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Darke S, Farrell M, Duflou J, Lappin J. Chronic obstructive pulmonary disease in heroin users: An underappreciated issue with clinical ramifications. Addiction 2024; 119:1153-1155. [PMID: 38069491 DOI: 10.1111/add.16407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/09/2023] [Indexed: 06/07/2024]
Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, New South Wales, Australia
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, New South Wales, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Julia Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Kensington, New South Wales, Australia
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van Hest N, Brothers TD, Williamson A, Lewer D. Health-care resource use among patients who use illicit opioids in England, 2010-20: A descriptive matched cohort study. Addiction 2024; 119:730-740. [PMID: 38049387 DOI: 10.1111/add.16401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 09/27/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND AND AIMS People who use illicit opioids have higher mortality and morbidity than the general population. Limited quantitative research has investigated how this population engages with health-care, particularly regarding planned and primary care. We aimed to measure health-care use among patients with a history of illicit opioid use in England across five settings: general practice (GP), hospital outpatient care, emergency departments, emergency hospital admissions and elective hospital admissions. DESIGN This was a matched cohort study using Clinical Practice Research Datalink and Hospital Episode Statistics. SETTING Primary and secondary care practices in England took part in the study. PARTICIPANTS A total of 57 421 patients with a history of illicit opioid use were identified by GPs between 2010 and 2020, and 172 263 patients with no recorded history of illicit opioid use matched by age, sex and practice. MEASUREMENTS We estimated the rate (events per unit of time) of attendance and used quasi-Poisson regression (unadjusted and adjusted) to estimate rate ratios between groups. We also compared rates of planned and unplanned hospital admissions for diagnoses and calculated excess admissions and rate ratios between groups. FINDINGS A history of using illicit opioids was associated with higher rates of health-care use in all settings. Rate ratios for those with a history of using illicit opioids relative to those without were 2.38 [95% confidence interval (CI) = 2.36-2.41] for GP; 1.99 (95% CI = 1.94-2.03) for hospital outpatient visits; 2.80 (95% CI = 2.73-2.87) for emergency department visits; 4.98 (95% CI = 4.82-5.14) for emergency hospital admissions; and 1.76 (95% CI = 1.60-1.94) for elective hospital admissions. For emergency hospital admissions, diagnoses with the most excess admissions were drug-related and respiratory conditions, and those with the highest rate ratios were personality and behaviour (25.5, 95% CI = 23.5-27.6), drug-related (21.2, 95% CI = 20.1-21.6) and chronic obstructive pulmonary disease (19.4, 95% CI = 18.7-20.2). CONCLUSIONS Patients who use illicit opioids in England appear to access health services more often than people of the same age and sex who do not use illicit opioids among a wide range of health-care settings. The difference is especially large for emergency care, which probably reflects both episodic illness and decompensation of long-term conditions.
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Affiliation(s)
- Naomi van Hest
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Thomas D Brothers
- Department of Epidemiology and Public Health, University College London, London, UK
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - Andrea Williamson
- School of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, UK
| | - Dan Lewer
- Department of Epidemiology and Public Health, University College London, London, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Harris M, Scott J, Hope V, Busza J, Sweeney S, Preston A, Southwell M, Eastwood N, Vuckovic C, McGaff C, Yoon I, Wilkins L, Ram S, Lord C, Bonnet P, Furlong P, Simpson N, Slater H, Platt L. Safe inhalation pipe provision (SIPP): protocol for a mixed-method evaluation of an intervention to improve health outcomes and service engagement among people who use crack cocaine in England. Harm Reduct J 2024; 21:19. [PMID: 38263202 PMCID: PMC10804795 DOI: 10.1186/s12954-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Over 180,000 people use crack cocaine in England, yet provision of smoking equipment to support safer crack use is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply, leading to pipe sharing and injuries from use of unsafe materials. This increases risk of viral infection and respiratory harm among a marginalised underserved population. International evaluations suggest crack pipe supply leads to sustained reductions in pipe sharing and use of homemade equipment; increased health risk awareness; improved service access; reduction in injecting and crack-related health problems. In this paper, we introduce the protocol for the NIHR-funded SIPP (Safe inhalation pipe provision) project and discuss implications for impact. METHODS The SIPP study will develop, implement and evaluate a crack smoking equipment and training intervention to be distributed through peer networks and specialist drug services in England. Study components comprise: (1) peer-network capacity building and co-production; (2) a pre- and post-intervention survey at intervention and non-equivalent control sites; (3) a mixed-method process evaluation; and (4) an economic evaluation. Participant eligibility criteria are use of crack within the past 28 days, with a survey sample of ~ 740 for each impact evaluation survey point and ~ 40 for qualitative process evaluation interviews. Our primary outcome measure is pipe sharing within the past 28 days, with secondary outcomes pertaining to use of homemade pipes, service engagement, injecting practice and acute health harms. ANTICIPATED IMPACT SIPP aims to reduce crack use risk practices and associated health harms; including through increasing crack harm reduction awareness among service providers and peers. Implementation has only been possible with local police approvals. Our goal is to generate an evidence base to inform review of the legislation prohibiting crack pipe supply in the UK. This holds potential to transform harm reduction service provision and engagement nationally. CONCLUSION People who smoke crack cocaine in England currently have little reason to engage with harm reduction and drug services. Little is known about this growing population. This study will provide insight into population characteristics, unmet need and the case for legislative reform. TRIAL REGISTRATION ISRCTN12541454 https://doi.org/10.1186/ISRCTN12541454.
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Affiliation(s)
- Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Jenny Scott
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
| | - Vivian Hope
- Public Health Institute/School of Public and Allied Health, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool, L2 2QP, UK
| | - Joanna Busza
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sedona Sweeney
- Department of Global Health and Development, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Andrew Preston
- Exchange Supplies, 1 Great Western Industrial Centre, Dorchester, Dorset, DT1 1, UK
| | | | | | - Cedomir Vuckovic
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Caitlynne McGaff
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Ian Yoon
- Department of Global Health and Development, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Louise Wilkins
- The Health Shop, 12 Broad Street, Nottingham, NG1 3AL, UK
| | - Shoba Ram
- The Maples, Verona House, 53 Filwood Rd, Bristol, BS16 3RX, UK
| | - Catherine Lord
- Bristol Drugs Project, 11 Brunswick Square, St Paul's, Bristol, BS2 8PE, UK
| | - Philippe Bonnet
- The Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK
| | - Peter Furlong
- Change Grow Live, 34 Albion Place, Leeds, LS1 6JH, UK
| | | | - Holly Slater
- POW Nottingham, 16 Independent Street, Nottingham, NG7 3LN, UK
| | - Lucy Platt
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Underner M, Perriot J, Peiffer G, Brousse G, Jaafari N. [Bronchial diseases and heroin use. A systematic review]. Rev Mal Respir 2023; 40:783-809. [PMID: 37925326 DOI: 10.1016/j.rmr.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/11/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION Heroin use can cause respiratory complications including asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis (BD). OBJECTIVES A general review of the literature presenting the data on the relationships between heroin consumption and bronchial complications, while underlining the difficulties of diagnosis and management. DOCUMENTARY SOURCES Medline, 1980-2022, keywords "asthma" or "bronchospasm" or "COPD" or "bronchiectasis" and "heroin" or "opiate" or "opiates", with limits pertaining to "Title/Abstract". Concerning asthma, 26 studies were included, as were 16 for COPD and 5 for BD. RESULTS Asthma and COPD are more prevalent among heroin addicts, who are less compliant than other patients with their treatment. The authors found a positive association between frequency of asthma exacerbations, admission to intensive care and heroin inhalation. Late diagnosis of COPD worsens the course of the disease; emphysema and BD are poor prognostic factors. CONCLUSION Bronchial diseases in heroin users can be identified by means of respiratory function exploration and chest CT scans. These tests should be performed frequently in view of optimizing their care, which includes their weaning themselves from addictive substances.
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Affiliation(s)
- M Underner
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - J Perriot
- Dispensaire Émile-Roux, CLAT, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - G Brousse
- Service d'addictologie, CHU de Clermont-Ferrand, université Clermont Auvergne, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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