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Caulkins JP, Tallaksen A, Taylor J, Kilmer B, Reuter P. The Baltic and Nordic responses to the first Taliban poppy ban: Implications for Europe & synthetic opioids today. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104314. [PMID: 38183860 DOI: 10.1016/j.drugpo.2023.104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
The 2000-2001 and the 2022-2023 Taliban opium bans were and could be two of the largest ever disruptions to a major illegal drug market. To help understand potential implications of the current ban for Europe, this paper analyzes how opioid markets in seven Baltic and Nordic countries responded to the earlier ban, using literature review, key informant interviews, and secondary data analysis. The seven nations' markets responded in diverse ways, including rebounding with the same drug (heroin in Norway), substitution to a more potent opioid (fentanyl replacing heroin in Estonia), and substitution to one with lower risk of overdose (buprenorphine replacing heroin in Finland). The responses were not instantaneous, but rather evolved, sometimes over several years. This variety suggests that it can be hard to predict how drug markets will respond to disruptions, but two extreme views can be challenged. It would be naive to imagine that drug markets will not adapt to shocks, but also unduly nihilistic to presume that they will always just bounce back with no lasting effects. Substitution to another way of meeting demand is possible, but that does not always negate fully the benefits of disrupting the original market. Nonetheless, there is historical precedent for a European country's opioid market switching to synthetic opioids when heroin supplies were disrupted. Given how much that switch has increased overdose rates in Canada and the United States, that is a serious concern for Europe at present. A period of reduced opioid supply may be a particularly propitious time to expand treatment services (as Norway did in the early 2000s).
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Affiliation(s)
- Jonathan P Caulkins
- Carnegie Mellon University Heinz College, 5000 Forbes Ave., Pittsburgh PA 15213, USA.
| | - Amund Tallaksen
- The Council of State Governments Justice Center, 22 Cortland St., Floor 22, New York, NY 10007, USA
| | - Jirka Taylor
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Beau Kilmer
- RAND Drug Policy Research Center, 1776 Main St., Santa Monica, CA 90401, USA
| | - Peter Reuter
- University of Maryland, 7251 Preinkert Drive, College Park, MD 20742, USA
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Karamouzian M, Buxton JA, Hategeka C, Nosova E, Hayashi K, Milloy MJ, Kerr T. Shifts in substance use patterns among a cohort of people who use opioids after delisting of OxyContin in BC, Canada: An interrupted time series study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103852. [PMID: 36122483 PMCID: PMC9885984 DOI: 10.1016/j.drugpo.2022.103852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND OxyContin was delisted from Canadian provincial drug formularies in March 2012 and replaced with a reformulated tamper-resistant form of oxycodone (i.e., OxyNeo). We assessed if delisting of OxyContin was associated with changes in the use of unregulated opioids and other substances among people who use opioids (PWUO). METHODS Data were derived from two prospective cohort studies of people who use drugs in Vancouver, BC, Canada from 2006 to 2018. PWUO who had at least one follow-up visit before and after delisting of OxyContin were included. Outcomes of interest were self-reported regular (i.e., at least weekly) use of heroin, non-prescribed prescription opioids, cannabis, methamphetamine, crack cocaine, and powder cocaine during the previous six months. Using quasi-experimental interrupted time series, we fit generalized least squares models to assess participants' immediate and long-term substance use practices after the policy change. RESULTS We analyzed data from 1014 participants who contributed to 17457 visits during the study. Following the delisting of OxyContin, heroin use increased immediately by 5.17% (95% confidence intervals [CI]: 0.68 to 9.67) and over time by 0.47% (0.35 to 0.58) per month. Non-prescribed prescription opioid use increased immediately by 1.80% (0.10 to 3.50) and over time by 0.16% (0.12 to 0.19) per month. Cannabis use increased immediately by 4.37% (0.88 to 7.87) and over time by 0.11% (0.02 to 0.19) per month. Methamphetamine use did not increase immediately but increased over time by 0.10% (0.01 to 0.18) per month. Crack cocaine use decreased immediately by 6.13% (-10.94 to -1.69) but not significantly over time. Lastly, powder cocaine use did not increase immediately or over time. CONCLUSIONS Delisting of OxyContin in BC was not associated with a reduction in unregulated opioid use among PWUO. Our findings point to a shift in substance use patterns of PWUO post-intervention and further highlight the unintended consequences of supply-reduction interventions in addressing the opioid epidemic.
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Affiliation(s)
- Mohammad Karamouzian
- British Columbia Centre on Substance use, Vancouver, BC, Canada, V6Z 2A9; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, V6T 1Z3; Centre on Drug Policy Evaluation, Saint Michael...s Hospital, Toronto, ON, CANADA, M5B 1T8.
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, V6T 1Z3
| | - Celestin Hategeka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115,USA; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, V6T 1Z3
| | - Ekaterina Nosova
- British Columbia Centre on Substance use, Vancouver, BC, Canada, V6Z 2A9
| | - Kanna Hayashi
- British Columbia Centre on Substance use, Vancouver, BC, Canada, V6Z 2A9
| | - M-J Milloy
- British Columbia Centre on Substance use, Vancouver, BC, Canada, V6Z 2A9; Department of Medicine, University of British Columbia, Vancouver, BC, Canada, V6Z 1Y6
| | - Thomas Kerr
- British Columbia Centre on Substance use, Vancouver, BC, Canada, V6Z 2A9; Department of Medicine, University of British Columbia, Vancouver, BC, Canada, V6Z 1Y6
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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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A rapid review of the impacts of "Big Events " on risks, harms, and service delivery among people who use drugs: Implications for responding to COVID-19. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103127. [PMID: 33549464 PMCID: PMC7816610 DOI: 10.1016/j.drugpo.2021.103127] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND "Big Events" are major disruptions to physical, political, and economic environments that can influence vulnerability to drug-related harms. We reviewed the impacts of Big Events with relevance to the COVID-19 pandemic on drug-related risk and harms and access to drug treatment and harm reduction services. METHODS We conducted a rapid review of quantitative, qualitative, and mixed methods literature relating to the following Big Events: respiratory infection pandemics, natural disasters, financial crises, and heroin shortages. Included studies reported data on changes to risks, harms, and/or service provisioning for people who use illicit drugs (other than cannabis) in the context of these Big Events. Searches were conducted in PubMed in May 2020, and two reviewers screened studies for inclusion. Peer-reviewed studies published in English or French were included. We used a narrative synthesis approach and mapped risk pathways identified in the literature. RESULTS No studies reporting on respiratory infection pandemics were identified. Twelve studies reporting on natural disaster outcomes noted marked disruption to drug markets, increased violence and risk of drug-related harm, and significant barriers to service provision caused by infrastructure damage. Five studies of the 2008 global financial crisis indicated increases in the frequency of drug use and associated harms as incomes and service funding declined. Finally, 17 studies of heroin shortages noted increases in heroin price and adulteration, potentiating drug substitutions and risk behaviors, as well as growing demand for drug treatment. CONCLUSION Current evidence reveals numerous risk pathways and service impacts emanating from Big Events. Risk pathway maps derived from this literature provide groundwork for future research and policy analyses, including in the context of the COVID-19 pandemic. In light of the findings, we recommend responding to the pandemic with legislative and financial support for the flexible delivery of harm reduction services, opioid agonist treatment, and mental health care.
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White G, Luczak SE, Mundia B, Goorah S. Exploring the Perceived Risks and Benefits of Heroin Use among Young People (18-24 Years) in Mauritius: Economic Insights from an Exploratory Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176126. [PMID: 32842510 PMCID: PMC7503563 DOI: 10.3390/ijerph17176126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
The decreasing age of young people injecting illicit drugs is an under-reported challenge for the prevention of HIV transmission worldwide. Young people aged 15-24 years represent 1 in 5 persons living with HIV in Mauritius where the epidemic is driven by injecting drug use and risky sexual behaviours. We recruited 22 heroin users aged 18-24 and 5 service providers working in harm reduction (HR) for the present study. Qualitative data were collected through unstructured interviews. We adopted an economic framework and an inductive approach to the analysis, which implied revising codes and themes. The risks heroin users described as consumers of illicit drugs and as clients of HR services could not be analyzed in isolation. Polydrug use emerged as a recurrent coping mechanism resulting from the changing dynamics within the heroin market. The risks faced by women went beyond addiction and infection with HIV. How participants viewed the risks and benefits linked to using heroin was greatly influenced by gaps in knowledge that left room for uncertainty and reinforcing mechanisms such as peer influence. The study shows that qualitative research can produce in-depth socio-behavioural insights required to produce more effective services for young people.
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Affiliation(s)
- Gareth White
- Health Policy and Financing Unit, Department of Public Health, Institute of Tropical Medicine Antwerp, 2000 Antwerp, Belgium
- Correspondence:
| | - Susan E. Luczak
- Department of Psychology, Dornsife College of Letters, Arts, and Science, University of Southern California, Los Angeles, CA 90089-1061, USA;
| | - Bernard Mundia
- Kenya AIDS NGO Consortium, Regent Court, P.O Box 69866-00400 Nairobi, Kenya;
| | - Smita Goorah
- Department of Medicine, Faculty of Science, University of Mauritius, Réduit 80837, Mauritius;
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Tyree GA, Mosery N, Closson EF, Mabude Z, du Toit C, Bangsberg DR, Safren SA, Mayer KH, Smit JA, Mimiaga MJ, Grelotti DJ. Trajectories of initiation for the heroin-based drug whoonga - qualitative evidence from South Africa. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102799. [PMID: 32535541 PMCID: PMC7493467 DOI: 10.1016/j.drugpo.2020.102799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 03/04/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Whoonga is a smoked heroin-based street drug that first emerged in South Africa a decade ago. While previous scientific reports suggest that use is growing and youth are particularly vulnerable, trajectories of initiation are not well characterized. METHODS In 2015, 30 men undergoing residential addiction treatment for this smoked heroin drug in KwaZulu-Natal, South Africa participated in semi-structured interviews about their experiences using the drug. Interview data were coded using qualitative content analysis. RESULTS Participant trajectories to initiating smoked heroin were "vertical" in the context of marijuana use or "horizontal" in the context of other hard drug use. Participants reporting vertical trajectories began smoking heroin as youth at school or in other settings where people were smoking marijuana. Several participants with horizontal trajectories started smoking heroin to address symptoms of other drug or alcohol addiction. Social influences on initiation emerged as an overarching theme. Members of participants' social networks who were smoking or distributing heroin figured prominently in initiation narratives. Surprisingly, references to injection drug use were absent from initiation narratives. Participants reported people who smoke heroin differ from those who inject heroin by race. CONCLUSION Consistent with theories implicating social and structural influences on substance use initiation, people who started smoking heroin had social contacts who smoked heroin and frequented places where substance use was common. Smoked heroin initiation for several participants with horizontal trajectories may have been averted if they accessed evidence-based treatments for stimulant or alcohol use disorders. With increasing reports of heroin use across Africa, a coordinated approach to address this growing epidemic is needed. However, because smoked heroin and injection heroin use occur in distinct risk environments, interventions tailored to people who use smoked heroin will be needed to prevent smoked heroin use, prevent transition to injection use, and mitigate other social harms.
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Affiliation(s)
- Griffin A Tyree
- University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Nzwakie Mosery
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaegology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, Suite 1108-9, Commercial City, Durban, KwaZulu-Natal 4001, South Africa
| | - Elizabeth F Closson
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States
| | - Zonke Mabude
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaegology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, Suite 1108-9, Commercial City, Durban, KwaZulu-Natal 4001, South Africa
| | - Carol du Toit
- SANCA Durban Alcohol & Drug Centres, 185 Vause Road, Durban, KwaZulu-Natal 4001, South Africa
| | - David R Bangsberg
- OHSU-PSU School of Public Health, 506 SW Mill Street, Portland, OR 97201, United States
| | - Steven A Safren
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States; University of Miami, 1320 S Dixie Highway, Coral Gables, FL 33146, United States
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Jennifer A Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaegology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, Suite 1108-9, Commercial City, Durban, KwaZulu-Natal 4001, South Africa
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, United States; Brown University, School of Public Health, 121 S Main Street, Providence, RI 02903, United States; Alpert Medical School, 222 Richmond Street, Providence, RI 02903, United States
| | - David J Grelotti
- University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, United States; HIV Neurobehavioral Research Program, University of California, San Diego, 220 Dickinson Street, San Diego, CA 92103, United States.
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Thomas N, van de Ven K, Mulrooney KJD. The impact of rurality on opioid-related harms: A systematic review of qualitative research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 85:102607. [PMID: 31864787 DOI: 10.1016/j.drugpo.2019.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/02/2019] [Accepted: 11/10/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Over the past decade, there has been mounting recognition that opioid use and related mortality and morbidity is a significant public health problem in rural, non-urban areas across the globe. Taking what has been termed the 'opioid crisis' as a starting off point, this article aims to systematically review the qualitative literature on the ways in which rurality shapes the risk for opioid-related harm. METHODS A systematic review was undertaken using database searches and secondary reference list searches for qualitative literature on rural and non-urban opioid-related harms. A total of 32 qualitative studies met the inclusion criteria. Data extraction was performed in NVivo 12 using a codebook based on the 'risk environment' framework. RESULTS The findings explore how rurality shapes the risk environment for opioid-related harms through four environment influences: (1) economic conditions, including economic transition and deindustrialisation that has occurred in many rural areas, and the high levels of economic distress experienced by rural residents; (2) physical conditions, including a lack of infrastructure and recreation opportunities, larger geographic distances, and limited transportation; (3) social conditions, where social networks could be both protective but also amplify risk through a lack of knowledge about treatment and risk behaviours, a lack of anonymity and stigmatisation of people who use opioids in rural areas; and (4) policy conditions including limited coverage and availability of harm reduction and drug treatment services, and stigmatising service provider practices. CONCLUSIONS The impact of rurality on risk of opioid-related harm is multifaceted. We suggest that future research on rural opioid use would benefit from drawing on the theoretical toolkit of rural criminology to attend to the ways the 'rural crisis', and attendant insecurities, anxieties and strains, impacts upon rural communities and shapes risk, along with how socio-cultural characteristics of the rural 'organise' risks of drug use.
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Affiliation(s)
- Natalie Thomas
- Centre for Rural Criminology, University of New England, Armidale, New South Wales, Australia; School of Humanities, Arts, and Social Sciences, University of New England, Armidale, New South Wales, Australia.
| | - Katinka van de Ven
- Centre for Rural Criminology, University of New England, Armidale, New South Wales, Australia; Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia
| | - Kyle J D Mulrooney
- Centre for Rural Criminology, University of New England, Armidale, New South Wales, Australia; School of Humanities, Arts, and Social Sciences, University of New England, Armidale, New South Wales, Australia
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Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya. Addict Behav 2019; 93:20-28. [PMID: 30682678 DOI: 10.1016/j.addbeh.2019.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Gender dynamics and interpersonal relations within intimate partnerships are known to determine health behaviors, including substance use, within couples. In addition, influence from intimate partners may occur in the context of wider social ecological determinants of health behavior. The aim of this study was to document the role of intimate partners in influencing injecting drug use among women in Kenya, where injecting drug use is on the rise. METHODS We performed secondary data analysis of an existing dataset from a 2015 qualitative study involving 45 women who inject drugs and 5 key stakeholders in coastal Kenya. Primary data had been collected via a combination of in-depth interviews and focus group discussions exploring sexual, reproductive, drug use, and other social contexts of women who inject drugs. The process by which intimate partners influenced women's initiation of drug use, transition to injecting practices, and maintenance of injecting drug use were identified using thematic analysis. RESULTS Boyfriends and intimate either facilitated or restrained women's drug-injecting. On the one hand, young women's entry into drug use was prompted by relationship problems, or a need to acquiesce with their drug-using boyfriends. Once women started injecting, intimate partners facilitated ongoing drug-injecting by financing the acquisition of drugs, peddling drugs to their women, or sharing their drugs with their women. The social capital that peddlers held insulated women from police arrests, and encouraged women to seek and sustain intimate relations with well-connected peddlers. Men's influences over women were driven by an underlying patriarchal drug acquisition and economic power. On the other hand, boyfriends and intimate partners who were non-injectors or non-drug users sought to moderate women's injecting drug use by encouraging them to inject less, to smoke or snort instead of injecting, or to enroll into rehabilitation. These moderating influences were most prominent when couples were pregnant. Despite men being a source of practical and emotional support, women were frequently unable limit or alter their injecting drug use, due to its addictive nature. Men's disagreement with women's ongoing injecting strained relationships, and occasionally led to separation. CONCLUSIONS Some boyfriends facilitated women's injecting drug use, while others moderated it, supporting assertions that intimate relationships can both be a site of injecting risks or protection. At the micro-level, these findings highlight an opportunity for couple-based interventions, leveraging on non-drug injecting males as a resource to support women adopt safer injecting practices. At a macro level, incorporating livelihood interventions into harm reduction programs is required in order to mitigate economic-based influence of male intimate partners on women's injecting drug use. At both levels, gender transformative approaches are essential. To gain a comprehensive understanding of women's injecting drug use, future studies drug use should explore women's contexts beyond micro influences and consider their wider macro-structural determinants.
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Abstract
Purpose of review Opioid use disorder (OUD) is a global phenomenon and is on the rise in Africa, denoting a shift from historical patterns of drug transport to internal consumption. In contrast, opioids for clinical pain management in Africa remain among the least available globally. This region also has the highest HIV and HCV disease burden, and the greatest shortages of health workers and addiction treatment. We undertook a systematic review of the literature to describe opioid use in Africa and how it is being addressed. Recent findings A total of 84 articles from 2000 to 2018 were identified. Descriptions of country-specific populations and patterns of opioid misuse were common. A smaller number of articles described interventions to address OUD. Summary OUD occurs in sub-Saharan Africa, with attendant clinical and social costs. Evidence-based policies and health system resources are needed to promote OUD prevention and management, and infectious disease transmission reduction.
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