Street Drug Use Research Articles

Hepatitis C Virus Elimination in Methadone-treated Patients: Implementation of Hepatology Clinic in a Methadone Treatment Program.

Patient ignorance and bureaucratic obstacles prevent initiation of hepatitis C virus (HCV) treatment in patients participating in methadone treatment program. Despite high safety and efficacy of currently available oral medications, the rate of patient-initiated treatment remains low. We evaluated the impact of an interventional program on treatment success rate and factors associated with treatment engagement. An intervention performed from 2018 to 2020 included an on-site Fibroscan and hepatologist evaluation, anti-viral HCV treatment initiation, and close support and follow-up by a dedicated team. Demographic and medical data were collected and comparison between patients who completed vs. patients who did not complete HCV treatment was done. Fifty-nine out of 74 HCV polymerase chain reaction-positive patients (79.7%) were willing and capable of undergoing on-site hepatologist and Fibroscan evaluations. Twelve (25%) of the participants had cirrhosis, 2 of whom were decompensated. Fifty of the 57 patients that got an anti-viral medication prescription (87%) initiated the treatment. Premature treatment discontinuation was rare (3 patients), intention-to-treat sustain virologic response (SVR) rate was 81% and per-protocol SVR rate was 97%. The rate of treatment initiation during the intervention was significantly higher than the patients' self-initiation rate (44 vs 12 patients). The main factors associated with successful completion of the care cascade was full abstinence from street drugs for 6 months before treatment initiation. Installing a hepatology clinic in an methadone treatment program center was associated with a 3-fold increase in the HCV treatment, with high adherence to treatment levels, and a high SVR rate. The main factor associated with low engagement to treatment was ongoing street drug use.

Associations between psychosocial factors and antiretroviral therapy outcomes differ by gender and sexual orientation among people living with HIV in British Columbia, Canada

ABSTRACT Little is known about how the co-occurrence of psychosocial factors affect sub-populations of people living with HIV (PLWH). We used cross-sectional data from 999 PLWH, aged ≥19, accessing antiretroviral therapy (ART) in British Columbia, Canada (2007–2010) to examine associations between psychosocial factors and ART-related outcomes separately for trans/cis inclusive women; heterosexual men; and gay, bisexual, and other men who have sex with men (gbMSM). Multivariable logistic regression examined associations between psychosocial factors (0–3): any violence in the past 6 months, depressive symptoms in the past week, and current street drug use (heroin, crack, meth or speedball) with sub-optimal adherence (outcome 1: average annual ART adherence <95% from interview until end of follow-up, death, or December 31st, 2018) and ever viral rebound (outcome 2) adjusting for potential confounders. Of 999 PLWH (264 women, 382 heterosexual men, and 353 gbMSM), women and heterosexual men had significantly higher median counts than gbMSM. Overall, higher counts were associated with sub-optimal adherence (adjusted odds ratio [aOR] = 1.26/1-unit increase, 95%CI = 1.07–1.49). All effect estimates were of a greater magnitude among gbMSM, but not significant for women or heterosexual men, highlighting the need for population (e.g., gender and sexual orientation)-centered care and research.

Improving Harm Reduction Services: A Qualitative Study on the Perspectives of Highly Marginalized Persons Who Inject Drugs in Montreal

Harm reduction (HR) is an alternative to the moralization of drug use and a pragmatic public health approach aimed at minimizing harms associated with use. This study sought to gain the perspectives of persons who inject drugs (PWID) on the adequacy of services provided by HR organizations in Montreal. Twenty-two semi-structured interviews and two focus groups were conducted with 30 participants. Some of the key advantages of HR perceived by participants include access to injection equipment, psychosocial support, and reduced social isolation. However, many wanted more opportunities for social insertion and greater value to be placed on their knowledge and life experiences (e.g., experiential knowledge of the street scene, drug use, sex work, or homelessness). This study suggests that PWID who access HR services in Montreal are interested in paid work opportunities in environments that promote power sharing, and activities that are conducted and managed by and for them.

Associations Among Health Behaviors and Psychosocial Outcomes in Adolescent and Young Adult Cancer Survivors.

Purpose: Adolescents and young adults (AYA) experience challenges both during and after their cancer treatment. Health behaviors are important contributors to health, yet little research examines health behaviors in AYA cancer survivors. We examined frequencies of health behaviors and associations between health behaviors, psychosocial, and clinical factors in AYA cancer survivors. Methods: Participants were survivors of AYA cancer (n = 60; 38.3% male; mean age = 25.3 years [standard deviation, SD = 4.6]; mean years since therapy completion = 9.0 [SD = 4.2]) from the Alberta Children's Hospital (ACH). Survivors were 13-21 years old at the time of diagnosis. Measures included demographic and clinical data, and the ACH Long-Term Survivor's Questionnaire. Health behaviors were compared with a control group (n = 600) using data from the 2017 Canadian Community Health Survey. Frequencies, conditional logistic regression, and logistic regression analyses were conducted. Results: Compared with controls, survivors reported engaging in physical activity (91.5% vs. 87.5%; odds ratio [OR] = 0.87, 95% confidence interval [CI] = 0.34-2.24; p = 0.77), smoking tobacco (15.3% vs. 19.7%; OR = 1.85, 95% CI = 0.89-3.85; p = 0.10), and street drug use (27.6% vs. 36.5%; OR = 1.60, 95% CI = 0.88-2.91; p = 0.12) at the same rate. Survivors reported binge drinking significantly less (61.0% vs. 76.6%; OR = 0.53, 95% CI = 0.30-0.92; p = 0.024) than controls. Logistic regression analyses revealed a significant model predicting binge drinking [χ2(5, 58) = 23.17, p < 0.001] with greater time off treatment, fear of another health condition, and higher mean body mass index emerging as significant predictors. Conclusion: AYA cancer survivors engage in risky health behaviors at rates similar to their peers. Further research is needed to understand factors mediating survivors' decision to participate in risky health behaviors.

Vulnerability of a young adult dental population in Los Angeles

A survey found high levels of vulnerability in a Los Angeles young adult dental population presenting for third molar extraction. A high proportion of them suffered abusive incidents as children, lived in nonnutritive households, were exposed to violence and were fiscally disadvantaged. The young adults had high prevalence of cigarette, alcohol and street-drug use as well as behavioral health issues, depression, nervousness and anxiety. Dentists should be aware of such vulnerabilities and their long-term consequences.

"It's Helped Me a Lot, Just Like to Stay Alive": a Qualitative Analysis of Outcomes of a Novel Hydromorphone Tablet Distribution Program in Vancouver, Canada.

North America is experiencing an overdose crisis driven by fentanyl, related analogues, and fentanyl-adulterated drugs. In response, there have been increased calls for “safe supply” interventions based on the premise that providing a safer alternative (i.e., pharmaceutical drugs of known quality/quantity, non-adulterated, with user agency in consumption methods) to the street drug supply will limit people’s use of fentanyl-adulterated drugs and reduce overdose events. This study examined outcomes of a hydromorphone tablet distribution program intended to prevent overdose events among people who use drugs (PWUD) at high risk of fatal overdose. Semi-structured qualitative interviews were conducted with 42 people enrolled in the hydromorphone distribution program. Additionally, over 100 h of ethnographic observation were undertaken in and around the study site. Transcripts were coded using NVivo and based on categories extracted from the interview guides and those identified during initial interviews and ethnographic fieldwork. Analysis focused on narratives around experiences with the program, focusing on program-related outcomes. Our analysis identified the following positive outcomes of being enrolled in the hydromorphone tablet distribution program: (1) reduced street drug use and overdose risk, (2) improvements to health and well-being, (3) improvements in co-management of pain, and (4) economic improvements. Our findings indicate that the hydromorphone distribution program not only is effective in responding to the current overdose crisis by reducing people’s use of illicit drugs but also addresses inequities stemming from the intersection of drug use and social inequality. Safe supply programs should be further implemented and evaluated in both urban and rural setting across North America as a strategy to reduce exposure to the toxic drug supply and fatal overdose.

Nurse home visiting and prenatal substance use in a socioeconomically disadvantaged population in British Columbia: analysis of prenatal secondary outcomes in an ongoing randomized controlled trial.

Nurse-Family Partnership (NFP) involves public health nurses providing frequent home visits from early pregnancy until children reach age 2 years, focusing on first-time parents experiencing socioeconomic disadvantage. Our aim was to evaluate NFP's effectiveness in improving child and maternal health. We conducted an analysis of prenatal secondary outcomes in an ongoing randomized controlled trial in British Columbia; the data used in this analysis were collected from January 2014 to May 2017. Participants were pregnant girls and women aged 14-24 years who were preparing to parent for the first time and experiencing socioeconomic disadvantage. They were randomly allocated 1:1 to the intervention (NFP plus existing services) or control group (existing services). Prespecified prenatal secondary outcome indicators were changes in use of nicotine cigarettes and alcohol use by 34-36-weeks' gestation. We also report on prespecified exploratory cannabis and street drug use measures. We used mixed-effect models for longitudinal and clustered data to estimate intervention effects. Analyses were by intention to treat. The median gestational age at baseline for the 739 participants (368 participants in the intervention group, 371 in the comparison group) was 20 weeks, 6 days. By 34-36 weeks' gestation, NFP significantly reduced cigarette counts (over the past 2 d) (difference in changes [DIC] of count -1.6, 95% confidence interval [CI] -6.4 to -1.3) in those who smoked. NFP also significantly reduced rates of prenatal cannabis use (DIC -6.4, 95% CI -17.0 to -1.7), but not rates of street drug or "any" substance use. While we observed decreased rates of cigarette and alcohol use in both groups (DIC of proportions -2.8, 95% CI -15.3 to 0.6; DIC -0.5, 95% CI -8.7 to 1.8, respectively), these changes were not statistically significant. We found no evidence that NFP was effective in reducing rates of prenatal cigarette and alcohol use; however, it led to reduced prenatal cannabis use, and in smokers it led to modest reductions in cigarette use. NFP may therefore hold promise for reducing some types of prenatal substance use in disadvantaged populations. Trial registration: ClinicalTrials.gov, no. NCT01672060.

"Something that actually works": Cannabis use among young people in the context of street entrenchment.

BackgroundCannabis is one of the most widely used substances among vulnerable young people (<26 years of age) experiencing street entrenchment. Although previous research has documented the role cannabis can play in harm reduction, substance use and mental health treatment and pain management, this research has predominantly been quantitative and focused on adult drug-using populations. Little qualitative work has examined how young people who use drugs understand, experience, and engage with cannabis in the context of street entrenchment and drug use trajectories that include the use of other substances such as alcohol, opioids and crystal methamphetamine (meth).MethodsSemi-structured, in-depth qualitative interviews were conducted between 2017 and 2019 with 56 young people recruited from a cohort of street-involved youth in Vancouver, Canada. We also conducted 13 interviews with 12 youth-focused care providers across the same time period. Interview data were triangulated by drawing on the findings of a program of anthropological research conducted by the senior author since 2008. Interviews were transcribed verbatim and thematic analysis was conducted.ResultsThe vast majority of study participants engaged in daily, intensive cannabis use at the same time as they cycled on and off other substances that were perceived as much more harmful (primarily alcohol, fentanyl, heroin and meth). While most participants derived significant pleasure from the use of cannabis, no participants in our study described using cannabis for purely recreational purposes. A number of participants explicitly framed cannabis as a form of mental health and substance use treatment that was more effective and “healthier” than the long-term use of psychopharmaceuticals and medication-assisted substance use treatment (e.g., opioid agonist therapies). Cannabis use was also understood to ameliorate some of the harms of, or even facilitate transitions out of, periods of street-based homelessness. While the majority of our participants highlighted the positive effects of regular cannabis consumption, some described how intensive cannabis use could generate significant harms.ConclusionIn the context of the recent legalization of non-medical cannabis use in Canada and amid ongoing overdose and housing crises, it is imperative that future policy and programming interventions and provider education and training be responsive to the ways in which vulnerable youth in our setting are actively using cannabis to navigate their everyday lives and healthcare needs.

Prevalence of adverse childhood experiences (ACE) in the Czech Republic

A cross-sectional survey was undertaken to estimate the prevalence of child maltreatment and adverse childhood experiences in the Czech Republic, as data on these is scarce. The survey was conducted among 1760 randomly selected students from five Czech universities. Participants filled in the adverse childhood experiences survey instrument. The results showed that the prevalence of child maltreatment and other adverse childhood experiences is high: emotional abuse was reported by 20.7%, physical abuse by 17.1%, sexual abuse by 6.4%, and physical neglect by 8.0%. Household dysfunction was also high, with household street drug use reported by 4.9%, alcohol misuse by 15.3%, mental disorder by 13.4%, parental violence by 22.1% and parental separation by 23%. Thirty-eight per cent had not experienced any adverse childhood experience, while 9.9% reported experiencing four or more types of adverse childhood experiences. There was a significant association between adverse childhood experiences and health-harming behaviours such as suicide attempt, drug use, risky sexual behaviour and tobacco use. The findings suggest that there is a need to invest in prevention programmes.

1290. Community Screening and Education for HIV and Hepatitis C (HCV) infection in South Texas with Rapid Point of Care Testing and a Mobile Phone Application (app)

BackgroundHIV and HCV infection cause considerable morbidity and mortality if untreated. The southern United States has the highest burden of new HIV diagnoses nationwide. Approximately 60% of hepatocellular carcinoma (HCC) in the United States is due to HCV. HCC incidence rates are the fastest growing among all cancers in Texas (TX). We aimed to use community screening events to provide additional diagnostic opportunities and surveillance data for HIV/HCV and to evaluate an HIV/HCV app to optimize public health education and prevention.MethodsTwo community HIV/HCV screening/education events occurred in April 2019 in the border city of Laredo, TX (at a community park) and San Antonio, TX (on a university campus). Those screened for HIV/HCV using point of care rapid tests completed a demographic and risk factor questionnaire. HIV/HCV education was offered to attendees via an app with a teach-back feature to assess short-term knowledge gains in specific areas: HIV and HCV cure, body organ impacted by HCV, HCV transmission, HCV symptoms.ResultsAttendees: Laredo event—approximately 260 people; San Antonio event approximately 100 people. 60 people were screened for HIV and HCV. 77% were Hispanic, 63% were female, 68% were 18–25 years old, 63% reported not having a primary care provider. One HCV seroreactive case was identified and linked to care. The most commonly reported risk factors were having tattoos (43%) and body piercing (37%). Other risk factors included street drug use (12%), home finger stick blood checks (12%), dental surgery outside the United States (12%). Fifty-three people utilized the HIV/HCV education app. 91% correctly identified that HIV cannot be cured, 87% correctly identified that HCV impacts the liver and that a test can confirm HCV infection. 81% correctly identified how HCV can be transmitted and 79% corrected identified that HCV can be cured. The app was rated 4.8/5, as “very useful” on a Likert scale.ConclusionFeatures of those screened included not being engaged in primary care, having risk factors for both HCV and HIV infection and the majority being young adults. The HIV/HCV mobile phone app was an acceptable education tool for those who utilized it. Appropriately developed and implemented apps can be effective in teaching key knowledge points about HIV/HCV infection.Disclosures All authors: No reported disclosures.

Masculine identity, street capital and sexual practices of a Chinese young man in Canada

ABSTRACTChinese people are currently the second largest visible minority group living in Canada; however, little is known about the sexual practices of Chinese youth living in Canada. Using a case study, we applied Bourdieu’s theory of social practise to illustrate how the sexual practices of a young Chinese immigrant man, Matthew, were shaped by his primary and secondary habituses, the cultural capital he held and competed for in each of the social fields he engaged in, and the prevailing patriarchal and heteronormative values in Canadian society (meta-field) that promote sexual conquests, hegemonic masculinity and homosocial solidarity. To develop effective sexual health promotion for Chinese youth living in Canada, multidisciplinary collaboration is needed to address the dynamic interplay of complex structural conditions that limit racialised young immigrant men’s options in life and put them at increased risk of engaging in street violence, alcohol and drug use and unsafe sexual practices.

Implications of use of opioid-containing analgesics for palliation of acute dental pain.

Initial palliation of acute dental pain with an opioid-containing pain reliever (OPR) is inappropriate but more likely to occur among the under- and uninsured who are unable to access the customary resources for dental care. To assess the implications of palliation with an OPR, the authors determined the prevalence of several health attributes and socioeconomic status (SES) of patients taking prescription or over-the-counter (OTC) palliative medications before they presented to an academically affiliated dental clinic for definitive treatment of acute dental pain. Prior palliation with any OPR/antibiotic combination was compared with a self-reported mood disorder, use of a psychotherapeutic or street drug, low SES (on Medicaid or self-payer), or high SES (having commercial dental insurance). Palliative medications were being taken by 34 percent of 851 patients including 20 percent who were taking an OPR. Use of any palliative prescription medication was significantly associated with low SES (odds ratio: 1.25; 95%; confidence interval: 1.35-2.88; p = 0.004). By comparison, high SES patients were significantly more likely to have used OTC analgesics or no medication (p < 0.001). Significantly more low SES patients self-reported mood disorders and street drug use (p = 0.048 and p = 0.019), respectively. Patients taking OPRs included those with self-reported mood disorders or use of a psychotherapeutic or street drug. Palliation of acute dental pain with OPRs cannot resolve the underlying dental condition and contributes to drug misuse and adverse interactions. Preferable palliation should utilize combinations of non-OPR analgesics. These have fewer risks and may provide an incentive to seek definitive dental treatment.

Assessing the longitudinal stability of latent classes of substance use among gay, bisexual, and other men who have sex with men

BackgroundAssociation between substance use and HIV-risk among gay and bisexual men (GBM) is well documented. However, their substance use patterns are diverse, and it is unknown whether self-reported use patterns are stable over time. MethodsSexually-active GBM, aged >16 years, were recruited in Metro Vancouver using respondent-driven sampling and followed across 5 study visits at six-month intervals (n = 449). To identify distinct patterns of substance use and their longitudinal stability, Latent Transition Analysis (LTA) was conducted for drugs reported by at least 30 participants. Intraclass correlation coefficients (ICC) quantified the stability of class assignments. ResultsSix classes characterizing ‘limited drug use’ (i.e., low use of all drugs, except alcohol), ‘conventional drug use’ (i.e., use of alcohol, marijuana, and tobacco), ‘club drug use’ (i.e., use of alcohol, cocaine, and psychedelics), ‘sex drug use’ (i.e., use of alcohol, crystal meth, GHB, poppers, and erectile dysfunction drugs), ‘street drug use’ (i.e., use of alcohol and street opioids) and ‘assorted drug use’ (i.e., use of most drugs) were identified. Across five visits (2.5 years), 26.3% (n = 118/449) of GBM transitioned between classes. The prevalence of limited use trended upwards (Baseline:24.5%, Visit 5:28.3%, p < 0.0001) and assorted use trended downwards (13.4%–9.6%, p = 0.001). All classes had strong longitudinal stability (ICC > 0.97). ConclusionThe stability of latent substance use patterns highlight the utility of these measures in identifying patterns of substance use among people who use drugs – potentially allowing for better assessment of these groups and interventions related to their health.

A latent class analysis of substance use and culture among gay, bisexual and other men who have sex with men

Assessments of gay and bisexual men’s substance use often obscures salient sociocultural and identity-related experiences related to how they use drugs. Latent class analysis was used to examine how patterns of substance use represent the social, economic and identity-related experiences of this population. Participants were sexually active gay and bisexual men (including other men who have sex with men), aged ≥ 16 years, living in Metro Vancouver (n = 774). LCA indicators included all substances used in the past six months self-reported by more than 30 men. Model selection was made with consideration to model parsimony, interpretability and optimisation of statistical criteria. Multinomial regression identified factors associated with class membership. A six-class solution was identified representing: ‘assorted drug use’ (4.5%); ‘club drug use’ (9.5%); ‘street drug use’ (12.1%); ‘sex drug use’ (11.4%); ‘conventional drug use’ (i.e. tobacco, alcohol, marijuana; 25.9%); and ‘limited drug use’ (36.7%). Factors associated with class membership included age, sexual orientation, annual income, occupation, income from drug sales, housing stability, group sex event participation, gay bars/clubs attendance, sensation seeking and escape motivation. These results highlight the need for programmes and policies that seek to lessen social disparities and account for social distinctions among this population.

Street drug use among emergency patients in a Public Hospital in Turkey.

Country-specific numbers of street drug (SD) users are well documented. However, little data exists regarding these patients' clinical presentations and outcomes in the emergency department (ED). Therefore, management of these patients in the emergency setting is still a subject of debate. The aim of this study is to determine the symptoms and signs of SD users presenting to the ED, and to report the substances, treatments, and outcomes. In this single-center study, symptoms, clinical findings, diagnoses, and outcomes of patients who reported to have used SDs or were diagnosed as SD users were investigated within a 1-year study period. Chi-square and Mann-Whitney U tests were performed to compare independent variables. Mean age of the 425 study patients was 25 ± 9 years (range: 12-64 years), and 6.1% (n = 26) of the patients were females. SDs used before presentation to the ED were mostly synthetic cannabinoids and "ecstasy." Overall prevalence of SD user admissions in ED was 0.24%. The most common presenting complaint was weakness/faintness in 21.1% (n = 90). Depressed level of consciousness was the most common physical sign (33.3%, n = 142). Incidences of altered mental status were significantly higher among ecstasy and/or bonsai users (n = 14, 27.5%; P = 0.027 and n = 46, 64.8%; P < 0.001, respectively), compared to other SD users. While 23.1% (n = 98) of the SD users did not warrant any medical intervention, 6.6% of the users (n = 28) underwent advanced life support. Self-reported SD users were mostly young males who were treated symptomatically and discharged. Almost one-third-mostly ecstasy and bonsai users-had depressed level of consciousness and required resuscitation.

Risk taking and adult attention deficit/hyperactivity disorder: A gap between real life behavior and experimental decision making

Adults with attention deficit/hyperactivity disorder (ADHD) are prone to suboptimal decision making and risk taking. The aim of this study was to test performance on a theoretically-based probabilistic decision making task in well-characterized adults with and without ADHD, and examine the relation between experimental risk taking and history of real-life risk-taking behavior, defined as cigarette, alcohol, and street drug use. University students with and without ADHD completed a modified version of the Cambridge Gambling Test, in which they had to choose between alternatives varied by level of risk, and reported their history of substance use. Both groups showed similar patterns of risk taking on the experimental decision making task, suggesting that ADHD is not linked to low sensitivity to risk. Past and present substance use was more prevalent in adults with ADHD. These finding question the validity of experimental probabilistic decision making task as a valid model for ADHD-related risk-taking behavior.

A comparison of recommendations and received treatment for mood and anxiety disorders in a representative national sample

BackgroundThe exact nature of treatment and management recommendations made, and received, for mood and anxiety disorders in a community population is unclear. In addition, there is limited evidence on the impact of recommendations on actual receipt of treatment or implementation of management strategies. We aim to describe the frequency with which specific recommendations were made and implemented; and thus assess the size of any gap between the recommendation and implementation of treatments and management strategies.MethodsWe used the Survey ‘Living with a Chronic Condition in Canada - Mood and Anxiety Disorders (SLCDC-MA), a unique crossectional survey of a large (N = 3358) and representative sample of Canadians with a diagnosed mood or anxiety disorder, which was conducted by Statistics Canada. The survey collected information on recommendations for medication, counselling, exercise, reduction of alcohol consumption, smoking cessation and reduction of street drug use. We also estimate the frequency that recommendations are made and followed, as well the impact of the prior on the latter. We consulted people with lived experience of the disorders to help interpret our results.ResultsThe results generally showed that most people would receive recommendations, almost all for antidepressant medications (94.6%), with lower proportions for the other treatment and management strategies (e.g. 62.1 and 66% for counselling and exercise). Most recommendations were implemented and had an impact on behaviour. The exception to this was smoking reduction/cessation, which was often not recommended or followed through. Other than with medication, at least 20% of the population, for each recommendation, would not have their recommendation implemented. A substantive group also exists who access treatments, and employ various management strategies, without a recommendation.ConclusionsThe results indicate that there is a gap between recommendations made and the implementation of treatments. However, its size varies substantially across treatments.

Spanking and adult mental health impairment: The case for the designation of spanking as an adverse childhood experience

Adverse Childhood Experiences (ACEs) such as child abuse are related to poor health outcomes. Spanking has indicated a similar association with health outcomes, but to date has not been considered an ACE. Physical and emotional abuse have been shown in previous research to correlate highly and may be similar in nature to spanking. To determine if spanking should be considered an ACE, this study aimed to examine 1): the grouping of spanking with physical and emotional abuse; and 2) if spanking has similar associations with poor adult health problems and accounts for additional model variance. Adult mental health problems included depressive affect, suicide attempts, moderate to heavy drinking, and street drug use. Data were from the CDC-Kaiser ACE study (N=8316, response rate=65%). Spanking loaded on the same factor as the physical and emotional abuse items. Additionally, spanking was associated with increased odds of suicide attempts (Adjusted Odds Ratios (AOR)=1.37; 95% CI=1.02 to1.86), moderate to heavy drinking (AOR)=1.23; 95% CI=1.07 to 1.41), and the use of street drugs (AOR)=1.32; 95% CI=1.4 to 1.52) in adulthood over and above experiencing physical and emotional abuse. This indicates spanking accounts for additional model variance and improves our understanding of these outcomes. Thus, spanking is empirically similar to physical and emotional abuse and including spanking with abuse adds to our understanding of these mental health problems. Spanking should also be considered an ACE and addressed in efforts to prevent violence.

Benzodiazepine Use, Misuse, and Harm at the Population Level in Canada: A Comprehensive Narrative Review of Data and Developments Since 1995.

Benzodiazepines are commonly prescribed psycho-pharmaceuticals (e.g., for anxiety, tension, and insomnia); they are generally considered safe but have potential adverse effects. Benzodiazepine use in Canada versus internationally is comparably high, yet no recent comprehensive review of use, misuse, or related (e.g., morbidity, mortality) harm at the population level exists; the present review aimed to fill this gap. We searched four key scientific literature databases (Medline, CINAHL, EBM Reviews, and Web of Science) with relevant search terms, and collected relevant "gray literature" (e.g., survey, monitoring, government reports) data published in 1995-2015. Two reviewers conducted data screening and extraction; results were categorized and narratively summarized by key sub-topics. Levels of benzodiazepine use in the general population have been relatively stable in recent years; medical use is generally highest among older adults. Rates of non-medical use are fairly low in general but higher in marginalized (e.g., street drug use) populations; high and/or inappropriate prescribing appears common in older adults. Benzodiazepines are associated with various morbidity outcomes (e.g., accidents/injuries, cognitive decline, sleep disturbances, or psychiatric issues), again commonly observed in older adults; moreover, benzodiazepines are identified as a contributing factor in suicides and poisoning deaths. Overall there is a substantial benzodiazepine-related health problem burden-although lower than that for other psycho-medications (e.g., opioids)-in Canada, mainly as a result of overuse and/or morbidity. National benzodiazepine prescription guidelines are lacking, and few evaluated interventions to reduce benzodiazepine-related problems exist. There is a clear need for reducing inappropriate benzodiazepine use and related harm in Canada through improved evidence-based practice as well as monitoring and control.

Substance Abuse amongst Middle Eastern Community in Metro Detroit, Michigan, USA

Background: Substance abuse is a global endemic costing billions. Its impact on healthcare is unparalleled, hence assessing risk factors and prevalence is necessary. The study objective was to review substance abuse amongst Middle Eastern community in Metro Detroit, Michigan US. Methods: A random sample (n=337) of Iraqi (Arab vs. Chaldean) who were residents in metro Detroit area were studied. The substance abuses studied were alcohol, amphetamine, sedative and street drugs. Chi-square test, Binary logistic regression and linear regression analysis were used. Results: Study results concluded that there was significant difference in the prevalence of substance abuse in the two groups, with Chaldeans having higher ‘all substance abuse’ prevalence. On further analysis, Chaldeans had a higher prevalence in alcohol (51%), whereas Arabs had more street drug use (9.8%) (p<0.001). Being a male, Chaldean, and having depression are a risk factor predictor for combined substance abuse. Depression was the common risk factor predictor for all combined substance, sedative and street drug use. Risk factor predictors for excellent health were among Chaldean, young, and those who do not report symptoms of depression. Employed and those who have stayed in the USA for a long time. Amongst the users, Arabs had a higher prevalence of hypertension, headache, amnesia, muscles or tendons conditions, and depression (p<0.005). Conclusion: There was significant difference between Arab and Chaldean in prevalence of substance abuse. Chaldeans had more alcohol usage, whereas Arabs had more street drug use. Individuals with depression and of Chaldean ethnicity have a high risk factor for combined substance–especially alcohol.