High Intensity Drug Research Articles

Suspected Counterfeit M-30 Oxycodone Pill Exposures and Acute Withdrawals Reported from a Single Hospital - Toxicology Investigators Consortium Core Registry, U.S. Census Bureau Western Region, 2017-2022.

Availability of counterfeit prescription pills (counterfeit pills) containing illegally made fentanyl, including counterfeit M-30 oxycodone (counterfeit M-30) pills, has risen sharply in the United States and has been increasingly linked to overdose deaths. In 2023, approximately 115 million counterfeit pills were seized in U.S. High Intensity Drug Trafficking Areas. However, clinical data on counterfeit pill-related overdoses are limited. Medical toxicology consultations during 2017-2022 from one U.S. Census Bureau Western Region hospital participating in the Toxicology Investigators Consortium Core Registry were analyzed. A total of 352 cases suspected to involve counterfeit M-30 pills, including 143 (40.6%) cases of fentanyl exposure and 209 (59.4%) cases of acute withdrawal were identified; consultations increased from three in 2017, to 209 in 2022. Patients aged 15-34 years accounted for 95 (67.4%) exposure cases. Among all patients with exposures, 81.1% were hospitalized, 69.0% of whom were admitted to an intensive care unit. Additional substances were detected in 131 (91.6%) exposures. Providing outreach to younger persons misusing prescription pills, improving access to and distribution of harm reduction tools including fentanyl test strips and naloxone, and promoting linkage of persons treated for overdose in hospitals to harm reduction and substance use treatment services are strategies to reduce morbidity associated with use of counterfeit M-30.

Law enforcement fentanyl seizures and overdose mortality in US counties, 2013–2020

BackgroundThe spread of illicitly manufactured fentanyl is driving steep increases in US overdose deaths. Fentanyl seizures are correlated with state-level opioid-related mortality; however, more granular seizure surveillance information has the potential to better inform overdose prevention and harm reduction efforts. MethodsUsing data on fentanyl pill and powder seizures from High Intensity Drug Trafficking Areas (HIDTA), we tested associations between seizure prevalence and overdose mortality, from 2013 to 2020. The primary exposure—seizure burden—was constructed by identifying counties having high (above the median) prevalence of pill, powder, or combined pill/powder seizure burden per 100,000 population. Poisson models accounted for county demographic, law enforcement and time trends. ResultsDuring the timeframe, there were 13,842 fentanyl seizures in 606 US counties. In adjusted models, counties with a high burden of pill or powder fentanyl seizures, or both (combined pills/powder) exhibited higher total overdose mortality than non-high burden counties (pills adjusted prevalence ratio [aPR]: 1.10 [95 % confidence interval [CI]: 1.08, 1.12]; powder aPR 1.12 [CI: 1.11, 1.13]; combined pills/powder aPR: 1.27 [CI: 1.25, 1.29]). A similar pattern of associations with fentanyl seizure burden was noted for overdose deaths involving synthetic opioids (pills [aPR]: 0.99 [CI: 0.96, 1.02]; powder aPR 1.29 [CI: 1.27, 1.30]; combined pills/powder aPR 1.55 [CI: 1.52, 1.58]). ConclusionsLaw enforcement data on fentanyl seizures predicts drug overdose mortality at the county-level. Integrating these data with more traditional epidemiologic surveillance approaches has the potential to inform community overdose response efforts.

Evaluation of dispensaries’ cannabis flowers for accuracy of labeling of cannabinoids content

BackgroundCannabis policies have changed drastically over the last few years with many states enacting medical cannabis laws, and some authorizing recreational use; all against federal laws. As a result, cannabis products are marketed in dispensaries in different forms, most abundantly as flowers intended for smoking and sometimes vaping. All samples used in this study were obtained directly from law enforcement. The sample collection process was facilitated and funded by the National Marijuana Initiative (NMI), part of the High-Intensity Drug Trafficking Area (HIDTA) program. This initial report focuses on cannabis flowers. Similar studies with other cannabis products will be the subject of a future report.MethodsA total of 107 Δ9-THC cannabis flower samples were collected by law enforcement from adult commercial use cannabis dispensaries, located in three different states (Colorado, Oregon, and California) and analyzed in this study for cannabinoid concentration. Samples were analyzed by GC-FID following our previously published procedure.DiscussionThe label claims for total Δ9-THC content ranged from 12.04 to 58.20% w/w, while GC-FID results showed a concentration ranging from 12.95 to 36.55% w/w. Of the evaluated 107 products, only 32 samples have Δ9-THC content within ± 20% of the labeled content. However, the remaining 75 samples were found to be out of the ± 20% acceptance criteria. The degree of agreement for the tested samples using ± 20% tolerance with label claims was only 30%. The results of this study indicate that there is a need for more stringent regulations to ensure that product labeling is accurate, as 70% of the evaluated products did not meet the ± 20% acceptance criteria. This highlights the importance of healthcare professionals and patients being vigilant about the Δ9-THC content, as inaccurate labeling of cannabis products could potentially result in adverse health effects. Furthermore, there is a pressing need for more rigorous regulation of commercial cannabis products in the United States.

NIDA on dramatic increase of mushroom seizures

From 2017 – 2022, law enforcement seizures across the United States of mushrooms containing psilocybin increased dramatically, according to a new study funded by the National Institute on Drug Abuse (NIDA). The number of law enforcement seizures increased from 402 seizures in 2017 to 1,396 in 2022. In addition, the total weight of psilocybin mushrooms seized by law enforcement increased from 226 kg (498 lbs.) seized in 2017 compared with 844 kg (1,861 lbs.) in 2022. This analysis, published in Drug and Alcohol Dependence, was led by researchers at New York University (NYU) Langone Health in New York City, and the University of Florida, Gainesville. The data used for the analysis were collected through the High Intensity Drug Trafficking Areas (HIDTA) program, a grant program aimed at reducing drug trafficking and misuse administered by the Office of National Drug Control Policy. Though law enforcement seizures do not necessarily reflect prevalence of use, they represent an indicator of the availability of illicit drugs. “We are in the middle of a rapidly evolving cultural, media, and legal landscape when it comes to psychedelics, and we need data to help shape informed and appropriate public health strategies,” said NIDA Director Nora D. Volkow, M.D., in announcing the research publication last week. “Moving forward, we must continue to track data on the availability of psychedelics, patterns in use, and associated health effects to guide efforts in promoting accurate education and reducing potential harms among people who do plan to use psychedelic drugs.” Adverse effects of psilocybin mushrooms, such as “bad trips,” are marked by “distorted thinking, perceptual changes, putting oneself in physical danger, and intense feelings of fear, anxiety, and confusion,” according to NIDA. “People who take psychedelic drugs like psilocybin may also experience short‐term side effects such as raised blood pressure and heart rate, agitation, confusion, vomiting, or nausea, which may be severe and require medical attention.” Joseph J. Palamar, Ph.D., M.P.H., associate professor at the NYU Grossman School of Medicine, co‐investigator on the NIDA‐funded National Drug Early Warning System (NDEWS), and lead author on the paper, said “Research studies suggesting its effectiveness in treating mental health issues and extensive positive media coverage may lead some people to seek ‘shrooms’ outside of medical contexts. People who use psilocybin outside of medical supervision need to be educated about risks associated with use.”

NIDA: Psilocybin mushroom seizures rose significantly

A National Institute on Drug Abuse (NIDA)‐funded study published in the journal Drug and Alcohol Dependence titled “National and Regional Trends in Seizures of Shrooms (Psilocybin) in the United States, 2017‐2022” reported a significant increase in law enforcement seizures of psilocybin mushrooms, also known as “magic mushrooms” or “shrooms,” in the United States from January 2017 to December 2022. The study is based on data from the White House Office of National Drug Control Policy's (ONDCP) High Intensity Drug Trafficking Areas (HIDTA) program, which tracks law enforcement seizures in hotspots across the country. Key findings include:

National and regional trends in seizures of shrooms (psilocybin) in the United States, 2017–2022

BackgroundPsilocybin, the principle psychoactive component in “shrooms”, is regaining acceptance in therapeutic settings, leading to media coverage of medical benefits associated with use. Possession is also becoming increasingly decriminalized throughout the United States. There is a lack of data on prevalence of shroom use, but trends in law enforcement seizure data can provide one indicator of shroom availability in US communities. We determined whether seizures of shrooms have shifted between 2017 and 2022. MethodsThis study examined national and regional trends in counts and total weight of shroom seizures reported to High Intensity Drug Trafficking Areas in the US between 2017 and 2022 (N=4526). ResultsThere were 402 seizures in 2017 compared to 1396 in 2022 with the plurality occurring in the Midwest (36.0%), followed by the West (33.5%). Between 2017 Quarter 1 (Q1) and 2022 Quarter 4 (Q4), the number of seizures increased by 368.9% (AQPC=7.0; 95 CI: 5.9–8.1) and there were significant increases in all four regions. In terms of weight, 226.0kg was seized in 2017 vs. 844.0kg in 2022, and the greatest total weight in seizures was in the West (1864.2kg, 42.6%), followed by the South (1831.9kg, 41.8%). Between 2017 Q1 and 2022 Q4, the total weight seized in the US increased by 2749.7% (AQPC=6.2, 95% CI: 0.3–12.4) and there were significant increases in all four regions. ConclusionsSeizures of shrooms have increased, suggesting that availability may be escalating; thus, increases in prevention efforts and harm reduction education are warranted.

Fostering Community-Engaged Research on Criminal Legal Innovations with Logic Models.

There is a persistent disconnect between research and practice, both in the social work profession as well as in the criminal legal system. Community-engaged research has been suggested as an approach to bridge this divide, but specific tools are needed to integrate research and practice efforts. This article presents three distinct logic model development processes that occurred in collaborative research and practice efforts in the context of criminal legal programming, including prosecutor-led diversion programs, a high-intensity drug court, and a multiagency justice and mental health collaborative. Logic model development incorporated multiple forms of program information using collaborative reflexivity, an approach focused on understanding the relationship between knowledge and power in the research process. For each program, the authors describe the context and process of logic model development, and how the logic models were used by both practitioners and researchers. The authors discuss how collaborative logic model development can facilitate community-engaged research, strengthen the research-practice connection, and advance applied social work scholarship.

Supply-side predictors of fatal drug overdose in the Washington/Baltimore HIDTA region: 2016-2020.

Rising rates of fentanyl- and polydrug-involved drug overdose deaths have prompted inquiry into the role of drug supply in fatal overdose outcomes in the United States. To date, however, there have been few empirical investigations of drug enforcement strategies on fatal overdose rates, despite knowledge that both drug use and supply are often geographically distributed. To address this limitation, we examined measures of drug enforcement as predictors of next-year fatal overdose rates in the Washington/Baltimore High Intensity Drug Trafficking Area (W/B HIDTA). We conducted mixed-effects models to examine the role of drug seizures and disruption in drug trafficking organizations (DTOs) and money laundering organizations (MLOs) on fatal overdose rates over a 5-year period (2016-2020) across 45 local jurisdictions in the W/B HIDTA region. Outcomes included any, opioid-involved, and fentanyl-involved fatal overdose. Adjusting for covariates, both the total number of drug seizures and amount of cocaine seized (in dosage units per capita) positively predicted next-year opioid- and fentanyl-involved fatal overdose rates. Disruption to DTO and MLO operations did not significantly predict next-year fatal overdose rates for any outcome. Supply-side enforcement activities alone may have limited impact on reducing fatal overdose rates, but may serve as important markers to identify communities at high risk of fatal overdose and facilitate targeted intervention. Our findings underscore the importance of comprehensive law enforcement approaches that extend beyond drug enforcement to integrate prevention, linkage to treatment, and harm reduction strategies as needed to address the overdose epidemic.

The Martinsburg Initiative: A Collaboration Between Public Safety, Public Health, and Schools to Address Trauma and Substance Use.

The Martinsburg Initiative (TMI) is a community-based model developed in Martinsburg, West Virginia, that implements a comprehensive approach to adverse childhood experiences and substance use prevention and mitigation by leveraging partnerships in public health and health care, public safety, and education. TMI receives coordinated federal funding and technical assistance from the Centers for Disease Control and Prevention, the Washington-Baltimore High Intensity Drug Trafficking Agency, and the National Association of County and City Health Officials to integrate evidence-based and promising strategies. It advances such strategies by translating them for implementation within the community, evaluating the reach and potential impact of the model, and by engaging key stakeholders. Preliminary results describing program reach and short-term outcomes collected for a subset of the interventions during implementation are presented. The model uses touchpoints across multiple community sectors in the city of Martinsburg to break the cycle of trauma and substance use across the life span.

Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021

BackgroundPrevalence of fentanyl-laced counterfeit prescription pills has been increasing in the US, possibly placing a wider population at risk for unintentional exposure. We aimed to determine whether there have been shifts in the number of fentanyl seizures and in the form of fentanyl seized in the US. MethodsWe examined quarterly national seizure data from High Intensity Drug Trafficking Areas to determine the number of drug seizures in the US containing fentanyl from January 2018 through December 2021. Generalized additive models were used to estimate trends in the number and weight of pill and powder seizures containing fentanyl. ResultsThere was an increase both in the number of fentanyl-containing powder seizures (from 424 in 2018 Quarter 1 [Q1] to 1539 in 2021 Quarter 4 [Q4], β = 0.94, p < 0.001) and in the number of pill seizures (from 68 to 635, β = 0.96, p < 0.01). The proportion of pills to total seizures more than doubled from 13.8% in 2018 Q1 to 29.2% in 2021 Q4 (β = 0.92, p < 0.001). Weight of powder fentanyl seizures increased from 298.2 kg in 2018 Q1 to 2416.0 kg in 2021 Q4 (β = 1.12, p = 0.01); the number of pills seized increased from 42,202 in 2018 Q1 to 2,089,186 in 2021 Q4 (β = 0.90, p < 0.001). ConclusionsSeizures of drugs containing fentanyl have been increasing in the US. Given that over a quarter of fentanyl seizures are now in pill form, people who obtain counterfeit pills such as those disguised as oxycodone or alprazolam are at risk for unintentional exposure to fentanyl.

Using Surveillance With Near-Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019.

In 2019, Connecticut launched an opioid overdose-monitoring program to provide rapid intervention and limit opioid overdose-related harms. The Connecticut Statewide Opioid Response Directive (SWORD)-a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups-required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients' status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD's near-real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.

Longitudinal Opioid Surveillance Project Involving Toxicologic Analysis of Postmortem Specimens from 9 Counties in Michigan Suggests the Discovery of New High-Intensity Drug Trafficking Areas.

Acetyl fentanyl (AF) is a Schedule I fentanyl analog that has been increasingly seen in heroin and fentanyl polydrug toxicity overdoses in Michigan (MI). Drug users are often unaware of the presence of AF in their drugs because it is often sold mixed into or disguised as heroin. High levels of AF in heroin drug products can cause increased incidence of overdose. This article describes data from a longitudinal opioid surveillance program and details 102 decedents in MI who were found to have evidence of heroin in their postmortem blood. A large portion of these decedents were also found to have evidence of fentanyl and AF. Our data further show significant overlap in incidence rates of AF and heroin-related overdose deaths in several MI counties, suggesting that AF is becoming enmeshed in heroin trafficking. Furthermore, we report unprecedented high incidence rates of AF and heroin-related overdose deaths in Calhoun county, and we propose that it is a high-intensity drug trafficking area. Highways US-131 and US-31 are likely used to transport these drugs. More study is needed into the drug trafficking trends in MI to ascertain drug sources and monitor the ever developing and dangerous polydrug heroin combinations.

Marijuana, Methamphetamine Confiscations Rose During COVID-19 Pandemic

Back to table of contents Previous article Next article Clinical & ResearchFull AccessMarijuana, Methamphetamine Confiscations Rose During COVID-19 PandemicTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:28 Apr 2021https://doi.org/10.1176/appi.pn.2021.5.9AbstractDrug seizures by law enforcement dipped in the early days of the pandemic, then rebounded last summer.iStock/iKaleb KroetschLaw enforcement confiscation of illegal drugs dipped early in the COVID-19 pandemic, then began to rise, according to a study in Drug and Alcohol Dependence. These changes were most pronounced for marijuana and methamphetamine, where seizures of these drugs exceeded pre-COVID-19 numbers in August of last year.“While drug seizures aren’t a great indicator of drug use, they can serve as an indicator for drug availability,” said lead author Joseph J. Palamar, Ph.D., M.P.H., an associate professor in the Department of Population Health at New York University Langone Medical Center.Palamar and colleagues analyzed law enforcement seizures of illegal drugs in five key regions in the Office of National Drug Control Policy’s High Intensity Drug Trafficking Areas Program: Chicago, Ohio, New Mexico, North Florida, and Washington, D.C./Baltimore. They examined monthly seizure trends in confiscations of cocaine, fentanyl, heroin, marijuana, and methamphetamine from March 2019 (one year before the COVID-19 pandemic) to September 2020.The overall number of seizures was less in April 2020 compared with March 2019, and then began to climb. In August 2020, there were 2,088 drug confiscations overall compared with 1,777 in June 2019, the peak of pre-pandemic seizures.Drug confiscations should not be taken as an indication of drug use, but of drug availability, says Joseph J. Palamar, Ph.D., M.P.H.New York University Langone Health“I wasn’t surprised that the number of seizures decreased early in the pandemic, but I was a bit surprised that seizures in late summer of 2020 surpassed peaks in 2019,” Palamar told Psychiatric News. “It makes me wonder whether drug availability has really increased that much or if law enforcement merely caught up from [re]laxed activity earlier in the pandemic.”Marijuana and methamphetamine seizures drove the overall increase in drug confiscations. Marijuana confiscations climbed to 665 in August 2020, compared with a pre-pandemic high of 614 in March 2019. Law enforcement seized 11,194 kg of marijuana in August 2020, compared with the highest pre-COVID weight of 4,744 kg in December 2019. Methamphetamine seizures also increased after an initial decline early in the pandemic. In August 2020 there were 476 methamphetamine confiscations, compared with 385 in June 2019. However, the weight of methamphetamine seized did not significantly change. Before the pandemic hit, marijuana and methamphetamine confiscations had been declining, but the rebound in confiscations of both drugs in the summer of 2020 were enough to derail the downward trend.Fentanyl seizures dipped in April 2020 and then rebounded. However, the April decline was not enough to disrupt an overall upward trend in confiscations from the beginning of the study, leading the researchers to conclude that fentanyl confiscations have increased over time. Cocaine and heroin seizures dipped at the start of the pandemic and then rebounded, but confiscations of both drugs declined over time.Palamar emphasized that drug confiscations should not be considered an indication of illicit drug use. However, some of the data in this study may dovetail with those of studies that track use.“Some studies suggest that a lot of people who already used marijuana increased use during the pandemic. If this is the case, then there may be higher demand, even if the increase in demand is based on the same people who [used marijuana before the pandemic],” he said. “Methamphetamine use has [also] been increasing again in recent years, especially among people who use heroin.”This study was supported by the National Institute on Drug Abuse. ■“Shifts in Drug Seizures in the United States During the COVID-19 Pandemic” is posted here. ISSUES NewArchived

Shifts in drug seizures in the United States during the COVID-19 pandemic

BackgroundLittle is known regarding how the COVID-19 pandemic has affected patterns of drug use in the United States. Because drug seizures can serve as a proxy for drug availability, we examined shifts in drug seizures in the US during the pandemic. MethodsWe examined trends in seizures of marijuana, cocaine, methamphetamine, heroin, and fentanyl within five High Intensity Drug Trafficking Areas—Washington/Baltimore, Chicago, Ohio, New Mexico, and North Florida. Trends were examined for number and total weight of seizures from March 2019 through September 2020 using Joinpoint regression. ResultsSignificant decreases in seizures involving marijuana (β = −0.03, P = 0.005) and methamphetamine (β = −0.02, P = 0.026) were detected through April 2020, and then seizures of marijuana (β = 0.10, P = 0.028) and methamphetamine (β = 0.11, P = 0.010) significantly increased through September 2020. The number of seizures involving marijuana and methamphetamine peaked in August 2020, exceeding the highest pre-COVID-19 number of seizures. Fentanyl seizures increased overall (β = 0.05, P < .001), but did not significantly drop during the start of COVID-19, and significant changes were not detected for cocaine or heroin. We also detected a significant increase in weight of marijuana seized from April through September 2020 (β = 0.40, P = .001). The weight of marijuana seized in August 2020 exceeded the highest pre-COVID-19 weight. ConclusionThe COVID-19 pandemic was associated with an immediate decrease in marijuana and methamphetamine seizures, and then increases throughout 2020 with some months exceeding the number (and weights) of seizures from the previous year. More research is warranted to determine the extent to which these seizures reflect changes in drug use.

Drug‐related harm coinciding with income assistance payments: results from a community‐based cohort of people who use drugs

Income assistance is critical to the health and wellbeing of socio-economically marginalized people who use illicit drugs (PWUD). However, past literature paradoxically identifies unintended increases in drug-related harm coinciding with synchronized payments that may magnify signals for drug use. The scope of such harm has not been fully characterized among non-institutionalized populations. This study examined socio-demographic, health and drug use-related correlates of payment-coincident drug-related harm. This observational study uses data from prospective community-based longitudinal cohorts of PWUD between December 2013 and May 2018. Vancouver, British Columbia, Canada. A total of 1604 PWUD receiving monthly income assistance. Our sample included 586 (36.5%) women, 861 (53.7%) non-white participants and 685 (42.7%) people living with HIV. The primary outcome was a self-reported composite measure of drug-related harm in the past 6months coinciding with income assistance, including higher-frequency substance use, non-fatal overdose and service barriers or interruptions. Subanalyses disaggregated this outcome. Payment-coincident drug-related harm was reported among 77.7% of participants during the study period. In multivariable models, key correlates positively and significantly associated with payment-coincident harm included: street-based income generation [adjusted odds ratio (aOR)=1.48, 95% confidence interval (CI)=1.26-1.74, P<0.001], sex work (aOR=1.66, 95% CI=1.35-2.04, P<0.001), illegal income generation (aOR=1.57, 95% CI=1.35-1.83 P<0.001), homelessness (aOR=1.34, 95% CI=1.13-1.58, P<0.001), exposure to violence (aOR=1.31, 95% CI=1.03-1.66, P=0.032), daily crack cocaine use (aOR=1.99, 95% CI=1.59-2.50, P<0.001), heavy alcohol use (aOR=1.64, 95% CI=1.37-1.97, P<0.001) and injection drug use (aOR=2.55, 95% CI=2.01-3.23, P<0.001). In subanalyses, specific harms were more likely among individuals reporting social, structural and health vulnerabilities. In Vancouver, Canada, people who use illicit drugs who receive income assistance report high prevalence of payment-coincident drug-related harm, particularly people experiencing socioeconomic and structural marginalization or engaging in high-intensity drug use.

Local Health Department Partnerships to Address Opioid Use and Overdose Prevention.

Local Health Department Partnerships to Address Opioid Use and Overdose Prevention.

Moving into an urban drug scene among people who use drugs in Vancouver, Canada: Latent class growth analysis.

BackgroundUrban drug scenes are characterized by high prevalence of illicit drug dealing and use, violence and poverty, much of which is driven by the criminalization of people who use illicit drugs (PWUD) and the associated stigma. Despite significant public health needs, little is understood about patterns of moving into urban drug scenes among PWUD. Therefore, we sought to identify trajectories of residential mobility (hereafter ‘mobility’) among PWUD into the Downtown Eastside (DTES), an urban neighbourhood with an open drug scene in Vancouver, Canada, as well as characterize distinct trajectory groups among PWUD.MethodsData were derived from three prospective cohort studies of community-recruited PWUD in Vancouver between 2005 and 2016. We used latent class growth analysis (LCGA) to identify distinct patterns of moving into the DTES among participants residing outside of DTES at baseline. Multivariable multinomial logistic regression was used to determine baseline factors associated with each trajectory group.ResultsIn total, 906 eligible participants (30.9% females) provided 9,317 observations. The LCGA assigned four trajectories: consistently living outside of DTES (52.8%); early move into DTES (11.9%); gradual move into DTES (19.5%); and move in then out (15.8%). Younger PWUD, those of Indigenous ancestry, those who were homeless or living in a single-room occupancy hotel (SRO), and those injecting drugs daily were more likely to move in then out of DTES (all p<0.05). Living in an SRO, daily injection drug use, and recent incarceration were also positively associated with early mobility (all p<0.05).ConclusionsNearly half of the participants moved into the DTES. Younger PWUD and Indigenous peoples appeared to have particularly high mobility, as did those with markers of social-structural vulnerability and high intensity drug use. These findings indicate a need to tailor existing social and health services within the DTES and expand affordable housing options outside the DTES.

Opioid Seizures by Law Enforcement in Relation to Emergency Room Visits

Opioid Seizures by Law Enforcement in Relation to Emergency Room Visits

Substance use patterns and HIV-1 RNA viral load rebound among HIV-positive illicit drug users in a Canadian setting.

Active illicit drug use can present a barrier to the medical management of HIV infection by complicating adherence to antiretroviral therapy (ART). Plasma HIV-1 RNA viral load (VL) rebound, defined as a period of detectable HIV VL following ART and VL suppression, can lead to the generation of viral resistance and potential treatment failure. We sought to investigate the contribution of substance use patterns on rates of VL rebound. We used data from the ACCESS study, a long-running community-recruited prospective cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, a setting of universal no-cost HIV treatment. We analysed time to VL rebound (that is, two consecutive observations ≥1,000 copies/ml) after ART initiation and sustained viral suppression (that is, two consecutive observations <50 copies/ml) using extended Cox regression models with a recurrent events framework. Between May 1996 and November 2013, 564 ART-exposed participants achieved at least one instance of VL suppression and contributed 1,893.8 person-years of observation. Over follow-up, 198 (35.1%) participants experienced ≥ one instance of VL rebound. In adjusted analyses, VL rebound was associated with younger age (adjusted hazard ratio [AHR] =0.97, 95% CI: 0.95, 0.98), heroin injection (≥ daily versus < daily, AHR =1.52, 95% CI: 1.01, 2.30), crack use (≥ daily versus < daily, AHR = 1.73, 95% CI: 1.08, 1.92) and heavy alcohol use (≥ four versus < four drinks/day, AHR =1.97, 95% CI: 1.17, 3.31). The present study suggests that in addition to heavy alcohol use, high-intensity illicit drug use, particularly ≥ daily heroin injection and ≥ daily crack smoking are risk factors for VL rebound. In addition to the impact of high-intensity drug use on health-care engagement and ART adherence, some evidence exists on the direct impact of psychoactive substances on ART metabolism and the natural progression of HIV disease. At-risk individuals should be provided additional supports to preserve virological control and maintain the benefits of ART.

Neonatal Abstinence Syndrome (NAS) in Southwestern Border States: Examining Trends, Population Correlates, and Implications for Policy.

Introduction Neonatal abstinence syndrome (NAS) is withdrawal syndrome in newborns following birth and is primarily caused by maternal drug use during pregnancy. This study examines trends, population correlates, and policy implications of NAS in two Southwest border states. Materials and Methods A cross-sectional analysis of Hospital Inpatient Discharge Data (HIDD) was utilized to examine the incidence of NAS in the Southwest border states of Arizona (AZ) and New Mexico (NM). All inpatient hospital births in AZ and NM from January 1, 2008 through December 31, 2013 with ICD9-CM codes for NAS (779.5), cocaine (760.72), or narcotics (760.75)were extracted. Results During 2008-2013 there were 1472 NAS cases in AZ and 888 in NM. The overall NAS rate during this period was 2.83 per 1000 births (95% CI 2.68-2.97) in AZ and 5.31 (95% CI 4.96-5.66) in NM. NAS rates increased 157% in AZ and 174% in NM. NAS newborns were more likely to have low birth weight, have respiratory distress, more likely to have feeding difficulties, and more likely to be on state Medicaid insurance. AZ border region (border with Mexico) had NAS rates significantly higher than the state rate (4.06 per 1000 births [95% CI 3.68-4.44] vs. 2.83 [95% CI 2.68-2.97], respectively). In NM, the border region rate (2.09 per 1000 births [95% CI 1.48-2.69]) was significantly lower than the state rate (5.31 [95% CI 4.96-5.66]). Conclusions Despite a dramatic increase in the incidence of NAS in the U.S. and, in particular, the Southwest border states of AZ and NM, there is still scant research on the overall incidence of NAS, its assessment in the southwest border, and associated long-term outcomes. The Healthy Border (HB) 2020 binational initiative of the U.S.-Mexico Border Health Commission is an initiative that addresses several public health priorities that not only include chronic and degenerative diseases, infectious diseases, injury prevention, maternal and child health but also mental health and addiction. The growing opioid epidemic and rise in NAS cases in the Southwest border, as partially shown in this study, provides another opportunity to track health illnesses and outcomes in the Southwest border, especially because there are targeted resources through High Intensity Drug Trafficking Areas (HIDTA) funding.