Physical health, illicit drug use, and demographic characteristics in rural stimulant users

HIV Prevalence and Associated Risks in a Respondent-Driven Sample of Illicit Stimulant Users in a Southern United States City

Stimulant abuse is a major contributor to HIV transmission in the United States, yet HIV prevalence among persons who use illicit stimulants remains unknown. We implemented respondent driven sampling (RDS) to estimate the prevalence of HIV infection in this high-risk population. We also examined RDS-adjusted rates of risk behaviors among HIV-positive and HIV-negative participants. Recruited from seven seeds, our sample of 387 participants was 46% female, 89% African American, and 45.94 years old on average. Participants were predominantly non-injection cocaine users, had large networks of stimulant users, and reported an established relationship with their recruiter. The adjusted population proportion of HIV infection was 0.07 (0.04, 0.11). The majority of sexually active participants reported engagement in risk behaviors (73%), but rates generally did not differ by HIV status. Our results highlight that stimulant use is a risk factor for HIV infection. This study also demonstrates that RDS is a very effective strategy for reaching stimulant users in the community.

Modeling Body-Mind-Spirit Well-Being and the Possibility of Relapse Intention in Adults Who Have a History of Substance Use in Taiwan

BACKGROUND: Substance use is a global mental health issue. There has been limited research exploring the relationships among body, mind, and spirit well-being and the possibility of relapse across different categories of substance users. AIMS: The purpose of the current path analysis was to examine the relationship between body-mind-spirit well-being and the possibility of relapse intention as well as other relevant predictors in people who had a history of substance use. METHODS: A cross-sectional survey was used. Participants were recruited in Southern Taiwan between December 2015 and June 2016. Data were collected from 467 participants who had a history of using controlled substances. RESULTS: Path analysis results revealed that body-mind-spirit well-being was negatively predictive of the possibility of relapse intention. Out of several predictors, stress influence and duration of substance use had direct effects on body-mind-spirit well-being and the possibility of relapse intention, respectively. Stress influence and duration of substance use were associated with decreased body-mind-spirit well-being and increased relapse intention scores. In addition, no history of health problems and male gender were associated with increased body-mind-spirit well-being. CONCLUSIONS: Stress management and the duration of substance use play an important role in body-mind-spirit well-being and relapse intention in people with a history of substance use. Health care professionals could teach substance users coping strategies to address their stress and problems, which may improve their health and reduce the possibility of relapse intention.

Comparing the Differences in Health of Body, Mental, and Spirit Among Category 3 and 4 Controlled Drug Users, Nursing Students, and Psychology Students

Drug abuse adversely affects the health of populations in many counties and contributes immensely to social issues. Schedule III and IV controlled drug abuse is popular in young adults. Medical education is one of the most stressful academic fields for students. The aim of this study was to compare the health differences in body, mind, and spirit among Schedule III and IV controlled drugs users, nursing students, and psychology students. This study uses a cross-sectional comparative study on a convenience sample. Four hundred eleven participants were recruited from three different samples that include Schedule III and IV controlled drug users (n = 211), nursing students (n = 100), and psychology students (n = 100), all from either a drug abuse prevention center or two universities in Southern Taiwan. Relying on the Health of Body, Mind and Spirit Scale, a linear regression model was used to identify the health differences among drug users, nursing students, and psychology students. The results show that drug users scored higher on the physical subscale (ß = -.249, p < .001), the mental subscale (ß = -.120, p < .05), the spiritual subscale (ß = -.154, p < .01), and the Health of Body, Mind and Spirit Scale (ß = -.210, p < .001) than psychology students. The nursing students scored higher on the mental subscale (ß = .146, p < .01) than drug users did. These results could help health staff and instructors understand the differences and improve the physical, mental, and spiritual health among Schedule III and IV controlled drug users, nursing students, and psychology students. Furthermore, future study could further investigate the factors that may affect physical, mental, and spiritual health.

Baseline medical comorbidities in adults randomized in the STRIDE trial for psychostimulant use disorders

BACKGROUND AND OBJECTIVES

Rates of medical illnesses may be higher among individuals with substance use disorders, complicating their care. This study aimed to expand the understanding of other medical conditions in treatment-seeking adults with stimulant use disorder (SUD) using data from Stimulant Reduction Intervention using Dose Exercise (STRIDE), a randomized, multisite trial investigating exercise augmentation of treatment as usual.

METHODS

Utilizing STRIDE baseline data, we examined demographic and clinical characteristics based on the number of self-reported diagnosed medical conditions among participants meeting eligibility criteria (passing medical screening exam and maximal exercise test, non-opioid dependent, no concomitant beta blocker, or opioid replacement therapy).

RESULTS

The majority (59%) of study participants (N = 302, mean age all participants = 39 years) did not report any history of other medical problems. Those with two or more conditions were older (mean age 46 years), reported more pain and worse physical functioning, and more psychiatric disorders (average 1.44). Hypertension was more common among participants with cocaine use disorders only (present in 16%) and liver disease was more common in those with cocaine plus other stimulant use disorders (present in 7%).

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

In this sample, patients with SUD were in surprisingly good health. A subpopulation had an overall higher burden of illness with worsened physical and psychiatric functioning. Provision of coordinated care may optimize treatment outcomes for patients based on medical comorbidity burden as well as type of drug abused, although these conclusions should be considered preliminary as they are based on self-reported data.

Days with pain and substance use disorders: is there an association?

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.

Current interventions to reduce sexual risk behaviors and crack cocaine use among HIV-infected individuals

The dual global epidemics of crack cocaine use and HIV have resulted in a large number of people living with HIV who use crack cocaine, many of whom continue to engage in unprotected sex. Crack use also increases the rate of HIV progression. Consequently, there is an urgent need for effective interventions to decrease crack use and unprotected sex and to improve antiretroviral therapy (ART) adherence in this population. This article reviews the recent published literature on interventions for reducing crack use and unprotected sex among people living with HIV. Only a few intervention outcome studies targeting exclusively HIV positive crack cocaine users were identified, whereas other studies used a mixed sample. Some interventions focused on reducing crack use and several focused on reducing sex-risk behaviors. Consequently, there is a critical need for efficacious interventions that address crack use, risky sex and ART adherence among people living with HIV.

Prevalence and correlates for nonmedical use of prescription opioids among urban and rural residents

BACKGROUND

In the United States, rural areas have reported an increase in overdose deaths secondary to nonmedical use of prescription opioids. Little is known about the differences in nonmedical use of prescription opioids among urban and rural adults.

METHODS

Using the 2008-2009 National Survey on Drug Use and Health, we examined the prevalence of nonmedical use of prescription opioids in urban and rural counties and determined bivariate and multivariate associations, stratified by county. We also compared type of opioids, stratified by county.

RESULTS

Among 75,964 respondents, the prevalence of nonmedical use of prescriptions opioids was similar among residents in urban and rural counties (4.7% vs. 4.3%, p=0.15). Urban and rural residents with severe psychological distress and nonmedical use of other prescription medications were more likely to report nonmedical use of opioids. Urban residents whose first use of illicit drugs was between the age of 18 and 25 and who reported alcohol use were more likely to report nonmedical use. Black and Hispanic urban residents were less likely to use prescription opioids nonmedically compared to white urban residents. Rural residents were more likely than urban residents to use acetaminophen with propoxyphene (61.1% vs. 55.8%, p=0.02), methadone (14.8% vs. 9.1%, p=0.003) and acetaminophen with codeine (3.5% vs. 1.9%, p=0.05).

CONCLUSIONS

Prevalence and risk factors related to nonmedical use of opioids are similar between urban and rural residents; however rural residents report propoxyphene, codeine, and methadone use more than their urban counterparts. Prevention and treatment interventions may need to be tailored for specific communities.

Alcohol and drug use among patients presenting to an inner-city emergency department: a latent class analysis

The inner city Emergency Department (ED) provides a window of opportunity for screening for alcohol and other drug misuse and substance use disorders (SUDs), in order to facilitate linkage for individuals who are in need of services targeting such issues. The majority of prior work in this area has focused on alcohol use. This study used latent class analyses to characterize substance use/SUDs among adults presenting to the ED for medical complaints or injuries. Participants (n=14,557; 77% participation; 45% male; 54% African-American) completed a computerized survey assessing demographics, health functioning, and substance use/SUDs. Although injured patients were significantly more likely to use tobacco, alcohol, and marijuana, and were more likely to have an alcohol use disorder, presenting complaint was not related to other drug use/diagnoses. Five latent classes were identified: (1) low users/SUDs (65.9%) (2) binge drinkers (24.3%), (3) marijuana users/SUD (3.5%), (4) cocaine users/SUD (2.9%), and (5) poly-drug users (3.3%). Compared to class 1, participants in the other classes were younger, male, without health insurance, with poor mental health functioning, tobacco users, and had prior substance use treatment. African-Americans were most likely to be in classes 3 or 4 and employed participants were most likely to be in class 2. In comparison to class 1, classes 2 and 3 reported better physical health; class 2 was more likely to present for injury whereas class 5 was more likely to present for a medical complaint. ED-based screening and interventions approaches need to address the co-occurrence of alcohol, illicit drug, and psychoactive prescription drug use.

Predictors of depressive symptomatology among rural stimulant users

This study examined sociodemographic and drug-related predictors of depressive symptoms among a rural, multistate sample of not-in-treatment stimulant drug users (n=710). Participants were recruited using respondent-driven sampling in Ohio, Arkansas, and Kentucky. The Patient Health Questionnaire (PHQ-9) was used to measure symptoms of depression. Moderate to severe depressive symptomatology was reported by 43.0% of the sample. Cumulative logistic regression analysis showed that daily and nondaily crack use as well as the daily use of cocaine HCl increased the odds of depressive symptoms. Methamphetamine use had no significant association with depression. The daily use of marijuana, the illicit use of tranquilizers, light/moderate cigarette smoking, and injection drug use also increased the risk of depressive symptoms. Living in Kentucky or Ohio (compared to Arkansas), having unstable living arrangements, and being White, female, and older were related to higher odds of depressive symptoms. These results suggest that a host of drug and nondrug factors need to be considered when addressing depressive symptoms in stimulant users.

Evaluation of a Community Approach to Address Substance Abuse in Appalachia

The purpose of this study was to evaluate a conference based program designed to enable 26 Appalachian teams to create intervention plans to address substance abuse in their communities. In March 2006, 26 Appalachian teams attended a conference to address substance abuse in their region. Teams of four to seven stakeholders generated community plans. The teams were evaluated 8 months later using a framework based on an adaptation of the Health Belief Model. Team leaders participated in structured telephone interviews. Results of this study found that the most common benefit to promulgating plans was community support. The most indicated barrier was time. The majority of teams believed that their community was susceptible to substance abuse problems. The cues that were most responsible for action were public awareness campaigns that emphasized the problems associated with substance abuse. The common denominator for team success was the ability to recruit key stakeholders and the ability to integrate with other organizations. The results of this study suggest that substance abuse is a threat to the health of the region. More effort on the part of communities will be needed to solve this problem. It will not be solved by a single agency, philosophy or program strategy, but must include multiple stakeholder participation.

What makes a respondent-driven sampling "seed" productive? Example of finding at-risk Massachusetts men who have sex with men

Several recent studies have sought to elaborate upon the applicability and validity of respondent-driven sampling (RDS) to find hard-to-reach samples in general and men who have sex with men (MSM) in particular. Few published studies have elucidated the characteristics associated with initial RDS participants ("seeds") who successfully recruited others into a study. A total of 74 original seeds were analyzed from four Massachusetts studies conducted between 2006 and 2008 that used RDS to reach high-risk MSM. Seeds were considered "generative" if they recruited two or more subsequent participants and "non-generative" if they recruited zero or one participant. Overall, 34% of seeds were generative. In separate multivariable logistic regression models controlling for age, race, health insurance, HIV status, and the study for which the seed was enrolled, unprotected anal sex in the past 12 months [adjusted odds ratio (AOR) = 6.68; 95% confidence interval (95% CI) = 1.27-35.12; p = 0.03], cocaine use during sex at least monthly during the past 12 months (AOR = 8.81; 95% CI = 1.68-46.27; p = 0.01), and meeting sex partners at social gatherings (AOR = 7.42; 95% CI = 1.58-34.76; p = 0.01) and public cruising areas (AOR = 4.92; 95% CI = 1.27-19.01; p = 0.02) were each significantly associated with increased odds of being a generative seed. These findings have methodological and practical implications for the recruitment of MSM via RDS. Finding ways to identify RDS seeds that are consistently generative may facilitate collecting a sample that is closer to reflecting the MSM who live in all of the communities in a given location or study sample.

Longitudinal changes in drug use severity and physical health-related quality of life among untreated stimulant users

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.

The impact of cigarette smoking on stimulant addiction

OBJECTIVES

Stimulant users smoke cigarettes at high rates; however, little is known about the relationship between tobacco and stimulants.

METHODS

Our goal in this article is to synthesize a growing literature on the role of cigarette smoking in stimulant addiction.

RESULTS

Early nicotine exposure may influence the development of stimulant addiction. Preclinical and clinical studies suggest a facilitatory role of nicotinic agonists for stimulant addiction. Smoking appears to be associated with more severe stimulant use and poorer treatment outcomes.

CONCLUSIONS

It is important to assess smoking and smoking-related variables within stimulant research studies to more fully understand the comorbidity. Integrating smoking cessation into stimulant treatment may improve nicotine and stimulant treatment outcomes.

Impaired physical health among methamphetamine users in comparison with the general population: the role of methamphetamine dependence and opioid use

AIM

To examine the extent of physical health impairment among a community sample of methamphetamine users in comparison with the general population, and factors associated with impairment among this group.

METHOD

A cross-sectional survey of 309 regular methamphetamine users from Sydney. The Physical Component Scale of the Short Form 12 (SF-12) was used to measure impairment in physical health (score < 40). Age-matched general population data for the SF-12 were derived from the Australian National Survey of Mental Health and Well-Being.

RESULTS

Participants had a higher prevalence of impaired physical health compared to the Australian general population (20% vs. 10%, p<0.05), but this effect occurred among only dependent methamphetamine users over 24 years of age (25 - 34 years, 23% vs. 10%; 35 - 44 years, 41% vs. 12%). Methamphetamine dependence remained significantly predictive of impaired physical health after adjusting for age and other confounding factors. Opioid pharmacotherapy was also related strongly to poor physical health, accounting for 63% of participants with physical impairment. Other factors associated with impaired physical health were being female, having less than 10 years of schooling, and having been diagnosed previously with an anxiety disorder (p<0.05).

CONCLUSION

Methamphetamine users are more likely to report impaired physical health than the general population, but this impairment is specific to older methamphetamine users who are dependent on the drug, particularly those who are enrolled in opioid pharmacotherapy.