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Journal Cover International Journal of Drug Policy
  [SJR: 1.074]   [H-I: 49]   [339 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0955-3959
   Published by Elsevier Homepage  [3044 journals]
  • From ecstasy to MDMA: Recreational drug use, symbolic boundaries, and drug
           trends
    • Authors: Marit Edland-Gryt; Sveinung Sandberg; Willy Pedersen
      Pages: 1 - 8
      Abstract: Publication date: December 2017
      Source:International Journal of Drug Policy, Volume 50
      Author(s): Marit Edland-Gryt, Sveinung Sandberg, Willy Pedersen
      Background Ecstasy pills with MDMA as the main ingredient were introduced in many European countries in the 1980s, and were often linked to the rave and club scenes. However, use gradually levelled off, in part as a response to increased concerns about possible mental health consequences and fatalities. Extensive use of MDMA now seems to be re-emerging in many countries. In this study, we investigated the cultural and social meaning associated with MDMA use in Oslo, Norway, with an emphasis on how users distinguish MDMA crystals and powder from “old ecstasy pills”. Methods Qualitative in-depth interviews (n=31, 61,3% males) were conducted with young adult party-goers and recreational MDMA/ecstasy users (20–34 years old, mean age 26.2 years). Results Research participants emphasised three important perceived differences between the MDMA crystals and ecstasy pills: (i) The effects of MDMA were described as better than ecstasy; (ii) MDMA was regarded as a safer drug; (iii) Users of MDMA crystals were described as more distinct from and less anchored in out-of-fashion rave culture than those using ecstasy. These differences were an important part of the symbolic boundary work MDMA users engaged in when justifying their drug use. Conclusion MDMA has re-emerged as an important psychoactive substance in Oslo’s club scene. One important reason for this re-emergence seems to be its perceived differentiation from ecstasy pills, even though the active ingredient in both drugs is MDMA. This perceived distinction between MDMA and ecstasy reveals the importance of social and symbolic meanings in relation to psychoactive substance use. Insights from this study can be important in terms of understanding how trends in drug use develop and how certain drugs gain or lose popularity.

      PubDate: 2017-09-05T13:37:35Z
      DOI: 10.1016/j.drugpo.2017.07.030
      Issue No: Vol. 50 (2017)
       
  • “I love having benzos after my coke shot”: The use of psychotropic
           medication among cocaine users in downtown Montreal
    • Authors: Rossio Motta-Ochoa; Karine Bertrand; Nelson Arruda; Didier Jutras-Aswad; Élise Roy
      Pages: 15 - 23
      Abstract: Publication date: November 2017
      Source:International Journal of Drug Policy, Volume 49
      Author(s): Rossio Motta-Ochoa, Karine Bertrand, Nelson Arruda, Didier Jutras-Aswad, Élise Roy
      Background Cocaine abuse is a major public health issue due to its role in the HIV and hepatitis C virus (HCV) epidemics in North America. A significant area of concern among people who use cocaine (PWUC), injected or smoked, is their frequent misuse of prescription drugs, particularly psychotropic medication (PM), such as tranquilizers, sedatives, stimulants, and antipsychotics. This paper aims to describe and understand practices of PM use among PWUC in downtown Montreal. Method Ethnographic methods including participant observation and semi-structured interviews were used in an iterative manner. Results Two thirds of the 50 participants were male. They ranged in age from 20 to 60 and most were homeless. A significant proportion of them reported polydrug use patterns that included frequent concomitant opioid use (heroin and/or prescription opioids (PO)). Benzodiazepine-based tranquilizers and the atypical antipsychotic quetiapine were the most frequently used PM. Routes of PM administration were oral, nasal and, to a lesser degree, intravenous. Five main PM use practices were identified: 1) “downers” from cocaine high (benzodiazepines and quetiapine); 2) enhancers of heroin/PO effects (benzodiazepines); 3) reducers or suppressors of heroin/PO withdrawal symptoms (benzodiazepines); 4) enablers of a different type of “trip” (benzodiazepines); and 5) treatment for mental and physical problems (benzodiazepines and quetiapine). Conclusion PM use practices showed several complementary functions that PM fulfill in a context of polydrug use. The soothing and stimulating effects of PM reinforce the patterns of drug use among participants, posing various risks including overdose, HIV/HCV transmission, PM dependence and accidents. The results highlight the need for clinicians to assess clients’ substance use patterns when prescribing PM and to question PWUC about PM use. The findings also underline certain unmet service needs in relation to overdose, HIV/HCV and mental health prevention/treatment among cocaine users.

      PubDate: 2017-08-25T12:33:37Z
      DOI: 10.1016/j.drugpo.2017.07.012
      Issue No: Vol. 49 (2017)
       
  • ‘Slamming’ among men who have sex with men accessing general drug
           services, in response to Schmidt, AJ et al., 2016, Illicit drug use among
           gay and bisexual men in 44 cities: Findings from the European MSM Internet
           Survey (EMIS)
    • Authors: Rachel Glass; Vivian D. Hope; Claire Tanner; Monica Desai
      Pages: 24 - 25
      Abstract: Publication date: November 2017
      Source:International Journal of Drug Policy, Volume 49
      Author(s): Rachel Glass, Vivian D. Hope, Claire Tanner, Monica Desai


      PubDate: 2017-09-05T13:37:35Z
      DOI: 10.1016/j.drugpo.2017.07.028
      Issue No: Vol. 49 (2017)
       
  • Support of supervised injection facilities by emergency physicians in
           Canada
    • Authors: Noam Katz; Lynne Leonard; Lorne Wiesenfeld; Jeffrey J. Perry; Venkatesh Thiruganasambandamoorthy; Lisa Calder
      Pages: 26 - 31
      Abstract: Publication date: November 2017
      Source:International Journal of Drug Policy, Volume 49
      Author(s): Noam Katz, Lynne Leonard, Lorne Wiesenfeld, Jeffrey J. Perry, Venkatesh Thiruganasambandamoorthy, Lisa Calder
      Background Despite evidence supporting the implementation of supervised injection facilities (SIFs) by multiple stakeholders, no evaluation of emergency physicians’ attitudes has ever been documented towards such facilities in Canada or internationally. The primary goal of our study was to determine the opinions and perceptions of emergency physicians regarding the implementation of SIFs in Canada. Methods We conducted a national electronic survey of staff and resident emergency physicians in Canada using an iteratively designed survey tool in consultation with content experts. Invitations to complete the survey were sent via email by the Canadian Association of Emergency Physicians. Inclusion criteria required respondents to have treated an adult patient in a Canadian emergency department within the preceding 6 months. The primary measure was the proportion of respondents who would support, not support or were unsure of supporting SIFs in their community with the secondary measure being the likelihood of respondents to refer patients to a SIF if available. Results We received 280 responses out of 1353 eligible physicians (20.7%), with the analysis conducted on 250 responses that met inclusion criteria (18.5%). The majority of respondents stated they would support the implementation of SIFs in their community (N=172; 74.5%) while 10.8% (N=25) would not and 14.7% (N=34) did not know. The majority of respondents said they would refer their patients to SIFs (N=198; 84.6%), with 4.3% (N=10) who would not and 11.1% (N=26) who were unsure. Conclusion The findings from our study demonstrate that the majority of emergency physician respondents in Canada support the implementation of such sites (74.5%) while 84.6% of respondents would refer patients from the emergency department to such sites if they did exist. Given that many Canadian cities are actively pursuing the creation of SIFs or imminently opening such sites, it appears that our sample population of emergency physicians would both support this approach and would utilize such facilities in an effort to improve patient-centered outcomes for this often marginalized population.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.07.013
      Issue No: Vol. 49 (2017)
       
  • Polydrug use and its association with drug treatment outcomes among
           primary heroin, methamphetamine, and cocaine users
    • Authors: Linwei Wang; Jeong Eun Min; Emanuel Krebs; Elizabeth Evans; David Huang; Lei Liu; Yih-Ing Hser; Bohdan Nosyk
      Pages: 32 - 40
      Abstract: Publication date: November 2017
      Source:International Journal of Drug Policy, Volume 49
      Author(s): Linwei Wang, Jeong Eun Min, Emanuel Krebs, Elizabeth Evans, David Huang, Lei Liu, Yih-Ing Hser, Bohdan Nosyk
      Background Polydrug use may challenge effective treatment for substance use disorders. We evaluate whether secondary substance use modifies the association between treatment and primary drug use among primary heroin, cocaine and methamphetamine (MA) users. Methods Data were obtained from prospective cohort studies on people who use illicit drugs (PWUD) in California, USA. Using repeated monthly data on self-reported secondary substance use (heroin, cocaine, MA, alcohol or marijuana; ≥1day in a month), primary drug use (≥1day in a month), and treatment participation, collected via timeline follow-back, we fitted generalized linear mixed multiple regression models controlling for potential confounders to examine the interactions between treatment and secondary substance use on the odds of primary heroin, cocaine and MA use, respectively. Results Included in our study were 587 primary heroin, 444 primary MA, and 501 primary cocaine users, with a median of 32.4, 13.3 and 18.9 years of follow-up, respectively. In the absence of secondary substance use, treatment was strongly associated with decreased odds of primary drug use (adjusted odds ratios (aORs): 0.25, 95% CI: 0.24, 0.27, 0.07 (0.06, 0.08), and 0.07 (0.07, 0.09)) for primary heroin, MA, and cocaine users, respectively. Secondary substance use of any kind moderated these associations (0.82 (0.78, 0.87), 0.25 (0.21, 0.30) and 0.53 (0.45, 0.61), respectively), and these findings were consistent for each type of secondary substance considered. Moreover, we observed different associations in terms of direction and magnitude between secondary substance use and primary drug use during off-treatment periods across substance types. Conclusion This study demonstrates secondary substance use moderates the temporal associations between treatment and primary drug use among primary heroin, MA and cocaine users. Disparate patterns of polydrug use require careful measurement and analysis to inform targeted treatment for polydrug users.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.07.009
      Issue No: Vol. 49 (2017)
       
  • Re-examining blood donor deferral criteria relating to injecting drug use
    • Authors: Brendan Quinn; Clive Seed; Anthony Keller; Lisa Maher; David Wilson; Michael Farrell; Sharon Caris; Jennifer Williams; Annie Madden; Alexander Thompson; Joanne Pink; Margaret E. Hellard
      Pages: 9 - 17
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Brendan Quinn, Clive Seed, Anthony Keller, Lisa Maher, David Wilson, Michael Farrell, Sharon Caris, Jennifer Williams, Annie Madden, Alexander Thompson, Joanne Pink, Margaret E. Hellard
      Background and aims Potential Australian blood donors are deferred indefinitely if they report a history of injecting drug use (IDU), or for 12 months if they report having engaged in sexual activity with someone who might have ever injected. Given incremental improvements in blood safety, this study sought to examine whether Australia’s IDU-related eligibility criteria reflected current scientific evidence, were consistent with international best practice and, if current IDU-related policies were to be changed, how this should happen. Methods An expert committee was formed to review relevant literature with a focus on issues including: the epidemiology of IDU in Australia and key transfusion-transmissible infections (TTIs) among Australian people who inject drugs (PWID); and, ‘non-compliance’ among PWID regarding IDU-related blood donation guidelines. International policies relating to blood donation and IDU were also reviewed. Modelling with available data estimated the risk of TTIs remaining undetected if the Blood Service’s IDU-related guidelines were changed. Results Very few (<1%) Australians engage in IDU, and IDU risk practices are reported by only a minority of PWID. However, the prevalence of HCV remains high among PWID, and IDU remains a key transmission route for various TTIs. Insufficient data were available to inform appropriate estimates of cessation and relapse among Australian PWID. Modelling findings indicated that the risk of not detecting HIV becomes greater than the reference group at a threshold of non-admission of being an active PWID of around 1.8% (0.5–5.1%). Excluding Japan, all Organisation for the Economic Co-operation and Development member countries permanently exclude individuals with a history of IDU from donating. Conclusion Numerous research gaps meant that the study’s expert Review Committee was unable to recommend altering Australia’s current IDU-related blood donation guidelines. However, having identified critical knowledge gaps and future areas of research, the review made important steps toward changing the criteria.

      PubDate: 2017-07-01T17:52:12Z
      DOI: 10.1016/j.drugpo.2017.05.058
      Issue No: Vol. 48 (2017)
       
  • Understanding experiences of and rationales for sharing crack-smoking
           equipment: A qualitative study with persons who smoke crack in Montréal
    • Authors: Hélène Poliquin; Karine Bertrand; Jorge Flores-Aranda; Élise Roy
      Pages: 18 - 26
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Hélène Poliquin, Karine Bertrand, Jorge Flores-Aranda, Élise Roy
      Background The distribution of safer crack-smoking equipment has been implemented in several Canadian cities to reduce potential health risks such as transmission of blood borne viruses (BBV). Little is known about the perspectives of persons who smoke crack (PWSC) on sharing crack-smoking materials or using in settings where safer crack-smoking equipment is provided. This paper presents data from the perspective of PWSC in Montréal on their experiences of, and rationales for, sharing crack-smoking equipment, in light of the risks of BBV transmission. Methods This qualitative study is based on analyses of BBV risk behaviours among people who use cocaine. Thirty-two semi-structured interviews were conducted in low-threshold community centres for persons who use drugs. Twenty-six interviewees who used cocaine also smoked crack, and constitute a subsample for analyses. Interview transcripts were coded inductively and analyzed thematically from a symbolic interactionist perspective. Results Participants demonstrated personal agency by adopting strategies to minimise sharing of smoking equipment. These included being firm in refusal to share, smoking alone, and keeping an extra pipe to give to others. Nonetheless, sharing seemed to be commonplace and was attributed to contextual and personal factors. These were linked to the social dynamics among smokers; economic reasons such as wanting to keep the accumulated crack resin; practical reasons such as lacking own smoking equipment; being ashamed to purchase or acquire crack pipes; fatalism; poor personal agency; and ambivalence or scepticism towards BBV transmission risks. Conclusion To reinforce harm reduction for PWSC, interventions aimed at reducing barriers to safer smoking practices should be developed at both structural and individual levels.

      PubDate: 2017-07-01T17:52:12Z
      DOI: 10.1016/j.drugpo.2017.05.059
      Issue No: Vol. 48 (2017)
       
  • Assessing support for supervised injection services among community
           stakeholders in London, Canada
    • Authors: Geoff Bardwell; Ayden Scheim; Sanjana Mitra; Thomas Kerr
      Pages: 27 - 33
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Geoff Bardwell, Ayden Scheim, Sanjana Mitra, Thomas Kerr
      Objectives Few qualitative studies have examined support for supervised injection services (SIS), and these have been restricted to large cities. This study aimed to assess support for SIS among a diverse representation of community stakeholders in London, a mid-sized city in southwestern Ontario, Canada. Methods This qualitative study was undertaken as part of the Ontario Integrated Supervised Injection Services Feasibility Study. We used purposive sampling methods to recruit a diversity of key informants (n=20) from five sectors: healthcare; social services; government and municipal services; police and emergency services; and the business and community sector. Interview data, collected via one-to-one semi structured interviews, were coded and analyzed using thematic analyses through NVivo 10 software. Results Interview participants unanimously supported the implementation of SIS in London. However, participant support for SIS was met with some implementation-related preferences and/or conditions. These included centralization or decentralization of SIS; accessibility of SIS for people who inject drugs; proximity of SIS to interview participants; and other services and strategies offered alongside SIS. Discussion The results of this study challenge the assumptions that smaller cities like London may be unlikely to support SIS. Community stakeholders were supportive of the implementation of SIS with some preferences or conditions. Interview participants had differing perspectives, but ultimately supported similar end goals of accessibility and reducing community harms associated with injection drug use. Future research and SIS programming should consider these factors when determining optimal service delivery in ways that increase support from a diversity of community stakeholders.

      PubDate: 2017-07-01T17:52:12Z
      DOI: 10.1016/j.drugpo.2017.05.009
      Issue No: Vol. 48 (2017)
       
  • Seroprevalence of HCV and HIV infection among clients of the nation’s
           longest-standing statewide syringe exchange program: A cross-sectional
           study of Community Health Outreach Work to Prevent AIDS (CHOW) Project
           participants, Hawai‘i, 2012
    • Authors: Thomas P. Salek; Alan R. Katz; Stacy M. Lenze; Heather M. Lusk; Dongmei Li; Don C. Des Jarlais
      Pages: 34 - 43
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Thomas P. Salek, Alan R. Katz, Stacy M. Lenze, Heather M. Lusk, Dongmei Li, Don C. Des Jarlais
      Background The Community Health Outreach Work to Prevent AIDS (CHOW) Project is the first and longest-standing statewide integrated and funded needle and syringe exchange program (SEP) in the US. Initiated on O‘ahu in 1990, CHOW expanded statewide in 1993. The purpose of this study is to estimate the prevalences of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, and to characterize risk behaviors associated with infection among clients of a long-standing SEP through the analysis of the 2012 CHOW evaluation data. Methods A cross-sectional sample of 130 CHOW Project clients was selected from January 1, 2012 through December 31, 2012. Questionnaires captured self-reported exposure information. HIV and HCV antibodies were detected via rapid, point-of-care FDA-approved tests. Log-binomial regressions were used to estimate prevalence proportion ratios (PPRs). A piecewise linear log-binomial regression model containing 1 spline knot was used to fit the age–HCV relationship. Results The estimated seroprevalence of HCV was 67.7% (95% confidence interval [CI]=59.5–75.8%). HIV seroprevalence was 2.3% (95% CI=0–4.9%). Anti-HCV prevalence demonstrated age-specific patterns, ranging from 31.6% through 90.9% in people who inject drugs (PWID) <30 to ≥60 years respectively. Age (continuous/year) prior to spline knot at 51.5 years (adjusted PPR [APPR]=1.03; 95% CI=1.02–1.05) and months exchanging syringes (quartiles) (APPR=1.92; 95% CI=1.3–3.29) were independently associated with anti-HCV prevalence. Conclusion In Hawai‘i, HCV prevalence among PWID is hyperendemic demonstrating age- and SEP duration-specific trends. Relatively low HIV prevalence compared with HCV prevalence reflects differences in transmissibility of these 2 blood-borne pathogens and suggests much greater efficacy of SEP for HIV prevention.

      PubDate: 2017-08-05T11:31:28Z
      DOI: 10.1016/j.drugpo.2017.06.009
      Issue No: Vol. 48 (2017)
       
  • Retention in medication-assisted treatment programs in
           Ukraine—Identifying factors contributing to a continuing HIV epidemic
    • Authors: Kostyantyn Dumchev; Sergii Dvoryak; Olena Chernova; Olga Morozova; Frederick L. Altice
      Pages: 44 - 53
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Kostyantyn Dumchev, Sergii Dvoryak, Olena Chernova, Olga Morozova, Frederick L. Altice
      Background Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004. Methods Data from clinical records of 2916 patients enrolled in OAT at thirteen sites from 2005 to 2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates. Results Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to not being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested—a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67). Conclusion Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TB patients through integrated care delivery systems.

      PubDate: 2017-08-15T12:04:31Z
      DOI: 10.1016/j.drugpo.2017.05.014
      Issue No: Vol. 48 (2017)
       
  • Development and validation of a novel scale for measuring interpersonal
           factors underlying injection drug using behaviours among injecting
           partnerships
    • Authors: Meghan D. Morris; Torsten B. Neilands; Erin Andrew; Lisa Maher; Kimberly A. Page; Judith A. Hahn
      Pages: 54 - 62
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Meghan D. Morris, Torsten B. Neilands, Erin Andrew, Lisa Maher, Kimberly A. Page, Judith A. Hahn
      Background People who inject drugs with sexual partners or close friends have high rates of syringe/ancillary equipment sharing and HIV and hepatitis C virus (HCV) infection. Although evidence suggests that interpersonal factors underlie these higher risk profiles, there is no quantitative measure of how interpersonal factors operate within injecting relationships. We aimed to develop and validate a quantitative scale to assess levels of injecting drug-related interpersonal factors associated with risky injecting behaviours within injecting partnerships. Methods We conducted qualitative interviews with 45 people who inject drugs (PWID) who reported having injecting partners to inform item development, and tested these items in a quantitative study of 140 PWID from San Francisco, USA, to assess internal reliability (Cronbach’s alpha) and validity (convergent, and discriminant validity). Results With results from the qualitative interview data, we developed the Interpersonal Dynamics in Injecting Partnerships (IDIP) scale with 54 final items for 5 subscales of injecting-related interpersonal factors. Exploratory factor analysis revealed 5 factors (“trust”, “power”, “risk perception”, “intimacy”, and “cooperation”) with eigenvalues of 14.32, 6.18, 3.55, 2.46, and 2.14, explaining 57% of the variance, and indicating good internal reliability (alpha: 0.92–0.68). Strong convergent validity was observed in bivariate logistic regression models where higher levels of trust, intimacy, and cooperation within partnerships were positively associated with partners sharing needles and injecting equipment, whereas higher levels of power and risk perception were negatively associated with partners sharing needles and injecting equipment. Conclusions These findings offer strong evidence that the IDIP scale provides a psychometrically sound measure of injecting drug-related interpersonal dynamics. This measurement tool has the potential to facilitate additional investigations into the individual and collective impact of trust, intimacy, power, cooperation, and risk perception on injection drug using behaviours and engagement in HIV and HCV testing and treatment among PWID in a variety of settings.

      PubDate: 2017-08-15T12:04:31Z
      DOI: 10.1016/j.drugpo.2017.05.030
      Issue No: Vol. 48 (2017)
       
  • Understanding interactions of formerly incarcerated HIV-positive men and
           transgender women with substance use treatment, medical, and criminal
           justice systems
    • Authors: Nina T. Harawa; Bita Amani; Jane Rohde Bowers; Jennifer N. Sayles; William Cunningham
      Pages: 63 - 71
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Nina T. Harawa, Bita Amani, Jane Rohde Bowers, Jennifer N. Sayles, William Cunningham
      Background Low levels of medical care engagement have been noted for HIV-positive people leaving systems of incarceration in the United States. Substance misuse frequently co-occurs with criminal justice involvement in individuals who are living with HIV. Methods We analyzed data from in-depth interviews with 19 HIV-positive individuals who were currently or formerly incarcerated in order to elucidate challenges faced in accessing care and maintaining HIV treatment regimens when cycling out of (and often back into) custody. Our thematic analysis used an ecosocial framework to describe participants’ shifts between substance use treatment, medical care, and criminal justice systems. Results Dominant themes included the dramatic increase in HIV-treatment-related autonomy required following release from jail because of differences in care delivery between custody-based and community-based care systems; the important, but temporary stabilization provided by residential substance use treatment programmes; and the inconsistency of substance use treatment approaches with chronic care models of disease management. Conclusion Enhanced integration of criminal justice, medical care, and substance use treatment institutions in planning for reentry of HIV populations may ease the impact of the dramatic shifts in context that often dissuade linkage and retention. This integration should include coordination with custody release processes, periodic assessments for active substance misuse in HIV treatment settings, support for (re)establishing health-promoting social networks, and options for long-term, residential substance use treatment programmes.

      PubDate: 2017-08-15T12:04:31Z
      DOI: 10.1016/j.drugpo.2017.05.013
      Issue No: Vol. 48 (2017)
       
  • A typology of vaping: Identifying differing beliefs, motivations for use,
           identity and political interest amongst e-cigarette users
    • Authors: Hannah Farrimond
      Pages: 81 - 90
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Hannah Farrimond
      Background The aim of this study was to identify and differentiate socially shared accounts of e-cigarette use (vaping) using Q-methodology, combining factor analysis with qualitative comments. Methods Seventy statements on e-cigarettes, drawn from media, academic and online discussions, were sorted by participants along a continuum of agreement/disagreement, commenting on strongly ranked items. Each participant thus created their own ‘account’ of their vaping. A by-person correlation matrix of the sorts was conducted, then factor analysed, to identify similar accounts (p<0.01). Fifty-five UK vapers participated by post, 55% male, mean age of 46, 84% only vaping/16% vaping and smoking, 95% vaping daily. Results Three accounts of e-cigarettes were identified. The first two were associated with having quit smoking; the third with ongoing tobacco smoking and vaping. In Factor One, ‘Vaping as Pleasure’, vaping was characterized as enjoyable, with long-term use envisaged and a medical model of vaping rejected. Factor One participants also held a strong vaping identity and were politically motivated to maintain the rights of adults to vape. In Factor Two, ‘Vaping as Medical Treatment’, vaping was understood as a pragmatic choice about how to medicate one’s smoking addiction, with the aim being to treat and ultimately reduce nicotine dependence. In Factor Three, ‘Ambivalent E-Cigarette Use’, participants reported fewer benefits and harboured more negative beliefs about e-cigarettes; they also strongly rejected a vaper identity, having no interest in online forums or being labelled a ‘vaper’ themselves. Conclusion The UK e-cigarette users in this sample were not a homogeneous group; differing in their beliefs, motivations for use, identity and political interest. In particular they diverged on whether they accepted a medicalized account of vaping and identified as a vaper. Public health messages targeted to one group of e-cigarette users may not resonate with others.

      PubDate: 2017-08-25T12:33:37Z
      DOI: 10.1016/j.drugpo.2017.07.011
      Issue No: Vol. 48 (2017)
       
  • Differences in prevalence, socio-behavioral correlates, and psychosocial
           distress between club drug and hard drug use in Taiwan: Results from the
           2014 National Survey of Substance Use
    • Authors: Wei J. Chen; Shang-Chi Wu; Wen-Ing Tsay; Yen-Tyng Chen; Po-Chang Hsiao; Ya-Hui Yu; Te-Tien Ting; Chuan-Yu Chen; Yu-Kang Tu; Jiun-Hau Huang; Hao-Jan Yang; Chung-Yi Li; Carol Strong; Cheng-Fang Yen; Chia-Feng Yen; Jui Hsu
      Pages: 99 - 107
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Wei J. Chen, Shang-Chi Wu, Wen-Ing Tsay, Yen-Tyng Chen, Po-Chang Hsiao, Ya-Hui Yu, Te-Tien Ting, Chuan-Yu Chen, Yu-Kang Tu, Jiun-Hau Huang, Hao-Jan Yang, Chung-Yi Li, Carol Strong, Cheng-Fang Yen, Chia-Feng Yen, Jui Hsu
      Background This study examined variation between users of ‘club’ and ‘hard’ drugs in Taiwan in terms of prevalence of use and demographics and psychosocial characteristics. Methods Data were derived from a survey of 17,837 Taiwanese civilians, aged 12–64 years, using stratified, multi-stage, random sampling. Participants completed a computer-assisted self-interview on tablet computers which covered use of legal substances, sedatives/hypnotics and prescription analgesics; use of illicit drugs/inhalants, risky sexual experiences; expectations of drugs; and psychological distress. Findings Approximately 1.29% of respondents reported ever using an illicit drug in their lifetime; prevalence estimates of club drugs (mainly ketamine, marijuana, and ecstasy) were slightly higher than hard drugs (mainly methamphetamine and heroin). Concurrent use of legal substances, particularly problematic use of alcohol and tobacco, as well as non-medical use of prescription drugs, were strong correlates of illicit drug use in general, with club drug use exhibiting an extremely strong association with alcohol use. Club drug users were demographically different from hard drug users, including in terms of their gender, age, and level of educational attainment. They were also more likely to be divorced or widowed, to report risky sexual partnerships and more depressive symptoms than hard drug users. Conclusions Our findings indicate drug type specific distinct psychosocial characteristics, which may warrant further attention in the design of treatment and intervention programs.

      PubDate: 2017-08-25T12:33:37Z
      DOI: 10.1016/j.drugpo.2017.07.003
      Issue No: Vol. 48 (2017)
       
  • Worries about others’ substance use—Differences between alcohol,
           cigarettes and illegal drugs'
    • Authors: Inger Synnøve Moan; Elisabet E. Storvoll; Ingunn Olea Lund
      Pages: 108 - 114
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Inger Synnøve Moan, Elisabet E. Storvoll, Ingunn Olea Lund
      Background While it is well documented that many experience harm from others’ substance use, little is known about the psychological strain associated with others’ use. The aims were: (1) to describe the prevalence of worries about others’ alcohol, cigarette and illegal drug use, (2) whose substance use people worry about, (3) the overlap in worries, and (4) to examine how worries about others’ use of each substance vary according to demographics, own substance use and experience of harm from others’ use. Methods A population survey was conducted among 16–64year old Norwegians (N=1667). Respondents’ reported on worries about others’ alcohol, cigarette and illegal drug use, measures of experiences of harm from others’ use of the three substances, and own substance use. Results Worries about others’ drinking were most prevalent. Among those who worried, others’ cigarette and illegal drug use caused more frequent worry. While worry about cigarette use was mostly associated with family members’ use, worry about others’ alcohol and illegal drug use more often concerned friends’/acquaintances’ use. About half worried about others’ use of at least one substance. Across all three substances, experience of harm from others’ substance use was most strongly related to worries. Conclusion Worries about others’ substance use are common and reflect the prevalence of use of the substances in the population. In sum, the findings suggest that worry about others’ alcohol and illegal drug use is primarily related to acute harm while worry about others’ cigarette smoking is more related to chronic harm.

      PubDate: 2017-08-25T12:33:37Z
      DOI: 10.1016/j.drugpo.2017.07.014
      Issue No: Vol. 48 (2017)
       
  • Why are some people who have received overdose education and naloxone
           
    • Authors: Stephen Koester; Shane R. Mueller; Lisa Raville; Sig Langegger; Ingrid A. Binswanger
      Pages: 115 - 124
      Abstract: Publication date: October 2017
      Source:International Journal of Drug Policy, Volume 48
      Author(s): Stephen Koester, Shane R. Mueller, Lisa Raville, Sig Langegger, Ingrid A. Binswanger
      Background Overdose Education and Naloxone Distribution (OEND) training for persons who inject drugs (PWID) underlines the importance of summoning emergency medical services (EMS). To encourage PWID to do so, Colorado enacted a Good Samaritan law providing limited immunity from prosecution for possession of a controlled substance and/or drug paraphernalia to the overdose victim and the witnesses who in good faith provide emergency assistance. This paper examines the law’s influence by describing OEND trained PWIDs’ experience reversing overdoses and their decision about calling for EMS support. Methods Findings from two complementary studies, a qualitative study based on semi-structured interviews with OEND trained PWID who had reversed one or more overdoses, and an on-going fieldwork-based project examining PWIDs’ self-identified health concerns were triangulated to describe and explain participants’ decision to call for EMS. Results In most overdose reversals described, no EMS call was made. Participants reported several reasons for not doing so. Most frequent was the fear that despite the Good Samaritan law, a police response would result in arrest of the victim and/or witness for outstanding warrants, or sentence violations. Fears were based on individual and collective experience, and reinforced by the city of Denver’s aggressive approach to managing homelessness through increased enforcement of misdemeanors and the imposition of more recent ordinances, including a camping ban, to control space. The city’s homeless crisis was reflected as well in the concern expressed by housed PWID that an EMS intervention would jeopardize their public housing. Conclusion Results suggest that the immunity provided by the Good Samaritan law does not address PWIDs’ fear that their current legal status as well as the victim’s will result in arrest and incarceration. As currently conceived, the Good Samaritan law does not provide immunity for PWIDs’ already enmeshed in the criminal justice system, or PWID fearful of losing their housing.

      PubDate: 2017-09-17T22:18:16Z
      DOI: 10.1016/j.drugpo.2017.06.008
      Issue No: Vol. 48 (2017)
       
  • Elimination of hepatitis C virus infection among PWID: The beginning of a
           new era of interferon-free DAA therapy
    • Authors: Jason Grebely; Julie Bruneau; Philip Bruggmann; Magdalena Harris; Matthew Hickman; Tim Rhodes; Carla Treloar
      Pages: 26 - 33
      Abstract: Publication date: September 2017
      Source:International Journal of Drug Policy, Volume 47
      Author(s): Jason Grebely, Julie Bruneau, Philip Bruggmann, Magdalena Harris, Matthew Hickman, Tim Rhodes, Carla Treloar


      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.08.001
      Issue No: Vol. 47 (2017)
       
  • Restrictions on access to direct-acting antivirals for people who inject
           drugs: The European Hep-CORE study and the role of patient groups in
           monitoring national HCV responses
    • Authors: J.V. Lazarus; K. Safreed-Harmon; S.R. Stumo; M. Jauffret-Roustide; M. Maticic; T. Reic; E. Schatz; J. Tallada; M. Harris
      Pages: 47 - 50
      Abstract: Publication date: September 2017
      Source:International Journal of Drug Policy, Volume 47
      Author(s): J.V. Lazarus, K. Safreed-Harmon, S.R. Stumo, M. Jauffret-Roustide, M. Maticic, T. Reic, E. Schatz, J. Tallada, M. Harris


      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.05.054
      Issue No: Vol. 47 (2017)
       
  • Healthcare contact and treatment uptake following hepatitis C virus
           screening and counseling among rural Appalachian people who use drugs
    • Authors: Dustin B. Stephens; April M. Young; Jennifer R. Havens
      Pages: 86 - 94
      Abstract: Publication date: September 2017
      Source:International Journal of Drug Policy, Volume 47
      Author(s): Dustin B. Stephens, April M. Young, Jennifer R. Havens
      Background Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings. Methods 503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and behavioral data were collected using computer-based questionnaires. Predictors of contacting a healthcare provider for follow-up following HCV-positive serotest and counseling were determined using discrete-time survival analysis. Results 150 (59%) of 254 participants reported contacting a healthcare provider within 18 months of positive serotest and counseling; the highest probability occurred within six months of serotesting. 35 participants (14%) reported they were seeking treatment, and 21 (8%) reported receiving treatment. In multivariate time-dependent modeling, health insurance, internet access, prior substance use treatment, meeting DSM-IV criteria for generalized anxiety disorder, and recent marijuana use increased the odds of making contact for follow-up. Participants meeting criteria for major depressive disorder and reporting prior methadone use, whether legal or illegal, were less likely to contact a provider. Conclusion While only 8% received treatment after HCV-positive screening, contacting a healthcare provider was frequent in this sample of rural PWID, suggesting that the major barriers to care are likely further downstream. These findings offer insight into the determinants of engaging the cascade of medical treatment for HCV and ultimately, treatment-as-prevention. Further study and increased resources to support integrated interventions with effectiveness in other settings are recommended to mitigate the impact of HCV in this resource-deprived setting.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.05.045
      Issue No: Vol. 47 (2017)
       
  • DOT-C: A cluster randomised feasibility trial evaluating directly observed
           anti-HCV therapy in a population receiving opioid substitute therapy from
           community pharmacy
    • Authors: Andrew Radley; Jan Tait; John F. Dillon
      Pages: 126 - 136
      Abstract: Publication date: September 2017
      Source:International Journal of Drug Policy, Volume 47
      Author(s): Andrew Radley, Jan Tait, John F. Dillon
      Background Direct-acting antiviral therapy (DAAs) for hepatitis C infection (HCV) have a much smaller burden of treatment than interferon-based regimes, require less monitoring and are very effective. New pathways are required to increase access to treatment amongst people prescribed opioid substitution therapy (OST). Methods An exploratory cluster randomised controlled trial with mixed methods evaluation was undertaken to compare the uptake of dried blood spot testing (DBST) and treatment of people with genotype 1 HCV infection in a conventional service pathway versus a pharmacist-led pathway in a population receiving OST. Results Pharmacies randomised to the conventional pathway obtained 58 DBST from 244 patients (24%):15 new reactive tests and 33 new negative tests were identified. Within the pharmacist-led pathway, 94 DBST were obtained from 262 patients (36%): 26 new reactive tests and 54 new negative tests were identified. Participants in the pharmacist-led pathway were more likely to take a DBST (p <0.003). Of participants referred for treatment through the conventional pathway, 4 patients from 15 with new reactive tests (27%) attended clinic for assessment. In the pharmacist-led treatment pathway, 20 patients from 26 with new reactive tests (77%) attended for assessment blood tests. Participants in the pharmacist-led pathway were more likely to proceed through the assessment for treatment (p <0.002). One participant completed treatment through the conventional pathway and three patients completed treatment through the pharmacist-led pathway. The process evaluation identified key themes important to service user completers and staff participants. Conclusion The study provides evidence that testing and treatment for HCV in a pharmacist led-pathway is a feasible treatment pathway for people who receive supervised OST consumption through community pharmacies. This feasibility trial therefore provides sufficient confirmation to justify proceeding to a full trial.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.05.042
      Issue No: Vol. 47 (2017)
       
  • Understanding real-world adherence in the directly acting antiviral era: A
           prospective evaluation of adherence among people with a history of drug
           use at a community-based program in Toronto, Canada
    • Authors: Kate Mason; Zoë Dodd; Mary Guyton; Paula Tookey; Bernadette Lettner; John Matelski; Sanjeev Sockalingam; Jason Altenberg; Jeff Powis
      Pages: 202 - 208
      Abstract: Publication date: September 2017
      Source:International Journal of Drug Policy, Volume 47
      Author(s): Kate Mason, Zoë Dodd, Mary Guyton, Paula Tookey, Bernadette Lettner, John Matelski, Sanjeev Sockalingam, Jason Altenberg, Jeff Powis
      Background Direct acting antiviral (DAA) treatments for Hepatitis C (HCV) are now widely available with sustained virologic response (SVR) rates of >90%. A major predictor of response to DAAs is adherence, yet few real-world studies evaluating adherence among marginalized people who use drugs and/or alcohol exist. This study evaluates patterns and factors associated with non-adherence among marginalized people with a history of drug use who were receiving care through a primary care, community-based HCV treatment program where opiate substitution is not offered on-site. Methods Prospective evaluation of chronic HCV patients initiating DAA treatment. Self-report medication adherence questionnaires were completed weekly. Pre/post treatment questionnaires examined socio-demographics, program engagement and substance use. Missing adherence data was counted as a missed dose. Results Of the 74 participants, who initiated treatment, 76% were male, the average age was 54 years, 69% reported income from disability benefits, 30% did not have stable housing and only 24% received opiate substitution therapy. Substance use was common in the month prior to treatment initiation with, 11% reported injection drug use, 30% reported non-injection drug use and 18% moderate to heavy alcohol use. The majority (85%) were treatment naïve, with 76% receiving sofosbuvir/ledipasvir (8–24 weeks) and 22% Sofosbuvir/Ribarvin (12–24 weeks). The intention to treat proportion with SVR12 was 87% (60/69). In a modified ITT analysis (excluding those with undetectable RNA at end of treatment), 91% (60/66) achieved SVR12. Overall, 89% of treatment weeks had no missed doses. 41% of participants had at least one missed dose. In multivariate analysis the only factor independently associated with weeks with missed doses was moderate to heavy alcohol use (p=0.05). Conclusion This study demonstrates that strong adherence and SVR with DAAs is achievable, with appropriate supports, even in the context of substance use, and complex health/social issues.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.05.025
      Issue No: Vol. 47 (2017)
       
  • Psychedelic pleasures: An affective understanding of the joys of tripping
    • Authors: Frederik
      Abstract: Publication date: Available online 13 September 2017
      Source:International Journal of Drug Policy
      Author(s): Frederik Bøhling
      Background This paper considers the pleasures of psychedelic drugs and proposes a Deleuzian understanding of drugged pleasures as affects. In spite of a large body of work on psychedelics, not least on their therapeutic potentials, the literature is almost completely devoid of discussions of the recreational practices and pleasures of entheogenic drugs. Yet, most people do not use psychedelics because of their curative powers, but because they are fun and enjoyable ways to alter the experience of reality. Methods In the analytical part of the paper, I examine 100 trip reports from an internet forum in order to explore the pleasures of tripping. Results The analyses map out how drugs such as LSD and mushrooms – in combination with contextual factors such as other people, music and nature – give rise to a set of affective modifications of the drug user’s capacities to feel, sense and act. Conclusion In conclusion it is argued that taking seriously the large group of recreational users of hallucinogens is important not only because it broadens our understanding of how entheogenic drugs work in different bodies and settings, but also because it may enable a more productive and harm reductive transmission of knowledge between the scientific and recreational psychedelic communities.

      PubDate: 2017-09-17T22:18:16Z
       
  • Desiring assemblages: A case for desire over pleasure in critical drug
           studies
    • Authors: Peta Malins
      Abstract: Publication date: Available online 9 September 2017
      Source:International Journal of Drug Policy
      Author(s): Peta Malins
      While critical drug researchers have long pushed for an acknowledgement of pleasure in discourses of drug use, few have explored the alternative possibilities offered by Deleuze and Guattari’s concept of desire. In this paper I map out some of the conceptual differences between pleasure and desire and explore the opportunities opened up by attending more closely to desire in critical drug studies. I suggest that while discourses of pleasure do make an important intervention into and against dominant narratives of risk, harm, and addiction, they may inadvertently be working to keep in place the very binaries and forms of neoliberal western subjectivity that support those narratives. I argue that a Deleuzo–Guattarian ontology of desire is a better tool with which to make sense of the complex relations that form between drugs and bodies, challenge medical and criminal responses to drug use, and bring forth assemblages that enhance, rather than diminish, bodily capacities.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.07.018
       
  • Making medicine; producing pleasure: A critical examination of medicinal
           cannabis policy and law in Victoria, Australia
    • Authors: Kari Lancaster; Kate Seear; Alison Ritter
      Abstract: Publication date: Available online 6 September 2017
      Source:International Journal of Drug Policy
      Author(s): Kari Lancaster, Kate Seear, Alison Ritter
      Several jurisdictions around the world have introduced policies and laws allowing for the legal use of cannabis for therapeutic purposes. However, there has been little critical discussion of how the object of ‘medicinal cannabis’ is enacted in policy and practice. Informed by Carol Bacchi’s poststructuralist approach to policy analysis and the work of science and technology studies scholars, this paper seeks to problematise the object of ‘medicinal cannabis’ and examine how it is constituted through governing practices. In particular, we consider how the making of the object of ‘medicinal cannabis’ might constrain or enact discourses of pleasure. As a case example, we take the Victorian Law Reform Commission’s review of law reform options to allow people in the Australian state of Victoria to be treated with medicinal cannabis. Through analysis of this case example, we find that although ‘medicinal cannabis’ is constituted as a thoroughly medical object, it is also constituted as unique. We argue that medicinal cannabis is enacted in part through the production of another object (so-called ‘recreational cannabis’) and the social and political meanings attached to both. Although both ‘substances’ are constituted as distinct, ‘medicinal cannabis’ relies on the ‘absent presence’ of ‘recreational cannabis’ to define and shape what it is. However, we find that contained within this rendering of ‘medicinal cannabis’ are complex enactments of health and wellbeing, which open up discourses of pleasure. ‘Medicinal cannabis’ appears to challenge the idea that the effects of ‘medicine’ cannot be understood in terms of pleasure. As such, the making of ‘medicinal cannabis’ as a medical object, and its invocation of broad notions of health and wellbeing, expand the ways in which drug effects can be acknowledged, including pleasurable and desirable effects, helping us to think differently about both medicine and other forms of drug use.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.07.020
       
  • Thinking with pleasure: Experimenting with drugs and drug research
    • Authors: Kane Race
      Abstract: Publication date: Available online 5 September 2017
      Source:International Journal of Drug Policy
      Author(s): Kane Race
      Within the field of drug and alcohol studies, researchers think about pleasure or against it; we analyse, consider, investigate, invoke or ignore it. The philosophically inclined may think of pleasure or write on it, but in each of these scenarios pleasure is kept at an arm’s length while the researcher appears to remain unmoved – detached observers, objective scientists, conceptual experts, program directors, sharp critics, policy advocates – sober judges whose sovereignty is secured by the formal conventions of positivist research, established theory, institutional authority and/or disciplinary knowledge. This paper asks what happens when pleasure is allowed to emerge as a constitutive element in the relations of drug and alcohol research. What happens when we conceive our work as thinking with pleasure, rather than simply researching pleasure or thinking about it' I return to the later work of Foucault, reading it alongside conceptions of the experiment drawn from Science and Technology Studies, arguing that both the pleasures of drug consumption and drug research might be conceived more generatively as mutually implicated in events.

      PubDate: 2017-09-11T13:42:25Z
      DOI: 10.1016/j.drugpo.2017.07.019
       
  • Risky pleasures and drugged assemblages: Young people’s consumption
           practices of AOD in Madrid
    • Authors: Montserrat Cañedo; Enrique Moral
      Abstract: Publication date: Available online 4 September 2017
      Source:International Journal of Drug Policy
      Author(s): Montserrat Cañedo, Enrique Moral
      Background Drawing on a research project that we carried out on the functionality of “excessive” consumption practices in the lifestyles of young people in Madrid, this article aims to understand how (dis)pleasurable states emerge during young people’s consumption of alcohol and other drugs. Methods This article claims that these states derive from “drugged assemblages,” that is, a set of (human and non-human) actants that intra-act to produce different effects. Although pleasure can be one of these effects, it is not always guaranteed: consumption practices are assemblages that fluctuate between pleasure and displeasure, and the former can be reached or not depending on the characteristics acquired by the assemblage. It is this fluctuation that makes pleasures “risky.” Drugged assemblages also configure and are configured by specific spatial-temporal and material apparatuses or dispositifs. We will analyse botellones, night-clubs and raves as examples of this kind of dispositif, focusing on how they work as a holistic frame where drugged assemblages emerge. Results Finally, we will focus on the different strategies and practices that young people, in constant intra-action with other agencies, develop in order to achieve and keep a “controlled loss of control” within the limits and potentials offered by these contexts, in a constant effort to avoid the risks that may result from the blurred line that divides pleasure and displeasure. Conclusion In this sense, we will argue that, despite the criticisms it has received, it is possible to make Measham’s concept of “controlled loss of control” compatible with a post-humanist theoretical framework.

      PubDate: 2017-09-05T13:37:35Z
      DOI: 10.1016/j.drugpo.2017.08.002
       
  • Effectiveness and cost-effectiveness of nationwide campaigns for awareness
           and case finding of hepatitis C targeted at people who inject drugs and
           the general population in the Netherlands
    • Authors: Charles W. Helsper; Mart P. Janssen; Gerrit A. van Essen; Esther A. Croes; Clary van der Veen; Ardine G. de Wit; Niek J. de Wit
      Abstract: Publication date: Available online 18 August 2017
      Source:International Journal of Drug Policy
      Author(s): Charles W. Helsper, Mart P. Janssen, Gerrit A. van Essen, Esther A. Croes, Clary van der Veen, Ardine G. de Wit, Niek J. de Wit
      Background Hepatitis C virus infection (HCV) is a serious, but underdiagnosed disease that can generally be treated successfully. Therefore, a nationwide HCV awareness campaign was implemented in the Netherlands targeting people who inject drugs (PWID) in addiction care (‘PWID intervention’) and high-risk groups in the general population (‘public intervention’). The objective of this study is to assess the effectiveness and cost-effectiveness of the interventions used in this campaign. Methods For the ‘PWID’ intervention, all addiction care centres in the Netherlands provided proactive individual HCV consultation and testing. The ‘public intervention’ consisted of health education through mass media and instruction of health care professionals. A Markov chain model was used to estimate incremental cost-effectiveness ratios (ICER, cost per QALY gained). We included a ‘DAA treatment’ scenario to estimate the effect of these treatment strategies on cost-effectiveness. Results The ‘PWID intervention’ identified 257 additional HCV-carriers. The ICER was €9056 (95% CI: €6043–€13,523) when compared to ‘no intervention’. The ‘public intervention’ identified 38 additional HCV-carriers. The ICER was €18,421 (95% CI: €7376–€25,490,119) when compared to ‘no intervention’. Probabilistic sensitivity analysis showed that the probability that the ‘PWID intervention’ was cost-effective was 100%. It also showed a probability of 34% that the ‘public intervention’ did not exceed the Dutch threshold for cost-effectiveness (€20,000). New treatment regimens are likely to improve cost-effectiveness of this strategy. Conclusion In a nationwide HCV awareness and case finding campaign, the intervention targeting PWID was effective and cost-effective. An intervention targeting risk groups in the general population showed only a modest effect and is therefore less likely to be cost-effective.

      PubDate: 2017-08-25T12:33:37Z
      DOI: 10.1016/j.drugpo.2017.07.022
       
  • Hepatitis C testing in general practice settings: A cross-sectional study
           of people who inject drugs in Australia
    • Authors: Kerryn Butler; Carolyn Day; Rachel Sutherland; Joe van Buskirk; Courtney Breen; Lucinda Burns; Sarah Larney
      Abstract: Publication date: Available online 5 August 2017
      Source:International Journal of Drug Policy
      Author(s): Kerryn Butler, Carolyn Day, Rachel Sutherland, Joe van Buskirk, Courtney Breen, Lucinda Burns, Sarah Larney
      Background People who inject drugs (PWID) often do not receive confirmatory RNA testing following positive HCV antibody testing. Expanding access to adequate testing and assessment will improve the progression of patients through the HCV care cascade with the potential to improve diagnosis as well as linkage to treatment. We aimed to determine current utilisation of general practitioners (GPs) by PWID in Australia compared to other settings for HCV testing and post-test discussions. Methods A national sample (n=888) of people who had injected drugs regularly in the past 6 months was interviewed about HCV antibody, RNA testing, and post-test discussions, and the settings where these took place. Results The majority of participants (n=735; 93%) reported antibody testing. Among participants who reported a positive result (n=435), 54% identified their regular GP as the setting where their most recent antibody test was conducted. Confirmatory RNA testing was reported by 60% (n=274) of those who reported being antibody positive. Among those who reported RNA testing (n=257), the most common setting reported was their regular GP (48%). There were no differences in the proportions who recalled post-test discussions at GPs compared to other settings. Conclusion HCV testing was most frequently undertaken by participants' regular GP. GPs are currently providing testing and post-test discussions at similar proportions to other more specialised settings. However, RNA testing is incomplete for more than one-third of the antibody positive PWID interviewed. Our findings suggest that the general practice setting is a common and accessible setting for PWID to access HCV testing. Targeting GPs to improve follow-up of positive antibody tests may help to improve patient progression through the HCV care cascade.

      PubDate: 2017-08-15T12:04:31Z
      DOI: 10.1016/j.drugpo.2017.07.008
       
 
 
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