Affect Drug Use Research Articles

Theory of Planned Behavior on The Psycho-Social Determinants of Drug Use Among Adolescents in Samarinda, East Kalimantan

Background: Drug abuse is serious global health problem. Drug users aged 10-59 years in Indonesia has been increasing steadily. According to data from National Board for Drug Abuse (Badan Narkotika Nasional, BNN), the prevalence of drug users in East Kalimantan was 59,195 (3.07%) of population aged 10-59 years of 1,930,936 people. This study aimed to investigate the psycho-social determinants of drug use among adolescents in Samarinda, East Kalimantan, using Theory of Planned Behavior.Subjects and Method: This was an analytical observational study with cross-sectional design. The study was carried out at Badan Rehabilitasi Tanah Merah, Samarinda, East Kalimantan, from July to August, 2017. A sample of 150 adolescents were selected for this study by fixed disease sampling, including 50 adolescent drug users, and 100 adolescent non drug users. The dependent variable was drug use. The independent variables were intention, attitude, subjective norm, perceived behavior control, peer group, parenting style, and family harmony. The data were collected by pre-tested questionnaire and analyzed using path analysis.Results: Drug use was directly determined by strong intention (b= 2.18; 95% CI= 1.22 to 3.14; p<0.001), negative attitude (b= 1.79; 95% CI= 0.76 to 2.82; p=0.001), low subjective norm (b= 1.13; 95% CI= 0.09 to 2.17; p= 0.034), and weak perceived behavior control (b= 2.83; 95% CI= 1.48 to 4.19; p<0.001). Intention was determined by weak perceived behavior control (b= 1.18; 95% CI = 0.14 to 2.22; p<0.001). Subjective norm was determined by family harmony (b= 2.03; 95% CI= 0.96 to 3.09; p<0.001), authoritarian parenting style (b= 1.25; 95% CI= 0.15 to 2.36; p=0.026), and peer group (b= 1.46; 95% CI= 0.37 to 2.54; p=0.009).Conclusion: Drug use is directly determined by intention, attitude, subjective norm, and perceived behavior control. Family harmony, authoritarian parenting style, and peer group affect drug use indirectly.Keywords: drug use, Theory of Planned Behavior, path analysisCorrespondence: Syukma Rhamadani Faizal Nur. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami No.36 A, Surakarta 57126, Central Java, Indonesia. Email: faizalrhamadani@gmail.com. Mobile: +6281253121828.Journal of Health Promotion and Behavior (2017), 2(3): 272-281https://doi.org/10.26911/thejhpb.2017.02.03.07

Childhood trauma in suicide attempters: Case-control study

IntroductionAn expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including substance abuse, depressive disorders, and attempted suicide among adolescents and adults. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship as observed in population studies.ObjectivesWe have tested the association between early trauma and suicide attempts in a sample of suicide attempters from the Eureca International Project and a matched healthy control sample.MethodsWe have studied the prevalence of childhood stressful events compared with healthy controls in a multicentre sample of 791 suicide attempters (SA) and 630 healthy controls (C), we have measured childhood parental neglect, physical abuse, sexual abuse, and emotional abuse, using the Childhood Trauma Questionnaire (CTQ). Chi2 tests were performed using SPSS v15.0.ResultsA significant increase in prevalence of childhood trauma was found in the suicide attempters sample for all types of trauma: childhood physical abuse: 25.3% (SA) vs. 11.1% (C) (Chi2 test: 120,108 P = 0.000); childhood sexual abuse: 18.2% (SA) vs. 2.4% (C) (Chi2 test: 88,212 P = 0.000); parental neglect 25.3% (SA) vs. 1.1% (C) (Chi2 test: 164,910 P = 0.000); childhood emotional abuse: 34.9% (SA) vs. 5.6% (C) (Chi2 test: 176,546 P = 0.000).Suicide attempters were increasingly overrepresented compared with controls if experiencing more than 1 trauma: represented 77% of the sample who suffered 1 type of childhood trauma vs. more than 90% of the sample with 2 or more types of trauma.ConclusionsA powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide.Disclosure of interestThe authors have not supplied their declaration of competing interest.

National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM): household survey component methods.

ABSTRACTOBJECTIVE To describe methodological aspects of the household survey National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM) related to sampling design and implementation, the actual obtained sample, instruments and fieldwork.METHODS A cross-sectional, population-based study with probability sampling in three stages of the population living in households located in Brazilian urban areas. Fieldwork was carried out between September 2013 and February 2014. The data collection instrument included questions related to: information about households, residents and respondents; chronic diseases and medicines used; use of health services; acute diseases and events treated with drugs; use of contraceptives; use of pharmacy services; behaviors that may affect drug use; package inserts and packaging; lifestyle and health insurance.RESULTS In total, 41,433 interviews were carried out in 20,404 households and 576 urban clusters corresponding to 586 census tracts distributed in the five Brazilian regions, according to eight domains defined by age and gender.CONCLUSIONS The results of the survey may be used as a baseline for future studies aiming to assess the impact of government action on drug access and use. For local studies using a compatible method, PNAUM may serve as a reference point to evaluate variations in space and population. With a comprehensive evaluation of drug-related aspects, PNAUM is a major source of data for a variety of analyses to be carried out both at academic and government level.

Factors Affecting Drug Use During Incarceration: A Cross-Sectional Study of Opioid-Dependent Persons from India

IntroductionSubstance abuse and criminality share a complex relationship. The rates of substance use among the prisoners, and that of criminal acts among substance users in community setting are high. Data from South Asian countries, including from India are inadequate. This study aimed to assess the pattern of criminal acts among opioid-dependent subjects and their substance use pattern in the month before, during and after imprisonment. MethodsUsing a cross-sectional study design and purposive sampling, opioid-dependent subjects (n=101) attending two community drug treatment clinics who have had any contact with the law were assessed using a specifically-designed tool to record criminal acts and substance use before, during and after last imprisonment. ResultsMost subjects (93%) had committed illegal acts in their lifetime. Physical assault was the most common illegal act, while 23% reported selling drugs and 9% reported committing serious crimes. About 95% were arrested and 92% had spent time in police lockups. About 29% were arrested for drugs possession or drug use, and 3% of injecting drug users arrested for carrying injection equipment. About 85% had been imprisoned at least once, of whom 88% used psychoactive substances in the 1-month period before their last imprisonment. Opioids were the most common substances used daily (68%), followed by cannabis (34%) and alcohol (22%). Ninety-seven percent reported the availability of substances in prisons, and 65% also used substances during their last imprisonment. Cannabis (35%) was the most common substances used in prison followed by opioids (19%). Seventy-six percent used substances soon after prison release, and 13% of opioid users experienced opioid overdose soon after prison release. Use of cannabis, injecting drugs, and opioid use before imprisonment were predictors of substance use in prison. ConclusionOpioid-dependent people have various contacts with the law, including imprisonment. Many users are dependent on substances during prison-entry, which is an important reason for their continued substance use in prisons. There is a need to provide substance abuse treatment across all stages of criminal justice system.

Short-term Efficacy of a Brief Intervention to Reduce Drug Misuse and Increase Drug Treatment Utilization Among Adult Emergency Department Patients.

Although brief interventions (BIs) have shown some success for smoking cessation and alcohol misuse, it is not known if they can be applied in the emergency department (ED) to drug use and misuse. The objectives of this investigation were to assess the 3-month efficacy of a BI to reduce drug use and misuse, increase drug treatment services utilization among adult ED patients, and identify subgroups more likely to benefit from the BI. This randomized, controlled trial enrolled 18- to 64-year-old English- or Spanish-speaking patients from two urban, academic EDs whose responses to the Alcohol, Smoking, and Substance Involvement Screening Test indicated a need for a brief or intensive intervention. Treatment participants received a tailored BI, while control participants only completed the study questionnaires. At the 3-month follow-up, each participant's past 3-month drug use and misuse and treatment utilization were compared to his or her baseline enrollment data. Regression modeling was used to identify subgroups of patients (per demographic and clinical factors) more likely to stop or reduce their drug use or misuse or engage in drug treatment by the 3-month follow-up assessment. Of the 1,030 participants, the median age was 30 years (interquartile range = 24 to 42 years), and 46% were female; 57% were white/non-Hispanic, 24.9% were black/non-Hispanic, and 15% were Hispanic. The most commonly misused drugs were marijuana, prescription opioids, cocaine/crack, and benzodiazepines. Although at follow-up the proportions of participants reporting any past 3-month drug misuse had decreased in both study arms (control 84% vs. treatment 78%), the decreases were similar between the two study arms (Δ-6.3%; 95% confidence interval [CI] = -13.0% to 0.0). In addition, at follow-up there were no differences between study arms in those who were currently receiving drug treatment (Δ1.8; 95% CI = -3.5 to 6.8), who had received treatment during the past 3 months (Δ-2.0; 95% CI = -6.5 to 2.4), or who at least contacted a treatment program (Δ 1.7; 95% CI = -2.4 to 6.1). Those whose baseline screening indicated the need for a brief instead of a more intensive intervention, and those currently engaged in drug treatment at the 3-month follow-up, were generally more likely to stop or decrease their drug use/misuse. The BI employed in this study did not reduce drug use and misuse or increase treatment utilization more than the control condition over a 3-month period. Future research should help determine what role, if any, BIs should play in affecting drug use and misuse among ED patients.

Contingency Management and Deliberative Decision-Making Processes.

Contingency management is an effective treatment for drug addiction. The current explanation for its success is rooted in alternative reinforcement theory. We suggest that alternative reinforcement theory is inadequate to explain the success of contingency management and produce a model based on demand curves that show how little the monetary rewards offered in this treatment would affect drug use. Instead, we offer an explanation of its success based on the concept that it accesses deliberative decision-making processes. We suggest that contingency management is effective because it offers a concrete and immediate alternative to using drugs, which engages deliberative processes, improves the ability of those deliberative processes to attend to non-drug options, and offsets more automatic action-selection systems. This theory makes explicit predictions that can be tested, suggests which users will be most helped by contingency management, and suggests improvements in its implementation.

How do drug market changes affect characteristics of injecting initiation and subsequent patterns of drug use? Findings from a cohort of regular heroin and methamphetamine injectors in Melbourne, Australia

BackgroundChanges in drug market characteristics have been shown to affect drug use patterns but few studies have examined their impacts on injecting initiation experiences and subsequent patterns of injecting drug use (IDU). MethodsWe collected data on self-reported injecting initiation experiences and past-month patterns of IDU from 688 regular heroin and methamphetamine injectors in Melbourne, Australia, who initiated injecting across three different drug market periods (prior to the Australian heroin shortage (‘high heroin’)/immediately following the shortage (‘low heroin’)/‘contemporary’ markets (fluctuating heroin and methamphetamine availability)). We used univariable and multivariable logistic regression to examine the relationship between period of injecting initiation and first drug injected, and multinomial logistic regression for the relationship between period of injecting initiation and current injecting patterns. Results425 participants (62%) reported initiating injecting in the high heroin period, 146 (21%) in the low heroin period, and 117 (17%) in the contemporary period. Participants who initiated injecting during the low heroin period were twice as likely to initiate injecting using a drug other than heroin (AOR: 1.94, 95% CI: 1.27–2.95). The most common patterns of drug use among study participants in the month preceding interview were polydrug use (44%) and primary heroin use (41%). Injecting initiation period was either non-significantly or weakly associated with current drug use pattern, which was more strongly associated with other socio-demographic and drug use characteristics, particularly self-reported drug of choice. ConclusionThe drug market period in which injecting initiation occurred influenced the first drug injected and influenced some aspects of subsequent drug use. In the context of highly dynamic drug markets in which polydrug use is common there is a need for broad harm reduction and drug treatment services which are flexible and responsive to changing patterns of drug use.

Friendship Intimacy, Close Friend Drug Use, and Self-Medication in Adolescence.

The current study examined between- and within-person processes related to friendship intimacy, close-friend substance use, negative affect, and self-medication. We tested between-person hypotheses that global negative affect, friendship intimacy, and close-friend drug use predict increased substance use, and the within-person hypothesis that friendship intimacy and close-friend substance use moderate the temporal relationship between daily negative affect and subsequent substance use (i.e., self-medication). Experience sampling methodology (ESM) was employed to capture daily variations in mood and substance use, and multilevel modeling techniques were used to parse between- versus within-person differences in risk for use. Findings supported between-person hypotheses that higher levels of negative affect and lower levels of friendship intimacy predicted greater substance use, and a consistent trend indicated that friendship intimacy and close-friend drug use interact to predict substance use more generally (though not for self-medication). Risk and protective mechanisms emerged from this interaction such that the effect of friendship intimacy on adolescent use depends on the degree of close-friend drug use. More specific reformulations of the risk processes involving friendships and self-medication among younger youth are indicated.

The Geography of Drug Abuse Epidemiology Among Probationers in Baltimore

Substance use is a pervasive health problem that contributes significantly to the recycling of offenders through the justice system. This study uses routine activities theory as a framework to determine whether the availability of illicit drugs in a probationer’s immediate residential environment is associated with their use of illegal substances. Combining narcotics-related calls for police service data, interviews with offenders, life history event calendars, and biological drug test results, a clustered-logit regression model of 250 drug-involved probationers indicates that the availability of drugs within the probationer’s immediate area is associated with a higher probability of testing positive for illicit substances. The results suggest a broader epidemiological framework to understand how environment affects drug use. Further research in this area will improve supervision practices of drug-involved individuals and interventions to reduce drug use.

Drug use among street children and adolescents: what helps?

The aim of this study was to investigate factors associated to frequent and heavy drug use among street children and adolescents aged 10 to 18 years. A sample of 2,807 street children and adolescents from the 27 Brazilian state capital cities was analyzed. A World Health Organization questionnaire for non-students was adapted for use in Brazil. Data analysis was performed using logistic regression and decision tree models. Factors inversely associated with frequent and heavy drug use were: being age nine to 11 years (OR = 0.1); school attendance (OR = 0.3); daily time (one to five hours) spent on the streets (OR = 0.3 and 0.4); not sleeping on the streets (OR = 0.4); being on the streets for less than one year (OR = 0.4); maintenance of some family bonds (OR = 0.5); presence on the streets of a family member (OR = 0.6); not suffering domestic violence (OR = 0.6); being female (OR = 0.8). All of these variables were significant at the p < 0.05 level. The findings suggest that being younger, having family bonds and engagement in school are important protective factors that affect drug use among this population and should be considered in the formulation of public policies.

Handling drug-related problems in rehabilitation patients: a randomized study

Drug-related problems (DRPs) have been found to be associated with increased morbidity, mortality, and health costs. To investigate whether the inclusion of pharmacists in a rehabilitation team influences the handling of DRPs in the ward and whether an intervention in hospital affects drug use after discharge. The rehabilitation ward of a general hospital in Oslo, Norway. Patients were randomized into an intervention group (IG) or a usual care group (CG). The IG patients were followed prospectively by a pharmacist, who reviewed the patients' drug therapies using information from their medical records and patient interviews. The pharmacist identified DRPs and suggested solutions during multidisciplinary team meetings. The IG patients received targeted drug counselling from the pharmacist before discharge. The drug therapy in the CG, for the period from study randomization to discharge, was assessed retrospectively by the pharmacist, who identified DRPs and recorded how they were acted upon. Three months after discharge, pharmacists who were blinded to the patient randomization, visited the patients at home and interviewed them about their medication. Types and frequencies of DRPs in the IG and CG were compared at hospital admission, at discharge, and 3 months after discharge. Of the 77 patients included, 40 belonged to the IG and 37 to the CG. Patient characteristics (IG vs CG) were as follows: age 73.5 versus 76.8 years; female 58 versus 68%; mean number of drugs at admission 8.3 versus 7.8; and mean number of drugs at discharge 8.5 versus 7.7. At admission, 4.4 DRPs per patient were recorded in the IG and 4.2 in the CG. Significantly more DRPs were acted upon and resolved in the IG; at discharge, the IG had 1.2 DRPs per patient and the CG had 4.0 (P < 0.01). At the home visit, a significant difference between the groups was found: 1.63 versus 2.62 DRPs (P = 0.02) for the IG and the CG, respectively. Involvement of a pharmacist in drug-therapy management, including participation in multidisciplinary team discussions, markedly improved the identification and resolution of DRPs during a hospital stay. The benefit persisted after discharge.

PROTOCOL: Family Behavior Therapy (FBT) for young people in treatment for non‐opioid drug use

PROTOCOL: Family Behavior Therapy (FBT) for young people in treatment for non‐opioid drug use

Recessions and the participation of youth in the selling and use of illicit drugs

Background There has been limited research on how recessions (or more generally, the strength of the economy) affect drug use and the related outcome of drug selling. This is especially important, given the current economic crisis. This paper aims to use a conceptual framework, previous research, and new research to predict how the current economic crisis may be affecting youth drug selling and drug use. Methods A conceptual framework to understand how a recession could affect youth drug selling and drug use is presented, along with a review of the literature on empirical investigations on how the strength of the economy affects these behaviours among teenagers. In addition, new analyses for young adults are presented. Results The conceptual framework postulates that a recession would have direct positive effects on the prevalence of youth drug selling but ambiguous direct effects on youth drug use. The conceptual framework also postulates that drug selling and drug use are inter-connected at the individual level and the aggregate level. Thus, any effect of a recession on one would likely affect the other in the same direction. The limited empirical evidence indicates that both drug selling and drug use among youth are higher when the economy is weaker. Conclusions The current economic crisis will likely increase both youth drug selling and drug use relative to what they would have otherwise been.

First, Catch Your Signal!

Over the years there have been many attempts to define what we mean by a signal. We have come to the view that attempts to provide a single, concise definition cannot succeed because a signal in pharmacovigilance is not an entity. There are several signal endpoints possible that depend on a multiplicity of factors, defying a deconstructural approach. It is a little like defining ‘love’, which is very subjective and, even allowing for that, it seems that there are different kinds of love. No definition allows us to understand the range of love and its attributes! This does not mean that the definitions are wrong, only that they do not give a full picture. One might start by saying that a signal in pharmacovigilance is any new information about a drug or its use that is interesting/important, and which may have some impact on the way the drug will be used. This simple concept is incorporated in all definitions, which are then expanded in a variety of ways. But the difficulty with this starting point is that a signal is part of a process that starts with an observation that arouses interest or concern. This is a value judgement by the observer, leading him or her to more thought, investigation and activity around the observation to the point where the observer feels they have a hypothesis to share with others. That point seems intuitively right to designate a ‘signal’ in the sense of information worth passing on to others, for them to know about and to consider further action. But all this is vague and subjective: what is ‘interesting’ or ‘important’? What kinds of ‘thought’ and activity’ are required? How does one decide whether one has sufficient information and argument to warrant telling others? There is another problem arising from the wide use of ‘signal’ and ‘alert’. Some would say that a signal is the point at which one individual starts to do more investigation, and an alert is the point at which one tells others about the result (who the others are is not clear, but seems to be usually used for the wider health professional audience). Some people use ‘signal’ and ‘alert’ in the opposite sense, but we will not complicate matters by mentioning ‘alert’ further! We propose that a signal can only be understood by answering the following questions: What do I think is an important observation affecting drug use and patient safety? How do I find these observations and consider them? How do I know when I have found enough for a signal? What should be done with the signal? These questions can be considered both generally and in relation to an individual case.

Effects of Drug Use on Sexual Risk Behavior: Results of an HIV Outreach and Education Program

We evaluated the effects on drug use and sexual risk of an HIV intervention for out-of-treatment drug users, and assessed the effect of drug use on unprotected sex with main and non-main partners. The intervention significantly reduced unprotected sex with a main partner, but did not affect drug use or unprotected sex with non-main partners. Participants who stopped using drugs by follow-up were less likely to have unprotected sex with both main and other partners.

Understanding factors influencing substance use in people with recent onset psychosis: A qualitative study

This qualitative study identifies factors influencing the use of substances in young people with recent onset psychosis. A purposive sample of 19 people aged between 16 and 35 years from an Early Intervention Service in the English National Health Service (NHS) was interviewed using a semi-structured guide. All had experienced a psychotic episode and were within 3 years of first contact with the service. All were either currently misusing substances or had been doing so in the 6 months prior to first contact with the service. All participants were/had been regular cannabis users and for 13(68%) cannabis was the primary drug of use. Thematic analysis identified four key themes in participants accounts of factors influencing their substance abuse: influence of perceived drug norms on behaviour; attributions for initial and ongoing drug-taking behaviour; changes in life goals affecting drug use; beliefs about the links between mental health and drug use. These findings have clear implications for interventions at a number of levels to support young people using substances in early psychosis including public health messages, education and psychological therapies.

Latino Disparities in Prescription Drug Use and Expenditures: A Nationally Representative Analysis

Latinos are disproportionately affected by the lack of affordable prescription drugs. Within the Latino population, there are significant heterogeneities in the patterns of prescription drug expenditures and use. However, studies have traditionally treated them as a single, monolithic group. To identify and quantify factors associated with disparities in drug use and expenditures between non-Latino whites and Latino subgroups. We examined trends in prescription drug use, total prescription drug expenditures, and the proportion of out-of-pocket (OOP) payment to total drug expenditures for whites and Latino subgroups using the Medical Expenditure Panel Survey from 1999 to 2006. Multivariate regressions were used to adjust for confounding factors that may also affect drug use and expenditures. Latinos were significantly less likely to use drugs compared to whites. Mexicans had significantly lower prescription drug costs and a higher proportion of OOP expenditures compared to whites after socioeconomic and demographic factors were controlled. Usual source of care, health insurance, and limited English proficiency were the most important factors associated with these disparities. Among the Latino subgroups, Puerto Ricans had drug expenditures and use patterns most similar to those of whites. Substantive disparities in prescription drug expenditures and use existed between whites and specific Latinos groups, with Mexicans faring the worst. Future health studies should examine Latino subgroups separately, rather than treating Latinos as a homogeneous group. Policies aimed at expanding insurance coverage and access to a usual source of care, as well as addressing language barriers, should substantially reduce these disparities.

Self-Medication, Bipolar Disorders, and Stimulant Dependence

Article AbstractSir: In the August 2008 issue of the Journal, Nejtek et al. present findings that both quetiapine and risperidone produced improvement in manic, mixed, and depressive symptoms. In turn, symptom reduction was associated with reduced drug cravings in patients with co-occurring bipolar and stimulant dependence disorders, albeit not affecting drug use. These are important findings in that (1) there is an extraordinarily high incidence of co-occurrence of substance abuse in general associated with bipolar disorders and, in particular, a high cooccurrence of stimulant abuse; and (2) there are few if any specific effective psychopharmacologic treatments for stimulant dependence.

Comparing patients' and healthcare professionals' ADR reports after media attention: the broadcast of a Dutch television programme about the benefits and risks of statins as an example

To compare adverse drug reaction (ADR) reports from patients and health professionals after the broadcast of a Dutch television consumer programme about the benefits and risks of statins. We performed a quantitative and qualitative analysis on patients' and health professionals' reports of ADRs to statins. These reports were received by the Netherlands Pharmacovigilance Centre Lareb between March 2007 and August 2007. Quantitative data consisted of patient age and gender, number of received reports and characteristics of the report (most frequently reported ADRs, seriousness, drug discontinuation and outcome of the reported reaction). Open text fields in the ADR reporting form were categorized and a content analysis was carried out. Media attention led to a peak in patient reporting of ADRs but not in reporting by health professionals. There were no differences between patient and health professional reports in seriousness of the ADRs and drug cessation. Patients reported nonrecovery more often than health professionals. The TV programme is mentioned as a reason for drug discontinuation in almost 30 reports. Patients often felt that they did not receive sufficient information and that their concerns were not adequately addressed by healthcare professionals. Media attention affects drug use and ADR reporting by patients. Patient reports can provide additional information, making them a useful source of information next to health professional reports. Content analysis provides vital insights into the impact of statins on daily life, and patients' concerns about adverse reactions should be recognized in reports to national pharmacovigilance centres.

Drugscapes and the role of place and space in injection drug use-related HIV risk environments

Although considerable research has been conducted to identify the behavioural characteristics that predispose individuals to inject drugs or become infected with HIV via injection drug use, much less research has been conducted on structural and policy determinants, cultural norms, stigma, and ecological factors which may affect drug use risk behaviour, users’ networks and HIV rates associated with drug use across geographic areas. For programme planners, whether official or grassroots, an understanding of place-based characteristics can help better identify risk environments to injection drug use-related HIV, and determine how to facilitate actions regarding public policy and harm reduction to aid in the reduction of risk. As such, we consider in this commentary the importance of geographic place and the socio-spatial and political processes related to place that may help determine where IDU-related HIV risk environments occur.