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McLintock K, Foy R, Canvin K, Bellass S, Hearty P, Wright N, Cunningham M, Seanor N, Sheard L, Farragher T. The quality of prison primary care: cross-sectional cluster-level analyses of prison healthcare data in the North of England. EClinicalMedicine 2023; 63:102171. [PMID: 37692078 PMCID: PMC10484963 DOI: 10.1016/j.eclinm.2023.102171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background Prisoners have significant health needs, are relatively high users of healthcare, and often die prematurely. Strong primary care systems are associated with better population health outcomes. We investigated the quality of primary care delivered to prisoners. Methods We assessed achievement against 30 quality indicators spanning different domains of care in 13 prisons in the North of England. We conducted repeated cross-sectional analyses of routinely recorded data from electronic health records over 2017-20. Multi-level mixed effects logistic regression models explored associations between indicator achievement and prison and prisoner characteristics. Findings Achievement varied markedly between indicators, prisons and over time. Achieved processes of care ranged from 1% for annual epilepsy reviews to 94% for blood pressure checks in diabetes. Intermediate outcomes of care ranged from only 0.2% of people with epilepsy being seizure-free in the preceding year to 34% with diabetes having sufficient blood pressure control. Achievement improved over three years for 11 indicators and worsened for six, including declining antipsychotic monitoring and rising opioid prescribing. Achievement varied between prisons, e.g., 1.93-fold for gabapentinoid prescribing without coded neuropathic pain (odds ratio [OR] range 0.67-1.29) and 169-fold for dried blood spot testing (OR range 0.05-8.45). Shorter lengths of stay were frequently associated with lower achievement. Ethnicity was associated with some indicators achievement, although the associations differed (both positive and negative) with indicators. Interpretation We found substantial scope for improvement and marked variations in quality, which were largely unaltered after adjustment for prison and prisoner characteristics. Funding National Institute for Health and Care Research Health and Social Care and Delivery Research Programme: 17/05/26.
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Affiliation(s)
- Kate McLintock
- Leeds Institute of Health Sciences (LIHS), University of Leeds, Level 10, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences (LIHS), University of Leeds, Level 10, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Krysia Canvin
- School of Medicine, Keele University, David Weatherall Building, Staffordshire, ST5 5BG, UK
| | - Sue Bellass
- Faculty of Science and Engineering, Institute of Sport, Manchester Metropolitan University, 99 Oxford Road, Manchester, M1 7EL, UK
| | - Philippa Hearty
- Spectrum Community Health CIC, Hebble Wharf, Wakefield, WF1 5RH, UK
| | - Nat Wright
- Spectrum Community Health CIC, Hebble Wharf, Wakefield, WF1 5RH, UK
| | - Marie Cunningham
- North of England Commissioning Support (NECS), John Snow House, Durham, DH1 3YG, UK
| | - Nicola Seanor
- North of England Commissioning Support (NECS), John Snow House, Durham, DH1 3YG, UK
| | - Laura Sheard
- Department of Health Sciences, University of York, Seebohm Rowntree Building, York, YO10 5DD, UK
| | - Tracey Farragher
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Room 2.544, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
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Abazid H, Abu-Farha R, Alsayed AR, Barakat M, Al-Qudah R. A comprehensive overview of substance abuse amongst Syrian individuals in an addiction rehabilitation center. Heliyon 2023; 9:e14731. [PMID: 37025821 PMCID: PMC10070527 DOI: 10.1016/j.heliyon.2023.e14731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Objectives This study aims to provide a comprehensive overview of substance abuse amongst Syrian individuals in an addiction rehabilitation center. Methods This is a descriptive cross-sectional survey-based study, from patients receiving treatment in an addiction rehabilitation center in Damascus. Syria. The study was conducted over a period of nine months. Results A total of 82 participants were recruited, the majority of them were males (n = 78.95.1%). More than half of those investigated reported multi-level failure (n = 46, 56.1%) during their education. Most of the participants (n = 44, 53.7%) started to use drugs at a friend's home. The family was shown to play a positive role in stopping the initial drug taking trials at early stages (33/56, 58.9%). Again, friends' effect was the main reason for the return of abusing drugs (20/56, 35.7%). Sources of drugs were mainly from drug promoters for most of the participants (n = 58, 70.7%) followed by friends (n = 28, 34.1%). Participants revealed that taking drugs were mostly accompanied by additional habits such as cigarette smoking before using their drugs (n = 65, 79.3%), or drinking alcohol (57.3%). Surprisingly, participants believed that drug abuse does not lead to addiction (n = 52, 63.4%). The most common experienced feeling was depressed, desperate, or sad (n = 47, 57.3%), followed by anxiety and the desire to escape reality and resort to imaginations (n = 44, 53.7%). Conclusions The findings of this study indicate the need of policymakers to give more attention, in developing preventive strategies, to friends, as a main cause of addiction, in addition to the family influences on individual's drug abuse, addiction behaviors, and mindsets. Understanding the influencing factors could spot the light on the key to solve the addiction problem. A realist rehabilitation programs must be well designed and implemented as the level of individuals, institutions and communities to face this problematic addiction disaster.
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Deuchar R, Densley J. Exploring the Intersection of Drug Addiction and Mental Ill-Health in Scottish Prisons: A Qualitative Study of Incarcerated Men. JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231161282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
This article presents insights from small-scale qualitative research exploring the intertwining nature of drug addiction and mental ill-health among men in Scottish prisons. Semi-structured interviews were conducted with 24 men in two Scottish prisons. The men’s narratives suggested that increased tension in prison halls had stimulated a huge surge in the use of New Psychoactive Substances (NPS), in turn increasing and deepening existing mental ill-health and violence. They believed health care in the prisons to be of low quality, and that methadone was prescribed as a mechanism for social control. Implications for future policy, practice and research are outlined.
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Affiliation(s)
- Ross Deuchar
- School of Education and Social Sciences, University of the West of Scotland, Paisley, UK
| | - James Densley
- School of Law Enforcement and Criminal Justice, Metropolitan State University, Saint Paul, MN, USA
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Avieli H. The role of substance use in the lives of incarcerated older adults: A qualitative study. Front Psychiatry 2023; 14:1116654. [PMID: 36993924 PMCID: PMC10040766 DOI: 10.3389/fpsyt.2023.1116654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundThe prevalence of drug abuse among older adults has grown over the last decade. Despite the expanding development of a body of research dedicated to studying this phenomenon, drug abuse by incarcerated older adults has been marginalized. Thus, the aim of the present study was to explore drug abuse patterns in the lives of incarcerated older adults.MethodSemi-structured interviews were conducted with 28 incarcerated older adults, and an interpretive analysis was used to analyze the participants’ narratives.FindingsFour themes emerged: (1) Growing up around drugs; (2) Prison onset; (3) Professionals, and (4) Lifelong substance abuse.ConclusionThe study findings reveal a unique typology of drug-related themes in the lives of incarcerated older adults. This typology sheds light on the interplay between aging, drug use, and incarceration and the way these three socially marginalized positions may intersect.
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Malpractice Claims and Ethical Issues in Prison Health Care Related to Consent and Confidentiality. Healthcare (Basel) 2022; 10:healthcare10071290. [PMID: 35885817 PMCID: PMC9324339 DOI: 10.3390/healthcare10071290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Respecting the consent and confidentiality of a patient is an underlying element in establishing the patient’s trust in the physician and, implicitly, obtaining the patient’s compliance. In particular, cases of inmate patients require increased attention in order to fulfill this goal against a background of institutional interferences, which, in certain situations, may endanger the autonomy of the physician and their respect for the inmate’s dignity. The purpose of this article is to depict the characteristics of consent and confidentiality in a prison environment, in special cases, such as hunger strikes, violent acts, HIV testing, COVID-19 measures, and drug use, bringing into focus the physician and the inmate in the context of the particular situation where the target is disciplining someone in order for them to conform to social and juridical norms. Respecting the dignity of the inmate patient requires an adequate approach of informed consent and confidentiality, depending on each case, considering the potential unspoken aspects of the inmate’s account, which can be key elements in obtaining their compliance and avoiding malpractice claims.
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Pape H, Lobmaier P, Bukten A. An evaluation of eight short versions of the Drug Use Disorder Identification Test (DUDIT). A prison population study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100043. [PMID: 36845984 PMCID: PMC9949308 DOI: 10.1016/j.dadr.2022.100043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
Background The eleven-item Drug Use Disorder Identification Test (DUDIT) is a recommended screening tool, but its length may impede its use in prison intake assessments. Hence, we examined the performance of eight brief DUDIT screeners against the full DUDIT, employing a sample of male inmates. Methods Our study included male participants in the Norwegian Offender Mental Health and Addiction (NorMA) study who reported pre-prison drug use and who had been incarcerated three months or less (n = 251). We performed receiver operating characteristic curve (ROC) analyses and estimated the area under the curve (AUROC) to assess the performance of DUDIT-C (four drug consumption items) and five-item versions that consisted of DUDIT-C and one additional item. Results Almost all (95%) screened positive on the full DUDIT (scores ≥6) and 35% had scores that were indicative of drug dependence (scores ≥25). The DUDIT-C performed very well in detecting likely dependence (AUROC=0.950), but some of the five-item versions performed significantly better. Of these, the DUDIT-C + item 5 (craving) had the highest AUROC (0.097). A cut-point of ≥9 on the DUDIT-C and ≥11 on the DUDIT-C + item 5 identified virtually all (98% and 97%, respectively) cases of likely dependence, with a specificity of 73% and 83%, respectively. At these cut-points, the occurrence of false positives was modest (15% and 10%, respectively) and only 4-5% were false negatives. Conclusions The DUDIT-C was highly effective in detecting likely drug dependence (according to the full DUDIT), but some combinations of DUDIT-C and one additional item performed better.
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Affiliation(s)
- Hilde Pape
- University College of Norwegian Correctional Service, P.O. Box 1, 2001 Lillestrøm, Norway,Corresponding author.
| | - Philipp Lobmaier
- Norwegian Centre for Addiction Research, University of Oslo, Norway,Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Bukten
- University College of Norwegian Correctional Service, P.O. Box 1, 2001 Lillestrøm, Norway,Norwegian Centre for Addiction Research, University of Oslo, Norway,Section for Clinical Addiction Research, Oslo University Hospital, Norway
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Murphy M, Sosnowy C, Rogers B, Napoleon S, Galipeau D, Scott T, Tao J, Berk J, Clarke J, Nunn A, Chan PA. Defining the Pre-exposure Prophylaxis Care Continuum Among Recently Incarcerated Men at High Risk for HIV Infection: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2022; 11:e31928. [PMID: 35142633 PMCID: PMC8874820 DOI: 10.2196/31928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background HIV disproportionately impacts criminal justice–involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in criminal justice systems is limited. Little is known about effective PrEP implementation and use in this unique public health context. Objective The aim of this study is to characterize the experience of implementing PrEP clinical care in a criminal justice setting for men vulnerable to HIV acquisition. Methods This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation. Results The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to release and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition. Conclusions Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the criminal justice context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic. International Registered Report Identifier (IRRID) DERR1-10.2196/31928
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Affiliation(s)
| | | | | | | | | | - Ty Scott
- Brown University, Providence, RI, United States
| | - Jun Tao
- Brown University, Providence, RI, United States
| | - Justin Berk
- Brown University, Providence, RI, United States
| | | | - Amy Nunn
- Brown University, Providence, RI, United States
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Parimah F, Owusu JO, Solomon AT, Appiah-Honny SA. Correlates of Drug Use among Offenders in Some Prisons in Ghana. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2021; 65:1703-1715. [PMID: 33040626 DOI: 10.1177/0306624x20964143] [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: 06/11/2023]
Abstract
Among others, the study sought to find out whether being convicted of the possession of marijuana for personal use for the first time or multiple times, would predict marijuana, and other drug use within the past 30 days. Using a cross-sectional survey, two hundred and fifty three (253) male offenders were conveniently sampled from three prisons in Ghana. The average age of participants was 31.26 (SD = 10.19). It was established that those who had been convicted of the possession of marijuana for personal use for the first time were likely to have used marijuana within the past 30 days (OR = 4.15, 95% CI = 2.00, 8.58), and other drugs within the past 30 days (OR = 2.44, 95% CI = 1.09, 5.47). Also, those who were recidivist robbers were likely to have used other drugs within the past 30 days (OR = 6.63, 95% CI = 2.55, 17.25). These, and other findings are discussed.
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9
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Kaplowitz E, Truong AQ, Macmadu A, Peterson M, Brinkley-Rubinstein L, Potter N, Green TC, Clarke JG, Rich JD. Fentanyl-related overdose during incarceration: a comprehensive review. HEALTH & JUSTICE 2021; 9:13. [PMID: 34013442 PMCID: PMC8133055 DOI: 10.1186/s40352-021-00138-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 05/05/2021] [Indexed: 06/07/2023]
Abstract
BACKGROUND Fentanyl and related compounds have recently saturated the illicit drug supply in the United States, leading to unprecedented rates of fatal overdose. Individuals who are incarcerated are particularly vulnerable, as the burden of opioid use disorder is disproportionately higher in this population, and tolerance generally decreases during incarceration. METHODS We conduct a systematic search for publications about fentanyl overdoses during incarceration in PubMed and PsycINFO, as well as lay press articles in Google, from January 1, 2013 through March 30th, 2021. RESULTS Not a single fentanyl overdose was identified in the medical literature, but 90 overdose events, comprising of 76 fatal and 103 nonfatal fentanyl overdoses, were identified in the lay press. Among the 179 overdoses, 138 occurred in jails and 41 occurred in prisons, across the country. CONCLUSIONS Fentanyl-related overdoses are occurring in correctional facilities with unknown but likely increasing frequency. In addition to the need for improved detection and reporting, immediate efforts to 1) increase understanding of the risks of fentanyl and how to prevent and treat overdose among correctional staff and residents, 2) ensure widespread prompt availability of naloxone and 3) expand the availability of medications to treat opioid use disorder for people who are incarcerated will save lives.
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Affiliation(s)
- Eliana Kaplowitz
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA.
- Center of Biomedical Research Excellence on Opioids and Overdose , The Rhode Island Hospital , RI, Providence, USA.
| | - Ashley Q Truong
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandria Macmadu
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Meghan Peterson
- Division of General Internal Medicine, Albert Einstein College of Medicine, New York City, NY, USA
| | - Lauren Brinkley-Rubinstein
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Traci C Green
- Center of Biomedical Research Excellence on Opioids and Overdose , The Rhode Island Hospital , RI, Providence, USA
- The Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA
- Department of Emergency Medicine , Brown School of Medicine , RI, Providence, USA
| | | | - Josiah D Rich
- The Center for Health and Justice Transformation, The Miriam Hospital, Providence, RI, USA
- Center of Biomedical Research Excellence on Opioids and Overdose , The Rhode Island Hospital , RI, Providence, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Norman C, McKirdy B, Walker G, Dugard P, NicDaéid N, McKenzie C. Large-scale evaluation of ion mobility spectrometry for the rapid detection of synthetic cannabinoid receptor agonists in infused papers in prisons. Drug Test Anal 2021; 13:644-663. [PMID: 33058556 DOI: 10.1002/dta.2945] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 11/10/2022]
Abstract
Synthetic cannabinoid receptor agonists (SCRAs), colloquially known as "spice," are commonly used in prisons and enter establishments via the mail in the form of infused papers. Many prisons use benchtop ion mobility spectroscopy (IMS) instruments to screen mail and seized materials for the presence of SCRAs and other controlled substances. The selectivity and sensitivity of Rapiscan Itemiser® 3E and Itemiser® 4DN Ion Trap Mobility Spectroscopy™ (ITMS™) systems were evaluated using 21 SCRA reference standards. Some differences in the SCRA reduced mobility (K0 ) values were observed between this study and those reported previously using IMS detection systems, particularly for cumyl and quinolinyl SCRAs (e.g., 5F-PB-22, Cumyl-4CN-BINACA, and 5F-Cumyl-PEGACLONE), although this was found to have little effect at an operational level. Operational reliability of the systems was evaluated by analyzing 392 paper and card samples with known drug content. ITMS™ system results (e.g., detect or nondetect) were in agreement with gas chromatography-mass spectrometry (GC-MS) analysis in up to 95% of samples tested. Overall, this study found the ITMS™ systems tested to be effective instruments when deployed for the rapid detection of SCRA-infused papers. Used effectively and with up-to-date substance libraries, they will help reduce the supply of SCRAs into prisons and identify emerging threats as they arise. Several emerging SCRAs (5F-MPP-PICA, 5F-EMB-PICA, and 4F-MDMB-BICA) were detected for the first time in Scottish prisons between May and August 2020 as a result of routine monitoring, and all were detected using the ITMS™ systems tested.
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Affiliation(s)
- Caitlyn Norman
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Brian McKirdy
- HMP Inverness, Scottish Prison Service, Inverness, UK
| | - Gillian Walker
- Public Protection Unit, Scottish Prison Service, Edinburgh, UK
| | - Pat Dugard
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Niamh NicDaéid
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Craig McKenzie
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
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Meyer JP, Culbert GJ, Azbel L, Bachireddy C, Kurmanalieva A, Rhodes T, Altice FL. A qualitative study of diphenhydramine injection in Kyrgyz prisons and implications for harm reduction. Harm Reduct J 2020; 17:86. [PMID: 33129341 PMCID: PMC7603760 DOI: 10.1186/s12954-020-00435-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/21/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND To reduce opioid dependence and HIV transmission, Kyrgyzstan has introduced methadone maintenance therapy and needle/syringe programs into prisons. Illicit injection of diphenhydramine, an antihistamine branded as Dimedrol®, has been anecdotally reported as a potential challenge to harm reduction efforts in prisons but has not been studied systematically. METHODS We conducted qualitative interviews in Kyrgyz or Russian with prisoners (n = 49), former prisoners (n = 19), and stakeholders (n = 18), including prison administrators and prisoner advocates near Bishkek, Kyrgyzstan from October 2016 to September 2018. Interviews explored social-contextual factors influencing methadone utilization in prisons. Transcripts were coded by five researchers using content analysis. Dimedrol injection emerged as an important topic, prompting a dedicated analysis. RESULTS After drinking methadone, some people in prison inject crushed Dimedrol tablets, a non-prescription antihistamine that is banned but obtainable in prison, to achieve a state of euphoria. From the perspectives of the study participants, Dimedrol injection was associated with devastating physical and mental health consequences, including psychosis and skin infections. Moreover, the visible wounds of Dimedrol injecting contributed to the perception of methadone as a harmful drug and supporting preference for heroin over methadone. CONCLUSION Dimedrol injecting is a potentially serious threat to harm reduction and HIV prevention efforts in Kyrgyzstan and elsewhere in the Eastern European and Central Asian region and requires further investigation.
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Affiliation(s)
- Jaimie P Meyer
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
| | - Gabriel J Culbert
- Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Lyuba Azbel
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA
| | | | | | - Tim Rhodes
- The London School of Tropical Hygiene and Tropical Medicine, London, UK
| | - Frederick L Altice
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA
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Bouck Z, Jain S, Sun X, Milloy MJ, Werb D, Hayashi K. Recent incarceration and risk of first-time injection initiation assistance: A prospective cohort study of persons who inject drugs. Drug Alcohol Depend 2020; 212:107983. [PMID: 32380374 PMCID: PMC7293943 DOI: 10.1016/j.drugalcdep.2020.107983] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Given the prevalence and harms of incarceration among persons who inject drugs (PWID) and their role in injection drug use initiation, we aimed to investigate whether recent incarceration influences the likelihood PWID assist others in their first-ever injection. METHODS Prospective cohort study of PWID in Vancouver, Canada who had their PReventing Injecting by Modifying Existing Responses (PRIMER) baseline visit between December 2014 and May 2017, reported never providing injection initiation assistance previously, and had ≥1 follow-up visit. The primary outcome, provision of injection initiation assistance, was defined via self-report as helping anybody inject for the first time in the past six months. The primary exposure was recent incarceration, i.e., self-report of being jailed, imprisoned or detained in the past six months. Participants were assessed biannually until November 2017, drop-out, or their first report of the primary outcome. RESULTS 1,199 PWID (62.1% male; mean (SD) age, 44.4 (12.3) years) were included in our study. Across 4,171 follow-up visits, 67 participants (5.6%) reported providing injection initiation assistance. The proportion of participants reporting recent incarceration varied between 2.4% to 5.1% per follow-up visit. Based on a multivariable discrete-time proportional hazards regression analysis, recent incarceration was associated with an increased risk of providing injection initiation assistance during the same six-month period (adjusted hazard ratio, 2.64; 95% CI, 1.19 to 5.86). CONCLUSIONS The observed association between recent incarceration and risk of providing injection initiation assistance suggests that incarceration could be contributing to the expansion of injection drug use practices within vulnerable populations over time.
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Affiliation(s)
- Zachary Bouck
- Centre for Drug Policy and Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON M5B 1T8, Canada; Dalla Lana School of Public Health, University of Toronto, 55 College St Room 500, Toronto, ON M5T 3M7, Canada
| | - Sonia Jain
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - M-J Milloy
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Dan Werb
- Centre for Drug Policy and Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON M5B 1T8, Canada; Division of Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada
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Abazid H, Abou‐Isba S, Abu Farha R, Al‐Jomaa EE. Drug abuse in Syria: pattern of use, causes and perception as perceived by Syrian addicts. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Husam Abazid
- Department of Clinical Pharmacy and Therapeutics Faculty of Pharmacy Applied Science Private University AmmanJordan
| | | | - Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics Faculty of Pharmacy Applied Science Private University AmmanJordan
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Choudhry K, Armstrong D, Dregan A. Prisons and Embodiment: Self-Management Strategies of an Incarcerated Population. JOURNAL OF CORRECTIONAL HEALTH CARE 2019; 25:338-350. [PMID: 31722608 DOI: 10.1177/1078345819880240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Weight gain and obesity in prison are, like elsewhere, associated with an increase in caloric intake and reduction in physical activity, but these factors are not solely under the control of a prisoner. Nineteen semistructured interviews were conducted in two male prisons in the United Kingdom to explore participants' thoughts, beliefs, and feelings on the role prison plays on weight change. Data from interviews were analyzed through grounded theory methodology. The concept of embodiment was used to explain not only how prisoners tend to believe the physical and emotional consequences of imprisonment could adversely affect weight and health but also how they adapted behaviors toward their health to try to take back control and power over their lives. The changes in prisoners' health-related behavior due to imprisonment show similarities to those seen in individuals responding to chronic illnesses, which suggest that imprisonment might be viewed as akin to an illness of the body.
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Affiliation(s)
- Khurshid Choudhry
- King's College London School of Medical Education, London, United Kingdom
| | - David Armstrong
- King's College London School of Medical Education, London, United Kingdom
| | - Alexandru Dregan
- King's College London School of Medical Education, London, United Kingdom
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15
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Bucerius SM, Haggerty KD. Fentanyl behind bars: The implications of synthetic opiates for prisoners and correctional officers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:133-138. [PMID: 31349150 DOI: 10.1016/j.drugpo.2019.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/12/2019] [Accepted: 05/20/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Fentanyl and derivatives are lethal components of North America's opioid crisis. Prisons often house a disproportionate number of illicit opiate users. To date, no on-the-ground empirical research exists on how opioids are altering the health and risk profile of prisons. The objectives of this study were to examine (1) how fentanyl and its analogues have shaped the prison experience for prisoners; and (2) how these opioids have altered the occupation of correctional officers (CO's). METHODS We conducted semi-structured interviews with 587 adult prisoners and 131 COs across four provincial prisons in Western Canada. Prisoners were recruited on their housing units and randomly selected. COs were recruited through non-probability, theoretical sampling. We employed a generalized prompt guide and asked a range of questions pertaining to how the presence of fentanyl and its analogues have changed the prison experience for prisoners and have impacted the work routine of COs. Interviews were digitally recorded, transcribed verbatim, thematically coded and analyzed using Nvivo 11. RESULTS For prisoners, we identified four main results: (1) the presence of fentanyl leads to an increased number of overdoses; (2) prisons are nonetheless perceived as a comparatively safe place to use drugs; (3) fentanyl is often mixed into other drugs, making it hard for drug users to avoid fentanyl; and (4) prisoners fear fentanyl is being weaponized. For officers, we identified: (1) increased fears about inadvertent personal exposure or widespread institutional opioid contamination; (2) fear of targeted poisonings; (3) changing attitudes towards opioid-using prisoners; and (4) a declining commitment to correctional careers. CONCLUSION The presence of fentanyl in prisons has significantly influenced how prisoners experience prison and relate to each other and how COs perceive their job. COs now identify fentanyl as the greatest risk to their safety in prisons.
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Abstract
Utilizing Bacchi’s poststructuralist approach, “What’s the problem represented to be?,” we critically examine how the “problem” of drug use in prison is represented within a key initiative—the Identified Drug User program (IDUP)—of prison drug policy in one Australian jurisdiction. We use two data sources for our analysis: interview transcripts of recently incarcerated young men (aged 19–24) with histories of injecting drug use and selected prison drug policy and program documents. We examine how the “problem” of drug use in prison is problematized within the IDUP and question commonly accepted ways of thinking that underpin the program. We explore the discursive and subjectification effects of problem representations which produce young men as “rational” and “choosing” and, at the same time, as “untrustworthy” and “deserving of punishment.” We highlight how these effects have consequences for young men’s connections to family while incarcerated which can work against the very issues the IDUP is trying to address. We make two claims in particular: that the IDUP produces harmful effects for young men and their families and that the harmful effects produced are, paradoxically, those the IDUP aims to avoid. Our analysis offers insights into how drug use in prison could be thought about differently, including suggestions that might reduce at least some of its adverse effects.
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Affiliation(s)
- Shelley Walker
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Melbourne, Victoria, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Kari Lancaster
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Mark Stoové
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Mandy Wilson
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Melbourne, Victoria, Australia
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The Efficacy of Dog Assisted Therapy in Detained Drug Users: A Pilot Study in an Italian Attenuated Custody Institute. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070683. [PMID: 28672787 PMCID: PMC5551121 DOI: 10.3390/ijerph14070683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/09/2017] [Accepted: 06/20/2017] [Indexed: 11/17/2022]
Abstract
Drug addiction is a major care and safety challenge in prison context. Nowadays, rehabilitation and specific therapeutic programs are suggested to improve health and well-being of inmates during their detention time and to reduce substance abuse relapse after release from prison. Among these programs, several studies reported the benefits for inmates coming from animal assisted interventions. In this pilot controlled study, we investigated the efficacy of a dog assisted therapy program addressed to 22 drug addicted male inmates housed in an attenuated custody institute in Italy. The study lasted six months, the treated group (12 inmates) was involved once a week for one hour in 20 dog assisted therapy sessions, whereas the control group (10 inmates) followed the standard rehabilitation program. One week before the beginning and one week after the end of the sessions, all inmates involved were submitted to symptom checklist-90-revised and Kennedy axis V. Inmates involved in the dog assisted therapy sessions significantly improved their social skills, reducing craving, anxiety and depression symptoms compared to the control group. Despite the limitation due to the small number of inmates enrolled and to the absence of follow up, we found these results encouraging to the use of dog assisted therapy as co-therapy in drug addicted inmates rehabilitation programs, and we claim the need of more extensive study on this subject.
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