Gender Differences and Correlated Factors of Heroin Use Among Heroin Users

Background: Gender differences in illicit drug use are becoming increasingly recognized. However, there are few studies concerning differences between male and female heroin users in China. Objectives: The study aimed to explore gender differences in terms of socio-demographic characteristics, drug-related behaviors, and treatment history among a heroin-using population in China. Methods: A cross-sectional study was conducted in four cities in December 2013. A total of 788 participants were recruited from several types of sites in each city: compulsory detoxification centers, methadone maintenance treatment clinics, and detention facilities. The data were collected via a self-administered questionnaire. Analysis of variance, chi-square test, and multivariate logistic regression analyses were conducted to examine gender differences in socio-demographic characteristics, drug-related behaviors, and treatment history. Results: Female heroin users were more likely to be unemployed, have more education, and use heroin with their spouse/companion (p <.05). Male heroin users were more likely to be in detention facilities and MMT clinics, and relapse when they felt hopeless (p <.05). Conclusions/Importance: Although there were some similarities between male and female heroin users, significant gender differences do exist in some aspects of socio-demographic characteristics and heroin use. The data provide evidence that interventions aimed at preventing the initiation of heroin use and reducing relapse should take gender into account.     

福州地区吸毒人群高危行为特征和复吸原因调查

目的:了解福州地区吸毒人群的高危行为特征和复吸原因。方法:自行设计问卷对福州地区强制戒毒人员进行相关内容调查。结果:在被调查的870例吸毒人员中,男性占75.2%,女性占24.8%;年龄34.16 a±s0.247 a,26-40 a年龄段占到68.9%(599例);女性低龄吸毒情况比男性严重;86.3%为初中及初中以下文化水平;未婚、离异和丧偶者占61.4%;53.0%为无业人员。静脉注射(552例,占63.4%)和烟枪吸(277例,占31.8%)为主要滥用方式;30.4%(265例)的人回答有共用吸毒器具行为;23.7%(206例)的人有多性伴侣,不使用安全套的比例占40.8%(355例);失眠(113例,13.0%)、身体疲劳(57例,6.6%)、性功能降低(41例,4.7%)是产生复吸的主要身体因素;打发无聊时间(222例,25.2%)、消除烦恼(192例,22.1%)以及被人冷落歧视、破罐破摔(120例,13.8%)是产生复吸的主要心理因素;毒友影响(265例,30.4%)、旧的吸毒环境引发毒瘾(152例,17.5%)是产生复吸的主要社会因素。结论:福州地区吸毒人群中存在注射、共用注射器具、多性伴侣等高危行为;复吸是身体因素、心理因素和社会因素共同作用的结果。开展毒品预防教育,对吸毒人群进行综合干预和戒毒后的后续管理,建立家庭社区综合康复机制,有助于改变吸毒人群的高危行为,预防复吸。     

The impact of compulsory drug detention exposure on the avoidance of healthcare among injection drug users in Thailand

BackgroundAlthough Thailand has relied on the use of compulsory drug detention centres as a strategy to try to address problematic drug use, little is known about the effects of exposure to these centres on people who inject drugs (IDU). Therefore, we undertook this study to explore whether exposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU.MethodsUsing Poisson regression analyses, we examined the relationship between compulsory drug detention exposure and avoiding healthcare among participants in the Mitsampan Community Research Project based in Bangkok.Results435 IDU participated in this study, including 111 (25.5%) participants who reported avoiding healthcare. In multivariate analyses, avoiding healthcare was positively associated with exposure to compulsory drug detention (adjusted prevalence ratio [APR] = 1.60; 95% confidence interval [CI]: 1.16–2.21), having been refused healthcare (APR = 3.46; 95% CI: 2.61–4.60), and experiencing shame associated with one's drug use (APR = 1.93; 95% CI: 1.21–3.09).ConclusionExposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU, suggesting that this system of detention may be contributing to the burden of preventable morbidity among IDU in this setting. Although further research is needed to confirm these findings, the results of this study reinforce previous calls to replace the system of compulsory drug detention with evidence-based public health interventions for IDU.     

戒毒人员的戒毒与操守

目的:了解戒毒人员的戒毒和操守状况。方法:自行设计“戒毒情况调查表”,对997例在所劳教戒毒人员进行调查。结果:被调查者既往经过反复自愿、强制、劳教戒毒的分别为566例(56·77%),941例,(94·38%)和708例(71·01%),其中504例曾戒毒3次以上。戒毒后操守时间最长不足0·3a者278例(27·88%),不足1a者469例(47·04%),2a以上只有48例(4·81%)。戒毒后复吸的主要原因有“无聊无事”,“想再尝试一口”,“毒友诱惑”,“感受到歧视、自卑”,“稽延性戒断症状”等。有844例认为,出所后有50%以上复吸的可能性。戒毒出所后最需要的是“家庭、社会的理解和支持”(544例,占54·56%)。结论:大部分患者经历多次反复戒毒,未能彻底戒除毒瘾。影响操守的原因很多。提示单纯戒毒不能降低复吸率,应该把心理辅导、社会和家庭支持有机纳入整个戒毒过程中,才能延长操守,降低复吸率。     

我国药物滥用监测工作调研

目的：研究我国药物滥用监测工作的现状和薄弱环节,完善监测工作机制,为建设成有组织、合理布局的监测体系提供依据。方法：对公安机关吸毒人员动态管控库的数据和历年药物滥用监测的数据进行比较,对省级药物滥用监测中心发放问卷进行面上调查。结果：（1）近年来药物滥用监测的数据量是公安机关吸毒人员动态管控数据库数据量的8．O％到17．7％,药物滥用监测数据中每年以海洛因为代表的阿片类滥用的比例大于公安机关吸毒人员动态管控数据库中阿片类滥用的比例（如2011年相差15．O％）,新型合成毒品滥用的比例小于公安机关吸毒人员动态管控库的比例（如2011年相差13．O％）。（2）药物滥用监测报表单位的覆盖范围差异比较大,其中公安和司法部门的强制隔离戒毒所的覆盖程度较好,分别为96．3％和92．5％;社区戒毒和拘留所的覆盖程度最小,分别为0和2．7％。（3）部分省市的药物滥用监测中心组织不够完善,日常的填表工作不够规范。例如,各省份监测中心的每月收集的报表量有较大差异,在某些月份出现一定的集中报告的情况。结论：监测工作在拘留所等报表单位上是薄弱环节,因而难以覆盖新型毒品滥用人群,导致监测的数据与公安机关的数据有一定的差距。并且监测系统存在政策、制度、经费和人力方面的不足。在今后的监测工作中重点加强公安机关拘留所的监测点的建设,以增加新型合成毒品滥用人员的报表数量;争取法律和政策的支持,加大经费的投入,增加鼓励机制。加强人员队伍建设,增加编制,定期对监测基层工作人员进行培训。     

社区海洛因依赖者美沙酮维持治疗的效果评估

目的:探讨美沙酮维持治疗在中国实施的可行性和有效性。方法:对海洛因依赖者开展美沙酮维持治疗试验性项目并定期开展小组心理干预、个别心理咨询和相关的支持活动。项目实施1a后,采用自制问卷对美沙酮维持治疗前后的效果进行评估,并将结果与37名社区海洛因依赖者进行比较。结果:美沙酮维持治疗后,维持者自我报告使用海洛因的比例由治疗前的100·0%下降为64·4%,其中,每天使用3次以上海洛因者由维持治疗前的50·0%降为0;对照组为43·2%。维持者的总违法犯罪率与维持治疗前和对照组比较,分别下降了4·6%和15·3%。维持者以注射方式吸毒的比例显著低于项目开展前和对照组(P<0·01),而从不使用安全套的比例明显少于项目前和对照组(P<0·01)。结论:在我国的海洛因依赖者中开展美沙酮维持治疗对于减少非法毒品的使用,降低违法犯罪率和减少感染艾滋病的高危行为是有效的。     

珠三角地区吸毒者脱毒治疗后复吸原因相关因素分析

目的 :了解珠三角地区吸毒者戒毒后复吸原因 ,并进行分析。方法 :对珠三角地区 2 0 0 3年 6月 - 2 0 0 4年 5月在强戒所、自愿戒毒中心戒毒的复吸人员采用自行设计的有关复吸状况、原因问卷进行调查分析。结果 :脱毒后复吸与以下因素有关 :重新获得快感、害怕戒断综合征的出现、无法摆脱毒友纠缠、无社会支持及受社会歧视、失业、家庭冷落、长期躯体不适、性功能障碍、关节肌肉疼痛、抑郁和焦虑情绪。结论 :珠三角地区吸毒者脱毒后复吸的原因与海洛因的依赖性、稽延性戒断症状和家庭社会支持不足有关。     

Compulsory drug detention in East and Southeast Asia: Evolving government,UN and donor responses

According to official accounts, more than 235,000 people are detained in over 1000 compulsory drug detention centers in East and South East Asia. Individuals in such centers are held for periods of months to years, and can experience a wide range of human rights abuses, including violation of the rights to freedom from torture and cruel, inhuman and degrading treatment; freedom from arbitrary arrest and detention; a fair trial; privacy; the highest attainable standard of health; and freedom from forced labor. Since 2010, an increasing number of United Nations agencies, human rights experts, and others have expressed concerns about rights abuses associated with compulsory drug detention centers, and since 2012, called for their closure. Although they do not represent a complete break from the past, these calls mark a significant shift from past engagement with drug detention, which included direct and indirect funding of detention centers and activities in detention centers by some donors. However, the lack of transparent governance, restrictions on free speech and prohibitions on monitoring by independent, international human rights organizations make assessing the evolving laws, policies and practices, as well as the attitudes of key governments officials, difficult. Looking specifically at publicly announced reforms and statements by government officials in China, Cambodia, Vietnam and Lao PDR reveals possible improvements in respect for the rights of drug users, and on-going challenges.     

Reawakening the dragon: changing patterns of opiate use in Asia, with particular emphasis on China's Yunnan province

Asian countries adjacent to the Golden Triangle and their neighbors have witnessed an evolution in "drug abuse" from traditional opium smoking to heroin eating, smoking, and finally heroin injection. A recent study of 630 heroin users was conducted in China's Yunnan Province, located close to the Golden Triangle. Data collected between August 1997 and February 1998 indicate injecting heroin users, in comparison to noninjectors, were more likely to have used drugs for a longer period of time, and to use drugs more frequently everyday. Other major differences existed between urban and rural subjects, especially highlighting differences between men and women. Women comprised a much higher proportion of urban subjects than rural subjects. Rural injectors were much more likely to be male, but urban injectors were almost evenly split between men and women. The emerging epidemic of heroin use in China and the continuing substance abuse problem in the United States provide an opportunity for collaborative research of mutual benefit.     

Prevalence rates and risk factors for hepatitis C among drug users not in treatment in Malaysia

Introduction and Aims. The prevalence of hepatitis C virus (HCV) among heroin dependants in treatment was estimated at 89.9%; however, virtually no information exists on the prevalence or risk behaviour among the larger population of drug users not in treatment. This study assessed the prevalence of HCV and associated risk factors among this group with a view to designing more effective intervention programs. Design and Methods. A cross‐sectional survey of 552 not‐in‐treatment drug users recruited from five key urban centres across peninsular Malaysia with on‐site serological testing for HCV and HIV seropositivity was conducted. Results. HCV prevalence was 65.4% for the overall sample, but higher among injecting drug users (67.1%) relative to non‐injecting drug users (30.8%). Bivariate analysis suggested seven risk factors though only sharing injecting paraphernalia and lifetime homosexual/bisexual behaviour remained significant in multivariate analysis. Discussion and Conclusions. With the majority (65.9%) sharing injecting equipment and about the same proportion (65.4%) being HCV positive, the risk of further transmission to new drug users is high. It is imperative that the nascent needle and syringe exchange and condom distribution program and its ancillary services—launched in 2005 to fight HIV—be fine tuned, as a first step, to control HCV. With its greater infectivity and non‐symptomatic character, HCV is more insidious. Given the shared risk factors of HCV and HIV, routine screening of drug users for HCV—currently non‐existent—should be instituted. This, with other intervention measures, will help detect and control HCV at an earlier stage while also checking the spread of HIV.[Vicknasingam B, Narayanan S, Navaratnam V. Prevalence rates and risk factors for hepatitis C among drug users not in treatment in Malaysia. Drug Alcohol Rev 2009;28:447–454]     

乘数法估计四川乐山市中区吸毒人群基数研究

目的:使用乘数法估计乐山市中区籍现有吸毒人群基数。方法:获得当地强戒所和自愿咨询检测门诊2003年5月31-2004年5月31日收戒或咨询人数r,问卷调查获乘数1/p,N=r/p计算估计数,定性和定量研究结合以解释估计结果。结果:r=507/511人,271份问卷获自称戒毒比例23.99%/4.17、咨询比例32.47%/3.08,估计数2114/1574人。23.99%和核对比例23.25%比较,χ2=0.0952,P=0.7576;一致性检验,k=0.5705,95%可信区间[0.4547,0.6862];灵敏度68.25%和特异度89.42%。与2002年自称戒毒比例(25.54%)比较,χ2=0.1623,P>0.05。公安部门登记、乘数法计算的总吸毒率为0.20%、0.39%和0.29%,三者多重比较,χ2为185.46、320.27、83.85和12.41,均P<0.01。结论:强戒所和VCT门诊为依托机构进行乘数法估计是可行的;自称戒毒比例稳定为24%,VCT比例33%,可满足估计,但需关注戒毒假阴性问题;至2004年7月26日目标人群估计数1574-2114人,是公安部门同期现有吸毒登记数的1.5-2倍。     

纳曲酮用于海洛因依赖治疗

目的 :了解纳曲酮抗复吸治疗效果。方法 :采用回顾性临床资料分析方法 ,分析 5 0例海洛因依赖者躯体脱毒后使用纳曲酮抗复吸治疗的临床资料。结果 :应用纳曲酮抗复吸治疗 6个月 ,患者对海洛因渴求程度分值从1 96±s 0 88降至 0 2 5±s 0 4 4 (P <0 0 1) ,复吸率从 2 8 6 %降至 5 0 % (P <0 0 1) ,17例原静脉注射毒品者复吸时11例改为烫吸 ,1例改为肌肉注射。结论 :纳曲酮能减轻或消除海洛因正性强化作用 ,间接淡化患者对海洛因的渴求程度 ,降低复吸率 ,无明显毒副作用 ;可使静脉注射海洛因者改变滥用方式 ,降低毒品危害     

四省市吸毒人群中丁丙诺啡药物滥用/使用的现况调查

目的:调查丁丙诺啡(buprenorphine,Bup)在吸毒人群中滥用/使用的一般情况,评价其药物滥用与药物依赖性潜力。方法:自拟调查表,采取回顾性调查方法,于2006年1月-2006年7月在北京、云南、湖北和广东四地区的六所公安、司法强制戒毒机构,以戒毒所为单位,对符合调查对象条件的全体戒毒人员进行整群调查。结果:(1)使用率:在3254例被调查者中,27.4%(892例)不同程度、不同目的使用过Bup。使用率以云南个旧最高,北京地区次之。(2)使用目的及场所:用于"戒毒或临时替代"及"治疗戒毒后稽延性症状"分别占55.8%和40.6%;82例(9.2%)为"体验特殊精神效应(如欣快、飘等)"。使用场所:主要是在"自己家中"(74.4%)和"戒毒所"(32.1%)。(3)使用方式:47.7%的人有多药使用的经历。在有多药使用者中,采用Bup加镇静催眠药(三唑仑、安定)、氯丙嗪、东莨菪碱和异丙嗪分别占47.6%、5.8%、1.2%和10.1%。(4)使用频率:连续3 d以上使用经历者占36.1%,偶尔使用/间断使用占34.3%,有时连续、有时间断使用占29.5%。(5)主要来源:"医院或诊所"、"戒毒机构"(或在戒毒机构中使用)、"药店"、"非正常渠道"(黑市)、"亲朋"分别占24.7%、38.7%、29.0%、18.4%,4.9%。(6)获得的难易程度:34.0%表示很容易得到,23.4%表示比较容易得到,12.5%表示比较困难得到,7.2%表示非常困难得到,22.8%表示不知道或不便回答。(7)使用后的感觉:46.0%应答者主诉使用后"有感觉",其中"快感"占33.8%,"幻觉"占26.6%,"飘感"占34.8%。这种特殊感觉"同海洛因不一样"占67.6%;"同海洛因一样,但比海洛因作用小"占25.8%;"同海洛因一样,但比海洛因作用强"占4.5%。以上主观效应是单一使用丁丙诺啡产生的占63.8%,合并用药产生的占36.2%。结论:本次调查有近30%的人不同程度和不同目的使用过丁丙诺啡;大多数Bup使用者属于医疗目的使用,但也有少数为"体验Bup特殊精神效应";Bup滥用/使用群体中近一半的人有多药使用的经历;大多数药品来源正常。对非医疗目的使用、多药使用、使用频率高、从非正常渠道获得、使用后有特殊感觉、容易获得的情况有必要进行进一步调查。     

Mandatory assessment of drug users in Malaysia: Implications on human rights

Aim: The study is founded upon a critical analysis of the extent to which the mandatory drug assessment in funneling drug users under Malaysia's compulsory treatment and rehabilitation programme is consistent with the principles of human rights guaranteed under the Malaysian Constitution.

Method: Empirical qualitative data from a case study encompassing direct observations of natural sites, a focus group comprising former and recovering drug users, secondary data from official documents and case files.

Results: Findings show that the mandatory drug assessment of drug users is subject to arbitrary arrest, unnecessary prolonged detention, lack of medical assistance and non-compliance to due process.

Conclusions: The mandatory drug assessment of drug users in Malaysia entails serious infringements of the principles of human rights.     

云南丽江地区药物滥用情况调查

目的··:了解云南省丽江地区药物滥用特点及一般情况。方法·· :采用自拟的《药物滥用情况调查表》,对丽江地区强制戒毒所收治的50例戒毒者进行调查。调查内容包括吸毒者的人口学特征以及成瘾药物的种类、用量,初始吸毒的时间、用量,吸毒方式,初始药物滥用原因,复吸原因等。结果··:50例被调查者全部为海洛因滥用者,其中男性49例,女性1例,平均年龄26.6a±s5.4a ;民族 :汉族10例,纳西族28例,彝族5例,其它少数民族3例 ,其余不详 ;多数吸毒者 (82 % )初始吸毒时间在1996年3月 -2000年5月 ;滥用的其它成瘾药物有:哌替啶(6.1 %)、美沙酮(4.1 %)、二氢埃托啡(2.0%)、地西泮(2.0 %)、三唑仑(2.0 %)等 ;初始吸毒方式主要是烫吸(占68.8 %),后来多转为注射(67.3%) ;有26.5%的人在吸毒前不知道吸毒违法,30%的人不知道毒品对身体的危害,60 %的人不知道吸毒会传染艾滋病;在复吸原因调查中,以“回到以前的毒友中,受到影响”最高(占92.0 %),87.5 %的人“认为戒不掉毒或把握不住自己”的最主要原因是环境因素。结论··:此调查反映了丽江地区药物滥用的一般情况。鉴于该地区日益严重的药物滥用问题 ,建议政府部门从打击毒品犯罪和预防药物滥用两方面加大禁毒力度 ,遏制药物滥用蔓延。     

强制隔离戒毒实施中的困境及出路

强制隔离戒毒工作伴随禁毒法的诞生已经开展近两年的时间了。然而,由于多种因素,强制隔离戒毒工作在实施过程中遇到了困境,例如:吸毒成瘾标准难认定、诊断评估体系不健全、戒毒民警队伍素质有待进一步提高,等等。这些问题严重阻碍了强制隔离戒毒工作的发展,难以有效降低戒毒人员的复吸率。针对这些问题,本文提出了相应的解决办法,如尽快制定科学的吸毒成瘾认定标准、建立诊断评估体系等等。     

REAWAKENING THE DRAGON: CHANGING PATTERNS OF OPIATE USE IN ASIA,WITH PARTICULAR EMPHASIS ON CHINA'S YUNNAN PROVINCE

Asian countries adjacent to the Golden Triangle and their neighbors have witnessed an evolution in “drug abuse” from traditional opium smoking to heroin eating, smoking, and finally heroin injection. A recent study of 630 heroin users was conducted in China's Yunnan Province, located close to the Golden Triangle. Data collected between August 1997 and February 1998 indicate injecting heroin users, in comparison to noninjectors, were more likely to have used drugs for a longer period of time, and to use drugs more frequently everyday. Other major differences existed between urban and rural subjects, especially highlighting differences between men and women. Women comprised a much higher proportion of urban subjects than rural subjects. Rural injectors were much more likely to be male, but urban injectors were almost evenly split between men and women. The emerging epidemic of heroin use in China and the continuing substance abuse problem in the United States provide an opportunity for collaborative research of mutual benefit. [Translations are provided in the International Abstracts Section of this issue.]     

利用戒毒所评价吸毒人群减少伤害服务及效果

目的:通过对戒毒所吸毒人员的调查,评价针对吸毒人员开展的减少伤害服务的效果和真实性。方法:2009-2010年间,选择减少伤害服务覆盖的云南省19个县的戒毒所为调查点,每半年每县单纯随机抽样方式纳入30名新入所3个月的静脉吸毒人员为调查对象,自行设计问卷收集调查对象入戒毒所前接受项目服务情况、服务质量、服务效果等方面数据。结果:共调查669人,35.66%接受过针具服务,46.02%接受过美沙酮服务,入所前一周与他人共用针具情况,接受外展服务有57人(13.73%),未接受外展服务有66(25.98%),P<0.001。结论:通过戒毒所定期调查,能较好反映当地吸毒人群行为干预综合服务覆盖率、服务质量、服务效果和服务真实性,方法可行,建议应用作为干预工作客观评估指标之一。     

强制隔离戒毒人员中美沙酮维持治疗的认知相关因素研究

目的:研究强制隔离戒毒人员对美沙酮维持治疗相关知识的认知情况及其相关因素,为针对性地开展健康宣传教育工作提供依据。方法:采用典型抽样与整群抽样结合的方法,使用自行设计的问卷对四川、湖南、广西三省共5家强制隔离戒毒所的1015名戒毒人员进行调查。结果:(1)强制隔离戒毒人员对美沙酮维持治疗相关知识的总体认知水平尚低,平均知晓率仅为48.0%。(2)认知情况男性好于女性,文化程度高者好于文化程度低者,吸毒史为10-20 a者好于吸毒史小于10 a和大于20 a者,曾经参加过美沙酮维持治疗者好于从未参加过者,所在戒毒所提供美沙酮维持治疗相关服务者好于未提供者。结论:强制隔离戒毒所应加强所内美沙酮维持治疗相关知识的宣传教育工作,重点关注女性、文化程度较低、汉族及吸毒史较长和较短的戒毒人员,对少数民族戒毒人员的宣传教育工作应当继续给予重视。同时大力推广强制隔离戒毒人员出所后的美沙酮维持治疗转介模式,并开始逐渐探索在强制隔离戒毒所内引入美沙酮维持治疗。     

海洛因依赖者操守成败相关因素的调查分析

目的:探讨海洛因依赖者操守成败的相关因素及预防复吸的对策。方法:问卷调查35名戒毒后操守12个月以上及36名屡戒不成的海洛因依赖者,比较两组的人口学资料,操守成败相关因素。结果:成功操守者吸毒时间相对较短(P<0.01);戒毒次数和接受替代治疗相对较少(P<0.01);吸毒前对毒品认识不足(P<0.05)及因吸毒而受到的法律制裁较多(P<0.05)。维持操守的主要因素是正确的认知;而失败的因素是未脱离吸毒环境。结论:维持操守主要与正确的认知有关,据此制定综合性的预防复吸措施。