Health status at entry to methadone maintenance treatment using the SF-36 health survey questionnaire

This study used the SF-36 general health questionnaire to measure the health status of heroin users at entry to a public methadone maintenance programme. Their results were compared to those from the general population and from three clinical groups: patients with minor medical, major medical and psychiatric problems. One hundred consecutive clients were interviewed in the first week on the programme using the SF-36 health questionnaire. Data were also gathered on their drug use, use of medical services and HIV risk behaviour. The results showed that heroin users at entry to the methadone maintenance programme had significantly worse physical and psychological health than the general population. Their scores were most similar to the psychiatrically depressed patients, although they had worse physical health than this comparison group. The greater the amount of heroin used by clients before entering the programme, the more pain they reported. Alcohol and marijuana use were associated with better social and physical health. The relationship between general health status and amount or frequency of drug use is not a clear one. Heroin users experience severe emotional and physical problems at the time of entering methadone maintenance treatment.     

The Influence of Drug Consumption on Condom Use and Other Aspects Related to HIV Infection Among Male Sex Workers in Spain

Higher rates of substance use have been associated with unsafe sex behavior. Male sex workers (MSW) present high rates of drug use during or after the professional sexual exchange with clients and also in their leisure. This research describes patterns of drug consumption among MSW in Spain and explores both the effect of substance use on professional and risk sexual behaviors. Participants were 100 agency MSW offering their services in Valencia and Castellón (Spain). Most of them were drug users and the most common substances were “soft drugs” and cocaine. An absence of injection drugs was found. Drug consumers indicated a higher HIV risk perceived and lower perceived influence of substance use on condom use negotiation. Drug influence on condom use is not clear. More investigation about drug influence on sexual risk behaviors among MSW is needed. The role of steady partners and clients must be taken into account too.     

Psychotropic drug use among caregivers of patients with dementia

The majority of research on "caregiver burden" focuses on mental health consequences. These stresses are associated with psychotropic drug use among some caregivers. The purposes of this paper are to identify the correlates of psychotropic drug use among caregivers of demented older adults and to determine whether or not certain types of psychotropics (ie, antianxiety, antidepressant, and sedative/hypnotic agents) have common or unique correlates. The prevalence of psychotropic drug use among caregivers in the sample (n = 510) is substantially higher than previously reported prevalence rates in the general population and among community-dwelling elderly. Using logistic regression techniques, caregiver characteristics (eg, gender, health, relationship to the patient) rather than severity of the patient's condition emerge as predictors of antianxiety, antidepressant, and sedative/hypnotic use. The caregiver's perception of how well he or she is supported in the caregiving role emerges as an important correlate of psychotropic drug use in general and especially of antidepressant consumption. Results suggest that caregivers are a high-risk group for the development of emotional symptoms such as nervousness, exhaustion, decreased appetite, and difficulty sleeping, symptoms that may or may not constitute a psychiatric disorder. Characteristics of the caregiver, especially aspects of the support system, should be important considerations in decisions to prescribe psychotropic drugs.     

Predicting the volume of health and social services: integrating cognitive impairment into the modified Andersen framework.

This investigation examined cognitive impairment as a predictor of the volume of community services used by older adults. Predictors of service volume were selected according to the modified Andersen framework and tested with 97 health care and 246 social service clients of a large multiservice agency. Results for health care clients showed that the effects of four predictors differ depending on clients' level of cognitive impairment; living arrangement, presence of secondary caregivers, client depression and task burden of the primary caregiver. No differences in predictor of social service use were observed for cognitively impaired and lucid clients.     

Needle-exchange in central London: operating philosophy and communication strategies

Despite a large number of needle-exchange schemes in the U.K., there are few accounts of how particular agencies attract injecting drug users. This paper describes a busy scheme in London, the take-up of services by clients, and the operating philosophy of the staff. From November 1987 to October 1988 The Exchange saw a mean of 257 clients per month, making an average three visits per client each month. An average of 8,950 needles and syringes were dispensed and 6,918 returned monthly, giving an average return rate of 77%. The Exchange also served as a referral agency to clients; 533 referrals were made, 63.4% of which were to drug and non-medical services, 36.6% to health services, and 9.2% to HIV services. To account for the take-up of services the paper describes The Exchange's open access policy, the staff's communication strategies and their adoption of the philosophy of harm-minimization in relation to injecting drug use. It is argued that these must be seen as integral to needle-exchange if it is to succeed as a comprehensive service.     

Social support networks and medical service use among HIV-positive injection drug users: implications to intervention

The study used network analysis to identify forms and sources of social support associated with a medical services use among a medically underserved population living with HIV/AIDS. Participants were African American former or current injection drug users (n=295; 34% female, 45% current drug users and 17% AIDS diagnosed). Outcomes were access to the same medical provider, use of outpatient services and emergency room (ER) use with or without subsequent hospitalization. Controlling for AIDS diagnosis, insurance, current drug use and gender, access to the same medical care provider was associated with more females in one's support network and more network sources of emotional support, financial support and instrumental assistance. Adjusting for confounders, outpatient service use was associated with more female support network members and more sources of emotional support. Controlling for participants' drug use and insurance, sub-optimal emergency department use was associated with greater number of active drug users in one's support network. Contrary to other study findings, having a supportive sex partner was associated with lower access to medical care, and kin support was not associated with medical service use. Results indicate that specific sources and forms of social support had differential influences on the sample's utilization of medical services. The findings suggest that promoting HIV-positive African American injection drug users' support network functioning may help improve HIV medical services utilization among this medically underserved population.     

The impact of needle exchange-based health services on emergency department use

OBJECTIVE: To examine the impact of the New Haven Community Health Care Van (CHCV), a mobile needle exchange-based health care delivery system, in reducing emergency department (ED) use among out-of-treatment injection drug users (IDUs) between January 1, 1996 and December 31, 1998. DESIGN: A pre-post comparison of ED utilization was performed using linked medical records from New Haven’s only two emergency departments. Fixed-effect negative binomial regression analysis was used to explore the impact of the CHCV on ED use within a longitudinal cohort. SETTING: Mobile health clinic in New Haven, Conn. PARTICIPANTS: Out-of-treatment IDUs. INTERVENTION: Acute care, linkages to medical, drug treatment, and social services. MEASUREMENTS AND MAIN RESULTS: Among 373 IDUs, 117 (31%) were CHCV clients, and 256 had not used CHCV services. At baseline, CHCV users were more frequent users of ED services (P<.001). After full-scale implementation, mean ED utilization declined among CHCV clients and increased within the non-CHCV group. CHCV use is associated with statistically significant reductions in ED use, with an incidence rate ratio (IRR) of 0.79 (95% confidence interval [95% CI], 0.66 to 0.95). Subgroup analyses demonstrated significant IRR reductions, notably among Hispanics (0.65; 95% CI, 0.47 to 0.90), men (0.79; 95% CI, 0.64 to 0.98), HIV-negative IDUs (0.79; 95% CI, 0.63 to 0.98), and those with mental illness (0.75; 95% CI, 0.60 to 0.94). CONCLUSION: Needle exchange-based health care services can reduce ED utilization among high-risk injection drug users. Such services may have an important role within communities with high rates of drug use and HIV/AIDS. This research was funded by the National Institute on Drug Abuse (R01-DA10186, Principal Investigator Frederick L. Altice).     

Depression,suicidal ideation,and related factors of methadone maintenance treatment users in Guangzhou,China

Mental health problems are prevalent among drug users. Methadone maintenance treatment (MMT) is an evidence-based effective treatment for drug addiction; however, there are few studies investigating depression, suicidal ideation, and their related factors among MMT users. In this cross-sectional study, 648 MMT users were recruited from six MMT clinics in Guangzhou, China. Data were collected through face-to-face interviews by trained interviewers. Of all participants, 270 (42.7%) exhibited probable depression (Depression Subscale of the Chinese short version of Depression, Anxiety, and Stress Scale (DASS-D), score?≥?10) and 99 (15.3%) reported having suicidal ideation in the last six months. After adjusting for significant socio-demographic characteristics, all studied variables, including drug use history, social support, family support for MMT use, and satisfaction toward MMT services were significantly associated with both probable depression and suicidal ideation in the last six months. Furthermore, depression fully mediated the associations between drug use history, satisfaction toward MMT services, and suicidal ideation. In the final multivariate models, probable depression was associated with social support (OR?=?0.88, 95% CI?=?0.83–0.93) and satisfaction toward MMT services provided by doctors (OR?=?0.59, 95% CI?=?0.40–0.86), while for suicidal ideation, social support (OR?=?0.85, 95% CI?=?0.78–0.92) and probable depression (OR?=?5.94, 95% CI?=?3.39–10.42) were significant. The findings suggest that there are unmet mental health needs among MMT users. For countries with limited resources of psychological services, mental health care toward MMT users should be implanted into current health care settings and incorporate components such as social support, family's understanding of MMT, and service satisfaction.     

Needle-sharing practices and risk for AIDS transmission among intravenous drug users in Seattle

Sharing of needles by intravenous drug users is known to be one of the major means for the transmission of the HIV virus into the general population. In Seattle, where liberal laws make acquisition of needles relatively easy, it has been assumed that needle sharing is not a significant problem. Results of a survey of 212 methadone maintenance clients demonstrated that needle sharing is quite prevalent among intravenous drug users in this area and that addicts fail to sterilize their needles between uses. Because the rate of HIV infection among Seattle's intravenous drug users is relatively low, immediate intervention efforts by public health authorities can prevent a rapid acceleration of the infection rate.     

American indians with substance use disorders: treatment needs and comorbid conditions

Background: American Indians and Alaska Natives (AI/ANs) experience significant disparities in health status and access to care. Furthermore, only limited data are available on substance use, mental health disorders, and treatment needs for this population. Addressing such disparities and developing culturally relevant, effective interventions for AI/AN communities require participatory research. Objectives and Methods: The Western States Node of the National Institute on Drug Abuse Clinical Trials Network partnered with two American Indian substance abuse treatment programs: an urban health center and a reservation-based program to assess client characteristics, drug use patterns, and treatment needs. Data collected by staff members at the respective programs from urban (n = 74) and reservation (n = 121) clients were compared. Additional sub-analysis examined patients reporting regular opioid use and mood disorders. Results: Findings indicate that urban clients were more likely to report employment problems, polysubstance use, and a history of abuse. Reservation-based clients reported having more severe medical problems and a greater prevalence of psychiatric problems. Clients who were regular opioid users were more likely to report having a chronic medical condition, suicidal thoughts, suicide attempts, polysubstance abuse, and IV drug use. Clients who reported a history of depression had twice as many lifetime hospitalizations and more than five times as many days with medical problems. Conclusions: Findings from this project provide information about the patterns of substance abuse and the importance of comprehensive assessments of trauma and comorbid conditions. Results point to the need for integrative coordinated care and auxiliary services for AI/AN clients seeking treatment for substance use disorders.     

Drug problems and patterns of service use amongst illicit drug users in Edinburgh

Some results are presented from a continuing prospective study of patterns of illicit drug use in the community. A study group of 115 illicit drug users in Edinburgh were contacted by a non-random method known as ‘snowballing’. These were interviewed using a standardized schedule that related to over 200 variables. The use of drugs services are discussed and it is noted that reasons for making contact with such services are complex and not directly associated with any one factor. Extent of illicit substance use and adverse consequences experienced as a result of illicit substance use, are seen to be associated with agency contact, although it is suggested that many other reasons such as social pressure have a role to play. Some individuals, including opiate users, reported that their drug use had not led to any adverse consequences, others had experienced a variety of adverse consequences yet had had no contact with a drugs agency. The implications of these results are discussed.     

Changes in substance use associated with emergency room and primary care services utilization in the United States general population: 1995-2000

OBJECTIVE: The purpose of this study was to compare changes in the prevalence of heavy problem drinking and drug use among those obtaining emergency room (ER), primary care, and other health care services between 1995 and 2000 in the U.S. general population. METHOD: Data analyzed are from the Alcohol Research Group's 1995 (n = 4925) and 2000 (n = 7612) National Alcohol Surveys. Data for the 1995 survey was based on face-to-face interviews in respondents' homes in the 48 contiguous states, while the 2000 interview was a random-digit dialing computer-assisted telephone interview of the household population in all 50 states. RESULTS: Those reporting any health services utilization were less likely to report heavy drinking, two or more alcohol problems, and symptoms of alcohol dependence during the previous year in 2000 compared with 1995, but heavy or problem drinking was not predictive of health services utilization at either time. Controlling for demographic characteristics and health insurance coverage, illicit drug users were almost twice as likely [odds ratio (OR) = 1.85] compared with nonusers, to report ER utilization, and one and a half times more likely (OR = 1.55) to report primary care utilization during the past year in the 2000 survey, but drug use was not significantly predictive of health services utilization in 1995. CONCLUSIONS: These data suggest that while those alcohol-involved individuals were no more likely than others to use ER and primary care services in either 1995 or 2000, those drug-involved individuals were more likely to do so in 2000, perhaps related to the fact that these individuals may be incurring more health problems associated with their drug use that require medical attention. While identification and intervention with problem drinkers in clinical settings has received a great deal of attention, drug users may be overrepresented in health service settings, and such settings also may provide a window of opportunity for screening and intervention for a reduction in drug-related problems.     

Measuring met and unmet need of drug misusers: integration of quantitative and qualitative data

This paper reports on the combination of qualitative and quantitative methods which were used to record the attitudes to, and perceptions of, drug treatment services by current, ex-, and potential clients in south-east London. Three research instruments were employed: a structured current client satisfaction survey (n = 333); a questionnaire which included open-ended questions, administered to drug users not currently in treatment (n = 88), and focus groups for young drug users not in treatment (n = 14), women in treatment (n = 7) and men in treatment (n = 11). The data thus collected were used to construct a picture of local met and unmet need and obstacles to the uptake of health care, which is supported by more than one perspective, and which can reasonably be used as the basis for the planning of local health care purchase. Three major concerns were revealed by the data: the inadequacy of existing GP drug services; the deterrent effect of long waiting lists for methadone treatment, and the role of treatment services in relation to those drug users who acknowledge that their drug use is problematic, but believe that treatment services have nothing to offer them.     

Mental health status, drug treatment use, and needle sharing among injection drug users.

This study examined the relationship among mental health symptoms, drug treatment use, and needle sharing in a sample of 507 injection drug users (IDUs). Mental health symptoms were measured through the ASI psychiatric scale. A logistic regression model identified that some of the ASI items were associated with needle sharing in an opposing direction. Specifically, anxiety was significantly and positively associated with needle sharing. Using psychotropic medication was significantly and negatively associated with sharing needles. Those who had higher levels of drug injecting were more likely to share needles and those with an HIV-positive status were less likely to share needles. Finally, IDUs who reported high levels of drug treatment use (in the 75th percentile in terms of number of treatment admissions) were also more likely to share needles. Results suggest that treating mental health problems in IDUs who are not drug free could reduce HIV risk behaviors. The results also suggest the need to develop new intervention methods for high-level drug treatment users who may be "cycling" through treatment with low levels of treatment completion.     

Help-seeking and referrals in a needle exchange: a comprehensive service to injecting drug users

From November 1987 to March 1989 total number of clients, visits made, including numbers of new clients and second visits, and referrals to other agencies were routinely monitored at The Cleveland Street Needle Exchange, the Middlesex Hospital, London. During the study period a total of 510 onward referrals were made, involving 277 clients. Of these, 305 (59.7%) were to drug agencies and 187 (36.7%) to medical services. A sample of clients were interviewed to identify demographic and behavioural characteristics. Comparisons were made between those clients receiving referrals and the general client population; no significant differences were found in terms of sex, age and current patterns of drug use. However, those who accepted and took up referrals were found to have begun opiate use, injecting drug use and daily injecting at an earlier age than the general client population. The scheme attracts and retains its clients and provides a comprehensive service to a client group not currently in contact with other services.     

Participant Observation and its Place in the Study of Illicit Drug Abuse

Participant observation has long been utilized as a valuable research methodology in the study of illicit drug abuse. It should not be viewed in isolation, but seen as an essential complement to the quantitative analysis of trends in drug use, such as epidemiological studies and the monitoring of services for drug users. Fieldwork conducted at the Drug Indicators Project and other relevant studies highlight the practical and ethical problems faced by the participant observer, including issues of access, co-operation and confidentiality. This is particularly pertinent when working with drug users not in contact with services. When working with drug users in a treatment context, the need to be flexible and sensitive to the needs of agency staff is stressed, and the ways in which participant observers can operate as volunteers are explored. Contemporary concern about HIV infection, AIDS, and risk behaviour amongst drug users, raises the potential for an expansion and redefinition of the role of the participant observer to take on some of the functions of health educator, and two options are suggested.