Characteristics Of Injection Drug Users Research Articles

Association between recreational drug use and sexual practices among people who inject drugs in Southwest China: a cross-sectional study

ObjectiveTo describe the differences in sexual practices among individuals with various drug administration patterns.SettingA detoxification centre in Southwest China, a part of the Chinese national sentential surveillance network for hepatitis...

Differences in HIV risk behavior of injection drug users in New York City by health care setting

The purpose of this study is to examine the HIV risk behaviors and demographic characteristics of injection drug users (IDUs) by type of health care setting, which can inform development of tailored structural interventions to increase access to HIV prevention and medical treatment services. IDU syringe customers were recruited from pharmacies as part of the “Pharmacist As Resources Making Links to Community Services” (PHARM-Link) study, a randomized community-based intervention in New York City (NYC) aimed at connecting IDUs to HIV prevention, medical, and social services. An ACASI survey ascertained demographics, risk behavior, health-care utilization, and location where health care services were received in the past year. Data were analyzed using logistic regression. Of 602 participants, 34% reported receiving health care at a community clinic, 46% a private medical office, 15% a mobile medical unit, and 59% an emergency room (ER). After adjustment, participants who attended a community clinic were significantly more likely to have health insurance, report syringe sharing, and be HIV positive. Whites, nondaily injectors, insured, and higher income IDUs were more likely to attend a private medical office. Participants who recently used a case manager and had multiple sexual partners were more likely to use a mobile medical unit. ER attendees were more likely to be homeless and report recent drug treatment use. These findings show that IDU demographics and risk behaviors differ by health care setting, suggesting that risk reduction interventions should be tailored to health care settings. Specifically, these data suggest that community clinics and mobile medical units serve high-risk IDUs, highlighting the need for more research to develop and test innovative prevention and care programs within these settings.

Factors associated with methadone treatment among injection drug users in Bangkok, Thailand

Little is known about the characteristics of injection drug users (IDU) who take methadone treatment in Thailand. We examined prevalence and correlates of methadone treatment among a community-recruited sample of IDU in Bangkok, Thailand. Among 273 participants, 143 (52.4%) reported accessing methadone treatment within the previous 6 months. Older age (adjusted odds ratio [AOR] = 1.90, 95% confidence interval [CI] = 1.10–3.30) and more than weekly midazolam injection (AOR = 1.85, 95% CI = 1.04–3.29) were positively associated, whereas alcohol use (AOR = 0.34, 95% CI = 0.18–0.63) and noninjection methamphetamine use (AOR = 0.49, 95% CI = 0.29–0.85) were negatively associated with methadone treatment. In subanalyses, 98.6% of IDU on methadone continued to inject drugs, and the most common reason for stopping methadone was becoming incarcerated (49%). Evidence-based addiction treatment in the form of methadone maintenance therapy, with attention paid to concomitant midazolam injection in this setting, should be implemented.

Nutrition Issues in the HIV-Infected Injection Drug User: Findings from the Nutrition for Healthy Living Cohort

Objective: The purpose of this paper is to highlight disparities between injection drug users (IDUs) and those who had never been IDUs from the Nutrition for Healthy Living (NFHL) cohort. Although IDUs were enrolled in the cohort throughout its duration, few analyses have sought to highlight findings specific to them.Methods: NFHL, a prospective, longitudinal cohort conducted from 1995–2005, included 881 human immunodeficiency virus (HIV) –infected men and women over the age of 18. Subjects were seen every 6 months; body composition and dietary and laboratory data were collected. Individuals were classified as current IDUs, past IDUs, and never-IDUs. The classification of ever-IDU combined current and past users.Results: In NFHL, a higher proportion of ever-IDUs were women, African American, had a high school education or less, smoked, and were housing insecure and food insecure compared to never-IDUs. Ever-IDUs had lower total, soluble, and insoluble fiber and individual micronutrient intakes. A higher proportion of ever-IDUs had hepatitis C and HIV-related symptoms, used highly active antiretroviral therapy (HAART) less, and had a CD4 count <500 cells/mm3, than never-IDUs, at the study endpoint.Conclusions: The course of HIV infection in past and current IDUs appears to be unique and requires more investigation. Physiologic and sociodemographic characteristics of IDUs contribute to poor disease management and nutritional status. Classic manifestations of HIV persist in IDUs in the HAART era.

Rethinking Approaches to Risk Reduction for Injection Drug Users

To identify and compare the drug-injecting network characteristics of cocaine and heroin injectors associated with a risk of HIV and hepatitis C virus (HCV). Active injectors were recruited from syringe exchange and methadone programs. Characteristics of all participants and their social networks were elicited. Regression analysis using generalized estimating equations examined the network characteristics of injection drug users (IDUs) relative to cocaine or heroin use in the past 6 months. Of 282 IDUs, 228 (81%) used cocaine and 54 (19%) used heroin as their primary injected drug. In analyses adjusted for age and gender, cocaine injectors compared with heroin injectors were more likely to live in unstable housing (odds ratio [OR] = 3.55, 95% confidence interval [CI]: 1.49 to 8.40), self-report HCV infection (OR = 4.69, 95% CI: 2.14 to 10.31), and have a greater number of IDUs in their social network (OR = 1.61, 95% CI: 1.14 to 2.28) and were less likely to be polydrug users (OR = 0.06, 95% CI: 0.02 to 0.16) and to have social support (OR = 0.97, 95% CI: 0.95 to 0.99). The injecting networks of cocaine users were more likely to have members who were older (OR = 1.08, 95% CI: 1.04 to 1.12), had a history of shooting gallery use (OR = 2.27, 95% CI: 1.08 to 4.76), and had shorter relationships with the subject (OR = 0.91, 95% CI: 0.85 to 0.97). Beyond personal behaviors, HIV and HCV infection risk seems to be linked to social network traits that are determined by drug type. Prevention efforts to control the spread of bloodborne viruses among IDUs could benefit from tailoring interventions according to the type of drug used.

Characteristics of young illicit drug injectors who use North America's first medically supervised safer injecting facility

The study examined whether North America's first medically supervised safer injection facility (SIF) attracts young injection drug users (IDUs) who are at high risk of health-related harm. Prevalence of SIF use was determined based on data obtained after the SIF's opening. Predictors of initiating future SIF use were determined based on behavioral information obtained from the participant's study visit immediately preceding the SIF's opening. The median duration between the acquisition of pre-SIF opening behavioral data and the more recent interview, where SIF use was measured, was 16 months. Characteristics of IDUs who did and did not subsequently initiate SIF use were statistically compared (N = 135). Data from the 6-month period prior to the SIF's opening showed that youth initiating SIF use were significantly more likely to have been in jail, to use heroin daily, to have overdosed, to have binged on drugs, to have loaned needles, and to have been homeless. The study suggests that among IDUs 29 years of age or younger, those who used the SIF were at higher risk than those who were not.

Regional differences in injecting practices and other substance use-related behaviour among entrants into opioid maintenance pharmacotherapy treatment in New South Wales, Australia

Background: Investigations of injecting drug users (IDUs) have been conducted largely in urban areas. Those studies that compare rural and urban IDUs often utilise small and possibly unrepresentative samples. Aim: To investigate regional differences in the characteristics of IDUs. Methods: The study compared the demographic, drug use-related, and treatment characteristics of 1045 urban, 213 regional, and 254 rural opioid maintenance pharmacotherapy (OMP) treatment entrants recruited as part of a feasibility study into the implementation of a state-based treatment outcome monitoring system. Results: Participants from regional and rural New South Wales (NSW) were significantly more likely to report sharing of needles and other injection equipment and higher non-opioid drug use and polydrug use than their urban counterparts. In addition, they were more likely to be living with dependent children, to be unemployed, and to be experiencing greater psychological problems than their urban counterparts. Needle sharing also was independently associated with being younger, female, having been arrested, or having non-opioid drugs of concern. Conclusions: Reasons for the higher rates of blood-borne virus (BBV) transmission risk-related behaviour among rural and regional IDUs should be investigated further and considered when planning for the targeted provision of harm reduction activities.

Demographic, HIV risk behavior, and health status characteristics of “crack” cocaine injectors compared to other injection drug users in three New England cities

Objectives To compare demographic, HIV risk behaviors, and health status characteristics of injection drug users (IDUs) who have injected “crack” cocaine with IDUs who have not. Methods Nine hundred and eighty-nine IDUs were recruited in New Haven, CT, Hartford, CT and Springfield, MA from January 2000 to May 2002. Participants were administered a modified version of the National Institute on Drug Abuse Risk Behavior Assessment Questionnaire. Results Nine percent ( n = 89) of participants reported “ever” injecting crack cocaine and 4.2% ( n = 42) reported injecting crack in the past 30 days. Lifetime and current crack injectors did not differ significantly on any demographic characteristics. Lifetime and current crack injectors did not differ on gender, age or marital status from IDUs who have never injected crack. Significant differences were found on race, education, employment and residence, with crack injectors more likely to be white, employed, better educated and living in New Haven than IDUs who have never injected crack. After adjusting for current (past 30 day) speedball and powder cocaine injection, crack injectors reported higher rates of risky drug use behaviors and female crack injectors reported higher rates of risky sexual behaviors. Crack injectors reported higher rates of abscesses, mental illness and Hepatitis C infection, but not Hepatitis B or HIV infection. Conclusions The emergence of crack cocaine injection requires urgent attention, as this new drug use behavior is associated with elevated rates of high risk behaviors.

Injection drug users’ use of pharmacies for purchasing needles in Anchorage, Alaska

Objectives: Sterile needle and syringe (NS) access may play a significant role in the reduction of disease transmission. This study describes various characteristics of injection drug users’ (IDUs) procurement of NS at pharmacies. Methods: IDUs were recruited as part of a two-arm clinical trial with one arm being taught how to purchase NS at pharmacies and the other arm being able to exchange NS at a needle exchange. Data were analysed using descriptive statistics (chi-square and binomial tests for categorical data, t-tests, ANOVA, correlation and Wilcoxon rank sums for interval-level data) and run using SAS [SAS/STAT User’s Guide, Version 6, 4th ed., vols. 1 and 2, SAS Institute Inc., Cary, NC]. Results: IDUs were able to purchase NS at most Anchorage pharmacies. More IDUs randomised to a syringe exchange programme (SEP) arm of a clinical trial obtained NS from known sterile sources as compared to those IDUs randomised to the pharmacy sales arm. Conclusions: Communities seeking to maximise the proportion of IDUs who obtain sterile NS need to have both legal pharmacy sales and SEPs.

Social support and zero sharing risk among hazardously drinking injection drug users

We compared the sociodemographic, drug use, and social support characteristics of injection drug users (IDUs) who reported at least 6 months having not “shared needles or works” (zero sharing risk) with those who reported recent equipment sharing. 187 AUDIT_positive (>8), active IDUs were recruited between February 1998 and October 1999 from a needle exchange program in Providence, RI. The sample was 64% male and 87% white, with a mean age of 36 years, and 32% of subjects reported zero sharing risk in the prior 6 months. Variables having significant ( P< .05) associations with zero sharing risk included: older age, lower heroin use frequency, lower cocaine use, and increased frequency of needle exchange visits. As social support from friends increased, the likelihood of sharing decreased. Subjects with substance_using friends or partners were significantly more likely to share than those without such associations (OR = 9.4; P< .05). Social support and social network composition influenced sharing behaviors in active, out_of_treatment drug injectors. Interventions that mobilize social support may increase the possibility of zero sharing, an important public health goal.

Characteristics of injection drug users who utilize tuberculosis services at sites of the Baltimore city needle exchange program.

To describe characteristics of needle-exchange program (NEP) participants who utilized tuberculosis services from an NEP site. Between June 1998 and May 1999, tuberculosis services were advertised and offered to Baltimore, Maryland, NEP participants. Demographic and tuberculosis-specific data were collected on participants who self-selected into services. Analyses were based on being tuberculin skin tested, returning for a skin test reading, and testing tuberculin positive. Among 691 contacts with NEP participants, this service performed 296 tuberculin tests, with an 84% return rate for skin test reading. Participants were 32% female, 87% African American, and 11% employed. Higher frequency of NEP visits was positively associated with requesting tuberculosis services and returning for skin test reading. Among those who returned for skin test reading, longer smoking duration and problems getting food in the past year due to a lack of money were associated with a positive test. Utilization of a tuberculosis service and high return rates can be achieved among NEP participants without formal recruitment strategies. Frequent exchange appears to facilitate return visits for NEP-based tuberculosis screening, which may imply accessibility for frequent exchangers. More extensive health services at sites of the Baltimore NEP appear to be warranted, with particular attention paid to effectiveness for frequent exchangers.

Characteristics of injection drug users derived from a large family study of alcoholism

Most descriptive studies on injection drug users (IDUs) has used treatment or referral samples. This study uses relatives ascertained through the Collaborative Study on the Genetics of Alcoholism (COGA) to describe patterns of drug use, psychiatric comorbidity, and selected high-risk behaviors among IDUs not ascertained through treatment or other referral networks. Relatives (N = 5,520) of alcoholic probands were administered semistructured interview, the Semistructured Assessment for the Genetics of Alcoholism (SSAGA), which assesses lifetime psychiatric symptoms and psychoactive substance use. IDUs were compared with those who had never used cannabis more than 20 times or other drugs more than 10 times (minimal drug use group), those who had used cannabis more than 20 times but no other illicit drugs more than 10 times (cannabis users), and those who had used other drugs more than 10 times but who had never injected (other drug users). Compared with other drug users, IDUs reported using more classes of drugs and began drug use at an earlier age. IDUs were significantly more likely to receive diagnoses of antisocial personality disorder (ASPD) and alcohol dependence, and reported elevated rates of suicidal ideas and attempts. IDUs were more likely to report a variety of behavioral difficulties beginning before age 15, and were more likely to engage in high-risk sexual behaviors. Half of the IDUs reported having shared needles; sharers were more likely to receive a diagnosis of ASPD, but did not differ on reporting high-risk behaviors. IDUs, regardless of whether selected through treatment, have high lifetime rates of mood disturbance and ASPD, and are likely to have a history of conduct difficulties beginning before age 15 years and to subsequently engage in a variety of other high-risk behaviors.