Nicotine dependence and HIV risk behaviors among illicit drug users

This study was concerned with examining the relation between nicotine dependence and HIV risk behaviors in a sample of 297 out-of-treatment drug users. A number of significant relationships were found between nicotine dependence and HIV risk behaviors. Crack-smoking injectors were found to have a higher degree of nicotine dependence when compared with exclusive injectors or exclusive crack smokers. Participants' impulsivity may be one possible reason why nicotine dependence is related to HIV risk behaviors. The results also suggest that drug abuse programs make available smoking cessation programs.     

Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users

Background

Release from prison is associated with a markedly increased risk of both fatal and non-fatal drug overdose, yet the risk factors for overdose in recently released prisoners are poorly understood. The aim of this study was to identify risk and protective factors for non-fatal overdose (NFOD) among a cohort of illicit drug users in Vancouver, Canada, according to recent incarceration.

Methods

Prospective cohort of 2515 community-recruited illicit drug users in Vancouver, Canada, followed from 1996 to 2010. We examined factors associated with NFOD in the past six months separately among those who did and did not also report incarceration in the last six months.

Results

One third of participants (n = 829, 33.0%) reported at least one recent NFOD. Among those recently incarcerated, risk factors independently and positively associated with NFOD included daily use of heroin, benzodiazepines, cocaine or methamphetamine, binge drug use, public injecting and previous NFOD. Older age, methadone maintenance treatment and HIV seropositivity were protective against NFOD. A similar set of risk factors was identified among those who had not been incarcerated recently.

Conclusions

Among this cohort, and irrespective of recent incarceration, NFOD was associated with a range of modifiable risk factors including more frequent and riskier patterns of drug use. Not all ex-prisoners are at equal risk of overdose and there remains an urgent need to develop and implement evidence-based preventive interventions, targeting those with modifiable risk factors in this high risk group.     

Vulnerability among Vietnamese illicit drug users in Australia: challenges for change

A broad range of vulnerabilities, risk factors and challenges for change were examined in order to better understand why ethnic Vietnamese have the highest profile in Australia in relation to illicit drug use. A literature review of vulnerability and risk factors experienced by ethnic Vietnamese people in Australia was conducted. Emerging themes and concepts were tested against the 1996 Australian Census (Victoria), databases specific to illicit drug use, and the outcomes of key informant interviews and community consultations. Vietnam-born Australians are the third largest ethnic community in Australia. Due to high unemployment, poor English proficiency, experiences of racism, social and economic difficulties, inter-generational conflicts and acculturation, the ethnic Vietnamese community has become vulnerable to involvement with illicit drug use and distribution. Addressing drug problems among the ethnic Vietnamese community in Australia is hampered by a lack of structured, appropriate education and employment programs, biased media reporting and poor utilisation of drug treatment services. Socio-economic disadvantage and level of exclusion from the legitimate economy heighten involvement in illicit drug use and its associated harms.     

Licit and illicit drug initiations and alcohol-related problems amongst illicit drug users in Edinburgh

A non-random study group of one hundred and fifteen regular illicit drug users were interviewed in Edinburgh between January and July 1988. It was found that initiation to the use of alcohol and tobacco generally preceded the first use of illicit substances. The circumstances of initiation to alcohol use often differed from those of initiation to an illicit substance. Results from the first phase of this longitudinal study also indicate that the majority of current users of illicit drugs have experienced a wide range of problems attributed to alcohol consumption. Opiate users in particular, reported experiencing alcohol-related trouble with the police, being involved in alcohol-related violence and being banned from premises due to their drinking.     

"They should have them all over the place": a health program for children of illicit drug users

A peer-based support and advocacy group for illicit drug users in collaboration with a community nurse developed an innovative program for the children of users. The program provides well-baby checks, immunization monitoring, parenting advice, monitoring of children's safety, a free lunch and education about nutrition, as well as activities for the children and mothers. In addition, it allows mothers to have time out in a friendly, relaxed, safe, and nonjudgmental environment. The program has been running for more than 7 years, costs little, and gives a hard-to-reach population access to valuable health care.     

Barriers associated with the treatment of hepatitis C virus infection among illicit drug users

BACKGROUND: Illicit drug users account for the majority of cases of HCV infection in the developed world, but few have received treatment. METHODS: We evaluated barriers to initiating HCV treatment -- including general treatment willingness -- and factors associated with these among HCV infected illicit drug users. Participants were recruited via convenience sampling from two community clinics in Canada. Individuals age >18 years with a history of illicit drug use completed interviewer-administered surveys. Those reporting positive HCV testing underwent additional questioning on willingness, uptake and barriers to treatment for HCV. RESULTS: Of 188 HCV positive illicit drug users, 16% (n=30) had received treatment for HCV. Factors associated with a decreased treatment uptake included current heroin use and HIV/HCV co-infection. Among those not having received therapy, 77% (117/153) indicated a willingness to receive HCV treatment. Factors associated with treatment willingness included not being infected with HIV, having not recently used drugs by injection and having reported physical health problems. Among those not having sought HCV treatment (n=107), the major reasons for not doing so were: lack of information about HCV or knowledge that treatment was available (23%), the absence of symptoms (20%) and the perceived side effects of treatment (14%). CONCLUSIONS: Among illicit drug users attending inner city clinics, we have observed a low uptake of HCV treatment, but a high willingness to receive therapy. An increased focus on improving education about the long-term consequences of HCV and the availability of effective treatment are important components for expanding HCV treatment among illicit drug users.     

The rise of Viagra among British illicit drug users: 5-year survey data

Viagra use among British nightclubbers, a sentinel population of illicit drug users, was first reported in 1999. There has since been little attention paid to the evolution of patterns of non-prescribed use, apart from among men who have sex with men. Beginning in 1999 an annual survey has been conducted with a specialist dance music magazine, permitting cross-sectional comparisons over time. Rising levels of lifetime and current use prevalence and data on patterns of both male and female use are reported, along with elevated prevalence levels among both gay men and women. Experimentation with Viagra appears increasingly to have become established among British nightclubbers who use recreational drugs. Ethnographic and epidemiological study and monitoring of adverse consequences is now needed to fully appreciate reasons for use and the extent of possible harms. [McCambridge J, Mitcheson L, Hunt N, Winstock A. The rise of Viagra among British illicit drug users: 5-year survey data. Drug Alcohol Rev 2006;25:111 - 113]     

Marijuana use among Latino adolescents: gender differences in protective familial factors

Given the important contextual function of family dynamics and traditional gender roles in Latino cultures, parental influences on substance use among Latino adolescents may differ across genders. This study examined associations between family factors (parental monitoring, parent-child communication, family cohesion, and familism) and marijuana use among 1,369 Latino adolescents in Southern California. Students from seven schools completed surveys in 9th and 11th grades. Longitudinal hierarchical linear regression analyses evaluated the associations between family factors in 9th grade and lifetime marijuana use in 11th grade, as well as gender differences in these associations. Girls reported higher levels of parental monitoring, parental communication, and familism than boys did, but there were no gender differences in family cohesiveness. In a regression model controlling for covariates and previous marijuana use, parent-child communication and family cohesion in 9th grade were each uniquely predictive of lower levels of marijuana consumption in 11th grade. Gender was a statistical moderator, such that higher levels of parent-child communication predicted lower marijuana use among boys, whereas girls' use was relatively low regardless of parent-child communication levels. Results are discussed in the light of the concurrent socialization processes of family and gender in Latino culture and its relation to preventing delinquent behaviors such as marijuana use.     

Factors associated with drug-related psychiatric disorders and suicide attempts among illicit drug users in Taiwan

Illicit drug users, entering a detention center and two psychiatric hospitals in Northern Taiwan, were interviewed for lifetime drug-use-related psychiatric disorders and suicide attempts. Among 197 participants, 17.3%, 16.8%, and 14.2% had a drug-induced psychotic disorder (DIP), a drug-induced mood disorder (DIM), and a history of suicide attempts, respectively. Continuous use of methamphetamine and joblessness were associated with DIP and DIM, accordingly. Polysubstance use was collectively correlated with DIP and DIM. Female gender and history of having any mood disorder were predictors of suicide. These results provide useful clues for detecting drug-related psychiatric disorders and suicide among illicit drug users. The study's limitations are noted.     

Stigma, discrimination and the health of illicit drug users

Persons who use illicit drugs are stigmatized in the United States. The conferral of a deviant social status on illicit drug users may serve to discourage use. However, stigmatization may also adversely affect the health of those who use illicit drugs, through exposure to chronic stress such as discrimination and as a barrier to accessing care. We hypothesized that aspects of stigma and discrimination would be associated with mental and physical health among illicit drug users. Using street outreach techniques, 1008 illicit drug users were interviewed about stigma and discrimination related to their drug use, and their health. We measured discrimination related to drug use, alienation, perceived devaluation, and responses to discrimination and stigma. Health measures included mental and physical health measures from the Medical Outcomes Study Short Form-36, depression symptoms from the Center for Epidemiological Studies Depression scale, and a sum of health conditions. In adjusted models, discrimination and alienation were both associated with poorer mental health, and only discrimination was associated with poorer physical health. Angry responses to discrimination and stigma were associated with poorer mental health. The association of stigma and discrimination with poor health among drug users suggests the need for debate on the relative risks and benefits of stigma and discrimination in this context.     

Cigarette smoking, illicit drug use, and routes of administration among heroin and cocaine users

Cigarette smoking is ubiquitous among illicit drug users. Some have speculated that this may be partially due to similarities in the route of administration. However, research examining the relationship between cigarette smoking and routes of administration of illicit drugs is limited. To address this gap, we investigated sociodemographic and drug use factors associated with cigarette smoking among cocaine and heroin users in the Baltimore, Maryland community (N=576). Regular and heavy cigarette smokers were more likely to be White, have a history of a prior marriage, and have a lower education level. Regular smoking of marijuana and crack was associated with cigarette smoking, but not heavy cigarette smoking. Injection use was more common among heavy cigarette smokers. In particular, regular cigarette smokers were more likely to have a lifetime history of regularly injecting heroin. Optimal prevention and treatment outcomes can only occur through a comprehensive understanding of the interrelations between different substances of abuse.     

Patterns and 14-year trends in mortality among illicit drug users in Finland: The HUUTI study

BackgroundAlthough mortality is a known complication of illicit drug use, robust epidemiological studies on drug-related mortality in Finland are scarce. We examined all deaths, specific causes of death, and trends in mortality among a large number of illicit drug users in Finland during a 14-year period.MethodsDetails of 4817 clients who sought treatment for drug use at Helsinki Deaconess Institute between 1997 and 2008 were linked to national cause of death register to identify all deaths and causes of death. Standardised mortality ratios (SMRs) were calculated to compare all-cause deaths in our study cohort with those in the general population. Trends in mortality rates were assessed using Poisson (log-linear) regression.ResultsA total of 496 deaths occurred during 41,567.5 person-years with crude mortality rate of 1193.2 per 100,000 person-years. Mean follow-up was 8.6 years and the mean age at death was 33.8 years. Most deaths (84.1%) occurred among male clients, 189 deaths occurred in the 25–34 age-group and all-cause SMR was 8.9 [95% confidence interval (CI) = 8.1–9.7]. Two-thirds (64.9%) were deaths from external causes and 35.1% from disease-related causes. The four leading causes of death were accidental poisoning/overdose (n = 165), suicide (n = 108), mental and behavioural disorders (n = 49) and circulatory system diseases (n = 45). Younger clients died from acute effects of drug use while older clients died more from chronic health conditions. A decline in annual rates was noted for all-cause mortality (P = 0.01), deaths from mental and behavioural disorders (P < 0.001) and suicides (P < 0.001).ConclusionThe four leading causes of death among illicit drug users are preventable. Overdose management training, drug education and other preventive measures could help reduce mortality.     

Prevention of HIV among drug users

The relationship between injection drug use and HIV was established early in the HIV epidemic, and injection drug use has continued to be an important risk factor for HIV throughout the world. This panel included 4 papers related to HIV prevention among drug users, focusing on effective prevention strategies, the importance of organizing the AIDS-affected community, the impact of knowledge of serostatus on risk behaviors, and developing interventions for drug-using homosexual and bisexual men. These papers, addressing various aspects of the epidemic and methods to enhance prevention efforts, all indicate that although extensive knowledge regarding how to reduce HIV risks among drug users has accumulated, many areas for further research and intervention development remain.     

Mortality and cause of death among 1705 illicit drug users: A 37 year follow up

Introduction and Aims. To examine the overall mortality and causes of deaths of a large cohort of users of illicit drugs in Stockholm over 37 years. Design and Methods. People with substance abuse were identified through records collected by different institutions in Stockholm in 1967. Subjects were followed in registers recording mortality and cause of death and in‐patient care stays until 2003. Results. More than half (n = 860) of the 1705 identified substance abusers died at an average age of 47 years, 25–30 years younger than the general population. The standardised rate ratio (SRR) for mortality was 3.3 among men and 3.5 among women. Incidence of mortality per 1000 person‐years was also increased, but somewhat lower for women. The difference between these two measures is mainly explained by a lower mortality among women in general. In‐patient care stays with both alcohol and drug‐related diagnoses were associated with higher risk of dying among women than men: SRR = 14.5 and SRR = 4.0, respectively. Accidents and suicide were the most common cause of death among the youngest subjects (15–24 years) and cardiovascular diseases and tumours among the oldest (≥55 years). Discussion and Conclusions. Accidents and suicide, especially at a young age, are two common causes of death that might be prevented by increased awareness in medical personnel, along with better treatment and supportive measures.[Stenbacka M, Leifman A, Romelsjö A. Mortality and cause of death among 1705 illicit drug users: A 37 year follow up. Drug Alcohol Rev 2009]