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At least 811 records · Page 45Linked to original sources
PubMed2003

Human rights in Vancouver: do injection drug users have a friend in city hall?

In april 2003, the Vancouver Police Department (VPD) initiated a crackdown in the city's Downtown Eastside, an area frequented by drug users and the site of one of the developed world's worst AIDS epidemics. Human Rights Watch (HRW) visited the city and issued a report documenting first-hand accounts of unnecessary use of force by police officers and other human rights abuses. In this article, HRW staffers Joanne Csete and Jonathan Cohen describe how the initial euphoria that greeted the election of Vancouver Mayor Larry Campbell has worn off; how a crackdown that was supposed to be aimed at drug traffickers had the effect of driving drug users away from health and harm-reduction services; and how both the VPD and city tried to discredit the HRW report. Finally, the authors discuss how concerns about the VPD have led to official complaints being filed, and they question whether police forces should be allowed to investigate themselves.

Canada↗
PubMed2003

[Use of methadone therapy at the Institute for Alcoholism and Drug Addiction in the Canton of Sarajevo].

INTRODUCTION: Number of addicts increased in our country, especially after the war, and needed adequate solution of the problem as well as use of the experiences from the other countries that faced before us "epidemy" of addictions. One of the solutions for harm reduction caused by use of opioid substances, primarily heroin, is use of methadone (heptanone), which is a good pharmacological replacement. METHODS: In this paper we have presented one-year experience in application of methadone for detoxification or substitution among the patients in our Institute. This retrospective-prospective study included 104 patients treated by methadone detoxification therapy and 59 patients included in the program of methadone substitution. This study involves analyses of the applied therapy compared to age, gender, profession, and duration of addiction, employment status and other social and demographic indicators. RESULTS: Methadone detoxification therapy. Among all age groups most dominant are addicts age 21-30 years (71%), and some in the age group 30-35 years (18%). Lack of adequate treatment programs, as well as break in continuity of treatment due to the war in our country, caused that we have in our sample 10% patients older than 36 years. Few patients younger than 20 years of age, we can explain with short working age of your department, but even now we can notice the incensement of young addicts number. First contact with the drug our addicts usually have between 13 and 18 years of age (61%), while earliest age of contact was 11. Duration of addiction is usually from 1 up to 9 years (65%), although we cannot neglect the number of addicts who are using the drug more than 10 years (35%). During our work, up to now, we did not have neither one case of HIV infection, which does not means that this disease is not present in the addicts population that we have not tested yet. Number of Hepatitis B and C positive addicts in our sample is in accordance with epidemiological data from other countries. There was 32% Hepatitis B positive, 58% Hepatitis C positive, and 23% Hepatitis B and C positive. Methadone substitution therapy. Among those included in the MST, male patients are most dominant, with average age of 31.4 years. Majority of patients has finished high school, they are unemployed, single, and living with their parents. First contact with drugs they had in average age of 16.4 years, while the duration of use had mean value of 10 years. Initial maintenance doses were between 10 and 50 mg, mean 36.1 mg, and maintenance doses after the two months had mean value of 61.6 mg. Among patients involved in MST, we have noted one HIV positive case, and significantly larger number of patients that are positive on Hepatitis: Hepatitis C 33%, and Hepatitis B and C (34%). CONCLUSIONS: Our experience during the application of both treatment types is positive. This treatment is well accepted by the addicts. The MDT and MST methods provides better functioning, easier follow up and better participation in the social and psychological therapeutic processes, which are conducted at our department. Positive improvement in social functioning. Better motivation for the continuation of treatment in the other institutions (therapeutic community). We did not have any side effects of the treatment in order to stop the therapeutic process. We need continuous education and sensibility of the whole society and political community in order to accept, finance and maintain methadone programs.

Adolescent↗
PubMedDate not supplied

[The experimental drug prescription program in Andalusia [PEPSA]: procedure for recruiting participants].

In this field note we describe the steps followed in the process of recruiting participants for the experimental drug prescription program in Andalusia (PEPSA). This trial is a comparative, randomized, open study of the difference between intravenous heroin treatment and oral methadone for socially excluded, opiate-dependent patients, in whom other available treatments have been unsuccessful. Because this is a hidden and hard-to-reach population, a specific approach was planned to put as many patients as possible in touch with the program. A previous study of the target population's distribution in the City of Granada was performed and the city was divided into three areas. Potential participants were interviewed in squares, soup kitchens and methadone dispensaries by outreach workers and peers, who suggested they make an appointment with a PEPSA physician. Peer-driven intervention was a crucial instrument in this recruitment procedure, allowing greater access to the target population. Furthermore, this approach allowed contact with drug users who do not attend health and social services. The work of the outreach team involved educating these users in harm reduction and offering them health and social alternatives beyond the clinical trial.

Administration, Oral↗
PubMedDate not supplied

[Prevention and control of HIV infection in the Osh region of the Kyrgyz Republic].

A total of 178 cases of HIV infection were diagnosed in the Osh region of the Kyrgyz Republic for January 1, 2003, the intensity of the prevalence of HIV infection being 14.5 per 100,000 of the population with this figure for the whole republic being equal to 5.9. In the dynamics of the HIV infection epidemic two periods were detected. During the first 3 years (1998-2000) a few individual imported cases of HIV infection were registered in the region. During the last 2 years (2001-2002) 98.8% of all cases of HIV infection registered in the region, as well as the presence of an epidemic outbreak among injection drug users (IDU), were detected. The risk factors of getting HIV infection were the intravenous use of drugs and a low level of information among young people concerning the routes of transmission of this infection and means of protection from HIV/AIDS: the promotion of healthy life style among young people, the introduction of the programs of "harm reduction" among IDU and the rules of safe sex.

Adolescent↗
PubMedDate not supplied

Substance use in Belgium : prevalence and management.

Substance use is emerging in Belgium. The 'typical user' starts at a young age. Polydrug use has become very common. Cannabis and alcohol are the most frequently used substances among the school population. Heroin and cocaine are the most frequently injected drugs. Sharing of injecting material and paraphernalia is reported to happen in half of the subjects injecting drugs. Substance use causes a lot of adverse organic, social and psychiatric events. Management of substance use consists of information, drug-free treatment and harm reduction, including substitution and maintenance programs. The management of care in Belgium differs between the regions.

Adolescent↗
PubMedDate not supplied

Methadone and buprenorphine maintenance therapies for patients with hepatitis C virus infected after intravenous drug use.

Heroin addiction is a chronic relapsing disease that is difficult to cure, but stabilisation and harm reduction can importantly increase the life time expectancy and the quality of life of the patient, his immediate vicinity and society in general. Currently, no proven effective pharmacological interventions are available for cocaine addiction, and treatment has to rely on existing cognitive behaviour therapies combined with contingency management strategies. Substitution therapy, however, is effective in caring for heroin addicts. Methadone is a synthetic opioid that counteracts withdrawal symptoms of heroin. Buprenorphine is a derivative of the morphine alkaloid, thebaine, and is a partial opioid agonist at the micro opioid receptor in the nervous system. A substitution treatment program effectively reduces and often eliminates heroin injection behaviour, rendering patients more socially stabilised. Reduction in the number of viral co-infections can be observed. Methadone undergoes oxidative biotransformation in the liver, but is also stored in the liver and released into the blood in unchanged form. The usual dose can be continued in patients with stable chronic liver disease, including advanced cirrhosis. In acute liver disease or acute decompensation of chronic liver disease, close clinical observation for signs of narcotic overdose or withdrawal is necessary. A modest alteration in methadone dose may be appropriate for some patients. Buprenorphine can cause liver dysfunction after sublingual and even more after intravenous administration. It is advised to follow the liver function during buprenorphine treatment and to warn the clients for intravenous use of buprenorphine. Neither methadone nor buprenorphine do influence the effect of interferon and ribavirin during the treatment of chronic hepatitis C patients. It may be necessary to increase the dosage of methadone during interferon treatment.

Adolescent↗
PubMed2005

Rethinking the regulatory framework for tobacco control in New Zealand.

Tobacco is a particularly unusual consumer product in that it is highly addictive, kills over half its long-term users, and is a major cause of premature death and health inequalities in New Zealand. We therefore examined the place of regulatory frameworks in advancing tobacco control, and suggest the formation of a Government Tobacco Authority. Such an authority could enable the Government to specify the design of tobacco products (to maximise harm reduction), to eliminate the marketing for profit of branded products, and to appropriately control the introduction of alternative nicotine delivery devices or less hazardous alternative tobacco products. As the authority could be funded through levies on the tobacco industry, it has the potential advantage of delivering major population health gains while costing the taxpayer nothing.

Commerce↗
PubMedDate not supplied

Drug use and risk of bloodborne infections: a survey of female prisoners in British Columbia.

BACKGROUND: Clinicians working in a women's prison in British Columbia observed hepatitis C sero-conversion among inmates, prompting this study to determine: the characteristics of women who do and do not report illicit drug use in prison; patterns of drug use inside prison; factors associated with illicit drug use that might contribute to bloodborne transmission inside prison. METHODS: A cross-sectional observational data set was created using an anonymous 61-item self-administered survey. RESULTS: Eighty-three percent (104/126) of eligible inmates participated. Seventy-four percent (77/104) reported their current prison sentence was related to illicit drug use and 25% (26/104) reported their ethnicity as Aboriginal. Ninety-three percent (97/104) reported a prior history of illicit drug use, of whom 70% (68/97) reported a history of injection drug use. Thirty-six percent (37/104) reported illicit drug use in prison, and 21% (22/104) reported injection drug use in prison. Fifty-two percent (54/104) reported hepatitis C sero-positivity, and 8% (8/104) reported HIV sero-positivity. Of the 22 women who reported prison injection drug use, 91% (20/22) reported hepatitis C infection and 86% (19/22) reported injecting with shared needles inside prison, with or without bleach cleaning. Women were more likely to report illicit drug use in prison if they had had illegal sources of income prior to incarceration (p=0.0081, OR 3.19), had previously injected drugs (p=0.036, OR 2.97), and had first injected drugs at a friend's house (p=0.066, OR 2.70). INTERPRETATION: The majority of women reporting prison injection drug use also reported hepatitis C sero-positivity and shared needle use. Canadian prisons are risk situations for transmission of bloodborne pathogens, and provide opportunities for harm reduction strategies.

Adult↗
PubMed2005

Experience of hepatitis C among current or former heroin users attending general practice.

The majority of injecting drug users in Ireland are infected with hepatitis C (HCV) and many attend general practice for methadone maintenance treatment. To describe awareness and experience of HCV infection, related investigations and treatment, a semi-qualitative interview study of current or former heroin users attending a general practice was carried out. Twenty-five patients (69% of total) were interviewed, of whom 23 were on methadone maintenance therapy at the time of the interview and 22 were HCV positive. While awareness of harm reduction measures and health implications of the infection was good, continued high-risk activity was common. Negative experiences at diagnosis, of subsequent investigations and treatments received were common. Only one person had been treated for HCV. We conclude there are a number of barriers to effective HCV management among heroin users and further research is needed to improve our understanding of this issue.

Adolescent↗
PubMed2004

HIV risk behavior and practices among heroin addicts in Lahore, Pakistan.

While the numbers of reported and estimated cases of HIV are still relatively low in Pakistan, behavioral patterns that could lead to an HIV epidemic are reported to exist among injection drug users. Therefore, this cross sectional study was conducted to estimate the prevalence of injection drug use and to assess the level of HIV knowledge and practices among male heroin addicts in Lahore, Pakistan. A total number of 660 male heroin addicts were recruited from 22 drug user sites in the city; data were collected using a pre-tested structured questionnaire. Analysis revealed a poor knowledge of the disease, its modes of transmission and ways to limit transmission with only 30% of the respondents considering them at risk for acquiring the disease. A prevalence of 23.3% of injection drug use was noted. HIV risk injection practices included: group injecting (83.2%), sharing syringes (58.7%), and re-using used syringes (78%). Various risky sexual practices included multiple partners (24%), homosexuality (10.8%), sexual contacts with commercial sex workers (CSW) (20.8%), and with transvestites (3.3%). Condom use was low (11-50%). Of the subjects, 5.5% reported trading sex for drugs or money. We recommend HIV/STD prevention programs encompassing health education and health promotion strategies based on harm reduction techniques be used for drug users.

Adult↗
PubMed2005

Two decades of HIV/AIDS in Hawaii: contrast with national trends.

This paper describes the HIV/AIDS epidemic in Hawaii. Data indicate gradual but steady changes in characteristics of infected populations. Most significant are increases in cases among Asian Pacific Islanders, women, heterosexuals and younger age groups. Early harm reduction measures and low incidence among injection drug users relative to other parts of the U.S. may have played a significant role in containing the epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Smoker preference for "elastic cigarettes" in the Canadian cigarette market.

Elastic cigarettes are characterized by yields of constituents that increase proportionally faster than smoke volume as cigarettes are smoked more intensely. Elasticity may function to overcome physical limitations in increasing puff volume during nicotine-seeking behaviour. The purpose of this study was to determine if there are elastic cigarettes in the Canadian cigarette market and to determine smoker preference for elastic cigarettes. Elasticity was calculated for 115 brands in the Canadian filtered cigarette market for puff volumes of 44 and 56 ml. Puff volumes, nicotine and tar deliveries were obtained from earlier published documents. Sales data were used as a proxy for smoker preference. Ordinary least squares regression was used to determine the association of sales and elasticity in the Canadian cigarette market. The cigarette brands ranged from a mean elasticity value of 1.21 to 0.67. Of the 115 Canadian cigarette brands tested, 23 brands had a mean elasticity value significantly over 1.00, making them elastic. After adjusting for brand, the average elastic cigarette sold an average of 361 million cigarettes while an inelastic cigarette sold 89.5 million cigarettes (p<0.0001). The difference in sales between elastic and inelastic cigarettes was independent of tar yield and filter type. Elasticity was not associated with tar yield (p=0.2734). There are elastic cigarettes in the Canadian cigarette market and the results suggest a possible smoker preference for elastic cigarettes. Utilizing elasticity may be valuable in the development of future harm reduction strategies.

Administration, Inhalation↗
PubMed2005

Issue network versus producer network? ASH, the Tobacco Products Research Trust and UK smoking policy.

Policy science studies of networks in smoking policy segment the smoking arena into a "producer network" of industrial and retail interests and an "issue network" of anti-smoking organisations. Case studies of ASH (Action on Smoking and Health) and the Tobacco Products Research Trust (TPRT) indicate that networks in smoking policy were more complex and overlapping. ASH pioneered a new style of media-conscious health activism in the 1970s with an anti-industry line. Nevertheless the strategy of harm reduction remained an objective for industry and government, and also for some public health interests through the work of the TPRT. First safer smoking and then nicotine were the focus of these activities.

Health Policy↗
PubMed1992

Alternative strategies.

Drug treatment alternatives in the United States are constrained by what is politically correct and expedient and by a federal policy of 'zero tolerance' for any illicit psychoactive drug use. A war on drugs will not solve all the problems posed by cocaine. Alternative strategies must address fundamental problems in ghetto life: violence, poverty, poor health, no education, no jobs, and few reasons for not taking drugs. Despite warnings of pharmacological determinism, cocaine is like other psychoactive drugs. Even with cocaine, when alternative behaviours are possible most people avoid out-of-control use. Public health strategies promoting a harm-reduction policy offer advantages. Recent reductions in cocaine use are a consequence of education, awareness of good health practices, and interest in other activities. Alternatives could include cocaine in a safer, non-lethal and controllable form but are unlikely in a political climate where politics and law prevail rather than medicine and humanity.

Cocaine↗
PubMedDate not supplied

Alcohol: its health and social impact in India.

Alcoholic beverages have been used in human societies since the beginning of recorded history. The patterns of alcohol intake around the world are constantly evolving, and alcohol is ubiquitous today. Research has contributed substantially to our understanding of the relation of drinking to specific disorders, and has shown that the relation between alcohol consumption and health outcomes is complex and multidimensional. Increases in the average volume of drinking are predicted for the most populous regions of the world in Southeast Asia including India. Cultural differences apparently influence the pattern of alcohol consumption. In addition, alcohol is linked to categories of disease whose relative impact on the global burden is predicted to increase. Therefore, it is appropriate to implement policies with targeted harm reduction strategies. The crucial need, from a public health perspective, is for regular means of coordination whereby prevention of alcohol-related problems is taken fully into account in policy decisions about alcohol control and regulation in the market for alcoholic beverages.

Alcohol Drinking↗
PubMed2006

[Epidemiology of HIV infection in the world and in France].

All continents are affected by HIV at various degrees and the situation of Africa is certainly one of the most serious with HIV prevalence over 20% in Austral Africa, and accounting for half of all HIV cases in the world. Eastern Europe has been recently affected by HIV mainly among IDU. In Asia, the spread of epidemic on general population follows HIV transmission linked to drug use and commercial sex. Similar trends have been observed in Western Europe: relapse of safer sex among men wich have sex with men (MSM) with new HIV contamination, decrease of HIV transmission among drug users and increase of new HIV diagnosis among heterosexuals originating from countries with high prevalence of HIV/AIDS, notably sub-Saharan Africa. Since the introduction of potent anti-retroviral agents in 1996, the numbers of AIDS cases and mortality due to AIDS have sharply decreased in Western Europe. The number of new HIV diagnosis in 2004 is around 7 000 cases in France. The two mostly affected populations in 2003-2004 are homosexuals and sub-Saharan Africans. The harm reduction policies conducted has markedly reduced HIV transmission among injecting drug users.

Adolescent↗
PubMed2006

CEE/CA: Report calls for decriminalization of sex work.

In December 2005, the Central and Eastern European Harm Reduction Network (CEEHRN) released a report calling for the decriminalization of sex work in the 27 countries of Central and Eastern Europe and Central Asia (CEE/CA). The report brings together a wealth of published and original information concerning sex work, laws regulating sex work, epidemiological data regarding HIV and other sexually transmitted infections (STIs), services available to sex workers, and human rights abuses faced by sex workers.

Crime↗