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Barriers to treatment for mental disorders in six countries of the Americas: A regional report from the World Mental Health Surveys. J Affect Disord 2022; 303:273-285. [PMID: 35176342 DOI: 10.1016/j.jad.2022.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mental health treatment is scarce and little resources are invested in reducing the wide treatment gap that exists in the Americas. The regional barriers are unknown. We describe the barriers for not seeking treatment among those with mental and substance use disorders from six (four low- and middle-income and two high-income) countries from the Americas. Regional socio-demographic and clinical correlates are assessed. METHODS Respondents (n = 4648) from seven World Mental Health surveys carried out in Argentina, Brazil, Colombia, Mexico, Peru, and the United States, who met diagnostic criteria for a 12-month mental disorder, measured with the Composite International Diagnostic Interview, and who did not access treatment, were asked about treatment need and, among those with need, structural and attitudinal barriers. Country-specific deviations from regional estimates were evaluated through logistic models. RESULTS In the Americas, 43% of those that did not access treatment did not perceive treatment need, while the rest reported structural and attitudinal barriers. Overall, 27% reported structural barriers, and 95% attitudinal barriers. The most frequent attitudinal barrier was to want to handle it on their own (69.4%). Being female and having higher severity of disorders were significant correlates of greater perceived structural and lower attitudinal barriers, with few country-specific variations. LIMITATIONS Only six countries in the Americas are represented; the cross-sectional nature of the survey precludes any causal interpretation. CONCLUSIONS Awareness of disorder or treatment need in various forms is one of the main barriers reported in the Americas and it specially affects persons with severe disorders.
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Silva LD, Strobbe S, Oliveira JLD, Almeida LYD, Cardano M, Souza JD. Social support networks of users of crack cocaine and the role of a Brazilian health program for people living on the street: A qualitative study. Arch Psychiatr Nurs 2021; 35:526-533. [PMID: 34561069 DOI: 10.1016/j.apnu.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/13/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
This cross-sectional qualitative study analyzed characteristics of social support for users of crack cocaine and the role of "Consultório na Rua" (CR), or "Office in the Street," a Brazilian program for people living on the street. Data were collected using 1) ethnographic field observations during the delivery of services from this program, 2) in-depth interviews with 17 users of crack cocaine, and 3) a focus group with professionals from CR. To analyze data, we used content analysis and analytical categories based on Social Network Analysis (SNA) theoretical statements. Results showed that family, peers, community members, and professionals from CR were the main social support providers. Participants mentioned receiving material, informational, and emotional support from CR members. It was observed that CR had a welcoming and inclusive approach, but CR team members identified challenges related to stigma directed toward people who use substances and live on the street. CR assumed a central role in the health and social assistance of users of crack cocaine living on the street, providing an important link to healthcare and social services. However, initiatives related to motivation to receive mental health services, treatment, or social reintegration were not observed in conjunction with this program.
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Affiliation(s)
- Lucas Duarte Silva
- University of São Paulo at Ribeirão Preto College of Nursing, 3900, Bandeirantes Avenue, 14040-902 Ribeirão Preto, SP, Brazil
| | - Stephen Strobbe
- University of Michigan School of Nursing 426, North Ingalls, Ann Arbor, MI 48109-2003, United States of America
| | - Jaqueline Lemos de Oliveira
- University of São Paulo at Ribeirão Preto College of Nursing, 3900, Bandeirantes Avenue, 14040-902 Ribeirão Preto, SP, Brazil
| | - Letícia Yamawaka de Almeida
- University of São Paulo at Ribeirão Preto College of Nursing, 3900, Bandeirantes Avenue, 14040-902 Ribeirão Preto, SP, Brazil.
| | - Mario Cardano
- Università degli Studi di Torino, Dipartimento di Culture Politica e Società, Lungo Dora Siena 62, 10153 Torino, Italy
| | - Jacqueline de Souza
- University of São Paulo at Ribeirão Preto College of Nursing, 3900, Bandeirantes Avenue, 14040-902 Ribeirão Preto, SP, Brazil
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Ribeiro M, Frajzinger R, Ogata Perrenoud L, Fischer B. Examining a migration-based phenomenon of heroin use in an urban drug scene in Sao Paulo, Brazil. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2021. [DOI: 10.1108/ijmhsc-06-2020-0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Brazil’s street-based drug use is mostly characterized by non-injection psychostimulant (e.g. crack-cocaine) drug use in Brazil, with limited interventions and service availability. Recently, an influx of multi-ethnic migrants within an urban drug scene in Sao Paulo was associated with heroin use, a drug normatively absent from Brazil. The purpose of this paper is to characterize and compare heroin use-related characteristics and outcomes for an attending sub-sample of clients from a large community-based treatment centre (“CRATOD”) serving Sao Paulo’s local urban drug scene.
Design/methodology/approach
All non-Brazilian patients (n = 109) receiving services at CRATOD for 2013–2016 were identified from patient files, divided into heroin users (n = 40) and non-heroin users (n = 69). Based on chart reviews, select socio-demographic, drug use and health status (including blood-borne-virus and other infections per rapid test methods) were examined and bi-variately compared. Multi-variate analyses examined factors independently associated with heroin use.
Findings
Most participants were male and middle-aged, poly-drug users and socio-economically marginalized. While heroin users primarily originated from Africa, they reported significantly more criminal histories, drug (e.g. injection) and sex-risk behaviors and elevated rates of BBV (e.g. Hepatitis C Virus and HIV). A minority of heroin users attending the clinic was provided methadone treatment, mostly for detoxification.
Originality/value
This study documented information on a distinct sample of mostly migration-based heroin users in Sao Paulo, Brazil. Based on the local experience, global migration dynamics can bring changes to established drug use cultures and services, including new challenges for drug use-related related behaviors and therapeutic interventions that require effective understanding and addressing.
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Benzano D, Ornell F, Schuch JB, Pechansky F, Sordi AO, von Diemen L, Kessler FHP. Clinical vulnerability for severity and mortality by COVID-19 among users of alcohol and other substances. Psychiatry Res 2021; 300:113915. [PMID: 33836472 PMCID: PMC8011305 DOI: 10.1016/j.psychres.2021.113915] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/27/2021] [Indexed: 12/26/2022]
Abstract
The COVID-19 pandemic is a public health emergency. Individuals with substance use disorder have a higher risk of infection and may suffer from more severe forms of the disease. Our goal is to investigate the prevalence of risk factors for COVID-19 severity in individuals with different substance use and explore whether specific types of substance are potentially associated with more clinical risk factors which could increase morbimortality in this population. The sample included 821 men hospitalized at an inpatient Addiction unit (305 alcohol users, 233 cocaine/crack users, and 283 multiusers). Data were collected using the Addiction Severity Index version 6. The most prevalent risk factors for COVID-19 severity observed in our sample were: smoking (82.5%), arterial hypertension (26.6%), respiratory problems (23.4%), and history of homelessness (25.1%). Arterial hypertension and cirrhosis occurred more frequently among alcohol users. Multiusers lived in the streets longer and had a higher prevalence of HIV than alcohol users. Overall, 28% of the sample had three or more risk factors. The frequency of risk factors was high and this scenario suggests that these individuals could be more susceptible to worse COVID-19 prognosis. Therefore, prevention strategies directed at specific characteristics of substance users merit attention during the pandemic.
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Affiliation(s)
- Daniela Benzano
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Felipe Ornell
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jaqueline Bohrer Schuch
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Anne Orgler Sordi
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Felix Henrique Paim Kessler
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil,Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Coêlho BM, Santana GL, Viana MC, Wang YP, Andrade LH. "I don't need any treatment" - barriers to mental health treatment in the general population of a megacity. ACTA ACUST UNITED AC 2021; 43:590-598. [PMID: 33950152 PMCID: PMC8639019 DOI: 10.1590/1516-4446-2020-1448] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/04/2021] [Indexed: 12/28/2022]
Abstract
Objective: Most countries fail to treat individuals with psychopathologies. Investigating treatment barriers and reasons for dropout are key elements to overcoming this scenario. Methods: A representative sample of 2,942 urban-dwelling adults was interviewed face-to-face within a cross-sectional, stratified, multistage probability survey of the general population. Psychiatric diagnosis, severity level, use of services, reasons for not seeking treatment, and treatment dropout were investigated. Results: Only 23% of individuals with a psychopathology of any severity level in the last 12 months received treatment. Low perceived need for treatment (56%) was the most common reason for not seeking treatment. The most visited settings were psychiatric, other mental health care, and general medical care. Among those with a perceived need for treatment (44%), psychological barriers were the most common reason for not seeking it. Treatment dropout was more prevalent among those who visited a general medical care setting. Among individuals still in treatment, human services and psychiatric care were the most common types. Female sex was associated with structural barriers (OR = 2.1). Disorder severity was negatively associated with need barriers (OR = 0.4), and positively associated with structural barriers (OR = 2.5) and psychological barriers (OR = 2.5). Conclusion: Despite the need for treatment and better services, psychological barriers were the major reason for not seeking treatment. Apart from providing more specialists, investing in awareness, de-stigmatization, and information is the ultimate strategy for improving psychiatric care.
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Affiliation(s)
- Bruno M Coêlho
- Núcleo de Epidemiologia Psiquiátrica (LIM-23), Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Geilson L Santana
- Núcleo de Epidemiologia Psiquiátrica (LIM-23), Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria C Viana
- Programa de Pós-Graduação em Saúde Pública, Departamento de Medicina Social, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Yuan-Pang Wang
- Núcleo de Epidemiologia Psiquiátrica (LIM-23), Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Laura H Andrade
- Núcleo de Epidemiologia Psiquiátrica (LIM-23), Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Rosário BDA, de Nazaré MDFS, Estadella D, Ribeiro DA, Viana MDB. Behavioral and neurobiological alterations induced by chronic use of crack cocaine. Rev Neurosci 2020; 31:59-75. [PMID: 31129656 DOI: 10.1515/revneuro-2018-0118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/25/2019] [Indexed: 01/01/2023]
Abstract
Crack cocaine is the crystal form of cocaine and can be smoked, and rapidly absorbed, and, in part for this reason, is potently addictive. It is hypothesized that crack cocaine is able to induce important changes in different tissues and organs, and thus dramatically alter behavior. Nevertheless, which alterations in the central nervous system are related to its frequent use is still a matter of discussion. The present study is a literature review of articles published between the years 2008 and 2018 on the theme 'crack cocaine and brain' available in PUBMED, MEDLINE, EMBASE, and Google scholar databases. The results show that the use of crack cocaine induces important behavioral, neuroanatomical, and biochemical alterations. The main behavioral sequelae include cognitive and emotional changes, such as increased anxiety and depressive symptoms, attention and memory deficits, and hyperactivity. Among the neurobiological alterations are reductions in the activity of the prefrontal, anterior cingulate cortex, and nucleus accumbens. Molecular changes include decreases in neurotrophic factors and increases in oxidative stress and inflammatory cytokines, which may be responsible for the morphological alterations observed. It is also hypothesized that these neurobiological changes might explain the emotional and cognitive dysfunctions experienced by crack cocaine addicts.
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Affiliation(s)
- Bárbara Dos Anjos Rosário
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil
| | | | - Débora Estadella
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil
| | - Daniel Araki Ribeiro
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil
| | - Milena de Barros Viana
- Departamento de Biociências, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim, 136, 11015-20 Santos SP, Brazil, e-mail:
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Salari N, Jalali A, Abdam B, Abdi A, Daryoushi H. Validation and psychometric properties of the community assessment inventory in Iranian persons who use drug. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:46. [PMID: 32682438 PMCID: PMC7368702 DOI: 10.1186/s13011-020-00290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/14/2020] [Indexed: 11/24/2022]
Abstract
Objective Social support is a key factor in the treatment and rehabilitation process of persons who use drug (PWUD). This highlights the need for a valid and reliable tool for assessing social support. The cultural and psychometric properties of community assessment inventory (CAI) in PWUDs under methadone therapy were examined in Iran in 2019. Methods The study was carried out as a validation and methodological study. At first, the original tool was translated into Farsi using forward-backward method. After ensuring face validity and content validity, construct reliability of the tool was supported using explorative and confirmatory factor analysis (EFA & CFA) using a sample group of 392 participants. The participants were selected through convenient-quota sampling from 24 drug clinics. Reliability of the questionnaire was supported using Pearson correlation coefficient and internal consistency based on Cronbach’s alpha. Results To determine content validity of the tool, CVI and CVR of it were obtained, which were on average equal to 0.79 and 0.59 respectively. The EFA supported correlation of the 37itmes of the tool (KMO = 0.975, Chi-square = 15,051.6, Pvalue=0.0001). The main indices of the model, based on CFA were higher than 0.9, which support goodness of fit of the model (χ2/DF = 2.98, CFI = 0.91, NFI, TLI = 0.905 GF = 0.92, REMSEA = 0.07, R2 = 0.99). Reliability of the tool based on internal consistency (Cronbach’s alpha) for the subscales were in 0.8–0.95 interval and equal to 0.85 for the whole tool. Conclusion As the results showed, CAI had acceptable indices for Iranian PWUDs under methadone therapy. The tool can be used for assessing social support level in the study population. It is a reliable and valid tool for studies in pertinent fields.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalali
- Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Behzad Abdam
- Student Research Committee, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Daryoushi
- Department of Pediatrics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Mendes RDO, Pacheco PG, Nunes JPCOV, Crespo PS, Cruz MS. Literature review on the implications of decriminalization for the care of drug users in Portugal and Brazil. CIENCIA & SAUDE COLETIVA 2019; 24:3395-3406. [PMID: 31508758 DOI: 10.1590/1413-81232018249.27472017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Substance use problems remain at the core of public concern in countries sharing a common culture and a distinct history like Brazil and Portugal. OBJECTIVE To describe findings of scientific literature about the implications of drug legislation change for the care of drug users in Brazil and Portugal. METHODS This is an integrative review of literature that considers inclusion and exclusion criteria, sample selection, analyses and categorization of 21 articles selected that were published in databases PubMed, SciELO and Biblioteca do Conhecimento on-line (B-ON) and included ordinances and laws related to the subject. RESULTS We observed that production on the repercussions of changes of legislation on care is scarce. Alcohol and tobacco are still a matter of concern in both countries. In Portugal, concerns about heroin-related issues have declined in recent years, but opioids use prevalence rates remain well above those of Brazil. Crack-related problems are a Brazilian reality without parallel in Portugal. In both cases, some actions are in place to change the policy in favor of a reduced repressive approach, with differentiation between users and drug dealers, increased punishment of dealers and reduced punishment of drug users.
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Affiliation(s)
- Rafael de Oliveira Mendes
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro. Av. Venceslau Brás 71, Botafogo. 22290-140 Rio de Janeiro RJ Brasil.
| | - Paula Gibin Pacheco
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro. Av. Venceslau Brás 71, Botafogo. 22290-140 Rio de Janeiro RJ Brasil.
| | | | | | - Marcelo Santos Cruz
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro. Av. Venceslau Brás 71, Botafogo. 22290-140 Rio de Janeiro RJ Brasil.
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Dickson-Gomez J, Tarima S, Glasman LR, Lechuga J, Bodnar G, de Mendoza LR. Intervention Reach and Sexual Risk Reduction of a Multi-level, Community-Based HIV Prevention Intervention for Crack Users in San Salvador, El Salvador. AIDS Behav 2019; 23:1147-1157. [PMID: 30341555 DOI: 10.1007/s10461-018-2314-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This article examines the effects of a multi-level, community-based HIV prevention intervention for crack users residing in low-income neighborhoods in San Salvador, El Salvador conducted between August 2011 and June 2016. The intervention consisted of three components introduced sequentially: (1) rapid HIV testing in community settings; (2) a social network HIV testing intervention; and (3) small group interventions with crack users who were members of the same social network. The intervention was evaluated with an interrupted time series design in which we used respondent-driven sampling to conduct 7 cross-sectional surveys with crack users along a 3-4 month period for each assessment (total n = 1597). Results revealed a significant increase in exposure to the intervention over time with 50% of the participants reporting exposure to one or more of the three components. Getting an HIV test at the community site was associated with reductions in total times each individual had sex without a condom (p < 0.05) compared to those who had been exposed to no intervention components. Being referred by another crack user through the Social Network HIV intervention was also associated with reductions in total numbers of condomless sex (p < 0.05) The cumulative effect of being exposed to more than one intervention component was associated with reductions in total number of times individuals had condomless sex (p < 0.05). In spite of the high level of intervention reach and that self-reported exposure to intervention components was associated with lower sexual risk, reductions in sexual risk over time were not observed in the full sample, indicating that the penetration of HIV prevention components was not sufficient to produce population level change.
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Affiliation(s)
- Julia Dickson-Gomez
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Sergey Tarima
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura R Glasman
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julia Lechuga
- Department of Psychology, College of Education, Lehigh University, Bethlehem, PA, USA
| | - Gloria Bodnar
- Fundación Antidrogas de El Salvador, Santa Tecla, El Salvador
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Zeferino MT, Fermo VC, Fialho MB, Kenthi A, Bastos FI. CRACK COCAINE USE SCENE IN THE CAPITAL OF THE STATE OF SANTA CATARINA/BRAZIL: THE (IN)VISIBILITY OF USERS. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2017-0460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to describe the characteristics of the crack cocaine use scene, its surroundings and consequences. Method: this study was based on the Time-location Sampling methodology. Between January and June 2011, 41 crack use scenes were mapped in Florianópolis (Brazil). After randomly selecting the scenes to be observed, the days and shifts for in-depth observation were selected by lottery, for a total of 98 scenes/shifts, this atep was performed between December 2011 and March 2012. The observations were recorded in a field diary, and were examined using content analysis and discussed based on the Brazilian and international literature on the topic. Results: the results show that crack cocaine use scenes were more concentrated in the central regions of Florianópolis. Policing was very ostensive in the communities surrounding these areas, which are strongly marked by drug trafficking. Healthcare, prevention and authority actions were incipient in the locations of substance use, which shows the invisibility of crack users in society. Conclusions: more investments are needed so that public policies work to help drug users access social and healthcare services.
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Toledo L, Góngora A, Bastos FIPM. [On the sidelines of society: crack use, deviation, criminalization and social exclusion - a narrative review]. CIENCIA & SAUDE COLETIVA 2018; 22:31-42. [PMID: 28076527 DOI: 10.1590/1413-81232017221.02852016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/01/2016] [Indexed: 12/12/2022] Open
Abstract
The article comprises a narrative review of the scientific literature, aiming to identify and discuss the contexts of vulnerability and social exclusion faced by users of crack cocaine and other substances who live on the sidelines of society in the Brazilian and international context. The paper summarizes insights from different theoretical frameworks, focusing on an integrated perspective of substance use and abuse, with an emphasis on the use of crack and its inter-relationships with social vulnerability, marginalization, social exclusion and deviation. In a first step, broad aspects of qualitative research on drugs are outlined. The subsequent section highlights issues associated with exclusion and social vulnerability of crack users, followed by an assessment of the main associations mentioned in the literature on drug use and criminal involvement. Finally, the concept of "sidelines of society" is discussed, as exemplified by situations and events experienced by users of crack and other substances, as mentioned in the literature.
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Affiliation(s)
- Lidiane Toledo
- Programa de Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Andrés Góngora
- Programa de Pós-Graduação em Antropologia Social, Museu Nacional, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Francisco Inácio P M Bastos
- Programa de Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil. .,Departamento de Informações em Saúde, Centro de Informação Científica e Tecnológica, Fiocruz. Rio de Janeiro RJ Brasil
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Budambula V, Matoka C, Ouma J, Ahmed AA, Otieno MF, Were T. Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users. BMC Public Health 2018; 18:193. [PMID: 29378631 PMCID: PMC5789578 DOI: 10.1186/s12889-018-5100-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
Background Substance use is increasingly becoming prevalent on the African continent, fueling the spread of HIV infection. Although socio-demographic factors influence substance consumption and risk of HIV infection, the association of these factors with HIV infection is poorly understood among substance users on the African continent. The objective of the study was to assess socio-demographic and sexual practices that are associated with HIV infection among injection drug users (IDUs), non-IDUs, and non-drug users (DUs) at an urban setting of coastal Kenya. Methods A cross-sectional descriptive study was conducted among 451 adults comprising HIV-infected and -uninfected IDUs (n = 157 and 39); non-IDUs (n = 17 and 48); and non-DUs (n = 55 and 135); respectively at coastal, Kenya. Respondent driven sampling, snowball and makeshift methods were used to enroll IDUs and non-IDUs. Convenience and purposive sampling were used to enroll non-DUs from the hospital’s voluntary HIV testing unit. Participant assisted questionnaire was used in collecting socio-demographic data and sexual practices. Results Binary logistic regression analysis indicated that higher likelihood of HIV infection was associated with sex for police protection (OR, 9.526; 95% CI, 1.156-78.528; P = 0.036) and history of sexually transmitted infection (OR, 5.117; 95% CI, 1.924-13.485; P = 0.001) in IDUs; divorced, separated or widowed marital status (OR, 6.315; 95% CI, 1.334-29.898; P = 0.020) in non-IDUs; and unemployment (OR, 2.724; 95% CI, 1.049-7.070; P = 0.040) in non-drug users. However, never married (single) marital status (OR, 0.140; 95% CI, 0.030-0.649; P = 0.012) was associated with lower odds for HIV infection in non-drug users. Conclusion Altogether, these results suggest that socio-demographic and sexual risk factors for HIV transmission differ with drug use status, suggesting targeted preventive measures for drug users.
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Affiliation(s)
- Valentine Budambula
- Department of Environment and Health Sciences, Technical University of Mombasa, P. O. Box 90420-80100, Mombasa, Kenya.
| | - Charles Matoka
- Department of Applied Sciences, Technical University of Mombasa, P. O. Box 90420-80100, Mombasa, Kenya
| | - James Ouma
- Department of Environmental Health, University of Kabianga, P. O. Box 2030-20200, Kericho, Kenya
| | | | - Michael F Otieno
- Department of Medical Laboratory Sciences, Kenyatta University, P. O. Box 43844-00100, Nairobi, Kenya
| | - Tom Were
- Department of Medical Laboratory Sciences, Masinde Muliro University of Science and Technology, P.O. Box 190-50100, Kakamega, Kenya.
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Pinsky I, Bernal C, Vuolo L, Neighbors C. Introducing care management to Brazil's alcohol and substance use disorder population. ACTA ACUST UNITED AC 2017; 40:320-324. [PMID: 29267603 PMCID: PMC6899403 DOI: 10.1590/1516-4446-2017-2235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/13/2017] [Indexed: 12/26/2022]
Abstract
Brazil has a sizable alcohol and substance use disorder (ASUD) population, yet there are considerable gaps in treatment access and retention. ASUD, a chronic medical condition, is highly comorbid with medical and behavioral health disorders. This indicates a need for more targeted interventions in order to achieve health care integration (a major goal of Brazil's health care system). Care management - that is, the organization of patient care by an institution - is a viable strategy to engage individuals with ASUD who might benefit from treatment but are not aware of or do not use the available resources, as well as to help maintain patients in treatment. Care management is considered an essential supplement to the treatment of chronic disease. The objective of this article is to discuss the applicability of care management for the treatment of ASUD within the public health care system in Brazil. We describe models of care management that have been adopted internationally and identify the feasibility and advantages for its adoption in Brazil.
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Affiliation(s)
- Ilana Pinsky
- The National Center on Addiction and Substance Abuse, New York, USA.,Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Camila Bernal
- The National Center on Addiction and Substance Abuse, New York, USA
| | - Lindsey Vuolo
- The National Center on Addiction and Substance Abuse, New York, USA
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Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses. Drug Alcohol Depend 2017; 180:401-416. [PMID: 28982092 DOI: 10.1016/j.drugalcdep.2017.08.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
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Vernaglia TVC, Leite TH, Faller S, Pechansky F, Kessler FHP, Cruz MS, Group BC. The female crack users: Higher rates of social vulnerability in Brazil. Health Care Women Int 2017; 38:1170-1187. [PMID: 28825524 DOI: 10.1080/07399332.2017.1367001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Female crack users who sought treatment are a hard to find part of the population. We studied sociodemographic and behavioral characteristics of crack users undergoing treatment in psychosocial care centers for alcohol and other drugs in six Brazilian cities. We carried out a cross-sectional study of 816 crack users and collected data with the Addiction Severity Index. Women were more likely to be in vulnerable situations: had worst levels of education, were not receiving money enough to their basic needs; more likely to be HIV positive (10.1%), to report sexual abuse (34%), and to be separated from their children (20%).
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Affiliation(s)
| | | | - Sibele Faller
- c Department of Psychiatry and Legal Medicine , Federal University of Rio Grande do Sul (UFRS) , Brazil
| | - Flavio Pechansky
- d Center for Drug and Alcohol Research , Federal University of Rio Grande do Sul (UFRGS) , Brazil
| | - Felix Henrique Paim Kessler
- c Department of Psychiatry and Legal Medicine , Federal University of Rio Grande do Sul (UFRS) , Brazil.,e Porto Alegre Clinical Hospital , Brazil
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Teixeira MB, Engstrom EM, Ribeiro JM. Revisão sistemática da literatura sobre crack: análise do seu uso prejudicial nas dimensões individual e contextual. SAÚDE EM DEBATE 2017. [DOI: 10.1590/0103-1104201711225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RESUMO Este artigo visa investigar como se conformam, no Brasil e internacionalmente, as abordagens ao uso prejudicial do crack e outras drogas. Foi realizada uma revisão crítica da literatura acerca do padrão de consumo do crack e os fatores a ele relacionados com busca sistemática em bases eletrônicas no período de 2010 a 2016. Foram analisados 37 artigos por autor, ano, país do estudo, metodologia; padrão de consumo de crack e fatores individuais e contextuais relativos a esse uso. Conclui-se que a abordagem ao uso de drogas deve estar focada na perspectiva da redução de danos, na promoção da autonomia e dos direitos humanos, e não na utopia de eliminação do consumo e da produção de drogas.
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Puga MAM, Bandeira LM, Pompilio MA, Croda J, de Rezende GR, Dorisbor LFP, Tanaka TSO, Cesar GA, Teles SA, Simionatto S, Novais ART, Nepomuceno B, Castro LS, do Lago BV, Motta-Castro ARC. Prevalence and Incidence of HCV Infection among Prisoners in Central Brazil. PLoS One 2017; 12:e0169195. [PMID: 28060860 PMCID: PMC5218405 DOI: 10.1371/journal.pone.0169195] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/10/2016] [Indexed: 12/12/2022] Open
Abstract
The aim of this multicenter, cross sectional study was to assess the prevalence, incidence and associated risk factors among incarcerated populations from twelve Brazilian prisons. The total of 3,368 individuals from twelve prisons was randomly recruited between March 2013 and March 2014. Participants were interviewed, and provided blood samples which were tested for antibodies to Hepatitis C (HCV ab). One year after the first investigation, a cohort study was conducted with 1,656 inmates who participated the cross sectional study. Positive samples were tested for the presence of HCV RNA. Out of 3,368 inmates, 520 (15.4%) were females, and 2,848 (84.6%) were males. The overall prevalence of HCV was 2.4% (95% CI: 1.9 to 2.9), with 0.6% (95% CI: 0.4 to 0.8) in females, and 2.7% (95% CI: 2.1 to 3.3) in males (p<0.01). HCV RNA was detected in 51/80 (63.7%) samples. Among men prisoners, multivariate analysis of associated factors showed independent associations between HCV exposure and increasing age, inject drug use, length of incarceration, smoking hashish, sharing needle and syringe and HIV positivity. During the cohort study, 7/1,656 new cases of HCV infection were detected, and the incidence rate was 0.4/100 person-year. Once high frequency rates of specific HCV risk behaviors and new HCV infections have been identified inside prisons, effective interventions strategies such as screening, clinical evaluation and treatment to reduce the spread of HCV infection are essential.
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Affiliation(s)
| | | | | | - Julio Croda
- Oswaldo Cruz Foundation, Mato Grosso do Sul, MS, Brazil
- Federal University of Grande Dourados, Dourados, MS, Brazil
| | | | | | | | | | | | | | | | - Bruna Nepomuceno
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | - Ana Rita Coimbra Motta-Castro
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
- Oswaldo Cruz Foundation, Mato Grosso do Sul, MS, Brazil
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Zeferino MT, Fermo VC, Fialho MB, Bastos FI. Semelhanças e contrastes nos padrões de uso de crack em Santa Catarina, Brasil: capital vs Meio Oeste. CIENCIA & SAUDE COLETIVA 2017; 22:97-106. [DOI: 10.1590/1413-81232017221.18342016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 10/19/2016] [Indexed: 11/21/2022] Open
Abstract
Resumo O crack é um problema relevante de saúde pública no Brasil, em função dos danos e riscos individuais e sociais secundários ao seu uso/abuso. O objetivo deste artigo é descrever características das cenas de uso de crack na Capital e no Meio-Oeste de Santa Catarina. O projeto se valeu da metodologia Time-Location Sampling. Em janeiro-junho de 2011, foram mapeadas 41 cenas de uso de crack na Capital e 33 no Meio-Oeste catarinense. Após seleção aleatória das cenas a serem observadas, foram sorteados os dias e os turnos em que estas seriam observadas em detalhe, totalizando 98 cenas/turno na Capital e 62 no Meio-O-este. As observações foram registradas em caderno de campo, analisadas via análise de conteúdo de Bardin e discutidas à luz da literatura nacional e internacional. Os usuários de crack entrevistados eram majoritariamente adultos do sexo masculino, com uma maior associação entre estar em situação de rua e consumir a droga na Capital. Enquanto no Meio-Oeste a maioria das cenas estavam ativas no período noturno, na Capital, apresentaram-se ativas em todos os períodos. Foram identificadas práticas de risco associadas ao uso do crack, como associação de múltiplas drogas, prostituição, compartilhamento de cachimbo e favores sexuais em troca da substância.
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Halpern SC, Scherer JN, Roglio V, Faller S, Sordi A, Ornell F, Dalbosco C, Pechansky F, Kessler F, Diemen LV. Vulnerabilidades clínicas e sociais em usuários de crack de acordo com a situação de moradia: um estudo multicêntrico de seis capitais brasileiras. CAD SAUDE PUBLICA 2017; 33:e00037517. [DOI: 10.1590/0102-311x00037517] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 06/06/2017] [Indexed: 11/21/2022] Open
Abstract
Resumo: O estudo teve como objetivo avaliar a gravidade do uso de substâncias psicoativas, situações de violência, saúde física e emocional de usuários de crack que buscam atendimento em Centros de Atenção Psicossocial para Álcool e Drogas (CAPSad), em relação ao status de moradia. Trata-se de um estudo multicêntrico em seis capitais brasileiras, com 564 usuários de crack categorizados em dois grupos: (1) usuários que estiveram em situação de rua (n = 266) e (2) nunca estiveram em situação de rua (n = 298). Para avaliar a gravidade do uso de substâncias e as características dos indivíduos utilizou-se o Addiction Severity Index, 6ª versão (ASI-6). Os usuários do grupo 1 demonstraram piores indicadores em relação às subescalas álcool, problemas médicos, psiquiátricos, trabalho e suporte familiar, além de maior envolvimento com problemas legais, violência, abuso sexual, risco de suicídio e problemas de saúde como HIV/AIDS, hepatite e tuberculose, além de possuírem menos renda para pagar necessidades básicas. Após análises multivariadas ajustadas para possíveis confundidores, não possuir renda suficiente para pagar necessidades básicas, apresentar sintomas depressivos e ter sido preso por roubo permaneceram significativos. Este trabalho avaliou de forma mais abrangente a gravidade do uso de drogas e a situação de moradia de usuários de crack. Abordagens desenvolvidas nos dispositivos de tratamento extra-hospitalares devem ser projetadas e adequadas de acordo com perfis e demandas específicos dos usuários, em especial aqueles em situação de rua.
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Affiliation(s)
| | | | | | | | - Anne Sordi
- Universidade Federal do Rio Grande do Sul, Brazil
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Krawczyk N, Kerrigan D, Bastos FI. The Quest to Extend Health Services to Vulnerable Substance Users in Rio de Janeiro, Brazil in the Context of an Unfolding Economic Crisis. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 47:477-488. [PMID: 27856941 DOI: 10.1177/0020731416679351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation's most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens. In consequence of such prospects, this commentary aims to discuss barriers marginalized substance users face in accessing health services that are at risk of worsening with government cutbacks. Using Rio de Janeiro as an example, we explore two primary issues: the resource-strained, under-staffed and decentralized nature of the Brazilian Unified Health System and the pervading stigma that bars vulnerable citizens from official structures and services. Abandoning initiated government efforts to increase access to health services would risk maintaining vulnerable citizens at the margins of public structures, inhibiting the opportunity to offer this population humane and urgently needed treatment and care.
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Affiliation(s)
- Noa Krawczyk
- 1 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Deanna Kerrigan
- 2 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Francisco Inácio Bastos
- 3 Institute for Scientific and Technological Information and Communication in Health (LIS/ICICT), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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Hyshka E, Anderson JT, Wild TC. Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev 2016; 36:295-304. [PMID: 27242102 DOI: 10.1111/dar.12427] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/24/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Research on perceived unmet need for care for mental health and substance use problems focuses on general populations to the detriment of hidden populations. This study describes prevalence and correlates of perceived unmet need for care in a community-based sample of street-involved people who use illicit drugs and identifies barriers to care. DESIGN AND METHODS A sample of 320 street-involved people who use drugs participated in a structured, interviewer-assisted survey in Edmonton, Canada. The survey included the Perceived Need for Care Questionnaire, which assessed unmet need for care for mental health and substance use problems across seven service types. Logistic regression examined the associations between perceived unmet need, extent of socioeconomic marginalisation and problem severity. Barriers underlying unmet service needs were also examined. RESULTS Most (82%) participants reported unmet need for one or more services during the past year. Odds of reporting one or more unmet needs were elevated amongst participants reporting substantial housing instability (adjusted odds ratio = 2.37; 95% confidence interval 1.19-4.28) and amongst participants meeting criteria for drug dependence (adjusted odds ratio = 1.22; 95% confidence interval 1.03-1.50), even after adjustment for sociodemographic covariates. Structural, rather than motivational barriers were the most commonly reported reasons underlying unmet service needs. DISCUSSION AND CONCLUSION Street-involved people who use drugs experience very high rates of perceived unmet need for care for mental health and substance use problems. General population studies on perceived unmet need are insufficient for understanding needs and barriers to care in hidden populations.[Hyshka E, Anderson JT, Wild TC. Perceived unmet need and barriers to care amongst street-involved people who use illicit drugs. Drug Alcohol Rev 2017;36:295-304].
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Affiliation(s)
- Elaine Hyshka
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada.,Inner City Health and Wellness Program, 606-1 Community Services Centre, Royal Alexandra Hospital, Edmonton, Canada
| | - Jalene Tayler Anderson
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada.,Human Geography Program, Department of Earth and Atmospheric Sciences, 1-26 Earth Sciences Building, University of Alberta, Edmonton, Canada
| | - T Cameron Wild
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada
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Diehl A, Pillon SC, dos Santos MA, Rassool GH, Laranjeira R. Criminality and Sexual Behaviours in Substance Dependents Seeking Treatment. J Psychoactive Drugs 2016; 48:124-34. [DOI: 10.1080/02791072.2016.1168534] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Fischer B, Kuganesan S, Gallassi A, Malcher-Lopes R, van den Brink W, Wood E. Addressing the stimulant treatment gap: A call to investigate the therapeutic benefits potential of cannabinoids for crack-cocaine use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1177-82. [DOI: 10.1016/j.drugpo.2015.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 01/14/2023]
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Krawczyk N, Filho CLV, Bastos FI. The interplay between drug-use behaviors, settings, and access to care: a qualitative study exploring attitudes and experiences of crack cocaine users in Rio de Janeiro and São Paulo, Brazil. Harm Reduct J 2015; 12:24. [PMID: 26245997 PMCID: PMC4527230 DOI: 10.1186/s12954-015-0059-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/29/2015] [Indexed: 12/02/2022] Open
Abstract
Background Despite the growing attention surrounding crack cocaine use in Brazil, little is understood about crack users’ histories, use patterns and the interplay of drug-use behaviors, settings, and access/barriers to care. Qualitative studies seldom cross-compare findings regarding people who use crack from different settings. This study aims to explore the insights of regular crack users in two major Brazilian cities and to examine how social and contextual factors, including stigma and marginalization, influence initial use and a range of health and social issues. Methods In-depth interviews and focus groups were conducted with 38 adult crack cocaine users recruited from impoverished neighborhoods in Rio de Janeiro and São Paulo. Interviews and focus groups were audio recorded and transcribed verbatim. Qualitative analysis was carried out, and content was organized and analyzed by recurrent themes relevant to study interests. Results For study participants from both cities, frequent crack cocaine use plays a central role in daily life and leads to a range of physical, psychological, and social consequences. Common concerns among users include excessive crack use, engagement in risky habits, infrequent health service utilization, marginalization, and difficulty reducing use. Conclusions Disadvantaged conditions in which many crack cocaine users grow up and live may perpetuate risk behaviors and stigma may further marginalize users from necessary health and recovery services. Reducing stigma and moralizing discourse related to drug use, especially among health professionals and law enforcement personnel, may help encourage users to seek necessary care. New harm-reduction-based care and treatment alternatives for marginalized drug users are being developed in parts of Brazil and elsewhere and should be adapted and expanded for other populations in need.
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Affiliation(s)
- Noa Krawczyk
- FIOCRUZ-Oswaldo Cruz Foundation, Av. Brasil, 4365, Biblioteca de Manguinhos #229, Rio de Janeiro, 21045-900, Brazil.
| | - Carlos Linhares Veloso Filho
- Psychiatry Institute, Federal University of Rio de Janeiro, Avenida Venceslau Brás, 71 - Fundos - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil.
| | - Francisco I Bastos
- FIOCRUZ-Oswaldo Cruz Foundation, Av. Brasil, 4365, Biblioteca de Manguinhos #229, Rio de Janeiro, 21045-900, Brazil.
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Leung KS, Parks J, Topolski J. Preventable hospitalizations among adult Medicaid beneficiaries with concurrent substance use disorders. Prev Med Rep 2015; 2:379-84. [PMID: 26844094 PMCID: PMC4721431 DOI: 10.1016/j.pmedr.2015.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE We aim to examine the relationships between substance use disorders and preventable hospitalizations for Ambulatory Care Sensitive Conditions among adult Medicaid beneficiaries. METHODS Cross-sectional analysis using de-identified Medicaid claims data in 2012 from 177,568 beneficiaries in Missouri was conducted. Logistic regression models were estimated for the associations of substance use disorder status with Ambulatory Care Sensitive Conditions, demographics, chronic physical and mental illnesses. Zero-inflated negative binomial regressions assessed substance use disorders, hospitalization for Ambulatory Care Sensitive Conditions, and length of hospital stay for Ambulatory Care Sensitive Conditions adjusting for co-morbid physical illnesses, mental illnesses and demographics. RESULTS Over 12% of the sample had been diagnosed for substance use disorder. Beneficiaries with substance use disorder were more likely than Nonsubstance use disorder beneficiaries to have admissions for chronic conditions including short/long-term complications of diabetes, uncontrolled diabetes, hypertension, chronic obstructive pulmonary disease/asthma, but not for acute conditions. While substance use disorder beneficiaries were more likely than Nonsubstance use disorder beneficiaries to be hospitalized for any Ambulatory Care Sensitive Conditions; there were no statistical differences between the two groups in terms of length of hospital stays. CONCLUSIONS Substance use disorder is statistically associated with hospitalizations for most Ambulatory Care Sensitive Conditions but not with length of hospital stay for Ambulatory Care Sensitive Conditions, after adjusting for covariates. The significant associations between substance use disorder and Ambulatory Care Sensitive Condition admissions suggest unmet primary health care needs for substance use disorder beneficiaries and a need for integrated primary/behavioral healthcare.
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Affiliation(s)
- Kit Sang Leung
- MIMH,University of Missouri - St. Louis, 4633 World Parkway Circle, St. Louis, MO 63134-3115, USA
| | - Joe Parks
- MIMH,University of Missouri - St. Louis, 4633 World Parkway Circle, St. Louis, MO 63134-3115, USA; Missouri Department of Social Services, 615 Howerton Court, PO Box 6500, Jefferson City, MO 65102-6500, USA
| | - James Topolski
- MIMH,University of Missouri - St. Louis, 4633 World Parkway Circle, St. Louis, MO 63134-3115, USA
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Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: a comprehensive narrative overview of English-language studies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:352-63. [PMID: 25662894 DOI: 10.1016/j.drugpo.2015.01.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/30/2014] [Accepted: 01/06/2015] [Indexed: 11/18/2022]
Abstract
There are an estimated several million crack-cocaine users globally; use is highest in the Americas. Most crack users are socio-economically marginalized (e.g., homeless), and feature elevated risks for morbidity (e.g., blood-borne viruses), mortality and crime/violence involvement, resulting in extensive burdens. No comprehensive reviews of evidence-based prevention and/or treatment interventions specifically for crack use exist. We conducted a comprehensive narrative overview of English-language studies on the efficacy of secondary prevention and treatment interventions for crack (cocaine) abuse/dependence. Literature searches (1990-2014) using pertinent keywords were conducted in main scientific databases. Titles/abstracts were reviewed for relevance, and full studies were included in the review if involving a primary prevention/treatment intervention study comprising a substantive crack user sample. Intervention outcomes considered included drug use, health risks/status (e.g., HIV or sexual risks) and select social outcome indicators. Targeted (e.g., behavioral/community-based) prevention measures show mixed and short-term effects on crack use/HIV risk outcomes. Material (e.g., safer crack use kit distribution) interventions also document modest efficacy in risk reduction; empirical assessments of environmental (e.g., drug consumption facilities) for crack smokers are not available. Diverse psycho-social treatment (including contingency management) interventions for crack abuse/dependence show some positive but also limited/short-term efficacy, yet likely constitute best currently available treatment options. Ancillary treatments show little effects but are understudied. Despite ample studies, pharmaco-therapeutic/immunotherapy treatment agents have not produced convincing evidence; select agents may hold potential combined with personalized approaches and/or psycho-social strategies. No comprehensively effective 'gold-standard' prevention/treatment interventions for crack abuse exist; concerted research towards improved interventions is urgently needed.
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Spector AY, Pinto RM, Rahman R, da Fonseca A. Implementation of Brazil's "family health strategy": factors associated with community health workers', nurses', and physicians' delivery of drug use services. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26:509-15. [PMID: 25599595 DOI: 10.1016/j.drugpo.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 11/28/2014] [Accepted: 12/07/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Brazil's "family health strategy" (ESF), provides primary care, mostly to individuals in impoverished communities through teams of physicians, nurses, and community health workers (CHWs). ESF workers are called upon to offer drug use services (e.g., referrals, counseling) as drug use represents an urgent public health crisis. New federal initiatives are being implemented to build capacity in this workforce to deliver drug use services, yet little is known about whether ESF workers are providing drug use services already. Guided by social cognitive theory, this study examines factors associated with ESF workers' provision of drug use services. METHODS Cross-sectional surveys were collected from 262 ESF workers (168 CHWs, 62 nurses, and 32 physicians) in Mesquita, Rio de Janeiro State and Santa Luzia, Minas Gerais State. OUTCOME VARIABLE provision of drug-use services. PREDICTORS capacity to engage in evidence-based practice (EBP), resource constraints, peer support, knowledge of EBP, and job title. Logistic regression was used to determine relative influence of each predictor upon the outcome. RESULTS Thirty-nine percent reported providing drug use services. Younger workers, CHWs, workers with knowledge about EBP and workers that report peer support were more likely to offer drug use services. Workers that reported resource constraints and more capacity to implement EBP were less likely to offer drug use services. CONCLUSION ESF workers require education in locating, assessing and evaluating the latest research. Mentorship from physicians and peer support through team meetings may enhance workers' delivery of drug use services, across professional disciplines. Educational initiatives aimed at ESF teams should consider these factors as potentially enhancing implementation of drug use services. Building ESF workers' capacity to collaborate across disciplines and to gain access to tools for providing assessment and treatment of drug use issues may improve uptake of new initiatives.
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Affiliation(s)
- Anya Y Spector
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 722 West 168th Street, Room 307, New York, NY 10032, United States.
| | - Rogério M Pinto
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States
| | - Rahbel Rahman
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States
| | - Aline da Fonseca
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States
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Bertoni N, Burnett C, Cruz MS, Andrade T, Bastos FI, Leal E, Fischer B. Exploring sex differences in drug use, health and service use characteristics among young urban crack users in Brazil. Int J Equity Health 2014; 13:70. [PMID: 25181954 PMCID: PMC4243730 DOI: 10.1186/s12939-014-0070-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/25/2014] [Indexed: 12/12/2022] Open
Abstract
Introduction Studies have shown important gender differences among drug (including crack) users related to: drug use patterns; health risks and consequences; criminal involvement; and service needs/use. Crack use is prevalent in Brazil; however, few comparative data by sex exist. We examined and compared by sex key drug use, health, socio-economic indicators and service use in a bi-city sample of young (18–24 years), regular and marginalized crack users in Brazil. Methods Study participants (total n = 159; n = 124 males and n = 35 females) were recruited by community-based methods from impoverished neighborhoods in Rio de Janeiro and Salvador. Assessments occurred by an anonymous interviewer-administered questionnaire and serum collection for blood-borne virus testing between November 2010 and June 2011. Descriptive statistics and differences for key variables by sex were computed; in addition, a ‘chi-squared automatic interaction detector’ (‘CHAID’) analysis explored potential primary factors differentiating male and female participants. Results Most participants were non-white, and had low education and multiple income sources. More women had unstable housing and income from sex work and/or panhandling/begging, whereas more men were employed. Both groups indicated multi-year histories of and frequent daily crack use, but virtually no drug injection histories. Men reported more co-use of other drugs. More women were: involved in sex-for-drug exchanges; Blood-Borne Virus (BBV) tested and HIV+. Both groups reported similar physical and mental health patterns; however women more commonly utilized social or health services. The CHAID analysis identified sex work; paid work; begging/panhandling; as well as physical and mental health status (all at p < 0.05) as primary differentiating factors by sex. Conclusions Crack users in our study showed notable differences by sex, including socio-economic indicators, drug co-use patterns, sex risks/work, BBV testing and status, and service utilization. Results emphasize the need for targeted special interventions and services for males and female crack users in Brazil.
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da Cruz TA, da Cunha GN, de Moraes VPM, Massarini R, Yoshida CMK, Tenguam PT, Garcia MV, Varoto DA, de Oliveira MB, de Andrade AG, de Azevedo-Marques Périco C, do Nascimento VB, Castaldelli-Maia JM. ICD-10 mental and behavioural disorders due to use of crack and powder cocaine as treated at a public psychiatric emergency service: an analysis of visit predictors. Int Rev Psychiatry 2014; 26:508-14. [PMID: 25137118 DOI: 10.3109/09540261.2014.928271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The present study investigated the predictors of an increased number of visits from individuals with some of the diagnoses noted in chapter F14 of ICD-10, from calls to the emergency psychiatric unit of a general hospital in São Paulo state, Brazil, in the period 2011-2012. Poisson regression models were carried out for the outcome variable, accounting for number of subsequent visits to the psychiatric emergency unit. For the analysis of this outcome we took into account the exposure time of each individual in the study. Our findings point to a population at risk for frequent psychiatric emergency service visits: individuals over 25 years. This population should be targeted for interventions on entry into public healthcare due to increased psychiatric morbidity and greater clinical morbidity already confirmed by previous studies. We discussed the need of these individuals for special attention during the clinical or psychiatric emergency consultation which, unfortunately, may be the access point for the public health system. None of the other variables were related to the outcome of interest, such as those related to the level of individual entry into the care network before and after treatment, and other variables related to medical acts during the visit.
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