Highlights • Supervised injection services (SISs) aim to reduce harm among drug users. • SISs have also been accused of fostering drug use and drug trafficking. • All studies converged to find that ...SISs fulfilled their harm-reduction objectives. • SISs were not found to increase drug use or crime. • 85% of the studies of the literature originated from Vancouver or Sydney.
In the 1960s, as illegal drug use grew from a fringe issue to a pervasive public concern, a new industry arose to treat the addiction epidemic. Over the next five decades, the industry's leaders ...promised to rehabilitate the casualties of the drug culture even as incarceration rates for drug-related offenses climbed. In this history of addiction treatment, Claire D. Clark traces the political shift from the radical communitarianism of the 1960s to the conservatism of the Reagan era, uncovering the forgotten origins of today's recovery movement.Based on extensive interviews with drug-rehabilitation professionals and archival research,The Recovery Revolutionlocates the history of treatment activists' influence on the development of American drug policy. Synanon, a controversial drug-treatment program launched in California in 1958, emphasized a community-based approach to rehabilitation. Its associates helped develop the therapeutic community (TC) model, which encouraged peer confrontation as a path to recovery. As TC treatment pioneers made mutual aid profitable, the model attracted powerful supporters and spread rapidly throughout the country. The TC approach was supported as part of the Nixon administration's "law-and-order" policies, favored in the Reagan administration's antidrug campaigns, and remained relevant amid the turbulent drug policies of the late twentieth and early twenty-first centuries. While many contemporary critics characterize American drug policy as simply the expression of moralizing conservatism or a mask for racial oppression, Clark recounts the complicated legacy of the "ex-addict" activists who turned drug treatment into both a product and a political symbol that promoted the impossible dream of a drug-free America.
•Only one quarter of people who inject drugs (PWID) had heard of PrEP, but most were interested in taking it.•Most PWID thought taking PrEP everyday would be easy.•PWID who are at higher risk for HIV ...were more likely to be interested in PrEP.
Limited research has examined pre-exposure prophylaxis (PrEP) interest among people who inject drugs (PWID). To date, few studies have examined the relationship between PrEP eligibility and PrEP interest among PWID.
Data were from an anonymous, cross-sectional survey of Baltimore Syringe Services Program (SSP) clients and non-client peers, restricted to HIV-uninfected participants (N = 265). Participants were classified as PrEP eligible/ineligible based on injection related criteria outlined in the CDC’s PrEP guidelines. Participants were asked if they were previously aware of PrEP, would be interested in taking PrEP, and the ease of taking PrEP daily. Participants self-reported their sociodemographic characteristics, health diagnoses, and recent drug use, overdose, and drug treatment history. We estimated bivariate and multivariate logistic regression models to test for significant predictors of interest in PrEP.
One-quarter of PWID had previously heard of PrEP and 63% of the sample was interested in taking PrEP. Only two respondents were currently taking PrEP. The majority (89%) thought taking PrEP every day would be easy. In the presence of other variables, PrEP interest was associated with PrEP eligibility (adjusted odds ratio aOR = 2.46; 95% Confidence Interval CI:1.34,4.50) and the number of medical diagnoses (aOR = 1.16; 95% CI:1.01,1.33)
Most PWID were unaware of PrEP but interested in taking it. PWID who were eligible for PrEP are more likely to be interested in taking it. Having co-morbid conditions was an important correlate of PrEP interest. These results underscore the importance of providers across the healthcare sector engaging PWID in discussions about PrEP.
•1 in 5 people who inject drugs in Vancouver tested positive for fentanyl in 2016.•Fentanyl exposure appears to be largely attributable to fentanyl-adulterated heroin.•However, fentanyl-adulterated ...stimulant drugs also exist in the local drug market.•Cannabis users were less likely to test positive for fentanyl.•Future research should examine how cannabis use may mitigate fentanyl exposure.
Vancouver, Canada is experiencing an opioid overdose crisis where fentanyl, a potent, synthetic opioid contaminating the illicit drug supply, has been detected in the majority of fatal overdose cases. Despite its growing presence throughout North America, few studies have characterized exposure to fentanyl among people who use illicit drugs (PWUD). We sought to identify the prevalence and correlates of fentanyl exposure among PWUD in Vancouver.
Data were derived from cohort studies of PWUD in Vancouver. In June—October 2016, we administered multi-panel urine drug screens (UDS) to detect recent exposure to fentanyl and eight other substances. Multivariable logistic regression was used to identify substance use patterns associated with recent fentanyl exposure among participants who injected drugs in the past six months (PWID).
Among 669 PWUD including 250 (37.4%) females and 452 (67.6%) PWID, 97 (14.5%) tested positive for fentanyl. All these individuals also tested positive for other substances, most commonly for morphine/heroin (89.9%), amphetamine/methamphetamine (75.3%) and cocaine (74.2%). A fentanyl detection rate was significantly higher among PWID (19.7%) compared to non-injection drug users (3.9%) (p<0.001). In multivariable analyses, younger age (adjusted odds ratio AOR: 0.96) and testing positive for morphine/heroin (AOR: 6.73), buprenorphine (AOR: 4.25), amphetamine/methamphetamine (AOR: 3.26), cocaine (AOR: 2.92) and cannabis (AOR: 0.52) remained independently associated with fentanyl exposure (all p<0.05).
With one in five PWID being exposed to fentanyl, there is an urgent need to design and scale up interventions to reduce overdose risk, including a range of opioid agonist therapies.
The Pastoral Clinic takes us on a penetrating journey into an iconic Western landscape—northern New Mexico’s Española Valley, home to the highest rate of heroin addiction and fatal overdoses in the ...United States. In a luminous narrative, Angela Garcia chronicles the lives of several Hispano addicts, introducing us to the intimate, physical, and institutional dependencies in which they are entangled. We discover how history pervades this region that has endured centuries of material and cultural dispossession, and we come to see its heroin problem as a contemporary expression of these conditions, as well as a manifestation of the human desire to be released from them. Lyrically evoking the Española Valley and its residents through conversations, encounters, and recollections, The Pastoral Clinic is at once a devastating portrait of addiction, a rich ethnography of place, and an eloquent call for a new ethics of care.
Sharing of equipment used for injecting drug use (IDU) is a substantial cause of disease burden and a contributor to blood-borne virus transmission. We did a global multistage systematic review to ...identify the prevalence of IDU among people aged 15–64 years; sociodemographic characteristics of and risk factors for people who inject drugs (PWID); and the prevalence of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) among PWID.
Consistent with the GATHER and PRISMA guidelines and without language restrictions, we systematically searched peer-reviewed databases (MEDLINE, Embase, and PsycINFO; articles published since 2008, latest searches in June, 2017), searched the grey literature (websites and databases, searches between April and August, 2016), and disseminated data requests to international experts and agencies (requests sent in October, 2016). We searched for data on IDU prevalence, characteristics of PWID, including gender, age, and sociodemographic and risk characteristics, and the prevalence of HIV, HCV, and HBV among PWID. Eligible data on prevalence of IDU, HIV antibody, HBsAg, and HCV antibody among PWID were selected and, where multiple estimates were available, pooled for each country via random effects meta-analysis. So too were eligible data on percentage of PWID who were female; younger than 25 years; recently homeless; ever arrested; ever incarcerated; who had recently engaged in sex work, sexual risk, or injecting risk; and whose main drugs injected were opioids or stimulants. We generated regional and global estimates in line with previous global reviews.
We reviewed 55 671 papers and reports, and extracted data from 1147 eligible records. Evidence of IDU was recorded in 179 of 206 countries or territories, which cover 99% of the population aged 15–64 years, an increase of 31 countries (mostly in sub-Saharan Africa and the Pacific Islands) since a review in 2008. IDU prevalence estimates were identified in 83 countries. We estimate that there are 15·6 million (95% uncertainty interval UI 10·2–23·7 million) PWID aged 15–64 years globally, with 3·2 million (1·6–5·1 million) women and 12·5 million (7·5–18·4 million) men. Gender composition varied by location: women were estimated to comprise 30·0% (95% UI 28·5–31·5) of PWID in North America and 33·4% (31·0–35·6) in Australasia, compared with 3·1% (2·1–4·1) in south Asia. Globally, we estimate that 17·8% (10·8–24·8) of PWID are living with HIV, 52·3% (42·4–62·1) are HCV-antibody positive, and 9·1% (5·1–13·2) are HBV surface antigen positive; there is substantial geographic variation in these levels. Globally, we estimate 82·9% (76·6–88·9) of PWID mainly inject opioids and 33·0% (24·3–42·0) mainly inject stimulants. We estimate that 27·9% (20·9–36·8) of PWID globally are younger than 25 years, 21·7% (15·8–27·9) had recently (within the past year) experienced homelessness or unstable housing, and 57·9% (50·5–65·2) had a history of incarceration.
We identified evidence of IDU in more countries than in 2008, with the new countries largely consisting of low-income and middle-income countries in Africa. Across all countries, a substantial number of PWID are living with HIV and HCV and are exposed to multiple adverse risk environments that increase health harms.
Australian National Drug and Alcohol Research Centre, Australian National Health and Medical Research Council, Open Society Foundation, World Health Organization, the Global Fund, and UNAIDS.
Choice, Behavioural Economics and Addiction is about the theory, data, and applied implications of choice-based models of substance use and addiction. The distinction between substance use and ...addiction is important, because many individuals use substances but are not also addicted to them. The behavioural economic perspective has made contributions to the analysis of both of these phenomena and, while the major focus of the book is on theories of addiction, it is necessary also to consider the behavioural economic account of substance use in order to place the theories in their proper context and provide full coverage of the contribution of behavioural economics to this field of study. The book discusses the four major theories of addiction that have been developed in the area of economic science/behavioural economics. They are: • hyperbolic discounting • melioration • relative addiction • rational addiction The main objective of the book is to popularise these ideas among addiction researchers, academics and practitioners. The specific aims are to articulate the shared and distinctive elements of these four theories, to present and discuss the latest empirical work on substance abuse and addiction that is being conducted in this area, and to articulate a range of applied implications of this body of work for clinical, public health and public policy initiatives. The book is based on an invitation-only conference entitled, Choice, Behavioural Economics and Addiction: Theory, Evidence and Applications held at the University of Alabama at Birmingham, March 30 - April 1, 2001. The conference was attended by prominent scientists and scholars, representing a range of disciplines concerned with theories of addiction and their consequences for policy and practice. The papers in the book are based on the papers given at the above conference, together with commentaries by distinguished experts and, in many cases, replies to these comments by the presenters.
Recent advances in the efficacy and tolerability of hepatitis C treatments and the introduction of a universal access scheme for the new Direct Acting Antiviral (DAA) therapies in March 2016, has ...resulted in a rapid increase in the uptake of hepatitis C treatment in Australia. Despite these positive developments, recent data suggest a plateauing of treatment numbers, indicating that more work may need to be done to identify and address ongoing barriers to hepatitis C treatment access and uptake. This paper aims to contribute to our understanding of the ongoing barriers to DAA therapies, with a focus on people who inject drugs. The paper draws on participant interview data from a qualitative research study based on a participatory research design that included a peer researcher with direct experience of both hepatitis C DAA treatment and injecting drug use at all stages of the research process. The study's findings show that residual barriers to DAA treatment exist at personal, provider and system levels and include poor venous access, DAA treatments not considered 'core-business' by opioid substitution treatment (OST) providers, and patients having to manage multiple health and social priorities that interfere with keeping medical appointments such as childcare and poor access to transport services. Further, efforts to increase access to and uptake of DAA hepatitis C treatment over time will require a focus on reducing stigma and discrimination towards people who inject drugs as this remains as a major barrier to care for many people.
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