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PubMed1995

Correlates of hepatitis C virus infections among injection drug users.

Injection drug users are at high risk for hepatitis C virus (HCV) infection. In Baltimore, Maryland, the prevalence of anti-HCV is greater among injection drug users who are black, human immunodeficiency virus (HIV) infected, have injected longer, have injected more frequently, and have injected cocaine than among other injection drug users. HCV infection occurs quickly after the initiation of injecting illicit drugs, with 78% of study participants anti-HCV positive after 2 years of injecting. The prevalence of anti-HCV among injection drug users does not appear to be related to socioeconomic factors or sexual practices. Some injection drug users remain free of anti-HCV even after years of injecting and serologic evidence of other bloodborne pathogens. Some of these injection drug users have HCV infection, demonstrated by HCV RNA in their sera. However, the basis for viral persistence in the absence of anti-HCV and for the absence of HCV infection in long-term drug users is not known. Further studies are indicated to determine the mechanism or mechanisms for the absence of anti-HCV in persons exposed to the virus, because the biologic basis for this condition may elucidate the elements missing in the immune response of the majority of HCV-exposed persons who acquire persistent infection. In addition, interventions to prevent HCV infections should be applied in populations at risk for injection drug use early or before drug use begins.

Adolescent↗
PubMed2002

HIV-1 infection in injection drug users.

Injection drug use is an efficient and ongoing means of HIV transmission and is the principal mode of transmission in some parts of the world. In the United States, approximately 10,000 injection drug users are believed to acquire HIV each year. The US Public Health Service hopes to decrease all HIV transmission in the United States by 50% in the next 5 years, by promoting care and prevention services to infected persons. Subtle differences in the virology and immunopathogenesis of HIV between injection drug users and other groups at risk are still being investigated. So far such differences have no practical implication. Comparison of progression rates and survival with HIV across risk groups has been difficult because of the many competing causes of death unrelated to HIV among injection drug users, but overall HIV disease progression rates are similar across risk groups, after adjusting for age. Some AIDS-related opportunistic infections are more common (such as tuberculosis) or less common (such as Kaposi's sarcoma) among injection drug users, based on rates of exposure and latent infection. Other comorbidities, including chronic psychiatric disorders and hepatitis C disease, are more common among injection drug users than among others with HIV infection. Highly active antiretroviral treatment seems to be as effective in persons with a history of injected drug use as in others. Increasing the numbers of HIV-infected injection drug users who know their diagnosis, increasing their access to care and prevention services, and increasing their adherence to a therapeutic regimen are the current challenges in confronting the HIV-epidemic among injection drug users. To overcome these obstacles, clinicians must have both technical knowledge and skill in assisting patients with behavior change.

Adolescent↗
PubMed1991

The attitudes of heroin users and matched non-users to drugs and drug users.

Compared with matched controls, heroin users were more tolerant of substance use and perceived themselves as slightly more unemployed, depressed, neat and aggressive. Both groups thought crack cocaine, heroin and alcohol dangerous. Heroin users were most in favour of cannabis, followed by controls who had used cannabis, with only controls who had never used cannabis being against it. It is concluded that the stereotype of a heroin user was not strongly believed by these heroin users or their peers.

Adult↗
PubMed1999

UK monitoring of problem drug users: the drug misuse database - a system based on regional centres.

UK drug treatment policy aims to reduce the harm to individuals and communities resulting from drug misuse through multidisciplinary community services, prescribing, detoxification and rehabilitation facilities. Drug Misuse Databases (DMD) were set up in England, Wales and Scotland in 1990 to monitor treatment demand; that in Northern Ireland is under development. The regional base of these DMDs provides good local context and data specificity, while periodic collation of regional data by the Department of Health provides national analyses. DMD will be able to deliver the TDI dataset with only minor adjustments, following harmonisation between the constituent UK countries.

Databases as Topic↗
PubMed2002

Prevention and treatment of hepatitis C in injection drug users.

Injection drug users constitute the largest group of persons infected with the hepatitis C virus (HCV) in the United States, and most new infections occur in drug users. Controlling hepatitis C in the U.S. population, therefore, will require developing, testing, and implementing effective prevention and treatment strategies for persons who inject drugs. Fortunately, a substantial body of research and clinical experience exists on the prevention and management of chronic viral diseases among injection drug users. The need to implement interventions to stop the spread of HCV among drug users is critical. The capacity of substance-use treatment programs need to be expanded to accommodate all who want and need treatment. Physicians and pharmacists should be educated in how to provide access to sterile syringes and to teach safe injection techniques, both of which are lifesaving interventions. The treatment of hepatitis C in drug users requires an interdisciplinary approach that brings together expertise in treating hepatitis and caring for drug users. Treatment decisions should be made individually by patients with their physicians, based on a balanced assessment of risks and benefits and the patient's personal values. Physicians should carefully assess, monitor, and support adherence and mental health in all patients, regardless of whether drug use is known or suspected. Research is needed to better understand how best to prevent and treat hepatitis C in substance users. In the meantime, substantial progress can be made if existing knowledge and resources are brought to bear.

Antiviral Agents↗
PubMed1992

Outreach to injecting drug users and female sexual partners of drug users on the lower east side of New York City.

In 1984, outreach to injecting drug users and their female sexual partners was initiated as part of HIV behavioral research projects. HIV, health, drug treatment and family planning information and services were provided in addition to recruiting subjects to the research program. Such outreach also poses certain problems--especially potential disruption of neighborhood day-to-day life and clashes with police. This paper discusses an outreach program to injecting drug users and their female sexual partners that was initiated in New York City to provide HIV-related information and services. We examine the successes of the program and problems that were involved in conducting outreach to persons who are typically not accessible through formal institutional channels.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Illicit drugs and driving: prevalence, beliefs and accident involvement among a cohort of current out-of-treatment drug users.

Drug-driving behaviour among out-of-treatment dependent drug users has not been investigated while a theoretical perspective on the propensity of certain drug users to drive while impaired has not been suggested. This paper examines illicit drugs and driving behaviour and accident involvement among out-of-treatment current drug users. Psychological evidence of belief-based mechanisms to account for the decision to drive while impaired by drugs are provided. A total of 210 out-of-treatment current drug users were interviewed in a non-clinical setting by privileged access interviewers. Questionnaire measures were: current illicit drug use, severity of dependence, illicit drugs and driving behaviour, impaired and unimpaired accident involvement and beliefs and perceptions about the impairing effects of a number of illicit drugs. Analyses are restricted to participants who reported driving during the previous 12 months (n = 71). Fifty-eight participants (81.7%) reported driving immediately after consuming illicit drugs, primarily heroin and cannabis. Of these 41.4% (n = 24) had at least one road accident as a driver, 15 of whom (62.4%) reported accident involvement following recent drug consumption. Belief-based results showed that participants who reported never driving after using illicit drugs perceived heroin, methadone and alcohol to be greater significance for accident risk and driving skills impairment than other drugs. Those drivers who reported drugs and driving behaviour believed only alcohol to be significantly more impairing than other drugs. Findings indicated that illicit drugs and driving behaviour is common among out-of-treatment drug users. Accident involvement among this cohort is characterised by the previous consumption of illicit substances. Differential beliefs about the effects of drugs on driving performance and accident risk were shown to be dependent upon frequency of drugs and driving behaviour. Results are discussed in terms of experiential factors and consistency theories of attitude formation and change.

Accidents, Traffic↗
PubMed1996

Natural history of HIV-1 infection and predictors of survival in a cohort of HIV-1 seropositive injecting drug users.

Injecting drug users represent a pivotal and increasing component of acquired immunodeficiency syndrome (AIDS) case reporting in the United States. This article describes the natural history of human immunodeficiency virus (HIV) disease in a New York City cohort of 328 HIV-infected injecting drug users. The study sample of nearly two-thirds men (predominately African Americans and Latino Americans) underwent follow-up from December 1988 through December 1993. Male injecting drug users reported a longer injecting drug use history and were more likely to share needles/works than female injecting drug users. Eighty-nine of 328 study subjects died during the 5 years of observation. Comparing African Americans and Latinos, race/ethnicity was not related to survival. Survival was related to baseline CD4 count and hemoglobin level. Zidovudine use and PCP prophylaxis did not predict survival. Because of the continuing and increasing impact of HIV disease on injecting drug users and communities of color, there remains an unquestionable need to develop effective prevention programs, to understand the natural history of HIV disease, and to develop appropriate therapeutic interventions to treat those with HIV disease.

Adult↗
PubMed1985

Risk reduction for the acquired immunodeficiency syndrome among intravenous drug users.

Intravenous drug users are the second largest risk group for the acquired immunodeficiency syndrome (AIDS) and a bridge to two other groups: children and heterosexual partners. In the absence of effective treatment or vaccines, control of the epidemic among drug users will rely on efforts to reduce needle sharing. However, the traditional image of intravenous drug users leads one to expect little or no risk reduction. We review characteristics of AIDS as a disease that impede efforts at risk reduction among drug users and report on current risk reduction among intravenous drug users in New York City. There has been a sustained increase in the demand for new, unused needles, as shown in the emergence of "resealed" needles and in interviews with persons selling needles in illicit drug-purchasing areas.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Screening for hepatitis B and vaccination of injecting drug users in NHS drug treatment services.

Hepatitis B vaccines are now available for people at high risk of infection. Injecting drug users are at particular risk. A UK national survey of statutory drug treatment facilities was conducted to assess what screening and vaccination procedures were offered to drug takers. Of the respondents 64% did not screen for hepatitis B and 71% did not offer vaccination to hepatitis B negative individuals. However, 63% respondents said they would advise vaccination for injecting drug users who continued to share. Fifty-eight per cent thought that the partners of hepatitis B positive clients should be screened and 50% thought that vaccination of partners was advisable. A policy of screening and vaccination for hepatitis B is recommended.

Hepatitis B↗
PubMed1999

Inhalant use and delinquent behavior among adolescents: a comparison of inhalant users and other drug users.

AIMS: To evaluate the association between inhalant use and delinquent or criminal behavior. DESIGN: A large statewide sample of high school students participated in a survey on drug use. Five groups were identified based on reported drug use: inhalant experimenters, other drug experimenters, inhalant users, other drug users and non-users. Inhalant users were compared with other drug users and inhalant experimenters with other drug experimenters on three measures of problem behavior. PARTICIPANTS: Over 13,000 students in grades 7-12 participated in the 1993 survey on drug use. MEASUREMENTS: Three measures of problem behavior: drinking and drug-taking, "trouble behavior" and minor criminal activity. FINDINGS: Among upper (9-12) grade level students only, both inhalant users and inhalant experimenters reported more minor criminal activity than other drug users and other drug experimenters, respectively. A similar trend was noted for trouble behavior. The same was not found for drinking and drug-taking behavior. CONCLUSIONS: The findings suggest that inhalant use is categorically different from other drug use, and that it has more in common with general delinquency than with general drug use. Prevention and treatment strategies should take this into consideration.

Administration, Inhalation↗