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PubMed1989

Risk behaviors for HIV-1 infection in Italian drug users: report from a multicenter study. First Drug User Multicenter Study Group.

In June 1987, a cross-sectional study was carried out on drug users attending public centers for drug dependency in Italy. Observed proportions of HIV seropositives among the 1,363 subjects from 34 public centers in 11 regions included in the study varied widely, with an overall seropositivity rate of 37%. Sharing syringes/needles, already used by other intravenous drug users, for preparing and injecting drugs represented independent risk factors for HIV-1 infection, while sexual lifestyle did not. Risk of infection increased with frequency of sharing equipment for preparing and for injecting drugs. Modification of risk behaviors in drug use was reported more frequently than in sexual lifestyle; both were significantly associated with knowledge of being seropositive for HIV-1 infection.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Response to overdose among injection drug users.

BACKGROUND: Drug overdose is a leading cause of mortality among illicit drug users. This study characterizes responses to overdose among injection drug users (IDUs) in Baltimore, Maryland, and identifies factors associated with medically inappropriate response. METHODS: A cross-sectional survey was administered to 924 IDUs in an ongoing cohort study between August 2003 and September 2004. Self-reported experiences of witnessing overdose were obtained by structured interview. Multiple logistic regression identified associations between overdose information sources and medically inappropriate responses. RESULTS: Most IDUs (69.7%) reported ever witnessing an overdose. The most common responses were walking the victim around (70.8%), shaking them (64.9%), and inflicting pain (62.6%). One in four (25.8%) injected the victim with salt water. Two thirds (63.4%) called 911, but more than half delayed the call by 5 or more minutes. The most common reason cited for delaying or foregoing the 911 call was the belief that they could revive the victim themselves, followed by fear of police involvement. Most IDUs had received information on how to prevent or respond to an overdose, but most (73.2%) received this information from friends or other drug users. IDUs who got overdose information solely from lay sources were less likely to call 911 (adjusted odds ratio [AOR] = 0.66, 95% confidence interval [CI] = 0.46-0.94) and more likely to inject the victim with salt water (AOR = 2.06, 95% CI = 1.36-3.13) than IDUs who received no information at all. Injection drug users who received information from medical and social services providers only were less likely to delay the 911 call (AOR = 0.35, 95% CI = 0.22-0.72). CONCLUSIONS: Inappropriate overdose responses are widespread among IDUs in Baltimore. Interventions that provide overdose education and reduce police response to overdose events may improve witness response and reduce mortality associated with drug overdose.

Adult↗
PubMed2005

Vaccination in the county jail as a strategy to reach high risk adults during a community-based hepatitis A outbreak among methamphetamine drug users.

Illicit drug use (IDU) is an important risk factor for hepatitis A, but implementing vaccination programs among drug users is difficult. During January 2001-July 2002, 403 hepatitis A cases were reported in Polk County, Florida; 48% were drug users and of these, 80% were recently in jail. To assess the county jail as a potential vaccination venue, we interviewed 280 inmates and conducted a serologic survey during July--August 2002. Of these, 227 (81%) reported a past IDU history. Previous HAV infection was found in 33%. In communities with illicit drug users at risk for hepatitis A and who are frequently jailed, vaccination programs in jails could be an important component of a community-based strategy to control hepatitis A outbreaks among illicit drug users.

Adolescent↗
PubMed2002

Drug users' involvement in the drug economy: implications for harm reduction and HIV prevention programs.

The purpose of this article is to explore individual and social characteristics associated with drug users' involvement in the drug economy among a sample of low-income heroin and cocaine users (n = 1,288) in Baltimore, Maryland. The study sample had participated in a network-oriented intervention study of human immunodeficiency virus (HIV) risk behaviors among drug users. Of the sample, 44% (n = 569) held at least one role in the drug economy, performing an average of 1.17 roles. A significantly higher percentage of those involved in the drug economy reported being daily drug users (60.6% vs. 40.2%), injecting heroin daily (36.0% vs. 21.8%), injecting speed daily (23.6% vs. 14.7%), and snorting heroin daily (18.3% vs. 13.4%). In terms of social networks, those involved in the drug economy reported a significantly larger social network (9.98 vs. 8.97), greater percentage of active drug users in their social network (47% vs. 44%), greater percentage of daily drug users in their social network (40% vs. 33%), and larger drug support networks (6.7 vs. 5.6). The study indicates the far-reaching influence of drug use on many aspects of their lives, including their involvement with the drug economy. Reducing drug users' frequency of use could have the consequence of decreasing this involvement. Being a part of the drug economy exposes drug users to many risks, but also places them in a position to influence others. Examining drug users' social networks could provide insight into the composition of their immediate social environment and could inform HIV prevention programs.

Adult↗
PubMed1991

The next problem: maintenance of AIDS risk reduction among intravenous drug users.

Intravenous drug users have surprised many policymakers and researchers by exhibiting large-scale AIDS risk reduction. Relapse from desired behavior change has been a traditional problem in treatment for drug misuse/dependence. Failure to maintain AIDS risk reduction was examined in a study of 399 intravenous drug users from New York City. Over 80% of the subjects reported initiating risk reduction, but 36% of those also reported that they did not fully maintain the risk reduction. Factors associated with initiating risk reduction were not necessarily associated with maintenance, indicating that different types of change processes may be occurring. At the policy level, one needs to think of long-term efforts to reduce the spread of HIV among drug users; "quick fix" programs are not likely to be effective.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Factors affecting cognitive functioning in a sample of human immunodeficiency virus-positive injection drug users.

Injection drug users represent a major vector of human immunodeficiency virus (HIV) infection in the nation's inner cities, and are an important population for harm reduction treatment interventions to target. However, there has been relatively little research examining the specific contribution of the multiple factors contributing to cognitive functioning among injection drug users that may affect engagement in, and response to, addiction and HIV-related interventions. The current study examined the independent contributions to neuropsychological (NP) test performance of premorbid educational attainment, medical and psychiatric history, long- and short-term drug use, assessed by laboratory, observation, and self-report measures, and HIV disease, assessed by plasma HIV-1 RNA viral load and CD4+ count, in a sample of 90 HIV-positive injection drug users dually addicted to heroin and cocaine. Fully 88% of the sample showed evidence of impairment (>1 standard deviation below the population mean) on an NP test battery selected to assess processes associated with successful engagement in the treatment of substance abuse and HIV, such as learning and memory of verbal information, capacity to solve new problems and deal with more than one stimulus at a time, visual-motor coordination, and visual tracking and cognitive flexibility. In addition to drug use, independent predictors of NP test performance were HIV viral load, educational attainment, and premorbid medical and psychiatric problems. Findings underscore the multiplicity of factors that contribute to cognitive impairment in HIV-positive drug-abusing individuals in addition to drug use. Clinical implications are discussed.

Adult↗
PubMed2002

Age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus infection among injection drug users admitted to drug treatment in 6 US cities.

OBJECTIVES: This study measured age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus (HCV) infection among injection drug users (IDUs) admitted to drug treatment programs in 6 US cities. METHODS: Remnant sera collected from persons entering treatment with a history of illicit drug injection were tested for antibodies to HIV, hepatitis C (anti-HCV), and hepatitis B core antigen (anti-HBc). RESULTS: Prevalence of anti-HBc and anti-HCV increased with age and reached 80% to 100% among older IDUs in all 6 cities. Although overall age-specific HIV prevalence was lower than anti-HCV or anti-HBc, this prevalence was greater in the Northeast than in the Midwest and West. CONCLUSIONS: The need continues for effective primary prevention programs among IDUs specifically targeting young persons who have recently started to inject drugs.

Adult↗
PubMed2000

Antiretroviral therapy for drug users.

Injection drug use represents the primary risk factor for up to 40% of patients with HIV infection. Physicians are generally reluctant to prescribe antiretroviral therapy (ART) for these patients due to possible poor adherence, and the potential for complex drug interactions to occur. Providing daily observed ART in conjunction with methadone maintenance therapy (MMT) has significantly improved accessibility of ART for many drug users. Knowledge of potential drug interactions between methadone, ART, and both legally and illegally prescribed drugs has permitted such interactions to be anticipated and either avoided or treated appropriately. Optimizing ART for drug users therefore demands a multidisciplinary approach from medical, clinical pharmacology and psychiatric services.

Anti-HIV Agents↗
PubMed2003

Towards more effective public health programming for injection drug users: development and evaluation of the injection drug user quality of life scale.

The psychometric properties of the Injection Drug User Quality of Life Scale (IDUQOL) were assessed in 61 Montreal IDUs in 2001, 85% of whom were reinterviewed within four weeks. The reliability of the IDUQOL was acceptable (ICC = 0.71) and concordance between the IDUQOL and the Flanagan Quality of Life Scale was moderate (Pearson coefficient = 0.57). Quality of life was negatively associated with injection cocaine and emergency department use with both instruments; these results were more striking for the IDUQOL. The IDUQOL is a culturally relevant quality of life instrument with good psychometric properties. The IDUQOL may be useful in the development and evaluation of interventions for IDUs.

Adult↗
PubMed2004

Trends in HIV prevalence among drug-users attending public drug-treatment centres in Italy: 1990-2000.

The occurrence of HIV infection among drug-users in Italy between 1990 and 2000 is described; the data concern drug-users attending a nation-wide network consisting of 510 public drug-treatment centres. We included only individuals with written documentation of an HIV-test result. Of the 1,299,972 attendees, 54.5% had a documented HIV-test result. The overall HIV prevalence among those with a test result was 19.8%. The annual prevalence decreased from 30.8% in 1990 to 15.8% in 2000 (chi-square for linear trend P < 0.0001); the decrease was more evident between 1990 and 1996, whereas the prevalence apparently levelled-off after 1996. The annual prevalence was significantly higher among females compared to males throughout the study period. The annual prevalence was consistently three to four times higher for prior attendees, compared to new entrants. Although information on whether or not the attendees injected drugs was not available for the entire study period, the proportion of attendees with a documented HIV-test result can be considered as an approximation of the proportion who inject drugs. Although HIV infection was widespread among injecting drug-users in Italy beginning in the mid-1980s, since the early 1990s it has been somewhat contained. However, the levelling-off of the prevalence after 1996 may conceal an increase in the number of new infections and should be more thoroughly investigated. Aggregated national-level data, despite their limitations, represent a reliable tool for monitoring the temporal trend of HIV prevalence among injecting drug-users in Italy.

Adult↗
PubMedDate not supplied

Hepatitis C infection among injecting drug users attending the National Drug Treatment Centre.

During a one year period from August 1992 to August 1993, 272 injecting drug users attending the National Drug Treatment Centre were tested for antibody to Hepatitis C Virus with a second generation EIA test. The overall sero-prevalence was 84% (N = 229). A significantly greater proportion of females tested positive than males (Female: Male, 94% v 80%, p < 0.012). Looking at sero-prevalence of Hepatitis C in relation to duration of intravenous drug misuse, we found that in those patients with a duration of misuse of greater than two years (N = 156) the sero-prevalence was 95% and in those with a duration of intravenous drug misuse of less than two years (N = 116) the sero-prevalence was 70%. We conclude that needle sharing continues to occur among injecting drug users during their first two years of injecting, despite the existence of harm minimization programmes. Our results would suggest that female injecting drug users are involved in greater at risk behaviour in relation to Hepatitis C than their male counterparts.

Adolescent↗
PubMed2003

Use and assessment of complementary and alternative therapies by intravenous drug users.

Intravenous drug users often have many health conditions in addition to their drug addiction, yet may be isolated from conventional sources of care. They have never before been examined for their use of complementary and alternative medicine (CAM) therapies. Our purpose was to study the prevalence and predictors of CAM use among persons with a history of intravenous drug use through a cross-sectional survey of intravenous drug users examining their utilization of health services, including CAM therapies. A total of 548 persons with a history of intravenous drug use, recruited from a needle-exchange program and a methadone maintenance clinic, both in Providence, Rhode Island, participated. Overall prevalence of any CAM use in the past 6 months, frequency of use of individual named CAM therapies and domains, and demographic and clinical characteristics associated with CAM users, reasons for CAM use and self-perceived effectiveness of CAM were also measured. Of the 548 participants, 45% reported use of at least one CAM therapy. The top three therapies--religious healing, relaxation techniques, and meditation--were all from the mind-body domain. Having a higher education and lower self-rated health were the two strongest predictors of CAM use, followed by having a regular doctor or clinic, being white and younger. There was a high level of self-perceived effectiveness of CAM therapies (4.1 on a scale of 1-5), and CAM users were likely to use CAM for reasons related to their addiction.

Complementary Therapies↗
PubMed2005

Overcoming barriers to prevention, care, and treatment of hepatitis C in illicit drug users.

Injection drug use accounts for most of the incident infections with hepatitis C virus (HCV) in the United States and other developed countries. HCV infection is a complex and challenging medical condition in injection drug users (IDUs). Elements of care for hepatitis C in illicit drug users include prevention counseling and education; screening for transmission risk behavior; testing for HCV and human immunodeficiency virus infection; vaccination against hepatitis A and B viruses; evaluation for comorbidities; coordination of substance-abuse treatment services, psychiatric care, and social support; evaluation of liver disease; and interferon-based treatment for HCV infection. Caring for patients who use illicit drugs presents challenges to the health-care team that require patience, experience, and an understanding of the dynamics of substance use and addiction. Nonetheless, programs are successfully integrating hepatitis C care for IDUs into health-care settings, including primary care, methadone treatment and other substance-abuse treatment programs, infectious disease clinics, and clinics in correctional facilities.

Alcohol Drinking↗
PubMed2001

Incentives vs outreach workers for latent tuberculosis treatment in drug users.

BACKGROUND: Drug users are at increased risk for latent tuberculosis infection (LTBI) and also at increased risk for noncompletion of medication regimens for treatment of LTBI or tuberculosis disease. Directly observed therapy (DOT) provided by outreach workers, the use of incentives, or both have been suggested as a means to increase adherence. OBJECTIVE: To compare the independent and combined effects of monetary incentives and outreach worker provision of DOT for LTBI treatment in a sample of active drug users. METHODS: The research design was a randomized controlled trial in a community outreach program setting. Participants consisted of a volunteer sample of 163 active injection drug and crack cocaine users placed on twice weekly DOT. Condition 1 of the interventions consisted of provision of DOT by an outreach worker at a location chosen by the participant (active outreach) and a $5 per visit incentive. Condition 2 was comprised of active outreach with no monetary incentive, and Condition 3, provision of DOT at the study community site and a $5 per visit incentive. The main outcome measures were percentage of medication taken as prescribed and completion of medication regimen. RESULTS: The percentage of prescribed medication taken was higher for those who received incentives, either with (71%) or without (68%) active outreach, compared to those who received active outreach alone (13%). Only 4% of participants assigned to Condition 2 completed treatment, compared to 53% of Condition 1 participants, and 60% of Condition 3 participants. CONCLUSIONS: Monetary incentives were clearly superior to active outreach. Active outreach in combination with monetary incentives did not increase adherence over incentives alone.

Adolescent↗
PubMed2002

Presentation, diagnosis, and management of arterial mycotic pseudoaneurysms in injection drug users.

Injection drug users frequently present with abscess, cellulitis, and endocarditis. The development of arterial mycotic pseudoaneurysm (AMP) as a sequela of injection drug use, however, is much less frequently reported. We undertook a study to determine the prevalence and presenting clinical characteristics of AMP, utilizing a retrospective review of all emergency department cases seen at one city public hospital for the 5-year period 1994-1999. Initial evaluation included physical examination, CT scan, ultrasound, and/or angiography. There were 7,795 patient visits for complications of injection drug use; 11 patients had AMP (0.14%). AMP involved the brachial (n = 5), subclavian (n = 2), radial (n = 2), femoral (n = 1) and popliteal arteries (n = 1). Fever was absent in the majority of patients (7/11). Either pulsatility or a mass was noted in three cases, and both were seen in 6/11 (54%). AMP was not initially suspected in three cases, which were treated as abscesses and surgically incised, resulting in arterial rupture. The annual prevalence of AMP in the presenting population was estimated to be 0.03%. However, a high index of suspicion for AMP should be maintained with injection drug users presenting with a mass or pulsatility over an artery, as there is risk of rupture, rapid exsanguination, and distal embolization.

Adult↗
PubMedDate not supplied

A nested-epidemic model for the spread of hepatitis C among injecting drug users.

Injecting drug users (IDUs) are the largest risk group for HCV infection. Studying injecting by classical epidemiological methods is no easy task, largely due to its hidden nature and low prevalence in general population terms. Thus, mathematical modelling can be of major help in performing a qualitative and quantitative evaluation of the costs and possible impact of the various interventions and to produce forecasts of both injecting drug use and HCV spread among IDUs. In the present paper an epidemic Mover-Stayer model for the spread of drug use, which has been recently proposed, is extended to mirror the spread of an infectious disease, in particular hepatitis C, among the injecting drug user population. In order to model the spread of a disease (HCV) among a population evolving following a different epidemic (injecting drug use) all the compartments of the 'external epidemic' (injecting drug use) are subdivided into two sub-compartments: the first one comprising individuals who are not affected by HCV and the second one comprising individuals affected. The resulting model may be defined the 'two epidemics' or, better, the 'nested epidemics' model. The model is a Mover-Stayer model for what concerns the 'external epidemic' (injecting drug use) but is a homogeneous epidemic model for HCV (all individuals are at risk of HCV the same). In the following, the dynamic equations are derived. Some qualitative analysis is performed in order to evaluate the asymptotic behaviour and the impact of possible prevention or harm reduction interventions. The results of a scenario analysis are also presented. The model, though simple, seems to be a very valuable tool for policy makers.

Disease Outbreaks↗
PubMed1999

Use of incentives to increase compliance for TB screening in a population of intravenous drug users. Vancouver Injection Drug Use Study Group.

SETTING: Intravenous drug users (IDUs) represent a high risk group for dual human immunodeficiency virus (HIV) and tuberculosis (TB) infection. Screening with TB skin testing has therefore been suggested in this group. Subjects' compliance for returning to have TB skin test results read is a major problem. In the setting of a needle exchange program we evaluated the role of financial incentives to increase compliance. METHODS: We evaluated the role of giving a small financial incentive of Can $5 to subjects if they returned to have their purified protein derivative (PPD) skin test read. IDUs who had previously been skin-tested were compared with IDUs drawn from a similar population who, prospectively, were offered a financial incentive. RESULTS: During the initial period 558 subjects were evaluated and no incentive was offered. During the second phase of the study 549 IDUs were assessed but were also offered Can $5 if they returned to have their skin test read. Use of incentives increased compliance from 43% to 78% (P = 0.001). During the same period three active cases of TB were also diagnosed. CONCLUSIONS: We suggest that use of financial incentives can increase the return of IDUs to have their skin tests read. Further studies are required to assess the efficacy of follow-up interventions, especially the use of isoniazid chemoprophylaxis.

Adult↗