Risk Factors Associated with HCV Among Opioid-Dependent Patients in a Multisite Study

We examined risk factors associated with hepatitis C virus (HCV) infection among opioid-dependent patients enrolled into medication-assisted therapy (buprenorphine or methadone) to determine factors affecting chronic infection. Patients (N = 1039) were randomized as part of a larger, multisite clinical trial sponsored by the National Drug Abuse Treatment Clinical Trials Network assessing liver function. HCV status was first assessed with an antibody screen; if positive, then current infection was determined with an antigen screen testing for detectable virus. Patients were classified as HCV negative, HCV positive but have cleared the virus, or as having chronic HCV. Logistic regression analysis was used to examine demographic and behavioral correlates of the three groups. Thirty-four percent of patients were classified with chronic infection and 14% had evidence of prior infection with apparent clearing of the virus. Chronic infection was associated with recent injection drug use and cocaine use. Chronic HCV infection was also associated with being older and Hispanic. Age, ethnicity, and current drug use increase the likelihood of being chronically infected with HCV. Strategies targeting high risk subgroups can aid in preventing further disease escalation.

Mortality among substance-using mothers in California: a 10-year prospective study

AIMS

To examine mortality rates and causes of death among a cohort of substance-using mothers and to identify risk factors that predict mortality.

DESIGN, SETTING, PARTICIPANTS

This is a prospective study of a cohort of 4447 substance-using mothers (pregnant or parenting) who were enrolled during 2000-02 in 40 drug abuse treatment programs across California.

METHODS

All mothers were assessed at baseline using the Addiction Severity Index. Mortality data were obtained from the National Death Index and causes of death were coded using ICD-10. Standardized mortality ratios (SMR) were calculated relative to women in the general population adjusted for age. Proportional hazard (Cox) regression was used to identify risk factors predicting death.

RESULTS

At the end of 2010, 194 deaths were confirmed, corresponding to a crude mortality rate of 4.47 per 1000 person-years and SMR of 8.4 (95% confidence interval: 7.2-9.6). Drug overdose (28.8%), cardiovascular disease (10%), and alcohol or drug disorders (8.9%) were the leading causes of death. Baseline factors associated with higher mortality included older age, being white (relative to African American or Hispanic), heroin, alcohol, cocaine or marijuana (relative to methamphetamine) as the primary drug problem, drug injection and greater severity of employment, medical/health and psychiatric problems.

CONCLUSIONS

Substance-using mothers have 8.4 times the mortality than that observed among US women of similar age. Greater severity of employment, medical/health and psychiatric problems contributed to the elevated mortality.

Hepatitis C among methadone maintenance treatment patients in Shanghai and Kunming, China

BACKGROUND

This study aims to: (1) document the prevalence of hepatitis C virus (HCV) among methadone maintenance treatment (MMT) patients in Kunming and Shanghai; (2) examine risk factors for HCV by comparing those who tested positive with those who were negative and (3) examine if HCV serostatus is related to attitudes toward MMT.

METHODS

Using data collected from 306 patients admitted to MMT in 2009-2010 in Shanghai and Kunming, we compared HCV-positive and HCV-negative patients (based on clinical records) on their HCV knowledge and risk behaviors and attitudes toward MMT.

RESULTS

The HCV seropositive rate was 53.3% (51.3% in Shanghai and 55.5% in Kunming) and a majority of patients did not know their serostatus. Patients scored on average fewer than 6 correct out of the 20 items in the HCV knowledge questionnaire. Recent injection use and length of opiate use were strong predictors of HCV status, while no differences were found between HCV-positive and HCV-negative individuals in sexual risks or HCV knowledge. Both groups expressed similar views toward MMT.

CONCLUSION

The high HCV prevalence and the general lack of knowledge about HCV infection, transmission and treatment suggest the need to provide HCV education and health promotion programs among patients in MMT.

Lifetime severity index for cocaine use disorder (LSI-Cocaine): a predictor of treatment outcomes

We developed a lifetime severity index for cocaine use disorder and examined its predictive validity of posttreatment outcome using data from the national Drug Abuse Treatment Outcome Study. The index, based on 28 items, considered frequency of use, recency, dependency, and attempt to quit. A higher value of the index, indicating greater severity, predicted a greater likelihood of relapse (the odds ratios were 5.7 for high severity and 4.4 for medium severity, relative to low severity) and shorter time to relapse. Similarly, the polytomous logistic analysis indicated that the index predicted levels of posttreatment cocaine use (odds ratios of daily use were 47.8 for the high severity and 18.8 for medium severity; the corresponding odds ratios of weekly use were 6.75 and 5.10 and for less-than-weekly use were 3.35 and 3.57). The index can be a useful measure for both clinical and research purposes.