Effects of drug treatment for heroin sniffers: a protective factor against moving to injection?

We explore the relationship between contact with treatment and transition to injection for heroin sniffers. Our primary research question is, does contact with treatment delay onset of injection for heroin sniffers? A stratified network-based sample was recruited from multiple communities in South Florida which were known for high drug use. Three categories of respondents were recruited based on injection outcome: long-term injectors, short-term injectors, and sniffers (n = 900). We answer our research question in two steps. First, we investigate the prevalence of drug treatment for heroin sniffers and injectors using case-control methods. The preliminary findings indicate a positive relationship between contact with treatment and injection status outcome. Second, we further examine the relationship by attempting to identify the causal factors that delay initial injection for a subgroup of current injectors using survival regression procedures. Delaying or preventing transition to injection could significantly decrease risk of HIV transmission by reducing or eliminating risky injecting behaviors. We conclude with a discussion of policy implications and suggestions for future research.     

Ecstasy use and its Association with Sexual Behaviors Among Drug Users in New York City

In the past two decades, recreational use of ecstasy has become a growing concern in the United States, although most studies assessing ecstasy use have focused on white, middle-class adolescents who use ecstasy during raves and in clubs. We assessed the prevalence of recent ecstasy use among predominantly minority heroin, cocaine, and crack users in New York City and the association between ecstasy and sexual risk above and beyond that of the other drugs. Between 2002 and 2004, injection and non-injection heroin, crack and cocaine users (N = 534) completed a risk behavior questionnaire that included items on ecstasy use. Logistic regression was used to investigate the relation between current ecstasy use and sexual behaviors. Of 534 illicit drug users, 69.7% were aged 25 years or older, 65.2% were Hispanic, 27.9% Black and 77.4% male; 36.7% were injectors. 17.2% of respondents reported recent (last six months) ecstasy use. In a multivariable logistic regression model, current ecstasy use was associated both with initiating sex before age 14 (adjusted odds ratio (AOR) = 1.51) and having two or more partners in the past two months (AOR = 1.86) after adjusting for age at study entry, current cocaine and marijuana use and being an injection drug user. This study suggests that ecstasy use may be more prevalent among urban drug users. Ecstasy use in urban settings, beyond clubs and raves, should continue to be monitored.     

Characterizing the drug-injecting networks of cocaine and heroin injectors in Montreal

BACKGROUND: There is little understanding about how the social networks of cocaine injectors are different from those of heroin users and about how such differences are associated with injection risk behaviours. Therefore, the objective of this study was to compare drug-injecting network characteristics of cocaine and heroin injectors believed to be associated with a risk of bloodborne infections. METHODS: Active injection drug users (IDUs) were recruited between April 2004 and January 2005 from three syringe exchange and two methadone treatment programs in Montreal, Canada. Characteristics of each participant and of up to 10 social network members (IDU and non-IDU) with whom frequent contact had occurred in the past month were elicited using a structured, interviewer-administered questionnaire. The current analysis focussed on the drug-injecting network members. Logistic regression was used to examine network characteristics in relation to cocaine and heroin injection. RESULTS: Of 282 study subjects, 81% used cocaine and 19% used heroin as their primary injected drug in the past 6 months. Compared to heroin injectors, participants who injected cocaine had lower odds of knowing their network members for a longer time (OR=0.92, 0.85-0.99), were more likely to report a larger IDU network (OR=1.64, 1.18-2.29) and have IDU partners who had a history of attending shooting galleries (OR=2.42, 1.05-5.56). INTERPRETATION: This study identified high-risk network-related factors associated with bloodborne infections in cocaine injectors. Prevention efforts may benefit from tailoring interventions according to type of drug used, with particular attention to the drug injecting-network of IDUs.     

Risk Factors Associated with the Transition with Transition to Heroin Injection: A Street Addict Role Perspective

The purpose of this paper is to identify characteristics of heroin sniffers likely to shift to injection by evaluating the street addict role theory as an informing theoretical framework to explain transition from heroin sniffing to injection. A nested case–control research design was used to identify 142 heroin sniffers who never had injected a drug (controls) and 146 recently transitioned injection drug users (cases) from a larger study of 600 African-American, Hispanic, and non-Hispanic white men and women who were street recruited from multiple communities known for high drug use. Univariate and multivariate logistic regression analyses were conducted to test the proposed hypotheses derived from the street addict role theory. Our findings partially support the utility of the street addict role perspective as an explanatory framework for understanding the role played by sociocultural factors in the transition to injection. This perspective can help contextualize this HIV-related behavior within the high risk social environment of heroin users. The development of effective prevention strategies for this group should be guided by a comprehensive understanding of the social environment where HIV-related risk behaviors occur.Sánchez is with the Department of Health Promotion and Disease Prevention, Robert Stempel School of Public Health, Florida International University, 11200 S.W. 8th Street—HLS574, Miami, Florida 33199, USA; Chitwood is with Department of Sociology, University of Miami, Coral Gables, Florida, USA; Koo is with the Department of Criminal Justice, California State University, Fullerton, USA.     

More free syringes, fewer drug injectors in the case of Spain

International policy on the prevention of HIV and other health problems among drug users should be guided by scientific evidence. However, it has frequently been argued that Needle Exchange Programs (NEPs) have negative effects such as facilitation of injection of illicit drugs, without providing evidence to support this hypothesis. Since the early 1980s Spain has experienced a severe HIV epidemic among drug injectors. A delayed but comprehensive implementation of harm reduction programs has taken place since the early 1990s. This paper assesses trends between 1991 and 2004, both in the number of sterile syringes exchanged or delivered by NEPs or other programs to improve injectors' access to sterile injection material, and in the number of injectors admitted to first treatment for heroin or cocaine dependence, as a proxy for trends in the number of new drug injectors in Spain. The results show increased access to sterile syringes and a sharp decrease in the number of new drug injectors, suggesting that NEPs have not promoted drug injection. A positive overall transition from injecting to smoking was also observed in the most frequent route of heroin or cocaine administration.     

Prevalence and Incidence of HCV Infection among Vietnam Heroin Users with Recent Onset of Injection

HCV infection continues to spread at an alarming rate among IDU populations. The available evidence suggests that HCV is acquired relatively quickly following onset of injection. However, there are few prospective studies of HCV acquisition, particularly among IDU populations in resource-poor settings. A sample of young male heroin injectors with recent onset of injection (<4 years) was recruited in Hanoi, Vietnam for a prospective assessment of the early course of injection (n = 179). Both behavioral and biological assessments (including detailed retrospective assessment of injection initiation) were conducted at baseline and repeated at 6-month intervals for a period of 16 months. Variables associated with HCV infection (p value < 0.05) in bivariate analyses were considered for inclusion in logistic regression models to identify risk factors independently associated with HCV infection. HCV incidence was calculated by using the incidence density approach and was expressed in terms of person-years of observation. The baseline of prevalence of HCV was 46%. HCV significantly increased in relation to time since first injection, from 30% in subjects with ≤10 months of injection risk to 70% in subjects with ≥30 months injection risk (p value = 0.0005). In multivariate logistic regression analysis, increasing age, incarceration in a drug detention facility (OR = 2.54; 95%CI 1.05, 6.15), and time since first injection remained significantly associated with HCV infection. Use of injection as primary mode of administration (OR = 2.56; 95%CI 0.98, 6.69) achieved marginal significance. After 16 months of follow-up, the incidence rate of HCV was 23.35 per 100 person-years and the mean time between first injection and first positive HCV test was 1.2 years. HCV is acquired much more rapidly among new injector populations than previously recognized, demonstrating the need for early behavioral intervention among new heroin-user populations. Particularly critical are interventions that target new heroin user populations, including interventions that improve understanding of viral transmission dynamics, that promote alternative strategies for drug sharing, and that delay initiation of injection.     

上海市嘉定区吸毒人员艾滋病流行病学调查分析

目的了解上海市嘉定区社区吸毒人员艾滋病、梅毒和丙肝感染情况,性病艾滋病知识知晓情况,以及吸毒、性行为状况,评估社区吸毒人员艾滋病防治效果。方法由镇（街道）禁毒社工对社区吸毒人员进行问卷调查,并采集血样进行血清学检测。结果2009年、2012年分别调查290人、283人,未检出HIV感染者;梅毒RPR阳性率分别为2．41％、3．18％：丙肝阳性率分别为27．93％、29．79％;艾滋病基本知识知晓率分别为83．79％、89．75％。2009年、2012年调查对象主要使用海洛因、冰毒和摇头丸等毒品,曾注射过毒品的比例分别为42．76％、43．82％,其中与别人共用过针具的比例分别为5．65％、6．90％。最近一个月发生性行为的比例分别为32．76％、43．82％;最后一次性行为使用安全套的比例分别为46.32％、50．81％：最近一年曾发生过商业性行为的比例分别为2．07％、5.30％。多元Logistic回归分析结果显示,年龄越大,知识得分越低,曾注射吸毒的比例越高;年龄越大,安全套使用率越低。结论嘉定区吸毒人员梅毒、丙肝感染率高,艾滋病知识知晓率有所提高,存在注射吸毒、共用注射器及不安全性行为等危险因素。应采取降低吸毒危害和经性传播的综合性干预措施。     

陕西省农村基层安全注射现状调查分析

为了解陕西省基层安全注射现状,采用分层多阶段随机抽样法,对陕西省6个地区(市)所辖6个县(区,市)30个乡(镇)180个村的乡村医生调查,发现陕西省乡村级预防接种和临床治疗中以玻璃注射器和一次性注射器混合使用为主(分别占54.8%和59.0%);预防接种和临床治疗采用多人一管注射的分别占44.3%和9.1%;在玻璃注射器灭菌中,水冲洗或浸泡、酒精棉擦拭方式分别占16.9%和42.7%;在一次性注射器处理中,重复使用和丢弃分别占1.3%和18.9%;有36.4%～74.0%的乡村医生不清楚计划免疫针对传染病和常见传染病传播途径及其危害性;认为多人一管不会有问题的占26.7%,接种人数多或缺少注射器时,可进行只换针头方式注射的占33.9%～61.7%.提示在陕西省基层预防接种和临床治疗中都应注意玻璃注射器和一次性注射器的安全注射问题;多人一管注射方式,水冲洗或浸泡、酒精棉擦拭灭菌玻璃注射器,反复使用和丢弃一次性注射器等是非安全注射的主要因素;乡村医生安全注射知识水平及责任心,特别是对不安全注射引起传染病及危害性后果的认识亟待进一步培训提高;对一次性注射器使用后统一回收或在包装上注明"严禁重复使用"是防止不安全注射的方法之一.     

Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: A pilot intervention study

Fatal heroin overdose has become a leading cause of death among injection drug users (IDUs). Several recent feasibility studies have concluded that naloxone distribution programs for heroin injectors should be implemented to decrease heroin overdose deaths, but there have been no prospective trials of such programs in North America. This pilot study was undertaken to investigate the safety and feasibility of training injection drug using partners to perform cardiopulmonary resuscitation (CPR) and administer naloxone in the event of heroin overdose. During May and June 2001, 24 IDUs (12 pairs of injection partners) were recruited from street settings in San Francisco. Participants took part in 8-hour training in heroin overdose prevention, CPR, and the use of naloxone. Following the intervention, participants were prospectively followed for 6 months to determine the number and outcomes of witnessed heroin overdoses, outcomes of participant interventions, and changes in participants’ knowledge of overdose and drug use behavior. Study participants witnessed 20 heroin overdose events during 6 months follow-up. They performed CPR in 16 (80%) events, administered naloxone in 15 (75%) and did one or the other in 19 (95%). All overdose victims survived. Knowledge about heroin overdose management increased, whereas heroin use decreased. IDUs can be trained to respond to heroin overdose emergencies by performing CPR and administering naloxone. Future research is needed to evaluate the effectiveness of this peer intervention to prevent fatal heroin overdose.     

四川省西昌市吸毒人群首次静脉注射吸毒情况调查

目的了解四川省西昌市吸毒人群从首次口吸毒到首次静脉注射吸毒的发生情况。方法于2004-05／07从社区中招募吸毒人群，调查其社会人口学、首次吸毒前吸烟、饮酒情况、首次吸毒的时间和方式及种类、首次静脉注射吸毒情况。结果在调查的451名吸毒人员中，首次使用的毒品均为海洛因，其中，首次为口吸和静脉注射的分别为80．7％（364／451）和19．3％（87／451）。从首次口吸到首次静脉注射的发生率为21．82／100人年（95％ CI为19．60～24．05），多因素Cox比例风险模型分析结果显示，初中以下文化（HR=1．38；95％ CI为1．12～1．70）和15岁以前开始吸烟（HR=1．41；95％ CI为1．15～1．73）与首次口吸到首次静脉注射发生的关系有统计学意义。结论首次口吸到静脉注射毒品的时间与文化程度有关，这一转变的发生率也与吸毒人群吸烟早迟有关。但需进一步了解吸毒人群首次静脉注射吸毒的发生情况及其影响因素。     

Housing Experiences among Opioid-Dependent,Criminal Justice-Involved Individuals in Washington,D.C.

Residential mobility and type of housing contributes to an individual’s likelihood and frequency of drug/alcohol use and committing criminal offenses. Little research has focused simultaneously on the influence of housing status on the use of drugs and criminal behavior. The present study examines how residential mobility (transitions in housing) and recent housing stability (prior 30 days) correlates with self-reported criminal activity and drug/alcohol use among a sample of 504 addicted, treatment-seeking opioid users with a history of criminal justice involvement. Findings suggest that those with a greater number of housing transitions were considerably less likely to self-report criminal activity, and criminal involvement was highest among those who were chronically homeless. Residential mobility was unassociated with days of drug and alcohol use; however, residing in regulated housing (halfway houses and homeless shelters) was associated with a decreased frequency of substance use. The finding that residing at sober-living housing facilities with regulations governing behavior (regulated housing) was associated with a lower likelihood of illicit substance use may suggest that regulated housing settings may influence behavior. Further research in this area should explore how social networks and other related variables moderate the effects of housing type and mobility on crime and substance use.     

Accelerated Transition to Injection Among Male Heroin Initiates in Hanoi,Vietnam: Implications for Early Harm Reduction Interventions

This paper examines changes in the interval between first heroin smoking and onset of injection in a large, out-treatment sample of male heroin users in Hanoi, Vietnam (n = 1,115). Mean age at initiation of heroin use (smoking) was 18.4 and mean age of onset of heroin injection was 20.9 years. Full multivariate analysis indicates that the interval between first heroin use (smoking) and first heroin injection has been significantly attenuated among more recent heroin initiates (P = 0.0043), suggesting that heroin users in Vietnam may be at increased risk for exposure to HIV relatively soon after onset of heroin use, highlighting the need for behavioral interventions that target heroin smokers. Critical intervention goals include delaying the onset of injection and improved education about safer drug sharing and drug injection practices.     

Rapid transmission of hepatitis C virus among young injecting heroin users in Southern China

BACKGROUND: Hepatitis C virus (HCV) is quickly spread through injection drug use. The prevalence and incidence of HCV in Chinese heroin users has been rarely reported. METHODS: A longitudinal cohort of young injection drug users (IDU) from southern China was established to study the risk factors for blood-borne infections (597 subjects). Individuals underwent analysis for the presence of hepatitis B surface antigen and antibodies to human immunodeficiency virus type 1 (HIV-1), HCV and hepatitis B surface antigen. Using self-reported risk behaviours, multivariate regression analysis was performed for factors associated with HCV prevalence and seroconversion. RESULTS: At baseline, HIV-1 and HCV prevalence was 17% and 72%, respectively. Significant factors associated with HCV seroprevalence included age >25 years (odds ratio [OR] = 1.71) and injection drug use for >2 years (OR = 2.60). HCV prevalence within one year of starting heroin use was 57% for any route of administration, and 80% if restricted to injectors. After two 6-month follow-up visits, 56 out of 159 baseline HCV seronegative individuals (148.9 total person years [py]), underwent seroconversion at an incidence rate of 37.6 per 100 py. Individuals who reported injection drug use were more likely to undergo HCV seroconversion (rate ratio [RR] = 6.59). CONCLUSIONS: HCV infection is rapidly acquired in heroin users who adopt injection in southern China. This study emphasizes the urgent need to implement and expand injection prevention and primary substance abuse prevention programmes in China.     

New evidence on intravenous cocaine use and the risk of infection with human immunodeficiency virus type 1.

To examine whether recent intravenous use of cocaine might be associated with increased risk of human immunodeficiency virus type 1 (HIV) infection, the authors studied 2,597 active intravenous drug users: 2,399 with recent cocaine injection and 198 with recent injection of heroin or other drugs but not cocaine. These subjects were adult residents of Baltimore City and the surrounding Maryland counties, recruited via outreach into the community between February 1988 and March 1989. In contrast to the first report on the cocaine-HIV association, the present study sample was not recruited solely from drug treatment programs. In the present study, estimated HIV seroprevalence was 26.4% for recent cocaine injectors as compared with 10.6% among all other recent intravenous drug users; the relative odds estimate was 3.03. In the untreated segment of the sample, HIV seroprevalence was 26.0% for recent cocaine injectors as compared with 8.9% among others (relative odds (RO) = 3.61). The estimated degree of association did not change appreciably when multiple logistic regression was used to hold constant potentially confounding and/or mediating variables such as receptive anal intercourse, number of sex partners, and use of injection equipment obtained at shooting galleries (RO = 2.64). Augmenting these cross-sectional data, preliminary prospective data showed excess risk of HIV seroconversion among recent cocaine injectors (estimated relative risk = 2.11). While other research has examined the cocaine-HIV association, the present study differs in that it has allowed a test for whether the association was a spurious artifact of studying drug users recruited solely from drug treatment programs, a broad array of alternative determinants of HIV infection have been held constant, and the association has been examined with seroconversion data. The results lend support to the abiding concern about the risk of HIV infection among cocaine users.     

基层合理用药培训情况对注射剂使用的影响因素分析

目的了解基层卫生服务机构合理用药培训情况,并分析其对注射剂药品合理使用的影响和作用,为进一步提升基层卫生服务机构合理用药水平提出优化建议。方法从湖北省荆门市抽取8家基层卫生服务机构随机抽取部分门诊处方数据,对样本基本情况做描述性统计分析,并采用非参数检验对合理用药培训情况与基层注射剂使用情况做相关性分析,最后对基层注射剂使用影响因素做回归分析。结果 87.04%的门诊医生参加过合理用药培训,合理用药的年平均培训次数为2.69,611例门诊处方中,含注射剂类药品的处方数为279,注射剂药物使用率为45.66%,平均每处方注射剂药品使用种类数为3.17,占43.39%。且在参加过合理用药相关培训的医生中,有80.85%对培训地点、次数和时长感到不满意或非常不满意,培训地点、次数、时长对注射剂药物合理使用具有显著影响(P<0.05)。结论基层卫生服务机构注射剂类药品使用率过高,合理用药培训的开展对于医生处方行为产生一定积极影响,应加强基层医疗人员合理用药相关培训。     

Non-injection Drug Use and Injection Initiation Assistance among People Who Inject Drugs in Tijuana,Mexico

Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39–4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98–21.78), heroin (AOR = 4.00, 95% CI = 1.88–8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16–3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting.