Drug driving among injecting drug users in Sydney, Australia: prevalence, risk factors and risk perceptions

Aims To examine the prevalence of drug driving, the prevalence of drug‐related motor vehicle accidents, risk perceptions of drug driving and factors associated with drug driving among injecting drug users (IDU). Design Cross‐sectional survey. Setting Sydney, Australia. Participants Three hundred current IDU. Findings Ninety‐five per cent had driven a vehicle, 74% in the previous 12 months (‘current drivers’). Eighty‐seven per cent of life‐time drivers reported having drug driven, and 88% of current drivers had drug driven in the previous 12 months. There were no significant sex differences in life‐time or recent drug driving. The most common drugs used before driving in the preceding year were: cannabis, heroin, amphetamines and cocaine. A third of life‐time drivers reported having had a drug driving accident, with males more likely to have done so, and 9% of current drivers reported a drug driving accident in the previous year. The most common drugs that had been used before the most recent drug driving accident were heroin, cannabis and alcohol. Alcohol was perceived to be the most dangerous substance for driving performance and cannabis the least dangerous. Recent drug drivers perceived drug driving to be less dangerous than non‐drug drivers. Recent drug drivers had driven more frequently over the preceding 12 months, had significantly higher levels of dependence, higher frequency of drug use, more extensive polydrug use and were more likely to have used and/or injected a drug in a car in the previous 12 months. Conclusions Drug driving and drug‐related accidents are large‐scale public health problems among IDU. These behaviours pose serious risks to IDU themselves and to the broader community.     

Needle sharing among southern Thai drug injectors

Aim To examine factors associated with needle sharing among injecting drug users (IDU) in southern Thailand. Design Using a cross‐sectional survey, 272 active IDU were interviewed about their socio‐economic background, needle sharing and drug use patterns at six drug‐treatment clinics in southern Thailand. Findings Ninety‐one per cent of IDU gave a past history of ever sharing injecting equipment: of these, 23% currently injected but did not share and 68% still shared. Only 5% of participants knew that bleaching needles could reduce HIV transmission risks. Recent needle sharing was correlated with number of IDU friends (OR 12.23; CI, 5.24–28.51), engaging in illegal jobs (OR 2.74; CI, 1.13–6.67), being unable to use new needles at all times (OR 2.89; CI, 1.17–7.14) and believing that cleaning contaminated shared needles with at least plain water could reduce HIV transmission (OR 3.32; CI, 1.16–6.68). Conclusions Our data suggest that AIDS prevention efforts should focus on approaches to reduce needle sharing. Needle exchange programs, HIV counseling and testing and bleach distribution may reduce levels of needle‐sharing risks.     

Assessing differences in groups randomized by recruitment chain in a respondent-driven sample of Seattle-area injection drug users

PurposeRespondent-driven sampling (RDS) is a form of peer-based study recruitment and analysis that incorporates features designed to limit and adjust for biases in traditional snowball sampling. It is being widely used in studies of hidden populations. We report an empirical evaluation of RDS's consistency and variability, comparing groups recruited contemporaneously, by identical methods and using identical survey instruments.MethodsWe randomized recruitment chains from the RDS-based 2012 National HIV Behavioral Surveillance survey of injection drug users in the Seattle area into two groups and compared them in terms of sociodemographic characteristics, drug-associated risk behaviors, sexual risk behaviors, human immunodeficiency virus (HIV) status and HIV testing frequency.ResultsThe two groups differed in five of the 18 variables examined (P ≤ .001): race (e.g., 60% white vs. 47%), gender (52% male vs. 67%), area of residence (32% downtown Seattle vs. 44%), an HIV test in the previous 12 months (51% vs. 38%). The difference in serologic HIV status was particularly pronounced (4% positive vs. 18%). In four further randomizations, differences in one to five variables attained this level of significance, although the specific variables involved differed.ConclusionsWe found some material differences between the randomized groups. Although the variability of the present study was less than has been reported in serial RDS surveys, these findings indicate caution in the interpretation of RDS results.     

Psychosocial factors explaining drug users’ intention to use a new syringe at each injection

Beyond the risk of HIV and HVC transmission associated with needle sharing, re-using one's own syringe constitutes an additional risk for injection drug users (IDUs). This practice can lead to serious infections such as cellulitis and endocarditis. In order better to target interventions promoting the adoption of this behaviour, this study attempts to identify factors associated with IDUs’ intention always to use a new syringe. The Theory of Planned Behaviour was applied in the development of the questionnaire administered to 117 IDUs during an interview. Over a period of 1 week, 35.7% of respondents failed to consistently use new syringes and only 39% of the entire sample indicated a firm intention to adopt this behaviour. A regression analysis demonstrated that perceived behavioural control and attitude predicted intention. Results indicate that interventions should serve primarily to help IDUs recognize the advantages of adopting this behaviour and develop skills to overcome certain obstacles.     

Estimating the Prevalence of Injection Drug Users in the U.S. and in Large U.S. Metropolitan Areas from 1992 to 2002

This paper estimates the prevalence of current injection drug users (IDUs) in 96 large U.S. metropolitan statistical areas (MSAs) annually from 1992 to 2002. Multiplier/allocation methods were used to estimate the prevalence of injectors because confidentiality restrictions precluded the use of other commonly used estimation methods, such as capture-recapture. We first estimated the number of IDUs in the U.S. each year from 1992 to 2002 and then apportioned these estimates to MSAs using multiplier methods. Four different types of data indicating drug injection were used to allocate national annual totals to MSAs, creating four distinct series of estimates of the number of injectors in each MSA. Each series was smoothed over time; and the mean value of the four component estimates was taken as the best estimate of IDUs for that MSA and year (with the range of component estimates indicating the degree of uncertainty in the estimates). Annual cross-sectional correlations of the MSA-level IDU estimates with measures of unemployment, hepatitis C mortality prevalence, and poisoning mortality prevalence were used to validate our estimates. MSA-level IDU estimates correlated moderately well with validators, demonstrating adequate convergence validity. Overall, the number of IDUs per 10,000 persons aged 15-64 years varied from 30 to 348 across MSAs (mean 126.9, standard deviation 65.3, median 106.6, interquartile range 78-162) in 1992 and from 37 to 336 across MSAs (mean 110.6, standard deviation 57.7, median 96.1, interquartile range 67-134) in 2002. A multilevel model showed that overall, across the 96 MSAs, the number of injectors declined each year until 2000, after which the IDU prevalence began to increase. Despite the variation in component estimates and methodological and component data set limitations, these local IDU prevalence estimates may be used to assess: (1) predictors of change in IDU prevalence; (2) differing IDU trends between localities; (3) the adequacy of service delivery to IDUs; and (4) infectious disease dynamics among IDUs across time.     

Determinants of health system delay among confirmed tuberculosis cases in Spain

BACKGROUND: Health system delay (HSD) is an important issue in tuberculosis (TB) control. This report investigates HSD and associated factors in a cohort of Spanish culture-confirmed TB patients. METHODS: Data were collected from clinical records. Using logistic regression with two different cut-off points to define HSD (median and 75th percentile), adjusted odds ratios were used to estimate the association between HSD and different variables. RESULTS: A total of 5184 culture-confirmed TB cases were included. Median and 75th percentile HSD were 6 and 25 days respectively. HSD significantly greater than the median was associated with: age >44 years, past or present intravenous drug use, diagnosis at a primary-care centre, prior preventive therapy, positive histology, request for drug-sensitivity testing, presence of silicosis or neoplasia in addition to TB, presence of non-TB related symptoms, and gastrointestinal site. HSD greater than the 75th percentile was related to the same variables, with the exception of diagnosis at a primary-care centre, positive histology, silicosis, non-TB-related symptoms and gastrointestinal site, for which the association disappeared; in contrast, an association with female gender emerged. CONCLUSION: Despite free health care being universally available in Spain, there are some groups of TB patients whose treatment is unduly delayed.     

Herpes simplex-Encephalitis bei Neugeborenen

Premature twins both affected with generalized herpes simplex infection including CNS involvement were treated with 5-Iodo-2′-deoxyuridin (IDU). Therapy was started 6 days and 5 days respectively, after appearance of the first symptoms. Nevertheless both babies died, twin A at the age of 24 and twin B at the age of 28 days. Herpes virus was cultured from all organs in twin A. The literature shows a decrease in mortality in children treated with IDU for herpes simplex encephalitis. The percentage of survivors with ultimate severe CNS damage, however, is very high and remains in treated or untreated patients the same. The institution of IDU therapy in neonates with manifest HSV encephalitis is therefore not unequivocally justified.     

Preventing relapse in incarcerated drug users in Yunnan Province,China

Introduction and Aims. The mainstay of drug control in China is compulsory incarceration and detoxification, but relapse rates following release are very high. The aim of the study was to explore factors which would help prevent relapse in injecting drug users following release from detoxification centres. Design and Methods. Semi‐structured interviews were carried out at three compulsory detoxification centres in Derhong prefecture, Yunnan Province, which has the highest proportion of injecting drug users in China. Results. Interviews were completed with 235 men and 125 women aged between 15 and 64 years. They had been injecting heroine for between 3 months and 25 years; the median number of times of previous compulsory detoxification was four, with 11% having undergone this more than 10 times. All but six wanted to quit permanently, but almost all acknowledged that relapse on release was almost inevitable. The month immediately following release was identified as most vulnerable time for relapse. Respondents identified three measures which would help decrease the rate of relapse. First, the environment of the detoxification centres should emphasise support and counselling rather than punishment. Second, families should be provided with support to help the user immediately after release. Third, arrangements could be made to help those individuals who request relocation, to find work elsewhere away from accustomed drug‐using social networks. Discussion and Conclusions. While a combination of these measures could help in some way to reduce rates of relapse following detention, given the failure of the detoxification/detention regimes to reduce drug use, consideration must be given to other approaches.[Zhu WX, Dong JQ, Hesketh T. Preventing relapse in incarcerated drug users in Yunnan Province, China. Drug Alcohol Rev 2009]