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Analytical findings in used syringes from a syringe exchange program. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 81:102770. [PMID: 32442881 DOI: 10.1016/j.drugpo.2020.102770] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Since it's first implementatation in 1984, Syringe Exchange Programs (SEP) are a critical component of harm reduction interventions among people who inject drugs.. The aim of this work was to use a scientific analytical approach to obtain drug use information through the analysis of the content of used syringes. METHODS 357 syringes were collected in New York City and submitted to qualitative analysis. Screening analysis was performed by gas chromatography mass spectrometry (GC-MS) and confirmatory analysis by liquid chromatography quadrupole time of flight mass spectrometry (LC-QTOF). RESULTS Of the 357 syringes analyzed, 275 (77.0%) were positive for one or more substances. The most common drug of abuse identified was heroin/related substances (72.0%), followed by cocaine/related substance (34.9%), fentanyl/related substance (13.5%), methamphetamine/related substance (7.6%) and furanylfentanyl (3.6%). Quinine/quinidine (18.5%) was the most common cutting agent detected, followed by levamisole (12.0%), caffeine (11.6%), lidocaine (11.6%), and phenacetin (6.9%). CONCLUSION Analysis of samples collected from a drug street scenario allows the identification of new substances being injected and provides information to harm reduction programs to identify strategies to reduce drug abuse.
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Rozental T, Silva ASVD, Oliveira RCD, Favacho ARDM, Oliveira MDLA, Bastos FI, Lemos ERSD. Seroprevalence of Bartonella spp., Coxiella burnetii, and Hantavirus among people who inject drugs in Rio de Janeiro, Brazil: a retrospective assessment of a biobank. Rev Inst Med Trop Sao Paulo 2018; 60:e31. [PMID: 30043935 PMCID: PMC6056887 DOI: 10.1590/s1678-9946201860031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/23/2018] [Indexed: 11/22/2022] Open
Abstract
The increasing use of illicit drugs imposes a public health challenge worldwide.
People who inject drugs (PWID) are more susceptible to health complications due
to immunosuppression associated with drug use and non-hygienic
self-administration of substances, contaminants, and liquids. PWID are subjected
to increased risk of acquiring and transmitting different pathogens (frequently
functioning as sentinel cases for (re)emerging pathogens), including those
transmitted by arthropods and vertebrate reservoirs in unhealthy environments. A
clear association between injection drug use and HIV, HBV, and HCV infections
has been described; however, other infectious viral and bacterial agents have
been seldomly assessed. In this study, we investigated the seroprevalence of
Bartonella spp., Coxiella burnetii, and
Hantavirus among 300 randomly selected PWIDs from Rio de
Janeiro, as part of a multi-city cross-sectional study carried out in the 1990s.
Point seroprevalences and respective 95% CIs are as follows: 9.3% for C.
burnetii (95% CI: 6.0%-13.0%), 1.0% for Bartonella
spp. (95% CI: 0.0%-3.0%), and 4.0% for
Hantavirus (95% CI: 2.0%-7.0%). In addition to the
blood-borne pathogens, the results of this study increase our knowledge on other
transmissible infectious agents in PWID. The high seroprevalence of C.
burnetii and Hantavirus found among PWID is
intriguing and suggests the need to carry out prospective studies, including
molecular analyses, to confirm these findings and allow a better understanding
of the putative relevance of these zoonotic infectious agents among PWID.
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Affiliation(s)
- Tatiana Rozental
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Oswaldo Cruz (IOC), Laboratório de Hantaviroses e Rickettsioses, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anamaria Szrajbman Vaz da Silva
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Oswaldo Cruz (IOC), Laboratório de Hantaviroses e Rickettsioses, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata Carvalho de Oliveira
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Oswaldo Cruz (IOC), Laboratório de Hantaviroses e Rickettsioses, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Maria de Lourdes Aguiar Oliveira
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Oswaldo Cruz (IOC), Laboratório de Vírus Respiratórios e do Sarampo, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Inácio Bastos
- Fundação Oswaldo Cruz (FIOCRUZ), Departamento de Informações em Saúde, Centro de Informação Científica e Tecnológica, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elba Regina Sampaio de Lemos
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Oswaldo Cruz (IOC), Laboratório de Hantaviroses e Rickettsioses, Rio de Janeiro, Rio de Janeiro, Brazil
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Gomes TB, Vecchia MD. Estratégias de redução de danos no uso prejudicial de álcool e outras drogas: revisão de literatura. CIENCIA & SAUDE COLETIVA 2018; 23:2327-2338. [DOI: 10.1590/1413-81232018237.21152016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/07/2016] [Indexed: 11/22/2022] Open
Abstract
O presente estudo traz uma sistematização acerca de experiências de atenção à saúde a pessoas que fazem uso prejudicial de álcool e outras drogas que têm por base as diretrizes da redução de danos no Brasil e no mundo. Foi realizado um levantamento bibliográfico em publicações de língua portuguesa e inglesa dos últimos dez anos hospedadas nas bases de dados SciELO, Lilacs, Medline e PsycINFO. Após a seleção do corpus, recorreu-se à metassíntese a fim de integrar o material obtido. Foi possível identificar e analisar avanços e impasses na implantação de estratégias de redução de danos, bem como comparar as diferentes abordagens identificadas nos serviços e ações de cuidado oferecidas aos usuários. Nota-se que a Redução de Danos tem se consolidado como estratégia de prevenção e tratamento e, dessa forma, torna-se imprescindível ampliar as produções acadêmica e científica na área.
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Inglez-Dias A, Ribeiro JM, Bastos FI, Page K. Políticas de redução de danos no Brasil. CIENCIA & SAUDE COLETIVA 2014; 19:147-57. [DOI: 10.1590/1413-81232014191.1778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 04/09/2013] [Indexed: 01/05/2023] Open
Abstract
Considerando a disseminação da epidemia de HIV e o controle de sua transmissão entre usuários de drogas injetáveis (UDI), estratégias de redução de danos foram incorporadas em diversos países, incluindo o Brasil. Considerando a emergência das drogas como tema central na agenda governamental, especialmente o crack, o presente artigo registra e discute as práticas observadas em um programa de pesquisa e atenção aos UDI: o UFO. Foram considerados aspectos tais como acesso e adesão do usuário, dificuldades de financiamento, sustentabilidade e avaliação de resultados. As etapas do estudo envolveram pesquisa documental, observação sistemática e entrevistas com informantes-chave. Destacamos características do UFO que poderiam contribuir para políticas de redução de danos no cenário brasileiro. O programa estudado se apresenta como um exemplo exitoso de iniciativas de redução de danos, obtendo sucesso no acesso e adesão desse grupo, favorecendo seu acesso aos serviços de saúde e prevenção de riscos associados ao uso de drogas.
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Bastos FI. Structural violence in the context of drug policy and initiatives aiming to reduce drug-related harm in contemporary Brazil: a review. Subst Use Misuse 2012. [PMID: 23186486 DOI: 10.3109/10826084.2012.705678] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Brazil, the 6th largest world economy, has experienced rapid economic, demographic, and social structural changes during the last decade. Notwithstanding, Brazil being one of the most unequal societies worldwide, 40 million of 200 million Brazilians have moved from poverty to middle-class standards during this period. This review analyzes the success of different Brazilian initiatives aiming to reduce drug consumption-related harms, as well as the failed attempts to curb structural violence, despite some very recent initiatives have yet to be fully implemented and evaluated.
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Syringe coverage in an Australian setting: does a high level of syringe coverage moderate syringe sharing behaviour? AIDS Behav 2012; 16:1156-63. [PMID: 21811845 DOI: 10.1007/s10461-011-0010-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We examined individual-level syringe coverage among 417 people who inject drugs who were recruited from pharmacies in New South Wales in 2009. There was a U-shaped distribution of syringe coverage with many people having very high (51%) or very low (23%) coverage. Overall, two-thirds of respondents (63%) reported adequate coverage (≥ 100%). Respondents who had not used a needle and syringe program in the previous month were more likely to report inadequate coverage (AOR 2.25, 95% CI 1.25-4.05) as were those who reported daily or more frequent injecting (AOR 3.69, 95% CI 2.00-6.81). Inadequate syringe coverage was not independently associated with receptive needle sharing. The level of syringe coverage was high among this sample, and met targets set out by UNAIDS and other organisations. We found that inadequate syringe coverage was not independently correlated with receptive needle sharing, possibly because coverage is sufficient to diminish the relationship between syringe availability and sharing behaviours.
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Andrade TMD. Reflexões sobre políticas de drogas no Brasil. CIENCIA & SAUDE COLETIVA 2011; 16:4665-74. [DOI: 10.1590/s1413-81232011001300015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 09/30/2011] [Indexed: 11/22/2022] Open
Abstract
Este artigo trás algumas reflexões sobre as políticas de drogas no Brasil, desde os momentos iniciais do enfrentamento do HIV/AIDS entre os usuários de drogas injetáveis. Nos dois primeiros capítulos, tendo como ponto de partida os programas de trocas de seringas (PTS), o autor aborda o percurso da Política de Redução de Danos no Brasil e o papel nela desempenhado pelo Departamento de DST, AIDS e Hepatites Virais. O terceiro capítulo traz as ações desenvolvidas pela Coordenação Nacional de Saúde Mental Álcool e outras Drogas e pela Secretaria de Políticas sobre Drogas - SENAD, a partir da retração do Departamento de DST e AIDS nas políticas sobre drogas, bem como o surgimento do PEAD e do "Plano Crack", enquanto planos emergenciais para fazer face ao aumento do consumo de crack no país. No quarto e quinto capítulos são discutidos os dispositivos da atual política brasileira sobre drogas, suas limitações vinculadas, sobretudo, à fragilidade da Estratégia Saúde da Família, e são analisadas criticamente algumas das ações previstas no PEAD e no "Pano Crack". No sexto capítulo o autor trás os efeitos da repressão em nome do combate ao tráfico na política brasileira sobre drogas, tendo como pano de fundo a marginalização e a exclusão social dos usuários. Por fim, são apresentadas algumas proposições para a Política de Álcool e Drogas no Brasil.
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Elias LDA, Bastos FI. Saúde pública, redução de danos e a prevenção das infecções de transmissão sexual e sanguínea: revisão dos principais conceitos e sua implementação no Brasil. CIENCIA & SAUDE COLETIVA 2011; 16:4721-30. [DOI: 10.1590/s1413-81232011001300021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 01/23/2010] [Indexed: 11/22/2022] Open
Abstract
Este artigo aborda o contexto histórico e o marco conceitual da implantação dos programas de redução de danos no campo da saúde pública, com ênfase nos programas brasileiros. A presente revisão teve como objetivo principal investigar a pertinência atual de tais programas no enfrentamento das infecções de transmissão sexual e sanguínea, em especial, a AIDS e a hepatite C. Os resultados sistematizados pela literatura nacional e internacional indicam que as ações práticas de redução de danos são mais efetivas quando integradas a outras medidas de saúde pública, guiadas por princípios em comum. Iniciativas de redução de danos afinadas com princípios de saúde pública não se prendem a modelos, nem se esgotam em cuidados de saúde propriamente ditos. Abrangem diversas modalidades de ações pragmáticas, com base em políticas públicas, devem estar em sintonia com a comunidade desde seu planejamento, e serem executadas em parceria com esta.
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Nardi HC, Rigoni RDQ. [Mapping harm reduction programs in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil]. CAD SAUDE PUBLICA 2009; 25:382-92. [PMID: 19219246 DOI: 10.1590/s0102-311x2009000200017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 08/31/2008] [Indexed: 11/22/2022] Open
Abstract
This study mapped and described 11 harm reduction interventions/programs in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil, in 2004-2006. Mapping was based on interviews and analysis of available documents and comparison with a previous study with data from 2003. We aimed to discuss the programs' sustainability (political, financial, and administrative) and operational characteristics, based on the following categories: type of links in the program or intervention; forms of inclusion in the municipalities; background, financing; typical activities; team hiring practices; volunteer work, if any; resources (human and financial); partnerships; municipal legislation, if any; and participation in forums for political representation. Despite the diversity of links and organizational formats, there were some common characteristics: precarious professional status; dependence on volunteer work to implement activities; influence of turnover in Municipal and State administration on the continuity of projects and partnerships, as well as on the maintenance of human and financial resources. We conclude that such factors lead to lack of continuity in the services provided to the target population.
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Affiliation(s)
- Henrique Caetano Nardi
- Programa de Pós-Graduação em Psicologia Social e Institucional, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Fonseca EMD, Nunn A, Souza-Junior PB, Bastos FI, Ribeiro JM. [Decentralization, AIDS, and harm reduction: the implementation of public policies in Rio de Janeiro, Brazil]. CAD SAUDE PUBLICA 2008; 23:2134-44. [PMID: 17700948 DOI: 10.1590/s0102-311x2007000900021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 03/19/2007] [Indexed: 11/21/2022] Open
Abstract
This paper assesses how decentralization of resources and initiatives by the Brazilian National SDT/AIDS Program has impacted the transfer of funds for programs to prevent HIV/AIDS among injecting drug users in Rio de Janeiro, Brazil (1999-2006). The effects of the decentralization policy on Rio de Janeiro's Syringe Exchange Programs (SEPs) are assessed in detail. Decentralization effectively took place in Rio de Janeiro in 2006, with the virtual elimination of any direct transfer from the Federal government. The elimination of direct transfers forced SEPs to seek alternative funding sources. The structure of local SEPs appears to be weak and has been further undermined by current funding constraints. Of 22 SEPs operating in 2002, only two are still operational in 2006, basically funded by the State Health Secretariat and one municipal government. The current discontinuity of SEP operations may favor the resurgence of AIDS in the IDU population. A more uniform, regulated decentralization process is thus needed.
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Tempalski B, Cooper HL, Friedman SR, Des Jarlais DC, Brady J, Gostnell K. Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19 Suppl 1:S47-58. [PMID: 18295468 PMCID: PMC2706511 DOI: 10.1016/j.drugpo.2007.11.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 11/01/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Scientific consensus holds that if, at the outset of the HIV/AIDS epidemic, injection drug users (IDUs) had had better access to sterile syringes, much of the epidemic among IDUs in the U.S. could have been prevented. In the context of preventing infectious diseases, 100% syringe coverage - that is, one sterile syringe per injector for each injection - is a public health goal. Notably, we know little about variations in syringe coverage within the U.S. and elsewhere, or about the social and political factors that might determine this coverage. METHODS Using data from Holmberg (1996), the 1990 United States Census, the 2000 Beth Israel National Syringe Exchange Survey (n=72), and estimates of IDUs in metropolitan areas (MSAs); (Friedman et al., 2004), we explore the impact of (1) political factors (ACT UP, outreach, early syringe exchange programme (SEP) presence, men who have sex with men (MSM) per capita, drug arrests, and police per capita); (2) local resources for SEPs; and (3) indicators of socioeconomic inequality on SEP coverage. We define "syringe coverage" as the ratio of syringes distributed at SEPs to the number of syringes heroin injectors need in a year. We calculated the number of syringes heroin injectors need in a year by multiplying an estimate of the number of IDUs in each MSA by an estimate of the average number of times heroin injectors inject heroin per year (2.8 times per day times 365 days). In this analysis, the sample was limited to 35 MSAs in which the primary drug of choice among injectors was heroin. RESULTS SEP coverage varies greatly across MSAs, with an average of 3 syringes distributed per 100 injection events (S.D.=0.045; range: 2 syringes per 10 injection events, to 3 syringes per 10,000 injection events). In bivariate regression analyses, a 1 unit difference in the proportion of the population that was MSM per 1000 was associated with a difference of 0.002 in SEP coverage (p=0.052); early SEP presence was associated with a difference of 0.038 in coverage (p=0.012); and having government funding was associated with a 0.040 difference in SEP coverage (p=0.021). CONCLUSIONS This analysis suggests that longer duration of SEP presence may increase syringe distribution and enhance successful programme utilization. Furthermore, MSAs with greater proportions of MSM tend to have better SEP coverage, perhaps providing further evidence that grassroots activism plays an important role in programme implementation and successful SEP coverage. This research provides evidence that government funding for SEPs contributes to better syringe coverage.
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Affiliation(s)
- Barbara Tempalski
- National Development and Research Institutes, Inc., New York, NY, USA.
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Bastos FI, Caiaffa W, Rossi D, Vila M, Malta M. The children of mama coca: Coca, cocaine and the fate of harm reduction in South America. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:99-106. [PMID: 17689352 DOI: 10.1016/j.drugpo.2006.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 11/22/2006] [Indexed: 11/30/2022]
Abstract
The paper reviews the main findings from substance misuse research carried out over the last two decades in South America looking at the main initiatives aimed at reducing drug related harm and curbing the spread of HIV/AIDS and other sexually transmitted and blood-borne diseases. The current challenges faced by harm reduction in the region are analysed from the perspective of the history of coca and its different uses in South America. Except in Brazil and Argentina, the implementation of initiatives to reduce drug related harm in South America has been very cautious. The paper aims to link the analysis of harms associated with the use of illicit substances, with the often paradoxically harmful effects of supply-side drug policies in the world's largest coca/cocaine producing area. Despite the undeniable success of many initiatives, the broader context of harm maximization through structural violence and entrenched corruption acts as a major disincentive for the comprehensive adoption of sound public health policies.
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Bastos FI. The prevention and care of HIV-infected drug users in contemporary Brazil. Subst Use Misuse 2006; 41:833-4. [PMID: 16809171 DOI: 10.1080/10826080600790144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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