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PubMed1997

Approaches to preventing alcohol-related problems: the experience of New Zealand and Australia.

New Zealand and Australia have experienced similarities in their drinking cultures and patterns since colonization. This paper briefly reviews those experiences and looks at the approaches both countries have taken in dealing with alcohol-related problems. Over 10 years ago Australia developed a national strategy embracing a harm reduction approach and more recently New Zealand embarked upon a similar process. As well as examining the development of these, other initiatives are examined. These include approaches to licensing of alcohol sales, taxation, alcohol promotion, control of drinking on licensed premises, drinking and driving intervention, community action, initiatives by Maori and Aboriginal people and efforts to educate the individual drinker.

Journal Article↗

PubMed1998

Women injecting drug users in London: the extent and nature of their contact with drug and health services.

Improved access to drug treatment and other health services remains central to HIV prevention and other harm reduction strategies among injecting drug users (IDUs) in the UK. Efforts have therefore been focused upon making such services more accessible and 'user friendly'. Women who use drugs are considered a 'hard to reach' population. This is largely based on data from a variety of official sources which have suggested that women are under-represented as clients of drug services. While current literature provides numerous explanations for this, there have been few empirical studies exploring the nature and extent of women's contact with such services. This paper presents findings from an European Community funded survey of women IDUs in London. Data from this survey suggest that women IDUs have surprisingly high levels of contact with a range of specialist and generic health services in relation to their drug use.

Journal Article↗

PubMed1997

Polydrug use at raves by a Western Australian sample.

This study aimed to quantify the patterns of drug use among a group of participants in the rave scene in Perth, Western Australia. Interviews were conducted with 83 people who had recently been to a 'rave'. The study incorporated a semi-structured qualitative interview and a structured quantitative questionnaire. This paper reports on the quantitative data collected concerning patterns of drug use in association with the last rave attended. Use of 'dance drugs' (ecstasy, amphetamines or LSD) was reported by 86.8% of the 76 respondents who had used at least one drug in association with their last rave. Nearly 80% of these had also used at least one other drug on this occasion (mean number used = 2.4). Cannabis and inhalants were the drugs most commonly combined with the 'dance drugs', several respondents used more than one 'dance drug' concurrently and 16.7% had used alcohol. It seems that a significant proportion of those using 'dance drugs' in association with raves and dance parties are mixing these drugs with other substances despite harm reduction advice to the contrary. The need for more research in this area is discussed.

Journal Article↗

PubMed2006

Addiction and sexually transmitted disease (STD), human immunodeficiency virus, (HIV), and acquired immune deficiency syndrome (AIDS): their mutual interactions.

We explore the links between substance use, misuse, addiction, and dependency1 and sexuality, sexually transmitted diseases (STD), human immunodeficiency virus (HIV), and acquired immune deficiency syndrome (AIDS) to increase our awareness of their interdependence and to identify new ways to perceive, judge, and intervene (or not to) with associated problems. We consider the sociocultural and economic context in which these behaviors occur; the impact these behaviors have on one another; the personal opinions and attitudes; the religious, moral, or political beliefs and agendas; the physiological and fiscal constraints; and theories of rational decision-making and psychological motivation that act to increase or reduce the incidence of these behaviors and their sequellae, while hindering or facilitating prevention, harm reduction, and treatment interventions. Mechanisms of epidemic spread of STDS/HIV/AIDS are presented in the Appendix. Each of these terms are loaded "container concepts" that are culture-bound and stakeholder-driven and whose dimensions are less than consensus-based. They represent a range of meanings, uses, and misuses in an ongoing politicalized area of human and systemic functioning and adaptations.

Behavior, Addictive↗

PubMed2006

A longitudinal study of syringe acquisition by Puerto Rican injection drug users in New York and Puerto Rico: implications for syringe exchange and distribution programs.

Increasing access to sterile syringes and new drug preparation materials is an effective means of reducing HIV transmission among injection drug users (IDUs), and a fundamental component of harm reduction ideology. The purpose of this study is to examine changes during a three-year period in syringe acquisition by street-recruited Puerto Rican IDUs characterized by frequent drug injection and high HIV seroprevalence. At baseline (1998-1999) and 36-month follow-up, 103 IDUs recruited in East Harlem, New York (NY), and 135 from Bayamón, Puerto Rico (PR) were surveyed about syringe sources and HIV risk behaviors in the prior 30 days. A majority of participants in both sites were male (NY 78.6%, PR 84.4%), were born in Puerto Rico (NY 59.2%, PR 87.4%), and had not completed high school (NY 56.3%, PR 51.9%). Compared to PR IDUs at follow-up, NY IDUs injected less (3.4 vs. 7.0 times/day, p < .001), and re-used syringes less (3.1 vs. 8.0 times, p < .001). Between baseline and follow-up, in NY the proportion of syringes from syringe exchange programs (SEPs) increased from 54.2% to 72.9% (p = .001); syringes from pharmacies did not increase significantly (0.2% to 2.5%, p = .095). In PR, the proportions of syringes from major sources did not change significantly: private sellers (50.9% to 50.9%, p = .996); pharmacies (18.6% to 19.0%, p = .867); SEP (12.8% to 14.4%, p = .585). The study indicates that NY SEPs became more dominant, while NY pharmacies remained a minor source even though a law enacted in 2001 legalized syringe purchases without prescription. Private sellers in PR remained the dominant and most expensive source. The only source of free syringes, the SEP, permitted more syringes to be exchanged but the increase was not statistically significant. Implications for syringe exchange and distribution programs are discussed.

Adult↗

PubMed2002

Prescribing to drug misusers in practice--often effective, but rarely straightforward.

Many reviews describe the effectiveness of methadone treatment in reducing illicit drug use and associated behaviours among opiate misusers. The strongest evidence includes social outcomes such as reduced debt and crime, and relates overwhelmingly to maintenance rather than detoxification treatment. Drug clinics are often dominated by individuals unable to withdraw fully from methadone, while the "harm reduction" model accepts some ongoing drug use, with attendant risks. Security measures are necessary to avoid abuse of treatments, but these may be undermined by the agenda of "partnerships with patients" in decision-making. Buprenorphine appears both safer and less addictive than methadone, and lofexidine is effective as a non-substitute detoxification method. Naltrexone can clearly reduce relapse rates, provided consumption is assured, while for individuals unable to detoxify or avoid euphoriant opiates, morphine and diamorphine are sometimes used. In non-opiate misuse, clinical studies of a wide range of medications have produced relatively few positive findings.

Drug Prescriptions↗

PubMedDate not supplied

Risking for protection: discourses around 'safe sex' among Chilean, Turkish and second-generation Greek women living in Melbourne, Australia.

The aim of this study was to identify the ways in which women from Turkish, second-generation Greek and Chilean backgrounds living in Melbourne, Australia, understand risks to their sexual health with a focus on STDs including HIV/AIDS. Data were derived from in-depth qualitative interviews with 20 women from each ethnic group (N = 60). Interviews were guided by a theme list, conducted in the woman's language of preference, tape-recorded and fully transcribed. Transcripts were double coded for key themes and analysed using ethnographic content analysis. The key findings are that for many women, reducing the risk of STDs to protect their physical health introduces risks to their social health and to the well-being of their family and community. Thus, women place priority over the protection of their social health as opposed to their physical health. Despite specific cultural differences in understandings of sexual health risks and illnesses, all women shared gendered commonalities in the ways in which they contextualise STDs within the wider context of social relationships and their everyday life. We conclude by arguing for interventions that specifically take into account social models of risk in STD and HIV/AIDS prevention and we consider the practical implications of this for harm reduction strategies in multicultural societies such as Australia.

Acquired Immunodeficiency Syndrome↗

PubMed2004

The "low-tar" strategy and the changing construction of Australian cigarettes.

This article documents design changes in Australian cigarettes since the adoption of a "low-tar" harm reduction strategy in 1966. It also determines the relative contributions of specific technologies to machine-tested tar and nicotine yields in 1980 and 1994, using data from tobacco industry documents. Our findings are consistent with a first generation of low-tar cigarettes, which relied primarily on filtration efficiency, being displaced by a second generation, which relied heavily on filter ventilation and were more attractive to consumers. In 1980, both tar and nicotine yields correlated most strongly with filter density (r=-.66, p<.01, and r=-.70, p<.01), whereas in 1994 both tar and nicotine yields correlated most strongly with percentage filter ventilation (r=-.97, p<.01, and r=-.95, p<.01). We also found that median percentage alkaloid content of tobacco rods rose from 2.16% in 1980 to 2.4% in 1994, despite median nicotine yield declining from 1.0 mg to.58 mg. These changes can be expected to reduce the utility of the FTC/ISO yield testing system.

Australia↗

PubMed1999

Integrated drug and alcohol intervention: development of an opportunistic intervention program to reduce alcohol and other substance use among psychiatric patients.

OBJECTIVE: This paper describes the rationale, aims and processes involved in developing and implementing an opportunistic intervention program to reduce substance misuse detected among psychiatric patients. METHOD: In this randomised, opportunistic intervention program, eligible patients recruited from a large psychiatric hospital and its associated community mental health centres are assigned to receive an integrated drug and alcohol intervention (IDAI) or alternatively allocated to a minimal intervention condition (MI). The IDAI is based on motivational enhancement and cognitive-behavioural principles, and incorporates harm-reduction approaches. This clinical program is based on the research findings and recommendations of the mental health and the drug and alcohol literature. RESULTS: A collaborative partnership between the Mental Health Services and the Drug and Alcohol Services was formed. Following a relatively short training period, mental health staff were trained to opportunistically detect drug and alcohol problems among psychiatric patients and offer appropriate integrated clinical care. CONCLUSION: The process of implementing an integrated opportunistic intervention program is achievable and can be readily incorporated in psychiatric hospitals and community mental health clinics.

Adolescent↗

PubMed2005

Blood-borne viral and sexually transmissible infections among psychiatric populations: what are we doing about them?

OBJECTIVE: To discuss the prevalence of blood-borne viral and sexually transmissible infections among psychiatric populations, as well as current treatment approaches, both locally and internationally. METHOD: In this paper, we outline available epidemiological data, as well as interventions designed to target infectious disease risk among those with serious mental illness. RESULTS: Within Australia, the prevalence of blood-borne viral and sexually transmissible infections among at-risk populations remains unacceptably high despite a number of successful harm reduction and prevention strategies. Although the highest rates of new infections occur among young people aged 15-29 years, recent research suggests that psychiatric populations are also at significant risk. However, despite increased rates, there is currently no coordinated strategy to educate, test and reduce disease risk among people suffering with mental illness within Australia. CONCLUSIONS: Although further epidemiological research at a local level is needed, interventions specifically targeting psychiatric populations and younger cohorts in particular, are essential. This will require multidisciplinary, collaborative service development, incorporating mental health, substance use and infectious disease specialists.

Adolescent↗

PubMed2001

Concurrent substance use and outcome in combined behavioral and naltrexone therapy for opiate dependence.

UNLABELLED: The effect of concurrent nonopiate drug use on outcome of treatment for opiate dependence. METHOD: Forty-seven opiate-dependent patients received a 6-month course of outpatient treatment with naltrexone and cognitive-behavioral therapy (behavioral naltrexone therapy, BNT) at a university-based research clinic. Opiate-negative urines and naltrexone ingestion were rewarded with monetary vouchers. Abstinence from other drugs was encouraged verbally, but no contingencies were placed on nonopiate drug use. The proportions of all urines (collected twice weekly) positive for cocaine, cannabis, and benzodiazepines over the course of treatment were evaluated as predictors of outcome of opiate dependence treatment, as measured by proportion of opiate-positive urines, days retained in treatment, and proportion of naltrexone doses taken, using Pearson product moment correlations and one-way analysis of variance (ANOVA). RESULTS: The majority of patients (78%) used a nonopiate drug at least once during the trial. There were no significant correlations between concurrent drug use measures and opiate dependence treatment outcomes, indicating no simple linear relationship between these measures. However, when concurrent drug use was trichotomized into abstinent, intermittent, and heavy use groups, groups with intermittent use had superior outcome compared to both abstinent and heavy use groups in several contrasts. CONCLUSIONS: Intermittent use of nonopiate drugs is common during outpatient treatment for opiate dependence and may be a favorable prognostic indicator. This may support a "harm reduction" approach as opposed to a strict abstinence-oriented approach. Further research is needed to identify the optimal therapeutic stance toward other drug use during treatment for opiate dependence.

Adolescent↗

PubMed2004

Barriers to enrollment in drug abuse treatment and suggestions for reducing them: opinions of drug injecting street outreach clients and other system stakeholders.

Alcohol and other drug abuse (AOD) treatment is a major means of HIV/AIDS prevention, yet clients of street outreach programs (SOP) who are injection drug users (IDU), and outreach workers and staff as well, report various obstacles to enrolling clients in AOD programs. This study assessed the barriers to AOD enrollment facing high risk street outreach clients and obtained suggestions for reducing them. Data were obtained from semistructured field interviews with: 1) IDU outreach clients (N = 144) of the six SOPs in New York City (NYC) and northern suburbs supported by the Office of Alcoholism and Substance Abuse Services (OASAS), the single state agency in New York State for AOD prevention and treatment, 2) outreach workers and staff of the six SOPs (N = 55), 3) staff of detox and AOD treatment programs in major modalities treating IDUs (N = 71), and 4) officials and administrators (N = 11) in OASAS, the AIDS Institute of the Department of Health (addresses all aspects of the HIV/AIDS epidemic in New York State), and the agency for public assistance in New York City, the Human Resources Administration (HRA). Principal barriers for street outreach clients included personal-family issues, lack of insurance/Medicaid, ignorance, suspicion, and/or aversion to AOD treatment (methadone maintenance especially), "hassles" with Medicaid, lack of personal ID, lack of "slots," limited access to intake, homelessness, childcare-child custody issues. Further, about 18% had no desire for AOD services, reported no barriers, or were too enmeshed in addiction to enroll. Outreach staff cited prospective client's lack of ID and lack of Medicaid, lack of "slots," and stakeholder agency bureaucracy. Treatment staff cited lack of client readiness, "hassles" posed by welfare reform, AOD programs' own "red tape," waiting lists, and near exclusionary preference for the Medicaid-eligible. Finally, agency managers cited client factors, inadequate funding and lack of appropriate programs, treatment program requirements, and societal stigmatization of addicts. Proposed remedies included dropping ID and insurance requirements for admission, major increases in resources, funding the transporting of outreach client treatment candidates to AOD services sites, education and training initiatives, increased inter-agency cooperation, and the need for stakeholder agencies, OASAS especially, to more effectively integrate abstinence-oriented AOD services with harm reduction and the public health aspects of AOD problems.

Adult↗

PubMedDate not supplied

African-American injection drug users: tensions and barriers in HIV/AIDS prevention.

This exploratory study utilized a focus group methodology to explore tensions and barriers in HIV/AIDS prevention among African-American injection drug users. Participants discussed HIV infection risks, national/community HIV prevention effectiveness, prevention barriers, ideas on barrier removal, and the tensions which exist between users and the larger African-American community. Recognizing the inevitability of continued drug use for many injectors, participants requested basic harm-reduction supplies including condoms, needle exchange programs, additional drug user treatment services, and the use of culturally- and gender-matched peer-led prevention and treatment outreach. Preliminary recommendations are made for consideration in HIV/AIDS prevention among African-American IDUs.

Adult↗

PubMed2001

Risk behaviors among injecting drug users in Northern Ireland.

Compared to elsewhere in the United Kingdom, drug policy in Northern Ireland has for the most part failed to incorporate harm reduction strategies. In light of the conservative drug policies, the purpose of this study was to investigate the nature and extent of risk behaviors among injecting drug users (IDUs) in Northern Ireland. Data for this study were drawn from in-depth interviews with 39 IDUs in Northern Ireland. The findings suggest that most IDUs engage in extensive risk behaviors that pose risk for HIV, Hepatitis B and C. and other infectious disease. Moreover, these risk behaviors are linked to the scarcity of new needles and a general lack of knowledge about injection practices that reduce risk for infectious disease. These findings are discussed in the context of conservative drug policies.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Characteristics of heroin addicts entering methadone maintenance treatment: quality of life and gender.

STUDY OBJECTIVE: To provide information on MMP patient's characteristics, particularly those related with Health Related Quality of Life (HRQoL) and gender. DESIGN: Cross-sectional study. Data were collected on socio-demographic, toxicological variables, HIV risk behaviors, and HRQoL through the Nottingham Health Profile (NHP). PATIENTS AND SETTING: Over a 30-month period (1996--1999) Barcelona's Municipal Drug Care Centres recruited 586 patients. MAIN RESULTS: Mean age of patients was 31 years, 70% were males and 25% were HIV-infected. Rates of unemployment, criminal records and low educational level were high. Most poly-drug users used cocaine. NHP mean score was related with poly-drug use, educational level and HIV status. Consistent condom use was related with HIV status. Females' route of administration was less likely to be injection, even though they were more frequently HIV-positive and manifested contemporary poorer general health. CONCLUSIONS: Patients QoL was poor. Nowadays harm reduction health strategies would need to face cocaine use, and sexual risk behaviors mainly among females and sexual partners.

Adult↗

PubMed2003

Brazilian response to the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic among injection drug users.

The Brazilian response to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic is being observed all over the world because of its success. Understanding the role of injection drug users (IDUs) in the epidemic and the political response thereto is a key factor in the control of the epidemic in Brazil. This paper summarizes some of the most important analyses of the Brazilian response to the HIV/AIDS epidemic among and from IDUs. Key elements of the response include the support of the Brazilian Universal Public Health System, the provision of universal access to highly active antiretroviral therapy, and the creation of harm reduction projects that are politically and financially supported by the federal government. The response among and from IDUs is a key element in overall control of the HIV/AIDS epidemic. The response to the epidemic among and from IDUs has been headed in the correct direction since its beginning and is now being intensively expanded.

Acquired Immunodeficiency Syndrome↗

PubMed2003

The challenge of implementation of preventive programs in a developing country: experiences, situations, and perspectives in Uruguay.

In recent years, Uruguay has seen an alarming increase in the percentage of persons with human immunodeficiency virus infection/acquired immunodeficiency syndrome who are injection drug users (IDUs) and their sex partners, which has consequently contributed to the rate of perinatal transmission. Development of preventive harm reduction and risk reduction strategies has become imperative. These strategies must be suitable for a developing country and focused on its population of IDUs. These strategies must include, as a preliminary step, a comprehensive analysis of the current local legal system and knowledge about the kinds of drugs used, the ways in which they are used, and their effects on public health. The conclusions of some studies and a pilot program that Institute of Social Research and Development, Instituto de Investigación y Desarrollo Social, Uruguay, implemented in 2001 have pointed to new avenues for the control of the epidemic spread among IDUs and to their social environment.

Adolescent↗

PubMed2003

Vulnerable among the vulnerable: drug users in situations of poverty and indigence in Argentina.

To study drug use in the context of poverty, it is necessary to undertake a complex analysis of various perspectives to understand the dense interweaving of socioeconomic, political, and cultural factors involved in the problem. The analysis of this social scenario was our starting point in planning holistic actions for the prevention of human immunodeficiency virus/acquired immunodeficiency syndrome and other illnesses related to drug use. Merely copying successful models from developed countries, which are designed for other contexts and populations, would result in insufficient and ineffective actions. The Asociación Civil Cristiana Recuperación Atención de Drogadependientes (ACCRAD), also known as "El Retoño" ("sprout"), is a nongovernmental organization that has been working since 1985 to consolidate a model of analysis and intervention that considers this complex framework and seeks to meet the needs of drug users from the poorest sectors of society. Our research on the use of drugs and its relationship to poverty, together with the documentation of harm-reduction interventions, has been carried out since 1997.

Argentina↗