Street Drug Use Research Articles

A heroin prescription trial: Case studies from Montreal and Vancouver on crime and disorder in the surrounding neighbourhoods

Background This study evaluates whether the instauration of a heroin prescription trial (‘NAOMI’) generated an impact on the occurrence of crime and disorder in surrounding areas. The clinical trial was initiated in Vancouver and Montreal in 2005, with the aim of assessing the benefits of heroin-assisted treatment (HAT) in Canada. While experiences from other jurisdictions where HAT trials have been implemented clearly demonstrate substantial crime reduction effects for trial participants, there is overall concern that HAT clinics – similar to other interventions aiming at problematic street drug users – may induce a ‘honeypot’ effect, leading to increases in crime and/or disorder problems in the vicinity of interventions. It has been argued that HAT clinics will attract undesirable behaviour associated with cultures of street drug use and thereby produce negative impacts on the community. Methods This study examined the incidence of crime and disorder in the Vancouver and Montreal sites before and during the NAOMI trial (2002–2006), using police calls for service and arrest data. Data were analysed by autoregression analyses. Results The analysis suggested that most indicators remained stable during the pre- and implementation phase of the NAOMI trial in both sites. Conclusion While the attribution of observed crime and disorder trends to the specific clinical interventions in Montreal and Vancouver is difficult and many extrinsic factors may play a role, this study has not generated any clear evidence from institutional police data to suggest increases or decreases in community-based problems associated with HAT programs in Canada.

Identity work among street-involved young mothers

The Youth Pathways Project tracked the life-course trajectories of street-involved young women (n=75) in Toronto over a one-year period. At first contact, 60% of these women had been pregnant, and 29% of those had children. In the interim leading up to the final interview 12 months later, five participants became pregnant and five had given birth. This paper examines the narratives of these 10 recently pregnant and/or newly parenting young women. Our focus is on the ways in which pregnancy and parenting are discursively constructed as a turning point away from street involvement and drug use. Using the concept of identity talk, we examine young women's descriptions of pregnancy and parenting. We note that risky practices that may have precipitated pregnancy are minimised, while the positive and transforming aspects of pregnancy and parenting are emphasised. Pregnancy and parenting are linked with short-term goals of personal change and leaving the street, but the long-term implications of motherhood, including poverty and poor health, are not addressed by participants. Our analysis contributes to a better understanding of the subjective meaning of pregnancy for street-involved young women. We suggest that these insights are important as part of an overall health promotion strategy for this vulnerable group.

Fentanyl use among street drug users in Toronto, Canada: Behavioural dynamics and public health implications

Prescription opioids (POs) are playing an increasingly central role in street drug use and related harms in North America. One distinct PO substance of interest is Fentanyl (Duragesic ®), a potent opioid analgesic designed for transdermal time-release application. Studies from Europe and North America have documented the sizeable overdose and mortality burden associated with the non-medical use of this drug. This study explores practices and risk dynamics associated with Fentanyl abuse, also considering public health implications. Semi-structured interviews were conducted with 25 regular street-entrenched illicit PO users in Toronto, Canada, a sub-sample of which were recent Fentanyl users. Results showed that while relatively rare on the illicit PO market in Toronto, Fentanyl is a highly desired, sought after and relatively expensive PO drug among street users. In addition, the new ‘matrix’ patch technology implemented for Fentanyl since 2005 is a limited safeguard against abuse as simple extraction methods are utilized by street users. Finally, distinct risk behaviours relevant for public health emerge due to the high black market costs of Fentanyl and the extraction techniques applied, potentially facilitating high risks for infectious disease (e.g., HCV, HIV) transmission and/or overdose. Consequently, prevalence and practices of Fentanyl use by street users require closer monitoring, targeted interventions and further research regarding risks and outcomes.

Transition to injection drug use among street youth—A qualitative analysis

Objectives To examine social contexts and processes influencing transition to drug injection among street youth. Methods 42 street youth participated in in-depth interviews. A typology of experiences was built founded on youth's street life and drug use trajectories. The transition to drug injection was examined through these experiences. Results We identified five types of mutually exclusive experiences. The “downtowner's” experience is characterised by early street life and drug consumption trajectories, and a strong identification with the downtown milieu. These youth progress from one drug to another and, in a milieu where drug injection is omnipresent, this escalation culminates in transition to injection. The “tripper” street life and substance use trajectories begin later and are less intense. Most “tripper” youth are already chronic hallucinogens users when they arrive in downtown Montréal. Although they judge “junkies” severely, they show some ambivalence towards injection. The “on the go” experience is characterised by trajectories of drug use and street life that are intermingled, leading to a loss of control. These youth, who often have serious delinquent behaviours, come to downtown Montréal to party and consume drugs, mostly stimulants. Their drug use pattern and network make them at high risk of starting cocaine injection. The “hard-luck's” experience is characterised by a lack of identification with the downtown milieu. These youth who use drugs recreationally, end up in the streets accidentally, often because of unemployment. The “alcoholic’ experience is related to alcohol misuse. These youth usually end up in the streets due to this dependence. Their street involvement is mostly an experience of solitude. The risk of transitioning to injection for both these types is low. Conclusions Some combinations of street life and drug use trajectories seem to contribute to injection among street youth. Some important factors interact and increase the risk of street youth transitioning to injection: poor personal assets; early rupture with primary social institutions; social integration into subcultures where both street life and “drug trips” are fashionable, drug preferences and the local drug market.

Assessing Cognitive Capacity for Participation in a Research Study

To give informed consent in research, persons must be mentally capable of understanding the study, risks, and benefits. An objective screening tool may assess cognitive capacity better than brief conversations or clinician input. The purpose is to explore the validity of the Mental Alternations Test (MAT) to assess the cognitive capacity of older (ages 50 years +) HIV+ persons (N = 81). Descriptive correlational quantitative method was used. About 12% of the sample was cognitively impaired. Contrary to expectations, primary language was the only variable with a significant relationship with the MAT (r = -.22, p = .02); there were no significant relationships between the MAT and age, education, alcohol, smoking, injection drug use, street or mind-altering drug use, physical functional status, depressive symptoms, comorbidities, or being diagnosed with AIDS. Our findings suggest caution in using the MAT as an instrument for assessing cognitive impairment in a linguistically diverse population.

Maternal Exposures to Cigarette Smoke, Alcohol, and Street Drugs and Neural Tube Defect Occurrence in Offspring

Cigarettes, alcoholic beverages, and street drugs contain substances potentially toxic to the developing embryo. We investigated whether maternal cigarette smoking, secondhand smoke exposure, and alcohol or street drug use contributed to neural tube defect (NTD) occurrence in offspring. We conducted a population-based case-control study among Mexican American women who were residents of the 14 Texas counties bordering Mexico. Case women had an NTD-affected pregnancy and delivered during 1995-2000. Control women were those who delivered live born infants in the same study area, without an apparent congenital malformation, randomly selected by year and facility. We interviewed women in person, 1-3 months postpartum, to solicit relevant information. Nonsmoking mothers exposed to secondhand smoke during the first trimester had an NTD odds ratio (OR) of 2.6 (95% confidence interval (CI)=1.6, 4.0) compared to those who neither smoked nor were exposed to secondhand smoke. Compared to the referent, the OR among women who smoked less than half a pack a day during the first trimester was 2.2 (95% CI=1.0, 4.8) and 3.4 (95% CI=1.2, 10.0) among those who smoked a half pack or more. Adjustment for maternal age, education, body mass index, and folate intake had a negligible effect on results. Alcohol and street drug use had no relation to NTD risk when adjusted for cigarette smoking. This study suggests that cigarette smoke including secondhand exposure is not only hazardous to the mother but may also interfere with neural tube closure in the developing embryo.

The fatty acid amide hydrolase C385A (P129T) missense variant in cannabis users: Studies of drug use and dependence in caucasians

A genetic variation in fatty acid amide hydrolase (FAAH), C385A (P129T), has been previously associated with risk for problem street drug use. FAAH is a mammalian enzyme that inactivates neuromodulatory-signaling lipids including the endogenous cannabinoid 1 receptor agonist anandamide. We investigated in adult Caucasians (N = 749) whether this FAAH variant altered the risk for trying, regular use of or dependence on cannabis, alcohol or nicotine, traditional "gateway" drugs. Consistent with our knowledge that the A/A genotype results in reduced FAAH expression and activity in humans, subjects with the A/A genotype were less likely to be THC dependent than subjects with either a C/C or C/A genotype (11% vs. 26%, P < 0.05). No association was observed between the A/A genotype and risk for alcohol or tobacco regular use, or DSM IV dependence. Controlling for regular use of nicotine and sedatives, both identified as confounders, those with the A/A genotype were at significantly reduced risk for being THC dependent (OR 0.25, 95% CI: 0.07-0.88) as compared with those with the C/A or C/C genotype, supporting a link between alterations in the endocannabinoid system and THC dependence. Unexpectedly, we found an increased risk for regular use of sedatives among the A/A genotype group. The relationship between the FAAH A/A genotype and risk for drug dependence in this study was drug class specific, suggesting it is not part of a more general drug abuse effect. These results, particularly the observation of altered risk for sedative drug use, should be investigated further in multiple ethnic populations.

Characteristics of homeless HIV-positive outreach responders in urban US and their success in primary care treatment

Homeless HIV+ persons with persistent mental illness and substance use disorders need services, but are hard to reach and enrol into treatment. Connecting them to services is a major challenge of the AIDS epidemic. This report describes characteristics of homeless HIV+ substance abusers who responded to outreach and enrolled in integrated treatment services. The target population was urban, homeless, HIV+ individuals with substance dependence and/or mental illness diagnoses. Health and physical functioning were measured using a refinement of the Medical Outcomes Study Health Survey. Questions based on the PRIME-MD measured subjects’ mental health status. Outreach occurred at shelters, soup kitchens, and on the streets. The outreach team consisted of a nurse, substance abuse counsellor, and a formerly homeless person. Outreach contacted 3,059 individuals; 1,446 entered the clinic, 110 of 206 eligible candidates enrolled in the study, and 82.7% of study participants completed 12-month follow-up interviews. Enrollees exhibited 5th percentile composite health scores. They reported heavy street drug use and unmet service needs particularly for housing and financial assistance. Outreach successfully recruited targeted individuals into treatment. They stayed in treatment and demonstrated improvements on measures of physical and mental health 12-months later.

The fatty acid amide hydrolase 385 A/A (P129T) variant: haplotype analysis of an ancient missense mutation and validation of risk for drug addiction

The human fatty acid amide hydrolase (FAAH) missense mutation c.385 C-->A, which results in conversion of a conserved proline residue to threonine (P129T), has been associated with street drug use and problem drug abuse. Although a link between the FAAH P129T variant and human drug abuse has been reported, the extent of risk and specific types of substance addiction vulnerability remain to be determined. Here, we investigated the relationship of the FAAH P129T variant to a number of linked single nucleotide polymorphisms to establish a haplotyping system, calculate the estimated age and origin of the FAAH 385 C-->A mutation and evaluate its association with clinically significant drug addiction in a case control study. The results showed a significant over-representation of the FAAH P129T homozygotes in 249 subjects with documented multiple different drug addictions compared to drug free individuals of the same ethnic backgrounds (P = 0.05) using logistic regression analysis controlling for ethnicity. To increase the logistic regression analysis power by increasing the sample size, the data from our previous study (Sipe et al. in Proc Natl Acad Sci USA 99:8394-8399, 2002) were pooled with the present cohort which increased the significance to P = 0.00003. Investigation of the FAAH chromosomal backgrounds of the P129T variant in both multiple different drug addicted and control subjects revealed a common ancestral haplotype, marked population differences in haplotype genetic diversity and an estimated P129T mutation age of 114,425-177,525 years. Collectively, these results show that the P129T mutation is the only common mutation in the FAAH gene and is significantly associated with addictive traits. Moreover, this mutation appears to have arisen early in human evolution and this study validates the previous link between the FAAH P129T variant and vulnerability to addiction of multiple different drugs.

Social and health behaviors in youth of the streets of Ibadan, Nigeria

Objectives This study documents the extent and impact of perceived patterns of behavior in a sample of youths of the streets of Ibadan, Nigeria, with the purpose of implementing a Life Skills Educational (LSE) intervention. Method The study uses both qualitative and quantitative methods of data collection. Qualitatively, two Focus Group Discussions (FGD) and two in-depth interviews (IDI) with 20 boys and 2 community leaders were conducted on separate occasions for the purpose of eliciting commonly exhibited behaviors and patterns of street youth. Quantitatively, 169 youths (89.3% male) were consecutively interviewed from five subcultural areas in Ibadan, Nigeria. Street youths were accessed through a snowballing technique made possible by “Area boys” (AB, adults, who serve as a symbol of authority for street children). Results The mean age of participants was 18.4 years. The majority was on the street for financial reasons, had been on the street for more than 1 year, and had not completed their primary schooling. While youths of the street were economically viable, 69% had a history of alcohol abuse, 14% of drug abuse, and 24% operated as drug couriers; 46% reported school refusal, 27% school suspension, and 47% school truancy. Forty-nine percent admitted to being sex workers and 11% had been raped and were, therefore, at risk of contacting sexually transmitted diseases (STD). One-third of youths had been arrested for various offenses, including street fighting and drug use. While females were in the minority, they were more likely to engage in antisocial behaviors compared with boys. Conclusions Although many youths of the street display antisocial behaviors, they also are an economically viable group. Some of their antisocial behaviors may have been exhibited within the context of economic survival. Implementing a life skill program to address these antisocial behaviors may help to increase the well being of street youths in developing countries in Africa.

Impact of Street Drug Use, HIV Infection, and Highly Active Antiretroviral Therapy on Reproductive Hormones in Middle-Aged Women

To assess the impact of street drug use and HIV infection on reproductive hormones in 82 women aged 28?56 and 15 HIV-uninfected, regularly cycling premenopausal historical controls. Prospective, pilot cohort study. Baseline blood samples were assayed for follicle stimulating hormone (FSH), human chorionic gonadotropin (hCG), prolactin (PRL), thyroid stimulating hormone (TSH), and estradiol (E(2)). Menopausal status was defined as premenopause: age<40, not amenorrheic; perimenopause: age>40, not amenorrheic; menopause: age>40, with> or =12 months' amenorrhea. Kruskal-Wallis testing was used to compare groups of women sorted by menopausal status and separated by drug use and HIV serostatus. Controls were regularly cycling premenopausal women. Thirty-eight of the 82 women (46%) reported substance abuse, and 47 of the 82 (57%) were HIV infected. TSH did not differ by HIV serostatus or drug use. PRL was elevated in drug users compared with nonusers and healthy volunteers (10.3, 5.9 vs. 6.2 ng/ml, respectively, p = 0.002), with no effect of HIV serostatus. FSH was reduced in each menstrual category related to drug use and in postmenopausal women associated with positive HIV serostatus. Highly active antiretroviral therapy (HAART) use was not related to PRL or E(2) but was associated with higher FSH. FSH was greater in cohort participants compared with controls. Drug use, not HIV, relates to increased PRL. Both drug use and HIV infection are associated with decreased FSH. Women in this socioeconomic stratum at high risk for HIV may be at risk for early menopause. Increased PRL may falsely reduce FSH, necessitating a more careful hormonal characterization of menopausal status in this sample of women.

A Multilevel Model of Drug Abuse Inside Prison

Elements from differential association and importation theory were incorporated into a contextual model to explain drug abuse inside prison. Data came from self-administered questionnaires given to more than 1,000 inmates in 30 different correctional institutions throughout Kentucky, Tennessee, and Ohio. Hierarchical linear modeling was used to examine the impact of correctional context on individual behavior. Results indicated that drug abuse inside prison varies across different correctional institutions. The effect of prior street-drug use on drug abuse in prison also varied across contexts. Moreover, an aggregate measure of crowding explained both drug abuse in prison as well as the effect of prior street-drug use on substance abuse in prison.

Health outcomes and quasi-supervised settings for street injecting drug use

Over a 12-month period during 2000, public injecting in Melbourne’s Central Business District (CBD) was displaced by a range of aggressive policing strategies. Public injecting was displaced into quasi-supervised settings such as public toilets and an outreach-serviced laneway. There is a complex relationship between the setting of drug use and acute health outcomes. Over the period of displacement to quasi-supervised settings, there was a specific reduction in the rate of non-fatal overdose per 1000 syringes used in the CBD. The change in setting of drug use was coincident with a change in the location of non-fatal overdose incidents, with limited evidence of differential changes in the number of overdoses in indoor and outdoor settings. This limited evidence of a differential reduction in overdose according to setting suggests the possibility that a blanket reduction in heroin purity does not solely account for the observed changes in the rate of non-fatal overdose. The findings suggest that there is a complex relationship between better health outcomes and the context of injecting in street drug use locations. Given this complex relationships caution should be exercised when projecting the likely impacts of police displacement and public health strategies to reduce harm in street drug markets.

Street drug use among young patients with Type 1 diabetes in the UK.

Diabetic ketoacidosis (DKA) and poor glycaemic control in young adults with Type 1 diabetes may be associated with street drug use. There are few studies in the UK looking at the prevalence of drug use in young adults with diabetes. One hundred and fifty-eight young adults, aged sixteen to thirty years, with Type 1 diabetes attending an urban diabetes clinic were sent an anonymous confidential postal questionnaire to determine the prevalence of street drug use. We received 85 completed responses. Twenty-nine percent of respondents admitted to using street drugs. Of those, 68 percent habitually took street drugs more than once a month. Seventy-two percent of users were unaware of the adverse effects on diabetes. Self-reported street drug usage in young adults with Type 1 diabetes is common and may contribute to poor glycaemic control and serious complications of diabetes.

Hepatitis A, B, and C in Canada

To estimate the incidence of and to describe the risk factors that were associated with the acquisition of hepatitis A, B, and C in well-defined Canadian populations from the Sentinel Health Unit Surveillance System (SHUSS).We used the 1993 to 1995 data on hepatitis A, B, and C infection in Canada, collected by SHUSS, a national surveillance system established by the Laboratory Centre for Disease Control in Health Canada in 1993, through consultation and collaboration with provincial partners. We calculated the rates of, and described and discussed the risk factors that were associated with, hepatitis A, B, and C infection, based on the SHUSS surveillance data.From 1993 to 1995, SHUSS reported 92 cases of hepatitis A, 89 hepatitis B, and 720 hepatitis C, yielding a rate of 3.9, 3.8, and 30.3 per 100,000, respectively. The reported rates varied substantially among participating health units, ranging from 0.8 to 8.1 per 100,000 for hepatitis A, 0.0 to 9.0 for hepatitis B, and 5.4 to 73.3 for hepatitis C. The most frequently reported risk factor for hepatitis A was a history of street drug use, followed by recent international travel and household contact with a hepatitis A case, household crowding, and a history of raw or undercooked shellfish consumption. The most frequently reported risk factors for the acquisition of hepatitis B included history of street drug use and occupational exposure. The most frequently reported risk factor for the acquisition of hepatitis C was a history of street drug use, followed by health care exposure and occupational exposure. Only 5% of persons with hepatitis B infection had a history of hepatitis B immunization.Despite the limitations of possible bias due to selective participation of SHUSS and the lack of information on risk factors among controls, the high exposure to known risk factors and the low rate of vaccination among hepatitis patients can provide useful information for the development of public health policies to control hepatitis A, B, and C infection in Canada.

Pills, thrills and diabetes — street drug use among young patients with type 1 diabetes

Pills, thrills and diabetes — street drug use among young patients with type 1 diabetes

A missense mutation in human fatty acid amide hydrolase associated with problem drug use.

Problem drug use and dependence are neurobehavioral disorders of complex origin. Although environmental factors contribute to drug abuse and addiction, genetic factors also play a significant role estimated at 40-60% of the total risk. Nonetheless, the precise identities of human genes that confer vulnerability to problem drug use remain mostly unknown. Here, we describe a natural single nucleotide polymorphism in the human gene that encodes the principal endocannabinoid-inactivating enzyme, fatty acid amide hydrolase (FAAH), that in homozygous form is strongly associated with both street drug use and problem drug/alcohol use. This single nucleotide polymorphism results in a missense mutation (385C-->A) that converts a conserved proline residue to threonine (Pro129-->Thr), producing a FAAH variant that displays normal catalytic properties but an enhanced sensitivity to proteolytic degradation. Collectively, these results suggest that genetic mutations in FAAH may constitute important risk factors for problem drug use and support a potential link between functional abnormalities in the endogenous cannabinoid system and drug abuse and dependence.

Descriptive Epidemiology of a Depressive Syndrome in a Western Canadian Community Population

To evaluate cross-sectional associations between depressive episodes and a set of potential biopsychosocial determinants in Calgary, Canada.Random digit dialling (RDD) was used to select a sample consisting of 2,542 household residents in Calgary. These subjects were interviewed over the telephone using the Composite International Diagnostic Interview (CIDI) short form for major depression, and a questionnaire evaluating a variety of biopsychosocial variables.The prevalence of major depression was associated with biological (family history of major depression, alcohol consumption, street drug use), psychological (ratings of stress, recent life events) and social factors (social support, marital status, income, level of education).This study confirms that major depression is correlated with a diverse set of potential determinants in community populations, and that the impact of these determinants may differ between different populations. Prospective studies will be needed to further investigate these associations.

Descriptive epidemiology of a depressive syndrome in a Western Canadian community population.

To evaluate cross-sectional associations between depressive episodes and a set of potential biopsychosocial determinants in Calgary, Canada. Random digit dialling (RDD) was used to select a sample consisting of 2,542 household residents in Calgary. These subjects were interviewed over the telephone using the Composite International Diagnostic Interview (CIDI) short form for major depression, and a questionnaire evaluating a variety of biopsychosocial variables. The prevalence of major depression was associated with biological (family history of major depression, alcohol consumption, street drug use), psychological (ratings of stress, recent life events) and social factors (social support, marital status, income, level of education). This study confirms that major depression is correlated with a diverse set of potential determinants in community populations, and that the impact of these determinants may differ between different populations. Prospective studies will be needed to further investigate these associations.

Characteristics of preterm delivery and low birthweight among 113,994 infants in Alberta: 1994-1996.

This study examined the impact of infant and maternal factors on preterm delivery and low birthweight (LBW) in Alberta between January 1, 1994 and December 31, 1996. Data on 113,994 births were collected from vital statistics registration birth data. Logistic regression models for preterm and LBW delivery suggested the key risk factors were multiple and still birth (odds ratios > 22.0). Other characteristics included female gender, birth defects, nulliparous women, maternal age 35 and greater, unmarried, history of abortion, maternal smoking, maternal street drug use, and having less than 4 prenatal visits (odds ratios 0.86-2.54). Interactions between smoking and alcohol, and smoking and parity were noted. Efforts to improve the currently low rates (8.2%) of smoking cessation during pregnancy are required. Social, economic and medical factors associated with delayed childbearing and birth outcomes should be investigated.