An overview of illegal opioid use and health services utilization in Canada

OBJECTIVES: Systematic research on health and treatment services availability for and utilization by illegal opioid users in Canada are very limited. Comparative data across provinces and territories is almost entirely absent. This study was designed to provide an overview of illegal opioid use and health services utilization among illegal opioid users across Canada. METHODS: A combination of statistical data and key informant data was used. Surveys were sent to key informants in all provinces and territories of Canada. Survey questions covered the number of illegal opioid users in each province, the number of opioid users receiving methadone maintenance treatment (MMT), the number of physicians authorized to prescribe methadone, and the number of opioid users receiving other outpatient and inpatient treatment. In addition, relevant data were collected from several statistical sources, both provincial and federal. The number of substance-use-related overdose deaths was obtained from the provincial coroners' offices. RESULTS: It is estimated that there were more than 80,000 regular illegal opioid users in Canada in 2003. The most prevalent treatment utilized was MMT; about one-quarter (26%) of the estimated opioid users received this type of treatment in 2003. Other forms of outpatient and inpatient treatment were of only minor importance compared with MMT. The number of illegal drug-related overdose deaths in Canada was 958 in 2002. Rates of drug use, health services utilization and overdose deaths showed considerable variation by province. CONCLUSIONS: Although the opioid use treatment system in Canada has expanded in recent years, especially with respect to the availability of MMT, the treatment utilization rates are still lower than in most countries in Western Europe. Rates of current treatment utilization as well as the relatively high number of overdose deaths suggest that there is still room for improvement in the Canadian health and social care system with respect to opioid use.     

Adherence, stereotyping and unequal HIV treatment for active users of illegal drugs

Adherence to antiretroviral therapy promotes viral suppression and extends the lives of individuals with HIV, yet illegal drug users are underrepresented among eligible persons receiving HIV treatment. One explanation for this is the assumption that drug users are less capable than others of adhering to complicated medication regimens. This paper investigates this assumption by making explicit a number of its underlying propositions and examining them in light of data collected from 52 active drug users living in and around Boston, USA, who were taking highly active antiretroviral therapy for HIV (HAART). The propositions are: (1) drug users lead "chaotic" lives; (2) active drug users are always using drugs; (3) being under the influence of drugs precludes taking medications as prescribed; and (4) drug users are intrinsically different from non-users in the lives they lead and the problems they face. Data collection consisted of a series of qualitative interviews with each participant. An analytic approach informed by grounded theory was used to construct thematic content categories from the data. Results revealed stability and control as well as "chaos" in the lives of study participants. Frequency of drug use varied considerably. Using did interfere with adherence, but not in every circumstance or all cases. Not "carrying" medications, competing priorities, and re-defining regimens were the most salient of a number of non-drug-use-related obstacles observed. Documentation of patterns of variation in corresponding data highlights the stereotypical quality of the propositions. Stereotyping risks overemphasis on drug use as a barrier to adherence for active users, and underemphasis on non-drug-use-related obstacles. Adherence capabilities of users, in contrast to inadequacies, are also obscured through stereotyping. As a medium for stigmatization, stereotyping may contribute to unequal treatment for drug users and other populations living with HIV.     

Treatment and prevention of use and abuse of illegal drugs: progress on interventions and future directions

State-of-the-art downstream interventions are generally successful for half of drug-abusing clients. But, only one in four abusers actually receives treatment. In the midstream, one setting (schools), one type of prevention ("one size fits all"), and a limited age-range focus (adolescence and preadolescence) have predominated. Accumulating evidence casts doubt on the effectiveness of widely disseminated school-based prevention approaches, although theory-based programs that emphasize skills training and adjunctive parent and neighborhood interventions fare better. Newer pursuits include intervening very early with higher risk children and expanding to primary health care settings and workplaces. Popular but unproven community approaches need more rigorous evaluation. Upstream national and state public policy and environmental interventions should be reexamined in light of their success for preventing tobacco and alcohol use.     

"Unequal opportunity": neighbourhood disadvantage and the chance to buy illegal drugs

STUDY OBJECTIVES: This study investigates whether subgroups of people living in disadvantaged neighbourhoods may be more likely to come into contact with drug dealers as compared with persons living in more advantaged areas, with due attention to male-female and race-ethnicity differences. DESIGN: Standardised survey data collected using stratified, multistage area probability sampling. SETTING: United States of America, 1998. PARTICIPANTS: Nationally representative sample of household residents age 12 or older (n = 25 500). MAIN RESULTS: Evidence supports an inference that women are less likely to be approached by someone selling illegal drugs. The study found no more than modest and generally null racial and ethnicity differences, even for residents living within socially disadvantaged neighbourhoods, where chances to buy illegal drugs are found to be more common. CONCLUSIONS: Limitations of survey data always merit attention, but this study evidence lends support to the inference that physical and social characteristics of a neighbourhood can set the stage for opportunities to become involved with drugs.     

Two steps forward; three backwards

The census indicated that India's population was about 850 million in 1991. This spiraling growth has resulted in a deteriorating standard of living, especially for women and children in the rural population. Minorities such as tribal women and low caste women also suffer disproportionately because of a lack of safe drinking water and fuel for the hearth. In certain areas women have to spend 3-4 hours to gather fuelwood. Despite achieving self-sufficiency in food-grain production by the 1980s, India's poor families do not have enough calories in their daily diets, they lack proper hygiene and sanitation, and do not send their children to school. In the remote villages of Arunachal Pradesh children are kept in school only for one year lest they get too much education and leave their families. Children are an economic asset to be put to work at an early age. Slum dwellers face not only an endless cycle of drudgery and hopeless poverty, but the associated evils of pests and diseases. The last 40 years and seven major economic plans have not made a dent in the lives of these people. All measures of poverty alleviation, rural and slum sanitation, child development schemes have eluded this group of people. Another segment of the population are rural people who were targeted by development programs, yet could not take advantage of the resources offered. Development programs are run by state and central governments, voluntary agencies, and cooperatives, but their performance remains unsatisfactory. General apathy is felt in the ranks of development workers, which is coupled with a corrupt bureaucracy and village leadership. Midday meal programs, soak pits, rural sanitation, immunization, and family welfare do not inspire this leadership. The bureaucracy has developed a vested interest in keeping the development workers as they are, and the funds received from international agencies are diluted down the line.     

School violence, substance use, and availability of illegal drugs on school property among US high school students

To determine if school violence is associated with substance use and availability of illegal drugs at school, this study examined data from the 1995 Youth Risk Behavior Survey, a nationally representative sample of 10,904 high school students. Adjusted odds ratios were calculated to describe the associations of tobacco, alcohol, and marijuana use (on and off school property), and availability of illegal drugs at school with five indicators of school violence--weapon-carrying, physical fighting, having property stolen or damaged, being threatened or injured, and being absent from school because of feeling unsafe. School violence indicators increased with the number of substances used and the location of use (on school property vs. off school property). School violence was associated with availability of illegal drugs at school, even among students who did not use substances. These findings suggest a need for coordinated violence and substance use prevention programs for youth in school and community settings.     

Consumption of tobacco, alcohol, psychotropic drugs and illegal drugs in high school students of the department in the Upper Pyrenees

A study was conducted on a representative sample of high school students in Hautes-Pyrénées, to measure their consumption of toxics (tobacco, alcohol, psychotropic and illicit drugs) and to explore the role of selected explanatory factors. Consumption levels were high, particularly for tobacco: 45% were smoker and 4% smoked more than 15 cigarettes each day. Less than 5% were alcohol daily consumers. Technical school students are a high risk population when they are 16 years old or less. Evening out represents a risk indicator: use of toxics is more frequent for students having twice evenings out each month or more. Prevention should be global, including the adolescents concerned and adults.     

Special report. Patients in possession of illegal drugs: what can you do about it?

Illicit drug use affects every area of the hospital/health care setting and presents thorny legal dilemmas for security directors and risk managers when patients are found using and/or attempting to sell controlled substances. Should you handle it privately or should you call in the police? Do local law enforcement and prosecutors really want to be bothered with every $25 worth of cocaine seized from a patient? If you inform the police and arrests are made, could your hospital develop a reputation as a drug-infested combat zone? If you handle it privately, are you at risk for litigation because of invasion of privacy or an illegal search? On the other hand, if drugs are reported and you do nothing, are you liable for a negligence lawsuit? Clearly, there is a need for proactive planning and policy development prior to being confronted with patient drug possession. In this report, hospital security directors discuss how they handle this situation at their facilities and how they formulate policies and procedures. We'll also offer advice from legal experts on patient privacy issues and interacting with local law enforcement.