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Winograd R, Marotta PL, O'Neil MM, Siddiqui S, Connors E, La Manna A, Goulka J, Beletsky L. Improving first responders' perceptions of overdose events and survivors through tailored occupational health-focused training co-facilitated by overdose survivors. HEALTH & JUSTICE 2024; 12:49. [PMID: 39699777 DOI: 10.1186/s40352-024-00309-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 12/02/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND First responders (law enforcement officers, emergency medical services, and firefighters) frequently interact with people who use drugs (PWUD). Based on the nature and outcomes of such encounters, these interactions have the potential either to reduce harm, or perpetuate it. Given increased funding and attention for first responder-led interventions involving PWUD, we must identify the most critical training for improving negative beliefs about these interventions and populations. In this study, we aimed to develop and evaluate a novel, evidence-based first responder training with an occupational wellness framing aiming to increase knowledge regarding and improve attitudes toward people who overdose and toward the overdose antidote, naloxone. METHODS We developed and evaluated the DOTS/SHIELD (Drug Overdose Trust & Safety/Safety & Health Integration in the Enforcement of Laws on Drugs) first responder training with three components: (1) matched first responder and overdose survivor trainers; (2) locally tailored substance use service information and practical referral instructions; and (3) occupational health content designed to make first responders' jobs easier and safer. We conducted pre- and post-tests at 151 Missouri-based trainings (December 2020-May 2023) to assess associated attitudinal changes among law enforcement vs. emergency medical services [EMS]/fire. RESULTS Among the matched sample (N = 1,003, 53.9% law enforcement), post-training attitudes toward people who overdose and toward naloxone were more positive than pre-training attitudes. On average, law enforcement held worse attitudes than EMS/fire toward people who overdose, though there were no professional differences in naloxone-related beliefs. CONCLUSIONS This training approach effectively combines three training components - peer trainers, practical substance use service referral information, and an occupational wellness framing - to positively influence first responders' views toward those who use drugs and toward naloxone.
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Affiliation(s)
| | | | | | | | | | - Anna La Manna
- University of Missouri-St. Louis, St Louis, USA
- Washington University in St. Louis, St Louis, USA
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Phillips S, Budesa Z, Smith R, Wood C, Winograd R. Longitudinal Assessment of Emergency Responders' Attitudes Toward People Who Overdose and Naloxone Following an Overdose Education Training. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:587-597. [PMID: 38600798 DOI: 10.1177/29767342241241401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND In addition to teaching overdose recognition and response, overdose education and naloxone distribution (OEND) trainings for emergency responders aim to improve trainee attitudes toward people who use drugs and toward naloxone. This study examines the training effectiveness long term, as well as the extent to which improvements are dependent on profession type or recent experience administering naloxone. METHODS A total of 774 emergency responders, consisting of law enforcement officers (LEOs) (n = 624, 81%) and emergency medical service (EMS) personnel (n = 150, 19%), attended OEND trainings and completed surveys immediately prior to ("pre") and following ("post") the training, as well as 6 months later ("follow-up"). Survey items assessed attitudes toward people who have overdosed, naloxone-related risk compensation (ie, "enabling") beliefs, and whether participants had administered naloxone since attending the training. Multiple regression and estimated marginal means were used to evaluate changes in scores. RESULTS Emergency responders showed improved attitudes (pre = 2.60, follow-up = 2.45, P < .001) and risk compensation beliefs (pre = 2.97, follow-up = 2.67, P < .001) 6 months following the training. Follow-up scores differed by profession, with LEOs endorsing worse attitudes (difference = 0.55, P = .013) and more risk compensation beliefs (difference = 0.67, P = .014) than EMS. In addition, having recently administered naloxone predicted more negative attitudes (EMS: difference = 0.55, P = .01; LEO: difference = 0.54, P = .004) and risk compensation beliefs (EMS = 0.73, P = .006; LEO = 0.69, P = .002) at follow-up. CONCLUSION Six months after an OEND training, emergency responders' attitudes toward people who overdose, and their risk compensation beliefs remained improved. However, LEOs had more negative follow-up attitudes and beliefs compared to EMS. Emergency responders who had administered naloxone had worse attitudes and beliefs at follow-up than those who had not. Of note, our sample evidenced sizable attrition between pre and follow-up assessments, leaving room for selection bias. Future studies should investigate how to mitigate negative effects of administering naloxone on attitudes toward those who overdose, and belief that naloxone is "enabling."
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Affiliation(s)
- Sarah Phillips
- University of Missouri-St. Louis, Missouri Institute of Mental Health, St. Louis, MO, USA
| | - Zach Budesa
- University of Missouri-St. Louis, Missouri Institute of Mental Health, St. Louis, MO, USA
| | - Ryan Smith
- University of Missouri-St. Louis, Missouri Institute of Mental Health, St. Louis, MO, USA
| | - Claire Wood
- University of Missouri-St. Louis, Missouri Institute of Mental Health, St. Louis, MO, USA
| | - Rachel Winograd
- University of Missouri-St. Louis, Missouri Institute of Mental Health, St. Louis, MO, USA
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Bejarano Romero R, Arredondo Sánchez-Lira J, Slim Pasaran S, Chávez Rivera A, Angulo Corral L, Salimian A, Romero Vadilllo JJ, Goodman-Meza D. Implementing a decentralized opioid overdose prevention strategy in Mexico, a pending public policy issue. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100535. [PMID: 37351156 PMCID: PMC10282171 DOI: 10.1016/j.lana.2023.100535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/13/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
The public health crisis due to opioid overdose is worsening in Mexico's northern region due to the introduction of illicitly manufactured fentanyl into the local drug supply. Though there is an increase in overdose deaths, there is no accurate report of overdoses by Mexican government agencies and no comprehensive opioid overdose prevention strategy. There is currently only an anti-drug marketing strategy which is likely insufficient to mitigate the growing epidemic. In order to address the growing opioid overdose crisis in the country, it is necessary to create and implement a decentralized prevention strategy, that includes naloxone distribution, expanded treatment services in regions most in need, and create active dialogue with community organisations already implementing harm reduction actions. Decisive action must be taken by the Mexican government to ensure the health and wellbeing of the Mexican citizens, especially those at high risk for opioid overdose.
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Affiliation(s)
- Raúl Bejarano Romero
- SDSU-UCSD Joint Doctoral Program in Interdisciplinary Research on Substance Use, 5500 Campanile Drive, San Diego, CA 92123-4119, USA
| | - Jaime Arredondo Sánchez-Lira
- School of Public Health and Social Policy, University of Victoria, British Columbia, HSD University of Victoria, Victoria, BC, Canada
| | - Said Slim Pasaran
- Integración Social Verter A.C., C. José Azueta 230, Primera, Mexicali, BC 21100, Mexico
| | | | - Lourdes Angulo Corral
- Integración Social Verter A.C., C. José Azueta 230, Primera, Mexicali, BC 21100, Mexico
| | - Anabel Salimian
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Jorge J. Romero Vadilllo
- Universidad Autónoma Metropolitana – Campus Xochimilco, Calz. del Hueso 1100, Coapa, Villa Quietud, Coyoacán, Ciudad de México, CDMX 04960, Mexico
| | - David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
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Gonzalez-Nieto P, Salimian A, Arredondo J, Angulo L, García de Loera A, Slim S, Shoptaw S, Cambou MC, Pitpitan EV, Goodman-Meza D. Intersections between syndemic conditions and stages along the continuum of overdose risk among women who inject drugs in Mexicali, Mexico. Harm Reduct J 2023; 20:79. [PMID: 37355611 PMCID: PMC10290314 DOI: 10.1186/s12954-023-00815-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Research on women who inject drugs is scarce in low- and middle-income countries. Women experience unique harms such as sexism and sexual violence which translate into negative health outcomes. The present work aims to provide insight into the experiences of women who inject drugs at the US-Mexico border to identify social and health-related risk factors for overdose to guide harm reduction interventions across the Global South. METHODS We recruited 25 women ≥ 18 years of age accessing harm reduction and sexual health services at a non-governmental harm reduction organization, "Verter", in Mexicali, Mexico. We employed purposeful sampling to recruit women who inject drugs who met eligibility criteria. We collected quantitative survey data and in-depth interview data. Analyses of both data sources involved the examination of descriptive statistics and thematic analysis, respectively, and were guided by the syndemic and continuum of overdose risk frameworks. RESULTS Survey data demonstrated reports of initiating injection drug use at a young age, experiencing homelessness, engaging in sex work, being rejected by family members, experiencing physical violence, injecting in public spaces, and experiencing repeated overdose events. Interview data provided evidence of stigma and discrimination toward women, a lack of safe spaces and support systems, risk of overdose-related harms, sexual violence, and the overall need for harm reduction services. CONCLUSION Women who inject drugs in Mexicali describe experiences of violence, overdose, and public injecting. Women are particularly vulnerable in the Mexicali context, as this area faces a noticeable lack of health and social services. Evidenced-based harm reduction strategies such as safe consumption sites and overdose prevention strategies (e.g., naloxone distribution and training) may benefit this population. Evidence from local organizations could help close the gap in service provision in low-resource settings like Mexico, where government action is almost nonexistent.
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Affiliation(s)
- Pablo Gonzalez-Nieto
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100, Mexicali, BC, Mexico
- Canadian Institute for Substance Use Research (CISUR), 2300, McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Anabel Salimian
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833, Le Conte Ave, CHS 52-215, Los Angeles, CA, 90095, USA
| | - Jaime Arredondo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100, Mexicali, BC, Mexico
- Canadian Institute for Substance Use Research (CISUR), 2300, McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Lourdes Angulo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100, Mexicali, BC, Mexico
| | - Alejandra García de Loera
- Universidad Autónoma de Aguascalientes (UAA), Avenida Universidad #940, 20100, Aguascalientes, AGS, Mexico
| | - Said Slim
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100, Mexicali, BC, Mexico
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Mary C Cambou
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833, Le Conte Ave, CHS 52-215, Los Angeles, CA, 90095, USA
| | - Eileen V Pitpitan
- School of Social Work, San Diego State University, Hepner Hall Room 119, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA
| | - David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833, Le Conte Ave, CHS 52-215, Los Angeles, CA, 90095, USA.
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Bailey K, Abramovitz D, Patterson TL, Harvey-Vera AY, Vera CF, Rangel MG, Friedman J, Davidson P, Bourgois P, Strathdee SA. Correlates of recent overdose among people who inject drugs in the San Diego/Tijuana border region. Drug Alcohol Depend 2022; 240:109644. [PMID: 36179507 PMCID: PMC9608984 DOI: 10.1016/j.drugalcdep.2022.109644] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 09/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Along the Mexico-US border, illicitly manufactured fentanyls (fentanyl) have been detected in other illicit drugs, including street opioid formulations known as 'china white.' We studied correlates of recent overdose among people who inject drugs (PWID), focusing on the risk of knowlingly or unknowingly using fentanyl in china white. METHODS From October 2020 - September, 2021 we surveyed participants in San Diego, California and Tijuana, Mexico and employed Poisson regression to identify correlates of recent overdose. RESULTS Of 612 PWID, most were male (74.0 %), Latinx (71.9 %), US residents (67.0 %). Mean age was 43 years. In the last six months, 15.8 % experienced overdose, 31.0 % knowingly used fentanyl and 11.1 % used china white, of whom 77.9 % did not think it contained fentanyl. After controlling for sex and race, factors independently associated with risk of overdose included knowingly using fentanyl, using china white and not believing it contained fentanyl, recent drug rehabilitation, being stopped/arrested by police, and homelessness. Further, PWID who believed china white contained fentanyl were less likely to use it. CONCLUSIONS Both intentional fentanyl use and unintentional exposure to fentanyl via china white were associated with overdose risk; however, PWID who believed china white contained fentanyl were less likely to use it. These data suggest that advanced drug checking systems should be implemented to empower PWID to avoid dangerous street formulations or to plan their drug use knowing its contents. Other overdose risk factors such as decreased tolerance following drug treatment, police interactions, and homelessness also require urgent intervention.
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Affiliation(s)
- Katie Bailey
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
| | - Daniela Abramovitz
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
| | - Thomas L Patterson
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
| | - Alicia Y Harvey-Vera
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America; US-Mexico Border Health Commission, P.º del Centenario 10851, Zona Urbana Rio Tijuana, 22320 Tijuana, BC, Mexico
| | - Carlos F Vera
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
| | - Maria Gudelia Rangel
- US-Mexico Border Health Commission, P.º del Centenario 10851, Zona Urbana Rio Tijuana, 22320 Tijuana, BC, Mexico; Universidad Xochicalco, Escuela de Medicina, Campus Tijuana, Rampa Yumalinda 4850, Chapultepec Alamar, 22110 Tijuana, BC, Mexico.
| | - Joseph Friedman
- University of California Los Angeles Center for Social Medicine, B7-435, UCLA Semel Institute, Los Angeles, CA 90095-1759, United States of America.
| | - Peter Davidson
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
| | - Philippe Bourgois
- University of California Los Angeles Center for Social Medicine, B7-435, UCLA Semel Institute, Los Angeles, CA 90095-1759, United States of America.
| | - Steffanie A Strathdee
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
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Baker P, Beletsky L, Garfein R, Pitpitan E, Oren E, Strathdee SA, Cepeda JA. Impact of SHIELD Police Training on Knowledge of Syringe Possession Laws and Related Arrests in Tijuana, Mexico. Am J Public Health 2022; 112:860-864. [PMID: 35446602 PMCID: PMC9137025 DOI: 10.2105/ajph.2021.306702] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/04/2022]
Abstract
Between 2015 and 2018, we provided training for 1806 municipal police officers in Tijuana, Mexico, in an effort to improve their knowledge and behaviors related to HIV and injection drug use. Correct knowledge of syringe possession laws improved from 56% before training to 94% after training and was sustained at 24 months (75%). Knowledge improvement was associated with decreases in arrests for syringe possession over time (adjusted odds ratio [AOR] = 0.87; 95% confidence interval [CI] = 0.85, 0.90). Officers with correct knowledge had significantly lower odds of reporting arrests (AOR = 0.63; 95% CI = 0.44, 0.89). Training was associated with sustained improvements in knowledge and practices that advance public health. (Am J Public Health. 2022;112(6):860-864. https://doi.org/10.2105/AJPH.2021.306702).
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Affiliation(s)
- Pieter Baker
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Leo Beletsky
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Richard Garfein
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Eileen Pitpitan
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Eyal Oren
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Steffanie A Strathdee
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Javier A Cepeda
- Pieter Baker and Javier A. Cepeda are with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Leo Beletsky is with the Bouvé College of Health Sciences and School of Law, Northeastern University, Boston, MA. Richard Garfein and Steffanie A. Strathdee are with the Department of Medicine, University of California, San Diego. Eileen Pitpitan and Eyal Oren are with the Graduate School of Public Health, San Diego State University, San Diego, CA
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Romero-Mendoza M, Peláez-Ballestas I, Almanza-Avendaño AM, Figueroa E. Structural violence and the need for compassionate use of methadone in Mexico. BMC Public Health 2022; 22:606. [PMID: 35351061 PMCID: PMC8962103 DOI: 10.1186/s12889-022-12955-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiological data from Mexico have documented an increase in heroin use in the last decade. However, there is no comprehensive care strategy for heroin users, especially those who have been accused of a crime. The objective of this study was to describe the heroin and methadone use of intravenous heroin users of both sexes who have been in jail, to offer evidence for the formulation of health policy. METHODS This study used an ethnographic approach, with open-ended interviews carried out from 2014 to the present. Heroin users of both sexes attending a private methadone clinic in Mexico City were invited to participate. The sample was non-probabilistic. All interviews were audiotaped and transcribed, and narratives were analyzed using thematic analysis. RESULTS Participants in this study were 33 users of heroin, two of them women, who had been in prison. They ranged in age from 33 to 62 years, had used heroin for a period of 13-30 years, and were from three states: Michoacan, Oaxaca, and Mexico City. Three principal categories of analysis were structured: 1. Pilgrimage for help (dynamics of the drama of suffering, pain, and time through health care spaces); 2) methadone use as self-care; and 3) accessibility to methadone treatment. The impossibility of access to methadone treatment is a condition which motivates users in their journey. The dynamics of methadone use are interpreted as a form of self-care and care to avoid substance use. Reducing the psychological, physical, and harmful effects of the substance allows them to perform daily activities. The inability to access treatment leads to a significant effect on users who experience structural violence. CONCLUSION Compassionate methadone treatment and holistic attention should be considered as a way to meet patients' needs and mitigate their suffering, based on public health policy that allows for human rights-based care.
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Affiliation(s)
- Martha Romero-Mendoza
- Instituto Nacional de Psiquiatría Ramón de La Fuente Muñiz, Camino a Xochimilco 101, Col, San Lorenzo Huipulco, CDMX, 144370 Tlalpan, Mexico City, Mexico
| | - Ingris Peláez-Ballestas
- Hospital General de México Dr. Eduardo Liceaga, Dr. Balmis 148, Col. Doctores, CDMX, 06720 Cuauhtémoc, Mexico City, Mexico
| | - Ariagor Manuel Almanza-Avendaño
- Facultad de Ciencias Humanas, Universidad Autónoma de Baja California, Calz. Castellón S/N, Esperanza Conjunto Urbano, 21350 Mexicali, BC Mexico
| | - Emilia Figueroa
- Clínica Integral de Tratamiento Contra Las Adicciones, Adolfo Prieto 1338, Col. Del Valle, Benito Juárez, CDMX, 03100 Mexico City, Mexico
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Del Pozo B, Sightes E, Goulka J, Ray B, Wood CA, Siddiqui S, Beletsky LA. Police discretion in encounters with people who use drugs: operationalizing the theory of planned behavior. Harm Reduct J 2021; 18:132. [PMID: 34915910 PMCID: PMC8675297 DOI: 10.1186/s12954-021-00583-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Policing shapes the health risks of people who use drugs (PWUD), but little is understood about interventions that can align officer practices with PWUD health. This study deploys the Theory of Planned Behavior (TPB) to understand what influences police intentions to make discretionary referrals to treatment and harm reduction resources rather than arrest on less serious charges.
Methods On-line surveys integrating TPB constructs and adapting an instrument measuring police intentions to make mental health treatment referrals were completed by police employees in Indiana, Massachusetts, and Missouri. They also included items about stigma towards PWUD and attitudes and beliefs about opioid addiction, treatment, and recovery. Findings Across the sites, 259 respondents perceived control over their decision to arrest for misdemeanors (69%) and confiscate items such as syringes (56%). Beliefs about others’ approval of referrals to treatment, its ability to reduce future arrests, and to increase trust in police were associated with stated practices of nonarrest for drug and possession and making referrals (p ≤ .001), and nonarrest for syringe possession (p ≤ .05). Stigma a towards PWUD was negatively associated with stated practices of nonarrest (p ≤ .05). Respondents identified supervisors as having the most influence over use of discretion, seriousness of the offense as the most influential value, and attitude of the suspect as the most important situational factor. The 17 Likert scale items analyzed had a Cronbach’s alpha of 0.81. Conclusion The TPB offers untapped potential to better understand and modify police practices. In designing interventions to improve the health outcomes of police encounters with PWUD, further research should validate instruments that measure the relationship between these variables and discretionary intentions, and that measure role-relevant police stigma towards PWUD.
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Affiliation(s)
- Brandon Del Pozo
- The Miriam Hospital/Warren Alpert Medical School of Brown University, 164 Summit Avenue, Providence, RI, 02906, USA.
| | - Emily Sightes
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, USA
| | - Jeremiah Goulka
- Health in Justice Action Lab, Northeastern University, Boston, USA
| | - Brad Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri St Louis, St. Louis, USA
| | - Saad Siddiqui
- Missouri Institute of Mental Health, University of Missouri St Louis, St. Louis, USA
| | - Leo A Beletsky
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, USA
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Baker P, Arredondo J, Borquez A, Clairgue E, Mittal ML, Morales M, Rocha-Jimenez T, Garfein R, Oren E, Pitpitan E, Strathdee SA, Beletsky L, Cepeda JA. Municipal police support for harm reduction services in officer-led referrals of people who inject drugs in Tijuana, Mexico. Harm Reduct J 2021; 18:76. [PMID: 34311765 PMCID: PMC8313001 DOI: 10.1186/s12954-021-00513-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Police constitute a structural determinant of health and HIV risk of people who inject drugs (PWID), and negative encounters with law enforcement present significant barriers to PWID access to harm reduction services. Conversely, police may facilitate access via officer-led referrals, potentiating prevention of HIV, overdose, and drug-related harms. We aimed to identify police characteristics associated with support for officer-led referrals to addiction treatment services and syringe service programs (SSP). We hypothesized that officers who believe harm reduction services are contradictory to policing priorities in terms of safety and crime reduction will be less likely to support police referrals. METHODS Between January and June 2018, police officers (n = 305) in Tijuana, Mexico, completed self-administered surveys about referrals to harm reduction services during the 24-month follow-up visit as part of the SHIELD police training and longitudinal cohort study. Log-binomial regression was used to estimate adjusted prevalence ratios and model policing characteristics and attitudes related to officers' support for including addiction treatment and SSP in referrals. RESULTS Respondents were primarily male (89%), patrol officers (86%) with a median age of 38 years (IQR 33-43). Overall, 89% endorsed referral to addiction services, whereas 53% endorsed SSP as acceptable targets of referrals. Officers endorsing addiction services were less likely to be assigned to high drug use districts (adjusted prevalence ratio [APR] = 0.50, 95% CI 0.24, 1.08) and more likely to agree that methadone programs reduce crime (APR = 4.66, 95% CI 2.05, 9.18) than officers who did not support addiction services. Officers endorsing SSPs were younger (adjusted prevalence ratio [APR] = 0.96 95% CI 0.93, 0.98), less likely to be assigned to high drug use districts (APR = 0.50, 95% CI 0.29, 0.87), more likely to believe that methadone programs reduce crime (APR = 2.43, 95% CI 1.30, 4.55), and less likely to believe that SSPs increase risk of needlestick injury for police (APR = 0.44, 0.27, 0.71). CONCLUSIONS Beliefs related to the occupational impact of harm reduction services in terms of officer safety and crime reduction are associated with support for referral to related harm reduction services. Efforts to deflect PWID from carceral systems toward harm reduction by frontline police should include measures to improve officer knowledge and attitudes about harm reduction services as they relate to occupational safety and law enforcement priorities. TRIAL REGISTRATION NCT02444403.
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Affiliation(s)
- Pieter Baker
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
- School of Public Health, San Diego State University, San Diego, CA USA
| | - Jaime Arredondo
- Programa de Política de Drogas, Centro de Investigación Y Docencia Económica, Aguascalientes, Mexico
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Annick Borquez
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
| | - Erika Clairgue
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
| | - Maria L. Mittal
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
- School of Medicine, Universidad Xochicalco, Tijuana, Baja California México
| | - Mario Morales
- School of Government and Public Policy, University of Arizona, Tuscon, AZ USA
| | - Teresita Rocha-Jimenez
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
| | - Richard Garfein
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
| | - Eyal Oren
- School of Public Health, San Diego State University, San Diego, CA USA
| | - Eileen Pitpitan
- School of Public Health, San Diego State University, San Diego, CA USA
| | - Steffanie A. Strathdee
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
| | - Leo Beletsky
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
- School of Law & Bouvé College of Health Sciences, Northeastern University, Boston, MA USA
| | - Javier A. Cepeda
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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10
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Sa M, C R, Ml M, Lr S, J TM, S J, X S, Rs G, Sa S, K D, K H, R M, Mj M, M O, A G, D W, Ai S. Examining the gender composition of drug injecting initiation events: A mixed methods investigation of three North American contexts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103056. [PMID: 33310638 PMCID: PMC8046711 DOI: 10.1016/j.drugpo.2020.103056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gender influences the health and social risks faced by individuals initiating drug injecting. Using mixed methods across three settings in North America, we investigated the gender composition of injection initiation events and the gendered risk environments in which they occurred. METHODS The PReventing Injecting by Modifying Existing Responses (PRIMER) study pooled data from three prospective community-recruited cohorts of people who inject drugs (PWID) in San Diego, USA, Vancouver, Canada, and Tijuana, Mexico. A qualitative subsample provided narrative data on their experiences of, and the contexts for, injection initiation events. Guided by Rhodes' risk environment framework, we examined the gender composition of initiation events stratified by city, and analyzed qualitative data using abductive thematic analyses. RESULTS Among 2,622 PWID (Tijuana: n = 531; San Diego: n = 352; Vancouver: n = 1,739), 112 (4.3%) reported providing initiation assistance to injection-naïve individuals in the previous six months. The proportion of gender concordant (e.g., male-male) initiation pairs varied, (χ2 = 10.32, p <0.001) with greater than expected concordance among pairs in Tijuana compared with those in Vancouver or San Diego. Sixty-one interviews provided context for the discrepancy across sites by highlighting the gendered injection initiation risk environments of prison/jail detention in Tijuana, intimate partnerships in San Diego, and overdose risk in Vancouver. CONCLUSIONS These results highlight how gender influences injection initiation events within spatial, social, and economic risk environments, and how this influence varies across settings. These findings can inform interventions to reduce the risk of injection initiation and related harms.
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Affiliation(s)
- Meyers Sa
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Rafful C
- Facultad de Psicología, Universidad Nacional Autónoma de México, University City, Coyoacán, 04510, Mexico City, Mexico
| | - Mittal Ml
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, Mexico
| | - Smith Lr
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Tirado-Muñoz J
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Jain S
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Sun X
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Garfein Rs
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Strathdee Sa
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - DeBeck K
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada
| | - Hayashi K
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada
| | - McNeil R
- School of Medicine, Yale, 333 Cedar Street, New Haven, CT, 06510, United States
| | - Milloy Mj
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9 Canada
| | - Olding M
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada
| | - Guise A
- Addison House, Guy's Hospital, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Werb D
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada
| | - Scheim Ai
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States.
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Fleiz C, Villatoro J, Dominguez M, Bustos M, Medina-Mora ME. Opioid Crisis Along Mexico's Northern Border: Treatment Needs Mexican Opioid Crisis. Arch Med Res 2020; 50:527-534. [PMID: 32035369 DOI: 10.1016/j.arcmed.2019.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Heroin production for external markets and low rates of use in Mexico have had a long history. A recent shift toward an increase in use and related problems calls for the evaluation of treatment needs in order to draw recommendations for policies. METHODS The objectives were to identify predictors of choice of treatment and barriers to care among persons that had been with no treatment. The study included a convenience sample of 600 face-to-face interviews of people 18 years of age and older and a rapid HIV and HCV tests in three cities on Mexico's Northern Border: Ciudad Juárez, San Luis Río Colorado and Tijuana. The choice of treatment (methadone, other pubic or private treatments with no experience with methadone maintenance and only self-help or religious care), was analyzed though a multiple logistic multimodal regression analysis. Informed consents to be interviewed and for HIC and HIV were signed by interviewers. RESULTS The majority of persons interviewed were males (89.7%) with an average age of 40. Having emigrated to the United States and a greater length of heroin use predicted seeking methadone treatment versus public or private treatment or informal care. The most important barriers to care were lack of information and stigma. HIC, HIV and other infectious and chronic diseases including depression were often unattended. CONCLUSIONS There is a need to reform treatment policies in order to cover this w emerging and demanding problem.
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Affiliation(s)
- Clara Fleiz
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Jorge Villatoro
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Mario Dominguez
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Marycarmen Bustos
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - María Elena Medina-Mora
- Departamento de Psiquiatría y Salud Mental, Escuela de Medicina, Universidad Autónoma de México, Ciudad de México, Mexico; Centro Global de Investigación en Salud Mental, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico.
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12
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Rocha-Jiménez T, Mittal ML, Artamonova I, Baker P, Cepeda J, Morales M, Abramovitz D, Clairgue E, Bañuelos A, Patterson T, Strathdee S, Beletsky L. The Role of Gender in the Health and Human Rights Practices of Police: The SHIELD Study in Tijuana, Mexico. Health Hum Rights 2019; 21:227-238. [PMID: 31239629 PMCID: PMC6586956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Globally, punitive drug law enforcement drives human rights violations. Drug control tactics, such as syringe confiscation and drug-related arrests, also cascade into health harms among people who use drugs. The role of police officer characteristics in shaping such enforcement and measures to reform police practices remains underexamined. We evaluated gender differences in syringe confiscation and syringe-related arrest behaviors among municipal police officers in Tijuana, Mexico, where syringe possession is legal. In the context of the SHIELD Study focusing on aligning policing with harm reduction measures, our baseline sample covered municipal police officers who reported having occupational contact with syringes. We used multivariable logistic regression with robust variance estimation via a generalized estimating equation to identify correlates of syringe-related policing behaviors. Among respondent officers (n=1,555), 12% were female. After considering possible confounding variables, such as district of service and work experience, female officers were significantly less likely to report confiscating syringes or arresting individuals for syringe possession. Consideration of officer gender is important in the design of interventions to improve the health and human rights of people who inject drugs and other highly policed groups, as well as measures to safeguard officer occupational safety. The feminization of law enforcement deserves special consideration as an imperative in reducing the public health harms of policing.
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Affiliation(s)
- Teresita Rocha-Jiménez
- Research associate at the University of California San Diego’s Division of Infectious Diseases and Global Public Health and a fellow at the Center for U.S.-Mexican Studies, University of California San Diego, USA
| | - Maria Luisa Mittal
- Project scientist at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | | | - Pieter Baker
- PhD student and research associate at the University of California San Diego and San Diego State University, USA
| | - Javier Cepeda
- Assistant professor at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Mario Morales
- Research assistant at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Daniela Abramovitz
- Principal statistician at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Erika Clairgue
- Research program manager at the University of California San Diego, USA
| | - Arnulfo Bañuelos
- Research liaison at the Secretaría de Seguridad Pública Municipal, department of special planning and projects, Tijuana, Mexico
| | - Thomas Patterson
- Distinguished professor of psychiatry at the University of California San Diego, USA
| | - Steffanie Strathdee
- Associate dean of global health sciences, Harold Simon Professor at the University of California San Diego Department of Medicine, and principal investigator at Project ESCUDO
| | - Leo Beletsky
- Professor at the School of Law and Bouvé College of�Health Sciences, Northeastern University, and an associate adjunct professor at the University of California San Diego, USA
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