS On average, both Global Severity Index score and use of many substances declined over the course of study. Global Severity Index score was significantly associated with (a) greater number of substances used in the past 6 months (p < .0001) and (b) use of crack cocaine, methamphetamine, and nonprescription use of prescription painkillers and tranquilizers. CONCLUSIONS Multiple and specific substances appear to incrementally increase psychological distress. Users of cocaine and methamphetamine are present in rural areas; these associations with poor psychological health raise concerns regarding availability of local treatment services for individuals with mental-health problems, as well as substance abuse.
Collapse
Affiliation(s)
- Brenda M. Booth
- Department of Psychiatry, Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 755, Little Rock, Arkansas 72205
| | - Geoffrey Curran
- Department of Psychiatry, Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 755, Little Rock, Arkansas 72205
| | | | - Patricia Wright
- Department of Psychiatry, Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 755, Little Rock, Arkansas 72205
| | - Sarah Frith
- Department of Psychiatry, Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 755, Little Rock, Arkansas 72205
| | - Carl Leukefeld
- Department of Psychiatry, Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 755, Little Rock, Arkansas 72205
| | - Russel Falck
- Department of Psychiatry, Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 755, Little Rock, Arkansas 72205
| | - Robert G. Carlson
- Department of Psychiatry, Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 755, Little Rock, Arkansas 72205
| |
Collapse
|
35
|
Borders TF, Booth BM, Falck RS, Leukefeld C, Wang J, Carlson RG. Longitudinal changes in drug use severity and physical health-related quality of life among untreated stimulant users. Addict Behav 2009; 34:959-64. [PMID: 19560873 DOI: 10.1016/j.addbeh.2009.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 05/19/2009] [Accepted: 06/01/2009] [Indexed: 12/22/2022]
Abstract
The primary objective of this study was to investigate whether drug use severity is associated with physical health-related quality of life (HRQL) over time. Data are from a longitudinal, multi-state, natural history community study of users of cocaine and/or methamphetamine who were interviewed at 6-month intervals over 2 years with a 79% follow-up participation rate. Physical HRQL was assessed with the physical component summary (PCS) of the SF-8 Health Survey and drug, alcohol, and psychiatric severity were all assessed with the Addiction Severity Index (ASI). Random coefficient regression analyses were conducted to test for longitudinal associations between the independent variables and SF-8 PCS scores. Reductions in drug use severity over time were accompanied by only minor improvements in SF-8 PCS scores, underscoring the potential long-term harm of illicit drug use on physical health. Greater psychiatric severity was strongly associated with lower SF-8 PCS scores, suggesting that clinical attention to mental health issues could potentially lead to improvements in perceived physical health as well as among stimulant users.
Collapse
Affiliation(s)
- Tyrone F Borders
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, United States.
| | | | | | | | | | | |
Collapse
|
36
|
Timmermans S, McKay T. Clinical trials as treatment option: bioethics and health care disparities in substance dependency. Soc Sci Med 2009; 69:1784-90. [PMID: 19819059 DOI: 10.1016/j.socscimed.2009.09.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Indexed: 10/20/2022]
Abstract
Bioethicists have warned against the dangers of mixing research with treatment. They are concerned that research priorities may take precedence over individual patient needs and that research subjects tend to misunderstand the purpose of research or overestimate the direct medical benefits of participating in studies. Yet, other work has questioned whether clinical research can always be separated from therapeutic benefit for participants. Using in-depth interviews with participants in two phase III randomized U.S. clinical trials for methamphetamine dependency, we examine the treatment options available to participants, their experiences with participating in the trials, and potential problems of trial participation. We find that while participants have experience with four alternative treatment modalities - quitting alone, support groups, in-patient treatment facilities, and consulting primary care physicians - the randomized clinical trials compare favorably to alternatives because they provide access to evidence-based behavioral treatments, specialized medical professionals, non-judgmental staff, and the possibility of receiving an experimental drug. We conclude that while randomized clinical trials are imperfect substitutes for clinical care, they constitute a fragile and sporadic therapeutic niche in a country with fundamental problems in access to health care, a mixed punitive-therapeutic drug addiction policy, and a profit-driven pharmaceutical development and approval process.
Collapse
Affiliation(s)
- Stefan Timmermans
- UCLA, Department of Sociology, Los Angeles, CA 90095-1551, United States.
| | | |
Collapse
|