1
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Carpenter DM, Zule WA, Hennessy CM, Evon DM, Hurt CB, Ostrach B. Factors associated with perceived ease of access to syringes in Appalachian North Carolina. J Rural Health 2023; 39:212-222. [PMID: 35819251 PMCID: PMC9772148 DOI: 10.1111/jrh.12698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To examine associations between perceived ease of syringe access, syringe sources, injection behaviors, and law enforcement (LE) interactions among people who inject drugs (PWID) in rural Appalachian North Carolina (NC). METHODS Using respondent-driven sampling, a diverse sample of 309 self-reported PWID were recruited from rural Appalachian NC. Data were collected via audio computer-assisted self-interview technology from February 2019 through March 2020. Respondents reported demographics, sources of syringes, LE interactions, and injection behaviors. Univariate, bivariate, and linear regression analyses were performed. FINDINGS Respondents most often obtained syringes from pharmacies and syringe service programs (SSPs). Twenty-one percent disagreed that it was easy to obtain sterile syringes, with 28% reporting low or no access to an SSP. PWID who reported longer physical distances to an SSP had greater difficulty accessing syringes (P<.001). PWID who reported greater ease of access to syringes reported engaging in receptive syringe sharing less often (P<.01). PWID who were stopped and searched by LE more often reported injecting drugs somebody else prepared with nonsterile supplies more often (P<.01). Participants shared used injection supplies more than twice as often than they shared used syringes. CONCLUSIONS These results underscore the importance of SSPs to mitigate the spread of human immunodeficiency virus and viral hepatitis in rural areas. Supporting mobile SSP services in rural areas could increase access to sterile syringes and injection supplies. SSPs should educate PWID about the importance of not sharing injection supplies. Pharmacies could increase syringe access in areas where SSPs do not operate.
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Affiliation(s)
- Delesha M. Carpenter
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William A. Zule
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Donna M. Evon
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher B. Hurt
- Institute for Global Health & Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bayla Ostrach
- Family Medicine & Medical Anthropology, Boston University School of Medicine, Boston, Massachusetts, USA
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2
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Lewer D, Croxford S, Desai M, Emanuel E, Hope VD, McAuley A, Phipps E, Tweed EJ. The characteristics of people who inject drugs in the United Kingdom: changes in age, duration, and incidence of injecting, 1980-2019, using evidence from repeated cross-sectional surveys. Addiction 2022; 117:2471-2480. [PMID: 35546310 PMCID: PMC9544601 DOI: 10.1111/add.15911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Mortality and drug treatment data suggest that the median age of people who inject drugs is increasing. We aimed to describe changes in the characteristics of people injecting drugs in the United Kingdom (UK). DESIGN Repeat cross-sectional surveys and modelling. SETTING Low-threshold services in the United Kingdom such as needle and syringe programmes. PARTICIPANTS A total of 79 900 people who recently injected psychoactive drugs in the United Kingdom, recruited as part of the Unlinked Anonymous Monitoring Survey (England, Wales, Northern Ireland, 1990-2019) and Needle Exchange Surveillance Initiative (Scotland, 2008-2019). MEASUREMENTS Age of people currently injecting, age at first injection, duration of injecting (each 1990-2019) and estimates of new people who started injecting (1980-2019). FINDINGS In England, Wales and Northern Ireland between 1990 and 2019, the median age of people injecting increased from 27 (interquartile range [IQR], 24-31) to 40 (IQR, 34-46); median age at first injection increased from 22 (IQR, 19-25) to 33 (IQR, 28-39); and median years of injecting increased from 7 (IQR, 3-11) to 18 (IQR, 9-23). Values in Scotland and England were similar after 2008. The estimated number that started injecting annually in England increased from 5470 (95% prediction interval [PrI] 3120-6940) in 1980 to a peak of 10 270 (95% PrI, 8980-12 780) in 1998, and then decreased to 2420 (95% PrI, 1320-5580) in 2019. The number in Scotland followed a similar pattern, increasing from 1220 (95% PrI, 740-2430) in 1980 to a peak of 3080 (95% PrI, 2160-3350) in 1998, then decreased to a 270 (95% PrI, 130-600) in 2018. The timing of the peak differed between regions, with earlier peaks in London and the North West of England. CONCLUSIONS In the United Kingdom, large cohorts started injecting psychoactive drugs in the 1980s and 1990s and many still inject today. Relatively few people started in more recent years. This has led to changes in the population injecting drugs, including an older average age and longer injecting histories.
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Affiliation(s)
- Dan Lewer
- Public Health and Clinical DirectorateUK Health Security AgencyLondonUK,Department of Epidemiology and Public HealthUniversity College LondonLondonUK,Clinical and Protecting Health DirectoratePublic Health Scotland, UKGlasgowUK
| | - Sara Croxford
- Public Health and Clinical DirectorateUK Health Security AgencyLondonUK
| | - Monica Desai
- Public Health and Clinical DirectorateUK Health Security AgencyLondonUK
| | - Eva Emanuel
- Public Health and Clinical DirectorateUK Health Security AgencyLondonUK
| | - Vivian D. Hope
- Public Health and Clinical DirectorateUK Health Security AgencyLondonUK,Public Health InstituteLiverpool John Moores UniversityLiverpoolUK
| | - Andrew McAuley
- Clinical and Protecting Health DirectoratePublic Health Scotland, UKGlasgowUK,School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Emily Phipps
- Public Health and Clinical DirectorateUK Health Security AgencyLondonUK
| | - Emily J. Tweed
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
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3
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Estévez-Lamorte N, Foster S, Gmel G, Mohler-Kuo M. Routes of Administration of Illicit Drugs among Young Swiss Men: Their Prevalence and Associated Socio-Demographic Characteristics and Adverse Outcomes. Int J Environ Res Public Health 2021; 18:11158. [PMID: 34769676 DOI: 10.3390/ijerph182111158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/01/2022]
Abstract
The prevalence of different routes of administration (ROAs) of illicit drugs other than cannabis was examined in young Swiss men, in addition to the association between socio-demographics and adverse outcomes and particular ROAs. Our sample consisted of 754 men (mean age = 25.4 ± 1.2 years) who participated in the Cohort Study on Substance Use Risk Factors and reported using any of 18 illicit drugs over the last 12 months. Prevalence estimates were calculated for oral use, nasal use, smoking, injecting, and other ROAs. Associations between ROAs and socio-demographics and adverse outcomes (i.e., alcohol use disorder (AUD), suicidal ideations, and health and social consequences) were calculated for using single versus multiple ROAs. The most prevalent ROA was oral use (71.8%), followed by nasal use (59.2%), smoking (22.1%), injecting (1.1%), and other ROAs (1.7%). Subjects’ education, financial autonomy, and civil status were associated with specific ROAs. Smoking was associated with suicidal ideations and adverse health consequences and multiple ROAs with AUD, suicidal ideations, and health and social consequences. The most problematic pattern of drug use among young adults appears to be using multiple ROAs, followed by smoking. Strategies to prevent and reduce the use of such practices are needed to avoid adverse outcomes at this young age.
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4
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Brown C, Siegele M, Wright M, Cook C, Parkes J, I Khakoo S, Sacks-Davis R, Buchanan RM. Injecting network structure determines the most efficient strategy to achieve Hepatitis C elimination in people who inject drugs. J Viral Hepat 2021; 28:1274-1283. [PMID: 34048117 DOI: 10.1111/jvh.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/05/2021] [Accepted: 05/16/2021] [Indexed: 12/09/2022]
Abstract
Transmission of Hepatitis C (HCV) continues via sharing of injection equipment between people who inject drugs (PWID). Network-based modelling studies have produced conflicting results about whether random treatment is preferable to targeting treatment at PWID with multiple partners. We hypothesise that differences in the modelled injecting network structure produce this heterogeneity. The study aimed to test how changing network structure affects HCV transmission and treatment effects. We created three dynamic injecting network structures connecting 689 PWID (UK-net, AUS-net and USA-net) based on published empirical data. We modelled HCV in the networks and at 5 years compared prevalence of HCV 1) with no treatment, 2) with randomly targeted treatment and 3) with treatment targeted at PWID with the most injecting partnerships (degree-based treatment). HCV prevalence at 5 years without treatment differed significantly between the three networks (UK-net (42.8%) vs. AUS-net (38.2%), p < 0.0001 and vs. USA-net (54.0%), p < 0.0001). In the treatment scenarios UK-net and AUS-net showed a benefit of degree-based treatment with a 5-year prevalence of 1.0% vs. 9.6% p < 0.0001 and 0.15% vs. 0.44%, p < 0.0001. USA-net showed no significant difference (29.3% vs. 29.2%, p = 0.0681). Degree-based treatment was optimised with low prevalence, moderate treatment coverage conditions whereas random treatment was optimised in low treatment coverage, high prevalence conditions. In conclusion, injecting network structure determines the transmission rate of HCV and the most efficient treatment strategy. In real-world injecting network structures, the benefit of targeting HCV treatment at individuals with multiple injecting partnerships may have been underestimated.
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Affiliation(s)
- Chloe Brown
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Mark Wright
- University Hospital Southampton, Southampton, UK
| | - Charlotte Cook
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Julie Parkes
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Salim I Khakoo
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Ryan M Buchanan
- Faculty of Medicine, University of Southampton, Southampton, UK
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5
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McKetin R, Sutherland R, Peacock A, Farrell M, Degenhardt L. Patterns of smoking and injecting methamphetamine and their association with health and social outcomes. Drug Alcohol Rev 2021; 40:1256-1265. [PMID: 34365687 PMCID: PMC9292494 DOI: 10.1111/dar.13364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/02/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
Introduction We examine how smoking and injecting methamphetamine change over time and correlate with specific health and social outcomes. Methods Panel data from a longitudinal cohort dependent on methamphetamine (N = 444; 891 months). Random effects regression models examined the relationship between smoking and/or injecting methamphetamine and past month outcomes (substance use, ≥daily injection, needle/syringe sharing, psychological distress, poor mental and physical health, sexual behaviour, psychotic symptoms, violent behaviour and crime). Effects were adjusted for between‐group differences at baseline. Results At baseline, 56% of participants only injected methamphetamine in the past month, 18% only smoked and 26% both injected and smoked (concurrent injecting and smoking). Compared to injecting only, concurrent injecting and smoking was associated with more days of methamphetamine use (b = 1.3, P < 0.001; adjusted [A] b = 1.2, P < 0.001), more frequent injection [odds ratio (OR) 1.8, P = 0.013; adjusted OR (AOR) 1.6, P = 0.042], violent behaviour (OR 2.1, P = 0.001; AOR 1.8, P = 0.013] and crime (OR 3.1, P < 0.001; AOR 2.5, P < 0.001). Non‐injecting related outcomes did not differ significantly for only smoking versus only injecting. There was no significant transition from injecting methamphetamine at baseline to non‐injecting methamphetamine use at follow up, or from exclusively smoking methamphetamine at baseline to any methamphetamine injection at follow up. Discussion and Conclusion Efforts are needed to address heavier methamphetamine use, more frequent drug injection and elevated violent behaviour and crime among people who concurrently smoke and inject methamphetamine.
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Affiliation(s)
- Rebecca McKetin
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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6
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Abstract
Damage to the skin, subcutaneous tissues and blood vessels are among the most common health harms related to injecting drug use. From a limited range of early reports of injecting-related skin and soft tissue damage there is now an increasing literature relating to new drugs, new contaminants and problems associated with unsafe injection practices. Clinical issues range from ubiquitous problems associated with repeated minor localised injection trauma to skin and soft tissue and infections around injection sites, to systemic blood infections and chronic vascular disease. The interplay of limited availability and access to sterile injecting equipment, poor injecting technique, compromised drug purity, drug toxicity and difficult personal and environmental conditions give rise to injection-related health harms. This review of injecting-related skin, soft tissue and vascular damage focuses on epidemiology and causation, clinical examination and investigation, treatment and prevention.
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Affiliation(s)
- Roy Robertson
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh Old Medical School, Edinburgh, UK
| | - Barbara Broers
- Division of Primary Care Medicine, Department of Community Medicine and Primary Care, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Magdalena Harris
- Sociology of Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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7
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Sutherland R, Dietze PM, Gisev N, Bruno R, Campbell G, Memedovic S, Peacock A. Patterns and correlates of prescribed and non-prescribed pregabalin use among a sample of people who inject drugs in Australia. Drug Alcohol Rev 2020; 39:568-574. [PMID: 32557912 DOI: 10.1111/dar.13083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 02/20/2020] [Accepted: 04/08/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND AIMS Pregabalin is a gamma-aminobutyric acid analogue registered and subsidised for the treatment of neuropathic pain in Australia. Despite pre-clinical evidence of low abuse potential, there are increasing reports of extramedical use and overdose deaths involving pregabalin. This study aimed to describe patterns of pregabalin use among an Australian sample of people who inject drugs (PWID) and identify sociodemographic, substance use and mental/physical health correlates of prescribed and non-prescribed use. DESIGN AND METHODS Data were obtained from the 2018 Illicit Drug Reporting System, comprising a cross-sectional sample of 905 PWID recruited from Australian capital cities. Multinomial logistic regression was used to identify correlates of past 6-month prescribed and non-prescribed pregabalin use. RESULTS One-quarter (25%) of participants reported any past 6-month pregabalin use, with 10% reporting prescribed use and 15% non-prescribed use. Past 6-month use of prescribed benzodiazepines and non-prescribed pharmaceutical opioids were associated with both prescribed and non-prescribed pregabalin use compared to no recent pregabalin use. Pain/discomfort on the day of interview was significantly associated with prescribed pregabalin use. Recent use of non-prescribed benzodiazepines and illicit stimulants and past year non-fatal overdose were significantly associated with non-prescribed pregabalin use (compared to no recent pregabalin use). DISCUSSION AND CONCLUSIONS Pregabalin use was relatively common among an Australian sample of PWID. Benzodiazepine and pharmaceutical opioid use were positively correlated with both prescribed and non-prescribed pregabalin use, suggesting that education campaigns regarding the risks of harm associated with concomitant use of these substances are warranted (targeting both health professionals and consumers).
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Affiliation(s)
- Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Paul M Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Raimondo Bruno
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Sonja Memedovic
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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8
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Brener L, Murphy DA, Ellard J, Cama E, Fraser N, Murray J. Knowledge, attitudes and practices related to hepatitis C among gay and bisexual men in the era of direct-acting antivirals: implications for treatment and prevention. Cult Health Sex 2020; 22:551-567. [PMID: 31131720 DOI: 10.1080/13691058.2019.1615125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/01/2019] [Indexed: 06/09/2023]
Abstract
Increases in hepatitis C (HCV) infections among gay and bisexual men have recently been reported in a number of countries, with sexual transmission being the primary route of infection. Given that in countries such as Australia most gay and bisexual men living with HIV are already engaged in clinical care - as are an increasing number of HIV-negative men - there is potential for reducing onward HCV transmission through proactive testing and treatment. This study explored knowledge, attitudes and practices related to HCV among 194 gay and bisexual men collected through an online survey in Australia. Overall, respondents had high levels of HCV knowledge; however, only 76% knew about the availability of new treatments for HCV. Men's knowledge of their own HCV testing history was uncertain, with one in six unaware if they had ever been tested. Among men who reported recent drug injecting, one-third had been injected by someone else, and two-thirds had injected someone else, indicating a subculture of cross-administering within sexualised drug-use networks. We argue that the robust sexual, socio-cultural and clinical infrastructure that has been developed by - and for - gay and bisexual men around HIV care and prevention creates the potential for reducing HCV in this group.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, NSW, Australia
| | - Dean A Murphy
- Centre for Social Research in Health, UNSW Sydney, NSW, Australia
- Department of Gender and Cultural Studies, University of Sydney, Sydney, NSW, Australia
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, NSW, Australia
| | - Jeanne Ellard
- Australian Federation of AIDS Organisations, Newtown, NSW, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, NSW, Australia
| | - Neil Fraser
- Positive Life NSW, Surry Hills, NSW, Australia
| | - Joel Murray
- Positive Life NSW, Surry Hills, NSW, Australia
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9
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Brener L, Murphy DA, Cama E, Murray J, Fraser N, Ellard J. HCV knowledge, disclosure practices, and risk perceptions among gay and bisexual men who do and do not engage in group sex while using drugs. AIDS Care 2020; 32:1258-1261. [PMID: 32338051 DOI: 10.1080/09540121.2020.1757023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ABSTRACT Research suggests that hepatitis C virus (HCV) transmission is more likely among gay and bisexual men (GBM) who engage in sexually adventurous practices, including group sex while using drugs. The current study explored drug use, sexual practices, HCV knowledge, HCV disclosure, and beliefs about HCV transmission among GBM (n = 193) reporting group sex after/while using drugs compared to those who did not. Survey findings indicate that men who participated in group sex while using drugs were more likely to have engaged in other sexually adventurous practices, ever injected drugs, have greater knowledge of HCV, and to be living with HIV. They were also more likely to perceive themselves at risk of acquiring HCV and to know that their sexual activities put them at risk. Interestingly, they had lower expectations of HCV disclosure and were less concerned about the HCV status of their partners. The lower expectations around disclosure and concern about the HCV status of their partners reflect the challenges for GBM in managing HCV transmission where there are limited effective behavioural strategies for reducing sexual transmission, This research also highlights the need to promote HCV testing and treatment to GBM who engage in group sex while using drugs.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Dean A Murphy
- Department of Gender and Cultural Studies, University of Sydney and Kirby Institute, UNSW, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Joel Murray
- National Association for People with HIV Australia, Newtown, Australia
| | | | - Jeanne Ellard
- Australian Federation of AIDS Organisations, Newtown, Australia
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10
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Peacock A, Larance B, Bruno R, Pearson SA, Buckley NA, Farrell M, Degenhardt L. Effectiveness and framing of pharmaceutical opioid abuse-deterrent formulations. Addiction 2019; 114:404-405. [PMID: 30767388 PMCID: PMC6656581 DOI: 10.1111/add.14556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 12/17/2022]
Abstract
Abuse-deterrent formulations (ADFs) of pharmaceutical opioids have limited capacity to reduce extra-medical use and harm; their impact is likely restricted to prevention of specific practices among population sub-groups. This debate highlights the importance of viewing ADFs as one component in a range of public health responses. Greater involvement of invested parties (e.g., prescribers, consumers) and reframing terminology will reduce discrimination and stigma.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of
New South Wales Sydney, NSW, Australia,School of Psychology, University of Wollongong, NSW,
Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of
New South Wales Sydney, NSW, Australia,School of Psychology, University of Wollongong, NSW,
Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of
New South Wales Sydney, NSW, Australia,School of Medicine, University of Tasmania, TAS,
Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New
South Wales Sydney, NSW, Australia
| | | | - Michael Farrell
- National Drug and Alcohol Research Centre, University of
New South Wales Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of
New South Wales Sydney, NSW, Australia
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Abstract
This study reports on an empirically underdocumented practice in contemporary aesthetic enhancement culture, the self-injection of unregulated DIY Botox and dermal filler kits purchased online. Data were collected from 4 online discussion forums containing disclosures in relation to use of DIY kits and analyzed using ethnographic content analysis. Motivation to source DIY Botox and dermal fillers online was grounded in desire to avoid financial cost of professional services and a lack of confidence in practitioners. Future intentions to order online raw materials and "formulas" to prepare dermal fillers at home were expressed. Individuals taught themselves to inject through watching YouTube tutorials and downloading Botox injection maps from the Internet. Although individuals demonstrated awareness of the health risks involved with self-injection of unregulated products, this was not a deterrent. Future research is warranted to document the injecting practices and health outcomes of individuals who inject DIY Botox and dermal filler kits to inform targeted harm reduction interventions by health-care practitioners.
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12
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Yeung A, Weir A, Austin H, Morrison K, Inverarity D, Sherval J, Henderson N, Joshi S, Ure R, McAuley A. Assessing the impact of a temporary class drug order on ethylphenidate-related infections among people who inject drugs in Lothian, Scotland: an interrupted time-series analysis. Addiction 2017; 112:1799-1807. [PMID: 28600805 DOI: 10.1111/add.13898] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/02/2017] [Accepted: 06/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS In April 2015, the UK government enacted a temporary class drug order (TCDO) on ethylphenidate in response to reported harms associated with its use, in particular an outbreak of infections among people who inject drugs (PWID) in Lothian, Scotland. This study assesses the effect that the TCDO had on reducing the most common infections identified during the outbreak: Streptococcus pyogenes and Staphylococcus aureus. DESIGN The outbreak was split into a pre-intervention period (35 weeks) and a post-intervention period (26 weeks) based around the date of the TCDO. Segmented negative binomial regression models were used to compare trends in weekly counts of infections between the pre- and post-intervention periods. SETTING AND PARTICIPANTS PWID in the Lothian region of Scotland. MEASUREMENTS Cases of S. pyogenes and S. aureus infections reported within the National Health Service, Lothian. FINDINGS There were 251 S. pyogenes and/or S. aureus infections recorded among 211 PWID between February 2014 and December 2015: 171 infections in the pre-intervention period and 51 in the post-intervention period. Significant trend changes in weekly S. pyogenes and/or S. aureus infections following the TCDO were found [relative risk (RR) = 0.88, 95% confidence interval (CI) = 0.82-0.94]. PWID who self-reported using novel psychoactive substances (NPS) were at higher risk of acquiring these infections (RR = 1.81, 95% CI = 1.12-2.93), particularly when comparing the risk of infection with NPS use for a specific strain, S. pyogenes emm76.0, against the risk of infection with NPS use for S. pyogenes (emm types other than emm76.0) (RR = 3.49, 95% CI = 1.32-9.21). CONCLUSIONS The UK government's 2015 temporary class drug order on ethylphenidate was effective in reducing infections among people who inject drugs during an outbreak situation in Lothian, Scotland.
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Affiliation(s)
- Alan Yeung
- Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, UK
| | - Amanda Weir
- Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, UK
| | - Hannah Austin
- Department of Public Health, NHS Lothian, Edinburgh, UK
| | | | - Donald Inverarity
- Department of Microbiology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jim Sherval
- Department of Public Health, NHS Lothian, Edinburgh, UK
| | - Naomi Henderson
- Department of Microbiology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Shruti Joshi
- Department of Microbiology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Roisin Ure
- Scottish Haemophilus Legionella Meningococcus Pneumococcus Reference Laboratory, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
| | - Andrew McAuley
- Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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13
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Affiliation(s)
- Roy Robertson
- Usher Institute, Edinburgh University, 1 Muirhouse Avenue, Edinburgh, EH4 4PL, UK
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14
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Rafia R, Dodd PJ, Brennan A, Meier PS, Hope VD, Ncube F, Byford S, Tie H, Metrebian N, Hellier J, Weaver T, Strang J. An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence. Addiction 2016; 111:1616-27. [PMID: 26990598 PMCID: PMC5347913 DOI: 10.1111/add.13385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/18/2016] [Accepted: 03/10/2016] [Indexed: 12/21/2022]
Abstract
AIMS To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of health-care resources. DESIGN A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and health-care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection. SETTINGS AND PARTICIPANTS Data on attendance to vaccination from a UK cluster randomized trial. INTERVENTION Two contingency management options were examined in the trial: fixed versus escalating schedule financial incentives. MEASUREMENT Life-time health-care costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios. FINDINGS The resulting estimate for the incremental life-time health-care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = -£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8-30). The probabilistic incremental cost per quality adjusted life-year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297-7172), with an 89% probability of being considered cost-effective at a threshold of £20 000 per quality-adjusted life years gained (97.60% at £30 000). CONCLUSIONS Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of health-care resources in the UK as long as the incidence remains above 1.2%.
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Affiliation(s)
- Rachid Rafia
- Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR)University of SheffieldSheffieldUK
| | - Peter J. Dodd
- Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR)University of SheffieldSheffieldUK
| | - Alan Brennan
- Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR)University of SheffieldSheffieldUK
| | - Petra S. Meier
- Section of Public Health, School of Health and Related Research (ScHARR)University of SheffieldSheffieldUK
| | - Vivian D. Hope
- Injecting Drug Use Team, HIV and STI Department, Centre for Infectious Disease, Surveillance and ControlPublic Health UK (PHE)LondonUK
| | - Fortune Ncube
- Injecting Drug Use Team, HIV and STI Department, Centre for Infectious Disease, Surveillance and ControlPublic Health UK (PHE)LondonUK
| | - Sarah Byford
- Centre for the Economics of Mental and Physical HealthKing's College LondonLondonUK
| | - Hiong Tie
- Centre for the Economics of Mental and Physical HealthKing's College LondonLondonUK
| | - Nicola Metrebian
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | | | - Tim Weaver
- Department of Mental Health, Social Work and Integrative MedicineMiddlesex UniversityHendonUK
| | - John Strang
- National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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15
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Grebely J, Litwin A, Dore GJ. Addressing reimbursement disparities for direct-acting antiviral therapies for hepatitis C virus infection is essential to ensure access for all. J Viral Hepat 2016; 23:664-6. [PMID: 27272285 PMCID: PMC6868522 DOI: 10.1111/jvh.12550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/08/2016] [Indexed: 01/21/2023]
Affiliation(s)
- J. Grebely
- The Kirby Institute, UNSW Australia, Sydney, NSW,
Australia
| | - A. Litwin
- Division of General Internal Medicine, Department of
Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx,
NY, USA
| | - G. J. Dore
- The Kirby Institute, UNSW Australia, Sydney, NSW,
Australia
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16
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Degenhardt L, Sara G, McKetin R, Roxburgh A, Dobbins T, Farrell M, Burns L, Hall WD. Crystalline methamphetamine use and methamphetamine-related harms in Australia. Drug Alcohol Rev 2016; 36:160-170. [PMID: 27286742 DOI: 10.1111/dar.12426] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/15/2016] [Accepted: 03/24/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Concerns about crystal methamphetamine use and harm have increased in multiple countries. This paper describes how changes in the availability and use of crystal methamphetamine have impacted on methamphetamine-related harms in Australia. DESIGN AND METHODS Data on methamphetamine use were obtained from population-level surveys, health service data and surveys of drug use among sentinel groups of ecstasy users and people who inject drugs. Data were obtained on seizures, arrests, clandestine laboratory detections, hospital separations, mental health unit admissions, drug telephone helpline calls and drug treatment episodes. Segmented linear regression models were fitted to identify changes in these series using log-transformed data where appropriate. RESULTS The availability of crystal methamphetamine has increased as evidenced by increased laboratory detections, domestic seizures and purity of the seized drug. Population surveys do not report an increase in the number of people who used at least once in the past year. However, more users report using crystal methamphetamine rather than lower-purity powder methamphetamine and more regular use. Indicators of methamphetamine-related harms have increased in parallel with this change. Amphetamine-related helpline calls, drug treatment, arrests and hospital admissions for amphetamine disorders and psychosis all peaked in the mid-2000s, declined for several years and have increased steeply since 2010. DISCUSSION AND CONCLUSIONS The increased availability and use of crystal methamphetamine have been associated with increased regular use and harms. Treatment is required for those experiencing problems and the capacity of health services to provide care needs to be enhanced.[Degenhardt L, Sara G, Connor JP, McKetin R, Roxburgh A, Dobbins T, Farrell M, Burns L, Hall WD. Crystalline methamphetamine use and methamphetamine-related harms in Australia. Drug Alcohol Rev 2017;36:160-170].
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Grant Sara
- Sydney Medical School, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Rebecca McKetin
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Amanda Roxburgh
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia.,National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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17
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Darke S, Duflou J, Torok M. The health consequences of injecting tablet preparations: foreign body pulmonary embolization and pulmonary hypertension among deceased injecting drug users. Addiction 2015; 110:1144-51. [PMID: 25808360 DOI: 10.1111/add.12930] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/03/2015] [Accepted: 03/19/2015] [Indexed: 11/27/2022]
Abstract
AIMS To determine: (1) the characteristics of cases presenting to the Department of Forensic Medicine Sydney (1997-2013) with foreign body pulmonary embolization; (2) the extent and locations of embolization; and (3) the relationship between extent, and use of other injection sites, with pathology. DESIGN Analysis of consecutive case presentations with foreign body pulmonary embolization. SETTING/PARTICIPANTS Sydney, Australia, with a total of 373 cases (271 males, 102 females). MEASUREMENTS Full autopsy reports, microscopy of tissue samples, and full toxicology. The extent and locations of embolization, inflammatory responses, clinical signs of pulmonary hypertension and signs of right-sided heart failure were examined. FINDINGS Cases increased from three (1997) to 58 (2013). In 43.4%, foreign particles were moderate-abundant in extent. Cases with moderate-abundant emboli were more likely to have injection sites other than the cubital fossa [odds ratio (OR) = 2.4]. In 6.9% of cases emboli were also found in other organs. A foreign body inflammatory response was present in 45.3%, vascular scarring in 8.0%, signs of pulmonary hypertension in 10.2% and signs of right-sided heart pathology in 5.4%. Cases with moderate-abundant deposition were more likely to have emboli in other organs (OR = 7.9), a foreign body inflammatory response (OR = 5.3), vascular scarring (OR = 3.4), signs of pulmonary hypertension (OR = 5.4) and right-sided heart pathology (OR = 5.3). CONCLUSIONS Cases of foreign body pulmonary embolization (resulting from injecting crushed tablets meant for oral use, such as benzodiazepines and pharmaceutical opioids) in Sydney, Australia increased markedly from 1997 to 2013. In a large proportion there were clinical consequences. More extensive embolization was associated with higher levels of pulmonary hypertension and right-sided heart pathology.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, Australia.,Department of Forensic Medicine Sydney, NSW Health Pathology, Sydney Medical School, University of Sydney, NSW, Australia
| | - Michelle Torok
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
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18
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Kapitány-Fövény M, Mervó B, Kertész M, Corazza O, Farkas J, Kökönyei G, Urbán R, Demetrovics Z. Is there any difference in patterns of use and psychiatric symptom status between injectors and non-injectors of mephedrone? Hum Psychopharmacol 2015. [PMID: 26216556 DOI: 10.1002/hup.2490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In recent years, increasing intravenous mephedrone use was reported in several countries. The aim of this study was to describe the characteristics of such a form of mephedrone use, while identifying the differences between injectors and non-injectors in patterns of mephedrone use and psychiatric symptom status. METHODS One hundred and forty-five mephedrone users were surveyed on patterns of mephedrone use using a structured questionnaire as well as the Brief Symptom Inventory. RESULTS Majority of users received mephedrone from acquaintances and used it in discos/parties settings regarding both first and current mephedrone use. Intranasal use was the most typical route of administration (84.4%). Injectors (11%) used the drug more frequently and in higher dosages. This group included a greater proportion of opiate users (37.5%) and showed more diffuse psychiatric symptoms. Regarding the predictors of being an injector, heroin use showed the highest odds ratio. CONCLUSIONS Intravenous mephedrone use is associated with a higher risk of harmful drug use, elevated psychiatric symptom profile and increased possibility of mephedrone being considered as an addictive substance. These findings might be important in efficient treatment planning.
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Affiliation(s)
- Máté Kapitány-Fövény
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Nyírő Gyula Hospital Drug Outpatient and Prevention Center, Budapest, Hungary.,Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Barbara Mervó
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Máté Kertész
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Ornella Corazza
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Judit Farkas
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary.,Nyírő Gyula Hospital Drug Outpatient and Prevention Center, Budapest, Hungary
| | - Gyöngyi Kökönyei
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Róbert Urbán
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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19
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Abstract
INTRODUCTION AND AIMS Needle and syringe programs (NSP), which provide sterile injecting equipment, are a cornerstone of Australia's drug harm reduction strategy and assist in reducing the spread of blood-borne virus infections, such as HIV and hepatitis C, among people who inject drugs. Some reports suggest that steroid users are an increasing proportion of clientele at NSPs. In this research, we investigate the experience of NSP workers who come into contact with people who use steroids and other performance- and image-enhancing drugs (PIED). DESIGN AND METHOD Thirteen NSP workers were recruited using purposive sampling strategies. Participants were interviewed using a semi-structured interview guide. Interviews were recorded, transcribed and coded for themes. RESULTS There are three key findings of this study. Firstly, NSP workers do not feel well informed about the substances that PIED users are injecting. Secondly, they were unsure what equipment PIED users required. Thirdly, PIED users were perceived to differ from other client groups, and these differences impacted upon the level of rapport staff could build with this group. DISCUSSION AND CONCLUSION PIED users pose unique challenges for NSP workers compared with other NSP client groups. The PIEDs used and the way in which they are used are substantially different compared with other NSP clients, and there appears to be a lack of knowledge within the workforce about these substances. This study highlights the need to engage in workforce training, but also the need to more effectively engage with PIED users in relation to effective harm reduction strategies.
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Affiliation(s)
- Matthew Dunn
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Australia; Centre for Health through Action on Social Exclusion, Faculty of Health, Deakin University, Melbourne, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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20
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Jacka B, Applegate T, Krajden M, Olmstead A, Harrigan PR, Marshall BDL, DeBeck K, Milloy MJ, Lamoury F, Pybus OG, Lima VD, Magiorkinis G, Montoya V, Montaner J, Joy J, Woods C, Dobrer S, Dore GJ, Poon AF, Grebely J. Phylogenetic clustering of hepatitis C virus among people who inject drugs in Vancouver, Canada. Hepatology 2014; 60:1571-1580. [PMID: 25042607 PMCID: PMC4211947 DOI: 10.1002/hep.27310] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/08/2014] [Indexed: 12/20/2022]
Abstract
UNLABELLED Little is known about factors associated with hepatitis C virus (HCV) transmission among people who inject drugs (PWID). Phylogenetic clustering and associated factors were evaluated among PWID in Vancouver, Canada. Data were derived from the Vancouver Injection Drug Users Study. Participants who were HCV antibody-positive at enrolment and those with HCV antibody seroconversion during follow-up (1996 to 2012) were tested for HCV RNA and sequenced (Core-E2 region). Phylogenetic trees were inferred using maximum likelihood analysis and clusters were identified using ClusterPicker (90% bootstrap threshold, 0.05 genetic distance threshold). Factors associated with clustering were assessed using logistic regression. Among 655 eligible participants, HCV genotype prevalence was: G1a: 48% (n=313), G1b: 6% (n=41), G2a: 3% (n=20), G2b: 7% (n=46), G3a: 33% (n=213), G4a: <1% (n=4), G6a: 1% (n=8), G6e: <1% (n=1), and unclassifiable: 1% (n=9). The mean age was 36 years, 162 (25%) were female, and 164 (25%) were HIV+. Among 501 participants with HCV G1a and G3a, 31% (n=156) were in a pair/cluster. Factors independently associated with phylogenetic clustering included: age <40 (versus age≥40, adjusted odds ratio [AOR]=1.64; 95% confidence interval [CI] 1.03, 2.63), human immunodeficiency virus (HIV) infection (AOR=1.82; 95% CI 1.18, 2.81), HCV seroconversion (AOR=3.05; 95% CI 1.40, 6.66), and recent syringe borrowing (AOR 1.59; 95% CI 1.07, 2.36). CONCLUSION In this sample of PWID, one-third demonstrated phylogenetic clustering. Factors independently associated with phylogenetic clustering included younger age, recent HCV seroconversion, prevalent HIV infection, and recent syringe borrowing. Strategies to enhance the delivery of prevention and/or treatment strategies to those with HIV and recent HCV seroconversion should be explored, given an increased likelihood of HCV transmission in these subpopulations.
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Affiliation(s)
- B Jacka
- Viral Hepatitis Clinical Research Program, The Kirby Institute,
UNSW Australia, Sydney NSW, Australia
| | - T Applegate
- Viral Hepatitis Clinical Research Program, The Kirby Institute,
UNSW Australia, Sydney NSW, Australia
| | - M Krajden
- BC Centre for Disease Control, Vancouver BC
| | - A Olmstead
- BC Centre for Disease Control, Vancouver BC
| | - PR Harrigan
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC
| | - BDL Marshall
- Department of Epidemiology, Brown University, Providence, RI,
USA
| | - K DeBeck
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC,School of Public Policy, Simon Fraser University, Vancouver, BC,
Canada
| | - M-J Milloy
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC,Department of Family Practice, Faculty of Medicine, University of
British Columbia, Vancouver, BC
| | - F Lamoury
- Viral Hepatitis Clinical Research Program, The Kirby Institute,
UNSW Australia, Sydney NSW, Australia
| | - OG Pybus
- Department of Zoology, University of Oxford
| | - VD Lima
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC,Division of AIDS, Department of Medicine, Faculty of Medicine,
University of British Columbia, Vancouver, BC, Canada
| | - G Magiorkinis
- Department of Zoology, University of Oxford,Virus Reference Department, Public Health England, London,
UK
| | - V Montoya
- BC Centre for Disease Control, Vancouver BC
| | - J Montaner
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC,Division of AIDS, Department of Medicine, Faculty of Medicine,
University of British Columbia, Vancouver, BC, Canada
| | - J Joy
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC
| | - C Woods
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC
| | - S Dobrer
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC
| | - GJ Dore
- Viral Hepatitis Clinical Research Program, The Kirby Institute,
UNSW Australia, Sydney NSW, Australia
| | - AF Poon
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver BC
| | - J Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute,
UNSW Australia, Sydney NSW, Australia
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21
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Robaeys G, Grebely J, Mauss S, Bruggmann P, Moussalli J, De Gottardi A, Swan T, Arain A, Kautz A, Stöver H, Wedemeyer H, Schaefer M, Taylor L, Backmund M, Dalgard O, Prins M, Dore GJ. Recommendations for the management of hepatitis C virus infection among people who inject drugs. Clin Infect Dis 2014; 57 Suppl 2:S129-37. [PMID: 23884061 DOI: 10.1093/cid/cit302] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In the developed world, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). The burden of HCV-related liver disease in this group is increasing, but treatment uptake among PWID remains low. Among PWID, there are a number of barriers to care that should be considered and systematically addressed, but these barriers should not exclude PWID from HCV treatment. Furthermore, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provides a framework for HCV assessment, management, and treatment. Further research is needed to evaluate strategies to enhance assessment, adherence, and SVR among PWID, particularly as new treatments for HCV infection become available.
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Affiliation(s)
- Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium.
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22
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Dertadian GC, Maher L. From oxycodone to heroin: two cases of transitioning opioid use in young Australians. Drug Alcohol Rev 2013; 33:102-4. [PMID: 24256365 DOI: 10.1111/dar.12093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 10/30/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS The non-medical use of pharmaceutical opioids is associated with a range of negative health consequences, including the development of dependence, emergency room presentations and overdose deaths. DESIGN AND METHODS Drawing on life history data from a broader qualitative study of the non-medical use of painkillers, this brief report presents two cases of transitions from recreational or non-medical pharmaceutical opioid use to intravenous heroin use by young adults in Australia. RESULTS Although our study was not designed to assess whether recreational oxycodone use is causally linked to transitions to intravenous use, polyopioid use places individuals at high risk for progression to heroin and injecting. Our first case, Jake, used a range of analgesics before he transitioned to intravenous use, and the first drug he injected was methadone. Our second case, Emma, engaged in a broad spectrum of polydrug use, involving a range of opioid preparations, as well as benzodiazepines, cannabis and alcohol. Both cases transitioned from oral to intravenous pharmaceutical opioids use and subsequent intravenous heroin use. DISCUSSION AND CONCLUSIONS These cases represent the first documented reports of transitions from the non-medical or recreational use of oxycodone to intravenous heroin use in Australia. As such, they represent an important starting point for the examination of pharmaceutical opioids as a pathway to injecting drug use among young Australians and highlight the need for further research designed to identify pharmaceutical opioids users at risk of transitions to injecting and to develop interventions designed to prevent or delay these transitions.
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Affiliation(s)
- George C Dertadian
- Institute for Culture and Society, University of Western Sydney, Penrith, Australia
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23
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Des Jarlais DC, Hagan H, Arasteh K, McKnight C, Semaan S, Perlman DC. Can intranasal drug use reduce HCV infection among injecting drug users? Drug Alcohol Depend 2011; 119:201-6. [PMID: 21794991 PMCID: PMC5157129 DOI: 10.1016/j.drugalcdep.2011.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/10/2011] [Accepted: 06/11/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preventing HCV infection among people who inject drugs is a difficult public health challenge. We examined the potential role of intranasal drug use in reducing HCV acquisition. METHODS Subjects were recruited from IDUs entering the Beth Israel drug detoxification program from 2005 to 2010. A structured interview was administered and serum samples were collected for HCV testing. RESULTS 726 active injecting drug users were recruited from 2005 to 2010. HCV prevalence was 71%, 90% reported recent heroin injection and 44% reported recent intranasal heroin use. In a multiple logistic regression analysis, being HCV seropositive was associated with more years injecting, Latino ethnicity, previous testing for HCV, and recent injection of speedball, and negatively associated with recent intranasal use of heroin (AOR=0.52, 95% CI 0.33-0.82) and intranasal use of speedball (AOR=0.41, 95% CI 0.31-0.80). The association between intranasal heroin use and lower HCV seroprevalance was observed among both new injectors and persons with long injecting histories (16+ years since first injection). CONCLUSION Encouraging intranasal use as an alternative to injection among persons currently injecting drugs may be a viable strategy for reducing HCV transmission.
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