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PubMed2003

Cause and manner of death in drug-related fatality: an analysis of drug-related deaths recorded by coroners in England and Wales in 2000.

This study investigated causes and manner of drug-related fatalities recorded in 2000 in the United Kingdom, measuring the 'masked' manner of death in cases typically recorded as overdose. A retrospective cohort study was used of 1037 cases of accidental drug-related fatalities reported by coroners in England and Wales to the National Programme of Substance Abuse Deaths. Whilst 802 cases were identified as direct acute overdose, representing 77% of the total accidental deaths, 23% of 'overdose' fatalities were caused by asphyxiation (7%), drug-related medical conditions (7%), non-drug-related conditions (4%), traumatic accidents (3%) and infections (2%). Younger people show higher risk of overdose and asphyxiation; older people show higher risk from pre-existing medical conditions. This study not only confirmed the high risk of overdose associated with heroin and polydrug use, but it also identified other high fatality risk factors for heroin/morphine users such as contracting an acute infection leading to septicaemia or endocarditis, or contracting a chronic infection such as HIV, HBV or HCV. In contrast, stimulants particularly featured in traumatic accidents, with amphetamine use most associated with cardio-vascular fatality. These findings highlight the 'masked' manner of death in cases commonly recorded as overdose and demonstrate the need for a more-detailed and systematic method of recording drug-related deaths in order to inform drug education and harm reduction strategies.

Adolescent↗

PubMed2006

High HIV prevalence and risk factors among injection drug users in Tashkent, Uzbekistan, 2003-2004.

OBJECTIVES: To determine HIV prevalence and potential associations with sociodemographic and behavioral factors among injection drug users (IDUs) in Tashkent, Uzbekistan. METHODS: Subjects in this cross-sectional study provided sociodemographic and risk behavior data and were tested for HIV antibody with a saliva-based enzyme-linked immunosorbent assay (ELISA), followed by saliva-based Western blot confirmation. RESULTS: Among the 701 IDU subjects enrolled, 209 (29.8%) were diagnosed with HIV infection, HIV infection was more likely among those unemployed (adjusted odds ratio [AOR]=1.47); whose first drug of abuse was heroin (AOR=2.21) or opium poppy extract (AOR=1.61); with a prior history of hepatitis (AOR=1.39); and those who reported never using condoms (AOR=1.65). Independent risk factors associated with HIV infection were heroin as the first illicit drug of abuse, prior hepatitis, lack of condom use, and unemployment. CONCLUSIONS: Heroin use, sexual transmission, and high unemployment seem to play important roles in HIV transmission. Implementation of effective harm reduction strategies is critical to control the expansion of the HIV epidemic in this country as well as in this region.

Adolescent↗

PubMed2006

Regional differences in injecting practices and other substance use-related behaviour among entrants into opioid maintenance pharmacotherapy treatment in New South Wales, Australia.

BACKGROUND: Investigations of injecting drug users (IDUs) have been conducted largely in urban areas. Those studies that compare rural and urban IDUs often utilise small and possibly unrepresentative samples. AIM: To investigate regional differences in the characteristics of IDUs. METHODS: The study compared the demographic, drug use-related, and treatment characteristics of 1045 urban, 213 regional, and 254 rural opioid maintenance pharmacotherapy (OMP) treatment entrants recruited as part of a feasibility study into the implementation of a state-based treatment outcome monitoring system. RESULTS: Participants from regional and rural New South Wales (NSW) were significantly more likely to report sharing of needles and other injection equipment and higher non-opioid drug use and polydrug use than their urban counterparts. In addition, they were more likely to be living with dependent children, to be unemployed, and to be experiencing greater psychological problems than their urban counterparts. Needle sharing also was independently associated with being younger, female, having been arrested, or having non-opioid drugs of concern. CONCLUSIONS: Reasons for the higher rates of blood-borne virus (BBV) transmission risk-related behaviour among rural and regional IDUs should be investigated further and considered when planning for the targeted provision of harm reduction activities.

Adolescent↗

PubMed2000

Treating substance abuse in the context of severe and persistent mental illness: clinicians' perspectives.

Patients with comorbid substance use and major mental disorders are treated frequently in the mental health system. Treatment models relevant for this subset of patients have emerged in recent years, however, few have been validated empirically and so relatively few sites benefit from this treatment development activity. Important additional sources of information about good treatment practices are the clinicians who have adopted the treatment of patients with dual disorders as a specialty. We conducted four focus groups (N = 12) with clinicians who were nominated by their peers as experienced and/or expert in treating persons with comorbid substance use and psychiatric disorders. Discussions followed a four-part outline that included (a) general questions about training and experience with the population, (b) preferred treatment methods, (c) motivational issues, and (d) recommendations to the field. Participants were trained in a variety of mental health disciplines and pursued substance abuse treatment credentials or other educational experiences outside of their primary training programs. Their treatment approaches emphasized psychoeducation, a good therapeutic relationship, and the need to be flexible regarding methods and goals. Abstinence was the preferred goal among most clinicians; even so, they expressed a pragmatic flexibility and other views consistent with the principles of harm reduction. Clinicians tended to respond to patients' ambivalent motivational states by addressing the consequences of behaviors in a nonconfrontive style; they also made use of positive incentives and external support. A number of recommendations were made to improve treatment, including greater institutional and programmatic support for the unique needs of this population.

Adult↗

PubMed2003

Adherence to methadone is associated with a lower level of HIV-related risk behaviors in drug users.

There have been limited studies on the potential role of methadone treatment in HIV prevention in Asia. Over an 8-week period, we assessed the profiles of drug-taking and HIV risk behaviors, and tried to identify their relationships with methadone adherence in 690 clients who attended Hong Kong's methadone treatment program. In the preceding month, 71% of respondents reported using drugs and two-thirds of those respondents who had injected drugs at some time in their lives injected then. Infrequent clients who attended methadone clinics <2 times in the previous week were twice more likely to have injected drugs in the last month and six times more likely to have >5 injections in the last week than frequent clinic attendees. Also, clients taking <60 mg methadone daily were twice more likely to have >5 injections in the last week than those taking > or = 60 mg methadone. The findings called for further studies on harm reduction programs for HIV prevention among drug users in Asian countries.

Adolescent↗

PubMed2003

Reaching adolescents who drink harmfully: Fitting intervention to developmental reality.

Alcohol use usually starts in early adolescence. While the greater proportion of young people develop adaptive patterns of drinking, many drink at harmful levels and may be at risk for future alcohol-related problems. Findings from the empirical literature suggest that universal prevention programs may delay onset of drinking among low-risk baseline abstainers; however, there is little evidence supporting their utility for at-risk adolescents. Further research is needed on how risk and protective factors interact to determine substance use trajectory, and intervention outcomes that take substance use trajectories into account may capture change more effectively than the use of absolute measures of substance use. Indicated prevention programs may benefit from modulations that account for adolescent individuation and identity formation. It is argued that motivational interviewing within a harm reduction framework is well suited to adolescents.

Adolescent↗

PubMed2002

Injection drug use in North America.

Injection drug use of psychotropic agents for nontherapeutic purposes is associated with some of the most pernicious infectious diseases seen in the United States. There is an inextricable link between infection, injection drug use (IDU) and other risk behaviors, especially those related to sexual activity. A number of national surveys now provide excellent databases to track the breadth, scope and impact of IDU across the United States. The prevalence of heroin use has increased over the past decade with larger numbers of users presenting for treatment of drug use disorders. A host of serious infections can result from IDU. Prevention and early intervention with evidence-based harm-reduction strategies are crucial to reducing and eliminating these odious consequences.

Communicable Diseases↗

PubMed2000

Citizens who inject drugs: the 'Fitpack' study.

Most injecting drug users have never been in drug treatment yet much research is done on samples with high treatment rates drawn from agency and peer recruited populations. This study accessed drug injectors with little or no prior drug treatment, described their characteristics, BBVI risk behaviours and feedback on services. Its results challenge some stereotypes about citizens who inject drugs. A sample of 511 'hidden' drug injectors, of whom only 28.7% had any specialist drug treatment agency contact, completed a questionnaire which was distributed with 'Fitpack' needle packs sold through community pharmacies in WA. The mean age of respondents was 26.2 years, 43.4% were women, 44.3% were living with their sexual partner, 41.7% were parents, and 46.4% were employed, mostly in full time work. In the previous month 61.2% had injected less frequently than daily. The study accessed a diverse group of drug injectors not typically seen in agency and peer recruited research. They provided useful feedback about how harm reduction strategies among injectors can be improved. However, they also reported higher rates of injecting and sharing than found previously in traditionally recruited samples of injectors which suggests there is no room for complacency regarding the potential for blood-borne viral infection (BBVI) transmission in this group.

Journal Article↗

PubMed2000

Rapid assessment and response to injecting drug use in Madras, south India.

HIV infection among injecting drug users (IDUs) is preventable, and in order to develop appropriate interventions, an assessment was carried out at Madras, South India using the Rapid Assessment and Response Guide on Injecting Drug Use developed by WHO. Data were collected with multiple methods from multiple sources using the principles of triangulation and induction. A total of 100 IDUs were interviewed. These interviews were complemented by focus groups and observations. A community advisory board ensured community ownership and participation. Findings showed that heroin, buprenorphine, diazepam and avil were the drugs most commonly injected. The use of pharmaceutical preparations as a 'cocktail' was also prevalent. Drug injectors interviewed were males, and most (81%) were from low-income groups living in slums. Direct (69%) as well as indirect sharing (94%) was common. Such unhygienic injecting practices, and the lack of access to sterile water, contribute to the high incidence of adverse health consequences. Compared with the buprenorphine injectors, heroin injectors were more likely to share injecting equipment (P=0.0022), inject more frequently (P=0.0013), have more drug using network members (P=0.0104), frequent 'shooting' locations (P=0.002), use the dealer's place to inject (P=0.0317), and face threats of arrest (P=0.0023). Many buprenorphine injectors managed their life without serious crises, and seemed to adopt a 'natural' harm reduction response. Sexual risk behaviour was prevalent among opioid users, and a history of commercial sex was associated with daily alcohol use (P=0.0221). The assessment led to an action plan which was presented and endorsed in an advocacy meeting by key stake-holders and decision-makers. The critical importance of implementing quality, accessible, community-oriented, and effective HIV interventions with the capacity to reach the majority of IDUs is discussed. Public health responses to injecting drug use must target changes among individuals at-risk, as well as in the community and risk environment.

Journal Article↗

PubMed2000

Rapid assessment of drug use and HIV vulnerability in south-east and east Asia.

In an 8-week period in late 1997, an assessment of the situation of drug use and HIV vulnerability in east and south-east Asia was carried out for the United Nations Joint Programme on AIDS (UNAIDS). It served to assist UNAIDS' Asia-Pacific team in setting priorities for action at a regional level, it having been realised that epidemics of HIV among injecting drug users (IDUs) were playing an important role in the development of the AIDS epidemic in Asia at both country and regional levels. Though essentially a desk exercise, contact with the extensive membership of the Asian Harm Reduction Network allowed a deeper and more efficient investigation than would otherwise have been possible, with access to key informants and 'grey' literature. The assessment found a situation of massive epidemics of HIV among IDUs either occurring, or about to occur, in most Asian countries; and parlous or non-existent public health responses to these problems in a context void of policy. As well as providing evidence to guide UNAIDS, and useful for advocacy by a wide range of people, the process of the situation assessment also generated interest and in some cases activity on the part of many individuals and institutions throughout the region. It is hoped that this will be the beginning of an ongoing monitoring of the situation.

Journal Article↗

PubMed2000

'First steps': using rapid assessment and response methods to develop research, intervention and advocacy capacity for addressing drug use in Rosario City, Argentina.

During the last decade, injecting drug use (IDU) has increased in Rosario City, Argentina, and more than half of all reported HIV cases are thought to be related to the sharing of injection equipment. Despite this, valid and systematic data on the extent and nature of injecting drug use are rare, and only a limited number of HIV prevention interventions currently operate in the city. In response, the Universidad Nacional de Rosario have used the Spanish translation of the Rapid Assessment and Response Guide on Injecting Drug Use (IDU-RAR) developed by the World Health Organization (WHO. The Rapid Assessment and Response Guide on Injecting Drug Use (draft for field testing). Geneva: WHO, 1998) as a first step in producing more detailed research data, identifying urgently needed interventions, and designing a long-term harm reduction strategy for Rosario. This paper describes this process and the outcomes of the assessment where key findings indicate that: 65% of those sampled were HIV positive; 70% shared injecting equipment; the majority were not in contact with drug treatment services; 13% were under the age of 20; and 62% of those injecting drug users with HIV had neither medical care or treatment for their condition.

Journal Article↗

PubMed2000

Processes and outcomes of training on rapid assessment and response methods on injecting drug use and related HIV infection in the Russian Federation.

In September 1997, Médecins Sans Frontières-Holland (MSF-H) began a project to provide training and support for HIV/AIDS prevention among injecting drug users (IDUs) in the Russian Federation, focusing on the use of the World Health Organization Rapid Assessment and Response Guide on Injecting Drug Use, and the European Peer Support Manual. As part of the training, participants are asked to carry out a rapid situation assessment (RSA) in their city or region as a major step towards designing and implementing an effective program to prevent HIV transmission among IDUs. This paper focuses on the first four training cycles of the programme (from January 1998 to January 1999), in which 89 health professionals and others from 32 Russian cities took part. A total of 28 rapid situation assessments were completed or almost completed by participants during these four cycles. The paper provides an overview of the methods used and major problems faced by participants undertaking these assessments, as well as summarising the 14 harm reduction programmes which resulted.

Journal Article↗

PubMedDate not supplied

Bareback sex and gay men: an HIV prevention failure.

Bareback sex, or actively seeking unprotected anal intercourse is occurring in the gay male community. This represents a new phenomenon, different from previously identified "relapse" unsafe sexual behavior and poses an important HIV prevention problem. This article reviews the extant literature regarding bareback sex. The lay press and scientific literature are reviewed. Although discussion of issues surrounding bareback sex is abundant in the gay press, scientific literature regarding this phenomenon is nonexistent. The evidence-based literature addresses relapse to unsafe sexual behavior. Although this literature provides further understanding of safer sexual behaviors in gay men, barebacking is a unique issue that requires additional exploration. In this article, factors underlying bareback sexual behavior are explored, including previous HIV prevention efforts and their relationship to this phenomenon. Finally, bareback sex in the gay male community and its implications for nursing practice, research, and education are explored. The harm reduction model is offered as a useful guide for nursing assessment and intervention.

Adult↗

PubMed1996

Alcohol and other drug problems in Australia: the urgent need for nurse education.

The economic, social and health costs associated with alcohol and other drug use, including medicines, impact on the Australian community profoundly. Many Australians use alcohol and other drugs (AODs) on a regular basis and a significant number experience problems at some time. There are about 25,000 drug-related deaths annually, the majority of which are related to alcohol and tobacco use. Many young people die or are injured as a direct result of alcohol intoxication, accidental overdose and related problems, and significant numbers of elderly people are hospitalised, permanently incapacitated or suffer avoidable trauma through adverse drug reactions and side-effects of medications. It is estimated that at least 25 per cent of acute hospital beds hold patients with alcohol-related problems directly associated with the medical diagnosis, and there are comparable numbers of people needing social and other forms of assistance at some time. Despite the preventative nature of many AOD problems and the call for harm reduction, timely intervention and support for the thousands of Australians attending hospitals, community health and mental health services, nurses are yet to effectively assist the community in preventing and responding to the range of AOD problems. Nursing policy, guidelines and clinical expertise are required to assist the community in addressing this issue. Undergraduate, postgraduate and continuing education have a vital role to play in providing the profession with the knowledge, skills and research base to meet this challenge.

Alcoholism↗

PubMed1996

Substance-misuse: the front line at the police station - an opportunity for intervention.

The Brighton project, 'Get It While You Can', has two ex-drug addict project workers visiting prisoners in police custody cells. They provide information about harm reduction and service provision within the Brighton area. They are also able to provide on-going support to the detainees after they have left the police station and to help them successfully access agencies in the town and further afield.

Journal Article↗

PubMed2001

Prevalence of antibodies to hepatitis C virus, HIV and human T-cell leukaemia/lymphoma viruses in injecting drug users in Tayside, Scotland, 1993-7.

The prevalence of blood-borne viruses in injecting drug users (IDUs) in Tayside, Scotland was determined by testing serum samples from IDUs who underwent attributable HIV antibody testing during 1993-7. The prevalence of antibodies to HIV was 29/802, (3.6%); to hepatitis C virus (HCV) 451/691, (65.3%); and to human T-cell leukaemia/lymphoma viruses type 1 and 2 (HTLV) 0/679, (0.0%). The prevalence of HIV and HCV antibodies were higher in subjects over the age of 25 (P = 0.03 and P = 0.001, respectively). During 1993-7 the prevalence of HCV fell only in younger female IDUs (P < 0.01). HIV prevalence has declined dramatically since 1985, when a rate of 40% was recorded in similar populations. Harm reduction measures have failed to control HCV the spread of infection among IDUs in Tayside, as indicated by the high proportion of antibody positive IDUs, particularly males under the age of 25. Future studies should address the nature and effective reduction of continuing risk taking among IDUs in Tayside.

Adolescent↗

PubMed2002

Prevalence of hepatitis C among injectors in Scotland 1989-2000: declining trends among young injectors halt in the late 1990s.

We previously reported a continual decline in anti-HCV prevalence among young injectors from Glasgow and Lothian between 1990 and 1997. The original study was extended to ascertain if the anti-HCV prevalence among injectors from Glasgow, Lothian, Tayside and Grampian had changed since 1997. Residual sera from injectors who had undergone attributable anti-HIV testing were tested anonymously for anti-HCV. In all four regions, no significant changes in prevalence were found among those aged < 25 years during the late 1990s (Glasgow 1997-9/00: 43%-41%; Lothian 1997-9: 13%-17%; Tayside 1997-9: 45%-35%; Grampian 1996-9: 28%-29%). Among those aged > or = 25 years, significant decreases in prevalence were only observed in Glasgow (1997-9/00: 79%-72%, P = 0.03) and Lothian (1997-9: 54%-45%, P = 0.05). The findings highlight that existing harm reduction measures, acknowledged as having helped to reduce the spread of HCV, are not sufficient to bring this epidemic under control and reduce transmission to sporadic levels.

Adolescent↗

PubMed2006

Hepatitis C virus infection among injecting drug users in Scotland: a review of prevalence and incidence data and the methods used to generate them.

It is estimated that of 50,000 persons in Scotland (1% of the county's population), infected with the hepatitis C virus (HCV), around 90% injected drugs. This paper reviews data on the prevalence and incidence of HCV, and the methods used to generate such information, among injecting drug users (IDUs), in Scotland. The prevalence estimate for HCV among IDUs in Scotland as a whole (44% in 2000), is comparable with those observed in many European countries. Incidence rates ranged from 11.9 to 28.4/100 person-years. The data have shaped policy to prevent infection among IDUs and have informed predictions of the number of HCV-infected IDUs who will likely progress to, and require treatment and care for, severe HCV-related liver disease. Although harm reduction interventions, in particular needle and syringe exchanges and methadone maintenance therapy, reduced the transmission of HCV among IDUs during the early to mid-1990s, incidence in many parts of the country remains high. The prevention of HCV among IDUs continues to be one of Scotland's major public health challenges.

Epidemiologic Methods↗