Transition from First Drug Use to Regular Injection among People Who Inject Drugs in Iran

A Pilot Study of Polysubstance Use Sequences across the Lifespan among Assiniboine and Sioux People Who Use Injection Drugs

Compared with other racial/ethnic groups in the United States, American Indians/Alaska Natives have the highest rates of acute Hepatitis C Virus (HCV) infection, the highest HCV-related mortality, and one of the fastest climbing rates of drug overdose deaths involving stimulants. In this pilot study, a life history calendar was administered to Indigenous people who use injection drugs (IPWIDs) to understand sequences of polysubstance use across the lifespan. 40 IPWIDs completed a questionnaire and life history calendar. Social sequence analysis was used to examine patterns in sequential phenomena among substances reported over years of the lifespan. Most participants (55%) began injecting substances before the age of 21, 62.5% shared syringes with others, and 45% had ever been diagnosed with HCV. An appreciably large increase in the use of stimulants occurred between the year prior to and following injection initiation (33% to 82%). A three-cluster solution distinguished younger IPWIDs transitioning into polysubstance use involving stimulants and/or narcotic analgesics from adults using narcotic analgesics with stimulants over longer periods of time, and adults most focused on stimulant use over time. Findings from this pilot study contribute to an understanding of how methamphetamine injection plays a role in the HCV epidemic among IPWIDs.

Epidemiology of Drug Use in Herat - Afghanistan

Background

Drug addiction is one of the alarming public health and social problems in Afghanistan and around the world. Addiction denotes the habitual use or the physical or mental dependence on narcotic drugs or psychotropic substances.

Methods

Drug addicts who were admitted to six public addicts' rehabilitation centers in Herat, Afghanistan between March and July 2019 were recruited for this descriptive study. A total of 299 drug addicts were included in this study. A 77-item questionnaire containing three subscales: 39 items for personal information, 32 items for drug use, and 6 items for dependence and treatment subscale were validated and used for data collection. IBM SPSS Statistics for Windows v.22.0 was used for data analyses.

Findings

The median age of the participants was 30 years. Of all participants, 79.1% were male, 56.6% were illiterate, and 1.7% were university graduates. In this study, 44.8% of the participants used heroin, 20.7% used opium and 15.4% used methamphetamine. Almost half of the participants (49.5%) declared that at least one member of their families was a drug user. Of the 299 drug users included in this study, 64.9% stated that at least one person close to them (except family members) used drugs. Over two-thirds of the participants (78.4%) had easy access to drugs, 26.8% had broken laws for money/drugs at least once.

Conclusion

This study revealed that male illiterate teenagers living in low-economic nuclear families were more vulnerable to drug use in Herat, Afghanistan. The most common reasons for drug use were curiosity, peer influence, and seeking pleasure.

Population Size Estimation of Drug Users in Isfahan City (Iran) Using Network Scale-up Method in 2018

BACKGROUND

To provide prevention programs and educate drug users (DUs), the estimation of their population is necessary. This study aimed to estimate the population size of this hidden group in Isfahan city as a metropolitan in Iran using the network scale-up ýmethod (NSUM).

METHODS

This cross-sectional study was performed in summer 2018 on 1000 people selected through a multistage sampling method based on 14 region of the municipality of Isfahan. The data collection tool was a questionnaire that was previously used in Dr. Banshi's national plan without any changes. The Cronbach's alpha value of the questionnaire was 0.826. Using correction factors such as transparency of response and the ratio of social network size used in previous national studies, the number of people with high-risk behaviors was estimated. The results were analyzed through NSUM based on survey analysis.

FINDINGS

Among all kinds of DUs, men were the largest consumers. The prevalence of use of opium, cannabis, heroin/crack, stimulants, ecstasy, hallucinogens, tramadol, zolpidem, tobacco, and drug injection was 2983, 2342, 613, 766, 86, 268, 1185, 213, 5869, 135 in 100000 people, among individuals of over 18 years of age. In both sexes, the prevalence of using opium and its nectar and illegal treatment with methadone and buprenorphine was higher in people of over 30 years of age, while the prevalence of consuming cannabis, ecstasy, tramadol, tobacco products, and stimulants was higher in the age group of 18 to 30 years.

CONCLUSION

The results indicated that the prevalence of different DUs in Isfahan city, especially among men was higher than the reported average (especially in young men of 18-30 years of age). Since the prevalence of drug use varies based on the type of substance used among age groups, targeted preventive planning based on the type of drug used and age group is recommended.

Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey

BACKGROUND

A Cross-sectional Rapid Situational Assessment of People Who Inject Drug (PWIDs) applying Respondent Driven sampling techniques (RDS) was used to recruit subjects/participants in a study aimed at assessing HIV prevalence and risk behaviors among injecting drug users in Nairobi and Coastal regions of Kenya. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. Past studies on PWID and its association to HIV and AIDS that have been conducted in Kenya do not provide sufficient information to support effective planning and comprehensive national response to the HIV and AIDS epidemic.

METHODS

A cross-sectional study design was adopted in which a set of initial subjects referred to as 'seeds' were first identified from which an expanding chain of referrals were obtained, with subjects from each wave referring subjects of subsequent waves. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. The second stage involved conducting assessment visits to the sites to identify potential collaborators that included non-governmental organizations (NGOs), drug treatment centres, health facilities, community based organizations (CBO's) among others. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. Key informant interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted using interview guides.

RESULTS

A total of 646 individuals (344 in Nairobi and 302 at the coast) were recruited for the study between January and March 2010. Of these 590 (91%) were male and 56 (9%) were female. Findings showed that most PWIDs initiated injecting drug use between the ages of 20-29 years, with the youngest age of initiation being 11 years and oldest age being 53 years. Most commonly injected drug was heroin (98%), with a small (2%) percentage injecting cocaine. Other non-injecting methods such as smoking or combining these two drugs with other drugs such as cannabis or Rohypnol were also common. Most PWIDs used other substances (cigarettes, alcohol, and cannabis) before initiating injecting drug use. The adjusted national HIV prevalence of PWIDs was 18.3% (19.62% unadjusted) with PWIDs in Nairobi region registering 18.33% (20.58% unadjusted) compared PWIDs for Coastal region indicating 18.27% (18.59% - unadjusted). The gender based HIV prevalence showed that women were more at risk of acquiring HIV (44.51%-adjusted) compared to men (15.97%-adjusted). The age specific HIV prevalence showed that PWIDs who initiated injecting at 11-19 years (44.7% adjusted) were most at risk in Nairobi compared to those who initiated injecting at age 20-24 years (23.2% - adjusted) in the coastal region. While all PWIDs continue to be at risk in the two regions, those from the Western parts of Nairobi, Kenya were at a relatively higher risk given their increased propensity for sharing injecting equipment and solutions.

CONCLUSIONS

Compared to the national HIV prevalence of (4.9%), the results show that People Who Inject Drugs (PWIDs) are at particularly high risk of infection in Kenya and there is urgent need for intervention (KenPHIA, 2018). This study also showed clear evidence that 70% of PWIDs are primary school educated, engage in high risk injecting and sexual behaviors comprising sharing of injecting equipment, unprotected heterosexual and homosexual sex. Given that initiation of injecting drug use begins early and peaks after formal school years (20-29 years), prevention programmes should be targeted at primary and secondary school students, college and out of school youth. Further, to protect People who inject drugs (PWIDs) from HIV infection, the country should introduce free Needle Syringe Programs (NSP) with provision of condoms and Methadone Assisted Therapy (MAT) as a substitute for drug use.

Drug injection and associated factors among the elderly living with HIV/AIDS in Tehran, Iran

Background: Injection of drugs is one of the most serious health problems among Iranian living with HIV/AIDS. The injection of drugs, accounting for the transmission of more than two-thirds of HIV infections. HIV remains a major concern around the world and is expected to be the third leading cause of mortality worldwide. Thus, the aim of this study was to explore the predictors of injection drug use in the elderly patients living with HIV/AIDS. Methods: This was a cross-sectional study executed in Tehran City, Iran, in 2018. A total of 160 individuals aged 60 years and older with HIV from different counseling centers were selected by convenience sampling. Data were collected using questionnaires including a positive state of mind, coping, social support, and a checklist of demographical variables. Bivariate analysis and multiple logistic regression using SPSS software version 21.0 were employed to determine factors associated with drug injection. The statistical tests were performed with a significance level of 5% (p≥0.05). Results: The study participants' mean(SD) age was 65.6(±6.6) years. In total, 33 people (20.6%) of the samples reported injection drug use. The frequency of injection drug use was greater among men (AOR: 2.28, 95% CI 2.2-22.8; p=0.010), those reporting a monthly income of ≥30000000 Rials (AOR: 31.56, 95% CI 2.95-338; p=0.004), subjects with past experience of drug use (AOR: 7.11, 95% CI 2.18-23.2; p=0.001), those with ≥2 years past from their HIV diagnosis (AOR: 4.04, 95% CI 1.12-14.58; p=0.033), and those living with more than two people in one residential place (Household size AOR: 5.9, 95% CI 1.64-21.24; p=0.007). Conclusion: It seems that the design and implementation of harm reduction programs among the elderly with HIV/AIDS who inject drugs are essential and should be considered as an agenda of policymakers and health professionals.

Associations Between Childhood Trauma and the Age of First-Time Drug Use in Methamphetamine-Dependent Patients

Childhood trauma is related to substance use disorder; however, few studies have examined the relationship between childhood trauma and the age at which the drug was first used. The aim of this study was to investigate the relationship between childhood trauma and the age of first-time drug use among methamphetamine-dependent patients. Moreover, we analyzed the characteristics of adverse family environment associated with severe childhood trauma and the risk factors for starting drugs in minors. A baseline interview was conducted with 110 participants who were in detoxification, including demographic information, past substance use, and age of first-time drug use. The participants' childhood trauma experience before 18 years of age was evaluated using the simplified version of the Childhood Trauma Questionnaire (CTQ-SF). The Chinese version of the Family Environment Scale (FES-CV) was used to assess the family environment of methamphetamine-dependent patients. Among 110 non-injecting methamphetamine-dependent patients, nearly half (n = 48, 43.6%) had moderate and severe childhood trauma. Correlation analysis showed that the age of first-time drug use negatively correlated with emotional abuse (r = -0.32, p < 0.01) and physical abuse (r = -0.27, p < 0.01). The age of first-time drug use negatively correlated with conflict (r = -0.20, p < 0.05) and independence (r = -0.22, p < 0.05) of family environment, but positively correlated with intellectual-cultural orientation (r = 0.28, p < 0.01). Additionally, childhood trauma factors significantly correlated with many indexes of family environment, especially cohesion (r = -0.45, p < 0.01), conflict (r = 0.49, p < 0.01), and independence (r = 0.33, p < 0.01). Additionally, the regression model showed that when emotional abuse increased by one point, the age of first-time drug use was 0.69 years earlier. These findings suggest that a detrimental family environment can aggravate childhood trauma, and the experience of childhood emotional or physical abuse may be an effective predictor of early drug use among methamphetamine-dependent patients.

When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

BACKGROUND

In Uganda, injection drug use is a growing but less studied problem. Preventing the transition to injection drug use may help prevent blood-borne viral transmission, but little is known about when and how people transition to injection drug use. A greater understanding of this transition process may aid in the country's efforts to prevent the continued growth of injection drug use, HIV, and hepatitis C Virus (HCV) infection among people who inject drugs (PWID).

METHODS

Using a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)-recruited through outreach and snow-ball sampling. Participants were interviewed about their experiences on when and how they transitioned into injection drug use and these issues were also discussed in 12 focus groups held with the participants.

RESULTS

All the study participants started their drug use career with non-injecting forms including chewing, smoking, and sniffing before transitioning to injecting. Transitioning was generally described as a peer-driven and socially learnt behavior. The participants' social networks and accessibility to injectable drugs on the market and among close friends influenced the time lag between first regular drug use and first injecting-which took an average of 4.5 years. By the age of 24, at least 81.6% (95.7% for females and 78.4% for males) had transitioned into injecting. Over 84.8% shared injecting equipment during their first injection, 47.2% started injecting because a close friend was already injecting, 26.4% desired to achieve a greater "high" (26.4%) which could reflect drug-tolerance, and 12% out of curiosity.

CONCLUSIONS

Over 81% non-injecting drug users in Kampala and Mbale districts transitioned into injecting by the age of 24; a process that reproduces a population of PWID but also puts them at increased risk of HIV and HCV infection. As Uganda makes efforts to introduce and/or strengthen harm reduction services, interventions targeting non-injecting drug users before they transition into injecting should be considered as a key component for HIV/HCV epidemic control efforts, and their evaluation considered in future researches.