Pregnancy and Sexual Health Among Homeless Young Injection Drug Users

PubMed Central

Hathazi, Dodi; Lankenau, Stephen E.; Sanders, Bill; Bloom, Jennifer Jackson

2009-01-01

Research on pregnancy and sexual health among homeless youth is limited. In this study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices, housing status, substance use, utilization of prenatal care, and histories of sexual victimization are described. A total of 81 lifetime pregnancies and 26 children were reported. Infrequent and ineffective use of contraception was common. While pregnancy motivated some homeless youth to establish housing, miscarriages and terminations were more frequent among youth who reported being housed. Widespread access to prenatal and medical services was reported during pregnancy, but utilization varied. Many women continued to use substances throughout pregnancy. Several youth reported childhood sexual abuse and sexual victimization while homeless. Pregnancy presents a unique opportunity to encourage positive health behaviors in a high-risk population seldom seen in a clinical setting. PMID:18692891

A TYPOLOGY OF DRUG-RELATED OFFENDING AMONG YOUNG HOMELESS INJECTION DRUG USERS

PubMed Central

Sanders, Bill; Lankenau, Stephen E.; Jackson Bloom, Jennifer; Hathaz, Dodi S.

2011-01-01

Research indicates a link between drug use and offending, particularly amongst high-risk individuals, such as homeless youth. The extent to which such youth interpret their offending as being related to their drug use, though, is understudied. This manuscript investigates the interpretations of drug-related offenses offered by 151 primarily white, male, homeless IDUs aged 16–29 years. Youth were asked specific questions about their drug-related offenses during in-depth interviews as part of a larger study investigating health risks surrounding drug injection between 2004 and 2006. The first section of the manuscript outlines offenses youth revealed committing either in pursuit of or after using a variety of substances. The second part of the manuscript examines the overall context (motivation, environment), and provides a seven-tiered typology of drug-related offending based on youth's interpretations, linking certain drugs to specific offenses within particular contexts. From here, some theoretical and practical implications of the findings are discussed. PMID:21423855

The Everyday Violence of Hepatitis C Among Young Women Who Inject Drugs in San Francisco

PubMed Central

Bourgois, Philippe; Prince, Bridget; Moss, Andrew

2005-01-01

A theoretical understanding of the gendered contours of structural, everyday and symbolic violence suggests that young addicted women are particularly vulnerable to the infectious diseases caused by injection drug use—especially hepatitis C. Participant-observation fieldwork among heroin and speed addicts in San Francisco’s Haight Ashbury neighborhood reveals that extreme levels of violence against women are normalized in the common sense of street-youth drug culture. Physical, sexual and emotional violence, as well as the pragmatics of income generation, including drug and resource sharing in the moral economy of street addicts, oblige most young homeless women to enter into relationships with older men. These relationships are usually abusive and economically parasitical to the women. Sexual objectification and a patriarchal romantic discourse of love and moral worth leads to the misrecognition of gender power inequities by both the men and women who are embroiled in them, as well as by many of the public services and research projects designed to help or control substance abusers. Despite deep epistemological, theoretical and logistical gulfs between quantitative and qualitative methods, applied public health research and the interventions they inform can benefit from the insights provided by a theoretical and cross-methodological focus on how social power contexts shape the spread of infectious disease and promote disproportional levels of social suffering in vulnerable populations. PMID:16685288

Adolescents, sex and injecting drug use: risks for HIV infection.

PubMed

Barnard, M; McKeganey, N

1990-01-01

In this paper we present data on the HIV-related risks for adolescents growing up in an area where injecting drug use is prevalent and HIV infection has been identified among local injecting drug users. We report on young peoples' knowledge, attitudes and perceptions of drug use and injectors; HIV and AIDS; sex, safer sex and condom use. These adolescents had an extensive and practically oriented knowledge of illicit drugs and drug injectors. The majority of adolescents contacted had an unsophisticated but approximate understanding of HIV transmission dynamics and how to guard against infection. Our data suggest that many adolescents find issues relating to sex awkward, embarrassing and difficult subjects for discussion. In a final section we consider some of the policy implications of our work focussing in particular on the prevention of injecting, the promotion of condom use, and the necessity of avoiding a focus upon risk groups.

"The first shot": the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil.

PubMed

Oliveira, Maria de Lourdes Aguiar; Hacker, Mariana A; Oliveira, Sabrina Alberti Nóbrega de; Telles, Paulo Roberto; O, Kycia Maria Rodrigues do; Yoshida, Clara Fumiko Tachibana; Bastos, Francisco I

2006-04-01

The context of first drug injection and its association with ongoing injecting practices and HCV (hepatitis C virus) infection were investigated. Injection drug users (IDUs) (N = 606) were recruited in "drug scenes" (public places, bars) in Rio de Janeiro, Brazil, interviewed, and tested for HCV. Sharing of needles/syringes was more prevalent at the first injection (51.3%) than at the baseline interview (36.8%). Those who shared syringes/needles at first injection were more likely to be currently engaged in direct/indirect sharing practices. Among young injectors (< 30 years), those reporting sharing of needles/ syringes at the first injection were about four times more likely to have been infected by HCV. Hepatitis C virus prevalence among active IDUs (n = 272) was 11%. Prison history and longer duration of drug injection were identified as independent predictors of HCV infection. To effectively curb HCV transmission among IDUs and minimize harms associated with risk behaviors, preventive strategies should target individuals initiating drug injection beginning with their very first injection and discourage the transition from non-injecting use to the self-injection of illicit drugs.

Non-injection Drug Use and Injection Initiation Assistance among People Who Inject Drugs in Tijuana, Mexico.

PubMed

Ben Hamida, Amen; Rafful, Claudia; Jain, Sonia; Sun, Shelly; Gonzalez-Zuniga, Patricia; Rangel, Gudelia; Strathdee, Steffanie A; Werb, Dan

2018-02-01

Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39-4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98-21.78), heroin (AOR = 4.00, 95% CI = 1.88-8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16-3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting.

Comparing Characteristics of Early-Onset Injection Drug Users to Those With Late-Onset Injection in Kermanshah, Iran.

PubMed

Jorjoran Shushtari, Zahra; Noroozi, Alireza; Mirzazadeh, Ali; Ahounbar, Elahe; Hajbi, Ahmad; Najafi, Mohammad; Bazrafshan, Ali; Farhadi, Mohammad Hossin; Farhoudian, Ali; Higgs, Peter; Shahboulagh, Farahnaz Mohammadi; Waye, Katherine; Noroozi, Mehdi

2017-05-12

Characteristics and behaviors of early-onset injection drug users are under studied topics in Iran. This study aimed to identify and compare the demographic characteristics as well as the drug using behaviors of early-onset and late-onset injection drug users in Kermanshah, West Iran. In this cross-sectional study using snowball and convenience sampling, we recruited 450 people during the Fall of 2014 from two drop in centers in Kermanshah, Iran. We collected data through face-to-face interviews. Early-onset injection is defined as whether the person reported their first injection at 22 years of age or younger. Subsequently, late-onset injection is defined as 23 years of age or older. We compared the characteristics of the two groups through both univariate and multiple logistic analyses. Overall, 54% (CI 95%: 44.3%, 62.2%) were early injectors. After controlling for low socioeconomic status, initiation of drug use at a young age, multiple drug use and methamphetamine use were all significantly associated with a higher likelihood of early-onset injection. Additionally, early-onset injection was associated with recent syringe borrowing (OR = 2.6, p = 0.001), recent syringe lending (OR = 1.4, p = 0.01), recent cooker sharing (OR = 3.2, p = 0.01) and injecting two or more times a day (OR = 2.2, p = 0.04). Early-onset injectors were more likely to report a lower socioeconomic status, initiation of first drug use at a younger age, using methamphetamine alongside polydrug use, and engaging in higher risk taking behaviors like borrowing needles. With these associations, the study emphasizes the need for drug-prevention programs to focus on the transition to injection drug use at younger ages.

Cross-border drug injection relationships among injection drug users in Tijuana, Mexico

PubMed Central

Wagner, Karla D.; Pollini, Robin A.; Patterson, Thomas L.; Lozada, Remedios; Ojeda, Victoria D.; Brouwer, Kimberly C.; Vera, Alicia; Volkmann, Tyson A.; Strathdee, Steffanie A.

2010-01-01

Background International borders are unique social and environmental contexts characterized by high levels of mobility. Among drug users, mobility increases risk for human immunodeficiency virus (HIV) in part through its effects on the social environment. However, the social dynamics of drug users living in border regions are understudied. Methods 1056 injection drug users (IDUs) residing in Tijuana, Mexico were recruited using respondent-driven sampling (RDS) from 2006 to 2007, and underwent surveys and testing for HIV, syphilis, and tuberculosis (TB). Using logistic regression on baseline data, we identified correlates of having ever injected drugs with someone from the US. Results Almost half (48%) reported ever injecting drugs with someone from the US. In RDS-adjusted logistic regression, factors independently associated with having ever injected with someone from the US included: having greater than middle school education (Adjusted Odds Ratio [AOR] 2.91; 95% Confidence Interval [C.I.] 1.52, 5.91), speaking English (AOR 3.24, 95% C.I. 1.96, 5.36), age (AOR 1.10 per year; 95% C.I. 1.07, 1.14), age at initiation of injection drug use (AOR 0.90 per year; 95% C.I. 0.86, 0.94), homelessness (AOR 2.61; 95% C.I. 1.27, 5.39), and having ever been incarcerated (AOR 11.82; 95% C.I., 5.22, 26.77). No associations with HIV, syphilis, TB, drug use, or injection risk behavior were detected. Conclusion Findings suggest that IDU networks in Mexico and the US may transcend international borders, with implications for cross-border transmission of infectious disease. Binational programs and policies need to consider the structure and geographic distribution of drug using networks. PMID:20889270

Prevalence of skin problems and leg ulceration in a sample of young injecting drug users.

PubMed

Coull, Alison F; Atherton, Iain; Taylor, Avril; Watterson, Andrew E

2014-08-13

Drug users suffer harm from the injecting process, and clinical services are reporting increasing numbers presenting with skin-related problems such as abscesses and leg ulcers. Skin breakdown can lead to long-term health problems and increased service costs and is often the first indication of serious systemic ill health. The extent of skin problems in injecting drug users has not previously been quantified empirically, and there is a dearth of robust topical literature. Where skin problems have been reported, this is often without clear definition and generic terms such as 'soft tissue infection' are used which lack specificity. The aim of this study was to identify the range and extent of skin problems including leg ulceration in a sample of injecting drug users. Definitions of skin problems were developed and applied to descriptions from drug users to improve rigour. Data were collected in needle exchanges and methadone clinics across Glasgow, Scotland, from both current and former drug injectors using face-to-face interviews. Two hundred participants were recruited, of which 74% (n = 148) were males and 26% (n = 52) were females. The age range was 21-44 years (mean 35 years). Just under two thirds (64%, n = 127) were currently injecting or had injected within the last 6 months, and 36% (n = 73) had previously injected and had not injected for more than 6 months.Sixty per cent (n = 120) of the sample had experienced a skin problem, and the majority reported more than one problem. Most common were abscesses, lumps, track marks and leg ulcers. Fifteen per cent (n = 30) of all participants reported having had a leg ulcer. This is an original empirical study which demonstrated unique findings of a high prevalence of skin disease (60%) and surprisingly high rates of leg ulceration (15%). Skin disease in injecting drug users is clearly widespread. Leg ulceration in particular is a chronic recurring condition that is costly to treat and has

Opioid Use Trajectories, Injection Drug Use and HCV Risk among Young Adult Immigrants from the Former Soviet Union Living in New York City

PubMed Central

Guarino, Honoria; Marsch, Lisa A.; Deren, Sherry; Straussner, Shulamith L.A.; Teper, Anastasia

2015-01-01

Available evidence suggests that young former Soviet Union immigrants in New York City have high rates of non-medical prescription opioid and heroin use, drug injection and injection-related risk behavior, making them vulnerable to hepatitis C virus (HCV)/human immunodeficiency virus (HIV) infection, overdose and associated harms. This group has been the focus of little research, however. This paper presents quantitative and qualitative data from 80 former Soviet immigrants (ages 18–29) to characterize their opioid use trajectories, injection risk behavior, HCV/HIV testing histories and self-reported HCV/HIV serostatus, and provides clinically meaningful data to inform tailored education, prevention and harm reduction interventions. PMID:26132715

HIV Prevention and Rehabilitation Models for Women Who Inject Drugs in Russia and Ukraine

PubMed Central

Skipalska, Halyna; Suvorova, Svetlana; Sukovatova, Olga; Zakharov, Konstantin; Hodgdon, Sara

2012-01-01

Women who inject drugs require gender-specific approaches to drug rehabilitation, modification of risk behaviors, and psychosocial adaptation. Improved outcomes have been demonstrated when the specific needs of women's subpopulations have been addressed. Special services for women include prenatal care, child care, women-only programs, supplemental workshops on women-focused topics, mental health services, and comprehensive programs that include several of the above components. To address the special needs of women injecting drug user (IDU) subpopulations, such as HIV-positive pregnant women and women with young children, recently released female prisoners, and street-involved girls and young women, HealthRight International and its local partners in Russia and Ukraine have developed innovative service models. This paper presents each of these models and discusses their effectiveness and implementation challenges specific to local contexts in Russia and Ukraine. PMID:23304535

"Injection first": a unique group of injection drug users in Tijuana, Mexico.

PubMed

Morris, Meghan D; Brouwer, Kimberly C; Lozada, Remedios M; Gallardo, Manuel; Vera, Alicia; Strathdee, Steffanie A

2012-01-01

Using baseline data from a study of injection drug users (IDUs) in Tijuana, Mexico (N = 1,052), we identified social and behavioral factors associated with injecting at the same age or earlier than other administration routes of illicit drug use (eg, "injection first") and examined whether this IDU subgroup had riskier drug using and sexual behaviors than other IDUs. Twelve-percent "injected first." Characteristics independently associated with a higher odds of "injection first" included being younger at first injection, injecting heroin as their first drug, being alone at the first injection episode, and having a sexual debut at the same age or earlier as when they initiated drug use; family members' illicit drug use was associated with lower odds of injecting first. When adjusting for age at first injection and number of years injecting, "injection first" IDUs had lower odds of ever overdosing, and ever trading sex. On the other hand, they were less likely to have ever been enrolled in drug treatment, and more commonly obtained their syringes from potentially unsafe sources. In conclusion, a sizable proportion of IDUs in Tijuana injected as their first drug using experience, although evidence that this was a riskier subgroup of IDUs was inconclusive.  Copyright © American Academy of Addiction Psychiatry.

Opioid Use Trajectories, Injection Drug Use, and Hepatitis C Virus Risk Among Young Adult Immigrants from the Former Soviet Union Living in New York City.

PubMed

Guarino, Honoria; Marsch, Lisa A; Deren, Sherry; Straussner, Shulamith L A; Teper, Anastasia

2015-01-01

Available evidence suggests that young former Soviet Union immigrants in New York City have high rates of non-medical prescription opioid and heroin use, drug injection and injection-related risk behavior, making them vulnerable to hepatitis C virus (HCV)/human immunodeficiency virus (HIV) infection, overdose and associated harms. This group has been the focus of little research, however. This paper presents quantitative and qualitative data from 80 former Soviet immigrants (ages 18-29) to characterize their opioid use trajectories, injection risk behavior, HCV/HIV testing histories and self-reported HCV/HIV serostatus, and provides clinically meaningful data to inform tailored education, prevention and harm reduction interventions.

The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD.

PubMed

Linton, Sabriya L; Celentano, David D; Kirk, Gregory D; Mehta, Shruti H

2013-10-01

Few studies have assessed the temporal association between homelessness and injection drug use, and injection-related risk behavior. Among a cohort of 1405 current and former injection drug users in follow-up from 2005 to 2009, we used random intercept models to assess the temporal association between homelessness and subsequent injection drug use, and to determine whether the association between homelessness and sustained injection drug use among active injectors differed from the association between homelessness and relapse among those who stopped injecting. We also assessed the association between homelessness and subsequent injection-related risk behavior among participants who injected drugs consecutively across two visits. Homelessness was categorized by duration: none, <1 month, and ≥1 month. Homelessness was reported on at least one occasion by 532 (38%) participants. The relationship between homelessness and subsequent injection drug use was different for active injectors and those who stopped injecting. Among those who stopped injecting, homelessness was associated with relapse [<1 month: AOR=1.67, 95% CI (1.01, 2.74); ≥1 month: AOR=1.34 95% CI (0.77, 2.33)]. Among active injectors, homelessness was not associated with sustained injection drug use [<1 month: AOR=1.03, 95% CI (0.71, 1.49); ≥1 month: AOR=0.81 95% CI (0.56, 1.17)]. Among those injecting drugs across two consecutive visits, homelessness ≥1 month was associated with subsequent injection-related risk behavior [AOR=1.61, 95% CI (1.06, 2.45)]. Homelessness appears to be associated with relapse and injection-related risk behavior. Strengthening policies and interventions that prevent homelessness may reduce injection drug use and injection-related risk behaviors. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Factors associated with time between using a drug and injection initiation among people who inject drugs in Kermanshah, Iran.

PubMed

Noroozi, Mehdi; Farhadi, Mohammad Hassan; Armoon, Bahram; Farhoudian, Ali; Shushtari, Zahra Jorjoran; Sharhani, Asaad; Karimi, Salah Eddin; Sayadnasiri, Mohammad; Rezaei, Omid; Ghiasvand, Hesam

2018-05-17

Background The transition from non-injection to injection drug use dramatically increases the risk of transmitting HIV and other blood borne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). The aim of this study was to explore factors associated with the transition from first illicit drug use to first injection among drug users. Methods Using snowball sampling and convenience sampling through needle and syringe programmes (NSPs), we recruited 500 people who inject drugs (PWID) in Kermanshah, between September and December 2014. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our main outcome variable was first illicit drug use to first injection (TIJ). TIJ was calculated by subtracting age at first drug injection from age of first illicit drug use. Results Overall, the average age at first drug use and injection were 21.4 [standard deviation (SD 5.6)] and 22.8 (SD 8.9), respectively. The average duration of injection was 6.0 (SD 4.6) years. Overall, the mean of TIJ for participants was 1.4 (IQR = 2, 4) years. Age of first injecting drug use negatively correlated with TIJ (R2 = 0.219, p = 0.001). Education level and socioeconomic status (SES), and negatively correlated with TIJ. Conclusion Some demographic factors and drug use characteristics including educational level, SES, knowledge of HIV status, age of initiating drug use, being a poly drug user and using methamphetamine were predictors of the time to transition.

Young people who use drugs engaged in harm reduction programs in New York City: Overdose and other risks.

PubMed

Calvo, Michele; MacFarlane, Jessica; Zaccaro, Heather; Curtis, Matthew; Cabán, María; Favaro, Jamie; Passannante, Marian R; Frost, Taeko

2017-09-01

Little is known about the engagement of young people who use drugs (PWUD) in harm reduction programs (HRPs), and few studies have included non-opioid users and non-injectors. While HRPs have effectively engaged PWUD, young people are under-represented in their services. The Injection Drug Users Health Alliance Citywide Study (IDUCS) is the largest community-based study of PWUD in HRPs in the US. From 2014-2015, 2421 HRP participants across New York City (NYC) completed a cross-sectional survey. We investigated differences in socio-demographics, service utilization, and risk behaviors between young (aged 18-30) and older participants and examined factors associated with overdose among young participants. The study included 257 young participants. They were significantly more likely than older participants to be white, educated, uninsured, unstably housed or homeless, and have a history of incarceration and residential drug treatment. They were more likely to report recent overdose but less likely to report knowledge of naloxone. Young participants also had higher rates of alcohol, marijuana, benzodiazepine, and injection drug use, and related risk behaviors such as public injection. Factors associated with past year overdose among young participants included experiencing symptoms of psychological distress (AOR=9.71), being unstably housed or homeless (AOR=4.39), and utilizing detox (AOR=4.20). Young PWUD who access services at HRPs in NYC differ significantly from their older counterparts. New York City and other urban centers that attract young PWUD should consider implementing harm reduction oriented services tailored to the unique needs of young people. Copyright © 2017. Published by Elsevier B.V.

The Cedar Project: mortality among young Indigenous people who use drugs in British Columbia

PubMed Central

Jongbloed, Kate; Pearce, Margo E.; Pooyak, Sherri; Zamar, David; Thomas, Vicky; Demerais, Lou; Christian, Wayne M.; Henderson, Earl; Sharma, Richa; Blair, Alden H.; Yoshida, Eric M.; Schechter, Martin T.; Spittal, Patricia M.

2017-01-01

BACKGROUND: Young Indigenous people, particularly those involved in the child welfare system, those entrenched in substance use and those living with HIV or hepatitis C, are dying prematurely. We report mortality rates among young Indigenous people who use drugs in British Columbia and explore predictors of mortality over time. METHODS: We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated age-standardized mortality ratios using Indigenous and Canadian reference populations. We identified predictors of mortality using time-dependent Cox proportional hazard regression. RESULTS: Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 person-years. Young Indigenous people who used drugs were 12.9 (95% confidence interval [CI] 9.2–17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6–10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The leading causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and suicide (n = 5 [12%]). Predictors of mortality included having hepatitis C at baseline (adjusted hazard ratio [HR] 2.76, 95% CI 1.47–5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01–3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00–8.09). INTERPRETATION: Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersections of historical and present-day injustices, substance use and barriers to care. PMID:29109208

Syringe Exchange, Injecting and Intranasal Drug Use

PubMed Central

Arasteh, Kamyar; McKnight, Courtney; Ringer, Martin; Friedman, Samuel R.

2016-01-01

Objective To assess trends in injecting and non-injecting drug use after implementation of large-scale syringe exchange in New York City. The belief that implementation of syringe exchange will lead to increased drug injecting has been a persistent argument against syringe exchange. Methods Administrative data on route of administration for primary drug of abuse among patients entering the Beth Israel methadone maintenance program from 1995 – 2007. Approximately 2000 patients enter the program each year. Results During and after the period of large scale implementation of syringe exchange, the numbers of methadone program entrants reporting injecting drug use decreased while the numbers of entrants reporting intranasal drug use increased (p < .001). Conclusion While assessing possible effects of syringe exchange on trends in injecting drug use is inherently difficult, this may be the strongest data collected to date showing a lack of increase in drug injecting following implementation of syringe exchange. PMID:19891668

Down in the Valley: Trajectories of Injection Initiation among Young Injectors in California’s Central Valley

PubMed Central

Syvertsen, Jennifer L.; Paquette, Catherine E.; Pollini, Robin A.

2017-01-01

Background Injection drug use initiation represents a critical point of public health intervention, as injection increases risk forblood borne infections including Hepatitis C and HIV. In this paper, weexplore pathways to injection initiation among youth (<=30) in the ruralcontext of California’s Central Valley, where rates of injection drug useare among the highest in the nation. Methods We draw on semi-structured qualitative interviews with 20 younginjectors to examine drug use histories, including the factors that participants associated with their transition to injection drug use. Results The average age was 24.7 years (range: 20–30), 45% were female(n=9), and 30% were Latino (n=6). Participants described a variety ofpathways to injection, culminating in a first injection that involvedeither opioids (n=12) or methamphetamine (n=8). Among the opioid group, the majority used prescription opioids before transitioning to injection, while a smaller number transitioned to opioid injection from non-opioid recreational drug use. Injectors who first used prescription opioidsoften described growing up in affluent suburban areas and transitioned toinjection with peers, owing to a combination of factors related toindividual tolerance, cost, and shifting drug markets. In contrast, methamphetamine initiates grew up in less affluent families withhistories of substance use that exposed them to drugs at an early age. Methamphetamine users transitioned from smoking and snorting toinjection, often with family members or intimate partners, within broadercontexts of social disadvantage and stress. Conclusions While much of the focus on young injectors has centered onthe current opioid epidemic, our data suggest a need to consider multiple pathways toward injection initiation of different drugs. Targetedinterventions addressing the unique injection transition contexts of bothopioids and methamphetamine are urgently needed in the Central Valley ofCalifornia. PMID:28458170

Higher risk of incident hepatitis C virus among young women who inject drugs compared with young men in association with sexual relationships: a prospective analysis from the UFO Study cohort.

PubMed

Tracy, Daniel; Hahn, Judith A; Fuller Lewis, Crystal; Evans, Jennifer; Briceño, Alya; Morris, Meghan D; Lum, Paula J; Page, Kimberly

2014-05-29

Female injection drug users (IDUs) may report differences in injection behaviours that put them at greater risk for hepatitis C virus (HCV). Few studies have examined these in association with HCV incidence. Longitudinal data from a cohort of 417 HCV-uninfected IDU aged 30 or younger were analysed. Cox proportional hazards was used to model female sex as a predictor of new HCV infection. General estimating equation (GEE) analysis was used to model female sex as a predictor of HCV-associated risk behaviour prospectively. Women were significantly more likely than men to become infected with HCV during study follow-up (HR 1.4, p<0.05), and were also more likely than men to report high-risk injecting behaviours, especially in the context of sexual and injecting relationships. Sex differences in injecting behaviours appeared to explain the relationship between sex and HCV infection. Young women's riskier injection practices lead to their higher rates of HCV infection. Further study on the impact of intimate partnership on women's risk behaviour is warranted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The social course of drug injection and sexual activity among YMSM and other high-risk youth: an agenda for future research.

PubMed

Clatts, Michael C; Goldsamt, Lloyd; Neaigus, Alan; Welle, Dorinda L

2003-12-01

The cumulative epidemiologic literature indicates that many injecting drug users (IDUs) initiate injection as a mode of drug administration during late adolescence or early adulthood. Recent studies have shown that IDUs are often exposed to viral infections relatively early in the course of injection, highlighting the importance of understanding this initiation process for both epidemiology and prevention. Epidemiologic evidence similarly suggests that at least some youth populations, most notably young men who have sex with men (YMSM), are at substantial risk for exposure to HIV and other sexually transmitted diseases (STDs) from early sexual activity. Despite the importance of this issue for both epidemiology and prevention, however, surprisingly little information is available on the social course of injection initiation, including the individual, social, or ecological factors that might mitigate or exacerbate transmission risks within the critical phase of early injection drug use. Similarly, we know little about the ways that YMSM and other high-risk youth understand risk, the kinds of exchanges and relationships in which they participate in the context of initiating sexual activity, or how drug use is operant in these exchanges and early sexual experiences. In this article, we explore key dimensions of the early initiation of injection and sexual risk, and discuss how a social network approach might be instrumental in understanding the social course of drug injection and sexual activities among youth and young adult populations.

Factors associated with pathways toward concurrent sex work and injection drug use among female sex workers who inject drugs in Northern Mexico

PubMed Central

Morris, Meghan D.; Lemus, Hector; Wagner, Karla D.; Martinez, Gustavo; Lozada, Remedios; Gómez, Rangel María Gudelia; Strathdee, Steffanie A.

2012-01-01

Aims To identify factors associated with time to initiation of (1) sex work prior to injecting drugs, (2) injection drug use, and (3) concurrent sex work and injection drug use (i.e., initiated at the same age) among female sex workers who currently inject drugs (FSW-IDU). Design Parametric survival analysis of baseline data for time to initiation event. Setting Tijuana and Ciudad Juarez situated on the Mexico-U.S. border. Participants 575 FSW-IDUs aged ≥18. Measurements Interview-administered surveys assessing context of sex work and injection drug use initiation. Findings Nearly half (n=256) initiated sex work prior to beginning to inject, a third (n=163) initiated injection first, and a quarter (n=136) initiated both sex work and injection drug use concurrently. Low education and living in Ciudad Juarez accelerated time to sex work initiation. Being from a southern Mexican state and initiating drug use with inhalants delayed the time to first injection drug use. Having an intimate partner encourage entry into sex work and first injecting drugs to deal with depression accelerated time to initiating sex work and injection concurrently. Early physical abuse accelerated time to initiating sex work and injection, and substantially accelerated time to initiation of both behaviors concurrently. Conclusions Among female sex workers who currently inject drugs in two Mexican-US border cities, nearly half appear to initiate sex work prior to beginning to inject, nearly one third initiate injection drug use before beginning sex work, and one quarter initiate both behaviors concurrently. Predictors of these three trajectories differ, and this provides possible modifiable targets for prevention. PMID:22775475

Compulsory drug detention and injection drug use cessation and relapse in Bangkok, Thailand.

PubMed

Fairbairn, Nadia; Hayashi, Kanna; Ti, Lianping; Kaplan, Karyn; Suwannawong, Paisan; Wood, Evan; Kerr, Thomas

2015-01-01

Strategies to promote the reduction and cessation of injection drug use are central to human immunodeficiency virus prevention and treatment efforts globally. Though drug use cessation is a major focus of drug policy in Thailand, little is known about factors associated with injection cessation and relapse in this setting. A cross-sectional study was conducted between July and October 2011 of a community-recruited sample of people who inject drugs in Bangkok, Thailand. Using multivariate logistic regression, we examined the prevalence and correlates of injection drug use cessation with subsequent relapse. Among 422 participants, 209 (49.5%) reported a period of injection drug use cessation of at least one year. In multivariate analyses, incarceration (adjusted odds ratio [AOR] 13.07), voluntary drug treatment (AOR 2.75), midazolam injection (AOR 2.48) and number of years since first injection (AOR 1.07) were positively associated with injection cessation of duration greater than a year (all P < 0.05). Exposure to compulsory drug detention was positively associated (AOR 2.61) and methadone treatment was negatively associated (AOR 0.38) with short-term cessation only. Injection drug use cessation was most often due to incarceration (74%), and relapse was associated with release from prison (66%). Half of the study participants had previously stopped injecting drugs for more than a year, and this was strongly associated with incarceration. Compulsory drug detention was associated with short-term cessation and relapse. A range of evidence-based strategies should be made available to facilitate sustained cessation of injection drug use in Thailand. © 2014 Australasian Professional Society on Alcohol and other Drugs.

Factors associated with pathways toward concurrent sex work and injection drug use among female sex workers who inject drugs in northern Mexico.

PubMed

Morris, Meghan D; Lemus, Hector; Wagner, Karla D; Martinez, Gustavo; Lozada, Remedios; Gómez, Rangel María Gudelia; Strathdee, Steffanie A

2013-01-01

To identify factors associated with time to initiation of (i) sex work prior to injecting drugs initiation; (ii) injection drug use prior to sex work initiation; and (iii) concurrent sex work and injection drug use (i.e. initiated at the same age) among female sex workers who currently inject drugs (FSW-IDU). Parametric survival analysis of baseline data for time to initiation event. Tijuana and Ciudad Juarez situated on the Mexico-US border. A total of 557 FSW-IDUs aged ≥18 years. Interview-administered surveys assessing context of sex work and injection drug use initiation. Nearly half (n = 258) initiated sex work prior to beginning to inject, a third (n = 163) initiated injection first and a quarter (n = 136) initiated both sex work and injection drug use concurrently. Low education and living in Ciudad Juarez accelerated time to sex work initiation. Being from a southern Mexican state and initiating drug use with inhalants delayed the time to first injection drug use. Having an intimate partner encourage entry into sex work and first injecting drugs to deal with depression accelerated time to initiating sex work and injection concurrently. Early physical abuse accelerated time to initiating sex work and injection, and substantially accelerated time to initiation of both behaviors concurrently. Among female sex workers who currently inject drugs in two Mexican-US border cities, nearly half appear to initiate sex work prior to beginning to inject, nearly one-third initiate injection drug use before beginning sex work and one-quarter initiate both behaviors concurrently. Predictors of these three trajectories differ, and this provides possible modifiable targets for prevention. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

PROTECTIVE FACTORS ASSOCIATED WITH SHORT-TERM CESSATION OF INJECTION DRUG USE AMONG A CANADIAN COHORT OF PEOPLE WHO INJECT DRUGS

PubMed Central

Luchenski, Serena; Ti, Lianping; Hayashi, Kanna; Dong, Huiru; Wood, Evan; Kerr, Thomas

2016-01-01

Introduction and Aims Strategies are needed to transition persons who inject drugs out of injecting. We undertook this study to identify protective factors associated with cessation of injection drug use. Design and Methods Data were derived from three prospective cohorts of people who use illicit drugs in Vancouver, Canada, between September 2005 and November 2011. Generalised estimating equations were used to examine protective factors and 6-month cessation of injection drug use. Results Our sample of 1663 people who inject drugs included 563 (33.9%) women, and median age was 40 years. Overall, 904 (54.4%) individuals had at least one 6-month injection cessation event. In multivariable analysis, protective factors associated with cessation of injection drug use included the following: having a regular place to stay [adjusted odds ratio (AOR) = 1.30; 95% confidence interval (CI) 1.13–1.48]; formal employment (AOR = 1.12; 95% CI 1.01–1.23); social support from personal contacts (AOR = 1.22; 95% CI 1.10–1.35); social support from professionals (AOR = 1.26; 95% CI 1.14–1.39); ability to access health and social services (AOR = 1.21; 95% CI 1.09–1.34); and positive self-rated health (AOR = 1.21, 95% CI 1.11–1.32). Discussion and Conclusions Over half of people who inject drugs in this study reported achieving 6-month cessation of injection drug use, with cessation being associated with a range of modifiable protective factors. Policy makers and practitioners should promote increased access to stable housing, employment, social support and other services to promote cessation of injection drug use. PMID:26661408

Injection and Sexual HIV/HCV Risk Behaviors Associated with Nonmedical Use of Prescription Opioids among Young Adults in New York City

PubMed Central

Mateu-Gelabert, Pedro; Guarino, Honoria; Jessell, Lauren; Teper, Anastasia

2014-01-01

Prevalence of nonmedical prescription opioid (PO) use has increased markedly in the U.S. This qualitative study explores the drug-use and sexual experiences of nonmedical PO users as they relate to risk for HIV and HCV transmission. Forty-six New York City young adult nonmedical PO users (ages 18–32) completed in-depth, semi-structured interviews. Despite initial perceptions of POs as less addictive and safer than illegal drugs, PO misuse often led to long-term opioid dependence and transition to heroin use and drug injection. Injectors in the sample reported sporadic syringe-sharing, frequent sharing of non-syringe injection paraphernalia and selective sharing with fellow injectors who are presumed “clean” (uninfected). Participants reported little knowledge of HCV injection-related risks and safer injection practices. They also reported engaging in unprotected sex with casual partners, exchange sex and group sex, and that PO misuse increases the risk of sexual violence. Prevention efforts addressing HIV/HCV risk should be targeted to young nonmedical PO users. PMID:25124258

Prevalence and correlates of neck injection among people who inject drugs in Tijuana, Mexico.

PubMed

Rafful, Claudia; Wagner, Karla D; Werb, Dan; González-Zúñiga, Patricia E; Verdugo, Silvia; Rangel, Gudelia; Strathdee, Steffanie A

2015-11-01

Injecting drugs in the neck has been related to adverse health conditions such as jugular vein thrombosis, deep neck infections, aneurysm, haematomas, airway obstruction, vocal cord paralysis and wound botulism, among others. We identified prevalence and correlates of neck injection among people who inject drugs (PWID) in Tijuana, Mexico. Beginning in 2011, PWID aged ≥18 years who injected drugs within the last month were recruited into a prospective cohort. At baseline and semi-annually, PWID completed interviewer-administered surveys soliciting data on drug-injecting practices. Logistic regression was used to identify predictors of injecting in the neck as the most frequent injection site at a single visit. Of 380 PWID, 35.3% injected in the neck at least once in the past 6 months, among whom 71.6% reported it as their most common injection site, the most common injecting site after the arms (47%). Controlling for age, years injecting and injecting frequency, injecting heroin and methamphetamine two or more times per day and having sought injection assistance were associated with injecting in the neck [adjusted odds ratios (AOR): 2.12; 95% confidence intervals (CI): 1.27-3.53 and AOR: 2.65; 95% CI: 1.52-4.53 respectively]. Injecting in the neck was very common among PWID in Tijuana and was associated with polydrug use and seeking injection assistance. Tailoring harm reduction education interventions for individuals who provide injection assistance ('hit doctors') may allow for the dissemination of safe injecting knowledge to reduce injection-related morbidity and mortality. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Heroin and Methamphetamine Injection: An Emerging Drug Use Pattern.

PubMed

Al-Tayyib, Alia; Koester, Stephen; Langegger, Sig; Raville, Lisa

2017-07-03

We sought to describe an emerging drug use pattern characterized by injection of both methamphetamine and heroin. We examined differences in drug injection patterns by demographics, injection behaviors, HIV and HCV status, and overdose. Persons who inject drugs (PWID) were recruited as part of the National HIV Behavioral Surveillance (NHBS) system in Denver, Colorado. We used chi-square statistics to assess differences between those who reported only heroin injection, only methamphetamine injection, and combined heroin and methamphetamine injection. We used generalized linear models to estimate unadjusted and adjusted prevalence ratios to describe the association between drug injection pattern and reported nonfatal overdose in 2015. We also examined changes in the drug reported as most frequently injected across previous NHBS cycles from 2005, 2009, and 2012. Of 592 participants who completed the survey in 2015, 173 (29.2%) reported only injecting heroin, 123 (20.8%) reported only injecting methamphetamine, and 296 (50.0%) reported injecting both drugs during the past 12 months. Injecting both heroin and methamphetamine was associated with a 2.8 (95% confidence interval: 1.7, 4.5) fold increase in reported overdose in the past 12 months compared with only injecting heroin. The proportion of those reporting methamphetamine as the most frequently injected drug increased from 2.1% in 2005 to 29.6% in 2015 (p < 0.001). The rapid increase in methamphetamine injection, and the emergence of combining methamphetamine with heroin, may have serious public health implications.

Experiences with urine drug testing by police among people who inject drugs in Bangkok, Thailand.

PubMed

Hayashi, Kanna; Ti, Lianping; Buxton, Jane A; Kaplan, Karyn; Suwannawong, Paisan; Wood, Evan; Kerr, Thomas

2014-03-01

Thailand has relied on drug law enforcement in an effort to curb illicit drug use. While anecdotal reports suggest that Thai police frequently use urine toxicology to identify drug users, little is known about the prevalence or impacts of this practice among people who inject drugs (IDU). Therefore, we sought to examine experiences with urine drug testing by police among IDU in Bangkok. Data were derived from a community-recruited sample of IDU in Bangkok participating in the Mitsampan Community Research Project between July and October 2011. We assessed the prevalence and correlates of being subjected to urine toxicology testing by police using multivariate Poisson regression. In total, 438 IDU participated in this study, with 293 (66.9%) participants reporting having been tested for illicit drugs by police. In multivariate analyses, reports of drug testing by police were independently and positively associated with younger age (adjusted prevalence ratio [APR]: 1.28), a history of methamphetamine injection (APR: 1.22), a history of incarceration (APR: 1.21), having been in compulsory drug detention (APR: 1.43), avoiding healthcare (APR: 1.15), and HIV seropositivity (APR: 1.19), and negatively associated with access to voluntary drug treatment (APR: 0.82) (all p<0.05). A high proportion of IDU in Bangkok were subjected to drug testing by police. Young people and methamphetamine injectors were more likely to have been tested. The findings indicate that drug testing by police is associated with the compulsory drug detention system and may be interfering with IDU's access to healthcare and voluntary drug treatment. These findings raise concern about the widespread practice of drug testing by police and its associated impacts. Copyright © 2013 Elsevier B.V. All rights reserved.

Global Epidemiology of HIV Among Women and Girls Who Use or Inject Drugs: Current Knowledge and Limitations of Existing Data.

PubMed

Larney, Sarah; Mathers, Bradley M; Poteat, Tonia; Kamarulzaman, Adeeba; Degenhardt, Louisa

2015-06-01

Women and girls who use and inject drugs are a critical population at risk of HIV. In this article, we review data on the epidemiology of drug use and injection among women globally and HIV prevalence among women and girls who use and inject drugs. Women and girls comprise one-third of people who use and inject drugs globally. There is substantial variation in HIV prevalence in this population, between and within countries. There is a pronounced lack of data examining HIV risk among particularly vulnerable subpopulations of women who use and inject drugs, including women who have sex with women, transgender women, racial and ethnic minority women, and young women. Women who use and inject drugs experience stigma and discrimination that affect access to services, and high levels of sexual risk exposures. There are significant gaps in our understanding of the epidemiology of drug use and injecting among women and girls and HIV risk and prevalence in this population. Women are frequently underrepresented in studies of drug use and HIV risk and prevalence among people who inject drugs, limiting our understanding of possible sex differences in this population. Most research originates from developed countries and may not be generalizable to other settings. A great deal of work is needed to improve understanding of HIV among particularly vulnerable subpopulations, such as transgender women who use drugs. Better data are critical to efforts to advocate for the needs of women and girls who use and inject drugs.

Hepatitis A and B among young persons who inject drugs--vaccination, past, and present infection.

PubMed

Collier, Melissa G; Drobeniuc, Jan; Cuevas-Mota, Jazmine; Garfein, Richard S; Kamili, Saleem; Teshale, Eyasu H

2015-06-04

Our study aims were to assess hepatitis A virus (HAV) and hepatitis B virus (HBV) susceptibility and infection among young persons who inject drugs (PWID) who may have been vaccinated as children and to evaluate self-report of HAV and HBV vaccination. We recruited PWID aged 18-40 years-old in San Diego during 2009 and 2010 and collected demographic, socioeconomic, health, and behavioral factors. Participants were asked if they had been vaccinated against HAV and HBV, and serum samples were collected for HAV and HBV serologic testing. Of 519 participants, 365 (72%) were male, 252 (49%) were white non-Hispanic, 38 (7%) were Black non-Hispanic, 138 (27%) were White Hispanic, and 22 (4%) were born outside the U. S. Of the total participants, 245 (47%) had surface hepatitis B antibody (anti-HBs) titers <10mIU/ml (i.e., HBV susceptible) and 325 (63%) had no detectable HAV antibodies (HAV susceptible). Hepatitis B surface antigen was detected in 7 (1%) of total participants; and 135 (26%) were anti-HCV-antibody positive. Compared to serologic findings, self-report of HBV and HAV vaccination was 71% and 41% sensitive, and 58% and 73% specific, respectively. HAV and HBV antibodies in half or more of this young PWID population did not have levels indicative of protection, and about a quarter had HCV infection, putting them at risk for complications resulting from co-infection with HAV or HBV. Programs serving this population should vaccinate PWIDs against HAV and HBV and not rely on self-report of vaccination. Published by Elsevier Ltd.

[Rational motivation of drug injection and prostitution].

PubMed

Beauchamp, Sylvie

2003-01-01

Homeless drug users and prostitutes constitute a population at risk for contracting and propagating AIDS. This study aims at understanding the paradox related to drug injection and prostitution among 21 homeless from Montreal. These behaviors are studied following the picoeconomic paradox of an apprehended desire. The results show that these homeless see drug injection as a self-reward motivated by imaginary emotional object, in spite of the known and dreaded consequences. Prostitution is described as a self-investment accessory to drug injection. This study concludes with reflections on AIDS prevention programs in relation with the needs of the homeless.

Prescription Drug Misuse Among Club Drug-Using Young Adults

PubMed Central

Kelly, Brian C.; Parsons, Jeffrey T.

2009-01-01

Nonmedical prescription (Rx) drug use has recently increased, particularly among young adults. Using time-space sampling to generate a probability-based sample of club-going young adults (18–29), 400 subjects provided data on Rx drug misuse. Club-going young adults misuse Rx drugs at high rates. An overwhelming majority of the sample indicated lifetime use of pain killers, sedatives, and stimulants. A majority indicated recent pain killer use. Variations by gender and sexuality exist in this population. Young lesbian/bisexual women emerged as the group most likely to abuse Rx drugs. Research into the contexts influencing these patterns is imperative. PMID:17994483

Transitions from injecting to non-injecting drug use: potential protection against HCV infection

PubMed Central

Des Jarlais, Don C.; McKnight, Courtney; Arasteh, Kamyar; Feelemyer, Jonathan; Perlman, David C.; Hagan, Holly; Cooper, Hannah L. F.

2013-01-01

Transitions from injecting to non-injecting drug use have been reported from many different areas, particularly in areas with large human immunodeficiency virus (HIV) epidemics. The extent to which such transitions actually protect against HIV and HCV has not been determined. A cross-sectional survey with HIV and hepatitis C (HCV) testing was conducted with 322 former injectors (persons who had injected illicit drugs but permanently transitioned to non-injecting use) and 801 current injectors recruited in New York City between 2007 and 2012. There were no differences in HIV prevalence, while HCV prevalence was significantly lower among former injectors compared to current injectors. Years injecting functioned as a mediating variable linking former injector status to lower HCV prevalence. Transitions have continued well beyond the reduction in the threat of AIDS to injectors in the city. New interventions to support transitions to non-injecting drug use should be developed and supported by both drug treatment and syringe exchange programs. PMID:24161262

Predictors of Sharing Injection Equipment by HIV-Seropositive Injection Drug Users

PubMed Central

Latkin, Carl A.; Buchanan, Amy S.; Metsch, Lisa R.; Knight, Kelly; Latka, Mary H.; Mizuno, Yuko; Knowlton, Amy R.

2009-01-01

Among HIV-positive injection drug users (IDUs), we examined baseline predictors of lending needles and syringes, and sharing cookers, cotton, and rinse water in the prior 3 months at follow-up. Participants were enrolled in INSPIRE, a secondary prevention intervention for sexually active HIV-positive IDUs in four US cities during 2001–2005. The analyses involved 357 participants who reported injecting drugs in the prior six months at either the 6- or 12-months follow-up visit. About half (49%) reported at least one sharing episode. In adjusted analyses, peer norms supporting safer injection practices, and having primary HIV medical care visits in the prior 6 months were associated with reporting no sharing of injection equipment. Higher levels of psychological distress was associated with a greater likelihood of reporting drug paraphernalia sharing. These findings suggest that intervention approaches for reducing HIV-seropositive IDUs’ transmission of blood-borne infections should include peer-focused interventions to alter norms of drug paraphernalia sharing and promoting primary HIV care and mental health services. PMID:19186356

Predictors of sharing injection equipment by HIV-seropositive injection drug users.

PubMed

Latkin, Carl A; Buchanan, Amy S; Metsch, Lisa R; Knight, Kelly; Latka, Mary H; Mizuno, Yuko; Knowlton, Amy R

2008-12-01

Among HIV-positive injection drug users (IDUs), we examined baseline predictors of lending needles and syringes and sharing cookers, cotton, and rinse water in the prior 3 months at follow-up. Participants were enrolled in Intervention for Seropositive Injectors-Research and Evaluation, a secondary prevention intervention for sexually active HIV-positive IDUs in 4 US cities during 2001-2005. The analyses involved 357 participants who reported injecting drugs in the prior 6 months at either the 6- or 12-month follow-up visit. About half (49%) reported at least 1 sharing episode. In adjusted analyses, peer norms supporting safer injection practices and having primary HIV medical care visits in the prior 6 months were associated with reporting no sharing of injection equipment. Higher levels of psychological distress were associated with a greater likelihood of reporting drug paraphernalia sharing. These findings suggest that intervention approaches for reducing HIV-seropositive IDUs' transmission of blood-borne infections should include peer-focused interventions to alter norms of drug paraphernalia sharing and promoting primary HIV care and mental health services.

[Analysis of inadvertent epidural injection of drugs].

PubMed

Kasaba, T; Uehara, K; Katsuki, H; Ono, Y; Takasaki, M

2000-12-01

We asked 31 anesthesiologists, who were on the Japanese Board of Anesthesiology, about inadvertent injection of drugs into the epidural space, and received answers from 28 (90%). Fifteen (54%) had an experience of inadvertent epidural injection, and five of them had two experiences. Injected drugs were ephedrine (6 times), a mixture of neostigmine and atropine (3), thiopental (2), etilefrine (2), vecuronium (1), suxamethonium (1), bicarbonate (1), midazolam (1), lactated Ringer's solution (1), nicardipine (1), and pentazocine (1). The inadvertent injection of thiopental or bicarbonate was noticed by back pain during injection. No treatment was added after the inadvertent injections, except a patient with an epidural steroid injection following thiopental. No neurological complications were found in any patients.

Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis.

PubMed

Ahmed, Tanvir; Long, Thanh Nguyen; Huong, Phan Thi; Stewart, Donald Edwin

2015-01-29

Hai Phong, located in northern Vietnam, has become a high HIV prevalence province among Injecting Drug Users (IDUs) since the infection shifted from the southern to the northern region of the country. Previous research indicates high levels of drug and sex related risk behaviour especially among younger IDUs. Our recent qualitative research provides a deeper understanding of HIV risk behaviour and highlights views and experiences of IDUs relating to drug injecting and sharing practices. Fifteen IDUs participated in semi-structured interviews conducted in September-October, 2012. Eligible participants were selected from those recruited in a larger scale behavioural research project and identified through screening questions. Interviews were conducted by two local interviewers in Vietnamese and were audiotaped. Ethical procedures, including informed consent and participants' understanding of their right to skip and withdraw, were applied. Transcripts were translated and double checked. The data were categorised and coded according to themes. Thematic analysis was conducted and a qualitative data analysis thematic framework was used. Qualitative analysis highlighted situational circumstances associated with HIV risks among IDUs in Hai Phong and revealed three primary themes: (i) places for injecting, (ii) injecting drugs in small groups, and (iii) sharing practices. Our results showed that shared use of jointly purchased drugs and group injecting were widespread among IDUs without adequate recognition of these as HIV risk behaviours. Frequent police raids generated a constant fear of arrest. As a consequence, the majority preferred either rail lines or isolated public places for injection, while some injected in their own or a friend's home. Price, a heroin crisis, and strong group norms encouraged collective preparation and group injecting. Risk practices were enhanced by a number of factors: the difficulty in getting new syringes, quick withdrawal management

Gender Differences in HIV and Hepatitis C Related Vulnerabilities Among Aboriginal Young People Who Use Street Drugs in Two Canadian Cities

PubMed Central

For the Cedar Project Partnership; Mehrabadi, Azar; Paterson, Katharina; Pearce, Margo; Patel, Sheetal; Craib, Kevin J. P.; Moniruzzaman, Akm; Schechter, Martin T.; Spittal, Patricia M.

2016-01-01

Objectives Vulnerability to HIV and Hepatitis C virus (HCV) infection for indigenous populations worldwide must be contextualized in experiences of current and past trauma. Aboriginal women entrenched in poverty face further gender-specific harms which place them at increased risk for HIV infection. Methods This study was cross-sectional and based on a community-based sample of Aboriginal young people (Métis, Aboriginal, First Nations, Inuit, and non-status Indians) between the ages of 14 and 30 years who used injection or non-injection non-cannabis illegal drugs (street drugs) in the previous month. Between October 2003 and July 2005, 543 participants living in either Vancouver or Prince George, Canada, were recruited by word of mouth, posters, and street outreach. Young people in the study completed a questionnaire administered by Aboriginal interviewers. Female participants (n = 262) were compared to male participants (n = 281) with respect to sociodemographics, trauma, sexual risk variables, and drug use patterns. Trained nurses drew blood samples for HIV and HCV antibodies and provided pre- and post-test counseling. Results Proportions positive for HIV and HCV were significantly higher among young women. HIV was 13.1% [9.5, 17.7] in women compared to 4.3% [2.5, 7.4] in men, and HCV was 43.6% [37.6, 49.8] in women as compared to 25.4% [20.5, 30.9] in men. When the analysis was restricted to young people who reported injection drug use, the proportions positive for HIV and HCV remained significantly higher among young women. Experiences of forced sex were reported by 70% of young women compared to 29% of young men, p < 0:001, while the median age of first forced sex was 6-years-old for both men and women. Discussion The results of the final model indicated that HIV had been associated with residing in Vancouver, having injected for longer, and sexual abuse, but not being female. However, this gendered analysis demonstrated that a greater proportion of young

Gender differences in HIV and hepatitis C related vulnerabilities among aboriginal young people who use street drugs in two Canadian cities.

PubMed

Mehrabadi, Azar; Paterson, Katharina; Pearce, Margo; Patel, Sheetal; Craib, Kevin J P; Moniruzzaman, Akm; Schechter, Martin T; Spittal, Patricia M

2008-01-01

Vulnerability to HIV and Hepatitis C virus (HCV) infection for indigenous populations worldwide must be contextualized in experiences of current and past trauma. Aboriginal women entrenched in poverty face further gender-specific harms which place them at increased risk for HIV infection. This study was cross-sectional and based on a community-based sample of Aboriginal young people (Metis, Aboriginal, First Nations, Inuit, and non-status Indians) between the ages of 14 and 30 years who used injection or non-injection non-cannabis illegal drugs (street drugs) in the previous month. Between October 2003 and July 2005, 543 participants living in either Vancouver or Prince George, Canada, were recruited by word of mouth, posters, and street outreach. Young people in the study completed a questionnaire administered by Aboriginal interviewers. Female participants (n = 262) were compared to male participants (n = 281) with respect to sociodemographics, trauma, sexual risk variables, and drug use patterns. Trained nurses drew blood samples for HIV and HCV antibodies and provided pre- and post-test counseling. Proportions positive for HIV and HCV were significantly higher among young women. HIV was 13.1% [9.5, 17.7] in women compared to 4.3% [2.5, 7.4] in men, and HCV was 43.6% [37.6, 49.8] in women as compared to 25.4% [20.5, 30.9] in men. When the analysis was restricted to young people who reported injection drug use, the proportions positive for HIV and HCV remained significantly higher among young women. Experiences of forced sex were reported by 70% of young women compared to 29% of young men, p < 0.001, while the median age of first forced sex was 6-years-old for both men and women. The results of the final model indicated that HIV had been associated with residing in Vancouver, having injected for longer, and sexual abuse, but not being female. However, this gendered analysis demonstrated that a greater proportion of young women were experiencing sexual abuse, and

Prevalence and correlates of neck injection among people who inject drugs in Tijuana, Mexico

PubMed Central

RAFFUL, CLAUDIA; WAGNER, KARLA D.; WERB, DAN; GONZÁLEZ-ZÚÑIGA, PATRICIA E.; VERDUGO, SILVIA; RANGEL, GUDELIA; STRATHDEE, STEFFANIE A.

2016-01-01

Introduction and Aims Injecting drugs in the neck has been related to adverse health conditions such as jugular vein thrombosis, deep neck infections, aneurysm, haematomas, airway obstruction, vocal cord paralysis and wound botulism, among others. We identified prevalence and correlates of neck injection among people who inject drugs (PWID) in Tijuana, Mexico. Design and Methods Beginning in 2011, PWID aged ≥18 years who injected drugs within the last month were recruited into a prospective cohort. At baseline and semi-annually, PWID completed interviewer-administered surveys soliciting data on drug-injecting practices. Logistic regression was used to identify predictors of injecting in the neck as the most frequent injection site at a single visit. Results Of 380 PWID, 35.3% injected in the neck at least once in the past 6 months, among whom 71.6% reported it as their most common injection site, the most common injecting site after the arms (47%). Controlling for age, years injecting and injecting frequency, injecting heroin and methamphetamine two or more times per day and having sought injection assistance were associated with injecting in the neck [adjusted odds ratios (AOR): 2.12; 95% confidence intervals (CI): 1.27–3.53 and AOR: 2.65; 95% CI: 1.52–4.53 respectively]. Discussion and Conclusions Injecting in the neck was very common among PWID in Tijuana and was associated with polydrug use and seeking injection assistance. Tailoring harm reduction education interventions for individuals who provide injection assistance (‘hit doctors’) may allow for the dissemination of safe injecting knowledge to reduce injection-related morbidity and mortality. PMID:25867795

Prevalence and characteristics of femoral injection among Seattle-area injection drug users.

PubMed

Coffin, Phillip O; Coffin, Lara S; Murphy, Shilo; Jenkins, Lindsay M; Golden, Matthew R

2012-04-01

Injection drug use (IDU) into central veins, most common among long-term IDUs with no other options, can lead to severe infectious, vascular, and traumatic medical consequences. To follow-up on anecdotal reports of femoral vein injection and related medical problems in Seattle, we analyzed data from the annual survey of a community-based syringe exchange program. A total of 276 (81%) of 343 program attendees completed the survey in August 2010. Among 248 IDUs, 66% were male, 78% white, and 86% primarily injected opiates. One hundred respondents (40%) had injected into the femoral vein, 55% of whom were actively doing so, and 58% of whom reported medical complications that they attributed to the practice. Most (66%) used the femoral vein due to difficulty accessing other veins, although 61% reported other veins they could access and 67% reporting using other sites since initiating femoral injection. While injecting into muscle was more frequent among older IDUs with longer injection careers, the prevalence of femoral injection was highest among respondents in their late twenties with 2.5-6 years of injecting drugs. Multivariate analysis demonstrated an increased risk of initiating femoral injection each calendar year after 2007. Injecting into the femoral vein was also associated with white versus other race (odds ratio [OR] 2.7, 95% CI 1.3-5.4) and injection of primarily opiates versus other drugs (OR 6.3, 95% CI 1.2-32.9) and not associated with age, length of IDU career, or a history of injecting into muscle. These findings suggest a secular trend of increasing femoral injection among Seattle-area IDUs with a high rate of related medical problems. Interventions, such as education regarding the hazards of central venous injection and guidance on safe injection into peripheral veins, are needed to minimize the health consequences of femoral injection.

The Cedar Project: correlates of attempted suicide among young Aboriginal people who use injection and non-injection drugs in two Canadian cities.

PubMed

Moniruzzaman, Akm; Pearce, Margo E; Patel, Sheetal H; Chavoshi, Negar; Teegee, Mary; Adam, Warner; Christian, Wayne M; Henderson, Earl; Craib, Kevin J P; Schechter, Martin T; Spittal, Patricia M

2009-06-01

Aboriginal leadership and families are deeply concerned about the rate of suicide attempt among their young people. The objectives of this study were to (a) describe the prevalence of suicide attempt and (b) to describe correlates of vulnerability to suicide attempts within a cohort of young Aboriginal people who use drugs in 2 Canadian cities. We aimed to situate the findings within the context of historical and lifetime trauma. Study design. The Cedar Project is a prospective cohort study involving 605 young Aboriginal people aged 14-30 who use drugs in Vancouver and Prince George, British Columbia, Canada. Multivariable logistic regression modelling identified independent predictors of suicide attempts. Estimates of adjusted odds ratios and 95% confidence intervals were calculated. In multivariable analysis, residing in Prince George (Adjusted Odds Ratio [AOR]: 1.80, 95% CI: 1.23, 2.64), ever having been sexually abused (AOR: 2.07, 95% CI: 1.39, 3.08), and ever having overdosed (AOR: 2.29, 95% CI: 1.53, 3.42) independently predicted lifetime attempted suicide. Suicide prevention and intervention programs must address historical and lifetime trauma among Aboriginal young people who struggle with substance dependence.

Drugs and Young People

MedlinePlus

Drug abuse is a serious public health problem. It affects almost every community and family in some way. Drug abuse in children and teenagers may pose a ... of young people may be more susceptible to drug abuse and addiction than adult brains. Abused drugs ...

The Threat of Hepatitis C as an Influence on Injecting Amphetamine Users' Change towards Non-Injecting

ERIC Educational Resources Information Center

Davey, Jeremy; Richards, Naomi; Lang, Cathryne P.; Davies, Amanda

2006-01-01

Young injecting drug users are a particularly vulnerable group for Hepatitis C (HCV) infection. One method for minimising the risk of contraction of Hepatitis C for amphetamine users (not widely explored in the research to date) is through encouraging non-injecting routes of administration (NIROA). Self-report data from 150 young injecting…

Women's injection drug practices in their own words: a qualitative study.

PubMed

Tuchman, Ellen

2015-03-07

There are significant gender differences in injection drug practices and relative risks involved for women who inject drug compared with men. This qualitative study aims to explore the social, contextual, and behavioral dimensions of injecting practices among women who inject drugs. Participants were selected by purposive venue-based sampling from a syringe exchange program in 2012-2013. In-depth interviews were conducted with 26 women to elicit detailed perspectives regarding injection drug use practices and women-focused decision-making. All interviews were transcribed verbatim and analyzed with Atlas.ti. Participant's mean age was 43.2 years, 48% Caucasian, 36% African American, and 16% Latina, poorly educated, mostly single, and heroin self-injectors. Three themes emerged; a) transitioning from non-injection to injection drug use; b) patterns and variations of initiation to injecting; and c) shifting toward autonomy or reliance on others. Women were predominantly influenced to transition to injection drug use by other women with their claims that injecting was a way to curtail their daily drug expenditure. More than half the women received their first injection from another woman in their social network rather than a male sexual partner. Self-injecting women exhibited agency around the circumstances of injection safety and potential risks. Other women revealed that their inability to inject themselves could and did make them dependent on others for unsafe injection practices. The finding that many women were influenced to transition to injection drug use and receive the first injection from a woman is contrary to literature claims that male sexual partners introduce and initiate women to injection drug use. Self-injecting women possessed capacity to act in a way that produced the results they wanted, not sharing prepared drugs or injecting equipment. In stark contrast, women assisted with injections could and did make them vulnerable to unsafe injecting

Profile of People Who Inject Drugs in Tehran, Iran.

PubMed

Amin-Esmaeili, Masoumeh; Rahimi-Movaghar, Afarin; Gholamrezaei, Maryam; Razaghi, Emran Mohammad

2016-12-01

The marked shift in the patterns of drug use in Iran, from opium smoking to injecting drug use, has led to serious health-related outcomes. This study was designed to explore characteristics of people who inject drugs (PWID) in Tehran, Iran. Nine hundred and four PWID were recruited from treatment and harm reduction facilities, as well as drug user hangouts in public areas in Tehran. Participants were interviewed using the Persian version of the World Health Organization Drug Injecting Study Phase II questionnaire. The median age at the time of the first illegal drug use, at the time of the first injection and current age was 20, 24 and 32, respectively. In more than 80% of the cases, the first drug used was opium. The transition from the first drug use to the first drug injection occurred after an average of 6.6 and 2.7 years for those who had started drug use with opium and heroin, respectively. Two-thirds of the participants shared injecting equipment within the last 6 months. Difficulty in obtaining sterile needles and thehigh cost of syringes were reported as the major reasons for needle/syringe sharing. Approximately 80% of community-recruited PWID reported difficulties in using treatment or harm reduction services. Self-detoxification and forced detoxification were the most common types of drug abuse treatment in alifetime. Despite a dramatic shift in drug policy in Iran during the past few years, wider coverage of harm reduction services, improvement of the quality of services, and education about such services are still necessary.

Risk behaviors and risk factors for HIV infection among participants in the Bangkok tenofovir study, an HIV pre-exposure prophylaxis trial among people who inject drugs.

PubMed

Martin, Michael; Vanichseni, Suphak; Suntharasamai, Pravan; Sangkum, Udomsak; Mock, Philip A; Leethochawalit, Manoj; Chiamwongpaet, Sithisat; Gvetadze, Roman J; Kittimunkong, Somyot; Curlin, Marcel E; Worrajittanon, Dararat; McNicholl, Janet M; Paxton, Lynn A; Choopanya, Kachit

2014-01-01

HIV spread rapidly among people who inject drugs in Bangkok in the late 1980s. In recent years, changes in drug use and HIV-associated risk behaviors have been reported. We examined data from the Bangkok Tenofovir Study, an HIV pre-exposure prophylaxis trial conducted among people who inject drugs, to assess participant risk behavior and drug use, and to identify risk factors for HIV infection. The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial. HIV status was assessed monthly and risk behavior every 3 months. We used generalized estimating equations logistic regression to model trends of injecting, needle sharing, drugs injected, incarceration, and sexual activity reported at follow-up visits; and proportional hazards models to evaluate demographic characteristics, sexual activities, incarceration, drug injection practices, and drugs injected during follow-up as predictors of HIV infection. The proportion of participants injecting drugs, sharing needles, and reporting sex with more than one partner declined during follow-up (p<0.001). Among participants who reported injecting at enrollment, 801 (53.2%) injected methamphetamine, 559 (37.1%) midazolam, and 527 (35.0%) heroin. In multivariable analysis, young age (i.e., 20-29 years) (p = 0.02), sharing needles (p<0.001), and incarceration in prison (p = 0.002) were associated with incident HIV infection. Participants reporting sex with an opposite sex partner, live-in partner, casual partner, or men reporting sex with male partners were not at a significantly higher risk of HIV infection compared to those who did not report these behaviors. Reports of HIV-associated risk behavior declined significantly during the trial. Young age, needle sharing, and incarceration were independently associated with HIV infection. Sexual activity was not associated with HIV infection, suggesting that the reduction in HIV incidence among participants taking daily oral tenofovir compared to those taking

The Cedar Project: a comparison of HIV-related vulnerabilities amongst young Aboriginal women surviving drug use and sex work in two Canadian cities.

PubMed

Mehrabadi, Azar; Craib, Kevin J P; Patterson, Katharina; Adam, Warner; Moniruzzaman, Akm; Ward-Burkitt, Barbara; Schechter, Martin T; Spittal, Patricia M

2008-04-01

In Canada, Aboriginal women and youth continue to be overrepresented amongst new cases of HIV, and are considered at increased risk for sex and drug-related harm. Young women involved in sex work are particularly vulnerable. The purpose of this study is to determine HIV-related vulnerabilities associated with sex work amongst young Aboriginal women in two Canadian cities. This study is based on a community-based cohort of Aboriginal young people (status and non-status First Nations, Inuit and Métis) between the ages of 14 and 30 who used injection or non-injection illegal drugs (street drugs) in the previous month. Participants lived in Vancouver, Canada, or Prince George, a remote, northern Canadian city. Between October 2003 and July 2005, 543 participants were recruited by word of mouth, posters, and street outreach. A baseline questionnaire was administered by Aboriginal interviewers, and trained nurses drew blood samples for HIV and HCV antibodies and provided pre- and post-test counselling. This study included 262 young women who participated at baseline. Analyses were conducted to compare socio-demographics, drug use patterns, injection practices, sexual experiences, and HIV and HCV prevalence between young women who reported being involved in sex work in the last 6 months (n=154) versus young women who did not (n=108). Logistic regression was used to identify factors independently associated with recent sex work involvement. Both sexual violence and drug using patterns were found to be markedly different for women having recently been involved in sex work. Multivariate analysis revealed daily injection of cocaine (AOR=4.4; 95% CI: 1.9, 10.1 and smoking crack (AOR=2.9; 95% CI: 1.6, 5.2) in the previous 6 months, and lifetime sexual abuse (AOR=2.5; 95% CI: 1.4, 4.4) to be independently associated with sex work. Harm reduction and treatment programs that address historical and lifetime trauma amongst Aboriginal people and prioritize emotional and physical

Injection Drug Users’ Involvement In Drug Economy: Dynamics of Sociometric and Egocentric Social Networks

PubMed Central

Yang, Cui; Latkin, Carl; Muth, Stephen Q.; Rudolph, Abby

2014-01-01

The purpose of this analysis was to examine the effect of social network cohesiveness on drug economy involvement, and to test whether this relationship is mediated by drug support network size in a sample of active injection drug users. Involvement in the drug economy was defined by self-report of participation in at least one of the following activities: selling drugs, holding drugs or money for drugs, providing street security for drug sellers, cutting/packaging/cooking drugs, selling or renting drug paraphernalia (e.g., pipes, tools, rigs), and injecting drugs in others’ veins. The sample consists of 273 active injection drug users in Baltimore, Maryland who reported having injected drugs in the last 6 months and were recruited through either street outreach or by their network members. Egocentric drug support networks were assessed through a social network inventory at baseline. Sociometric networks were built upon the linkages by selected matching characteristics, and k-plex rank was used to characterize the level of cohesiveness of the individual to others in the social network. Although no direct effect was observed, structural equation modeling indicated k-plex rank was indirectly associated with drug economy involvement through drug support network size. These findings suggest the effects of large-scale sociometric networks on injectors’ drug economy involvement may occur through their immediate egocentric networks. Future harm reduction programs for injection drug users (IDUs) should consider providing programs coupled with economic opportunities to those drug users within a cohesive network subgroup. Moreover, individuals with a high connectivity to others in their network may be optimal individuals to train for diffusing HIV prevention messages. PMID:25309015

Incarceration and injection drug use in Baltimore, Maryland.

PubMed

Genberg, Becky L; Astemborski, Jacquie; Vlahov, David; Kirk, Gregory D; Mehta, Shruti H

2015-07-01

There is limited longitudinal research examining incarceration and subsequent changes in drug use among people who inject drugs (PWID) in the United States. The objective of the current study was to characterize the frequency of incarceration and estimate the association between incarceration and subsequent injection drug use among current and former PWIDs in one US city. ALIVE (AIDS Linked to the Intravenous Experience) is a prospective cohort study of current and former PWIDs, with semi-annual follow-up occurring since 1988. Baltimore, Maryland, USA. A total of 3245 participants with 48 738 study visits were included. Participants enrolled from 1988 to 2012 with a median of 13 follow-up visits per participant (Interquartile range = 7-25). Incarcerations were defined as any self-reported jail or prison stays in the previous 6 months that were ≥7 days or longer. The primary outcome was defined as any self-reported injection drug use in the previous 6 months. At baseline, 29% were female, 90% African American and 33% HIV-positive. Fifty-seven per cent of participants experienced at least one incarceration episode. After adjusting for confounders, there was a positive association between incarceration and subsequent injection drug use [adjusted odds ratio (AOR) = 1.48, 95% confidence interval (CI) = 1.37-1.59]; however, stratified analysis showed that the effect was restricted to those who were not injecting at the time of incarceration (AOR = 2.11, 95% CI = 1.88-2.37). In the United States, incarceration of people who had previously stopped injecting drugs appears to be associated with an increased risk of subsequent injecting. © 2015 Society for the Study of Addiction.

Identifying injection drug use and estimating population size of people who inject drugs using healthcare administrative datasets.

PubMed

Janjua, Naveed Zafar; Islam, Nazrul; Kuo, Margot; Yu, Amanda; Wong, Stanley; Butt, Zahid A; Gilbert, Mark; Buxton, Jane; Chapinal, Nuria; Samji, Hasina; Chong, Mei; Alvarez, Maria; Wong, Jason; Tyndall, Mark W; Krajden, Mel

2018-05-01

Large linked healthcare administrative datasets could be used to monitor programs providing prevention and treatment services to people who inject drugs (PWID). However, diagnostic codes in administrative datasets do not differentiate non-injection from injection drug use (IDU). We validated algorithms based on diagnostic codes and prescription records representing IDU in administrative datasets against interview-based IDU data. The British Columbia Hepatitis Testers Cohort (BC-HTC) includes ∼1.7 million individuals tested for HCV/HIV or reported HBV/HCV/HIV/tuberculosis cases in BC from 1990 to 2015, linked to administrative datasets including physician visit, hospitalization and prescription drug records. IDU, assessed through interviews as part of enhanced surveillance at the time of HIV or HCV/HBV diagnosis from a subset of cases included in the BC-HTC (n = 6559), was used as the gold standard. ICD-9/ICD-10 codes for IDU and injecting-related infections (IRI) were grouped with records of opioid substitution therapy (OST) into multiple IDU algorithms in administrative datasets. We assessed the performance of IDU algorithms through calculation of sensitivity, specificity, positive predictive, and negative predictive values. Sensitivity was highest (90-94%), and specificity was lowest (42-73%) for algorithms based either on IDU or IRI and drug misuse codes. Algorithms requiring both drug misuse and IRI had lower sensitivity (57-60%) and higher specificity (90-92%). An optimal sensitivity and specificity combination was found with two medical visits or a single hospitalization for injectable drugs with (83%/82%) and without OST (78%/83%), respectively. Based on algorithms that included two medical visits, a single hospitalization or OST records, there were 41,358 (1.2% of 11-65 years individuals in BC) recent PWID in BC based on health encounters during 3- year period (2013-2015). Algorithms for identifying PWID using diagnostic codes in linked administrative

The Social and Environmental Context of Cross-border Drug Use in Mexico: Findings from a Mixed Methods Study of Young IDUs Living in San Diego, CA

PubMed Central

Wagner, Karla D.; Moynihan, Matthew J.; Strathdee, Steffanie A.; Cuevas-Mota, Jazmine; Clark, Maureen; Zúñiga, María Luisa; Volkmann, Tyson A.; Teshale, Eyasu; Garfein, Richard S.

2012-01-01

We report the results of qualitative (n=19) and quantitative (n=545) interviews with young injection drug users (IDUs) in San Diego, California, USA about their experiences using drugs in Tijuana, Mexico, and associated risks for HIV infection. Young IDUs who have ever traveled to Mexico (n=365) used a variety of injection (54%) and non-injection (30%) drugs there, and appear to be heavier users than those who have never traveled to Mexico. Sociocultural themes influencing drug use in Mexico included: interactions amongst the purpose of travel, drug preference, and route of administration; familiarity with the border region; evolving relationships with the US and Mexican drug markets; and the experience of crossing the US/Mexico border. Interventions for IDUs in border regions need to be sensitive to the ethnicity, familiarity with the border region, and life history of participants, as well as differences in national policies that could influence drug use and risk for HIV on both sides of the border. PMID:23216441

Injecting drug use: Gendered risk.

PubMed

Zahnow, Renee; Winstock, Adam R; Maier, Larissa J; Levy, Jay; Ferris, Jason

2018-06-01

Research demonstrates gender related differences in drug-use practices and risk behaviours. Females' structural vulnerability stemming from traditional gender roles and gender-power relations may enhance their propensity to experience injecting related risk. In this paper we explore gender differences in injection practices at the initiation event, during the first year of injecting and in the most recent 12-month period, to inform more effective harm reduction strategies. Data used in this study were drawn from the Global Drug Survey 2015. The study employs chi-square and logistic regression to assess gender differences in injection behaviours in a sample of current injectors residing in six global regions: North-West Europe; Southern Eastern Europe; North America. South America and Oceania. Females were more likely than males to report being injected by an intimate partner at initiation (OR = 4.4, 95%CI: 2.2-8.8), during the first year of injecting (OR = 4.8, 95% CI: 2.4-9.3) and in the most recent 12-month period (OR = 2.5, 95%CI: 1.0-6.2). Females reported greater difficulties accessing sterile equipment (X 2 (2,N = 453) = 8.2, p = 0.02) and were more likely to share injecting equipment than males (X 2 (1,N = 463) = 3.9, p = 0.05). Our findings highlight females' continued dependence on their intimate partner to administer the injection into the first year of their injecting career. Females remained more likely than males to rely on intimate partners for injection during the most recent 12-month period. Females report greater difficulties in sourcing sterile equipment and are more likely to share injecting equipment. We suggest that these findings reflect the broader social structure in which females are disempowered through traditional gender roles and the lack of gender appropriate harm reduction services. Copyright © 2018 Elsevier B.V. All rights reserved.

Young women's attitudes toward injectable and implantable contraceptives.

PubMed

Gold, M A; Coupey, S M

1998-02-01

To assess the potential acceptability of implantable and injectable contraceptive characteristics by young women of diverse ethnic and educational backgrounds. A cross-sectional self-administered survey. The waiting room of three clinical sites: an elite women's college health service, a coeducational state university health service, and an inner city hospital-based adolescent clinic. 328 young women awaiting medical care in one of three clinical sites, aged 13 to 21 years (85% 18-21 years); ethnic distribution differed significantly by site. The majority (83%) were sexually active, and of those who were sexually experienced, 25% had been pregnant. A 47-item questionnaire examining attitudes toward characteristics of injectable and implantable contraceptive methods, menstrual, sexual, and gynecologic history. Sixty-two percent of the sample agreed that they would get an injectable method. There was little variation in agreement to get an injectable method by sexual or pregnancy history. Fewer subjects (24%) agreed that they would like to get subdermal implants and agreement to get an implantable method of contraception did not vary by sexual history; however, ever-pregnant young women (33%) were significantly more likely to agree to implants than never-pregnant subjects (21%; chi2, 4.109; p = 0.04). Seventy-four percent of subjects said they would stop using a contraceptive that caused irregular menses, whereas 65% would stop using a method that caused amenorrhea. An injectable contraceptive method has universal appeal across ethnic, educational, and age categories, whereas implants are less appealing. Irregular bleeding and amenorrhea are poorly perceived side effects of long-acting contraceptives.

Admissions of injection drug users to drug abuse treatment following HIV counseling and testing.

PubMed

McCusker, J; Willis, G; McDonald, M; Lewis, B F; Sereti, S M; Feldman, Z T

1994-01-01

The outcomes of counseling and testing programs related to human immunodeficiency virus (HIV) infection and risk of infection among injection drug users (IDUs) are not well known or understood. A counseling and testing outcome of potential public health importance is attaining admission to drug abuse treatment by those IDUs who are either infected or who are at high risk of becoming infected. The authors investigated factors related to admission to drug abuse treatment among 519 IDUs who received HIV counseling and testing from September 1987 through December 1990 at a men's prison and at community-based testing sites in Worcester, MA. By June 1991, 123 of the 519 IDUs (24 percent) had been admitted to treatment. Variables associated with their admission included a long history of drug injection, frequent recent drug injection, cleaning injection equipment using bleach, prior drug treatment, and a positive HIV test result. Logistic regression analyses, controlling for effects of recruitment site, year, sex, and area of residence, generally confirmed the associations. IDUs in the study population who were HIV-infected sought treatment or were admitted to treatment more frequently than those who were not infected. The results indicate that access to drug abuse treatment should be facilitated for high-risk IDUs and for those who have begun to inject drugs recently.

Intracochlear drug injections through the round window membrane: Measures to improve drug retention

PubMed Central

Plontke, Stefan K.; Hartsock, Jared J.; Gill, Ruth M.; Salt, Alec N.

2016-01-01

The goal of this study was to develop appropriate methodology to apply drugs quantitatively to perilymph of the ear. Intratympanic applications of drugs to the inner ear often result in variable drug levels in perilymph and can only be used for molecules that readily permeate the round window (RW) membrane. Direct intracochlear and intralabyrinthine application procedures for drugs, genes or cell-based therapies by-pass the tight boundaries at the round window, oval window, otic capsule and the blood-labyrinth barrier. However, perforations can release inner ear pressure, allowing cerebrospinal fluid to enter through the cochlear aqueduct, displacing the injected drug solution into the middle ear. Two markers, fluorescein or fluorescein isothiocyanate (FITC)-labeled dextran, were used to quantify how much of an injected substance was retained in cochlear perilymph following an intracochlear injection. We evaluated whether procedures to mitigate fluid leaks improved marker retention in perilymph. Almost all procedures to reduce volume efflux, including the use of gel for internal sealing and glue for external sealing of the injection site, resulted in improved retention of the marker in perilymph. Adhesive on the RW membrane effectively prevented leaks but also influenced fluid exchange between CSF and perilymph. We conclude that drugs can be delivered to the ear in a consistent, quantitative manner using intracochlear injections if care is taken to control the fluid leaks that result from cochlear perforation. PMID:26905306

Hepatitis C infection and other drug-related harms among inpatients who injected drugs in Turkey.

PubMed

Alaei, A; Alaei, K; Waye, K; Tracy, M; Nalbandyan, M; Mutlu, E; Cetin, M K

2017-06-01

Hepatitis C virus (HCV) is easily spread among those who share drug injection equipment. Due to the ease of contraction and growing prevalence of HCV in Eastern Europe, the aims of this study focused on describing risky injection practices as well as the prevalence of HCV, HIV and hepatitis B virus (HBV) among people who inject drugs (PWID) who were admitted to public and private drug treatment centres in Turkey from 2012 to 2013. Other aims included identifying correlates of needle sharing and HCV infection. Of the 4694 inpatients who ever injected drugs and the 3914 who injected in the past 30 days, nearly all (98%) reported heroin as their drug of choice, the vast majority reported ever sharing a needle (73.4% and 79.3%), and the mean age at first injection was 23 years. Of current PWID, 51.9% were HCV-positive, 5.9% were HBV-positive and only 0.34% of lifetime PWID were HIV-positive. Predictors of increased needle sharing include younger age, being unemployed, having lesser education and reporting heroin as a drug of choice. Significant predictors of HCV infection included being 40 years or older, receiving treatment in the Mediterranean region of Turkey, reporting heroin as a primary substance, a longer duration of drug use and sharing needles. With this information, it is essential to improve access to clean injection equipment in Turkey, to focus on improving education on clean injection practices and to enhance efforts in testing and treating HCV-positive PWID. © 2016 John Wiley & Sons Ltd.

The Cedar Project: Historical trauma, sexual abuse and HIV risk among young Aboriginal people who use injection and non-injection drugs in two Canadian cities☆

PubMed Central

For the Cedar Project Partnership; Pearce, Margo E.; Christian, Wayne M.; Patterson, Katharina; Norris, Kat; Moniruzzaman, Akm; Craib, Kevin J.P.; Schechter, Martin T.; Spittal, Patricia M.

2016-01-01

Recent Indigenist scholarship has situated high rates of traumatic life experiences, including sexual abuse, among Indigenous peoples of North America within the larger context of their status as colonized peoples. Sexual abuse has been linked to many negative health outcomes including mental, sexual and drug-related vulnerabilities. There is a paucity of research in Canada addressing the relationship between antecedent sexual abuse and negative health outcomes among Aboriginal people including elevated risk of HIV infection. The primary objectives of this study were to determine factors associated with sexual abuse among participants of the Cedar Project, a cohort of young Aboriginal people between the ages of 14 and 30 years who use injection and non-injection drugs in two urban centres in British Columbia, Canada; and to locate findings through a lens of historical and intergenerational trauma. We utilized post-colonial perspectives in research design, problem formulation and the interpretation of results. Multivariate modeling was used to determine the extent to which a history of sexual abuse was predictive of negative health outcomes and vulnerability to HIV infection. Of the 543 eligible participants, 48% reported ever having experienced sexual abuse; 69% of sexually abused participants were female. The median age of first sexual abuse was 6 years for both female and male participants. After adjusting for sociodemographic variables and factors of historical trauma, sexually abused participants were more likely to have ever been on the streets for more than three nights, to have ever self-harmed, to have suicide ideation, to have attempted suicide, to have a diagnosis of mental illness, to have been in the emergency department within the previous 6 months, to have had over 20 lifetime sexual partners, to have ever been paid for sex and to have ever overdosed. The prevalence and consequences of sexual abuse among Cedar Project participants are of grave concern

Disassortative mixing patterns of drug-using and sex networks on HIV risk behaviour among young drug users in Yunnan, China.

PubMed

Li, J; Luo, J; Li, J; Liu, H

2015-09-01

The dominant mode of HIV transmission in China has changed from injection drug use to sexual contact. The objectives of this study were to describe the disassortative and assortative mixing patterns of drug-using and sex networks among young drug users in China. Cross-sectional study. Respondent-driven sampling (RDS) was used to recruit young drug users in an egocentric network study in Yunnan, China. Egos were categorized as having disassortative mixing network patterns if they reported both sex and drug-using networks. Egos who only had a sex network (no drug-using network), or only a drug-using network (no sex network) were categorized as having assortative mixing network patterns. Multiple logistic regression was performed to analyze the relationships between disassortative patterns with risky sexual behaviour and drug-using practices. A total of 426 participants were recruited into the study. Two hundred forty-two egos reported disassortative mixing patterns and 139 egos had assortative patterns. The RDS-adjusted proportion of having a disassortative pattern was 53.2%. Participants with disassortative patterns were more likely to engage in HIV risk behaviour compared to those with assortative patterns. Specifically, drug users with disassortative patterns reported more multiple sex partners (31.4% vs 19.6%), concurrent partnerships (52.1% vs 39.0%), non-regular sex partners (12.0% vs 4.3%), and sex partners who were IDUs (24.9% vs 12.5%). Consistent condom use with regular or non-regular partners was low (between 18.9% and 47.2%) regardless of the mixing pattern. However, parenteral risk for HIV transmission was relatively low in both groups. The transition of the HIV epidemic in China from injection drug use to sexual contact may be attributed to disassortative mixing in drug-use and sexual networks. HIV programs should consider disassortative mixing patterns when designing new behavioural interventions. Copyright © 2015 The Royal Society for Public Health

Testing a fall risk model for injection drug users.

PubMed

Pieper, Barbara; Templin, Thomas N; Goldberg, Allon

2012-01-01

Fall risk is a critical component of clinical assessment and has not been examined for persons who have injected illicit drugs and are aging. The aim of this study was to test and develop the Fall Risk Model for Injection Drug Users by examining the relationships among injection drug use, chronic venous insufficiency, lower extremity impairments (i.e., decreased ankle range of motion, reduced calf muscle endurance, and leg pain), age and other covariates, and the Tinetti balance and gait total score as a measure of fall risk. A cross-sectional comparative design was used with four crossed factors. Standardized instruments were used to assess the variables. Moderated multiple regression with linear and quadratic trends in age was used to examine the nature of the relationship between the Tinetti balance and gait total and age and the potential moderating role of injection drug use. A prespecified series of models was tested. Participants (n = 713) were men (46.9%) and women with a mean age of 46.26 years and primarily African American (61.7%) in methadone treatment centers. The fall risk of a 48-year-old leg injector was comparable with the fall risk of a 69-year-old who had not injected drugs. Variables were added to the model sequentially, resulting in some lost significance of some when they were explained by subsequent variables. Final significant variables in the model were employment status, number of comorbidities, ankle range of motion, leg pain, and calf muscle endurance. Fall risk was associated with route of drug use. Lower extremity impairments accounted for the effects of injection drug use and chronic venous insufficiency on risk for falls. Further understanding of fall risk in injection users is necessary as they age, attempt to work, and participate in activities.

Injection Drug Use Trajectories Among Migrant Populations: A Narrative Review.

PubMed

Melo, Jason S; Mittal, Maria Luisa; Horyniak, Danielle; Strathdee, Steffanie A; Werb, Dan

2018-01-24

Dual epidemics of injection drug use and blood-borne disease, characterized as "syndemics," are present in a range of settings. Behaviors that drive such syndemics are particularly prevalent among mobile drug-using populations, for whom cross-border migration may pose additional risks. This narrative review aims to characterize the risk factors for injection drug use initiation associated with migration, employing a risk environment framework and focusing on the San Diego-Tijuana border region as the most dynamic example of these phenomena. Based on previous literature, we divide migration streams into three classes: intra-urban, internal, and international. We synthesized existing literature on migration and drug use to characterize how mobility and migration drive the initiation of injection drug use, as well as the transmission of hepatitis and HIV, and to delineate how these might be addressed through public health intervention. Population mixing between migrants and receiving communities and the consequent transmission of social norms about injection drug use create risk environments for injection drug use initiation. These risk environments have been characterized as a result of local policy environments, injection drug use norms in receiving communities, migration-related stressors, social dislocation, and infringement on the rights of undocumented migrants. Policies that exacerbate risk environments for migrants may inadvertently contribute to the expansion of epidemics of injection-driven blood-borne disease. Successful interventions that address emerging syndemics in border regions may therefore need to be tailored to migrant populations and distinguish between the vulnerabilities experienced by different migration classes and border settings.

Continued Transmission of HIV Among Young Adults Who Inject Drugs in San Francisco: Still Room for Improvement.

PubMed

Mirzazadeh, Ali; Evans, Jennifer L; Hahn, Judith A; Jain, Jennifer; Briceno, Alya; Shiboski, Stephen; Lum, Paula J; Bentsen, Christopher; Davis, Geoff; Shriver, Kathy; Dimapasoc, Melanie; Stone, Mars; Busch, Michael P; Page, Kimberly

2018-04-01

We measured HIV incidence rate, trend and risk factors in 564 HIV-negative young people (< 30 years) who inject drugs (PWID) in San Francisco between 2000 and 2014. HIV incidence was 0.93/100 person-years (PY; 95% CI 0.50, 1.73). Incidence varied between 0.62/100 PY in 2000-2002 and 1.06/100 PY in 2012-2014 (P for trend = 1.0). HIV incidence varied significantly (P < 0.01) by race/ethnicity: among Hispanics it was 8.19/100 PY (95% CI 3.41, 19.68), African-Americans 4.59/100 PY (95% CI 1.15, 18.37), and Whites 0.26/100 PY (95% CI 0.06, 1.03). Male participants who reported sex with men (MSM) had higher HIV incidence (2.63/100 PY; 95% CI 1.31, 5.25) compared to males who did not report MSM (0.50/100 PY; 95% CI 0.12, 1.99) (P = 0.01). Despite an overall stable HIV incidence trend, incidence was elevated among African-American and Hispanic PWID, and men who have sex with men. Addressing prevention needs in these key populations is critical for the goal of eliminating HIV transmission.

Resilient children of injection drug users.

PubMed

Pilowsky, Daniel J; Zybert, Patricia A; Vlahov, David

2004-11-01

To examine associations between resilience in children of injection drug users and children's coping strategies, parenting stress, and children's social support. Injection drug-using parents (n=91) and their children aged 6 to 11 (n=117) were recruited in Baltimore (1997-1999). Resilience was defined as scoring in the lowest quartile of the Child Behavior Checklist total psychopathology score. Coping strategies used by resilient and nonresilient children, the extent and types of social support that they received, and the level of parenting stress reported by their parents were compared and contrasted. Rates of depressive, anxiety, and disruptive behavior disorders were 15.4%, 22.2%, and 21.4%, respectively, for the entire sample. Compared with the nonresilient, resilient children were less likely to use two avoidance coping strategies (internalizing [p=.002] and externalizing [p=.017]). The level of actual support received by resilient and nonresilient children did not differ significantly (p=.202). Perceived support was greater among resilient children (as reported by their parents; p <.001), and their parents reported lower parenting stress (p=.042). A significant proportion of children of injection drug users are in need of clinical care. Interventions to help children of substance-abusing parents modify their coping style merit exploration.

Large decline in injecting drug use in Amsterdam, 1986-1998: explanatory mechanisms and determinants of injecting transitions.

PubMed

van Ameijden, E J; Coutinho, R A

2001-05-01

To study community wide trends in injecting prevalence and trends in injecting transitions, and determinants. Open cohort study with follow up every four months (Amsterdam Cohort Study). Generalised estimating equations were used for statistical analysis. Amsterdam has adopted a harm reduction approach as drug policy. 996 drug users who were recruited from 1986 to 1998, mainly at methadone programmes, who paid 13620 cohort visits. The prevalence of injecting decreased exponentially (66% to 36% in four to six monthly periods). Selective mortality and migration could maximally explain 33% of this decline. Instead, injecting initiation linearly decreased (4.1% to 0.7% per visit), cessation exponentially increased (10.0% to 17.1%), and relapse linearly decreased (21.3% to 11.8%). Non-injecting cocaine use (mainly pre-cooked, comparable to crack) and heroin use strongly increased. Trends were not attributable to changes in the study sample. Harm reduction, including large scale needle exchange programmes, does not lead to an increase in injecting drug use. The injecting decline seems mainly attributable to ecological factors (for example, drug culture and market). Prevention of injecting is possible and peer-based interventions may be effective. The consequences of the recent upsurge in crack use requires further study.

Correlates of lending needles/syringes among HIV-seropositive injection drug users.

PubMed

Metsch, Lisa R; Pereyra, Margaret; Purcell, David W; Latkin, Carl A; Malow, Robert; Gómez, Cynthia A; Latka, Mary H

2007-11-01

Among HIV-positive injection drug users (IDUs), we examined the correlates of lending needles/syringes with HIV-negative and unknown status injection partners. HIV-positive IDUs (N=738) from 4 cities in the United States who reported injection drug use with other IDUs in the past 3 months participated in an audio computer-assisted self-administered interview. Eighteen percent of study participants self-reported having lent their needles to HIV-negative or unknown status injection partners. Multivariate analyses showed that 6 variables were significantly associated with this high-risk injecting practice. Older IDUs, high school graduates, and those reporting more supportive peer norms for safer drug use were less likely to lend needles/syringes. Admission to a hospital for drug treatment in the past 6 months, having injected with >1 person in the past 3 months, and having more psychiatric symptoms were all associated with more risk. These findings underscore the need for a continued prevention focus on HIV-positive IDUs that recognizes the combination of drug use, mental health factors, and social factors that might affect this high-risk injecting practice, which could be associated with HIV and hepatitis C transmission.

Injected with controversy: sales and administration of injectable contraceptives in drug shops in Uganda.

PubMed

Stanback, John; Otterness, Conrad; Bekiita, Martha; Nakayiza, Olivia; Mbonye, Anthony K

2011-03-01

Informal drug shops are the first line of health care in many poor countries. In Uganda, these facilities commonly sell and administer the injectable contraceptive depot medroxyprogesterone acetate (DMPA), even though they are prohibited by law from selling any injectable drugs. It is important to understand drug shop operators' current practices and their potential to provide DMPA to hard-to-reach populations. Between November 2007 and January 2008, 157 drug shops were identified in three rural districts of Uganda, and the operators of the 124 facilities that sold DMPA were surveyed. Data were analyzed with descriptive methods. Only 35% of operators reported that the facility in which they worked was a licensed drug shop and another 9% reported that the facility was a private clinic; all claimed to have some nursing, midwifery, or other health or medical qualification. Ninety-six percent administered DMPA in the shop. Operators gave a mean of 10 injections (including three of DMPA) per week. Forty-three percent of those who administered DMPA reported disposing of used syringes in sharps containers; in the previous 12 months, 24% had had a needle-stick injury and 17% had had a patient with an injection-related abscess. Eleven percent said they had ever reused a disposable syringe. Overall, contraceptive knowledge was low, and attitudes toward family planning reflected common traditional biases. Provision of DMPA is common in rural drug shops, but needs to be made safer. Absent stronger regulation and accreditation, drug shop operators can be trained as community-based providers to help meet the extensive unmet demand for family planning in rural areas.

Emergence of cocaine and methamphetamine injection among HIV-positive injection drug users in Northern and Western India

PubMed Central

Mehta, Shruti H.; Srikrishnan, Aylur K; Noble, Eva; Vasudevan, Canjeevaram K; Solomon, Suniti; Kumar, M Suresh; Solomon, Sunil S

2014-01-01

Background Little is known regarding the epidemiology of drug injection and risk behaviors among injection drug users (IDUs) across India. In particular, there is limited data on the prevalence of stimulant injection. Methods We sampled 801 HIV positive IDUs from 14 locations throughout India to represent the geography of India as well as the diversity in IDU epidemic stage (established epidemics, emerging epidemics and large cities). All participants underwent a behavioral survey and blood draw. Given prior associations with stimulant injection and HIV risk, we compared stimulant injectors (cocaine and/or methamphetamine) to those who injected opiates and/or pharmaceuticals only. Results The median age was 33; 86% were male. The primary drugs injected were heroin, buprenorphine and other pharmaceuticals. In all but four sites, >50% of those actively injecting reported needle sharing. Stimulant injection was most common in emerging epidemics. Compared to exclusive opiate injectors, stimulant injectors were significantly younger, more likely to be educated and employed, more likely to report non-injection use of heroin, crack/cocaine and amphetamines, heavy alcohol use, recent needle sharing (71% vs. 57%), sex with a casual partner (57% vs. 31%) and men having sex with other men (33% vs. 9%; p<0.01 for all). Conclusions Emerging IDU epidemics have a drug/sexual risk profile not previously been observed in India. Given the high prevalence of stimulant injection in these populations, HIV prevention/treatment programs may need to be redesigned to maximize effectiveness. The high levels of injection sharing overall reinforce the need to ensure access to harm-reduction services for all. PMID:24382362

Improving measurement of injection drug risk behavior using item response theory.

PubMed

Janulis, Patrick

2014-03-01

Recent research highlights the multiple steps to preparing and injecting drugs and the resultant viral threats faced by drug users. This research suggests that more sensitive measurement of injection drug HIV risk behavior is required. In addition, growing evidence suggests there are gender differences in injection risk behavior. However, the potential for differential item functioning between genders has not been explored. To explore item response theory as an improved measurement modeling technique that provides empirically justified scaling of injection risk behavior and to examine for potential gender-based differential item functioning. Data is used from three studies in the National Institute on Drug Abuse's Criminal Justice Drug Abuse Treatment Studies. A two-parameter item response theory model was used to scale injection risk behavior and logistic regression was used to examine for differential item functioning. Item fit statistics suggest that item response theory can be used to scale injection risk behavior and these models can provide more sensitive estimates of risk behavior. Additionally, gender-based differential item functioning is present in the current data. Improved measurement of injection risk behavior using item response theory should be encouraged as these models provide increased congruence between construct measurement and the complexity of injection-related HIV risk. Suggestions are made to further improve injection risk behavior measurement. Furthermore, results suggest direct comparisons of composite scores between males and females may be misleading and future work should account for differential item functioning before comparing levels of injection risk behavior.

HIV and injecting drug use in Indonesia: epidemiology and national response.

PubMed

Afriandi, Irvan; Aditama, Tjandra Yoga; Mustikawati, Dyah; Oktavia, Martiani; Alisjahbana, Bachti; Riono, Pandu

2009-07-01

Indonesia is facing one of the most rapidly growing HIV-epidemics in Asia. Risk behaviour associated with injecting drug use, such as sharing contaminated needles, is the main risk factor for HIV infection. Among the general population the prevalence of HIV-infection is still low (0.2%), but up to 50% or more of the estimated 145.000 - 170.000 injecting drug users are already HIV-positive. Overrepresentation of injecting drug users and continued risk behavior inside Indonesian prisons contribute to spread of HIV. Through sexual contacts, HIV is transmitted from current or previous injecting drug users to their non-injecting sexual partners; 10-20% of this group may already be infected. The national response targeted to limit spread of HIV through injecting drug use has included needle and syringe program (NSP), methadone maintenance treatment (MMT), voluntary counseling and testing (VCT), and outreach program as priority programs. However coverage and utilization of the harm reduction services is still limited, but effective integration with HIV testing and treatment is expanding. By 2008, there were 110 service points for NSP and 24 operational MMT clinics. Nevertheless, utilization of these services has been less satisfactory and their effectiveness has been questioned. Besides effective prevention, HIV- testing and earlier treatment of HIV-seropositve individuals, including those with a history of injecting drug use, will help control the growing HIV-epidemic in Indonesia.

Association between Pregnancy and Active Injection Drug Use and Sex Work among Women Injection Drug Users in Saint Petersburg, Russia.

PubMed

Girchenko, P; Ompad, D C; Bikmukhametov, D; Gensburg, L

2015-06-01

Widespread use of unsafe sexual practices among women injecting drugs both practicing and not practicing sex work leads to high levels of unplanned pregnancies in this population. The goal of this study was to investigate the association between pregnancy and active drug use and sex work. Data were collected using a convenience sample of 500 women in Saint Petersburg, Russia, in 2013. All women had recent experience of drug use, of which 200 were pregnant at the time of the study. The study consisted of a structured interview followed by a rapid HIV test. Pregnancy was protective against both active drug use and sex work. For HIV-positive women, these associations were stronger than for HIV-negative women: drug use prevalence ratio (PR) was 0.59 vs 0.85; for sex work, the PRs were 0.36 vs 0.64. Higher levels of education were associated with a lower prevalence ratio for active drug use and sex work in all models. Having children was not associated with active drug use or sex work. Pregnancy might be an optimal time for conducting interventions aimed at cessation of drug use and sex work among women injecting drugs.

Increasing Awareness about HIV Prevention among Young People Who Initiated Injection Drug Use in a Canadian Setting, 1988–2014

PubMed Central

Bahji, Anees; Wood, Evan; Ahamad, Keith; Dong, Huiru; DeBeck, Kora; Milloy, M-J; Kerr, Thomas; Hayashi, Kanna

2015-01-01

Background Globally, harm reduction interventions, including needle and syringe programs (NSPs), have been shown to reduce HIV risks among people who inject drugs (PWID). However, little is known about the impact of these efforts on the circumstances of first injection. Therefore, we sought to identify changes in the awareness about HIV prevention and syringe borrowing at the time of first injection drug use in Vancouver, Canada, during a period of NSP expansion. Methods Data were drawn from prospective cohorts of PWID in Vancouver, who initiated injecting between 1988 and 2014. Multivariable regression was used to assess changes in the awareness about HIV and NSPs and syringe borrowing behaviour at first injection against calendar year of first injection. Results Among 1,044 participants (36.9% female), at the time of first injection 73.9% reported having known syringe sharing was an HIV risk, 54.1% reported having heard of NSPs, and 7.8% reported having borrowed a syringe used by others. In multivariable analyses, calendar year of first injection was independently and positively associated with awareness about HIV (adjusted prevalence ratio [APR]: 1.09; 95% confidence interval [CI]: 1.06, 1.11) and awareness about NSPs (APR: 1.18; 95% CI: 1.13, 1.24). While calendar year of first injection was significantly and negatively associated with syringe borrowing at first injection in bivariable analyses, the association did not remain significant in multivariable analyses (adjusted odds ratio: 0.90; 95% CI: 0.72, 1.14). Conclusions We found that awareness about HIV and NSPs at first injection have increased over time amongst PWID in this setting. However, declining trends in syringe borrowing at first injection were not determined after adjustment for socio-demographic characteristics. This suggests that HIV prevention efforts may have contributed to increased awareness about HIV prevention, but further research is needed to identify sub-populations at heightened risk

Young people's attitudes towards illicit drugs: A population-based study.

PubMed

Friis, Karina; Østergaard, Jeanette; Reese, Sidsel; Lasgaard, Mathias

2017-12-01

Previous studies indicate that young people who have positive attitudes towards illicit drugs are more inclined to experiment with them. The first aim of our study was to identify the sociodemographic and risk behaviour characteristics of young people (16-24 years) with positive attitudes towards illicit drug use. The second aim was to identify the characteristics of young people with positive attitudes towards illicit drugs among those who had never tried drugs, those who had tried cannabis but no other illicit drugs, and those who regularly used cannabis and/or had tried other illicit drugs. The analysis was based on a population-based survey from 2013 ( N = 3812). Multiple logistic regression was used to analyse the association between sociodemographic and risk behaviour characteristics and positive attitudes towards illicit drugs. Young men had twice the odds of having positive attitudes towards illicit drug use compared with young women (AOR = 2.1). Also, young age, being single, being employed, smoking tobacco, practising unprotected sex, and experimental cannabis use were associated with positive attitudes towards illicit drug use. Finally, use of cannabis at least 10 times during the previous year and/or use of other illicit drugs had the strongest association with positive attitudes to illicit drug use (AOR = 6.0). Young people who have positive attitudes towards illicit drug use are characterized by a broad range of risky behaviours. These findings may help to identify young people at risk of initiating illicit drug use and thereby support the development and implementation of prevention programmes.

The association between neighborhood socioeconomic disadvantage and high-risk injection behavior among people who inject drugs.

PubMed

DeCuir, Jennifer; Lovasi, Gina S; El-Sayed, Abdulrahman; Lewis, Crystal Fuller

2018-02-01

Although much research has been conducted on the determinants of HIV risk behavior among people who inject drugs (PWID), the influence of the neighborhood context on high-risk injection behavior remains understudied. To address this gap in the literature, we measured associations between neighborhood socioeconomic disadvantage and high-risk injection behavior, and determined whether these associations were modified by drug-related police activity and syringe exchange program (SEP) accessibility. Our sample was comprised of 484 pharmacy-recruited PWID in New York City. Measures of neighborhood socioeconomic disadvantage were created using data from the 2006-2010 American Community Survey. Associations with high-risk injection behavior were estimated using multivariable Poisson regression. Effect modification by drug-related police activity and SEP accessibility was assessed by entering cross-product terms into adjusted models of high-risk injection behavior. Neighborhood socioeconomic disadvantage was associated with decreased receptive syringe sharing and unsterile syringe use. In neighborhoods with high drug-related police activity, associations between neighborhood disadvantage and unsterile syringe use were attenuated to the null. In neighborhoods with high SEP accessibility, neighborhood disadvantage was associated with decreased acquisition of syringes from an unsafe source. PWID in disadvantaged neighborhoods reported safer injection behaviors than their counterparts in neighborhoods that were relatively better off. The contrasting patterns of effect modification by SEP accessibility and drug-related police activity support the use of harm reduction approaches over law enforcement-based strategies for the control of blood borne virus transmission among PWID in disadvantaged urban areas. Copyright © 2017 Elsevier B.V. All rights reserved.

The staying safe intervention: training people who inject drugs in strategies to avoid injection-related HCV and HIV infection.

PubMed

Mateu-Gelabert, Pedro; Gwadz, Marya Viorst; Guarino, Honoria; Sandoval, Milagros; Cleland, Charles M; Jordan, Ashly; Hagan, Holly; Lune, Howard; Friedman, Samuel R

2014-04-01

This pilot study explores the feasibility and preliminary efficacy of the Staying Safe Intervention, an innovative, strengths-based program to facilitate prevention of infection with the human immunodeficiency virus and with the hepatitis C virus among people who inject drugs (PWID). The authors explored changes in the intervention's two primary endpoints: (a) frequency and amount of drug intake, and (b) frequency of risky injection practices. We also explored changes in hypothesized mediators of intervention efficacy: planning skills, motivation/self-efficacy to inject safely, skills to avoid PWID-associated stigma, social support, drug-related withdrawal symptoms, and injection network size and risk norms. A 1-week, five-session intervention (10 hours total) was evaluated using a pre- versus 3-month posttest design. Fifty-one participants completed pre- and posttest assessments. Participants reported significant reductions in drug intake and injection-related risk behavior. Participants also reported significant increases in planning skills, motivation/self-efficacy, and stigma management strategies, while reducing their exposure to drug withdrawal episodes and risky injection networks.

THE STAYING SAFE INTERVENTION: TRAINING PEOPLE WHO INJECT DRUGS IN STRATEGIES TO AVOID INJECTION-RELATED HCV AND HIV INFECTION

PubMed Central

Mateu-Gelabert, Pedro; Gwadz, Marya Viorst; Guarino, Honoria; Sandoval, Milagros; Cleland, Charles M.; Jordan, Ashly; Hagan, Holly; Lune, Howard; Friedman, Samuel R.

2014-01-01

This pilot study explores the feasibility and preliminary efficacy of the Staying Safe Intervention, an innovative, strengths-based program to facilitate prevention of infection with the human immunodeficiency virus and with the hepatitis C virus among people who inject drugs (PWID). The authors explored changes in the intervention's two primary endpoints: (a) frequency and amount of drug intake, and (b) frequency of risky injection practices. We also explored changes in hypothesized mediators of intervention efficacy: planning skills, motivation/self-efficacy to inject safely, skills to avoid PWID-associated stigma, social support, drug-related withdrawal symptoms, and injection network size and risk norms. A 1-week, five-session intervention (10 hours total) was evaluated using a pre- versus 3-month posttest design. Fifty-one participants completed pre- and posttest assessments. Participants reported significant reductions in drug intake and injection-related risk behavior. Participants also reported significant increases in planning skills, motivation/self-efficacy, and stigma management strategies, while reducing their exposure to drug withdrawal episodes and risky injection networks. PMID:24694328

Associations between injection risk and community disadvantage among suburban injection drug users in southwestern Connecticut, USA.

PubMed

Heimer, Robert; Barbour, Russell; Palacios, Wilson R; Nichols, Lisa G; Grau, Lauretta E

2014-03-01

Increases in drug abuse, injection, and opioid overdoses in suburban communities led us to study injectors residing in suburban communities in southwestern Connecticut, US. We sought to understand the influence of residence on risk and injection-associated diseases. Injectors were recruited by respondent-driven sampling and interviewed about sociodemographics, somatic and mental health, injection risk, and interactions with healthcare, harm reduction, substance abuse treatment, and criminal justice systems. HIV, hepatitis B and C (HBV and HCV) serological testing was also conducted. Our sample was consistent in geographic distribution and age to the general population and to the patterns of heroin-associated overdose deaths in the suburban towns. High rates of interaction with drug abuse treatment and criminal justice systems contrasted with scant use of harm reduction services. The only factors associated with both dependent variables-residence in less disadvantaged census tracts and more injection risk-were younger age and injecting in one's own residence. This contrasts with the common association among urban injectors of injection-associated risk behaviors and residence in disadvantaged communities. Poor social support and moderate/severe depression were associated with risky injection practices (but not residence in specific classes of census tracts), suggesting that a region-wide dual diagnosis approach to the expansion of harm reduction services could be effective at reducing the negative consequences of injection drug use.

Correlates of risky injection practices among past-year injection drug users among the US general population.

PubMed

Ropelewski, Lauren R; Mancha, Brent E; Hulbert, Alicia; Rudolph, Abby E; Martins, Silvia S

2011-07-01

With an estimated 1 million active injection drug users (IDUs), injection drug use continues to be a public health concern in the United States. Risky injection practices have been associated with the transmission of HIV, Hepatitis B and C, as well as other skin and soft tissue infections. We used data from 463 respondents, aged 18 and older, who were past-year IDUs in the 2005-2008 National Survey of Drug Use and Health (NSDUH). We investigated correlates of risky injection behavior among these recent IDUs. Older age (≥ 35 versus 18-25) was associated with reusing one's own needle at last injection (aOR=1.80 [1.02-3.17], as were past year heroin (aOR=2.59 [1.18-5.66]) and cocaine injection (aOR=2.17 [1.13-4.15]). Past year crack cocaine use was positively associated with not cleaning needles with bleach (aOR=2.18 [1.10-4.33]). Past year cocaine injection was associated with obtaining needles in a risky manner (aOR=2.29 [1.23-4.25]). Methamphetamine injection was associated with obtaining needles in less risky ways (aOR=0.41 [0.20-0.84]). Our findings indicate that some IDUs are continuing to engage in high risk injection behaviors. The identification of potential at-risk populations of IDUs may have implications for harm reduction interventions and HIV prevention programs. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Correlates of injection drug use among individuals admitted to public and private drug treatment facilities in Turkey.

PubMed

Mutlu, Elif; Alaei, Arash; Tracy, Melissa; Waye, Katherine; Cetin, Mustafa Kemal; Alaei, Kamiar

2016-07-01

The number of individuals seeking treatment for drug use has been increasing in recent years in Turkey. However, existing research on patterns and risk factors for drug use and how they vary by age and location in Turkey is limited. We examined the socio-demographic characteristics, drug use behaviors, and treatment history of citizens admitted to inpatient substance use treatment at public and private facilities in Turkey during 2012 and 2013 and identified correlates of lifetime and current injection drug use. Of the 11,247 patients at the 22 public treatment centers in 2012-2013, a majority were male, lived with family, were unemployed, and had an average age of 27 years. Within private clinics (n=663), a higher proportion was female (9.7% private vs. 5.7% public), aged 11-17 years old (13% vs. 7.4%), used cannabis as their primary drug (18.4% vs. 13.2%), and had previously received drug treatment (57% vs. 47.2%). Within public centers, 40.4% reported ever injecting drugs and 33.7% reported injecting in the past 30 days; the corresponding percentages at private clinics were 22.5% and 18.1%. Significant predictors of injection drug use included being homeless, being a temporal employee or unemployed, having higher education, heroin as a preferred drug, having a longer duration of drug use, and prior drug treatment. Prevention and intervention efforts are needed to reduce the transition to heroin and injection drug use among youth as well as improve access to a variety of drug treatment options for people who use substances in Turkey. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Factors Influencing Transition to Shisheh (Methamphetamine) among Young People Who Use Drugs in Tehran: A Qualitative Study.

PubMed

Noroozi, Alireza; Malekinejad, Mohsen; Rahimi-Movaghar, Afarin

2018-01-29

Iran has experienced an emerging epidemic of methamphetamine use during recent years which has added to existing non-injecting and injecting opioid use in the country. This study explored factors influencing the initiation into or transition to methamphetamine use among young people who use drugs (PWUD). We conducted 42 semi-structured, in-depth interviews with young PWUD (n = 35) and health care workers (HCWs) (n = 7) between July and October 2011 in Tehran, Iran. The PWUD were purposefully recruited from different tiers of drug services and lived in geographically diverse areas of Tehran. The HCWs were substance use experts and/or service providers of treatment and harm reduction facilities. All interviews were recorded, transcribed, and coded using OpenCode 3.6 software. The predominant factors for initiation into or transition to methamphetamine use were individual domain factors. The peer domain factors were the second most frequently stated perceived factor category for transition to methamphetamine use. Other perceived factors affecting transition to stimulant use included both family and community domains. Drug prevention programs should consider targeting certain settings, including workplaces and sports clubs, for preventative interventions. Existing opioid treatment and harm reduction services should be adjusted in response to the methamphetamine use epidemic.

Hepatitis A prevalence among injection drug users.

PubMed

Wells, Rebecca; Fisher, Dennis; Fenaughty, Andrea; Cagle, Henry; Jaffe, Adi

2006-01-01

The purpose of this study was to develop a descriptive model of the association between injection drug use and hepatitis A (HAV) in a sample of injection drug users (IDUs). From May 1997 to July 1999, 493 subjects were administered the NIDA Risk Behavior Assessment (RBA). Participants had blood drawn; sera were tested for antibodies to HAV, hepatitis B core (HBcAB), and hepatitis C. The principal method of analysis was logistic regression. The study took place in a community-based field station in Anchorage, Alaska. Eligibility was determined using the following criteria: a) age greater than 17 years, b) possession of picture identification, c) positive urinalysis for cocaine metabolites, morphine, and/or amphetamines using the ONTRAK system (Roche Diagnostics), and d) injection drug use in the last six months as confirmed by presentation of track marks. Presence of antibodies to HAV infection. The prevalence of total HAV antibody in our sample was 33% (161/493). The final multivariate logistic model, using positive HAV serostatus as the outcome, included positive HBcAB serostatus (OR = 3.43; 95% CI, 2.22-5.30), less than high school education (vs. high school or greater education) (OR = 2.05; 95% CI, 1.33-3.17), age (OR = 1.06 (each year); 95% CI, 1.03-1.09), number of days injected heroin in the last 30 days (OR = 1.05 (each day), 95% CI, 1.01-1.08), and race (White vs. all other race/ethnicities) (OR = 0.49; 95% CI, 0.32-0.75). A model including both demographic and drug use variables best describes HAV prevalence in this sample. Findings suggest that IDUs are targets for interventions focusing on hepatitis vaccinations and hygiene practices. Further research is needed to understand the association of HAV with hepatitis B infection.

Cross-border injection drug use and HIV and hepatitis C virus seropositivity among people who inject drugs in San Diego, California.

PubMed

Horyniak, Danielle; Wagner, Karla D; Armenta, Richard F; Cuevas-Mota, Jazmine; Hendrickson, Erik; Garfein, Richard S

2017-09-01

The prevalence of HIV and Hepatitis C Virus (HCV) are significantly lower among people who inject drugs (PWID) in San Diego, CA, USA compared with PWID in Tijuana, Mexico, located directly across the border. We investigated associations between cross-border injection drug use (IDU), HIV and HCV seroprevalence and engagement in injecting risk behaviours while on each side of the border. Using baseline interviews and serologic testing data from STAHR II, a longitudinal cohort study of PWID in San Diego, bivariate and multivariable logistic regression analyses examined associations between recent (past six months) cross-border IDU and HIV and HCV antibody seropositivity, socio-demographics, drug use characteristics, and participants' connections to, and perceptions about Mexico. Chi-squared tests and McNemar tests examined associations between cross-border IDU and injecting risk behaviours. Of the 567 participants (93% U.S.-born, 73% male, median age 45 years), 86 (15%) reported recent cross-border IDU. Cross-border IDU was not associated with HIV (OR: 0.85, 95% CI: 0.37-1.95) or HCV seropositivity (OR: 1.01, 95% CI: 0.62-1.65). Age, identifying as Hispanic or Latino/a, and being concerned about risk of violence when travelling to Mexico were independently associated with decreased odds of recent cross-border IDU. Injecting cocaine at least weekly, having ever lived in Mexico and knowing PWID who reside in Mexico were associated with increased odds of recent cross-border IDU. PWID who reported cross-border IDU were significantly less likely to engage in receptive needle sharing, equipment sharing, and public injection while in Mexico compared with in San Diego (all p<0.001). Prevalence of HIV and HCV infection was similar among PWID who had and had not injected in Mexico, possibly due to practising safer injecting while in Mexico. Research is needed to elucidate contextual factors enabling U.S. PWID to inject safely while in Mexico. Copyright © 2017 Elsevier B.V. All

Needle Exchange Programs and Drug Injection Behavior

ERIC Educational Resources Information Center

DeSimone, Jeff

2005-01-01

This study examines how drug injection and needle sharing propensities respond when a needle exchange program (NEP) is introduced into a city. I analyze 1989-1995 Drug Use Forecasting data on adult male arrestees from 24 large U.S. cities, in nine of which NEPs opened during the sample period. After controlling for cocaine and heroin prices, AIDS…

Effectiveness of HIV prevention social marketing with injecting drug users.

PubMed

Gibson, David R; Zhang, Guili; Cassady, Diana; Pappas, Les; Mitchell, Joyce; Kegeles, Susan M

2010-10-01

Social marketing involves applying marketing principles to promote social goods. In the context of health behavior, it has been used successfully to reduce alcohol-related car crashes, smoking among youths, and malaria transmission, among other goals. Features of social marketing, such as audience segmentation and repeated exposure to prevention messages, distinguish it from traditional health promotion programs. A recent review found 8 of 10 rigorously evaluated social marketing interventions responsible for changes in HIV-related behavior or behavioral intentions. We studied 479 injection drug users to evaluate a community-based social marketing campaign to reduce injection risk behavior among drug users in Sacramento, California. Injecting drugs is associated with HIV infection in more than 130 countries worldwide.

Effectiveness of HIV Prevention Social Marketing With Injecting Drug Users

PubMed Central

Zhang, Guili; Cassady, Diana; Pappas, Les; Mitchell, Joyce; Kegeles, Susan M.

2010-01-01

Social marketing involves applying marketing principles to promote social goods. In the context of health behavior, it has been used successfully to reduce alcohol-related car crashes, smoking among youths, and malaria transmission, among other goals. Features of social marketing, such as audience segmentation and repeated exposure to prevention messages, distinguish it from traditional health promotion programs. A recent review found 8 of 10 rigorously evaluated social marketing interventions responsible for changes in HIV-related behavior or behavioral intentions. We studied 479 injection drug users to evaluate a community-based social marketing campaign to reduce injection risk behavior among drug users in Sacramento, California. Injecting drugs is associated with HIV infection in more than 130 countries worldwide. PMID:20724686

The importance of social networks in their association to drug equipment sharing among injection drug users: a review.

PubMed

De, Prithwish; Cox, Joseph; Boivin, Jean-François; Platt, Robert W; Jolly, Ann M

2007-11-01

To examine the scientific evidence regarding the association between characteristics of social networks of injection drug users (IDUs) and the sharing of drug injection equipment. A search was performed on MEDLINE, EMBASE, BIOSIS, Current Contents, PsycINFO databases and other sources to identify published studies on social networks of IDUs. Papers were selected based on their examination of social network factors in relation to the sharing of syringes and drug preparation equipment (e.g. containers, filters, water). Additional relevant papers were found from the reference list of identified articles. Network correlates of drug equipment sharing are multi-factorial and include structural factors (network size, density, position, turnover), compositional factors (network member characteristics, role and quality of relationships with members) and behavioural factors (injecting norms, patterns of drug use, severity of drug addiction). Factors appear to be related differentially to equipment sharing. Social network characteristics are associated with drug injection risk behaviours and should be considered alongside personal risk behaviours in prevention programmes. Recommendations for future research into the social networks of IDUs are proposed.

Effects of police confiscation of illicit drugs and syringes among injection drug users in Vancouver.

PubMed

Werb, Daniel; Wood, Evan; Small, Will; Strathdee, Steffanie; Li, Kathy; Montaner, Julio; Kerr, Thomas

2008-08-01

Drug market policing has been associated with various harms among injection drug users (IDU). However, little is known about instances in which drugs and injecting equipment are confiscated from IDU in the absence of a formal arrest. We examined factors associated with being stopped, searched, or detained by police among participants in the Vancouver Injection Drug Users Study (VIDUS) using logistic regression. We also examined actions taken by study participants immediately following instances in which drugs or syringes were confiscated by police. Among 465 active IDU, 130 (28.0%) reported being detained by police in the last 6 months without being arrested. In multivariate logistic regression analysis, factors associated with being stopped, searched or detained by police included homelessness (Adjusted Odds Ratio [AOR]=3.96, 95% CI: 1.86-8.45), recent incarceration (AOR=3.52, 95% CI: 1.75-7.10), frequent crack use (AOR=2.24, 95% CI: 1.34-3.74), requiring help injecting (AOR=5.20, 95% CI: 1.21-22.39), and lending syringes (AOR=3.18, 95% CI: 1.09-9.30). Of those who reported being detained, 34% participants reported having had drugs confiscated, and 70% of these reported that they immediately acquired more drugs. Fifty-one percent of participants who reported being detained also reported having had syringes confiscated, and of this group, 6% reported immediately borrowing used syringes. Our study demonstrates that the IDU most affected by street-level policing tend to possess various characteristics, such as homelessness, that place them at heightened risk for various adverse health outcomes. Our findings also suggest that the confiscation of drugs and/or needles and syringes through discretionary policing practices have the potential to exacerbate drug market activity or prompt increased syringe borrowing. These findings indicate the need for ongoing evaluation of the public health impacts of discretionary policing approaches.

[Injecting drug abuse: survival after intensive care admission and forensic toxicology reports at death].

PubMed

Sigvaldason, Kristinn; Ingvarsson, Thoroddur; Thordardottir, Svava; Kristinsson, Jakob; Karason, Sigurbergur

2014-10-01

Injecting drug abuse is a worldwide problem with serious consequences for the individual and for society. The purpose of this study was to gather information on the most serious complications of injecting drug use from two perspectives, intensive care admissions and forensic toxicology reports. Firstly, intensive care admissions related to injecting drug abuse during a five year period were reviewed for demographics, complications and 5 year survival. Secondly, information from forensic toxicology reports regarding deaths amongst known injecting drug abusers were gathered for the same period. A total of 57 patients with a history of active injecting drug use were admitted to intensive care or approximately 1% of admissions, most often for overdose (52%) or life threatening infections (39%). Median age was 26, males were 66%. The most common substances used were prescription drugs. Hospital mortality was 16% and five year survival 65%. Average time from hospital discharge to death was 916±858 days. During the study period 38 deaths of individuals with a history of injecting drugs were identified by forensic toxicology reports or 4.1/10(5) population/year (age 15-59). Cause of death was most often overdose (53%), usually from prescription opiates but multiple drug use was common. The life expectancy of injecting drug abusers after intensive care admission is substantially decreased, with 35% death rate within five years. A widespread use of prescription drugs is of concern. Injecting drug abuse seems to be a similar health problem in magnitude in Iceland as in other Scandinavian countries.

Association between prescription drug misuse and injection among runaway and homeless youth

PubMed Central

Al-Tayyib, Alia A; Rice, Eric; Rhoades, Harmony; Riggs, Paula

2013-01-01

Background The nonmedical use of prescription drugs is the fastest growing drug problem in the United States, disproportionately impacting youth. Furthermore, the population prevalence of injection drug use among youth is also on the rise. This short communication examines the association between current prescription drug misuse (PDM) and injection among runaway and homeless youth. Methods Homeless youth were surveyed between October, 2011 and February, 2012 at two drop-in service agencies in Los Angeles, CA. Prevalence ratios (PR) and 95% confidence intervals (CI) for the association between current PDM and injection behavior were estimated. The outcome of interest was use of a needle to inject any illegal drug into the body during the past 30 days. Results Of 380 homeless youth (median age, 21; IQR, 17-25; 72% male), 84 (22%) reported current PDM and 48 (13%) reported currently injecting. PDM during the past 30 days was associated with a 7.7 (95% CI: 4.4, 13.5) fold increase in the risk of injecting during that same time. Among those reporting current PDM with concurrent heroin, cocaine, and methamphetamine use, the PR with injection was 15.1 (95% CI: 8.5, 26.8). Conclusions Runaway and homeless youth are at increased risk for a myriad of negative outcomes. Our preliminary findings are among the first to show the strong association between current PDM and injection in this population. Our findings provide the basis for additional research to delineate specific patterns of PDM and factors that enable or inhibit transition to injection among homeless and runaway youth. PMID:24300900

Association between prescription drug misuse and injection among runaway and homeless youth.

PubMed

Al-Tayyib, Alia A; Rice, Eric; Rhoades, Harmony; Riggs, Paula

2014-01-01

The nonmedical use of prescription drugs is the fastest growing drug problem in the United States, disproportionately impacting youth. Furthermore, the population prevalence of injection drug use among youth is also on the rise. This short communication examines the association between current prescription drug misuse (PDM) and injection among runaway and homeless youth. Homeless youth were surveyed between October 2011 and February 2012 at two drop-in service agencies in Los Angeles, CA. Prevalence ratios (PR) and 95% confidence intervals (CI) for the association between current PDM and injection behavior were estimated. The outcome of interest was use of a needle to inject any illegal drug into the body during the past 30 days. Of 380 homeless youth (median age, 21; IQR, 17-25; 72% male), 84 (22%) reported current PDM and 48 (13%) reported currently injecting. PDM during the past 30 days was associated with a 7.7 (95% CI: 4.4, 13.5) fold increase in the risk of injecting during that same time. Among those reporting current PDM with concurrent heroin, cocaine, and methamphetamine use, the PR with injection was 15.1 (95% CI: 8.5, 26.8). Runaway and homeless youth are at increased risk for a myriad of negative outcomes. Our preliminary findings are among the first to show the strong association between current PDM and injection in this population. Our findings provide the basis for additional research to delineate specific patterns of PDM and factors that enable or inhibit transition to injection among homeless and runaway youth. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Treatment of severe motion sickness with antimotion sickness drug injections

NASA Technical Reports Server (NTRS)

Graybiel, Ashton; Lackner, James R.

1987-01-01

This report concerns the use of intramuscular injections of scopolamine, promethazine, and dramamine to treat severely motion sick individuals participating in parabolic flight experiments. The findings indicate that a majority of individuals received benefit from 50-mg injections of promethazine or 0.5 mg-injections of scopolamine. By contrast, 50-mg injections of dramamine and 25-mg injections of promethazine were nonbeneficial. The use of antimotion drug injections for treating space motion sickness is discussed.

Pattern of Drug Use and Associated Behaviors Among Female Injecting Drug Users From Northeast India: A Multi-Centric, Cross-Sectional, Comparative Study.

PubMed

Ambekar, Atul; Rao, Ravindra; Agrawal, Alok; Goyal, Shrigopal; Mishra, Ashwani; Kishore, Kunal; Mukherjee, Debashis; Albertin, Cristina

2015-01-01

Studies from developed countries document the presence of injecting drug use among females and significantly higher vulnerabilities and risks as compared with male injecting drug users (IDUs). Studies comparing vulnerabilities and drug use patterns between female and male IDUs are not available for developing countries. The aim of the study was to assess the drug use pattern and related HIV vulnerabilities among female IDUs and compare these findings with those from male IDUs from four states of Northeast India. The study used data collected as part of a nationwide study of drug use pattern and related HIV vulnerabilities among IDUs. Ninety-eight female and 202 male IDUs accessing services from harm reduction sites across the four states of Northeast region of India were chosen through random sampling methodology. Drug use pattern, injecting practices, and knowledge of HIV were assessed using a structured questionnaire. Significantly higher proportion of female IDUs was uneducated, unemployed, reported their occupation as sex workers, and switched to injecting drug use faster as compared with male IDUs. Female IDUs practicing sex work differed significantly from those who did not with respect to frequency of daily injections, choice of drugs injected, and concomitant use of non-injecting drugs. More than half of female IDUs initiated sharing within the first month of injecting. The study demonstrates that female IDUs differ from male IDUs in their drug use pattern, initiation into injection as well as injecting behavior, which would be an important consideration during designing of female-specific interventions.

Syringe vending machines for injection drug users: an experiment in Marseille, France.

PubMed Central

Obadia, Y; Feroni, I; Perrin, V; Vlahov, D; Moatti, J P

1999-01-01

OBJECTIVES: This study evaluated the usefulness of vending machines in providing injection drug users with access to sterile syringes in Marseille, France. METHODS: Self-administered questionnaires were offered to 485 injection drug users obtaining syringes from 32 pharmacies, 4 needle exchange programs, and 3 vending machines. RESULTS: Of the 343 respondents (response rate = 70.7%), 21.3% used the vending machines as their primary source of syringes. Primary users of vending machines were more likely than primary users of other sources to be younger than 30 years, to report no history of drug maintenance treatment, and to report no sharing of needles or injection paraphernalia. CONCLUSIONS: Vending machines may be an appropriate strategy for providing access to syringes for younger injection drug users, who have typically avoided needle exchange programs and pharmacies. PMID:10589315

Predictors of injecting cessation among a cohort of people who inject drugs in Tijuana, Mexico.

PubMed

Horyniak, Danielle; Strathdee, Steffanie A; West, Brooke S; Meacham, Meredith; Rangel, Gudelia; Gaines, Tommi L

2018-04-01

Little is known about the cessation of injecting drug use (IDU) among people who inject drugs (PWID) in low and middle-income settings, where access to effective interventions for reducing drug use (e.g., opioid substitution treatment; OST), may be limited. We measured the incidence and identified predictors of IDU cessation among a cohort of PWID in Tijuana, Mexico. Data were drawn from 621 participants in Proyecto El Cuete IV, a prospective cohort of PWID recruited in 2011 and interviewed biannually to 2016. A multivariable Extended Cox model was constructed to identify socio-demographic, drug use, risk environment and health-related predictors of IDU cessation (no IDU for ≥six months). 141 participants (23%) reported at least one IDU cessation event during follow-up. The crude IDU cessation rate was 7.3 per 100 person-years (95% Confidence Interval [CI]: 6.2-8.7). IDU cessation was negatively associated with injecting at least daily on average and heroin/methamphetamine co-injection in the past six months, and positively associated with testing HIV positive at baseline, being on methadone maintenance therapy in the past six months, and recent arrest. Concern for personal safety was also independently associated with IDU cessation. The rate of IDU cessation among PWID in Tijuana was low. These findings underscore the importance of expansion of services including OST to help reduce drug use and facilitate IDU cessation for those who wish to do so. In this setting, interventions addressing individual-level economic barriers as well as broader social and structural barriers to harm reduction services are integral. Copyright © 2018 Elsevier B.V. All rights reserved.

Commentary: the value of PrEP for people who inject drugs.

PubMed

Coleman, Rosalind L; McLean, Susie

2016-01-01

The offer of pre-exposure prophylaxis (PrEP) is recommended as an additional option for HIV prevention for people at substantial risk of HIV infection as part of combination HIV prevention approaches. Implementing this depends on integrating PrEP in public health programmes that address risky practices with evidence-based interventions, and that operate in an enabling legal and policy environment for the delivery of health services to those at higher risk of HIV infection. What does this recommendation mean in terms of the diverse range of HIV prevention needs of key populations, some of whom are so discriminated against that they exist essentially outside formal systems such as national public health services, and for whom a substantial risk of HIV is part of a larger adverse and hostile situation? We discuss this question with reference to people who inject drugs, informed by concerns and comments that emerged from a series of consultations. HIV prevention is part of a spectrum of injecting drug users' priorities, and their access and uptake of HIV prevention services is contingent on their wider "risk environment." The need to address structural barriers to services and human rights violations, and to improve access to comprehensive harm reduction programmes are of prime importance and would have higher value than a mono-focus on HIV prevention. Where existing harm reduction activities are inadequate, fragile or dependent on external donors, shifts in funding priorities, including, for example, towards PrEP, could threaten investment in the broader programmes. For these reasons, it cannot be assumed that PrEP promotion will always be supported by people who inject drugs.The sexual partners of people who inject drugs, non-opioid users who also inject and for whom there is no established substitution treatment, as well as drug users who are unable to negotiate safe sex may value PrEP. As for all key populations, the involvement of people who inject drugs in

Transition to injecting drug use in Iran: a systematic review of qualitative and quantitative evidence

PubMed Central

Rahimi-Movaghar, Afarin; Amin-Esmaeili, Masoumeh; Shadloo, Behrang; Malekinejad, Mohsen

2015-01-01

Background Injection drug use has been increasing over the past decade in Iran. This study aims to review the epidemiological and qualitative evidence on factors that facilitate or protect against transition to injection in Iran. Methods Five international (Medline, Web of Science, EMBASE, CINAHL, PsycINFO), one regional (IMEMR) and three Iranian (Iranmedex, Iranpsych, IranDoc) databases were searched and key experts were contacted. Two trained researchers screened documents to identify relevant studies and independently extracted data using a pre-specified protocol. A thematic analysis was applied to the qualitative data and a random effect meta-analysis model was used to determine age of first injection. Results A total of 39 documents from 31 studies met the eligibility criteria; more than 50% were conducted between 2006 and 2008. The weighted mean age of first injection was 25.8 years (95% Confidence Interval: 25.3–26.2). Overall, drug users had used drugs for 6 to 7 years before starting to inject. Heroin was the first drug of injection in the majority of cases. Factors influencing transition to injection included 1) individual (pleasure-seeking behavior and development of drug dependency), 2) social network (role of peer drug users in first injection use), and 3) environmental (the economic efficiency associated with injection and the wide availability of injectable form of drugs in the market). Conclusion Harm reduction policies in Iran have almost exclusively focused on drug injectors. However, given the extent of non-injection drug use, evidence from this study can provide insight on points of interventions for preventing transition to injection use. PMID:26210009

Prevalence and risk factors for injection site skin infections among people who inject drugs (PWID) in Tehran.

PubMed

Noroozi, Mehdi; Armoon, Bahram; Ghisvand, Hesam; Noroozi, Alireza; Karimy, Mahmood; Bazrafshan, Mohammad Rafi; Marshall, Brandon D L; Dieji, Bahman

2018-05-20

Injection drug use is one of the major public health problems in Iran. Injection drug use is associated with numerous negative health outcomes, such as blood-borne infections (HIV, HCV) and injection site skin infections (abscesses, cellulitis). The aim of this study was to determine prevalence of injection site skin infections and its associated risk factors among people who inject drugs (PWID) in Tehran, Iran. The cross-sectional study was conducted from March to August 2016 in Tehran province. A total of 500 PWID were recruited by convenience and snowball sampling from Drop-in Centers (DIC) in the South of Tehran. Our primary outcomes were self-report of ever having injection sites skin infections and receiving treatment for them. We first examined associations between individual variables and lifetime history of having injection site infections in bivariate analysis using the chi-square or Fisher's exact tests, as appropriate. Variables with P-value <.2 were included in a multiple logistic regression model. Overall, 40% (CI95%: 30.3%, 52.2%) of participants reported ever having an injection site infection. In the multivariable model, those with low socioeconomic status (AOR = 2.4, P = .03), self-reported as HIV positive (AOR =1.6, P = .01), reporting more than 3 injections per day (AOR = 4.1, P = .03) and reuse of their own syringes (AOR = 8.5, P = .03) were more likely to have injection sites skin infections. PWID who used needle and syringe program (NSP) services were less likely to report injection site infections (AOR = 0.5, P = .04). We have identified several risk factors for injection sites infections among PWID, including frequency of injection per day, reuse of their own syringes, not using NSP services, HIV status, socioeconomic status with skin infections in PWID. Prevention strategies to reduce skin infections should focus on high-risk injection behaviors and improving access to NSP services. © 2018 Wiley Periodicals, Inc.

Laser-irradiated drug chromatographic analysis and laser injection of drugs to treat staphyloccocal lesions of skin

NASA Astrophysics Data System (ADS)

Zharov, Vladimir P.; Latyshev, Alexei S.; Kovsh, Anna I.; Razumova, Svetlana A.; Masyukova, Svetlana A.; Volnukhin, Vladimir A.

2001-05-01

This article deals with further development of laser drug delivery methods. In order to estimate the effect of laser- drug interactions, we carried out the chromatographic fractionation of dexamethasone, hydrocortisone, and gentamicine, both prior to and after irradiating them by pulsed Er:YAG laser radiation. The laser radiation parameters were as follows: the wavelength, pulse energy, and pulse duration were, respectively, 2.94 micrometers , 0.7 J, and 100 microsecond(s) . The total laser radiation dose administered to a 100 (mu) l sample of these drug preparations amounted to 150 J. A chromatographic analysis revealed that drug samples exposed to Er:YAG laser radiation did not show any change. The results obtained made it possible to employ pulsed Er:YAG laser radiation to perform laser-acoustic injection of the above-mentioned drug preparations to study the treatment of staphylococcal lesions in 30 guinea pigs. The perforated channel depth was measured and the injected drug solution volume was calculated. It was found that laser injection enabled one to introduce therapeutic doses of drugs, and that it expedited the healing of lesions by 3 to 4 days, as compared to the control group that received the topical application of drugs without laser irradiation.

Use of liposomes as injectable-drug delivery systems.

PubMed

Ostro, M J; Cullis, P R

1989-08-01

The formation of liposomes and their application as delivery systems for injectable drugs are described. Liposomes are microscopic vesicles composed of one or more lipid membranes surrounding discrete aqueous compartments. These vesicles can encapsulate water-soluble drugs in their aqueous spaces and lipid-soluble drugs within the membrane itself. Liposomes release their contents by interacting with cells in one of four ways: adsorption, endocytosis, lipid exchange, or fusion. Liposome-entrapped drugs are distributed within the body much differently than free drugs; when administered intravenously to healthy animals and humans, most of the injected vesicles accumulate in the liver, spleen, lungs, bone marrow, and lymph nodes. Liposomes also accumulate preferentially at the sites of inflammation and infection and in some solid tumors; however, the reason for this accumulation is not clear. Four major factors influence liposomes' in vivo behavior and biodistribution: (1) liposomes tend to leak if cholesterol is not included in the vesicle membrane, (2) small liposomes are cleared more slowly than large liposomes, (3) the half-life of a liposome increases as the lipid dose increases, and (4) charged liposomal systems are cleared more rapidly than uncharged systems. The most advanced application of liposome-based therapy is in the treatment of systemic fungal infections, especially with amphotericin B. Liposomes are also under investigation for treatment of neoplastic disorders. Liposomes' uses in cancer therapy include encapsulation of known antineoplastic agents such as doxorubicin and methotrexate, delivery of immune modulators such as N-acetylmuramyl-L-alanine-D-isoglutamine, and encapsulation of new chemical entities that are synthesized with lipophilic segments tailored for insertion into lipid bilayers. Liposomal formulations of injectable antimicrobial agents and antineoplastic agents already are undergoing clinical testing, and most probably will receive

Managing la malilla: Exploring drug treatment experiences among injection drug users in Tijuana, Mexico, and their implications for drug law reform

PubMed Central

Syvertsen, Jennifer; Pollini, Robin A.; Lozada, Remedios; Vera, Alicia; Rangel, Gudelia; Strathdee, Steffanie A.

2012-01-01

Background In August 2009, Mexico reformed its drug laws and decriminalized small quantities of drugs for personal use; offenders caught three times will be mandated to enter drug treatment. However, little is known about the quality or effectiveness of drug treatment programs in Mexico. We examined injection drug users’ (IDUs) experiences in drug treatment in Tijuana, Mexico, with the goal of informing program planning and policy. Methods We examined qualitative and quantitative data from Proyecto El Cuete, a multi-phased research study on HIV risk among IDUs in Tijuana. Phase I consisted of 20 in-depth interviews and Phase II employed respondent-driven sampling to recruit 222 IDUs for a quantitative survey. We also reviewed national drug policy documents, surveillance data, and media reports to situate drug users’ experiences within the broader sociopolitical context. Results Participants in the qualitative study were 50% male with a mean age of 32; most injected heroin (85.0%) and methamphetamine (60.0%). The quantitative sample was 91.4% male with a mean age of 35; 98.2% injected heroin and 83.7% injected heroin and methamphetamine together. The majority of participants reported receiving treatment: residential treatment was most common, followed by methadone; other types of services were infrequently reported. Participants’ perceptions of program acceptability and effectiveness were mixed. Mistreatment emerged as a theme in the qualitative interviews and was reported by 21.6% of Phase II participants, primarily physical (72.0%) and verbal (52.0%) abuse. Conclusions Our results point to the need for political, economic, and social investment in the drug treatment system before offenders are sentenced to treatment under the revised national drug law. Resources are needed to strengthen program quality and ensure accountability. The public health impact of the new legislation that attempts to bring drug treatment to the forefront of national drug policy

HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities.

PubMed Central

Kral, A H; Bluthenthal, R N; Booth, R E; Watters, J K

1998-01-01

OBJECTIVES: This study deter- mined human immunodeficiency virus (HIV) seroprevalence and factors associated with HIV infection among street-recruited injection drug users and crack cocaine smokers. METHODS: An analysis was performed on HIV serologies and risk behaviors of 6402 injection drug users and 3383 crack smokers in 16 US municipalities in 1992 and 1993. RESULTS: HIV seroprevalence was 12.7% among injection drug users and 7.5% among crack smokers. Most high-seroprevalence municipalities (>25%) were located along the eastern seaboard of the United States. In high-seroprevalence municipalities, but not in others, HIV seroprevalence was higher for injection drug users than for crack smokers. Among injection drug users, cocaine injection, use of speedballs (cocaine or amphetamines with heroin), and sexual risk behaviors were independently associated with HIV infection. Among crack smokers, sexual risk behaviors were associated with HIV infection. CONCLUSIONS: Injection drug users and crack smokers are at high risk for HIV infection. PMID:9584014

Mental health and family relations among people who inject drugs and their family members in Vietnam.

PubMed

Li, Li; Tuan, Nguyen Anh; Liang, Li-Jung; Lin, Chunqing; Farmer, Shu C; Flore, Martin

2013-11-01

This article explores the association of people who inject drugs and their family members in terms of mental health and family relations. The objective was to understand the family context and its impact on people who inject drugs in a family-oriented culture in Vietnam. Cross-sectional assessment data were gathered from 83 people who inject drugs and 83 of their family members recruited from four communes in Phú Thọ province, Vietnam. Depressive symptoms and family relations were measured for both people who inject drugs and family members. Internalized shame and drug-using behavior were reported by people who inject drugs, and caregiver burden was reported by family members. We found that higher level of drug using behavior of people who inject drugs was significantly associated with higher depressive symptoms and lower family relations reported by themselves as well as their family members. Family relations reported by people who inject drugs and their family members were positively correlated. The findings highlight the need for interventions that address psychological distress and the related challenges faced by family members of people who inject drugs. The article has policy implication which concludes with an argument for developing strategies that enhance the role of families in supporting behavioral change among people who inject drugs. Copyright © 2013 Elsevier B.V. All rights reserved.

Field-based performance of three pre-market rapid hepatitis C virus antibody assays in STAHR (Study to Assess Hepatitis C Risk) among young adults who inject drugs in San Diego, CA.

PubMed

Jewett, A; Smith, B D; Garfein, R S; Cuevas-Mota, J; Teshale, E H; Weinbaum, C M

2012-07-01

Approximately 4.1 million Americans are estimated to have been infected with hepatitis C virus (HCV), 45-85% of whom are unaware of their infection. Persons who inject drugs (PWID) account for 55.8% of all persons with HCV antibody (anti-HCV) in the U.S. PWID have limited access to healthcare and are infrequently tested for anti-HCV using conventional laboratory assays. To evaluate performance characteristics (sensitivity and specificity) of three, pre-market rapid point-of-care tests (one oral fluid and two finger-stick assays) from two manufacturers (Chembio and MedMira) in settings providing services to young adult PWID in San Diego, CA. Behavioral risk assessment surveys and testing for HCV were conducted among persons who reported injection drug use (IDU) within the past 6 months as part of the Study to Assess Hepatitis C Risk (STAHR) among PWID aged 18-40 years in 2009-2010. Sensitivity and specificity of the rapid anti-HCV assays were evaluated among STAHR participants, using two commonly used testing algorithms. Variability in sensitivity (76.6-97.1%) and specificity (99.0-100.0%) was found across assays. The highest sensitivity achieved for the Chembio finger-stick blood, Chembio oral fluid and MedMira finger-stick blood tests was 97.1%, 85.4% and 80.0% respectively; the highest specificity was 99.0%, 100.0% and 100.0%, respectively. In multivariate analysis false negative anti-HCV results were associated with female sex for the MedMira blood assay. Sensitive anti-HCV rapid assays are appropriate and feasible for high-prevalence, high-risk populations such as young PWID. Copyright © 2012 Elsevier B.V. All rights reserved.

Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non-Indigenous people who inject drugs.

PubMed

Smirnov, Andrew; Kemp, Robert; Ward, James; Henderson, Suzanna; Williams, Sidney; Dev, Abhilash; Najman, Jake M

2016-09-01

Despite over-representation of Indigenous Australians in sentinel studies of injecting drug use, little is known about relevant patterns of drug use and dependence. This study compares drug dependence and possible contributing factors in Indigenous and non-Indigenous Australians who inject drugs. Respondent-driven sampling was used in major cities and 'peer recruitment' in regional towns of Queensland to obtain a community sample of Indigenous (n = 282) and non-Indigenous (n = 267) injectors. Data are cross sectional. Multinomial models were developed for each group to examine types of dependence on injected drugs (no dependence, methamphetamine-dependent only, opioid-dependent only, dependent on methamphetamine and opioids). Around one-fifth of Indigenous and non-Indigenous injectors were dependent on both methamphetamine and opioids in the previous 12 months. Psychological distress was associated with dual dependence on these drugs for Indigenous [adjusted relative risk (ARR) 4.86, 95% confidence interval (CI) 2.08-11.34] and non-Indigenous (ARR 4.14, 95% CI 1.59-10.78) participants. Unemployment (ARR 8.98, 95% CI 2.25-35.82) and repeated (> once) incarceration as an adult (ARR 3.78, 95% CI 1.43-9.97) were associated with dual dependence for Indigenous participants only. Indigenous participants had high rates of alcohol dependence, except for those dependent on opioids only. The drug dependence patterns of Indigenous and non-Indigenous people who inject drugs were similar, including the proportions dependent on both methamphetamine and opioids. However, for Indigenous injectors, there was a stronger association between drug dependence and contextual factors such as unemployment and incarceration. Expansion of treatment options and community-level programs may be required. [Smirnov A, Kemp R, Ward J, Henderson S, Williams S, Dev A, Najman J M. Patterns of drug dependence in a Queensland (Australia) sample of Indigenous and non-Indigenous people who

Injectable Drug Eluting Elastomeric Polymer: A Novel Submucosal Injection Material

PubMed Central

Tran, Richard T.; Palmer, Michael; Tang, Shou-Jiang; Abell, Thomas L.; Yang, Jian

2011-01-01

Background Biodegradable hydrogels can deliver therapeutic payloads with great potentials in endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) to yield improvements in efficacy and foster mucosal regeneration. Objective To assess the efficacy of an injectable drug eluting elastomeric polymer (iDEEP) as a submucosal injection material. Design Comparative study among 3 different solutions using material characterization tests, ex vivo and in vivo porcine models. Setting Academic hospital. Interventions 30 gastric submucosal cushions were achieved with saline (0.9%), sodium hyaluronate (0.4%), and iDEEP (n = 10) in ex vivo porcine stomachs. Four porcine gastric submucosal cushions were then performed in vivo using iDEEP. Main outcome measurements Maximum injection pressure, Rebamipide release rate, submucosal elevation duration, and assessment of in vivo efficacy by en bloc resection. Results No significant difference in injection pressures between iDEEP (28.9 ± 0.3 PSI) and sodium hyaluronate (29.5 ± 0.4 PSI, P > .05) was observed. iDEEP gels displayed a controlled release of Rebamipide up to 2 weeks in vitro. The elevation height of iDEEP (5.7 ± 0.5 mm) was higher than saline (2.8 ± 0.2 mm, P < .01) and SH (4.2 ± 0.2 mm, P < .05). All EMR procedures were successfully performed after injection of iDEEP, and a large gel cushion was noted after the resection procedure. Limitations Benchtop, ex vivo, and non-survival pig study. Conclusions A novel injection solution was evaluated for endoscopic resection. These results suggest that iDEEP may provide a significant step towards the realization of an ideal EMR and ESD injection material. PMID:22301346

Mental Health Status, Drug Treatment Use, and Needle Sharing among Injection Drug Users

ERIC Educational Resources Information Center

Lundgren, Lena M.; Amodeo, Maryann; Chassler, Deborah

2005-01-01

This study examined the relationship among mental health symptoms, drug treatment use, and needle sharing in a sample of 507 injection drug users (IDUs). Mental health symptoms were measured through the ASI psychiatric scale. A logistic regression model identified that some of the ASI items were associated with needle sharing in an opposing…

Young Women's Experiences of Resisting Invitations to Use Illicit Drugs

ERIC Educational Resources Information Center

Koehn, Corinne V.; O'Neill, Linda K.

2011-01-01

Ten young women were interviewed regarding their experiences of resisting invitations to use illicit drugs. Hermeneutic phenomenology was used to gather and analyze information. One key theme was the motivations that inspired women to refuse drug offers. Young women resisted drug invitations because of their desires to be authentic, protect their…

76 FR 3488 - Implantation or Injectable Dosage Form New Animal Drugs; Oxytetracycline and Flunixin

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-20

.... FDA-2010-N-0002] Implantation or Injectable Dosage Form New Animal Drugs; Oxytetracycline and Flunixin... combination drug injectable solution containing oxytetracycline and flunixin meglumine in cattle. [[Page 3489... veterinary prescription use of HEXASOL (oxytetracycline and flunixin meglumine) Injection for the treatment...

Mental and Physical Health Correlates of Discrimination Against People Who Inject Drugs: A Systematic Review.

PubMed

Couto Cruz, Camila E; Salom, Caroline; Maravilla, Joemer; Alati, Rosa

2018-05-01

The perception that people who use illicit drugs are deviant has contributed to the stigmatization of this population. The primary aim of this review is to examine the links among injection-related discrimination, mental health, physical health, and quality of life in people who inject drugs. We also identify settings, perpetrators of discrimination, and coping strategies developed by people who inject drugs to deal with the issue. Online databases MEDLINE (PubMed), EMBASE, CINAHL (EbscoHost), and PsycINFO (APA PsycNET) were searched for articles focusing on injection-related discrimination against people who inject drugs. Findings were compared for consistency. Qualitative and quantitative articles were evaluated separately. Eleven articles were included in the final review. Several links between discrimination and negative health outcomes were identified. Discrimination was associated with engagement in risky injecting behavior as well as psychological distress. The perpetrators of discrimination against people who inject drugs included general community members and service providers. Attempts to hide addiction was the main strategy used to cope with discrimination. Injection-related discrimination was associated with higher psychological distress levels, unhealthy behaviors, and low quality of life in people who inject drugs. By addressing the stigma of deviance, discrimination and associated negative health outcomes may be reduced.

Suboptimal Addiction Interventions for Patients Hospitalized with Injection Drug Use-Associated Infective Endocarditis.

PubMed

Rosenthal, Elana S; Karchmer, Adolf W; Theisen-Toupal, Jesse; Castillo, Roger Araujo; Rowley, Chris F

2016-05-01

Infective endocarditis is a serious infection, often resulting from injection drug use. Inpatient treatment regularly focuses on management of infection without attention to the underlying addiction. We aimed to determine the addiction interventions done in patients hospitalized with injection drug use-associated infective endocarditis. This is a retrospective review of patients hospitalized with injection drug use-associated infective endocarditis from January, 2004 through August, 2014 at a large academic tertiary care center in Boston, Massachusetts. For the initial and subsequent admissions, data were collected regarding addiction interventions, including consultation by social work, addiction clinical nurse and psychiatry, documentation of addiction in the discharge summary plan, plan for medication-assisted treatment and naloxone provision. There were 102 patients admitted with injection drug use-associated infective endocarditis, 50 patients (49.0%) were readmitted and 28 (27.5%) patients had ongoing injection drug use at readmission. At initial admission, 86.4% of patients had social work consultation, 23.7% had addiction consultation, and 24.0% had psychiatry consultation. Addiction was mentioned in 55.9% of discharge summary plans, 7.8% of patients had a plan for medication-assisted treatment, and naloxone was never prescribed. Of 102 patients, 26 (25.5%) are deceased. The median age at death was 40.9 years (interquartile range 28.7-48.7). We found that patients hospitalized with injection drug use-associated infective endocarditis had high rates of readmission, recurrent infective endocarditis and death. Despite this, addiction interventions were suboptimal. Improved addiction interventions are imperative in the treatment of injection drug use-associated infective endocarditis. Copyright © 2016 Elsevier Inc. All rights reserved.

Patterns of Drug Use in a Sample of 200 Young Drug Users in London

ERIC Educational Resources Information Center

McCambridge, Jim; Strang, John

2004-01-01

A cross-sectional analysis of baseline data collected during a secondary prevention intervention study was conducted to describe patterns of drug use in a non-treatment sample of young drug users recruited in ten further-education colleges across inner London. Participants were 200 young people who were either weekly cannabis users and/or who had…

Intravitreal, Subretinal, and Suprachoroidal Injections: Evolution of Microneedles for Drug Delivery.

PubMed

Hartman, Rachel R; Kompella, Uday B

Even though the very thought of an injection into the eye may be frightening, an estimated 6 million intravitreal (IVT) injections were made in the USA during 2016. With the introduction of new therapeutic agents, this number is expected to increase. In addition, drug products that are injectable in ocular compartments other than the vitreous humor are expected to enter the back of the eye market in the not so distant future. Besides the IVT route, some of the most actively investigated routes of invasive administration to the eye include periocular, subretinal, and suprachoroidal (SC) routes. While clinical efficacy is the driving force behind new injectable drug product development for the eye, safety is also being improved with time. In the case of IVT injections, the procedural guidelines have evolved over the years to improve patient comfort and reduce injection-related injury and infection. Similar advances are anticipated for other routes of administration of injectable products to the eye. In addition to procedural improvements, the design of needles, particularly those with smaller diameters, length, and controlled bevel angles are expected to improve overall safety and acceptance of injected ophthalmic drug products. A key development in this area is the introduction of microneedles of a length less than a millimeter that can target the SC space. In the future, needles with smaller diameters and lengths, potentially approaching nanodimensions, are expected to revolutionize ophthalmic disease management.

Crystal methamphetamine and initiation of injection drug use among street-involved youth in a Canadian setting.

PubMed

Werb, Dan; Kerr, Thomas; Buxton, Jane; Shoveller, Jeannie; Richardson, Chris; Montaner, Julio; Wood, Evan

2013-12-10

Although injection drug use is known to result in a range of health-related harms, including transmission of HIV and fatal overdose, little is known about the possible role of synthetic drugs in injection initiation. We sought to determine the effect of crystal methamphetamine use on risk of injection initiation among street-involved youth in a Canadian setting. We used Cox regression analyses to identify predictors of injection initiation among injection-naive street-involved youth enrolled in the At-Risk Youth Study, a prospective cohort study of street-involved youth in Vancouver, British Columbia. Data on circumstances of first injection were also obtained. Between October 2005 and November 2010, a total of 395 drug injection-naive, street-involved youth provided 1434 observations, with 64 (16.2%) participants initiating injection drug use during the follow-up period, for a cumulative incidence of 21.7 (95% confidence interval [CI] 1.7-41.7) per 100 person-years. In multivariable analysis, recent noninjection use of crystal methamphetamine was positively associated with subsequent injection initiation (adjusted hazard ratio 1.93, 95% CI 1.31-2.85). The drug of first injection was most commonly reported as crystal methamphetamine (14/31 [45%]). Noninjection use of crystal methamphetamine predicted subsequent injection initiation, and crystal methamphetamine was the most commonly used drug at the time of first injection. Evidence-based strategies to prevent transition to injection drug use among crystal methamphetamine users are urgently needed.

A Randomized Intervention Trial to Reduce the Lending of Used Injection Equipment Among Injection Drug Users Infected With Hepatitis C

PubMed Central

Latka, Mary H.; Hagan, Holly; Kapadia, Farzana; Golub, Elizabeth T.; Bonner, Sebastian; Campbell, Jennifer V.; Coady, Micaela H.; Garfein, Richard S.; Pu, Minya; Thomas, Dave L.; Thiel, Thelma K.; Strathdee, Steffanie A.

2008-01-01

Objectives. We evaluated the efficacy of a peer-mentoring behavioral intervention designed to reduce risky distributive injection practices (e.g., syringe lending, unsafe drug preparation) among injection drug users with hepatitis C virus (HCV) infection. Methods. A randomized trial with a time-equivalent attention-control group was conducted among 418 HCV-positive injection drug users aged 18 to 35 years in 3 US cities. Participants reported their injection-related behaviors at baseline and at 3- and 6-month follow-ups. Results. Compared with the control group, intervention-group participants were less likely to report distributive risk behaviors at 3 months (odds ratio [OR]=0.46; 95% confidence interval [CI]=0.27, 0.79) and 6 months (OR=0.51; 95% CI=0.31, 0.83), a 26% relative risk reduction, but were no more likely to cite their HCV-positive status as a reason for refraining from syringe lending. Effects were strongest among intervention-group participants who had known their HCV-positive status for at least 6 months. Peer mentoring and self-efficacy were significantly increased among intervention-group participants, and intervention effects were mediated through improved self-efficacy. Conclusions. This behavioral intervention reduced unsafe injection practices that may propagate HCV among injection drug users. PMID:18382005

A randomized intervention trial to reduce the lending of used injection equipment among injection drug users infected with hepatitis C.

PubMed

Latka, Mary H; Hagan, Holly; Kapadia, Farzana; Golub, Elizabeth T; Bonner, Sebastian; Campbell, Jennifer V; Coady, Micaela H; Garfein, Richard S; Pu, Minya; Thomas, Dave L; Thiel, Thelma K; Strathdee, Steffanie A

2008-05-01

We evaluated the efficacy of a peer-mentoring behavioral intervention designed to reduce risky distributive injection practices (e.g., syringe lending, unsafe drug preparation) among injection drug users with hepatitis C virus (HCV) infection. A randomized trial with a time-equivalent attention-control group was conducted among 418 HCV-positive injection drug users aged 18 to 35 years in 3 US cities. Participants reported their injection-related behaviors at baseline and at 3- and 6-month follow-ups. Compared with the control group, intervention-group participants were less likely to report distributive risk behaviors at 3 months (odds ratio [OR]=0.46; 95% confidence interval [CI]=0.27, 0.79) and 6 months (OR=0.51; 95% CI=0.31, 0.83), a 26% relative risk reduction, but were no more likely to cite their HCV-positive status as a reason for refraining from syringe lending. Effects were strongest among intervention-group participants who had known their HCV-positive status for at least 6 months. Peer mentoring and self-efficacy were significantly increased among intervention-group participants, and intervention effects were mediated through improved self-efficacy. This behavioral intervention reduced unsafe injection practices that may propagate HCV among injection drug users.

Changes in patterns of injecting drug use in Hungary: a shift to synthetic cathinones.

PubMed

Péterfi, Anna; Tarján, Anna; Horváth, Gergely Csaba; Csesztregi, Tamás; Nyírády, Adrienn

2014-01-01

The spread of synthetic cathinone injecting is a new phenomenon observed in recent years in Hungary. Until 2010, when the first anecdotal reports on cathinone injecting appeared, injecting was associated with the use of heroin and amphetamine. In this paper we review available evidence of the changes in the drug market and a concurrent shift in patterns of injecting drug use that have been taking place in Hungary since 2010. Remarkable changes have been observed in police seizures data since 2010. While new psychoactive substances have appeared, the availability of heroin has dropped significantly. A qualitative study in 2011 revealed that these market changes correlate with changes in patterns of injecting drug use: decreasing heroin use and the appearance of mephedrone injecting were reported by treatment and needle and syringe programme (NSP) personnel. These changes are detectable in other routine epidemiological data collection systems in the following years as well (i.e. treatment, drug-related deaths, NSP clientele). Heroin-related treatment demand dropped, as did heroin-related mortality. Parallel to this, a growing number of clients appeared in treatment and in NSPs who were primarily injecting cathinones. The shift to cathinones can be observed in amphetamine and heroin injectors as well. Monitoring changes in patterns of injecting drug use are especially important because of the vulnerability of this drug-user population and the consequences of this high-risk route of drug administration. The realignment observed in Hungary is to be further investigated with regard to its determinants, changes in risk behaviour, and in treatment needs. Copyright © 2014 John Wiley & Sons, Ltd.

Injection drug users’ involvement in drug dealing in the downtown eastside of Vancouver: Social organization and systemic violence

PubMed Central

Small, Will; Maher, Lisa; Lawlor, Jeff; Wood, Evan; Shannon, Kate; Kerr, Thomas

2014-01-01

Background Illicit drug markets are a key component of the risk environment surrounding injection drug use. However, relatively few studies have explored how injection drug users’ (IDUs) involvement in drug dealing shapes their experiences of drug market-related harm. This exploratory qualitative study aims to understand IDUs’ dealing activities and roles, as well as the perceived benefits and risks related to participation in illicit drug markets, including experiences of drug market violence. Methods Ten IDUs with extensive involvement in drug dealing activities were recruited from the Vancouver Injection Drug User Study (VIDUS) and participated in semi-structured qualitative interviews, which elicited discussion of experiences dealing drugs, perceived benefits and hazards related to dealing, and understandings of drug market violence. Results Participant's involvement in drug market activities included corporate sales, freelance or independent sales, and opportunistic sales termed “middling” as well as drug market-related hustles entailing selling bogus drugs and robbing dealers. Participants primarily dealt drugs to support their own illicit drug use, and we found that arrest and criminal justice involvement, hazards stemming from drug debts, and drug market-related violence were key risks related to dealing activities. Conclusion The challenges of managing personal consumption while selling drugs exacerbates the hazards associated with drug dealing. Efforts to address drug dealing among IDUs should consider both drug dependency and the material conditions that propel drug users towards dealing activities. Interventions should explore the potential of combining enhanced drug treatment programs with low threshold employment and alternative income generation opportunities. PMID:23664788

"Scripting" Risk: Young People and the Construction of Drug Journeys

ERIC Educational Resources Information Center

Mayock, Paula

2005-01-01

The concept of risk, and its centrality to social life, is theoretically much discussed within late modernity. This paper examines young people's drug use and their drug transitions within a framework of risk drawing on findings from a longitudinal ethnographic study of drug use among young people in a Dublin inner-city community. Fifty-seven…

[Myonecrosis in users of injecting drugs (a clinical case)].

PubMed

Shestakova, I V; Iushchuk, N D; Tishkevich, O L

2010-01-01

Myonecrosis remains one of the severest manifestations of skin and soft tissue infections. Clostridia (C. perfringens, C. novyi, C. septicum, C. sordellii, C. histolyticum) are dominant and Staphylococcus aureus, Streptococcus pyogenes, Bacillus cereus, and Bacteriodes fragilis are much less in the etiology of myonecrosis. Cases of gas gangrene have recently become more frequent among injection drug users all over the world. Russia has become the largest opiate market in Europe and consumption of these narcotic drugs is annually growing. In the Russian Federation, a larger number of injection drug users uniquely results in a rise of cases of Clostridium- and mixed flora-induced myonecrosis. Gas gangrene in HIV-positive drug abusers seems to rapidly progress to multiple organ failure and to show high death rates, rather than to develop a localized form. The analyzed case of mixed flora-induced gas gangrene is of interest to physicians of any specialties who can encounter this wound infection in HIV-positive patients.

Willingness to use drug checking within future supervised injection services among people who inject drugs in a mid-sized Canadian city.

PubMed

Kennedy, Mary Clare; Scheim, Ayden; Rachlis, Beth; Mitra, Sanjana; Bardwell, Geoff; Rourke, Sean; Kerr, Thomas

2018-04-01

Esclating epidemics of fatal overdose are affecting communities across Canada. In many instances, the unanticipated presence of powerful opioids, such as fentanyl, in street drugs is a contributing factor. Drug checking offered within supervised injection services (SIS) is being considered as a potential measure for reducing overdose and related harms. We therefore sought to characterize the willingness of people who inject drugs (PWID) to use drug checking within SIS. Data were derived from a cross-sectional survey examining the feasibility of SIS in London, Canada, a mid-sized city. Multivariable logistic regression was used to examine factors associated with willingness to frequently (always or usually) use drug checking at SIS. Between March and April 2016, 180 PWID were included in the present study, including 68 (38%) women. In total, 78 (43%) reported that they would frequently check their drugs at SIS if this service were available. In multivariable analyses, female gender (Adjusted Odds Ratio [AOR] = 2.31; 95% confidence interval [CI]: (1.20-4.46), homelessness (AOR = 2.36; 95% CI: 1.14-4.86), and drug dealing (AOR = 2.16; 95% CI: 1.07-4.33) were positively associated with willingness to frequently check drugs at SIS. These findings highlight the potential of drug checking as a complement to other services offered within SIS, particularly given that subpopulations of PWID at heightened risk of overdose were more likely to report willingness to frequently use this service. However, further research is needed to determine the possible health impacts of offering drug checking at SIS. Copyright © 2018 Elsevier B.V. All rights reserved.

Injectable, in situ forming poly(propylene fumarate)-based ocular drug delivery systems.

PubMed

Ueda, H; Hacker, M C; Haesslein, A; Jo, S; Ammon, D M; Borazjani, R N; Kunzler, J F; Salamone, J C; Mikos, A G

2007-12-01

This study sought to develop an injectable formulation for long-term ocular delivery of fluocinolone acetonide (FA) by dissolving the anti-inflammatory drug and the biodegradable polymer poly(propylene fumarate) (PPF) in the biocompatible, water-miscible, organic solvent N-methyl-2-pyrrolidone (NMP). Upon injection of the solution into an aqueous environment, a FA-loaded PPF matrix is precipitated in situ through the diffusion/extraction of NMP into surrounding aqueous fluids. Fabrication of the matrices and in vitro release studies were performed in phosphate buffered saline at 37 degrees C. Drug loadings up to 5% were achieved. High performance liquid chromatography was employed to determine the released amount of FA. The effects of drug loading, PPF content of the injectable formulation, and additional photo-crosslinking of the matrix surface were investigated. Overall, FA release was sustained in vitro over up to 400 days. After an initial burst release of 22 to 68% of initial FA loading, controlled drug release driven by diffusion and bulk erosion was observed. Drug release rates in a therapeutic range were demonstrated. Release kinetics were found to be dependent on drug loading, formulation PPF content, and extent of surface crosslinking. The results suggest that injectable, in situ formed PPF matrices are promising candidates for the formulation of long-term, controlled delivery devices for intraocular drug delivery. Copyright 2007 Wiley Periodicals, Inc.

Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia.

PubMed

Wickersham, Jeffrey A; Loeliger, Kelsey B; Marcus, Ruthanne; Pillai, Veena; Kamarulzaman, Adeeba; Altice, Frederick L

2016-01-01

While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.

Clinical effectiveness of multiple-drug injection treatment in unruptured ectopic pregnancies: a retrospective study.

PubMed

Dai, Quan; Wang, Lu-Lu; Shao, Xiao-Hui; Wang, Si-Ming; Dong, Xiao-Qiu

2012-10-01

To study the effect of local interventional treatment of unruptured ectopic pregnancies with multiple-drug injection guided by color Doppler sonography. In this retrospective analysis, 49 patients with an unruptured ectopic pregnancy were treated with two different local injection methods administered under sonographic guidance. The patients were divided into single-drug (n = 23) and multiple-drug (n = 26) injection groups, and they received a locally administered injection of methotrexate alone or a combination including methotrexate, hemocoagulase, antibiotics, and anti-inflammatory drugs, respectively. Overall, local injection treatment was successful in 44 patients. The 5 patients with failed treatment underwent laparotomy about 1 week after single-drug injection. Serum β-human chorionic gonadotropin (β-hCG ) levels, ectopic pregnancy mass sizes, blood flow at various points after treatment, the incidence of pelvic bleeding, and the time for serum β-hCG levels to return to normal and the mass to resolve were analyzed in the remaining 44 patients. Single-drug treatment was successful in 18 patients; 10 of 23 had low to moderate pelvic bleeding after treatment, and 5 were referred for surgery. All 26 patients were successfully treated by multiple-drug injection. Only 2 patients had a small amount of pelvic bleeding. Differences between groups were statistically significant (P < .05) for surgery rates, the incidence of pelvic bleeding, transient increases in serum β-hCG levels, mean days to normal β-hCG levels, mean days of mass resolution, and mean mass diameters 1 to 6 weeks after treatment. Local multiple-drug injection under color Doppler guidance is a new, safe, and effective method for treating unruptured ectopic pregnancies. It accelerates the serum β-hCG decline and facilitates mass resolution. This regimen is associated with a very low rate of pelvic bleeding, improves the success rate of conservative treatment, and, therefore, has value as an

75 FR 9333 - Implantation or Injectable Dosage Form New Animal Drugs; Tilmicosin

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-02

.... FDA-2010-N-0002] Implantation or Injectable Dosage Form New Animal Drugs; Tilmicosin AGENCY: Food and... dose range for use of an injectable solution of tilmicosin phosphate for treatment of respiratory... 300 (tilmicosin injection, USP) Injection, available by veterinary prescription for use in the...

U.S. Drug Use and Migration experiences of Mexican Female Sex Workers who are injection Drug Users

PubMed Central

Ojeda, Victoria D.; Burgos, José Luis; Rangel, María Gudelia; Lozada, Remedios; Vera, Alicia

2013-01-01

Objective To describe U.S.-based drug/sex behaviors and correlates of lifetime U.S. drug use by Mexican female sex workers who inject drugs (FSW-IDUs). Methods Between 2008–2010, 315 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. Results Twenty-seven percent (n=85) of FSW-IDUs were U.S. migrants; of these, 46% (n=39) were deportees. One-half of U.S.-migrant FSW-IDUs consumed illicit drugs in the U.S., and two-thirds of these injected drugs in the U.S. Among U.S. injectors, over 75% ever received or shared used injection equipment. The majority (92%) of U.S.-migrant FSW-IDUs never obtained U.S. drug treatment services. HIV prevalence was 4% among U.S.-migrant and 5% among non-U.S. migrant FSW-IDUs; 100% of U.S.-migrant and 75% of non-U.S. migrant FSW-IDUs were unaware of their HIV status. Conclusions Binational coordination to improve access to substance use treatment and HIV testing services in Mexico and the U.S. among marginalized binational migrants may be critical to containing HIV transmission. PMID:23698687

U.S. drug use and migration experiences of Mexican female sex workers who are injection drug users.

PubMed

Ojeda, Victoria D; Burgos, José Luis; Rangel, A Gudelia; Lozada, Remedios; Vera, Alicia

2012-11-01

To describe U.S.-based drug/sex behaviors and correlates of lifetime U.S. drug use by Mexican female sex workers who inject drugs (FSW-IDUs). Between 2008-2010, 315 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. Twenty-seven percent (n=85) of FSW-IDUs were U.S. migrants; of these, 46% (n=39) were deportees. One-half of U.S.-migrant FSW-IDUs consumed illicit drugs in the U.S., and two-thirds of these injected drugs in the U.S. Among U.S. injectors, over 75% ever received or shared used injection equipment. The majority (92%) of U.S.-migrant FSW-IDUs never obtained U.S. drug treatment services. HIV prevalence was 4% among U.S.-migrant and 5% among non-U.S. migrant FSW-IDUs; 100% of U.S.-migrant and 75% of non-U.S. migrant FSW-IDUs were unaware of their HIV status. Binational coordination to improve access to substance use treatment and HIV testing services in Mexico and the U.S. among marginalized binational migrants may be critical to containing HIV transmission.

Drug preparation, injection, and sharing practices in Tajikistan: a qualitative study in Kulob and Khorog.

PubMed

Otiashvili, David; Latypov, Alisher; Kirtadze, Irma; Ibragimov, Umedjon; Zule, William

2016-06-02

Sharing injection equipment remains an important rout of transmission of HIV and HCV infections in the region of Eastern Europe and Central Asia. Tajikistan is one of the most affected countries with high rates of injection drug use and related epidemics.The aim of this qualitative study was to describe drug use practices and related behaviors in two Tajik cities - Kulob and Khorog. Twelve focus group discussions (6 per city) with 100 people who inject drugs recruited through needle and syringe program (NSP) outreach in May 2014. Topics covered included specific drugs injected, drug prices and purity, access to sterile equipment, safe injection practices and types of syringes and needles used. Qualitative thematic analysis was performed using NVivo 10 software. All participants were male and ranged in age from 20 to 78 years. Thematic analysis showed that cheap Afghan heroin, often adulterated by dealers with other admixtures, was the only drug injected. Drug injectors often added Dimedrol (Diphenhydramine) to increase the potency of "low quality" heroin. NSPs were a major source of sterile equipment. Very few participants report direct sharing of needles and syringes. Conversely, many participants reported preparing drugs jointly and sharing injection paraphernalia. Using drugs in an outdoor setting and experiencing withdrawal were major contributors to sharing equipment, using non-sterile water, not boiling and not filtering the drug solution. Qualitative research can provide insights into risk behaviors that may be missed in quantitative studies. These finding have important implications for planning risk reduction interventions in Tajikistan. Prevention should specifically focus on indirect sharing practices.

Patterns of Substance Use and Correlates of Lifetime and Active Injection Drug Use Among Women in Malaysia

PubMed Central

Wickersham, Jeffrey A.; Loeliger, Kelsey B.; Marcus, Ruthanne; Pillai, Veena; Kamarulzaman, Adeeba; Altice, Frederick L.

2016-01-01

Background While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. Objectives To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. Methods A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. Results Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n=33) of participants with 21.4% (n=22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. Conclusion Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women. PMID:26636885

Differences in illegal drug consumption between native and immigrants in a large sample of injected drug users in Catalonia (Spain).

PubMed

Saigí, Núria; Espelt, Albert; Folch, Cinta; Sarasa-Renedo, Ana; Castellano, Yolanda; Majó, Xavier; Meroño, Mercè; Brugal, M Teresa; Casabona, Jordi

2014-01-01

The aims of this study were to describe illegal drug abuse patterns in relation to the migration process and use of drug treatment centers among immigrant injected drug users (IDUs) involved in harm reduction programs, and to compare the characteristics of immigrant and native IDUs. Cross-sectional study of 748 IDUs aged ≥18 years attending harm reduction centers between 2008 and 2009. We explored differences in socio-economic status, illegal drug consumption, health status and use of treatment centers in native versus immigrant IDUs. We also described whether immigrant IDUs started using injected drugs before or after entering the host country. Immigrant IDUs tend to live alone more frequently, start injection at later ages, use heroin and inject it more frequently and use drug treatment centers less frequently than native IDUs. Seventy-six percent of immigrants began using illegal drugs before arriving at the host country. Those who started in other countries were residing in the host country for 5 years or less (63.9%). Overall, immigrant IDUs attended drug treatment centers (36.9%) less frequently than native IDUs (71.8%). In conclusion, migration could be a risk factor for illegal drug abuse initiation or increase in consumption, often with the adoption of local consumption patterns and aggravated due to a lower access to drug treatment centers.

Spatial Epidemiology of HIV among Injection Drug Users in Tijuana, Mexico.

PubMed

Brouwer, Kimberly C; Rusch, Melanie L; Weeks, John R; Lozada, Remedios; Vera, Alicia; Magis-Rodríguez, Carlos; Strathdee, Steffanie A

2012-01-01

The northwest border city of Tijuana is Mexico's fifth largest and is experiencing burgeoning drug use and human immunodeficiency virus (HIV) epidemics. Since local geography influences disease risk, we explored the spatial distribution of HIV among injection drug users (IDUs). From 2006-2007, 1056 IDUs were recruited using respondent-driven sampling, and then followed for eighteen months. Participants underwent semi-annual surveys, mapping, and testing for HIV, tuberculosis, and syphilis. Using Average Nearest Neighbor and Getis-Ord Gi* statistics, locations where participants lived, worked, bought and injected drugs were compared with HIV status and environmental and behavioral factors. Median age was thirty-seven years; 85 percent were male. Females had higher HIV prevalence than males (10.2 percent vs. 3.4 percent; p =0.001). HIV cases at baseline ( n =47) most strongly clustered by drug injection sites ( Z -Score -6.173; p < 0.001), with a 16 km 2 hotspot near the Mexico/U.S. border, encompassing the red-light district. Spatial correlates of HIV included syphilis infection, female gender, younger age, increased hours on the street per day, and higher number of injection partners. Almost all HIV seroconverters injected within a 2.5 block radius of each other immediately prior to seroconversion. Only history of syphilis infection and female gender were strongly associated with HIV in the area where incident cases injected. Directional trends suggested a largely static epidemic until July-December 2008, when HIV spread to the southeast, possibly related to intensified violence and policing that spiked in the latter half of 2008. While clustering allows for targeting interventions, the dynamic nature of epidemics suggests the importance of mobile treatment and harm reduction programs.

Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities.

PubMed

West, Brooke S; Abramovitz, Daniela; Staines, Hugo; Vera, Alicia; Patterson, Thomas L; Strathdee, Steffanie A

2016-02-01

We know little about predictors of injection drug cessation and relapse among female sex workers who inject drugs (FSW-PWID) at the US-Mexico border. Among HIV-negative FSW-PWID taking part in a behavioral intervention study in Tijuana and Ciudad Juárez, Cox regression was used to identify predictors of time to first cessation of injection, which was defined as reporting not having injected drugs for a period of 4 months or longer, and among that subset, we examined predictors of time to injection relapse. Among 440 women, 84 (19%) reported ceasing injection during follow-up (median time to cessation = 9.3 months); of these, 30 (35%) reported relapse to injection (median time to relapse = 3.5 months). The rate of injection cessation was lower for women reporting trading sex prior to age 18 (adj. hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.41-1.01), ever being sexually abused (adj. HR = 0.44, 95% CI = 0.27-0.71), and a higher number of vaginal sex acts with casual clients (adj. HR = 0.99 per transaction, 95% CI = 0.98-1.00). The rate of cessation was higher for women who spent more hours on the streets on a typical day (adj. HR = 1.04/h, 95% CI = 1.01-1.08) and who lived in Tijuana vs. Ciudad Juárez (adj. HR = 2.15, 95% CI = 1.14-4.07). The rate of relapse was higher among women reporting regular drug use with clients (adj. HR = 2.17, 95% CI = 0.96-4.89) and those scoring higher on a risk injection index (adj. HR = 2.04, 95% CI = 1.15-3.61). The rate of relapse was lower for FSW-PWID with higher than average incomes (adj. HR = 0.40, 95% CI = 0.18-0.89). These findings have important implications for the scale-up of methadone maintenance treatment programs (MMTPs) in Mexico and indicate a need for gender-specific programs that address sexual abuse experiences and economic vulnerabilities faced by FSW-PWID.

Facilitating treatment entry among out-of-treatment injection drug users.

PubMed Central

Booth, R E; Kwiatkowski, C; Iguchi, M Y; Pinto, F; John, D

1998-01-01

OBJECTIVE: High risk injection practices are common among injecting drug users (IDUs), even following intervention efforts. Moreover, relapse to risk behaviors has been reported among those who initiate risk reduction. Substance abuse treatment offers the potential to reduce or eliminate injecting risk behaviors through drug cessation. We report on the effectiveness of two intervention strategies in facilitating treatment entry among out-of-treatment IDUs: motivational interviewing (MI), and intervention developed to help individuals resolve their ambivalence about behavior change, and free treatment for 90 days. These conditions were compared with an intervention focusing on a hierarchy of safer injecting practice, referred to here as risk reduction (RR), and no free treatment. METHODS: Nearly 200 out-of-treatment IDUs were randomly assigned to one of four experimental conditions: MI/free treatment, MI/no free treatment, RR/free treatment, and RR/no free treatment. Regardless of assignment, we assisted anyone desiring treatment by calling to schedule the appointment, providing transportation, and waiving the intake fee. RESULTS: Overall, 42% of study participants entered treatment. No significant differences were found between MI and RR; however, 52% of those assigned free treatment entered compare with 32% for those who had to pay. Other predictors of treatment entry included prior treatment experiences, perceived chance of contracting acquired immunodeficiency syndrome (AIDS) greater than 50%, "determination" stage of change, greater frequency of heroin injecting, and fewer drug-using friends. CONCLUSIONS: These findings support the importance of removing barriers to treatment entry. PMID:9722817

The Role of Internalized Stigma in the Disclosure of Injecting Drug Use Among People Who Inject Drugs and Self-Report as HIV-Positive in Kohtla-Järve, Estonia.

PubMed

Johannson, Annika; Vorobjov, Sigrid; Heimer, Robert; Dovidio, John F; Uusküla, Anneli

2017-04-01

Disclosure of injecting drug use and its associations with stigma have received very little research attention. This cross-sectional study examined the role of internalized HIV and drug stigma (i.e., self-stigmatization) in the disclosure of injecting drug use among people who inject drugs (PWID) self-reporting as HIV-positive (n = 312) in Kohtla-Järve, Estonia. The internalization of both stigmas was relatively high. On average, PWID disclosed to three disclosure targets out of seven. Disclosure was highest to close friends and health care workers and lowest to employers and casual sex partners. Internalized drug stigma was negatively associated with disclosure to other family members (AOR = 0.48; 95% CI 0.30-0.77) and health care workers (AOR = 0.46; 95% CI 0.25-0.87). Internalized HIV stigma was positively associated with disclosure to health care workers (AOR = 2.26; 95% CI 1.27-4.00). No interaction effect of internalized stigmas on disclosures emerged. We concluded that effects of internalized stigmas on disclosures are few and not uniform.

Venous access and care: harnessing pragmatics in harm reduction for people who inject drugs.

PubMed

Harris, Magdalena; Rhodes, Tim

2012-06-01

To explore the facilitators of long-term hepatitis C avoidance among people who inject drugs. We employed a qualitative life history design. Recruitment took place through low-threshold drug services and drug user networks in South East and North London. Participants were interviewed at the recruitment services or in their homes. The sample comprised 35 people who inject drugs, 20 of whom were hepatitis C antibody-negative. Participants' average injecting trajectory was 19 years (6-33), with 66% primarily injecting heroin, and 34% a crack and heroin mix. Nine (26%) of the sample were female and the average age was 39 years (23-53). Two interviews were conducted with each participant, with the second interview incorporating reference to a computer-constructed life history time-line. Interview accounts were audiorecorded, transcribed verbatim and analysed thematically. Hepatitis C risk awareness was recent and deprioritized by the majority of participants. The facilitation of venous access and care was an initial and enduring rationale for safe injecting practices. Difficult venous access resulted in increased contamination of injecting environments and transitions to femoral injecting. Participants expressed an unmet desire for non-judgemental venous access information and advice. Harm reduction interventions which attend to the immediate priorities of people who inject drugs, such as venous access and care, have the potential to re-engage individuals who are jaded or confused by hepatitis C prevention messages. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

The efficacy of interviewing young drug users through online chat.

PubMed

Barratt, Monica J

2012-06-01

Despite the fact that most young people who use 'party drugs' also use the Internet, accounts of drugs research involving qualitative interviewing using real-time instant messaging or online chat are yet to be published. This paper assesses the efficacy of conducting qualitative research interviews with young party drug users through instant messaging. In 2007-2008, 837 Australian residents who reported recent use of psychostimulants and/or hallucinogens and participated in online drug discussion completed a web survey and a subsample of 27 completed online interviews (median age 21, range 17-37, 59% male). Experienced drug users were more likely to volunteer to be interviewed than novices. The time and space flexibility provided by the online interviews was convenient; however, interviews were more prone to interruption. Establishing legitimacy, personal disclosure, appropriate linguistic style and humour facilitated the development of rapport and enabled the production of more detailed and in-depth data. These strategies were not successful in all cases and when unsuccessful, interviewees were more easily able to exit the interview by choosing not to respond. Young drug users already using the Internet to chat about drugs find online interviewing an acceptable and convenient way to contribute to research. With adequate preparation to develop technical and cultural competencies, online interviewing offers an effective way of engaging with young people that is worthy of consideration by researchers in the alcohol and other drug field. © 2011 Australasian Professional Society on Alcohol and other Drugs.

The rise of injecting drug use in east Africa: a case study from Kenya

PubMed Central

Beckerleg, Susan; Telfer, Maggie; Hundt, Gillian Lewando

2005-01-01

Studies on injecting drug use in East Africa are reviewed. The existingstudies document the spread of heroin injection in Kenya and Tanzania, both countries where HIV rates are high. No data from Uganda on injecting drug use was found by the authors. A case study of the growth of heroin injection in a Kenyan coastal town is presented. The need for needle-exchange programmes and other prevention services is discussed. PMID:16122382

Needle and Syringe Cleaning Practices among Injection Drug Users.

ERIC Educational Resources Information Center

Fisher, Dennis G.; Harbke, Colin R.; Canty, John R.; Reynolds, Grace L.

2002-01-01

Evaluates the effect of needle exchange on the bleach-mediated disinfection (BMD) practices of 176 needle and syringe sharing injection drug users (IDUs). Results reveal that IDUs who traded sex for money or drugs were less likely to practice BMD, and IDUs who reported a reduced number of sex partners were more likely to practice BMD. (Contains 36…

'Trafficking' or 'personal use': do people who regularly inject drugs understand Australian drug trafficking laws?

PubMed

Hughes, Caitlin E; Ritter, Alison; Cowdery, Nicholas; Sindicich, Natasha

2014-11-01

Legal thresholds for drug trafficking, over which possession of an illicit drug is deemed 'trafficking' as opposed to 'personal use', are employed in all Australian states and territories excepting Queensland. In this paper, we explore the extent to which people who regularly inject drugs understand such laws. Participants from the seven affected states/territories in the 2012 Illicit Drug Reporting System (n = 823) were asked about their legal knowledge of trafficking thresholds: whether, if arrested, quantity possessed would affect legal action taken; and the quantities of heroin, methamphetamine, cocaine and cannabis that would constitute an offence of supply. Data were compared against the actual laws to identify the accuracy of knowledge by drug type and state, and sociodemographics, use and purchasing patterns related to knowledge. Most Illicit Drug Reporting System participants (77%) correctly said that quantity possessed would affect charge received. However, only 55.8% nominated any specific quantity that would constitute an offence of supply, and of those 22.6% nominated a wrong quantity, namely a quantity that was larger than the actual quantity for supply (this varied by state and drug). People who regularly inject drugs have significant gaps in knowledge about Australian legal thresholds for drug trafficking, particularly regarding the actual threshold quantities. This suggests that there may be a need to improve education for this population. Necessity for accurate knowledge would also be lessened by better design of Australian drug trafficking laws. © 2014 Australasian Professional Society on Alcohol and other Drugs.

Mental Health and Family Relations: Correlated Reports from People Who Inject Drugs and their Family Members in Vietnam

PubMed Central

Li, Li; Tuan, Nguyen Anh; Liang, Li-Jung; Lin, Chunqing; Farmer, Shu C.; Flore, Martin

2013-01-01

Background This article explores the association of people who inject drugs and their family members in terms of mental health and family relations. The objective was to understand the family context and its impact on people who inject drugs in a family-oriented culture in Vietnam. Methods Cross-sectional assessment data were gathered from 83 people who inject drugs and 83 of their family members recruited from four communes in Phú Thọ province, Vietnam. Depressive symptoms and family relations were measured for both people who inject drugs and family members. Internalized shame and drug-using behavior were reported by people who inject drugs, and caregiver burden was reported by family members. Results We found that higher level of drug using behavior of people who inject drugs was significantly associated with higher depressive symptoms and lower family relations reported by themselves as well as their family members. Family relations reported by people who inject drugs and their family members were positively correlated. Conclusion The findings highlight the need for interventions that address psychological distress and the related challenges faced by family members of people who inject drugs. The article has policy implication which concludes with an argument for developing strategies that enhance the role of families in supporting behavioral change of people who inject drugs. PMID:23910167

Spatial Epidemiology of HIV among Injection Drug Users in Tijuana, Mexico

PubMed Central

Brouwer, Kimberly C.; Rusch, Melanie L.; Weeks, John R.; Lozada, Remedios; Vera, Alicia; Magis-Rodríguez, Carlos; Strathdee, Steffanie A.

2012-01-01

The northwest border city of Tijuana is Mexico’s fifth largest and is experiencing burgeoning drug use and human immunodeficiency virus (HIV) epidemics. Since local geography influences disease risk, we explored the spatial distribution of HIV among injection drug users (IDUs). From 2006–2007, 1056 IDUs were recruited using respondent-driven sampling, and then followed for eighteen months. Participants underwent semi-annual surveys, mapping, and testing for HIV, tuberculosis, and syphilis. Using Average Nearest Neighbor and Getis-Ord Gi* statistics, locations where participants lived, worked, bought and injected drugs were compared with HIV status and environmental and behavioral factors. Median age was thirty-seven years; 85 percent were male. Females had higher HIV prevalence than males (10.2 percent vs. 3.4 percent; p=0.001). HIV cases at baseline (n=47) most strongly clustered by drug injection sites (Z-Score −6.173; p < 0.001), with a 16 km2 hotspot near the Mexico/U.S. border, encompassing the red-light district. Spatial correlates of HIV included syphilis infection, female gender, younger age, increased hours on the street per day, and higher number of injection partners. Almost all HIV seroconverters injected within a 2.5 block radius of each other immediately prior to seroconversion. Only history of syphilis infection and female gender were strongly associated with HIV in the area where incident cases injected. Directional trends suggested a largely static epidemic until July–December 2008, when HIV spread to the southeast, possibly related to intensified violence and policing that spiked in the latter half of 2008. While clustering allows for targeting interventions, the dynamic nature of epidemics suggests the importance of mobile treatment and harm reduction programs. PMID:23606753

Profile of male Brazilian injecting drug users who have sex with men.

PubMed

Ferreira, Aline Dayrell; Caiaffa, Waleska Teixeira; Bastos, Francisco I; Mingoti, Sueli Aparecida

2006-04-01

This study aims to characterize the profile of male injecting drug users who have sex with other men (MSM IDUs) recruited through a cross-sectional multi-city survey (AjUDE-Brasil II Project) in six Brazilian cities, in 2000-2001. MSM IDUs were compared to other male IDUs using bivariate and multivariate procedures (logistic regression and answer tree analysis with the CHAID algorithm). Among the 709 male IDUs, 187 (26.4%) reported ever having had sex with other men, while only 37 reported sex with other men in the previous six months. MSM IDUs were more likely to be unemployed (OR = 2.3), to have injected tranquilizers (OR = 3.6), and to be HIV-seropositive (OR = 2.1), compared to other male IDUs. Male same-sex relations in this subgroup appear to be associated with strategies to finance drug consuming habits, including sex for drugs with occasional female partners or obtaining injection paraphernalia from occasional sex partners. Further studies should focus on this especially vulnerable subgroup of IDUs, due to the bidirectional and complex interrelationships between their drug injecting habits and sexual risk behaviors.

Injection drug use among female sex workers in Iran: Findings from a nationwide bio-behavioural survey.

PubMed

Karamouzian, Mohammad; Mirzazadeh, Ali; Rawat, Angeli; Shokoohi, Mostafa; Haghdoost, Ali A; Sedaghat, Abbas; Shahesmaeili, Armita; Sharifi, Hamid

2017-06-01

Globally, one in three women who inject drugs is involved in sex work which increases their vulnerability to sexually transmitted infections including HIV. This study was conducted to improve our understanding of injection drug use practices among Iranian female sex workers (FSWs) and shed light on the high-risk profile of FSWs who inject drugs (FSW-IDUs). This survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 13 cities in Iran. Data were collected through face-to-face interviews and lifetime injection drug use was assessed through the responses to the question "Have you ever injected any illicit drugs?". Independent variables included a range of socio-demographic and risk characteristics. Logistic regression models were applied to investigate the correlates of lifetime history of injection drug use. Median (Q1, Q3) age of the participants was 30 (25, 37) and a total of 127 (14.6%, 95% confidence interval (CI): 12.3-17.1) had ever injected drugs. In the multivariable logistic regression model, older age (adjusted odds ratio (AOR)=AOR 25-34 vs. <18 =3.37, 95% CI: 1.64, 7.70; AOR ≥35 vs. <18 =2.80, 95% CI: 1.11, 7.10), longer duration (>5 years) of involvement in sex work (AOR=1.06, 95% CI: 1.02, 1.10), and history of drinking alcohol (AOR=4.42, 95% CI: 2.67, 7.32) were positively associated with lifetime history of drug injection and younger age at sex work debut (AOR=0.52, 95% CI: 0.28, 0.96) was negatively associated with lifetime history of illicit drug injection among FSWs. The prevalence of injection drug use among FSWs in Iran is concerning. Given the potential of this sub-population in bridging HIV into the general population, gender-sensitive and peer-led harm reduction programs should be further scaled up to meet the special needs of this vulnerable population. Copyright © 2017 Elsevier B.V. All rights reserved.

The association between neighborhood residential rehabilitation and injection drug use in Baltimore, Maryland, 2000-2011

PubMed Central

Linton, Sabriya L.; Jennings, Jacky M.; Latkin, Carl A.; Kirk, Gregory D.; Mehta, Shruti H.

2014-01-01

This study utilized multilevel cross-classified models to longitudinally assess the association between neighborhood residential rehabilitation and injection drug use. We also assessed whether relocating between neighborhoods of varying levels of residential rehabilitation was associated with injection drug use. Residential rehabilitation was categorized into three groups (e.g. low, moderate, high), and lagged one visit to ensure temporality. After adjusting for neighborhood and individual-level factors, residence in a neighborhood with moderate residential rehabilitation was associated with a 23% reduction in injection drug use [AOR=0.77; 95% CI (0.67,0.87)]; residence in a neighborhood with high residential rehabilitation was associated with a 26% reduction in injection drug use [AOR=0.74; 95% CI (0.61,0.91)]. Continuous residence within neighborhoods with moderate/high rehabilitation, and relocating to neighborhoods with moderate/high rehabilitation, were associated with a lower likelihood of injection drug use. Additional studies are needed to understand the mechanisms behind these relationships. PMID:24840154

Measures to prevent and reduce drug abuse among young people in Burma.

PubMed

Khant, U

1985-01-01

Opium and to a certain extent cannabis were the only drugs of abuse in Burma until the early 1970s when heroin addiction spread rapidly among young people, reaching epidemic proportions. Heroin addiction has caused serious social and health problems that prompted the authorities to adopt new legislation in 1974, the Narcotic and Dangerous Drugs Law, which provided for compulsory treatment and severe penalties for drug-related infractions, including the death sentence for certain categories of drug trafficking. The authorities in Burma consider that legislation, drug-law enforcement, prevention, treatment and rehabilitation, and community measures are important and interrelated strategies in combating drug abuse among young people. Various forms of drug-abuse preventive programmes are carried out for such groups as youths, parents, community leaders and professionals dealing with the problems of the young. Preventive school programmes include lectures and discussions; exhibitions; essay writing and other forms of competition for students; in-service training for teachers; healthy alternatives to drug use; a scheme for talented students; and participation in a national mass movement for literacy. Young people are also encouraged to take active part in various community programmes such as the "Red Cross" and voluntary fire brigades as well as in specially designed programmes that are carried out at the local level to prevent and reduce drug abuse. As the extended family still prevails in Burma, with parents and elders being respected by the young, this important resource is utilized in coping with drug abuse among young people.(ABSTRACT TRUNCATED AT 250 WORDS)

Acceptability and design preferences of supervised injection services among people who inject drugs in a mid-sized Canadian City.

PubMed

Mitra, Sanjana; Rachlis, Beth; Scheim, Ayden; Bardwell, Geoff; Rourke, Sean B; Kerr, Thomas

2017-07-14

Supervised injection services (SIS) have been shown to reduce the public- and individual-level harms associated with injection drug use. While SIS feasibility research has been conducted in large urban centres, little is known about the acceptability of these services among people who inject drugs (PWID) in mid-sized cities. We assessed the prevalence and correlates of willingness to use SIS as well as design and operational preferences among PWID in London, Canada. Between March and April 2016, peer research associates administered a cross-sectional survey to PWID in London. Socio-demographic characteristics, drug-use patterns, and behaviours associated with willingness to use SIS were estimated using bivariable and multivariable logistic regression models. Chi-square tests were used to compare characteristics with expected frequency of SIS use among those willing to use SIS. Design and operational preferences are also described. Of 197 PWID included in this analysis (median age, 39; interquartile range (IQR), 33-50; 38% female), 170 (86%) reported willingness to use SIS. In multivariable analyses, being female (adjusted odds ratio (AOR) 0.29; 95% confidence interval (CI) 0.11-0.75) was negatively associated with willingness to use, while public injecting in the last 6 months (AOR 2.76; 95% CI 1.00-7.62) was positively associated with willingness to use. Participants living in unstable housing, those injecting in public, and those injecting opioids and crystal methamphetamine daily reported higher expected frequency of SIS use (p < 0.05). A majority preferred private cubicles for injecting spaces and daytime operational hours, while just under half preferred PWID involved in service operations. High levels of willingness to use SIS were found among PWID in this setting, suggesting that these services may play a role in addressing the harms associated with injection drug use. To maximize the uptake of SIS, programme planners and policy makers should consider

Access to Sterile Injecting Equipment is More Important Than Awareness of HCV Status for Injection Risk Behaviors Among Drug Users

PubMed Central

COX, JOSEPH; MORISSETTE, CAROLE; DE, PRITHWISH; TREMBLAY, CLAUDE; ALLARD, ROBERT; GRAVES, LISA; STEPHENSON, RANDOLPH; ROY, ÉLISE

2010-01-01

Awareness of hepatitis C virus (HCV) infection status is expected to influence risk behaviors. In 2004–2005, injection drug users (IDUs) recruited from syringe exchange programs (SEPs) and methadone clinics in Montreal, Canada, were interviewed on drug use behaviors (past 6 months) and HCV testing. Subjects (n = 230) were classified as low/intermediate risk (20.4% borrowed drug preparation equipment only) and high risk (19.6% borrowed syringes), and 54.5% reported being HCV positive. Logistic regression modeling showed that compared to no risk (60% borrowed nothing), low/intermediate risk was associated with fewer noninjecting social network members, poor physical health, and problems obtaining sterile injecting equipment. High risk was associated with all of these factors except social networks. HCV status was not associated with any level of risk. Improved access to sterile injecting equipment may be more important than knowledge of HCV status in reducing injection risks among this IDU population. The study limitations are noted and recommendations discussed. PMID:19242863

Effects of Sex Work on the Prevalence of Syphilis Among Injection Drug Users in 3 Russian Cities

PubMed Central

Platt, Lucy; Rhodes, Tim; Judd, Ali; Koshkina, Evgeniya; Maksimova, Svetlana; Latishevskaya, Natalia; Renton, Adrian; McDonald, Tamara; Parry, John V.

2007-01-01

Objectives. We examined risk factors for syphilis infection among injection drug users in 3 Russian Federation cities, focusing particular attention on the potential roles of gender and sex work. Methods. We conducted a cross-sectional survey of injection drug users in Moscow, Volgograd, and Barnaul, collecting behavioral data and testing for antibodies to Treponema pallidum. Associations between presence of antibodies to T pallidum and covariates were explored. Results. Overall, the prevalence of antibodies to T pallidum was 11% (95% confidence interval=9.7%, 13.1%). Syphilis was associated with involvement in sex work and with gender in Moscow and Barnaul but not in Volgograd. Female injection drug users not involved in sex work were more likely than men to be younger and to have recently begun to inject; female injection drug users involved in sex work were more likely than those not involved in sex work to inject daily. Conclusions. Syphilis transmission dynamics varied by region. Sex work can increase syphilis risk among injection drug users, potentially feeding the momentum of sexually transmitted HIV and syphilis among noninjectors. Targeted interventions are needed to reduce both sexual and injection risk behaviors among injection drug users. PMID:17018827

77 FR 4226 - Implantation or Injectable Dosage Form New Animal Drugs; Danofloxacin

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-27

.... FDA-2011-N-0003] Implantation or Injectable Dosage Form New Animal Drugs; Danofloxacin AGENCY: Food... amending the animal drug regulations to reflect approval of a supplemental new animal drug application.... 801-808. List of Subjects in 21 CFR Part 522 Animal drugs. Therefore, under the Federal Food, Drug...

Perspectives on biomedical HIV prevention options among women who inject drugs in Kenya.

PubMed

Bazzi, Angela Robertson; Yotebieng, Kelly A; Agot, Kawango; Rota, Grace; Syvertsen, Jennifer L

2018-03-01

Due to heightened vulnerability to HIV from frequent engagement in sex work and overlapping drug-using and sexual networks, women who inject drugs should be a high priority population for pre-exposure prophylaxis (PrEP) and other biomedical HIV prevention tools. Kenya is one of the first African countries to approve oral PrEP for HIV prevention among "key populations," including people who inject drugs and sex workers. The objective of this study was to explore preferences and perceived challenges to PrEP adoption among women who inject drugs in Kisumu, Kenya. We conducted qualitative interviews with nine HIV-uninfected women who inject drugs to assess their perceptions of biomedical HIV interventions, including oral PrEP, microbicide gels, and intravaginal rings. Despite their high risk and multiple biomedical studies in the region, only two women had ever heard of any of these methods. All women were interested in trying at least one biomedical prevention method, primarily to protect themselves from partners who were believed to have multiple other sexual partners. Although women shared concerns about side effects and product efficacy, they did not perceive drug use as a significant deterrent to adopting or adhering to biomedical prevention methods. Beginning immediately and continuing throughout Kenya's planned PrEP rollout, efforts are urgently needed to include the perspectives of high risk women who use drugs in biomedical HIV prevention research and programing.

Microwave coagulation therapy and drug injection to treat splenic injury.

PubMed

Zhang, Guoming; Sun, Yuanyuan; Yu, Jie; Dong, Lei; Mu, Nannan; Liu, Xiaohong; Liu, Lanfen; Zhang, Yan; Wang, Xiaofei; Liang, Ping

2014-01-01

The present study compares the efficacy of 915- and 2450-MHz contrast-enhanced ultrasound (CEUS)-guided percutaneous microwave coagulation with that of CEUS-guided thrombin injection for the treatment of trauma-induced spleen hemorrhage. In a canine splenic artery hemorrhage model with two levels of arterial diameter (A, <1 mm and B, between 1 and 2 mm), hemostatic therapy was performed using 915- and 2450-MHz microwaves and drug injection. Therapy efficacy was measured by comparing bleeding rate, hemostatic time, bleeding index, bleeding volume, and pathology. The most efficient technique was CEUS-guided 915-MHz percutaneous microwave coagulation therapy in terms of action time and total blood loss. The success rate of the 915-MHz microwave group was higher than that of the 2450-MHz microwave and the drug injection groups (except A level, P < 0.05). Hemostatic time, bleeding index, and bleeding volume were significantly less in the 915-MHz microwave group than those in the 2450-MHz microwave and drug injection groups (P < 0.05). Obvious degeneration and necrosis of parenchyma and large intravascular thrombosis were observed in the cavity of larger vessels in the 915-MHz microwave group, but pathologic changes of light injury could be seen in the other groups. The present study provides evidence that microwave coagulation therapy is more efficient than thrombin injection for the treatment of splenic hemorrhage. Furthermore, treatment with 915-MHz microwaves stops bleeding more rapidly and generates a wider cauterization zone than does treatment with 2450-MHz microwaves. Copyright © 2014 Elsevier Inc. All rights reserved.

High risk behavior for HIV transmission among former injecting drug users: a survey from Indonesia.

PubMed

Iskandar, Shelly; Basar, Diba; Hidayat, Teddy; Siregar, Ike M P; Pinxten, Lucas; van Crevel, Reinout; Van der Ven, Andre J A M; De Jong, Cor A J

2010-08-10

Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. However, former injecting drug users (fIDUs) are often overlooked as a high risk group for HIV transmission. We compared HIV risk behavior among current and former injecting drug users (IDUs) in Indonesia, which has a rapidly growing HIV-epidemic largely driven by injecting drug use. Current and former IDUs were recruited by respondent driven sampling in an urban setting in Java, and interviewed regarding drug use and HIV risk behavior using the European Addiction Severity Index and the Blood Borne Virus Transmission Questionnaire. Drug use and HIV transmission risk behavior were compared between current IDUs and former IDUs, using the Mann-Whitney and Pearson Chi-square test. Ninety-two out of 210 participants (44%) were self reported former IDUs. Risk behavior related to sex, tattooing or piercing was common among current as well as former IDUs, 13% of former IDUs were still exposed to contaminated injecting equipment. HIV-infection was high among former (66%) and current (60%) IDUs. Former IDUs may contribute significantly to the HIV-epidemic in Indonesia, and HIV-prevention should therefore also target this group, addressing sexual and other risk behavior.

How do drug market changes affect characteristics of injecting initiation and subsequent patterns of drug use? Findings from a cohort of regular heroin and methamphetamine injectors in Melbourne, Australia.

PubMed

Horyniak, Danielle; Stoové, Mark; Degenhardt, Louisa; Aitken, Campbell; Kerr, Thomas; Dietze, Paul

2015-01-01

Changes in drug market characteristics have been shown to affect drug use patterns but few studies have examined their impacts on injecting initiation experiences and subsequent patterns of injecting drug use (IDU). We collected data on self-reported injecting initiation experiences and past-month patterns of IDU from 688 regular heroin and methamphetamine injectors in Melbourne, Australia, who initiated injecting across three different drug market periods (prior to the Australian heroin shortage ('high heroin')/immediately following the shortage ('low heroin')/'contemporary' markets (fluctuating heroin and methamphetamine availability)). We used univariable and multivariable logistic regression to examine the relationship between period of injecting initiation and first drug injected, and multinomial logistic regression for the relationship between period of injecting initiation and current injecting patterns. 425 participants (62%) reported initiating injecting in the high heroin period, 146 (21%) in the low heroin period, and 117 (17%) in the contemporary period. Participants who initiated injecting during the low heroin period were twice as likely to initiate injecting using a drug other than heroin (AOR: 1.94, 95% CI: 1.27-2.95). The most common patterns of drug use among study participants in the month preceding interview were polydrug use (44%) and primary heroin use (41%). Injecting initiation period was either non-significantly or weakly associated with current drug use pattern, which was more strongly associated with other socio-demographic and drug use characteristics, particularly self-reported drug of choice. The drug market period in which injecting initiation occurred influenced the first drug injected and influenced some aspects of subsequent drug use. In the context of highly dynamic drug markets in which polydrug use is common there is a need for broad harm reduction and drug treatment services which are flexible and responsive to changing

Ocular manifestations of injection drug use.

PubMed

Kim, Rubin W; Juzych, Mark S; Eliott, Dean

2002-09-01

Injection drug use can result in a variety of severe ocular conditions. Hematogenous dissemination of various fungi and bacteria may produce endophthalmitis with resultant severe visual loss. Retinal arterial occlusive disease may result from talc and other particulate emboli. Most commonly, life-threatening systemic diseases such as endocarditis and HIV infection secondarily affect the eye. Because many of these conditions may result in blindness if untreated, accurate diagnosis and prompt initiation of therapy are essential.

Free-hand ultrasound guidance permits safe and efficient minimally invasive intrathymic injections in both young and aged mice

PubMed Central

Tuckett, Andrea Z.; Zakrzewski, Johannes L.; Li, Duan; van den Brink, Marcel R.M.; Thornton, Raymond H.

2014-01-01

The goal of this study was to evaluate whether using an aseptic free-hand approach for ultrasound-guided injection facilitates injection into the thymic gland in mice. We used this interventional radiology technique in young, aged, and immunodeficient mice and found that the thymus was visible in all cases. The mean injection period was 8 s in young mice and 19 s in aged or immunodeficient mice. Injection accuracy was confirmed by intrathymic location of an injected dye, or by in vivo bioluminescence imaging of injected luciferase-expressing cells. Accurate intrathymic injection was confirmed in 97% of cases. No major complications were observed. We conclude that an aseptic free-hand technique for ultrasound-guided intrathymic injection is safe, accurate, and reduces the time required for intrathymic injections. This method facilitates large-scale experiments, injection of individual thymic lobes, and is clinically relevant. PMID:25701534

Fluorescent blue lights, injecting drug use and related health risk in public conveniences: findings from a qualitative study of micro-injecting environments.

PubMed

Parkin, Stephen; Coomber, Ross

2010-07-01

This paper presents findings relating to injecting drug users' experiences and opinions of public toilets illuminated with fluorescent blue lights and presents an empirical assessment of the intended deterrent effect of such installations. Data analysis identified that blue lights deterred less than half the sample interviewed. Furthermore over half (18/31) of the sample were prepared to inject in conditions specifically designed to deter injecting practice. Of these, 11 respondents were completely undeterred and 7 individuals were only partially deterred by blue light environments. These findings are discussed within the interpretative frameworks of Pierre Bourdieu's theory of habitus and symbolic violence. The authors conclude that fluorescent blue lights contribute towards the development of situated resistance by injecting drug users within a public injecting habitus; a resistance that produces and reproduces drug-related harm and is a behaviour that opposes the symbolic violence of harm reduction intervention. The paper concludes with suggestions for theory-driven practical intervention that may seek to disrupt the harmful elements of the public injecting habitus. 2010 Elsevier Ltd. All rights reserved.

Perforator-Guided Drug Injection in the Treatment of Abdominal Wall Pain.

PubMed

Weum, Sven; de Weerd, Louis

2016-07-01

Pain from the abdominal wall can be caused by nerve entrapment, a condition called abdominal cutaneous nerve entrapment syndrome (ACNES). As an alternative to surgery, ACNES may be treated with injection of local anesthetics, corticosteroids, or botulinum toxin at the point of maximal pain. The point of maximal pain was marked on the abdominal skin. Using color Doppler ultrasound, the corresponding exit point of perforating blood vessels through the anterior fascia of the rectus abdominis muscle was identified. Ultrasound-guided injection of botulinum toxin in close proximity to the perforator's exit point was performed below and above the muscle fascia. The technique was used from 2008 to 2014 on 15 patients in 46 sessions with a total of 128 injections without complications. The injection technique provided safe and accurate administration of the drug in proximity to the affected cutaneous nerves. The effect of botulinum toxin on ACNES is beyond the scope of this article. Perforator-guided injection enables precise drug administration at the location of nerve entrapment in ACNES in contrast to blind injections. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A qualitative exploration of travel-related risk behaviours of injection drug users from two Slovene regions

PubMed Central

2011-01-01

This qualitative study of travel-related risk behaviours of Slovene injection drug users was based on interviews with individuals enrolled in drug addiction treatment programmes run by three regional centres for prevention and treatment of drug addiction. The primary objective of the study was to analyse behaviour patterns and practices of injection drug users during travel. Methods Travel-related problems of Slovene injection drug users were identified on the basis of data obtained by 25 in-depth interviews. A semi-structured questionnaire with 13 open-ended questions was developed after a preliminary study and review of the literature, and on the basis of experience with the treatment of drug addiction in Slovenia. Results The sample comprised 25 individuals, 18 men and seven women, aged 25 to 53 years. The interviews were 10 to 30 minutes long. The results obtained were presented as identified risk behaviours. Five categories were generated, providing information on the following topics: procurement of illicit drugs, criminal acts/environment, HIV and hepatitis B and C infections, storage and transport of substitution medication and pre-travel health protection. The first three categories comprise the injection drug users' risk behaviours that are most frequently explored in the literature. The other two categories - storage and transport of medication across the border and pre-travel health protection - reflect national specificities and the effectiveness of substitution treatment programmes. The majority of participants denied having shared needles and other injecting equipment when travelling. Participants who had no doctor's certificate had recourse to various forms of risk behaviour, finding a number of ways to hide the medication at the border. Conclusion This qualitative study provides insight into potential travel-related risk behaviour of injection drug users from two Slovene regions - central and coastal. The potential value of this qualitative study

Injecting risk behaviours following treatment for hepatitis C virus infection among people who inject drugs: The Australian Trial in Acute Hepatitis C.

PubMed

Alavi, Maryam; Spelman, Tim; Matthews, Gail V; Haber, Paul S; Day, Carolyn; van Beek, Ingrid; Walsh, Nick; Yeung, Barbara; Bruneau, Julie; Petoumenos, Kathy; Dolan, Kate; Kaldor, John M; Dore, Gregory J; Hellard, Margaret; Grebely, Jason

2015-10-01

A barrier to hepatitis C virus (HCV) treatment among people who inject drugs (PWID) has been a concern that interferon-based HCV treatment may increase injecting risk behaviours. This study evaluated recent (past month) injecting risk behaviours during follow-up among PWID that did and did not receive HCV treatment. The Australian Trial in Acute Hepatitis C (ATAHC) was a prospective study of natural history and treatment of recent HCV infection. Analyses were performed using generalized estimating equations. Among 124 participants with a history of injecting drug use (median age 32 years), 69% were male, and 68% were treated for HCV infection. HCV treatment was not associated with an increase in recent injecting drug use (adjusted odds ratio (aOR) 1.06, 95% CI 0.93, 1.21) or recent used needle and syringe borrowing during follow-up (aOR 0.99, 95% CI 0.89, 1.08). HCV treatment was associated with a decrease in recent ancillary injecting equipment sharing during follow-up (aOR 0.85, 95% CI 0.74, 0.99). Further, among treated participants who remained in follow-up (n=24), ancillary injecting equipment sharing significantly decreased from 54% at enrolment to 17% during follow-up (P=0.012). HCV treatment was not associated with drug use or used needle and syringe borrowing during follow-up, but was associated with decreased ancillary injecting equipment sharing during follow-up. Programs to enhance HCV assessment and treatment among PWID should be expanded, given that HCV treatment does not lead to increases in injecting risk behaviours and has previously been demonstrated to be safe and effective among PWID. Copyright © 2015 Elsevier B.V. All rights reserved.

An analysis of respondent-driven sampling with injecting drug users in a high HIV prevalent state of India.

PubMed

Phukan, Sanjib Kumar; Medhi, Gajendra Kumar; Mahanta, Jagadish; Adhikary, Rajatashuvra; Thongamba, Gay; Paranjape, Ramesh S; Akoijam, Brogen S

2017-07-03

Personal networks are significant social spaces to spread of HIV or other blood-borne infections among hard-to-reach population, viz., injecting drug users, female sex workers, etc. Sharing of infected needles or syringes among drug users is one of the major routes of HIV transmission in Manipur, a high HIV prevalence state in India. This study was carried out to describe the network characteristics and recruitment patterns of injecting drug users and to assess the association of personal network with injecting risky behaviors in Manipur. A total of 821 injecting drug users were recruited into the study using respondent-driven sampling (RDS) from Bishnupur and Churachandpur districts of Manipur; data on demographic characteristics, HIV risk behaviors, and network size were collected from them. Transition probability matrices and homophily indices were used to describe the network characteristics, and recruitment patterns of injecting drug users. Univariate and multivariate binary logistic regression models were performed to analyze the association between the personal networks and sharing of needles or syringes. The average network size was similar in both the districts. Recruitment analysis indicates injecting drug users were mostly engaged in mixed age group setting for injecting practice. Ever married and new injectors showed lack of in-group ties. Younger injecting drug users had mainly recruited older injecting drug users from their personal network. In logistic regression analysis, higher personal network was found to be significantly associated with increased likelihood of injecting risky behaviors. Because of mixed personal network of new injectors and higher network density associated with HIV exposure, older injecting drug users may act as a link for HIV transmission or other blood-borne infections to new injectors and also to their sexual partners. The information from this study may be useful to understanding the network pattern of injecting drug users

Science and scepticism: Drug information, young men and counterpublic health.

PubMed

Farrugia, Adrian; Fraser, Suzanne

2017-11-01

It is perhaps no surprise that young people can be sceptical of the drug-related information they receive in school-based health education, health promotion and the media. Significant societal anxiety surrounds young people's drug consumption, so it is tempting to approach this scepticism as a problem to be solved. In this article, we look closely at a group of young Australian men (n = 25), all of whom hold deeply sceptical views about the drug information they received in schools, social marketing campaigns and public speech generally. We do not approach their scepticism as a problem to be solved in itself, however. Instead, we analyse its origins and how it relates to the way knowledge is constructed in drug education, health promotion and media accounts of drug use. To conceptualise this scepticism, we draw on Irwin and Michael's analysis of the changing relationship between science and society, Warner's theorisation of publics and counterpublics, and Race's related notion of 'counterpublic health'. The article organises the data into three key themes: scepticism about the accuracy of the claims made about drug risks and dangers, scepticism about representations of drug users, and scepticism about the motivations behind the health messages and drug policy in general. We then draw these different aspects of scepticism together to argue that the young men can be seen to constitute a health 'counterpublic', and we consider the implications of this approach, arguing for what has been described as a more diplomatic engagement between science and publics.

Synergistic anti-tumor activity through combinational intratumoral injection of an in-situ injectable drug depot.

PubMed

Kim, Da Yeon; Kwon, Doo Yeon; Kwon, Jin Seon; Park, Ji Hoon; Park, Seung Hun; Oh, Hyun Ju; Kim, Jae Ho; Min, Byoung Hyun; Park, Kinam; Kim, Moon Suk

2016-04-01

Here, we describe combinational chemotherapy via intratumoral injection of doxorubicin (Dox) and 5-fluorouracil (Fu) to enhance the efficacy and reduce the toxicity of systemically administered Fu and Dox in cancer patients. As the key concept in this work, mixture formulations of Dox-loaded microcapsules (Dox-M) and Fu-loaded Pluronic(®) hydrogels (Fu-HP) or Fu-loaded diblock copolymer hydrogels (Fu-HC) have been employed as drug depots. The in vitro and in vivo drug depot was designed as a formulation of Dox-M dispersed inside an outer shell of Fu-HP or Fu-HC after injection. The Dox-M/Fu-HP and Dox-M/Fu-HC formulations are free flowing at room temperature, indicating injectability, and formed a structural gelatinous depot in vitro and in vivo at body temperature. The Fu-HP, Fu-HC, Dox-M/Fu-HP, Dox-M/Fu-HC, and Dox-M formulations were easily injected into tumor centers in mice using a needle. Dox-M/Fu-HC produced more significant inhibitory effects against tumor growth than that by Dox-M/Fu-HP, while Fu-HP, Fu-HC and Dox-M had the weakest inhibitory effects of the tested treatments. The in vivo study of Dox and Fu biodistribution showed that high Dox and Fu concentrations were maintained in the target tumor only, while distribution to normal tissues was not observed, indicating that Dox and Fu concentrations below their toxic plasma concentrations should not cause significant systemic toxicity. The Dox-M/Fu-HP and Dox-M/Fu-HC drug depots described in this work showed excellent performance as chemotherapeutic delivery systems. The results reported here indicate that intratumoral injection using combination chemotherapy with Dox-M/Fu-HP or Dox-M/Fu-HC could be of translational research by enhancing the synergistic inhibitory effects of Dox and Fu on tumor growth, while reducing their systemic toxicity in cancer patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mortality among people who inject drugs: a systematic review and meta-analysis

PubMed Central

Degenhardt, Louisa; Bucello, Chiara; Lemon, James; Wiessing, Lucas; Hickman, Mathew

2013-01-01

Abstract Objective To systematically review cohort studies of mortality among people who inject drugs, examine mortality rates and causes of death in this group, and identify participant- and study-level variables associated with a higher risk of death. Methods Tailored search strings were used to search EMBASE, Medline and PsycINFO. The grey literature was identified through online grey literature databases. Experts were consulted to obtain additional studies and data. Random effects meta-analyses were performed to estimate pooled crude mortality rates (CMRs) and standardized mortality ratios (SMRs). Findings Sixty-seven cohorts of people who inject drugs were identified, 14 of them from low- and middle-income countries. The pooled CMR was 2.35 deaths per 100 person–years (95% confidence interval, CI: 2.12–2.58). SMRs were reported for 32 cohorts; the pooled SMR was 14.68 (95% CI: 13.01–16.35). Comparison of CMRs and the calculation of CMR ratios revealed mortality to be higher in low- and middle-income country cohorts, males and people who injected drugs that were positive for human immunodeficiency virus (HIV). It was also higher during off-treatment periods. Drug overdose and acquired immunodeficiency syndrome (AIDS) were the primary causes of death across cohorts. Conclusion Compared with the general population, people who inject drugs have an elevated risk of death, although mortality rates vary across different settings. Any comprehensive approach to improving health outcomes in this group must include efforts to reduce HIV infection as well as other causes of death, particularly drug overdose. PMID:23554523

Free-hand ultrasound guidance permits safe and efficient minimally invasive intrathymic injections in both young and aged mice.

PubMed

Tuckett, Andrea Z; Zakrzewski, Johannes L; Li, Duan; van den Brink, Marcel R M; Thornton, Raymond H

2015-04-01

The goal of this study was to evaluate whether use of an aseptic free-hand approach to ultrasound-guided injection facilitates injection into the thymic gland in mice. We used this interventional radiology technique in young, aged and immunodeficient mice and found that the thymus was visible in all cases. The mean injection period was 8 seconds in young mice and 19 seconds in aged or immunodeficient mice. Injection accuracy was confirmed by intrathymic location of an injected dye or by in vivo bioluminescence imaging of injected luciferase-expressing cells. Accurate intrathymic injection was confirmed in 97% of cases. No major complications were observed. We conclude that an aseptic freehand technique for ultrasound-guided intrathymic injection is safe and accurate and reduces the time required for intrathymic injections. This method facilitates large-scale experiments and injection of individual thymic lobes and is clinically relevant. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs - 20 Cities, United States, 2015.

PubMed

Burnett, Janet C; Broz, Dita; Spiller, Michael W; Wejnert, Cyprian; Paz-Bailey, Gabriela

2018-01-12

In the United States, 9% of human immunodeficiency virus (HIV) infections diagnosed in 2015 were attributed to injection drug use (1). In 2015, 79% of diagnoses of HIV infection among persons who inject drugs occurred in urban areas (2). To monitor the prevalence of HIV infection and associated behaviors among persons who inject drugs, CDC's National HIV Behavioral Surveillance (NHBS) conducts interviews and HIV testing in selected metropolitan statistical areas (MSAs) (3). The prevalence of HIV infection among persons who inject drugs in 20 MSAs in 2015 was 7%. In a behavioral analysis of HIV-negative persons who inject drugs, an estimated 27% receptively shared syringes and 67% had condomless vaginal sex in the previous 12 months. During the same period, 58% had tested for HIV infection and 52% received syringes from a syringe services program. Given the increased number of persons newly injecting drugs who are at risk for HIV infection because of the recent opioid epidemic (2,4), these findings underscore the importance of continuing and expanding health services, HIV prevention programs, and community-based strategies, such as those provided by syringe services programs, for this population.

Defining populations and injecting parameters among people who inject drugs: Implications for the assessment of hepatitis C treatment programs.

PubMed

Larney, Sarah; Grebely, Jason; Hickman, Matthew; De Angelis, Daniela; Dore, Gregory J; Degenhardt, Louisa

2015-10-01

There is considerable interest in determining the impact that increased uptake of treatment for hepatitis C virus (HCV) infection will have on the burden of HCV among people who inject drugs (PWID). An understanding of the size of the population of PWID, rates of injecting cessation and HCV prevalence and incidence within the PWID population is essential for such exercises. However, these parameters are often uncertain. In this paper we review methods for estimating the size of the population of PWID and related parameters, taking into account the uncertainty that exists around data on the natural history of injecting drug use; consider issues in the estimation of HCV prevalence among PWID; and consider the importance of opioid substitution therapy and prisons as settings for the prevention and treatment of HCV infection among PWID. These latter two points are illustrated through examples of ongoing work in England, Scotland and Australia. We conclude that an improved understanding of the size of PWID populations, including current and former PWID and parameters related to injecting drug use and settings where PWID may be reached, is necessary to inform HCV prevention and treatment strategies. Copyright © 2015 Elsevier B.V. All rights reserved.

Modeling Initiation into Drug Injection among Street Youth

ERIC Educational Resources Information Center

Roy, Elise; Godin, Gaston; Boudreau, Jean-Francois; Cote, Philippe-Benoit; Denis, Veronique; Haley, Nancy; Leclerc, Pascale; Boivin, Jean-Francois

2011-01-01

This study aimed at examining the predictors of initiation into drug injection among street youth using social cognitive theory framework. A prospective cohort study based on semi-annual interviews was carried out. Psychosocial determinants referred to avoidance of initiation. Other potential predictors were: sociodemographic characteristics,…

Prevalence and Correlates of Heroin–Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico

PubMed Central

Meacham, Meredith C.; Strathdee, Steffanie A.; Rangel, Gudelia; Armenta, Richard F.; Gaines, Tommi L.; Garfein, Richard S.

2016-01-01

Objective: Although persons who inject drugs (PWID) in the western United States–Mexico border region are known to inject both heroin and methamphetamine, little is known about the prevalence and risks associated with co-injection of this depressant–stimulant combination (also known as “goofball” and “Mexican speedball”). Method: Baseline data from parallel cohort studies of PWID conducted concurrently in San Diego, CA, and Tijuana, Mexico, were used to estimate the prevalence and identify correlates of heroin–methamphetamine co-injection. PWID older than 18 years of age who reported injecting illicit drugs in the past month (N = 1,311; 32.7% female) were recruited in San Diego (n = 576) and Tijuana (n = 735) and completed interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were used to identify correlates of heroin–methamphetamine co-injection. Results: The prevalence of co-injection in the past 6 months was 39.9% overall and was higher in Tijuana (55.8%) than in San Diego (19.8%). In multivariable analyses adjusting for study cohort, distributive syringe sharing, purchasing syringes prefilled with drugs, finding it hard to get new syringes, reporting great or urgent need for treatment, and younger age were independently associated with co-injection. Past-6-month overdose was significantly associated with higher odds of co-injection in San Diego than in Tijuana. Conclusions: These findings indicate that heroin–methamphetamine co-injection is more common in Tijuana than in San Diego, yet this practice was only associated with overdose in San Diego. Heroin–methamphetamine co-injection was also independently associated with HIV-associated injection risk behaviors. Overdose-prevention interventions should address co-injection of depressants and stimulants. PMID:27588536

Cross-border migration and initiation of others into drug injecting in Tijuana, Mexico.

PubMed

Rafful, Claudia; Melo, Jason; Medina-Mora, María Elena; Rangel, Gudelia; Sun, Xiaoying; Jain, Sonia; Werb, Dan

2018-04-01

Efforts to prevent injection drug use (IDU) are increasingly focusing on the role that people who inject drugs (PWID) play in facilitating the entry of others into this behaviour. This is particularly relevant in settings experiencing high levels of IDU, such as Mexico's northern border region, where cross-border migration, particularly through forced deportation, has been found to increase a range of health and social harms related to injecting. PWID enrolled in a prospective cohort study in Tijuana, Mexico, since 2011 were interviewed semi-annually, which solicited responses on their experiences initiating others into injecting. Univariate and multivariable logistic regression analyses were conducted at the Preventing Injection by Modifying Existing Responses (PRIMER) baseline, with the dependent variable defined as reporting ever initiating others into injection. The primary independent variable was lifetime deportation from the USA to Mexico. Among 532 participants, 14% (n = 76) reported initiating others into injecting, the majority of participants reporting initiating acquaintances (74%, n = 56). In multivariable analyses, initiating others into injecting was independently associated with reporting living in the USA for 1-5 years [adjusted odds ratio (AOR) = 2.42; 95% confidence interval (CI) 1.22-4.79, P = 0.01], and methamphetamine and heroin injection combined (AOR = 3.67; 95% CI 1.11-12.17, P = 0.03). Deportation was not independently associated with initiating others into injecting. The impact of migration needs to be considered within binational programming seeking to prevent the expansion of epidemics of injecting and HIV transmission among mobile populations residing in the Mexico-USA border region. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Injection Drug Users' Perceived Barriers to Using Self-Initiated Harm Reduction Strategies.

PubMed

Bonar, Erin E; Rosenberg, Harold

2014-08-01

Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs' perceived barriers to engaging in these behaviors. We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one's drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants' most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated.

Society and its influences on drug use among young individuals in Tehran, Iran.

PubMed

Mirlashari, Jila; Demirkol, Apo; Salsali, Mahvash; Rafiey, Hassan; Jahanbani, Jahanfar

2013-01-01

Illicit Drug use poses a substantial public health problem around the world, mainly affecting young people. Current estimates suggest that Iran has the highest rate of opium addiction per capita in the world. It has been suggested that multiple elements contribute to the process of drug use. The aim of this study is to explore the probable components in the society that might play a role in the initiation of drug use among young adults. The study is qualitative in nature. Twenty four in-depth interviews were conducted with drug-using young men (n = 10) and women (n = 10) and their family members (n = 4). Based on our data analysis, developing a pro-drug attitude, conformist attitude of society toward treating youth and young individuals, and having weak approach toward prevention were identified as important determinants of substance use. We recommend the need for early intervention, especially for at-risk communities. The results of this research suggest that dealing with a major problem such as drug use needs a comprehensive assessment of the context in which young people live and use substances. According to our findings, exploring young drug users experiences is not only important but also useful for policy makers to develop more effective prevention and intervention programs.

A harm reduction programme for injecting drug users in Nepal.

PubMed

Singh, M

1997-01-01

The Lifesaving and Lifegiving Society (LALS), a street-based nongovernmental organization established in Nepal in 1991, utilizes a harm-reduction strategy to minimize the spread of HIV among injecting drug users. Community health outreach workers, many of whom are former drug addicts, work in the streets of Kathmandu, educating, counseling, and distributing bleach, sterile water, swabs, and clean needles. They demonstrate how to clean syringes and distribute condoms. LALS also provides primary health care services such as treatment for abscesses. Clients are informed about the limited drug treatment services in Nepal and are offered the option of home detoxification under LALS supervision. LALS promotes the message that drug users should be treated as victims of a disease rather than as criminals. Family involvement, fostered through home visits, is considered important to sustaining behavioral changes and family members are informed about ways of encouraging drug users to give up drug use or at least practice safe injecting techniques. Education of and networking with Narcotics Division and other police officers has been essential to LALS' success. LALS is working with the Nepali Red Cross on integrating HIV prevention into family planning programs. A current priority is to reduce dependence on funding from donor agencies and mobilize support from private businesses.

Prevalence and Correlates of Heroin-Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico.

PubMed

Meacham, Meredith C; Strathdee, Steffanie A; Rangel, Gudelia; Armenta, Richard F; Gaines, Tommi L; Garfein, Richard S

2016-09-01

Although persons who inject drugs (PWID) in the western United States-Mexico border region are known to inject both heroin and methamphetamine, little is known about the prevalence and risks associated with co-injection of this depressant-stimulant combination (also known as "goofball" and "Mexican speedball"). Baseline data from parallel cohort studies of PWID conducted concurrently in San Diego, CA, and Tijuana, Mexico, were used to estimate the prevalence and identify correlates of heroin-methamphetamine co-injection. PWID older than 18 years of age who reported injecting illicit drugs in the past month (N = 1,311; 32.7% female) were recruited in San Diego (n = 576) and Tijuana (n = 735) and completed interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were used to identify correlates of heroin-meth-amphetamine co-injection. The prevalence of co-injection in the past 6 months was 39.9% overall and was higher in Tijuana (55.8%) than in San Diego (19.8%). In multivariable analyses adjusting for study cohort, distributive syringe sharing, purchasing syringes prefilled with drugs, finding it hard to get new syringes, reporting great or urgent need for treatment, and younger age were independently associated with co-injection. Past-6-month overdose was significantly associated with higher odds of co-injection in San Diego than in Tijuana. These findings indicate that heroin-methamphetamine co-injection is more common in Tijuana than in San Diego, yet this practice was only associated with overdose in San Diego. Heroin-methamphetamine coinjection was also independently associated with HIV-associated injection risk behaviors. Overdose-prevention interventions should address co-injection of depressants and stimulants.

Changes in time-use and drug use by young adults in poor neighbourhoods of Greater Buenos Aires, Argentina, after the political transitions of 2001-2002: Results of a survey

PubMed Central

2011-01-01

Background In some countries, "Big Events" like crises and transitions have been followed by large increases in drug use, drug injection and HIV/AIDS. Argentina experienced an economic crisis and political transition in 2001/2002 that affected how people use their time. This paper studies how time use changes between years 2001 and 2004, subsequent to these events, were associated with drug consumption in poor neighbourhoods of Greater Buenos Aires. Methods In 2003-2004, 68 current injecting drug users (IDUs) and 235 young non-IDUs, aged 21-35, who lived in impoverished drug-impacted neighbourhoods in Greater Buenos Aires, were asked about time use then and in 2001. Data on weekly hours spent working or looking for work, doing housework/childcare, consuming drugs, being with friends, and hanging out in the neighbourhood, were studied in relation to time spent using drugs. Field observations and focus groups were also conducted. Results After 2001, among both IDUs and non-IDUs, mean weekly time spent working declined significantly (especially among IDUs); time spent looking for work increased, and time spent with friends and hanging out in the neighbourhood decreased. We found no increase in injecting or non-injecting drug consumption after 2001. Subjects most affected by the way the crises led to decreased work time and/or to increased time looking for work--and by the associated increase in time spent in one's neighbourhood--were most likely to increase their time using drugs. Conclusions Time use methods are useful to study changes in drug use and their relationships to every day life activities. In these previously-drug-impacted neighbourhoods, the Argentinean crisis did not lead to an increase in drug use, which somewhat contradicts our initial expectations. Nevertheless, those for whom the crises led to decreased work time, increased time looking for work, and increased time spent in indoor or outdoor neighbourhood environments, were likely to spend more time

Changes in time-use and drug use by young adults in poor neighbourhoods of Greater Buenos Aires, Argentina, after the political transitions of 2001-2002: Results of a survey.

PubMed

Rossi, Diana; Zunino Singh, Dhan; Pawlowicz, María Pía; Touzé, Graciela; Bolyard, Melissa; Mateu-Gelabert, Pedro; Sandoval, Milagros; Friedman, Samuel R

2011-01-20

In some countries, "Big Events" like crises and transitions have been followed by large increases in drug use, drug injection and HIV/AIDS. Argentina experienced an economic crisis and political transition in 2001/2002 that affected how people use their time. This paper studies how time use changes between years 2001 and 2004, subsequent to these events, were associated with drug consumption in poor neighbourhoods of Greater Buenos Aires. In 2003-2004, 68 current injecting drug users (IDUs) and 235 young non-IDUs, aged 21-35, who lived in impoverished drug-impacted neighbourhoods in Greater Buenos Aires, were asked about time use then and in 2001. Data on weekly hours spent working or looking for work, doing housework/childcare, consuming drugs, being with friends, and hanging out in the neighbourhood, were studied in relation to time spent using drugs. Field observations and focus groups were also conducted. After 2001, among both IDUs and non-IDUs, mean weekly time spent working declined significantly (especially among IDUs); time spent looking for work increased, and time spent with friends and hanging out in the neighbourhood decreased.We found no increase in injecting or non-injecting drug consumption after 2001. Subjects most affected by the way the crises led to decreased work time and/or to increased time looking for work--and by the associated increase in time spent in one's neighbourhood--were most likely to increase their time using drugs. Time use methods are useful to study changes in drug use and their relationships to every day life activities. In these previously-drug-impacted neighbourhoods, the Argentinean crisis did not lead to an increase in drug use, which somewhat contradicts our initial expectations. Nevertheless, those for whom the crises led to decreased work time, increased time looking for work, and increased time spent in indoor or outdoor neighbourhood environments, were likely to spend more time using drugs. These data suggest that

Kalaban: Young drug users' engagements with law enforcement in the Philippines.

PubMed

Lasco, Gideon

2018-02-01

A violent 'war on drugs' continues to be waged in the Philippines, even as the use of drugs - particular methamphetamine - continues to rise. Furnishing contextual background to the current situation, this paper explores how long-running law enforcement approaches in the Philippines might be viewed by those in their receiving end by presenting findings of an ethnography among marginalized young men. Semi-structured interviews and focus group discussions were conducted among 20 young men throughout a 12-month period of participant-observation from December 2011 to September 2013. Young people make use of various 'tactics' to keep using drugs and evade law enforcement, even as drug use itself is a tactic in their everyday lives. A sense of hypocrisy and injustice, borne of their own experiences, informs their view of law enforcers, whom they call kalaban (enemy). They feel they are being unfairly targeted, but in their view, this danger is just part of the perils of their everyday lives. Young men's resort to various tactics speaks of an agency that is often ignored in public discourses. Their 'lay assessments of risks' and experience-based perceptions of law enforcement raises questions about the efficacy of fear-based anti-drug campaigns. Overall, the study offers an ethnographic argument against the punitive methods being employed by the Philippines, and for measures that reframe the relationship between police and young drug users - from hostility to trust. Copyright © 2017 Elsevier B.V. All rights reserved.

Breast abscess after intravenous methamphetamine injection into the breast.

PubMed

Kistler, Amanda; Ajkay, Nicolas

2018-05-01

Intravenous drug use is a problem plaguing our society. We present a case of a young female who injected methamphetamine into her mammary vein, resulting in the formation of a breast abscess. This case demonstrates a rare but dangerous complication of intravenous drug use and a possible differential diagnosis in a patient presenting with a breast abscess. © 2017 Wiley Periodicals, Inc.

Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US.

PubMed

Des Jarlais, D C; Cooper, H L F; Arasteh, K; Feelemyer, J; McKnight, C; Ross, Z

2018-01-01

We identified potential geographic "hotspots" for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an "end of the epidemic" stage, while HCV is in a continuing, high prevalence (> 50%) stage. We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011-2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential "hotspots" for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk-passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk-injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.

Deportation Experiences of Women Who Inject Drugs in Tijuana, Mexico

PubMed Central

Robertson, Angela M.; Lozada, Remedios; Vera, Alicia; Palinkas, Lawrence A.; Burgos, José Luis; Magis-Rodriguez, Carlos; Rangel, Gudelia; Ojeda, Victoria D.

2013-01-01

Deportation from the United States for drug offenses is common, yet the consequences of deportation for women drug users are poorly documented. In 2008, in Tijuana, Mexico, we conducted an exploratory qualitative study of migration, deportation, and drug abuse by interviewing 12 Mexican injection-drug-using women reporting U.S. deportation. Women reported heavy drug use before and after deportation, but greater financial instability and physical danger following deportation than when in the United States. We identified an unmet need for health and social services among deported drug-using women, including HIV prevention, drug treatment, physical and mental health services, and vocational training. Binational coordination is needed to help deported women resettle in Mexico. PMID:21917563

Incidence and predictors of onset of injection drug use in a San Francisco cohort of homeless youth.

PubMed

Parriott, Andrea M; Auerswald, Colette L

2009-01-01

Few studies document incidence of injection drug use among homeless youth. We followed a cohort of 70 street-recruited homeless youth in San Francisco, California who had never injected drugs for six months in 2004-5. We examined initiation of injection drug use and its predictors, informed by prior ethnographic findings. Data were analyzed using exact logistic regression. 11.4% of youth initiated injection drug use. Having no high school education, being over 21 years old, and being in disequilibrium predicted initiation. Limitations, implications and suggestions for future research are noted. Funding was provided by the National Institute for Child Health and Development.

Outcomes from a large 10 year hepatitis C treatment programme in people who inject drugs: No effect of recent or former injecting drug use on treatment adherence or therapeutic response.

PubMed

Elsherif, Omar; Bannan, Ciaran; Keating, Shay; McKiernan, Susan; Bergin, Colm; Norris, Suzanne

2017-01-01

People who inject drugs (PWID) are historically viewed as having "difficult to treat" hepatitis C disease, with perceived inferior treatment adherence and outcomes, and concerns regarding reinfection risk. We evaluated for differences in treatment adherence and response to Peginterferon-alfa-2a/Ribavirin (Peg-IFNα/RBV) in a large urban cohort with and without a history of remote or recent injection drug use. Patient data was retrospectively reviewed for 1000 consecutive patients-608 former (no injecting drug use for 6 months of therapy), 85 recent (injecting drug use within 6 months) PWID, and 307 non-drug users who were treated for chronic hepatitis C with Peg-IFNα/RBV. The groups were compared for baseline characteristics, treatment adherence, and outcome. There was no significant difference in treatment non-adherence between the groups (8.4% in PWID vs 6.8% in non-PWIDs; RR = 1.23, CI 0.76-1.99). The overall SVR rate in PWID (64.2%) was not different from non-PWIDs (60.9%) [RR = 1.05, 95% CI 0.95-1.17]. There was no significant difference in SVR rates between the groups controlling for genotype (48.4% vs 48.4% for genotype 1; 74.9 vs 73.3% for genotype 3). Former and recent PWID had similar adherence rates. PWID have comparable treatment adherence and SVR rates when compared to non-drug users treated with Peg-IFNα/RBV. These data support a public health strategy of HCV treatment and eradication in PWID in the DAA era.

HIV and hepatitis B and C co-infection among people who inject drugs in Zanzibar.

PubMed

Khatib, Ahmed; Matiko, Eva; Khalid, Farhat; Welty, Susie; Ali, Ameir; Othman, Asha; Haji, Shaaban; Dahoma, Mohammed; Rutherford, George

2017-11-28

People who inject drugs are at high risk of acquiring hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) due to risky injection and sexual practices. The objective of this study is to investigate the epidemiology of HIV, hepatitis B, and hepatitis C, and co-infection of these viruses among people who inject drugs in Zanzibar, Tanzania. We used respondent-driven sampling to identify 408 participants, from whom we collected demographic data, information on sexual behaviours and injection drug practices, and blood samples for biological testing. Prevalence of hepatitis B surface antigenaemia, HCV, and HIV infection were 5.9, 25.4, and 11.3%, respectively. Of the participants who were hepatitis B surface antigen (HBsAg) positive, 33.5% were infected with HCV and 18.8% were infected with HIV. Of the HCV-infected participants, 29.3% were infected with HIV. Of the participants who were infected with HIV, 9.0% were HBsAg positive, 66.6% had HCV and 8.5% had both. None of the potential risk factors we measured were associated with HBsAg positivity. In contrast, older age and longer duration of injection drug use were independently associated with HCV infection. HCV infection among people who inject drugs is lower in Zanzibar than in other countries, but could rise without proper interventions. These findings underscore the importance of screening people who inject drugs for HIV, HBsAg, and HCV; providing HBV vaccination to those who are eligible; initiating antiretroviral therapy for those who are co-infected with HIV/HBV and HIV/HCV; and introducing interventions that have high impact on reducing needle sharing.

76 FR 22610 - Implantation or Injectable Dosage Form New Animal Drugs; Enrofloxacin

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-22

.... FDA-2011-N-0003] Implantation or Injectable Dosage Form New Animal Drugs; Enrofloxacin AGENCY: Food... amending the animal drug regulations to reflect approval of a supplemental new animal drug application... INFORMATION: Bayer HealthCare LLC, Animal Health Division, P.O. Box 390, Shawnee Mission, KS 66201, filed a...

75 FR 13225 - Implantation or Injectable Dosage Form New Animal Drugs; Flunixin

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-19

.... FDA-2010-N-0002] Implantation or Injectable Dosage Form New Animal Drugs; Flunixin AGENCY: Food and... amending the animal drug regulations to reflect approval of an original abbreviated new animal drug... copy of BANAMINE-S, sponsored by Schering-Plough Animal Health Corp. under NADA 101-479. The ANADA is...

Prescription Drug Misuse and Sexual Behavior Among Young Adults.

PubMed

Wells, Brooke E; Kelly, Brian C; Rendina, H Jonathon; Parsons, Jeffrey T

2015-01-01

Though research indicates a complex link between substance use and sexual risk behavior, there is limited research on the association between sexual risk behavior and prescription drug misuse. In light of alarming increases in prescription drug misuse and the role of demographic characteristics in sexual risk behavior and outcomes, the current study examined demographic differences (gender, sexual identity, age, relationship status, parental class background, and race/ethnicity) in sexual risk behavior, sexual behavior under the influence of prescription drugs, and sexual risk behavior under the influence of prescription drugs in a sample of 402 young adults (ages 18 to 29) who misused prescription drugs. Nearly half of the sexually active young adult prescription drug misusers in this sample reported recent sex under the influence of prescription drugs; more than three-quarters reported recent sex without a condom; and more than one-third reported recent sex without a condom after using prescription drugs. Zero-inflated Poisson regression models indicated that White race, younger age, higher parental class, and being a heterosexual man were all associated with sexual risk behavior, sex under the influence of prescription drugs, and sexual risk under the influence of prescription drugs. Findings have implications for the targeting of prevention and intervention efforts.

Prescription Drug Misuse and Sexual Behavior among Young Adults

PubMed Central

Wells, Brooke E.; Kelly, Brian C.; Rendina, H. Jonathon; Parsons, Jeffrey T.

2015-01-01

Though research indicates a complex link between substance use and sexual risk behavior, there is limited research on the association between sexual risk behavior and prescription drug misuse. In light of the alarming increases in prescription drug misuse and the role of demographic characteristics in sexual risk behavior and outcomes, the current study examines demographic differences (gender, sexual identity, age, relationship status, parental class background, and race/ethnicity) in sexual risk behavior, sexual behavior under the influence of prescription drugs, and sexual risk behavior under the influence of prescription drugs in a sample of 402 young adults (18–29) who misuse prescription drugs. Nearly half of the sexually active young adult prescription drug misusers in this sample reported recent sex under the influence of prescription drugs, more than three quarters reported recent sex without a condom, and more than one-third reported recent sex without a condom after using prescription drugs. Zero-inflated Poisson regression models indicated that white race, younger age, higher parental class, and being a heterosexual man were all associated with sexual risk behavior, sex under the influence of prescription drugs, and sexual risk under the influence of prescription drugs. Findings have implications for the targeting of prevention and intervention efforts. PMID:25569204

Intracerebral haemorrhage and drug abuse in young adults.

PubMed

McEvoy, A W; Kitchen, N D; Thomas, D G

2000-10-01

The epidemic of abuse of the so-called 'designer drugs' amphetamine, cocaine and ecstasy--is fast replacing traditional aetiological factors as the largest cause of intracerebral haemorrhage among young adults. Traditional teaching is that these represent hypertensive haemorrhages. Recent reports, however, have indicated that these patients may harbour underlying vascular malformations. We review 13 patients with a positive history of drug abuse preceding the onset of intracerebral haemorrhage. These patients presented to the National Hospital for Neurology and Neurosurgery in central London over a 7-month period. Of the 13 patients (eight male, five female), average age 31 years (19-43) years), 10 were well enough to undergo cerebral angiography. Intracranial aneurysms were demonstrated in six patients and arteriovenous malformations in three patients. In only one of the patients was the angiogram normal. A further patient was subsequently shown to have a middle cerebral artery aneurysm at autopsy. The epidemiology, pharmacology and systemic effects of these drugs are considered. The mechanisms by which these compounds cause intracerebral complications and their influence on prognosis are discussed. The incidence of intracerebral haemorrhage (ICH), ischaemic cerebral infarctions and subarachnoid haemorrhage (SAH) following drug abuse is increasing. Contrary to historical opinion, drug-related ICH is frequently related to an underlying vascular malformation. Arteriography should be part of the evaluation of most young patients with nontraumatic ICH. A thorough history focusing on the use of illicit substances and toxicological screening of urine and serum should be part of the evaluation of any young patient with a stroke.

Injection Drug Users’ Perceived Barriers to Using Self-Initiated Harm Reduction Strategies

PubMed Central

Rosenberg, Harold

2014-01-01

Introduction and Aims Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs’ perceived barriers to engaging in these behaviors. Method We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. Results The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one’s drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants’ most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. Discussion and Conclusions Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated. PMID:25419201

Social influences upon injection initiation among street-involved youth in Vancouver, Canada: a qualitative study

PubMed Central

Small, Will; Fast, Danya; Krusi, Andrea; Wood, Evan; Kerr, Thomas

2009-01-01

Background Street-involved youth are a population at risk of adopting injection as a route of administration, and preventing the transition to injection drug use among street youth represents a public health priority. In order to inform epidemiological research and prevention efforts, we conducted a qualitative study to investigate the initiation of injection drug use among street-involved youth in Vancouver, Canada. Methods Qualitative interviews with street youth who inject drugs elicited descriptions of the adoption of injection as a route of administration. Interviewees were recruited from the At-Risk Youth Study (ARYS), a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Audio recorded interviews were transcribed verbatim and a thematic analysis was conducted. Results 26 youth aged 16 to 26 participated in this study, including 12 females. Among study participants the first injection episode frequently featured another drug user who facilitated the initiation of injecting. Youth narratives indicate that the transition into injecting is influenced by social interactions with drug using peers and evolving perceptions of injecting, and rejecting identification as an injector was important among youth who did not continue to inject. It appears that social conventions discouraging initiating young drug users into injection exist among established injectors, although this ethic is often ignored. Conclusion The importance of social relationships with other drug users within the adoption of injection drug use highlights the potential of social interventions to prevent injection initiation. Additionally, developing strategies to engage current injectors who are likely to initiate youth into injection could also benefit prevention efforts. PMID:19405977

Frequent food insecurity among injection drug users: correlates and concerns.

PubMed

Strike, Carol; Rudzinski, Katherine; Patterson, Jessica; Millson, Margaret

2012-12-08

Food insecurity and nutrition are two topics that are under-researched among injection drug users (IDUs). Our study examined the extent and correlates of food insecurity among a sample of IDUs and explored whether there is an association between food insecurity and injection-related HIV risk. A cross-sectional survey was conducted using interviewer-administered questionnaires. Data were collected at a needle exchange program in London, Ontario, Canada between September 2006 and January 2007. Participants included 144 English-speaking IDUs who had injected drugs in the past 30 days. Participants were asked about their socio-demographic characteristics, HIV risk behaviours, food insecurity, and health/social service use. In the past 6 months, 54.5% of participants reported that on a daily/weekly basis they did not have enough to eat because of a lack of money, while 22.1% reported this type of food insecurity on a monthly basis. Moreover, 60.4% and 24.3% reported that they did not eat the quality or quantity of food they wanted on a daily/weekly or a monthly basis, respectively. Participants reported re-using someone else's injection equipment: 21% re-used a needle, 19% re-used water, and 37.3% re-used a cooker. The odds of sharing injection equipment were increased for food insecure individuals. Findings show that IDUs have frequent and variable experiences of food insecurity and these experiences are strongly correlated with sharing of injection-related equipment. Such behaviours may increase the likelihood of HIV and HCV transmission in this population. Addressing food-related needs among IDUs is urgently needed.

Violent and Non-Violent Criminal Behavior among Young Chinese Drug Users: A Mixed Methods Study.

PubMed

Liu, Liu; Chui, Wing Hong; Chen, Ye

2018-03-02

Young drug users are found to be increasingly involved in criminal justice issues. This exploratory and descriptive study aims to analyze the criminal behaviors among young Chinese drug users through a mixed methods research design. Quantitative analysis indicates that young drug users with and without a history of criminality show significant differences in terms of several features. Male drug users, particularly, those who are older, with religious beliefs, and initiated into drug use at younger age were most likely to commit crimes. Among drug users with criminal experiences, those who committed crimes prior to drug initiation have a greater likelihood of committing violent crimes. Furthermore, young drug users with severe depression are more likely to commit crimes, especially violent ones. Qualitative analysis further illustrates that young male drug users often get involved in criminal conduct of the youth gang nature with propensity for engaging in violent crimes as compared to their female counterparts who are more likely to turn into drug dealers and traffickers, in addition to engaging in larceny. The research findings are consistent with developmental theories and "victim to offender cycle". Integrated mental health and substance use services are suggested for crime prevention among young Chinese drug users.

Violent and Non-Violent Criminal Behavior among Young Chinese Drug Users: A Mixed Methods Study

PubMed Central

Liu, Liu; Chen, Ye

2018-01-01

Young drug users are found to be increasingly involved in criminal justice issues. This exploratory and descriptive study aims to analyze the criminal behaviors among young Chinese drug users through a mixed methods research design. Quantitative analysis indicates that young drug users with and without a history of criminality show significant differences in terms of several features. Male drug users, particularly, those who are older, with religious beliefs, and initiated into drug use at younger age were most likely to commit crimes. Among drug users with criminal experiences, those who committed crimes prior to drug initiation have a greater likelihood of committing violent crimes. Furthermore, young drug users with severe depression are more likely to commit crimes, especially violent ones. Qualitative analysis further illustrates that young male drug users often get involved in criminal conduct of the youth gang nature with propensity for engaging in violent crimes as compared to their female counterparts who are more likely to turn into drug dealers and traffickers, in addition to engaging in larceny. The research findings are consistent with developmental theories and “victim to offender cycle”. Integrated mental health and substance use services are suggested for crime prevention among young Chinese drug users. PMID:29498649

High hepatitis C incidence in relation to prescription opioid injection and poly-drug use: Assessing barriers to hepatitis C prevention.

PubMed

Puzhko, Svetlana; Roy, Élise; Jutras-Aswad, Didier; Artenie, Andreea Adelina; Fortier, Emmanuel; Zang, Geng; Bruneau, Julie

2017-09-01

Prescription opioid (PO) injection and poly-drug use have been associated with hepatitis C virus (HCV) infection among people who inject drugs (PWID). Poly-drug use is often a barrier to key HCV preventive programmes including opioid agonist treatment. The contribution of specific drug combinations to high HCV incidence in poly-drug users has not been assessed previously. Addressing this knowledge gap could enhance HCV treatment and prevention efforts. We examined the association between specific drugs and number of drugs used in addition to injected POs, and HCV seroconversion. PWID participating in a cohort study in Montréal (HEPCO), HCV-seronegative at baseline and followed between 2004 and 2013, were included. Data were collected by interview-administered questionnaires. Blood samples were tested for HCV new infections at each 3-6 month follow-up visit. Time-varying Cox regression models were utilized. Of 356 participants (81.5% males; mean age: 34.7 years), 123 (34.6%) reported injected POs in the past month at baseline. In univariate analyses, recent use of the following drugs was associated with HCV seroconversion: injected POs, injected cocaine, injected heroin, non-injected tranquilisers, and smoked crack/cocaine. The relative excess risk of HCV seroconversion due to interaction (RER1 HR ) was the highest for co-use of injected POs with the following substances: injected cocaine (RER1 HR =3.44), smoked crack/cocaine (RER1 HR =1.27), and non-injected tranquilisers (RER1 HR =0.8). In addition, a significant linear trend (p<0.001) towards higher risk was observed with increasing the number of these three drugs used in combination with injected POs. Specific drugs and number of drugs used in addition to injected POs play a modulating role in the risk of HCV primary infection. Poly-drug use among people who inject POs has to be addressed in order to improve harm reduction programmes and reduce HCV transmission in this high-risk population. Copyright © 2017

Attitudes toward medication-assisted treatment among fishermen in Kuantan, Malaysia, who inject drugs.

PubMed

Brown, Shan-Estelle; Wickersham, Jeffrey A; Pelletier, Alyssa R; Marcus, Ruthanne M; Erenrich, Rebecca; Kamarulzaman, Adeeba; Altice, Frederick L

2017-01-01

Fishermen who inject drugs represent an understudied group at high risk for HIV in Malaysia. This study describes fishing, drug use, and attitudes toward medication-assisted treatment (MAT) for opioid use disorders. Thirty-four male ethnic Malay fishermen completed semistructured interviews analyzed by content analysis. Analysis revealed four themes surrounding opioids, which they called ubat ("medicine"): (a) the fishing lifestyle facilitating substance use, (b) previous unsuccessful attempts to quit, (c) categorizing substances as haram or halal, and (d) attitudes toward MAT. Fishermen's environment permits substance use, including injecting drugs on boats. Fishermen expressed more positive attitudes toward methadone and negative attitudes toward buprenorphine.

Syringe Disposal Among Injection Drug Users in San Francisco

PubMed Central

Martinez, Alexis N.; Carpenter, Lisa; Geckeler, Dara; Colfax, Grant; Kral, Alex H.

2011-01-01

To assess the prevalence of improperly discarded syringes and to examine syringe disposal practices of injection drug users (IDUs) in San Francisco, we visually inspected 1000 random city blocks and conducted a survey of 602 IDUs. We found 20 syringes on the streets we inspected. IDUs reported disposing of 13% of syringes improperly. In multivariate analysis, obtaining syringes from syringe exchange programs was found to be protective against improper disposal, and injecting in public places was predictive of improper disposal. Few syringes posed a public health threat. PMID:20466956

"Who has ever loved a drug addict? It's a lie. They think a 'teja' is as bad person": multiple stigmas faced by women who inject drugs in coastal Kenya.

PubMed

Mburu, Gitau; Ayon, Sylvia; Tsai, Alexander C; Ndimbii, James; Wang, Bangyuan; Strathdee, Steffanie; Seeley, Janet

2018-05-25

A tenth of all people who inject drugs in Kenya are women, yet their social contexts and experiences remain poorly understood. This paper reports how multiple forms of stigma are experienced by women who inject drugs in coastal Kenya and the impact that they have on their ability to access essential health services. In 2015, in-depth interviews and focus group discussions were held with 45 women who inject drugs in two coastal towns. These data were supplemented with in-depth interviews with five individual stakeholders involved in service provision to this population. Data were analyzed thematically using NVivo. Women who inject drugs experience multiple stigmas, often simultaneously. These included the external stigma and self-stigma of injection drug use, external gender-related stigma of being a female injecting drug user, and the external stigma of being HIV positive (i.e., among those living with HIV). Stigma led to rejection, social exclusion, low self-esteem, and delay or denial of services at health facilities. HIV and harm reduction programs should incorporate interventions that address different forms of stigma among women who inject drugs in coastal Kenya. Addressing stigma will require a combination of individual, social, and structural interventions, such as collective empowerment of injecting drug users, training of healthcare providers on issues and needs of women who inject drugs, peer accompaniment to health facilities, addressing wider social determinants of stigma and discrimination, and expansion of harm reduction interventions to change perceptions of communities towards women who inject drugs.

High Mortality Among Non–HIV-Infected People Who Inject Drugs in Bangkok, Thailand, 2005–2012

PubMed Central

Vanichseni, Suphak; Suntharasamai, Pravan; Sangkum, Udomsak; Mock, Philip A.; Gvetadze, Roman J.; Curlin, Marcel E.; Leethochawalit, Manoj; Chiamwongpaet, Sithisat; Chaipung, Benjamaporn; McNicholl, Janet M.; Paxton, Lynn A.; Kittimunkong, Somyot; Choopanya, Kachit

2015-01-01

Objectives. We examined the causes of hospitalization and death of people who inject drugs participating in the Bangkok Tenofovir Study, an HIV preexposure prophylaxis trial. Methods. The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial conducted during 2005 to 2012 among 2413 people who inject drugs. We reviewed medical records to define the causes of hospitalization and death, examined participant characteristics and risk behaviors to determine predictors of death, and compared the participant mortality rate with the rate of the general population of Bangkok, Thailand. Results. Participants were followed an average of 4 years; 107 died: 22 (20.6%) from overdose, 13 (12.2%) from traffic accidents, and 12 (11.2%) from sepsis. In multivariable analysis, older age (40–59 years; P = .001), injecting drugs (P = .03), and injecting midazolam (P < .001) were associated with death. The standardized mortality ratio was 2.9. Conclusions. People who injected drugs were nearly 3 times as likely to die as were those in the general population of Bangkok and injecting midazolam was independently associated with death. Drug overdose and traffic accidents were the most common causes of death, and their prevention should be public health priorities. PMID:25880964

What happened to the HIV epidemic among non-injecting drug users in New York City?

PubMed

Des Jarlais, Don C; Arasteh, Kamyar; McKnight, Courtney; Feelemyer, Jonathan; Campbell, Aimee N C; Tross, Susan; Cooper, Hannah L F; Hagan, Holly; Perlman, David C

2017-02-01

HIV has reached high prevalence in many non-injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non-injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs. Serial-cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years. Mount Sinai Beth Israel drug treatment programs in New York City, USA. We recruited 3298 non-injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7% male, 6.1% white, 25.7% Hispanic and 65.8% African American. Smoking crack cocaine was the most common non-injecting drug practice. Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ 2 and multivariable logistic regression were used to compare 2005-10 versus 2011-14. HIV prevalence declined approximately 1% per year (P < 0.001), with a decline from 16% in 2005-10 to 8% in 2011-14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV-positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person-years (95% confidence interval = 0.03/1000-7/1000). HIV prevalence has declined and a high percentage of HIV-positive non-injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non-injecting drug use related sexual transmission HIV epidemics. © 2016 Society for the Study of Addiction.

Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US

PubMed Central

Cooper, H. L. F.; Arasteh, K.; Feelemyer, J.; McKnight, C.; Ross, Z.

2018-01-01

Objective We identified potential geographic “hotspots” for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an “end of the epidemic” stage, while HCV is in a continuing, high prevalence (> 50%) stage. Methods We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011–2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential “hotspots” for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk—passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk—injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. Results Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. Discussion For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US. PMID

Trends in Injection Risk Behaviors among People Who Inject Drugs and the Impact of Harm Reduction Programs in Ukraine, 2007-2013.

PubMed

Makarenko, Iuliia; Ompad, D C; Sazonova, Y; Saliuk, T; DeHovitz, J; Gensburg, L

2017-02-01

The study examined trends in injection risk behaviors among people who inject drugs (PWIDs) and assessed the impact of harm reduction programs in Ukraine during 2007-2013. We performed a secondary analysis of the data collected in serial cross-sectional bio-behavioral surveillance surveys administered with PWIDs in Ukraine in 2007, 2008, 2011, and 2013. Using data from 14 Ukrainian cities, we assessed short-term trends in injection risk behaviors with the Cochran-Armitage test for trend and multivariable logistic regression models, adjusted for age, sex, region, marital status, education level, occupation, age at injection drug use initiation, experience of overdose, and self-reported HIV status. The overall test for trend indicated a statistically significant decrease over time for sharing needle/syringe during the last injection (p < 0.0001), sharing needle/syringe at least once in the last 30 days (p < 0.0001), and using a common container for drug preparation (p < 0.0001). The prevalence of injecting drugs from pre-loaded syringes was high (61.0%) and did not change over the study period. After adjusting for all significant confounders and comparing to 2007, the prevalence of sharing needle/syringe during the last injection was unchanged in 2008 (OR = 1.06, 95% CI = 0.92, 1.21), and declined in 2011 (OR = 0.18, 95% CI = 0.15, 0.22) and 2013 (OR = 0.17, 95% CI = 0.14, 0.21). Sharing needles/syringes in the last 30 days significantly decreased when compared to that in 2007 (2008: OR = 0.81, 95% CI = 0.74, 0.89; 2011: OR = 0.43, 95% CI = 0.38, 0.47; and 2013: OR = 0.31, 95% CI = 0.27, 0.35). The prevalence of using common instruments for drug preparation also decreased compared to that in 2007 (2008: OR = 0.88, 95% CI = 0.85, 0.91; 2011: OR = 0.85, 95% CI = 0.85, 0.90; and 2013: OR = 0.74, 95% CI = 0.71, 0.76). The observed reduction in the prevalence of injection risk behavior

Patterns of Drug Use, Risky Behavior, and Health Status Among Persons Who Inject Drugs Living in San Diego, California: A Latent Class Analysis

PubMed Central

Roth, Alexis M.; Armenta, Richard A.; Wagner, Karla D.; Roesch, Scott C.; Bluthenthal, Ricky N.; Cuevas-Mota, Jazmine; Garfein, Richard S.

2015-01-01

Background Among persons who inject drugs (PWID), polydrug use (the practice of mixing multiple drugs/alcohol sequentially or simultaneously) increases risk for HIV transmission and unintentional overdose deaths. Research has shown local drug markets influence drug use practices. However, little is known about the impact of drug mixing in markets dominated by black tar heroin and methamphetamine, such as the western United States. Methods Data were collected through an ongoing longitudinal study examining drug use, risk behavior, and health status among PWID. Latent class analysis (LCA) was used to identify patterns of substance use (heroin, methamphetamine, prescription drugs, alcohol, and marijuana) via multiple administration routes (injecting, smoking, and swallowing). Logistic regression was used to identify behaviors and health indicators associated with drug use class. Results The sample included 511 mostly white (51.5%) males (73.8%), with mean age of 43.5 years. Two distinct classes of drug users predominated: methamphetamine by multiple routes (51%) and heroin by injection (49%). In multivariable logistic regression, class membership was associated with age, race, and housing status. PWID who were HIV-seropositive and reported prior sexually transmitted infections had increased odds of belonging to the methamphetamine class. Those who were HCV positive and reported previous opioid overdose had an increased odds of being in the primarily heroin injection class (all P-values < .05). Conclusion Risk behaviors and health outcomes differed between PWID who primarily inject heroin vs. those who use methamphetamine. The findings suggest that in a region where PWID mainly use black tar heroin or methamphetamine, interventions tailored to sub-populations of PWID could improve effectiveness. PMID:25313832

A Qualitative Exploration of Gender in the Context of Injection Drug Use in Two US–Mexico Border Cities

PubMed Central

Cruz, Michelle Firestone; Mantsios, Andrea; Ramos, Rebeca; Case, Patricia; Brouwer, Kimberly C.; Ramos, Maria Elena; Fraga, Wendy Davila; Latkin, Carl A.; Miller, Cari L.; Strathdee, Steffanie A.

2009-01-01

Injection drug use is of increasing concern along the U.S.–Mexico border where Tijuana and Ciudad (Cd.) Juarez are located. We conducted a qualitative study to explore the context of drug use, with a focus on gender differences. In-depth interviews were conducted with 10 male and 10 female injection drug users (IDUs) in Tijuana and 15 male and 8 female IDUs in Cd. Juarez. Topics included types of drugs used, injection settings, access to sterile needles and environmental influences. Interviews were taped, transcribed and translated. Content analysis was conducted to identify themes. Several themes emerged with respect to gender: (a) how drugs were obtained; (b) where drugs were used; (c) relationship dynamics surrounding drug use; and (d) sex in exchange for money or drugs. Men reported buying and injecting in shooting galleries and other locations, whereas women tended to buy and inject drugs with people they knew and trusted. All men reported having shared syringes in shooting galleries, often with strangers. In these two cities, venue-based interventions may be more appropriate for male IDUs, whereas personal network interventions may be more appropriate among female IDUs. PMID:16865542

Peer Norms and Sharing of Injection Paraphernalia among Puerto Rican Injection Drug Users in New York and Puerto Rico

ERIC Educational Resources Information Center

Andia, Jonny F.; Deren, Sherry; Robles, Rafaela R.; Kang, Sung-Yeon; Colon, Hector M.

2008-01-01

This study examines the influence of peer norms on sharing of injection paraphernalia (e.g., indirect sharing behaviors, including sharing of cookers, cotton, rinse water and back/front loading) among Puerto Rican injection drug users (IDUs) in Bayamon, Puerto Rico, and East Harlem, New York City. Data were collected from 873 Puerto Rican IDUs…

Careers in Drug and Alcohol Research: AN Innovative Program for Young Appalachian Women

NASA Astrophysics Data System (ADS)

Noland, Melody Powers; Leukefeld, Carl; Reid, Caroline

Supported by a grant from the National Institute on Drug Abuse, the University of Kentucky's Center on Drug and Alcohol Research developed the Young Women in Science Program to encourage young women from Appalachia to pursue scientific careers гп drug and alcohol research. This 3-year program, which involved 26 young women entering the ninth grade in 13 counties in southeastern Kentucky, included a summer residential program, community educational sessions, and matching students with mentors. When participants' scores prior to and after the 3-week residential program were compared, it was found that participants increased their science knowledge and improved their scores on confidence in science. Other significant changes occurred as well. These preliminary data indicated that some positive changes resulted from the program, even though contact time with the young women has been modest to date. The program shows considerable promise for providing the encouragement and skills needed for these young women to pursue careers in drug and alcohol research.

Injecting drug users and their health seeking behavior: a cross-sectional study in dhaka, bangladesh.

PubMed

Shariful Islam, Sheikh Mohammed; Biswas, Tuhin; Bhuiyan, Faiz Ahmed; Islam, Md Serajul; Rahman, Mohammad Mizanur; Nessa, Hurun

2015-01-01

Introduction and Aim. Injecting drug users (IDUs) are amongst the most vulnerable people to acquisition of HIV/AIDS. This study aims to collect information on IDUs and their health seeking behavior in Bangladesh. Design and Methods. A cross-sectional study was conducted among 120 IDUs attending a drug rehabilitation center in Dhaka, Bangladesh. Data were collected on sociodemographics, drug use, health seeking behavior, knowledge of injecting drugs, and sexual behavior. Results. The mean ± SD and median (IQR) age of the participants were 32.5 ± 21.3 and 33 (27-38) years, respectively, with only 9.2% females. Injection buprenorphine was the drug of choice for 40% of participants, and 58% of the participants first started drug use with smoking cannabis. 73.3% of participants shared needles sometimes and 57.5% were willing to use the needle exchange programs. 60% of the participants had no knowledge about the diseases spread by injection. Condom use during the last intercourse with regular partners was 11.7% and with any partners 15.8%. Conclusion. IDUs in Bangladesh are a high-risk group for HIV/AIDS due to lack of knowledge and risky behaviors. Education and interventions specifically aimed at IDUs are needed, because traditional education may not reach IDUs or influence their behavior.

Injecting Drug Users and Their Health Seeking Behavior: A Cross-Sectional Study in Dhaka, Bangladesh

PubMed Central

Biswas, Tuhin; Bhuiyan, Faiz Ahmed; Islam, Md. Serajul; Rahman, Mohammad Mizanur; Nessa, Hurun

2015-01-01

Introduction and Aim. Injecting drug users (IDUs) are amongst the most vulnerable people to acquisition of HIV/AIDS. This study aims to collect information on IDUs and their health seeking behavior in Bangladesh. Design and Methods. A cross-sectional study was conducted among 120 IDUs attending a drug rehabilitation center in Dhaka, Bangladesh. Data were collected on sociodemographics, drug use, health seeking behavior, knowledge of injecting drugs, and sexual behavior. Results. The mean ± SD and median (IQR) age of the participants were 32.5 ± 21.3 and 33 (27–38) years, respectively, with only 9.2% females. Injection buprenorphine was the drug of choice for 40% of participants, and 58% of the participants first started drug use with smoking cannabis. 73.3% of participants shared needles sometimes and 57.5% were willing to use the needle exchange programs. 60% of the participants had no knowledge about the diseases spread by injection. Condom use during the last intercourse with regular partners was 11.7% and with any partners 15.8%. Conclusion. IDUs in Bangladesh are a high-risk group for HIV/AIDS due to lack of knowledge and risky behaviors. Education and interventions specifically aimed at IDUs are needed, because traditional education may not reach IDUs or influence their behavior. PMID:25692067

Syringe Sharing in Drug Injecting Dyads: A Cross-Classified Multilevel Analysis of Social Networks.

PubMed

Shahesmaeili, Armita; Mirzazadeh, Ali; McFarland, Willi; Sharifi, Hamid; Haghdoost, Ali Akbar; Soori, Hamid

2018-05-15

We examined the association of dyadic-level factors with syringe sharing among people who inject drugs (PWID) in Kerman, Iran. In a cross-sectional study, we collected data on 329 drug-injecting dyads by individual face-to-face interviews. An injecting dyad was defined as 2 PWID who knew each other and injected drugs together during the last 6 months. If they reported at least 1 occasion of syringe sharing, the dyad was considered high-risk. Dyadic-level factors associated with syringe sharing were assessed using cross-classified multilevel logistic regression. The rate of syringe sharing was significantly higher for dyads who were more intimate (adjusted odds ratio [AOR] 4.5, CI 95%, 2.3-8.6), who had instrumental support (AOR 2.1, 95% CI 1.1-4.5), and who pooled money for drugs (AOR 4.1, 95% CI 2.0-8.3). The rate was lower in same-sex dyads (AOR 0.4, 95% CI 0.2-0.9) and in dyads who shared health information (AOR 0.5, 95% CI 0.2-0.9). Findings highlight close-peer influences on syringe-sharing behavior.

A decline in the prevalence of injecting drug users in Estonia, 2005–2009

PubMed Central

Uusküla, A; Rajaleid, K; Talu, A; Abel-Ollo, K; Des Jarlais, DC

2013-01-01

Aims and setting Descriptions of behavioural epidemics have received little attention compared with infectious disease epidemics in Eastern Europe. Here we report a study aimed at estimating trends in the prevalence of injection drug use between 2005 and 2009 in Estonia. Design and methods The number of injection drug users (IDUs) aged 15–44 each year between 2005 and 2009 was estimated using capture-recapture methodology based on 4 data sources (2 treatment data bases: drug abuse and non-fatal overdose treatment; criminal justice (drug related offences) and mortality (injection drug use related deaths) data). Poisson log-linear regression models were applied to the matched data, with interactions between data sources fitted to replicate the dependencies between the data sources. Linear regression was used to estimate average change over time. Findings there were 24305, 12292, 238, 545 records and 8100, 1655, 155, 545 individual IDUs identified in the four capture sources (Police, drug treatment, overdose, and death registry, accordingly) over the period 2005 – 2009. The estimated prevalence of IDUs among the population aged 15–44 declined from 2.7% (1.8–7.9%) in 2005 to 2.0% (1.4–5.0%) in 2008, and 0.9% (0.7–1.7%) in 2009. Regression analysis indicated an average reduction of over 1700 injectors per year. Conclusion While the capture-recapture method has known limitations, the results are consistent with other data from Estonia. Identifying the drivers of change in the prevalence of injection drug use warrants further research. PMID:23290632

Individual and Network Interventions With Injection Drug Users in 5 Ukraine Cities

PubMed Central

Lehman, Wayne E. K.; Latkin, Carl A.; Dvoryak, Sergey; Brewster, John T.; Royer, Mark S.; Sinitsyna, Larisa

2011-01-01

Objectives. We evaluated the effects of an individual intervention versus a network intervention on HIV-related injection and sexual risk behaviors among street-recruited opiate injection drug users in 5 Ukraine cities. Methods. Between 2004 and 2006, 722 opiate injection drug users were recruited to participate in interventions that were either individually based or based on a social network model in which peer educators intervened with their network members. Audio computer-assisted self-interview techniques were used to interview participants at baseline and follow-up. Results. Multiple logistic analyses controlling for baseline injection and sexual risks revealed that both peer educators and network members in the network intervention reduced injection-related risk behaviors significantly more than did those in the individually based intervention and that peer educators increased condom use significantly more than did those in the individual intervention. Individual intervention participants, however, showed significantly greater improvements than did network members with respect to reductions in sexual risk behaviors. Conclusions. Social network interventions may be more effective than individually based interventions in changing injection risk behaviors among both peer educators and network members. The effectiveness of network interventions in changing sexual risk behaviors is less clear, probably owing to network composition and inhibitions regarding discussing sexual risk behaviors. PMID:20395584

Estimating the number of HIV-infected injection drug users in Bangkok: a capture--recapture method.

PubMed

Mastro, T D; Kitayaporn, D; Weniger, B G; Vanichseni, S; Laosunthorn, V; Uneklabh, T; Uneklabh, C; Choopanya, K; Limpakarnjanarat, K

1994-07-01

The purpose of the study was to estimate the number of injection drug users infected with the human immunodeficiency virus (HIV) in Bangkok to allow planning for health services for this population. A two-sample capture-recapture method was used. The first capture listed all persons on methadone treatment for opiate addiction from April 17 through May 17, 1991, at 18 facilities in Bangkok. The second capture involved urine testing of persons held at 72 Bangkok police stations from June 3 through September 30, 1991. Persons whose urine tests were positive for opiate metabolites or methadone were included on the second list. The first capture comprised 4064 persons and the recapture 1540 persons. There were 171 persons included on both lists, yielding an estimate of 36,600 opiate users in Bangkok. Existing data indicate that 89% of opiate users in Bangkok inject drugs and that about one third are infected with HIV, yielding an estimate of approximately 12,000 HIV-infected injection drug users in Bangkok in 1991. During the 1990s the number of cases of acquired immunodeficiency syndrome (AIDS) and other HIV-related diseases, including tuberculosis, in the population of HIV-infected injection drug users in Bangkok will increase dramatically, placing new demands on existing health care facilities. The capture-recapture method may be useful in estimating difficult-to-count populations, including injection drug users.

[Injecting drug users and antiretroviral therapy: perceptions of pharmacy teams].

PubMed

Yokaichiya, Chizuru Minami; Figueiredo, Wagner dos Santos; Schraiber, Lilia Blima

2007-12-01

To understand the perceptions of pharmacy teams about their role in the healthcare assistance challenges and adherence to antiretroviral therapy by injecting drug users living with HIV/AIDS. Qualitative study through focus groups and thematic discourse analysis of pharmacists, technicians and assistants with more than six months of experience with medication supply, in 15 assisting units for STD/AIDS in the city of São Paulo, in 2002. Three groups were formed, totaling 29 participants, originating from 12 out of the 15 existing services, and including 12 university level professionals and 17 high-school level professionals. The groups concluded that the pharmacy has an important role in the antiretroviral drug supply, which is reflected in the treatment adherence, because trust-based relationships can be built up through their procedures. In spite of this, they pointed out that such building-up does not take place through excessively bureaucratic activities. This has negative repercussions for all patients, especially for injecting drug users, considered "difficult people". Such concept sums up their behavior: they are supposed to be confused and incapable to adhere to treatment, and have limited understanding. Staff members, however, affirm they treat these patients equally. They do not realize that, by this acting, the specific needs of injecting drug users may become invisible in the service. There is also the possibility that stigmatizing stereotypes may be created, resulting in yet another barrier to the work on adherence. Although the pharmacy is recommended as a potentially favorable place to listen to and form bonds with users, the results show objective and subjective obstacles to render it suitable for the work on adherence.

Correlates and subgroups of injecting drug use in UK gay and bisexual men: Findings from the 2014 Gay Men's Sex Survey.

PubMed

Melendez-Torres, G J; Bourne, Adam; Hickson, Ford; Reid, David; Weatherburn, Peter

2018-04-16

Evidence to understand which gay and bisexual men (GBM) inject drugs remains scant, especially in the UK. We describe correlates of last-year injecting in UK GBM, and characterise subgroups of GBM who inject drugs by types of drugs used. Using data from the 2014 Gay Men's Sex Survey, an opportunistic internet-based survey conducted of GBM living in the UK, we examined via logistic regression correlates with any injecting of six drugs (amphetamine/speed, crystal methamphetamine, heroin, mephedrone, GHB/GBL, and ketamine) in the last year. We estimated latent class models to understand underlying subgroups of injecting drug use among GBM reporting injecting drug use in the last year. Injecting was most common in GBM who were of middle age, who were HIV seropositive, and who lived in London, and was significantly associated with sexual risk with multiple partners in the last year, whether steady or non-steady. Most GBM who engaged in injecting either injected crystal methamphetamine, mephedrone or both (class 1, chemsex, 88.6% of injectors), whereas a smaller group had a focus on opiates (class 2, opiate, 7.9%). A small but identifiable subgroup (class 3, eclectic, 3.5%) engaged in injecting across the range of drugs examined. This is the first epidemiological analysis to describe subgroups of injecting, and to describe correlates of injecting drug use, in UK GBM. Implications for design of harm reduction services include a need to focus on injecting drug use beyond opiates, currently the focus of most harm reduction services. Copyright © 2018 Elsevier B.V. All rights reserved.

Attitudes toward medication-assisted treatment among fishermen in Kuantan, Malaysia, who inject drugs

PubMed Central

Brown, Shan-Estelle; Wickersham, Jeffrey A.; Pelletier, Alyssa R.; Marcus, Ruthanne M.; Erenrich, Rebecca; Kamarulzaman, Adeeba; Altice, Frederick L.

2017-01-01

Fishermen who inject drugs represent an understudied group at high risk for HIV in Malaysia. This study describes fishing, drug use, and attitudes toward medication-assisted treatment (MAT) for opioid use disorders. Thirty-four male ethnic Malay fishermen completed semistructured interviews analyzed by content analysis. Analysis revealed four themes surrounding opioids, which they called ubat (“medicine”): (a) the fishing lifestyle facilitating substance use, (b) previous unsuccessful attempts to quit, (c) categorizing substances as haram or halal, and (d) attitudes toward MAT. Fishermen’s environment permits substance use, including injecting drugs on boats. Fishermen expressed more positive attitudes toward methadone and negative attitudes toward buprenorphine. PMID:27404914

Intradermal needle-free powdered drug injection by a helium-powered device.

PubMed

Liu, John; Hogan, N Catherine; Hunter, Ian W

2012-01-01

We present a new method for needle-free powdered drug injection via a bench-top gas-powered device. This injector provides an alternative method of vaccine delivery to address the cold chain problem--the cost and risk of transporting temperature sensitive vaccines to developing countries. The device houses interchangeable nozzle inserts to vary orifice geometries and is capable of delivering polymer beads (1-5 µm diameter) into the dermal layer of porcine tissue. Results for injection shape and injection depth versus nozzle orifice diameter demonstrate the device's controllability.

Young Men and Drugs--A Nationwide Survey. National Institute on Drug Abuse Research Monograph Series 5.

ERIC Educational Resources Information Center

O'Donnell, John A.; And Others

Results of a national survey of drug use among young males (19-30) are reported. For most drugs, half or more of the users used the drug less than 10 times. The data suggest a possible decline in the use of cigarettes. Several implications of the drug epidemic of the late 1960's are noted. Differences of drug use between blacks and whites seem to…

Microwave freeze-thaw technique of injectable drugs. A review from 1980 to 2014.

PubMed

Hecq, J-D; Godet, M; Jamart, J; Galanti, L

2015-11-01

Microwave freeze-thaw treatment (MFTT) of injectable drugs can support the development of centralized intravenous admixtures services (CIVAS). The aim of the review is to collect information and results about this method. A systematic review of the scientific literature about injectable drug stability studies was performed. The data are presented in a table and describe name of the drug, producer, final concentration, temperature and time of freezing storage, type of microwave oven, thawing power, method of dosage and results after treatment or final long-term storage at 5±3 °C. From 1980 to 2014, 59 drugs were studied by MFTT and the results were presented in 49 publications. Forty papers were presented by 8 teams (2 to 18 by team). The temperatures of freezing storage vary from -70 °C to -10 °C, the time storage from 4 hours to 12 months, the thaw from low to full power. Dosages are mainly made by high performance liquid chromatography. Most of the 59 drugs are stable during and after treatment. Only 3 teams have tested the long-term stability after MFTT, the first for ganciclovir after 7 days, the second for ceftizoxime after 30 days and the third for 19 drugs after 11 to 70 days. This review can help CIVAS to take in charge the productions of ready-to-use injectable drugs. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Within-prison drug injection among HIV-infected male prisoners in Indonesia: a highly constrained choice.

PubMed

Culbert, Gabriel J; Waluyo, Agung; Iriyanti, Mariska; Muchransyah, Azalia P; Kamarulzaman, Adeeba; Altice, Frederick L

2015-04-01

In Indonesia, incarceration of people who inject drugs (PWID) and access to drugs in prison potentiate within-prison drug injection (WP-DI), a preventable and extremely high-risk behavior that may contribute substantially to HIV transmission in prison and communities to which prisoners are released. This mixed method study examined the prevalence, correlates, and social context of WP-DI among HIV-infected male prisoners in Indonesia. 102 randomly selected HIV-infected male prisoners completed semi-structured voice-recorded interviews about drug use changes after arrest, drug use cues within prison, and impact of WP-DI on HIV and addiction treatment. Logistic regression identified multivariate correlates of WP-DI and thematic analysis of interview transcripts used grounded-theory. Over half (56%) of participants reported previous WP-DI. Of those, 93% shared injection equipment in prison, and 78.6% estimated sharing needles with ≥ 10 other prisoners. Multivariate analyses independently correlated WP-DI with being incarcerated for drug offenses (AOR = 3.29, 95%CI = 1.30-8.31, p = 0.011) and daily drug injection before arrest (AOR = 5.23, 95%CI = 1.42-19.25, p = 0.013). Drug availability and proximity to drug users while incarcerated were associated with frequent drug craving and escalating drug use risk behaviors after arrest. Energetic heroin marketing and stigmatizing attitudes toward methadone contribute to WP-DI and impede addiction and HIV treatment. Frequent WP-DI and needle sharing among these HIV-infected Indonesian prison inmates indicate the need for structural interventions that reduce overcrowding, drug supply, and needle sharing, and improve detection and treatment of substance use disorders upon incarceration to minimize WP-DI and associated harm. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Within-Prison Drug Injection among HIV-infected Male Prisoners in Indonesia: A Highly Constrained Choice

PubMed Central

Culbert, Gabriel J.; Waluyo, Agung; Iriyanti, Mariska; Muchransyah, Azalia P.; Kamarulzaman, Adeeba; Altice, Frederick L.

2016-01-01

Background In Indonesia, incarceration of people who inject drugs (PWID) and access to drugs in prison potentiate within-prison drug injection (WP-DI), a preventable and extremely high-risk behavior that may contribute substantially to HIV transmission in prison and communities to which prisoners are released. Aims This mixed method study examined the prevalence, correlates, and social context of WP-DI among HIV-infected male prisoners in Indonesia. Methods 102 randomly selected HIV-infected male prisoners completed semi-structured voice-recorded interviews about drug use changes after arrest, drug use cues within prison, and impact of WP-DI on HIV and addiction treatment. Logistic regression identified multivariate correlates of WP-DI and thematic analysis of interview transcripts used grounded-theory. Results Over half (56%) of participants reported previous WP-DI. Of those, 93% shared injection equipment in prison, and 78.6% estimated sharing needles with ≥10 other prisoners. Multivariate analyses independently correlated WP-DI with being incarcerated for drug offenses (AOR=3.29, 95%CI=1.30–8.31, p=0.011) and daily drug injection before arrest (AOR=5.23, 95%CI=1.42–19.25, p=0.013). Drug availability and proximity to drug users while incarcerated were associated with frequent drug craving and escalating drug use risk behaviors after arrest. Energetic heroin marketing and stigmatizing attitudes toward methadone contribute to WP-DI and impede addiction and HIV treatment. Conclusions Frequent WP-DI and needle sharing among these HIV-infected Indonesian prison inmates indicate the need for structural interventions that reduce overcrowding, drug supply, and needle sharing, and improve detection and treatment of substance use disorders upon incarceration to minimize WP-DI and associated harm. PMID:25659895

Rejuvenating harm reduction projects for injection drug users: Ukraine's nationwide introduction of peer-driven interventions.

PubMed

Smyrnov, Pavlo; Broadhead, Robert S; Datsenko, Oleksandra; Matiyash, Oksana

2012-03-01

A peer-driven intervention (PDI) for injecting drug users (IDUs) was implemented in five Ukrainian city-sites to test-pilot its effectiveness in rejuvenating harm reduction (HR) projects that had become moribund. A PDI relies on drug users in a unique way to educate their peers in the community and recruit them for HIV prevention services. The goal of the PDI was to recruit in six month 500 IDUs who had never been respondents before to each of the five HR projects, especially stimulant- and women-injectors, and IDUs<25 years of age. We standardized the PDI's structure and operations across all five sites. All five PDIs were started in May 2007 using a carefully selected handful of "seed" IDU-recruiters who were trained to educate three peers who had never received HR services. We also accessed the database of all five projects and analysed the new respondents they recruited six-months prior to the start-up of the PDIs with the new recruits generated by the PDIs. Whilst the HR projects in the five city-sites recruited 72 new respondents on average during the six months prior to the PDIs' start-up, the PDIs recruited 455 new respondents on average in each city during their six months of operation, indicating that the PDI was 6.3 times more powerful as a recruitment mechanism. Compared to traditional outreach the PDIs resulted in significant increases in the recruitment of women- and young-injectors, and IDUs who injected a more diverse variety of drugs. The PDI can have a rejuvenating effect when added to HR projects that had become stagnate over time, resulting in an increase in the number and diversity of new IDU-respondents. Copyright © 2012 Elsevier B.V. All rights reserved.

Evaluation of an online injecting drug use stigma intervention targeted at health providers in New South Wales, Australia

PubMed Central

Brener, Loren; Cama, Elena; Hull, Peter; Treloar, Carla

2017-01-01

People who inject drugs are highly stigmatised. Discriminatory experiences are commonly reported, particularly in health care settings. This article evaluates an online stigma reduction training module targeting health providers working with people who inject drugs. A total of 139 participants completed a pre- and post-survey including attitude items and items depicting hypothetical scenarios and concerns around client behaviours. Participants’ attitudes towards people who inject drugs were more positive and they showed less concerns about client behaviours after completing the online training module. Findings highlight the benefits of online training in reducing discriminatory attitudes towards people who inject drugs and improving confidence in working with this client group. PMID:28567299

History of medication-assisted treatment and its association with initiating others into injection drug use in San Diego, CA.

PubMed

Mittal, Maria Luisa; Vashishtha, Devesh; Sun, Shelly; Jain, Sonia; Cuevas-Mota, Jazmine; Garfein, Richard; Strathdee, Steffanie A; Werb, Dan

2017-10-03

Medication-assisted treatment (MAT) remains the gold standard for the treatment of opioid use disorder. MAT also reduces the frequency of injecting among people who inject drugs (PWID). Relatedly, data suggest that PWID play a key role in the initiation of others into drug injecting by exposing injecting practices to injection-naïve drug users. Our primary objective was to test whether a history of MAT enrollment is associated with a reduced odds of PWID providing injection initiation assistance. Preventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256-01), is a multi-site cohort study assessing the impact of socio-structural factors on the risk that PWID provide injection initiation assistance. Data were drawn from a participating cohort of PWID in San Diego, CA. The primary outcome was reporting ever providing injection initiation assistance; the primary predictor was reporting ever being enrolled in MAT. Logistic regression was used to model associations between MAT enrollment and ever initiating others into injecting while adjusting for potential confounders. Participants (n = 354) were predominantly male (n = 249, 70%). Thirty-eight percent (n = 135) of participants reported ever initiating others into injection drug use. In multivariate analysis, participants who reported a history of MAT enrollment had significantly decreased odds of ever providing injection initiation assistance (Adjusted Odds Ratio [AOR]: 0.62, 95% Confidence Interval [CI]: 0.39-0.99). These preliminary findings suggest an association between MAT enrollment and a lower odds that male PWID report providing injection initiation assistance to injection-naïve drug users. Further research is needed to identify the pathways by which MAT enrollment may impact the risk that PWID initiate others into drug injecting.

Correlates of Injection Drug Use among Female Sex Workers in Two Mexico-U.S. Border Cities

PubMed Central

Strathdee, Steffanie A.; Philbin, Morgan M.; Semple, Shirley J.; Pu, Minya; Orozovich, Prisci; Martinez, Gustavo; Lozada, Remedios; Fraga, Miguel; de la Torre, Adela; Staines, Hugo; Magis-Rodríguez, Carlos; Patterson, Thomas L.

2008-01-01

Objective: To characterize the overlap between injection drug use and sex work by women in Tijuana and Cd. Juarez, situated on the Mexico-U.S. border. Methods: FSWs aged ≥18 years who were not knowingly HIV-positive and reported having unprotected sex with ≥1 client in the prior two months underwent interviews and testing for HIV, syphilis gonorrhea and Chlamydia. Logistic regression identified factors associated with injecting drugs within the last month. Results: Of 924 FSWs, 18.0% had ever injected drugs. Among FSW-IDUs (N=114), prevalence of HIV, syphilis titers >1:8, gonorrhea and Chlamydia was significantly higher at 12.3%, 22.7%, 15.2% and 21.2% compared to 4.8%, 13.1%, 5.2% and 11.9% among other FSWs (N=810). FSW-IDUs also had more clients in the past six months (median: 300 vs. 240, p=0.02). Factors independently associated with injecting drugs in the past month included living in Tijuana, being younger, being married/common-law, longer duration in the sex trade, speaking English, earning less for sex without condoms, often using drugs before sex, and knowing other FSWs who injected drugs. Conclusions: FSW-IDUs had higher STI levels, engaged in riskier behaviors and were more vulnerable to having unsafe sex with clients compared to other FSWs, indicating that this subgroup is an important bridge population requiring focused prevention. PMID:17714888

A Case of Polymicrobial Endocarditis due to Anaerobic Organisms in an Injection Drug User

PubMed Central

Oh, Seunghee; Havlen, Pamela R; Hussain, Nasir

2005-01-01

Endocarditis is a serious complication of injection drug use most commonly due to Staphylococcus aureus. We report a case of tricuspid valve polymicrobial bacterial endocarditis in an injection drug user from 3 oral anaerobes: Actinomyces odontolytica, Veillonella species, and Prevotella melaninogenica. The patient was believed to have acquired these organisms due to his habit of licking the needle in order to gauge the strength of the cocaine prior to injection. The patient was successfully treated with a 6-week course of penicillin G and metronidazole. This case demonstrates the importance of a detailed history in designing empiric therapy. PMID:16191149

A case of polymicrobial endocarditis caused by anaerobic organisms in an injection drug user.

PubMed

Oh, Seunghee; Havlen, Pamela R; Hussain, Nasir

2005-10-01

Endocarditis is a serious complication of injection drug use most commonly caused by Staphylococcus aureus. We report a case of tricuspid valve polymicrobial bacterial endocarditis in an injection drug user from 3 oral anaerobes: Actinomyces odontolytica, Veillonella species, and Prevotella melaninogenica. The patient was believed to have acquired these organisms from his habit of licking the needle in order to gauge the strength of the cocaine prior to injection. The patient was successfully treated with a 6-week course of penicillin G and metronidazole. This case demonstrates the importance of a detailed history in designing empiric therapy.

Tissue compatibility and pharmacokinetics of three potential subcutaneous injectables for low-pH drug solutions.

PubMed

Wu, Zimei; Tucker, Ian G; Razzak, Majid; McSporran, Keith; Medlicott, Natalie J

2010-07-01

The aim of the study was to investigate the tissue tolerance and bioavailability of four formulations containing 5% ricobendazole solubilised at low pH, following subcutaneous injection in sheep. Formulations were: a water-in-oil emulsion, a microemulsion, a hydroxypropyl-beta-cyclodextrin (HP-beta-CD, 20%) drug solution, and a low-pH drug solution (reference). In-vitro cytotoxicity of the formulations was investigated in L929 fibroblasts using MTS viability and lactate dehydrogenase leakage assays. Each formulation and respective vehicle was injected into either side of the back of a sheep to investigate the tissue tolerance and pharmacokinetics. In-vitro studies suggested that both the emulsion and the microemulsion are unlikely to give a burst release of the low-pH drug solution in aqueous media. The microemulsion showed the greatest in-vitro cytotoxic effect but no significant difference was observed between the other formulations. In sheep, the three new formulations and vehicles caused little or no injection-site reactions compared with a marked response to the reference formulation. Bioavailabilities of HP-beta-CD formulation, emulsion and microemulsion formulations, relative to the reference formulation, were 194, 155 and 115%, respectively. The three new subcutaneous injectables showed promise for reducing irritation of low-pH solubilised ricobendazole. HP-beta-CD significantly enhanced the drug absorption. Controlling the burst release of the low-pH drug solution may improve tissue tolerance and minimise post-injection precipitation, and hence increase drug bioavailability. The in-vitro cytotoxicity studies did not predict the in-vivo irritation effects.

Injection drug use facilitates hepatitis C virus infection of peripheral blood mononuclear cells.

PubMed

Resti, Massimo; Azzari, Chiara; Moriondo, Maria; Betti, Letizia; Sforzi, Idanna; Novembre, Elio; Vierucci, Alberto

2002-08-01

Infection of peripheral blood mononuclear cells (PBMCs) with hepatitis C virus (HCV) has been demonstrated and has been found to play a role in relapse of HCV disease and vertical transmission of HCV. Injection drug use is thought to impair function of the immune system and induce tolerance to viruses; therefore, HCV infection of PBMCs could be more likely to occur in injection drug users (IDUs) with HCV infection. Of 108 women who tested negative for human immunodeficiency virus type 1 and positive for HCV RNA, 51 had a history of injection drug use and 57 had no known risk factor for HCV infection. HCV infection was found, by nested reverse-transcription polymerase chain reaction analysis, in the PBMCs of 33 IDUs and of 13 non-IDUs (P=.00003). No correlation was found between infection of the PBMCs and HCV genotype or virus load. Route of transmission and viral factors, as well as immunologic dysfunction, may play a role in viral tropism.

A typology of drug selling among young adults in the United States.

PubMed

Vaughn, Michael G; Salas-Wright, Christopher P; DeLisi, Matt; Shook, Jeffrey J; Terzis, Lauren

2015-02-01

Although studies have found that young adults who sell drugs are more likely to be involved in risky behaviors than those who do not sell drugs, there has been relatively little research that has explored heterogeneity among young adults who sell drugs. Using a pooled sample of 18 to 25 year olds from the National Survey on Drug Use and Health (2006-2010) who report past-year drug selling (N = 5,373), this study employs latent profile analysis to specify latent groups and assess the correlates of group membership. Findings indicate substantial differences among young adults who sell drugs. In particular, the analysis found four groups of drug sellers: normative (49.6%), club drug users (23.6%), polysubstance users (16.0%), and criminal offenders (10.8%). Club drug users were characterized by high levels of ecstasy and hallucinogen use, polysubstance users were more likely to be depressed and anxious, White and female than the other groups. Criminal offenders were overwhelmingly male and more likely to be comprised of African-Americans and Hispanics. RESULTS indicate that drug selling in early adulthood varies substantially. Contrary to media and popular notions most drug sellers are not involved in crime and polysubstance using drug sellers are in clear need of mental health services. Further, most drug sellers in this age range are White. Findings suggest that policy efforts that operate under the assumption of homogeneity of drug selling may be misguided.

The association between psychosocial and structural-level stressors and HIV injection drug risk behavior among Malaysian fishermen: A cross-sectional study.

PubMed

Michalopoulos, Lynn Murphy; Jiwatram-Negrón, Tina; Choo, Martin K K; Kamarulzaman, Adeeba; El-Bassel, Nabila

2016-06-02

Malaysian fishermen have been identified as a key-affected HIV population with HIV rates 10 times higher than national rates. A number of studies have identified that psychosocial and structural-level stressors increase HIV injection drug risk behaviors. The purpose of this paper is to examine psychosocial and structural-level stressors of injection drug use and HIV injection drug risk behaviors among Malaysian fishermen. The study employs a cross-sectional design using respondent driven sampling methods. The sample includes 406 fishermen from Pahang state, Malaysia. Using multivariate logistic regressions, we examined the relationship between individual (depression), social (adverse interactions with the police), and structural (poverty-related) stressors and injection drug use and risky injection drug use (e.g.., receptive and non-receptive needle sharing, frontloading and back-loading, or sharing drugs from a common container). Participants below the poverty line had significantly lower odds of injection drug use (OR 0.52, 95 % CI: 0.27-0.99, p = 0.047) and risky injection drug use behavior (OR 0.48, 95 % CI: 0.25-0.93, p = 0.030). In addition, participants with an arrest history had higher odds of injection use (OR 19.58, 95 % CI: 9.81-39.10, p < 0.001) and risky injection drug use (OR 16.25, 95 % CI: 4.73-55.85, p < 0.001). Participants with depression had significantly higher odds of engaging in risky injection drug use behavior (OR 3.26, 95 % 1.39-7.67, p = 0.007). Focusing on participants with a history of injection drug use, we found that participants with depression were significantly more likely to engage in risky drug use compared to participants below the depression cutoff (OR 3.45, 95 % CI: 1.23-9.66, p < 0.02). Findings underscore the need to address psychosocial and structural-level stressors among Malaysian fishermen to reduce HIV injection drug risk behaviors.

Young Adult Follow-Up of Hyperactive Children: Antisocial Activities and Drug Use

ERIC Educational Resources Information Center

Barkley, Russell A.; Fischer, Mariellen; Smallish, Lori; Fletcher, Kenneth

2004-01-01

Background: Hyperactive/ADHD children are believed to be a greater risk for adolescent and young adult antisocial activity and drug use/abuse, particularly that subset having comorbid conduct problems/disorder. Method: We report on the lifetime antisocial activities and illegal drug use self-reported at young adult follow-up (mean age 20-21 years;…

Survey of abuses against injecting drug users in Indonesia

PubMed Central

Davis, Sara LM; Triwahyuono, Agus; Alexander, Risa

2009-01-01

In Indonesia, an ongoing government "war on drugs" has resulted in numerous arrests and anecdotal reports of abuse in detention, but to date there has been little documentation or analysis of this issue. JANGKAR (also known in English as the Indonesian Harm Reduction Network), a nongovernmental organization (NGO) based in Jakarta, surveyed 1106 injecting drug users in 13 cities about their experiences of police abuse. Of those interviewed, 667 or 60% reported physical abuse by police. These findings indicate the importance of continuing efforts to promote police reform and harm reduction in Indonesia. PMID:19852845

Women who inject drugs in the republic of georgia: in their own words.

PubMed

Kirtadze, Irma; Otiashvili, David; O'Grady, Kevin; Zule, William; Krupitsky, Evgeny; Wechsberg, Wendee; Jones, Hendrée

2015-01-01

This study describes the initiation and maintenance of illicit drug use, risky behaviors, and the substance use treatment experiences of women in Georgia. Qualitative interviews with 55 drug-using women (mean age 36 years; SD = 9.52), were conducted during April-September 2011. Participants presented diverse histories of drug use initiation and substance use, risky behaviors, and drug treatment participation. All participants reported concurrent use of different substances, including home-produced injection preparations. Women described their experiences of both the positive and negative effects (physical and psychological) that they attributed to their use of drugs. Findings enrich our understanding of the environment in which substance use is initiated and maintained in a female population in Georgia, and illustrate the importance of culture and the role of social factors in the development of injection drug use. Results can provide direction for tailoring the development of interventions for substance use disorders, public policy discussions regarding the treatment of women who use drugs, and future research on substance use among women in Georgia and other post-Soviet nations.

75 FR 59610 - Implantation and Injectable Dosage Form New Animal Drugs; Firocoxib

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Part 522 [Docket No...) filed by Merial Ltd. The NADA provides for the veterinary prescription use of firocoxib injectable... Veterinary Medicine (HFV-110), Food and Drug Administration, 7500 Standish Pl., Rockville, MD 20855, 240-276...

Club drug use and dependence among young adults recruited through time-space sampling.

PubMed

Parsons, Jeffrey T; Grov, Christian; Kelly, Brian C

2009-01-01

Ketamine, methylenedioxymethamphetamine (MDMA/ecstasy), cocaine, gamma-hydroxybutyrate (GHB), methamphetamine, and d-lysergic acid diethylamide (LSD/acid) have been identified as "club drugs" because of their link to club culture among young adults. Yet little is known about users' demographic differences in the prevalence of club drugs. This study sought to provide a comprehensive profile of users' demographic differences in prevalence of club drug use and dependence. Using time-space sampling, a stratified sample of 400 18- to 29-year-old club-going young adults was recruited into the Club Drugs and Health Project. Though participants reported using an array of club drugs, almost all participants (90.0%) were cocaine users. Although there were several sexual orientation and gender differences in recent drug exposure, patterns of use (measured in days) were fairly similar across gender, sexual orientation, and age. Finally, a majority of individuals (58.5%) met or exceeded criteria for club drug dependence, with most (61.7%) indicating cocaine was the one drug causing them significant problems. Cocaine is a major drug in club culture. It is essential to develop culturally appropriate drug education and prevention initiatives for young adults using club drugs.

Correlates of HIV infection among female sex workers in Vietnam: injection drug use remains a key risk factor.

PubMed

Le, Linh-Vi N; Nguyen, Tuan A; Tran, Hoang V; Gupta, Nisha; Duong, Thanh C; Tran, Ha T T; Nadol, Patrick; Sabin, Keith; Maher, Lisa; Kaldor, John M

2015-05-01

Women who sell sex and use drugs have dual risks for HIV infection. Despite increasing reports of drug use among female sex workers (FSW) in Vietnam, FSW HIV interventions remain focused mainly on sexual risk reduction. We assessed the impact of drug use and inconsistent condom use on HIV infection among FSW in Vietnam, which few studies have quantified. We surveyed 5298 women aged ≥18 years who had sold sex in the past month from ten geographically dispersed provinces. We performed multivariate logistic regression on data from provinces with high (≥10%) or low (<10%) HIV prevalence among FSW. Compared to FSW who never used illicit drugs, the odds of HIV infection among FSW who had ever injected drugs and those who reported non-injection drug use were 3.44 (CI 2.32-5.09) and 1.76 (CI 1.14-2.71), respectively, in high-prevalence provinces. FSW who always used condoms with clients had lower odds of HIV infection than those who did not (AOR=0.71; CI 0.52-0.98). In low-prevalence provinces lifetime injection drug use (AOR 22.05, CI 12.00-40.49), but not non-injecting drug use or inconsistent condom use, was significantly associated with HIV infection. Because injection drug use and inconsistent condom use were key risk factors for HIV infection in high-prevalence provinces, drug injection risk reduction should be as much a focus of HIV prevention as sexual risk reduction. Where HIV prevalence remains low in FSW, a more general emphasis on harm reduction for all drug users will benefit FSW. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Injecting Drug Users Retention in Needle-Exchange Program and its Determinants in Iran Prisons

PubMed Central

Shahbazi, Mohammad; Farnia, Marzieh; Moradi, Ghobad; Karamati, Mohammadreza; Paknazar, Fatemeh; Mirmohammad Khani, Majid

2015-01-01

Background: Participation and to stay in a health program depends on many factors. One of these programs is Needle Exchange Program (NEP) in prisons. Objectives: The current study aimed to evaluate the retention of injecting drug prisoners and find the related factors in Iran. Patients and Methods: This cohort study analyzed data about injecting drug male prisoners who were participated in NEP in three Iranian prisons. Data was collected from October 2009 to June 2010. A proper approach of survival analyses including Kaplan-Meier method, Log-Rank test, and Cox Proportional Hazard Model were used to evaluate Injecting Drug Users (IDUs) retention in NEP and its determinants. Results: Out of 320 prisoners, 167 were from Isfahan Central Prison, 82 from Tehran-Ghezel-Hesar Prison, and 71 from Hamadan Central Prison. Two-hundred and fifty prisoners (78.4%) had history of drug injection; and drug injection was the most common choice for 115 persons (35.9%). Participants were followed up for 29 weeks, the mean (SD) time of retention in the program was 24.1 (0.6) weeks. There was a significant relationship between age, number of used needles per week, duration of addiction, age of addiction onset, as well as imprisonment age, main method of drug use, type of main using drug, Hepatitis B Virus (HBV) infection, job status, reason of arrestment, history of involvement in harm reduction programs, and the length of retention (P < 0.05). There was also significant relationship between the history of using harm reduction services (P = 0.007), tattooing (P = 0.01), longer durations of addiction (P = 0.048), and retention. Conclusions: Tattooing and longer duration of addiction were two important factors that significantly increased retention in the program. In contrast, history of using harm reduction services was the factor that decreased persistence. The risk of quitting the program may decrease about 68% in those who did not involve in harm reduction programs. PMID:26405681

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis.

PubMed

Guise, Andy; Horyniak, Danielle; Melo, Jason; McNeil, Ryan; Werb, Dan

2017-12-01

Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We reviewed and synthesized existing qualitative scientific literature systematically to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. We searched six databases (Medline, Embase, PsychINFO, CINAHL, IBSS and SSCI) systematically, along with a manual search, including key journals and subject experts. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes throughout studies. From 1731 initial results, 41 studies reporting data from 1996 participants were included. We developed eight descriptive themes and two analytical (higher-order) themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity and coping with pain and trauma. Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual

Awareness of and attitudes toward direct-to-consumer prescription drug advertising among young adults.

PubMed

Alperstein, Neil M

2014-01-01

This study examines awareness and knowledge of and attitudes toward direct-to-consumer (DTC) prescription drug advertising among young adults between 18 and 24 years of age. The study finds that young adults are not as aware of prescription drug advertising as older consumers, however, they are aware of specific heavily advertised drugs, especially those for allergy medications, birth control, and sleep aids. Young adults hold mixed to negative views about advertising in general, and they do not view DTC prescription drug advertising as a beneficial source of information, nor do they believe such advertising serves to educate consumers.

Correlates of Double Risk of HIV Acquisition and Transmission Among Women who Inject Drugs in St. Petersburg, Russia.

PubMed

Girchenko, Polina; King, Elizabeth J

2017-04-01

Russia continues to experience a growing HIV epidemic, and women account for an increasing proportion of new HIV diagnoses in the country. This study aims to provide up-to-date information on factors associated with unsafe sex and drug use behaviors among women who inject drugs in St. Petersburg, Russia. In this community-based sample of 500 women who inject drugs, 64% tested positive for HIV. Women reported the following: 21% reported injection risk, 22% reported sexual risk, and 18% reported double risk. Multivariable analyses using logistic multinomial regression showed that older age is associated with increased risk behaviors. Involvement in transactional sex is associated with injection risk [aOR = 1.59 (1.02, 2.48)] but protective against sexual risk [aOR = 0.11 (0.06, 0.19)]. Exposure to sexual violence is associated with increased injection risk [aOR = 1.78 (1.01, 3.14)] and double risk [aOR = 3.38 (1.50, 7.63)]. These findings indicate the need to address both the unsafe injection and sexual risks among women who inject drugs in Russia.

78 FR 44432 - New Animal Drugs; Change of Sponsor; Fentanyl; Iron Injection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-24

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Parts 510, 522, and 524 [Docket No. FDA-2013-N-0002] New Animal Drugs; Change of Sponsor; Fentanyl; Iron Injection AGENCY..., NADA 141-337 for RECUVYRA (fentanyl) Transdermal Solution to Elanco Animal Health, A Division of Eli...

Deportation and mental health among migrants who inject drugs along the US-Mexico border

PubMed Central

Pinedo, Miguel; Burgos, José Luis; Zúñiga, María Luisa; Perez, Ramona; Macera, Caroline A.; Ojeda, Victoria D.

2016-01-01

Objective This study describes the prevalence and factors of depressive symptoms among a sample of persons who inject drugs (PWID) with a history of deportation from the US in Tijuana, Mexico. In 2014, 132 deported PWID completed a structured questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Short Depression Scale (CESD-10) screening instrument. Eligible participants were ≥18 years old, injected drugs in the past month, spoke English or Spanish, and resided in Tijuana. Multivariate analyses identified factors associated with depressive symptoms. Among deported PWID, 45% reported current symptoms of depression. Deported PWID who were initially detained in the US for a crime-related reason before being deported (Adjusted Odds Ratio (AOR): 5.27; 95% CI: 1.79–15.52) and who perceived needing help with their drug use (AOR: 2.15; 95% 1.01–4.61) had higher odds of reporting depressive symptoms. Our findings highlight the need for effective strategies targeting deported migrants who inject drugs to treat mental health and drug abuse in Tijuana. Investing in the mental health of deported PWID may also be a viable HIV prevention strategy. PMID:27132880

Sericin/Dextran Injectable Hydrogel as an Optically Trackable Drug Delivery System for Malignant Melanoma Treatment.

PubMed

Liu, Jia; Qi, Chao; Tao, Kaixiong; Zhang, Jinxiang; Zhang, Jian; Xu, Luming; Jiang, Xulin; Zhang, Yunti; Huang, Lei; Li, Qilin; Xie, Hongjian; Gao, Jinbo; Shuai, Xiaoming; Wang, Guobin; Wang, Zheng; Wang, Lin

2016-03-01

Severe side effects of cancer chemotherapy prompt developing better drug delivery systems. Injectable hydrogels are an effective site-target system. For most of injectable hydrogels, once delivered in vivo, some properties including drug release and degradation, which are critical to chemotherapeutic effects and safety, are challenging to monitor. Developing a drug delivery system for effective cancer therapy with in vivo real-time noninvasive trackability is highly desired. Although fluorescence dyes are used for imaging hydrogels, the cytotoxicity limits their applications. By using sericin, a natural photoluminescent protein from silk, we successfully synthesized a hydrazone cross-linked sericin/dextran injectable hydrogel. This hydrogel is biodegradable and biocompatible. It achieves efficient drug loading and controlled release of both macromolecular and small molecular drugs. Notably, sericin's photoluminescence from this hydrogel is directly and stably correlated with its degradation, enabling long-term in vivo imaging and real-time monitoring of the remaining drug. The hydrogel loaded with Doxorubicin significantly suppresses tumor growth. Together, the work demonstrates the efficacy of this drug delivery system, and the in vivo effectiveness of this sericin-based optical monitoring strategy, providing a potential approach for improving hydrogel design toward optimal efficiency and safety of chemotherapies, which may be widely applicable to other drug delivery systems.

Recurrent wound botulism among injection drug users in California.

PubMed

Yuan, Jean; Inami, Gregory; Mohle-Boetani, Janet; Vugia, Duc J

2011-04-01

Botulism is an acute neurologic illness characterized by cranial nerve palsies and descending flaccid paralysis. Botulism is a rare disease and recurrent botulism even more rare. We review cases of recurrent wound botulism (WB) among injection drug users (IDUs) in California from 1993 through 2006 and describe 2 case patients. From botulism surveillance data for 1993-2006, we identified patients with >1 episode of clinical WB, defined as acute descending paralysis with a visible wound or recent history of injection drug use. For each patient, ≥1 of their WB episodes was laboratory confirmed. We extracted demographic, clinical, and laboratory information from case and laboratory reports and compared clinical characteristic frequency of initial and second WB episodes. During 1993-2006, 17 IDUs had recurrent WB, 14 with 1 recurrence and 3 with 2 recurrences. Of 25 laboratory-confirmed episodes, 22 were confirmed through serum testing and 3 through wound testing. Patients were 32-61 years old, and 94% were male. All patients reported heroin injections; 88% specified black tar heroin use and 76% reported subcutaneous injection. The most common presentations were having a visible wound, speech difficulty, double vision, respiratory difficulty, and trouble swallowing. There were no significant differences in clinical presentation between initial and second episodes. As the California epidemic of WB among IDUs continues, WB episodes are recurring. Both clinicians and IDUs should be aware of the potential for WB to recur among IDUs to enable timely diagnosis and early botulinum antitoxin administration and supportive care. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

Do law enforcement interactions reduce the initiation of injection drug use? An investigation in three North American settings.

PubMed

Melo, J S; Garfein, R S; Hayashi, K; Milloy, M J; DeBeck, K; Sun, S; Jain, S; Strathdee, S A; Werb, D

2018-01-01

The prevention of drug injecting is often cited as a justification for the deployment of law enforcement and for the continuation of drug criminalization policies. We sought to characterize the impact of law enforcement interactions on the risk that people who inject drugs (PWID) report assisting others with injection initiation in three North American countries. Cross-sectional data from PWID participating in cohort studies in three cities (San Diego, USA; Tijuana, Mexico; Vancouver, Canada) were pooled (August 2014-December 2016). The dependent variable was defined as recently (i.e., past six months) providing injection initiation assistance; the primary independent variable was the frequency of recent law enforcement interactions, defined categorically (0 vs. 1 vs. 2-5 vs. ≥6). We employed multivariable logistic regression analyses to assess this relationship while controlling for potential confounders. Among 2122 participants, 87 (4.1%) reported recently providing injection initiation assistance, and 802 (37.8%) reported recent law enforcement interactions. Reporting either one or more than five recent interactions with law enforcement was not significantly associated with injection initiation assistance. Reporting 2-5 law enforcement interactions was associated with initiation assistance (Adjusted Odds Ratio=1.74, 95% Confidence Interval: 1.01-3.02). Reporting interactions with law enforcement was not associated with a reduced likelihood that PWID reported initiating others into injection drug use. Instead, we identified a positive association between reporting law enforcement interactions and injection initiation assistance among PWID in multiple settings. These findings raise concerns regarding the effectiveness of drug law enforcement to deter injection drug use initiation. Copyright © 2017 Elsevier B.V. All rights reserved.

Incident syphilis infection among people who inject drugs in Tijuana, Mexico

PubMed Central

Pines, Heather A.; Rusch, Melanie L.; Vera, Alicia; Rangel, Gudelia; Magis-Rodriguez, Carlos; Strathdee, Steffanie A.

2017-01-01

Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006–2007, 940 PWID (142 females and 798 males) were recruited via respondent driven sampling and followed for 18 months. At semi-annual visits, participants were tested for syphilis and completed surveys, which collected information on socio-demographics, sexual behaviors, substance use, and injection behaviors. Poisson regression was used to estimate syphilis incidence rates (IRs), incidence rate ratios (IRRs), and 95% confidence intervals (CIs). Twenty-one participants acquired syphilis during follow-up (IR=1.57 per 100 person-years, 95% CI: 1.02–2.41). In a multivariate analysis, syphilis incidence was higher among females (IRR=3.90, 95% CI: 1.37–11.09), HIV-positive participants (IRR=4.60, 95% CI: 1.58–13.39), and those who reported ever exchanging sex for drugs, money, or other goods (IRR=2.74, 95% CI: 0.97–7.76), while syphilis incidence was lower among those living in Tijuana for a longer duration (IRR=0.95 per year, 95% CI: 0.91–1.00) and those reporting ≥daily injection drug use (past 6 months) (IRR=0.22, 95% CI: 0.09–0.54). Our findings suggest interventions that address the destabilizing conditions associated with migration and integrate sexual and drug-related risk reduction strategies may help reduce syphilis incidence among PWID along the Mexico-US border. PMID:25614523

Incident syphilis infection among people who inject drugs in Tijuana, Mexico.

PubMed

Pines, Heather A; Rusch, Melanie L; Vera, Alicia; Rangel, Gudelia; Magis-Rodriguez, Carlos; Strathdee, Steffanie A

2015-12-01

Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006 to 2007, 940 PWID (142 women and 798 men) were recruited via respondent-driven sampling and followed for 18 months. At semi-annual visits, participants were tested for syphilis and completed surveys, which collected information on socio-demographics, sexual behaviours, substance use and injection behaviours. Poisson regression was used to estimate syphilis incidence rates (IRs), incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Twenty-one participants acquired syphilis during follow-up (IR = 1.57 per 100 person-years, 95% CI: 1.02-2.41). In a multivariate analysis, syphilis incidence was higher among women (IRR = 3.90, 95% CI: 1.37-11.09), HIV-positive participants (IRR = 4.60, 95% CI: 1.58-13.39) and those who reported ever exchanging sex for drugs, money, or other goods (IRR = 2.74, 95% CI: 0.97-7.76), while syphilis incidence was lower among those living in Tijuana for a longer duration (IRR = 0.95 per year, 95% CI: 0.91-1.00) and those reporting at least daily injection drug use (past 6 months) (IRR = 0.22, 95% CI: 0.09-0.54). Our findings suggest interventions that address the destabilising conditions associated with migration and integrate sexual and drug-related risk reduction strategies may help reduce syphilis incidence among PWID along the Mexico-US border. © The Author(s) 2015.

Development and evaluation of injectable nanosized drug delivery systems for apigenin.

PubMed

Karim, Reatul; Palazzo, Claudio; Laloy, Julie; Delvigne, Anne-Sophie; Vanslambrouck, Stéphanie; Jerome, Christine; Lepeltier, Elise; Orange, Francois; Dogne, Jean-Michel; Evrard, Brigitte; Passirani, Catherine; Piel, Géraldine

2017-11-05

The purpose of this study was to develop different injectable nanosized drug delivery systems (NDDSs) i.e. liposome, lipid nanocapsule (LNC) and polymeric nanocapsule (PNC) encapsulating apigenin (AG) and compare their characteristics to identify the nanovector(s) that can deliver the largest quantity of AG while being biocompatible. Two liposomes with different surface characteristics (cationic and anionic), a LNC and a PNC were prepared. A novel tocopherol modified poly(ethylene glycol)-b-polyphosphate block-copolymer was used for the first time for the PNC preparation. The NDDSs were compared by their physicochemical characteristics, AG release, storage stability, stability in serum, complement consumption and toxicity against a human macrovascular endothelial cell line (EAhy926). The diameter and surface charge of the NDDSs were comparable with previously reported injectable nanocarriers. The NDDSs showed good encapsulation efficiency and drug loading. Moreover, the NDDSs were stable during storage and in fetal bovine serum for extended periods, showed low complement consumption and were non-toxic to EAhy926 cells up to high concentrations. Therefore, they can be considered as potential injectable nanocarriers of AG. Due to less pronounced burst effect and extended release characteristics, the nanocapsules could be favorable approaches for achieving prolonged pharmacological activity of AG using injectable NDDS. Copyright © 2017 Elsevier B.V. All rights reserved.

Reviewing harm reduction for people who inject drugs in Asia: the necessity for growth.

PubMed

Stone, Katie Alexandra

2015-10-16

There is an estimate of three to five million people who inject drugs living in Asia. Unsafe injecting drug use is a major driver of both the HIV and hepatitis C (HCV) epidemic in this region, and an increase in incidence among people who inject drugs continues. Although harm reduction is becoming increasingly accepted, a largely punitive policy remains firmly in place, undermining access to life-saving programmes. The aim of this study is to present an overview of key findings on harm reduction in Asia based on data collected for the Global State of Harm Reduction 2014. A review of international scientific and grey literature was undertaken between May and September 2014, including reports from multilateral agencies and international non-governmental organisations. A qualitative survey comprising open-ended questions was also administered to civil society, harm reduction networks, and organisations of people who use drugs to obtain national and regional information on key developments in harm reduction. Expert consultation from academics and key thinkers on HIV, drug use, and harm reduction was used to verify findings. In 2014, 17 countries in Asia provide needle and syringe programmes (NSP) provision and 15 opioid substitution therapy (OST). It is estimated that between 60 and 90 % of people who use drugs in Asia have HCV; however, treatment still remains out of reach due to cost barriers. TB testing and treatment services are yet to be established for key populations, yet nearly 15 % of the global burden of new cases of HIV-TB co-infection are attributed to southeast Asia. Eighteen percent of the total number of people living with HIV eligible for antiretroviral treatment (ART) accessed treatment. Only Malaysia and Indonesia provide OST in prison, with no NSP provision in prisons in the region. To reduce HIV and viral hepatitis risk among people who inject drugs, there is a necessity to significantly increase harm reduction service provision in Asia. Although

Explanations and expectations: drug narratives among young cannabis users in treatment

PubMed Central

Järvinen, Margaretha; Ravn, Signe

2015-01-01

This article analyses how young people enrolled in drug addiction treatment in Copenhagen, Denmark, explain their cannabis careers and how they view their possibilities for quitting drug use again. Inspired by Mead and narrative studies of health and illness, the article identifies four different drug use ‘aetiologies’ drawn upon by the interviewees. These cover childhood experiences, self-medication, the influence of friends and cannabis use as a specific lifestyle. A central argument of the article is that these explanations not only concern the past but also point towards the future by assigning the interviewee a more or less agential position in relation to drugs. Further, the drug narratives are viewed as interactional achievements, related to the social context in which they were produced, namely, the institutional setting of the treatment centres. The article is based on 30 qualitative interviews with young people in drug addiction treatment. PMID:25688710

Drug use as a driver of HIV Risks: Re-emerging and emerging issues

PubMed Central

El-Bassel, Nabila; Shaw, Stacey A.; Dasgupta, Anindita; Strathdee, Steffanie A.

2014-01-01

Purpose of Review We reviewed papers published in 2012–2013 that focused on re-emerging and emerging injection and non-injection drug use trends driving HIV risk behaviors and transmission in some parts of the world. Recent Findings While HIV incidence has declined in many countries, HIV epidemics remain at troubling levels among key drug using populations including females who inject drugs (FWID), FWID who trade sex, sex partners of people who inject drugs (SP-PWID), young PWID, and people who use non-injection drugs in a number of low- and middle- income countries such as in Central Asia, Eastern Europe, Southeast Asia, and parts of Africa. Summary HIV epidemics occur within contexts of global economic and political forces, including poverty, human rights violations, discrimination, drug policies, trafficking, and other multi-level risk environments. Trends of injection and non-injection drug use and risk environments driving HIV epidemics in Central Asia, Eastern Europe, Southeast Asia, and parts of Africa call for political will to improve HIV and substance use service delivery, access to combination HIV prevention, and harm reduction programs. PMID:24406532

A fragmented code: The moral and structural context for providing assistance with injection drug use initiation in San Diego, USA.

PubMed

Guise, Andy; Melo, Jason; Mittal, Maria Luisa; Rafful, Claudia; Cuevas-Mota, Jazmine; Davidson, Peter; Garfein, Richard S; Werb, Dan

2018-05-01

Injection drug use initiation is shaped by social networks and structural contexts, with people who inject drugs often assisting in this process. We sought to explore the norms and contexts linked to assisting others to initiate injection drug use in San Diego, USA, to inform the development of structural interventions to prevent this phenomenon. We undertook qualitative interviews with a purposive sample of people who inject drugs and had reported assisting others to initiate injection (n = 17) and a sub-sample of people who inject drugs (n = 4) who had not reported initiating others to triangulate accounts. We analyzed data thematically and abductively. Respondents' accounts of providing initiation assistance were consistent with themes and motives reported in other contexts: of seeking to reduce harm to the 'initiate', responding to requests for help, fostering pleasure, accessing resources, and claims that initiation assistance was unintentional. We developed analysis of these themes to explore initiation assistance as governed by a 'moral code'. We delineate a fragmented moral code which includes a range of meanings and social contexts that shape initiation assistance. We also show how assistance is happening within a structural context that limits discussion of injection drug use, reflecting a prevailing silence on drug use linked to stigma and criminalization. In San Diego, the assistance of others to initiate injection drug use is governed by a fragmented moral code situated within particular social norms and contexts. Interventions that address the social and structural conditions shaped by and shaping this code may be beneficial, in tandem with efforts to support safe injection and the reduction of injection-related harms. Copyright © 2018 Elsevier B.V. All rights reserved.

Tuberculosis knowledge among injecting drug users visiting syringe exchange programme in Tallinn, Estonia.

PubMed

Rüütel, Kristi; Parker, R David; Sobolev, Igor; Loit, Helle-Mai

2012-12-01

The purpose of the current study was to describe tuberculosis (TB) knowledge, beliefs, and experience with TB services among injecting drug users. Participants for this anonymous, cross-sectional study were recruited from a community based syringe exchange programme in Tallinn, Estonia. A structured questionnaire was completed and included information on socio-demographics, health history, drug use, and knowledge about TB and HIV. The study included 407 people (79% male, mean age 27.9 years, mean injection drug use 9.4 years). 32.9% of participants reported HIV infection and 1.7% lifetime history of TB. 26.4% participants (n=106) reported symptoms suggestive of TB. 93% of participants recognized correctly that TB is air-borne infection and 91% that HIV is a risk factor for TB. Only 40% of the participants knew that TB diagnostics and treatment in Estonia are free of charge for everybody and 58% reported they knew where to get health care services in case they suspected that they had TB. TB transmission and treatment adherence knowledge was better among those in contact with either health care or harm reduction services, e.g the community based syringe exchange programme. Similar to HIV services, TB prevention and education should be integrated into harm reduction and drug treatment programmes to facilitate early diagnosis and treatment of TB among injecting drug users.

Cognitive Behavioral Theories Used to Explain Injection Risk Behavior among Injection Drug Users: A Review and Suggestions for the Integration of Cognitive and Environmental Models

ERIC Educational Resources Information Center

Wagner, Karla Dawn; Unger, Jennifer B.; Bluthenthal, Ricky N.; Andreeva, Valentina A.; Pentz, Mary Ann

2010-01-01

Injection drug users (IDUs) are at risk for HIV and viral hepatitis, and risky injection behavior persists despite decades of intervention. Cognitive behavioral theories (CBTs) are commonly used to help understand risky injection behavior. The authors review findings from CBT-based studies of injection risk behavior among IDUs. An extensive…

Epidemiological aspects of HCV infection in non-injecting drug users in the Brazilian state of Pará, eastern Amazon

PubMed Central

2014-01-01

Background Currently, sharing of drug paraphernalia is the main form of HCV transmission worldwide. In South America, consistent findings indicate that shared sniffing equipment is an important factor in the spread of HCV among non-injecting drug users. Epidemiological data on the status of HCV infection in illicit drug users in the Amazon region are scarce, although reports of clinical cases of hepatitis or pathologies associated with HCV infection in other population groups are numerous. Thereby, this study investigated the prevalence, genotype frequency, and epidemiological factors associated with HCV infection in non-injecting drug users in the state of Pará, eastern Amazon. Results During 2008–2011, 300 non-injecting drug users attending drug-treatment centers participated in this study. Most non-injecting drug users were male (63.7%). The mean age was 32.5 years. The non-injecting drugs most consumed were: cannabis (15.6%), cocaine paste (21.3%), and oxi cocaine (25.7%). Tobacco (60.9%) and alcohol (79.4%) were also commonly consumed. One hundred six (35.1%; CI 95%: 29.8 - 41.1) non-injecting drug users presented anti-HCV antibodies by EIA. The HCV-RNA prevalence was 28.0% (95% CI: 20.6 - 35.8). Genotypes 1 (76.9%) and 3 (23.1%) of HCV have been identified. A multivariate analysis demonstrated that HCV infection was independently associated with the following factors: “age (≥ 35 years)”, “tattoos”, “use of a needle or syringe sterilized at home”, “shared use of drug paraphernalia”, “uses drugs for more than 5 years”, and “use of drugs everyday”. Conclusions This study revealed a high prevalence of HCV infection in non-injecting drug users, and most infections are occasioned by genotype 1. Likely, HCV transmission is associated with the tattoos, the use of needle or syringe sterilized at home by people over the age of 35 years, and sharing, time and frequency of use of non-injecting drugs. These findings should serve as an

Epidemiological aspects of HCV infection in non-injecting drug users in the Brazilian state of Pará, eastern Amazon.

PubMed

Oliveira-Filho, Aldemir B; Sawada, Leila; Pinto, Laine C; Locks, Daiane; Bahia, Santana L; Castro, Jairo A A; Hermes, Renata B; Brasil-Costa, Igor; Amaral, Carlos E M; Lemos, José Alexandre R

2014-02-25

Currently, sharing of drug paraphernalia is the main form of HCV transmission worldwide. In South America, consistent findings indicate that shared sniffing equipment is an important factor in the spread of HCV among non-injecting drug users. Epidemiological data on the status of HCV infection in illicit drug users in the Amazon region are scarce, although reports of clinical cases of hepatitis or pathologies associated with HCV infection in other population groups are numerous. Thereby, this study investigated the prevalence, genotype frequency, and epidemiological factors associated with HCV infection in non-injecting drug users in the state of Pará, eastern Amazon. During 2008-2011, 300 non-injecting drug users attending drug-treatment centers participated in this study. Most non-injecting drug users were male (63.7%). The mean age was 32.5 years. The non-injecting drugs most consumed were: cannabis (15.6%), cocaine paste (21.3%), and oxi cocaine (25.7%). Tobacco (60.9%) and alcohol (79.4%) were also commonly consumed. One hundred six (35.1%; CI 95%: 29.8 - 41.1) non-injecting drug users presented anti-HCV antibodies by EIA. The HCV-RNA prevalence was 28.0% (95% CI: 20.6 - 35.8). Genotypes 1 (76.9%) and 3 (23.1%) of HCV have been identified. A multivariate analysis demonstrated that HCV infection was independently associated with the following factors: "age (≥ 35 years)", "tattoos", "use of a needle or syringe sterilized at home", "shared use of drug paraphernalia", "uses drugs for more than 5 years", and "use of drugs everyday". This study revealed a high prevalence of HCV infection in non-injecting drug users, and most infections are occasioned by genotype 1. Likely, HCV transmission is associated with the tattoos, the use of needle or syringe sterilized at home by people over the age of 35 years, and sharing, time and frequency of use of non-injecting drugs. These findings should serve as an incentive for the establishment of a program of Hepatitis C

Injectable nanocomposite cryogels for versatile protein drug delivery.

PubMed

Koshy, Sandeep T; Zhang, David K Y; Grolman, Joshua M; Stafford, Alexander G; Mooney, David J

2018-01-01

Sustained, localized protein delivery can enhance the safety and activity of protein drugs in diverse disease settings. While hydrogel systems are widely studied as vehicles for protein delivery, they often suffer from rapid release of encapsulated cargo, leading to a narrow duration of therapy, and protein cargo can be denatured by incompatibility with the hydrogel crosslinking chemistry. In this work, we describe injectable nanocomposite hydrogels that are capable of sustained, bioactive, release of a variety of encapsulated proteins. Injectable and porous cryogels were formed by bio-orthogonal crosslinking of alginate using tetrazine-norbornene coupling. To provide sustained release from these hydrogels, protein cargo was pre-adsorbed to charged Laponite nanoparticles that were incorporated within the walls of the cryogels. The presence of Laponite particles substantially hindered the release of a number of proteins that otherwise showed burst release from these hydrogels. By modifying the Laponite content within the hydrogels, the kinetics of protein release could be precisely tuned. This versatile strategy to control protein release simplifies the design of hydrogel drug delivery systems. Here we present an injectable nanocomposite hydrogel for simple and versatile controlled release of therapeutic proteins. Protein release from hydrogels often requires first entrapping the protein in particles and embedding these particles within the hydrogel to allow controlled protein release. This pre-encapsulation process can be cumbersome, can damage the protein's activity, and must be optimized for each protein of interest. The strategy presented in this work simply premixes the protein with charged nanoparticles that bind strongly with the protein. These protein-laden particles are then placed within a hydrogel and slowly release the protein into the surrounding environment. Using this method, tunable release from an injectable hydrogel can be achieved for a variety of

Exchange of Sex for Drugs or Money in Adolescents and Young Adults: An Examination of Sociodemographic Factors, HIV-Related Risk, and Community Context.

PubMed

Boyer, Cherrie B; Greenberg, Lauren; Chutuape, Kate; Walker, Bendu; Monte, Dina; Kirk, Jennifer; Ellen, Jonathan M

2017-02-01

The goal of this research was to examine associations among sociodemographic factors, HIV risk, and community context (e.g., economic insecurity, job training, housing instability, crime victimization, and perceived community norms) in adolescents and young adults who ever exchanged sex for drugs or money. Anonymous survey data were collected using ACASIs at community venues where adolescents and young adults congregate in resource-challenged, STI prevalent, urban, US neighborhoods. Conventional descriptive statistics, Fisher's exact tests, and generalized estimating equations approaches were used to examine associations. Participants (1818, 95.5 % of those screened eligible) were, on average, aged 21.0 years; 42.2 % were males, and 4.6 % were transgender. Almost one-third (32.1 %) identified as gay or lesbian, 18.1 % identified as bisexual; 66.2 % were Black and 21.0 % were Hispanic; 1.3 % was 'living on the street'. A sizeable proportion reported HIV-related risk: 16.3 % exchanged sex, 12.6 % had sex with someone they knew to be HIV-infected, 7.8 % had sex with someone who injected drugs, and 1.3 % injected drugs. Multivariate comparisons identified a number of variables (e.g., being male or transgender, homelessness, sex with a partner who has HIV, STI history, unemployment, job training access, housing instability, crime victimization, perceived community norms) that were significantly associated with exchange of sex (p < 0.05). This research contributes to the knowledge-base regarding exchange of sex among adolescents and young adults, particularly as it relates to community context. Longitudinal studies to describe the trajectory of social, health, and physical risks and consequences are needed for development of effective evidence-based prevention strategies.

Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2015.

PubMed

Giese, Coralie; Igoe, Derval; Gibbons, Zorina; Hurley, Caroline; Stokes, Siobhan; McNamara, Sinead; Ennis, Orla; O'Donnell, Kate; Keenan, Eamon; De Gascun, Cillian; Lyons, Fiona; Ward, Mary; Danis, Kostas; Glynn, Ronan; Waters, Allison; Fitzgerald, Margaret

2015-01-01

In February 2015, an outbreak of recently acquired HIV infections among people who inject drugs (PWID) was identified in Dublin, following similar outbreaks in Greece and Romania in 2011. We compared drug and risk behaviours among 15 HIV cases and 39 controls. Injecting a synthetic cathinone, snow blow, was associated with recent HIV infection (AOR: 49; p=0.003). Prevention and control efforts are underway among PWID in Dublin, but may also be needed elsewhere in Europe.

Laser-induced microjet injection into preablated skin for more effective transdermal drug delivery

NASA Astrophysics Data System (ADS)

Jang, Hun-jae; Hur, Eugene; Kim, Yoonkwan; Lee, Seol-Hoon; Kang, Nae G.; Yoh, Jack J.

2014-11-01

A breakthrough in the efficient transdermal delivery of drug via the laser-driven microjet is reported. A single source of laser beam is split into two: one beam ablates a targeted spot on a skin and another beam drives the injector for fast microjet ejection into a preablated spot. This combined ablation and microjet injection scheme using a beam splitter utilizes 1∶4 laser energy sharing between generation of the microhole via ablation and the microjet which is generated using the Er:YAG laser beam at a 2940-nm wavelength and 150-μs pulse duration. A careful analysis of the injection mechanism is carried out by studying the response of the elastic membrane that separates a driving water unit for bubble expansion from a drug unit for a microjet ejection. The efficiency of the present delivery scheme is evaluated by the abdominal porcine skin test using the fluorescein isothiocyanate staining and the confocal microscopy for quantitative delivery confirmation. The depth of penetration and the injected volume of the drug are also confirmed by polyacrylamide gel tests.

Laser-induced microjet injection into preablated skin for more effective transdermal drug delivery.

PubMed

Jang, Hun-Jae; Hur, Eugene; Kim, Yoonkwan; Lee, Seol-Hoon; Kang, Nae G; Yoh, Jack J

2014-11-01

A breakthrough in the efficient transdermal delivery of drug via the laser-driven microjet is reported. A single source of laser beam is split into two: one beam ablates a targeted spot on a skin and another beam drives the injector for fast microjet ejection into a preablated spot. This combined ablation and microjet injection scheme using a beam splitter utilizes laser energy sharing between generation of the microhole via ablation and the microjet which is generated using the Er:YAG laser beam at a 2940-nm wavelength and pulse duration. A careful analysis of the injection mechanism is carried out by studying the response of the elastic membrane that separates a driving water unit for bubble expansion from a drug unit for a microjet ejection. The efficiency of the present delivery scheme is evaluated by the abdominal porcine skin test using the fluorescein isothiocyanate staining and the confocal microscopy for quantitative delivery confirmation. The depth of penetration and the injected volume of the drug are also confirmed by polyacrylamide gel tests.

The Longitudinal Impact of Adolescent Drug Use on Socioeconomic Outcomes in Young Adulthood

ERIC Educational Resources Information Center

Broman, Clifford L.

2009-01-01

This study investigates how drug use in adolescence contributes to socioeconomic outcomes in young adulthood. Several studies have investigated whether drug problems alter the life course in ways that are detrimental to young adult achievement, but findings are inconsistent. We use data from the National Longitudinal Study of Adolescent Health to…

Short-term cessation of sex work and injection drug use: evidence from a recurrent event survival analysis.

PubMed

Gaines, Tommi L; Urada, Lianne A; Martinez, Gustavo; Goldenberg, Shira M; Rangel, Gudelia; Reed, Elizabeth; Patterson, Thomas L; Strathdee, Steffanie A

2015-06-01

This study quantitatively examined the prevalence and correlates of short-term sex work cessation among female sex workers who inject drugs (FSW-IDUs) and determined whether injection drug use was independently associated with cessation. We used data from FSW-IDUs (n=467) enrolled into an intervention designed to increase condom use and decrease sharing of injection equipment but was not designed to promote sex work cessation. We applied a survival analysis that accounted for quit-re-entry patterns of sex work over 1-year stratified by city, Tijuana and Ciudad Juarez, Mexico. Overall, 55% of participants stopped sex work at least once during follow-up. Controlling for other characteristics and intervention assignment, injection drug use was inversely associated with short-term sex work cessation in both cities. In Ciudad Juarez, women receiving drug treatment during follow-up had a 2-fold increase in the hazard of stopping sex work. In both cities, income from sources other than sex work, police interactions and healthcare access were independently and significantly associated with shorter-term cessation. Short-term sex work cessation was significantly affected by injection drug use. Expanded drug treatment and counseling coupled with supportive services such as relapse prevention, job training, and provision of alternate employment opportunities may promote longer-term cessation among women motivated to leave the sex industry. Copyright © 2015 Elsevier Ltd. All rights reserved.

Short-Term Cessation of Sex Work and Injection Drug Use: Evidence from a Recurrent Event Survival Analysis

PubMed Central

Gaines, Tommi L.; Urada, Lianne; Martinez, Gustavo; Goldenberg, Shira M.; Rangel, Gudelia; Reed, Elizabeth; Patterson, Thomas L.; Strathdee, Steffanie A.

2015-01-01

Objective This study quantitatively examined the prevalence and correlates of short-term sex work cessation among female sex workers who inject drugs (FSW-IDUs) and determined whether injection drug use was independently associated with cessation. Methods We used data from FSW-IDUs (n=467) enrolled into an intervention designed to increase condom use and decrease sharing of injection equipment but was not designed to promote sex work cessation. We applied a survival analysis that accounted for quit-re-entry patterns of sex work over 1-year stratified by city, Tijuana and Ciudad Juarez, Mexico. Results Overall, 55% of participants stopped sex work at least once during follow-up. Controlling for other characteristics and intervention assignment, injection drug use was inversely associated with short-term sex work cessation in both cities. In Ciudad Juarez, women receiving drug treatment during follow-up had a 2-fold increase in the hazard of stopping sex work. In both cities, income from sources other than sex work, police interactions and healthcare access were independently and significantly associated with shorter-term cessation. Conclusions Short-term sex work cessation was significantly affected by injection drug use. Expanded drug treatment and counseling coupled with supportive services such as relapse prevention, job training, and provision of alternate employment opportunities may promote longer-term cessation among women motivated to leave the sex industry. PMID:25644589

‘Safer Environment Interventions’: A qualitative synthesis of the experiences and perceptions of people who inject drugs

PubMed Central

McNeil, Ryan; Small, Will

2014-01-01

There is growing acknowledgment that social, structural, and environmental forces produce vulnerability to health harms among people who inject drugs (PWID), and safer environment interventions (SEI) have been identified as critical to mitigating the impacts of these contextual forces on drug-related harm. To date, however, SEIs have been under-theorized in the literature, and how they minimize drug-related risks across intervention types and settings has not been adequately examined. This article presents findings from a systematic review and meta-synthesis of qualitative studies reporting PWID’s experiences with three types of SEIs (syringe exchange programmes, supervised injection facilities and peer-based harm reduction interventions) published between 1997 and 2012. This meta-synthesis seeks to develop a comprehensive understanding of SEIs informed by the experiences of PWID. Twenty-nine papers representing twenty-one unique studies that included an aggregate of more than 800 PWID were included in this meta-synthesis. This meta- synthesis found that SEIs fostered social and physical environments that mitigated drug-related harms and increased access to social and material resources. Specifically, SEIs: (1) provided refuge from street-based drug scenes; (2) enabled safer injecting by reshaping the social and environmental contexts of injection drug use; (3) mediated access to resources and health care services; and, (4) were constrained by drug prohibition and law enforcement activities. These findings indicate that it is critical to situate SEIs in relation to the lived experiences of PWID, and in particular provide broader environmental support to PWID. Given that existing drug laws limit the effectiveness of interventions, drug policy reforms are needed to enable public health, and specifically SEIs, to occupy a more prominent role in the response to injection drug use. PMID:24561777

Hepatitis C in injection drug users: It is time to treat.

PubMed

Grassi, Alberto; Ballardini, Giorgio

2017-05-28

Injection drug users (IDUs) are at risk of hepatitis C virus (HCV) infection, due to needle and syringe sharing. Chronic HCV infection is a major cause of liver-related morbidity and mortality but can be cured with antiviral treatment leading to sustained viral response (SVR). It is well demonstrated that, when close cooperation between specialists in drug addiction and psychiatrists is assured, patients on maintenance treatment with methadone/buprenorphine can be treated for HCV with response rate, tolerability and side effects similar to those reported in non-IDUs. Current guidelines recommend that active injection drug use should not exclude patients from HCV treatment, but many services remain reluctant to treat IDUs. No significant pharmacodynamic interactions were reported between approved direct anti-viral agents (DAAs) and buprenorphine or methadone. Dose adjustments are not recommended; therefore DAAs appear to be the "perfect" therapy for patients taking opiate substitutive therapy. These suggestions have been recently recognized by the European Association for the Study of the Liver (EASL) and included in EASL Recommendations on Treatment of Hepatitis C 2016. Guidelines confirm that HCV treatment for IDUs should be considered on an individualized basis and delivered within a multidisciplinary team setting; a history of intravenous drug use and recent drug use at treatment initiation are not associated with reduced SVR and decisions to treat must be made on a case-by-case basis.

High-risk behaviors after release from incarceration among people who inject drugs in St. Petersburg, Russia.

PubMed

Cepeda, Javier A; Niccolai, Linda M; Lyubimova, Alexandra; Kershaw, Trace; Levina, Olga; Heimer, Robert

2015-02-01

Injection drug use, infectious disease, and incarceration are inextricably linked in Russia. We aimed to identify factors associated with time to relapse (first opioid injection after release from prison) and using a non-sterile, previously used syringe at relapse in a sample of people who inject drugs in St. Petersburg. We collected data on time from release to relapse among individuals with a history of incarceration, a subsample of a larger study among people who inject drugs. Proportional hazards and logistic regression were used to identify factors associated with time to relapse and injection with a non-sterile previously used syringe at relapse, respectively. The median time to relapse after release was 30 days. Factors that were independently associated with relapsing sooner were being a native of St. Petersburg compared to not being native (AHR: 1.64; 95% CI 1.15-2.33), unemployed at relapse compared to employed (AHR: 4.49; 95% CI 2.96-6.82) and receiving a previous diagnosis of HBV and HCV compared to no previous diagnosis (AHR: 1.49; 95% CI 1.03-2.14). Unemployment at relapse was also significant in modeling injection with a non-sterile, previously used syringe at relapse compared to those who were employed (AOR: 6.80; 95% CI 1.96-23.59). Unemployment was an important correlate for both resuming opioid injection after release and using a non-sterile previously used syringe at relapse. Linkage to medical, harm reduction, and employment services should be developed for incarcerated Russian people who inject drugs prior to release. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Individual and Network Factors Associated With Prevalent Hepatitis C Infection Among Rural Appalachian Injection Drug Users

PubMed Central

Lofwall, Michelle R.; Frost, Simon D. W.; Oser, Carrie B.; Leukefeld, Carl G.; Crosby, Richard A.

2013-01-01

Objectives. We determined the factors associated with hepatitis C (HCV) infection among rural Appalachian drug users. Methods. This study included 394 injection drug users (IDUs) participating in a study of social networks and infectious disease risk in Appalachian Kentucky. Trained staff conducted HCV, HIV, and herpes simplex-2 virus (HSV-2) testing, and an interviewer-administered questionnaire measured self-reported risk behaviors and sociometric network characteristics. Results. The prevalence of HCV infection was 54.6% among rural IDUs. Lifetime factors independently associated with HCV infection included HSV-2, injecting for 5 or more years, posttraumatic stress disorder, injection of cocaine, and injection of prescription opioids. Recent (past-6-month) correlates of HCV infection included sharing of syringes (adjusted odds ratio = 2.24; 95% confidence interval = 1.32, 3.82) and greater levels of eigenvector centrality in the drug network. Conclusions. One factor emerged that was potentially unique to rural IDUs: the association between injection of prescription opioids and HCV infection. Therefore, preventing transition to injection, especially among prescription opioid users, may curb transmission, as will increased access to opioid maintenance treatment, novel treatments for cocaine dependence, and syringe exchange. PMID:23153148

Co-infection by human immuno deficiency virus, hepatitis B and hepatitis C virus in injecting drug users.

PubMed

Devi, Kh Sulochana; Brajachand, Ng; Singh, H Lokhendro; Singh, Y Manihar

2005-03-01

Injecting drug users (IDUs) are at risk of parenterally transmitted diseases such as hepatitis B virus (HBV) hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections. The present study was undertaken to find out the prevalence of HIV infection, HBV infection and HCV infection among IDUs of a deaddiction centre. Serum samples from 250, injecting drug users (IDUs) from a de-addiction centre were screened for HBsAg using immunochromatography, anti HCV antibody by 3rd generation ELISA test and anti HIV antibody by ELISA test and immunochromatographic rapid test during the period August to October 2002. One hundred and forty-nine (59.6%) IDUs were positive for HIV antibody, 226 (90.4%) were positive for anti HCV antibody and 27 (10.8%) were positive for HBsAg. There was co-infection of HIV, HBV and HCV in 15 (6%) of the IDUs. The Co-infection of HBV and HCV were found in 12 cases (4.8%) and Co-infection of HIV and HCV was found in 131 cases (52.4%). The IDUs were in sexually active age group with a risk of infection to their sexual partner. There is high prevalence of HCV and HIV infection and co-infection of both viruses among IDUs. Comprehensive public health interventions targeting this population and their sexual partners must be encouraged. Increase coverage of needle, syringe exchange programme (NSEP) to young and new IDUs is required before they are exposed to blood borne viruses.

The micro-social risk environment for injection drug use: An event specific analysis of dyadic, situational, and network predictors of injection risk behavior.

PubMed

Janulis, Patrick

2016-01-01

This study explores the risk environment for drug use by examining injection risk behavior during specific injection episodes. By leveraging multiple observations of injection episodes of participants, the study attempts to move beyond global assessment of environmental variables to simultaneously model within (i.e., event level) as well as between (i.e., individual level) predictors of injection risk. Furthermore, gender is also explored as a potential moderator of the relationship between the association of specific partner characteristics (e.g., having an injection partner who is also a sexual partner) and injection risk behavior. Data is used from the Sexual Acquisition of Transmission of HIV Cooperative Agreement Study (SATHCAP). Multilevel structural equation modeling is utilized to predict within and between variations in underlying injection risk behavior as measured using four indicators of injection risk. Results indicated that a number of partner level characteristics (i.e., being emotionally close with the partner, sexual partnership, being a first time partner) and one social situational (i.e., the number of non-injectors present at the injection episode) characteristic predicted event level injection risk behavior. However, the impact of partner characteristics also appears to be moderated by gender of the participants. More specifically, sharing a sexual partnership with an injection partner was more strongly associated with injection risk among females as compared to males and females indicated higher levels of risk when injecting with other females while the partner's gender showed no significant association with risk for male injectors. These results suggest that people who inject drug do report varying levels of risk during different injection episodes and this variation can be explained by partner and situational characteristics. Improved understanding of the social processes surrounding injection episodes is required to further refine harm

Street Policing, Injecting Drug Use and Harm Reduction in a Russian City: A Qualitative Study of Police Perspectives

PubMed Central

Platt, Lucy; Sarang, Anya; Vlasov, Alexander; Mikhailova, Larissa; Monaghan, Geoff

2006-01-01

We undertook a qualitative exploration of police perspectives on injecting drug use and needle and syringe access among injecting drug users (IDUs) in a Russian city which has witnessed explosive spread of HIV associated with drug injecting. Twenty-seven in-depth qualitative interviews were conducted in May 2002 with police officers of varying rank who reported having regular contact with IDUs. All interviews were tape-recorded, transcribed, translated and coded thematically. Accounts upheld an approach to policing which emphasised high street-based visibility and close surveillance of IDUs. IDUs were depicted as ‘potential criminals’ warranting a ‘pre-emptive’ approach to the prevention of drug-related crime. Street policing was described as a means of maintaining close surveillance leading to the official registration of persons suspected or proven to be users of illicit drugs. Such registration enabled further ongoing surveillance, including through stop and search procedures. While aware of drug users' reluctance to carry injecting equipment linked to their fears of detention or arrest, accounts suggested that the confiscation of previously used injecting equipment can constitute evidence in relation to drugs possession charges and that discovery of clean injecting equipment may be sufficient to raise suspicion and/or further investigation, including through stop and search or questioning. Our findings suggest an uneasy relationship between street policing and needle and syringe access, whereby policing strategies can undermine an HIV prevention ethos promoting needle and syringe accessibility among IDUs. We conclude that facilitating partnerships between policing agencies and HIV prevention initiatives are a critical feature of creating environments conducive for risk reduction. PMID:16855880

Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early

PubMed Central

Parolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, Marianna; Cristofalo, Patrizia

2016-01-01

Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents' addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and

Correlates and contexts of U.S. injection drug initiation among undocumented Mexican migrant men who were deported from the United States

PubMed Central

Robertson, Angela M.; Lozada, Remedios; Pollini, Robin A.; Rangel, Gudelia; Ojeda, Victoria D.

2012-01-01

Preventing the onset of injection drug use is important in controlling the spread of HIV and other blood borne infections. Undocumented migrants in the United States face social, economic, and legal stressors that may contribute to substance abuse. Little is known about undocumented migrants’ drug abuse trajectories including injection initiation. To examine the correlates and contexts of U.S. injection initiation among undocumented migrants, we administered quantitative surveys (n=309) and qualitative interviews (n=23) on migration and drug abuse experiences to deported male injection drug users (IDUs) in Tijuana, Mexico. U.S. injection initiation was independently associated with ever using drugs in Mexico pre-migration, younger age at first U.S. migration, and U.S. incarceration. Participants’ qualitative interviews contextualized quantitative findings and demonstrated the significance of social contexts surrounding U.S. injection initiation experiences. HIV prevention programs may prevent/delay U.S. injection initiation by addressing socio-economic and migration-related stressors experienced by undocumented migrants. PMID:22246511

Risk behaviour determinants among people who inject drugs in Stockholm, Sweden over a 10-year period, from 2002 to 2012.

PubMed

Karlsson, Niklas; Santacatterina, Michele; Käll, Kerstin; Hägerstrand, Maria; Wallin, Susanne; Berglund, Torsten; Ekström, Anna Mia

2017-08-16

People who inject drugs (PWID) frequently engage in injection risk behaviours exposing them to blood-borne infections. Understanding the underlying causes that drive various types and levels of risk behaviours is important to better target preventive interventions. A total of 2150 PWID in Swedish remand prisons were interviewed between 2002 and 2012. Questions on socio-demographic and drug-related variables were asked in relation to the following outcomes: Having shared injection drug solution and having lent out or having received already used drug injection equipment within a 12 month recall period. Women shared solutions more than men (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.03; 2.21). Those who had begun to inject drugs before age 17 had a higher risk (OR 1.43, 95% CI 0.99; 2.08) of having received used equipment compared to 17-19 year olds. Amphetamine-injectors shared solutions more than those injecting heroin (OR 2.43, 95% CI 1.64; 3.62). A housing contract lowered the risk of unsafe injection by 37-59% compared to being homeless. Women, early drug debut, amphetamine users and homeless people had a significantly higher level of injection risk behaviour and need special attention and tailored prevention to successfully combat hepatitis C and HIV transmission among PWID. ClinicalTrials.gov Identifier, NCT02234167.

"Now drugs in Libya are much cheaper than food": A qualitative study on substance use among young Libyans in post-revolution Tripoli, Libya.

PubMed

Elamouri, Fauzi Muftah; Musumari, Patou Masika; Techasrivichien, Teeranee; Farjallah, Anwer; Elfandi, Sufian; Alsharif, Osama Fathi; Benothman, Hussein; Suguimoto, S Pilar; Ono-Kihara, Masako; Kihara, Masahiro

2018-03-01

Libya is facing a rapidly growing epidemic of illicit drug use and HIV. This situation is fueled by a complex array of factors, mainly the consequences of the political and military turmoil of the Arab Spring. Although it is extensively documented in other settings that young people are one of the most vulnerable groups to both HIV and illicit drug use, no study has explored this issue among young people in Libya. The current study addresses this research gap. This study is a qualitative study using in-depth interviews guided by a semi-structured questionnaire. We used a maximum variation, purposive sampling strategy to recruit male and female participants, aged 14-18 years, from schools, prisons, and community-based informal re-education and rehabilitation centers in Tripoli, Libya. In total, 31 participants were recruited: 6 females and 25 males. Sixteen participants were prisoners and residents of community-based informal re-education and rehabilitation centers, and 15 were recruited in schools. Risk factors for drug use included peer influence, the increased availability and affordability of drugs, disruption of social life and healthy recreational activities, and the distress and casualties of the war. Protective factors were religious beliefs and practices, good parent-child connectedness, and high self-esteem and future aspiration. Risk factors for HIV were insufficient knowledge related to HIV transmission and unsafe injection practices, such as sharing needles and syringes. We found individual, interpersonal, family, and structural-level factors that interplayed to shape the vulnerability of young people to drug use and HIV infection in Tripoli, Libya. Structural factors, including the increased availability and affordability of drugs, provided the frame within which other factors, such as peer influence, insufficient knowledge of substance use, and HIV, operated to increase the vulnerability of young people to drugs and HIV, while religious beliefs and

Multimodal assessment of spatial distribution of drug-tracer uptake by brain tissue after intra-arterial injections

NASA Astrophysics Data System (ADS)

Singh-Moon, Rajinder; Chaudhuri, Durba; Wang, Mei; Straubinger, Robert; Bigio, Irving J.; Joshi, Shailendra

2014-02-01

It is challenging to track the rapid changes in drug concentrations after intra-arterial (IA) administration to elucidate the pharmacokinetics of this method of drug delivery. Traditional pharmacokinetic parameters (such as protein binding) that are highly relevant to intravenous (IV) administration do not seem to apply to IA injections. Regional drug delivery is affected by the biomechanics of drug injection, resting blood flow, and local tissue extraction. In-vivo and ex-vivo, optical methods for spatial mapping of drug deposition can assist in visualizing drug distributions and aid in the screening of potential drugs and carrier candidates. We present a multimodal approach for the assessment of drug distribution in postmortem tissue specimens using diffuse reflectance spectroscopy, multispectral imaging, and confocal microscopy and demonstrate feasibility of distinguishing route of administration advantages of liposome-dye conjugate delivery. The results of this study suggest that insight on drug dynamics gained by this aggregated approach can be used to help screen and/or optimize potential drug candidates and drug delivery protocols.

Latent Growth Curve Modeling of Non-Injection Drug Use and Condomless Sexual Behavior from Ages 18 to 21 in Gay, Bisexual, and Other YMSM: The P18 Cohort Study.

PubMed

Halkitis, Perry N; Bub, Kristen; Stults, Christopher B; Bates, Francesca C; Kapadia, Farzana

2018-01-02

HIV/AIDS continues to be a health disparity faced by sexual minority men, and is exacerbated by non-injection drug use. We sought to delineate growth in non-injection drug use and condomless sex in a sample of racially and economically diverse of gay, bisexual, and other young men who have sex with men (YMSM) as they emerged into adulthood between the ages of 18 and 21 and who came of age in the post-HAART era. Behavioral data on drug use and condomless sex, collected via a calendar based technique over 7 waves of a cohort study of 600 YMSM, were analyzed using latent growth curve modeling to document patterns of growth in these behaviors, their associations, and the extent to which patterns and associations are moderated by race/ethnicity and socioeconomic status. Significant growth was noted in the frequencies of condomless oral and anal intercourse, alcohol to intoxication, marijuana use, and inhalant nitrate use. High levels of association were noted between all behaviors across time but associations did not differ by either race/ethnicity or socioeconomic status. The link between drug use and risky sexual behavior continue to be evident in YMSM with significant increases in these behaviors demonstrated as YMSM transition between adolescence and young adulthood. Conclusions/Importance: Healthcare for a new generation of sexual minority males must address the synergy of these behaviors and also nest HIV prevention and care within a larger context of sexual minority health that acknowledges the advances made in the last three decades.

Drawing attention to a neglected injecting-related harm: a systematic review of AA amyloidosis among people who inject drugs.

PubMed

Harris, Magdalena; Brathwaite, Rachel; Scott, Jenny; Gilchrist, Gail; Ciccarone, Dan; Hope, Vivian; McGowan, Catherine R

2018-04-26

Chronic skin and soft tissue infections (SSTI) among people who inject drugs (PWID) can lead to AA amyloidosis: a serious, yet neglected, multi-organ disease. We aim to synthesize findings on the epidemiology, risk factors, clinical outcomes, screening recommendations and challenges to treatment for AA amyloidosis among PWID. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the following bibliographic databases in July 2017: CINAHL Plus, Embase, Global Health, MEDLINE, PsycEXTRA, PsycINFO and SCOPUS. Studies were included if they investigated AA amyloidosis in PWID. Studies were not restricted to location, study type, year or language of publication. Study heterogeneity precluded meta-analysis; we present a narrative review of the literature. Thirty-seven papers from eight countries met inclusion criteria. A total of 781 PWID are reported on, of whom 177 had AA amyloidosis. Where disease causality is established, it is attributed to chronic inflammation caused by injecting-related SSTIs. Most (88.7%) PWID with AA amyloidosis had SSTIs. The proportion of PWID with AA amyloidosis at post-mortem ranged from 1.6% (Germany) to 22.5% (Serbia). Biopsy studies reported from 5.26% (Portugal) to 50% (Germany) of AA amyloidosis in PWID with suspected or known kidney disease. Following diagnosis, the typical trajectory for PWID with AA amyloidosis was rapid deterioration of renal function requiring haemodialysis. Treatment difficulties, end-stage renal failure and premature death from sepsis were observed. Good outcomes, including reversibility of AA amyloidosis, are attributed to rapid treatment of the underlining inflammation and injecting cessation. Notably, given the population in question, no studies were published in addiction or harm reduction journals; most (92%) appeared in specialist nephrology and medical journals. There is strong evidence of an association between skin

Controlled-release, pegylation, liposomal formulations: new mechanisms in the delivery of injectable drugs.

PubMed

Reddy, K R

2000-01-01

To review recent developments in novel injectable drug delivery mechanisms and outline the advantages and disadvantages of each. A MEDLINE (1995-January 2000) search using the terms polyethylene glycol, liposomes, polymers, polylactic acid, and controlled release was conducted. Additional references were identified by scanning bibliographies. All articles were considered for inclusion. Abstracts were included only if they were judged to add critical information not otherwise available in the medical literature. A number of systems that alter the delivery of injectable drugs have been developed in attempts to improve pharmacodynamic and pharmacokinetic properties of therapeutic agents. New drug delivery systems can be produced either through a change in formulation (e.g., continuous-release products, liposomes) or an addition to the drug molecule (e.g., pegylation). Potential advantages of new delivery mechanisms include an increased or prolonged duration of pharmacologic activity, a decrease in adverse effects, and increased patient compliance and quality of life. Injectable continuous-release systems deliver drugs in a controlled, predetermined fashion and are particularly appropriate when it is important to avoid large fluctuations in plasma drug concentrations. Encapsulating a drug within a liposome can produce a prolonged half-life and a shift of distribution toward tissues with increased capillary permeability (e.g., tumors, infected tissue). Pegylation provides a method for modification of therapeutic proteins to minimize many of the limitations (e.g., poor stability, short half-life, immunogenicity) associated with these agents. Pegylation of therapeutic proteins is an established process with new applications. However, not all pegylated proteins are alike, and each requires optimization on a protein-by-protein basis to derive maximum clinical benefit. The language required to describe each pegylated therapeutic protein must be more precise to accurately

Incorporating geographic settings into a social network analysis of injection drug use and bloodborne pathogen prevalence.

PubMed

Wylie, John L; Shah, Lena; Jolly, Ann

2007-09-01

Using social network analysis, we investigated how communal meeting places can link injection drug user (IDU) populations and create opportunities for the transmission of bloodborne pathogens. In our locale, specific hotels played a key role in the injection drug scene. Within this hotel network some IDU injected at only one hotel while others injected at multiple hotels; this latter group potentially acted as spatial bridges linking relatively distinct hotel networks. Pathogen prevalence showed a gradation with the highest prevalence occurring at the centre of the network. Consistent with pathogen prevalence, people most central to the network were more likely to engage in risky injection practices. Incorporating geographic place into analyses involving IDU can contribute to an understanding of pathogen transmission patterns in an area and assist public health efforts to develop targeted intervention programs.

Self-report prevalence and associated factors to drug hypersensitivity in Mexican young adults.

PubMed

Bedolla-Barajas, Martín; Puente-Fernández, Cecilia; Flores-Merino, Miriam V; Morales-Romero, Jaime; Domínguez-García, Ma Victoria

2017-07-01

Drug hypersensitivity is defined as any unfavorable reaction that occurs after the administration of any drug. It may or may not be mediated by the involvement of the immune system. Epidemiological data related to drug hypersensitivity reactions in our country are scarce. To determine the prevalence of drug hypersensitivity in a group of young adults, as well as to identify associated factors. A structured questionnaire was applied to young people aged 18 to 25 years. The instrument was oriented to identify reactions of drug hypersensitivity, as well as the most prevalent drugs involved. In addition, a personal and family history of atopic diseases was included. Analysis for associations between variables was been done through logistic regression. The prevalence of drug hypersensitivity reactions was 12% (144 of 1,200). The antibiotics were the agents most related to hypersensitivity reactions (9.8%) followed by nonsteroidal anti-inflammatory drugs (1.6%). Factors associated with drug hypersensitivity were a personal history of asthma, odds ratio (OR) 3.15 (95% confidence interval [CI], 1.44-6.91), maternal and paternal history of drug hypersensitivity, OR 2.33 (95% CI, 1.21-4.48) and OR 3.11 (95% CI, 1.22-7.92), respectively. The results of this research show that drug hypersensitivity in young adults is a highly prevalent event and it is associated with personal history of asthma and history of drug hypersensitivity in parents.

Time trend of injection drug errors before and after implementation of bar-code verification system.

PubMed

Sakushima, Ken; Umeki, Reona; Endoh, Akira; Ito, Yoichi M; Nasuhara, Yasuyuki

2015-01-01

Bar-code technology, used for verification of patients and their medication, could prevent medication errors in clinical practice. Retrospective analysis of electronically stored medical error reports was conducted in a university hospital. The number of reported medication errors of injected drugs, including wrong drug administration and administration to the wrong patient, was compared before and after implementation of the bar-code verification system for inpatient care. A total of 2867 error reports associated with injection drugs were extracted. Wrong patient errors decreased significantly after implementation of the bar-code verification system (17.4/year vs. 4.5/year, p< 0.05), although wrong drug errors did not decrease sufficiently (24.2/year vs. 20.3/year). The source of medication errors due to wrong drugs was drug preparation in hospital wards. Bar-code medication administration is effective for prevention of wrong patient errors. However, ordinary bar-code verification systems are limited in their ability to prevent incorrect drug preparation in hospital wards.

Increasing availability of illicit drugs among people who inject drugs in Bangkok, Thailand.

PubMed

Hayashi, Kanna; Nosyk, Bohdan; Ti, Lianping; Suwannawong, Paisan; Kaplan, Karyn; Wood, Evan; Kerr, Thomas

2013-09-01

In recent years, the Thai government has strengthened drug law enforcement as a strategy to address a continuing epidemic of illicit drug use. We sought to assess temporal trends in street-level availability of illicit drugs among injection drug users (IDUs) in Bangkok, Thailand. Using univariate statistics and multivariate logistic regression, we assessed changes in the availability of five substances (heroin, methamphetamine, crystal methamphetamine, midazolam, and illicit methadone) between 2009 and 2011 and examined social, structural and individual factors influencing availability among community-recruited samples of IDUs in Bangkok. Availability was measured in three levels: immediate (available in ≤10 min); moderate (available in 10-90 min); and delayed (available in >90 min; our reference category). The analyses included 718 IDUs, including 165 (23.0%) women. Controlling for changes in participant characteristics between assessments, and in a period of constant nominal illicit drug prices, moderate availability of all substances increased significantly between 2009 and 2011, with adjusted odds ratios ranging between 2.36 (illicit methadone) and 4.61 (crystal methamphetamine) (all p<0.01). Immediate availability of all substances but heroin also increased (all p<0.01). More immediate availability of methamphetamine was also associated with a history of incarceration (p<0.05). Despite the Thai government's intensified drug suppression efforts, the availability of illicit drugs among IDUs in Bangkok increased significantly between 2009 and 2011. The findings raise concern about the overreliance on drug law enforcement-based approaches and point to the need for greater investment in evidence-based drug policies. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Police Victimization Among Persons Who Inject Drugs Along the U.S.-Mexico Border.

PubMed

Pinedo, Miguel; Burgos, Jose Luis; Zuniga, Maria Luisa; Perez, Ramona; Macera, Caroline A; Ojeda, Victoria D

2015-09-01

Problematic policing practices are an important driver of HIV infection among persons who inject drugs (PWID) in the U.S.-Mexico border region. This study identifies factors associated with recent (i.e., past 6 months) police victimization (e.g., extortion, physical and sexual violence) in the border city of Tijuana, Mexico. From 2011 to 2013, 733 PWID (62% male) were recruited in Tijuana and completed a structured questionnaire. Eligible participants were age 18 years or older, injected illicit drugs within the past month, and spoke Spanish or English. Multivariable logistic regression analyses identified correlates of recent experiences of police victimization (e.g., bribes, unlawful confiscation, physical and sexual violence). Overall, 56% of PWID reported a recent police victimization experience in Tijuana. In multivariable logistic regression analyses, factors independently associated with recent police victimization included recent injection of methamphetamine (adjusted odds ratio [AOR] = 1.62; 95% CI [1.18, 2.21]) and recently received injection assistance by a "hit doctor" (AOR = 1.56; 95% CI [1.03, 2.36]). Increased years lived in Tijuana (AOR = 0.98 per year; 95% CI [0.97, 0.99]) and initiating drug use at a later age (AOR = 0.96 per year; 95% CI [0.92, 0.99]) were inversely associated with recent police victimization. Physical drugusing markers may increase PWID susceptibility to police targeting and contribute to experiences of victimization. Interventions aimed at reducing police victimization events in the U.S.-Mexico border region should consider PWID's drug-using behaviors. Reducing problematic policing practices may be a crucial public health strategy to reduce HIV risk among PWID in this region.

The Cost of Drug Use in Adolescence: Young People, Money and Substance Abuse

ERIC Educational Resources Information Center

McCrystal, Patrick; Percy, Andrew; Higgins, Kathryn

2007-01-01

It is now common for young people in full-time compulsory education to hold part-time jobs. However, while the 1990s experienced a rise in illicit drug use particularly among young people and an increase in the level of interest in identifying factors associated with drug use, little attention has been paid to the influence of the money young…

The dynamics of injection drug users' personal networks and HIV risk behaviors.

PubMed

Costenbader, Elizabeth C; Astone, Nan M; Latkin, Carl A

2006-07-01

While studies of the social networks of injection drug users (IDUs) have provided insight into how the structures of interpersonal relationships among IDUs affect HIV risk behaviors, the majority of these studies have been cross-sectional. The present study examined the dynamics of IDUs' social networks and HIV risk behaviors over time. Using data from a longitudinal HIV-intervention study conducted in Baltimore, MD, this study assessed changes in the composition of the personal networks of 409 IDUs. We used a multi-nomial logistic regression analysis to assess the association between changes in network composition and simultaneous changes in levels of injection HIV risk behaviors. Using the regression parameters generated by the multi-nomial model, we estimated the predicted probability of being in each of four HIV risk behavior change groups. Compared to the base case, individuals who reported an entirely new set of drug-using network contacts at follow-up were more than three times as likely to be in the increasing risk group. In contrast, reporting all new non-drug-using contacts at follow-up increased the likelihood of being in the stable low-risk group by almost 50% and decreased the probability of being in the consistently high-risk group by more than 70%. The findings from this study show that, over and above IDUs' baseline characteristics, changes in their personal networks are associated with changes in individuals' risky injection behaviors. They also suggest that interventions aimed at reducing HIV risk among IDUs might benefit from increasing IDUs' social contacts with individuals who are not drug users.

Attitudes of regular injecting drug users towards the legal status of the major illicit drugs.

PubMed

Darke, Shane; Torok, Michelle

2013-09-01

The study aimed to determine injecting drug users' (IDU) attitudes, and correlates of attitudes, towards continued prohibition, decriminalisation or legalisation of the major illicit drugs. This study used structured interview with 300 IDUs who had injected on at least a weekly basis over the preceding 12 months. Methamphetamine was rated the most harmful of the five illicit substances and cannabis the lowest. By far the highest level of support for legislative change was for cannabis, with only 8.7% supporting continued prohibition. While there was majority support for change to the legal status of heroin, the modal position was for decriminalisation. Support for changing the status of the three illicit psychostimulants was low, with the majority believing that methamphetamine (63.3%), cocaine (53.3%) and 3,4-methylenedioxy-N-methylamphetamine (53.3%) should remain illegal. Demographic characteristics were largely unrelated to attitudes. Lower levels of perceived harm were associated with increased likelihood of support for legalisation of all substances. Recent use was positively related to support for both decriminalisation and legality of heroin, but was not associated with views on other substances. Higher lifetime polydrug use was associated with support for the legalisation of heroin, methamphetamine, cocaine and 3,4-methylenedioxy-N-methylamphetamine. IDUs expressed nuanced views on different substances. In policy debates, care should be taken not to speak for IDUs by imputing their beliefs. It is clear that the fact that a group uses illegal drugs does not necessarily imply that they support changes to their legal status. © 2013 Australasian Professional Society on Alcohol and other Drugs.

When the dragon's awake: a needs assessment of people injecting drugs in a small urban centre.

PubMed

Gustafson, Diana L; Goodyear, Lesley; Keough, Fran

2008-06-01

St. John's, Newfoundland and Labrador is one of the smallest Canadian provincial capitals. Like other Canadian coastal communities, St. John's has been affected by dramatic economic and institutional restructuring that negatively impacted community health. Marginalized populations including people who inject drugs are more negatively affected by the gap between health needs and available services. A mixed methods needs assessment began with a survey and key informant and focus group interviews to determine attitudes, knowledge, and practices of people with current or previous experience injecting drugs. An environmental scan of programmes and services was conducted followed by a community consultation with key stakeholders, community agencies, study participants, the media, and members of the public to share and validate findings, solicit feedback, and gather data about future knowledge transfer activities. This paper examines two of the five barriers to health and health services for people injecting drugs: First, there was a discrepancy amongst people injecting drugs between awareness and use of safer practices, and second, there was a limited formalized network of health and social programmes and services. Accurate and timely information about safer practices, whilst an essential component of a harm reduction approach, is insufficient to reduce the risk of negative health outcomes for people injecting drugs. Funding new programmes and services, although desirable, is not always feasible in small urban centres with limited human and material resources. Recommendations for promoting health, reducing harm, and building local capacity must consider these limitations. Registered nurses are well positioned to provide leadership through collaborative community-based research, education and advocacy.

Macro Social Flaws and Intervention's Unfinished Business: A Personal Note on Young People's Drug Use in Hong Kong.

PubMed

Cheung, Yuet W

2015-01-01

This paper traces how social, economic, and cultural changes in Hong Kong in the past five decades might have affected the pattern of illicit drug use among young people in Hong Kong. The prevalence of illicit drug use by young people had been very low before the 1990s, and like adult users, young users mostly used heroin. This pattern of drug use started to change in the late 1990s, when there was a sudden upsurge of drug use among young people, and psychoactive drugs such as ketamine quickly replaced heroin as the most popular drugs among them. An attempt is made to explain the new pattern of young people's drug use with respect to the changes of the social, economic and cultural conditions of Hong Kong since the 1960s, making use of Beck's risk society perspective and Parker's concept of normalization of recreational drug use. The identification of macro social flaws points to the need to address societal factors impeding successful interventions, which will involve reducing the blockage of upward mobility for young people, and providing them with the latest scientific knowledge of the physical and mental damages of ketamine and other psychoactive drugs for their better understanding of the risk of drug use.

Narrating the social relations of initiating injecting drug use: transitions in self and society.

PubMed

Rhodes, Tim; Bivol, Stela; Scutelniciuc, Otilia; Hunt, Neil; Bernays, Sarah; Busza, Joanna

2011-11-01

Few studies have explored drug injectors' accounts of their initiation of others into injecting. There also lacks research on the social relations of initiating injecting drug use in transitional society. We draw upon analyses of 42 audio-recorded semi-structured interviews with current and recent injecting drug users, conducted in 2009 in the Republic of Moldova, a transitional society of south-eastern Europe. A thematic analysis informed by narrative theory was undertaken, focusing on accounts of self-initiation and the initiation of others. We also reflect upon the potential of peer efforts to dissuade would-be injectors from initiating. Findings emphasise initiation into injecting as a symbolic identity transition, enabled through everyday social relations. In turn, our analysis locates the drug transitions of the self inside an account of societal transition. We find that personal narratives of self transition are made sense of, and presented, in relation to broader narratives of social transition and change. Furthermore, we explore how narratives of self-initiation, and especially the initiation of others, serve to negotiate initiation as a moral boundary crossing. Self-initiation is located inside an account of transitioning social values. In looking back, initiation is depicted as a feature of a historically situated aberration in normative values experienced by the 'transition generation'. Accounts of the initiation of others (which a third of our sample describe) seek to qualify the act as acceptable given the circumstances. These accounts also connect the contingency of agency with broader narratives of social condition. Lastly, the power of peers to dissuade others from initiating injection was doubted, in part because most self-initiations were accomplished as a product of agency enabled by environment as well as in the face of peer attempts to dissuade. Copyright © 2011. Published by Elsevier B.V.

Vitamin A levels and human immunodeficiency virus load in injection drug users.

PubMed Central

Semba, R D; Farzadegan, H; Vlahov, D

1997-01-01

Although low plasma vitamin A levels are associated with increased mortality and higher vertical transmission during human immunodeficiency virus (HIV) infection, it is unknown whether plasma low vitamin A levels are a marker for circulating HIV load. We conducted a cross-sectional study within a prospective cohort study of injection drug users in order to evaluate the relationship between plasma vitamin A levels and HIV viral load. Plasma vitamin A level was measured by high-performance liquid chromatography. Infectious viral load was measured by quantitative microculture of serial fivefold dilutions of 10(6) peripheral blood mononuclear cells. A total of 284 HIV-infected adults (79 women, 205 men) were studied. Plasma vitamin A levels consistent with deficiency were found in 28.9% of adults. A total of 38.0% of women and 25.3% of men had vitamin A deficiency (P < 0.04). The median infectious viral load for the entire study population was 8 infectious units per million cells. No significant relationship between plasma vitamin A levels and infectious viral load was observed in these injection drug users. This study suggests that there is no correlation between HIV viral load and plasma vitamin A levels in injection drug users, and these variables may represent independent risk factors during HIV infection. HIV-infected adult women appear to be at higher risk of developing vitamin A deficiency. PMID:9008289

Effects of the Affordable Care Act's young adult insurance expansion on prescription drug insurance coverage, utilization, and expenditures.

PubMed

Look, Kevin A; Arora, Prachi

2016-01-01

The US Affordable Care Act (ACA) extended the age of eligibility for young adults to remain on their parents' health insurance plans in order to address the disproportionate number of uninsured young adults in the United States. Effective September 23, 2010, the ACA has required all private health insurance plans to cover dependents until the age of 26. However, it is unknown whether the ACA dependent coverage expansion had an impact on prescription drug insurance or the use of prescription drugs. To evaluate short-term changes in prescription health insurance coverage, prescription drug insurance coverage, prescription drug use, and prescription drug expenditures following implementation of the ACA young adult insurance expansion using national data from 2009 and 2011. Full-year health insurance coverage increased 4.9 percentage points during the study period, which was mainly due to increases in private health insurance among middle- and high-income young adults. In contrast, full-year prescription drug insurance coverage increased 5.5 percentage points and was primarily concentrated among high-income young adults. Although no significant short-term changes in overall prescription drug use were observed, a 30% decrease in out-of-pocket expenditures was seen among young adults. While the main goal of the ACA's young adult insurance expansion was to increase health insurance coverage among young adults, it also had the unintended positive effect of increasing coverage for prescription drug insurance. Additionally, young adults experienced substantial decreases in out-of-pocket spending for prescription drugs. It is important for evaluations of health care policies to assess both intended and unintended outcomes to better understand the implications for the broader health system. Copyright © 2015 Elsevier Inc. All rights reserved.

Coffee shops and clinics: the give and take of doing HIV/AIDS research with injecting drug users.

PubMed

Marsh, A; Loxley, W

1992-06-01

We discuss recruiting and interviewing injecting drug users and using research as health promotion in the context of collecting information related to human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) from a convenience sample of 200 injecting drug users, half in treatment and half not, in 1989 and 1990 in Perth, Western Australia. A variety of recruiting methods were used including advertising, referral by agency staff, 'snowballing' and approaches to personal contacts and others known to inject by the interviewer. Snowballing and personal contacts were the most successful means of recruiting those not in treatment, while advertising was comparatively unsuccessful with this group because of the importance of establishing the credibility of the study and the interviewer among injecting drug users before they will volunteer to be involved. The promotion of behavioural risk reduction among respondents during the interview is detailed. We argue that the traditionally rigid separation between research and intervention is inappropriate in the HIV/AIDS context. When lives are potentially at stake, any contact with injecting drug users, especially those not in treatment (where may receive HIV/AIDS education), must be used as an HIV/AIDS prevention opportunity, and the interview is an ideal opportunity. The employment of research as community intervention is also discussed.

Patterns of drug treatment entry by Latino male injection drug users from different national/geographical backgrounds.

PubMed

Reynoso-Vallejo, Humberto; Chassler, Deborah; Witas, Julie; Lundgren, Lena M

2008-02-01

This study examined patterns of treatment entry by Puerto Rican, Central American, Dominican, and other Latino male injection drug users (IDUs) in the state of Massachusetts over the time period 1996-2002. Specifically, it explored whether these populations had different patterns relative to three paths: entry into detoxification only, entry into residential treatment, or entry into methadone maintenance. Using a state-level MIS dataset on all substance abuse treatment entries to all licensed treatment programs, bi-variate and logistic regression methods were employed to examine patterns of drug treatment utilization among Latino men residing in Massachusetts. Three logistic regression models, which controlled for age, education, homelessness, employment, history of mental health treatment, health insurance, criminal justice involvement, having injected drugs in the past month, and number of treatment entries, indicated that Puerto Rican men were significantly less likely to only use detoxification services and residential treatment services, and significantly more likely to enter methadone maintenance compared to Latino men from Central American, Dominican, or other Latino backgrounds. For example, Central American men were 2.4 times more likely to enter only detoxification programs and 54% less likely to enter methadone maintenance programs than Puerto Rican male IDUs. For program planning, include the need to (a) develop varied drug treatment services to meet the needs of non-homogenous Latino groups within the population, (b) tailor outreach efforts to effectively reach all Latino groups, and (c) increase awareness among practitioners of differential patterns of treatment utilization.

Outreach-based HIV prevention for injecting drug users: a review of published outcome data.

PubMed Central

Coyle, S L; Needle, R H; Normand, J

1998-01-01

OBJECTIVE: Over the past decade, a body of observational research has accrued about the effects of outreach-based human immunodeficiency virus (HIV) interventions for drug users. The authors reviewed the findings related to postintervention behavior changes and integrated findings across studies to provide the best estimate of program impact. METHODS: The authors conducted a computerized literature search to locate published accounts of HIV intervention effects on drug users. Thirty-six publications covered outreach-based HIV risk reduction interventions for out-of-treatment injecting drug users (IDUs) and reported intervention effects on HIV-related behaviors or HIV seroincidence. Two-thirds of the publications reported that participation in street-based outreach interventions was followed with office-based HIV testing and counseling. The authors described the theoretical underpinnings of outreach intervention components, the content of the interventions, and the outcome measures that investigators used most frequently. The authors also described and critiqued the evaluation study designs that were in place. Because most of the evaluations were based on pretest and posttest measures of behavior rather than on controlled studies, results were examined with respect to accepted criteria for attributing intervention causality, that is, the plausibility of cause and effect, correct temporal sequence, consistency of findings across reports, strength of associations observed, specifically of associations, and dose-response relationships between interventions and observed outcomes. RESULTS: The majority of the published evaluations showed that IDUs in a variety of places and time periods changed their baseline drug-related and sex-related risk behaviors following their participation in a outreach-based HIV risk reduction intervention. More specifically, the publications indicated that IDUs regularly reported significant follow-up reductions in drug injection, multiperson

Circular Migration by Mexican Female Sex Workers Who are Injection Drug Users: Implications for HIV in Mexican Sending Communities

PubMed Central

Ojeda, Victoria D.; Burgos, José Luis; Hiller, Sarah P.; Lozada, Remedios; Rangel, Gudelia; Vera, Alicia; Artamonova, Irina; Rodriguez, Carlos Magis

2013-01-01

Background Circular migration and injection drug use increase the risk of HIV transmission in sending communities. We describe female sex workers who are injection drug users’ (FSW-IDUs) circular migration and drug use behaviors. Methods Between 2008-2010, 258 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. Results 24% of FSW-IDUs were circular migrants. HIV prevalence was 3.3% in circular migrants and 6.1% in non-circular migrants; 50% of circular and 82% of non-circular migrants were unaware of their HIV infection. Among circular migrants, 44% (n=27) consumed illicit drugs in their birthplace; 70% of these (n=20) injected drugs and one-half of injectors shared injection equipment in their birthplace. Women reporting active social relationships were significantly more likely to return home. Discussion Circular migrant FSW-IDUs exhibit multiple HIV risks and opportunities for bridging populations. Regular HIV testing and treatment and access to substance use services is critical for FSW-IDUs and their sexual/drug-using contacts. PMID:21833727

Addressing the HIV/AIDS Epidemic Among Puerto Rican People Who Inject Drugs: The Need for a Multiregion Approach

PubMed Central

Gelpí-Acosta, Camila; Albizu-García, Carmen E.; González, Ángel; Des Jarlais, Don C.; Santiago-Negrón, Salvador

2014-01-01

High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue. Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence. These disparities should be addressed by the development of a federally supported Northeast–Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions. PMID:25211722

Addressing the HIV/AIDS epidemic among Puerto Rican people who inject drugs: the need for a multiregion approach.

PubMed

Deren, Sherry; Gelpí-Acosta, Camila; Albizu-García, Carmen E; González, Ángel; Des Jarlais, Don C; Santiago-Negrón, Salvador

2014-11-01

High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue. Injection drug use as a risk for HIV is still overrepresented among Puerto Ricans. Lower availability of syringe exchanges, drug abuse treatment, and antiretroviral treatment for PWID in Puerto Rico contribute to higher HIV risk and incidence. These disparities should be addressed by the development of a federally supported Northeast-Puerto Rico collaboration to facilitate and coordinate efforts throughout both regions.

Treatment helps young women preserve fertility during breast cancer chemo

Cancer.gov

Researchers have found that young women with breast cancer were able to better preserve their fertility during cancer treatments by using hormone-blocking drug injections that put them into temporary menopause. The results announced today at the annual me

Injection drug users trained by overdose prevention programs: Responses to witnessed overdoses

PubMed Central

Lankenau, Stephen E.; Wagner, Karla D.; Silva, Karol; Kecojevic, Aleksander; Iverson, Ellen; McNeely, Miles; Kral, Alex H.

2012-01-01

In response to the growing public health problem of drug overdose, community-based organizations have initiated overdose prevention programs (OPP), which distribute naloxone, an opioid antagonist, and teach overdose response techniques. Injection drug users (IDUs) have been targeted for this intervention due to their high risk for drug overdose. Limited research attention has focused on factors that may inhibit or prevent IDUs who have been trained by OPPs to undertake recommended response techniques when responding to a drug overdose. IDUs (n=30) trained by two OPPs in Los Angeles were interviewed in 2010–11 about responses to their most recently witnessed drug overdose using an instrument containing both open and closed-ended questions. Among the 30 witnessed overdose events, the victim recovered in 29 cases while the outcome was unknown in one case. Participants responded to overdoses using a variety of techniques taught by OPP. Injecting the victim with naloxone was the most common recommended response while other recommended responses included stimulating the victim with knuckles, calling 911, and giving rescue breathing. Barriers preventing participants from employing recommended response techniques in certain circumstances included prior successes using folk remedies to revive a victim, concerns over attracting police to the scene, and issues surrounding access to or use of naloxone. Practical solutions, such as developing booster sessions to augment OPP, are encouraged to increase the likelihood that trained participants respond to a drug overdose with the full range of recommended techniques. PMID:22847602

What are the factors associated with HIV testing among male injecting and non-injecting drug users in Lashio, Myanmar: a cross-sectional study.

PubMed

Saw, Yu Mon; Yasuoka, Junko; Saw, Thu Nandar; Poudel, Krishna C; Tun, Soe; Jimba, Masamine

2013-06-20

HIV testing is an effective intervention for reducing HIV risk and providing information on HIV status. However, uptake of HIV testing is a major challenge within the drug-using population due to the stigma and discrimination associated with their illegal drug use behaviours. This study thus aimed to identify factors associated with HIV testing among injecting drug users (IDUs) and non-injecting drug users (NIDUs) in Lashio, Myanmar. A cross-sectional study was conducted from January 2010 to February 2010. This study was carried out in Lashio city, Northern Shan State, Myanmar. In total, 158 male IDUs and 210 male NIDUs were recruited using a respondent-driven sampling method. Proportion of both drug users who were ever tested for HIV and factors associated with HIV testing. Approximately 77% of IDUs and 46% of NIDUs were ever tested for HIV. The multivariate analysis revealed that having ever received drug treatment was positively associated with HIV testing among both IDUs (adjusted OR (AOR) 13.07; 95% CI 3.38 to 50.53) and NIDUs (AOR 3.58; 95% CI 1.38 to 9.24). IDUs who were married (AOR 0.24; 95% CI 0.06 to 0.94) and who injected at least twice daily (AOR 0.30; 95% CI 0.09 to 0.97) were less likely to undergo HIV testing. Among NIDUs, those who belonged to Shan (AOR 0.30; 95% CI 0.11 to 0.84) or Kachin (AOR 0.30; 95% CI 0.10 to 0.87) ethnicities were less likely to test for HIV. IDUs and NIDUs who have received drug treatment are more likely to test for HIV. Integrating HIV testing into drug treatment programmes alongside general expansion of HIV testing services may be effective in increasing HIV testing uptake among both IDUs and NIDUs in the Northern Shan State of Myanmar.

The Chinese Youth Attitudes toward Young Drug Users scale: an initial scale development and refinement.