RESUMO
BACKGROUND: Heroin production for external markets and low rates of use in Mexico have had a long history. A recent shift toward an increase in use and related problems calls for the evaluation of treatment needs in order to draw recommendations for policies. METHODS: The objectives were to identify predictors of choice of treatment and barriers to care among persons that had been with no treatment. The study included a convenience sample of 600 face-to-face interviews of people 18 years of age and older and a rapid HIV and HCV tests in three cities on Mexico's Northern Border: Ciudad Juárez, San Luis Río Colorado and Tijuana. The choice of treatment (methadone, other pubic or private treatments with no experience with methadone maintenance and only self-help or religious care), was analyzed though a multiple logistic multimodal regression analysis. Informed consents to be interviewed and for HIC and HIV were signed by interviewers. RESULTS: The majority of persons interviewed were males (89.7%) with an average age of 40. Having emigrated to the United States and a greater length of heroin use predicted seeking methadone treatment versus public or private treatment or informal care. The most important barriers to care were lack of information and stigma. HIC, HIV and other infectious and chronic diseases including depression were often unattended. CONCLUSIONS: There is a need to reform treatment policies in order to cover this w emerging and demanding problem.
Assuntos
Heroína/administração & dosagem , Epidemia de Opioides/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/terapia , Ópio/administração & dosagem , Adolescente , Adulto , Feminino , Humanos , Masculino , Metadona/uso terapêutico , México , Grupos de Autoajuda , Estados Unidos , Adulto JovemRESUMO
INTRODUCTION: Little is known about the cessation of injecting drug use (IDU) among people who inject drugs (PWID) in low and middle-income settings, where access to effective interventions for reducing drug use (e.g., opioid substitution treatment; OST), may be limited. We measured the incidence and identified predictors of IDU cessation among a cohort of PWID in Tijuana, Mexico. METHODS: Data were drawn from 621 participants in Proyecto El Cuete IV, a prospective cohort of PWID recruited in 2011 and interviewed biannually to 2016. A multivariable Extended Cox model was constructed to identify socio-demographic, drug use, risk environment and health-related predictors of IDU cessation (no IDU for ≥six months). RESULTS: 141 participants (23%) reported at least one IDU cessation event during follow-up. The crude IDU cessation rate was 7.3 per 100 person-years (95% Confidence Interval [CI]: 6.2-8.7). IDU cessation was negatively associated with injecting at least daily on average and heroin/methamphetamine co-injection in the past six months, and positively associated with testing HIV positive at baseline, being on methadone maintenance therapy in the past six months, and recent arrest. Concern for personal safety was also independently associated with IDU cessation. CONCLUSIONS: The rate of IDU cessation among PWID in Tijuana was low. These findings underscore the importance of expansion of services including OST to help reduce drug use and facilitate IDU cessation for those who wish to do so. In this setting, interventions addressing individual-level economic barriers as well as broader social and structural barriers to harm reduction services are integral.
Assuntos
Usuários de Drogas , Comportamentos Relacionados com a Saúde , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Feminino , Heroína/administração & dosagem , Humanos , Incidência , Masculino , Metanfetamina/administração & dosagem , México/epidemiologia , Estudos Prospectivos , Fatores de RiscoRESUMO
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.
Assuntos
Cocaína/administração & dosagem , Comportamento Cooperativo , Usuários de Drogas/psicologia , Usuários de Drogas/estatística & dados numéricos , Heroína/administração & dosagem , Metanfetamina/administração & dosagem , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , México , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
Addiction to illicit substances or medicines is influenced by cultural, religious, ethnic factors as well as local availability. The purpose of this study was to evaluate the profile of drug users and characteristics of the psychoactive substances used in French overseas territories, using data from the OPPIDUM survey. OPPIDUM is an annual, nationwide, multicentric, cross-sectional study based on specialized care centres that included subjects presenting a drug addiction or under opiate maintenance treatment. The current study includes data from the 2012 and 2013 surveys and focuses on patients included by drug addiction centres located in French overseas departments and territories: French Pacific Ocean (French Polynesia, New Caledonia), French Americas (Guadeloupe, Saint Martin, French Guiana) and Reunion Island. Data from metropolitan France (2013 survey) were included as reference. Two hundred and forty-five patients were included. The sex ratio was 3.7 for the Pacific Ocean, 3.5 for the French Americas and 3.3 for Reunion Island. Cannabis was consumed in all the territories, from 50.8% in Reunion Island to 81.7% in Pacific Ocean. Cocaine was most frequently consumed in the French Americas (61%), mainly in the 'freebase' form (91%), whereas 6.5% of cocaine users in metropolitan France did so. Problematic use of medicines was most frequent in Reunion Island. Heroin seems rarely used in all overseas territories. This study highlights the complexity of substances used in French overseas territories, which often differ from that in mainland France. The relative difference between different areas provides valuable information for future investigations and possible interventions.
Assuntos
Cocaína/administração & dosagem , Heroína/administração & dosagem , Drogas Ilícitas , Psicotrópicos/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Cocaína/efeitos adversos , Feminino , França/epidemiologia , Guiana Francesa/epidemiologia , Guadalupe/epidemiologia , Heroína/efeitos adversos , Humanos , Masculino , Martinica/epidemiologia , Nova Caledônia/epidemiologia , Polinésia/epidemiologia , Psicotrópicos/efeitos adversos , Reunião/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: Although persons who inject drugs (PWID) in the western United States-Mexico border region are known to inject both heroin and methamphetamine, little is known about the prevalence and risks associated with co-injection of this depressant-stimulant combination (also known as "goofball" and "Mexican speedball"). METHOD: Baseline data from parallel cohort studies of PWID conducted concurrently in San Diego, CA, and Tijuana, Mexico, were used to estimate the prevalence and identify correlates of heroin-methamphetamine co-injection. PWID older than 18 years of age who reported injecting illicit drugs in the past month (N = 1,311; 32.7% female) were recruited in San Diego (n = 576) and Tijuana (n = 735) and completed interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were used to identify correlates of heroin-meth-amphetamine co-injection. RESULTS: The prevalence of co-injection in the past 6 months was 39.9% overall and was higher in Tijuana (55.8%) than in San Diego (19.8%). In multivariable analyses adjusting for study cohort, distributive syringe sharing, purchasing syringes prefilled with drugs, finding it hard to get new syringes, reporting great or urgent need for treatment, and younger age were independently associated with co-injection. Past-6-month overdose was significantly associated with higher odds of co-injection in San Diego than in Tijuana. CONCLUSIONS: These findings indicate that heroin-methamphetamine co-injection is more common in Tijuana than in San Diego, yet this practice was only associated with overdose in San Diego. Heroin-methamphetamine coinjection was also independently associated with HIV-associated injection risk behaviors. Overdose-prevention interventions should address co-injection of depressants and stimulants.
Assuntos
Heroína/administração & dosagem , Metanfetamina/administração & dosagem , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Idoso , California/epidemiologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Uso Comum de Agulhas e Seringas , Prevalência , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVES: To examine the relationship between nonmedical use of prescription opioids and heroin initiation from childhood to young adulthood, and to test whether certain ages, racial/ethnic, and income groups were at higher risk for this transition. STUDY DESIGN: Among a nationally representative sample of US adolescents assessed in the 2004-2011 National Surveys on Drug Use and Health cross-sectional surveys (n = 223,534 respondents aged 12-21 years), discrete-time hazard models were used to estimate the age-specific hazards of heroin initiation associated with prior history of nonmedical use of prescription opioids. Interactions were estimated between prior history of nonmedical use of prescription opioids and age of nonmedical use of prescription opioid initiation, race/ethnicity, and income. RESULTS: A prior history of nonmedical use of prescription opioids was strongly associated with heroin initiation (hazard ratio 13.12, 95% CI 10.73, 16.04). Those initiating nonmedical use of prescription opioids at ages 10-12 years had the highest risk of transitioning to heroin use; the association did not vary by race/ethnicity or income group. CONCLUSIONS: Prior use of nonmedical use of prescription opioids is a strong predictor of heroin use onset in adolescence and young adulthood, regardless of the user's race/ethnicity or income group. Primary prevention of nonmedical use of prescription opioids in late childhood may prevent the onset of more severe types of drug use such as heroin at later ages. Moreover, because the peak period of heroin initiation occurs at ages 17-18 years, secondary efforts to prevent heroin use may be most effective if they focus on young adolescents who already initiated nonmedical use of prescription opioids.
Assuntos
Analgésicos Opioides/administração & dosagem , Heroína/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Analgésicos Opioides/efeitos adversos , Criança , Estudos Transversais , Prescrições de Medicamentos , Feminino , Heroína/efeitos adversos , Humanos , Masculino , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , Adulto JovemRESUMO
During the last decade, the veterinary anesthetics have gained popularity as recreational drugs. The aim of this study was to document the use of "anestecia de caballo" (xylazine) and its consequences among drug users in Puerto Rico. The study combined a cross-sectional survey with 89 drug users and two focus groups conducted in Mayagüez with frontline drug treatment providers. Drug users were recruited from communities of the San Juan metropolitan area using a variety of ethnographic and outreach strategies. A short questionnaire developed for the study collected information on sociodemographics, xylazine use, and its consequences. The two focus groups were conducted to discuss the details related to xylazine use, its consequences, and utilization awareness. The sample comprised 63 males (70.8%) and 26 females with a mean age of 37.2 years. The mean number of years of drug use was 14.3, with a mean frequency of drug use of 5.9 times daily. More than 65% reported speedball as the principal drug of use. The prevalence of xylazine use was 80.7%. More than 42% of the sample used xylazine in a mixture with speedball. The main route of administration of xylazine was injection but 14% reported the use of xylazine by inhalation. More than 35% of the sample reported skin lesions and 21.1% reported at least one overdose episode. Multiple logistic regression analysis revealed that males (OR = 3.47, CI = 1.10-12.00) and those who reported speedball as their main drug of use (OR = 9.34, CI = 2.51-34.70) were significantly more likely to be xylazine users. Focus groups revealed that drug users claimed to recognize the presence of xylaxine in a mixture of speedball based on its effects, taste, the color of the drug (dark brown), and its odor. In conclusion, the use of xylazine among drug users in Puerto Rico seems to be an emerging trend with potentially serious health consequences.
Assuntos
Hipnóticos e Sedativos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Xilazina , Administração por Inalação , Adulto , Cocaína/administração & dosagem , Estudos Transversais , Combinação de Medicamentos , Feminino , Grupos Focais , Heroína/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Porto Rico/epidemiologia , Úlcera Cutânea/etiologia , Inquéritos e Questionários , Adulto JovemRESUMO
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.
Assuntos
Infecções por HIV/prevenção & controle , Redução do Dano , Dependência de Heroína/complicações , Heroína/administração & dosagem , Abuso de Substâncias por Via Intravenosa/complicações , Administração por Inalação , Adolescente , Adulto , Idade de Início , Estudos Transversais , Progressão da Doença , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Heroína/efeitos adversos , Dependência de Heroína/epidemiologia , Humanos , Injeções Intravenosas , Masculino , Fumar/efeitos adversos , Fumar/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Fatores de Tempo , Vietnã/epidemiologia , Adulto JovemRESUMO
BACKGROUND: In August 2009, Mexico reformed its drug laws and decriminalized small quantities of drugs for personal use; offenders caught three times will be mandated to enter drug treatment. However, little is known about the quality or effectiveness of drug treatment programs in Mexico. We examined injection drug users' (IDUs) experiences in drug treatment in Tijuana, Mexico, with the goal of informing program planning and policy. METHODS: We examined qualitative and quantitative data from Proyecto El Cuete, a multi-phased research study on HIV risk among IDUs in Tijuana. Phase I consisted of 20 in-depth interviews and Phase II employed respondent-driven sampling to recruit 222 IDUs for a quantitative survey. We also reviewed national drug policy documents, surveillance data, and media reports to situate drug users' experiences within the broader sociopolitical context. RESULTS: Participants in the qualitative study were 50% male with a mean age of 32; most injected heroin (85.0%) and methamphetamine (60.0%). The quantitative sample was 91.4% male with a mean age of 35; 98.2% injected heroin and 83.7% injected heroin and methamphetamine together. The majority of participants reported receiving treatment: residential treatment was most common, followed by methadone; other types of services were infrequently reported. Participants' perceptions of program acceptability and effectiveness were mixed. Mistreatment emerged as a theme in the qualitative interviews and was reported by 21.6% of Phase II participants, primarily physical (72.0%) and verbal (52.0%) abuse. CONCLUSIONS: Our results point to the need for political, economic, and social investment in the drug treatment system before offenders are sentenced to treatment under the revised national drug law. Resources are needed to strengthen program quality and ensure accountability. The public health impact of the new legislation that attempts to bring drug treatment to the forefront of national drug policy should be systematically evaluated.
Assuntos
Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Drogas Ilícitas/legislação & jurisprudência , Abuso de Substâncias por Via Intravenosa/reabilitação , Adulto , Estudos Transversais , Coleta de Dados , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Heroína/administração & dosagem , Heroína/efeitos adversos , Humanos , Masculino , Metanfetamina/administração & dosagem , Metanfetamina/efeitos adversos , México , Aceitação pelo Paciente de Cuidados de Saúde , Desenvolvimento de Programas , Saúde Pública/legislação & jurisprudência , Centros de Tratamento de Abuso de Substâncias , Adulto JovemRESUMO
The main objective of this study was to analyze emotional response to a set of everyday emotional visual stimuli unrelated to drug use. Two groups of prescribed opiate drug abusers (heroin+methadone vs. methadone-only groups) currently participating in the Andalusian Experimental Prescribed Drug Program (Programa Experimental de Prescripcion de Estupefacientes de Andalucia, PEPSA) were studied, and comparisons made between them, within them for different phases, and between them and a normative group of nonusers. For this purpose we used the I.C.E.R.E., an instrument based on the I.A.P.S. (International Affective Picture System) and on Peter Lang's S.A.M. (Self-Assessment Manikin). The results showed patterns of emotional response in the opiate users, compared to the non-users, characterized by a lower rating of the everyday natural stimuli of a pleasant nature and a greater sensitivity to the stimuli of a neutral and negative nature. These patterns were quite stable even in different clinical situations and stages of development of the P.E.P.S.A.
Assuntos
Afeto , Prescrições de Medicamentos/estatística & dados numéricos , Emoções Manifestas , Dependência de Heroína/epidemiologia , Dependência de Heroína/psicologia , Adulto , Feminino , Heroína/administração & dosagem , Dependência de Heroína/diagnóstico , Humanos , Injeções Intravenosas , Masculino , Entorpecentes/administração & dosagem , Índice de Gravidade de Doença , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologiaRESUMO
The present study describes complex drug and sexual risk in a group of male sex workers (n = 79) who were recruited in the context of a larger study of young heroin users in Hanoi, Vietnam (n = 1270). Male sex workers were significantly more likely than male non-sex workers to be migrants (P < 0.001) and to have unstable housing (P < 0.001), to have lifetime exposure to marijuana (P < 0.001), 3,4 methylenedioxymethamphetamine (MDMA, ecstasy) (P < 0.01), amphetamines (P < 0.05), cocaine (P < 0.01) and morphine (P < 0.001). Male sex workers are more likely to currently use MDMA (P < 0.05), amphetamines (P < 0.001), morphine (P < 0.05) and to 'smoke' as their most frequent mode of heroin administration (P < 0.01). Male sex workers are more likely to have both male and female concurrent sex partners (P < 0.001), to have a history of sexual victimisation (P < 0.001), to have had more than three different sex partners in the past 30 days (P < 0.001), and to have had partners who injected drugs before sex (P < 0.001) or who used drugs during sex (P < 0.01). In their last sexual encounter with a client partner, approximately one-third (31.1%) reported having had receptive anal sex. In nearly three-quarters of these exchanges (71.4%), no condom was used. Similarly, in their last sexual encounter with a client partner, 42.2% reported having had insertive anal sex and in nearly half (47.4%) of these encounters no condom was used. Consistent with recent data from elsewhere in the region, there is an urgent need for additional research on male sex work in South-east Asia in order to properly situate behavioural interventions for male sex workers in this region.
Assuntos
Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Heroína/administração & dosagem , Homossexualidade Masculina/estatística & dados numéricos , Entorpecentes/administração & dosagem , Trabalho Sexual/estatística & dados numéricos , Adolescente , Adulto , Estimulantes do Sistema Nervoso Central/administração & dosagem , Infecções por HIV/transmissão , Alucinógenos/administração & dosagem , Humanos , Masculino , Fatores de Risco , Assunção de Riscos , Inquéritos e Questionários , Sexo sem Proteção/prevenção & controle , Sexo sem Proteção/psicologia , Vietnã/epidemiologiaRESUMO
This study was designed to assess HIV risk behaviors, HIV seroprevalence, and tuberculosis (TB) infection in shooting gallery managers in Puerto Rico. The subjects were 464 injection drug users (IDUs), of whom 12.5% reported managing shooting galleries. The median frequency of drug injection was higher in shooting gallery managers than in nonmanagers. A trend was observed for purified protein derivative (PPD) reactivity to increase according to the length of time spent as a gallery manager, but this trend was not statistically significant. However, anergy rates increased significantly with increase in the number of months spent as shooting gallery manager (p = .021). Multivariate analyses showed that IDUs reporting shooting gallery management experience of > or = 25 months were more likely to be infected with HIV. Prevention programs need to emphasize strategies to protect the health of shooting gallery clients and, in particular, shooting gallery managers. Additional studies are required to determine effective strategies for reducing the risk of HIV and TB infection in shooting galleries.
PIP: Little information is currently available on the health status of individuals who manage the settings in which drug injection-related behaviors occur. The present study investigated HIV risk behaviors, HIV seroprevalence, and tuberculosis infection among 464 injecting drug users recruited from areas in San Juan, Puerto Rico, known to have high levels of drug activity. 58 respondents (12.5%) reported having been a shooting gallery manager, for a median duration of 18 months. Managers were more likely to be female, over 35 years of age, not married, homeless, to inject only cocaine, to inject more frequently, to have a history of incarceration, and to report disability than drug users who were not managers. No differences in rates of HIV, tuberculosis, or anergy existed between managers with 1-24 months of management experience and nonmanagers. However, gallery managers with 25 or more months of experience were nearly 3 times more likely to be infected with HIV, nearly 2 times more likely to be anergic, and 2.5 times more likely to have tuberculosis than nonmanagers. 41% of nonmanagers, 48% of managers with 1-24 months of experience, and 71% of those who had been managers for 25 months or more were HIV-seropositive. The compromised health status of long-term shooting gallery managers underscores the need for public health interventions to interrupt the spread of sexually transmitted diseases, HIV, and tuberculosis in this high-risk setting.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/etiologia , Infecções por HIV/transmissão , Soropositividade para HIV , Uso Comum de Agulhas e Seringas , Abuso de Substâncias por Via Intravenosa/epidemiologia , Tuberculose/etiologia , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Adulto , Cocaína/administração & dosagem , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Heroína/administração & dosagem , Humanos , Masculino , Análise Multivariada , Entorpecentes/administração & dosagem , Porto Rico/epidemiologia , Análise de Regressão , Fatores de Risco , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Abuso de Substâncias por Via Intravenosa/virologia , Fatores de Tempo , Tuberculose/virologiaRESUMO
Since 1989, heroin production worldwide has risen; in New York City, as its purity rose and prices fell, street-level markets were restructured and offered heroin in addition to cocaine and crack (which had been popular during the 1980s). While officials estimate that there are between 500,000 and one million hard-core, chronic heroin users nationwide, evidence of supplemental users heralding another heroin era includes: more overdoses and overdose deaths, greater demand for treatment, larger seizures of heroin at all levels of distribution and related arrests, and broader media coverage. In this article, the authors describe the characteristics of populations in which there may have been a percentage increase of new users, such as young middle- or upper-class European-Americans, young Puerto Ricans and recent Haitian and Russian immigrants. The abstinence of young African-Americans is also noted. The article ends with a preliminary needs assessment of the new users in the areas of health (including AIDS), housing, employment, treatment, arrest and imprisonment.